Assigment .Apa seven . All instructions attached.

Anisley Longa

Question 1

What factors might have contributed to the increase in TB cases from the mid-1980s to 1992?

1.       Increased immigration in the USA – there was a noticeable rise in the increase in number of immigrants moving in, especially from TB-infested countries. This is believed to have increased the chances of having the TB disease.

2.      HIV and AIDS – with a rise this particular epidemic being on the surge at the time it is believed to have led to the increase of TB cases. HIV is known to weaken one’s immune system. Therefore, the infected people were more susceptible to tuberculosis. A co-infection of the two was considered fatal.

3.      Drug resistance – the emergence of drug-resistant TB strands played a major role too in this rise in the cases of TB at this time.

Decline in TB-funded programs- prior to the mid-1980s the USA had been successful in its TB campaign. This led to a decrease in the funding for these programs and hence a resurgence of the disease

Question 2

A. In 2007, which group had the greatest number of TB cases? 

Answer: 45-64 Males

B. Does this mean that males 44-65 years of age are at greatest risk for developing TB?

Answer: No. There are many factors that influence the number of cases in a particular group like age, access to healthcare services, and population sizes not to mention population size. 

Estimating the Risk of Developing TB Disease

 

The number of TB cases per 100,000 population, called the TB case rate, is determined by

the following equation: 

 

       number of new TB cases that occur during a specified time period x 100,000 the population at risk  

Also called cumulative incidence or an incidence rate, this formula provides an estimate of the risk for developing a disease. The population at-risk information for the United States, which is needed to calculate the TB incidence (or case) rate, is collected by the US Census. Information on the US population by year can be found on the United States Census Bureau’s American Factfinder website (http://factfinder.census.gov/home/saff/main.html?_lang=en).  

Question 3

A.   Estimated population values and the number of new TB cases reported to the CDC appear in Table 2 below. Use this data to calculate the TB (incidence rates) case rates for the years 2000 to 2007.

B. Describe the trend in TB incidence rates over time.

The incidence rate values varied between the groups. The variation is not constant because the groups have different population numbers so there is typically no way to note a trend or pattern of the sort. However, the incidence rate appears to be higher in the male gender as opposed to that of the females.

Year       New Cases   US Population Estimates          Case rate per 100,000 (incidence rate)

2000     16309                    281,189,655                                                                      5.8

2001       15946                    284,750,000                                                                      5.6

2002    15056                    289,538,462                                                                      5.2

2003    14837                   290,921,569                                                                        5.1

2004     14501                    295,938,776                                                                      4.9

2005    14065                   293,020,833                                                                       4.8

2006      13754                     299,000,000                                                                      4.6

2007    13299                     302,250,000                                                                      4.4

Question 5

A. Which group has the highest incidence rate of TB in 2007?  

Males 65 years old and older

B. Why do you think this age group has the highest TB case (incidence) rate of TB?  

Age-related susceptibility plays a major role in this as a person’s immune system weakens with an increase in age at old age. Moreover, males are seen to be more susceptible to TB disease as they have a higher incidence rate than women.

C. Is your answer for question 5a different from your answer for question 2a? If so, justify

why your answer is different? 

Yes. In 5(a), age-related susceptibility plays a major role in this as a person’s immune system weakens with an increase in age at old age yet in 2(a) the children strengthen their immunity as they grow older, unlike the case of the males of 65 years old and older. 

Question 6

Describe the change in TB case (incidence) rates presented in Table 4 below.

There is a significant yet gradual decrease in the incidence rate from 1953 onwards. This is probably due to the medical advancements against the disease. However gradual the decrease, there were times when the rate would increase slightly but then decrease a year later.

 

 

 

 

 

Question 7 (the question is in the graph below make sure to answer it)

Table 4 includes the cause-specific death rates associated with TB.  

Definition:   number of deaths associated with TB each year  x 100,000  Mid-period population

 

Answer; TB mortality rate decreased by approximately 7.14% between 1977 and 1978.

 

Question 8

What is the TB death rate percent change between 1978 and 1979?

 

TB death rate decreased by approximately 30.77% between 1978 and 1979.

 

 

 Question 9 

What are the possible reasons there was such a large difference between the rates for these

years?

Answer:

                    I.           Change in risk factors- TB-associated factors like improved housing, improved health care systems and reduced exposure to infected persons reduced as time went by.

                  II.           Improved health care – health care systems improved drastically as depicted by the decrease in mortality rates at the time.

                III.           Health interventions- intensified efforts such as an increase in health awareness of TB and the campaigns on the control and prevention of the disease became rampant and thus the drop in mortality rate.

 

TB Morbidity (Incidence Rates vs. Prevalence Ratios)

Tuberculosis is a disease where people can become infected and remain infected without symptoms for many years. TB infection (without active disease) is called latent TB infection. The identification and treatment of people with latent TB infection is an important goal of TB control because successful treatment of TB infection will prevent the progression from infection to active disease. TB infection can be detected using a skin test and more recently.

through a blood test.  

 

An epidemiologic measure that can be used to measure the proportion of a population with a specific infection or disease is called the prevalence ratio. For example, conducting tuberculin skin testing in a homeless shelter would provide a measure of the proportion of residents who have been infected with TB. This would include both old and new infections.

 

The following formula can be used to determine the prevalence ratio: 

number of new and old TB infections during a specified time period x 100,000 total (usually mid-period population) during the same time period 

 

Note: incidence rates and prevalence ratios may be expressed per 100 or per 1,000. They are commonly presented per 100,000.

 

Question 10 

Suppose that a county TB controller would like to know how many people currently living in a local nursing home are infected with TB. After receiving the appropriate approval and consent from the nursing home residents and administration, she has a trained nurse administer and read the results of tuberculin skin tests. Of the 100 nursing home residents who were tested, 30 had positive tuberculin skin test results during July of that year. 

What is the prevalence ratio of TB infection in this nursing home during the month of July?

Provide your answer per 100.

Prevalence Ratio = (Number of Positive Test Results / Total Number of Tested Individuals) * 100

Prevalence Ratio = (30 / 100) * 100

Prevalence Ratio = 30%

 

Question #11

Nurses conduct continuous assessments. Compare and contrast the tools used to assess families and communities. 

A.       Family Health History

 Nurses collect details about the medical history of the family, including any genetic conditions or diseases. This assists with recognizing possible dangers and guiding preventive operations. These include:

                    I.           Genogram: it is a tool used to determine the structure and relationships of a family’s hierarchy. It focuses on relationships within families, genetic traits, and illness patterns.

                  II.           Family Assessment: to measure the family functionality and coping strategies such as the Calgary Family Assessment Model.

B.      Community Evaluation

                                I.           Surveys are utilized for gathering data on various aspects related to community health, like demographics, socioeconomic factors, health habits, and healthcare access. These surveys aid in the identification of community needs, strengths, and areas for development.

                              II.           Asset mapping community: this consists of identifying and recording community resources like welfare services and support networks. This evaluation helps in the recognition of existing strengths and resources that may boost community health.

                            III.           Community Health Assessments: Community health assessments are comprehensive tests of the community's well-being that entail investigating data on demographics, epidemiology, indicators of health, and environmental factors. These assessments assist establish targeted treatments and health-promoting programs.

 

 

Question #12

You have been asked to describe the science of epidemiology to a new group of nursing students. Covering the web of causation, morbidity, and mortality, how would you explain this to the students?

Epidemiology is a branch of public health that looks into the patterns, causes, and illnesses in communities. It is important to identify the factors that contribute to the development and spread of illnesses as well as create preventive and control measures. When teaching nursing students about epidemiology, I would emphasize three key concepts: the chain of causality, morbidity, and mortality.

As stated by Krieger, N. (1994), the web of Causation is a model used in epidemiology to figure out how various factors interact and contribute to disease development. It states that diseases are impacted by various factors such as social and behavioral aspects, and biological and environmental factors. They may trigger the cause or course of the disease. Understanding the hierarchy of connections aids epidemiologists in identifying risk factors and focusing on preventive actions.

Morbidity is the presence of an illness in a community. In accordance with Murray, C. J., & Chen, L. C. (1992), it depends on the number of people affected by the defect and the impact it has on their health. Morbidity rates are studied by epidemiologists to better understand the distribution and effect of the illness on a particular community.

Mortality is the rate of death in a population. Epidemiologists look into mortality rates to approximate the impact of the illness on the general health and well-being of the community. They may detect trends and causes of death by looking into the mortality rates and eventually lead to improvement of the health services.

 

REFERENCES

 

Ganguli, M. (2009). Depression, cognitive impairment and dementia: Why should clinicians care about the web of causation?. Indian journal of psychiatry, 51(Suppl1), S29.

Krieger, N. (1994)Epidemiology and the web of causation: has anyone seen the spider?. Social science & medicine, 39(7), 887-903.

Murray, C. J., & Chen, L. C. (1992). Understanding morbidity change. The Population and Development Review, 481-503.

Ghoncheh, M., Pournamdar, Z., & Salehiniya, H. (2016). Incidence and mortality and epidemiology of breast cancer in the world. Asian Pacific journal of cancer prevention, 17(S3), 43-46.