CriticalAssessmentof40Gestation&HFM

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Sociology

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Apr 3, 2024

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Critical Assessment of Study Article Student Reviewer: Title: The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study Authors: Kua, Jo A., Pang, Junxiong Journal: PLoS ONE Publication Date: 11 August 2020 Purpose of study : The purpose of this study was to pinpoint significant risk and protective factors associated with HFMD. Study design : The study design was a “retrospective unmatched case-control study.” Data source and/or Sample: N=725 n=363 (cases, with HFMD) n=362 (control, without HFMD) “parents of preschool-age children who attended childcare centers in Singapore from year 2016 to 2018.” The source of the data used in the sample was from participating childcare centers in Singapore. After consent was given from completed, standardized questionnaires, the total sample size was N=725, with the case group n=363 and the control group n=362. Primary measure : Primary Exposure: preschool-age children Primary Measure: risks factors associated with HFMD infections Test used – Odds Ratio/Risk Ratio? : For the researchers’ statistical analysis, “Univariate logistic regression model was used to report unadjusted odds ratios (ORs) of each independent variable. Adjusted ORs were derived from the multivariate logistic regression model controlled for age group, parent’s education level, mother’s age, HFMD-infected siblings, and preschool admission period as potential confounders.” Complete the below 2x2 table with the appropriate data from the study article that produced the results : Epidemiology 2x2 Table Disease/Condition Status Yes No Total

Exposure Status Yes 28 37 65 No 329 323 652 Total 357 360 717 Calculation used with the above numbers that produced the resulting OR or RR : 12173/9044=1.35 Explain how the above measure of association is interpreted for this (case-control or cohort) study ? According to the produced measure of association, the results of this case-control study indicate that those with a gestational age of 37-42 weeks have a slightly higher chance of being exposed to HFMD compared to children with a gestational age of less than 37 weeks. Advantages of using a case-control/cohort study : The researchers’ decision to use a case-control design for this study was advantageous for various reasons. Considering the various possible exposures associated with HFMD, this study design is useful in narrowing down the most significant ones. With numerous studies done previously on all the possible factors of HFMD, the researchers were able to quickly utilize their case and control groups to validate those findings. Additionally, case-control sample sizes are typically smaller, so their 33.3% response rate from the initial recruitment can be overlooked. Limitations of using a case-control/cohort study : Alongside the advantages, the use of a case-control for this study also has its limitations. The researchers were unable to “provide evidence of correlation instead of causation,” making the findings from this study design plausible, but only theoretical. Furthermore, the information on exposure being utilized for the study is only based on observations and documentation from the year 2016 to 2018. With limited information and no verifiable data in either cases or controls, researchers cannot accurately assess if controls are really controls. Clear establishment of the exposure-disease relationship is also questionable because of the data from this study and the high possibility of HFMD misdiagnosis There are two general categories of bias discussed in Chapter 6 of your textbook: information bias (which includes recall bias, interviewer/abstractor bias, and prevarication bias) and selection bias. Identify and discuss the plausibility of these biases for this study : The study’s data collection methods introduce various potential biases. Notably, Kua and Pang address the presence of recall bias “inevitable as parental-reporting was used to collect children’s habits and other variables of interest.” The researchers’ findings of risk and protective factors for HFMD in the broader population source also raised concern for selective bias. As the study’s data was collected from the years 2016 to 2018, with childcare centers being the primary source of identifying cases and controls, the legitimacy of controls are difficult to determine. Describe methods the authors used to minimize bias and confounding. If there were none (not very likely, but possible), what are some ways that they could have minimized the problems of bias and confounding? (Chapter 6 discusses techniques for minimizing both categories of bias and confounding.) :

To better combat the plausibility of recall bias, Kua and Pang ensured the questionnaire design was standardized and close-ended, only recruiting cases within the 2-year period. The researchers were also able to correctly identify 86.5% of cases through medical records, minimizing the plausibility of selective bias. To best combat confounding, the calculations done for the study accounted for “any significant proportion differences in the variables for childcare centres.” A way the researchers could have further minimized the problem of bias and confounding would be to observe the controls and their exposure status following the initial study. As the control group had a poorer understanding of HFMD, there is a stronger chance of confounding affecting the results of the study.

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