Alzheimer Disease

Alzheimer Disease 

Magnolia's of Lancaster is a Senior Living Center for residents diagnosed with varying degrees of dementia. They offer a Memory Care Program for individuals with Alzheimer's Disease (AD) and dementia caused by blunt head trauma. I have the privilege of working there as a Resident Care Assistant assisting with ADL's and facilitating activities for the residents. It has been one of the most rewarding experiences I have ever had. These inspiring individuals who worked as teachers, nurses, and computer engineers have accomplished so many feats throughout their life but cannot remember their own success. My favorite part of my job is remembering it for them. Certain cues will help the residents remember parts of their life and it is so rewarding to see their faces light up as they relive one of their favorite moments. During our Christmas party this past year a resident who can barely speak was singing along perfectly with Jingle Bells. 

Of course there are many challenges associated with Alzheimer's Disease, one of them being the impact that the disease has on family members. It is heartbreaking to watch a resident have a conversation with their son or daughter without knowing who they are or how they know them. The devastating effects of the disease take a huge toll on family members. I found it inspiring that many of the managers and supervisors at Magnolia's of Lancaster had no previous professional experience with dementia or AD before they applied for the position but rather had personal experience with a parent or other family member who was diagnosed with AD. Individuals in the early stage of the disease are aware of what is happening to them and it terrifies them to witness other individuals suffering through the later stages. 

Similar to other mental illnesses, there was minimal amount of research done on AD until recently. Medication has been developed to slow the progression of the disease but there is a lack of scientific evidence for any preventive measures. As scientists develop a deeper understanding of the disease, they have started to make correlations between behaviors and have begun to identify protective factors and risk factors. 

The global prevalence of AD is estimated to be around 24 million and will continue to rise as the worldwide population continues to age. AD seems to be more prevalent in the United States compared to Africa, Asia and Europe which may have to do with methods of diagnosis. Some factors that are highly associated with AD include diabetes, smoking, hypertension and obesity. Education, increased leisure activity, a Mediterranean diet and more physical activity have been correlated with a decreased risk for AD. I find it incredible interesting that cognitive reserve can reduce an individuals risk for AD. Studies of "normal aging" indicate that higher educational or occupational attainment slow the progression of cognitive and functional decline. Although the etiology of AD remains unclear, Epidemiologists and Public Health professionals should be concerned with the genetic and environmental risk factors that may be associated with the disease. 

Traffic in the Dominican Republic

 Republic of the Dominican

This past winter break, I had the privilege of visiting Cap Cana in the Dominican Republic with my family. We had a beautiful time swimming in the Caribbean water, soaking up the sun and exploring the island. We ventured on a guided tour through "rural" Dominican Republic. We visited a local village where we met the teachers and school children before heading up to the top of a mountain to observe coffee bean production, cigar rolling and cocoa plants. I'm not convinced that we experienced the authentic Dominican lifestyle as the school was funded by the tour company and the farm on the mountain was owned and operated by affiliates of the company. Regardless, it was informational and we learned a lot about the culture of the Dominican Republic. 

Dominican Cocoa

Inside of a Cocoa plant

Cigar Rolling

Our tour guide talked a lot about how Dominican's make a living. Because of the tobacco, cocoa and coffee exports there is always opportunities in agriculture. Individuals will also commute from their villages for months at a time to work at resorts in Punta Cana, Cap Cana and the southern part of the Island as housekeepers and servers. Certain business laws prevent individuals from being able to purchase real estate for their business so many families sell products such as art and food right inside their own home. I noticed that residents of the Dominican Republic are always looking for ways to make money. Children will run up and down the beaches soliciting hats made from palm leaves and older gentlemen will sell wooden crafts. 

During the ride from our resort to the village, we traveled on main highways as well as dirt roads. The main roads were well-paved with lines drawn, traffic lights and for the most part people paid attention to traffic laws. Compared to the driving situation in India, it was much safer. I did notice 3, 4 even 5 individuals riding on motorcycles and several people riding in the flat bed of trucks. The passengers were almost exclusively men. Later on our tour guide mentioned that this is how some individuals earn a living in the Dominican. Many people commute to more urban areas for work or to other villages and don't have means of transportation. Therefore they rely on friends or family members to drive them there for a small fee. Our tour guide said that more often than not, the passengers are friends of the driver. They drove at or above the posted speed limit and none of the individuals wore seat belts. As discussed in class, this presents a major public health concern because of fatalities, medical costs, loss of productivity and implications on their village or family members. However, there is a lack of public transportation in the Dominican and residents must find a way to get back and forth from their job. Even if individuals were required to wear helmets or they restricted the passengers to 2, it would create a safer environment.

HIV/AIDS Testing Clinics

HIV/AIDS Testing 

Virginia Department of Health offers a wide variety of HIV awareness, prevention and testing programs:

HIV Prevention Among Communities of Color -  HIV prevention interventions within minority communities at increased risk for HIV infection. More than 30% of the grant award is for HIV prevention among Black and Latino men who have sex with men.  

 
AIDS Services and Education Grants - support outreach, innovative prevention interventions for hard to reach populations and supportive services for persons living with HIV, target transgender individuals.


 
Men who have Sex with Men HIV Prevention Program -addresses the disparity between the impact of the epidemic on gay and bisexual men and the amount of funding being targeted to this community.
 
African-American Faith Initiative - stemmed from request for faith-based HIV programs in minority communities.


Community HIV Testing Services- provides HIV antibody testing in outreach and non-invasive settings for men who have sex with men, injection drug users, sexual partners of these populations, high risk heterosexuals and incarcerated individuals.

Although these programs are available to the general population, they typically target individuals who are more susceptible to the disease. A staggering one in four individuals infected with HIV are not aware they have the virus. This presents a major public health concern to susceptible populations and has led to the installation of various testing and prevention programs. 

In Sub-Saharan Africa, less than 12% of people who want to be tested for HIV are able to do so currently. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS released an initiative the recommends HIV testing be a standard part of medical care in all African healthcare facilities regardless of the reason they came in for. I don't believe that mandatory HIV screening is financially or operationally feasible in Sub-Saharan Africa. Africa is plagued with Malaria, Tuberculosis, poverty, poor living conditions and malnutrition. Diarrhea is one of the biggest killers of children living in Africa. The AIDS/HIV epidemic should not be minimized and public health officials should continue to work towards eradication but HIV testing requires funding and support. In a previous blog post, I discussed necessary and sufficient causes of disease. If we used the HIV testing funds and operations staff to decrease malnutrition and provide safer water sources, individuals would be less susceptible to communicable diseases. Although HIV testing is necessary, it is not sufficient to eradicate HIV/AIDS.

HIV testing clinic in Sub-Saharan Africa

The HIV testing initiative in the United States has taken place in conjunction with increased access to treatment and care. The highly developed United States healthcare system permits discussion of mandatory vaccinations and HIV testing because of available resources. African countries do not have the time, resources or personnel to implement HIV testing. Even in the United States, the HIV testing initiative has met strong opposition. First, who will fund this project? Even insured individuals would have to absorb the cost of the test. Individuals in low socioeconomic classes are more susceptible to HIV/AIDS and may not be able to afford the test. Second, routine testing may lead to lower-quality or unethical testing programs. In an effort to increase the number of individuals testing for HIV, hospitals and clinics may sacrifice the integrity of their organization. Finally, individuals living with HIV, still face disease related stigma and discrimination. 






 

Polio in Syria

          Polio in Syria

What is Polio? 

Polio is a disease caused by a virus that is spread through oral-fecal transmission. Typically by eating or drinking items contaminated with feces from an infected individual. Most people with polio do not initially feel sick. They may experience minor symptoms, such as a fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. Most people recover from polio but in some cases, it can lead to permanent crippling of the arms and legs. Although polio has a lower R naught than measles and pertussis, it remains a major public health concern. 

Individual with severe crippling due to polio.

 

Values of R0 of well-known infectious diseases
Disease	Transmission	R0
Measles	Airborne	12–18
Pertussis	Airborne droplet	12–17
Diphtheria	Saliva	6–7
Smallpox	Social contact	5–7
Polio	Fecal-oral route	5–7
Rubella	Airborne droplet	5–7
Mumps	Airborne droplet	4–7
HIV/AIDS	Sexual contact	2–5
SARS	Airborne droplet	2–5
Influenza (1918 pandemic strain)	Airborne

Polio in the United States

The first case of polio was reported in the 19th century and it soon became one of the most dreaded diseases of the 20th century. Through the late 1940's and the early 1950's, 35,000 people were crippled by polio each year. Travel and commerce between affected cities was restricted and public health officials imposed quarantines on not only homes but entire towns. Through the development of vaccine and public health awareness, the disease has since been eradicated from the United States for over 30 years. 

Current Situation

According to the World Health Organization (WHO), 17 cases of polio have been reported in Syria as of November 2013. In March 2011, more than 90% of individuals were vaccinated but due to the civil unrest, immunization rates have dramatically decreased. Although not every individual had been vaccinated, herd immunity helped prevent the spread of the disease. Due to the conflict in the area, less than 68% of individuals are vaccinated, leading to the increase of polio cases. 

Oral polio vaccinations.

Government officials and public health officers have advocated for a vaccine drive but the political unrest and safety concerns pose a threat to both citizens and visitors of Syria. 

The polio outbreak in Syria is a reminder of the power of disease. Before the 2013 outbreak, there were no reported cases of polio in Syria since 1999. Epidemiologists and public health officials are still trying to determine the cause of this outbreak and mode of transmission. Some believe it spread from the Middle East or another African country. 85% of polio cases reported worldwide are found in Africa with the remaining cases isolated in the Middle East. This polio outbreak is an example of the impact that place of residence and the current state of the government can have on an individuals health. The outbreak of polio in Syria is one of the most challenging outbreaks since the eradication of polio. This outbreak exemplifies the damage that disorder in society can have on the infrastructure of a health system.

Syria isn't the only country that has experienced disease outbreak due to violence. Health professionals have been forced to flea certain territories because of civil unrest. This has led to fewer vaccinations, less health education and an increase in disease outbreak. We are faced with the challenging task of maintaining the health of a population in the presence of political dispute.