Week 1 Discussion topic: exercise

Week 1 Discussion topic: exercise

Good morning Professor and class,

I have chosen to do excise 1.5 from chapter one. The first question is what are six cancers associated with obesity incidence rates. The six most common cancers associated with obesity within young adults ages 15-35 are: 1.Colorectal: 12% (Cancer, 2020). 2. Thyroid: 12% (Cancer, 2020). 3. Breast: 11% (Cancer, 2020). 4. Prostate: 30% (Bleyer, Spreafico, & Barr 2020). 5.Cervix: 21% (Cancer, 2020). 6. Lymphomas: 22% (Cancer, 2020).

(American Cancer Society, 2020). The rate of obesity within New Jersey for people younger than 18 is 22.8%. The rate for children is pretty close, for African American it is 34.2%, for Hispanic children it is 26.2% and for Caucasians it is 26.1%. (Americans Health Ranking, 2020). The numbers are devastating to look at, over all NJ is 28th in in rank for unhealthiest state in terms of obesity. NJ is stepping up and they have been for a while, they have set up the Obesity prevention program of NJ in place since 2013. This program offers education and resources to families of meal ideas as well as activity plans to get people moving. It has a great deal of data as well, it is filled with statistics about obesity and information of what can happen if people don’t take action. (NJAAP, 2020). NJ obesity rates have decreased from 2017, by about 4.9%, so although I do I think some of the programs are working, however I think much more work needs to be done. The numbers of obesity, and the issues it causes consistently grow, I feel as if more proactive action needs to happen. The only state involvement includes that physical education is a requirement, healthy food financing funding’s, and there are laws preempting local policies related to nutrition, however I don’t believe it is enough, because than our incidence rates would be much lower and we would see a consistent decrease in numbers, which is not the case. (Americans Health Ranking, 2020).

References:

Americans Health Ranking. 2020. NJ Obesity Rates. Retrieved from: https://www.americashealthrankings.org/explore/annual/measure/Obesity/state/NJ (Links to an external site.)

American Cancer Society. (2019, February 4). Obesity-related cancers rising in young adults in the US: Millennials have about double the risk of some cancers compared to Baby Boomers at same age. ScienceDaily.

Bleyer, A., Spreafico, F., & Barr, R. (2020). Prostate cancer in young men: An emerging young adult and older adolescent challenge. Cancer, 126(1), 46-57.

Cancer. 2020. Statistics. Retrieved from: https://www.cancer.org (Links to an external site.)

NJAAP. 2020. Obesity prevention. Retrieved from: https://njaap.org/programs/obesityprevention/

Response to a peer for week 1 :

Good morning Angelic,

Diabetes is a serious health problem affecting many people in America. Although this problem can be manage in simple ways like through diet modification, physical activity and medications, many Americans do not have the appropriate resources, education or information to better manage this serious health problem affecting our communities. Due to the increasing need to educate people on the importance of preventing and managing diabetes, it is important to identify and assess individuals at risk in other to better manage diabetic disease (Tung & Peek, 2015). Connecting with a diabetes support group is usually a good resource to hep identify different outcomes related to diabetes because these groups are often open, no registration needed and are free to welcomes people with pre-diabetes, type 1 or 2 diabetes as well as those with an interest in diabetes education. Also, there is a National Diabetes Prevention Program database created by the CDC in partnership with other individual organizations such as American Diabetes Association (ADA), and the American Medical Association (AMA ) have provided a framework for type 2 diabetes prevention efforts in the U.S. Diabetes outcome that are creating a significant impact to the community are increased risk of serious health complications such as vision loss, heart disease, stroke, kidney failure, and amputation of toes, feet, or legs. Many people in the community who have had amputations due to diabetes either did not know they are diabetic or did not have the proper education and treatment on how to better manage this disease process ( Klonoff, 2015). Many people in the community can monitor their blood glucose level, excises and calories in-take without having to leave their homes. When individuals are keeping personal data about their health, they are motivated to make life style adjustments, adherence to their treatment plans and goals and are excited about receive adequate education on how to manage their health and utilize the emerging power of telemedicine support that is increasingly associated with medical monitors.

References:

Klonoff D. C. (2015). Improved outcomes from diabetes monitoring: the benefits of better adherence, therapy adjustments, patient education, and telemedicine support. Journal of diabetes science and technology, 6(3), 486–490.

Tung, E. L., & Peek, M. E. (2015). Linking community resources in diabetes care: a role for technology?. Current diabetes reports, 15(7), 45.

· Week 2 discussion topic: Describe the diagnostic or screening tool selected, its purpose, and what age group it targets.

Has it been specifically tested in this age group?

Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not?

Good afternoon Professor and class,

Zika virus is a tetrogenic virus that is most commonly passed through the bites of infected mosquitoes. The incidence and prevalence of the zika virus, as a result, is determined by the prevalence of mosquitoes in a given geographical area. The detrimental risk of contracting the disease is highest amongst pregnant individuals and the possible fetal and maternal issues zika could cause. Typically, screening for zika begins at the patient intake assessment at a doctor’s appointment. In an article by DeCocker (2019), “CDC’s top priority for Zika is to protect pregnant women because of the risks associated with ZIKV infection during pregnancy” (p. 292). This article goes on to state that screening must be performed at every prenatal and postpartum visit to educate the patient on risk of exposure and to determine, and be able to act upon, exposures in a timely fashion (p. 293). The patient is typically asked if she has visited a zika infected area or has traveled outside the country within the last ninety days. If exposure has been detected, bloodwork is performed to determine if the patient is carrying the Zika antibody while appropriate counseling is done pre- and post- testing. DeCocker (2019) studied testing for this particular patient population and determined that while studies exist more studies are needed to identify “the limitations of prenatal and postnatal testing for detection of ZIKV-associated birth defects and long-term neurocognitive deficits are needed to improve guiding and counseling for women with a possible infectious exposure” (p. 293). The testing that does exist merely determines the presence of the antibodies in the prenatal and post-natal population. A study by Bingham, Cone, Mock, Heberlein-Larson, Stanek, Blackmoer and Likos (2016), determined the differences in Zika testing utilizing urine, serum, and saliva specimens. The study identified that limited data exists in regard to testing for zika utilizing alternative methods, such as urine and saliva. However, the authors suspect that saliva can be contributed to the passing of the disease (p. 477). The study compared “53 persons with Zika virus disease with urine, saliva, and serum specimens collected on the same date found positive results from testing in 49 (92%) urine specimens, 43 (81%) saliva specimens, and 27 (51%) serum specimens” (p. 477). Because a limited amount of studies has been done, the study concluded in stating that the most indicative way of determining Zika antibodies is through the utilization of serum analysis, but urine may also be a possible screening tool. In my personal practice, if there were a quick-test method to determine positive antibody exposure in urine, such as a dipstick, it would be timelier and less invasive than serum testing. It also maintains a level of truth, if patients are poor historians. In my opinion, testing methods that are least invasive but also provides quick and accurate results is beneficial for all parties involved.

References:

Bingham, A. M., Cone, M., Mock, V., Heberlein-Larson, L., Stanek, D., Blackmore, C., & Likos, A. (2016). Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease – Florida, 2016. MMWR. Morbidity And Mortality Weekly Report, 65(18), 475–478.

DeCocker, K. (2019). Zika Virus and Pregnancy Concerns. Nursing Clinics of North America, 54(2), 285–295.

Week 2 discussion response to a peer:

Good afternoon Ravi,

I enjoyed reading your post. OraQuick Advance is a rapid, point-of-care HIV test that is manufactured by Ora Sure Technologies Inc. It is a rapid test that looks for antibodies to HIV-1 and HIV-2 and is approved by the FDA to be used with oral fluid, fingerstick blood, and whole blood (Orasure Technologies Inc, 2016). IV-1 and HIV-2 are the viruses that cause AIDS. Early diagnosis is key to early intervention and starting antiviral therapy. The package insert does not explicitly state what age group it targets but there includes a statement that “clinical data has not been collected to demonstrate the performance of the OraQuick ADVANCE ® Rapid HIV-1/2 Antibody Test in persons under 12 years of age” (Orasure Technologies, Inc, 2016, p.8). The test is considered valid and reliable based on numerous clinical studies. Guillon et al. (2018) provides details of several trials showing >99% sensitivity and specificity claimed across the various specimens allowed including oral fluid, fingerstick blood and whole blood. In addition, per the package, in a study utilizing 4,999 people, a false positive occurred in 0.01% while a false negative occurred in 8.3%. Only 1.1% of the study subjects received no result. This reflects an expected outcome of 91.7% for test specificity meaning the results will be positive when HIV is present. There is also an expected outcome of 99.99% for test sensitivity meaning the results will be negative when HIV is present. The expectation of one false positive out of every 5,000 tests in uninfected people shows that it truly is sensitive to measure the presence of antibodies to HIV-1 and HIV-2. Martin (2018) details a study involving 252 participants that illustrates a negative predictive value (NPV) and positive predictive value (PDV) of 1.0 and sensitivity and specificity of 100%. Negative predictive value of a test is important as it reflects the probability that the disease is truly absent when the test reflects a negative result (Curley & Vitale, 2016). Positive predictive value of a test is also important because it reflects a positive test result when the disease being tested for is present (Curley & Vitale, 2016). Key to accuracy is quality control (Martin, 2018). If continuing to engage in behavior that would put a person at risk for HIV, repeat testing should be done at a later time. I would strongly consider integrating this test into practice. Early diagnosis of HIV is critical. When asked preference of testing type, 65.8% stated a test preference for oral fluid testing over fingerprick or whole blood testing method (Martin et al., 2018). The most common reason was that oral fluids testing was less painful. Those that chose blood testing felt it was more accurate. The results discussed related to OraQuick ADVANCE for both oral fluid and blood testing provide evidence of similar accuracy and allow a choice to ensure a greater number are getting tested. With three ways to utilize the test, it allows for the possibility of a larger number of people getting tested.

  1. Week 3 discussion topic: What is the fundamental difference between the method you have chosen (either the case-control or cohort method) and the randomized controlled trial?
  2. What are the advantages and disadvantages of the study method you chose (case-control or cohort study)?
  3. What are the characteristics of a correlational study?
  4. Where does the method you chose (case-control or cohort study) fall on the research pyramid? What does where it is on the research pyramid mean?

Good afternoon Professor and class,

The fundamental difference between case-control studies and randomized controlled trial is the selection of the participants. In the case-control, simply put, you have two groups of individuals: one group with a certain outcome (cases), and one group without that certain outcome (controls). In randomized control trials (RCTs) participants are chosen at random to either receive or not receive a treatment/intervention (Curley,2020). Another fundamental difference is the direction of the studies. Case-control studies essentially move backwards in time by choosing an outcome first (Morrow,2010).

A disadvantage of the case-control study is that it uses odds ratio (OR) and this can’t be used as a calculation of risk as with relative risk (RR) in a cohort study. The OR cannot be used to predict whether or not certain exposures or risk factors will turn in to whatever outcome (disease process) is being measured. Also as noted previously, these studies are done by identifying an outcome first and working backwards to find possible correlation with exposure. However, the advantage of this method is that it is a relatively simple calculation which can create the argument of someone being more likely or less likely to have said outcome based on a certain exposure (Curley, 2020).

Herrera et al. (2020) did a case study to assess the association between interatrial block (IAB) with cognitive impairment. A total of 265 subjects with 143 cases and 122 controls showed a higher prevalence of IAB (51% vs 31%), higher prevalence of advanced IAB (19.6% vs 8.2%) with cognitive impairment (Herrera et al., 2020). The case-control study managed to show an independent association between IAB and cognitive impairment. Currently, one of the main treatments of heart failure is the use of ACE inhibitors. Authors of a randomized control trial showed that ACEI, specifically enalapril might be the most effective for patients diagnosed with Heart Failure, however there has also been a 10-20% intolerance observed with patients starting to have a troubling cough after starting the medication (Uribe, 2018).

As per Curley (2020), in correlational studies, “rates are calculated for characteristics that describe populations and are used to compare frequencies between different groups at the same time or the same group at different times.” They essentially do just what the name implies; find a correlation or relationship such as between high red meat consumption and incidence of cancer. Correlational studies don’t link direct exposure but they do open the door for further investigation and more specific targeted studies (Curley, 2020).

Case-control studies are almost on the bottom of the evidence-based research pyramid. The lower on the pyramid a study is, the greater number of studies there are with lower amounts of evidence. Moving up the pyramid represents a lower number of studies with a higher degree of evidence (narrower) (St. John & McNeal, 2017).

References:

Curley, A. L. (2020). Population-based nursing: Concepts and competences for advanced practice (3rd ed.). Springer Publishing Company.

Herrera, C., Bruna, V., Abiznda, P., Diez-Villanueva, P., Formiga, F., Torres, R.,…Martinez-Selles,, M. (2020). Relation of interatrial block to cognitive impairment in patients>70 years of age (from the CAMBIAD case-control study). American Journal of Cardiology, 136, 94-99.

Morrow, B. (2010). An overview of case-control study designs and their advantages and disadvantages. International Journal of Therapy & Rehabilitation, 17(11), 570-574.

St. John, K., & McNeal, K. S. (2017). The strength of evidence pyramid: One approach for charaterizing the strength of evidence of geoscience education research (GER) community claims. Journal of Geoscience Education, 65(4), 363- 372. https://files.eric.ed.gov/fulltext/EJ1161347.pdf (Links to an external site.)

Herrera, C., Bruna, V., Abiznda, P., Diez-Villanueva, P., Formiga, F., Torres, R.,…Martinez-Selles,, M. (2020). Relation of interatrial block to cognitive impairment in patients>70 years of age (from the CAMBIAD case-control study). American Journal of Cardiology, 136, 94-99.

Uribe, L. M. (2018). Heart failure: Treatment with ACE inhibitors. CINAHL Nursing Guide, , .

Week 7 discussion topic: 1. Locate a lay press article from a national newspaper, for example, from The New York Times, The Washington Post, or other national publication. The article should be no more than three (3) years old.

Locate an article on one of the following topics:

A. Sex trafficking

B. Environmental global health issue: For example, but not limited to: Safe water, sanitation, disasters, or oral health.

  1. Read over your chosen article and respond to the following:

· Provide a summary of your article. Include the name of the newspaper and author, as well as date of publication.

· Include data that supports the significance of the topic. For example, related deaths, health care costs, demographic information.

· During NR503, we have discussed the determinants of health, at-risk groups, social justice theory, outcomes, inter-professional collaboration, advocacy, and other concepts related to epidemiology and population health. How do the concepts addressed in NR503 relate to your article’s topic? Provide definitions and examples in your writing.

· Integrate information from the World Health Organization and the SDG’s.

Good evening Professor and class,

In the article reviewed that was published by USA Today in April of 2021, a middle-aged woman, who runs a bar in Texas, has been accused of selling the time and sexual acts of their waitresses to their clients (Aspegren, 2021). This has been going on for approximately ten years in which customers could pay $70 to receive 15 minutes with a waitress (Aspegren, 2021). The owner’s two sons and a nephew acted as “enforcers” who would ensure the waitresses remained compliant with these acts and would not call the authorities (Aspegren, 2021). The victims included adults, one minor, and a victim who was flown into Texas from Puerto Rico specifically to perform these sex acts (Aspegren, 2021). The woman, her two sons and nephew are all under arrest and face jail time and fines (Aspegren, 2021).

Sex trafficking is a global problem, with 4.8 million people being victims of forced sexual exploitation in 2016, 99% of which were female (International Labour Organization & Walk Free Foundation, 2017). In 2018, the United States reported an increase in human trafficking cases, the top three origin countries are the US, Mexico and the Philippines, finding that the most vulnerable populations were most commonly trafficked, including children in welfare and juvenile justice systems, foster care, runaways, homeless, and unaccompanied foreign children (U.S. Department of State, 2020). Traffickers have used the ease of access and reach of the internet to start recruiting victims online using a “hunting” and “fishing” techniques where the traffickers either actively approach the victim in an online space (hunting) or wait for the victims to respond to ads that (fishing) (United Nations Office on Drugs and Crime, 2021). The internet has become a very effective way for traffickers to recruit at-risk persons because it can be anonymous, easy to use and access, and it is far-reaching.

The populations most at-risk for being trafficked include populations who face health disparities, which is “confounding variables that result in subpar health communication” (Chamberlain University, n.d.). According to the World Health Organization (WHO), 73% of countries have national plans of action regarding violence against women and 79% of countries globally have a national guideline or protocol that address health care system responses to violence against women (World Health Organization, 2020). Within these countries, it’s reported that only 66% of them have training programs for healthcare providers that educates them on the appropriate responses and treatments for violence against women (World Health Organization, 2020). As Nurse Practitioners (NP), screening patients for trafficking should be a priority, especially in these at-risk groups, which is a subgroup or population that share high risk factors like health conditions or health factors (Curley, 2020).

These victims fall under both of these definitions and by working closely with advocacy centers and other healthcare professionals, a screening tool can be used to identify these victims and report the occurrence to the appropriate law enforcement agencies (Moore et al., 2017). This will then lead to appropriate services and follow up care such as mental health care, ongoing medical care for STIs and safety planning (Moore et al., 2017). Awareness and education are the most important first-step for healthcare providers to make to help eradicate sex trafficking, which is becoming a more prominent issue within the US. References:

Aspegren, E. (2021, April 1,). Family charged for coordinating sex trafficking operation at Houston bar for more than a decade, US attorneys say. Usa Todayhttps://www.usatoday.com/story/news/nation/2021/04/01/houstonfamily- sex-trafficking-operation-bar-puerto-allegre/4845328001

Chamberlain University. (n.d.). NR503-60510: Population health epidemiology and statistical principles. https://chamberlain.instructure.com/courses/76835/pages/week-5- lesson-culture-and-socioeconomic-status?module_item_id=11213712. https://chamberlain.instructure.com/courses/76835/pages/week-5-lessonculture- and-socioeconomic-status?module_item_id=11213712

Curley, A. (2020). Population-based nursing : Concepts and competencies for advanced practice (3rd ed.). Springer Publishing Company. International Labour Organization, & Walk Free Foundation. (2017). Global estimates of modern slavery forced labour and forced marriage

Moore, J. L., Kaplan, D. M., & Barron, C. E. (2017). Sex trafficking of minors. Pediatric Clinics of North America, 64(2), 413-421. https://doiorg. chamberlainuniversity.idm.oclc.org/10.1016/j.pcl.2016.11.013

U.S. Department of State. (2020). 2019 trafficking in persons report: United states. (). https://www.state.gov/reports/2019-trafficking-in-persons-report- 2/united-states

United Nations Office on Drugs and Crime. (2021). Global report on trafficking in persons 2020. United Nations Publication, https://www.unodc.org/documents/data-and analysis/ tip/2021/GLOTiP_2020_15jan_web.pdf