課程資訊
課程名稱
環境與職業流行病學之暴露評估計量模擬及應
Exposure and Dose Metrics for Environmental and Occupational Epidemiology 
開課學期
106-2 
授課對象
公共衛生學院  公共衛生學系  
授課教師
 
課號
EH5026 
課程識別碼
844 U1360 
班次
 
學分
2.0 
全/半年
半年 
必/選修
選修 
上課時間
星期三6,7(13:20~15:10) 
上課地點
 
備註
限學士班三年級以上
總人數上限:15人 
Ceiba 課程網頁
http://ceiba.ntu.edu.tw/1062EH5026_ 
課程簡介影片
 
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課程概述

空氣汙染的量測誤差會影響相關健康效應的評估,而誤差的來源包括暴露濃度在時序上的變異以及量測的計量方式。本課程將透過Excel試算表,針對可逆(reversible)、不可逆(irreversible)、等比例(proportional)及超過閾值而誘發(discrete)之四類健康效應,進行汙染物暴露濃度模擬,以了解暴露計量(exposure metrics) 包含之變異性,並探討暴露計量與體內劑量之關係,以及可能之誤差。建此基礎之上,本課程將引導學生應用上述模擬之結果及觀察,針對課程指定之文獻進行回顧及批判分析,提出該文獻暴露評估之限制,進一步於期末報告利用分組方式,結合暴露計量觀念提出可行之研究設計及解決方案。

Hazardous exposures are usually complex extended temporal processes leading to the development of biological responses, “damage/adverse responses/health effects”. A study intended to determine the quantitative relationship between exposure and risk of the effect requires a careful matching of the temporal variation in exposure with the kinetics of uptake, distribution and metabolism and matching those to the dynamics of response. However, bias and attenuation of the health risk estimate can be introduced when there is exposure error in air pollution measurement. Adequate exposure metrics may provide a means of reducing error (leading to less bias and uncertainty in health risk estimates) if they capture variability in exposure, which depends on the study design, health outcome, and pollutant of interest.

To enable this, the course will start from a review of the basic components of exposure assessment for air pollution and subsequently introduce exposure metrics for four types of health outcomes: different combination of reversible/irreversible and discrete/proportional outcomes. Students will develop knowledge of exposure determinants and its temporal behavior (variability), in conjunction with skills for modeling temporal behavior of exposures and outcomes through simulations using excel spreadsheets. Guided critical analysis of publications will be performed, and information from simulations will be used to design an exposure assessment matched to the biology of the adverse effect(s). In the finals, the class will culminate with a design project where small groups of students design a new study of a specific exposure and hypothesized effect(s) reported in a previously critiqued scientific paper.
 

課程目標
本課程之整體目標在於培養學生根據流行病學中不同類型的健康效應,有能力判斷並使用正確、合適的暴露計量來探討汙染物及不良健康危害之因果關係。具體的目標包含以下四點:(1) 課程利用閱讀文獻、討論、批判思考之方式穩固學生暴露評估之基礎知識;(2) 學習如何使用暴露計量之模擬來探討暴露評估策略對前述四類健康效應之影響;(3) 利用前述學習之方法探討課程指定文獻中暴露計量與健康效應之關係,並指出暴露評估之限制;(4) 針對文獻中暴露評估之限制,於期末分組報告提出改良之研究設計。

The overall goal of this class is to develop the student’s ability to perform a biologically-based exposure assessment suited for testing an agent based hypothesis about a causal exposure-risk relationship in an epidemiological study.

The specific learning objectives are:

1. The student’s knowledge base of exposure characteristics and assessment methods, and their application will be broadened through presentations, readings, critiques, and discussions of exposure assessment for environmental and occupational epidemiology.

2. The students will be introduced to a temporal modeling approach for simulating environmental and occupational exposures (exposure metrics), formulating a model of a linked exposure and health effects process as the basis for designing an epidemiologic study, and they will apply this approach to four different types of disease outcomes.

3. The students will be able to apply the knowledge and use their analytical skills to critique the exposure assessments and linkage with the health outcomes in selected publications.

4. Given a previously critiqued publication with a limited exposure assessment, the students will develop an improved study design using the temporal model approach that will provide a better test of the epidemiologic exposure-risk hypothesis, and present that approach to the class.
 
課程要求
課堂除了教師授課,亦採用討論及分組報告之方式進行。

The course sessions will include presentation on the topic of the day by the lecturer, and discussions of reading, review of homeworks, paper critiques, and other topics of interest.  
預期每週課後學習時數
 
Office Hours
另約時間 
參考書目
1.Thomas Smith and David Kriebel, “A Biological Approach to Environmental
Assessment and Epidemiology,” Oxford University Press, 2010.
(Available at NTU library)

2.Mark Nieuwenhuijsen, "Exposure assessment in occupational and
environmental epidemiology," Second Edition. Oxford University Press, 2015.
(Available at NTU library)
 
指定閱讀
Critique papers (subject to change):

1. Cohn, B. A., Wolff, M. S., Cirillo, P. M., & Sholtz, R. I. (2007). DDT and breast cancer in young women: new data on the significance of age at exposure. Environmental Health Perspectives, 1406-1414.
2. Kreiss, K., Gomaa, A., Kullman, G., Fedan, K., Simoes, E. J., & Enright, P. L. (2002). Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. New England Journal of Medicine, 347(5), 330-338.
3. Chang, H. Y., Shih, T. S., Guo, Y. L., Tsai, C. Y., & Hsu, P. C. (2004). Sperm function in workers exposed to N, N-dimethylformamide in the synthetic leather industry. Fertility and sterility, 81(6), 1589-1594. 
評量方式
(僅供參考)
 
No.
項目
百分比
說明
1. 
Class research design project 
50% 
This will be worth 50% of the class grade. 
2. 
Paper critiques 
15% 
Each critique will be worth 5%; and all of the critiques will be worth 15% of the course grade. 
3. 
Homeworks 
15% 
Total of three homeworks will be worth 15% of the course grade. 
4. 
Class participation 
5% 
5% of the class grade for participation in discussions. 
5. 
Midterm 
15% 
15% of the course grade. 
 
課程進度
週次
日期
單元主題
第1週
2/28  (no class) 
第2週
3/7  (1) Introduction to nature of exposure and its assessment in epidemiology
(2) Review of course organization and schedule  
第3週
3/14  Exposure characterization – strategies for quantitative measurements and practical issues (I)  
第4週
3/21  Exposure characterization – strategies for quantitative measurements and practical issues (II) 
第5週
3/28  Applications of exposure assessment in epidemiology (I) 
第6週
4/4  (no class) 
第7週
4/11  (1) Applications of exposure assessment in epidemiology (II)
(2) Biomarkers as indicators of exposure (I) 
第8週
4/18  (1) Biomarkers as indicators of exposure (II)
(2) Exposure and dose metrics: approaches for epidemiologic studies (I) 
第9週
4/25  Exposure and dose metrics: approaches for epidemiologic studies (II) 
第10週
5/2  Midterm 
第11週
5/9  1. Midterm discussion
2. Research design 
第12週
5/16  Exposure and dose metrics: approaches for epidemiologic studies (III) 
第13週
5/23  1. Homework 3 in-class discussion
2. Research design & critique  
第14週
5/30  Paper critique 1 
第15週
6/6  Demonstration of final project (presentation by course instructor) 
第16週
6/13  Paper critique 2 
第17週
6/20  Paper critique 3 
第18週
6/27  Project presentation