CPP2066 life course epidemiology

Question 1

what is life course epidemiology?

Answer 1

• a life course approach in epidemiology investigates the long term effects on chronic disease risk and ageing of physical and social hazards during gestation, childhood, adolescence, young adulthood and later adult life across generations
• it studies biological, behavioural and psychosocial pathways that operate across the life course and influence the development of chronic diseases

Question 2

give some examples of factors affecting childbirth in Britain in 1946

Answer 2

• social class gradients affecting nutrition/diet and cost of childbirth (before NHS)
• still on rations from war affecting mother’s nutrition
• less medical knowledge + advances
• lower hygiene and sanitation (often shared bathrooms with many families and only half had running hot water

Question 3

give some examples of healthcare changes since 1946

Answer 3

• NHS introduced
• development of vaccines
• reduction of occupational hazards
• clean air act
• shift of diseases affecting now middle and later life
• awareness and advances of diet and nutrition
• more advanced medications and treatments

Question 4

give some examples of education changes since 1946

Answer 4

• education act forming the 11+ exam to get into secondary school
• many reports improving access to higher education

Question 5

give some examples of emotional well being changes since 1946

Answer 5

• mother’s began to learn the importance of bonding and relationship with their child for its development
• start talking about mental health issues and normalising them

Question 6

across the UK what is the general location spread of a higher proportion of people with ischemic heart disease?

Answer 6

• highest in wales, north west and north east

Question 7

what is the link between coronary heart disease mortality and birth weight?

Answer 7

• as birthweight increases, risk of mortality of coronary heart disease decreases

Question 8

why is fetal undernutrition/lower body weight linked to increased risk of coronary heart disease?

Answer 8

• undernutrition =
  - adapted liver metabolism = increased LDL, cholesterol and fibrinogen
  - changes in structure of heart, blood vessels and kidney = hypertension and left ventricular hypertrophy
  - re-set HPA and GH-IGF axes = hypertension and left ventricular hypertrophy and non-insulin-dependent diabetes
  - changes in pancreas and muscle = non-insulin-dependent diabetes

= all lead to coronary heart disease

Question 9

what is the link between grip strength and birth weight?

Answer 9

• the higher the birth weight, the increase grip strength

Question 10

why is cognitive function an important aspect of health and function?

Answer 10

• key determinant of everyday mastery
• highly socially and culturally patterned
• a marker of underlying physiological process
• associated with health and survival

Question 11

what does this diagram show?

Answer 11

• the correlation coefficients between different factors affecting the national adult reading test scores

Question 12

what is the correlation between birth weight and cognitive function?

Answer 12

• increased birth weight causes increased cognitive function

Question 13

what could be some possible causes as to why a higher birthweight is linked to better cognitive function?

Answer 13

• Insulin-like growth factor play a critical role in determining physical growth, and have receptors located in brain areas important for cognition like the hippocampus
• thyroid hormone also has dual somatic and CNS effects and may also interact with IGF
• glucocorticoids are negatively associated with physical growth and cognition and are partly under control of thyroid hormone and also diminish IGF production

Question 14

what is the association between early adversity and childhood cognition?

Answer 14

• the higher the severity/frequency of early adversity, the lower the childhood cognition

Question 15

what are adverse childhood experiences (ACEs)?

Answer 15

• things that happen in a child’s life that can negatively impact them for the rest of their lives
• e.g. abuse of any form, parents’ divorce, living with someone struggling with addiction or substance abuse, witnessing domestic violence, living with someone with severe mental illness, losing a parent or close relative

Question 16

what do adverse childhood experiences increase the risk of in children?

Answer 16

• suicide rates
• substance abuse
• early sexual experiences
• intimate partner violence
• less attendance to school

Question 17

what is the correlation between cardiovascular disease risk and dementia risk?g

Answer 17

increased risk of cardiovascular disease is correlated with an increased risk of dementia