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Medical Assignment: Prehypertension Risk Factors

Question

TasK: A critical review evaluates the clarity, quality and originality of research, as well as its relevance and presentation. A good review carefully analyses an article's strengths and weaknesses before assessing its overall value. Writing a critical review can be a useful academic exercise that helps to improve basic epidemiological skills. By assessing the work of others, students become familiar with specific evaluation criteria for public health research and develop critical thinking skills of more general application. Critiquing other scientific research will help you to develop good writing skills which will be essential for you when submitting your own research for publication.

The objectives of this assessment are to:

  1. Learn to efficiently and critically review and interpret the scientific literature in public health
  2. Learn and apply principles of epidemiology when evaluating research

Answer

Executive Summary
Prehypertension, like hypertension, is related to elevated risk of cardiovascular diseases. However, cardiovagal modulation experienced a significant decrease in young prehypertensive participants in comparison to normotensive participants. The present Medical Assignment is reviewed with the help of a definite checklist, called STROBE (strengthening the reporting of observational studies in epidemiology) checklist. The introduction linked the present study to available clinical and demographic research in the discussed issue. However, this has not shed light on the purpose or rationale of the research. The study design of this Medical Assignment has specified geographical and demographical ranges accepted by the researcher. However, no justification is provided for this choice. Use of keywords has helped to provide a succinct guideline.

Overall, the researcher has lacked in the area of justifications that may hinder the ability of readers to understand. The methodological design of the present study has been logically elaborated by the researcher. The researchers use a Global Physical Activity Questionnaire to assess participant activity. The statistical analysis has also shed light on the large drop-out number among participants, and the justifiable reasons for the choice of were only 178 participants in the follow-up stage. A limitation of the chosen study is that there exists a bias in gender of the selected participants. The conclusion section of this study has shed light on overall summary of this Medical Assignment as well as pointed out its limitations and future scope.

1. Description
Hypertension is a changing risk parameter pertaining to cardiovascular ailments. This parameter is known to be related to decreased cardiovagal modulation and enhanced oxidative stress. Prehypertension, like hypertension, is related to elevated risk of cardiovascular diseases. The present article aims to determine the association between cardiovagal modulation, prehypertension, oxidative stress, and related risk parameters. Thiyagarajan et al. (2013) recruit 178 participants with the help of hypertension screening programs that are conducted in India. Subjects are categorised into normotensive (n = 81) and prehypertensive (n = 97) classes. These classes underwent further subdivision based on their age groups. The age groups that are classified in this test are 20 to 39 years and 40 to 60 years. Thiyagarajan et al. (2013) measure the basal physiological, variability of heart rate, risk factors and oxidative stress that involve reactive substances to thiobarbituric acid and TAC (total antioxidant capacity). The results in the present cross-sectional Medical Assignment study deduce a significant hike in the oxidative stress of prehypertensive subjects, irrespective of their age groups.

However, cardiovagal modulation experienced a significant decrease in young prehypertensive participants in comparison to normotensive participants. TAC correlation with the root mean square of net successive R waves and their interval differences are measured. This difference acts as a prominent parameter of cardiovagal modulation (r = 0. 4370; P < 0.001). The average arterial pressure is found to be significant after necessary adjustments for observable risk parameters (r = ?0.3180; P < 0.001). Thiyagarajan et al. (2013) state correlation between average arterial pressure and R wave intervals is reduced after recalibrating the risk factors (r = 0.1990; P = 0.009). Prehypertension in the age group of 20 to 39 adults can influence increment in oxidative stress and alterations in cardiovagal modulations. Thiyagarajan et al. (2013) deduce that the middle-aged adults are in a twilight zone that exposes them to possibilities of developing cardiovascular dysfunctions. The aforementioned risk parameters for cardiovascular complications in case of young adults diagnosed with prehypertension are equivalent to middle-aged adults.

2. Article critique
The present article is reviewed with the help of a definite checklist, called STROBE (strengthening the reporting of observational studies in epidemiology) checklist (Strobe-statement.org, 2007). The purpose of this list is to frame the criterion on the basis of which the researcher has critiqued the present article.

2.1 Title and abstract: The title of this Medical Assignment article successfully reflects its aim and the populace that is studied. In addition to this, the article also enumerated the study design that has been used in the present research. Thiyagarajan et al. (2013) have chosen a cross-sectional study to elaborately explore this issue in the prehypertensive subjects. The research title clearly sheds the light on the variables and their interaction that are to be studied. This provides ample details in the research title without crowding it with unnecessary information. According to the findings of Sévoz-Couche & Brouillard (2017), this method of enumerating the study design in the research title can help to remove false assumptions about the study and replace with factual data. In addition to this, the abstract is concisely formulated to summarise the entire work in a balanced and informative manner. The abstract contains necessary parameters of a cross-sectional study and is presented in a succinct and comprehensible manner. Use of definite keywords, such as “blood pressure”, “heart rate variability”, “cardiovascular risk factors”, “oxidative stress”, “hypertension” and “prehypertension” has helped the reader to understand the focus of this study.

2.2 Introduction
A succinct and guiding introduction is a major strength of a well-written article. As opined by Zipes et al. (2018), the introductory paragraph is essential to provide a precise background of the study. In addition to this, the introduction should also shed a brief light on the objectives of Medical Assignment.

2.2.1 Background and rationale: The background shed a comprehensive light on the prehypertensive population and the impact of the stress levels to provide undue exposure to cardiovascular complications. Baynard et al. (2014) state the health disparities that can be associated with the experience of oxidative stress. The introduction linked the present study to available clinical and demographic research in the discussed issue. However, has not shed light on the purpose or rationale of the research. Aboriginal health risks and behaviours that make them a high risk of developing frailty compared to general population. Thus, this section partially addresses the STROBE framework.

2.2.2 Objectives: Another limitation of this research is the lack of distinct research aim and objectives in the study. Thiyagarajan et al. (2013) have overtly discussed the basis of implementing the research. However, lack of distinct aim and objectives can reduce reader comprehensibility while addressing this study. Hence, this does not achieve the STROBE guidelines.

2.3 Methods
2.3.1 Settings and participants: According to the recommendations given in STROBE framework, a comprehensive research article must be enriched with study designs, settings, population, dates and parameters (Strobe-statement.org, 2007). This has been achieved by the present research in a proficient manner. The section of this research has specified geographical ranges of the study. However, no justification is provided for this choice. The chosen community belong from Puducherry, India. Thiyagarajan et al. (2013) enumerate the study period, which is between March and December 2011. An additional aspect of this research is the response rate that has been obtained from hypertension screening programmes conducted in the mentioned geographical place. Total number of participants that have provided their consent for this research is 524. As stated by Sclocco et al. (2016), appropriate sampling method is critical to implement an authentic research. The sampling method is comprehensively outlined with the help of the regime followed in the screening camp.

The blood pressure of volunteers is recorded thrice with 5-minute gaps in between. The automatic monitor records the final reading after allowing the participants to rest for 5 minutes in sitting positions. Average recordings are considered final, and the screening amounted to the next stage which involved 294 volunteers out of the initial 524. The inclusion criteria mandated by Thiyagarajan et al. (2013) involve systolic blood pressure to be lesser than 140 mm Hg, and diastolic blood pressure of lesser than 90 mm Hg. The selected age group is 20 to 60 years (influenced from Pal et al. 2015). Similarly, the researchers have also described the exclusion factor, in accordance to STROBE framework that involves medical histories of chronic illness, such as diabetes, cardiovascular or renal diseases, and autonomic insufficiency. Individuals who are actively related to sports or under medication for chronic illness and prehypertension are also excluded. Hence, the researcher has proficiently abided by the STROBE guidelines.

2.3.2 Study design: The methodological design of the present study has been logically elaborated by the researcher. As opined by Fadaee et al. (2017), ease in understanding of research design can facilitate the researcher to analyse gaps in their working. In this case, the systematic enumeration helps to understand efficient measures that are applied to assess the participants and check for possible frailties in the issues to be discussed. However, Thiyagarajan et al. (2013) did not provide ample justifications for their choice. The design does not shed light on the reason behind the usage of blood pressure and heart rate measurement. According to the findings of Kim et al. (2015), it is essential that justification is amplified to appropriation in order to facilitate replication of the study to confirm validity of the results. In addition to this, reason behind the formulation of inclusion and exclusion criteria on the basis of the aforementioned evaluations is not explained. The risk factors related to cardiovascular disease are not mentioned.

The circumference of the waist is measured between the iliac crest and the costal border. Thiyagarajan et al. (2013) used a Global Physical Activity Questionnaire to assess participant activity. They quantified this result in the form of metabolic equivalents. However, no justification is provided for the usage of these parameters. As opined by Kovacic & Somanathan (2015), the readers may face certain problems in understanding the usage of equipments. This is further concurred by the statement of Kanthak et al. (2016), who state purpose of Lead II electrocardiogram and temperature maintenance is not clarified. The global questionnaire is widely accepted and can be an apt choice for this study. However, Child et al. (2018) argue it has shown better results in combination of a pilot study with the chosen population. Specificity and sensitivity of the questionnaire is evaluated with the help of normal alcohol and nicotine consumption in a community setting.

2.3.3 Statistical methods: The statistical appraisal of this Medical Assignment is thoroughly described. The methods that are used to present the observed data in this research involve a root mean square deviation and regression. As commented by Saranya et al. (2015), the systematic record and documentation involve facilitation to the readers in the form of possible replication of the present study. The statistical analysis has also shed light on the large drop-out number among participants, and the justifiable reasons for the choice of were only 178 participants in the follow-up stage. Thiyagarajan et al. (2013) show a majority of prehypertensive participants are middle-aged individuals. There are 62 older adults, whereas there are 35 young adults in this category. In case of prehypertensive subjects, male to female ratio is designated as 2.18, in case of younger adults, as well as 1.21 in case of older adults.

Statistical-methods-in-medical-assignment.jpg

(Source: Thiyagarajan et al. 2013)

The statistical analysis shows a prolonged history of hypertension in the family that has been equally segregated between prehypertensive and normotensive middle-aged adults (33.87% and 37.14%) and young adults (34.28% and 30.43%). According to Sanchez-Gonzalez et al. (2015), the residual modulation factors are a critical expression to formulate credible data. These factors are expressed in the form of frequency and time domain indices that are significantly reduced in case of prehypertensive younger adults. This can be in comparison with the normotensive adults that are chosen in this study. However, no considerable difference is analysed between normotensive and prehypertensive middle-aged individuals in this statistical appraisal. Furthermore, Thiyagarajan et al. (2013) have used an LF/HF ratio to analyse sympathovagal balance in a statistical manner. Overall, this criterion has been achieved by the researchers as given in STROBE guidelines.

2.4 Results
The results of this Medical Assignment are exhibited in a systematic and methodical manner. This system of presentation caters to the strength of this research and can facilitate understanding of the reader. The subsections of research results are described in accordance to variables that are compared and measured. The utilisation of graphs and tables are appropriate in this context. The statistical appraisal has been explained accurately in the form of figure legends. As stated by Topol & Teirstein (2015), this has made it easier for comparison of the results that have been obtained in the observational study. The results that have been formulated in the context of these observations are further associated to that of the measures identified previously. Thiyagarajan et al. (2013) have not limited their findings to the primary objective of their study. The results are also presented in the form of data representation with appropriate explanations for the abbreviations involved. The findings are graphically represented against mean ± standard deviation or frequency.

Statistical significance is maintained in each of the calculations. As opined by Urden, Stacy & Lough (2017), this maintenance has helped the researchers to obtain credible results for the issue. The analysis of correlation has revealed direct association between TBARS and TAC with 23.2% variance in average arterial pressure and 36.8% variance in RR wave interval. The indirect correlation between the arterial pressure and cardiovagal modulation has helped the research study to verify the results in terms of the results. Risk factors of cardiovascular devices involve age, weight, high blood pressure or low physical activity. The levels of fasting plasma glucose and triglycerides also help to show reduced but considerable correlation for the same parameters. The aforementioned correlation appraisal reveals indirect correlation between the RR interval and TBARS which is further explained in the form of a linear regression appraisal.

2.5 Discussion and conclusion
The discussion of this Medical Assignment has been seen to be proficient aligned to the STROBE guidelines. The section summarised the critical results of the research strengths, limitations and biases. The admission of Thiyagarajan et al. (2013) can be used as limitations in order to transform the research through high grade demographical observation. According to the opinions of Sévoz-Couche & Brouillard (2017), it is observed that investigators address biases of the research in order to render it an additional reliability. In the present research study, Urden, Stacy & Lough (2017) observe strong correlation among oxidative stress, prehypertension and cardiovagal modulation. Similarly, weak correlation is observed between prehypertension and cardiovagal modulation. This has led the hypothesis pertaining to oxidative stress, that the identified parameters play a crucial role in pathogenesis of changed cardiovagal modulation and prehypertension. Conduction of longitudinal research in the future can elucidate a fundamental association among oxidative stress, prehypertension and cardiovagal modulation.

However, Kanthak et al. (2016) have utilised the information from Framingham cardiac study report to reveal a presence of additional risk parameters that can render vulnerabilities in middle aged people. This vulnerability can enhance a lifetime risk in the issue of cardiovascular systems for remaining years, thereby reducing cognitive longevity by approximately 10 years. The researchers have discussed the statistical appraisal in cases of prehypertensive young adults. The trends of similarity can provide a comprehensive understanding of oxidative stress, increases cardiovascular risk and cardiovagal modulation. As indicated by Kovacic & Somanathan (2015), presence of associated heart risks and prehypertension in adults can predispose them to added risks for adverse events. Nevertheless, CV risk factors and prehypertension can be assessed in the younger age groups by timely diagnosis (Heart.org, 2014). As seen above, this discussion has been extended beyond observable results that the researchers have obtained from the cross-sectional study. Thiyagarajan et al. (2013) have efficiently elaborated the issues that can be linked to early onset, elevated prevalence as well as incidence of cardiovascular complications in chosen population.

QA majority of the chosen cohort has obtained awareness about the need of stress reduction. Another social issue has been shed light on that involves reluctance of diagnosis of cardiovascular complications in young adults. A limitation of the chosen study is that there exists a bias in gender of the selected participants. This amounts to more male subjects in young prehypertension class, in comparison to other classes. As opined by Kim et al. (2015), gender bias can expose a study to undue influences that can tilt observations in a specific genre. This is because, younger males are more exposed to development of prehypertension, when compared to younger females in age group of 20 to 39 years. Additionally, measurement of blood pressure is done on separate events, once in the laboratory, and the other time in screening camps. However, categorisation of subjects is based on recordings obtained from laboratories. The conclusion section of this study has shed light on overall summary of this research as well as pointed out its limitations and future scope. Medical assignments are being prepared by our medical experts from top universities which let us to provide you a reliable best assignment help service.

Reference List
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Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. London, UK: Elsevier Health Sciences.

Zipes, D. P., Libby, P., Bonow, R. O., Mann, D. L., & Tomaselli, G. F. (2018). Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine. London, UK: Elsevier Health Sciences.

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Fadaee, S. B., Beetham, K. S., Howden, E. J., Stanton, T., Isbel, N. M., & Coombes, J. S. (2017). Oxidative stress is associated with decreased heart rate variability in patients with chronic kidney disease. Redox Report, 22(5), 197-204. DOI: https://doi.org/10.1080/13510002.2016.1173326

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Kovacic, P., & Somanathan, R. (2015). Cardiovascular diseases: Electron transfer, reactive oxygen species, oxidative stress, toxicity, antioxidants and arrhythmia. Open Journal of Medicine, 3(1). DOI: 10.3823/506

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