Improving the Prevention of Cardiovascular Diseases - Research Paper Example

? Critical Appraisal Critical Appraisal Question The trial does address a clearly focused question. The question is whether proper attention is being paid towards effectively dealing with dental caries in infants to prevent the severity, and extreme situation the children face. Mothers are taught on the best methods of breastfeeding; the time to do it, and healthy weaning of infants to provide a safe growing environment for them. The effectiveness of such a study is seen in the reduction of cases of early childhood caries, and the rapid response by mothers to provide their children with proper diets, which maintain their health (Feldens et al. 2007). It is crucial for problems affecting early child years to be addressed. They form a platform on which many individuals find the chance to voice their fears. The ministry of health and other organizations are keen to make the situation in the region a priority. Some have gone as far as confirming if the various studies carried out through education programmes benefit the people. Many issues are tackled by the study to find out some of the diseases that affect infants and increase the mortality rate in the region. The effectiveness of such study is, therefore, seen with the intervention of all groups. This is with the aim of aiding in the region’s nutritional health (Feldens et al. 2007). Such intensity is should be welcomed by all groups around the world, for the benefit of all societies. Question 2 The participants in this study allocated to the intervention and control groups were distributed appropriately. The number of children/infants in both groups provides the study with adequate information on the distribution of feeding behaviours by those involved. The control group needed an unlimited number of participants because at this stage; the children needed more attention, and their situation might have had the highest problem (Feldens et al. 2007). In the intervention stage, the infants after birth could have the right conditions set for them as the study began, than as they got older. This offers clinicians a chance to monitor the dietary tendencies the child grows up to adhere to after the study is complete. The high number of participants allows for a conclusive result. This is because, if any group has a number of participants who might not make it through the study, a high number is still present to give the study a conclusive result. Mothers and infants who had other impediments to breastfeeding were not included in the research study. This may have produced different results, thus; presenting inconclusive results. The socio-economic background of these families forms the basis for which this study is conducted. Taking the participants from public health system presents the clinicians and researchers with the right foundation to base the study (Feldens et al. 2007). Question 3 The number of participants in the study was enough to minimise the inclusion of chance. This high number provided the study with enough subjects to include in the assessments, and give logical explanations as to the different scenarios presented. It would reduce the play of chance because the number of mothers involved in this study was more than 89.5%. This was higher than all the eligible mothers required to create mother-child pairs in the study. Out of the 559 participants, the 500 that took part in the study gave the study a basis on which to conduct their research findings, and offer probable conclusions (Feldens et al. 2007). It is crucial for studies about various research findings to have a high number of participants. As seen earlier, the basing of research findings relies heavily on the number of participants at the end of the study. The high number offers the study a variety of test subjects. This means that, the mothers and fathers of these infants have different backgrounds before the child’s birth. The education, occupation, and family status offer enough information about many families. This guarantees conclusive findings on the growth environment of the infant, and the research findings (Feldens et al. 2007). This indicates the need to have a high number of participants, and their role identified in this study. Question 4 It was crucial that the participants and clinicians be blinded as to the children’s study groups so that the study could go ahead without glitches, or bias. Clinicians, therefore, carried out their visual examination in clinics away from the homes of the participants. It was also vital that clinicians and paediatricians be blind to the participants’ group status so that they could provide impartial assistance to all the groups present. All the participants that showed signs of problems after the period specified could be sent to their primary care givers for treatment, and further assessment. These were some of the ethical aspects that were involved in blinding the clinicians against the participants’ group status (Feldens et al. 2007). Also, for a research study to take place without bias, researchers and clinicians, in this case, have to be blind to the different situations that present themselves. It is particularly easy to assume something about a participant based on their immediate environment. A clinician may be inclined to make assumptions, which presents a challenge to arriving at conclusive results in the study. Blinding also aids in the correct assessment of participants. As in this study, clinicians were blind to the groups present. They were to assess them and give correct evaluation as clinicians, without knowing what results were expected by the groups present. This may offer the study a base from which to base their analysis for all the participants (Feldens et al. 2007). Question 5 The groups were not entirely dissimilar at the start of the trial. However, there was no evidence to show of any imbalance between the groups during the start of the trial. This was in terms of the group’s family income, the children’s ages, and the maternal education of all those involved. Income by the groups present was reasonably low, and any difference between income in the intervention and control groups was minor. The minor losses to follow-up did not warrant any glitches or bias in the study because the two groups were similar (Feldens et al. 2007). Therefore, such losses did not make up for much difference during the start of the trial. It is said that a high percentage of mothers who give birth in the region through the public system are economically challenged. To some extent, this may be true. Some of the evidence that indicates infants affected by caries, such as family income, age, and maternal education was not documented for all families involved in the study. In many areas, these are the predictors of dental caries in many infants, in developing countries (Feldens et al. 2007). However, in this study, the dissimilarity between these two sets of groups, with regards to the above predictors was not that much. In income, for example, the difference in percentage was 63.5% and 58.7% for the intervention and control groups respectively. Question 6 During the conclusion of the trial, not all participants could be accounted for in the study groups. Some of participants in the study groups moved to another city. Others, sadly, died. Others blatantly refused to remain a part of the study till the end, while others succumbed to maternal illness. This was the situation the researchers were presented with at the end of the study. The results were, therefore, based on the remaining number of participants. In some other cases, there was the moving of mother-child pairs and their addresses could not be found. In others, infants in a study group would be given up for adoption (Feldens et al. 2007). All these were factors that saw the number of participants reduce significantly. All the reasons for the reduction in participants go back to the point earlier made about the high number of participants. It is vital to have a high number, to reduce the risk of chance. In this case, the study underwent changes in terms of the participants. The reasons for the inconclusive research findings were more or less the same for the two groups. It is common in many developing countries to have a shift in numbers as seen in this study. However, to prevent the coming up short in such a case, having the number of participants report their non-inclusion in the study may provide an avenue to find alternatives. It may assist researchers find solutions to the problems presented (Feldens et al. 2007). Question 7 The operationalization of the primary outcome was robust in that; it covered most of the areas commonly affected by ECC. It is a national problem that needs addressing, and this was one way to go about treating, or diagnosing the problem. The loss of participants from both groups was indicator enough that the trial is highly likely to be unbiased in its selection of participants. Although there may be a likely occurrence of information bias, this does not imply that the primary outcome of the trial was not met. Memory loss could be attributed to this, but the trial does achieve its core target of ensuring a large number of mothers get educated on the adverse effects of ECC (Feldens et al. 2007). It may work by increasing the chances of fighting the diseases affecting most of the mothers, and infants in the region. The environment from which participants can be taken from should be wide. This is to avoid any similarity between the groups involved in the study. Predictors of ECC can easily be identified if there is a wide area of research. This projects the participants, and how they dwell in their environment. Time taken for the study should be minimal. As in this case, memory loss was not indicated as a problem because, the duration for the collection of data was short (Feldens et al. 2007). Question 8 The effect of the intervention treatment was a reduction in the number of children/infants with ECC. The intervention group status associated with most of the feeding practices was targeted by the dietary intervention. These practices ensured that mother-child pairs knew of what proper measures to include in the diets of their children during the trial. This was to achieve the best results. The dietary intervention included longer duration of exclusive breastfeeding. Healthy breastfeeding and weaning was crucial in the protection against ECC for all groups. Another dietary intervention included the later introduction of sugar into the children in the group status. Also, there was the small probability of having eaten honey, chocolate, or sweets by the children in this group. This treatment effect saw a lower percentage of dental caries as compared to the other group (Feldens et al. 2007). To fight the spread and problems caused by ECC, mothers need to be introduced to dietary measures that offer them solutions. Solutions which might help them tackle ECC from the time of birth of the child, to the time it may no longer pose a threat. This better prepares the government, and other support groups to tackle the issue. They might be better placed to assist mothers in raising their children through their struggle of fighting ECC (Feldens et al. 2007). Although the study and research may hit some glitches, it is not expected to be much because the results of any study are not likely to favour anyone if they are forged. In fact, false information may prove as one of the biggest challenges the study may face. Question 9 One main cause of bias in the trial would likely be the lack of being ‘blind’ to one’s group status. Many mothers in the intervention group would likely provide wrongful information to the trial’s staff, even if they did not stick to the group’s dietary habits, or regulations. This may have been with the intention to gratify the research team. Another would be memory loss among the mothers. This is not such a tremendous cause of bias because of the duration of the check-ups (Feldens et al. 2007). It was a short period between which the feeding practices were checked, and data collected, which implies that the memory loss would be out of ignorance. As seen, falsifying information may not benefit anyone. It may be out of neglect that mothers fail to adhere to the strict dietary measures, hence; the need to falsify information during data collection (Feldens et al. 2007). Errors are expected in any study or research carried out. This study is no exception. There is a possibility of reducing the recorded cases of ECC. This is if there are regular check-ups by clinicians to homes with growing children. Question 10 The outcomes of this trial may be practical to the major population of infants immediately after birth. This group has a higher chance of surviving ECC because the introduction of methods to avoid the dental caries would help tremendously. The group is less affected by the elements present that lead up to the development of dental caries, thus; easier to address mothers who might want to prevent the spread of ECC (Feldens et al. 2007). If they are keen on addressing the issue of ECC, they will be willing to follow instructions provided by the clinicians during these occasional visits. Also, constant visits to clinicians about the required diet specifications may assist mothers around the world to combat the spread of ECC. They may be effective in reducing the number of cases reported on ECC tremendously in many regions. In order to monitor the growth and spread of ECC, it is vital to monitor the use and consumption of sugar. It is vital because this use tends to determine future dietary tendencies among individuals. This, eventually, determines the spread of caries into the children’s adult years (Feldens et al. 2007). Question 11 The quality of this study is aimed at improving the prevention of ECC in areas that are developed, or are developing. The measures in place to prevent ECC should already be in effect, and followed inadvertently. This is to assist mothers who may have difficulty adjusting to routines that help in the prevention process of dental caries among their children. The quality is, therefore, exceptional. Participants in the intervention group receive more attention (Feldens et al. 2007). This proves that, the more attention a group receives from clinicians on issues that affect them; there is the possibility of reducing the problems associated with these issues. However, the study still needs more work. This is because the number of children affected by dental caries is still high. The dietary behaviour programmes need addressing to find a solution to better the situation that infants face during breastfeeding, and introduction of sugar in their diet. Some practices among parents and families on the proper diet for their children acts as a determinant for all those affected by ECC. In order to tackle and raise the bar for eradicating the prevalence of ECC, people need awareness. If these issues are addressed, the quality of the study will improve vastly, and better the chances of mothers combat ECC (Feldens et al. 2007). Reference Feldens, CA, Vitolo, MR, & Drachler, ML 2007, ‘A randomized trial of the effectiveness of home visits in preventing early childhood caries’, Journal of Community Dent Oral Epidemiology, vol. 35, pp. 215-223. Read More