Category: Nursing

PUB 540 Principles of epidemiology Topic 2 DQ 2

Topic 2 DQ 2

 

Explain the importance of validity and reliability in diagnostic testing or research. Describe how validity relates to sensitivity and specificity in diagnostic testing. Identify a health screen specific to a diagnostic test that is currently being debated regarding its use, recommended ages, or frequency, and discuss how validity and reliability play into this debate. What other factors should you consider when you assess the recommendations for a diagnostic test or screen? PUB 540 Principles of epidemiology Topic 2 DQ 2.

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Topic 2 DQ 2

Validity is crucial in research and testing because it ensures that no external forces like bias are skewing the results and it supports generalizability, application to real-life settings, and application in other contexts (Andrade, 2018). Simply put, validity measures how well a research or diagnostic testing instrument is performing its intended task (Andrade, 2018). This concept relates to sensitivity and specificity because it allows researchers or diagnosing providers to describe a tool’s ability to produce sensitive and specific results (Andrade, 2018). Reliability is also incredibly important because it relates to consistency in the methods used to obtain such research and testing results, furthermore allowing for the calculation of specificity (Andrade, 2018). PUB 540 Principles of epidemiology Topic 2 DQ 2.

One example where validity and reliability may become debatable is in the use of genetic testing as a means of a diagnostic approach (Burke, 2014). For example, a genetic disease called multiple endocrine neoplasia type 2 (MEN2), can benefit greatly from genetic testing where sensitivity can be seen at 95% to 98% and specificity approaches 100% (Burke, 2014). However, this positive predictive value of the genetic testing in this case is seen to be strongly effected by how prevalent the disease is in the population being tested (Burke, 2014). This creates a low positive predictive value when the same genetic testing is conducted amongst a population with little likelihood of the same disease (Burke, 2014). Furthermore, other forms of genetic testing typically have low sensitivity due to limitations of causative mutations that the test is able to identify (Burke, 2014). Because of these issues and as with all other diagnostic testing, the genetic testing results should always be compared against the “gold standard” method for a particular diagnosis (Burke, 2014). A definitive diagnosis should always be based on a combination of new medical data and well-trusted standards (Burke, 2014). PUB 540 Principles of epidemiology Topic 2 DQ 2.

References

Andrade, C. (2018). Internal, external, and ecological validity in research design, conduct, and evaluation. 
Indian journal of psychological medicine
, 
40
(5), 498.

Burke, W. (2014). Genetic tests: clinical validity and clinical utility. 
Current protocols in human genetics
, 
81
(1), 9-15.

Topic 2 DQ 2

When using a test to distinguish between individuals with normal and abnormal results, it is imperative to understand how characteristics of the disease are distributed in varying populations (Celentano & Szlko, 2019). This is why validity and reliability are so important to the success of diagnostic testing. The validity of a test is the ability to differentiate between those that have a disease and those who do not (Celentano & Szlko, 2019). The reliability of a test indicates the extent to which it is without bias and ensures dependable measurement across time and the various items of the tools given in the research (Bajpai & Bajpai, 2013). PUB 540 Principles of epidemiology Topic 2 DQ 2.

There are two key factors to validity: (1) sensitivity of the test and (2) specificity of the test (Celentano & Szlko, 2019). The sensitivity of the test is the ability to determine who has the disease PUB 540 Principles of epidemiology Topic 2 DQ 2. The specificity of the test is the ability to determine who does not have the disease (Celentano & Szlko, 2019).

A health screen that is currently being debated is a breast exam for women, specifically a mammogram to screen for breast cancer. Young women experience a breast exam at routine women appointments, but the mammogram is not performed until the age of 45 (Pratt, 2018). New research suggests that women with specific risk factors should begin breast screenings at the age of 30, but some experts say it may not be effective for women of this age group (Pratt, 2018).

Validity and reliability play into this debate because it is important to know what age group of women are affected are which are not. Only then will experts be able to determine whether or not mammograms will prove to be beneficial at a younger age.

Other factors that should be considered are the health risks and drawbacks associated with the test itself. One large drawback in mammography screening is breast cancer overdiagnosis and overtreatment (Kresser, 2017). For this example, it is critical for research experts to take this factor into consideration before determining whether or not to lower the age for mammograms PUB 540 Principles of epidemiology Topic 2 DQ 2.

References

Bajpai, S. & Bajpai, R. (2013). Goodness of Measurement: Reliability and Validity. Retrieved from https://www.ejmanager.com/mnstemps/67/67-1380953319.pdf

Celentano, D.D. & Szklo, M. (2019). 
Gordis Epidemiology 
(6
th
 Ed). Philadelphia, PA: Elsevier Inc.

Kresser, C. (2017). The Downside of Mammograms. Retrieved from https://kresserinstitute.com/the-downside-of-mammograms/

Pratt, E. (2018). Should Some Women Get Mammograms at 30? Retrieved from https://www.healthline.com/health-news/some-women-should-have-mammograms-starting-at-age-30 PUB 540 Principles of epidemiology Topic 2 DQ 2

pub 540 Principles of epidemiology Topic 2 DQ 1

Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

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Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems? pub 540 Principles of epidemiology Topic 2 DQ 1

 

Topic 2 DQ 1

Before I address this week’s topic, I will write about a personal experience that illustrates a gap in surveillance. Many years ago while still living in New Jersey, I contracted food poisoning from eating undercooked chicken at a picnic. I knew it was raw the moment I put it in my mouth. I sought care because I was very ill and a stool sample was sent to the lab who, I assume, was mandated to report the illness under jurisdictional law. I do not recall the offending organism, but it was most likely 
Salmonella
. Six months after I was ill, I received a call from the health department asking where I had eaten. Six months! I always think of this and about how many people could have been made ill if I had eaten in a restaurant rather than a picnic pub 540 Principles of epidemiology Topic 2 DQ 1. Potentially six months of customers could have been at risk.

Disease surveillance is the mechanism by which public health organizations monitor changes in disease distribution, congenital malformations, toxic environmental hazards, noncommunicable diseases, and other injuries (Celentano & Szklo, 2019). This was done by analyzing and interpreting data that has been collected from local, state, and territorial health departments (Centers for Disease Control and Prevention [CDC], n.d.). While there are various modes of surveillance, there are strengths gaps associated with each. Passive surveillance, or passive reporting, is the mandated reporting of reportable diseases, such as sexually transmitted infections, to local health departments (Celentano & Szklo, 2019). Mandated reporting allows public health departments to constantly monitor for these reportable diseased with little effort or cost. Some of the gaps caused by passive surveillance are related to the small numbers of cases and that it relies on the conscientiousness of the reporter (Celentano & Szklo, 2019). In Active surveillance, or active reporting, people are specifically recruited and trained to perform surveillance duties which inherently makes them more conscientious (Celentano & Szklo, 2019). Surveyors may conduct interviews of providers or patients or pull data from medical records (Celentano & Szklo, 2019). Sentinel surveillance consists of a well-designed system of selected reporting sites and are employed when high-quality data are needed (World Health Organization [WHO], 2020). Selected reporting sites serve a large population, have providers trained in diagnosing and treating the disease that is under surveillance, and high-quality diagnosis equipment (WHO, 2020). Because this type of surveillance if focused on specific geographic areas and monitoring for certain diseases, it is likely to miss diseases outside of that geographic area or rare diseases that are seen in small numbers (WHO, 2020). pub 540 Principles of epidemiology Topic 2 DQ 1

“No single agency can confront all global health challenges alone” (Centers for Disease Control and Prevention [CDC], n.d., para. 6). This is why the Centers for Disease Control (CDC) partners with the World Health Organization (WHO), and others, to coordinate global health monitoring and strategies. Surveillance can be challenging in undeveloped areas related to the difficulty in physically accessing these areas and in maintaining communication with health departments (Celentano & Szklo, 2019). Sometimes, lack of up-to-date diagnostic equipment in these areas results is underreporting of diseases because they simply were not detected (Celentano & Szklo, 2019). Another challenge that exists when attempting to coordinate surveillance is the use of common terms, forms, surveillance systems. An example of this is the WHO report, World Malaria Report of WHO, that reported 584,000 deaths from malaria worldwide in 2014 while another group of researchers reported 854,000 deaths from malaria that same year (Celentano & Szklo, 2019).

What can be done to improve our global surveillance? Standardization of terms and methods. The National Notifiable Diseases Surveillance Systems (NNDSS) is doing just that by implementing reporting systems based on the National Electronic Disease Surveillance System (NEDSS) architectural standards (Centers for Disease Control and Prevention [CDC], 2018). This will standardize communication between health care systems and health departments, increase interoperability, provide resources to local health departments, and assist health departments to manage and report reportable disease data to the CDC (CDC, 2018). pub 540 Principles of epidemiology Topic 2 DQ 1

.

References

Celentano, D. D., & Szklo, M. (2019). 
Gordis epidemiology
 (6th ed.). Retrieved from https://www.gcumedia.com/digital-resources/elsevier/2019/gordis-epidemiology_6e.php

Centers for Disease Control and Prevention. (2018). 
National notifiable diseases surveillance system
[Fact sheet]. Retrieved from https://wwwn.cdc.gov/nndss/document/NNDSS-Fact-Sheet-508.pdf pub 540 Principles of epidemiology Topic 2 DQ 1

Centers for Disease Control and Prevention. (n.d.). Global health: What CDC is doing. Retrieved January 11, 2020, from https://www.cdc.gov/globalhealth/what/default.htm

Centers for Disease Control and Prevention. (n.d.). National notifiable diseases surveillance system (NNDSS). Retrieved January 11, 2020, from https://wwwn.cdc.gov/nndss/ pub 540 Principles of epidemiology Topic 2 DQ 1

World Health Organization. (2020). Types of surveillance. Retrieved January 11, 2020, from https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/en/

PUB 540 Principles of epidemiology

An epidemiologic profile is a summary of a significant public health issue, or issues, in your community, county, state, or country. An epidemiological profile helps to coordinate activities and policies from various agencies and organizations to improve health.

Review the available data, reports, and documents for your locale. Assess how the methods of epidemiology (study designs, data collection, measures of association, etc.) are used to determine who needs what services, where the services are needed, and how those services should be delivered. Define your community as your city, metropolitan area, or county and write a 2,000-2,250 word epidemiological profile (word limit excludes references and title page) PUB 540 Principles of epidemiology. The profile can be a general profile that provides a landscape picture of several significant chronic and infectious diseases in your defined community, or it can be a specific profile that targets one health issue, such as diabetes, asthma, STDs, flu, heart disease, obesity, alcohol abuse, or other drug use. Include the following:

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Executive Summary

Describe the purpose of the epidemiologic profile and the health issue(s) it addresses. Discuss its importance to the community and how it will be utilized.

Summarize the key findings from your review of available data, reports, and documents for the community.

Introduction

Describe the defined community and population using demographic and socio-economic information and data.

Briefly describe the history and cultural background of the community.

Explain any unique contextual information that pertains to the public health of the defined community.

Describe any key public health projects, grants, or existing epidemiology-related working groups or committees in the community/county PUB 540 Principles of epidemiology.

Description of Available Data

Identify at least two different data sources relevant to your profile. Discuss data from these sources and their relation to the issue or community.

Discuss the methods used in the data collection process (data source and organization providing the data; how often the data are collected; data limitations including response rates, missing data, selection of participants, etc.). Potential data sources and databases might include the following depending on what is available for your community or county:

Behavioral Risk Factor Surveillance System (BRFSS) data

Youth risk behavioral survey

Surveillance, epidemiology, and end results (SEER) program data

CDC Wonder (multiple data sources)

County health rankings data (multiple data sources)

Alcohol-related disease impact data

Demographic health survey data (international)

Global school-based student health survey (international)

Local evaluation reports from the department/ministry of health or other nonprofit organizations

Interpretation of Results Regarding Key Health Issue

Size and magnitude of the measures

Trends and comparisons

Economic costs

Discussion of Problems and Strategies

Discuss disparities, limitations, and gaps in the information available regarding the health issue(s).

Describe potential public health strategies to address these gaps.

Use graphs and tables where appropriate.

Conclusion

You are required to cite to at least five sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

MPH

2.1 Apply epidemiological methods to the breadth of settings and situations in public health practice.

MSN Public Health Nursing

6.2 Apply epidemiological methods to the breadth of settings and situations in public health practice.

 

Historical Review of Epidemiology

 

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt

James Lind

Edward Jenner

Ignaz Semmelweis

John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.

Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses.

Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for succes.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

 

Topic 2: Disease Surveillance and Measurement

 

Objectives:

Evaluate the effectiveness of disease surveillance in public health.

Apply measurement tools to assess the impact of disease, its burden, and associated risk factors.

Discuss the importance of validity and reliability.

Evaluate the steps for investigating the occurrence of disease.

Oswego Outbreak Case Study

 

Read the “Oswego Outbreak Investigation,” located in the Topic Materials.

Part 1

Complete the following:

Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.

Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission?

Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale.

Part 2

In a 500-750 word paper, evaluate the situation and present your findings. Including the following:

Does this case meet the definition of an “outbreak?” Why or why not?

Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.

Discuss the possible routes of transmission for the expected agent.

Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Topic 2 DQ 1

 

Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems?

Topic 2 DQ 2

 

Explain the importance of validity and reliability in diagnostic testing or research. Describe how validity relates to sensitivity and specificity in diagnostic testing. Identify a health screen specific to a diagnostic test that is currently being debated regarding its use, recommended ages, or frequency, and discuss how validity and reliability play into this debate. What other factors should you consider when you assess the recommendations for a diagnostic test or screen?

Topic 3: Causal Inference, Confounding, and Bias

 

Objectives:

Determine sources of bias within a study design.

Describe confounding relationships.

Evaluate the types of causal relationships associated with causation.

Assess measures of morbidity.

Measuring Morbidity: Prevalence and Incidence

 

Read the scenario below and complete the assignment as instructed.

Scenario

In Community X (population 20,000), an epidemiologist conducted a prevalence survey in January of 2012 and reported an HIV prevalence of 2.2%. Over the next 12 months, the department of health reported an additional 50 new HIV cases between February 2012 and January 2013. The total population stayed constant at 20,000.

Part 1

How many people had HIV in January 2012? Present or describe the formula you used to arrive at your answer.

Calculate the incidence rate assuming no HIV-related deaths over the 12-month period. Present or describe the formula you used to arrive at your answer. Be sure to clearly indicate the numerator and denominator used in your calculation and include an appropriate label for the rate.

In a summary of 200-250 words, interpret the results and discuss the relationship between incidence and prevalence. Discuss whether or not the epidemiologist should be concerned about these new HIV infections, assuming a previous incidence rate of 0.5 per 1,000 person-years prior to this updated risk assessment.

Part 2

A rapid test used for diagnosing HIV has a sensitivity of 99.1% and a specificity of 90%. Based on the population prevalence of 2.2% in 2012, create a 2×2 table showing the number of true positives, false positives, false negatives, and true negatives. Calculate the positive predicative value and negative predictive value for this test. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.

In 200-250 words, discuss whether or not the epidemiologist should recommend this test as part of a universal HIV screening program. Provide rationale for your recommendation applying the positive and negative predictive values. Present or describe the formula you used to arrive at your answer.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Topic 3 DQ 1

 

Differentiate between bias and confounding. Discuss the criteria necessary to establish a factor as a confounder and provide an example applying these criteria. What is one way to adjust for a confounding relationship in the study design or the analysis?

Topic 3 DQ 2

 

Explain the two major types of bias. Identify a peer-reviewed epidemiology article that discusses potential issues with bias as a limitation and discuss what could have been done to minimize the bias (exclude articles that combine multiple studies such as meta-analysis and systemic review articles). What are the implications of making inferences based on data with bias? Include a link to the article in your reference.

Topic 4: Study Designs I

Objectives:

Compare and contrast randomized trials and cohort studies.

Differentiate between experimental and observational categories of study designs.

Multicausality: Confounding Assignment

 

These estimates include the influence of other extraneous variables, such as confounders. Confounding is often considered a type of bias, but it is a real relationship that requires an adjustment in the study design or analysis. Understanding how to identify confounding is important as most associations have multiple causal factors. Recognizing if a study adjusted for the appropriate confounding variables is important to determine the validity of the association. To assist your proficiency with the concept of confounding, and how it ultimately affects public health, this practice assignment has been provided.

Complete Problems 1 to 4 from the “Multicausality: Confounding – Assignment” by Schoenbach, located in your Topic Materials. Check your answers against the solutions presented in the “Multicausality: Confounding – Assignment Solutions” Topic Material. PUB 540 Principles of epidemiology.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

Topic 4 DQ 2

Describe the characteristics and design of a cohort study. Based on a disease or health condition identified from the “2020 LHI Topics” on the Healthy People 2020 website, or an article from the GCU library, discuss a real example of a cohort study (include the link to the article in your post to the forum). Include the participants, exposures or treatment groups, timeframe, and outcomes that were measured. Why is a cohort study described as an “observational” study rather than an “experimental” study design?

Topic 5 DQ 1

Describe the common characteristics and design of a case-control study. Discuss the three important features when it comes to selecting cases and controls, and identify a situation when one of these might be violated. Discuss the limitations of using questionnaires for determining exposure status and provide examples of alternative strategies for collecting this information in a case-control study. PUB 540 Principles of epidemiology.

Topic 5 DQ 2

Discuss the strengths and weaknesses of cross-sectional studies and examples of how they can be “descriptive” or “analytic” study designs. Discuss an example of a disease where survival could influence the association between a possible exposure and the disease when measured with a cross-sectional study. Do not discuss examples used in the textbook.

Topic 6: Measures of Association and Application

Objectives:

 

Differentiate between association and causal relationships.

Determine the relative risk and odds ratio as measures of association.

Evaluate the utility of the population attributable risk.

Evaluate the types of causal relationships and associated guidelines for establishing causality.

Calculating Odds Ratio

Data can be qualitative or quantitative. Qualitative data is helpful to generate a hypothesis and gather information if little is known about an expected association. Focus groups, key informant interviews, and case studies are types of qualitative data collection methods used to identify common themes from which to build a hypothesis. Quantitative data collection and analysis is used to test a hypothesis and make comparisons to determine the direction and strength of a potential association. The Behavioral Risk Factor Surveillance System (BRFSS) is cross-sectional panel survey used to collect quantitative data on adult behaviors and risk factors. It is one of the largest U.S. health data collection efforts. The data can be used to analyze associations on a state or country level. Follow the steps to obtain a 2×2 contingency table (also known as a “cross tabulation”) crossing binge drinking with depression PUB 540 Principles of epidemiology.

Retrieve the “BRFSS Web-Enabled Analysis Tool” resource provided in the Topic Materials.

Select “Cross Tabulation.”

Select “2015” for the year.

Select “Arizona” for the state.

Select “Alcohol Consumption: Binge drinkers (males having five or more drinks on one occasion, females having four or more drinks on one occasion)” for Step 2 Select Row.

Select “Chronic Health Conditions: Ever diagnosed with a depressive disorder, including depression, major depression, dysthymia, or minor depression” for Step 3 Select Column.

Skip Steps 4 and 5.

Select “Sample Size” for Step 6 Select Statistics and run the report for the cross tabulation.

Part 1

Using the data from the cross tabulation results, calculate the odds ratio for depression among those exposed to binge drinking. Interpret the odds ratio and discuss if the odds ratio is a good estimate of the relative risk in this situation. Why or why not? Show your 2×2 table and all calculations. Present or describe the formula you used to arrive at your answer. PUB 540 Principles of epidemiology.

Part 2

Use the Topic Material, “BRFSS Web-Enabled Analysis Tool,” located on the CDC website, and run a report for two variables of interest to you. Create a 2×2 table and calculate the odds ratio for this association. Interpret the odds ratio and discuss the public health importance of the association. Show your
2×2 table
. Present or describe the formula you used to arrive at your answer.

Refer to the “Creating a 2×2 Contingency Table” resource for guidance in creating 2×2 contingency tables.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Topic 6 DQ 1

Differentiate between association and causation using the causal guidelines. Discuss which of the guidelines you think is the most difficult to establish. Discuss the four types of causal relationships and use an example not listed in the textbook to describe each relationship. PUB 540 Principles of epidemiology.

Topic 6 DQ 2

Explain the difference between 
relative risk
, 
attributable risk
, and 
population attributable risk
. Provide an example (not from the textbook) of how each type of risk is used in epidemiology. How would you propose using population attributable risk to advocate for a health policy or intervention relative to your health interest?

Topic 7: Applying Epidemiology to Policy

Objectives:

Apply epidemiological methods to the breadth of settings and situations in public health practice.

Discuss the means by which social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels.

Benchmark – Epidemiologic Profile Assignment

An epidemiologic profile is a summary of a significant public health issue, or issues, in your community, county, state, or country. An epidemiological profile helps to coordinate activities and policies from various agencies and organizations to improve health.

Review the available data, reports, and documents for your locale. Assess how the methods of epidemiology (study designs, data collection, measures of association, etc.) are used to determine who needs what services, where the services are needed, and how those services should be delivered. Define your community as your city, metropolitan area, or county and write a 2,000-2,250 word epidemiological profile (word limit excludes references and title page).The profile can be a general profile that provides a landscape picture of several significant chronic and infectious diseases in your defined community, or it can be a specific profile that targets one health issue, such as diabetes, asthma, STDs, flu, heart disease, obesity, alcohol abuse, or other drug use. Include the following:

Executive Summary

Describe the purpose of the epidemiologic profile and the health issue(s) it addresses. Discuss its importance to the community and how it will be utilized. PUB 540 Principles of epidemiology.

Summarize the key findings from your review of available data, reports, and documents for the community.

Introduction

Describe the defined community and population using demographic and socio-economic information and data.

Briefly describe the history and cultural background of the community.

Explain any unique contextual information that pertains to the public health of the defined community.

Describe any key public health projects, grants, or existing epidemiology-related working groups or committees in the community/county.

Description of Available Data

Identify at least two different data sources relevant to your profile. Discuss data from these sources and their relation to the issue or community.

Discuss the methods used in the data collection process (data source and organization providing the data; how often the data are collected; data limitations including response rates, missing data, selection of participants, etc.). Potential data sources and databases might include the following depending on what is available for your community or county:

Behavioral Risk Factor Surveillance System (BRFSS) data

Youth risk behavioral survey

Surveillance, epidemiology, and end results (SEER) program data

CDC Wonder (multiple data sources)

County health rankings data (multiple data sources)

Alcohol-related disease impact data

Demographic health survey data (international) PUB 540 Principles of epidemiology

Global school-based student health survey (international)

Local evaluation reports from the department/ministry of health or other nonprofit organizations

Interpretation of Results Regarding Key Health Issue

Size and magnitude of the measures

Trends and comparisons

Economic costs

Discussion of Problems and Strategies

Discuss disparities, limitations, and gaps in the information available regarding the health issue(s).

Describe potential public health strategies to address these gaps.

Use graphs and tables where appropriate.

Conclusion

You are required to cite to at least five sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

MPH

2.1 Apply epidemiological methods to the breadth of settings and situations in public health practice.

MSN Public Health Nursing

6.2 Apply epidemiological methods to the breadth of settings and situations in public health practice.

 

Topic 7 DQ 1

Epidemiological methods are used in a variety of public health areas (including infectious disease, chronic disease, and social health) and settings (including the community, schools, and the workplace). Epidemiological methods are used to assess, describe, analyze, and make comparisons of populations to inform evidence-based practices, policies, and interventions. Propose a study based on the methods you have learned thus far designed to investigate an association within one of the public health areas listed (infectious disease, chronic disease, or social health) and the methods you would apply. Discuss and define the risk factor or exposure that is being assessed, the method of comparison that is used, and the setting or situation (community, school, workplace, etc.) your study would look to address. Consider the concepts of causal inference, measures of association, and study design. PUB 540 Principles of epidemiology.

Topic 7 DQ 2

Race is often used as a descriptor of disease burden and helps us to determine where health disparities exist in order to address them, which is important. It is helpful to differentiate between race as a descriptor and race as a risk factor. Think about institutional racism and its influence on health. Consider the factors related to race and ethnicity that might be influencing disease status more than the genetics of race when answering this discussion question.

Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.” Discuss the ethical and public health implications of this statement. When might collecting data on race perpetuate institutional racism leading to health disparities and when is it necessary to improve public health? Provide support and examples for your answer. Consider ethical issues related to respect for persons, beneficence, and justice as described in “The Belmont Report.”

Topic 8: Environment and Genetics

Objectives:

Discuss how genetic and environmental factors interact in causing disease.

Explain the biological and genetic factors that affects a population’s health.

Topic 8 DQ 1

 

One method to investigate gene-environment interactions is to study monozygotic twins. Identify an example of a twin study not listed in the textbook used to examine the gene-environment interaction of a specific disease or condition. Briefly summarize the gene-environment interaction investigated, the methods, and the results. What are other possible methods for studying gene-environment interactions as they relate to improving population health?

Topic 8 DQ 2

 

Using the CDC Wonder website, set the query criteria for pancreatic cancer for the United States as illustrated below. Compare the rates by race for Wisconsin and Colorado. Discuss possible biological, genetic, and environmental reasons for differences. What are potential social determinants that contribute to the disparity presented between the two states? PUB 540 Principles of epidemiology.

Use this query upon entering the CDC Wonder website:

Select “Cancer Statistics” under the Wonder Systems tab

Select “Cancer Incidence 1999 – 2013” and click “Data Request”

Organize table layout:

Group results by 1. States and 2. Race (leave the rest of the group options as “None”)

Measures – click “Count” (default) and “Age Adjusted Rates”

Select location – select “States” and “The United States”

Select year and demographics

Year – 2014

Sex – All genders

Age groups – All ages

Ethnicity – All ethnicities

Race – All races

Select cancers of interest – select “Pancreas”

Other options – keep default settings PUB 540 Principles of epidemiology

Historical Review of Epidemiology

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt

James Lind

Edward Jenner

Ignaz Semmelweis

John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

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Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.

Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses. Historical Review of Epidemiology.

Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for succes.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
for assistance. Historical Review of Epidemiology.

PUB 540 Principles of epidemiology Topic 1 DQ 1

Define 
endemic
, 
epidemic
, and 
pandemic,
 and provide an example of each. Describe a current epidemic. Describe one example of each of the prevention types (primary, secondary, and tertiary) that could be applied to control the epidemic.

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Topic 1 DQ 1

According to MacIntyre and Bui (2017) a true epidemic has a rise in case rates over days or weeks, whereas an endemic disease may rise or fall over years or decades. The words epidemic and pandemic are often misused. A pandemic is simply a global epidemic, and an epidemic is an outbreak of disease that attacks many people at about the same time and spreads through a defined population (MacIntyre and Bui, 2017). It is defined by rate of growth of the epidemic curve. Epidemics have a sudden and immediate impact on the health system and require surge capacity. The rapid increase in cases observed during an epidemic or pandemic is what causes immediate impacts on health systems, stressing these systems beyond normal operating capacity. A pandemic of a highly infectious microbe will evolve rapidly and affect many people within a short period of time (MacIntyre and Bui, 2017). PUB 540 Principles of epidemiology Topic 1 DQ 1.

According to Troncoso (2015), an influenza pandemic once it begins, would be expected to reach its peak within 2 months. Malaria, TB and AMR organisms, are usually endemic diseases. Endemic diseases may occur in very high numbers, but their rate is constant or changes slowly, over months or years, sometimes decades (Troncoso, 2015). An unprecedented epidemic of Ebola virus has been causing thousands of deaths in West Africa since 2014 (Guinea, Liberia, Nigeria and Sierra Leone). The Ebola virus was first identified in 1976 in Yambuku, Zaire (now Democratic Republic of Congo) and Nzara, South Sudan. The Ebola virus is a zoonotic pathogen, and its circulation among humans is rare, which explains the fact that the outbreaks are intermittent and unpredictable. The most likely reservoir seems to be a fruit bat, although the link has not been confirmed (Chowell and Nishivra, 2014).

The virus has caused more than 30 outbreaks since it was identified in 1976, with less than 1600 deaths before 2014. In most cases, the virus started in rural areas and the epidemics were controlled with routine public health measures, such as the identification of cases, contact tracing, and isolation and quarantine of the patient to break the chain of transmission. PUB 540 Principles of epidemiology Topic 1 DQ 1. These public health measures have a proven efficacy record for the control of epidemics (Chowell and Nishivra, 2014).

According to Chowell and Nishivra (2014) proven treatments or vaccines against Ebola are still not available. Hence, thus the current working toolbox available to control the spread of Ebola still hinges on supportive medical care to increase the survival of those infected and basic non-pharmaceutical public health measures to prevent transmission, namely: 1) infection control measures including standard precautions in health care settings; 2) rapid contact tracing and isolation of infectious individuals; and 3) social distancing interventions in the community which may include the dissemination of awareness campaigns to inform the population on how to avoid contracting the disease, quarantining individuals potentially exposed to infectious individuals and restricting the movement of communities exhibiting local transmission to prevent onward transmission PUB 540 Principles of epidemiology Topic 1 DQ 1. These actions must be conducted in close collaboration with local community leaders to effectively reach the population at large (Chowell and Nishivra, 2014).

MacIntyre, C. R., & Bui, C. M. (2017). Pandemics, public health emergencies and antimicrobial resistance – putting the threat in an epidemiologic and risk analysis context.

Troncoso, A. (2015). Ebola outbreak in West Africa: a neglected tropical disease. Asian Pacific Journal of Tropical Biomedicine, 5: 4, pgs. 255-259.

Chowell, G., & Nishivra, H. (2014). Transmission dynamics and control of Ebola virus disease (EVD): a review. BMC Medicine, 12: 196. PUB 540 Principles of epidemiology Topic 1 DQ 1.

 

Topic 1 DQ 1

Endemic is a disease that exists permanently in a region or population. An example of this is Mexico. The water in Mexico is known for having parasites that locals have built up an immunity to that people not from that region often get very sick over. Epidemic outbreaks are a disease that attacks many peoples at about the same time and may spread through one or several communities. An example of this would be the bird flu or mad cow disease. The areas that are affected and many different government agencies act with notifications and action plans to bring it under control. Pandemic would be something that spreads worldwide. Our ability to travel has brought this to the forefront of the governments and disease control PUB 540 Principles of epidemiology Topic 1 DQ 1. The ability to work with other countries and knowing who is going where allows the population to be safe from a disease making itself present so quickly because of the people transporting the issues with them. Bed bugs would be an example of this.

 

Prevention
:

Primary Prevention – When you are trying to prevent yourself from getting a disease. An example of this is sunscreen to prevent skin cancer

 

Secondary Prevention – This would be having a doctor give you an once over and check your skins condition to see if you have skin cancer and if you do be able to treat it as early as possible.

 

Tertiary Prevention – Is needed once something like skin cancer has happen and is now part of your life. The person learns to best adapt to the situation and learns the rules of living with such a situation.

 

World Health Organization. (2019). Dengue and severe dengue. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue PUB 540 Principles of epidemiology Topic 1 DQ 1

Multicausality: Confounding Assignment

 
pub 540 Topic 4: Study Designs I

These estimates include the influence of other extraneous variables, such as confounders. Confounding is often considered a type of bias, but it is a real relationship that requires an adjustment in the study design or analysis. Understanding how to identify confounding is important as most associations have multiple causal factors. Recognizing if a study adjusted for the appropriate confounding variables is important to determine the validity of the association. To assist your proficiency with the concept of confounding, and how it ultimately affects public health, this practice assignment has been provided. pub 540 Topic 4: Study Designs I.

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Complete Problems 1 to 4 from the “Multicausality: Confounding – Assignment” by Schoenbach, located in your Topic Materials. Check your answers against the solutions presented in the “Multicausality: Confounding – Assignment Solutions” Topic Material.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. pub 540 Topic 4: Study Designs I.

You are not required to submit this assignment to LopesWrite.

Topic 4 DQ 1

 

Based on the “Multicausality: Confounding – Assignment,” by Schoenbach, discuss two significant insights you learned about confounding. Use specific examples from the assignment to support your answer.

Topic 4 DQ 2

 

Describe the characteristics and design of a cohort study. Based on a disease or health condition identified from the “2020 LHI Topics” on the Healthy People 2020 website, or an article from the GCU library, discuss a real example of a cohort study (include the link to the article in your post to the forum) pub 540 Topic 4: Study Designs I. Include the participants, exposures or treatment groups, timeframe, and outcomes that were measured. Why is a cohort study described as an “observational” study rather than an “experimental” study design?

Multicausality: Confounding Assignment

 

These estimates include the influence of other extraneous variables, such as confounders. Confounding is often considered a type of bias, but it is a real relationship that requires an adjustment in the study design or analysis. Understanding how to identify confounding is important as most associations have multiple causal factors. Recognizing if a study adjusted for the appropriate confounding variables is important to determine the validity of the association. To assist your proficiency with the concept of confounding, and how it ultimately affects public health, this practice assignment has been provided.

BUY A PLAGIARISM-FREE PAPER HERE

Complete Problems 1 to 4 from the “Multicausality: Confounding – Assignment” by Schoenbach, located in your Topic Materials. Check your answers against the solutions presented in the “Multicausality: Confounding – Assignment Solutions” Topic Material.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this pub 540 Multicausality: Confounding assignment to LopesWrite.

Topic 4 DQ 1

 

Based on the “Multicausality: Confounding – Assignment,” by Schoenbach, discuss two significant insights you learned about confounding. Use specific examples from the assignment to support your answer. PUB 540 Topic 4 DQ 1

Oswego Outbreak Investigation

NOTE: The following resource was prepared for class use by replicating portions of the Centers for Disease Control and Prevention’s (CDC), “Oswego – An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide” (CDC, n.d.), except for the “Questions” section, with the understanding that the CDC document is in the public domain and available for educational use.

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Background:

On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper held on the previous evening, April 18. Family members who did not attend the church supper did not become ill. Accordingly, Dr. Rubin focused the investigation on the supper. He completed interviews with 75 of the 80 persons known to have attended, collecting information about the occurrence and time of onset of symptoms, and foods consumed. Of the 75 persons interviewed, 46 persons reported gastrointestinal illness Oswego Outbreak Investigation.

Clinical Description:

The onset of illness in all cases was acute, characterized chiefly by nausea, vomiting, diarrhea, and abdominal pain. None of the ill persons reported having an elevated temperature; all recovered within 24 to 30 hours. Approximately 20% of the ill persons visited physicians. Oswego Outbreak Investigation. No fecal specimens were obtained for bacteriologic examination.

Description of the Supper:

The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 p.m. and continued until 11:00 p.m. Food was spread out on a table and consumed over a period of several hours Oswego Outbreak Investigation. Data regarding onset of illness and food eaten or water drunk by each of the 75 persons interviewed [are provided in the Excel “Oswego Line Listing Workbook” (CDC, n.d.)]. The approximate time of eating supper was collected for only about half the persons who had gastrointestinal illness.

Conclusion:

The following is quoted verbatim from the report prepared by Dr. Rubin:

The ice cream was prepared by the Petrie sisters as follows:

On the afternoon of April 17 raw milk from the Petrie farm at Lycoming was brought to boil over a water bath, sugar and eggs were then added and a little flour to add body to the mix. The chocolate and vanilla ice cream were prepared separately. Hershey’s chocolate was necessarily added to the chocolate mix. At 6 p.m. the two mixes were taken in covered containers to the church basement and allowed to stand overnight. They were presumably not touched by anyone during this period. Oswego Outbreak Investigation

On the morning of April 18, Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix, and three ounces of vanilla and one can of condensed milk to the chocolate mix. Then the vanilla ice cream was transferred to a freezing can and placed in an electrical freezer for 20 minutes, after which the vanilla ice cream was removed from the freezer can and packed into another can which had been previously washed with boiling water. Then the chocolate mix was put into the freezer can which had been rinsed out with tap water and allowed to freeze for 20 minutes. At the conclusion of this both cans were covered and placed in large wooden receptacles which were packed with ice Oswego Outbreak Investigation. As noted, the chocolate ice cream remained in the one freezer can.

All handlers of the ice cream were examined. No external lesions or upper respiratory infections were noted. Nose and throat cultures were taken from two individuals who prepared the ice cream.

Bacteriological examinations were made by the Division of Laboratories and Research, Albany, on both ice creams. Their report is as follows: “Large numbers of
Staphylococcus aureus
and
albus
were found in the specimen of vanilla ice cream. Only a few staphylococci were demonstrated in the chocolate ice cream.”

Report of the nose and throat cultures of the Petries who prepared the ice cream read as follows: “
Staphylococcus aureus
and hemolytic streptococci were isolated from nose culture and
Staphylococcus albus
from throat culture of Grace Petrie.
Staphylococcus albus
was isolated from the nose culture of Marian Petrie. The hemolytic streptococci were not of the type usually associated with infections in man Oswego Outbreak Investigation.”

Discussion as to Source: The source of bacterial contamination of the vanilla ice cream is not clear. Whatever the method of the introduction of the staphylococci, it appears reasonable to assume it must have occurred between the evening of April 17 and the morning of April 18. No reason for contamination peculiar to the vanilla ice cream is known.

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In dispensing the ice creams, the same scooper was used. It is therefore not unlikely to assume that some contamination to the chocolate ice cream occurred in this way. This would appear to be the most plausible explanation for the illness in the three individuals who did not eat the vanilla ice cream.

Control Measures: On May 19, all remaining ice cream was condemned. All other food at the church supper had been consumed. Oswego Outbreak Investigation.

Conclusions: An attack of gastroenteritis occurred following a church supper at Lycoming. The cause of the outbreak was contaminated vanilla ice cream. The method of contamination of ice cream is not clearly understood. Whether the positive
Staphylococcus
nose and throat cultures occurring in the Petrie family had anything to do with the contamination is a matter of conjecture.

Note: Patient #52 was a child who while watching the freezing procedure was given a dish of vanilla ice cream at 11:00 a.m. on April 18.

Addendum:

Certain laboratory techniques not available at the time of this investigation might prove very useful in the analysis of a similar epidemic today. These are phage typing, which can be done at CDC, and identification of staphylococcal enterotoxin in food by immunodiffusion or by enzyme-linked immunosorbent assay (ELISA), which is available through the Food and Drug Administration (FDA). Oswego Outbreak Investigation.

One would expect the phage types of staphylococci isolated from Grace Petrie’s nose and the vanilla ice cream and vomitus or stool samples from ill persons associated with the church supper to be identical had she been the source of contamination. Distinctly different phage types would mitigate against her as the source (although differences might be observed as a chance phenomenon of sampling error) and suggest the need for further investigation, such as cultures of others who might have been in contact with the ice cream in preparation or consideration of the possibility that contamination occurred from using a cow with mastitis and that the only milk boiled was that used to prepare chocolate ice cream Oswego Outbreak Investigation. If the contaminated food had been heated sufficiently to destroy staphylococcal organisms but not toxin, analysis for toxin (with the addition of urea) would still permit detection of the cause of the epidemic. A Gram stain might also detect the presence of nonviable staphylococci in contaminated food.

Reference

Centers for Disease Control and Prevention. (n.d.). Oswego – An outbreak of gastrointestinal illness following a church supper: Student guide (Case No. 401-303). Retrieved from https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf Oswego Outbreak Investigation

Topic 4 DQ 2

 
pub 540 Topic 4 DQ 2

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Describe the characteristics and design of a cohort study. Based on a disease or health condition identified from the “2020 LHI Topics” on the Healthy People 2020 website, or an article from the GCU library, discuss a real example of a cohort study (include the link to the article in your post to the forum). Include the participants, exposures or treatment groups, timeframe, and outcomes that were measured. Why is a cohort study described as an “observational” study rather than an “experimental” study design? pub 540 Topic 4 DQ 2