Exploring The Whitehall Study And Health Determinants

Background of the Whitehall Study

Description Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	This assessment has two parts. The first part involves reading three research articles, and applying what you have learned about epidemiological measures and study design to answer a series of multiple choice questions. The second requires you to consider several health issues and decide the most appropriate study design to use for that health issue.
Instructions	This assessment has two parts. The first part involves reading three research articles, and applying what you have learned about epidemiological measures and study design to answer a series of multiple choice questions. The second requires you to consider several health issues and decide the most appropriate study design to use for that health issue.
Multiple Attempts Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Not allowed. This Test can only be taken once.
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The Whitehall study is a ground-breaking longitudinal (prospective cohort) study that clearly demonstrated the association between social determinants of health (the social gradient) and morbidity and mortality (cardiovascular disease) in a population of British civil servants (Breeze et al., 2001; Chandola et al., 2008; (Marmot et al., 1978).

Read these papers and answer the following questions.

Question 1: What is the sampling frame for the Whitehall studies

	a.	Clinical and mortality records for British civil service employees
	b.	19,029 males for Whitehall I and 10,308 males and females for Whitehall II
	c.	British civil servants evaluated across seven phases from 1967-2004
	d.	Employment records for the British civil service

How was disease risk assessed (data collection and analysis) for the Marmot paper

	a.	Data was collected using medical and behavioural questionnaires and clinical examination. Relative risk was calculated to assess disease risk.
	b.	Data was collected using medical and behavioural questionnaires and clinical examination. Logistic regression was used to calculate odds ratios.
	c.	Data was collected using medical and behavioural questionnaires, a job stress questionnaire and clinical examination. Cox proportional hazard models were used to calculate hazard ratios and logistic regression was used to calculate odds ratios.

How was disease risk assessed (data collection and analysis) for the Breeze paper

	a.	Data was collected using medical and behavioural questionnaires and clinical examination. Logistic regression was used to calculate odds ratios.
	b.	Data was collected using medical and behavioural questionnaires, a job stress questionnaire and clinical examination. Cox proportional hazard models were used to calculate hazard ratios and logistic regression was used to calculate odds ratios.
	c.	Data was collected using medical and behavioural questionnaires and clinical examination. Relative risk was calculated to assess disease risk.

How was disease risk assessed (data collection and analysis) for the Chandola paper

	a.	Data was collected using medical and behavioural questionnaires, a job stress questionnaire and clinical examination. Cox proportional hazard models were used to calculate hazard ratios and logistic regression was used to calculate odds ratios.
	b.	Data was collected using medical and behavioural questionnaires and clinical examination. Logistic regression was used to calculate odds ratios.
	c.	Data was collected using medical and behavioural questionnaires and clinical examination. Relative risk was calculated to assess disease risk.

When we consider whether we can generalise the results of these studies to other populations, we need to consider (select all that apply):

	a.	The type of work done by the people in the population
	b.	The gender distribution of the population
	c.	Economic similarity of the population
	d.	The class structure of the population
	e.	Ethnic diversity within the population
	f.	Whether the population is in a rural or remote location

Could we use an existing Australian research study cohort, such as the 45 and Up study, to explore the same things as explored in the Whitehall studies? Why/ why not

Yes, we can use an existing Australian research study cohort. The main reasons why we can use an existing Australian research study cohort to explore the same things explored in the Whitehall studies are:

We have many Australians who have varying grades of employment.

We have many Australians especially the old who experience different socioeconomic disadvantages.

We have many Australians who work in very stressing work environments and thus end up suffering from work stress.

This part of the assessment presents five health issues. Identify the best study design to use to explore each health issue, and explain your reason for choosing this study design. Include an explanation of advantages and disadvantages of using that study design for that health problem, including any ethical considerations.

Select the most appropriate study design to explore the causal relationship between lung cancer and smoking. 

	a.	Randomised controlled trial
	b.	Cohort study
	c.	Case-control study
	d.	Cross-sectional study

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question)

I choose case-control study design. The main reason why I choose case-control study is because this study considers the people who have a certain outcome of interest (e.g. a disease) and compares them to those who don’t have that outcome and explores the possible cause(s) of the outcome and its relationship to the outcome (Schrag, Horsfall, Walters, Noyce, and Petersen, 2015, pp.57-64). Therefore, case-control study will effectively explore the relationship between lung cancer which is the outcome and smoking which is the cause.

The main advantages of the case-control study are:

Very efficient and effective in studying the relationships between outcomes (diseases) and causes and thus helps in coming up with some preventive measures.

Cheap and less-time consuming.

The main disadvantages are:

Subject to selection bias

Don’t allow the calculations of incidences or absolute risks.

Ethical considerations

The major ethical considerations which should be observed when conducting case-control study is making sure all the participants are aware of the study and willing to participate in the study without being forced, and keeping their data (e.g., health data) safely and away from unauthorized access.

Disease Risk Assessment in the Whitehall Studies

Select the most appropriate study design to explore the association between depression and binge eating in a population of obese adolescents and adults. 

	a.	Randomised controlled trial
	b.	Case-control study
	c.	Cohort study
	d.	Cross-sectional study

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question) 

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question) 

I choose cohort study since this study deals with cohorts. A cohort is a group of people who have some common characteristics and are most likely to have experienced a certain common event in a certain period of their life (Tuccori et al., 2016, pp.i1541-i1546). In this case, the people under concern (cohorts) have depression and binge eating habits and experience the same problem of obesity at certain periods of their life which could be at their adolescence or their adult age.

The advantages of cohort study are:

It allows calculation of incidence

It facilitates the study of rare exposures

It allows the examination of multiple effects in one exposure

The disadvantages are:

Very expensive and time-consuming

Not very good at studying diseases or disorders with long latency

Not very good for studying rare diseases

The ethical considerations

The researchers involved in cohort studies must observe ethics of highest order as they mostly collect the data of different groups who might have experienced common events at the same or different periods of life. Therefore, the researchers must make sure to collect only the relevant and the required data and make sure to use the data for only the intended purposes to avoid having some problems with the people who gave their data.

Select the most appropriate study design to explore the long-term effects of detention on the mental and physical health of asylum seekers. 

	a.	Cross-sectional study
	b.	Cohort study
	c.	Randomised controlled trial
	d.	Case-control study

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question) 

I choose cross-sectional study since it allows researchers to use a small sample of the target population to study the characteristics of the population (Dutra and Glantz, 2014, pp.610-617). In this case, we can study the long-term effects of detention on the mental and physical health of asylum seekers by just looking at a few asylum seekers.

The main advantages of cross-sectional study are:

Can be used to prove or disapprove assumptions.

Is a bit cheap and less time-consuming as the researchers don’t have to consider the entire population but only a portion of the population for them to understand the entire population.

This study can be used in various types of research

The main disadvantages are:

Can’t be used to determine the causes and the effects of the outcomes under consideration

Can’t help in analysing the behaviour of the outcomes for a certain period of time.

It can give some flawed or skewed outcomes if not properly implemented.

The ethical concerns

The researchers must always observe ethics and follow all the principles and guidelines which are followed by the people (community) where they are taking the study.

Select the most appropriate study design to explore the relationship between folate supplementation during pregnancy and development of autism in offspring. 

	a.	Cross-sectional study
	b.	Case-control study
	c.	Randomised controlled trial
	d.	Cohort study

Generalizing the Results of the Whitehall Studies

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question) 

I choose case-control study. As already stated earlier, case-control study deals with analysing a certain outcome (disease, disorder, conditions, e.t.c) and its relationship with the possible cause(s) of the outcome. Autism is a kind of disorder mostly found in children/offspring and may be caused by inadequate folate supplementation, and so it can be effectively studied in case-control studies.

The main advantages of case-control study are:

Helps us to understand the relationship between an outcome and the cause and thus come up with some ways which can help to improve the outcome.

Is relatively cheap and less time consuming when compared to some other studies, and this means it can be done with much ease.

The main disadvantages are

It doesn’t allow calculations of absolute risks

Highly subject to selection bias

The ethical considerations

Since the case-control study is mostly associated with the medical field, the people conducting the study must be very careful to observe all the ethics applicable in the medical field especially when it comes to dealing with the health data of the people.

Select the most appropriate study design to test a drug for use in elderly people diagnosed with Alzheimer’s Disease.

	a.	Randomised controlled trial
	b.	Case-control study
	c.	Cohort study
	d.	Cross-sectional study

Why did you choose this study design? Explain advantages/disadvantages and ethical considerations. (Short answer question) 

I choose randomised control trial because randomized controlled trial allows researchers to test new treatments and reduces the bias which may arise during the testing period (Patton and Donoghue, 2015, pp.1-9). Therefore, the functioning of the drug for use in elderly people diagnosed with Alzheimer ’s disease can be easily tested using randomised control trial and very few or no bias will be experienced in the testing process.

The main advantages of randomised control trial are:

Greatly minimises allocation and selection bias.

Minimises confounding errors

Allows comparison of various treatment options to determine the best.

The main disadvantages are:

Is a very costly study design and requires high-level skills and experience to be done accordingly to yield the desired results.

The results obtained using this design may not always mimic the real-life situations

Its application is highly limited

Ethical considerations

Randomised control trial raises many ethical concerns and challenges since it’s not easy to ethically randomise patients in real life situations. Again, we have some researches which can’t be ethically performed since they will have to compromise the ethics of many societies, and this is ethically unacceptable.

References

Breeze, E., Fletcher, A.E., Leon, A.D., Marmot, M.G., Clarke, R.J., and Shipley, M.J. (2001). Do Socioeconomic Disadvantages Persist Into Old Age? Self-Reported Morbidity in a 29-Year Follow-Up of the Whitehall Study. American Journal of Public Health, 91(2), 277-283.

Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., Badrick, E., Kivimaki, M., and Marmot, M. (2008). Work stress and coronary heart disease: what are the mechanisms? European Heart Journal, 29, 640-648. doi:10.1093/eurheartj/ehm584

Dutra, L. M., & Glantz, S. A. (2014). Electronic cigarettes and conventional cigarette use among US adolescents: a cross-sectional study. JAMA Pediatrics, 168(7), 610-617.

Marmot, M.G., Rose, G., Shipley, M., and Hamilton, P.J.S. (1978). Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology and Community Health, 32, 244-249.

Patton, R., & Donoghue, K. (2015). Randomised controlled trial. Evidence-Based Nursing, 18(3), 1-9.

Schrag, A., Horsfall, L., Walters, K., Noyce, A., & Petersen, I. (2015). Prediagnostic presentations of Parkinson’s disease in primary care: a case-control study. The Lancet Neurology, 14(1), 57-64.

Tuccori, M., Filion, K. B., Yin, H., Oriana, H. Y., Platt, R. W., & Azoulay, L. (2016). Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ, 352(2), i1541-i1543.