Should this study be trusted to support decision making? Please rate your confidence (1=lowest confidence; 10=highest confidence) in the study discussion/conclusions. Please explain your rating

Answer Explanations

• 1

  user-481327
  Overreaching conclusion based on evidence presented in the article.
• 5

  user-569374
  Due to the inconsistency in the observed associations between exposure variables and the limited number of potential confounders included in the regression models, these results should be considered in the context of other existing and subsequent research. The findings of a sex-specific association between higher urinary fluoride concentrations and significant decreases in male IQ scores is of concern, but should be assessed in other populations to assess the reproducibility of the findings in the context of regulatory decision making.
• user-868575
  N/A
• 6

  user-480186
  See above
• 1

  user-965103
  Most importantly, the authors don't seem to realize that children born in areas with fluoridated water will continue to have increased fluoride exposure after birth. The conclusions of the study focus on exposure during pregnancy, but the observed associations may very well have resulted from exposure during the subsequent 3 to 4 years.
  From a water-fluoridation-policy perspective this may be less important, as lowering the fluoride content of the water would be the solution in either case. In terms of advice for pregnant women, or people raising small children, there could be important differences though.
  
  Further, without a clear biological explanation for the observed difference between boys and girls, and in the presence of multiple earlier studies showing no such difference, I find it doubtful that this difference is more than a chance association.
  If that's what it is, then you could also wonder whether it is chance that you do see an association in boys, or that you don't see one in girls. Either would be equally likely, casting doubt over the reliability of any conclusions from this study.
  
  In conclusion: although some tentative conclusions might be possible, these should be used solely to guide further research, as this study doesn't seem robust enough to base any kind of policy decisions on.
• 7

  user-134615
   The study's discussion and conclusions are thoughtful and grounded in the data collected. The authors acknowledge the limitations of their study, such as potential confounders and the observational nature of their design, which adds credibility to their interpretation. They refrain from making overly definitive claims and call for further research to confirm and expand upon their findings. However, while the discussion is cautious and balanced, the inherent uncertainties in the study design and results reduce confidence in using the conclusions as a sole basis for decision-making on water fluoridation policies.
  
  

  
  
• 6

  user-603573
  The study has good sample size and it has minimised the errors of measuring urinary fluoride level by analysing 3 serial samples. 
• 2

  user-319692
  The conclusions should be tempered due to the limitations of the study. 
• 1

  user-777357
  The limitations were mentioned in the analyses and discussion sections.
• 6

  user-881218
  The finding of this study can be used with other additional larger sampled studies' findings.
• 7

  user-163602
  As above
• 6

  user-368556
  Similar studies should be conducted to support the conclusion. 
• 6

  user-751579
  The biological coherence and potential pathways of causality or exposure and outcome could be considered sound and adequate; nevertheless the  accompanying and acknowledged limitations offer the plausibility of alternative explanation and inferences.