excess mortality

Question 1

what is excess mortality?

Answer 1

the number of deaths actually recorded being greater than the number expected of the basis of past data

Question 2

what are biologists interested in terms of excess mortality?

Answer 2

health of individuals and population
what determines health?
what is ‘modifiable’?
what can we do and what’s best to change/improve health?
what are out challenges?

Question 3

causality vs association

Answer 3

Association should not be confused with causality; if X causes Y, then the two are associated (dependent). However, associations can arise between variables in the presence (i.e., X causes Y) and absence (i.e., they have a common cause) of a causal relationship,

x causes y// y causes x
x and y are caused by 3rd factor (confounder)
x and y are associated only by artefact
x and y are associated by chance

*artefact= as a result of investigative procedure; not occurring naturally

Question 4

what is a confounder?

Answer 4

A Confounder is an extraneous variable whose presence affects the variables being studied so that the results do not reflect the actual relationship between the variables under study.

Question 5

what are risk factors?

Answer 5

something that increases your likelihood of getting disease
a risk factor is any characteristic, condition, or behaviour that increases the likelihood of developing a disease or health problem

the more risk factors you have, the higher your likelihood of developing chronic diseases

Question 6

what are the two types of risk factors?

Answer 6

modifiable;
smoking, diet, physical activity, high blood pressure

non-modifiable;
age, family history, ethnicity

Question 7

explain excess mortality in relation to scotland and glasgow.

Answer 7

excess mortality in scotland is higher than the rest of the UK.
most evident in glasgow, compared with socioeconomically similar UK cities.
the phenomenon is improving more slowly in Glasgow than rest of UK
(health is determined through complex and related factors)

Question 8

observational vs experimental

Answer 8

Observational is where you observe certain variables and try to determine if there is any correlation. Experimental is where you control certain variables and try to determine if there is any causality.

Question 9

what is epidemiology?

Answer 9

defined by WHO;
‘the study of the distribution and determinants of health-related states/events in specified populations and the application of this study to control of health problems’

Question 10

how does physical activity relate to epidemiology?

Answer 10

most physical activity epidemiology is observational and shows associations between exposures and disease and further experimental data is needed to establish causality

Question 11

what are the types of epidemiological evidence?

Answer 11

observational:
descriptive studies (case reports of case series)
analytical studies (correlational-ecological, cross sectional surveys, case control studies, cohort studies)

experimental:
(randomised control trials)

Question 12

what is a randomised control trial?

Answer 12

A study in which a number of similar people are randomly assigned to 2 (or more) groups to test a specific drug, treatment or other intervention.

Question 13

what is a cohort study?

Answer 13

Cohort studies are a type of longitudinal study—an approach that follows research participants over a period of time (often many years). Specifically, cohort studies recruit and follow participants who share a common characteristic, such as a particular occupation or demographic similarity.

Question 14

what is a case-control study?

Answer 14

A study that compares two groups of people: those with the disease or condition under study (cases) and a very similar group of people who do not have the disease or condition (controls).

Question 15

what is a cross-sectional survey?

Answer 15

Cross-sectional studies are observational studies that analyse data from a population at a single point in time. They are often used to measure the prevalence of health outcomes, understand determinants of health, and describe features of a population.

Question 16

what is a correlational (ecological) study?

Answer 16

A correlational research design investigates relationships between two variables (or more) without the researcher controlling or manipulating any of them. It’s a non-experimental type of quantitative research

Question 17

what are case reports of case series?

Answer 17

A case report is a detailed report of the diagnosis, treatment, response to treatment, and follow-up after treatment of an individual patient. A case series is group of case reports involving patients who were given similar treatment.

Question 18

what can minimise confounding variables?

Answer 18

There are several methods you can use to decrease the impact of confounding variables on your research: restriction, matching, statistical control, and randomisation. In restriction, you restrict your sample by only including certain subjects that have the same values of potential confounding variables.

Question 19

what is reverse causality?

Answer 19

becomes a possibility when the “effect” of something could actually be its cause. For example, some studies have observed that diet soda drinkers are more likely to be obese than people who don’t drink diet soda.

Question 20

what can minimise reverse causality?

Answer 20

Temporal sequence
To eliminate the potential of the variables being reverse causation, look to see if the exposure precedes the outcome.

Question 21

what is the criteria for causality with epidemiological evidence?

Answer 21

appropriately sequenced; does the measure of physical activity/fitness/sedentary behaviour precede onset of disease?

plausibility; is the association consistent with other knowledge?

consistency; are findings consistent in different populations?

strength; what is the strength of association between the causal factor and the effect (what is the relative risk)?

dose-response; are increased levels of physical activity or fitness associated with greater effect?

reversibility; is a reduction in activity levels/fitness associated with an increase in disease risk

strong study design; are the findings based on strong study designs?

Question 22

what is considered the gold-standard study design?

Answer 22

randomised controlled trial.

The randomised controlled trial (RCT) is considered to provide the most reliable evidence on the effectiveness of interventions because the processes used during the conduct of an RCT minimise the risk of confounding factors influencing the results.

The main purpose of random assignment is to prevent selection bias by distributing the characteristics of patients that may influence the outcome randomly between the groups, so that any difference in outcome can be explained only by the treatment.

Question 23

why it is difficult to do RCTs (randomised controlled trials) evaluating the effects of health behaviours on hard disease outcomes?

Answer 23

Health promotion programs cannot be expected to produce changes in “hard” disease outcomes within a short time frame; therefore, randomized controlled trials are not practical.

Question 24

criteria used to evaluate strength of evidence in ACSM position stand on exercise and physical activity for older adults.

Answer 24

evidence level
A; overwhelming evidence for randomised controlled trials and/or observational studies, which provides a consistent pattern of findings on the basis of substantial data
B; strong evidence from a combination of randomised controlled trials and/or observational studies but with some studies showing results that are inconsistent with the overall conclusion
C; generally positive or suggestive evidence from a smaller number of observational studies and/or uncontrolled/nonrandomised trials
D; panel consensus judgement that the strength of the evidence is insufficient to place it in categories A->C

Question 25

list some modifiable risk factors.

Answer 25

diet physical activity levels smoking alcohol consumption body weight blood pressure cholesterol blood sugar levels stress sleep quality substance abuse sun exposure occupational hazards social isolation environmental factors

Question 26

list some non-modifiable risk factors

Answer 26

age genetics gender ethnicity family medical history previous health conditions congenital conditions menopause

Question 27

discuss age in terms of a risk factor?

Answer 27

age is a non-modifiable risk factor... we all grow older, but we don't all age at the same rate.

Question 27

what is a blue zone?

Answer 27

regions known for having high life expectancy and concentrations of centenarians okinawa japan, ikaria greece, sardinia italy, nicova costa rica, loma linda california

Question 28

what is a typical diet in a blue zone region?

Answer 28

plant-based diet; blue zones predominantly follow a plant-based diet, with vegetables, fruits, legumes, and whole grains making up the majority of their meals. (meat is eaten sparingly, typically only a few times a month)

Question 29

how is your risk of dying related to your age?

Answer 29

risk of death in a given year doubles approximately every eight years. 85% of deaths in the UK are caused by age-related diseases.

Question 30

what is a non-communicable disease?

Answer 30

A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others

Question 31

what is dementia?

Answer 31

Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities. In people who have dementia, the symptoms interfere with their daily lives. Dementia isn't one specific disease. Several diseases can cause dementia. Dementia generally involves memory loss.

Question 32

what proportion of our genetic code is unique to us?

Answer 32

a printed version of your entire genetic code would require 262,000 A4 pages.... just about 500 would be unique to us.

Question 33

what genotype is associated to a higher body weight?

Answer 33

FTO genotype is associated to a higher body weight and linked to obesity *people with obesity-risk FTO variant have higher circulating levels of the hunger hormone ghrelin in their blood

Question 34

how does sex relate to biological risk factor?

Answer 34

woman tend to live longer than men. this could be to do with fat and muscle quantity and distribution. men tend to store fat around stomach (vital organs) whereas woman more around waist.

Question 35

what is the most significant non-modifiable risk factor?

Answer 35

age. older adults face higher risks for chronic diseases and mortality.

Question 36

what risk factor plays a key role in disease susceptibility?

Answer 36

certain ethnic groups are at higher risk for conditions like diabetes, even with similar BMI levels

Question 37

how do genetics impact disease risk?

Answer 37

inherited traits, such as the FTO gene, influence the likelihood of developing obesity and related diseases.

Question 38

what is a growing concern with an ageing population?

Answer 38

age-related diseases are becoming more prevalent, with shifting demographics, age-related diseases like dementia and cardiovascular conditions are a growing concern.

Question 39

what is meant by an ageing population?

Answer 39

Population ageing refers to the increasing in number, percentage of older people aged 60yr, above, at the same time the number and percentage of the young age population aged 15yr old, and below in a population structure is decreasing.

Question 40

how should we address risk factors?

Answer 40

holistically; combining lifestyle changes with awareness of non-modifiable risks can help mitigate overall health risks.

Question 41

give examples of common diseases and how do they affect disease risk/severity?

Answer 41

cardiovascular disease, cancer, type 2 diabetes, COVID-19 behavioural factors affect disease risk/severity

Question 42

what are behavioural risk factors?

Answer 42

physical inactivity obesity dietary intake smoking alcohol intake sleep

Question 43

exercise vs physical activity

Answer 43

Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposefully focused on improvement or maintenance of one or more components of physical fitness. Physical activity is any bodily movement produced by skeletal muscles that require energy expenditure.

Question 44

what is visceral fat?

Answer 44

Visceral fat is belly fat found deep within your abdominal cavity. It surrounds important organs, including your stomach, liver and intestines. It's different than subcutaneous fat, which is fat just below your skin. Visceral fat is actually more dangerous to your health.

Question 45

pros and cons of BMI as a use of health indication

Answer 45

BMI is used to screen for obesity, but it does not displace clinical judgment. BMI is not a measure of body fat. Social determinants, race, ethnicity, and age may modify the risk associated with a given BMI

Question 46

what is the world health organisation's definition of health?

Answer 46

health is a state of complete physical, mental, and social well-being and not merely the absence of disease

Question 47

what are the problems with the WHO's definition of health?

Answer 47

'health is a state of complete physical, mental, and social well-being and not merely the absence of disease' contributes to the medicalisation of society; definition of 'complete health' implies most people are unhealthy most of the time; support medical and pharmaceutical industries in expanding disease definition; new screening technologies detect minor abnormalities that may not cause illness; pharmaceutical companies create drugs for conditions not previously considered health issues; intervention thresholds for conditions like blood pressure, lipids, and sugar are lowered, leading to more medical treatment. since 1948 the demography of population and the nature of diseases have changed considerably. (In 1948 acute diseases presented the main burden of illness and chronic diseases led to early death. In that context WHO articulated a helpful ambition. Disease patterns have changed, with public health measures such as improved nutrition, hygiene, and sanitation and more powerful healthcare interventions. The number of people living with chronic diseases for decades is increasing worldwide; even in the slums of India the mortality pattern is increasingly burdened by chronic diseases. In this context the WHO definition becomes counterproductive as it declares people with chronic diseases and disabilities definitively ill. It minimises the role of the human capacity to cope autonomously with life’s ever changing physical, emotional, and social challenges and to function with fulfilment and a feeling of wellbeing with a chronic disease or disability.) the operationalisation of the WHO definition is problematic as it refers to a complete state of health, which is impractical and neither measurable not operational despite the WHO's systems for classifying diseases, disabilities and quality of life.

Question 48

what does the WHO'S definition of health overlook?

Answer 48

the human ability to cope and function with chronic conditions, while still feeling fulfilled and well

Question 49

what is a better definition for health?

Answer 49

instead of focusing solely on life expectancy it may be more meaningful to prioritise peoples ability to participate in society. Similarly, helping individuals improve their capacity to manage health challenges could be a more realistic goal than striving for full recovery. 'resilience or capacity to cope and maintain one's integrity equilibrium, and sense of wellbeing- the ability to adapt and self manage'

Question 50

what are the fundamental conditions and resources for health?

Answer 50

peace shelter education food income stable eco-system sustainable resources social justice equity

Question 51

what are the three domains of health?

Answer 51

physical mental social autonomy; capacity for control over one's self sense of us; capacity for relating to and with others control; capacity for navigating social spaces sense of 'us'; ability to choose one's level of social participation

Question 52

what is physical health?

Answer 52

a healthy body can adapt to changing conditions to keep itself balanced (allostasis)

Question 53

what is allostatsis?

Answer 53

“maintaining stability through change”, allostasis refers to a continuous process of energy balance instantiated by the brain to anticipate, regulate, and perform adaptive responses to environmental stressors.

Question 54

what is it called when your body can't adapt to stress?

Answer 54

allostatic load *when you're exposed to stress (like intense exercise/sudden change in temperature), a healthy body responds to protect itself, making adjustments (like swearing to cool down/increasing your heart rate to pump more blood); these changes help prevent harm and restore balance. If your body can't adapt successfully over time, this stress builds up, leading to damage (allostatic load), which can eventually result in illness

Question 55

what is mental health?

Answer 55

sense of coherence; helps people deal with and recover from serious stress (can even prevent conditions like PTSD) how well you understand, manage, and find meaning in difficult situations.

Question 56

what is social health?

Answer 56

how well people can live their lives, fulfil their potential, and manage responsibilities (even with a medical condition) the ability to live independently and participate in social activities, including work. *health is a balance between what you can do and the limitations you face- which can change throughout life and be influenced by things like social and environmental challenges. people who successfully adapt to their illness can still feel healthy and participate in life despite their limitations.

Question 57

what are examples of cardiovascular diseases?

Answer 57

coronary heart disease angina heart attack congenital heart disease stroke (atherosclerosis can underline coronary heart heart disease- angina and heart attack- and stroke)

Question 58

what is atherosclerosis?

Answer 58

thickening or hardening of the arteries caused by a build-up of plaque in the inner lining of an artery. Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.

Question 59

what is type 2 diabetes?

Answer 59

Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood Type 2 diabetes occurs when the pancreas, a large gland behind the stomach, can't produce enough insulin to control your blood glucose level, or when the cells in your body don't respond properly to the insulin that is produced. This means your blood glucose levels may become very high, and is known as hyperglycaemia. In people who don't have diabetes, the pancreas makes a normal amount of insulin. If you have type 2 diabetes the body doesn't make enough insulin/the insulin made doesn't work properly. Insulin acts like a key, helping glucose move into our cells. In type 2 diabetes, the key doesn't work properly. Without enough insulin, the level of glucose in the body gets too high.

Question 60

type 1 vs type 2 diabetes

Answer 60

The insulin-producing cells have been attacked and destroyed by your immune system. This is why type 1 diabetes is known as an autoimmune condition. Type 2 diabetes isn't an autoimmune condition. Your body isn't making enough insulin or what it makes isn't working properly.

Question 61

what is cancer?

Answer 61

cancer is disease where some of the body's cells grow uncontrollably and spread to other parts of the body. Normally, cells grow and divide in a controlled way, but in cancer, this process goes wrong, leading to the formation of abnormal cells that can form tumours or spread through the bloodstream or lymphatic system.

Question 62

what is metastasis?

Answer 62

in metastasis, cancer cells break away from where they first formed, (primary cancer), travel through the blood/lymph system and form new tumours (metastatic tumours) in other parts of the body. The metastatic tumour is the same type of cancer as the primary tumour.

Question 63

what are the most common types of cancer in men and women?

Answer 63

men 1. prostate cancer 2. lung cancer 3. bowel (colorectal) cancer women 1. breast cancer 2. lung cancer 3. bowel (colorectal) cancer *smoking is a key risk factor for lung cancer

Question 64

what are examples of respiratory diseases?

Answer 64

asthma; airway inflammation causing shortness of breath COPD; bronchitis where the airways are inflamed and narrowed and Emphysema where the alveoli lose structure and trap air cystic fibrosis; mutations in both copies of the gene for the cystic fibrosis transmembrane conductance regulator (CFTR) leads to a thick sticky mucus which leads to chronic infections and reduced function

Question 65

what is depression?

Answer 65

low mood that lasts for a long time and affects your everyday life. in the mildest form, depression can mean just being in low spirits, it doesn't stop you leading your normal life but makes everything harder to do and seem less worthwhile. at its most severe, depression can be a life-threatening because it can make you feel suicidal or simply give up the will to live

Question 66

what is dementia? and what are the 4 types?

Answer 66

dementia is broad umbrella term used to describe a range of progressive neurological disorders. there are many types of dementia and some may present with a combination of types. alzheimer's disease vascular dementia frontotemporal dementia dementia with lewy bodies

Question 67

alzheimer's disease, vascular dementia, frontotemporal dementia, dementia with lewy bodies

Answer 67

Both vascular dementia and Alzheimer's disease are types of dementia that can affect thinking, behavior, and the ability to carry out everyday tasks. Vascular dementia occurs through damage to blood vessels in the brain. Alzheimer's disease occurs through plaques and tangles forming in the brain. Frontotemporal dementia: Abnormal amounts or forms of tau and TDP-43 proteins accumulate inside neurons in the frontal and temporal lobes. Lewy body dementia: Abnormal deposits of the alpha-synuclein protein, called “Lewy bodies,” affect the brain's chemical messengers.

Question 68

how does social deprivation link to health?

Answer 68

People in the most disadvantaged social groups and communities experience a multitude of different types of social exclusion processes such as homelessness, school exclusions, or long-term unemployment, which in turn results in poor health, disease, and disability

Question 69

what are 4 indicators of the risk factor of socioeconomic status?

Answer 69

male unemployment lack of ownership overcrowding in households low occupational social class (IV & V)

Question 70

what behaviours are associated with higher mortality?

Answer 70

smoking and alcohol in specific and multiple health outcomes (also reducing/stabilising) **modifying behavioural risk factors is challenging

Question 71

in what way are environmental factors risk factors?

Answer 71

air pollution and exposure to microplastics are emerging health hazards that increase the risk of cardiovascular diseases and mortality

Question 71

what approach should be taken to modify behaviours which are associated with higher mortality?

Answer 71

a multi-disciplinary approach is needed; legislative, intervention, individual, cultural, environmental approaches.

Question 72

what are public health strategies which are looking a reducing excess mortality?

Answer 72

targeting behaviours such as reducing processed food intake, increasing physical activity and addressing environmental risks can help lower excess mortality

Question 73

in which ways are microplastics contributing to excess mortality and affecting health?

Answer 73

micro and nano plastics are an emerging concern for human health, although research is still ongoing. - respiratory and digestive issues; inhales/digested microplastics may cause inflammation/irritation in the lungs and digestive system. They can accumulate in the body, potentially leading to long-term health issues. -toxic chemical exposure; microplastics can carry harmful chemicals, such as endocrine disruptors and heavy metal, which may interfere with hormone function and increase the risk of cancers, reproductive issues, and developmental problems -immune system impact; early research suggests that microplastics could trigger immune system responses, potentially leading to chronic inflammation/other immune-related disorders. -cellular damage; nano plastics, due to their tiny size, can penetrate cells and tissues, possibly causing oxidative stress, cell damage, or even affecting organ function (*skin irritation, respiratory problems, cardiovascular disease, digestive problems, reproductive effects, cancer)

Question 74

why is ultra-processed food and why is it problematic for health?

Answer 74

industrial formulations made with no or minimal whole foods and produced with substances extracted from foods/synthesised in laboratories, such as dye, flavourings and preservatives. they typically contain much higher levels of sodium compared to non-processed/minimally processed foods. Sodium is often added to ultra-processed foods for flavour, preservation, and texture enhancement.

Question 75

are fruits or vegetables better for health?

Answer 75

both are important for a healthy diet but it is generally recommended to focus slightly more or veg because they tend to be lower in sugar while rich in essential nutrients, fibre, and antioxidants.

Question 76

when is obesity considered an epidemic?

Answer 76

obesity is considered an epidemic when it affects a large proportion of the population across multiple regions/countries, with rates rising significantly over time. collecting worldwide data helps us determine is excess body weight is within expected levels or is it is becoming an epidemic (this process is known as surveillance)

Question 77

what are the surgical interventions to reduce obesity?

Answer 77

adjustable gastric band (AGB) roux-en-Y gastric bypass (RYBG) vertical gastrectomy (VSG)

Question 78

what does adjustable gastric banding (AGB) involve ?

Answer 78

Adjustable gastric banding (AGB). This procedure involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt to form a small pouch that serves as a new, much smaller stomach.

Question 79

what does roux-en-Y gastric bypass (RYBG) involve ?

Answer 79

This surgery reduces the size of your upper stomach to a small pouch about the size of an egg. The surgeon does this by stapling off the upper section of the stomach. This reduces the amount of food you can eat. The surgeon then attaches this pouch directly to part of the small intestine called the Roux limb

Question 80

what does a vertical gastrectomy (VSG) involve?

Answer 80

Vertical sleeve gastrectomy is surgery to help with weight loss. The surgeon removes a large portion of your stomach. The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat and makes you feel full after eating small amounts of food.

Question 81

what two major demographic processes are causing profound change?

Answer 81

population ageing; Population ageing refers to the increasing in number, percentage of older people aged 60 yr, above, at the same time the number and percentage of the young age population aged 15 yr old, and below in a population structure is decreasing. population migration; Births are continuing to outnumber deaths and immigration continues to outnumber emigration, resulting in a growing population.

Question 82

discuss the consequences of population changes (immigration and ageing).

Answer 82

The population of the UK is constantly changing and is projected to continue changing in the coming decades. With lower birth rates and higher life expectancy, the shape of the UK population is transforming. Whilst longevity is something to celebrate, the proportion of those of a working age is shrinking whilst those of a pensionable age is increasing. While a larger population can increase the size and productive capacity of the workforce, it also increases pressure and questions the sustainability to provide social services such as education, healthcare and housing.

Question 83

what are age related conditions?

Answer 83

dementia frailty sarcopenia chronic conditions social isolation depression

Question 84

what is sarcopenia?

Answer 84

related to ageing. Sarcopenia represents a muscle-wasting syndrome characterized by progressive and generalized degenerative loss of skeletal muscle mass, quality, and strength occurring during normal ageing

Question 85

what is frailty?

Answer 85

related to ageing. frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event and increases the risk of adverse outcomes, including falls, delirium, and disability. while most older people do not become frail, frailty becomes more prevalent with age, affecting around 10% of those over 65, increasing to around 65% of those over 90. increased risk of falls; poorer mobility; inability to perform activities of daily living; disability; incident hospitalisation; death

Question 86

what are the different ranges of BMI and how they relate to your health?

Answer 86

BMI < 18.5 = underweight range BMI 18.5 - <25 = healthy BMI 25 - <30 = overweight BMI 30+ = obesity obesity BMI 30- <35 =class 1 BMI 35-<40 =class 2 BMI 40+ = class 3 (severe)

Question 87

describe bonfenbrenner's social-ecological model

Answer 87

five domains capture the influences to people's health can be applied to a range of health conditions/lifestyle behaviours useful for considering variables to design health interventions. individual (knowledge, attitudes, behaviour) interpersonal (families, friends, social networks) institutional (school, workplace, church, organisation) community (culture, formal/informal social norms) public policy (national, state, local laws)