Leaf on test tubes INTRODUCTION TO EPIDEMIOLOGY AND ENVIRONMENTAL HEALTH E2040 – Lecture E2041 – Practice WHAT IS THIS COURSE ALL ABOUT? 1.Course rules and expectations Syllabus, class content, and the course instructors 2.Introduction to the topic Definition of epidemiology and public health The tasks of epidemiology The role of the environment in human health SYLLABUS HIGHLIGHTS Study materials will be available in IS.MU before each lecture 2 exams (midterm and final during examination period) Mandatory attendance at the practice sessions 2 assignments that require preparation at home Read the syllabus! CLASS CONTENT 1.Essential concepts in epidemiology and environmental health 2.Disease occurrence and determinants in populations 3.Measures of disease frequency, defining cases 4.The basics of quantitative methodology 5.Introduction to data analysis, sources of data 6.Measures of association and effect 7.Study designs in epidemiology 8.Confounding, effect modification, and bias in epidemiology studies 9.Critical evaluation of research studies 10.Ethical considerations in epidemiology research and practice 11.Translating science into practice INSTRUCTORS Obsah obrázku Lidská tvář, osoba, Čelo, Brada Popis byl vytvořen automaticky Obsah obrázku Lidská tvář, osoba, úsměv, ret Popis byl vytvořen automaticky Obsah obrázku osoba, Lidská tvář, oblečení, muž Popis byl vytvořen automaticky Obsah obrázku Lidská tvář, osoba, oblečení, úsměv Popis byl vytvořen automaticky Obsah obrázku osoba, Lidská tvář, Brada, obočí Popis byl vytvořen automaticky Albert Kšiňan Daniel Szabó Andrea Dalecká Hynek Pikhart Martin Bobák Anna Bartošková WHAT IS EPIDEMIOLOGY? WHAT DOES AN EPIDEMIOLOGIST DO? Write down first three things that come to your mind 1 idea = 1 sticky note Put your sticky notes on the whiteboard - discuss how many ideas were related to infectious diseases pie chart made of people to represent epidemiology WHAT IS EPIDEMIOLOGY? Study of health and disease 1.Their patterns 2.Their causes 3.In defined populations 4.To inform policy decisions, prevention, and evidence-based medicine = public health Public health: Organized community efforts to prevent disease and promote health, efforts accomplished through a combination of programs, services, and policies that protect and promote the health of entire communities Benefits of Population Health Management (PHM) BRANCHES OF EPIDEMIOLOGY Infectious Disease Epidemiology Environmental Epidemiology Social Epidemiology Nutritional Epidemiology Occupational Epidemiology Epidemiology of specific diseases (e.g., cardiovascular) Etc… POPULATION VS CLINICAL APPROACH Public Health Model Focus on population Prevention and health promotion of the community Interventions aimed at the environment, lifestyle, and human behavior Medical Model Focus on individual Diagnosis and treatment of the patient Emphasis on medical care TASKS OF EPIDEMIOLOGY Research, surveillance, and evaluation §Focus on data §Quantitative analysis Translating science into practice §Evidence-based medicine WHO recommendations: Intrapartum care for a positive childbirth experience https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf §Policy development Chlorpyrifos ban in the US https://www.epa.gov/ingredients-used-pesticide-products/frequent-questions-about-chlorpyrifos-2021- final-rule "[The modern day epidemiology] is competent in statistics but not a statistician; has a grasp of concrete biomedical reality without being a clinician responsible for the medical care of individuals, is able to comprehend the basic elements of society and social structure without being a sociologist or anthropologist, and can also work with large amounts of electronic data and program complex analytic models without being a computer scientist.” (https://www.goldsteinepi.com/blog/should-all-epidemiologists-be-data-scientists/index.html) RESEARCH IN EPIDEMIOLOGY Write down two questions that epidemiologists may be interested in answering 1 idea = 1 sticky note Put your sticky notes on the whiteboard A PUBLIC HEALTH APPROACH Defining the problem/surveillance Risk and protective factor identification Developing and testing prevention strategies Implementation and adoption of the strategies EXAMPLE OF SAFE TO SLEEP CAMPAIGN SIDS risk factors: Sex of the baby Ethnicity and SES of the family Prematurity Family history But also: Stomach sleeping Bed-sharing Exposure to secondhand smoke Risk factors modifiable by an intervention MULTILEVEL INTERVENTIONS Implementation of Safe to Sleep at different levels of influence Including safe sleep guidelines to education of nursing students Addressing cultural practices related to infant sleep (e.g. bed-sharing) Educating parents on safe infant sleep RESEARCH AND EVALUATION Data and understanding data is essential! …and many more Major part of this course will be focused on data and their understanding PREVENTION AND POLICY The ultimate goal of the field is improving population health HISTORY OF EPIDEMIOLOGY John Snow Investigation into the causes of the 19th-century cholera epidemics in London Identification of the Broad Street pump as the cause Snow removed the pump handle – this probably ended the outbreak Obsah obrázku diagram, Plán, schématické, skica Popis byl vytvořen automaticky Picture: https://en.wikipedia.org/wiki/Epidemiology HISTORY OF EPIDEMIOLOGY British Doctors' Study A prospective cohort study starting in 1950s First statistical evidence that tobacco smoking increased the risk of lung cancer undefined Picture: https://en.wikipedia.org/wiki/British_Doctors_Study EPIDEMIOLOGICAL TRANSITION Image result THE ROLE OF THE ENVIRONMENT Environmental epidemiology is the study of the effect on human health of physical, biologic, and chemical factors in the external environment, broadly conceived. Estimating environmental health impacts EXPOSOME CONCEPT The totality of human environmental (meaning all non-genetic) exposures from conception onwards Source: Vrijheid, M. (2014). The exposome: A new paradigm to study the impact of environment on health. Thorax;69:876–878. doi:10.1136/thoraxjnl-2013-204949 Large number of environmental factors identified as having effects on child development Ruiz Jdel et al. Contributions of a child’s built, natural, and social environments to their general cognitive ability: a systematic scoping review. PLoS One 2016; 11: e0147741. Slide courtesy of Dr. Katarzyna Kordas EXAMPLE OF LEAD EXPOSURE Lead exposure (even low-level) is associated with poor outcomes (particularly IQ loss) Slide courtesy of Dr. Katarzyna Kordas fig3 EXAMPLE OF LEAD EXPOSURE How do you understand the table? What does it mean? Bellinger DC. A strategy for comparing the contributions of environmental chemicals and other risk factors to neurodevelopment of children. Environ Health Perspect 2012; 120: 501-507. Slide courtesy of Dr. Katarzyna Kordas EXAMPLE OF LEAD EXPOSURE Obsah obrázku text, řada/pruh, Vykreslený graf, diagram Popis byl vytvořen automaticky Even with low-level chemical exposures, we worry about shifting the IQ distribution Pruss-Ustun et al. (2004) Lead exposure. In: Ezzati M et al., eds. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva, WHO: 1495-1542. Slide courtesy of Dr. Katarzyna Kordas LEAD EFFECTS BEYOND CHILDHOOD Reuben A, Caspi A, Belsky DW, Broadbent J, Harrington H, Sugden K, Houts RM, Ramrakha S, Poulton R, Moffitt TE. Association of childhood blood lead levels with cognitive function and socioeconomic status at age 38 and with IQ change and socioeconomic mobility between childhood and adulthood. JAMA 2017; 317: 1244-51. Slide courtesy of Dr. Katarzyna Kordas PROJECTIONS FOR GLOBAL LEAD EXPOSURE (𝜇G/DL) AMONG CHILDREN, 2010-30 Pruss-Ustun et al. (2004) Lead exposure. In: Ezzati M et al., eds. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva, WHO: 1495-1542. Slide courtesy of Dr. Katarzyna Kordas WPRO—western pacific region EMRO—Eastern Mediterranean region SEARO—South East Asia https://eridirect.com/blog/2016/02/5-hard-facts-about-lead-in-e-waste/#:~:text=E%2Dwaste%20exposed% 20areas%20are,is%20mounting%20with%20each%20finding RECAPITULATION Write down three take home messages from the lecture 1 take home message = 1 sticky note Put your sticky notes on the whiteboard QUESTIONS? 60 Questions That Make You Think - Thought-Provoking Questions