[MUSIC] Hi, my name is Fred Paccaud, I'm professor of epidemiology and public health at the University of Lausanne. And I'm head of the Institute for Social and Preventive Medicine, a part of the Lausanne University Hospital. >> I am Antoine Flahault, the head of the Institute of Global Health at the Faculty of Medicine, University of Geneva. And both of us are belonging to the the Ecole Romande de Santé Publique, the French-speaking School of Public Health in Switzerland. >> We are glad to offer this course on screening and related methods and related policies. Screening as a public health strategy, will be developed in this course, taking two parts. Actually, the first will be devoted to the metrics of screening, to the methods used to monitor the implementation, the outcomes of the screening. And in the second parts, we will present a set of case studies, clinical situation, clinical conditions, which are using screening. >> You are a cancer specialist, you are a physician. In daily practice, you want to know if you have to apply a screening program in your practice. Or you are a public health professional, and you want to know if you have to apply screening programs in your country. This book will be helpful for you, because we'll teach you why this particular screening is helpful, on which basis it is founded, why it is needed to apply for your patients, for your population. Do you have to start these new programs in your parctice, or in your population, in your country? Do you have to stop it? All these issues will be discussed with specialist in epidemiology, specialist in ethics, specialist in values, disciplines of medicine. >> To sum up, this course is aiming to provide the practitioners, appropriate tools to make the appropriate decisions >> But the first actor in this book, will be you. Through the forum, you will have an opportunity to exchange, to interact between yourselves and also between the teachers, between the faculty. You will be able to co-construct the MOOC together with us. >> We do think that screening is an extremely important topic for public health, currently and for the future. So we do hope that you will join this course and that you will enjoy it. >> Hello, my name is Gillian Bartlett-Esquilant. I am a professor from the Department of Family Medicine at McGill University, where I hold the position of Associate Chair and the Research and Graduate Program Director. I am a collaborator for research and teaching with the Institute for Social and Preventive Medicine, and the University of Lausanne. I am trained in epidemiology and biostatistics, but I have developed an expertise in communication and knowledge translation in the primary healthcare context. Particularly, for health promotion and implementation of genomic medicine. I have successfully led the development of three graduate programs at McGill, at the graduate and post-graduate level. I have a particular interest in educational innovation, that leverages the latest technology to reach more learners in diverse settings. Welcome to the second edition of the course that was originally entitled, To Screen or Not to Screen, Methods in Health Policies through Case Studies. Based on the feedback from our learners, we have made significant improvements to the MOOC now entitled Disease Screening in Public Health. This edition includes new material in the form of videos and up-to-date publications, improved quizzes and reorganization of previous modules. The new edition of this course has been produced by the Institute of Social and Preventive Medicine in Lausanne, the University of Lausanne. With support from the School of Public Health of Southwest Switzerland, and the University of Geneva. The objectives of the course are to increase the competency of people involved in the scientific field of screening, and to understand the public health perspective in screening programs. With this course, you will understand that screening cannot be considered as a test in isolation. But must be considered as an entire program that is complex and requires careful evaluation and considered decisions by patients, providers, and policy makers. I will be guiding you through this MOOC with an introduction to each module that highlights a common theme in the course, explains the learning objectives, and the evaluation for that module. You can follow this course at your own pace. We recommend that you follow the modules in the order they are presented, as the content is linked and builds in a cumulative fashion. You have heard from Dr. Paccaud and Dr. Flahault, what this course will offer and who might be interested in taking it. I will briefly provide you with some background information on how the field of screening and public health has developed, where it started and where it is today. And why we feel it's important to offer this particular course. I will then give you an overview of the course content and what to expect in terms of evaluation. To understand how we have arrived at today's screening practices, we need to understand the historical perspective of public health efforts and how they have evolved over time. A key concept is that the original purpose of public health was to improve the health of our society as a whole. So when it came to screening for disease, the idea was to protect the society from a disease carried by an individual. Early evidence of this practice dates back to the Middle Ages, with the visual inspection of sex workers to try and identify those with venereal disease. This was to protect the clients, and not necessarily to improve the health of the workers. This early form of individual screening was accompanied by collective measures, such as quarantine. In the 14th century, ships arriving from infected ports were required to sit at anchor for 40 days before landing. This practice was called quarantine, and was derived from the Italian phrase meaning 40 days. What was interesting was that for a very long time, disease could only be detected when symptoms were very obviously made manifest. And the only option was to isolate the individual or group, until the disease ran its course. There was a very small window for intervention, in order to control a potential epidemic. From that time, until well into the late 1800s and early 1900s, quarantine of communities or groups and the improvement of sanitation, were the main public health measures to prevent the introduction, transmission, and spread of communicable diseases. The most feared diseases at the time, were outbreaks of cholera, diphtheria, and yellow fever. Smallpox was already on the decline, due to very early vaccination programs. In the 1860s, the germ theory of disease began to change the practice of public health. Now, individuals could be identified with specific infectious agents, which were identifiable before presentation of clinical symptoms. This was revolutionary for conditions such as tuberculosis, where patients were identified, isolated and treated earlier in the course of the disease. With the discovery and the growing availability of new antibiotics after World War II, and new vaccines against polio, measles, mumps and rubella, the incidence and mortality from infectious diseases, steadily declined, leading to a changing pattern of disease. During the 20th century, chronic non infectious illnesses and conditions became the leading causes of death in most high-income countries. Unhealthy diets, sedentary lifestyles, excessive use of alcohol, tobacco or drugs, contributed to the incidence of these illnesses. As a result, public health shifted from not only combating diseases, but also to preventing diseases and promoting good health. As you will learn in this course, both infectious and noncommunicable diseases, are the focus of screening in public health today. Screening programs now no longer just protects society from an individual, but they attempt to improve the health of the individual for the betterment of society. The foundation for screening is still the early identification of disease, usually before clinical symptoms. This could be the physiopathological changes for noncommunicable disease, or the presence of a toxic agent, or the detection of infectious agents. This is seen with screening in cancer, cardiovascular disease, respiratory conditions, and infectious diseases, such as HIV. Seminal work, including that from the Wolfson Institute of Preventive Medicine, lead to a general theory of early diagnosis and early treatment and screening. From prenatal screening of trisomy 21, to breast cancer screening, to screening of cardiometabolic disorders, this theory became an essential foundation for public health strategy. The 1960s marked another important transition that was catalyzed by an influential report by Wilson Jungner. This was to the World Health Organization, that highlighted concerns and the need for evaluation of the true benefits of screening. Evaluation of screening programs for benefits and harms, along with the provision of appropriate information to make informed decisions, were implemented. Alongside the changing focus from communicable disease, to more complex chronic conditions. The reach of screening is growing in popularity and complexity. However, research and training on the development, implementation, and evaluation of these programs, remains fragmented and is often disease-specific. With this course, we hope to provide a broad overview of some of the most important aspects of disease screening in modern public health, and to promote a more global approach to the science of screening. This course contains eight modules. With modules 1 and 2 providing theoretical training on fundamental terms and concepts. Modules 3, 4, 5 and 6, then follow the life course in the presentation of different substantive topics and screening. This includes module 3 that will deal with prenatal and perinatal screening. Module 4 that deals with screening for cardiometabolic conditions. Module 5 that deals with cancer screening. And Module 6 that deals with public mental health and screening in the aging population. Module 7 is specific for screening in low to middle-income countries, with the challenges that context presents, including how to screen migrants from these countries. Module 8 will cover the evaluation, planning and decision-making about implementation of screening programs. And will conclude with interviews with experts on topics, that we think will be key in the future of public health screening. As you complete this course, you will be asked to answer questions during the videos. These questions do not count towards the evaluation of the course, but are there to ensure you understand the material presented, before you continue with the module. If you wish to be evaluated in the course to earn a course certificate, you must pass the quizzes at the end of each module. To pass, at least 60% of your responses, must be correct in each quiz. The remaining videos in module 1, will be given by Dr. Idris Guessous, who is a senior lecturer in the Population and Epidemiology in Geneva and in Lausanne, and the division of chronic diseases at the Institute of Social and Preventative Medicine in Lausanne. The learning objectives for the first module are to define key concepts related to screening. To identify the important differences between early diagnosis and screening. And to distinguish different populations that might be appropriate for screening. I am happy to welcome you to this learning experience, and I look forward to accompanying you through the course. Thank you for your time and attention. I hope you enjoy the course. [MUSIC]
