PONTIFICIA UNIVERSIDAD CATLICA DE CHILE

ESCUELA DE ENFERMERA

M CECILIA ARECHABALA M

OBJETIVOS DE LA CLASE
ANALIZAR LOS PRINCIPALES DISEOS DE INVESTIGACIN
CUANTITATIVOS

OBJETIVOS DE LA INVESTIGACIN EN SALUD

1. DESCRIBIR
2. EXPLORAR
3. EXPLICAR
4. PREDECIR Y CONTROLAR

PROCESO CUANTITATIVO

(Hernndez, Fernndez y Baptista, 2006)

CONCEPTOS RELEVANTES
INVESTIGACIN

EN

EL

1. CAUSALIDAD
Causa

Efecto

2. MULTICAUSALIDAD
Causa
Causa
Causa

Efecto

(Burns y Grove,2004)

DISEO

DE

UNA

CONCEPTOS RELEVANTES
INVESTIGACIN

EN

EL

DISEO

3. PROBABILIDAD: causa probable

4. SESGO
5. CONTROL : credibilidad de los hallazgos
6. MANIPULACIN: forma de control estudios
experimentales y cuasi-experimentales

(Burns y Grove,2004)

DE

UNA

CARACTERSTICAS DE UN BUEN DISEO DE INVESTIGACIN

A. Pertinencia:
El diseo seleccionado sea el adecuado para responder la
pregunta de investigacin

MUY ESTRUCTURADO

MUY FLEXIBLE

(Polit y Hungler,2000)

CARACTERSTICAS DE UN BUEN DISEO DE INVESTIGACIN

B. Ausencia de sesgo (error sistemtico):

Diferencias entre los participantes, conceptos o creencias previas del
investigador, proceso de recoleccin de los datos, anlisis estadstico.

CONTROL DE VARIABLES

TRIANGULACIN

(Polit y Hungler,2000)

CARACTERSTICAS DE UN BUEN DISEO DE INVESTIGACIN

C.PRECISIN

REDUCIR LA VARIABILIDAD ATRIBUIBLE A VARIABLES EXTERNAS:

instrumentos de medicin precisos y diseo que controle las variables
externas

(Polit y Hungler,2000)

CARACTERSTICAS DE UN BUEN DISEO DE INVESTIGACIN

D. POTENCIA:
Capacidad de un estudio de detectar relacin entre las variables

(Polit y Hungler,2000)

TIPO DE PREGUNTA

TIPO DE ESTUDIO

comprensin

cualitativo

causa, etiologa

cohorte, caso y control

pronstico

cohorte

screening

transversal, cohorte

diagnstico

estudio con gold standard

terapia/intervencin

estudio randomizado

DISEOS OBSERVACIONALES

1. DESCRIPTIVOS
a)
b)
c)

Frecuente
Muestra nica
Cautela con los resultados

2. DESCRIPTIVOS COMPARATIVOS
a)
b)

Diferencias en las variables

Dos grupos

DISEO DESCRIPTIVO

DISEO DESCRIPTIVO COMPARATIVO

DISEOS OBSERVACIONALES

3.

NOTIFICACIN DE UN CASO
a)
b)

4.

Descripcin detallada
Fenmeno poco frecuente

ESTUDIO DE CASOS

DISEOS OBSERVACIONALES
5. ESTUDIOS ANALTICOS
5.1 Estudios de casos y controles: el objetivo es comparar la frecuencia
de exposicin a la(s) variable(s) independiente(s) del estudio en los sujetos
casos y controles. La hiptesis de trabajo, pretende encontrar evidencia de una
mayor tasa de exposicin entre los sujetos casos en comparacin con los
controles si el factor estudiado se comporta como un "factor de riesgo.

http://escuela.med.puc.cl/recursos/recepidem/PDF/EPIANAL7.pdf

DISEOS OBSERVACIONALES
5. ESTUDIOS ANALTICOS
5.2 Estudios de cohorte: consiste en el seguimiento de una o ms
cohortes de individuos sanos, con diferentes grados de exposicin
a un factor de riesgo, se mide en ellos la aparicin de la
enfermedad o condicin en estudio.

http://escuela.med.puc.cl/recursos/recepidem/PDF/EPIANAL7.pdf

DISEOS OBSERVACIONALES
5. ESTUDIOS ANALTICOS

5.3 Estudios transversales: recolectan los datos en un momento y en

un tiempo nico. Describen variables y analizan su incidencia e
interrelacin en un momento dado. FOTOGRAFIA DE UN SUCESO

(Hernndez, Fernndez y Baptista, 2006)

DISEOS EXPERIMENTALES

Elementos de la investigacin experimental:

Aleatorizacin
Manipulacin de la variable independiente
Control del entorno

(Burns y Grove,2004)

DISEOS EXPERIMENTALES

1. CUASIEXPERIMENTALES:
a) Grupo control no equivalente: til cuando no es posible
ticamente o humanamente posible controlar el total de las
variables.

(Burns y Grove,2004)

DISEOS EXPERIMENTALES

2. EXPERIMENTALES
Ensayo Randomizado Controlado

PERSONAS ELEGIBLES

ASIGNACIN ALEATORIA

INTERVENCIN A

INTERVENCIN B

INTERVENCIN C

VENTAJAS Y DESVENTAJAS
OBSERVACIONALES

EXPERIMENTALES

COSTOS

PROBLEMAS TICOS

RIESGO DE SESGO

Alonso et al., 2004

VENTAJAS Y DESVENTAJAS
OBSERVACIONALES

EXPERIMENTALES

menor

COSTOS

mayor

menor

PROBLEMAS TICOS

mayor

mayor

RIESGO DE SESGO

menor

Alonso et al., 2004

DISEOS DE INVESTIGACIN
CARACTERSTICAS
OBSERVACIONAL v/s EXPERIMENTAL
CONTROLADO

v/s NO CONTROLADO

LONGITUDINAL

v/s TRANSVERSAL

PROSPECTIVO

v/s RETROSPECTIVO

DESCRIPTIVO

v/s ANALTICO

VERDADERO O FALSO
UN ESTUDIO RANDOMIZADO PUEDE SER

EXPERIMENTAL
LONGITUDINAL
NO CONTROLADO
RETROSPECTIVO
ANALTICO

VERDADERO O FALSO
UN ESTUDIO RANDOMIZADO PUEDE SER

EXPERIMENTAL
LONGITUDINAL

V
V

NO CONTROLADO

RETROSPECTIVO
ANALTICO

F
V

VERDADERO O FALSO
UN ESTUDIO DE COHORTE PUEDE SER

EXPERIMENTAL
LONGITUDINAL
CONTROLADO
RETROSPECTIVO
ANALTICO

VERDADERO O FALSO
UN ESTUDIO DE COHORTE PUEDE SER

EXPERIMENTAL
LONGITUDINAL

F
V

CONTROLADO
RETROSPECTIVO
ANALTICO

F
V
V

EJERCICIOS

ESTUDIO N1
Objetivo: To simultaneously evaluate the associations of cigarette smoking with the risks of
cancers of the stomach, lung, colon, and rectum, which have been the leading cancer sites
in recent years in Miyagi Prefecture, Japan, we conducted a hospital-based study.
Metodologa: Study subjects consisted of 614 stomach, 515 lung, 324 colon, and 164
rectal cancer cases and 2444 hospital controls admitted to a single hospital in Miyagi
Prefecture from 1997 to 2001. Information on smoking habit and other lifestyle factors was
collected using a self-administered questionnaire. Distributions of referral base among
cases and controls were also investigated. For each site, odds ratios (ORs) and 95%
confidence intervals (95% CIs) for smoking habit were estimated with adjustment for age,
year of survey, history of alcohol drinking, family history of index cancer, and occupational
history, respectively, using an unconditional logistic regression model.
Resultados: Cigarette smoking (ever vs. never) was associated with an increased risk of
stomach (OR = 1.62; 95% CI 1.20-2.19) and lung (OR = 3.82; 95% CI 2.49-5.86) cancer
among males and lung cancer among females (OR = 2.02; 95% CI 1.28-3.18). For female
stomach cancer, the association with cigarette smoking was uncertain (OR = 0.65, P =
0.1533). For rectal cancer, a significant increased risk was observed in both-sex-combined
analysis. There was no association between cigarette smoking and the risk of colon cancer.
Detailed analysis showed that the association of cigarette smoking with cancer risk might
be modified by the patient referral pattern, i.e., screened or not screened.
Conclusin: The present results indicate that the association of cigarette smoking with
cancer risk may differ among sites and sexes. In terms of the population attributable risk, a
large proportion of leading cancers in males appears to be related to cigarette smoking.

ESTUDIO N2
BACKGROUND: Having an affected relative is a strong predictor of an individual's lifetime risk
of developing many diseases. In primary care this is of importance in preventive healthcare.
AIM: To compare and contrast perceptions of family history across common diseases among
primary care patients using the theoretical framework of Leventhal's Common Sense Model
(CSM).
METHODS: Thirty semi-structured interviews were conducted with patients identified in general
practice, who had a family history of either cancer, heart disease or diabetes. We performed
qualitative constant comparative analysis of transcript data.
RESULTS: People with a family history of cancer had a greater sense of personal vulnerability
than people with a family history of heart disease: family history of diabetes was generally
viewed as the least threatening. Using the CSM constructs we identified factors which
determine individual perceptions of family history. Beliefs about consequences and timeline
were influenced by witnessing painful, lingering or sudden familial death; people who felt their
risk was determined by inheritance were more likely to feel vulnerable and have less control,
while those who felt able to change lifestyle or behaviour felt more able to control their
perceived risk.
CONCLUSION: Factors influencing perceptions of family history may vary between individuals
and between diseases. To use the family history as a tool in preventive healthcare we will need
to consider the individual's personal understanding of disease risk and their ideas about cause
and controllability of the familial illness. Perceived risk may then be used to motivate preventive
health behaviours.

ESTUDIO N3
OBJETIVO: This study evaluated the associations between economic, social,
psychological factors, and health-related quality of life of hemodialysis patients.
METODOLOGA: End-stage renal disease patients who had received maintenance
hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to
participate. Demographic, economic, and psychosocial data of patients were
collected. Depression was assessed by the Beck Depression Inventory. Healthrelated quality of life was measured by the Medical Outcomes Study Short-Form 36.
Multivariable linear regression analyses were performed.
RESULTADOS: Eight hundred sixty-one patients (373 males, mean age 59.4 +/13.2 years) completed the study. Higher monthly income was positively associated
with role emotional and mental health (P < 0.05), and so was increased frequency of
social activities with social functioning (P < 0.05). The more worries, the stronger the
inverse associations with social functioning (P < 0.05) and mental health (P < 0.01).
Higher depression scores were associated with lower scores of all Short-Form 36
dimensions (P < 0.01).
CONCLUSIN: Higher monthly income and increased social activities are
associated with better health-related quality of life, whereas more worries and higher
depression scores are associated with worse health-related quality of life of
hemodialysis patients.

ESTUDIO N4
BACKGROUND: There is a paucity of randomised controlled trials of weight management in
primary care.
AIM: To ascertain the feasibility of a full trial of a nurse-led weight-management programme in
general practice.
METHOD: A total of 123 adults (80.3% women, mean age 47.2 years) with body mass index >
or =27 kg/m(2), recruited from eight practices, were randomised to receive structured lifestyle
support (n = 30), structured lifestyle support plus pedometer (n = 31), usual care (n = 31), or
usual care plus pedometer (n = 31) for a 12-week period.
RESULTS: A total of 103 participants were successfully followed up. The adjusted mean
difference in weight in structured support compared to usual care groups was -2.63 kg (95%
confidence interval [CI] = -4.06 to -1.20 kg), and for pedometer compared to no pedometer
groups it was -0.11 kg (95% CI = -1.52 to 1.30 kg). One in three participants in the structuredsupport groups (17/50, 34.0%) lost 5% or more of their initial weight, compared to less than one
in five (10/53, 18.9%) in usual-care groups; provision of a pedometer made little difference
(14/48, 29.2% pedometer; 13/55, 23.6% no pedometer). Difference in waist circumference
change between structured-support and usual-care groups was -1.80 cm (95% CI = -3.39 to
-0.20 cm), and between the pedometer and no pedometer groups it was -0.84 cm (95% CI =
-2.42 to 0.73 cm). When asked about their experience of study participation, most participants
found structured support helpful.
CONCLUSION: The structured lifestyle support package could make substantial contributions
to improving weight-management services. A trial of the intervention in general practice is
feasible and practicable.

ESTUDIO N5
OBJECTIVE: To estimate the hypothetical fraction of hypertension incidence associated with dietary and
lifestyle factors in women.
METHOD: 83,882 adult women aged 27 to 44 years who did not have hypertension, cardiovascular disease,
diabetes, or cancer in 1991, and who had normal reported blood, with follow-up for incident hypertension for
14 years through 2005. Six modifiable lifestyle and dietary factors for hypertension were identified. The 6
low-risk factors for hypertension were a body mass index (BMI) of less than 25, a daily mean of 30 minutes
of vigorous exercise, a high score on the Dietary Approaches to Stop Hypertension (DASH) diet based on
responses to a food frequency questionnaire, modest alcohol intake up to 10 g/d, use of nonnarcotic
analgesics less than once per week, and intake of 400 microg/d or more of supplemental folic acid.
RESULTS: 12,319 incident cases of hypertension were reported. All 6 modifiable risk factors were
independently associated with the risk of developing hypertension during follow-up after also adjusting for
age, race, family history of hypertension, smoking status, and use of oral contraceptives. For women who
had all 6 low-risk factors (0.3% of the population), the hazard ratio for incident hypertension was 0.22 (95%
confidence interval [CI], 0.10-0.51); the hypothetical PAR was 78% (95% CI, 49%-90%) for women who
lacked these low-risk factors. The corresponding hypothetical absolute incidence rate difference (ARD) was
8.37 cases per 1000 person-years. The PARs were 72% (95% CI, 57%-82%; ARD, 7.76 cases per 1000
person-years) for 5 low-risk factors (0.8% of the population), 58% (95% CI, 46%-67%; ARD, 6.28 cases per
1000 person-years) for 4 low-risk factors (1.6% of the population), and 53% (95% CI, 45%-60%; ARD, 6.02
cases per 1000 person-years) for 3 low-risk factors (3.1% of the population). Body mass index alone was the
most powerful predictor of hypertension, with a BMI of 25 or greater having an adjusted PAR of 40% (95%
CI, 38%-41%) compared with a BMI of less than 25.
CONCLUSIONS: Adherence to low-risk dietary and lifestyle factors was associated with a significantly lower
incidence of self-reported hypertension. Adopting low-risk dietary and lifestyle factors has the potential to
prevent a large proportion of new-onset hypertension occurring among young women.