Epi Final

Front 1

Why do we measure comparisons?

Back 1

summarize relationships between exposure and disease by comparing at least two measures of disease frequency

Front 2

two main options for comparison (2)

Back 2

1. ratio of two measures of disease frequency

2. difference between two measures of disease frequency

Front 3

rate/risk ratio (also called relative risk) definition

Back 3

comparing disease occurrence among exposed with disease occurrence among comparison group (usually unexposed) in a ratio measure

Front 4

formula for rate/risk ratio (relative risk)

Back 4

(rate or risk in exposed group)/(rate or risk in unexposed group)

Rexp/Runexp

Front 5

cumulative incidence formula

Back 5

CIexp/CIunexp

[a/(a+b)]/[c/(c+d)]

Front 6

incidence rate formula

Back 6

IRexp/IRunexp

(a/person-time exp)/(c/person-time unexp)

Front 7

what does calculating the rate/risk ratio (relative risk) tell you?

Back 7

gives info on the relative effect of the exposure on the disease --> tells us how many times higher/lower the disease risk is among the exposed, compared to the unexposed

Front 8

RR = 1.0

Back 8

no association between exposure and disease

Front 9

RR = 2.0

Back 9

two times the risk of disease in the exposed as compared to the unexposed

Front 10

RR = 1.6

Back 10

1.6 times a risk of getting the disease in the exposed compared to the unexposed...or 60% increased risk of disease in the exposed

Front 11

RR = 0.5

Back 11

0.5 times or half the risk of disease in the exposed compared to the unexposed

Front 12

what is a difference measure?

Back 12

comparing disease occurrence among the exposed with the disease occurrence among the unexposed by subtracting one from the other

Front 13

rate/risk difference formula (attributable risk/rate)

Back 13

RD = (rate or risk of exp) - (rate or risk in unexp)

RD = Rexp - Runexp

Front 14

Confidence interval difference formula

Back 14

CIexp - CIunexp

[a/(a+b)] - [c/(c+d)]

Front 15

Incidence rate difference formula

Back 15

IRexp - IRunexp

(a/persontime of exp) - (c/person-time for unexp)

Front 16

RD = 0

Back 16

no association

Front 17

what does the rate/risk difference (attributable risk) give info on? (3)

Back 17

1. gives the absolute effect of exposure on disease occurrence

2. gives the excess disease risk in the exposed group compared to unexposed

3. gives the public health impact of an exposure...assuming exposure causes the disease, how much disease would be prevented if the exposure were removed

Front 18

If RR for lung cancer = 14.0 vs. 1.6 for heart disease, AND RD for lung cancer = 130/100,000/yr vs. 256/100,000/yr, how do we interpret the results? (they surveyed those who smoke and don't smoke)

Back 18

cigarette smoking is a much stronger risk factor for lung disease than for heart disease BUT the elimination of cigarettes would prevent far more deaths from heart disease than lung disease (# people impacted from heart disease is larger than for lung disease)

Front 19

population risk/rate difference (PRD) definition

Back 19

measures excess disease occurrence among the total population that is associated with the exposure.--> Helps evaluate which exposures are most relevant to the health of the population

Front 20

two formulas for PRD

Back 20

1. PRD = (RD)*(Pexp) --> Pexp = proportion of population that is exposed , RD = risk or rate difference

2. PRD = Rtotal - Runexp --> Rtotal = risk/rate in total population, Runexp = risk/rate among unexposed

Front 21

if PRD = 85/100,000 for hypertension disease (non-fatal heart attack is the diagnosis/effect), interpret the results

Back 21

If hypertension were eliminated, 85/100,000 cases of non-fatal heart attacks could be eliminated among the total population studied

Front 22

cohort study definition

Back 22

study where two or more groups of people are free of disease (differing in their exposure vs. unexposure) and are compared with respect to disease incidence

Front 23

In a cohort study, can the researcher allocate exposure?

Back 23

no...he must observe the relationship

Front 24

Ranch hand study: exposed group

Back 24

air force servicemen who sprayed agent orange in Vietnam war (1960's)

Front 25

rand hand study: unexposed group

Back 25

air force servicemen who flew other missions than the agent orange one during Vietnam war (1960's)

Front 26

ranch hand study: outcome of interest

Back 26

cancer, PTSD, adverse male mediated pregnancy outcomes

Front 27

ranch hand study: hypothesis

Back 27

discover if agent orange is not associated with the outcomes under study, then the outcome rates will be the same in both groups

Front 28

randomization of treatments: for a cohort study

Back 28

can't randomize in an observational study so we select a comparison group as alike as possible to the exposed group

Front 29

pacebo use to reduce bias: for a cohort study

Back 29

can't use placebo in observational study so must make groups as comparable as possible

Front 30

blinding to avoid bias: for a cohort study

Back 30

crucial to have follow-up rates and comparable ascertainment of outcomes in the exposed and comparison groups

Front 31

timing of cohort study : retrospective

Back 31

both the exposure and disease have occurred at the start of the study

Front 32

timing of cohort study: prospective

Back 32

exposure has occurred, disease has not occurred

Front 33

timing of cohort study: ambi-directional

Back 33

elements of both the exposure and disease have occurred, but not all of either

Front 34

retrospective traits against prospective?

Back 34

cheaper, faster --> efficient with a disease with long latency period --> exposure data may be inadequate

Front 35

prospective traits against retrospective?

Back 35

more expensive/time consuming --> not efficient with disease with long latency period --> better exposure and confounder data --> less vulnerable to bias

Front 36

issues with cohort study design (8)

Back 36

1. selection of exposed population

2. selection of unexposed group

3. the need to assemble special cohorts for rare exposures

4. assembling a general cohort that will facilitate accurate and complete data if disease is common

5. three possible source of comparison groups

6. Multiple sources of exposure info

7. multiple sources of outcome info

8. multiple approaches to follow-up

Front 37

how do you select the exposed group? Give some examples (6)

Back 37

depends on hypothesis and what's feasible

1. occupational groups

2. groups undergoing specific medical treatment

3. groups with unusual diet/life style

4. professional groups

5. students/ college alumni

6. geographically defined areas

Front 38

give an example of a special cohort

Back 38

rubber workers in Akron, OH --> exposed to benzene industrial solvent --> got cancer

Front 39

give an example of a general cohort

Back 39

Framingham Heart studies --. exposure was smoking and family history --> got heart disease, stroke, gout, etc

Front 40

What's the principle in selecting the unexposed group?

Back 40

you want unexposed to be as close as possible to the exposed group with respect to all factors except the exposure

Front 41

counterfactual ideal: in selecting the unexposed group

Back 41

the ideal comparison group consists of exactly the same individuals in the exposed group had they not been exposed

Front 42

three possible sources of comparison group (3)

Back 42

1. internal comparison: unexposed members of the same cohort

2. comparison cohort: a cohort who is not exposed from another similar population

3. general population data: use pre-existing data from the general pop. as basis for comparison

Front 43

which of the three possible sources of comparison is the best?

Back 43

depends on situation

Front 44

Sources for exposure info? (3)

Back 44

1. pre-existing records: data recorded before the disease occurrence (detail may or may not be adequate, some records are missing, don't contain info on confounders)

2. questionnaires, interviews (good but not routinely recorded and have potential for recall bias)

3. direct physical exams, tests, environmental monitoring

Front 45

sources of outcome information (4)

Back 45

1. death certificates

2. physician, hospital, health plan records

3. questionnaires

4. medical exams

Front 46

why would you use blinding in a cohort study? what would it entail?

Back 46

to ensure that there is comparable ascertainment of the outcome in both groups -->the people who are doing the experiment don't know those who are exposed and those who are unexposed

Front 47

what does every cohort study require in order to ascertain the outcome data?

Back 47

follow-up

Front 48

follow-up definition

Back 48

tracing or following all subjects from exposure into the future

Front 49

what are resources utilized to conduct follow-up?

Back 49

town lists, phone books, birth/death/marriage records, driver's license lists, hospital records, friends/family, etc

Front 50

what is the weakness of follow-up?

Back 50

time consuming

Front 51

what's the problem if one loses a lot of follow-ups?

Back 51

the validity of the study becomes doubtful

Front 52

bias in cohort studies (3)

Back 52

1. selection (healthy worker effect and loss to follow-up)

2. confounding

3. misclassifying

Front 53

loss to follow-up definition

Back 53

researcher loses contact with the participant resulting in the loss of data from that person

Front 54

healthy worker effect

Back 54

workers represent the exposed group and tend to be healthier than the general population

Front 55

confounding bias

Back 55

confounding factor (other factor) is associated with both the exposure and the outcome under study...needs to be controlled for/adjusted for or the data will be skewed

Front 56

misclassification

Back 56

distorts the strength of the rate/risk ratio

-if misclassification of outcome is related to exposure, then it's non-random

-if misclassification of outcome is not related to the exposure, then it's non-differential random

Front 57

strengths of cohort study (3)

Back 57

1. if retrospective, good for rare exposures (long induction/latent periods)

2. can evaluate multiple effects of an exposure

3. if prospective, good info on exposures, less vulnerable to bias, and a clear temporal relationship between the exposure and the disease

Front 58

weaknesses of cohort study (3)

Back 58

1. inefficient for rare outcomes

2. if retrospective, poor info on exposures and more vulnerable to bias

3. if prospective, expensive and time consuming, inefficient for diseases with long induction/latency periods

Front 59

"TROHOC" studies

Back 59

term originally given to case-control studies because their logic seemed backwards (to a cohort study) and they seemed more prone to bias --> no basis to this assumption

Front 60

case-control study

Back 60

method of sampling a population in which cases of the disease are identifies, and a sample of the population that produced the cases --> exposures are determined for individuals in each group

Front 61

when would we want to conduct a case-control study? (5)

Back 61

1. when exposure data are expensive or difficult to obtain

2. when the disease has a long induction/latent period

3. when the disease is rare

4. when little is known about the disease

5. when the underlying problem is dynamic

Front 62

what kind of cases do we use in case-control?

Back 62

ALWAYS use incident (new) cases

Front 63

why do we always use "new" cases in case-control?

Back 63

1. closer in time to causal agent

2. determinants of survival are excluded

3. reduced confusion between cause and effect of disease

Front 64

what do the cases provide in a case-control?

Back 64

the numerator to the rates of disease in exposed and unexposed

Front 65

what do the controls provide in a case-control?

Back 65

the denominator

Front 66

case-control studies can be considered a ???? of a cohort study

Back 66

more efficient form

Front 67

purpose to the controls in the case-control

Back 67

to estimate the exposure distribution in the source population that produced the cases

Front 68

what are sources for finding controls?

Back 68

random digit dialing, residence lists, drivers' license records

Front 69

advantage of general population controls

Back 69

assurance that they come from the same base population as the cases

Front 70

disadvantage of the general population controls

Back 70

time consuming, expensive, hard to contact and get cooperation, may remember the exposures differently than cases

Front 71

recall bias in case-control

Back 71

those with a health problem recall the exposure better

Front 72

response bias in case-control

Back 72

those who respond are different than those who don't

Front 73

Berksonian bias

Back 73

occurs when hospital controls are not from the same source as the cases

Front 74

advantage of hospital controls (4)

Back 74

1. same selection factors that led cases to hospital also led the controls to hospital

2. easy to identify and access

3. accuracy of exposure recall compared to those of cases since controls are also sick

4. more willing to participate bc they're bored

Front 75

disadvantage of hospital controls (2)

Back 75

1. may not accurately represent the exposure history in the population that produced the cases

2. hospital catchment areas may be different for different diseases

Front 76

what illnesses make good hospital controls?

Back 76

this that have no relation to the risk factors under study

Front 77

special controls: who are they and when are they used?

Back 77

friends, spouses, siblings, deceased people --> rarely used

Front 78

The "would criterion"

Back 78

if a member of a control group actually had the disease would he/she end up as a case in my study? answer should be yes!

Front 79

test to analyze a case-control study

Back 79

odds ratio

Front 80

odds definition

Back 80

the ratio of the probability of an event occurring to that of it not occuring

Front 81

odds ratio formula

Back 81

odds of exp being a case/odds of an unexp being a case

(a/b)/(c/d)

Front 82

strengths of case-control (2)

Back 82

1. efficient for rare diseases and diseases with long induction/latent period

2. can evaluate many risk factors for the same disease

Front 83

weaknesses of case-control (4)

Back 83

1. inefficient for rare exposures

2. vulnerable to bias because of retrospective nature of the study

3. may have poor information on exposure because retrospective

4. difficult to infer temporal relationship between exposure and disease

Front 84

9 steps to a good epi analysis - see assign 7 and lecture 9 notes (no notecards)

Back 84

N/A

Front 85

Merriam-Webster's "cause" definition

Back 85

something that brings about a result

Front 86

Rothman's "cause" definition

Back 86

an event, condition, or characteristic that without which, the disease would not have occurred (something that has to be there for the disease to occur)

Front 87

Susser's "cause" definition

Back 87

something that makes a difference

Front 88

association is ??? to causation

Back 88

not equal

Front 89

5 things to consider when evaluating epi associations (5)

Back 89

1. could the association be due to chance?

2. could the association be due to bias?

3. could the association be due to confounding?

4. how representative are the results?

5. does the association represent a cause/effect relationship?

Front 90

characteristics of a cause (3)

Back 90

1. temporality: the cause must precede the effect

2. cause can be either host or environmental factors

3. presence of a causative exposure (positive) or lack of a causative exposure (negative)

Front 91

many times causes get confused with what?

Back 91

risk factors (ex. location) sometimes it's looked at as a cause when really it's just a risk factor

Front 92

divine retribution

Back 92

theory of God's will: you did something wrong and so that's why you're sick...imbalance in body caused by air, water, land, stars, etc

Front 93

miasma

Back 93

disease transmitted by miasmas/clouds clinging to earth's surface

Front 94

germ theory of disease and Henle-koch postulated

Back 94

microbes must always be found with the disease...single agent --> single disease...one to one relationship between exposure and disease

Front 95

web of causation

Back 95

the idea of multiple causes contributing to a chronic disease

Front 96

recent controversies about causation

Back 96

causation cannot be established and causal criteria should be abandoned

Front 97

timeline of causation theories (5)

Back 97

1. divine retribution

2. miasma

3. germ theory

4. web of causation

5. controversy

Front 98

creator of causal pies

Back 98

KJ Rothman

Front 99

causal pies: sufficient cause

Back 99

the whole pie: set of conditions without any one of which the disease would not have occurred

Front 100

causal pies: component cause

Back 100

one piece of the pie: any one of the set of conditions which are necessary for the completion cause

Front 101

causal pies: necessary cause

Back 101

a component cause that is a member of every sufficient cause

Front 102

attributes of the causal pies (4)

Back 102

1. completion of sufficient cause means occurrence of disease

2. component causes can act far apart in time

3. a component cause can involve the presence/lack of a causative exposure

4. blocking the action of any component cause prevents the completion of the sufficient cause and therefore prevents the disease

Front 103

Sir AB Hill (1965) causal "guidelines" (9)

Back 103

1. strength of the association

2. consistency

3. specificity

4. temporality (cause before effect)

5. biological gradient

6. plausibility

7. coherence

8. experiment

9. analogy

Front 104

what are sir AB Hill's causal guidelines?

Back 104

guidelines to help determine if associations are causal

Front 105

should Hill's viewpoints be used as "hard and fast rules"

Back 105

no

Front 106

strength of association

Back 106

the larger the association, the more likely the exposure is causing the disease --> strong associations are more likely to be causal bc they're less likely to be due entirely to confounding or bias --> weak associations may be causal but it is harder to rule out confounding or bias

Front 107

consistency

Back 107

association is observed repeatedly in differing PPT --> replicating the association in different sample (with different studies) gives evidence of causation

Front 108

specificity

Back 108

a single exposure should cause a single disease (especially for infectious disease) --> it's presence DOES provide causality , but it's absence does not mean causation

Front 109

temporality

Back 109

causal factor must precede the disease in time

Front 110

which one of Hill's guidelines does everyone agree with?

Back 110

temporality

Front 111

biological gradient

Back 111

a dose-response relationship between exposure and disease --> some exposures have a "threshold" below which there are no adverse outcomes rather than a "dose-response"

Front 112

plausibility/coherence

Back 112

it just makes sense: association does not conflict with current knowledge, research, history, and biology

Front 113

experiment

Back 113

investigator-initiated intervention can modify the exposure (lessen it) and in turn lessen/remove the disease (good evidence of causation, but most studies are just observational)

Front 114

analogy

Back 114

has a similar relationship been observed with another exposure/disease?

Front 115

what is a requirement for causality?

Back 115

temporality

Front 116

why do we perform clinical trials?

Back 116

document effectiveness/safety of a new "therapy" to obtain FDA approval

Front 117

characteristics of clinical trials?

Back 117

focused on individuals, exposure is manipulated, tightly controlled, restricted bc only those that met the study criteria can participate

Front 118

definition of "phases" of clinical trial and how many phases are there?

Back 118

stage that occurs in drug development...there's 4 phases

Front 119

clinical means...

Back 119

human

Front 120

pre-clinical means...

Back 120

animals

Front 121

T/F: pre-clinical studies must occur before clinical

Back 121

true

Front 122

phase 1

Back 122

<100 healthy people --> gather data on safety, toxic effects, gross side effects

Front 123

phase 2

Back 123

100-200 sick people --> safety, side effects, proof of concept

Front 124

phase 3

Back 124

3K to 9K sick individuals --> 4 yrs --> safety, effectiveness, side effects, indications of use--> 5 diff doses

Front 125

phase 4

Back 125

marketplace --> safety and effectiveness --> general population with disease and off-label use

Front 126

after drug is in stage 4, the company has to tract what?

Back 126

adverse effects and outcomes

Front 127

after drug is out, what happens is one sees it doing a different positive effect

Back 127

they go back to phase 3 and do a new study for that new effect

Front 128

strengths to animal studies (4)

Back 128

1. few ethical issues

2. low costs

3. fast results

4. gives a "model"

Front 129

weaknesses to animal studies (2)

Back 129

1. results may not be applicable to humans

2. dosing amounts are different

Front 130

ethical issues with clinical studies: historically

Back 130

informed, voluntary consent must be obtained before study begins

Front 131

ethical issues with clinical studies: control groups

Back 131

all controls must be treated with same care and "treatment" as cases...they still get a placebo, it's just not the real drug

Front 132

other considerations with clinical trial: study group

Back 132

must be representative of the whole population

Front 133

attrition

Back 133

people dropping out of study is a worry, so figure out why they're dropping out...intent-to-treat

Front 134

community trial strengths

Back 134

ability to obtain direct, realistic estimates

Front 135

community trial limitations

Back 135

less control over study populations/randomization

Front 136

screening tests goal

Back 136

recognize a disease before the onset so we can have earlier intervention

Front 137

screening tests strengths (4)

Back 137

1. less expensive

2. quicker

3. less effort

4. less risk

Front 138

screening tests limitations (2)

Back 138

1. bias

2. reliability/validity of tests

Front 139

screening

Back 139

identification of unrecognized disease or defects by the application of tests, exams, other rapidly applied tests --> positive screens are followed by diagnostic tests to confirm actual disease

Front 140

situations for screening tests/programs

Back 140

social

scientific

ethical

Front 141

social

Back 141

health problem is important to community --> diagnostic follow-up and intervention is available when required --> favorable cost-benefit ratio --> public acceptance is high

Front 142

scientific

Back 142

history of the condition is understood --> prevalence of disease is high

Front 143

ethical

Back 143

program can alter the natural history of the condition in a significant proportion to those screened --> suitable, acceptable tests for screening and diagnosis of the condition as well as acceptable, effective prevention methods

Front 144

when should a screen test NOT be performed?

Back 144

when there's no treatment available

Front 145

characteristics of a good screening test (5)

Back 145

1. simple

2. rapid

3. inexpensive

4. safe

5. acceptable

Front 146

evaluation of screening tests (2)

Back 146

1. reliability: repeated measurements, consistency

2. validity: content accurate

Front 147

reliability

Back 147

precision: the ability of a measuring instrument to give consistent results

Front 148

repeated measurement reliability

Back 148

degree of consistency among repeated measurements of the same person on more than one occasion

Front 149

internal consistency reliability

Back 149

the degree of agreement or homogeneity within a questionnaire measure of an attitude, personal characteristic, psychologic attribute

Front 150

interjudge reliability

Back 150

reliability assessments derived from agreement among trained experts

Front 151

validity

Back 151

accuracy: the ability of a measuring instrument to give a true measure

Front 152

relationship between reliability and validity

Back 152

it's possible to be highly reliable and not valid --> it's not possible to be valid but not reliable

Front 153

measurement bias

Back 153

constant errors that are introduced by a faulty measuring device and tends to reduce the reliability of measurements

Front 154

study screening calculations --> lecture 10b --> assign 8

Back 154

NA

Front 155

study age adjustment calculations --> lecture 11 --> assign 9

Back 155

NA

Front 156

charity reporting act of 1994

Back 156

required for all not-for-profit hospitals --> makes sure that the needs of the community are being met

Front 157

definition/purposes/attributes of community based health care (10)

Back 157

1. dynamic process - changes based on the needs of the community

2. identify health problems and goals

3. establishes health priorities

4. facilitates collaborative action planning

5. improves community health status, quality of life, reduces overall healthcare costs

6. improve multiple sectors of the community

7. based on quantitative/qualitative population based health status/services data

8. emphasis on community ownership

9. develop community competence in IDing and responding to health problems and goals

10. prioritizes need to strategically plan

Front 158

components of a community health assessment (6)

Back 158

1. assemble existing data

2. assess quality of data among the data sets (there may be costs associated with this)

3. collect additional data: objective and subjective

4. identify and prioritize concerns

5. inventory resources

6. compare concerns with resources to ID unmet need and opportunities for collaborative effort (collaborate, don't compete)

Front 159

objective data

Back 159

medical records/lab tests

Front 160

subjective data

Back 160

surveys/focus groups/key informants (a leader in the community that has a unique knowledge about the community and what you are studying--> they may be helpful in pushing things through and answering Q's)

Front 161

info needed for community based research (7)

Back 161

1. good quality data (objective)

2. perceived needs

3. perceived barriers (planning for a data/project analysis mid program and allocating funds/gathering data at the beginning for the analysis)

4. attitudes (are people collaborative or confrontational?)

5. behaviors (are they easy or hard to change?)

6. knowledge

7. support/decision info

Front 162

data concerns in community health based program (4)

Back 162

1. cost per effort to obtain

2. quality (reliability/validity?)

3. population based/sampling scheme

4. standard measures

Front 163

direct outcomes of community health assessment (6)

Back 163

1. better understand the health status of the community

2. description of health indicators

3. identification of health concerns

4. prioritizing of health concerns - developing a strategic plan

5. matching resources with needs

6. recommendation of appropriate actions - evidence based decision making

Front 164

indirect outcomes of community health assessment (4)

Back 164

1. build alliances between/among agencies and facilities

2. foster community involvement

3. learn how to better measure health indicators

4. reputation as a community resource knowledge about community health problems/concerns

Front 165

environmental hazard exposures (6)

Back 165

1. chemical agents

2. electromagnetic radiation

3. ionizing radiation

4. heavy metals

5. air pollution

6. temperature increases from global warming

Front 166

health effects attributed to environmental exposures (4)

Back 166

1. cancer

2. infertility

3. reproductive/developmental impacts

4. infectious diseases (Malaria)

Front 167

hazardous agents in the workplace (5)

Back 167

1. ionizing radiation

2. infectious agents

3. toxic substances

4. drugs

5. carcinogenic agents

Front 168

health effects attributed to hazardous agents in the workplace (5)

Back 168

1. health risks for pregnant workers and unborn fetus

2. various lung diseases

3. dermatologic problems

4. bladder cancer among dye workers

5. leukemia among workers exposed to benzene

Front 169

study designs in env. epi and what they do (3)

Back 169

1. descriptive - provide info for IDing new problems and hypothesizing new risks

2. etiologic - shows exposure-effect relationships

3. retrospective cohort studies - studies the effects of occupational exposures

Front 170

what does one use to collect exposure data in the work place?

Back 170

employment records (personal ID info, demographics, work history, info about potent ion confounders)

Front 171

healthy worker effect in relation to occupational exposure (hint: morbidity and mortality)

Back 171

health worker effect may reduce the measure of effect for an exposure that increases morbidity or mortality

Front 172

ecologic study designs do what?

Back 172

measure the association between exposure with morbidity/mortality

Front 173

case-control studies (pertaining to ecological studies)

Back 173

provide more complete exposure data (against cross sectional) but precise exposure data may be difficult bc of confounding

Front 174

env epi: dose-response curve

Back 174

assess the effect of exposure...as dose goes up, effect should go up

Front 175

env epi: threshold

Back 175

lowest dos at which a response occurs

Front 176

env epi: latency

Back 176

time period between initial exposure and a measurable response

Front 177

env epi: synergism

Back 177

combined effect of several exposures is greater than sum of individual effects (2+2=5)

Front 178

chemical agents

Back 178

household cleaners, paints, pesticides, auto chemicals

Front 179

what are acute toxicity effects of chemical agents?

Back 179

skin irritation

Front 180

what are chronic toxicity effects of chemical agents?

Back 180

cancer

Front 181

insecticides

Back 181

kills insects

Front 182

herbicides

Back 182

kills plants (weeds)

Front 183

rodenticides

Back 183

kills rodents

Front 184

four classes of insecticides

Back 184

1. organophosphates

2. organocarbamates

3. pyrethroids

4. organochlorides

Front 185

three examples of organochloride insecticides

Back 185

1. DDT - toxic to wildlife

2. lindane - head lice treatment

3. chlordane

*all very persistent

Front 186

asbestos

Back 186

mineral fiber used in building materials associated with lung cancer

(used in insulation, ship building materials, construction, cars)

Front 187

three toxic metals

Back 187

1. arsenic

2. mercury

3. lead

Front 188

mercury's uses

Back 188

used to treat syphilis, agricultural fungicide, and in dental amalgams

Front 189

what effects is mercury responsible for?

Back 189

Minamata disease (mid 1950s) in Minamata, Japan --> neurological condition due to contaminated fish consumption

Front 190

lead's uses

Back 190

paints, gasoline

Front 191

what effects is lead responsible for?

Back 191

central nervous system effects (even at low levels), intelligence/development/behavior effects

Front 192

during what years did children's elevated blood lead levels decline?

Back 192

1988-2002

Front 193

electron/magnetic fields include...

Back 193

nonionizing radiation: power lines, microwaves, radios, ovens, stoves, clocks, cell phones

Front 194

LA and swedish studies found an association between proximity to power lines and ....

Back 194

cancer risk

Front 195

US and norwegian studies found increased risk for .... among male electrical workers?

Back 195

male breast cancer

Front 196

ionizing radiation consists of...

Back 196

high energy protons, neutrons, and particles (alpha/beta) --> electromagnetic energy in x-rays/gamma rays

Front 197

ionizing radiation: natural sources

Back 197

radon and cosmic rays--> radon is the cause of nearly 20% of U.S. lung cancers

Front 198

ionizing radiation: synthetic sources

Back 198

medical x-rays and nuclear generators

Front 199

allergens

Back 199

provoke an allergic reaction in those susceptible

Front 200

physical and mechanical energy

Back 200

agents associated with accidental injury/ unintentional injuries/ noise, vibration, temperature extremes

Front 201

what is the leading cause of death within the age group 1-44?

Back 201

accidental injuries

Front 202

hazard surveillance (in the occupation)

Back 202

ID and characterize the known chemical, physical, biologic agents

Front 203

sentinel health event

Back 203

case of unnecessary disease, disability, death --> the occurrence of it is a warning signal that the preventative actions and medical care needs improved

Front 204

biologic hazards

Back 204

hospital employees, sewage workers, agricultural workers are exposed to biohazards daily

Front 205

mineral and organic dusts

Back 205

coal dust (mining and black lung disease) and rubber dust (COPD)

Front 206

vapors

Back 206

organic solvents (benzene) can cause cancer and damage organs (especially the liver) --> drunken symptoms

Front 207

exposure in the occupational setting is up to .....times ....than in the ambient environment

Back 207

100 times higher

Front 208

psychosocial aspects of occupational health

Back 208

work overload (coronary heart disease), job stress, absence, and physical activity

Front 209

a study found an association between work stress and what disease?

Back 209

periodontal disease

Front 210

community environmental health hazards (4)

Back 210

1. hazardous waste sites

2. air pollution

3. nuclear facilities

4. drinking water

Front 211

notorious waste sites (5)

Back 211

1. love canal, NY

2. valley of the drums, KY

3. times beach, MO

4. string fellow acid pits, Ca

5. Casmalia waste disposal facility, Ca

Front 212

what's the biggest concern with hazardous waste sites?

Back 212

contaminated water supplies

Front 213

air pollutants (4)

Back 213

1. sulfur oxides

2. particulate matter

3. ozone

4. heavy metals

Front 214

studies conducted in.... and....and....show a correlation between increased air pollution and....

Back 214

NYC, St Louis, Tennessee --> increased air pollution and daily mortality

Front 215

environmental tobacco smoke (ETS) --> second-hand smoke causes what?

Back 215

reduced lung function --> 3,000 lung cancer deaths annually --> bronchitis, asthma, pneumonia

Front 216

nuclear facilities include

Back 216

weapon production, testing sites, and nuclear power plants

Front 217

studies show that living in proximity to nuclear facilities shows results of what?

Back 217

cancer

Front 218

drinking water may be what?

Back 218

may be contaminated from toxicants leaching into ground water

Front 219

what helps clean drinking water? what does this decrease?

Back 219

chlorination --> decreases new cases of GI disease

Front 220

what toxicants are most present in drinking water?

Back 220

lead, asbestos