EPI 390 Lecture 13Outline of Last Lecture I. Nutritional Epidemiology – OutcomeII. Nutritional Epidemiology - ExposureIII. VitaminsIV. Dietary SupplementsV. Regulation of Dietary SupplementsVI. Why take Vitamins as SupplementsOutline of Current Lecture I. The Goal of Medico-legal InvestigationsII. Osteoarthritic Skeletal ModificationsIII. Information gathered from Radial TuberosityIV. Complications with identifying RaceV. Protecting the Public HealthVI. Levels of PreventionVII. Public Health Intervention CampaignsVIII. Bridging Population and CasenessCurrent LectureI. The Goal of Medico-legal Investigationsa. When do epidemiologists get involved in Medico-legal situations?i. Professors are required to give back to the community. When do they get asked to give expertise on these issues?1. Creation of Biological profile – this is the epidemiological piece! The epidemiology is the science portion and the advice given to the public health practitioners so that they can decide how best tocome up with prevention methods.b. Ultimate goal of Medico-Legal investigations – find out exactly who it isi. This is the individualization, not just the characteristics – i.e. race, gender, and height. 1. To do this, you need exact, not general details (many people can fit those details).c. Caseness – in terms of being proactive in the investigation i. How are you going to conduct the study? Who are you interested in? These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.ii. Go out and test hypothesis you’ve already created (not a retrospective study. It’s a prospective study, in which you generate the hypothesis and define caseness up front)d. 40-50% of cases can’t get to individualization.i. The ability to do individualization is only as good as primary profile (occasionally secondary)II. Osteoarthritic Skeletal Modificationsa. OA lipping = skeletal modifications (do not confuse with OP!)i. Boney extrusions form on the lips of the vertebrae. They are rarely found in the middle (thoracic) of the spine; instead they’re usually seen in the cervical spine (neck) or lumbar spine. 1. Cervical lipping occurs pretty early in life. ii. Lipping is formed due to compensatory mechanisms related to biological/biomechanical stress. The lipping is on the contralateral side – compensation on the side of the pain results in stress on the opposite side.iii. The lipping is considered a skeletal pathology. These extrusions develop over a long time1. OA lipping is a chronic, not an acute, condition.2. Lipping is more common in males>females, and in older people>younger people.b. What does lipping tell us? These observations can help indicate SES, as well as Age and Sex.i. SES is typically a proxy for lifestyle. There are some generalizations that can be made associated SES and general bodily strain sustained.III. Information gathered from Radial Tuberositya. Radial tuberosity occurs at muscle attachment sites.i. Wear at muscle attachment sites are key indicators of lifestyle.ii. Using the muscles pulls on ligaments and tendons. This creates stress at the attachment sites. 1. The stress sends a signal to the skeleton to build up and make more robust the site. There’s an electric potential that is set in to motion to stimulate osteoblasts to come to the site and lay down more bone.IV. Complications with identifying Racea. Race is difficult to determine from unidentifiable remains. Epidemiologists prefer not to determine race, especially if taking the case to court.i. The skeleton is not very forthcoming in indicating race as defined by government census. There are loose associations to race in the skull, but they are faulty.V. Protecting the Public Healtha. Definition of Public Health - The science and practice of protecting and improvingthe health of a community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazardsi. This definition looks at health on a larger scale (the masses), not just the individuals found in a clinical setting.b. Prevention practices are the bridge between epidemiology and public health.i. The mission of prevention practices: To prevent, manage, control, or eradicate ‘disease’ or adverse health events.1. “Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability.” (M. Porta, 2008)ii. Public health practitioners want to work in prevention to protect and improve the community.iii. The trilogy of primary, secondary, and tertiary prevention fits well with the goal of eradication, elimination, and minimization practices in prevention.VI. Levels of Preventiona. Primary: Prevent the initial development of a diseasei. i.e. Immunization to reduce exposure to a risk factor (Ex-)ii. i.e. Removing vending machines from schools/work places to limit obesityiii. i.e. Taking dietary supplements, exercising, etc. to build up bones in order to prevent OP.b. Secondary: Early detection of an existing diseasei. The individuals haven’t necessarily started showing symptoms. In secondary prevention, you are dealing with morbidity and determining who’s at risk. 1. Need to figure out who has disease/is a case and is still asymptomatic via screening. Also find people who are high risk before they become a case.ii. Reduce severity and complications (reduce morbidity)iii. Identify and treat ‘high-risk’ individuals/groupsiv. i.e. Cancer screeningv. i.e. Screening individuals at risk for developing OP.c. Tertiary: Reduce the impact of the diseasei. Reduce the # and consequences of disease complicationsii. Tertiary prevention is initiated when primary and secondary preventions have failed and the individual has ended up with disease.1. This has implications of morbidity and mortality.iii. i.e. In OP end up in tertiary when you fracture bonesiv. i.e. Individuals are in the clinical phase of their illnessv. i.e. Treatment: drug therapy, surgery1. Like with cancer.vi. i.e. Ancillary: physical therapyvii. i.e. Reduce disease complications (joint contractures)d. Effective prevention strategies often interact and operate across levels.e. The outcome and primary interest is disease – Epidemiologists and Public health officials don’t want a disease threat to progress to tertiary prevention levels.i. So whenever such a case arises, you study it to develop