אפידמיולוגיה מחקרים תיאוריים. observational studies. observational studies י"ז/אייר/תש"ע תיאורי אנליטי. Analytic. Descriptive תיאורי אנליטי.
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1 מחקרים אפידמיולוגים אפידמיולוגיה לתלמידי הסבה תצפיתיים ניסויים סוגי מחקר- 1 (מחקרים תצפיתיים) Randomized Controlled Trials (RCT) Case reports מחקרים תצפיתיים מחקרים תצפיתיים observational studies Analytic בודקים התפלגות מחלות באוכלוסיה, ובוחנים את התכונות הבסיסיות של התפלגות זו. מחקרים ים- כשמם, מתארים את התפלגות המחלה, ומגדירים קבוצות בסיכון גבוה. מחקרים ים- מכמתים את התופעות ומחשבים את הסיכון/ odds. מאתרים גורמי סיכון אפשריים. במסגרת מחקרים תצפיתיים אין כל התערבות מצד החוקר. Descriptive Case reports מחקרים תצפיתיים observational studies Descriptive Analytic מחקרים ים מחקרים ים יכולים רק לתאר את "מי, מה, מתי, איפה" אך לא מה גרם לסיטואציה מסוימת. מחקרים ים מספקים מידע לגבי מספר הפעמים שמשהו קרה, או אחוז, או מספר ממוצע של אירועים. דיווחי מקרים- Case reports סדרת דיווחי מקרים- Case series מחקרים ים אינם מספקים מדדי קשר בין משתנים. מחקרי חתך- 1
2 Case Report- Allergy to banana in a 5-month-old infant A 5-month-old boy suffered three episodes of generalized urticaria 20 min after the ingestion of a fruit purée containing apple, banana and orange. Skin testing showed positive results to banana and chestnut. Other tests were negative. The value of specific immunoglobulin E (Pharmacia CAP-FEIA, Uppsala, Sweden) to banana was 58 KU/l, to orange was 9.7 KU/l, to chestnut was 5.6 KU/l and to latex was 1.6 KU/l. Orange, apple and latex products were well tolerated. He never had eaten chestnut. The parents rejected a banana challenge test. The route of sensitization in our case might be via placenta, breast-milk, and inadvertent oral intake of food or even via inhalation. An early frequent exposure to banana allergens was considered a possibility factor for the development of banana sensitization. We found that the banana consumption during pregnancy and lactation by the mother of our patient was greater than usual. It is not frequent to find so high levels of sensitization to any fruit in first year of life. In our case, latex, chestnut and orange sensitizations did not seem to be clinically relevant. However, latex and foods known to crossreact with banana antigens should be given to banana-sensitive individuals with great caution. Pediatr Allergy Immunol Jun;15(3): דיווחי מקרים מה ניתן להסיק מדיווח זה? 1. לאישה בהריון אסור לאכול בננות, "יותר מהרגיל". 2. לא לתת לתינוקות בני 5 חודשים, מחית המערבבת תפוחים, בננות ותפוזים. 3. במידה וכן נותנים לתינוק מחית המערבבת תפוחים, בננות ותפוזים, יש להגיע לחדר מיון תוך 20 דקות מזמן ההאכלה. ניתן להסיק מסקנות מדיווח זה? האם מסקנות אלו הינן נכונות כלפי כל הילדים בכל הגילאים? אולי מסקנות אלו נכונות רק לגבי ילדים שנולדו בספרד? מה לדם ילדים שנולדו בארץ? עם אולי המסקנות נכונות רק לגבי הילדים של המשפחה המתוארת? מה ניתן להסיק מדיווח זה? מדובר בדיווח רציני כיוון שהציגו שני מקרים רק אחד. דומים, ולא לא אם בכלל לעשן סיגריות בטעמים, בעיקר המסקנה: לא עישנתם בעבר, או אם עישנתם והפסקתם לפני 17 שנה. Flavored cigar smoking induces acute eosinophilic pneumonia Two cases of acute eosinophilic pneumonia (AEP) following smoking of flavored cigars were analyzed for characteristic features.none of our patients had a history of smoking flavored cigars/cigarettes in the past. One of them had never smoked, and the second patient was an ex-smoker who quit 17 years ago. Both patients presented with community-acquired pneumonia-like symptoms that did not respond to treatment with antibiotics. Their chest radiographs revealed bilateral diffuse infiltrates. The diagnosis of AEP was established based on the clinical picture, BAL that revealed an average eosinophil count > 45%, and immediate clinical improvement after introducing corticosteroids. All other possible causes were excluded during the initial workup. Chest Apr;131(4):
3 דיווחי מקרים Case reports אז כבר הבנו שלא ניתן להסיק מסקנות מרחיקות לכת מדיווחי מקרים. מדוע? ניתן להוכיח סיבתיות. כיוון שלא ייתכן שהקשר שנצפה בדיווחי מקרים הינו מקרי בלבד. קשה מאוד לקשר בין הסיבה לתוצאה כאשר מדובר במספרים קטנים. דיווחי מקרים Case reports אז למה זה טוב? חשובים על מנת לזהות או לתת איזשהו רמז לתוצאים (outcomes) שעלינו לחפש במחקרים עתידיים. Case series of use of Manuka honey in leg ulceration The historical and current literature reports the successful use of honey to manage a diversity of wound aetiologies. However, only in the last 40 years is research on its mode of action and contribution to wound healing being investigated. The challenge of managing chronic non healing wounds generated interest in researching non standard therapies. The aims of the study were to gain insight into the practical use of Manuka honey in wound management. The objective was to test the feasibility of further rigorous research into the use of honey in the management of chronic wounds. Instrumental case series were used to examine the use of Manuka honey in eight cases of leg ulceration. To collect the necessary data, photographs, acetate tracings, data monitoring and patient comments and observations were used to add greater reliability and validity to the findings. The wounds were dressed weekly with Manuka honey. The results obtained showed three males and five females with ulceration of different aetiologies were studied. A mean initial wound size for all wounds of 5.62 cm(2) was obtained. At the end of four-week treatment period, the mean size was 2.25 cm(2). Odour was eliminated and pain reduced. The conclusions drawn were that the use of Manuka honey was associated with a positive wound-healing outcome in these eight cases. Arterial wounds showed minimal improvement only. סדרת דיווחי מקרים- Serial of case reports/ case series תיאור של מספר דיווחי מקרים דומים/תיאור של טיפול חדשני במספר קטן של אנשים. מחקרים אלו יותר טובים מאשר דיווחי מקרים בודדים. Int Wound J Mar;2(1):10-5 סדרת דיווחי מקרים- Serial of case reports/ case series זה מה יש! לא תמיד ניתן להגיע למספרים גדולים של מטופלים/חולים- ולכן אין ברירה אלא להסתפק בסדרת דיווחי מקרים. Methylmercury exposure in Wisconsin: A case study series Many popular varieties of commercially sold fish, including tilefish, seabass, shark, and swordfish, contain enough mercury so that eating them once or twice a month can lead to high mercury body burdens. Wisconsin has issued mercury-based sport-fish consumption advice to people of all ages since Wisconsin's advisory was revised in 2000 to address all inland waters and again in 2004 to integrate information about sport-caught fish with advice for commercially sold fish. Because of the increased popularity of fish as a source of dietary protein, a significant percentage of the US population may be at risk of methylmercury-induced y health problems. Although several studies have assessed mercury exposure among children and women of child-bearing age, very little is known about mercury body burdens among men or postmenopausal women. This article describes fish consumption and mercury exposure among 14 people who consumed fish twice a week or more and 1 person who ate no fish. Steadystate blood mercury levels available for 10 adults and 1 child ranged from <5 to 58 microg/l and correlated well with dietary mercury intake estimates. Three of these individuals reported vague, subclinical symptoms such as mental confusion, sleep difficulty, balance problems, or visual disturbances, which improved after their mercury levels returned to normal. 3
4 מחקרי חתך מחקר חתך- Cross Sectional תיאור כמותי של המצב כפי שהוא בהווה (צילום מצב). הנחקרים נבחרים ללא קשר לחשיפה ולתוצאה (הימצאות). דוגמאות למחקרי חתך: לכמה אנשים שנמצאים בחדר יש חולצה לבנה? איזה אחוז מהסטודנטים לרוקחות לוקחים תרופות נוגדות דיכאון? מהי התפלגות הגילאים בקרב מאושפזי מחלקת אורטופדיה? איזה אחוז מהילדים בגן החובה יודעים לקרוא? המטרה של מחקר חתך לצורך תאור התפלגויות משתני החשיפה והמחלה באוכלוסייה. (תבנית זו יעילה בעיקר לחקר מחלות שכיחות, עם מהלך ארוך). קשרים להעלאת השערות מחקריות חדשות בהתבסס על ל בין משתני חשיפה ונתוני המצאות. הערכת המועילות של שירותי בריאות (לפני ואחרי פעולת התערבות.) לא ניתן לבחון השערות אטיולוגיות שכן אלו דורשות נתוני היארעות (נגיע לזה). Cross Sectional מחקר חתך- Cross Sectional מחקר חתך- מחקר חתך מחקר חתך כמה אנשים אנשם עם שפעת כמה אנשים אנשם עם שפעת הגיעו היום למרפאה? הגיעו היום למרפאה, (לרוב בשנים- כמה אנשים ולכמה מהם יש יל"ד? חלו ב- MS בשנת 99). כיוון שבמחקר חתך, אנו "מצלמים" תמונת מצב הכוללת הן את החשיפה והן את התוצאה- לא ניתן לבדוק נסיבתיות!! (שפעת/יל"ד). למה לא יודעים מה קדם כל אדם נבדק פעם אחת. 4
5 מחקר חתך- המדד במחקרי חתך: 2/8 1/8 3/8 המצאות - Prevalence מספר מקרי המחלה בזמן ספציפי מספר האוכלוסייה החשופה באותו הזמן ציר הזמן המצאות - Prevalence Prevalence of overweight and obesity in the homeless population Grey bars: total study population (n = 201) Black bars: males (n = 174); White bars: females (n = 27) BMC Public Health Apr 5;7:51 המצאות - Prevalence Hairdressing is associated with scalp disease in African schoolchildren Background: Anecdotal reports suggest that certain disorders are common in African hair and may be associated with hairstyles. Objectives A cross-sectional study of 1042 schoolchildren was performed to test this hypothesis. Methods A questionnaire was administered and scalp examinations performed, after ethics approval. Results Participants included 45% boys and 55% girls. The majority of boys, 72.8%, kept natural hair with frequent haircuts (within 4 weeks). The prevalence of acne (folliculitis) keloidalis nuchae (AKN) was 0.67% in the whole group and highest (4.7%) in boys in the final year of high school, all of whom had frequent haircuts. The majority of girls (78.4%) had chemically relaxed hair, which was usually combed back or tied in ponytails, vs. 8.6% of boys. Traction alopecia (TA) was significantly more common with relaxed than natural hair, with an overall prevalence of 9.4% (98 of 1042) and of 17.1% in girls, in whom it increased with age from 8.6% in the first year of school to 21.7% in the last year of high school. The proportion with TA in participants with a history of braids on natural hair was lower (22.9%), but not significantly, than among those with a history of braids on relaxed hair (32.1%). No cases of central centrifugal cicatricial alopecia were identified. Conclusions We found associations between hairstyle and disease in our population of schoolchildren. AKN appears to be associated with frequently cut natural hair and TA with relaxed hair. These associations need further study for purposes of disease prevention Br J Dermatol 2007 יתרונות מחקר החתך חסרונות מחקר החתך מהיר ולא יקר. מחקר יעיל לתיאור אוכלוסיות. יש לו יישומים בבדיקה ראשונית של השערות לאטיולוגיות. אינו תבנית מתאימה לחקר מחלה נדירה או מחלה עם מהלך קצר. לכך הסיכון לפתח מחלה שכן באופן ישיר את אינו מודד נדרשים נתוני היארעות. הקשר שבין החשיפה להוכחה. (סיבה) והמחלה (תוצאה) אינו ניתן 5
6 מה גרם למה? ילדים שמנים התביישו להשתתף בשיעורי ספורט, היה להם יותר קשה בשיעורים ולכן נמנעו מהם. משקל עודף ירידה בפעילות גופנית ילדים שלא ביצעו פעילות גופנית, הלכו במקום זה לקפיטריה לאכול ולכן השמינו. Strong inverse association between physical fitness and overweight in adolescents: a large school-based survey. BACKGROUND: Studies examining the relationship between physical fitness and obesity in children have had mixed results despite their interrelationship making intuitive sense. We examined the relationship between physical fitness and overweight and obesity in a large sample of adolescents in the Republic of Seychelles (Indian Ocean, African region). Methods: All students of four grades of all secondary schools performed nine physical fitness tests. These tests assessed agility, strength and endurance, and included the multistage shuttle run, a validated measure of maximal oxygen uptake. Weight and height were measured, body mass index (BMI) calculated, and "overweight" and "obesity" were defined based on the criteria of the International Obesity Task Force. Age- and sex-specific percentiles for each fitness test were calculated. Results: Data were available in 2203 boys and 2143 girls from a total of 4599 eligible students aged years. The prevalence of overweight was 11.2% (95% confidence interval: ) in boys and 17.5% ( ) in girls. For 7 of the 9 tests, the relationship between BMI and fitness score, as assessed by locally weighted regression, was characterized by a marked inverse J shape. Students with normal body weight achieved "good" performance markedly more often than overweight or obese students on 7 of the 9 tests of fitness and more often than lean children. For example, good performance for the multistage shuttle run was achieved by 25.6% (SE: 2.1) of lean students, 29.6% (0.8) of normal weight students, 7.9% (1.3) of overweight students and 1.2% (0.9) of obese students. Conclusions. This cross-sectional study shows a strong inverse relationship between fitness and excess body weight in adolescents. Improving fitness in adolescents, likely through increasing physical activity, might need special interventions that are responsive to the ability and needs of overweight children מחקרים אפידמיולוגים תצפיתיים ניסויים Randomized Controlled Trials (RCT) Case reports 6
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