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 ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/master04.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252"
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Second Level
Third Level
Fourth Level
Fifth Level
February 22, 2006
WHO- Postgraduate course 2006 – CC = studies
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Click to edit Master title style=
Click to edit Master subtitle st= yle
October 25, 2001
Mailman School of Public Health
<= span style=3D'mso-spacerun:yes'> 
Departm= ent of Epidemiology
Lecture 7
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February 22, 2006 =
WHO- Postgraduate course 2006 – CC studies
Case-control studi= es
Hans Wolff
Service d’épidémiologie clinique
Département de médecine communautaire <= /span>
Hans.Wolff@hcuge.ch
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Outli= ne
§Case-control = study
§
§Relation to c= ohort study
§Selection of controls
§Sampling sche= mes of controls
------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/slide0593.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff
February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Case-control studies (CCS)
Genetic factors
cases:
ill
Environmental factors
exposed
non exposed
controls:
Not ill&= #13;
Initial situation
Lifestyle
No= t ill
Presumed cause
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3Qf2ADxN8GiNAZ46dLTGAE8dupZs6UprDPBUwaM1BnheZjtaY4CnDt6S1hjgaUNHawzwvIBHawzw 1KGjNQZ4XsCjNQZ46tANaI0Bng/waI0BnhpsMzkth9YY4KmC91E4aZHZDvBUwNsVDqZbAx/g+QBv /6yH1AHe84I3xyaApwVeIqJuB3jqWW0LWwAeAjyEAA8BHkKAhwAPIcBDgIcQ4CHAQ4CHEOAhwEMI 8BDgIQR4CPAQAjwEeAjwMAICPAR4CAEeAjyEAA8BHkKAhwAPoUv6A2osUgwFz4JvAAAAAElFTkSu QmCC ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/slide0594.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff
February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Case-control studies (CCS)
Genetic factors
cases:
ill
Environmental factors
exposed
non exposed
controls:
Not ill
exposed
non exposed
Did they were exposed or not ?<= b>
Lifestyle
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
1.  Example:  Passive Smoking & Breast Cancer=
Smoking
Cases
Controls
Odds
Ratio
Unexposed
Passive
n
40
22.2
%
140
77.8
n
234
38.7
%
370
61.3
1.0
2.2
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Case-Control Design
SAMPLE
BC Cases
180
= Pass= ive
Smokers =
Non-exposed
40
140
Controls
604
Pass= ive
Smokers =
Non-exposed
234
370
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Presence or absence of disease ...<= /div>
… is fixed by design in case-c= ontrol studies.
§Cases have the disease
§Controls don’t.
§We can NOT compute a risk of disease
§We CAN compute prevalence of exposure in cases and controls=
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Passi= ve Smoking & Breast Cancer
<= span style=3D'font-family:Tahoma;font-size:133%;color:yellow;mso-color-index:3'= >§  Cases:  all incident breast cancer in = Geneva
§  Controls:<= span style=3D'mso-spacerun:yes'>  random sample of the Geneva
                     female population
§  Exposure:  questionnaire on lifetime history
                      of exposure to pas= sive smoke
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Have you ever been exposed?
§ … to passive smok= ing at least 1 hour
      per day for at least 1 year?  (Yes / No)
§
§  At home ?  At work ?  During leisure time ?
§
§  If yes, describe= each episode of exposure
§  Duration, who, size of the room, etc…
§
§  Unexposed =3D never active, never passi= ve
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
What should be always true for a case-control study?
=
=
1. Cases and controls are randomized with respect to exposure.
2. Cases are a representative sample of all cases in the general population
3. Controls are a representative sample of the general population
4. Cases and controls have the same population of origin
5. Always start with some cases, then identify their valid controls
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Fundamental conditions for the validity
of this case-control design
Cases and controls :
§ Originate from Geneva resident, <75 = y.
 are sampled independently of their expo= sure to
  passive smoke
<= span style=3D'font-family:Tahoma;font-size:125%;color:yellow;mso-color-index:3'= >§  All incident cases over a given time period<= /div>
<= span style=3D'font-family:Tahoma;font-size:125%;color:yellow;mso-color-index:3'= >§  Controls are a random sample of population
Solution:
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Case Definition
§Incident (=3D newly diagnosed) =
§Between 1/1/92 and 12/31/93
§Resident of Geneva
§Aged < 75 yrs
§Identified:  all pathology labs of Geneva
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Control Definition
§Never diagnos= ed with breast cancer
§Between 1/1/9= 2 and 12/31/93
§Resident of Geneva
§Aged < 75 yrs
§Stratified ra= ndom sample
§Population controls
§Why not use hospital controls?
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Prevalence of Passive Smoking
Smoking
Cases
Controls
Unexposed
Passive
n
40
140
n
234
370
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
The proportion of passive smoker cases is…
370
234
40
234
370
604
140
40
140
180
1.
2.
3.
4.
5.
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Prevalence of Passive Smoking
Smoking
Cases
Controls
Unexposed
Passive
n
40
140
%
22.2
77.8
n
234
370
%
38.7
61.3
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
140
180
140
40
140
77.8
77.8
22.2
1.
2.
3.
4.
=3D
3.5
=3D
3.5
=3D
77.8
=3D
1.8
= The odds of passive smoking
in CASES is…
5.  Answers 1 or 2
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Odds of Passive Smoking in CASES
3.5
3.5
Odds =3D
77.8/22.2=3D
140/40=3D
Odds =3D
100.0
180
Total
77.8
140
Passive
22.2
40
Unexposed
%
N
Smoking his= tory
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Odds of Passive Smoking in CONTROLS
1.6
1.6
Odds =3D
61.3/38.7=3D
370/234=3D
Odds =3D
100.0
604
Total
61.3
370
Passive
38.7
234
Unexposed
%
N
Smoking his= tory
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
AR in case-control study?
Recall
ARdu= ration =3D Risk (E+) - R(E-)
Since risk cannot be computed directly from a case-c= ontrol study, AR cannot be computed either.
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
RR in case-control study?
RR =3D Risk (E+) / R(E-)
=
Since risk cannot be computed directly from a case-control study, RR cannot be computed either
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Odds= Ratio of Passive Smoking
Group
Odds
Odds Ratio
Cases
Controls
3.5
1.6
3.5
1.6
=3D
2.2
1.6
1.6
=3D
1.0
Reference
Group
Your interpretation?
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Inter= pretation of the Odds Ratio (1)
=
§The odds of being a passive smoker are 2.2 greater in breast cancer cases= than in population controls.
Alternatively:
=
= §The odds of breast cancer is 2.2 greater in those exposed to passive smoke= than in unexposed.
§ WHY ?
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
you could have <= span style=3D'position:absolute;top:35.5%;left:56.36%;width:39.13%;height:7.5%'= >done the perfect cohort study instead of the <= span style=3D'position:absolute;top:56.75%;left:58.05%;width:35.58%;height:7.5%= '>case-control study
Imagine ...
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f5+9RSuHvDpl3SNUa7dvy/3qfcH941QL91qv7JkOZvm203dtb/aok+9TW+TpTQmOZqFX+KnUwDDU jIf/ALX8NG75v+A0ULQA3b8392nKvzfLT1FFADGoWnfw0LQBHt/4Ev8As/w0bfl/u09R8y06qAiV dq/M3zUbfm3U7+Knfw/8BoC7Ifur827/AIDTl+bav3f96nN9ykx+8X/eqiiWNdtTfxL/AHqZjZ0/ vVKv3KyZaJI2+7t+VqtQsyt8v3qqrVqDllfvWbOiJcj+ZW2qqt/tULHt3fNuqOP/AFjVYPEBfuaR uiqyrt+7u/8AZar7flZf4mq7IB6VWb+L/eoE0gjj+bb92nMvzKu3d81ROMbf96rUQyrUmVG1hm3c q/Lt/wB2nbdvzMu7/eqznYy4pG/1qp2qLs00IVX5vmoVWZtzLUn8LUf8s1pBoN27V+WnKu75tvy/ 7P8AFTW/hqxGiq/lgfLQHUdGu75VXd8v977tOVVVW+Xcv+y1D8Osa/KvtT5jscoOgpXLK0zbV+6u 3/dqnIyq25W3fLViT71VJD8zVtEwkRSN8rbqzbpdytWhJ/qqpXEjIr4PVa0ictQzNtG7bTpP9Y3+ 9SVscwi0tJ/FR/DQA5acv3t1JGfmpV+8tSUSK21f7q07czfLupv92lx8tSWhGXcvzUL/AHaWl/ho LQLR/e3UUUDBv4Wpyqvy7W/3t1NHKrTm+7UgHltRTPMb1ooCyP/Z ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/slide0583.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff
February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Cohort Design (Risk period: 2 yrs)<= /div>
Female Population of Geneva
Passive Smokers
55,500
Breast
Cancer
= No Breast
Cancer
55,360
140
Non-exposed
35,100
Breast
Cancer
No Breast
Cancer
35,060
40
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Odds Ratio of Breast Cancer
Breast Cancer=
Present (A)
Absent (B)
Passive
Smokers
140
55,360
Unexposed
40
35,060
Odds (A/B)
0.00253
0.00114
Odds Ratio
2.2
1.0 (ref)
Your interpretation?
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Identi= ty of Odds Ratio
=
<= span style=3D'font-family:Tahoma;font-size:142%;color:yellow;mso-color-index:3'= >§Case-control study:
§Odds ratio of passive smoking = =3D 2.2
<= span style=3D'font-family:Tahoma;font-size:142%;color:yellow;mso-color-index:3'= >§Cohort study:
§Odds ratio of breast cancer =3D 2.2
§Same interpretation
=
§Identical Odds Ratio in the cohort and in the case-control studies.
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Female Population of Geneva
Passive Smokers
Breast
Cancer
140
F1 =3D 1.0
Fn =3D fraction included into the sample
No Breast
Canc= er
55,360
55,500
Non-exposed
Breast
Cancer
40
No Breast
Canc= er
35,060
35,100
F2 =3D 0.005
F3 =3D 1.0
F4 =3D 0.005
Breast Cancer
= Passive
Smo= kers
140
Non-exposed
40
180
Controls
Passive
Smokers
370
Non-exposed
234
604
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Relati= on of Case-Control to Cohort Studies
=
<= span style=3D'font-family:Tahoma;font-size:142%'>§In a case-control study:
<= span style=3D'font-family:Tahoma;font-size:38%;visibility:hidden'>§
§CASES are sampled among people in the unexposed and passive smok= ers cohorts who did develop breast cancer
§
§CONTROLS are sampled among people in the unexposed and passive s= mokers cohorts who did not develop breast = cancer
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Odds Ratio and Relative Risk
=
=
= §Relative Risk
=3D
140
55,500
40
35,100
=3D
2.2
=
=
= §Odds Ratio=3D
140
55,360
40
35,060
=3D
2.2
Note effect of rare disease on denominator= s
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Inter= pretation of the Odds Ratio (2)
=
§The = ODDS of breast cancer is 2.2 great= er in = those exposed to passive smoke= than in unexposed.
Alternatively:
=
= §The = RISK of breast cancer is 2.2 great= er in those exposed to passive smoke= than in unexposed.
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Equivalence OR and= RR
The OR i a good estimation for the RR if :
the preval= ence of the illnass is low (<10%)
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Comparison of the OR and = RR
Illness with low prevalence
RR=3D=
2/100
1/100
=3D 2
2 / 1
98 / 99
=3D 2.02
OR=3D=
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Comparison of the OR and = RR
Illness with high prevalence
RR=3D=
50 / 100
25 / 100
=3D 2
50 / 25
50 / 75
=3D 3
OR=3D=
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February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Advantages of Case-Control Studies (1)
=
=
§Less expensive …
=
=
<= span style=3D'font-family:Tahoma;font-size:133%'>§Require smaller sample sizes …
=
=
<= span style=3D'font-family:Tahoma;font-size:133%'>§Shorter duration … than prospective study
=
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<= span style=3D'font-family:Tahoma;font-size:133%'>§Study multiple risk factors for 1 disease
=
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= §Easily reproduced in different populations by different investigators
------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/slide0591.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff
February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Disadv= antages of Case-Control Studies (1)
=
=
§Information about exposure is often obtained after the diagnosis is done
§
§Example:  diet, physical activity<= /div>
=
=
§Dependent on the subject’s memory, which may be affected by the disease
------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/slide0592.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff
February 22, 2006
WHO- Postgradua= te course 2006 – CC studies
Disadv= antages of Case-Control Studies (2)
=
=
§Population of origin for cases is difficult to define precisely.
§
§Difficult to identify appropri= ate control group
=
=
= §Does not provide estimate of risks and attributable risk
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Epidemiology is the basic science of public health and preventive medicine.
Biostatistics is the quantitative foundation of epidemiology. It is important to present a comprehensive view of the fields of epidemiol= ogy, biostatistics, preventive medicine, and public health by showing their int= errelationships and by emphasizing their relevance to clinical practice, research, and pub= lic health policy. Our goal is to combine the theory and application of epidemiology, with a smattering of biostatistics, in a manner that allows participants to critically appraise and interpret scientific literature, a= nd to design and conduct clinical research. 
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collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function PlaySound( href, loop ){ href=3D unescape(href); if( window.event ) window.event.cancelBubble =3D true; pptSound.src =3D href; pptSound.loop =3D loop ? -1 : 0; } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { =09 if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D37, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0529.htm",1,-1,1),new hrefList(= "slide0560.htm",1,-1,1),new hrefList("slide0593.htm",1,-1,1),new hrefList("= slide0594.htm",1,-1,1),new hrefList("slide0561.htm",1,-1,1),new hrefList("s= lide0562.htm",1,-1,1),new hrefList("slide0563.htm",1,-1,1),new hrefList("sl= ide0564.htm",1,-1,1),new hrefList("slide0565.htm",1,-1,1),new hrefList("sli= de0566.htm",1,-1,1),new hrefList("slide0567.htm",1,-1,1),new hrefList("slid= e0568.htm",1,-1,1),new hrefList("slide0569.htm",1,-1,1),new hrefList("slide= 0570.htm",1,-1,1),new hrefList("slide0571.htm",1,-1,1),new hrefList("slide0= 572.htm",1,-1,1),new hrefList("slide0574.htm",1,-1,1),new hrefList("slide05= 75.htm",1,-1,1),new hrefList("slide0576.htm",1,-1,1),new hrefList("slide057= 7.htm",1,-1,1),new hrefList("slide0578.htm",1,-1,1),new hrefList("slide0579= .htm",1,-1,1),new hrefList("slide0580.htm",1,-1,1),new hrefList("slide0582.= htm",1,-1,1),new hrefList("slide0583.htm",1,-1,1),new hrefList("slide0584.h= tm",1,-1,1),new hrefList("slide0585.htm",1,-1,1),new hrefList("slide0586.ht= m",1,-1,1),new hrefList("slide0587.htm",1,-1,1),new hrefList("slide0588.htm= ",1,-1,1),new hrefList("slide0589.htm",1,-1,1),new hrefList("slide0597.htm"= ,1,-1,1),new hrefList("slide0595.htm",1,-1,1),new hrefList("slide0596.htm",= 1,-1,1),new hrefList("slide0590.htm",1,-1,1),new hrefList("slide0591.htm",1= ,-1,1),new hrefList("slide0592.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix 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browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/buttons.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhWAESAPf4AAAAAIAAAACAAICAAAAAgIAAgACAgICAgAQEBISEBASEBISEhAQEhMTExAQE /KTM9Pz8/ERERPz8BAT8/KSkpGRkhMTcxCRkxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAMDAwP8AAAD/AP//AAAA//8A/wD//////yH5BAEAAPgALAAAAABYARIA QAj/APEJHEiwoMGDCBMqXMiwocOHECNKnEixosWLGCEiQKCRo8YDIEHig2DxAD4LKD1avDDhgUuV GUOGbHBR5QGYFBG4fHAB58EKECJEwCfUYAWPFGAygLCRKQIIUKM6WAohKUGgCikcFWh1INWoYKVS 7SrQ41GbIhGYLAuVQVOoC+IyXUuUAkG1HE3KFDhAwkgJc5/qDZmxsOHDiBMrXsy4sePDGyP7lChT 5MULmDPnlDw5YmW6FTNrfgi0aNGEZPEtbfo2bNTUpYeeRph69dPWrqvCNFuBIGG1A59CYPAVQtwF cw0OxWdTIOiBCQAjaAB17fOFII8voGmRc+eOkilm/z9OvTtnjN4hYk1YoT3H2rnBOphPAB9skgq3 2lcaX/5YnJVt9BloAar12UEIRGCZdQghMABI1Tn32IQUVthYexhmqGGGMBHAgIfEhSiiiATAtOGJ GnYI4ogsEldicAYOGNJGZaml3Y0L3NTZUBz1xlB0PUoUI0jlVWRSVN89xBKSGB1YU1TMoRfVBEle hR9HQs1GEHxQ3RZZbveZthxt/LEmXHyp5XWABSCpaRJwbM13gAACPHVccgJFgF+NEhqUAEkQSCfc ddhVhh5dVTaEAEsTUNlkZUWKN9BNGDE6QU8OrSdbllzpxyVTTrU21Uj3scfhp7nNpyoDaTIEJ3P9 If8J2kbLNYegg9JRBwGhFvbq66+ZUiDssMQWK2yHxiZLrInKNotss8l+B5yBrr5p2UIJvortANoC 6+234IbLla/elRtZjeamh5CC3Sb0YLvixivvYkDFGlZqBNh7r4n6goVvv6/ZlCicN+kL71ALTnpQ dCIZp7CihkLA3UQmoWRBogyxtBPGCTnZncVR1rSTo5nuydC/Eo8kUH+lOoTyyvjoCuZu+PjYIKLD rZybtrM1d10C0QXKEVz48GrQkEeWdFJKlbb0UmEeV0SzyC6RvNB646LWIVjUNeC1zAFb+RDKXksM 9r531bwmpQW9+hQDDsx5pqwDRWBXcFES2hc+gEn/wJGdEEWdE6LoWcoxQweaTNmkhydkKaYMYY2Q p1unbLl/pPKbn3v7EZRvrKvqlja2ONvrtoIw9tn2g32/tQBlhtYkU+MNikZ7QYlPDPuMldpOmuJX nVo5VF3HjI+q89mteX5IDd/fVFClma5kiE4f2XUJhlz09gj2NbTDRifkmu7zXjR++RVJ/lPznuvr QH2iD6S+UewP9Dnon6d2NLwN8n90BB6hC68cFMCHoe+ACASP9c4DowUyEF0OPFcDI0ij/VXPaAKC UfhS95AKGoQ7IBRICI1HwhGaUIQoLGEKT6jCFrLwhSuMoQtlCMMZ2rCGOKShDm+4wxzy8Ic+DGIP B4cIRCKGMCAAOy== ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/frame.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Case-control studies - Hans Wolff ------=_NextPart_01C63A7D.A35F4290 Content-Location: file:///C:/5209C636/CCS_OMS_Wolff_2006_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252"
 No= tes
Slide Show
Outline
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