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 2 (
.300)

!"# Quantitative Method I

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$%& #'("#!"#

()" 1 "+,
'-

   ก!
ก,ก
-'
.!#/#0#%(1

()"2 & %ก'/$#

2 3 ก& . 4ก ,/"%(1

()"3 "+,
'-

   ก!
ก,5&,,ก6ก#
ก ,-

()"4 "+,
'-

   ก!
ก,ก#..  $#" %.

1. DISTRIBUTION
• Normal distribution
• #ก#'
.$!
• Histogram ก8/#-#'
.$!
• ) 9')#'
.$!
• Binomial distribution
• Poisson distribution
2. CENTRAL TENDENCY
• Arithmetic Mean : '/:!('2
• Geometric Mean : '/:!('2
• Harmonic Mean : '/:!;9. '
• Median
• Mode


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(THAMLE :Thailand Medical Licensing Examination 2007 ) กก
 Hct % % 60 
( )(* + (,ก ก ++ normal distribution 89 %:8;
;<ก:=9=<
a. median S.D.
b. mean S.D.
c. median range
d. mean range
e. mode range
 3. VARIATION

The variance: &B '/!,/#,"ก$6#กก ("#()".5
/()3ก)C"C/#ก'/:!C"'/ก#("#

()".5("#& ก (δ2)

Standard deviation : &B '/!,/#,"ก$6#กก ("#()".5("#ก%/.
"/# (S2)

The coefficient of variation

Probability ; risk , rate…etc.

4. INCIDENCE

CUMULAIVE INCIDENCE (CI)

number of new events at specified time

×k

number of risk group at specified time

K= 10n

Meaning: average risk in each event

Unit : rate per population

Example : new cases of DHF = 100 cases Risk group or population at beginning of time = 10,000
persons During three months

100

CI= ×1000 = 10 per 1,000 population

10,000

Incidence density (ID)

Number of new events at specified time

×k

person – time

K = 10n
Meaning : risk hazard or hazard rate

Unit: cases per person per time

Person time (p-t): number of persons at each point of time;

10 persons × 10 days = 100 p-d

5 persons × 5 days = 25 p-d

Total of p-t = 125 p-d

Or number of persons × length of observation

Example: news cases of DHF 100 cases Person time = 125 p-d During three months

100 cases

ID = ×100

125 p-d

= 80 cases per 100 person per day


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(THAMLE :Thailand Medical Licensing Examination 2007 )( ก =BC+9%ก 60 (* 
) 1,000  + (, DM 200 
;<
ก (:H(:I(BJH(* +C9 (, DM ;H%ก 50
 8 incidence (, IB
a. 5%
b. 6.25%
c. 20%
d. 25%
e.50%
 5. PREVALENCE

Number of existing cases of disease at point of time

×k

Total number of population at the same point of time

K= 10n

Meaning : magnitude of problems

Unit : rate per population

Example : total cases of DHF 200 cases Total population = 10,000 persons

200

P = × 1,000 = 20 per 1,000 population

10,000

6. OTHERS
6.1 Fatality rate

Number of death from each disease

×k

Total number of cases

K = 10n

Meaning : severity of disease

Unit : rate per population

Example : number of 10 death from DHF Total cases of DHF = 100 cases

10

Fatality rate = × 100 = 10 %

100

10 er 100 population

6.2 SURVIVAL RATE

Survival rate is the rate to determined survival time of the patient in each disease by using Kaplan-
Meier procedure.


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(THAMLE : Thailand Medical Licensing Examination 2007 ) กก JกLก ก;< leptospirosis =
I(* 2548 %
%+
;ก  = 0.4 : %
ก
 = 0.02
%( ก  case fatality rate
 IB

a. 0.0002

b. 0.004

c. 0.4

d. 0.02
%( ก 

e. 0.4
%( ก 
 6.3 HEALTH IMPACT

6.3.1 Risk difference or attributable risk: Incidence of exposed (I e) – Incidence of

unexposed (I o)

Meaning : risk difference between exposed group and unexposed group

Unit : the same as incidence in the formula

Exposed persons who get sick

R (exposed) =

All exposed persons

Unexposed persons who get sick

R (unexposed)=

All unexposed persons

6.3.2 Risk ratio:

R (exposed)

RR=

R (unexposed)

Meaning : relative risk between exposed group and unexposed group.

6.3.3 Odds of case exposure

Exposed cases Unexposed cases

All cases All cases

6.3.4 Odds of control exposure

Exposed controls Unexposed controls

All controls All controls

 6.3.5 Odds ratio:

Odds of case exposure

OR=

Odds of control exposure

7. EFFICACY OF DRUG THERAPY

1. Risk reduction (ARR) : EER-CER

EER = experimental event rate: number of success in experimental group divided by total samples of
experiment.

CER = control event rate: number of success in control group divided by total samples of control.

Using in phase III of drug trial

2. EFFICACY OF DRUG THERAPY

Number needed to treat (NNT) is the number of patient that must be treated with the proposed
therapy in order to have one additional successful result. ;Hก;HI<

NNT = 1/ ARR

3. RISK OF DRUG THERAPY

Number needed to harm (NNH) tell us how many people need to exposed before harm will be fall
one additional person or one additional harmful outcome event will be occur. ;Hก;H<

NNH = 1/ AAR

AAR= absolute risk difference.

Using in phase IV of drug trial.

8. ASSOCATIONS

Correlation : B ;  B%

( B S%กก

Covariance: ( (   กH ; (, B

( H)=B9 ก;<( ( =ก ;  B

9%C:
 9. ESTIMATION
9.1 Point estimation: (,ก (  ;
% %( ก <9 :
=<
BJH T<=9%9 C:

%
9.2 Interval estimation: (,ก (  ;
% %( ก %C==<BJH T<=9

9%C:
% :%ก (  +%ก8JH
H) <:HC<% ;
% 
10. Level of confidence: <+ SH%HB8J T%กH ;
% %( ก %C=%H

( I<9  P(L<μ<U) =0.95 B8JT%กH μ %C= L : U (, 0.95 B S% 95% :
T%กH μ 9%ก L B S%กก U (, 0.05 B S% 5%
10.1 Confidence intervals (CI)
- The limits of the 95% CI show how precise the result are.
- If the CI is very wide, the result are not very precise.
- If the CI is very narrow, the result are very precise
10.2 TYPE I ERROR
- This occurs when the null hypothesis is rejected event though it is really true.
- This is a false positive study result.
- Alpha (α) known as the level of significance, is defined as the maximum probability of
making a Type I error that we are willing to except.
10.3 TYPE II ERROR
- This occurs when the null hypothesis is not rejected (Ho is accepted and no difference is
found) even though it is really false (and the groups are different).
- Beta (β) as the maximum probability of making a Type II error or failing to reject the null
hypothesis when it is actually false.
- Power is the ability to detect a statistically significant difference when it actually exists.(1-β)
- A summary of the types of conclusions and errors that may be drawn from a statistical test
of a drug vs. placebo




(THAMLE :Thailand Medical Licensing Examination 2006) )ก JกL( ;;V%

=B
+ก+
 กT<JกLกก:
%
%:50 ก:;ก:BJH+:ก <:%I
+
ก
%ก:<:% 
:ก ;%SH(%SHX)+
ก
 8)%I J:<
type II error I<9
a. ;Hก:<:%
b.:<ก:<:%
c.:< p< 0.05 (, p< 0.01
d. ;H p < 0.05 (, p< 0.1
e.:<
ก
 Bก:<:%
(THAMLE :Thailand Medical Licensing Examination 2006) ก JกL++ case-control Bก =9
aspirin ก+ก (,T B=< :S%< + Odds ratio = 0.7  confident interval 95% ก+ 0.3-
1.3 89 ;H) (, 2   confident interval 95% IB
a. 0.3-1.3
b. 0.3-0.7
c. 0.5-0.9
d. 0.1-1.1
e. 1.3-2.9

(THAMLE :Thailand Medical Licensing Examination 2006) +%+

;ก %ก ก;<T  4/1000
%(*
 P-value = 0.9 : power = 93% SH% (:ก <:%+:< :SH% (,%I
a. Type I error = 0.07
b. Type II error = 0.07
c. Type I error = 0.1
d. Type II error = 0.1
e. Type I error = 0.9

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C #" D3C)"/ 

!..

1. Daniel W. W. Biostatistics: A foundation for analysis in the health sciences. Eight edition. John Wiley &
Sons, Inc. 2005.
2. ก+,-. /.012-34+52. ก.6/1786.9:3;<1=1: ;<1=1;>.:6+4ก.6461:.6?,9/1@+- A6BC1DC3@EF.,Bก6G3D:./1H-.,+-
2546.
3. Dan Mayer. Essential evidence based medicine. Cambridge University press 2004.
4. David L. Katz. Clinical epidemiology & evidence-based medicine: fundamental principles of clinical
reasoning & research. Sage publications. 2001.

ก
  

 
 2 (
.300)

!"# SCREENING

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  .

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SCREENING

Scope:

The procedures which can be applied rapidly to sort out apparently well persons who probably have a
disease from those who probably do not.

1. DIAGNOSTIC

• It is the procedure to obtained clinical information from history, physical examination, laboratory and
imaging procedures.

2. CONCEPTS OF SCREENING

• Person with a disease can be identified by use of a screening test before the time of routine diagnosis.
• Treatment at the time of detection by screening, as opposed to the time of routine diagnosis, results in an
improved chance of survival.
3. TYPES OF SCREENING
• Mass screening: whole population
• Multiphasic screening
• Targeted screening
• Opportunistic screening
 4. CRITERIA FOR A SUCCESSFUL SCREENING

• -Morbidity or mortality of the disease must be a sufficient concern to public health.

• -Effective early treatment must be known to reduce morbidity or mortaliy.
• -A high risk population must be exist.

CRITERIA

• The test should be sensitive and specific.

• The test must be acceptable to the target population.
• Minimal risk should be associated with the test.
5. VALIDITY
• Sensitivity: The proportion of people with the disease who have a positive test for the disease.
• Specificity: The proportion of people without the disease who have a negative test.
• Positive predictive value: The proportion of persons with positive test results who actually have the disease
of interest.
• Negative predictive value: The proportion of persons with negative test results who actually do not have
the disease of interest.

Sensitivity

True positive

TP + FN
 Specificity
Positive predictive value

True negative
True positive

TN + FP TP + FP

Negative predictive value Accuracy

True negative TP + TN

TN + FN Grand total




(THAMLE :Thailand Medical Licensing Examination 2005) (d=9%=<H)=B9ก JกL clinical trial
 H
 ( validity ) กH<

A. T HJกL%+
;ก C

B. ก:<:%:ก:+ %+:ก%

C. ก:<:%:ก:+) ก

D. =9ก  ( randomization ) =ก 

%

E.
;<
ก:
%I<9 100%
(THAMLE :Thailand Medical Licensing Examination 2005) )++<%+=B;<BJH= 200 

(,T  I (,T 

: positive 60 40

: negative 20 80

89BJH<%+I<9: positive jT%ก (,T  I

A. 0.3

B. 0.33

C. 0.6

D. 0.67

E. 0.75

(THAMLE :Thailand Medical Licensing Examination 2006) =ก

B Sj%I9B<ก=Iก 1,000

T<=9j);<=B +ก+ก <%+
kI<9:<j
ก <%+
k

specificity %j);<=B;< (, 9%: IB

a.60
b.86
c.71
d.92
e.83
(THAMLE :Thailand Medical Licensing Examination 2007)%
ก
%C9=Bl% 70 (* (, 0.1/(*
%
ก
%C9(mT B= (, 0.08/(* %
ก
%C9(mT  :)I9 (, 0.02/(* 8 life
expectation%C9=Bl% 70 (* H (,T B=: :)I9

a. 1

b. 2

c. 5

d. 8

e. 10

6. Cutoff point
• It is the point on the continuum between normal and abnormal.
• Receiver operator characteristics curve (ROC)




(THAMLE :Thailand Medical Licensing Examination 2007) กก <:%B = กL SH%
=9<ก %T H  8J;
89Bก กL
j
 ;H
9 8B<I<9 =9<=< (,
cut point =ก <(ก
;-;<(ก
;
(THAMLE :Thailand Medical Licensing Examination 2007) กก <:%B = กL SH%
=9<ก %T H  8J;
89Bก กL
j
 ;H
9  8B<I<9=9<=< (,
cutoff =ก <(ก
;-;<(ก

7. Ideality test
• Inexpensive, convenient and painless, safe and 100% accuracy.
• Gold standard is a jargon term, used to describe a method, procedure, or measurement that is widely
accepted as being the best available.
8. Bayes> theorem

Bayes’ theorem

Positive predictive value;

(Se) (P)

(Se)(P)+(1-Sp)(1-P)



Se = Sensitivity

Sp = Specificity

P = Prevalence


 (@ABCD@
BD)

(THAMLE :Thailand Medical Licensing Examination 2005) ก

;k Bl;% 60-70 (*
%BVC;ก :ก:Sก+j)Bก
++ linear relation 9%=<
%I(j< (, null hypothesis

A. %ก+%BVC;ก :ก:S

B. j)Bก
Iก+%BVC;ก :ก:S

C. j)
 inverse relation ก+%BVC;ก :ก:S

D. < Bj)Bก

ก+%BVC;ก :ก:S

E.  Bj)Bก

ก+%BVC;ก :ก:S < 0.05

(THAMLE :Thailand Medical Licensing Examination 2005) =ก JกL(dH:

%
cerebrovascular disease I<9<j

ODD ratio 95%Cl

ก C++B H 1.8 0.99-2.20

<SH  0.4 0.35-0.45

C9Bl; 0.9 0.75-2.10

%กก 50(* 2.3 0,96-3.20

<T:B;
C 1.55 0.44-2.85

9%=< (, protective factor

A. ก C++B H
B. <SH 
C. C9Bl;
D. %กก 50 (*
E. <T:B;
C
(THAMLE :Thailand Medical Licensing Examination 2006)  =9%I =ก ) %  %
%ก infarction ก+p
;ก H (:HI(
a. Ki-square
b. Pair T test

(THAMLE :Thailand Medical Licensing Examination 2006) ก JกL ;  กHก+ก =9
(s;=ก กLT %  =+ ; BJH C9)ก ;I<9 ก+9%C:I9 กHก+% 
<+ก JกL ก ;;กT :;<(s;HH
( =< (,++ Ratio
a.%
b. 
c. <+ก JกL
d.ก ;;uกT 
e.;<%(s;

(THAMLE :Thailand Medical Licensing Examination 2006) ) %==ก =9+ ;ก % . 
C9=9+ ;ก ( : 1,000   :S%ก 100  T< :S%ก j: 10  (,ก ++=<
a. cluster sampling
b. simple random sampling
c. systematic random sampling

(THAMLE :Thailand Medical Licensing Examination 2007). ก )  CA breast stage 1,2,3,4 +
C9(m 9%: 20,40,60,80
( ก JกLj (,++=< (9%j 4
 :S%ก)

a. Ratio

b. Interval

c. Nominal

d. Ordinal
(THAMLE :Thailand Medical Licensing Examination 2007) C BBJHJกL กHก+
 % 
9  4 ;< (%  w
 <j 20,35,35,10 ก JกLj:กL9%C:++=<

1. Interval

2. Ordinal

3. Ratio

4. Nominal

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Reference

1. B. Burt Gerstman. (1998). Epidemiology kept simple: An introduction to classic and modern
epidemiology. New York: Wiley-Liss.
2. John M. Last.(1988) A dictionary of epidemiology. 2nd edition. New York: Oxford university press.
3. Raymond S. Greenberg., et al. (2001). Medical epidemiology. 3rd edition. New York: Lange/McGraw-
Hill.
4. Leon Gordis. (2000). Epidemiology. 2nd edition. Philadelphia : W.B. Saunders company.

76b-476b-BAc- imork (Mc)

6.36 P.M. 27/10/2551