Principles of Epidemiology
for Public Health (EPID600)
Introduction to the course
Faculty: Victor J. Schoenbach, PhD
Lorraine K. Alexander, PhD
home page
Department of Epidemiology
Gillings School of Global Public Health
University of North Carolina at Chapel Hill
www.unc.edu/epid600/
(Note: these slides have verbatim speaker notes.)
1/11/2011
Introduction
1
Safety warnings
(actual instructions on products)
Marks and Spencer bread pudding:
“Product will be hot after heating”
Rowenta iron: “Do not iron clothes on
body”
Nytol (a sleep aid): “Warning: may cause
drowsiness”
Kitchen knife: “Warning: keep out of
children”
8/15/2007
Introduction
2
Safety warning:
Don’t believe everything you read
Are the Durham Public Schools that bad?
Introduction
3
From Consumer Reports, Selling It
Introduction
4
EPID600, Principles of Epidemiology
Introduction
5
EPID600 Instructors
Faculty
Victor Schoenbach (“Vic”)
EPID600(160) classroom since fall 2001
Internet since summer 2002
Lorraine Alexander
EPID600(160) since 1994 (Carl M. Shy)
1/11/2011
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8/15/2007
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John C. Cassel, M.D.
8/15/2007
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8
“Epidemiology is fundamentally
engaged in the broader quest for
social justice and equality.”
John C. Cassel, M.D.
5/12/2010
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9
August, 1973
7/24/2010
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10
“I’m studying epidemiology”:
3 responses
- You're studying what?”
- “Does that have something to do
with skin?”
- “Uh-huh. And what else are you
studying?”
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The epidemiologic perspective
• Epidemiology is a way of thinking
about health – human ecology
• Much more than a collection of
methods – a way of using them
• Epidemiologists consider context,
heterogeneity, dynamics, inference
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What is epidemiology?
“The study of the distribution and
determinants of health related
states and events in populations,
and the application of this study to
control health problems”
John M. Last, Dictionary of Epidemiology
8/15/2007
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What is epidemiology? (con’t)
“The study of the distribution and
determinants of health related
states and events in populations,
and the application of this study to
control health problems”
John M. Last, Dictionary of Epidemiology
8/15/2007
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What is epidemiology, really?
• Study of the health and disease of the
“body politic” – the population.
• Basic science of public health
•What causes disease?
•How does disease spread?
•What prevents disease?
•What works in controlling disease?
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What for?
1. Provide the scientific basis to prevent
disease & injury and promote health.
2. Determine relative importance to
establish priorities for research & action.
3. Identify sections of the population at
greatest risk to target interventions.
4. Evaluate effectiveness of programs in
improving the health of the population.
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What for? – more
5. Study natural history of disease from
precursor states through clinical course
6. Conduct surveillance of disease and
injury occurrence in populations
7. Investigate disease outbreaks
– Milton Terris, The Society for Epidemiologic Research (SER) and the
future of epidemiology. Am J Epidemiol 1992; 136(8):909-915, p 912
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Natural history of disease
• Disease is a process
• Natural history is the entire process
of development of a disease
• Tells us what we can expect to
happen
• Fundamental concept for studying
and controlling disease
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www.lauriegarrett.com
8/15/2007
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Plague!
September 30, 1993 earthquake
levels over one million homes in
Maharashtra State, in India, with powerful
aftershocks.
Peasants harvest and store their
crops, then decamp.
August 1994, farmers return to stored
grains, rats, fleas & Yersinia pestis.
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Plague!
September 14, 1994 – four cases of
bubonic plague in Mamala, Beed District,
Maharashtra State.
Health care infrastructure still
disrupted from earthquake.
September 18, Festival of Ganesh
in Surat, hundreds of miles to northwest,
rapidly growing and crowded city.
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Plague!
September 21, cases of pneumonic
plague in Surat.
Public hospital doctors alert private
doctors, but 80% flee Surat, closing all
private clinics and hospitals
September 22 – media barrage in
India and outside – “Surat Fever”.
500,000 Surati’s depart in one week.
8/15/2007
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Plague!
Suratis take trains all over India,
disappearing into densely-packed cities.
Five Indian states go on emergency
health alert status.
Actions by Indian federal
government are slow in coming and
ineffectual; Minister of Health is not even
a physician. WHO also ineffectual.
8/15/2007
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Plague!
Remaining medical personnel in
Surat work round the clock, suffer
exhaustion.
Sales of tetracycline soar and
become depleted.
Plague expertise in short supply
throughout the world (CDC has a halftime scientist).
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Plague!
Indian and multinational drug
companies promote anitibiotics,
cleansers, pesticides, rat poison.
20% of tourism packages canceled;
Gulf State Nations, Pakistan, and Sri
Lanka ban all flights, citizens, goods, and
postal communications (!) with India.
Bombay stock market crashes.
8/15/2007
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Plague!
Russia, China, Egypt, Malaysia,
Bangladesh close all connections to
India; others inspect all Indian travellers
(10 suspected cases in NYC had
malaria, typhoid, viruses, liver dis.). KLM
sprays pesticides in plane cabins.
Delhi closes all public schools.
October 2 – Indian federal officials
announce over 4,000 cases.
8/15/2007
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Plague!
India’s National Institute of
Communicable Diseases and All India
Institute of Medical Sciences engage in
stand-off over specimens and decline
outside laboratory assistance despite
limited equipment and no airconditioning. Most of original specimens
deteriorate through lack of proper
handling.
8/15/2007
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Plague!
Lack of definitive laboratory
diagnosis undercuts governmental public
health authority. Alternative theories
abound – hantavirus, melioidosis,
Burkholderia pseudomallei, leptospirosis,
tularemia, Pseudomonas pseudomallei,
conspiracy theories (rebels, U.S.).
Ministry of Defense takes over all
remaining blood and sputum samples.
8/15/2007
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Plague!
Thousands of worried well fill
hospitals.
Widespread inappropriate use of
antibiotics, DDT.
$1.3 billion lost trade and tourism.
Lessons learned: Public health matters.
8/15/2007
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About EPID600
Cooperative learning model designed by
Carl M. Shy in 1990s - structured learning
tasks where students
• apply concepts and methods
• exercise critical judgment
• confront complexities of real life
Small group with TA consultant
Resources
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Learning resources
• Lectures – live, recorded, Powerpoint
slides with verbatim speaker notes, and
audio tutorials (web searchable)
• Textbook (see www.unc.edu/epid600/ for
information)
• Case studies, approximately weekly
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Learning resources – con’t
• Course websites (just Google “EPID600”):
• http://blackboard.unc.edu – announcements,
all materials organized by course module, and
links to everything
• http://www.unc.edu/epid600/ – most of the content
and submission forms that are displayed in
Blackboard – for when you can’t or don’t want to
log in to Blackboard
• Instructors – your TA, Vic, Lorraine
• Each other
8/15/2007
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Finding information
• Search the net – open or targeted, e.g.
predictive value site:epidemiolog.net/epid160/lectures
• www.epidemiolog.net: Understanding
the fundamentals of epidemiology – an
evolving text (includes problems and
answers), old EPID168 exercises,
examinations, spreadsheets, more …
1/11/2011
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Course schedule
• 9-12 hours/week (including class attendance)
• Most weeks – 1-2 textbook chapter(s), a case
study article with questions, small group
discussion
• Three examinations interspersed
• Suggestion to spread out the workload:
- Before Exam 1 read ahead in textbook
- After Exam 1 begin your final paper (Exam 3)
8/15/2007
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Course schedule
EPID600 spring 2011 classroom course schedule (Tuesday lab)
Tue lecture
Sun
Mon
(3:30p)
Tues lab (5:00p) Thu
Fri
Sat
1/9/2011 1/10/2011
Blackboard site open
by today
1/16/2011 1/17/2011
Martin Luther King, Jr.
Holiday
1/23/2011 1/24/2011
Indiv. cs02 due:
Studying populations
1/30/2011 1/31/2011
Indiv. cs03 due:
Incidence
2/6/2011 2/7/2011
Indiv. cs04 due:
Screening
1/11/2011
Start Module I:
Introduction
1/18/2011
Start Module II:
Studying populations
1/25/2011
Start Module III:
Incidence
2/1/2011
Start Module IV:
Screening
2/8/2011
Start Module V:
Intervention studies
1/11/2011
Lab - DVD: Part I
The Age of AIDS
1/18/2011
Lab:
Introduction
1/25/2011
Lab:
Studying populations
2/1/2011
Lab:
Incidence
2/8/2011
Lab:
Screening
1/13/2011
###### 1/15/2011
Online discussion of
Indiv. cs01
The Age of AIDS
due:
1/20/2011
###### 1/22/2011
2/13/2011 2/14/2011
Indiv. cs05 due:
Interventions studies
2/15/2011
Start Module VI:
Cohort studies
2/15/2011
Lab:
Intervention studies
2/17/2011
Group cs05 due:
Intervention studies
1/11/2011
Introduction
1/27/2011
Group cs02 due:
Studying
2/3/2011
Group cs03 due:
Incidence
2/10/2011
Group cs04 due:
Screening
###### 1/29/2011
###### 2/5/2011
###### 2/12/2011
Peer and TA
evaluations
###### due
2/19/2011
Exam 1 posted
35
Challenges in an introductory course
• Diversity of backgrounds – biology,
physiology, math/statistics, public health,
epidemiology
• Diversity of interest –
from: “I epidemiology”
to:
“Let me out of here!”
• Basic epidemiologic concepts are still
evolving
8/15/2007
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Course objectives
1. Explain the population perspective, access
population data, describe public health
problems
2. Apply and interpret measures of disease
occurrence and correlates in populations
3. Use basic methods for investigating disease
outbreaks
4. Explain relative strengths and limitations of
different epidemiologic study designs
5. Identify and control major sources of error in
community health studies
8/15/2007
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Course objectives – continued
6. Evaluate epidemiologic evidence by
applying criteria for causal inference
7. Use epidemiologic methods in evaluating
public health interventions
8. Comprehend basic ethical and legal
principles related to epidemiologic data
9. Appreciate complexities in applying
scientific evidence in making policy
8/15/2007
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Evaluation and grading
Several examinations:
• Two with multiple choice /
calculation / short answer
• One with essay questions (the “final
paper”)
Class participation / group work
See Blackboard | Syllabus | Grading & Evaluation
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UNC-CH Honor Code
• Integrity of academic work is vital to
scholarly activity
• Integrity of academic work is an
individual and collective responsibility
• Your participation in EPID600 implies
full observance of the Honor Code
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What is prohibited?
Academic cheating includes unauthorized
copying, collaboration on examinations,
and plagiarism.
Plagiarism is the intentional representation
of another person's words, thoughts, or
ideas as one's own.
If you are uncertain in a specific instance,
ask an instructor.
8/15/2007
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What students say about EPID600
“EPID600 was an excellent overview of the
methods.”
“Epi was great, and Bios was also good”
“EPID600 was very interesting and
probably one of the most valuable as
epidemiology is a foundation of public
health and through that course you
learned history and practical knowledge.”
1/11/2011
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What students say about EPID600
“. . . Extremely difficult to follow due to the
cluttered and disorganized nature of the
course website (there was a BlackBoard
site AND a class website . . .)”
“I was expecting to take an Epid class that
discussed the prevalence and spread of
major (and less known) diseases
throughout the world . . .”
1/11/2011
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What students say about EPID600
“I’ve heard horror stories about EPID 600,
and I fear taking it.”
“. . . Make Bios and EPID more challenging,
we can take it . . .”
“I don’t feel at all prepared with regard to my
knowledge of epidemiology . . .”
“I basically taught myself the material . . .”
1/11/2011
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What students say about EPID600
“I do not feel that I have a good grasp of
concepts still.”
“I almost feel like I need to take it again to
really absorb all the information.”
“I don’t feel confident about any of the
material.”
“The course was great. My main problem
was that I already knew everything.”
1/11/2011
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Thank you
Xie xie ni
Gracias, grazie
Spacibo
Naishitz
Gàn xìe
Hvala
Cám o*n
2/21/2011
Asante
Dhanyawad
Merci, Danke
Arigato, Shohkrahn
Multu^mesc
Ngiyabonga
Kamsa hamnida
Introduction
46