NURS 8310 OBSERVATIONAL STUDY DESIGNS

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The study conducted by Palència et al. (2020) examines the evolution of socioeconomic disparities in cancer mortality rates across nine European cities during the most recent economic recession. The main advantage of this study is its extensive geographical scope, which ensures the accuracy of the findings. The study demonstrates that there is a disparity in the mortality rate among males with various types of cancer, including lung cancer, depending on their economic level in the majority of cities. However, the level of inequality did not worsen as the economy deteriorated. Among women, only two cities exhibited disparities in cancer mortality rates, including both overall cancer and lung cancer, based on socioeconomic status. Following the regression analysis, the magnitudes of the aforementioned disparities did not deteriorate. The weakness of the study is in its region of focus. The depiction only offered a limited glimpse of each metropolis, potentially leading to a distorted perception of the city as a whole.

The study conducted by Najafpour et al. (2019) investigates the potential factors contributing to falls among hospitalized patients. An admirable aspect of this research is its comprehensive demonstration of the numerous causes of patient falls. They can arise as a result of a patient’s sickness, the medications they are prescribed, and other factors associated with their medical treatment. The study also discusses the modifiable factors that might be altered to decrease the likelihood of falling. Furthermore, this study was conducted over an extended duration of 9 months, ensuring the replicability of the findings. The study conducted by Najafpour et al. (2019) is limited by its single-site design, as it was exclusively carried out at one healthcare institution. Consequently, the outcomes and suggestions may lack relevance to different establishments.

The authors utilized the demographics, data sources, and epidemiologic measures of association in their study.

A cross-sectional investigation was conducted by Palència et al. in 2020. It consists of minor regions located in nine European cities. The study uses the composite deprivation index as a metric for assessing social and economic conditions. Researchers utilize the hierarchical Bayesian model to determine a refined standardized mortality ratio.

The research conducted by Najafpour et al. (2019) is situated within a hospital in Tehran and spans 9 months. The study was conducted on a sample of 185 individuals who had previously had injuries from falls. Additionally, 1145 individuals were not included in the research but were paired with the patients. The controls were located in the same areas as the controls that fell simultaneously. The researchers examined the patients’ demographics, comorbidities, medicines, and clinical conditions. In addition, they examined the individuals who were admitted and their activities before and following the autumn season. The study obtained the necessary data from hospital information systems, electronic records, and error reporting systems. Additional sources encompass firsthand observation and interviews conducted with individuals who have had falls, as well as their relatives and other individuals responsible for their care.

Lastly, provide your analysis of the suitability of the design for the study. Do you concur with the researchers’ selection of design?

(Palència et al., 2020) employed a cross-sectional approach in their investigation, enabling them to examine a substantial population within a limited timeframe. I concur that the utilization of a composite index provides academics with a standardized approach to examine the functioning of the economy in each location. To ensure the reproducibility of the study findings, it is crucial to employ a standardized mortality rate. I am quite impressed by the duration of time that Najafpour et al. (2019) dedicated to doing their research. Additionally, employing prospective nested case-control research is advantageous as it mitigates selection bias by ensuring that both the case study and the controls are drawn from the same population. I concur with this proposal due to its efficacy and cost-saving benefits. The study is meticulously designed, encompassing comprehensive observations, rigorous analysis of outcomes, and meticulous presentation of findings. Are you in agreement with the findings of the study? Elaborate on your thought process.

• Do you agree with the researchers’ conclusions? Justify your reasoning.

I agree with (Palència et al., 2020) that there are social differences in the death rates of both men and women with all cancer and lung cancer. But the economic downturn did not make the differences between people worse. I agree with this conclusion because sometimes the effects of an economic downturn in areas like health and education don’t show up for a long time, or they don’t show up at all. (Najafpour et al., 2019) concludes that there are many reasons why patients fall. I agree with the conclusion that some things, like the patient’s ability to see, the availability of help with manual transfers, and the control of medications, can be changed to help. Are you in agreement with the conclusions drawn by the researchers? Provide a logical and well-supported explanation for your thinking.

                                                        References

Palència, L., Ferrando, J., Marí-Dell’Olmo, M., Gotsens, M., Morrison, J., Dzurova, D., Lustigova, M., Costa, C., Rodríguez-Sanz, M., Bosakova, L., Santana, P., & Borrell, C. (2020). Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer epidemiology, 69, 101827. https://doi.org/10.1016/j.canep.2020.101827

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study. International journal of health policy and management, 8(5), 300-306. https://doi.org/10.15171/ijhpm.201

SAMPLE 2

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Strength and limitations

Nguyen and colleagues (2020) conducted a case study investigation to ascertain how antibiotic therapy is linked to Inflammatory Bowel Disease in the larger population.  The strength of this study is eradicating selection bias by enrolling all patients with new onset IBD.  It utilized a nationally representative sample size of 23,982 biopsied and confirmed cases with a predictive value of 95%.  The limitation of the study is the assumption that all prescribed and dispensed medications through the Prescribe Drug Register were used by the patient, which may falsify antibiotics therapy association with IBD.  The observational case study did not permit measuring confounding factors, incident rates, and absolute risk.  Additionally, the study concentrated on adults with new-onset IBD instead of including those with chronic disease.

The authors’ population of interest are patients with new-onset IBD that were studied over ten years, with findings consistent with increased risk of IBD in the population exposed to antibiotics.  They utilized the population-based register extracted from the Sweden National Board of Health and Welfare as the source, Epidemiology Strengthened by Histopathology Report in Sweden (ESPRESSO), the Sweden Patient Register, and the Prescribed Drug Register.

Research is the use of scientific methods to generate new knowledge systematically.  This research study is deemed appropriate because its methodology and design are statistically validated and shed light on the effect of antibiotics on the population epidemiology of IBD (Bhaskar & Manjuladevi, 2016).  I agree with their conclusion.  Nguyen et al. (2020) conducted a ten-year population-based case study of patients 16 years and older, using data collected from and stored in ESPRESSO, a comprehensive data source harmonizing 28 pathology laboratories in Sweden.  They sampled 32,690, out of which 23,982 individuals met inclusive criteria.  They used conditional logistic regression to determine the multivariable-adjusted ratio (OR) and confidence interval (CI).  Castro and Ferreira (2021) described linear and logistic regression as a statistical tool to evaluate the relationship between the dependent, the outcomes, and the independent variables, the predictor, using simple regression analysis.  With OR of 1.94, 95% CI, and p-trend of <.0001, they concluded that using antimicrobial therapies was significantly associated with developing Ulcerative Colitis and Crohn’s disease (IBD).

Second Article

Palència et al. (2020) conducted an ecological trend in the nine European metropolitan areas before and after their economic crisis to examine the effect of socio-economic inequalities on cancer mortality, particularly lung, colon, prostate, and breast cancer, within three-period intervals: before (two intervals: 2000−2003 and 2004−2008) and after (one interval: 2009−2014).

Strength And Limitation

The strength of the study lies in its use of a standardized mortality ratio as an indicator to calculate the mortality rate per 100,000 people.  A standardized mortality ratio (SMR) is an indirect method used to estimate and compare the ratio of death observed in a general population over a specific period (Pérez-Panadés et al., 2020).  One of the limitations is that areas with no data in the Euro Healthy project were excluded from the study; this could potentially impact the SMR negatively.

The population sampled are men and women.  The data source was obtained from the Euro Healthy project, Mortality Register, and Census or Population Records.  The authors utilized a composite deprivation index and SMR as socio-economic and mortality indicators, respectively, as epidemiology measures to compute socio-economic inequalities in mortalities.

The researchers’ design choice is appropriate.  They utilized a population-based epidemiologic method, the social deprivation index (SDI), a measuring tool to gauge the level of deprivation in a geographical area.  The SDI effectively monitors inequality, develops and modifies policies and programs, and assists in equitable resource allocation (Zelenina et al., 2022).

I agree with their conclusion that mortality inequality exists among men and women residing in different deprived geographical areas.  However, the financial crisis had no significant effect on the mortality rate, as evidenced by the statistically significant relative ratio and 95% credible interval.

References

Bhaskar, S. B., & Manjuladevi, M. (2016). Methodology for research II.  Indian Journal of Anaesthesia, 60(9), 646-651.  https://doi.org/10.4103/0019-5049.190620

Castro, H. M., & Ferreira, J. C. (2021). Linear and logistic regression models: When to use and how to interpret them? Jornal Brasileiro de Pneumologia, 48(6). https://doi.org/10.36416/1806-3756/e20220439

Nguyen, L. H., Örtqvist, A. K., Cao, Y., Simon, T. G., Roelstraete, B., Song, M., Joshi, A. D., Staller, K., Chan, A. T., Khalili, H., Olén, O., & Ludvigsson, J. F. (2020). Antibiotic use and developing inflammatory bowel disease: A national case/control study in Sweden.  The Lancet.  Gastroenterology & Hepatology, 5(11), 986. https://doi.org/10.1016/S2468-1253(20)30267-3

Palència, L., Ferrando, J., Marí-Dell’Olmo, M., Gotsens, M., Morrison, J., Dzurova, D., Lustigova, M., Costa, C., Rodríguez-Sanz, M., Bosakova, L., Santana, P., & Borrell, C. (2020). Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession.  Cancer Epidemiology, 69, 101827.  https://doi.org/10.1016/j.canep.2020.101827

Pérez-Panadés, J., Botella-Rocamora, P., & Martínez-Beneito, M. A. (2020). Beyond standardized mortality ratios, some uses of smoothed age-specific mortality rates in small areas studies.  International Journal of Health Geographics, 19(1). https://doi.org/10.1186/s12942-020-00251-z

Zelenina, A., Shalnova, S., Maksimov, S., & Drapkina, O. (2022). Characteristics of Composite Deprivation Indices Used in Public Health: A Scoping Review Protocol.  International Journal of Environmental Research and Public Health, 19(17).  https://doi.org/10.3390/ijerph191710565