Review by Emma Clark, Paediatric & Perinatal Epidemiology, 18, pp. 313-314, 2004

As a current student in epidemiology I was asked to review this introductory epidemiology course on CDROM. It has been designed to be used in a variety of formats such as distance learning, self-paced learning, learning in the classroom or for short courses. It requires Windows 98 or Mackintosh System 8.1, a Pentium or 68040/25 MHz or any PowerMac, and Quick-Time 3.0. The QuickTime software can be downloaded from the CD-ROM. It is divided into three sections: objects and methods of epidemiological research; validity of epidemiological research; and epidemiological analysis. Objects and methods of epidemiological research include measures of disease frequency, measures of effect and measures of potential impact. Validity of epidemiological research includes validity, selection bias, information bias and confounding. Epidemiological analysis includes statistical inferences about effect measures, stratified analysis and matching. Dynamics of infection are not covered.

It is easy to navigate around the CD as each page has clearly labeled tabs that take you directly to the Index or Table of Contents. There is a useful Glossary which provides definitions of all technical and epidemiological terms used. There are also numerous web links to teaching aids such as DASL (an online library of data-files and stories that illustrate the use of basic statistics methods), statistical packages such as STATA and even a link to Statistics Job Announcements (an online list of places hiring people with backgrounds in statistics). Each topic has its own page that includes short videos of examples of epidemiological research. I found them interesting and they fitted well with each topic.

Unfortunately all the examples used were from the developed world. This CD-ROM could be made to appeal to a broader audience by including examples of epidemiological research carried out in low- and middle-income countries.

Each topic also has quizzes and multiple choice questions to 'provide self-evaluation of basic terms and concepts' . These are excellent. Having the courseon CD-ROM allows the student to work out the answers in their own time, click a button and see the correct answer with explanations. When a correct answer is supplied the computer produces cheering, bugle playing and occasionally a crowd of people shouting 'wow!' which can become annoying. Luckily on the first page of the CD-ROM you are given instructions about turning off the sound effects, and I thoroughly recommend this!

The statistics package used is Data Desk. The version included with ActivEpi is a student version with some limitations, but it can be used to analyze modest-sized data sets. Tutorials are included to teach the students the programming required to use Data Desk, but I still found it unwieldy. Students who use other statistical packages such as STATA or SPSS are unlikely to want to spend time learning how to manipulate another package. I found this to be the least satisfactory part of the course.

The authors are from the United States and some of the language is American, e.g. 'epidemiologic' instead of epidemiological. Also Odds Ratio is sometimes confusingly called the Risk Odds Ratio. The author also uses some epidemiological concepts not often mentioned such as the 'Big Mac Assumption' which may not be fully understood by people from different countries.

In summary, this course achieves its aim of providing a good introduction to epidemiology. Topics are covered well and there are excellent features such as the quizzes and the glossary. I personally found it a good revision aid and the quizzes allowed me to test my understanding. I think it would appeal to all students of epidemiology and would be a well-used resource for university libraries or departments. It would also be useful for people who are unable to attend a university course in epidemiology. Potential areas for change in a future edition include the use of examples of epidemiological studies from low- and middle-income countries, to include dynamics of infection, to change the sound effects and to consider removal of some terminology that may not be universally understood. The CD-ROM would become more user-friendly if it could interface with a variety of statistical packages.

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