6002HLS

5pm, Friday, 9 September 2022

STUDY ONE

Despite some existing literature documenting the association between oral health and general health among aging population, there remain important gaps in what is known. These gaps include the following areas in the field.

First, given life expectancy improvements on global scale, there has been a rise in the population aged over 65 years, even in less income countries (Global health and aging, 2011). The population termed ‘the elderly’ (aged over 65 years) has been increasing, while the proportion entering this age group who retain their health and functioning also increases. This is true as much in oral health as it is in general health (Peterson & Yamamoto, 2005). The World Health Organisation has highlighted new challenges in maintaining the dentition and oral health of those aged over 65 years (Peterson & Yamamoto, 2005). However, there is little knowledge about how these trends will impact upon the lived experience of these people.

Oral Health-Related Quality of Life (OHRQoL) is a multidimensional construct that measure the impact of oral health or diseases on an individual’s daily functioning, well-being or overall quality of life (Locker, 1988; Masood et al., 2014). Most measures of OHRQoL have been built upon Locker’s conceptualisation of the impact of oral disease based on the WHO model of health (Slade, 1997). This model postulated that there are five quality of life consequences of oral disease: impairment, functional limitation, pain/discomfort, disability, and handicap.

Second, there have been studies aimed at improving the oral health of the aging population supported by different types of intervention. Studies have investigated the effect of teaching care staff oral hygiene and have reported improved knowledge of, and ability to judge, oral and denture hygiene, as measured by the denture hygiene, plaque, and gingival bleeding indices. It has been reported that education of the elderly and their caregivers in oral health care can substantially improve the oral health scores of clients which may in turn affect their oral health-related quality of life. Although these studies yielded promising results, a lack of clinical randomised controlled trials limits assessing effectiveness of the different approaches to improving oral hygiene; such studies could improve insight into this topic.

This study aimed to assess the effectives of an oral health promotion intervention aimed at improving aspects of oral health related quality of life in an older population.


 
STUDY TWO

Identifying the factors associated with Hospital-acquired Pneumonia (HAP) is important to prevent HAP and reduce the incidence of HAP. This may ultimately decrease length of hospital stay, mortality, reduce inappropriate antibiotic use, and to improve patients’ functional outcomes. Several studies have identified age, smoking, chronic pulmonary disease, type of surgery, malnutrition, state of unconsciousness during hospitalization, mechanical ventilation, use of a nasogastric tube, multi-trauma and poor health condition are potential risk factors for the HAP (6-8). These studies mainly investigated the risk factors for ventilator- associated pneumonia in intensive care units (ICUs). Several studies have investigated the incidence of HAP in non-ICU patients. They found the incidence of HAP outside the ICU was 2-4 cases per 1,000 patients. The risk factors associated with HAP in non-ICU patients include age, malnutrition, steroid use, chronic renal failure, anemia, unconscious, comorbidity, recent hospitalization, and thoracic surgery (9-11). These findings suggest that the risk factors for HAP vary among patients in different wards. Therefore, it is important to understand the occurrence of and factors associated with HAP in various departments for the prevention of nosocomial infections.

In hospitals, nurses are responsible for most of the life care, nursing and treatment of bedridden patients. Identifying the risk factors of HAP is important for improving the quality of nursing and therapeutic effect of bedridden patients. However, our previous study surveyed the nurses’ knowledge and attitudes on complications of bedridden patients including HAP, and found their knowledge on the related factors are not adequate (12). Therefore, it is necessary to understand the incidence of HAP and related factors among bedridden patients in Australia. To our best knowledge, no study has estimated the incidence of HAP among older hospitalized bedridden patients in general wards. It is not clear which factors contribute to bedridden HAP in Australia. To fill this research gap, this study aims to identify the prevalence and related factors of HAP among older bedridden patients in various departments (ICU, orthopaedics, neurology medicine, neurosurgery, general surgery, cardiovascular, other surgery and other medicine) in Australia by using a nationwide multi-center hospital-based study sample during June 2019 to March 2022.

 
STUDY THREE


In our aging population hypertension is a highly prevalent, and the main cause of chronic disease such as stroke and cardiovascular disease, which has a high impact on burden of disease, quality of life, and use of healthcare.

Worldwide estimates are that 30% of men and 18% of women aged 60 years have symptomatic hypertension. In early stages clinical management of hypertension is targeted at improving patients' self-management, losing weight, physical exercise and adequate use of medication. Involving community-based nurse professionals in the management of hypertension ensures that this care is delivered closely to the patient. A recent review showed that substituting physicians for appropriately trained nurses could produce as highly quality care as primary care doctors and achieves as good outcomes for patients. The availability of skilled nurses is limited and nursing time invested in any intervention needs to be examined critically. Therefore we wondered whether an individual session with a trained nurse, which was focused on supporting patients' self-management, would be effective in hypertension patients. On the basis of previous research on changing life style behavior by family physicians (FPs), we expected a small but relevant change in patient behavior. The aim of this study was to evaluate the clinical effectiveness of a session nurse-based intervention for enhancing self-management in older patients with hypertension.

The intervention consisted of education and self-management of hypertension symptoms. It was performed by a nurse and aimed to change life style behavior, by improving dietary intake and physical functioning. On a time-scale the intervention consisted of three parts. Firstly, patients had to prepare for the home visit of the nurse, using an educational leaflet about hypertension and a booklet with health-status charts. The patients needed to fill out their level of exercise, salt intake level and their symptoms prior to the nurse home visit. The charts were discussed during a 30-minute nurse home visit; this is the second part of the intervention. In this home visit patients got insight in their own hypertension symptoms. Subsequently, they agreed to try to change one of four life style items (physical exercise, weight loss, use of a medication and how to use over the counter medication). The third part of the intervention was a follow-up phone call after approximately 3 months. In this phone call the nurse evaluated to what extent the patient had been able to adapt his life style change and subsequently what actions need to be taken to maintain this change.



STUDY FOUR

Title: Physical activity and prevalence and incidence of mental disorders in adolescents and young adults in Brisbane, Australia

Physical activity is associated with a range of health benefits, and its absence can have harmful effects on health and well-being, increasing the risk for coronary heart disease, diabetes, certain cancers, obesity, hypertension and all cause mortality. Physical inactivity may also be associated with the development of mental disorders; some clinical and epidemiological studies have shown associations between physical activity and symptoms of depression and anxiety in longitudinal studies. Although the issue of physical activity has been addressed in substance use prevention studies with mixed results, little is known about the effect of physical activity on the risk of developing other incident or recurrent mental disorders as defined by DSM-IV.

The study aims for this study are: (1) the association of regular physical activity with 12-month and lifetime mental disorders according to DSM-IV criteria, and (2) whether regular physical activity at baseline is prospectively associated with decreased risks of incident DSM-IV mental disorders in adolescence and young adulthood as the peak period for first onset of most mental disorders.


Note: Based on DSM-IV criteria: mental disorders is defined as somatoform disorder, anxiety disorders including post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder, mood and substance disorders, including nicotine dependence, and also eating disorders.


 
STUDY FIVE

Unstable angina (UA) is an irregular type of angina pectoris (Yeghiazarians Y, Braunstein JB, Askari A, & PH, 2000) and a type of acute coronary syndrome (ACS) (Wiviott S. D. & Braunwald E, 2004). Every year, in the U.S, more than one million people are hospitalized due to unstable angina and non–ST-segment elevation myocardial infarction (UA/NSTEMI) (Braunwald E et al., 2000) and incidence is increasing in many countries. Previously, survival rates, complication rates, and functional parameters were used as indicators of the efficacy of coronary artery disease (CAD) treatment (Benzer W, Höfer S, & N.B, 2003). Over the past years, however, the quality of life (QoL) of patients with chronic diseases such as cardiovascular disease has also become an important indicator of successful clinical practice (Donald, 2009).

Percutaneous coronary intervention (PCI) has been known as a breakthrough method that has become a frequently used revascularization technique for improving health of patients with CAD (Grech ED, 2003). Some studies have also shown that PCI improves the QoL of CAD patients. A study of 65 patients receiving PCI found that QoL measured with the SF-36 (Short Form) improved significantly over time in six out of the eight domains and all other domains showed an increase at 3-month follow-up. Moreover, all five domains of the Seattle angina questionnaire improved significantly; however, the angina stability score at 3-month follow-up was lower than the baseline value (Man Sin Wong & Sek Ying. Chair, 2007). A 2008 study comparing PCI and optimal medical therapy alone showed remarkable improvements in health outcomes during the follow-up period in the PCI group but these disappeared after 36 months (William et al., 2008).

Although the effect of PCI on QoL in CAD patients has been established in several countries, there is little research concerning this area especially among the aged population in multiple countries, including Australia. As Australia has long been in the face of aged population and experiences a growing burden of non-communicable diseases, research on this area will inform better clinical practice.

This study aims to assess the effect of PCI on QoL among patients with unstable angina after PCI after PCI.


 
STUDY SIX

Dental caries are considered a major international public health problems as, if not properly and timely treated, they contribute to other heath conditions. Some of these include, but not limited to, immediate conditions (e.g., poor dental health, pain, infection, altered eating habits or sleep disturbances), childhood development (e.g., altered cognitive development, reduced speech development or reduced growth involving low body weight and height) and psychological outcomes for both children and their families (e.g., altered wellbeing and quality of life, poor self-esteem or altered concentration) (Baggio, Abarca, Bodenmann, Gehri, & Madrid, 2015; Riggs et al., 2014). The World Health Organization (WHO) reported that dental caries affects around 60–90% of children at 3-5 years (WHO, 2017). Despite some improvement in dental caries in children, caries remains prevalent globally.

Among the contributors, sugar intake is among the leading causes of tooth problems (Peres et al., 2016; Tedstone, Targett, & Allen, 2015). Excess sugar also leads to other systemic health problems including obesity, diabetes, and cardiovascular diseases (Marshall, 2015; World Health Organization, 2015). At present, the association between child’s sugar consumption (Hong, Whelton, Douglas, & Kang, 2018; Peres et al., 2016; Skafida & Chambers, 2018), dietary habits (Leong, Gussy, Barrow, de Silva-Sanigorski, & Waters, 2013; Peres et al., 2016) and oral hygiene practice (Leong et al., 2013; Marinho, 2009) has been investigated. However, mechanisms underlying dental problems through sugar intake of caregivers including mothers are not clearly understood. The question of whether there is any link between mother’s sugar intake, child’s sugar intake and child’s dental conditions such as caries remains under research. It is hypothesized that mothers who consume more sugar are more likely to feed their children with added sugar which they are in turn more likely to develop dental caries. This mechanism could have been explored by cross-sectional studies. Yet, given the reliability and validity of these studies in question, it calls for further investigations using a better design.

The aim of the current study is to assess mother’s sugar intake, children’s sugar intake and their association with child’s dental diseases.

 
Please follow the assignment structure below (Requirements are sentences in red colours in the brackets).

Introduction section (Total: 10 marks)
(1) Brief introduction of the area of research relevant to your topic of research interests
(2 Marks)
(Less than 200 words, 1-10 references, please provide reasons why you think the study is important in the field, what has been done and where are the gaps in the chosen study topic, what is the significance of the study)

(2) Provide research questions, study aim and objectives (3 Marks)
(You need to provide research questions, study aim, and specific research objectives to specify the study aim)

(3) Provide research hypothesis for the study based on the given study aim (1 Mark)
(You need to provide both alternative and null hypothesis, and you may have more than one pair of hypotheses depending on the number of objectives you may have for the study)

(4). Provide research framework for the study based on the given study aims and objectives (4 Marks)
(You need to describe the rationale of the relationship between dependent and independent variables. Why do you think they are related or correlated; your framework should consist of a figure).

Methods section (Total: 13 Marks)

(1) Which design is appropriate in investigating the question in your study;
provide a rationale as to why you have made this choice? (Note –there may be
more than one suitable choice) (3 Marks)

(Please just give a name of the study design, for example, randomise control trial or experimental study, or cohort study design, etc. Then explain the reason why you choose this type of study design.
You need to describe your study design plan: e.g., if it is a randomised control trial, how would you do randomisation, blinding (double bling is preferred), control group type (placebo or control). If it is not randomised control trial, how would you control the confounding effect from variables other than dependent and independent variables; how you would ensure the generalisation of the study through the study design?).

(2) Who will be your study sample? What is your target population? Do you have sampling frame? What are your comparison groups? Are they groups and/or time points? (3 Marks).
(You need to describe the target population, and your study sample in relation to sampling issue. If you have a sampling frame, please indicate this. If there are two groups, what are your comparison or control group? How many groups and how many time-points you would choose for your data collection?).

(3) What are the names of variables, are there more than two variables in this study? (2 Marks)

(You need to describe the names of the variables: for example, dependent variables, independent variables, and demographic variables; In addition, please explain the type of each variable: e.g., ratio, interval, ordinal, nominal or dichotomous variable).

(4) What is your data collection methods and how would you measure the variables designed in the study? (1 Marks)
(You need to describe the data collection methods, measures in details and data collection procedure, such as survey method or physiological or laboratory tests or mixed data collection methods or others, what variables are measured, how you will collect data [e.g., access to medical record, get access to patients at hospital, community intervention projects managed by City Council], when and where you will get your data?).

(5) Once you have determined the best and most feasible sampling method, you must decide on the size of sample you will need to be able to best reflect what is true of the population. Conduct an appropriate sample size calculation for this study (2 marks).
(You need to select the right sample size formula for your study; first select your precision, remember most researchers permit a 5% type I error, assuming a two-tailed hypothesis, and 10 per cent type II error. Are you comparing repeated measurements as in a pretest/post-test study? Comparing measurements when there are two comparison groups, e.g. mean or proportion?)

Limitations of the study

(6) Are there potential sources of bias or error related research design?
What might they be? (2 Marks)
(Please describe any errors or bias you would make in the study design, sampling,
data collection process).


 
Part 2 (17 marks)

You have been randomly allocated 1/6 datasets from the teaching team for Assignment 1 Part 2. You are required to independently complete the questions for this study. Only use the dataset that was assigned to you.

Part 2 consists of 3 questions for a total of 17 marks.


Database: Set F Nursing.sav


Based on the following information about the study, please answer the questions below for the study.

Background The number of bedridden patients increases with the increasing prevalence and incidence of diseases among older population (1). Staying in bed at hospital could cause many complications, and pneumonia is one of the most common complications. Hospital-acquired Pneumonia (HAP) is a major nosocomial infection worldwide resulting in increased morbidity, mortality, and medical costs. Older bedridden patients, whose basic physiological needs are carried out in bed, often accompanied by worse immune, swallowing and respiratory dysfunction, are at high risk of HAP (2). Approximately 1.1% to1.5% of all hospital patients developed HAP (3),and there were 5.8% to 8.3% of older hospitalized patients developed HAP in western country (2, 4).
Objective: Objective: To identify the incidence and related factors for hospital-acquired pneumonia (HAP) among older bedridden patients
Rationale In hospitals, nurses are responsible for most of the life care, nursing and treatment of bedridden patients. Identifying the risk factors of HAP is important for improving the quality of nursing and therapeutic effect of bedridden patients.
Subjects Data was collected from 1500 hospital patients who were aged 65-96 in a tertiary hospital in Australia
Aim of the study This study aims to describe the factors which may be related to hospital bedridden patients in patients in Australia.
Data • Demographic variables
1) Age, 2) gender, 3) education
• Pneumonia related factors
4) BMI, 5) Bed ridden time, 6) Pneumonia, 7)
Bed time in days, 8) Charlson score, 9) Days staying at
Hospital, 10) Having medical insurance, 11) Smoking, 12)
whether was admitted to ICU.

Note. Charlson Comorbidity Index predicts the ten-year mortality for a patient who may have a range of comorbid conditions. The higher the score, the more likely to die in ten years
Variable name and reasonable range Study variables and reasonable range for each variable in the dataset D.
1) Age (Range 65-96)
2) Gender (Range 0-1)
3) Education (Range 1-5)
4) BMI (Range 15-45)
5) BedriddenTime (Group in days, range 1-4)
6) Pneumonia (Range 0-1)
7) BedtimeDays (Range 1-6596)
8) CharlsonScore (Range 3-16)
9) DaysatHospital (Range 1-219)
10) MedInsurance (Range 0-1)
11) Smoking (Range 0-1)
12) ICUAdmission (0-1)

Please follow the assignment structure below (Detailed notes are presented in red colours in the brackets).

1. Variables: you need to identify the types of the variables as listed below

• Demographic variables: 1) Age, 2) gender, 3) education

• Pneumonia related factors: 4) BMI, 5) Bed ridden time, 6) Pneumonia, 7) Bed time in days, 8) Charlson score , 9) Days staying at Hospital, 10) Having medical insurance, 11) Smoking, 12) whether was admitted to ICU

Variables/measurement type for each variable in the following table (2 marks)
(You need to describe the type of variable, i.e., specify whether they are
dichotomous, nominal, ordinal, interval or ratio type for the variables)
Variable Type of variable
2. Data management and data cleaning (2 marks)

Please delete data are outside the range of the scores which were specified below:

1) Age (Range 65-96)
2) Gender (Range 0-1)
3) Education (Range 1-5)
4) BMI (Range 15-45)
5) BedriddenTime (Group in days, range 1-4)
6) Pneumonia (Range 0-1)
7) BedtimeDays (Range 1-6596)
8) CharlsonScore (Range 3-16)
9) DaysatHospital (Range 1-219)
10) MedInsurance (Range 0-1)
11) Smoking (Range 0-1)
12) ICUAdmission (0-1)


(REMEMBER THAT DATA CLEANING would be included as part of the process in determining the quality of the data – Please check invalid values and duplication of the cases).
Please record every action you will make and present the ID number and action you will take in a table (e.g., deletion of invalid values and duplication of the cases).
Please use table to list up to three columns: ID number, problems, and actions.

Please use this table format to complete the data cleaning process

Problem ID Action
Delete a number in a data cell (provide identified error) Action
Delete whole case data for age outside the 10-14 years range
Age variable outside range
(delete the whole person’s data as the person’s age is not eligible)
Gender variable outside range (delete only a wrong number, not the whole person’s data)
Education variable outside of range (delete only a wrong number, not the whole person’s data
BMI variable outside range (delete only a wrong number, not the whole person’s data)
Bedriddentime outside range (delete only a wrong number, not the whole person’s data)
BedtimeDays variable outside range
(delete only a wrong number, not the whole person’s data)
CharlsonScore
variable outside range
(delete only a wrong number, not the whole person’s data)
DaysatHospital variable outside range
(delete only a wrong number, not the whole person’s data)
MedInsurance variable outside range
(delete only a wrong number, not the whole person’s data)
Smoking variable outside range
(delete only a wrong number, not the whole person’s data)
Repeated/duplicate data (delete whole person’s data)

Note. Missing data can be retained as system missing or be changed to -999. If you change it to be -999, you need to change the missing cells as -999 in the data in the data view, so SPSS can identify discrete missing values.

3. Descriptive Analysis: For each variable, choose the appropriate numerical statistical summary for all participants, provide the results of statistical assumption (skewness and kurtosis figures) if the variables are ratio or interval data type (total 13 marks):

a. Normality check (2 marks). The distribution of the continuous variables need to be checked. This can be checked by using descriptive statistics analysis (checking skewness and kurtosis) (This is for you to answer research question only).

b. Conduct data analysis using SPSS and present data using publication format (5 marks): Please run descriptive analysis, then use publication table presentation format to present the results. Graphs can be used but not repeating the results when you have already presented them.
Please justify the reason of your choice of data presentation method. You need to describe how you will present the data for each variable based on the statistical assumption check. The statistical assumption is normality check if the variables are interval or ratio data. If the variable does not show the normal distribution pattern, you need to present data using median and range (min, max).
Please do not do any comparison analysis or association analysis for this assignment as you are only assessed for your understanding of descriptive analysis.

c. Interpretation of the results (6 marks): Finally, you need to describe the descriptive analysis results for each variable and explain what the results mean to audience using descriptive analysis method.
Note. Please quote n(%) for categorical variable, and mean(SD) for continuous variable when you do interpretation.