Philippe P
Can Fam Physician. 1984 Sep;30:1771-82.
The physician must act as primary medical advisor on behalf of the patient. Because the basis of prevention is epidemiology, problems of validity in the epidemiologic literature ought to be recognized by the primary medical advisor, so that he may optimize prevention. This article addresses the question of validity from the standpoint of the material, analysis, and interpretation. Validity of the material is discussed from four main points of reference: the diagnostic criteria of the disease, selection biases, misclassification of exposure, and control group relevance. Validity of the analysis is considered from the standpoint of the etiologic hypothesis; the notion of the “expected minimum analysis” is discussed. The three main aspects of this are the control of confounders, the introduction of test-variables, and the concept of refinement of the independent and dependent variables. Validity of interpretation is presented as a function of the introduction of test-variables. A relevant analysis may help discriminate between alternate interpretations, defined as the inverse path relationship, the confounded relationship, and the common cause pathway.
医生必须代表患者担任主要医疗顾问。由于预防的基础是流行病学,主要医疗顾问应该认识到流行病学文献中的有效性问题,以便他能够优化预防措施。本文从材料、分析和解释的角度探讨有效性问题。材料的有效性从四个主要参考点进行讨论:疾病的诊断标准、选择偏倚、暴露的错误分类以及对照组的相关性。分析的有效性从病因假设的角度进行考虑;讨论了“预期最小分析”的概念。其三个主要方面是混杂因素的控制、测试变量的引入以及自变量和因变量的细化概念。解释的有效性表现为测试变量引入的函数。相关分析可能有助于区分替代解释,定义为反向路径关系、混杂关系和共同原因路径。