Subject

Introduction to Epidemiology

  • code 12063
  • course 2
  • term Semester 2
  • type OB
  • credits 2

Main language of instruction: Spanish

Teaching staff

Head instructor

Dr. Carlos GARCÍA - cgarciaf@uic.es

Office hours

Dr. Albert Sánchez Niubó (asanchezn@uic.es)

Coordinador: Dr. Carlos Gª Forero (cgarciaf@uic.es

Introduction

In the event that the health authorities announce a new period of confinement due to the evolution of the health crisis caused by COVID-19, the teaching staff will promptly communicate how this may effect the teaching methodologies and activities as well as the assessment.

Health and disease are not random phenomena. Their patterns can be identified even before having knowledge of pathophysiological mechanisms. Such knowledge is possible by identifying population patterns and comparisons among groups of people according to hypotheses. The discipline providing the methodology to determine these patterns is Epidemiology.

Epidemiology is a scientific method of reasoning about causes and effects that, unlike clinical medicine, addresses the relationships between causes and health outcomes in groups. Thus, it makes it possible to analyze the natural course of diseases that allows establishing etiological hypotheses. This provides the basis for developing and evaluating promotion and prevention programs in groups.

The main role of the epidemiologist is the design of scientific research and its application in public health. In this course, students will learn basic epidemiological methods and their applications. In this course, we will understand how to apply and interpret epidemiological methods for health promotion, prevention, and clinical practice.

During the course, we will present descriptive and analytical epidemiology, and basic study designs, including randomized trials, case-control studies, and cohort-based studies. We will learn how to measures risk and methods for controlling bias and confusion to ensure causally valid and generalizable interpretations.

The course follows the framework curricula of the Association for Prevention Teaching and Research (APTR). This will enable students to critically appraise epidemiological information and will lay the foundations for Clinical Epidemiology and Public Health.

Pre-course requirements

It is required to have taken the course Biostatistics.

Objectives

1) Describing the identifiable causes of disease using population pattern analysis, group comparisons, and individual monitoring as core epidemiology methods.

2) Understanding health and illness as determined phenomena, with detectable patterns that can be looked for and surveyed.

3) Designing hypotheses to determine the association between exposure and health outcomes, comparing disease frequencies as a function of exposure.

4) Examining the conditions in which the exposures and outcomes are causally associated, and assessing the factors that may offer alternative explanations, such as random error and bias.

5) Selecting which type of study answers a specific question, distinguish when a random trial is needed to prove efficacy and effectiveness.

6) Differentiating between ethics that conditions the use of a clinical assault.

7) Applying indicators in diagnostic decision making, and their applications in the area of patient safety, quality control, and interventions.

8) Assessing how epidemiological reasoning can be applied to identify patterns in the populations and formulating causal hypotheses both cross-sectional and longitudinal comparisons.

Competencies

  • 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
  • 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
  • 28 - Obtaining and using epidemiological data and assess trends and risks in health related decision-making.
  • 36 - Be able to formulate hypotheses, collect and critically evaluate information for problem solving using the scientific method.
  • 37 - Acquire basic training for research.
  • CB-2 - To know how to apply and incorporate knowledge, an understanding of it and its scientific basis and the ability to solve problems in new and loosely defined environments, including multidisciplinary contexts that include both researchers and highly specialised professionals.
  • CB-3 - To know how to evaluate and select the appropriate scientific theories and precise methodologies required by their field of study to make judgements based on incomplete or limited information. Where necessary and appropriate, this includes a reflection on the ethical and social responsibility linked to the solution suggested in each case.
  • CB-6 - To have developed sufficient autonomy to participate in research projects and scientific or technological cooperation within the student’s own thematic and interdisciplinary context. This should also include a high degree of knowledge transfer.
  • CTP-3 - To develop critical thinking and reasoning as well as self-assessment skills.
  • CTS-2 - To demonstrate sensitivity to environmental issues and act accordingly.

Learning outcomes

By the end of the course, the student must be able to:

1) Define Epidemiology and its use in epidemiological reasoning

2) Explain how ethical principles affect epidemiological research

3) Calculate frequencies and rates to quantify and describe the distribution of health outcomes

4) Explain the basic concepts of epidemiological analysis: exposure, outcome, risk, bias, and confounding 

5) Identify and describe basic epidemiological designs

6) Use the principles of causality to health outcomes and to make hypotheses about their mechanisms

7) Use evidence of association to assess whether a relationship is causal

8) Apply the concepts of test performance to diagnostic validity and screening

9) Apply the concepts of benefit, harm, and costs to health decisions 

10) Describe the applicability of epidemiological methods in Public Health, clinical and basic research, and health policy 

Syllabus

CM1 History and uses of epidemiology

-History of epidemiology
-Ethics in epidemiology
-Applications of epidemiology

Development of epidemiological reasoning and the situation of epidemiology in a historical context. Evaluation of epidemiology and its ethical conditions. Applications of epidemiology in Medicine and other disciplines

CM2 & CM3 Descriptive epidemiology

-Disease, frequency and severity
-Prevalence and incidence.
-Natural history of the disease: exposure and outcome.
- Epidemiological hypotheses: who, where and when.

Analysis tools: definition of cases and populations, measures of incidence, prevalence and morbidity and mortality. Description of the disease: vital statistics, surveillance and measures of health status. Natural history analysis methods. Patterns of the disease: people, places and times. Exposures, latent periods and measures of dispersion

TP 1 Epidemiological hypotheses and indicators

CM 4 & CM 5 Association and causality

-- Association measures: data description, risk and impact measures.
-- Bias, confusion and adjustment. Mediation and interaction.
-- Causality: principles of contributing cause. Cause of cause.
Estimation of risk measures: relative, attributable risk and population fractions. Identification of bias and confounding. Effect modification. Adjustment methods. Bradford-Hill criteria. DAGs.

TP 2 Contingency tables and impact measures

 CM 6 & CM7 Analytical Epidemiology and Decision Making

--Internal and external validity.
-- Epidemiological designs observations
Experimental designs: trials without equivalent control and controlled trials.  

Control and generalization. Representativeness biases and causality biases. Observational designs. ecological, cross-sectional, case control, prospective and retrospective cohorts. Experimental designs: community trial and controlled trials. Clinical trial: equivalence, superiority and non-inferiority.

TP3 Designing an epidemiological study

Teaching and learning activities


In blended

1. Masterclass Lesson (LM)

2. Presentation and Resolution of cases (PRc)

3. Project-based learning (PBL)

4. Individual Academic Mentoring (TAP)

5. Self-study and personal work (ATP)

 

1. Theoretical-practical classes (LM): Full-group online Collaborate sessions. Teachers will explain theoretical topics and propose exercises to be solved during the classroom. Classroom dynamics will integrate theoretical work with practical exercises.

2. Problem-solving classes (PRc): Divided group sessions in a conventional classroom. In each session, review exercises will be carried out around problems that given to the students in advance.

a) Each student will choose a minimum of 2 of the 5 problems to do individually and will upload their solution into the Moodle platform.

b) On the day of the session, the teacher will call volunteers to the board to present the resolution of one of the problems.

c) Individually, each student will review the problems they have done and complete the remaining ones. At the end of the session, each student will upload the 5 exercises proposed in a second Moodle activity.

3. Epidemiological study project (ABp): Practical work in which students, in random groups of 5 , will develop a project on a health problem addressed in an epidemiological fashion. This exercise will require choosing, applying, and interpreting a study design, seeking information about it, and interpreting its results.

Course Moodle page: The course website will present the available material (syllabus, bibliography, review exercises, forms, data files, etc.) tasks and schedule. In addition, forums will be created for questions on the course.

To achieve the objectives, the constant work of the student is essential. 

Presence

The course is done in a blended format. Lectures will be held online and practical face-to-face format with divided groups in the classroom. The attendance to the indicated shifts must be respected. Shift changes will only be accepted with prior authorization from the coordinator. Shift demands must be notified at least 48 hours before the session.


The course has two credits, estimating a student work time for the average student of 27, therefore it requires a total of 54 hours of student work (20 in the classroom and 37 outside the classroom).

Evaluation systems and criteria


In blended

ORDINARY CALL

CONTINUING ASSESSMENT ACTIVITIES

1. Individual learning portfolio (20% of the final grade): a compendium of the tasks of the practical sessions. The students will have to return the exercises and self-assessments in pre-task and task.

Each student will upload exercises solved in the pre-task sessions to Moodle. A minimum of two exercises from each session must be returned to obtain a passing grade in the course. In addition, a second task will be uploaded after the face-to-face session with solved exercises. It will be necessary to deliver at least two complete sessions (10 exercises).

2. Preparation and defense of the group project (20% of the final grade): Evaluation of the group project. This evaluation implies the individual delivery of the final project. As participation in the work of each student can be unbalanced, each student must submit the complete project and a dossier with their individual contributions. One of the group members, selected at random, will present the project to the teachers in a 10-minute online session. Only students who have submitted the project will be assessed.

Lack of originality or plagiarism will not be tolerated in any evaluation activities. In the event of such conduct, involved activities will be considered as undelivered, without the possibility of recovering the score.

 

FINAL EVALUATION ACTIVITY

4. Final exam (60% of the final grade): Theoretical-practical final exam using multiple-choice and short-answer questions. The practical section will evaluate the competences related to the choice, application, and interpretation of the designs and measures that are part of the program. Two practical exercises will be solved with the help of the desired material.

Depending on the pandemic situation, the final exam will be taken online or in the classroom.

Participation in classroom exercises will be taken into account, providing that the task follows a correct format. Students who participate in the resolution of exercises in the practical sessions may have a bonus of up to 10% of the final grade. (10% of the grade).

 

SECOND CALL

In case of obtaining a total of under 5 points in the first call, the student will take the final exam of the second call. Qualifications of the continuous assessment will be used, and the qualification of the final exam will average the rest of the activities, with a weight of 60%.

Not-presented will be possible when a student has not taken the final exam of the first session or has not presented the minimum number of activities necessary to be evaluated. If the student has a grade of Not-presented, the exam will suppose 100% of the final grade and a maximum qualification of 7 can be achieved. 

Bibliography and resources

Basic reference 

     Friis, RH. Epidemiology 101Sudbury, Mass: Jones and Bartlett Publishers, 2010. 220p.   

This is a compulsory reference for the course. Students are expected to be up to date in the reading of the book. Materials will be followed rigorously so that readings will be recommended prior to the sessions.  

Other sources 

  1. Saracci R.  Epidemiology: A Very Short Introduction. Oxford U.K.: Oxford  University Press, 2010
  2. Ward H, Toledano MB, Shaddick G, Davies B, Elliott P. Oxford Handbook of Epidemiology for Clinicians. Oxford, U. K.: Oxford University Press, 2012. 416 p. (Oxford Medical Handbooks).
  3. Gordis L. Epidemiología. 3ª ed. Madrid: Elsevier España, S.A., 2014.
  4.  Hulley SB, Cummings SR  y col. Diseño de las investigaciones clínicas. 3ª ed.  Lippincot Williams and Wilkins, 2008.
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