Epidemiology Final

The U.S. Centers for Disease Control and Prevention receives at least ____ reported outbreaks per year in the U.S., although this is usually only the "tip of the iceberg."

1,000

During 2008, the most recent year for which data are finalized, ____ food-borne disease outbreaks were reported.

1,034

The average smoker will die how many years earlier than nonsmokers?

13-14 years

When was the last case of (wild virus) polio in the U.S., according to the WHO?

1979

Low birth weight is defined as a term infant weighing less than ____.

2,500 grams

Current evidence suggests that ____ of cancers may be caused by infectious agents.

20%

In what year did the National Cancer Institute and the National Human Genome Research Institute establish The Cancer Genome Atlas?

2005

Body Mass Index (BMI) is the measure used to define overweight and obesity. Obesity is defined as a BMI of what measure?

30 or over

What percentage of babies are actually born on their expected date of delivery?

5%

What is the overall case fatality rate of lung cancer in the United States (men and women combined)?

70.7%

In 2008, there were approximately ____ adults in the United States with cardiovascular disease, including people with high blood pressure.

82,600,000

What are the risk factors for teen pregnancy?

According to a report published by the American Academy of Pediatrics in 2005, 45% of high school females and 48% of high school males had sexual intercourse. In this same report, predictors of early sexual activity were early pubertal development, a history of sexual abuse, poverty, lack of attentive and nurturing parents, cultural and family patterns of early sexual experience, lack of school or career goals, substance abuse, and poor school performance. These predictors of early sexual activity are also predictors of teen pregnancy.

CVD is the leading cause of death in the United States for all but one ethnic group. Which one?

Asian Americans

Discuss the mainstream treatments of cancer.

Cancer therapy has come a long way over the last 20 years. Death rates for cancer have declined since 1991 and this is in part due to improved therapeutic methods and combinations of treatments, as well as improved preventive interventions. The most common therapies include: surgery, chemotherapy, and radiation, or any combination of the three. Surgery is the oldest form of cancer treatment and most people with cancer have some form of surgery. It can (1) provide tissue for diagnosis, (2) remove or debulk a tumor, and (3) determine if and how far a tumor has spread for staging the cancer. Surgery may be preventative in some cases. A mastectomy (surgical removal of a breast) is an example of possible preventive surgery when done in a woman at a particularly high risk for breast cancer. In tumors that have not metastasized to distant areas, surgery may provide the best chance of cure. Chemotherapy is the use of drugs to kill cancer cells. The goal is to target the effects of the drug only on the rapidly dividing and growing cancer cells and minimize the effects on any normal cells. Chemotherapy is frequently used in conjunction with surgery. It has the advantage of targeting distant metastatic cells or cancer cells that are not visible but may still be local to the primary tumor. Most chemotherapy is given as a combination of agents in which each agent targets a different function or process of the cancer cell. Radiation therapy is the use of radiation to treat localized tumors. This therapy is tightly targeted to the tumor to minimize effects to the surrounding tissues. Radiation can be administered to the tumor externally via specialized machines or internally via radioactive seeds or pellets inserted directly into the tumor. Radiation therapy is frequently used to shrink the tumor prior to surgery, but may also be given after the surgery to kill any remaining cancer cells. Hormone therapy is frequently used in combination with the above therapies in the treatment of breast and prostate cancers. Immunotherapy uses biologic agents that mimic the body's natural signals. Monoclonal antibodies targeted against specific antigens in the cancer cells are now being used against some tumors and more work is being done to identify tumor-specific antigens for other cancers.

How is cancer classified?

Cancers are generally named according to the body organ they initially affect, referred to as the primary tumor, and the type of cells that are affected. Once a cancer is diagnosed, it is classified by the changes in its genes (genotyping), the cell (grading), and its degree of invasion of local and distant tissues (staging). Prognosis, or expected outcome, is dependent on these factors, as is the specific treatment plan for that cancer. Having an understanding of these classifications is important in epidemiology to insure that studies compare like entities.

Which vaccine is linked to the greatest number of deaths each year?

DPT

A substance that is capable of producing an immune response may be live or inactivated and is referred to as an antibody.

False

Before the polio vaccine, 50,000-60,000 persons were paralyzed each year from the polio virus infection and about 21,000 deaths occurred.

False

Diabetes mellitus is an endocrine disorder that is characterized by high blood pressure.

False

Disease outbreaks typically occur in restricted geographical areas close to water.

False

Known risk factors for Type 1 diabetes mellitus include drinking soda pop.

False

Menarche, the age of onset of menstruation in females, typically occurs around the age of 15 years, but varies by ethnicity and country of origin.

False

Stroke is the second most common cause of death in the U.S.

False

The first generation rabies vaccine was developed in 1971.

False

The most commonly occurring type of cancer is colorectal cancer in both American men and women.

False

The overall death rate due to cardiovascular disease in American men is almost 10% higher than the death rate in women.

False

In 1948, the National Heart Institute and Boston University began an ambitious project to follow over time a large number of persons who had not yet developed cardiovascular disease to study the characteristics of the disease and determine the risk factors. This project is commonly known today as the ____.

Framingham Heart Study

In 1988, research indicated that high levels of ____ cholesterol reduces the risk of death from cardiovascular disease.

HDL

Prevalence of diabetes varies greatly among different ethnic groups. What group has the highest prevalence?

Native Americans

Discuss three risk factors for cardiovascular disease

Obesity is considered not based on weight alone but on a body mass index (BMI) which is also dependent on height. A BMI >30 is considered obese. Obesity puts an extra strain on the heart to pump the blood and increases blood pressure. And although it is a risk factor for cardiovascular disease on its own, it also linked to higher cholesterol and triglyceride levels as well as diabetes, hypertension, and coronary artery disease. Diets high in saturated fats and cholesterol promote atherosclerosis and obesity. Diets high in salt (sodium) raise blood pressure. Unrefined whole grain foods and oily fish that contain omega-3 fatty acids have been shown to lower cholesterol. Fruits and vegetables with fewer calories help maintain a healthy weight to prevent obesity and control blood pressure. Hypertension, or high blood pressure, is also considered an independent risk factor for cardiovascular disease and stroke. High blood pressure is defined as systolic pressure above 140 and/or diastolic pressure above 90. It's considered a partially modifiable risk factor in that it may be partly due to genetics and partly due to lifestyle choices. When blood pressure is lowered with the use of medications and/or lifestyle changes, the risk of developing heart disease is lowered.

Metabolic syndrome is also known as ____.

Syndrome X

The brain consists of two major hemispheres, the right and the left, which are joined by tissue called the corpus callosum. The right hemisphere controls movements of which part of the body?

The left side

Along with sanitation improvements and the discovery of antibiotics, vaccines had the largest impact on infectious diseases in the 20th century.

True

Cancer is the second leading cause of death in the United States.

True

Infertility is defined as the inability to conceive after 12 consecutive months.

True

Most food-borne illnesses are preventable.

True

Prostate cancer is far more common in African American men than it is among men of any other ethnicity or race.

True

Slightly more than one in three Americans has some form of cardiovascular disease (CVD).

True

The current goal of the American Heart Association is "to improve the cardiovascular health of all Americans by 20%, while reducing deaths from cardiovascular disease and stroke by 20%" by 2020.

True

The health status of a country is often measured by the country's rates of infant and/or maternal mortality.

True

The prevalence of diabetes in the U.S. is about equal in adult men and adult women.

True

There are an estimated 75 million food-borne illnesses in the U.S. each year.

True

Which first generation vaccine was introduced in 1935?

Yellow Fever Vaccine

Coronary heart disease (CHD) is the most common type of heart disease and it occurs when the coronary arteries become stiffened and narrowed by ____________________.

atherosclerotic plaque

Insulin is a hormone produced by specialized cells, the ____ cells, in the islets of ____ of the ____.

beta; Langerhaans ; pancreas

Once the outbreak is established, a(n) _______________ needs to be formalized, and the number of cases needs to be counted.

case definition

It is now well documented that atherosclerosis, or "hardening of the arteries," has its beginning in ____ and therefore the public health emphasis on prevention and public policies need to focus on earlier intensive interventions.

childhood

What sexually transmitted disease can cause preterm labor and premature rupture of the membranes, as well as conjunctivitis in newborns?

chlamydia

Outbreaks are generally classified as one of two types: ____.

common source and propagated

The blood vessels that branch off the aorta and supply the heart muscle are called ____.

coronary arteries

Since 1902, the CDC has defined a food-borne disease outbreak as the occurrence of two or more similar illnesses resulting from ingestion of spoiled food.

false

By what week of pregnancy has the brain, spinal cord, heart and gastrointestinal tract of the fetus begun to form?

fifth

a rate of disease among those who have eaten a particular item

food specific attack rate

Once the population at risk has been identified, it's finally time to develop a(n) ____ about the suspected cause of the outbreak and then test it.

formal hypothesis

What is the strongest risk factor for developing cancer?

growing older

There are currently two vaccines in use that not only prevent the infection against which they are targeted but also have a role in cancer prevention. Which are they?

hepatitis B and HPV

the probability of developing a particular disease during a given period of time; the numerator is the number of new cases during the specified time period and the denominator is the population at risk during the period

incidence rate

Cancer in the ____ is the second most common cancer when considering men and women combined.

lung and bronchus

The MMR vaccine is a live, attenuated vaccine that combines antigens for what infectious diseases?

measles, mumps, and rubella

Women aged 35 and over are ____ have a twin or triplet/+ birth compared to younger mothers.

much more likely to

Genetic manipulation is an area under investigation for the treatment of diabetes. One genetic focus is using ____ to produce insulin for use in persons with Type 1 diabetes mellitus.

non-beta cells

What is the single best predictor (strongest risk factor) Type 2 diabetes?

obesity

The ultimate goal of an outbreak investigation is to control existing disease and ____, as well as to find the cause of the problem.

prevent future occurrence

In an outbreak, a ____ is the quickest study to complete because the investigator usually has access to a group of cases from the outbreak itself.

retrospective design

the rate of disease in an outbreak that is due to transmission of the disease from person to person

secondary attack rate

Diabetes mellitus was the ____ leading cause of death in the United States in 2007.

seventh

What is the strongest risk factor for pancreatic cancer?

smoking

What is a suspected risk factor for Sudden Infant Death Syndrome (SIDS), a condition in which an infant stops breathing and dies during sleep?

smoking around infants

The onset of sperm production occurs mid-puberty in boys and is associated with a surge of what hormone?

testosterone

Exposure to carcinogens is a significant risk factor for cancer. What is the most studied carcinogen?

tobacco smoke

In a propagated epidemic with person to person transmission, control measures may include ____.

treating the carriers and vaccinating the population at risk

A miscarriage is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving, generally defined in humans at prior to 20 weeks of gestation.

true

Cardiovascular disease is the leading cause of death for both men and women in the United States across all races and ethnicity except Asian Americans.

true

A fertilized egg is called a(n) ____.

zygote