Reference no: EM132368502 , Length: word count : 1200
Assignment
CASE 1. The Case of the Capri Tourist "Trots".
The Italian Ministry of Public Health investigated an incident in the tourist district of Capri Island, Italy, which involved a gastrointestinal illness outbreak among a group of 22 U.S. tourists.
The tourists who became ill reported that they had felt fine and then all of a sudden began feeling bad an average of 4.5 hours after eating near the central square in the city. Most of them reported multiple symptoms including stomach coli., diarrhea, nausea and vomiting or feelings of wanting to vomit. Their symptoms lasted an average of 26 hours.
The national and international news media outlets picked up the story and caused a panic resulting in many calls to the mayor's office a dramatic drop in the number of tourists visiting downtown Capri and a loss of business in the same. After interviewing many people from the tour, epidemiologists from the Capri Dept. of Public Health identified "hand-crafted" tuttifrutti gelato purchased from a single street vendor as the most likely source. They determined that virtually all the sick persons had ingested the gelato but that the 18 non-sick (well) people on the tour had rarely done so.
Your task: Based on the symptoms and putative vehicle: (i) identify the most likely cause of the illness (putative pathogen), (2) the study design that would have been used by the Italian epidemiologists to identify the source, and (3) the statistical methods they most likely used to analyze their data to confirm or reject their hypothesis.
CASE 2. The Case of the Depressed Dentists.
The epidemiological evidence suggests that U.S. dentists are at-risk for many stress-related physical and emotional conditions including back, neck, and hand pain, eye strain, marital problems, alcohol and drug addiction, depression and suicide.
In addition, suicide rates among dentists is more than doubled that of the general population and close to three times greater than other white collar and professional workers. Epidemiologists at the American Dental Association (ADA) undertook a study to identify the factors associated with suicide in U.S. dentists. They used extant 2000-2010 data from a national U.S. Department of Labor database which contained data on occupational, sociodemographic, and other characteristics and merged it with files from a national mortality database maintained by the U.S. Department of Health and Human Services.
• Your task: (i) Identify the study design.
CASE 3. The Case of the Resistant Chicken Workers.
A study of 258 workers at the Rico (Tasty Chicken) chicken processing plant in Aguas Calientes) Mexico, was undertaken to determine the risk for developing antibiotic resistant bacteria in their upper respiratory tracts. Throat and nasal swabs were taken prior to the workers beginning their employment at the chicken processing plant and the results indicated that all were negative for any antibiotic resistant strains. The workers were tested every 6-months for a 6o-month period.
At the end of the 6o months, 51% of the chicken workers tested positive for at least one strain of antibiotic resistant bacteria and 26% tested positive for multi-drug resistant strains. Workers on the chicken parts processing line were 2.5 and 4.1 times more likely to test positive for antibiotic resistant bacteria strains compared to their respective co-workers on the chicken packaging line and those loading semi-trucks with the packaged chicken products.
• Your task: (1) Identify the three most likely bacterial strains that may have infected the chicken workers (2) and identify the study design used.
CASE 4. The Case of the Shaky Drugs.
Pre-clinical neurotoxicity study results have raised serious concerns about the adverse effects of methamphetamines and other amphetamine-type stimulant abuse and dependence on the brain. Specifically, it has been hypothesized that these stimulants may damage dopamine neurons, resulting in dopamine-related disorders such as Parkinson's disease (PD). Investigators in Kentucky conducted a study to investigate the long-term medical consequences of methamphetamines and other amphetamine-type stimulant abuse and dependence.
They used statewide records which contained information on illicit drug abuse and dependence linked to the Kentucky medical records database. They compared the drug histories among patients with a confirmed diagnosis of Parkinson's disease made during the period January 1, 2010 and December 31, 2012 with patients of the same age, ethnicity, and sex who had been admitted during the same time period for other non-neurological conditions (e.g., gallbladder surgery).
• Your task: (1) Identify the study design used
CASE 5. The Case of the Jiarfing Moms.
Nausea and vomiting symptoms (NVP) affect approximately 75% of all women during early pregnancy. The cause remains unknown despite many decades of study. An FAO researcher decided to investigate the association of the reported NVP prevalence in 21 countries with quantitative estimates of per capita intakes of major food groups. She reported finding that countries with higher NVP prevalence had significantly higher per capita intakes of simple carbohydrates and fruits but lower intakes of coffee, alcohol, and animal products including meat, fish, and milk and eggs.
Your task: (1) Identify the study design used
CASE 6. The Case of the Fishy Switch and Bait.
Investigators at UCLA designed a study to investigate the efficacy of fish oil dietary supplements for lowering blood pressure in female adults with primary hypertension. Their study involved a group of too hypertensive, postmenopausal patients who were randomly assigned to receive either a fish oil supplement or a matched control supplement (corn oil) along with their regular anti-hypertension medications for an 8-week period. At the end of the 8-week period, all too subjects stopped taking either the fish or corn oil supplements for four weeks. Then, at the end of the 4-week period, the subjects who had previously received the fish oil supplement were given the corn oil control supplements; those previously on the corn oil were given the fish oil supplements. The two groups continued to receive these supplements for another 8-weeks.
• Your task: (0 Identify the study design used and (2) the most appropriate data analysis method(s).
CASE 7. The Case of the Autoimmune Ex-Flyboys.
A study was conducted at the Veteran's Administration (VA) to evaluate the association of personal factors and self-reported environmental and occupational exposures with the risk of scleroderma. Sixty male airforce veterans with a positive history of sclerodema were recruited from VA neurological outpatient centers (2010-2015) across the United States and 6o without scleroderma were recruited from VA outpatient hospital records who were similar regarding age, sex, and ethnicity. A detailed questionnaire was used to collect data on occupation, vocational and recreational exposures, and sociodemographic and lifestyle factors was administered to the 120 male participants. Chronic occupational exposure to jet fuel was associated with increased risk for scleroderma after controlling for smoking, drug use, education, and other factors. No associations were found for chronic occupational exposure to pesticides, herbicides, flame retardants, or other chemicals.
• Your task: (1) Identify the study design used and the type and the most common clinical manifestations of the disease.
CASE 8. The Case of the Runny Amazonian Pre-Schoolers.
During a 3-week period, a study team investigated the association of a specific type of severe intestinal infection with linear growth stunting and impaired cognitive development in pre-school children living in low-income
neighborhoods in a peri-urban area of Manaus, Brazil. The parents of the affected children reported that their kids were experiencing frequent, painful passage of stools (diarrhea) with an acrid-like odor that looked like it was composed of a mixture of mucus, water, and blood. Some of the kids also experienced rectal prolapse. Laboratory analysis of stool samples confirmed a specific cause.
• Your task: (i) identify the most likely cause of children's symptoms and (2) the most appropriate study design to investigate this problems
CASE 9. The Case of the Dirty Yellow Key Conch Eaters.
In June 2010, clusters of illnesses were reported in Miami-Dade, Broward, and Monroe counties in southern Florida among persons who had eaten at seafood restaurants. The illness that the 56 identified patients developed was characterized by fatigue, nausea and vomiting, abdominal pain/discomfort, clay-colored bowel movements, jaundice, loss of appetite, low-grade fever, dark urine, joint pain. Florida state epidemiologists identified conchs as the source of the outbreak. Further investigation revealed that the suspect conchs were harvested at Marathon Key and the cause was identified.
• Your task: (1) Based on the symptoms and putative vehicle, identify the most likely cause of the illness and its incubation time and, (2) identify the most appropriate study design for investigating this important local public health problem
CASE 10. The Case of the Chemically Disrupted Workers.
A study was conducted to investigate the hypothesis that men chronically exposed to endocrine-disrupting (EDC) chemicals in their workplace have an increased risk for developing prostate cancer. The researchers used published data from n northern European cohorts (1980 to 2015; n= 150,757) to investigate the association of job titles with exposure to io EDC groups. Twelve percent of the men were classified as exposed to EDCs at work based on their job titles. Classification of exposure to one or more EDC groups was associated with an increased risk of prostate cancer (OR= 1-25; 95% C-I.= 1-04, 1-49) as were most specific EDC groups. This association was consistent across cohorts. In addition, prostate cancer risk rose with increasing number of EDC groups (OR 2.11; 95% C.1.= 1.10, 4.06) for exposure to 4 or more EDC groups).
• Your task: (1) identify which type of occupational EDC exposures are most likely associated with prostate cancer and (2) identify the study design that was used in this study.