A large charity is seeking to fund a project to investigate the question, “How does exposure to green spaces affect the risk of Alzheimer's Disease in UK adults?” The charity received three applications with quite different study designs. Carefully read and review the details of each proposed study:
Study 1: 300 people in the UK aged over 60 with a diagnosis of Alzheimer's Disease recorded in their GP patient records and 600 controls without a diagnosis will be recruited from the charity’s mailing/telephone list. Participants will be interviewed about how much time they spent in green spaces in the 20 years before their diagnosis and grouped into high, medium and low exposure. Interviewers will also collect information on highest educational qualifications, employment type (or most recent employment type) and distance to the nearest recreational green space 20 years prior to diagnosis, as these are all considered to be potential confounders. Odds ratios will be calculated to estimate the association between daily walking and Alzheimer's Disease, conditioning on these confounders along
with age, sex and GP practice.
Study 2: 1500 individuals in the UK aged over 65 years old will be recruited from the electoral register. A baseline assessment of cognitive and mental state will be carried out by a doctor (employed by the study) and participants with a diagnosis of Alzheimer's Disease will be excluded. Participants will use a GPS tracking wristwatch to record their daily movements for one month (starting from the anniversary of their study enrolment) during each year of follow up. This will be used to identify the average time spent in green spaces per day. Further assessments of cognitive and mental state will be carried out every five years by a doctor to identify Alzheimer's Disease. Rate ratios for Alzheimer's Disease will be calculated to examine the association between green space exposure and Alzheimer's Disease, conditioning on age, sex, highest education qualification and current/most recent employment type which will be recorded at baseline.
Study 3: 5000 individuals in the UK aged over 40 years will be recruited from GP practices during routine appointments. Participants will be excluded from the study if they have diabetes, rheumatoid arthritis, or Alzheimer's Disease. Participants will fill in quarterly online or postal questionnaires describing their daily exposure to green spaces. The date of any diagnosis with Alzheimer's Disease in GP patient records will be recorded. Cumulative incidence ratios will be calculated to estimate the association between daily green space exposure and risk of Alzheimer's Disease, conditioning on current/most recent employment type, involvement in social activities, age and sex (all measured by questionnaire at baseline).
Discuss the relative strengths and weaknesses of the three proposals, to the different study designs, populations, definitions of exposure and outcome, measures of association, potential sources of error and bias, ambiguity, and any other relevant concerns. You should consider - and report - information on the occurrence of Alzheimer's Disease in the UK.
Outline and justify how you would conduct a better study to best answer the question, "How does exposure to green spaces affect the risk of Alzheimer's Disease in UK adults?” This may draw on elements from all, one, or more of the proposed designs and/or your own ideas.
The first proposal primarily put emphasizes the efficiency of green spaces that affected the risk factor of Alzheimer’s diseases. The study considered 300 people in the UK aged over 60 years with the diagnosis of Alzheimer’s disease recorded in their general practitioner’s record. the strength of the study relies on the study design in methodology. The study proposed that the interview would be conducted where interviewers will collect the information’s and participants will be interviewed about the time they spend in space in 20 years before and after diagnosis. Jamshed (2014) stated that the most common method of qualitative study is an interview. According to LoBiondo-Wood, G., and Haber (2017), getting first-person data is crucial for conducting qualitative research since it provides direct information about the mental situation. However, the weakness of the study is that the study failed to analysis potential bias. The response of each participant might vary under specific socio-demographic environment. The error may occur during the information synthesis. Besides, the study sample is small for adequate information. According to Stutz et al. (2018), for obtaining the adequate information sample size is also crucial. Moreover, ethical consideration is another weakness of the study since it is difficult to obtain for every participant. The study can be ambiguous since the result may give rise to other interpretations. Association between daily walking and Alzheimer's disease will be conducted through study.
The primary goal of the study is to evaluate the efficiency of green space in the UK for Alzheimer’s patient aged over 65 years old. The study proposed that 1500 individuals will recruit form electoral register. Doctors will assess the cognitive and mental state of the participants and participants will use GPS tracker of recording their daily movement. The strength of the study relies on the Sample size of the study and assessment study. The sample size is adequate for obtaining the data, which indicate the efficiency. According to Krueger (2014), the purpose of the quantitative study is to investigate empirically using the scientific method. The study will conduct the assessment by doctors. According to Parahoo (2014), since the participants will be selected randomly from the electoral registers and potential bias will be reduced. The potential error can occur during the assessment of the cognitive and mental state along with the daily movement of each participant. The strength of the study is the study will be long-term but the potential error can occur from long-term assessment. The calculated association will be green space exposure and Alzheimer's disease. The study can be ambiguous since depending on the determination of result.
The prime goal is to estimate the association between daily green space exposure and risk of Alzheimer's disease. The study proposed that 5000 individuals over 40 years will recruit form the routine appointment. According to Parahoo (2014), Purpose of the quantitative study is to investigate empirically using the scientific method. The study will eliminate potential bias such as participants with diabetes, rheumatoid arthritis or Alzheimer. The date of any diagnosis with Alzheimer's disease in GP patient records will be recorded. It is a potential strength since the recorded data of the laboratory will provide concrete evidence but potential error can obtain during the diagnosis. The strength of the study relies on the assessment method through questioner. According to Krueger (2014), the post questioner helps to obtain the thinking of different individuals without making them uncomfortable. However, a major drawback of the study is that the many participants may refuse to respond to the study and the potential error can occur during data obtaining since it will not possible to get the idea of their mind. Consequently, the bias of the study can be maximized. The statistical analysis is the strength of the study. Moreover, the study can be ambiguous since the different result can be obtained. However, the sample size is too high for obtaining data in order to measure the association between daily green space exposure and risk of Alzheimer’s disease. According to, ethics should be considered while obtaining the data through questioner. Here ethical issue can arise since the study will be constructed based on individual opinion.
Studies have shown that the natural environment can enhance health and many other neurological diseases. the Alzheimer can be cured by exposing the individual in the green space since it restore mental awareness, helped to recover from stress experience by producing brain protective factors.Therefore, the study can be conducted in order to assess the efficiency of the green space for reducing the risk factor of the health. A randomized trail control study can be conducted where approximately 700 individual of 65 years or more than 65 years will be recruited for the study from a general practitioner and doctors will conduct the cognitive and mental state assessment. The control group will involve the participants who are at higher risk of Alzheimer and no remediation can be given to them. The trial group involves participants who are at higher risk of Alzheimer and exposed to green space. Participants having any other diseases will be eliminated for reducing potential bias of the study. Participants from each group will be accesses for their cognitive ability and mental state by doctors depending on the degree of exposure after each year. The outcome of exposure of each participant will be compared and assessed. Informed consent should be taken from each participant for avoiding any ethical dilemma, which may disrupt the process of work. The rate ratio for Alzheimer’s disease will be calculated in order to obtain the association between green space exposure and Alzheimer’s disease. The age, sex, highest education and qualification will be recorded for the further study.
According to Krueger (2014), the sample size for data analysis is crucial for obtaining error-free data with the support of literature. Moreover, it will be easier to assess the participants with limited sample size for a longer period of time, the 700 individuals will be recruited for obtaining accurate data. According to Parahoo (2014), randomized trial control is proved to be potential primary study for investigating any issues. Therefore, the randomized trail control is beneficial for obtaining data without any potential error and bias. In order to make the study more focused on obtaining the association between the exposure of the green space and risk factor of the Alzheimer’s, participants with any other disease are eliminated. Efficiency can be measured for any other diseases by measuring heart rate, cognitive ability and will bring. This assessment will provide population a potential recommendation for reducing the risk factor of the Alzheimer’s disease and will provide the healthy life.
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