1. Research Design
health & medical project and need a sample draft to help me learn.
I want you to do a research design for my topic "Road Traffic Accidents in Patients
Diagnosed with Obstructive Sleep Apnea"
I have attached a couple files were provided to me how to make a research design with a
sample paper. I am also attaching my hypothesis, lit review, intro to the problem, so the
research design should be based on them.
Requirements: In depth
Top of Form
COMMUNITY WATER FLUORIDATION
Method
This quantitative research/correlational study will demonstrate the continued
effectiveness of community water fluoridation as an oral health intervention to
communities
without access to fluoridated water. Despite decades of evidence supporting the
effectiveness of
water fluoridation, efforts to begin a community water fluoridation program in non-
fluoridated
areas are repeatedly abandoned. Between October 1, 2019 and October 31, 2019, oral
health data
was obtained on children eight years of age participating in their prospective counties
school-
based sealant program. Water fluoridation status, rural/urban status and socioeconomic
status
(SES) was obtained from a parental questionnaire and each child’s zip code. This study
compared eight-year-old children’s decay experience and prevalence between areas with
and
without water fluoridation in Ohio.
Population
The participants for this study were obtained from The Ohio Department of Health’s
(ODH) School-based sealant program (SBSPs) which targets children from low-income
families
who many have difficulty accessing dental care. Oral health data was obtained by
2. convenience
sampling of children participating in their local school-based sealant program. Enrollment is
voluntary and parents were sent a letter requesting their child’s participation in a study
investigating the associations between oral health and systemic fluoride consumption.
Guidelines
for this study included only children that were eight years of age by the examination date
and
had either exposure to systemic fluoride or no exposure to systemic fluoride. Any children
over
or under the age of eight or who were given supplemental fluoride were excluded. Eight-
year-
old children were selected as permanent first molars and incisors have erupted and
overexposure
to fluoride can be exhibited by dental fluorosis indicating previous fluoride contact.
Data Collection Methods
The children that had parental consent to participate in the study and had parental
questionnaire completed, were examined by two dentists, three dental hygienists and four
second-year dental students using standard epidemiologic criteria as outlined by the World
Health Organization. Disease prevalence was defined as the presence of one or more teeth
with
decay that extended into the dentin, that were filled as a result of decay or that was
extracted
because of decay. Disease was recorded as a count of the total number of decayed, missing
or
filled teeth. The deciduous (baby teeth) were identified with “dmft” and permanent
dentition
were identified with “DMFT.” Despite the examiners working or trained to operate under
similar
conditions, examiner calibration was conducted prior to the study.
The level of fluoride in the water was obtained from a database maintained at the facility
which supplies water to Cuyahoga County, the Cleveland Water Department, and kept
updated
by regular communication with the Cuyahoga County Board of Health and the Ohio
Environmental Protection Agency. The optimum concentration of fluoride in the water is
considered to be approximately one part per million (ppm), although this varies slightly
according to mean daily temperatures within a county. Fluoride concentrations for this
study
were categorized as negligible (0.0–0.29 ppm), suboptimal (0.3–0.69 ppm), or optimal (≥0.7
ppm). In Cuyahoga County, Lake Erie naturally has 0.1 to 0.3 mg/L of fluoride. Between 0.7
and
0.9 mg/L is added to the water supply totaling approximately 1.0 mg/L which is designated
by
Ohio Revised Code 6109.20. A small percentage of children in rural Ohio do not have access
3. to
fluoridated water.
Location status was assessed by using Rural-Urban Continuum Codes (RUCC) from the
United States Department of Agriculture Economic Research Service. The RUCC
classifications
were used to determine if the location was rural or metropolitan. Socioeconomic status was
determined by a parental questionnaire collecting information on household income,
education
attained, occupation and if they had dental insurance. Details included in the consent
comprised
of where the data would be used, identities of participants and families would not be
revealed for
safety and privacy and compensation would not be provided other than the usual services
provided by the sealant program. Other data collected were race, ethnicity and enrollment
in the
Free and Reduced Meal Program (as an estimate of family income.) If a parent did not give
informed consent for the study, it did not exclude children from the sealant program. All
indices
were matched for the zip codes of the child or the zip code of the clinic if the resident code
was
not available.
Hypothesis: Patients diagnosed with severe Obstructive Sleep Apnea (OSA) are more likely
to be involved in a motor vehicle accident (MVA) than patients without OSA.
Null Hypothesis: There is no difference in the likelihood of patients diagnosed with severe
Obstructive Sleep Apnea (OSA) and patients without OSA being involved in a motor vehicle
accident (MVA).
The revised hypothesis is that patients diagnosed with severe Obstructive Sleep Apnea
(OSA) will have an increased risk of involvement in a motor vehicle accident (MVA)
compared to patients without OSA. This hypothesis is based on the literature which
suggests that OSA reduces sleep quality, leading to drowsiness and decreased alertness
while driving and increasing the risk of MVA.
The null hypothesis is that patients with severe OSA will not have an increased risk of
involvement in a motor vehicle accident compared to patients without OSA. This null
hypothesis is based on the idea that OSA does not necessarily have a negative impact on
sleep quality, alertness, and driving behavior, and therefore would not lead to an increased
risk of MVA.
4. Literature Review
The association between sleep apnea and the incidence of all types of traffic accidents has
been a subject of increasing interest in recent years, with evidence suggesting that
individuals with the selected pathology are at a higher risk of vehicle accidents compared to
those without the condition. The purpose of this literature review is to examine and
synthesize the current state of knowledge on the topic of road traffic accidents in
individuals diagnosed with all types of severity of OSA. The review will focus on the
magnitude of the problem, the underlying mechanisms linking OSA to road traffic accidents,
and the potential interventions that could reduce the risk of accidents in this population. By
synthesizing the available evidence, this review aims to provide a comprehensive
interpretation of the relationship between severe OSA and road traffic accidents and to
inform future research and interventions aimed at reducing the risk of accidents in this
population.
When it comes to the general population, obstructive sleep apnea (known as OSA) is a very
common disorder that frequently remains untreated. In people in their middle years, the
prevalence of OSA can be as low as 10% and as high as 50% in persons over 60. Cognitive
dysfunction, melancholy, anxiety, memory issues, and sleeplessness are just a few of the
symptoms of OSA. It can also increase your risk of obesity, hypertension, diabetes, and
cardiovascular diseases. The effect of OSA on driving is especially alarming because the
condition's extreme daytime drowsiness has been established as a major health risk in both
commercial but also non-commercial transportation. This is because there is a chance that
these conditions might affect alertness, memory, concentration, and nevertheless executive
function, which could raise the risk of traffic accidents (Slowik et al., 2022).
The first element regarding the selected topic which will be approached is that of the
incidence of motor vehicle accidents in groups of patients diagnosed with OSA. As evidence
to the proposed hypothesis for this work, Udholm et al. (2022) used Danish registry data to
explore both the severity, and the risk of traffic accidents in individuals with a diagnosis of
OSA and compared these to a reference cohort. Results showed that selected sample of
patient had an increased risk of motor vehicle accidents compared to the reference cohort.
More than that, it also states that patients with OSA also tended to be involved accidents
that led to more severe outcomes. These values were also confirmed by a study conducted
by Cheng et al., (2021) which investigated the effect of OSA on overall injury risk. One of the
conclusion states that these patients tend to have an overall 83.1% higher risk of overall
injury, with traffic injuries being one of them. The pilot study which was conducted found
5. that 26% of drivers hospitalized after MVAs were at high risk for OSA. The higher rates of
hospital readmission within 1 year of discharge for patients with moderate and high risk for
OSA, compared to the low-risk group, further highlights the need for intervention in this
patient population. Both these statement, further confirm the fact that patients with OSA
tend to be more frequently involved in traffic related accidents.
As previously stated, OSA is characterized by frequent breathing pauses while a person is
asleep. As a result, there are more frequent awakenings and less restorative sleep. People
who have OSA therefore have increased daytime drowsiness as a result of sleep loss.
Constant sleep disruption and poor quality sleep can contribute to weariness, a loss in
general alertness, and worse cognitive performance during the day. This mechanism was
incriminated as a potential risk factor for the higher rates of traffic accidents in this lot of
patients and was further investigated by researchers (Lal et al., 2021). The goal of the study
by Sabil et al., (2021) was to assess the degree to which people with Obstructive Sleep
Apnea (OSA) are more likely to be involved in car accidents than the general population.
Participants got clinical and polysomnographic tests after being chosen from a sleep
research facility. The connections between OSA severity, level of daytime drowsiness, and
other possible risk variables with self-reported motor vehicle collisions and near-misses
were examined by the researchers using a variety of approaches such as driving
simulations, personal questionnaires and also polysomnography. The research, which
included 2,673 OSA sufferers, found that those with untreated OSA (AHI > 5 occurrences per
hour) had a self-reported crash risk that was three times greater (0.05 motor vehicle
accidents every year) than that of healthy people (0.03 motor vehicle crashes per year).
Furthermore, 11% of the OSA-afflicted participants— who were mostly middle-aged, obese
men—reported experiencing an accident as a result of feeling drowsy or dozing off behind
the wheel. 32% of participants admitted to falling asleep behind the wheel, and 26%
reported at least one near-miss brought on by tiredness. The findings also showed a
significant overall relationship between tiredness and a rise in reported near-misses. These
results underline how important it is to identify and treat OSA in order to lower the risk of
car accidents.
In addition to these elements, some studies focused on risk factors for OSA as indirect
causes of increased incidence of traffic accidents. Obstructive sleep apnea has been proven
to be a major risk factor associated with obesity (OSA). The buildup of extra body fat,
especially in the neck and upper airway, which might result in mechanical constriction and
greater resistance to airflow during sleep, is mostly to blame for this connection.
Additionally, obesity may increase the pharyngeal walls' size and ability to collapse, which
can further constrict the airway and raise the risk of sleep disordered breathing. More than
that, a number of metabolic and hormonal alterations linked to obesity may possibly play a
role in the development of OSA. It is crucial to remember that losing weight can enhance
general health and quality of life while also being found to lessen the severity of OSA in
obese people (St-Onge,Tasali, 2021). Pocobelli et al. (2021) conducted a significant study on
the association between Obstructive Sleep Apnea (OSA) and increased risk of vehicle
accidents among non-commercial drivers. The researchers carried out a thorough
evaluation of potential confounding variables such as Body Mass Index to account for their
6. impact on the results. The results of the study were clear and demonstrated a strong
correlation between the presence of OSA and the likelihood of a vehicle accident among
non-commercial drivers.
The findings of Pocobelli et al. (2021) study provide critical insights into the impact of OSA
on driving safety. With the prevalence of OSA on the rise, it is essential to understand the
extent of the problem and take necessary measures to mitigate the risk. The strong link
established between OSA and higher risk of vehicle accidents among non-commercial
drivers support the need for more extensive research in this field to better understand the
underlying mechanisms and develop effective interventions to address the problem. It is
also important to educate individuals about the dangers of OSA and encourage individuals
with OSA to seek medical attention and undergo appropriate treatment. The research did
not, however, look at whether obesity contributed to auto accidents on its own. Later, a
review conducted by Felix et al., (2022) that discovered a connection between obesity and a
greater risk of accidents and serious or fatal injuries filled this gap. They did, however, also
point out that, regardless of fat, treating OSA might enhance driving ability and lower
collision risk. The high incidence of OSA in obese people, which was noted in the research,
raises the risk that obese drivers may fall asleep at the wheel or have other driving-related
impairments, such lower attentiveness, as evaluated by EEG. According to recent research
(Adekolu & Zinchuk, 2022)., obese people with OSA were twice as likely to get in auto
accidents as their healthy counterparts. The prevalence of Obstructive Sleep Apnea (OSA)
has been on the rise, and its impact on driving safety has been of great concern to
researchers. Previous studies have found a strong association between OSA and increased
accident rates among non-commercial drivers, with the severity of OSA being measured by
the Apnea-Hypopnea Index. One key aspect of OSA that has been explored as a risk factor
for driving accidents is the relationship between neck circumference and OSA.
Research has shown that among non-commercial drivers with OSA, a larger neck
circumference and severe daytime sleepiness are highly predictive of a greater collision
risk. Neck circumference is widely used as a measure of obesity, and the association
between larger neck circumference and greater collision risk highlights the need for early
identification and treatment of OSA in obese individuals. On the other hand, another study
found no correlation between Body Mass Index (BMI) or hypoxemia and the likelihood of a
collision or near-miss, but did establish a link between crash risk and neck circumference.
This highlights the importance of considering neck circumference as a predictor of
OSArelated driving hazards, in addition to BMI (Wojnowski et al., 2022).
It is crucial to conduct more research on Obstructive Sleep Apnea and how it affects non-
commercial driving behavior. More thorough research is required in order to improve
current understanding of the connection between OSA and driving safety. The impact of
OSA on driving behavior can be better understood by contrasting self-reported traffic
violations and authorized driving records amongst the non-commercial drivers who were
diagnosed with this condition compared to the healthy sample. Analysis of the link between
OSA and driving safety, specifically in groups of OSA sufferers, will also be helpful.
Numerous studies have examined the relationship between OSA and auto accidents, with
the vast majority highlighting the severe negative effects OSA has on driving performance.
7. The findings of these studies highlight the need for additional research into how OSA affects
CMV drivers' ability to drive. Additionally, the high frequency of OSA among CMV drivers
and the potential risks this illness poses underscore the necessity of accurate OSA screening
and diagnosis in this population. To guarantee the safety of both drivers and the general
public, effective management and treatment of OSA are crucial. Further study is required to
better understand the effects of OSA on driving performance and to create efficient
screening, management, and treatment strategies to address this disease among CMV
drivers, given the crucial role that CMV drivers play in transportation and commerce. The
importance of the problem underlines the necessity of continuing research and observation
to make sure that
CMV drivers are prepared to carry out their responsibilities in a safe and efficient manner.
References
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(2021). Effect of Obstructive Sleep Apnea on the Risk of Injuries—A Nationwide
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