have okay wait myself sharing sorry yeah today there's 12 including myself and then vinaia will be 13 so it be 12 I think yeah so that's how I counted it because we have one missing today yeah so there there's going to be 12 of you today in Zoom yeah you're welcome yeah today there's 11 of you me makes 12 so okay let me um I Tri I think I this I have it okay let me go back and share um no big deal um um again take breaks and and I I tend to talk fast I apologize for that oh yeah oh there goes my screen again it came back on oh okay well let me let me see if I could do this again since okay this is beautiful okay my screen came back on again yeah the monitor it it just said it was not um I have an old MacBook but that should not be a difference I it's not that old seven years old but let me sh um can you see that PowerPoint can you see it I'm gonna make it can you see the PowerPoint yes we can see it yes cool okay so you guys have this book this is the main book that we're going to use this introduction it's everything is straight from the book and you know it's it's a pretty straightforward class I I can't I don't know how to make it interesting other the case but I think it you know I just tell my experiences and and if you guys have any experiences in public health are there any public health nurses in here I don't think so any of you work in public health okay just please if you have any information you want to share um just let me know let us know okay so today we're g to the first chapter is going to be very basic going to talk about the basic um foundations of epidemiology you know and it's so funny because when they when they um Professor Dr Mari says you're going to teach epidemiology I go I can't even say the word but now I say it all the time now and now um I kind of wish I kind of got into it um in the beginning I I might have gone to Public Health because it is kind of interesting it's a little bit science a little math um you know nerdy people like me but um it's fun that anyway so so anyway the these are the objectives and you can see here we're g to do lot of definitions like EP epidemic endemic and pandemic and we are going to talk about the kind of differentiate the different types of epidemics and talk about um disease transmission Concepts you know what's a standard case definition this is important and uh I as I lecture this I kind of remember um what's on the quiz and so I'll try to point out from my memory um like pedology triangle you're going to have to know that but again it's on the book it's very straightforward okay and then the three three levels of um prevention just like there's a three levels of prevention in the individual patient there is three levels of prevention in population health and just basically some um definitions that's for this chapter and then for the other chapter um um we have um some of the pioneers of py it's a little bit more interesting when you put it to um a person who did what okay so let's talk about the meaning of Health what is health and you probably seen this before and health is this there's multiple Dimensions there's six dimensions but basically health is when you don't have illness and so there is different um health is multifaceted with several um multiple definitions and so these are the um six definitions they have it includes the physical health like you know if our body is functioning just like a card does everything working social and how are your relationships and mental are you able to think clearly and emotional you have your emotions um spiritual does not have to be religious you could be spiritual not be religious but you know how how does you know is your spiritual health um satisfying to you and environment environmental you know do you live in an area where um is there a complicated external factors like is it um the weather or too much traffic or is it too quiet but anyway there are six dimensions here and sometimes when you have um something going wrong in one or two of the different um dep um Dimensions your health could be not the way you know it could be altered and maybe not fully functioning just because one of these Dimensions um may be not functioning but anyway that's the main definition Health comprised of these six um Dimensions okay so Public Health it's it's basically um we're talking about um the health of people in the population you know you live in the Los Angeles County or Orange County some of you live in different cities whe it's alante or torrent or those I know those are set populations but when we talk about public health you know it is a science it is and there's some art to it too trying to um wherever population that you live in how to live your best optimal um Health how how do you keep that um best Optimal Health at the population level and that's where we have the public health officials and healthcare workers who work really hard and to ensure that everyone in that particular population has um you know the means to um to thrive in that population and they address concerns affecting the population and so you know that their goal is to ensure that um each person I mean um the population has um conditions and the tools to um to maintain those six dimensions of um health so now we have populations so we you know based on the population of people like I mentioned whether it's a city it's a county or if it's um a country you know we collect statistics um on those particular pop potion and for different things so you know it could be social economic like okay um what what is the percentage of population at this level at the um you know the higher income or the lower income how many people are married um what's the average age of marriage you know it's all kinds of statistics and they use it to try to um create policies or to create programs to promote um population health and look at the work force and they also work um at Geographic factors and then um later on today and also the next following week we'll talk about some health indicators as well and how we study population and public health so how it relates to how Public Health relates to epidemiology so epidemiology there's there's a lot of subfields of Public Health epidemiology um we'll talk about the definition um in second here um you use a lot of statistics and talk about the health services and they do um regard epidemiology as the foundation of Public Health so there's the definition okay the definition of epidemiology is study and distribution of the terance of health related stag events and um human populations it could be like um natural diseases such just like um uh for example the co that just happened so um they look at that that's an example of one thing they look at and then they try to find a way to prevent and control the problems such as Co and try to slow it down so that's epidemiology there distribution and determinance of health related States for events in human populations and then application of this study to prevent and control health problem so when we look at populations or are different types of um Concepts we do talk about um Health with States um they could be diseases such as mental illness or could be heart disease or influenza infectious diseases such as chalera and then also too we also talk about is associated with health such as um physical activity um nutrition um environment of poisoning you know what kind of condition are you working um seat belt use um different states have about mandatory helmets for U motorcycles or seat belts and um provision and use of health services and also events too there's some states or some areas that more prone to um injury um drug abuse is everywhere and unfortunately suicide as well so those are some of the health related states that um epidemiologists look at and public health officials look at as well so there are three core Public Health functions here and you could just look at this um basically one is the assessment and monitor of health of communities and populations at risk and then once you assess um the problems you you try to formulate public policies designed to solve ident identified local national health problems and priorities so you assess the problems then they create um public policies and once the policies are in place they try their very best officials do to ensure that the populations have access to appropriate cost effective care and this is where you find your health promotion programs and disease prevention servic um we talking about programs such as um tobacco sociation we talk about screening and you have other organizations for example one of the classes I teach at UA chilo um I teach leadership um and management in my um senior course and one of the things that we do that each we have a clinical groups not just um not quite at the hospital but each group they have to do a project and they do a big presentation and they have um they work in community and I actually one of my groups had to do um cancer screening and they chose to do canc um with the American Cancer Society we partner up with them and they did um their project on prostate cancer and colon cancer in the local community because that seems to have um to be a big problem locally in the Hilo area and then I had another group of three um two students who looked at underage drinking so those are some examples of um populations you know and then we addressed the pro um the problems there and I think my third group did a symposium for transcultural but we and then um another group did one on um dental care in children so we have various programs and projects and those are are similar to what health promotion programs are and so and then you know you can see here for this pyramid that um counseling education it reaches out to a smaller amount of people and sometimes you know you could it goes like some of the things that we do like social economic factors poverty education um some of these policies they have a larger impact you can see um you know it it grows and um the things you have in place it reaches out to um you're trying to reach out to a larger um set of people especially when you're trying to address education housing needs you're trying to reach the whole Community or counseling education you're just trying to usually oneon-one or maybe a different people and then as far this is what this arrows mean smaller impact and larger impact so epidemiology is a science and I think all of you have taken um statistics and they are very um they stick to the scientific method and they and in scientific the scientific method in the p is really important because when we use the scientific method it ensures that accuracy um you get accurate results and it's important to be methodical so it is a science and um the importance it's important to have to keep really meticulous data and to do everything methodically whatever the research problem is or whatever the research study is and follow the scientific method just like the nursing process um right now we do have a um it's a little changed from the traditional nursing process for um for the patient I think now it's six now the New Gen before it used to be five but very similar so you look at the scientific method here you start with the hypothesis the problem and then they figure out um the scientist the researcher figures out what experiments are appropriate for that in studying that hypothesis and then they get whatever results they get from those experiments they generally gen um generate um conclusions and then then they then they try to figure out whether should um is the explanations are adequate and they could um form policies or there needs to be more followup but you know usually in research studies you're all always going to have followup and you're always tweaking something and you're always trying to find a ways to improve something as um as you do as you know nursing you do evidence-based um practice and so you're always trying to find ways to be um to do better and to improve the situation so the scientific method here you know you have the problem you do the hypothesis you do your testing here you interpret the data and then you disseminate the the data and and generate a conclusion here so you know some of the things that to help you with the scientific method you always ask a lot of questions you do a lot of research I know and um then you you know you try do a hypothesis and not today but I think it's either next week and the following week I'll talk about why it's important not to change the hypothesis but once you you construct a hypothesis it should be the final hypothesis there should not be any change again it's really important to be very consistent and appropriate and methodical you do your research studies you analyze the problems and then um your portra findings so there are different study designs in theology these are the main ones they use um two the two main ones that they use is descriptive and analytic and you can see the differences here the descriped you know you're ask asking who what when where it's more of a like a qualitative at first because you're trying to find um and sometimes the descript ends up being an analytic and then uh once you kind of you're trying to formulate like what's going on and trying to gather your thoughts basically descriptive you know because especially like for example um covid we don't know we didn't know quite what was going on with covid we didn't know how the disease process um happen and and even Co today like before when when it first hit everyone they thought okay um you know you can't touch anything or it's Airborne but as you found out recently um this CDC said it's droplet so um Co it used to be considered Airborne now it's droplet but um even if you standing close to a person and they're speaking those droplets have been speaking you can still get the CO that's why it's important to have mask if they're infected but now covid has so many strains out there now and I think with the vaccinations it kind of helped um maybe slow it slow it down but I think a better way to describe it is make it more manageable as far as um it's not not as um fatal because when it first started when we didn't have the vaccinations a lot of people sadly you probably know someone that that that died or know someone somebody who died or you seen it in as a healthcare worker but for example but it started up one point it is griped and that's eventually as we got more and more data then they were able to create vaccines and make it analytical and did a lot of test trials um they probably could have done more before they put it out but they were in such a hurry because so many people were suffering so there was this sense of urgency to try to find something to slow that disease down but anyway I'm sorry digressing um so we'll we'll talk about more in the designs in detail as we go along in this class so at the bottom of the pyramid here you can see the descriptive epidemiology the case studies case reports and as we get more specific and more scientific and use more statistics um the analytical um gets to be you know we do the control and um cohort studies that's later so descriptive um this is this is a good illustration that um you know we're going to talk about health related states by um who you know who's the the person or the the population um the place where did it occur and what time frame did it occur and what are the um particular clinical criteria that is um attributed to this particular um problem that you're studying so analytical we are going to you there there is a little bit more um statistics involved and why instead of instead um in addition to who what when and where they're going to do it's more of a why and how and so you have your experimental and observational those those are considered analytical studies your experiment mental um we mentioned Co the vaccination they do have they did use control trials not just with the vaccinations but with medications as well and we'll talk about more later in the coming weeks to talk about um they have randomized and non-randomized groups and then they have uncontrolled Tri um trials that you just it just occurs naturally and then you have your observational where you have different cohorts you're studying case Control Pro you know cross-sectional longitudinal again not today but this just to show you what what we're going to stud in the future um chapters so here are some examples of the activities performed um in epidemiology uh mentioned covid describing the natural history of the disease identifying risk factors for disease injuring death um let's see assisting carrying out public health programs being a resource um person identifying where the public health problem is the greatest monitoring diseases communicating public health information like I'm thinking the public health information like for example like you watch the news in the morning or channel five or Channel whatever news you watch local news and they said oh okay by the way Costco they they're recalling berries um there is a Cas with berries so I'm not going to try the bur that bubble but um they found something in the processing or salmonella was found in um in one of the plants and um there is a recall of a particular product so that would be an example of communicating the public health information so here are some of the studies here too so you see that and they call this the disaster management cycle you know they have studies they track um it's a lot of Little Steps in between but that's basically the the process that they use so the types of emologic information you know you have the public health assessment um the causes of the disease um completing the clinical picture and then you also whatever program is put out there always um reassessing if it's um effective and also in addition to effective um is it um useful um is it is it producing the results that um you wanted to produce so you're always evaluating there's always evaluations happening so some of questions like a diagnose you do have a diagnosis like here like the prostate specific antigens SEC test for prostate cancer this is the one that um that my students did study and you know if that's a good screening tool and then um the causes why we talk about stroke and I'll show there there is a graph on strokes and how that develop I don't think it's this chap this it's coming in one of the um the chapters and it's obesity cause of metabolic syndrome some of the good treatments and the prognosis what are the chances of of a person having a heart detect again so this is a for example of a pyus ination of the different diseases that are the most common diseases that you see in your patients you can see the cardiovascular is a big chunk of it it's almost it's almost a half it's like a good maybe um I don't know less than half that's that's a lot cancer is second um you know cancer you know it's interesting how cancers um is climbing up in cardiovascular and I'm guess I don't think I think they're finding um treatments for cancer but I just think that cancer is happening more it's just maybe because of the diet could be a changing environment it's just um you know a diet is you know like in United States like they you know the preservatives that we use and some of the foods that we eat in the United States that in C in countries in Europe that they ban like Pop-Tarts we eat Pop-Tarts here I know I I I used to eat the cinnamon one brown sugar one but in in Europe they they ban those they don't they don't um because there's something in there and then even like the red the red skittles because of the dye and I'm also thinking about the cereals I know we probably eat all these things now like the morning cereals and sometimes that they think oh it's very healthy but then if they use products such as Roundup Roundup is um found to be um cancer causing but we still use um cancer um we still use that um for our foods and like corn and things like that so um there might there's probably a lot of things that we don't know that goes on with the FDA and um and a far is approving so just like the pharmaceutical um world um why are some medications more um accessible are not as accessible to um lower income um the cost so I'm sure there's a lot of things that um there's a lot of things out there that probably is Diamond very secretive we don't know in the public but back to cancer I'm thinking the same thing with foods that sometimes um the foods that we eat probably could cause cancer so it's probably best to try to eat as organic and as healthy as possible to have less preservatives just to keep yourself that you know if you cook it I'm so busy because we're we're working all the time like I am right now but it's easy to say but um we we just try our best to do what we have so other questions is um health promotion um I mean this is interesting the school meals does it harm the children's future health and I um I mentioned this in the class yesterday um one like each first lady have like a pro has a project and I I don't know if you remember but and I know you're busy with school but Michelle Obama one of her main projects is that to have school lunches the school lunches that be I mean I remember school lunches when I was a k it was just crap but I there's some there was some things I liked about it like um I can't actually can't remember but it was not maybe the the most nutritious but I know and she saw that she saw kids being being more obese um so she wanted to start with the quality of the food in the schools so she was trying to mandate that schools have a healthier policy see for example taking away um vending machines like sodas which is a good idea because sodas is not really good for you um you know with the phosphorus in the sodas it caused weakening the bones for example and also the caffeine and also um anyway that that's just an example of health promotion and as far as disease surveillance um like when with the next um they look at the flu you know the flu is very cyclic and the flu is always out there why we have the Blu vaccine because that's um especially when it first broke out in the early 1900s be for around the end of World War I they called the Spanish flu and that that took out a lot of people I think it probably took out more people or just as much people as it did with the covid you know in relation to their population and so it it prompted them to try to develop a vaccination against the flu so that would be disease surveillance for example and then finally another question is health and qualities we're always trying to to equal the the field regarding who has access to these problems um why shouldn't people have the same life expectancy why do people like lower skill unskilled manual workers live um have a life expectancy five years lower than the um person that does not have um or not manual workers for example and and then as we know um there are some gaps in healthcare services some populations don't have as easy access to um programs as other populations do and so that's what public health tries to do they try to equal the playing field they try they work hard and do the very best in in ensuring that their population gets um taken care of so mention the different types of definitions of epidemic endemic and pandemic you have the epidemic um which is you can see here so like the example of an epidemic it's basically this is South America so basically in this area it's a Define population a health related problem happened um over a period of time where the endemic it kind sporadically in different pockets of the world or different pockets of the geographical area but it's persistent and it happen maybe a little bit longer than the epidemic but they call it endemic so it's happening like a little bit extensive it extends beyond that local area there and then where you have a pandemic it's very Global pandemic means like everywhere um it's Global affects a large number of number of people in many countries in continents or regions you can see that okay so this is interesting and I I have a lot interesting slides throughout the class talks about the differences um as 2017 that's that's still like seven um seven years ago but in comparison to 211 for example we're talking about obesity Among Us um adults by state so if you look at the um the index here so the light green is the um less than 20% so you you you strive to be in the green you don't want to be in the dark red so some of the green area I don't I don't think anyone's in the like green but like they're in the green areas that includes California and Hawaii um and some of the other states too so give me a second here um Harley Quinn stop and then the yellow is more so like a Alaska some of these um midwest states and the red the red is like a lot of the southern states and Northeastern states you see that that's 2011 and then they also include gu Puerto Rico but then you know 2017 the green states have turned yellow including California Colorado still remain green and in the red States more this is um obesity here and then there's some dark red which is very concerning that includes like um States like Alabama abama and Mississippi Louisiana they turn like like a burgundy red so very very concerning um surpris Hawai is so great but okay um yeah so I think obesity it could be many things I I actually don't think that um the so having a lot of technology I think people are not as moving as much as they used to I remember when I was a kid um we didn't have a lot we only had like five or six basic TV channels and we played outside all day came home all dirty and but we played we didn't have could not watch TV and you know we just played I I remember just playing rolling in the dirt basically and I was a tomboy so I play football and baseball a very young age and then so the kids today it's easy to go home and watch Netflix or um or Max or one of those other channels or um or YouTube and they do social media maybe just being more sedentary maybe has um increased obesity that's what I'm guessing it's so easy to go um when you get home from your clinical you're not going to go run five miles unless you're really dedicated it's like H I think I'm gonna go eat dinner and watch Netflix it's so easy or I'm gonna watch the news or watch TV or something so easy to do because we're tired and I'm with you I was thinking that before I came on today so I I couldn't do e anything so why is epidemiology the foundation of Public Health because they carry out these these Public Health functions they assess the health the communities they create help create public policies they sure assure that all populations have access to approprate cost effective care um basically like I mentioned before health promotion these prevention so um this is the second before this okay I'm so sorry happened here I think I don't know why that did that I apologize okay s okay you know what um this is the one I ended with so do you guys need 10 minutes to go bathroom yes yeah so I think is I'm going to talk about primary prevention and stuff so why don't you go ahead and take 10 minutes and come back at um 70 actually could come back at at 7:10 little 14 minutes do you want to come back at 7:10 go to bathroom take care of stuff so come back at 7:10 guys okay thank you for come on everybody outside qu come on to the bathroom rocket no rocket no the [Music] how are you Mom I have to tell you something we lost another shirt today look at our paintings mom sh SEC service down a rally pnsy [Music] pizza oh man one of these were supposed to be in the freezer you that supposed to be in the freezer mine this is mine I have no I didn't no brother demat sh in Iowa Pennsylvan Pennsylvania why is it so big all jokes andu Oh I thought you bought me something I did something to install today Mom Mom swiming was really fun they were doing flips I I tried to do a flip and instead she did this on the water she fell like this why did you fall like that I don't know chips you don't know he never came back like you never gone a myth where all these dishes come from I was I don't know I got home and it was like that what time are you done with class um two hours what in two hours nuh or earlier I don't know why I don't know why huh why such a playing Pizza who the hell eat cheese pizza cheese pizza is gross bro cheese pizza it's like missing so much for all hey Harley stop stop it Harley Harley leave me alone are you on the toilet are you on the toilet are you on the on the toilet can I come in then e for for for it's fine the door's openam come Harley Harley leave me alone okay guys I'm back so I'll wait for you guys to come back and thank you for your emails between your group and the other group I got like oh we want this we want that that's fine I'm gonna look at all of them and I'll do my best to accommodate everybody's request and I think I forgot I think I was was trying to get out I forgot to post the discussion question now everybody has a discuss so you have it open now for week one so you could be every week you just like murge you have to do a discussion question because they can't we can't um Rec um the lectures for Angelus um school so you do a discussion question it is very brief just like a couple lines paragraph okay about the class today just say you but no all right anyway so we talk about the def today we're talking about the definitions of epidemiology and some of and we're going to talk about some of the people um that were that made epidemiology some of the Pioneers okay so I'm gonna I'm gonna um we're almost done with this part point and then we have one more and then I'll stay behind you have questions and after that we're pal all done unless you want to stay on for three hours anyway oh I see you shaking your head you don't want to have a party okay I hear you it's Saturday night right you have things places to go okay give me a second let me share my screen there again yeah you can see what yeah okay so switch up okay this is you probably stud this in microbiology or biology and so but we have to start here and talk about disease transmission so these are the different ways that we disease transmission occurs um the main way that we're all very familiar about is personto person contact UM for example sexual transmitted diseases that's one way a person gives another person disease um a second way is my bone so you could get a disease such as like you go to a restaurant now you're probably never going to go again but hepatitis A so you could get Hepatitis A um from using a fork um that was used by another person that had hepatitis A so you could get in other words you could get a disease from an object in an animate project um object and so that's called fite form for example vehicle born is in um they in animate intermediate such as for example you have um drug users gain in drugs they use needles those needles could have HIV or Hepatitis B and they share those needles and those needles are considered vehicle Bor consisting of containing the HIV or hepatitis or whatever disease um that needle might have and then finally um we talk about there's Vector born you have an invertebrate animal or um so and also not just anver animal like a like an insect such as mosquitoes mosquitoes is the most very this common cause of diseases for example they um mosquitoes is um part of why malaria happens also some other mosquito causing um diseases include westn virus and also one that happened about 12 years ago here um happened mainly in Africa it also happened here in the United States um the Aven flu I don't know if you remember that from yesterday um it's a um it's a disease from the birds and but I'm trying to remember the details but that's an example of a vector born disease transmission so you can see some of the stuff here another definition and this will be on your quiz so take note of this okay and I will put this on your study um guide there are different types of um there's a common source propagated and mixed epidemics so these are types of epidemics by the common source a common source is a point of contact and um they that there's one common source and then from that Source it could spread into an epidemic into the community single Source propagated um again um a person um they they have a disease and they um spread a disease or they go to like diseas is like flying they got they get the disease in um let's just say southeast Asia they fly to Hawaii or to the mainland here in California and they spread the disease and the one that's happening right now I don't know if you know this from the news is the den disease U de n that um that is something that's happening in the southeast Asia such as Cambodia and Vietnam it's this type of disease that I think it's very similar to um it has to do with water and I can't think of it's it's it's it's very it's similar to chera but um anyway they they get this disease um it starts in a water area in Vietnam and Cambodia and the person gets that disease um I think recently they have brought this disease over to here in the United States and so you do see some cases of then um the D um disease and then you have mix where you have a combination of propagated and common source propagate is very complicated so couple slides back we talk about the differences between endemics and epidemic it could it could easily become an endemic and a pandemic with a propagated because you don't know where the s is and it's just happening so fast just like the co right and you have the mixed here so with the common source it does happen pretty rapidly and and but the good thing about the common source that you're able you have a good idea who the common source is and as far as identifying and isolating and then usually you could try to find a solution to that problem and hopefully after you find a solution it could cause a decrease in that um health problem so you can see here to the common source the persistence Source like it's just hard you can see the Comon Source it ends pretty quickly you know this is like days of this is oh actually this is hours so you can see how the cases could decrease you know because they found like okay it's um probably this is food poisoning for example um food poisoning is very easily um especially if it's like in one area such as a church um function or Community function they they found the source okay we'll get them treated um for the food poisoning they can stop it but if it's something else that's complicated or or spreads to a different um a larger population you could see it could occur longer propagated people are are traveling and G to another person and that person give to the other so that that gets kind of complicated and then then you have like the random ones in intermittent source as well so those are some examples of the Epic curves and so here are some of the Cycles um Anthrax it's it still happens but it was very common in the 1800s where they had um an insect um they like a fly or something and they um that have what happened they bit the blood of an animal that was infected you you know maybe some the um cow ate some infective um grain maybe the grain was was growing in some infective area with colola or some other infectious diseases so when that happens um you know you the combination of the fly and the uh animal the the human is going to eat the the cow you know and not knowing that the meat is bad and then through this and then as a result then they you know they ingest and also inhale the spor inhaling from the the Flies that's spreading through the um the air and so they get the disease and then they get it through the you know you can see here the different ways of ingesting and also cutaneous through the skin also through um respiratory so that's just the cycle that's the cycle of Anthrax and I think it still occurs today but fortunately there are vaccinations for it botulism that happen happens in like in um Foods especially in canned foods that are um infectious um they are harvested in the in the cans and if uh especially the babies the infants they ingest this they can get really sick of bism adult bism again you know from the cans so you see that and colorup that's affected in the water we have feces um it's in the water especially um happens more frequently in countries where they don't have really good Water Systems um it's not as sophisticated and so as a result some of the um human fees could cross contaminate into these water systems and then when we um and they they contain Cola and then so the humans they could um get the col by eating um maybe food from that water or something so that's the cycle of that and I don't want to talk too much about color because some of you guys going to be doing some case studies and cola so we'll we'll sa that to later that's a that's an example of a common source propagated is just like you know what happened with covid for example even now it arised from infections being transmitted from one infected person to another and so as I mentioned early today in class um covid now uh recently has been considered droplets it used to be concerned Airborne for example but now it's considered droplet so but you still have to work mask is still protect you so you want to make sure you use good infection control techniques hand washing um wearing masks when it's appropriate if you're caring for patients um with covid um you may need to wear um iew like those um yellow jumpsuits now you guys in the hospitals and clinicals do you guys still have to wear masks in clinicals or is it optional optional it's optional it is okay okay yeah in the hospital in Hawaii where I I well I'm GNA quit this I can't do it anymore but I I worked a couple days a week we we still have to wear the mask it's Hawaii's always the last with the mask thing we're always um I think that's why the numbers were so low they're very very conservative here in Hawaii and so we still wear mask in the hospital but I know some of the Kaisers I saw in the news like my brother-in-law works at the Kaiser um Sunset and they made mask optional but he works in the ovar so he's still wearing mask but you can see how the droplets here um the size is humans are 60 120 microns the droplets is more than five microns so they still you still could get it but just be careful some other examples of propagated um tuberculosis that's why we have the Nega um the the filtration rooms where the negative air flow so the the air flow does not go into the public so these people with tuberculosis even parts of um types of influenza uh so they have they should be in isolation in these rooms and they should have these signs outside the rooms such as um especially for the Airborne where the visitors has to see the nurse first proper handwashing wearing n95 mask um you know keeping the door closed that's that's really important and here are some drop precautions there's the I know millions of acronyms right um this one is Spider-Man talks about the different types um with the each lettera talking about the different types of um drop precautions such as sepsis the Paro virus um influenza rubella um adino virus a lot of these and some of this I'm going to talk about in Med search too when we talk about the infection so but that's an example of propagated you have mixs where you could get from a both a common source and propagated and it in with the mix it's it's a little bit more aggressive than the common source it happens pretty um it's more intense and it could last a longer period of time um chosis is one and this is one um situation where they attended the music festival and the festival was in this open field with grass I guess this one was just all women that's interesting so anyway these women were exposed to this chosis and so these are the symptoms that they um develop here okay so when we do in assessment regarding in the standard case definition this is this is the definition so you can read this so the standard criteria case definition where cases are consistently diagnosed regardless of where or when they were identified so once they are a case definition they meet all that there's like certain criteria to be um determined as a case definition so they have a set of guidelines to be considered a case definition for example for covid when Co first started case number one so their case definition of why how are they counted as a case so for Co for example they're count as a case because they have a positive PCR result so in because they have a positive PC result that is a case and that's how they count cases um that's in the official case where they and they also have public case where they have the symptoms of Co but they haven't officially tested positive for covid but they say it's probable because they have the symptoms but there you know there's a there's like a lack time of when you test positive Co so it takes about a day or two to find a catch up to you because yes I test positive for Co that's probable but for a case they have a criteria too to be determined as to be counted as a case so yeah so a case is a person has been diagnosed or having a disease and then you have the primary case index and so the index case is not always the primary case but it's the one that is very significant because they spread the disease to other people as well and you know when we talk about Co you know it was spreading especially when people are having funerals or you know in churches um in the community and also like you meet up with another person and they spread Co and we know what happened after that secondary cases is that you know after um the one person the index person spreads another person will um you know they they get introduced in the population and they eventually get it like so you have that one person here that's the index case and then all these people got the case so those are secondary cases and there's different levels of diagnosis you have suspected probable and confirmed where the suspected they have the symptoms the probable is you know they're waiting you know the test is inconclusive but they have all these symptoms but maybe they will become positive a couple days and then confirm is Def like a positive p are and I I talked about oh maybe I didn't okay I I I will introduce this this is the triangle of epidemiology and you will need to know this for your upcoming quiz very similar um this is how infection works so you have the host you have the environment and you have the Infectious agent so all of these three entities together along with time and this is how infectious disease occurs you know with time is a constant here and you know the host that's carrying disease um they base on the environment sometimes like you heard you know when Co was happening that if the environment was um that it didn't I don't know you heard two things like it didn't like um heat it like the cold weather so there were a lot of things out there so it could be bad or maybe you're in a crowded um you're in the area where there's a lot of people maybe at the airport or the party um where it's not people not wearing masks at the time that would be considered environment so but it makes them um very there's a big likelihood that they could get covid this is back before the vaccinations happened so that would be considered environment and then infectious agent might be the person curing the covid then you have the host here anyway this is the triangle of a iology so this is based on the chical B disease model where you have the environment you have the host and you have the agent which is the the actual infection s there and the key thing and this you'll you'll see this on your quiz you need to know this how we stop the the infection from occurring or stopping the epidemic is we have to break the ch chain so you heard this many times Breaking the Chain saving the life preventing infection so somewhere along this chain if we could break one chain or several chains we could prevent or slow down the epidemic such as handwashing um I'm going to mention hand washing that's that's the most common most effective way of preventing infection is handwashing also um you know cleaning your um equipment like for example for me when I work in the hospital or clinicals I don't carry I don't bring my shoes into the house I keep my shoes in the bag or in a car and so I keep it isolate from everything else and I never wear those shoes for other things only for the hospital and that's how I keep and and you're not supposed to be carrying phones in in the clinical but do you know there's the nurses that carry the phones in the Ziploc bags just because they don't want be in case like their gloves or hands touch their the phone they don't want to make sure that the phone stays clean of infection but um I clean I always clean my phone with the alcohol just like with my censis after constant cleaning could break the chain also you know you wearing masks when in the appropriate situations also um like if you know you have Co stay away from the person anyway there these are different ways to stop the epidemic and the cycle so we talked about today about we mentioned fites earlier when we talked about inanimate op objects um they you know clothing and towels they could transmit disease and then also to like I mentioned shoes yeah phone okay so you see that already right I know um my my husband needs to teach our kids and myself like never touch the elevator with your fingers like we always use our elbow and you know you you guys are all nurses we're all nurses to be um you know when we go to the bathroom you should always use a paper towel if possible to open the door or use are other things in our fingertips our fingers and then um pens you can see where um disease you know things happen we mentioned Vector earlier when we talked about this the disease cycle so um insects and animals they could spread um diseases and I want to mention something here in and in Hawaii there's this one disease that's called I don't know if you heard about rat lung disease have you anyone heard about that rat lung disease so what happens with rat lung disease is like the snail um they they are in the the lettuce and the produce and so when that happens you know they they they carry this um they TR they help transmit disease and so the um the rats um also you know eat the snails um but the snails when they get into the lettuce um it has this some type of infection and the lettuce um has this particular um parasite this infection and what happens if a person eats the the lettuce and don't wash it properly they develop these really bad neurological effects and they start noticing years ago and it's pretty bad because it's and you know when it comes to neuro neurological symptoms involving the nervous system in the brain it's usually irreversible you cannot um turn it around but unless you have um extensive physical therapy or occupational therapy to get um your body doing things the back back to the way it was before you get the disease but um I had this great video um I'll show another time by maybe the next time we meet in person I don't have it readily available right now but uh I know for a while there I live in the um it happened in rural areas and I live in the rural area in the Big Island and I wasn't eating a lot of salad just because I was so scared getting that disease but I think we learning um learning to live in a rural area like that we um wash all our vegetables and then we soak it for at least half an hour in baking soda like a tablespoon of baking soda put in water we soak our vegetables you you you you'd be amazed of all the crap that comes out of that water it's it's meaz there's times where become it's murky it's it's very um the vegetables are not clean at all so I do that with all my vegetables I wash it a baking soda water and then I rinse it off and with water it's um but yeah and I'm very particular with vegetables and fruits so anyway I'm probably figing you guys out with all these diseases I don't want to eat anymore but it happens the pl um the plague and this was very prominent in I think the especially in the like late 1500s early 1600s I think during the times of King Henry VI and I want to mention King Henry the because I was listening a lot of his book and he was actually a pretty um for that time period pretty um kind of clean and very weird conscious regarding how to um about handwashing and about infection control because when this this plague happened he moved his wife number two in the family and all the people around him to the countryside and then when they he had like lots of parties in his castles he he made everyone um you um clean up after themselves pick up their um their Mas and don't leave things around and he was very conscious about that but back in this days the plague was very prominent it killed a lot of people in Europe and so the cause of the plague happened from these um roen fleas and you know they get into the um the person the carriers of the rap and squirrels and then we we get it yeah and back then in the 1600s they didn't have sewer systems everything was just thrown in in the um open area so it I just can't imagine but that's where our ancestors came from and then so we have the word here's another term concept Reservoir the reservoir is the habitat um which infectious agent lives and humans could often serve both as um in the reservoir and host you have the human Reservoir and the animal and the non-living Reservoir says that the osis and then an animal transmiss diseases such as the rabies would be an example that carrier okay this we'll talk more about that in the next chapter um Tri Mary this poor lady so she some reason how somehow they were able to identify her as the one spreading tyo in New York City this is the early 1900s late 1800s she was a cook and for some reason um she was the source for typhoid she didn't have the typhoid but she was the source and you can see the people sck with typhoid we'll talk about that we'll sa that for a second here and then we have direct you you need to know for your quiz direct transmission and then direct transmission directly skinto skin contact with another person such as like contamin hand touching another contaminate um non-contaminated hands you could spread disase that way um kissing sexual intercourse or indirectly you know through like a like a f or organism that's indirect so you can see the definition here the differences direct um transmission here the guidelines for that and direct to the vehicle V airb I just did a sum that's it and here's a here's another triangle of epidemiology but more advanced more towards populations so you have um same triangle but dealing with not with just one person but like a populations with the um similar traits and and talking and when defining a health related problem and then like for example let's say um people in Los Angeles has this problem and then the environment of Los Angeles is it making the problem worse whatever what do they have more Smog or is the weather too hot for example and then what are their cause of effects is it maybe something um from the factories surrounding factories is it um maybe some of the buildings in Los Angeles have like they're using paint That's not um that carries Asus for example so this would be an example of an advanced epidemiology triangle chronic diseases just eat that one and so as far as prevention you we have um primary secondary tertiary you you'll need to know this and this slide actually Explains It All where the primary prevention you have um things such as immunization and vaccinations education and medication campaigns we share this with the public um and but they don't have the disease we're just trying to find a way to prevent them from have get the Disease by use of education and vaccinations and there's no impairment as a result with the secondary um there is some impairment but we're trying our very best to yeah to ensure that the disease do not become more um you know the person be doesn't become elevated um they they they don't become um they don't get the disease the disease doesn't get worse and we DET tertiary they really have a disease it's pretty extensive but they're trying to find ways to deal with the dis disease like like a stroke you stroke is per um one that you can't use as well so thanks to occupational therapy you find a ways to um to deal with having stroke post stroke so you know primary is you know you have um you could wear a mask you could wear helmets while um riding a bik for example that's primary passive is this is this is interesting so with the passive you don't have um in in California many states they have fluoride so when you have fluoride in the water I mean you're not doing anything you're just drinking the water that comes to your house or you buy in a store and they have fluoride and the fluoride prevents cavities and then I wanted to mention about fluoride because in Hawaii we're the only state in the country that does not have fluoride in the water and guess what shockingly the the kids have the highest rate of cavities because there there isn't fluoride in water I don't understand that so that's something that's kind of puzzling to me why don't doesn't the water why have fluoride so they um you have to find other ways to get fluoride such as some toothpaste for example but again this is passive primary prevention secondary prevention is that they already have the disease but they're trying to find a ways to stop it for example this is a mamogram and here you can see like a small cancer scene ready from a mamogram and so there are doing ways of how to prevent that from becoming third stage or extensive stages of of cancer such as maybe CH chemotherapy or radiation or maybe or possible surgery as well terciary that they already have disease again like a stroke and then they try to find a ways in order to to live every day with the stroke such as of altering the ways that they move their bodies and do things for themselves okay I'm sorry that was a lot any questions on that it's pretty straightforward when I hear your case studies it's um a a little bit more interesting and after this um I know if you don't mind I'm going to go straight there's only one more unless you want to break I only have one more PowerPoint with 25 slides very brief you want me just go ahead and do it okay I see I see St you guys want to go out or something right okay give me a second here let me go ahead and um end the slide I'll put the other one and the other one's just talking about the people who hers keeps itching though still okay I love having a monitor again I would the first week didn't have a that was Pap okay very short chapter I could see the sadness in your eyes it don't smile too big I see some of you guys okay okay so historic so these are the the main people how did epidemiology happen so it talks about like how it developed okay these are um people um they great people you know and they're very very um some of it of course someone someone had to be unethical you know to develop um to conduct these studies so there were not these um ethical standards in place for search but it had to happen somewhere to get where we are today but um yeah I I'll share with you minut some of these things that they they did to to seek for answers Believe It or Not Hypocrites way back before Christ 460 and he you know I actually did not know this till I started teaching this class so he was able to describe some important infectious um Health Concepts that way back when and now makes me wonder why it took so long um knowing what he knew back then um he was very significant because before him everything was like Supernatural it just happened naturally like maybe um you know like an alien which there probably is because you know we're part of a universe but he he made things more rational and put things in rational context and had some concrete evidence in explaining things so that's hoces like for example he he did observe different diseases occurring in different locations and he also um discovered components of malaria in swamp areas so that was hypoc do they feed it a lot and he also introduced terms like epidemic and endemic and this before Christ 460 um BC pretty interesting then you have um many hundreds of years um thousands of years later um Thomas cenam he believes OB observation very very keen observation why they were likeing and he was able to describe diseases in its varing at me and even when was discovered some psychological mental um psychological malies he probably started recognizing SS of um schizophrenia but didn't know the official term yet and he did push for things such as um again King Henry the died around um the early around this time6 24 I don't know the exact year but he came along after that and he also carried on like fresh air and exercise healthy diet helped prevent these diseases from happening and then 100 years later you have James Lynn and he during this time there were a lot of um exploration of different countries uh and a lot of these Sailors were getting sick but and a lot of these ships carried um items such as oranges and so they uh and they were getting scurvy and so he made some observations of these um Sailors that have scurvy um and they recognized eating these fruits prevented scurvy from happening this man um meeste in the middle of 1700s okay this is this interesting he noed that his milk M never got the SM pox but they got coox so this is controversial he exposed his wife and children to CPX so her arms but the Chinese observe they they're way before these um before the 1700s and they observed that there's a weaker strain of um small poox was prevent was protected against a stronger strain so this is interesting this violation this was the birth of vaccinations today that the weaker strain was protective against the stronger string of diseases this is the start of vaccinations Edward Jenner um 1700 not too long ago couple hundred years ago he also attempted to give a Dairy Maid um calox in her youth by um cutting her arm and rubbing some of the Infectious grease into the room but she didn't get sick but eventually you know through the other studies before he did invent a vaccination for smoke p and today all of us get that for one of our childhood vaccinations this poor boy has um small pox here see that and then IGN simwise he and this is kind of disgusting I'm so sorry to mention this but he observed that mid um lot of women were dying in labor and is just because of the lack of infection control methods and he noticed that some of the doctors and the students will not wash their hands and in their hands they had like leftover C CER from other people and they were conducting pelv again I'm sorry so go they were conducting public exams um there was no sense of infection control there and so they never practiced they just did that so he pushed for hand thanks to him he pushed for handwashing and prevention of spread of disease because I think before him lots of women died in child birth um needless they didn't have to die if they had stronger infection control methods such as washing your hands and keeping everything clean then um that wouldn't happen a lot of those words those deaths shouldn't happen this guy um he is the official founder of of epidemiology is johon snow johon Snow's the the founder descriptive and analytic so he did do a study I won't talk too much about this I I think one of you guys are doing this question regarding the um the Cola in London in 1848 um but he did find through his meticulous recordkeeping that color was was attributed to this water pump in London and people were drinking out water and so the next slide here it talks about like here's the water way from different parts of the city and the pump area was the pumps with the color was like right here and so he he was able to put all the cases here and and discover okay um using epidemiology methods and that was his the the study they brought more notice to epidemiology as a science John snow and then so yeah he kept Good Records this is two different areas one in lambath and one in voxal and South workg and it talks about different populations in and compared to um and then he did um using statistics talking about the ratio the rate ratio of cola in these different cities Pastor he was 1822 and he he identified the causes of rabies and he was able to discover um the bacteria causing anthra and he discovered the the vaccine for anthra coot um late 1800 1910 he did the um Theory very this is also very very important in microbiology was able to look through the um at the sports the in a microscope and see the different stages of microorganisms and he was able to look at the shapes of the organisms which is the basilis or coxy for the anthr it's bailus that causes the um disease so he was able to determine it was a bailus um organism another guy I know sorry jump back to 1600s he was and this is actually pretty good for 1600s and they kept the book and a detailed record of people who who they died and he he he was one of the pioneers of developing these life tables and these disease events and he divided us into acute and chronic so the next like here so you can look here kind of hard it's a little small but he every person that died he these different categories I'm I'm looking at these categories one is Spotted Fever a mother rifling of the lights um I don't know what that is now um someone who is shot starved Stitch swine pox teeth and worms so that's that's how they kept records in the 1600s so by thanks to him and keeping these records they were able to understand um one of the um why people die and when there's causes it it kind of look like the early stages of Public Health even back in the 1600s I don't know this man far he extended Vital Statistics made it more sophisticated and this is what we use today um especially when we're tracing problems health related issues how um in some areas like for example heart disease for example um automobile deaths and some is it's more prominent than others by keeping detailed Vital Statistics and if you notice in the death records They will um State how did this person died or they did they died of various um like a multitude of problems usually that's the case like especially when they get older they usually just not die of one thing they die of like I know when my dad died he died pretty young and they used for his death they said that he died of prostate cancer um sepsis diabetes and I think those are the three things so it's usually um multifactoral different diseases this man razini and he talks about diseases and healthcare workers he was pretty um prominent in occupational health and things and this is really 1700 and he noticed like noxious Vapors that could cause a person to get sick but and I'm thinking now this is back in 7 00 but we were still using um paint and some other substances for our houses up to um 1960s where they got rid of lead based paint so he discovered this early 1700s so this is interesting okay this is our this is our um yeah she's very important to nursing she found the nursing for singale she's also the the founding um she's very she founded Public Health nursing she pushed for um hand washing she was the first public not just the nurse first public health nurse and she created a lot of change in um nursing and also probably medicine as well push for infectious um strong infection control methods and so thanks to Nill this is why we're here today as nurses um and that's why we have a a strong um science because of her okay poor Mary this is I I was I was going to tell you going um back to her so this poor lady um she was kind of like identified as a carrier of typhoid fever there were over 250 cases in New York City she did not have the symptoms but she was the carer but this is where it gets controversial for Mary so between for three years she was confined in the sanit sanitarium and then she had she got some good attorneys and say this is unconstitutional this is not I should not be confined and I don't have the disease but um but then we have to mention her because for her this is how we um talk about the importance of quarantining and you mentioned in the in the co we had quarantine was infect you know we couldn't go to um to the hospital for a while or go to work um she was quarantined from spreading tyo to other people and so as a result of her case uh Public Health officials and epidemiologists really um kind of really brought notice the importance of keeping track of the carriers of diseases such as typhoid um fever um Tak Taki Takaki talks about CA cor um disease these are people who don't have enough protein in their diet and they have a a thyine deficiency happens a lot in countries that don't have um access to protein um so some of the signs are the protruding bellies so as a result of that um you know he discovered um pressure pressure core disease that's the lack of protein there so that's the Cy this man Shad talks about um sanitation Public Health too having an official Public Health sanitation department the importance of um you know sewer systems and sanitary inspections this kind of was the start of regulating the health industry and also you know sewer um having sewers um Safe Water um all of those things and he did research on tuberculosis and tuberculosis was has been around for like hundreds of years it was not to like the the late 1940s so they really be came down with something to prevent the spread of tuberculosis um I I read a lot of books or listen to a lot of books one was called the Midwife about I don't know if you watch the series about these um British midwives in London and they um um they these poor people in London after World War II were living in these settlements like families as big as um 18 18 people in two bedroom apartment really really Crow conditions so as a result of that tuberculosis was spreading Le so um they were working quickly trying to find a way to stop the spread of um of tuberculosis they did find a way to send them off to um to the countryside and they realized that just exposing them to clean air um So eventually um they found ways to slow down um tuberculosis but again he he discovered that s keeping strong close um regulated sanitation um directives and guidelines will prevent the spread of diseases thanks to this man this guy um siden Stricker um he per um improved the way we keep Vital Statistics especially the reports of clinical diseases keeping Strong Hospital records um this these are important especially when we um make policies regarding certain problems also like for reimbursement for insurances anyway is um he stressed and emphasized the importance of keeping um accurate records this other okay this ISE any maternity nurses out there aspired maternity nurses so she is um known for um show demonstrating that breast breastfeeding is really um good for um babies he was she was strong advocate of breastfeeding and and J is also a midwife so she did case control studies um breast mil carried a lot of antibodies um so she recognized also too back in um the 1900s she also studied breast cancer and she did recognize that genes could influence cancer risk so yeah she way back in the 1960s um she studied breast cancer and and women who didn't um have children and women who didn't um um breastfeed they they had a higher risk of breast cancer because of a gene and also probably hormones as well this other lady um she studied occupational um Health too she's very impressive she was the first woman appointed to the faculty at Harvard Medical School this man he is the um I mentioned um snow this this other man um Frost is the father of modern epidemiology kind of perfected it even more bringing in statistics in with epidemiology and also um he made advances in epidemiology that's all you need to know for him and then here's a study um such as for cardiovascular disease so you can see how this is how for example cardiovascular disease and other diseases are studied and this is how we develop these epic curves and these charts because they started a timeline from as early as 1948 for the cardiovascular disease up to present time so you can see in the timeline for cardiovascular diseases where how cardio um vascular disease could be reduced by introducing these um diagnostic tools for example in 1979 we introduced echocardiography and exercise testing so by introducing that we could see um how cardiovascular diseases developed using Elco cardiograms and even into 1999 there's other um diagnostic tools they developed they and then also back in 2009 they do they studied more the gene studies anyway it just um a progression um the Fring um of how cardiovascular disease was studied and so this is an example of a cohort study design that happened over a span it looks like over 60 years here so um we'll talk more about cohart designs a little bit later in the um term and I'm going to talk about this throughout the term two smoking and lung cancer the strong colation if you smoke there a bigger likelihood you are going to get lung cancer through the many studies that are out there and they St these people were say over 20 years and it is the amount of C consumption Coes with the number of lung cancer people getting lung cancer here that's it I know I talk pretty fast it's all there in slides um and I any questions on anything well thank you guys for being such a great class for a Saturday night and it's still light um not quite dark yet um you can even have dinner or even go out if you want or you probably like okay I just want to rest and um I would try to figure out a way to um to to rep um replace the class next week you already have a discussion so you already writing a discussion so I got to figure it out how you could get credit for four hours out what will constitute a a anyway I'm I'm I'm still thinking about it I've been thinking actually been thinking about it for a while but I will see you guys in class on Tuesday everybody here at Mid surge right yeah so I'll see you guys at um 6 o'clock on Tuesday night and and I'll stick around if you have any other questions and yeah let me know if you need anything some of you guys send some emails during the break I I try to answer all of them and again you could you could text me email me call me if you want you know texting is good email is good too I I respond pretty quickly but anyway any questions okay thank you guys for your patience and I will see you on Tuesday night take care of you guys aloha