Compare and contrast clinical health services to public health and epidemiology in terms of a) how they are defined, b) goals, c) their target focus and d) functions.

Answers should address all components of the question. Therefore, paraphrasing the question and using it in your response will ensure all parts are answered. Additionally, since the exam is open-book, please be sure you properly cite any references that you use in answering the questions. Cryptic and unsupported answers will not be accepted for credit.
Question 1 Compare and contrast clinical health services to public health and epidemiology in terms of a) how they are defined, b) goals, c) their target focus and d) functions.

Question 2 Managerial epidemiology is integrated through general management functions. Explain each of the management functions in terms of the managerial epidemiology, i.e., what are the:

a. Planning functions, example(s)?
b. Directing functions, example(s)?
c. Controlling functions, example(s)?
d. Organizing functions, example(s)?
e. Financing function, example(s)?

Question 3 Describe the “natural history of disease” and disease progression from its inception to its resolution.
Question 4 What are some of the many epidemiologic contributions to quality assurance in healthcare and public health?

Question 5 (Use Case and tables for questions below)
December 31, 2009: A 48 year old male computer technician with hypertension, smoker, sedentary lifestyle, who does not do any aerobic exercise, enjoys fast food, eating it three times per day, with a family history of coronary artery disease (CAD), and a personal history of high cholesterol has a stressful deadline at work, which requires him to travel 17 hours on a plan to go on location in Australia. Unfortunately, he suffers an acute myocardial infarction in route to location and dies. He is now part of our epidemiology population mortality statistics. Calculate the U.S. Mortality Rates, which includes our computer technician in terms of crude rate of mortality, adjusted mortality rates and cause-Specific mortality rate using the 2009 statistics.

Input Data for Calculations:
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-2009 U.S. Census: 305,529,237 Total
-2009 U.S. Census: Males 148,094,000
-2009 U.S. Census: Females 153,388,000

Population by Age and Sex: 2009
Age Both sexes Male Female
Number Percent Number Percent Number Percent
.35 to 39 20,445 6.8 10,169 6.9 10,275 6.7
.40 to 44 20,877 6.9 10,322 7.0 10,556 6.9
.45 to 49 22,712 7.5 11,162 7.5 11,550 7.5
.50 to 54 21,654 7.2 10,611 7.2 11,043 7.2
.55 to 59 18,755 6.2 9,083 6.1 9,671 6.3

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-2009 U.S. Deaths: 2,436,682
-2009 U.S. Male Deaths 1,217,047
-2009 U.S. Female Deaths 1,219,635
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2009 Deaths By Gender/Age All races, male

All ages……………1,217,047
1-4 years………………14,872
5-14 years………………2,507
15-24 years…….………3,244
25-34 years…..………22,294
35-44 years……………29,150
45-54 years……………46,498
55-64 years…….……114,615
65-74 years…….……183,945
75-74 years…….……225,740
75-84 years…….……311,135
>=85 years…….……262,839
Not stated……………………206

2009 CVD/ Heart Attack Mortality,
Male/Age
Age (All) 186,464
35-44 55,957
45-54 115,615
55-64 276,844
65-74 677,598
Source: CDC (2009)
a. Calculate the Crude mortality rate for the entire U.S. in 2009.
b. Calculate a total adjusted mortality rates by gender for all men (males-only).
c. Calculate an age/sex adjusted mortality rate using the demographics of the diseased computer technician.
d. Compare b) morality rate calculated with c) mortality rate calculated. Is the adjusted mortality rate for males, age 45-54 years of age higher or lower than for all males, all ages?
e. Calculate a Cause-Specific mortality rate for deaths related to Cardiovascular Disease (Heart Attacks), using the demographics of our computer technician.
Question 6 Case Study #1: 2.1. Food poisoning outbreak at Bluegrass Hospital
An outbreak of food poisoning occurred among the 400 staff and patients at Bluegrass Hospital a few hours after eating dinner. Among the 60 people who became ill, the Symptoms were mainly nausea, vomiting and diarrhea. The infection control nurse investigated the outbreak and reported results in

Table 2.5 Below
1. What is the “crude” attack rate?
2. What are the food-specific attack rates for those who consumed, and did not consume each food item?
3. How many times more likely are people who consumed specific food items to get sick compared to those who did not consume each item?
4. Which food item is the most likely cause of this “common source” outbreak?
5. What are the incubation period and most likely cause of the outbreak?

Question 7

Case Study #2: Osteoporosis Marketing Plan
You are the Director of Community Relations, reporting to the Chief Operating Officer (COO) at Allright Memorial Hospital, Anywhere, USA. You have been asked by your COO to spearhead a community council with local public health officials, who will be focused on women over 50 for the prevention of osteoporosis. Your committee’s strategic plan SWOT analyses revealed the following information.
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Background:
The purpose of this project is to create an intervention prevention program that minimizes osteoporosis in women over 50 and with the health risks associated with the condition for Anywhere, USA. Per the Centers for Medicare and Medicaid (CMS), abstracted from medical claims data, “an estimated 10 million Americans have osteoporosis and 34 million Americans have low bone mass, placing them at an increased risk for osteoporosis. An analysis, using the Anywhere, USA state hospital database shows a slightly higher rate of risk than the national average. The report shows that osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures of other sites. Osteoporosis can be prevented. Early diagnosis and treatment can reduce or prevent fractures from occurring”. (CMS 2007)
The Committee Objectives:

1. To research and identify best community partners and interventions for prevention of high risk osteoporosis residents in Anywhere, USA.
2. To use create a health promotion marketing plan for early bone density screening targeted throughout the Anywhere, USA communities.

Targets: At Risk Population for Osteoporosis
Age: Postmenopausal woman over >= 50 years of age
Race: Caucasian, Asian, African-American and Hispanic women
History: Women who have a family or personal history of fractures after age 50
Health Conditions: Women who have menopause before the age of 45 due to a medical condition or unknown cause.
Healh Behaviors: Women who have premature menopause due to anorexia, bulimia, tabacco and alcohol use, or excessive exercise.
Nutrient Deficiencies: Calcium and/or vitamin D deficiency
Lifestyle: Sedentary, inactive lifestyle
Medical Treatements: Steroid (corticosteroids), radiation and/or chemotherapy treatments
Source: NIH 2010, Chart: Meyer 2010

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Case Questions:

1. Using reliable primary resources do research and determine who the best community partners, and the most effective interventions for prevention promotion for high risk osteoporosis residents in Anywhere, USA. Your own hospital is one community partner, and it radiology services (bone density machines) are a resource. What other and resources within the community would be appropriate?

2. Create a health promotion marketing plan for early bone density screening targeted throughout the Anywhere, USA communities using the 4-Ps. Your marketing plan also needs a mission statement, a statement of purpose, objectives and timelines of how you will implement the program.