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TYPE OF
STUDY
OBSERVATIONAL STUDIES
ALTERNATIVE
NAME
A. DESCRIPTIVE STUDIES
B. ANALYTICAL STUDIES
1. Ecological
Co-rrelational
2. Cross sectional
Prevalence
3. Case control
Case reference
4. Cohort
Follow up
EXPERIMENTAL/
INTERVENTIONAL STUDIES
A. RANDOMIZED CONTROLLED
TRIALS (RCT)
B. NON RANDOMIZED CONTROLLED
TRIALS
Clinical Trials
DESCRIPTIVE EPIDEMIOLOGY
Describes the distribution of disease patterns
according to time, place and person.
PROCEDURES IN DESCRIPTIVE STUDIES
Major signs
Minor signs
(intermittent or constant)
Oropharyngeal candidiasis
Chronic progressive or
disseminated herpes simplex
infection
Generalized lymphadenopathy
PLACE
PERSON
Birth order
Month, week
Gender
Family size
Marital
status
Height
Day,
Country,
region
Urban/rural
Hour of
onset
Duration
Social
status
Education
B.P.
Blood
cholesterol
Personal
habits
TIME DISTRIBUTION
Time trends/fluctuations
I.
II.
Periodic fluctuation
PROPAGATED
EPIDEMIC
Single
exposure
(Point source)
Person to person
Multiple/Continuous
/repeated exposure
Animal reservoir
Arthropod vector
EPIDEMIC CURVE
Graph of time distribution of epidemic cases
Shows time relationship with exposure to
a suspected source
Number of cases
Time
Causative factors
Infectious agent
Chemical contamination
Examples:
Salmonella food poisoning
Bhopal gas tragedy, India (MIC gas)
Minamata disease, Japan (methyl mercury in fish)
4
2
17
15
13
11
0
3
10
Examples:
PROPAGATED EPIDEMIC
Usually person to person transmission of
an infectious agent
(Epidemics of Polio & Hepatitis A, Measles)
Gradual rise and gradual fall
Speed of spread depends upon
1.Herd immunity
2.Opportunities for contact
3.SAR
Susceptible
Source/vector
Immunity
( Susceptibles )
Gradual
rise
Gradual
fall
Propagated Epidemic
Peak
Measles
Early spring
Winter
GIT Inf.
Summer
Sunstroke
Summer
Seasonal Trend
PNEUMONIA
DIARRHOEA
15
10
Series1
5
0
NO. OFCASES
NO. OFCASES
15
10
Series1
5
0
J F M A M J J A S O N D
J F M A M J J A S O N D
MONTH
MONTH
B. CYCLIC TREND
Disease at regular time intervals/cycles
(days, weeks, months, years)
Measles
(Prevaccination era)
Rubella
years
6-9 years Variation in herd
immunity
Influenza pandemics
7-10
Antigenic
years
variation
Weekends -
Automobile accidents
in US
Variation in herd
immunity
NO. OF CASES
MEASLES
10
8
6
4
2
0
Series1
1 2 3 4 5 6 7 8 9 10 11
YEARS
Tuberculosis,
Polio,
Diphtheria
SMR
TB mortality in England
1400
1200
1000
800
600
400
200
0
BCG, DRUGS
1871
1891
1911
1931
years
1951
1971
PLACE DISTRIBUTION
Geographical pathology: Study of geography of disease
I.INTERNATIONAL VARIATIONS
Japan
Stomach Cancer
India
Japan
Western
countries
Developed
countries
Developing
countries
II.NATIONAL VARIATIONS
Some parts of a country are affected more
than other parts
e.g. Lathyrism, Malaria, Leprosy,
Nutritional deficiency diseases
BIMARU states
III.RURAL-URBAN VARIATIONS
RURAL:
Helminthic diseases,
Skin Inf.,
Zoonotic diseases
High IMR and MMR
URBAN:
Accidents, Lung cancer,
Cardiovascular diseases,
Mental illness, drug abuse
CAUSES FOR VARIATION:
Difference in population density, Social class, medical care,
education, sanitation, environmental factors
IV.LOCAL DIFFERENCES
Variation between outer and inner city areas
Spot map/shaded map
Shows at a glance areas of high & low frequency,
boundaries & patterns of disease distribution
Clustering of cases in map
Common source of inf./Common risk factor
MIGRATION STUDIES
To evaluate the role of possible genetic and environmental
factors in disease causation
A.
Comparison of disease and death rates in migrants with
those of their kins who stayed at home
(Genetically similar groups, under different environments)
If the rates (after some years) are similar to country of
adoption
Change in the environment
Study of twins in two different environments
B.
Comparison of migrants with local population of host
country
(Genetically different, under same environment)
If rates of disease and deaths are similar to the country
of origin
Genetic factors responsible
Examples of Migration studies:
1. Japanese living in USA have a higher coronary heart
disease than Japanese in Japan
2. Japanese in USA have similar (to USA) rate of
stomach and colon cancer
PERSON DISTRIBUTION
1.AGE: Childhood-Measles
Middle age-Cancer
Old age-Atherosclerosis
Chronic diseases show progressive increase with
age (Cumulative exposure to some risk factors)
Bimodality:
2 separate peaks in age incidence curve
Hodgkins disease, leukaemia, Breast Cancer in females
Indicates 2 distinct set of causal factors may be present
Only small number of observations
Hodgkin's disease
8
Rate
6
4
2
0
0
10 20 30 40 50 60 70 80 90
Age
Bimodal peak
2.SEX
In males: Coronary heart disease, Lung Cancer
In females: Diabetes, Hyperthyroidism, Obesity
Causes:
Basic biological differences including sex linked genetic
inheritance, Cultural and behavioral differences
(smoking, automobiles use, alcoholism)
3.ETHNICITY
Diabetes - Asians
Congenital adrenal hyperplasia - Eskimos
Tay sachs disease - Jews
Causes: Genetic/Environmental factors
4.MARITAL STATUS
For married persons: Less mortality
Less morbidity
Less mental illness
Less suicide rate
More Sexually Transmitted Diseases
More Cancer cervix
(Hypothesis from the studies which
shows that Cancer cervix is rare in nuns)
5.OCCUPATION
Altered Habits
Sedentary workers: Heart disease
Occupational diseases
Coal miners: Silicosis
Bysinossis: Cotton dust
Occupation accidents
6.SOCIAL STATUS
High Social Class
Better health,
Better nutritional status,
longer life expectancy
Coronary Heart Disease, Hypertension, Diabetes
Low Social Class
More Infectious diseases and Alcoholism
7.BEHAVIOUR
Smoking, sedentary life style,
Over eating, drug abuse,
Mass movements (in pilgrimages)-Infections, STDs
8.STRESS
Susceptibility to diseases
9.MIGRATION
Migration from rural to urban areas
(Increase in malaria, filaria, leprosy)
4. MEASUREMENT OF
DISEASE
Prevalence study
More useful for chronic disease
Distribution pattern may suggest causal hypothesis
B. Longitudinal studies:
6. FORMULATION OF A HYPOTHESIS
Hypothesis is a supposition ,arrived at from
observation. It can be accepted or rejected,
using the analytical studies
Hypothesis should specify:
Hypothesis: