NURS 4211/ 4210 WK 2 EPIDEMIOLOGY: DEFINE YOUR POPULATION AND SELECTED PROBLEM WALDEN

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The specific health problem I will be performing my project on is pediatric asthma, concerning preventing asthma attacks in children of elementary school age. It has been said that asthma is the “epidemic of the 21st century” (Mutius, 2020). Some studies suggest maternal nutrition and environment during pregnancy can aid with pediatric asthma prevention in their baby (Gur, 2017). Risk factors for asthma and asthma exacerbation are cigarette smoking (both maternal during pregnancy and second-hand smoke during adolescence), indoor dampness and molds, and even obesity (Mutius, 2020). Avoidance of these factors can prevent asthma from developing in children and can prevent the exacerbation of the disease itself.

           Of local data close to my community, there was a report published by The University of Texas at Austin stating that in 2021 children with asthma were 60% higher than the national average hospitalized due to asthma exacerbations (The University of Texas at Austin, 2021). Children with asthma, especially uncontrolled, tend to miss more school days. This can decrease the child’s chance of having academic achievements and positive interactions with other children and places stipulations on the child’s life regarding what they can and cannot do due to the risk of asthma attacks (Serebrisky, 2019). A Centers for Disease Control and Prevention (CDC) study found that children in Texas with asthma miss an average of 2.3 more school days than children without asthma (Texas Dept of State Health Services, n.d.). 

According to the Texas Department of State Health Services, almost 7% of children in Texas have asthma, which is more than 492,000 children (Texas Department of State Health Services, 2020). In 2018, Texas children with uncontrolled asthma accounted for more than 115,000 emergency room visits and 12,200 hospitalization total (Texas Dept of State Health Services, n.d.). Nationally, an average of 195 children die from asthma (Arroyo, 2017). In 2020, the CDC found 4,226,659 children under 18 have asthma (CDC, 2022). 

           Avoiding environmental triggers and taking necessary precautions is critical to prevent developing pediatric asthma or exacerbating the disease. For children with uncontrolled asthma, long-term effects of the disease include but are not limited to recurrent croup, middle lobe syndrome, recurrent pneumonia, and chronic obstructive pulmonary disease (COPD) (Trivedi, 2019). Families that have a child with asthma have many stressors to face: work and financial burden, stress, anxiety, and mental health (Foronda, 2020). 

           Multiple websites are being utilized for this project, such as the CDC, the Texas Department of Health and Human Services, the National Library of Medicine, and other scholarly research. I have also utilized the school nurse for information regarding asthma in children and what she has found to be true among the population. I will continue performing research to gain more knowledge about the subject. Pediatric asthma is an increasing issue in the community that needs to be addressed so children can grow to lead healthier lives.

References: 

Arroyo, A. C. (2017, Sept 29). Where Do Children Die from Asthma? National Data from 2003–2015. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876061/

CDC. (2022). Most Recent National Asthma Data. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Foronda, C. K.-P. (2020). Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review. Retrieved from Elsevier: https://reader.elsevier.com/reader/sd/pii/S0891524520300791?token=8C21A0EF669573CD0A8A95955CAB11C6F7E93CABB68E1ECBF72EE107A2FE03DA16B1B622D03B7C2FF796C9057E1C5ECD&originRegion=us-east-1&originCreation=20221207171008

Gur, M. H. (2017, Dec. 20). Better understanding of childhood asthma, towards primary prevention – are we there yet? Consideration of pertinent literature. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749133/

Mutius, E. a. (2020, Sept.). Primary prevention of asthma: from risk and protective factors to targeted strategies for prevention. Retrieved from Science Direct: https://www.sciencedirect.com/science/article/pii/S0140673620318614

Serebrisky, D. a. (2019, Jan 22). Pediatric Asthma: A Global Epidemic. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052318/

Texas Department of State Health Services. (2020). Asthma Program Home. Retrieved from Texas Department of State Health Services: https://www.dshs.state.tx.us/asthma/default.aspx

Texas Dept of State Health Services. (n.d.). Strategic Plan for Asthma Control in Texas, 2021-2024. Retrieved from Texas Department of Health and Human Services: https://www.dshs.state.tx.us/asthma/Documents/Asthma-Control-Strategic-Plan-2021-2024.pdf

The University of Texas at Austin. (2021, Oct 21). Asthma Hospitalization Rate for Kids in Travis County is Much Higher than National Average. Retrieved from The University of Texas at Austin: https://socialwork.utexas.edu/asthma-hospitalization-rate-for-kids-in-travis-county-is-much-higher-than-national-average/

Trivedi, M. a. (2019, June 25). Asthma in Children and Adults—What Are the Differences and What Can They Tell Us About Asthma? Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603154/

 For my research project, I started by working with my mentor to identify a growing problem in our community. She described the increase in osteomyelitis cases, and when I pressed for further information the common link was both males and females aged 40-50 with co-morbidities of obesity and diabetes. We know that obesity and diabetes are a growing problem nationwide, but for my project my aim is to determine how prevalent it is among that age group and to provide education in order to reduce the number of patients with obesity and diabetes.

            According to the CDC, the rate of obesity nationwide is 41.9%. Of this statistic, the highest prevalence was among adults aged 40 to 59, which accounts for 44.3% of the obesity rate (Centers for Disease Control, n.d.). Currently, the obesity rate in Alabama is 39%, which places Alabama as third in the nation (Alabama Public Health, 2022). According to a U.S. News World report (n.d.), approximately 32.5% of the population in Madison county where I reside are obese. That same report states that 10.6% of the Madison county population has diabetes.

            Nationwide, the current rate of those with type 2 diabetes is 1 in 10 with a median age of 45 (Centers for Disease Control, 2021). As of April of 2022, approximately 14.1% of Alabama residents have type 2 diabetes, an estimated 119,000 Alabama residents have diabetes and are unaware, and 34.6% of adults in Alabama are considered prediabetic (American Diabetes Association, 2022).

            In Alabama, the highest rates of obesity and diabetes are occurring in those with lower incomes and a lack of college education. In Madison county, the current number of those with both diabetes and obesity is 26.8% (Centers for Disease Control, 2022). Currently, there is limited data regarding what age ranges are most affected in this area. However, I anticipate that my research and survey will show that the most commonly afflicted age range will be those 40-50. In order to reduce the number of diabetes and obesity cases in Alabama, there will have to be a significant push for education. Even outside of socioeconomic status and education status, there is a culture in the South of “just deep fry it”, and oftentimes celebrations in the South include food. In Alabama, we have a culture of eating whether happy, sad, etc., and it will be very difficult to break people of those habits. However, obesity and diabetes can cause a catalogue of health issues, and it is imperative that we provide the education necessary to prevent both diseases.

         To gather statistics and research for this project, I will be relying on government websites such as the CDC, WHO, Alabama Department of Public Health, and any others that can provide the statistics and information necessary. Also, I will be utilizing my mentor for current information regarding what she is seeing in her clinic and in the hospital as it relates to obesity and diabetes. Another resource that I will be using is the Walden library, which is full of articles that will aid in my research.

References:

Alabama Public Health (2022). Obesity. https://www.alabamapublichealth.gov/obesity/#:~:text=CDC%20Data%3A%20Alabama%20Has%20Nation’s,highest%20position%20in%20the%20nationLinks to an external site..

American Diabetes Association (2022). The Burden of Diabetes in Alabama. https://diabetes.org/sites/default/files/2022-04/ADV_2022_State_Fact_sheets_all_rev_AL-4-4-22.pdfLinks to an external site..

Centers for Disease Control (n.d.). Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.htmlLinks to an external site..

Centers for Disease Control (2021). Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/type2.html#:~:text=Healthy%20eating%20is%20your%20recipe,adults%20are%20also%20developing%20it.Links to an external site..

Centers for Disease Control (2022). Alabama county diabetes incidence obesity. https://www.cdc.gov/diabetes/atlas/obesityrisk/dmincid/data_Alabama.xls.Links to an external site.

U.S. News & World Report (n.d.). How Healthy is Madison County? https://www.usnews.com/news/healthiest-communities/alabama/madison-county.

The health problem focus of my project will be diabetes in older adults in an adult day care center located in Fort Worth, Texas.

Diabetes is a prevalent condition among the elderly. About 20% of people have this disease by age 75 (Dr. Helard Manrique, 2022). Diabetes in older persons has a different metabolic profile than diabetes in younger patients, necessitating a different therapeutic strategy. Significant morbidity from macro- and microvascular complications is linked to diabetes. The aging of the population mainly drives the diabetes epidemic, as more than 25% of Americans under 65 years old have diabetes (Dr. Helard Manrique, 2022). Even though the effects of diabetes on working-age individuals are frequently discussed, diabetes in older adults is associated with higher mortality, decreased functional status, and an increased chance of institutionalization. Diabetes in older persons increases their risk of developing acute and long-term microvascular and cardiovascular problems.

To better understand and treat diabetes in older persons, new and growing information is available. Special considerations should be made to support general health and quality of life. Age-related diseases like cognitive impairment, cardiovascular disease, and others that affect diabetes education and care are frequently present in older persons. According to statistics, 33% of persons 65 and older have diabetes (ADA, 2022).

With a 40% spike in the past ten years, Texas has one of the highest rates of diabetes in older adults (txohc, 2022). The Texas Demographic Center projects that by 2040, approximately 8 million people will be living with diabetes, with a prevalence that might rise to 23.8% (txohc, 2022). Diabetes rates in Texas consistently outperformed the national average from 1999 to 2019. In 2019, 12.9% of Texans and 10.9% of all Americans had diabetes (txohc, 2022).

Helping diabetic patients acquire nutritious food more frequently is a recommended strategy for caregivers of diabetic patients. People who are food insecure are less likely to eat vegetables and less likely to switch to a diet low in fat, according to the National Diabetes Education program. Another finding showed a correlation between food insecurity and average fast food and soda consumption of 24% and 142% higher, respectively (ADA, 2022). Food insecurity is also associated with a higher risk of obesity and BMI in patients. Therefore, adult Day Care Centers should focus on the dietary intake of the older people who visit them to ensure healthier lives.

Some of the websites and research that proved extremely helpful are mentioned below.

References

ADA. (2022). Statistics About Diabetes. Retrieved from https://diabetes.org/about-us/statistics/about-diabetes#:~:text=Diagnosed%20and%20undiagnosed%3A%20Of%20the,seniors%20(diagnosed%20and%20undiagnosed).

Dr. Helard Manrique, M. J. (2022). Diabetes and Older Adults. Retrieved from Endocrine: https://www.endocrine.org/patient-engagement/endocrine-library/diabetes-and-older-adults

M. Sue Kirkman, Vanessa Jones Briscoe, Nathaniel Clark, Hermes Florez, Linda B. Haas, Jeffrey B. Halter, Elbert S. Huang, Mary T. Korytkowski, Medha N. Munshi, Peggy Soule Odegard, Richard E. Pratley, Carrie S. Swift; Diabetes in Older Adults. Diabetes Care 1 December 2012; 35 (12): 2650–2664. https://doi.org/10.2337/dc12-1801Links to an external site.

txohc. (2022). Diabetes in Texas. Retrieved from txohc: https://txohc.org/communication/data-dashboard/diabetes/