One Health II - Exam 3 - Lec 10-15

Who is considered a Regulatory Veterinarian in Kentucky?

1. State Public Health Veterinarian
2. State Veterinarian
3. Fish and Wildlife Veterinarian
4. USDA/APHIS Veterinarians

What veterinarian is dedicated to addressing zoonotic public health issues?

State Public Health Veterinarian

What are some examples that would be addressed by the State Public Health Veterinarian?

- Zoonosis
- Vector-borne diseases
- Antibiotic Resistance
- Food and Water Safety
- Rabies

Does every state have a State Public Health Veterinarian?

No while others have several

What is the NASPHV?

National Association of State Public Health Veterinarians

What is the division of epidemiology and health planning responsible for? Give some examples?

Carrying out state-level public health surveillance

- Acute infectious and reportable diseases
- Public Health Data
- Disaster Preparedness and Response

What is the division of epidemiology and health planning responsible for more specifically?

- Communicable disease control
- Disease surveillance
- Outbreak Investigation
- Injury Prevention and Research
- Vital Statistics
- Health Data

Who is involved with Infectious Disease Surveillance at the State level?

- State Epidemiologist
- Medical Consultants
- Public Health Vet
- Infectious Disease Epidemiologists
- Nurse Consultants
- Other DPH Staff

Who is involved with Infectious Disease Surveillance at the Local level?

- Regional Epidemiologist
- Local Epidemiologist
- Public Health Nurses
- Environmental Health Specialists

What can you achieve by understanding the disease process?

Interventions to STOP the disease and prevent future outbreaks

What are some examples of projects worked on by the State Public Health Veterinarian?

- Campylobacter Investigation
- USDA Oral Bait Dropping Program

What all is included within the Rabies Program?

- Maintain rabies data
- Animal Bite Consults and Follow up
- Qualified persons for Rabies Vaccinations
- BATA: Rabies Tested Bat Identification Program

Give some examples of Zoonotic diseases?

Anthrax, Brucellosis, Hantavirus, Leptospirosis, Psittacosis, Tularemia, Q Fever

What should be considered before giving a human Post Exposure Prophylaxis?

* Exposure
-- Broken skin to saliva
-- Saliva on m.m.
*Animal Tests Positive
*Unable to observe or test animal
*Wake up to a bat in the room

When considering Human Post Exposure Prophylaxis what are some exceptions?

Small rodents and lagomorphs

Who does the State Public Health Veterinarian collaborate with?

- Local Health Departments
- Regulatory Veterinarians
- One Health Conference & Quarterly Meetings
- CDC/CSTE
- Local Universities
- BATA

What is the scientific discipline describing handling, preparation, and storage of food in ways that prevent foodborne illness?

Food Safety

What is the effort to protect food from acts of intentional adulteration?

Food Defense

What is the CDC estimate for how many people contract food borne illnesses in the U.S. each year?

48 million

What is the CDC estimate for how many people are hospitalized for food borne illnesses in the U.S. each year?

128,000

What is the CDC estimate for how many people die from food borne illnesses in the U.S. each year?

3,000

What is the cost of food borne illnesses annually in health care and related expenses?

$152 billion

WHO's first ever global estimates of food borne diseases found who to account for almost 1/3 of the deaths?

Children under 5

What are the 2 broad classifications for enteric diseases?

Infections and Intoxications

What is a consequence of the growth of a microorganism in the bosy?

Infection

What is caused by ingestion of food already contaminated by toxins?

Intoxications

In regards to an infection: Illness can result from what 2 mechanisms?

* Viruses, bacteria or parasites invade the intestinal mucosa - multiply - and directly damage.
* Bacteria & certain viruses invade and multiply in the intestinal tract - release toxins - Surrounding tissues are damaged or normal function is interfered with

How long is the incubation period for an infection compared to an intoxication?

Relatively long - days compared to hours

What symptoms are usually included with infection?

Diarrhea, Nausea, Vomiting, Abdominal Cramps

**Fever and Elevated White Blood Count

What might sources of toxin include?

Certain bacteria, poisonous chemicals, toxins found naturally in animals, plants or fungi

What do intoxications most often result from?

Bacteria that release toxins into food during growth in the food such as Staph aureus.

Does live bacteria need to be consumed to cause illness if a toxin is ingested?

No

Why does illness from a toxin manifest more rapidly that that due to infection?

Time for growth and invasion of the intestinal lining is not required

What is the most common and sometimes only symptom of intoxication?

Vomiting

What is rarely present with intoxication?

Fever

Look back at lecture 15

Slide 31-32

What is a poisonous substance produced by a living organism?

Toxin

What is the Min and Max incubation period for Staph aureus?

30 minutes
8 hours

What questions should be answered to determine why health conditions vary throughout populations?

- Who was affected?
- Where did the health event occur?
- When did the health event occur?

What classifies the occurrence of disease according to variables such as person, place and time?

Descriptive Epidemiology

What is a descriptive epidemiologic study?

One that is concerned with characterizing the amount and distribution of health and disease within a population

What does a descriptive epidemiologic study provide valuable information for?

- Prevention of disease
- Design of interventions
- Conduct of additional research

What are Descriptive Epidemiologic Studies used for?

- Permit evaluation of trends in health and disease
- Provide a basis for planning, provision and evaluation of health services
- Identify problems to be studied by analytic methods and suggest areas that my be fruitful for further investigation

What are the 3 types of Descriptive Epidemiologic Studies?

*Case Reports
*Case Series
*Cross-sectional Studies

What accounts for a single occurrence of a noteworthy health-related incident or of a small collection of such events?

Case Reports
--- Rabies

What is a larger collection of cases of disease, often grouped consecutively and listing common features?

Case Series
--- Biting Dogs

What are the advantages of Case Reports and Series?

**Can aggregate cases from disparate sources to generate hypotheses and describe new syndromes
**Simple to write, read and contains lots of information

What are the limitations of Case Reports and Series?

**Cannot test for statistical association because there is no relevant comparison
**Based on individual exposure
**Cannot establish causality - only identify potential associations

What is a type of investigation that examines the relationship between diseases and other variables of interest as they exist in a defined population at one point in time?

Cross-Sectional Studies
- Beer and Obesity

What does descriptive epidemiology and descriptive studies provide a basis for?

Generating hypotheses

What do descriptive epidemiologic studies connect intimately with?

The process of epidemiologic inference

What is epidemiologic inference initiated with

Descriptive observations

What are some examples of person variables?

age, sex, race/ethnicity, socioeconomic status, marital status, nativity, migration, religion

What is perhaps the most important factor to consider when describing occurrence of disease or illness?

Age

What are some examples of age associations?

- Some infections occurring more commonly during childhood
- Leading cause of death among young adults is unintentional injuries

What increases with age?

The incidence of and mortality from chronic diseases

What have epidemiologic studies shown in a wide scope of health phenomena including morbidity and mortality?

Sex Differences

What is defined as a descriptive term for a person's position in society?

Socioeconomic Status

T or F: Nearly all chronic diseases display an inverse relationship with Socioeconomic Status.

True

What are some examples of Place Variables?

- International
- National (within-country)
- Urban-rural differences
- Localized patterns of disease

What are some examples of Time Variables?

- Secular Trends
- Cyclic (seasonal) Trends
- Point Epidemics
- Clustering

What refers to gradual changes in the frequency of disease over long time periods?

Secular Trends

What are increases and decreases in the frequency of a disease or other phenomenon over a period of several years or within a year?

Cyclic (Seasonal) Trends

What are some possible reasons for changes in trends?

- Actual Reality
- Artifactual

Explain an artifactual change in trend?

**Errors in numerator
--- changes in recognition, rules and reporting
**Errors in denominator
--- over or under estimation of the population at risk

What is a closely grouped series of events or cases of a disease or other health-related phenomena with well-defined distribution patterns in relation to time, place or both?

Clustering

What is clustering often used to describe?

Aggregation of uncommon conditions

What might clustering reflect?

- common exposure to an etiologic agent
- chance occurences

What refers to the aggregation of events in a geographic region?

Spatial Clustering

What denotes the occurrence of events related to time?

Temporal Clustering

What is the habitual presence of a disease within a given geographic area?

Endemic

What is the occurrence of an infectious disease clearly in excess of normal expectancy and generated from a common source?

Epidemic

What is a worldwide epidemic affecting an exceptionally high proportion of the global population?

Pandemic

What is a disease that occurs singly or widely scattered and is not an epidemic or endemic?

Sporadic

What is usually the greatest source of error in Descriptive Epi studies?

Chance - the role of 'randomness'

What is chance largely determined by?

Sample size - more is better

What are the three main forms of sources of error/bias in Descriptive Epi?

Chance
Selection Bias
Observation Bias

What is it called when the subjects (cases) are not representative of the entire population at risk?

Selection Bias

What is it called when there are systematic differences in how data is obtained?

Observation Bias

In general is bias more prevalent in descriptive studies or analytic studies?

Analytic studies

T or F: Descriptive studies are useful for determining causality.

False

T or F: Descriptive studies are relatively inexpensive and less time-consuming than analytic studies.

True

What do Descriptive studies describe?

Patterns of disease occurrence
- who does and does not get sick
- Where rates are highest and lowest
- Temporal patterns

What are the results of descriptive studies useful for?

Epidemiologist and Public Health Administrators

When is Descriptive Epidemiology used?

When little is known about the disease

When is Analytic Epidemiology used?

When insight about various aspects of disease is available

What does Descriptive Epidemiology rely on?

Preexisting Data
- who, where, when

What does Analytic Epidemiology rely on?

Development of new data
- why

What is illustrated by Descriptive Epidemiology?

Potential associations

What is evaluated by Analytic Epidemiology?

The causality of associations

What is a hypothesis?

An educated guess, unproven idea, based on observation or reasoning, can be proven or disproven through investigation, any conjecture cast in a form that will allow it to be systematically confirmed or refuted

What is the hypothesis generation usually expressed as?

"null hypothesis"

What is the purpose of an analytic study?

To test the null hypothesis and either reject it or find it acceptable

What does a well-designed study isolate?

The many variables that can affect the outcome in a way that excludes those outside the design of the study

What are the major types of analytic studies?

- Observational (no intentional control of exposure)
- Interventional (exposures are controlled/known)

What are some different types of Observational Analytic Studies?

- Ecological Studies
- Cohort Studies
- Case-Control Studies

What are some different types of Interventional Analytic Studies?

- Clinical Studies (Random)
- Community Studies (Non-Random)

What is a study in which the units of analysis are populations or groups of people rather than individuals?

Ecologic Studies

What are some examples of analyzing ecologic studies?

*Incidence of diseases following vax programs
*How tobacco taxes affect tobacco use
*Certain occupations and hearing loss
*Student study habits and grades

What types of groups are Ecologic Studies conducted on?

Groups on which interventions will be or have been applied. The difference in outcomes are then compared to evaluate those interventions.