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UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database

Discuss about the Critical Analysis of Qualitative Literature for Tourism.

The assignment aims to critically analyse 4 peer reviewed qualitative journal articles.  The report will contain my opinion on the trustworthiness and reliability of the articles reviewed. Furthermore, it will also elaborate on the strength and weakness of each article.  The four articles that will be critically analysed are on incidence, mortality and risk management of stroke across U.K, new sports team’s member identification, tourism accessibility, and identification of child abuse by primary school teachers and healthcare professionals.

Lee, S., Shafe, A. C., & Cowie, M. R. (2011). UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the General Practice Research Database. 

This study investigated the recent epidemiological trends of stroke in the UK. It was a time trend analysis carried out from the year 1999 to 2008 in the UK General Practice Research Database. Evidence from other studies suggested that stroke is a major reason for mortality and morbidity in the UK. The prevalence rates are as high as 110,000 per year (Syme et al., 2005). A higher proportion of aged population was cited as a major contributor to the prevalence of this cardiovascular disorder. The primary objectives of the study were to assess the recent trends along with the risk factors that were found associated with first and second strokes, along with the pharmacological therapies (Lee, Shafe & Cowie, 2011). The validity of the GPRD database used for the study has been confirmed by several other studies, which state the presence of high quality data in the database (Herrett, Thomas & Smeeth, 2011). The respondents were aged 18 years or above and had reported incidence of first stroke between 1999 and 2008. However, haemorrhagic and ischemic strokes could not be distinguished. To ensure that the initial stroke event was not reconsidered during follow-up as second stroke, codes for stroke rehabilitation or monitoring were excluded.

The study extracted data using GPRD GOLD online version. These were then analysed using SAS V.9.02. Calculations for incidence and prevalence rates were done based on cohort.  Read codes were used to identify co-morbidities and the pharmacological therapies that were prescribed a year before incidence of first stroke were recorded. Second strokes included cardiovascular events that occurred 56 days after the first stroke. 32,151 patients without previous cardiovascular history reported first strokes from 1999-2008. Stroke incidence reduced by 30% during this period, from 1.48/1000 person per year in 1999 to 1.04/1000 person per year in 2008 (p<0.001). Patients aged more than 80 years showed a 42% reduction from 18.97-10.97/1000 person per year (p<0.001). However, the prevalence increased by 12.5% from 6.4/1000 to 7.2/1000 persons during the same time period. It was found that 15% first strokes were fatal and mortality was high in women (18.6% in women; 11.3% in men). On a follow-up of 5 years, 24% respondents showed occurrence of second cardiovascular events of which 75% was stroke.

Starting with a clean slate: An analysis of member identification with a new sports team

The study further found that 65% patients had hypertension and of them 67% were treated with antihypertensive agents a year before the stroke. 96.6% women and 97.4% men with hypertension ayear after stroke were found to receive antihypertensive therapy by 2008. The results also found that 11% patients had AF before first stroke and of them 25% were under anticoagulant prescriptions. The results were consistent with other studies (Heuschmann et al., 2008) (Feigin et al., 2009) The strength was the use of GPRD, which is the largest primary care database containing record for more than 3 million patients. Limitations were the unavailability of secondary care prescription data.


Lock, D., Darcy, S., & Taylor, T. (2009). Starting with a clean slate: An analysis of member identification with a new sports team. 

Significant changes have been observed in Australian professional soccer since 2003. These changes culminated in replacing National Soccer League (NSL) with A-League. The sports environment in Australia is highly contested and congested. On comparing the attendance, it was found that the A-league was relatively successful than the NSL (Lock, Taylor & Darcy, 2008). This study aimed to investigate the strength of identification of club members with new sports teams, the possible factors that can affect this identity and the nature of the relationship the members shared with the team (Lock, Darcy & Taylor, 2009). A 7-item Spectator Identity Scale (SSIS) was used to measure sports fan identity with an established team (Wann & Branscombe, 1993). The scale helped to ascertain significant differences that existed based on gender, age, and salary and employment status. Responses were collected from male respondents (91.8%) who were employed full time (71.8%).  Most of the respondents belonged to the age group 21-35 years (51.4%). They were made to rate the 7 items on a scale of 1-8. A high rating indicated greater identification with the team. The mean ID scores for the participants was found to be higher than the score reported by previous research (42.94 for the present study compared to 39.3 for the prior study). An online questionnaire was developed and distributed (Dillman, 2011).

The differences based on gender, age, membership category, salary and employment were calculated using a one-way ANOVA test.  Significant differences were observed between groups for and salary and age. No significant results were observed for gender, employment status and membership category on identification with a team. Fan identity was found to be stronger among younger members of Sydney FC (Fink, Trail & Anderson, 2002).  A noticeable plateau was observed among members belonging to the age group 36–55 years. A factor analysis was used to validate the reliability of the observed in the SSIS scales. The Kaiser-Meyer-Olkin and Bartlett’s test of sphericity were used to confirm the accuracy of the results. Each of the 7 variables displayed factor loading ≥ 0.50, which validated inclusion of 7 statements in relation to identification with new sports team.

Inherent complexity: Disability, accessible tourism and accommodation information preferences


However, it was evident from the results that 2 elements related to display of Sydney FC’s insignia or name at workplace, clothing or home and degree of dislike towards the greatest rivals of the team showed weaker communalities to fan identity. They were not consistent with previous study results (Wann & Branscombe, 1990). Therefore, it can be stated that the Sydney FC attracted greater members compared to NSL (44.9%). Most of the members were new supporters. The strength of the study lies in the fact that it evaluated the strength of identification of members with the new soccer team. Furthermore, it successfully established the relationship between low incomes with higher identification. However, the limitation lied in the use of online survey as majority of homes may not have sufficient access to the internet.

Darcy, S. (2010). Inherent complexity: Disability, accessible tourism and accommodation information preferences.

Much research has been carried out to investigate the key factors that may contribute in selection of hotels by consumers. In addition, a series of well-documented problems and constraints, encountered by disabled people, while selecting tourist accomodation (PwD) have been identified.  Hotel rooms are not promoted in an appropriate manner to assist diabled people in making accommodation choices (Tantawy, Kim & Pyo, 2005). Furthermore, low occupancy has been reported for accessible rooms and results from studies show that non-disabled customers disliked using such rooms. The study investigated the key selection criteria that enable PwD to make decisions on rooms, which suit their needs (Darcy, 2010). Difference in responses with respect to demographic variables and type of disability were evaluated. Electronic snowballing technique was used to draw the sample for the online questionnaire developed for the research. The respondents belonged to PwD population who used accessible rooms while travelling that was designated under the Building Code of Australia.

The relative importance of room selection criteria was analyzed and the determinants for the accommodation choices were identified.  A 5 point likert Hotel Accessibility Scale (HAS) was used to evaluate room criteria importance for the respondents. 55 individual items were tested and the internal reliability was validated using the Cronbach α coefficient (Kuijpers, Ark & Croon, 2013). The online and paper based questionnaire prepared for the sample group contained questions on the demographic profile, accommodation preferences, attributes, impairment profile and travel patterns (Dillman, 2011). 566 completed questionnaires were obtained from the 1070 participants. The sample was found to be well educated, 33% were employed full-time and displayed a greater proportion of mobility disabilities and low proportion of people with mental retardation, when compared to the Australian statistics. Statistically significant results (95%; p < 0.05) were observed while assessing relationship between sociodemographic variables and access room criteria. People with disability in vision, mobility, hearing and cognitive skills showed significant variations in criteria preference. Preferences for access information showed a greater rank for floor plan with digital photography (70%, mean= 1.54) followed by textual icons and AAA icons. However, digital photography did not prove useful for visually impaired people (Eichhorn et al., 2008).

Identification, reporting and management of child abuse: perceptions of primary school teachers and healthcare professionals


The study further confirmed that consideration of bedrooms and detailed information of bathrooms influenced the determination of appropriateness of an accommodation. More than half of the respondents wanted a detailed photography of the rooms and bathrooms to assist them in selecting the hotels, compared to photographs of the general property. Thus, the strength of the research lies in the fact that it highlighted the complex information that is needed by people to make informed decisions about hotel accommodations (Warnken, Bradley & Guilding, 2005). It emphasized on detailed information and defined criteria for accessibility of rooms. Use of electronic snowballing technique was a limitation owing to less internet access and irregular checking of organizational websites. 

Schols, M. W., De Ruiter, C., & Öry, F. G. (2013). How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study.

Child abuse is a significant health concern globally. Results from different studies show that the prevalence of child maltreatment did not decrease when compared to previous national surveys (Dakil et al., 2012). Evidence from several research suggest that children aged between 0 and 11 years, are most vulnerable to become victims of child abuse (Euser et al., 2010). Primary school teachers and child healthcare workers play an essential role in identifying and preventing incidents of child abuse among children who are at risk. The study aimed to focus on strategies for primary and secondary prevention of child abuse (Schols, De Ruiter & Öry, 2013). Primary prevention included identification of risk factors for increasing the likelihood of abuse and its subsequent detection. 2 local health service organizations and 3 primary schools were enlisted in the study. The study involved voluntary participation of the primary school teachers and the healthcare workers.  A low average income and lower than average number of migrants were found in the municipalities where the study was conducted (Alink et al., 2011). Prior approval was taken from the principal of each school. Participants included 11 public child healthcare nurses, 6 child healthcare physicians, 15 primary school teachers and 1 school principal. Recruitment was done by distribution of hard copy leaflet or through emails. 6 focus group interviews were taken for an average duration of 90 minutes. The interview consisted of open ended questions that allowed the volunteers to voice their opinion and experiences on child abuse. The interviews were led by 2 trained interviewers who questioned the participants on signs of child abuse, value of the risk detection tool and responsibilities associated with reporting child abuse incidents.

The responses were audio-recorded, transcribed and reviewed several times. The key issues were identified using the I-change model. Several predisposing factors such as information source, cultural factors, action cues and knowledge level influenced the awareness on child abuse (van Stel et al., 2012). The results further revealed that teachers became aware by observing behavioral changes or actual signs such as bruises in the child. Knowledge on signs of abuse, physical or mental neglect and reporting procedures also proved essential in identification of abuse incidents among children (Staal et al., 2013). Strength of the study was in its identification of attitude, self efficacy, risk perception and barriers in child abuse identification. However, one limitation was in selection bias. The participants might have been more willing to prevent child abuse than average healthcare workers and school teachers.

Conclusion

The first study will underpin my research and help me to identify management techniques of vascular risk factors (Lee, Shafe & Cowie, 2011). The second study will provide an insight into factors that govern identification of club members for new soccer team (Lock, Darcy & Taylor, 2009). The third article will assist me in understanding the importance of digital photography of rooms and detailed information on room access in influencing choice of accommodation by disabled people (Darcy, 2010). The fourth article will provide a deeper understanding of the different cues, physical signs behavioral and attitude changes that help in child abuse identification (Schols, De Ruiter & Öry, 2013). 

References

Alink, L., Iron Horn, RV, Bakermans-Kranenburg, MJ, Pannebakker, F., Birds, T., & Euser, S. (2011). Child abuse in the Netherlands in 2010. The Second National Prevalence Study of Child and Youth Abuse (NPM-2010).

Dakil, S. R., Cox, M., Lin, H., & Flores, G. (2012). Physical abuse in US children: risk factors and deficiencies in referrals to support services. Journal of Aggression, Maltreatment & Trauma, 21(5), 555-569.

Darcy, S. (2010). Inherent complexity: Disability, accessible tourism and accommodation information preferences. Tourism Management, 31(6), 816-826.

Dillman, D. A. (2011). Mail and Internet surveys: The tailored design method--2007 Update with new Internet, visual, and mixed-mode guide. John Wiley & Sons.

Eichhorn, V., Miller, G., Michopoulou, E., & Buhalis, D. (2008). Enabling access to tourism through information schemes?. Annals of Tourism Research, 35(1), 189-210.

Euser, E. M., van IJzendoorn, M. H., Prinzie, P., & Bakermans-Kranenburg, M. J. (2010). Prevalence of child maltreatment in the Netherlands. Child Maltreatment, 15(1), 5-17.

Feigin, V. L., Lawes, C. M., Bennett, D. A., Barker-Collo, S. L., & Parag, V. (2009). Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. The Lancet Neurology, 8(4), 355-369.

Fink, J. S., Trail, G. T., & Anderson, D. F. (2002). An examination of team identification: Which motives are most salient to its existence?. International Sports Journal, 6(2), 195.

Herrett, E. L., Thomas, S. L., & Smeeth, L. (2011). Validity of diagnoses in the general practice research database. Br J Gen Pract, 61(588), 438-439.

Heuschmann, P. U., Grieve, A. P., Toschke, A. M., Rudd, A. G., & Wolfe, C. D. (2008). Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors. Stroke, 39(8), 2204-2210.

Kuijpers, R. E., Ark, L. A., & Croon, M. A. (2013). Testing hypotheses involving Cronbach's alpha using marginal models. British Journal of Mathematical and Statistical Psychology, 66(3), 503-520.

Lee, S., Shafe, A. C., & Cowie, M. R. (2011). UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the General Practice Research Database. BMJ open, 1(2), e000269.

Lock, D., Darcy, S., & Taylor, T. (2009). Starting with a clean slate: An analysis of member identification with a new sports team. Sport Management Review, 12(1), 15-25.

Lock, D., Taylor, T., & Darcy, S. (2008). Soccer and social capital in Australia: Social networks in transition. Sport and social capital, 317-338.

Schols, M. W., De Ruiter, C., & Öry, F. G. (2013). How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study. BMC public health, 13(1), 807.

Staal, I. I., Hermanns, J. M., Schrijvers, A. J., & van Stel, H. F. (2013). Risk assessment of parents’ concerns at 18 months in preventive child health care predicted child abuse and neglect. Child abuse & neglect, 37(7), 475-484.

Syme, P. D., Byrne, A. W., Chen, R., Devenny, R., & Forbes, J. F. (2005). Community-based stroke incidence in a Scottish population. Stroke, 36(9), 1837-1843.

Tantawy, A., Kim, W. G., & Pyo, S. (2005). Evaluation of hotels to accommodate disabled visitors. Journal of Quality Assurance in Hospitality & Tourism, 5(1), 91-101.

van Stel, H. F., Staal, I. I., Hermanns, J. M., & Schrijvers, A. J. (2012). Validity and reliability of a structured interview for early detection and risk assessment of parenting and developmental problems in young children: a cross-sectional study. BMC pediatrics, 12(1), 71.

Wann, D. L., & Branscombe, N. R. (1990). Die-hard and fair-weather fans: Effects of identification on BIRGing and CORFing tendencies. Journal of Sport and Social issues, 14(2), 103-117.

Wann, D. L., & Branscombe, N. R. (1993). Sports fans: Measuring degree of identification with their team. International Journal of Sport Psychology.

Warnken, J., Bradley, M., & Guilding, C. (2005). Eco-resorts vs. mainstream accommodation providers: an investigation of the viability of benchmarking environmental performance. Tourism Management, 26(3), 367-379.

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