400417 Epidemiology and Quantitative Methods
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Epidemiology and Quantitative Methods (400417)
Added on 2020-04-29
400417 Epidemiology and Quantitative Methods
Epidemiology and Quantitative Methods (400417)
Added on 2020-04-29
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Running head: EPIDEMIOLOGYEpidemiologyName of the student:Name of the University:Author’s note
1EPIDEMIOLOGYIntroduction (Over view of the paper):Issue addressed and significance of the researchThe main purpose of the study by Wu et al., (2017) was to evaluate the effect of diet control andphysical activity among obese patients with schizophrenia being treated with Clozapine. Investigationin this area is a novel idea because schizophrenia patients often need to take antipsychotic drugs likeClozapine during their treatment, however it increases the risk of weight gain in patients (Gressier etal., 2016). Hence, in patients who require long term treatment with Clozapine, managing weight gainhas become a priority. The research by Wu et al., (2017) is important as it tries to find a solution toaddress weight gain issues and complication in patients taking Clozapine by determining the effect ofdiet control and physical activity regimen in such patients. The significance of this research is alsorealized because past studies of weight management programs gave inconsistent results. Hence, themain exposure or intervention studied in the research article was six months of continuous dietarycontrol and regular physical activity and the outcome expected was weight loss. Study design, study population and main findingsWu et al., (2017) used randomized controlled study design to investigate about the topic andselection of this research design is appropriate for this research as it mainly aims to evaluate anintervention. RCT is the best study design for clinical trials where main aim is to study the effect of anew treatment and use of this study design is likely to reduce bias during research too (McCambridge,Kypri & Elbourne, 2014). The participants include in the study included patients with DSM-IVdiagnosis of schizophrenia and the main inclusion criteria was they must be taking at least 300 mg ofClozapine per day for at least a year and they must be obese. The participants were divided into studygroup who were placed on diet and physical activity regimen, whereas the control group received nointervention. The final outcome of the study was that decrease in body weight, body mass index and
2EPIDEMIOLOGYwaist circumference was found in study group compared to control group. Despite this outcome, theauthor reported about the challenges and future work in accordance with the study result which isindicative of high quality and high validity research article. The researcher emphasized that real effectof this intervention cannot be seen unless long term adherence to the diet control and physical exerciseregimen is not followed. Hence, by this statement the author suggested about new areas of researchsuch as to find out appropriate strategy to promote long term adherence to diet control and physicalactivity programs.Future direction of the study The future implication from the study is also evidenced which is lifestyle modificationinterventions must be regularly implemented in schizophrenia patients to avoid obesity relatedcomplication. This fact is also supported by Correll et al., (2014) as they explained that considering theimpact of psychotropic medication is necessary to implement management strategies to improvephysical and mental health outcomes in schizophrenia patients. Appraising the internal validityAlthough outcome and intervention in epidemiological studies depend on causal association,however certain non-causal association also alters the outcome of the study. The presence of non-causal association affects the internal validity and transferability of the study results (Elwood, 2017)..In the study by Wu et al., (2017), non-causal association between intervention and outcome needs to beanalyzed to find out any error in study design or other variables that affects the desired outcome for anintervention. The results of the study mainly proved that diet control and physical activity interventionis effective in reducing weight in obese schizophrenia patients taking Clozapine. The internal validityof the study was found to be high because all consideration was made by the research to take theappropriate sample for the study. The inclusiveness in the sample was maintained by taking appropriate
3EPIDEMIOLOGYinclusion and exclusion criteria. The decision of not taking patients who were taking any othermedications apart from Clozapine reduces biasness in results. Considering this point was usefulbecause in the presence of other medications, specific effect of Clozapine could not be investigated.Evidence shows that there are various drugs whose common side effect is body weight (Domecq et al.,2015). Hence, including patients taking combination of other medications would have affected thepurpose of the study and its outcome. Although appropriate sample was taken for the study, however one limitation in the researcharticle was that no specific sampling strategy was taken to recruit the participants. Wu et al., (2017)mentioned taking participants from 753 hospitalized patient, however it is not clear what strategy wasapplied to select only 56 patients. Secondly, the small sample size also affected the validity of thestudy result as only 56 samples cannot give a clear idea about the effect of an intervention that needs toapplied in real setting. No step was taken to ensure that the correct sample size has been taken for thestudy. In addition, as the study results were mainly evaluated on the basis of BMI data too, the authordefined specific BMI in the inclusion criteria only for Asian individual. Hence, it is not clear whetheronly Asian participants were included in the study or other groups too. These factors may have animpact on the final outcome and the transferability of the research. Therefore, both information biasand sampling bias distort the true association between the intervention and outcome and influences thecredibility of the study (Skelly, Dettori, & Brodt, 2012). The potential for confounding in research can also be accessed by analyzing the statisticalprecision of the study. The baseline data for both control and intervention group was kept same and thisis reflective of a high quality RCT study. The body fat percentage was also a confounding variable inthe study because no changes in fat percentage were seen both in men and women after three monthsand six months. Body fat percentage was also a part of anthropometric measurement for the study,however no changes in body fat percentage apart from other variables like waist circumference, hip
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