Lectures 24 and 25: Statistics; Making Sense of Uncertainty

After this lecture, you should be able to answer the following:

1. What is "statistics?" What is the role of "statistics" in Public Health?

2. Discuss the uncertainty of science using the example of the NCI's recommendation that women aged 40-49 should have regular mammograms. Do the risks outweigh the benefits?

3. How do scientists quantify uncertainty? What is probability? What is the p value? What is the 'Law of Small Probabilities?' Using this law, explain the phenomenon of 'cancer clusters.'

4. How is it that sometimes a low p-value study leads to erroneous conclusions?

5. What can be said of studies that include many subjects? Are they considered to be more statistically powerful than smaller studies? Should one always remember that systemic error due to bias or confounding can be present in even the largest studies?

6. What are screening tests? What types of screening tests are available for secondary prevention? What is the main difference between the two major types of screening tests? Define the following terms (from the blackboard): i) true positives, ii) false positives, iii) true negatives, iv) false negatives.

7. What is the death rate? The birth rate? The fertility rate? What do these different statistics tell us about the health of the population?

8. What is risk assessment? What is the difference between risk assessment and risk perception?

9. Please read the assigned homework material carefully and answer all the homework questions.

Lectures 21 and 22 and 23: Problems and Limits of Epidemiology

After this lecture, you should be able to answer the following:

1. It is not realistic to expect to succeed at a randomized, double-blind epidemiological study that requires people to alter their behavior over a significant amount of time. Do you agree or disagree with this statement? Why or why not?

2. Why is "statistical significance" required in epidemiological studies?

3. What are "confounding" variables? Give an example.

4. What is "bias" in an epidemiological study? What are some examples of the different types of "bias." Explain these different types of "bias" using examples.

5. What is meant by the term "dose-response" relationship with respect to agents that cause disease? Provide an example of a dose-response relationship that demonstrated that radiation exposure can result in adverse health consequences.

6. What do we mean by "ethics in epidemiology?" To try to answer this using the example of the Alabama Syphilis Study conducted by the U.S. Public Health Service from the 1930s-1970s.
In your answer, talk about things like the Norweigan Syphilis Study, salvarsan, penicillin, and painful spinal tap. In your opinion, was the Alabama Syphilis Study ethical? Why or why not? How might you have done the study differently?

7. What are IRBs? What kinds of power do these IRBs have with respect to clinical trials?

8. Please read the assigned homework material carefully and answer all the homework questions.

Lecture 19: Topic: Bioterrorism (Dr Lau Cam)

Disclaimer: Let it be known that this lecture DOES NOT IN ANY WAY CONDONE THE ACT OF BIOTERRORISM. It simply points out some important facts that can help Public Health officials be better prepared in the event of such an attack. The slides for this lecture were provided by either Dr Lau Cam (St. John's University) or the UCLA School of Public Health and are available online at: http://www.ph.ucla.edu/cphdr/bioterrorism

After this lecture, you should be able to answer the following:


1. What is the definition of biological terrorism? What kinds of acts of biological terror have been carried in the United States since 1980? Why is bioterrorism a potential threat to us? Why might this type of terror be used versus other types of terrorist actions?

2. What are the two possible ways that a bioterror attack could occur? What is the difference between them?

3. List some of the roles of public health authorities in bioterrorism related disasters.

4. The CDC classifies bioterrorist agents into three categories. What are these categories? How are they defined? List examples of members of each category.

5. What is Real Time Outbreak Disease Surveillance?

6. What is the incubation time for inhalational anthrax? What kinds of symptoms will the disease elicit in the patient? What is the tell-tale radiographic sign that a patient has inhalational anthrax (in other words, what will their chest X-ray look like?)? What drugs are used to treat inhalational anthrax?

7. List and define the following terms: outbreak, epidemic, pandemic

8. Please make sure to do the assigned reading and answer all homework questions.

Lectures 17 and 18 and 20: Epidemiologic Principles and Methods

After this lecture, you should be able to answer the following:

1. What is the definition of "epidemiology?"

2. What is the definition of "disease frequency?"

3. What is the definition of "incidence?" How does the incidence help identify causes of disease? Use thalidomide as an example.

4. What is the definition of "prevalence?" Why is it that the prevalence will be much higher than the incidence with respect to chronic diseases that are not lethal? What kinds of diseases generate similar incidence and prevalence rates?

(From the Chalkboard)...What is the French Paradox? What does red wine have to do with it? Genetics? What is resveratrol? What does resveratrol do to mice?

5. What does the distribution of a disease tell the epidemiologist?

6. What is an epidemic curve? Draw one and explain to your study partner what the curve means.

7. How does information on the distribution of cancer mortality lead to hypotheses about causes of different types of cancer?

8. With respect to people who move from low cancer-rate countries to high cancer-rate countries, explain the hypothesis that environmental factors rather than genetics is involved.

9. What are prospective studies? retrospective studies? What advantage do most epidemiological studies have compared to most animal studies?

10. Using the "randomized, double-blind clinical trial" as an example, explain what intervention studies are.

11. Explain the design and results obtained during the clinical trial of Jonas Salk's polio vaccine in the 1950s.

12. Explain the design and results obtained from the "randomized, double-blind" Physician's Health Study.

13. What are cohort studies? What are the different types of cohort studies? What does the Relative Risk in a cohort study say about the association between an exposure and a disease? Describe the Relative Risk obtained from the Doll and Hill cohort study to your study partner.

14. What are case-control studies? Are they prospective? retrospective? In what way are case-control studies more efficient than cohort studies? What was the Reye's syndrome case-control study? What is Reye's syndrome? What does the Odds Ratio in a case-control study say about the strength of an association between an exposure and a disease? How does one calculate the odds ratio? Explain the British Breast Cancer Study to your study partner. What do the results of that study suggest concerning breast-cancer risk and long-term contraceptive use?

15. Please read the assigned homework material carefully and answer all the homework questions.