VET656: Critical Appraisal of Healthcare Article Report

This report offers a detailed critical appraisal of a public health research article focusing on healthcare disparities and frailty among Aboriginal Australians. The review begins with a general description of the study by Freeman, outlining its structure, clarity, and adherence to reporting guidelines. It then delves into an in-depth critique of the article's title, abstract, introduction, methods, results, discussion, conclusions, references, and acknowledgments. The analysis examines the study's strengths, such as its representative sample and appropriate statistical tests, while also identifying limitations, including the brevity of the literature review and the absence of a pilot study. The report concludes with an assessment of the study's overall quality, highlighting its contributions to the field and suggesting areas for future research to improve the scientific merit.

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1. General Description
The study by Freeman (1) is about the assessment of the risk related to keeping poultry and
livestock by farmers. The paper has a standard logical construction i.e. it has the introduction,
methods, results and conclusions. Furthermore, the abstract is provided under the same
subheadings. The paper is written in a clear and comprehensible manner because every section is
subdivided under relevant subheadings, the English used is straight forward and simple, the
outcomes are presented in a table and then followed by descriptions. These make it easy for the
ready to scan through and even read and understand. There are no noticeable grammatical or
typographical errors and if there be then they must be minimal. Furthermore, the paper is a peer-
reviewed journal, and therefore one would expect minimal grammatical or typographical errors.
2. Article Critique
2.1 Title and Abstract and Keywords
The title and abstract present a clear summary of the paper. The title alone informs the reader of
the population being studied, what is being investigated and the possible outcomes. furthermore,
the abstract has been presented under the subheadings of the whole structure of the article such
as introduction, methods, results and conclusions. According to STROBE guidelines (2) of
reporting, the title should hint to the reader what the stud is all about. The authors have also
noted the keywords used in the research, and they appear appropriate because they represent the
keywords found in the research title and research question.
2.2 Introduction
The introduction is appropriate for the subject of study because it first gives a broader
background perspective and then cites previous studies on the same topic and their findings
concerning the current study. Then the researchers point out an existing knowledge gap that
needs to fill by the current study. The literature review is relevant but not comprehensive. It is

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relevant in the sense that it has appropriate information for the research subject and the cited
literature is current (i.e. published within the last 10 years). It is however not comprehensive
because only seven studies have been cited and there are no descriptions of the research designs,
research topics, methodology and statistical findings. The study appears original in concept
because it first outlines the previous studies in relation to the current research topic and then
points out the research gap. There is a logical flow of the aim of the study based on the reviewed
literature and it is clearly stated at the end of the literature review. However, the study doesn’t
state a null hypothesis.
2.3 Materials and Methods
The study design is consistent with the aim of the study because it examines a prospective cohort
study on private agricultural farmers who are licensed pesticide applicators. A prospective cohort
study was appropriate in achieving the aim of the study because it allows the researchers to
follow a group of subjects with similar characteristics over time concerning some factors under
assessment to ascertain the impact of these factors on the outcome (3). However, there was no
pilot study carried out to test the methodology. This might be a source of weakness to the study
because the methodology of a prospective study on the current research topic was not tested
using pilot study for feasibility, adverse events (4) etc. to improve on it.
The sample (49,884) was highly representative of the target population (57,310) because it
represented over 80% of the population. A highly representative sample improves the validity
and reliability of the study because the conclusions can be taken as the true state of the general
population (5). Controls were required in the study were effectively used. The controls were
appropriately used. For instance, the authors controlled for pesticides related to certain types of
cancer, control for smoking to ascertain increased risks for lung cancer among others. these

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controls were appropriate because they were specific. According to Bhuyan (6) appropriate use
of controls in experiments results to the elimination of experimental errors and experimental bias
thus ensuring that the outcomes are valid because they also eliminate any possible confounding
variables.
The selection method for the sample and controls were clearly described. The licensed pesticide
applicators were recruited and had to be either poultry or livestock farmers. The study also
controlled for pesticides linked to come types of cancers. Leung (7) observes that an in-depth
description of the sampling procedure increases the internal validity of the study and
replicability. Data analysis and presentation was presented in details. An analytic software SAS
version 9.1 was used for data analysis. The specific statistical tests used included relative risks,
Poisson regression, and confidence intervals. Statistical tests are important in research because
they allow researchers to make quantitative decisions regarding a given sample and the general
population. Additionally, they are used to test a hypothesis made regarding a significant
observed sample (8).
The authors used a self-administered questionnaire to collect data. The study has provided an
overview of the questions in the questions to validate that the research instrument was relevant
and appropriate. However, the questionnaire was not tested in the current study as well as a pilot
study. However, there is a link for the questionnaire which was obtained from a government
website ‘Agricultural Health Study’. Even though the researchers did not test the validity of the
questionnaire, it had previously been tested and used in a published article. The use of
questionnaire is effective when dealing with a large population because it enables easy, faster
and economical data collection. However, the questions are specific and limit any other

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additional or explanatory information from the participants, and which would be important
during data analysis and interpretation (9).
The ethical approval for the study was acquired from the ethical review boards of the National
Institute of Health and other interested parties. The study doesn’t indicate whether consent was
obtained from the participants. It is an ethical requirement for epidemiological studies that
informed consent is obtained from the participants and all the details regarding the study
explained to them before the commencement of the study (10).
2.4 Results
The outcomes and the statistical tests of the study were clearly presented. The outcomes of the
statistical tests were presented with respective figures and summary tables for each of the
outcomes. The theoretical presentation has a logical flow, addresses the research question and
relates all the tables to the figures. Additionally, the tables have clearly been presented with the
title for each one of them on the top. Additionally, the tables have columns and rows that have
clearly been demarcated with the title for each column being presented in bold. This makes the
tables appear unambiguous and easy to read, compare and tally. The tables have adhered to the
Cochrane checklist of reporting qualitative research (11). There were no missing data.
The numbers and statistical values are accurate and clear. This is because they were generated by
an analytical software; SAS in addition to the fact that it is a peer-reviewed journal article. An
example of the statistical tests used includes relative risk (RR), confidence interval (CI) and
alpha level. Relative risk is important in measuring association in epidemiology. It is feasible
when there are incidences of prevalence’s (12). On the other hand, CI is an indication of the
possible range of values of the population mean; they provide richer data and the possible values
of the true population mean (13). For instance, the RR OF 1.4; 95% ci 0.99-2.0 showed that there

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was a positive association between rearing poultry and a high risk of colon cancer. This,
therefore, shows that the statistical tests used were relevant and appropriate for the study.
The sample was sufficient to justify the findings. The sample size was over 80% of the target
population. This is far much higher than the minimum sample size recommended by most of the
researchers. Ledford (14) recommends a sample size of over 15% as being adequate to represent
the target population and justify the outcomes. Additionally, the outcomes are both clinically and
statistically significant. They are clinically significant because the statistical tests of RR
(statistically significant) found a positive association between poultry and livestock farming with
an increased risk of lung cancer (clinically significant). Therefore, the findings can be used by
clinicians to ascertain the reason for any observable prevalence of lung cancer among livestock
and poultry farmers. The outcomes are believable because they are not only logical but
scientifically proven.
2.5 Discussion and Conclusion
The authors have not critiqued the methodology used but instead, have described as a matter of
procedure. This makes replicability very difficult because the weaknesses and strength of the
methodology are not exposed. However, the outcomes have been discussed comprehensively
(15). The authors have used prose to show the results and a summary table of the prose.
Furthermore, the tables have titles and are cited in the prose, making comparison and reading
easy and fast. The results have adhered to the Cochrane statement guidelines of the report (16).
The results section has not been discussed concerning any other literature of the same topic but
instead, it's just a presentation of the statistical tests’ outcomes and figures. But the discussion bit

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comprises of the outcomes and extends beyond the methods and outcomes of the study by citing
other studies with similar or contrary outcomes
The conclusions are a precise reflection of the outcomes of the study. The researchers observe
that there was a low risk of lung cancer among poultry farmers compared to non-farmers.
However, the risk of other cancers was high with increased poultry or livestock farming
depending on the kind of animals reared. Due to the conflicting outcomes with previous studies
and lack of a comprehensive study, the authors conclude clearly by recommending further
research.
2.6 References
The study used the Vancouver referencing style and they are up to date and appropriate as cited
in the body of the research.
2.7 Acknowledgements and Funding
The source of funding is acknowledged and appreciated. The study was funded by the Intramural
Research Program of the National Institutes of Health. The source of data is equally identified
and appreciated. There is no information on the specific contribution of each author to the article
except for a disclaimer on their biographies.
3 Conclusion
The critiqued study was of relatively high quality. Generally, the study has a logical
construction, simple English and understandable with no observable grammatical or
typographical errors. The abstract was also brief but comprehensive enough to give an overview
of the content of the study. The aim of the study was also stated clearly and the identification of
the knowledge gap was sufficient proof of its originality in concept. Moreover, the methodology
was relatively comprehensive and with the sample being overly representative and the use of

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statistical tests enhanced the validity and reliability of the study. The appropriate use of tables,
statistical tests, and logical flow in the presentation of the results made the study more credible
and both clinically and statistically significant. Furthermore, the comparison with previous and
relevant literature in the discussion section pointed out the relevance of the study.
However, the study was not without significant limitations. The literature review was too brief to
warrant the identification of a research gap. Furthermore, the study didn’t state the null
hypothesis and the research design was not critiqued thus making it difficult to be replicated in
another population. The absence of a pilot study to test the feasibility of the questionnaire
increased the likelihood of measurement error. There is, therefore, the need for a detailed
literature review, a critique of the research design and a pilot study to be carried out to improve
the scientific merit of the research

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