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MEDS90001 Population Health Assignment 2012

Questions 1 to 5 are based on a modified abstract from a recent case-control study. Aim of study was to evaluate association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischaemic stroke.

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Margaret Ayers
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164 views

MEDS90001 Population Health Assignment 2012

Questions 1 to 5 are based on a modified abstract from a recent case-control study. Aim of study was to evaluate association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischaemic stroke.

Uploaded by

Margaret Ayers
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MEDS90001 FOUNDATIONS OF BIOMEDICAL SCIENCES

Population Health Assignment 2012


ASSIGNMENT IS DUE BY 5:00 PM ON JUNE 15 2012
Instructions: Your assignment should be submitted with the following formatting; Normal default margins (1 inch = 2.54cm top, bottom, left and right) Times New Roman, size 12 font Single line spacing Type the question number in bold (e.g. Question 1) at the beginning of your answer Allow a minimum of one blank line between each completed question/part Number the pages bottom right. Please make sure that ONLY your student number is on the top right corner of every page, and that your name is not placed anywhere on the assignment. The title of the document you submit should be your student number. Late submission of papers will incur a penalty 5% per day or part thereof. Remember to allow plenty of time for submission, as the assessment will be time stamped with when it completes uploading to the LMS.

Submission: Go to Population Health Assignment Submission Click View/Complete and you will go to the Turnitin login. Enter a Submission Title. Click Browse and locate your essay file on your computer. Click Submit. Check the document you are submitting is the correct one. If so click Yes, submit.

Further details regarding size and format can be viewed on the submission page after you click view/complete.
For content related issues please contact: Professor Danny Liew [email protected] (Part A questions 1-5, Part B) Dr Tim Moore [email protected] (Part A questions 6-7)

MEDS90001 Foundations of Biomedical Science 2012

PART A (50 marks) Questions 1 to 5 are based on the following modified abstract from a recent case-control study (Am Heart J 2011; 162: 717-724.) Each can be answered in less than 100 words BACKGROUND Although the role of Mediterranean diet on cardiovascular disease prevention has long been evaluated and understood, its association with the development of stroke has been rarely examined. The aim of the present work was to evaluate the association between adherence to the Mediterranean diet and the development of an acute coronary syndrome (ACS) or ischaemic stroke. METHODS During the period from 2009 to 2010, 1,000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischaemic stroke, and 500 populationbased, control subjects, 1-for-1 matched to the patients by age and sex. Sociodemographic, clinical, psychological, dietary, and other lifestyle characteristics were measured. Adherence to the Mediterranean diet was assessed by the validated MedDietScore (theoretical range 0-55). (A higher score indicates greater adherence to a Mediterranean diet.) RESULTS After various adjustments were made, it was observed that for each unit increase of the MedDietScore, the corresponding odds ratio for having an ACS was 0.91 (95% CI 0.87-0.96), whereas regarding stroke, it was 0.88 (95% CI 0.82-0.94). CONCLUSION [Intentionally left blank]

Question 1 (6 marks) In this study, there were 2 case groups and 1 control group. Define each of the case groups and the control group.

Question 2 (6 marks) It is stated that ...for each unit increase of the MedDietScore, the corresponding odds ratio for having an ACS was 0.91 (95% CI 0.87-0.96)... Interpret these findings. Question 3 (6 marks) Why were controls matched 1-for-1 by age and sex to each patient with ACS or stroke? Question 4 (6 marks) Write an appropriate sentence for the Conclusion. Question 5 (6 marks) In terms of studying the potential benefits of a Mediterranean diet on risk of ACS and ischaemic stroke, what other study designs could have been adopted?

MEDS90001 Foundations of Biomedical Science 2012

Question 6 (10 marks) In two seminal studies, known as Whitehall I (multiple publications including: Marmot MG, Shipley MJ, & Rose G. Inequalities in death specific explanations of a general pattern. Lancet 1984;i:1003-6) and Whitehall II (multiple publications including: Marmot MG, Stansfield S, Patel C, North F, Head J, White I, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337(8754):1387-93.), Michael Marmot and colleagues explored social determinants of health in relation to the risk of coronary heart disease. a. On what groups of people were these studies performed? b. What are the findings of these studies? c. What was postulated as a major cause of CHD risk? d. What are the implications of these findings? (References not required. Maximum 250 words.)

Question 7 (10 marks) Describe the relationship between tuberculosis and poverty, making specific reference to causal pathways and the poverty/ill-health cycle. (References not required. Maximum 250 words.)

PART B (50 marks) This is a critical appraisal exercise. Your answer should be no longer than 1000 words. The clinical scenario: You are looking after Mr Jones, a 63-year-old man who was admitted to hospital 4 days ago with a non-ST-elevation myocardial infarction (NSTEMI). He is now stable and ready for discharge on the following medications: aspirin, metoprolol (a beta-blocker), ramipril (an ACE inhibitor) and atorvastatin (a statin). Mr Jones does not have thrombocytopaenia (low platelet count), anaemia (low haemoglobin), renal impairment, significant bleeding past history, nor a history of strokes. You wonder about oral anticoagulation therapy for Mr Jones to improve his mortality and morbidity risks post NSTEMI. (Note: he does not have any other indications for anticoagulation.) Because of the need for close monitoring (with regular blood tests), Mr Jones does not want to take warfarin, an existing oral anticoagulant. However, you are aware of the recently published randomised controlled trial of rivaroxaban, a new oral anticoagulant that does not need close monitoring, in patients post acute coronary syndrome, including NSTEMI (Mega JL, et al. New Engl J Med, 13 Nov 2011, Epub before print). The publication is provided. In the context of deciding whether or not rivaroxaban would be suitable for Mr Jones, please critically appraise the study under the 2 broad headings of Internal Validity and External Validity. Regarding external validity, construct your answer using a PICOT format.

MEDS90001 Foundations of Biomedical Science 2012

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