Professional Documents
Culture Documents
5,
when the relative risk describes the risk of a disease given exposure compared to no
exposure.
Since the relative of 2.0 is greater than 1 (>1) the risk in exposed group is greater
than the risk in the unexposed group there is a positive association between the
exposure and the outcome. And the 0.5 is less than 1 (<1) risk in exposed group is
less than that in unexposed group, there is a negative association between the
exposure and the outcome. Here the exposure may be a protective factor. (See pg
71-72)
2. The researchers analyzed the occurrence of cancer identified between April 1991
and July 2002 for 50,000 troops who served in the first Gulf War (ended April 1991),
and that of 50,000 troops who served elsewhere during the same period. What study
design do you think they used?
Cohort Study design.
There are a few reasons for this conclusion
There are two groups of people who share common characteristic or
experience within a define time period
A retrospective cohort study because the investigator looks into what
happened to the exposed and the unexposed members over time, the
occurrence between the two is then compared
It uses the historic records of the exposure and possible outcome
[The study design would mostly likely be a Case-Control Study, because the study period is
retrospective as well as the design is restricted to a control group of population i.e soldiers
commission during the gulf war compared to the rest of the soldiers elsewhere during the
same period. The direction of the study is from outcome to exposure, meaning that the
population had already developed the disease and now the study is trying to establish the
exposure factors for the disease.]
3. What are the differences between the cohort study and case-control study?
Cohort Study
Case-Control study
Retrospective
From outcome to Source
Heterogenous case and control
Less reliable recalled exposure
Rate can only be estimated directly
Prospective
From Cause to outcome
Homogenous healthy subject
Reliable outcome information
Rate can be calculated indirectly
4. Persons diagnosed with new-onset Lyme disease were asked how often they walk
through woods, use insect repellant, wear short sleeves and pants, etc. Twice as many
patients without Lyme disease from the same physicians practice were asked the
same questions, and the responses in the two groups were compared. What study
design do you think they used?
Case-control study design
There are a few reasons for this conclusion.
There are two distinct group of people;
One with the disease Case, and the other without the disease Control.
By comparing the similar exposure factors between the two groups to
establish the outcome.
The study direction is then Outcome to Exposure.
The study is retrospective.
5. A cross-sectional study has been carried out on etiology of lung cancer, and the
results suggest that drinking may be associated with lung cancer. How to correctly
understand this result?
In order to understand the result more correctly we first have to calculate the
prevalence rate of drinking to lung cancer and compare with the prevalence of
non-drinkers to lung cancer. Using the ratio of the two prevalence rate we can
determine if the conclusion that drinking is associated with lung cancer is
correct.
Next please use the case-control study for further analysis on etiology of lung cancer.
You can express your research by design pattern of case-control study, and list some
necessary notes.
6. A case control study of multiple sclerosis (MS) was conducted in which family
history of MS was collected on all first- and second-degree relatives. Among the
500 cases, 16 reported an affected relative. Among the 500 age- and sex-matched
controls, 8 reported an affected relative.
Please analyze the data. Do these data suggest a familial component to MS?
Table 1 The relationship between family component and Multiple sclerosis (MS)
Exposed
16
Unexposed
484
492
Total
500
500
Odds ratio=b/c=8/484=0.0165
X2=(b-c)2/(b+c)=(8-484)2/(8+484)=460.52, p>0.01
OR 95% CI=exp [ln (b/c)1.96 1/b+1/c]
7. Epidemiology
9. Exposure
Exposure is a very common used term in epidemiology, it refers to the causal
factors that may associated with the disease.
beneficial ------harmful
10. Cluster sampling
The entire population of interest is divided into groups, or
clusters, and a random sample of these clusters is selected.
Cluster sampling is typically used when the researcher can
not get complete list of the members of a population they
wish to study but can get a complete list of groups or
cluster of the population.
It is also used when a random sample would produce a list of
subjects so widely scattered that surveying them would
prove to be far too expensive.
11. Questionnaire
A questionnaire is a research instrument consisting of a
series of questions and other prompts for the purpose of
gathering information from respondents
12. What are the purposes and application of cross-sectional study?
Describes the distributing of disease or health events
within populations
To provide etiological clues
To identify high risk groups in the population
15. Describe one disease and provide examples of prevention strategies by levels of
prevention
Three levels of prevention include; Primary, Secondary and Tertiary levels.
Hypertension is an abnormal increase in systolic blood pressure and is one of the
common cause of cardiovascular disease.
Primary prevention- is to prevent the development of the disease, restricting salt
intake to prevent hyperstension
Secondary prevention- screening programs for the early detection of the disease
before the clinical stages. Periodic blood pressure measurement to detect
elevated bp in time to prevent the progression of the disease.
Tertiary prevention- treatment and rehabilitation of the disease after is has
occurred by improve the duration or the outcome of illness or improve quality of
life for chronic disease. E.g. Hypertension medication and concsulting for
lifestyle and diet are necessary to control bp and also prevent some complication
of cardiovascular disease such as coronary heart disease. (See pg 13-14)
20. Confounding
A situation in which the effects of two processes are not separated. The distortion
of the apparent effect of an exposure on risk brought about by the association
with other factors that can influence the outcome
26. What kinds of experimental studies can you name? And what are the
characteristics of experimental studies?
Experimental studies include
Clinical trial,
Field trial and
Community trial.
General characteristics
Prospective
Assigning one or more intervention to the subjects
28. Can you list biases related with different kinds of studies?
Type of studies
Related biases
Recall bias
Interviewer bias
Berkson bias
Prevalence and incidence bias
Cohort study
Screening study
29. Can you list commonly used methods to control for confounding factors?
Method
During Study Design
Randomization
Restriction
Matching
During analysis
Stratification
Standardization
Usage
Often used in RCT
All types of studies
Mainly used in case control studies
Used in all studies and often performed
before multivariate adjustment
Commonly used to control for age and
sex
Multivariate adjustment
Used in all studies
30. What are the advantages and disadvantages of screening?
Advantages:
Early detection is secondary prevention
Simpler testing procedures can be used
Tests can be applied to a large population
Screening can be relatively inexpensive (cost effective)
Disadvantages:
Issues of false positives and negatives must be considered