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Larry Sawchuk

TUBERCULOSIS (Captain of Men of Death)  Contagious disease: ◦ 9 million people annually 1person/second. ◦ 2.5 million people died every year, or 1 person/15 seconds  Social: 1. Women as primary caregivcrs. 2. Women spending time at home with the sick.  Physiological Differences: 1. The onset (stressor) of childbearing/giving birth. 2. Symptoms of cough and sputum expectoration is less common in women 3. Women delayed the seeking of treatment.  Bovine (M. Bovis) ◦ Possible that TB is a mutant bovine form. ◦ Domestication of cattle (Neolithic 6000-7000BC, Old World) – TB was endemic.  Mycobacterium tuberculosis. 1. Non-motile (incapable of motion), rod-shaped. 2. Covered in 'waxy sheath'. 3. Does not produce any significant toxin. 4. Multiplies slowly (6-12 hours). 5. Can survive outiside human host. 6. Can survive dessication (it doesn't dry up). 7. 4000-gene sequence or genome of the TB bacillus. 8. 24hr: An infected host can expel 2-4 bacilli. 9. Immune system response – only a fraction of those infected will develop active disease. ◦ Influence on genetics.  Transmission optimal conditions: ◦ Overcrowding. ◦ Poor public/personal hygiene. Nutrition Dose/exposure Outcome to of Bacilli Infection Host Other Resistance Diseases Decline in deaths due to respiratory tuberculosis (1830-1860)  Identified in 1880 (Robert Koch).  Chemo and vaccines in 1950s. Frost & Grigg: A theoritical plot of TB morbidity and mortality. Morbidity is sickness, mortality is deaths. Mortality or death rate=total number of deaths/population at risk. Expressed as a proportion or rate. Crisis Mortality as an Agent of Change  The sudden and dramatic increase in the death arising from a common, unusual casual factor operation for a limited period.  Triggered by famine, flood, drought, war, epidemic, smog. Mortality patterns:  In most western industrialized countries, there has been a progressive decline in the death rate.  The improvement in health varies in every population. ◦ Uniqueness of the mortality experience.  Decline occurred before modern medical biomedicine. ◦ Better living quality/hygiene. ◦ Selection/immunity takes place. Epidemics Epidemiological transition (Omran): Population goes to stages and phases.  A sudden increase in an infectious disease frequency above typical background or prevailing death rates for a given population.  Pandemic: A special case of an epidemic which is spread over a vast geographic area. Massive Disease Outbreak  Trying out new medicine.  1818: Flu crisis  Creating a catastrophe. Gibraltar Case Graph  Logit: p/1-p, where p is a proportion.  3 distinct time: Periods of marked change.  The lines of best fit.  The shaded area: Error there is inherent in the estimation of the mortality trend. Harvesting Effect or short-term mortality displacement  Occurs when there is a heightened, temporary, mortality rate in those with
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