Josephine Thomas Beach
August 15, 2011
Epidemiology is defined as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems” (Stanhope & Lancaster, 2008, p. 243). Epidemiology takes an interdisciplinary approach at protecting the health of the entire community and is concerned with the risk of disease, the rate of disease development, and the levels of existing disease in a population (Stanhope & Lancaster, 2008). According to Medscape’s (2011) website, sexually transmitted infections (STIs) are prevalent among homeless girls and women (both sheltered and unsheltered) and is attributed to lack of access to condoms, survival sex, prostitution, intravenous drug use, language barriers, and citizenship status. Healthy people reports an estimated 1.1 million people are living with HIV/AIDS. 1 in 5 infected persons are unaware resulting in 56,000 new infections annually (HealthyPeople.gov, 2011). Up to sixteen percent of all persons living with HIV/AIDS are homeless (The National AIDS Housing Coalition, 2011). According to the Chatham-Savannah Authority for the Homeless (2011), “According to the Stewart B. McKinney Act, a person is considered homeless who lacks a fixed, regular, and adequate night-time residence and has a primary night- time residency that is (A) a supervised publicly or privately or privately operated shelter designed to provide temporary living accommodations…(B) an institution that provides a temporary residence for individuals intended to be institutionalized, or (C) a public or private place not designed for or ordinarily used as, a regular sleeping accommodation for human beings” (para 1). Contributing factors to homelessness include lack of affordable housing, budget cuts in social programs, substance abuse, mental health, changes in the labor market, divorce, and runaways. In the veteran population, homelessness is usually related to battle fatigue or post traumatic stress syndrome (Amore & Aspinall, 2011). When investigating and outbreak, both speed and accuracy are important and an determine if reported outbreaks are truly outbreaks. Local health department records, hospital discharge records, mortality records along with records from neighboring states, national data, telephone surveys, and local community surveys are all used to determine baselines and trends. Multifactorial elements may contribute to false-positive elevations include better reporting factors, increased population sizes. Additionally, all outbreaks are not investigated based on availability of resources among other factors (Centers for Disease Control and Prevention, 2011). Verifying the diagnosis, the third step in the process, is a two-fold process. Both the clinical diagnosis and the laboratory results must be verified. According to the Center for Disease Control and Prevention’s website (2011) interviewing the patient also assists in establishing a hypothesis for the cause, source, and spread of the disease. The fourth step is to establish a standard set of criteria based on simple and objective measures. The case definition is comprised of four mechanisms; clinical information about HIV, characteristics of people infected, information about the location of the outbreak, and the specific timing of the outbreak (Centers for Disease Control and Prevention, 2011). For example, a decreased T-cell count, an elevated fever, tiredness, nausea, and enlarged lymph nodes would satisfy the clinical requirement. Increased visits to the mobile clinic from inhabitants of a homeless population with the same symptoms would be the characteristic qualification. By time the criterion might be all visitors within a 90-day...
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