Epidemiological Analysis- Chronic Health Problem

Epidemiological Analysis- Chronic Health Problem

Atopic dermatitis (AD) is an incurable chronic skin condition that affects people across all lifespans (Chiesa Fuxench et al. 2019). The disease has significant social, financial, and health impacts, necessitating concerted efforts to address AD adequately. This paper discusses the etiology, signs and symptoms, and pathophysiology of AD. Furthermore, it discusses epidemiology, screening guidelines, surveillance, and reporting and develops a plan for addressing the disease.

Background and Significance of the Disease

Chiesa Fuxench et al. (2019) report that AD is characterized by pruritus and inflammation that begins in early childhood. It is worth noting that an adult-onset variant of AD exists. Its course is intermittent and presents with exacerbations and remissions (Chiesa Fuxench et al., 2019). The other manifestations of AD include xerosis, lichenification, and eruption of eczematous lesions (Frazier & Bhardwaj, 2020). Also, AD is likely to present with peripheral eosinophilia and heightened immunoglobulin E reactivity (Frazier & Bhardwaj, 2020). The worst affected body parts include the limbs, neck, and face. The disease is uncommon in the regions around the axillae and groins (Frazier & Bhardwaj, 2020). Poorly managed AD predisposes patients to viral and bacterial skin infections, blepharitis, conjunctivitis, insomnia, anxiety, and depression (Kim et al., 2019).

The pathophysiology of AD is not well defined. However, various pathways have been postulated to cause AD. Firstly, the altered production of T cells results in the overproduction of Th2 cells compared to the other subsets of T cells (Kim et al., 2019). This triggers the secretion of type 2 cytokines, which promote the secretion of Immunoglobulin E (Kim et al., 2019). Furthermore, Th2 cells promote the secretion of interleukin (IL) 31, which elicits inflammation and pruritus (Sroka-Tomaszewska & Trzeciak, 2021). Also, IL-4 and 13 have been implicated in AD-associated inflammation and pruritus (Kim et al., 2019). Secondly, damage to the epithelial barrier allows antigen entry, hence the secretion of inflammatory mediators. For instance, filaggrin mutation predisposes people to AD by triggering the release of inflammatory cytokines such as IL-33 (Sroka-Tomaszewska & Trzeciak, 2021).

Various factors have been implicated in the etiology of AD. To begin with, the disease has a genetic predisposition. Notably, the presence of mutated filaggrin increases the risk of AD. Filaggrin promotes the proliferation of the epidermal barrier (Frazier & Bhardwaj, 2020). As such, mutations increase the risk of antigen entry and release of inflammatory mediators. Also, Staphylococcus aureus infection exacerbates AD ( Torres et al., 2019). This microorganism can act as a superantigen, hence predisposing patients to AD. Herpes simplex virus is the other microorganism that exacerbates AD ( Torres et al., 2019). Climatic conditions such as heat and dry conditions worsen skin dryness associated with AD. Also, perspiration worsens pruritus and triggers the inflammatory pathway (Frazier & Bhardwaj, 2020). Furthermore, environmental factors have been implicated. Examples include exposure to cigarette smoke, fragrances, and aeroallergens (Frazier & Bhardwaj, 2020).

Nationaleczema.org (n.d.) reports that about 9.6 million people aged below 18 years in the USA have AD. This represents a prevalence of about 15 percent among children and teenagers (Nationaleczema.org, n.d.). Approximately 3.2 million of this population has moderate to severe AD (Nationaleczema.org, n.d.). Furthermore, about 16.5 million adults in the USA have AD (Nationaleczema.org, n.d.). This represents a prevalence rate of about 7.3 percent(Nationaleczema.org, n.d.). Approximately 40 percent of this adult population has moderate to severe AD (Nationaleczema.org, n.d.). Nationaleczema.org (n.d.) reports that about 80 percent of cases are reported before the age of six years (early childhood). About 6 percent of the adult population report the onset of symptoms after 60 years (Chiesa Fuxench et al., 2019). The highest prevalence has been recorded among whites and multiracial adults (Chiesa Fuxench et al., 2019). Also, the prevalence is higher in adult women compared to adult males. On the other hand, children are affected equally regardless of their gender. The severity of the disease is higher among African American and Hispanic children than white children. In addition, children born in the USA have a 50 percent higher risk of getting AD compared to those born in other countries (Chiesa Fuxench et al., 2019).

After a comprehensive search of the scholarly databases, this writer was not able to find data on the prevalence or incidence of atopic dermatitis in all states. This indicates a gap in the surveillance and reporting of cases of atopic dermatitis at the state level. As such, concerted efforts should be made to initiate the recording and reporting of data at this level.

Surveillance and Reporting

AAFA.org (n.d.) reports that the surveillance and reporting of atopic dermatitis are accomplished by the Asthma and Allergy Foundation of America and the National Eczema Association. The surveillance and reporting are done at the national level. These organizations partner with donors such as pharmaceutical companies. For instance, the last surveillance and reporting were facilitated by Sanofi Genzyme and Regeneron (AAFA.org, n.d.). National data reports on various themes, including the prevalence of atopic dermatitis in the USA, the severity of the disease among patients, and the burden of the disease (AAFA.org, n.d.). Furthermore, the data indicates the sociodemographic characteristics of the population. This allows researchers to compare different populations and make decisions regarding AD management in these populations. Each surveillance report targets a specific population, such as adults, healthcare providers, or the general public. These reports are availed via published manuscripts in peer-reviewed journals, via press releases, and by providing online summary reports.

Epidemiological Analysis

Atopic dermatitis is a problem of concern. As mentioned earlier, it is an incurable chronic skin condition characterized by pruritus and inflammation that begins in early childhood (Chiesa Fuxench et al., 2019). Its course is intermittent and presents with exacerbations and remissions. According to Chiesa Fuxench et al. (2019), dry skin, lichenification, and the emergence of eczematous lesions are some of the additional symptoms of AD. According to Kim et al. (2019), patients with poorly treated AD are more likely to have bacterial and viral skin infections, mental health problems such as depression, and ocular infections such as keratitis.

Atopic dermatitis affects people across all lifespans. As earlier stated, data from 2019 indicates that about 9.6 million people aged below 18 years in the USA have AD (Nationaleczema.org, n.d.). This represents a prevalence of about 15 percent among children and teenagers (Nationaleczema.org, n.d.). Approximately 3.2 million of this population has moderate to severe AD (Nationaleczema.org, n.d.). Furthermore, about 16.5 million adults in the USA have AD (Nationaleczema.org, n.d.). This represents a prevalence rate of about 7.3 percent (Nationaleczema.org, n.d.). Approximately 40 percent of this adult population has moderate to severe AD (Nationaleczema.org, n.d.). Nationaleczema.org (n.d.) reports that about 80 percent of cases are reported before the age of six years (early childhood). About 6 percent of the adult population report onset of symptoms after 60 years (Chiesa Fuxench et al., 2019). The highest prevalence has been recorded among whites and multiracial adults (Chiesa Fuxench et al., 2019). Also, the prevalence is higher in adult women compared to adult males. On the other hand, children are affected equally regardless of their gender. The severity of the disease is higher among African American children and Hispanic children compared to white children. In addition, children born in the USA have a 50 percent higher risk of getting AD compared to those born in other countries (Chiesa Fuxench et al., 2019).

As aforementioned, various factors increase the risk of AD. AD has a genetic inclination. A family history of AD increases the risk of the disease among first-degree relatives. Furthermore, the presence of mutant filaggrin increases the likelihood of antigen entrance and the release of inflammatory mediators (Frazier & Bhardwaj, 2020). According to Torres et al. (2019), Staphylococcus aureus infection worsens AD. The other pathogen that worsens AD is the herpes simplex virus (Torres et al., 2019). Xerosis related to AD is exacerbated by climatic factors such as heat and dryness (Frazier & Bhardwaj, 2020). Furthermore, exposure to dust mites, tobacco smoke, and other allergens increases the risk of AD (Frazier & Bhardwaj, 2020).

AD has economic and social impacts. It results in the loss of more than 5 million workdays annually in the USA (Nationaleczema.org, n.d.). Severe to moderate AD is a predictor of unemployment in about 16 percent of adults in the USA (Nationaleczema.org, n.d.). AD increases healthcare costs due to prolonged hospitalizations and regular visits to the emergency rooms. The out-of-pocket cost of managing AD is about $600 per patient (Nationaleczema.org, n.d.). However, forty-two percent of patients have reported an individual out-of-pocket cost of at least $1000 annually, whereas 8.5 percent of patients report an average cost of about $5000 annually (Nationaleczema.org, n.d.). The annual cost of managing AD-associated in-patient cases among adults is more than $8 million (Nationaleczema.org, n.d.). On the other hand, the annual cost of managing in-patient children is more than $3 million. The total direct and indirect costs for managing AD in the USA are more than $5 billion annually (Nationaleczema.org, n.d.).

Screening and Guidelines

The diagnosis of atopic dermatitis is based on the clinical manifestations of the disease. Three criteria are used to diagnose patients. Firstly, the patient must present essential features. These features include pruritus and eczema (Frazier & Bhardwaj, 2020). Eczema targets children’s extensor surfaces, the face, and the neck, whereas flexural surfaces are targeted in other age groups (Frazier & Bhardwaj, 2020). Also, the disease spares the area around the axillae and groin (Frazier & Bhardwaj, 2020). These essential features should be chronic or have a history of relapse. Secondly, important features that facilitate diagnosis may be present. These features include dry skin, atopy, and onset in childhood (Frazier & Bhardwaj, 2020). Thirdly, nonspecific associated features should be considered. They include periorbital and perioral changes, ichthyosis, facial pallor, lichenification, and pityriasis alba (Frazier & Bhardwaj, 2020). Fourthly, the diagnosis should be made after the exclusion of other conditions. These conditions include scabies, psoriasis, ichthyoses, and seborrheic dermatitis (Frazier & Bhardwaj, 2020). Laboratory tests and biomarkers are not indicated for the routine diagnosis of AD. However, Torres et al. (2019) report that laboratory tests can be used to rule out immunodeficiency, measure IgE levels, and identify Staphylococcus aureus after skin swabs.

The American Academy of Dermatology formulated a clinical guideline to facilitate the management of AD. The guideline has four sections that address various of these. The first section explores the assessment and diagnosis of AD (AAD.org, n.d.). Also, this section categorizes the severity of AD and its clinical associations and identifies risk factors for AD. The second section discusses the topical therapies used in managing and treating AD (AAD.org, n.d.). This explores both pharmacological and non-pharmacological approaches to the management of AD. The third section discusses systemic therapy and phototherapy used to manage and treat the disease (AAD.org, n.d.). The fourth section discusses the prevention of AD flares and identifies key adjunct therapies (AAD.org, n.d.).

There is no standard screening test for the diagnosis of AD. This is because reliable biomarkers for AD do not exist (Sroka-Tomaszewska & Trzeciak, 2021). Screening tests for T lymphocytes and novel cytokines such as IL-12 and 31 are nonspecific and not sensitive to the diagnosis of AD (Frazier & Bhardwaj, 2020). Furthermore, it is worth noting that a gold standard severity screening scale has not been developed. More than twenty-eight scales are used. The SCORing Atopic Dermatitis Index and the Eczema Area and Severity Index are examples of severity scales that are used in clinical practice (Frazier & Bhardwaj, 2020).

Plan

Nurse practitioners can play a significant role in addressing AD. Firstly, the evaluation of surveillance and reporting reveals a gap at the state level. Nurses can address this gap via policy formulation and advocacy. To achieve this, they should collaborate with relevant organizations such as the Asthma and Allergy Foundation of America and the National Eczema Association (AAFA.org, n.d.). The policy should aim at promoting periodic surveillance and reporting of the prevalence, distribution, and burden of AD in each state (AAFA.org, n.d.). State surveillance and reporting should occur concomitantly with the national surveillance and reporting process and should target patients, the public, and healthcare providers (AAFA.org, n.d.). Targeted surveys will be used to collect data. Consistently improved AD surveillance and reporting at the state level will improve disease management because every state will be actively involved in AD management.

Secondly, nurse practitioners should be actively involved in diagnosing and assessing patients. The diagnosis is dependent on the established criteria that examine patients’ clinical manifestations (Frazier & Bhardwaj, 2020). Timely diagnosis and assessment will enable nurses to initiate prompt patient interventions. Furthermore, it will allow nurse practitioners to identify the severity of the disease and develop individualized care plans for each patient (Frazier & Bhardwaj, 2020). As such, the prognosis of the disease will be improved, and better patient outcomes will be recorded.

Thirdly, nurse practitioners should develop and implement evidence-based care plans that address both pharmacotherapy and non-pharmacological approaches. Pharmacotherapy embraces both topical and systemic therapies ( Torres et al., 2019). Examples of topical therapies include corticosteroids, calcineurin inhibitors, antihistamines, antimicrobials, and antiseptics (Frazier & Bhardwaj, 2020). Examples of systemic agents include cyclosporine, azathioprine, methotrexate, corticosteroids, calcineurin inhibitors, and antimicrobials (Frazier & Bhardwaj, 2020). Non-pharmacological approaches entail the use of moisturizers and wet wrap therapy (Frazier & Bhardwaj, 2020). Also, patients should be educated to avoid environmental irritants and other allergens.

The success of the interventions will be demonstrated by various metrics. To begin with, the availability of surveillance and reporting data at the state level will indicate the success of the first intervention. Also, a decrease in the percentage of the population with moderate to severe AD will demonstrate the success of the second and third interventions. Furthermore, a decrease in hospitalizations, emergency department visits, and healthcare costs will indicate the success of the second and third interventions.

Conclusion

Atopic dermatitis is an incurable chronic skin condition that presents with pruritus inflammation, and eczema. National surveillance and reporting reveal that more than 9 million children and 16 million adults have AD. The American Academy of Dermatology provides a clinical guideline to facilitate the management and treatment of AD. Nurse practitioners can play a key role in addressing AD by implementing evidence-based care plans, diagnosing and assessing patients, and advocating for surveillance and reporting at the state level.

References

AAFA.org. (n.d.). Atopic Dermatitis in America. https://aafa.org/asthma-allergy-research/our-research/atopic-dermatitis-in-america/#:~:text=The%20study%20finds%20that%20AD,in%20the%20U.S.%20adult%20population

AAD.org. (n.d.). Atopic Dermatitis Clinical Guideline. https://www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis

Chiesa Fuxench, Z. C., Block, J. K., Boguniewicz, M., Boyle, J., Fonacier, L., Gelfand, J. M., Grayson, M. H., Margolis, D. J., Mitchell, L., Silverberg, J. I., Schwartz, L., Simpson, E. L., & Ong, P. Y. (2019). Atopic Dermatitis in America Study: A Cross-Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population. Journal of Investigative Dermatology, 139(3), 583–590. https://doi.org/10.1016/j.jid.2018.08.028

Frazier, W., & Bhardwaj, N. (2020). Atopic Dermatitis: Diagnosis and Treatment. American Family Physician, 101(10), 590–598. https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html

Kim, J., Kim, B. E., & Leung, D. Y. M. (2019). Pathophysiology of atopic dermatitis: Clinical implications. Allergy and Asthma Proceedings, 40(2), 84–92. https://doi.org/10.2500/aap.2019.40.4202

Nationaleczema.org. (n.d.). Eczema Stats. https://nationaleczema.org/research/eczema-facts/

Sroka-Tomaszewska, J., & Trzeciak, M. (2021). Molecular mechanisms of atopic dermatitis pathogenesis. International Journal of Molecular Sciences, 22(8). https://doi.org/10.3390/ijms22084130

Torres, T., Ferreira, E., Gonçalo, M., Mendes-Bastos, P., Selores, M., & Filipe, P. (2019). Update on atopic dermatitis. Acta medica portuguesa, 32(9), 606-613. https://doi.org/10.20344/amp.11963

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Please choose ONE from these topics:
ASTHMA
ATOPIC DERMATITIS
GASTRITIS

Week 6
Epidemiological Analysis: Chronic Health Problem
Assignment
Purpose
The purpose of this assignment is:

Integrate knowledge and skills learned throughout the NR503 course
Direct application of course objectives utilizing epidemiological analysis of a chronic health problem, along with state and national level data.

Activity Learning Outcomes
This assignment enables the student to meet the following course outcomes:

See weekly outcomes from Weeks 1-6.

Due Date
This assignment must be submitted by Sunday, 11:59 p.m. MT at the end of Week 6.

Total Points Possible
This assignment is worth 200 points.

Preparing the Assignment
Requirements
This paper should clearly and comprehensively discuss a chronic health disease. Select a topic from the list provided by your course faculty.

The paper should be organized into the following sections:

Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the paper’s content. No heading is used for the Introduction per APA’s current edition.
Background and Significance of the disease, including Definition, description, signs, and symptoms. Incidence and prevalence of statistics by state with a comparison to national statistics pertaining to the disease. If, after a search of the library and scholarly databases, you are unable to find statistics for your home state or other states, consider this a gap in the data and state as much in the body of the paper. For instance, you may state something like, “After an exhausting search of the scholarly databases, this writer is unable to locate incidence and/or prevalence data for the state of…” This indicates a gap in surveillance that will be included in the “Plan” section of this paper.
Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
Epidemiological Analysis: Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 W’s: What, Who, Where, When, Why. Use details associated with all of the W’s, such as the “Who” which should include an analysis of the determinants of health. Include costs (both financial and social) associated with the disease or problem.
Screening and Guidelines: Review how the disease is diagnosed and current national standards (guidelines). Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost.
Plan: Integrate evidence and provide a plan for how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility are useful?) Note:  Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts. All interventions should be based on evidence connected to a resource, such as a scholarly piece of research.
Summary/Conclusion: Conclude in a clear manner with a brief overview of the key points from each section of the paper utilizing the integration of resources.
The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
Adhere to all paper preparation guidelines (see below).