Population Health and Epidemiology in Australia - Report Example

Population Health and Epidemiology Executive summary Whitby et al. (2005) say that population health is one of the main topics that has gained attention these days owing to the fact that there are many diseases that have become prevalent within the populations of a country. The health care professionals have to be aware of the disease spread in the country thus, be aware of the country profiles as well as the knowledge of the population divisions, the ethnicities within the country and the disease profiling with respect to these population divisions. Suzanne et al. (2009) say that for being a health care professional of a particular region, the abilities of a professional are reflected by the fact that how strategic the healthcare professional is in helping out to create ways through which a disease that might be prevalent in a region, can be eradicated. Here the report will be dealing with strategies to prevent the spread of Dengue fever within a locality. For this the drug treatment is to be tested on the patients to check the effectiveness of drugs. The issue of the kind of prevention strategies that need to be implemented is very important in this case for allowing the disease to be eradicated at a successful level from the region. In addition to this the other factors that count are the therapies that are designed for the diseased patients in the population and also requires successful drug trials that are conducted on the diseased patients. Background Statistics of Dengue in Australia Nigel et al. (2005) say that Dengue fever is a viral disease that has captured the attention of almost the entire world. In this respect a major disaster that has occurred is in Paraguay and other areas of Latin America including Brazil and is considered to be the pioneer in the ways it has been controlling the disease. McCredie (2009) says that Dengue is the kind of malarial disease that is caused by a viral agent and which has been responsible for many deaths all over the world. In modern days medication and vaccine has been designed for the purpose. However, more needs to be done to combat the disease. Dengue has been the cause of deaths in the Australian region as well. Teo et al. (2009) say that there are several species of the virus that have inhabited many areas of the country. Simasathien and Watanaveeradej (2005) say that the different viral species cause disease of the same nature. However, the areas that the causal agents inhabit differ region by region as is the case in Australia. Nigel et al. (2005) say that one of the species of the virus known as Aedes aegypti has been found to inhabit Queensland in vast majority. The species known as Ae katherinensis, is generally found in northern areas of Queensland. Wang et al. (2009) say that the main species of this causative agent is Ae Albopictus and this specie is a major threat to Australian regions. Figure 1: Dengue virus in Australian states Nigel (2005) says that the area regarded as most sensitive to Dengue fever attack is Queensland. Thereby it has been estimated by health authorities based in Queensland that there might be an outbreak in the areas of Cairns and Townsville in epic proportions that might be hard to control. Authorities have notified 175 deaths in the northern areas of Queensland. However, since the last five years only two deaths due to Dengue have been noticed in Torres Strait Islands. Canyon (2008) argues that the virus is generally localized in the northern Queensland region of Australia in greater proportions and it can spread if a population mix occurs. The higher authorities have notified that people are the only source causing the virus to spread and this issue needs to be dealt with. Whitby et al. (2005) say that it has been estimated that Dengue has been introduced in local areas of Australia because of the international travelers and thus a population mix is created. International travelers bring with them newer and different strains of virus, which makes these viruses undergo mutational changes. Figure 2: Dengue in Queensland Current status Diamond (2005) says that designing new ways to prevent the disease has become necessary as it has the highest rates of spread across the world regardless of the ethnicities and borders. Kalayanarooj (2008) has discussed the steps, which are taken when the person is in a healthy and unaffected state. This is the stage which calls for vaccination against the virus. However, if a person has been infected with the virus, then the affected person needs to be medicated leading to drug therapy for the infected ones. Halstead (2002) says that Dengue is a kind of a malarial disease that is spread through mosquitoes, which are usually found in stagnant water, as well as in unhygienic areas of certain regions. The virus resides inside a mosquito and has two hosts. It is a unique virus that has the human-mosquito-human life cycle. Koraka et al. (2009) say that these viruses have a unique property of mutating at very high rates. These are highest mutating entities that become drug resistant after a very short period of exposure to drugs. The research is being conducted in this regard in order to see if the disease can be controlled by producing drugs that act at a molecular level. The main lag in this case is that virus is a highly mutating entity. Nigel et al. (2005) say that after a diagnosis has been made the only way to control the disease from being any more violent is the drug therapy. Recommendations Lars and Saul (2008) say that drug designing in the case of viral diseases should be done by keeping in mind the fact that the virus will be able to resist the drug after it gets used to it. Research has made possible the designing of drugs that fight the disease. Nevertheless, there is a requirement of innovation. The diseases of such kind need to be controlled at the molecular level rather than by using the drugs that target the symptoms of the diseases. The newer drugs need to be based on some molecular level principles. The main strategies to produce drugs are the viral replication or viral entry inhibitor molecular entities that somehow interfere with the viral replication in the host cells. There are drugs that have been designed and are being experimented by the researchers. Sun et al. (2009) say that according to molecular biology principles, the drugs also include the class of drugs that target proteases in infectious viruses and also work against viral RNA replication. Some important viral proteins especially NS3 are targeted by some of these drugs. In addition to this, research has been going on concerning the newer and innovative ways to design molecules that prevent the entry of viruses into host cells. Lescar et al. (2008) say that there are three main molecular biology principles which are incorporated to produce better drugs against Dengue so that these drugs can be trialed on the patients. These three principles include molecular inhibitors that prevent viral entry, viral RNA replication inhibitors and viral protease inhibitors. Viral proteases are the main targets as these are responsible for metabolism of newer proteins in the virus. McCredie (2009) says that drug therapy is the only way to fight disease after it starts to progress in a patient. Drug intervention is very necessary in this case. This intervention will help in controlling the massive disease that is increasing on a global scale in rising numbers. From the labs and the theories, newer drugs need to be tested on afflicted people. This needs large number of drug trails to be performed on Dengue fever patients. Drugs are to be trialed on each of the Dengue fever patients who have reported in the local medical facilities and only these patients are the ones included in the drug trials. Many types of preventive and therapeutic interventions are being used on the Dengue patients these days. These interventions, including gene therapy, need to be tested on a large scale but gene therapy holds the disadvantage of being time consuming. The changes in a patient, if any, occur after a long time as compared to the shorter periods of changes introduced through drug therapy. Seed et al. (2009) say that the main purpose of drug therapy is that this can be provided to the poor patients within a community. It has been seen that Dengue is a disease prevalent in underprivileged communities within a country as these are the communities out of reach of proper facilities and lacking medical awareness. Drugs can be within their reach from any nearby hospital and the medical stores but in contrast, tools as gene therapy cannot be performed in any hospital as these kinds of complex and sophisticated facilities take time to reach the medical facilities. Drugs can be available at any time of the day as well as in any quantity required or as prescribed. Simasathien and Watanaveeradej (2005) say that this leaves an option of drug therapy that includes the class of drugs working on three main molecular principles described above. Drugs first have to be tested on Dengue fever patients as a trial and it has to be seen as to whether the drug is effective or not. Furthermore, the main objective that needs to be noticed after the drug has been administered as a trial to the patients is the recovery time that the patient shows. In addition to drug therapy, vaccines are still underway to be prepared for the eradication of the disease. However, research is still going on to find out as to which kind of vaccination will best suit the variety of viruses that are to come. From drug therapy it has been noticed that the drugs can be distributed, if successful in the treatment on the patients, to the countries which are not financially equipped for manufacturing their own drugs. The drug therapy can be one step toward formulating even better medicines in the future to be used for the patients. This trial can be helpful in understanding the mechanism of the drug action and recovery speed of the patients. Thus, if the viruses mutate at higher rates, newer drugs can be designed according to the anticipated mutation. Intervention Evaluation The three main kinds of drugs based on three principles have been selected and the only way to see how effective they can prove to be is to trial these drugs on Dengue fever patients. Drug therapy has been chosen as the main choice for the intervention and it needs to be trialed on the population. 1. Target patients For this purpose first of all Dengue patients who are currently reported in the clinics and the hospitals within the selected locality need to be chosen. In this case, a hospital in the locality is chosen as a hospital is thought to be much more reliable for the provision of better healthcare as compared to smaller clinics. Therefore, Dengue patients who have recently reported to the hospital are chosen. 2. Sample size A higher sample size is needed in this case. If the number of recently enrolled Dengue fever patients is higher in the chosen, then the sample size will be kept to a maximum limit of 2000. This is due to the reason that a greater number of the sample size than as mentioned can create confusions and intermixed results. 3. Division of the samples into groups The diagnosis record of the patients in hospital records will be reflective of the stage of the disease in the patients. Thereby, 2000 patients will be divided into groups according to the kind of drug being used. Three main classes of the drugs are to be trialed on Dengue fever patients, including viral RNA replication inhibitors, viral protease inhibitors and viral entry inhibitors. Thereby, 2000 patients will be divided into three main groups. The groups will be named accordingly. One group will be having approximately 660 patients. 4. Data collection The hospital staff will administer the drugs in an organized manner for a fixed period of one month. It has to be made sure that three classes of drugs are administrated to three target patient groups in an organized manner with the notice in the change of the vitals being taken by the hospital staff at regular intervals. The vital records of each patient recorded within a period of one month will be reflective of the effectiveness of the drugs. 5. Data organization The drug trial data collected from the hospital needs to be organized according to the class of drug administered to the three groups of patients. Changes in the patient vitals need to be noticed thoroughly so that the effectiveness of drugs can be interpreted accurately. The symptoms that occur in Dengue fever patients include shivering, sweating especially cold sweats and high fever. These are the main symptoms that need to be noticed for a change during the trials. The data collected from the hospital needs to be explanative of the positive or no changes that have been induced by the trial drug in the patients, specifically in the case of symptoms. Thereby, the resultant data can be arranged according to the changes induced in the symptoms. DRUG TRIAL DESIGN PATIENTS ENROLLED IN THE HOSPITALS 2000 PATIENTS SELECTED PATIENTS DIVIDED INTO THREE MAIN GROUPS DEPENDING ON THE KIND OF THE DRUG BEING ADMINISTERED (APPROX.) 660 PATIENTS 660 PATIENTS 660 PATIENTS Figure 3: Drug trial design Magnitude of Drug trial Benefits The knowledge that had been gained about antiviral drug mechanism seems to be helpful in drug trial to help stop the virus from spreading in the human body. The main aim behind carrying out the trial has been to check the effectiveness of each class of drug on Dengue fever patients having varying symptoms, which depend upon the severity of the disease. Gwadz et al. (ahead of print) say that the sample size needs to be kept larger so that the drug trial results can be of higher frequency, displaying coherent results that can be used to draw conclusions in this case. If the sample size would have been kept lower, it would have been difficult to obtain coherency in the results and the conclusions would not have been possible to make. Vandekerckhove et al. (2009) say that the larger sample size will prove to be helpful as the results will be showing medical health professionals the class of drug that can be used currently on the patients. Thereby, the older medicines that are proving to be unsuccessful can be replaced with the newer drugs. Silverberg et al. (2009) say that following the basic trial design that has been adopted in this paper, newer and better trials can be designed to check the drugs’ effectiveness. Similarly, on the basis of the molecular approach, newer drugs can be formulated that can help in designing better drugs. This would allow for speeding up the process of healing in Dengue fever patients. Conclusions Based on the success results of the trials, the medicines that were failing on the patients previously can be replaced with the ones that have been successful on the patients. It is known that the virus responsible for the disease mutates at a rapid rate and so after sometime the drugs will need to be changed. Newer drugs need to be prepared based on the older principles, but with better and different chemical ingredients. References Canyon, D.V. (2008). Historical analysis of the economic cost of dengue in Australia. J Vector Borne Dis, 45(3), 245-8. Diamond, M. (2005). Development of effective therapies against West Nile virus infection. Expert Review of Anti-infective Therapy, 3(6), 931-944. Halstead, S.B. (2002). Dengue. Curr Opin Infect Dis, 15(5), 471-6. Kalayanarooj, S. (2008). Choice of colloidal solutions in dengue hemorrhagic fever patients. J Med Assoc Thai, 91(3), S97-103. 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Seed, C.R., Kiely, P., Hyland, C.A., & Keller, AJ. (2009). The risk of dengue transmission by blood during a 2004 outbreak in Cairns, Australia. Transfusion, Epub ahead of print. Simasathien, S., & Watanaveeradej, V. (2005). Dengue vaccine. J Med Assoc Thai, 88(3), S363-77. Sun, W. et al. (2009). Phase 2 clinical trial of three formulations of tetravalent live-attenuated dengue vaccine in flavivirus-naïve adults. Hum Vaccin, 5(1), 33-40. Suzanne, M., Tomlinsona, D., Malmstroma, Niklaus, M., & Yuan-Ping, P. (2009). Structure-based discovery of dengue virus protease inhibitors, Antiviral Research, 82(3), 110-114. Teo, D., Ng, L.C., & Lam, S. (2009). Is dengue a threat to the blood supply? Transfus Med, 19(2), 66-77. Wang, Q.Y., Patel, S.J., Vangrevelinghe, E. et al. (2009). A small-molecule dengue virus entry inhibitor. Antimicrob Agents Chemother, 53(5), 1823-31. Whitby, K., Pierson, T., Geiss, B., Lane, K., Engle, M., & Zhou, Y. (2005). Castanospermine, a potent inhibitor of dengue virus infection in vitro and in vivo. Journal of Virology, 79(14), 8698–8706 Read More