47 which is app 2 deaths from polio per 100000 people 1987 11353680 x 100000

# 47 which is app 2 deaths from polio per 100000 people

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= 1.47 which is app. 2 deaths from polio per 100,000 people 1987 = 11/353,680 x 100,000 = 3.11 app. 3 1988 = 2.51 app. 3 1989 = 3.1 app. 3 1990 = 4.1 app. 4 The deaths from polio was constant from 1987 to 1989 before increasing in 1990. Case Fatality Rate = Total deaths from polio/Total no. of cases having polio X 100 1986 = 5/45 x 100 = 11.1 which is app. 11% 1987 = 11/62 x 100 = 17. 7 which is app. 18% 1988 = 10/49 x 100 = 20.4 app 20% 1989 = 14/82 x 100 = 17.07 app. 17% 1990 = 20% Questions 8 and 9 refer to the following information: OUTCOME AFTER 10 YRS At Beginning of Study CHD Developed CHD Did Not Develop 2,000 Healthy smokers 200 1,800 4,000 Healthy non- smokers 70 3,930 The results of a 10-year cohort study of smoking and coronary heart disease (CHD) are shown above: 8. The incidence of CHD in smokers that can be attributed to smoking is: [ONE

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APPLIED EPIDEMIOLOGY 6 POINT] Risk/Incidence of CHD in smokers = a/(a+b) x 100 = 200/(200+1800) x 100 = 10% 9. The proportion of the total incidence of CHD in smokers that is attributable to smoking is: [ONE POINT] Risk in non-smokers = c/(c+d) x 100 = 70/4000 x 100 = 1.75 Therefore AR = (10 – 1.75) which 8.25 app. 8 This means that smoking alone causes 8 cases of CHD per 100 people who smoke 10. Discuss the types of study design that can be used in assessing causality? Which one is the gold standard? [TWO POINTS] Randomized clinical trials and cohort studies are the two study designs which can be used to assess the cause of a disease. In a randomized control trials, the investigator identifies the study population and then groups them into two groups – control and treatment group. In the treatment group, the investigator introduces a change deliberately and then measures the effect that the introduced change has on the outcome the researcher is interested in. The intervention and control group are then followed to determine whether the disease develops or not. Cohort studies on the other hand, is whereby the researcher identifies two groups of participants who have been exposed to a given factor and then follows them overtime to establish whether the disease develops. Randomized clinical trials is the gold standard because it usually the most accurate. 11. To study the relationship between oral contraceptive (OC) use and ovarian cancer, CDC initiated a study – the Cancer and Steroid Hormone Study. Case-patients were enrolled through eight regional cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. a. What type of design is this study? Where they can get the comparison group? [ONE POINT] Cohort study design: The participants were enrolled in a study and followed overtime to establish the development of ovarian cancer in the exposed and the non-exposed group. The comparison group can be obtained from hospital visitors. b. What types of bias are of particular concern in this study? [ONE POINT] o Bias in the ascertainment of the exposure status o Temporal bias c. What steps might you take to minimize these potential biases in this study?
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