401076 Introduction To Epidemiology

401076 Introduction To Epidemiology

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401076 Introduction To Epidemiology

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401076 Introduction To Epidemiology

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Course Code: 401076
University: Western Sydney University

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Country: Australia

Question:

The following questions are only a guide to your assignment. These points should be addressed but the organisation and subheading is up to you.
1) Overview of the paper you selected.
-What is the issue addressed in the paper, is it important? Were the objectives clearly stated
– What was the study design? – What was the exposure /or intervention? -What was the main study outcome?
-What was the study population?
-What were the main findings? Are the results clearly presented?
Were the authors advise for future direction or about the study implication? 
2) Appraise the internal validity
To what extent can the observed association between the exposure and outcome be attributed to non-causal explanations? Are the results likely to be affected by chance variation?  -Are the results likely to be affected by biases, what kind of biases ? corroborate your arguments with details from the paper! are the results likely to be affected by confounding? If yes what are those that authors have missed? Back it up with referencing, has any interaction or sub-group analysis was conducted –bring evidence from paper
3) Do you believe a causal association between exposure and outcome is plausible? 
This is based on your conclusion on internal validity but also appraisal of possible causal association based on several criteria we have covered in class
4) Appraise the external validity of the finding
can the findings be applied to the source population from which the study population was derived? -Can the study results be applied to other relevant populations? Appraise the overall quality of the discussion section.

 
Answer:

The main issue that is addressed in this paper is associated with the effect of clozapine treatment among the patients with schizophrenia. It is reported that, following the treatment of clozapine, gaining weight is very common among the people who are treated with this medicine. Therefore the study, examined the impact of physical activity and dietary practices among the obese patients suffering from the disease schizophrenia.  Therefore, it can be stated  that,  in the present study, the objective is clearly mentioned (Wu et al., 2007).
From the study, it is observed that the study follows the randomized controlled study design. In the Eastern Taiwan, approximately clozapine-treated53 patients who are obese in nature (having the Body Mass Index of more than 27) are recruited in this study randomly to the control group or to the intervention group. The detailed sampling technique showed that,  initially, 753 hospitalized patients’ data were collected in between September 2003 to February 2004 (Wu et al., 2007). All the patients in the selected sample population matched the criteria of DSM-IV diagnosis of schizophrenia and the all the patients were under age group of 18-65 years. Along with this, patients who are not taking medicine that is clozapine less than 300 mg were excluded from the study. Not only this, but the patients taking any kind of antipsychotic drugs or any type of lipid lowering medications were also not considered as ideal sample population for  this study. The Asian individuals along with BMI of higher than 27kg/m2 were considered to be included in the present study. Moreover,  the patients with any type of mental  illness, persons  with disability during walking, pregnant  women are also not included in the study. After implementing all the inclusion and exclusion criteria, only 56 patients were eligible for the final study and they were randomly assigned to the control or intervention group of the study (Wu et al., 2007).

 
As a part of the intervention, primarily dietary intervention that is dietary control was implemented by the registered dietician. The registered dietician is responsible for taking care of the calorie intake of the patients who were included in this study (Wu et al., 2007).  It is reported in the study that, the calorie intake of the women participants was restricted to 1300 kcal to 1500 kcal per day and on the other hand, in case of male subjects the calorie intake was restricted to the 1600 kcal to 1800 kcal per day. According to the study of Reid Baron and Zee (2014), it is reported that, the minimum dietary requirement for the women is approximately 1200 kcal per day and in case of males this dietary intake requirement is almost 1600 to 1800 kcal per day. As a part of this, the researchers measured the daily calorie intake of the participants and along with this, the type of foods such as artificial sweeteners, sugar free versions of foods and drinks,  fruit and vegetables (up to 7.5 servings per day) consumed by those people was  also analysed by the researchers.  The study of Liu et al. (2018),  reported that, the current average macronutrient intake of the  Taiwan population is composed of 10-14% of protein diet, 20-30% of fat diet and 58 -68% of carbohydrate diet in terms of calorie supply to the body of the individuals (Wu et al., 2007).
 Another important intervention that is implemented in this study is associated with the physical activity of the people. According to the US Surgeon general’s report, it was reported that,   persons of all ages should have a minimum of 30 minutes physical activity every day and it is also mentioned that, the physical activity should be moderate in nature. According to the study of Duncan et al. (2015), it is reported that, as a part of the moderate intensity daily exercises, an individual may perform brisk walking on most of the days in a week. In this study, it was reported that, the authors had designed a different physical activity plan moderate in nature for the study participants. In this context, it can be stated that, the physical activity program of the current study comprised of a 6 months activity and all the physical activities designed for this program was performed by the individuals three days in a week by the study population of the current study (Wu et al., 2007). Therefore, it can be stated that , the physical activity program designed in such a way that , it can be performed in the hospital environment. In this physical activity program, the participants performed consisted level of walking for 1.62 km for approximately 40 minutes, performing stair case exercise  that is walking up 231 stairs and walking down for 330 stairs.  The measurement of the stair (walking up) was 14 cm per stair and the measurement of the stair (walking down) was 13.5 cm per stair. This stair activity lasted for 20 minutes under the supervision of the registered nurses of the hospital (Wu et al., 2007).  The researchers also assured that throughout the 6 months period of exercise intervention, the walking speed of the participants and distances of the walking were same and only the intensity of the warm up exercises were changed during the 6 months period. As a part of this, the researchers encouraged the participants to perform the warm exercises within 60 minutes ; however the participants were instructed not to force themselves during the exercise schedule. It was estimated that during the performances of the physical activity, the participants approximately expended energy at a specific rate of 600 to 750 kcal per week. Along with this, in order to motivate the participants towards the exercise program, different motivational activities were performed and as a part of this, the participants were performed various rewards such as sugar-free drinks, soap  and toilet paper (Wu et al., 2007).
 
The main outcome of this study showed that dietary control program and regular physical activity program can significantly decrease the body weight and along with this, the intervention can also improve metabolic profiles of IGFBP-3, triglyceride and insulin among obese inpatients taking clozapine for the treatment of schizophrenia (Wu et al., 2007).
The collected data was analysed by using the variance and covariance analysis (ANCOVA) with SPSS statistical software (version 10.0). The anthropometric data, hormonal profile and metabolic data of the participants in the intervention group were compared with the data of the control group participants at beginning of the study and the same analysis was performed after three months and at the end of the study. The data that were collected at the initiation of the study were used as the covariate in this study. While performing the analysis of the collected data, a repeated measure ANCOVA was used for all the baseline data (Wu et al., 2007).  For adjusting the cofounding variables, mix-designed ANCOVA was used and this same method was also used for testing the correlation in between the variables. In this study, for all the cases p value of 0.05 was considered as significant. The study result showed that only 53 patients completed the whole process and from the control group 3 people withdrew themselves from the study as they were discharged from the hospital.  After identifying the subjects in this study, 25 patients were assigned to the control group and on the other hand, 28 persons were assigned to the intervention group of the study. In the control group, 44 per cent of the subjects were male and rest of the population that were female that is 56 per cent of the total population was female. On the other hand, in the intervention group there were 17 women and 11 men along with the mean age group of 42.2±7.5 years (Wu et al., 2007). However, no significance differences were found in between the two groups in terms of age or gender of the participants. While discussing the anthropometric measures that is BMI, waist-to-hip ratio waist and hip circumference, body weight, and fat percentage of body weight, it was found that, there was no significant differences in between the two study groups. From the study, it can be reported that, all the study findings were presented in a tabular formant. From the result table, it was observed that, at the baseline data no significant differences regarding the body fact percentages among the men (30.9%±4.8% in the study group and 30.0%±5.1% in the control group) and among women (43.6%±10.7% and 41.4%±5.7%, respectively) (Wu et al., 2007). However, the body fat percentage of the men was significantly lower than that of the body fat percentage of the women (p<0.001); however free fat mass among the men was higher than that of the female.  As shown in the table 1, body fat percentages at three and six months were not reduced within the intervention group participants and also among the intervention group and control group population of the present study.  Therefore after three and six months, the difference in between the free fat percentages of in between the women and men disappeared in between the men and women of the study population.   Although no difference was found in between the above said parameters, reduction in the parameters in the study group like body weight, BMI and waist and hip circumference measures were observed (Wu et al., 2007). All the parameters decreased significantly (p<0.05) after three and six months period among the intervention group compared with the control group of the study. However, the hip circumference of the study population in the intervention group was reduced only after the 6 months of the intervention. The researchers found that, significant differences were found among the intervention group participants after the three months in the parameters like body weight, BMI, hip circumferences but the waist circumference was reduced among the intervention group only after 6 months of the intervention (Wu et al., 2007).   On the other hand, the data presented in the table 2 of this study, it was reported that,  no differences were found at the baseline data of the insulin levels, prolactin, triglyceride, cortisol, cholesterol and serum glucose among the control and intervention group of the study. However, during the intervention process at 3 and 6 months significant differences were noted in between the control and intervention group. While discussing about the levels of the triglyceride among the participants, it was reported that, there was significant differences in between the control and intervention group at the six months of the study (Wu et al., 2007). However, the study failed to show any significant differences in between the control and intervention group the study regarding the insulin levels, prolactin, triglyceride, cortisol, cholesterol and serum glucose after three months and six months of the intervention. Along with this, significant decrease in the triglyceride and cortisol concentrations at 3 and 6 months of the intervention was reported  among the patients and on the contrary, in case of insulin levels changes were observed only 6 months of the intervention of the present study Surprisingly, the triglyceride level of the control  group significantly enhanced at 6 months compared to the level of 3 months (Wu et al., 2007). In case of the growth hormone level of the study population, it was reported that, no changes were reported in between the study and control group of the study regarding the level of growth hormone, IGF-1, IGFBP-3, and the molar ratio of IGF-1 and IGFBP-3.  From the data of table 3 of the study it was reported that, there were no changes in the levels of IGF-1 and growth hormone levels among the intervention and  control group participants even after 3 months and 6 months (Wu et al., 2007). Although level of IGFBP-3 was similar among the participants of both groups, still at the end of 6 months, the level of IGFBP-3 was lower among the intervention group than that of the control group of the study.  Surprisingly, it was found that, the participants of the control groups had higher level of these growth factors after six months compared to the level of the baseline data of the study. The molar ratio of the IGFBP-3 and IGF-1 of the study group showed no significant differences while compared with the data of the control group (Wu et al., 2007).  As a part of the future direction of the present study, the researchers proposed that, life style medication can be prescribed to prevent obesity related abnormalities and in various studies this findings were also reported (Wu et al., 2007). While discussing the chance variance of the study, it can be stated that, no chance variance was present in the study.  However, while discussing the biases of the present study, it can be stated that, the due to lack of adequate work forces and work site support, it was not possible to monitor all the study participants. Therefore, it may be stated that, lack of proper observation of the patients can be marked as study bias (Wu et al., 2007).   In this regard, it can be stated that, the level of the physical fitness of the study population can be accounted as one of the confounding factors of this study. According to the study of Attux et al.  (2013), it is  stated that  the intensity of the exercise is correlated with the level of fitness and so an individual with low level of physical fitness is not capable of performing exercises at same level like a physically fit person. However, the authors did not consider the level of physical fitness of the individuals during the sampling process and so it may affect the study result as all the subjects will not be able to perform exercises in a same manner (Wu et al., 2007). Yes, sub group analysis was performed in this study in terms of the gender of the study population. The study discussion showed that, there was different outcome for men and women. The average waist-hip ratio of the clozapine- treated patients with schizophrenia was 0.97 for men and 0.88 for women. According to the study of Du et al. (2017), it is reported that, Japanese criteria for central obesity are 0.9 for men and 0.8 for women. Therefore, the present study reported that both men and women had central obesity.  As per the study discussion, it can be stated the causal relationship in between exposure and outcome is plausible as in various other studies, this association is also established by the authors. According to the report of Xu et al. (2017), it is stated that community based physical activity interventions are quite effective in improving the obesity condition among the community people. This study finding also supported the credibility of the nutritional intervention program that is also found in the study of Wu et al. (2007). Another study by Martin et al. (2018) reported that, use of healthy diet and regular physical activity are highly associated with the reduction of obesity. Therefore, it can be stated that, the study findings of the present study is quite relevant. Taylor et al. (2018) also stated that, physical intervention can reduce the prevalence of the obesity among the selected study population. The findings of the study cannot be applied to other population as the exposure-outcome relationship is completely based on those who use clozapine due to schizophrenia. However, in case of such type of patients, the study findings can be applied. Yes, the  study findings can be applied to other population as from the previous study findings it is clear that physical activity and nutritional intervention are effective in reducing obesity among the people.   References Attux, C., Martini, L. C., Elkis, H., Tamai, S., Freirias, A., Camargo, M. D. G. M., ... & Bressan, R. A. (2013). A 6-month randomized controlled trial to test the efficacy of a lifestyle intervention for weight gain management in schizophrenia. BMC psychiatry, 13(1), 60. Du, P., Wang, H. J., Zhang, B., Qi, S. F., Mi, Y. J., Liu, D. W., & Tian, Q. B. (2017). Prevalence of abdominal obesity among Chinese adults in 2011. Journal of epidemiology, 27(6), 282-286. Duncan, M. J., Stanley, M., Smith, M., Price, M. J., & Leddington Wright, S. (2015). Coincidence anticipation timing performance during an acute bout of brisk walking in older adults: effect of stimulus speed. Neural plasticity, 2015. Liu, Y. T., Hsu, C. S., Chang, C. C., & Hsu, S. H. (2018, October). Nutrition Security and Optimal Dietary Intake in Taiwan. In a workshop at Institute for Food and Resource Economics, University of Bonn (Vol. 17). Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, (1). Reid, K. J., Baron, K. G., & Zee, P. C. (2014). Meal timing influences daily caloric intake in healthy adults. Nutrition research, 34(11), 930-935. Taylor, R. W., Gray, A. R., Heath, A. L. M., Galland, B. C., Lawrence, J., Sayers, R., ... & Hatch, B. (2018). Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. The American journal of clinical nutrition, 108(2), 228-236. Wu, M.K., Wang, C.K., Bai, Y.M., Huang, C.Y. & Lee, S.D. (2007). Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Psychiatric services, 58(4),544-550. Xu, F., Marchand, S., Corcoran, C., DiBiasio, H., Clough, R., Dyer, C.S., Nobles, J., White, J., Greaney, M.L. & Greene, G.W. (2017). A community-based nutrition and physical activity intervention for children who are overweight or obese and their caregivers. Journal of obesity, 2017. Free Membership to World's Largest Sample Bank To View this & another 50000+ free samples. Please put your valid email id. E-mail Yes, alert me for offers and important updates Submit  Download Sample Now Earn back the money you have spent on the downloaded sample by uploading a unique assignment/study material/research material you have. After we assess the authenticity of the uploaded content, you will get 100% money back in your wallet within 7 days. UploadUnique Document DocumentUnder Evaluation Get Moneyinto Your Wallet Total 12 pages PAY 8 USD TO DOWNLOAD *The content must not be available online or in our existing Database to qualify as unique. 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401076 Introduction To Epidemiology

401076 Introduction To Epidemiology

Free Samples

401076 Introduction To Epidemiology

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401076 Introduction To Epidemiology

0 Download10 Pages / 2,410 Words

Course Code: 401076
University: Western Sydney University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:
You have to select one published articles that details epidemiology research on an emerging, debatable, public health issue.
Answer:

General Description of the Study
The article “Cardiovagal Modulation, Oxidative Stress, and Cardiovascular Risk Factors in Prehypertensive Subjects: Cross-Sectional Study” by Ramkumar Thiyagarajan, Pravati Pal, Gopal Krushna Pal,  Senthil Kumar Subramanian, Zachariah Bobby, Ashok Kumar Das, and Madanmohan Trakroo examined prehypertension in young adults. The article provides significant results on prehypertension among young adults where it is linked to augmented oxidative stress, as well as decreased cardiovagal modulation (Thiyagarajan et al., 2013). The title of the article clearly reflects the content of the entire paper from the introduction to the conclusion where the authors provides information regarding the connection between prehypertension amongst young adults and the augmented oxidative stress and changed cardiovagal modulation. This is evident throughout the article as the conclusion of the article provides a clear summary of the topic (Lloyd-Jones et al., 2006). The authors organized the article in a logical manner that makes it easy through read through by providing the different headings. In addition, the article is easy to follow; however, the language is not general and only fits students pursuing nursing and related fields and not general audience. Ultimately, it is evident from the article that it is free from grammatical and typos errors that makes the article and excellent one for research purposes.
Introduction
The introduction of the article provides great information that is appropriate for the study. The authors start by introducing the concept of prehypertension as those persons with systolic blood pressure (BP) that range from 120-139mm Hg or diastolic BP that ranges from 80-90mm Hg. The authors further underscores the fact that this description is founded on the increase in risk of cardiovascular complications that are linked to level of blood pressure that was previously taken to be normal (Grotto, Grossman, Huerta & Sharabi, 2006).  In addition, the article further provides appropriate information when the authors argue that the reduced cardiovagal modulation is a primary indicator for forecasting prospect cardiovascular diseases and morbidity that is linked to premature aging, prehypertension, as well as hypertension (Thiyagarajan et al., 2013). In the article, appropriate information in the introduction that captures the topic is that oxidative stress is generated by unevenness between reactive oxygen elements along with the antioxidants in the genetic system.
The literature reviewed in the article is relevant in the introduction and is comprehensive. The authors used a range of literature from different authors to further provide detailed information concerning the association between prehypertension and augmented oxidative stress, as well as altered cardiovagal modulation in younger adults. Accordingly, the literature used in the article ranges from different authors that have explored the same or related topic where the information is relevant to the current study and makes the introduction part great through the information that is provided. For instance, Venza , Visalli , Cucinotta , Teti & Venza (2012) emphasizes the relationship between prehypertension and increased oxidative stress and decreased modulation. These articles reviewed by the authors in the introduction demonstrates how appropriate the literature that were used by the authors. This is an important strength of the article because the literature reviewed by the authors succinctly and reliably reflects the topic under investigation making the article an incredible source for research in the nursing field (Venza, Visalli, Cucinotta, Teti & Venza, 2012). Furthermore, the literature that was reviewed in the introduction is up-to-date and provides current literature that is relevant to the current study under investigation. The authors of the literature have great knowledge on the link between prehypertension and increased oxidative stress and decreased cardiovagal modulation, which means that they command a massive knowledge on the subject.
Additionally, the study appears original from the introduction because of the concepts that the authors used. This apparent from the definition of prehypertension where the authors defines prehyptension using 17th report of The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. This definition provides basis for the entire article as the authors use the definition to provide information regarding the topic under investigation (Thiyagarajan et al., 2013). In fact, at the top of the first page of the article it is indicated “original article”, which makes the concept of association between prehypertension and amplified oxidative stress plus declined cardiovagal modulation original all through the paper.
The aims of the of the study follow a logical way where it is assessing the link of cardiovagal modulation, oxidative stress, in addition to cardiovascular risk factors in youthful plus middle-aged prehypertensive participants. This aim provides a clear picture of what the paper will cover, thus providing the reader with what the article plans to explore at the introduction part. However, the authors do not clearly state the aims because it is not easy to identify them at the end of the introduction and needs a careful reading to identify these aims (Lloyd-Jones et al., 2006). The study did not provide the null hypothesis because the authors never mentioned this hypothesis in the introduction part.
Materials and Methods
The design of the study was that of cross-sectional study that targeted subjects in hypertension screening camps in Puducherry, India. In addition, the design of the study targeted young (20-39 years plus middle-aged adults (40-60 years).  This study design was consistent with the aims of study investigating the association between prehypertension and increased oxidative stress plus declined cardiovagal modulation in youthful and middle-aged persons. Therefore, the study used a design method that was appropriate and consistent with the aims.
In the study, the authors did not undertake a pilot study in the article as it is not indicated in the methods part of the study. The final sample of 178 participants was the representative of the entire study population drawn from hypertension screening camps in the area of study that was in Puducherry, India. Nonetheless, one limitation of the sample was that it recruited more males than females in the younger prehypertension group as compared to other groups in the study. This would influence the observations since young persons are vulnerable to develop prehypertension as compared to young females (Thiyagarajan et al., 2013).
Control group in any study plays a leading role in providing a basis of comparing the results in a study and the authors in this particular study used the control group to get reliable and valid results. Control group in the study was an important consideration of the authors as they included the normotensive group to find the link between prehypertension and augmented oxidative stress with declined cardiovagal modulation. The control group in the study was appropriate because it allowed for better analysis of the results. Therefore, the control was appropriate for the study.
The authors clearly stated the selection process of the needed sample for investigating the topic. The participants of the study were selected from the society by four hypertension screening camps carried in Puducherry, India. Thus, study recruited 294 out of 524 volunteers and the final sample was 178 participants. The inclusion criteria in the study included systolic BP of <140mm Hg, diastolic BP <90mm Hg, and aged between 20 and 60 years (Wu et al., 2008). On the other hand, the exclusion criteria included history of chronic diseases, cardiovascular diseases, diabetes, main autonomic deficiency, or kidney illnesses; sports people; treatment for prehypertension, as well as chronic diseases. Figure 1 shows how the selection process of groups in the study. The study used The Global Physical Activity Questionnaire (GPAQ) to evaluate the physical exercise of the participants that was measured as metabolic comparables. However, the questionnaire has not been provided anywhere in the article, including the appendix part. Therefore, the authors never provided any figure or link of the questionnaire in the article. In addition, it is clear that the authors sought ethical approval from the Jawaharlal Institute of Postgraduate Medical and Research (JIPMER) Scientific Advisory Committee and Institute Human Ethics Committee. Also, the participants consent in the study was sought by the researchers. Thus, the study procedure was described to the participants, plus printed informed consent was obtained prior to their input in the research (Thiyagarajan et al., 2013). Results  The authors presented the results of the study in a coherent and unambiguous way providing a clear picture on the relationship between prehypertension and increased oxidative stress along with declined cardiovagal modulation among the youthful and middle-aged persons. The statistical tests were clearly mentioned in results section that provided a better understanding of the subject under investigation (Passariello et al., 2007). Throughout the results section, statistical tests were used adequately and appropriately. In addition, table 1 shows a clear data that was collected from the study that is presented clearly. The table has been divided into two groups: prehypertension and normotension. Also, in the stud, there is no missing data indicated by the authors. The authors used numbers, percentages, and statistical values that ate accurate and clear in the entire results section. I find most of these numbers, statistical values and percentages very accurate and clear all through the results section. Furthermore, the numbers, percentages and statistical values provides a better insight regarding the topic. Consequently, if statistical tests had not been used in the study, then it cannot be justified because these values are important in a quantitative study of this nature towards getting the needed results. The size of the sample used in a study should be appropriate in terms of size to guarantee valid and reliable results. The sample of the study that finally used was 178, which is large enough to justify the findings. This sample was appropriate for the study because it lies within the recommended range of 30% of the entire selected sample for consideration before the final sample was obtained through both the inclusion and exclusion criteria (Thiyagarajan et al., 2013). Additionally, the findings of the study are clinically significant for the study because the results reflect the question of the research that entailed the investigation of the relationship between prehypertension along with augmented oxidative stress and decreased cardiovagal modulation in younger and middle-aged adults. The results of the study were believable because they reflect the aims of the study (Pavithran, Nandeesha, Sathiyapriya, Bobby & Madanmohan, 2008). Conclusions The authors critique and discuss the results of the study considerably. The authors assert that the primary results of the research is that younger adults with prehypertension has declined cardiovagal modulation, increased oxidative stress, as well as cardiovascular risk factors equal to that of the middle-aged persons. In addition, the authors argue that declined cardiovagal modulation is a vital indicator for prediction of prospect cardiovascular morbidity. The authors further claim that declined cardiovagal modulation in prehypertensive young persons (Pal et al., 2011). The authors further critique and discuss the fact that amplified oxidative stress parameters among young in addition to middle-aged prehypertensive persons plus well-built relationship of oxidative stress with prehypertension after changing for perplexing cardiovascular risks factors are consistent with results of past researches. Furthermore, the study critique that the limitation of the study is that it used more male participants than females increasing bias of the study. Thus, the results of the study are comprehensively discussed all through the discussion section of the article (Thiyagarajan et al., 2013). The results discussed by the authors are in relation with other important literature on the topic. For instance, the authors cite the report of the Framingham heart research, which disclosed that the existence of many risk factors in middle-age persons, which grow the life span risk for cardiovascular diseases for the lingering duration plus lowers permanence by ten years. There are many other studies that have been used by the authors to provide comprehensive information on the topic. In addition, the authors confined themselves in their discussion on the methods and results of the study. This is important in allowing the reader to focus on the topic under study. The conclusion of the study clearly reflects the results of the study. The conclusion of the article was that prehypertension among younger adults is linked to increased stress and changed cardiovagal modulation. In addition, the authors conclude that the risk factors for cardiovascular diseases in prehypertensive younger people were established to the same to those of middle-aged persons who are in the sunset zone for growth of cardiovascular dysfunctions (Gawel, Wardas, Niedworok & Wardas, 2004). Funding The source of funding for the article was from the Department of Science and Technology, and Government of India. Accordingly, the funding was made through the INSPIRE fellowship. In the article, the authors affirmed no conflict of interest. There is no statement of exactly how each author contributed to the article. References Gawel S, Wardas M, Niedworok E, & Wardas P. (2004). Malondialdehyde (MDA) as a lipid peroxidation marker. Wiad Lek. 57 (2):453–455. Grotto I, Grossman E, Huerta M, & Sharabi Y. (2006). Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults. Hypertension. 48 (2):254–259. Lloyd-Jones DM, Leip EP, Larson MG, D'Agostino RB, Beiser A, Wilson PW, Wolf PA, & Levy D. (2006). Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50  years of age. Circulation. 113(3):791–798. Pal GK, Adithan C, Amudharaj D, Dutta TK, Pal P, Nandan PG, & Nanda N. (2011). Assessment of sympathovagal imbalance by spectral analysis of heart rate variability in prehypertensive and hypertensive patients in Indian population. Clin Exp Hypertens. 33 (2):478–483. Passariello G, Peluso A, Moniello G, Maio A, Mazo S, Boccia G, Passariello N, Lettieri B, & Chiefari M. (2007). Effect of autonomic nervous system dysfunction on sudden death in ischemic patients with angina syndrome died during electrocardiographic monitoring in intensive care unit. Minerva Anestesiol. 73 (2):207–212. Pavithran P, Nandeesha H, Sathiyapriya V, Bobby Z, & Madanmohan T. (2008). Short-term heart variability and oxidative stress in newly diagnosed essential hypertension. Clin Exp Hypertens. 30 (1):486–496. Thiyagarajan, R., Pal, P.,  Pal, G.K,,  Subramanian, K.S., Bobby Z., Das, K.A, & Trakroo, M. (2013). Cardiovagal Modulation, Oxidative Stress, and Cardiovascular Risk Factors in Prehypertensive Subjects: Cross-Sectional Study. American Journal of Hypertension,  26(7); 850-857. Venza I, Visalli M, Cucinotta M, Teti D, & Venza M. (2012). Association between oxidative stress and macromolecular damage in elderly patients with age-related macular degeneration. Aging Clin Exp Res. 24(2):21–27. Wang Y, & Wang QJ. (2004). The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 164(5):2126–2134. Wu JS, Lu FH, Yang YC, Lin TS, Chen JJ, Wu CH, Huang YH, & Chang CJ. (2008). Epidemiological study on the effect of pre-hypertension and family history of hypertension on cardiac autonomic function. J Am Coll Cardiol. 51(4):1896–1901. 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