TUGAS UJIAN AKHIR SEMESTER EPIDEMIOLOGI LANJUT

Diajukan Untuk Memenuhi Tugas Ujian Tengah Semester (UTS) Mata Kuliah
Epidemiologi Lanjut

Dosen Pengampu : Dr. dr. Candra Bumi, M.Si

Disusun Oleh :

Roni Sandi Arifin

NIM. 182520102020

PROGRAM STUDI ILMU KESEHATAN MASYARAKAT

PROGRAM PASCA SARJANA
UNIVERSITAS JEMBER
2019
A. Critical Appraisal of a Case-control Study :
Judul : The Effectiveness of Maternal Pertussis Vaccination in Protecting Newborn Infants in Brazil A Case-Control
Study
Tahun : 2019
Penulis : Eder Gatti Fernandes, Ana Paula S.Sato, Lourdes R.A. Vaz-de-lima, Marcela Rodriguez, Daniela Leite,
Cyro A. de Brito, Expedito J.A Luna, Telma Regina M.P Carvalhanas, Maria Ligia Bacciote Neger Ramos, Helena
Keico Sato, Euclides A. de Castilho, on behalf of Maternal Pertussis Vaccine Working Group.
Jawaban
No. Pertanyaan Bagian pada Jurnal
Ya Tidak dijelaskan Tidak
Pertussis is a highly contagious
respiratory disease caused by
Bordetella pertussis. The disease most
commonly affects infants and young
children and can induce uncontrollable
violent coughing for long periods. In
Brazil, the current routine childhood
Apakah penelitian ini membahas vaccination schedule includes three
1. √
pertanyaan/masalah dengan jelas ? doses of the diphtheria-tetanus-whole-
cell pertussis + Haemophilus
influenzae b + hepatitis B (DTwP-Hib-
HBV). DTwP vaccine coverage
reached the national goal of 95%
during the 1990s, resulting in a great
decrease of the number of pertussis
cases.

Apakah metode penelitian yang
2. digunakan sesuai untuk menjawab
pertanyaan penelitian ?
Apakah terdapat cukup subjek
(karyawan, tim, organisasi) dalam
3. penelitian untuk menetapkan
bahwa penelitian itu tidak terjadi
secara kebetulan ?
Apakah pemilihan kasus dan
4. control didasarkan pada eksternal,
kriteria objektif, dan tervalidasi ?
5. Apakah kedua kelompok
sebanding pada awal studi
This is an unmatched case-control
study. General characteristics and the
mother’s vaccination status were
√
compared between cases and controls.
Epi-info (version 3.5.3) and Stata13
software were used for this analysis.
with laboratoryconfirmation (culture
or real time polymerase chain
reaction) of pertussis. The cases were
identified through the National
√
Notifiable Diseases Information
System database (Sistema de
informação de Agravos de
Notificação, SINAN).
Considering the limited data available
concerning effectiveness of maternal
pertussis vaccination when vaccination
during pregnancy, The present study is
an unmatched case-control evaluation
√
aimed to assess the effectiveness of
maternal Tdap vaccination during
pregnancy in preventing pertussis in
infants younger than 2 months of age
in São Paulo State, Brazil.
√ The minimal sample-size estimation
was 29 cases and 115 controls,
considering a non-paired study, 50%
of vaccinated mothers among controls,

Apakah kriteria hasil objektif dan
6.
tidak bias digunakan ?
7. Apakah ada pengerukan data ?
8. Apakah metode pengukuran yang
digunakan valid untuk mengukur
hasilnya ? jika tidak, apakah
hasilnya dinilai oleh orang yang
mengetahui tugas ?
four controls for each case (4:1),
significance level of 0.05, power of
the 80%, odds ratio of 0.25 and two-
tailed test.
Exclusion criteria were: (1) having
received immunosuppressive drugs or
corticosteroids at a dose greater than 2
mg/kg /day for more than 15 days; (2)
having a primary or acquired
√ immunodeficiency; (3) having heart,
neurological or renal disease; (4)
having a chromosomal anomaly or
serious congenital disease; or (5)
having previously received transfusion
of blood or blood products.
√
√ 2.3. Statistical analysis and sample-
size estimation This is an unmatched
case-control study. General
characteristics and the mother’s
vaccination status were compared
between cases and controls. An
unadjusted VE was calculated as VE =
1 - OR, where OR is the odds ratio for
vaccination in pregnancy, between
cases and controls. For the adjusted
VE, the OR was calculated using
logistic regression analysis. The
 multiple logistic regression model was
performed based on variables
statistically associated with the
outcome, using a stepwise forward
strategy. The variables that presented a
p ≤ 0.2 in the bivariate analysis were
selected for inclusion in the
multivariable model and those that had
p < 0.05 were retained in the final
multivariate model. Epi-info (version
3.5.3) and Stata13 software were used
for this analysis.
We found a high level of effectiveness
(83%) for maternal Tdap vaccination
during pregnancy in preventing
pertussis in infants before their first
dose of DTwP, a result consistent with
those of earlier studies. An assessment
Apakah efek ukuran praktis of the maternal vaccination program in
9. √
relevan ? England showed a vaccine
effectiveness of 91% (95% CI, 84 to
95%) among infants <3 months of age.
while another casecontrol in England
estimated that maternal vaccination
with Tdap had an effectiveness of 93%
in protecting infants.
10. Seberapa tepat perkiraan √ We found a high level of effectiveness
efeknya ? diberikan interval ? (83%) for maternal Tdap vaccination
 during pregnancy in preventing
pertussis in infants before their first
dose of DTwP.
Exclusion criteria were: (1) having
received immunosuppressive drugs or
corticosteroids at a dose greater than 2
mg/kg /day for more than 15 days; (2)
having a primary or acquired
Mungkinkan terdapat faktor
11. √ immunodeficiency; (3) having heart,
perancu yang dicatat ?
neurological or renal disease; (4)
having a chromosomal anomaly or
serious congenital disease; or (5)
having previously received transfusion
of blood or blood products.
12. Apakah hasilnya dapat √ We found a high level of effectiveness
diaplikasikan di organisasi anda ? (83%) for maternal Tdap vaccination
during pregnancy in preventing
pertussis in infants before their first
dose of DTwP a result consistent with
those of earlier studies. An assessment
of the maternal vaccination program in
England showed a vaccine
effectiveness of 91% (95% CI, 84 to
95%) among infants <3 months of age
[7], while another casecontrol in
England estimated that maternal
vaccination with Tdap had an
effectiveness of 93% in protecting
infants.
B. Critical Appraisal of a Cohort or Panel Study :
Judul : Association Between Asthma and Depression : A National Cohort Study
Tahun : 2018
Penulis : Hyo Geun Choi, MD, PhD, Joo-Hee Kim, MD, PhD, Ji-Young Park, MD, Yong II Hwang, MD, PhD,
Seung Hun Jang, MD, PhD, and Ki-Suck Jung, MD, PhD.S
Jawaban
No. Pertanyaan Bagian pada Jurnal
Ya Tidak dijelaskan Tidak
Individuals often experience stress in
relation to the risk of choking, which
can be a persistent fear even after their
symptoms are relieved with treatment.
This realistic or anticipatory fear is
usually associated with anxiety or
Apakah penelitian ini membahas
1. √ mood disorders, which can cause
pertanyaan/masalah dengan jelas ?
frequent psychiatric comorbidities in
people with asthma. Moussavi et al
showed that 18.1% of adults with
asthma have comorbid depressive
disorders based on the World Health
Organization World Health Survey.
2. Apakah metode penelitian yang √ This national retrospective cohort
digunakan sesuai untuk menjawab study relied on data from the Korean
pertanyaan penelitian ? National Health Insurance Service
(NHIS)-National Sample Cohort. The
Korean NHIS selects samples directly
from a database of the entire

Apakah terdapat cukup subjek
(karyawan, tim, organisasi) dalam
3. penelitian untuk menetapkan
bahwa penelitian itu tidak terjadi
secara kebetulan ?
4. Apakah pemilihan kohort / panel
berdasarkan pada eksternal
objektif dan criteria valid ?
population to prevent nonsampling
errors.
Among these participants, we selected
those who were diagnosed with
√
asthma by a physician more than 2
times to avoid overdiagnosis.
√ This national retrospective cohort
study relied on data from the Korean
International Health Insurance Service
(NHIS) National Sample Cohort. The
selected data may be classified in to
1476 levels (age[18 categories], sex [2
categories], and income level [41
categories] using randomized statified
systematic sampling methods via
proportional allocation to represent the
entire popilation. This cohort database
includes (1) personal information, (2)
health insurance claim codes
(procedures and prescriptions), (3)
International Classification of
Diseases, Tenth Revision (ICD-10)
diagnostic codes, (4) death records
from the Korean National Statistical
Office (using the Korean Standard
Classification of disease), (5)
socioeconomic data (residence and

Apakah merupakan perwakilan
5. kohort / panel dari populasi
tertentu ?
Apakah tindak lanjut dari kasus /
6.
subjek cukup lama ?
7. Apakah kriteria hasil objektif dan
tidak bias digunakan ?
income), and (6) medical examination
data from clinics and hospitals for
each participant from 2002 to 2013.
Using the Korean NHIS-National
Sample Cohort, we retrospectively
analyzed the patients’ medical
histories. Of the 1,125,691
participants, we included those
participants who were diagnosed with
√ asthma (ICD-10 code J45) or status
asthmaticus (ICD-10 code J46)
between 2002 and 2013. Among these
participants, we selected those who
were diagnosed with asthma by a
physician more than 2 times to avoid
overdiagnosis.
participants who were diagnosed with
asthma (ICD-10 code J45) or status
√
asthmaticus (ICD-10 code J46)
between 2002 and 2013.
√ To prevent selection bias in selecting
the matched participants, the control
group participants were sorted using a
random number order and then
selected from the top to the bottom.
the matched control participants were
alive at the same time as each matched
asthma participant (index date).
 Therefore, members of the control
group who died before the index date
were excluded. In both the asthma and
control groups, participants who had a
history of depression before the index
date were excluded
Apakah metode pengukuran yang
This method was modified from a
8. digunakan valid untuk mengukur √
previous study.
hasilnya ?
Two prospective studies have reported
that asthma predicts the incidence of
depression. Walters et al found a
significant association between the
diagnosis of asthma and the incidence
of depression (adjusted incidence rate
ratio 1.59 with 10 years of follow-up)
using data derived from the United
Apakah efek ukuran praktis
9. √ Kingdom General Practice Research
relevan ?
Database. Meanwhile, Brunner et al
showed that the risk of elevated
incident depressive symptoms among
people with asthma did not differ from
the risk among peoplewithout asthma
using the Coronary Artery Risk
Development inYoung Adults with 20
years of follow-up.
10. Seberapa tepat perkiraan √ This study used a population-based
efeknya ? diberikan interval ? sample to examine the association
 between asthma and depressive
disorders. Longitudinally, compared
with the comparison group without
asthma, after matching for potential
confounding variables (ie, sex, age,
residence, and underlying diseases),
asthma was associated with the
subsequent development of depressive
disorders, with an HR of 1.35 (1.31-
1.40). We further observed that
compared with the participants
without depression, depressive
disorders were associated with the
subsequent development of asthma
with an HR of 1.25 (1.21-1.29),
suggesting that there might be a
bidirectional association between these
2 diseases.
Therefore, members of the control
group who died before the index date
Mungkinkan terdapat faktor were excluded. In both the asthma and
11. √
perancu yang dicatat ? control groups, participants who had a
history of depression before the index
date were excluded (n = 6,303).
Apakah hasilnya dapat
12. √
diaplikasikan di organisasi anda ?