University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health. Department of Epidemiology. Fall PBHL Epidemiology I

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1 University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health Department of Epidemiology PBHL Epidemiology I COPH Building (Ed III) Room: 3202 Day and time: Tuesday 1:00-4:00 pm Course Syllabus Instructor: Marsha L. Eigenbrodt, MD, MPH Co-instructor: Leonard N. Mukasa, MBChB, PhD

2 Instructor: Eigenbrodt 8/29/2006 PBHL Epidemiology I Fall, 2006 Course Description This is an introductory course that focuses on the basic principles and methods of epidemiologic research and practice. It presents an overview of the history and theoretical basis of epidemiology, measures of morbidity and mortality, disease transmission and risk, major epidemiologic study designs, measures of association, sources of error including bias, confounding and interaction, evaluation of screening tests, inference and causality. The course will provide an overview of how epidemiology is used to accomplish the following tasks vital to public health: 1) Describe the natural history and prognosis of diseases 2) Assess the extent and importance of diseases in public health 3) Identify the cause or etiology of disease (identify risk factors) 4) Evaluate effectiveness of disease prevention measures and of healthcare 5) Provide the foundation for public health policy development Prerequisites Biostatistics I (may be taken concurrently) or equivalent. No prior experience or courses relating to epidemiology is assumed. Basic mathematical skills are necessary. Required Text/Materials Epidemiology by Leon Gordis, third edition. The textbook is available at the UAMS Book Store. All students must bring a calculator to class. Teaching format Teaching format: Class activities will be of three basic types: lecture, review of exercises/homework and group exercises. Except for days when in-class group activities are scheduled, the first 2 ½ hours of a class session will generally be in a lecture format. The last minutes of class time will usually be used to review homework or other assignments. Individuals may make appointments outside of class or attend scheduled help sessions to discuss any remaining questions. Group work will involve review of CDC case studies and/or of epidemiological articles. Each student will be assigned to a group. Group activities have been scheduled to assure students understand the major concepts that have been covered in the textbook, classroom lectures/discussion, or in the homework to that point. The group activity is also intended to foster a collaborative attitude among students. Group learning activities will be one format used for class reviews. Prior to group activities as well as at other times throughout the course, readiness assessments (short quizzes) will be given to assure understanding of material covered to that point. The results of these assessments and group answers for group activities/exercises will be used to determine much of the class participation grade. 1

3 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Examinations There will be a midterm and a final examination. The tests will be in-class, closed-book tests. Except under extraordinary circumstances, if a student misses a scheduled exam, a 20% point deduction will automatically be incurred. Any make-up exams will be conducted by appointment. Not taking the scheduled midterm or final examinations, without prior consultation with the instructor, is an automatic grade of zero. Grading Final grades will be assigned in the following manner: A: ; B: 80 to <90; C: 70 to < 80, D: 60 to <70, and F: < 60. Numerical scores will be determined by examinations, homework and class participation weighted as follows: 40% - Mid-term examination 45% - Final examination 10% - Homework timeliness, completion, and graded on an intermittent basis 5% - Class participation will be based on readiness assessments, group activities (eg discussions and group answers), classroom responses, and/or other class presentations. Readiness assessments will contribute to the participation grade. Extra credit activities may be made available to the entire class as deemed appropriate by the instructor. Homework: Homework will consist of the exercises at the end of most chapters of the Gordis textbook and exercises that will be distributed in class. The questions at the end of each assigned chapter in the Gordis textbook should be worked and understood, but they will not be turned in for grading. The answers for the Gordis questions are available at the back of the textbook. Students may be asked to work assigned problems in class as part of the class participation grade. The other assigned exercises will be turned in and will be graded. All assignments should be completed prior to the start of the following class period unless otherwise specified in the syllabus. Exercises for grades must be turned in on time. Late or incomplete homework will result in points being deducted. For any exercises requiring calculations, all work must be shown; otherwise, no credit will be given. Answers will be made available after the homework has been turned in and graded. Grades of Incomplete (i.e., I ) will be assigned only in exceptional circumstances and is at the discretion of the instructor. Except in the case of serious illness/injury, advanced approval of the instructor is required. An agreement indicating what activities are expected and the dates for their completion will be agreed upon by the student and instructor. Also, the consequences of taking an incomplete and of not meeting deadlines will be agreed upon and specified in the agreement. Office Hours Beginning in the third week of the semester, weekly help sessions will be established and continued if participation indicates the need. Otherwise, the instructors can be reached by telephone or via in the contact information below. Students with questions or needing help on homework should make every effort to attend the scheduled help sessions. However, if a student cannot reasonably attend these sessions, the instructor(s) will make every effort to schedule a meeting in a timely manner. 2

4 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Miscellaneous Students should complete the reading assignments prior to class. Information covered in class, in handouts, and in the assigned chapters of the Gordis textbook are required and will be subject to testing unless otherwise specified. Academic Calendar The UAMS academic calendar, which lists important information for this and other classes (dates for class withdrawal, holidays, etc), is available on the internet at College of Public Health Policies Attendance: Students are expected to be diligent in the pursuit of their studies and in their class attendance. Students have the responsibility of making arrangements satisfactory to the instructor regarding all absences. Such arrangements should be made prior to the absence if possible. Policies of making up work missed as a result of absence are at the discretion of the instructor, and students should inform themselves at the beginning of each semester concerning the policies of their instructors. Students with a disability: It is the policy of the UAMS College of Public Health to accommodate students with disabilities pursuant to federal law, state law, and the University s commitment to equal educational opportunities. Any student with a documented disability who needs accommodation should request to meet with the course instructor or the Associate Dean for Student and Academic Affairs no later than within the first 14 days (two weeks) following the first class meeting to develop an accommodation plan. Any student with a documented disability who determines later in the semester to seek accommodation or who develops a disability during the semester, should refer to the procedures outlined in the college catalogue. Failure to follow these procedures may be construed as a waiver of your rights under the Rehabilitation Act of 1973 and the Americans with Disabilities Act of Academic Integrity: Plagiarism: Plagiarism is defined as adopting, appropriating for one s own use and/or incorporating in one s own work, without acknowledgement, passages, tables, photographs, models, figures, and illustrations from the writings or works of others; presenting parts of passages of other s writing as products of one s own mind. Any student who plagiarizes may be subject to receiving a zero on the written work and may be dismissed from the College of Public Health. The College of Public Health subscribes to a web-based plagiarism detection and prevention system that is used by colleges and universities nationwide. The system works by scanning the student s document and matching the document against databases of texts, journals, electronic and web sources (including web sites that distribute or sell pre-written essays or term papers). Course instructors may, at their discretion, submit students written work to the plagiarism detection system for the purpose of evaluating whether students have plagiarized. Course Objectives for Introduction to Epidemiology 1. Be able to describe the role of epidemiology in public health practice and research and be able to articulate the types of questions and problems that are amenable to epidemiologic investigation. 3

5 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM 2. Be able to calculate, interpret, and communicate the following measures: a. Incidence b. prevalence c. Crude mortality rate d. Age-, sex-, and cause-specific mortality rates e. Mortality rates i. adjusted for age by the direct and indirect method ii. Infant mortality rate f. Case-fatality rate g. Proportionate mortality h. Attack rate i. Years of potential life lost j. Excess risk k. Relative risk (risk ratio) l. Relative odds (odds ratio) m. Attributable Risk 3. Be able to define and, where appropriate, be able to calculate the following: a. Validity b. Reliability c. Sensitivity d. Specificity e. Predictive power positive f. Predictive power negative 4. Be able to recognize and describe major characteristics (including relative strengths and weaknesses) of the following types of epidemiologic designs and their applicability in public health practice or research: a. Ecologic or correlation study b. Case-comparison study c. Cohort study d. Cross-sectional study e. Clinical trial (including stratification and blinding) 5. Be able to list strengths and weaknesses of data commonly used for public health practice 6. Be able to define: bias, confounding, and interaction or effect modification 7. Be able to define type I and type II error and the relationship between sample size and power in epidemiologic studies 8. Be able to defend choice of one sided and two sided statistical tests 9. Be able to summarize and critically review an epidemiologic article. 10. Be able to describe the contribution of genes and the environment in the development of disease. Relating Epidemiology I Course Objectives to Core COPH and Departmental Objectives The COPH and Departmental Objectives (see list) are addressed, at least partially, as follows: COPH Core Objective 2: Course Objective 5. COPH Core Objective 8: Course Objectives 1-4, and 6-9. Departmental Objective 1: Course Objective 9. Departmental Objective 8: Course Objective 1. Departmental Objectives 11-13: Course Objective 2. 4

6 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Core COPH Objectives 1) Define the components of community-based public health practice. 2) Describe basic and contemporary issues of public health, including tools of community-based health assessment, surveillance, health promotion, disease prevention, policy, cultural competency, and ethics. 3) Demonstrate the ability to complete descriptive analyses as well as nonparametric, regression, multiple comparisons of means and analysis of variance for one- and two-factor experiment biostatistics for datasets. 4) Demonstrate an understanding of core statistical concepts, including database principles, basic probability principles, diagnostic test statistics, tests of hypotheses, sample-size estimation, and power of tests. 5) Describe the elements of the common chemical, physical, and biological hazards in the occupational and community settings, along with the ways in which these hazards are evaluated, controlled, and regulated. 6) Define the major components of at least two models of health behavior change, i.e., the Health Belief Model, Transtheoretical Model, Social Cognitive Theory. 7) Describe the organizational arrangements, financing, health status issues, health insurance, health manpower, cost of health care, quality of health care, access and regulatory issues of the health care delivery system in the United States. 8) Describe the core concepts of epidemiology, including its history and theoretical basis; measures of morbidity, mortality, disease transmission and risk; major study designs; measures of association; bias, confounding and interaction; evaluation of screening tests; inference; and causality. Departmental Objectives Technical Skills 1. Read, interpret, and critically evaluate the scientific literature (encompasses measures of risk, measures of association, research designs, hypothesis development and testing, assessment of bias, causality and inference). 2. Design and develop procedures and materials for implementing an epidemiologic study in the field. 3. Select and interpret the results of standard univariate and multivariate statistical techniques. 4. Carry out statistical analyses using common statistical techniques. 5. Develop databases using commonly available software. 6. Calculate sample size for standard research designs. 7. Demonstrate facility in the use of common statistical software, e.g., SAS and Epilnfo. 8. Describe the purpose, history, and use of epidemiology and epidemiologic methods. 9. Describe the current state-of-the-art and gaps in knowledge related to the area of epidemiologic interest. Communication Skills 10. Review and synthesize relevant scientific literature. 11. Prepare, present, and communicate epidemiologic and other scientific information effectively to a broad range of scientific audiences, orally and in writing (includes technical reports and slide presentations). 12. Prepare, present, and communicate epidemiologic and other scientific information effectively to administrative audiences, orally and in writing. 13. Prepare, present, and communicate epidemiologic and other scientific information effectively to a broad range of community audiences (e.g., community, legislative, and advocacy groups), orally and in writing. 5

7 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Organizational, Management, And Leadership Skills 14. Describe the organizational and team structures needed to carry out epidemiologic research and public health activities (community-based outbreak investigations, needs assessments, preventive interventions). 15. Collaborate in implementation of an epidemiologic research study. 16. Collaborate in implementation of public health activities and interventions. Primary Instructor Co-Instructor Marsha L. Eigenbrodt, MD, MPH Leonard N. Mukasa, MBChB, PhD Assistant Professor Chief Epidemiology Officer, TB Program Department of Epidemiology, UAMS COPH Arkansas Department of Health Department of Cardiology, UAMS Tel (501) Telephone: (501) Office: AR Department of Health Office: UAMS College of Public Health Building, Room th floor, Epidemiology Suite, Office

8 Instructor: Eigenbrodt 8/29/2006 The following is a general outline of the intended class schedule. Any variations from the schedule will be announced in class. If a student misses a class, it is his/her responsibility to find out any changes from the following schedule. The readings that are listed should be completed prior to the class where they are listed. The homework that is assigned will be turned in the following week unless otherwise indicated. PBHL 5173 (Epidemiology 1) Class Schedule and Assignments Date Topic Reading Assignments Homework Assignments Week 1 Aug 22 Week 2 Aug 29 Week 3 Sept 5 Week 4 Sept 12 Week 5 Sept 19 Week 6 Sept 26 1) Introductions, Course Overview 2) Student Honor Council Presentation (1:15) 3) Epidemiology: definition, applications, characteristics, historical perspective. 4) Disease Transmission and Outbreak investigation Measuring Disease Occurrence: Morbidity and Mortality Surveillance Team Assignment Measuring Disease Occurrence: Mortality Direct and Indirect Adjustment Natural History of Disease Life table Principles of Scientific Investigation Deriving inferences from Epidemiologic Studies Introduce terms bias confounding, effect modification Overview of Epidemiologic study design: Ecological Design Measuring validity and reliability of tests: Sensitivity, specificity and predictive power Team Learning Activity over previous material Screening Programs Gordis Textbook, Chapters 1 and 2 Gordis Chapter 3 & first half Ch 4 Gordis Chapter 4-last half & Ch 6 (mainly p95-101, p ) Handout Gordis Chapter 14 Gordis Chapter 5 Gordis Chapter 18 Gordis Ch 2 questions HW due: none to turn in HW assigned: Ch 3 questions Exercise I (for grade) HW due: Exercise I (for grade) HW assigned: Ch 4 questions HW due: none to turn in HW assigned: Ch 6 q1-5 & Ch 14 Exercise II (for grade) HW due: Exercise II (for grade) HW assigned: Ch 5 questions HW due: none to turn in HW assigned: Ch 18 questions Article to read and critique for Oct 3 7

9 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Week 7 Oct 3 Epidemiologic Study Design : Cohort design and Incidence Team Activity for 1) Summarizing/Critiquing an Article Gordis Chapter 9 Handout HW due: Article review/critique (for grade) HW assigned: Ch 9 Week 8 Oct 10 Complete discussion of article Team Activity for Review and Questions HW due: Be prepared to discuss the assigned article and work problems Week 9 Oct 17 Week 10 Oct 24 Week 11 Oct 31 Midterm Exam Epidemiologic Study Design: Case control and cross-sectional study design Review midterm exam Begin Odds ratios Measures of Risk and Association Relative Risk and Odds Ratios Attributable Risk Gordis Chapter 10 and 11 Gordis Chapter 11 and 12 HW due: None HW assigned: Ch 10 and Exercise III for grade HW due: Exercise III (for grade) HW assigned: Ch 11 and Article for review/critique (for grade) due 11/21 Week 12 Nov 7 Team Learning Activity: Selected Questions Risk: Absolute vs Relative Risk Attributable Risk Gordis Chapter 12 and 13 HW due: none to turn in HW assigned: Ch 12 and Exercise IV for grade Week 13 Nov 14 Week 14 Nov 21 Week 15 Nov 28 Week 16 Dec 5 Epidemiologic Study Design: Randomized Trials Type I and Type II errors Power Causal Inference: Bias, Confounding, Effect Modification, Team Learning Activity: Review Article Complete Bias, confounding and effect modification Introduction to Health Services Evaluation Team Learning Activity: Article review Bias confounding and effect modification Complete exercises remaining questions-bias Gordis Chapter 7 and 8 Gordis Chapter 15 Bias and confounding Gordis Chapter 15 Effect modification Gordis Chapter 17 p HW due: Exercise IV (for grade) HW assigned: Ch 8 HW due: Article critique (for grade) HW assigned: Ch 15, begin Article for review/critique (for grade) due 12/5 HW due: None to turn in HW assigned: Ch 15, complete Exercise V (for grade) due 12/12 HW due: Article critique (for grade) HW assigned: All questions Ch 17 8

10 Instructor: Eigenbrodt 8/29/2006 5:52:45 PM Week 17 Dec 12 Finals Week Dec 19 Introduction to Genetic and Environmental Factors in Disease Discussion of Ethics Course Evaluation Team Learning Activity for Review for final Final Exam Gordis Chapter 16: HW due: Exercise V (for grade) HW assigned: study for final exam 9

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