Cvd risk
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This document discusses risk and probability as they relate to developing diseases. It defines risk as the probability of an event occurring, and provides examples of calculating risk percentages. It explains that epidemiology studies the health factors of populations, and that researchers identify risk factors for diseases by comparing groups with different lifestyles or genetic traits. Correlations between mortality rates from diseases like heart disease and smoking patterns are presented, though a correlation does not necessarily prove causation.
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State primary objectives of descriptive epidemiology
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List characteristics of person, place, and time
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Descriptive vs. Analytic Epidemiology
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Objectives of Descriptive Epidemiology
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State primary objectives of descriptive epidemiology
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After reading Chapter 9 of Epidemiology for public health practice, complete Study Questions and Exercises 1–9. This activity is located on pages 431–432. Submit your responses in the form of a Word document.
1- Calculate the etiologic fraction when the RR for disease associated with a given exposure is 1.2, 1.8, 3, and 15.
2- The impact of an exposure on a population does not depend upon:
· a.the strength of the association between exposure and disease.
· b.the prevalence of the exposure.
· c.the case fatality rate.
· d.the overall incidence rate of disease in the population.
· The next seven questions (3–9) are based on the following data: The death rate per 100,000 for lung cancer is 7 among nonsmokers and 71 among smokers. The death rate per 100,000 for coronary thrombosis is 422 among nonsmokers and 599 among smokers. The prevalence of smoking in the population is 55%. (If necessary, refer to the chapter on cohort studies for formulas for RR.)
3- What is the RR of dying of lung cancer for smokers versus nonsmokers?
4-What is the RR of dying of coronary thrombosis for smokers versus nonsmokers?
5-What is the etiologic fraction of disease due to smoking among individuals with lung cancer?
6-What is the etiologic fraction of disease due to smoking among individuals with coronary thrombosis?
7-What is the population etiologic fraction of lung c.
Frequency Measures Used in EpidemiologyIntroductionIn e.docx
Frequency Measures Used in Epidemiology
Introduction
In epidemiological studies, many qualitative variables have only two possible categories, such as
Alive or dead
Case or control
Exposed and unexposed
The frequency measures for dichotomous variable include:
Ratio
Proportion
Rate
( All the above 3 measure are based on the same formula: )
Ratios, Proportion, and Rates Compared
In a ratio, the values of x and y may be completely independent from each other or x is a part of y
For example , the gender of the children attending a specific program could be compared in one of the following ways:
Proportion is a ratio in which X is included in Y
For example , the gender of the children attending a specific program
Rate is a proportion that measures the occurrence of an event in a population over time
Rate = X
Ratios, Proportion, and Rates Compared
Example 1: The following table was part of an article published by Dr. Mshana and his colleagues. The title of this study is “Outbreak of a novel Enterobacter sp. carrying blaCTX-M-15 in a neonatal unit of a tertiary care hospital in Tanzania. ". Please use this table to answer the following questions.
Source: Mshana SE, Gerwing L, Minde M, Hain T, Domann E, Lyamuya E, et al. Outbreak of a novel Enterobacter sp. carrying blaCTX-M-15 in a neonatal unit of a tertiary care hospital in Tanzania. International journal of antimicrobial agents. 2011;38(3):265-9.
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Example 1
What is the ratio of males to females? 7 : 10
What proportion of premature babies? 12/17=0.706
What proportion of patients were discharged? 11/17=0.647
What is the ratio of prematurity to birth asphyxia ? 12 : 5
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5
Example 2:
In 1989, 733,151 new cases of gonorrhea were reported among the United States civilian population. The 1989 mid-year U.S. civilian population was estimated to be 246,552,000. What is the 1989 gonorrhea incidence rate for the U.S. civilian population? (For these data we will use a value of 105 for 10n ).
Answer:
Incidence rate = X
Incidence rate = X = 297.4 per 100,000
6
Measures of association:
They are used to quantify the relationship between exposure and disease among two groups
They are used to compare the disease occurrence among one group with the disease occurrence in the another group
They include the following measures based on the study design:
Risk Ratio (RR):
It also called relative risk
It is used to compare the risk of health related events in two groups
The following formula cis used to calculate the RR:
A risk ratio of 1.0 indicates identical risk in the two groups
A risk ratio greater than 1.0 indicates an increased risk for the numerator group
A risk ratio greater than 1.0 ...
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Confounding is a mixing of effects of extraneous factors (confounders) with the effect of the exposure of
interest. The association between exposure and disease is distorted because it is mixed with the effect
of another factor that is also associated with the disease. A confounder is therefore an alternative
explanation for the observed association between an exposure and disease. The result of confounding is
to distort the true association either towards or away from the null. Many epidemiologists refer to
confounding as a type of bias.
Example: Who can run faster, men or women?
Exposure: gender
Outcome: speed
Hypothesis: The average running speed of men is faster than the average running speed of women.
All men and women in one town invited to participate in a road race. On race day, both men and
women come and race. The average running time for the men is faster than the women.
CONCLUSION: Men run faster than women, because of their gender.
But wait! Someone notices that women with young children did not race. In fact, women who ran
the race were, on average, older than men who ran. For example, the average age of women was 50
years while the average age of men was 25 years. CONCLUSION: Perhaps men were faster not
because of their gender, but because they were younger.
Another race is held, this time making sure that the ages in the two groups (men and women) are
comparable. In other words, the men and women have same distribution of ages. Race result: Once
again, men are faster. CONCLUSION: Controlling for age, men are still faster than women.
But wait! Someone points out that the men are, on average, taller than the women. CONCLUSION:
Perhaps men were faster not due to their gender, but because their legs are longer.
Another race is held, this time making sure both heights and ages in the two groups (men and
women) are comparable. Race result: Once again, men are faster. CONCLUSION: Men are faster
than women, regardless of age or height.
But wait! Someone points out that 50% of the women had hair longer than their shoulders, and
only 5% of the men did! CONCLUSION: Long hair made the women run slower? (Is this a reasonable
conclusion?)
The point of this exercise is to demonstrate that there are in fact often many alternative explanatory
factors for the association between an exposure and an outcome. Properly considering potential
confounding factors is an important part of any epidemiologic analysis.
Criteria for confounding
Let’s review the meaning of association. If a characteristic is associated with disease, then the risk of
disease is different among people with the characteristic compared to those without. If the
CONFOUNDING
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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