Lokaci-lokaci yayin bala'in cutar ta Covid-19, ma'aikatan kimiyya na CDC sun yi amfani da bayanan karatun su don kimanta ingancin na yanzu ko na kwanan nan na rigakafin Covid-19 don rage haɗarin gwajin inganci ga Covid-19. Duk da yake gaskiyar "gwajin tabbatacce" ya kasance mai ɗan rikice-rikice saboda sirrin PCR Ct lambobin ƙofar da ke tattare da su waɗanda suka ba da damar marasa lafiya tare da Covid-19 da ba a gane su ba daga wasu makonnin da suka gabata don ci gaba da kasancewa mai inganci, burina anan shine in kwatanta hanyoyin cututtukan cututtukan cututtukan CDC waɗanda suka ba da rahoton yawan allurar da suka ba da rahoton illar da suka yi.
Nazarin cututtukan cututtukan da aka sarrafa ya faɗi cikin ƙira uku kuma uku kawai. Ko dai an ƙididdige jimlar jimillar batutuwa, kuma an ƙididdige kowane batu duka biyu don matsayi na shari'a da matsayi na baya-bayan nan - wannan binciken ne na yanki-ko samfurin mutanen da aka fallasa da samfurin mutanen da ba a bayyana ba ana bin su don ganin wanene ya zama shari'ar kuma wanene iko - nazarin ƙungiya-ko samfurin lokuta da samfurin sarrafawa an samu, kuma kowane batu da aka kimanta don matsayi na baya-wannan binciken ne. Idan binciken ƙungiyar ya ƙunshi bazuwar batutuwa a cikin waɗanda aka fallasa da waɗanda ba a bayyana ba, wannan gwaji ne da ba a so (RCT), amma ƙirar binciken har yanzu ƙungiya ce.
A cikin nazari na juzu'i da binciken ƙungiyar, da hadarin na samun sakamakon sha'awa (watau kasancewa batun batun, a nan, gwada tabbatacce) ana iya ƙididdige shi ga mutanen da aka fallasa ta yawan adadin da aka fallasa daga cikin waɗanda aka fallasa da aka raba ta jimlar adadin da aka fallasa. Hakazalika ga wanda ba a bayyana ba. Abin da ke da sha'awa, kwatankwacin waɗannan haɗari guda biyu, haɗarin dangi (RR), shine haɗari a cikin wanda aka fallasa ta hanyar haɗari a cikin wanda ba a sani ba. RR yayi kiyasin yadda hadarin ya fi muni a cikin waɗanda aka fallasa idan aka kwatanta da waɗanda ba a bayyana ba. Don maganin alurar riga kafi ko wani bayyanar da ke rage haɗari, RR zai zama ƙasa da 1.0.
Nazarin ƙetare-tsaye da ƙungiyoyi, ta hanyar ƙirar samfuran su, suna ba da damar kimanta RR daga bayanan su. Duk da haka, nazarin kula da shari'ar ba ya ƙyale haɗarin sakamakon da za a ƙididdigewa, saboda canza lambobin dangi na samfurori da aka kwatanta da sarrafawa yana rinjayar abin da zai zama ƙididdigar haɗari. Madadin haka, binciken kula da shari'a yana ba da izinin kimantawa na rashin daidaito na sakamakon, ba hadarin ba. Misali, 2:1 rashin daidaiton abin da ke faruwa. Wannan ƙimar ba ta da tasiri ta ƙirar ƙira. A cikin nazarin nazarin yanayin, an ƙididdige ƙididdiga na dangi (ko rashin daidaituwa, OR) na sakamakon ta hanyar rashin daidaituwa na sakamakon a cikin fallasa, rarraba ta rashin daidaituwa tsakanin waɗanda ba a bayyana ba.
Ga maganin alurar riga kafi, ana ƙididdige tasirin sa kamar 1.0 – RR. Don bayanan binciken sarrafa shari'a wanda kawai ƙididdigewa KO ba RR ba, yaushe ne OR ke kimanta RR daidai da yadda za a musanya shi a cikin wannan dabarar? Wannan tambayar tana da cikakken tarihin cututtukan cututtukan da suka wuce iyakar yanzu, amma a cikin mafi sauƙi, OR yana kusantar RR yayin da yake cikin yawan jama'a, lokuta ba safai ba idan aka kwatanta da sarrafawa.
Yanzu zuwa ga CDC da kurakuran cututtukan cututtuka na tsari. A wani bincike da aka yi kwanan nan. Link-Gelles da abokan aiki Samfuran jimillar mutane 9,222 da suka cancanci Covid-19-kamar alamomin masu neman gwajin Covid-19 a CVS da Walgreen Co. Pharmacies a lokacin Satumba 21, 2023 zuwa Janairu 14, 2024. Sun tantance matsayin rigakafin da ya gabata na kowane mutum, da kuma ingancin sakamakon gwajin. Ta hanyar ma'anar, wannan binciken ne na yanki, saboda ba a ƙididdige lambobi na kowane mutum na shari'o'i da sarrafawa, ko lambobin mutum ɗaya na fallasa (alurar riga kafi) da waɗanda ba a bayyana ba (marasa alurar riga kafi). Adadin jimillar batutuwa ne kawai aka gwada.
Koyaya, masu binciken sun ƙididdige OR ba RR daga waɗannan bayanan ba, ta hanyar amfani da hanyar bincike na ƙididdiga da ake kira koma bayan logistics wanda ke ba da damar daidaita OR don wasu dalilai masu ruɗani. Babu wani abu mara kyau tare da yin amfani da koma baya na dabaru da samun ORs da aka kiyasta a cikin kowane ƙirar binciken; matsalar tana amfani da ƙimar OR maimakon RR a cikin dabarar ingancin rigakafin 1.0 - RR. Saboda ƙirar binciken ya kasance mai ɓarna, masu binciken zasu iya bincika yanayin yanayin da ya faru a cikin yawan jama'a daga lambobin da aka ƙirƙira, amma ba su bayyana yin hakan ba. A zahiri, shari'o'in sun ƙunshi 3,295 na jimlar 9,222 samfuri, 36%, wanda bai kusan isa ba don amfani da OR azaman madadin RR. Wannan gaskiya ne a tsakanin abubuwan da aka fallasa (25%) da waɗanda ba a fallasa (37%) ba.
Duk da haka, yana yiwuwa a sami cikakken ra'ayi na nawa wannan mummunan zato ya shafa da'awar da marubutan suka yi gabaɗayan ingancin alluran kashi 54%. Lambobin batutuwa masu dacewa, waɗanda aka nuna a cikin teburin da ke ƙasa, an bayyana su a cikin Tables 1 da 3 na takardar Link-Gelles. Lissafin RR daga waɗannan danyen bayanai yana da sauƙi. Haɗarin da ke cikin allurar rigakafin shine 281 / 1,125 = 25%; a cikin marasa lafiya, 3,014/8,097 = 37%. RR shine rabon waɗannan biyun, 25%/37% = 0.67, don haka tasirin maganin alurar riga kafi dangane da waɗannan albarkatun albarkatun zai zama 1.0 - 0.67 = 0.33 ko 33%.
Hakanan ana iya ƙididdige OR daga waɗannan ɗanyen bayanan kamar 0.56, wanda idan aka yi amfani da shi a cikin dabarar ingancin maganin zai ba da inganci na 44%, wanda ya bambanta da ingancin 33% kamar yadda aka kiyasta ta amfani da RR.
Koyaya, Link-Gelles et al. sun yi amfani da daidaitacce OR = 0.46 kamar yadda aka samu daga nazarin koma bayan aikin su. Wannan ya bambanta da wanda ba a daidaita shi ba OR = 0.56 ta hanyar 0.46 / 0.56 = 0.82. Zamu iya amfani da wannan ma'aunin daidaitawa, 0.82, don kimanta abin da ɗanyen RR zai kasance idan an daidaita shi da abubuwa iri ɗaya: 0.67 * 0.82 = 0.55. Ana nuna waɗannan lambobi a cikin tebur ɗin da ke ƙasa, kuma suna nuna cewa ingantaccen ingancin rigakafin ya kai kusan 45%, ba wai 54% da ake da'awar ba, kuma ƙasa da ainihin matakin 50% da ake so.
A matsayina na masanin cututtukan cututtuka, ban san dalilin da yasa abokan aiki na a CDC za su yi kuskuren amfani da OR a matsayin madadin RR ba lokacin da abin da ake buƙata na wannan canji bai cika ba kuma ana iya dubawa cikin sauƙi a cikin bayanan nasu. Sun yi wannan kuskure a wani wuri (Tenforde et al.) Inda kuma ya sami babban bambanci a ingancin rigakafin, kusan 57% sabanin 82%. Wataƙila mawallafa sun yi tunanin cewa kawai hanyar da za a iya daidaitawa don sauye-sauye masu rikice-rikice masu yawa shine koma baya na logistic wanda ke amfani da OR, amma haɗarin haɗari don daidaitawa RR ya dade yana samuwa a cikin fakitin ƙididdigar ƙididdigar kasuwanci daban-daban kuma ana iya aiwatar da su cikin sauƙi (juniper).
Ya zama abin mamaki a gare ni cewa a fili babu ɗaya daga cikin mawallafa sama da 60 da ke tsakanin takardun Link-Gelles da Tenforde da suka gane cewa samfurin nazarin karatun su ya kasance kashi-kashi-kashi ne, ba tsarin shari'a ba, don haka cewa madaidaicin ma'auni don yin amfani da shi don kimanta tasirin maganin alurar riga kafi shine RR ba OR ba, kuma cewa rashin lafiya-cuta zato don OR ba ta maye gurbin bayanan su ba. Don haka waɗannan binciken sun yi kiyasin ingancin ingancin rigakafin na gaskiya a sakamakon su. Wannan ba batun ilimi bane kawai, saboda CDC za a iya yanke shawarar manufofin kiwon lafiyar jama'a daga sakamakon da ba daidai ba kamar waɗannan.
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Harvey Risch, Babban Masanin Kimiyya a Cibiyar Brownstone, likita ne kuma Farfesa Emeritus na Epidemiology a Makarantar Yale na Kiwon Lafiyar Jama'a da Makarantar Magungunan Yale. Babban sha'awar bincikensa shine ilimin ilimin ciwon daji, rigakafi da ganewar asali, da kuma hanyoyin cututtukan cututtuka.
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