1¾«IAJJJJKC:\WORD\WP\NORMAL.STYEPSONLXLPOSTGRADUATE DIPLOMA IN OCCUPATIONAL HEALTH FINAL EXAMINATION PAPER I: EPIDEMIOLOGY AND BIOSTATISTICS (TOTAL CREDIT IS 17% OUT OF 100%. ALL PARTS ARE WEIGHTED EQUALLY) DATE MONDAY 31 AUGUST 1992 TIME 9.30 - 12.30 VENUE SEMINAR ROOM 1, DEPARTMENT OF COMMUNITY HEALTH PART I: 1. Height and weight are often used in epidemiological studies as possible predictors of disease outcomes. In a study to compare self-reported weight and measured weight on 10 people, the following data was recorded. Person Self-reported Measured Difference weight (kg) weight (kg) 1 55 60 -5 2 56 54 +2 3 60 64 -4 4 53 55 -2 5 55 60 -5 6 79 87 -8 7 56 60 -4 8 80 81 -1 9 60 58 +2 10 56 56 0 Test the hypothesis or compute a 95 per cent confidence interval for the difference between self-reported and measured weights. 2. Outline the general procedure of hypothesis testing between two sample proportions. 3. Discuss the properties of the normal (Gaussian) distribution. PART II: Epidemiology short questions 1. You are an occupational medical practitioner working in an asbestos-cement factory that has been operating since the mid- 1950's and has roughly 1 500 employees. You have noticed that there are a number of cases of lung cancer in the factory population. Some of these are among smokers, others among non- smokers. You become interested in studying the occurrence of lung cancer. Explain the survey/s that could be designed and the occurrence measure/s that could be used to pursue your interest and investigate the occupational aetiology of lung cancer in this population. List the advantages and disadvantages of each design that is feasible. 2. During a 4-year period there were 532 Sharps injuries due to accidents among the personnel at certain medical laboratories. The number of employees at these laboratories was 520 at the beginning of the period and 680 at the end. Which measure of occurrence can be calculated? Calculate this. 3. What do you understand by Sensitivity Specificity Positive predictive value Negative predictive value of a screening test. Use a fourfold table to illustrate your answer. Give one line definitions only. 4. In a mass screening aimed at early diagnosis of HIV infection, an ELISA test is used where both the sensitivity and specificity are 99%. Of those attending the screening, one per thousand have the disease. What proportion of those who screen positive have the disease?. How would you proceed with these results in hand? 5. Of 725 female industrial workers exposed to radium in their work between 1915-29 in the U.S., 22 died of malignant bone tumours. The expected number was 0.27. Calculate the SMR. 6. In a study, male vulcanization workers were compared with all working men with regard to the cumulative incidence of esophageal cancer during a 13-year period. The results are shown in the table below. Perform an "indirect" age standardization, i.e., calculate the SMR. Vulcanization Workers Comparison Group No.of No.With No.Of No.With Men Age Disease Men Disease (thousands) 15-24 ? 651 0 337 25-34 ? 518 6 431 35-44 ? 500 90 522 45-54 ? 465 381 507 55-64 ? 211 626 367 Total 8 2,345 1,103 2,164 List some common validity problems in occupation epidemiology studies. List some common validity problems in occupation epdemiology studies. 7. The alcohol consumption of individuals in a random sample from a population was established. The individuals were divided into those who did and those who did not consume alcohol. A follow-up showed an excessive incidence of lung cancer among the consumers of alcohol. Discuss its validity. PART III: Criticise the article provided by using a structured approach listing the sort of validity problems that may be expected to be encountered in the research process. Cover Purpose, aim, objectives, methods, results, discussion and recommendations. PAPER II: OCCUPATIONAL MEDICINE AND TOXICOLOGY (TOTAL CREDIT IS 17% OUT OF 100%. ALL QUESTIONS ARE WEIGHTED EQUALLY) DATE TUESDAY 1 SEPTEMBER TIME 9.30 - 12.30 VENUE SEMINAR ROOM 1, DEPARTMENT OF COMMUNITY HEALTH 1. You are asked to draw up guidelines, directed at occupational health doctors, for lung function testing in South African manufacturing industry. Prepare a draft. 2. Prepare the outline of a lecture, to be given to an audience consisting of health and safety officers from union and industry and health inspectors, on the health hazards and safe use of solvents. Concentrate on general principles, using examples of the more hazardous solvents. 3. You are the occupational health practitioner for a large clothing factory. There have been a number of musculoskeletal complaints from workers involving the back, neck and upper limb. Write down a strategy for helping the company and its occupational health service to solve the problem. Include epidemiological, ergonomic and medical aspects. PAPER III: OCCUPATIONAL HEALTH SERVICES MANAGMENT & ORGANISATION INCLUDING SAFETY, LEGISLATION AND INDUSTRIAL RELATIONS (TOTAL CREDIT IS 17% OUT OF 100%. ALL QUESTIONS ARE WEIGHTED EQUALLY.) DATE TUESDAY 1 SEPTEMBER TIME 14.00 - 17.00 VENUE SEMINAR ROOM 1, DEPARTMENT OF COMMUNITY HEALTH 1. You are called in to consult for a large financial institution which owns several high-rise office blocks in Central Business Districts across the country. There are disturbing reports of health-related complaints and a suspicion that productivity may be being affected in several of these work environments. Write a concise plan of action for management to follow in investigating the problem bearing in mind all people working in, and all processes being conducted in, a large office block. This should include recommendations for regular surveillance. Bear in mind also industrial relations aspects of introducing any new policies which may affect work or the work environment in such a situation. 2. The Department of Manpower is contemplating a new system for setting occupational exposure limits in South Africa. You are approached for your advice as to whether the current legislative provision is adequate or not. If not, you are asked to consider a system for limit setting for South Africa. Should South Africa be setting its own limits? If so, through what mechanisms? If not, what system should be adopted? Should the new system take into account the different views of interested parties? How might this best be achieved? Discuss the ethical issues along with issues that are uppermost in the minds of ordinary workers, worker organisations, management and employer organisations and those responsible for occupational health and safety in the state departments of manpower and health. 3. A local agribusiness employing around 5000 workers (includes their dependents) producing fruit approach you with a view to setting up an occupational health service. The nearest town is 20 kilometers away and has only a few private GPs with a private hospital. The only public health service is provided parttime by one of the GPs acting as District Surgeon. Produce a memorandum outlining the sort of service you think should be set up including structural aspects such as staffing, salaries, budget for capital and running expenses, and functional aspects in terms of the type of services to be rendered. 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