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Day 5. Teach Epidemiology. Professional Development Workshop. Centers for Disease Control and Prevention Global Health Odyssey Museum Tom Harkin Global Communications Center June 8-12, 2009. Teach Epidemiology. Teach Epidemiology.

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slide1

Day

5

Teach Epidemiology

Professional Development Workshop

Centers for Disease Control and PreventionGlobal Health Odyssey MuseumTom Harkin Global Communications Center June 8-12, 2009

slide2

Teach Epidemiology

Teach Epidemiology

slide3

Teach Epidemiology

Welcome to

Web Sites

Teach Epidemiology

slide4

Teach Epidemiology

Teach Epidemiology

Teach Epidemiology

slide5

Teach Epidemiology

Welcome to

Teach Epidemiology

Teach Epidemiology

slide6

Time Check

9:15 AM

slide7

Teach Epidemiology

Teach Epidemiology

slide8

Teaching Epidemiology

Group 5

Teach Epidemiology

slide9

Teach Epidemiology

9

Teach Epidemiology

slide12

Association

Cause

X

Mark

Empty Beer Bottles

Cause

Scenario 1- Guilt By Association

Not Observed

Wendy

Observed

slide13

Definition

Confounding

A situation in which an association between a given exposure and an outcome is observed as a result of the influence of a third unobserved factor, called a confounder.

slide14

Review

Confounding

A situation in which an association between a given exposure (Mark) and an outcome (empty bottles) is observed as a result of the influence of a third unobserved factor, called a confounder (Wendy)

Obviously we should have spoken to Wendy.

slide15

Association

Cause

X

Cause

Lung Cancer

Match-Carrying

Review - Diagram of Confounding

Confounder

Not Observed

Smoking

Observed

slide17

Association

Cause

X

Cause

Coffee

Cancer

1

Confounding

Confounder

Not Observed

Observed

slide18

Association

Cause

X

Cause

Low Birth Weight Babies

Drinking Alcohol during Pregnancy

2

Confounding

Confounder

Not Observed

Observed

slide19

Association

Cause

X

Cause

Eating Pretzels

Auto Accidents

3

Confounding

Confounder

Not Observed

Observed

slide20

Association

Cause

X

Cause

Watching TV

Acne

4

Confounding

Confounder

Not Observed

Observed

slide21

Association

Cause

X

Cause

Playing Volleyball

Skin Cancer

5

Confounding

Confounder

Not Observed

Observed

slide22

Association

Cause

X

Cause

Driving Motorcycles

Hepatitis C

6

Confounding

Confounder

Not Observed

Observed

slide23

Association

Cause

X

Cause

Playing Baseball

Oral Cancer

7

Confounding

Confounder

Not Observed

Observed

slide24

Association

Cause

X

Cause

Skin Cancer

Sand

8

Confounding

Confounder

Not Observed

Observed

slide25

Association

Cause

X

Cause

Eating Ice Cream

Drowning

9

Confounding

Confounder

Not Observed

Observed

slide27

Had Bedsores

9%

824

79

745

No Bedsores

3%

8,576

8,290

286

Scenario

Died

Not Died

Total

Risks

Relative Risk

a

b

X 3

c

d

90

Individuals with bedsores are 3 times more likely to die than those without bedsores.

slide28

Cause

Scenario 2

“If we can keep our patients from getting bedsores, then we can go a long way towards preventing hospital deaths.”

“The study establishes a clear progression beginning with patients getting bed sores and ending with death.”

Getting bedsores

Death

slide29

Confounding

Is cause the only possible association between the two?

1.

Cause

2.

Chance

3.

Bias

4.

Reverse Time Order

5.

Confounding

slide30

Association

Cause

X

Bedsores

Deaths

Cause

Scenario 2

Not Observed

?

Observed

slide31

Not Observed

Not Observed

Wendy

?

Association

Association

Cause

Cause

Observed

Observed

X

X

Bedsores

Mark

Broken Beer Bottles

Death

Cause

Cause

Scenarios

Scenario 1

Scenario 2

slide32

Association

Cause

X

Bedsores

Death

Cause

Scenario 2

Confounder

Not Observed

?

Observed

slide33

Association

Cause

X

Bedsores

Death

Cause

Scenario 2

Brainstorm

Not Observed

?

Severity of Medical Condition

Observed

slide34

Definition

Stratification

A procedure which creates strata based on categories of the suspected confounding variable and examines the exposure-disease association within each stratum (subgroups).

slide36

Had Bedsores

51.9%

106

55

51

No Bedsores

50.0%

19

5

5

Scenario 2 Stratified

Patients with

High Medical Severity

Died

Not Died

Total

Risks

Relative Risk

a

b

x1

c

d

90

There is no association!!

slide37

Had Bedsores

3.3%

718

24

694

No Bedsores

3.3%

8,566

281

8,285

Scenario 2 Stratified

Patients with

Low Medical Severity

Died

Not Died

Total

Risks

Relative Risk

a

b

x1

c

d

90

There is no association!!

slide38

High Severity

51.7%

116

60

56

Low Severity

3.2%

9,284

305

8,979

Scenario 2 Adjusted

All Patients Based on Severity of Illness ONLY

Died

Not Died

Total

Risks

Relative Risk

a

b

x16

c

d

90

The high relative risk show that severity of illness is a CONFOUNDER.

slide39

Scenario 2

Summary – Relative Risk of Death

slide42

Confounding

Is the association due to confounding?

1.

Cause

2.

Chance

Bias

3.

4.

Reverse Time Order

Confounding

5.

slide44

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

Teach Epidemiology

slide45

Time Check

10:00 AM

slide46

Teach Epidemiology

Teach Epidemiology

slide47

Teaching Epidemiology

Group 6

Teach Epidemiology

types of bias

TYPES OF BIAS

Using the definitions of the types of bias given, match the following phrases with the appropriate bias.

name the bias
Name the Bias
  • epidemiologist asks specific questions to case

Information Bias

name the bias1
Name the Bias
  • better memory recall

Recall Bias

name the bias2
Name the Bias
  • Heightened knowledge of risk

Awareness Bias

name the bias3
Name the Bias
  • spends more time on case

Information Bias

name the bias4
Name the Bias

error in sampling process

Selection Bias

name the bias5
Name the Bias
  • time lapse

Recall Bias

name the bias6
Name the Bias
  • Publicity

Awareness Bias

name the bias7
Name the Bias
  • less recall

Recall Bias

name the bias8
Name the Bias
  • Magazines

Awareness Bias

name the bias9
Name the Bias
  • Memory

Recall Bias

name the bias10
Name the Bias
  • Higher focus on past behaviors

Recall Bias

name the bias11
Name the Bias
  • more than one disease present

Berkson’s Bias

name the bias12
Name the Bias
  • fabrication of information

Recall Bias

name the bias13
Name the Bias
  • probes for more with case

Information Bias

name the bias14
Name the Bias
  • unbalanced in comparison to target population

Berkson’s Bias

name the bias15
Name the Bias
  • Social stigma

Recall Bias

name the bias16
Name the Bias
  • hospital admission

Berkson’s Bias

name the bias17
Name the Bias
  • media

Awareness Bias

slide67

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

Teach Epidemiology

slide68

Time Check

10:45 AM

slide69

Teach Epidemiology

Teach Epidemiology

slide70

Teaching Epidemiology

Group 7

Teach Epidemiology

slide92

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

Teach Epidemiology

slide93

Time Check

11:30 AM

slide95

Teach Epidemiology

95

Teach Epidemiology

slide96

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

96

Teach Epidemiology

slide98

Identifying Patterns and Formulating Hypotheses

John Snow, MD

(1813-1858)

Father of Epidemiology

“On the Mode and Transmission of Cholera”

98

slide100

Identifying Patterns and Formulating Hypotheses

A Mysterious Ailment

By Jerry Bishop, Staff Reporter of the Wall Street Journal

A mysterious, often fatal illness is breaking out in epidemic proportions among young homosexual men and drug users. More than 180 cases of the strange illness have been reported since last summer to the federal Center for Disease Control in Atlanta. As of last Friday, at least 74 of the victims have died. All the victims are men and 90% of them are either homosexual or bisexual. Many of the victims are drug users. The illness is characterized by months of fever, malaise, and drastic weight loss. In almost all cases the patients develop overwhelming infections of one or more of a dozen different viruses, bacteria or protozoa. The infecting microbes are types that do not ordinarily cause overt human disease. Many of the patients also develop a rare type of cancer. To the astonishment of medical scientists, most of the patients appear to have recently developed a defect in their immune systems that prevents them from fighting off infections. The infections are extremely difficult to control with antibiotics and antiviral drugs. "We are reasonably confident that this is, in fact, a new medical problem," said Dr. Harold Jaffe, an epidemiologist on a new task force organized by the Center for Disease Control to search for the cause of the illness. In an effort comparable to that launched last year to unravel the mystery of toxic shock syndrome, the center's task force is trying to find out whether a new germ has emerged or whether something in the environment has changed to account for the sudden outbreak of the illness. For example, the task force is checking into the use of sexual stimulants by the victims on the possibility these chemicals can impair the immune system and leave the user vulnerable to infections. Among such stimulants are chemicals that are inhaled. These include amyl nitrate sold in glass vials, known by the street name "poppers" and isobutyl nitrate sold as "liquid incense." First hints that some unusual illness was breaking out came earlier this year when researchers in New York and Los Angeles reported cases of both a rare kind of pneumonia and a rare cancer called Kaposi's sarcoma occurring in a few young men. The men were either homosexual or drug users or both. The disease center alerted doctors and health officials around the country last summer to the strange ailment. This week's New England Journal of Medicine, published today, devotes three articles to describing 19 of the patients, six of whom died. Publishing three lengthy articles on the same illness is unusual for the medical

slide101

Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2006

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

1998

1990

2006

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

101

slide103

Identifying Patterns and Formulating Hypotheses

Answer the Question

Teach Epidemiology

slide104

Identifying Patterns and Formulating Hypotheses

What’s My Hypothesis?

Whistles

104

Teach Epidemiology

slide107

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

107

Teach Epidemiology

slide108

Enduring Epidemiological Understandings

“… they can distinguish between foundational concepts and elaborations or illustrations of those ideas.”

Ken Bain, What the Best College Teachers Do

108

Teach Epidemiology

slide110

110

Teach Epidemiology - 501 (Tuesday) CDC June 2009

slide111

21

62

21

21

6

21

21

90

90

90

90

90

90

90

21%

21%

21%

21%

21%

6%

62%

21

21

21

62

21

21

6

79

79

38

79

79

79

94

100

100

100

100

100

100

100

or

or

or

or

or

or

or

100

100

100

100

100

100

100

Making Group Comparisons and Identifying Associations

Trial 1

Trial 2

Tested Negative for Heroin

Tested Positive for Heroin

Risk of Negative Heroin Test

Tested Negative for Heroin

Tested Positive for Heroin

Risk of Negative Heroin Test

Relative Risk

Total

Total

Bupe

Bupe

1

Nothing

No Bupe

Bupe is not associated with having a negative tests for heroin.

Nothing

Trial 3

Compared to what?

Trial 4

Tested Negative for Heroin

Tested Positive for Heroin

Risk of Negative Heroin Test

Tested Negative for Heroin

Tested Positive for Heroin

Risk of Negative Heroin Test

Relative Risk

Relative Risk

Total

Total

Bupe

Bupe

.34

3.5

No Bupe

No Bupe

Bupe is associated with having a positive test for heroin!

Bupe is associated with having a negative test for heroin.

111

Teach Epidemiology

slide112

Buprenorphine

Buprenorphine & Naloxone

Placebo

Making Group Comparisons and Identifying Associations

112

Teach Epidemiology

slide113

DZ

DZ

E

Controlled Trial

Case-Control Study

DZ

E

Healthy People

DZ

E

DZ

DZ

Random Assignment

Healthy People

Healthy People

DZ

DZ

E

Cohort Study

Cross-Sectional Study

E

-

-

-

-

DZ

E

DZ

Healthy People

DZ

DZ

E

E

E

E

Making Group Comparisons and Identifying Associations

Teach Epidemiology

DrugEpi 3-5 Fundamentals of Study Design

slide115

Making Group Comparisons and Identifying Associations

Test the hypothesis:

People who watch more TV eat more junk food.

Teach Epidemiology

slide118

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

118

Teach Epidemiology

slide119

Enduring Epidemiological Understandings

“… they can distinguish between foundational concepts and elaborations or illustrations of those ideas.”

Ken Bain, What the Best College Teachers Do

119

Teach Epidemiology

slide122

1

By Chance

By Chance

25 cards

25 cards

25 cards

25 cards

Explaining Associations and Judging Causality

Relative Risks

Greater than 1

Less than 1

122

Teach Epidemiology

slide127

Enduring Epidemiological Understandings

Knowledge that “… is connected and organized, and … ‘conditionalized’ to specify the context in which it is applicable.”

National Research Council , Learning and Understanding

127

Teach Epidemiology

slide128

Enduring Epidemiological Understandings

“… they can distinguish between foundational concepts and elaborations or illustrations of those ideas.”

Ken Bain, What the Best College Teachers Do

128

Teach Epidemiology

slide130

DZ

E

%

Hypothesis

or

DZ

%

or

Healthy People

Healthy People

DZ

E

-

?

DZ

Risk

Relative Risk

Total

Exposure

Outcome

a b

c d

Turned Up Together

Enduring Epidemiological Understandings

130

Teach Epidemiology

slide132
1.

2.

3.

4.

5.

6.

7.

8.

.

Top 8 Reasons to Teach / Learn about Epidemiology

Empowers students to be scientifically literate participants in the democratic decision-making process concerning public health policy.

Empowers students to make more informed personal health-related decisions.

Increases students’ media literacy and their understanding of public health messages.

Increases students’ understanding of the basis for determining risk.

Improves students’ mathematical and scientific literacy.

Expands students’ understanding of scientific methods and develops their critical thinking skills.

Provides students with another mechanism for exploring important, real world questions about their health and the health of others.

Introduces students to an array of career paths related to the public’s health.

132

Teach Epidemiology

slide133

Workshop Goal

To increase the frequency with which epidemiology is taught to students in grades 6-12

133

Teach Epidemiology

slide134

Workshop Goal

Innovation

… an idea, practice or object that is perceived as new by an individual or other unit of adoption.

Everett M. Rogers, Diffusion of Innovations

Teach Epidemiology

slide135

Workshop Goal

Diffusion

The process by which an innovation is communicated through certain channels over time among the members of a social system (with the aim being to maximize the exposure and reach of innovations, strategies, or programs.)

Everett M. Rogers, Diffusion of Innovations

Teach Epidemiology

slide137

What do you mean - Teach Epidemiology?

Explore Public Health Career Paths

http://www.asph.org/document.cfm?page=1038

137

Teach Epidemiology

slide138

What do you mean - Teach Epidemiology?

Leverage the Young Epidemiology Scholars Competition

http://www.collegeboard.com/yes/

138

Teach Epidemiology

slide139

What do you mean - Teach Epidemiology?

Leverage the Science Olympiad Competition

http://soinc.org/

139

Teach Epidemiology

slide140

What do you mean - Teach Epidemiology?

Show and Discuss Is Epidemiology in Your Future?

http://www.rwjf.org/pr/product.jsp?id=26931#content

140

Teach Epidemiology

slide141

What do you mean - Teach Epidemiology?

Infuse Epidemiology into Existing Lesson about Something Else

141

Teach Epidemiology

slide142

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.collegeboard.com/yes/ft/iu/units.html

142

Teach Epidemiology

slide143

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://ccnmtl.columbia.edu/projects/epiville/

143

Teach Epidemiology

slide144

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.diseasedetectives.org/

144

Teach Epidemiology

slide145

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.cdc.gov/excite/

145

Teach Epidemiology

slide146

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www2a.cdc.gov/epicasestudies/

146

Teach Epidemiology

slide147

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.cdc.gov/excite/ScienceAmbassador/ScienceAmbassador.htm

147

Teach Epidemiology

slide148

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.buffetbusters.ca/

148

Teach Epidemiology

slide149

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.montclair.edu/Detectives/

149

Teach Epidemiology

slide150

What do you mean - Teach Epidemiology?

Teaching Existing Epidemiology Lessons

http://www.montclair.edu/drugepi/

150

Teach Epidemiology

slide151

What do you mean - Teach Epidemiology?

View a News Item from an Epidemiologic Perspective

http://www.nationalacademies.org/headlines/

151

Teach Epidemiology

slide152

What do you mean - Teach Epidemiology?

During the coming school year, participate in an online Teach Epidemiology In the News - Social Network and teach epidemiology.

Teach Epidemiology

slide154

Pre-Workshop Assessment

154

Teach Epidemiology

slide155

Pre-Workshop Assessment

Teach Epidemiology

slide156

Workshop Process Evaluation

Teach Epidemiology

slide157

Day

5

Teach Epidemiology

Professional Development Workshop

Thank You