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Observational - Non-Interventional
Experimental - Interventional
OBSERVATIONAL:
Here nature allowed to take its
course. Changes and differences
in one variable are studied in
relation to changes and
differences in another.
Investigator DOES NOT intervene.
- (e.g. Smoking v/s lung cancer:
Investigator does not decide who
smokes and who must not).
EXPERIMENTAL:
Investigator deliberately
introduces change in one variable
and measures effect of this on
outcome.
- These have ethical problems in
humans as well as costs involved.
- Therefore most studies are
OBSERVATIONAL.
Observational studies
Observational studies
cont..:
Descriptive studies:
Description by
- Person - stating what pop. and
sub pop. do or do not
develop disease.
- Place Its geographical location
- Time - How does frequency of
disease vary with time.
Case reports
with
DESCRIPTIVE STUDIES
cont:
In investigating affected
individuals they can lead to
hypothesis formulation.
OBSERVATIONAL STUDY:
(analytical)
CORRELATIONAL
(ECOLOGICAL) STUDIES
Ecological (Correlational):
Ecological (Correlational).:
Investigator measures characteristic of
entire population to describe disease in
relation to age, sex etc.
E.g. Pap Smears Correlation with mortality
from cancer of the Cervix.
- For example the % in Cancer Cervix in 2
periods.
- 1950-1954 - Time pap started to be
used widely
- 1960-1964 - Time notable in mortality
could have started
Ecological (Correlational)..:
ECOLOGICAL (CORRELATIONAL):
Example raises question
(hypothesis) that:
Screening mortality from Ca.
Cervix.
Hypothesis cant be tested
(answered) with this data since:
a) Dont know whether women
screened are those who
experienced lower mortality i.e.
ECOLOGICAL (CORRELATIONAL):
b) Cant control for potential confounding
factors.
E.g.
-In Study of per capita average daily intake
of pork in relation to Breast Cancer.
- A strong +ve Correl. between death from
Ca. breast and pork eating was noted.
(Hypothesis).
- However pork eating may be marker to
other factors e.g.
-fat in body)
- vegetable eating) - These risk of
breast Cancer.
Ecological (Correlational):
Cant separate confounders using
correlational data.
- More dramatic illustration of this limitation is:
-Very strong +ve correlation between per
capita number of colour TV sets and CHD
mortality in different nations.
Hypothesis is there is association between
colour TVs and CHD mortality.
- However colour TVs are related with other
lifestyles and these risk of CHD e.g.
smoking, cholesterol, inactivity.
Ecological (Correlational):
- Again absence of correlation does not
mean absence of valid statistical
associations.
E.g. In early 70s use of oral
contraceptives in USA.
At same time mortality rates from CHD
among all childbearing women 30%.
-This information does not support a +ve
association between use of Oral
Contraceptives and risk of fatal CHD.
ECOLOGICAL (CORRELATIONAL):
ECOLOGICAL (CORRELATIONAL):
Ecological (Correlational).:
E.g. In various countries the per capita alcohol
consumption showed a striking simple
inverse linear relationship with CHD
mortality.
This meant that: Countries with per capita alcohol
consumption had CHD mortality risk
ECOLOGICAL (CORRELATIONAL):
CHD Rate
A
B
Alcohol Consumption
Ecological (Correlational):
OBSERVATIONAL STUDIES
(DESCRIPTIVE)
CROSS-SECTIONAL STUDIES
CROSS-SECTIONAL Studies
Also Descriptive studies sometimes
called prevalence surveys.
- Here exposure and disease are
assessed simultaneously in individuals
of well defined pop.
(Diarrhoea/Bacterial infection).
Its like a specific window e.g. calendar
year, in which community wide survey
is conducted
*OR:
Cross-sectional studies.:
Pre-employment exam
Pre-school entrance exam
CROSS-SECTIONAL Studies.:
Hypothetical Situation
OCCUPATIONAL EXPOSURE &
DISEASE PREVALENCE
MEASURED BY X-SECTIONAL
SURVEY:
A = 10 and
90
B=15
110
Another example:
- Investigators compared prevalence
rates of CHD among white farmers
between;
X Sectional studies..:
It could be :