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NR 503 Population Health, Epidemiology and Statistical Principles
NR 503 Population Health, Epidemiology and Statistical Principles – Chamberlain Homework Help and Study Guide Chapter 1-20 (Questions & Correct Answers).... [Show More] Question 1 Which of the following is a condition which may occur during the incubation period? • Onset of clinical illness • Receipt of infection • Signs and symptoms of disease • Transmission of infection • Isolation of disease carrier through quarantine That's correct! The incubation period is defined as the interval from receipt of infection to the time of onset of clinical illness. Accordingly, individuals may transmit infectious agents during the incubation period as they show no signs of disease that would enable the isolation of sick individuals by quarantine. Question 2 Chicken pox is a highly communicable disease. It may be transmitted by direct contact with a person infected with the varicella-zoster virus (VZV). The typical incubation time is between 10 to 20 days. A boy started school 2 weeks after showing symptoms of chicken pox including mild fever, skin rash, and fluid-filled blisters. One month after the boy returned to school, none of his classmates had been infected by VZV. The main reason was: • Herd immunity • All had been immunized prior to the school year • Contact was after infectious period • Subclinical infections were not yet detected • Disease was endemic in the class That's correct! The disease is spread by contact with an infected individual who can transmit the agent (VZV) to immunologically naive persons during the incubation period and for several days after onset of clinical illness. Since the boy started school 14 days after showing signs consistent with chicken pox, it is most likely that he was no longer infectious. Question 3 The ability of a single person to remain free of clinical illness following exposure to an infectious agent is known as: • Hygiene • Vaccination • Herd immunity • Immunity • Latency That's correct! Immunity is the capacity of a single individual to avoid disease susceptibility when exposed to an infectious agent. Herd immunity is a population characteristic. For certain diseases, individual immunity can be acquired by vaccination, but this is not true for all infectious diseases. Question 4 Which of the following is characteristic of a single-exposure, common-vehicle outbreak? • Long latency period before many illnesses develop • There is an exponential increase in secondary cases following initial exposures • Cases include only those who have been exposed to sick persons • The epidemic curve has a normal distribution when plotted against the logarithm of time • Wide range in incubation times for sick individuals That's correct! Single-exposure, common-vehicle outbreaks involve a sudden, rapid increase in cases of disease that are limited to persons who share a common exposure. Additionally, few secondary cases develop among persons exposed to primary cases. A histogram of the outbreak can plot the number of cases by time of disease onset. In single-exposure, common-vehicle outbreaks, a log transformation of the time of disease onset will often take on the characteristic shape of a normal distribution (i.e., a bell curve) with the median incubation time found at the peak of the curve. Question 5 What is the diarrhea attack rate in persons who ate both ice cream and pizza? • 39/52 • 21/70 • 39/67 • 51/67 • none of the above That's correct! The attack rate in this example is defined as the number of persons who develop diarrhea divided by the total number of people at risk. In this example, the at-risk group is those who have eaten both ice cream and pizza. Of these 52 persons, 39 developed diarrhea. Question 6 What is the overall attack rate in persons who did not eat ice cream? • 30% • 33% • 35% • 44% • 58% That's correct! The attack rate is the number of persons with diarrhea (14 + 9) divided by the total number of persons who did not eat ice cream (40 + 30). Question 7 Which of the food items (or combination of items) is most likely to be the infective item(s)? • Pizza only • Ice cream only • Neither pizza nor ice cream • Both pizza and ice cream • Cannot be assumed from the data shown That's correct! Among persons eating ice cream, over 70% developed diarrhea regardless of their pizza consumption (39/52 and 11/15). Among both groups of persons who did not eat ice cream, each attack rate was equal to or less than 35% (14/40 and 9/30). Question 8 Which of the following reasons can explain why a person who did not consume the infective food item got sick? • They were directly exposed to persons who did eat the infective food item • Diarrhea is a general symptom consistent with a number of illnesses • There may have been an inaccurate recall of which foods were eaten • All of the above • None of the above That's correct! Without knowledge as to the specific agent in this instance, it is also likely that it can be spread by direct contact with infected persons. Since diarrhea is a general disease symptom, it is possible that several infectious agents may be present at this meal or others eaten during the same time period. Further, information regarding food consumption may have been collected long after the disease episode. This may have led persons to incorrectly remember the foods that they consumed. Question 9 An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, and low-grade fever between 10 p.m. on September 24 and 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence and the number reporting illnesses consistent with the described symptoms and onset time. Calculate the attack rate among all students at the boarding school. That's correct! The answer is found by dividing the total number of cases (57) by the total number of students (846). This equals 6.7%. Question 10 An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, and low-grade fever between 10 p.m. on September 24 and 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence and the number reporting illnesses consistent with the described symptoms and onset time. Calculate the attack rates for boys and girls separately. That's correct! For boys, the attack rate includes all cases (40 + 3) divided by the total number of students who are boys (380 + 46). The attack rate is 10.1%. For girls, the attack rate includes all cases (12 + 2) divided by the total number of students who are girls (343 + 77). The attack rate is 3.3%. Question 11 An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, and low-grade fever between 10 p.m. on September 24 and 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence and the number reporting illnesses consistent with the described symptoms and onset time. What is the proportion of total cases occurring in boys? That's correct! The proportion of cases occurring in boys is equal to the number of cases in boys divided by the total number of cases (43/57). This equals 75.4%. Question 12 An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, and low-grade fever between 10 p.m. on September 24 and 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence and the number reporting illnesses consistent with the described symptoms and onset time. What is the proportion of total cases occurring in students who live in dormitories? That's correct! The proportion of cases occurring in dormitory residents is equal to the number of cases in residents divided by the total number of cases (52/57). This equals 91.2%. Question 13 An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, and low-grade fever between 10 p.m. on September 24 and 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence and the number reporting illnesses consistent with the described symptoms and onset time. Which proportion is more informative for the purpose of the outbreak investigation? That's correct! Both proportions are useful. Dormitory residents account for over 90% of the cases indicating an outbreak of an infectious agent that was transmitted at the school. Furthermore, over 75% of the cases were boys indicating that the responsible agent was more likely to have been transmitted in the boys’ dormitory. Question 14 A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial and were divided equally into the treatment and placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the prevalence of CHD at the initial exam? That's correct! The prevalence of CHD at the initial exam was 309 cases of CHD divided by 12,327 participants. This equals a prevalence of 25.1 cases of CHD per 1,000 persons. Question 15 A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial and were divided equally into the treatment and placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the incidence of CHD during the 5-year study? That's correct! The incidence rate reflects the number of new cases developing in the population at risk. Since prevalent CHD cases were excluded from the study, the population at risk was 12,018 (12,327 persons less 309 cases of CHD). During the 5-year study period, 982 incident cases of CHD developed. This equals an incidence rate of 81.7 cases of CHD per 1,000 persons. Question 16 Which of the following are examples of a population prevalence rate? • The number of ear infections suffered by 3-year-old children in March, 2006 • The number of persons with hypertension per 100,000 population • The number of cases of skin cancer diagnosed in a dermatology clinic • b and c • All of the above That's correct! Prevalence is the number of affected persons in a specified population size at a given time. Only answer (b) fits this definition. Example (a) is more consistent with an incident rate while answer (c) is a selected group of persons who may not be representative of a general population. Question 17 What would be the effect on age-specific incidence rates of uterine cancer if women with hysterectomies were excluded from the denominator of incidence calculations assuming that most women who have had hysterectomies are older than 50 years of age. • The rates in all age groups would remain the same. • Only rates in women older than 50 years of age would tend to decrease. • Rates in women younger than 50 years would increase compared to women older than 50 years of age. • Rates would increase in women older than 50 years of age but may decrease in younger women as they get older. • It cannot be determined whether the rates would increase or decrease. That's correct! Women who have had hysterectomies (i.e., removal of the uterus) are no longer at risk for uterine cancer. For women older than 50 years of age, this would increase the age-specific incidence rate as there would be the same number of uterine cancers occurring among fewer women at risk. Further, rates may decrease among younger women who have had hysterectomies as they are no longer at risk for uterine cancer and thus may decrease the number of potential cases occurring in their age group over time. Question 18 A survey was conducted among 1,000 randomly sampled adult males in the United States in 2005. The results from this survey are shown below. The researchers stated that there was a doubling of risk of hypertension in each age group younger than 60 years of age. You conclude that the researchers’ interpretation: • Is correct • Is incorrect because prevalence rates are estimated • Is incorrect because it was based on proportions of the population sample • Is incorrect because incidence rates do not describe risk • Is incorrect because the calculations do not include adult females That's correct! The survey reports the disease status of a population at a specific point in time. In this case, a random sample of adult males in 2005 provides a reliable estimate of the prevalence of hypertension. Since there is no information on duration of hypertension in these men, incidence cannot be calculated. Therefore, the researchers are not able to make a statement concerning risk of hypertension in the population. Question 19 The incidence and prevalence rates of a chronic childhood illness for a specific community are given below. Based on the data, which of the following interpretations best describes disease X? • The duration of disease is becoming shorter. • The duration of disease is becoming longer. • The case-fatality rate of this disease is decreasing. • Efforts to prevent new cases of this disease are becoming more successful. • The risk of the disease has decreased over the past 20 years. That's correct! Prevalence and incidence are related by the duration of disease. If incidence is increasing over time, then duration of illness has to decrease in order to keep the prevalence rate constant. This may occur through better treatments to cure disease or through higher case-fatality rates as a disease becomes more lethal. Since incidence is increasing over time, it is evident that risk is also increasing and that prevention efforts are not successful. Question 20 A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. What is the incident rate of tuberculosis per 100,000 persons in 2003? That's correct! The answer is 29 new cases of tuberculosis per 100,000 persons. This is found by dividing the new cases of tuberculosis by the total population at risk (580/2,000,000) and multiplying this rate by 100,000 to standardize the rate. Question 21 A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. Has the risk of tuberculosis increased or decreased during 2003? That's correct! The risk of tuberculosis has increased over the historic incident rate. This comparison can be made by standardizing the historic rate to a rate per 100,000 persons. To do this, multiply the numerator and denominator by 25. Question 22 Which of the following is an advantage of active surveillance? • Requires less project staff • Is relatively inexpensive to employ • More accurate due to reduced reporting burden for health care providers • Relies on different disease definitions to account for all cases • Reporting systems can be developed quickly That's correct! Active surveillance entails a concerted effort to collect information about disease occurrence. It typically involves dedicated staff members who have been specifically directed to contact physicians and hospitals in order to collect reports of disease cases in a specified population. This activity requires a large amount of staff and resources in order to accomplish its goals. Question 23 The population of a city on February 15, 2005, was 36,600. The city has a passive surveillance system that [Show Less]
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NR 503 Week 6 Discussion: Open Forum Discussion
NR 503 Week 6 Discussion: Open Forum Discussion All students are … to make one post. You are not … to provide reply posts. You can use this time to... [Show More] have an unstructured conversation about genetics, current population health news or other course related topics of interest. ANSWER Prof and Classmates, I truly found this week’s reading material interesting and thought provoking. As future practitioners, it is essential that we ensure an accurate family history assessment is conducted on patients to determine if they are at a higher risk for health problems. It is also our responsibility to determine these risks and inform the patient regarding their options. My paternal side of my family has terrible health problems ranging from strokes, hypertension, cancers, and Alzheimer’s. My primary health care provider is aware of this family history and has utilized primary and secondary prevention measures to help me avoid them. She has recently talked to me about genetic testing to determine if I have the Alzheimer’s gene. My husband and I are still discussing whether or not I will have the testing done. I am torn on what to do and am not sure which choice I will make. I do not want to live my life in fear of the future, yet I also want to know to be able to fight it and prepare myself. My situation has made me stop and think how I would handle a patient situation similar to mine if I were the provider. Do you feel in these types of situations that genetic testing should be done or not? I look forward to hearing your opinions. Sincerely, LaKeshia Jones \ [Show Less]
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NR 503 Week 5 Assignment: Infectious Disease Paper Infectious Disease: Chickenpox
NR 503 Week 5 Assignment: Infectious Disease Paper Infectious Disease: Chickenpox Chamberlain College of Nursing NR503: Population Health Epidemiology a... [Show More] nd Statistical Principles Infectious Disease: Chickenpox Chickenpox, also known as varicella, is a highly contagious disease caused by the varicella-zoster virus (VZV). It is a self-limiting disease that presents during childhood, but can cause severe illness and complications in adolescents and adults. When an individual is infected by the varicella-zoster virus, blister-like rashes can easily develop on the face and stomach, and then spread throughout the entire body. The virus remains dormant in the nerve cells, and may reactivate in later adult years in the form of herpes zoster, or shingles. The infection develops from either direct skin contact or respiratory airborne droplets from an exposed individual. Other symptoms of chickenpox include fever, malaise, headache, and loss of appetite. High risk people, such as infants, elderly, and those with weakened immune systems, may have serious complications from chickenpox. These include bacterial skin infections, pneumonia, sepsis, and encephalitis. The varicella vaccine is the safest and most effective way to prevent chickenpox. Treatments such as calamine lotion, acetaminophen, and antiviral medications, can help relieve symptoms of chickenpox. According to the CDC (2014), chickenpox accounts for more than 9000 hospitalizations in the United States and 95% of Americans had chickenpox before age 18. The highest prevalence of chickenpox is in the 4 to 10-year-old age group, with most cases occurring during the winter and spring. With the vaccine introduced in 1995, the incidence of varicella has dramatically declined by 90% with 99% reduction in the mortality rate in 2008-2011 compared with pre-vaccine years (Leung, Bialek, & Marin, 2015). Determinants of Health There are a few determinants of health that contribute to the development of chickenpox, including social, biology and genetics, and health services. One of the most important determinants of health for people at risk for varicella is access to the vaccine. According to Papaloukas, Giannouli, and Papaevangelou (2014), the rates of chickenpox have decreased over the past 20 years because of the varicella vaccine, which is now a commonly recommended vaccine for children in the United States. Lack of access to health services can greatly impact a person’s health. While the vaccine is readily available, social determinants can also create barriers to high-quality care and education. If families with low socioeconomic status lack resources to meet daily needs, it may be difficult to visit physicians due to finance and transportation issues. Lastly, the biological determinant of age contributes to the development of chickenpox because there is a higher prevalence of the condition in children under ten. Adults over 20 have a risk of death that is 25 times higher when compared to children between one to four (Papaloukas et al., 2014). Host Factors The epidemiological triangle, which consists of the host, agent, and environment, is a model utilized to understand how infectious diseases spread. In the case of the chickenpox, the agent that is the cause of the disease is a microbe, particularly the varicella zoster virus. VZV enters the respiratory tract and conjunctiva, and replicates as a primary infection. Agent factors of varicella include infectivity, which occurs 4 to 6 days after exposure, and secondary attack rate, which occurs 90% within a household (some reference). The host in chickenpox is the same as the reservoir and it is carried by humans and only infects humans. Since only those acting as hosts can transmit the disease, varicella outbreaks are commonly seen among children under ten. Environmental factors include increased disease transmission in overcrowded places. In the United States, there is also a seasonal fluctuation with the highest incidence of chickenpox in the winter and early spring. Role of the Family Nurse Practitioner (FNP) The community health FNP plays a vital role in reducing chickenpox rates by advocating for the varicella vaccination. Community health nurses can also track the effectiveness of treatments through research and data collection from various medical facilities. They can also analyze data to find trends that help healthcare professionals understand the various factors that may affect the spread of the disease and increase the risk of potential health complications. Since 2011, there is no current data on the mortality rates of chickenpox in the U.S. Therefore, case finding, collecting data, reporting and data analysis are important tasks of community health nurses. While VZV associated deaths are rare, finding those specific cases can help understand the conditions leading to death and assess treatment effectiveness. Active surveillance sites are still common despite the dramatic decline of varicella outbreaks. It is helpful to analyze data and statistics to determine trends in different locations and across time to better understand the epidemiology of chickenpox. References Centers for Disease Control and Prevention. (2016). Chickenpox. Retrieved from https://www.cdc.gov/chickenpox/about/index.html Leung, J., Marin, M., Leino, V., Even, S., & Bialek, S.R. (2016). Varicella immunization requirements for US colleges: 2014-15 academic year. Journal of American College Health, 64(6), 490-495. doi:10.1080/07448481.2016.1138481 Gershon, A.A. (2017). Is chickenpox so bad, what do we know about immunity to varicella zoster virus, and what does it tell us about the future? Journal of Infection, 74(1), 27-33. doi: 10.1016/S0163-4453(17)30188-3 Papaloukas, O., Giannouli, G., & Papaevangelou, V. (2014). Successes and challenges in varicella vaccine. Therapeutic Advances in Vaccines, 2(2), 39-55. doi:10.1177/2051013613515621 [Show Less]
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NR 503 Week 8 Final Exam Study Guide Chapter 2 to 20
NR 503 Week 8 Final Exam Study Guide Chapter 2 to 20 Chapters 2-4 Which of the following is a condition which may occur during the incubation period? ... [Show More] Transmission of infection Chicken pox is a highly communicable disease. It may be transmitted by direct contact with a person infected with the varicella-zoster virus (VZV). The typical incubation time is between 10 to 20 days. A boy started school 2 weeks after showing symptoms of chicken pox including mild fever, skin rash, & fluid-filled blisters. One month after the boy returned to school, none of his classmates had been infected by VZV. The main reason was: Contact was after infectious period The ability of a single person to remain free of clinical illness following exposure to an infectious agent is known as: Immunity Which of the following is characteristic of a single-exposure, common-vehicle outbreak? The epidemic curve has a normal distribution when plotted against the logarithm of time What is the diarrhea attack rate in persons who ate both ice cream & pizza? 39/52 What is the overall attack rate in persons who did not eat ice cream? 33% Which of the food items (or combination of items) is most likely to be the infective item(s)? Ice cream only Which of the following reasons can explain why a person who did not consume the infective food item got sick? • They were directly exposed to persons who did eat the infective food item • Diarrhea is a general symptom consistent with a number of illnesses • There may have been an inaccurate recall of which foods were eaten (all of the above) An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Calculate the attack rate among all students at the boarding school. The answer is found by dividing the total number of cases (57) by the total number of students (846). This equals 6.7%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Calculate the attack rates for boys & girls separately. For boys, the attack rate includes all cases (40 + 3) divided by the total number of students who are boys (380 + 46). The attack rate is 10.1%. For girls, the attack rate includes all cases (12 + 2) divided by the total number of students who are girls (343 + 77). The attack rate is 3.3%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. What is the proportion of total cases occurring in boys? The proportion of cases occurring in boys is equal to the number of cases in boys divided by the total number of cases (43/57). This equals 75.4%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. What is the proportion of total cases occurring in students who live in dormitories? The proportion of cases occurring in dormitory residents is equal to the number of cases in residents divided by the total number of cases (52/57). This equals 91.2%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Which proportion is more informative for the purpose of the outbreak investigation? Both proportions are useful. Dormitory residents account for over 90% of the cases indicating an outbreak of an infectious agent that was transmitted at the school. Furthermore, over 75% of the cases were boys indicating that the responsible agent was more likely to have been transmitted in the boys’ dormitory. A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial & were divided equally into the treatment & placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the prevalence of CHD at the initial exam? The prevalence of CHD at the initial exam was 309 cases of CHD divided by 12,327 participants. This equals a prevalence of 25.1 cases of CHD per 1,000 persons. A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial & were divided equally into the treatment & placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the incidence of CHD during the 5-year study? The incidence rate reflects the number of new cases developing in the population at risk. Since prevalent CHD cases were excluded from the study, the population at risk was 12,018 (12,327 persons less 309 cases of CHD). During the 5-year study period, 982 incident cases of CHD developed. This equals an incidence rate of 81.7 cases of CHD per 1,000 persons. Which of the following are examples of a population prevalence rate? The number of persons with hypertension per 100,000 population What would be the effect on age-specific incidence rates of uterine cancer if women with hysterectomies were excluded from the denominator of incidence calculations assuming that most women who have had hysterectomies are older than 50 years of age. Rates would increase in women older than 50 years of age but may decrease in younger women as they get older. A survey was conducted among 1,000 r&omly sampled adult males in the United States in 2005. The results from this survey are shown below. The researchers stated that there was a doubling of risk of hypertension in each age group younger than 60 years of age. You conclude that the researchers’ interpretation: Is incorrect because prevalence rates are estimated The incidence & prevalence rates of a chronic childhood illness for a specific community are given below. Based on the data, which of the following interpretations best describes disease X? The duration of disease is becoming shorter. A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. What is the incident rate of tuberculosis per 100,000 persons in 2003? The answer is 29 new cases of tuberculosis per 100,000 persons. This is found by dividing the new cases of tuberculosis by the total population at risk (580/2,000,000) & multiplying this rate by 100,000 to st&ardize the rate. A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. Has the risk of tuberculosis increased or decreased during 2003? The risk of tuberculosis has increased over the historic incident rate. This comparison can be made by st&ardizing the historic rate to a rate per 100,000 persons. To do this, multiply the numerator & denominator by 25. [Show Less]
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NR 503 Week 2 Discussion: Epidemiological Methods
NR 503 Week 2 Discussion: Epidemiological Methods Consider one of the following disease processes: • Zika • Salmonella • MRSA → Selected Diseas... [Show More] e • Clostridioides difficile • Depression (Choose population:Adult, Older Adult, Adolescent) • Attention Deficit Disorder • Dementia • Osteoporosis Next, choose a diagnostic or screening method. You may use one of the following web sites to locate a screening tool, a scholarly article, or a tool from a professional web site of your choice (for example, from the American Psychological Association).: U.S. Preventative Services Task Force (Links to an external site.) Agency for Healthcare Research and Quality (Links to an external site.)Links to an external site. SAMHSA-HRSA (Links to an external site.). Reply to the following prompt: Describe the diagnostic or screening tool selected, its purpose, and what age group it targets. Has it been specifically tested in this age group? Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme Disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not? Need assistance? Click here for the Week 2 FAQ document that discusses these terms. You should include a minimum of two (2) scholarly articles from the last five (5) years (3 is recommended). Respond to a minimum of two (2) individuals, peer and/or faculty, with a scholarly and reflective post of a minimum of two (2) paragraphs of 4-5 sentences. A minimum of one (1) scholarly article should … utilized to support the post in addition to your textbook. Your work should have in-text citations integrating at a minimum one scholarly article and the course textbook. APA format should … utilized to include a reference list. Correct grammar, spelling, and APA should … adhered to when writing, work should … scholarly without personalization or first person use. ANSWER Class, Osteoporosis is a common medical condition, especially in the elderly population. Their bones become frail as a result of hormone alterations or a lack of other elements such as calcium (Jeremiah, Unwin, Greenawald, & Casiano, 2015). The fracture risk assessment tool (FRAX) is a screening that can be utilized to predict osteoporosis-related fractures in middle age to older adults. It is predicted that by 2020 over 12 million Americans over age 50 will have osteoporosis (American Family Physician, 2018). Therefore, appropriate screening is a vital and essential factor as healthcare members. Osteoporosis predisposes individuals to bone fractures and increased morbidity and mortality rates (Stanciu,2016). The FRAX screening tool predicts your chances of breaking a hip or major bone over the next 10 years. FRAX score is calculated by utilizing sex, age, body mass index (BMI), current smoking habits, glucocorticoid usage, parental hip fractures, alcohol use, prior fragility fracture, history of rheumatoid arthritis, and secondary causes of osteoporosis (Kanis et al.,2015). The target group is women who are postmenopausal age 40-90 years old and it has been tested on that age range (Golob & Laya, 2015). Understanding things such as predictive ability, validity, and reliability along with other numerical information in a study is important as it allows you to determine accuracy and accountability of a study (Curley & Vitale, 2016). The predictive ability of the FRAX screening tool is manifested in its ability to identify the risk for osteoporosis. Multiple research studies have proven the high accuracy of utilizing FRAX to determine individuals’ risk for fractures and osteoporosis (Curry et al.,2018). Predictive validity in one study was at 0.661 and 0.541 in women all age 60 and older when 533 individuals were screened (Chen et al.,2016). FRAX has a low sensitivity of predicting osteoporosis for women ages 50-64 (Bansal et al., 2015). In terms of reliability and validity of the FRAX scores, the reliability is 0.82, and the validity is 0.77. As with any screening tool, there are both advantages and disadvantages. The FRAX screening tool is a great tool because it is cost-effective which is something that must be considered in a family practice setting for patients. Also, it does not expose the patient to any unnecessary radiation that other screening tools such as the dual-energy x-ray absorptiometry (DXA) do. However, some of the disadvantages of the FRAX tool is that it speculates that BMI and mortality are constant for different ethnicities. Furthermore, it is limited to the known risk factors and not the unknown (Stancui, 2016). Therefore, the FRAX screening tool is a vital tool and an essential factor that health care providers should use in their practices. Since it is fairly accurate and is cost-effective, I would utilize this tool in my future practice as an advanced practice nurse. Reference: American Family Physician. (2018). Screening for Osteoporosis to Prevent Fractures: Recommendation Statement. Retrieved from https://www.aafp.org/afp/2018/1115/od1.html Bansal, S., Pecina, J. L., Merry, S. P., Kennel, K. A., Maxson, J., Quigg, S., & Thacher, T. D. (2015). US Preventative Services Task Force FRAX threshold has a low sensitivity to detect osteoporosis in women ages 50-64 years. Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, 26(4), 1429–1433. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1007/s00198-015-3026-0 Chen, S., Chen, Y., Cheng, C., Hwang, H., Chen, C., & Lin, M. (2016). Comparisons of different screening tools for identifying fracture/osteoporosis risk among community-dwelling older people. Medicine, 95(20), e3415. DOI: 10.1097/MD.0000000000003415. Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company. Curry, S., Krist, A., Owens, D., Barry, M., Caughey, A., Davidson, K., … US Preventive Services Task Force. (2018). Screening for osteoporosis to prevent fractures US Preventive Services Task Force recommendation statement. JAMA-Journal of the American Medical Association, 319(24), 2521–2531. DOI: doi: 10.1001/jama.2018.7498. Golob, A. L., & Laya, M. B. (2015). Osteoporosis: Screening, Prevention, and Management. Medical Clinics of North America, 99(3), 587–606. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.mcna.2015.01.010 Jeremiah, M. P., Unwin, B. K., Greenawald, M. H., & Casiano, V. E. (2015). Diagnosis and Management of Osteoporosis. American Family Physician, 92(4), 261–268. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=26280231&site=eds-live&scope=site Kanis, J. A., Harvey, N. C., Johansson, H., Oden, A., Leslie, W. D., & McCloskey, E. V. (2015). FRAX and fracture prediction without bone mineral density. Climacteric, 18(sup2), 2-9. Stanciu, M. (2016). Evaluation of Osteoporosis Risk Factors with Frax Score in Elderly. Acta Medica Transilvanica, 21(1), 46–48. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=119937549&site=eds-live&scope=site from Week 2: Discussion - Epidemiological Methods Sep 9, 2019 5:15am Cassandra Moore Delanie, You did a great job further discussing osteoporosis and the DEXA screening tool that can be utilized to assess the risk of fractures. I have heard of the DEXA scan but have very limited knowledge on it as well. In the future as family nurse practitioners, it will be vital to utilize screening tools such as this to further evaluate the at-risk population. I choose osteoporosis as well; however, I choose to look at the FRAX screening tool. You pointed out that the DEXA scan can be used on patients of all ages, did you find a certain age range that it is typically used for? Also, did you come across any articles regarding the relationship between vitamin D deficiency and osteoporosis? There is a connection between vitamin D deficiency and osteoporosis between the elderly that can be treated to reduce the severity of osteoporosis (Francis et al.,2015). It is always interesting to learn about deficiencies and the body and correlation with disease processes. I often think of our bodies like a car, and how they require oil, gas and appropriate maintenance to run efficiently, just the same as the human body and its requirements. Incidence rates paint a good picture of how often cases occur within a particular population which allows for better determination of risk assessment (Curley & Vitale, 2016). Reducing fractures by 2.5-3.6% through the utilization of DEXA screening as you stated is a good incidence rate. With that, I would utilize it in my future practice. Finally, you made a great point that a CT scan can be extremely costly, but it also places the patient at risk for unnecessary radiation. Great job on your post. I certainly learned new information from you. Reference: Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company. Francis, R. M., Aspray, T. J., Bowring, C. E., Fraser, W. D., Gittoes, N. J., Javaid, M. K., ... & Tanna, N. (2015). National Osteoporosis Society practical clinical guideline on vitamin D and bone health. Maturitas, 80(2), 119-121 from Week 2: Discussion - Epidemiological Methods Sep 10, 2019 3:29am Cassandra Moore Dr.Sinnaeve, Screenings are used to catch diseases in people who do not have any symptoms in hopes of decreasing morbidity and mortality (Curley & Vitale, 2016). As a future family nurse practitioner, it is important to first determine who needs to be screened and then secondly convince those in need to follow through with the screening. However, for this to occur the patient population must be educated and see the benefit and need for the screening. Providing patients with this information and education will vital as a provider. Educating patients on the facts regarding the screening process in terms of what the patient can expect will be beneficial. If you take something like colorectal cancer screening you can find data to show the patient its value and provide them with numerical data that may be convincing. Multiple studies have determined the significance of colorectal cancer screenings in reducing mortality (Williams, Wilkerson, & Holt, 2018). Discussing facts with patients and the value of certain tests will allow them to buy into what you are trying to convince them of and improve the chances of follow-through. I believe that patients have 100 % control over their health. I believe that it is the job of the providers to educate their patients but not force or attempt to get them to do something they do not want. I appreciate honesty and hope to always be able to provide my patients with that. Discussing with them the alternatives if they do not wish to follow the suggestions is important. However, I do not believe in “trying to scare patients” into following recommendations. Therefore, providing them with the facts and education and allowing them to make their own decisions will be the approach I will use in the future. Reference: Curley, L. A., & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company. Williams, R. M., Wilkerson, T., & Holt, C. L. (2018). The role of perceived benefits and barriers in colorectal cancer screening in intervention trials among African Americans. Health Education Research, 33(3), 205–217. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1093/her/cyy013 [Show Less]
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NR 503 Week 8 Final Exam Study Guide; Chapter 2-4, 5-6, 7-8, 9-15, 16-20
NR 503 Week 8 Final Exam Study Guide; Chapter 2-4, 5-6, 7-8, 9-15, 16-20 Chapters 2-4 Which of the following is a condition which may occur during the ... [Show More] incubation period? Transmission of infection Chicken pox is a highly communicable disease. It may be transmitted by direct contact with a person infected with the varicella-zoster virus (VZV). The typical incubation time is between 10 to 20 days. A boy started school 2 weeks after showing symptoms of chicken pox including mild fever, skin rash, & fluid-filled blisters. One month after the boy returned to school, none of his classmates had been infected by VZV. The main reason was: Contact was after infectious period The ability of a single person to remain free of clinical illness following exposure to an infectious agent is known as: Immunity Which of the following is characteristic of a single-exposure, common-vehicle outbreak? The epidemic curve has a normal distribution when plotted against the logarithm of time What is the diarrhea attack rate in persons who ate both ice cream & pizza? 39/52 What is the overall attack rate in persons who did not eat ice cream? 33% Which of the food items (or combination of items) is most likely to be the infective item(s)? Ice cream only Which of the following reasons can explain why a person who did not consume the infective food item got sick? • They were directly exposed to persons who did eat the infective food item • Diarrhea is a general symptom consistent with a number of illnesses • There may have been an inaccurate recall of which foods were eaten (all of the above) An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Calculate the attack rate among all students at the boarding school. The answer is found by dividing the total number of cases (57) by the total number of students (846). This equals 6.7%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Calculate the attack rates for boys & girls separately. For boys, the attack rate includes all cases (40 + 3) divided by the total number of students who are boys (380 + 46). The attack rate is 10.1%. For girls, the attack rate includes all cases (12 + 2) divided by the total number of students who are girls (343 + 77). The attack rate is 3.3%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. What is the proportion of total cases occurring in boys? The proportion of cases occurring in boys is equal to the number of cases in boys divided by the total number of cases (43/57). This equals 75.4%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. What is the proportion of total cases occurring in students who live in dormitories? The proportion of cases occurring in dormitory residents is equal to the number of cases in residents divided by the total number of cases (52/57). This equals 91.2%. An outbreak of gastroenteritis occurred at a boarding school with a student enrollment of 846. Fifty-seven students reported symptoms including vomiting, diarrhea, nausea, & low-grade fever between 10 p.m. on September 24 & 8 p.m. on September 25. The ill students lived in dormitories that housed 723 of the students. The table below provides information on the number of students per type of residence & the number reporting illnesses consistent with the described symptoms & onset time. Which proportion is more informative for the purpose of the outbreak investigation? Both proportions are useful. Dormitory residents account for over 90% of the cases indicating an outbreak of an infectious agent that was transmitted at the school. Furthermore, over 75% of the cases were boys indicating that the responsible agent was more likely to have been transmitted in the boys’ dormitory. A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial & were divided equally into the treatment & placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the prevalence of CHD at the initial exam? The prevalence of CHD at the initial exam was 309 cases of CHD divided by 12,327 participants. This equals a prevalence of 25.1 cases of CHD per 1,000 persons. A group of researchers are interested in conducting a clinical trial to determine whether a new cholesterol-lowering agent was useful in preventing coronary heart disease (CHD). They identified 12,327 potential participants for the trial. At the initial clinical exam, 309 were discovered to have CHD. The remaining subjects entered the trial & were divided equally into the treatment & placebo groups. Of those in the treatment group, 505 developed CHD after 5 years of follow-up while 477 developed CHD during the same period in the placebo group. What was the incidence of CHD during the 5-year study? The incidence rate reflects the number of new cases developing in the population at risk. Since prevalent CHD cases were excluded from the study, the population at risk was 12,018 (12,327 persons less 309 cases of CHD). During the 5-year study period, 982 incident cases of CHD developed. This equals an incidence rate of 81.7 cases of CHD per 1,000 persons. Which of the following are examples of a population prevalence rate? The number of persons with hypertension per 100,000 population What would be the effect on age-specific incidence rates of uterine cancer if women with hysterectomies were excluded from the denominator of incidence calculations assuming that most women who have had hysterectomies are older than 50 years of age. Rates would increase in women older than 50 years of age but may decrease in younger women as they get older. A survey was conducted among 1,000 r&omly sampled adult males in the United States in 2005. The results from this survey are shown below. The researchers stated that there was a doubling of risk of hypertension in each age group younger than 60 years of age. You conclude that the researchers’ interpretation: Is incorrect because prevalence rates are estimated The incidence & prevalence rates of a chronic childhood illness for a specific community are given below. Based on the data, which of the following interpretations best describes disease X? The duration of disease is becoming shorter. A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. What is the incident rate of tuberculosis per 100,000 persons in 2003? The answer is 29 new cases of tuberculosis per 100,000 persons. This is found by dividing the new cases of tuberculosis by the total population at risk (580/2,000,000) & multiplying this rate by 100,000 to st&ardize the rate. A prevalence survey conducted from January 1 through December 31, 2003 identified 580 new cases of tuberculosis in a city of 2 million persons. The incidence rate of tuberculosis in this population has historically been 1 per 4,000 persons each year. Has the risk of tuberculosis increased or decreased during 2003? The risk of tuberculosis has increased over the historic incident rate. This comparison can be made by st&ardizing the historic rate to a rate per 100,000 persons. To do this, multiply the numerator & denominator by 25. Which of the following is an advantage of active surveillance? More accurate due to reduced reporting burden for health care providers The population of a city on February 15, 2005, was 36,600. The city has a passive surveillance system that collects hospital & private physician reports of influenza cases every month. During the period between January 1 & April 1, 2005, 2,200 new cases of influenza occurred in the city. Of these cases, 775 persons were ill with influenza according to surveillance reports on April 1, 2005. The monthly incidence rate of active cases of influenza for the 3-month period was: 20 per 1,000 population The population of a city on February 15, 2005, was 36,600. The city has a passive surveillance system that collects hospital & private physician reports of influenza cases every month. During the period between January 1 & April 1, 2005, 2,200 new cases of influenza occurred in the city. Of these cases, 775 persons were ill with influenza according to surveillance reports on April 1, 2005. The prevalence rate of active influenza as of April 1, 2005, was: 20 per 1,000 population The population of a city on February 15, 2005, was 36,600. The city has a passive surveillance system that collects hospital & private physician reports of influenza cases every month. During the period between January 1 & April 1, 2005, 2,200 new cases of influenza occurred in the city. Of these cases, 775 persons were ill with influenza according to surveillance reports on April 1, 2005. What can be inferred about influenza cases occurring in the city? The average duration of influenza is approximately 1 month A study found that adults older than age 50 had a higher prevalence of pneumonia than those who were younger than age 50. Which of the following is consistent with this finding? Incidence rates do not vary by age, but older adults have pneumonia for a longer duration compared to younger adults Which of the following statements are true? More than one answer may be correct. Prevalence rates are useful for public health planning Incidence rates can be used to estimate prevalence when the mean duration of the disease is known A disease has an incidence of 10 per 1,000 persons per year, & 80% of those affected will die within 1 year. Prior to the year 2000, only 50% of cases of the disease were detected by physician diagnosis prior to death. In the year 2000, a lab test was developed that identified 90% of cases an average of 6 months prior to symptom onset; however, the prognosis did not improve after diagnosis. Comparing the epidemiology of the disease prior to 2000 with the epidemiology of the disease after the development of the lab test, which statement is true concerning the disease in 2000? Incidence is higher & prevalence is higher than in 1999 A disease has an incidence of 10 per 1,000 persons per year, & 80% of those affected will die within 1 year. Prior to the year 2000, only 50% of cases of the disease were detected by physician diagnosis prior to death. In the year 2000, a lab test was developed that identified 90% of cases an average of 6 months prior to symptom onset; however, the prognosis did not improve after diagnosis. Which statement is true concerning the duration of the disease after the development of the lab test? Mean duration of a case of the disease is longer in 2000 A disease has an incidence of 10 per 1,000 persons per year, & 80% of those affected will die within 1 year. Prior to the year 2000, only 50% of cases of the disease were detected by physician diagnosis prior to death. In the year 2000, a lab test was developed that identified 90% of cases an average of 6 months prior to symptom onset; however, the prognosis did not improve after diagnosis. Which statement is true concerning the disease-specific mortality rate after the development of the lab test? The mortality rate for the disease is the same in 2000 In a coastal area of a country in which a tsunami struck, there were 100,000 deaths in a population of 2.4 million for the year ending December 31, 2005. What was the all-cause crude mortality rate per 1,000 persons during 2005? The answer is 41.7 per 1,000 persons. The rate is calculated by dividing 100,000 deaths by the population of 2,400,000 persons. To express as a rate per 1,000 persons, the rate is multiplied by 1,000. In an industrialized nation, there were 192 deaths due to lung diseases in miners ages 20 to 64 years. The expected number of deaths in this occupational group, based on age-specific death rates for lung diseases in all males ages 20 to 64 years, was 238 during 1990. What was the st&ardized mortality ratio (SMR) for lung diseases in miners? The answer is 81. The ratio is calculated by dividing 192 observed deaths by the 238 expected deaths for this age group. To express it as an SMR, the ratio is often multiplied by 100. In 2001, a state enacted a law that required the use of safety seats for all children under 7 years of age & m&atory seatbelt use for all persons. The table below lists the number of deaths due to motor vehicle accidents (MVAs) & the total population by age in 2000 (before the law) & in 2005 (4 years after the law was enacted). What is the age-specific mortality rate due to MVAs for children ages 0 to 18 years in 2000? 6.1 per 1,000 In 2001, a state enacted a law that required the use of safety seats for all children under 7 years of age & m&atory seatbelt use for all persons. The table below lists the number of deaths due to motor vehicle accidents (MVAs) & the total population by age in 2000 (before the law) & in 2005 (4 years after the law was enacted). Using the pooled total of the 2000 & 2005 populations as the st&ard rate, calculate the age-adjusted mortality rate due to MVAs in 2005. The correct answer is 2.3 MVA deaths per 1,000 persons. The key to calculating the age-adjusted rate is to pool the observed numbers for both time periods & to calculate the expected numbers of deaths in the 2005 population assuming that a common rate applied to the population. For example, for those under 7 years, the pooled rate equals (44 + 20) divided by (3,500 + 4,000). The pooled rate for this group is 8.5 per 1,000 persons. When this rate is multiplied by the 4,000 children under 7 years of age in 2005, the expected number of deaths is 34.13. Performing the same calculation for each age group results in 111.7 deaths in those 7 to 18 years of age, 175.8 deaths in those 19 to 49 years, & 237.35 deaths for those 50 years or more. The total number of deaths expected in 2005 based on this pooled rate is 558.98. Therefore, the age-adjusted overall rate for 2005 is 558.98 deaths divided by 240,000 persons. In 2001, a state enacted a law that required the use of safety seats for all children under 7 years of age & m&atory seatbelt use for all persons. The table below lists the number of deaths due to motor vehicle accidents (MVAs) & the total population by age in 2000 (before the law) & in 2005 (4 years after the law was enacted). Based on the information in the table, it was reported that there was an increased risk of death due to MVAs in the state after the law was passed. These conclusions are: Correct, because both the total & the age-adjusted mortality rates are higher in 2005 than in 2000 For colorectal cancer diagnosed at an early stage, the disease can have 5-year survival rates of greater than 80%. Which answer best describes early stage colorectal cancer? Incidence rates will be much higher than mortality rates The following table gives the mean annual age-specific mortality rates from measles during the first 25 years of life in successive 5-year periods. You may assume that the population is in a steady state (i.e., migrations out are equal to migrations in). The age-specific mortality rates for the cohort born in 1915-1919 are: 2.4 3.3 2.0 0.6 0.1 The following table gives the mean annual age-specific mortality rates from measles during the first 25 years of life in successive 5-year periods. You may assume that the population is in a steady state (i.e., migrations out are equal to migrations in). Based on the information above, one may conclude: Children ages 5 to 9 had the highest rate of death in all periods Which of the following characteristics indicate that mortality rates provide a reliable estimate of disease incidence? More than one answer may be correct. The case-fatality rate is high The duration of disease is short Which of the following statements are true? More than one answer may be correct. A mortality rate is an example of an incidence rate Among those who are 25 years of age, those who have been driving less than 5 years had 13,700 motor vehicle accidents in 1 year, while those who had been driving for more than 5 years had 21,680 motor vehicle accidents during the same time period. It was concluded from these data that 25-year-olds with more driving experience have increased accidents compared to those who started driving later. This conclusion is: Incorrect because rates are not reported For a disease such as liver cancer, which is highly fatal & of short duration, which of the following statements is true? Choose the best answer. Incidence rates will be equal to mortality rates The prevalence rate of a disease is two times greater in women than in men, but the incidence rates are the same in men & women. Which of the following statements may explain this situation? The case-fatality rate is lower for women The table below describes the number of illnesses & deaths caused by plague in four communities. The case-fatality rate associated with plague is lowest in which community? Community C The table below describes the number of illnesses & deaths caused by plague in four communities. The proportionate mortality ratio associated with plague is lowest in which community? [Show Less]
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NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem (Lupus Disease).
NR 503 Week 6 Assignment: Epidemiological Analysis: Chronic Health Problem (Lupus Disease). Systemic Lupus Erythematosus NR 503: Week 6 Sometimes... [Show More] just looking at a patient, the provider has a difficult time knowing what is wrong with the patient. In this paper we are going to discuss the disease known as systemic lupus erythematosus, or SLE. This disease is one that attacks its patients’ body and is not always easily diagnosed. The patient is often more fatigued, running fevers and has a rash appear that they are unfamiliar with. This disease will be discussed at length and will look at the incidence, prevalence and statistics as well as the signs, symptoms and other background information about the disease. Background Systemic lupus erythematosus, also known as SLE or lupus is a chronic autoimmune disease that can damage any part of a person’s body such as skin, joints, and organs (Lupus Foundation of America, 2014). A person with Lupus has symptoms of severe arthritis with pain and swelling in the joints and are often placed on steroids and immune system suppressants such as methotrexate are often used as part of the treatment. This is because the immune system of a patient with lupus is overactive. Lupus is a chronic disease and has no cure, but the symptoms can be managed with medical treatment. Patients can also use antimalarial drugs to help prevent the disease from having flare-ups. Lupus causes a patient to be more sensitive to sunlight or UV rays and can cause their disease to flare-up. It is important that they get plenty of rest, exercise regularly, limit alcohol use and eat a healthy diet, as these will help improve their immune system function. A person living with lupus must learn self-management skills and learn how to manage their disease so that they are not feeling sick all the time. Each person with SLE will have different treatments depending on their system involvement and symptoms. The prevalence of SLE in the United States have ranged from 1.8 to 23.2 cases per 100,000 per year (Ferucci, 2014). Studies have shown that the disease is highest in Afro-Americans then Asians and followed by Caucasians. This disease seems to affect more women that are at their child-bearing age. The table below shows some of the prevalence of SLE by age, sex and region. There was no data found for the state of Illinois. Table 1. Prevalence of SLE according to the primary definition, categorized by sex and region Unadjusted Age-adjusted Rate Rate 95% confidence 95% confidence Denominator # of cases Interval Interval Female 116,551 251 215 (190-244) 271 (238-307) Male 95,365 34 36 (26-50) 54 (36-77) Regional Alaska 117,964 130 110 (93-131) 149 (124-177) Phoenix 70,311 125 178 (149-212) 248 (204-297) Oklahoma 23,641 30 127 (89-179) 138 (96-191) United States 1.4 million 63,052 194 n/a Note: Reprinted from Data for Prevalence of SLE according to the primary definition, categorized by sex and region, by Ferucci, E. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617772/ Sept. 2014. Current surveillance methods The centers for disease control and prevention funded studies in California by using data obtained from hospitals, laboratories, rheumatologists, nephrologists, commercial laboratories and a state hospital discharge database. They looked at medical records to determine the patients that met at least four out of eleven of the American College of Rheumatology classification criteria of SLE (Dall’Era, M, 2017). They did this to determine the prevalence and incidence of the disease in Hispanics and Asians. Case control studies and cohort studies are done to help show the factors that are related to developing SLE. This way once the physician determines the patient’s risk factors, they can start preventative treatment to try and control the risk of getting SLE. However, SLE tends to show up in patients that have a lower risk than those with a higher risk. People should avoid smoking as this is a risk that can be avoided that can lead to SLE, cancer and cardiovascular diseases. Descriptive epidemiological analysis The prevalence of SLE in the United States is approximately 20 cases in 150 per 100,000 people. Since we are more able to detect this illness now, the incidence has tripled within the last 40 years. There seems to be a correlation between geographical location and race as well as the frequency and severity of the disease when looking at prevalence. For some reason, this disease appears more in urban areas than rural areas. Within the United States this disease is presented highest in Asians, African Americans, African Caribbean’s and Hispanics when compared to Caucasians. The disease has also been found in the European countries to be more prevalent in Asian and Africans, but SLE is not found much in Africa. It has been found that those that are not Caucasian tend to be more ill and have a higher risk of early mortality with SLE. If patients contract the disease as a child, they also have a more severe disease with higher damage and higher mortality rates. It has been found that race, age and gender play a large role in mortality rates and the effects the disease has on the patient. Screening and diagnosis The diagnosis of SLE requires the patient to have four or more of the eleven criteria, which include: malar rash, discoid rash, photosensitivity, oral ulcer, arthritis, serositis, renal disorder, persistent proteinuria neurologic disorder, hematologic disorder, immunologic disorder and positive antinuclear antibody test result or ANA (Washio, 2018). The four that most patients present with are the positive ANA, arthritis, hepatologic disorder and immunology disorder. Lupus can be difficult to diagnose and requires time to diagnose. Physicians must perform a history and physical examination including all major systems at each clinic visit. They must look at the disease activity at every visit (Fernando, 2016). It can also be difficult to tell if the inflammation is current from the patients’ symptoms or if it is damage that could show permanent changes, and there are some tools they can use to determine these changes. There are many scales to use, however they have not been validated and are not recommended to use in the diagnosis of SLE. There is the health assessment questionnaire that is widely used in rheumatoid arthritis and it has been validated in patients with SLE who have arthritis (Fernando, 2016). The only problem with this questionnaire is that it only focuses on the joint pain and arthritis and SLE has many different symptoms. There is a short form-36 that is preferred to be used in clinical practice for the diagnosis of SLE and it has been validated. It has been shown that the ANA test is one of the most sensitive diagnostic tests available for SLE. 98% of patients with SLE will have a positive ANA test, confirming the diagnosis. Plan of Action Working as a nurse practitioner I will want to care for my patients with Lupus by helping to reduce their inflammation, regain mobility, decrease their pain and their frequency of increased disease symptoms. At each and every visit we would assess and monitor any rashes on the skin, mucous membranes for any oral lesions or ulcers, assess and manage the patients pain, explain to patients the importance of deep breathing exercises to prevent lung diseases, encourage the patient to do activity as tolerated with rest breaks as they probably get very fatigued with any activity, monitor labs, order any needed medications such as steroids and immunosuppressants and review healthy nutrition with them to help promote healing and prevent more inflammation. In my community, I would first identify the people that are at increased risk of developing lupus and try to do some preventative interventions. We need to develop and put into action strategies to help improve the communication with those patients in the community and the physicians in the community. Often patients are scared to go to the physician’s office. We need to obtain large population samples in our area that includes health records and geographical data so that we can try and identify any new risk factors and health disparities that may be playing a part in patients with SLE. Our community could bring patients in to be researchers to evaluate data through social media and questionnaires to help find some patient-centered approaches to evaluate autoimmune disease research. Lupus affects a patient’s life at times by causing them severe joint pain, fatigue and depression. Depression often sets in as a patient cannot function in their life the way they want to. They often have stress because they are too tired and hurt too bad to work and often cannot hold a job due to their disease. They are at increased risk of strokes, headaches, vision problems, seizures and can have trouble expressing their thoughts at times which also makes it difficult for them to hold a job (Ferucci, 2014). One research study that was reviewed showed that patients with SLE that did twelve weeks of aerobic exercise supervised by a health professional, led to reduced fatigue and increased vitality for those patients (Wu, 2017). This would be a good intervention to push for with patients and educate them on. Patients need to also be educated on smoking. Smoking increases the risk of cardiovascular disease in patients with SLE and affects the heart and blood vessels (Lupus Foundation of America, 2014). Education in the community regarding SLE and the signs and symptoms to be aware of as well as what to do to be diagnosed and management of the disease would be a large intervention. The prevalence of the disease would be assessed over several years to see if the interventions were effective and to determine what else could be done further in getting the awareness of this disease out into the community. Patients need to become more aware of their symptoms and be able to feel comfortable in coming to their providers for diagnosis and treatment. Conclusion SLE is a chronic, autoimmune disease that is not curable. Patients can control their symptoms with medical management, exercise, rest and good nutritional habits. Management of this disease also varies from patient to patient depending on their severity of symptoms and how they manifest. This disease is often difficult to diagnose because it can mimic many similar diseases and it does take time to diagnose by monitoring a patient’s symptoms over time. They must look at clinical findings and monitor over time as well as laboratory testing. The prevalence of the disease has increased over the last many years but could also be related to their being more information out about the disease and better diagnosis of the disease. The need to stress the importance of taking medications and keeping appointments must be stressed to patients that have SLE. This disease has no specific cause but can be related to genetic, ethnic or environmental factors. There are also many risk factors that could cause SLE such as low birthweight, childhood exposure to agricultural pesticides, cigarette smoking, estrogen use and exposure to ultraviolet light. SLE has had elevated mortality rates over the last few decades, but those rates have decreased. Life expectancy varies depending on the involvement of major organs. With the improvement in treatment and advances in medical care patients are living longer with SLE. The earlier they are diagnosed the better and therefore healthcare workers need to get out in our communities and really stress the signs and symptoms of the disease and make it better known. SLE can be a more manageable disease if we detect it early and can educate the patient on management of the disease early on. References: Dal’Era, M, et al. (2017). The incidence and prevalence of systemic lupus erythematosus in San Francisco county, California: The California lupus surveillance project. Arthritis Rheumatoid. 69(10): 1996-2005. doi: 10.1002/art.40191 Fernando, M (2016). How to monitor SLE in routine clinical practice. Journal of Rheumatology. 6(30). 445-468. Ferucci, E. (2014). Prevalence and incidence of systemic lupus erythematosus in a population-based registry of American Indian and Alaska native people. Arthritis Rheumatoid. 66(9): 2494-2502. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617772/ Lupus Foundation of America (2014). Retrieved on August 16, 2019 from: https://www.lupus.org/resources/what-is-lupus Washio, M. (2018). Epidemiology of systemic lupus erythematosus. AJN. 7(30). 231-238. Wu, M, (2017). The effectiveness of exercise in adults with systemic lupus erythematosus. Worldviews Evid Based Nursing. 14(4): 306-315. doi: 10.1111/wvn.12221. [Show Less]
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NR 503 Week 5 Discussion: Open Forum Discussion
NR 503 Week 5 Discussion: Open Forum Discussion All students are required to make one post. You are not required to provide reply posts. You can use ... [Show More] this time to have a non-structured conversation from the Podcast and web site links below. Provide one fact or element from the web site exploration that applies to this module’s topic of populations as risk. Everyone should review the AETCMC Self-Assessment link:. Podcast Kaiser: Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. (Links to an external site.)Links to an external site. Web Site Links: Important self-assessment: Self-assessment (culture and attitudes) (Links to an external site.)Links to an external site. National CLAS Standards (Links to an external site.)Links to an external site. New CLAS Report and Toolkit from OMH (Links to an external site.)Links to an external site. HHS Providing Enhanced Resources: Cultural Competency Training (Links to an external site.)Links to an external site. ANSWER Prof and class, The topic of cultural awareness and cultural competency is something that is stressed repeatedly for healthcare providers. Considering current events this topic should be taught to the entire world. Cultural tolerance, understanding, and cultural respect need to be incorporated into professional situations and into personal situations as well. The CLAS goal is to improve healthcare providers cultural competency skills to improve the care of our culturally diverse nation (AETC-NMC | Self-Assessment, 2019). This requires that each provider be aware of their own cultural knowledge and beliefs. The provider can then continue to gain the skills necessary to be able to provide knowledgeable, respectful, high quality care to a culturally diverse population. CLAS has cultural competency tests, learning tools, and training aides to assist in this process. I was interested to learn that there is a need for culture training on patients with a diagnosis of HIV and AIDS as well as for patients from the LGBTQ populations. Even in the year 2020 there is still a lack of cultural tolerance and understanding. The CLAS standards aim for providers to care for patients in an “effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices” (National CLAS Standards - The Office of Minority Health, n.d.). Healthcare providers must practice CLAS standards to advance health equity and keep caring and compassion universal. Advanced practices nurses must have cultural awareness and be culturally competent in order provide safe, high-quality, holistic patient care regardless of a patient’s culture, cultural beliefs, values, or personal preferences. Health care providers must individualize care and be cognizant of each patients’ cultural beliefs. The key to progressing healthcare to a culturally competent state is by improving health equity and cultural understanding at every point of care, one patient at a time (National CLAS Standards - The Office of Minority Health, n.d.). AETC-NMC | Self-Assessment. (2019). Aetcnmc.Org. https://www.aetcnmc.org/self-assessment.html National CLAS Standards - The Office of Minority Health. (n.d.). Www.Minorityhealth.Hhs.Gov. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53 [Show Less]
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NR 503 Week 3 Discussion: Chronic Health and Occupational Health Articles
NR 503 Week 3 Discussion: Chronic Health and Occupational Health Articles Utilizing the list below, choose two research methods. 1. Next, find two arti... [Show More] cles, one on each of the chosen methods, from the Chamberlain College library, or you may use one that is provided within the course and one you find from the library. The articles should … related to population health and infectious disease, chronic health, occupational health, global health, genomics, or environmental health: Randomized Control Trial Cohort Study Case-Control Study Cross-Sectional 2. Read each article and answer the following questions for each article: Does the study design specify a question, goal, of the study? Explain the methodology (Randomized Control Trial, Cohort Study, Case-Control Study). Describe the participant information, include recruitment. Is selection bias present? How is data collected? Are the variables … ? If yes, discuss. If no, how does this impact your interpretation of the study? How was the data analyzed, what statistics are provided? What are potential errors … to the study design? What are the weaknesses of the type of study design/method? Discuss the outcomes and the implications for implementation. 3. Post your analysis of the research studies to the DB. Your analysis should have in-text citations and utilize a scholarly voice with APA formatting. You may choose to write a Word doc and upload your doc to the discussion board for this week. 4. Respond to a total of two posts; either two (2) peer posts or a peer and faculty post, with a minimum of one paragraph of 4-5 sentences for each of their articles. Your reply post should integrate in-text citation(s) and … formatted with APA and a scholarly voice. ANSWER Professor and Class, I have chosen to focus on one article on chronic health and the other article will be on occupational health. I will answer the assigned questions utilizing an article review of a randomized control trial method and a cohort study. Article 1: Effectiveness of a pyschoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity : study protocol for a randomized, controlled trial. The goal of this study was to ‘evaluate the effectiveness of an intervention based on a psychoeducational program carried out by primary care nurses to improve the response rate of depression in patients with chronic physical illness and also to assess the impact of the intervention on improving control of the physical pathology.”(Casañas ,et al, 2019). The methodology utilized was a randomized control trial. In this type of study participants are selected randomly by chance to receive one clinical intervention. The first group of participants is considered the control group while the other group is the experimental group. The experimental group is the group that received the intervention to be tested while the second group which is the control group received an alternative or conventional treatment. A total of 504 patients underwent randomization. They performed a multicenter, randomized controlled clinical trial involving participants who suffer from major depression and has at least one comorbidity of type 2 diabetes, chronic obstructive pulmonary disease or asthma. Participants who were above 50 years assigned to primary health center from different locations in Barcelona city were eligible for inclusion with a score above 12 on the Beck Depression Inventory score. Participants were randomly distributed into the intervention group and control group .The intervention group were assigned to receive usual care in addition to psychoeducatioal intervention that lasted 90min once a week for 12 sessions, this sessions was organized by two primary care nurses and the control group received usual care alone. There is bias because non speaking Spanish participants were excluded. . Data was collected by online survey, mini interview and questionnaires. The variables for this study included the dependent variable which is the rate of remission and response while the independent variable will be the patients group. Data analysis is performed on an intention-to-treat basis, all the patients that signed the informed consent and attended the initial interview will be included. “Descriptive statistics will be performed to evaluate the homogeneity between the two groups” (Casañas ,et al, 2019).The potential for error is that some of the participants may drop out of the study due to the fact that the study would last for a year. Randomized controlled trials sometimes do not provide the answers that the researchers are looking for. They do not provide the information that is needed for the most part and they tend not to be specific on whether the patient is going to benefit from the treatment or not. They are sometime very expensive due to the length of the research. The outcome was positive overall and the study showed a decrease of at least 50% in comparison to the initial evaluation of depressive symptoms. Future studies are needed in order to determine if patients can really benefit from this treatment. Article 1: Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people. The study does not specify a question .The goal of this study is to examine if there is a relationship between knee pain and falls in older people ( Hicks,et al, 2020). This study is a Cohort Study. Cohort studies are used to investigate the cause of a situation and to establish a link between risk factors and health outcomes. In this case we are looking at the correlation between knee pain and fall Three hundred and thirty three people from the age of 70 and older participated in the study. They were 156 men and 176 women with a one year follow up for falls. The men lived in the community while the women were from different part of the country. Participants were further divided into two groups, one group had pain and the other had no pain There is bias because participants were excluded if had insufficient knowledge of English language and there were more women than men. Data was collected by self report and questionnaires. Medical history, health history, physical activities and history of falls was obtained. The independent variable would be the knee pain while the dependent will be the fall The data analysis utilized was the Chi-square tests which were used to compare the prevalence of participants in pain that and the no pain group. The statistics provided are that (36%) participants were categorized as having knee pain. This group took more medications and had more medical conditions compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. The only potential errors that could be that the questionnaires were completed by the elderly and this may not always be accurate. A major weakness of this study is that it is completely dependent upon the participants’ honesty to report if and when they take fall at home. The study was not clear on the definition of pain did not specify the location to the knee joint; therefore, some participants may have reported some other form of leg pain. Moreover, the participants did not record the duration of the pain which makes it almost impossible to identify if the pain was reported as acute or chronic This study design can be time-consuming and expensive since the cohort needs to be followed for a long period of time, and the longer the time period involved, the more likely that participants can and will be lost to follow-up (Curlely & Vitale, 2016). The overall outcome is that the presence of knee pain will increase the risk of multiple falls in the elderly, however addressing knee pain as well as the .risk factors will assist in the prevention of falls in older people with knee pain. The only implication for implementation would be how to educate the elderly on how important it is to take their pain medication so they can be free from pain in order not to fall. References: Casañas, R., Martín Royo, J., Fernandez-San-Martín, M. I., Raya Tena, A., Mendioroz, J., Sauch Valmaña, G., Masa-Font, R., Casajuana-Closas, M., Fernandez Linares, E. M., Cols-Sagarra, C., Gonzalez Tejón, S., Foguet-Boreu, Q., & Martín Lopez, L. M. (2019). Effectiveness of a psychoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity: study protocol for a randomized, controlled trial. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4198-7 Hicks, C., Levinger, P., Menant, J. C., Lord, S. R., Sachdev, P. S., Brodaty, H., & Sturnieks, D. L. (2020). Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-1487-2 L, A., & Vitale, P. A. (2016). Population-based nursing : concepts and competencies for advanced practice. Springer Publishing Company. . [Show Less]
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NR 503 Week 1 Discussion: Exercise and Discussion Questions from Curley Text Book
NR 503 Week 1 Discussion: Exercise and Discussion Questions from Curley Text Book Go to the end of Chapter 2: Identifying Outcomes, in your Curley course ... [Show More] text. Under “Exercises and Discussion Questions” select Exercise 2.5 OR 2.6 and respond in a minimum of two (2) paragraphs of 4-5 sentences each. You should address each bullet point in the exercise you select. Your work should have in-text citations integrating at a minimum one scholarly article from this week’s readings and course textbook. APA format should … utilized to include a reference list. Correct grammar, spelling, and APA should … adhered to when writing, work should be scholarly without personalization or first person use. Exercise 2.5 Diabetes affects a growing number of Americans. You have been invited to join a collaborative of community agencies … in tackling diabetes from a community perspective. What resources will you use to identify different outcomes related to diabetes? What outcomes related to diabetes are of most interest to community members? How will you compare the outcomes you select to monitor at the local level with state and national outcomes? Exercise 2.6 APRNs should not only recognize but also make it part of their practice to develop strategies to reduce or eliminate health disparities. Review information from Healthy People 2020 and the CDC Office of Minority Health and Health Disparities websites. What health disparities can you find that are relevant to your community? How can you better advocate for minority groups who have poorer health outcomes? What specific objectives in Healthy People 2020 can help this effort? Respond to exercise post of two peers. Faculty posts are in addition to the two peer posts. ANSWER The preventable differences that “socially disadvantaged populations” have related to injury, violence, the burden of disease, or even the achievement of an ideal level of health are known as health disparities (HD) (CDC, 2018). Several factors define a population (CDC, 2018). These factors include: education, gender, income, disability, race, geographic location, sexual orientation, and/or ethnicity (CDC, 2018). HDs are unjust and are associated with the imbalanced disbursement of resources (CDC, 2018). HD can be caused by a wide range of factors (Curley & Vitale, 2016). These include unequal educational opportunities, threats from the environment, insufficient access to healthcare, poverty level, behavioral and individual factors, housing, access to clean water and fresh food, physical or mental disability, work environment, and socioeconomic status (Curley & Vitale, 2016). Advanced Practice Registered Nurses (APRNs) have a moral commitment to care about people and must continually fight against these inequities (Pearson , 2012). These APRNs understand that most chronic health related issues are correlated with the injustices of society (Pearson , 2012). Understanding a community’s needs aids in serving the community more efficiently (Ballad Health, 2018). This can be accomplished by performing a needs assessment that aids in the visualization of the health status of its inhabitants (Ballad Health, 2018). In the health needs assessment, performed by Ballad Health, for Dickenson County, Virginia, it was determined that socioeconomic status plays a big role in the health of its population (Ballad Health, 2018). Most of the households in Dickenson County have a significantly lower household income than the rest of the state (Ballad Health, 2018). For Dickenson County in 2018, the average household income was $25,000-$50,000. However, for the state, the average was around $68,144 (Ballad Health, 2018). Only 35% of the population in Dickenson County has a high school diploma and only 10% have a bachelor’s level education or higher (Ballad Health, 2018). Another HD in Dickenson County is access to care (Ballad Health, 2018). Dickenson County only has four primary care offices and for specialized care, individuals must travel upwards to 50 miles to receive treatment (Ballad Health, 2018). APRNs are in a prime position to aid in the elimination of HD (Curley & Vitale, 2016). APRNs can support minority groups that have poor health outlooks in a number of ways (Curley & Vitale, 2016). These include (but are not limited to) advocating for better/more affordable health insurance for them and making sure that health services are sufficient in the underserved area (Curley & Vitale, 2016). The U.S. Department of Health and Human Services published Healthy People 2020 in December 2010 (Curley & Vitale, 2016). This initiative functions as a roadmap for the U.S. in the achievement of specific heath objectives (Curley & Vitale, 2016). These objectives were established to aid in the improvement of all Americans (Curley & Vitale, 2016). The specific objectives that can aid in efforts to reduce HDs include: • AHS-1.1 Increase the proportion of persons with medical insurance • AHS-3 Increase the proportion of persons with a usual primary care provider • AHS-4.1 (Developmental) Increase the number of practicing medical doctors • AHS-4.4 (Developmental) Increase the number of practicing nurse practitioners • HC/HIT-1.1Increase the proportion of persons who report their health care provider always gave them easy-to-understand instructions about what to do to take care of their illness or health condition (HP2020, 2019) References Ballad Health. (2018). Community Health Needs Assessment: Dickenson Community Hospital. Retrieved from Ballad Health: https://www.balladhealth.org/community-health-needs-assessment CDC. (2018, August 17). Health Disparities. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/healthyyouth/disparities/index.htm Curley, A. L., & Vitale, P. A. (2016). Population-Based Nursing: Concepts and Competencies for Advanced Practice (Second ed.). New York: Springer Publishing Company. HP2020. (2019). Data2020 Search. Retrieved from Healthy People 2020: https://www.healthypeople.gov/ Pearson , G. S. (2012). The concept of social justice for our psychiatric nursing practice. Perspectives in Psychiatric Care, 48, 185-186. [Show Less]
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