Cohort study.pptx
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The document discusses cohort studies, providing examples and key details. It describes a large cohort study of over 5,000 people in Framingham, Massachusetts that began in 1948 and is still ongoing. Cohort studies have advantages like establishing causality and being highly valid, but also drawbacks like being expensive, time-consuming, and prone to loss of follow-up. Retrospective cohorts use existing records to trace exposure and outcomes, while prospective cohorts enroll and follow participants over time.
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Study Designs Cohort StudiesChapter 7Learning.docx
Study Designs: Cohort
Studies
Chapter 7
Learning Objectives
• Differentiate cohort studies from other
study designs
• List main characteristics, advantages, and
disadvantages of cohort studies
• Describe three research questions that
lend themselves to cohort studies
• Calculate and interpret a relative risk
• Give three examples of published studies
discussed in this chapter
Temporality
• Temporality refers to the timing of
information about cause and effect.
• Did the information about cause and effect
refer to the same point in time?
• Or, was the information about the cause
garnered before or after the information
about the effect?
Limitations of Other Study
Designs
• Demonstrating temporality is a
difficulty of most observational
studies.
Limitations of Other Study
Designs (cont’d)
• Cross-sectional and case-control study
designs are based on exposure and
disease information that is collected at the
same time.
• Advantage: Efficient for generating and
testing hypotheses.
• Disadvantage: Leads to challenges
regarding interpretation of results.
Limitations of Other Study
Designs (cont’d)
• Cross-sectional studies:
– Present difficulties in distinguishing the
exposures from the outcomes of the disease,
especially if the outcome marker is a
biological or physiological parameter.
Limitations of Other Study
Designs (cont’d)
• Case-control studies:
– Raise concerns that recall of past
exposures differs between cases and
controls.
Limitations of Other Study
Designs (cont’d)
• There has been no actual lapse of time
between measurement of exposure and
disease.
• None of the previous study designs is well
suited for uncommon exposures.
What is a cohort?
• A cohort is defined as a population group,
or subset thereof, that is followed over a
period of time.
• The term cohort is said to originate from
the Latin cohors, which referred to one of
ten divisions of an ancient Roman legion.
What is a cohort? (cont’d)
• Cohort group members experience a
common exposure associated with a
specific setting (e.g., an occupational
cohort or a school cohort) or they share a
non-specific exposure associated with a
general classification (e.g., a birth
cohort—being born in the same year or
era).
Cohort Effect
• The influence of membership in a particular
cohort.
• Example: Tobacco use in the U.S.
– Fewer than 5% of population smoked around the
early 1900s.
– Free cigarettes for WWI troops increased
prevalence of smoking in the population.
– During WWI, age of onset varied greatly; then
people began smoking earlier in life.
– One net effect was a shift in the distribution of the
age of onset of lung cancer.
Cohort Analysis
• The tabulation and analysis of morbidity or
mortality rates in relationship to the ages
of a specific group of people (cohort)
identified at a particular period of time and
followed as they pass thro.
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This document provides an overview of various research designs used in public health, including observational studies like cohort and case-control studies, as well as experimental designs like randomized controlled trials. It discusses key aspects of research design such as minimizing bias, ensuring adequate sample size and power, collecting and analyzing data appropriately, accurately reporting and interpreting results, and addressing limitations. Overall, it emphasizes the importance of rigorous research methodology in generating reliable evidence to inform public health practice and policy.
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Study Designs: Cohort
Studies
Chapter 7
Learning Objectives
• Differentiate cohort studies from other
study designs
• List main characteristics, advantages, and
disadvantages of cohort studies
• Describe three research questions that
lend themselves to cohort studies
• Calculate and interpret a relative risk
• Give three examples of published studies
discussed in this chapter
Temporality
• Temporality refers to the timing of
information about cause and effect.
• Did the information about cause and effect
refer to the same point in time?
• Or, was the information about the cause
garnered before or after the information
about the effect?
Limitations of Other Study
Designs
• Demonstrating temporality is a
difficulty of most observational
studies.
Limitations of Other Study
Designs (cont’d)
• Cross-sectional and case-control study
designs are based on exposure and
disease information that is collected at the
same time.
• Advantage: Efficient for generating and
testing hypotheses.
• Disadvantage: Leads to challenges
regarding interpretation of results.
Limitations of Other Study
Designs (cont’d)
• Cross-sectional studies:
– Present difficulties in distinguishing the
exposures from the outcomes of the disease,
especially if the outcome marker is a
biological or physiological parameter.
Limitations of Other Study
Designs (cont’d)
• Case-control studies:
– Raise concerns that recall of past
exposures differs between cases and
controls.
Limitations of Other Study
Designs (cont’d)
• There has been no actual lapse of time
between measurement of exposure and
disease.
• None of the previous study designs is well
suited for uncommon exposures.
What is a cohort?
• A cohort is defined as a population group,
or subset thereof, that is followed over a
period of time.
• The term cohort is said to originate from
the Latin cohors, which referred to one of
ten divisions of an ancient Roman legion.
What is a cohort? (cont’d)
• Cohort group members experience a
common exposure associated with a
specific setting (e.g., an occupational
cohort or a school cohort) or they share a
non-specific exposure associated with a
general classification (e.g., a birth
cohort—being born in the same year or
era).
Cohort Effect
• The influence of membership in a particular
cohort.
• Example: Tobacco use in the U.S.
– Fewer than 5% of population smoked around the
early 1900s.
– Free cigarettes for WWI troops increased
prevalence of smoking in the population.
– During WWI, age of onset varied greatly; then
people began smoking earlier in life.
– One net effect was a shift in the distribution of the
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• The tabulation and analysis of morbidity or
mortality rates in relationship to the ages
of a specific group of people (cohort)
identified at a particular period of time and
followed as they pass thro.
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The capacity for cholera culture testing was increased in 19 of 34 districts in Balochistan, where 7,789 samples were tested and 197 cases were identified. Recent demands for Congo and Dengue PCR kits were met with 150 of each being provided to a lab. Trainings were conducted for lab assistants on proper sample collection for cholera, AJS, and typhoid in 11 flood-affected districts, and for ELISA testing of Dengue, HAV, and HEV in Quetta. Assessments were done of laboratories in 7 districts to identify gaps and strengthen facilities.
WR__EPI updates_21st Feb-Updated Nasirabad.ppt
The document summarizes EPI activities in Balochistan province, including support provided by WHO. It discusses expanded outreach immunization activities conducted from August to December 2022 in flood-affected districts. It provides coverage data for measles and other vaccines in Nasirabad region before and after the October 2022 measles response. It also outlines support provided by WHO for EPI programs in 2023, including integrated outreach activities, birth dose vaccinations, refurbishment of health facilities, and training.
climate and health webinar presentations_2.2023.pdf
- A study examined the risk of mortality from schizophrenia during an extreme heat event in British Columbia in 2021 that caused record-breaking temperatures and a 95% increase in deaths.
- The study used a population-based case-control design to analyze the association between schizophrenia, antipsychotic medication use, and death during the heat wave.
- Results found that people with schizophrenia were at disproportionately high risk of death from the extreme heat. Certain antipsychotic medications were also found to be independently associated with higher risk of death during the heat wave.
- The study concludes that antipsychotic medication is an important risk factor, and people with schizophrenia require special protections during extreme heat events which will increase due to climate change
analyticalstudydesignscasecontrolstudy-160305174642.pdf
Analytical case-control studies compare exposures in groups with and without a disease. Cases are selected who have the disease, and controls without the disease are matched on characteristics like age and sex. Investigators collect exposure data and calculate odds ratios to evaluate associations between exposures and diseases. Case-control studies are useful for rare diseases and outbreak investigations but are susceptible to biases from non-representative sampling and inaccurate recall of past exposures.
8381.ppt
This document discusses descriptive epidemiology and describes different types of descriptive epidemiology studies. The objectives of descriptive epidemiology are to evaluate disease trends, allow comparisons, and identify problems to study analytically. Descriptive studies describe who gets sick, disease patterns, and can identify changes over time due to various factors. Types of descriptive studies discussed include case reports, cross-sectional studies, and correlational studies. Each type has advantages and limitations for understanding disease patterns and generating hypotheses.
Role of Environment in Infection Prevention and Control Webinar 2.pdf
This document announces an online webinar about environmental services management for infection prevention and control. The webinar will take place on October 7, 2021 and feature two speakers discussing practical approaches for environmental cleaning and disinfection in healthcare settings, as well as the challenges of environmental services in limited resource settings. The webinar objectives are listed and include understanding infection transmission, cleaning and disinfection strategies, product selection, and monitoring processes to enhance cleaning and disinfection. Frontline healthcare workers and those involved in infection prevention are encouraged to register for the webinar.
7th Sep Medical Camp.pdf
This document contains data from medical camps held from June 6th to September 7th 2022 in flash flood and monsoon affected areas of Balochistan, Pakistan. It includes information on the total number of patients treated at each camp by gender and age group for various ailments including diarrhea, ARI, snake bites, skin infections and others. A total of 5,645 patients including 2,262 females and 1,766 children were seen across 25 districts in Balochistan and treated for different medical conditions during relief efforts after the floods and rains.
Bullettin_ 06th September 2022.pdf
The document provides an overview of weather conditions, water levels, and disaster response activities in Balochistan province. It summarizes that over the past 24 hours:
- Mainly hot and humid weather was reported across most of Balochistan with a chance of light rain in some areas.
- Several canals and dams are below capacity due to low water levels and discharges.
- Relief operations including the distribution of food, tents and other supplies continued in many flood-affected districts.
Floods update 22nd August, 2022.pdf
1) 22 medical camps were arranged in the last 24 hours in Balochistan, Pakistan, treating a total of 4,190 patients.
2) The majority of patients suffered from diarrhea (761), acute respiratory infections (879), or skin diseases (856).
3) Since July 3rd, over 560 medical camps have been arranged across 34 districts in Balochistan, treating over 120,000 patients in total.
Flood 04-09-2022.pdf
The document summarizes health response activities and needs for flood-affected areas of Balochistan province in Pakistan as of September 4th, 2022. It reports that 1,180 medical camps have been organized treating 285,166 patients across 31 affected districts. Key vulnerable groups include over 1.3 million children under 5, over 624,000 children under 2, and over 734,000 pregnant and lactating women. Ongoing health response activities include integrated medical camps and support from nutrition and water/sanitation working groups. Immediate needs cited are assessment of impacted health services, essential medicines/equipment, and measures to address potential disease outbreaks.
Flood DSR 31-08-2022.pdf
1) Over 34 districts in Balochistan province have been affected by floods, with over 9 million people impacted, including 253 deaths and 164 injuries. 500,000 livestock have also died.
2) Medical camps have treated over 227,000 patients and 297 health facilities have been damaged. The health response is ongoing with nutrition and WASH services in severely affected districts.
3) Key challenges include shortages of healthcare workers and supplies due to damaged roads. There is a risk of disease outbreaks which requires increased prevention, monitoring, and response efforts.
Floods update 30th August, 2022.pdf
The document details medical camps set up in Balochistan province in response to flooding. Over the past 24 hours, 22 medical camps treated 4418 patients in 7 districts. The majority of patients suffered from diarrhea (1273), acute respiratory infections (700), and skin diseases (779). Children accounted for the largest proportion of patients. No major disease outbreaks have been reported from flooded areas and the health situation remains under control.
2 Sep Med Camp .pdf
This document summarizes patient data from 16 medical camps organized across 15 union councils in Balochistan, Pakistan on September 2nd, 2022 in response to flash flooding and monsoon rains. A total of 4,237 patients were treated, including 1,143 males, 1,454 females, and 1,640 children. The majority of cases seen were related to diarrhea (1,010), acute respiratory infections (1,091), and skin infections (988). No cases of snake bites were reported. The camps were organized by the Health Department, Peoples' Primary Healthcare Initiative (PPHI), and other non-profits to provide relief to affected communities.
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4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
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Cohort study.pptx
- 1. Cohort studies 14th June 2021 Dr Tehzeeb Zulfiqar
- 2. Objectives To understand basic description of the study design To show real life example of a Cohort study To highlight key design issues, biases and how to control
- 3. Study design
- 4. Cohort study
- 5. Cohort study
- 6. • More than 5,000 people 30 and 62 years of age, free of coronary heart disease were recruited. • Examined every 2 years – 70 years and still going on • Now three generations are enrolled-children, parents and grandparents http://www.framinghamheartstudy.org/ Started in Framingham, Massachusetts, USA in 1948
- 8. Some other notable cohort studies
- 9. Advantages and disadvantages of Cohort studies Advantages • High level of evidence about establishment of disease • Causal inferences can be established • High external validity Drawbacks • Misclassification • Expensive • Time consuming • Lost to follow up
- 10. Prospective and Retrospective cohorts
- 11. Retrospective or historical cohorts • Requires good record (such as birth record) of past exposure for a group of people who can then be traced to determine their health status. • Record linkages • Birth records • Hospital admissions • Emergency presentations • Midwives notifications • Cancer registries
- 12. Comparing the strengths and weakness of different study designs Cross sectional Randomized controlled Trials Cohort Investigation of rare disease or outcome Investigation of rare exposure Testing multiple effects of an exposure Study of multiple exposures Establishing temporality (exposure come before outcome) Give a direct measure of incidence Explore exposures which changes over time Time required cost Ethical problems
- 13. Analysis of RCT & Cohort and cross sectional studies • What type of analysis are appropriate for these study designs? • Give formulas Statistical test Cross- sectional RCT Cohort Incidence Prevalence Relative risk Attributable risk Prevalence ratio Odds ratio
- 14. Thank you