(1) Basic researches- new knowledge & technology are generated to deal with major unresolved problems .it provide information require it for planning healthcare and monitoring trends or among other thing e.g
(a) Identifying the factor that influence a certain behavior
(b) Comparing treatment regimen among other thing
(2) Applied research –Identification of priority problem and evaluation of policies & programmes that will deliver the greatest benefit using optimally the available resources .
(3) Clinical Hospital research
(4) Experimental / Laboratory research
(5) Epidemiological research
(6) Health system research
Designs of Research / studies.
(1) Observational study design
(2) Experimental study design
Observational: Descriptive and Analytical.
There are three main type of study designs
Descriptive studies- Describe the patterns of health problem especially in relation to person, place and time
e.g case record –Reporting a case you have never seen before in a journal.
Case series –reporting more than one case
Cross section e.g side view – looking at a number / set of people in a class.
Descriptive researches- study the frequency amount and distribution by person .place & time of dx or events within a population. It include case report, case series reports & cross sectional researches.
Advantages
(1) It generates information quickly hence useful when result are needed urgently and when resources for study are limited.
Disadvantages
It cannot determine the pattern of manifestation or long term trends of the health issue in focus.
Case reports – Are usually report of unusual dx or association. It is expected to generate information for further investigation.
Case series report – Aggregate of case reports
Advantages of case report studies.
(1) It generate research issues
(2) It sensitizes physicians to differential diagnosis and alternative management techniques.
(A) Cross sectional study – measurement are done as single observation and set out to describe a situation e.g the distribution of an event in a population in relation to age ,set and other specific characteristic .
Disadvantages – difficult to ascertain temporal relationship since both exposure dx are measured at the same times.
Ecological correlation study – Anther eg of descriptive study
(B) Analytical studies –can be a retrospective study or the control
The subject of interest is individual in the population but in contrast to descriptive research that looks at the entire population, but inference is not to individual but to the population from w they are selected.
The objective of analytic research is not to formulate but to test hypothesis and to investigate causal factors.
Analytical studies are stronger than cross sectional studies in establishing association.
(c) Case control study – case &control – test hypothesis on association between suspect anthological factors and the occurrence of the dx. It is a retrospective research. It compares the frequency of exposure ti the suspected etiological factor between person with the dx (cases) and those without the dc control
Advantages of case control researches
(1) A short study time and it is particular useful for study of drug include illnesses.
(2) It is relatively inexpensive
(3) It is suitable for study of rare dx.
(4) There is no risk to the subject
(5) Allow to studies of several different anthological factors .
(6) It requires comparatively few subjects.
(7) In case control researches, risk factors can be identified so that rational
Preventive & control programmes can be established.
(8) Ethical problem are minimal.
(9) There is no risk of athriction – subject will not disappear.
(10) It is relatively easy to carry out.
Disadvantages.
1. It might be difficult to select an appropriate control group.
2. There is problem of bias because we are relying on memory of past records and the accuracy may be uncertain and the validity of these might be impossible.
3. We cannot distinguish between causes and associated factors.
Cohort studies – Exposure & non exposure
4. Cohort is a group of indiv. Who share a common experience within a defined time period. A cohort study is a prospective study in to the investigator compares the occurrence of dx in a group of indiv who are exposed to the suspected risk factor to another group of indiv who are not exposed.
The info. Obtained on the incidence of dx or outcome in each study group is analysed to obtain a relative risk. If the incident of dx is higher in exposed than in unexposed group, there is an evidence of association.
Types of cohort studies
i Prospective cohort study – The outcome has not occurred a the time the investigation begins. Exposure & non exposure are ascertained at present. These study groups are followed for several years and the outcome is measured.
Eg long term effects of exposure to uranium in miners to assess subsequent development of lung cancer.
- study of oral contraceptives and health the Royal college of general practitioners.
ii Retropective cohort study –is one in w outcome has occurred by the start of investigation. Here, exposure is ascertained from objective record of the past, and the outcome is ascertained at present
iii Combination of prospective and retrospective cohort studies – Here exposure is ascertained from objectives records of the part e.g. pple exposed to ionizing radiam from atomic bomb, then we follow up and measure outcomes in the future.
Advantages of cohort studies
i There is lack of bias – bcos there is objectives records.
ii It is a method of calculating the incidence of a dx.
iii The absolute risk can be calculated directly.
iv It permits observation of many outcomes.
v There is temporal (cause-effect) relationship btw wt they were exposed to and the outcome.
vi Since exposure is not assigned, ethical concerns are minimal.
Disadvantages
i It is not cost effective / costly.
ii It will take a long time and thee will be they will disappear athrition of the subject.
iii Suitable for common dx.
iv Changes in status of subjects wt respect to the factor exposure been studied.
v There might be changes overtime in diagnostic criteria.
Ethical issues in research
This is a system of moral principles and rules of conduct guiding researches to protect against possible abuses.
In 1947, the ist international code of ethics for research involving human subjects was established. This code lay down the stds for carrying out human exptam. Revised in 1975 and 1983.
1. In carrying out a study, do not use the pt name, initials or hospital no
2. Do not use any identifying info. Published in written description.
3. Do not unpro imfringe on pt privacy without informed consent.
4. photography should not be published without written informed
5. animal exptam must proceed human exptam.
c. experimental / Intervention studies
The is similar in approach to cohort studies but the conditions in is the studies are carried out are under the direct control of the coordinator, as a result, informed consent must be obtained.
Aims of exptal studies.
1. To provide scientific proof of etiologic is may permit the modification or control of those dx.
2. To provide a method for measuring the effectiveness and efficiency of health services for the prevention, control and treatment of dx to improve the health of the community.
Exptal epidemiology has advantages & disadvantage of cohort studies Addition disadvantage are cost, ethics and feaslbilities.
Types
1. Randomized control – After obtaining informed consent, decision is taken on is subject to be exposed to or deprived of the facture by randomization. Randomization is a statistical procedure by to participants are allocated into group usually called study and control group to receive or not to receive an exptal preventive or therapeutic procedure.
Quasi exptal studies – A study is a true expt only if decisions about exposure & nonexposure to the factor under investigation are made by the investigator. This control is not always possible for the investigation i.e the control of decision about exposure & nonexposure is not totally in the control of the investigator, so the investigator can perform the quasi expt in with observation are made by and after intervention are made to are not under the investigator control.
In quasi expt, allocation into the study and control group is without randomization.
Eg of expt studies.
- Clinical trials – Trying drugs on people
- Field trials – using vaccines eg finding effects of oral polio vacc. On children community interventions eg fluorination of their water and the outcome or prevention of dental caries or not.
- How to select subject into small grps / subject selection.
- Look for inclusion and exclusion criteria.
- Inclusion- pple in the study must be a cohort i.e have similar xteristics.
- Selection of controls- should be similar in all respect to the study grp except exposure to the factors.
- Exclusion- pple that are pregnant etc
RESEARCH
Title – must be concise but accurate it must show the subject of study, research design and the location and use. Must not be more than 20 – 22 words. Time must be included.
Abstract / summary – This part is the most widely publicized, published and most read. It is best written towards the end of the research but not at the last minute because it will probably need several drafts/ rewrite. It should be a distillation of the thesis, a concise description of the problems addressed, the method of solving it/ them the result and conclusions. Abstracts do not use. Contain references and it should be fully representatives of the study done i.e. contain all the components of the study done.
Declaration: - Declaration that the study is done by you put your name and sign.
Acknowledgement: - Appreciations of all the contributors.
Introduction: - must give insight to the problems identified for the research and must give a general overview of the present knowledge of the subject or topic. Background info is given here as to the magnitude of the problems, talk about who is affected and a justification for the study.
It should contain a statement of the possible benefits that may be derived from the results that emanate from the study. It must also contain the aims and objectives of the study.
Usually the general aims and objectives talks about the overall goal of the dissertative and the specific objectives break down this goal into simple achievable stages.
Literature review – chapter 2.
It provides an idea of what information already exist about the chosen topic so as to avoid unnecessary duplication. It affords the research the opportunity to learn about what other researchers inner field have done about the problem thereby enabling the statement of the problem as initially conceived to be refined when necessary.
It enables the researchers to familiarize himself what the methods use by others and what type of results they obtained.
Literature review must contain the ffg:
Standard definitions, classification, local perspectives, global prospective, policy statements.
Sources of literature review:
Formal literatures, journals, textbooks, reports of expert’s committee conference proceedings, electronic literature like the interest, unpublished works.
Materials and methodology – chapter 3
In methodology, we want to give enough information to enable others to repeat the study and be in a position to compare the result with yours.
It describes the exptal techniques used, it reports what you’ve done on several difference problems, it should be possible for a competent researcher to reproduce exactly what has been done by following the description because there is a good change that another researcher may want to do the same expect.
Important things methodology must contain
- Study area / location
- Demography xtics – age, sex, religion
- State sample size
- You must be honest to provide information about drop-outs, non compliance
- talk about sampling method used
- talk about data collection techniques and tools e.g. questionnaires, observations or interviews.
Results of study – chapter 4
There you state the result as you observe it. It is a presentation of what was report findings, give tables and figures.
Tables and figure must be complete by themselves and should be comprehensive enough
No discussion or conclusion should be included in the result.
Discussion – chapter 5
This is the main section that the ability of the author in logical thinking. You don’t have to repeat results but you compare them what respect to existing literature
Discuss the result obtained in a summarized pattern.
Conclusion and recommendation – chapter 6
From the results, you draw the conclusion. It emanates from results then recommend for further studies.
References
There are 2 major types
Vancouver and Harvard
Vancouver referencing – names are cited and are arranged and numbered in the order into they occurred in the text. It includes name, title, journal, year journal was published and page where the referent was gotten.
Harvard referencing – drawing up a list of authors with their names in alphabetical order and numbering the list as such includes: name, date, title, journal volume, and page.
Waste management: - Refuse and sewage Disposal.
Solid wastes are made up of gabbage (food waste), rubbish paper, plastic, wood, metal, glass etc), demolition product, sewage treatment residues, dead animals e.t.c. it constitute health hazard if not well managed because:
(1) It decomposes and favours fly breeding
(2) It attracts rodent
(3) The pathogens in it can be transmitted into food directly or indirect
(4) It can cause water and soil pollution
(5) It has unsiclic appearance and bad odours
Sources of refuse
(1)Street refuse is includes leaves, papers, straws some animal droppings etc.
(2) Market refuse – putrid vegetables, animal matters etc.
(3) Industrial refuse
4) Domestic refuse from home – refuse gabbage.
Refuse might is carried out in 3 stages to include:
(1) Storage (2) collection (3) final disposal.
Storage – Galvanized steel dustbin with close fitting cover a suitable receptacle for storing refuse. The capacity will depend upon the number of user and the frequency of collection.
Paper sack is a recent invocation in western countries.
Public bins are used for a larger number of people.
Collection / transportation – This can be done from house to house to avoid refuse been dispersed along the street.
Collection from public bins is also possible.
Refuse should be transported in enclosed vans
There is a wide varieties of refuse collection vehicles of difference shapes and sizes
Final disposal – The choice of a particular method is governed by local factors such as costs and availability of land and Labour.
Principal methods include:
(1) Open dumping – This is not a sanitary method of refuse disposal but it is easy and not expensive. It can be used to reclaim land for cultivation since it gradually converts to humus.
(2) Controlled tipping or sanitary land fill – This is very useful where suitable land is available. The refuse is placed in a trench or other prepared area adequately compacted and covered with earth at the end of each working day.
Chemical, bacteriological and physical changes occur in the buried refuse.
(3) Incineration – This is by burning. It is the method of choice where suitable land is not available. Hospital waste is to particularly dangerous is best disposal off by incineration.
(4) Composting – This is a method of combined disposal of refuse and night feaces soil or sludge (remnant from sewage treatment). It is a process of nature whereby organic matter break down under bacteria action resulting in the formation of relatively stable humus – like material called the compost is has considerable manure value for the soil. Composting should be done far away from city limits.
(5) Burial – is suitable for small camp and the refuse in it is covered with soil on daily basis.
Sewage treatment
Sewage is waste water from a community containing solid and liquid excreta, waste derived from houses, factories and industries. Silage is waste water without excreta (night soil).
The aim of sewage treatment is to stabilize the organic matter so that it can be disposal off safely. It is also to convert the sewages water into an effluent of an acceptable purity which can be safely disposal into land or sea.
Biochemical oxygen Demand (BOD) – This tests the organic content of the sewage. It is the amount of O2 consumed by the sewage within specified no of days and at specified temperature (usually 5 days and 20oc)
Modern sewage treatments.
(1) Primary treatment – This involves:
(a) Screening where metal screens intercept large floating objects such as wood, masses of gabbage, dead animals etc.
(b) Grit chamber – is a long narrow chamber their with the sewage passes to allow settlement of heavier solids.
(c) Primary sedimentation – sewage flows very slowly in the 1o sedimentation tank to allow for sedimentation of suspended matter under the influence of gravity.
2) Secondary treatment
Effluent from 1o sedimentation tank is subjected to:
(a) Aerobic oxidation – This is biological treatment with the use of trickling fulter which is made of a bed of stones, a complex biological growth consisting of algae, fungi protozoa etc. is formed. (Zooleal layer) in the fulter which oxidizes the organic matter in the effluent.
(b) 2o sedimentation – This is carried out in the 2o sedimentation tank for about 2- 3hrs. The sludge is carried aerated sludge.
EPIDERMIOLOGY This is the study of the frequency distribution and determinants of health related events or states in a defined population and the application of the study to the control of health problem
Road traffic accidents: - A non communicable dx.
Non communicable dx are conditions that cause impairment of bodily xture and fxn and necessitates the modification of the person’s normal life.
It usually exists over an extended period of time.
In communicable dx, we talk about triad of agent, host and environment.
In non communicable dx, we talk about risk factors which are attribute or exposure that is significantly associated with the development of a dx.
It could also be determinants that can be modified by intervention thereby reducing the possibility of occurrence of dx or other specified outcomes. Some risk factors can be modified, others can not be modified. Examples of non- modifiable risk factors includes
Age, sex, ethnicity / race and genetic makeup etc.
Modifiable ones are the risk behaviors, smoking, drinking, poverty promiscuity etc.
An accident is an unexpected unplanned occuence it may involved injury. It can also be defined as an unpremeditated events resulting in a recognizable damage.
- An occurrence in a sequence of events to user produces untended injury, death or property damage.
RTA are the causes of the highest injury mortality rate.
They are more in the developed than in developing countries, likewise in the urban than in the rural areas.
Commoner in males than in female; commoner in the young and very old. Commoner in singles, divorce, separated than in those that are married.
Commoner in the night than the day.
Risk factors – Alcohol consumption, use of marijuana or in the host.
- In the young and the old – Risk behavior.
- The old have slow reflexes and poor sight.
- Vehicular problems – Old be bad tyres, old rickety cars, bad breaks, poor light or glare. Absence of wipers,
- Environments – steep roads, winding roads, slippery surfaces pot holes, sharp bends, narrow roads and bridges and poor road signs
Control of RTA
Prevention:
- Primordial: prevention of emergence or dev of risk factors in pop graphs in to they have not yet appeared.
- Primary: (1) health promotion: (i) H/E (don’t drink / smoke and drive, obey road traffic signs), (ii) environmental modification – roads, better road signs, (iii) Lifestyle / behavioral changes (iv) H/E proper.
- Specific protection: use of salt belts, helmets
- Secondary: early diagnosis and treatment
Hospitals that will take care of RTA victims, hospital should treat before asking for police report. Provision of ambulances.
- Tertiary: Disability imitation – Do physiotherapy
- Rehabilitation – provision of crutches, wheel chairs etc.
- Legislation –To prevent and punish culprits
- Surveillance – Watching over and see if there are more accident occurring so as to take preventive actions against them.
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