NAME: Dayleen Jae G Young

NUR 627: Advanced Epidemiology and Biostatistics for Nursing

Practice Questions I

Due: 9/11/2017

Please save the file with your last name before you attach to Black Board.

The test includes 32 questions for a total of 37 points. (15% of the course grade)

Please answer all the questions, show your calculations and justify your answer for each
question using your own words to get full credit.

Questions 1 and 2 use the information below:

Population of the city of Atlantis on March 30, 2003 = 193,000

No. of new active cases of TB occurring between January 1 and June 30, 2003 = 65
No. of active TB cases according to the city register on June 30, 2003 = 268

1. The incidence rate of active cases of TB for the 6-month period was: [ONE POINT]

a. 7 per 100,000 population

b. 14 per 100,000 population
c. 26 per 100,000 population
d. 34 per 100,000 population
e. 130 per 100,000 population

You can calculate the incidence rate of active TB cases in 6-month period by using
the formula Incidence rate = Number of new Cases during the 6 month period divided
by the Population if the city of Atlantis multiple by 100,000

Incidence rate= 65/193,000* 100,000= 33.6 or 34 per 100,000 population

2. The prevalence of active TB as of June 30, 2003, was: [ONE POINT]

a. 14 per 100,000 population

b. 139 per 100,000 population
c. 144 per 100,000 population
d. 264 per 100,000 population
e. none of the above
 You can calculate the prevalence by using the formula Prevalence = Number of active
TB cases divided by the Population if the city of Atlantis multiple by 100,000

Prevalence= 268/193,000* 100,000=138.8 or 139 per 100,000 population

3. Which of the following is an advantage of active surveillance? [ONE POINT]

a. requires less project staff

b. is relatively inexpensive to employ
c. relies on different disease definitions to account for all cases
d. reporting systems can be developed quickly
e. more accurate due to reduced reporting burden for health care providers

Active surveillance requires a large amount of staff and resources to collect

information and these people are specifically directed to the health care providers
such as physician or institution like a hospital to collect reports of cases of a disease
in a specific population

Question 4 is based on the information given below:

In an Asian country with a population of 10 million people, 100,000 deaths occurred

during the year ending December 31, 2005. These deaths included 70,000 deaths from
cholera in 95,000 people who were sick with cholera.

4. What was the case-fatality rate from cholera in 2005? [ONE POINT]
Case fatality= 70,000 / 95,000 *100=73.6 % or 74%, which means that this is the
percentage of people who were diagnosed and died from cholera in 2005

We can calculate the case fatality rate from cholera by using the formula, Case Fatality= deaths
from cholera/ people who were sick with cholera *100

5. What would be the effect on age-specific incidence rates if women with hysterectomies
were excluded from the denominator of calculations, assuming that there are some
women in each age group who have had hysterectomies? [ONE POINT]

a. the rates would remain the same

b. the rates would tend to decrease
c. the rates would tend to increase
d. the rates would increase in older groups and decrease in younger groups
e. it cannot be determined whether the rates would increase or decrease

The rate would increase because the denominator will decrease since we have excluded the
people who had hysterectomies in the population risk.

For example, total of new cases is 80 and population at risk is 100

80/100*1000=800 incidence per 1,000
If we exclude the people who had hysterectomies for example there were 10 of them
80/90*1000=888.9 or 889 incidences per 1000. The incidence rate increased.

Question 6 is based on the following information:

A colon cancer screening study is being conducted in Nottingham, England. Individuals

50 to 75 years old will be screened with the Hemoccult test. In this test, a stool sample is
tested for the presence of blood.

6. If the Hemoccult test result is negative, no further testing is done. If the Hemoccult test
result is positive, the individual will have a second stool sample tested with the
Hemoccult II test. If this second sample also tests positive for blood, the individual will
be referred for more extensive evaluation. What is the effect on net sensitivity and net
specificity of this method of screening? [ONE POINT]

a. Net sensitivity and net specificity are both increased

b. Net sensitivity is decreased and net specificity is increased
c. Net sensitivity remains the same and net specificity is increased
d. Net sensitivity is increased and net specificity is decreased
e. The effect on net sensitivity and net specificity cannot be determined from the
data

In diagnostics tests, the net sensitivity generally decreases with increasing number of test,
due to the number of positive cases identified correctly whereas the net specificity increases
due to the negative cases identified correctly.

7. Age-adjusted death rates are used to:[ONE POINT]

a. Correct death rates for errors in the statement of age

b. Determine the actual number of deaths that occurred in specific age groups in a
population
c. Correct death rates for missing age information
d. Compare deaths in persons of the same age group
e. Eliminate the effects of differences in the age distributions of populations in
comparing death rates

Age adjusted death rates are used when there are differences in the age distribution
for the populations that are being compared. So it is used for the number of death on
an age specific range e.g 50-55 then divided with the midyear population of the same
age range then use the multiplier.
 A survey was conducted among the non-hospitalized adult population of the United
States during 1988 through 1991. The results from this survey are shown below.
Age Group Persons with Hypertension (%)
1829 years 4
3039 years 10
4049 years 22
5059 years 43
6069 years 54
70 and older 64

The researchers stated that there was an age-related increase in the risk of
hypertension in this population. You conclude that the researchers interpretation:
[ONE POINT]

a. is correct
b. is incorrect because it was not based on rates
c. is incorrect because incidence rates do not describe risk
d. is incorrect because prevalence is used
e. is incorrect because the calculations are not age-adjusted

The conclusion should have been that this population has that percentage of existing
hypertensive people with the specific age groups during 1988-1991. An increase in
the risk means new cases which would be incidence.

8. For a disease, such as pancreatic cancer, which is highly fatal and of short duration:
[ONE POINT]

a. Incidence rates and mortality rates will be similar

b. Mortality rates will be much higher than incidence rates
c. Incidence rates will be much higher than mortality rates
d. Incidence rates will be unrelated to mortality rates
e. None of the above

If the disease as high fatality and short in duration, here would be the same number of
people who will get the disease and die from it. Thats why the incidence and mortality would
almost be the same.

9. In 1990, there were 8,000 deaths due to lung diseases in miners aged 20 to 64 years. The
expected number of deaths in this occupational group, based on age-specific death rates
from lung diseases in all males aged 20 to 64 years, was 3,500 during 1990.

a. What was the standardized mortality ratio (SMR) for lung diseases in miners? [ONE
POINT]
 SMR- Observed Deaths / Expected Deaths*100
8,000/3,500=2.28 or 2.3

b. Interpret the value of the SMR: [ONE POINT]

2.3 to 1

Questions 11-14 are based on the information given below:

A physical examination was used to screen for breast cancer in 3,000 women with biopsy-
proven adenocarcinoma of the breast and in 5,000 age- and race-matched control women.
The results of the physical examination were positive (i.e., a mass was palpated) in 2,000
cases and in 500 control women, all of whom showed no evidence of cancer at biopsy.

10. What is the sensitivity of the physical examination? Interpret it. [ONE POINT]

2,000/3,000*100=66.7 0r 67% Percentage of people who has cancer who are correctly
identified as having the condition

What is the specificity of the physical examination? Interpret it. [ONE POINT]

4,500/5,000*100= 90% the percentage of healthy people who are correctly identified as
not having breast cancer

11. What is the positive predictive value of the physical examination? Interpret it. [ONE
POINT]

2,000/2500*100=80% the probability that people who were screened with a positive
screen of breast cancer was diagnosed with breath cancer.

12. What is the negative predictive value of the physical examination? Interpret it. [ONE
POINT]

4,500/5,500*100=81.8 % or 82% the probability that people who were screened with a
negative screen of breast cancer and they dont have breast cancer

Question 15 is based on the following information:

A physical examination and an audiometric test were given to 600 persons with suspected
hearing problems, of whom 400 were found to have them. The results of the
examinations were as follows:

PHYSICAL EXAMINATION
HEARING PROBLEMS
Result Present Absent
Positive 360 40
 Negative 40 160

AUDIOMETRIC TEST
HEARING PROBLEMS
Result Present Absent
Positive 380 20
Negative 20 180

13. Compared with the physical examination, the audiometric test is: [TWO POINTS]

a. Equally sensitive and specific

b. Less sensitive and less specific
c. Less sensitive and more specific
d. More sensitive and less specific
e. More sensitive and more specific

Base on the data above, It shows that Physical examination has a sensitivity of
(360/400*100)90% and Specificity of (160/200*100) =80%, while Audiometric test
has a sensitivity of (380/400*100)=95% and Specificity of (180/200*100)=90%

Questions 16a and 16b are based on the information given below:

14. Calculate the age-adjusted death rate for disease Z in communities X and Y by the direct
method, using the total of both communities as the standard population.

16a. The age-adjusted death rate from disease Z for community X is: [TWO POINTS]

11.2 deaths per 1,000

16b. The age-adjusted death rate from disease Z for community Y is: [TWO POINTS]

9.3 deaths per 1,000

COMMUNITY X COMMUNITY Y

Age No. of people No. of Deaths No. of people No. of Deaths

from Disease Z from disease Z

Young 8,000 80 15,000 55

Old 18,000 223 5,000 75

 For Community X:
The specific death rates in community X are:
(80/ 8,000) x 1000 = 10 per 1000 for the Young
(223/18,000) x1000=12.4 or 12 per 1000 for the Old

The standard population

Standard Population: Young = 8,000 + 15,000 = 23,000, Old = 18,000 + 5,000 = 23,000
Total Standard Population = 46,000
Applying the rates From Community X to the standard population we calculate the expected
deaths:
Young: 10 per 1000 x 23,000 = 230 expected cases
Old: 12.4 per 1000 x 23,000 = 285.2 or 285 expected cases
Total Expected cases = 230+ 285 = 515 expected cases in community X
Age-adjusted rate for community X = total expected cases divided by the population of total
standard population = (515 expected cases/ 46,000) X 1000 = 11.2 per 1000

For Community Y:
The specific death rates in community Y are:
(55/ 15,000) x 1000 = 3.6 or 4 per 1000 for the Young
(75/5,000) x1000=15 per 1000 for the Old

The standard population

Standard Population: Young = 8,000 + 15,000 = 23,000, Old = 18,000 + 5,000 = 23,000
Total Standard Population = 46,000
Applying the rates From Community Y to the standard population we calculate the expected
deaths:
Young: 3.6 per 1000 x 23,000 = 82.8 or 83 expected cases
Old: 15 per 1000 x 23,000 = 345 expected cases
Total Expected cases = 83+ 345 = 428 expected cases in community Y
Age-adjusted rate for community Y = total expected cases divided by the population of total
standard population = (428 expected cases/ 46,000) X 1000 = 9.3 per 1000

15. Which of the following is a good index of the severity of a short-term, acute disease?
[ONE POINT]

a. Cause-specific death rate

b. 5-year survival
c. Case-fatality rate
d. Standardized mortality ratio
e. None of the above

Case fatality rate = (Deaths due to the disease / Total number of cases of the disease) x 100. It
represents the degree or power, how a disease can kill a person.
 16. The occurrence in a community or region of cases of an illness, specific health-related
behavior, or other health-related events clearly in excess of normal expectancy is a/an:
[ONE POINT]
A: Pandemic
B: Endemic
C:Epidemic

Pandemic is an epidemic occurring worldwide, usually affecting a large number of

people.
Endemic is refers to infectious disease agent that is habitually present in an environment
Epidemic is more cases than normal expected within a community due to its rapid spread
to a large number of people.

17. The level of prevention that takes place during the early phases of pathogenesis and
includes activities that limit the progression of disease is: [ONE POINT]

A: Primary Prevention
B. Secondary Prevention
C. Tertiary Prevention

Primary Prevention is a level of prevention when people are not sick, it is mostly disease
prevention and health promotion.
Secondary Prevention is use for asymptomatic diseases or early stages of disease with the
goal of early diagnosis and treatment, this includes Screenings.
Tertiary Prevention when the disease is advance with the goal to prevent or delay death.

18. The probability that an event will occur, e.g., that an individual will become ill or die
within a stated period of time or by a certain age is: [ONE POINT]

A: Epidemiologic Transition
B. Risk
C. Hypothesis

Risk include the over health of a person, hereditary, lifestyle. Risk factors are used in a
disease like in Cancer for Breast cancer, it would depend on when the first-degree family
member was diagnosed and you must start mammogram depending on that. For Colon Cancer is
the same you have to do a colonoscopy 10 years earlier the age the first-degree member was
diagnosed and you have to do it 5 years instead of 10 years.

19. A measure that refers to the mortality rate associated with a specific cause of death
divided by the population size at the midpoint of a time period times a multiplier is the:
[ONE POINT]

A: Crude Death Rate

B: Sex-specific Rate
C:Cause-Specific Mortality Rate
 Crude death rate is the number of deaths in specific geographic area during a specific
time per 1,000 mid year total population of the same geographic area. Sex specific
mortality rate is the mortality a month males or females, the numerator and
denominator will be limited to one gender. And Cause specific mortality rate it is the
number of deaths from a specific cause per people at risk.

20. This classifies the occurrence of disease according to the variables of person, place, and
time: [ONE POINT]

A:Descriptive Epidemiology
B: Analytic Epidemiology
C: Environmental Epidemiology

Analytical epidemiology is concerned with the search for causes and effects, or the
why and the how.
Environmental Epidemiology seeks to understand how physical, chemical, biologic,
as well as, social and economic factors affect human health
Descriptive Epidemiology provides a way of organizing and analyzing data to
understand disease frequency geographically and over time, and how disease (or
health) varies among people based on personal characteristics (person, place, and
time).

21. Wearing a safety belt is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

Providing an educational offering about wearing seat belts meets the criteria for primary
prevention because it is aimed at reducing the exposure of persons to injury.

22. Providing education to a diabetic on how to use his/her insulin is an example of which
level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

Tertiary prevention aims to lessen the impact of an ongoing illness or injury that has lasting
effects. This patient is already diabetic and is using insulin for maintenance and to control blood
sugar, to prolong life and to reduce complications of high blood sugar.
 23. Encouraging individuals to take a daily dose of aspirin to reduce the chance of a heart
attack is an example of which level of prevention? [ONE POINT]

a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Community prevention

Secondary prevention is aims to lessen the effect of a disease that has already occurred. For this
question encouraging to take daily dose of aspirin will prevent further heart attack or stokes.

24. Epidemiology is: [ONE POINT]

a) a method of applying primary, secondary, and tertiary prevention in a community setting.

b) concerned primarily with the empowerment of individuals in the of care their own health.
c) the study of the distribution and determinants of diseases in a specific population.
d) concerned only with life expectancy of humans.

Nursing and medicine use epidemiology to help guide clinical practice and influence health
outcomes. It is discipline that provides systematically studying the spreading and factors of
health, disease, and conditions related to health status.
Epidemiology looks at long term and infectious diseases to understand and explain how and why
health and illness occur.

25. Providing training or instructing patients on how to modify their diets and take their
medications to prevent a second heart attack is an example of ________ prevention.
[ONE POINT]

a) primary
b) secondary
c) tertiary
d) community

Tertiary prevention aims to help people with chronic illness, to manage their disease and to
improve function as much as possible to prolong their life,

e) 26. Sensitivity and specificity are important criteria for screening and diagnostic
15. instruments. What is specificity? [ONE POINT]

A) Different method of measuring the same attributes yielding similar results

B) Ability to differentiate the construct being measured from other similar concepts
C) Instrument's ability to identify a case correctly
D) Instrument's ability to identify non-cases correctly.
Convergence refers to the different method of measuring the same attributes yielding similar
results.
Discriminability refers to the ability to differentiate the construct being measured from other
similar concepts.
Specificity is the ability to correctly detect patient who do not have the disease.
Sensitivity is the ability to correctly detect a patient who has a disease.

27. The nurse researcher knows that there are two primary criteria for assessment of
an instrument. What is reliability? [ONE POINT]

A) Degree of consistency or accuracy with which an instrument measures an attribute

B) Magnitude and direction of a relationship between two variables
C) Extent to which an instrument yields the same results on repeated
administrations
D) Extent to which an instrument's items are measuring the same attribute

Reliability in which assessment will produce a stable and consistent result. You must have a
reliable instrument to consider at test to be valid.

28. The purpose of a double blind or double masked study is to: [ONE POINT]

a. Achieve comparability of treated and untreated subjects

b. Reduce the effects of sampling variation
c. Avoid observer and subject bias
d. Avoid observer bias and sampling variation
e. Avoid subject bias and sampling variation

The double masked or double-blind study in which neither the patient/subjects nor observer
knows the control or test group by doing this subjects will be truthful to their symptoms and
there will be more accuracy if a treatment is effective, the observers will have no measurement
bias, because being aware of the intervention given to the subject can lead to decisions to modify
and change the experiment.

29. Which of the following improves the reliability of diabetes screening tests? [ONE
POINT]
a) Having the same lab analyze all samples

b) Taking more than one sample for each subject and averaging the results
c) Insuring that the instrument is standardized before each sample is analyzed
d) a and c only
 e) All of the above

All of the above are needed to have a reliable diabetes screening test. If different labs are
to test the samples, then they might have different normal values or different protocol per
facility, Taking more than one sample to each one so that there will be a reserve sample in
case one isnt enough and averaging to have an equal distribution and to ensure that you
use a standardize equipment so results will be accurate and at the same level.

30. Which of the following is a measure of disease prognosis? [ONE POINT]

a) Prevalence

b) Median survival time

c) Age-adjusted mortality rates
d) Standardized mortality ratio

The mean survival is one way to see how good a treatment works, It is also a way to know the
the average length of time of survival from start of the treatment of the a disease or the date of
diagnosis after a treatment or the disease in general.