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ARTICLES TAKEN FOR COHORT STUDY

A) C Delcourt et al, (2009), Epidemiology of diabetic retinopathy- Contrast between the

expected prevalence and the frequency of reported cases in the French population Diabetes and Metabolism, Vol. 35 Issue- 6, p 431-438. B) TKW Tam et al, (2005), Epidemiological study of diabetic retinopathy in a primary care setting in Hong Kong, Hong Kong Med J Vol. 11 No 6, p 438-445. HEALTH CONDITION FOR STUDY- Diabetes Retinopathy. INTRODUCTION This assignment or essay will focus on the cohort study that is studying the various type of research methods followed for a single disease or any single condition to find out what could be the better option for studying, along with this the sampling technique is also analyzed to get a better sampling for the above taken condition. STUDY TYPES The first article was merely a review of the previous studies done and the approach to find the epidemiology in French population is based on the literature study which is also from observational screening, but in the second article where the epidemiology of Diabetes retinopathy is done in Hong Kong a retrospective community based study design is followed. To have a cohort study on the designs of the study we have to know first the meanings of the type of study design followed in that, in the sequence lets have a look at the study design of the second one that is the retrospective study design. This type of study design makes use of those datas as well as informations that were recorded for any other purposes rather than research. In the health care sector these type of data collection for any study is said to be chart reviews as it is the data taken from the recorded medical history. As everything has its own pros and cons similarly with the case of retrospective study since it takes the data that were collected earlier so it is a time saving as well as less expense method of study design. Even though many scholars think this method to be dirty and quick but if it is done carefully then these things can be avoided easily. Even though scholars preferably follow prospective study rather than retrospective studies but the advantage is that it is done as part of completion of the expectations from the prospective study. Other advantages are it helps in clarification of hypothesis, giving right justice to the questions designed for the study, and identify different factors which can give rise to a prospective study. It also helps in analyzing datas derived from different outcomes. The main disadvantage in this type of study desings is the effect of bias on this study design, the two most important bias affecting the studies are selection as well as the information bias.(Hess, 204, p 1171) Lets have a look at its counterpart research study design method that is systemic literature review where literature review is done by correct selection, of peer reviewed papers and journals and articles and synthesis is done according to the research question asked which were all from

highly acclaimed journals. Due to its different perspectives it is employed for study design in various other subjects and fields such as psychology, nursing, occupational therapy etc. The major advantage of this type of study design is it provides strongest evidences as well as supports for any medical condition. The reason behind is it provides details of the literature available in a summary with regard to a research question. The second advantage is the study design is transparent in approach which tries to mitigate the bias that is seen retrospective studies. Both qualitative as well as quantitative analysis of the data were available under this study design.(Moher et al, 2007, p 78) Even though currently there are no substantial disadvantages against the systemic literature reviews but 300 studies suggest that there many methods as well as guidelines through which the study designs can be improved.(Shojania et al, 2007, p 24 So in the above two studies the first study where the systemic literature study is carried out to support the hypothesis as well as to answer the research questions asked in aims and objectives seem to be more consistent and valid as it contains papers, literatures, journals, articles, electronic databases and those contain different type of observational as well as non observational studies rather than the single retrospective study done in the second study which is affected by many biases. In the first study the Wisconsin epidemiological study methods has not been included as they are outdated now which gives and edge to that study. SAMPLING TECHNIQUES The first study was based on the systemic reviews of the literature so there is no specified sampling techniques followed for this type of study design but still it is the better way than what is followed in the second type of study as the WSDER studies are not considered in this literature review as they are outdated, where the study was done as per the age of patients during the diagnosis and the type of treatments they have received rather than the type of diabetes they are suffering from. So they have taken those studies which were showing the prevalence of Diabetes retinopathy in different continents like USA, Australia, UK, Italy etc. which shows that relevant literatures were taken to answer the research question. The study was important on that ground that it has included different cohort studies as well as longitudinal studies while reviewing literature, along with this other literatures are also considered where the study is based on the observational screening methods thus its sampling technique is quiet diverse in nature where all type of study designs methods are involved. The only disadvantage of the study is that there is no population based cross sectional study literature taken to do the systemic reviews due to its non availability especially pertaining to French population.(Savoie et al, 2003, p 168) In the second study where study was done in ten primary clinics in Hongkong where different data collected were based upon only screening methodology and previously recorded data. Demographic as well as clinical data were also taken for the study which is more or less like WSDER study where patients age and sex at the time of treatment and treatment provided is given primary importance rather than on prevalence of diabetes retinopathy in various parts of honking and how it is occurring and why.

On comparing both the sampling methods followed in studies the first study is based on the random as well as multi stage sampling while the second study is based on the systemic sampling technique. The first method is based upon different sampling methods at different stages where the sample size differs in each stage or in each literature that is reviewed. For example in incidence of DR determination while clinical cohort studies, randomized control trial studies, long term follow up studies, population based screening studies were taken or literatures where these type of studies were done in different population in France were taken while in prevalence of DR only hospital based retrospective studies were taken into account. (Mann, 2003 p 54) In the second study systemic sampling method is followed which is limited as the second study deals only with the clinical record studies in ten different hospitals with different exclusion and inclusion criterias. So on comparing the sampling techniques of both the studies the first study sampling technique seem to be much diverse as well as answering the research questions in a much better way as assessment can be done in different study design methods and it gives better validity to the result obtained than the sampling technique that is followed in the second study. Another advantage of the sampling method followed in the first study over the second one is the standard error determination which is difficult in the second one as the data were collected from the clinical data which were maintained already and there is no surety of its accuracy while in systemic review all the data that were collected are highly authenticated as the study itself is highly authenticated due to exhaustive study of the literatures which were highly acclaimed.(Mann, 2003, p 56) SAMPLE SIZES When the research aim is to find the prevalence of a disease in a particular population then the question which rises for any research is what will be the size of the sample and how big it will be? It is not feasible to go to each individual and do an assay as the unit sampling cost will be much higher and the time that will be behind the research will be more. So the sample size determination is very important in this regard as it involves the cost of the survey to be carried out. There are many subsidiary questions that arrive along with this- what sample size will determine that the results obtained were accurate? Which type of sampling method will be perfect and for which sample size the hypothesis obtained were correct? And what is the expected value and how it varies in real population with that sample size. Considering the above criterias the first study where systemic literature review is taken into account no doubt must have required much time and money but the data collected through that sample size will be extreme accurate and can also present the expected and the real value to the research question. Since in different stages that is finding the incidence of DR, prevalence of DR, declared prevalence of DR and screening programs for declared DR the sample size varies according to different studies so the conclusion as well as generalizations can be done for the French population but in the second study where retrospective method is followed only screened data were taken from ten hospitals of HONGKONG and the sample size is also small to make

any generalizations for the population of Hongkong. So even though the sample size is quiet large and time taking in the first study but it has capability to give more accuracy to the results than the second one as well as it can showcase the actual and the expected results rather than only calculating and giving generalizations based on the theoretical hospital records which were not free from errors.(Louise and Woolson, 1988, p 562 DATA COLLECTION METHODOLOGY During any epidemiological study the data can be collected in two ways in the first method the data is either collected by measuring the variables available or by asking the people concerned with that variable. When studies like the above two mentioned were taken where epidemiology of a particular disease in a population has to be found out then the sample size will be large as well as the data generated will be of high quality. Taking the first study into account the data collection methodology is quiet high as the data were collected from the observational screening as well as the longitudinal studies where the sample size is big as number of literature reviewed were large so from the synthesis as well as analysis the data that is generated is also of high quality as it is statistically validated and is mostly in numerical figures that were easy to interpret and also valid. Along with that those literatures were also taken where questionnaire and interview method is followed for the screening of the disease. But in the second study only screening methods were employed for the data collection that too screening of the clinical records of the patients during a given time period. So the first study has an advantage over the second one as the cumulative effect of both interview and questionnaire method is obtained. CONCLUSION So from the above cohort study with regard to the epidemiology of Diabetes Retinopathy it is suggested that the systemic review of literature is a better approach than the retrospective studies when the sample size is large even though in the first case both time and money expenditure is less but the results accuracy is in doubt and it is affected by errors and bias, whereas the main objective of the systemic review is to minimize the errors and bias. Thus it is a better approach for the epidemiological study than the retrospective one.

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