sign in sign up
<<
Home , Global health

Updated 8-26-13

Course Syllabus

PubH 6365 Section 001 of Global Fall, 2013

Credits: 2 Meeting Days: M, W (09/04/2013 - 10/21/2013) Meeting Time 11:15 A.M. - 01:10 P.M. Meeting Place: Mayo A110 Instructor: Alan Lifson, MD, MPH Office Address: WBOB 492 Office Phone: 612-626-9697 Fax: 612-624-0315 E-mail: [email protected] Office Hours: By appointment

I. COURSE DESCRIPTION This course will focus on the considerable burden due to infectious and noninfectious within middle and low-income countries, as well as the underlying risk factors that lead to their emergence and spread. Students will learn about and review different measures of burden and health status. Different diseases of international significance will be reviewed, with a focus on epidemiologic and methods used describe and analyze disease determinants. The course will also expose students to different interventions (prevention and control strategies) that have been used in both emergency situation, and to reduce the burden of more diseases that significantly impact the health of populations. The scientific literature concerning specific diseases of interest will be examined and discussed in order to illustrate these principles.

We recognize that it is impossible to cover all subjects in global health. Using a case-study approach, the course will instead select a variety of diseases or health problems of international importance. We will focus instead on approaches to dealing with these different problems, and some of the methodologies used to study them. This course will allow students to gain both skills and a greater understanding of public health research and practice as it applies to .

II. COURSE PREREQUISITES This class if available to Masters or Doctoral students from the School of Public Health; additional students may be admitted by permission of the instructor. Prerequisites include PUBH 6320 Fundamentals of Epidemiology or PUBH 6341 Epidemiologic Methods I

1

Updated 8-26-13

III. COURSE GOALS AND OBJECTIVES Learning objectives include greater appreciation and understanding of: • Major indicators of health and health disparities on a global basis, including ) • Selected global diseases of major public health significance • Social, economic, cultural and other determinants of health and health disparities on a global basis, such as , and war • Different methodologies used to conduct analysis on global health topics, and review of different publications in the literature illustrating these methodologies • Prevention and control strategies to reduce the burden of disease in different global populations

IV. METHODS OF INSTRUCTION AND WORK EXPECTATIONS This course will utilize a case-study approach, and facilitated class discussion. After a general orientation to global health, we will select 12 diseases of international importance along with specific countries in which this disease has been a major public health problem. The last class will serve as a synthesis of information and concepts discussed in the class,

V. CASE STUDY APPROACH: Each class will last two hours.

Lecture (first hour of class) The first hour will be a lecture on some general topic in global health. These lectures are intended to complement assigned readings from the course textbook.

Class Discussion (second hour of class) There will be two types of class discussions:

a. Discussion of Published Article For each class, the instructor will also select a journal article that represents either an epidemiologic investigation of the determinants of this disease, or an intervention study (clinical or community trial) to reduce . Students are expected to read this article in advance of the class. The class discussion will include the following points in relation to the article:

1. What is the research question? What is the study design?

2. What is the study population? How were they recruited? What are inclusion and exclusion criteria?

3. What were the primary and secondary outcomes? How were they measured?

4. What was the intervention, or primary exposures of interest? What were secondary exposures/determinants of outcome/potential confounders? How were they measured?

5. What were the main stated conclusions? What are the implications for global health and prevention of disease? What additional research questions remain?

6. What are the limitations of this study, and cautions in its interpretation?

2

Updated 8-26-13

b. Class Discussion of a "Challenging Problem" Students will be assigned to groups, and asked how they would address a "challenging problem" in global health. Students will have two group presentations over the course of the semester.

The goal for each team is to tackle a real-life global health-related problem and to come up strategies for how this can best be addressed. The class presentation should include discussion of the following points:

1. Describe the problem to be solved, including its epidemiology in the context of the specific country or geographic area.

2. What are some of the risk factors (both immediate and underlying) that may be contributing to this problem?

3. What are the main objectives of your intervention or approach to control or minimize this problem?

4. What specific intervention or strategic approach do you recommend to help control or minimize this problem?

5. Which organizations/stakeholders will you partner with to implement this intervention?

6. As part of your monitoring and evaluation plan, what measures or outputs will you use to help assess program impact?

7. What do you see as the challenges/barriers/limitations in implementing this intervention?

VI. COURSE TEXT AND READINGS The required text for this course is: Michael Merson, Robert Black, Anne Mills. Global Health: Diseases, Programs, Systems and Policies. Copyright 2012. (Jones & Bartlett)

Additional assigned readings will be posted to the course web site.

3

Updated 8-26-13

VI. COURSE OUTLINE/SCHEDULE

WEEK 1: 9-4-12 Introduction to Global Health

Lecture: Introduction to Global Public Health: Concepts, Overview Data Used To Monitor Global Health (Morbidity/Mortality)

Readings: Merson: Introduction: xviii-xxiv Chapter 1: Measures of Health and Disease in Populations

Lozano et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-228

WEEK 2: 9-9-12 Lecture: Culture, Behavior and Health Hepatitis E

Class Article: Hepatitis E Outbreak

Readings: Merson: Chapter 2: Culture, Behavior and Health Chapter 5: Infectious Diseases (read over few weeks)

Boccia D, et al. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 2006;42:1679-84.

CDC. Investigation of Hepatitis E Outbreak Among — Upper Nile, South Sudan, 2012-2013. MMWR 2013; 62:581-6.

9-11-12 Lecture: Social Determinants of Health Lymphatic Filariasis,

Class Article: and Filariasis

Readings: Merson: Chapter 3: Social Determinants of Health

Simonsen PE, et al. Lymphatic filariasis control in Tanzania: effect of six rounds of mass drug administration with ivermectin and albendazole on infection and transmission. BMC Infect Dis. 2013 Jul 21;13:335.

WHO. Transmission assessment surveys on the Global Programme to Eliminate Lymphatic Filariasis: WHO Position Statement. Wkly Epidemiol Rec 2012;48:478-82.

4

Updated 8-26-13

WEEK 3: 9-16-12 Lecture: Design of Health Systems

Class Discussion: Polio Eradication in (class presentation)

Readings: Merson: Chapter 12: Design of Health Systems

Poliomyelitis: In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook - 12th Edition (May 2012)

9-18-12 Lecture: Management and Planning for Global Health

Class Discussion: Childhood in Nicaragua (class presentation)

Readings: Merson: Chapter 13: Management and Planning for Global Health

Kotloff KL et al. The Burden and Etiology of Childhood Diarrhea in Asia and Africa. Lancet 2013;382:209-22.

WEEK 4: 9-23-12 Lecture: and Health

Class Discussion: Multidrug resistant TB in prisons (class presentation)

Readings: Merson: Chapter 18: Globalization and Health

Simooya OO. Infections in prison in low and middle income countries: and prevention strategies. Open Infect Dis J 2010; 4, 33-37

9-25-12 Lecture: Prevention

Class Article: Suicide and Pesticides Readings: Merson: Chapter 9: Chapter 8: Unintentional and Violence

Yip et al. Means restriction for suicide prevention. Lancet 2012; 379: 2393–99

Gunnell, Eddleston. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol 2003;32:902–9

5

Updated 8-26-13

WEEK 5: 9-30-12 Lecture: Health and the Economy

Class Article: Harm reduction for injection drug abusers

Readings: Merson: Chapter 15: Health and the Economy

Mathers BM, Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733-45.

ASSIGNMENT 1 DUE

10-2-12

Lecture: Complex Emergencies

Class Discussion: in Kenyan camp (class presentation)

Readings: Merson: Chapter 11: Complex Emergencies Chapter 6:

WEEK 6: 10-7-12 Lecture:

Class Discussion: /population control in Ethiopia (class presentation)

Readings: Merson: Chapter 4: Reproductive Health

Cleland JG, Family planning in sub-Saharan Africa: progress or stagnation? Bull World Health Organ. 2011;89:137-43.

10-9-12

Lecture: Cooperation in Global Health

Class Discussion: in occupied Palestine (class presentation)

Readings: Merson: Chapter 17: Cooperation in Global Health Chapter 7: Chronic Diseases and Risks (read over few weeks)

Husseini et al. Cardiovascular diseases, mellitus, and in the occupied Palestinian territory. Lancet 2009;373:1041–9

6

Updated 8-26-13

WEEK 7: 10-14-12 Lecture: Pharmaceuticals Smoking

Class Article: Indoor Air

Readings: Merson: Chapter 10: Chapter 14: Pharmaceuticals

Smith KR, Effect of reduction in household on childhood in (RESPIRE): a randomised controlled trial. Lancet. 2011;378:1717-26.

Gall ET. Indoor Air Pollution in Developing Countries: Research and Implementation Needs for Improvements in Global Public Health Am J Pub Health 2013,103, e67-72.

ASSIGNMENT 2 DUE

10-16-12 Lecture: Evaluation of Large Scale Health Program , Dengue

Class Article:

Readings: Merson: Chapter 16: Evaluation of Large Scale Health Programs

Paaijmans KP, et al. Understanding the link between malaria risk and climate. Proc Natl Acad Sci U S A. 2009;106:13844-9.

Costello A. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009 May 16;373:1693-733.

WEEK 8: 10-21-12

Class: Working in global health (panel) Lucy Salter, Director, Global Program, National Alliance of State and Territorial AIDS Directors

7

Updated 8-26-13

VII. WRITTEN ASSIGNMENTS

ASSIGNMENT 1: Due 9-23-13 Select one communicable disease of global health significance. Pick one country in which this disease is a problem. For this disease and country, write a 3 page paper (single space, not counting references) with at least 8-10 references describing:

1. What is the and prevalence of the disease in the specific country/geographic setting? Who is at risk for the disease, and what are the epidemiologic trends?

2. What is the health burden of the disease (morbidity/mortality) or other health consequences?

3. How is the disease acquired? What are the proximal risk factors for this disease or health problem?

4. What are the distal risk factors for this health problem? (e.g., culture, poverty, women's status, climate change, war, urbanization)

5. What intervention strategies are available for this health condition? What is the evidence for their efficacy?

ASSIGNMENT 2: Due: 10-14-13 Select one non-communicable disease of global health significance. Pick one country in which this disease is a problem. For this disease and country, write a 3 page paper (single space, not counting references) with at least 8-10 references that describes the following:

1. What is the incidence and prevalence of the disease in the specific country/geographic setting? Who is at risk for the disease, and what are the epidemiologic trends?

2. What is the health burden of the disease (morbidity/mortality) or other health consequences?

3. What are the proximal risk factors for this disease or health problem?

4. What are the distal risk factors for this health problem? (e.g., culture, poverty, women's status, climate change, war, urbanization)

5. What intervention strategies are available for this health condition? What is the evidence for their efficacy?

VIII. EVALUATION AND GRADING Below is a list of the activities by which you will be graded and their assigned weights:

Activity Percent of Grade In class presentations 40%

Assignment 1 20%

Assignment 2 20%

Class Participation 20%

8

Updated 8-26-13

Class Participation: A sign-up sheet will be circulated each class, and will be counted as part of the student's overall grade in terms of participation. This reflects the core belief that coming to and participating in class is an essential part of the learning process.

Grades: Final grades will be assigned as follows:

Grade Percent 100.0 - 92.5 A 89.9 - 92.4 A- 87.3 - 89.8 B+ 82.4 - 87.2 B 80.0 - 82.3 B- 77.5 - 79.9 C+ 72.4 - 77.4 C 70 - 72.3 C- 69 or below F

Incomplete Contracts: A grade of incomplete “I” shall be assigned at the discretion of the instructor when, due to extraordinary circumstances (e.g., documented illness or hospitalization, death in family, etc.), the student was prevented from completing the work of the course on time. The assignment of an “I” requires that a contract be initiated and completed by the student before the last day of class, and signed by both the student and instructor. If an incomplete is deemed appropriate by the instructor, the student in consultation with the instructor, will specify the time and manner in which the student will complete course requirements. Extension for completion of the work will not exceed one year (or earlier if designated by the student’s college). For more information and to initiate an incomplete contract, students should go to SPHGrades at: www.sph.umn.edu/grades.

Course Evaluation: Beginning in fall 2008 the SPH will collect student course evaluations electronically using a software system called CoursEval. The system will send email notifications to students when they can access and complete their course evaluations. Students who complete their course evaluations promptly will be able to access their final grades just as soon as the faculty member renders the grade in SPHGrades: www.sph.umn.edu/grades. All students will have access to their final grades two weeks after the last day of the semester regardless of whether they completed their course evaluation or not. Student feedback on course content and faculty teaching skills are important means for improving our work. Please take the time to complete a course evaluation for each of the courses for which you are registered.

University of Minnesota Uniform Grading and Transcript Policy A link to the policy can be found at onestop.umn.edu.

9

Updated 8-26-13

IX. OTHER COURSE INFORMATION AND POLICIES

Grade Option Change (if applicable): For full-semester courses, students may change their grade option, if applicable, through the second week of the semester. Grade option change deadlines for other terms (i.e. summer and half-semester courses) can be found at onestop.umn.edu.

Course Withdrawal: Students should refer to the Refund and Drop/Add Deadlines for the particular term at onestop.umn.edu for information and deadlines for withdrawing from a course. As a courtesy, students should notify their instructor and, if applicable, advisor of their intent to withdraw. Students wishing to withdraw from a course after the noted final deadline for a particular term must contact the School of Public Health Student Services Center at [email protected] for further information.

Student Conduct, Scholastic Dishonesty and Policies: Students are responsible for knowing the University of Minnesota, Board of Regents' policy on Student Conduct and Sexual Harassment found at www.umn.edu/regents/polindex.html. Students are responsible for maintaining scholastic honesty in their work at all times. Students engaged in scholastic dishonesty will be penalized, and offenses will be to the SPH Associate Dean for Academic Affairs who may file a report with the University’s Academic Integrity Officer. The University’s Student Conduct Code defines scholastic dishonesty as “plagiarizing; cheating on assignments or examinations; engaging in unauthorized collaboration on academic work; taking, acquiring, or using test materials without faculty permission; submitting false or incomplete records of academic achievement; acting alone or in cooperation with another to falsify records or to obtain dishonestly grades, honors, awards, or professional endorsement; or altering, forging, or misusing a University academic record; or fabricating or falsifying of data, research procedures, or data analysis.”

Plagiarism is an important element of this policy. It is defined as the presentation of another's writing or ideas as your own. Serious, intentional plagiarism will result in a grade of "F" or "N" for the entire course. For more information on this policy and for a helpful discussion of preventing plagiarism, please consult University policies and procedures regarding academic integrity: http://writing.umn.edu/tww/plagiarism/. Students are urged to be careful that they properly attribute and cite others' work in their own writing. For guidelines for correctly citing sources, go to http://tutorial.lib.umn.edu/ and click on “Citing Sources”. In addition, original work is expected in this course. It is unacceptable to hand in assignments for this course for which you receive credit in another course unless by prior agreement with the instructor. Building on a line of work begun in another course or leading to a thesis, dissertation, or final project is acceptable.

Disability Statement: It is University policy to provide, on a flexible and individualized basis, reasonable accommodations to students who have a documented (e.g., physical, learning, psychiatric, vision, hearing, or systemic) that may affect their ability to participate in course activities or to meet course requirements. Students with are encouraged to contact Disability Services to have a confidential discussion of their individual needs for accommodations. Disability Services is located in Suite 180 McNamara Alumni Center, 200 Oak Street. Staff can be reached by calling 612/626-1333 (voice or TTY)

Mental Health Services: As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or stressful events may lead to diminished academic performance or reduce a student’s ability to participate in daily activities. University of Minnesota services are available to assist you with addressing these and other concerns you may be experiencing. You can learn more about the broad range of confidential mental health services available on campus via www.mentalhealth.umn.edu

10