RESEARCH STUDIES

RESERCH STUDIES
THE EPIDEMILOGICAL STUDIES CLASSIFICATION
DESCRIPTIVE STUDIES: - Individual Case report Case series - Population Correlation Transverse

RESERCH STUDIES
THE EPIDEMILOGICAL STUDIES CLASSIFICATION
ANALITIC STUDIES: - Observational Case control Cohort study - Experimental Randomized clinical studies Clinical trials Therapy equivalence studies

RESERCH STUDIES

COHORT STUDY

COHORT STUDY

Longitudinal studies of incidence Offers the best information regarding the causality Compares two similar groups (exposed unexposed) from the same population (cohort) Direct appreciation of the risk Types of cohort studies: - prospective - retrospective - bidirectional

COHORT STUDY
THE DESIGN OF COHORT STUDY

Objective: demonstrates the importance of a factor in a disease etiology.

The study begins from a population (cohort) without a disease, which is stratified in two similar subgroups (lots): the group exposed and unexposed to the risk factor

COHORT STUDY
COHORT STUDY DIAGRAM
with disease exposed without disease population

persons without disease

with disease unexposed without disease

present study direction

future

COHORT STUDY
For the group exposed to the risk factor we have to specify:

The assumed risk factors and the ways of their measurement Subjects eligible criteria ( age, sex) Tracking period The measurement that needs to be taken in order to prevent a subjects loss from the study The defining of the used diagnosis procedures

COHORT STUDY
The dates are placed in a contingency table 2x2

With disease Exposed to the risk factor Unexposed to the risk factor TOTAL a+c a c

Without disease b d b+d

TOTAL

a+b c+d a+b+c+d

COHORT STUDY
DATA ANALYSIS

Incidence =

No. of cases with disease in a period of time p total number of population

Incidence comparison can be done :

- as proportion (relative risk)

- as difference (attributable risk)

COHORT STUDY

RELATIVE RISK = the ratio between the disease incidence from the persons exposed and unexposed to the risk factor.

a RR a b c cd

R R

1 0

R1 = disease risk in exposed group R0 = disease risk in unexposed group

Relative risk shows how many times the disease risk is greater in exposed groups than the disease risk in unexposed group.

COHORT STUDY

ATTRIBUTABLE RISK = the difference between the disease risk in exposed and unexposed group.

RA = R1 R0

Attributable risk shows with how much is greater the risk in the exposed group than in the unexposed group.

COHORT STUDY
INTERPRETATION:

RR >1 =1 <1

RA >0 =0 <0 association risk factor disease indifferent factor protection factor

COHORT STUDY
STATISTICAL ANALYSIS OF THE COHORT STUDY

The adequate statistic test is Chi test.

If the result of the statistical analysis is a p value smaller than 0,05 then we get a statistically significant result.

IC = confidence interval = 95%

COHORT STUDY
ADVANTAGES:

Good validity

Offers the best information regarding the causality and the natural history of the disease The most efficient measurement of the risk (RR) They are efficient in diseases with higher incidence Can observe the mechanism of action of the risk factor Can observe the late effects of the disease

COHORT STUDY
DISAVANTAGES:

Expensive
Cant be repeated

Requires a long time to finish and a large number of subjects

Long-term observation is difficult when the disease has a long latency period Produce errors, especially selection and confusion errors

COHORT STUDY

Testing the following hipothesys was wanted: oral breathing during the child's growing period favors the appearance of the maxillary compression syndrome. For testing the hipothesys, a study in Tirgu Mures was initiated, in which children from 5 kindergardens were included. The children of both groups were between 3 and 4 years old and had similar characteristics regarding sex distribution, background, feeding habits, the presence of dento-maxillary anomalies in parents or siblings, the harmonious development of the cephalic end, dimentions , intermaxillary and occlusal relations. 51 children were exposed to the risk factor studied. They were oral breathing either due to upper airways' obstruction, septum deviations/adenoids whose surgical treatment was refused by the parents or treatment-refractory rhinitis. The group of children not exposed to the risk factor, didn't present oral breathing at rest, and their upper airways' permeability was normal. The maxillary growth of the children in both groups was kept under observation for 4 years, tracking the possible starting symptoms of the maxillary compression syndrome.