According to Aatsinki, et al. (2019), Gut microbiota composition is largely linked to a series of temperament traits that occur among infants. The context of the study by Hamad, et al (2019) is to explore the occurrence of Attention-Deficit/Hyperactive Disorder (ADHD) among infants after they are administered with a certain dosage of antibiotic medications. The study which is a Population-Based Cohort survey aimed to explore the risks associated with antibiotic exposure during an infant’s first year and the potential of developing personality disorders due to the consumption of these drugs. The primary exposure of interest is the risk increase of ADHD which was observed within a duration of more than three weeks to determine the association. The exposure was accurately assessed in terms of the cohort included and the scope of risks the cohort was exposed to. The exposure involved filling one or more prescriptions of antibiotics within the first year of infancy.
The primary outcome of interest was the potential of the identified service users or cohort to develop ADHD within their first years of life due to the use of antibiotics. Using a Cox proportional hazards regression tool, the analysis determined high risks of ADHD condition among service users who had been exposed to four or more of antibiotic prescriptions. The study incorporated a quantitative approach in assessing the potential development of ADHD due to exposure to antibiotics. The study cohort involved children born in Manitoba, Canada, between 1998 and 2017. The selection model included identifying service users who have filled 1 or more antibiotic prescriptions within the first year of infancy. The sampling criteria were susceptible to bias because determining the frequency of use from either home-based care models or through physician attendance lists was not feasible. Data sources used within the study were largely effective and accurate. The institutions that approved the study provided it with more basis and authenticity.
To minimize the effects of confounding factors within the study, the researchers conducted a matched clinical trial that involved children born between 1998 and 2017. With the large cohort size that is matched, the confounding factors or risk elements associated with ADHD are equally distributed among the sample groups. Also, within the case-control study, the age which is a key confounding factor matches every service user with one or more subjects of the control samples of similar age. The sample size was not only able to have the same age-gap distribution but also able to match the compared groups and adequately mitigate confounding by age.
After completion of the study, confounding bias was controlled through stratification. Through this control method, the researchers divided the samples into subgroups according to the potential confounding factors which included age, gender, frequency of antibiotic use, and exposure groups. The control method was effective in enabling the researcher to adequately determine the probability of ADHD diagnosis and the associations between antibiotics consumption and the development of ADHD. A critical aspect of an epidemiological study is comparison. The measures of association reported within the study and which have been used to draw comparisons include the risk ratio and rate ratio. The measures of the association have been used to compare how vulnerable children exposed to frequent antibiotic medication use are in developing ADHD. The measures of statistical ability reported in the study included Hypothesis Testing whereby a set of random variables was largely observed to inform the findings.
The population-based cohort study which considered findings from different models or subgroups within the study considerably determined that consumption of antibiotics medications within the first year of an infant largely contributes to the development of ADHD. Even though the findings of the epidemiological study considerably reflect on the true impacts of exposure to antibiotic medications during the first year of an infant, random errors, confounding bias, and selection bias may impact interpretation. From the different study groups incorporated in the study, information bias in terms of exposure and outcome from the sample groups may be untrue. Confounding bias may also ensue as the service groups may be exposed to other ADHD related conditions such as sleep disorder which may impact interpretation.
Within the epidemiological study, the correct classification of individuals to exposure and characteristics is essential in determining the outcome of the study and how it is interpreted. The probability of individuals being misclassified within the epidemiologic study is consistent among the study groups. A consideration of the alternative interpretations of the study’s findings demonstrates that non-differential misclassification may cause bias on the risk ratio or risk rate. The discussion section of the study satisfactorily addressed the study limitations. The study’s inability to account for all the confounding sources was addressed, the risk estimates and the potency of the study to draw varied interpretations were also identified.
According to the researchers, the wide-ranging and final outcome of the study is that from the varying study group’s outcomes, antibiotic use during the first year of life is not linked to the development of ADHD in infancy. The different considerations and clinical trials considerably justify the researchers’ final verdict. The results of this study can be integral in informing the development milestones of schizophrenia and the risk factors associated with the condition among youths who are susceptible to alcohol and substance abuse.
