Ibn-Sina nursing and midwifery

collage
Article critique
Breastfeeding and obesity in Brazilian children
Prepared by:

Asma R. Mansrah, Khadejah A. Manasrah,

Amal Islimia
Supervisor:

Dr. Saleh Hajeer

17/5/2016

Abstract
The overall goal of a research critique is to formulate a general evaluation of the merits of
a study and to evaluate its applicability to clinical practice.
A research critique goes beyond a review or summary of a study and carefully appraises
a studys strengths and the research study can be evaluated by its component parts, and a
thorough research critique examines all aspects of a research study.
This purpose of this paper is to critically appraise a research article
Breastfeeding and obesity in Brazilian children
The Article objective is: to assess whether obesity is associated to occurrence of
breastfeeding and to duration of total and exclusive breastfeeding in Brazilian children.
I can say that the title is very clear and give me the right impression when I read the
whole paper, because it wasn't complicated and it gave me some hints about the subject
of the article, so I decided to start.
Our aim is to produce a critique of this paper and to explore issues.
In the other hand the study provides an abstract was clear, and reflects the summary of
the research article and I can understand from such small paragraph.
This paper is an academic critique of an article written by Juliana F. Novaes, et al. (2011)
titled: Breastfeeding and obesity in Brazilian children. The authors undertook a research
study to assess whether obesity is associated to occurrence of breastfeeding and to
duration of total and exclusive breastfeeding in Brazilian children. our examination
systematically focuses on specific aspects of the article in terms of process and validity of
research methods and results. We have attempted to develop a cohesive and unified
explanation which not only expounds the particulars of the research but which also
formulates a clear interpretation of that research throughout.

1. Source
Is the report from a peer reviewed publication?
Is the research current and from a current source?

Published in European Journal of Public Health, by Oxford University Press on behalf of

the European Public Health Association
Writing Style
Is the article well written (concise, grammatically correct, avoids the use of jargon)?
Yes, overall its well written, but the language can tone down to be more reader friendly.
And there is good in spelling and grammar.
Is it well laid out and organized?
Yes, its organized well.
Report Title
Is the title clear, accurate, and unambiguous?
Yes, the tile clearly tells its a scale development and validation study.
The title of the study had been able to show the understandable picture of the whole
content of the study, in short but interesting manner, the title here concise but
informative, and sound interesting. But it not contain the essence of a quantitative study
in health care research and give clear but succinct picture of the contents of the study.
But it not contain the method of study.
Abstract
Does the abstract offer a clear overview of the study, including the research
problem, Sample, methodology, findings, and recommendations?
Yes, In the study, The abstract that had been presented at the beginning of the paper start
name as background, gives the reader the summary of the research that gives short
explanation regarding the entire content of the article such as the objective, methodology,
conclusion as well as its connection to the field of study. That is the reason why it can be
considered as a good abstract because the abstract give the readers with the quick
overview of the research question, aim, methods adopted and main results of the study .
Furthermore, the abstract is also concise, following the standard word count between 150
to 300 words.

the abstract is divided into parts: background, aims, method which include design,
setting, participants, main outcome measures, results, and conclusions. The abstract may
be give all that needed to read, and no recommendations were mentioned in abstract of
study.
Research Problem
Is the problem identified clearly?
Is it significant--does the researcher provide a good argument for significance?
Is it relevant to nursing/health care?
In this research the problem not mentioned in titled part, its component of the
introduction Obesity is an emergent public health problem in Brazil and many other
countries. It is one of the most serious nutrition problems affecting children, with
potentially severe consequences for physical and mental health. Obesity has multiple
causes and consequences, representing a challenge for health professionals who work
with children. Preventive measures can avoid long-term harmful consequences of organic
or psychosocial origin, so that low-cost preventive measures should be favoured. If a
protective role for breastfeeding is confirmed, it could represent an effective weapon
against obesity, adding to its many other already known advantages.
The problem statements agreed with the title and seemed to be of educational
significance. The problem was clearly visible to the average reader, and it give obvious
view why the researchers felt this study needed to be done. and give comprehensive view
about the problem Also its provide good argument for significance and its summarized
Literature Review
Is it convincing that the author reviewed a sufficient amount of literature?
Is it balanced, presenting literature that supports and that differs from
the researcher's position?
Is the review written critically (giving strengths and weaknesses of
previous work)?
Is the review comprised only of primary sources?
Are references current, or a combination of current and classic?

The authors cited no clear review of literature; however, several appropriate references
were used in the introduction section. These statements contributed to the overall
understanding of the subject and to the reasoning for establishing the problem statement.
It should be several sources to review by the authors to establish the need for the study.
Theoretical Framework
Is a theoretical framework specified?
Does the framework "fit" the problem? Include all relevant variables?
Are concepts (variables) defined clearly from a theoretical standpoint?
If no framework is provided, should there be one? Is it difficult to understand the
relationships among variables in the study without a framework to tie the pieces
together?
Are results interpreted in reference to the theoretical framework?
This is descriptive quantitative prospective study.
The framework that is most identifiable in this study is a conceptual framework. There is
no specific theory that is related to the researchers focus in this study. The framework in
this study is broad. The basis of the study is related to previous research studies and the
researchers
Variables
Are the variables in the study appropriate to the problem?
Are the variables relevant to nursing practice?
Are the means to measure the variables appropriate?
The variables used in this study appropriate to achieve the aims and relevant to medical
research.
Design (overall)
Is the design specified correctly? What design was used?
Is the design appropriate to answer the research question?
Did the researcher attempt to control for threats to internal and external validity?

This study was conducted quantitative with 1066 children, A cross-sectional study was
conducted with 764 school-children aged between 6 and 10 years, enrolled in the two
larger public (n = 2) and private (n = 2) schools in city of Vicosa, Minas Gerais, Brazil
during 2005/2006.
The design appropriate to answer research question and can met the aim of the study.
METHODOLOGY
The Design for this paper is quantitative cross-sectional design
Strengths Uses of this Method
The researcher is able to contact large numbers of people quickly, easily and
efficiently using a postal questionnaire (since all he / she has to do is identify the
group that will be targeted and post them the list of questions).
Questionnaires are relatively quick and easy to create, code and interpret
(especially if closed questions are used). In addition, the respondent - not the
researcher - does the time-consuming part of completing the questionnaire.
A questionnaire is easy to standardize. For example, every respondent is asked the
same question in the same way. The researcher, therefore, can be sure that
everyone in the sample answers exactly the same questions, which makes this a
very reliable method of research.
Questionnaires can be used to explore potentially embarrassing areas (such as
sexual and criminal matters) more easily than other methods. The questionnaire
can, for example, be both anonymous and completed in privacy. This increases the
chances of people answering questions honestly because they are not intimidated
by the presence of a researcher.
Sample
Is the sample size adequate?
Is the sample likely to be similar to members of the appropriate population overall?
Are the criteria for including and/or excluding people or items from the sample
clear and appropriate?
Yes its adequate, The sample size was calculated using the following premises:
overweight prevalence (8%),14 the desired level of precision of 2%, 95% of power, 5%
of significant level and estimated loss of 10%., and all of them were recruited to increase
the power of the study and to be 95% significant, this is suitable for human studies.
Was the setting and sample described in sufficient detail?

The sample and setting aspects of the study have been described in sufficient detail. It
had been able to show and describe the settings of the study, from the place and
organization that are involved. The city of Vicosa, located in the region of Minas Gerais
in Southeast Brazil, has a population of around 64 800 inhabitants of which 59 792
(92.2%) live in the urban area.
And the paper describe the informants, who they were, how many were chosen and the
reason for the choices. The paper tell how the samples were obtained, and describe the
setting in which the study.
The sampling design for this study appears to have been well planned. The study setting
was well matched to the sample the researchers sought to obtain. A very good level of
detail is provided about the data collection procedures and measures used in the study.
A questionnaire was applied preferably to the mothers during the consultation. The
questionnaire evaluated family characteristics, conditions of the mother during
pregnancy, childs birth, duration of breastfeeding and practice of physical activities by
the children. The duration of exclusive and total breastfeeding was registered after
information of the mother, and classified according to exclusive breast milk intake and
intake of breast milk independent of any other solid or liquid food, including non-human
milk, respectively.16 Pregnancy weight gain was considered excessive when over 16 kg,
in accordance to guidelines of the Brazilian Health Ministry.17 Birth weight <2500 g,
25003000 g and 3000 g were considered as low, insufficient and normal, respectively.
It had been able to show the organization that is primarily involved in the said setting and
the aspects that are related to it. On the other hand, the approach that had been used in
accessing the participant was stated, by describing whether the participants were
advertised on a notice board or approaches the potential participants personally.
The outcome variable of the study was obesity in children, and the explanatory variables
referred to occurrence of breastfeeding and duration of total and exclusive breastfeeding.
Ethical Considerations
Does the researcher indicate that approval was obtained from appropriate review
boards?
Were the rights of human subjects protected (confidentiality, freedom from coerci
on)?

Is there any possibility that the subjects might have felt pressured to participate or
their responses influenced in some other way?
The process of gaining access to the recruit participants can be considered as appropriate
because it had been able to get their permission.
Furthermore, it had also followed the ethical issues and consideration they did not survey
patients as this was primarily a clinical, not a quality control audit; as such, IRB was not
required.
This study was approved by the Research Ethics Committee of Federal University of
Minas Gerais (protocol number 0392/05). Participation in the study was entirely
voluntary: child consent and signed informed consent of the parents or legal guardians of
each participant were obtained prior of the study
Data Analysis
Several statistics were used in the interpretation of the data. The analysis of the data was
done so used the softwares Epi Info 6.0,20 Sigma-Stat 2.0321 and SPSS 15.0 for
Windows.
The results were first analysed as categorical variables. The chi-square test or Fishers
test were used for bivariate comparisons with obesity prevalence, with determination of
the odds ratio (OR) and 95% confidence interval (95% CI) for each of the variables.
Variables were adjusted with multiple logistic regression, and the cut-off for inclusion
was a P < 0.2 in the bivariate analysis with obesity. The variables were included in the
regression analysis according to descending OR values with the enter method, for
analysis of occurrence of breastfeeding and duration of total and exclusive
breastfeeding.
Descriptive Statistics
The adjusted OR was compared between two groups: obesity (BMI > 2SD) and noobesity (BMI 2 SD). For the analysis of occurrence of breastfeeding, confounding
variables were considered as those associated to the outcome and modifying the OR of
the first category of breastfeeding in at least 10%. Factors independently associated to
the outcome in the final model of multiple logistic regression were considered as
confounding variables in the analysis of duration of total and exclusive breastfeeding.
The KolmogorovSmirnov normality test was used to determine if the distribution of
values was normal to all variables. According to the distribution of variables in the

normal curve, the Students t-test, Mann Whitney test, one-way analysis of variance and
the KruskalWallis test were used to compare means or medians of the variables.
Pearson or Spearman correlation tests were also employed. Values of P < 0.05 were
considered to be statistically significant
Result
The authors discuss the results in a manner that is objective and reflective of the
data. The researchers began the study with the prevalence of obesity was 10.7%. The total
percentage of boys was 49.9%. The majority of children (92.6%) were breastfed during
infancy. Only 23.2% of children were exclusively breastfed at least 4 months. The
median duration of total and exclusive breastfeeding was 8.6 and 1.5 months,
respectively. And then the researcher show the correlation and significant of variables
and describe it by word and tables of data.
Discussion and Interpretation of Findings
Does the discussion "fit" with the data? Is it logical based on the data and results
presented?
Does the researcher discuss the findings in regard to previous research?
Does the researcher discuss the findings in regard to the theoretical framework?
Does the researcher identify limitations of the study? How do these affect the quality
of the study?
Does the researcher discuss implications for practice? Are these appropriate?
For the most part, the discussion of this article takes the ideas presented in the Results
section and makes value statements based upon them. Thus, the interpretation of the
results is reserved for this section (although some interpretation is undertaken in the
previous section). Generally, the results are discussed in relation to previous research
studies.
In terms of success, it is perhaps useful to reiterate the research question for this article:

This study did not show a protective effect of breastfeeding against obesity in schoolaged children or a doseresponse relationship, even after adjustment for confounding

variables. Our results do not support the hypothesis that breastfeeding promotion would

reduce obesity in Brazilian children population.

The results do not support the hypothesis that breastfeeding promotion would reduce
obesity in our population. Nevertheless, it is still of utmost importance to promote and

stimulate breastfeeding, due to the many other benefits for the baby and the mother.
Non-breastfeeding is not a risk factor to which one is either exposed on unexposed. The
types of foods received by children who are not breastfed may vary between high- and
low-income countries. This highlights the need for additional studies on more detailed
dietary patterns in developing countries, like Brazil.
Recommendations

Future studies are thus necessary for a better understanding of a protective effect

of breastfeeding against obesity in children of developing countries like Brazil.

Implications for public health policy and practice are that the protective effect of
breastfeeding against obesity is small as compared to other influencing factors

such as sedentary habits and obesity of the mothers.

Importance to promote and stimulate breastfeeding, due to the many other
benefits for the baby and the mother