International Public Health Including Epidemiology Final Exam

Question 1 of 59

1. Question

1 point(s)

Culture is an integrated system of learned behavior patterns that are characteristic of the members of any given group or society. Building upon this definition, culture consists of a group’s manners, customs, beliefs, ceremonies, literature, social institutions, myths and legends, knowledge, values, laws (written and unwritten), ideas and thought patterns, music, cuisine, language, arts and artifacts, concepts of self, morals, and ideals.

True
False

Question 2 of 59

2. Question

1 point(s)

Four components are necessary for developing cross-cultural competency. Which ONE of the following is NOT a component of building cross-cultural relationships?

Becoming aware of one's personal biases.
Recognizing that some attitude of cultural superiority is unavoidable.
Social interactions are often authoritarian.
Prioritizing relationships above projects.
Treating everyone with respect.

Question 3 of 59

3. Question

1 point(s)

Examples of culture influencing health include ALL of the following EXCEPT which ONE?

Belief in supernatural powers may result in reliance on spiritual healing rituals in addition to, or instead of, modern medicine.
People who view life from a standpoint of self-determination are often less motivated to take action against their own illness.
People of traditional cultures often believe that health care providers have a higher status and therefore should make the decisions.
Cultural norms may dictate what symptoms are appropriate to reveal and how they are described.
Some peoples hold that the mention of illness will cause that illness.

Question 4 of 59

4. Question

1 point(s)

People involved with international service normally experience culture shock. Symptoms typical of culture shock include all of the following, except which ONE?

Withdrawal from people, especially host nationals
Enhanced work performance
Depression
Compulsive cleanliness
Bitterness

Question 5 of 59

5. Question

1 point(s)

Living by the rules of a new culture is essential for success in that environment. Which ONE of the following is NOT a principle of cultural adaptation?

Few patterns of behavior in new cultures are actually immoral or reprehensible; they are simply different.
Tension is created when people behave contrary to expectations. However, expatriates are generally excused from following cultural norms because of their unfamiliarity with the culture.
Adjustment begins with becoming aware of behavioral differences, reflecting on their causes, and observing how to alter one’s own behavior.
To successfully adapt to and function within a new culture, expatriates must observe, understand, and adjust to the behavior of nationals.
People within a particular culture generally expect that everyone will understand and abide by their beliefs and values.

Question 6 of 59

6. Question

1 point(s)

Reentry shock is a common experience among persons returning home from a significant cross-cultural journey. Which ONE of the following is NOT a feature of reentry shock?

Expatriates who have been living among relatively low-income people often feel a sense of injustice at the disparity.
Friends and family back home frequently admire returning expatriates and are anxious to learn about their experience.
The pace of life in developing countries often seems unhurried in comparison to that of the home culture and requires significant adjustment.
Expatriates find their values regarding family and spiritual life are greatly influenced by their international experience.
Expatriates report that their attitudes toward racism, patriotism, and international relations are profoundly changed.

Question 7 of 59

7. Question

1 point(s)

Which statement about disasters is the MOST accurate?

Emergencies and disasters are the same thing
A disaster event has accepted universal minimum values that can be used to define the loss
Many times, disaster events can be predicted
Disasters can occur independent of human involvement

Question 8 of 59

8. Question

1 point(s)

True or False: Individuals should be encouraged to respond to disasters, even if not through an organization or government entity.

True
False

Question 9 of 59

9. Question

1 point(s)

True or False: Any kind of aid and relief is useful after a disaster event.

True
False

Question 10 of 59

10. Question

1 point(s)

Medical disaster response efforts should include which of the following?

Triage of disaster victims
Providing continuity of care for disaster victims with chronic illnesses
Providing medical care for displaced peoples
All of these

Question 11 of 59

11. Question

1 point(s)

Being personally prepared to respond to a disaster includes all of the following EXCEPT which ONE?

Having a personal or family disaster kit
Developing and practicing a personal or family disaster plan
Staying informed about potential or current disaster events, including political and social concerns
Keeping one’s camera available to photograph disaster events.

Question 12 of 59

12. Question

1 point(s)

True or False: Unburied dead bodies constitute a health hazard.

True
False

Question 13 of 59

13. Question

1 point(s)

Which ONE of the following statements regarding the Sustainable Development Goals (SDGs) is MOST true?

There are fewer Sustainable Development Goals than Millennium Development Goals
These goals are to be achieved by 2050
These goals deemphasize global partnership in favor of national independence
These goals include measures to ensure environmental sustainability

Question 14 of 59

14. Question

1 point(s)

Providing healthcare services does not necessarily enhance overall health. It is difficult to keep the paramount goal of health in view for ALL of the following reasons, EXCEPT which ONE?

Impact of health interventions is not easily measured.
Health status is not easily measured.
Care for people who are critically ill is usually perceived as more intriguing and more valuable than disease prevention or health promotion.
Curative care specialists are usually more revered than are those in public health or primary care.
Saving lives through the control of diseases like polio and measles provides exemplary motivation for preventive health intervention.

Question 15 of 59

15. Question

1 point(s)

Several types of organizations provide leadership for health systems, including ALL but which ONE of the following?

Government agencies
Private, and usually fee-for-service, healthcare providers.
The National Institutes of Health (NIH)
Non-governmental organizations (NGOs)
Health insurance plans that cater to enrolled individuals

Question 16 of 59

16. Question

1 point(s)

Vaccine-preventable diseases have declined dramatically since the Expanded Program on Immunization (EPI) was initiated. Which ONE of the following statements about EPI is MOST correct?

EPI is successful because it is easily understood, easily implemented, inexpensive and causes immediate benefit.
Governments have used EPI to test the effects of biological warfare agents.
EPI is most effective as a separate service from well child and prenatal care.
Worldwide, EPI's vaccine schedules include pneumococcus and influenza.
EPI makes use of a single-dose, combination vaccine administered just once during the first year of life.

Question 17 of 59

17. Question

1 point(s)

Improved management of childhood illnesses, as well as aspects of nutrition, immunization, contraception and maternal health, are all part of Integrated Management of Childhood Illness (IMCI). Which ONE of the following is NOT a principle of the Integrated Management of Childhood Illness disease management protocols?

Designed for use by community health workers
Relies upon a very small number of medications
Guided by symptoms and signs only
Integration of early detection, treatment and prevention of disease
Requires radiological confirmation of suspected pneumonia before treatment

Question 18 of 59

18. Question

1 point(s)

Which ONE of the following statements about communication for health is TRUE?

Messages such as "Boil the water" and "Don't take drugs" inherently take into account motivations behind unhealthy behaviors.
Maslow's Hierarchy of Needs provides a theoretical basis for one-way messages.
One step to developing an effective communications program is working with consultants to develop and test messages.
Media campaigns and social marketing strategies are generally less cost-effective than one-on-one healthcare services.
Maslow's Hierarchy of Needs can help communicators assess the community's felt needs.

Question 19 of 59

19. Question

1 point(s)

Which ONE of the following statements is FALSE with respect to competence of healthcare professionals?

Most physicians are responsible to teach junior learners during medical training.
Clinical pharmacists are trained to provide direct education to patients regarding prescribed medical therapies.
Individuals who have completed training in a healthcare specialty are usually competent upon graduation to teach that specialty to novice learners.
Physical therapists receive training in patient education skills for a wide range of therapeutic exercise regimens.

Question 20 of 59

20. Question

1 point(s)

Which ONE of the following statements about motivation for learning is MOST true?

Intrinsic motivation may be encouraged by helping learners realize they are never really in control.
Intrinsic motivation may be encouraged by helping learners see that life is ultimately meaningless.
Emotions are unreliable and unpredictable, and they are best disregarded.
The most effective learners are intrinsically motivated through a sense of control and purpose.

Question 21 of 59

21. Question

1 point(s)

The following options are all benefits of direct observation, EXCEPT which one?

Enables you to establish a baseline for each student in terms of abilities, comfort level with patients, etc.
Reinforces the importance of the student by communicating that you care.
Enables you to assess the student’s ability in specific areas.
Encourages acute anxiety, which improves performance.
Enables you to specify strengths and weaknesses rather than make global judgments.

Question 22 of 59

22. Question

1 point(s)

The following statement is an example of which level of feedback? “I feel disappointed when night-duty residents do not come to morning report to review the admissions.”

Level 1: Description of observed behavior
Level 2: Your personal reaction (not judgment)
Level 3: Likely outcome of behavior based on experience
Level 4: Punitive consequence of continued infraction

Question 23 of 59

23. Question

1 point(s)

Which one of the following contains THREE elements of The Kemp Model?

Instructional problems/goal, content sequencing, instructional delivery
Instructional objectives, strategies, Prezi slides
Learner characteristics, coffee & donuts, designing the message
PowerPoint mastery, evaluation instruments, task analysis

Question 24 of 59

24. Question

1 point(s)

Active learning requires which ONE of these elements?

Expensive software.
Work by the participants designed to engage with the topic.
Long slide decks.
In-classroom physical exercise.

Question 25 of 59

25. Question

1 point(s)

Which ONE of the following statements regarding breastfeeding is TRUE?

Breastfeeding alone does not provide adequate nutrition for a 1-month-old infant.
Transitional foods can be introduced by 2 to 3 years of age.
Breastfeeding provides little protection against diarrheal diseases.
Breastfeeding significantly improves an infant’s odds of surviving the first 2 to 3 months of life.

Question 26 of 59

26. Question

1 point(s)

Each of the following is among the most commonly utilized measures of health of a population, EXCEPT which ONE?

National per capita expenditure for healthcare
Mortality rate for children under age 5 years
Infant mortality rate
Maternal mortality rate
Life expectancy at birth

Question 27 of 59

27. Question

1 point(s)

Economic development and physical health are closely connected. Economic growth enhances the general health of a population through improvements in all of the following, EXCEPT which ONE?

Incentives for increased childbearing
Nutrition
Water and sanitation
Medical services

Question 28 of 59

28. Question

1 point(s)

Each of the following are leading risk factors for DALYs lost in low-income nations EXCEPT which ONE?

Unsafe drinking water, sanitation and hygiene
Underweight
Hyperlipidemia
Unsafe sex
Vitamin A deficiency

Question 29 of 59

29. Question

1 point(s)

The Expanded Program on Immunization (EPI) in most developing nations includes vaccination against which ONE of the following diseases?

Pertussis
Malaria
Pneumococcus
Influenza
Hepatitis A

Question 30 of 59

30. Question

1 point(s)

Which ONE of the following statements about HIV prevention is TRUE?

In the absence of antiretroviral drug treatment, HIV infection carries a 47 percent fatality rate.
Barrier contraceptives are nearly 100 percent effective in reducing risk of acquiring HIV infection.
Treatment against other STIs has no influence on the risk of acquiring HIV.
Peripartum prophylaxis of HIV-infected pregnant women significantly decreases the risk of mother-to-infant transmission.
Orphans of AIDS victims are at no increased risk for developing HIV infection themselves.

Question 31 of 59

31. Question

1 point(s)

Which of the following reflects the relative risk of death in the 2 districts?

The fact that in Southwark district 40 times as many people died of cholera as compared with the Lambeth district.
The fact that the population of the Southwark district is at least 8 times greater than the Lambeth district.
The fact that the death rate was over 5 times greater in the Southwark than in the Lambeth district.
The fact that the absolute number of deaths in the Lambeth district is much less than in the Southwark district.

Question 32 of 59

32. Question

1 point(s)

Why do you suppose this particular study, whose results are shown in the above figure, was restricted to doctors?

Because doctors smoked more than the population at large, making them easier to study because of the increased risk of lung cancer.
Because doctors comprise a well-defined occupational group with similar socioeconomic status, and are relatively easy to follow up.
Because doctors who develop lung cancer are more likely to seek care and be correctly diagnosed.
Because the per day cigarette consumption of doctors, who are more health conscious, was anticipated to be less than that of the population at large.

Question 33 of 59

33. Question

1 point(s)

The language of epidemiology uses key terms which convey essential concepts. Match each term with the appropriate definition.

Sort elements

Surveillance, observation, hypothesis testing, analytic research, and experiments.
Analysis of times, persons, places, and classes of people affected.
Factors that influence health: biological, chemical, physical, social, cultural, economic, genetic, and behavioral.
Diseases, causes of death, behaviors such as use of tobacco, positive health states, reactions to preventive regimes, and provision and use of health services.
Those with identifiable characteristics, such as occupational groups.
The aims of public health—to promote, protect, and restore health.

Study
Distribution
Determinants
Health-related states and events
Specified populations
Application to prevention and control

Question 34 of 59

34. Question

1 point(s)

Which ONE of the following features of smallpox was NOT important to successful eradication?

There are non-human hosts of smallpox.
The majority of smallpox patients have symptoms.
Smallpox significantly less contagious than measles.
Persons with smallpox infection are usually bedridden.
The mode of smallpox transmission is direct contact.

Question 35 of 59

35. Question

1 point(s)

From the data in the above table, which ONE statement is MOST TRUE about the contribution of asbestos exposure and smoking to the risk of lung cancer?

Men who both smoke and are exposed to asbestos dust have the highest lung cancer rates.
Men who both smoke and are exposed to asbestos dust have intermediate lung cancer rates.
Men exposed to asbestos dust alone have the highest lung cancer rates.
Men who smoke but are not exposed to asbestos dust have the lowest lung cancer rates.
From this data, it is not possible to draw a conclusion about the contribution of asbestos exposure and smoking to the risk of lung cancer.

Question 36 of 59

36. Question

1 point(s)

True or False: Epidemiologists prefer to define health states as “disease present” or “disease absent”, rather than to identify gradations of disease such as mild, moderate, or severe.

False
True

Question 37 of 59

37. Question

1 point(s)

Based upon the data presented in the above table, which ONE of the following statements is most TRUE?

Prevalence rate is a useful measure of the frequency of type 2 diabetes in different populations.
Incidence rate of type 2 diabetes in Singapore is greater among men than women.
Differing definitions of type 2 diabetes are easily corrected in such a study.
Prevalence rate is not a useful measure of type 2 diabetes because the disease has such a high incidence.

Question 38 of 59

38. Question

1 point(s)

Which ONE of the following is among the main causes of inaccurate information reported by vital registration systems?

Incorrect or incomplete death certificates.
Age at death measured uniformly.
Intentional efforts made so that poorer segments of populations are correctly counted.
Enforced reference to ICD rules for selecting the underlying cause of death.
Nepotism in hiring practices at the Ministry of Health resulting in professional incompetence and distortions in reporting.

Question 39 of 59

39. Question

1 point(s)

The crude mortality rate per 100,000 population for all cancers in Côte d’Ivoire is 70.5, and the age-standardized mortality rate is 160.2 per 100,000 population. What explains the large difference between these two rates?

The average life expectancy in Cote d’Ivoire is low, and there are not many people in the older age groups (and cancer risk increases with age).
The average life expectancy in Cote d’Ivoire is low, and there are many people in the older age groups (and cancer risk increases with age).
The average life expectancy in Cote d’Ivoire is on par with Europe, and there are many people in the older age groups (and cancer risk increases with age).
The average life expectancy in Cote d’Ivoire is low, and cancer diagnosis and treatment is readily available.

Question 40 of 59

40. Question

1 point(s)

What is the ONE main reason for standardizing rates according to a population with a standard age distribution (for example, the WHO world standard population)?

Age standardization compensates for unanticipated deaths in the pediatric population.
Age standardization ensures that differences in death rates are not due simply to differences in age distribution in the populations.
Age standardization emphasizes the economic contribution of persons age 20 through 60.
Age standardization ensures that elderly persons are correctly counted, especially in older population cohorts.

Question 41 of 59

41. Question

1 point(s)

What is the population attributable risk or attributable fraction (proportion) for smoking in the example in the above table?

56.25%
36.55%
162.25%
41.40%
71.85%

Question 42 of 59

42. Question

1 point(s)

Types of studies in epidemiology can be divided into two large categories: observational and experimental. Match each type of study to the appropriate category.

Sort elements

Observational
Experimental

Ecological
Randomized control trials

Question 43 of 59

43. Question

1 point(s)

True or False: In the case of a rare disease, the odds ratio and relative risk are usually very similar.

True
False

Question 44 of 59

44. Question

1 point(s)

Relative risk and odds ratio are two important tools in observational studies. Match the appropriate tool to the type of observational study (cohort or case-control).

Sort elements

Cohort
Case-control

Relative risk
Odds ratio

Question 45 of 59

45. Question

1 point(s)

True or False: Random error can be reduced by decreasing the size of the study sample and improving the reliability of the measurement method.

True
False

Question 46 of 59

46. Question

1 point(s)

A cross-sectional study of Downs syndrome has found an association with birth order. What could be ONE cause of confounding in this study?

Above-the-mean number of Downs syndrome participants who are of higher birth order
Above-the-mean number of Downs syndrome participants who are of lower birth order
Maternal age
Downs syndrome participant age

Question 47 of 59

47. Question

1 point(s)

Application of an appropriate observational study design should take into account the potential disadvantages associated with the types of studies being considered. Match each of the following disadvantages with the corresponding observational study designs.

Sort elements

Case-control
Cohort
Ecological

Selection bias
Cost
Confounding

Question 48 of 59

48. Question

1 point(s)

Which ONE of the following is the most accurate statement about the use of biostatistics in epidemiological research?

To draw conclusions by collecting data on each individual in a population
To prove which factors cause a disease or other outcome.
To influence health policy through generating persuasive graphs.
Statistics are mathematical tools used to draw reliable inferences/conclusions about populations based upon samples of the populations.

Question 49 of 59

49. Question

1 point(s)

Which ONE of the following statements about geographical information system (GIS) analysis is MOST correct?

GIS is most useful for analyzing situations where the boundaries for the population under study are not well defined.
Geographical information system (GIS) analysis is most appropriate for well-defined, stable populations where readily available data on exposures can be assigned to particular persons and locations
GIS is most useful for analyzing potential factors impacting the population when only subtle differences exist between these factors.
GIS is most appropriate for situations where the population members under study regularly leave the area and new members arrive.

Question 50 of 59

50. Question

1 point(s)

Which ONE statement about normal distribution is TRUE?

Almost all natural phenomenon occur with a normal distribution.
Ninety-five percent of the values will occur within two standard deviations of the mean.
Each normal distribution may have more than one peak and multiple means.
Ninety-five percent of the values will occur within a standard deviation of the mean.
College test score results usually follow a standard distribution, with equal numbers of high scores and low scores.

Question 51 of 59

51. Question

1 point(s)

True or False: Aggregate data about personal income are better reported as median income rather than average income.

True
False

Question 52 of 59

52. Question

1 point(s)

True or False: The shorter the confidence interval, the closer the sample mean is likely to be to the population mean

True
False

Question 53 of 59

53. Question

1 point(s)

True or False: A wide confidence interval is more preferable than a narrow one.

True
False

Question 54 of 59

54. Question

1 point(s)

True or False: When using the data in this table to calculate the attributable fractions of smoking and asbestos exposure for lung cancer, addition of the fractions can yield a result higher than 100 percent.

True
False

Question 55 of 59

55. Question

1 point(s)

Which ONE of the following statements is one of Koch’s Postulates?

Every case of the disease does not necessarily need to have the organism present.
The organism must cause the specific disease when inoculated into every animal.
The organism only needs to isolated from the animal, it need not be isolated in pure culture.
The organism must be shown to not only grow in pure culture, but also be isolated from the animal.

Question 56 of 59

56. Question

1 point(s)

What is causal inference? Select the ONE BEST definition.

A technique to establish irrefutable proof of cause and effect.
Another term for selection bias.
The design and analysis of data to uncover whether cause-effect relationships may exist between treatment/exposure variables and outcome variables.
A procedure that is usually straightforward and with minimal room for interpretation.

Question 57 of 59

57. Question

1 point(s)

Why is time-series analysis of short-term associations between an environmental exposure (such as hot weather) and mortality considered an acceptable method to assess causality? All the following explanations are valid EXCEPT which ONE?

It is acceptable because acute effects occur within hours or days of the exposure.
It is acceptable because it uses the exposed group as its own control. On hot days the population is exposed, and on cooler days the same population serves as a control.
It is acceptable because, if daily data are used, the population size or character does not change during the study period; confounding can be ignored.
A plausible explanation for the association between hot weather and mortality is a useful consideration.

Question 58 of 59

58. Question

1 point(s)

A positive association has been identified between higher income, higher fruit and vegetable consumption, reduced ischemic heart disease, and reduced mortality. Public health actions that could reduce ischemic heart disease risk for the low-income groups include which ONE of the following?

Applying taxes on fruits and vegetables.
School lunches can be a target for improved diets.
Promoting use of vegetable feed for livestock.
Distributing healthy diet information among graduate students.
Reallocating funds for school lunches towards meals for more elderly long-term care residents.

Question 59 of 59

59. Question

1 point(s)

A statistically significant association has been demonstrated in a case-control study between the use of a drug for asthma and young peoples’ risk of dying from asthma. Before you recommend the withdrawal of the drug, all of the following effects would need to be considered, EXCEPT which ONE?

Bias
Confounding
Chance
Irreversibility