Is There An Association Between Tobacco And Oral/ Head Cancers

You will need to appraise 3 articles of a topic and research question.
Research question: Is there an association between tobacco and oral/ head cancers? You can choose any
population/country. You can also choose studies from different countries. For example case-control study
from Asia and/or cohort study from Europe.
1. Search the library database to find three studies that answer your research
question. All three studies must be of different study designs. For instance, you
could include cross-sectional, case-control, cohort and RCTs. Systematic
reviews and literature reviews are not allowed. These studies do not have to
prove their hypothesis or agree with each other. Please note that marks will be
deducted if all identified papers are of similar study.
2. Critically appraise all three articles you found. Your answers are to be written in
the tables provided to you which was based on CASP checklist and other types of
checklist (JBI checklist for cross-sectional study).
3. In the table, you are required to answer either “Yes”, “No”, “Unclear”.
4. For each of the answer of “Yes”, “No” or “Unclear”, you will need to
provide the “Evidence” that you found in the article to support your
answers.
5. For each of the “Evidence”, you will need to critically appraise stating
your justification, compare and contrasting or/and providing solution.
Please see table for an example of how “evidence” is written.
References: The quality of references used is important. “high quality
Reference” is defined as articles which are peer-reviewed and published in notable
international and national journals. Articles such as newspaper, websites, social media
statements, unsolicited articles and non-peer reviewed articles are not of “high quality
reference”. You shall Include all the sources you have used within your text and organize
them in alphabetical order according to APA 6th edition style.

Table 3 Cohort study: The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in severe dengue (Low et al., 2018)
Critical appraisal questions	Underline your answer
Did the study address a clearly focused issue?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution The objective of this study was to evaluate VEGF and PTX-3 as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The objective is specific to evaluating the two biomarkers among so many markers mentioned in the pilot study that was conducted before this study. (Low, Gan, & Ho, 2015) The dengue classification (severe and non-severe) was validated, specific and measureable. It was derived from the World Health Organisation dengue guideline. (World Health Organization, 2009) The study also specifically evaluated the predictive and diagnostic accuracy of the two markers.
Critical appraisal questions	Underline your answer
Was the cohort recruited in an acceptable way?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution The participants were recruited prospectively based on the eligibility criteria. All participants who are 15 years or older, presented only in the first 3 days of illness and a positive NS1 Ag test. However, it was unclear of the definition of the “illness” as it can represent a specific onset of a symptoms or whether it is due to fever. Majority of the existing studies defined the illness begin when patient developed fever. (Ahmed, 2010; Kumar, Gittens-St Hilaire, & Nielsen, 2013; Mahboob et al., 2010) Based on Table 1, we can assume that all patients were recruited based on the fever presented within the first 3 days of illness. Suggestion to the author is to clearly define what is “illness”. NS1 Ag is a standard diagnostic test but again, most other studies used Dengue IgM as confirmatory method. (Mahboob et al., 2010; Tang et al., 2015; Thein et al., 2014) However, the author justified that Dengue IgM and a more highly accurate RT-PCR was used to double confirm the NS1 Ag positive cases.
Critical appraisal questions	Underline your answer
Was the exposure accurately measured to minimise bias?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution This study did not measure any exposure (environmental, social determinants, etc). Perhaps, the exposure in this study was not the objective in assessing the biomarkers. The “exposure” here for this cohort study should be defined as the biomarkers itself. Thus, the “exposure” is considered accurately measured by the laboratory technique called as ELISA. (Dussart et al., 2008)
Critical appraisal questions	Underline your answer
Was the outcome accurately measured to minimise bias?	Yes/No/Unclear

PUBH6005_Assessment Brief 3 Page 4 of 8

Evidence: justification, compare and contrasting or/and providing solution The outcome was the use of clinical dengue classification (World Health Organization, 2012). It was used by the clinician/treating physician to diagnose the patients recruited. The accuracy of the WHO clinical classification is well documented in other study citing that the “severe dengue” category has good sensitivity and specificity. (Alexander et al., 2011)
Critical appraisal questions	Underline your answer
Have the authors identified all important confounding factors?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution Confounding factors such as age, sex and ethnicity have been identified. There were other confounding factors such pregnancy; patient with autoimmune disorder, haematological disorder, cancer, cardiovascular disease or on long term warfarin and aspirin. These were identified and it was excluded from the analysis. The different days of illness could also affect the biomarker results and thus, this confounding factor has been included into the statistical analysis.
Critical appraisal questions	Underline your answer
Have they taken account of the confounding factors in the design and/or analysis?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution Confounding factors have been controlled for by exclusion (restricted analysis) and included into the multivariate regression analysis. However, possible confounding factor that the author has not taken into account was the treatment effect. No analysis on the treatment in regards to the biomarker prediction. Perhaps, future study to evaluate these biomarkers must include the types of treatment. Treatment for dengue are mainly fluid resuscitation and it should be noted down on the different commonly used fluids for resuscitation in dengue. (World Health Organization, 2012)
Critical appraisal questions	Underline your answer
Was the follow up of subjects complete enough?	Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution The follow up of the subjects were up to the day of discharge from the hospital or health care facility. This should suffice as the patient recovered and free of the symptoms or complication of the disease. Other studies did not have long follow-up, instead they used cross-sectional study as their study design. This could possibly due to the availability of resources to support the long term follow-up. (Colbert et al., 2007; Mairuhu et al., 2005; Thein et al., 2014)
Critical appraisal questions	Underline your answer
Was the follow up of subjects long enough?	Yes/No/Unclear

PUBH6005_Assessment Brief 3 Page 5 of 8
Evidence: justification, compare and contrasting or/and providing solution
The follow up of the subjects were up to the day of discharge from the hospital or health
care facility. It was the maximum duration of the patients can be follow-up. Though some
patients might develop another episode of dengue known as secondary dengue, this
study has addressed their objective. It will be interesting to have future study that also
follow-up even longer period of time to identify sequelae and secondary which is more
common in dengue endemic countries/ tropical countries. (Guzmán et al., 2002; Ludolfs,
Schilling, Altenschmidt, & Schmitz, 2002) However, this depends on the resources
available to conduct such long-term study

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