CMAN 380 Module Final Exam 2023 with complete solution

CMAN 380 Module Final Exam 2023 with complete solution Epidemiologic Triangle Environment, agent, host Factors factors affected by... -diet/exercise -recreational activities -management of stress levels Genes vs. Lifestyle Heart Disease -Family history made up only 17% of a person's risk -Poor lifestyle choices, 83% of the risk Cancer -About 25% of colon cancers are in people with some family history of the disease -75% of colon cancers are not from genetics -80% to 90% of lung cancers are caused by smoking Types of studies prospective v. retrospective Prospective study key components All subjects are free of disease at the start of the study Establish a causal association between factor X and the disease Y Demonstrate a temporal relationship (factor X preceded disease Y) Prospective study time frame Investigators have a primary focus Example: to learn more about cardiovascular disease or cancer Data collected from the cohort is over time Investigators identified a cohort (group) of possible subjects who would be feasible to follow for a prolonged period Prospective study examples Framingham Heart Study Nurses Health Study Physicians' Health Study Framingham heart study In 1948, FHS scientists and participants embarked on an ambitious project to identify risk factors for heart disease. Today, the study remains a world-class epicenter for cutting-edge heart, brain, bone, and sleep research Calculate a Risk Score Learn your risk of developing heart disease. Type simple information such as your age and weight into our calculators. High blood pressure, high blood cholesterol, smoking, obesity, diabetes, physical inactivity Risk assessment tool for estimating your 10 year risk of having a heart attack Framingham heart study Evidence Based Research taking findings from studies and implementing into practice Colas and Osteoporosis from Framingham Osteoporosis Study cola consumption lowers bone mineral density in older women related to phosphoric acid Prospective Study NHS 3 These studies are largest and longest investigations that influence women's health started in 1976, expanded in 1989, still going can join at any time Findings from Nurses' Health Study (NHS) Smoking increases risk of colon cancer A Mediterranean-type diet reduces risk of incident of CHD and stroke. Fish intake reduces risk of stroke. Refined carbohydrates and trans fats increase risk of CHD. Physical activity (3 hours/week reduces risk of breast cancer. Diabetes increases risk of hip fracture. Increasing years spend working rotating night shifts increases risk of hip fracture. Higher Vitamin D level lowers risks of colon cancer Banning Trans Fats Trans fats in a comprehensive assessment of diet in the Nurses' Health Study cohort of more than 100,000 women and developed a regularly updated database of the trans-fat content of foods. After 8 years of follow-up and after accounting for known risk factors for heart disease, we found that women with the highest intake of trans fats had a 50% higher risk of hospitalization or death attributable to coronary heart disease Margarine-primary source of trans fat-greater risk Health Professional Follow up Study Largest prospective study on men's health Began in 1986 to learn men's lifestyle factors to incidence of serious illnesses Predictors of CVD: Smoking, weight, exercise, alcohol, fruits and vegetables, whole grains, nuts, sugary beverages, red and processed meat Yogurt and prevention of type 2 DM Cancer Study Purpose is to identify risks for various cancers associated with lifestyle factors. Retrospective Study -the cases have already occurred before the investigator initiates the study -investigators "jump back in time" to identify a useful cohort which was initially free of disease and 'at risk' -causal statements should not be made -use available records to determine exposure status at the beginning of the observation period -retrospective studies are useful for unusual exposures or occupation -use health records, next of kin, National Death Index, etc to determine outcomes Retrospective study examples exposure to chemicals used in tire manufacturing was associated with an increased risk of death. tire manufacturing factory employee health records to identify those who had had jobs which involved exposure to the chemicals in question (e.g., workers who actually manufactured tires) and non-exposed coworkers (e.g., clerical workers or sales personnel in the same company). subjects and compare the incidence of death in the exposed and non-exposed workers. FDA investigates multistate outbreak of E.coli, related to Chipotle chain example of a retrospective study Time dimension R- looking back in time P- looking into the future outcome R- already happened P- following up into future Exposure R- already happened P- looking into the future Causal Relationships R- no causation P- causal Selective screening whoever fits criteria Definition of screening the process of using clinical tests and/or examinations to identify patients who require additional health-related interventions screening is a key component of many secondary prevention interventions -involves the testing of groups of individuals who are at risk for a certain condition but are as yet asymptomatic screening test is NOT a diagnostic test using tests to detect the likely presence of diseases or conditions before illness or symptoms screenings screening Based on the clinical research and evidence-based preventive care presented by the US Preventive Services Task Force (USPSTF) U.S. Preventive Services Task Force Develop screening recommendations Based on the grading of research evidence "A" being the highest grade Examples of common screenings breast cancer screening hypertension screening selective screening tests 2. the screening technique is valid 3. the screen technique is reliable validity distinguishing correctly -sensitivity -specificity reliability consistency of test results over time & between examiners sensitivity the ability to identify correctly those who do have the disease sensitivity identifies the proportion of individuals who truly DO have the disease AND are given a positive test result specificity ability to identifies those who do not have the disease -true negatives specificity identifies the proportion of individuals who truly DO NOT have the disease and were given the correct negative test results low sensitivity high false negative Case Study: Retrospective Study of Salmonella Outbreak Investigations of food borne illnesses are the most common type of retrospective study. This CDC website includes reports of epidemiological investigations for salmonella outbreaks in recent years. Review a report of interest to you. Nurse's Health Study is one of the largest prospective studies ever conducted. 122,000 female registered nurses were enrolled in the Nurses' Health Study in 1976. 116,686 female registered nurses were enrolled in the Nurses' Health Study II in 1989. Both female and male nurses and nursing students are currently being enrolled online for the Nurse's Health Study 3. To become a study participant, click on Join. Health Professionals Follow-Up Study began in 1986. It surveys male health professionals, including nurses, regarding lifestyle factors and health outcomes. Click on "Questionnaires" to review questionnaires from various years. "Questions by Type" lists questions asked by area. Cancer Study module The attached study published in the May 19, 2016 issue of JAMA Oncology utilized data from the Nurses Health Study and the Health Professionals Follow-Up Study to identify risks for various cancers associated with lifestyle factors. Case Study: Colas and Osteoporosis This link will direct you to findings from the Framingham Osteporosis study that identified a causal relationship between consumption of cola beverages and low bone mineral density. A dose-response effect was demonstrated between cola consumption and decreased bone density (see Figure 1). Criteria for Establishing a Screening Program CRITERIA FOR ESTABLISHING A SCREENING PROGRAM