PA and H, lecture 4

winniesmith2's version from 2017-11-02 15:14

Section 1

Question Answer
What is the issue subjective measuresCan't ask the person/population social desirable questions
What is the USA's study BRFSS (behavioural risk behaviour survey) findThat 25 to 30% of the population were physically inactive. Straight parallel line from 1992 to 2004.
What did Troiano et al , USA study 2003-04 find They compared self-report data VS. directly measured physical activity (using Actigraph sensor). With self-report 45% were meeting guidelines. However, with direct measures only 5% were meeting guidelines.
What did the Canadian health measures survey find (CHMS) 2007-2009The same as the USA 2003-2004 study. Self-report 52.5% that guidelines. Direct measure 15.4%.
What did health survey England find 2008.Same as the USA 2003- 2004 study. Self-report 39%. Direct measure 5%.
what does NHANES stand forNational health and nutrition examination survey.
describe NHANESHealth and nutrition study in USA. Has assessed over 180,000 people to assess key health trends. Each participant represents 65,000 people in America. Annually 15 counties are assessed with 5000 people assessed each year. It started in 1960 but has been running annually since 1999. Two of the impacts of the study have been analysis of cholesterol levels and lead free gasoline. First an interviewer would go to their house and ask about their health and eating habits as well as the income of that member of the house. Next they be invited to a mobile clinic where they are assessed by doctors, dentists, phlebotomist and nutrition experts. They were also given a cash gift to thank them for their time including detailed report of the findings.

Section 2

Question Answer
what does CHMS stand forCanadian health measures survey. Conducted by statistics Canada
What were the CHMS objectives (1) Estimate the numbers of individuals in Canada with selected health conditions, characteristics, exposures  Estimate the distribution and distributional patterns of selected diseases, risk factors and protective characteristics  Assess the validity of prevalence estimates based on self- and proxy-reported information  Monitor trends based to the extent possible with available historical data
When did CHMS start2004. 2007-2008 in field.
What were the CHMS objectives (2) Ascertain relationships among risk factors, protection practices, and health status  Provide a platform for possible add-on studies  Explore emerging public health issues and new measurement technologies  (Possibly) Collect a nationally representative sample of genetic material and other covariates for future genetic research  Potential platform and infrastructure for ongoing physical measures surveys  Share our experience with others
what were the operational principles• Informative and educational, not interrogative and judgemental
what were the survey parameters Budget (with buy-ins) $33 million over 6 yrs  National estimates, n = 5,000 over 2 years  Atypical sample design (cost, logistics)  Ages 6-79 (6-11, 12-19, 20-39, 40-59, 60-79)  2007-2008 in the field  Direct measures completed in mobile clinic
How will participants selectedFirst select a sampling frame. Second select clusters (where populations lie). Third stand schedule. Fourth select households. Fifth contact household. Sixth select respondent. Book in home interview. In home interview and book clinic visit. Clinic measures. Informed consent needed interview and clinic measures. Choices of what they consented too.
Describe the conceptual frameworkLook at page 9
What consent the participants have to do for the physical measures• Physical measures -To participate in the physical measure tests, including providing samples of blood and urine • Lab report- To receive a copy of the Report of Laboratory Tests • Reportable diseases -To allow Statistics Canada to test blood for hepatitis B and C viruses and to contact respondent, as well as provincial authorities, if results are positive • Biostorage -To allow the storage of blood and urine for use in future health studies • DNA storage -To allow the storage of DNA for use in future health studies • Youth assent -For respondents under 14, to assent to take part in the survey
What was included in the questionnaireHealth status, nutrition and food, medication use, health behaviours, environmental factors, social economic information. Particular interest in environmental contaminants.
what was assessed at the clinic- physical measures• Anthropometry – height, weight, waist and hip circumference, sitting height – 5 skinfolds • Cardiorespiratory Fitness – blood pressure, resting heart rate – modified Canadian Aerobic Fitness Test (step test) – spirometry • Musculoskeletal Fitness – hand grip strength – sit-and-reach flexibility – curl-ups • Physical Activity – accelerometry • Oral Health Exam.
What other site requirements for the trailers/mobile clinics• Location central to sample area • Minimum 60 ft. by 50 ft. to accommodate the trailers once parked • Electrical, water and telecommunications hook-ups nearby • Parking and/or public transit access • Contribution in kind for space and parking
Staffing- what did each trailer require• 1 mobile team • 7.5 “sites” per year • 19 measurement staff (manager, 2 Senior HMS, 4 HMS, 3 lab techs, 4 clinic coordinators, 2 dentists, 2 dental recorders, 1 site logistics officer) • 10 interview staff • Central support for – Advance arrangements – Public relations – Technical support – Training and retraining
What was assessed at the clinic- blood measures• Diabetes (oral glucose tolerance test) – Fasting glucose – Fasting insulin – HbA1c • Cardiovascular Disease – HDL, LDL, total cholesterol, triglycerides, Apo B, Apo A-1 – Homocysteine – Fibrinongen – High Sensitivity C-reactive protein • Nutritional Status – RBC folate – Vitamin B12 – Vitamin D – Calcium. ALSO-  Infectious Disease Markers – Hepatitis A antibody – Hepatitis B (anti-HBs, anti-HBc, HBsAg) – Hepatitis C antibody.  General – CBC – Blood chemistry panel – Surplus blood – DNA sample. - Environmental exposure
What was assessed at the clinic- blood measures- environmental exposureLead, cadmium, Manganese, Total mercury, Arsenic, Nickel, Copper, Zinc, Selenium, Uranium, Molybdenum – Inorganic Mercury (on those with high Total Mercury) – PBDE + Non-coplaner PCBs + Organochlorine pesticides (lipid adjusted and unadjusted) – Perfluorinated Compounds (PFHS, PFOS, PFOA)
What was assessed in the clinic- urine measures– Inorganic Mercury – Phthalates and metabolites (11) – Organophosphate pesticides and metabolites (6) – Phenoxy Herbicide (2,4-D) – Bisphenol A – Cotinine – Microalbumin – Creatinine – Iodine

Section 3

Question Answer
how are the results reported to respondents • At end of clinic visit, respondents will receive results of their physical tests • Lab test results sent to respondents 8 to 12 weeks after the clinic visit (with respondent’s prior consent) • Early reporting protocol in place for lab results beyond threshold values
infectious disease reporting Testing done only with respondent’s prior consent to the reporting of positive results  Lab will report a positive result for hepatitis B or C virus to CHMS medical advisor within 24 hours  Medical advisor will provide results and respondent information to provincial authorities within 48 hours  Medical advisor will contact respondent within three days by phone to provide result and counselling  Medical advisor will follow up by sending a letter and information brochures about the viruses to the respondent
What is the data flow of information page 19
What is the biological specimen flow goes from the mobile examination centre to health Canada(chronic disease nutrition), NML (infectious disease biorespository) and Québec public health (environmental biomarkers). Health Canada and Québec public health both feed into NML.
What is the storage proposal• Information on purposes of storage, access and right of withdrawal provided to respondents prior to collection • Storage of blood and urine: all consenting respondents • Storage of DNA: 20 years and above with consent • NML in Winnipeg selected as biorepository for indefinite storage • Access controlled by Statistics Canada
What is the flow of storage proposalpage 20
What is the analytical potential of the study• 46 questionnaire modules containing 722 questions • Approximately 50 physical measures variables • Over 120 biospecimen analytes • About a dozen Environment Canada weather / pollution indicators • Potential linkage to health records
What does CHMS offer• Unique and nationally representative dataset • Stored samples (serum, urine, DNA) for future research • Experience and expertise • Training opportunities • Catalyst for developing a national biorespository strategy • Potential leadership for domestic and international coordination and harmonization • Comprehensive measurement scope • Opportunity for continuity and expansion (additional content and / or geography)

Section 4

Question Answer
BMI: self-report versus measured: findings  19.7% of respondents (n=67) were misclassified  29.9% were 6-17 yrs (n=20)  70.1 % were 18+ yrs (n=47)  53.7% were female, 46.3% were male  For adults most common misclassifications were from normal to overweight (n=21) and from overweight to obese (n=19)  Height was reported accurately but weight was under-reported by all age groups.
Prevalence of hypertension: self-report versus measured: findings Do you have high blood pressure?  Are you on medication for high blood pressure?  Total hypertensive: 18.3%  47.8% were aware, 52.2% not aware  54.3% of hypertensives were on drugs  64% of these were controlled (<140/90 mmHg)
Diabetes: findings• Do you have diabetes? – 6 of the 156 people (3.8%) who gave a fasting sample reported having diabetes – Impaired Fasting Glucose: 7 or 4.5% (including 2 of the diabetics) • 90 respondents had the OGTT (20+, no diabetes) – Impaired Glucose Tolerance: 8/90 (8.9%)* – Diabetes: 1/90 (1%)
How to know an individual has metabolic syndromeWhen they have three or more of the criteria to be diagnosed, for example: abdominal obesity, triglycerides hi, HDL cholesterol low, high blood pressure and high insulin resistance
Abdominal obesity waist circumference size for men and womenmen >102cm. Women> 88cm.
Diagnostic criteria for high triglycerides>/= 1.69 mmol/L (everyone had this)
Diagnostic criteria for low HDL cholesterolmen <1.04 mmol/L. Women <1.29 mmol/L
Diagnostic criteria for high blood pressure>/= 130 /
Diagnostic criteria for insulin resistance>/= 6.1 mmol/L
Metabolic syndrome, the numbers Total fasting sample: 157 (aged 6-79 yrs)  N=93 or 59% did not have any risk factors  N=64 or 41% (had at least one risk factor)  N=12 or 7.6% had metabolic syndrome (at least 3 risk factors)  Age range 9 yrs to 79 yrs

Section 5

Question Answer
What is the UK Bio Bank study billion pound study. assessed 500,000 people in 2010. Interested in banking tissue, not as detailed phenotyping. (compared to USA/canada 2000/yr and HSE 8000).
HSEHealth survey england. Nurses do questionnaires and then direct measures.
What is phARaoHPhysical activity and respiratory health study.
What were phARaoH objectivesProfiling study (looking at COPD)--> to understand the barriers and enablers to activity. Part A 2013, B 2016.
What does COPD stand for chronic obstructive pulmonary disease.
What does COPD cost to the NHSover £800 million for direct healthcare costs.
(Rationale- breathlessness) The vicious cycle of inactivityYou feel breathless --> you become fearful of activity that makes you breathless--> you avoid those activities which make you breathless --> you do less activity --> your muscles become weaker --> weak muscles use more oxygen and are less efficient --> you feel breathless
What was the inclusion criteria for phARaohMales and females aged between 40 and 75 years. Reside in Leicestershire (including Rutland).
Recruitment (controls) phARaohStop smoking service clinics, posters and leaflets, websites, radio show adverts, newspapers
Control recruitment flowchartRecruitment --> participant calls/texts/emails study team--> LU study team member contacts participant--> telephone screening (consent to fast)--> appointment booking.
Patient recruitment flowchartGP practises join-> conduct database search COPD patients meeting criteria- > letter --> patient reply --> telephone screening --> appointment
PhARaoH study measures Consent, blood pressure, blood sample, anthropometry, body composition, AGE reader, spirometry, pulse wave analysis, grip strength, QMVC (knee one), ISWT (incremental shuttle walk test), questionnaires, accelerometry.
Feedback flowchartpg 34/35

Section 6

Question Answer
Low BMI<18.5
Optimal BMI18.5 - 24.9
Borderline High BMI25.0 - 29.9
High BMI>30
Optimal waist circumference Male <102cm. Female <88cm
High waist circumference male >102cm. Female >88cm.
Percentage body fat, 20-390-7 low. 7- 20% optimal. 20-25 border line. 25+ high
Percentage body fat for 40-59 up to 10 low. - 22% optimal, from 28 high.
Percentage body fat for 60-79 up to 12 low - 25 optimal - 30 + high.
What is systolic pressure (higher number) is the force at which your heart pumps blood around your body.
What is diastolic pressure (lower number) is the resistance to the blood flow in the blood vessels
Why is high blood pressure dangerous it puts extra strain on your blood vessels, heart and other organs, such as the brain, kidneys and eyes. Having a continuously high blood pressure can lead to the development of conditions such as heart disease.
What is optimal blood pressure more than 90/60 and less than 120/80. Below this is low.
Prehypertension blood pressuremore than 120/80 and less than 140/90
What is hypertension stage 1 blood pressure more than 140/90 but less than 160/100. More than this is hypertension stage 2.
Grip strength norms- male (20-29)fair 97-105, good 106-112, very good 113-123, excellent >/= 124.
Grip strength norms- female (20-29)fair 55-60, good 61-64, very good 65-70, excellent >/=71
What does QMVC stand forQuadriceps Maximal Voluntary Contraction