DISAIN STUDI EPIDEMIOLOGI

1. DISAIN STUDI EPIDEMIOLOGI Maxs U.E. Sanam FKH Undana

2. METODE PENELITIAN EPIDEMIOLOGIS • SURVEI vs EKSPERIMEN • SURVEI : Survei deskriptif vs Survei analitik • SURVEI (Noneksperimen) • TIDAK ada intervensi/perlakuan terhadap variabel • Hanya dilakukan observasi terhadap fenomena alam, sosial, atau • Mencari hubungan fenomena tsb di antara variabel • Pengambilan data menggunakan sampel dan kuisioner

3. Deskriptif vs Analitis • Survei deskriptif (Epidemiologi deskriptif) • Dilakukan tanpa hipotesis • Biasanya studi awal ataupun studi karakterisasi suatu penyakit baru • Survei analitis (Epidemiologi analitis) Mengidentifikasi dan menguji hipotesis tentang adanya asosiasi antara paparan terhadap faktor risiko dan terjadinya suatu kejadian penyakit (exposure of interest vs a particular outcome)

4. EKSPERIMENTAL • Ada intervensi/perlakuan terhadap variabel • Adanya kelompok Kontrol • Randomized clinical trial (Uji Klinis Teracak) • Community or herd trial (Uji Kelompok atau Masyarakat)

5. Diagram Pohon menguraikan hubungan di antara tipe-tipe Rancangan Studi Epidemiologis utama

6. Faktor Risiko • Faktor Risiko Intrinsik (berasal dari host) • Jenis kelamin dan usia • Faktor anatomi dan fisiologis • Faktor nutrisi • Faktor imunitas • Faktor ekstrinsik (di luar host) • Fisik, kimiawi, biologis, psikologis, budaya, perilaku, manajemen

7. Hubungan antara Agen, Faktor Risiko, dan Efek (Penyakit) Faktor Risiko Internal Eksternal Agen penyakit Man/Animals as Host Sakit

8. Case Reports • describes some ‘newsworthy’ clinical occurrence, such as • unusual combinationof clinical signs • experience with a novel treatment, or • a sequence of events thatmay suggest previously unsuspected causal relationships. • Case reports are generallyreported as a clinical narrative.

9. Contoh Studi Kasus • Trivierat al (2001) reported the occurrence of fatal aplasticanaemia in an 88 year-old man who had takenclopidogrel, a relatively new drug on the market that inhibits platelet aggregation. • The authors speculatedthat his fatal illness may have been caused by clopidogrel and wished to alert other clinicians to a possibleadverse effect of the drug. • Reference: Trivier JM, Caron J, Mahieu M, Cambier N, Rose C (2001). Fatal aplastic anaemia associatedwith clopidogrel. Lancet, 357: 446.

10. Cases series • Acase report shows that something can happen once, a case series shows thatit can happen repeatedly. • A case series identifies common features among multiple cases • and describes patterns of variability among them.

11. Contoh Case Series • After bovine spongiform encephalopathy (BSE) appeared in British cattle in 1987, there was concern thatthe disease might spread to humans. • A special surveillance unit was set up to study Creutzfeld-Jacobdisease (CJD), a rare and fatal progressive dementia that shares clinical and pathological features of BSE. • In 1996 investigators at the unit described ten cases that met the criteria for CJD but had all occurred atunusually young ages, showed distinctive symptoms and, on pathological examination, had extensive prionprotein plaques throughout the brain similar to BSE. • Reference: Will RG, Ironside JW, Zeidler M, Cousens SN, Estibeiro K, Alperovitch A et al (1996). A newvariant of Creutzfeld-Jacob disease in the UK. Lancet, 347: 921 - 925.

12. Descriptive studies based on rates • Descriptive studies based on rates quantify the burden of disease on a population • Usingincidence, prevalence, mortality or other measures of disease frequency. • Most use datafrom existing sources (such as birth and death certificates, disease registries or surveillancesystems). • Descriptive studies can be a rich source of hypotheses that lead later toanalytic studies.

13. Contoh Studi deskriptis yang didasarkan pada frekuensi/intensitas • Schwarz et al (1994) conducted a descriptive epidemiological study of injuries in a predominantly African-American part of Philadelphia. • An injury surveillance system was set up in a hospital emergency centre. • Denominator information came from US census data. These authors found a high incidence of intentionalinterpersonal injury in this area of the city. • Reference: Schwarz DF, Grisso JA, Miles CG, Holmes JH, Wishner AR, Sutton RL (1994). A longitudinalstudy of injury morbidity in an African-American population. Journal of the American Medical Association,271: 755 - 760.