A study on the condition known as Down’s Syndrome found that birth order was inversely associated with incidence of Downs Syndrome.

A study on the condition known as Down’s Syndrome found that birth order was inversely associated with incidence of Downs Syndrome. Birth order is the order a child is born into their family (first, second, third etc). Complete the diagram below and explain the relationship between birth order, Down’s Syndrome and maternal age. Note: If you do not have a health background you will have to do some background reading on Down’s Syndrome.                                                            (3 marks)

2.      Assess the following scenarios and identify the method used to control for confounding and provide a brief description of how the method controls confounding.   

       (9 marks) 

In each scenario, exercise is the exposure, myocardial infarction (heart attack) is the disease and sex is the confounder.

A.     A study of exercise and myocardial infarction that is limited to men.

B.      A case control study of exercise and myocardial infarction that includes men and women. Controls are selected so that the proportions of male and female subject groups are identical.

C.      A study of exercise and myocardial infarction that includes men and women. The study determines relative risk separately for men and women and compares these to the crude relative risk.

3.

A) Examine the above pie charts which show two causal mechanisms for the development of lung cancer. Using the sufficient-component cause model of disease causation, describe which are component causes, which are necessary causes and which are sufficient causes for lung cancer.                                                                                         (6 marks)

B) Describe how any of the component causes shown may fulfill any two of Bradford-Hills criteria for causation.                                                                             (4 marks)

C) Compare the sufficient-component cause model with Bradford-Hills criteria for causation and discuss why the sufficient-component cause model is better.          (5 marks)

4.      A case control study was conducted to examine the effects of kava drinking and prostate cancer in Fiji. Cases of prostate cancer were matched to controls and the following results were tabled.

  Fijian: I Taukei Fijian: Indian Origin Fijian: Other races Combined

  Kava Use Yes Kava Use No Kava Use Yes Kava Use No Kava Use Yes Kava Use No Kava Use Yes Kava Use No

Case (Prostate cancer) 113 57 82 58 56 44 251 159

Control

(No prostate cancer)

65 105 57 83 52 48 174 236

A)     Calculate the appropriate crude measure for the association between kava use and prostate cancer overall, and interpret this finding.                                                     (3 marks)

B)      Calculate the odds ratios for kava use and prostate cancer for each ethnic group.

(6 marks)

C)      Describe the purpose of stratification of results by ethnicity and explain what the resultant odds ratios (in a. and b.) indicate about the relationship between kava use and prostate cancer.                                                                                                         (5 marks)

5.      A rapid kit screening test for identifying Typhoid was applied to 500 people. It is known that the prevalence of Typhoid in this population is 51 cases per 100 people (0.51). The sensitivity of the test is known to be 94.12%. The specificity of the test is known to be 89.80%

A)     Discuss what the sensitivity and specificity of this test indicate.              (4 marks)

B)     Use the information given above to complete the table below.        (4 marks)

  According to Gold Standard  

Screening Test Result Positive (Typhoid) Negative ( No Typhoid) Total

Positive  

Negative  

Total  

C)     Calculate the positive and negative predictive values for the test and interpret these.

     (4 marks)

D)     Describe how the test would perform in a population with lower prevalence of Typhoid.                                                                            (2 marks)

6.      Measles outbreaks are becoming are becoming a concern globally. Measles is considered to be highly infective. Describe what this means and in a short essay describe three factors that could be contributing to the increased incidence of measles worldwide. In addition, discuss two preventive strategies that would be needed to prevent an outbreak of measles in your setting and justify why these strategies would be needed. [Be sure to identify these as being either a high risk or mass interventions]. Describe three strategies for controlling a measles outbreak should one occur in your setting.                                                                                                               (15 marks)

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