Community 5

1. What is it called when an epidemiologist writes a summary of a food poisoning outbreak, from cause to plans, for prevention in the future?
Descriptive epidemiology

There are two principal types of epidemiology, analytic epidemiology and descriptive epidemiology. Descriptive epidemiology describes the amount and distribution of disease, which may suggest possible causes. These causes can then be confirmed or corrected through more advanced methods of research.

2. Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. How can this be explained?
Difference in genetic inheritance between the two brothers

Assuming the two brothers lived in the same household, the environment and the agent or infectious organism are the same. The only difference could be between the two brothers themselves and their genetic inheritance.

3. When would the wheel model of epidemiology be more helpful than the epidemiological triangle model?
When there are multiple causes for a chronic disease

The epidemiological triangle model of agent-host-environment is very useful especially with single-cause infectious diseases. However, with the multiple factors involved in chronic diseases, the wheel model is more useful in analyzing and identifying the multiple variables.

4. Why is it so important to discover all the variables that may be involved in creating a disease state in some persons?
To find variables susceptible to prevention or early intervention.

Identifying risk factors is critical to creating or discovering specific prevention and intervention approaches that reduce chronic disease morbidity and mortality. Because some risk factors cannot be avoided, knowing other risk factors involved allows for more possibilities of preventing the problem.

5. What is the advantage of the web of causation model in comparison with the epidemiological triangle model?
The web of causation model shows the relationships among variables.

Although it is a more recently created model, the web of causation model is more useful because it illustrates the complexity of relationships among causable variables. It is not easier to understand and use as it has more variables than the three (agent, host, and environment) in the epidemiological model.

6. The textbook summarizes a research study of sexually transmitted infections among young adults. What was determined to be a major variable in exposure to infection?
The environment in which the young adults lived

The researchers concluded that ecosocial or contextual conditions strongly enhance sexually transmitted disease risk by increasing sexual risk behaviors and likelihood of exposure to infection.

7. A community health nurse determined exactly how many cases of a particular disease were current in the community. What should the nurse do before determining what interventions should be planned?
Compare the current rate with the previous rate of disease

No conclusions can really be drawn from just knowing a number. Only by converting that count to a rate and then comparing the rate with the previous rate, or with the rate in the broader environment or a similar community nearby, can any conclusions be drawn as to whether there is a problem or intervention needed.

8. People were very concerned about another outbreak of swine flu. All care providers were asked to report, without individual names, any new cases to the public health department for tracking. What would be most helpful for local media to report to keep citizens informed?
The ongoing incidence rate

As only new cases were being reported to the health department, the media could only report the ongoing incidence rate, that is, the number of new cases reported each day.

9. In trying to determine whether the swine flu outbreak was getting worse, what rate should be carefully observed?
The swine flu incidence rate

The incidence rate of new cases would be most useful for detecting short-term acute disease changes, as the swine flu duration is usually relatively short.

10. A newspaper published an article about the athletic banquet at the local high school that had approximately 1000 family members in attendance. Exactly 650 persons became ill within 24 hours, complaining of severe diarrhea, vomiting, and cramping. What is the attack rate?
650:1000

Rates are calculated by the number of people with the problem over the number exposed to the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness. Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.

11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu during the month of January were precisely the same. Which disease would have the higher prevalence rate?
As a chronic condition, diabetes would have the higher prevalence rate

Diabetes would have the higher prevalence rate because it is a long-term chronic condition that typically does not decrease. Although flu might have a higher incidence rate of new cases, because flu is typically of short duration, the prevalence rate would remain low. Flu is contagious, which could increase the incidence rate but not the prevalence rate.

12. Why do we not know the incidence or prevalence of gonorrhea?
Gonorrhea is not a reportable condition.

The text states that data on many conditions are not available because surveillance is not widely conducted. In other words, there is no responsibility to report cases of most diseases, including gonorrhea. Further morbidity rates are subject to underreporting. Information is only available related to conditions where care providers are required to report that specific condition or where those affected die and mortality data are available.

13. Which group should be used for determining the community’s pregnancy rate?
Women between 15 and 45 years old in the community

Although pregnancy is not specifically addressed, the text stresses that only those susceptible to a particular condition should be considered in the denominator. In the case of pregnancy, only women of childbearing age are susceptible.

14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac disease?
Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among non athletes

Attributable risk is determined by subtracting the rate of disease among nonexposed individuals (such as athletes) from the rate of disease among those exposed (the individuals with a sedentary lifestyle).

15. A nurse did a study of two skin lotions: an inexpensive one and an expensive one. The nurse found that there was a risk factor of 0.7 for skin sores using the inexpensive one and a risk factor of 1.2 using the expensive one. Which one should the nurse use?
The inexpensive lotion

A risk factor of less than one means the factor is actually protective, so the inexpensive lotion is helpful in preventing skin sores. A risk factor of more than one means the factor increases risk, so using the expensive lotion increases the probability of getting a skin lesion.

16. What is the name for the model that demonstrates the progression of disease from prepathogenesis through disease outcome?
Natural history model

The natural history of disease model explains disease from prepathogenesis through resolution of the disease process.

17. What level of prevention does a screening examination, required for each school athlete before being active in school sports, represent?
Secondary prevention

Screening, because it may result in early diagnosis and treatment, is secondary prevention.

18. What disease would be the best choice for screening if any of the following were possible?
Disease B, which can be controlled if caught early in the disease process

There is no point in doing a screening if there is no treatment or if there is a known risk of social stigma and discrimination if it becomes known that the person has the disease. Discussion and disagreement continue as to whether genetic information should be used in family planning. However, it is extremely useful to the individuals concerned and society if screening can lead to early diagnosis and successful control of the disease process.

19. One hundred women received notification that their screening tests suggested that they might have a serious health problem. How can you reassure these scared women so they will come in for follow-up testing and treatment?
Point out that screening is only suggestive and that not all positive screenings mean they actually have the health problem.

Not all positive screening results are confirmed with further diagnostic testing. The positive predictive value of a test (proportion of true positive results relative to all positive test results) is usually known for any screening test. Although one could argue that the test could be wrong, it is more therapeutic—because you want people to attend future screenings—to emphasize that screening is only suggestive than to say the screening test is inaccurate.

20. What is the best way to increase the positive predictive value of a screening test?
Test a group at high risk for the health problem

The positive predictive value is affected by what proportion of the tested population has the problem. To increase the positive predictive value, screen populations most at risk for the problem.

21. Healthy People 2020 establishes goals for improving the health of all Americans. What is most necessary to determine whether Americans’ health is improving?
Comprehensive and systematically collected surveillance data on the health status of various population groups

Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and continuing data to characterize health problems and evaluate goal achievement. Surveillance is crucial.

22. Which kind of study would be most helpful in examining potential risk factors in comparison with disease at a specific time through collecting data regarding current exercise, sleep patterns, and current health status among 12-year-olds?
Cross-sectional study

By definition a cross-sectional study examines relationships between potential causal factors and disease at a specific time.

23. A researcher, interested in the onset of early menses, compared the life experiences and history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did not, to determine what variables might be observed. How would this study be categorized?
Retrospective study

When a study looks at individuals with a particular condition in comparison with those who do not have the disease, based on their exposures to various life situations, it is a retrospective study; that is, the study requires participants to look back at previous experiences.

24. One famous study followed a cohort of nurses over their lives, collecting data and health histories as they aged. What kind of study is this?
Prospective study

Prospective studies monitor a group of individuals to determine if and when disease occurs.

25. A researcher wanted to engage in the best possible research design to obtain reliable information about the possible cause(s) of a disease. Which design would the researcher choose?
Prospective study

The most advantageous research design, because it obtains more reliable information and can more easily establish a stronger temporal relationship between presumed causal factors and their effects, is a longitudinal cohort prospective study.

26. Which research design would a researcher with limited time and funds probably choose?
Retrospective study

Because longitudinal cohort or incidence studies are costly in terms of resources and staff and often lose subjects over time, a retrospective study may be used because it is faster and less demanding of resources.

27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to determine whether a new drug would notably lower the blood levels of cholesterol in otherwise healthy persons. What kind of study would the researcher probably choose?
Experimental study

Experimental design is used to test treatment and prevention strategies. Subjects are randomly assigned to the experimental group to obtain the new drug while the control group receives a placebo or alternative. The changes in blood cholesterol level would then be measured.

28. The lack of certain B vitamins can result in pellagra. Where would a nutritional deficiency fit in the agent-host-environment model?
Agent factor

Nutritional deficiencies are included under agent factors. Although too much of an agent can cause disease (such as obesity related to diabetes), so can too little of an agent.

29. What is the Tuskegee Syphilis Study best known for today?
Unethical and racist treatment of uninformed subjects

As treatment was knowingly withheld over many years resulting in incredible harm to the subjects and their families, public outrage over unethical, racist, and discriminatory behavior of the researchers continues today.

1. What types of data do epidemiologists gather to try to determine which factors may lead to disease? Select all that apply.
Demographic characteristics, Geographic data, When disease struck the area

The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and common time factors (time—or when the disease struck).

2. What kind of information must be analyzed to derive an adequate explanation of disease? Select all that apply.
Description of commonalities among those who became ill, Depiction of the possible pathogen, Portrayal of the geographic area where people became ill

The epidemiological triangle includes the agent (pathogen), host (people who are susceptible and become ill), and environment (the geographic area where people became ill). These three areas allow for an explanation of disease.

3. What is the advantage of the ecosocial epidemiology model over both the web of causation model and the epidemiological triangle model? Select all that apply.
It decreases the focus on the individual person., It emphasizes the role of complex political and economic context, Its use suggests possible public policy interventions.

The ecosocial approach challenges both the individually focused risk factor approach and molecular epidemiology (sequencing of genes to improve individual susceptibility), as it emphasizes the role of macro-level socioenvironmental factors, especially complex political and economic forces in health and illness.

4. Which factors are necessary to assume there might be a cause-effect relationship between a particular variable A and a specific illness? Select all that apply.
It is easy to understand how the variable A could lead to the illness, Research studies consistently demonstrate a relationship between variable A and the illness, The more of variable A present, the sicker the person becomes.

There are six criteria for assuming possible causation including strength of the association, dose-response relationship, temporarily correct relationship, biological plausibility, consistency among studies, and specificity. Only the “easy-to-understand,” consistent research studies and the increased dose leading to increased illness are consistent with those six criteria.

5. A nurse wanted a screening test that was very sensitive in determining who might have a particular illness. What might be a problem with using such a sensitive test? Select all that apply.
Persons who do not have the illness are told that they might, which leads to anxiety, as well as time and cost of follow-up diagnostic tests.
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Such a test may have lower specificity, so some persons with the disease are told they are disease free and hence do not receive care.

The problem with very sensitive tests is that the test picks up almost all people with the disease but also many others who do not have the disease. These “false positives” result in persons needing follow-up diagnostic tests. Additional time, effort, and expense, as well as worry, result until the negative test results are obtained. There is no problem with persons receiving true negative test results and celebrating that knowledge or with persons having their condition correctly diagnosed and treated.

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