Summer Course: Introduction to Epidemiology. August 25 , 0900-1030. C ourse overview; Epidemiology background. Dr. N. Birkett, Department of Epidemiology & Community Medicine, University of Ottawa. A Disaster. 2,224 people One week later: 1,513 are dead (68%) Very high mortality:
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
The Government is extremely fond of amassing great quantities of statistics. These are raised to the nth degree, the cube roots are extracted, and the results are arranged into elaborate and impressive displays. What must be kept ever in mind, however, is that in every case, the figures are first put down by a village watchman, and he puts down anything he damn well pleases!
Sir Josiah Stamp (1880-1941),
Her Majesty’s Collector of Internal Revenue.
A 29-year-old previously healthy man was referred to the University of California at Los Angeles (UCLA) Medical Center with a history of fever, fatigue, lymph node enlargement and weight loss of almost 25 lb. over the preceding 8 months. He had a temperature of 39.5C, appeared physically wasted and had swollen lymph nodes. Laboratory evaluation revealed a depressed level of peripheral blood lymphocytes. The patient suffered from simultaneous infections involving Candida albicansin his upper digestive tract, cytomegalovirus in his urinary tract and Pnuemocystis carinii in his lungs. Although antibiotic therapy was administered, the patient remained severely ill.
On June 5, 1981, MMWR published a report of five cases of Pneumocystis carinii pneumonia (PCP) among previously healthy young men in Los Angeles. All of the men were described as “homosexuals”; two had died. Local clinicians and the Epidemic Intelligence Service Officer stationed at the Los Angeles County Department of Public Health, prepared the report and submitted it for MMWR publication in early May 1981. Before publication, MMWR editorial staff sent the submission to CDC experts in parasitic and sexually transmitted diseases. The editorial note that accompanied the published report stated that the case histories suggested a “cellular-immune dysfunction related to a common exposure” and a “disease acquired through sexual contact.”.
Originally was called
“gay-related immune deficiency”
CDC defines a case of AIDS as a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for diminished resistance to that disease. Such diseases include KS, PCP, and serious opportunistic infection(s). Diagnoses are considered to fit the case definition only if based on sufficiently reliable methods (generally histology or culture). However, this case definition may not include the full spectrum of AIDS manifestations, which may range from absence of symptoms (despite laboratory evidence of immune deficiency) to non-specific symptoms (e.g., fever, weight loss, generalized, persistent lymphadenopathy) to specific diseases that are insufficiently predictive of cellular immunodeficiency to be included in incidence monitoring (e.g., tuberculosis, oral candidiasis, herpes zoster) to malignant neoplasms that cause, as well as result from, immunodeficiency. Conversely, some patients who are considered AIDS cases on the basis of diseases only moderately predictive of cellular immunodeficiency may not actually be immunodeficient and may not be part of the current epidemic. Absence of a reliable, inexpensive, widely available test for AIDS, however, may make the working case definition the best currently available for incidence monitoring.
The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems.
Common sense made difficult
Public Health Epidemiology
social action vs. science
The healthiest people is not that which possesses the best or the greatest number of hospitals, but rather that which needs the fewest.
Chief ‘gesundheitfuhren’, Germany around 1935
Performed early work on vital statistics registration.
‘When anyone dies, then, either by tolling or ringing a bell, or by bespeaking of a Grave of the Sexton, the same is known to the Searchers, corresponding to the said Sexton. The Searchers hereupon (who are ancient matrons, sworn to their office) repair to the place where the dead corpse lies, and by view of the same, and by other enquiries, they examine by what disease or causality the corpse did die.’
‘Hereupon they make their Report to the Parish-Clerk and he, every Tuesday night, carries in an Account of all the Burials and Christenings happening that Week, to the Clerk of the Hall. On Wednesday the general account is made up and printed and on Thursdays published and dispersed to the several Families, who pay four shillings per Annum for them.’
Two priests, a Dominican and a Jesuit met for their regular Monday morning walk. They got into a discussion about whether it was a sin to smoke and pray at the same time. The Jesuit was sure that it wasn’t a sin while the Dominican was sure that it was. Unable to resolve it, they decided to ask their superiors.
Dominican: What did your superior say?
Jesuit: He said that it definitely was not a sin.
Dominican: That’s strange because mine said that it was a sin.
Jesuit:What did you ask him?
Dominican: Whether it was a sin to smoke while praying.
Jesuit: I asked if it was a sin to pray while smoking.