Introduction to Public Health & Epidemiology PDF Fall 2024 Lecture 1

Introduction to Public Health & Epidemiology Public Health (PM 906) Microbiology & Immunology Department Fall 2024 Lecture 1 The Overall Aim of the Course Understand all scientific disciplines required for health education and p...

Introduction to Public Health & Epidemiology Public Health (PM 906) Microbiology & Immunology Department Fall 2024 Lecture 1 The Overall Aim of the Course Understand all scientific disciplines required for health education and promotion. Understand epidemiology and how it acts as the base of public health actions. Learn how to control communicable and non-communicable diseases. Understand how to improve mental, environmental, occupational, geriatric and family health. Understand more about healthy food and nutrition, supplying safe drinking water, treating and disposing wastes. Course Content Introduction to disease epidemiology. Epidemiological studies Communicable Disease Control and Prevention Non-communicable Disease Control and Prevention Water borne diseases Food and Milk Microbiology Pollution, Environmental Health & Sustainable development Family Health Mental health Occupational health Nutrition Course Assessment A. Class work (25%) distributed as: 1. Quizzes (2 quizzes) (10%) 2. Assignments (10%) 3. Attendance (5%) B. Final written exam (75%)  What is Public Health? Public Health is the art and science of preventing disease, promoting health and prolonging life through organized efforts of society It is concerned with promoting health of the whole population and the prevention of disease from which it suffers. According to the World Health Organization (WHO), health is not limited to the lack of disease but includes an individual’s physical, mental and social states. Pharmacists can have a great contribution in the promotion of public health.  The pandemic of COVID-19, What does that mean? COVID-19 situation updates for week 35 (27 August- 02 September 2023) The coronavirus disease COVID-19 continues to spread at the regional and global levels. As of 2 September 2023, the global cumulative incidence of COVID-19 reached 770,090,297 reported cases and 6,972,616 associated deaths with a case-fatality ratio (CFR) of 0.91%. Meanwhile, the Eastern Mediterranean Region (EMR) has reported a total of 23,389,586 cases representing 3.04% of the global count, with 351,405 associated deaths (CFR 1.5%).  Epidemiology Epidemiology incorporates much wider concepts than just fighting epidemics. epi (upon), demos (the people), and logos (to study) Epidemiology is the study of the distribution and determinants of health- related states or events in human populations and the application of this study to the control of health problems  Epidemiology The core of epidemiology is the use of quantitative methods to study disease and risk factors in human populations. Epidemiology is concerned with the observation, identification, description, experimental investigation and theoretical explanation of natural phenomena. Epidemiology is one of the tools used to improve public health Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data. Role of epidemiologist vs. clinician Clinician Epidemiologist v Patient’s v Community’s diagnostician diagnostician v Investigations v Investigations v Diagnosis v Predict trend v Therapy v Control v Cure v Prevention  Objectives of Epidemiology 1. Identify factors that cause disease (disease etiology) 2. Identify risk factors or conditions that can affect the spread of disease 3. Explain how and why diseases and epidemics occur 4. Determine the extent of disease found in a community and identify the health need of the community 5. Establish a clinical diagnosis of disease 6. Study the prognosis of diseases and predict the future health needs of a population 7. Evaluate the effectiveness of health programs 8. Evaluate the effectiveness of existing and new preventive (e. g. vaccines) and therapeutic measures 9. To provide the foundation for developing public policy and making regulatory decisions relating to environmental and health problems.  A look into the History of Public Health Theories of Disease Causation Miasma Theory (bad air theory) Contagion or Germ Theory Diseases were believed to be caused Diseases are caused by contact with by malodorous and poisonous the ill. particles created by decomposing organic matter. *Effectiveness of proper *Effectiveness of isolation of sanitation and public hygiene lepers and quarantine with plague Epidemiological studies have made great contributions towards unravelling the complex interplay of a range of risk factors and causative agents  Pharmacoepidemiology It is the application of epidemiologic knowledge, methods, and reasoning to the study of the effects (beneficial and adverse) and use of drugs in human populations It is used to describe, measure, explain, control and predict the uses and effects of drugs in a defined time, place and population. Role of Pharmacoepidemiology: 1. It aids in the discovery of benefits and hazards of drug use. Example: Aspirin use has been found to reduce the risk of recurrent cardiovascular conditions. 2. Pharmacoepidemiological methods are used to measure illegal drug use and outbreaks of misuse. 3. Drug development and approval processes are greatly dependent on data and information generated through epidemiological studies. 4. Post-marketing surveillance detects and measures adverse, drug reactions and other unintended effects after a drug product has been released to the marketplace.  Pharmacoepidemiology Sources of Pharmacoepidemiological data: 1. Spontaneous Reporting in the United States: The Food and Drug Administration (FDA) is a federal agency of the United States that has regulatory responsibility for ensuring the safety of all marketed medical products, including pharmaceuticals (i.e., drugs and biologics). 2. Global Drug Surveillance: The WHO Program for International Drug Monitoring. 3. Automated databases.  Pharmacoepidemiology Pharmacists are at least in some part responsible for monitoring diseases and drug use. For some pharmacists, the population may be the patients in their community pharmacy, while for other pharmacists, their population may include serving millions of individuals while working for the FDA. Examples of pharmacy-related epidemiology and pharmacoepidemiology duties include: Monitoring levels of disease and/or drug utilization Guiding distribution of drugs Providing useful information on the beneficial and harmful effects of drugs, including risk/benefit information.  The Epidemiologic Triangle Disease is produced by exposure of a susceptible host to a noxious agent in the presence of environmental factors that aid or hinder agents of the disease Biologic traits (e.g. genetic characteristics, race, ethnic origin, sex and age) Social traits (e.g. marital status, lifestyle, diet and residence) Biological (e.g. microorganisms) Chemical (e.g. toxins), Nutritional (e.g. excess food, lack 1. Physical (e.g. temperature, of food, vitamin deficiency) moisture, water, pollution, Physical forces (e.g. automobiles) altitude) Energy (e.g. ionizing radiation) 2. Social (overcrowding, poverty, drug and alcohol abuse)  Preventive Medicine The branch of medicine that is primarily concerned with preventing physical, mental, and emotional disease and injury Levels of Prevention Primordial prevention To prevent the emergence of risk factors e.g. obesity Primary prevention To prevent the occurrence of a disease if risk factors are present. Primary prevention activities can be directed to individuals (health education & immunization) or to the environment (environmental sanitation, safe drinking water, clean air, an environment free from toxic substances). Secondary prevention The early detection and prompt treatment of a disease in early preclinical stages. Examples: the neonatal detection of phenylketonuria (PKU) and congenital hypothythyroidism testing, the Pap test to detect in situ carcinoma of the cervix Tertiary prevention The limitation of disability and the rehabilitation from disease Attempts to restore the person to as normal a life as possible Preventive Medicine Most community pharmacies typically provide several preventive services, such as vaccinations; and blood pressure and glucose lipid screenings. It is advantageous to use the patient encounter to discuss preventive services with these patients and to offer services as available or refer for services as appropriate. Making referrals to other health centers for patients to receive additional preventive services that are not offered in the pharmacy is another way to help people in the community.  Screening tests It is the identification among apparently healthy individuals, of those who are sufficiently at risk from a specific disorder to justify a subsequent diagnostic test or procedure, or, in certain circumstances, direct intervention and hence prevention. Screening tests must be reliable, in other words if the test is repeated on the same person the results should be consistent. The test must also be valid. Two measures of validity are sensitivity and specificity: Test sensitivity is its ability to test true positives, i.e., to identify disease that is actually present. Test specificity is its ability to identify true negatives, i.e., when the test result says the disease is not present, it definitely is not present. Screening tests A screening test may have both high specificity and high sensitivity (the ideal situation). However, this is not always the case. A test with high sensitivity but low specificity would identify most of the people in a population with the disease, but would be less useful at identifying those without the disease. In other words there would be a large number of false positives, people who were positive on the test but did not actually have the disease. A test with high specificity but low sensitivity is good at identifying those without the disease but less helpful at identifying those with the disease, i.e., there will be many false negatives – people negative on the test who do in fact have the disease. Role of Pharmacist in Public Health What could be the role of pharmacists in Public Health?