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8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
1/22
CURRICULUM CONTENT-1Apply diseases prevention in the communitybased on determinants of morbidity andmortality and their natural history KULIAHKE 1, 2, 3)
CURRICULUM CONTENT-4
Apply methods to Determine: a) RiskFactors/Cause and b) Effectiveness ofTreatment/Prevention/Intervention ofDiseases in the Community
KULIAH KE 14, 15, 17, 18, 19)
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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1. Compare epidemiological design, e.g:cross-sectional, case-control, cohortandclinical studydesign to determine riskfactors and effectiveness of treatment,prevention, and intervention of diseases
in the community
Apply methods to Determine: a) Risk Factors/Cause and b) Effectiveness of Treatment/Prevention/Intervention of Diseases in theCommunity (KULIAH KE 14, 15, 17, 18, 19)
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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3. Describe the application of clinicaltrialsto determine the effectiveness of
intervention, prevention, and treatmentof diseases
4. Describe the concept of patientvariability, variability in medical
research, variability of measurement,
both in individual and population level
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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6.Describe sources of biasand how tominimize those biases in descriptive
research design, cross-sectional,
case-control, cohort, and clinical trialsfor research
5. Differentiate internal validity, externalvalidity, selection bias, information
bias, and confounding factors
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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References
2. Cross-sectional:Sudigdo page 97
3. Cohort (prospective & retrospective)
Greenberg page 113
4. Case-control:Greenberg page 127
5. Clinical trials:Greenberg page 91
1. Descriptive:Greenberg page 45-63
7. Diagnostic Testing: Greenberg - 77
6. Variability and Bias: Greenberg - 141
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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A. Descriptive study (how much, who,where, when)
1. Descriptive cross-sectional2. Descriptive longitudinal
B. Analytical study (why?)
1. Experimental (clinical and community trials)2. Observational
a) Cross-sectional analytic
b) Case-controlc) Cohort
Cohort prospective
Cohort retrospective
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Epidemiology Study Circle1. Descriptive study
(WHO, WHERE, WHEN)
2. Hypothesisformulation
3. Analytical study
to test hypothesis
4. Dataanalysis
New hypothesis
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Independent variable Dependent variable
Risk factors Disease incidence
CauseEffect
Coronary disease
ExamplesSmoking
Blood cholesterolHypertension
Anemia among
pregnant womenNutrition intake
Fe intake
Blood lost
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Descriptive study Analytical Study
1.To describe diseasedistribution in a popu-
lation (how much,
who, where, when)
1.To study theexplanation, whythe
disease distributed
like that
2.Notto study
relationship between
dependent and
independent variables(only to study disease
distribution)
2.To study relationship
between dependent
and independent
variables
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Descriptive study Analytical Study
3.As a foundation ofhypothesis
formulation
3.As a tool to answerthe hypothesis
4.Not usingcomparison group 4.Always usingcomparison
group/s
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Did investigator
assign exposures?
Experimental study
Random allocation?
Randomised
controlled
trial
Non-
randomised
controlled
trial
Observational study
Comparison group?
Analytical
study
Descriptive
study
Direction?
Cohort
study
Case-
Control
study
Cross-
sectional
study
Yes No
Yes No Yes No
Exposure
and
outcome
at the same
time
Exposure Outcome
Exposure Outcome
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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A. Experimental
1. Randomized controlled trials
2. Non randomized controlled trials
B. Observational study
1. Descriptive study2. Analytical (explanation) study
a) Cross-sectional analytic
b) Case-controlc) Cohort
Direction of observation
GROUPING-1
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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A. Descriptive
1. Cross-sectional (prevalence study)
2. Longitudinal (incidence study)
B. Analytic (explanation study)
1. Clinical trials (experimental)2. Observational
a) Cross-sectional analytic
b) Case-controlc) Cohort
Direction of observation
GROUPING-2
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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CASE A850 women using IUD (intra uterine devices) in
Family Planning Clinics in Bali have been observedprospectively since the first day of IUD use. Before
IUD was inserted each woman was examined for
IUD contra indications such as urogenital
infections. After 5 years, the incidence of PID(pelvic inflammatory diseases) was analyzed. The
results showed that women-years incidence rate
among urban women was four time greater than
rural women. The incidence of PID also found five
times greater among women with more mobile
husband.
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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The study design of CASE A is:
A. Community trials
B. Cohort prospective
C. Cohort retrospective
D. Descriptive cross-sectional
E. Descriptive longitudinal
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Ex: 500 sample
Coronary disease and blood
cholesterol are measured at
the same time
1. Cross-sectionalanalytic
2. Cohort3. Case-control
Healthy
populationand exposed
Healthypopulation
not exposed
How
manywill get
the
disease
Population
who has
the disease
Howmany
will get
the
disease
Population
who doest
have the
disease
How
manywere
exposed
Howmany
were
exposed
OBSERVATIONAL
STUDY
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Time
If coronary diseaseis measured at one pointof time descriptive cross-sectional (this is
a prevalence study of coronary disease)
If blood cholesterol is measured at one pointof time descriptive cross-sectional (this is
prevalence study of blood cholesterol)
BASED ON STUDY OBJECTIVES AND
MEASUREMENT OF VARIABLES
Ex: 500 sample
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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BASED ON STUDY OBJECTIVES AND
MEASUREMENT OF VARIABLES
Time
If dependent variable (for example: coronarydisease)is measured at one point and at the
same time with independent variable (for
example: blood cholesterol)and study
objective is understand the relationshipbetween these variables this is cross-
sectional analytic
Dependent and independentvariables at the same timeEx: 500 sample
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Time
If sample of population measured (examined)periodically, in certain length of time (1, 3, 5
years) in order to know how many of them will
get a disease this is a descriptive
longitudinal study we will get the incidence
of coronary disease by WHO, WHEN, WHERE
BASED ON STUDY OBJECTIVES AND
MEASUREMENT OF VARIABLES
Ex: 500 sample
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Did investigator assign
exposures?
Intervention/eksperimental/clinical trials:
Example: 500 sample/patients with coronary
disease provided aspirin by the investigator
and another 490 sample/patientsprovidedplacebo (as a control group)
Observasional investigator only observe
people with risk factor (cohort)or with disease(case-control)or with disease and risk factor
at the same time (cross-sectional)or only one
group with out comparison (descriptive)
Yes
No
Monday &
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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Did investigator
assign exposures?
Experimental study
Random allocation?
Randomised
controlled
trial
Non-
randomised
controlled
trial
Observational study
Comparison group?
Analytical
study
Descriptive
study
Direction?
Cohort
study
Case-
Control
study
Cross-
sectional
study
Yes No
Yes No Yes No
Exposure
and
outcome
at the same
time
Exposure Outcome
Exposure Outcome
Today
Monday &
Tuesday
Tuesday & Thursday
8/12/2019 Lecture Wirawan Ing Desk Cross Sectional 2009
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References
2. Cross-sectional:Sudigdo halaman 971. Descriptive:Greenberg halaman 45-63
TO DAY WORK ON TASK 21 & 22)PAGES (STUDY GUIDE)
ARTICLE IN THE APPENDIXES (TheIncidence of Duodenal and GastricUlcers in Large Health MaintenanceOrganization)