Epidemiology Final

Based on the table below, what is the neonatal mortality rate? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

• 1 per 100,000 (Number of deaths among infants less than 28 days during specific time/ Number of live births during same time) x 100,000

Based on the table in question 2, what is the Proportionate mortality ratio for cancer among persons ages 55 years or older? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

• 5 percent

An age-adjusted rate is a weighted average of which of the following?

• Age-specific rates Point prevalence proportion Attack rates None of the above

A placebo is • An inert tablet (like a sugar pill) • An inert injection (like saline) • Sham surgery • All of the above

• All of the above

Which of the following best defines a fomite?

• Clothing Fly Habitat Time

What are the steps to performing a CHNA (according to the IRS)? (5)

• Define the community it serves. • Assess the health needs of that community. • In assessing the community's health needs, solicit and take into account input received from persons who represent the broad interests of that community, including those with special knowledge of or expertise in public health. • Document the CHNA in a written report (CHNA report) that is adopted for the hospital facility by an authorized body of the hospital facility. • Make the CHNA report widely available to the public.

Reportable diseases are:

• Diseases that each state requires physicians and laboratories to report Diseases that the CDC requests the state department of health to report to the CDC Diseases that the CDC requires each state to report to the CDC Diseases that physicians must report to the hospital administration

____________ refers to the benefits of a treatment, procedure, or service among those who use it in contrast to those who do not

• Efficacy Effectiveness Validity Healthy participant effect

Application of the study of the distribution and determinants of health-related states or events in order to prevent and control health problems is not included in the role of epidemiology

• False

Epidemiology involves studying only infectious communicable disease, not events like injury, obesity, mental health disorders, seat belt use, etc.

• False

True or False? A primary case is the same as an index case.

• False

Epidemiology originally involved the study of what type of disease?

• Infectious Noninfectious Both of these are correct

You are faced with an anti-vaccine person at a public meeting about your hospital requiring all employees to be immunized against influenza. How would explain to them the importance of the policy? Make sure that you discuss herd immunity!

• It is important to get vaccinated because you are not only protecting yourself, but you are protecting others around you, including fellow coworkers and patients. If enough people become vaccinated, herd immunity can develop which would make a large part of the population immune to the flu. • There is also virtually no evidence that vaccines will have adverse effects on you.

Public health surveillance includes all of the following, EXCEPT:

• Public health action Systematic collection of data Analysis of data Interpretation and dissemination of data All of these are included in public health surveillance

Discuss and describe Healthy People 2030.

Healthy People 2030 is a national agenda or strategic plan for public health in the United States. • Reduced the number of objectives to avoid overlap and prioritize the biggest public health issues.

What is NHANES?

Annual Survey that is designed to assess the health of adults and children in the United States

Suppose a highly effective new drug is discovered for treating a form of rapidly fatal cancer. Which of the following rates would be least affected by the widespread use of this drug?

Five-year survival rate for this type of cancer Prevalence proportion for this type of cancer • Incidence rate for this type of cancer Mortality rate for this type of cancer

True or False: Original Medicare covers routine dental, hearing, and vision care.

False

True or False? Descriptive epidemiology involves identifying and quantifying associations, testing hypotheses, and identifying causes of health-related states or events.

False

True or False? The experimental study is effective when the outcome of interest is rare. •

False

Which of the following contains, spreads, or harbors an infectious organism?

Fomites Vectors Reservoirs • Carriers

Infectious disease is best defined as:

Harmful development in a microscopic organism Alteration of the organism's normal functioning • Disease caused by an invading pathogen Body not capable of carrying on its normal functions

Which of the following is NOT a type of selection bias in cohort studies?

Healthy Worker Effect Loss to follow-up • Neyman Bias All of these are types of selection bias in cohort studies

Some researchers consider Meta-analyses to be the best type of study. Why would they think that, and why is it not true?

Meta Analysis is a statistical methodology that combines the results of different trials that are considered similar enough to allow them to be combined (quantitatively). Combines a lot of data to back up a finding or conclusion. It is not the strongest type of study because it is only as strong as the weakest study in the group. Not all studies collect data the same way, therefore one study can throw the whole meta analysis off track.

Which of the following stages is associated with the incubation period?

Stage of susceptibility • Stage of presymptomatic disease Stage of clinical disease Stage of recover, disability, or death

Establishing a valid statistical association is a necessary part of establishing a cause-effect relationship

True

Medicare Advantage plans provide the same level of coverage as Original Medicare and often include prescription drug coverage and other extras.

True

Those diseases and infections that are transmitted between vertebrate animals and humans are referred to as ________.

Zoonoses

What are some of the weaknesses of using data from County Health Rankings?

data is old and not granular enough, sampling of the community is small and not representative enough of the community

List at least 5 social determinants of health

economic status, education, social/community context, health and healthcare, neighborhood built environment

Describing health-related states or events by person, place, and time allows us to do all of the following, EXCEPT:

identify the extent of the public health problem. describe the public health problem in a way that can be communicated easily. identify who is at greatest risk. provide clues as to the causes of disease. • All of these are can be done when describing health-related states or events by person, place, and time.

What is AHRQ?

lead Federal agency charged with improving the safety and quality of America's health care system

What is NVSS?

lead Federal agency charged with improving the safety and quality of America's health care system •System that is legally responsible for the registration of births, deaths, marriages, divorces, and fetal deaths. Annual Survey that is designed to assess the health of adults and children in the United States Principal agency which provides statistical information to guide actions and policies to improve the public health of the American people

What are some of the common things that are used when risk adjusting healthcare data? Why?

o patient's age o gender o past medical history o other diseases or conditions (comorbidities) the patient had at hospital arrival that are known to increase the patient's risk of dying or readmission. Numerical Methods: • Measures of central tendency • Measures of Dispersion

Definition of epidemiology includes all of the following, EXCEPT:

study of determinants study of disease frequency study of disease patterns health-related states or events • All of these are included in the definition of epidemiology

Which of the following is a nuisance variable to be controlled? • Effect modifier • Confounder • Binary variable • Dichotomous variable

Confounder

Researchers use matching to control for what in a research study?

Confounding

Researchers use randomization to control for what in a research study?

Confounding

Researchers use regression analysis to control for what in a research study?

Confounding

Researchers use restriction to control for what in a research study?

Confounding

Researchers use stratification to control for what in a research study?

Confounding

Assuming that you have found a relationship between two variables. If their relationship is not causal, what are the possible alternative explanations?

Confounding Bias Chance

Discuss how a researcher can control for confounding. Make sure you give all of the different ways.

Confounding factors get in the way of the relation you want to study, only randomized experimental studies allow us to balance out confounding among groups. How to control for confounding - Randomization, Restriction, Matching, Stratification, Multivariate Analysis (ex. multiple linear regression, logistic regression)

What type of study is described? 1. Researchers recently announced that increased palm oil consumption is related to higher IHD mortality rates in developing countries. The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and interaction between palm oil consumption and country economic development level. The authors controlled for per capita consumption of beef, pork, chicken, coconut oil, milk cheese, and butter. In developing countries, for every additional kilogram of palm oil consumed per capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant.

Correlational

What type of study is described? 3. Researchers have found that fish consumption is associated with a reduced risk from all-cause, ischemic heart disease, and stroke mortality. The fish consumption data in 1961-1963, 1979-1981, and 1989-1991 and mortality data were obtained from the Food and Agriculture Organization and the World Health Organization, respectively. Fish consumption was independently, significantly, and inversely associated with all-cause (P< 0.001), ischemic heart disease (P< 0.001), and stroke (P< 0.05 to < 0.001) mortality in all three time periods in both sexes, after adjusting for confounding factors.

Correlational

What type of study is described? A recent Canadian study found that many physicians do not wash their hands often enough. Of the 354 local physicians in one Canadian city, 144 responded to a mailed survey, yielding a 44.9% response rate. Only 45.3% reported performing pre-procedure and post-procedure hand hygiene at least 80% of the time. Stepwise logistic regression results suggested that the variables "presence of hand hygiene auditing" (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.47- 6.91), "being too busy" (OR, 0.43; 95% CI, 0.20-0.90), "forgetfulness" (OR, 0.27; 95%, CI, 0.13-0.56), and "the perception that hand hygiene products are damaging to the skin" (OR, 0.31;95% CI, 0.11-0.88) were the only independent predictors of physician hand hygiene compliance.

Cross-Sectional

What type of study is described? Researchers recently reported that investing in improved nursing work environments is a key strategy to retain nurses. 3186 bedside nurses of 272 randomly selected nursing units in 56 Belgian acute hospitals were surveyed. A logistic regression analysis was used to estimate the impact of organization of nursing care on nurse reported intention to leave controlling for differences in region (Walloon, Flanders, and Brussels), hospital characteristics (technology level, teaching status, and size) and nurse characteristics (experience, gender, and age). 29.5% of Belgian nurses have an intention-to-leave the hospital. Patient-to-nurse staffing ratios and nurse work environments are significantly (p < 0.05) associated with intention-to-leave.

Cross-Sectional

Discuss how a researcher can diminish chance when conducting a research study?

Increase the sample size

What is infant mortality, how is it calculated, and what are some of the risk factors for infant mortality?

Infant mortality is death of children under the age of one. • It is calculated by the number of newborn deaths (under one year) divided by the amount of resident live births in a specific geographic area • Risks: Birth defects, maternal pregnancy complications, sudden infant death syndrome, preterm birth or low birth weight

How well the researchers performed the study is what? • Internal Validity • External Validity

Internal Validity

When considering if there is a causal relationship, what does plausibility mean?

-Biological or social models exist to explain the association Biologically different organisms have the same mechanism The studies used plausible techniques to study the relationship None of the above

The attack rate is associated with which of the following?

-Cumulative incidence Incidence density Cases of disease occurring over and extended period of time Person-years

Which of the following study designs involves the population as the unit of analysis?

-Ecological Study Case report/case series Cohort Cross-sectional

Sex" reflects what type of data?

-Nominal Ordinal Discrete Continuous

If the mean age of a group of people is 45 and the median age is 50, what do you know about the distribution of ages?

-The age distribution is skewed left The age distribution is skewed right The age distribution is symmetric There is insufficient information to know how ages are distributed

A psychiatrist devised a short screening test for depression. An independent blind comparison was made with a gold standard for diagnosis of depression among 200 psychiatric outpatients. Among the 50 outpatients found to be depressed according to the gold standard, 35 patients were positive for the test. Among 150 patients found not to be depressed according to the gold standard, 30 patients were found to be positive for the test. What is the Positive Predictive Value of the test?

.54 = (True Positive / (True Positive + False Positive))

A psychiatrist devised a short screening test for depression. An independent blind comparison was made with a gold standard for diagnosis of depression among 200 psychiatric outpatients. Among the 50 outpatients found to be depressed according to the gold standard, 35 patients were positive for the test. Among 150 patients found not to be depressed according to the gold standard, 30 patients were found to be positive for the test. What is the sensitivity of the test?

.70 = (True Positive/ (True Positive + False Negative))

A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known. What was the sensitivity of the test?

.71 = (True Positive/ (True Positive + False Negative))

A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known. What was the predictive value of a positive test?

.75 (Proportion of people with positive test who have disease) True Positive/(True Positive + False Positive ))= 150/(150+50)

A psychiatrist devised a short screening test for depression. An independent blind comparison was made with a gold standard for diagnosis of depression among 200 psychiatric outpatients. Among the 50 outpatients found to be depressed according to the gold standard, 35 patients were positive for the test. Among 150 patients found not to be depressed according to the gold standard, 30 patients were found to be positive for the test. What is the specificity of the test?

.80 = (True Negative/ (False Positive + True Negative))

A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known. What is the overall accuracy of the test?

.88 = (True Positive + True Negative) / (True Positive + False Negative + False Positive + True Negative)

A psychiatrist devised a short screening test for depression. An independent blind comparison was made with a gold standard for diagnosis of depression among 200 psychiatric outpatients. Among the 50 outpatients found to be depressed according to the gold standard, 35 patients were positive for the test. Among 150 patients found not to be depressed according to the gold standard, 30 patients were found to be positive for the test. What is the Negative Predictive Value of the test?

.89 = (True Negative / (False Negative + True Negative))

A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known. What was the predictive value of a negative test?

.91 = (True Negative / (False Negative + True Negative))

A screening test for a newly discovered disease is being evaluated. In order to determine the effectiveness of the new test, it was administered to 900 workers. 150 of the individuals diagnosed with the disease tested positive. A negative test finding occurred in 60 people who had the disease. A total of 50 persons not diseased tested positive for it. Assume the prior probability is not known. What was the specificity of the test?

.93 = ( True Negative / (False Positive + True Negative) ) = (640/(50+640)

A cohort study was performed looking at the use of postmenopausal hormones and the risk of coronary heart disease. Attack rate - cumulative incidence rate Person-time rate - incidence density rate Postmenopausal hormone use Ever use Past use Current use Never use Coronary heart disease 30 19 11 60 Person-years 54,308.7 24,386.7 29,922.0 51,477.5 What is the relative risk of CHD among women who ever used postmenopausal hormones and those who never used postmenopausal hormones?

0.47 (a/a+b)/(c/c+d)

What is the standardized morbidity ratio (SMR) for Population B, using Population A as the standard?

0.689 (Number of observed deaths/expected deaths)

About how many Americans are covered by Medicare?

1 in 5

Based on the table in question 2, what is the Age-specific mortality rate for persons ages 55 years or older? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

1,880 per 100,000 (Number of deaths by age group/ population at the time) x 100,000

How does each of the following conditions influence the prevalence of a disease in a population? For each scenario, assume that no other changes occur. Your choices are: increases prevalence, decreases prevalence, or has no effect on prevalence. 1. A treatment is developed that prolongs the life of people suffering from the disease , 2. A new measure is developed that prevents new cases of disease from occurring , 3. There is an immigration of a large number of healthy people into the population.

1. Increase prevalence 2. Decrease prevalence 3. Decrease prevalence

Describe BRFSS and how its data is utilized.

1.BRFSS (Behavioral Risk Factor Surveillance System) 2. Common source for county health rankings and research articles to describe the rate of these behaviors 3. 400,000 adult interviews each year 4. Collects behavioral health risk data like (smoking, drinking, exercise, seat belts, immunizations)

Consider a group of 1,000 newborn infants. 100 infants were born with serious birth defects and 20 of these 100 died during the first year of life. 90 of the 900 remaining infants without any birth defects also died during the first year of life. 1. Calculate the prevalence of serious defects in this population at the time of birth.

100/1000 = .1

Calculate the overall cumulative incidence of mortality in this entire population.

110/1000 = .11

Approximately what share of the federal budget goes toward Medicare?

15

Based on the information below, in what age group is the YPLL for suicide the greatest? The following table refers to deaths attributed to all causes, all malignant cancers, accidents and adverse effects, suicide and self-inflicted injury, and homicide and legal intervention among Black males in the United States, 2002.

15-24

Based on the table in question 2, what is the maternal mortality rate? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

156 per 100,000 (Number of deaths due to childbirth during specified time/ Number of live births in same time period) x 100,000

For the two populations below, what is the crude mortality rate for Population A

16.45 per 1,000

What are the attributable risk?

175 per 100,000

cohort study involved an assessment of the relationship between cigarette smoking and the incidence of coronary heart disease. • For cigarette smokers, the coronary heart disease incidence rate was Ie = 500 per 100,000. • For nonsmokers, it was Io = 250 per 100,000. • In the overall population, the coronary heart disease rate was It = 300. What is the relative risk (or sometimes called risk ratio) of developing coronary heart disease?

2

A cohort study of alcohol use and academic performance was conducted in an undergraduate student population over 3 years. There were 2,000 students in the study. Of the 1,450 who drank alcohol, 872 displayed significantly reduced academic performance on standardized tests. Of the 550 students who didn't drink alcohol, 124 showed reduced academic performance on standardized tests. • 1.0 • 2.67 • 5.18 • 8.51

2.67

A cohort study involved an assessment of the relationship between cigarette smoking and the incidence of coronary heart disease. • For cigarette smokers, the coronary heart disease incidence rate was Ie = 500 per 100,000. • For nonsmokers, it was Io = 250 per 100,000. • In the overall population, the coronary heart disease rate was It = 300. What is the attributable risk? • 200 per 100,000 • 250 per 100,000 • 300 per 100,000 • 500 per 100,000

250 per 100,000

Based on the table in question 2, what is the infant mortality rate? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

28 per 1,000 (Number of deaths among infants ages 0-1 year during a specified time period/ Number of live births in the same time period) x 1,000

Based on the information below, what is the rate ratio of all malignant cancers to accidents? The following table refers to deaths attributed to all causes, all malignant cancers, accidents and adverse effects, suicide and self-inflicted injury, and homicide and legal interveAntion among Black males in the United States, 2002

3.8

Based on the table below, what is the Cause-specific mortality rates for those who died from stroke? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

32 per 100,000 (Number of deaths from a specific cause occurring during given time period/ Population from which deaths occurred) x 100,000

A pharmacist noticed an increase in the sale of anti-diarrhea medications and contacted the local Department of Public Health. An investigation revealed that most of those who developed diarrhea had attended a wedding the previous weekend. After interviewing those who had attended the wedding, the investigators believed that a cream sauce used in the pasta may have been the source of the outbreak. There were 332 people at the wedding. Of the 285 who chose pasta, 197 became ill, while only 8 of those who did not eat pasta became ill. What is the value of the appropriate measure of association? • 0.52 • 1.00 • 4.06 • 10.9

4.06

Suppose that, in a given region, 20% of its population is younger than 15 and 10% is older than 65 years of age. What would the dependency ratio be?

43

What percentage of Medicare beneficiaries lived on incomes of less than $26,200 in 2016, including income from Social Security and all other sources?

50

A cohort study involved an assessment of the relationship between cigarette smoking and the incidence of coronary heart disease. • For cigarette smokers, the coronary heart disease incidence rate was Ie = 500 per 100,000. • For nonsmokers, it was Io = 250 per 100,000. • In the overall population, the coronary heart disease rate was It = 300. What is the attributable-risk percent?

50%

A cohort study was performed looking at the use of postmenopausal hormones and the risk of coronary heart disease. Postmenopausal hormone use Ever use Past use Current use Never use Coronary heart disease 30 19 11 60 Person-years 54,308.7 24,386.7 29,922.0 51,477.5 What is the risk of coronary heart disease among ever users of postmenopausal hormones?

55.2 per 100,000

A cohort study of smoking and lung cancer was conducted in a small island population. There were a total of 1,000 people in the study, and the study was conducted over a ten year period. Four hundred were smokers and 600 were not. Of the smokers, fifty developed lung cancer. Of the non-smokers, 10 developed lung cancer. What is the relative risk? • 2.2 •5 • 7.5 • 8.4

7.5

Based on the table in question 2, what is the Cause-specific mortality rates for those who died from heart disease? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

73 per 100,000 (Number of deaths from a specific cause occurring during given time period/ Population from which deaths occurred) x 100,000

Based on the table in question 2, what is the fertility rate? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

76 per 1,000 (Number of live births during a specific time/ Population women 15-49) x 1,000

A psychiatrist devised a short screening test for depression. An independent blind comparison was made with a gold standard for diagnosis of depression among 200 psychiatric outpatients. Among the 50 outpatients found to be depressed according to the gold standard, 35 patients were positive for the test. Among 150 patients found not to be depressed according to the gold standard, 30 patients were found to be positive for the test. What is the accuracy of the test?

78 = (True Positive + True Negative) / (True Positive + False Negative + False Positive + True Negative) =

Based on the table below, what is the crude death rate? Refer to the following table reflecting mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year).

801 per 100,000 (Number of deaths during a given time period/ Population from which deaths occurred) x 100,000

Based on the information below, what is the crude mortality rate (per 100,000) for all causes? The following table refers to deaths attributed to all causes, all malignant cancers, accidents and adverse effects, suicide and self-inflicted injury, and homicide and legal intervention among Black males in the United States, 2002.

818 (Number of deaths occurring during a given time period/ Population from which deaths occurred) x 100,000

A cohort study assessed the relationship between cigarette smoking and the incidence of lung cancer. • For cigarette smokers, the lung cancer incidence rate was Ie = 200 per 100,000. • For nonsmokers, the lung cancer incidence rate was Io = 25 per 100,000. • The lung cancer incidence rate in the entire population was It = 100 per 100,000. What is the attributable-risk percent? • 12.5% • 50% • 65% • 87.5%

87.5%

What is the age-adjusted mortality rate for population B using population A as the standard.

9.45 per 1,000

What share of all primary care physicians (excluding pediatricians) report that they are accepting Medicare patients in their practice?

93

An unplanned type of experimental study where the levels of exposure to a presumed cause differ among a population in a way that is relatively unaffected by extraneous factors, such that the situation resembles a planned experiment, is called: • A nonrandomized experiment • A natural experiment • A placebo-controlled experiment • All of these are correct

A natural experiment

What is a Phase IV study? • The experimental drug or treatment is given to a few hundred people to see if it is effective and to further evaluate its safety • Researchers confirm the drugs effectiveness, monitor side effects, compare it to commonly used treatment, and collect information that will allow the experimental drug or treatment to be used safely • Researchers test an experimental drug or treatment in a small group of people for the first time. The researchers evaluate the treatment's safety, determine a safe dosage range, and identify side effects A study to examine further uses and possible side effects of a drug already approved by the FDA

A study to examine further uses and possible side effects of a drug already approved by the FDA

How do we prevent bias in an experimental trial? • Blinding • Randomization • Regression Analysis • AandB

AandB

Which of the following is NOT a type of immunity?

Acquired Active Passive • Transfer

Discuss and describe the difference between active and passive immunity

Active immunity- When the body produces its own antibodies by either receiving vaccine or contracting the disease Passive immunity- Acquired through transplacental transfer from mother to unborn child or injection of antibodies from a person or animal that has already been exposed

What effect does randomization in a large intervention study have? • Minimizes bias in the observation of outcomes of interest • Minimizes potential bias in the allocation of participants to treatment group • Both A and B are correct • Neither A nor B is correct.

Both A and B are correct

Describe a confidence interval and discuss how it is used to determine statistical significance.

CI is a statistical calculation that tells you the range of hypotheses that are compatible with the data. As the sample size increases, the interval becomes closer to the point estimate and the statistical significance of the results increase. When the sample size is too small, the CI may contain the null l hypothesis. This means the result is NOT statistically significant and null hypothesis is accepted.

The second leading cause of death in the US is _________

Cancer

What type of study is described? Researchers recently warned that a new blood thinner might be dangerous. They reported that a 33-year-old Hispanic female with multiple medical problems presented to the emergency department (ED) with a 5-day history of vaginal bleeding and a 3-day history of dizziness, fatigue, and weakness. Prior to ED presentation, she had been initiated on dabigatran 150 mg twice daily for atrial fibrillation. Four days later, she began having profuse vaginal bleeding. She discontinued all of her home medications including dabigatran, and her bleeding subsided the next day. Upon presentation to the ED, her hemoglobin was 7.1 g/dL, for which she was transfused 2 units of packed red blood cells, increasing her hemoglobin to 9.6 g/dL. Because the patient was in atrial fibrillation, warfarin was initiated once she was clinically stable, and she was never restarted on dabigatran. Her hemoglobin was stable throughout admission with no further bleeding. She was discharged on warfarin and closely followed without incident.

Case Report

What type of study is described? The California Department of Public Health (CDPH) reported this past week that physicians and public health officials have identified 20 cases of a paralytic illness that is similar to polio. Ages have ranged from 2 to 16 and some adults were stricken as well. Clinical presentations in the cases included the sudden onset of paralysis in at least one arm or leg. Most of the children have not recovered significant use of the affected limbs. All of the first five children had been vaccinated for polio. Vaccine status was not immediately known for the other cases.

Case Series

What type of study is described?Researchers reported recently that synthetic cannabinoids in "Spice" products can cause potentially serious health care conditions that necessitate ED evaluation. They retrospectively reviewed cases presenting to their Emergency Department (ED) during a 3-month period with chief complaints of Spice drug use before arrival. Six cases presented were identified. Two patients were admitted after reporting seizures. All but one presented with tachycardia. Two patients had hallucinations. The average length of ED observation was 2.8 h. No patient with seizures had recurrent episodes. Most cases can be discharged from the ED after a period of observation.

Case Series

Researchers use blinding to control for what in a research study?

Chance • Bias Confounding None of the above

Which of the following are secondary research? (Select all that apply)

Data from County Health Rankings

Which of the following is are legitimate sources of cases for a case-control study? (select all that apply)

Disease registries, e.g. cancer registries. Hospitals • Members of the general population responding to an advertisement seeking subjects with a particular condition Patients at an outpatient clinic

Notifiable diseases are:

Diseases that each state requires physicians and laboratories to report -Diseases that the CDC requests each state health department report to the CDC Diseases that hospitals require physicians to report to administration Diseases that the CDC requires each state health department report to the CDC

What are the types of descriptive epidemiologic studies? Briefly define each

Ecological Studies- Studies different populations at the same time or same population at different times. Focuses on comparisons of groups rather than individuals. Case Reports- Involves profile of a single individual Case Series- Involves a smaller group of people with a similar diagnosis Cross Sectional Surveys- Conducted over a short period of time and the unit of analysis is the individual

Which of the following study designs provides a useful way to obtain prevalence data?

Ecological Study Case report/case series Cohort • Cross-sectional

Which of the following is not a descriptive study design?

Ecological Study Case report/case series • Cohort Cross-sectional

What are the causal criteria suggested by Dr. Hooker

Effect size Consistency Exposure Dose Response Plausibility Human Experimental Evidence

How often are not-for-profit healthcare organizations required to perform a CHNA?

Every three years

Which of the following best defines pathogen?

Extent of pathogenicity A microscopic organism (plant or animal) • An organism capable of causing disease All of the above

How well the result of the current study can be applied to different populations is what? • Internal Validity • External Validity

External Validity

In a case-control study, one can calculate either a risk ratio or an odds ratio.

False

Medicare Advantage plans let you go to any doctor or hospital who accepts Medicare

False

Once you enroll in Medicare, you must give up any other health care coverage you have.

False

Original Medicare, Medicare Advantage plans and Medicare prescription drug plans offer the same coverage nationwide. Medicare supplement insurance (Medigap) plans vary by state.

False

We sometimes classify epidemics by how they spread through a population. Which of the following is NOT an example of a point source epidemic?

Hepatitis B contracted through contaminated water consumed after a football practice Salmonella poisoning contracted by a group of family and friends from grandma's potato salad • Influenza All of these are examples of point source epidemics

In determining causation, it has been suggested that people use the Hooker criteria. Please read over the following statement about smoking and lung cancer. Discuss how you would apply the criteria to the statement. In other words, discuss the criteria and how each one is addressed in the statement. Discuss as many of the criteria as possible.

Hooker causal criteria- effect size, consistency, exposure dose response, plausibility, human experimental evidence

In the epidemiology triangle, the term agent is equivalent to which of the following?

Host • Pathogen Environment Field Investigator

Epidemiology includes the study of which of the following?

Human Behavior Accidents Disease • All of these are correct

Epidemiology includes the study of which of the following?

Human Behavior Accidents Disease • All of the above

Discuss and describe the International Classification of Disease. Make sure to discuss the differences between ICD-9 and ICD-10.

ICD is the standard diagnostic tool for epidemiology. Managed by the WHO, it is a classification system with codes for classifying diseases and everything that goes along with that Used for billing in the US ICD 9 has 17,000 codes and US was last to abandon it ICD 10 added in 2015 by US, had laterality, specificity, extensive severity parameters, and complexity parameters

What are the types of analytical epidemiologic studies? Briefly define each

In analytical studies, researchers observe the relationships between variables Case-Control Studies- is designed to help determine if an exposure is associated with an outcome Cohort Studies- Cohorts of persons placed in a group can be studied as a group, forward in time (prospectively) or backward in time (retrospectively)

How does the strategy for a case-control study differ from that of a cohort study? (Select the one best answer.) -Case-control studies are retrospective, while cohort studies are always prospective. -Randomization can be used in a cohort study, but can't be used in a case-control study -The goal of cohort studies is to test an association, but case-control studies just document the frequency of risk factors. -In case-control studies subjects are selected and grouped based on their disease status, but in cohort studies subjects are selected and grouped based on exposure status.

In case-control studies subjects are selected and grouped based on their disease status, but in cohort studies subjects are selected and grouped based on exposure status.

Which of the following are examples of primary research? (select all that apply)

In depth interview • Survey • Focus Groups

Was the Tuskegee syphilis study an experimental study?

No

What is the hierarchy of evidence? List studies from best to worst?

Not all studies provide the same level of evidence; you must decide what to accept when looking at a large body of evidence. • Best Single Study: Single Randomized Controlled trials • Cohort Studies- Prospective being better than retrospective • Case Control Studies • Cross Sectional Surveys • Correlation Studies • Case Reports and Case Series • Worst Studies: Expert Opinion, Anecdotal Reports

When is the period each year when people with Medicare can change their Medicare health and prescription drug plans

October 15- December 7

Explain what an odds ratio is and then explain what it means if you have an odds ratio of 1, 0.5, and 3.

Odds Ratio- Compares the odds disease in those with exposure to the odds of disease among those without exposure. It does not compare the incidence of disease between the two groups (Case Control Study) EXAMPLE FROM PPT 1. 1 = The odds of gastric cancer is the same for those who ate chili peppers compared to those who did not eat chili peppers 2. .5 = The odds of gastric cancer is .5 higher for those who ate chili peppers compared to those who did not eat chili peppers 3. 3 = The odds of gastric cancer is 3 times higher for those who ate chili peppers compared to those who did not eat chili peppers

What share of the total Medicare population is enrolled in a Medicare Advantage plan, such as a Medicare HMO or PPO, instead of the traditional Medicare program?

One in 3

Discuss the difference between an outbreak, an epidemic, and a pandemic?

Outbreak: sudden increase in the incidence of a health-related state Epidemic: Health-related state or event in a defined population above the expected over a given period of time Pandemic: Epidemic affecting a large number of people in many countries, continents, or regions

Describe what a p-value measures. Discuss how to interpret a p-value of 0.01 and 0.10.

P value tells you the extent to which the null hypothesis is compatible with the data • P-values reflect two things: the magnitude of the association and sample size (sample variability) • P-value provides a means for evaluating chance and can range from 0 to 1. A small p-value indicates that the result is unlikely to be a product of chance. A p-value less than or equal to 0.05 indicates that the role of chance is sufficiently small that the investigators are willing to reject a null hypothesis in favor of the alternative. • 0.01 - results are unlikely due to chance and we reject null hypothesis • 0.10 - chance is likely the explanation for the finding and we accept null hypothesis

The cost of an in-patient stay is covered by which part of Medicare?

Part A

Doctors' services, outpatient care and some medical equipment are covered by which part of Medicare

Part B

What type of study is an "Investigation of the effectiveness of the poliomyelitis vaccine?" • Therapeutic trial • Prophylactic tria

Prophylactic trial

Which groups of people are covered by Medicare?

People age 65 and older People under age 65 with a long-term disability who have received Social Security Disability Insurance payments for at least two years People with end-stage renal disease (ESRD)People with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease • All of the above

A study was conducted in men aged 40-70 in order to determine whether exercising for 2 or more hours per week decreases the likelihood of a heart attack. The cases were 1,000 men who had recently had a heart attack; of these, 236 reported that they had regularly exercised for two or more hours per week prior to their heart attack. 1,000 controls were also selected for the study; of these, 379 reported that they exercised regularly. Calculate the magnitude of the association between regular exercise and heart attack. What does your calculation suggest? (Select one answer.)

People who exercise regularly have about 2.0 times the risk of having a heart attack compared to people who don't exercise. People who exercise regularly have about a 50% chance of having a heart attack. -People who exercise regularly have about 0.5 times the risk of having a heart attack compared to people who don't exercise.

The __________ is defined as the effect on patient outcomes that may occur due to the expectation by a patient that a particular intervention will have an effect. • Interviewer effect • Recall effect • Selection effect • Placebo effect

Placebo effect

Describe and discuss primary and secondary data? Make sure to include the pros and cons of each.

Primary Data- data collected from a firsthand source (surveys, interviews, experiments) 1. Pro: Original, accurate 2. Con: Time consuming, expensive II. Secondary Data- data obtained from existing research. 1. Pro: quick to obtain, cheap 2. Con: Outdated, may have trouble finding specific data needed for a population

Discuss and compare primary, secondary, and tertiary prevention.

Primary- actions taken prior to the onset of disease (immunization, sanitation, education, media campaigns, warning labels) Secondary- reduces the progress of disease after it is already present (cancer screening) Tertiary- reduces the limitation of disability from disease after it has already occurred (physical therapy for stroke patients)

What is NCHS

Principal agency which provides statistical information to guide actions and policies to improve the public health of the American people

Describe how a researcher can minimize bias in a research study.

Properly designing and conducting the research study and using the same methods, instruments and researchers. • Blinding the interviewers and observers/raters to the participants exposure or disease status. • Rely on health records instead of the respondents' memories (recall) when possible.

What are the pros and cons of survey research?

Pros: only way to probe opinion of a large group, applicable to other professional fields, cheaper Cons: not as deep info, hard to ensure representative sample, results may be biased because participants can lie, many not care, or may not actively engage, and questions don't address "why?

What are the pros and cons of focus groups?

Pros: participants can build on each other's answers, follow-up questions, non-verbal cues, lots of answers at one time/less time-consuming than interviews Cons: peer pressure from other participants, expensive, need a trained interviewer/facilitator, selection bias (those who choose to participate may not represent population entirely), assertive/outspoken members of group may overshadow introverts

What are the pros and cons of in-depth interviews?

Pros: requires fewer participants, deep understanding (follow up questions, tone, body language), no peer pressure, more relaxed, one-on-one atmosphere Cons: prone to bias, time-consuming, expensive, difficult to find individuals willing to participate, experimenter must be skilled and experienced, data is not generalizable

Which one of the following is the most time consuming and costly study design?

Prospective Study

Describe and compare quantitative and qualitative research.

Quantitative research is research involving data and numbers while qualitative research is collecting and analyzing non numerical data to understand concepts, opinions, or experiences.

Explain what relative risk is and then explain what it means if you have a relative risk of 1, 0.5, and 3.

Relative risk-is the ratio of the risks for an event for the exposure group to the risks for the non- exposure group (Used in Cohort Study) 1 = No change in risk of an event whether you were exposed or not .5 = Person has a 50% chance they will not be at risk for an event if they were part of the exposure group 3 = Person is 3x more likely for an event to occur if they were exposed

A description of communicable disease prevention and control may include all of the following, EXCEPT:

Remove, eliminate, or contain the cause or source of infection Disrupt and block the chain of disease transmission Protect the susceptible population against infection and disease • All of these could be part of a description of communicable disease prevention and control

Discuss and compare notifiable and reportable diseases?

Reportable diseases- (state level) required that the disease be reported to the state, each state has own laws on which diseases are reportable Notifiable diseases- (national level) voluntary these to be reported to the CDC, considered to be notifiable if it is of considerable public health importance because of their seriousness These diseases can be reported if: causes serious morbidity or death, have potential to spread, can be controlled with appropriate intervention

What is a Phase 1 drug trial? • The experimental drug or treatment is given to a few hundred people to see if it is effective and to further evaluate its safety. •Researchers test an experimental drug or treatment in a small group of people for the first time. The researchers evaluate the treatment's safety, determine a safe dosage range, and identify side effects. • Researchers confirm the drugs effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the experimental drug or treatment to be used safely. • A study to examine further uses and possible side effects of a drug already approved by the FDA

Researchers test an experimental drug or treatment in a small group of people for the first time. The researchers evaluate the treatment's safety, determine a safe dosage range, and identify side effects.

A cohort study of smoking and lung cancer was conducted in a small island population. There were a total of 1,000 people in the study, and the study was conducted over a ten year period. Four hundred were smokers and 600 were not. Of the smokers, fifty developed lung cancer. Of the non-smokers, 10 developed lung cancer. In order to measure the strength of association between smoking and lung cancer in this population, which measure of exposure-disease association would you use?

Risk • Risk Ratio Odds Ratio Attack Rate

What is risk adjustment, how is it done, and why is it important in healthcare?

Risk Adjustment - A statistical process that considers underlying health status or spending of a patient when looking at their health care outcomes or costs • In healthcare today, organizations are being compared on their outcomes. • The problem is that all hospitals treat different patients • Risk adjustment allows hospitals to be fairly compared

Which of the following is an example of active primary prevention?

Screening Vitamin fortified bread • Immunization All of these are correct

Which study is the highest in the Hierarchy of Evidence? • Cross-sectional study • Single Randomized Placebo Controlled Study • Cohort study • Anecdotal reports

Single Randomized Placebo Controlled Study

Suppose a study looking at the association between smoking and bladder cancer found an odds ratio = 2.4. What would be the best way to interpret this? (Select one answer.)

Smokers have 2.4 times the risk of developing bladder cancer compared to non- smokers

Two Cohort studies were performed A cohort study assessed the relationship between cigarette smoking and the incidence of lung cancer. • For cigarette smokers, the lung cancer incidence rate was Ie = 200 per 100,000. • For nonsmokers, the lung cancer incidence rate was Io = 25 per 100,000. • The lung cancer incidence rate in the entire population was It = 100 per 100,000. A cohort study involved an assessment of the relationship between cigarette smoking and the incidence of coronary heart disease. • For cigarette smokers, the coronary heart disease incidence rate was Ie = 500 per 100,000. • For nonsmokers, it was Io = 250 per 100,000. • In the overall population, the coronary heart disease rate was It = 300. Is cigarette smoking a stronger risk factor for lung cancer or coronary heart disease?

Stronger risk for lung cancer

What is surveillance in health?

Systematic ongoing collection, analysis, interpretation, & dissemination of health data II.We monitor to identify sudden changes in occurrence & follow long-term trends/patterns. As a result, we identify whether a health problem is getting worse

When considering if there is a causal relationship, what does effect size mean?

The cause should proceed the effect • The larger the effect, the more likely that the exposure is causing the disease The more serious the case, the larger the effect None of the above

Your hospital just received a poor rating on hospital compare for postoperative infection rates. The newspaper has called. What should you tell them? Why is the data possibly wrong? What are the problems with the data on that website?

The data that was collected was most likely through indirect standardization and did not take into account the patient's age, gender, past medical history for the hospital's specific area. The infection rates are most likely being compared to a "national average" which is unfair to look at considering different areas have people that are more or less healthy compared to others

If the relative risk of getting a disease in those exposed to a drug compared to those not exposed to the drug is 0.55, what does that mean?

The drug makes patients 45% more likely to get the disease • The drug makes patients 55% more likely to get the disease The drug makes patients 45% less likely to get the disease The drug makes patients 55% less likely to get the disease

How does a proportion differ from a rate?

The numerator is not contained in the denominator for a rate The numerator is not contained in the denominator for a proportion. -A rate is a proportion with the added dimension of time. Proportions and rates are the same.

What type of study is "Assessment of the effectiveness of radiation versus surgery in prostate cancer patients?" • Therapeutic trial • Prophylactic trial

Therapeutic trial

Which of the following are advantages to case-control studies? (Select all that apply). They tend to be less expensive and more efficient than prospective cohort studies. They are feasible for rare diseases. They allow you to study multiple outcomes of a single risk factor. They are good for diseases that have a long latency period (i.e., a long time between exposure and manifestation of disease).

They tend to be less expensive and more efficient than prospective cohort studies. They are feasible for rare diseases. . They are good for diseases that have a long latency period (i.e., a long time between exposure and manifestation of disease

Why are double-blind placebo-controlled randomized trials the best type of research study?

This is because this study provides the opportunity to have the least amount of: Bias, Chance, Confounding

What is the main reason why it is important to use precise, specific criteria for what constitutes a "case," i.e. in defining the outcome? To avoid misclassification with respect to the outcome. • To limit the number of subjects in the study. • To avoid selection bias. • To avoid interviewer bias

To avoid misclassification with respect to the outcome

What is the goal of randomization? • To blind the researcher to which group the subject has been assigned. • To ensure that a diverse group of people are in the study • To ensure that the baseline characteristics of the groups being compared are the same • To ensure that the results are statistically significant

To ensure that the baseline characteristics of the groups being compared are the same

The purpose of blinding is... • To ensure that the groups being compared similar except for exposure being studied • To ensure statistical significance • All of the above To prevent the investigator or the study subject from knowing which group they are being assigned to

To prevent the investigator or the study subject from knowing which group they are being assigned to

The primary principle to be followed in identifying an appropriate control group is that controls should be a sample of the population that gave rise to the cases, and if a member of the control group had had the disease being studied, they would have been identified as a potential case for the study

True

True or False : Selection of a high-risk population of developing the outcomes of interest is a primary strategy to ensure the accumulation of an adequate number of cases that will develop the end points.

True

True or False: Medicare Supplemental Insurance covers some of Original Medicare's out-of- pocket costs?

True

True or False: Medicare supplement insurance (Medigap) plans help with some costs that Original Medicare (Parts A and B) does not pay

True

True or False: You are still eligible for Medicare at age 65 even if your age for full retirement benefits from Social Security is 66 or older.

True

True or False? A beehive-shaped pyramid indicates that the population is having low birth rates as well as low death rates.

True

True or False? Establishing a valid statistical association is a necessary part of establishing a cause-effect relationship.

True

What are secular trends?

Usually brief, unexpected increases in health-related states or events • Represent long-term changes in health-related states or events Represent periodic increases and decreases in the occurrence of health-related states or events None of the above

The capacity and strength of the disease to produce severe and fatal cases of illness is its:

Variolation • Virulence Pathogenicity Pathogenesis

Herd immunity is

When animals cannot transmit a disease because they are immune • Resistance a population has to the invasion and spread of an infectious disease Only requires approximately 40% of the population to be immune All of the above

In a cohort study examining the association between smoking and laryngeal cancer, suppose the risk ratio = 17. How would you interpret this relative risk in words? • There were 17 more cases of laryngeal cancer in the smokers • Smokers had 17% more laryngeal cancers compared to non-smokers • Smokers had 17 times the risk of laryngeal cancer compared to non-smokers • 17% of the laryngeal cancers in smokers were due to smoking

• Smokers had 17 times the risk of laryngeal cancer compared to non-smokers

When considering if there is a causal relationship, what does consistency mean?

• The association is observed repeatedly in different persons, place, times and circumstances The researches use consistent methods in their research study The researchers found consistent methods in all of their patients None of the above.

An advantage of using hospital-based controls is that they are more likely to cooperate and are likely to remember past exposures with the same accuracy as the cases.

• True

Humans can serve as all of the following, EXCEPT:

• fomites reservoirs Hosts Humans cannot serve as any of these