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Case Study or Share an Experience – End of Life Care- A Related Experience

Stephanie was a 65 year old who was enrolled to hospice after a difficult and prolonged admission in hospital. She had spent most of her time in the rural areas managing rural property and race horses. At first, Stephanie was admitted in a NSW hospital secondary to a basal cell carcinoma, which had spread, to the brain tissue despite surgical intervention. This was followed by a long duration in the ICU where she experienced seizures and was intubated. She was later discharged following successful management with anti-convulsants and intubation. Unfortunately, she thereafter developed a deep intracranial infection as a secondary complication from the surgery whose chances of resolving were minimal.

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As the health status of Stephanie deteriorated, Stephanie’s sister requested to consult on palliative care. Since she had become unresponsive to treatment, it was unanimously decided that she was to be referred to the hospice center for end-of life care. Stephanie had a number of symptoms which significantly contributed to a deteriorating health status. The most serious symptoms were that of a hyperactive delirium, on and off headaches and seizures. Severally, Stephanie’s seizure, depression, anxiety and seizure medications were revised. Although she became very weak, symptomatic and largely dependent, she stabilized. Case Study or Share an Experience – End of Life Care- A Related Experience.

Stephanie’s family  was her  power of attorney and   were precise that she was not to receive further interventions that would burden her such as being transferred to another facility, cannulation, resuscitation  and surgical interventions (Chan, Webster & Bowers, 2016). Her preferred place of death was hospice. Nursing care for this patient involved: continuous management of her mobility which was worsening and issues related to a high fall risk. Regularly, her mobility was reviewed by the hospitals occupational therapist and physiotherapist. Stephanie also had issues with the integrity of her skin and continence. This needed some modification in her care needs as her health status continued to deteriorate. Since the wound on her scalp was purulent and foul-smelling, her care needs had to include wound care and aesthetic matters. Since she was confused most of the time, she severally attempted to remove the dressing. Therefore, in order to suit her needs, nursing care utilized a variety of head gears.

As her condition improved, in collaboration with the senior nursing staff and the clinical nursing counselor, we became more actively involved in her care for it to be effective such as by genuinely desiring to link with Stephanie’s love for dogs and horses. It was undeniable that Stephanie had a lot of sense of humor which made it easy and possible to positively connect with her. In order to ensure that staff had clinical and emotional support regarding her care, several education sessions were held. Despite the fact that most staff were surprised on how her condition had generally stabilized, others were concerned that a short-term special unit was not the most appropriate strategy for her in the long term.

As recommended by Kisorio & Langley (2016), Stephanie’s care revolved in the entire nursing team for the purpose of ensuring that staff not only cared for their own health but also upheld a positive and compassionate outlook on her overall health status. A pastoral team was also contacted which provided her with the audience to discuss all her fears and other stressing issues. The hospitals social worker, who was also a highly trained counselor spent time with both the family and Stephanie discussing complex issues. After quite a long period of stability, Stephanie eventually deteriorated. Her end-of-life care was immediately initiated six days before a peaceful death in hospice. In the moths that preceded, Stephanie had developed a lot of trust in the staff working in the hospice while her friends and family came to terms that she would die in the long run. Whenever they could, the often visited and when she finally died, everyone was happy to go console and comfort Stephanie. Our mission as the care team was to ensure that Stephanie smiled which she actually did. Case Study or Share an Experience – End of Life Care- A Related Experience

References

Chan, R. J., Webster, J., & Bowers, A. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. 
Cochrane Database of Systematic Reviews
, (2).

Kisorio, L. C., & Langley, G. C. (2016). Intensive care nurses’ experiences of end-of-life care. 
Intensive and Critical Care Nursing
, 
33
, 30-38.

 

 

Week 8: Case Study or Share an Experience (graded)

Purpose

This week’s graded topics relate to the following Course Outcome (CO).

CO 2 – Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO #1)

The Assignment

This week you have two options for your initial discussion post. Select the option that is best for you! Please remember to use and credit the lesson or required NIH website (there was not a textbook reading this week), AND one outside scholarly source.

Option #1 – Case Study to Consider

Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance. Case Study or Share an Experience – End of Life Care- A Related Experience.

How would you respond to Michael and serve as advocate for your patient?

Option #2 – Share a Related Experience

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?

Grading

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric. Case Study or Share an Experience – End of Life Care- A Related Experience

Complimentary or Alternative (CAM) Therapy Essay

Question 1

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Herb Name

Rationale

Benefits

Consequences

Drug interaction

Vasambu (Acorus calamus)

Relieves gastric issues such as peptic ulcers by regulating digestive acids for easy digestion. It also eases counter-acidity and heartburn issues.

 

Eases Indigestion, acid reflux and constipation

Complimentary or Alternative (CAM) Therapy Essay

Nausea and vomiting

Interacts with Monoamine Oxidase Inhibitors (MAOIs) used in the management of depression, interacts with sedatives and can potentially lead to too much sleepiness, interacts with H2-blockers and proton-pump inhibitors causing hyperacidity which reduces the effectiveness of antacids (Tachjian, Maria & Jahangir, 2010)

Yohimbine(
Pausinystalia johimbe
)

Increases blood pressure, levels of epinephrine, the heart rate and central sympathetic outflow.

Anxiety, depression, erectile dysfunction (impotence), dry mouth and exhaustion.

 

Paralysis, difficulty breathing, sleeps difficulties, irritability, frequent urination, low blood pressure and death in high doses.

Interacts with MAOIs, clonidine, Tricyclic antidepressants, antihypertensives, stimulants, naloxone, and phenothiazine’s.

Gynura (
Gynura procumbens
)

Reduces blood pressure and improves microcirculation by inhibiting  angiotensin-converting enzyme

Lowers cholesterol, reduces hypertension, treats sinusitis, relives constipation

Weight gain, hepatic toxicity
,
jaundice and hepatomegaly, and hypotension when used in high doses(Tachjian, Maria & Jahangir, 2010).

Can reduce the effectiveness of  antihypertensives

Black cohosh(
Actaea racemosa)

Increases or decreases the effects of estrogen in some parts of the body as a selective estrogen receptor modulator

Improves sleep patterns and mood and reduces hot flashes for menopausal women. Used in the treatment of premenstrual syndrome, acne, osteoporosis, and dysmenorrhea.

Camping, stomach upsets, weight gain, rash and vaginal spotting/bleeding, hepato-toxicity, dark urine, and jaundice.

Interacts with Atorvastatin and may cause damage to the liver and reduces the effectiveness of cisplatin.

Licorice (Glycyrrhiza glabra)

Reduces swelling, thin mucus secretions reduces cough and increase  the production of chemicals that promote ulcer healing

Eczema, dyspepsia, irritable bowel syndrome and stomach ulcers.

High blood pressure, low potassium, headaches, retention of sodium and water, decreased libido in men

Increases the breakdown of warfarin hence reducing its effectiveness, reduces levels of potassium in the body which increases digoxin side effects, reduces the effectiveness of estrogen pills and furosemide (Tachjian, Maria & Jahangir, 2010).

Aconite (
Aconitum
)

Stimulates and causes paralysis of nerves that transmit pain signals causing pain relief.

Joint pains, nerve pains, gout, inflammation, and wounds.

Vomiting, nausea, palpitations, respiratory  complications and paralysis, hypotension and death

Reduces the efficiency and effectiveness of antihypertensives.

Echinacea
(
Echinacea purpurea)

Stimulation of macrophages and other immune system cells resulting in their activation and cytokine release.

Common cold, anxiety, gingivitis, herpes simplex virus, tonsillitis influenza and infection of the middle ear.

Diarrhea, dry mouth, sleeping difficulties, muscle and joint aches, dermatitis, dyspnea tongue numbness, and dizziness.

Increases the risk of liver toxicity when used together with statins and niacin, increases the absorption of midazolam in the body, and increases the QT interval when used together with amiodarone(Tachjian, Maria & Jahangir, 2010).

Danshen(
Salvia miltiorrhiza
)

Prevents clotting of blood and platelets through blood thinning. It also promotes vasodilation which improves circulation (Tachjian, Maria & Jahangir, 2010).

Angina, coronary artery disease, venous thromboembolism, heart disease, liver cirrhosis, hyperlipidemia, stroke, and high blood pressure

Increases the risk of bleeding among people with bleeding disorders, reduces blood pressure

Increases digoxin side effects, slow the clotting of blood when used with anticoagulants increasing the risk of bleeding, prolongs the action duration of warfarin (Tachjian, Maria & Jahangir, 2010).

Hawthorn(
Crataegua monogyna
)

Increases blood supply to the heart through vasodilation and positive inotropic effects.

Cerebral insufficiency, CHF, angina, and bradyarrhythmia

Nausea, sweating, palpitations, agitation, headaches, fatigue and insomnia.

Increases the dilation of the coronary artery with theophylline, sodium nitrate, epinephrine, and adenosine, and increases sleep induced by barbiturates(Tachjian, Maria & Jahangir, 2010)

Saw Palmetto (
Serenoa repens
)

Prevents the conversion of testosterone to dihydrotestosterone which is a more potent form of testosterone

Benign prostatic hyperplasia(BPH), androgenic hyperplasia, prostate cancer and  underactive bladder(Tachjian, Maria & Jahangir, 2010)

Toxicity of the liver and pancreas

Interacts with anticoagulants and can increase the risk of bleeding.

Question 2

Vitamin Name

Rationale

Benefits

Consequences

Complications and drug interaction

Vitamin A

Undergoes conversion in the retina, attaches to opsin in rhodopsin which triggers impulses to the brain that permit light perception (Ezzo, 2007).

General healthy growth and development, healthy eyes, skin, and teeth

Toxicity, nausea, irritability, anorexia, hair loss, blurred vision, and anemia

Reduces the efficacy of doxycycline, warfarin, and neomycin

Vitamin B1

Thiamin is converted from the provitamin form to the active form and used for energy metabolism.

Helps to maintain a healthy metabolism and normal appetite, digestion, and nerve function

Urticaria, angioedema, anaphylaxis, cyanosis and warmth sensation

Interacts with anti-seizure medications, chloramphenicol, and levodopa. And can result in significant renal impairment (Ezzo, 2007).

Vitamin C

Undergoes reversible oxidation in the body in an oxidation-reduction reaction to facilitate metabolism of lipids, carbohydrates, iron, respiration in cells and resistance to infections.

Strengthens vascular blood vessels, increases elasticity of the skin, improves the absorption of iron and serves as an anti-oxidant (Ezzo, 2007).

Vomiting, nausea, heartburn, trouble breathing and abdominal pains

Limits the duration and intensity of action of coumarins.

Complimentary or Alternative (CAM) Therapy Essay

Vitamin D

Vitamin D undergoes hydroxylation resulting in a primary active metabolite which binds to vitamin d receptors used in different regulatory roles (Ezzo, 2007).

Strengthens bones

Headaches, a metallic taste, loss of appetite, dry mouth, and fatigue

Interacts with antacids which contain aluminum and increases its rate of absorption. Can lead to irregular heartbeats when it interacts with digoxin.

Vitamin E

Reacts with lipid radicals that are unstable to form stable lipids and vitamin E radicals which are then converted back to stable vit E.

Improves  the circulation of blood and safeguards the body from free radicals

Hemorrhagic stroke, bleeding, easy bruising, stomach cramps, and blurred vision.

Increases the rate of absorption of cyclosporines. Increases the risk of bleeding and bruising when taken along with warfarin.

Vitamin K

Converts coagulation factors II, VII, IX, and X  to their active forms to promote blood coagulation(Ezzo, 2007).

Improves the blood coagulation process

Palpitations, shortness of breath, sweating, pain and swelling at the site of injection

Increases the risk of bleeding when taken with aspirin. Interacts with NSAIDs and Warfarin.

Zinc

Influences resistance to  epithelial apoptosis as an antioxidant

Helps in building muscles and to maintain oxygen-rich blood

fever, coughing, stomach pain, fatigue

Reduces the efficacy and absorption of quinolones and tetracyclines (Ezzo, 2007).  .

Calcium

 

Promotes strong and healthy bones and teeth

Complimentary or Alternative (CAM) Therapy Essay

 

Iron

Combines with chains of globin and porphyrin for hemoglobin formation which is essential for carrying oxygen (Ezzo, 2007).

Promotes the body’s immunity, growth and development, and fertility.

Abdominal upsets abdominal pains, constipation, diarrhea, nausea, and vomiting.

Reduces the efficacy and absorption of quinolones and tetracyclines.

Question 3

Acupuncture is a form of complementary therapy whose origin was based on traditional Chinese medicine with principles that are closely linked to Taoism and Confucianism. Among most of the commonly existing complementary medicines, acupuncture is widely used in Asian countries and the West as it has demonstrated to be highly efficacious in the management of various conditions. It is a technique that involves the stimulating particular points on the body through the insertion of thin needles on the skin. The stimulation from acupuncture is believed to influence inflammatory markers and induce changes in the hormone levels (Jishun & Mittelman, 2014). It has demonstrated to have numerous benefits in treating  low back pains, rheumatoid arthritis, migraine, osteoarthritis, migraine, and  post-operative vomiting and nausea,

Among patients suffering from migraine headaches, acupuncture reduces the intensity and frequency of headaches to the extent that patients may not require the use of prophylactic treatment. Among patients who have just undergone surgery, acupuncture is not only an effective antiemetic but also reduces pain and the need for opioids post-surgery. These effects have been linked to the P6 acupoint on the wrist and the release of endorphins respectively (Chou & Chu, 2018). Ultimately, this also helps to reduce the side-effects of opioids post-surgery which negatively impacts the process of patient recovery from surgery.

Scientific research reveals that even when used alone or when combined with other forms of treatment, acupuncture has significant benefits in clinical rheumatoid arthritis. In a study that was conducted by Chou & Chu (2018), it was established that acupuncture has no significant side effects on individuals suffering from RA. Instead, it promotes functioning capacity and the quality of life. Its mechanisms were attributed to an antioxidative and anti-inflammatory outcomes and regulating the functioning of the immune system.

Question 4

           
A commonly prescribed supplement by medical professionals in practice is calcium. Calcium supplements are highly recommended to prevent the deterioration of bone density and bone strength in people who may be at high risk of inadequate dietary calcium intake or osteoporosis irrespective of age. Osteoporosis has however been identified to be a common occurrence among post-menopausal women (Reid, Bristow & Bolland, 2015). Some of the factors which increase the risk of post-menopausal women to osteoporosis include lack of physical exercise, excessive weight, and low estrogen levels. Calcium performs the following roles in the body: regulating impulse transmission, regulating the secretion of hormones, maintaining basic life activities, the skeleton and vascular activities (Reid, Bristow & Bolland, 2015).

The mode of action of calcium supplements is highly dependent on adequate amounts of total calcium levels in the body. Calcium primarily exists in the skeleton as hydroxyapatite, calcium carbonate, and amorphous calcium phosphate. Calcium which exists in the bones constantly exchanges with plasma calcium and this helps to maintain a balance of calcium levels (Reid, Bristow & Bolland, 2015). A slight disturbance in this balance to fulfill the body’s needs often results in depletion of calcium in bones. Potential concerns with patients taking calcium supplements are: constipation, rebound acidity and hypercalcemia. Overdosing/hypercalcemia can result in confusion, nausea, and vomiting among other neurological issues and manage through rigorous rehydration (Reid, Bristow & Bolland, 2015). Complimentary or Alternative (CAM) Therapy Essay

 

References

Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on rheumatoid arthritis and associated mechanisms: a systemic review. 
Evidence-Based Complementary and Alternative Medicine
, 
2018
.

Ezzo, D. C. (2007). Drug interactions with vitamins and minerals. 
US Pharm
, 
1
, 42-55.

Jishun, J., & Mittelman, M. (2014). Acupuncture: past, present, and future.

Reid, I. R., Bristow, S. M., & Bolland, M. J. (2015). Calcium supplements: benefits and risks. 
Journal of internal medicine
, 
278
(4), 354-368.

Tachjian, A., Maria, V., & Jahangir, A. (2010). Use of herbal products and potential interactions in patients with cardiovascular diseases. 
Journal of the American College of Cardiology
, 
55
(6), 515-525. Complimentary or Alternative (CAM) Therapy Essay

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Complimentary or Alternative (CAM) Therapy Essay Assignment:

Write a 1200-1500 word APA formatted essay with three sources of support, addressing all of the following topics:

Compile a list of at least 10 herbal medications you have seen patients taking in your practice. Discuss the rationale for taking each medication, possible benefits and consequences of taking it, and drugs that it may interact with. This question can be completed as a grid or an essay.

Compile a list of at least 10 vitamins and minerals, including the rationale for taking each medication and benefits and consequences of taking it. Also list any potential complications and drug interactions. This question can be completed as a grid or an essay.

Choose one type of complementary or alternative (CAM) therapy and discuss its benefits in preventing and treating disease. Discuss how the use of this CAM therapy can reduce the need for medications. Research this therapy on ProQuest or another scholarly database.  What does the research demonstrate regarding its efficacy?

Choose one nutritional supplement you see commonly prescribed or recommended by medical professionals in your practice.  Discuss the reasons why this supplement is recommended and its method of action. What concerns should you have regarding a patient taking this supplement? Could the patient overdose and if so what are the consequences and treatment? Complimentary or Alternative (CAM) Therapy Essay

Benchmark – Epidemiologic Profile Assignment

An epidemiologic profile is a summary of a significant public health issue, or issues, in your community, county, state, or country. An epidemiological profile helps to coordinate activities and policies from various agencies and organizations to improve health.

Review the available data, reports, and documents for your locale. Assess how the methods of epidemiology (study designs, data collection, measures of association, etc.) are used to determine who needs what services, where the services are needed, and how those services should be delivered. Define your community as your city, metropolitan area, or county and write a 2,000-2,250 word epidemiological profile (word limit excludes references and title page).The profile can be a general profile that provides a landscape picture of several significant chronic and infectious diseases in your defined community, or it can be a specific profile that targets one health issue, such as diabetes, asthma, STDs, flu, heart disease, obesity, alcohol abuse, or other drug use. Include the following: Benchmark – Epidemiologic Profile Assignment.

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Executive Summary

Describe the purpose of the epidemiologic profile and the health issue(s) it addresses. Discuss its importance to the community and how it will be utilized.

Summarize the key findings from your review of available data, reports, and documents for the community.

Introduction

Describe the defined community and population using demographic and socio-economic information and data.

Briefly describe the history and cultural background of the community.

Explain any unique contextual information that pertains to the public health of the defined community.

Describe any key public health projects, grants, or existing epidemiology-related working groups or committees in the community/county. Benchmark – Epidemiologic Profile Assignment

Description of Available Data

Identify at least two different data sources relevant to your profile. Discuss data from these sources and their relation to the issue or community.

Discuss the methods used in the data collection process (data source and organization providing the data; how often the data are collected; data limitations including response rates, missing data, selection of participants, etc.). Potential data sources and databases might include the following depending on what is available for your community or county: Benchmark – Epidemiologic Profile Assignment

Behavioral Risk Factor Surveillance System (BRFSS) data

Youth risk behavioral survey

Surveillance, epidemiology, and end results (SEER) program data

CDC Wonder (multiple data sources)

County health rankings data (multiple data sources)

Alcohol-related disease impact data

Demographic health survey data (international)

Global school-based student health survey (international)

Local evaluation reports from the department/ministry of health or other nonprofit organizations

Interpretation of Results Regarding Key Health Issue

Size and magnitude of the measures

Trends and comparisons

Economic costs

Discussion of Problems and Strategies

Discuss disparities, limitations, and gaps in the information available regarding the health issue(s).

Describe potential public health strategies to address these gaps.

Use graphs and tables where appropriate. Benchmark – Epidemiologic Profile Assignment

Conclusion

You are required to cite to at least five sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Benchmark – Epidemiologic Profile Assignment

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

MPH

2.1 Apply epidemiological methods to the breadth of settings and situations in public health practice.

MSN Public Health Nursing

6.2 Apply epidemiological methods to the breadth of settings and situations in public health practice. Benchmark – Epidemiologic Profile Assignment

PUB 540 Principles of epidemiology Topic 1 DQ 2

Discuss the role the CDC’s 
Morbidity and Mortality Weekly Report
 (MMWR) plays in conveying public health information and recommendations. Describe the type of data and information provided by the 
MMWR
. Choose a report posted within the last 2 years from the “Publications – Weekly Report” tab. Provide a brief summary of the disease report, including the natural history and mode of transmission, and whether the report is an example of descriptive epidemiology or analytical epidemiology.

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Topic One, discussion question 2:

This assignment was to review the Morbidity and Mortality Weekly Report (MMWR). The MMWR is created and distributed by the Centers for Disease Control and Prevention (CDC). It is said to be the “voice of the CDC,” and the main chancel for scientific publication that is accurate, objective, and reliable for public health information and the recommendations of the CDC (CDC, 2018). PUB 540 Principles of epidemiology Topic 1 DQ 2

The MMR has different types of data and information published such as (CDC, 2018):

Recommendations and Reports

Which are articles that supply policy statements for prevention and treatment

Surveillance Summaries

Analyzes data from to find trends and or patterns

Supplements

As indicated this data is historical events or information, proceedings from conferences, etc. that can was formed from the MMWR Recommendations and Reports or Surveillance Summary.

The second part of this assignment was to pick a publication from the weekly report to review. I have selected the January 3, 2020 article, Characteristics of patients experiencing rehospitalization or death after hospital discharge in a nationwide outbreak of e-cigarette, or vaping, product use – associated lung injury – United States, 2019.

The center of diseases controls and prevention as well as the food and drug administration, public health departments at the state and local levels have been investigating the growth and negative effects of e-cigarettes and vaping as it is associated with lung injuries (Mikosz, et al. 2019).  PUB 540 Principles of epidemiology Topic 1 DQ 2

One of the main areas with this article is the understanding that at least 25 percent of those re-hospitalized and deaths occur within two days after discharge. Due to this there needs to be a review of the current discharge process and review ways to improve the process, such as a follow-up within 48 hours after hospital discharge, especially those with a chronic condition e.g., diabetes, leads to higher morbidity and mortality (Mikosz, et al. 2019).

The CDC has confirmed as of December 10, 2019 that 52 individuals have died from lung injuries associated with these products (Mikosz, et al. 2019). The CDC has developed a special task force to look at data collected from state health departments as well as hospitalization reports to find areas of opportunity to understand more about the products (Mikosz, et al. 2019). PUB 540 Principles of epidemiology Topic 1 DQ 2

This report is an example of Descriptive epidemiology as it provides a way of organizing and analyzing data on e-cigarettes and vaping in order to understand the lung injuries occurring and how it impacts different individuals based on their unique characteristics (Descriptive Epidemiology n.d.).

References:

Boston University School of Public Health (n.d.) Descriptive epidemiology. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPHModules/EP/EP713_DescriptiveEpi/EP713_DescriptiveEpi_print.html.

Center of Disease Control and Prevention (CDC). (2018). Morbidity and mortality weekly report. Retrieved from 
https://www.cdc.gov/mmwr/author_guide_rrss.html

Mikosz, C., Danielson, M., Anderson, K., et al. (2019). Characteristics of patients experiencing rehospitalization or death after hospital discharge in a nationwide outbreak of e-cigarette, or vaping, product use–associated lung injury — United States, 2019. 
MMWR and Morbidity and Mortality Weekly Report. U.S. Department of Health and Human Services. (68)
1183-1188. DOI: 
http://dx.doi.org/10.15585/mmwr.mm685152e1external icon

 

Re: Topic 1 DQ 2

The Morbidity and Mortality Weekly Report (MMWR) is a weekly published report by the Center for Disease Control and Prevention (CDC). It is the main vehicle for publishing public health information and recommendations that have been received by the CDC from state health departments. It contains in-depth articles that relay policy statements for prevention and treatment on all areas in CDC’s scope of responsibility. MMWR delivers useful information to readers in the public health community, private clinicians, researchers, educators, students, and news media. Reports are based on science (especially epidemiology) or on public health policy or practice. Recommendations contained within reports must be acceptable to the CDC (CDC, 2019) PUB 540 Principles of epidemiology Topic 1 DQ 2

On December 20
th
, 2019, the CDC published an article on Driving Under the Influence of Marijuana and Illicit Drugs Among Persons Aged ≥16 Years. In the United States, driving while impaired is illegal. Nonetheless, an estimated 10,511 alcohol-impaired driving deaths occurred in 2018. The contribution of marijuana and other illicit drugs to these and other impaired driving deaths remains unknown. Data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH) indicated that in the United States during 2014, 12.4% of all persons aged 16–25 years reported driving under the influence of alcohol, and 3.2% reported driving under the influence of marijuana. The impairing effects of alcohol are well established, but less is known about the effects of illicit substances or other psychoactive drugs (e.g., marijuana, cocaine, methamphetamines, and opioids, including heroin). This report provides the most recent national estimates of self-reported driving under the influence of marijuana and illicit drugs among persons aged ≥16 years, using 2018 public-use data from NSDUH (Azofeifa et al., 2019).

Since descriptive epidemiology is described as the identification of disease patterns among cases and in populations by time, place and person (CDC, 2012), the above MMWR article would be an example of descriptive epidemiology. PUB 540 Principles of epidemiology Topic 1 DQ 2

 

References:

Center for Disease Control and Prevention. (2019). Morbidity and Mortality Weekly Report (
MMWR
) Weekly. Retrieved from

https://www.cdc.gov/mmwr/author_guide.html

 

Azofeifa, A., Rexach-Guzman, B., Hagemeyer, A., Rudd, R., and Sauber-Schatz, E. (2019). Driving Under the Influence of Marijuana and Illicit Drugs Among Persons Aged ≥16 Years — the United States, 2018. Retrieved from

https://www.cdc.gov/mmwr/volumes/68/wr/mm6850a1.htm?s_cid=mm6850a1_w#

 

Center for Disease Control and Prevention. (2012). Introduction to Epidemiology. Retrieved from

https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section7.html 
  PUB 540 Principles of epidemiology Topic 1 DQ 2

PUB 540 Principles of epidemiology Topic 1 DQ 1

Define 
endemic
, 
epidemic
, and 
pandemic,
 and provide an example of each. Describe a current epidemic. Describe one example of each of the prevention types (primary, secondary, and tertiary) that could be applied to control the epidemic.

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Topic 1 DQ 1

According to MacIntyre and Bui (2017) a true epidemic has a rise in case rates over days or weeks, whereas an endemic disease may rise or fall over years or decades. The words epidemic and pandemic are often misused. A pandemic is simply a global epidemic, and an epidemic is an outbreak of disease that attacks many people at about the same time and spreads through a defined population (MacIntyre and Bui, 2017). It is defined by rate of growth of the epidemic curve. Epidemics have a sudden and immediate impact on the health system and require surge capacity. The rapid increase in cases observed during an epidemic or pandemic is what causes immediate impacts on health systems, stressing these systems beyond normal operating capacity. A pandemic of a highly infectious microbe will evolve rapidly and affect many people within a short period of time (MacIntyre and Bui, 2017). PUB 540 Principles of epidemiology Topic 1 DQ 1.

According to Troncoso (2015), an influenza pandemic once it begins, would be expected to reach its peak within 2 months. Malaria, TB and AMR organisms, are usually endemic diseases. Endemic diseases may occur in very high numbers, but their rate is constant or changes slowly, over months or years, sometimes decades (Troncoso, 2015). An unprecedented epidemic of Ebola virus has been causing thousands of deaths in West Africa since 2014 (Guinea, Liberia, Nigeria and Sierra Leone). The Ebola virus was first identified in 1976 in Yambuku, Zaire (now Democratic Republic of Congo) and Nzara, South Sudan. The Ebola virus is a zoonotic pathogen, and its circulation among humans is rare, which explains the fact that the outbreaks are intermittent and unpredictable. The most likely reservoir seems to be a fruit bat, although the link has not been confirmed (Chowell and Nishivra, 2014).

The virus has caused more than 30 outbreaks since it was identified in 1976, with less than 1600 deaths before 2014. In most cases, the virus started in rural areas and the epidemics were controlled with routine public health measures, such as the identification of cases, contact tracing, and isolation and quarantine of the patient to break the chain of transmission. PUB 540 Principles of epidemiology Topic 1 DQ 1. These public health measures have a proven efficacy record for the control of epidemics (Chowell and Nishivra, 2014).

According to Chowell and Nishivra (2014) proven treatments or vaccines against Ebola are still not available. Hence, thus the current working toolbox available to control the spread of Ebola still hinges on supportive medical care to increase the survival of those infected and basic non-pharmaceutical public health measures to prevent transmission, namely: 1) infection control measures including standard precautions in health care settings; 2) rapid contact tracing and isolation of infectious individuals; and 3) social distancing interventions in the community which may include the dissemination of awareness campaigns to inform the population on how to avoid contracting the disease, quarantining individuals potentially exposed to infectious individuals and restricting the movement of communities exhibiting local transmission to prevent onward transmission PUB 540 Principles of epidemiology Topic 1 DQ 1. These actions must be conducted in close collaboration with local community leaders to effectively reach the population at large (Chowell and Nishivra, 2014).

MacIntyre, C. R., & Bui, C. M. (2017). Pandemics, public health emergencies and antimicrobial resistance – putting the threat in an epidemiologic and risk analysis context.

Troncoso, A. (2015). Ebola outbreak in West Africa: a neglected tropical disease. Asian Pacific Journal of Tropical Biomedicine, 5: 4, pgs. 255-259.

Chowell, G., & Nishivra, H. (2014). Transmission dynamics and control of Ebola virus disease (EVD): a review. BMC Medicine, 12: 196. PUB 540 Principles of epidemiology Topic 1 DQ 1.

 

Topic 1 DQ 1

Endemic is a disease that exists permanently in a region or population. An example of this is Mexico. The water in Mexico is known for having parasites that locals have built up an immunity to that people not from that region often get very sick over. Epidemic outbreaks are a disease that attacks many peoples at about the same time and may spread through one or several communities. An example of this would be the bird flu or mad cow disease. The areas that are affected and many different government agencies act with notifications and action plans to bring it under control. Pandemic would be something that spreads worldwide. Our ability to travel has brought this to the forefront of the governments and disease control PUB 540 Principles of epidemiology Topic 1 DQ 1. The ability to work with other countries and knowing who is going where allows the population to be safe from a disease making itself present so quickly because of the people transporting the issues with them. Bed bugs would be an example of this.

 

Prevention
:

Primary Prevention – When you are trying to prevent yourself from getting a disease. An example of this is sunscreen to prevent skin cancer

 

Secondary Prevention – This would be having a doctor give you an once over and check your skins condition to see if you have skin cancer and if you do be able to treat it as early as possible.

 

Tertiary Prevention – Is needed once something like skin cancer has happen and is now part of your life. The person learns to best adapt to the situation and learns the rules of living with such a situation.

 

World Health Organization. (2019). Dengue and severe dengue. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue PUB 540 Principles of epidemiology Topic 1 DQ 1

Historical Review of Epidemiology

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt

James Lind

Edward Jenner

Ignaz Semmelweis

John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.

Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses. Historical Review of Epidemiology.

Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for succes.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
for assistance. Historical Review of Epidemiology.

PUB 540 Principles of epidemiology

An epidemiologic profile is a summary of a significant public health issue, or issues, in your community, county, state, or country. An epidemiological profile helps to coordinate activities and policies from various agencies and organizations to improve health.

Review the available data, reports, and documents for your locale. Assess how the methods of epidemiology (study designs, data collection, measures of association, etc.) are used to determine who needs what services, where the services are needed, and how those services should be delivered. Define your community as your city, metropolitan area, or county and write a 2,000-2,250 word epidemiological profile (word limit excludes references and title page) PUB 540 Principles of epidemiology. The profile can be a general profile that provides a landscape picture of several significant chronic and infectious diseases in your defined community, or it can be a specific profile that targets one health issue, such as diabetes, asthma, STDs, flu, heart disease, obesity, alcohol abuse, or other drug use. Include the following:

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Executive Summary

Describe the purpose of the epidemiologic profile and the health issue(s) it addresses. Discuss its importance to the community and how it will be utilized.

Summarize the key findings from your review of available data, reports, and documents for the community.

Introduction

Describe the defined community and population using demographic and socio-economic information and data.

Briefly describe the history and cultural background of the community.

Explain any unique contextual information that pertains to the public health of the defined community.

Describe any key public health projects, grants, or existing epidemiology-related working groups or committees in the community/county PUB 540 Principles of epidemiology.

Description of Available Data

Identify at least two different data sources relevant to your profile. Discuss data from these sources and their relation to the issue or community.

Discuss the methods used in the data collection process (data source and organization providing the data; how often the data are collected; data limitations including response rates, missing data, selection of participants, etc.). Potential data sources and databases might include the following depending on what is available for your community or county:

Behavioral Risk Factor Surveillance System (BRFSS) data

Youth risk behavioral survey

Surveillance, epidemiology, and end results (SEER) program data

CDC Wonder (multiple data sources)

County health rankings data (multiple data sources)

Alcohol-related disease impact data

Demographic health survey data (international)

Global school-based student health survey (international)

Local evaluation reports from the department/ministry of health or other nonprofit organizations

Interpretation of Results Regarding Key Health Issue

Size and magnitude of the measures

Trends and comparisons

Economic costs

Discussion of Problems and Strategies

Discuss disparities, limitations, and gaps in the information available regarding the health issue(s).

Describe potential public health strategies to address these gaps.

Use graphs and tables where appropriate.

Conclusion

You are required to cite to at least five sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

MPH

2.1 Apply epidemiological methods to the breadth of settings and situations in public health practice.

MSN Public Health Nursing

6.2 Apply epidemiological methods to the breadth of settings and situations in public health practice.

 

Historical Review of Epidemiology

 

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt

James Lind

Edward Jenner

Ignaz Semmelweis

John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.

Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses.

Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for succes.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

 

Topic 2: Disease Surveillance and Measurement

 

Objectives:

Evaluate the effectiveness of disease surveillance in public health.

Apply measurement tools to assess the impact of disease, its burden, and associated risk factors.

Discuss the importance of validity and reliability.

Evaluate the steps for investigating the occurrence of disease.

Oswego Outbreak Case Study

 

Read the “Oswego Outbreak Investigation,” located in the Topic Materials.

Part 1

Complete the following:

Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.

Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission?

Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale.

Part 2

In a 500-750 word paper, evaluate the situation and present your findings. Including the following:

Does this case meet the definition of an “outbreak?” Why or why not?

Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.

Discuss the possible routes of transmission for the expected agent.

Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Topic 2 DQ 1

 

Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems?

Topic 2 DQ 2

 

Explain the importance of validity and reliability in diagnostic testing or research. Describe how validity relates to sensitivity and specificity in diagnostic testing. Identify a health screen specific to a diagnostic test that is currently being debated regarding its use, recommended ages, or frequency, and discuss how validity and reliability play into this debate. What other factors should you consider when you assess the recommendations for a diagnostic test or screen?

Topic 3: Causal Inference, Confounding, and Bias

 

Objectives:

Determine sources of bias within a study design.

Describe confounding relationships.

Evaluate the types of causal relationships associated with causation.

Assess measures of morbidity.

Measuring Morbidity: Prevalence and Incidence

 

Read the scenario below and complete the assignment as instructed.

Scenario

In Community X (population 20,000), an epidemiologist conducted a prevalence survey in January of 2012 and reported an HIV prevalence of 2.2%. Over the next 12 months, the department of health reported an additional 50 new HIV cases between February 2012 and January 2013. The total population stayed constant at 20,000.

Part 1

How many people had HIV in January 2012? Present or describe the formula you used to arrive at your answer.

Calculate the incidence rate assuming no HIV-related deaths over the 12-month period. Present or describe the formula you used to arrive at your answer. Be sure to clearly indicate the numerator and denominator used in your calculation and include an appropriate label for the rate.

In a summary of 200-250 words, interpret the results and discuss the relationship between incidence and prevalence. Discuss whether or not the epidemiologist should be concerned about these new HIV infections, assuming a previous incidence rate of 0.5 per 1,000 person-years prior to this updated risk assessment.

Part 2

A rapid test used for diagnosing HIV has a sensitivity of 99.1% and a specificity of 90%. Based on the population prevalence of 2.2% in 2012, create a 2×2 table showing the number of true positives, false positives, false negatives, and true negatives. Calculate the positive predicative value and negative predictive value for this test. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.

In 200-250 words, discuss whether or not the epidemiologist should recommend this test as part of a universal HIV screening program. Provide rationale for your recommendation applying the positive and negative predictive values. Present or describe the formula you used to arrive at your answer.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Topic 3 DQ 1

 

Differentiate between bias and confounding. Discuss the criteria necessary to establish a factor as a confounder and provide an example applying these criteria. What is one way to adjust for a confounding relationship in the study design or the analysis?

Topic 3 DQ 2

 

Explain the two major types of bias. Identify a peer-reviewed epidemiology article that discusses potential issues with bias as a limitation and discuss what could have been done to minimize the bias (exclude articles that combine multiple studies such as meta-analysis and systemic review articles). What are the implications of making inferences based on data with bias? Include a link to the article in your reference.

Topic 4: Study Designs I

Objectives:

Compare and contrast randomized trials and cohort studies.

Differentiate between experimental and observational categories of study designs.

Multicausality: Confounding Assignment

 

These estimates include the influence of other extraneous variables, such as confounders. Confounding is often considered a type of bias, but it is a real relationship that requires an adjustment in the study design or analysis. Understanding how to identify confounding is important as most associations have multiple causal factors. Recognizing if a study adjusted for the appropriate confounding variables is important to determine the validity of the association. To assist your proficiency with the concept of confounding, and how it ultimately affects public health, this practice assignment has been provided.

Complete Problems 1 to 4 from the “Multicausality: Confounding – Assignment” by Schoenbach, located in your Topic Materials. Check your answers against the solutions presented in the “Multicausality: Confounding – Assignment Solutions” Topic Material. PUB 540 Principles of epidemiology.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

Topic 4 DQ 2

Describe the characteristics and design of a cohort study. Based on a disease or health condition identified from the “2020 LHI Topics” on the Healthy People 2020 website, or an article from the GCU library, discuss a real example of a cohort study (include the link to the article in your post to the forum). Include the participants, exposures or treatment groups, timeframe, and outcomes that were measured. Why is a cohort study described as an “observational” study rather than an “experimental” study design?

Topic 5 DQ 1

Describe the common characteristics and design of a case-control study. Discuss the three important features when it comes to selecting cases and controls, and identify a situation when one of these might be violated. Discuss the limitations of using questionnaires for determining exposure status and provide examples of alternative strategies for collecting this information in a case-control study. PUB 540 Principles of epidemiology.

Topic 5 DQ 2

Discuss the strengths and weaknesses of cross-sectional studies and examples of how they can be “descriptive” or “analytic” study designs. Discuss an example of a disease where survival could influence the association between a possible exposure and the disease when measured with a cross-sectional study. Do not discuss examples used in the textbook.

Topic 6: Measures of Association and Application

Objectives:

 

Differentiate between association and causal relationships.

Determine the relative risk and odds ratio as measures of association.

Evaluate the utility of the population attributable risk.

Evaluate the types of causal relationships and associated guidelines for establishing causality.

Calculating Odds Ratio

Data can be qualitative or quantitative. Qualitative data is helpful to generate a hypothesis and gather information if little is known about an expected association. Focus groups, key informant interviews, and case studies are types of qualitative data collection methods used to identify common themes from which to build a hypothesis. Quantitative data collection and analysis is used to test a hypothesis and make comparisons to determine the direction and strength of a potential association. The Behavioral Risk Factor Surveillance System (BRFSS) is cross-sectional panel survey used to collect quantitative data on adult behaviors and risk factors. It is one of the largest U.S. health data collection efforts. The data can be used to analyze associations on a state or country level. Follow the steps to obtain a 2×2 contingency table (also known as a “cross tabulation”) crossing binge drinking with depression PUB 540 Principles of epidemiology.

Retrieve the “BRFSS Web-Enabled Analysis Tool” resource provided in the Topic Materials.

Select “Cross Tabulation.”

Select “2015” for the year.

Select “Arizona” for the state.

Select “Alcohol Consumption: Binge drinkers (males having five or more drinks on one occasion, females having four or more drinks on one occasion)” for Step 2 Select Row.

Select “Chronic Health Conditions: Ever diagnosed with a depressive disorder, including depression, major depression, dysthymia, or minor depression” for Step 3 Select Column.

Skip Steps 4 and 5.

Select “Sample Size” for Step 6 Select Statistics and run the report for the cross tabulation.

Part 1

Using the data from the cross tabulation results, calculate the odds ratio for depression among those exposed to binge drinking. Interpret the odds ratio and discuss if the odds ratio is a good estimate of the relative risk in this situation. Why or why not? Show your 2×2 table and all calculations. Present or describe the formula you used to arrive at your answer. PUB 540 Principles of epidemiology.

Part 2

Use the Topic Material, “BRFSS Web-Enabled Analysis Tool,” located on the CDC website, and run a report for two variables of interest to you. Create a 2×2 table and calculate the odds ratio for this association. Interpret the odds ratio and discuss the public health importance of the association. Show your
2×2 table
. Present or describe the formula you used to arrive at your answer.

Refer to the “Creating a 2×2 Contingency Table” resource for guidance in creating 2×2 contingency tables.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Topic 6 DQ 1

Differentiate between association and causation using the causal guidelines. Discuss which of the guidelines you think is the most difficult to establish. Discuss the four types of causal relationships and use an example not listed in the textbook to describe each relationship. PUB 540 Principles of epidemiology.

Topic 6 DQ 2

Explain the difference between 
relative risk
, 
attributable risk
, and 
population attributable risk
. Provide an example (not from the textbook) of how each type of risk is used in epidemiology. How would you propose using population attributable risk to advocate for a health policy or intervention relative to your health interest?

Topic 7: Applying Epidemiology to Policy

Objectives:

Apply epidemiological methods to the breadth of settings and situations in public health practice.

Discuss the means by which social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels.

Benchmark – Epidemiologic Profile Assignment

An epidemiologic profile is a summary of a significant public health issue, or issues, in your community, county, state, or country. An epidemiological profile helps to coordinate activities and policies from various agencies and organizations to improve health.

Review the available data, reports, and documents for your locale. Assess how the methods of epidemiology (study designs, data collection, measures of association, etc.) are used to determine who needs what services, where the services are needed, and how those services should be delivered. Define your community as your city, metropolitan area, or county and write a 2,000-2,250 word epidemiological profile (word limit excludes references and title page).The profile can be a general profile that provides a landscape picture of several significant chronic and infectious diseases in your defined community, or it can be a specific profile that targets one health issue, such as diabetes, asthma, STDs, flu, heart disease, obesity, alcohol abuse, or other drug use. Include the following:

Executive Summary

Describe the purpose of the epidemiologic profile and the health issue(s) it addresses. Discuss its importance to the community and how it will be utilized. PUB 540 Principles of epidemiology.

Summarize the key findings from your review of available data, reports, and documents for the community.

Introduction

Describe the defined community and population using demographic and socio-economic information and data.

Briefly describe the history and cultural background of the community.

Explain any unique contextual information that pertains to the public health of the defined community.

Describe any key public health projects, grants, or existing epidemiology-related working groups or committees in the community/county.

Description of Available Data

Identify at least two different data sources relevant to your profile. Discuss data from these sources and their relation to the issue or community.

Discuss the methods used in the data collection process (data source and organization providing the data; how often the data are collected; data limitations including response rates, missing data, selection of participants, etc.). Potential data sources and databases might include the following depending on what is available for your community or county:

Behavioral Risk Factor Surveillance System (BRFSS) data

Youth risk behavioral survey

Surveillance, epidemiology, and end results (SEER) program data

CDC Wonder (multiple data sources)

County health rankings data (multiple data sources)

Alcohol-related disease impact data

Demographic health survey data (international) PUB 540 Principles of epidemiology

Global school-based student health survey (international)

Local evaluation reports from the department/ministry of health or other nonprofit organizations

Interpretation of Results Regarding Key Health Issue

Size and magnitude of the measures

Trends and comparisons

Economic costs

Discussion of Problems and Strategies

Discuss disparities, limitations, and gaps in the information available regarding the health issue(s).

Describe potential public health strategies to address these gaps.

Use graphs and tables where appropriate.

Conclusion

You are required to cite to at least five sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competency:

MPH

2.1 Apply epidemiological methods to the breadth of settings and situations in public health practice.

MSN Public Health Nursing

6.2 Apply epidemiological methods to the breadth of settings and situations in public health practice.

 

Topic 7 DQ 1

Epidemiological methods are used in a variety of public health areas (including infectious disease, chronic disease, and social health) and settings (including the community, schools, and the workplace). Epidemiological methods are used to assess, describe, analyze, and make comparisons of populations to inform evidence-based practices, policies, and interventions. Propose a study based on the methods you have learned thus far designed to investigate an association within one of the public health areas listed (infectious disease, chronic disease, or social health) and the methods you would apply. Discuss and define the risk factor or exposure that is being assessed, the method of comparison that is used, and the setting or situation (community, school, workplace, etc.) your study would look to address. Consider the concepts of causal inference, measures of association, and study design. PUB 540 Principles of epidemiology.

Topic 7 DQ 2

Race is often used as a descriptor of disease burden and helps us to determine where health disparities exist in order to address them, which is important. It is helpful to differentiate between race as a descriptor and race as a risk factor. Think about institutional racism and its influence on health. Consider the factors related to race and ethnicity that might be influencing disease status more than the genetics of race when answering this discussion question.

Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.” Discuss the ethical and public health implications of this statement. When might collecting data on race perpetuate institutional racism leading to health disparities and when is it necessary to improve public health? Provide support and examples for your answer. Consider ethical issues related to respect for persons, beneficence, and justice as described in “The Belmont Report.”

Topic 8: Environment and Genetics

Objectives:

Discuss how genetic and environmental factors interact in causing disease.

Explain the biological and genetic factors that affects a population’s health.

Topic 8 DQ 1

 

One method to investigate gene-environment interactions is to study monozygotic twins. Identify an example of a twin study not listed in the textbook used to examine the gene-environment interaction of a specific disease or condition. Briefly summarize the gene-environment interaction investigated, the methods, and the results. What are other possible methods for studying gene-environment interactions as they relate to improving population health?

Topic 8 DQ 2

 

Using the CDC Wonder website, set the query criteria for pancreatic cancer for the United States as illustrated below. Compare the rates by race for Wisconsin and Colorado. Discuss possible biological, genetic, and environmental reasons for differences. What are potential social determinants that contribute to the disparity presented between the two states? PUB 540 Principles of epidemiology.

Use this query upon entering the CDC Wonder website:

Select “Cancer Statistics” under the Wonder Systems tab

Select “Cancer Incidence 1999 – 2013” and click “Data Request”

Organize table layout:

Group results by 1. States and 2. Race (leave the rest of the group options as “None”)

Measures – click “Count” (default) and “Age Adjusted Rates”

Select location – select “States” and “The United States”

Select year and demographics

Year – 2014

Sex – All genders

Age groups – All ages

Ethnicity – All ethnicities

Race – All races

Select cancers of interest – select “Pancreas”

Other options – keep default settings PUB 540 Principles of epidemiology

pub 540 Principles of epidemiology Topic 2 DQ 1

Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

BUY A PLAGIARISM-FREE PAPER HERE

Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems? pub 540 Principles of epidemiology Topic 2 DQ 1

 

Topic 2 DQ 1

Before I address this week’s topic, I will write about a personal experience that illustrates a gap in surveillance. Many years ago while still living in New Jersey, I contracted food poisoning from eating undercooked chicken at a picnic. I knew it was raw the moment I put it in my mouth. I sought care because I was very ill and a stool sample was sent to the lab who, I assume, was mandated to report the illness under jurisdictional law. I do not recall the offending organism, but it was most likely 
Salmonella
. Six months after I was ill, I received a call from the health department asking where I had eaten. Six months! I always think of this and about how many people could have been made ill if I had eaten in a restaurant rather than a picnic pub 540 Principles of epidemiology Topic 2 DQ 1. Potentially six months of customers could have been at risk.

Disease surveillance is the mechanism by which public health organizations monitor changes in disease distribution, congenital malformations, toxic environmental hazards, noncommunicable diseases, and other injuries (Celentano & Szklo, 2019). This was done by analyzing and interpreting data that has been collected from local, state, and territorial health departments (Centers for Disease Control and Prevention [CDC], n.d.). While there are various modes of surveillance, there are strengths gaps associated with each. Passive surveillance, or passive reporting, is the mandated reporting of reportable diseases, such as sexually transmitted infections, to local health departments (Celentano & Szklo, 2019). Mandated reporting allows public health departments to constantly monitor for these reportable diseased with little effort or cost. Some of the gaps caused by passive surveillance are related to the small numbers of cases and that it relies on the conscientiousness of the reporter (Celentano & Szklo, 2019). In Active surveillance, or active reporting, people are specifically recruited and trained to perform surveillance duties which inherently makes them more conscientious (Celentano & Szklo, 2019). Surveyors may conduct interviews of providers or patients or pull data from medical records (Celentano & Szklo, 2019). Sentinel surveillance consists of a well-designed system of selected reporting sites and are employed when high-quality data are needed (World Health Organization [WHO], 2020). Selected reporting sites serve a large population, have providers trained in diagnosing and treating the disease that is under surveillance, and high-quality diagnosis equipment (WHO, 2020). Because this type of surveillance if focused on specific geographic areas and monitoring for certain diseases, it is likely to miss diseases outside of that geographic area or rare diseases that are seen in small numbers (WHO, 2020). pub 540 Principles of epidemiology Topic 2 DQ 1

“No single agency can confront all global health challenges alone” (Centers for Disease Control and Prevention [CDC], n.d., para. 6). This is why the Centers for Disease Control (CDC) partners with the World Health Organization (WHO), and others, to coordinate global health monitoring and strategies. Surveillance can be challenging in undeveloped areas related to the difficulty in physically accessing these areas and in maintaining communication with health departments (Celentano & Szklo, 2019). Sometimes, lack of up-to-date diagnostic equipment in these areas results is underreporting of diseases because they simply were not detected (Celentano & Szklo, 2019). Another challenge that exists when attempting to coordinate surveillance is the use of common terms, forms, surveillance systems. An example of this is the WHO report, World Malaria Report of WHO, that reported 584,000 deaths from malaria worldwide in 2014 while another group of researchers reported 854,000 deaths from malaria that same year (Celentano & Szklo, 2019).

What can be done to improve our global surveillance? Standardization of terms and methods. The National Notifiable Diseases Surveillance Systems (NNDSS) is doing just that by implementing reporting systems based on the National Electronic Disease Surveillance System (NEDSS) architectural standards (Centers for Disease Control and Prevention [CDC], 2018). This will standardize communication between health care systems and health departments, increase interoperability, provide resources to local health departments, and assist health departments to manage and report reportable disease data to the CDC (CDC, 2018). pub 540 Principles of epidemiology Topic 2 DQ 1

.

References

Celentano, D. D., & Szklo, M. (2019). 
Gordis epidemiology
 (6th ed.). Retrieved from https://www.gcumedia.com/digital-resources/elsevier/2019/gordis-epidemiology_6e.php

Centers for Disease Control and Prevention. (2018). 
National notifiable diseases surveillance system
[Fact sheet]. Retrieved from https://wwwn.cdc.gov/nndss/document/NNDSS-Fact-Sheet-508.pdf pub 540 Principles of epidemiology Topic 2 DQ 1

Centers for Disease Control and Prevention. (n.d.). Global health: What CDC is doing. Retrieved January 11, 2020, from https://www.cdc.gov/globalhealth/what/default.htm

Centers for Disease Control and Prevention. (n.d.). National notifiable diseases surveillance system (NNDSS). Retrieved January 11, 2020, from https://wwwn.cdc.gov/nndss/ pub 540 Principles of epidemiology Topic 2 DQ 1

World Health Organization. (2020). Types of surveillance. Retrieved January 11, 2020, from https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/en/

PUB 540 Principles of epidemiology Topic 2 DQ 2

Topic 2 DQ 2

 

Explain the importance of validity and reliability in diagnostic testing or research. Describe how validity relates to sensitivity and specificity in diagnostic testing. Identify a health screen specific to a diagnostic test that is currently being debated regarding its use, recommended ages, or frequency, and discuss how validity and reliability play into this debate. What other factors should you consider when you assess the recommendations for a diagnostic test or screen? PUB 540 Principles of epidemiology Topic 2 DQ 2.

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Topic 2 DQ 2

Validity is crucial in research and testing because it ensures that no external forces like bias are skewing the results and it supports generalizability, application to real-life settings, and application in other contexts (Andrade, 2018). Simply put, validity measures how well a research or diagnostic testing instrument is performing its intended task (Andrade, 2018). This concept relates to sensitivity and specificity because it allows researchers or diagnosing providers to describe a tool’s ability to produce sensitive and specific results (Andrade, 2018). Reliability is also incredibly important because it relates to consistency in the methods used to obtain such research and testing results, furthermore allowing for the calculation of specificity (Andrade, 2018). PUB 540 Principles of epidemiology Topic 2 DQ 2.

One example where validity and reliability may become debatable is in the use of genetic testing as a means of a diagnostic approach (Burke, 2014). For example, a genetic disease called multiple endocrine neoplasia type 2 (MEN2), can benefit greatly from genetic testing where sensitivity can be seen at 95% to 98% and specificity approaches 100% (Burke, 2014). However, this positive predictive value of the genetic testing in this case is seen to be strongly effected by how prevalent the disease is in the population being tested (Burke, 2014). This creates a low positive predictive value when the same genetic testing is conducted amongst a population with little likelihood of the same disease (Burke, 2014). Furthermore, other forms of genetic testing typically have low sensitivity due to limitations of causative mutations that the test is able to identify (Burke, 2014). Because of these issues and as with all other diagnostic testing, the genetic testing results should always be compared against the “gold standard” method for a particular diagnosis (Burke, 2014). A definitive diagnosis should always be based on a combination of new medical data and well-trusted standards (Burke, 2014). PUB 540 Principles of epidemiology Topic 2 DQ 2.

References

Andrade, C. (2018). Internal, external, and ecological validity in research design, conduct, and evaluation. 
Indian journal of psychological medicine
, 
40
(5), 498.

Burke, W. (2014). Genetic tests: clinical validity and clinical utility. 
Current protocols in human genetics
, 
81
(1), 9-15.

Topic 2 DQ 2

When using a test to distinguish between individuals with normal and abnormal results, it is imperative to understand how characteristics of the disease are distributed in varying populations (Celentano & Szlko, 2019). This is why validity and reliability are so important to the success of diagnostic testing. The validity of a test is the ability to differentiate between those that have a disease and those who do not (Celentano & Szlko, 2019). The reliability of a test indicates the extent to which it is without bias and ensures dependable measurement across time and the various items of the tools given in the research (Bajpai & Bajpai, 2013). PUB 540 Principles of epidemiology Topic 2 DQ 2.

There are two key factors to validity: (1) sensitivity of the test and (2) specificity of the test (Celentano & Szlko, 2019). The sensitivity of the test is the ability to determine who has the disease PUB 540 Principles of epidemiology Topic 2 DQ 2. The specificity of the test is the ability to determine who does not have the disease (Celentano & Szlko, 2019).

A health screen that is currently being debated is a breast exam for women, specifically a mammogram to screen for breast cancer. Young women experience a breast exam at routine women appointments, but the mammogram is not performed until the age of 45 (Pratt, 2018). New research suggests that women with specific risk factors should begin breast screenings at the age of 30, but some experts say it may not be effective for women of this age group (Pratt, 2018).

Validity and reliability play into this debate because it is important to know what age group of women are affected are which are not. Only then will experts be able to determine whether or not mammograms will prove to be beneficial at a younger age.

Other factors that should be considered are the health risks and drawbacks associated with the test itself. One large drawback in mammography screening is breast cancer overdiagnosis and overtreatment (Kresser, 2017). For this example, it is critical for research experts to take this factor into consideration before determining whether or not to lower the age for mammograms PUB 540 Principles of epidemiology Topic 2 DQ 2.

References

Bajpai, S. & Bajpai, R. (2013). Goodness of Measurement: Reliability and Validity. Retrieved from https://www.ejmanager.com/mnstemps/67/67-1380953319.pdf

Celentano, D.D. & Szklo, M. (2019). 
Gordis Epidemiology 
(6
th
 Ed). Philadelphia, PA: Elsevier Inc.

Kresser, C. (2017). The Downside of Mammograms. Retrieved from https://kresserinstitute.com/the-downside-of-mammograms/

Pratt, E. (2018). Should Some Women Get Mammograms at 30? Retrieved from https://www.healthline.com/health-news/some-women-should-have-mammograms-starting-at-age-30 PUB 540 Principles of epidemiology Topic 2 DQ 2

pub 540 Principles of epidemiology Topic 2: Disease Surveillance and Measurement

Topic 2: Disease Surveillance and Measurement

Objectives:

Evaluate the effectiveness of disease surveillance in public health.

Apply measurement tools to assess the impact of disease, its burden, and associated risk factors.

Discuss the importance of validity and reliability.

Evaluate the steps for investigating the occurrence of disease.

Oswego Outbreak Case Study

 

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Read the “Oswego Outbreak Investigation,” located in the Topic Materials.

Part 1

Complete the following:

Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance. pub 540 Principles of epidemiology Topic 2: Disease Surveillance and Measurement.

Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission?

Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale. pub 540 Principles of epidemiology Topic 2: Disease Surveillance and Measurement.

Part 2

In a 500-750 word paper, evaluate the situation and present your findings. Including the following:

Does this case meet the definition of an “outbreak?” Why or why not?

Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.

Discuss the possible routes of transmission for the expected agent.

Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies. pub 540 Principles of epidemiology Topic 2: Disease Surveillance and Measurement.

General Requirements

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

Topic 2 DQ 1

 

Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.

Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems? pub 540 Principles of epidemiology Topic 2: Disease Surveillance and Measurement