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2220MED Epidemiology Question  The following questions are guide to your essay as these points should be addressed. These are all epidemiological concepts that we covered in the course but you are free to arrange them differently under sub-heading or stick to question answer format if you find it difficult.  1) Overview of the paper you selected. a. What is the issue addressed in the paper, is it important novel?  b. What was the exposure or intervention? -What was the outcome? c. What was the study design? d. What was the study population? e. What were the main findings? Were the authors advise for future direction or about the study implication  2) Appraise the internal validity To what extent can the observed association between the exposure and outcome be attributed to non-causal explanations? Consider the following questions in your critique: Are the results clearly presented? Are the results likely to be affected by chance variation? Are the results likely to be affected by biases, what kind of biases ? are the results likely to be affected by confounding; has any interaction or sub-group analysis was conducted.   3) Do you believe a causal association between exposure and outcome is plausible? This is based on your conclusion on internal validity but also appraisal of possible causal association based on several criteria. 4) Appraise the external validity of the finding: can the findings be applied to the source population from which the study population was derived? Can the study results be applied to other relevant populations? Appraise the overall quality of the discussion section.  Answer The Relationship Between Consumption Of Coffee And Tea And Endometrial Cancer Risk Cancer refers to a group of diseases caused by abnormal growth of cells in different parts of the body that can spread and invade other parts of the body. Some of the basic symptoms of the disease include prolonged cough, change in movement of the bowels, unexplained weight loss, abnormal bleeding, and a lump in some cases (Hutchison, Boscoe, & Feingold 2018). The signs and symptoms of cancer may vary from one person to another depending on their immune systems and the type of cancer. The symptoms may also differ due to the body part invaded by the disease. It should be noted some of the symptoms associated with cancer are not limited to the disease as they can be seen as signs of other diseases. These signs include sudden unexplained weight loss or gain, fatigue, a thickened area mostly under skin known as lump, changes in bowel movements, prolonged cough, sudden bleeding, changes exhibited on the skin, and hoarseness (Fitzgerald et al., 2017). Some other symptoms include pain in the joints and muscles, night fevers and sweating, some unexplained digestion discomfort and fatigue. Cancer is caused by changes in the process of mutation among cells in the body. Even though cancer occurs to people with no noticeable risk factors, doctors argue that there are some of the risk factors associated with cancer include an individual’s age. It is believed that cancer takes a long time to develop in human body and that is the reason why most patients diagnosed with cancer are old, aged 65 years and above (Xiaofei, Lin, & Shihua 2017). It should be noted that there are emerging trends of younger people being diagnosed with the disease. There are some inheritable conditions that may increase an individual’s chance of getting cancer. But one should know that coming from a family with man cancer cases does not necessarily mean that he or she must get the disease. There are some chronic health conditions that ma increase one’s chances of getting the disease, conditions like ulcerative colitis. The environment one lives or works in ma increase the chances of getting cancer (Cardoso, Graca, Klut, Trancas, & Papoila 2016). Living with people who smoke leads to inhaling secondhand smoke and working in areas with polluted with asbestos and benzene may increase the probability of being a cancer patient. Some lifestyle habits such as smoking, excessive consumption of alcohol, unsafe sex, excess sunburns and being obese. Some lifestyle practices are believed to reduce the chances of being a cancer victim. Importance Of The Study A study done on the relationship between consumption of tea and coffee and risk of getting Endometrial Cancer shows that some life practices reduce the probability of getting the disease. Based on the research done in Roswell Park Cancer Institute, Buffalo New York shows that the there are chances that an individual taking some amount of coffee and tea on daily basis has a lower risk of getting endometrial cancer than those people who do not take such beverages.Endometrial cancer is a category of cancer disease where the abnormal mutations of cells occur in the uterus and is sometimes known as the uterine cancer (Hvidberg et al., 2016). This type of cancer is easily detected due to the fact that leads to frequent abnormal vaginal bleeding that makes women seek medical attention as fast as possible. It can be treated at an early stage through the surgical removal of the uterus. Some of the basic signs that one may be suffering from this type of cancer include bleeding between periods, vaginal bleeding after menopause, pelvic pain, and abnormal blood stained discharge from the vagina. The risk factors associated with endometrial cancer include changes in the balance of female hormones in women’s body (Niederdeppe et al., 2014). It is believed that there are two types of hormones created by the ovaries in women’s body; estrogen and progesterone. There is some balance that needs to be maintained between the two hormones such that any variation leads to abnormal cell mutation that may lead to endometrial cancer. Krieger (2017) explains that beginning menstruation early before 12 years and or late start of menopause may creates to exposure that may lead to endometrial cancer.  Doctors explain that not having been pregnant at all may lead to a woman getting endometrial cancer. Other known risk factors associated with this type of cancer include old age, obesity, and an inherited colon cancer syndrome and hormone therapy for breast cancer. The exposure to the tamoxifen used during such therapy increase the risk of getting this kind of cancer but most people overlook the risks due to the benefits of the therapy. Some of the known ways of preventing this type of cancer include discussing the best way out with the doctor during hormone therapy (Kim, Vance, Chen, & Chun 2018). Use of birth control pills for at least one year in a life time may reduce the risks of getting this type of cancer. Avoiding obesity and maintaining healthy weight may also reduce the chances of contracting the disease. Frequent exercise is one of the methods of reducing the risks of getting the disease. Based on the research study on the relationship between the risk of getting endometrial cancer and consumption of the world’s popular beverages; coffee and tea, there are other ways of reducing the risk of getting endometrial cancer. The findings and results from the study show that by taking some amount of coffee and tea on daily basis, one reduces the risks of getting the disease (Mäkel et al., 2014). The importance of this study rests in the fact that there are some people in our communities who have given up in the fight against endometrial cancer and the revelations from this study presents to the one of the best and cheapest ways of preventing the disease. The Exposure And The Outcomes The stud exposes a number of women to the consumption of a given amount of tea, coffee and the some women to the consumption of both the two beverages. In the study, the women used were marked as those who used to take no tea, those who take 1-2 spoons per day, and those who take more than two. The same procedure is repeated for another set of sample of women but using coffee (Birmann et al., 2016). The third set was subjected to the use of both coffee and tea; again here the consumptions were of different quantities. There are some other parameters that were tested like the women’s weight, lifestyle behavior like smoking history, and their level of study; whether they had gone bellow high school or beyond high school. Holding all other variables constant, the study results indicated that there are negative relationships between the risks of getting endometrial cancer and the consumption of the beverages (Seidelin et al., 2016). The outcome was that the women who consumed some mount of tea and coffee had reduced risk of developing the abnormal cell mutation in the periphery of the uterus that would lead to endometrial cancer. The Study Design And The Study Population The data used in this study were collected from patients who were seeking medical services from Roswell Park Cancer Institute, Buffalo New York. The sample consisted of 541 women who had some historical experience with endometrial cancer and other 541 women with intact uterus (Jeppesen et al., 2017). The data was collected as part of the Patient Epidemiologic Data System (PEDS) in the hospital between 1982 and 1998 after the approval of Institutional Review Board.. the data was collected through the use of comprehensive epidemiological questionnaires given to all the targeted respondents who had come to the hospital for cancer diagnosis and or treatment. The research indicates that a half of the women given the questionnaires returned them filed. The time given for the filling of the questionnaires was roughly one month. The eligible population was 5650 women who visited the hospital for cancer related services but a sample of 541 patients were used on either side; the control and the ones subjected to the variables. The control consisted of 541 women who had no cancer history and exhibited intact uterus while the other 541 women were subjected to the consumption of varying amounts of tea, coffee and a combination of the two beverages. The Patient Epidemiologic Data System questionnaire included a 16 page instrument that consisted of self administered topics on personal lifestyle such as tobacco smoking, alcohol consumption, and diet. Other areas covered I the booklet included the cancer history of one’s family, occupational and environmental information on exposure, and medical history of the participant (Birmann et al., 2016). The information required on diet included the 44-item food frequency questionnaire that covered the food and diet used some time before the diagnosis. The study paid some focus on the diet the patients used some time before the study. This data was collected by the use of 44-item food frequency questionnaire (FFQ). It should be note that data on beverages were asked separately from other food stuff given that the main study was on the effects of the beverages. The Study Findings The findings of the study show that there is a negative relationship between consumption of tea and coffee and the risk of contracting endometrial cancer. The findings further showed that the body mass index of an individual have some effects on the relationship studied.  The negative association between the consumption of coffee and the risk of contracting this type of cancer was mostly exhibited among women with normal weight where as the women with heavy wait were more responsive to the variations on tea consumption cancer (Hvidberg et al., 2016). Consumptions of coffee in high amounts exhibited a reduction in the risks of endometrial cancer primarily among normal weight women. On the other hand consumption of tea showed some reduction of such risks in heavier weight women. Given that both the beverages provided caffeine, it meant that the variation in the effects of the two beverages depended on other phytochemicals that were specific among the beverages used. The study showed that tea has high level of catechins and aflavines. These classes of flavonoid that are available in tea are said to reduce the activities of aromatase and the production of estradiolit should be noted that the women used in the research were mostly in their postmenopausal stage where the main source o estrogen is aromatization of androgens to estrogens(Xiaofei, Lin, & Shihua 2017). This process takes place in the peripheral adipose tissues.  For this reason, it is strongly believed that consuming a lot of tea which is rich in flavonoids reduces the risk of getting endometrial cancer as it regulates the activities of aromatase in heavier women. Internal Validity And Internal Causal One of the main strengths of this study is the fact that there were data regarding women who had some past experience with endometrial cancer and the women without such experiences. Krieger (2017) states that the availability of such pieces of data enabled comparison of the two sets of population. The results of the study were not affected by the cofounders given that the epidemiologic data provided more than enough data that was used to offset the effects of cofounders. Even though this factor was achieved effectively, there were some challenges encountered in the process.  The fact that the study was based in the hospital, there were chances that there could be some variations from between the patients visiting the hospital and other groups of the patients who suffer the same type of cancer in the general population. The research study tried to address this challenge by using the same measures used in other studies on diet and endometrial cancer (Seidelin et al., 2016). The use of the frequent food questionnaire resembles the ones used in other related studies. Other same measures included the use of common risk factors like the body mass index were also similar and that suggested that the bias was not an issue that could alter the findings and the results of the study.    Application Of The Findings At the point of the study, there was no information regarding the size of the quantity of beverages used and the researchers opted to use the number of cups per day. This would lead to misclassifications if the sizes of the cups used differed substantially. The frequent food questionnaires used had not been validated for the study even though they were compared to the ones used in other related studies (Jeppesen et al., 2017).  Based on these limitations of the study, it should be noted that the research findings and results cannot be applied directly in the population the stud represented. References Birmann, B. M., Barnard, M. E., Bertrand, K. A., Ying Bao, Crous-Bou, M., Wolpin, B. M., … Tworoger, S. S. (2016). Nurses’ Health Study Contributions on the Epidemiology of Less Common Cancers: Endometrial, Ovarian, Pancreatic, and Hematologic. American Journal of Public Health, 106(9), 1608–1615. Retrieved from Cardoso, G., Graca, J., Klut, C., Trancas, B., & Papoila, A. (2016). Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study. Psychology, Health & Medicine, 21(5), 562–570. Retrieved from Hutchison, L. M., Boscoe, F. P., & Feingold, B. J. (2018). Cancers Disproportionately Affecting the New York State Transgender Population, 1979-2016. American Journal of Public Health, 108(9), 1260–1262. Retrieved from Hvidberg, L., Lagerlund, M., Pedersen, A. F., Hajdarevic, S., Tishelman, C., & Vedsted, P. (2016). Awareness of cancer symptoms and anticipated patient interval for healthcare seeking. A comparative study of Denmark and Sweden. Acta Oncologica, 55(7), 917–924. Jeppesen, M. M., Mogensen, O., Hansen, D. G., Iachina, M., Korsholm, M., & Jensen, P. T. (2017). Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up. Acta Oncologica, 56(2), 262–269. Kim, K., Vance, T. M., Chen, M.-H., & Chun, O. K. (2018). Dietary total antioxidant capacity is inversely associated with all-cause and cardiovascular disease death of US adults. European Journal of Nutrition, 57(7), 2469–2476. Retrieved from Krieger, N. (2017). Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100%. American Journal of Public Health, 107(4), 541–549. Retrieved from Mäkel, K. T., Visuri, T., Pulkkinen, P., Eskelinen, A., Remes, V., Virolainen, P., … Pukkala, E. (2014). Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland. Acta Orthopaedica, 85(1), 32–38. Retrieved from Niederdeppe, J., Lee, T., Robbins, R., Kim, H. K., Kresovich, A., Kirshenblat, D., … Fowler, E. F. (2014). Content and Effects of News Stories About Uncertain Cancer Causes and Preventive Behaviors. Health Communication, 29(4), 332–346. Seidelin, U. H., Ibfelt, E., Andersen, I., Steding-Jessen, M., Høgdall, C., Kjær, S. K., & Dalton, S. O. (2016). Does stage of cancer, comorbidity or lifestyle factors explain educational differences in survival after endometrial cancer? A cohort study among Danish women diagnosed 2005–2009. Acta Oncologica, 55(6), 680–685. Trudel-Fitzgerald, C., Savard, J., Slim, L.-M., Roy, R.-C., Flett, G. L., Hewitt, P. L., & Ivers, H. (2017). The relationship of perfectionism with psychological symptoms in cancer patients and the contributing role of hyperarousability and coping. Psychology & Health, 32(4), 381–401. Retrieved from Xiaofei Yang, Lin Gao, & Shihua Zhang. (2017). Comparative pan-cancer DNA methylation analysis reveals cancer common and specific patterns. Briefings in Bioinformatics, 18(5), 761–773.

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