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The relationship between stress and breast cancer has been examined in many epidemiological studies, the results of which have yielded mixed results. One reason for these differences is the use of different measures of stress. For example, death of a spouse or close relative is a major acute stressor, whereas stress experienced in daily life is more moderate and chronic in nature. As these different types of stress likely have different physiological and psychological impacts, the observed relationship with breast cancer risk may differ.

While the relationship between the acute stress of major life events and the risk of breast cancer has been assessed in several studies, less attention has been paid to perceived daily stress. A number of studies have shown that prolonged, low-level stress of daily life results in a persistent activation of stress hormones, which may impair estrogen synthesis, and may thereby be related to a lower risk of breast cancer. Finally, daily stress may also indirectly affect the risk of breast cancer through variations in health related behavior.

A study was launched in Copenhagen, Denmark to assess the relationship between self reported intensity and frequency of stress and first time incidence of primary breast cancer. The study recruited a population-based sample of n=7,018 Danish women. All women were asked about their perceived level of stress at baseline (2000-2001). Women were excluded if they had been diagnosed with breast cancer before the start of the study (n=120) or if they provided no information on stress or other variables (n=209). The remaining 6,689 women were followed until 2015, with n=26 (< 0.1%) lost to follow-up.

Women in the study were asked about their level of stress in terms of intensity and frequency. In the questionnaire, stress was defined as the sensation of tension, nervousness, impatience, anxiety, or sleeplessness. The women were asked to report their stress intensity as none (0), light (1), moderate (2) or high (3) and the frequency as never/hardly ever (0), monthly (1), weekly (2) or daily (3). The responses of the two questions were then added together to obtain a composite score ranging from 0 to 6. This stress score was also categorized as low (0-1), medium (2-4) and high stress (5-6). Participants were followed from the date of the baseline examination until the end of the study period in December 2015, during which time there were n=251 first diagnoses of primary breast cancer.


(a) What type of epidemiological study is this?
(b) Provide a justification for your response.

c. What are disadvantages of this study design identified in the previous question? Get Nursing Help Today

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