You are on page 1of 8

Lecture Objectives ^^ Define veterinary health & its components: The sum of all contributions to the complete physical

mental and social well being of HUMANS through understanding & application of veterinary science. Components: Zoonotics dzs, food protection, mgmt of lab health, education, biomedical researchetc. Define zoonotic disease & discuss possible modes & routes of zoonotic dz transmission: An infectious dz that naturally can be transmitted to people. Modes: direct, indirect, horizontal, & vertical transmission. List a variety of ways vets play a role in zoonotic dz prevention & control: Deworming, vaccination, research, educationetc Be able to explain One Medicine Human med & Vet med should come together, and meet at Public Health. Define epidemiology and list several uses of epidemiology: The study of dz in populations & of factors that determine its occurrence Used to: determine the origin of a dz, investigate & control a dz of unknown cause, acquire information on the ecology & history of a dz, create disease control programs, assess the economic effects of a dz & analyze the costs & economic benefits of alternative control programs. Define general dz transmission terminology: 1. Anthropozoonosis: maintained in animal populations, but humans can get it. Rabies. 2. Zooanthroponosis: maintained in human populations, but animals can get it. Human Tb to elephants. 3. Amphixenosis: everybodys got it. Staph, strep. ^^ Calculate & interpret prevalence & incidence risk, risk ratio & odds ratio: Prevalence: If you were to select an animal right now at random out of a population, prevalence is the chance that that animal has the disease. P = (animals that have the dz at that moment) / (Total animals in population). Ex. 5 sick cows in a herd of 20 cows. P = 5/20 P = 25%

Incidence risk: The likelihood that a healthy cow will become sick in that herd over a period of time. IR = (become sick over a period of time) / (total population during same period of time) *If animals are removed (die, sold) you must adjust IR. IR = (become sick over a period of time) / (total population (.5)(# removed)) Risk ratio: Is eating chocolate & getting fat related? a/a+b c/c+d (Got fat) / (ate chocolate) divided by (Got fat) / (didnt eat chocolate) a/a+b The risk of you getting fat from eating chocolate. c/c+d The risk of you staying slim if you dont eat chocolate. If the value is > 1 that means that eating chocolate is associated with getting fat. If value is 1 that means eating chocolate has no effect on weight gain. If less than 1, that means that eating chocolate will actually keep you from getting fat. Odds ratio: axd bxc (Ate chocolate & got fat) x (didnt eat chocolate & didnt get fat) / (ate chocolate but didnt get fat x didnt eat chocolate but got fat anyways) a/b The odds of you getting fat from eating chocolate. c/d The odds of you staying slim if you dont eat chocolate. Choose the most correct measure of association for an observational study: Risk Ratio can be used in Cohort studies & Clinical Trials only. (PROSPECTIVE ONLY) Odds Ratio is best used in Cross sectional & Case-control studies. Being less restrictive, it can be used in either prospective or retrospective as well. ^^ Explain Evidence Based Medicine: The effort to base medical decisions on strongest scientific proof possible. You must ask the correct question, acquire the information, appraise its quality, apply the results and then act on the patient. Explain the difference between independent & dependent variables: Independent: exposures Dependent: outcomes

Know which questions to ask to decide if study is experimental or observational: *Does the investigator DIRECTLY control who gets what? Is there a comparison group? Is it randomized? Describe what makes a good clinical trial: It has at least two groups a treatment group & a control group. Its randomized to avoid personal influence & bias, plus deals with confounding factors Its blinded to prevent bias Know which questions to ask to decide if observational study is analytical or descriptive: No comparison group? = Descriptive. Then its Case report or Case series Comparison group. = Analytical. Then its Cohort, Case Control or Cross Sectional ^^ Be able to differentiate between Cohort, Case Control or Cross Sectional studies: 1. Cohort: enrollment is based on EXPOSURE status. Take two groups of people. One that never eats chocolate, one that eats it everyday. Follow them and see which group gets fat (usually prospective). Calculate the RR and see if chocolate causes obesity. * you can do this retrospectively, in which case you gather up a bunch of medical records of people who ate chocolate/didnt, and whether or not they became fat. So its still based on exposure status. 2. Case - Control: enrollment is based on OUTCOME status. Like a murder mystery, usually retrospective. Take two groups of people. One with obesity, one without. Do the fat ones eat a lot of chocolate? * Whats weird is the prospective case control study, in which case the exposure & outcome are known. 3. Cross Sectional Studies: Take just a random sample of people. Nothing about exposure/outcome is known at enrollment, but you figure it out and then do an Odds Ratio (only!) to see if theres any statistical association between exposure & outcome. Be able to differentiate between retrospective & prospective Cohort, Case Control or Cross Sectional studies Retrospective: using medical records. Fast & cheap, with lower quality info. Prospective: collect the data yourself. $$$, takes forever, but better data. ^^

ID major advantages & disadvantages of Cohort Studies: (Prospective) Adv: can see that exposure preceded outcome, can obtain biological parameter info (useful for screening), no recall bias, can estimate incidence risk and rate, multiple outcomes can be assessed. (Prospective) Dis: Long term, expensive, inefficient for rare dzs. ID major advantages & disadvantages of Case Control studies: Adv: can investigate several exposures effect on the same outcome, can use for rare & common dzs. Cheap. Fast. Dis: HIGHLY susceptible to many types of bias. Limited to a single outcome. Bias prevents causal association. Selecting valid controls is very difficult. ID different aspects of cross sectional studies: The population is sampled once & exposure + outcome is assessed at the same time. Like a census. It's a survey and you make your own inference. NAHMS collects livestock surveys on demographics, different dzs, and prevalences. You cannot do Incidence Risks, or RR. Can only do Odds ratio. Be able to determine when a causal inference is possible: Only when a non-random sample is chosen, or when you are SURE exposure came before outcome (time invariant i.e. breed, gender). With cross sectional studies that look at a random sample, it can't say anything about cause and effect, because you don't know if exposure came before outcome. Therefore you can only see Prevalence & frequency of outcome. ^^ Be able to differentiate between a continuous & a categorical variable. Continuous any value. Gray scale. Categorical This or that. Gender. Color. Differentiate between a nominal and ordinal categorical variable: Nominal theres no value of one group over another, they're unrelated, no ranking order. Gender, ethnicities. Ordinal - Ordered. Category 5 Hurricane versus a Cat2. Be able to determine if data are paired/unpaired: Paired: your weight before you started a diet, and your weight afterwards. Matched, related. Unpaired: Comparing your weight to someone else's. No relationship. Be able to interpret a p-value & power and explain how they're related to Type I and Type II errors: The p-value is a % chance that all your fancy statistical math is all bullshit. Therefore you want it LOW. The p-value of .05 means there's a 5% chance the new treatment is not

significantly different than the old treatment. - Low p-value means there's less Type 1 error in your study (Type 1 Error The new treatment isn't any better than the old treatment, but the math seemed to say there is) Power is the ability to detect if there really is a difference between the new treatment and the old treatment. - Power detects bullshit, and thus lowers your Type II Error in your study (The new treatment is better than the old one I swear, but some how I can't make the math agree!) You want low p-value and high power for a good study, but most of all you need common sense. Other things can screw up your p-values (low sample number for example), and it doesn't mean the new treatment sucks. Be able to explain the general use of Survival analysis: Its time to some event. So you can make fancy calving graphs & compare it to your neighbours. If one of your animals did not make it to the event (abortion, sold) that animal is Censored. Understand the behaviour of antibody titers: If I have 2 antibodies against HIV, and you have 600, I'm pretty sure you'll test positive for HIV and I won't. But what's the exact cutoff number?? Someone smarter than me figures that out. That's the struggle, cutoff values. Also, titers have lives of their own. Theyre synthesized in response to exposure, and eaten up after a period of time. So, you have an antibody titer of 600? You're likely constantly exposed OR that particular antibody has a reaaaally long lifetime. Some diseases cause lifelong high antibody titers (immunity) i.e. chicken pox. Others only last 6 months i.e. Kennel Cough. What if I went from 2 antibodies to 600? That's probably a significant change in titer. In fact, you only need a 4-fold increase for it to be significant. Calculate & determine Se and Sp for different cutoff values; understand how Se and Sp vary with different cutoff values for a positive/negative test; understand how prevalence influences predictive values: Se: Those who have disease that actually test positive Sp: Those that don't have the disease that actually test negative. Prevalence: Chance that you pick an animal at random that's sick. Apparent prevalence: chance that you pick at random and it tests positive. At a large titer cutoff, youre pretty sure you have the disease. So, you could say that Specificity is high. At a low titer cut off, everyone and their mother tests positive, doesn't mean much. Sensitivity is high. However, sensitivity is dependent on prevalence.

If a disease is pretty common (oral herpes) we cant design a decent screening test for it because we just assume everyone has it. At low prevalence, the disease is pretty rare; we assume you don't have it. So we'll test you a few times to see if you have a rise in titer, to see if those that actually have it will successfully test positive. This is why you get the HIV test every 6 months, because it's low prevalence. At low prevalence, the chance of you getting it much less testing positive for it is pretty damn small. We assume it's a rare thing to have. LOW PPV, HIGH NPV At high prevalence, its harder to see who doesn't have it because practically everyone has it. HIGH PPV LOW NPV. So a test works best with medium prevalence. Be able to differentiate 'true' case report/series from a multitude of other hybrid designs: True case reports are descriptive, no comparisons. Ex. I saw a weird disease in my clinic so I thought I'd write it up and share with the world. Hybrid design: a journal takes my case report and someone else's and compares the survival times, for example. It ranks a bit higher than descriptive studies. ^^ Be able to define herd immunity: The collective immunity status of a herd. Be able to assess studies reporting vaccine efficacy: Theres a long checklist. Be able to calculate & interpret vaccine efficacy: It requires risk ratio, absolute risk difference, incidence in each exposure group, and number needed to treat. In short, appreciate that its more complicated than you thought. Know where to report adverse vaccine events: TWO places 1. The manufacturer 2. USDA CVB ^^ What are some bite related infections? Rabies Pasteurella (normal flora) Capnocytophaga (normal flora) others.

All bites should be reported. Advice for clients: Breed selection Make sure dog is socialized Wait til child is 4 years old Keep up to date on shots/deworming Have pet sterilized Educate owners on responsible pet ownership Be cautious around strange dogs Dont try to stop pets that are fighting Advice for immunocompromised clients: Wash your hands after petting Dont touch stray animals Keep cats indoors Be careful about what your pet eats/drinks Get someone else to change the litter box Trim your cats nails Dont handle sick animals Dont let pet kiss/lick your face/wounds Avoid reptiles & exotics Keep fleas off your pet Wear gloves when cleaning cages Less common zoonotic diseases associated with immunocompromised Rhodococcus equi Bordetella bronchiseptica ^^ Risk = Hazard + Outrage The goal of risk communication is Stakeholder relations medium hazard medium outrage ^^ Bartonellosis (Cat scratch fever) is Bartonella henselae. Vector: flea. Swollen lymph nodes, and red papule at inoculation site. Diagnosed via culture, PCR or antigen detection. Avoid fleas and scratches. Toxoplasmosis: T. gondii . Obligate intracellular parasite. Cats. Get it from eating raw meat or handling cat feces that are a few (1-5)days old. Clean litter box everyday, cook

meat. Diagnosis: IgM antibodies = current infection. IgG antibodies = has been infected in the past. Lack of specificity though, so its not that good. Recrudescent in immunocompromised. Pregnant women becoming infected during pregnancy during first gestation will be more severe than if in the second half. Advice: Clean the litter box daily or have someone else do it for you Wear gloves while gardening Keep outdoor sandboxes covered Don't eat raw meat, don't feed cat raw meat. Plague: Yersinia pestis. 10-20 people a year on average. The last plague was 1929 in Los Angeles. Cat fleas. REPORTABLE to DSHS. Category A bioterrorism. Bubonic: Swollen lymph nodes. Septicemic: untreated bubonic. Pneumonic: From inhalation. ^^ TAHC started because of Babesia "Texas Fever" TAHC is only for livestock. Brucellosis: Texas is free of Brucellosis. Free status is a government status that affects trade. All feral swine are positive for B. suis. Tuberculosis is major Public Health issue. Transmitted through snot, unpasteurized milk, feces. Blame Mexico. Most often detected at slaughterhouses. TSE's: transmissible Spongiform Encephalopathies. Scrapie. Prions. Transmitted via ingestion of contaminated feed. 1997: Ban on European imports. 2004: Specified Risk Materials (SRM): No CNS products from animals 30 months or older. Anthrax: burn not bury bodies. Present in Texas. Don't open carcass. REPORTABLE.