TUTORIAL – CHAPTER 3

MANAGING PEOPLE
(HRM 2204)

1.State the type of error (5 mark)

Situation Types of Source of error/principle

error(random/systematic of error
The cloth tape measure
that you use to measure
the length of an object had Systematic Measurement bias
been stretched out from
years of use.
During study about
benzene causing cancer, Individual biological
workers that are severely ill Random variation
were on leave.
Chemist no.1 applied
different techniques when
taking measurement systematic Selection bias
compared to chemist no.2
During study on salt that
can cause hypertension,
those with high stress level Random Individual biological
were also included in the variation
study.
2. Explain the techniques to control Confounding during DESIGN phase
and ANALYTICAL phase of study (5 marks)

A Confounder is a variable whose presence affects the variables being studied

so that the results do not reflect the actual relationship. There are various ways to
exclude or control confounding variables including Randomization, Restriction and
Matching.
Confounding is a major problem in e research, and it accounts for many of the
discrepancies among published studies. Nevertheless, there are ways of
minimizing confounding in the design phase of a study, and there are also
methods for adjusting for confounding during analysis of a study
Methods for Minimizing Confounding in the Study Design Phase Confounding is
a major problem in research, and it accounts for many of the discrepancies among
published studies. Nevertheless, there are ways of minimizing confounding in the
design phase of a study, and there are also methods for adjusting for confounding
during analysis of a study.
The ideal way to minimize the effects of confounding is to conduct a large
randomized clinical trial so that each subject has an equal chance of being
assigned to any of the treatment options. If this is done with a sufficiently large
number of subjects, other risk factors (i.e., confounding factors) should be equally
distributed among the exposure groups. The beauty of this is that even unknown
confounding factors will be equally distributed among the comparison groups. If all
of these other factors are distributed equally among the groups being compared,
they will not distort the association between the treatment being studied and the
outcome.
The success of randomization is usually evaluated in one of the first tables in a
clinical trial, i.e., a table comparing characteristics of the exposure groups. If the
groups have similar distributions of all of the known confounding factors, then
randomization was successful. However, if randomization was not successful in
producing equal distributions of confounding factors, then methods of adjusting for
confounding must be used in the analysis of the data.
There is no limit on the number of confounders that can be controlled It controls
for both known and unknown confounders. If successful, there is no need to
"adjust" for confounding
Limitations of Randomization to Control for Confounding ,It is limited to
intervention studies
It may not be completely effective for small trials.
Limiting the study to subjects in one category of the confounder is a simple way
of ensuring that all participants have the same level of the confounder. For
example,If smoking is a confounding factor, one could limit the study population to
only non-smokers or only smokers.
If age is a confounding factor, restrict the study to subjects in a specific age
category, e.g., persons over 65 year old.
Drawbacks of Restriction,Restriction is simple and generally effective, but it has
several drawbacks.It can only be used for known confounders and only when the
status of potential subjects is known with respect to that variable.Residual
confounding may occur if restriction is not narrow enough. For example, a study of
the association between physical activity and heart disease might be restricted to
subjects between the ages of 30-60, but that is a wide age range, and the risk of
heart disease still varies widely within that range.Investigators cannot evaluate the
effect of the restricted variable, since it doesn't vary.Restriction limits the number
of potential subjects and may limit sample size. If restriction is used, one cannot
generalize the findings to those who were excluded.Restriction is particularly
cumbersome if used to control for multiple confounding variables.
Matching Compared Groups is another risk factor can only cause confounding if
it is distributed differently in the groups being compared. Therefore, another
method of preventing confounding is to match the subjects with respect to
confounding variables. This method can be used in both cohort studies and in
case-control studies in order to enroll a reference group that has artificially been
created to have the same distribution of a confounding factor as the index group.
For example,In a case-control study of lung cancer where age is a potential
confounding factor, match each case with one or more control subjects of similar
age. If this is done the age distribution of the comparison groups will be the same,
and there will be no confounding by age.In a cohort study on effects of smoking
each smoker (the index group) who is enrolled is matched with a non-smoker
(reference group) of similar age. Once again, the groups being compared will have
the same age distribution, so confounding by age will be prevented
Advantages of Matching is particularly useful when trying to control for complex
or difficult to measure confounding variables, e.g., matching by neighborhood to
control for confounding by air pollution.It can also be used in case-control studies
with few cases when additional control subjects are enrolled to increase statistical
power, e.g., 4 to 1 matching of controls to cases.
And lastly is drawbacks of matching.It can only be used for known confounders.
It can be difficult, expensive, and time-consuming to find appropriate matches.One
cannot evaluate the effect of the matched variable.Matching requires special
analytic methods.