HLED

Using the table of classification of recommendations, indicate how the following evidence should be graded: Well-conducted, randomized controlled trials and over a decade of use in clinical practice indicate that a large proportion of breast cancer can be cured among women with early breast cancer if the treatment is used on women with early breast cancer.

A

An investigator selects the known cause-and-effect relationships that bring about coronary artery disease and uses these to investigate how multiple interventions can be used together to reduce the incidence and improve the outcome of the disease. This is an example of which of the following approaches?

A combination of reductionist and systems thinking

An association between populations that eat more fish and a lower mortality rate from coronary heart disease in the same population would establish which of the following?

A group association that may be helpful in generating a hypothesis about the relationship between fish consumption and coronary heart disease.

Which of the following features distinguishes a system from a heap...i.e., a collection of parts?

A system changes if you take away or add pieces; if you cut a system in half, you do not get two smaller systems, but rather, you get a system that will not function. A heap can be divided into pieces, each of which can function on its own. In a system, the arrangement of the pieces is crucial because the parts are connected to each other and work together; in a heap, the arrangement is irrelevant. The behavior of a system depends on its overall structure, while in a heap, size, rather than structure, determines behavior. Correct! All of these are correct.

Which of the following is not true of the FDA use of animal testing of drugs?

Absence of toxicity in animal testing has been shown to correlate very closely with the absence of toxicity in human studies.

Which of the following is needed for a healthcare market to operative effectively?

An informed purchaser Purchasing power Multiple competing providers negotiation Correct! All of these are correct

Which of the following ancillary or supportive criteria is addressed in this statement: The mechanism that predisposes some infants to SIDS is unknown, but active research is beginning to identify predisposing factors related to brain development?

Biological plausibility

Examples of Ecosystem Health and Physical Environment factors that have impacts on human health include

Climate Change Migration Land use changes Food production Correct! All of these are correct.

Which of the following organizations is not a regulatory agency, but establishes policy and makes recommendations for the United States?

CDC

Using the table of classification of recommendations, indicate how the following evidence should be graded: On the basis of good evidence, it is concluded that a new treatment cures approximately the same percentage of patients as the standard treatment but has a substantial increase in side effects.

D

Which of the following ancillary or supportive criteria is addressed in this statement: Infants who are put to bed prone less than half the time have an increased incidence of SIDS compared to those who are never put to bed prone. Those who are always put to bed prone have an increased incidence of SIDS compared to those who are put to bed prone less than half the time?

Dose response relationship

Which type of adverse effect is most likely to be reported as part of the spontaneous reporting system?

Dramatic conditions occurring soon after the drugs administration that rarely occur in clinical practice in the absence of the drug

Which of the ideal criteria for a successful screening program is satisfied by the following statement: Detection of colon cancer prior to the development of symptoms results in a cure more frequently than detection of colon cancer after symptoms develop?

Early detection improves outcomes

Using the table of classification of recommendations, indicate how the following evidence should be graded: Expert opinion suggests a large impact of a new intervention to cure Abreast cancer.

I

Which of the following roles does a case-control study primarily play in establishing contributory cause?

Individual association

An investigator examines the factors that influence an outcome and creates a system diagram indicating the direction and magnitude of the impact of factors without requiring a demonstration of cause-and-effect relationships. This is an example of which of the following approaches?

Integrative or systems thinking

Asbestos and radon exposure greatly increase the hazard of cigarette smoking. This can be best described as an example of which of the following?

Multiplicative Interaction

Which of the following is true of tests used for screening for disease?

One positive screening test is not usually sufficient to diagnose a disease. Changes within the range of normal can be due to a disease. The range of normal is not the same for all groups or populations. Correct! All of these are correct.

Which of the following is true of behavioral change?

Positive feedback is important for successful behavioral change. Peer and/or family support is helpful in achieving behavioral change. Population-wide efforts are most effective when they complement other efforts aimed at individual behavioral change. Correct! All of these are correct

Which of the following best describes the contributions of social sciences to public health?

Public health can be viewed as an application of many of the social sciences.

Which of the following most accurately describes the microbiological influences component of One Health?

RNA viruses have an increased probability of mutation compared to DNA viruses.

Chicken pox is viewed as a lifelong disease that produces different manifestations at different ages. This is an example of which of the following uses of systems analysis?

Utilize systems analysis to help understand the impact of a disease over the life span.

Which of the ideal criteria for a successful screening program is satisfied by the following statement: Screening for colon cancer has been approved for insurance coverage, and patients are increasingly undergoing the screening tests with a tolerable level of side effects?

Screening is acceptable in terms of costs. harms, and patient acceptance

Which of the following ancillary or supportive criteria is addressed in this statement: The relative risk or odds ratio for sudden infant death syndrome (SIDS) and infants who sleep prone is approximately 6?

Strength of Association

In West Virginia, residents reported an average of 10 unhealthy days in the past 30 days. In North Dakota, residents reported an average of 4 unhealthy days in that same period. Which of the following statements is most likely to be true?

The Gini index in West Virginia is higher than the Gini index in North Dakota.

The U.S healthcare system is unusual in which of the following ways, as compared to healthcare systems in other developed countries?

The United States spends far more per capita and a higher percentage of its GDP than any other country. The United States has a higher percentage of uninsured patients than other developed countries. The United States has a higher percentage of its costs related to administration than most other developed countries. The United States has a higher percentage of specialists compared to generalists than most other developed countries. Correct! All of these are correct.

Which of the ideal criteria for a successful screening program is satisfied by the following statement: Colon cancer is the second most common cause of death from cancer?

The disease produces substantial mortality or morbidity.

Which of the following is true of the employment-based health insurance system in the United States?

The largest number of Americans is covered by health insurance obtained through employment. Large employers generally offer a choice of health plans. Comprehensive plans often include deductibles and copayments. Correct! All of these are correct

Which of the ideal criteria for a successful screening program is satisfied by the following statement: Screening those older than 50 years using fecal occult blood testing every year and flexible sigmoidoscopy every 3 to 5 years have been shown to be effective strategies for screening for colon cancer?

There is a feasible testing strategy.

Which of the following is true of Medicare Part D?

There is a wide variety of plans providing a range of benefits at a range of costs.

Which of the following is not a regulatory agency, but establishes policy and makes recommendations globally?

WHO

Which of the following roles does a cohort study primarily play in establishing contributory cause?

cause precedes the effect

The _____________ is the amount an individual must pay as a portion of the charges for a particular service.

copayment

The amount individuals need to pay out-of-pocket before being eligible for insurance coverage is known as the:

deductable

The primary goal of FDA phases 2 and 3 is to:

demonstrate that the drug has efficacy

Which of the following is the first step in an outbreak investigation?

detecting a possible outbreak

Which of the following is the last step in an outbreak investigation?

determining the outbreak is over

FDA requirements for efficacy need to be established based upon randomized controlled trials for all of the following types of products, except:

dietary supplements

Lead-time bias is an important factor to consider when analyzing which criteria for a successful screening program?

early detection improves outcomes

Which of the following is not a likely consequence of being uninsured in the United States?

emergency care is not available

The statement 'Case-control studies were important in establishing a cause and effect relationship between having infants sleep prone and sudden infant death syndrome' is best described as which component of the evidence-based public health approach?

etiology

Possible health impacts of pet ownership include

exposure to parasites like Toxoplasma gondii decreased blood pressure increased exercise Correct! All of these are correct.

Which of the following roles does a population comparison or ecological study primarily play in establishing contributory cause?

group association

The statement 'The Back-to-Sleep campaign directed information at parents and caregivers with the involvement of clinicians, crib manufacturers, and the media. The mortality from SIDS fell by approximately 50% within several years of the beginning of the Back-to-Sleep campaign' is best described as which component of the evidence-based public health approach?

implementation and evaluation

Pregnant women are highly motivated to stop smoking. This can be best described as an example of which of the following?

leverage point

When an individual has not smoked any cigarettes in 6 months and participates in regular activities to avoid smoking and curb cravings, he or she can be said to be in the ____________ stage of behavioral change.

maintenance

_______________ is a joint federal and state program that covers mothers with low incomes and their children.

medicaid

______________ is a federal program for the elderly that covers hospital services.

medicare part a

The price paid by the purchaser for health insurance policy on a monthly or yearly basis.

premium

_______________ is the stage of behavioral change where an individual decides that he will change his eating habits right after the holidays and announces his plan to his family and friends.

preparation

The statement 'Sudden infant death syndrome (SIDS) is the most common cause of death between age 1 month and 1 year. Twenty years ago, it resulted in over 5,000 deaths per year' is best described as which component of the evidence-based public health approach?

problem description

The statement 'The guidance for having infants sleep on their backs to reduce the incidence of SIDS has a grade of A' is best described as which component of the evidence-based public health approach?

recommendations

An investigator studies the etiology of a disease, taking into account or adjusting for potential confounding variables. This is an example of which of the following approaches?

reductionist thinking

All of the following are limitations of randomized controlled trials for the investigation of safety, except:

serious side effects are often overlooked due to infrequent observation.

Which of the following is not included in the definition of socioeconomic status as used in the United States?

social class

FDA approval of a drug has all of the following implications, except:

the drug is free from life threatening side effects