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The University of Vermont BASIC INFORMATION Course title: Instructor: Contact info: Online office hours: WELCOME TO EPIDEMIOLOGY

1 Here is a great definition of Epidemiology from the Centers for Disease Control and Prevention (CDC): "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems." A look at the key words will help illuminate the meaning: StudyEpidemiology is the basic science of public health. It's a highly quantitative discipline based on principles of statistics and research methodologies. DistributionEpidemiologists study the distribution of frequencies and patterns of health events within groups in a population. To do this, they use descriptive epidemiology, which characterizes health events in terms of time, place, and person. DeterminantsEpidemiologists also attempt to search for causes or factors that are associated with increased risk or probability of disease. This type of epidemiology, where we move from questions of "who," "what," "where," and "when" and start trying to answer "how" and "why," is referred to as analytical epidemiology. Health-related statesAlthough infectious diseases were clearly the focus of much of the early epidemiological work, this is no longer true. Epidemiology as it is practiced today is applied to the whole spectrum of health-related events, which includes chronic disease, environmental problems, behavioral problems, and injuries in addition to infectious disease. PopulationsOne of the most important distinguishing characteristics of epidemiology is that it deals with groups of people rather than with individual patients. ControlFinally, although epidemiology can be used simply as an analytical tool for studying diseases and their determinants, it serves a more active role. Epidemiological data steers public health decision making and aids in developing and evaluating interventions to control and prevent health problems. This is the primary function of applied, or field, epidemiology. See: CDC's EXCITE educational tool: http://www.cdc.gov/excite/classroom/index.htm In this course, you will learn about the concepts mentioned above. You will also learn how to apply the technical methods of epidemiology to the study and control of diseases and other health-related conditions. This is an online course. It is open to graduate, post baccalaureate, continuing education students and professionals. COURSE SUMMARY Epidemiology is the study of disease distribution and health determinant in a given population. It is also a specific way to think about cause and effect. Rarely do we observe a health determinant that is both necessary and sufficient to cause a particular health outcome. Rather, the determinants of disease are often multi-factorial with many of those factors remaining unidentified. Epidemiology methods give us a framework in which we can order complex Epidemiology I (Principles and Methods) Matthew Thomas, PhD, Clinical Instructor, College of Medicine Matthew.C.Thomas@uvm.edu

relationships between health determinants and health outcomes into information that can be used to improve population health. These methods also allow us to estimate how these determinants affect the health of the population, particularly by assigning a value of risk. LEARNING OBJECTIVES Course Learning Objectives 1. Describe populations especially in terms of person, place and time 2. Identify disease transmission models and calculate disease frequency 3. Identify major sources of health data and define the concept of surveillance 4. Identify the strengths and weaknesses of different types of study design 5. Identify the criteria for assessing causality 6. Calculate measures of excess risk and apply them to establishing associations between exposure and disease 7. Calculate the reliability and validity of screening tests 8. Identify confounding factors that inhibit our ability to see an association between exposure and disease 9. Perform and outbreak investigation and analysis 10. Evaluate health policy using epidemiology methods PREREQUISITE KNOWLEDGE AND COMPETENCIES Undergraduate level MATH course TEXTS Required text - Koepsell TD, Weiss NS. Epidemiologic methods: studying the occurrence of illness. New York, NY: Oxford University Press, 2003. On Reserve at Bailey/Howe with a loan period of 24 hours Available for purchase at the UVM bookstore Optional text - Gordis L. Epidemiology 4th ed. Philadelphia: Elsevier/Saunders, 2009. On Reserve at Dana as a 2 hour loan period Available for purchase at the UVM bookstore BEHAVIORAL EXPECTATIONS All electronic interactions (e-mail, chats, discussion forums, etc.) are an extension of the classroom and should be treated as such. Class members may disagree with one another on various topics discussed online. That is completely acceptable; disagreement and critique promote learning. Please take care to distinguish academic criticism from personal attacks. If you are offering criticism do not frame your remarks in ways that are demeaning to others. Similarly, try not to be defensive if your idea receives criticism in a way that is not a personal attack. SCHEDULE Module 1: Populations/ Person, Place, Time Upon viewing the lecture slides and reading the required materials, the student will be able to: identify the defining characteristics of the following concepts (1) defined populations, (2) undefined populations, (3) population-at-risk, (4) closed populations, (5) open populations; use demographic characteristics and geographic differences to assess variability of disease; apply the concepts of age, period and birth cohort

effects when describing variability in disease Module 2: Disease Transmission and Frequency Upon viewing the lecture slides and reading the required materials, the student will be able to: formulate a case definition; identify the defining characteristics of the following concepts (1) disease states, (2) disease events, (3) risk and susceptibility; define and calculate (1) prevalence, (2) cumulative Incidence, (3) incidence rate, (4) mortality, (5) case fatality, (6) proportional mortality, (7) period prevalence Module 3: Surveillance and Sources of Data Upon viewing the lecture slides and reading the required materials, the student will be able to: identify the basic components of surveillance; define and identify examples of active and passive surveillance; define numerator and denominator data; identify the strengths and weaknesses of major sources of data Module 4: Study Design Upon viewing the lecture slides and reading the required materials, the student will be able to: define, identify examples and list the strengths and weaknesses of (1) descriptive and analytic study designs; (2) randomized and non-randomized study designs; (3) cohort, case-control, cross-sectional, and longitudinal study designs Module 5: Causality Upon viewing the lecture slides and reading the required materials, the student will be able to: enumerate Hill's criteria for causation, identify the common misconceptions about the nature of the causes of illness and injury Module 6: Excess Risk Upon viewing the lecture slides and reading the required materials, the student will be able to: define and calculate (1) relative risk; (2) risk difference; (3) attributable risk percent; (4) population attributable risk; (5) population attributable risk percent; (5) odds ratio Module 7: Measurement Error and Screening Upon viewing the lecture slides and reading the required materials, the student will be able to: Upon viewing the lecture slides and reading the required materials, the student will be able to: define the concepts of reliability and validity; define and calculate: (1) concordance; (2) sensitivity and specificity; (3) positive and negative predictive value; define the concepts and identify the drawbacks of non-differential and differential misclassification Module 8: Confounding Upon viewing the lecture slides and reading the required materials, the student will be able to: define confounding and explain how it affects estimates of prevalence, incidence and excess risk; calculate risk and excess risk measures that are adjusted for confounding variables Module 9: Bias

Upon viewing the lecture slides and reading the required materials, the student will be able to: define and identify sources of bias Module 10: Outbreak Upon viewing the lecture slides and reading the required materials, the student will be able to: define an outbreak and the relationship between surveillance and outbreak investigations, identify the basic steps to an outbreak investigation and create an epidemic curve Module 11: Policy Upon viewing the lecture slides and reading the required materials, the student will be able to: identify the strengths and weaknesses of shaping health policy in the context of different study designs; use epidemiology methods to evaluate health policy ASSIGNMENTS Problem sets Written answers are required for the problem sets. The problems sets can be found at the end of a module and are to be submitted on Blackboard. Working together on problem sets using the Discussion boars for homework problems forum in the Discussion Board is encouraged. However, once the discussion is over, each individual is expected to compose and turn in his or her own answers to the problem sets. Submitted answers for a problem set that are not the student's own work will be considered plagiarism, and may result in no credit for that problem set. Other students prefer to work independently, which is also fine. Use of the discussion board is entirely up to you. In general, answers that are submitted on time, represent the student's own work, and reflect a good-faith effort to grapple with the issues will receive full credit. This policy is an attempt to reward hard work and to discourage fixation on the number of points earned. However, a thoughtful response that is given full credit may not necessarily be correct. You should always try to reconcile what you wrote with what is discussed in lecture, with the "official" answers (to be posted on the course website one week after the due date), and with any instructor feedback on your own answers. Late homework will only be accepted if prior arrangement has been made with the instructor. If you will be unable to turn in answers to a problem set on time, you should make arrangements with the instructor about how to turn them in without incurring a late penalty. A late homework is due no later than one week past the original due date. TECHNICAL HELP RESOURCES To get technical help using Blackboard, click on the Help Tab found at the top of every Bb page. Also, make sure you are using a supported browser. LEARNER SUPPORT Here are some websites that you may find useful. You are not required to use any of these sites for any of the coursework. UVM Dana Medical Library: http://library.uvm.edu/dana/ University of Pittsburgh Supercourse: http://www.pitt.edu/~super1/

VALUES AND POLICIES Inclusiveness Student learning accommodations statement In keeping with University policy, any student with a documented disability interested in utilizing accommodations should contact ACCESS, the office of Disability Services on campus. ACCESS works with students to create reasonable and appropriate accommodations via an accommodation letter to their professors as early as possible each semester. Contact ACCESS: A170 Living/Learning Center - 802-656-7753 - access@uvm.edu. ACCESS Office http://www.uvm.edu/~access/ Policy on Disability Certification and SupportStudents http://www.uvm.edu/~uvmppg/ppg/student/disability.pdf Student responsibilities and rights: Code of Academic Integrity This policy addresses plagiarism, fabrication, collusion, and cheating. http://www.uvm.edu/~uvmppg/ppg/student/acadintegrity.pdf Grading policies For information on grading and GPA calculation, go to http://www.uvm.edu/academics/catalogue and click on "Policies and General Information" for an A-Z listing, and select "G" for grading. Policy on Grade Appeals http://www.uvm.edu/~uvmppg/ppg/student/gradeappeals.pdf Policy on FERPA Rights Disclosure The purpose of this policy is to communicate the rights of students regarding access to, and privacy of their student educational records as provided for in the Family Educational Rights and Privacy Act (FERPA) of 1974. http://www.uvm.edu/~uvmppg/ppg/student/ferpa.pdf