Epidemiological Issues - Article Example

Epidemiology Objectives: The focus of this article is to claim the assessment of the incidence of onboard injury among the Sri Lankan flight assistants and to explain the determinants of onboard injury. The objective of this article is to evaluate the given article, “Incidence and predictors of onboard injuries among Sri Lankan flight attendants”. The objectives of this article are analytical in nature. In Sri Lanka, there are no issued studies on injuries to flight employees and health. Work-related injury adds to a major segment of the international injury load, and it is vital to know the local load of wound in this group. The most important objective is to make assessment about the injury incidence among Sri Lankan flight attendants and to depict the elements of onboard injuries (Agampodi, Dharmaratne and Agampodi, 2009, p. 1-2). The purpose of a good analytical technique is to be able to enumerate precisely each of the unidentified quantities that the laboratory will have to settle on (Maumy, Boulanger, Dewe, Gilbert and Govaerts, 2005). Assessing the occurrence of onboard injury requires the stipulation of the injuries of Sri Lankan flight attendants. One policy is to use measures, which take into consideration the quantitative nature of the onboard injury (Quantifying disease in populations, n.d.). The purpose of this assessment is to apply epidemiological concepts to critically review this given article. Study Design: A vivid cross-sectional study was executed among Sri Lankan flight attendants. All flight attendants experiencing their annual physical condition and first aid preparation were encouraged to participate. Flight attendants who flew incessantly for a six-month phase prior to data compilation were incorporated in the study sample. Flight attendants experiencing preliminary training before their primary flight (novel recruits) and flight attendants who had not flown for 6 months (such as following childbirth) were kept out from the study (Agampodi, Dharmaratne and Agampodi, 2009, p. 2). The sample was not derived from a proper random sampling. It comprised of batches of flight attendants employed in the identical time period in dissimilar years. Diversities in training procedures could influence the result of the current study. Another restriction was recall bias. Accounting of injury is reliant on recollect, which count on individual traits, rigorousness of injuries and impact of the injury on the individual (Agampodi, Dharmaratne and Agampodi, 2009, p. 4). Epidemiology is the study of how frequently ailments take place in diverse groups and why. Epidemiological knowledge is used to prepare and estimate strategies to avert illness and as a channel to the management of patients in whom ailment has already expanded (What is Epidemiology? n.d.). Thus, in this study, epidemiological concepts are linked with statistics to show how numerical figures have helped to assess the strategies. The study design might be feasible, as 3000 flight attendants have been incorporated in the study having 90 per cent confidence intervals. Sample size: The overall study population comprised of 3,000 flight attendants. Required sample size was computed to estimate a wound occurrence within 10 per cent of its exact value and a 90 per cent confidence level. A total of 271 respondents were needed and with an anticipated 10 per cent non-respondent rate, the required sample size was 298 (Agampodi, Dharmaratne and Agampodi, 2009, p. 2). The sample size collected is also not considered to be appropriate, as it has not been collected through random sampling. The confidence interval is wide enough which recommends that the estimates are not constant and requires further studies (Agampodi, Dharmaratne and Agampodi, 2009, p. 5). A confidence interval that grips the value of no disparity between treatments points to the treatment under examination, which is not considerably dissimilar from the control (Davies and Crombie, 2009). If the confidence interval is quite extensive, capturing a varied range of effect sizes, it can be concluded that the study is likely to be small. Thus, any estimates of the size of consequences will be quite vague. Such a research is ‘low-powered’ and offers less information (Davies and Crombie, 2009, p. 4). Participant selection: For, all the flight attendants registering for guidance during the study period and meeting eligibility criteria were chosen as study units. Spoken permission was derived from all participants before data collection. Ethical authorization for the study was acquired from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya (Agampodi, Dharmaratne and Agampodi, 2009, p. 2). A self-managed questionnaire was used for data compilation. Authors seem to explain the aims and the survey of the study and compose data prior to each teaching session. The assessment of potential selection bias in legion studies is much like the assessment of confounding. The question of selection bias is whether the exposed and unexposed groups can be comparable except for contradictory exposure status (Savitz, 2003, p. 78). The participants in this study may not be appropriate to meet the objectives of the study. The participants belong to the country of Sri Lanka and their characteristics may be different from the other nation’s residents. Thus, one cannot draw an overall conclusion by taking into consideration only the inhabitants of Sri Lanka. As the training processes are different, the result of the present study could have been affected. The selection of participants confined in certain regions or certain groups of individuals cannot be applied to a generalized framework. Measurement: There may be possibility of measurement bias in this present study. Measurement bias is a systematic error resulting from inaccurate classification of study subjects. Such a bias can result in misclassification of exposure and/or disease status. Techniques to reduce differential misclassification in evaluation of risk features include usage of uniform questionnaire designs and checking data against other resources (Brownson and Petitti, 1998, p. 79). A moving airplane has manifold multifaceted dynamic forces, which could cause falls, trips and slides. The present study found that 16 per cent of flight attendants had encountered at least one such occurrence during the phase of the research (Agampodi, Dharmaratne and Agampodi, 2009, p. 4). The age of the respondents varied from 21 years to 54 years (Agampodi, Dharmaratne and Agampodi, 2009, p. 2). Thus, it can be understood that the sufferings, which are experienced by a flight attendant of age 21, will definitely be different from the person who is of 54 years. The validity and reliability of the measurement process to accept the findings as truthful seems to be questionable. Confounding: Possible prejudices may occur on account of the confounding consequences. A confounding result might occur whenever there is a factor that is related to the explanatory variable and/or to the dependent variable. In such a case, one might interpret wrongly the relations between the explanatory and the dependent variable, a phenomenon that might lead to wrong results and conclusions of a study (Potential Biases and the Confounding Effect, n.d.). There is potential for confounding as the variables, which have been taken into account such as, sex, weight, duration of service, not being a Moor, trained in ergonomics. Most of the important factors/ characteristics have been considered in the design. However, certain factors have not been taken into account, for example, ergonomic training which has been considered as one of the important variables might infer diverse result as the training varies from center to center. Agampodi, Dharmaratne and Agampodi (2009) argued that there have been certain limitations in this study. The study has taken into account the cross-sectional research method, which includes a subset of a population. Thus, it cannot be used to generalize the population and a long period of time is being ignored in this kind of study. In the univariate analysis, the inhabitants, which has higher hazard of injury, were females not fitting in to Moor/Malay ethnic group, with below seven years of onboard knowledge, under the age of 30, with weight below 56 kilograms and have not undergone ergonomics guidance. Height was not related with onboard harms in the univariate evaluation and was not incorporated in the multivariate representation (Agampodi, Dharmaratne and Agampodi, 2009, p. 3). Occurrence of injury accounted in dissimilar sources offers a wide range of statistics. These rates were mostly derived from compensation information and claims. However, a study carried out in Canada using a questionnaire review of 60 flight attendants accounted 48 per cent of flight attendants maintaining onboard injuries. In reviews using mailed questionnaires, in spite of a low reaction rate, the propensity to over account the incidence of injury was far above the ground. Agampodi, Dharmaratne and Agampodi (2009) noticed a higher injury occurrence of 795 per 1,000 individual years than rates based on information, but lower than viewed in researches using mailed questionnaires (Agampodi, Dharmaratne and Agampodi, 2009, p. 4). Analyses: The analysis and the interpretations were not appropriate enough as viewed by the authors themselves. Evaluation of risk factors in the current study raises numerous important points. It is obvious that female flight attendants are at higher hazard to injury because of higher biological susceptibility. However, the experimental risk factors could be interconnected. In normal conditions, the earnings of female flight attendants are higher in comparison to their male counter parts. Their knowledge is restricted and they are typically the junior associates among the flight attendants. All these aspects could put in to a higher threat of injury among them. However, even after regulating for period of service and other aspects, they still remained more susceptible than males. The surveillance made on the Moor/Malay ethnic group is complicated to describe. However, the extensive confidence interval proposes that the estimates are not steady and needs further research (Agampodi, Dharmaratne and Agampodi, 2009, p. 4-5). Overall assessment of the internal and external validity of the study’s findings: Internal Validity is the estimated truth about inferences concerning causal relationships. It is not pertinent in most observational or explanatory studies (for instance). However, for researches that evaluate the consequences of communal programs or interferences, internal validity is possibly the primary deliberation. The key query in internal validity is whether pragmatic changes can be accredited to interference (that is, the cause) and not to other probable causes (Internal validity, n.d.). Due to the overextension of muscles and ligaments while dragging, pushing or lifting objects or turbulence, the flight attendants are subjected to injury. Therefore, the causal relationship is established in this study. External validity is associated to generalizing. As validity refers to the estimated truth of proposals, inferences, or endings, hence, external validity refers to the estimated truth of conclusions the occupy generalizations (External validity, n.d.). In this study it has been found that with a subset of populations belonging to Malay ethnic group aged between 21 to 54 years have been considered into the study to generalize the entire populations. Thus, it cannot be inferred that all the flight attendants may undergo similar pain or injuries. What is the contribution of the findings to current knowledge? Occupational injury and musculoskeletal difficulties pose a major health vulnerability to flight attendants in Sri Lanka. Females are at higher risk, and the bulk of the injuries are accounted as avoidable injuries. The cross-sectional data, which has been used in the study, could have been replaced by longitudinal data (time-series data) for a longer period of time could have been taken into consideration instead of a same point of time. Through the cross- sectional study, data for only a given time period could be analyzed and interpreted. References: 1. “7. Potential Biases and the Confounding Effect”. (n.d.). Available at: http://www.tau.ac.il/~ronyb/phd/chp07.pdf (Accessed on Sept. 2, 2009). 2. Agampodi, S.B., Dharmaratne, S.D., Agampodi, T.C. (July 11, 2009). “Incidence and predictors of onboard injuries among Sri Lankan flight attendants” BMC Public Health 2009, 9:227. Available at: http://www.biomedcentral.com/content/pdf/1471-2458-9-227.pdf. (Accessed on Sept. 2, 2009). 3. Brownson, R.C., Petitti, D.B. (1998).Applied epidemiology: theory to practice Monographs in Epidemiology and Biostatistics. Oxford: Oxford University Press 4. Davies, H.T., Crombie, I.K. (April 2009). “What are confidence intervals and p-values?” Available at: http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_are_Conf_Inter.pdf (Accessed on Sept. 2, 2009). 5. “External validity” (n.d.). Research Methods- Knowledge Base. Available at: http://www.socialresearchmethods.net/kb/external.php (Accessed on Sept. 2, 2009). 6. “Internal validity” (n.d.). Research Methods- Knowledge Base. Available at: http://www.socialresearchmethods.net/kb/intval.php (Accessed on Sept. 2, 2009). 7. “Quantifying disease in populations” (n.d.). Available at: http://www.bmj.com/epidem/epid.2.html (Accessed on Sept. 2, 2009). 8. Mamdani, M, Sykora, K, Li, P, Normand, S-L. T, Streiner, D.L, Austin, P.C, Rochon P.A, Anderson, G.M. (2005). “Readers guide to critical appraisal of cohort studies: 2. Assessing potential for confounding” BMJ; 330; 960-962. Available at: http://www2.kumc.edu/internalmedicine/schedule-current_files/BMJs%20Readers%20Guide%20for%20Cohort%20Studies%20part%202.pdf (Accessed on Sept. 2, 2009). 9. Savitz, D.A. (2003). Interpreting epidemiologic evidence: strategies for study design and analysis Monographs in Epidemiology and Biostatistics. Oxford: Oxford University Press. 10. “What is Epidemiology?” (n.d.). Available at:http://www.bmj.com/epidem/epid.1.html (Accessed on Sept. 2, 2009). Read More