Healthcare Research: Application Exercises 1, 2, and 3 Analysis

This document provides comprehensive answers to three research application exercises. The first exercise analyzes two articles focusing on breast cancer risk in nurses and the link between diet and colorectal cancer. Questions cover study designs, population data, exclusion criteria, significant findings, and statistical interpretations like hazard ratios and confidence intervals. The second exercise examines a public health department's screening process for latent tuberculosis and an asthma-COPD overlap study. The final exercise explores nursing leadership during disasters and ethical guidelines in Ebola treatment trials. The answers include detailed explanations and analyses of the research methodologies, findings, and implications of each study. This assignment offers valuable insights into various aspects of healthcare research, including study design, statistical analysis, and practical applications.

Research Application Exercise 1
Instructions for completing the exercise:
1. Read the following two articles and use them to answer the following questions. Use
links to Article 1 and Article 2 to access the readings.
2. Note your responses on this document
Wegrzyn, R., et. al. (2017). Rotating night-shift work and the risk of breast cancer in the nurses'
health studies. American Journal of Epidemiology, 186(5), 532–540.
Article 1 (https:/doi.org/10.1093/aje/kwx140)
Shivappa, N., et. al. (2015). Inflammatory potential of diet and risk of colorectal cancer: a case –
control study from Italy. British Journal of Nutrition, 114, 152–158
doi:10.1017/S0007114515001828
Article 2 (https://tinyurl.com/ybkmfy3p)
Question 1:
What study design is the Wegrzyn article?
Answer: The study design is based on data collected from two cohort studies, which were
Nurses Health Study (1988-2012) and Nurses’ Health Study II (1989-2013).
Question 2:
What area of interest is being addressed in the Wegrzyn article?
Answer: The researchers aim at examining the association between breast cancer risk and
rotating night shift in nurses to find evidence supporting the statement of circadian disruption
being a probable carcinogen.
Question 3:
In the Wegrzyn article what is the total population (n=?) per group used in the study data?
Answer: In the first Nurses Health Study, the population was n= 78,516
In the Nurses’ Health Study II, the population was n= 114,559
Hence the total population of the study is n= 1,93,075

Application Exercise 1
Question 4:
What is the exclusion criteria of the study population for primary analysis in the
Wegrzyn article?
Answer: Parous women at the baseline were excluded from the study.
Question 5:
Why is exclusion criteria used and why is it important to this or any study?
Answer: Women nurses bearing offsprings were excluded from the study as the reported shift
work for parous women at baseline could not be attributed to either pre-pregnancy or post-
pregnancy period.
Question 6:
What is a significant finding of the mean ages between the groups in the Wegrzyn article?
Answer: According to the research findings, the women with 20 years or more at baseline shift
work showed increased risk of breast cancer than the women with 20 years or more of
cumulative shift work.
Question 7:
Why is the answer in question 6 significant to consider with regard to the overall incidence of
breast cancer? (Hint: To answer elements of this question you will need to find statistical data
on breast cancer https://ww5.komen.org/BreastCancer/Statistics.html)
Answer: The median age of breast cancer diagnosis in the United States is 62. The study result
shows that circadian disruption in the female nurses are leading them to increased risk of
breast
Question 8:
Why is hazard ratio used in the study vs risk ratio?
Answer: Hazard ratio shows the instantaneous incidence rates of the risk of breast cancer in
nurses, which would be better indicator to fulfill the objective the research topic instead of risk
ratio which is a ratio of cumulative risks.
Question 9:
For an odds ratio of 4.10, when calculating 95% confidence intervals, would a confidence
interval of 3.10 – 7.87 be statistically significant?
Answer: The confidence interval would be statistically significant.
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Application Exercise 1
Question 10:
Is a relative risk of 0.79 considered a positive or negative association?
Answer: Relative risk less than 1 would be interpreted as reduced risk by exposure, hence
negative association.
Question 11:
Is type of study is the Shivappa article?
Answer: The researchers conducted a multi-center case control study to examine the
association between the risk of CRC and dietary inflammatory index.
Question 12:
Is the Shivappa study retrospective or prospective?
Answer: The study conducted is retrospective as the information collected is from the past
history of the participants.
Question 13:
What is the hypothesis of the study reported Shivappa article?
Answer: According to the hypothesis stated by the researchers of the study, there is a direct
correlation in the increase incidence of risk of CRC with increase in the dietary inflammatory
index score, which indicates pro-inflammatory diet.
Question 14:
In the Shivappa article, results of the dietary inflammatory index as a continuous variable, are
reported as (multivariable OR 1.13, 95 % CI 1.09, 1.18), is this finding significant or not
significant for Colorectal cancer (CRC)?
Answer: The finding for DII as continuous variable is significant for Colorectal Cancer.
Question 15:
A postmenopausal woman is asking about how she might decrease her risk for Colon Cancer.
Based on the Shivappa study, what advice can you give her?
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Application Exercise 1
Answer: The women would be advised to reduce the DII score, that is, stop intaking pro-
inflammatory diet, to reduce the risk of Colon Cancer.
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