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Select and describe one aspect/genomics, Newborn screening, or pharmacogenetics/pharmacogenomics that you believe is rapidly transforming public health and healthcare.

                  I believe screening for sickle cell disease/sickle cell trait in newborns and adults is rapidly changing the outcome of healthcare for minorities affected by the disease.  Sickle cell disease (SCD) is an inherited autosomal recessive disorder caused by the replacement of normal haemoglobin (HbA) by mutant haemoglobin, known as hemoglobin S or Sickle hemoglobin, and the disease causes red blood cells to become hard, sticky and transform into a C- shape (Runkel et al., 2020, and CDC, 2020). Hemoglobin is primarily located in red blood cells and it functions in delivering oxygen to all organs in the body. Symptoms for sickle cell disease typically starts in the first years of life and it includes pain, infections, anemia, acute chest syndrome, stroke, and acute splenic sequestration. People who carry the sickle cell trait (SCT) inherit one sickle cell gene (“S”) from one parent and one normal gene (“A”) from the other parent. People with the sickle cell trait do not exhibit any signs of the disease, but they can pass the trait on to their children. SCD/SCT are diagnosed with a simple blood test and newborns are screened for their sickle cell status as early as 24-48 hours after birth (CDC, 2020).  Early diagnosis provides opportunity to prevent, minimize, or more adequately adapt to an anticipated health burden, and allows parents to make informed decisions regarding prevention or for coping with the anticipated hemoglobin disease (Headings, V., 1982).

What is the relevant challenge for public health practitioners around this topic?

               Sickle cell disease presents a challenge for practitioners because there is not enough data collected about this disease to help practitioners to better understand the impact this disease has on the heath of the individual.  Currently the exact number of people living with SCD in the United States is unknown, but it is estimated that SCD affects approximately 100,000 Americans, it occurs in about 1 out of every 365 black or African Americans births, it occurs in about 1 out of every 16,300 Hispanics-American births, and about 1 in 13 Black or African American babies are born with sickle cell trait (SCT) (CDC, 2020).  

What is one possible public health response to the stated challenge?

               To address this challenge, the Centers for Disease Control and Prevention (CDC) is collecting information about this disease via its Sickle Cell disease Collection (SCDC) Program.  This program focuses on the long-term trends of this disease to better understand diagnosis, treatment, and healthcare access for people with sickle cell disease in the United States (CDC, 2020). As more information is collected about this disease, I believe it will help public health officials and practitioners to identify any socioeconomic disparities related to Sickle Cell Disease.

Select and describe one challenging aspect of either medication errors, drug safety, or inappropriate use of prescription drugs.

              The World Health Organization (WHO) defines an adverse drug event (ADE) as a detrimental response to a medication that is undesired and unintended, excluding therapeutic failure, poisoning, and unintended overdose (Trivalle, C. et al, 2011). I believe the most challenging aspect of an adverse drug event (ADE)is failure of the patient to read or understand their drug prescription labels due to poor health literacy.  Studies have shown that patients with poor health literacy have more difficult time using medication properly, more likely to have poorer health outcome, and more likely to be hospitalized (Battle, C. ,2009).

Describe the public health impact of this issue and explain what you think is one important public health response.

               Adverse drug events (ADEs) represent a major public health problem and causes 1.3 million emergency department visits each year. Establishing effective communication is one response that could help eliminate ADE in people with poor health literacy. Effective communication by healthcare professionals can help ensure patients receive the message being delivered (Battle, C. ,2009).

Discuss how you personally can (or will) exercise critical thinking in your career as a public health professional. Give examples and explain what basic science elements you think are most important to understand in your public health career.

               I currently work as a Public Health Veterinarian and I can utilize critical thinking skills in solving problems by analyzing data to determine my decision. For examples, my job involves determining if a slaughter establishment is operating in regulatory compliance to produce a safe and wholesome product for human consumption. My decision is based on data collection results on meat samples and daily surveillance.  My scientific background in microbiology have been an essential basic science element in helping me interpret Establishment data of microbiological samples.

References:

Battle,C. (2009). Essentials of Public Health Biology: A Guide for the Study of Pathophysiology. Jones and Bartlett Publishers. Ch. 6.

Centers for Disease Control and Prevention (CDC) (2020). Sickle Cell Disease (SCD): Data & Statistics on Sickle Cell Disease. https://www.cdc.gov/ncbddd/sicklecell/data.html

Centers for Disease Control and Prevention (CDC) (2020). Sickle Cell Disease Research: Sickle Cell Data Collection (SCDC) Program. https://www.cdc.gov/ncbddd/hemoglobinopathies/scdc.html

Headings, V. (1982). Sickle cell disease in childhood: strategies for early diagnosis. Am. J. Pediatr Hematol Oncol; 4(1): 67-71.

Runkel, B., Kluppelholz, B., Rummer, A., Sieben, W., Lampert, U., Bollig, C., Markes, M., Paschen, U., & Angelescu, K. (2020). Screening for sickle cell disease in newborns: a systematic review. Systematic Review; 9(250).

Trivalle, C., Burlaud, A., &  Ducimetiere, P. (2011). Risk factors for adverse drug events in hospitalized elderly patients: a geriatric score. European Geriatric Medicine; 2: 284-289.

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