Module 2 (Health Epidemiology and Ethical Issues)

Question 1

What is the definition of epidemiology?

Answer 1

the study of the distribution and determinants of disease frequency in human populations

Question 2

What was the John Snow’s investigation of cholera?

Answer 2

London cholera outbreaks in the mid 1800s
Snow suspected an association with a (potentially contaminated) water supply, the Thames river
Those consuming water from one supply (the Broad Street pump) had higher rates of cholera death

This made him the first to use epidemiology to study cholera

Question 3

What is the Morbidity and Mortality Weekly Report?

Answer 3

Often called “the voice of CDC,” the MMWR series is the agency’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations.

Question 4

What is prevalence?

Answer 4

Number of existing cases of a disease (divided by) the population

Question 5

What factors change prevalence rates?

Answer 5

Incidence and prognosis

If causes or risk factors increase, so do incidence and prevalence
If ability to diagnose increases, incidence and prevalence APPEAR to increase

Question 6

What is the closest thing to an experiment that epidemiologists do?

Answer 6

An intervention study

It involves experiment group (provided a treatment) and controls (not provided a treatment) and follows up to see which within each group did or did not have an outcome.

Question 7

What studies are used more commonly in public health?

Answer 7

Cohort
Case Control
Cross-Sectional

Question 8

Why are experiments usually considered unethical in public health?

Answer 8

It is considered unethical to expose the experimental group to toxic agents (e.g. radiation) to determine their outcomes for the future health of others.

Question 9

What are the typical steps of an outbreak investigation?

Answer 9

verify the diagnosis
construct a working case definition
find cases systematically
Gather copious data (who/what/when/person/place/time/etc.)
Look for a common source of exposure
Develop hypothesis

Question 10

What is a case control study?

Answer 10

Retrospective / looking at known disease and identifying exposures

A case-control study is designed to help determine if an exposure is associated with an outcome (i.e., disease or condition of interest).

Question 11

What is a cohort study?

Answer 11

Prospective / looking forward - find exposures and see what outcomes happen

Cohort studies are a type of longitudinal study—an approach that follows research participants over a period of time (often many years). Specifically, cohort studies recruit and follow participants who share a common exposure

Question 12

What is a cross sectional study?

Answer 12

In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in the other two types, the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study.

Exposure & outcome both known (will have some of each group & their 4 combos) - used for in depth analysis

Question 13

What is a common issue with cohort studies?

Answer 13

it can be hard to isolate which of the many factors are responsible for health differences

Question 14

What factors help lend validity to study results?

Answer 14

strong association
dose-response relationship
known biological explanation
large study population
consistent results from several studies from several studies
high relative risk or odds ratio

Question 15

What is the epidemiologic triad?

Answer 15

Question 16

What is the Belmont Report (1976)?

Answer 16

The Belmont Report was written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission, was charged with identifying the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and developing guidelines to assure that such research is conducted in accordance with those principles.

Question 17

What were other major components of the Belmont Report?

Answer 17

Informed Consent
Institutional Issues
Vulnerable Populations
Protocol Review
Human Subject Regulations
Biological Materials and Data

Question 18

What were the 3 major ethical principles of the Belmont Report?

Answer 18

Respect for persons
Beneficence (protecting persons from harm AND protecting their well being)
Justice (fairness in distribution of both benefits / burdens or research)

Question 19

What were the Helsinki Accords and their effect on research ethics?

Answer 19

The Helsinki Final Act was an agreement signed by 35 nations that concluded the Conference on Security and Cooperation in Europe, held in Helsinki, Finland. The multifaceted Act addressed a range of prominent global issues and in so doing had a far-reaching effect on the Cold War and U.S.-Soviet relations.

The Helsinki Accords introduced a unique international instrument that linked security and human rights. Respect for human rights and fundamental freedoms, and equal rights and self-determination of peoples, were included in the First Basket on European security.

Question 20

What is the Nuremberg Code (1947)?

Answer 20

The Nuremberg Military Tribunal’s decision in the case of the United States v Karl Brandt et al. includes what is now called the Nuremberg Code, a ten point statement delimiting permissible medical experimentation on human subjects. According to this statement, humane experimentation is justified only if its results benefit society and it is carried out in accord with basic principles that “satisfy moral, ethical, and legal concepts.”

Question 21

What was the Framingham Heart Study and its controversy?

Answer 21

Framingham Study is a population-based, observational cohort study that was initiated by the United States Public Health Service in 1948 to prospectively investigate the epidemiology and risk factors for cardiovascular disease. It has grown into an ongoing, longitudinal study gathering prospective data on a wide variety of biological and lifestyle risk factors and on cardiovascular, neurological and other types of disease outcomes across 3 generations of participants.

Critics of Framingham expressed uncertainty about whether study participants represented Americans in general and about the study’s family-based approach.

Question 22

What was the Tuskegee study and its controversy?

Answer 22

The U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee was conducted between 1932 and 1972 to observe the natural history of untreated syphilis. As part of the study, researchers did not collect informed consent from participants and they did not offer treatment, even after it was widely available. The study ended in 1972 on the recommendation of an Ad Hoc Advisory Panel. After the study, sweeping changes to standard research practices were made. Efforts to promote the highest ethical standards in research are ongoing today.

Question 23

What is the NHANES and its three editions?

Answer 23

National Health and Nutrition Examination Survey

NHES I focused on selected chronic disease of adults aged 18-79. NHES II and NHES III focused on the growth and development of children. The NHES II sample included children aged 6-11, while NHES III focused on youths aged 12-17. All three surveys had an approximate sample size of 7,500 individuals.

provides vast data on tobacco use and many other topics

Question 24

What are common approaches to handling public health issues?

Answer 24

Social norms approach
Regulatory approach
Prohibition approach

Question 25

What are the main components of the public health code of ethics?

Answer 25

Humans have a right to the resources necessary for health
Humans are inherently social and interdependent
The effectiveness of institutions depends heavily on the public’s trust
Collaboration is a key element to public health
People and their physical environment are interdependent.
Each person in a community should have an opportunity to contribute to public discourse.
Identifying and promoting the fundamental requirements for health in a community are of primary
concern to public health
Knowledge is important and powerful
Science is the basis for much of our public health knowledge
People are responsible to act on the basis of what they know
Action is not based on information alone