Written Response Submission Form: Epidemiological Triangle

Item 1

Sam, a 35-year old, married mother of two, is an elementary school teacher at a private school in a suburban area. She recently complained of chest pains and an incessant cough, which resulted in her coughing up blood earlier today. Concerned, she has just entered the emergency room department at the city hospital. Diego is the ER nurse who processed Sam’s intake and took a sputum culture to be tested. Laboratory results confirm infection with tuberculosis. Concerned about Sam’s positive test result, Diego decided to re-interview Sam and determined that she recently returned from a mission trip to poverty stricken areas of Buenos Aires, Argentina.

Address the following:

• Based on this scenario, use the epidemiological triangle, the web of causality, and/or the ecological model to examine Sam’s infection with TB. Include in your response the elements of the epidemiological triangle (host, agent, environment); the web of causality; and/or the ecological model.
• Explain the significance of the “shrinking world” and how it may impact the field of epidemiology. Be sure to include global health data to support your explanation.

Question One

Epidemiological Triangle

An epidemiological triangle is an ideal tool for examining the manner in which Sam acquired TB. The three elements of the epidemiological triangle are the host, agent, and environment, which analyze the vector capable of causing disease, the host that is vulnerable to the agent, and the environment that allows the agent and the host to interact (Gulis & Fujino, 2015). In this context, the agent of TB is the mycobacterium tuberculosis, which is carried from one person to another through airborne particles. The host is Sam because she was vulnerable to the bacteria, and she currently harbors it in her body system. Based on the provided information, it is likely that the disease’s environment is the poverty-stricken areas of Buenos Aires, Argentina, where Sam had recently visited. Arguably, poverty-stricken areas are a breeding ground of airborne illnesses such as TB because people in such regions likely live in overcrowded and poorly ventilated rooms that allow the transmission of airborne diseases.

Web of Causality

According to Oleske (2009), the web of causation model posits that a disease may have multiple links, some quite distant as possible etiologic factors. This information implies that Sam’s TB may be caused by multifactorial factors that have an immediate or non-immediate impact on the host. For example, Sam’s infection could be caused by multifactorial factors such as tubercle bacillus; poor nutrition, which increases one’s susceptibility to the disease; overcrowding, which causes poor ventilation; tobacco smoking, excessive alcohol use and consuming unpasteurized milk products.

Ecological Model

The ecological model suggests that there are multiple influences of a health behavior or problem. For example, in this context, Sam’s health issue could be influenced by various levels of forces such as lack of public policies that address early detection and management of TB and social norms that promote healthy behaviors such as working in well-ventilated rooms.

Question Two

The “shrinking world” concept mainly stems from the progressive change in globalization over the past decades. As noted by Buck et al. (1988), the ‘shrinking world” denotes that, “measured in terms of travel time, the world has become progressively smaller, and that it tends to become more and more a single epidemiologic universe” (p.135). Unlike before, distances between continents have shrunk due to evolution in advanced modes of transport and improved infrastructure, and interaction among people has also increased significantly.

The concept of the “shrinking world” is significant in epidemiology because it helps healthcare practitioners examine the manner in which individuals acquire infectious diseases. For example, in 2019, there was an outbreak of mysterious pneumonia, COVID-19, characterized by fever, dry cough, fatigue, and occasional gastrointestinal symptoms in Wuhan, Hubei, China (Yi-Chi et al., 2020). By December 2019, 66% of the Huanan Seafood Wholesale Market staff had been infected by the virus (Yi-Chi et al., 2020). By February 2020, the WHO reported the virus in other parts of the globe, including the United States, Singapore, and France. Statistics reveal that as of February 6, 2020, 28,276 confirmed cases with 565 deaths had been documented by WHO (Yi-Chi et al., 2020). This global health data exemplifies the importance of the “shrinking world” in examining disease transmission. Most notably, the concept enables health practitioners to consider the possibility of an individual suffering from a given disease despite its prevalence in other areas besides the patient’s locality.

The concept of the “shrinking world” may impact epidemiology by facilitating better management of infectious diseases. Most notably, with the increased interactions across countries of the globe, healthcare practitioners will be better positioned to collaborate efforts aimed at controlling contagious diseases.

Rubric

Item 2

You are a public health nurse who is interested in obtaining data related to a health behavior problem that you see in your nursing practice. You would like to research this health behavior problem and access resources for health data that might be available to help inform your nursing practice. NOTE: For this Assessment, you are to identify a health problem or behavior and not an infectious disease or specific diagnosis (Some examples of health problems or behaviors: smoking, obesity, substance abuse, teen pregnancy, or mental illness).

• Identify two sources of data that you might access to research your health problems or behaviors. Then, explain why you would use these two sources of data, including the type of data you are likely to find with each source.
• Explain the incidence and prevalence of the health problems or behaviors you selected based on the sources of data you identified.
• Describe the levels of prevention as they relate to nursing practice for the health problems or behaviors you selected.
• Explain what it means to “think upstream.” Then, explain how you might integrate this perspective into your nursing practice for the health problems or behaviors you selected.
• Explain how the determinants of health help nurses and healthcare professionals advocate for patients related to the health problems or behaviors you selected.

Your Response

Question One

The selected health problem for this assignment is childhood obesity. The two primary sources of data that I might use to research obesity are medical journals and government websites. Medical journals are mainly scholarly reviewed articles published on medicine, sciences, and epidemiology databases such as PubMed, CINAHL, and Cochrane library to disseminate medical data to healthcare practitioners. Government websites such as the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), and Centers for Medicare and Medicaid Services (CMS) may also provide valuable insights into the selected health problem. Some of the types of data that I might find in medical journals and government websites include qualitative and quantitative data on obesity. Quantitative data may consist of statistics on the disease’s prevalence and the financial burden on the government and patients’ families. Qualitative data may include descriptions of the condition and its risk factors.

I would select medical journals and government websites to access research on childhood obesity for multiple reasons. First, the majority of medical journals are cost-effective sources of research. As averred by Wang et al. (2019), online open-access medical journals provide various information without imposing costs. Therefore, as I pursue research on childhood obesity, I would have access to a wide range of data from medical journals at no cost. Second, I would use medical journals because of their high level of reliability. Most notably, the majority of the medical journals are reviewed by experts in the medical field, which implies that the information contained in such sources is verified, reliable, and of high quality. Third, I would select the medical journals because of their comprehensiveness and accessibility. A majority of the medical journals are open access and updated with new research, which implies that I can access up-to-date information in these sources of information when the need arises. I would also utilize government websites for research because they are credible, reputable, and contain a broad range of information about medical issues preserved over several years.

Question Two

Both the medical journals and government websites selected for this research posit that obesity is a significant problem in the United States and globally. According to the CDC statistics, the prevalence of obesity for children and adolescents in the United States aged 2-19 years was 18.5%, with approximately 13.7 million individuals affected by the condition in 2019 (“Childhood obesity facts”, 2019). Medical journals reveal that obesity prevalence among 2-19-year-olds from 2011 to 2012 was 16.9% (Ogden et al., 2014). These statistics prove the seriousness of childhood obesity as a health issue in the United States. The two figures also suggest a slight increase in childhood obesity in the country between 2011 and 2019. The CDC also posits that the prevalence of obesity in the country varies across economic status, age groups, and races. For example, the CDC shows that obesity prevalence among 2-5-year-olds, 6-11-year-olds, and 12-19-year-olds was 13.9%, 18.4%, and 20.6%, respectively, in 2019 (“Childhood obesity facts”, 2019). These figures suggest that as children grow older, they may become more vulnerable to obesity, probably because of their anonymity in selecting eating habits than younger children who are often in their parents’ care.

Another typical pattern in the prevalence of childhood obesity is its variation among people of different races and economic statuses. The CDC shows a higher prevalence of obesity among Hispanics and non-Hispanic blacks than non-Hispanic Whites (“Childhood obesity facts”, 2019). Furthermore, the CDC posits a higher prevalence of obesity among people of lower economic status than their counterparts.

In terms of incidence, medical journals show a promising pattern of incidence of childhood obesity. Most notably, scholars aver that obesity incidences declined by age in the United States (Cheung et al., 2016). Findings from research by Cunningham et al. (2014) also support this view by showing a decline in incidences of obesity among kindergarten children compared to eighth-graders. This information suggests that older children are more susceptible to obesity.

Question Three

Disease prevention is a vital part of nursing practice. Most notably, nurses and other healthcare practitioners are tasked with preventing disease occurrence and collaborating with other practitioners to prolong a patient’s life. According to the literature, there are three levels of disease prevention in nursing practice- primary, secondary, and tertiary- all of which play a critical role in promoting health. Primary prevention entails “measures seeking to prevent the initial occurrence of a disease by personal and communal efforts” (Outwater et al., 2017, p.338). In this context, primary prevention may entail nurses’ efforts to combat obesity among children between the age of 2-19 years. Some of the primary prevention methods for childhood obesity may include educating children and their families about healthy diets and physical activities to protect them from developing lifestyle diseases.

Unlike primary prevention, secondary prevention may occur during the onset of a disease. Scholars aver that secondary prevention entails detecting disease and retarding it at an early stage and using appropriate treatment to reduce the occurrence of chronicity (Outwater et al., 2017). In childhood obesity, nurses can undertake secondary preventive measures such as screening families and children for obesity each time they visit healthcare centers. Arguably, early screening can help detect and manage the disease at an early stage to prevent severity.

The third level of prevention, as proposed by scholars, is tertiary prevention. This prevention level involves the participation of healthcare providers in developing “measures aimed at softening the impact of established disease and disability” (Outwater et al., 2017, p.338). In essence, tertiary prevention entails rehabilitating an already existing condition. Some of the measures that nurses may undertake at this level include enlightening patients on the manner in which to follow their prescribed therapy, physical exercise, and diet.

Question Four

The concept of “upstream thinking” is often used in policy-making to provide a different lens of approaching issues that affect populations. As averred by Meili (2013), upstream thinking implies making smarter decisions based on long term thinking. Meili illustrates this concept using a public health parable of flailing drowning children floating in a river. The author posits that individuals approaching such an issue using downstream thinking would continue rescuing the children as they come floating at the edge of the river. However, an individual using upstream thinking would question the person that keeps chucking the kids in the river, and the people would head upstream to find out (Meili, 2013). In essence, upstream thinking in the healthcare context would involve long-term thinking and making decisions that would lead to optimal healthcare outcomes.

In my nursing practice, I would integrate the concept of “upstream thinking” to examine decisions that would yield the most optimal health outcome in matters of childhood obesity. In my view, the majority of the existing healthcare decisions are based on short-term thinking. For example, in most scenarios, the system reacts to patients with obesity by providing therapy and other treatments to prevent the condition’s chronicity. However, very few individuals attempt to look beyond healthcare provision and address other factors contributing to childhood obesity. As a nursing practitioner knowledgeable about “upstream thinking”, I would approach childhood obesity through a lens that examines the cause of the healthcare problem. These causes would include social factors such as low educational attainment among caregivers and poverty. Arguably, if approached from this lens, the prevalence of childhood obesity would decline significantly because the issue would be addressed from the root cause-upstream- before it becomes a health problem.

Question Five

From a healthcare perspective, determinants of health are circumstances and factors that directly or indirectly affect a person’s health. These health determinants may include individuals’ economic status, working conditions, physical environment, access to health services, and education and literacy levels. Understanding the determinants of health helps nurses identify the most critical factors that are likely to contribute to a health condition and advocate for measures that can help mitigate such adverse circumstances and improve patients’ health.

In the context of childhood obesity, nurses’ understanding of the determinants of health can help the former identify social factors that trigger the disease and advocate for better social conditions for the most vulnerable populations. For example, one of the most visible determinants of childhood obesity is an individual’s economic status. Arguably, families that live below the poverty line have limited access to healthy foods because of financial constraints. Such families may often rely on low-nutrient and high-calorie diets, which tend to be more affordable than healthy high-nutrient and fewer calories diets. As a result, children raised in poverty-stricken families are more likely to be vulnerable to obesity than their counterparts. Also, children raised in a family with low educational attainment may be more susceptible to obesity because caregivers may not know the best diet plans for their children.

The highlighted social determinants of health help nurses understand and advocate for initiatives that would assist reduce cases of obesity at the community level. For example, in the scenario of poverty, nurses can advocate for the establishment of food programs to feed families that are identified as food insecure and vulnerable to obesity. Also, nurses can advocate for the establishment of education programs to enlighten families about obesity and some of the preventive measures that families can adopt to combat the disease.

Rubric

References

Provide a citation for each resource you used to write your response to this Assessment. A sample citation is provided below :

• Robertson, C. (2016). Safety, nutrition, & health in early education (6th ed.). Boston, MA: Cengage Learning.

Mastery Rubric

In order to achieve mastery of this Competency, you must achieve a “2” on every rubric row in addition to meeting the additional expectations indicated in the Mastery Rubric.

Professional Skill Building

The faculty Assessor will provide feedback based on the following Professional Skill(s): Written Communication, and Engaging Multiple Social and Cultural Perspectives. Although the feedback is here to inform the development of your skills, it is not a barrier to achieving the Competency, unless the writing is too poor to be able to score the content of the Assessment. Review the rubric and check your work based on the learning objectives listed. If you are concerned that you will not meet these expectations yet, reach out to your Coach so he or she can work with you to further develop this important professional skill.

It is highly recommended that you use this opportunity to practice these important skills in the context of this Competency Assessment in order to receive feedback about your current level of proficiency.

References

“Childhood obesity facts” (2019, June 24). Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/childhood.html

Buck, C., Pan American Sanitary Bureau, Llopis, A., World Health Organization. (1988). The challenge of epidemiology: Issues and selected readings. Pan American Health Organization. ISBN: 9275115052, 9789275115053.

Cheung, P., Cunningham, S., Narayan, K.M.V., & Kramer, M.R. (2016). Childhood obesity incidence in the United States: A systematic review. Child Obesity, 12(1), 1-11. https://doi.org/10.1089/chi.2015.0055

Cunningham, S.A., Kramer, M.R., & Narayan, K.M.V. (2014). Incidence of childhood obesity in the United States. The New England Journal of Medicine 370(5), 403-411. https://doi.org/10.1056/nejmoa1309753

Gulis, G., & Fujino, Y. (2015). Epidemiology, population health, and health impact assessment. Journal of Epidemiology, 25(3), 179-180. https://dx.doi.org/10.2188%2Fjea.JE20140212

Meili, R. (2013, November 18). Upstream thinking, healthy society and reviving Canadian democracy. Canadian Centre for Policy Alternatives. https://www.policyalternatives.ca/publications/commentary/upstream-thinking-healthy-society-and-reviving-canadian-democracy

Ogden, C., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814. https://doi.org/10.1001/jama.2014.732

Oleske, D.M. (2009). Epidemiology and the delivery of health care services: Methods and applications. Springer Science and Business Media (3rd ed.). ISBN: 1441901647, 9781441901644

Outwater, A., Leshabari, S.C., & Nolte, E. (2017). Disease prevention: An overview. International Encyclopedia of Public Health, 2, 338-349. https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.1016%2FB978-0-12-803678-5.00117-X

Wang, J.Z., Pourang, A., & Burrall, B. (2019). Open access medical journals: Benefits and challenges. Clinics in Dermatology, 37(1), 52-55. https://doi.org/10.1016/j.clindermatol.2018.09.010

Yi-Chi, W., Ching-Sung, C., & Yu-Jiun, C. (2020). The outbreak of COVID-19: An overview. Journal of the Chinese Medical Association, 83(3), 217-220. https://journals.lww.com/jcma/fulltext/2020/03000/the_outbreak_of_covid_19__an_overview.3.aspx

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