Epidemiology

Healthy People 2020 is a framework to assist communities in preventing disease and
promoting health. Search the scientific literature and find a research study related to
one of the Focus areas identified by Healthy People 2020.
In a 750-1000-word essay, critically appraise the study by answering each of the
following questions:
What is the study question and is it relevant?
Does the study add anything new?
What type of research question is being asked?
Was the study design appropriate for the research question?
Did the study methods address the most important potential sources of bias?
Was the study performed according to the original protocol?
Does the study test a stated hypothesis? If so, what is it?
Does the data justify the conclusions?
Are there any conflicts of interest?
There are methodological points to consider in appraising literature that are specific to
cross-sectional, cohort, case-control, clinical trials, and case studies. Based on the design
of this study, what are the key methodical points to consider?
You are required to use a minimum of three scholarly resources.
Prepare this assignment according to the APA guidelines found in the APA Style Guide,
located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the
assignment; therefore, students should review the rubric prior to beginning the
assignment to become familiar with the assignment criteria and expectations for
successful completion of the assignment.
You are required to submit this assignment to Turnitin. Refer to the directions in the
Student Success Center. Only Word documents can be submitted to Turnitin.

Epidemiology

Diabetes – Type1, Type 2 and gestational diabetes mellitus – is one of the focus areas
of Healthy People 2020. This paper provides a critical appraisal of a research study related to
gestational diabetes. Gestational diabetes is a key complication during pregnancy and it can

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result in perinatal complications in the infant and the mother and it greatly increases the
probability of cesarean section (HealthyPeople, 2014).
Research study: Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy
Outcomes by Crowther, C. A,. Hiller, J. E., Moss, J. R., McPhee, A. J., Jeffries, S., &
Robinson, J. S. New England Journal of Medicine 2005; 352: 2477-2486
The study question is: what is the effect of treatment of gestational diabetes mellitus
on pregnancy outcomes? The study question is relevant in the sense that it provides insight
and knowledge on how treatment of women with gestational diabetes mellitus affects
pregnancy outcomes both on the mother and the newborn. The study adds something new in
existing literature since it provides new knowledge that the treatment of ladies with this
disease – including insulin therapy, monitoring of blood glucose, and dietary advice –
reduces the rate of grave perinatal outcomes which are essentially defined as nerve palsy,
bone fracture, shoulder dystocia, as well as death (Crowther et al., 2005). The research
question being asked is: what are the effects of treatment for gestational diabetes mellitus on
infants and mothers?
The study design was appropriate for the research question since it entailed women
with gestational diabetes assigned to routine care group and others assigned to the
intervention group. The study design used by the researchers involved women who had twin
or singleton pregnancy between 16 weeks’ and 30 weeks’ gestation; had risk factors for the
disease on selective screening or a positive 50-g oral glucose-challenge test; went to antenatal
clinics at the collaborating health organizations; and had a 75-g oral glucose tolerance test at
24 weeks to 34 weeks’ gestation where the venous plasma glucose level was lower than 7.8
mmol per liter following an overnight fast and was between 7.8 mmol per liter to 11.0 mmol

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per liter at 2 hours. Women were given advice to follow a standard diet 48 hours before the
oral glucose-tolerance test, and to fast for eight hours the night prior to the test.
The study methods actually addressed the most important potential sources of bias.
This is because stratification was consistent with center and twin or singleton gestation. In
addition, randomization was carried out centrally using numbers produced by computer with
variable block sizes of 10, 8 and 6 (Crowther et al., 2005). The care of the ladies within the
intervention group did duplicate clinical care where universal screening and treatment for
gestational diabetes mellitus are available. The care of ladies within the routine-care group
did replicate clinical care where screening the disease is unavailable. The study was
performed according to the original protocol since the study went on as the researchers had
anticipated and they did not diverge from the plan of the research. The researchers formed 2
groups of women with the disease: of the 1,000 that took part in the study, 510 were assigned
to the routine-care group whereas 490 to the intervention group. The researchers obtained
clinical outcomes up to the moment of discharge from hospital for each of the women and
their 1,030 babies.
The study tests stated hypotheses. The hypotheses are: (i) the treatment of gestational
diabetes mellitus will decrease perinatal complications; (ii) treatment of diabetes mellitus has
effects on maternal outcome, quality of life and mood. The data justifies the conclusions
primarily because the conclusions were derived from the data obtained from the research
study. The conclusions are in line with the data obtained. Results of the research were that the
rate of grave perinatal outcomes amongst the newborns was substantially lower in the
intervention group in relation to the routine-care group. There were no perinatal deaths
amongst the newborns of mothers who were in the intervention group, and there were 5
perinatal deaths amongst newborns born to ladies within the routine-care group. The
researchers concluded that the treatment of ladies with gestational diabetes mellitus decreased

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the rate of serious perinatal outcomes. The benefits were linked to an increased usage of
induction labor for the mother as well as an increased rate of admission to the neonatal
nursery for the newborn. The researchers asserted that the earlier gestational age at birth as a
result of labor induction might have contributed to the decrease in grave perinatal outcome.
The researchers also concluded that the research showed an improved health-related quality
of life amongst ladies within the intervention group, both in the antenatal period as well as 3
months following birth, with a decrease in the occurrence of depression following birth
(Crowther et al., 2005). The results of this research are different from reports that suggest a
decline in the perception of women of their own health after they get a diagnosis of the
disease (Infanti, 2014). In this study, there are not any conflicts of interest. The researchers
were objective in the study. The key methodical point to consider is that this research study
was a randomized clinical trial.

Reference

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EPIDEMIOLOGY
Crowther, C. A,. Hiller, J. E., Moss, J. R., McPhee, A. J., Jeffries, S., & Robinson, J. S.
(2005). Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy
Outcomes by New England Journal of Medicine 2005; 352: 2477-2486
HealthyPeople. (2014). Diabetes.

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