# Collaborative notes for HLTH301

Instructions:
Do not remove these instructions. This page will contain interactive questions and visualisations for the HLTH301: Evidence based health

"Y wants to know if a combination of breathing exercises and medications is better in improving asthma symptoms than medications alone. How will Y construct the PICO formatted question?"

## Frame a PICO question:
- Are people with asthma more likely to have reduced symptoms with breathing exercises and medication, or just medication alone?
- Is a combination of breathing exercises and medication more effective in comparison to medications alone in improving people with asthma symptoms?
- Compared to medication alone, what is the effectiveness of using both breathing exercises and medication for people with asthma in reducing their symptoms? Meg N- Mindfulnedss
-
- P: People with Asthma symptoms, I: combination of breathing exercises and medications, C: only medication, O: reduction in Asthma symptoms.

""Compared with no interventions or anxiolytic medications, what is the effectiveness of mindfulness meditation for young people with anxiety for reduction in anxiety symptoms?" what search terms can be constructed?"

- Mindfullness and anxiety reduction, anxiolytic medication and anxXiety, untreated anxiety symptoms, youth anxiety treatment methods, alternative medicine anxiety treatments
- Anxiety Symptoms
- Youth anxiety rates
- interventions for anxiety
- anxiety reduction
- alternative anxitey tretaments
- mindfullness anxiety
- mindfulness meditation and anxiety, anxiolytic medication and anxiety, anxiety symptom reduction, anxiety interventions
Mindfulness meditation and anxiety symptoms
- anxiolytic medication for anxiety
- minfulness for anxiety
Youth anxiety causes
- effectiveness of anxiolytic medications
- Anxiolytic medication for anxiety
Mindfulness for anxiety
Mindfulness in young people
anxiolytic vs mindfulness for anxiety
Anxiety treatment for young people

"Which search term combination will search for mindfulness and meditation but not for anxiety"

- Mindfulness AND meditation NOT anxiety
- Mindfulness OR meditation NOT anxiety
- Mindfulness AND meditation NOT anxiety

## Critical appraisal exercise:
### We will study the following article:

https://www.ncbi.nlm.nih.gov/pubmed/24491199?report=abstract

Download a copy of the full text of this article from below:
https://arinbasu.github.io/HLTH301-evidence-based-health/mindfulness_meditation.pdf

Open the PDF in a reader and answer the following questions:
(Put a tick mark next to the choice)

### Have Xthe authors declared conflict of interest in the research?
- Yes xxxxx
- Five of the six authors have no competing interests to report.
Dr. Ola Schenström has founded a company that, among other
things, markets online mindfulness products.
### x
- yes
- no xxxxX
- I cannot say :100:
- I could not find that information
- "Swedish Council for Working Life and Social Research" funding was not involve in any decision making for the study.
This study was made possible in part by a generous
grant from the Swedish Council for Working Life
and Social Research (FAS 2008-1145). The funding
body was not involved in the study design, in the
collection, analysis and interpretation of data, in the
writing of the report, or in the decision to submit the
article for publication.
### Based on the abstract, what was the purpose of this study? (Write free text, one text per line)
-The current trial aims at evaluating the efficacy of a stand-alone, unguided, Internet-based mindfulness treatment program for anxiety.
-
-

### What was the study design? (put a cross-mark against the best choice in your opinion)

- Randomized controlled trial XxX
- Prospective cohort study
- Case control study
- Case series

### Is this the most appropriate design for the question?
- Yes 🔥 xxxxxx probably given randomised control studies are considered the gold standard as they reduce bias in some ways - compares groups
- No
- Maybe

### Read the first paragraph of the methods section. Which participants would NOT be included in the study? (Write one sentence or phrase or word per line, add lines as necessary)

- Those under 18 years of age
- People who do not have access to the internet
- We applied the following inclusion criteria: (a) at
least 18 years old, (b) access to the Internet,
(c) meeting diagnostic criteria for a primary diagnosis
of social anxiety disorder, panic disorder with or
without agoraphobia, generalized anxiety disorder,
or anxiety disorder not otherwise specified, (d) not
participating in any other psychological treatment
for the duration of the study, (e) no extensive prior
internet-based mindfulness treatment for anxiety 243
experience with mindfulness meditation, and (f) if on
prescribed medication for anxiety/depression, dosage had to be constant for 3 months prior to the start
of the treatment.
- those who did not give written informed consent

### What would be 'your chance of being included in the study if you were to suffer from anxiety and sought treatment? (put a cross mark)
- High Xx
- Medium
- Low
- Can't say

### How did they make sure that the randomiation process was proper and valid? (cross-mark next to the best choice in your opinion)

- Using an online random number generator service
- Using a random numbers table
- They did not explain the process

"After pre-assessment, participants were randomly allocated to the mindfulness treatment group (MTG) or the discussion forum control group (CG) by an **online true random-number service independent** of the investigators."
### Read the intervention: what are some issues that you can think of that can be messy? (Write as many points as you can)
- self-reporting
-Brief program?
-Biases when filling out questionnaires
-Self-reporting bias
-Placebo?
over diagnosis of anxiety and use of medications

### Read table 1. Are the treatment and the control groups comparable on all counts?
- yes
- no
- not clear

### Read tables 2 and 3. What would you say about the intervention
- The intervention was successful in reducing anxiety
- The intervention was not successful in reducing anxiety
- I cannot say or uncertain

Useful for those who may meet the inclusion### To whom will this treatment be applicable?
Yes some extent, this study indicates there is some merit in using mindfulness exercises to reduce anxiety symptoms :+1:
this study shows promise for web-based anxiety treatment programmes.

# Causality lecture (29/7/2019)

## Smoking and Lung Cancer:
Null hypothesis tells us that there is no linkage between Smoking and Lung Cancer

People who are heavy *smokers* Are As likely to have **lung cancer** as those who smoke less:
Yes
NO xXXxxxXxxxxxXx

What is your hypothesis?
- People who are heavy smokers are more likely to have lung cancer than those who smoke less. "alternative hypothesis" H1.
- (This statement is alternative hypothesis, we call it H1
- )
- People who are heavy smokers are less likely to have lung cancer than those who smoke less.
(This too is an alternative hypothesis, say H1)
there is no relationship between the number of cigarettes a person smokes per day and the risk of lung cancer.Ho
- People who are heavy smokers are equally as likely to have lung cancer than those who smoke less
- (this is your null hypothesis, H0).

   digraph{smokers -> lung_cancer}

## Before the study
| Statement | H0 True | H0 False |
|-----------|---------|----------|
| reject H0 |Type 1 error |Correct|
| Fail to reject H0 | Correct|Type 2 error|

(null hypothesis was wrong to start with, data was not likely to find error): it's about status quo

# After completion of study
- Find out the effect size
- If the measure of effect is Risk Ratio or Odds Ratio
- Null would be 1.0
- If the measure of effect is Risk difference,
- Null would be 0

# Example of chance

- Study on Smoking and Lung Cancer found that compared with non-smokers, Smokers were 5.6 times likely to suffer from Lung Cancer (RR = 5.6) and the associated p-value = 0.001

Suggests that the risk was 5.6 times

- If H0 was true, then they would find this result about 0.1% of the times the study were to be repeated
- This is another way of saying that H0 is highly unlikely
The larger the sample size, the lower is usually the p-value
A single p-value is not informative

Example of a chance (continued)

Study on coffee consumption and pancreatic cancer found that compared with those who consumed 1-2 cups of coffee per day, those who consumed 6+ cups of coffee were 2.3 times likely to die from pancreatic cancer (RR = 2.3; 95% CI: 0.87 - 3.23; p = 0.08)

## what is your conclusion?
-Those who consume 6+ cups of coffee per day are 2.3 times more likely to die from pancreatic cancer than those who consume 1-2 cups of coffee per day :) (correct)
- Not statistically significant, CI includes null value of 1, P value is over 0.05
-Since the alpha value of 0.05 is smaller than the p value of 0.08 there is not sufficient evidence to (good)
reject H0 ?????

## Problem of AR%
- Pretend that tea drinking and lung cancer
- study finds RR of 1.2 for heavy tea drinkers and lung cancer
- what is the attributable risk?
- 17% X X Xxxxx
- 34%
- 50%
- (Put a cross mark next to the most likely answer)
Hint: RR - 1/ RR

# Risk communication lecture (5/8/2019)