Excess Mortality Flashcards

Question

Whagt is a powered outcome, what's the powered aim of FFIT programme?

Answer 1

A powered outcom is the main aim of the research determined by the number of the participants for reliability and the powered aim of FFIT it is weight loss at 12 months.

Answer 2

A non powered outcome is one which does not dictate the sample size of the sample population.

Answer 3

A Longitudinal experiment works as so: 1. Measure outcome in exposed group (A) before they have recieved intervention x (T₁) 2. Then apply intervention x to Group A 3. Measure outcome in group A after they have recieved intervention x (T₂) 4. Estimate of the effect of intervention x is the change in outcome (T₂ - T₁)

Answer 4

Before-and-after research is the most common as it is easy and inexpensive.

Answer 5

No because there are external factors which may influence the T2 of the group and learning effects.

Answer 6

Have two groups, one exposed to intevention (A), and control group (B). Measure outcome in both groups at baseline (T₁) Apply inteverntion x to (A) Measure outcome in both groups at follow up Estimate effect of x by comparing change (T₂ - T₁) between groups.

Answer 7

Selection bias is the bias introduced by the selection of individuals, groups or data for analysis in such a way that proper randomization is not achieved, thereby ensuring that the sample obtained is not representative of the population intended to be analyzed.

Answer 8

Selection bias effects two group before and after experiments as it leads to one group being fundamentally different to the other groups, rendering results effectively unreliable.

Answer 9

10k kids had to drink 3/4 pint of milk a day Another 10k to get none teachers tended to put weaker, less well nourished kids in interventuion group study found that control group were taller and heavier than intervention group milk had not led to smaller children but the two groups were fundamentally disimilar due to the initial selection bias.

Answer 10

To reduce selection bias one must use randomisation control trial (RCT) experimental design. In this exoerimental design randomisation is used to allocate participanrts in group A or B at T1. Then apply intevention x to group A only. Measure outcome in both groups at follow up (T2) Estimate the effect of x by comparing T2 -T1 between groups.

Answer 11

In research, a cross-sectional study is a type of observational study that analyzes data from a population, or a representative subset, at a specific point in time—that is, cross-sectional data. Coined snapshot study as each participant is analysed at one point in time. Allows researchers to look at many factors at once (age, income, gender as well as health risk factors and outcomes). Designed to determine current state - prevelance

Answer 12

* Random Sampling * Most representative - every member of the population has an equal chance of being picked. * Stratified Sampling * Separate groups e.g.ethnic minority vs majority, then sample systematically (e.g. every 20th postcode) to ensure you have adequate samples of each group. * Convenience Sampling * Take those people who are available however the representativeness is questionable.

Answer 13

Descriptive research design involves measuring participants at more than one point in time Observing change in these participants gives a better basis for causal inferences than a cross sectional design.

Answer 14

Reliability refers to the consistency of an instrument/ measurements * Determines if the results are repeatable

Answer 15

The three common forms of reliability are: 1. Inter-rater reliability - when 2 or more people are taking the measurement or applying the instrument of measurement. 2. Test-retest reliability - when you repeat the measure on one or more occasions and expect the result to be similar. 3. Internal consistency reliability - Applies to questionnaires. Looks at the extent to which the items on the scale are all telling you the same thing.

Answer 16

Validity refers to the accuracy of an instrument/measurement The degree to which you're measuring what you're claiming to measure. There are different types: Construct validity: Does the test measure the concept that it’s intended to measure? Internal validity: The extent to which the dependent variables can be attributed to changeds in independent vairable.

Answer 17

Studies with control and randomisation like an RCT have the highest internal validity.

Answer 18

An RCT is a randomised control trial

Answer 19

The different types are: Construct validity: Does the test measure the concept that it’s intended to measure? Internal validity: The extent to which the dependent variables can be attributed to changeds in independent vairable. External validity: The extent to which the results can be generalised.

Answer 20

The problem is, the more srictly controlled the study is, the higher the internal validity will be. However the lower the external validity will be.

Answer 21

The FFIT was a RCT (randomised control trial) to design the effectiveness of a weight managent programme delivered through a football regime to help men between 35 and 65 lose weight and retain the weight loss after 12 months.

Answer 22

747 men in study, half randomly allocated to intervention group for 12 weeks. While other half were the control and did not participate in the intervention at all.

Answer 23

Both groups had measurements taken and were followed up after 12 months to find out if they had retained the changes over a longer term.

Answer 24

Between group contamination. It's important that the control groups don't know anything about the intervention group. They had to keep the groups seperate. Hard to do amongst football fans. E.g. man in intervention group may be a fan of man in comparison group as they support the same team. If the control group member found out about intervention may decide to do it as well and the results for the control will be skewered.

Answer 25

A solution would be to do a cluster randomised control trial - randomisation of football clubs, not the men. Randomising the collective, not the individuals.

Answer 26

The groups were measured at different times at 12 weeks but not at baseline or 12 months

Answer 27

Blinding is where researchers and participants do not know what group the participants are in.

Answer 28

Blinding is important because researchers and/or participants may influence outcomes of the experiment.

Answer 29

FFIT struggled with blinding because the participants know if they are in the intervention or not and may of the fieldworkers knew the participants, becoming friendly and participants would tell researchers intentionally or non intentionally about their intervetion. FFIT managed to overcome this issue by hiring new field workers for primary outcome (weight at 12 months). As they have no recollection of any of the participants groups.

Answer 30

Lack of retention in a study makes results less reliable as there is an attrition bias due to the powered nature of the primary aim. * This was caused by the fact that only those with good outcomes want to be followed up. Also if the loss:follow up ratio is higher in one group in an RCT the groups are no longer similar, leading to the same problem found with selection bias.

Answer 31

FFIT offered home visits to maximise retention.

Answer 32

Challenges faced included: * Distance * SATNAV locating issues * Communicare link was down (system they were using) * Very costly to get researchers to participants homes depending on where the participant was.

Answer 33

There was a 92% follow up; very effective

Answer 34

The aim of FIT for LIFE * adapt FFIT to deliver to prisoners * Came about when prison officer saw FFIT on tv and thought it would be good for prisoners due to poor living environments and poor diet.

Answer 35

* Challenges included: * Fieldworker safety * Equipment clearance * Laptops, cameras, anything sharp and syringes proved to be problematic prohibited items as they were useful for measurements

Answer 36

The measurements taken were: * Weight * Waistline * Height * Blood pressure * Body composition

Answer 37

Literacy rates Focus/concentration levels Prisoners becoming agitaed and distressed Incomplete data due to the lack of attention span and irritation

Answer 38

Increase physical activity and decrease sedentary times over 12 months.

Answer 39

There were 1000 participants in EuroFIT?

Answer 40

What tech based challenges did EuroFIT face? * Lots of blood vials which had to be individually labelled * Had to send text reminders to get men to fast and this did not always work. * Had to get samples to Scotland from sites in England

Answer 41

The report data was collected using questionnaires.

Answer 42

* Data was often messy - needed extensive cleaning * Data missing as they may have skipped questions * Solutions included getting fieldworkers to complete questionnaire but not always possible. As: * Time consuming * Participants may have to leave * Good training to spot 'non-sensical' answers * Online questionnaires - can be programmed for sense. However: * Time consuming - need to learn software * WIFI availability? * Imputation could be used to resolve issue. - statistical technique to estimate the missing values

Answer 43

Standard descriptive stats * Mean and standard deviation * Median and interquartile range (non-parametric data) * Frequencies * Mean change and 95% confidence intervals Inferential stats (looks for significat differences between variables) * T - tests (2 measures - e.g. pre/post) * ANOVA (three or more measures, including between group differences) * Non - parametric equivalents (if data is not normally distributed)

Answer 44

Normal Distribution is a distribution that has most of the data in the center with decreasing amounts evenly distributed to the left and the right. Non-normal Distributions Skewed Distribution is distribution with data clumped up on one side or the other with decreasing amounts trailing off to the left or the right.

Answer 45

Qualatitive data is used to understand how things work * e.g. as part of a process evaluation in an experimental or quasi-experimental study

Answer 46

Some methods include: * In depth 1:1 interviews * Focus groups * Observation

Answer 47

The tool used to conduct 1:1 in depth interviews and focus groups effectively is called a topic guide. It makes sure the interview does not get off track and that the correct data is collected.

Answer 48

An observation proforma is used to dictate what field notes are about. It's a list of topics relevant to research question you're trying tp address wtih the observation.

Answer 49

* Reliability and validity do not apply in qualatative data. * Any views count, even deviant views. * Sampling frames ensure representativeness of views

Answer 50

Ensuring the interview venue is in a comfortable, private place as to make the participant feel safe and secure in disclosing information. It is not always possible to do this. As reality doesn't always allow for a quiet and comfortable place.

Answer 51

NVivo is a type of qualitative software which addresses patterns and trends amongst the data and the data patterns are called themes. Thus its thematic analysis.

Answer 52

Deductive analysis is theory driven whereas Indiuctive analysis is theory generating.

Answer 53

BMI = weight/height²

Answer 54

Humans have 3 billion base pairs.

Answer 55

Humans have 20k-30k genes

Answer 56

A chimp is 96% genetically similar to a human whereas a cat is 90% genetically similar to a cat.

Answer 57

FTO was the first obesity gene discovered in 2007.

Answer 58

The FTO genotype is associated with a higher body weight. Those heterozygous for it are heavier than a person without it. Those homozygous for it are even heavier, at 1.8kg than a normal person on average.

Answer 59

People with the obesity-risk FTO variant have higher circulating levels of the hunger hormone, gherlin, in their blood. This means they get hungry soon after eating food. People with the obesity risk variant of the FTO gene eat more and prefer higher calorie foods compared with those with the low risk version.

Answer 60

In 5 years, the number of ppl aged 65+ will outnumber children under 5. This is driven by falling fertility rates and remarkable increases in life expectancy, population ageing will increase, even accelerate,

Answer 61

You are considered to have a family history of CVD if: * Your dad or bro was under the age of 55 when they had CVD * Your mum or sis was under 65.

Answer 62

Some examples of behaviorial risk factors are: * Physical inactivity * Dietary intake * Smoking * Alcohol intake * Sleep

Answer 63

5.3 million deaths are caused by physical inactivity annually and 5.1 milliion are caused by smoking.

Answer 64

The prevelance (number of adults who exhibit behaviour) of smoking and inactivity is 26% and 35% respectively.

Answer 65

8.7 and 9.3

Answer 66

Planned, structured and repetitive bodily movements done to improve physical health.

Answer 67

The more vigorous exercise one does, the lower their risk of mortality.

Answer 68

Any bodily movement produced by skeletal muscles that result in energy expenditure.

Answer 69

In 2011 the guidelines for PA were: * 150 minutes of moderate or 75 mins of vigorous PA per week in bouts of at least 10 mins. * Muscle strengthening activities 2x per week * Minimise the amount of time spent sedentary.

Answer 70

The guidelines for PA in 2019 are: * Some is good, more is better * Muscles strenghthening activities 2x per week * 150 mins of moderate PA and 75 mins of vigorous PA per week * Or even shorter durations of extremely vigorous activity * Minimise the amount of time sedentary.

Answer 71

In kids: * Bone health * Cognitive function * Muscle fitness In adults: * Reduce risk of dementia * reduce anxiety * sleep In elderly: * Reduces frailty * reduces falls

Answer 72

The WHO definition of 1948 defined health as “A state of complete physical, mental and social. well-being and not merely the absence of. disease or infirmity”.

Answer 73

The WHO definition of health is criticised due to: * The absolutness of the word, "complete" in relation to wellbeing. 1. This unintentionally contributes to the medicalisation of society. The requirement for "complete" health would leave most of us unhealthy all of the time. This allows for the tendencies of drug industries to redefine diseases. They'd use tech to scan for anything that isn't completely healthy and suggest pills to buy from them.

Answer 74

The second problem is that since 1948 the demography of populations and the nature of disease have changed considerably. * In 1948 acute diseases presented the main burden of illness * Disease patterns have changed, with public health measures such as improved nutrtion, hygiene, and sanitation and more powerful healthcare interventions. * Chronic diseases are increasing worldwide. * In this context the WHO definition becomes counterproductive as it declares ppl with chronic diseases and disabilities and definitvely ill. * It minimises the role of the human capacity to cope 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.

Answer 75

the third problem is the operationalisation of the definition. WHO has developed several systems to classify diseases and describe aspects of health, disability, functioning, and quality of life. Yet because of the reference to a complete state, the definition remains impracticable because 'complete' is neither operational or measurable.

Answer 76

To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource fo everyday life, not the objective of living.

Answer 77

"The ability to adapt and to self manage."

Answer 78

In the physical domain a healthy organism is capable of allostasis. When confronted with physiological stress, a healthy specimen is able to mount a protective response, to reduce the potential for harm, and restore an (adapted) equilibrium. If this physiological coping strategy is not successful, damage or "allostatic load" remains, which may finally result in illness.

Answer 79

The maintenance of physiological homeostasis through changing circumstances.

Answer 80

In the mental domain Antonovsky says it's the "sense of coherence" as a factor that contributes to a successful capacity to cope, recover from strong psychological stress, and prevent PTSDs.

Answer 81

Subjective faculties enhancing the comprehensibility, manageability and meaningfulness of a difficult situation.

Answer 82

A strengthened capability to adapt and to manage yourself often improves subjective wellbeing and may result in a positive interaction between mind and body.

Answer 83

* People's capacity to fulfil their potentials and obligations * Ability to manage their life with some degree of independence despite a medical condition * Ability to participate in social activities including work.

Answer 84

1. Coronary Heart disease 2. Angina 3. Heart attack 4. Congenital heart disease 5. Stroke

Answer 85

Type 2 diabetes means one's pancreas cannot produce enough insuliin or the insulin produced does not work properly. Without enough insulin, the blood sugar lvls get too high.

Answer 86

Depression is a low mood that lasts for a long time. In mildest form depression can make you have low spirits at most severe, can be more life threatening.

Answer 87

Dementia is a broad umbrella term used to describe a range of progressive neurological disorders. There are many different types of dementia and some ppl may present with a combination of different types.

Answer 88

Alzheimer's Vascular dementia frontotemporal Dementia with Lewy bodies Young onset dementia

Answer 89

Neurofibrillary tangles are insoluble twisted fibers found inside the brain's cells. These tangles consist primarily of a protein called tau, which forms part of a structure called a microtubule. Amyloid plaques are hard, insoluble accumulations of beta amyloid proteins that clump together between the nerve cells (neurons) in the brains of Alzheimer’s disease patients.

Answer 90

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells. This can happen as a result of: narrowing and blockage of the small blood vessels inside the brain. a single stroke, where the blood supply to part of the brain is suddenly cut off.

Answer 91

Profound changes are in progress due to two major demograohic processes: * Population ageing * Population migration

Answer 92

* In 2016 population of UK was 65.5 million * UK population is projected to keep growing reaching 74million + by 2039 * Births are continuing to outnumber deaths and immigration continues to outnumber emmigration leading to larger population.

Answer 93

With lower birth rates and higher life expectancy, the shape of the UK is transforming. The proportion of those at working age is shrinking while those at 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.

Answer 94

Some age related conditions: * Dementia * Frailty * Sacropenia * Chronic conditions (heart, musculoskeletal and circulatory systems) * Social isolation * Depression

Answer 95

Frailty is the 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. Whilst most older people do not become frail, frailty becomes more prevelant with age, affecting around 10% of those over 65, increasing to around 65% of those 90 and above.

Answer 96

Some of the symptoms of frailty include: * Increased risk of falls * Poorer mobility * Inability to pereform activities of daily living * Disability * incident hospitalisation * Death

Answer 97

Sarcopenia is a condition characterized by loss of skeletal muscle mass and function. Although it is primarily a disease of the elderly, its development may be associated with conditions that are not exclusively seen in older persons.

Answer 98

* developed in 1981 (census data) * 4 indicators * male unemployment * lack of car ownership * overcrowding in households * low occupational social class (IV and V)

Answer 99

Some of the pros and cons include: _Pros_ * simple * doesn't include health measures (important when analysing health data) _Cons_ * lack of car ownership is not a fair reflection * only considers male unemployment which may have been an accurate representation in the 80s but the times have changed

Answer 100

* Alcohol related liver disease

Answer 101

_1. Healthy liver_ _2. Fatty liver_ * Deposits of fat lead to liver enlargement _3. Liver fibrosis_ * Scar tissue forms _4. Cirrhosis_ * Growth of connective tissue destroys liver cells

Answer 102

People who drink too much may start to feel pain and tingling in their limbs. This is known as alcoholic neuropathy. In people with alcoholic neuropathy, the peripheral nerves have been damaged by too much alcohol use.