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PHE3EPI Epidemiology For Public Health

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  • Course Code: PHE3EPI
  • University: La Trobe University
  • Country: Australia

Question:

For this assessment you need to develop a public health research proposal.

The purpose of this assessment is to provide you with practice and experience in designing a research proposal, which will be useful in your future academic and professional life.

In general, a research proposal explains:

  • what the intended study wants to answer
  • why this study is necessary and important
  • where and how will the study be conducted
  • who are the study’s participants
  • how will you analyse your data

Below you can find four scenarios, each describing a public health problem that needs to be addressed. For this assessment you are required to develop a research proposal for one of the four scenarios using the recommended study design to investigate the problem.

What You Need To Do:

  1. Choose a scenario: Choose one of the four scenarios and its matching study design (note that scenario #3 has two different options to choose from)

  2. Include the following seven points in your research proposal:

(Note: No abstract and introduction/ further background information on your topic is required)

1) Research question: formulate an appropriate research question

2) Study design: describe the study design and why this particular one is the most appropriate for the public health problem of your choice

3) Sampling methods: describe the sample and the sampling and recruitment methods you will use

4) Data collection: explain what sort of data you are going to collect and what method you will you use. Include here as well where you want the data collection to take place

5) Data analysis: what data needs to be analysed and what measures of frequency and/or association are appropriate for this study design?

6) Strengths and limitations of the study design: what are the strengths and limitations of the proposed study design?

7) Referencing: use in-text citations to support your approach and justifications and add a reference list (APA6).

Scenarios

1. The Buruli Ulcer

The Buruli ulcer is a nasty but rare infection of the skin caused by the bacterium Mycobacterium ulcerans. The flesh-eating, from origin tropical ulcer can cause significant damage to the skin, soft tissue and even bone. In Victoria, the ulcer was solely endemic in the coastal areas, however, cases of Buruli ulcer are significantly increasing in Victoria and spreading into new geographical locations. Up till now, it is not clear how humans become infected with the bacteria, although it is speculated that the infection is picked up from the environment and it does not appear to be contagious.

Design a case-control study to investigate the cause of the transmission of the infection

2. Permanent Brain Injury In Afl Players

Over the last few years, research has made clear that there is a link between repeated head concussions and permanent brain injury. The symptoms of ‘chronic traumatic encephalopathy’ (CTE) include behavioural, mood and thinking problems, resulting over time in dementia. CTE has been related to contact sports such as American football, boxing and ice hockey, and recently to AFL as well. A definitive diagnosis, however, can only be made after death during an autopsy (https://www.abc.net.au/news/2020-02-27/australian-rules-great-graham-polly-farmer-diagnosed-with-cte/12005508).

The organisation Dementia Australia aims to urge football players at all levels to be more aware of the potential risks of repeated head injuries and of returning to play prior to medical clearance being given. It recommends further research, which may lead to improved policies on concussion and stronger punishments for clubs and coaches if those policies are breached.

Design a longitudinal study to investigate the impact of multiple head injuries on the development of CTE and the final post-mortem diagnosis in AFL players.

3. Medically Supervised Injecting Rooms

A high number of Victorians are losing their lives to drug-related overdoses. The use of medically supervised injecting rooms can potentially reduce overdose deaths and overdose harm and decrease the number of discarded needles and syringes in neighbouring areas. The rooms offer a safe and hygienic place where people can inject their drugs under medical supervision and they provide users with access to education and treatment to overcome drug dependency. Currently, a medically supervised injecting room is being trialed in Richmond (https://www2.health.vic.gov.au/alcohol-and-drugs/aod-treatment-services/injecting-room).

Design a cross-sectional study to investigate the impact of the injecting rooms in Richmond on the people living in the neighbourhood

or

Design a cross-sectional study to investigate the impact of the injecting rooms on drug user’s lives

4. The Paf Intervention

Older people make up a considerable proportion of Australia’s population—in 2017, there were 3.8 million people aged 65 and over (comprising 15% of the total population), and it is expected that in 2057 this number will have grown to 8.8 million older people (22% of the population). Research has shown that physical activity can prevent or delay age-related disability, however, recommended activity levels are seldomly met.

Physical Activity Facilitation (PAF) is an intervention shown to increase physical activity in adults with depression (Haase, Taylor, Fox, Thorp & Lewis, 2010). The intervention uses behaviour change techniques delivered face-to-face and via telephone sessions by specially trained facilitators. It is hypothesised that the same technique can be used to improve physical activity levels in older adults.

Design a randomised controlled trial to investigate the effect of the PAF intervention in older people living in Melbourne.

 

Answer:

Research question: The research question is “What are the causes of the transmission of Buruli ulcer”? Thus, the research aims at investigating the causes of the transmission of the infection, which is caused by the bacterium Mycobacterium ulcerans.

Study design: The study design chosen for this research is a case controlled study. This is because a case-control analysis is intended to assist in evaluating whether an exposure is connected with an outcome (i.e., illness, or concern condition). In theory, the analysis of case-control may be easily defined; first, identifying the cases (a group identified to have the outcome) and the controls (a group identified to be free from the outcome). Then going back in time and figure out the participants of each category have exposure(s), contrasting the level of exposure in the case category to the control group. By nature, the case-control analysis is retrospective as it begins with the result and then tracks back to the examination of exposures.  When participants are enrolled in their corresponding groups, the result of each subject is already identified to the investigator. That is what renders case-control experiments 'retrospective' and not the reality that the researcher typically takes use of formerly collected evidence (Tenny & Hoffman, 2019). Thus, for this research this study design will be appropriate.

Sampling methods: For this research, two groups of participants will be recruited. Two groups of participants will be recruited. The control group will consist of participants without any signs and symptoms of buruli cancer and the case patients will be recruited from a Public Hospital at Melbourne. The Public Hospital record will be scanned thoroughly to get information about patients with buruli ulcer. The case patient is an individual with a clinical lesion and a positive M. ulcerans PCR or a positive culture result (usually both). Each of the group’s data and information will be collected and analysed to evaluate and determine the common risk factors that might have triggered the infection. Other information like occupational history, social history, Lifestyle factors and demographic factors will be taken into consideration in order to understand and interpret the factors behind the transmission of the disease. Information will be collected with the help of a questionnaire which will be distributed to both of the groups and analysed to get the results.

Data collection: Questionnaires and interview surveys will be conducted to collect the data. Each of the groups will be given questionnaires and asked several questions which will be analysed to interpret the common transmission factors. Case-patients and control participants will receive a standardized questionnaire containing questions regarding their medical history; their natural environment and behaviour; and their exposure to soil, animals and insects. Case-patients may be required to restrict their answer to the 12-month period previous to their BU diagnosis. The environmental actions and behaviours, such as styles of clothes worn, precautions taken to defend against insect bites, forms of skin damage care, areas of their bodies most often attacked by insects, household pets and natural fauna with which they had daily interaction, and varieties of soil items to which they had been subjected in the previous year, will be investigated.

Data analysis: Case-patient ages and control subjects will be measured using a 2-sample t test. Fisher exact test, Chi-square analysis and logistic regression will be used to calculate the odds ratio (OR) and 95 per cent conviction interval (CI) for BU after correction for age and place of residence.   Multivariate models will be calculated by adding a backward elimination methodology to the logistic regression when controlling for age and city of residence. In all mathematical models, p values < 0.05 will be called statistically significant.

Strengths and limitations of the study design:

Strength- Case control trials are useful with unusual diseases or diseases with a long time of delay between diagnosis and disease manifestation. They are time-consuming and less costly; they are helpful when exposure details are expensive or difficult to obtain (Melamed & Robinson, 2019).

Limitation- While case-control studies are an important method of examining unusual events, there are major limitations inherent in this design. As with other observational studies, associations measured in case-control studies may or may not be causal relationships. Generally with observational research, while methodological approaches exist to account for confusion, some significant confounders may be unspecified for unusual outcomes which are often studied in case-control research (Pandis, 2014).

 

References

Melamed, A., & Robinson, J. N. (2019). Case–control studies can be useful but have many limitations: Study design: case?control studies. BJOG: An International Journal of Obstetrics & Gynaecology, 126(1), 23-23. doi: 10.1111/1471-0528.15200

Pandis, N. (2014). Case-control studies: Part 1. American Journal of Orthodontics and Dentofacial Orthopedics, 146(2), 266-267. doi: 10.1016/j.ajodo.2014.06.005

Tenny, S., & Hoffman, M. R. (2019). Case Control Studies. Retrieved 13 May 2020, from https://www.ncbi.nlm.nih.gov/books/NBK448143/ 

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