London School of Osteopathy

MOst/BOst.

ARU CANDIDATE NUMBER: 1070020/1 Module Code: Module Title: Module Leader: Year: Level: Assessment type: Weighting: Length: Due date: Feedback due: One (semester 2) 1 (15 credits) Coursework (critique) 30% 1000 words MAXIMUM Friday 6th May 2011 Saturday 21st May 2011

Title of article: Associations of education with 30 year life course blood pressure trajectories: Framingham Offspring Study Actual word count: 1020 Check list: top sheet (this one, with the spaces filled in) marking grid (next page) introduction (literature research strategy) the critique reference list

70%+

60-69%

Marking standards (by mark band) 50-59% 40-49%

30-39%

1-29%

Mark (30%)

1. Recognise, identify and recall the normal structure and function of the heart, lungs, gastrointestinal system, lymphatic system & blood, whether active or at rest. 2. Recognise, identify and recall the normal structure of the pelvic organs. 3. Locate relevant structures (surface anatomy). 4. Demonstrate an appreciation of the clinical manifestations of simple disorders of structure and function relevant to osteopathic practice. 5. Demonstrate academic skills such as interpretation of physiological data from case studies and the critical evaluation of published articles. 6. Make effective use of library resources and computer databases to consult reference materials, and consider the merit of the information obtained, and use the written format to convey results of the critique in a coherent and accurate manner.

Excellent information base, exploring and analysing key physiological concepts with considerable originality. Demonstrates detailed and comprehensive understanding of the subject area.

Good information base; explores and key physiological concepts with some originality. Understanding

Satisfactory information base that begins to explore and analyse the key physiological concepts but is still mainly imitative.

Basic information base; omissions in understanding of major physiological concepts. Largely imitative.

Limited information base; limited understanding of key physiological concepts.

Inadequate information base; lack of understanding of physiological concepts. Wholly imitative.

Very good academic/ intellectual skills.

Good academic/ intellectual skills.

Acceptable academic/ intellectual skills.

Some difficulties with academic/ intellectual skills.

Weak academic/ intellectual skills.

Very weak academic/ intellectual skills.

(40%)

Excellent Good Satisfactory use Basic use of learning Limited use of Inadequate use of (30%) management of management of learning resources with no learning learning learning resources, of learning resources. self-direction. Some resources, No self- resources. Major complemented by resources with Some lack of difficulty with direction, little problems with self-direction/ some selfstructure/accur structure and input to team work structure/ exploration. direction. acy in accuracy in and difficulty with accuracy in Structured/ Structured and expression. expression. Difficulty structure/ accuracy expression. accurate mainly Some lapses in in maintaining in expression. Standard of expression. accurate professional professional Professional presentation does Excellent level of expression. presentation standard of presentation skills not achieve professionalism in Professionally presentation are not yet secure professional presentation. presented standards A mark of 0% may be awarded for non-submission, poor or dangerous practice, incoherent and insufficient work, and in situations where the student fails to address the assignment brief and related learning outcome.

Comment:

This essay will critically look at an article from the BBC (2011) Education reduces blood pressure sauced from a study by Loucks et al (2011) titled Associations of education with 30 year life course blood pressure trajectories: Framingham Offspring Study. According to the article, higher levels of education have been linked to lower levels of heart disease due to the reduced blood pressure. According to Loucks et al (2011) the study shows that those with lower education have higher blood pressure. Other factor such as smoking, medication and drinking has affect on the blood pressure but at a lower level. Loucks et al (2011) suggests that associations may be stronger in females than males and goes on to suggests that socio-economic inequalities is a contribution factor to the increase blood pressure: from access to schooling and education attainment which leads to high strained jobs with low level of control and therefore increasing blood pressure. The result of the research was based on a study from 1971 to 2001 involving 3890 participants, all whom were the offspring of the original cohort of the Framingham Heart Study. As to why this sample was used and not a random sample was not made clear by the authors. As the main objective of this study is to find relations between blood pressure and education, the author(s) should have made better use of the general population and focused in depraved and affluent areas to find comparative results, which may produce stronger evidence to support their research. The study samples show that many of the samples were born in the 1930s. A study of this significance should have been more up to date. Education and lifestyle itself after the 2nd World War would significantly affect the data and the result. Life expectancy and the socio-economic inequalities was rife, therefore, all of the results are outdated. The research will need new sets of data and the author(s) may need to focus on a particular period rather than a 30-year life course that does not reflect the current social lifestyle. According to Rajulton (2001) Longitude data introduce many complexities and the author(s) may have experienced problems in creating a strong theory and paradigms to explain the behaviour or systems. The researches are not unified i.e. there are many studies but no uniform measurements across the disciplines. This is clear from the literature within Loucks et als research where the author has cited work from Diez Rouz et al (2002) where the work based on socioeconomic disadvantage and change in blood pressure associated with aging whereas the study from Walsemann et al (2008) titled Accumulating disadvantage over the life course: Evidence from a Longitudinal Study Investigating the Relationship Between Education in Youth and Health in Middle Age may have been more appropriate. The study should have drawn from wider literatures and other research to ensure a unified and coherent conclusion that could lead to uniform measurement in future research. The research was looking at education less than 12 years to more than 17 years. It does not look at those at university level but only those who has

finished high school or above. There may be more distinct data if the author(s) has increased their range of study. By studying the data, it can clearly be seen that there is a gap between less than 12 years to 13-16 years and a greater gap between those of 13-16 years to more than 17 years (Figure 1). If the author(s) has introduced another range of university students i.e. 21 years or above, there may be more evidence to support their findings. In table 2, the author(s) has used more than 17 years a base for their model adjustment, as to why more than 17 years was chosen has not been justified. There are also too many variables and mechanisms such as diet, socio backgrounds, sex, parenting, work condition and etc. in the research to define and lead to any one conclusion and the author(s) has explicitly states that these findings provide evidence that education may be a potential risk factor for elevated blood pressure. These factors will need to be systematically reduced so that the cause and effect can be determined that will lead to a clearer conclusion. The author(s) has also found inconsistencies for DBP, however, there are no explanations to this finding and should be investigated further. As the author(s) has also mentioned, the study was largely based on white participants and the findings should not reflect the whole population, which is not reflected in the article from the BBC. This is a major flaw with the research itself. Other races and ethnicities would also introduce other variables, such as lifestyle and expectations, which may give different data. The analytical part of the study could have also been better presented by subheadings and differentiation especially for layman and those with basic medical knowledge. However, despite the criticism above, it is important to note that the study has produced significant findings. Although it is not a first study of this kind, it has proved that there is a link between blood pressure and education. The study itself can be used as base for future research. Although the data is outdated (in terms of socio and economic development), the theory is still valid as it is backed up by sound findings from the author(s) through logical data and methodology. Overall the article from BBC did not correctly sum up the study by Loucks et al. There are links between education and blood pressure but it fails to understand the intricacies and the failings of the study. The study itself by Loucks et al has good structure and knowledge but has failed to investigate variables and mechanisms closely to ascertain links between lifestyle and blood pressure. The study does not reflect the socio and economical changes especially in terms changes in womens status since the 1930s. The findings are also not applicable to the whole population and only reflect Caucasians living in the US. The author(s) did not give suggestions to further research, which is essential in a study with new findings.

References Loucks, E, Abrahamowicz, M, Xiao Y and Lynch JW (2011) Associations of education with 30 year life course blood pressure trajectories: Framingham Offspring Study BMC Public Health, 11:139 Diez Roux, D, Chambless, L, Merkin, S, Arnett, D, Eigenbrodt, M Nieto, F, Szklo, M and Sorlie P (2002) Socioeconomic disadvantage and change in blood pressure associated with aging Circulation, 106(6): 703-710 Rajulton, Fernando (2001) The Fundamentals of Longitudinal Research: An Overview Special Issue on Longitudinal Methodology, Canadian Studies in Population, Vol. 28(2), pp 169-185 Walesmann, K, Geronimus, A and Gee, G (2008) Accumulating Disvantage Over the Life Course: Evidence from a Longitudinal Study Investigating the Relationship Between Education in Youth and Health in Middle Age Research on Aging 30:169 Website: BBC : http://www.bbc.co.uk/news/health-12577353 [Accessed 2nd May 2011] Framingham Heart Study: http://www.framinghamheartstudy.org/participants/offspring.html [Accessed 3rd May 2011]