World Health Organization (WHO) reports a sharp increase in the number of Ebola cases in West Africa. According to WHO, over ten thousand people have been infected. The spread of the current infection is increasing at an uncontrollable rate (DiLorenzo, 2014). The most current WHO statistics indicate that over 50 percent of those infected have succumbed to the disease. Most importantly, the disease continues to spread in other West African countries apart from Liberia, Guinea, and Sierra Leone, which forms the epicenter of infection (DiLorenzo, 2014). Containing the disease has remained a challenge for most organizations and governments. The most recent reported case in Mali is an example of how the disease can easily spread across borders.
Besides the continuous need to raise awareness, restrict the movement of people, and reduce body contacts, the medical and behavioral challenges still undermine various organizations efforts to contain the spread of the disease. Reasonable numbers of people in the hardest-hit countries are still withdrawn from medical attention (DiLorenzo, 2014). Besides, the hardest-hit countries lack adequate medical facilities that can efficiently handle the cases. The lack of technical laboratories that can potentially manage the contaminated blood samples has greatly undermined the efforts to contain the spread of the disease.
Countries in West Africa are keenly tracking the spread of the disease while limiting cross-border migrations. Even though countries like Ghana have been cleared free from the Ebola virus, various concerns such as the health care workers strike leave the country exposed to infections. The WHO, US government, and other associated organizations have put every effort to ensure that the spread of the disease is contained through the provision of medical and food supplies as well as through the construction of urgently required treatment centers (DiLorenzo, 2014).
Polio in Syria
Centers for Disease Control and Prevention (CDC) recommends that those visiting Syria and neighboring countries should be vaccinated against the poliovirus. The recommendation follows a warning from the Global Polio Eradication Initiative (GPEI) that the polio cases in Syria are on the rise. The GPEI observed that the country has reported over 30 cases between 2013 and 2014. The country is suffering from a widespread poliovirus due to increased conflicts, which has reduced the possibility of immunization (Centers for Disease Control and Prevention, 2014). Besides, the spread of the virus is increasingly spreading in neighboring countries including Lebanon, Turkey, Jordan, and Iraq that are currently experiencing a huge influx of refugees from Syria (Kaiser Family Foundation, 2014).
CDC recommends that people traveling in and out of these countries should be vaccinated against the virus due to higher possibilities of being contaminated. Humanitarian aid workers, health care workers, and journalists working in these countries have a greater risk of being contaminated with the virus particularly from infected people. CDC advises that even adults who had been vaccinated should receive a back-up vaccine before engaging in various duties in these countries particularly Syria. Besides, it is recommended that people of all ages residing in the country for at least four weeks should indicate a polio vaccination proof before leaving the country (Centers for Disease Control and Prevention, 2014). Furthermore, it is a requirement that the vaccination is conducted between four weeks and one year before leaving Syria. The vaccination must be documented (Centers for Disease Control and Prevention, 2014).
Polio is a contagious viral disease that affects the nervous system. The disease spread through contacts (Centers for Disease Control and Prevention, 2014). Besides, the disease spread through contaminated food and drinking water. Polio causes paralysis of the limbs due to muscle dysfunction on minimal occasions. Death occurs when the virus affects the nervous system that controls breathing muscles and cardiac movements.
References
Centers for Disease Control and Prevention (2014). Polio in Syria.Web.
DiLorenzo, S. (2014). Who: number of Ebola linked cases passes 10,000. Associated Press. Web.
Haemorrhage from your ears, mouth, skin, and every conceivable part of the body was the picture painted by the media. The one thing that was uniform in all renditions of the deadly disease was apathy, poverty, remote areas in Africa, and lack of modern amenities.
However, all these changed when the first victim of the disease, a doctor, infected a nurse in The United States of America (Chappell and Rampton par.1). All hell broke loose and overnight, quarantines and screening areas in airports became the norm (Belluz, par.11). Ebola, the disease that had achieved notoriety for its high mortality rate threatened to become a global problem.
Ebola is a viral disease that attacks all the cells of the body in a systematic process starting with the white blood cells (Tam, par 14). It takes about two to 21 days before symptoms appear. The virus remains active in the hosts body even after the host is dead. Moreover, patients who are recovering from an infection continue to spread the Ebola virus through breast milk or semen for up to seven weeks (World Health Organization, par.10).
Ebola virus spreads through animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelopes, and porcupines (World Health Organization, par.7). The animals may be either ill, or dead. These animals are known to host the virus naturally. However, to be infected, one has to be in close contact with body fluids or organs of the infected animal (World Health Organization, par.6). Human-to-human transmission of virus is similar to that between human and animal.
The initial symptoms include fever, headache, muscle pain, fatigue, and sore throat. Later, victims show symptoms of impaired kidney and liver function, vomiting, diarrhoea, and rash with possible signs of internal and external bleeding (World Health Organization). A low white blood cell and platelet count coupled with elevated liver enzymes will be shown in a laboratory test (World Health Organization, par.11).
Due to the similarity of the symptoms Ebola shows with other diseases prevalent in the tropics, such as malaria, doctors conduct further tests. After doctors ascertain the infection, treatment ensues using supportive care and treatment of itemised symptoms to reduce the mortality rate (World Health Organization, par.12). No licensed product is available for treatment, but there exist experimental drugs.
Prevention includes reducing wildlife-to-human and human-to-human transmission, and outbreak containment measures such as proper disposal of fluids and burial of infected dead (World Health Organization, par. 16-20).
The human body is comprised of an array of organs and organ systems. All these organs need to work optimally to give the body ample functionality. The skin is a part of these organs. Similar to other organs of the human body, the skins functionality is liable for impairment by diseases. A case in point is Lupus. It affects the skin and by extension, the entire body.
Although most people choose to ignore diseases that affect the skin based on the notion that they do not have much of an effect on the body, it is important to point out that the optimal functionality of the skin is crucial to the overall wellbeing of the body. Therefore, the essay explores the pertinent aspects of discoid lupus erythematosus in a bid to develop a clear understanding of this disease about which little is known in the public domain.
Overview of Lupus
Lupus is a condition that occurs in people as an inflammatory reaction in the body. In the overall sense, it can affect various parts of the body, such as blood cells, kidneys, bones, and skin. The principle behind the operation of the disease is that it sets the bodys immune system against body organs.
It achieves this feat by catalyzing the deployment of the bodys defense mechanism against the target organ. For instance, when it affects the skin, the bodys immune system attacks the skin cells the same way it would attack pathogens that get into the body system. As a result, the target organ is damaged by the bodys immune system.
According to Sontheimer (2013), approximately two-thirds of the victims of Lupus end up with a skin disease called cutaneous lupus erythematosus. It manifests in the form of rashes or lesions that appear in sun-exposed areas of the body, such as the face. It is important to note that cutaneous lupus erythematosus can occur in three different forms.
These include acute cutaneous Lupus, subacute cutaneous Lupus, and chronic cutaneous Lupus. Chronic cutaneous Lupus is further subcategorized into three different forms, including discoid lupus erythematosus (DLE), tumid Lupus, and lupus panniculitis (Eastham, 2013). Although there are some key features that distinguish these different forms of cutaneous Lupus, this essay focuses entirely on discoid lupus erythematosus.
Discoid Lupus Erythematosus
This disease causes photosensitive skin eruptions on its victims. Being photosensitive, it can affect sun-exposed body parts such as face, hands, and legs. However, it mostly affects the face and the head. Eastham (2013) notes that discoid lupus erythematosus is manifested by red, scaly, and thick disc-shaped lesions, which mostly appear on the scalp and the face.
The disease can occur as a localized infection or a widespread one, that affects several parts of the body simultaneously. Apart from sun-exposed body parts, discoid lupus erythematosus can affect the lips and the inside of the mouth (Sontheimer, 2013). Such infections cause ulcers inside the mouth.
The lesions that appear on the body as a result of discoid lupus erythematosus are usually painless and no to not cause itchiness (Eastham, 2013). However, some cases of painful lesions have also been reported (Panjwani, 2009). The lesions cause skin discoloration and scars in the long run. Further, they can promote the development of cancer, if left unattended for long (Sontheimer, 2013).
Unfortunately, this is usually the case because most people opt not to seek medication due to the mild demeanor of the disease. In some victims, it leads to permanent hair loss due to scarring of the scalp (Eastham, 2013). If left untreated, discoid lupus erythematosus moves from the skin into other organs within the body, hence turning into systemic lupus erythematosus.
Its mortality rates are relatively low, making its prognosis favorable. It mainly affects patients from a psychological point of view. The disfigurement that may occur if the condition is not promptly dealt with effects the quality of patients lives by causing image problems (Panjwani, 2009). However, prompt treatment of the disease can abate the disfigurement. The disease is exacerbated by exposure to sunlight.
It is associated with factors such as immune signaling and other environmental factors that instigate antibody secretion and the dysfunction of T-cells (Eastham, 2013). Information about the etiology of discoid lupus erythematosus is scanty. However, certain genetic predispositions are believed to be vulnerable to the disease. Research is ongoing to establish the genetic characteristics of individuals who are usually affected by the disease because the exact link between the disease and its victims remains elusive.
According to Eastham (2013), discoid lupus erythematosus represents between 50% and 85% of all cases of cutaneous lupus erythematosus across the world. It is reportedly two to three times more prevalent in women than men. Sontheimer (2013), on the other hand, notes that the prevalence of the disease is 17 to 48 per every 100,000 people worldwide. Statistics show that African Americans have registered more cases of the disease than Whites or Asians.
The disease is classified among the rare disease categories across the world. This classification is based on the guidelines used for categorizing diseases. Taking the U.S. as an example, discoid lupus erythematosus features among the rare diseases since it affects less than 200,000 of the U.S. population (Eastham, 2013).
Treatment for discoid lupus erythematosus still requires much research to guide practitioners on how to handle the disease better. A handful of clinical trials have been successfully carried out, but they do not provide adequate evidence to suggest the best way to treat the disease (Eastham, 2013). The treatment of this disease is often left in the hands of the dermatology department.
However, discoid lupus erythematosus victims would benefit more from a comprehensive analysis that incorporates the patients history, blood count, erythrocyte sedimentation rate, midstream urine, and antinuclear antibody (Panjwani, 2009).
This review is important, because usually it is not expressly determinable if a patient has systemic Lupus or not, and the only way to find out is through a thorough examination. Further, since it is a disease that is known to be exacerbated by sunlight, patients should be advised to avoid the sun or use sunscreen.
Conclusion
Based on the issues that have been outlined in this essay, discoid lupus erythematosus occurs rarely, but it does exist and affects people across the world. The limited nature of information pertaining to the disease extends to the medical field too. Experts are yet to establish crucial information concerning its etiology and treatment.
However, the little that is known about the disease should act as a basis for further research, because it is important to find out how it motivates the immune system to attack body organs. Staying without this knowledge may turn out to be very costly to the human race if one day, the disease sets the immune system against the brain or the heart.
Panjwani, S. (2009). Early Diagnosis and Treatment of Discoid Lupus Erythematosus. The Journal of the American Board of Family Medicine, 22(2), 206-213. Web.
Clostridium tetani are the microorganisms that are responsible for causing tetanus disease. It is active in the absence of oxygen, and it is sensitive to heat. The microorganism belongs to the genus Clostridium, and its form of a gram strain corresponds to the shape of a drumstick or the tennis rackets. Sporulation that happens inside the cells determines its appearance. According to Thwaites and Loan (2015), the microorganism depends on fermentation because it is an obligate anaerobe.
Spores of the microorganism can only develop in the body of a host through an open wound. Clostridium tetani are motile and use rotary flagella to move in the body of a living organism. It can survive in different environments. It is mainly found in the dusty environment, soil, and sediment. Campbell et al. (2009) analysis found that the microorganism can also live in intestinal tracts of animals and humans. In this environment, it develops and become pathogenic.
History of the Tetanus
Tetanus is an ancient disease that was associated with causing serious muscle spasms and wounds. The causal factor for the disease was discovered in 1884 by Carle and Rattone. Transmission, cause, and clearance of the ambiguities associated with tetanus were approved in the year 1890. The study was conducted by injecting Clostridium Tetani that was extracted from an infected person into an animals body.
The analysis hence demonstrated that the microorganism is responsible for causing tetanus and could be neutralized using antibodies. According to Campbell et al. (2009), neutralization was conducted using specific antibodies to reduce levels of tetanus among people. Tetanus antitoxin was used to cause passive immunity in human bodies. Antitoxin was hence used to prevent infections and during the treatment processes.
Transmission
Tetanus infections are transmitted by exposing deep-tissue puncture wounds to Clostridium tetani bacteria. The microorganism is naturally found in rusty metals, dust, sediments, fecal matter, and soils. According to Rodrigo, Fernando, and Rajapakse (2014), when the deep wound is exposed to substances that are likely to allow survival of Clostridium tetani will cause the transmission of tetanus in a hosts body. The microorganism can only survive in the absence of oxygen.
Wounds contain dead cells, and as a result, they offer favorable conditions for it to survive in the host. The growth process starts in open and dirty wounds where it ferments and releases small quantities that are the causal agent of tetanus disease. Toxins are released during the immobile stages of their growth. Scores of toxins are freed after the cell lyses and discharge the contents into the body of the victim. Tetanus toxins are disseminated to neurons, bloodstreams, and the nervous systems causing the disease in the hosts body (Thwaites & Loan, 2015).
Symptoms
Symptoms of tetanus emerge between the 7th and 10th day after infection. The incubation period can vary ranging from 4 days to 3 weeks and even months depending on the distance of the injury site and the central nervous system. The severity of the symptoms is more for victims with short incubation periods. Symptoms are detected as a result of muscles becoming stiff especially the jaws, abdominal, and limb causing difficulties when swallowing substances and breathing problems.
Other symptoms include fever, diarrhea, sore throat, sweating, tachycardia, headache, and bloody stools. The microorganism causes tetanus toxin that is a potent neurotoxin. It works at different sites of the central nervous system, and the manifestation of tetanus emerges after it blocks inhibitory impulses. It attacks the body by blocking the release of neurotransmitters interfering with messages that are sent to the brain (Hassel, 2013).
Pathogen and immune system
Pathogens can be cleared by the immune system of the host. Specific antibodies are injected into the hosts body to neutralize toxin levels. Rodrigo et al. (2014) support that Induced passive immunity in humans can be used for preventing and treating the disease. Pathogens can persist and cause chronic infection. For instance, in severe cases, muscle spasms can cause bone fractures, aspiration pneumonia, pulmonary embolism, and acute renal failure. Clostridium tetani lack particular virulence to cause diseases, but it evades our immune response through transmission in open wounds that contain dead cells.
Treatment options
According to Hassel (2013), tetanus is treated through applying different methods like supportive care, medications that are meant to manage muscle spasms, wound treatment, vaccination, antibiotics, and the use of tetanus immune globulin to control the infection. Medications that are supposed to reduce muscle spasms include baclofen, dantrolene, and benzodiazepines, for example, midazolam and diazepam.
Antibiotics are used when killing Clostridium tetani in the body of a host, for instance, the use of penicillin and metronidazole. Surgically cleaning wounds is vital and it helps in removing any thriving tetanus bacteria. Vaccination is also important as part of treatment among people who develop tetanus.
Vaccines play a significant role as one of the most preventive strategies of tetanus (Hassel, 2013). Tetanus vaccines enable people to have enough protection for five years, but its effectiveness decreases gradually. Tetanus immune globulin is administered as a preventive strategy to people who have never been vaccinated, and those who have doubts concerning their vaccination history. It is advisable to boost immunity especially for patients with open and dirty wounds.
Booster shots of tetanus immune globulin are also administered to patients with suppressed immune systems, for instance, people suffering from acquired immune deficiency syndrome. The public prevents tetanus by ensuring children are vaccinated. People should clean wounds using uncontaminated water and soaps and seek medical advice for open and dirty wounds. The public should avoid direct contact with causal factors by wearing protective gear to prevent accidents and infections from dirty and sharp objects (Campbell et al., 2009).
Statistics
Tetanus has remained a major health problem worldwide. Its effects are common in developing countries. Clostridium tetani are sensitive to heat and hence it causes a tropical disease that affects many people in third world nations. Statistics indicate that approximately 1 million people die from tetanus every year. About 80% of the annual deaths reported occur in South East Asia and Africa and it is endemic in ninety countries worldwide. Incomplete deployment of the vaccine among vulnerable people is the primary cause of tetanus. Approximately, 50% of the reported deaths are a result of neonatal tetanus.
The most current outbreak occurred in 2005, and it affected tsunami survivors in Indonesia. About 112 victims had injuries that were caused by the debris. They were lying in dirty water that could have contributed to the transmission of the disease (Rodrigo et al., 2014).
Relevance to Health Worker and Patient in the United States
Understanding the causes, preventive measures, and treatment procedures are important factors that facilitate in addressing the tetanus epidemic. Health workers can manage to handle their patients by administering the right preventive and therapeutic drugs. They can also advise them on different ways of preventing and detecting symptoms of tetanus and hence reporting it on time. Patients can benefit from learning the need for keeping their open wounds clean and avoiding causal factors of tetanus. Clostridium Tetani is a microorganism that causes a worldwide known disease.
References
Campbell, J. I., Lam, T. Y., Huynh, T. L., To, S. D., Tran, T. N., Nguyen, V. H., && Baker, S. (2009). Microbiologic characterization and antimicrobial susceptibility of Clostridium tetani isolated from wounds of patients with clinically diagnosed tetanus. The American Journal of Tropical Medicine and Hygiene, 80(5), 827-831.
Hassel, B. (2013). Tetanus: Pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Toxins, 5(1), 73. Web.
Rodrigo, C., Fernando, D., & Rajapakse, S. (2014). Pharmacological management of tetanus: an evidence-based review. Critical Care. Web.
Thwaites, C. L., & Loan, H. T. (2015). Eradication of tetanus. British Medical Bulletin, 116(1), 69. Web.
According to the World Health Organization (WHO), zoonoses are diseases caused by pathogens. Through a natural process, they are transmitted from animals to human beings. With the emerging global issues such as climate change and severe weather conditions, so much has to be done to guarantee environmental safety (Cotruvo, Dufour, Rees, Bartram, Carr, Cliver, Craun, Fayer, & Gannon 17).
Bradleys Classifications of Water-Related Diseases
Bradley gives four main classifications of water-related infections. These include; water-borne infections such as typhoid and cholera, water-washed infections which result from poor personal or domestic cleanliness, water-based infections where part of the pathogens life cycle is in an aquatic environment and finally, infections with water-related insect vectors which are transmitted by insects that breed in water such as mosquitoes (Cotruvo et al. 32-4).
The World Health Organization provides two other water-related transmissions. There are those transmitted by inhalation of water aerosols and those passed on by consumption of raw or undercooked contaminated fish (Cotruvo et al. 34).
Zoonoses are considered to be water-related for two major reasons. First, part of the pathogens life cycle enters water either through feces or urine. Secondly, the pathogen is transmitted from animals to humans through a water-related avenue. This can be either through water ingestion or by contact (Cotruvo et al. 36).
One of the factors affecting the distribution of water-borne zoonoses is the presence of contaminated water sources that aid the movement of pathogens from one victim to another. Poor sanitation and disposal of animal and human waste also create healthy breeding grounds for the parasites.
Schistosomiasis, also known as bilharzias, is an example of a parasitic disease. Snails, water and humans are the main carriers of the pathogen that causes this disease. Larvae will usually emerge from infected snails that get into water and later penetrate human skin, finally end up in the human host where they mature into adult worms.
They mate and the female deposits eggs. The eggs then move to intestines, and later are released either through stool or urine from the human body into water. They then proceed to produce in the water giving birth to what is known as miracidia, a larval form that can smoothly swim about. The miracidia enters a snail host and later comes out as the larvae (Shope 1).
Schistosomiasis infections are common in African countries, South America and Asia with prevalence being high among women and younger people (Shope 1). A recent occurrence was witnessed in Mberengwa district, Zimbabwe in March 2010. The outbreak affected quite a number of school going children.
The parasites are favored by mid range temperatures of between 25 oC and 28 oC. This is bound to worsen as the effects of climate change continue to seriously bite globally. Human activities are also a menace to the environment and are slowly contributing to the spread of schistosomiasis (Shope 1).
Several drinking water companies exist in America to offer quality water services. These companies are required to produce consumer confidence reports on a yearly basis and make them accessible to consumers. The York Water Company is one such company.
The companys 2009 Consumer Confidence Report indicates that the it provides water services to over 180,000 people in 43 communities in York and Adams County, Pennsylvania. Water used by this company comes from a variety of sources that include rivers and lakes. These sources may be contaminated with viruses and bacteria among other contaminants. The company uses nitrate for purification purposes and this can be harmful if not used in the correct amounts (TYWC 2).
Works Cited
Cotruvo, Joseph A., Dufour, Alfred., Rees, Gareth., Bartram, Jamie., Carr, Richard., Cliver, Dean O., Craun, Gunther F., Fayer, Ronald., and Gannon, Victor P. J. Waterborne Zoonoses: Identification, Causes and Control. World Health Organization, 2004. Web. <https://www.who.int/water_sanitation_health/diseases/zoonoses.pdf>.
Shope, Robert E. Impacts of Global Climate Change on Human Health: Spread of Infectious Disease. Center for International Earth Science Information Network. n.d. Web. <http://www.ciesin.columbia.edu/docs/001-367/001-367.html>.
The York Water Company (TYWC). 2009 Annual Drinking Water Quality Report. The York Water Company. 2009. Web. <https://www.yorkwater.com/>.
The International Classification of Diseases-Clinical Modification (ICD-9-CM) refers to different codes used to classify a wide range of injuries and diseases. The codes are also used to conduct the required surveillance for different diseases and health issues (Bowie 21). The ICD-9-CM codes were implemented in 1979 (Bowman 13). Due to the ineffectiveness of the ICD-9-CM codes, many nations have adopted the use of ICD-10-CM.
Differences Between ICD-9-CM and ICD-10-CM
There are some striking differences between these two codes. To begin with, ICD-10-CM code sets should be treated as an upgrade for the ICD-9-CM. It should be noted that ICM-10-CM has 19 times as many procedure codes as those outlined in ICM-9-CM ( International Classification of Diseases, (ICD-10-CM/PCS) Transition par. 4). ICM-9-CM has 3,824 codes while ICM-10-CM has 71,924. The new ICM-10-CM has more diagnostic codes. For instance, ICD-10-CM has 69,823 diagnostic codes while ICD-9-CM has 14,025. This fact explains why the model is more effective for diagnosing various diseases.
The other critical difference is that the improved version embraces the use of alphanumerical categories while ICD-9-CM uses numerical ones (Bowman 8). The new set of codes is also characterized by a different order for every chapter. As well, ICD-10-CM has new titles and subtitles. The developers of the ICM-10-CM also presented new groupings for different conditions. The procedure structure defined by ICD-9-CM is characterized by 3-4 characters while ICD-10-CM has 7. Each of these 7 characters is either numeric or alphanumeric. All the characters outlined in the ICD-9-CM code sets are numeric. ICM-9-CM code sets have at least 3 characters (Bowie 31). ICD-10-CM codes are grouped using numbers 0-9 and letter A-H, J-N, and P-Z ( International Classification of Diseases, (ICD-10-CM/PCS) Transition par. 7). These differences, therefore, explain why healthcare facilities should embrace the use of the ICD-10-CM code sets.
Why They Chose to Upgrade ICD-9-CM
Several reasons can be used to explain why many nations and professionals decided to upgrade the ICM-9-CM. these original code sets lack appropriate details thus creating the need for extra documentation (Olsen 37). The new set of codes was therefore aimed at addressing this need. The pioneers also wanted to have specific code descriptions in an attempt to reduce errors (Dalgleish 19). Such an upgrade was also essential towards achieving the required IT potential in healthcare. ICD-10-CM data is easy to retrieve, share, and analyze. ICM-10-CM was also implemented to improve coding accuracy, efficiency, and consistency (Boyle and Kostick 3).
Dalgleish observes that ICM-9-CM codes were unable to offer various reimbursement services (42). Reimbursement purposes emerged after the codes had already been implemented. The introduction of ICD-10-CM was therefore critical towards establishing the best payment systems. The new codes are currently making it easier for organizations, policymakers, and professionals to compare various documentations (Olsen 59). As well, experts believe strongly that ICD-10-CM will promote the development of new tools that can detect fraud and malpractices in healthcare. The ultimate goal is to achieve the targeted healthcare goals and keep up with medicine (Bowman 102).
Works Cited
Bowie, Mary. Understanding ICD-10-CM and ICD-10-PCS: A Worktext. Boston: Cengage Learning, 2015. Print.
Bowman, Sue. Why ICD-10 Is Worth the Trouble. AHIMA 1.1 (2004): 1-13. Print.
Boyle, Ginger, and Karen Kostick 2016, Coding UTI to Sepsis in ICD-9-CM and ICD-10-CM. PDF file. Web.
As a nurse, one must be exposed to different patients with different diseases, and there needs to be a better understanding from the hospital administration and other people of the risks/consequences associated with the exposure and potential disease spread among healthcare profession. This paper shall examine The spread of diseases within healthcare providers.
Health care Centers should come up with ways to avoid the spread of communicable disease within the healthcare populations and methods of controlling infections. Some steps that health care workers can take in order to prevent the spread of infections include correct hand washing; enveloping sneezes and coughs; employing gloves, masks and defensive clothing; getting frequent immunizations; availing tissues and hand cleaners; and following hospital procedures when handling blood or infected objects (Medline Plus, 2011).
Others claim that infections should not be controlled among health care providers, since by them acquiring these infections they develop natural immunity. This research attempts to answer the question: What is the most successful approach to solve health care providers risks of exposure?
This paper shall first explain the different types of communicable diseases that health care providers are usually exposed to, before exploring possible solutions for these infections. Thereafter, the two shall be merged to build a persuasive research paper.
This research will use academic journals, websites and books. These resources are easily accessible from academic libraries as well as the internet. It may be quite hard to trace the precise resources, but this can be tackled by exploring the content in different resources. The paper will make use of trusted sources and cite them properly so that readers can believe the credibility of the research.
Problem Definition
Workers in current health care surroundings are exposed, daily, to numerous infections. As a result, of augmented possibility of contracting contagious infections, disease control inside the hospital surroundings has developed to extraordinary heights.
Communicable Diseases
So as, to categorize communicable infections that pose a noteworthy threat to health care providers, it is crucial to identify the methods of spread of various forms of infectious agents. The two key forms of transmissible infections are air-borne and blood-borne and (Ayers, 1998).
While blood-borne pathogens are many, it is a commonly accepted medical view that hepatitis virus A, B, and C and human immunodeficiency virus (HIV) pretense the greatest threat to health care providers (Ayers, 1998). According to the Occupational Safety and Health Administration (OSHA), the key airborne infection causing apprehension is tuberculosis (TB) (Ayers, 1998). Comprehending the unique characteristics of air-borne and blood-borne infections is crucial to this paper and is explained below.
Blood-Borne Pathogens
The human immunodeficiency virus causes HIV/AIDs is in the human body. HIV contact mostly occurs through the nose, mouth, eye or skin and exposure through cuts or needle sticks infected with the virus (Ayers, 1998). Health care provider dealing with HIV/AIDs patients is at risk of contacting the infection if he/she comes into contact with blood or fluid that is infected with the virus. Since the AIDS virus is deadly, health care providers must take required precautions to ensure their safety.
Hepatitis is an inflammation of the liver (Ayers, 1998). This infection is usually known as hepatitis A and, as it increasingly degenerates, the name changes to hepatitis B or C. The serene virus, hepatitis A, is transmitted by contaminated food or drinks.
Hepatitis B virus is transmitted by exposure to blood or almost all body fluids. Individuals are likely to contact the infection including homosexuals, consumers of drugs, heterosexual cohorts, health care workers, and persons who are regularly exposed to a range of bodily fluids constantly.
Hepatitis C is a liver infection and is the gravest form of hepatitis. Symptoms can emerge from two weeks to six months after the contact.
Airborne Pathogen
Airborne pathogens are pathogenic microbes that exist in airborne discharges and can cause infections in persons (Ayers, 1998). Some examples of these pathogens include mononucleosis, measles, whooping cough, chicken pox, influenza, meningitis, mumps and tuberculosis (Ayers, 1998).
Cytomegalovirus Mononucleosis
Contagion with cytomegalovirus (CMV) is widespread. The disease can be transmitted by sexual contact, organ transplants, respiratory droplets, blood transfusions, saliva and urine (Medline Plus, 2011). Several people with this infection experience a mononucleosis-like condition.
CMV disease in the United States is usually experienced between the ages 10 35 (Medline Plus, 2011). Most persons are exposed to CMV but do not notice it since it has no indicators in its early stages. Individuals with a weak immune system will experience a rigorous form of the infection.
Measles
Measles is a terrifically infectious ailment. The illness is transmitted by contact with fluids from the lips, nose or gullet of an ill person. Coughing and sneezing places infected droplets into the atmosphere. Individuals who have suffered from the infection or those who have been immunized against the measles have resistance to infection.
Prior to prevalent immunization, measles were so widespread during infancy that nearly all people became ill with the infection by age 18. The cases of measles had decreased over the last few decades in Canada and the United States. Nevertheless, rates have begun to increase again lately.
Whooping Cough
Whooping cough is a communicable bacterial infection that leads to unmanageable coughing. The name is derived from the sound one creates when he/she acquires a breath following the cough. One might have pungent spells or might cough so roughly that he/she heaves. Anybody can acquire whooping cough, although it is widespread in infants and kids. The sounds can be so irritating making it hard for one to consume food or take breaths.
Chicken Pox
Chickenpox is an illness caused by virus in which an individual grows extremely tickly blisters in the entire body. In the past, it used to be one of the typical childhood illnesses. Nevertheless, it has turned out to be less widespread since chickenpox immunization was introduced.
Varicella-zoster virus, a component of the herpes virus family, causes chickenpox (Medline Plus, 2011). Chickenpox is easily transmitted. One can acquire chickenpox by contacting fluids from a chickenpox wound, or if near a person with the illness when he/she sneezes or coughs. Those with serene illness may as well be infectious. An individual with chickenpox turns out to be infectious 1 to 2 days prior to their blisters emerge. They stay infectious until all the sores have busted.
Influenza
Influenza is an illness caused by several viruses, which affects the respiratory process. The viruses travel from the air to a persons body through the mouth or nose. Every year, a large proportion of persons contact flu every year. The flu might be severe or even fatal for aged persons and individuals with definite chronic sicknesses. Signs of the flu emerge swiftly and are shoddier than those of the common cold. They could include sore throat, headache, body or muscle aches and cough Fever (Medline Plus, 2011).
Meningitis
Meningitis is soreness of the lean tissue that environs the spinal cord and brain, known as the meninges. Different forms of meningitis exist. The most widespread is viral meningitis, which is acquired when a virus penetrates the body via the mouth or nose and moves to the head. Bacterial meningitis is fatal though rare (Medline Plus, 2011). It typically begins with bacteria that lead to a cold-like illness. It can wedge blood vessels in the head resulting to destruction of the brain or stroke.
It can as well harm other parts of the body. Meningococcal infections and pneumococcal diseases can result to bacterial meningitis (Medline Plus, 2011). Any person can acquire meningitis, although it is widespread in persons whose bodies experience difficulties in combating infections. Meningitis develops swiftly hence if one experiences severe headaches together with an abrupt fever and a rigid neck, it is essential to seek medical treatment immediately.
Mumps
Mump infections are caused by mumps virus. Symptoms of mumps include headache, fever, appetite loss, muscle pains, fatigue and loss of appetite. Engorgement of the salivary glands pursues these signs. Severe cases are uncommon, although they result to hearing impairment; inflammation of the brain, testicles, breasts, spinal cord or ovaries; and loss of pregnancy (Medline Plus, 2011). One can contract mumps by being near to someone who is infected.
Tuberculosis
Tuberculosis (TB) is a bacterial illness caused by a microbe called Mycobacterium tuberculosis (Medline Plus, 2011). The microbes typically assail the lungs, although they can also injure other body segments. TB is transmitted through the air when an individual with TB sneezes, coughs or talks (Medline Plus, 2011).
Those persons with a weak immune system are likely to acquire TB if exposed. Signs of TB in the lungs include mass loss, night sweats, a cough that endures for 3 weeks or above, fever and chills, coughing up blood or mucus and weakness or weariness (Medline Plus, 2011).
Rubella
Rubella illness in adults may lead to inflammation and ache in the joints. Illness in the primary three months of expectancy has an 85 per cent threat of causing rigorous hurt to a growing baby.
Diphtheria and Tetanus
Diphtheria is a severe infectious illness, leading to fatality in 5-10 per cent of situations with the utmost rates amid the juvenile and the aged (Van Der Weyden, 2005). Tetanus is a severe illness that frequently leads to death.
Lack of appropriate measures for disease control will lead to loss of staff and clinicians. This will lead to decreased efficiency, making a vicious phase as a load is placed on those who are left. Both direct and non direct costs of chronic infections in the shape of lost productivity will continue to increase.
The insurance will also be overstrained since it has to compensate the infected health care providers. The name of the health center will also be tarnished, since it is supposed to offer clear guidelines that will help prevent infections among health care providers.
As a result, the health centre might experience difficulties in obtaining employees in the future. T he centre will also lose its ability to compete globally as by not providing guidelines to health care providers, it will be viewed as not conforming to international standards. Finally, the health institution will lose its overall profitability due to decreased efficiency among the little health care providers who remain.
Those who see no need for control of diseases among health workers ground their reasons on the fact that, the health provider becomes prone to infections through acquiring infections.
Problem Solutions
Most diseases that are likely to spread among health care providers can be prevented using vaccination or unsophisticated preventive measures.
Importance of Immunization for Health Care Providers
Health care workers are at risk of exposure to infectious illnesses at the place of work owing to their contact with contaminated patients body fluids, respiratory secretions or blood (Family Doctor, 2011). Most infectious diseases can be managed with immunizations. Immunizing health care providers aids guard their health and stop disease spread amid patients and health workers, and health workers and relatives outside the place of work.
Routine Immunizations Recommended for Health Care Providers
Immunizations suggested for health care providers include diphtheria, tetanus, polio, varicella, influenza, acellular pertussis and Measles Mumps Rubella (MMR) (Ayers, 1998). Some of these vaccines are freely provided to health care providers. Most workers access immunizations through their home community health centers.
Hepatitis A
This virus subsists for just a few hours and can be eradicated through appropriate grooming values and, if the contact is not more than two weeks old, serum can be used to avoid contagion. Avoidance of hepatitis A is as easy as cleaning hands and ascertaining that infected persons do not prepare meals.
Cytomegalovirus Mononucleosis
CMV illness can be infectious if the infected individual comes in close contact with another individual. To avoid this infection, do not kiss or have sex with a person suffering from the ailment. When preparing organ transplants or blood transfusions, the CMV position of the donor should be examined to shun transmitting CMV to a receiver who is not infected.
Diphtheria and Tetanus
Diphtheria is most widespread and most rigorous in unvaccinated or partially vaccinated persons. Shield from vaccine reduces over time except when intermittent boosters are used. Vaccination against tetanus and diphtheria is proposed for all grown ups in most nations. The immunizations may be administered earlier in the occasion of a profound bite or wound.
Whooping Cough
Whooping cough or pertussis is an extremely infectious illness of the throat and lungs. Resistance from childhood immunizations containing pertussis decline with duration, hence, it is suggested that health care workers obtain one dose of youth/grown-up acellular pertussis. Acellular pertussis is usually merged with diphtheria and tetanus, so it can be used in position of regular diphtheria or tetanus boosters (Family Doctor, 2011).
Tuberculosis
Tuberculosis can be prevented by appropriate ventilation of rooms. Health care providers should also ensure that they take proper diet so as to ensure that their immune system is strong to fight microbes associated with TB. If acquired, it should be treated with antibiotics.
Measles, Rubella and Mumps
Measles is an extremely infectious illness that is rigorous in newborns, kids and adults who have destabilized immune structures. Health care providers who are over forty years old must have one of these: certification of physician-diagnosed measles, evidence of two measles immunizations or laboratory proof of resistance against measles illness (Bloom,2005).Persons aged over forty years have possibly had measles infection and are, hence, deemed protected.
Mumps is a serene illness. Nevertheless, problems such as encephalitis or soreness of the mind are widespread in grown-ups. Persons are deemed secure from mumps infection if they are more than forty years old, own evidence of one dose of mumps vaccine and serologic confirmation of resistance or a record of laboratory-verified mumps illness (California Health Care Foundation, 2005).
Persons are deemed shielded against rubella disease if they have evidence of one dose of rubella immunization or laboratory certification of rubella protection (Bloom, 2005). Rubella epidemic in health care institutions is of exacting concern because of the possible spread to expectant health care workers and patients.
Rubella vaccine is suggested for unguarded health care workers who may put other pregnant women at risk of contacting rubella through regular face-to-face touch (Bloom, 2005). Health workers are supposed to be offered two doses of measles-mumps-rubella immunizations free of charge (California Health Care Foundation, 2005).
Meningitis
Meningitis epidemics are best controlled by vaccinations. However, if contacted, one should begin antibiotic treatment. Health care providers should employ scrupulous hygiene practices, for example, washing hands frequently.
Hepatitis B Virus Infection
Hepatitis B vaccine is suggested for health care workers who might have contact with body fluids, blood or open skin. The probability of spread of Hepatitis B virus to a health care worker from an extremely transmittable source, for instance a needle stick, is said to be 19-40 per cent (Health Council of Canada, 2006).
Persons are deemed resistant if they have finished a sequence of Hepatitis B immunizations, and one recognized lab test that demonstrates they have acquired adequate resistance to the virus. Individuals who fail to acquire immunity to the first vaccine sequence are supposed to be presented a second sequence of vaccine with an examination for antibodies to confirm immunity, to be executed one to six months following conclusion of the vaccine sequence.
Any health care worker who becomes exposed to Hepatitis B virus must consult the local community health centre, Occupational Health department or a family physician for suitable screening, examination and actions to stop the transmission of the infection (Institute of Medicine, 2001).
Hepatitis B can also be managed by utilizing general safety measures, using private toiletry items, excellent hygiene practices, and refraining from sexual actions.
Chickenpox
Chickenpox illness is apt to be rigorous in grown ups. Proof of shield against varicella illness consists of a self-reported account or physician identification of herpes zoster or varicella illness, laboratory certification of resistance, or certification of two dosages of live varicella immunization for grown ups. Varicella immunization is presented to health care workers who lack shield against chickenpox illness. One should take two dosages of immunizations in between two months.
HIV/AIDs
Health care providers must wear gloves so as to avoid contact with blood or body fluids from the patient. Needle sticks used to inject these patients should also be handled properly to avoid infection.
Influenza
Every health care worker is at risk of obtaining and transmitting the influenza virus to relatives, patients and buddies. It is vital to avoid disease communication to individuals at high danger of influenza-linked problems, for example, those with declined immune structures, pulmonary mayhems, chronic health issues and the aged.
Influenza immunization of health care workers is known to decrease the sickness and bereavement of patients under their treatment in long-term situations, and worker infections in the influenza period. Yearly influenza vaccine should be presented to health care workers.
In case, some health care providers are infected, and they decide to leave, new employees can be recruited to reduce workload on those who remain (Centers for Disease Control and Prevention, 2003). This will ensure that efficiency is maintained and that overall profitability of the institution does not crumble. It will also be able to compete globally.
The Comprehensive Paper
Workers in current health care surroundings are usually exposed to numerous infections. Some of these infections include Tuberculosis, whooping cough, measles, chicken pox, hepatitis A, hepatitis B, Influenza, HIV/AID, meningitis and CMV.
TB is spread through the air when a person with TB sneezes, coughs or talks (Medline Plus, 2011). So as, to prevent it, there should be appropriate ventilation of rooms. Health care providers should also ensure that they take proper diet so as to ensure that their immune system is strong to fight microbes associated with TB. If acquired, it should be treated with antibiotics.
Whooping cough/ pertussis is a communicable bacterial infection that leads to unmanageable coughing. Since resistance from childhood immunizations containing pertussis decline with duration, health care workers, obtain one dose of youth/grown-up acellular pertussis, in order to be secure from this ailment.
Measles is transmitted by contact with fluids from the mouth, nose or throat of an ill person (Manning, 2005). If a health care provider has never been infected with this infection, he/she should seek immunization. Health care providers who are over forty years old have possibly had measles infection and are, hence, deemed protected (Health Council of Canada, 2006).
Cytomegalovirus (CMV) can be transmitted by sexual contact, organ transplants, respiratory droplets, blood transfusions, saliva and urine. Health care providers should refrain from getting into contact with body fluids of the infected persons.
Every health care worker is at risk of obtaining and transmitting the influenza virus to relatives, patients and buddies. Hence, each of them should be immunized against the infection.
Chickenpox is an illness caused by virus in which an individual grows extremely tickly blisters in the entire body. Health care providers should all be immunized against this virus.
Hepatitis A and B and C can be prevented by appropriate hygiene and vaccinations (World Health Organization, 2005). Mump infections are highly contagious. They can be prevented by vaccinations. HIV contact mostly occurs through the nose, mouth, eye or skin and exposure through cuts or needle sticks infected with the virus. Health care providers must wear gloves so as to avoid contact with blood or body fluids from the patient.
Needle sticks used to inject these patients should also be handled properly to avoid infection. Rubella illness in adults may lead to inflammation and ache in the joints (Leape, 1994). Rubella vaccine is suggested for unguarded health care workers, who may put other pregnant women at risk of contacting rubella through regular face-to-face touch. Any person can acquire meningitis, although it is widespread in persons whose bodies have low immune systems.
Health care providers should employ appropriate hygiene practices, for example, washing hands frequently so as to prevent infection (California Health Care Foundation, 2005). If infected, one can use antibiotics for treatment. Diphtheria and tetanus are both severe infectious illness that affect health care providers. Vaccinations against tetanus and diphtheria are proposed for all health care providers in most nations.
In case, some health care providers are so infected that they can no longer be retained in their various positions, new employees can be recruited to reduce workload on those who remain. This will ensure that efficiency is maintained and that overall profitability of the institution does not crumble. This will also aid in maintaining the competitive position of the health institution, since few losses will be incurred.
References
Ayers, M. (1998). Communicable diseases: legal and ethical issues facing the health provider. Web.
Bloom, R. (2005). Public health in transition. Scientific American, 293(3), 92-99.
California Health Care Foundation (2005). National Private health survey. Web.
Centers for Disease Control and Prevention (2003). The power of prevention: reducing the health and economic burden of chronic disease. Atlanta: Department of Health and Human Services.
The outbreak is a series of similar events within a community or a particular region that is characterized by an illness the frequency of which exceeds the expectancy of a norm. The quantity of instances that show that the occurrence of an outbreak depends on the present agent of an infection, the size of the population that has been affected by the infection, previous instances of outbreaks, and lastly, the place and time when the outbreak occurred (Manitoba Health n.d., p. 1). In the majority of cases, an outbreak is related to an infectious disease, but an outbreak can also occur in a case of a non-infectious disease, for example, cancer or diabetes. However, the methods of investigation are similar for all types of outbreaks (Outbreaks investigations n.d., par. 1).
Why Investigate an Outbreak
The main reason for an outbreak investigation is the identification of its source, When the source of an outbreak is identified, then control is being established in order to prevent future instances of an outbreak. Furthermore, an outbreak investigation is often implemented to train new employees and learn about the past disease and the methods of its transmission within a population. The decision to conduct an outbreak investigation is directly linked to its severity, the possibility of further spreading, or the political reasons influenced by a particular degree of deep concern expressed by the population (Outbreaks investigations n.d., par. 8).
The outbreak that will be investigated in this paper is the outbreak of the foodborne diseases because of an array of reasons such disease still remain a health challenge worldwide. Some foodborne diseases are taken under control while others pose a new danger to the population. Particular sections of a population under question are more likely to be affected by a foodborne disease because of their age, immunity suppression, or other conditions that affect the susceptibility to the disease.
Furthermore, individuals that travel to new environments can often be exposed to unfamiliar foods that may negatively affect their health. In the majority of countries, foodborne diseases occur as a result of people consuming food that is being prepared outside the house, and that is being frequently exposed to poor hygiene. Such challenges require continuous adaptations to the ever-changing environment that affect the spreading of the foodborne diseases as well as the development of innovative methods of dealing with the mentioned challenges (World Health Organization 2008, p. 5).
Public concern is one of the main features of an outbreak investigation. In investigating an outbreak, health authorities should find a perfect balance between the scientific aspect of an investigation and the ability to respond to public concern. Therefore, an outbreak investigation should complete a plan that outlines the ways in which relevant information is being presented to the concerned public. Furthermore, in some cases of an outbreak, close communication with the public will be instrumental in finding out about new instances of the disease under investigation.
Another important participant in the outbreak investigation is the media. It is an interface of the communication between the health organization and the public. By establishing a close connection with the media, a health organization that conducts the investigation will have an option to facilitate the reporting about the disease cases, give the public information about the ways the disease can be avoided, and maintain the support from the public (World Health Organization 2008, p. 7).
The relationship between a further investigation of the occurred outbreak and the measures of control relates to the amount of information about the known sources of an outbreak as well as they way these sources was transmitted (Investigating an outbreak n.d., p. 6).
Investigation Proper
Detection
A foodborne disease outbreak is an occurrence that is characterized by two or more individuals experience similar symptoms after being exposed to the same source of food, or there is otherwise evidence that particular food was a cause of the outbreak.
On the early morning of April 18th, the Department of Health in London received a concerned call from a mother whose son and daughter were suffering from a severe case of vomiting and nausea. They both got sick during the previous day and consumed some over-the-counter medication that gave no results. The children visited a Birthday party where they consumed some burgers and fries along with other children. The mother had also contacted other parents to ask whether their kids were okay. It had appeared that those children were having the same symptoms of nausea and vomiting. Furthermore, the Department of Health received similar calls in the course of the two following days. This was an obvious case of a foodborne disease outbreak.
The etiologic agents of the foodborne disease outbreak include bacterial toxins, bacterial infections, viruses, parasites, and noninfectious agents. A foodborne disease is usually accompanied by vomiting, diarrhea, nausea, and cramps in the abdominal area. By its own definition, foodborne diseases are being transmitted through the consumption of food; however, some of the bacteria agents can be transmitted through water, contact with animals as well as direct contact of person to person (Washington State Department of Health 2013, p. 3).
The contaminated food that may have been consumed by an individual may be contaminated from nature. They become acceptable for consuming after cooking. The examples of such foods are pork that can be affected by Yersinia enterocolitica, seafood affected by Vibrio parahaemolyticus, milk products affected by Salmonella or Cryptosporidium parvum and others. The second group of bacteria-contaminated food is the food that has been contaminated by poor handling. Poor handling includes contamination through dirt, unwashed hands, and infected lesions.
The virus of Staphylococcus aureus can easily contaminate food from the handlers skin and quickly grow at room temperature thus producing a dangerous toxin that is stable to heat and cannot be eliminated by the process of cooking. The third way in which food products can be contaminated is the way of cross-contamination through other foods or the surrounding environment. The most common way is the cross-contamination of bacteria that come from raw meat and eggs on raw foods by the means of kitchen utensils and unwashed surfaces. The last and the least common way of food contamination is contamination by the means of intentional acts.
Microbiologic Investigation
On April 20th, the Department of Health made a visit to the emergency room at the local hospital to look at the records of thirty-five patients who all came in with the same problem of vomiting, nausea, and abdominal pains. The most prevalent symptom was vomiting that was detected in ninety-one percent of the affected individuals, then went diarrhea with eighty-five percent and abdominal pains with sixty-eight percent.
The average body temperature of the patients was 37.8C. All of the performed blood tests taken from fifteen patients showed a significant increase in white blood cells. By April 21st, there have been eighty-five instances of reported instances of a foodborne disease. All patients were recent visitors to their local fast food restaurant. The dates of the reported cases of illness were from April 18th to April 21st. The average age of affected patients was 15 years, ranging from seven to twenty-two years old.
Source: The common food item identified through the means of interviewing was a beef burger. When the food had been taken for analysis, there had been no evidence of a harmful bacteria. Thus, the food was probably contaminated by the means of cross-contamination from other products like salads, eggs, or badly prepared shellfish.
Incubation period: The period of incubation for a foodborne illness ranges from one day to one week. The most of the reported instances of illness were on April 18th-20th.
Leading Hypothesis: an infection that was spread through food or a drink served at the fast food restaurant.
Environmental Investigation
On the basis of the clinical findings and the results of the interviews outlined above, the health investigators concluded that an outbreak was caused by a viral pathogen that most likely appeared in the food due to the process of cross-contamination in a fast-food restaurant between April 18th and April 21st. Thus, the environmental investigation consisted of interviewing restaurant staff on the types of products they handled, the meals served to customers as well as the places each employee worked in the restaurant.
Furthermore, restaurant employees had been questioned about whether they wore gloves as well as the hand washing policy in the kitchen, and whether anyone from the staff had been ill between April 18th and the 21st. In the restaurant, the burger preparing area had its own refrigerator. When order had been placed by the customer, burgers were made separately by an employee responsible for burgers. Each day new supplies of meat, lettuce, cheese, and vegetables were added to the refrigerator along with the products left from the previous day. However, when the restaurant had been open and orders had been coming in, there was no time for keeping all required products for a burger in a refrigerator. Furthermore, the containers for products were not cleaned on a regular basis.
Thus, the Health Department closed the restaurant on April 22nd. There was distinct evidence that the restaurants food had been the primary reason for the outbreak. The action of closing the restaurant was solely based on the circumstantial evidence (the restaurant had some issues with improper food handling). Because there was a number of unsanitary actions, closing a restaurant for a short period of time had been the smartest solution until the problems were resolved. Despite the fact that the most likely reason for the foodborne disease outbreak had been identified, it is crucial to conduct a further investigation because:
the actual reason may not be the restaurant; however, it is most likely;
more detailed information is required on the outbreak to find out whether the restaurant is safe to open again;
more detailed information is required to prevent the outbreak from happening again (Gastroenteritis at a university in Texas n.d., p. 16).
Dose Response
The dose response is available in a case when the possibility of a foodborne illness is directly linked to the time of the exposure to the harmful ingredient. For instance, if an individual ate two burgers was more likely to become ill than a person that ate one burger, the dose response takes place. Thus, in order to support the hypothesis of a harmful exposure, the dose response must be supported. Evaluating a dose response is important in an outbreak when a population had been exposed to the same harmful agent, as the case with the fast food restaurant.
Paying attention to the design of the investigation is crucial in making sure that the dose response can be easily determined. The first step of the dose-response evaluation was asking questions about the levels of exposure to the harmful ingredient, for example, how many and how often the burgers were eaten. After evaluating the number and frequency of the eaten burgers in a fast food restaurant, then information on the relative risks, levels of exposure, and odds ratios is identified. Statistical significance of the dose-response metric can be calculated with the help of statistical test (World Health Organization 2008, p. 35).
Case-Control Study
In a circumstance like a case with the burgers, there is no clearly identified cohort of all individuals exposed to the illness because it was clear that not all cases were reported. Furthermore, not all non-exposed individuals can be asked questions about how they were feeling. In this case, when the most relevant information had been gathered. In this case-control study, the cases of ill individuals are compared to those of healthy (World Health Organization 2008, p. 30). The health institution used a questionnaire for getting information about the cases of an outbreak:
Exposure
Cases
Controls
Total
Ate the burger
35
15
50
Did not eat the burger
3
50
53
Total number
38
65
103
Percentage affected
92%
23%
48%
In this case-control study, 92% of the reported cases of illness had consumed the burger compared to 23% of the controls. Thus, the burger is suggested to be the primary reason for an outbreak. However, the relative risk cannot be identified with the use of the above table, because the quantity of all affected individuals is not known. Instead odd ratio is used and calculated as the cross-product:
Odds ratio= Ate the burger cases*Did not eat the burger controls/Ate the burger controls* Did not eat the burger cases
Odds ratio=35*50/15*3=38,8
The above-calculated odds ratio suggest a possible but not close relationship between the foodborne disease outbreak and the burger served at the fast-food restaurant as a primary source. Since the case-control study had been conducted two days after the last case of an outbreak, there was a possibility that the harmful bacteria was not present in the tested samples of the burger.
Discussion and Conclusion
Appearing cases of foodborne disease outbreak still continue to arise and disturb the health care system. Furthermore, because of a variety of harmful bacteria, it is hard to successfully detect and treat the outbreak (Stephen & Ostroff 2000, par. 1). The foodborne disease outbreak investigated in the paper was indeed an outbreak because it was defined as two or more illnesses caused by the same bacteria that are linked to eating the same food (Virginia Department of Health 2015, par. 1). All of the acquired results were issued to the public and the media in order to ensure that the cases of illness would not repeat again.
The fast food restaurant had been re-opened by the Public Health England when all testing were made, and there were no signs of poor food handling left. Furthermore, the Department of Health had encouraged the public to evaluate the risks associated with a foodborne disease and to carefully choose the places where to eat, paying close attention to the way employees handle the products (Department of Health n.d., par. 7).
The department of health had interviewed the individuals affected by the illness and made sure that the symptoms were treated and eliminated as soon as possible. To prevent the illness cases from occurring in the future, additional evaluation of the restaurant conditions and food handling habits had been conducted. Despite the fact that there had been no distinct type of bacteria found during the testing, the most likely source of the illness was the burger ingredients cross-contaminated by means of poor food handling.
A foodborne disease outbreak is not the one to be ignored or disregarded, so the Department of Health did everything in its power to quickly resolve the issue and make sure that no serious consequences occurred in those individuals who had suffered from the foodborne disease outbreak. Lastly, it is important to note that the media did a great job in providing the public with all necessary information on the outbreak, the ways to report it in a case of an illness, as well as the methods of prevention.
For many years, scientists and other researchers have sought to undertake tones of research experiments with the aim of discovering the structure of reliable ways of diagnosing and subsequently curing human diseases. Without a doubt, their efforts paid off with the discovery of many medicinal drugs and injections such as the deoxyribonucleic acid discovered by Watson and Crick fifty years ago (Teng, 2009).
Years down the line, things have changed, and the future looks promising as far as heart disease treatment is concerned. With the help of genomic tools and an array of leukemia, important mechanistic insights have come into being. According to the Academic Search Premier that discuses missense mutations that are relevant to human cardiac disease, illnesses resulting from cardiovascular problems are the number one cause of deaths in America and other countries. This paper will seek to discuss the role played by mitochondrial dysfunction in cardiovascular disease.
Aim of the study
The article Serial Review by Victor Darley paints a clear picture of how cardiovascular disease endangers the future of adults, as it is the leading cause of morbidity and mortality worldwide since 1900. This indicates that the leading cause of cardiovascular disease is atherosclerosis, which accounts for three-fourths of the total deaths related to heart diseases (Darley, 2004). The process is rigid as injured atherosclerosis develops.
Consequently, this development causes the accumulation of lumps of lipids in the area with the injured artery. According to facts laid upon by mitochondria susceptibility and its role in mediating for damages due to increased nitro oxidative stress, it is true to say that very few people understand this behavior. Given the explanation, the article is aimed to discuss the aspects of relating mitochondrial function and damage to the development of cardiovascular disease and the risk factors involved.
Genes involved
Because mitochondria are responsible for the reaction of nitrogen and oxygen species that mediate alterations and functions, they are very sensitive. Additionally, since they are the main producers of oxidative energy required by the cell, they act as cell power plants (Teng, 2009). Sources that maintain mitochondrial DNA mutations have close links with many reported cases of human diseases.
Furthermore, marked clinical heterogeneity shows that deficits of endocrine, renal, cardiovascular, and neuromuscular functions are also related to missense mutations. This indicates that the gene involved in this missense mutation in relation to cardiac diseases is the mitochondrial gene. When the cardiac cells experience abnormal functions, they begin to face cardiac complications commonly referred to as cardiomyopathy and cardiac arrhythmias (Darley, 2004).
The biological role of this gene is to distribute tissues. In simple terms, it rearranges and deletes or inserts mutations. This means that single-base mutations result in missense mutations or simply alter the protein function.
In addition, this gene (mtDNA) mutates or synthesizes the rNA and tRNA proteins. This happens because the rearrangement of mutations normally leads to the deletion of a number of mitochondrial encoded genes, which are also associated with tRNA thus causing defects in mitochondrial protein synthesis (Teng, 2009). Documented evidence asserts that the onset of subacute humans bilateral blindness marks the presence of missense mutation. This effect takes place either sequentially or simultaneously with defects associated with cardiac conditions. Those who suffer from these defects lack additional neurological symptoms.
Mutation nomenclature
Mutation nomenclature is the biological yet common name used to represent the mutation types. Mutation nomenclature is also the description given to sequence variants (Darley, 2004). In missense mutation, one can use deletion, insertions, and intronic mutations to describe the sequence variants of this nomenclature. In deletion, the gene leaves out the nucleotides that normally result in a shift in the frame reading that ultimately truncates the protein.
On the other end, insertions are the added nucleotides that also facilitate the shift that usually truncates the involved protein while intronic mutations take place in the areas between the coding regions otherwise known as the exons.
Mutation linkage
A missense mutation was first linked with Lebers hereditary, which is an optic neuropathy (Darley, 2004). It is also associated with myopathy, which is an abnormal disease or condition of the skeletal muscle. This condition is usually described by subacute bilateral blindness and it affects both eyes of a human. The condition affects the eye either sequentially or simultaneously. Research findings reveal that this condition affects mostly adults with males facing a greater risk of infection than females. This aspect suggests that the secondary factors of this condition influence the onset of the disease (Teng, 2009).
Public health implications
In conclusion, the study has enabled the researchers to document that by virtue of mitochondrias ability to modulate subcellular levels of oxidant via a stringent respiratory interaction between regulation and the relative balance of RNS and ROS, mitochondria are able to critically function in signaling the growth and subsequent death of some cells. Any factor that leads to alteration of the balance between cells can as well change the mitochondrial performance.
Consequently, this can influence the cell. This knowledge has led to greater insights into mitochondrial function in cardiac diseases as missense mutation has revealed the process by which cells develop, grow, and die (Teng, 2009). Based on this research, the lives of people are safer than never before following the fact that cardiovascular diseases account for a huge number of deaths in many countries. Doctors can now understand the best ways of treating these heart diseases or conditions with much ease.
References
Darley, V. (2004). Mitochondrial dysfunction in cardiovascular disease. Web.
Teng, S., et al, (2009). Modeling effects of human single nucleotide polymorphisms on protein-protein interactions. Biophysical Journal, 96 (6), 21782188.
Parkinson s disease (PD) is a serious progressive disease that was first described in 1817 by James Parkinson. Many years passed before it was established that disappearance of doperminergic and non-doperminergic nerve cells in the substantia nigra of the mid brain was a primary feature in PD patients (Jankovic, 2008).
This disappearance results the depletion of dopamine in the striatum. These nerve cells are responsible for controlling movement. Statistics indicate that PD as a neurologenerative disorder in the United States is only superseded by the Alzheimers disease (Scott & Stacy, 2009).The mean age marking the onset of the disease is 57 year and it affects about 1 to 2% of the population above 60 years (LeWitt, 2008).
The actual cause of the death of these cells to date remains unconfirmed. It has been suggested a number of contributing factors may include, genetic mutations, abnormal handling of some proteins by ubiquitin-proteasome and autophagy-lysosomal systems , mitochondrion dysfunction, inflammation , environmental factors, and other pathogenic mechanism (Jankovic, 2008).
There are many forms of parkinsonian disorders categorized into four groups namely: primary (idiopathic)parkinsonism, secondary (acquired,symptomatic) parkinsonism heterodegenerative parkinsonism and the multiple system degeneration type(Jankovic,2008). PD impairs motor and non-motor function in patients predisposing them to significant physical, economic and emotional burdens that is manifested by disability, deficit in health-related quality of life (HRQOL), and increased risk of early mortality (Scott & Stacy, 2009).
This papers aims to deeply examine the present therapeutic interventions for Parkinsons disease. In the first section, various aspects of cognitive, pharmacogical and alternative treatments for this disorder will be presented. The second part will try to relate the clinical manifestations of the disorder with the above treatments and a personal opinion for treatment will be offered. The last section before the conclusion covers contemporary attitudes towards the above treatments.
Therapeutic Interventions
To date, there are no known neuroprotective agents for PD. Although some agents have yielded promising neuroprotective effects in cell cultures and animals, their effects have been inconclusive in humans. In recent years PD therapy has focused on modifying disease progression other than controlling neurological symptoms (Scott & Stacy, 2009). Treatment for PD may involve pharmacological, functional surgery or rehabilitation procedures (physical therapy, speech therapy and Occupational therapy).
Unlike surgery and alternative treatment, Most pharmacological interventions are designed to replenish and enhance delivery of dopamine to the affected areas of the brain .Because dopamine is unable to cross the blood brain barrier, pharmacological formulations use Levodopa ,the precursor of dopamine.
The efficacy of levodopa has been established in the decades proceeding its first introduction in the 1960s (Oertel et al. 2011).The delivery of this precursor to the brain is made by coupling it to Dopa Decarboxylase inhibitors (DDI) such as Carbidopa or benserazide or Catechol-O-Methyltransferase (COMT)(e.g, Entacapone and Talcapone). This coupling enhances the efficacy of levodopa by preventing its peripheral conversion and increases it bioavailability in the brain (Scott & Stacy, 2009).
Over the years, Levodopa has become the preferred drug for the treatment of motor signs and symptoms of PD (LeWitt, 2008). Patients are known to recover from impairment of speech, gait and dexterity 15 to 30 minutes after administration of oral dose. For this reason, this response is also used as a confirmation criterion for proper diagnosis of PD (LeWitt, 2008 ).
Both pharmacological and surgery (Deep Brain stimulation) have been shown to provide symptomatic benefits by reducing tremor ,rigidity ,stiffness and slowed movement (LeWitt, 2008). However, most levodopa users experience motor complication with continued usage of the drug. This has been attributed to its direct neuromodulatory and neurotransmitter actions (LeWitt, 2008).
Apart from pharmacological and surgical treatment many patients of PD also receive rehabilitation assistance in the course of the disease (Oertel et al., 2011).The efficacy of this therapy is not conclusive. The rehabilitation involves specialist drawn from the fields of occupational therapy, occupational therapy and speech-language therapy.
These rehabilitations may be in form of monotherapy or as part of a team of approach (Oertel et.al., 2011). They can also be engaged as part of adjunctive treatment with drug therapy or as mainstay treatment for symptoms that are resistant to other therapies (Oertel et.al., 2011).
Physical therapy can reduce dependence on caregivers and improve the quality of life in PD patients by improving movement, enhancing function and lessening pain (Scott & Stacy, 2008) Physical therapy is limited in that can only address issues such as balance, lack of coordination,fatigue,gait,immobility and weakness. It can also be used to develop exercise program for PD patients before motor problems arise. Recent studies have shown that exercise has a positive effect on motor sign and gait (Oertel et al., 2011).
On the other hand, occupational therapy can help patients learn to perform mundane activities affected by the disease such as handwriting and use of various appliances. Emerging evidence has also shown that gait could be significantly improved through cued training , treadmill training in addition to cultural alternatives such as Tai Chi and Qijong (Oertel et al., 2011).
Most drug therapies and surgical treatment are temporary although the later has been shown to produce much longer beneficial symptoms. The response to levodopa changes after two years and motor fluctuation and dyskinesias develop within 5 years of administration. To counter this effect, a combination therapy of levodopa and doperminergic agonists has been suggested in the initial treatment of PD (LeWitt, 2008).
Another management alternative suggested involves delaying the introduction of levodopa in early PD when symptoms are mild and tolerable. This strategy requires that levodopa be introduced only when the progression has reached levels of serious discomfort and disability (LeWitt ,2008 ). In the United States, levodopa administered together with AAD inhibitor, carbidopa on permilligram basis is efficacious
Pharmacological therapy, just like surgical and rehabilitation procedures also involves a combination of an array of regimens for optimizing symptomatic relief (LeWitt, 2008). Adjunctive therapies are common features of parkinsonism (Oertel, 2011).In stable PD, Efficacy for most drug agents is enhanced by supplementation with other medications (Oertel, 2011).
For advanced PD, Levodopa may be combined with dopaminergic agonists, amantadine ,MAO-B inhibitor or COMT inhibitor (LeWitt, 2008). Pharmacological therapy unlike surgery which is only a viable option in late PD, has been shown to be effective for early and advanced stages of PD. Drug therapy is the primary treatment for PD (Hayes Fung, Kimber, & OSullivan, 2010). Higher doses of Levodopa produce greater improvements but predisposes the patient to earlier wearing off.
Dopaminergic agonists are an alternative to levodopa as they do not produce motor fluctuation and dyskinesias . However, they require augmentation with levodopa within two years to use to produce symptomatic improvement.
Clinical trials have shown cholinesterase inhibitors produce beneficial improvement in cognitive and psychotic symptoms (Hayes et al., 2010).Drug therapy for PD can also trigger of aggravate a range of neurophychiatric symptoms (Hayes et al., 2010). In such cases drug therapy using clozapine has been shown to reduce psychotic symptoms.
Recidivism in more pronounced in drug therapies than in other interventions. Levodopa , administered thrice daily, offers symptomatic control throughout the day. However after years of treatment, motor complications typically, dyskinesias and motor fluctuations result. A meta- analysis by Oertel and colleagues (2011) found <40% likelihood or motor fluctuations and dyskinesias after 4-6 years of levodopa therapy.
Surgical treatment may be considered when pharmacological intervention fails to slow down PD progression and severe motor fluctuations and dyskinesias persist. In recent year Deep Brain Stimulation (DBS) has gained importance due to its beneficial effects in certain motor symptoms.
According to Deuschl and fellow researchers (2006) the administration of continous electrical impulses to the subthalamic nucleus by a surgical implant has produced improvements in motor symptoms in advanced stages of PD .DBS appear to produce long lasting beneficial effects on motor symptoms such as tremor, bradykinesia and dyskinesias although its efficacy has not been conclusively established (Hayes et al., 2010).
However, surgical treatments have not been shown to improve other symptoms such gait dysfunction and fall. In some cases some symptoms have worsened after the surgery (Hayes et al.,2010).
Common Symptoms and Management
Rest tremor, bradykinesia, rigidity and postural dysfunction are the primary motor signs of PD (Jankovic ,2008). These features indicate a positive diagnosis as they are unique from other related parkinsonian disorders.
Secondary motor symptoms include hympmimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing,dystonia and glabellar reflexes (Jankovic, 2008). Non motor symptoms are autonomic dysfunction, cognitive abnoramalities,sleep disorders and sensory disorders such as anosmia, parasthesias and pain (Jankovic, 2008).
For brevity ,the following sections only present the motor symptoms of PD. This symptoms result primary from impairment of motor control and levodopa dopeminergic agonist therapy usually are the first pharmacologicall intervention taken. Functional surgery and rehabilitation therapy can also be considered when the drug therapies fail to control symptoms.
Bradykinesia (slowness in movement ) is a distinguishing clinical feature of PD and is said to be the hallmark of basal ganglia disorders (Jankovic ,2008). It features difficulties in planning, initiating and executing movement and with performing tasks that require fine motor control (Jankovic, 2008). It is also manifested by loss of spontaneous movements,drooling,dysarthria ,impaired blinking ability and hypomimia (Jankovic, 2008).
Rest tremor is also a prevalent symptom of PD. It mostly occurs at extremities but may also involve lips, chin,jaw and legs (Jankovic, 2008). However proper diagnosis is essential to distinguish it from other forms of tremors such as Essential Tremors. Clinical pathological studies have shown that patients with PD have degeneration of a subgroup of mid-brain (A8) neurons (Jankovic, 2008). Though rarely used, clinical trial have indicated that Thalomotony may improve tremor (Oertel,2011).
Rigidity is characterized by increased resistance in movement of limbs and also in the neck, shoulders, wrists, ankles and hips. In PD patients movement in these parts may be accompanied with pain (Jankovic, 2008).
Rigidity of the neck and trunk may result in abnormal axial postures, Striatal limb deformities may also develop in some patients. Deformities of the hand are characterized by ulnar deviation, flexion of metacarpophalangeal joints and extension of the distal interphalangeal joints (Jankovic ,2008). Foot deformities are characterized by extension of flexion of the toes.
Postural instability occurs in advanced PD and is as a result of loss of postural reflexes (Jankovicl, 2008). It is said to be the main contributing factor for falls and ensuing fractures (Jankovic, 2008). Other factors cited to influence postural instability in PD patients include: orthostatic hypotension,age related sensory changes and Kinesthesia (Jankovic, 2008).
Treatment has involved doperminergic therapy and functional surgery (pallidotomy and Deep Brain Stimulation). However these interventions have been known to produce scant improvements (Jankovic, 2008).Physical therapy has also been cited as potentially effective in improving postural instability (Oertel et.al., 2011)
Freezing is one of the most disabling clinical features of PD though its occurrence is not universal (Jankovic, 2008). It commonly affects legs and is characterized by inability to walk which normally occurs at the initiation of movement and during movement. It is a common cause of falls (Jankovic, 2008).
The main subtypes of freezing are: start hesitation, turn hesitation, hesitation in tight quarters, destination hesitation and open space hesitation (Jankovic, 2008).It is mostly severe during OFF periods but can be subdued by levodopa therapy (Jankovic, 2008). It is more common in women than men.
Risk factors for freezing include rigidity, bradykinesia, postural instability and generally advanced stage of PD. Rehabilitation therapy are mostly used to treat freezing due to its poor response to pharmacological therapies. Cued training has been found to be effective in reducing the severity of freezing of gait (Oertel et.al., 2011). A reduction in dopeminergic therapy has been recommended for ON freezing although this strategy may negatively impact on wearing of (Oertel et al., 2011).
Other pharmacological therapies for freezing include strategies such as adjustment of levodopa dose/formulation (standard and CR formulation), dopamine agonists and COMT/MOA-B inhibitors (Oertel et al., 2011).
Contemporary Attitudes Towards Treatment
The choice for a therapeutic intervention for PD is usually a subjective one (Rascol, Goetz, Koller, Poewe, & Sampaio, 2002,). Medical practitioners may base their selection on past experiences of a particular therapy. Other noted considerations include age, perceived expectations, comorbidity, safety, efficacy, technical experience and cost (Rascol et al., 2002). In de novo patients there is always concern about how long to delay the introduction of levodopa for efficacy purposes and the long term motor complications that arise.
In early PD characterized by absence of motor complications, adjunct therapy with relative safety implications is usually acceptable while in advanced PD patients, treatment decisions is normally based on the present motor fluctuations and dyskinesia (Rascol et al., 2002). It is common practice to delay non-pharmacological interventions; especially functional surgery unless motor complication failed response to drug therapies persists.
For surgical interventions such as DBS, application is only acceptable if the symptomatic benefits are considered greater than the nature of risks from surgery and that there is strong likelihood that the procedure will be more beneficial than convential drug therapies (Deuschl et al., 2006). Witt, Kutin, Timmermann, Zurowski and Woopen (2011) have also found out that the risk of altered personality is especially alarming for patients, caregivers and clinicians.
Suggested Treatment
For early PD, I recommend a monotherapy of immediate or controlled releases of dopamine argonists (e.g pramipexole, piribedi, ropinirole) .These drugs have been found to be effective in early PD. Clinical trials data also indicate that there is low risk for developing complications with introductory dopamine argonist therapy (Oertel et al., 2011, p. 224).
Controlled Release (CR) Levodopa should only be introduced when motor symptoms have worsened to an extent of great discomfort and possible disability. This mode is based on clinical evidence that early usage of levodopa may contribute to early emergence of motor fluctuations and dyskinesias.
Adjunct therapies of amantadine, COMT (entacapone only) and MAO-B inhibitors can also form part of the early interventions. Amantadine has been shown to induce symptomatic improvements while MAO-B inhibitors are well tolerated and have low daily doses. For patients with persistent or emerging disabling tremor, DBS at the subthalamic nucleus can be considered.
For advanced/late PD, I recommend a combination of immediate release levodopa with MAO-B and COMT Inhibitors. Levodopa has been established as the most effective treatment for motor fluctuations that is common during this stage. The inhibitors serve to enhance the efficacy of levodopa. Another upside of levodopa is that it has also been shown to be effective in advanced PD patient with cognitive dysfunction in addition to possessing anti-hallucination properties.
For persistent dyskinesias, Amantadine can be used in addition to reducing the daily doses of levodopa and MAO-B/COMT inhibitors. Dopamine agonists can also be considered to compensate for reduce doses of levodopa. However, it adverse effects of inducing hallucination and psychosis should be noted.
For severe motor fluctuations DBS by stimulation of subthatllamic nucleus can be considered when drugs therapies have failed to contain it. Alongside medical and surgical interventions, rehabilitation therapies such as cognitive movement training and cued training are also advised. Late PD also present with a host of non-motor symptoms. The suggestion in this section is only for the motor symptoms which greatly impair the quality of life.
Conclusion
PD is a serious progressive disease that results in a much reduced quality of life in victims. To date the discovery for a neuroprotective agent for PD remains elusive. Current pharmacological therapies are the first line of intervention in initiation of treatment. However as the disease progresses, pharmacological agents lose their effectiveness.
Apart from their symptomatic benefits of therapeutic drugs for PD also produce an array of side effects hence necessitating a combination of different regiments. Clinical trials for modern surgical interventions such as Deep Brain Stimulation have produced positive results so far and their usage is gaining acceptance in many quarters. However the effects of such invasive procedures have not been well established. Rehabilitation measures can only be used as supplementary therapy with surgical or pharmacological therapies.
References
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Hayes, M.W., Fung, S.V., Kimber, T.E., & OSullivan, J.D. (2010). Current concepts in the management of Parkinsons. Medical Journal of Australia, 192(3), 144-149.
Jankovic, J. (2008). Parkinsons disease: clinical features and diagnosis. Neurosurgery and Psychiatry, 79, 368-376.doi: 10.1136/jnnp.2007.131045
LeWitt, P.A. (2008). Levodopa for the treatment of Parkinsons Disease.New England Journal of Medicine, 359, 2468-2476.
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Rascol ,O., Goetz, C., Koller, W., Poewe, W.,& Sampaio, G. (2002). Treatment interventions for Parkinsons Disease: an evidence based assessment. Lancet, 359, 1589-98.
Scott, B.L., & Stacy M.A. (2009). The management of parkinsons disease in the primary care setting. Elsevier Internal Medicine News. Web.
Witt, K.,Kutin,J., Timmermann, L., Zurowski, M., & Woopen,C. (2010). Deep Brain Stimulation and the search for Identity. Neuro ethics. Doi: 10-1007/s12152-011-91-00-1.