Topic: UNIT 2 NURSING SITUATION INITIAL POST.

ASSIGNMENT INSTRUCTIONS

Discussion Question #2: Original Post and Reply Post for Unit on Epidemiology:
Original Post:
Visit one of the websites listed on the home page of Unit 2 (also listed under this unit’s “Additional Resources”. ) Preview reports that address recent (within the last five years) epidemiological investigations, issues, or concerns. Choose one topic and research it further using the library data base (newspapers, journal articles, etc.) Then summarize your chosen article and additional findings into 3-5 paragraphs and post as a discussion board. Think of the epidemiological triangle as you write. Try to include the background, predisposing factors, barriers to interventions, and other epidemiological “players” in your summary.
THEN Reply Post:
Read and reply to one of your colleague’s original posts. See if you can identify the components of the epidemiological triangle in the summary. Offer any insights or new “angles” that might be a consideration in addressing the issue.
As always; Use of two references in the original post, and preferably in the reply post, in APA format and correct grammar/sentence structure is expected.

Unit 2: Epidemiological Nursing/Environmental Nursing (Sep 03 – Dec 10)

Welcome to Unit 2!

After completing your reading, and viewing the Powerpoints, check out these links
as you need to be familiar with them as a public/community health nurse.
• CDC http://www.cdc.gov
• Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/
• FL Department of Health http://www.doh.state.fl.us/ Click on epidemiology and Diseases & Conditions.
In addition:
The mission of an epidemiologist is to break at least one of the sides of the Triangle,
disrupting the connection between the environment, the host, and the agent, and
stopping the continuation of disease. For examples of epidemiologists at work, see the
BAM! site at www.bam.gov/sub_diseases/diseases_detectives.html,
www.bam.gov/sub_diseases/diseases_sars_who.html,
www.bam.gov/sub_diseases/diseases_wnv.html, and
www.bam.gov/sub_yourbody/yourbody_smoking.html.

HIV In African Americans
STUDENT SUZANN 9/4/2012 4:04:28 PM

Introduction
My chosen epidemiological concern is the reported increase of Human Immunodeficiency Virus (HIV) among African Americans. As part of its overall public health mission, Center for Disease Control and Prevention (CDC) provides leadership in helping control the HIV/AIDS epidemic by working with community, state, national, and international partners in surveillance, research, and prevention and evaluation activities. These activities are important because CDC estimates that about 1.1 million Americans are living with HIV, and that 21% of these persons do not know they are infected. African Americans are the racial/ethnic group most affected by HIV (Centers for Disease Control and Prevention, 2009).
Pathophysiology
HIV is a blood-borne pathogen present in body fluids example: blood, vaginal fluid, semen, breast milk…with the typical routes of transmission: blood or blood products, intravenous drug abuse, heterosexual and homosexual activity, and maternal-child transmission before or during birth (McCance, Huether, Brashers, & Rote, 2010, p.318). Clinical manifestation includes the depletion of CD4+ cells, serologically negative (no detectable antibody), serologically positive (positive for antibody against HIV). The presence of circulating antibody against the HIV indicated infection by the virus although many of these individuals are asymptomatic (McCance, et al., 2010, p.321).
Affected Population/Statistics
African Americans face the most burden of HIV of all racial groups in the United States (US). Despite representing only 14% of the US population in 2009, African Americans accounted for 44% of all new HIV infection in that year. Compare with other races and ethnicities, African Americans accounted for a higher proportion of HIV infections at all stages of the disease-from new infections to death (HIV among African Americans, 2009, p.1, para.1). In 2009, black men accounted for 70% of estimated new HIV infections among all blacks, which is six and half times higher than that of white men and two and a half times higher than Latino men. African American women accounted for 30% of estimated new infections among all blacks, which is more than 15 times as high as the rate for white women, and more than three times as high as that of Latino women (HIV among African Americans, 2009, p.1).
Challenges/Predisposing factors
African Americans face a number of challenges that contribute to higher rates of HIV infection. Some issues are:
A. Sex within the same communities with partners of the same race/ethnicity means that they face a greater risk of HIV infection with each new sexual encounter.
B. Socioeconomic issues associated with poverty, including limited access to high-quality health care, housing, and HIV prevention education.
C. Lack of awareness of HIV status and late diagnosis.

D. Stigma, Fear, Discrimination, Homophobia, and negative perception of HIV testing.
Interventions
CDC and its partners are pursuing a high-impact prevention approach to advance the goals of the National HIV/AIDS strategy and maximize the effectiveness of current HIV prevention methods. This approach focuses of implementing programs that have shown the greatest potential to reduce new HIV infections in populations and geographic areas at highest risk (HIV among African Americans, 2009, p.2)
Summary
The impact of HIV/AIDS on African Americans has grown overtime; nonetheless, I believe efforts to address associated disparities among this group has intensify through designated programs, Community interventions/teaching, and personal testimonials from those living with the disease. The question is: are African Americans receptive to the continuous efforts of those who are working tirelessly to decrease the spread of HIV/AIDS?
Reference
Center for disease control and prevention. (2009). HIV among African Americans. Retrieved from: http://www.cdc.gov/hiv/topics/aa/PDF/aa.pdf
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2010). Pathophysiology: The biologic basic for disease in adults and children. Maryland Height, MI: Mosby Elsevier.

Respond

OBESITY STUDENT MICHELLE PAPER
9/5/2012 7:14:28 PM

According to the Center for Disease Control (2011) adult obesity affects more than one-third of Americans in the United States. Vitolins, Crandall, Miller, Marion, and Spangler (2012) reports, “Obesity is the second leading cause of preventable death in the United States” (p.267). Continued increase of obesity and resulting consequences requires an effective change to combat this epidemic.
In 2012, Hindle and Mills inform excessive weight gain is the result of great caloric intake with low caloric expenditure. This imbalance could result from metabolic predisposition, behavioral, and environmental factors (Hindle & Mills, 2012). These factors may result from genetics, illness, physical activity level, culture, meal choices, education, and societal pressure (Hindle & Mills, 2012).
The Center for Disease Control (2011) reports likelihood of adult obesity includes educational background, income, and ethnicity. According to the Center for Disease Control (2011) rate of obesity based on ethnicity is as followed non Hispanic blacks (49.5%), Hispanics (39.1%) and non Hispanic whites (34.3%). Non Hispanic blacks and Mexican American men with higher incomes are more likely to become obese (Center for Disease Control, 2011). Women in the low income category and without college degrees are more likely to become obese (Center for Disease Control, 2011).
Burke and Wang (2011) reports weight loss can be achieved with lifestyle changes including reduction in daily caloric intake, nutritional meal choices, medications, exercise and surgical intervention. However, barriers to these methods of care may cause individuals to remain obese. According to Vitolins et al. (2012) barriers to weight loss include lack of information, low self-esteem, poor result from pass interventions, noncompliance, and lack of recognition to health consequences. These barriers can be diminished with easier access to healthier meals, increased provision of education by healthcare providers, media outlets, and individual support.
References
Adult Obesity Facts. (2011) Retrieved from http://www.cdc.gov/obesity/data/adult.html
Burke, L. E., & Wang, J. (2011). Treatment strategies for overweight and obesity. Journal Of Nursing Scholarship, 43(4), 368-375. doi:10.1111/j.1547-5069.2011.01424.x
Hindle, L., & Mills, S. (2012). Obesity: self-care and illness prevention. Practice Nursing, 23(3), 130-134.
Vitolins, M. Z., Crandall, S., Miller, D., Ip, E., Marion, G., & Spangler, J. G. (2012). Obesity educational interventions in U.S. medical schools: A systematic review and identified gaps. Teaching & Learning In Medicine, 24(3), 267-272. doi:10.1080/10401334.2012.692286

Traumatic Brain Injury
STUDENT KERY 9/5/2012 7:40:42 PM

Background
Traumatic Brain Injury (TBI) is defined by McCance & Huether as “an insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes” (2010, p. 583). The Center for Disease and Control (CDC) further classifies TBI’s into mild, moderate, and severe however, a mild TBI may not exclude a patient from having long-term effects from the injury (2010). 1.1 million Americans are treated and released yearly at emergency departments (ED) for TBI and approximately 50,000 people die annually from TBI’s (Corrigan & Orman, 2010). Another 235,000 Americans are hospitalized each year for TBI, causing a nearly $60.4 billion dollar economic burden in the year 2000 alone (Corrigan & Orman, 2010). Included in this overwhelming cost are the approximately 124,000 patients who develop long-term disabilities yearly resulting from their TBI (Corrigan & Orman, 2010). As a result of the overwhelming burden placed upon the community and society as a whole, TBI’s have become a serious public health issue requiring much needed education on prevention, advancement in treatment, and improvement in long-term care to improve patient outcomes.
Predisposing Factors
In order to identify the predisposing factors of TBI, we must first examine the most common populations effected and causes for TBI. Males have a higher incidence of TBI throughout all ages and races, much of this is due to high risk behavior such as sports, violent crimes, and motor vehicle accidents (Corrigan & Orman, 2010). Age is another risk factor for TBI with those over 74 and younger than 10 years old having higher incidence rates (Corrigan & Orman, 2010). By far the most common cause of TBI for those 74 and over are falls, in fact falls have been proven as the leading cause of all TBI’s in the United States (Corrigan & Orman, 2010). Low socioeconomic status is another predisposing factor to TBI’s. Corrigan & Orman affirm that he risk for developing a TBI is doubled for those who are uninsured (2010). Those with a low socioeconomic status may attribute their increased risk for TBI to lack of education on TBI prevention, unavailable funds for protective equipment, and inability to seek timely care.
Barriers to Interventions
Barriers to Interventions vary among the different populations of those who suffer from TBI. For instance, as discussed earlier those with a low socioeconomic status may not be able to afford protective equipment or seek timely care for TBI. The elderly may live alone, and have many unsafe factors in the home, which put them at greater risk for falls. Males who participate in high-risk behavior may be peer pressured into participating in such behaviors, even when they are aware of proper preventative measures. Ultimately educating the community on the risks, signs, and means of prevention can help prevent TBI however, whether an individual is ready to learn or not can be a barrier to prevention in and of itself.
Other Epidemiological “Players”
There are many other significant epidemiological players regarding TBI. One is the collection of data regarding TBI’s. Sources of data for TBI in the United States may consist of National Health Interview Surveys, the National Hospital Discharge Survey-Healthcare Cost Utilization Project, and Uniform Billing (UB-92) claims data, all of which may have limitations in accurate accountability of TBI (Corrigan & Orman, 2010). Another significant player in the epidemiology of TBI are the long-term effects/disability the patient may be left with. These long terms effects may vary from behavior issues, cognitive ability, and functional ability, all of which create a large burden for the patient, family, and community. Lastly history of having a previous TBI, may have contributing factors to predisposing one to another TBI, this topic continues to be researched especially in sports related injuries (Corrigan & Orman, 2010).
References:
Center for Disease and Control and Prevention. (2010). Traumatic brian injury in the
united states: Emergency department visits, hospitalization, and deaths 2002-2006.
Retrieved from: http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf
Corrigan, J. D. & Orman, J. A. (2010). The epidemiology of traumatic brain injury.
Journal of Head Trauma Rehabilitation 25 (2), 72-80.
McCance, S., & Huether, S. (2010). The biologic basis for disease in adults and
children. Maryland Heights, MI: Mosby Elsevier.

Respond

West Nile Virus

As of September 4, it has been reported that 1,993 people in 48 states have acquired the West Nile virus (WNV) infections in the course of 2012 and out of those, 87 have died (CDC, 2012). A total of 1,069 of cases were classified as neuroinvasive with presentation of meningitis or encephalitis, and the other 924 were classified as non-neuroinvasive. Almost 45% of cases have originated in Texas. (CDC, 2012). The WNV outbreak of this past summer is one of the worst seen in the United Unites since the virus was first detected in our country in 1999 (CDC, 2012).
The WNV is the agent of transmission, acquired by humans and other animals via infected mosquitoes (host) who have fed on infected birds. In rare cases, it has been transmitted by blood transfusions and organ transplants. While most people are asymptomatic, some may present from mild symptoms such as fever and malaise, to severe neuro-invasive effects (CDC, 2012). Although a vaccine against WNV has been found for horses, efforts are still focused on researching the vaccine for humans (FLDOH, 2012).
Public Health entities have responded aggressively to inform the public about primary prevention. The Centers for Disease Control and Prevention have published comprehensive manual titled: Guidelines for Surveillance, Prevention, and Control and have circulated a shorter version in a fact sheet, to inform the community about precautionary measures, risk factors, symptomatology and interventions if contamination is suspected (CDC, 2012). The CDC recommends minimizing exposure to mosquito bites by using repellents containing EPA-registered active ingredient when outside, especially at dusk and dawn; wearing long sleeves and pants when carrying outside activities; ensuring window and door screens at home are intact and in use; and emptying containers with standing water (environmental factors) when not in use such as buckets, flower pots, pet dishes, tire swings and wading pools (CDC, 2012). In our state, the Florida Department of Health has developed a similar initiative called Drain and Cover which exhorts the community to drain water from all containers that could be potential harbor for mosquitoes, and to cover skin with clothing and mosquito repellent when outdoor activities are required (FLDOH, 2012).
Experts from different states interviewed by CBS News earlier this year, explain a few influential factors to this year’s WNV outbreak. They agree that the high temperatures we have experienced this year, combined with rapid changes between rain and drought, have created the perfect environment for mosquitoes to live longer and reproduce rapidly, while accelerating their life-cycle by making them reach a biting age quicker. On the other hand, they explain that high temperatures facilitate the multiplication of West Nile virus within a mosquito; and cause birds to fly to populated, urban areas looking for water, attracting with them the mosquitoes (Jaslow, 2012). New York City is a great example of a city that has implemented a successful year-round program for mosquito prevention, surveillance and control and they spray high-risk areas identified by using outbreak data from previous years (Jaslow, 2012).
In the meantime, there is still a concern that more cases will be reported this year as the season typically ends in September (Jaslow, 2012).
References
Centers for Disease Control and Prevention [CDC]. (2012). West Nile virus update: September 4. Atlanta, GA. Retrieved from http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
Florida Department of Health [FLDOH]. (2012). West Nile virus. Tallahassee, FL. Retrieved from http://www.doh.state.fl.us/Environment/medicine/arboviral/WestNileVirus.html
Jaslow, R. (2012, August 24). What’s making the 2012 West Nile virus outbreak the worst ever? CBS News. New York, NY. Retrieved from http://www.cbsnews.com/8301-504763_162-57500089-10391704/whats-making-the-2012-west-nile-virus-outbreak-the-worst-ever/

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