University of Alberta

Course Guide for SPH Fall 2016 School of Public Health

Fundamentals of Epidemiology for Public Health September 5, 2016 – December 7, 2016 Mondays, 9:00-12:00 pm ECHA 1-498

Instructor:

Teaching Assistants:

Maria-Beatriz Ospina, Msc, PhD Phone: (780) 735-8732 Email: [email protected] Office: 5S138 Lois Hole Hospital for Women, Robbins Pavilion Royal Alexandra Hospital

Abdelsalam Elhenawi, MD, MSc, PhD [email protected] Sana Amjad, MBBS, MSc candidate(Global health) [email protected]

Course Description

Epidemiology is a scientific discipline that aims to: 1) describe and characterize patterns of disease occurrence; 2) identify determinants of disease and other health-related conditions; and 3) evaluate disease prevention and health care interventions. With a focus on human populations, epidemiology is directly linked with public health research, policy, and practice and provides the conceptual and practical tools necessary for studying, understanding and solving public health problems, regardless of one's area of concentration or specialization. This course introduces students to the basic principles of epidemiology. It provides a foundation for students who want to learn more about the design, conduct, and evaluation of epidemiological studies and investigations. For those who will not take more advanced courses in epidemiology, the course will enable them to better understand the studies they read in scientific journals or in popular media, and interact more effectively with epidemiologists, biostatisticians, and other public health professionals. Course content includes: definition and uses of epidemiology in public health, principles of causation and causality, measures and data sources used in epidemiology, study designs, bias, confounding and effect modification, outbreak investigations, and surveillance and screening methods. Emphasis will be placed on applying these concepts to real-world problems in public health, and fostering critical thinking of epidemiological studies through case studies.

Objectives

Upon completion of this course, students will be able to: 1. Understand the basic principles and concepts of epidemiology and their application to public health research and practice. 2. Familiarize with a variety of study designs in epidemiology applied to the study of public health issues. 3. Build skills in assessment, synthesis and critical appraisal of epidemiological literature.

Competencies

Successful completion of this course will contribute to the attainment of the following core competencies: • • •

SPH 597 [Fall 2016] Course Syllabus

Explain what epidemiology is and how it can be used to inform public health issues. Distinguish between association and causation and understand the criteria to evaluate causal associations. Describe a public health problem in terms of magnitude, person, University of Alberta, School of Public Health Page 2

• • • • • • •

time, and place. Identify key sources of epidemiological data; their strengths, limitations, and potential ethical issues. Understand, calculate and interpret commonly used measures of disease frequency and association in epidemiology. Familiarize with the characteristics of epidemiological study designs and identify their inherent strengths and weaknesses. Explain the concept of bias in epidemiological studies. Be familiar with the concept of effect modification and how it differs from confounding. Describe standard approaches to disease outbreak investigations. Identify, discuss and illustrate the basic principles, objectives, and elements of surveillance and screening in public health.

In addition, each session has specific learning objectives that explicitly state the concepts and skills that students are expected to master. This course is reading, writing, and research intensive, and uses guided self-instruction, student-led discussions and peer-group training as major teaching tools. Consequently, students who successfully complete the course will be able to: • Read and critically evaluate epidemiologic articles (and media summaries of them) and discuss them with other professional and lay audiences; • Develop "thought-provoking" questions and moderate discussions; • Provide constructive feedback and assistance to fellow students.

Learning Resources

All required materials are made available through E-class. Detailed information on learning objectives and assignments/tasks for each individual session will be posted on eClass. Assigned readings can be textbook chapters and/or scientific articles. Power Point lectures complement the assigned readings for each session and will be posted on eClass. Required Textbook: •

Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers: 2013.

Hard-copies of the book have been ordered by UofA Bookstore. Note: You can also use the 2008 edition (which is cheaper). Supplemental Resources: This course gives an introduction to the field of epidemiology. The SPH 597 [Fall 2016] Course Syllabus

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following books are recommended (not mandatory) to those with more extensive interest in the field. • •

•

• •

Friis R, Sellers, T. Epidemiology for Public Health Practice (3rd Edition). Boston: Jones and Bartlett Publishers; 2004. Gerstman BB. Epidemiology Kept Simple: Introduction to Traditional and Modern Epidemiology (3rd Edition). Oxford: John Wiley & Sons; 2013. Koepsell TD, Weiss N. Epidemiologic Methods: Studying the Occurrence of Illness. New York: Oxford University Press; 2003. Porta M (Ed). A Dictionary of Epidemiology (5th Edition). New York: Oxford University Press; 2008. Oleckno WA, Anderson B. Essential Epidemiology: Principles and Applications. Prospect Heights, IL: Waveland Press; 2002.

The embedded links below are very important and useful sources of epidemiologic information • • • •

Centers for Disease Control and Prevention Epidemiology Supercourse The WWW Virtual Library: Medicine and Health: Epidemiology Gapminder

Science in the Cinema There are some very nice movies and documentaries about Epi topics. Enjoy! • • • • • • •

And the Band Played (1993) http://bit.ly/1IsMNZV Miss Evers’ Boys (1997) http://bit.ly/1NtXrA3 Last Man on Earth (1964) http://bit.ly/1XEnPxz 12 Monkeys (1995) http://bit.ly/1OKr0My The Black Death (2015) http://bit.ly/1QjcAVD The Deadly Deception (2014) http://bit.ly/1jCsRYI The Influenza Pandemic of 1818 (2014) http://bit.ly/1XEp3Jn

Need a Break? What about a bit of fun in-between readings? •

The Outbreak: www.survivetheoutbreak.com/

Class Structure: Weekly class sessions will last between 2:30 – 2:50 hours. Classes will begin with a lecture given by the course instructor or guest speaker reviewing the topic of the session. Lectures will be followed by active learning activities (e.g., discussion and debates, group work, case studies, and problem solving activities). We will use a SPH 597 [Fall 2016] Course Syllabus

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clicker-free student response system (SRS) (Poll Everywhere) for some in-class activities; you are welcome to bring your cell phone or computer to participate in the SRS-based activities. We will have a 10-minutes break between activity blocks. At the beginning of the course, you will be assigned to a small group of 4-5 students. You will work with your group throughout the semester in both the in-class activities and completing a Group Project. You are expected to come to class having read and reviewed all assigned materials and be ready to participate in all activities to share your learning with your classmates. Office Hours: If you have questions about the course material, please post your question on eClass in the space created for this purpose. We ask this because your question may be similar to a question someone else may have. If you have questions/concerns about your grades or any particular circumstance, please feel free to email the instructor or the TA. We will respond to your email or posting as soon as possible.

Library

The University of Alberta library system’s website www.library.ualberta.ca details the range of services offered to students on and off campus. If you need further information or assistance, contact the Library's Electronic Reference Desk at www.library.ualberta.ca/ereference/index.cfm or call 1-800-2070172.

Course Evaluation Mid Point As is the case with all SPH instructors, I am interested in improving Evaluation: the course. I need to hear from you in order to do that well. I will

gather feedback and recommendations from you at the mid-point of the course, by administering an anonymous course evaluation. Please feel free to provide feedback and recommendations at any time of the course, so we can change what is not working for the remainder of the course.

Final Course Following completion of the course, you will receive a standardized

summative evaluation. Course evaluations will be done online by Test

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Evaluation: Scoring and Questionnaire Services. An invitation to participate in the

survey is emailed to each student. One email will be sent for each start date, i.e., if a student has surveys with different start dates, they will receive multiple messages. Note that the message includes a login button.

Student Evaluation Assignment/Exams 1) In-Class Forums (n=8)

Percentage 10%

Date Weeks: 3 to 12

Moderation

5%

TBA

Participation

5%

Weeks: 3 to 12

2) Assignments (n=3)

15%

Weeks: 4, 9 and 11

3) Quizzes (n = 3)

15%

Weeks: 5, 7 and 8

4) Group Project

25%

Project Paper

15%

Deadline: November 14

Project Presentation

10%

November 28

35%

December 5 (9:00 – 11:30 am)

5) Final Examination

Evaluation of Course Work

1) In-Class Forums (10%) In-Class Forums are integral to this course. They are designed to enrich your learning experience by enabling you to interact with your fellow students, the TA and the instructor. Each week, a Small Group will be assigned as Moderators of the In-Class Forum. In-Class Forum Moderators will help leading inclass discussions/activities based on the week’s readings and lectures. Students may use supplemental resources (videos, news, TED talks) to facilitate the discussion (think creatively!!). Students are encouraged to contact the instructor and/or the TA the week before they moderate to make sure they understand the concepts and clear up any questions they have. Students who are not In-Class Forum Moderators are expected to actively participate during the discussions. A detailed rubric for

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this activity (for both In-Class Forum Moderators and Participants) will be posted on eClass at the beginning of the course. We all bring something unique to these discussions, from our understanding, our own experiences, and value systems. Therefore, we should all be respectful of others while expressing our viewpoints and opinions. 2) Assignments (15%) Three assignments (5% each) will allow you to practice some basic epi calculations and interpretation of results. You may need a calculator to complete some of the exercises. You will complete and submit the assignments individually, although you are free to discuss the questions and material with your classmates. 3) Quizzes (15%) You will complete a short quiz (no more than 5 multiple-choice questions) at the end of sessions (Weeks) 5, 7 and 8. The purpose of these quizzes is to evaluate your understanding of the material covered in the readings and/or lecture for that given week. Quizzes will be worth 5% each. 4) Group Project (25%) It is very uncommon for anyone in public health or epidemiology to work alone. Virtually every project is conducted by groups of people working together towards a common goal. To gain experience in working in interdisciplinary teams, students will be assigned to small groups of 4-5 students to work on a Group Project through the duration of the course. The Group Project will be based on a topic (condition, disease, event) of interest of your group’s choice and consist of two parts: 1) Search the epidemiological peer-reviewed literature to describe the topic of interest in terms of person, place and time. It is expected that epidemiological measures (i.e., frequency and association) will be included in the description of the condition. 2) Choose one epidemiological article (cross-sectional, ecological, case-control, cohort, or experimental study) focusing on the condition of interest and complete a short critique of the article. It is expected that you will work on your Group Project throughout the course and the concepts reviewed in the sessions and lectures will help you to structure the Paper. The instructor and TA will provide feedback on the topic of choice and advice you on the tools for critical appraisal. Deliverables of the Group Project are:

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• Project Paper (15%): Maximum of 10 pages (exclusive of title page and references), double-spaced, 12 pt font, 1-inch margins and prepared in Vancouver style. • Presentation (10%): A 15-min presentation followed by a 5min discussion period. Each member of the group is expected to deliver part of the presentation. Your group is not limited to using PowerPoint. Please go wild with creativity!. If you think you can better communicate your message using drama, a play, skit, simulation, incorporating video, song, dance, GO FOR IT! Just be sure to think critically and teach the class about your article and critique. • The topic of the Group Project and the article your group will review must be emailed to the instructor and TA by September 26 (Session 4). The paper must be submitted no later than November 21. Group presentations will be scheduled November 28. Additional details on the rubric for this activity will be posted on eClass and discussed during the course. 5) Final Examination (35%) The final exam will cover the entire course material. The exam will be open-book (i.e., class notes, lecture notes, textbook). The final exam must be completed within 2.5 hours. The final exam format consists of multiple choice and short answer questions. Examples may include: • • • •

Feedback and Grading

Defining key terms/concepts in epidemiology Calculation and interpretation of various epidemiological measures Identifying various study designs Communication of epidemiological results to end-users.

Marked assignments and quizzes will be returned within one week and Answer Keys will be posted on eClass. Late assignments will NOT be accepted. Detailed rubric for all course activities will be available on eClass. Grades reflect judgments of student achievement based on a combination of absolute achievement and relative performance in the course. I will assign marks (e.g. percentages) throughout the term. A maximum of 100% can be obtained. A letter grade will be assigned at the end of the term based upon the percent of course points as follows:

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% of Course Points 96% - 100% 91% - 95% 86% - 90% 81% - 85% 76% - 80% 71% - 75% 66% - 70% 61% - 65% 56% - 60% 51% - 55% 46% - 50% 41% - 45% Equal or Below 40%

Letter Grade A+ A AB+ B BC+ C CD+ D DE

I follow the University of Alberta Grading System, which uses a letter grading system with a four-point scale of numerical equivalents for calculating grade point averages. University of Alberta Calendar Section 23.4 Regulations and Information for Students Evaluation Procedures and Grading System The University of Alberta Grading System The University of Alberta uses a letter grading system with a four-point scale of numerical equivalents for calculating grade point averages. Grades reflect judgments of student achievement made by instructors. These judgments are based on a combination of absolute achievement and relative performance in a class. Some instructors assign grades as intervals during the course and others assign marks (e.g. percentages) throughout the term and then assign a letter grade at the end. Instructors must adapt their approaches to reflect the letter grading system. Grade distribution should reflect those shown in this document. (EXEC 03 FEB 2003) Descriptor Excellent

Good Satisfactory Failure

SPH 597 [Fall 2016] Course Syllabus

Grading in Graduate Courses Letter Grade Grade A+ A AB+ B BC+ C CD+

Point Value 4.0 4.0 3.7 3.3 3.0 2.7 2.3 2.0 1.7 1.3

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Descriptor

Academic Integrity

Grading in Graduate Courses Letter Grade Grade Point Value D 1.0 F 0.0

Plagiarism is a serious offence. The University of Alberta is committed to the highest standards of academic integrity and honesty. Students are expected to be familiar with these standards regarding academic honesty and to uphold the policies of the University in this respect. Students are particularly urged to familiarize themselves with the provisions of the Code of Student Behaviour (online at www.ualberta.ca/CodeofStudentBehaviour) and avoid any behaviour which could potentially result in suspicions of cheating, plagiarism, misrepresentation of facts and/or participation in an offence. Academic dishonesty is a serious offence and can result in suspension or expulsion from the University. University of Alberta policy about course outline can be found in Section 23.4(2) of the University Calendar. (GFC 29 SEP 2003)

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Detailed Course Outline by Week WEEK 1. September 5, 2016 No Class – Labour Day WEEK 2. September 12th, 2016 -Course overview -Understanding Epidemiology -Causation and Causal inferences Instructor: Dr. Maria-Beatriz Ospina Learning Objectives: By the end of this week you should be able to: • • • • • •

Explain what epidemiology is and how it can be used to inform public health practice. Understand the genesis of epidemiology from a historical perspective. Familiarize with practical and contemporary applications of the discipline. Distinguish between association/risk factors and causation/causes. Familiarize with the Bradford-Hill viewpoint to evaluate causal relationships. Describe the components of the sufficient-component cause model.

Required Readings: •

Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapters 1 and 15.

Recommended Readings (NOT REQUIRED): •

Khoury MJ, Lam TK, Ioannidis JPA, Hartge P, Spitz MR, Buring JE, et al. Transforming Epidemiology for 21st Century Medicine and Public Health. Cancer Epidemiol Biomarkers Prev. 2013; 22(4): 508–16.

•

Phillips CV, Goodman KJ. The missed lessons of Sir Austin Bradford Hill. Epidemiol Perspect Innov. 2004 Oct 4;1(1):3.

• •

Armenian HK. Epidemiology: A problem solving journey. Am J Epidemiol. 2009;169:127–31. Krieger N. Epidemiology and the web of causation: has anyone seen the spider?. Soc Sci Med 1994;39(7): 887-903.

WEEK 3. September 19, 2016 Finding and using public health data in epidemiology -Descriptive epidemiology (person, place, time) -Sources of epidemiological data -Ethics of data access, electronic health records, privacy and secondary use of data Instructors: Dr. Tania Bubela; Dr. Maria-Beatriz Ospina; Learning Objectives: By the end of this week you should be able to: • Describe a public health problem in terms of magnitude, person, time, and place. SPH 597 [Fall 2016] Course Syllabus

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• •

Identify key sources of epidemiological data in Canada, strengths and limitations of different data sources and methods for accessing them. Familiarize with ethical principles about data access, electronic health records, privacy and secondary use of data.

Required Readings: • Koepsell TD, Weiss N. Epidemiologic Methods: Studying the Occurrence of Illness. New York:Oxford University Press; 2003. Chapters 7 and 6. • Lucyk K, Lu M, Sajobi T, Quan H. Administrative health data in Canada: lessons from history. BMC Medical Informatics and Decision Making 2015; 15:69. Recommended Readings (NOT REQUIRED): • Gavrielov-Yusim N, Friger M. Use of administrative medical databases in population-based research. J Epidemiol Community Health 2014;68:283-7. • Alberta Health. Overview of administrative health datasets. 2015. Available at: http://bit.ly/1VH5cEq WEEK 4. September 26, 2016 Epidemiological Measures - Measures of disease frequency: Incidence and prevalence -Comparing disease frequencies: Relative and absolute measures of effect -Rate adjustment: Direct and Indirect Standardization Instructor: Dr. Maria-Beatriz Ospina Learning Objectives: By the end of this week you should be able to: • Familiarize with basic epidemiologic measures of disease frequency and mortality, measures of association, and measures of potential impact. • Distinguish between rates, ratios, and proportions. • Identify commonly used rates in public health (crude, specific, adjusted) and specialized measures of disease frequency. • Define and explain epidemiologic concepts of prevalence (including point and period prevalence) and incidence (including both incidence density and cumulative incidence). • Understand and interpret absolute and relative measures of effect. Required Readings: • Gerstman BB. Epidemiology Kept Simple: Introduction to Traditional and Modern Epidemiology (3rd Edition). Oxford: John Wiley & Sons; 2013. Chapter 3 Recommended Readings (NOT REQUIRED): • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapters 2 and 3. • Noordzij M, Dekker FW, Zoccali C, Jager KJ. Measures of Disease Frequency: Prevalence and Incidence. Nephron Clin Pract 2010;115:c17–c20. • Tripepi G, Jager KJ, Dekker FW, Wanner C, Zoccali C. Measures of effect: relative risks, odds ratios, risk difference, and 'number needed to treat'. Kidney Int 2007;72(7):789-91. • Tripepi G, Jager KJ, Dekker FW, Zoccali C. Measures of effect in epidemiological research. Nephron Clin Pract 2010;115(2):c91-3.

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WEEK 5. OCTOBER 3, 2016 Epidemiological study designs -Overview and concepts of critical appraisal of epidemiologic studies -Observational Studies I: Case reports, case series, ecological studies, cross-sectional studies Instructor: Dr. Maria-Beatriz Ospina Learning Objectives: By the end of this week you should be able to: • Recognize and describe important characteristics of case reports, case series, ecological studies and cross-sectional studies, including its strengths and limitations. • Describe and identify the types of epidemiologic questions that can be addressed by these studies. • Apply knowledge of these study designs to evaluate findings in the scientific literature. Required Readings: • du Prel J-B, Rohrig B, Blettner M. Critical appraisal of scientific articles: Part 1 of a series on evaluations of scientific publications. Dtsch Arztebl Int 2009; 106(7): 100–5. • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapter 6. Recommended Readings (NOT REQUIRED): • Kempen JH. Appropriate use and reporting of uncontrolled case series in the medical literature. Am J Ophthalmol 2011;151(7):7-10. • Morgerstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health 1995;16:61-81. • Stephenson JM, Babiker A. Overview of study design in clinical epidemiology. Sex Transm Infect 2000;76:244-247 doi:10.1136/sti.76.4.244. WEEK 6. October 10, 2016 No Class – Thanksgiving WEEK 7: October 17, 2016 Epidemiological study designs Observational Studies II: Case-control studies and Cohort studies Instructor: Dr. Maria-Beatriz Ospina Learning Objectives: By the end of this week you should be able to: • Recognize and describe important characteristics of case-control studies and cohort studies, including its strengths and limitations. • Describe and identify the types of epidemiologic questions that can be addressed by these studies. • Apply knowledge of these study designs to evaluate findings in the scientific literature. Required Readings: • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapters 8 and 9. Recommended Readings (NOT REQUIRED): SPH 597 [Fall 2016] Course Syllabus

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• •

Grimes DA, Schulz KF. Cohort studies: marching toward outcomes. Lancet 2002;359(9303):341-5. Schulz KF, Grimes DA. Case-control studies: research in reverse. Lancet 2002;359(9304):431-4.

WEEK 8: October 24, 2016 Epidemiological study designs -Experimental Studies Instructor: Dr. Cristina Villa-Roel Learning Objectives: By the end of this week you should be able to: • Recognize and describe important characteristics of experimental studies, including their strengths and limitations. • Describe key features of experimental studies (i.e., recruitment, enrolment, informed consent process, allocation concealment, randomization, masking, blinding, follow-up, outcome ascertainment, data analysis). • Describe bias pertaining to experimental designs • Apply knowledge of experimental design characteristics to evaluate findings in the scientific literature. Required Readings: • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapter 7. Recommended Readings (NOT REQUIRED): • Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials. BMJ 2010;340:c332 doi: 10.1136/bmj.c332. • Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet. 2002 Feb 23;359(9307):696-700. • Schulz KF, Grimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet. 2002 Feb 16;359(9306):614-8. • Schulz KF, Grimes DA. Generation of allocation sequences in randomised trials: chance, not choice. Lancet. 2002 Feb 9;359(9305):515-9.

WEEK 9: October 31, 2016 -Chance vs. Bias -Confounding vs. Effect modification Instructor: Dr. Maria-Beatriz Ospina Learning Objectives: By the end of this week you should be able to: • Define bias and discuss differences between random and systematic error (bias). • Understand how bias can impact study results. • Familiarize with methods of bias prevention and control. • Define and give examples of confounding and effect measure modification (EMM) • Describe methods for assessing confounding and EEM SPH 597 [Fall 2016] Course Syllabus

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Required Readings: • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapter 10, 11 and 13 Recommended Readings (NOT REQUIRED): • Sackett DL. Bias in analytic research. J Chronic Dis 1979;32:51-63. http://jameslindlibrary.org/wpdata/uploads/2014/06/Sackett-1979-whole-article.pdf. • Delgado-Rodriguez M. Llorca J. Bias. J Epidemiol Community Health 2004;58:635–641

WEEK 10. November 7, 2016 No Class – Reading Week

WEEK 11: November 14, 2016 Epidemiology in Practice Surveillance and screening in public health Instructor: Dr. Maria B. Ospina Learning Objectives: By the end of this week you should be able to: • Define public health surveillance, purposes and types. • Differentiate screening test, diagnostic test and screening program. • Define primary, secondary and tertiary prevention. • List the characteristics of diseases appropriate for screening. • Define and calculate sensitivity, specificity, positive and negative predictive values. • Describe the outcome measures for evaluating the effectiveness of a screening program Required Readings: • Aschengrau A; Seage GR. Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers; 2013. Chapter 16. • Declich S, Carter AO. Public health surveillance: historical origins, methods and evaluation. Bull World Health Organ. 1994; 72(2): 285–304. Recommended Readings (NOT REQUIRED): • Andermann Ann, Blancquaert I, Beuchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ. 2008; 86(4): 317–9. • Harris R, Sawaya GF, Moyer VA, Calonge N. Reconsidering the Criteria for Evaluating Proposed Screening Programs: Reflections From 4 Current and Former Members of the U.S. Preventive Services Task Force. Epidemiol Rev 2011; 33(1): 20-35. WEEK 12: November 21, 2016 Epidemiology in Practice Outbreak & Cluster Investigations Instructor: Amy Colquhoun Learning Objectives: SPH 597 [Fall 2016] Course Syllabus

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By the end of this week you should be able to: • Define and understand the key terms used in outbreak investigations • Describe why outbreaks are important to investigate • Understand the main steps involved in cluster investigations • Describe the key analytic and communication considerations when conducting cluster investigations Required Readings: •

Gerstman BB. Epidemiology Kept Simple: Introduction to Traditional and Modern Epidemiology (3rd Edition). Oxford: John Wiley & Sons; 2013. Chapter 12.

Recommended Readings (NOT REQUIRED): • •

Reingold AR. Outbreak investigations: a perspective. Emerging Infectious Diseases 1998;4(1):21-7. Palmer SR. Epidemiology in search of infectious diseases: methods in outbreak investigation. J Epidemiol Community Health 1989;43(4):311-4.

Examples: Cluster Investigation Guidelines/Fact Sheets • Alberta Health Services. Guidelines for the Investigation of Clusters of Non-Communicable Health Events. Edmonton: Alberta Health Services; 2011. Available at: http://www.health.alberta.ca/documents/Investigation-Clusters-Guidelines-2011.pdf • National Cancer Institute: http://www.cancer.gov/about-cancer/causesprevention/risk/substances/cancer-clusters-fact-sheet • Field Epidemiology pamphlet (University of North Carolina): http://nciph.sph.unc.edu/focus/vol5/issue4/5-4ClusterInvestigations_issue.pdf Related Articles (for more information/interest) • Aldrich T, Sinks T. Things to know and do about cancer clusters. Cancer Invest 2002; 20:810–816. • Colquhoun A, Jiang Z, Maiangowi G, et al. An investigation of cancer incidence in a First Nations community in Alberta, Canada, 1995-2006. Chronic Dis Can 2010;30(4):137-42. • Elliott P, Wakefield J. Disease clusters: should they be investigated, and, if so, when and how? JR Stat Soc A 2001;164:3-12. • Goodman M, LaKind JS, Fagliano JA, et al. Cancer cluster investigations: review of the past and proposals for the future. Int J Environ Res Public Health 2014; 11:1479-99. • Thun MJ, Sinks T. Understanding cancer clusters. Ca-A Cancer J. Clin. 2004, 54, 273–280. • Wartenberg D, Greenberg M. Solving the cluster puzzle: Clues to follow and pitfalls to avoid. Stat Med 1993;12:1763–70. WEEK 13. November 28, 2016 Small Group Project Presentations WEEK 14. December 5, 2016 Final Exam

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Schedule at a Glance Topic

--Maria Ospina -Aschengrau (Ch 1, 15)

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Important Dates and Deadlines -----

Tania Bubela, Maria Ospina -Koepsell (Ch 6, 7) -Lucyk 2015

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Maria Ospina -Gertsman 2013 (Ch 3)

Assignment 1

Email Maria topic of SmallGroup Project

Maria Ospina -Aschengrau (Ch 6) -du Prel 2009

In-class Quiz 1

Mid-Point Course Evaluation

Instructor(s)/ Main reading

Week

Date

1 2

Sep 5 Sep 12

3

Sep 19

4

Sep 26

5

Oct 3

6

Oct 10

No Class - Thanksgiving

7

Oct 17

Epidemiological study designs -Observational Studies II: Case-control studies and Cohort studies

Susan Armijo-Olivo -Aschengrau (Ch 8,9)

In-class Quiz 2

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8

Oct 24

Epidemiological study designs -Experimental studies

CristinaVilla-Roel -Aschengrau (Ch 7)

In-class Quiz 3

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9

Oct 31

-Chance vs. Bias -Confounding vs. Effect modification

Assignment 2

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10

Nov 7

Reading Week

Maria Ospina -Aschengrau (Ch 10, 11, 13) ---

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11

Nov 14

Epidemiology in Practice -Surveillance and screening in public health

Maria Ospina -Aschengrau (Ch 16) -Declich 1994

Assignment 3

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12

Nov 21

Epidemiology in Practice -Outbreak investigations

Amy Colquhoun -Gertsman 2013 (Ch 12)

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13

Nov 28

Small Group Project Presentations

Maria Ospina

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Deadline for submission of Small-Group Project ---

14

Dec 5

Final Exam

Maria Ospina

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9:00 – 11 am

No Class – Labor Day Course overview -Understanding Epidemiology -Causation and Causal inferences Finding and using public health data in epidemiology -Descriptive epidemiology (person, place, time) -Sources of epidemiological data -Ethics of data access, electronic health records, privacy and secondary use of data Epidemiological Measures -Incidence and prevalence -Comparing disease frequencies: Relative and absolute measures of effect -Rate adjustment: Direct and indirect standardization Epidemiological study designs -Overview and concepts of critical appraisal of epidemiologic studies -Observational Studies I: Case reports, case series, ecological studies, cross-sectional studies

SPH 597 [Fall 2016] Course Syllabus

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Assignment

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