Assigment .Apa seven . All instructions attached.

DALIA SALGADO

5/31/23, 6:48 PM

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Discussion # 4: Dalia salgado

Question 1

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

The rise in tuberculosis (TB) incidences observed between the mid-1980s and 1992 can be ascribed to a convergence of multiple factors. One of the contributing factors to the increased prevalence of tuberculosis is the HIV/AIDS epidemic, which compromises the immune system, rendering individuals more vulnerable to the disease. During this era, there was a notable surge in immigration from nations with elevated tuberculosis (TB) prevalence, which played a role in the escalation of TB incidences in the United States (CDC 2007). Moreover, the state of contentment arising from a consistent decline in tuberculosis cases caused deterioration in the public health infrastructure for tuberculosis control. Additional factors that have contributed to the situation include an escalation in homelessness and drug abuse, resulting in heightened population density and compromised immune systems, as well as an upsurge in cases of multidrug-resistant tuberculosis. The restricted availability of high-quality healthcare services for vulnerable groups may have played a role in the postponement of diagnosis and therapy.

Question 2

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

The table shows that the group aged 45-64-year-old males had the greatest number of cases.

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

This statement is not necessarily true. The numerical values presented in Table 1 solely represent the frequency of occurrences without any additional quantitative information. To obtain an estimate of the risk of developing the disease, it is necessary to calculate an incidence rate by considering the number of individuals in each group.

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.

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The incidence rates of tuberculosis have exhibited a consistent decrease from 2000 to 2007, with a decline from 5.8 per 100,000 to 4.4 per 100,000.

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

The trend in TB incidence rates from 2000 to 2007 is generally downward, indicating a decrease over time. It went from 5.8 cases per 100,000 population in 2000 to 4.4 cases per 100,000 population in 2007. This suggests that there were fewer new cases of TB in the US each year during this period, indicating that TB control measures were likely effective. It also might reflect general improvements in healthcare or living conditions that reduce the transmission of TB. However, a more detailed analysis would be required to accurately identify the cause(s) of this decline.

Question 4

The TB incidence rates (cases per 100,000 population) for 2007 according to the provided data are as follows:

< 5 Males: (245 / 10,652,174) * 100,000 = 2.3

< 5 Females: (221 / 10,652,174) * 100,000 = 2.1

5-14 Males: (143 / 20,428,571) * 100,000 = 0.7

5-14 Females: (170 / 18,888,889) * 100,000 = 0.9

15-24 Males: (915 / 21,785,714) * 100,000 = 4.2

15-24 Females: (666 / 20,812,500) * 100,000 = 3.2

25-44 Males: (2557 / 42,616,667) * 100,000 = 6.0

25-44 Females: (1759 / 41,880,952) * 100,000 = 4.2

45-64 Males: (2747 / 37,121,622) * 100,000 = 7.4

45-64 Females: (1294 / 39,212,121) * 100,000 = 3.3

65+ Males: (1502 / 15,978,723) * 100,000 = 9.4

65+ Females: (1076 / 21,959,184) * 100,000 = 4.9

 

Question 6

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

In general, the incidence rates of tuberculosis have exhibited a consistent downward trend since 1953. During the late 1980s and early 1990s, there was a rise in cases of tuberculosis, which can be attributed to the HIV/AIDS epidemic and a lack of focus on the necessary public health infrastructure for treating the disease. The incidence rates of tuberculosis cases exhibited a decline starting from the year 1993.

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

1.3-1.4/1.4 X 100 = -7.1%

Question 8

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

0.9-1.3 /1.3 X 100= -30.8%

Question 9 

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

A plausible explanation for the phenomenon could be attributed to an artifact, specifically a modification in the categorization of the illness. Indeed, this is the case. The second footnote, which is located at the bottom of the table, indicates that the significant reduction in mortality rate in 1979 can be attributed to the exclusion of tuberculosis-related late effects such as bronchiectasis or fibrosis, as well as pleurisy with effusion without any specified cause, from the tuberculosis death count CDC 2008).

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.

 The prevalence ratio of tuberculosis infection in July is estimated to be 30%, with 30 cases per 100 individuals. This indicates that a proportion of 30% of nursing home residents have been subjected to TB at some stage in their lifetime, with the possibility of some being recent or new infections, while others may be older infections that occurred earlier in their lives.

 

Question #11

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

  The calculated incidence rate of tuberculosis infection over the course of one year is 7%, based on a total of 70 individuals. This is derived from a ratio of 5 cases of TB infection to the total population of 70. Given that all 70 individuals who underwent testing over the course of a year had initially tested negative for tuberculin skin test in the preceding July, it can be inferred that the 5 individuals who tested positive for the skin test in the following year were indicative of recent or new tuberculosis infections.

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 scientific field that focuses on investigating the distribution, patterns, and determinants of health and disease conditions in specific populations. This discipline plays a vital role in informing public health decision-making. The field of public health necessitates a comprehensive grasp of various fundamental concepts, including the "web of causation," which refers to a complex interplay of factors that contribute to the onset of a disease. Additionally, "morbidity," which denotes the prevalence of illness or disease within a population, and "mortality," which pertains to the frequency of death within a population, is essential for gaining insight into the health status of communities and for devising, executing, and assessing interventions aimed at managing and preventing health issues.

References

Galea, S., & Riddle, M. (2019). An argument for consequentialist epidemiology. American Journal of Epidemiology, 188(5), 861-867.

Porta, M. (Ed.) (2014). A Dictionary of Epidemiology. Oxford University Press.

Rothman, K.J., Greenland, S., & Lash, T.L. (2012). Modern Epidemiology. Lippincott Williams & Wilkins.

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