following information applies to questions 1-4. In January 2000 you began a one-year study o

1. following information applies to questions1-4.
   In January 2000 you began a one-year study of tuberculosis (TB) in a subsidized housing community in the Lower East Side of New York City. You enrolled 500 residents in your study and checked on their TB status on a monthly basis. At the start of your study on January 1st, you screened all 500 residents. Upon screening, you found that 20 of the healthy residents were immigrants who were vaccinated for TB and so were not at risk. Another 30 residents already had existing cases of TB on January 1st. On February 1st, 5 residents developed TB. On April 1st, 5 more residents developed TB. On June 1st, 10 healthy residents moved away from New York City were lost to follow-up. On July 1st, 10 of the residents who had existing TB on January 1st died from their disease. The study ended on December 31, 2000. Assume that once a person gets TB, they have it for the duration of the study, and assume that all remaining residents stayed healthy and were not lost to follow-up.
   What was the prevalence of TB in the screened community on January 1st?Answer

2. 		50/500, or 10%
   		30/500, or 6%
   		20/450, or 4.4%
   		30/450, or 6.7%

2 points

Question 2

What was the prevalence of TB on June 30th?Answer

		10/450, or 2.2%
		10/500, or 2%
		40/500, or 8%
		40/490, or 8.2%

2 points

Question 3

What was the cumulative incidence of TB over the year?Answer

		10/450, or 2.2%
		40/500, or 8%
		10/480, or 2.1%
		40/450, or 8.9%

2 points

Question 4

What was the case-fatality rate among residents with TB over the course of the year?Answer

		10/500, or 1.02%
		10/40, or 25%
		10/30, or 33%
		10/450, or 2.2%

2 points

Question 5

The purpose of double blinding in clinical trials is to:Answer

		Reduce error that results from how the outcome is assessed
		Reduce error that results from subject's participation in the trial
		Reduce error that results from assignment to study conditions
		The 1st and 3rd answers only
		All of the above

2 points

Question 6

An analysis that includes all subjects who were randomized to the treatment and comparison groups, regardless of whether they received or completed their assigned study protocol.Answer

		Run-in period
		Efficacy analysis
		Comparability
		Intent-to-treat analysis

2 points

Question 7

The ideal comparison group in a cohort studyAnswer

		Is as similar as possible to the exposed group with respect to factors other than the exposure that could influence the development of disease.
		Would, if possible, consist of exactly the same individuals in the exposed group had they not been exposed.
		Both of the above
		Neither of the above

2 points

Question 8

Noncompliance in an experimental study biases the results toward the null.Answer

True

False

2 points

Question 9

The following information applies to questions 9and 10.
A study was done to determine whether the amount of money spent on soft drinks was related to mortality from diabetes. The investigators collected data on per capita (average per person) soft drink consumption in 10 U.S. states and examined its relationship to mortality rates from diabetes in those 10 states. In order to calculate per capita sales, they gathered annual data on soft drink sales from commerce records and then divided these figures by the state's population from the most recent Census. The mortality data were gathered from the vital records department in each state. Here are the data that they collected.

U.S. State	Annual Per Capita Soft Drink Sales	Annual Diabetes Mortality Rate (per 100,000 population)
Massachusetts	$150	207
New York	$300	353
Florida	$500	688
Alabama	$700	801
Alaska	$50	75
California	$500	605
Nevada	$200	310
Idaho	$250	325
Ohio	$400	454
Arkansas	$350	405

What type of study is this?Answer

		Ecologic
		Cross-sectional
		Case-control
		Cohort

2 points

Question 10

Based on these findings, the investigators concluded that there was an association between consumption of soft drinks and mortality from diabetes. A potential flaw in this reasoning is that it is not known if the people who died from diabetes consumed soft drinks.Answer

True

False

2 points

Question 11

Each activity below has a specific purpose in epidemiological research. Match each activity in the first column with its corresponding purpose in the second column by selecting the correct letter. Each activity has only one correct answer.Answer

- A. B. C. D. Conduct screeningRead Answer Items for Question 11 - A. B. C. D. Blind/mask study staffRead Answer Items for Question 11 - A. B. C. D. Include a large sample sizeRead Answer Items for Question 11 - A. B. C. D. Use matchingRead Answer Items for Question 11

Answer A. Decreases confounding B. Decreases interviewer bias C. Increases statistical stability D. Improves survival

2 points

Question 12

The following information applies to questions 12-14.
An article was recently published on the relationship between caffeine consumption during pregnancy and low birth weight. The article was based on the results of a case-control study. As you know, caffeine is present in a wide variety of beverages, foods, and medications, including coffee, tea, and colas. The following statements have been taken from the introduction and results sections of the article. Select the Hill's guideline that best describes each statement.
Caffeine exposure during pregnancy could have a harmful effect because caffeine interferes with cell division, metabolism, and growth.Answer

		Consistency
		Dose-response
		Temporality
		Biological plausibility
		Strength of the association

2 points

Question 13

Four prior case-control studies and three cohort studies of caffeine intake during pregnancy have shown an increased risk of low-birth-weight infants among women who consumed high amounts of caffeine.Answer

		Consistency
		Dose-response
		Temporality
		Biological plausibility
		Strength of the association

2 points

Question 14

The risk of low birth weight increased as the caffeine consumption increased. Compared to women who did not consume any caffeine during pregnancy, the relative risk of giving birth to a low-birth-weight infant was 1.4 for women who had low caffeine consumption, 2.3 for women who had moderate caffeine consumption, and 5.6 for women who had high caffeine consumption.Answer

		Consistency
		Dose-response
		Temporality
		Biological plausibility
		Strength of the association

2 points

Question 15

Use the following information to answer questions 15-17.
Suppose that your company has just developed a new screening test for a disease and you are in charge of testing its validity and feasibility. You decide to evaluate the test on 1000 individuals and compare the results of the new test to the gold standard. Below are the results.

		Gold Standard Determination of Disease	Total
Results of Screening Test		Yes	No
Positive	285	7	292
Negative	15	693	708
Total	300	700	1,000

Calculate thesensitivity of the new screening test. Answer

		285/300 = 95%
		285/1000 = 28.5%
		15/300 = 5%
		693/700 = 99%

2 points

Question 16

What is the correct interpretation of the results of a calculation ofspecificity?Answer

		The test is able to correctly classify as positive 95% of those with the disease.
		The test is able to correctly classify as negative 99% of those without the disease.
		Of those who screened positive, 97.6% of them actually have the disease.
		Of those who screened negative, 97.9% of them actually do not have the disease.

2 points

Question 17

What would happen to thepredictive value positive if this test were administered in a population with a disease prevalence of 1% instead of 30%? (Note that the sensitivity and specificity of the test remain the same.)Answer

		Predictive value positive would remain the same.
		Predictive value positive would increase.
		Predictive value positive would decrease.

2 points

Question 18

The following information applies to questions 18 through 20.
The association between cellular telephone use and the risk of brain cancer was investigated in a case-control study. The study included 475 cases and 400 controls and the following results were seen:

		Cases	Controls
Cellular Phone User	Yes	270	200	470
No	205	200	405
	Total	475	400	475

Calculate the odds ratio based on these data.Answer

		OR = (200*205) / (270*200) = 0.76
		OR = (270/475) / (200/400) = 1.33
		OR = (270/470) / (200/405) = 1.80
		OR = (270*200) / (200*205) = 1.32

2 points

Question 19

The p-value for this odds ratio is 0.06. What is the correct interpretation of this p-value?Answer

		Given that the null hypothesis is not true, the chances of seeing these results, or more extreme results, is 6%
		Given that the null hypothesis is true, there is a 6% chance that users of cell phones will develop brain cancer
		Given that the null hypothesis is true, the chances of seeing these results, or more extreme results, is 6%
		Given that the null hypothesis is not true, there is no association between cell phone use and brain cancer

2 points

Question 20

Gender was considered a potential confounder and effect measure modifier in this study. The data were stratified into males and females in order to assess these issues.

Males	Females
		Cases	Controls			Cases	Controls
Cellular Phone User	Yes	242	150		Yes	28	50
No	100	50		No	105	150
Stratum-specific OR = 0.8		Stratum-specific OR = 0.8

Choose the correct statement about gender as a confounder and/or effect modifier in this study.Answer

		Gender is a confounder and effect modifier.
		Gender is not a confounder but is an effect modifier
		Gender is a confounder but not an effect modifier
		Gender is neither a confounder nor an effect modifier

2 points

Question 21

The uses of epidemiology include:Answer

		Understanding how a risk factor is related to a health outcome
		Developing etiologic hypotheses
		Evaluation of health services
		All of the above

2 points

Question 22

John Snow:Answer

		Was the father of modern biostatistics.
		Established postulates for transmission of infectious disease.
		Was an early epidemiologist who used natural experiments.
		Argued that the environment was associated with diseases such as malaria.

2 points

Question 23

A dynamic population is one that adds new members through immigration and births and loses members through emigration and deaths.Answer

True

False

2 points

Question 24

Descriptive epidemiology characterizes the amount and distribution of disease within a population to enable the epidemiologist to:Answer

		Test hypotheses regarding causality of disease
		Generate testable hypotheses regarding etiology
		Evaluate trends in health and disease within a population
		The 2nd and 3rd answers only
		All of the above

2 points

Question 25

When interpreting public health data from different sources, it is important to consider:Answer

		The amount of missing data
		The population covered
		Any changes in data collection methods
		The 2nd and 3rd answers only
		The 1st and 3rd answers only
		All of the above

2 points

Question 26

A study collects information on occupation and blood pressure among current Mass Turnpike toll booth collectors and current Turnpike office workers. What type of study is this?Answer

		Case report
		Case series
		Ecological study
		Cross-sectional study

2 points

Question 27

27)The Health Professionals Cohort Study began in 2005 in order to evaluate a series of hypotheses about men's health relating nutritional factors to the incidence of serious illnesses such as cancer, heart disease, and other vascular diseases. Every two years, members of the study will receive surveys with questions about diseases and health-related topics like smoking, physical activity, and medications taken. The surveys that ask detailed dietary information will be administered in four-year intervals. What kind of cohort study is this?Answer

		Retrospective
		Prospective
		Ambidirectional

2 points

Question 28

Selection bias is most likely to occur in which type of study?Answer

		Prospective cohort studies
		Retrospective cohort studies
		Case-control studies
		Both the 2nd and 3rd answers

2 points

Question 29

Interviewer/recording bias can occur inAnswer

		Case-control studies only
		Cohort studies only
		Experimental studies only
		Any type of epidemiologic study

2 points

Question 30

Differential misclassification can bias study results in which direction?Answer

		Toward the null
		Away from the null
		Either toward or away from the null

2 points

Question 31

Which of the following is true about theP value?Answer

		Indicates the probability of seeing the observed result, and results more extreme, by chance alone (given that the null hypothesis is true)
		Indicates the probability that the null hypothesis is true
		Rules out the role of bias and/or confounding
		Indicates that the results observed are of medical or public health significance

2 points

Question 32

When assessing the results of a study, what are the possible explanations for the observed results? Answer

		The observed results may be due to chance (i.e., random error)
		The observed results may be true
		The observed results may be due to bias
		The observed results may be due to confounding
		All of the above

2 points

Question 33

Which of the following statements is/are true about the 95% confidence interval?Answer

		If you did the study 100 times and got 100 point estimates and 100 confidence intervals, in 95 of the 100 results, the true point estimate would lie within the given interval.
		The range within which the true measure of effect lies with a stated probability, or a certain degree of assurance (95%).
		The confidence interval is calculated around the point estimate and quantifies the variability around the point estimate.
		The 1st and 2nd answers only
		All of the above

2 points

Question 34

Compensating research participants is a necessary part of the research protocol, ensures participation, and enhances the quality of the data collected.Answer

True

False

2 points

Question 35

A cohort study of liver cancer among alcoholics was conducted. Incidence rates of liver cancer among alcoholic men are compared to a group of non-alcoholic men. Gender is a confounder in this study.Answer

True

False

2 points

Question 36

Which of the following should be included in an informed consent process?Answer

		An explanation of the research study
		A statement that a participant may withdraw at any time from the study
		An acknowledgement of possible risks to the participant
		Information on whom to contact for answers to questions about the research
		The 1st, 2nd, and 3rd answers only
		All of the above

2 points

Question 37

A study of the risk of pulmonary hypertension among women who take diet drugs to lose weight was undertaken. The crude relative risk of pulmonary hypertension comparing diet drug users to nonusers is 17.0, and the age-adjusted relative risk is 5.0. Age is a confounder in this study.Answer

True

False

2 points

Question 38

Town A and Town B are both located in Massachusetts. Both towns have approximately 100,000 residents, and their own water supply. Fluoride is added to the water supply of Town A; nothing is added to the water supply of Town B. The decision to add fluoride to Town A's water, and not Town B's, was made using a random number table. Both towns are monitored and compared with regards to the occurrence of new cases of dental caries (cavities) over a 5 year period. What type of study is this?Answer

		Individual Preventive Randomized Controlled Trial
		Community Preventive Randomized Controlled Trial
		Individual Therapeutic Randomized Controlled Trial
		Community Therapeutic Randomized Controlled Trial

2 points

Question 39

Subjects with a confirmed diagnosis of carpal tunnel syndrome were compared to a comparable group without carpal tunnel syndrome and both groups were asked about their prior occupational and recreational exposures, including hours per week of computer use. This is an example of which study design?Answer

		Case-control study
		Prospective cohort study
		Retrospective Cohort Study
		Cross-sectional study

2 points

Question 40

The difference between primary and secondary prevention of disease is:Answer

		Primary prevention means control of causal factors, while secondary prevention means control of symptoms.
		Primary prevention means control of acute disease, while secondary prevention means control of chronic disease.
		Primary prevention means control of causal factors, while secondary prevention means early detection and treatment of disease.
		Primary prevention means increasing resistance to disease, while secondary prevention means decreasing exposure to disease.