Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
An epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called study and control groups to receive and not receive an experimental preventive or therapetuic procedure, maneuver, or intervention .
Social and Preventive Medicine Classroom discussion topic on types of Epidemiological study designs available.
sole reference is Park text book 20th edition
An epidemiological experiment in which subjects in a population are randomly allocated into groups, usually called study and control groups to receive and not receive an experimental preventive or therapetuic procedure, maneuver, or intervention .
Social and Preventive Medicine Classroom discussion topic on types of Epidemiological study designs available.
sole reference is Park text book 20th edition
3.conducting research effectively in a clinical setup with voice oversAnjali Ahuja
Informative content on types of clinical study like experimental and non-experimental studies with examples which explains what kind of study yields specific results, when to consider hypothesis, how observational study differs from experimental etc.
Health: “a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”.
Health is fundamental human right and nation has a responsibility for the health of its people.
The health problems of India may be conveniently listed under the following heads:
1. Communicable disease problems
2. Noncommunicable disease problems
2. Nutritional problems
3. Environmental sanitation problems
4. Medical care problems
5. Population problems
The science and art of preventing disease, prolonging life, and promoting physical and mental health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery, which will ensure to every individual in the community a standard of living adequate for the maintenance of health.
Demography addresses human populations as population per se, that is, their sizes and structures.
It is the scientific study of human population.
Demographic processes :
1. fertility 4. migration &
2. mortality 5. social mobility
3. marriage
Indicator is a variable which gives an indication of a given situation or a reflection of that situation.
Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community.
Indicators help to measure the extent to which the objectives and targets of a programme are being attained.
Immunization is a process of protecting an individual from a disease through introduction of live attenuated, killed or organisms or antibodies in the individual system.
Immunization is the process of protecting an individual by active or passive method.
The immunizing agents are
Vaccines, Immunoglobulins and antisera
Why vaccination?
Prevention of deadly and debilitating diseases.
Keeps child from suffering through a preventable illness.
Less doctor visits
No hospitalization
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Observingthedistributionofdiseaseorhealth related events in human population.
• Identify the characteristics with which the disease is associated.
• Basically 3 questions are asked who, when and where.
• Who means the person affected, where means the place and when is the time distribution.
As per John M. Last (1988) Epidemiology is the study of the distribution and determinants of health related states or events in specified populations, and the application of this study to the control of health problems.
The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
National programme for prevention and control of cancer, diabetes, CVDs and s...Dr Lipilekha Patnaik
NCDs are surpassing the burden of communicable diseases in India, need for National Programme on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke was envisaged.
On 19 November 1985, GOI renamed EPI program, modifying the schedule as ‘Universal Immunization Program’ dedicated to the memory of Late Prime Minister Mrs Indira Gandhi.
UIP has two vital components: immunization of pregnant women against tetanus, and immunization of children
A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health and to seek help when needed.
ICD-10 is a statistical classification, which means that it contains a limited number of mutually exclusive code categories, which describe all disease concepts.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Study designs, Epidemiological study design, Types of studies
1. STUDY DESIGNS
- An Overview
Dr Lipilekha Patnaik
professor, Community Medicine
Institute of Medical Sciences & SUM Hospital,
Siksha ‘O’ Anusandhan deemed to be University
Bhubaneswar, ODISHA, INDIA
E mail– drlipilekha@yahoo.co.in
1
2. Session Outline
Study designs and its types
Observational and Interventional studies
Uses of different studies
Systematic review and metaanalysis
Hierarchy of study designs in research
An introduction to Qualitative study
Ideal study design for different situations
2
3. Study Design
A study design is a specific plan or protocol
for conducting the study,
which allows the investigator to translate the
conceptual hypothesis into an operational one.
3
5. Quantitative vs Qualitative
vQuantitative research is used to quantify the
problem by way of generating numerical data
which can be transformed into useable
statistics. It can generalize results from sample
to population.
vQualitative research is exploratory research.
It is used to gain an understanding of
underlying reasons, opinions etc. and provides
insight into the problem.
5
7. Types of epidemiological studies
Types of studies Alternative name Unit of study
OBSERVATIONALSTUDIES
◦ Descriptive studies – Case report, case series Individuals
◦ Cross sectional surveys
◦ Analytical studies
◦ Ecological Correlation Populations
◦ Cross-sectional Prevalence Individuals
◦ Case-control Case-reference Individuals
◦ Cohort Follow-up Individuals
EXPERIMENTALSTUDIES (Intervention Studies)
◦ Randomized control trials Clinical Trials Patients
◦ Field trials Healthy People
◦ Community trial Community studies Communities
7
8. DESCRIPTIVE STUDIES
ØDescriptive study is the first phase of epidemiological
investigation.
ØObserving the distribution of disease or health related
events in human population.
ØIdentify the characteristics with which the disease is
associated.
ØBasically 3 questions are asked when, where and who
i.e. Time, place and person distribution.
8
10. Case Reports
ØDetailed presentation of a single case.
ØGenerally report a new or unique finding
üe.g. previous undescribed disease
üe.g. unexpected link between diseases
üe.g. unexpected new therapeutic effect
üe.g. adverse events
10
11. Case Series
ØExperience of a group of patients with a
similar diagnosis
ØCases may be identified from a single or
multiple sources
ØGenerally report on new/unique condition
11
12. Cond.
ØAdvantages
•Useful for hypothesis generation
•Informative for very rare disease with few
established risk factors
ØDisadvantages
•Cannot study cause and effect relationships
•Cannot assess disease frequency
12
17. Ecological Study
žIt is not easy to establish links between environmentalexposures
and health outcomes using individuallevel data.
žEcological study designs provide one way of avoiding these
difficulties and studying the effects of environmentalexposures on
different health outcomes.
žEcological studies look for associations between the occurrenceof
disease and exposure to known or suspected causes.
žHowever, the unit of analysis is not an individualbut a population /
a group of persons
17
19. Cross-sectional Study
Data collected at a single point in time
An “observational” design that surveys exposures and
disease status at a single point in time (a cross-section
of the population)
Describes associations
Prevalence
19
A “Snapshot”
20. 20
time
Study only exists at this point in time
Study
population
No Disease
Disease
factor present
factor absent
factor present
factor absent
21. Sample of Population
Playing
outdoor games
regularly
Not playing
outdoor games
Prevalence of
Overweight/
obesity
Prevalence of
Overweight/
obesity
Time Frame = Present
21
Defined Population of school
going adolescents
Example
22. Why we do cross-sectional study?
ØTo assess the burden of disease in a population
and to assess the need for health services.
ØTo compare the prevalence of disease in
different populations.
ØTo examine trends in disease prevalence or
severity over time.
ØTo find out association
22
25. Case-Control Studies
§Start with people who have disease (Cases)
§Match them with controls that do not have
disease
§Look back and assess exposures
25
26. Other Name Retrospective Study
Unit of Study Cases/Control
Study QuestionWhat has happened ?
Direction of Inquiry= F O
Study Design
26
30. Cohort Study
Cohort is defined a group of people who share a
common characteristic or experience within a
defined time period (age, occupation, exposure)
Birth cohort, exposure cohort
30
31. Begin with disease-free individuals
Classify patients as exposed/unexposed
Record outcomes in both groups
Compare outcomes using relative risk
31
32. Other Name Prospective Study / Follow-up
Study/Incidence Study
Unit of Study Individual
Study Question What is happening ?
Directionof Inquiry F O
Study Design
32
36. EXPERIMENTAL STUDIES
1. Experimental studies are similar in approach to cohort studies
excepting that the study condition are under direct control of the
investigator.
2. There is some action, intervention or manipulation which are
deliberate.
AIM OF EXPERIMENTAL STUDY
1. To provide scientific proof of aetiological factor.
2. To provide a method of measuring the effectiveness and efficiency of
health services for the prevention control and treatment of diseases.
TYPES OF EXPERIMENTAL STUDIES
1. Animal study
2. Human study
36
38. Other Name Intervention Study
Objective To know the effect of intervention
Unit of Study Individual meeting entry criteria
Study Question What is happening after intervention in both
groups ?
Direction of Inquiry I E
Study Design (Intervention with Standard of care or placebo)
38
39. Experimental Design
39
time
Study begins here (baseline point)
Study
population
Intervention
Control
outcome
no outcome
outcome
no outcome
baseline
future
RANDOMIZATION
40. Participants are allocated in to two groups.
1) study group : To receive preventive and
therapeutic manoeuvres.
2) control group : Not to receive any
intervention or to receive standard of care.
40
Randomisation
41. 41
time
Study begins here
obese students
Intervention
(Regular exercise
&Outdoor games)
Control
Decrease BMI
No change of BMI
Decrease BMI
No change of BMI
Obese
students Future
(After 2 years)
RANDOMIZATION
43. Different studies have different uses
Objective Type of study
Prevalence Cross-sectional
Incidence Cohort
Causal association Cohort
Case-control
Prognosis Cohort
Natural history of
disease
Cohort
Treatment effect Randomised Controlled
Trial
43
44. Did the investigator assign
exposure?
Experimental Study Observational Study
Yes No
Random Allocation?
Comparison Group?
Yes Yes
No
No
Analytical
Study
Descriptive
Study
Randomized
Control
trial
Non-
Randomized
Control trial
Direction?
Exposure Outcome
Exposure and
outcome at
the same time
Cohort
Study
Case
Control
Study
Cross-
Sectional
Study
Exposure Outcome
44
45. Systematic Review
“A review that is conducted according to clearly stated, scientific
research methods, and is designed to minimize biases and errors
inherent to traditional, narrative reviews.”
Margaliot, Zvi, Kevin C. Chung. Systematic Reviews: A Primer for Plastic Surgery Research. PRS Journal.
120/7 (2007)
45
46. Meta analysis
ØMeta-analysis is a statistical analysis of a collection of
studies.
ØMeta-analysis methods focus on contrasting and comparing
results from different studies in anticipation of identifying
consistent patterns and sources of disagreements among
these results.
Ø“While all meta-analyses are based on systematic review of
literature, not all systematic reviews necessarily include meta-
analysis.”
46
48. QUALITATIVE RESEARCH
Qualitative research can provide insight into
the priblem which is not possible with purely
quantitative data
• A means for exploring and understanding the
meaning individuals or groups ascribe to social or
human problems
• Study human behavior and social world
Help us to understand the world in which we
live and why things are the way they are
48
49. Qualitative research answer questions on:
◦Why people behave the way they do
◦How opinions and attitudes are formed
◦How people are affected by the events that
go on around them
◦How and why cultures have developed
◦The difference between social groups
49
50. Which is the ideal study design?
§A rare case of Dermatomyositis came to the hospital –
Case report
§Prevalence of Hypertension among adolescents in Bhubaneswar city –
Cross sectional
§To find out the association of bottle feeding with the incidence of diarrhea –
Cohort
§Association of Smoking and MI –
Case Control
§Safety and efficacy of Malaria vaccine –
RCT
§To explore factors of nonuse of contraceptives in a tribal community –
Qualitative study
50