Epidemiology for the Health Communicator
MET CM 751

Overview: The purpose of this course is to introduce the basic principles and methods of epidemiology and demonstrate their applicability in the field of public health. A further objective is to provide an introduction to the basic skills needed to critically interpret the epidemiologic literature relevant to public health professionals. (4 cr.)

The overall goals of this course are to:
•    Introduce the basic principles and methods of epidemiology and demonstrate their applicability to public health and medicine.
•    Enable you develop the skills to understand medical and public health journal articles and to identify potential threats to the validity of their conclusions.
•    Enable you to interpret and communicate the results of medical and public health studies for the general public.

Course Description: Epidemiology is a methodology that enables public health professionals to identify the determinants of health, disease, and injury in human populations and provides a means of assessing the magnitude of public health problems and the success of interventions designed to control them. Results of epidemiologic investigations provide the basis for decisions and recommendations about personal behavior, medical screening and treatment, and health policy recommendations. Consequently, these studies are vital, but epidemiologists also recognize that the validity of such studies can be undermined by bias, by random variation (chance), and by other factors that can distort the associations being tested.

Careers in virtually all aspects of health communication require an understanding of epidemiologic methods, concepts, and terminology. In addition, they also require an understanding of the limitations and potential pitfalls in epidemiologic studies. This course will introduce you to the basic principles and methods of epidemiology and provide a clear understanding of their limitations.

Specific Learning Objectives: Each section of the course reader begins with a list of specific learning objectives that emphasize the mastery of concepts and skills necessary to achieving the goals and enabling you to function as a public health professional.

Sample Course Assignments

Week #1 - Discussions
Assignment #1 Introduce Yourselves

Create a message to introduce yourself to your fellow students and instructor. Write a brief paragraph or two telling about your educational and professional background, your interests, and your expectations for this course.

Assignment #2 Smoking in the United States

The Weekly Mortality and Morbidity Report (MMWR) published by CDC. This widely read publication provides summaries of studies ranging from outbreak investigations to surveys of current behaviors.
Please read The Weekly Mortality and Morbidity Report from the CDC article entitled “Cigarette smoking among adults – United States 2007” (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a2.htm).
Read this brief report and consider its purpose. Summarize and discuss your conclusions regarding its purpose, its conclusions, and its importance briefly (<250 words). In your remarks consider the following points:

• What was the purpose of conducting, analyzing and publishing this information?
• Were the author’s trying to establish any associations, e.g. that smoking causes heart disease or cancer? Were they trying to compare methods of smoking cessation?
• Of what potential importance is this information to public health specialists? Or the media? Or the general public? Or other organizations with an interest in smoking related diseases?
• What type of study is this, i.e. how would it be classified among the study types presented in the course?

Assignment #3 Pneumocystis Pneumonia

Los Angeles (Reported by MS Gottlieb, MD, HM Schanker, MD, PT Fan, MD, A Saxon, MD, JD Weisman, DO, Div of Clinical Immunology-Allergy, Dept of Medicine, UCLA School of Medicine; I Pozalski, MD, Cedars-Mt. Sinai Hospital, Los Angeles; Field Services Div, Epidemiology Program Office, CDC).

On June 4, 1981, MMWR published a report about Pneumocystis carinii pneumonia in five young men, all of whom were sexual active homosexuals. Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients, such as individuals with cancer who are being treated with chemotherapy. However, from October 1980-May 1981 five previously healthy young men were treated for Pneumocystis pneumonia at 3 different hospitals in Los Angeles, California. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. All 5 also had evidence of current or previous infection with cytomegalovirus, or CMV. In addition, all five reported using inhalant drugs, and 1 reported parenteral [injection] drug abuse. This was the first published report of what, a year later, became known as acquired immunodeficiency syndrome (AIDS).

Briefly, (<250 words) comment on the potential importance and impact of this study. Then discuss with your peers.

• What conclusions would you draw from this report? Of what potential importance is this information to public health specialists? Or the media? Or the general public?
• What type of study is this, i.e. how would it be classified among the study types presented in the course?
• What hypotheses (explanations) do you supposed were discussed based on the information given in the brief summary presented here?
• What were the limitations of this study?

Week #2 - Discussions
Assignment #4 Disease Frequency

Hypothetically, suppose that the mayor of your town was startled to learn that there are three people who were recently diagnosed as HIV+ in his neighborhood. He is concerned that this may just be the tip of the iceberg, and he is wondering if this signals an epidemic. He wants your help in assessing the magnitude of the HIV problem in your town, and he wants to determine how your town compares to surrounding towns. Your goal is not to figure out the cause of the HIV cases; instead just focus on how you would assess the magnitude of the problem.

Write a short summary (250-300 words) outlining what information (data) you need in order to assess the magnitude of the problem and how you would express the results? Then discuss with your peers.

Week #3 - Discussions
Assignment #5 Perneger’s Conclusions

Read excerpts from “Risk of Kidney Failure Associated with the Use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs” by Perneger, et al.. Examine the methods and results carefully. Then write a succinct paragraph (<250 words) indicating what the authors’ conclusions are and whether you think the conclusions are valid. Provide justification for your answer.

Week #4 - Discussion
Assignment #6 Statins in the Water Supply?

Ridker RM, et al., “Rosuvastatin to Prevent Vascular Events in Men and Women
with Elevated C-Reactive Protein.” New England Journal of Medicine. 2008:359:2195-207 (Nov. 20, 2008).

People with elevated cholesterol levels have an increased risk of developing heart disease, and people with elevated C-reactive protein (a marker of chronic inflammation) also have increased risk of heart disease. Drugs that lower cholesterol levels in blood (e.g. statins) have been shown to reduce the risk of heart disease in people with elevated cholesterol levels. A study in the New England Journal of Medicine (Ridker et al. Nov. 20, 2008) reported on the effects of a statin drug versus placebo in people who had elevated C-reactive protein levels, but normal LDL cholesterol levels and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.

The rates of the primary end point were 0.77 per 100 person-years of follow-up in the statin-treated group and 1.36 per 100 person-years of follow-up in the placebo group. So the rate ratio was 0.57.

One other relevant fact that isn’t mentioned is that the cost of Rosuvastatin therapy is $3.45 per day.

Read the abstract for this article and examine the results in Table 3. Then provide your viewpoints on this study focusing on the following points:

1. Were the conclusions valid?
2. Should these findings prompt changes in medical practice? Should physicians begin measuring C-reactive proteins in all patients routinely? If C-reactive protein is found to be elevated, should a patient with normal LDL be prescribed Rosuvastatin?
3. How would you weigh the costs and benefits of Rosuvastatin in patients like these?

How should this be reported in the lay press?

Week #5 - Discussion
Assignment #7 Bias Discussion

Read excerpts from “Risk of Kidney Failure Associated with the Use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs” by Perneger, et al. (note that these are the same excerpts seen in an earlier discussion topic). Could bias have affected this study? Write a succinct paragraph (<250 words) indicating whether the specific types of bias discussed in the course could have affected these results and conclusions.

Week #6 - Discussions
Assignment #8 Validation of a Study

Write a short (<250 words) critique of the paper by Ridker et al. “A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women” (New England Journal of Medicine 2005;352:1293-304). In your critique state whether you think the conclusions are valid, and discuss whether you believe the authors adequate addressed the issues of chance, bias, and confounding. Your postings (and further discussions) should incorporate the concepts and terminology introduced in the course.

Week #7 - Discussion
Assignment #9 TV and Autism

Read the Time magazine article—”Does Watching TV Cause Autism?” (October 20, 2006), and write a brief summary (250-300 words) of your assessment of whether TV is a cause of autism. Specifically discuss the potential flaws in this conclusion.

Assignment #10 Communicating Medical News
Read the Perspective article by Susan Dentzer entitled, “Communicating Medical News—Pitfalls of Health Care Journalism” from the Jan. 1, 2009 issue of New England Journal of Medicine. Discuss your views on this topic, commenting specifically on the extent to which you agree or disagree with the author.