RAMA MEDICAL COLLEGES HOSPITAL & RESEARCH CENTRE, HAPUR

DEPARTMENT OF COMMUNITY MEDICINE

SAMPLE ANSWERS

MULTIPLE CHOICE QUESTIONS

Q.1 Incidence is defined as :
(a) Number of new cases in an area.
(b) Number of new cases and old cases in a time period from an area.
(c) Incidence depends on duration.
(d) Incidence depends on duration.
Ans: (a)

Q.2 Which is not an analytical study?

(a) Case Control (b) Cohort study.
(c) RCT (d) Cross sectional study.
Ans: (c)

Q.3 Which of the following is not an Interventional study?

(a) Cohort study (b) RCT
(c) Field trials (d) Community trials.
Ans: (a)

Q.4 Descriptive studies are concerned with:

(a) Time distribution (b) Place distribution
(c) Person distribution (d) All of the above
Ans: (d)

Q.5 Framingham heart study is an example of :-

(a) Case control study (b) Cohort study
(c) Cross- sectional study (d) RCT
Ans: (b)
SHORT NOTES :-

Q1- Indicators of health?

Answer – An ideal indicator should be:

Valid, Precise, Sensitive, Specific

Types of Indicators Indicators can be categorized as vital and behavioral. VITAL INDICATORS These
encompass:

Mortality indicators: Crude death rate; infant mortality rate; maternal mortality rate; perinatal mortality
rate, etc. Morbidity indicators: Incidence and prevalence of infectious disease. An example of incidence
indicator is the number of new cases of pulmonary tuberculosis in a given year in a defined population.
Disability indicators: These play a supportive role to other vital indicators. These include sickness
absenteeism rates; paralytic poliomyelitis rate; blindness prevalence rate, etc.

Service indicators: These indicators reflect the provision of health facilities. Examples are proportion of
population served by PHC/subcenters; doctor population ratio; proportion of population having access
to safe drinking water; literacy rate, etc.

Composite indicators: These indicators encompass many facets and hence provide a better measure
tation of life, growth rate, physical quality of life index, etc. are all comprehensive indicators. The
Physical Quality of Life Index (PQLI) has gained popularity in recent times.6a It consists of three
components: Infant mortality rate, life expectancy at one year of age and basic literacy, in population
above 15 years of age. All three components are adequate for international and intercultural
comparisons because no society wants to let its infants die and all people want to live longer and to
have access to basic literacy.

Q2- Rehabilitation?

Answer :- Rehabilitation: Rehabilitation can be considered as a preventive measure in that if effectively

utilized, it can prevent further social drift of the affected individual. Social drift is the phenomenon of
going down the social ladder due to loss of ability to generate income caused by disease.

The aim of rehabilitation is to integrate the affected individual in the community by optimizing his
functional ability. It involves psychological, vocational and social and educational intervention.

 Psychological rehabilitation is of acute importance as, immediately after experiencing a

handicap, the hitherto normal individual may not be able to cope up with the new stress
situation. This is known as crisis intervention. The individual needs to be made to understand
the importance of life and how he can cope with the new situation. If the handicapped have to
lead a normal life and are to be accepted by the members of the family and the community,
vocational rehabilitation is very important. Creating job opportunities and training the
handicapped for such jobs go a long way in alleviating their suffering. Legislation to accord
preferential treatment to the handicapped is also needed.
 Social rehabilitation is extremely important to provide adequate support to the handicapped
individual. The family members should be taught to maintain social support and involve the
disabled in domestic affairs. Stigma attached to disease should be tackled by effective education.
 Sometimes the handicap may be of such an extent that vocational rehabilitation may not be
possible. An example is severe mental retardation. In such a situation, rehabilitation efforts
should be geared to train the individual in activities of daily living.
DIFFERENCES :-

A) Case control study & cohort study.

CASE CONTROL STUDY COHORT STUDY

• Proceed from effect to cause Proceed from cause to effect
Start with diseased population • Start with people exposed to the factor under
study
Case control provide information about one • Useful for evaluating more than one
outcome only outcome related to single exposure
• Allow to study the range of exposure • Usually focus on one exposure only
Suitable for study of a rare disease • Impractical to consider cohort study for rare
diseases •
For rare exposure study, case control may not Suitable for rare special exposure study
suitable one •
LONG QUESTION

QUESTION : What are different types of epidemiological studies ? Describe briefly about
cohort study ?
Answer:- Epidemiological studies can be broadly classified as observational and experimental study .

Observational study
• Descriptive—it includes case report, case series, correlation/ecological study,
cross-sectional/prevalence studies.
• Analytical—can be of following type – Group based—the unit of study is population as group, e.g.
ecological study – Individual based i. Cross-sectional ii. Retrospective—this can be case control study iii.
Prospective—this is cohort study, also called follow-up study

Experimental Study (Interventional study) —. OBSERVATIONAL STUDY In this study nature is allowed to
take its own course, investigator only measure do not intervene or manipulate any variable. This
includes descriptive and analytical epidemiology. The descriptive epidemiology is concerned with
measuring frequency and study of distribution of health related problem in population whereas
analytical epidemiology attempts to analyze the cause or determinants of disease (how the disease
caused?) by testing the hypothesis that has been setout in the study.

EXPERIMENTAL STUDY (INTERVENTIONAL STUDY) Unlike the observational study, the researcher in an
experimental epidemiological study, control or manipulate one or more factors in the study to obtain
information how the factors influence the variables in the study and draw inference. This manipulation
may be deliberate application or withdrawal of suspect causal factor or changing one variable in the
experimental group while making no change in the control group and comparing the outcome in both
groups. The experiments are designed to test the cause effect hypothesis

Study design may be classified into different type according to time of measurement of specific factor
(cause) and its effects (disease).

Cross-sectional:-

A survey or study that examines people in a defined population at one point of time. Cross-sectional
study may be descriptive, analytical, or both. Descriptive crosssectional survey usually provides
prevalence data but repeated survey can be used to give an estimate of incidence. In cross-sectional
surveys the information on cause and effect is simultaneously gathered and the time sequence cannot
be determined (e.g. study of relationship between body built and hypertension). Hypothesis may be
generated from this type studies. This approach is useful during investigation of epidemic. This cannot
distinguish whether exposure preceded the development of a disease or presence of a disease affect the
individual’s level of exposure. From epidemiological study it has been noted that individuals with cancer
have significantly lower level of B-carotene in blood but from the study it is not possible to comment,
which is the cause and effect. It is to be noted that in cross-sectional design observations are made at
one point of time only.
Longitudinal study design: In contrast to previous designed described there is another type called
longitudinal study design. In this design the observations or data refer to for more than one point of
time. The difference between cross-sectional surveys and longitudinal studies can be expressed similar
to difference between snapshot and motion picture.

Retrospective (Backward Looking Study) Here the investigator start with effect and goes back to find
the cause.

Prospective (Forward Looking) In this study the investigator start with causative factor and goes
forward to the effect. The term prospective not necessarily mean that the study is carried out in future,
it can be carried out based on findings on record in past. Study population are divided into two groups,
exposed to the factor of interest and not exposed to that factor, and then followed up to see and
compare the development of disease in these two groups. ‘Retrospective’ and ‘prospective’ are
distinguished by temporal relationship between initiation of study and the occurrence of disease
outcome being studied.

COHORT STUDY :-It is an observational analytical study in which individuals are identified on the basis of
presence or absence of exposure to a suspected risk factor for a disease and followed over time to
determine the occurrence of subsequent outcome. This is also called ‘cause to effect study’ as the
outcome of interest has not occurred at the initiation of investigation

Features of a Cohort Study • Exposure has started or yet to start but outcome has not yet occurred.
However, in retrospective cohort study both have occurred, but investigation is designed to proceed
from cause to effect.

• Proceeds from cause to effect.

• Use a nonexposed group to support or refute an inference.

Cohort: A well-defined group of people who share some common characteristic or experience called
cohort. A group of people born during a particular year is called birth cohort, a cohort of smokers has
the experience of smoking in common.

Type of Cohort Study Depending upon the temporal relationship between the initiation of the study and
the occurrence of the outcome (e.g. disease) the study can be classified under following heading.

• Prospective cohort study: The study subjects are classified on the basis of presence or absence of
exposure and followed up to find the development of the outcome of interest. In this type, exposure
may or may not have occurred but outcome must not have occurred at the beginning of the study.

 Retrospective (historical) cohort study: The subjects are also classified on the basis of presence
or absence of exposure but in this type both the exposure and the outcome of interest have
already occurred at the banging of the study. A historical cohort study depends upon the
 availability of good data or records that allow reconstruction of the exposure of cohorts to a
suspected risk factor and follow-up of their outcome (e.g. mortality or morbidity) over time.

Methodology (Steps) of Cohort Study

• Selection of study subject

• Selection of comparison group

• Obtaining information on exposure

• Follow-up

• Analysis and interpretation.