2019 end of semester exam PDF

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POPLHLTH 111 Question/Answer Booklet

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THE UNIVERSITY OF AUCKLAND SEMESTER ONE, 2019 Campus: City POPULATION HEALTH Population Health (Time Allowed: TWO Hours)

First name (please write as legibly as possible within the boxes)

Last name

Student ID number

Email Address (Username) Note: x x x x x x

@aucklanduni.ac.nz

This exam consists of 13 questions. The exam is worth 100 marks in total. Calculators are NOT permitted. Print your first name, last name (as they appear on your ID card), ID number and Username in the boxes above. Answer all questions on the Question/Answer sheet. The whole booklet will be handed in at the end of examination. Two overflow pages are provided at the end of this booklet in case you need more space. If you use the overflow page, you must: 1. Within the regular space for that answer, clearly state that your answer is continued on an overflow page (e.g. "Answer is continued on overflow page 21"). 2. On the overflow page, clearly state the question number(s) to which you are responding. Failure to do so may result in your work not being marked.

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Questions 1 and 2 are related to the scenario below: You are a health professional who regularly advises your patients to follow a diet low in saturated fat (SF) in order to reduce their risk of heart disease. During a recent consultation, a patient told you of a new study she read about on the internet that showed no relationship between SF consumption and heart disease. She asks you if you are aware of the study and whether you think that she could now increase her SF consumption without increasing her risk of heart disease. You hadn’t seen the article so you tell her that you will read it and get back to her with your thoughts about its validity. You download a copy of the paper and summarise the study design and results. x The study was undertaken in New Zealand. x In 2001, people aged 45 to 75 years were invited through advertisements in newspapers, on television and social media, to take part in a study that required them to complete a questionnaire about their diet. x The first 20,000 people who responded to the advertisements were recruited into the study. x They were all sent a food frequency questionnaire which had a series of questions about how often they had eaten a range of common foods over the last 3 months. All 20,000 people completed and returned the questionnaire in 2001. x To keep the study simple, no other questions were asked. x From the analyses of the questionnaires, the investigators divided the participants into two equal-sized groups of 10,000 each. x The exposure group included the 10,000 participants with the highest self-reported saturated fat consumption and the comparison group were the remainder (i.e. lower saturated fat consumption). x All participants were followed for 10 years by using their NHI (National Health Information) numbers to check if they had been admitted to hospital or died during the 10 years after they completed and returned their food frequency questionnaires. x Over the 10-year follow-up period there were 950 heart disease events (either admissions to hospital or deaths) in the group reporting higher saturated fat consumption and 1,000 heart attack events in the group reporting lower saturated fat consumption.

POPLHLTH 111 Question/Answer Booklet

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Question 1 a) What kind of epidemiological study design is this? What are the TWO defining features of this kind of study? (3 marks) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

b) Illustrate the study by completing the GATE frame included, using the information from the scenario above. Label the actual GATE frame using JUST the ‘P,E,C,O, and T’ letters. Also draw ONE arrow next to the T. Then draw in the relevant divisions in the GATE frame circle and square, as shown in class and in the GATE Notes, to help describe the study. Finally, write ALL the numbers mentioned above in the GATE frame. Do not add any other words or numbers. (3 marks)

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c) Complete the table below. It should be possible for someone with no knowledge of the study to understand all the important design features of the study, how it was done, and the study numbers by examining your GATE frame and the PECOT descriptions in the table. (3 marks) Write ONE sentence describing EACH component of the study (do not mention the numbers again because you should put these into theGATE frame). *In the ‘E’ section below, also describe how participants were allocated to E or C

P

E*

C

O

T

* Describe how participants were allocated to E or C:

POPLHLTH 111 Question/Answer Booklet

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Question 2 a) The paper reported the occurrence of heart disease in each group and the 95% confidence intervals. The occurrence of heart disease in the higher SF group was EGO = 9.5/100/10 years (95% CI: 8.9 to 10.1) and the occurrence of heart disease in the lower SF group was CGO = 10.0/100/10 years (95% CI: 9.4 to 10.6). The paper also reported that the RR was 0.95 (95% CI: 0.8 to 1.1). No adjustments were made to the analyses. To help make sense of the study results, you use the RAMBOMAN acronym to consider different types of error that might have occurred in the study. RAMBOMAN identifies the stages of a study where errors can occur. At each of the stages included in the table below, state whether you think it is likely that errors would have occurred (Yes or No) AND then in ONE sentence, explain why you chose Yes or No. (6 marks) RAMBOMAN stages

1. State whether you think that the study is likely to have errors at each of the stages included (YES or NO) – ½ mark each; 2. Explain why you think this in ONE sentence – 1 mark each 1. 2.

Recruitment

1. 2. Allocation and Adjustment

1. 2. Maintenance

1. 2. Blind or Objective Measurement of Exposures

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b) Based on the 95% confidence intervals given above for EGO and CGO the study findings are unlikely to be considered statistically significant. Explain why. (2 marks) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

POPLHLTH 111 Question/Answer Booklet

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Question 3 In Norway, the age-standardized hip fracture rate is 420/100,000/year. Whilst this is comparable to Sweden and Denmark, it is nearly double the rates found in sociodemographically comparable countries like France and The Netherlands. To reduce the hip fracture rates, researchers in Norway investigated known food and lifestyle risk factors. The results of their study are summarized below. Risk factor

Heavy alcohol use Low physical activity Tobacco smoking

Prevalence of risk factor in the population 10% 40% 20%

Relative Risk

Risk Difference

2 5 6

30/100 30/100 60/100

Population Attributable Risk 3% 24% 13%

a) Using the terms PGO, CGO and EGO, where CG is the unexposed group, state the formulae for calculating EACH of the following. (2 marks) Risk Difference: _______________________________________________________ Population Attributable Risk: ______________________________________________ b) Assuming that the interventions available have equivalent efficacy, the most effective highrisk (individual) intervention would involve targeting which ONE of the three risk factors noted above? Explain the main reason for your answer using the findings provided in the table. (2 marks) Risk factor: ___________________________________________________________ Reason: ______________________________________________________________________ ______________________________________________________________________ c) Assuming that the interventions available have equivalent efficacy, the most effective population-based (mass) intervention would involve targeting which ONE of the three risk factors noted above? Explain the main reason for your answer using the findings provided in the table. (2 marks) Risk factor: ____________________________________________________________ Reason: ______________________________________________________________________ ______________________________________________________________________

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Question 4 Researchers at the University of Auckland conducted a study to assess a new screening test for hip fractures. The researchers conducted the study among a representative sample of 4000 people living in the North Island. The prevalence of hip fracture in this study population, determined by a gold standard diagnostic test was 10%. The sensitivity and specificity of the new screening test is 90%. Answer the following questions based on these findings. a) Fill in the blanks in the GATE frame below describing the findings of the screening study on hip fractures. (3 marks) P ____

Hip fractures (based on gold standard test)

Hip fractures (based on new screening test)

EG ___

+ -

CG

___

a ___

b ___

c

d 3240

___

b) Calculate the positive predictive value of the screening test when applied to the population of the North Island. Show your workings. (2 marks) Calculation:

Answer: _______________

c) The calculated positive predictive value for the population of the South Island was higher than that of the North Island. In which population is the prevalence of hip fracture likely to be greatest? (1 mark) ______________________________________________________________________

POPLHLTH 111 Question/Answer Booklet

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Question 5 The Index of Multiple Deprivation (IMD) and NZDep2013 are both small area measures of deprivation. Health and Crime are two domains of deprivation included in the IMD that are not in NZDep2013. State the two aspects of deprivation that EACH of these domains measure (4 marks) i)

Health: ____________________ and ____________________

ii)

Crime: ____________________ and ____________________

Question 6 a) The PROGRESS acronym can be used to consider equity in population health. State the relevant word(s) from the PROGRESS acronym associated with each of the population health examples provided in the table below (5 marks) Population Health Example Ownership of malaria bed-nets decreases with decreasing household wealth In many cultures, having a son is preferable to a daughter, and over centuries, this has resulted in infanticide of baby girls Some communities have too few health services to provide adequate levels of primary care Populations with fewer networks are more likely to experience higher rates of mortality Some working environments have a higher risk of injury or death than others

PROGRESS term

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b) Table X shows the results from a recent report that investigated inequities in cycling-related events near major tertiary institutes in New Zealand. Using the data provided in the table below, calculate the Extremal Quotient showing your working AND write your interpretation of the results (3 marks) Table X Tertiary Institute A B C D E F G

Crashes involving cyclists per 1,000 students per year 500 275 300 450 50 120 150

Calculation:

Extremal Quotient: ______________________________________________________ Interpretation: ___________________________________________________________ ________________________________________________________________________

c) List THREE reasons inequities in health should be reduced, as outlined in the paper by Woodward and Kawachi (2000). (3 marks) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

POPLHLTH 111 Question/Answer Booklet

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Question 7 A small survey was conducted to investigate the use of public transport to attend lectures in a small class at The University of Auckland. There were 20 students who were randomly recruited from the class to participate in the survey. Participants were asked a number of questions, including the standard ethnicity question and whether they came to their lecture by public transport (bus, train or ferry) on the day of the survey (Y: Yes) or not (N: No). The researcher decides to report their findings by ethnic group using the Total Response Output method and to classify the ethnicity data at Level 1 of this classification system.

Use of Public Transport

ethnicity 3

ethnicity 2

ethnicity 1

Participant

The participants’ responses are recorded at Level 4 in the Table below:

A

Māori (21111)

N

B

NZ European (11111)

C

Hawaiian (37122)

N

D

Czech (12919)

N

E

European nfd (10000)

G

Indian nfd (43100)

H

Thai (41415)

I

NZ European (11111)

J

Moroccan (51122)

K

Turkish (51127)

L

NZ European (11111)

M

Singaporean Chinese (42114)

N

N

Fijian (36111)

N

O

Australian (12811)

Finnish (12922)

P

Fijian Indian (43112)

NZ European (11111)

N

Q

NZ European (11111)

Māori (21111)

N

R

Filipino (41111)

Cambodian (41211)

Y

S

English (12114)

Māori (21111)

T

French (12924)

U

NZ European (11111)

Burmese (41411)

Indonesian (41412)

German (12711)

Y

N Y

Chinese nfd (42100)

Bengali (43111)

Y Y

Māori (21111)

Y N

Māori (21111)

Y

Italian (12611)

Tongan (33111)

Y

N N

Māori (21111)

Y

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Write down the number of students using public transport to attend lectures (numerator) AND the number of people counted in EACH ethnic group (denominator) below, using the Total Response Output method. (5 marks) A. European:

___________/_____________

B. Māori:

___________/_____________

C. Pacific Peoples:

___________/_____________

D. Asian:

___________/_____________

E. MELAA:

___________/_____________

b) The Ministry of Health prefers to use the Prioritised Output method for ethnicity coding. From the numbered list provided below, identify which are advantages and which are disadvantages of Prioritised Output. Note: there could be more than one advantage or disadvantage. I. II. III. IV.

V. VI.

It is an externally applied single ethnicity which is inconsistent with the concept of self-identification It places people in a specific ethnic group, which over-represents some groups at the expense of others It creates issues in interpretation of data reported by ethnic groupings, where comparisons between groups include overlapping data It ensures that where a need exists to assign people to a single ethnic group, ethnic groups of policy importance or of small size, are not swamped by the New Zealand European ethnic group It creates complexities in the distribution of funding based on population numbers It produces data that is easy to work with as each individual appears only once. This means the sum of the ethnic group populations will add up to the total population in New Zealand (2 marks)

Advantages (list the number(s)): ______________________________________________ Disadvantages (list the number(s)): ____________________________________________

POPLHLTH 111 Question/Answer Booklet

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Question 8 Urban design is an important aspect of the built environment, which can influence population health. The City Rail Link in Auckland is designed to improve connectivity of trains and buses, which in turn will improve levels of ‘active transport’ in the city. List THREE other aspects of urban design taught in class that could improve active transport and/or physical activity AND describe how they would achieve this. (6 marks)

Aspect 1: _________________________ ______________________________________________________________________ ______________________________________________________________________

Aspect 2: _________________________ ______________________________________________________________________ ______________________________________________________________________

Aspect 3: _________________________ ______________________________________________________________________ ______________________________________________________________________

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Question 9 a) Define “Velocity” AND “Veracity” in the context of Big Data. (2 marks) Velocity: ______________________________________________________________________ Veracity: ______________________________________________________________________

b) You are an ethics advisor for the University and are asked to develop a new protocol for big data researchers. You decide to base your protocol on the IDI data access frameworks. State TWO actions that researchers should take to comply with the ‘safe data’ principle. (2 marks) ______________________________________________________________________ __________________...