Epidemiology is for Everyone: Or How I Learned to Stop Scrolling Twitter and Calculate Incidence Rates

By Virginia Kotzias, PhD Research Fellow at the Centre for Global Health Inequalities Research (CHAIN), Institute for Sociology and Political Science, Norwegian University of Science and Technology

There’s a running joke on the internet that the COVID-19 pandemic turned everyone into an amateur epidemiologist. Suddenly, people who had never even heard of the field were well-versed in case-fatality ratios, risk factors, and the burden of infection. As months wore on and results from epidemiological studies were translated into policies that affected people’s daily lives, the importance of epidemiology within the field of Public Health became very clear, very fast.

Meme about armchair epidemiologists (Source: imgflip.com)

Spoiler alert: I am not an epidemiologist (except in the armchair-internet sense), but as a researcher in health policy and practice, I’ve worked closely with some amazing epidemiologists and have long understood the value of the field. This is why, when the Norwegian Research School of Global Health (NRSGH) offered an opportunity to take a deep dive into the discipline, I jumped.

In April 2022, NRSGH and the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen co-hosted two back-to-back epidemiology courses. The first, “Conceptual Foundations of Epidemiologic Study Design and Analysis,” was taught by the blockbuster scholar, Kenneth Rothman (Boston University) and pharmacoepidemiologist Vera Ehrenstein (Aarhus University). The purpose of the class was to provide an introduction to the core concepts, methods, study designs, and limits of modern epidemiology. Preparation for the 5-day intensive course was no joke: we were required to read Epidemiology: An Introduction, several articles, and complete homework assignments that served as the basis for group discussions. It was pretty awesome, and meant that I walked away from the class with a solid, beginner’s grasp of measures of disease and effect, types of epidemiologic study design, approaches to analysis and managing bias, and the strengths and limitations of each.

The second course, simply titled “Advanced Epidemiology” was taught by Matt Fox (Boston University). This class built upon the basics of the prior week to “go deeper” into epidemiological topics, with a special focus on causal inference and models. We spent a significant amount of time on the importance of framing clear research questions and describing the counterfactual, and learned varying approaches to identify and account for different types of confounding and bias. We ended with a survey of statistical and other approaches to identifying associations between exposure(s) and disease(s) and the threshold of validity and precision necessary to make causal claims in epidemiological research. I gained so much from this class that I didn’t want it to end – so I was thrilled to find that Matt is the co-host of two podcasts (SERious EPIand Free Associations) that continue these discussions about epidemiological topics. (I may or may not have listened to the entire back catalogue of SERious EPI episodes over the summer).

Posing with Rothman’s Epidemiology: An Introduction.

Since completing these classes, I’ve been able to define my current PhD project more clearly and think through tough questions in a more systematic way. I work pretty definitively in the social science space, which is complicated – relationships between social policies, complex health phenomena, and the natural world are messy and confounding (in every sense of the word). Luckily for me, epidemiology is a discipline that tackles difficult relationships like this all the time and has developed a pretty robust toolbox of methods and approaches to handle them. Thinking like an epidemiologist – or at least, trying to – helped me approach my research questions and study design in new ways.

I appreciate the importance of public health, am dedicated to the field, and have always found my work to be meaningful. But by combining my prior training as a health policy analyst with what I learned from these classes, I feel better equipped to take on the increasingly complex challenges faced by all of us working in the public health world. Though it required a lot more effort than a long night scrolling Twitter and earning my social media badge as an armchair epidemiologist, my training as an amateur epidemiologist has been useful in my current PhD work – and will continue to shape my thinking about research, populations, and study design throughout my career as a health researcher. 

A typical day in the Conceptions of Epidemiology course.

Special thanks to Drs. Rothman, Ehrenstein, and Fox for teaching excellent courses, to NRSGH and CISMAC for hosting them, and to NRSGH for generous travel funding to support my attendance.

Medical publishing in high impact journals: learning from editors’ notion

Blog post written by Muhammad Asaduzzaman, PhD Research Fellow, Department of Community Medicine & Global Health, Institute of Health and Society, University of Oslo

Medical publishing or publishing of medical research is a fundamental need for the scientific advancement of both modern treatment and disease prevention. Similarly, it is equally important for global health researchers particularly the early career researchers such as doctoral and postdoctoral research fellows who need their research to be published in impactful journals. Therefore, I was willing to join the highly recognized ‘2-day Course in Medical Publishing’ organized by the University of Oslo (UiO), Oslo University Hospital, New England Journal of Medicine, Journal of the Norwegian Medical Association, and Annals of Internal Medicine which is being conducted since 2017. This course is highly competitive due to limited space, high profile resource persons (the editors of the high impact journals and experienced researchers from UiO) and course gap in last 2 years for the pandemic.  However, I am grateful to the Norwegian Research School of Global Health (NRSGH) who supported me to join the course this year from June 07 to June 08, 2022 held at Gaustad Sykehus, Sognsvannsveien 21,Oslo.

Darren B. Taichman is presenting on scientific writing

At present, I am at the final year of my PhD fellowship and focusing on the manuscript writing and publishing. My research topic is the transmission dynamics and One Health digital surveillance of antibiotic resistance, which is also a global pandemic and alarming threat to all. That is why, the research findings of my PhD project should be well communicated and publishing in good journals is one of the most important dissemination pathways to public and scientific community. My motivation to attend this course was to learn from the editors of high impact journals on what they look for and how they handle the whole publishing process from writing the cover letter to the acceptance of a manuscript. 

The course was a mix of lectures and group works based on assignments such as critical review of published articles and peer review of the manuscripts from group members. The lectures and presentations covered almost every aspect of open access publishing of an article. Dr. Michael Bretthauer, Professor of Clinical Effectiveness Group, UiO talked about the study design, planning, ethics, data sharing and protection policies and clinical trial registration process whereas Mette Kalager from UiO gave the outline of the structure of a good paper (including tables and figures) and the checklist to choose a good journal based on topic of interest and target audiences. We were fortunate to have Christine Laine, Editor-In-Chief, Annals of Internal Medicine and Darren B. Taichman, Deputy Editor, New England Journal of Medicine (NEJM) as the guest lecturers. Christine provided a brief but necessary overview of the peer review process and the journals’ work process as well as the elements of good title and abstract. Darren focused on the scientific writing process, language editing and how to deal with the rejection of the manuscript to move forward. All these information are very practical and new to me from the editors’ perspective.

The group works in between the lecture sessions were very helpful to the participants to know about others’ works and to have feedback from the peers and the editors assigned to the group. My group was assigned to Are Brean, Editor-In- Chief, Journal of the Norwegian Medical Association. In the group sessions, we critically reviewed several already published articles and gave feedback on our peers’ works which helped us a lot to improve our current manuscript. However, the group distribution beforehand with sharing submitted abstracts among group members and more time allocation in  group work would be more beneficial for the early career researchers. 

Are Brean, Editor-In- Chief, Tidsskriftet and the author 

To my context, this course was a great learning platform and I would suggest this for all PhD students irrespective of disciplines. This was also an eye opening experience for me to know about the publishing process in the high impact journals, which passes through several layers, and process (e.g. involves editor, deputy and associate editors, reviewers, in-house statistical editors with multiple communications). NRSGH has always been supportive for its members and this is another wonderful initiative for scientific capacity building to aid global health researchers in Norway.