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Preventing Spina Bifida and Other Neural Tube Defects: STIRS Student Case Study

Richard Riegelman MD, MPH, PhD
Department of Epidemiology, The George Washington University
Washington, District of Columbia
riegel@gwu.edu 

Abstract:  Neural tube defects including spina bifida and anencephaly result from failure of closure of the cranium and spinal column.  These severe developmental anomalies normally occur during the first month of gestation before most women recognize that they are pregnant. Neural tube defects are among the most common congenital defects, occurring in approximately 1 per 2,000 deliveries in most parts of the world including – until recently – the United States.  This case describes a series of investigations, including population comparisons (ecological studies), case-control studies, cohort studies and randomized controlled trials, illustrating the steps used to establish folic acid deficiency as a contributory cause of neural tube defects. The case study also illustrates the effectiveness of increasing folic acid intake in women of childbearing age and challenges students to draw conclusions and make recommendations. This is a capstone or advanced undergraduate analytical case study which selectively illustrates key quantitative reasoning concepts drawn from the four component of the STIRS frameworks i.e.  scientific thinking and evidence-based problem solving; study design, implementation and execution;  data-based and statistical reasoning; plus  analytical and logical reasoning and evidence-based decision making . The case requires background preparation by students and basic understanding of study design and use of statistics. Essay and objective questions are provided along with sample answers for Facilitators to use as part of the case and/or for student assessment. Recommendations are made for VALUE rubrics that may be used to evaluate the case study as well as materials that may be included in e-portfolios.

This is an Analysis Case, based on case categories from the National Center for Case Study Teaching in Science. The case study is based on actual events/studies.

Use in Courses: This case study may be used as a module in a variety of upper level undergraduate courses including senior seminars and capstone courses, evidence-based thinking/ critical thinking courses, including specific topics courses such as food and health, developmental biology, reproductive health, or society and health. In addition, this case would enhance student mastery of concepts for research methods-oriented courses in the sciences, social sciences, and public health. The case could be coupled with additional materials on screening and/or balancing harms and benefits and utilized as part of a capstone or synthesis course; suggestions for this are included in the Facilitator’s Guide.

The case study is well-suited to advanced undergraduate courses and may be incorporated into a capstone course. 

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Professor Riegelman developed this case study as an example for the STIRS Program.