Posted: December 20th, 2021

saint HCM530 full course [ all discussions all case study midterm final except module 7 case study

Module 1 DiscussionThe discussion question for this module is a series of questions related to a case study found in Chapter 1 of the text. Please answer all three questions (found below) in your initial response.Chapter 1 (pp 7-15): CASE STUDY—GROUP HEALTH EAST (GHE)100,000-member managed care organizationMixed model55-year-old administrator (Mr. Jones)Two large multi-specialty groups, each with a separate clinic500 individual MDs in communityAffiliated with two major hospitals in BostonEach clinic maintains a functional designTwo divisions (support services and clinical services)Considering moving to a “matrix model”Initial Discussion Questions:What are the advantages and disadvantages of a matrix model for GHE in terms of direct and indirect costs, as well as benefits such as improved coordination?How many product lines should the organization identify?How should the organization determine which product lines ought to maintain separate identities as part of the matrix design?Be sure in your initial response you support your findings and post with at least two quality, primary sources, which may include you textbook. Cite and reference your sources. (write 5-6 sentence summaries for each question).Module 2 DiscussionThe discussion question for this module is a series of questions related to a case study found in Chapter 3 of the text. Please answer all three questions (found below) in your initial response.Chapter 3: CASE STUDY (3.2)—Breast Cancer ScreeningIn Case Study 3.2 in the text, Pisano and colleagues (2006) compared the performance of digital to film mammography for breast cancer screening. Now assume that the sensitivity and specificity of digital mammography is 85% and 95% respectively, the sensitivity and specificity of film mammography is 55% and 85% respectively, and that 0.03% of women below the age of 50 have breast cancer, and 12% of symptomatic women have breast cancer.Initial Discussion Questions:How successful is film mammography in identifying women with breast cancer, or ruling out the disease in women without breast cancer?Are there any recent advances (previous 5 years) that could improve the success rates? If so, please explain what they are.Be sure in your initial response you support your findings and post with at least two quality, primary sources, which may include you textbook. Cite and reference your sources. (write 5-6 sentence summaries for each question).Module 3 DiscussionThe discussion question for this module is a series of questions related to a case study found in Chapter 3 of the text. Please answer all three questions (found below) in your initial response.Chapter 5: CASE STUDY (5.3)—Inpatient Quality of Care Indicators for Bluegrass HospitalSuppose that the Kentucky Hospital Association (KHA) decided to provide a service to its member hospitals by using the inpatient claims database to calculate inpatient quality of care indicators for each hospital. They provide a report to each hospital comparing them to national norms. Table 5.5 presents some of these indicators for Bluegrass Hospital, a fictional 200-bed hospital located in Central Kentucky. Upon receiving this report, Bluegrass Hospital organizes a quality improvement (QI) team to evaluate and develop recommendations.Initial Discussion Questions:From an Assessment of the report card only, Bluegrass Hospital would seem to be deficient in which areas? Why?Since the report is based on an Assessment of administrative data, what should the first course of action be? Why?Research an inpatient quality of care indicator and provide a 5-6 sentence summary of an article from peer reviewed literature that describes how performance on that indicator can be improved upon.Module 4 DiscussionClinical, research and managerial epidemiologists deal in risk. Risk is the chance that a person may or may not develop the condition, with or without exposure, in a defined time period. There is more than one type of risk.Type of RiskAbsolute risk(incidence, prevalence)Relative risk (RR)(Odds Ratio)Attributablerisk/fractionRisk ObjectiveTo determine the rates of disease by person, place and timeTo identify the risk factors for the diseaseTo develop approaches for disease preventionExampleBirth/death rates are absolute!What are the odds?Increase/decrease in incidence/proportion?What do we know about the absolute, relative risk and attributable risk of smoking and lung cancer?How may this knowledge help in private and public health epidemiology?Be sure in your initial response to provide at least two examples from peer reviewed literature that expound upon this relationship (write 5-6 sentence summaries for each article).Module 5 DiscussionThe cost effectiveness analysis (CEA) is one type of a benefit analysis tool used in managerial epidemiology. Others include cost-utility, cost-effectiveness, cost-consequence, and cost of illness. Since medical quality and health services have a high individual perception regarding value, different stakeholders will have different perspectives when performing and interpreting a CEA. Different decision makers, i.e., physicians, administrators, employers, payers, government and other public and private officials all have varying perspectives. Therefore, it is the common perspective that is generally most useful when making comparisons among the various interpretations of the CEA or other cost/benefit analysis results and outcomes.Where does the CEA fit into public health and clinical epidemiological research, as well as, health services research?What are some examples and characteristics of medical cost and effectiveness measures?Be sure in your initial response to provide at least two examples from peer reviewed literature that further clarify or illustrate your response (write 5-6 sentence summaries for each article).Module 6 DiscussionHow research is designed is important to its validity. In research, and particularly government funded research, the Institutional Review Board is the authority on requirements for research design.DHHS, Institutional Review Board Guidebook. Chapter 4: Considerations of Research DesignA. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f1″>IntroductionF. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f9″>Case-Control StudiesB. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f5″>ObservationG. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f10″>Prospective StudiesC. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f6″>Record Reviews and Historical StudiesH. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f11″>Clinical TrialsD. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f7″>Surveys, Questionnaires, and InterviewsI. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f12″>Identification and Recruitment of SubjectsE. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f8″>Epidemiologic StudiesJ. .hhs.gov/ohrp/archive/irb/irb_chapter4.htm#f13″>Assignment of Subjects to Experimental and Control GroupsFour common research designs used in epidemiological studies are cohort, case control, longitudinal, and cross-sectional studies. However, there are also prospective and retrospective, quantitative, qualitative and quasi (mixed) research designs. Data is what drives medical research and its design. Medical research drives scientific findings that ultimately result in improving human health. All of the various research study designs that fall into either descriptive or analytical epidemiology.All research studies fall into either descriptive or analytical epidemiology. What are those study designs and how are they defined?What are the strengths and weaknesses of each of the designs you have defined?Be sure in your initial response to provide at least two examples from peer reviewed literature that further clarify or illustrate your response (write 5-6 sentence summaries for each article).Module 7 DiscussionIn last week’s discussion, we looked at types of research designs. This week, we will look at requirements of designs using real people, i.e., the clinical trials.Office for Human Research Protections (OHRP) There are two types of clinical studies, i.e., clinical trials and observational studies. How do they differ and provide examples of each?Who can participate in a clinical study and what is the process to protect them from harm?Be sure in your initial response to provide at least two examples from peer reviewed literature that helps to support your position (write 5-6 sentence summaries for each article).Module 8 DiscussionDisease may be classified as acute, subacute or chronic. It may be emerging or reemerging.Why is it a challenge in defining diseases as either totally chronic or totally infectious (acute) in nature?What are examples of emerging and reemerging diseases? Would HIV be considered an emerging or reemerging?Be sure in your initial response to provide at least two examples from peer reviewed literature that helps to support your position (write 5-6 sentence summaries for each article).hCM530Case Study 1 Outbreak of Influenza in a Kentucky Nursing Home Assume that an outbreak of Influenza A occurred among 400 residents of a New York Nursing Home during December 2006 and January 2007, despite the vaccination of 375 of them between mid-October and mid-November of 2006. The residents, 70% of whom were female, had a mean age of 85 years and shared common recreational and dining areas. (Textbook Case Study 2.2) Case Questions: Base your reply upon this influenza outbreak case, research of influenza, and proposed solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. If 75 of the residents developed influenza-like illness (ILI), what proportion of the residents became sick? 2. Of those with ILI, 40 developed pneumonia, 25 required hospitalizations, and two died. What proportion of those with ILI developed pneumonia? What percent of those with ILI and pneumonia were hospitalized? What proportion of those with ILI died? 3. Of the 375 residents who were vaccinated, 60 developed ILI. Of the 25 residents who were not vaccinated, 20 developed ILI. What percent of vaccinated residents developed ILI? What percent of unvaccinated residents developed ILI? How many more times higher is the rate of ILI among those who were unvaccinated compared to those who were vaccinated? 4. Of the 375 vaccinated residents, 35 developed pneumonia following ILI compared to 15 residents among the 25 who were not vaccinated. What percent of vaccinated residents developed pneumonia following ILI? What percent of unvaccinated residents developed pneumonia following ILI? How many more times higher is the pneumonia following ILI among those who were unvaccinated compared to those who were vaccinated? 5. What was the vaccine efficacy for preventing LIL and pneumonia?Case study 2Needs Assessment for Stroke Services in Ontario, Canada The Queen’s Health Policy Research Unit (QHPRU) estimated the need for stroke services in Ontario, Canada using measures of prevalence and incidence of (1) modifiable and nonmodifiable risk factors for stroke; (2) acute cases of stroke; (3) major sequelae of stroke (Hunter D , 2000 and Hunter D, 2004). They identified the effective health services that are targeted at each of these three dimensions, and linked these steps to estimate need for health services. They compared the estimate of need for health services to compiled measures of levels of stroke-related health services in Eastern Ontario to see if there was a gap (unmet need) or surplus (overmet need) of these services. The numbers below have been changed slightly from the original source. (Textbook Case Study 4.3) Download Case Reports: http://mcgill.academia.edu/LorieKloda/Papers/78206/Creation_and_pilot_testing_of_StrokEngine_A_stroke_rehabilitation_intervention_website_for_clinicians_and_familiesCase Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. Risk factors for stroke include heavy alcohol consumption, atrial fibrillation, diabetes, hypercholesterolemia, hypertension, obesity, low physical activity, smoking, ischemic heart disease, transient ischemic attack. Where might QHPRU get estimates of the incidence of these conditions? 2. For each risk factor, or stroke sequelae, QHPRU listed the kind of intervention that would be effective, and the proportion of people for whom this intervention would be appropriate. According to Table 4.3, which three interventions are appropriate for hypercholesterolemia, and for what proportion of high-risk individuals? 3. The following types of interventions were recommended for acute stroke services: (a) surgical intervention (carotid endarterectomy); (b) thrombolytic therapy; (c) imaging of the brain, either computed tomography (CT) or magnetic resonance imaging (MRI); (d) non-invasive imaging of the vessels (ultrasonography or magnetic resonance angiography); (e) invasive imaging of the vessels (cerebral angiography); (f) rehabilitation therapy. For what percent of at-risk individuals are these services recommended? 4. Estimates of people in Eastern Ontario with hypercholesterolemia are as follows: aged 25-44: 30,000 men and 13,000 women; aged 45-64: 33,000 men and 42,500 women; aged 65 and above: 17,000 men and 42,000 women. How many residents in Ontario will need fasting lipoprotein analysis and dietary and pharmacologic interventions for hypercholesterolemia? 5. It is estimated that Eastern Ontario provides dietary and pharmacologic intervention for hypercholesterolemia to 66,000 and 15,500 patients respectively. What is the level of unmet need in terms of the number of patients not receiving each of these two recommended interventions? What percent of need is not currently being met in Eastern Ontario? 6. The incidence of acute stroke cases was estimated at 3,500 cases, 100 of whom died before reaching the hospital. The prevalence of chronic stroke cases was estimated to be 4,300. Use Table 4.4 to estimate the number acute and chronic stroke cases needing core stroke services, and services for chronic stroke and disability. 7. It is estimated that Eastern Ontario provides thrombolytic therapy and carotid endarterectomy to 50 and 200 patients respectively. CT and MRI brain imaging is provided to 1,000 and 150 patients respectively. Non-invasive and invasive imaging of the vessels is provided to 425 and 170 patients respectively. Rehabilitation is provided to 1,400 acute stroke survivors, and homecare services are provided to 1,400 chronic stroke with disability patients. What is the level of unmet need in terms of the number of patients not receiving each of recommended services for acute or chronic stroke victims? What percent of need is not currently being met in Eastern Ontario? HCM530 Case Study 3 Age and Gender Adjustment in Two Managed Care Organizations The purpose of standardization is to make two or more populations “similar” along dimensions in which they differ. Earlier, we demonstrated two methods of age-adjustment. For example, we know that Florida has proportionately more older folks, and older folks die at higher rates than younger folks. In order to compare the mortality rate of Florida to Alaska, we needed to control for this disparity by adjusting for differences in the age mix of the two states. Conceptually, we can adjust for more than one dimension, e.g., age and gender, if we want to compare two or more populations, know that the age and gender mix will be different in those two populations, and also know that some disease-specific mortality rates depend on both age and gender. Such is the case with cardiovascular disease in two large MCOs, Bluegrass East (BGE) and Bluegrass West (BGW), the former with 100,000 members, and the latter with 120,000 members. Suppose we want to compare the cardiovascular mortality rate of BGE and BGW. Suppose that BGE has a higher proportion of older folks, and a higher proportion of women, than BGW. Assume that the crude disease-specific mortality rate for cardiovascular disease is 290 (per 100,000) in BGE and 160 (per 100,000) in BGW. (Textbook Case Study 6.2) Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. From these statistics alone, which MCO has the higher cardiovascular mortality rate? 2. The member mix in BGE and BGW is quite different. In BGW, 90% of the population is less than 55 years old compared to 77% in BGE. Refer to Table 6.7 to guide the calculation of age-adjusted cardiovascular mortality rates using the direct age-adjustment technique and the U.S. population as the standard. With age-adjusted rates, which MCO has the higher mortality rate? 3. Now assume that 60% of the members in BGW are men compared to 40% in BGE. Men have higher cardiovascular mortality rates than women. Refer to Table 6.8 to calculate age and Gender adjusted cardiovascular mortality rates. With age- and gender-adjusted rates, which MCO has the higher cardiovascular mortality rate? HCM530Case Study 4Risk Adjustment with Multivariate Techniques (New York)The state of New York (https://monkessays.com/write-my-essay/health.state.ny.us/nysdoh/consumer/heart/1996-98cabg.pdf) hasreported risk adjusted mortality statistics for coronary artery bypass graft surgery (CABG) for a numberof years, as discussed earlier in the text. New York uses the second major approach to risk adjustment, amultivariate model. Such models control for different kinds of patient characteristics that are likely toinfluence mortality. Table 4.1 reports the multivariate model used to calculate this risk-adjustedmeasure. (Textbook Case Study 6.4)Table 4.1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.Logistic RegressionPatient Risk Factor Prevalence (%) Coefficient P-Value Odds RatioDemographicsAge …. 0.0671 <0.0001 1.069Female Gender 28.92 0.5105 <0.0001 1.666Hemodynamic StateUnstable 1.32 1.0423 <0.0001 2.836Shock 0.45 1.8458 <0.0001 6.333ComorbiditiesDiabetes 30.91 0.3607 0.0010 1.434Malignant Ventricular Arrhythmia 2.228 0.9759 <0.0001 2.654COPD 15.97 0.5012 <0.0001 1.651Renal Failure (no dialysis),Creatinine > 2.5 1.89 0.9213 <0.0001 2.513Renal Failure requiring Dialysis 1.89 0.9213 <0.0001 5.688Hepatic Failure 0.10 3.0535 <0.0001 21.190Severity of Atherosclerotic ProcessAortoiliac Disease 5.42 0.5481 0.0006 1.730Stroke 7.01 0.4775 0.0016 1.621Ventricular FunctionEjection Fraction <20 1.77 1.4235 <0.0001 4.151Ejection Fraction 20-29 7.40 0.8183 <0.0001 2.267Ejection Fraction 30-39 14.49 0.6186 <0.0001 1.856Previous Open Heart Operations 5.98 0.6800 <0.0001 1.974Intercept = -9.4988C Statistic = 0.793Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a mpaper, so your answer should not be numbered, but rather it should use titles and subtitles.1. Which factors are supposedly related to CABG morality?2. Which factors are the most strongly related to CABG mortality?3. How could one derive an expected mortality rate from the multivariate model?HCM530 Case Study 5 Planning with Electron-Beam Computed Tomography (EBCT) The use of electron-beam computed tomography (EBCT) for screening of asymptomatic high risk cardiac population to assess for developing coronary heart disease is a new low risk alternative to the traditional invasive heart catheterization. The cardiac CT is recommended by the American College of Cardiology (ACC) as a secondary prevention test to screen prior to a myocardial infarction and death. Garcia (2005) cites that 1 in 20 emergency department (ED) patients present with chest pain and 3-5% of heart attacks have been missed by ED physicians. Another 20-40% of patients who have an invasive heart catheterization are negative. He recommends the cardiac CT as a method to solve some of these issues; however, continued validation is needed. The CT is not an answer for all patients, such as the obese, where visualization is difficult, or those with irregular heart rhythms. Hospitals and clinics across the nation are now purchasing the EBCT scanners. This case study will discuss the screening ability and healthcare planning challenges when bringing in new technology to the healthcare market. A recent purchase of an EBCT scanner was installed in a central U.S. clinic which serves a 300-bed tertiary hospital. The hospital and clinic took great care in training all staff in its use and patient preparation methods, including running a pilot on several local volunteers. Three months post pilot Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. What are the sensitivity, specificity, and predictive values of EBCT? 2. Compare Valanis’s criteria for a good screening program with the eight criteria which the ACC/American Heart Association (AHA) panel proposed for selection of a screening procedure. 3. Provide descriptive epidemiology of this IL region to support the need to purchase a cardiac CT 4. (Health care planning) What should be done at this point to encourage use of this screening/diagnostic test for coronary heart disease?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. Question :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. Question :Describe the “natural history of disease” and disease progression from its inception to its resolution.Question 4. Question :What are some of the many epidemiologic contributions to quality assurance in healthcare and public health?Question 5. Question :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:___________________-2009 U.S. Census: 305,529,237 Total-2009 U.S. Census: Males 148,094,000-2009 U.S. Census: Females 153,388,000Population by Age and Sex: 2009AgeBoth sexesMaleFemaleNumberPercentNumberPercentNumberPercent.35 to 3920,4456.810,1696.910,2756.7.40 to 4420,8776.910,3227.010,5566.9.45 to 4922,7127.511,1627.511,5507.5.50 to 5421,6547.210,6117.211,0437.2.55 to 5918,7556.29,0836.19,6716.3___________________-2009 U.S. Deaths: 2,436,682-2009 U.S. Male Deaths 1,217,047-2009 U.S. Female Deaths 1,219,635___________________2009 Deaths By Gender/Age All races, maleAll ages……………1,217,0471-4 years………………14,8725-14 years………………2,50715-24 years…….………3,24425-34 years…..………22,29435-44 years……………29,15045-54 years……………46,49855-64 years…….……114,61565-74 years…….……183,94575-74 years…….……225,74075-84 years…….……311,135>=85 years…….……262,839Not stated……………………2062009 CVD/ Heart Attack Mortality,Male/AgeAge (All)186,46435-4455,95745-54115,61555-64276,84465-74677,598Source: CDC (2009)________________Case Questions: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. Question :Case Study #1: 2.1. Food poisoning outbreak at Bluegrass HospitalAn 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 inTable 2.5 BelowCase1Midterm____________________Questions: 5 pts each1. 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. Question :Case Study #2: Osteoporosis Marketing PlanYou 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._________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 OsteoporosisAge: Postmenopausal woman over >= 50 years of ageRace: Caucasian, Asian, African-American and Hispanic womenHistory: Women who have a family or personal history of fractures after age 50Health 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 deficiencyLifestyle: Sedentary, inactive lifestyleMedical Treatements: Steroid (corticosteroids), radiation and/or chemotherapy treatmentsSource: NIH 2010, Chart: Meyer 2010________________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.final1Managerial Epidemiology: What is the cost-effectiveness analysis and what is it used for in healthcare and public health? Provide an example study.Question 2. Question :Qualitative, Quantitative (Cause-Effect): You are the Chief Operating Officer of a hospital. The Human Resources Director reports to you. Two of your valued Directors have a random drug screening for controlled substances with a group of hospital cohorts, and the result comes up as positive for heroine. Your experience with epidemiology and your understanding of cause-effect makes you skeptical of these general screening results. You request that the specimens be sent out to a specialty lab for confirmatory testing with gas chromatography specific for heroine. The results of the confirmatory testing show that both Directors are negative (0 mg/dl) for all control substances, including heroine. A further investigation revealed that both Directors attended a morning meeting the day of the random test and had eaten poppy seed muffins. You do research and find that poppy seed muffins produce a byproduct in the body that mimics opiates/heroine in a screening.Discuss why these results occurred , i.e., the two very different results between a screening, and the confirmatory test in terms of a) qualitative and b) quantitative testing, c) specificity, d) reliability.Question 3. Question :Research Methods: Why is the randomized clinical trial (RCT) research considered the “gold standard” in clinical epidemiology research? What is an IRB and why is it requirement when performing research with human beings?Question 4. Question :Decision Making: Clinical epidemiology research should be based on empirical evident. Define empirical evidence and what it means in decision making in both private and public health decision making in regard to interventions, i.e., the implementation of medical testing, processes or public health programs.Question 5. Question :Risk Factor Research: Why is the Framingham Heart Study a pivotal research program in healthcare today? What are some of the milestones the study has given to clinical epidemiology?Question 6. Question :Case 1 of 2 (50 Pts): Cost-Effectiveness Analysis (CEA): In Wu et al. (2006) researchers performed an analysis to evaluate the cost-effectiveness of doing stool DNA testing in addition to other types of traditional

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