NR 503 Week 2: Discussion- Screening and Reliability
Chamberlain University NR 503 Week 2: Discussion- Screening and Reliability– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 503 Week 2: Discussion- Screening and Reliability assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 503 Week 2: Discussion- Screening and Reliability
Whether one passes or fails an academic assignment such as the Chamberlain University NR 503 Week 2: Discussion- Screening and Reliability depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 503 Week 2: Discussion- Screening and Reliability
The introduction for the Chamberlain University NR 503 Week 2: Discussion- Screening and Reliability is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NR 503 Week 2: Discussion- Screening and Reliability
After the introduction, move into the main part of the NR 503 Week 2: Discussion- Screening and Reliability assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 503 Week 2: Discussion- Screening and Reliability
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 503 Week 2: Discussion- Screening and Reliability
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 503 Week 2: Discussion- Screening and Reliability
A Papanicolaou test or better known as Pap smear testing is a method of cervical cancer screening. It is used to detect cervical epithelial changes that can be pre-cancerous and cancerous (Sachan, Singh, Patel, & Sachan, 2018). There are two forms of cervical screening testing, conventional and liquid-based cytology. There is no clinical or significant difference in the results. As with any testing and results, there can be a potential false-positive or a false-negative. In essence, one is not better than the other. Both methods share the same high accuracy rate. If further testing is needed a colposcopy is performed as the diagnostic test.
Cervical cancer screening consist of cytology (Pap smear) for women with a cervix at ages 21-29 every 3 years and for women 30 to 65 cytology every 3 years or cytology with human papilloma virus (HPV) every 5 years. There has been a large reduction rate of cervical cancers in the United States. Early screening and detection reduces cervical rates 60% to 90% within 3 years of interventions (U.S. Preventive Services Task Force [USPSTF], 2012). Unfortunately, for developing countries cervical cancer is higher due to the lack of knowledge, technology, and experience.
“The overall sensitivity of the Pap test in detecting a high-grade squamous intraepithelial lesion (HSIL) is 70.2%. A Pap screening done in association with a HPV DNA test increases the sensitivity for early detection of precancerous lesions” (Sachan, Singh, Patel, & Sachan, 2018). There can be 6 different pap results, I will list the severity in ascending order: negative, atypical squamous cells (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells-cannot exclude HSIL (ASC-H), and atypical glandular cells (ACG) (The American College of Obstetrician and Gynecologists [ACOG], 2016). Depending on the results and the patient’s age will depend on if a colposcopy, biopsy, or an endocervical sampling is needed.
Situations that can alter the screening for this patient is having a total hysterectomy (medical history). It is not recommended a pap smear be performed on someone without a cervix due to a lack of cervical precancerous lesions. Another alteration could be if their immediate family member has been diagnosed with cancer early in life (family history). If a patient is HIV positive they may require more frequent screening. Also, the patient’s age. Studies have found screening prior to age 21 and after age 65 with previous normal Pap smear results is not beneficial. The risk outweighs the benefits and can potentially cause physical and/or psychological damage.
Reference
The American College of Obstetrician and Gynecologists. (2016). Abnormal cervical cancer screening test results. Retrieved from https://www.acog.org
Sachan, P.L., Singh, M., Patel, M.L., & Sachan, R. (2018). A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific Journal of Oncology Nursing, 5(3), 337-341.
U.S. Preventive Services Task Force. (2012). Cervical Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org.
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Sample Answer 2 for NR 503 Week 2: Discussion- Screening and Reliability
The screening test that I chose is Type 2 Diabetes Mellitus (DM). Healthy People 2020 (2018) states diabetes is one of the significant public health problems and the 7th leading cause of death in the United States. At workplace, I even get to see many patients who didn’t control their glucose levels and ended up getting emergency or intensive care units due to high blood sugar levels such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). The complications of diabetes cause cardiovascular disease, however modifiable cardiovascular risk factor such as abnormal blood glucose is considered to be preventable if the levels of hemoglobin A1c, fasting plasma glucose level, and OGTT are under control (Nathan, 2015). This screening test detects abnormal glucose level by measuring HbA1c, fasting plasma glucose or with an oral glucose tolerance test (USPSTF, 2015). According to data from U.S. Preventive Services (2015), patients with glucose for Hemoglobin A1c level is higher than 6.5%, fasting plasma glucose level is higher than 7.0 mmol/L, and OGTT results is higher than 11.1 mmol/L are often considered positive for diabetes type 2. Positive predictive value (PPV) is the percentage of patients with a positive test who actually have the disease (Gordis, 2014). It tells us how many of test positive are true positives and this number is as close to 100 as possible (Thomas, Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). If the number is higher, it indicates that the test gives us the correct results. When calculating PPV, sensitivity, and specificity are used. Sensitivity is the ability of a test to correctly classify an individual as ‘diseased’ and specificity is the ability of a test to correctly identify those who do not have the disease (Thomas, Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). Formula of PPV is True positive / true positive + false positive.
Checking the validity of any screening test is essential to verify the accuracy of the test. Validity is also measured by specificity and sensitivity (Thomas, Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). A new diagnostic test with the gold standard summarized the validity of tests (2008). True positive (TP) occurs when the test correctly diagnosed the disease and the test is positive. False positive (FP) test happens when the test wrongly diagnosed the disease when the disease is absent. False negative (FN) occurs when the test has incorrectly diagnosed a diseased person as normal. Lastly, true negative (TN) occurs when those who have no disease has also negative with the test.
Let’s say there is a patient who is recently diagnosed with type 2. Upon the patient’s history, a healthcare provider finds out that the patient has a great uncle on his father’s side who died of secondary kidney failure due to uncontrolled blood sugar and an aunt on his mother’s side who died of septic shock due to unhealed infection from lower extremity amputation caused by diabetes. Does this information change my recommendation for screening? I will say no since the great uncle and aunt are not considered as first-degree relative and they are second and third-degree relative. However, family history is essential for the identification of individuals who is at risk for diabetes at a younger age.
Gordis, L. (2014). Epidemiology, 5th Edition. Retrieved from https://bookshelf.vitalsource.com/#/books/9781455737338/
Healthy People 2020. (2018). Diabetes. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes (Links to an external site.)
Nathan, D. M. (2015). Diabetes: Advances in diagnosis and treatment. Jama, 314(10), 1052- 1062. doi:10.1001/jama.2015.9536
Thomas, R., Parikh, R., Mathai, A., Parikh, S., Sekhar, G. C., & Thomas, R. (2008). Understanding and using sensitivity, specificity and predictive values. Indian Journal of Ophthalmology, 56(1), 45-50.
U.S. Preventive Services (USPSTF). (2015). Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes#tab (Links to an external site.)
Sample Answer 3 for NR 503 Week 2: Discussion – Epidemiological Methods
Colorectal Cancer: Screening
Colorectal cancer (CRC) is a major health problem given its high incidence and associated morbidity and mortality (US Preventive Services Task Force, 2016). Colorectal cancer is the fourth most common cancer diagnosed each year in the United States. This year, it is estimated that 135,430 adults in the United States will be diagnosed with colorectal cancer. These figures include 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer.
It is estimated that 50,260 deaths (27,150 men and 23,110 women) will be attributed to colon or rectal cancer this year (Lin, Piper, Perdue, Rutter, Webber, O’Connor, Smith, & Whitlock, 2016). Colorectal cancer is the second leading cause of cancer death in the United States for men and women combined. It is the second leading cause of cancer death in men and the third leading cause of cancer death in women. Colorectal cancer mainly affects older adults, but an increasing incidence is observed in younger people (Lin et al., 2016).
When colorectal cancer is detected early, it can often be cured. The mortality rate of this type of cancer has decreased since the mid-1980s (Lin et al., 2016), probably due to the fact that currently there are better treatments and, in general, it is detected in its initial stage.
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation) (2016).
Assessment of Risk
A colon cancer risk assessment survey at Cleveland Clinic in Cleveland, Ohio, found that participants who exercised more, followed a healthy diet and did not smoke were less likely to have a personal history of colorectal cancer or colon polyps (2015). For the vast majority of adults, the most important risk factor for colorectal cancer is older age. Most cases of colorectal cancer occur among adults older than 50 years; the median age at diagnosis is 68 years (Kalady & Heald, 2015). Male sex and black race are also associated with higher colorectal cancer incidence and mortality. Black adults have the highest incidence and mortality rates compared with other racial/ethnic subgroups. Also, A positive family history (excluding known inherited familial syndromes) is thought to be linked to about 20% of cases of colorectal cancer. About 3% to 10% of the population has a first-degree relative with colorectal cancer (Lin et al., 2016). The USPSTF did not specifically review the evidence on screening in populations at increased risk; however, other professional organizations recommend that patients with a family history of colorectal cancer (a first-degree relative with early-onset colorectal cancer or multiple first-degree relatives with the disease) be screened more frequently starting at a younger age and with colonoscopy (2016).
The main risk factors for colorectal cancer are family history and older age, but some other factors have been linked to a higher risk, including excessive alcohol consumption, obesity, physical inactivity, smoking cigarettes and possibly the diet (Lin et al., 2016). In addition, people with a history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease) have a higher risk of colorectal cancer than people who do not have those diseases (Lin et al., 2016). And people who have some inherited diseases (such as Lynch syndrome and familial adenomatous polyposis) are also at increased risk of colorectal cancer.
Several screening tests have been created to help doctors find colorectal cancer early, when it is most treatable. Some tests that detect adenomas and polyps can actually prevent the onset of cancer, since these tests allow the detection and removal of lumps that might otherwise become cancerous. That is, screening for colorectal cancer can be a way to prevent cancer, not just detect it when it starts.
Screening
Screening is an activity of medical practice. It is defined by WHO as “presumptive identification, with the help of tests, examinations or other techniques susceptible of rapid application, of the subjects affected by a disease or an anomaly that until then had gone unnoticed “( Doubeni, Weinmann, & Adams, 2013).Screening is a secondary prevention measure; its purpose basic is to reduce the incidence of complications derived from a pathology (for example, blindness in diabetic retinopathy), decrease mortality by a disease (for example, colorectal cancer) and / or increase the quality of life of people affected by a certain pathology (Doubeni, Weinmann, & Adams, 2013).
Screening Test:
Fecal occult blood test based on guaiac (FOBT)
Historically utilized guaiac-based tests that identify the presence of hemoglobin based on a nonspecific peroxidase reaction (Weiss, 2013). With regard to the reliability of a standard of annual high-sensitivity fecal occult blood testing (sensitivity for cancer ≥70%) .Guaiac-based FOBT is no longer recommended for cancer screening because it does not detect most polyps and cancers. Furthermore, the false-positive rate with guaiac tests is high if patients do not follow the recommended dietary (withholding notably meat, certain vegetables, iron supplements) or pharmaceutical (withholding nonsteroidal anti-inflammatory drugs, vitamin C) restrictions. Finally, multiple stool collections are needed for optimal interpretation of guaiac-based FOBT results.
Fecal immunochemical testing (FIT)
Has evolved as the preferred occult blood test for colorectal cancer screening due to the lack of specificity and sensitivity of guaiac-based methods. FIT specifically detects the presence of human hemoglobin, eliminating the need for dietary and medication restrictions (Weiss, 2013). For colorectal cancer screening only, a single collection is required. The specificity of FIT is routinely >95% with reported sensitivities ranging from 40% to 70% based on the patient population (Weiss, 2013). The clinical specificity of FIT is 97% based on internal studies conducted at Mayo.
Sigmoidoscopy, flexible (SF) or rigid (SR),
It is necessary a previous preparation of the intestine by means of enemas but, in general, it is tolerated without need of sedation. It allows to visualize the distal colon and take biopsies, although biopsies are not usually performed because of the risk of explosion that exists in cauterization and also because the presence of polyps in the distal colon is usually associated with polyps in the proximal colon and is required, therefore, a complete colorectal exam. One of its main limitations is the inability to examine the proximal colon as well as the doubtful ability to detect polyps less than 1 cm in diameter (Weiss, 2013). The risk of complications is low.
The double contrast barium enema
DCBE is the type of enema most proposed as a CRC screening technique. It requires liquid diet, laxatives and enemas during the previous 24 hours. Between 5 and 10% of explorations are not conclusive and it is necessary to repeat them or perform a posterior colonoscopy (Weiss, 2013). It can miss sigma and rectum injuries.
Colonoscopy
Requires prior bowel preparation and sedation. The risk of complications is greater than in any of the above (perforation, severe bleeding, respiratory depression) (Weiss, 2013). False negatives are little frequent. So far, there have been no controlled and randomized trials that the evaluate as a screening technique for the reduction of mortality by CRC. On the other hand, research is being carried out on non-invasive possibilities, such as molecular biology, calprotectin detection or virtual colonoscopy. Colonoscopy is currently considered the reference test or gold standard for the diagnosis of CCR, allowing the capture of samples (biopsy) for anatomopathological examination, as well as the extirpation of cancers and premalignant lesions. It has not been widely used as a technique primary screening in moderate risk population, although it is the test of selection of screening recommended by the American College of Gastroenterology.
The conclusion that is finally drawn is that the fecal occult blood test is the test that has greater scientific evidence as a population screening technique for CRC. Very few diagnostic tests, perhaps none, identify with certainty whether the patient has the disease in question or not. The validity of a diagnostic test depends on its ability to correctly detect the presence or absence of the disease being studied, which is expressed mathematically in several indices: sensitivity, specificity, positive predictive value and negative predictive value, overall value of the test, reason of positive likelihood and reason of negative likelihood (Weiss, 2013).
Doubeni, C.A., Weinmann, S., Adams, K., (2013). Screening colonoscopy and risk of incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Int Med.
Kalady, M. F. & Heald, B. (2015). Diagnostic Approach to Hereditary Colorectal Cancer Syndromes.Clin Colon Rectal Surg. 28(4): 205–214. doi: 10.1055/s-0035-1564432
Lin, J.S., Piper, M.A., Perdue, L.A., Rutter, C. M., Webber, E.M., O’Connor, E., Smith, N., & Whitlock, E.P (2016). Screening for Colorectal Cancer Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 315(23):2576-2594. doi:10.1001/jama.2016.3332
US Preventive Services Task Force (2016). Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(23):2564-2575. doi:10.1001/jama.2016.5989
Weiss, N. (2013). Case-control studies of screening for colorectal cancer: Tailoring the design and analysis to the specific research question.Epidemiology. 24(6): 894–897 doi: 10.1097/EDE.0b013e3182a777b2
Sample Answer 4 for NR 503 Week 2: Discussion – Epidemiological Methods
Thank you for the thorough review of colon cancer and the screening guidelines. You did a great job using data from EBP to discuss the validity and reliability of various colon cancer screening tests. As such, I’d like to use your thread to demonstrate to the class how to apply sensitivity, specificity and PPV in the clinical environment. I’ll use FIT screening as my example.
Positive predictive value (PPV) is generally more useful for a patient, while sensitivityresults are more useful for the APN. For example, as a patient, you want to know if you should panic or not, right? The PPV will inform your patient of the odds of actually having the disease if there is a positive test. A PPV of 10% indicates to the patient, “if your test comes back positive, you have a 10% chance of actually having colorectal cancer”. Sensitivity, on the other hand, is defined as the proportion of people with the disease who have a positive result. For example, a FIT with a 93% sensitivity will identify 93% of patients who have the disease, but will miss 7% of patients who have the disease. This information is useful to the APN when deciding which test to use, but is of little value to the APN if the test result is negative.
NR 503 Week 2 Healthy People 2020 Impact Paper
Healthy People 2020 Impact Paper
Population health addresses and focuses on health outcomes of specific groups based on the geographic distribution in communities, disability, age, or ethnicity, among other factors. The concept of epidemiology is critical in population health as it facilitates the scientific and systematic study of the distribution and occurrence of determinants of diseases among different groups to develop effective strategies for intervention. The Healthy People (HP) 2020 outlines specific objectives regarding specific health issues and provides guidelines and screening tools to help detect the diseases among different populations early onstage for effective treatment. Conducting a comprehensive epidemiological analysis facilitates the identification of prevalence, risk factors, susceptible people or impacts, and effective planning of effective interventions at the state or national level.
Overview, Background, and Significance of the Problem
Dementia is a collective term for the syndrome characterized by significant impairment and decline in cognitive, social, and behavioral functions by affecting an individual’s thinking, remembering, or decision-making capabilities, interfering with daily living activities (ADL). The most common type of dementia is Alzheimer’s disease (AD) which is a condition that causes memory loss and challenges in thinking or solving problems hence interfering with daily activities and routines, and others include cerebrovascular and Lewy body disease (Hwang et al., 2019). Although dementia is more prevalent among the older population, this health condition is not a normal part of aging. Racial and ethnic disparities heighten the risk of dementia; hence minority populations including Hispanics, non-Hispanic whites, African-Americans, Indian, and Alaska natives are more susceptible.
The primary risk factor for dementia is age, and the aging population is growing more racially and ethnically diverse. The prevalence of AD in California among people aged 65 years and above was approximately 660,000, which is 11% of the total rate in the United States of 5.8 million, and 177,345 of this population was from Los Angeles (L.A.) (Ross et al. 2021). The number of Americans living with AD may rise to 16 million by 2030. AD has severe implications on families since, in 2020, approximately 1.6 million caregivers, 60% of whom are female in California, will bear the burden by providing 1, 849 million hours of unpaid care at a value of $24 billion, which impacts their social, emotional and physical well-being (Ross et al. 2021). Alzheimer’s disease and related dementias (ADRD) also affect the healthcare system, with the disease cost amounting to around $4.2 billion in California. The number of deaths associated with dementia in 2017 was approximately 266,957 from AD in the U.S., and 25,017 were in California, precisely 3,994 in L.A (Ross et al. 2021). The mortality rate of AD in California was 47 per 100,000 in 2018, with 16,627 deaths, compared to 37.3 per 100,000 in the United States (Alzheimer’s Association Report, 2020). In 2018, Californians aged 65 to 84 in 2018 identified as Black or African American reported the highest death rates.
Epidemiological Analysis
Descriptive epidemiology entails the organization and analysis of data defining and describing the frequency of disease variation by covering the aspects of time, person, and place and correlating the three components to determine risk factors accurately. By 2050, the number of patients with AD may rise exponentially from 5.8 million to 13.8 million, and 68% of this global increase will be in low and middle-income countries (LMICs) (Zhang et al., 2021). The percentage of people with AD increases rapidly with age since populations within 65-74 years, 75-84 years and above at the percentage rate of 3%, 27%, and 32% AD. An estimated 60% of the population residing in have dementia, and the number may rise to 152 million globally in mid-century in LMICs (Zhang et al., 2021). The lifetime risk for AD is approximately 20% and 10% for women and men at age 45.
Moreover, the incidence of dementia is higher among racial and ethnic minority groups; hence older Black and Hispanics are more at risk for ADRD. Data for Medicare beneficiaries report a diagnosis of ADRD among 13.8% and 12.2% African American and Latino population (Alzheimer’s Association Report, 2020). A behavioral risk factor survey findings show that 11% of Americans aged 45 years and above report cognitive but 54% do not consult healthcare providers (Alzheimer’s Association Report, 2020). Age is a common risk factor for ADRD; hence, the older population comprising adults aged 65 years and above is more susceptible. Women are also at risk for ADRD since out of the 5.2 million people with this health condition, 3.3 million are female (Healthy People 2020, n.d.). The global prevalence of AD is higher in women, 1.17 times more than in men (Zhang et al., 2021). Similarly, people with a family history of ADRD are at a greater risk since 19 new genes heighten the likelihood of contracting late-onset AD.
Application of HP 2020
HP 2020 initiative outlines specific national goals and objectives to reduce health threats and promote healthy lives. One of the goals is to achieve longer, high-quality lives free of diseases, illnesses, injuries, disabilities, or premature deaths (Healthy People 2020, n.d.). Another specific goal of this initiative is to alleviate avoidable disparities, attain equity and establish social and physical environments that influence the health of all populations. The goal is to minimize morbidity and related costs and to improve the quality of life for people with ADRD by promoting healthy behaviors, increasing practical diagnostic tools, and offering social or behavioral resources to support caregivers. The first objective is to increase the number of individuals diagnosed with dementia or their caregivers’ knowledge of diagnosis from 38.3% to 68.2% (Healthy People 2020, n.d.). The significant threats and burden of ADRD to the public health system have prompted its inclusion as a new topic in the HP 2020 initiative.
The recommended guidelines for the AD diagnostic process emphasize dividing the steps to detect, differentiate, diagnose and treat, and healthcare providers utilize various tools and approaches. The mini-mental state examination (MMSE) test is the most commonly used cognitive screening tool that entails 11 questions that healthcare providers may take 10 to 30 minutes to administer (Hwang et al., 2019). The MMSE has a cut-off value of 23/24 out of a possible 30, which indicates good reliability and validity in identifying dementia. The maximum point for the MMSE score is 30, and any points below 24 indicate concerns about dementia, whether mild, moderate, or severe. Age, education, and ethnicity affect interpretation. Early diagnosis of ADRD helps patients seek early treatment and interventions concerning lifestyle changes.
Population Level Planning and Interventions
The Department of public health in California designed and released the Assessment of cognitive complaints toolkit for AD (ACCT-AD) to assist healthcare providers in the primary care setting with an effective instrument to detect and diagnose AD or other mental issues. Utilization of systems such as the behavioral risk factor surveillance system (BRFSS), Medicare current beneficiary survey, or National health and aging trends study (NHATS) will help monitor data mortality rates, ADRD diagnoses, or utilization of services and assess the extent of progress (CDC, 2018). The Healthy Brain Initiative is a program developed in partnership with the Alzheimer’s Association and the Centers for disease control and prevention to enhance cognitive health. The program aims to strengthen knowledge about care planning, improve access to evidence-based interventions and services for people with dementia and emphasize the importance of caregivers. This strategy seeks to enhance the competence of the current workforce through extensive training to empower public health professionals with relevant knowledge on the most appropriate and reliable evidence of dementia for proper detection and treatment and meeting health needs. The outcomes of this program include increased workforce capacity, demand and utilization of dementia-related services, and improved early detection, diagnosis, and professional care (CDC, 2018). Other outcomes are an informed public and people with dementia or their caregivers, and supportive communities. Seeking public feedback using online surveys is an effective strategy to get responses to the effectiveness of the programs, such as an increased awareness of brain health and seeking input on recommendations for improvement.
Conclusion
Identifying prevalence or incidence rates, risk factors, or the burden of a chronic illness facilitates the development of strategies for strategic intervention. Infectious and chronic health diseases such as cancer, diabetes, arthritis, lung cancer, dementia, and osteoporosis are the leading cause of mortality and disability and contribute to a significant burden in healthcare due to costs associated with treatment and management. Dementia is among the leading causes of disability and mortality among older adults, and prevalence has increased exponentially, especially in relation to associated public health costs. Thus, relevant stakeholders at the state and national levels should increase efforts to develop and implement appropriate interventions for population health issues and monitor progress to ensure effectiveness.
References
Alzheimer’s Association Report, (2020). 2020 Alzheimer’s disease facts and figures. The Journal of the Alzheimer’s Association. https://doi.org/10.1002/alz.12068
Centers for Disease Control and Prevention (2018). Healthy brain initiative, state, and local public health partnerships to address dementia: The 2018-2023 road map. Alzheimer’s Association. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf
Healthy People 2020. (n.d.). Dementias, including Alzheimer’s disease. https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease
Hwang, A. B., Boes, S., Nyffeler, T., & Schuepfer, G. (2019). Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. In Plos One, 14(7). https://doi.org/10.1371/journal.pone.0219569
Ross, K. L., Beld, M., & Yeh, C. J. (2021). Alzheimer’s disease and related dementias facts and figures in California: Current status and future projections. California Department of Public Health. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Library/Alzheimers%27%20Disease%20Program/151764_Alzheimers_Disease_Facts_and_Figures_Reportv3_ADA.pdf
Zhang, X. X., Tian, Y., Wang, Z. T., Ma, Y. H., Tan, L., & Yu, J. T. (2021). The Epidemiology of Alzheimer’s Disease Modifiable Risk Factors and Prevention. In Journal of Prevention of Alzheimer’s Disease, 8(3). https://doi.org/10.14283/jpad.2021.15
NR 503 Week 2 Healthy People 2020 Impact Paper
Healthy People 2020 Impact Paper
Population health addresses and focuses on health outcomes of specific groups based on the geographic distribution in communities, disability, age, or ethnicity, among other factors. The concept of epidemiology is critical in population health as it facilitates the scientific and systematic study of the distribution and occurrence of determinants of diseases among different groups to develop effective strategies for intervention. The Healthy People (HP) 2020 outlines specific objectives regarding specific health issues and provides guidelines and screening tools to help detect the diseases among different populations early onstage for effective treatment. Conducting a comprehensive epidemiological analysis facilitates the identification of prevalence, risk factors, susceptible people or impacts, and effective planning of effective interventions at the state or national level.
Overview, Background, and Significance of the Problem
Dementia is a collective term for the syndrome characterized by significant impairment and decline in cognitive, social, and behavioral functions by affecting an individual’s thinking, remembering, or decision-making capabilities, interfering with daily living activities (ADL). The most common type of dementia is Alzheimer’s disease (AD) which is a condition that causes memory loss and challenges in thinking or solving problems hence interfering with daily activities and routines, and others include cerebrovascular and Lewy body disease (Hwang et al., 2019). Although dementia is more prevalent among the older population, this health condition is not a normal part of aging. Racial and ethnic disparities heighten the risk of dementia; hence minority populations including Hispanics, non-Hispanic whites, African-Americans, Indian, and Alaska natives are more susceptible.
The primary risk factor for dementia is age, and the aging population is growing more racially and ethnically diverse. The prevalence of AD in California among people aged 65 years and above was approximately 660,000, which is 11% of the total rate in the United States of 5.8 million, and 177,345 of this population was from Los Angeles (L.A.) (Ross et al. 2021). The number of Americans living with AD may rise to 16 million by 2030. AD has severe implications on families since, in 2020, approximately 1.6 million caregivers, 60% of whom are female in California, will bear the burden by providing 1, 849 million hours of unpaid care at a value of $24 billion, which impacts their social, emotional and physical well-being (Ross et al. 2021). Alzheimer’s disease and related dementias (ADRD) also affect the healthcare system, with the disease cost amounting to around $4.2 billion in California. The number of deaths associated with dementia in 2017 was approximately 266,957 from AD in the U.S., and 25,017 were in California, precisely 3,994 in L.A (Ross et al. 2021). The mortality rate of AD in California was 47 per 100,000 in 2018, with 16,627 deaths, compared to 37.3 per 100,000 in the United States (Alzheimer’s Association Report, 2020). In 2018, Californians aged 65 to 84 in 2018 identified as Black or African American reported the highest death rates.
Epidemiological Analysis
Descriptive epidemiology entails the organization and analysis of data defining and describing the frequency of disease variation by covering the aspects of time, person, and place and correlating the three components to determine risk factors accurately. By 2050, the number of patients with AD may rise exponentially from 5.8 million to 13.8 million, and 68% of this global increase will be in low and middle-income countries (LMICs) (Zhang et al., 2021). The percentage of people with AD increases rapidly with age since populations within 65-74 years, 75-84 years and above at the percentage rate of 3%, 27%, and 32% AD. An estimated 60% of the population residing in have dementia, and the number may rise to 152 million globally in mid-century in LMICs (Zhang et al., 2021). The lifetime risk for AD is approximately 20% and 10% for women and men at age 45.
Moreover, the incidence of dementia is higher among racial and ethnic minority groups; hence older Black and Hispanics are more at risk for ADRD. Data for Medicare beneficiaries report a diagnosis of ADRD among 13.8% and 12.2% African American and Latino population (Alzheimer’s Association Report, 2020). A behavioral risk factor survey findings show that 11% of Americans aged 45 years and above report cognitive but 54% do not consult healthcare providers (Alzheimer’s Association Report, 2020). Age is a common risk factor for ADRD; hence, the older population comprising adults aged 65 years and above is more susceptible. Women are also at risk for ADRD since out of the 5.2 million people with this health condition, 3.3 million are female (Healthy People 2020, n.d.). The global prevalence of AD is higher in women, 1.17 times more than in men (Zhang et al., 2021). Similarly, people with a family history of ADRD are at a greater risk since 19 new genes heighten the likelihood of contracting late-onset AD.
Application of HP 2020
HP 2020 initiative outlines specific national goals and objectives to reduce health threats and promote healthy lives. One of the goals is to achieve longer, high-quality lives free of diseases, illnesses, injuries, disabilities, or premature deaths (Healthy People 2020, n.d.). Another specific goal of this initiative is to alleviate avoidable disparities, attain equity and establish social and physical environments that influence the health of all populations. The goal is to minimize morbidity and related costs and to improve the quality of life for people with ADRD by promoting healthy behaviors, increasing practical diagnostic tools, and offering social or behavioral resources to support caregivers. The first objective is to increase the number of individuals diagnosed with dementia or their caregivers’ knowledge of diagnosis from 38.3% to 68.2% (Healthy People 2020, n.d.). The significant threats and burden of ADRD to the public health system have prompted its inclusion as a new topic in the HP 2020 initiative.
The recommended guidelines for the AD diagnostic process emphasize dividing the steps to detect, differentiate, diagnose and treat, and healthcare providers utilize various tools and approaches. The mini-mental state examination (MMSE) test is the most commonly used cognitive screening tool that entails 11 questions that healthcare providers may take 10 to 30 minutes to administer (Hwang et al., 2019). The MMSE has a cut-off value of 23/24 out of a possible 30, which indicates good reliability and validity in identifying dementia. The maximum point for the MMSE score is 30, and any points below 24 indicate concerns about dementia, whether mild, moderate, or severe. Age, education, and ethnicity affect interpretation. Early diagnosis of ADRD helps patients seek early treatment and interventions concerning lifestyle changes.
Population Level Planning and Interventions
The Department of public health in California designed and released the Assessment of cognitive complaints toolkit for AD (ACCT-AD) to assist healthcare providers in the primary care setting with an effective instrument to detect and diagnose AD or other mental issues. Utilization of systems such as the behavioral risk factor surveillance system (BRFSS), Medicare current beneficiary survey, or National health and aging trends study (NHATS) will help monitor data mortality rates, ADRD diagnoses, or utilization of services and assess the extent of progress (CDC, 2018). The Healthy Brain Initiative is a program developed in partnership with the Alzheimer’s Association and the Centers for disease control and prevention to enhance cognitive health. The program aims to strengthen knowledge about care planning, improve access to evidence-based interventions and services for people with dementia and emphasize the importance of caregivers. This strategy seeks to enhance the competence of the current workforce through extensive training to empower public health professionals with relevant knowledge on the most appropriate and reliable evidence of dementia for proper detection and treatment and meeting health needs. The outcomes of this program include increased workforce capacity, demand and utilization of dementia-related services, and improved early detection, diagnosis, and professional care (CDC, 2018). Other outcomes are an informed public and people with dementia or their caregivers, and supportive communities. Seeking public feedback using online surveys is an effective strategy to get responses to the effectiveness of the programs, such as an increased awareness of brain health and seeking input on recommendations for improvement.
Conclusion
Identifying prevalence or incidence rates, risk factors, or the burden of a chronic illness facilitates the development of strategies for strategic intervention. Infectious and chronic health diseases such as cancer, diabetes, arthritis, lung cancer, dementia, and osteoporosis are the leading cause of mortality and disability and contribute to a significant burden in healthcare due to costs associated with treatment and management. Dementia is among the leading causes of disability and mortality among older adults, and prevalence has increased exponentially, especially in relation to associated public health costs. Thus, relevant stakeholders at the state and national levels should increase efforts to develop and implement appropriate interventions for population health issues and monitor progress to ensure effectiveness.
References
Alzheimer’s Association Report, (2020). 2020 Alzheimer’s disease facts and figures. The Journal of the Alzheimer’s Association. https://doi.org/10.1002/alz.12068
Centers for Disease Control and Prevention (2018). Healthy brain initiative, state, and local public health partnerships to address dementia: The 2018-2023 road map. Alzheimer’s Association. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf
Healthy People 2020. (n.d.). Dementias, including Alzheimer’s disease. https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease
Hwang, A. B., Boes, S., Nyffeler, T., & Schuepfer, G. (2019). Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. In Plos One, 14(7). https://doi.org/10.1371/journal.pone.0219569
Ross, K. L., Beld, M., & Yeh, C. J. (2021). Alzheimer’s disease and related dementias facts and figures in California: Current status and future projections. California Department of Public Health. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Library/Alzheimers%27%20Disease%20Program/151764_Alzheimers_Disease_Facts_and_Figures_Reportv3_ADA.pdf
Zhang, X. X., Tian, Y., Wang, Z. T., Ma, Y. H., Tan, L., & Yu, J. T. (2021). The Epidemiology of Alzheimer’s Disease Modifiable Risk Factors and Prevention. In Journal of Prevention of Alzheimer’s Disease, 8(3). https://doi.org/10.14283/jpad.2021.15