PREVENTIVE - FINAL 2021

What is the formula of treatment threshold?

(harm / [harm + benefit])

1. Major complication of diabetes:

-microvascular (retinopathy, nephropathy, neuropathy). -macrovascular (atherosclerosis). responsible for 2/3 of deaths caused by DM.

1. How can we measure nicotine exposure?

-mild poisoning: • fatigue, headache • dizziness, nausea, vomiting • excess sweating, salivation • abdominal pain • diarrhoea • cramping -moderate poisoning: • difficulties in talking and walking • miosis • difficulty in concentration • tremor -severe poisoning: • marked miosis • paralysis • respiratory difficulties • cyanosis • respiratory paralysis coma, death

What are the requirements for mass screening?

-there is a treatment for the disease=the screening will improve prognosis -there are facilities for diagnosis and for treatment of the disease -the disease is severe, very harmful -cost effectiveness?

1. A multiple choice question about solanine

-toxic substance naturally occurring in food -glycoalkaloid, in potatoes and tomatoes -cholinesterase inhibitor -causes green on potatoes -allowable level < 20mg/100g

1. Cumulative incidence range:

0-1

Etiology fraction formula:

1. (CIR-1)/CIR The etiologic fraction (or population attributable risk) is yet another risk parameter, measuring what proportion of the disease risk can be attributed to this gene.

What are the measures for diagnostic overweight/obesity?

1. BMI (BMI>30 kg/m^2) 2. Waist circumference (men>94 cm, women>80 cm) 3. Waist-to-hip ratio

1. What is used for diagnosis of chronic bronchitis?

1. Clinical signs 2. Reported symptom history 3. Maybe also spirometry?

1. Characteristics of EBM

1. Clinically relevant scientific evidence 2. Clinical judgment 3. Patients preferences and values *components of EBM: knowledge, experience, patient data, available resources, patient preferences. *correct steps in EBM: ask a question, find evidence, criticize the evidence, apply evidence, evaluate.

4 types of toxins and mechanisms of action

1. Goitrigens: suppress the thyroid gland 2. Oxalic acid: decrease iron absorption 3. Marine toxins, ciguatera saxitoxin and tetrodotoxin: neurotoxicity. 4. Solanine: cholinesterase inhibitor. Tomatoes and potatoes. 5. Mushroom toxins (amanitins): stop protein synthesis. Other methods of action: increase free radical production, disrupt cell membranes, etc.

Which hepatitis virus are chronic?

1. Hepatitis B 2. Hepatitis C 3. Hepatitis D

How to prevent HAV infection:

1. Hygiene - wash hands 2. Sanitation - clean water source 3. Vaccine - as part of regular childhood vaccination programs, and also for travelers 4. Immunoglobulins (IG)

What is the cause for explosion of health costs?

1. Inflation rates 2. Increasing demand 3. Ageing of the population 4. Development in technology 5. Pressing concerns of patient laws

1. What bias is found in screening

1. Lead time bias (early detection is confused with increased in survival time) 2. Length-time bias (screening tests detect more diseases that have long latency periods. Short ones may be missed - slowly progressive cancer is more likely to be detected than rapidly prog) 3. Volunteer bias

1. What defect indirect mortality rate?

1. Number of persons in the study population 2. Observed number of deaths in the study population 3. Death rates from the standard population Smaller groups, such as countries, cities.. Analyzes: 1. Mortality from a number of cases - to identify disease with high mortality 2. mortality from a specific cause - to identify risks in the study group 3. More analytical then SDR

What does etiological study estimate?

Association between exposure and disease.

1. Objectives of preventing chronic respiratory infection:

1. Reducing tobacco smoking in the whole population 2. Encouraging smoking cessation for patients 3. Control of ambient air pollutants 4. Prevention of occupational exposures

1. Problem with lack of indicators for vaccines

1. The net health gain from influenza vaccine uptake cannot be measured 2. We do not see which diseases or complications could have been avoided if the vaccine would have been administered

3 parasites which are zoonosis?

1. Toxoplasma 2. Echinococcosis 3. Schistosoma

What are the prevention measures against gastrointestinal infections?

1. What are the prevention measures against gastrointestinal infections? Primary: legislation, education (of food handlers), HACCP, guidelines, protection of water sources, hygiene, provision of sanitation. Secondary: epidemic control and outbreak investigations

1. mention 4 diseases of zoonosis (not pathogens):

1. brucellosis 2. tularemia 3. Q fever 4. Schistosomiasis 5. Lyme disease 6. Rabies 7. Cat-scratch disease (Bartonella henselae) 8. Rocky-spotted mountain fever (Rickettsia rickettsii)

What is the fraction of smoking and COPD?

80-90% of COPD cases are cigarette smokers. 10-15% of smokers have COPD.

What does p=0.446 mean?

A small P-value tells us how strong our evidence is against the null hypothessis. Smaller than 0.05 is statistically strong. This P-value means that we don't have enough evidence to reject.

1. Which disease can be if there is obstruction of the lung? a. Lung cancer b. Bronchitis c. Emphysema d. External alveolitis

a. Lung cancer b. Bronchitis - yes c. Emphysema - yes d. External alveolitis

what do you calculate using direct standardization?

Age standardized death rate. Crude death rate. Descriptive. Can compare two countries in one year, or one country in two years. Big populations.

What are informal payments?

Also known as envelope or under-the-table payments. They are unofficial payments for goods/services that should be fully funded.

1. which heavy metal can cause emphysema?

Cadmium (chronic effect)

what is the advantage of adding fluoride in low dose to water?

Can prevent dental caries.

1. How to prevent zoonosis

Caring for the health of animals is the first important step in preventing zoonoses. Good personal hygiene, wearing protective clothing and vaccination, can minimize the risk of some animal-borne diseases affecting people.

What zoonoses cause occupational diseases

I guess any person who's occupation is at a farm can get brucellosis and Q fever? Also avian influenza from poultry on the farm. Anthrax from the wool industry. Tularemia from ticks in the garden? Lyme from ticks in the forest if you work in the forest (cutting trees?).

1. In an outbreak investigation, what kind of analytical study would you conduct?

If you can reach almost every person affected - cohort. If you aren't able to reach a considerable proportion of the affected population - case-control.

What model of analytical study will be used for outbreak investigation?

Cohort if we can find most of the exposed subjects; case-control if we can't find most of the subjects.

1. Range for confidence interval

Confidence interval is a type of interval estimation. Usually 95%. Maybe they meant cumulative incidence? The range is 0-1.

1. Health monitoring:

Continuous and systemic collection of death about the health of the population, and publishing it to the patients, professionals, and legislators.

1. Incidence density: decay constant, mass

Decay constant: it's actually the incidence rate in the equation of calculating cumulative incidence. It is the constant in the question. The bigger it is, the higher the proportion diseased (the faster of spreading the disease in the population). Incidence density: amount of treatment measured in time that's needed to prevent one outcome event. It is used to calculate the number needed to treat for chronic treatment. I had this question in multiple choice form - asked about the incidence density and the answer was decay constant (I think).

1. Something about the demand curve:

Demand curve shows inverse relationship between quantity and price: if the demand goes up the price goes down, and vice versa (demand goes down, price increases). Influenced by: price of substitute goods. Supply curve shows linear correlation between quantity and price: if the supply quantity increases, the price increases, etc. influenced by: # of sellers.

Give an example from a clinician perspective about a hypothesis that can be studied with ecological studies

Determining incidence of cholera deaths in specific locations, to identify exposure.

1. what is zoonosis?

Disease passed from animal to human. A zoonosis is any disease or infection that is naturally transmissible from vertebrate animals to humans.

1. Which two groups would you advise should not drink any alcohol?

Pregnant women, and liver disease?

Lyme disease - prevention and treatment

Prevent by wearing long sleeve shirts and pants and closed shoes in the woods. Maybe use bug repellant. Treatment: antibiotics, doxycycline.

what type of prevention is it if we tell all women of child bearing age to get folate supplements?

Primary prevention

What are the stages of health policy process?

Problem identification, issue recognition --> policy formulation --> implementation --> evaluation

What is herd immunity?

Proportion of a host population that is immune to an infection.

What ecto-parasites

Ectoparasites: parasites that live externally on another animal. Lice for example. Endoparasites: live inside the body of another animal. Giardia lamblia for example.

1. John snow - what kind of study?

Etiological (cholera transmission in water)

What question is relevant for researcher to start the etiological study?

Etiological studies, checks the relationship between exposure and disease. So maybe the first question would be something about exposure?

What is ex ante moral hazard?

Ex ante moral hazard: when insured individuals tend to behave in a more risky manner (eg. do not take actions to prevent a disease). Ex post moral hazard: after (post) injury/illness already occurred. If the person has insurance, then he is shielded from paying for the full cost of the medical service. As a result, the person consumes more medical services than he would if he had no insurance.

1. Mode of transmission for HAV

Fecal-oral.

Food source of mercury?

Fish

In health policy the term-keeper related?

Gatekeeper: one of the first people you see in the health care system. Usually the GP. Need referral from him to see a specialist or to get other services. Aim - to reduce costs, by preventing duplicative and inappropriate care. Policy keeper: agents that keeps the specific policy and tries to move the policy forward.

1. What is asbestos?

Generic term for group of magnesium silicate mineral fibers.

genetic phenotype and related protection to IDM

Genetic predisposition in type I DM shows 25-30% concordance in twins homozygous. 5-10% in heterozygous. HLA DR3, DR4, DR3/DR4 gene locus present in 95%. HLA DR2 is protective.

What nicotine can cause: a. Coronary artery disease b. hemorrhagic stroke c. Increased risk for respiratory tract infection d. ???

I don't think I would choose respiratory tract infection.. I think A and B.

1. Effects of acute cadmium toxicity

Pulmonary edema

What does prevalence depend on?

Incidence rate * average time (length) of disease

What are the characteristics of gastrointestinal infections?

Infectious agent enters the body (through mouth/oral cavity), disease can induce diarrhea, transmitted by food or water, summer season, controlled by adhering to hygiene and food/water quality standards.

1. What causes pneumoconiosis?

Inhalation of harmful particles (dust?) that lead to lung fibrosis (maybe macrophages eat up the dust particles in the lung, and start an inflammatory response leading to fibrosis).

What is pneumoconiosis

Interstitial lung disease caused by occupational inhalation of dust leading to lung fibrosis.

Most common cause of NHS visit due to occupational condition

Joint pain

1. Sources of provitamin A

Liver is the only correct answer - DO NOT CHOOSE CARROT! IT'S A TRAP! (it gives vitamin A, but not provitamin )

Effect of arsenic?

Lung, bladder, skin cancer. Hyperpigmentosis and hyperkeratosis. Black foot disease

1. Name 3 Zoonoses that are passed by ecto-parasite:

Maybe Lyme disease (borrelia, from ticks), maybe also Tularemia (ticks) and tick-born encephalitis? Maybe also Rickettsia - rocky mountain spotted fever (lice).

1What is the cause for increased demand in health care?

Maybe increased ageing of the population? And increase in technology development? And increase in chronic disease (degenerative).

1. Relationship between alcohol and something above age 40

Maybe they're referring to the causes of worsening liver disease (HCV/hepatitis)? Because two of those causes were infected at age>40 and drinking alcohol (and HIV co-infection).

Median survival age

Median = middle value in a list of data that is organized from smallest to largest. From anki: mean survival age is the area under the survival curve... The median age of survival is calculated from a survivor curve. This statistical graph shows the chances of living beyond a specific age and the median survival age is the age at which the survival chances are 50% (probability 0.5).

Question about definition of screening of occupational disease?

Medical screening: testing to diagnose disease in individuals at an early and, hopefully, reversible stage. For occupational health surveillance, medical screening should be done to co-workers of affected individuals.

question about why we need to have immunization monitoring?

Monitoring is the systematic and continuous process of examining data, procedures and practices. It is used to measure progress, identify problems, develop solutions, and guide policies and interventions. It can help improve the quality of the immunization program by ensuring: - all infants and pregnant women are immunized - vaccines and safe injection equipment are delivered in correct quantities and on time - staff are well trained and adequately supervised - information on disease incidence and adverse events following immunization are collected and analyzed - increase community confidence in the vaccines delivered and the immunization service they receive

Which epidemiological indices are inverse to income?

Morbidity, mortality (due to homicide, in Brazil), under-5 mortality,

I have a study about something, and the number needed to treat is 6 what can I say about the study (and the confidence interval is 95%=5-16)

NNT=6 means that 6 people need to be treated in order to have one less bad outcome (one less death for example) or that one can benefit from the treatment. The higher the NNT - the less effective the drug being tested. SO - if the NNT falls in the confidence interval (as it does in this case, 6 is between 5-16), then we can say that the study is 95% correct or that there's a 95% chance the drug is effective? And that we need to treat 6 people to get one less bad outcome. BUT if the NNT was outside of the range of the confidence interval, then we would say that the study is wrong.. or something like that.

Something about avian flu

One of the risks of international travel and commerce: avian influenza (H5 and 7 strains). Zoonosis.

Mass approach prevention?

PRIMARY prevention, where mass population is screened for possible risk of disease, for early detection. This way we can prevent healthy people from becoming asymptomatic. Decreases prevalence. (high risk approach is secondary prevention)

Which model the ecological studies use?

Scatter plot

What kind of graph is used for ecological studies?

Scattered plot

1. Which country has the highest diabetes 1? a. Finland b. Spain c. Sweden d. France

Someone said they read that there's a northsouth gradient, so the answer is Spain.???

1. Stochastic effects of toxins:

Stochastic effect: no threshold. As dose increases, more likely to cause disease. Radiation and cancer. Deterministic effect: there's a threshold. As dose increases the disease is more severe. Radiation and hair loss.

1. What is measured in an etiological study?

Strength of association between exposure and disease occurrence. Causal research. Analytical/descriptive.

1. What is toxicology?

The study of adverse effects of chemicals on human body and other living organisms, and the assessment of the probability of their occurrence.

What is medicare?

US federal social insurance program, for elderly and non-elderly with disabilities. Four parts: A-D. Medicaid: covers certain low-income individuals, for hospital and physician services. Financed by joint force of state and federal government. But many providers don't take care of Medicaid patients. Major payer of nursing home care.

1. How to calculate NNT

Using ARR (ARR=EER-CER, and NNT=1/AAR), CI (Acute), and ID (chronic)?

1. Which inactive agents can be used as biological weapons?

VEE, anthrax, staphylococcus enterotoxin B, botulinum toxin, agents of hemorrhagic fever, small pox, yersinia pestis, tularensis.

1. What disease are altered with climate change

Yellow fever, malaria, and lyme disease

Select the false about validity: a. external validity is an indispensable part of internal validity -? b. internal validity is affected by systemic error - ? c. external validity is generalization - ? d. ועוד משהו משהו

a. external validity is an indispensable part of internal validity - I think this is false.. b. internal validity is affected by systemic error - this is true c. external validity is generalization - this is true d. ועוד משהו משהו Validity: accuracy. How close the test results are to the true value. Internal validity: how well a study is organized. How free it is from bias/error (systemic error, confounding, etc). Factors that compromise internal validity: if the subjects or investigators know the assignment of the groups in a randomized trial. Solve by blinding! Single/double/triple. External validity: how well the findings can be applied to the real world; how well the result can be extrapolated to the general population. Factors that compromise external validity: selection bias, volunteerism, differences in patients compliance.

1. What are the charact. of progressive health insurance system: a. tax is an example -? b. affluent people pay more than poor - ? c. affluent people pay less than poor - ? d. private insurance is an example - ?

a. tax is an example - yes b. affluent people pay more than poor - yes c. affluent people pay less than poor - no (regressive) d. private insurance is an example - no (regressive)

1. actors of health policy (not the primary health care):

consumer (patient), provider (doctor), funder (insurance companies), legislators (government).

1. aflatoxin, subtypes and what they cause

from aspergillus flavus and paracisticus. Mycotoxins that contaminate grains, corn and nuts. B1, B2, G1, G2, M1. Aspergillus flavus: B1, B2 Aspergillus parasiticus: B1, B2, G1, G2 B1: hepatotoxic, nephrotoxic, genotoxic, carcinogenic - hepatocellular carcinoma M1: milk and breast milk

hepatitis that can be transmitted fecal orally:

hepatitis A and E.

Nitrogen dioxide exposure has an effect on which

is COPD and asthma patients

What epidemiological indicators will show linear relationships with income on a population level? a. is strong both in the range of low in come and strong in the range of high income b. is strong in the range of low income and weak in the range of high income c. is weak in the range of low income and strong in the range of high income d. is approximately linear

is strong in the range of low income and weak in the range of high income

Which curve describes alcohol?

j shaped curve

Classification of osteoporosis:

low bone mineral density. • public health problem: bone fractures mainly in older age groups. • before 50 the incidence of fractures increases with age and more frequent among men (accidents). • after 50 bone fragility increases and becomes responsible for the increasing incidence of fractures. • eighty percent of those affected by osteoporosis are women. • hip, vertebrae and bones in the underarm are the most frequent sites of fractures mainly in women. • risk factors: women, age, family history, very thin, Caucasian, low sex hormones/estrogen, menopause, low testosterone/estrogen in men, low calcium/vitamin D intake, excessive protein/caffeine/sodium intake, inactivity, smoking, alcohol, steroids, anticonvulsants, etc. Cadmium. • bone mass density screening, HRT treatment

What is the leading cause of death in low income countries? a. ischemic heart disease b. diarrhoea diseases c. lower respiratory infections d. stroke

lower respiratory infections

1. what epidemiological markers(?) change in developed countries?

more non-communicable diseases? Increase in life expectancy and quality of life? Decreased mortality and morbidity? Increased obesity, increased DMII?

2 indicator that has linear relationship with income?

mortality and morbidity (inverse linear). Life expectancy is sigmoid/exponential - not linear!

1. Explain the value in prevalence? (another question was what is the range of prevalence)

number of cases of disease out of the whole population. At a point in time. No dimension. 0-1. Depends on incidence rate and average duration of disease.

1. What is terrorism?

preplanned and implemented, politically motivated systematic use of violence and intimidation carried out by underground extremist groups (religious, ethnic, etc.) or agents against civil citizens, target populations to achieve political pressure and gain advantage.

What is the genetic material in influenza?

single stranded RNA nucleoprotein, surrounded by capsid