What are focus areas of nutritional epidemiology?

a) The role of nutritional factors in causing disease in a population.

b) How changes in food intake in the population can promote good health.
c) Both of the options given are correct.
d) None of the options given is correct.

Question 2

In an epidemiological context, what is the population at risk?

a) The proportion of a population that engage in risky behaviours.

b) The group of people that may experience the outcome we want to study.
c) A group of people participating in a study that may be harmful to them.
d) The population group with the highest relative risk of disease.

Question 3

In which one of the following circumstances will the prevalence of a disease in the population
increase, all else being constant?

a) If the incidence rate of the disease falls.

b) If survival time with the disease increases.
c) If recovery of the disease is faster.
d) If the population in which the disease is measured increases.

Question 4

Which of the following statements about exposures is true?

a) 'Exposure' refers to contact with some factor that may be harmful or beneficial to health.
b) An exposed individual has a greater risk of disease.
c) Dietary intake is not an 'exposure' because individuals make a choice about what they eat.
d) High body mass index is a risk factor for a range of health conditions, therefore, it cannot
be treated as a single exposure.

Question 5

Epidemiological measures of effect assess the _______ between an exposure and an outcome.

a) strength of the causal mechanisms

b) strength of the reversibility
 c) strength of the association
d) strength of a confounding factor

Question 6

It is possible to reduce (though not eliminate) information bias in assessment of dietary intake
by

a) gathering information about many different aspects of people's dietary habits.

b) collecting data about dietary intake at the onset of a study, before people have experienced
symptoms of disease.
c) collecting data on all possible confounders.
d) making sure that the study sample is representative of the population.

Question 7

In a cohort study, the risk ratio of developing diabetes was 0.86 when comparing consumers of
tea (the exposed) to those who did not drink tea (the unexposed). Which one statement is
correct?

a) The tea drinkers have lower risk of developing diabetes.

b) The tea drinkers have higher risk of developing diabetes.
c) Based on the information given we cannot tell if the observed difference in disease risk is
the result of chance.
d) The risk ratio is close to the value one, so there is no difference in disease risk between the
two groups.

Question 8

When epidemiologists judge the evidence to establish possible causes of a health outcome, they
consider

a) The estimated strength of the association between an exposure and the outcome.
b) Evidence that the exposure of interest has appeared before the outcome.
c) Evidence showing that reductions in the exposure level will reverse the risk of the
outcome.
d) All of the options given.

Question 9

Randomised, controlled trials provide strong evidence that an observed effect is due to the
intervention (the assigned exposure). One reason is because
 a) when the participants are randomised, many characteristics and possible confounding
factors are likely to be evenly distributed in the groups.
b) it is easier to measure the outcome variable with great precision in randomised, controlled
trials compared to in other study designs.
c) the exposure level and the outcome are measured at the same time.
d) the study participants are volunteers and therefore motivated to take part in the study.

Question 10

Confounding is a particular challenge in nutritional epidemiology because

a) people change their diets over time.

b) it is difficult to measure people's diets accurately in large studies.
c) the are no good methods to adjust for confounding in nutritional studies.
d) different dietary components are correlated with each other, making it difficult to separate
their effects.

Questions and Answers

1.
In 1945 there were 1,000 women who worked in a factory painting radium dials on watches. The
incidence of bone cancer in these women up to 1975 was compared with that of 1,000 women who
worked as telephone operators in 1975. Twenty of the radium dial painters and four of the telephone
operators developed bone cancer between 1945 and 1975. This study is an example of a:
A. Experimental study
B. Case series
C. Clinical trial
D. Cohort study
E. Case-control study

2.
Question 2-3. The following table gives the results of a screening test for diabetes compared to a
confirmatory evaluation (oral glucose tolerance test). The sensitivity of this screening test for diagnosing
diabetes is:
A. 23%
B. 29%
C. 63%
D. 99%
E. 100%

3.

Question 2-3. The following table gives the results of a screening test for diabetes compared to a
confirmatory evaluation (oral glucose tolerance test). The specificity of this screening test for diagnosing
diabetes is
A. 23%
B. 29%
C. 63%
D. 99%
E. 100%
4.

The following figure show the epidemic curve for an out break of fever and rash among a group of
children at a summer camp. They were exposed to a younger relative of one of the campers with fever
and rash who had come to visit on the 9th • The average incubation period for the organism in this
outbreak is
A. 8 days
B. 12 day
C. 16 days
D. 20 days

5.

A comparison of clinically diagnosed versus autopsy-confirmed gastric and peptic ulcers was performed
or 100„000 consecutive diseased patients in several large hospitals as shown in the following table,
From these data, the sensitivity of clinical diagnosis was:
A. 1,500/1700
B. 200/96,000
C. 95,800/96,000
D. 1,500/4,000
E. 2,500/4,000
6.
You would typically use a descriptive study
A. For a comparison between a new SSRI drug and Venlafaxine
B. To compare the difference between random sampling and alternate sampling methods for assessing
the efficacy of [CT and psychotherapy as a treatment for depression patients with psychotic depression
C. To document a cluster of Wegener's granulomatosis cases that has recently appeared in your area
D. To evaluate the effects of Team Based Learning (TBL) versus didactic lecture
E. None of the above

7.
Validity can be defined as:
A. The degree to which an instrument measures what it is supposed to measure.
B. The degree to which results are consistent on a repeat measurement
C. A measure of the degree or strength of association between two variables.
D. Concerned with measuring the frequency of new cases with reliability
E. None of the above

8.
Reliability can be defined as:
A. The degree to which an instrument measures what it is supposed to measure
B. The degree to which results are consistent
C. A measure of the degree or strength of assoclation between two variables
D. Concerned with measuring the frequency of new cases with reliability
E. Ensuring that patients all take a test under the same conditions

9.
A school district has been using an intelligence test to evaluate students and make important placement
decisions, such as who gets placed into gifted and other special education settings. However, a group of
psychologists advises the school district that there is a problem with this particular test. More
specifically, the criticism is that scores on this test correlate too highly with students socioeconomic
status. This criticism most directly suggests a problem with the test's:
A. Internal consistency
B. Test-retest reliability
C. Discriminant validity
D. Convergent validity
E. Predictive validity

10.
California Highway Patrol statistics revealed that more accidents occurred to blue cars than to cars of
any other color. The inference that while driving a blue car, one is at higher risk of an accident than
while driving a car of another color is
A. Correct
B. Incorrect, because the comparison is not based on rates
C. Incorrect, because no control or comparison group is used
D. Incorrect, because no test of statistical significance has been made
E. Incorrect, because prevalence is used instead of incidence

11.

An outbreak of gastritis occurred on a cruise ship. The data in the following table were obtained shortly
after the outbreak, from a questionnaire completed by everyone on board the ship. What is the relative
risk of developing gastritis from herring consumption?
A. 0,5
B. 2,0
C. 2.3
D. 8,0
E. 1,0

12.
In a study of 500 cases of a disease and 500 controls, the suspected etiological factor is found in 400
cases and 100 controls. The absolute risk of disease in people with the factor is
A. . 80%
B. 40%
C. 16%
D. 20%
E. Cannot be computed from the data given

13.
Epidemic refers to
A. A disease that has a low rate of occurrence but that is constantly present in a community or region
B. An attack rate in excess of 10 per 1,000 population
C. The occurrence of finesses of similar nature clearly in excess of the normal expectation for that
population at that time
D. Diseases of the respiratory system that occur seasonally
E. The annual case rate per 100,000 population
14.
Regionville is a community of 100,000 persons. During 1985 there were 1,000 deaths from all causes. All
cases of tuberculosis have been found and they total 300 - 200 males and 100 females. During 1985,
there were 60 deaths from tuberculosis, 50 of them males. The crude mortality rate for Regionville is
A. 300 per 100,000
B. 60 per 1,000
C. 10 per 1,000
D. 100 per 1,000
E. 200 per 1,000

15.
The mean birth weight of first-born infants of 23 women who smoked more than one pack of cigarettes
per day during pregnancy was 200 g lower than those of the first-born infants of 16 women who never
smoked, The difference was statistically significant at the 5% level (P<0,05). This means which of the
following?
A. Smoking during pregnancy retards fetal growth
B. The difference observed between mean birth weights was too large to have occurred by chance alone
C. The difference observed between mean birth weights could have been easily occurred by chance
alone
D. The number of patients studied was not sufficient to achieve a conclusive result
E. Smoking during pregnancy does not influence fetal growth

16.
An outbreak of gastritis occurred on the Northern Star cruise ship travelling from New York to Nassau.
The data in the table below was obtained from a questionnaire completed by everyone on board the
ship, shortly after the outbreak. Data from an Outbreak of Gastritis on the Northern Star Cruise Shuzii
FOOD People who ate food People who did not eat food Sick Well Sick Well Shrimp
and rice 200 SOO 100 900 Chicken 650 350 100 900 Stir fried pork 200 800 500 500 Oysters 300 700 400
600 Chocolate mousse 600 400 450 550 Given this information, what is the relative risk of developing
gastritis from Shrimp and rice on the Northern Star ship?
A. 5.0
B. 1.0
C. 3.2
D. 2,0
E. 7.5

17.
You would typically use a descriptive study
A. For a comparison between a new SSR1 drug and Venlafaxine
B. To compare the difference between random sampling and alternate sampling methods for assessing
the efficacy of ECT and psychotherapy as a treatment for depression patients with psychotic depression
C. To document a cluster of Wegener's granulomatosis cases that has recently appeared in your area
D. To evaluate the effects of Team Based Learning (TBL) versus didactic lecture
E. None of the above

18.
Validity can be defined as:
A. The degree to which an instrument measures what it is supposed to measure.
B. The degree to which results are consistent on a repeat measurement
C. A measure of the degree or strength of association between two variables
D. Concerned with measuring the frequency of new cases with reliability
E. None of the above

19.
Reliability can be defined as:
A. The degree to which an instrument measures what it is supposed to measure.
B. The degree to which results are consistent
C. A measure of the degree or strength of association between two variables.
D. Concerned with measuring the frequency of new cases with reliability
E. Ensuring that patients all take a test under the same conditions.