Epidemiology Report: Respiratory Health in Indigenous Children

This report provides a critical analysis of an epidemiology study examining respiratory health in Torres Strait Islander and Aboriginal children. The study, employing a non-experimental design with cross-sectional and cohort elements, investigates the prevalence of respiratory symptoms, including asthma, and associated factors in the Australian Capital Territory. The report evaluates the study's methodology, including the use of questionnaires, sample size, and response rates, and discusses the major outcome variables such as respiratory health and the prevalence of respiratory symptoms. It highlights the primary exposure variable of respiratory health and its association with the study's outcomes. The analysis also addresses potential biases, confounding factors, and the measures taken to mitigate them. Key findings reveal higher prevalence of certain respiratory symptoms among indigenous children and the influence of environmental factors. The report concludes by assessing the study's generalizability and applicability to broader populations, while acknowledging limitations such as the reliance on older literature and potential biases. Overall, the report underscores the importance of the study's findings for public health interventions and highlights the need for further research in this area.

Running head: EPIDEMIOLOGY 1
Epidemiology
Student’s Name
Institutional Affiliations

EPIDEMIOLOGY 2
Epidemiology
Question 1
After a thorough review of the journal’s authors, title, and abstract, my impression is that
the article is of good quality. The article is authored by Nicholas Glasgow, one of the medical
icons and a doctor of philosophy in medicine. Nicholas Glasgow is one of the renowned
palliative medicine specialists as well as a general practitioner (Glasgow et al., 2017). He has
done a lot of significant work and high-quality research in medicine; for instance, he examined
or assessed the interface amidst secondary and primary care in developing nations in his doctoral
thesis (Dolan et al., 2018). Additionally, he is considered as one of the excellent primary health
care researchers. As result of the authors’ experience, this article’s quality is unquestionable. In
the same token, the journal’s title also speaks for the paper, for example, it mentions the
research’s population and disease of research. Generally the critical and creative evaluation and
analysis of the article abstract show a logical and well-organized presentation looking towards
meeting the authors’ intended objectives. The abstract outlines the study’s objective,
methodology, results, and conclusion thus gives the readers a clear aim and content preview.
Therefore, all the aforementioned reasons are clear indications of a high quality paper.
Question 2
The rationale of the study is to measure or examine atopic disease and respiratory
symptoms in Torres Strait Islander and Aboriginal children. It measures the respiratory
symptoms of both non-indigenous and indigenous children in the Australian Capital Territory.
The rationale is well articulated by the authors since it clearly outlines the study’s intended
purpose or aim, therefore, demonstrating resilient convincing power in the entire journal.
Question 3

EPIDEMIOLOGY 3
The research embraces a non-experimental study design, employing cross-sectional and
correlational analyses to help in generating the research findings. It also employs cohort study
design. It can be said to be a descriptive design because it involves survey and observation, for
example, two-stage questionnaires survey is conducted among children in the Australian Capital
Territory. On the other hand, the study is a cohort because it involves sampling a group of
individuals sharing defining characteristics, for examples, kindergarten children of the same age
bracket. The researchers used prospective cohort study to help in determining the risks factors
for contracting the respiratory diseases. In addition, the researchers follow the participants over
time and they assess outcome and exposure during the follow-up. The study’s abstract outlines
its objectives, methods, results, and conclusion, therefore, giving a clue of its content. In its
subsequent pages, it uses the abstract’s outline to discuss the topic.
Question 4
The major outcome variables in the study include respiratory health and prevalence of
respiratory system. These are considered the major outcome variables because they have been
used in the study to determine the sample size. Additionally, it is important to note that the
research’s objective depend on them. The research is interested in studying the prevalence of the
respiratory the diseases such as asthma.
Question 5
The primary exposure variable is always related to either decrease or increase of a
particular health outcome (Sackett, 2000). Remarkably, the primary exposure variable in the
study is respiratory health. It is significantly associated with the study’s outcome which is the
prevalence of respiratory symptoms in Torres Strait Islander and Aboriginal children in the ACT

EPIDEMIOLOGY 4
(Glasgow et al. 2003). The study examines respiratory health of kindergarten children through
assessing the prevalence of respiratory symptoms.
Question 6
It is important to note that the overall research design was appropriate for the study
question. The critical review of the authors’ methodology is based on the approach. The overall
study design as well as hypothesis testing exhibits a well-organized, relevant, and appropriate
presentation of research’s questions, ideas as well as results which are duly interpreted to support
the aims and goal of the research. The research design aids the article to draw its strength from a
coherent and consistent thesis, which matches up the both the introduction and conclusion.
Notably, this demonstrates a strong convincing power in the findings or results, integral text as
well as interpretation.
Question 7
It is important to acknowledge that the study employs a large sample, for example, a
sample of 10,600 non-indigenous children. Such a large sample size help in gathering more
information as well reduces uncertainty, therefore, increasing the study’s validity and reliability.
Additionally, such a large sample size leads to greater precision, gives greater power of detecting
differences, and reduces the margin error. In the same vein, the response rate was quite
recommendable. Out of the possible 100% recruited individuals, 92% participated in the study
up to the end and the research found that the response rates were consistent for both the non-
indigenous and indigenous subpopulations. The researchers also standardized the calculations of
the response rates. Notably, the response rates and sample size positively impacts the study by
reducing uncertainty and increasing its reliability and validity.
Question 8

EPIDEMIOLOGY 5
The study found that indigenous children were highly prevalent to a dry cough at night,
wheeze with colds (Raanan et al., 2015) as well parent-reported asthma in comparison to the
non-indigenous children. Similarly, the results showed that the prevalence of hay-fever and
eczema were higher in non-indigenous children in comparison to indigenous children (Glasgow
et al. 2003). The indigenous children were found to be having much exposure to the household as
well as environmental tobacco smoke as opposed to the non-indigenous children. The study
found that there existed too much dry coughing during the night and breathe shortness of
exercise.
Question 9
The presence of asthma was measured through examining the associations or relations
between atopic disease, the prevalence of respiratory symptom, and indigenous status. This was
conducted through a number of univariate analyses via the use of Haenszel and Mantel odd ratios
(Glasgow et al. 2003). The adjusted odds ratios were derived using logistics regression model to
assess the effects of interaction with the covariates. Data analysis was conducted through the use
of statistical package for the social science program. The rates were truncated to whole
percentages points while the P values <0.5 were taken as statistically viable. This particular
measurement had one limitation that is, rounding off of the percentage points to the whole
number. This can raise uncertainty in regards to the research.
Question 10
Some of the sources of bias in the study include confounding factors and selection bias
(Miller et al., 2001). Selection bias manifested itself through the over-representation of children
acknowledged by their parents as having asthma. Additionally, bias was introduced by the

EPIDEMIOLOGY 6
diverse understanding of the questionnaires amidst the two respondent groups. It is, however,
important to note that these biases had minimal effect on the study’s outcome or result.
Question 11
Chance influences the effect of bias. It was entertained in the study to act as a cause of
the observed association between the indigenous and non-indigenous children and the respiratory
symptoms (Sarna et al. 2018). Chance also played a role in determining the confidence interval
and P-values which play a significant role in results’ interpretation.
Question 12
The effects of possible confounders in the study were eliminated through logistic
regression models, matching, and restriction (Hayes and Preacher, 2014). For example, in the
study, the confounding factors such as age group and sex were handled by selecting subjects of
the same age group. Matching was used to handle potential confounders, for instance, the girls
and boys in the same age group were matched. Similarly, the Mantel-Haenszel estimator was
employed to offer an adjusted outcome in accordance with the strata (Elo and Kyngäs, 2008).
Question 13
These findings can be applied to all indigenous and non-indigenous children.
Furthermore, it can be generalized to those suffering from respiratory diseases in the country.
First, the study had a high response rate ranging between 82 percent and 90 percent. Secondly,
the subjects were selected through a non-random probability (Haby et al., 2001). The study did
not apply a random selection of the subjects; it attested all the kindergarten children in the
Australian Capital Territory. It is also important to note that there was no late respondent; all the
respondents responded within the study’s timeframe. In the same token, all the target population
members had an equal opportunity of being selected in the study.

EPIDEMIOLOGY 7
Question 14
Generally, the creative and critical assessment and analysis of the article background and
abstract demonstrate a well-organized as well as logical presentation which meets the authors’
objectives and intended purpose. The journal draws its strength from a coherent and consistent
thesis which matches up the introduction and conclusion thus demonstrating a strong convincing
power in the interpretation, findings, and integral text. The critical review of the writers’
methodology is founded on the overall study design, therefore, demonstrating well-organized
and appropriate presentations research questions and results, and ideas which are properly
interpreted to support the research’s goal (Graneheim and Lundman, 2014). The authors rely on
old sources and literature review which date back to 1990s to support the research. This
weakness hinders the credibility of the research. In spite of the limitation, the article is authored
by some of the professional and experienced authors in the healthcare industry. Nicholas
Glasgow is one of the renowned palliative medicine specialists as well as a general practitioner.
He has done a lot of significant work and high-quality research in medicine, for instance, he
examined or assessed the interface amidst secondary and primary care in developing nations in
his doctoral thesis. Additionally, he is considered as one of the excellent primary health care
researchers. As result of the authors’ experience, this article’s quality is unquestionable.

EPIDEMIOLOGY 8
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