The global health issue which I have chosen and has affected the international health community is Zika Virus.

Comment 1

The social determinants of health refer to the social and economic conditions that determine an individual’s health and medical well-being. Economic and social conditions are variedly distributed amongst people and they affect people’s working and living conditions differently. The social determinants of health affect an individual working and living conditions.   Social determinants are informed by public policies that mirror the political ideologies of the people in authority. Economic conditions determine the social conditions of a community. People who live in affluent areas are more content with their lives and they are mentally and physically healthier than people who are not content with their social status. Poor people generally are less healthy and have shorter life expectancies as compared to rich people.

This differences in health are social injustices and they illuminate powerful health determinants in the modern world. The differences have allowed an increased understanding of how remarkably sensitive health issues are in the social environment. Social determinants contribute to the development of diseases in that poor people are generally more exposed to pathogens than the rich. They eat and drink contaminated food and water, the share amenities and they have no easy access to medical attention.

According to the epidemiologic triad model, the repeated interaction of a disease-causing agent on their host in a conducive environment results in the spread of infectious diseases (CDC, 2014).  The pathogen leaves its host and enters another potential host through a relevant portal.  The pathogen thrives and multiplies in its habitat in what is referred to as a chain of infection (WHO, 2014). Understanding the various transmission channels and exit portals enable a care provider to know the best cause of prevention and treatment. Control measures are typically employed in the section of the infection chain that allows easy intervention.  For instance, in the treatment of a bacterial respiratory infection, a nurse can administer antibiotics to a patient. A nurse can also wear protective gear such as masks and gloves to protect them from getting infections by touching infected bodily fluids.

Comment 2

The global health issue which I have chosen and has affected the international health community is Zika Virus. It is a virus, which is spread by mosquito popularly known as Aedes species of mosquito. The said species of mosquito can bite both during the day and night.  An issue of concern about Zika virus is pregnancy. The virus can pass through placenta thereby leading to birth defects. Zika virus can also be spread through sexual intercourse or sexual acts (Salazar, 2016).  Unfortunately, Zika virus does not have a vaccine. Some of the symptoms of Zika virus include headache, fever, joint pain, rash, muscle pain and red eyes. According to CDC, Zika virus symptoms can last for days or weeks. Death and hospitalization after Zika infection are very rare. After one is infected with Zika virus, immunity is built against infections in the future ((U.S.), 2018). Mosquitos, which spread Zika virus, can also spread chikungunya virus and dengue virus.

In the US, Zika infections have been reported in Florida and Texas states. On a global level, Zika infections have been reported in each continent except Europe and Antarctica. CDC already issued travel notices for regions including Asian nations of Singapore and Maldives, African countries of Guinea-Bissau and Angola, regions in Central America, Caribbean and Mexican regions such as Costa Rica, Belize, Guatemala, El Salvador, Nicaragua, Honduras and Panama. The CDC also reported other regions affected though it did not issue travel notices especially in Asia and Africa ((U.S.), 2018).

Health care delivery systems all over the world need to work together to address Zika virus especially by creating awareness and providing education on prevention of transmission to areas of risks. As said earlier, there is no vaccine for Zika Virus and they key here is the prevention of mosquito bites (Salazar, 2016). Travellers who are outside their home countries should be made aware of higher risk regions.  There is also need for safe sex practices to prevent Zika infections. CDC suggests the use of both male and female condoms to reduce Zika transmission through sexual acts.

Analyze salient ethical issues in child psychiatric mental health practice

Assignment 1: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

  • Analyze      salient ethical issues in  child psychiatric      mental health practice
  • Compare      ethical dilemmas with state health laws and regulations
  • Analyze      ethical decision-making processes

To prepare:

  • Review      the literature for moral/ethical issues encountered by a PMHNP
  • Select      one of the articles you found that      was published within the last 5      years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

  • Summarize the moral/ethical      issue in the article (no more than 1 paragraph).
  • Describe the moral and      ethical dilemmas surrounding the issue.
  • Analyze the ethical issue      and compare them to the state health laws and regulations in your state. Please use( Texas) law
  • Outline the process of      ethical decision making you would      use to address this ethical dilemma.
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    ControversiesintheuseofantidepressantsinchildrenandadolescentsAdecadesincethestormandwheredowestandnow3.pdf

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    Journal of Child & Adolescent Mental Health

    ISSN: 1728-0583 (Print) 1728-0591 (Online) Journal homepage: http://www.tandfonline.com/loi/rcmh20

    Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now?

    Soraya Seedat

    To cite this article: Soraya Seedat (2014) Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now?, Journal of Child & Adolescent Mental Health, 26:2, iii-v, DOI: 10.2989/17280583.2014.938497

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    Published online: 16 Jul 2014.

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    EDITORIAL

    Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now?

    As we focus in this special issue on new developments in diagnosis and treatment (with a particular emphasis on paediatric psychopharmacology), I thought that the time was opportune to pause and reflect on a potentially life-threatening medical condition in children and adolescents: Major Depressive Disorder (MDD). The prevalence of MDD in pre-pubertal children (2.8%) doubles after puberty (5.8% in adolescents 13–18 years of age), is twofold more preponderant in post-pu- bertal girls than boys, and is characterised by episodic recurrences in adolescence and adulthood. About half of all adolescents with current MDD will have a subsequent depressive episode over the next five years. Paediatric MDD is arguably the most important risk factor for suicide and, in fact, accounts for more than half of adolescent suicides. However, it is a potentially preventable and highly treatable cause of other psychiatric morbidity, alcohol and drug use, academic and social impairment, and disability. The World Health Organization has identified adolescent depression as one of the key priority areas for diagnosis and treatment in low and middle income countries, where the burden of the disorder is greatest. Timely recognition and treatment of youth is therefore critical. Over the past decade the use of antidepressants in children and adolescents has raised widespread public concern and debate. Despite the passage of time and the emergence of new evidence (including unpublished data), professional opinions among psychiatrists continue to be divided on issues of antidepressant effectiveness and safety. Currently, there are only two FDA (US Food and Drug Administration)-approved medications for the treatment of paediatric MDD: fluoxe- tine (for children and adolescents aged 7–17 years) and escitalopram (for adolescents aged 12–17 years). Additional evidence from randomised controlled trials (RCTs) indicates that sertraline and citalopram, in children 7–17 years of age, are also beneficial for the treatment of MDD but these agents are not FDA approved. Placebo response rates in trials of paediatric MDD exceed 30%, perhaps not surprising considering the multi-site nature of these RCTs and the inclusion of young patients with less severe depressive symptomatology.

    In pondering the evidence that guides the prescription of antidepressants in children and adoles- cents, it is prudent to take a trip down memory lane. In 2003 there were worrying signals from RCTS of paroxetine, indicating a lack of efficacy of this selective serotonin reuptake inhibitor (SSRI) relative to placebo in paediatric depression and an elevated risk of harmful outcomes that included self-harm and suicidal behaviour. The FDA and the UK Medicines and Healthcare Products Regulatory Agency (MHRA) subsequently issued health advisories warning about the increased risk of suicidality with antidepressants in this age group. The FDA then commissioned a widely publicised data review of antidepressant RCTs in child and adolescent MDD. Based on conclu- sions drawn from the review, the FDA requested pharmaceutical companies to include a ‘black box’ warning to the package labelling of all antidepressants about the increased risk of suicidality in children under 18 years (Isacsson and Rich 2014). No completed suicides had occurred in any of the RCTs that were reviewed. In 2007 this was extended to include young adults under 25 years of age. Around the same time, the Treatment for Adolescents with Depression Study (TADS), the first trial to compare the effectiveness of fluoxetine, cognitive behaviour therapy (CBT), their combina- tion, or placebo, in adolescents with MDD, found that fluoxetine was superior to placebo at three months. However, CBT was not superior to placebo. Over time the three active treatments (fluoxe- tine, CBT and fluoxetine + CBT) had comparable efficacy, in response and remission rates (March et al. 2004). Of note, the risk of suicidal ideation and attempts was low across all three treatments.

    http://dx.doi.org/10.2989/17280583.2014.938497 iii

     

     

    Further analysis of TADS data showed that both fluoxetine and combination therapy were at least as cost-effective in the short term as other treatments commonly used in primary care.

    The benefits of antidepressants for internalising disorders in youth were also supported by a meta-analysis assessing the efficacy of antidepressants and risk of reported suicidal ideation/ suicide attempts for treatment of paediatric MDD, obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders published in 2007 (Bridge et al. 2007). Antidepressants were superior to placebo and were associated with a 3% increase in suicidal ideation/attempts compared with a 2% rate on placebo. The antidepressant-placebo difference in risk of 1% was not statistically signif- icant and, more importantly, there were no completed suicides in any of the RCTs included in the meta-analysis.

    Further interesting (and confusing) data came to light. In the five years preceding the black box warning (1999–2003), there had been an increase in the diagnosis of MDD coupled with an increase in the use of SSRIs across all ages. However, in the five years following the black box warning there had been the opposite effect! There was a notable decrease in the diagnosis of depression and the prescription of antidepressants in countries such as the USA, UK, Sweden, Canada and Australia. More disturbing was an increase in the number of completed suicides in these countries (except UK where there was no difference). Notably, in a recently published study of all cases of suicide in 10–19 year olds in Sweden (Isacsson and Ahlner 2013) that included toxicology data on antidepressants taken immediately before death, there was a substantial increase in suicide cases in the five years after the warning. As this increase was notable in youth who were not on antidepressants, the authors have suggested that “these truly suicidal persons might have been denied antidepressants or abstained from them, due to the ‘black box’ and then committed suicide because of untreated depression” (Isacsson and Ahlner 2013: 6).

    So where do we stand with the numerous systematic reviews meta-analyses and new studies that have been published since the black box? First, it needs to be emphasised that there have been no completed suicides in any of the placebo-controlled RCTs of newer generation antide- pressants in children and adolescents. Second, the benefit–risk ratio for the use of antidepres- sants, more specifically fluoxetine, in children and adolescents with moderate-to-severe depression is favourable (Soutullo and Figueroa-Quintana 2013). Close observation and monitoring of youth before and following initiation of treatment, regardless of the type of treatment, should be part and parcel of routine care. Third, CBT or interpersonal therapy should be considered as a first-line in this age group, even in moderate-to-severe paediatric depression. Fourth, adding CBT to an antide- pressant does not appear to improve response in paediatric MDD in the longer term, challenging the often held notion that combining these treatments trumps giving either alone. Fifth, as adoles- cent MDD has a relapsing and remitting course continuing treatment for at least 6 to 12 months after acute phase treatment (antidepressant or CBT) has been demonstrated to prevent relapse. Finally, evidence that antidepressant treatments improving the quality of life among children and adolescents with depressive or anxiety disorders is inconclusive and more research is required in this regard. In summary, evidence relating to the risk–benefit profile of antidepressants is still contradictory and not much has changed since 2003. Closing the knowledge gaps in cost-effective diagnosis, treatment and prevention of child and adolescent MDD, using family based approaches, remains a priority.

    References

    Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA. 2007. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. Journal of the American Medical Association 297: 1683–1696.

    Isacsson G, Ahlner J. 2014. Antidepressants and the risk of suicide in young persons—prescription trends and toxicological analyses. Acta Psychiatrica Scandinavica 129: 296–302.

    Isacsson G, Rich CL. 2014. Antidepressant drugs and the risk of suicide in children and adolescents. Paediatric Drugs 16: 115–122.

    iv

     

     

    March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. 2004. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association 292: 807–820.

    Soutullo C, Figueroa-Quintana A. 2013. When do you prescribe antidepressants to depressed children? Current Psychiatry Reports 15: 366–373.

    Soraya Seedat Editor-in-Chief, Journal of Child & Adolescent Mental Health email: sseedat@sun.ac.za

    v

How would you explain the analysis of variance, assuming that your audience has not had a statistics class before?

Assignment1

How would you explain the analysis of variance, assuming that your audience has not had a statistics class before?

Assignment 2

What is an interaction? Describe an example and identify the variables within your population (work, social, academic, etc.) for which you might expect interactions?

Issues In Health Care Reform (Interview)

Assignment 1: Issues in Health Care Reform (Interview)

According to the AACN (2006), “Political activism and commitment to policy development are central elements of professional nursing practice” (p. 13). Throughout this course, you will hone the skills and competencies required for this type of involvement in policy.

Research is an essential step in the process of acquiring the skills and competencies, and interviews are one form of research that can serve as a valuable source of information. As such, this Assignment (which you will start this week, and submit by the end of Week 9) provides an opportunity for you to identify a health reform issue of interest and discuss the issue with a state or national politician (or their aide).

To prepare:

  • Identify      a state or national politician (state representative or legislator,      senator, congressman, governor, etc.), or aide, whom you would like to      interview regarding current issues in health care reform. (I live in the state of Maryland.      The 2 states senators are Chris Van Hollen since 2017 and Ben Cardin since      2007; the Governor name is Larry Hogan. You can also google any of the      information about the state of Maryland in the US)
  • As      soon as possible, contact the individual’s office to request a meeting.      Keep in mind that it may be difficult to get on their calendar, so plan      accordingly. You may conduct the interview in person or by phone.
  • In      advance of the interview, ask yourself:
    • What       health care policy issue is important to me personally?
    • What       issue do I want to bring to this person’s attention?
  • With      this in mind, develop your list of questions for the interview around your      selected health policy issue. In addition, you may wish to include      questions related to health care reform:
    • What       are your constituents most concerned about regarding health care reform?
    • What       are the trade-offs associated with recent health care reform policy?

To complete:

  • Write  a 3- to 4-page paper with at least 5 scholarly references providing a summary and analysis of the interview and the health care reform issues you discussed. Include an introduction and a conclusion.

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate (at least 5 references). Refer to the Publication Manual of the American Psychological Association to ensure that your in-text citations and reference list are correct.

This assignment is due by Thursday 04/26/18 by 10 pm.

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.

Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”

Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”

McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3(4), 242–244.

The PPACA of 2010 encourages the formation of accountable care organizations (ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains.

Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey begins. Health Care Financial Management, 64(8), 57–63.

This article provides information on the importance of health care provider organizations taking steps to become accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States.

Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine the Future of Nursing: Leading Change, Advancing Health report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/rights/index.html

This website introduces the Affordable Care Act and presents the timeline for implementation of the various provisions of the Act.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html

Read the full Affordable Care Act law at this website. An overview of the law is also provided along with an outline of how the Affordable Care Act helps reduce health insurance costs.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations. Baltimore: Author.

Note: The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Kathleen White explains the structure of accountable care organizations (ACO) and discusses the benefits and challenges of becoming an ACO.

Optional Resources

APRN Joint Dialogue Group Report. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from http://www.aacn.nche.edu/education-resources/APRNReport.pdf

Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15), 1715–1716.

Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. JHealth Affairs, 26, w44-w57. doi:10.1377/hlthaff.26.1.w44–57

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982–990.

Kaiser Health News. (2011). Accountable care organization proposed regulations: Resources. Kaiser Family Foundation. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The-News.aspx