Tag: Clinical-Nursing

PUB-540 – Creating a 2×2 Contingency Table

Creating a 2×2 Contingency Table

Creating a 2×2 contingency table is very useful in calculating a variety of public health measurements, including sensitivity and specificity, negative and positive predictive value, risk ratios, attack rate ratios, and odds ratios.

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A 2×2 table is actually a 3×3 table when you include the rows and columns for the totals. If you are setting up a table to measure the sensitivity and specificity of a test or its negative and positive predictive values, you should put the test results on the y-axis (rows) and the actual presence of disease on the x-axis (columns). PUB-540 – Creating a 2×2 Contingency Table.

Disease

No Disease

Total

Test (+)

(a)

(b)

a + b

Test (-)

(c)

(d)

c + d

Total

a + c

b + d

a + b + c + d

The highlighted section is where you will enter the data for each corresponding cell. You can set up the table switching the rows and columns but you will generally see them set up in this format with test results on the y-axis and disease on the x-axis. PUB-540 – Creating a 2×2 Contingency Table

Setting up a table to measure the association of a risk factor or exposure is similar, with the outcome or disease on the x-axis and the presence of the risk factor or exposure on the y-axis.

Disease

No Disease

Total

Exposure (+)

(a)

(b)

a + b

Exposure (-)

(c)

(d)

c + d

Total

a + c

b + d

a + b + c + d

Note: You can set up the table differently but you will need to be cognizant of which numbers you are putting in your numerator and denominator for the measure you are calculating. For example:

Exposure (+)

Exposure (-)

Total

No Disease

(b)

 (d)

b + d

Disease

 (a)

 (c)

a + c

Total

a + b

b + c

a + b + c + d

PUB-540 – Creating a 2×2 Contingency Table

Effectiveness of Studies Used in Epidemiology

A premise of epidemiology is that health outcomes are not random occurrences within a population, but are linked to particular risk factors and diseases. Epidemiologists utilize a range of study design methods to evaluate evidence-based associations to understand and improve health outcomes. Use the specific Excel worksheets, located in the “Excel Study Design Workbook,” to complete this assignment.

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Part 1:
 
Study Design Comparison

Using the “Study Design Comparison Worksheet,” compare and contrast the characteristics of the different types of study design types discussed in this course Effectiveness of Studies Used in Epidemiology. You will be able to use this as a reference throughout the program.

Part 2: Article Comparison

Consider an area of interest that you want to explore as a potential topic for your Epidemiological Profile project. Search for two articles that fit any two of the four study designs (randomized trial, cohort, case-control, and cross-sectional) pertaining to the interest area you chose. Review the articles provided in the “Study Design Resource Document” to practice identifying articles for each study design. (Do not use the actual articles listed in the “Study Design Resource Document” for this assignment.) Complete the “
Article Comparison Worksheet
” to compare the study design characteristics in each of your two articles. Include details of any gaps in the characteristics or identify if information is missing. Effectiveness of Studies Used in Epidemiology.

General Requirements

Upon completion of both worksheets, submit the “Excel Study Design Workbook.”

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

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

You are not required to submit this assignment to LopesWrite. Effectiveness of Studies Used in Epidemiology

 

Study Design Resource Document

Case-Control Study Examples

Carton M, Barul C, Menvielle G, et al. (2017)
Occupational exposure to solvents and risk of head and neck cancer in women: a population-based case-control study in France.

http://bmjopen.bmj.com/content/7/1/e012833 
   Effectiveness of Studies Used in Epidemiology

Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB. (2005)
Diabetes increases the risk of hepatocellular carcinoma in the United Sates: a population based case control study.

https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC1774454/

Cramer DW, Vitonis VF, Terry KL, Welch WR, Titus LJ. (2016)
The association between talc use and ovarian cancer: a retrospective case-control study in two US states.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/

 

Cross-Sectional Study Examples

Nilsen P, Holmqvist M, Nordqvist C, Bendsten P. (2007)
Linking drinking to injury – a causal attribution of injury to alcohol intake among patients in a Swedish emergency room.
http://www.tandfonline.com.lopes.idm.oclc.org/doi/abs/10.1080/17457300701374759

Johnson JV, Hall EM. (1988)
Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population.
https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC1349434/

Elliott AM, Luo N, Tembo, G, et al. (1990)
Impact of HIV on tuberculosis in Zambia: a cross  sectional study.
http://search.proquest.com.lopes.idm.oclc.org/docview/1776431657?accountid=7374
   Effectiveness of Studies Used in Epidemiology

PUB 540 – Article Comparison Worksheet

Topic of Interest:

Search Terms:

Article #1

Article #2

Author, Year, Title

Article importance
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Study design type

How were participants selected or recruited?

PUB 540 – Article Comparison Worksheet

How many participants? (state the number of cases and controls or exposes and unexposed)

If appropriate, how long was the average length of follow-up?

What sources of data were used to measure the exposure and outcome(s)?

How was the exposure  defined or measured?

How was the outcome defined or measured?

What was the primary measure of association or statistical method used? (relative risk, odds ratio, logistic regression, etc.)

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PUB 540 – Article Comparison Worksheet

How did the authors control for bias and confounding?

What were the strengths of the study?

What were the weaknesses of the study?

What were the primary findings and conclusions?

PUB 540 – Article Comparison Worksheet

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.

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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.

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

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. Epidemiologic Profile Assignment

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. Epidemiologic Profile Assignment

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 Epidemiologic Profile Assignment

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) Epidemiologic Profile Assignment

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. Epidemiologic Profile Assignment

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. Epidemiologic Profile Assignment

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 NursingEpidemiologic Profile Assignment

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

Topic 5: Study Designs II

Objectives:

Compare and contrast case control and cross-sectional studies.

Evaluate the strengths and weaknesses of study designs used in epidemiological assessments.

Select methods to evaluate public health programs. pub 540 Topic 5: Study Designs II