School of Public Health

Public health Nutrition

Take home exam
31/3/2020

‫ الساعة الرابعة مساء‬3.4.2020 ‫عليكم تقديم الحل عبر الصف االلكتروني و ذلك حتى يوم الجمعة‬

Q1: Select the most appropriate answer, only one is correct?

A. During an 8-hr work shift at a corporate headquarters building, 30 employees (20
females and 10 males) visited the company's physician with complaints of nausea,
vomiting, headaches, and dizziness. All affected individuals responded to the
supportive treatment and were sent home.
In order to search for possible causes of the outbreak, the physician performed an
investigation.

* 1. If 600 persons worked in the building, then the attack rate (CI) was:
a. 3%. B. 5%. c.10%. d. 20%. e.30%.
**the answer is (B) 5%

* 2. If 400 females and 200 males worked in the building then the male-to-female ratio was:
a. 0.3 b.0.5 c.1.0 d. 2.0 e. 3.0

the answer is ( b)0.5

B. The table below shows the distribution of cases and population at risk by floor of the
office building:-

Floor No. Of cases Persons at risk

A 4 20
B 7 155
C 6 135
D 8 180
E 5 110
TOTAL 30 600

* 3. The floor with the highest risk was:-

a. A b. B c. C d. D e. E
the answer is (A)
* 4. The risk for workers on the high-risk floor was greater than the overall risk (risk for all)
by __4___ times (higher by how many times?).
a. 1 b. 2 c. 3 d. 4 e. 5
the answer is (d)
 5. If we would like to apply the overall risk to highest floor risk then the expected
number of cases an that floor would be:
 a. 1 b. 2 c. 3 d. 4 e. 5
the answer is (a) 1
C. A survey of all workers was conducted to determine whether other persons were
affected beyond (other than) those who sought care at the physician's office. All 600
employees were surveyed. 400 questionnaires were completed and returned. A total of
80 persons reported symptoms consistent with the syndrome observed among workers
who sought medical attention.

* 6. The response rate among all workers to the questionnaire was:

a. 5.0% b. 7.5% c. 20.0% d. 37.5% e. 67.0%
the answer is (e)
* 7. Based an the survey the attack rate was:
a. 5.0% b. 7.5% c. 20.0% d. 37.5% e. 67.0%
the answer is c
* 8. From all with symptoms The proportion of individuals who sought care was:
a. 5.0% b. 7.5% c. 20.0% d. 37.5% e. 67.0%

the answer is ( d)
* 9. It was considered that the outbreak was a point source. The factors which suggest this
was:
1. Tight clues tearing of cases in time of onset.
2. No more than average risk among office-mates of cases.
3. Lack of similar illness among family members of cases.
4. Lack of further cases when the cooler was removed .
5. Large number of affected persons.
(five)
10. If you were informed that Coliforms were isolated from 20 of the cases and from 5 of the
well people then the percentage of risk attributed to Coliform that can be avoided is:
a. 97% b. 66% c. 50% d. 33% e. 40%

* 11. If any person suffered from the symptoms remains as carrier and 5 of these people died
then the prevalence after one year would be about:
a. 4.2 b. 6% c. 10% d. 4.11% e. 114%
75\595=0.12

Q2: Answer by true or false and if you answer by false then what would make
the statement correct.

__1.fales Infant mortality rate is the death rate of children during the first year of life where
the denominator is all born in the same year.
Number of new death of chidren less than year and the denomiator the all born alive
in the same year

fales2. The importance of child mortality rate comes from the fact that it reflects the effect
 of malnutrition and infections diseases for the people aged 1-8 years old.
Aged 1-less than5 years
false_3. In the person time incidence rate each person continues being presented in the
denominator unless he is infected or dead, while in CI the denominator includes all
healthy people at the beginning of the study.
In the incidence rate person time the denominator include total time free of disease
(even if he dies) while in CI the denomiator include all population at risk at the
beginning of the period
true_4. The prevalence rates are not usually used for evidence on causality but they are
suitable for diseases with gradual onset. For chrinoc disease

false5. The CI = Incidence rate when the rate is high and the study period is long.
When the rate is low or when the study period is low

true6. If Salmonella were isolated from 5% of students who ate in the university cafeteria
during one year of follow up, this means that there is an association between eating
in the cafeteria and salmonella.

Q 3. Select the most correct answer for the following:

1. Herd immunity is aid to be existed when:
a) A large population of the community is immunized which do no allow for
person to person infection

2.What is the most likely effect on risk, as the incidence rate of stomach cancer
decreases ?
a) Increase c) Stay the same
b) Decrease d) Can’t be determined from this information
3. If a new drug was inserted in the treatment of a chronic disease and you know that the
affected patients will not cure but prevent occurrence of additional cases by reducing the
bacteria shedding you expect the following to happen for incidence and prevalence:
a. Incidence will increase, prevalence will decrease.
b. Incidence will remain unchanged and prevalence will decrease.
c. Non of them will be affected.
d. Incidence will decrease and prevalence will become stable

4. If a disease was recorded at an annual rate of 5/100,000 with no change occurring over
the past five years then the disease can be called:
a. Endemic b. Epidemic c. Pandemic d. all answers are correct.

5. The role of Vitamin D deficiency in the occurrence of osteoporosis among women can
be classified as ___________ in causation:
a. host b. agent c. environment d. all choices are correct

Q.4 One of the achievements of epidemiology is the clarification of the health

disease spectrum and Natural history. Give an example of a disease and draw
 a model for it (Graph) indicating on it the deferent stages of the spectrum, the
causative factors and levels of intervention.
Type 2 diabetes is a chronic condition that affects the way your body receives
sugar (glucose), which is an important source of energy for your body.

When you have type 2 diabetes, your body resists the effect of insulin, a
hormone that regulates the movement of sugar in cells, or does not produce
enough insulin to maintain a normal glucose level.

Type 2 diabetes is popular with adult diabetes, but today the number of
children with this disorder is increasing, perhaps as a result of increased
obesity in childhood. There is no cure for type 2 diabetes, but it can help you
lose weight, eat good food, and exercise in controlling diabetes. If diet and
exercise are not enough to control your blood sugar well, you may also need
diabetes medication or insulin therapy.

Causative factors of diabetes tybe2 melitus

Genetic susceptibility
Environmential factors
Lack of exercise (physical)
Nutrition obisity
Insuline resistance

Q.5 20,000 person are living in a city. 1000 of these were born this year and are under the
age of 1 year old. 5000 are between 1 and 4 years old.

1. If you were informed that a disease has attacked the city killing 500 person then
the mortality rate in the city is:
500\20000=0.025=2.5%

2. If 20 of the deaths are under 1 year old the infant mortality is:
20\1000=.02=20%

3. If the total number of infected people was 7,500 then survival rate was:
Case fatilaty=500\7500=0.067 1-0.067=0.93 the survival is 93%
4. Based on the previous question the morbidity rate was:
7500\20000=0.375 = 37%
Q.6. In a laboratory that deals with radioactive materials workers were
provided with protection coats to protect them from radiation. 100 worker
from the total of 500 in the lab. have never used the coat as they do not feel
comfort with it. The public health authority have checked all the workers at
the time of employment when they were supplied with the coats and non had
cancer. Four years later they were re-tested, results were as following:
16 of the coat users developed cancer and 40 of the non users developed
cancer. The rest were free.
Note: Consider the people wearing the coat as non exposed to radiation and
those not wearing it as exposed.
1. Fill in the table:

Diseased Not Total

diseased
Exposed 40 60 100

Not 16 384 400

exposed
Total 56 444 500

2. What is the incidence among the exposed?

=40\100=0.4
3. What is the incidence among the unexposed?
16/400=0.04

4. .What is the relative risk (risk ratio) in non users as compared to users.?
Interpret the result.
RE/R-E=0.4\0.04=10fold R.R more than 1
There is an association between exposure and the outcome ten fold
‫ مرات‬10 ‫تزيد نسبة الحدوث مع التعرض ب‬
5. What is the risk attributable to not using the coats?

.4-.04=0.36 36%
6. What is the proportion (percent) of cancer among non users attributed to not
using the coats? Interpret your results.

0.36\0.4=0.9 90% percent of disaeae can be eleminated if the

exposure stopped
7. what is the proportion (percent) of cancer among all the workers (total
population) attributed to not using the coats? Interpret your results

0.4-0.112=0.228\0.4=0.72 72% percent of disease in total population can be

eleminated if the exposure stopped