ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ ﻭ ﺍکﻮﻟﻮژﻴک

ﺍﻫﺪﺍﻑ آﻤﻮﺯﺷﻲ: • ﺍﺭﺯﺵ ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ ﺩﺭ ﻧﻈﺎﻡ ﺳﻼﻣﺖ • ﻣﺮﺍﺣﻞ ﺍﻧﺠﺎﻡ ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ • ﺗﻮﺟﻪ ﺑﻪ ﺗﺤﻠﻴﻞ ﺯﻣﺎﻧﻲ ﻭ ﻣکﺎﻧﻲ ﺩﺭ ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ • ﺟﺎﻳگﺎﻩ ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺍکﻮﻟﻮژﻴک • ﺧﻄﺎﻱ پﺮ ﺍﻫﻤﻴﺖ ﺩﺭ ﺗﻔﺴﻴﺮ ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺍکﻮﻟﻮژﻴک

ﺍﻧﻮﺍﻉ ﻣﻄﺎﻟﻌﺎﺕ ﺑﺮ ﻣﺒﻨﺎﻱ ﻣﻮﺍﺟﻬﻪ • ﺗﻮﺻﻴﻔﻲ: ﺑﺎ ﻫﺪﻑ ﺑﺮﺭﺳﻲ ﻭ ﺗﻮﺻﻴﻒ ﻳﻚ ﻭﺿﻌﻴﺖ ﺑﺪﻭﻥ آﻨﻜﻪ ﻗﺼﺪ ﺑﺮﺭﺳﻲ ﻳﻚ ﺭﺍﺑﻄﻪ )آﺰﻣﻮﻥ ﻓﺮﺿﻴﻪ( ﺭﺍ ﺩﺍﺷﺘﻪ ﺑﺎﺷﻴﻢ • ﺗﺤﻠﻴﻠﻲ: ﺑﺎ ﻫﺪﻑ ﺑﺮﺭﺳﻲ ﻳﻚ ﺭﺍﺑﻄﻪ ، ﺍﺧﺘﻼﻑ ﻳﺎ ﺍﺭﺗﺒﺎﻁ )آﺰﻣﻮﻥ ﻓﺮﺿﻴﻪ( ﺻﻮﺭﺕ ﻣﻲ پﺬﻳﺮﺩ

ﻣﻄﺎﻟﻌﺎﺕ ﺗﻮﺻﻴﻔﻲ • گﺰﺍﺭﺵ ﻣﻮﺭﺩ) (case report • گﺰﺍﺭﺵ ﻣﻮﺍﺭﺩ) (case series • ﻣﻄﺎﻟﻌﺎﺕ ﺍﻛﻮﻟﻮژﻴﻚ) (ecologic or correlational • ﻣﻄﺎﻟﻌﺎﺕ ﻣﻘﻄﻌﻲ) (cross sectional

ﺍﻧﻮﺍﻉ ﻣﻄﺎﻟﻌﺎﺕ ﺗﻮﺻﻴﻔﻲ ﺗﺤﻠﻴﻠﻲ ﺍﻱ ﻣﺪﺍﺧﻠﻪ ﻣﺸﺎﻫﺪﻩ ﺍﻱ گﺰﺍﺭﺵ ﻣﻮﺭﺩ ﻛﺎﺭآﺰﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﻛﻮﻫﻮﺭﺕ گﺰﺍﺭﺵ ﻣﻮﺍﺭﺩ ﻛﺎﺭآﺰﻣﺎﻳﻲ ﻣﻴﺪﺍﻧﻲ ﻣﻮﺭﺩ ﺷﺎﻫﺪﻱ ﺍﻛﻮﻟﻮژﻴﻚ ﻛﺎﺭآﺰﻣﺎﻳﻲ ﺍﺟﺘﻤﺎﻋﻲ ﻣﻘﻄﻌﻲ

ﻣﻄﺎﻟﻌﺎﺕ ﺗﻮﺻﻴﻔﻲ ﺑﻪ چﻪ پﺮﺳﺶﻫﺎﻳﻲ پﺎﺳﺦ ﻣﻲﺩﻫﻨﺪ؟ ﻛﺴﻲ؟ چﻪ ﻛﺠﺎ؟ چﻪ ﻭﻗﺖ؟ ﺑﻪﺧﺎﻃﺮ ﺩﺍﺭﻳﻢ ﻛﻪ ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﺗﺤﻠﻴﻠﻲ ﺑﻪﺩﻧﺒﺎﻝ پﺎﺳﺦ ﺑﻪ پﺮﺳﺶﻫﺎﻱ ﺍﺯ ﻗﺒﻴﻞ چگﻮﻧﻪ، آﻴﺎ، ﻭ. . . ﻫﺴﺘﻴﻢ.

ﺍﻫﻤﻴﺖ ﻣﻄﺎﻟﻌﺎﺕ ﺗﻮﺻﻴﻔﻲ ﺩﺭ چﻴﺴﺖ؟ • ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ ﺩﺭ ﺷﺮﻭﻉ ﻛﺸﻒ ﻳﻚ پﺪﻳﺪﻩﻱ ﺳﻼﻣﺘﻲ ﺩﺭ ﻫﺮ ﻣﻨﻄﻘﻪ ﻳﺎ ﻫﺮ گﺮﻭﻩ ﺍﻫﻤﻴﺖ ﺯﻳﺎﺩﻱ ﺩﺍﺭﻧﺪ. • ﻫﺮ ﻣﻄﺎﻟﻌﻪﻱ ﺗﺤﻠﻴﻠﻲ ﺩﺍﺭﺍﻱ ﺑﺨﺶ، ﻳﺎ ﺑﺨﺶﻫﺎﻱ، ﺗﻮﺻﻴﻔﻲ ﺍﺳﺖ ﻛﻪ ﺑﺪﻭﻥ ﺍﻧﺠﺎﻡ آﻦ ﺑﺨﺶﻫﺎ ﺭﺳﻴﺪﻥ ﺑﻪ ﻧﺘﻴﺠﻪگﻴﺮﻱ ﺻﺤﻴﺢ ﻣﻤﻜﻦ ﻧﻤﻲﺑﺎﺷﺪ. ﻫﺮچﻨﺪ ﻣﻤﻜﻦ ﺍﺳﺖ ﺑﺨﺶﻫﺎﻱ ﺗﻮﺻﻴﻔﻲ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻨﻬﺎ ﺩﺭ ﺣﺪ ﺧﻮﺩ آﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺭﺯﺵ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ.

گﺰﺍﺭﺵ ﺑﻴﻤﺎﺭ • ﺍﺭﺍﻳﻪﻱ ﺩﻗﻴﻖ ﻭ ﺣﺘﻲﺍﻟﻤﻘﺪﻭﺭ ﺗﻔﺼﻴﻠﻲ ﻭﺿﻌﻴﺖ ﻳﻚ ﻣﻮﺭﺩ ﺧﺎﺹ ﺍﺯ ﻳﻚ ﺑﻴﻤﺎﺭﻱ. ﻣﻌﻤﻮﻻ ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ ﻳﺎ ﺩﺭ ﺍﻭﻟﻴﻦ ﻣﻮﺍﺭﺩ ﻳﻚ ﺑﻴﻤﺎﺭﻱ ﻳﺎ ﺑﺮﺍﻱ ﺗﻈﺎﻫﺮﺍﺕ ﺟﺪﻳﺪ ﻳﺎ ﻧﺎﺷﻨﺎﺧﺘﻪﻱ ﻳﻚ ﺑﻴﻤﺎﺭﻱ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺍﺳﺘﻔﺎﺩﻩ ﻣﻲگﺮﺩﺩ.

ﺳﺮﻱ ﺑﻴﻤﺎﺭﺍﻥ • ﻧﻮﻋﻲ گﺰﺍﺭﺵ ﺑﻴﻤﺎﺭ ﺍﺳﺖ ﻛﻪ ﺍﻳﻦ ﺑﺎﺭ چﻨﺪ ﺑﻴﻤﺎﺭ ﺑﺎ ﺗﻈﺎﻫﺮﺍﺕ ﺑﺎﻟﻴﻨﻲ ﻳﺎ ﺧﺼﻮﺻﻴﺎﺕ ﻣﺸﺎﺑﻪ ﺩﻳگﺮ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﻣﻲگﻴﺮﻧﺪ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺩﺭ ﺍﺑﺘﺪﺍﻱ پﻴﺪﺍﻳﺶ ﻳﻚ ﺑﻴﻤﺎﺭﻱ ﻣﻲﺗﻮﺍﻧﺪ ﺭﺍﻩﻧﻤﺎﻱ ﺑﺴﻴﺎﺭ ﻣﻨﺎﺳﺒﻲ ﺑﺮﺍﻱ ﻣﻄﺎﻟﻌﻪﻫﺎﻱ ﺑﻌﺪﻱ ﺑﺎﺷﺪ. • ﻳﻜﻲ ﺍﺯ ﺑﻬﺘﺮﻳﻦ ﻧﻤﻮﻧﻪﻫﺎ ﺑﺮﺍﻱ ﺍﻳﻦ ﻧﻮﻉ ﻣﻄﺎﻟﻌﻪ، گﺰﺍﺭﺵ ﻣﺮﻛﺰ ﻛﻨﺘﺮﻝ ﺑﻴﻤﺎﺭﻱﻫﺎﻱ آﻤﺮﻳﻜﺎ ﺩﺭ ﻣﻮﺭﺩ ﺳﻨﺪﺭﻭﻣﻲ ﺑﻮﺩ ﻛﻪ ﺑﻌﺪﻫﺎ ﺑﻪﻧﺎﻡ ﺳﻨﺪﺭﻭﻡ ﻧﻘﺺ ﺍﻳﻤﻨﻲ ﺍﻛﺘﺴﺎﺑﻲ ) (AIDS ﻣﻌﺮﻓﻲ ﺷﺪ.

ﻣﻄﺎﻟﻌﺎﺕ ﻣﻘﻄﻌﻲ ﻣﻄﺎﻟﻌﺎﺗﻲ ﻫﺴﺘﻨﺪ ﻛﻪ ﺑﻴﺶﺗﺮ ﺑﻪﻣﻨﻈﻮﺭ ﺗﻮﺻﻴﻒ ﻳﻚ ﻳﺎ چﻨﺪ پﺪﻳﺪﻩﻱ ﺳﻼﻣﺘﻲ ﺩﺭ ﺯﻣﺎﻥ ﻭ ﻣﻌﻤﻮﻻ ﻣﻜﺎﻥ ﺗﻌﺮﻳﻒ ﺷﺪﻩﺍﻱ ﺍﻧﺠﺎﻡ ﻣﻲگﺮﺩﺩ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ ﻣﻌﻤﻮﻻ ﺑﺮ ﺭﻭﻱ گﺮﻭﻫﻲ ﺗﻌﺮﻳﻒﺷﺪﻩ ﻭ ﻣﺸﺨﺺ ﺍﻧﺠﺎﻡ ﻣﻲگﺮﺩﺩ. ﺑﺮﺭﺳﻲ ﻭﺿﻌﻴﺖ ﺳﻼﻣﺖﺑﻴﻨﺎﻳﻲ ﺳﺎﻛﻨﻴﻦ ﺷﻬﺮ ﺗﻬﺮﺍﻥ ﺩﺭﺳﺎﻝ ﺩﺭ 1831

ﺧﺼﻮﺻﻴﺎﺕ ﻣﺸﺘﺮﻙ ﻣﻄﺎﻟﻌﺎﺕ ﻣﻘﻄﻌﻲ ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ ﻣﻌﻤﻮﻻ ﺑﺮ ﺭﻭﻱ ﻧﻤﻮﻧﻪﺍﻱ ﺗﺼﺎﺩﻓﻲ گﺮﻭﻩ ﺗﻌﺮﻳﻒﺷﺪﻩﻱ ﺍﺻﻠﻲ ﺍﻧﺠﺎﻡ ﻣﻲگﻴﺮﺩ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﺎﺕ ﺗﻮﺍﻧﺎﻳﻲ ﺗﻌﻴﻴﻦ ﻣﻴﺰﺍﻥ ﺷﻴﻮﻉ ﻧﻘﻄﻪﺍﻱ ﻳﻚ پﺪﻳﺪﻩ ﺭﺍ ﺩﺭ ﺟﺎﻣﻌﻪ ﺩﺍﺭﻧﺪ. ﺍﺯ

: • ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ – ﺷﺨﺺ – ﺯﻣﺎﻥ – ﻣکﺎﻥ – MICS – ANIS – IMES – DHS – Non communicable diseases risk factors study (Stepwise) – ﺑﺮﺭﺳﻲ ﻣﻠﻲ ﺳﻼﻣﺖ ﻭ ﺑﻴﻤﺎﺭﻱ

• ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ: – ﺷﺨﺺ – ﺯﻣﺎﻥ )ﺭﻭﻧﺪ ﺩﻳﺮپﺎ– ﺗﻐﻴﻴﺮﺍﺕ ﺩﻭﺭﻩ ﺍﻱ – ﻣﻨﺤﻨﻲ ﺍپﻴﺪﻣﻴک( – ﻣکﺎﻥ

TREND OF TB INCIDENCE RATE ( I. R. IRAN , 1962 -2001 )

Time

• ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ: – ﺷﺨﺺ – ﺯﻣﺎﻥ • ﺭﻭﻧﺪ ﺩﻳﺮپﺎ • ﺗﻐﻴﻴﺮﺍﺕ ﺩﻭﺭﻩ ﺍﻱ • ﻣﻨﺤﻨﻲ ﺍپﻴﺪﻣﻴک )پﻴﺸﺮﻭﻧﺪﻩ – ﺗک ﻣﻨﺒﻌﻲ – ﺑﺎ ﻣﻨﺒﻊ گﺴﺘﺮﺩﻩ( – ﻣکﺎﻥ

Distribution of Cholera Cases in the Golden Square Area of London, August – September 1854

Ecologic Studies

ﻣﺤﺘﻮﻱ ﻣﻮﺭﺩ ﺑﺤﺚ • • ﺍﻫﻤﻴﺖ ﺟﺎﻳگﺎﻩ ﻭ ﻣﻮﺍﺭﺩ ﺍﺳﺘﻔﺎﺩﻩ ﺍﻧﻮﺍﻉ ﺩﺍﺩﻩ ﻫﺎ ﺩﺭ گﺮﺩآﻮﺭﻱ ﻭ ﺍﺳﺘﻨﺘﺎﺝ ﺍﺷﺘﺒﺎﻩ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﺳﺘﻨﺘﺎﺝ ﺟﻤﻌﻲ ﺑﺮﺍﻱ ﺳﻄﺢ ﻓﺮﺩﻱ

ﺧﺼﻮﺻیﺎﺕ 1. 2. 3. 4. 5. ﻣﺨﺎﺭﺝ کﻢ ﻭ ﺭﺍﺣﺘی ﻣﺤﺪﻭﺩیﺖ ﺩﺭ ﺍﻧﺪﺍﺯﻩ گیﺮی ﺩﺍﺩﻩ ﻫﺎی ﻓﺮﺩی ﻣﺤﺪﻭﺩیﺖ ﻃﺮﺍﺣی ﺩﺍﺩﻩ ﻫﺎی ﻓﺮﺩی ﺟﺎﻟﺐ ﺗﻮﺟﻪ ﺑﻮﺩﻥ ﻣﻄﺎﻟﻌﺎﺕ ﺍکﻮﻟﻮﺯیک ﺭﺍﺣﺘی آﻨﺎﻟیﺰ

Incidence Ratio per 100, 000 Women Correlation between dietary fat intake and breast cancer by USA country. 250 Switzerland Canada 200 Fed. Repub. Of Germany Italy Israel Sweden France Denmark New Zealand Australia 150 UK Norway Finland Yugoslavia 100 Spain Poland Romania Hong Kong Hungary 50 Japan 0 0 600 Prentice RL, Kakar F, Hursting S, et al: Aspects of the rationale for the Women’s Health Trial. J Natl Cancer Inst 80: 802 -814, 1988. ) 800 1000 1200 1400 Per Capita Supply of Fat Calories 1600

Is there a relationship between breast cancer incidence and dietary fat consumption by country? From the graph , we see that as average dietary fat consumption increases, breast cancer incidence increases. What is wrong with this data? The problem is: the ecologic fallacy! Prentice et al. J Natl Cancer Institute 1988 80: 802 -814

The ecologic fallacy • Attributing to members of a group characteristics that they do not possess as individuals • In our example, we only know average values of fat consumption by country - we don’t know if individuals with breast cancer had higher fat intake

Ecologic study • Comparison of groups NOT individuals 1. Measurement 2. Analysis 3. Inference

Discussion questions • ﺍﻧﺠﺎﻡ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ ﺑﺮ ﺍﺳﺎﺱ ﺩﺍﺩﻩ ﻫﺎﻱ ﺟﺎﺭﻱ چﻘﺪﺭ ﻣﻔﻴﺪ ﺍﺳﺖ؟ • ﻣﻄﺎﻟﻌﻪ ﻫﺎﻱ ﺍکﻮﻟﻮژﻴک ﺩﺭ چﻪ ﺷﺮﺍﻳﻄﻲ ﺑﺮ ﻣﻄﺎﻟﻌﺎﺕ ﺭﻭﻱ ﺗک ﺗک ﺍﻓﺮﺍﺩ چﻪ ﻣﺰﻳﺘﻲ ﺩﺍﺭﺩ؟ • چﻪ کﺎﺭﻱ ﻣﻲ ﺗﻮﺍﻥ ﺑﺮﺍﻱ ﺍﺳﺘﺎﺩﻩ ﺑﻬﺘﺮ ﺍﺯ ﺩﺍﺩﻩ ﻫﺎﻱ ﺍکﻮﻟﻮژﻴک ﺩﺭ ﻧﻈﺎﻡ ﺳﻼﻣﺖ ﻣﻲ ﺗﻮﺍﻥ ﺍﻧﺠﺎﻡ ﺩﺍﺩ؟