List and briefly describe two health services organizations that support health-related policy implementation and evaluation activities. What are your thoughts about their effectiveness? What are your recommendations for improving their efforts? 

Should be supported by at least two references. 

At least 250 words

 Respond 1

Impetigo

 The purpose of this discussion is to review impetigo. Impetigo can be mistaken for other skin conditions such as herpes simplex. Therefore, it is necessary to accurately identify what it is. Impetigo is a skin disorder that is superficial in nature. It can spread from person to person and on other parts of the body (Centers for Disease Control and Prevention [CDC], 2020).

Pathophysiology

 The main form of transmission is direct contact. The infection is caused by bacteria (CDC, 2020). Staphylococcus aureus is the main causative agent in older children. Group A beta-hemolytic streptococci also causes impetigo (Hubert & VanMeter, 2018). Interruption in the skin barrier allows the bacteria to access fibronectin receptors in the skin, which is needed for colonization (Nardi & Schaefer, 2020). Infection is further spread by itching due to the irritable nature of the lesions. Autoinoculation with hand creates more vesicles (Hubert & VanMeter, 2018).

The Most Common Presenting Symptoms

            Impetigo can be found on any part of the body (CDC, 2020). However, it is mostly seen on the face (Hubert & VanMeter, 2018). Small red vesicles quickly become larger. The vesicles break open and forms a yellowish-brown crust. Liquid with honey colored appearance is seen under the crusts (Hubert & VanMeter, 2018).

Routinely Diagnosed

 Impetigo is diagnosed by initial observation of an abnormality in the skin during a physical exam. The diagnosis can be confirmed with a bacterial culture, especially if there is an epidemic or if methicillin-resistant staph aureus (MRSA) is a concern. A biopsy of the skin can be obtained in some cases of untreatable impetigo (Nardi & Schaefer, 2020). Serologic testing for streptococcus antibodies is not done since anti-streptolysin O (ASO) response is not strong enough for diagnosing impetigo in this manner. Nonetheless, it can be used in conditions where

post-streptococcal glomerulonephritis is questioned for patients who had a new outbreak of impetigo (Nardi & Schaefer, 2020). Otherwise lab testing is not needed (CDC, 2020).

Standard Treatment Plan

 Impetigo is managed with antibiotics since it is a bacterial infection. Administration of antibiotic drugs is needed in cases where the infection is extensive. Otherwise the topical cream is prescribed when the infection is in a mild state (Hubert & VanMeter, 2018). If left untreated, the infection will resolve on its own. However, treatment with antibiotics decreases complications (Nardi & Schaefer, 2020). Prior to applying topical antibiotic cream, soap and water should be used to remove the crust. The treatment of choice with antibiotic cream are mupirocin, retapamulin, and fusidic acid. Otherwise, preferred treatment with systemic antibiotics are amoxicillin-clavulanate, cephalosporins, dicloxacillin (Nardi & Schaefer, 2020).

Link(s) to Routine Screening and Treatment Guidelines

 National screening guidelines for impetigo was not found. However important facts that can benefit both patient and the Advanced Practice Registered Nurse (APRN) are provided in the link below. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/impetigo.aspx

Additionally, Kwak et al. (2017) provided a detailed summary of recommendations for skin and soft tissue infection including impetigo, which can be accessed in the reference.

Treatment guidelines for impetigo is provided in the link below. Clinical features are included.

https://medicalguidelines.msf.org/viewport/CG/english/impetigo-16689666.html

Respond 2

 Atopic Dermatitis

Atopic dermatitis, or eczema, is a chronic disease that causes skin inflammation, erythema, and extreme pruritus. It is a common disease that usually appears in babies and children and resolves before the teenage years, but anyone can get it, and some adults continue to have symptoms (NIAMS, 2019). Although from appearance it looks like it could be spread from person to person contact, atopic dermatitis is not contagious. No one knows what causes atopic dermatitis, but it seems to have a genetic component. Treatment can help control symptoms, but depending on severity of symptoms, living with the disease may be hard for some (NIAMS, 2019).

Pathophysiology

The pathogenesis of atopic dermatitis is not entirely understood, but there appears to be a link between defects in “skin barrier function, immune dysregulation, and environmental and infectious agents” (Kapur et al, 2019). In individuals with atopic dermatitis, defective immune responses may contribute to susceptibility to increased bacterial and viral infections; the infectious agent most often seen is Staphylococcus aureus (Kapur et al, 2019).

Signs and Symptoms

Incessant pruritus is the main and most debilitating symptom and diagnosis of atopic dermatitis (Kim, 2020) . The extreme itchiness is worse at night and often impedes sleep for sufferers. The dryness and itchiness of the skin causes the person to scratch, which worsens the itch, which worsens the scratching, and the vicious cycle continues (Cole, 2020). Other signs and symptoms of atopic dermatitis include dry, red, inflamed, scaly, discolored skin.

Diagnostic criteria

There are no specific diagnostic tests for AD. Diagnosis of the disorder is based on specific criteria that consider the patient’s history and clinical manifestations (Kim, 2020).

Treatment

The goal of treatment options is restoration of the protective skin barrier, which includes hydration and restoration of the skin, limiting itching, and decreasing inflammation (Kapur et al, 2018). Successful management entails education, good skin care and hygiene practices, anti-inflammatory treatments with topical corticosteroids (first-line) and/or topical calcineurin inhibitors (TCIs), and the treatment of skin infections, if warranted (Kim, 2020).

Interesting Tidbits

Atopic dermatitis and asthma are diseases that are both associated with inflammatory responses in the body. Studies suggest that there is a strong likelihood between having eczema as a child and developing asthma as an adult (Cherney, 2020). I am not sure how true it is, but my doctor has told me that there is a well-known correlation in patients with the triad of asthma, allergic rhinitis, and eczema and high IQ levels.

Scholarly APA responses atleast 2 , 8-10 lines 

Resonds 1

1. Has your community been directly affected by gun violence/mass shootings? Discuss the affects you have noted.
   My community has not dealt with any mass shootings, but gun violence and shootings are common in the metro area. We don’t have frequent shootings, but they have increased in recent years. Suicide by gun is also most common method for suicide in my community.
2. Discuss what you believe to be the greatest risk factor(s) in your community that could be associated with a potential for violence.
   Risk factors in my community are drug use and gun availability due to it being a big hunting community. Also being a farming community, the stress of farming and middle age men is a risk factor for suicide.
3. What are your thoughts about the Predictive Firearm Violence Risk Scale?
   The Predictive Firearm Violence Risk Scale is a scale that developed to determine future firearm violence in an area or from an individual (Bakes, 2017). The scale goes over different criteria and determines points for each criterion based on severity. Serious fighting with in the past 6 months, friend weapon carrying, community environment, and firearm threats are all areas assessed in the 10-point SaFETy score. Each 1 point was associated with an increase in the risk for future firearm violence (Bakes, 2017).
4. Will you use this scale in your practice? Why or why not?
   I think this is a good starting point scale to use during an assessment of a patient after determining accessibility of firearms for the individual. This determines risky behavior that may lead to firearm violence (Goldstick, et al., 2017).
5. What type of changes has your community made to help improve safety?
   My community has incorporated gun safety classes as well as education for safe gun storage. There is also more education on mental health and suicide that has helped people assess accessibility to different methods of suicide. With guns being number one method in our community, gun education has been a huge topic for safety.  
6. What are your thoughts about the Columbine shooter’s mother’s TED Talk?
   I can not image grieving the loss of a son to suicide after not knowing he was dealing with a mental illness as well as dealing with a community mass shooting and guilt he caused before his suicide. I think it is amazing that she took this experience and is educating people regardless of the attacks and guilt she has felt from the actions of her son. Getting information out to the public on mental illness and the ways that it can contribute to violence and risky behavior is vital to ending mass shooting and suicides. It is true that many times loved ones do not know that someone close to them is dealing with mental illness and contemplating suicide. Being aware of the warning signs and actions displayed by the individual can help prevent suicide and other violence towards others (Parekh, 2018).

Response 2

 Gun Violence and Mass Shooting

The United States of America represents one of the world’s developed countries that the rate of gun violence has substantially elevated. Within the gun violence, mainly homicides, contribute to disparities in life expectancy between white and minority group African American (Ludwig, 2017).
This discussion aims to elaborate on gun violence, mass shooting, and to answer the following questions:
1. Has your community been directly affected by gun violence/mass shootings? Discuss the effects you have noted.
2. Discuss what you believe to be the most significant risk factor(s) in your community that could be associated with violence.
3. What are your thoughts about the Columbine shooter’s mother’s TED Talk?

Gun violence/Mass shootings lead to many consequences including physical, social, psychological, and mental on the victims and the witnesses lastly economic where the victims would face the loss of wage, medical bill, and the need to adapt to a new lifestyle. In the US, this act of violence is currently categorized as a public health crisis that has a critical impact on the taxpayers, and the average cost per American is $700 a year. Overall, Gun violence/mass shooting cost America $ 229 billion a year which, 8.9 billion costs directly to the aftermath and half of this amount go for prison cost and indirectly 221 billion which over half of them would be used to the impacts on the quality of life of the victims. (Follman et al., 2015) A study was done between 2008-2017, published in 2019 by The Center of American Progress (2020) on gun violence in America related to a state-by-state analysis. Massachusetts ranked the first state with the lowest gun suicide rate in the United States of America.

Furthermore, “The Spirit of America” was placed after Hawaii, the second state with less gun death rate. This result could explain that Massachusetts’s laws create several obstacles that make the licensing and buying process far more difficult for people with ill intent. Nonetheless, this public health crisis is still a concerning issue in the state. The following impacts could be noted: deadly consequences on children and teens, it creates new anxieties for the younger generation of students in school mass shooting, affected more individual in the city that rural areas, disproportionately affected black, Hispanic and teens, when witnessed violence children are harmed in multiple ways (physical, mental, psychological and psychiatric (Everytown, 2020). Based on the statistic data related to Massachusetts gun Violence, its Model has been praised by different state and with the extreme risk protective order (ERPO) bill which stands as a court-issued civil order that prevents gun tragedies by reducing access to guns for the individual at elevated risk of endangering themselves and others (MCPV, 2018).

Several factors could contribute to gun violence or mass shooting, multiple studies have shown those factors dependents and or independents including jealousy, mercy killing, fight (argument, conflict, brawl, between two persons and intervener assisting victim), stressors (disaster, loss of housing, financial struggle, job issues, civil legal problems, criminal legal problems, traumatic anniversary, physical health, interpersonal related to family, violence perpetrator, violence victim, social network), Suicide ( thoughts, intent, attempt), substances abuse ( drugs, alcohol) and substance involvement, depressed mood, mental illness (Schwab-Reese & Peek-Asa, 2017 ). As some contributing factors, such as Antecedent of gun Violence and developmental issues followed by the antecedent of gun violence related to gender and culture, is more resistant to change with the gun accessibility (APA, 2013).

After analyzing the gun violence in Massachusetts, besides its role model in this emerging public health crisis in the United States of America. Two majors factors that could elaborate as follow:
1- Individuals at elevated risk to endanger themselves and others (mental illness, behavioral challenges, victims, stress unbalanced)
2- The accessibility to guns. Although the proximity with other states (Vermont, Maine, New Hampshire) that allow easy access to guns could interfere with Massachusetts’s safety and security policies.

Dylan’s mother, who stood for the shooter’s mother after healing and to keep healing herself from his son shooting in Columbine High School in Colorado, where he killed 13 people and wounded more than 20 and lastly killed himself, she decided to help others and become an advocate for gun violence. Based on her presentation, she has described gun violence and mass shooting as severe problems that everyone should pay attention to. This event associated with physical, mental, psychological consequences affect the victims, directly and indirectly, the witness and related family to the individual. She learned that mental illness and some form of depression associated with easy access to guns and some social, environmental disposition could contribute to the mass shooting. Until the crime, she thought that she knew her son enough, but realized two years ago his son was dealing with a severe depression that made him feel that killing people would grant him to commit Suicide. She has paid the impact of this event towards multiple diseases such as breast cancer, depression, anxiety, insomnia, isolation, and the worst was she fells that she would feel better if she could end her life. With a motivation to know and understand better, she decided to find help for her trauma, redefined herself, and decided to help others by educating them on mental health, access to guns as well presented her apology to every that her son might hurt directly and indirectly.
 

Scholarly references atleast 2, 8-10 lines each.

Quality of Care

As the role of advanced nurse practitioners continues to increase in providing care to patients who are hospitalized, the necessity of measuring and monitoring the impact of their care on outcomes of patients and quality of care increases as an aspect of performance evaluation (Quatrara & Dale Shaw, 2017). This paper purposes some of the outcome measures that are currently in use.
• Effectiveness of Care
This metric looks into the NP’s compliance with the guidelines of best practice and the achieved outcomes, such as reduced rates of readmission. The best patient outcomes can only be achieved by keeping the best practice guidelines up-to-date, given the increasing technological changes in healthcare. Tracking of compliance of an APN with the given guidelines is very critical. This also goes for monitoring of treatment outcomes and alerting the NPs when a review of the guidelines needs to be done (Quatrara & Dale Shaw, 2017).
• Readmissions
This is a very significant outcome measure following hospitalization, which proves to be very costly. The performance of how the NPs reduce readmissions should be evaluated to enhance the timeliness and accuracy of data for making informed decisions (Quatrara & Dale Shaw, 2017).
• Time to consultation or treatment
This is an outcome measure that determines the time delays in giving and receiving services to the patients. An APN should keep this to a minimum by ensuring that each contact of the patient under her care and the physician is properly managed by an efficient patient flow system for scheduling visits and for providing the clients with notifications with regard to the projected waiting times. Also, emergency situations that demand quick intervention can be identified and acted on within the shortest time possible. An APN can reduce the long waiting times for her patients during follow-up visits. Overcrowding of clinical settings results in increased length of stay, mortality rates, and costs of admission (Hsueh & Dorcy, 2016).
• Patients’ experience
Patient-reported outcome measures (PROMs) fall under this category of outcome measure. They are used to evaluate the perception and experiences of patients of their healthcare from APNs. This can help determine the level of patient satisfaction and feedback with regard to what can be improved and to enable a quicker response to the identified issues. Patient experience can be used as a measure of balance for work improvement (Hsueh & Dorcy, 2016).
• Cost of care
Evidence shows that nurse practitioners have continuously demonstrated to be cost-effective providers of high-quality healthcare for the past 50 years (Woo et al., 2017). They offer an enhanced equivalent level of medical care at a reduced cost as compared to the physicians. Studies show that APNs in a physician practice reduced the costs of patient visits by approximately one-third, especially when seeing the patients independently (Woo et al., 2017). The cost-effectiveness of a nurse practitioner is not reliant on actual price setting and is shown in acute, primary, and long-term care settings. These reduced costs also apply to the management of health for the elderly population.

References
Hsueh, M. T. F., & Dorcy, K. S. (2016). Improving Transitions of Care with an Advanced Practice Nurse: A Pilot Study. Clinical Journal of Oncology Nursing, 20(3).
Quatrara, B., & Dale Shaw, K. (2017). Selecting advanced practice nursing outcomes measures. Outcome assessment in advanced practice nursing. New York, NY: Springer Publishing Company, 45-58.
Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 63.

 Subject Code and Name PUBH6005 Epidemiology
Assessment Assignment
Individual/Group Individual
Length 1000 words (+/- 10%)
Learning Outcomes This assessment addresses the following subject learning outcomes:
• Differentiate between different types of research designs, including observation and experimental and mixed methods designs
• Assess levels of evidence and make recommendations
Submission Week 6 Sunday 11:55pm AEST
Weighting 30%
Total Marks 100 marks
*Please Note: This time is Sydney time (AEST or AEDT). Please convert to your own time zone (eg. Adelaide = 11:25pm).
Context:
This assignment covers learning topics from Module 2.1 and 2.2
PUBH6005: Epidemiology Assignment
This assessment is aimed at consolidating the students understanding of Module 2 content
By prescribing this assessment, students are able to reflect on their understanding of study design, sampling and population risk
Instructions:   https://charteredessay.com/pubh6005-epidemiology-assessment-assignment-individual-group-individual/
This assignment has two parts. PART 1 involves reading three research articles, and applying what you have learned about epidemiological measures and study design to answer a series of short answer questions. PART 2 requires you to consider several health issues and decide the most appropriate study design for investigating that health issue.
Students are to log in to their Blackboard account and complete the assignment in the prescribed link on the Blackboard page.
PART 1
The Whitehall study is a ground-breaking longitudinal (prospective cohort) study that clearly demonstrated the association between social determinants of health (the social gradient) and morbidity and mortality (cardiovascular disease) in a population of British civil servants (Breeze et al., 2001; Chandola et al., 2008; Marmot et al., 1978).
Read these papers and answer the following questions.
1. What is the sampling frame for each phase of the Whitehall study (Whitehall I and II)? (5 marks)
2. How was disease risk assessed (both in data collection and analysis) in each of the three studies and why? (15 marks)
3. To what extent can the results of each of the three studies be generalised to other populations (include reasons for your answer)? (10 marks)
4. Would it be feasible to conduct a similar study in Australia using an existing cohort such as the 45 and up study cohort or the Australian Women’s longitudinal study cohort? Why or why not? (20 marks)
PART 2
For each of the following scenarios identify the best study design to explore each health issue and explain your reason for choosing this study design. Include an explanation of advantages and disadvantages of using the selected study design and include any ethical considerations. Support your reasons with justification and referenced examples of research studies.
1. Causal relationship between lung cancer and smoking (10 marks)
2. Association between depression and binge eating in a population of obese adolescents and adults (10 marks)
3. Long term effects of detention on the mental and physical health of asylum seekers (10 marks)
4. Relationship between folate supplementation during pregnancy and development of autism in offspring (10 marks)
5. Testing of a drug for use in elderly people diagnosed with Alzheimer’s disease (10 marks)
Submission Instructions:https://studenthome.work/nrsg266-unit-outline-learning-outcomes-lo1-critically-analyse-the-concept-of-healthy/
Access assignment link on Blackboard under Assessment 2 – Assignment via Assessment in main navigation menu in Blackboard. The assignment questions are embedded in Blackboard and you can submit your answers directly into Blackboard.
Assessment Criteria:
• Knowledge and understanding of the appropriate use of epidemiological study designs
• Analysis and application with synthesis of new knowledge to the strengths and weaknesses of different epidemiological study designs
• Analysis and application with synthesis of new knowledge of study design characteristics to select the most appropriate to the study question
• General assessment criteria:
o Shows a sophisticated understanding of the key issues o Shows ability to interpret relevant information and literature in relation to chosen topic
o Demonstrates a capacity to explain and apply relevant concepts o Shows evidence of reading beyond the required readings o Justifies any conclusions reached with well-formed arguments and not merely assertions
• Correctly uses academic writing, presentation and grammar:
o Complies with academic standards of legibility, referencing and bibliographical details (including reference list)
o Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction
o Uses appropriate APA style for citing and referencing research