🏷️ LIMITED TIME OFFER: GET 20% OFF GRADE+ YEARLY SUBSCRIPTION →
Log in
Biology
3
answers
0
watching
153
views

True or False? A group of 250 women over the age of 40 arerecruited for a study to determine the effects that calcium has onbone health. Half of the participants are given a calciumsupplement and the other half are given a placebo. If 13 women oncalcium develop osteomalacia and 27 women not on the placebodevelop osteomalacia, the relative risk for developing osteomalaciafor women over 40 on a calcium supplement is 0.48 when compared tothose women not taking a calcium supplement. This indicates thattaking calcium has no effect on the population of interest's healthbecause the relative risk is less than 1.0.

True

False

Watch
3
answers
0
watching
153
views

For unlimited access to Homework Help, a Homework+ subscription is required.

Unlock all answers

Get 1 free homework help answer.
Already have an account? Log in
Share
Already have an account? Log in
Share
Collen Von
Collen VonLv2
30 Sep 2019
Already have an account? Log in
Share

Related textbook solutions

Molecular Cell Biology
8 Edition,
Lodish
ISBN: 9781464183393
Biology: Science for Life with Physiology
6 Edition,
Belk
ISBN: 9780134555430
Concepts of Biology
OER Edition,
Openstax
ISBN: 9781938168116
Biology
2nd Edition, 2013
Openstax
ISBN: 9781947172517
Essentials of Biology
5 Edition,
Mader
ISBN: 9781259660269

Related questions

While the concepts of screening and surveillance are intertwined there are subtle distinctions between the two ideas. The main goals are data collection to measure magnitude, changes, and trends in populations. The objective is to create interventions in defined populations. On the contrary, testing to identify individuals with infection or disease is the main goal of screening. The area of breast cancer screening and breast cancer surveillance has been a point of contention. Please read the following article and weigh in on which side seems most convincing:

There is a heated debate in this country about the risks and benefits associated with screening mammography. Proponents on both sides of the debate feel equally as strongly for or against annual breast cancer screening. Despite one’s opinions regarding the utility of screening mammography, it is difficult to deny that the rates of false-positive exams, the rates of overdiagnosis, and the cost of annual screening are too high. We can do better. It is time to stop devoting energy to arguing about data from studies performed decades ago and start working toward gathering new evidence. In late 2015, we will initiate the WISDOM study to investigate the safety and effectiveness of a personalized breast cancer screening model. This model will use a comprehensive risk assessment process to determine individualized screening regimens for women in the interventional arm. The data collected in this study will better inform the screening debate and will allow us to shed more light and less heat on the issue.

There is a great debate in this country about the risks and benefits of screening mammography. On one side of the debate are those in favor of the one-size-fits-all model of performing annual mammograms starting at the age of 40 for women who are not known to be at greatly elevated risk of developing breast cancer. The radiology community argues that this model reduces the rates of interval cancers, aids early detection, and should not be changed. On the other side of the debate are those who support the United States Preventive Services Task Force (USPSTF) recommendations to screen women biennially starting at age 50, and to screen women in their 40s based on personal preferences regarding the potential benefits and harms of screening.1 Specialists on this side of the debate believe that annual screening results in unacceptably high rates of false-positive recalls, overdiagnosis, and overtreatment.

Recently, the USPSTF published a draft update to the 2009 breast cancer screening recommendations, and the debate has once again intensified. The solution to this problem is not to continue the debate with repetitious reviews of studies that were performed more than 30 years ago, but to focus ahead on how to make breast cancer screening safer and more effective. The time has come to put the debate to rest by conducting a modern-era screening trial.

Before focusing on the future, let us first take a moment to review the current state of breast cancer screening in the United States. The majority of providers in this country continue to recommend annual screening starting at age 40.2 Proponents of annual screening mammography cite a resulting relative reduction in breast cancer mortality of 21%, which is based on data from randomized screening trials performed in the 1970s and 1980s.3 However, this estimated benefit comes with significant drawbacks. After 10 years of annual screening, over one-half of women screened will receive a false-positive recall, and 7% to 9% will undergo a benign biopsy.4,5 False-positive recalls and benign biopsies can cause long-lasting psychological distress that can negatively impact a woman’s willingness to undergo screening for breast cancer in the future. Additionally, false-positive recalls and overdiagnosis cost the United States an estimated $4 billion per year,6 and screening in aggregate is estimated to cost between $8 and 10 billion per year.7 This estimate is based on a screening mammogram costing between $135 and $195. If the cost of mammography increases, the overall cost of breast cancer screening increases proportionally. As a country and as healthcare professionals, we can and should do better.

Breast cancer screening should harness the advances that have been made in breast cancer risk assessment and our understanding of breast cancer tumor biology. Screening should be more effective at finding relevant and consequential cancers, and should result in fewer benign biopsies. Screening should also be better integrated with prevention. Lastly, screening should be more cost-effective. A personalized screening model could potentially achieve all of these goals.

The aim of a personalized screening model would be to focus resources on those women who are most likely to benefit. The foundation of the model would be a comprehensive risk assessment that would take into consideration a woman’s classical risk factors for breast cancer, such as her personal and family history of breast disease. This comprehensive risk assessment would also include an evaluation of breast density and germline genetic testing. These risk factors would then be placed into a breast cancer risk model that would estimate the woman’s 5-year risk of developing breast cancer, and personalized screening recommendations would be made according to this risk. Women at high risk of developing breast cancer would be screened more frequently, and women at low risk would be screened less frequently. This risk estimation could also be used to make recommendations regarding chemoprevention, thereby integrating screening and prevention, which is the real key to reducing mortality from breast cancer.

This model has the potential to optimize the benefits of mammography in the context of modern systemic therapy while minimizing harms. Using a similar risk model in 3 independent study populations, it has been shown that 50% of cancers occur in women with the top 20% predicted risk.8 This model is also practical because these risk factors are easy to assess, and it is estimated to be more cost-effective than annual screening, despite the use of genetic testing, which has decreased in cost significantly since the Supreme Court ruling in June 2013 that stated that the human genome could not be patented.

Personalized screening may be the way forward, but this can only be determined in the setting of a randomized controlled trial. In the fall of 2015, a randomized controlled trial comparing personalized breast cancer screening with annual screening will be initiated within the Athena Breast Health Network that spans the University of California and the Sanford Health system in the Midwest. This study will be called the WISDOM study (Women Informed to Screen Depending on Measures of Risk). We have received a large grant from the Patient-Centered Outcomes Research Institute to perform this trial, and are also working with payers and self-insured employers, such as Blue Shield of California and UC Health, to create a Coverage with Evidence Development policy that will cover the medical costs of the trial. Using surrogate endpoints and long-term follow-up, we aim to determine whether personalized screening is as effective, less morbid, more preferred by women, and enables prevention more as compared with annual screening. Our hope is that this trial will provide us with the information we need in order to determine the safest and most effective way to screen women for breast cancer. Then, and only then, will we be able to put “The Great Mammography Debate” to rest.

As we move toward a more biology-based approach to the treatment of diseases, our approach to screening for and preventing those diseases should follow suit. The opportunity before us is to learn who is at risk for which type of breast cancer, and to optimize our screening and prevention strategies for each individual according to her personal risk. Over the last 20 years, many advances have been made in our understanding of the risk factors that contribute to a woman’s risk of developing breast cancer. The time has come for us to harness this knowledge and apply it in an evidence-generating fashion to shed more light and less heat on the screening controversy.

Do you believe that US Preventive Services Task Force (USPSTF) recommendations should be followed or do you believe screening should start at age 40? Why or why not?

3) Under the Safe Drinking Water Act, which of the following parties is responsible for collecting and analyzing levels of regulated contaminants in New Mexico drinking water

a) US EPA

b) State Drinking Water Bureau

c) Public drinking water suppliers

d) Homeowners with private water wells

4) Albuquerque relied entirely on groundwater for it's drinking water until 2008, when it began also using surface water supplied by the San Juan-Chama project. Once the water utility started blending chlorinated surface water with treated groundwater, one would expect that exposures to disinfection byproducts to increase within the population served by the water utility.

True

False

5)

The half-life of methylmercury in the blood is approximately 70 days. This toxicokinetic measure is one of the main reasons that the FDA fish consumption guidelines include not only pregnant women but all women of reproductive age.

True

False

6) Some groundwater in New Mexico is naturally high in uranium, a metallic element associated with increased cancer risk and kidney toxicity. Which of the following options would a public water utility be legally allowed to use under the SDWA to address uranium levels in their water which exceeded the uranium MCL.

A. Blend their water with other water much lower in uranium to reduce levels below the MCL

B. Change to a different water source that meets the uranium MCL.

C. Provide uranium filters to all their water customers with instructions with how to install on their house tap.

D. Notify customers of high uranium content and provide water consumption guidelines similar to FDA fish consumption advisory.

E. All the above

F. A and B Only

7) Under the Safe Drinking Water Act, chemicals known or suspected of being human carcinogens are permitted to be present in public drinking water.

True

False

8) A real estate developer in Santa Fe wants to create a "Totally-Green" community for wayward Hollywood types that features on-site wastewater recycling, 100% solar energy, and drinking water supplied solely by a large community rainwater collection and storage device called the "Earth Mother" He indicates to prospective clients that this will be a very exclusive community consisting of just 20 individual households, each situated on roughly five acres of land. Based on these characteristics, this community would be exempt from SDWA rules and regulations.

True

False

9) Which of the following factors might regulators take into account when considering whether to revise lower the MCL for a particular water contaminant.

a) Magnitude of health protection afforded by lowering MCL

b) Additional cost associated with reducing contaminant levels to meet revised MCL

c) Technological feasibility of lowering contaminant level to meet revised MCL

d) All the above

10) In 2015, investigators from Virginia Technical University collected samples of tap water from 252 households in Flint Michigan and analyzed them for lead content. They found that 40% of the samples contained lead in excess of 5 ppb and 10% of the samples (90th percentile) contained greater than 25 ppb of lead. Several samples exceeded 100 ppb and one sample exceeded 1,000 ppb. One reasonable explanation for this wide variation in water lead levels from one house to another in Flint would be variation in the presence and prevalence of leaded plumbing in each household.

True

False

11) Which of the following toxicological principles best explains why cancer-causing water contaminants are much more likely to have a Maximal Contaminant Level Goal (MCLG) of zero compared to contaminants associated only with non-cancer effects.

a) Differing toxicokinetics

b) Inorganic versus non-organic effects

c) Shape of dose-response curve

d) Differential absorption

Case Study

Skolnikland is in Eastern Africa, with a population of 30 million people. The country has a plains region, a hill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both hills and mountains. There are two seasons of heavy rainfall.

The citizens come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The large cities are mixed ethnically. One ethnic group is economically and socially very dominant. The people from this group live in the capital and most of the large cities. The national language is the language of this dominant ethnic group.

According to World Bank criteria, Skolnikland is among the poorest countries in the world. The economy has been growing at about 4% per year on average over the last decade, but the economy had very slow economic growth in the decades prior to that. The richest 10% of the population controls 80% of the national income.

About 80% of the people live in rural areas and 20% in urban areas. The number of people living in urban areas has been growing recently at an increasing pace. Most people earn their livelihood in agriculture but there is an increasing garment manufacturing industry in the two largest cities. There are also a number of mining industries. In addition, other export industries are beginning to grow, mostly focused on the export of commodities to China.

The total fertility rate is about 4.5 but it has been declining slowly over the last two decades, from over 6. There is an almost equal number of men and women in the population. Infant mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live births. Thirty-five percent of the children are underweight for age.

The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate has been growing at an increasing pace and about 75% of the girls now attend school regularly, although many of them are of very low quality.

Only about 50% of citizens have access to safe water. Only about 30% have access to sanitary disposal of human waste.

HIV prevalence is 7% of the adult population. The number of new HIV cases annually has begun to plateau. About half of the people eligible for treatment for HIV are on treatment. Malaria is rampant in the plains.

Investments in the road system have been growing at a solid pace in the last decade and the use of private automobiles has begun recently to increase more rapidly.

Skolnikland has a pluralistic health system that is made up of public and private institutions, publicly financed providers, licensed private providers, unlicensed medical practitioners, and traditional healers. There is no health insurance, except for some free services for the poor in the few publicly financed hospitals, which the better off people do not attend. The health system is not very effective or efficient and is generally of low quality. The HIV, TB, and malaria programs are not effective or efficient and they are just beginning to adopt paradigms for services that follow global best practices.

QUESTION 26

What is a DALY?

Refer Case Study from question 1 to answer this question.

A. An indicator that compares the burden of deaths across the population of different countries.

B. A composite health gap indicator that measures the amount of health and disability-free life that is lost because of disease, injury, and premature death.

C. A WHO indicator used to summarize the expected number of years to be lived in good health.

QUESTION 27

What is an example of a conditional cash transfer that you can use to improve child health?

Refer Case Study from question 1 to answer this question.

A. Provide tax breaks to families with children.

B. Give money to mothers whose children received a full course of vaccination.

C. Pay higher fees to vaccination programs with better outcomes.

QUESTION 28

What usually takes place during the demographic transition?

Refer Case Study from question 1 to answer this question.

A. Fertility falls before mortality falls

B. Mortality falls and then fertility falls

C. Mortality and fertility fall at the same time

QUESTION 29

Which force is likely to have the greatest direct impact on epidemiological change in the medium and long terms on today's middle-income countries?

Refer Case Study from question 1 to answer this question.

A. Population growth

B. Population aging

C. Urbanization

QUESTION 30

Which is the most accurate statement about the distribution of age at death in Niger (a very low income country) and Norway (a very high income country) today?

Refer Case Study from question 1 to answer this question.

A. About 5% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65.

B. About 30% of the deaths in Niger are among those under 15, while the overwhelming majority of deaths in Norway are among those over 65.

C. The overwhelming majority of deaths in both countries occur among people aged 65 and over.

Weekly leaderboard

Home
Homework Help 3,900,000
Biology 460,000
Start filling in the gaps now
Log in