EPIDEMIOLOGY 1

Syllabus 2011
COURSE DESCRIPTION
This introduction to epidemiology focuses on measures of disease frequency and
association, observational study designs, and diagnostic and screening tests.
The course reviews the use of these tools and the role of epidemiology in
measuring disease in populations, estimating risks, and influencing public policy.
Study designs reviewed include cross sectional, ecologic, case-control and
cohort studies.

Instructors: Carlos G. Grijalva MD MPH Carlos.Grijalva@vanderbilt.edu
Department of Preventive Medicine, 2622 VAV
Marie R. Griffin MD MPH, Marie.Griffin@vanderbilt.edu
Department of Preventive Medicine, 2634 VAV

Teaching Assistants: William Cooper MD MPH William.cooper@vanderbilt.edu
Rachel Hayes PhD Rachel.M.Hayes@vanderbilt.edu
Adriana Hung, MD MPH Adriana.Hung@vanderbilt.edu

Course administrator: Cindy Naron, Cindy.Naron@vanderbilt.edu ph 343-6338
Department of Preventive Medicine, 2638 VAV

Required book: Epidemiology, 4th edition Leon Gordis, 2008 Elsevier, Inc


Course Requirements Percent of Grade
Class work: bring Gordis book and calculators to
all classes
Attendance
mandatory*
Small group sessions for CDC problems and
articles; each student presents at least once/week
40%
Quizzes 30%
Final exam 30%
* All absences must be discussed with instructors. Missed small group sessions
must be made up and will receive partial credit

COURSE OBJECTIVES
This course will introduce students to the basic concepts and principles of
epidemiology and their applications to public health. Lectures and small group
sessions covering these topics are organized with a particular emphasis (theme)
per week:
WEEK 1: Focus on basic epidemiological concepts, description of
populations (Readings: Gordis, chapters 1-3)
1. Epidemiology: definition and uses of epidemiologic methods
2. Incidence, prevalence, rates and risks
WEEK 2: Focus on Defining Outcomes, overview of study designs
(Readings: Gordis, chapters 4, 6-9)
3. Direct adjustment for age or other population differences
4. Ways of expressing prognosis/survival including life tables and Kaplan
Meier curves
5. Descriptive studies: case series, surveillance, cross sectional, ecologic
studies
6. Prospective versus retrospective studies
7. Introduction to randomized controlled trials
8. Strengths and weaknesses of cohort studies and when to use
WEEK 3: Focus on Defining Exposures, measurements of association
(Readings: Gordis, chapters 10-14)
9. Strengths and weaknesses of case-control studies and when to use
10. Issues in control selection
11. Measures of association: rate and risk ratios, odds ratios, attributable risk
12. Biologic plausibility and causality assessment
13. Effective communication of research results
WEEK 4-5: Focus on Bias, confounding & effect modification (Reading:
Gordis, chapter 15), Diagnostic/Screening Tests & Measurements
(Readings: Gordis, chapters 5, 18) and Genetic Epidemiology (Reading:
Gordis, chapter 16)
14. Information and selection bias
15. Confounding and effect modification
16. Accuracy and reliability: sensitivity, specificity, ROC and AUC
17. Impact of prevalence (prior probability) on the predictive value of tests
18. Characteristics of a good screening test
19. Effects of measurement error: misclassification of population, exposure,
controls, outcomes, covariates
20. Recognizing the roles of genetic and environmental factors in disease
causation

COMPETENCIES ACHIEVED
After completing Epidemiology I, students will be able to demonstrate the
following competencies:
1. Understand the role of epidemiology in public health
2. Calculate and interpret measurements of disease frequency and
measurements of association
3. Recognize the elements of study designs
4. Understand and recognize threats to the validity of observed associations:
Bias, confounding, effect modification and measurement error
5. Calculate and interpret measurements of validity and reliability of
diagnostic and screening tests
6. Interpret study findings within relevant sociocultural contexts
7. Communicate study findings effectively

STUDENT RESPONSIBILITIES
Students are encouraged to read Gordis chapters in preparation for class and
small group sessions. The application of epidemiological concepts is illustrated
reviewing exercises and articles published in high-impact factor journals. Some
materials used for the small group sessions include terms and concepts that may
not have been covered in class yet.
Small group sessions (3 sessions per week)
Each student is assigned to one small group per week. Within the small groups,
students are assigned for at least one presentation per week (either original
research article (including landmark articles) or database review). Students have
full access to audiovisual resources for their presentations.
Tuesday Sessions: (Students only) Students will work with their small group on
the CDC problems. Students should also review articles assignments for the
small group sessions with TAs. Students are expected to be ready to discuss the
exercise and articles with their TAs during next sessions.
Wednesday Sessions: (Students with TAs, CDC and theme of the week
article) All students review theme articles prior to session. Students assigned to
the article are expected to fill out the article template and present to their group.
The first part of the session will be a TA-led discussion of the CDC exercise. The
second part of the session will be the students presentation of the theme article
using the article template.
Friday Sessions: (Students with TAs, theme of the week article, database and
landmark articles) All students review theme article, database and landmark
articles. Assigned students will present on the theme of the week article,
database article, and landmark article. Students use the article and database
templates to guide the presentations.
All students are expected to read all materials provided for the small group
sessions even if they are not responsible for the presentation.
EPIDEMIOLOGY I SCHEDULE
Monday Tuesday Wednesday Thursday Friday
Week 1:
1:00-2:00



2:15-4:00
1
Epidemiology Intro
(L1, CG)

2
Measures of Frequency:
morbidity (L2, MG)
SG Session
(Orientation and
introduction of
templates)
CDC exercise:
Epidemic in South
Carolina

SG Session (TAs)
Rotavirus deaths, NEJ M
2010
Who Counts?, Lancet
2007 (discussion only)
Census
Landmarks:
HIV, NEJ M
HIV, MMWR (discussion
only)
Week 2:
1:00-2:00



2:15-4:00
5
LABOR DAY

HOLIDAY
6
Measures of
Frequency:
mortality (L3, MG)
7
Quiz: Chapters 1-4,
6

8
Randomized
Controlled Trials
(L5,CG)
9
Retrospective Cohort
Studies (L7, CG)

Prognosis (L4, MG,
CG)

SG Session
Students
review/prepare
materials for
sessions with TAs

SG Session (TAs)
CDC Exercise:
Smoking and lung
cancer
Million Women,
Lancet 2007

Review quiz

Prospective
Cohort Studies (L6,
CG)

SG Session (TAs)
Second hand smoking,
Pediatrics 2010
NHANES
Landmark: Framingham
Week 3:
1:00-2:00



2:15-4:00
12
Case Control
Studies (L8,
CG)
13
Measures of
Association: OR,
RR (L9, CG)
14
Estimating
Prevention: AR (L10,
CG)

15
Causal Inference
(L11, MG)

16
Effective communication
(L12, WS)
Quiz, Chapters
7-9

SG Session
Students
review/prepare
materials for
sessions with TAs

SG Session (TAs)
CDC Exercise: Oral
contraceptives and
ovarian cancer
Asthma and IPD,
NEJ M 2005
Review quiz

SG Session (TAs)
Antipsychotics NEJ M
2009
TennCare
Landmark: Adenoca
vagina
Week 4
1:00-2:00



2:15-4:00
19
Bias and
Confounding
(L13, CG)

20
Effect Modification
(L14, CG)

21
Diagnostic Tests
(L15, CG)

22
Screening Tests
(L16, MG)

23
Measurement issues
(L17, CG)

Quiz, Chapters
10-14

SG Session
Students
review/prepare
materials for
sessions with TAs

SG Session (TAs)
CDC Exercise: HIV
screening
Screening, NEJM
2010
Review quiz SG Session (TAs)
Cancer screen, J AMA
2003
BRFSS
Landmark: Breast cancer
screening
Week 5
1:00-2:00



2:15-4:00
26
Satcher lecture
(L18, Michelle
Holmes)
27
Genetic
Epidemiology (L19,
AH)
28
Genetic
Epidemiology (L20,
AH)


29


Review (CG, MG)
30
Final Exam
(Covers entire course)

Quiz, Chapters
5, 15, 16, 18
Review quiz
L, lecture; SG, small groups; CG, Carlos Grijalva; MG, Marie Griffin; WS, WilliamSchaffner; AH, Adriana Hung


Article Article Database Landmark Article Article Database Landmark
Warolin,Joshua Karpinos,Ashley Hinz,Eugena Tique,Jose Young,Jessica Keegan,Kirk Marshall,Andre Hoffman,Joshua
Williams,Sarah Redhage,Leigh Snyder,Rebecca Tolleson,Christopher Curlin,Howard Williams,Candice Gunter,Oliver Jahangir,Eiman
Widmer,Kyle Kappa,Stephen Lotsu,Dzifaa Gowda,Meghana Oetgens,Mathew
Dove,Dwayne
Wednesday Wednesday
Article Article Database Landmark Article Article Database Landmark
Keegan,Kirk Jahangir,Eiman Young,Jessica Marshall,Andre Karpinos,Ashley Tolleson,Christopher Warolin,Joshua Williams,Sarah
Kappa,Stephen Curlin,Howard Gowda,Meghana Williams,Candice Hinz,Eugena Widmer,Kyle Dove,Dwayne Redhage,Leigh
Hoffman,Joshua Oetgens,Mathew Gunter,Oliver Tique,Jose Lotsu,Dzifaa Snyder,Rebecca
Wednesday Wednesday
Article Article Database Landmark Article Article Database Landmark
Snyder,Rebecca Williams,Sarah Karpinos,Ashley Warolin,Joshua Gunter,Oliver Marshall,Andre Keegan,Kirk Young,Jessica
Lotsu,Dzifaa Tique,Jose Tolleson,Christopher Hinz,Eugena Oetgens,Mathew Hoffman,Joshua Jahangir,Eiman Curlin,Howard
Redhage,Leigh Dove,Dwayne Widmer,Kyle Williams,Candice Gowda,Meghana
Kappa,Stephen
Wednesday Wednesday
Article Article Database Landmark Article Article Database Landmark
Jahangir,Eiman Young,Jessica Hoffman,Joshua Gowda,Meghana Tolleson,Christopher Warolin,Joshua Tique,Jose Dove,Dwayne
Kappa,Stephen Williams,Candice Curlin,Howard Keegan,Kirk Hinz,Eugena Redhage,Leigh Widmer,Kyle Karpinos,Ashley
Marshall,Andre Gunter,Oliver Oetgens,Mathew Williams,Sarah Snyder,Rebecca Lotsu,Dzifaa
Small Group Assignments
ClassroomA:Cooper ClassroomB:Hayes
ClassroomA:Hayes ClassroomB:Cooper
Friday Friday
Friday Friday
First
week
Second
week
Friday Friday
Friday Friday
Third
week
Fourth
week