Case 5 DHS 652

Anonymous
timer Asked: Jan 6th, 2018
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Question description

Please answer the following questions in a paper of at least 6 pages:

  1. A researcher is studying the effect of factors that may contribute to a birth defect. The following is a table summarizing the results of bivariate and multivariate analysis.

Table 1. Bivariate versus Multivariate

Variable

Crude OR

95% CI

Adjusted OR

95% CI

Gene X

0.986

0.974–0.998

0.985

0.971–0.999

Gene Y

4.317

1.916–9.727

3.430

1.377–8.547

Gene Z

2.02

1.081–3.891

1.34

0.854–2.115

Gene T

3.365

1.021–11.088

6.236

1.562–24.892

  1. Identify variables from Table 1 that should be further analyzed (to rule out whether they are confounders or effect modifiers). Briefly provide rationale.
  2. Stratified analysis was conducted on one of the genes in Table 1 and odds ratios were obtained. What do these results suggest:

Drug A=0: OR=2.2 for birth defect given presence of gene

Drug A=1: OR=1.4 for birth defect given presence of gene

  1. Critically review the following controversial paper published (and later retracted) by Wakefield et al, which implicated MMR vaccine as a possible etiologic contributor to Autism, etc. You may use either version for your review. Describe potential sources of bias and other limitations in the study:

Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children A J Wakefield, S H Murch, A Anthony, J Linnell, D M Casson, M Malik, M Berelowitz, A P Dhillon,
M A Thomson, P Harvey, A Valentine, S E Davies, J A Walker-Smith
The Lancet, Volume 351, Number 9103 28 February 1998

Pro 7 Con Arguments: “Should any vaccines be required for children? Retrieved from http://vaccines.procon.org/ on November 5, 2013.

Tutor Answer

Dr.Bestwriter
School: Cornell University

Hello😊 Here you go.

Surname 1
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Question 1.

A researcher is studying the effect of factors that may contribute to a birth defect. The following
is a table summarizing the results of a bivariate and multivariate analysis.

Table 1. Bivariate versus Multivariate
VariableCrude OR95% CI

Adjusted OR95% CI

Gene X 0.986

0.974–0.998 0.985

0.971–0.999

Gene Y 4.317

1.916–9.727 3.430

1.377–8.547

Gene Z 2.02

1.081–3.891 1.34

0.854–2.115

Gene T 3.365

1.021–11.0886.236

1.562–24.892

a.

Identify variables from Table 1 that should be further analyzed (to rule out whether they
are confounders or effect modifiers). Briefly, provide rationale.

Referring to Table 1, Gene X and Gene Y need further analyses to ascertain their probable
confounding or effect modification characteristics. For example, Gene Y displays the highest
prevalence rates indicated by the odds ratio due to the exposure to the condition when compared

Surname 2
to those who are not exposed (OR=4.317). This indicates a confounding effect that may
influence the exposure rate beyond the expected levels in a medical perspective. Therefore, this
calls for further analyses on the cases of the exposed in comparison to the unexposed in line with
the expected outcomes. The higher the Odds Ratio (greater than 1), the positive the association
between the exposure conditions and the outcomes from the exposure.

Coming to Gene X, the effect of the modifiers on the exposure rates especially on influencing
the outcomes of the study calls for further analysis too. This is as a result of the exceedingly
lower prevalence rates registered (OR=0.986). Since the Odds ratio indicates a value less than 1,
it indicates a negative influence of the exposure to the drug on the birth defect gene under study.
Consequently, there is an inverse relationship between the exposure and the outcomes of the
observation indicated. This calls for further analysis of the causative risk factors causing the
negative outcome; being the only gene with a negative risk to the subjects implicated within the
study. By so doing, a better explanation in the understanding of the extremes involved in the
epidemiological analysis will be arrived at.

b.

Stratified analysis was conducted on one of the genes in Table 1 and odds ratios were
obtained. What do these results suggest:

Drug A=0: OR=2.2 for birth defect given presence of gene
Drug A=1: OR=1.4 for birth...

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Anonymous
Wow this is really good.... didn't expect it. Sweet!!!!

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