NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem

Chamberlain University NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem   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 6: Epidemiological Analysis: Chronic Health Problem              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem  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 6: Epidemiological Analysis: Chronic Health Problem              

The introduction for the Chamberlain University NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem  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.

How to Write the Body for NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem              

After the introduction, move into the main part of the NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem 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 6: Epidemiological Analysis: Chronic Health Problem              

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 6: Epidemiological Analysis: Chronic Health Problem              

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.

Stuck? Let Us Help You

Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease. 

Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem  assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW. 

Sample Answer for Epidemiological Analysis Chronic Health Problem

Epidemiological Analysis Chronic Health Problem

Chronic health problems are a concern to the healthcare system, at the individual, population, and national management levels owing to their impacts on care cost, access, safety, and thus, quality. Understanding the natural process of these diseases, their diagnosis, treatment, and epidemiological characteristics is important in preventive and curative care. The burden of the disease reflects its impact on the social, cultural, economic, and political underpinnings behind the disease’s impact on healthcare costs and disability (Leung et al.,2020). Asthma is a chronic disease that involves the respiratory system with a huge burden on the health system in my state, California, and nationally. The purpose of this paper is to describe the background and significance of asthma, its surveillance and reporting system, epidemiology, screening, and plan of care.

Background and Significance of Asthma

Asthma is a reversible inflammatory disease affecting the small and medium airways. It leads to hyperresponsiveness of these airways as well their acute smooth muscle contraction that results in limitation of breathing efficiency. The inflammatory hyperresponsiveness and airway smooth muscle contraction leading to the narrowing of the airway lumen due to mucosal edema and disruption (Leung et al., 2020). Chronic asthma is characterized by repeated bouts of inflammation that lead to remodeling of the airway due to proliferation and matrix deposition

Signs and Symptoms

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines asthma as a chronic airway inflammation that causes fluctuating expiratory airflow limitation and respiratory symptoms over time (Roman-Rodriguez & Kaplan, 2021). As opposed to chronic obstructive pulmonary disorder (COPD), asthma symptoms are reversible and fluctuating. The 2019 report of the global initiative for asthma (GINA) specifies two key features of asthma: variable respiratory symptoms and variable expiratory flow limitations (Global Initiative for Asthma, 2019). Asthma patients can present with a history of shortness of breath, wheezing, cough, or chest tightness. The national institute for health and care excellence (NICE) latest guidelines on asthma assessment, diagnosis, and chronic management published in 2017, emphasize the presence of seasonality of these symptoms, triggers for exacerbations, and family history of atopy in the clinical assessment of chronic asthma.

ALSO READ:

NR 503 Week 7: Discussion-Global and Environmental Health

NR 503 Week 7 Reflection on Achievement of Outcomes Concept Map

NR 503 Week 7: Discussion- Presentation of Epidemiological Problem Abstract

NR 503 Week 8: Reflection on Achievement of Program Outcomes

NR 503 Week 8: Discussion – Health Policy and Ethics

On examination, the presence of expiatory polyphonic wheeze is a key sign of asthma but not a pathognomonic of asthma. Therefore, a combination of symptoms from history, physical examination findings, and objective test findings is required to distinguish asthma from other chronic lower repository diseases. Sometimes, chronic cough can be the chief complaint in asthma patients and thus can be confused with other chronic lower respiratory diseases. This cough variant is common in pediatric patients who usually report asthma sooner after showing cough as the only symptom.

Incidence and Prevalence

According to the United Health Foundation, the current prevalence of asthma in the United States is 7.5% per 2019-2020 survey data from the National Survey of Children’s Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), and Maternal and Child Health Bureau (MCHB) (United Health Foundation, n.d.). The least prevalence was reported in North Dakota (4%) while the highest prevalence was reported in Connecticut (11%). The prevalence of asthma in California in 2020 was 6.4%, which is 1.1% below the national estimates during that year. California ranked 14^th in terms of health regarding the prevalence of asthma.

California Department of Public Health reported California asthma prevalence data in 2020 in terms of lifetime prevalence and current prevalence. In the general Californian population, the figure is about 15.1% (California Department of Public Health, n.d.). This includes the proportion of those who had been diagnosed with asthma in their lifetime and currently report not having it. As shown in Table 1, compared to national estimates during 2020, this prevalence is still lower than the highest reported value, 18.4% (Farzan et al., 2019). This value represents a 1.3% increase in the 2014 average prevalence of asthma among adults and children in California according to the California Air Resources Board (n.d.). Therefore, the prevalence of asthma has been rising in California in the past decade.

Table 1

California state and National Asthma prevalence

Surveillance and Reporting

Disease surveillance involves the systematic and periodic collection, analysis, and interpretation of health data of a given disease condition from various primary sources (CDC, 2022). Disease surveillance and reporting are important in providing warning about trends, identifying emergencies, informing health policies and planning, and guiding disease monitoring at the public health level. Asthma surveillance and reporting in the United States is done at the state and national levels (California Department of Public Health, n.d.). Surveillance and reporting are, therefore, important for quality improvement purposes and ensuring health safety through health prevention based on health data.

Asthma is part of many chronic conditions for which surveillance is done at the state and national levels. At the national level, various programs are used to collect, analyze and disseminate surveillance data and inform the national government for planning, policy-making, and implementations. These programs collect data through various methods such as surveys, prevalence reports, physician visits, self-management education, mortality reports, and electronic health records (California Air Resources Board, n.d.). At the national level, National Center for Health Statistics (NCHS) surveys and the Vital Statistics System provide access to national data on various chronic diseases including asthma (CDC, 2022). Other programs include but are not limited to National Health Interview Survey, National Hospital Discharge Survey, Behavioral Risk Factor Survey, and Center for Disease Control Asthma Surveillance Data.

Doctor’s office visits, health insurance information, personal household interviews, discharge information from the hospital records, and medication use records are some of the key sources of the surveillance data for these programs (California Air Resources Board, n.d.). The Behavioral Risk Factor Survey collects its data through regular surveys regarding many chronic conditions. At the state level, the California Environmental Health Tracking Program, California Health Interview Survey, Office of Statewide Health Planning and Development, CDPH California Breathing County Level Asthma Data, and California Asthma Public Health Initiative are involved in the asthma data surveillance and reporting. Adult and child asthma prevalence at the state level in many states is reported by the Behavioral Risk Factor Surveillance System (BRFSS) (CDC, 2022). Asthma is, therefore, a chronic disease that is mandated for reporting and forms part of the annual national epidemiological reports. The last available data on asthma surveillance and reporting is for 2020 at the national level. This calls for improved coordination with state-level surveillance systems to harmonize and update these reports for local consumption and progress comparison.

Descriptive Epidemiological Analysis of Asthma

Asthma epidemiology varies with various populations, regions, periods, risks, and outcomes. Worldwide, asthma affects up to 18% of the general population (Global Initiative for Asthma, 2019). This prevalence rate varies among different countries and regions. In the United States, asthma prevalence among children varies with race and state. The prevalence data in 2015 showed an average prevalence rate of 8.4% but this value could rise to 13.4% in some races and socioeconomic settings (Farzan et al., 2019). Farzan et al. in 2019 conducted a prevalence study about asthma and its presentation in Imperial Valley, one of the agricultural regions of California. This study found a prevalence rate of 22.4 percent with wheezing as the most commonly reported symptom. This finding suggests a possibility of underdiagnosis of asthma in remote regions.

The current national prevalence of asthma among adults and children in the United States according to the national and state surveillance systems administered by the Centers for Disease Control and Prevention (CDC) per the 2020 data is 7.8%. This translates to about 5 million people with asthma currently. Despite this disease being mostly diagnosed during childhood, it is more common in adults than children in the US. About 21 million adults against 4 million children have asthma currently. Females are more affected than males in most age groups. Asthma is also common among people who live below the federal poverty threshold (California Air Resources Board, n.d.). Non-Hispanic whites and blacks have higher prevalence rates than Hispanics and persons of Asian descent (Centers for Disease Control and Prevention, 2022).  

In California, hospitalizations due to asthma are more common in children and African Americans. Certain triggers cause asthma attack episodes. Some of the commonest asthma triggers include but are not limited to exercise, cold, pollen, cat dander, tobacco smoke, air pollution, dust mites, and acute infections (Dharmage et al., 2019). According to a recent study by Pate et al. (2021), mortality related to asthma is higher among blacks, adults, and females. By regions, death due to asthma was higher in the northwest and Midwest regions of the US. The disparities in asthma indicators in the above descriptive epidemiology can be attributed to unequal access to care, different geographical locations, demographic characteristics, lower socioeconomic levels, and general poverty levels.

Screening, Diagnosis, Guidelines

Various guidelines are used in different practice jurisdictions to screen diagnose and treat asthma among children and adults. Some of the most used guidelines for screening, diagnosis, and treatment of asthma are the Global Initiative for Asthma (GINA) and the National Institute for Health and Care Excellence (NICE) guidelines. Among children under 5 years old, screening is done through clinical judgment using patient history and physical exams. Based on this clinical judgment, treatment is intimated, and the patient is monitored for improvement until five years old when reassessment for objective tests is done. The GINA guidelines recommend no use of tests for children but emphasize assessment of symptoms, and risk factors and through clinical evaluation to screen for asthma in children. Children above five years and adults can be screened or diagnosed using tests such as spirometry according to NICE guidelines. In the case of normal spirometry despite a high clinical suspicion index of asthma, the clinical can consider Fractional exhaled nitric oxide (FeNO) to make the diagnosis.

Currently, there is no gold standard test for screening or diagnosis of asthma. However, spirometry with bronchodilator response remains the main and most widely used screening and diagnostic test for asthma in older children and adults. Methacholine testing is a provocation test that assesses airway hyperresponsiveness among asthma patients (Cockcroft, 2020). Selvanathan et al. (2020) conducted a study to assess the performance of spirometry with bronchodilator response in asthma diagnosis involving 500 subjects. This study reported a negative predictive value of 57 for use of spirometry in asthma diagnosis. Sensitivity studies on spirometry in asthma diagnosis have reported mixed outcomes but insist on the use of clinical judgment and other tests such as methacholine test for diagnosis. The reliability of the various tests depends on the patient population among other factors.

Plan of Action

Upon graduation, a nurse practitioner is expected to educate, protect, advocate for, and promote the patient’s health regarding asthma and related outcomes. Specific goals will be to increase the number of patients at risk of asthma who are diagnosed in time, reduce the number of emergency room visits, and reduce the number of exacerbations. The knowledge of risk factors and treatment of asthma will be important. One of the interventions to achieve these goals will be patient education on risk factor avoidance and the use of medication and inhalers to promote adherence. This will reduce the risk of exacerbation and readmissions (Scullion, 2018). The second intervention is the coordination of care and referral to appropriate community resources that will promote and complement their care such as community pharmacies and reduce the risk of exacerbation and readmission. The third intervention is to conduct early rereferral of cases where the diagnosis of cancer is nonconclusive so that early diagnosis can be made by a specialist such as pulmonologists (Mowbray et al., 2020). These interventions’ goals are measurable and align well with the healthy people 2030 goals on asthma that aim at improving detection, prevention, and treatment.

Conclusion

Asthma is a reversible chronic inflammatory condition of the lower airway that is characterized by airway hyperresponsiveness and airway reversibility. This disease contributes to significant mortality and morbidity among children and adults. In my state, California, the current prevalence is slightly lower than national estimates, but the burden of the disease is still a problem for the state healthcare system. California ranks 14^th in terms of asthma burden but there is still a need to do more to prevent, treat, and promote population health. The disease’s key symptoms include wheezing, dry cough, and shortness of breath which are a threat to the health safety of the patients. Therefore, a timely diagnosis is required. The current guidelines, NICE and GINA recommend reliance on the clinical history and physical examination for diagnosis. The use of spirometry is reserved for patients above 5 years. Methacholine testing, although not mentioned in current guidelines has been used to assess airway hyperresponsiveness. Spirometry is the most widely used but has varied viability and reliability scores in asthma diagnosis. As a nurse practitioner, my obligation will be to prevent asthma, ensure early detection, and prevent readmission and exacerbations. My key intervention will be patient education, care coordination, and early patient referral to strive to achieve the healthy people 2030 goals.

References

California Air Resources Board. (n.d.). Asthma & Air Pollution. Arb.ca.gov. Retrieved October 5, 2022, from https://ww2.arb.ca.gov/resources/asthma-and-air-pollution

California Department of Public Health. (n.d.). California Breathing County Asthma Data Tool. Cdph.ca.gov. Retrieved October 5, 2022, from https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CPE/Pages/CaliforniaBreathingCountyAsthmaProfiles.aspx

CDC. (2022, May 25). Data, Statistics, and Surveillance. Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/asthmadata.htm

Centers for Disease Control and Prevention. (2022, May 26). Most Recent National Asthma Data. Cdc.gov. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Chaplin, S. (2018). Diagnosis, monitoring, and management of chronic asthma. Prescriber, 29(4), 31–33. https://doi.org/10.1002/psb.1665

Cockcroft, D. W. (2020). Methacholine challenge testing in the diagnosis of asthma. Chest, 158(2), 433–434. https://doi.org/10.1016/j.chest.2020.04.034

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in Pediatrics, 7, 246. https://doi.org/10.3389/fped.2019.00246

Farzan, S. F., Razafy, M., Eckel, S. P., Olmedo, L., Bejarano, E., & Johnston, J. E. (2019). Assessment of respiratory health symptoms and asthma in children near a drying saline lake. International Journal of Environmental Research and Public Health, 16(20), 3828. https://doi.org/10.3390/ijerph16203828

Global Initiative for Asthma. (2019). Global strategy for asthma management and prevention, 2019 update. GINA, 1–201. https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf

Leung, D. Y. M., Akdis, C. A., Bacharier, L. B., Cunningham-Rundles, C., Sicherer, S. H., & Sampson, H. A. (Eds.). (2020). Pediatric allergy: Principles and Practice: Principles and practice (4th ed.). Elsevier – Health Sciences Division.

Mowbray, F. I., DeLaroche, A. M., Parker, S. J., Jones, A., & Ravichandran, Y. (2020). Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department. International Emergency Nursing, 50(100844), 100844. https://doi.org/10.1016/j.ienj.2020.100844

Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma surveillance – the United States, 2006-2018. MMWR Surveillance Summaries, 70(5), 1–32. https://doi.org/10.15585/mmwr.ss7005a1

Roman-Rodriguez, M., & Kaplan, A. (2021). GOLD 2021 strategy report: Implications for asthma-COPD overlap. International Journal of Chronic Obstructive Pulmonary Disease, 16, 1709–1715. https://doi.org/10.2147/COPD.S300902

Scullion, J. (2018). The nurse practitioners’ perspective on inhaler education in asthma and chronic obstructive pulmonary disease. Canadian Respiratory Journal: Journal of the Canadian Thoracic Society, 2018, 2525319. https://doi.org/10.1155/2018/2525319

Selvanathan, J., Aaron, S. D., Sykes, J. R., Vandemheen, K. L., FitzGerald, J. M., Ainslie, M., Lemière, C., Field, S. K., McIvor, R. A., Hernandez, P., Mayers, I., Mulpuru, S., Alvarez, G. G., Pakhale, S., Mallick, R., Boulet, L.-P., Gupta, S., & Canadian Respiratory Research Network. (2020). Performance characteristics of spirometry with negative bronchodilator response and methacholine challenge testing and implications for asthma diagnosis. Chest, 158(2), 479–490. https://doi.org/10.1016/j.chest.2020.03.052 United Health Foundation. (n.d.). Explore Asthma in California. America’s Health Rankings. Retrieved October 5, 2022, from https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/asthma/state/CA

Sample Answer 2 for Epidemiological Analysis Chronic Health Problem

Identification of the Health Problem

Chronic conditions have a significant effect on public health. Nurses and other healthcare providers implement evidence-based initiatives to enhance chronic conditions’ prevention, detection, and management. Hepatitis C is an example of a chronic disease with high prevalence globally. Hepatitis C is a viral, blood-borne infection. The global statistics show that about 170 people have the infection. Hepatitis C ranks among the top 15 leading causes of mortalities in the United States. The Centers for Disease Control and Prevention (CDC) reports that mortalities related to hepatitis C infection exceeded those of HIV over the last decade (CDC, 2023). Understanding the hepatitis C disease, its process, surveillance, prevention, and management is crucial for healthcare providers. Therefore, this paper discusses hepatitis C. It focuses on topics that include its background and significance, surveillance and reporting, epidemiological analysis, screening and guidelines, and planning.

Background and Significance

Hepatitis C is the selected chronic infection. Hepatitis C is a viral and blood-borne infection. Hepatitis C exists in acute and chronic forms. The Hepatitis C virus is highly infectious with a prolonged survival period, which increases its potentiality for transmission. Currently, no vaccine exists for use in preventing hepatitis C. A focus is on avoiding its associated risk factors such as sharing equipment used for injection and standard precautions when in environments with a risk of being exposed to blood. Specific groups of people are at risk of being affected by hepatitis C. They include those who share injection equipment, including drug addicts, patients on long-term dialysis, healthcare providers, engaging in unprotected sex with an infected person, and children born to mothers with hepatitis C (CDC, 2023).

People with acute hepatitis do not show any symptoms of hepatitis C. Symptoms develop after a long period of infection because of liver cirrhosis. Patients with hepatitis C present to the hospital with symptoms that include right upper abdominal pain, ascites, clay-colored or pale stools, fatigue, dark urine, itching, jaundice, fever, nausea and vomiting, and loss of appetite. Patients also report easy bleeding and bruising, edema of the lower extremities, weight loss, confusion, slurred speech, drowsiness, and spider angiomas (CDC, 2023).

Hepatitis C is a public health concern in the state of Florida. In 2021, the rate of chronic hepatitis C in Florida was 58.2%. The rate represented 22005 people in the state. The rates vary across the counties in Florida. For example, Bradford County’s rate in 2021 was 20.4% while Broward County had 3.3% in the same year (flhealthcharts.gov, n.d.-b). The prevalence rate of hepatitis C in Florida was 8.2% in 2021. Counties had varying prevalence rates. For example, Bay County had a prevalence rate of 3.8% while Brevard had 1.3% in 2021(flhealthcharts.gov, n.d.-a).

In 2020, the reported cases of newly identified hepatitis C in the United States were 107300. The number represented 40.7% of hepatitis C cases in every 100,000 people. There was an increase in hepatitis C-associated mortalities in 2020 to 3.45 deaths in 100,000 people as compared to 3.33 per 100,000 people in 2019. There were 64% newly reported cases of hepatitis C among men and 66.8% of new cases among women in 2020. The most affected age groups by hepatitis C are 20-39 and 55-70 years (CDC, 2022). After detailed research, the researcher could not find age-specific mortality rates due to hepatitis C in Florida.

Table 1

Hepatitis C Cases in Florida and the USA

Surveillance and Reporting

Surveillance refers to the process of systematic data collection, collation, analysis, interpretation, and dissemination to the involved public health stakeholders for actions to be taken. A surveillance system for any disease has components that include health event detection, investigation and confirmation, data collection, analysis, interpretation, feedback, dissemination of results, and response for prevention and control (Ryerson et al., 2020). Surveillance helps recognize cases of hepatitis C, required interventions, the impact of public health interventions, and the need for additional strategies to prevent its population spread.

The CDC has developed a surveillance system used in the United States for hepatitis C. The CDC provides best practice models that states can adopt for enhanced hepatitis C surveillance. They include case ascertainment and reporting through the creation of an electronic system for collecting and storing hepatitis C test results. States should also have a system for receiving laboratory data and entering into a registry for hepatitis C. The other model for hepatitis C surveillance for use in the United States is the enhanced surveillance system where providers and institutions should consider actions such as establishing outbreak response plans, investigation of random samples, and creation of linkages to care, treatment, and reduction of harm among the priority populations (CDC, 2023).

Case ascertainment for hepatitis C is achievable using laboratory tests that include anti-HCV and HCV detection tests. In addition, total bilirubin and ALT investigations should be ordered to determine if cases are acute or chronic. Mandated reporting is required for hepatitis C. All states require laboratory reporting for acute hepatitis C. The reporting includes laboratory indicators, negative anti-HCV among children aged less than 36 months,and all negative and undetectable HCV RNA results. The complete reporting of all hepatitis tests should include negative hepatitis C results for use in making public health decisions. There is also provider and healthcare facility reporting for hepatitis C diagnoses. The reporting aligns with the CDC/CSTE Position Statement for hepatitis C case definitions (CDC, 2023). Children aged 2-36 months diagnosed with hepatitis C are classified under the Perinatal Hepatitis C category.

Epidemiological Analysis

Hepatitis C is a viral and blood-borne infection that affects the liver. It causes liver inflammation and cirrhosis and associated symptoms. Infection with hepatitis C occurs through exposure to infected blood from unsafe injection practices, poor health care, sexual practices associated with blood exposure, and injection drug use. Chronic hepatitis C develops after acute hepatitis in around 55-85% of the affected populations. Patients affected by hepatitis C experience several symptoms, including fever, chronic fatigue, jaundice, nausea, vomiting, ascites, weight loss, lower limb edema, coma, confusion, drowsiness, dark urine, and abdominal pain. Early diagnosis is crucial for effective treatment, care, and prognosis (WHO, 2023). However, global statistics show that about 19% of the population with hepatitis C knows their disease status.

Everybody is at risk of hepatitis C. However, specific populations are most vulnerable to it. They include health care providers, patients requiring frequent blood transfusions, organ recipients before June 1992, injection drug users, and infants born to mothers infected with the hepatitis C virus. The other groups of people at risk include those with high-risk sexual behavior, sexually transmitted diseases, multiple partners, and those who share razors, toothbrushes, and other items with infected people (CDC, 2023; Parsons, 2022).

Several individual factors influence hepatitis C progression. They include age, sex, ethnicity, existing comorbidities, fatty liver, and alcohol intake. Alcohol intake elevates hepatitis virus replication while fatty liver worsens inflammation and hepatic scarring. Concurrent conditions such as HIV and hepatitis B elevate liver damage. Hepatitis C progression is slower among individuals of African-American backgrounds than among other ethnicities. Males have a high progression of hepatic injury than females while individuals aged 40 years old and above have a high susceptibility to accelerated fibrosis (Parsons, 2022).

All the global populations are at risk of hepatitis C. Global statistics show that around 58 million people have hepatitis C with 1.5 million new cases reported annually. The prevalence rate of hepatitis C is higher in low and middle-income countries when compared to the developed nations. For instance, the prevalence of hepatitis C is less than 2% in developed countries while low-middle-income countries such as Egypt have a 15% prevalence of the infection. Statistics also show that about 3-5 million Americans have hepatitis C (Mukhtar et al., 2019; Parsons, 2022).

Most people infected by hepatitis C virus remain asymptomatic for a period of between two weeks and six months. The virus can also not be detected during this period because of low antibody levels to be detected through the normal tests. Some patients might also have weakened immunity to develop antibodies to be detected for hepatitis C (Parsons, 2022). Therefore, individual factors influence the duration of the infection and the onset of symptoms.

Hepatitis C is a crucial public health concern. Around 58 million people globally have hepatitis C with annual 1.5 million new cases. Hepatitis C is also among the leading causes of liver diseases, including cirrhosis and cancer. It also contributes to about 290000 deaths annually reported around the world (Yang et al., 2023). Hepatitis C is costly to patients, families, healthcare systems, and the country. Patients incur high costs in seeking treatments, frequent hospitalizations, and lose their productivity due to the disease. The government spends enormous resources in treating, diagnosing, and preventing hepatitis C. For example, the government spends an average of $17,178 for non-disabled adults with chronic hepatitis and $17,879 for disabled adults (Roebuck, 2019). Hepatitis C does not have a vaccine. However, treatments using antivirals exist. An effective intervention is educating the public about the prevention, risk factors, and health effects of hepatitis C. Therefore, it makes it an important public health concern.

Screening, Diagnosis, and Guidelines

            The diagnosis of hepatitis C is done in two steps. The first step entails testing the patient for anti-HCV antibodies. Providers use a serological test that identifies people exposed to the virus. If the test is positive, a nucleic acid test is done for HCV ribonucleic acid. The anti-HCV antibody test confirms chronic hepatitis C infection. A patient who was infected with the virus will test positive for the anti-HCV antibody test due to a history of exposure to the virus (Bhattacharya et al., 2023). An assessment of the extent of liver damage should be done once a person has tested positive for hepatitis C virus.

            The American Association for the Study of Liver Diseases has developed a guideline for testing, managing, and treating hepatitis c infection. The guideline recommends universal screening, a simplified treatment algorithm, and treatment of all vulnerable populations in jail or prison with hepatitis C infection. The guideline also recommends the use of direct-acting antiviral therapy for any patient who is diagnosed with either acute or chronic hepatitis C (Bhattacharya et al., 2023).

The recommended initial treatments for hepatitis C include sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, elbasvir/grazoprevir, sofosbuvir/velpatasvir+weight-based ribavirin, and sofosbuvir/velpatasvir/vaxolaprevir. Patients with decompensated cirrhosis should be treated with sofosbuvir/velpatasvir+ weight-based ribavirin, sofosbuvir/velpatasvir, or ledipasvir/sofosbuvir+weight-based ribavirin. Retreatment with the combinations should be considered if patients show a failed response to treatment. The guideline also has recommendations for special populations such as pregnant women, those with HIV, and children. For example, approved direct-acting antivirals should be used in children with chronic hepatitis C while a case-by-case approach should be adopted for pregnant women (Bhattacharya et al., 2023). Further, the guideline recommends annual screening for all at-risk populations for early detection and management of hepatitis C. Anti-HCV test is used for diagnosing hepatitis C. The test has a sensitivity and specificity of more than 99%. The positive predictive value of the anti-HCV test is 99.7% while its negative predictive value is 87.3% (Liu et al., 2021). Its cost is $147.33.

Plan

            A nurse practitioner can address hepatitis C after graduation in several ways. One of the ways in which the nurse practitioner can address it is through health education. Nurse practitioners can empower with knowledge about the causes, effectiveness, prevention, and treatment of hepatitis C. Health education is an effective tool, which will help the population to adopt healthy lifestyles and behaviors that minimize the risk of hepatitis C. It also raises the population’s awareness about the importance of utilizing the available screening services for early detection and treatment of hepatitis C (Bhattacharya et al., 2023). An effective way to measure the effectiveness of health education includes the administration of pre- and post-educational surveys to determine knowledge changes in the population.

            The second strategy a nurse practitioner might use to address hepatitis C is screening at-risk populations to identify and initiate early treatments. Screening is an effective tool that can enhance the detection of infected, asymptomatic cases and facilitate timely treatment for improved prognostic outcomes (Day et al., 2019). An effective strategy to measure the effectiveness of screening is comparing the positive rates among the screened populations, treatment uptake rates, and reduction in hepatitis rates in the population.

            The last intervention that nurse practitioners can use to address hepatitis is by linking them to existing social support resources. Hepatitis C can be distressing to patients and their significant others. The loss of functional abilities and productivity in social and occupational roles predisposes patients to negative health outcomes and poor quality of life. A nurse practitioner might link them to social support groups for people with illnesses for them to receive the social, psychological, and emotional support that they need to overcome their challenges (Khorvash et al., 2022). An effective approach to measuring the effectiveness of linking patients with social support groups would be undertaking surveys to determine their perceived quality of life before and after being enrolled in the social support groups.

Summary/Conclusion

            Hepatitis C is a viral and blood-borne infection with a significant disease burden to the global population. The incidence and prevalence rate of hepatitis C in America and Florida is high. Current surveillance methods are effective in ensuring timely detection; prevention and management of hepatitis C. Nurse practitioners utilize epidemiological analysis to understand hepatitis C better. Nurse practitioners can address hepatitis C through health education, screening, and linking the affected with the existing social support programs and groups for their health and wellbeing.

References

Bhattacharya, D., Aronsohn, A., Price, J., Lo Re, V., III, & the American Association for the        Study of Liver Diseases–Infectious Diseases Society of America HCV Guidance Panel.       (2023). Hepatitis C Guidance 2023 Update: American Association for the Study of Liver         Diseases– Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clinical Infectious Diseases, ciad319. https://doi.org/10.1093/cid/ciad319

CDC. (2022, September 14). 2020 Hepatitis C | Viral Hepatitis Surveillance Report | CDC.             https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-c.htm

CDC. (2023, July 18). Viral Hepatitis Surveillance and Case Management—Hepatitis C | CDC.             https://www.cdc.gov/hepatitis/statistics/surveillanceguidance/HepatitisC.htm

Day, E., Hellard, M., Treloar, C., Bruneau, J., Martin, N. K., Øvrehus, A., Dalgard, O., Lloyd,     A., Dillon, J., Hickman, M., Byrne, J., Litwin, A., Maticic, M., Bruggmann, P., Midgard,        H., Norton, B., Trooskin, S., Lazarus, J. V., Grebely, J., & Users (INHSU),  the I. N. on         H. in S. (2019). Hepatitis C elimination among people who inject drugs: Challenges and  recommendations for action within a health systems framework. Liver International,       39(1), 20– 30. https://doi.org/10.1111/liv.13949

flhealthcharts.gov. (n.d.-a). Hepatitis C, Acute—Florida Health CHARTS – Florida Department   of Health | CHARTS. Retrieved October 13, 2023, from https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalIndNoGrp.Da taviewer&cid=8651

flhealthcharts.gov. (n.d.-b). Hepatitis C, Chronic (Including Perinatal)—Florida Health   CHARTS – Florida Department of Health | CHARTS. Retrieved October 13, 2023, from             https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalIndNo            Grp.Dataviewer&cid=8660

Khorvash, F., Ataei, B., Baghersad, Z., &Boroumandfar, Z. (2022). Effectiveness of the   Educational-Supportive Program to Improve the Quality of Life Among Patients with   Hepatitis C virus (HCV): A Quasi-Experimental Study. Jundishapur Journal of Health   Sciences, 14(2), Article 2. https://doi.org/10.5812/jjhs-121626

Liu, H.-Y., Lin, Y.-H., Lin, P.-J., Tsai, P.-C., Liu, S.-F., Huang, Y.-C., Tsai, J.-J., Huang, C.-I.,    Yeh, M.-L., Liang, P.-C., Lin, Z.-Y., Dai, C.-Y., Huang, J.-F., Chuang, W.-L., Huang, C.-        F., & Yu, M.-L. (2021). Anti-HCV antibody titer highly predicts HCV viremia in patients    with hepatitis B virus dual-infection. PLOS ONE, 16(7), e0254028.            https://doi.org/10.1371/journal.pone.0254028

Mukhtar, N. A., Ness, E. M., Jhaveri, M., Fix, O. K., Hart, M., Dale, C., Pratt, C., &Kowdley, K.             V. (2019). Epidemiologic features of a large hepatitis C cohort evaluated in a major   health system in the western United States. Annals of Hepatology, 18(2), 360–365.             https://doi.org/10.1016/j.aohep.2018.12.003

Parsons, G. (2022). Hepatitis C: Epidemiology, transmission and presentation. Prescriber, 33(6),             20–23. https://doi.org/10.1002/psb.1992

Roebuck, M. C. (2019).Assessing the Burden of Illness of Chronic Hepatitis C and Impact of       Direct-Acting Antiviral Use on Healthcare Costs in Medicaid.

Ryerson, A. B., Schillie, S., Barker, L. K., Kupronis, B. A., &Wester, C. (2020). Vital Signs:       Newly Reported Acute and Chronic Hepatitis C Cases ― United States, 2009–2018.        Morbidity and Mortality Weekly Report, 69(14), 399–404.       https://doi.org/10.15585/mmwr.mm6914a2

WHO. (2023). Hepatitis C. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c             

Yang, J., Qi, J.-L., Wang, X.-X., Li, X.-H., Jin, R., Liu, B.-Y., Liu, H.-X., & Rao, H.-Y. (2023). The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019. Frontiers in Public Health, 11, 1041201. https://doi.org/10.3389/fpubh.2023.1041201

Week 7: Discussion- Presentation of Epidemiological Problem Abstract 

Professor and class, 

The United State is spending close to $16 Billion dollars annually on sexually transmitted diseases (STDs) (Centers for Disease and Prevention [CDC], 2017). Southern states, like Georgia, sees a large number of syphilis cases. Surprisingly, there was once a time where syphilis was at its lowest and was on the verge of elimination.  Now, the rates of syphilis have doubled, causing an incidence rate in the U.S of 5.5 cases per 100,000 (CDC). Men have the highest prevalence. Their rates have continued to climb. Men who have sex with men or MSM are at the greatest risk and have the highest rates of syphilis with 15.6 per 100,000 or 88.9% of all U.S. cases (CDC, 2017). This has been termed a MSM epidemic. A rapid plasma regain (RPR) is the lab of chose to routinely screen for syphilis. Once diagnosed there are 3 main stages: primary, secondary, and latent. Treatment dosage varies but the treatment of choice is Penicillin Benzathine G given intramuscularly. Once there is a positive lab and confirmation lab, it must be reported by law to the state’s public health department. This is normally done by the laboratory and physician. There is an electronic system where this is transmitted through. After being reported, it is then used for surveillance. It is the goal of providers to help educate the community on syphilis awareness. Patients must be open to talk about their sex health with their providers. Three ways to work towards the goal of syphilis prevention are: to provide information and encourage safe sex, screen for all STDs, and lastly, treat the patient and notify their partners. These actions will limit the exposure and transmission of syphilis; therefore, decreasing the rates of syphilis in Georgia and the U.S.  

Resource 

Centers for Disease and Prevention (CDC). (2017). Sexually Transmitted Disease (STDs). Retrieved from https:www.cdc.gov/std/syphilis/defualt.htm