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PUBH6005: Epidemiology Assignment- 3 Critical Appraisal Essay
Name of student: Sapna Rani
Student ID: 00306144T
Prevalence of alcoholic fatty liver in the United States
Introduction: Liver diseases are of three types which can occur due to the consumption of alcohol such as fatty liver, alcoholic hepatitis, and cirrhosis. But fatty liver has become common nowadays and its cases are increasing day by day in the United States. (White, 2012). But unlike other liver diseases, it is reversible and it can be treated by quitting alcohol consumption. Fatty liver has become quite common among persons who frequently consume alcohol because liver and GIT are the main sites in our body where alcohol is metabolized. There are two pathways of alcohol metabolism in our body: alcohol dehydrogenase, cytochrome P450 (Moriya, 2015). Methodology: Method: Three papers were selected and then evaluated to explain the NHMRC form. In this article, bias, confounding factors, clinical factors, and acceptability have been included. This article includes the CASP framework with a checklist that can explain and
support the questions. Search strategy: Before starting critical appraisal, I thoroughly read the articles and research questions to identify the relation between alcohol consumption and fatty liver. Systematic reviews apply strategies to eliminate bias and random errors. Evidence uses rigorous methodology and
designs (White, 2012).
Databases: The databases include (1) Google Scholar (2) Medline via PubMed (3) ProQuest. I studied 160 articles, out of which I have selected three articles that are most compatible with the research question. Keywords: Search terms used in the article include: · Fatty liver · Alcohol consumption · Alcoholic fatty liver
· Liver diseases · Chronic liver diseases · Elevated liver enzymes Inclusion criteria: The inclusion criteria of these articles include thoroughly studied articles,
academic research papers that were published in the English language in the last ten years.
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Results:
Table 1 Cross-sectional study: “ Prevalence of Alcoholic fatty liver disease among adults in United States, 2001-2016”
Critical appraisal questions Underline your answer
1. Were the criteria for inclusion in the sample clearly defined? Yes
Evidence: It was clearly defined as cross-sectional study was performed and individuals were selected after proper interview and examination.
Critical appraisal questions Underline your answer
2. Were the study subjects and the setting described in detail? Yes
Evidence: The study subjects and setting were described in detail as it showed that the data was collected from 2001 to 2016. So extensive study was done to perform this research. About 70% individuals were selected after interview and 67% individuals were selected after examination.
Critical appraisal questions Underline your answer
3. Was the exposure measured in a valid and reliable way? Yes
Evidence: The exposure was also measured in a reliable way as the age of patients was taken into account and elevated liver enzyme levels such as ALT, AST was also considered. The study was conducted on the persons who had a past history of alcohol consumption in the 12 months.
Critical appraisal questions Underline your answer
4. Were objective, standard criteria used for measurement of the condition? Yes
Evidence: The objectives of this study were clearly defined as the number of deaths caused by alcohol fatty liver has been increased to a great extent. So this study was conducted to know about the prevalence of alcoholic fatty liver in US adults.
Critical appraisal questions Underline your answer
5. Were confounding factors identified? No
Evidence: The confounding factors were not identified to perform this study because only alcohol was taken into account.
Critical appraisal questions Underline your answer
6. Were strategies to deal with confounding factors stated? No
Evidence: The confounding factors were not considered to perform this study so the strategies to deal with confounding factors were not stated.
Critical appraisal questions Underline your answer
7. Were the outcomes measured in a valid and reliable way? Yes
Evidence: The outcomes of this study were measured properly as this study was performed on 34,243 individuals and statistical analysis was done to obtain results.
Critical appraisal questions Underline your answer
8. Was appropriate statistical analysis used? Yes
Evidence: Yes, proper statistical analysis was performed to obtain its results. Multivariable logistic regression was used to know about the prevalence of alcoholic fatty liver among adults in US. (Wong et. al. 2019)
Reference
Wong, T., Dang, K., Ladhani, S., Singal, A. K., & Wong, R. J. (2019). Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016.
JAMA, 321(17), 1723-1725.
Table 2 Case-control study: “ Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis: a case control study”
Critical appraisal questions Underline your answer
1. Did the study address a clearly focused issue? Yes
Evidence: This study addresses a focused issue because the development of fats in the liver also depends on the duration of alcohol intake.
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If alcohol is being consumed for a longer period of time then it will cause alcoholic fatty liver.
Critical appraisal questions Underline your answer
2. Did the authors use an appropriate method to answer their question? Yes
Evidence: The method used is appropriate to answer all of the questions and there are no chances of biases because this study was performed in hospital.
Critical appraisal questions Underline your answer
3. Were the cases recruited in an acceptable way? Yes
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Evidence: the cases are recruited in an acceptable way in this study as this study was perfumed on 320 patients and 320 persons were categorized in the control group. The duration of alcohol consumption was about 10 to 30 years of these patients.
Critical appraisal questions Underline your answer
4. Were the controls selected in an acceptable way? Yes
Evidence: The controls were selected in an acceptable way as the control were selected in accordance with the cases. 320 controls were selected and they
were similar to cases.
Critical appraisal questions Underline your answer
5. Was the exposure accurately measured to minimise bias? Unclear
Evidence: the exposure measurements are not clearly measured in this study. Although, the duration of alcohol consumption and medical history were taken into account.
Critical appraisal questions
Underline your answer
6. Aside from the experimental intervention, were the groups treated equally? Yes
Evidence: Both groups were treated equally apart from their medical conditions. So bias was reduced by treating them equally.
Critical appraisal questions Underline your answer
7. Have the authors taken account of the potential confounding factors in the design and/or in their analysis? Unclear
Evidence: The confounding factors related to this study are unclear. Although the age, gender, duration of alcohol consumption was taken into account.
Critical appraisal questions Underline your answer
8. How large was the treatment effect? Unclear
Evidence: The treatment effect is unclear because this study mainly focuses on alcohol consumption and liver diseases. So the researchers focused on the duration of alcohol consumption instead of the duration of treatment.
Critical appraisal questions Underline your answer
9. How precise was the estimate of the treatment effect? Unclear
Evidence: The treatment is unclear in this study because the main focus was on the disease in this study instead of the treatment of disease.
Critical appraisal questions Underline your answer
10. Do you believe the results? Yes
Evidence: Yes, I believe in the results because the results have been obtained by applying statistical analysis, and patients were selected after conducting the proper interview and medical examination.
Critical appraisal questions Underline your answer
11. Can the results be applied to the local population? Yes
Evidence: The results can be applied to the local population as well because the rate of alcohol consumption has been increased to a great extent and it has also increased the prevalence of alcoholic liver diseases including alcoholic fatty liver.
Critical appraisal questions Underline your answer
12. Do the results of this study fit with other available evidence? Yes
Evidence: There are many studies in literature which support this study and still many studies are in progress to know about the effect and association of alcohol on liver diseases. Valenti et al. 2007 has also conducted this type of study. (Corrao et a. 1993)
Reference
Corrao, G., Arico, S., Lepore, A. R., Valenti, M., Torchio, P., Galatola, G.,... & Di Orio, F. (1993). Amount and duration of alcohol intake as risk factors of
symptomatic liver cirrhosis: a case—control study. Journal of clinical epidemiology, 46(7), 601-607.
Table 3 Cohort study: “Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups- the multi-ethnic cohort”
Critical appraisal questions Underline your answer
1. Did the study address a clearly focused issue? Yes
Evidence: The study addressed the clearly focused issue because liver diseases have become major sources of morbidity and mortality in different states of America.
Critical appraisal questions Underline your answer
2. Was the cohort recruited in an acceptable way? Yes
Evidence: the cohorts were recruited in acceptable way because they were selected after getting their complete information on questionnaire. Their personal information and previous medical history was also determined.
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4/29/2020 Originality Report
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Critical appraisal questions Underline your answer
3. Was the exposure accurately measured to minimise bias? Yes
Evidence: the exposure was accurately measured to minimize the bias. The patient’s history, gender, medical history and duration of consumption of
alcohol was taken into count before starting the study.
Critical appraisal questions Underline your answer
4. Was the outcome accurately measured to minimise bias? Yes
Evidence: The outcome was accurately measured to minimize the bias and the data of patients was collected from the year 1999 to 2012. Biases were then
minimized by doing accurate measurement and by proper diagnosis of disease.
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Critical appraisal questions Underline your answer
5(a) Have the authors identified all important confounding factors? Yes
Evidence: The authors identified all important confounding factors such as gender, medial history, body mass index and history of alcohol consumption.
Critical appraisal questions Underline your answer
5(b) Have they taken account of the confounding factors in the design and/or analysis? Yes
Evidence: The confounding factors were taken into account by applying MEC study design.
Critical appraisal questions Underline your answer
6(a) Was the follow up of subjects complete enough? Yes
Evidence: The follow up of the subjects is complete enough and its duration lasts for 1993 to 1996 and data of liver patients was collected between 1999 to 2012. Patients were selected after taking their information on questionnaire.
Critical appraisal questions Underline your answer
6(b) Was the follow up of subjects long enough? Yes
Evidence: The duration of follow up is long and the duration of the study is around 3 years. This study was conducted by taking the data of 1993 to 1996 and data of liver patients was obtained from 1999 to 2012.
Critical appraisal questions Underline your answer
7. What are the results of this study? Yes
Evidence: it has been found that there were 5783 patients who were suffering from liver disease. This study was conducted on different nations and there were 24.9% Americans in which liver diseases were found and the most common cause was alcohol.
Critical appraisal questions Underline your answer
8. How precise are the results? Yes
Evidence: The results are precise because results have been obtained by applying statistical analysis. SAS analysis was applied to obtain its results and P values were obtained from both sides.
Critical appraisal questions Underline your answer
9. Do you believe the results? Yes
Evidence: Yes, I believe on results because the results have been obtained after applying statistical analysis and extensive study has been performed to obtain its results.
Critical appraisal questions Underline your answer
10. Can the results be applied to the local population? Yes
Evidence: The results can partially be applied to local population because this study was conducted on different population such as Americans, Africans etc. So the results which have been obtained on American population can only be applied to local population.
Critical appraisal questions Underline your answer
11. Do the results of this study fit with other available evidence? Yes
Evidence: The results are considered to be supported by other studies in literature. Wong et. al. (2015) also found out the association and prevalence of
alcoholic fatty liver disease in United States.
Critical appraisal questions Underline your answer
12.What are the implications of this study for practice? Yes
Evidence: Alcohol consumption has become quite common among American population and prevalence of fatty liver disease is also increasing day by day. So
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this study can be used to raise awareness among American population and to raise awareness of alcohol consumption with fatty liver. (Setiawan, 2016)
Reference
Setiawan, V. W., Stram, D. O., Porcel, J., Lu, S. C., Le Marchand, L., & Noureddin, M. (2016). Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology, 64(6), 1969-1977.
Discussion: Article 1: Cross-sectional study authored by Wong et al. 2019
In this cross-sectional study, different diseases were considered in the American population such as alcoholic fatty liver disease, alcoholic hepatitis, cirrhosis, complications caused by cirrhosis (Wong, 2019). This study was conducted by taking the data of patients between 2001- 2016. The study population was selected after taking proper interviews and medical examinations. The liver enzyme levels, gender, previous medical history, and duration of alcohol consumption were taken into account before conducting this study (Wong, 2019) This study was conducted on the study population after taking interviews and medical examinations on persons. While examining patients, their alcohol consumption habit was taken into account. Hepatitis B and hepatitis C patients were excluded from this study (Wong, 2019). Then statistical analysis was applied to get its results. Multivariable logistic regression was applied to obtain results and linear trends in prevalence were also analyzed. Results showed that there were about 4.3% of persons who were identified with AFLD. Its prevalence remained stable till 2016 with stage 1. But the prevalence of AFLD increased by 0.6% during this tenure (Wong, 2019). Article 2: Case-Control study authored by
Corrao et al. 1993
This case-control study indicates the prevalence of alcoholic liver diseases. This study was mainly conducted in the hospital so 320 patients were selected after the interview and medical examination (Corrao, 1993). Then 320 pairs were matched with these patients to conduct a case-control study. Their lifetime alcohol consumption was also considered with it.
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Then the results were obtained by statistical analysis. Conditional logistic regression was applied to obtain results. And it increased from 1 to 4.2 for LDAI of 25 g or more. This study was conducted on patients who were consuming alcohol from 10 years to 30 years (Biselli, 2010). The results suggested that there are dose- dependent relationships between liver disease and consumption of alcohol. And it gives rise to various diseases such as alcoholic fatty liver, alcoholic cirrhosis. Article 3: Cohort study authored by Setiawan et al. 2016
This cohort study aims to analyze the epidemiology of alcoholic liver diseases as liver diseases and cirrhosis have become major sources of mortality and morbidity in the United States. It has been studied that in 2013 more than 36000 deaths occurred due to liver diseases in the United States. The untreated alcoholic fatty liver led to chronic liver disease which caused almost 66,000 deaths in United States in a year. The prevalence of the liver disease has been increased from 1988 to 2008 (Setiawan, 2016). This prospective cohort study was performed on more than 215,000 males and females. This study was conducted on patients of age 45- 75 years old. The CLD and cirrhosis were identified on the basis of inpatient and outpatient history. Their alcohol-related disorders were also considered for this study such as alcohol consumption rate, alcoholic neuropathy (Stepanova, 2013). Then statistical analysis was applied to obtain its results. The whole analysis was performed by using the SAS system. This study was performed on 5,783 persons, these patients were suffering from chronic liver disease followed by alcoholic fatty liver. Some of these patients were suffering from cirrhosis and some had no cirrhosis (Setiawan, 2016). About 51.7% of patients had NAFLD, 8.6% of patients had ALD. The persons who were at the age of 70 years or more were at high risk of developing of chronic liver disease. Discussion on bias, confounding factors and chances
Bias is a systematic error and it should be minimized by proper selection of cases and proper measurement. Because any error or biases can lead to false
results. Research studies also depend on confounding factors sometimes, it arises when risk factors and outcomes both are dependent on or associated with a third variable (White, 2012). To reduce confounding or to avoid it, those controls should be selected who are independent of exposure. It can also be reduced by randomization and matching. It can also be adjusted by applying different statistical analysis such as multivariable analysis and stratified analysis.
Stratification is the best technique and most of the researchers use this technique. Chance is also an error that can occur during research but it is a sample and it can be minimized by recruiting a large sample (Zakhari, 2016). Conclusion: This paper concluded that alcohol is associated with many liver diseases such as alcoholic fatty liver, chronic liver disease etc. if it is not treated then it may lead to chronic liver disease or cirrhosis which are untreatable in most of the cases (Zakhari, 2016). The widespread of this alcoholic fatty liver diseasea is increasing day by day in the United States and females are at high risk of this liver disease. The development of alcoholic fatty liver is dose-dependent and duration-dependent of alcohol.
Reference
Wong, T. (2019, May 7). Prevalence of Alcoholic Fatty Liver Disease Among Adults in the United States, 2001-2016. Retrieved from
https://jamanetwork.com/journals/jama/fullarticle/2732559
Corrao, G., Arico, S., Lepore, A. R., Valenti, M., Torchio, P., Galatola, G.,... & Di Orio, F. (1993). Amount and duration of alcohol intake as risk factors of
symptomatic liver cirrhosis: a case—control study. Journal of clinical epidemiology, 46(7), 601-607. Setiawan, V. W., Stram, D. O., Porcel, J., Lu, S. C.,
Marchand, L. L., & Noureddin, M. (2016, July 17). Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.28677
Moriya, A., Iwasaki, Y., Ohguchi, S., Kayashima, E., Mitsumune, T., Taniguchi, H.,. Yamamoto, K. (2014, November 27). Roles of alcohol consumption in fatty
liver: A longitudinal study. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0168827814008745
White, D. L., Kanwal, F., & El–Serag, H. B. (2012, October 4). Association Between Nonalcoholic Fatty Liver Disease and Risk for Hepatocellular Cancer,
Based on Systematic Review. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1542356512011536
Sayiner, M., Koenig, A., Henry, L., & Younossi, Z. M. (2016). Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United
States and the rest of the world. Clinics in liver disease, 20(2), 205-214. Zakhari, S., Radaeva, S., & Vasiliou, V. (2016, January 1). Hepatic and Extrahepatic
Malignancies in Alcoholic Liver Disease. Retrieved from https://link.springer.com/chapter/10.1007/978-3-319-20538-0_13
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Stepanova, M., Rafiq, N., Makhlouf, H., Agrawal, R., Kaur, I., Younoszai, Z.,... & Younossi, Z. M. (2013). Predictors of all-cause mortality and liver-related
mortality in patients with non-alcoholic fatty liver disease (NAFLD). Digestive diseases and sciences, 58(10), 3017-3023.
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Prevalence of alcoholic fatty liver in the United States
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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This article includes the CASP framework with a checklist that can explain and support the questions.
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CASP framework with checklist that can explain or support in analyzing and justifying the questions and characteristics
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Systematic reviews apply strategies to eliminate bias and random errors.
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Systematic reviews apply strategies for eliminating biases and random errors
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Search terms used in the article include:
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Search terms used in the search include
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The inclusion criteria of these articles include thoroughly studied articles, academic research papers that were published in the English language in the last ten years.
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Inclusion criteria Inclusion criteria are the original peer-review articles, academic research papers, Scholarly articles (perspective articles, opinions, reviews, documents), published in English language within last ten years
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Table 1 Cross-sectional study:
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Table 1 Cross-sectional study
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“ Prevalence of Alcoholic fatty liver disease among adults in United States, 2001-2016”
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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Were the criteria for inclusion in the sample clearly defined?
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Were the criteria for inclusion in the sample clearly defined
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Were the study subjects and the setting described in detail?
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Were the study subjects and the setting described in detail
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Was the exposure measured in a valid and reliable way?
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Was the exposure measured in a valid and reliable way
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Were objective, standard criteria used for measurement of the condition?
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Were objective, standard criteria used for measurement of the condition
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Were confounding factors identified?
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Were strategies to deal with confounding factors stated?
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Were strategies to deal with confounding factors stated
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The confounding factors were not considered to perform this study so the strategies to deal with confounding factors were not stated. Critical appraisal questions Underline your answer
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Were strategies to deal with confounding factors stated Critical appraisal questions Underline your answer
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Were the outcomes measured in a valid and reliable way?
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Were the outcomes measured in a valid and reliable way
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Was appropriate statistical analysis used?
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Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016.
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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Table 2 Case-control study:
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“ Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis:
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Lepore et al1993 Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis
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a case control study”
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Did the study address a clearly focused issue?
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Did the authors use an appropriate method to answer their question?
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Were the cases recruited in an acceptable way?
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Were the controls selected in an acceptable way?
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Were the controls selected in an acceptable way
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The controls were selected in an acceptable way as the control were selected in accordance with the cases.
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Were the controls selected in an acceptable way
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Was the exposure accurately measured to minimise bias?
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Was the exposure accurately measured to minimise bias
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Aside from the experimental intervention, were the groups treated equally?
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Aside from the experimental intervention, were the groups treated equally
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Have the authors taken account of the potential confounding factors in the design and/or in their analysis?
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How large was the treatment effect?
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How precise was the estimate of the treatment effect?
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Do you believe the results?
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Can the results be applied to the local population?
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Do the results of this study fit with other available evidence?
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Do the results of this study fit with other available evidence
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Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis:
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Lepore et al1993 Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis
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a case—control study.
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Case-control study
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Table 3 Cohort study:
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Table 3 Cohort study
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Did the study address a clearly focused issue?
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Did the study address a clearly focused issue
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Was the cohort recruited in an acceptable way?
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Was the cohort recruited in an acceptable way
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Was the exposure accurately measured to minimise bias?
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Was the exposure accurately measured to minimise bias
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the exposure was accurately measured to minimize the bias.
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Was the exposure accurately measured to minimise bias
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Was the outcome accurately measured to minimise bias?
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Was the outcome accurately measured to minimise bias
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Biases were then minimized by doing accurate measurement and by proper diagnosis of disease. Critical appraisal questions Underline your answer 5(a) Have the authors identified all important confounding factors?
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Biases are minimized with accurate measurement and diagnosis of cancers Critical appraisal questions Underline your answer Have the authors identified all important confounding factors
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Critical appraisal questions Underline your answer 5(b) Have they taken account of the confounding factors in the design and/or analysis?
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Critical appraisal questions Underline your answer Have they taken account of the confounding factors in the design and/or analysis
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Critical appraisal questions Underline your answer 6(a) Was the follow up of subjects complete enough?
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Critical appraisal questions Underline your answer Was the follow up of subjects complete enough
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Critical appraisal questions Underline your answer 6(b) Was the follow up of subjects long enough?
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Critical appraisal questions Underline your answer Was the follow up of subjects long enough
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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What are the results of this study?
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What are the results of this study
4/29/2020 Originality Report
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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How precise are the results?
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How precise are the results
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Do you believe the results?
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Do you believe the results
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Can the results be applied to the local population?
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Can the results be applied to the local population
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Critical appraisal questions Underline your answer
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Critical appraisal questions Underline your answer
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Do the results of this study fit with other available evidence?
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Do the results of this study fit with other available evidence
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(2015) also found out the association and prevalence of alcoholic fatty liver disease in United States.
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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Critical appraisal questions Underline your answer 12.What are the implications of this study for practice?
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Critical appraisal questions Underline your answer What are the implications of this study for practice
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Cross-sectional study authored by Wong et al.
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Cross-sectional study authored by Alam et al
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Case-Control study authored by Corrao et al.
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Case control study authored by Gupta et al
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Cohort study authored by Setiawan et al.
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Cohort Study Authored by Jayalekshmi et al
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Bias is a systematic error and it should be minimized by proper selection of cases and proper measurement.
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Discussion on bias, confounding factors and chances Bias is a systematic error that should be minimized by proper selection of the cases and proper measurement
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It can also be adjusted by applying different statistical analysis such as multivariable analysis and stratified analysis.
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Confounding can be adjusted during statistical analysis by using stratified analysis and multivariate analysis techniques
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Prevalence of Alcoholic Fatty Liver Disease Among Adults in the United States, 2001-2016.
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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Retrieved from https://jamanetwork.com/journals/jam a/fullarticle/2732559
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https://jamanetwork.com/journals/jam a/fullarticle/2626571
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ProQuest document 83%
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Student paper
Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis:
Original source
Lepore et al1993 Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis
4
Student paper
a case—control study.
Original source
Case-control study
6
Student paper
Retrieved from https://aasldpubs.onlinelibrary.wiley.co m/doi/full/10.1002/hep.28677
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Retrieved from http://onlinelibrary.wiley.com/doi/10.10 02/pros.22643/full Fillion, L., & Henry, J
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(2014, November 27).
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2014-05-27
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Retrieved from https://www.sciencedirect.com/science/ article/abs/pii/S0168827814008745
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Retrieved from https://www.sciencedirect.com/science/ article/pii/S016762961500082X
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L., Kanwal, F., & El–Serag, H.
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White, D.L., Kanwal, F, El-Serag, HB
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Association Between Nonalcoholic Fatty Liver Disease and Risk for Hepatocellular Cancer, Based on Systematic Review.
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Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review
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Retrieved from https://www.sciencedirect.com/science/ article/abs/pii/S1542356512011536
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Retrieved from https://www.sciencedirect.com/science/ article/pii/S016762961500082X
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Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United States and the rest of the world.
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Prevalence of Nonalcoholic Fatty Liver Disease in the United States
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Hepatic and Extrahepatic Malignancies in Alcoholic Liver Disease.
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Liver Disease in the Alcoholic
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Retrieved from https://link.springer.com/chapter/10.10 07/978-3-319-20538-0_13
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Retrieved from https://link.springer.com/chapter/10.10 07/978-3-319-59489-7_4 8
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Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD).
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Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD)
