Principles of Epidemiology for Public Health EPID 600

Principles of Epidemiology for Public Health (EPID 600) Introduction to the course Faculty: Victor J. Schoenbach, Ph. D Lorraine K. Alexander, Ph. D home page Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill www. unc. edu/epid 600/ (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

EPID 600, Principles of Epidemiology Introduction 5

EPID 600 Instructors Faculty Victor Schoenbach (“Vic”) EPID 600(160) classroom since fall 2001 Internet since summer 2002 Lorraine Alexander EPID 600(160) since 1994 (Carl M. Shy) 1/11/2011 Introduction 6

8/15/2007 Introduction 7

John C. Cassel, M. D. 8/15/2007 Introduction 8

“Epidemiology is fundamentally engaged in the broader quest for social justice and equality. ” John C. Cassel, M. D. 5/12/2010 Introduction 9

August, 1973 7/24/2010 Introduction 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? ” 8/15/2007 Introduction 11

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 1/11/2011 Introduction 12

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 Introduction 13

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 Introduction 14

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? 8/15/2007 Introduction 15

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. 8/15/2007 Introduction 16

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 8/15/2007 Introduction 17

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 8/15/2007 Introduction 18

www. lauriegarrett. com 8/15/2007 Introduction 19

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. 8/15/2007 Introduction 20

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. 8/15/2007 Introduction 21

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 Introduction 22

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 Introduction 23

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). 8/15/2007 Introduction 24

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 Introduction 25

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 Introduction 26

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 air-conditioning. Most of original specimens deteriorate through lack of proper handling. 8/15/2007 Introduction 27

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 Introduction 28

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 Introduction 29

About EPID 600 Cooperative learning model designed by Carl M. Shy in 1990 s - structured learning tasks where students • apply concepts and methods • exercise critical judgment • confront complexities of real life Small group with TA consultant Resources 1/11/2011 Introduction 30

Learning resources • Lectures – live, recorded, Powerpoint slides with verbatim speaker notes, and audio tutorials (web searchable) • Textbook (see www. unc. edu/epid 600/ for information) • Case studies, approximately weekly 1/11/2011 Introduction 31

Learning resources – con’t • Course websites (just Google “EPID 600”): • http: //blackboard. unc. edu – announcements, all materials organized by course module, and links to everything • http: //www. unc. edu/epid 600/ – 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 Introduction 32

Finding information • Search the net – open or targeted, e. g. predictive value site: epidemiolog. net/epid 160/lectures • www. epidemiolog. net: Understanding the fundamentals of epidemiology – an evolving text (includes problems and answers), old EPID 168 exercises, examinations, spreadsheets, more … 1/11/2011 Introduction 33

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 Introduction 34

Course schedule 1/11/2011 Introduction 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 Introduction 36

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 Introduction 37

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 Introduction 38

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 1/11/2011 Introduction 39

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 EPID 600 implies full observance of the Honor Code 8/15/2007 Introduction 40

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 Introduction 41

What students say about EPID 600 “EPID 600 was an excellent overview of the methods. ” “Epi was great, and Bios was also good” “EPID 600 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 Introduction 42

What students say about EPID 600 “. . . Extremely difficult to follow due to the cluttered and disorganized nature of the course website (there was a Black. Board 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 Introduction 43

What students say about EPID 600 “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 Introduction 44

What students say about EPID 600 “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 Introduction 45

Thank you Xie xie ni Gracias, grazie Spacibo Naishitz Gàn xìe Hvala Cám o*n 2/21/2011 Introduction Asante Dhanyawad Merci, Danke Arigato, Shohkrahn Multu^mesc Ngiyabonga Kamsa hamnida 46