Epidemiology module of practical skills for mbbs student

Radiography Report Form
Film number [ ]

To answer the questions, please choose the appropriate box and mark an x in the box; if you are unsure of the answer, please choose ‘no’.

Quality of the film

no yes
1. Adequate exposure? [ ] [ ]

2. Proper position? [ ] [ ]

Parenchymal shadows

no yes
3. Round shadows? [ ] [ ]

If yes:

Smaller than 2 millimeters? [ ] [ ]

Larger than 2 millimeters? [ ] [ ]

Location:

R upper? [ ] [ ]

L upper? [ ] [ ]

R lower? [ ] [ ]

L lower? [ ] [ ]

4. Irregular shadows? [ ] [ ]

If yes:

Smaller than 2 millimeters? [ ] [ ]

Larger than 2 millimeters? [ ] [ ]
Location:

R upper? [ ] [ ]

L upper? [ ] [ ]

R lower? [ ] [ ]

L lower? [ ] [ ]
5. Calcification? [ ] [ ]
6. Cavity? [ ] [ ]

Pleura
7. Presence of thickening? [ ] [ ]

8. Presence of calcification? [ ] [ ]
ASTHMA QUESTIONNAIRE – Selected questions

Interviewer (initials)

Today’s date

day

mo

Year

STUDY NUMBER

SUBJECT ID NUMBER

Date of Birth

Gender:

Male

Female

day

mo

year

GENERAL RESPIRATORY HEALTH QUESTIONS

The following questions are about your lung health IN THE PAST 12 MONTHS.

Please answer yes or no. If in doubt about the answer, please answer no.

At any time in the past 12 months:

A. Have you had wheezing or whistling in your chest, when you did not have a cold?	1.Yes __	2. No __
B. Have you woken up with a feeling of tightness in your chest?	1.Yes __	2. No __
C. Have you been woken by an attack of coughing?	1.Yes __	2. No __
D. Have you been woken by an attack of shortness of breath?	1.Yes __	2. No __
E. Have you had an attack of shortness of breath that came on during the day when you were not doing anything strenuous?	1.Yes __	2. No __
F. Have you had an attack of shortness of breath that came on after you stopped exercising?	1.Yes __	2. No __

A. Which of the following statements best describes your breathing?

	Check one:
1.	I rarely get trouble with my breathing
2.	I do get regular trouble with my breathing but it always gets completely better
3.	My breathing is never quite right

HISTORY OF ASTHMA

1. Have you ever had asthma?

1.Yes __

2.No __

IF YES TO '1', ask:

A. Do you still have it?	1.Yes __	2.No __
B. Was it confirmed by a doctor?	1.Yes __	2.No __
C. At what age did it start?	___________years
D. if you no longer have it, at what age did it stop?	___________years

SUBJECT ID NUMBER

OTHER ILLNESSES

	A. Did you have any lung trouble before the age of 16?		1.Yes __		2.No __
	B. Have you ever had pneumonia?		1.Yes __		2.No __
if yes to B ask:
		How many times have you had pneumonia?	___________times
		Age at first episode:	___________years
		Age at last episode:	___________years

The following questions are about some parts of your background which may be important to us in evaluating your health. Please answer to the best of your memory.

TOBACCO SMOKING
SMOKING BY PEOPLE LIVING AROUND YOU:
When you lived at home:

A. Did your father smoke?	1.Yes ___	2.No ___
B. Did your mother smoke?	1.Yes ___	2.No ___

In your current household

C. Do any members of your current household smoke? (other than you)?

1.Yes ___

2.No ___

YOUR CIGARETTE SMOKING

D. Have you ever smoked cigarettes? (No means less than 20 packs of cigarettes or less than one cigarette a day for one year)

1.Yes ___

2.No ___

IF YES TO 'D', ask:

1. Do you now smoke cigarettes? (as of 1 month ago)	1.Yes ___	2. No ___
2. How old were you when you first started regular cigarette smoking?	______________years
3. If you have sopped smoking cigarettes completely, how old were you when you stopped?	______________years
4. How many cigarettes do you smoke per day now?	__________________ cigarettes per day
5. On average, for the entire time that you smoked, how many cigarettes did you smoke per day?	__________________ cigarettes per day

SUBJECT ID NUMBER

FAMILY HISTORY

As some illnesses are associated with childhood and family history we would like to ask you about your family members, and about your childhood.

			Check one:
			1.Yes				2. No		3.Don’t know
Was your natural father ever told by a doctor that he had:
	1. Emphysema
	2. Lung cancer
	3. Asthma
Was your natural mother ever told by a doctor that she had:
		1. Emphysema
		2. Lung cancer
		3. Asthma

What was your country of birth ____________________________

In what country did you spend the majority of the first 10 years of your life?

____________________________

Were these first 10 years spent in the (check one only):

Countryside or small village	1.
Town smaller than 10,000 people	2.
City 10,000 to 100,000 people	3.
City larger than 100,000 people	4.

What was your father's usual occupation? _____________________________

What was your mother’s usual occupation? _____________________________

YOUR CURRENT JOB (or last job, if you are not currently working)

1. Who is your current employer (name of company): _____________________________
2. What type of industry or sector is this: _____________________________
3. What is your job? _____________________________
4. In this job, are you exposed regularly to dust, gases, or fumes? 1. Yes 2. No __
5. In any previous job, were you exposed regularly to dust, gases, or fumes? 1. Yes 2. No

Practical Exercise

Interpreting Results: validity and generalizability of results
A study was undertaken to determine whether the results of treatment of smear positive cases of pulmonary tuberculosis had changed over time. It was expected that, with the improvements in modern treatment, the results would have improved. A similar number of cases was selected from the records of a tuberculosis ward for three calendar periods, 1968-1969, 1973-1975 and 1982-1983. The results of treatment were as follows:

Period	Total (%)	Successful (%)	Positive (%)	Died (%)	Abandoned (%)
1968-1969	89 (100)	61 (69)	8 (9)	5 (6)	15 (17)
1973-1975	89 (100)	61 (69)	15 (17)	7 (8)	6 (7)
1982-1983	90 (100)	52 (58)	12 (13)	7 (8)	19 (21)

Statistical analysis, using the chi-square test, was performed and the p=0.12, leading the investigators to conclude that there was no change in the response to treatment over the period studied.

1. Is this conclusion valid? (check one) yes [ ] no [ ]
2. If no, what might lead the investigators to draw a wrong conclusion?

Factor	Category		Studied (%)	Not studied (%)
TOTAL			268 (100)	580 (100)
Age group	15-34		66 (25)	148 (26)
	35-54		95 (35)	201 (35)
	55 +		107 (40)	231 (40)
Extent of disease	Limited		152 (57)	391 (67)
	Advanced		116 (43)	189 (33)
Gender	Male		190 (71)	410 (71)
	Female		78 (29)	170 (29)

The patients chosen for study were part of the whole group of smear positive cases who had been diagnosed and recorded in the years under study. They comprised 37% of such cases in 1968-1969, 24% of cases in 1973-1975 and 38% of cases in 1982-1983. The studied cases were not different from the whole group of patients in age (p=0.96), gender (p=0.95) or ethnic origin (p=0.35). There was, however, a significant difference in the extent of pulmonary tuberculosis among those studied compared with the whole population (extensive tuberculosis was present in 43% of those studied and 33% of those not studied, p=0.003).

3. 
   Is the sample a valid reflection of the condition of all the patients in this locality?
   

Check one [ ]yes [ ] no

3. 
   Is it justifiable to conclude that the results obtained in the sample apply to the whole group of patients diagnosed and recorded in this community?
   

Among the group studied, the results of treatment were not different in the two gender groups (p=0.24), nor in the various ethnic groups (p=0.10) but were different in different age groups (p<0.001) and between those with extensive and those with less extensive disease (p=0.001).

3. 
   Which factor(s) would be most likely to contribute to a wrong conclusion concerning the trend in results of treatment?
   

3. 
   How would you control for confounding in this situation?
   

3. 
   Will this ensure that the results are valid?