EPI/STAT

EPI/STAT

2A

Read  & answer the following Chapter and question  from the following book

Aschengrau, A., & Seage, G. R., III. (2014). Essentials of epidemiology in public health (3rd ed.). Burlington, MA: Jones & Bartlett.

Chapter 2: Questions 1, 4, 6, and 12

Chapter 4: Question 2

Chapter 5: Question 1

PART 2B

If you read the “Health” page (either paper or web-based) of any major news source (e.g., The New York Times, CNN), reports of the occurrence of health outcomes are

common headlines. For example, you may see the following or similar headlines:

“Breast Cancer Increasing in Asian-American Women”

“Teenage Smoking at an All-Time Low”

Have you ever wondered where this information comes from and what it really means?

Governmental agencies and other organizations routinely collect descriptive epidemiological statistics on many health outcomes. For example, statistics on the

occurrence of cancer in the United States have been continuously collected since the early 1970s through the Surveillance, Epidemiology, and End Results (SEER) Program

of the National Cancer Institute.

For this Case Study Assignment, you will analyze and interpret descriptive epidemiologic statistics. To prepare for this Assignment, review the material presented in

the textbook.

A case study worksheet will be provided by your instructor for this Assignment in the form of a Microsoft Word document. Download the worksheet and type your answers

directly into the document to complete the Assignment. Be sure that your completed worksheet contains your responses to all questions.

Part 2c

Problem Set: Measures of Disease Frequency

Question 1)

Which type of measure of disease frequency best describes each of the following scenarios?

â—¦  Percentage of students enrolled in a college who developed influenza during the spring semester of 2012.

â—¦  Percentage of students enrolled in an epidemiology class who had sore throats on the first day of class.

â—¦  Percent of breast cancer patients who underwent mastectomy during 2012.

â—¦  Percent of men found to have high blood pressure at their yearly physical.

â—¦  Number of newly-diagnosed cases of AIDS in a year per 100,000 persons.

â—¦  Percent of infants born with spina bifida out of 1,000 liveborn infants.

Percent of drivers found to be legally drunk at the time of their car accident.

Question 2)

Suppose that you began a one-year study of tuberculosis (TB) in a subsidized housing community in the Lower East Side of New York City on January 1st, 2010. You

enrolled 500 residents in your study and checked on their TB status on a monthly basis. At the start of your study on January 1st, you screened all 500 residents. Upon

screening, you found that 20 of the healthy residents were immigrants who were vaccinated for TB and so were not at risk. Another 30 residents already had existing

cases of TB on January 1st. On February 1st, 5 residents developed TB. On April 1st, 5 more residents developed TB. On June 1st, 10 healthy residents moved away from

New York City were lost to follow-up. On July 1st, 10 of the residents who had existing TB on January 1st died from their disease. The study ended on December 31,

2010. Assume that once a person gets TB, they have it for the duration of the study, and assume that all remaining residents stayed healthy and were not lost to

follow-up.

â—¦  Is the subsidized housing community in the Lower East Side of New York City a dynamic or fixed population? Briefly explain the rationale for your answer.

â—¦  What was the prevalence of TB in the screened community on January 1st?

â—¦  What was the prevalence of TB on June 30th?

â—¦  What was the cumulative incidence of TB over the year?

Suppose that you wanted to calculate the incidence rate of TB in the study population. Calculate the amount of person-time that would go in the denominator of this

incidence rate. Be sure to show your work.

QUESTION 3

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.

â—¦      A treatment is developed that prolongs the life of people suffering from the disease

â—¦      A new measure is developed that prevents new cases of disease from occurring

â—¦      There is immigration of a large number of healthy people into the population.

â—¦       The case-fatality rate for the disease increases

PART 3A

Read  & answer the following Chapter and question  from the following book

Aschengrau, A., & Seage, G. R., III. (2014). Essentials of epidemiology in public health (3rd ed.). Burlington, MA: Jones & Bartlett.

â—¦      Chapter 3: Questions 2, 4, 5, 6, and 7

â—¦               Chapter 9: Question 3

PART 3B

For this Case Study Assignment, you will analyze and interpret the epidemiological evidence for a possible association between vaccination with the

measles/mumps/rubella (MMR) vaccine and the occurrence of autism.

Link:

http://c.ymcdn.com/sites/www.aptrweb.org/resource/resmgr/prevention_modules/module_2_student_case.pdf

Using the information provided in the case study, complete Sections B, C, and D (pp. 5–10), typing your answers into a separate document.

Be sure that your completed document contains your responses to all questions from Sections B, C, and D of the case study.

PART 3C

Question 1

A cohort study of smoking and bladder cancer was conducted in a small island population. There were a total of 1000 people on the island. Four hundred were smokers and

600 were not. Fifty of the smokers developed bladder cancer.  Ten of the non-smokers developed bladder cancer.

â—¦  Construct a two by two table using the data given above. Be sure to label the cells and margins.

â—¦  Which measure of comparison would you use to describe the relative effect of smoking on the risk of bladder cancer?

â—¦  What is the formula for this measure of comparison?

â—¦  Calculate this measure of comparison using the given data.

State the meaning of your answer in one sentence.

QUESTION 2

Recently, a report was published describing a string of cases of Norwalk virus gastroenteritis among passengers on cruise ships. From this report, an epidemiologist

went on to form a number of hypotheses as to why there had been this rather unusual increase in reported gastroenteritis outbreaks on cruise ships in 2012. The cruise

ship owners contacted the Centers of Disease control and Prevention (CDC) to conduct an in-depth analysis of the possible modes of transmission of the Norwalk virus in

the cruise ship environment. CDC investigators interviewed all of the passengers on the last affected cruise (N=3,000) and obtained information on the passenger’s

recreational activities. They found the following results: 1,000 passengers had gone swimming in the upper deck pool and 2,000 passengers had never gone swimming in

the upper deck pool. 100 of the passengers who swam in the upper deck pool and 100 of the passengers who did not swim in this pool developed Norwalk virus

gastroenteritis during the cruise. FYI: The cruise lasted one week.

â—¦  Set up the 2×2 table for these data.

â—¦  Calculate the risk ratio of gastroenteritis associated with swimming in the upper deck pool.

â—¦  State in words your interpretation of the above risk ratio

â—¦  Calculate the risk difference in the above example

State in words your interpretation of the above risk difference

QUESTION 3

â—¦        Recently, Australian researchers conducted a study of the relationship between optimism and colon cancer survival. Their hypothesis was that colon cancer

patients who had a positive outlook on life would have a lower five-year cumulative incidence of mortality. The study included 100 recently diagnosed colon cancer

patients who underwent psychological testing and were found to have a optimistic outlook on life and 100 recently diagnosed colon cancer patients who underwent the

same psychological tests and were found to have a pessimistic outlook on life. By the end of five years of follow-up, 50 of the 100 patients with the optimistic

outlook and 75 of the 100 patients with the pessimistic outlook had died from colon cancer.

Set up and fill in the two by two table using these data.

What is the prevalence of colon cancer in the study population?

Compare the cumulative incidence of mortality in the optimistic group to the cumulative incidence of mortality in the pessimistic group using a

ratio measure of association.

State in words your interpretation of the result you found in part c.

PART 4A: Discussion 1: Epidemiological Study Designs

Understanding the differences among the types of epidemiological study designs is important for translating the results to public health practice. For this Discussion,

you will identify and design epidemiological research studies. To prepare, review the Learning Resources about epidemiologic study designs. Then, go to the Walden or

another scholarly library and find an epidemiological research study that was published in the last 3 months and uses one of the study designs we are learning about in

this module.

Briefly summarize the study in your own words, identify the study design it uses, and discuss what features it has that identify it as that type of study design. Do

not just copy the abstract or parts of the article. Then, redesign the same study using a different study design than the authors did. This does not mean finding

another article on the topic. Instead, pretend you are the epidemiologist and design your own study on the topic, using the information we’ve been learning in class

about study designs, exposures, outcomes, and measures of association. You are the researcher! For the study you are designing, be sure to include information on who

the participants would be and how you would measure the exposure and outcome variables. Discuss why your study design is stronger or more limited than the original

study design, and how you arrived at this conclusion. Finally, pose a question about study designs to your peers that is based on your post.

PART4B:

Discussion 2: Ethics in Epidemiological Research

An Experimental Study in the Primary Prevention of Type 2 Diabetes

Imagine that researchers are conducting a randomized controlled trial of a high-fiber supplement as a preventive measure in persons at increased risk of type 2

diabetes. People enrolled in the study are disease-free at the time they agree to participate in the trial, but they all have a family history of type 2 diabetes and

are considered at high-risk (80%) to develop the disease during their lifetime. The 10,000 participants who start the trial are healthy individuals who are randomly

allocated to receive either high-fiber supplements or placebo for several years. As you can imagine, this study will be quite expensive and will require a large

infrastructure of personnel and materials to carry it out successfully.

Because type 2 diabetes has reached epidemic proportions in the United States, the potential benefits of this research are important at a population level.

Unfortunately, high-fiber supplements have also been shown in a few studies to be associated with gastrointestinal blockage (which can be life-threatening) and reduced

nutrient absorption, which may lead to anemia, osteoporosis, and other debilitating chronic diseases. The supplements may also reduce absorption of certain medications

and cause gastrointestinal distress. The potential side effects of continuous high-fiber supplementation are only partially understood, and long-term effects are

unknown.

Respond to at least three of the following questions:

â—¦   What are the potential risks and benefits to be considered when designing this study?

â—¦   When the side effects and long-term effects of a potential preventive measure are largely unknown, is it ethical to expose participants to these risks? Why or

why not?

â—¦   Is it ethical to deny the possible prevention benefits of high-fiber supplements to persons in the placebo group? Why or why not?

â—¦   Do the potential benefits outweigh the potential risks to the participants and to society? Why or why not?

PART 5A

Read  & answer the following Chapter and question  from the following book

Aschengrau, A., & Seage, G. R., III. (2014). Essentials of epidemiology in public health (3rd ed.). Burlington, MA: Jones & Bartlett.

â—¦   Chapter 10: Questions 2, 3, and 5

â—¦   Chapter 11: Questions 3 and 6

â—¦               Chapter 13: Questions 3 and 5

PART 6 A:

http://www.cdc.gov/epicasestudies/downloads/xfdz_gas_s.doc

Answer the following question from thr case study

1, 4, 6, 11, 12, and 14.

PART 7

Respond to the following questions:

â—¦   What is the epidemiological causal inference model used by the authors? How did they apply the model to the association they studied?

â—¦   Do you agree with the author’s choice of causal model? Why or why not? Provide evidence to support your assessment.

â—¦   What are the implications for public health policy, given the evidence for causality presented in the article?

Make sure that your discussion focuses on evaluating your article using the entire causal model that the authors used (as opposed to using one or two criteria). Be

sure to cite the article you reviewed using proper APA formatting, and include in-text citations and references as appropriate.

Part 7B

This final Assignment provides you the opportunity to reflect on what has taken place in this course. Think about what you now know about epidemiology and how this

information may impact you as a public health professional and your efforts to effect positive social change.

To complete this Assignment, respond to the following:

Describe your reaction upon reaching the end of this course. Reflect on the knowledge you gained as a result of taking this course. Were there any things that

surprised you? Did you find some modules more useful or interesting than others? If so, why? Which assignments and discussions were most useful to you? Were there

things that you wanted or expected that were not covered? How do you think that you will or can use information from this course in your career as a public health

professional to effect positive social change?

Prior to submitting your Professional Learning Journal Assignment, review the Journal Assignment Rubric located in the Course Information area.

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