Elizabeth Breeze, MSc, CStat, Astrid E. Fletcher, PhD, David A. Leon, PhD, Michael G. Marmot, PhD, MBBS, Robert J. Clarke, MD, MRCP, and Martin J. Shipley, MSc Elizabeth Breeze, Astrid E. Fletcher,...

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I need this assignment before due date there are questions to answer by going through attached three studies. The assignment should be according to rubric. There is limit of 1000 words and these words should be decided according to given marks.


Elizabeth Breeze, MSc, CStat, Astrid E. Fletcher, PhD, David A. Leon, PhD, Michael G. Marmot, PhD, MBBS, Robert J. Clarke, MD, MRCP, and Martin J. Shipley, MSc Elizabeth Breeze, Astrid E. Fletcher, and David A. Leon are with the Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England. Michael G. Marmot and Martin J. Shipley are with the Interna- tional Centre for Health and Society, Department of Epidemiology and Public Health, University Col- lege Medical School, London. Robert J. Clarke is with the Clinical Trial Service Unit and Epidemio- logical Studies Unit, University of Oxford, Oxford, England. Requests for reprints should be sent to Eliza- beth Breeze, MSc, CStat, London School of Hy- giene and Tropical Medicine, Keppel Street, Lon- don WC1E 7HT, England (e-mail: elizabeth.breeze@ lshtm.ac.uk). This article was accepted May 24, 2000. A B S T R A C T Objectives.This study examined (1) the relation of employment grade in middle age to self-reported poor health and functional limitations in old age and (2) whether socioeconomic status at ap- proximately the time of retirement mod- ifies health differentials in old age. Methods. Survivors of the Whitehall Study cohort of men were resurveyed. Respondents were aged 40 to 69 years when they were originally screened in 1967 to 1970. Results. Compared with senior ad- ministrators, men in clerical or manual (low-grade) jobs in middle age had quadruple the odds of poor physical per- formance in old age, triple the odds of poor general health, and double the odds of poor mental health and disability. At most, 20% of these differences were ex- plained by baseline health or risk fac- tors. Men who moved from low to mid- dle grades before retirement were less likely than those who remained in low grades to have poor mental health. Conclusions. Socioeconomic status in middle age and at approximately re- tirement age is associated with morbid- ity in old age. (Am J Public Health. 2001; 91:277–283) February 2001, Vol. 91, No. 2 American Journal of Public Health 277 There is a small but growing body of evi- dence from the United Kingdom that socioeco- nomic differentials in mortality persist into old age1–3 and may even be widening.4,5 Although rate ratios tend to be smaller for older people than for younger people in the United Kingdom and the United States,4–6 absolute differentials can still be large.5 There is little equivalent information on self-reported morbidity. Analyses of cross- sectional studies show that self-reported health and disability, respiratory function, and blood pressure are all worse among older people in disadvantaged socioeconomic groups.7,8Analy- ses of the Office for National Statistics Lon- gitudinal Study in England and Wales showed that adverse socioeconomic circumstances were associated with self-reported limiting long- term illness after a 20-year follow-up period among survivors.9 The first Whitehall Study, an investiga- tion of male British civil servants that was ini- tiated in the late 1960s, showed an inverse mor- tality gradient (all causes and major causes) across employment grades.10 The Whitehall II Study, following a later cohort, revealed gra- dients in morbidity in middle age across so- cioeconomic groups.11,12 A resurvey of the sur- vivors of the first cohort enabled us to study the long-term effects of employment grade on self- reported illness in old age. Methods Data Source In the Whitehall Study, 19029 men, most aged 40 to 69 years, were examined between 1967 and 1970 to identify cardiorespiratory disease and its risk factors.13 Participants com- pleted a questionnaire concerning their jobs, their personal and family medical histories, and their smoking habits. Approximately two thirds of the respondents were also asked about car ownership and physical activity related to work, and one third were asked about leisure activity in general. A clinical examination in- cluded height and weight, blood pressure, elec- trocardiogram, and a blood sample analyzed for cholesterol and blood sugar. Participants were registered with the National Health Ser- vice Central Register for mortality notification (99% were successfully located). Resurvey The resurvey took place in 1997–1998 after a successful pilot study of 400 survivors in 1996.14 The National Health Service Cen- tral Register identified the health authority in which the cohort member was registered with a family doctor. Chief executives of the rele- vant health authorities granted permission to the register to provide addresses of survivors (or, failing this, to forward mail to them). In- vitation letters, consent forms, and question- naires were sent to individuals, along with up to 2 reminders. A short version of the ques- tionnaire covering priority information was sent with the second reminder. The resurvey ques- tionnaire included questions on socioeconomic status (SES) and retirement, diseases diagnosed Do Socioeconomic Disadvantages Persist Into Old Age? Self-Reported Morbidity in a 29-Year Follow-Up of the Whitehall Study February 2001, Vol. 91, No. 2278 American Journal of Public Health TABLE 1—Resurvey Responses by Selected Characteristics: Whitehall Study, 1997–1998 Total No. Invited Completed Full Completed Short to Take Part Questionnaire, No. (%) Questionnaire, No. (%) χ2 P Age at resurvey, y <75 3029="" 2316="" (76)="" 262="" (9)="" 75–79="" 2937="" 2236="" (76)="" 272="" (9)="" ≥80="" 2571="" 1616="" (63)="" 339="" (13)="">< .001="" baseline="" employment="" grade="" high="" 555="" 443="" (80)="" 23="" (4)="" middle="" 6743="" 5052="" (75)="" 657="" (10)="" low="" 1239="" 673="" (54)="" 193="" (16)="">< .001="" baseline="" smoking="" status="" never="" 2078="" 1588="" (76)="" 186="" (9)="" ex-smoker="" 3370="" 2496="" (74)="" 318="" (9)="" pipe/cigar="" smoker="" 332="" 249="" (75)="" 28="" (8)="" cigarette="" smoker="" 2753="" 1832="" (67)="" 341="" (12)="">< .001="" baseline="" evidence="" of="" cardiovascular="" disease="" yes="" 1114="" 813="" (73)="" 127="" (11)="" no="" 7133="" 5353="" (75)="" 746="" (10)="" .437="" baseline="" respiratory="" symptoms="" no="" phlegm="" 6399="" 4666="" (73)="" 638="" (10)="" persistent="" cough/phlegm="" 1070="" 748="" (70)="" 110="" (10)="" increasing="" cough/phlegm="" 409="" 267="" (65)="" 56="" (14)="" hospital="" admission="" in="" past="" 647="" 481="" (74)="" 69="" (11)="" .018="" total="" 8537="" 6168="" (72)="" 873="" (10)="" by="" a="" doctor,="" and="" ability="" to="" carry="" out="" everyday="" activities.="" outcome="" measures="" we="" used="" 4="" measures="" of="" self-reported="" morbidity:="" general="" poor="" health,="" poor="" mental="" health,="" poor="" physical="" performance,="" and="" dis-="" ability.="" those="" rating="" their="" health="" as="" poor="" or="" very="" poor="" on="" a="" 5-point="" scale="" ranging="" from="" very="" good="" to="" very="" poor="" were="" classified="" as="" being="" in="" poor="" general="" health.="" poor="" mental="" health="" was="" defined="" as="" a="" score="" below="" 60%="" of="" the="" maximum="" on="" the="" 5-item="" mental="" health="" section="" of="" the="" short="" form="" 36="" health="" survey="" (sf-36).15="" poor="" physical="" performance="" was="" de-="" fined="" as="" a="" score="" below="" 40%="" of="" the="" maximum="" on="" the="" 10-item="" physical="" performance="" section="" of="" the="" sf-36,="" which="" asks="" people="" to="" state="" whether="" their="" health="" limits="" their="" activity="" ex-="" tensively,="" a="" little,="" or="" not="" at="" all.="" finally,="" dis-="" ability="" was="" classified="" as="" an="" inability="" to="" engage="" in="" at="" least="" 1="" of="" 5="" instrumental="" activities="" of="" daily="" living="" (cooking="" a="" hot="" meal,="" cutting="" toenails,="" dressing="" oneself,="" doing="" light="" housework="" and="" simple="" repairs,="" and="" going="" up="" and="" down="" stairs="" and="" steps).="" data="" on="" mental="" health,="" physical="" perform-="" ance,="" and="" disability="" were="" available="" only="" for="" those="" who="" completed="" the="" full="" questionnaire.the="" sf-="" 36="" indexes="" were="" scored="" as="" recommended.16as="" a="" result="" of="" missing="" data,="" 4%="" of="" those="" complet-="" ing="" the="" full="" questionnaire="" were="" not="" assigned="" a="" mental="" health="" score,="" 3%="" were="" not="" assigned="" a="" physical="" performance="" score,="" and="" fewer="" than="" 1%="" were="" excluded="" from="" the="" disability="" analyses.="" socioeconomic="" and="" risk="" factor="" measures="" the="" main="" baseline="" socioeconomic="" clas-="" sification="" used="" was="" employment="" grade="" (high,="" middle,="" or="" low).="" high="" grades="" comprised="" sen-="" ior="" managers="" and="" administrators;="" middle="" grades="" comprised="" executives="" and="" professionals="" (e.g.,="" economists,="" statisticians,="" and="" scientists)="" in="" less="" senior="" positions;="" and="" low="" grades="" included="" cler-="" ical="" staff,="" printing="" room="" officers,="" security="" of-="" ficers,="" messengers,="" and="" catering="" staff.="" other="" socioeconomic="" indicators="" were="" car="" ownership="" and,="" measured="" retrospectively="" at="" the="" resurvey,="" housing="" tenure="" at="" baseline="" (owner="" vs="" renter).="" these="" variables="" were="" found="" to="" be="" clear="" discriminators="" of="" mortality="" rates="" among="" older="" people="" in="" the="" united="" kingdom="" in="" the="" 1970s,1="" were="" incorporated="" in="" the="" townsend="" index="" of="" deprivation,17="" and="" have="" subsequently="" been="" used="" as="" socioeconomic="" indicators.5,18="" respondents="" were="" considered="" to="" have="" preexisting="" cardiovascular="" disease="" if="" they="" had="" at="" least="" 1="" of="" the="" following="" at="" baseline:="" an="" ab-="" normal="" electrocardiogram;="" self-reported="" symptoms="" of="" angina,="" claudication,="" or="" poten-="" tial="" myocardial="" infarction19;="" medication="" for="" high="" blood="" pressure;="" or="" a="" hospital="" admission="" for="" a="" heart="" condition.="" we="" adjusted="" for="" car-="" diorespiratory="" disease="" clinical="" risk="" factors="" that="" existed="" at="" baseline="" because="" these="" risk="" factors="" are="" associated="" with="" later="" disability20–22="" and="" can="" lead="" to="" more="" general="" problems="" in="" func-="" tioning="" and="" health.="" the="" variables="" used="" in="" the="" analyses="" were="" as="" follows:="" being="" in="" the="" top="" quintile="" in="" terms="" of="" systolic="" or="" diastolic="" blood="" pressure="" or="" total="" cholesterol="" level="" (assessed="" with="" the="" entire="" 1960s="" cohort),="" body="" mass="" index="" of="" 30="" kg/m2="" or="" greater,="" blood="" sugar="" level="" above="" 96="" mg/dl,="" persistent="" or="" increasing="" du-="" ration="" of="" cough="" or="" phlegm="" or="" hospital="" admis-="" sions="" for="" respiratory="" disease,="" and="" 4="" or="" more="" hospital="" admissions="" for="" other="" reasons.="" statistical="" analysis="" chi-squaretestsforheterogeneitywereused="" todetermineunivariateassociations.logistic="" re-="" gression(stata5forwindows3.123)wasused="" to="" estimateoddsratios="" (ors)and95%confidence="" intervals="" (cis)="" foreachoutcome.allmodels="" in-="" cluded="" adjustment="" for="" age="" at="" resurvey="" (younger="" than="" 75="" years,="" 75–79="" years,="" 80="" years="" or="" older).="" results="" atthe="" timeof="" theresurvey,="" therewere8537="" men="" from="" the="" original="" screening="" who,="" accord-="" ing="" to="" national="" health="" service="" central="" register="" records,="" were="" alive="" and="" living="" in="" great="" britain.="" of="" these="" individuals,="" 6168="" completed="" a="" full="" questionnaire="" (72%)and873ashortone="" (10%),="" 209="" of="" the="" latter="" by="" telephone.="" seven="" percent="" of="" respondents="" had="" been="" in="" high="" employment="" grades="" at="" the="" initial="" screening,="" 12%="" had="" been="" in="" lowgrades,="" and81%hadbeen="" inmiddlegrades.="" the="" median="" age="" of="" respondents="" at="" the="" resurvey="" was="" 77="" years="" (range:="" 67–97),="" and="" the="" median="" follow-up="" interval="" was="" 29="" years="" (range:="" 26–31).="" response="" rates="" were="" lowest="" among="" men="" in="" low="" employment="" grades,="" older="" men,="" smokers,="" february="" 2001,="" vol.="" 91,="" no.="" 2="" american="" journal="" of="" public="" health="" 279="" table="" 2—distribution="" (%)="" of="" characteristics="" of="" resurvey="" respondents,="" by="" employment="" grade="" at="" baseline:="" whitehall="" study,="" 1997–1998="" employment="" grade="" at="" baseline,="" %="" high="" middle="" low="" (n="466)" (n="5708)" (n="866)" �2="" p="" resurvey="" age,="" y=""><75 37.8="" 37.5="" 30.1="" 75–79="" 38.2="" 36.4="" 29.3="" ≥80="" 24.0="" 26.1="" 40.5="">< .001="" net=""><$16500 0.9="" 8.2="" 47.8="">< .001="" had="" risen="" 1="" grade="" category="" .="" .="" .="" 39.7="" 50.8="">< .001="" had="" paid="" job="" after="" leaving="" civil="" service="" 44.9="" 22.8="" 18.7="">< .001="" cardiovascular="" disease="" angina="" 11.4="" 14.5="" 16.7="" .03="" heart="" attack="" 10.5="" 11.4="" 15.0="" .006="" stroke="" 7.3="" 8.4="" 8.2="" .74="" baseline="" cardiovascular="" disease="" 11.4="" 13.3="" 14.5="" .26="" top="" quintile="" systolic="" blood="" pressure="" 7.3="" 12.7="" 15.6="">< .001 diastolic blood pressure 10.7 13.3 13.6 .27 total cholesterola 23.4 19.0 16.8 .15 .001="" diastolic="" blood="" pressure="" 10.7="" 13.3="" 13.6="" .27="" total="" cholesterola="" 23.4="" 19.0="" 16.8="">
Answered Same DayMar 20, 2021PUBH6005

Answer To: Elizabeth Breeze, MSc, CStat, Astrid E. Fletcher, PhD, David A. Leon, PhD, Michael G. Marmot, PhD,...

Sunabh answered on Mar 22 2021
152 Votes
Running Head: EPIDEMIOLOGY        1
EPIDEMIOLOGY        2
PUBH6005
EPIDEMIOLOGY

Table of Contents
Part 1    3
1. Sampling Frame for Each Phase of Whitehall Study    3
2. Assessment of Disease Risk in the Three Papers    3
3. Generalisation of the Results from these Three Papers to Other Populations    
4
4. Feasibility of Conducting Similar Study in Australia with Existing Cohort    4
Part 2    4
1. Causal Relationship between Lung Cancer and Smoking    5
2. Link between Depression and Binge Eating in an Obese Grown-Up Population    5
3. Long-Term Impact of Detention on Physical and Mental Health of Asylum Seekers    5
4. Relationship between Folate Supplementation during Pregnancy and Development of Autism in Offspring    6
5. Testing a Drug for Use in Elderly People Diagnosed with Alzheimer’s disease    6
References    7
Part 1
1. Sampling Frame for Each Phase of Whitehall Study
Whitehall studies are used to investigate the social determinants of health such as mortality rates, cardiovascular disease prevalence and much more. Initially there were 2 phases of Whitehall study, Phase 1 examined more than 17,500 male civil servants who belonged to the age group 20 to 64 years’ old, which was pursued for a period of 10 years. The Phase 2 of this study involved 10,308 civil servants between the age groups 35 years and 55 years, which was pursed until 1988. The Whitehall study conducted by conducted by Breeze et al. (2001) reflected only 1st phase of the study. 19029 men belonging to the age group 40 to 69 years were examined between 1967 and 1970 in order to identify the risk factors associated with the cardiorespiratory disease. Phase 2 of the study included a resurvey of the 400 survivors in 1996.
2. Assessment of Disease Risk in the Three Papers
Breeze et al. (2001) accessed the disease risk through Whitehall study; both the phases of Whitehall study were implied because authors were analysing the association between socioeconomic factor and morbidity. The Whitehall study followed by a resurvey was an effective method to analyses the social determinants of health in this study.
Marmot, Rose, Shipley and Hamilton (1978) used a longitudinal study including 17530 civil servants, which were working in London. Social determent of health chosen was employment grade and authors tried to find its association with coronary heart disease. 7-year follow-up elected a clear inverse relationship between the variables and the follow up period was required in order to monitor the employment grade.
Chandola et al. (2008) used Whitehall II study in order to study the risk factor coronary heart disease (CHD) and its association with work stress. Several other outcomes such as metabolic syndrome, heart rate variability, incident CHD and much more were also accessed.
3. Generalisation of the Results from these Three Papers to Other Populations
Results presented by Chandola et al. (2008)...
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