Tag Archives: Evidence-based policies

“In our fight against cancer—we must be unwilling to postpone—for the loved ones we’ve lost and the ones we can save.”

A Promise to a Dying Brother

When I was inducted into the Honor Society in winter 2013, I thought that being on top of my batch will be enough to get me through my journey as a Public Health Ph.D. candidate. Recruiting a dissertation chair is the most challenging so far, especially getting a response from them. What if I do not get a dissertation chair who will be a good match with my dissertation topic? Can I submit my premise and finish my dissertation to another university? A night before my youngest brother passed away; I was on the phone with him. He told me that he is too tired, and I responded that it is okay to let go. He asked me to promise him to go back to school and take on a graduate degree to make a difference. “Promise me that at some point to be involved in a research project that could make a difference to individuals diagnosed with pancreatic cancer.” He passed away in 2007, a few weeks before his 40th birthday, and three months before his only daughter’s first birthday.

Focusing on the impact of cigarette smoking as a factor that promotes pancreatic cancer rather than initiates it will amplify the importance of behavioral change, and enhance the quality of life. The outcome of pancreatic cancer remains dismal, even with treatment combinations of surgery, radiotherapy and chemotherapy with an estimated annual economic burden of $4.9 billion annually (Pandol, Apte, Wilson, Gukovskaya, and Edderkaoui, 2012). Advances in patient management and understanding the biology of pancreatic cancer has taken substantial progress over the years. Herman, Schulick, Hruban and Goggins (2011) found that screening first-degree relatives of individuals with family members affected by pancreatic cancer can identify non-invasive precursors of the disease. In this 2011 study shows the gradual rise in the incidence and number of deaths caused by pancreatic tumors, even with the decline in incidence and mortality of other common cancers. Furthermore, Vincent et al. found that despite developments in detection and management of pancreatic cancer, only about 4% of patients will live five years after diagnosis. Moreover, Vincent et al. (2011) found that present surgical resectioning offers the only chance of cure and improve the survival rate for those with malignant disease localized to the pancreas. Statistical analysis in 2012 study shows 80–85% of patients with advanced unresectable disease responds poorly to most chemotherapeutic agents. Therefore, it is warranted to have continued understanding of the biological mechanisms contributory to the development and progression of pancreatic tumors. On the other hand, Klein et al. (2004) emphasized the significance of quantification of the risk of individuals with a family history of pancreatic cancer as a rational basis for cancer risk screening and counseling. In a prospective registry-based approach of this 2004 study, the risk of these individuals showed an increased risk of developing the disease. Klein et al. (2004) performed standardized incidence ratios and compared the number of incident pancreatic cancers observed with those expected using Surveillance, Epidemiology and End Results (SEER) rates. It was quantified in this registry-based study the pancreatic cancer risk in kindreds with a family member who was diagnosed with the disease, supporting the hypothesis of increased risk in association with family history. While Blackford et al. (2009) failed to identify the signature tobacco-related mutation in cigarette smokers that could have strong implication to the development of pancreatic cancer; this 2009 study found the nonspecific DNA damage caused by tobacco carcinogens. Furthermore, the combined causality of non-tobacco-related mutagenic risk factors such as inherited predisposition to cancer may share mutagenic properties with the tobacco mutagens active in pancreatic tissues (Ding et al., 2008; Prokopczyk et al., 2002). The types and patterns of these mutations provide insight into the mechanisms by which cigarette smoking causes pancreatic cancer (Blackford et al., 2009). Porta et al. (2009) and Blackford et al. (2009) suggested that smoking enhances the risk for pancreatic cancer through mechanisms other than genetic mutation. The development of pancreatic cancer may have a non-significant association to pipe smoking and smokeless tobacco use, but in a large collaborative pooled analysis of non-cigarette tobacco use in 11 studies within the International Pancreatic Cancer Case-Control Consortium (PanC4) found that cigar smoking is associated with an excess risk of the disease (Bertuccio et al., 2011). Cigarette smoking was found to be an established risk factors— both exposure to environmental tobacco smoke (ETS), and active cigarette smoking (Vrieling et al., 2010). Over 40,000 individuals are diagnosed with pancreatic cancer, and less than 5% of patients diagnosed has a survival rate of five years. The component of the smoke of cigarettes that produced in the body as a metabolite of nicotine and the most abundant carcinogens in tobacco smoke is 4-(methyl nitrosamine)-1-(3-pyridyl)-1-butanone (NNK). Vary widely in nicotine content and carcinogenic nicotine metabolites, cigarettes, cigars, and other tobacco products—nicotine reaches the lungs and is quickly absorbed into the bloodstream during smoking. A cigar containing as many as 20 grams of tobacco can have nicotine between 5.9 and 335.2 mg per gram of tobacco (Henningfield, Fant, Radzius, & Frost, 1999). Prokopczyk et al. (2002) noted that the nicotine levels in pancreatic juice in smokers is seven times higher than non-smokers. Blackford et al. (2009) concluded that smokers diagnosed with pancreatic carcinomas harbors more mutations than the non-smoker, therefore, doubles the risk, accounting for 20 to 25% of pancreatic cancers.

Pandol et al. (2012) stated that the pro-carcinogenic effects of smoking on the pancreas are inadequately studied, confirming that tobacco smoking is the strongest avoidable risk and the major environmental factor for pancreatic cancer. Pandol et al. provided valuable insights into the pathogenesis of pancreatic cancer, particularly in the initiation and progression of the disease. Determining the mechanisms underlying the effect of smoking compounds on fibrosis and inflammation will improve our limited knowledge of pancreatic biology. Pancreatic cancer can be classified as genetic, environmental, or both; as well as a disease caused by inherited DNA mutation or mutation by chance. While advances in Genomics gives the promise to early pancreatic cancer detection through better understanding of pancreatic biology, it is paramount to embrace the significance of lifestyle habits that can be modified to evidence-based healthier concepts that translates to reduced cancer risk. Applying lessons learned from the outcome of my proposed study, and existing body of knowledge will prevent the emergence of pancreatic cancer, reduce cancer risk and advance population health. Early behavioral change and interventions will improve the survival rate and quality of life during the time course of pancreatic cancer progression.

References

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Bertuccio, P., La Vecchia, C., Silverman, D. T., Petersen, G. M., Bracci, P. M., Negri, E., … & Boffetta, P. (2011). Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4). Annals of Oncology, mdq613.

Blackford, A., Parmigiani, G., Kensler, T. W., Wolfgang, C., Jones, S., Zhang, X., … & Hruban, R. H. (2009). Genetic mutations associated with cigarette smoking in pancreatic cancer. Cancer research69(8), 3681-3688.

Bosetti, C., Lucenteforte, E., Silverman, D. T., Petersen, G., Bracci, P. M., Ji, B. T., … & La Vecchia, C. (2012). Cigarette smoking and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (Panc4). Annals of oncology23(7), 1880-1888.

Bouvier, A. M., David, M., Jooste, V., Chauvenet, M., Lepage, C., & Faivre, J. (2010). Rising incidence of pancreatic cancer in France. Pancreas39(8), 1243-1246.

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Colditz, G. A., Wolin, K. Y., & Gehlert, S. (2012). Applying what we know to accelerate cancer prevention. Science translational medicine4(127), 127rv4-127rv4.

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Edderkaoui, M., Park, C., Lee, I., Nitsche, C., Gerloff, A., Grippo, P. J., … & Gukovskaya, A. S. (2011, November). Novel model of pancreatic neoplastic lesions induced by smoking compound NNK. In Pancreas (Vol. 40, No. 8, pp. 1321-1321). 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA: LIPPINCOTT WILLIAMS & WILKINS.

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Gould, G. S., Watt, K., Cadet-James, Y., & Clough, A. R. (2015). Using the risk behaviour diagnosis scale to understand Australian Aboriginal smoking—a cross-sectional validation survey in regional New South Wales. Preventive Medicine Reports2, 4-9.

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Henningfield, J. E., Fant, R. V., Radzius, A., & Frost, S. (1999). Nicotine concentration, smoke pH and whole tobacco aqueous pH of some cigar brands and types popular in the United States. Nicotine & Tobacco Research1(2), 163-168.

Hoffmann, D., Hoffmann, I., & El-Bayoumy, K. (2001). The less harmful cigarette: a controversial issue. A tribute to Ernst L. Wynder. Chemical research in toxicology14(7), 767-790.

Hruban, R. H., Iacobuzio-Donahue, C., Wilentz, R. E., Goggins, M., & Kern, S. E. (2000). Molecular pathology of pancreatic cancer. Cancer journal (Sudbury, Mass.)7(4), 251-258.

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Labilles, U. (2015). Reevaluating the Impact of Cigarette Smoking on Pancreatic Cancer (Unpublished, Advanced Quantitative Reasoning and Analysis (RSCH – 8250H – 3), 2015 Summer Qtr. Wk11Assgn3LabillesU) Walden University, Minneapolis.

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Lowenfels, A. B., & Maisonneuve, P. (2003). Environmental factors and risk of pancreatic cancer. Pancreatology3(1), 1-8.

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Pandol, S. J., Apte, M. V., Wilson, J. S., Gukovskaya, A. S., & Edderkaoui, M. (2012). The burning question: why is smoking a risk factor for pancreatic cancer? Pancreatology12(4), 344-349.

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Dallas’ Renaissance Plan: A Response to the Second Wave of Environmental Justice

Dallas is the seventh largest city in the United States with a population exceeding 1.1 million citizens in the year 2000. Dallas is the fourth largest park system in the United States. The second wave of the environmental justice movement is a concept concerned with urban design, public health, and availability of outdoor physical activities. The upgrade to the 21,526 acres of parkland will amplify the quality of and access to outdoor recreation. The Dallas Park and Recreation Department’s “Renaissance Plan” is a response to  the increased demand of the citizens for new and expanded park facilities, recreation programs, open space areas, and unique recreational amenities. Physical activity is one of the health indicators for Healthy People 2010, and responding to these demands is a step forward of meeting its goals.  Dallas’ wide spectrum of park facilities will provide physical activities that will have positive health outcome to Dallas residents including the low-income population of the Dallas County and contiguous counties. Recognition of environmental exposure affecting economically and politically disadvantaged members of the community gave birth to the first wave of environmental justice movement. In addition to health problems related to environmental exposures, environmental justice (EJ) also cover disparities in physical activity, dietary habits, and obesity among different populations. Disparities on the access of public facilities and resources for physical activity (PA) is an EJ issue that has a negative impact on health among low-income and racial/ethnic minorities (Labilles, 2013). The 2007 cross-sectional study of Taylor et al. suggest an association between disproportionate low access to parks and recreation services (PRS) and other activity-friendly environments in low-income and racial/ethnic minority communities.  The prevalence of lower levels of PA and higher rates of obesity was observed in the minority population, which is a direct outcome of the prevalence of lower levels of PA. These differences violate the fair treatment principle necessary for environmental justice.

The treatment of health conditions associated with physical inactivity such as obesity poses an economic cost of at least $117 billion each year. Physical inactivity contributes to many physical and mental health problems.  The reported 200,000-deaths per year in the US is attributed to physical inactivity, and data from surveillance system indicate that people from some racial/ethnic minority groups experience disproportionately higher rates of chronic diseases associated with physical inactivity. Taylor, Poston, Jones & Kraft (2006) findings, provided preliminary evidence for the hypothesis that socioeconomic status disparities in overweight and obesity are related to differences in environmental characteristics. However, most of the studies had encountered epidemiologic “black box” problem, making it impossible to determine which characteristics of the environment (e.g., density of food service outlets or physical activity resources) may be most important (Labilles, 2013). Ellaway et al. found that body-mass index (BMI), waist circumference, and prevalence of obesity, and greater obesity risk is associated with low area or neighborhood socio-economic status.

References

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Ellaway A, Anderson A, Macintyre S. Does area of residence affect body size and shape? Int J Obes Relat Metab Disord. 1997; 21:304-308.

Labilles, U. (2013). Environment Matters: The Disproportionate Burden of Environmental Challenges. PUBH 8115-1 Environmental Health Spring Qtr. Minneapolis: Walden University.

Taylor, W., Floyd, M., Whitt-Glover, M. & Brooks, J. (2007).  Environmental Justice: A Framework for Collaboration between the Public Health and Parks and Recreation Fields to Study Disparities in Physical Activity. Journal of Physical Activity & Health, 4, supp 1, s50-s63.

US Dept of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

US Dept of Health and Human Services. Healthy People 2010: With understanding and improving health and objectives for improving health (2nd ed). Washington: US Govt Printing Office; 2000.

Wolf AM, Manson JE, Colditz GA. The economic impact of overweight, obesity, and weight loss. In: Eckel R, ed. Obesity Mechanisms and Clinical Management. Philadelphia: Lippincott, Williams, & Wilkins; 2002.

 

 

A Summer Phenomenon

For 26 days in 2011, every place in Texas showed higher concentrations of lung-damaging ozone than allowed by federal air-quality standards, especially in Dallas. The federal standard set in 2008 is 75 parts per billion. The spike in ozone which is particularly a summer phenomenon is exacerbated by trucks carrying drilling materials that emit nitrogen oxides, and natural gas escaping from pipelines or storage tanks that emit volatile organic compounds, or VOCs. Known ozone “precursors” such as nitrogen oxides and VOCs can react with each other to form ozone when aided by sunlight. The most difficult environmental issue North Central Texas face today is air quality. Dallas Forth Worth (DFW) region meets the standard for five of six criteria air pollutants defined by the EPA. The six pollutants are carbon monoxide, lead, nitrogen dioxides, ozone, particulate matter, and sulfur dioxide. The only air pollutant for which DFW do not meet the National Ambient Air Quality Standard is the ozone. In hot summers, combination of nitrogen dioxides and VOCs and concentrations of traffic and industry, Dallas is an ideal incubator for the creation of ground-level ozone.

Discussion

Under the Clean Air Act, ozone pollution has long been regulated because of its tremendous hazards to the public. Under the Clean Air Act, ozone poses tremendous hazards to the public health and the environment. High ozone levels lead to respiratory distress and disorders; decreased lung function; increases in the emergency room visits and sick days. To address the serious problem of ozone, the Clean Air Act provides a multi-step process for ensuring that all areas of the country achieve acceptable ozone levels. EPA establish nationwide air quality standards for ozone (called National Ambient Air Quality Standards), which are required to be strong enough to protect public health with an adequate margin of safety. The next step, EPA designate areas of the country that meet the standards, and those who do not. The last step, requiring states to submit plans for achieving and maintaining compliance with EPA’s ozone standards — with especially strict requirements for areas that currently do not meet the standards. The U.S. Environmental Protection Agency (EPA) updated its ozone air quality standards in March 2008. The EPA towards the end of 2012 promised the DFW residents for stronger protections against the harmful public health and environmental impacts of ground-level ozone. The agency announced on January 7, 2012 about its determination that Wise County, Texas contributes to high ozone levels in nearby Dallas-Fort Worth. This action required polluters in Wise County  to do their fair share to reduce ozone levels in Dallas-Fort Worth. Wise County was included in the DFW ozone designation due in large part to the emissions of nitrogen oxides, and volatile organic compounds from a recent boom in oil and gas production in the area. According to the Technical Support Document (TSD), the final area designations in the Dallas-Fort Worth (DFW) area for the 2008 ozone national ambient air quality standards are based on several factors and indicators. The population density and degree of urbanization were analyzed. TSD stated: EPA evaluated the population and vehicle use characteristics and trends of the area as indicators of the probable location and magnitude of non-point source emissions. These include ozone precursor emissions from on-road and off-road vehicles and engines, consumer products, residential fuel combustion, and consumer services. Areas of dense population or commercial development are an indicator of area source and mobile source NO2 and VOC emissions that may contribute to ozone formation that contributes to nonattainment in the area. Rapid growth in population or vehicle miles traveled (VMT) in a county on the urban perimeter signifies increasing integration with the core urban area and indicates that it may be appropriate to include such perimeter area(s) as part of the nonattainment area.

Conclusion

It is very important to recognize the effect of ozone to a population, especially adults and children who are already had chronic respiratory diseases such as asthma. Exposure may compromise the ability of the body to fight respiratory infections. Bell et al. (2004) a multisite time-series study of 95 large US urban communities throughout a 14-year period  found that widespread pollutant such as ozone adversely affects public health.

References

Area Designations for the 2008 Ozone National Ambient Air … (n.d.). Retrieved from http://www.epa.gov/airquality/ozonepollution/designations/2008standards/documents/R6_DFW_TSD_Final.pdf

Bell, M., McDermott, A., Zeger, S., Samet, J. & Dominici, F. (2004). Ozone and Short-term Mortality in 95 US Urban Communities, 1987-2000. JAMA;292(19):2372-2378. doi:10.1001/jama.292.19.2372.

Dallas Fort-Worth Breathes Easier Following EPA’s Decision … (n.d.). Retrieved from http://blogs.edf.org/energyexchange/2013/01/16/dallas-fort-worth-breathes-easier-following-epas-decision-on-wise-county-ozone-petitions/

Green Dallas…building a greener city! (n.d.). Retrieved from http://www.greendallas.net/air_quality.html

Labilles, U. (2013). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished,  PUBH-8115-1/HUMN-8115-1-Soc Behave Cultural Fact in Public Health. 2013 Spring Qtr. WK7Disc) Walden University, Minneapolis.

 

 

 

 

A Challenge to Public Health Surveillance Interoperability and Clinical Research

The obstacles that impact interoperability of the disease surveillance systems starts with the issue of balance between the public interest in the collection of information and the privacy rights. In theory, properly utilized, surveillance is a fundamental government activity, indispensable in nature (Gostin & Gostin, 2000). The legal complications brought about by the Fourth Amendment prohibition against unreasonable searches and seizures, triggered the social impetus behind HIPAA and the HHS Report. The Fourth Amendment is a constitutional protection against wrongful enforcement of the law on access to private medical records. These offers insight into the growth and development of non-Fourth Amendment protections for medical records privacy, and examines later actions that appear to restrict or undercut these potential medical record protections. The shared goals of both public health surveillance and the protection of health information privacy will encourage individuals to fully utilize health services and cooperate with health agencies. The key to protecting the well-being of the community is the optimum balance between public health activities and privacy protection. This balance is challenged by the enactment and enforcement of current legislation such as the Health Insurance Portability and Accountability Act’s Privacy (HIPAA). The way public health exception of HIPAA Rule was drafted resulted to confusion and put this balance in jeopardy, as well as recognized reluctance to provide information to state and local public health agencies. Wilson (2009) stated that the exception ambiguously defines the role of public health authorities in maintaining the privacy of personally identifiable health information. Incertitude about privacy can be equipoised by initiatives by state and federal policy makers such as the report “Confidentiality of Individually-Identifiable Health Information” issued by the Department of Health and Human Services (HHS).  This report reflected a legitimate interpretation and representation of the best aspects of constitutional and judicial protections of medical records privacy using current innovative technology in health information and communication.

State, local, and tribal public health authorities shares the privacy challenges that are inherent in data sharing. Wilson (2009) stated that, in the process of promulgating the Privacy Rule, HHS recognized the need to inscribe an exception for public health purposes in order to allow authorities at all levels of government to continue to collect, analyze, and use health information that would otherwise be unavailable without prior patient consent. State courts and policy makers have produced some protection for individuals’ medical histories which are characterized more by their diversity and conflicting standards than by the quality of protection. Unfortunately, state laws offer little additional support for medical records protection from law enforcement intrusion, thereby it is paramount for continued collaboration between public health professionals, health leaders and policy makers to focus on needed amendments to protect the interest of both the public, patients and researchers which will then bridge the divide on the interpretation of the law. It is critical to acknowledge that challenge of law- and policy-makers in finding common ground between individual privacy expectations and the communal health authorities’ needs for identifiable health data. The dissemination and use of identifiable health data for public health purposes are typically supported by the public, but it relies on how the government and other entities maintain appropriate privacy and security protections in acquiring the data. It is warranted for the continued improvement on the level of protection afforded to the public and patients by state laws governing medical records privacy. Moral justifications should be considered in establishing firm, consistent set of rules governing law enforcement’s use and exchange of private medical records and data needed in clinical research. The obstacles that forestall data-sharing practices should be assessed and remedied within each jurisdiction. Legal interpretations should be openly discussed to properly develop and implement model policy to strengthen disease surveillance, and increase the efficiency of data-sharing practices between researchers and public health authorities at all levels.

References

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Bernstein, A. B., & Sweeney, M. H. (2012). Public health surveillance data: legal, policy, ethical, regulatory, and practical issues. MMWR Surveill Summ, 30-4.

Carroll, L. N., Au, A. P., Detwiler, L. T., Fu, T. C., Painter, I. S., & Abernethy, N. F. (2014). Visualization and analytics tools for infectious disease epidemiology: A systematic review. Journal of biomedical informatics.

Chan, M., Kazatchkine, M., Lob-Levyt, J., Obaid, T., Schweizer, J., Sidibe, M., … & Yamada, T. (2010). Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med7(1), e1000223.

Chowdhary, S., & Srivastava, A. (2013). Cloud Computing: A Key to Effective & Efficient Disease Surveillance System. In Int. Conf. on Advances in Signal Processing and Communication. ACEEE (Lucknow).

El Emam, K., Hu, J., Mercer, J., Peyton, L., Kantarcioglu, M., Malin, B., … & Earle, C. (2011). A secure protocol for protecting the identity of providers when disclosing data for disease surveillance. Journal of the American Medical Informatics Association18(3), 212-217.

Gostin, L. O., & Gostin, L. O. (2000). Public health law: power, duty, restraint (Vol. 3). Univ of California Press.

Gostin, L. O., Hodge, J. G., & Marks, L. (2002). The Nationalization of Health Information Privacy Protections. Tort & Insurance Law Journal, 1113-1138.

Hodge Jr, J. G., Torrey Kaufman, J. D., & Jaques, C. (2012). Legal Issues Concerning Identifiable Health Data Sharing Between State/Local Public Health Authorities and Tribal Epidemiology Centers in Selected US Jurisdictions.

Kulynych, J., & Korn, D. (2003). The New HIPAA (Health Insurance Portability and Accountability Act of 1996) Medical Privacy Rule Help or Hindrance for Clinical Research? Circulation108(8), 912-914.

Labilles, U. (2014). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK11Disc) Walden University, Minneapolis.

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: a crisis of opportunity. American journal of public health, 102(3), e1-e7.

Office for Civil Rights, H. H. S. (2002). Standards for privacy of individually identifiable health information. Final rule. Federal Register67(157), 53181.

Van Der Goes Jr, P. H. (1999). Opportunity Lost: Why and How to Improve the HHS-Proposed Legislation Governing Law Enforcement Access to Medical Records. University of Pennsylvania law review, 1009-1067.

Wilson, A. (2009). MISSING THE MARK: THE PUBLIC HEALTH EXCEPTION TO THE HIPAA PRIVACY RULE AND ITS IMPACT ON SURVEILLANCE ACTIVITY. HOUS. J. HEALTH L & POL’Y131(156), 131.

Middle East Respiratory Syndrome (MERS) and Global Disease Surveillance System

The first confirmed case of Middle East Respiratory Syndrome (MERS) in the United States raised concerns about the rapid spread of the disease if there is no disease surveillance system in place. MERS infection was first reported in Saudi Arabia in 2012. MERS morbidity and mortality is alarming in which its clinical features resembles severe acute respiratory syndrome (SARS) with the mortality rate of approximately 60% for those who was hospitalized with severe acute respiratory condition. The federal and state health officials released the information about the first U.S. MERS case on May 2, 2014 which is an example of the importance of disease surveillance in the public health system. The patient is a health care provider who flew from Saudi Arabia’s capital Riyadh to the United States, with a stop in London. He took a bus to Indiana after landing in nearby Chicago. On April 27, he began experiencing shortness of breath, coughing, and fever. Medical staff members who came into direct contact with this patient was placed in full isolation at Community Hospital in Munster, then were taken off duty and put in temporary home isolation. MERS have no known treatments, and symptoms can take up to 14 days to occur. The exposed medical staff members will be allowed back to work after the incubation period ends and their laboratory results are confirmed to be negative for the virus. The most important factor that is needed to be considered is the probability of rapid situational changes on the progression of human-to-human transmission. Anticipating this probability will be dependent upon the quality of surveillance systems to monitor symptomatic and mild infections. These include the network structure of infections within the MERS-CoV clusters. Understanding the pandemic potential of this virus is paramount to saving lives, therefore, it is important to acknowledge the significance of the necessary requirements for a sustained globalized environment in which the continued commitment of richer countries to make it a moral obligation to help institute required reforms, policies, structures and systems required for public health and disease surveillance. It is important to develop counter-measures in the event MERS-CoV starts evolving, and mutate that will make it easier to infect humans. Mathematical epidemiologists use reproduction number (R0) to measure the average number of infections in a fully susceptible population caused by one infected individual. In this scenario, R0 of this virus will need to be increased which will then pose a relevant challenge for estimating R0 from a series of outbreaks distributed through time. In a bioterrorism standpoint, it is critical for investigators to explore the probability for this virus to be mutated in a laboratory setting. Enhanced surveillance is needed to trace active contacts, as well as vigorous monitoring of the MERS-CoV animal hosts and transmission routes to human beings within and beyond the target population. As long as the transmission properties remain small, the rapid identification, and isolation of cases with a basic R0 will keep human-to-human transmission under control. Early detection of milder, and asymptomatic cases is paramount for the reduction of case fatality rate, since mortality rate of this disease is related to late stage diagnosis and comorbid medical conditions. Globalization has its positive and negative impacts, making the world smaller and increase its vulnerability to infectious disease outbreak. Renewed commitment to public health, and strong international partnerships are essential to strengthen national and international cooperation in infectious disease prevention and control.

References

Bauch, C. T., & Oraby, T. (2013). Assessing the pandemic potential of MERS-CoV. The Lancet382(9893), 662-664.

Breban, R., Riou, J., & Fontanet, A. (2013). Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk. The Lancet382(9893), 694-699.

CDC – Coronavirus – Middle East Respiratory Syndrome – MERS-CoV. (n.d.). Retrieved from http://www.cdc.gov/coronavirus/mers/

Heymann, D. L., & Rodier, G. R. (1998). Global surveillance of communicable diseases. Emerging infectious diseases4(3), 362.

Labilles, U. (2014). Middle East Respiratory Syndrome (MERS): The World is Getting Smaller. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK9Assgn) Walden University, Minneapolis.

Man treated for deadly MERS virus in Indiana improving: state … (n.d.). Retrieved from http://www.reuters.com/article/2014/05/04/us-usa-health-mers-idUSBREA4208620140504?feedType=RSS

Man treated for deadly MERS virus in Indiana improving: state … (n.d.). Retrieved from http://www.orlandosentinel.com/news/nationworld/sns-rt-us-usa-health-mers-20140502,0,6981423.story

WHO calling in the experts on MERS-CoV | Hospital Infection … (n.d.). Retrieved from http://hicprevent.blogs.ahcmedia.com/2013/07/08/who-forms-emergency-committee-to-prepare-for-mers-cov-emergence/

“Personal Health Records (PHR) and Health Information Exchange (HIE) in Managing Regional Multi-Site Medical Specialty Practice”

The true, meaningful use of personal health records (PHR), and  health information exchange (HIE) between regional sites or multi-site specialty practice could amplify coordination and efficiency for higher quality and  patient-centered care. PHR and HIE have been advocated as key new components in the effective delivery of modern health care. What is the impact of PHR and HIE to healthcare system? How can sharing health information between regional sites or multi-site specialty practice bridge the communication gap?  What is the role of specific-disease surveillance system in enhancing the management and delivery of quality of care? The effective use of cancer-related information aggregated from evolving health communication and information technology can help identify disease cluster such as the incidence of skin cancer in a geographic area which could improve communication strategy on a population wide basis. The processes of health communication and supportive health information technology infrastructure can influence patients’ health decisions, health-related behavior, and health outcomes. These make health communication and health information technology play an increase central role in health care delivery and public health. HINTS data could help a regional manager harness the appropriate communication channel to coordinate between facilities, and to identify barriers to the use of health information across community. Gauging the target group’s attitudes, regarding perceptions of health-relevant topics such as cancer screening will help develop more effective communication strategies. For example, a marked increase in the incidence rate of non-melanoma skin cancer (NMSC) based on a comprehensive surveillance system could help Mohs Micrographic Surgery facilities coordinate with dermatologists and dermato-pathologists. HINTS data can help refine information age health communication theories, and offer unique recommendations for managers, communication planners and researchers in their common aim to reduce the population cancer burden through effective, evidence-based, and patient- or public-centered communication (Hesse et al., 2006; Hesse et al., 2005; Nelson et al., 2004). The concept that captures an interactive phenomenon such as shared decision-making (SDM) utilized in concert with HINTS data recommendations will improve clinicians and patients communication. Kasper, Légaré, Scheibler & Geiger (2012) asserted that the complexity of challenges physicians have to face in critical decision making, can be alleviated by outsourcing parts of the information and decision making process to other health or medical professionals to provide optimal conditions for communication in the physician patient dyad.

References

Finney Rutten, L. J., Davis, T., Beckjord, E. B., Blake, K., Moser, R. P., & Hesse, B. W. (2012). Picking up the pace: changes in method and frame for the health information National Trends Survey (2011–2014). Journal of health communication17(8), 979-989.

Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K., . . . Viswanath, K. (2005). Trust and sources of health information: The impact of the Internet and its implications for health care providers: Findings from the first Health Information National Trends Survey. Archives of Internal Medicine, 165, 2618–2624.

Hesse, B. W., Moser, R. P., Rutten, L. J. F., & Kreps, G. L. (2006). The health information national trends survey: research from the baseline. Journal of Health Communication11(S1), vii-xvi.

Kasper, J., Légaré, F., Scheibler, F., & Geiger, F. (2012). Turning signals into meaning–‘Shared decision making’meets communication theory. Health Expectations15(1), 3-11.

Labilles, U. (2014). The Role of Disease-specific Surveillance and Health Information Exchange (HIE) in Managing Regional Multi-site Medical Specialty Practice. (Unpublished, RSCH-8100H-2. Research Theory, Design, and Methods. 2014 Spring Qtr. WK7Assgn) Walden University, Minneapolis.

Nelson, D. E., Kreps, G. L., Hesse, B. W., Croyle, R. T., Willis, G., Arora, N. K., . . . Alden, S.
(2004). The Health Information National Trends Survey (HINTS): Development, design,
and dissemination. Journal of Health Communication, 9, 443–460.

Office of Disease Prevention and Health Promotion. (2010). Healthy People 2020. Retrieved
from http://www.healthypeople.gov/2020/default.aspx

Scholl, I., Loon, M. K. V., Sepucha, K., Elwyn, G., Légaré, F., Härter, M., & Dirmaier, J. (2011). Measurement of shared decision making–a review of instruments. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen105(4), 313-324.

Viswanath, K. (2005). Science and society: The communications revolution and cancer control. Nature Reviews Cancer, 5, 828–835.

Wen, K. Y., Kreps, G., Zhu, F., & Miller, S. (2010). Consumers’ perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey.Journal of medical Internet research12(4).

Parental Obesity and New Mentality: Raising the Risk of Child Obesity

Our nation’s most urgent health problem is the disparities in health care. There are stark disparities in health by gender and socioeconomic status. According to Davis et al. (2005), “the social and community environments affect health directly as well as indirectly by influencing behavior”(p. 2168). Which group do we put parents who have a distorted perception of their child’s body size? This phenomenon is most prevalent among low-income women and Hispanic mothers. But regardless of race or socioeconomic background, the obesity epidemic is eroding the general impression of what healthy looks like. What if obese is the new normal? If obese is the new normal, then it will be our failure as Public Health professionals to emphasize the importance of the role of parents and family to combat child obesity. Parents should play a crucial role in influencing children’s food habits and physical activity. Parental obesity may increase the risk of a child becoming obese. Wrotniak et al. (2004) is the first study to examine the incremental effects of parental weight change on child weight change while controlling for variables that influence child weight loss. The study stated that youth benefit the most from parents who lose the most weight in family-based behavioral treatments (Wrotniak et al., 2004, p. 342).

The prevalence of obesity is increasing in all pediatric age groups according to the Health and Nutrition Examination Survey (NHANES). Genetics, environment, metabolism, lifestyle, and eating habits are among the factors believed to play a role in the development of obesity. More than 90% of cases are idiopathic; less than 10% are associated with hormonal or genetic causes. Hirschler et al. (2008) found an association between mothers’ distorted perception of their children’s shape and eating habits and mothers’ obesity and their children’s overweight. The study provides clues for obesity prevention programs. There is a multitude of health problems that are associated with obesity. Without dealing with the new trend of maternally distorted perception of their child’s body size, health problems faced by family care physicians will continue to rise. There will be continued prevalence of obesity associated diseases such as type 2 diabetes and heart disease to hyperlipidemia, asthma, and obstructive sleep apnea. According to Friedman & Schwartz (2008), “A key concept in developing obesity-related policies is creating ‘optimal defaults’17. When there is an optimal default, the health promoting behaviors are those that come most easily, require the least effort or thought, and offer a more healthful option” (p.718).

References

JAMA Network | JAMA Pediatrics | Parent Weight Change as a … (n.d.). Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=485676

Hirschler, V., Calcagno M., Clemente A., Aranda C., Gonzalez, C. (2008, July 21). Association between school children’s overweight and maternal obesity and perception of      their children’s weight status. Journal Pediatric Endocrinololgy & Metabolism. 7:641-9.

Cohen, L., Chavez, V., Chehimi, S. (2010). Achieving Health Equity and Social Justice. L. Liburd & W. Giles, Prevention is Primary (pp. 33-53). San Francisco: Jossey-            Bass.

Friedman, R., & Schwartz, M. (2008). Public Policy to Prevent Childhood Obesity, and the Role of Pediatric Endocrinologists.Journal of Pediatric Endocrinology &                    Metabolism, 21, 717-725.

Prostate Cancer Screening for Early Detection and Treatment

 

Prostate Cancer Screening for Early Detection and Treatment.