HSCI 216 Lecture Notes - Lecture 5: Cirrhosis, Dengue Fever, Rocky Mountain Spotted Fever

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HSCI 216
Day 5
June 8, 17
Evolutionary Epidemiology
Evolutionary Epidemiology
- Epidemiology
- Collecting epidemiological data
- Health outcomes
Learning Objectives
- To be able to define epidemiology
- To be able to explain what evolutionary epidemiology is and why it is important
- To describe the ways epidemiological data is collected
- To describe possible health outcomes fmor disease
What is epidemiology?
- A discipline that studies the causes of disease, looking at WHO is affected, WHERE
disease occur, WHEN they occur and the social, environmental, dietary and lifestyle
correlates of disease occurrence
What is disease?
o Is a biomedically measurable lesion, or an anatomical or physiological irregularity
Therefore, the makes epidemiology
- A discipline that studies the causes of lesions or anatomical or physiological irregularities
looking at WHO is affected, WHERE diseases occur, WHEN they occur and the social,
environmental, dietary and lifestyle correlates of disease occurrence
The “Traditional Biomedical” approach to disease is dichotomous
- Healthy or sick
- However the limit between health and disease is not always clear!
Conventional criteria for “disease” involves functional impairment
What is functional impairment?
- A health condition, in which the normal function of a part of the body is less than full
capacity
Signs of functional impairment
- Include manifestations of some sort of decrease in ability that is noticeable to others
What should be considered a “functional impairment”?
- The smoke detector principle
o Is a minor inconvenience
o But if it doesn’t go off, you can get burnt and die
Smoke detector principle
- Defenses should theoretically be expressed to a degree that is near the optimum needed to
protect against a given threat
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What are defenses?
- Ex: symptoms such as cough or fever are not defects but in fact are the body’s defenses
in action
- Also pain, nausea, vomiting, diarrhea, anxiety, fatigue, sneezing, inflammation, anaemia,
morning sickness (but vomiting, the stuff is coming out of your body)
- Do we do a disservice by blocking these defenses?
In psychiatry:
- Suffering, statistical deviance, and physical lesion
- Often correlated by are not sufficient to diagnosed a disorder
What is the Darwinian concept of mental health/disorder?
1. Capacity to achieve biological goals is the best single attribute that characterizes mental
health
2. Functional capacities established in consideration of the environment in which the
individual lives
Let’s consider the example of insecure attachment
Attachment theory: relationship between early experience and adult personality and behaviour
- Infants with emotionally available caregivers develop a model of the self as loved and
valued and others as loving
- Infants with emotionally unavailable caregivers develop a model of the self as unloved or
rejected and the develop insecure strategies for coping with their distress
- Adults expect significant others to be available
Evolutionary perspective of patterns of attachment
- Belsky proposed that patterns of attachment can be equally adaptive:
- If resources are chronically low or unpredictable, it can be adaptive to “choose” a
quantity-oriented strategy, rapid psychological and physical development, ealirer mating,
and multiple, short-term relationships
Actual Data Shows:
After controlling for age, cultural background and other confounders
- secure individuals are likely to engage in enduring romantic relationships and invest
heavily in parental care
- insecure individuals frequent one stands and sex outside established relationships and
tend to be cold, remote and unsupportive parents
Antisocial Personality Disorder (Psychopathies) (Killers)
- Deceitful and manipulative in order to gain personal profit
- Superficial charm but tend to be callus lack empathy and cynical and contemptuous of the
feelings, rights and suffering of others
How do they fare in life?
~ 50% go through life undiagnosed and undetected
- Lalumiere et al.:
- Those scoring higher ADDD
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FACEBOOK “Sperminator” impregnates 12 women
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Evolutionary Perspective
- Health status is multidimensional. Anatomical and physiological integrity and function
can be modified as the result of lesion, genetic mutation, malfunction or in response to
environmental (physical or social) challenges. Those, changes may result in undesirable,
painful or uncomfortable
Evolutionary perspective on changes in health status
- Proximates: Immediate reactions to health challenges. Symptoms (fever, pain, obesity,
loss of appetite, psychological states depression, anxiety, etc.)
- Ultimate: Evolutionary origin and function of the reaction
- Why do pain, fever, and negative emotions persist? may have a cost but a bit of the
fever will help you survive that challenge of the pathogen in your body pain = means
don’t do that or else you’ll get injured
- Need to look at both as a unit
Evolutionary theory and its contribution to Epidemiology
- To solve or ameliorate undesirable, painful or uncomfortable outcomes is important to
investigate and differentiate between “true malfunction” and the “uncomfortable
secondary effects” of adaptions
- Understanding this difference is critical to avoid suppressing natural defenses
- A little bit of a fever is a good thing and to not take meds for it
The origins of the principle
The Day the Universe Changes
- VIDEO
Increases in population density
- Sanitation (sewers system, garbage management, clean water supply…)
- Hospital systems
The emergence of the modern medicine and epidemiology resulted from:
- The rise of the hospitals for the masses (early 1800s) with large numbers of patients
divided by age sex and types of disease
- Standardization and centralization of record keeping by the first “health insurance
organizations”
- The belief that human health and disease patterns followed mathematical laws!!!
(William Farr)
- Emergence of medical math = early Epidemiology
How do we study health and disease at the population level?
Collection of Epidemiological Data
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