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Introduction
Multiple sclerosis (MS) is a chronic inflammatory condition that has been studied by medical scientists and practitioners worldwide due to its high prevalence. Indeed, almost 3 million individuals worldwide have developed this neurodegenerative disease, and 900 thousand of them live in the United States (Walton et al., 2020). Studying how MS is reported, screened, prevented, and treated is significant for epidemiology as the problem of increasing cases evolves and affected people need additional assistance in dealing with the chronic condition. This paper aims to describe the disease’s definition, symptoms, incidence, prevalence, discuss surveillance and reporting strategies and reveal the knowledge gaps in the current approaches. Furthermore, the assignment includes an epidemiological analysis of the MS, determinants of health it impacts, financial and social costs it causes, and current screening guidelines developed for its diagnosis. Lastly, a plan of how a nurse practitioner can address the chronic health condition after graduation is offered based on the evidence and possible patient outcomes improvement.
Background and Significance of Multiple Sclerosis
Multiple sclerosis is a chronic inflammatory disease that primarily affects the human brain and spinal cord, causing different symptoms such as loss of vision or limb movement disability. The condition is lifelong, may be diagnosed at a young age, and not result in severe dysfunction if timely treated and supported by a multidisciplinary team of physicians. MS is autoimmune and develops when the immune system damages the brain or spinal cord cells’ myelin sheath, making them weak or dysfunctional (Dobson & Giovannoni, 2019). The disease can be the relapsing-remitting type with the repeating symptoms’ episodes or the primarily progressive one with no remission periods and gradually worsening conditions. The symptoms of MS are diverse and frequently co-occur: blurred vision, difficulty walking, numbness in different parts of the body, fatigue, and coordination issues (Tobin, 2019). Moreover, the inadequate levels of vitamin D and sun exposure are proven related to the higher risk of developing sclerosis; thus, the long-lasting deficiency can lead to symptoms’ occurrence (Tobin, 2019). The increasing incidence of the disease signs signals the urgent need for screening to prevent severe outcomes.
MS prevalence grows worldwide due to environmental factors and changes in people’s lifestyles. White and especially Nordic Europe ethnicities’ representatives develop the chronic condition more frequently than others; thus, European and Northern America’s countries have significant incidence rates (Tobin, 2019). Indeed, in 2021, 913.925 individuals were registered with the MS in the United States, with a prevalence of 288 per 100.000 inhabitants (Walton et al., 2020). With the rising attention to the disease, the statistics became more precise and collected by related local governmental and non-profit organizations to establish regulations necessary to improve treatment and diagnosis. However, after an exhausting search of the scholarly databases, no current incidence and prevalence data charts per state were found. For instance, information about New Jersey’s situation is not represented in the state’s Department of Health databases. The article about the condition statistics in the United States identified that in the Northeastern coast where the state is located, the prevalence was 377.4 per 100.000, the highest rate across the country (Wallin et al., 2019). This gap in surveillance requires additional consideration from healthcare providers and statistics researchers.
Surveillance and Reporting
Surveillance is essential for the public health sector of epidemiology because it helps timely and systematically collect, evaluate, interpret, and address information about specific diseases nationwide. In the United States, the Centers for Disease Control and Prevention (CDC) recently launched a National Neurological Conditions and Surveillance System (NNCSS) to control neurological conditions’ statistics and develop strategies to support further research (Rocca et al., 2020). CDC (2022) states that “surveillance data can be collected from a variety of sources, including administrative data (e.g., Medicare, Medicaid), mandated reports, surveys, and registries” (para. 3). Monitoring of MS is performed through screenings such as MRIs, questionnaires, and discussions with the experts in diagnosis and treatment (Rocca et al., 2020). NNCSS merges the data about multiple sclerosis and Parkinson’s disease to estimate the prevalence, explore the incidence, and assist the researchers in providing evidence sufficient to get funding for disease exploration. The systematic method is beneficial for tracking the overall situation with the chronic condition; however, the localized outbreaks or specific epidemiological factors might be missed among the averaged numbers.
Reporting process allows the healthcare providers to assess the efficiency of the interventions, prevention, diagnosis, and treatment strategies to improve patient outcomes and address disease-related challenges. For instance, MRI is the optimal procedure for MS screening, and interpretation of its results enables organizations to report them to NNCSS if the disease benchmarks are reached (Lee et al., 2021). Furthermore, nursing practitioners nationwide are encouraged to track the incidence of the disease or collect the statistics to maintain awareness of the local situation. No mandated MS reporting laws exist in the United States; thus, neither healthcare organizations nor patients must register their conditions (Lee et al., 2021). Although the absence of legislative obligations is understandable regarding patients’ autonomy, the severe outcome is that many people do not report the symptoms’ relapses and making the national statistics less precise.
Epidemiological Analysis
Epidemiological analysis of chronic disease is a helpful tool for practitioners to explore the conditions, encounter the aspects that can be improved through interventions, and forecast changes in prevalence in specific populations or locations. International organizations such as WHO use epidemiological data to develop general recommendations countries can use for decision-making, diagnosis, prescription, and support for the affected people (Walton et al., 2020). MS has diverse incidence worldwide due to the difference in the determinants of health, screening options, and treatment policies; thus, the descriptive analysis should be narrowed to a specific nation or state for more precise and valuable conclusions.
Asking five questions: what, who, where, when, and why are the foundation of descriptive epidemiological analysis, and responding to them in terms of the United States’ population, social, healthcare, and economic aspects is necessary. Multiple sclerosis is a chronic autoimmune condition developed in the spinal cord or brain as the immune system attacks the cells’ protective sheath and damages the connection between the nerves (Dobson & Giovannoni, 2019). MS diagnosis is based on screenings such as Magnetic Resonance Imaging (MRI) or blood tests, and by identifying the symptoms: loss of vision, numbness in limbs, and lack of coordination. The disease is a lifelong condition, and in the United States, nearly 913.000 individuals live with it, 74% of whom are women, and the average age of illness identification is 36 years (Walton et al., 2020). Most individuals with MS have the relapsing-remitting type rather than the primary progressive one.
Epidemiological exploration of populations affected by multiple sclerosis must address the national determinants of health to provide sufficient information for retrieving patterns or forecasts. Indeed, in the United States, conditions such as genetics, access to healthcare, economic stability, social support, and living environment are fundamental. MS is not directly inherited, yet the risk of developing it increases by 0,5-1 percent if a parent or sibling has been diagnosed (Wallin et al., 2019). Furthermore, white ethnicities and women are at higher risk of developing sclerosis with the influence of environmental factors. There is no significant prevalence among populations from lower-income regions or neighborhoods; however, the inability to make costly screening in time results in the further conditions’ worsening (Wallin et al., 2019). Furthermore, the accessibility for individuals diagnosed with MS is well-developed, and such determinants as social support and financial help based on the Americans with Disabilities Act are provided.
In the United States, the number of people with MS keeps growing regardless of a region’s specific location or economic status. Global epidemiological research revealed that the further a population lives from the equator, the higher the disease incidence because of the connection between vitamin D deficiency and MS development (Walton et al., 2020). Consequently, the increasing prevalence is registered in Canada and Northern America, and the Northeastern coast has the most cases per 100.000 inhabitants (Walton et al., 2020). Furthermore, in the states where most inhabitants represent white ethnicity, the number of cases keeps growing combined with the current changes in the lifestyle. As the COVID-19 pandemic evolved, the ability to get sufficient vitamins outdoors, move the body, and spend less time at sedentary work decreased, putting more American citizens at risk of developing MS.
Multiple sclerosis can occur at any age, and even a child might develop the condition if they have inherited autoimmune inflammatory issues. In the United States, the average age of the disease identification is 36 years, and adults of 20 to 40 years old are at the highest risk (Dobson & Giovannoni, 2019). There are no epidemiological patterns discovered to suggest the time-related for MS because of the significant influence of external factors and lack of data about the predisposition.
The reasons for multiple sclerosis to occur and disrupt the work of the human nervous system are the combination of health deviations with environmental factors. Indeed, predisposition to autoimmune issues can grow into a chronic disease if an individual gets insufficient vitamin D and other nutrients, has stressful life with severe habits such as smoking; they are at risk (Tobin, 2019). There are no direct causes of MS; thus, symptoms are the most appropriate way to notice problems and reach for medical assistance. Consequently, the issue of late diagnosis exists concerning the condition, and, combined with people’s unawareness of symptoms, the disease can be noticed only after a severe attack (Tobin, 2019). Strategies to identify risks of autoimmune deviations that evolve with the technological and scientific progress are the expected supporters in retrieving and addressing specific reasons for MS development.
Multiple sclerosis diagnosis and treatment is costly for the United States’ healthcare financing and society. The prices for screening and therapy grow within the technological progress, and insurance coverage forces patients and organizations to invest more to address the disease. Hartung (2021) states that “direct healthcare costs, which can average $70,000 a year, have risen rapidly over the last decade and are driven by the escalating cost of disease-modifying therapies (DMTs)” (p. 3). The societal burden of multiple sclerosis is significant for the United States because it is prevalent among the employable population. The outcomes, such as disability and loss of vision, make citizens incapable of fulfilling their needs and obligations as social members, and the government is forced to provide them with additional support.
Screening and Guidelines
Screening is the most precise approach for multiple sclerosis diagnosis and, combined with blood analysis and questionnaires, helps identify the autoimmune inflammation at its early stages. The definition standard is two attacks or symptom flare-ups with a minimum of 24 hours duration and not more than 30 days period between episodes (Tobin, 2019). Current national guidelines suggest that diagnosis must be based on three procedures: magnetic resonance imaging (MRI) with an intravenous contrast agent, lumbar puncture for cerebrospinal fluid (CSF) examination, and basic CSF biochemistry test (Ömerhoca et al., 2018). MS can be submitted when at least two areas of the nervous system’s cells are damaged, and the recently developed McDonald criteria of diagnostic sensitivity can identify the definite disease after the first attack (Ömerhoca et al., 2018). No specific tests exist to check for MS, and physicians rely on symptoms when prescribing further activities.
Spinal cord MRI remains the most valuable screening for multiple sclerosis due to its high specificity, sensibility, and predictability. The procedure can be based on quantitative T1 mapping, diffusion tensor imaging (DTI), or magnetization transfer imaging (MTI), and define the deviation through assessing the spinal cord atrophy (Hemond & Bakshi, 2018). MRI has the highest signal and contrast sensitivity to noise among screenings and allows to identify of the deviations in white and grey spinal matters.
MRI has more than 90% accuracy in predicting the disease and is the best for MS identification; however, it is necessary to consider that the encountered cells’ damage can relate to conditions. Spinal cord MRI specificity is high because it displays the exact places with abnormalities and, if performed shortly after attacks, can show the nervous system’s parts at the highest risk (Rocca et al., 2020). The procedure’s cost depends on the spinal area of screening and the hospital’s geographical location and differs between $1000 to $5000 (MDsave, n. d.). The average price for spinal cord MRI at a common hospital is around $1400, and, for example, in New Jersey, about $800 must be paid for it (MDsave, n. d.). The highly sensitive screening is necessary for differential diagnosis and worth the price considering the timely defined and treated MS outcomes.
Plan
The evidence collected through descriptive epidemiological analysis, current prevalence tendencies, diagnosis, and treatment strategies suggests that interventions of different levels are necessary to improve the situation with multiple sclerosis. Modern nursing practitioners have the right and opportunity to influence the healthcare systems’ operations through advocating for patient-centered care, developing programs to address the issues, and implementing them (Jarrett, 2022). The professionals’ position is beneficial for promoting interventions because they interact with patients, physicians, quality improvement teams, and policymakers. Multiple sclerosis can be addressed on three levels – prevention, screening, and disease management, and nursing practitioners can lead and integrate the related projects through advocacy for change in their hospital, state, or nationwide.
The primary level intervention can address disease prevention and must comply with the environmental factors that cause MS development. Most people are unaware of the early symptoms or might confuse them with other diseases, and the patient education initiative can become a practical approach to decrease the incidence nationwide (Nazareth et al., 2018). Secondary intervention based on the differential diagnosis can contain the change in reporting the incidence based on screening and definite MS submission (Dobson & Giovannoni, 2019). Today, the statewide incidence data is not available, and passing a policy that enables organizations to track and publish results can impact the strategies used in different organizations and help retrieve the most efficient ones.
The intervention for addressing the disease management is necessary to improve the situation with the MS outcomes. Indeed, more than a half of affected people do not report the relapsing episodes, ease the symptoms instead of complete treatment, and develop severe disabilities (Nazareth et al., 2018). Nursing practitioners can research why patients refuse to reach the hospital and advocate for practical changes that make re-attendance seem crucial and accessible. The effectiveness of interventions can be evaluated through collaboration with the quality improvement team, policy updates, or patient records’ statistical analysis (Jarrett, 2022). The table below represents the three interventions that can be developed and integrated for healthcare organizations nationwide.
Table 1. Nurse Practitioners’ Interventions to Address The Multiple Sclerosis-Related Issues
Summary
Multiple sclerosis is a chronic autoimmune condition that is being widely studied due to the increasing incidence worldwide. More than 913.000 individuals live with MS in the United States, and the prevalence is 288 per 100.000 inhabitants (Walton et al., 2020). The disease is diagnosed in adults of the average age of 36 years; women and white ethnicities’ representatives are at the higher risk (Dobson & Giovannoni, 2019). The NNCSS system exists for surveillance of neurological conditions’ statistics and the development of strategies to support further research (Rocca et al., 2020). There is no reporting policy for MS, and the problem of lacking information about screening approaches and outbreaks exists in current healthcare. Diagnosis, treatment, and disease outbreaks are a massive financial and societal burden for the United States due to the costly equipment, life-long treatments, and high risk of disability among the affected. There are specified procedures to test for MS; however, screening, such as MRI, is the most beneficial and precise (Hemond & Bakshi, 2018). National guidelines suggest considering two long-lasting attacks with less than 30 days break between them as sufficient to check and define multiple sclerosis.
Nursing practitioners can impact MS treatment and diagnosis nationwide through advocacy for patient outcomes improvement and interventions. Evidence revealed that the related operations could be updated on prevention, screening, and disease management levels, enabling healthcare providers to develop different initiatives. People are mostly unaware of MS symptoms and prevention options, and more than half of the affected do not report the relapsing episodes, ease the symptoms instead of complete treatment, and develop severe disabilities (Nazareth et al., 2018). Nursing practitioners can act as the medium between patients and healthcare organizations to research the former’s behaviors and gather feedback sufficient to encourage the latter to take immediate action. Patient education, screening, reporting policies updates, and increase of services’ accessibility are the foundation for further improvements in multiple sclerosis treatment and diagnosis.
References
Centers for Disease Control and Prevention. (2022). National Neurological Conditions Surveillance System (NNCSS). Web.
Dobson, R., & Giovannoni, G. (2019). Multiple sclerosis–a review. European Journal of Neurology, 26(1), 27-40. Web.
Hartung, D. M. (2021). Economics of multiple sclerosis disease-modifying therapies in the USA.Current Neurology and Neuroscience Reports, 21(7), 1-8. Web.
Hemond, C. C., & Bakshi, R. (2018). Magnetic resonance imaging in multiple sclerosis.Cold Spring Harbor Perspectives in Medicine, 8(5), a028969. Web.
Jarrett, L. (2022). A multiple sclerosis nurse specialist narrative, focusing on supporting people to manage cognitive changes. British Journal of Neuroscience Nursing, 18(1), 32-40. Web.
Lee, J. K., Bermel, R., Bullen, J., Ruggieri, P., & Jones, S. E. (2021). Structured reporting in multiple sclerosis reduces interpretation time.Academic Radiology, 28(12), 1733-1738. Web.
MDsave. (n. d.). Spinal cord MRI price. Web.
Nazareth, T. A., Rava, A. R., Polyakov, J. L., Banfe, E. N., Waltrip II, R. W., Zerkowski, K. B., & Herbert, L. B. (2018). Relapse prevalence, symptoms, and health care engagement: Patient insights from the multiple sclerosis in America 2017 survey.Multiple Sclerosis and Related Disorders, 26, 219-234. Web.
Ömerhoca, S., Akkaş, S. Y., & İçen, N. K. (2018). Multiple sclerosis: Diagnosis and differential diagnosis. Archives of Neuropsychiatry, 55(1), 1-9. Web.
Rocca, M. A., Preziosa, P., & Filippi, M. (2020). What role should spinal cord MRI take in the future of multiple sclerosis surveillance?.Expert Review of Neurotherapeutics, 20(8), 783-797. Web.
Tobin, W. O. (2019). Management of multiple sclerosis symptoms and comorbidities.CONTINUUM: Lifelong Learning in Neurology, 25(3), 753-772. Web.
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., & Baneke, P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS.Multiple Sclerosis Journal, 26(14), 1816-1821. Web.
Wallin, M. T., Culpepper, W. J., Campbell, J. D., Nelson, L. M., Langer-Gould, A., Marrie, R. A., & LaRocca, N. G. (2019). The prevalence of MS in the United States: A population-based estimate using health claims data.Neurology, 92(10), 1029-1040. Web.
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