CMAN 380 Module Final Exam 2023 with complete
solution
Epidemiologic Triangle
Environment, agent, host
Factors
factors affected by...
-diet/exercise
-recreational activities
-management of stress levels
Genes vs. Lifestyle
Heart Disease
-Family history made up only 17% of a person's risk
-Poor lifestyle choices, 83% of the risk
Cancer
-About 25% of colon cancers are in people with some family history of the disease
-75% of colon cancers are not from genetics
-80% to 90% of lung cancers are caused by smoking
Types of studies
prospective v. retrospective
Prospective study key components
All subjects are free of disease at the start of the study
Establish a causal association between factor X and the disease Y
Demonstrate a temporal relationship (factor X preceded disease Y)
Prospective study time frame
Investigators have a primary focus
Example: to learn more about cardiovascular disease or cancer
Data collected from the cohort is over time
Investigators identified a cohort (group) of possible subjects who would be feasible to
follow for a prolonged period
Prospective study examples
Framingham Heart Study
Nurses Health Study
Physicians' Health Study
Framingham heart study
In 1948, FHS scientists and participants embarked on an ambitious project to identify
risk factors for heart disease. Today, the study remains a world-class epicenter for
cutting-edge heart, brain, bone, and sleep research
Calculate a Risk Score
Learn your risk of developing heart disease. Type simple information such as your age
and weight into our calculators.
High blood pressure, high blood cholesterol, smoking, obesity, diabetes, physical
inactivity
, Risk assessment tool for estimating your 10 year risk of having a heart attack
Framingham heart study
Evidence Based Research
taking findings from studies and implementing into practice
Colas and Osteoporosis from Framingham Osteoporosis Study
cola consumption lowers bone mineral density in older women
related to phosphoric acid
Prospective Study NHS 3
These studies are largest and longest investigations that influence women's health
started in 1976, expanded in 1989, still going
can join at any time
Findings from Nurses' Health Study (NHS)
Smoking increases risk of colon cancer
A Mediterranean-type diet reduces risk of incident of CHD and stroke. Fish intake
reduces risk of stroke.
Refined carbohydrates and trans fats increase risk of CHD.
Physical activity (>3 hours/week reduces risk of breast cancer.
Diabetes increases risk of hip fracture.
Increasing years spend working rotating night shifts increases risk of hip fracture.
Higher Vitamin D level lowers risks of colon cancer
Banning Trans Fats
Trans fats in a comprehensive
assessment of diet in the
Nurses' Health Study cohort of more
than 100,000 women and developed
a regularly updated database of the trans-fat content of foods.
After 8 years of follow-up and after accounting for known risk factors for heart disease,
we found that women with the highest intake of trans fats had a 50% higher risk of
hospitalization or death attributable to coronary heart disease
Margarine-primary source of trans fat-greater risk
Health Professional Follow up Study
Largest prospective study on men's health
Began in 1986 to learn men's lifestyle factors to incidence of serious illnesses
Predictors of CVD:
Smoking, weight, exercise, alcohol, fruits and vegetables, whole grains, nuts, sugary
beverages, red and processed meat
Yogurt and prevention of type 2 DM
Cancer Study
Purpose is to identify risks for various cancers associated with lifestyle factors.
Retrospective Study
-the cases have already occurred before the investigator initiates the study
-investigators "jump back in time" to identify a useful cohort which was initially free of
disease and 'at risk'
-causal statements should not be made
-use available records to determine exposure status at the beginning of the observation
period
solution
Epidemiologic Triangle
Environment, agent, host
Factors
factors affected by...
-diet/exercise
-recreational activities
-management of stress levels
Genes vs. Lifestyle
Heart Disease
-Family history made up only 17% of a person's risk
-Poor lifestyle choices, 83% of the risk
Cancer
-About 25% of colon cancers are in people with some family history of the disease
-75% of colon cancers are not from genetics
-80% to 90% of lung cancers are caused by smoking
Types of studies
prospective v. retrospective
Prospective study key components
All subjects are free of disease at the start of the study
Establish a causal association between factor X and the disease Y
Demonstrate a temporal relationship (factor X preceded disease Y)
Prospective study time frame
Investigators have a primary focus
Example: to learn more about cardiovascular disease or cancer
Data collected from the cohort is over time
Investigators identified a cohort (group) of possible subjects who would be feasible to
follow for a prolonged period
Prospective study examples
Framingham Heart Study
Nurses Health Study
Physicians' Health Study
Framingham heart study
In 1948, FHS scientists and participants embarked on an ambitious project to identify
risk factors for heart disease. Today, the study remains a world-class epicenter for
cutting-edge heart, brain, bone, and sleep research
Calculate a Risk Score
Learn your risk of developing heart disease. Type simple information such as your age
and weight into our calculators.
High blood pressure, high blood cholesterol, smoking, obesity, diabetes, physical
inactivity
, Risk assessment tool for estimating your 10 year risk of having a heart attack
Framingham heart study
Evidence Based Research
taking findings from studies and implementing into practice
Colas and Osteoporosis from Framingham Osteoporosis Study
cola consumption lowers bone mineral density in older women
related to phosphoric acid
Prospective Study NHS 3
These studies are largest and longest investigations that influence women's health
started in 1976, expanded in 1989, still going
can join at any time
Findings from Nurses' Health Study (NHS)
Smoking increases risk of colon cancer
A Mediterranean-type diet reduces risk of incident of CHD and stroke. Fish intake
reduces risk of stroke.
Refined carbohydrates and trans fats increase risk of CHD.
Physical activity (>3 hours/week reduces risk of breast cancer.
Diabetes increases risk of hip fracture.
Increasing years spend working rotating night shifts increases risk of hip fracture.
Higher Vitamin D level lowers risks of colon cancer
Banning Trans Fats
Trans fats in a comprehensive
assessment of diet in the
Nurses' Health Study cohort of more
than 100,000 women and developed
a regularly updated database of the trans-fat content of foods.
After 8 years of follow-up and after accounting for known risk factors for heart disease,
we found that women with the highest intake of trans fats had a 50% higher risk of
hospitalization or death attributable to coronary heart disease
Margarine-primary source of trans fat-greater risk
Health Professional Follow up Study
Largest prospective study on men's health
Began in 1986 to learn men's lifestyle factors to incidence of serious illnesses
Predictors of CVD:
Smoking, weight, exercise, alcohol, fruits and vegetables, whole grains, nuts, sugary
beverages, red and processed meat
Yogurt and prevention of type 2 DM
Cancer Study
Purpose is to identify risks for various cancers associated with lifestyle factors.
Retrospective Study
-the cases have already occurred before the investigator initiates the study
-investigators "jump back in time" to identify a useful cohort which was initially free of
disease and 'at risk'
-causal statements should not be made
-use available records to determine exposure status at the beginning of the observation
period
