University of Alberta

Course Guide for SPH 597 Winter 2015 School of Public Heath Fundamentals of Epidemiology for Public Health January 5, 2015 – April 10, 2015

Instructor: Megan Lefebvre, PhD Instructor contact information: Megan Lefebvre: [email protected] Instructor contact: Please contact me by the email listed above; I will get back to you within 72 hours. Teaching Assistant: Emily Hastings, PhD student: [email protected]

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Course Description

This course will be an introduction to epidemiology for Masters of Public Health students and students with little exposure to epidemiology. The goal of the course is to introduce students to epidemiology; how epidemiologists measure and compare disease frequencies and associations in a population, sources of health data, study design, bias, confounding, causation, outbreak investigations, screening, surveillance, combing qualitative methods with epidemiology and using public health policy in epidemiology. An emphasis will be placed on applying the fundamentals of these concepts to public health contexts. Online sessions will integrate public health ethical issues and critical thinking of the literature.

Objectives

The aim of this course is to promote an understanding of epidemiology, its application to improving human health, and to understand how epidemiology works with alternate methods to address public health concerns. A focus will be on critical thinking of public health practice and epidemiologic studies through case studies and communicating public health knowledge to various audiences. Upon completion of this course, students will be able to:  Understand the principles underlying epidemiology  Interpret descriptive epidemiology  Calculate and interpret basic epidemiologic measures of disease frequency and measures of associations  Describe and recognize commonly used epidemiological study designs and identify their inherent strengths and weaknesses  Communicate epidemiological-related knowledge to the appropriate end users (e.g., participants/patients, community organizations, government organizations)  Identify and address ethical issues pertaining to epidemiological and public health-related content  Critique epidemiological peer-reviewed articles  Understand different approaches to research (i.e., quantitative and qualitative methods)  Consider reflexivity (i.e., the process of highly attentive to how and why you make decisions and interpretations)  Understand the contributions of others; giving and receiving feedback constructively, and further 2

    

Competencies

developing your own and other colleagues’ ideas Use creativity and thoroughness in exploration of an issue Promote positive change (by being proactive) Articulate your self-awareness of your own abilities (knowledge and skills, and limitations) Identify and be aware of your own cultural influences, biases, and assumptions (how they shape your understanding and actions) Act ethically (in a manner consistent with your ethical and legal principles)

This course adopts the principles of adult learning theory to improve your learning experience. These principles are:  Guided self-instruction  Small group learning  Peer group learning  Problem-based learning  Short didactic review lectures (these are available on eClass to review before participating in the online discussions) While most “classes” will be structured, the intent is to learn from each other’s experiences. You are encouraged to bring forward resources for the group. This is a very intense course; expect to spend a lot of time outside the “classroom” reading and working on assignments. Accordingly, I expect that students will complete 9-12 hours of self-instruction each week (i.e., reading, writing, reflecting, discussing, and learning on your own time). I recognize, however, that a lot of epidemiological concepts and ways of thinking may be new to some students. I designed this course, therefore, to be “epidemiology intensive” in the first 6 weeks. Then, in the last 6 weeks of the course, you can apply your newly acquired epidemiology skills to public health.

My approach to teaching this course

Graduate school is one of the most exciting times of your lives! Graduate school provides you with an opportunity to think, listen, learn, and grow as much as you can. My 3

approach to graduate teaching and learning uses the engaged scholarship paradigm; there is a mutual respect between all learners (e.g., course facilitators and learners) and bi-directional communication. Moreover, I do not see myself as the “expert” or course instructor, but more as a “facilitator”; I facilitate a space to create and share ideas, to think critically, and to learn. Each individual participating in this course is an expert in his/her own area of interest and, therefore, has a lot of expertise and experience to offer to the class. Finally, this is why I demand full participation in this course. As in life, most things are not black and white, meaning there are few “right answers”. A fundamental skill I hope you learn in graduate school is the ability to think critically, formulate a position on an issue, and respectfully defend your position. It is for this reason why we spend a lot of class time thinking critically, critiquing, and discussing various epidemiologyand public health-informed evidence. As a result, the workload will be demanding! I believe the best way to learn how to critically think is by reading, doing, and teaching others. Learning resources Required textbook

Supplemental resources

Required textbook: Aschengrau, A & Seage, GR (2013). Essentials of Epidemiology in Public Health (3rd edition). Sudbury, Massachusetts: Jones and Bartlett Publishers. Along with the text, everyone is expected to read widely throughout the course. We have listed journals and textbooks which may interest you: Journals: -

Canadian Journal of Epidemiology and Biostatistics; http://www.cjeb.ca/ Canadian Journal of Public Health; http://www.cpha.ca/en/cjph.aspx Epidemiology American Journal of Epidemiology; http://aje.oxfordjournals.org, International Journal of Epidemiology 4

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Journal of Clinical Epidemiology Qualitative Health Research Qualitative Research BMJ – Epidemiology for the uninitiated; http://www.bmj.com/about-bmj/resourcesreaders/publications/epidemiology-uninitiated

Textbooks See eClass, “SPH 597 Textbooks”, for recommended textbooks. 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 1-800207-0172.

Course Evaluation Mid-Point Evaluation:

As with all SPH instructors, I am interested to hear your feedback. If something is not working for you, please let me know asap! You can schedule a one-on-one meeting via eClass, e-mail me, or participate in the anonymous mid-point eClass evaluation. During week 4, I will ask you to anonymously submit your feedback so we can change what is not working (sooner rather than later) for the remainder of the course. Also, I will be asking for your feedback quite a bit during the first few weeks to ensure I have created a learning environment which works for everyone. Please do not hesitate to contact me at any time.

Final Course Evaluation:

Following completion of the course, you will receive a standardized summative evaluation. Course evaluations will be done online by Test 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.

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Student Evaluation Assignment #1: Weekly quiz journal entries

Percentage /

10%

Date Quizzes: Jan 12, 19, 26, Feb 2

#2: Class participation

15%

Journals: Feb 9, March 2, 9, 16, 23 All weeks

#3: Moderating assignment #4 Group Research Project:

20%

Starting week 3 (Jan 12)

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Critical appraisal presentation Critical appraisal paper Public health communiqué

#5 Final examination Evaluation of Course Work

23,

30% Critical appraisal presentation: 10% Critical appraisal paper: 10% Public health communique: 10%

25%

March 30 March 30 March 30

April 8, 2015 (12:00 – 2:30pm MT)

Assessment #1 (10%) – Weekly quiz / journal entry Quiz From weeks 2-5 you will be asked to complete an online short quiz prior to that week. Each quiz will consist of 5-10 questions based on your required readings of that week. For example, for week 2 you are required to read Aschengrau & Seage chapters 2, 3, 4; quiz 1 will be based these readings. To access the quiz, login to eClass, scroll to the appropriate week, click the “Quiz” icon. Here you will see the quiz questions, follow the prompts to submit your responses. The quiz will be available to you on eClass every Monday at 5pm MT prior to the class that it is required. The online quiz will close the following Sunday at 5pm MT. If you do not complete the quiz by Sunday 5pm MT, you will receive a zero for that quiz. There is no time limit to complete each quiz; please take your time, however, you only have 1 attempt to complete the quiz. In other words, you cannot login, compete 6

part of the quiz, exit, and re-attempt/complete your quiz the next day. For this reason, we encourage you to read and review other materials when completing the quiz, and discuss with your colleagues (you can phone a friend!). Journals From week 6, 8-12 you will be asked to complete a short, 1 paragraph (single-spaced, 12 point font, Times New Roman) journal entry prior to class. We will assign a thought provoking question based on the topic of that week. For example, on week 10 we discuss outbreak investigations; the journal entry will be a question around infectious or chronic disease outbreaks investigations. These entries are not meant to be essays but rather your viewpoints of the thought-provoking question. Please draw on your work/life experience to critically think about and answer the journal question. To access the journal question and write your response, login to eClass, scroll to the appropriate week, click the “Journal” icon. Here you will see the journal question, click “start or edit my journal entry”, and when you have finished your journal entry, click “save changes”. The journal submission guidelines are similar to the quiz: The journals will be available to you on eClass every Monday at 5pm MT prior to the class that it is required. The journals will close the following Sunday at 5pm MT (you can login and edit your journal anytime until Sunday at 5pm). If you do not submit your journal entry by Sunday 5pm MT, you will receive a zero. We will grade your journal entries on quality of content (including your ability to critically think/write about the topic of the week and your understanding of the material). Assessment #2 (15%) – Class participation Your participation will help make this course valuable, exciting, and challenging. We expect you to keep up with the course schedule and contribute discussions and activities for the topic each week, as you would attend and participate regularly in a class if you were on campus. Discussion threads will be accessible Monday morning at 7

9:00 am MT and end at Sunday at 5:00 pm MT. Students are expected to contribute thoughtful postings each week to demonstrate understanding of assigned readings and concepts. Please, do not post discussion messages or questions to a week that has passed. Emily, myself, and other students are not expected to go back to previous weeks to read late postings. If you fall behind, just move on and post to the week being discussed. The course will go quickly so be sure to set aside adequate time to keep up with the discussions each week. We will evaluate your participation in the online discussions primarily based on the quality of your contributions to the throughout the course. For example, one or two, well-written, thought provoking, and meaningful posts will earn a higher grade than multiple posts that do not contribute to the discussion and our learning. To earn high participation marks, you must demonstrate:  Consistent participation  Clear, concise communication with your (interdisciplinary) classmates  “Listen” well  An in-depth understanding of readings and ability to apply them to discussion  An ability to synthesize information (rather than simply repeating points from readings)  An understanding of the contributions of others, giving and receiving feedback constructively, and further developing your own and other colleagues’ ideas  Creativity and thoroughness in exploration of an issue  That you can introduce relevant resources that might enrich the class discussion Assessment #3 (20%) – Moderating assignment Each week, 2-3 students will act as the moderator for the week’s discussion. As the moderator, you will be responsible for moderating, leading, and facilitating that week’s discussion. Preparation for this assignment includes:  Reviewing course material prior to your chosen week  Identifying learning objectives, key words, and major themes from the assigned readings  Creating a lesson plan. Your lesson plan should include a summary of the learning objectives, explanations of key concepts and key words, and a plan 8

 

as how you will guide the discussion. For example, you may want to consider 2-3 guiding questions you will ask your discussion group to keep the discussion flowing throughout the week. You can also include points on the kinds of questions your classmates will ask, and how you will respond to your classmates’ posts. The week before your topic, please meet with Megan and Emily to review your lesson plan. By Sunday January 11 5pm MT, please email Megan ([email protected]) the week you would like to moderate.

Assessment #4 – Group Research Project (30%) You will work with your assigned small groups to complete the group research project. Your project will be based on a disease or risk factor of your groups’ choice. Please choose one epidemiological article from the peer-reviewed literature to critique (e.g., a study which used an ecological, crosssectional, case-control, cohort, or experimental study design). The project will consist of 3 parts: Class presentation (10%): Each group must give a 20 minute oral presentation in the format of your choice! (15 minutes for the presentation and 5 minutes for questions). Your group is not limited to using PowerPoint. Please let go wild with creativity! If you think your message will be better communicated using drama, a play, skit, simulation, incorporating video, song, dance, GO FOR IT! Just be sure to think critically and teach us about your article and appraisal. The presentation, however, should focus on the descriptive epidemiology of your group’s disease or risk factor, followed by a summary, and critique of your article. Critical appraisal (10%): Each group must submit 1 short critique of the research paper you chose:  3-pages maximum (single space, 12 point font Times New Roman)  You can use bullet points  Use Chapter 14 (page 365) of Aschengrau & Seage (3rd edition) as a guide for your appraisal. Do not be afraid to challenge the authors with their choice of method, data collection tools, interpretation, and public health significance! Ask yourselves and answer:  What is the situation now? 9

      

What was the situation in the past? What can we do differently to CHANGE the situation and challenge the “dominant” (or the status quo) What are the “hidden” sources of bias? Why do we care about these biases? How do these bias impact the study results? Do you “buy” the researcher’s bottom line? Why / why not? How did the author’s findings appropriately address a public health issue? Or did the authors miss the boat? What would you do differently? Why?

Public health communiqué (10%): Each group must also submit a communique** of the research paper you presented aimed at a lay audience. Focus on what the public needs to know about this disease (or risk factor) and the research presented in the paper. **NOTE: Although some groups may prefer to do a paperbased (1 page) communique, I encourage your group to go wild with creativity and use an arts-based approach! Meaning you and your group can go wild with creativity and use video, collage, photo, play / skit (and videotape), rap, or song to present your communique to a lay audience. The title of your presentation and the research paper your group will critique must be submitted via email to Megan Lefebvre ([email protected]) by March 2, 2015. 



One member of each group please email Megan Lefebvre by March 30, 2015 (by 4pm MT): o Oral presentation file / link o Critical appraisal o Public health communique See “Penalty for Late Assessment” below for our policy on late assessments.

Group presentations are scheduled for Wednesday April 1 @1:00-3:00pm MT Assessment #5 (25%) – Final Examination The final exam will cover the entire course material. The exam will be open-book (i.e., class notes, lecture notes, textbook), however, you are not permitted to use the internet. The final exam must be completed within 2.5 hours. More details about the content will be provided later in the course, however, the format may consist of multiple choice and short answer 10

questions; examples might include:         Penalty for Late Assessment

Interpretation of descriptive epidemiology Identifying various study designs Define a key term or concept How is a key term or concept applied in a public health context? Various epidemiological calculations Causation in epidemiology Describing qualitative inquiry Applying the concepts of an outbreak investigation to a scenario

Starting at the due date/time, for each 24 hours that your assignment is late, your grade for the assignment will be reduced by 20% (unless there is a documented medical reason or family emergency). Twenty-four hours after the due date/time, the mark will be reduced by 40%, and so on.

Identifying a proctor

During the week of class, everyone, except those residing in Edmonton, will need to find a proctor for your final exam. If you live in Edmonton, you will be expected to write your final exam on campus in a location specified closer to the final exam. For those of you who live outside of Edmonton, your proctor needs to have a professional affiliation (e.g. law firm, hospital, school) and a business address to which the exam can be mailed. Please e-mail Megan with your proctor’s contact information (name, affiliation, business address, email address, telephone number) by Sunday January 11, 2015.

Feedback and grading

Feedback I aim to assess and grade your assignments as quickly as possible. As I believe written feedback is essential, I usually provide everyone with individual feedback. If for some reason I am unable to provide immediate feedback, I will notify you. Grading There is no doubt that grades involve a power relationship between students and instructors. Although I try to create a friendly, mature, and “safe” learning environment where we work together to exchange ideas and learn from each other,

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at the end of the day I must assess and assign you the grade you earn in this course. Adapted from the University of Alberta Grading System: Grades reflect judgments of student achievement made by myself. These judgments are based on a combination of absolute achievement and relative performance in this class. I will assign marks (e.g. percentages) throughout the term and then assign a letter grade at the end. 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

Grading in Graduate Courses Letter Grade Grade Point Value A+ 4.0 A 4.0 A3.7 B+ 3.3 B 3.0 B2.7 C+ 2.3 C 2.0 C1.7 D+ 1.3 D 1.0 12

Descriptor

Academic Integrity

Grading in Graduate Courses Letter Grade Grade Point Value 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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Schedule at a Glance Week 1

Date Jan 5-9

Topic Course introduction and overview Overview of Epidemiology Overview of Descriptive Epidemiology

Homework Aschengrau & Seage: Ch 1, 5

eClass Live! Introduction Session Wed Jan 7 @ 1:002:30pm MT By Sunday Jan 11 email Megan with: -

2

Jan 12-16

3

Jan 19-23

4

Jan 26-30

Measures of Disease Frequency: Incidence and Prevalence Comparing Disease Frequencies: Relative and Absolute measures of effect Data sources Overview of epidemiologic study designs Experimental studies

Your final exam proctor information The date and session you would like to moderate (Assignment #3)

Aschengrau & Seage: Ch 2, 3, 4 Quiz 1 Aschengrau & Seage: Ch. 6, 7 Quiz 2 Aschengrau & Seage: Ch 8

Cohort studies

Quiz 3 5

Feb 2-6

Case-control studies

Aschengrau & Seage: Ch 9 Quiz 4

6

Feb 9-13

Bias

7 8

Feb 16-20 Feb 23-27

NO Class: Reading Week Confounding and effect measure modification

9

March 2-6

Causal Inference

eClass Live! Session: Study Designs (date and time TBA)

Aschengrau & Seage: Ch 10 Journal 1

14

Aschengrau & Seage: Ch 11, 12, 13 Journal 2 Aschengrau & Seage:

eClass Live! Session:

Ch 15 Journal 3

Bias, Confounding, EMM and Causal Inference (time and date TBA) Group project titles and research paper due March 2

10

March 913

Outbreak Investigations

11

March 1620

Surveillance and screening in Public Health

Oleckno: pp 279-298 Journal 4 Aschengrau & Seage: Ch 16 Oleckno pp 298-305

12

March 2327

Qualitative Inquiry Investigating vulnerable populations

Journal 5 TBA Journal 6

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March 30 – April 3

Student Presentations

April 8

FINAL EXAMINATION

15

Oral presentation Critique Public Health communique

eClass Live! Session: Review outbreaks, screening, surveillance, and qualitative inquiry (time and data TBA) eClass Live! Session: Group presentations Wednesday April 1 @ 1:00-3:00pm MT 12:00-2:30pm MT