Current and future public health is characterized by the increase of chronic and degenerative diseases, corresponding to the worldwide ageing of the population. The increasing prevalence of these conditions together with the long incubation period of the chronic diseases and the continual technological innovations, offer new opportunities to develop strategies for early diagnosis.
Public Health has an important mandate to critically assess the promises and the pitfalls of disease screening strategies. This MOOC will help you understand important concepts for screening programs that will be explored through a series of examples that are the most relevant to public health today. We will conclude with expert interviews that explore future topics that will be important for screening.
By the end of this MOOC, students should have the competency needed to be involved in the scientific field of screening, and understand the public health perspective in screening programs.
This MOOC has been designed by the University of Geneva and the University of Lausanne.
This MOOC has been prepared under the auspices of the Ecole romande de santé publique (www.ersp.ch) by Prof. Fred Paccaud, MD, MSc, Head of the Institute of Social and Preventive Medicine in Lausanne (www.iumsp.ch), in collaboration with Professor Antoine Flahault, MD, PhD, head of the Institute of Global Health, Geneva (https://www.unige.ch/medecine/isg/en/) and Prof. Gillian Bartlett-Esquilant (McGill University, Quebec/ Institute of Social and Preventive Medicine, Lausanne).
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Introduction to Key Concepts in Screening
This module will provide a brief welcome by Dr. Fred Paccaud and Dr. Antoine Flahault. An overview of screening and an introduction on how the course is organized and evaluated will be provided by Dr. Gillian Bartlett-Esquilant. Dr. Idris Guessous, a Senior Lecturer in the Population Epidemiology Unit in the Department of Community Medicine, Primary Care and Emergency Medicine (Geneva), and in the Department of Ambulatory Care and Community Medicine (PMU Lausanne) & Division of Chronic Diseases at the Institute of Social and Preventive Medicine (Lausanne) will provide lectures on definitions of screening. Natural history of diseases and the characteristics of subclinical conditions allowing early diagnosis will be presented. A quiz on the key concepts for screening will complete this module.
Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes) University of Geneva and Université Paris Descartes – Sorbonne Paris Cité
Fred Paccaud (In Partnership with UNIGE)
Professor of epidemiology and public health and Director of the Institute of social and preventive medicine Lausanne University Hospital
Gillian Bartlett-Esquilant
Professor of Epidemiology and Research and Graduate Program Director and Associate Chair for the Department of Family Medicine at McGill University. University of Lausannne and McGill University
[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.
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Antoine FlahaultProfessor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)
Fred Paccaud (In Partnership with UNIGE)Professor of epidemiology and public health and Director of the Institute of social and preventive medicine
Gillian Bartlett-EsquilantProfessor of Epidemiology and Research and Graduate Program Director and Associate Chair for the Department of Family Medicine at McGill University.
