2A epidemiological paradigms

Question 1

what is a paradigm?

Answer 1

A set of concepts, thought patterns or methodologies that form a particular view of understanding or interpreting the world

Question 2

what are the 3 main epidemiological paradigms

Answer 2

1. Programming paradigm
2. Adult risk factor paradigm
3. Life course paradigm

Question 3

What is the programming paradigm and what are its limitations?

Answer 3

• based on the hypothesis that exposures in critical periods of growth (including in utero and early infancy) can have a long term impact on risk of disease in adulthood
• Assumes there are specific periods during which certain exposures will have lasting effects on body structure or function of body organs
• classic example is the Barker hypothesis: hypothesises that in utero malnutrition can increase risk of coronary heart disease later in life
• criticisms of studies in the area tend to criticise the methodology. Studies often use historical data which may be inaccurate, adjusting for confounders is difficult and dependent on data availability. Additionally birthweight is a poor marker of maternal nutrition.

Question 4

What is the adult risk factor paradigm and what are its limitations?

Answer 4

• considers the impact on lifestyle and behaviours on the onset and progression of diseases
• the main causes of morbidity and mortality are poor lifestyle choices
• Limitations: framework does not take into account why people make these decisions in the first place, it ignores the wider determinants of health
• can promote blaming of individuals

Question 5

What is the lifecourse paradigm and what are its limitations?

Answer 5

• Combines the programming and adult risk factor paradigms
• different biological and social factors throughout life independently, cumulatively and interactively influence health and disease later in life
• also recognises that there are particular critical periods of development such as in utero and early infancy when exposures may have a greater impact on future health and health risk
• main limitation centres on limitation in research methodology particularity the difficulty around carrying out and following up subjects in long term cohort studies across generations