Question 1
1.    What characteristic distinguishes a meta-analysis from a systematic review?
a.    Qualitative assessment of individual studies included in the review
b.    Statistical combination of the results of two or more studies

c.    The inclusion of only randomized trials in the review
d.    The use of informal/subjective methods to collect and interpret information
e.    Clearly described search strategy and study selection
Question 2
1.    QUESTIONS 2-6 Refer to the study by Jordan et al., 2013 (provided with this assignment).
Figure 2 of the Jordan et al. meta-analysis depicts a forest plot illustrating the estimates of the association between hysterectomy and ovarian cancer. How many of the individual studies (in figure 2) reported statistically significant reductions in the risk of ovarian cancer in women with hysterectomy compared to women without hysterectomy?

Question 3
1.    How would you interpret the overall summary estimate (relative risk) provided in Figure 2? (1-2 sentences)

Question 4
1.    Is it appropriate to use the overall summary estimate provided in Figure 2 to understand the true association between hysterectomy and ovarian cancer? Why/why not? (2-3 sentences maximum)

Question 5
1.    What significant sources of heterogeneity did the authors identify in Table 2? (select all that apply)
a.    Hysterectomy prevalence
b.    Country of study
c.    Year of diagnosis
d.    Study type
e.    Control response rate
Question 6
1. In the forest plots in Figures 2 and 3, you can see that each of the studies reports confidence intervals. The narrower the confidence interval, the higher the weight assigned to the study (as depicted by the size of the shaded square/rectangle symbols around each study estimate). What is generally the reason some studies have narrower (smaller) confidence intervals compared to others?

a.    The studies have a larger amount of bias
b.    The studies have a smaller amount of bias
c.    None of the above
d.    The studies have larger sample sizes
e.    The studies have a smaller amount of heterogeneity
Question 7
1.    In order to estimate the prevalence of HIV in females in India, the Department of Health set up HIV testing facilities at a representative sample of antenatal care clinics throughout different Provinces in India. This is an example of what type of surveillance?

a.    Passive
b.    Sentinel
c.    Active
d.    Syndromic
e.    Pandemic
Question 8
1. To confirm an outbreak of a disease, you need to assess whether there is a real increase in the rate of disease (more cases than expected). Which of the following does NOT account for a real increase in disease cases? (select all that apply.)

a.    An outbreak
b.    An increase in population size
c.    Seasonal variation
d.    Changes in reporting procedures (e.g. moving from passive to active surveillance)
e.    Improved diagnostic test
Question 9
1.    If an infectious disease has a reproductive number of 4, what proportion of the population would we need to vaccinate to achieve the herd immunity threshold?

a.    90%
b.    50%
c.    75%
d.    25%
e.    96%
Question 10
1.    A food poisoning outbreak at a restaurant is an example of what type of epidemic?

Question 11
1.    When a screening test increases the period between detection (through screening) and usual clinical diagnosis without improving survival time, what type of bias does this represent?

a.    Measurement bias
b.    Length bias
c.    Loss-to-follow-up bias
d.    Lead-time bias
e.    Volunteer bias
Question 12
1.    When selecting an appropriate screening test, what factors should you take into account when determining whether to choose either a high sensitivity or high specificity?

Question 13
1.    You wish to evaluate a new screening test that has become available for an infectious disease that results in chronic health problems if left undiagnosed. Results from your evaluation found that of the 1448 people with a positive test result, 797 were subsequently confirmed to have the infectious disease. Among the 10,892 people with a negative test result, 129 were later diagnosed with the infectious disease.

What is the sensitivity of this test? (please round your answer to 1 decimal place.)

Question 14
1.    What is the specificity of this test? (please round your answer to 1 decimal place.)

Question 15
1.    Five years after the successful implementation of the screening test mentioned in Question 13, early intervention had reduced the spread of infection and the prevalence of the disease has reduced to 1.2%. Assuming the same sensitivity and specificity of the test (as in Q13), what will happen to the positive predictive value of the test now (compared to five years ago)? (2-3 sentences: Please justify your answer with the PPV calculations from both 5 years ago (in question 13) and now to receive full marks.)

Question 16
1.    In order to try and reduce the prevalence of obesity in children, the Australian government decided to implement a tax on all soft drinks (soda) sold in Australia. This is an example of:
a.    Mass prevention strategy
b.    Low-risk prevention strategy
c.    High-risk prevention strategy
d.    None of the above
e.    Medium-risk prevention strategy
Question 17
1.    When thinking about the causes of influenza, we know that 100% of influenza cases have been exposed to the influenza virus, but not all of those exposed to the virus will get sick. We know that inadequate hand washing increases the risk of developing influenza in some but not all cases of influenza.  With regards to understanding influenza causation:

a.    Both exposure to the influenza virus and inadequate hand-washing are consequences of influenza

b.    Both exposure to the influenza virus and inadequate hand-washing are necessary causes

c.    Exposure to the influenza virus is a necessary cause; inadequate hand-washing is a component cause

d.    Exposure to the influenza virus is a component cause; inadequate hand-washing is a necessary cause

e.    Inadequate hand-washing is not a cause of influenza

Question 18
1.    You are a policy advisor in the Department of Health in a country where road traffic accidents have been identified as a significant cause of death amongst the population.  As funding is limited, you need to determine which risk factors should be given priority for prevention strategies to reduce the public health burden of road traffic accidents.
You identify a case-control study that has been previously conducted in your country, which examines the risk factors for road traffic accidents. Based on the data provided (see Table below), you need to prioritize the risk factors in order of which should be given funding priority to make the biggest impact on the public health burden of road traffic accidents (where 1 is the risk factor with the biggest impact, and 3 is the risk factor with the smallest impact). You will need to estimate the proportion of road accidents in the population attributable to each of the risk factors to justify your answer.

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