Professional Documents
Culture Documents
Lecture X
Lecture X
Lecture X
Lecture series
Introduction:
All protocols start with an introduction section. It is a description of the
scientific background to the research question and should include the
following sections (paragraphs):
a. The importance of the topic
The introduction often begins with a statement of the importance of
the research area based on, for example, the number of people who
suffer from the disease being studied or the cost that it presents to the
health authorities.
b. A brief review of current research
The introduction should include a brief review of the landmark studies
and important recent ones. It is essential to do a literature search (e.g.
Medline, Embase) to be sure you have covered the literature
adequately
c. The need for further (your) research
The introduction is not primarily aimed at summarizing present
knowledge but must make the case for the need for further (your)
research by highlighting the gaps in present knowledge.
d. The broad long-term goals (benefits) of the proposed research
The introduction often concludes with the broad long-term goals
(benefits) of the proposed research.
Research question/hypothesis
Every research work must have research question (s)/hypothesis.
Research question:
Definition: A Research Question is a statement that identifies the
phenomenon to be studied
Many studies have more than one research question.
FINER Criteria for a Good Research question:
1. Feasible
Adequate number of subjects
Adequate technical expertise
Affordable in time and money
Manageable in scope
2. Interesting
Getting the answer intrigues the investigator and her/his friends
3. Novel
Confirms, refutes or extends previous findings
Provides new findings
4. Ethical
Amenable to a study that institutional review board will approve
5. Relevant
To scientific knowledge
To clinical and health policy
To future research
Example of research question
For cross sectional descriptive studies:
What is the prevalence of dry eye among the computer users of
Dhaka University?
Who are the people mostly affected by conjunctivitis?
For case control studies:
Is there any association between computer use and dry eye?
What are the risks of conjunctivitis?
Interventional study:
Does amitryptyline reduce frequency of migraine attack
compared with propranolol?
Type of exposure
Type of patient
Hypothesis:
Definition:
A hypothesis is an educated guess about how things work.
Many study questions undergo a further transformation into a final and
most specific version, termed research hypothesis
When Hypothesis?
Other than descriptive type of cross sectional study all may have a
hypothesis
Characteristics of a good hypothesis:
Simple
Specific
Stated in advance
When hypothesis should be formulated?
If any of the following terms appear in the research question:
Greater than
Less than
Causes
Leads to
Compared with
More likely than
Associated with
Related to
Similar to
Correlated with
Example of hypothesis:
Chocolate may causes migraine
Bacterial growth may be affected by temperature
Ultra violet light may cause cataract
Types of hypothesis:
Null hypothesis or hypothesis of no difference:
There is no association between the predictor and
outcome (e.g. there is no difference in the
frequency of dinking well water between subjects
who develop peptic ulcer disease and those who do
not)
Alternative hypothesis:
The proposition that there is an association (e.g.
the frequency of drinking well water is different in
subjects who develop peptic ulcer than in those
who do not)
In research only alternative hypothesis should be written. The null
hypothesis does not need to be written in the dissertation/thesis.
Objectives in Research:
Research objectives may be stated as:
1. General objective
2. Specific objectives
3. Ultimate objectives
1. General objective:
It is a short statement of the proposed research
It tells in a summary form what will be done during the study
2. Specific objectives:
Every research work involves several tasks. Statement that tell about
each task that will be undertaken during the research work, are termed
as specific objectives
3. Ultimate objective:
If we have written the section of rationale well and given
justification of undertaking the present study, the ultimate
objectives have been covered. However, if we feel the need of
writing the ultimate objectives separately, write them in the
objectives section.
Ultimate objectives describe the idea on the way findings of your
study will be useful and beneficial.
Example: The findings of this case control study will help develop an
authentic document on different risk factors of red eye in Bangladeshi
university student. Such document is so far unavailable in the country.
Use action verb in stating objectives
To assess----------------------------------To examine----------------------------------To describe----------------------------------To explore----------------------------------To elucidate-----------------------------------
Literature review:
Secondary sources are less easily defined than primary sources. What
some define as a secondary source, others define as a tertiary source.
Nor is it always easy to distinguish primary from secondary sources. A
newspaper article is a primary source if it reports events, but a
secondary source if it analyses and comments on those events.
In science, secondary sources are those which simplify the process of
finding and evaluating the primary literature.
More
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Study design
Types of studies:
Epidemiological studies are mainly classified as
1. Observational
2. Experimental
1. Observational studies
Characteristics:
Observational studies allow nature to take its course
The investigator measures but does not intervene
Have no control over exposures; simply observe what happens
to groups of people
Examine associations between risk factors and outcomes
Types:
Two types:
i. Descriptive
ii. Analytical
i. Descriptive study:
Definition:
A descriptive study is limited to a description of the occurrence of a disease
in a population and is often the first step in an epidemiological investigation.
Characteristics:
To describe present or past characteristics of persons with a particular
outcome
Merely describes, does not analyze
Only one group is studied
No comparison group
No conclusion can be made about the association between exposure
and outcome
Type:
1. Case report
2.
3.
4.
5.
Case series
Cross sectional
Survey
Archival research
Definition:
An analytical study goes further by analyzing relationships between health
status and other variables.
Table: Types of epidemiological study (1)
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Observational
Experimental
Descriptive
Analytical
Case report
Ecological
RCT
Case series
Cross sectional
Cluster randomized
controlled trials
Cross sectional
Case control
Field trial
Survey
Cohort
Community trial
Alternative name
Unit of study
Correlational
Prevalence
Case-reference
Follow-up
Populations
Individuals
Individuals
Individuals
Experimental studies
Randomized controlled trials
Cluster randomized controlled
trials
Field trials
Intervention studies
Clinical trials
Community trials
Community intervention
studies
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Individuals
Groups
Healthy
people
Communities
1. Case study:
Definition:
Case study refers to the collection and presentation of detailed information
about a particular participant or small group, frequently including the
accounts of subjects themselves.
Characteristics:
It is a qualitative descriptive research
It is useful in rare diseases
It may be first to provide clues in identifying a new disease or adverse
health effect from an exposure
The case study looks intensely at an individual or small participant
pool, drawing conclusions only about that participant or group and only
in that specific context.
It provides insights for research questions to be addressed by
subsequent, planned studies
It generates hypothesis
Strengths
provide real examples
encourage replication
are generally practical in nature
Provide innovative ideas.
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2. Case series
Definition:
A case series is a study very similar in structure and form as case reports, but
describes a group of cases, instead of a single patient.
This study design may be retrospective or prospective, and usually
requires a relatively small sample size (usually 10 or more).
Characteristics:
Retrospective or prospective
Usually involves a smaller number of patients
Case series may be consecutive or non-consecutive, depending on
whether all cases presenting to the reporting authors over a period of
time were included
Case series may be confounded by selection bias, which limits
statements on the causality of correlations observed
It generally involve patients seen over a relatively short time
Case-series studies do not include control subjects
It provides insights for research questions to be addressed by
subsequent, planned studies
It generates hypothesis
Disadvantages:
Weakest kinds of observational studies
Represent a description of typically unplanned observations
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3. Survey:
4. Archival research:
Study method that examines existing records to obtain data and test
hypothesis.
Example: A researcher might study crime statistics in different countries to
see if there is a relation between capital punishment and the murder rate.
5. Anecdote:
A short account (or narrative) of an interesting or amusing incident, often intended to
illustrate or support some point.
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Analytical studies
Ecological (correlational) study:
Ecology:
Derived from Greek word, Meaning: study of house
The study of the relationships among living organisms and their environment
Human ecology means the study of human groups as influenced by
environmental factors, including social and behavioral factors.
Ecological study:
Definition:
A study in which the units of analysis are populations or groups of people,
rather than individuals
Common types of ecological study are geographical comparisons, time trend
analysis or studies of migration.
Example:
A study of mortality from lung disease in different cities that are known to
have differing levels of air pollution would comprise an ecologic study. The
unit of analysis is a city.
Look at the association between smoking and lung cancer deaths in different
countries. The unit of analysis is a country
Characteristics:
Examine rates of disease in relation to a population-level factor
Population-level factors include summaries of individual population
members, environmental measures, and global measures
Study groups are usually identified by place, time, or a combination of
the two
Limitations include the ecological fallacy and lack of information on
important variables
Ecologic studies generally make use of secondary data that have been
collected by the government, some other agency or other
investigators.
Advantages include low cost, wide range of exposure levels, and the
ability to examine contextual effects on health.
Advantages:
Simple to conduct
Low cost
Wide range of exposure levels
Ability to examine contextual effects on health
Disadvantages:
Inferior to non-ecological designs such as cohort and case-control
studies
It is susceptible to the ecological fallacy.
lack of information on important variables
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Cohort study
Information on individual members
are inevitable
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18
Risk ratio
(relative risk)
Disease
Yes
No
Yes
No
A
A+B
C
C+D
Risk
Factor
Disadvantages:
We cannot come to the conclusion about the disease aetiology
We cannot follow up the cases
Very weak analytical power
We cannot find out the incidence of the disease
Example:
Javadi MA, Katibeh M, Rafati N, Dehghan MH, Zayeri F, Yaseri M, et al. 2009,
Prevalence of diabetic retinopathy in Tehran province: a population-based
study BMC Ophthalmology vol. 9, pp. 12
Findings:
Screened patients: 7989
Diabetic patients: 759 (9.5%)
Of them, 639 patients (84.2%) underwent eye examination
Five patients (0.7%) with media opacity were excluded
Examined patients with diabetes: 634
Diabetic retinopathy: 240
Standardized prevalence of retinopathy: 37%
non proliferative 27.3%
proliferative diabetic retinopathy 9.6%
The prevalence of any type of visual impairment (BCVA < 20/60) in patients
with PDR was remarkably higher than that in patients without PDR (18.5% vs.
7.0%, P = 0.002, OR = 2.09, 95% CI: 1.02- 4.26).
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Advantages:
Cheap, easy and quick studies
Rapid and less time consuming
Small sample size is sufficient
Suitable for rare diseases (e.g. macular edema)
Multiple exposures can be examined
No ethical problem
Risk factor can be identified
Disadvantages:
Control selection difficult
Subject to bias (Any systemic error in which there is tendency to
produce result in own favour)
We can not measure incidence
Multiple outcomes cannot be studied
Do not establish risks and rates directly
Not suitable for rare exposure
21
Example:
Leske MC, Chylack LT, Jr, Wu SY, The Lens Opacities Case-Control Study
Group, 1991, The Lens Opacities Case-Control Study: Risk Factors for
Cataract, Arch Ophthalmol. vol. 109, no. 2, pp. 244-51.
Objective:
To evaluated risk factors for age-related nuclear, cortical, posterior
subcapsular, and mixed cataracts
Participants: 1380
Age range: 40-79
Type of cataract:
Posterior subcapsular only, 72 patients;
Nuclear only, 137 patients;
Cortical only, 290 patients;
Mixed cataract, 446 patients; and
Controls, 435 patients.
Statistical analysis: Logistic regression analyses
Low education increased risk (odds ratio [OR]= 1.46)
Regular use of multivitamin supplements decreased risk (OR =0.63) for all
cataract types.
Dietary intake of riboflavin, vitamins C, E, and carotene, which have
antioxidant potential, was protective for cortical, nuclear, and mixed cataract;
Diabetes increased risk of posterior subcapsular, cortical, and mixed
cataracts (OR =1.56).
Oral steroid therapy increased posterior subcapsular cataract risk (OR =
5.83). Females (OR =1.51) and nonwhites (OR = 2.03) were at increased risk
only for cortical cataract.
Risk factors for nuclear cataract were a nonprofessional occupation (OR
=1.96), current smoking (OR = 1.68), body mass index (OR = 0.76), and
occupational exposure to sunlight (OR =0.61).
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Cohort studies
Syn: longitudinal study, follow-up study, incidence study, concurrent study,
prospective study
Definition:
A study in which two or more groups of individuals those are free of disease
and those differ according to the extent of exposure to a factor of interest,
are followed over a period of time to see how their exposures affect their
outcomes.
In terms of time
Prospective >90%
Retrospective <10%
In terms of inquiry
Always forward, i.e. from cause (exposure) to effect
Advantages:
Accurate estimation of risk directly
Can establish population-based incidence
Temporal relationship between exposure and disease (exposure should
obviously precede disease)
Rare exposure(asbestos > lung cancer)
Can be used where randomization is not possible
Magnitude of a risk factors effect can be quantified
Multiple outcomes can be studied (smoking > lung cancer, COPD,
larynx cancer)
Disadvantages:
Losses to follow up
Ethical problem (you are morally responsible because you are not
advising him that do not smoke because it will harm you)
High cost
Long time
Hawthorne effect
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24
25
2. Retrospective cohort:
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Example:
Prospective Cohort study:
Lindblad BE, Hakansson M, Philipson B, Wolk A, 2007, Alcohol Consumption
and Risk of Cataract Extraction: A Prospective Cohort Study of Women, vol.
114, no. 4, pp. 680-85
Purpose
To investigate the association between alcohol consumption and the risk of
cataract extraction
Design
Population-based prospective cohort study
Participants
34,713 women participating in the Swedish Mammography Cohort; Age: 49 to
83 years
Data collection tool: a self-administered questionnaire about alcohol,
smoking, and other lifestyle factors
Completion year: 1997
Results
Duration of follow up 84 months
Incident cases of age related cataract extraction: 3587
Compared with never drinkers, the relative risk of cataract extraction among
current drinkers was 1.11 (95% confidence interval [CI] 1.021.21) after
adjustment for age and other potential risk factors.
In multivariate analysis, an increment of 13 g alcohol intake per day was
associated with a 7% increased risk of cataract extraction (relative risk, 1.07;
95% CI 1.021.12)
World famous cohorts:
British Doctors' Cohort Study
Framingham Heart Study
EPIC Study: European Prospective Investigation into Cancer and
Nutrition
Nurses' Health Study
Physicians' Health Study
Women's Health Initiative
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Characteristics
Total population
Breakthrough
Risk factors
Asthma
Inhaled steroids prescribed at any time
Oral steroids prescribed before
vaccination
Oral steroids prescribed 3 month after
vaccination
Vaccine given before 15 months of age
Varicella vaccination followed MMR
vaccine within 28 days
Area A
80,584
Area B
8,181
268
97
aRR=2.4
aRR=2.8
aRR=1.4
aRR=3.1
Verstraeten T, Jumaan AO, Mullooly JP, Seward JF, Izurieta HS, DeStefano F. A
Retrospective Cohort Study of the Association of Varicella Vaccine Failure With
Asthma, Steroid Use, Age at Vaccination, and Measles-Mumps-Rubella
Vaccination. Pediatrics 2003;112;e98-e103
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Case
reports
Case series
Subjects
Single case
>1; exact
number can
vary
Characteristics
Describes
unusual
feature of a
case
A group of
cases; no
control group
Orientation
Time factor
Cost
Present
Quick
Inexpensive
Present
Quick
Inexpensive
Follow up
period
Purpose
None
Cause effect
relationship
Measure of
disease
frequency and
risk
Potential
problems
Cross
sectional
studies
Several
subjects
assessed
individually
point-in-time
picture of
health status/
health-related
behaviour
Present
Quick
Inexpensive
None
Generate
hypothesis
Cannot be
interpreted
Generate
hypothesis
Cannot be
interpreted
Generate
hypothesis
Cannot be
interpreted
None
None
Prevalence,
Association
Cannot assess
seasonal
variation
Remarks
Ecologica
l studies
Case control
Cohort
Aggregate
group of
individuals
Two groups of
subjects
Two groups of
subjects
often
studied by
geographi
cal area
One group is
exposed to risk
factor of interest
and other is nonexposed
Future
Time consuming
Expensive
None
Often prolonged
Generate
hypothesis
Cannot be
interprete
d
Correlation
Test hypothesis
Test hypothesis
Can be
suggested
Can be interpreted
Odds ratio
Ecological
fallacy
Recall and
selection bias
Prevalence,
Incidence,
Relative risk,
Attributable risk
Attrition
Present
Quick
Inexpensiv
e
None
Can study
multiple causes
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of disease;
useful for
studying rare
diseases
30
single exposure
Experimental study:
Type:
1. Clinical trials
2. Field trials
3. Community trials
Clinical trials
Randomized
Non randomized
Pre-test/post-test study (before-after studies)
Quasi-experimental study
Different name of clinical trial:
Randomized Clinical trial
Randomized Drug trial
Randomized control trial
Commonly used Design in clinical trial:
1. Parallel design
2. Cross-over designs
3. Cluster randomized trial
4. Factorial trial
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Parallel design
32
Example:
Silaste ML, 2003, Dietary effects on antioxidants, oxidised LDL and
homocysteine,[Thesis] Department of Internal Medicine, University of Oulu,
Finland
Objective:
To investigate the influence of modifications in the vegetable, berry, and fruit
intake and dietary fat on the plasma concentrations of antioxidants, lipids,
lipoprotein(a), oxidised LDL, folate, and homocysteine.
Research questions:
Does a diet high in common vegetables, berries, citrus fruit, and poly
unsaturated fatty acid (PUFA) enhance the plasma concentrations of
carotenoids, vitamin C, and vitamin E?
Do the modifications in the dietary intake of vegetables, berries, and
fruit influence the plasma concentrations of lipids, lipoproteins, and
oxidised LDL?
How do the dietary modifications and gene polymorphisms affect the
serum paraoxonase-1 activity?
Does a high intake of natural folate from food increase the serum
folate concentration and decrease the plasma tHcy concentration?
Do the common gene polymorphisms alter the dietary response of
plasma tHcy concentration?
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Study design:
Randomized control trial cross over design
Methodology:
The intervention consisted of
Baseline diet: 2 weeks
Two diet periods (low and high vegetable diets) 5 weeks each
Wash-out period in between: 3 weeks
An important feature of the study was a crossover design, in which each
individual served as her own control.
The order of the study diets was randomly assigned for each subject.
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35
Figure: Flow diagram of recruitment for the prospective, clusterrandomized trial, Sydney, New South Wales, Australia, 2006 and
2007 winter influenza seasons.
36
Factorial trials
Proposed by R.A. Fisher in the 1920s
Developed in the 1940s for use in industrial experiments
This design is used to assess simultaneously the effects of main
treatments and one or several other factors.
In a specific case of two treatments A and B if one wished to assess
simultaneously the effects in subjects who are:
Given neither A nor B
Given A alone and not B
Given B alone and not A
Given both A and B
The simplest factorial experiment, a 22 design
Drug
A
Level
A=0
A=1
B=0
None
A alone
B alone
A&B
both
B=1
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DREAM Study
(Diabetes reduction assessment with Ramipril and Rosiglitazone
Medication)
Factorial design
Rosiglitazone
Ramipril
Ramipril+
Rosiglitazone
Placebo
Rosiglitazone+
placebo
Start: May 2001 Follow 3 to 5 years
Final Results: 2005/2006
Placebo
Ramipril+
Placebo
Placebo+ Placebo
Before-After studies
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Quasi-experimental designs
No randomization
No intervention in control group
39
Community Trial
40
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Validity
ranking
Types of study
design
Highest
Randomized clinical
trial
Prospective cohort
study
Retrospective cohort
study
Nested case-control
study
Time-series analysis
Cross-sectional study
Ecologic study
Cluster analysis
Case study
Lowest
Anecdote
42
Phase
of trial
Subject
Phase I
Duration
of study
Purpose
Study procedure
Healthy
20-80
Volunteers/target
disease (Ca, HIV)
Up to 1
month
Metabolic and
pharmacological action
Maximally tolerable dose
Phase
II
Patients with
target disease
200-300
Several
months
Safety, efficacy
pharmacokinetics
Establishes minimum
and maximum effective
dose
Randomization
Double blind
Compare with a placebo
Phase
III
Patients with
target disease
Several
hundred
to
thousands
Several
years
Thousands
Ongoing
Post marketing
Monitor ongoing safety in
large populations
Phase IV Patients
No.
of subjects
43
Uncontrolled
Observational
Blinding
Sampling
Probability sampling
Simple random sampling
Stratified random sampling
Systematic random sampling
Cluster sampling
Multistage sampling
Nonprobablity sampling
Judgment or purposive sampling
Quota sampling
Convenient sampling
Snowball Sampling
Snowball sampling is a method in which a researcher
identifies one member of some population of interest,
speaks to him/her, and then asks that person to identify
others in the population that the researcher might speak
to. This person is then asked to refer the researcher to yet
another person, and so on.
Snowball sampling is very good for cases where members
of a special population are difficult to locate.
For example, Selection of beggars has no frame work. This
can be best done by asking an initial group of beggars to
supply the names of other beggars they come across.
Selection of street sex workers also can be made following
this network approach
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75
12
5
5
3
45
Systematic sampling
Population size (N=500)
Decide sample size (n=100)
Calculate interval size (interval 5)
Cluster sampling
Divide population into clusters
Clusters: Random selection
Include all patients within sample cluster
Suppose that we need a random sample of n=200 households from a
population of N=8000 households of a city. Since there does not exist any
good list of the households, it would be a difficult job to sample the individual
households. It would be at the same time too expensive to prepare such a
list. Instead, we can obtain a sample of blocks by dividing the entire area into
a number of blocks and then selecting 200/8000 =2.5% of the blocks.
Suppose we make 80 blocks each with 100 households. Then 2.5% of 80
blocks implies 80*2.5%=2 sample blocks. These 2 blocks contain 200
households. These households located within the boundaries of the sample
blocks comprise the sample.
Multistage cluster sampling
Upzilla (3 out of 6)
Union (for each upzilla select 2 union)
Village (for each union select 5 village)
Go to village, randomize people
The national Iodine deficiency disorders surveys of 1993, 1999 and 2004
conducted under the joint collaboration of UNICEF and Dhaka University
46
on a population of clusters (at least in the first stage). In stratified sampling, the
analysis is done on elements within strata.
2. In stratified sampling, a random sample is drawn from each of the strata, whereas
efficiency
Cluster Vs Stratified Sampling
Cluster Sampling
When natural groupings are evident in a statistical population, cluster sampling
technique is used.
Cluster sampling can be opted if the group consists of homogeneous members.
The advantages of cluster sampling over other sampling methods is, it is cheaper
as compared to the other methods.
The main disadvantage of cluster sampling is, it introduces higher sampling error.
This sampling error can be represented as design effect.
Stratified Sampling
Stratified sampling is a method where in, the member of a group are grouped into
relatively homogeneous groups.
For heterogeneous members in the groups, stratified sampling is a good option.
The advantages of stratified sampling are, this method ignores the irrelevant ones
and focuses on the crucial sub populations. Another advantage is, with this
method, for different sub populations, you can opt for different sampling
techniques. This sampling method also helps in improving the efficiency and
accuracy of the estimation. This sampling method allows greater balancing of
statistical power of tests.
The disadvantages of this sampling method are, it requires choice of relevant
stratification variables which can be tough at times. When there are homogeneous
subgroups, it is not much useful. Its implementation is expensive. If not provided
with accurate information about the population, then an error may be introduced
Dr. Md. Atiqul Haque, Assistant professor
47
Department of Public Health and Informatics
Bangabandhu Sheikh Mujib Medical University, Dhaka
Population
Cluster one
Cluster two
Cluster three
Sample one
Stage 1:
Randomly
selected
districts
within the
country
Sample two
Stage 2:
Randomly
selected
upzillas
within those
districts
Stage 3:
Randomly
selected
village within
those upzilla
48
Sample three
Stage 4:
Randomly
selected
Tuberculosis
patients with
each village for
study
49
Statistics
Definition: Statistics may be defined as the science and art of
collection, organization, analysis, interpretation and presentation of
numerical data from which a definite conclusion can be made.
C
O
A
I
P
collection
organization
analysis
interpretation
presentation
Parameter: Character of population
Statistic: Character of sample
Biostatistics:
It deals with data relating to biological aspects of human being.
Biostatistics is much broader term and includes the vital statistics.
E. g. Marriage, divorce birth, death etc.
Data: Data is a set of values recorded on one or more observational
units.
Variable:
Definition:
A variable is a characteristic of a person, object or phenomenon that
can take on a different value.
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Types of variable
A variable can be classified in a number of ways.
A. The causal relationship
B. The design of the study
C. The unit of measurement
From the viewpoint of causation:
In studies that attempt to investigate a causal relationship or
association, four sets of variables may operate:
1. Changes variables, which are responsible for bringing about
change in a phenomenon
2. Outcome variables, which are the effects of a change variable;
3. Variables which affect the link between cause-and-effect
variables;
4. Connecting or linking variables, which in certain situations are
necessary to complete the relationship between cause-and-effect
variables.
Connecting or linking
variables (4)
Cause
Effect
Outcome variable (2)
In research terminology:
Change variables are called: independent variables
Outcome/effect variables are called: dependent variables
The unmeasured variable affecting the cause-and-effect relationship
are called extraneous variables
The variables that link a cause-and-effect relationship are called
intervening variables.
Hence:
1. Independent variable:
The cause supposed to be responsible for brining about
change(s) in a phenomenon or situation
2. Dependent variable: The outcome of the change(s) brought
about by introduction of an independent variable
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Smoking(Assum
ed
cause)Independ
ent variable
Change
variables (1)
Affect the relationship
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MortalityIndepe
ndent variable
Use of contraceptive
FertilityDepende
nt variable
Intervening variables
Socioeconomic status
Provision and quality of health services
Motivation of the individual
Age
Religion
Extraneous variables
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Study population
Age
Gender
Level of motivation
Attitudes
Religions
Active variables
A researcher can manipulate
Attribute variables
A researcher cannot manipulate
54
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Variable
Qualitative
(Outcome: Narrative)
Quantitative
(Outcome: Numerical)
Discrete
Discrete
Nominal
Ordinal
Continuous
Interval
Ratio
Scale of measurement:
Proposed by S S Stevens in 1946
a) Nominal or classificatory scale
b) Ordinal or ranking scale
c) Interval scale
d) Ratio scale
a) Nominal variable (scale)
Definition: A nominal variable consists of named categories, with no
implied order among the categories.
Properties:
Observations of a qualitative variable can only be classified and
counted. There is no natural order (for example- Gender).
Data categories are represented by labels or names
Even when the labels are numerically coded, the data
categories have no logical order.
e.g.
Gender:
1. Male
2. Female
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Marital Status:
1. Unmarried
2. Married
3. Divorced
4. Widow
b) Ordinal or ranking scale
Definition: An ordinal variable consists of ordered categories, where
the differences between cannot be considered to be equal.
Properties:
The categories are distinct, mutually exclusive and exhaustive
The categories are possible to be ranked or order
The distance or difference from one category to the other
category is not necessarily constant
Variables with an ordered series
e.g.
Mild
Moderate
Severe
What Does Mutually Exclusive Mean?
A statistical term used to describe a situation where the occurrence of one event is
not influenced or caused by another event. In addition, it is impossible for mutually
exclusive events to occur at the same time.
Mutually Exclusive Events
Non-Mutually Exclusive Events
Two events are mutually exclusive if
Two events are non-mutually exclusive if
they cannot occur at the same time
they have one or more outcomes in
(i.e., they have no outcomes in
common.
common).
Interval variables:
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Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Add or subtract
No
No
Yes
Yes
No
No
Yes
Yes
No
No
No
Yes
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If no
If yes,
ask
Nominal
If yes,
ask
Ordinal
Ratio
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Exposure variable
Response variable
Dependent variable
y-variable
Case-control group
Explanatory variable
Independent variable
x- variable
Risk factor
Treatment group
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