Healthcare Epidemiology Answer 2022

Running head: HEALTHCARE
EPIDEMIOLOGY
Name of the Student
Name of the University
Author Note

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Table of Contents
Part A.........................................................................................................................................2
Answer 1................................................................................................................................2
Answer 2................................................................................................................................2
Answer 3................................................................................................................................3
Answer 4................................................................................................................................3
Part B..........................................................................................................................................4
Answer 1................................................................................................................................4
Answer 2................................................................................................................................4
Answer 3................................................................................................................................5
Answer 4................................................................................................................................5
Answer 5................................................................................................................................5
References..................................................................................................................................6

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Part A
Answer 1
According to Breeze et al., (2001) the sampling frame used for the white hall study
was resurveying the survivors of the Whitehall cohort study who were aged between 40 to 69
years of age. Smaller sample size and the large variable range was chosen for this study.
Whitehall, I included male British civil servants as the sampling frame which showed a high
mortality gradient and Whitehall II was a resurvey conducted as stated in the previous
section. These were the sampling frames of the two Whitehall phases.
Answer 2
According to Marmot et al., (1978), it can be stated that the authors assessed the
disease (Coronary Heart Disease- CHD) among various grades of workers. The findings
suggested that lower grade workers had 3 to 6 times higher mortality rates than men from the
highest employment grade. They used a longitudinal study of 7350 civil servants who are
working in London to assess the risk of disease at various levels of employment.
According to Chandola et al., (2008) it can be stated that for the determination of
behavioural and biological factors they performed a mechanism-based study on the Whitehall
II study. The authors used a risk ration cross-sectional study to analyze the underlying
mechanisms for the underlying CHD among the sample population.
Breeze et al., (2001), collected data from 19029 men with most of the men aged
between 40 to 69 years. The time frame used for the data collection purpose was 1967 to
1970. A questionnaire concerning medical histories and job-related factors were given to the
participants, filling up of which resulted in the data analysis process. Whereas, the Whitehall
study II conducted a resurvey on the 400 survivors of study I in the year 1996. The data
analysis process used for this paper was Chi-square heterogeneity analysis required for

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univariate associations. The odd ratio was estimated at 95% confidence intervals associated
with each outcome.
Answer 3
From all the three studies, a few points can be summarized. The first point states that there is
an increase in the association of CHD in people who are working in long employment grades.
This value has been found to be significantly higher than the high employment grade
workers. Similarly, it was also found that several underlying factors were the main reasons
for CHD among the populations identified. Thus, it can be stated that socioeconomic status in
the middle age and also during the retirement age can be stated to be associated with the old
age morbidity associated with chronic health disorders such as CHD. All the three studies
including the two phases of the Whitehall study can be generalized in this way for other
populations in Australia.
Answer 4
The Australian cohort associated with 45 and Up study states that more than a quarter
of a million people one in 10 NSW men including women aged above 45 are used as the
participants in the cohort study (SAX Institute, (n.d.). This cohort study has been found to
focus on research projects based on physical activity and sleep as the investigative factors for
early retirement. From the three previously discussed studies, it can be observed that the age
range chosen for the studies were 40 to 69 years. Thus, it can be stated that the chosen age
range was above 45 years. Therefore, it would be feasible to conduct a similar study in
Australia using the existing cohort such as 45 and Up study.
All the socio-demographic and lifestyle factors have been studied in three age groups-
18-23, 45-50 and 70-75 in the Women's longitudinal study. This cohort can be used for a
large number of issue-based research studies. However, previous research studies were based

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on men as the participants aged between 40 and 69. To perform the same study by using this
cohort, it can be stated that only the middle age group can be selected from this longitudinal
study (Women's Health Australia, n.d).
Thus, it can be stated that it would be feasible to conduct a similar study in Australia
using an existing cohort study such as the Australian Women’s longitudinal study and the 45
and Up cohort study.
Part B
Answer 1
The chosen study design for the analysis of the relationship between lung cancer and
smoking habits is the case-control study design. This design has been selected based on a
piece of evidence collected from a piece of literature (Remen et al., 2018).
The advantage of a case-control study for this study is that it can analyse the relationship
between the cause of a specific disease associated with exposure. The main disadvantage of
this design is that the design is exposed to recall bias and it is very difficult to distinguish
temporal casualty.
Answer 2
The chosen study design for the analysis of the association between depression and
binge eating in a population of obese adolescents and adults is Prospective cohort study
(Sonneville et al., 2013).
The main advantage of this study design is the minimisation of recall bias since the
collection of results occurs at regular intervals. The main disadvantage of this study design is
that a large number of subjects are required for the analysis.

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Answer 3
The study design chosen to understand the long term effects of detention on the physical and
mental health of asylum seekers is the Systematic Review (Filges, Montgomery & Kastrup,
2018).
The main advantage of a systematic review is the overview or synthesis of available
pieces of evidence for a specific medical research question. The disadvantage is that the
existing bias is not taken care of while the synthesis process is performed.
Answer 4
The study design chosen to understand the relationship between folate
supplementation during pregnancy and development of autism in offspring is the Generation
R study based on the Prospective Cohort Study (Steenweg-de Graaff et al., 2015).
The main advantage of this study design is the minimisation of recall bias since the
collection of results occurs at regular intervals. The main disadvantage of this study design is
that a large number of subjects are required for the analysis.
Answer 5
The study design was chosen to understand the testing of a drug for use in elderly
people diagnosed with Alzheimer’s disease is the Randomised controlled trial (Arnold &
Betensky, 2018).
The main advantage of using RCT is that it is effective in the removal of statistical
biases and confounding factors from the study. However, the disadvantage is that the trial
may fail to achieve a high efficacy for widely accepted cases. The results may not always be
equivalent to real-life conditions.

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Thus, from the above five questions, it can be stated that there are various study
designs available to analyse various issues in the field of health and epidemiology. The study
designs which were chosen as the best for the given situations were the case control study
design, the prospective cohort study design, the randomised controlled trial, the systematic
review analysis and the generation R population based prospective cohort study. These study
designs have few common ethical considerations including the informed consent for the
participants, prevention of data breaching, maintenance of anonymity during the use of
survey questionnaires in the study designs and maintenance of autonomy in during the
research study. Care must be taken that all the participants are respected equally irrespective
of their gender, sex or age and race and no force must be applied for the people to participate
in the study. These are the overall ethical considerations of all the studies which have been
found to be common.

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References
Arnold, S. E., & Betensky, R. A. (2018). Multi-Crossover Randomized Controlled Trial
Designs in Alzheimer’s Disease. Annals of neurology, 84(2), 168.
Breeze, E., Fletcher, A. E., Leon, D. A., Marmot, M. G., Clarke, R. J., & 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.
Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., ... &
Marmot, M. (2008). Work stress and coronary heart disease: what are the
mechanisms?. European heart journal, 29(5), 640-648.
Filges, T., Montgomery, E., & Kastrup, M. (2018). The impact of detention on the health of
asylum seekers: a systematic review. Research on Social Work Practice, 28(4), 399-
414.
Marmot, M. G., Rose, G., Shipley, M., & Hamilton, P. J. (1978). Employment grade and
coronary heart disease in British civil servants. Journal of Epidemiology &
Community Health, 32(4), 244-249.
Remen, T., Pintos, J., Abrahamowicz, M., & Siemiatycki, J. (2018). Risk of lung cancer in
relation to various metrics of smoking history: a case-control study in Montreal. BMC
cancer, 18(1), 1275.
SAX Institute. (n.d.). 45 and up study. Retrieved from https://www.saxinstitute.org.au/our-
work/45-up-study
Sonneville, K. R., Horton, N. J., Micali, N., Crosby, R. D., Swanson, S. A., Solmi, F., &
Field, A. E. (2013). Longitudinal associations between binge eating and overeating

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and adverse outcomes among adolescents and young adults: does loss of control
matter?. JAMA pediatrics, 167(2), 149-155.
Steenweg-de Graaff, J., Ghassabian, A., Jaddoe, V. W., Tiemeier, H., & Roza, S. J. (2015).
Folate concentrations during pregnancy and autistic traits in the offspring. The
Generation R Study. The European Journal of Public Health, 25(3), 431-433.
Women's Health Australia. (n.d.). Australian Longitudinal study on Women’s Health.
Retrieved from http://www.alswh.org.au/