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NSG 522 Final Exam: Questions &
Answers
When is isolation used? (Ans- Used in the inpatient setting (hospitals/nursing homes), used for persons who are known to be ill with a contagious disease. State laws as well as accrediting organizations and isolation? (Ans- Require one or two beds to be designated and as isolation beds. When does Quarantine occur? (Ans- Used for persons who have been exposed to a contagious disease but may or may not become ill. Example of Quarantine in action? (Ans- Exposure to COVID19 quarantining at home. Descriptive epidemiology describes what? (Ans- Frequency of events, and Pattern of Events (Who- Person, Where- Place, When- Time) What graphics can be used to describe person? (Ans- Tables, and Population Pyramid What graphics can be used to describe place? (Ans- Spot maps What graphics can be used to describe time? (Ans- Event Timelines Define Public Health Surveillance (Ans- Ongoing, systematic collection, analysis and interpretation of health- related data essential to information for the planning, implementation, and
of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control What does Public Health Surveillance use data for? (Ans- To monitor health problems to facilitate their prevention or control. What can information gained from surveillance be used for? (Ans- Planning disease control and prevention programs, Policy-making What are health indicators? (Ans- Markers of health status. Anything that could effect health or illness is a health indicator. List example health indicators (Ans- physical or mental illness, impairments or disabilities, social well- being, service provision, resource availability. What constitutes a notifiable disease in the United States? (Ans- Diseases that are of considerable public health importance because of their seriousness- Cause serious morbidity or death, have the potential to spread, can be controlled with appropriate intervention. What is true of Notifiable diseases in the US legally? (Ans- Federal and State mandated reporting List the measures of disease occurrence (Ans- Counts- Number/Frequency, Ratios, Proportions, Percentages, Rates. Ratios serve what function? (Ans- Compare two things How is a ratio calculated? (Ans- By dividing the numerator by the denominator
What is the infant mortality rate? (Ans- Deaths of infants less than 1 year of age. Per 1,000 live births What is the single most widely used health indicator to compare nations? (Ans- Infant mortality rate What is the neonatal mortality rate? (Ans- Deaths of infants < 28 days of age, per 1,000 live births What is Perinatal mortality rate? (Ans- deaths that occur from 28 weeks of gestation to 7 days after child is born What is maternal mortality rate? (Ans- Deaths of women due to pregnancy related causes during pregnancy or during the first 42 days after pregnancy termination regardless of the duration of the pregnancy, per 100,000 live births. Define Morbidity (Ans- Morbidity rate is a measure of the frequency of occurrence of disease or injury in a defined population during a specified interval. What are the two major measures of disease frequency? (Ans- Incidence and prevalence What does prevalence refer to? (Ans- The status of disease, not the onset What does prevalence measure? (Ans- The frequency of a disease at a particular point in time. Measures ALL cases (old and new) at a specified period of time. How is prevalence calculated? (Ans- As a proportion
Prevalence= (Ans- Number of individuals who have a disease at a particular point in time/ Total population at risk at the specified time. Point prevalence= (Ans- Assessed at one specific point in time Period prevalence= (Ans- Assessed during a certain period. Incidence measures? (Ans- The rate at which people without a disease develop the disease during a specified period. Epidemiology is defined as? (Ans- the study of the distribution and determinants of health-related states or events in specified populations and the application of this knowledge to the control of health problems What are the core Epidemiological Functions? (Ans- Surveillance Field Investigations Analytic Studies Evaluation Linkages Policy What type of science is Epidemiology? (Ans- Quantitative What does measurement focus on in Epidemiology? (Ans- Distribution and Determinants of health-related states and events
What are examples of Health Behaviors? (Ans- Nutrition, Physical Activity, Rest/Relaxation, Tobacco Use, Alcohol use, Illicit substance use, immunizations. Describe Multi-causality (Ans- Etiology of all diseases is multifactorial. What is the 'Causal Pie' Model made up of? (Ans- Causative agent or event, characteristics of the person, characteristics of the environment, presence of preventative factors, action of catalysts or additive factors, mediating and moderating factors, interaction between the factors. What does the Bradford Hill Criteria for Causation tell us? (Ans- Several criteria are listed that help us determine if causal association is reasonable. What does the Bradford Hill Criteria for causation not tell us? (Ans- Statistical or clinical significance. Occurrence of disease can be understood using which 3 models? (Ans- Epidemiological Triad or Triangle, BEINGS Model, Web of causation. What three aspects make up the Epidemiological Triad/Triangle? (Ans- Agent, Host, Environment acronym BEINGS Model of Disease Causation, what does it mean? (Ans- Biological, Behavioral Environmental Immunological Nutritional Genetic Services, Social, Spiritual
What does the Web of Causation tell us? (Ans- There are many different factors that make up chronic diseases and negative health conditions. Risk factors do not guarantee someone will get a disease. What does Spectrum of Disease describe? (Ans- The Severity of Disease the severity of disease can vary from? (Ans- Mild to fatal What does the natural history of disease describe? (Ans- The progression of the disease process over time in an untreated individual. Describes the STAGES of Disease What are the different stages of disease? (Ans- Susceptibility Preclinical Clinical Recovery, Disability, Death Preclinical is also known as? (Ans- Subclinical, Presymptomatic or latent disease What stage of disease does exposure take place? (Ans- Stage of Preclinical/Subclinical/Presymptomatic/Latent Disease When stage do the onset of symptoms take place? (Ans- Stage of Clinical Disease When stage do pathologic changes occur? (Ans- Preclinical/Subclinical/Presymptomatic/Latent Disease What stage is the usual time of diagnosis? (Ans- Stage of Clinical Disease What stage may pathology be detected by screening? (Ans- Subclinical Disease
What is the goal of tertiary prevention? (Ans- To reduce the long term impact of disease and disability. Primary Prevention occurs in which stage of disease? (Ans- Stage of Susceptibility Secondary Prevention occurs in which stage of disease? (Ans- Preclinical/Subclinical/Presymptomatic/Latent disease Which levels of prevention occur in the stage of clinical disease? (Ans- Secondary prevention during the early part of stage Tertiary prevention occurs during more advanced disease Define Communicability of Disease? (Ans- The ability of a disease to be transmitted from one person to another OR to spread through the population. What elements make up the Chain of infection? (Ans- Reservoir Portal of Exit Transmission- Direct, Indirect, Airborne Portal of Entry Susceptible Host Define Reservoir? (Ans- Habitat in which the agent grows and lives Reservoirs can be? (Ans- Human Animal Invertebrates (insects, arachnoids) Environment Is the Reservoir always the source from which an agent is transferred to a host? (Ans- No. For example the reservoir of Clostridium botulinum is soil but the source of most botulism infections is improperly canned food. Do Reservoirs show the effects of illness? (Ans- Not always
Define a carrier? (Ans- A person with inapparent infection who is capable of transmitting the pathogen to others. Define Portal of Exit? (Ans- The path by which a pathogen leaves it's host. Examples of portal of exit? (Ans- Respiratory Tract Blood Semen Other body fluids Crossing the placenta (mother-to-fetus) blood sucking mosquitos What are the two main categories of mode of transmission? (Ans- Direct and Indirect Examples of two forms of direct transmission (Ans- Direct contact, and Droplet Spread Examples of three forms of indirect transmission (Ans- Airborne, Vehicle borne, Vector borne Provide examples of direct transmission (Ans- Direct Contact- Kissing, Sex, Soil contact Provide examples of indirect transmission (Ans- Vehicle borne Vector borne Examples of vehicles (Ans- Food, water, bedding, instruments Examples of Vectors (Ans- Mosquitos, fleas, ticks What is a fomite? (Ans- Inanimate objects that may indirectly transmit an infectious agent. Such as tissues, bedding, or surgical scalpels.
What is cocooning? (Ans- Used to protect infants from communicable diseases. Only family and friends who are fully immunized are allowed to be around the infant. Incidence is a measure of? (Ans- The ONSET of disease. The APPEARANCE of disease. Measures the NEW How is incidence proportion calculated? (Ans- Number of NEW cases of a disease during a specified time period/ Population at risk of the disease at the start of that time period. Incidence proportion is also known as? (Ans- Risk, Attack Rate, Probability of developing a disease How is Incidence Rate Calculated? (Ans- Number of NEW cases of a disease in a specified time period/ Time that each person was observed, totaled for all persons. What is Incidence rate also known as? (Ans- Person-Time Rate How does Incidence Rate differ from Incidence Proportion? (Ans- More accurate estimate of risk, More difficult to calculate, Accounts for incomplete data. With a large population size calculating this could be very cumbersome. What are the top three levels of Evidence (Ans- Systematic Reviews (Meta Analysis), Randomized Controlled Trials, Nonrandomized Trials. What are the middle three levels of evidence? (Ans- Cohort Studies, Case- control Studies, Cross-sectional studies. What are the bottom two levels of evidence? (Ans- Case reports/Case Series and Opinion/Experience/Theory
Describe characteristics of Systematic Reviews: Meta-Analyses (Ans- Study of Studies, Method used in Cochrane Reviews and AHRQ Reviews, Very powerful methodology, Stringent Criteria for inclusion in the analysis, Quantitative analysis to combine and compare results of the studies. Which studies are experimental? (Ans- Randomized Trials and Non- Randomized trials (quasi-experiments) Which studies always have an intervention? (Ans- Randomized control trials and non randomized trials. Which studies are considered observational studies? (Ans- Cohort Studies, Case-control studies, Cross-sectional studies Which studies are prospective? (Ans- Randomized control trials, Quasi- experiments (non-randomized trials), Prospective Cohort Studies Which Studies are retrospective in nature? (Ans- Retrospective cohort studies, Case-control studies. Are cross-sectional studies prospective or retrospective? (Ans- They are neither. Characteristics to Randomized Control Trials (Ans- Randomization to treatment group, Control of the intervention. Characteristics to Non-randomized clinical trials (quasi-experiments) (Ans- No randomization to treatment groups, comparison group may be different from the intervention group, control of the intervention. Describe prospective cohort studies (Ans- A group (cohort) of disease-free individuals is identified at one point in time and then followed over a period of time to determine whether the outcome (disease) occurs.
What are the two types of risk? (Ans- Absolute Risk and Attributable Risk What is absolute risk? (Ans- The overall incidence of the disease in a specified population. How is absolute risk calculated? (Ans- Calculated the same as incidence proportion. Define Attributable Risk (Ans- The amount of disease associated with a causative factor in a specified population. What are measures of association used for? (Ans- To compare the occurrence of disease in one group with the occurrence of disease in another group. What are two measures used for association? (Ans- Risk Ratio/Relative Risk (RR) and Odds Ratio (OR). Define Relative risk (Ans- Relative risk is a measure of association between the exposure to a particular factor and the risk of a particular disease or outcome. What type of studies can calculate relative risk (Ans- Prospective Studies When is the odds ratio used over the risk ratio/relative risk? (Ans- When the RR cannot be calculated. Used in case-control and other RETROspective studies. RR or OR= 1? (Ans- Risk/Odds in the exposed is equal to the risk/odds in the non-exposed group RR or OR >1 (Ans- Risk/Odds in the exposed group is greater than the risk/odds in the non-exposed group.
RR or OR <1 (Ans- Risk or Odds in the exposed group is less than the risk/odds in the non-exposed group. Why do confidence intervals need to be calculated for Risk ratios and odds ratios. (Ans- Because RR and OR are estimates. They need a confidence interval associated with them. If the confidence interval includes 1 what does this mean? (Ans- There is not a difference between the exposed or unexposed groups. If the confidence interval does not include 1 what does this mean? (Ans- There is a difference between groups If there is a difference between groups with the confidence interval, what do you then determine? (Ans- You have to determine whether the difference is increased or decreased. This is done through interpretation of the RR o OR. What is the purpose of health screening? (Ans- To promote detection of diseases in their earliest stages, when treatment has the greatest chance of working, in order to reduce morbidity and mortality. What type of prevention does health screening fall under? (Ans- Secondary. What occurs in the subclincal disease stage? (Ans- Symptoms are not apparent or asymptomatic, Pathological changes occur and some can be detected by screening. This is the incubation period for infectious diseases and the Latency period for chronic diseases. Define Sensitivity (Ans- Probability that a person with the disease will test positive for the disease (true positive). The ability of tests to correctly identify those with the disease. Probability of correctly identifying the disease.
Confirmed= (Ans- All criteria are met. Endemic= (Ans- Amount of disease usually present in a community Hyperendemic= (Ans- Persistent high levels of disease Sporadic= (Ans- Occurs infrequently and irregularly Epidemic= (Ans- An increase in the number of cases above what is expected in the population in that area. Outbreak= (Ans- An epidemic but in a limited geographical area Pandemic= (Ans- Epidemic that has spread over several countries or continents. Types of Spread in Epidemic (Ans- Common Source, Propagated, Mixed Define Common Source (Ans- attributed to a specific source Define Propagated Source (Ans- Transmitted from person to person Define Mixed Epidemic (Ans- Stats with a common source and then spread by person-to-person contact. Which statistic is especially good at investigating disease outbreaks (Ans- Attack Rates- They describe rapidly occurring new cases of disease in a well identified population over a limited time period. What type of study is especially suited for studying outbreaks? (Ans- Case Control During a field investigation what takes place in establishing criteria for case identification. (Ans- Standard Clinical Criteria (What), Loose case definition
vs. strict case definition. A case may be further characterized by Who, Where, and When. How are cases counted during field investigations (Ans- Using standard descriptive statistics. exposure status and disease frequency need to be determined and compared with the appropriate at-risk population. How is time examined? (Ans- Epidemic Curve How are epidemic curves classified? (Ans- Epidemic Curve- Common source vs. propagated vs. mixed What can only be calculated through prospective studies? (Ans- Relative Risk Which study is always retrospective? (Ans- Case-Control An Epidemic Curve can be used to describe what characteristic of health- related states/events (Ans- Time What is the function of Adjusted Rates? (Ans- Adjusted Rates are used to control for the effects of variables such as age on a health outcome What elements must be present in a rate? (Ans- Period of time, It is always a Ratio, Population Which Study designs are descriptive in nature? (Ans- Cross sectional study and Ecological Study
