Design Patterns Gang Of Four Epub 155 |BEST|
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However, several limitations are associated with the included studies. Overall, the included cohort studies had methodological limitations that included small sample sizes, lack of data on alcohol intake during or before critical exposures, assessment of alcohol intake only intermittently, and inadequate control for important covariates such as body weight or physical activity. For the population-based case-control design, the authors of the master thesis referenced above suggested that selection bias may have occurred in the case-control design as well. While case-control studies help to elucidate the association of potential risk and disease, many case-control studies base their results based on negative findings (i.e., people who already have the disease versus those who do not) and on the convenience of study design, and thus cannot address causation. In the studies examining long-term exposure of alcohol, the authors indicated that confounding and reverse causation played a role in observing the findings (Bjelakovic et al. 2008). In general, cohort studies, especially those based on self-reported data, are prone to measurement error and recall bias. Only one study examined pair matching which is a process in which two members of a cohort are selected at random and matched for the purposes of minimizing misclassification of exposure or outcome.
Several issues may have implications for the findings. For example, one study may result in different RRs for moderate versus heavy drinking. Nonetheless, many researchers agree that a graded dose-response relationship exists with increasing risk of disease with higher levels of alcohol use. However, the relationship might be nonlinear. On the other hand, many of the included studies did not account for binge alcohol drinking. The definition of binge drinking or whether moderate or heavy drinking was used varied among the studies, but this may play a role in between-study heterogeneity. Another study may have detected a higher RR specifically in men. There is some evidence that the association between alcohol and breast cancer is stronger in women than in men. The included studies were at moderate risk of bias due to poor statistical analysis, limited adjustment for confounding variables, or variable follow-up periods. Finally, many of the included studies failed to assess compliance or assume it was excellent (i.e., >80%). Failure of the studies to assess compliance may limit the ability of the author to draw an accurate conclusion. This is especially important in alcohol-studies because compliance is typically less than perfect. A recent study examined the accuracy of alcohol self-reporting among college students . d2c66b5586