Timetables are in!

Seems I was the first to notice that the timetables had been published.

Deciding everyone else must have seen this I didn't mention to anyone except the two people who have become most important to me.  I'll change their names to Jack and Jill haha to protect their privacy.

Feeling that we would have all been in touch far more than we were, there was some disappointment but the type where you are sure your friends are there for you if you need them, yet you just feel busy and kind of forget to text.

Knowing this, I am still safe in the knowledge that we will all prop each other up during the coming terms.  For sure.  We all have different skills to bring to our group.  Not sure I would be so excited to return without those two.

So the timetable is all over the place again, changing from week to week.

Filling in my paper diary with timings,  I began to dread the year ahead, knowing it was going to get technical, scientific and tricky.  Yet as I read the words 'immunology' and 'research skills' I couldn't help but feel a little excited.  There was something about illness (getting well, more specifically) that excites me.

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In my own news, for whatever long winded reason, I tested my fasting blood sugars.

They were 5.5mmol/l - if you look this up on the type of websites I respect, it seems this is cause for slight concern.  Bordering on pre-diabetes.

A myriad of feelings overwhelmed me like a surfer under a wave.  

So began the research.  Taking me back to those days when I was diagnosed with crohns disease.  

In the past 2 weeks i have learnt so so much and I'm excited to face this head on and get to grips with what I need to do to lower that blood sugar.  Also, loosing weight which will be wonderful as it's just in time for my trip of a lifetime to Jamaica! More on that in another post, I think.

The next post will have details of my meeting last night with my PA(!)  Super helpful!

Chronic disease epidemiology

What is chronic disease epidemiology?

It is a way of investigating a link between dietary behaviour and chronic diseases.

Epidemiological studies used:

* 24 hours recall
* Diet history
* Food frequency questionnaire

Types of chronic disease:

* type 2 diabetes
* Heart disease
* Stroke

Ways to investigate the link between dietary behaviour and chronic diseases

* Anthropometric
 Using body weight, height, skin folds, waist and hip circumference

* Biochemical tests

Blood, urine, faeces, tissues are rested to deter subclinical deficiencies

* Clinical observation

Observation of pallor,  hair, nails, skin, eyes, lips, mouth , muscles, joints

* Dietary assessment

Obtain report of food items consumed, portion sizes, frequency, calculation of nutritional intake

Stages of change model

The stages of change model is often used in nutrition and dietetics.

What does Stages of Change model mean?

It begins with building a solid foundation of recovery.

There are 5 steps:

1.  Pre contemplation

This is where the patient is not actively looking for change.  Perhaps they were not aware of needing a change or have no desire to change.

2.  Contemplation

The patient is beginning to wonder if there may be an issue needs addressing.  Is there  a problem here or not?

3.  Preparation

A plan is being developed to address the problem.

4.  Action

New behaviours are beginning to be implemented to address the problem.  This typically lasts 3-6 months.

5.  Maintenance

Symptom free behaviour continuing the good work!

Confounding factors

Within nutrition, confounding factors play a large part in trials.

The relationship between disease and exposure can experience confounding.  IE Alcohol drinkers.  Do they suffer more heart disease than non alcohol drinkers?
As smoking is often associated with alcohol consumption, is it possible that alcohol drinkers may have more heart disease but due to smoking as opposed to drinking alcohol?  This would be confounding.

Therefore, the relationship between alcohol and heart disease could be due to some confounding variable.

RCTs - Randomised control trials

Placebos are used in randomised control trials to limit the potential for any bias.

Blind controls as used in cases where subjects do not know if they belong to the placebo group or not.

Double blind controls happen where neither the subject being tested or the investigators are aware wh his in the placebo group.

Case control and cohort studies

What are case control studies and cohort studies?

What does this mean in clinical nutrition?

Case control studies are observational studies in which two existing groups (differing in outcome) are identified and compared on the basis of a casual attribute.

Group 1 - Has the condition or disease plus another factor.
Group 2 - Does not have the disease but has the same factor.

Cohort studies uses a group of people who share a common defining characteristic such as graduation or birth etc.
An analysis over time of risk factors of people who do not have a disease but uses correlations to determine the absolute risk.

What is Scientific bias?

Scientific bias is a systematic error.  It gives an association that is not true.

In nutrition there are 5 main types of bias which can be found within studies:

Measurement bias - Poorly measured or improperly measured tests. Such as machines not been correctly calibrated for example.

Interviewer Bias - The outcome of the results is shaped by the belief of the interviewer.  For example, should the interviewer feel there would be a benefit from the test, they will impress upon the subject their own bias.

Selection bias - Proper randomisation of subjects is not achieved.

Social acceptability bias - Survey respondents will answer questions in a manner which will be viewed favourably by others.  Some people change their habits to encourage a better view of themselves.  If there was an exercise questionnaire,  subjects may be inclined to increase their exercise for better opinions of themselves.

Recall bias - Inaccurate recollections by study participants.  It is not always easy to remember.  IF subjects were asked to write down what the had eaten earlier in the day, they might well not remember.

Bias Mind map.