ANALYSIS OF EPIDEMIOLOGICAL RESEARCH AND ANALYTICAL

RESEARCH JOURNAL

Lecturer:

dr. Arulita Ika Fibriana, M. Kes.

Conducted by:

Tiffanny Ocktivianie Tobing (6411419029)

PUBLIC HEALTH DEPARTMENT

STATE UNIVERSITY OF SEMARANG

2021
Analytical Research

1. Cross sectional Journal

The title of the journal : Relationship between Smoking and Obesity:
A Cross-Sectional Study of 499,504 Middle Aged Adults in the UK General
Population
The date of the journal : April 17, 2015
The analysis of contents :
Smoking and obesity are major that public health concern, this is
because the prevalence of both is increasing globally, smoking
consumption is risk of cancer, respiratory and cardiovascular disease and
can leading preventable cause of death in developed countries. The
relationship between smoking and obesity is complex and not completely
understood, but it is possible that the association reflects reverse
causation due to overweight individual, who are trying to lose weight but
in some point they still smoking or start to smoking. In the previous study
discuss about the possible causal mechanism between smoking and
obesity, the previous study focused on overall association and there is
general paucity of studies examining whether the associations are
moderated by age, gender or socioeconomic status. Associations between
smoking and obesity masked important sub-group differences, current
smokers were less likely to be obese than never smokers but this was not
true among younger participants and those living in the most affluent
areas of residence, increasing risk of obesity with increasing consumption
of cigarettes, whether measured by number of cigarettes smoked daily or
pack years. current smokers are less likely to be obese than never
smokers and former smokers are more likely to be obese than current
 smokers. However, association does not necessarily imply causation,
possible causal between obesity with smoking are reduced calorific
intake, due to a central effect, impaired smell or taste, a change in food
preference, or a direct metabolic effect on the absorption or storage of
calories, or increased energy expenditure
The analysis of Method :
We conducted a cross-sectional study using baseline data from the
UK Biobank cohort study, the time is taken between 2006 and 2010 with
UK Biobank recruited 502,682 members of the general public, aged 31 to
69 years, via 22 research clinics located across the United Kingdom, and
conducted a detailed baseline survey. Information collected from these
middle aged adults, included socio demographic characteristics, physical
activity measurements, past medical and surgical history, lifestyle risk
factors (including smoking and alcohol consumption), anthropometric
measures (including height and weight) and biological samples. Smoking
behavior was recorded via self-completed, touch screen questionnaire,
the information that include in the research is current smoking status,
amount smoked, duration of smoking and time since quitting smoking,
smoking status was categorized into current, former or never smoker,
and the amount of smoked by current smokers assessed in three ways,
such as number of cigarettes, duration of smoking and lifetime
consumption of cigarettes. For the self-reported was physical activity and
alcohol consumption, physical activity reported as the number of days
per week on which participants walked for at least 10 minutes, and for
the alcohol consumption reported as the frequency of the consumed
alcohol such as, never consume, occasionally, 1 until 3 times per month, 1
– 2 times per week, 3 – 4 per week and daily.
2. Case-Control Journal
The title of the journal : A Case-Control Study on the Risk Factors for
Meningococcal Disease among Children in Greece
The date of the Journal : June 28, 2016
The analysis of the contents :
Invasive meningococcal disease (IMD) is a contagious bacterial
disease caused by a meningococcus (Neisseria meningitidis), a Gram-
negative bacterium that is classified into 13 capsular groups according to
its capsular polysaccharides, meningitis and septicemia are the two main
clinical forms of IMD, and sometimes both clinical forms are found in the
same patient. Meningococcal meningitis is a serious infection of the
meninges that can cause severe brain damage and other sequelae. In
meningococcal septicaemia, the onset of the symptoms is sudden and
death can follow within hours. IMD has a high fatality rate and many
survivors develop permanent sequelae, meningococcal infections are
transmitted between people through respiratory droplets or secretions.
N
There is substantial evidence that approximately 10% of the
general population are asymptomatic carriers, although this rate varies
with age, and is associated with a peak in early adulthood, conjugate
vaccines is available for the protection of humans from the most common
capsular groups of IMD. Polysaccharide vaccines are available in bivalent
(A, C), trivalent (A, C, W), and quadrivalent (A, C, W, Y) forms, conjugate
vaccines, which are more immunogenic and can provide herd immunity.
The risk of meningococcal infection in an individual is dependent on the
balance of the virulence of the strain and the host’s immune response,
both active and passive smoking in particular have been found to
increase the risk of IMD in pediatric populations, other risk factors
include crowded living conditions, close contact with an infected person,
 a history of recent upper respiratory tract infections and low socio-
economic status. Genetic mutations of MBL (an acute protein phase that
contributes to the elimination of bacteria by activating the complement
system) have been identified as possible risk factors associated with IMD.
The analysis of the Method :
This study use case control study, that uses 133 children with 44 cases
group and 89 control group, cases were had been hospitalized with a
diagnosis of IMD (meningococcal meningitis or sepsis), in all cases, N.
meningitidis was identified in samples of biological material (blood or
CSF) in the laboratory and isolated using bacterial cultures or molecular
techniques, such as polymerase chain reaction (PCR), controls were
children hospitalized in the surgical wards of the two hospitals with a
diagnosis that was unrelated to IMD or other infections. All controls were
matched to cases using the sex and age (year of birth) of each child, and
the week of admission. When it was possible, at least two controls were
randomly selected for every case.
3. Cohort Journal
The title of the journal : The impact of physical activity on healthy
ageing trajectories: evidence from eight cohort studies
The date of the journal : October 28, 2016
The analysis of contents :
This study aims to investigate the impact of physical activity on
trajectories of healthy ageing, while taking into sociodemographic factors
and other correlated lifestyle factors. Ageing has been associated with an
increased risk of non-communicable diseases, frailty, and disability,
World Health Organization (WHO) defined healthy ageing as the “process
of developing and maintaining the functional ability that will enable older
people to do the things that matter to them”, and this process is not
homogeneous in the population. Physical activity promotion can reduce
the risk of developing non-communicable disease and the healthcare
expenditure and can increase the satisfaction with one’s life and with the
ageing process, physical activity is strongly associated with healthier
ageing trajectories, better cognitive function trajectories and improved
frailty trajectory. There is the positive impact of physical activity on
supporting healthy ageing, in particular the opportunity to attenuate
health and functioning declines in older age, increasing any levels of
physical activity or breaking sedentary behavior can be beneficial to
health and functioning in older adults, physical activity has been focus of
public health policies that most common in high income countries.
effectiveness of physical activity interventions might be uncertain given
short follow-up periods and highly selected populations in most trials.
Public health policies on physical activity promotion can play a key role in
reducing burdens of disability as well as healthcare costs in ageing
populations, although policies that promote individual-based
interventions may be helpful to develop plans and approaches to increase
physical activity at the individual level, it is also important to provide a
supportive environment for active ageing and address environmental and
social factors related to physical activity in older age.
The analysis of methods :
This study use cohort study design, that it is necessary to incorporate
data from multiple cohort studies and use comparable measure for
physical activity and health ageing, this study based on the ageing
trajectories of health (ATHLOS) that is used to harmonise data from 17
international ageing cohort studies and to investigate trajectories of
healthy ageing and their potential determinants in different older
populations. This study conceptualized healthy ageing using multiple
 indicators of health, physical and cognitive functioning and generated a
common measure across multiple cohorts.
4. Experimental Journal
The title of the journal : School Health Promotion: A Quasi
Experimental Study on Clean and Healthy Living Behavior among
Elementary Students in Jayapura, Papua, Indonesia
The date of the journal : December 2020
The analysis of contents :
Clean and healthy living behavior is a set of actions that make a person or
family able to help themselves to maintain their health, lack of physical
activity, lack of consuming fruits and vegetables, excessive food portions
and fast food intake in children result in overweight or obesity. Indonesia
has program, called PHBS that conducted by government and the purpose
of this program is to give health promotion to community, the PHBS
program is still low in elementary children, such as handwashing with
soap, consuming risky foods once per day, consuming salty food, fatty
food and caffeine, lack of physical activity. Health promotion has a
purpose to give a knowledge to the target, so the target or community
will be able to aware and change their behavior, knowledge is the result
of knowing, which occurs after sensing the object and is influenced by the
intensity of the attention of perception because of understanding. This
study aimed to determine the effect of health education using
audiovisuals (videos and posters) on the knowledge and attitudes of
students in the provision of PHBS compared to the health education using
poster only, the results indicated that both techniques of interventions
had a significant impact on the knowledge and attitudes of the students,
that the students get the audiovisuals based education has higher
knowledge if compare with students don’t get the audiovisuals.
 Knowledge related to learning is influenced by various factors from
natural and intervention directly or indirectly in the form of available
information tools, the information provided by using audiovisual that can
make students focus more on listening actively during the process of
providing education. The use of audiovisual and poster-based health
education provided a significant effect on knowledge and attitude in the
provision of clean and healthy living behavior in the experiment and
control group, however, the experimental group showed a higher mean
score than the control group, which indicated that audiovisual-based
education was more effective than the use of posters alone to increase the
knowledge and attitudes of clean and healthy living behavior. This study
serves as an input for nurses, teachers, and parents to teach and facilitate
students to maintain the students’ clean and healthy living behavior.
The analysis of methods :
This study used Quasi Experimental study with pretest and posttest with
a comparison group design, the respondents in this study were students
in grades 4 and 5 from two elementary schools in Waena Inpres State
Elementary School, including Elementary School of Inpres Bertingkat
Perumnas 1 Waena as an experimental group and Elementary School of
Inpres 5.81 Perumnas 1 Waena as a control group. There were 272
students selected using purposive sampling, which 136 students assigned
in each group, the inclusion criteria of the respondent were all students in
grades 4 and 5, willing to become a respondent, and could write and read
fluently and for the exclusion criteria were students who did not attend
school at the time of the research data collection

Descriptive Research

1) Case report
The title of the journal : Pulmonary Candidiasis Associated with
Severe COVID-19: Case Report
The date of the journal : October 9, 2021
The analysis of contents :
Co-infections have been widely described in COVID-19 patients, bacterial
infections being the main cause but also have been reported fungal
infections in up to 20 % of the cases. Candida species are the second most
common fungi identified in pulmonary mycotic infections affecting
hospitalized COVID-19 patients after Aspergillus, since the beginning of
the covid-19 pandemic, co-infections have been frequently reported and
mostly patients in hospitalized with severe or critical condition, this
made healthcare associated infections are the cause of an increase in
morbidity and mortality in patients with or without corona virus
infection. The corona virus has caused an overload of the healthcare
systems worldwide, initially all the effort was conducted to this new
disease management, several microorganisms have been identified as co-
pathogens, the bacteria are the most frequent isolated, and in less
proportion fungal species. Patients with COVID-19 in the intensive care
unit are at high risk of developing healthcare-associated infections due to
the requirement for invasive procedure that in this patient main risk for
developing invasive candidemia that could prolong hospital stay, central
venous, surgical procedures and the use of broad spectrum antibiotics.
For this case report, this study found that there was 65 years old female
with previous diagnosis of Diabetes Mellitus, Patients with COVID-19 in
the intensive care unit are at high risk of developing healthcare-
associated infections due to the requirement for invasive procedure and
diagnosed for admission SARS COV 2 pneumonia, this patient has
treatment zinc, ascorbic acid, vitamin D, dexamethasone and
anticoagulation with enoxaparin. Imipenem was also started due to a
suspected co-infection. A positive urine culture for E. coli, such as
sensitive to carbapenems, amikacin, ceftriaxone and levofloxacin) was
reported, so a 4-days antibiotic treatment was completed. When the
laboratory was taken the patients presented anemia, leukcytosis with
neutrophilia, renal failure, elevated D-dimer and positive non-
quantitative troponin, the Treatment according to the national protocol
for COVID-19 was continued in our institution, antibiotic therapy with
levofloxacin was started for persistent suspicion of sepsis secondary to
bacterial coinfection; antiviral treatment with remdesivir was also added.
Primary Candida pneumonia is considered a rare disease at present,
being little information regarding its pathophysiology available, hence
the importance of reporting this clinical case, damage to the lung
epithelium by viral invasion and the inflammatory response could
facilitate the passage of candida into the bloodstream, another possibility
is Candida translocation from the gastrointestinal tract in patients who
develop sepsis or septic shock, the diagnosis of invasive Candida
infections is challenging, specific characteristics of this type of infection
such as transient fungemia, low fungal load in cultured tissues, not using
specific culture media for fungi routinely or the need of invasive
procedures for taking samples, makes it difficult to achieved
microbiological isolation. A prompt diagnosis and treatment are the key
to reduce mortality. In patients with COVID, mortality was higher in those
who did not receive antifungals, the medical management of Invasive
Candidiasis follow the same methodology for patients with or without
COVID. In general, antifungal therapy should be started immediately after
positive blood cultures and an active search for possible metastatic foci is
 necessary, such as endocarditis, retinal and deep liver or splenic
abscesses
The analysis of methods :
This study use case report study that have one of the patients with covid-
19 and the several diseases, such as DM and diagnose with SARS COV 2
pneumonia. This study focused on explaining about patient cases and
how to get the treatment to reduce from another disease.
2) Case series
The title of the journal : A Case Series of Gastrointestinal
Tuberculosis in Renal Transplant Patients
The date of the journal : January 26, 2013
The analysis of contents :
Mycobacterium tuberculosis (MT) is a common infectious agent,
particularly in developing countries, with a reported incidence of 18.9
cases/100.000 inhabitants/year in general population, in transplanted
patients the incidence of this opportunistic agent is even more frequent,
with 512 cases/100.000 inhabitants/year and it is often linked to adverse
outcomes. In transplants recipient mycobacterium infection can be due to
primary infection, reactivation of latent TB favored by
immunosuppression or in a lesser extent that can be transmitted by the
allograft. Gastro-intestinal tuberculosis (GITB) is an infrequent
manifestation of TB but a potentially lethal one, in nontransplant
population, the most common symptoms of Gastro-intestinal are
abdominal pain, anorexia, fever and change in bowel habits, however, in
RT recipients gastrointestinal bleeding, fever, and abdominal pain are the
most frequent complains revealing a predominant ulcerative feature of
the
disease and reflecting the decreased inflammatory response in
immunocompromised patients. There are some cases that we have to
discuss,
 Case 1 : the patient is 53 years old man with stage renal failure of
unknown etiology was on hemodialysis, he underwent a first RT
with cyclosporine, mycophenolate mofetil, and prednisolone as
immunosuppressive therapy, he had kidney transplantation, that
the donor of kidney had cytomegalovirus (CMV) positive with the
immunosuppressive therapy, in the immediate post-transplant
period there is no surgical or infectious complications, delay draft
function or acute rejection episodes. He was admitted with mild
fever, profuse night sweating, and weight loss of 10% of his body
weight, with three months of evolution, he had no diarrhea,
urinary symptoms, graft pain or other complaints, he had no
recent travel history or known TB exposure, tuberculin skin
testing was negative, tuberculin skin testing was negative.
Antituberculosis (anti-TB) therapy was started with rifampicin,
isoniazid, pyrazinamide, and ethambutol, with clinical
improvement, nine months later, the patient is asymptomatic and
the examination of the small bowel transit and colonoscopy
showed no abnormalities and no evidence of reinfection.
 Case 2 : the patient is 53 years old woman with inactive carrier of
hepatitis B and ESRD secondary to membranoproliferative
glomerulonephritis, she underwent a deceased kidney
transplantation, she has immunosuppressive therapy was
declizumab, prednisolone, MMF, TAC and there was no delayed
graft function, acute rejection episodes and surgical or infectious
complications and renal allograft function remained normal, she
 has laparotomy showed few small bowel and colon loops with a
whitish appearance and nodular structures of 5 mm in diameter
along the ICV, after anti-TB therapy suspension, the patient is
asymptomatic, with no signs of reinfection
The analysis of methods :
The method of this study is explain about case of Gastrointestinal TB in
Renal translplant patients, that describe two example of case and
describe the symptoms, factor that affect, the data is collect by medical
record in the hospital.
3) Ecological research
The title of the journal : Ecological Study on Hospitalizations for
Cancer, Cardiovascular, and Respiratory Diseases in the Industrial Area of
Etang-de-Berre in the South of France
The date of the journal : February 22, 2013
The analysis of contents :
Relationships between urban air pollution and hospitalizations for
cardiorespiratory causes are well established in many studies around the
world, this is the first ecological study on hospitalizations related to
industrial air pollution near a large industrial estate in France, it
highlights the cardiovascular effects of air pollution. An excess risk of
hospitalizations for myocardial infarction was found for women living in
the districts exposed to industrial air pollution and for men living in the
highly exposed
Districts, in a Canadian study, where SHR for cardiovascular and
respiratory diseases increased in industrial cities compared to a
reference city, with higher ratios in women. The estimated excess risk of
hospitalizations for acute MI was greater in women while men were
mostly hospitalized for cardiovascular causes, this could be related to a
higher sensitivity of women to the effects of air pollution or to a better
control of confounding factors in men than in women. there is no excess
risk for asthma hospitalizations in children while a case crossover study
found a relationship between hospitalizations or emergency visits for
asthma attack and SO2 peaks in children living near refineries, the lack of
significant results for respiratory diseases most probably shows that
hospitalization indicators are not the best indicators to evaluate the
respiratory health effects of air pollution in adults in France. There is
association between the exposure to industrial air pollution and acute
leukemia in men, however, this association observed in men may suggest
a potential occupational exposure due to compounds processed or
emitted by petrochemical industries. In ecological studies, the choice of
exposed and non-exposed areas is usually based on the distance to the
industrial site, making the hypothesis that exposure decreases as the
distance increases. This study underlines that, in terms of
hospitalizations for respiratory diseases and cancers, the health condition
of the population exposed to the industrial air pollution was similar to
those of non-exposed people. However, the results illustrate the impact of
industrial air pollution on the cardiovascular system, efforts should be
done to decrease the levels of SO2, particles, and some carcinogenic
compounds emitted by the industries, by improving industrial processes
and using less polluted fuels. For instance, decreasing the level of road
traffic particles would require the implementation of an interurban
public transport network, as well as the development of rail transport for
raw materials and goods. Prevention of the cardiovascular diseases
should be a public health priority in the study area, particularly in
women, general practitioners, key players in the health prevention,
would have clear and useful information on harmful
 cardiovascular effects of air pollution.
The analysis of methods :
This study used ecological study that in ecological studies, the choice of
exposed and non-exposed areas is usually based on the distance to the
industrial site, making the hypothesis that exposure decreases as the
distance increases, this study use to make a relevant result, exposure to
air pollution, assessed as the annual average levels of modeled
concentrations, depends on the parameters of dispersion and
meteorological models, corrections and adjustments were implemented
at each modeling step to limit errors and bias, this study use the average
values for each geographical unit may have resulted in a dilution effect of
exposure when modeled concentrations were heterogeneous within
district
4) Cross sectional study
The title of the journal : Relationship between Smoking and Obesity:
A Cross-Sectional Study of 499,504 Middle Aged Adults in the UK General
Population
The date of the journal : April 17, 2015
The analysis of contents :
Smoking and obesity are major that public health concern, this is because
the prevalence of both is increasing globally, smoking consumption is risk
of cancer, respiratory and cardiovascular disease and can leading
preventable cause of death in developed countries. The relationship
between smoking and obesity is complex and not completely understood,
but it is possible that the association reflects reverse causation due to
overweight individual, who are trying to lose weight but in some point
they still smoking or start to smoking. In the previous study discuss about
the possible causal mechanism between smoking and obesity, the
previous study focused on overall association and there is general paucity
of studies examining whether the associations are moderated by age,
gender or socioeconomic status. Associations between smoking and
obesity masked important sub-group differences, current smokers were
less likely to be obese than never smokers but this was not true among
younger participants and those living in the most affluent areas of
residence, increasing risk of obesity with increasing consumption of
cigarettes, whether measured by number of cigarettes smoked daily or
pack years. current smokers are less likely to be obese than never
smokers and former smokers are more likely to be obese than current
smokers. However, association does not necessarily imply causation,
possible causal between obesity with smoking are reduced calorific
intake, due to a central effect, impaired smell or taste, a change in food
preference, or a direct metabolic effect on the absorption or storage of
calories, or increased energy expenditure
The analysis of methods :
We conducted a cross-sectional study using baseline data from the UK
Biobank cohort study, the time is taken between 2006 and 2010 with UK
Biobank recruited 502,682 members of the general public, aged 31 to 69
years, via 22 research clinics located across the United Kingdom, and
conducted a detailed baseline survey. Information collected from these
middle aged adults, included socio demographic characteristics, physical
activity measurements, past medical and surgical history, lifestyle risk
factors (including smoking and alcohol consumption), anthropometric
measures (including height and weight) and biological samples. Smoking
behavior was recorded via self-completed, touch screen questionnaire,
the information that include in the research is current smoking status,
amount smoked, duration of smoking and time since quitting smoking,
 smoking status was categorized into current, former or never smoker,
and the amount of smoked by current smokers assessed in three ways,
such as number of cigarettes, duration of smoking and lifetime
consumption of cigarettes. For the self-reported was physical activity and
alcohol consumption, physical activity reported as the number of days
per week on which participants walked for at least 10 minutes, and for
the alcohol consumption reported as the frequency of the consumed
alcohol such as, never consume, occasionally, 1 until 3 times per month, 1
– 2 times per week, 3 – 4 per week and daily.
References

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Pascal, L., Pascal, M., Stempfelet, M., Goria, S., & Declercq, C. (2013). Ecological
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https://doi.org/10.1155/2013/328737

Veronica Purba, E. R., Lusmilasari, L., & Hastuti, J. (2020). School health
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