A12 PREVMED MAIN HANDOUT APRIL 2024 DAWN CASUNCAD-11-15.pdf

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch sin...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. • Advantages: o Less potential bias in recall & observation o Allows for calculation of incidence rate o Can study the association of one factor and many subsequent effects • Disadvantages: o Requires large sample & long follow-up period o More expensive o Attrition – patients are loss to follow up o Confounders o Controls are difficult to identify o Surveillance bias o No blinding and randomization o Inferential statistics: RELATIVE RISK (RR)!!!! • Issues: o Selection bias – Most common source is loss to follow-up o Information bias o Confounding • Example: Follow-up in a population of adults who were exposed or not exposed as children to radiation of the neck to assess risk for thyroid CA. SUMMARY OBSERVATIONAL-ANALYTIC STUDIES CROSSCASE-CONTROL COHORT SECTIONAL “Who WILL develop the “What is “What happened?” disease?” happening?” “Who developed the disease? Collects data from a group of people to assess frequency of disease (and related risk factors) at a particular point in time. Compares a group of people with disease to a group without disease. Looks for prior exposure or risk factor. Disease prevalence Can show risk factor association with disease, but does not establish causality. ODDS RATIO (OR) Compares a group with a given exposure or risk factor to a group without such exposure. Looks to see if exposure increases the likelihood of disease RELATIVE RISK (RR) Design Objective Timing Example COMMUNITY/FIELD TRIALS • Unit of analysis is a group of individuals or a community • The selection of population & size depends on prediction of incidence of disease • Field trials, in contrast to clinical trials, involve people who are healthy but presumed to be at risk; data collection takes place “in the field,” usually among non-institutionalized people in the general population CLINICAL TRIALS • Individual subjects are used as experimental unit • The determination of sizes of the groups depends on the expected incidence of the disease or unfavorable outcome (death) and estimates of differences in outcome in the different groups. • TYPES: o Preventive § aka Prophylactic § Interventions given are aimed for disease prevention § (-) risk factor § (-) disease o Therapeutic § interventions given are aimed to treat established disease SUPPLEMENT Madalas malito ang mga students sa difference ng case control and retrospective cohort, so better to study this table. Case-Control Study: Case-control studies start with the identification of individuals with the outcome of interest (cases) and individuals without the outcome (controls). Researchers then look back in time to assess exposure histories for both groups. The main goal is to compare the odds of exposure in cases to the odds of exposure in controls. This helps in estimating the strength of the association between the exposure and the outcome. EXPERIMENTAL ANALYTIC STUDIES RANDOMIZED CONTROLLED TRIALS • Provide the best evidence for testing any hypothesis or to investigate any possible cause and effect relationship • Resemble cohort studies by follow up of subjects • Involves action or manipulation or intervention on the part of the investigator • Uses control group for baseline • Difficult to carry out and raise some ethical issues • Guides: o Randomize treatment A and treatment B to distribute equally the known and unknown determinants of outcome. o Proper accounting of patients (<20% loss to follow-up) o Blinding o No co-intervention o Similar characteristics of all participants. Retrospective Cohort Study: Retrospective cohort studies begin by selecting a group of individuals with a common exposure (cohort) and then follow them backward in time to determine their outcomes. The primary aim is to compare the incidence of the outcome among those exposed to the incidence among those unexposed within the same cohort. This allows for the calculation of relative risk or risk ratios. These studies are retrospective, meaning they look back at past data or events. Like case-control studies, retrospective cohort studies are also retrospective, but they follow a group of people who were exposed or unexposed to a particular factor. Suppose you want to study the association between smoking and lung cancer. You would identify a group of people with lung cancer (cases) and a group of people without lung cancer (controls). Then, you'd gather information about their smoking history and compare the odds of smoking among cases and controls. Let's say you want to study the relationship between the use of a specific medication (e.g., a pain reliever) and the development of a certain adverse event (e.g., kidney damage). You would identify a group of people who used the medication (exposed cohort) and a group who did not use it (unexposed cohort) in the past. Then, you'd look back at their medical records to determine how many in each group developed kidney damage. PHASES OF CLINICAL RESEARCH TRIAL TYPICAL STUDY SAMPLE Phase 1 Small number of HEALTHY volunteers Phase 2 Small number of patients WITH disease of interest Phase 3 LARGE number of patients RANDOMLY assigned to either treatment or placebo (usually the best available treatment) Phase 4 POST-MARKETING surveillance of patients AFTER the treatment is approved PURPOSE “Is it safe?” Assess safety, toxicity, pharmacokinetics, and pharmacodynamics “Does it work?” Assesses treatment efficacy, optimal dosing, and adverse effects “Is it as good or better?” Compares the new treatment to the current standard of care. “Can it stay?” Detects rare or longterm adverse effects. Can result in treatment being withdrawn from market. SUPPLEMENT BLINDING Blinding: unawareness of true nature of treatment Double blind Single blind trial Triple blind trial trial Either the subject Neither subject or the Subject, data nor person investigator is collector and data assessing unaware of analyst are all treatment efficacy nature of not aware is aware treatment given Dr. Mann TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 11 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. QUANTIFYING RISK Exposure/ Intervention (+) WITH DISEASE/ CASES NO DISEASE/ CONTROLS Total A B A+B (-) Total C A+C D B+D C+D A+B+C+D ODDS RATIO (OR) • Usually used in CASE-CONTROL studies • the odds of having disease in exposed group (cases) divided by odds of having disease in unexposed group (control) 𝐴 𝑂𝑑𝑑𝑠,-.%. 𝑨𝑫 𝑶𝑹 = = 𝐶 = 𝑂𝑑𝑑𝑠,(*4&(5. 𝐵 𝑩𝑪 𝐷 OR=1 Exposure does not affect odds of outcome/disease OR>1 Exposure associated with higher odds of outcome OR<1 Exposure associated with lower odds of outcome RATIO • Obtained by dividing one quantity by another • a single number that represents the relative size of two numbers PROPORTION • special type of ratio in which numerator is part of the denominator RATE • measure of how quickly something of interest happens • frequency of occurrence of events over a given TIME interval o Time, place and population must be specified for each type of rate. Dr. Tan RELATIVE RISK (RR) • The ratio of incidence of disease among people with risk factor to incidence of disease among people without risk factor • Also known as Risk Ratio • Typically used in COHORT studies • Risk/probability of developing disease in the exposed group divided by risk in the unexposed group 𝑎 (𝑘) 𝑎+𝑏 - MORBIDITY RATES INCIDENCE No. of NEW cases No. of people AT RISK (during a time PERIOD) Looks at new cases = incidents Numerator Sa madaling sabi, the larger the odds ratio, mas likely ang outcome or disease/sakit if with exposure. On the other hand, the smaller the odds than 1, the less likely the disease is to be found with exposure. Kapag 1 lang, walang effect and exposure sa disease. 𝑎 (𝑘) 𝑏 Denominator Value PREVALENCE No. of cases Total population at a point in time Look at ALL current cases PREVALENCE • number of affected persons present in the population at a specific time divided by the number of persons in the population at that time, that is, what proportion of the population is affected by the disease at that time? 𝑨 𝑃𝑟𝑜𝑏𝑎𝑏𝑖𝑙𝑖𝑡𝑦%23(.%/ = 𝑨+𝑩 𝑪 𝑃𝑟𝑜𝑏𝑎𝑏𝑖𝑙𝑖𝑡𝑦7!%23(.%/ 𝑪+𝑫 RR = 1: indicates null value (no effect of exposure or treatment on outcome) RR<1: indicates protective effect (protective factor) RR>1: indicates a harmful effect (risk factor) 𝑹𝑹 = For RR naman, mas gusto natin if RR is less than 1, because it means the factor is protective. Dr. Tan RELATIVE RISK REDUCTION • The PROPORTION of risk reduction attributable to the intervention as compared to a control 𝑅𝑅𝑅 = 1 − 𝑅𝑅 e.g., if 2% of patients who receive a flu shot develop the flu, while 8% of unvaccinated patients develop the flu, then RR = 2/8 = 0.25, and RRR = 0.75). Gordis Epidemiology, 2013 AR AND ARR: TO ASSESS FOR RISK DIFFERENCE ATTRIBUTABLE RISK (AR) The difference in risk between exposed and unexposed groups 𝐴𝑅 = 𝑅𝑖𝑠𝑘%23(.%/ − 𝑅𝑖𝑠𝑘7*%23(.%/ 𝐴 𝐶 𝐴𝑅 = − 𝐴+𝐵 𝐶+𝐷 e.g., if risk of lung cancer in smokers is 21% and risk in nonsmokers is 1%, then 20% of the lung cancer risk in smokers is attributable to smoking ~ HARM • Can be presented as: ABSOLUTE RISK REDUCTION (ARR) The difference in risk attributable to the intervention as compared to a control 𝐴𝑅𝑅 = 𝑅𝑖𝑠𝑘7*%23(.%/ − 𝑅𝑖𝑠𝑘%23(.%/ 𝐶 𝐴 𝐴𝑅𝑅 = − 𝐶+𝐷 𝐴+𝐵 e.g. intervention as compared to a control (e.g., if 8% of people who receive a placebo vaccine develop the flu vs. 2% of people who receive a flu vaccine, then ARR = 8% − 2% = 6% = .06) ~TREATMENT NNH AND NNT NUMBER NEEDED TO HARM (NNH) Number of patients who need to be exposed to a risk factor for 1 patient to be harmed. 𝑵𝑵𝑯 = 𝟏 𝑨𝑹 NUMBER NEEDED TO TREAT (NNT) Number of patients who need to be treated for 1 patient to benefit. 𝑵𝑵𝑻 = 𝟏 𝑨𝑹𝑹 MEASURES OF DISEASE FREQUENCY Numerator Denominator POINT PREVALENCE* Total cases (old and new) at a FIXED point in time Total population at that time Interview question “Do you currently have asthma?” PERIOD PREVALENCE Total cases (old and new) at a PERIOD of time Total population at that period of time “Have you had asthma during the last [n] years?” *More useful than incidence rate in describing the occurrence of chronic conditions FACTORS INFLUENCING PREVALENCE RATE Increased by Decreased by 1. Longer duration of disease 1. Shorter duration of 2. Prolongation of life of disease patient without cure 2. High case fatality rate 3. Increase in new case 3. Decrease in new (incidence) cases(incidence) 4. In- migration of cases 4. In-migration of healthy 5. Out-migration of healthy people people 5. Out-migration of cases 6. In-migration of susceptible 6. Improved cure rate of people cases 7. Improved diagnostic facilities • It is important to review some basic concept: INCIDENCE o The importance of understanding the “numerator” and the • defined as the number of new cases of a disease that occur “denominator” [proportions, rates, ratios] during a specified period of time in a population at risk for o Defining the numerator [“case”] developing the disease o Defining the denominator [“population at risk”] TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN Page 12 of 77 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. VITAL STATISTICAL RATES AND RATIOS FERTILITY RATES NUMERATOR RATE CRUDE BIRTH RATE: Measures how fast people are added to the population through births GENERAL FERTILITY RATE: More specific rate than the crude birth rate since births are related to the segment of population deemed to be capable of giving birth AGE SPECIFIC FERTILITY RATE: Shows variation in fertility by age TOTAL FERTILITY RATE: Standardized index for overall fertility level Represents the average number that would be born to a women throughout her lifetime Indicator of cohort fertility GROSS REPRODUCTION RATE: Gives an idea about replacement of females in the population DENOMINATOR K Number of registered Live births in a year Midyear population 1,000 Number of registered live births in a year Midyear population of women 1544 years old 1,000 Number of live births per woman of a given age groups Number of women in a given age of group 1,000 Sum of all age specific fertility rate for each year of women from 15-49 y/o Please take note! GFR – 15-44 y/o TFR – 15-49 y/o 1,000 Dr. Mann Total fertility rate restricted to female births only 1,000 NATALITY RATES RATE CRUDE BIRTH RATE: Affected by accuracy of registration of live births, fertility status of female, proportion of child bearing females, cultural and social practices GENERAL FERTILITY RATE: Relates to the segment of population which is actually capable of giving birth NUMERATOR DENOMINATOR K Number of live births in 1 year Midyear population 1,000 Number of live births in 1 year Number of women (1544 y/o) 1,000 MORTALITY RATES RATE NUMERATOR DENOMINATOR K Number of deaths in a calendar year Midyear population 1,000 Number of deaths in a specified group in a calendar year Midyear population of the same specified group 100,000 Number of deaths from a certain cause in a calendar year Midyear population 100,000 Deaths under 1 year of age in a calendar year Number of live births in the same year 1,000 Number of deaths from 28 weeks AOG to infant <7 days old (do not confuse this definition to the perinatal period set by WHO) Number of live births and fetal deaths 28 weeks or more during the same year 1,000 Number of deaths among those under 28 days of age in a calendar year Number of live births in the same year 1,000 POST-NEONATAL MORTALITY RATE: Influenced mainly by environmental or genetic and nutritional factors as well as infections Number of deaths among those 28 days to less than 1 year of age in a calendar year Number of live births in the same year 1,000 MATERNAL MORTALITY RATE: Affected by maternal health practices; diagnostic ascertainment; completeness of registration of births Number of deaths due to pregnancy, delivery, puerperium in a calendar year Number of live births in the same year (Ideally: Number of pregnancies) 1,000 CHILD MORTALITY RATE: Reflects the main environmental factors affecting health of a child Sensitive indicator of socio-economic development in a community Number of deaths at 1-4 y/o Total population of children ages 1-4 y/o 1,000 Number of deaths from a particular cause /population group in a year Total deaths in a year 100 Number of deaths among those 50 years and older in a calendar year Total deaths in a year 100 Number of deaths from a specified cause Number of cases of the same disease 100 CRUDE DEATH RATE: Affected by age and sex composition of the population; adverse environmental condition; peace and order conditions of a place SPECIFIC MORTALITY RATE: Can be made specific according to age, sex, occupation, education, exposure to risk factors. Graph of age specific mortality rates shows a J shaped or U shaped curve CAUSE OF DEATH RATE: Affected by completeness of registrations of death; composition of population; disease ascertainment in the community which may be used to determine the 10 leading cause of death INFANT MORTALITY RATE: Please remember this as Most sensitive index of assessing health status in the community. Dr. Mann High IMR means low level of health standards which maybe secondary to poor maternal and child health care, malnutrition, poor environmental sanitation, or deficient health care service PERINATAL MORTALITY RATES NEONATAL MORTALITY RATE: Cause of death are mainly due to pre-natal or genetic factors MUST KNOW! Dr. Mann PROPORTIONATE MORTALITY RATE SWAROOP’S INDEX: Please remember this as a Sensitive indicator of standard of health care. Dr. Mann Developed countries have a higher Swaroop’s index than less developed ones So why are developing countries/less developed countries have lower Swaroop’s index? This just implies that the higher the rate, the better is the health status of the population (since this indicates that are fewer deaths in the younger population) Dr. Tan CASE FATALITY RATE: Measures killing power of disease High CFR means a more fatal disease. A higher CFR is expected from a hospital statistics than from the community MUST KNOW! Dr. Mann TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 13 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. SUPPLEMENT IMPORTANT LIFE PERIOD AGE GROUP PERIOD Neonate: <28 days old Perinatal: Infant: < 1 yo 22 completed weeks AOG – Child: 1-4yo <7days old (WHO) (Do not confuse this with Fertile: perinatal mortality rate) o GFR- 15-44 y/o Post-Neonatal: o TFR- 15-49 y/o 28 days old to <1yo Productive/Working: 15-64yo POPULATION DYNAMICS DEFINITION OF TERMS 1. POPULATION o Total number of individuals in a territory or a locality living o at a specified moment of time with an agreed definition of residence o All persons falling within the scope of a census or other inquiry 2. POPULATION DYNAMICS o It is the study of changes in size and composition of the o population and the determinants of population growth such as births, deaths, migration. • Growth o Difference between birth rate and death rate o Factors: § Births or fertility § Deaths § Migration o Net growth rate= birth rate minus death rate plus in-migration rate minus the out-migration rate • Size • Composition o Sex ratio § Found to be high at birth § Tend to decrease as age increases reaching 99% in middle life § Females were found to have longer life expectancy than males § Sex ratio is higher in rural areas than in urban areas § It is also higher in frontier communities • Number of males in the population/number of females in the population x 100 • Interpretation- there are _____ males for every 100 females in the population Dr. Mann • Age group o Dependency Ratio: § represents the number of dependents that need to be supported by every working individual § Computed by: (Population 0-14 yo) + (Population ≥65yo) x 100 Population aged 15-64 years Significance: provides an index of age- induced economic drain on manpower resources Dr. Mann POPULATION PYRAMID • A population pyramid, or age structure graph, is a simple graph that conveys the complex social narrative of a population through its shape • important graphs for visualizing how populations are composed when looking at groups divided by age and sex CHARACTERISTICS OF A POPULATION PYRAMID • Population pyramid special type of histogram • Male population shown at the left • Females right • Youngest at base • Oldest at top • Chronologically arranged • And represented by horizontal bar TYPES OF POPULATION PYRAMID 1. EXPANSIVE • used to describe populations that are young and growing • characterized by their typical ‘pyramid’ shape • has a broad base and narrow top • show a larger percentage of the population in the younger age cohorts • typically representative of developing nations, whose populations often have high fertility rates and lower than average life expectancies 2. CONSTRICTIVE • used to describe populations that are elderly and shrinking • often look like beehives and typically have an inverted shape with the graph tapering in at the bottom • have smaller percentages of people in the younger age cohorts and are typically characteristic of countries with higher levels of social and economic development • Base that is narrower than middle of the pyramid, usually the result of a recent rapid decline in fertility 3. STATIONARY • Narrow base and a roughly equal numbers in each age group, tapering off at the older ages, indicating a moderate proportion of children and a slow or zero rate of growth • used to describe populations that are not growing • characterized by their rectangular shape, displaying somewhat equal percentages across age cohorts that taper off toward the top • characteristic of developed nations, where birth rates are low and overall quality of life is high populationeducation.org populationeducation.org TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. populationeducation.org Page 14 of 79 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Parameters Fertility/ death rate Median Age Dependency Ratio YOUNG POPULATION INTERMEDIATE OLD POPULATION High Moderate Low 15-20 years 1:1 21-25 2-3 26-30+ years 1-2 (rapid (moderate population population growth) growth) Developing countries Note: The Philippines has a young population. (slow population growth) Developed countries Dr. Mann SOME FACTORS AFFECTING AGE COMPOSITION: • Fertility – with high fertility → Young population • Peace and Order Situation – immediate post war period → babies boom = younger population • Social Status • Educational Status • Urban-Rural differences – Urban population tends to have older age composition than rural o Most Filipinos prefer to live in urban areas because of better job opportunities, higher educational centers, more advanced facilities • Cause and Effect Nature – present composition is the effect of previous structure ✔GUIDE QUESTION Q: Increase in the life expectancy is mainly due to? A: Decrease in mortality in the younger age groups Q: How can we call declare a place as an “URBAN” area? A: Definition of Urban area for the Philippines by National Census and Statistics Office • All cities & Municipalities having a population of at least 1000 persons per sq. kilometer • With population density of at least 500 persons per sq. km • Districts not included in aforementioned criteria regardless of population size but have the following: street patterns; at least 6 establishments (commercial, manufacturing, recreational, personal services); at least 3 of the following: town hall, church, park, cemetery, marketplace, public building (school, hospital, library) • Barangay having at least 1000 inhabitants which meets the criteria aforementioned and the occupation of the inhabitants is non-farming or fishing OVERPOPULATION/ POPULATION EXPLOSION • exists when the economy cannot support the population in the face of a rapid population growth. • economic support is measured in terms of: o State of health and nutrition o Level of unemployment o Level of education o State of housing SUPPLEMENT TOOLS OF POPULATION DYNAMICS ESTIMATING POPULATION GROWTH Pt=P0 (1+r) t Where P0 is population size at the previous census and Pt is the size of the census t years later, and r is the annual growth rate between now and the next t years POPULATION DENSITY • population per unit of land • Number of people per square kilometer • Measure intensity of land use Why do we need to know this? Because population density can affect rate of disease transmission and environmental health Dr. Mann POPULATION DISTRIBUTION • patterns of settlement and dispersal of a population • How people are distributed in a specified space or geographic area • The following can affect the population distribution: o Physical factor o Political o Social/cultural o Economic Dr. Mann • Population Increase – the total population increase resulting from interaction of births, deaths, and migration in a population in a given period of time • Population momentum – the tendency for population growth to continue beyond the time that replacement level fertility had been achieved because of relatively high concentration of people in the childbearing years • Population optimum – the ideal number of people that can be sustained in a given area • Population Policy – explicit or implicit measure instituted by a government to influence population size, growth, distribution, or composition • Population projection – the computation of future changes in population numbers, given certain assumptions about future trends in the rate of fertility, mortality, and migration DEMOGRAPHY • Empirical, statistical and mathematical study of human populations • Uses: o Planning and administration o Control and prevent health problems o Study determinants or reasons for occurrence of such problems o To know growth and dispersal of population groups in the past as well as to predict the future developments and their possible consequences • Tools: o Counts – absolute # of a population occurring in a specified point in time o Ratio o Proportion – special type of ratio o Rate-frequency- occurrence of events over a given interval of time § Useful when events are dynamic § Measures the amount of change § More valuable to use when making comparisons between and among populations which differ in distribution LIFE EXPECTANCY OF FILIPINOS • The current life expectancy for Philippines in 2023 is 71.66 years, a 0.18% increase from 2022. o The life expectancy for Philippines in 2022 was 71.53 years, a 0.18% increase from 2021. o The life expectancy for Philippines in 2021 was 71.41 years, a 0.18% increase from 2020. o The life expectancy for Philippines in 2020 was 71.28 years, a 0.18% increase from 2019. RESEARCH AND BIOSTATISTICS RESEARCH PROCESS Step – 1: Identifying the Problem • The first and foremost task in the entire process of scientific research is to identify a research problem. • A well-identified problem will lead the researcher to accomplish all important phases of the research process, starting from setting objectives to the selection of the research methodology. Step – 2: Reviewing of Literature • A review of relevant literature is an integral part of the research process. It enables the researcher to formulate his problem in terms of the specific aspects of the general area of his interest that has not been so far researched. Step – 3: Setting research questions, objectives, and hypotheses • After discovering and defining the research problem, researchers should make a formal statement of the problem leading to research objectives. • An objective will precisely say what should be researched, to delineate the type of information that should be collected, and provide a framework for the scope of the study. The best expression of a research objective is a well-formulated, testable research hypothesis. o Specific objectives are detailed objectives that describe what will be researched during the study, whereas the general objective is a much broader statement about what the study aims to achieve overall. • A hypothesis is an unproven statement or proposition that can be refuted or supported by empirical data. Hypothetical statements assert a possible answer to a research question. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the October 2023 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 15 of 79