hipoTezebis

formireba da Sefaseba
swavlebis miznebi

 hipoTezis formirebis mniSvnelobis aRwera

 hipoTezebis Seqmnisadmi midgomebis

aRwera afeTqebis savele gamokvlevisaTvis

 hipoTezis Sefaseba
ra aris hipoTeza?

hipoTeza epidemiologiaSi aris:

– dakvirvebaze dafuZnebuli varaudi. mas mivyavarT
iseT mosazrebamde, romlis uaryofac SesaZlebelia

– iseTi formiT arsebuli nebismieri varaudi, romelic

iZleva testirebisa da WeSmaritebis dadgenis
saSualebas
ra aris hipoTeza?

afeTqebis pirobebSi hipoTeza SesaZloa

mimarTuli iyos:
– agentze
– agentis wyaroze
– gadacemis gzaze (da gadacemis meqanizmi/veqtori)
– eqspoziciebze, romlebic daavadebis risks zrdian
ratom aris hipoTeza mniSvnelovani?

hipoTezis gareSe…
 ris gamokvlevas apirebT?
 ra SekiTxvebs SeitanT Tqvens kiTxvarSi?
 romeli klinikuri nimuSebis aRebas apirebT?
 garemos romeli nimuSebis aRebas apirebT?
rogor unda Seiqmnas hipoTeza

 Sesaswavl sakiTxSi gaTviTcnobiereba

 aRwerilobiTi epidemiologiis gamoyeneba
 gancalkevebuli SemTxvevebis Seswavla
 pacientebTan gasaubreba
 adgilobrivi xelisuflebis warmomadgenlebTan
gasaubreba
Sesaswavl sakiTxSi gaTviTcnobireba

 romeli agentebi iwveven aseTi saxis klinikur

manifestacias?
 romelia agentis Cveuli rezervuarebi?
 Cveulebriv rogor xdeba agentis gadacema?
 Cveulebriv romeli gadamtanebi vlindeba?
 romlebia cnobili risk-faqtorebi?

“mouyareT Tavi saeWvo monacemebs.”

 Sesaswavl sakiTxSi gaTviTcnobireba

 wignebSi, JurnalebSi arsebuli statiebi

 wina afeTqebis gamokvlevebis angariSebi
 Sesaswavli sagnis eqspertebi
 interneti:
– www.who.int
– www.cdc.gov
– http://vm.cfsan.fda.gov/~mow/intro.html
(Bad Bug Book)
 rogor unda Seiqmnas hipoTeza

 Sesaswavl sakiTxSi gaTviTcnobiereba

 aRwerilobiTi epidemiologiis gamoyeneba

 gancalkevebuli SemTxvevebis Seswavla

 pacientebTan gasaubreba

 adgilobrivi xelisuflebis warmomadgenlebTan gasaubreba

 rogor unda Seiqmnas hipoTeza
 Sesaswavl sakiTxSi gaTviTcnobiereba

aRwerilobiTi epidemiologiis gamoyeneba

 gancalkevebuli SemTxvevebis Seswavla

 pacientebTan gasaubreba

 adgilobrivi xelisuflebis warmomadgenlebTan gasaubreba

aRwerilobiTi epidemiologia

 adamiani
– romel jgufs(ebs) (asakis, sqesis, saqmianobis da sxvaTa
mixedviT) aqvs yvelaze maRali maCveneblebi?
 adgili
– maRali dasnebovnebis maCveneblebi erT adgilas
dafiqsirda?
 dro (epidemiuri mrudi)
– mianiSnebs Tu ara forma gadacemis gzaze?
– miuTiTebs Tu ara viwro piki eqspoziciis konkretul droze?
aRwerilobiTi epidemiologia

adamiani
– romel jgufs(ebs) (asakis, sqesis, saqmianobis da sxvaTa
mixedviT) aqvs yvelaze maRali maCveneblebi?
 adgili
– maRali dasnebovnebis maCveneblebi erT adgilas
dafiqsirda?
 dro (epidemiuri mrudi)
– mianiSnebs Tu ara forma gadacemis gzaze?
– miuTiTebs Tu ara viwro piki eqspoziciis konkretul droze?
 adamiani: salmonelozis afeTqeba

 Cveuli asakobrivi gavrceleba – umetesad bavSvebi

da xandazmulebi
 afeTqebis asakobrivi ganawileba – 18–30 w.
asakobriv jgufSi; bavSvebsa da xandazmulebs Soris
TiTqmis ar aris SemTxvevebi.
 ra saxis eqspoziciebi Seesabameba am asakobriv
ganawilebas?
aRwerilobiTi epidemiologia
 adamiani
– romel jgufs(ebs) (asakis, sqesis, saqmianobis da sxvaTa
mixedviT) aqvs yvelaze maRali maCveneblebi?
adgili
– maRali dasnebovnebis maCveneblebi erT adgilas dafiqsirda?
 dro (epidemiuri mrudi)
– mianiSnebs Tu ara forma gadacemis gzaze?
– miuTiTebs Tu ara viwro piki zemoqmedebis konkretul
droze?
adgili: afeTqeba moxucebulTa TavSesafarSi

dasavleTis frTa aRmosavleTis frTa

SemTxveva

Din. PT

Kit.

TV
TV

mTavari Sesasvleli
adgili: afeTqeba moxucebulTa TavSesafarSi

dasavleTis frTa aRmosavleTis frTa

SemTxveva

Din. PT

Kit.

TV
TV

mTavari Sesasvleli
adgili: adamianis dasavleT nilosis virusis
SemTxvevebi, niu iorki, 1999

laboratoriulad dadasturebuli
dasav. nilosis virusis
mqone adamianebi
CrdiloeT qvinsi
North Queens
serologiuri mimoxilviTi
Serosurvey
kvlevisArea
adgili

adam. SemTx.

qalaqi/sofeli
sagrafo
aRwerilobiTi epidemiologia

 adamiani
– romel jgufs(ebs) (asakis, sqesis, saqmianobis da sxvaTa
mixedviT) aqvs yvelaze maRali maCveneblebi?
 adgili
– maRali dasnebovnebis maCveneblebi erT adgilas dafiqsirda?
dro (epidemiuri mrudi)
– mianiSnebs Tu ara forma gadacemis gzaze?
– miuTiTebs Tu ara viwro piki zemoqmedebis konkretul
droze?
 ra SeiZleba gavigoT epidemiuri
mrudidan?

 problemis masStabi

 gavrcelebis modeli

 eqspoziciis periodi

 epidemiis mimdinare statusi

 ukiduresi SemTxvevebi (“kudebi”)

 masStabi
30
25
20
Outbreak Case
afeTqebis SemTxveva
15 afeTqebis SemTxveva ar aris
Non-Outbreak Case
10
5
0
9 16 23 30 7 14 21 28 4 11 18 25 2 9 16

seqtemberi oqtomberi noemberi dekemberi

dawyebis kvira
 epidemiuri mrudebi da wyaro
SemTxvevebi saerTo erTjeradi wyaro saerTo persistentuli (mudmivi)
6
10
9
wyaro
5 8
7
4
6
SemTxvevebi
3 5
4
2 3
1
2
1
0 0
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 10 11 12
dReebi dReebi

SemTxvevebi saerTo gamravlebadi wyaro

10
9
xangamoSvebiTi 12

8 wyaro 10
7
8
6 SemTxvevebi
5 6
4
3 4
2
2
1
0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 1 2 3 4 5 6 7 8 9 10 11 12 13

dReebi kvireebi
inkubaciuri da eqspoziciis periodebi

25

20

15

10

0
9 16 23 30 7 14 21 28 4 11 18 25 2 9 16
seqtemberi oqtomberi noemberi dekemberi
dawyebis kvira
inkubaciuri da eqspoziciis periodebi
4 kvira
25

20

15

10

0
9 16 23 30 7 14 21 28 4 11 18 25 2 9 16
seqtemberi oqtomberi noemberi dekemberi
dawyebis kvira
inkubaciuri da eqspoziciis periodebi
4 kvira
25

20

15 2 kvira

10

0
9 16 23 30 7 14 21 28 4 11 18 25 2 9 16
seqtemberi oqtomberi noemberi dekemberi
dawyebis kvira
 rogor unda Seiqmnas hipoTeza
 Sesaswavli sakiTxis gaTviTcnobiereba

 aRwerilobiTi epidemiologiis gamoyeneba

gancalkevebuli SemTxvevebis Seswavla

 pacientebTan gasaubreba

 adgilobrivi xelisuflebis warmomadgenlebTan gasaubreba

 ukiduresi SemTxvevebi
 adamianis mixedviT
– sxvebTan saerTo ra saxis eqspozicia ganicada am pacientma?

 adgilis mixedviT
– stumari, romelic im adgilas ar cxovrobs? Cveulebriv naklebad
eqvemdebareboda zemoqmedebebs, SeiZleba Seamciros SesaZleblobaTa
areali

 drois mixedviT
– dawyebis TariRi/dro - adre? gvian? sxvebTan saerTo ra saxis eqspozicia
ganicada (magram SesaZloa gansxvavebul dros) am pacientma?
dro: stafilokokiT gamowveuli gastroenteritis
afeTqeba

SemTxveva
SemTxvevaTa raodenoba

18 aprili dawyebis dro 19 aprili

 rogor unda Seiqmnas hipoTeza

 Sesaswavli sakiTxis gaTviTcnobiereba

 aRwerilobiTi epidemiologiis gamoyeneba

 gancalkevebuli SemTxvevebis Seswavla

pacientebTan gasaubreba

 adgilobrivi xelisuflebis warmomadgenlebTan gasaubreba

 pacientebTan gasaubreba

 saubari Ria kiTxvebiT

 maTi azriT ra aris wyaro?
 sakvebiT gamowveuli afeTqebis dros dasviT
SekiTxvebi sakvebTan dakavSirebiT. zogjer
SeixedeT samzareuloSic
 zogjer SekribeT pacientebi erTad, rom isaubron,
raTa gaarkvioT, iyvnen Tu ara isini saerTo
eqspoziciis qveS?
 rogor unda Seiqmnas hipoTeza
 Sesaswavli sakiTxis gaTviTcnobiereba

 aRwerilobiTi epidemiologiis gamoyeneba

 gancalkevebuli SemTxvevebis Seswavla

 pacientebTan gasaubreba

adgilobrivi xelisuflebis warmomadgenlebTan gasaubreba

 gaesaubreT adgilobrivi xelisuflebis
warmomadgenlebs

 ras fiqroben isini?

 raime uCveulo movlenas, dResaswauls, festivals,

sportul movlenas an Sekrebas xom ar qonia adgili?

 xom ar gamoiyenes raime axli produqti, adgilobrivi

nawarmi, sxva?
 yvelafris Tavmoyra

hipoTezebis formirebis sxvadasxva gzis

arsebobam SeiZleba gamoiwvios bevri sxvadasxva
hipoTezis formireba!
 Sesaswavli sakiTxis gaTviTcnobiereba
 aRwerilobiTi epidemiologia
 gancalkevebuli SemTxvevebi
 pacientebTan gasaubreba
 adgilobrivi xelisuflebis warmomadgenlebTan
gasaubreba
 Semdegi etapi

 hipoTezebis Sedareba faqtebTan

– yvela samxili erTi mimarTulebiT miuTiTebs?
– romeli samxilia yvelaze Zlieri?
 laboratoriuli monacemebis Segroveba
– garemodan aRebuli nimuSebi
– klinikuri nimuSebi
 analizuri kvlevebi
– retrospeqtuli kohortiT kvlevebi
– SemTxveva-kontrolis kvlevebi
 daskvna

 hipoTezebis formireba nebismieri afeTqebis gamokvlevis

mniSvnelovani etapia
 hipoTezebi SeiZleba Seiqmnas sxvadasxva gziT – sagnis
gaTviTcnobierebiT, monacemebis SeswavliT, pacientebTan
da adgilobrivi xelisuflebis warmomadgenlebTan saubriT
 kargi hipoTezebis gareSe epidemiologiuri kvlevebi
SesaZlebelia uSedego iyos
analizuri epidemiologia

dalia
avad myofi
wyali?

diax 43

ara 3

sul 46

% dalia wyali
93%
 hipoTezebis Sefaseba

rogorc wesi, analizuri epidemiologiis

gamoyenebiT
kohortiT kvleva (riskTa Tanafardoba)
SemTxveva-kontroliT kvleva (SansTa Tanafardoba)

sxvagvarad, SeadareT faqtebi hipotezebTan

 analizuri epidemiologiis
sakvanZo punqti

sakvanZo punqti = Sedarebis jgufi

 analizuri epidemiologiis magaliTebi
daavadeba
% avad
dalia wyali? diax ara sul
myofi

diax 43 27 70 61%
eqspozicia

ara 3 2 5 60%

sul 46 29 75 61%

% dalia wyali 93% 93%

 cxrili 2 x 2-ze

daavadeba
diax ara sul

a b
diax a+b
eqspozicia

c d
ara c+d

a+c b+d
 fardobiTi riski (fr)

dakvirveba iyo warmoebuli yvela individumze

erTi da imave drois ganmavlobaSi

riski eqspozirebulTa Soris a / (a+b)

riski araeqspozirebulTa Soris c / (c+d) =
fr =
kohortiT kvleva
(sakvebismieri afeTqebis magaliTi)

daavadeba
mirTva vanilis nayini? diax ara sul

diax 43 11 54
eqspozicia
ara 3 18 21

sul 46 29 75

dazianebadoba eqspozirebulTa Soris = a/a+b = 43/54 = 0.796 ~80%

dazianebadoba araeqspozirebulTa Soris = c/c+b = 3/21= 0.143 ~14%

fardobiTi riski a/a+b 0.796

= = 5.6
c/c+d 0.143
 fardobiTi riskis interpretacia
wina magaliTSi, fr 5.6 niSnavs, rom vanilis nayinis moxmarebelTa
Soris daavadebis ganviTarebis albaToba 5.6-jer metia, vidre
nayinis ar momxmarebelTa Soris

Tu fr = 1 riski eqspozirebulTa Soris tolia

araeqspozirebulTa Soris riskis
(asociacia ar arsebobs)

Tu fr > 1 riski eqspozirebulTa Soris metia,

vidre riski araeqspozirebulTa
Soris (asociacia dadebiTia)

Tu fr < 1 riski eqspozirebulTa Soris naklebia

vidre riski araeqspozirebulTa Soris (asociacia ar
arsebobs)
 literatura

– Dicker R. Principles of Epidemiology, 2nd Edition, CDC

– Gregg M. Field Epidemiology, 2nd Edition, Oxford U.
Press
– Thomas, Weber. Epi Methods for Study of Infectious
Diseases. Oxford U. Press
– Timmreck T. An Intro to Epidemiology, 3rd ed. Jones &
Bartlett
– Aschengrau A, Seage G. Essentials of Epidemiology
in Public Health. Jones & Bartlett