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Uses of Epidemiology
? Answer all questions. The assignment has three (3) sections (A,B and C) on the following pages.
? Please note that you are not expected to undertake a literature review to answer these questions. Refer to the reading list provided “BELOW” with this description if you want to answer those questions or want to understand more about the subject topics, if you wish but detailed further reading is not required.
Copying someone else?s work or quoting from text without adequate attribution of the source is plagiarism and is not acceptable. All assignments will be verified by plagiarism detection software. Penalties will be applied for plagiarism.
USEFUL REFERENCE BOOKLIST FOR THIS ASSIGNEMNT
The Essential Epidemiology text is:
Webb PW, Bain CJ. Essential Epidemiology: An Introduction for Students and Health Professionals 2nd ed. Cambridge University Press; 2011.
Other recommended texts which might be of interest are:
Beaglehole R. Basic Epidemiology. World Health Organization, Geneva, 1993.
Hennekens CH, Buring J. Epidemiology in Medicine. Boston: Little, Brown and Co; 1987.
Fletcher, RH, Fletcher, SW. Clinical Epidemiology: the essentials. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2005.
Rothman K, Greenland S, Lash T.L. Modern Epidemiology. 3rd Ed. Boston: Little, Brown & Co; 2008.
Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology. 2nd ed. New York: Oxford University Press; 1996.
Elwood JM. Critical appraisal of epidemiological studies and clinical trials. 3rd ed. New York: Oxford University Press; 2007.
Buettner P, Muller R. Epidemiology. New York: Oxford University Press; 2012.
Bland M. An Introduction to Medical Statistics. 3rd ed. Oxford: Oxford University Press; 2000.
Woodward M. Epidemiology: Study Design & Data Analysis. 2nd ed. London: Chapman & Hall/CRC; 2004.
Friedman GD. Primer of Epidemiology. 5th ed. New York: McGraw-Hill Book Co; 2003.
Lilienfeld AM, Lilienfeld DE, Stolley P. Foundations of Epidemiology. 3rd ed. New York: Oxford University Press; 1994.
Hebel JR, McCarter RJ. A Study Guide to Epidemiology and Biostatistics. 7th ed. Baltimore: University Park Press; 2011.
Gordis L. Epidemiology. 4th ed. Philadelphia : Elsevier/Saunders; 2009.
Friis RH, Sellers. Epidemiology for public health practice / Robert H. Friis, Thomas A. Sellers. 4th ed., Mass. : Jones and Bartlett Publishers; 2009.
THE ASSIGNMENT QUESTIONS:
SECTION A (30 marks)
There are 10 separate questions in (Section A). Each question is worth “three marks”.
Part 1: The following questions all relate to studies designed to assess the effectiveness of a new water filtration method. This method consisted of activated charcoal impregnated with chemicals, sitting in a small package similar to a tea-bag through which water could be poured. The aim of the new method was to filter out infectious agents and thus decrease the likelihood of suffering gastroenteritis (nausea, vomiting and/or diarrhoea).
For each study, state what type of study it is and briefly (one or two sentences should be enough) justify your choice:
1) All people in the village were randomised to either receive the filters, or use their usual method of water purification. Over the following six months the cases of gastroenteritis in the two groups were determined and the rates compared between the groups.
2) A random sample of villagers was selected and the subjects asked whether they had used the filters in the last two months and whether they had suffered gastroenteritis-like symptoms.
3) A random sample of villagers was selected and the subjects asked whether or not they wanted to use the new filters. Those who said they would were provided with filters. The subjects who did not want to use filters used their usual method of water purification. The rate of gastroenteritis-like symptoms was compared between the two groups.
4) Persons with gastroenteritis who reported to the local hospital were asked about whether or not they had used the new filters over the previous four weeks. A comparison group was chosen from people presenting to the hospital with an injury. These injured people were also asked whether they had used the new filters in the previous four weeks. The proportions of people in the two groups who had used the filters were compared.
5) The rates of gastroenteritis in towns where the filters had been made available were compared to the rates in towns where the filters had not yet been used.
6) A random sample of villagers who had previously been diagnosed with gastroenteritis was chosen. The subjects were then randomly assigned to either receive the new filter or not. The rate of gastroenteritis in the two groups over the next four weeks was compared.
7) People using the new filters were asked to complete a daily diary recording any symptoms of gastroenteritis. After six months the proportion that had developed gastroenteritis was determined.
8) People using the new filters were asked to complete a daily diary for six months recording any symptoms of gastroenteritis. The proportion of people with symptoms in the filter group was compared to the proportion of people with symptoms who did not use the new filters over the same period.
Part 2. Answer the following question:
9) Players suffering a ruptured anterior cruciate ligament in their knee were asked what type of studs were on the sole of the boots they were wearing at the time of the injury. A random sample of their team-mates who had not injured their knees were asked what type of studs were on the boots they were wearing in the same game. The type of studs were compared between the two groups. What type of study is this?
10) Players were assigned (based on their date of birth) to one of four groups, with each group having to wear a different type of football boot. The groups wore the same type of boot for the whole season. The rate of leg injury was recorded for all players during the year and summarised in a detailed end of season report. At the end of the season the rate of leg injury was compared between the players in each of the four groups. What type of study is this?
SECTION B (30 marks)
A new researcher, Associate Lecturer Macaskill, was interested in studying the relationship between occupational exposure to a new chemical (Substance Red) and the risk of developing chronic renal failure (a disease of the kidney). Ms Macaskill had heard that some of the workers had previously been exposed to another substance, Hirdite. She thought that exposure to Hirdite might also cause chronic renal failure (but this was not known for sure) or might change the effect of Substance Red.
Six thousand workers were enrolled in the study – 4,000 had been exposed to Substance Red and 2,000 had not been exposed. None of these workers had chronic renal failure at the beginning of the study. After 10 years of follow-up, 190 of the workers had been diagnosed with chronic renal failure. Of the 4,000 exposed workers, 140 had developed chronic renal failure.
1) Draw a table that summarises this information. (4 marks)
2) Calculate the crude relative risk. Interpret this in words suitable to explain this result to a lay audience. (6 marks)
Of the 2,000 unexposed workers, 1,000 had also been exposed to Hirdite and 40 of these had been diagnosed with chronic renal failure. Of the 4,000 exposed workers, 1,000 had also been exposed to Hirdite and 80 of these had been diagnosed with chronic renal failure
3) Show that Hirdite is an independent risk factor for chronic renal failure. (3 marks)
4) Do you think Hirdite has confounded the crude RR of Substance Red? Justify your answer, both in terms of the relative risk estimates and the criteria for confounding. Show any relevant working. (14 marks)
5) Do you think Hirdite is an effect modifier of the relationship between Substance Red and chronic renal failure? Justify your answer, showing all necessary working (if any). (3 marks)
SECTION C (40 marks)
For the study below……
1) Draw a flow diagram that summarises what happened in the study. (10 marks)
2) For each relevant stage of the study identify whether you think this may have introduced important selection bias. Justify your opinion. (30 marks)
Based on relatively flimsy evidence, Professor McGeechan hypothesised that eating two macaroons each day would improve the academic performance of Masters level University students. He invited the entire in-coming cohort of the School of Public Health to take part in a study to test this hypothesis. Students who agreed to take part in the study we assigned to one of three groups – pink macaroons, green macaroons or normal diet. The students were allowed to say which group they would like to be in but the final allocation was undertaken by the Professor. He made the allocation based on the student’s surname, with A-G allocated to eat pink macaroons (Group 1), H-Q allocated to eat green macaroons (Group 2) and R-Z allocated to eat their normal diet (Group 3). Students completed a general aptitude test at the beginning of the study and again at the end of semester. The average test score, the proportion of students with scores above 80%, and the mean difference between scores at the beginning and at the end of semester, for each student were compared.
300 students were enrolled in the School of Public Health at the beginning of the year. 270 of these agreed to participate in the study ? 90 students were allocated to each of the three groups.
Of the 90 students allocated to Group 1, 30 did not finish the study because they withdrew from their course (10 students), they were worried about putting on weight (five students) or they wanted to concentrate on their studies because they had failed their first two assignments (15 students). Due to a computer error there was no other information available about the students who dropped out of Group 1.
All 90 Group 2 students completed the study. However, the same computer error resulted in the final test results of 20 students being lost. It was known that the computer error had resulted in the loss of a random sample of the original 90 Group 2 students.
Of the 90 students allocated to Group 3, 30 did not finish the study. The reasons for this were not known. The average baseline tests results of the students who dropped out of Group 3 were the same as those who remained in Group 3 and completed the study. Also, it was known that those who dropped out were of similar age and sex to those who remained.
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