Experimental epidemiological studies involve investigators designing research with control over protective factors being studied. Subjects are randomly assigned to exposed and unexposed groups to eliminate confounding. Types of experimental studies include randomized controlled trials (RCTs) that evaluate therapies, controlled field trials (CFTs) of preventive interventions like vaccines, and community trials (CTs) involving whole communities, one exposed to a factor and one unexposed. These studies provide strong evidence when confounding is not an issue as in observational studies.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Observational study is divided into descriptive and analytical studies.
Non-experimental
Observational because there is no individual intervention
Treatment and exposures occur in a “non-controlled” environment
Individuals can be observed prospectively or retrospectively
COHORT STUDY- an “observational” design comparing individuals with a known risk factor or exposure with others without the risk factor or exposure.
looking for a difference in the risk (incidence) of a disease over time.
best observational design
data usually collected prospectively (some retrospective)
CASE CONTROL - EFFECT TO CAUSE
Retrospective
When disease is rare
.
Cohort, case control & survival studies-2014Ramnath Takiar
The presentation discusses about Cohort, Case-control and Survival studies. The concept of Cohort and Case-control studies is explained with the help of diagrams as perceived by me. Some discussion is also there about survival and relative survival. Appropriate data is also provided to explain about survival and relative survival.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
2. History
James Lind – 1747.
one of the first noted,
controlled clinical experiment
in the history of medicine
3. Experimental studies
confounding factors are usually not a problem in
experimental studies
epidemiologists usually study human populations (mainly
through observational studies)
experimental studies are largely used in basic medical
sciences where investigators design researches on animal
models
4. Experimental studies
in experimental studies, the investigator has "control" over
the protective factor that is being investigated
the investigator determines which of the subjects will get a
drug that is being investigated, and who does not
the control group gets either placebo or the best existing
drug on the market – so called gold standard
5. Experimental studies
the best way to classify subjects in the investigated groups
(exposed to investigated drug and unexposed) is
randomization, which indicates the random distribution of
the subjects in the groups
randomization is primarily used to eliminate the effects of
confounding factors
6. Experimental studies
when we use experimental studies in epidemiology, we can
get very strong evidence
these studies should not be implemented until the
probability of a causal or risk relationship has been well
determined using the other types of study designs
7. Types of experimental studies
randomized controlled trial (RCT)
controlled field trial (CFT)
community trial (CT)
8.
Randomized controlled trial (RCT)
the main goal of RCT is to evaluate the therapeutic
approach to the patients who are included in the study
individually
in RCT, we can investigate the effect of drugs, surgical
procedures, certain physical therapeutic methods and other
therapeutic approaches
9.
Controlled field trial (CFT)
in CFT we want to estimate the effect of preventive
intervention most commonly on healthy subjects, which are
included in the study individually
CFT was most frequently applied when investigating the
efficacy of a vaccine
10.
Controlled field trial (CFT)
The Salk Polio Vaccine Field
Trial - Jonas Salk administers
his polio vaccine on February
26, 1957 in the Commons
Room of the Cathedral of
Learning at the University of
Pittsburgh where the vaccine
was created by Salk and his
team
11.
Controlled field trial (CFT)
unlike RCT, CFT most commonly includes healthy subjects,
and sampling is carried out from the population
when investigating the efficacy and safety of the vaccine, we
need to divide the healthy subjects into two groups, one that
will get the active substance (exposed group) and the other
who will be given placebo (unexposed group)
12. Controlled field trial (CFT)
in this type of experimental study we can show results in
several ways:
relative risk
survival curves
effectiveness of the investigated vaccine (calculation of
the population preventable fraction - PPF)
13. Population preventable fraction (PPF)
tells us about the proportion of newly diagnosed cases of
the disease that can be prevented at the population level if
we apply a preventative measure in that population
𝑃𝑃𝐹 % =
𝑝 1 − 𝑅𝑅
𝑝 1 − 𝑅𝑅 + 𝑅𝑅
× 100
p – the proportion of the population that is exposed to the protective factor
RR – relative risk
14. Community trial (CT)
the community trial is a type of experimental study that
involves at least two whole communities, one exposed and
the other unexposed
some of the protective factors cannot be investigated on
individuals because all inhabitants of a particular geographic
area are exposed to such factors
15. Community trial (CT)
in this case, all inhabitants of a geographic area that is
exposed to a protective factor are included in the study, and
as a control group all inhabitants of another geographic area,
where such a factor is lacking
16. Community trial (CT)
one of the best known
community trials began in
1944 in the United States,
and that was a study of the
effect of water fluorination
on health of the teeth in
children
17. Natural experiment
the natural experiment is not a type of experiment studies
the term natural experiment refers to the implementation
of observational epidemiological studies in case of
unfortunate events, such as natural disasters (e.g. flood, fire
or earthquake), or accidents caused by human error and
neglect (for example, Chernobyl catastrophe and methyl-
mercury poisoning in the Gulf Minamata in Japan)
18. Experimental studies ? (mark the correct answer)
confounding factors are usually big problem in experimental
studies
WRONG
confounding factors are usually not a problem in experimental
studies
CORRECT
19. Controlled field trial (CFT)? (mark the correct answer)
CFT was most frequently applied when investigating the
efficacy of a vaccine
CORRECT
CFT was most frequently applied when investigating the
efficacy of a surgical procedure
WRONG
20. Community trial (CT)? (mark the correct answer)
the community trial is a type of analytical study that involves at
least two whole communities, one exposed and the other
unexposed
WRONG
the community trial is a type of experimental study that
involves at least two whole communities, one exposed and the
other unexposed
CORRECT
