- Page 1: Understanding the Fundamentals of E
- Page 5 and 6: Table of Contents Chapter (in Acrob
- Page 7 and 8: 1. Introduction Definition, charact
- Page 9 and 10: problems (Schwartz and Carpenter, 1
- Page 11 and 12: HIV - a new or newly-recognized vir
- Page 13 and 14: d = principal investigator's degree
- Page 15 and 16: Analytic studies typically involve
- Page 17 and 18: Observational sciences especially a
- Page 19 and 20: McGavran EG. What is public health?
- Page 21 and 22: 2. An evolving historical perspecti
- Page 23 and 24: Time line for the history of public
- Page 25 and 26: as a one-room bacteriology laborato
- Page 27 and 28: − Health surveys − Research fun
- Page 29 and 30: his scientific peers of the correct
- Page 31 and 32: Kuhn, Thomas S. The structure of sc
- Page 33 and 34: 3. Studying populations - basic dem
- Page 35 and 36: The demographic balancing equation
- Page 37 and 38: ates. Similarly, bulges in the repr
- Page 39 and 40: When the baby boom cohort retires 1
- Page 41 and 42: The pervasiveness, strength, viciou
- Page 43 and 44: Total fertility rate (TFR) Standard
- Page 45 and 46: Life expectancy The technique, of u
- Page 47 and 48: Excerpt from the U.S. 1993 abridged
- Page 49 and 50: At the other end of the life table,
- Page 51 and 52: to change, hopefully to decline. If
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Thought question: Professors typica
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Descriptive studies and surveillanc
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4. The Phenomenon of Disease Concep
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Classification is the foundation As
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As we gain more sophisticated under
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To recapitulate the above discussio
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Classifying cause of death Since mo
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Laboratory and other objectively me
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distribution but are not diabetic (
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program in the general population,
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Infectious disease Incubation "time
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the direct effects of carcinogenic
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patient outcomes. The design and ev
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detected by screening will appear b
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Morrison, Alan S. Screening in chro
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e relevant. Compromises might be fo
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educational attainment by the numbe
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Distributions - the fuller picture
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Per capita income: Should health ca
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Deaths of children < 1 year of age
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No. of persons with senile dementia
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Incidence Immigration Relationship
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Examples: arthritis, cholelithiasis
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Cohort - entrance into the populati
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Sample calculation: 200 people free
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• The units of time must be state
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Calculation of person-time in a coh
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Original Calculation of person-time
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average risk for a member of the co
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However: Nurses: 601 cases/89,538 w
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treated. If the rate at which patie
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Incidence and prevalence in a popul
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small prevalence. So if the seropre
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Appendix on weighted averages Becau
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Appendix on exponents and logarithm
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and epidemiology. The notation ln(x
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3. For the following hypothetical d
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c. ________________ 6 fatalities /
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Measuring disease and exposure - As
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5. a. Flow Diagram Population of si
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New cases Q ID = ------------------
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Overview 6. Standardization of rate
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differences between the groups in f
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∑ (stratum-specific rates × stan
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especially important when comparing
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copy this cell to the other columns
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where the RR k are the stratum-spec
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and the observed number of deaths i
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Directly standardized rate for A =
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5,022 Indirectly standardized = —
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the situation among older age group
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Appendix on Standardized Mortality
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across age strata, then the damage
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d. How would you feel about the con
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Cases per 100,000 Mean annual incid
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d. dt Indirectly standardized rates
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The second ingredient for an standa
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Group US rate /100,000 County pop.
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Crude rates are comparable because
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The “Big Picture” 7. Relating r
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CHD and oral contraceptives in Brea
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Some basic measures Before diving i
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esophageal cancer? First, if we did
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ought in here as well. When we cont
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Exposure Disease Yes No Total Yes a
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Relation of the odds ratio to the r
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the case-control study estimates th
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If the data had come from a cross-s
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Excess risk = CIR - 1 = 1.0 (i.e.,
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strength of the relationship (e.g.,
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drawn on ordinary graph paper. Howe
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Measures of Impact Concept Relative
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Attributable risk proportion The AR
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show that a large proportion (i.e.,
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Incidence Diagrammatic representati
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1. high frequency of disease 2. pow
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With this diagram and notation we c
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vaguer) “attributed to”. Incide
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Summary There are three categories
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CIR can be directly estimated if th
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I0 I = ——————— 1 + P1
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PD|e PE (RR - 1) PD|e PE (RR - 1) P
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Walter, Stephen D. Choice of effect
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a. Quit rates were measured as the
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1. Definitions: Relating risk facto
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There is an extremely strong associ
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8. Analytic study designs The archi
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Progression of types of studies In
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Cross-sectional A cross-sectional s
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Follow-up studies Along with case-c
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of interest community-level influen
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ecological approach may be the appr
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What measures can be estimated from
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Ability to estimate risk Ascertainm
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individuals, this relationship does
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Odds Ratio (OR) Exposure odds in ca
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Simple randomization - assignment o
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The relationship of an attribute to
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(a / m1) / (b / m1) ad ORe (Exposur
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Validity The validity of a case-con
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Since the strategic advantage of th
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c = f0N1 = number of exposed noncas
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experienced the event under study.
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approach, the odds ratio computatio
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Exposure Yes No Total Cases A B M1
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Miettinen, Olli S. The clinical tri
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Mantel, N. and Haenszel, W.: Statis
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Peto, R., Pike, M.C., Armitage, P.,
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4. The authors state that "There we
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5. In contrast to many earlier inve
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In this study the use of hospitaliz
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Follow-up must be longer for any gi
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While acknowledging the very import
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world. Even as late as the 1950's,
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Causal Inference Direct observation
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data on the effects of radiation on
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But excluding an explanation based
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Strength of the association Pronou
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Experimental evidence Certain types
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To issue an indictment, the grand j
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10. Sources of error A systematic f
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the data in the table. (Note that t
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associations. So the same terms may
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"Negative bias" - The observed meas
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Classifying sources of bias Inspite
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The study population is a subset of
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This estimate of the prevalence of
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unmatched control groups will presu
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The odds ratio for this table is 3.
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Selection bias in cohort studies Se
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Information bias Information bias r
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following chapter). The concept of
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P h y s i c i a n A Comparison of d
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item). Alpha values of 0.80 are are
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Hypothetical scenario showing effec
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presumably classified as informatio
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Appendix 1 Formulas to see the effe
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Algebraically, _ Pr(E|D') = — the
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Gregorio, David L.; James R. Marsha
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Sources of error - Assignment 1. Th
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Alpha (α) is the probability by wh
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Sources of error - Assignment solut
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3. ii) Selective survival--if OC us
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a. Flow diagram: 1960-1962 1967-196
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Introduction 11. Multicausality: Co
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estimate of what the outcomes would
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A hypothetical example (with apolog
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Questions to ask: There are many as
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Confounding arises from unequal dis
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CHD Incidence by Behavior Pattern a
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In this way, the 1,129 Type A's wit
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exposure. If we assume a baseline r
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Further insight can be gained by co
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Table 7a Colon cancer and drinking
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atio of the observed number of expo
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ural-specific exposure prevalences,
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eing infected, and the more of them
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studies deal with a delimited geogr
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University of Massachusetts at Amhe
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similarly distributed in cases and
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"There have been many important ste
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MAIN POINTS Confounding is a disto
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Greenland, S. and Neutra R.: Contro
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Appendix The following discussion i
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i n1i wi = ----- If exposure is unr
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Multicausality: Confounding - Assig
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4. The following table, published i
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1. Multicausality: Confounding - As
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link between HCS and MI to ensure t
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Multicausality 12. Multicausality:
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Interdependent effects The precedin
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epidemiologic data. Put simply, the
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BP 0 These two lines are parallel;
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ean intake and B representing genet
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Fourth, proportion of disease attri
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Incidence and incidence ratios of f
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% with evidence of impaired red blo
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cancer rate among the light smokers
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Age standardized lung cancer rates
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R11 - R00 = R10 - R00 + R01 - R00 (
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and R111 = R100 × R010 × R001 / (
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R110 = R100 × R010 / R000 (multipl
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Risk ln(risk) 0.19 -1.67 0.13 -2.01
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have clinical or public health sign
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Baseline Characteristics Associated
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Weiss, Noel S. Accounting for the m
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A. Synergism apparently exists in t
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5. Walker (International Journal of
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(or equivalently, the rate for pers
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impact. Synergism in this sense imp
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13. Multicausality - analysis appro
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very far on instruments but needs t
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Summarizing the relationships Often
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We saw in the chapter on effect mod
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So the multiplicative model for joi
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misleading summary. These circumsta
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w1 CID1 + w2 CID2 Summary CID = —
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c d bcn0 + adn1 Var(ln(CIR)) ≈
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Kleinbaum, Kupper, and Morgenstern;
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1 + 1 + 1 3 ORMH = —————
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Risk = R00 + Obesity effect Obesity
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two (or more) factors that "interac
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OR = exp(β3) β3 is the difference
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Other regression models [Optional f
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Know the epidemiologic meaning of t
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14. Data analysis and interpretatio
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and questionable data. Monitoring p
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presence of particular proteins (e.
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4. Count - the number of entities,
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Algorithms - A procedure that uses
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Imputation causes the least distort
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Prenatal exposure to diethylstilbes
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Possible outcomes (Colors of pairs
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In a strict decision-making mode, t
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C = area between -z and +z D = area
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two-tailed 5% significance level).
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If the p-value is not small (i.e.,
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OR we observed was greater than 1.0
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Large trials (e.g., 250 deaths) Tru
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The concept behind the confidence i
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Formulas for confidence intervals f
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Woolf SH, Battista RN, Anderson GM,
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Stallones, Reuel A. The use and abu
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C - Clustered observations, which d
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For example, suppose that n, the sa
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* See previous table Margin of erro
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Even in randomized trials problems
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Pr(H|T) is therefore a function of
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That information gives you pause. C
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Part II 1. In table 2 from the Rose
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If the OR for Current OC use were t
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6. There are no interaction (produc
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24. Submit manuscript from previous
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Cooperative agreement A cooperative
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Assurances by the applicant and her
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The new element is the grant award.
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1. What needs to be done? 2. How lo
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Postaward Final report What to do
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2. maintain close supervision of th
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Publication Epidemiology Working Gr
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Weed, Douglas L. Between science an
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1.3 Specific Objectives of Data Man
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engender a basic conflict between t
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1.4.2 Integration Integrate the dat
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2. Consistency of the protocol's im
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2. Coding of a sample of data forms
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2.3 The steps in the Editing proces
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Although it is rare to use more tha
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The first stages of data analysis s
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have less power to exclude the stat
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greater nonresponse by heavy drinke
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Imputation is then carried out as f
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(normal) distribution in the popula
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Appendix **************************
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___________________________________
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Public health approach The public h
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health, particularly at the world l
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Causative or preventive agents Scur
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Human behavior is also biology The
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crowded, under-resourced urbanized
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Bibliography Annas, George J.; Leon
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18. Overview and Conclusion A look
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Epidemiology is expanding In recen
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More reliance on "soft money" - res
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__________ This is not a new challe