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TutorialTambahan

Kelas MKO KMPK

Q.1
Casecontrol: Case Ca paru C t l Bebas Control B b Ca C paru Dibagi berdasarkan penyakitnya Membandingkan M b di k proporsi i paparan (merokok vs tidak merokok)

R
Intervention Control

Outcome

Outcome
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Q.2
Cohortstudy Seluruh populasi, dibagi berdasar paparannya. Yangdibandingkan: Angka kejadian penyakitnya p y y
Cohort study

Population

Non Random Allocation

Group A

Group B

Q.3
Rumah sakit sebagai tempat penelitian:
Lebih mudah menemukan kasus diRS Diagnosissudah tegak dan akurat Akses ke rekam medis yanglengkap Pasien P i cenderung d l bih mudah lebih d h diajak di j k bekerjasama b k j (karena penelitian ini tentang penyakit yang mereka derita) Mudah mendapatkan kontrol

Q.4
Sumber kasus yanglain:
Akta kematian,laboratorium patologi klinik,data dari perusahaan asuransi, asuransi dokter, dokter datadari tempat kerja

Sumber kontrol yanglain:


Tetangga,teman,pasien laindari dokter yang sama,populationbased

Q.5
Mudah Kemungkinan besar berasal dari lingkungan yangsama dengan pasien kasus (statussosial ekonomi,tempat tinggal,akses ke layanan kesehatan dll) kesehatan, Rekam medis standard Mudah bekerjasama

Q.8
Discuss:guna casecontrolstudy Kontrol yangberasal dari RS mungkin dirawat karena penyakit lainyangjuga disebabkan oleh merokok Sehingga,kebiasaan merokok pada kontrol akan lebih tinggi daripada populasi normal hubungan antara merokok dan Ca Paru akan ?
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Q.9
Cases Cigarette smoker Non-smoker T l Total 1,350 7 1 357 1,357 Controls 1,296 61 1 357 1,357

Proporsi perokok pada kasus: Proporsi perokok pada kontrol:

1.350/1.357=99.5% 1.296/1.357=95.5%

Q.11
Oddsmerokok pada pasien Ca Paru (kasus):

Odds = probability / (1 - probability) = proportion / (1 - proportion)

Odds of smoking, cases: (1350 / 1357) / (7 / 1357) = 1350 / 7 = 192.9 192 9 : 1

Odds = # yes / # no = # wins / # losses = # exposed / # unexposed

Q.11b
Oddsmerokok pada pasien kontrol:

(1296 ( 96 / 1357) 35 ) / ( 6 61 / 1357) 35 ) = 1296 96 / 6 61 = 21.2 : 1

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Q.12
Ratio of odds = (a/c) / (b/d) = (1350 / 7) / (1296 / 61) = 192.9 / 21.2 = 9.1
Cross-product ratio = (a x d / b x c) = (1350 x 61) / (1296 x 7) = 9.1

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Q.14
Jumlah rokok 0 114rokok/hari #kasus 7 565 #Kontrol 61 706

OR=565/706 7/61

1-14 cigarettes, OR = (565 x 61) / (706 x 7) = 7.0 15-24 cigarettes, OR O = (445 ( x 61) ) / (408 ( x 7) ) = 9.5 25+ cigarettes, OR = (340 x 61) / (182 x 7 ) = 16.3 All smokers, OR = (1350 x 61) / (1296 x 7) = 9.1
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Q.16
Chance Selectionbias Information f i bi bias Confounding Investigatorerror

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Q.17
Ruleofthumb:80%responserate

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Q.18
Daily number of cigarettes smoked 0 1-14 15-24 25+ All smokers Total Deaths from lung cancer 3 22 54 57 133 136 Personyears at risk 42,800 38,600 38,900 25,100 102,600 145,400 Mortality rate per 1000 person-years p y 0.07 0.57 1.39 2.27 1.30 0.94 Rate Ratio referent 8.1 19.8 32.4 18.6 Rate difference per 1000 person-years p y referent 0.50 1.32 2.20 1.23

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Thetwomajortypesofbias:
Selection bias Measurement bias

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Selectionbias
Occurswhenthereisadifferencebetween characteristicsofpeopleselected forastudyand those notselected If it occurs: we see a relation between risk factor and disease that is different in those in the study compared with those who would have been eligible but did not participate

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Whyisitimportant?
Becausewedoastudytotryandgeneralizethe resultstoTHEWHOLEPOPULATION eg Letstryandfindoutwhatproportionofpost menopausal p womeninAustraliauseHRT?

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Remember..
Wheneverwedoastudy, y,weselectag group pof people,dothestudy,gettheresult... Wethenusetheresulttogeneralizetothewhole population eg isthisthetrueprevalenceofwomenonHRTin Australia?

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Prevalenceofpostmenopausalwomenin Australiausing gHRT?


Howcanweselectthewomenforourstudy?

How would YOU do it ?

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Prevalenceofpostmenopausalwomenin Australiausing gHRT?


Howcanweselectthewomenforourstudy? AskALLwomen Advertiseinthenewspapers GotoGP Recruitfromshoppingcentres Recruitfromgyms Doorknock Randomtelephonecontact
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Always think critically about HOW recruitment might have effected the type of subjects you have in your study

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?Bias
AskALLwomen=theTRUTH!! Advertiseinthenewspapers=?healthconsciouswomen GotoGP=?morelikelytobeonHRT Recruitfromshoppingcentres=?healthconsciouswomen Recruitfromgyms=?healthconsciouswomen Doorknock=? ?lesshealthconsciouswomenbecauseat home Randomtelephonecontact=?lesshealthconsciouswomen becauseathome

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Selectionbiasincasecontrolstudies
C Can be b a major j problem bl Controlsshouldbeselectedsothattheyrepresent thegeneralpopulationfromwhichthecasesare drawn.

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Selectionbiasincasecontrolstudies
Eg Case control study of childhood brain tumor. Cases = all cases at the Royal Childrens Hospital. Hospital How do we find controls? How might you do this?

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Hospitalbasedcontrols
Oftenused Couldtherebeaproblem? Best=matchedtopostcode.Why? g Casecontrolstudy yoflung gcancerattheAlfred Eg Hospital.Canyoucollectcontrolsfromthe orthopoedic unit?

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Selectionbiasincohortstudies
Less problem because exposure is identified before disease, disease but still problem if wrong control group selected eg potential problem if general population is used as a control in occupational health studies: healthy worker effect

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Cohortstudies
Problemoflosstofollowup ThosethatdropoutofthestudyNOTthesameas thosethatstay yinastudy y Mayintroducebias

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Measurementbias
Occurswhenthemeasurementorclassificationof diseaseorriskfactorarenotaccurate i.e.theyarenotcorrectlymeasuringwhattheyare supposedtomeasure

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Errorsinmeasurementmayoccurdueto:
Ob Observer(observer ( b bias) bi ) Studyparticipant(responderbias) The h instruments(e.g. ( questionnaireor sphygmomanometer)usedtomakethe measurements

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