DISAIN STUDI EPIDEMIOLOGI Maxs U.E. Sanam FKH Undana

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

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)

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

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

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

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

Case Reports describes some ‘newsworthy’ clinical occurrence, such as unusual combination of clinical signs experience with a novel treatment, or a sequence of events that may suggest previously unsuspected causal relationships. Case reports are generally reported as a clinical narrative.

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

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

Contoh Case Series After bovine spongiform encephalopathy (BSE) appeared in British cattle in 1987, there was concern that the disease might spread to humans. A special surveillance unit was set up to study Creutzfeld-Jacob disease (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 at unusually young ages, showed distinctive symptoms and, on pathological examination, had extensive prion protein plaques throughout the brain similar to BSE. Reference: Will RG, Ironside JW, Zeidler M, Cousens SN, Estibeiro K, Alperovitch A et al (1996). A new variant of Creutzfeld-Jacob disease in the UK. Lancet, 347: 921 - 925.

Descriptive studies based on rates Descriptive studies based on rates quantify the burden of disease on a population Using incidence, prevalence, mortality or other measures of disease frequency. Most use data from existing sources (such as birth and death certificates, disease registries or surveillance systems). Descriptive studies can be a rich source of hypotheses that lead later to analytic studies.

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 intentional interpersonal injury in this area of the city. Reference: Schwarz DF, Grisso JA, Miles CG, Holmes JH, Wishner AR, Sutton RL (1994). A longitudinal study of injury morbidity in an African-American population. Journal of the American Medical Association,271: 755 - 760.