Association Between Rotating Night Shift Work And Risk Of Coronary Heart Disease Among Women

Part

Question

Answer

Points

Title

1.Title of the article, journal name, your name

Association between rotating night shift work and risk of coronary heart disease among women.

3

Purpose/Research problem

2a. What is the purpose of the study? Is it clearly identified? Is the research problem important?

 To assess   the risk of coronary heart disease and rotational shift amongst women.  The research problem is significant because Rotational usually elevate 24% of the risk of coronary heart disease such as angina pectoris and angioplasty (Lao et al., 2018).  It also  contributed to disease burden and high  premature death because  circadian clocks alters with  rotational shift

5

2b. Identify the dependent variable(s)

Rotational shift amongst  female

3

2c. Identify the independent variable(s)

the risk of coronary heart disease (Vetter et al., 2016)  

3

Literature review

3a. Are the cited sources relevant to the study?

Yes.  The article cited provide an insight into impact of  Shift work, extend of shift work  on  cardiovascular disease (Vetter et al., 2016)  

3

3b. Does the literature review offer a balanced critical analysis of the literature?

 Yes. balanced critical analysis of literature presence which reflected in discussion of prevalence of heart disease, link with shift,  reason and gap in current research

3

3c. Are the cited studies recent?

The researchers included the papers of recent years such as 2007 to 2014. However, researchers also included the papers of 1989 to 1999 (Vetter et al., 2016) .

3

Theoretical framework*

4a. Has a conceptual or theoretical framework been identified?

No  conceptual framework is explicitly  identified (Vetter et al., 2016)  

3

4b. If yes, is the framework adequately described?

No conceptual framework is identified.   However, presence of framework could facilitate researchers in identifying other confounding factors (Varpio et al., 2020).

3

Design and procedures

5a. Identify the study design used in this study? Make sure that you select the exact type of design used, i.e., one of the three discussed this week.

Prospective cohort study (Vetter et al., 2016)  

5

5b. Is the study design appropriate to answer the research question?

Prospective cohort study aims to follow a group of similar individuals with specific difference in certain factors over time ((Bloomfield & Fisher, 2019). In this case since researches want to see correlation between rotating night shift work and risk of coronary heart disease for female participants, this design is suitable to take follow up for similar female groups 

3

5c. What type of sampling design was used?

Purposive sampling

5

5d. Was the sample size justified on the basis of a power analysis or other rationale?

Sample size are 189,158 individuals.  Purposive sampling is a non-probability sampling that usually focus on choosing participants based on own judgment (Bhardwaj, 2019).. In this case, since they specifically want to focus on women with rotational shift, it is suitable sample size  with suitable sampling  technique

5

5e. Are the inclusion and exclusion criteria clearly identified? What are they?

 Two inclusion criteria

 For  1976 data

1) registered US nurses  (Vetter et al., 2016)  

2)  aged 30 to 55

3)  have experience of rotational shift,

 For 1989 data

1) registered US nurses 

2)  aged 25 to 42

3)  have experience of rotational shift

 No exclusion criteria is mentioned

5

5f. What measurement tools were used for the dependent variable(s)?

Electrocardiographic findings and elevated enzyme levels assessed were used for assessing symptoms.     Alternative Healthy Eating Index and validated food frequency questionnaire and angiogram were used for assessment (Vetter et al., 2016)  .

5

5g. What measurement tools were used for the independent variable(s)?

Baseline assessments was done for rotational shift by including questionnaires.  The specific    measurement such as lifetime shift work history.

5

5h. Were validity and reliability issues discussed?

 No. Validity and reliability of the fundamental discuss reliability focus on replication of the research by future researchers while validity focus on instrumental measurement (Heale & Twycross, 2015).  In this case, reliability is low and discussed because uncontrolled confounding factors were present.

4

Ethical considerations

6a. Were the participants fully informed about the nature of the research?

Yes. Informed consent was obtained.

3

6b. Were the participants protected from harm?

Yes through   informed consent and maintenances of privacy and confidentiality.

2

6c. Was ethical permission granted for the study?

Yes. Permission of the study was granted from Brigham and Women’s Institutional Review Board.

3

Data analysis

7a. What type of data and statistical analysis was undertaken?

Age- and multivariable-adjusted Cox proportional hazards were used for assessing the risk of heart disease. P-trend calculations were also done for the research.

3

7b. Was the statistical analysis appropriate to address the research question?

The research also aims to the relationship between the risk of coronary heart disease and rotational shift amongst women (Fife, 2020). Hence, analysis of relation and other confounding factors are suitable using multivariable model.

2

Results

8. What are the results of the study? Did the results answer the research question(s)?

 The findings reported that Women who work as a registered nurse and it has long duration of rotational shift 10 to experience  higher risk of heart disease. The highest destination observed for the population who are constantly involved in rotational shifts without adequate sleep.  Women in their 55 years are  at high risk  as they are more likely to begin their new night shift. The rate difference is 86.5 women out of 100000 women working  in rotational shifts.

5

Discussion

9a. Were the findings linked back to the literature review?

 The findings linked with literature as the emerging literature suggested that circadian clocks alters with  rotational shift and  hence, disruptions of sleep reduce   normal functioning of hear (Torquati et al., 2018). Therefore, hypertension and dyslipidemia increase risk of heart disease.

3

9b. Did the authors identify study limitations? What were they?

Yes.

 Limitation of the study are

1) high sample size

2) presence of uncontrollable confounding factors such as pre-existing hypertension

3) self-reports for angiogram

4) No information of  intensity of night shift work

5

9c. Do you think the limitations are serious enough to impact the internal and external validity** of the study?

1)  It has a significant impact on external and internal  validity. For example, presence of uncontrollable confounding factors such as pre-existing hypertension  and other heart related condition  may provide the hypothesized impact but with information bias (Heale & Twycross, 2015). It has  low external validity because result can only applied to women.

3

Overall assessment

10. What is your overall assessment of the study?

1) The study is quantitative study which improve reliability and validity. The relationship between two variables  and rate difference were mentioned. However, presence of confounding factors and self-reports for angiogram introduced information bias.  All of these  factors must be considered for the research.

5

Total

100

Part

Question

Answer

Points

Title

1.Title of the article, journal name, your name

Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic

3

Purpose/Research problem

2a. What is the purpose of the study? Is it clearly identified? Is the research problem important?

 To  estimate  frequency of and reason for reported forgone  medical care during pandemic . The research problem  is significant because US health care system experienced major disruptions  that delayed  or refused health care for priority patients. Many Patients in the United States experienced severe heart attacks, lack of ventilation and bed and refusal of care which further increased the mortality rate (Whaley et al. 2020).  Therefore, it is crucial for conducting research to estimate the prevalence and reason behind forgone care.

5

2b. Identify the dependent variable(s)

Forgone Medical Care of United states adults

3

2c. Identify the independent variable(s)

 Initial Phase of the COVID-19 Pandemic

3

Literature review

3a. Are the cited sources relevant to the study?

 Yes.  The article cited specifically focused on US health care setting in COVID-19 Pandemic (Anderson et al., 2021).

3

3b. Does the literature review offer a balanced critical analysis of the literature?

Literature review provided a balanced critical analysis by indicating prevalence, reason and gap in current research (Anderson et al., 2021)..

3

3c. Are the cited studies recent?

The researchers included the papers of 2020   that provided brief insight into conditions US health care setting in COVID-19 Pandemic.

3

Theoretical framework*

4a. Has a conceptual or theoretical framework been identified?

No  conceptual framework is identified

3

4b. If yes, is the framework adequately described?

No conceptual framework is identified.   However, presence of framework could facilitate researchers in solving new and emerging practical problems (Varpio et al., 2020).

3

Design and procedures

5a. Identify the study design used in this study? Make sure that you select the exact type of design used, i.e., one of the three discussed this week.

 Cross sectional study using public health survey (Anderson et al., 2021).

5

5b. Is the study design appropriate to answer the research question?

Cross sectional study usually collects data at a single point of time to assess  the large pool of subjects and differences in the variable(Bloomfield & Fisher, 2019). In the current context the data was collected within a specific point of time  for identifying the prevalence and reason behind Forgone care , (7th July and 2022 july). The research also aims to address “What are the frequency of and reasons for reported forgone medical care from March to mid-July 2020, the initial phase of the coronavirus disease 2019 (COVID-19) pandemic”. Hence, this study design was most suitable to gather data from large sample  in specific point of time such as Initial Phase of the pandemic (Anderson et al., 2021)..

3

5c. What type of sampling design was used?

 Sample size are 35?000 individuals. probability sampling

5

5d. Was the sample size justified on the basis of a power analysis or other rationale?

Probability sampling helps professionals to obtain statistical inference by creating accurate sample of the population. In this case, since a large number of the population encountered challenges in receiving care, it is justified (Bhardwaj, 2019). However, no power analysis was done.

5

5e. Are the inclusion and exclusion criteria clearly identified? What are they?

  Inclusion criteria 1) all of the categories of forgone care

2) missed prescription medications 3) missed schedule for  mental health

4)missed elective surgical procedures (Anderson et al., 2021).

 Exclusion criteria 1) excluded new health issues  2)missed dosage of mail ordered (Anderson et al., 2021).

5

5f. What measurement tools were used for the dependent variable(s)?

 16-item module used for assessing health status and health insurance status, race and ethnicity is mentioned through NORC.

5

5g. What measurement tools were used for the independent variable(s)?

No specific tool was used for assessing initial phase of COVID 19.

5

5h. Were validity and reliability issues discussed?

No. Validity and reliability of the fundamental discuss reliability focus on replication of the research by future researchers while validity focus on instrumental measurement (Heale & Twycross, 2015).  In this case, reliability discussed in the limitation such as   mail-order drugs were excluded.

4

Ethical considerations

6a. Were the participants fully informed about the nature of the research?

 Yes through   informed consent.

3

6b. Were the participants protected from harm?

 Yes through   informed consent and maintenances of privacy and confidentiality (Anderson et al., 2021).

2

6c. Was ethical permission granted for the study?

 Yes. Permission of the study was granted from Johns Hopkins Bloomberg School of Public Health institutional review board. 

3

Data analysis

7a. What type of data and statistical analysis was undertaken?

StataCop has been used for analysis and frequency of forgone medical care was measured through Pearson χ² tests.

3

7b. Was the statistical analysis appropriate to address the research question?

The research also aims to assess frequency of forgone care and the differences in the group in terms of frequency specifically in initial phase of pandemic that contributed to this forgone care which was already reflected in the results .  Hence, Pearson χ² tests is suitable to compare  expected frequencies and the observed frequencies (Fife, 2020).

2

Results

8. What are the results of the study? Did the results answer the research question(s)?

 Yes. Results comply with the research question. The result suggested that 41% of the respondent experience going to medical care where some of them experienced forgone for financial concern and others experienced forgone care for fear of transmission. Older adults unable to see due to technical challenges in tele-health. Professionals refused care due to   lack of resources and  workforce shortage.

5

Discussion

9a. Were the findings linked back to the literature review?

 The findings are linked back to literature because emerging literature also suggested that  pandemic might increase health disparities and half of population did not receive care due to fear of transmission or workforce shortage (Baggio  et al.,2021).

3

9b. Did the authors identify study limitations? What were they?

 Yes.

 Limitation of the study are

1) high sample size (Anderson et al., 2021).

2) No information regarding health insurance status.

3) heterogeneity in responses

5

9c. Do you think the limitations are serious enough to impact the internal and external validity** of the study?

 It  affected  internal validity as  sampling bias of data obtained Johns Hopkins COVID-19 Civic Life and Public Health Survey may   limit hypothesized impact. It also have low generalizability as  only data obtained from Johns Hopkins COVID-19 Civic Life which cannot be implemented in other setting (Heale & Twycross, 2015).   .

3

Overall assessment

10. What is your overall assessment of the study?

 The study is quantitative study which improve reliability and validity.   The frequency , reason for forgone and differences in ethnicity accurately mentioned. However, study has large sample size with no power analysis. The sampling biases is existed and study cannot be replicated due to exclusion of mailed ordered.  Many confounding factors are present in the study. This factors must be considered in future. 

5

Total

100