NR 503 week 3 discussion Epidemiology

Week 3 Discussion

This week we will explore current events related to epidemiology. You will present a scientific article to the class. Please focus on interpreting the research question, methodology, results, and conclusions from a sample of peer-reviewed scientific literature. Please be sure the article is related to epidemiology, summarizing its contents for the class, and providing a succinct written summary. Current events must have been published within the last six months. Written summaries should include:

State the objectives of the study

The primary focus of this study was to evaluate the molecular characteristics of influenza B viruses circulating in a region of Lombardia in Northern Italy, during the influenza season of 2015–2016 (Piralla et al., 2017). Influenza B virus is compiled of two main strains including Victoria and Yamagata (Piralla et al., 2017). Vaccines have been recommended as the best option for combating the disease however in the past only one of the lineages was included for the B virus (Piralla et al., 2017). Due to costs, limited vaccines are still utilized while certain countries are providing more advanced vaccinations called quadrivalent (Piralla et al., 2017).

Summarize the study design and findings

Nasopharyngeal swabs were collected for patients exhibiting flu-like symptoms at two pediatric hospitals in Northern Italy (Piralla et al., 2017). Children under 8 years of age required parental consent and children above 8 years of age gave written consent for the research study (Piralla et al., 2017). Influenza is characterized as a respiratory illness of sudden onset with a fever (38 degrees Celsius) accompanied by at least one general symptoms including headache, malaise, fatigue, body aches or chills (Piralla et al., 2017).

“Respiratory samples were extracted using the QIAsymphony1 instrument with QIAsymphony1 DSP Virus/Pathogen Midi Kit (Complex 400 protocol) according to the manufacturer’s instructions (QIAGEN, Qiagen, Hilden, Germany).” (Piralla et al., 2017, p.8)

A total of 763 children (416 males, 54.5%; median age, 4.3 years; age range, 3 months to 14 years) with ILI were enrolled, and their nasopharyngeal samples were collected. We obtained 523 samples from Milano and 240 from Pavia. Among them, 137 (17.9%) tested positive for influenza viruses, 66 (48.2%) for influenza A and 71 (51.8%) for influenza B. None of the enrolled children had received the seasonal influenza vaccine prepared for the 20015–2016 season

(Piralla et al., 2017, p. 13).

The strain of B virus most commonly found was of Victorian lineage, which was not included in the vaccination of that year or the previous year (Piralla et al., 2017). The recommendation is to include both major strains of the influenza B virus, creating larger coverage for possible epidemics (Piralla et al., 2017).

Piralla, A., Lunghi, G., Ruggiero, L., Girello, A., Bianchini, S., Rovida, F., & … Esposito, S. (2017). Molecular epidemiology of influenza B virus among hospitalized pediatric patients in Northern Italy during the 2015-16 season. Plos One, 12(10), e0185893. doi:10.1371/journal.pone.0185893

• Provide a reference of the article

Provide your opinion on how the “average” reader will respond to the article. Will the article influence decision making or thinking? Does the article leave out any important information?

With any science research article, the average reader is going to struggle with staying attentive unless they have an assignment including this or a personal interest. The article dives deep into the statistics and I wish this was explained more clearly and concisely. When I first started my bachelors program of nursing I never felt confident reading these science research articles. I feel more confident in my ability to skim, and retain the important information the authors are trying to provide. The year of 2015-2016 was examined without any vaccinations given, and I would include the following year including the same area with children who were vaccinated to provide further clarification of efficiency. I think the average reader will gain appreciation for the difficulty of acquiring productive vaccinations and finding the right strains to prevent.

Piralla, A., Lunghi, G., Ruggiero, L., Girello, A., Bianchini, S., Rovida, F., & … Esposito, S. (2017). Molecular epidemiology of influenza B virus among hospitalized pediatric patients in Northern Italy during the 2015-16 season. Plos One, 12(10), e0185893. doi:10.1371/journal.pone.0185893

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Frank Levandowski III

Dr. Stoffers and Class,

A current event that requires investigating is overdose deaths due to prescription opioid and non-prescription opioid. Opioid overdose deaths have been declared an epidemic by the Centers for Disease Control (CDC).  In 2016 opioid-related death, this includes prescription opioids, fentanyl and heroin have accounted for over 42,000 deaths in the United States (CDC, 2018).  All information below is from the article increases from 2002-2015 in prescription opioid overdose deaths in combination with other substances (Kandel, Hu, Griesler, & Wall, 2017). This study objective was to see if an increase in prescription opioid has caused an increase in opioid overdose deaths and with hope to provide insight on future preventative measures.  An analytic observational study was used, statistical information was gathered from the National Multiple-Cause-of-Death Files from 2002-2003 and 2014-2015 on overdose deaths. Data was gathered on all opioid death from 2002-2003 and 2014-2015 in the United States.  Then the information was placed into groups of overdoses caused by benzodiazepines, antidepressants, heroin, alcohol, cocaine and a category of any the five substances.  The information was also divided into ages 18-34, 35-49, and greater than 50, sex, and race whites, African-Americans, and Hispanics. 

Results showed an overall in prescription opioids increased by 2.6 times and a huge 5.6 increase in non-prescription opioids (Kandel, Hu, Griesler, & Wall, 2017).  When comparing age-related deaths 18-34-year-old increases included heroin 4.6 to 23.1, benzodiazepines 17.0 to 26.5, alcohol 8.6 to12.3, and a decrease in antidepressants and cocaine (Kandel, Hu, Griesler, & Wall, 2017).  Deaths for ages 35-49 increases were similar with heroin 4.6 to 15.3, benzodiazepines 16.9 to 28.6, alcohol 9.2 to 14.8, and a decrease in antidepressants and cocaine (Kandel, Hu, Griesler, & Wall, 2017).  Deaths for ages 50 and older increased alcohol 7.0 to 14.0, heroin, 5.1 to 9.4, benzodiazepines 16.7 to 28.7 with the same decrease in antidepressants and cocaine (Kandel, Hu, Griesler, & Wall, 2017). Deaths by gender, with prescription opioids, showed no difference, however, non-prescription showed males to be at a 70% higher because of heroin use (Kandel, Hu, Griesler, & Wall, 2017).   Female deaths showed a higher rate than males when combining all categories because of benzodiazepines (Kandel, Hu, Griesler, & Wall, 2017). Total deaths by race all increase with African-Americans 11.8% higher, whites 5.2% and Hispanics 7.6% (Kandel, Hu, Griesler, & Wall, 2017).  With heroin in first place again by a lot in all three races and benzodiazepines and alcohol a close second with antidepressants and cocaine showing a decrease (Kandel, Hu, Griesler, & Wall, 2017). 

The study was unable to give numbers of the percent of deaths caused by prescription opioids because the data does not distinguish deaths by medical or non-medical use.  The study did provide information on prescription opioid did increase by 8%, with 2002 75 million to 81 million in 2014 (Kandel, Hu, Griesler, & Wall, 2017). However, with the increased population within the United States from 288-319 million, provides insight of prevalence of persons prescribed opioids actually decrease from 26% to 25.4% (Kandel, Hu, Griesler, & Wall, 2017). 

What I believe most readers will conclude after reading this article is that the problem is with street drugs, not prescription medication.  This article did not provide enough data to separate the deaths by prescription medication and non-prescribed medications.  Benzodiazepines and antidepressants need a prescription; however, this does not mean the persons who overdosed on them had a prescription.  To the general public, it would seem as there is no problem with prescription medication as a cause of overdose deaths.  I believe the study did not provide the correct data to be able to meet the objective pertaining to prescription medication.  I do believe it provides shocking data to help offer insight on future preventative measures on drug abuse.

Melissa,

I really appreciate the amount of detail you put into describing the study. The major consensus is understanding there is a problem. I think people assume there is one answer to the problem when the problem is like a tree with many branches. There really is not a root of the problem, but the answers supplied can attack the tree branches. This helped create an understanding of increased use of drugs in general, where opiates take the main notice from the media and other people. Working in the ER I have seen a few young deaths due to opiates. The number of benzodiazepines taken to cause death is more difficult to approach than opiates. I personally believe the decriminalization for drugs would help in many ways, because jail time for addicts does not help. Rehab can be offered and supportive services. Another interesting take was to stop calling addiction a disease when really it is not. When I was in nursing school I watch a new documentary on describing the victimizing mindset of addiction when this can be cured or stopped. Someone with congestive heart failure does not simply cure the illness from stopping something. Again, the most important factor is the public is continuing to gain an understanding to how important the drug, substance abuse, suicide issue is in America.

Frank

Frank, thank you for your post. It sounds like a great research article. What are your thoughts on children over the age of eight giving their own consent? I find it very intriguing that under the age of eight, parental consent was necessary but over the age of eight, it was not. Very interesting. 

Dr. Patti Stoffers

Dr. Stoffers,

I think defining an age of consent is difficult, because every child develops uniquely, but a standard has to be set. In one instance the legal age of independent consent for research studies in Canada is age 14 (Knoppers et al., 2016). In the Netherlands the legal age of consent is 12 for research, but the parents must consent as well (). My girlfriend is a pediatrician resident and provides an insight into the pediatric struggles. I see children in the ER (emergency room) I work in, however much more limited compared to a pediatric ready hospital. I agree with the age of consent at 8 years of age and older being the correct age of consent. A child develops to be able to understand the pros and cons of a procedure plus multiple people are involved in the discussion prior to an answer being selected.

Knoppers, B. M., Senecal, K., Boisjoli, J., Borry, P., Cornel, M. C., Fernandez, C. V., & … Wright Clayton, E. (2016). Recontacting pediatric research participants for consent when they reach the age of majority. (cover story). IRB: Ethics & Human Research, 38(6), 1-9.

Frank Levandowski III

(Knoppers et al., 2016)