NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem

Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or 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: Evaluation of an Epidemiological Disease or Problem              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or 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: Evaluation of an Epidemiological Disease or Problem              

The introduction for the Chamberlain University NR 503 Week 6: Evaluation of an Epidemiological Disease or 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: Evaluation of an Epidemiological Disease or Problem              

After the introduction, move into the main part of the NR 503 Week 6: Evaluation of an Epidemiological Disease or 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: Evaluation of an Epidemiological Disease or 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: Evaluation of an Epidemiological Disease or 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.

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Sample Answer for NR 503 Week 6: Evaluation of an Epidemiological Disease or Problem

For most people, arthritis is a health condition associated with people over the age of 65. The stiff, inflamed joints and nagging aches and pains are just seen as side effects of aging and years of wear and tear on the body. While arthritis is a health condition that results from inflammation of the joints and causes chronic pain, it is not just a health condition that affects elderly people. Arthritis can develop in children, teenagers, even adults in their twenties and thirties. As a long-term care nurse for over 15 years, my familiarity with the effects of arthritis in patients living in long-term care (LTC) facilities settings is considerable. Residents suffering from chronic arthritis find it extremely difficult to lift items, open doors, walk long distances, and perform activities of daily living (ADL): bathing, getting dressed, using the toilet, eating, transferring oneself to or from the bed or chair, or generally participating in activities that require strength and flexibility. Millions of people suffering from arthritis do not live in LTC facilities, so they do not have nursing assistance to help them with their ADLs or instrumental activities of daily living (IADLs): housework, grocery shopping, driving, caring for pets, etc.  On the other hand, millions of arthritis sufferers are forced to give up their independence every year and move into long-term care facilities as they find they are no longer able to perform normal daily functions due to the pain and discomfort caused by their arthritis.

The Georgia Department of Public Health (GDPH) reports that arthritis is the predominant reason for disability in the United States and Georgia, affecting over 53 million people across the nation (Bayakly, 2015). In 2013, one in four adults in Georgia, ranging in ages from 18 to 85, were reported to have been diagnosed with arthritis by their primary care physicians (Bayakly, 2015). With the average age of onset arthritis reported to be 47 years old, cost-effective evidence-based strategies are needed to treat LTC patients suffering with arthritis (Tavakoli, Akwara, Kish, 2018). This paper will examine the prevalence of osteoarthritis (OA) and rheumatoid arthritis (RA) and describe their backgrounds. The paper will also discuss surveillance methods, provide an epidemiology analysis of OA and RA, and explain how they are diagnosed. Lastly, this paper will reflect on what actions can be taken to address OA and RA as a family nurse practitioner. 

Background of arthritis

Arthritis is a degenerative joint disease that causes swelling, tenderness, and pain of the joints. Arthritis may affect one joint and cause occasional discomfort, but it often times affects multiple joints in the body and decreases mobility. People of all ages can develop arthritis; however, their chances increase as they grow older. The Centers for Disease Control and Prevention (2018) report there are over 100 types of arthritis. The most prevalent cases of arthritis are osteoarthritis and rheumatoid arthritis (CDC: Arthritis basics, 2018). Other commonly diagnosed forms of arthritis include juvenile rheumatoid arthritis, knee osteoarthritis, degenerative joint disease, fibromyalgia, and gout (CDC: Arthritis basics, 2018). OA occurs in the joints when cartilage begins to break down; this may be the result of injury, aging, or overuse of the joints (CDC: Arthritis basics, 2018). Osteoarthritis is the most common type of arthritis and affects 30 million people or 60 percent of all diagnosed cases within the U.S. (CDC: Arthritis basics, 2018) and for 70.9 percent of all cases in Georgia (Martyn, Bayakly, & Bagchi, 2013). Furthermore, OA is the reason for 79 percent of hospitalizations among Georgia patients 65 years and older (Martyn, Bayakly, & Bagchi, 2013). OA targets the neck, lower back, hands, hips, and knees and worsens over time, resulting in permanent disability (PubMed Health, 2018).

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Rheumatoid arthritis is an autoimmune disorder that occurs when the immune system attacks the healthy cells in the connective tissue lining of the joints, causing damage and inflammation to joints throughout the body (CDC: Arthritis basics, 2018). Rheumatoid arthritis mainly attacks the synovial membrane soft tissue that lines the joints and leads to bone damage (CDC: Arthritis basics, 2018). RA causes chronic pain in the joint tissues of the hands, wrists, and knees; as a result, the person may develop a lack of balance or a deformity of the hands. Advanced RA may affect other tissues and cause health issues in organs such as the lungs and heart (CDC: Arthritis basics, 2018). RA is the most diagnosed autoimmune inflammatory arthritis in adults, affecting about 1 percent of U.S. general population and accounting for 0.7 percent of hospitalizations among Georgia patients ages 35 – 65 and over (Martyn, Bayakly, & Bagchi, 2013). RA is often misdiagnosed or mistaken for other disorders (Martyn, Bayakly, & Bagchi, 2013). The burden that OA, RA and other forms of arthritis places on arthritis sufferers is significant as it leads to a lower quality of life. Due to physical limitations and difficulty of staying healthy, arthritis sufferers find it increasingly difficult to work or participate in social or familial activities. 

Signs and symptoms

The overall symptoms of OA are aching pain, stiffness in affected areas, decreased range of motion, and joint swelling. The general symptoms of RA include pain, stiffness, weakness, tenderness, and swelling of the joints. Accompanying systemic symptoms for RA are weight loss, fever, fatigue, eye inflammation, anemia, pleurisy, and subcutaneous nodules (PubMed Health, 2018). When RA symptoms worsen, they are called flare-ups; when symptoms do not appear, they are said to be in remission (CDC: Arthritis basics, 2018). Risk factors associated with osteoarthritis and rheumatoid arthritis are multifactorial and include familial, individual, or behavioral causes (Martyn, Bayakly, & Bagchi, 2013). Hereditary risk factors are genetic mutations that increase the risk of RA or OA; individual risk factors include aging, being female, and being White; behavioral risk factors are joint injuries sustained during an activity, repetitive motion characteristic of certain jobs, long-term infections, and obesity (Martyn, Bayakly, & Bagchi, 2013). In terms of the effect of RA and OA on patients in long-term care, the ability of these arthritic conditions to debilitate the body has adverse mental effects. Affected residents often experience feelings of fear, helplessness and anxiety, which lead to depression and increased stress levels. Many patients with RA suffer from comorbidity

Incidence/Prevalence statistics

Of the 1.7 million adult Georgians who report having been diagnosed with arthritis, 76,000 report they are disabled (Martyn, Bayakly, & Bagchi, 2013). Among racial and ethnic groups diagnosed with arthritis, the most affected group is White non-Hispanic at 69 percent (Ibid.). RA and OA are most prevalent among women at 59 percent (Ibid.). Women are 30 percent more likely to report symptoms of arthritis than men at 22 percent (Ibid.). Among racial and ethnic groups, White non-Hispanic females are most likely to report arthritis symptoms at 32 percent, followed by White non-Hispanic males at 25 percent, Black non-Hispanic females at a 26 percent, and Black non-Hispanic males at 20 percent (Ibid.). Georgians 65 years and older report arthritis symptoms at 57 percent while Georgians ages 18 to 24 years old only report at 4 percent (Ibid.). Among Georgia adults diagnosed with arthritis, 58 percent were still employed, 10 percent had retired, and 18 percent were totally disabled and unable to work (Ibid.). 

On average, 24,360 Georgia residents are hospitalized every year due to arthritis complications (Martyn, Bayakly, & Bagchi, 2013). Of the Georgia adults who have health insurance, 28 seek medical attention for arthritis; 18 percent of Georgia adults without health insurance seek medical attention for arthritis symptoms (Martyn, Bayakly, & Bagchi, 2013).  The rate of hospitalizations was highest among women at 58 percent , Whites  at 77 percent, and patients 55 years and older at 77 percent (Ibid.). Per year, an average of 2,084 Georgians dies from arthritis or health issues linked to arthritis (Ibid.). Of these deaths, 66 percent occurred among females, 66 percent occurred among Whites, and 61 percent among people age 65 years or older (Ibid.).  The prevalence of arthritis is drastically lower in metro-Atlanta county health districts: the lowest numbers reveal Clayton County at 16.7 percent, DeKalb County at 17.6 percent, and Fulton County at 20 percent (Ibid.). The prevalence of arthritis is higher outside of metro-Atlanta counties: the cities with the highest incidences are Dublin at 32.8 percent, Albany at 31.2 percent, Augusta at 31.2 percent, Waycross at 31.1 percent, and North Georgia health districts at 31.1 percent (Ibid.). 

               Figure 2: Georgia public health district arthritis comparison.

On a national scale 22.7 percent (54.4 million people) of the population has been diagnosed with arthritis, and 21 million of these sufferers complain they are disabled due to their arthritis (CDC: Arthritis related statistics, 2018). 7.1 percent of people between the ages of 18 to 44 report they have been diagnosed with arthritis; 29.3 percent of people between the ages of 45 to 64 report arthritis; 49.6 percent of people age 65 and older have reported doctor-diagnosed arthritis (Ibid.). 26 percent of the women and 19.1 percent of men in the U.S. report doctor-diagnosed arthritis (Ibid.). Out of the 54.4 million people to be diagnosed with arthritis, 4.4 million are Hispanics, 41.3 million are non-Hispanic Whites, 6.1 are non-Hispanic Blacks, and 1.5 are non-Hispanic Asians (Ibid.). By 2040, 78 million or 26 percent of the adult U.S. population is projected to be diagnosed with some form of arthritis (Ibid.).            

Current surveillance methods

The CDC (2018) suggests the Behavioral Risk Factor Surveillance System (BRFSS) is the most reliable resource for accessing state-specific arthritis prevalence statistics. The BRFSS survey system is based in every state, the District of Columbia, and three U.S. territories (CDC: State statistics, 2018). The system randomly dials individuals aged 18 years or older who have a registered phone number (CDC: State statistics, 2018).  The BRFSS system has been collecting arthritis data from since 1996 (Ibid). The Morbidity and Mortality Weekly Report (MMWR) provides an arthritis surveillance summary that explains the differences between each type of arthritis and the impact arthritis has at the state and local levels (Ibid.). The CDC (2018) also recommends self-reporting methods to estimate the prevalence of doctor-diagnosed arthritis. Researchers should consider individuals to have self-reported, if they ever responded “yes” to the following question found in the National Health Interview Survey (NHIS) and the state-based Behavioral Risk Factor Surveillance System (BRFSS): “Have you been informed by a physician or other healthcare professional that you have some form of arthritis?” (Ibid.). For public health surveillance, the CDC has coordinated with the National Arthritis Data Workgroup to administer the National Health Interview Survey (NHIS) to identify people in every U.S. state and territory with at least one of the 100 diseases that fall under arthritis conditions (Ibid.). The Georgia Department of Public Health relies on the information collected by the CDC, BRFSS, and minimum data set (MDS) nurses in public and private healthcare facilities to compile its state numbers on arthritis (Martyn, Bayakly, & Bagchi, 2013).

Epidemiology analysis

Nationwide, approximately 54 million people report having been diagnosed with arthritis.. Risk factors are multifactorial, with old age, being White and female as the main factors. OA affects over 30 million adults; research suggests wear and tear plays a large role in its diagnosis. RA affects a little over one percent of the national population; research suggests that behavioral and genetic factors play a role in its diagnosis. Women develop arthritis more than men, especially after age 50 with a significantly higher age-adjusted prevalence in women at 23.5 percent than in men at 18.1 percent. Inactive adults have a higher prevalence of arthritis conditions at 23.6 percent than adults who report they are active at 18.1 percent.  In Georgia, 26 percent of the population suffers from some form of arthritis. White non-Hispanics report doctor-diagnosed arthritis at 29 percent, which is more than any other racial/ethnic group in the state. Georgians 65 years are more prone to doctor-diagnosed arthritis. Cobb-Douglas County has reported to date the lowest prevalence of arthritis at 18.4 percent. The population most affected is White women over the age of 65.

Incidence of RA in women is lower among women who take oral contraceptives compared with women who have never taken oral contraceptives or those who have stopped taking oral contraceptives (Tavakoli, Akwara, & Kish, 2018). Research shows that female subfertility increases RA in women (Tavakoli, Akwara, & Kish, 2018). Women who breastfeed and women who go through a postpartum period after a first pregnancy are at greater risk of RA (Ibid.). Environmental factors such as viral and bacterial infections increase the chance of RA in men and women (Ibid.). Men and women who smoke cigarettes increase their risk of RA (Ibid.). Over 15 percent of female in-home nursing assistance insurance claims are due to arthritis (Ibid.). The numbers show that 10 percent of nursing home residents receiving benefits for arthritis or arthritis related conditions are women over age 50 diagnosed with arthritis (Ibid.).

In 2013, the national arthritis medical care costs and earnings losses totaled $303.5 billion; attributable lost wages amounted to $164 billion (CDC: Cost statistics, 2018). The direct total cost per adult in national arthritis medical amounted to $2,117 (CDC: Cost statistics, 2018). OA is the second most costly hospitalized health conditions among U.S. residents, accounting for $16.5 billion of the combined costs for hospitalizations and $6.2 billion in hospital costs for privately insured patients (CDC: Cost statistics, 2018). Adults with arthritis bring home $4,040 less pay compared to adults without arthritis due to taking days off to recuperate from symptoms (CDC: Cost statistics, 2018).  The State of Georgia estimates it loses over $2.4 billion in direct costs and $1.5 billion in indirect costs treating patients with arthritis conditions (Martyn, Bayakly, & Bagchi, 2013).

Diagnosis and Screening and Prevention

To diagnose arthritis, a doctor will ask about symptoms then perform a physical examination to detect swollen joints or loss of range of motion (Martyn, Bayakly, & Bagchi, 2013). To distinguish the type of arthritis the doctor will order blood tests and X-rays (Ibid.). Doctors’ evaluations may include questions about symptoms, current and past health issues, health habits, and family medical history (Martyn, Bayakly, & Bagchi, 2013). Doctors will conduct a hands-on joint evaluation; depending on the findings, the doctor may order lab or imaging tests (CDC: Arthritis basics, 2018). The primary care doctor may refer the patient to a rheumatologist for a more comprehensive assessment (CDC: Arthritis basics, 2018). If necessary, the rheumatologist may make a referral for an orthopaedist who will determine if surgery is needed (CDC: Arthritis basics, 2018). To date there are no specific screening tests for arthritis (Ibid.). Early diagnosis has been determined to be the best screening method to detect arthritis (Ibid.).  The National Arthritis Action Plan is a public health strategy headed by the CDC and the Arthritis Foundation to combine efforts with other health organization to educate the public about arthritis and self-management goals (Ibid.).

Since there is a lack of data about the sensitivity, specificity, and costs factor of tests used to diagnose arthritis, more specifically rheumatoid arthritis, a five-year study was conducted to compare the following tests: B-cell gene expression, MRI, IL-6 serum level, and genetic assay (Busiman et al., 2016). The results of the study revealed, the B-cell exam was the overall best test when doctors used it as an additional test to confirm early diagnosis and as an overall diagnostic replacement in at-risk patients (Busiman et al., 2016). The following numbers show the B-cell test has better health outcomes, one of the lowest cost values, and high prevention value: B-cell gene expression test sensitivity reads 0.60, specificity reads 0.90, costs on average is $170—which means the test is not that sensitive to false positive results, it’s about 90 percent accurate, and is affordable without insurance (Busiman et al., 2016).  

Nurse practitioner implementation plan and conclusion

Arthritis is the leading cause of disability in the U.S. and Georgia. There are 100 different types of arthritis that affect people of all ages and backgrounds. OA and RA are the most common types of arthritis, and women are affected more than men. After I graduate, I will use my knowledge of arthritis and its management to develop a fall prevention strategy for LTC patients. My program will involve a risk assessment for patients who walk with gaits or who have been noted to have balance difficulties or a history of falling. The assessment will involve muscle evaluation for weakness, an orthostatic hypotension check, a full examination of the feet, and a replacement of inefficient and unsafe footwear. The assessment will evaluate the patient’s ADL capabilities and use of mobility aids. I will also give patients a questionnaire about fears, falling, exercise, medication, and health goals. This information will make a difference in how interventions and treatment plans are executed.

Since arthritis is characterized by pain, stiffness and inflammation in affected joints, nurse practitioners play a pivotal role in both the early detection of arthritis symptoms in at risk patients and the pain management of patients with chronic arthritis. The first action I will take is getting involved in arthritis community programs that educate the general public about non-pharmaceutical pain management methods. Addiction to pain medication has become a national concern, and arthritis patients who become addicted to pain medications will only make their health conditions worse. Next, I will address the physical, psychological and social needs of the patient by asking questions during patient check-ups about each of these areas then by providing resources to help resolve any concerns.  My goal is to improve the patient’s quality of life, so I will focus on a holistic approach to alleviating arthritis symptoms that involves a manageable diet and exercise regimen, participation in a social or spiritual activity, and shared decision making about treatment options.

References

Bayakly, A. R. (2015). Burden of Chronic Disease in Georgia. Retrieved from Georgia Department of Public Health website: https://dph.georgia.gov/sites/dph.georgia.gov/files/Chronic%20Disease%20Burden_Rana_8.13.15.pdf

Buisman, L. R., Luime, J. J., Oppe, M., Hazes, J. M. W., & Rutten-van Mölken, M. P. M. H.

(2016). A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Research & Therapy, 18, 135. http://doi.org/10.1186/s13075-016-1020-3

Centers for Disease Control and Prevention (CDC). (2018, February 21). Arthritis basics. Retrieved from https://www.cdc.gov/arthritis/basics/index.html

Centers for Disease Control and Prevention (CDC). (2018, August 1). Arthritis-related statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm

Centers for Disease Control and Prevention (CDC). (2018, July 18). Arthritis: State statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm

Centers for Disease Control and Prevention (CDC). (2018, July 18). State statistics. Retrieved from https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm

Martyn, A., Bayakly, A. R., & Bagchi, S. (2013). Georgia Arthritis Burden Report. Retrieved from Georgia Department of Public Health (Epidemiology Program) website: https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/Arthritis%20Burden%20Report_2013.pdf

PubMed Health. (2018). Arthritis. Retrieved from NIH – National Institute of Arthritis and Musculoskeletal and Skin Diseases website: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024677/

Tavakoli, N., Akwara, C., & Kish, P. (2018). Considerations in the management of rheumatoid arthritis among older adults in long-term care. Annals of Long Term Care, 26(4), 18-23. Retrieved from DOI: 10.25270/altc.2018.08.00035

Sample Answer 2 for NR 503 Week 6: Evaluation of an Epidemiological Disease or 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=NonVitalIndNo      Grp.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

NR 503 Week 7 Discussion

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