Health Promoting Behaviors of Young Adults with Chronic Lyme Disease

Lyme disease is the most prevalent arthropod-borne (tick) disease in North America. The disease is more prevalent in some Eastern and Central states than in Western states. The general problem is that, in southern California especially in Los Angeles County, both patients and practitioners fail to recognize the disease, resulting in misdiagnosis and delayed treatment. Consequently, the patient may develop the long-term, chronic Lyme disease (CLD). The purpose of this phenomenological study was to explore the impact of CLD on the health-promoting behaviors of ethnically diverse young adults from similar educational and socioeconomic backgrounds based on their lived experiences. The geographical focus of this study was restricted to Los Angeles County, California, because researchers have demonstrated a general lack of awareness of CLD as well as a gap when it comes to representing CLD clients from diverse ethical and socio-economic groupings. Data were collected from face-to-face semistructured interviews of 9 participants, based on the health belief model constructs on an ethnically diverse group of young adults clinically diagnosed with CLD. Data were coded and explored for themes. Key results of the study include the existence of excellent health prior to CLD, marked declined in health status because of the disease not being recognized or properly treated, and the use of various modalities of treatment including conventional antibiotic treatment and complementary and alternative treatments to combat the disease. Social implications of this study include increased awareness of physicians and the community in the Los Angeles County of Lyme Disease as an emerging epidemic, development of preventive measures against this disease, and generation of rich data and propositions regarding CLD for further research

A Model Infectious Disease Curriculum for Fourth Grade Students: Integrating Prevention and Education Concepts in the Classroom

Despite the significant need for prevention education and updated disease curricula in elementary schools, there is a deficit of model units, lesson plans, and activities at the fourth grade level. An infectious disease and prevention teaching unit has been developed, following guidelines specified by the Centers for Disease Control and Prevention and a format consistent with proven pedagogical methods. This curriculum was tested in five classrooms with a total of 94 students.Prior to implementation, an assessment of all fourth grade teachers in the district examined their perceived knowledge of infectious diseases and their perceived self-efficacy in teaching such content. Evaluation of student progress included student pre and post-tests to assess changes in knowledge. Upon completion of the unit, teachers evaluated the unit to determine its relevance, effectiveness, and ease of implementation, and completed a post-test on their own knowledge and efficacy.Results indicate that the unit was effective in increasing student comprehension and interest in infectious disease prevention, and teacher efficacy in delivery of the material. This model curriculum can serve as a foundation to increase school health education in critical public health areas such as infectious diseases and preparedness, and provide an early introduction to public health careers

Managing medically unexplained illness in general practice

Provides practical management strategies that general practitioners (GPs) can use when patients present with medically unexplained symptoms. Background Patients with medically unexplained symptoms commonly present to general practice and experience significant disability. Many have a history of trauma, which complicates the therapeutic relationship between doctor and patient. Because diagnosis is an expected outcome of a medical interaction, doctors and patients can feel frustrated and lost without one. Objective This article provides practical management strategies that general practitioners (GPs) can use when patients present with medically unexplained symptoms. Discussion Three types of common presentations are discussed. Enigmatic illnesses occur when the doctor and patient believe that a bio-medical disease is likely, but a diagnosis is not forthcoming. Contested illnesses occur when a patient is committed to a diagnosis the doctor does not accept. Chaotic illnesses occur when symptoms are over-determined; there are many possible diagnoses, but none fully explain the complex web of distress the patient experiences. Common strategies for managing medically unexplained symptoms are discussed, and specific approaches to each presentation are outlined

Scientific Polarization

Contemporary societies are often "polarized", in the sense that sub-groups within these societies hold stably opposing beliefs, even when there is a fact of the matter. Extant models of polarization do not capture the idea that some beliefs are true and others false. Here we present a model, based on the network epistemology framework of Bala and Goyal ["Learning from neighbors", \textit{Rev. Econ. Stud.} \textbf{65}(3), 784-811 (1998)], in which polarization emerges even though agents gather evidence about their beliefs, and true belief yields a pay-off advantage. The key mechanism that generates polarization involves treating evidence generated by other agents as uncertain when their beliefs are relatively different from one's own.Comment: 22 pages, 5 figures, author final versio

Antibiotic Maximalism: Legislative Assaults on the Evidence-Based Treatment of Lyme Disease

Antibiotics, and the deadly pathogens that have evolved to resist them, are one of the major public health concerns of our time. The introduction of penicillin in the early 1940s signaled a new era—not only for the treatment of devastating infections, but also for the out-witting of antibiotics by fast-evolving bacteria. If the middle of the twentieth century saw the era of antibiotic innovation, the past several years might be labeled the era of antibiotic resistance, when untreatable infections have become a modern scourge. Methicillin-resistant Staphylococcus aureus (MRSA) is the most notorious antibiotic resistant “superbug”; this antibiotic-resistent pathogen has emerged as an endemic problem in hospital and long-term care settings. In 2011, bills were introduced in both houses of Congress to encourage the development of new antibiotics to replace those that have become ineffective. Yet, unless or until a truly “miracle” antibiotic (i.e., one which may not be resisted by bacteria) is someday developed, the only solution to antibiotic resistance is to reduce the use of antibiotics. Surprisingly, amidst public-health efforts to prevent antibiotic-resistant pathogens by reining in excessive antibiotic use, several states have passed laws that legitimize intensive antibiotic regimens even when those regimens contradict the best available medical evidence. Although this unprecedented legislative activity has occurred in the context of a controversial medical diagnosis, chronic Lyme disease, the legal and political repercussions threaten the established role of state medical licensing boards in promoting evidence-based standardization of medical practice. The most intrusive of these statutes prevents state licensing boards from disciplining physicians who prescribe regimens of long-term antibiotic therapy that are specifically proscribed by mainstream clinical practice guidelines (CPGs) on Lyme disease treatment. Such laws promote the view of non-standard practitioners who favor the intensive, maximalist use of antibiotics for a condition that mainstream physicians dispute even exists. In an attempt to protect unnecessary antibiotic regimens, recent legislation legitimizes a treatment paradigm that poses an undue risk of harm to individual patients and to the public health. By enacting laws that protect and legitimize repudiated treatments, state legislatures have responded to a movement of non-standard “Lyme literate medical doctors” (LLMDs)—a movement that has been described as an “antiscience” and “parallel universe of pseudoscientific practitioners” by mainstream practitioners. In addition, by interfering with the legal authority of state medical boards to enforce evidence-based standards on antibiotic use, states have also sided with a fringe movement of physicians who oppose the “encroachment” of third-parties, including the government, upon the physician-patient relationship. These advocates decry the influence of evidence-based clinical guidelines and state medical licensing boards on the medical practice. Removing the power of state regulators to discipline physicians for dangerous, non-standard Lyme disease treatment is perceived as an opening salvo in the attack on the legitimacy of state medical oversight

When should you order a Lyme titer?

Lyme titers should be ordered for patients with signs or symptoms of disseminated Lyme disease, but who do not have the pathognomonic erythema migrans rash (strength of recommendation [SOR]: C, based on expert opinion). Symptomatic patients with erythema migrans should be treated without being tested, given the high probability of having Lyme disease

Case 9 : Managing Expectations: Lyme Disease

Increasing cases of Lyme disease are creating public outcry. The Public Health Agency of Canada (PHAC) has been tasked with the surveillance and guidance for this tick-borne disease but has not seen additional funding. Evidence-based analysis has indicated the most impactful use of resources would be spent on prevention and awareness. Despite this information, the push for increasing the healthcare budget to allow for more Lyme disease funding is growing. A desire to increase resources for acute care in the hopes of better diagnostic testing, more freely prescribed antibiotics, and dedicated Lyme clinics is being put forward from advocacy groups. As climate change worsens, Lyme incidences rising in the foreseeable future is probable. As the president of PHAC, managing different stakeholders within and outside of the organization while managing expectations is crucial. The ability to engage and inform while maintaining a positive public perception is key, as this will lay the framework for other initiatives to launch in the future. Balancing this delicate situation while maintaining an evidence-based approach will take caution and strategic skills

Case 12 : Policy Window - When Lyme is in the Limelight

Melissa Doug is a senior policy analyst at the Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases at the Public Health Agency of Canada. She has been tasked with preparing Question Period (QP) notes for the Minister of Health. She has very little time to prepare a clear, succinct, and jargon-free note by 8:30 a.m. for the Director’s approval. Once the note is approved, the Director will forward it to the Minster of Health with an update on the status of activities being undertaken for the Action Plan on Lyme Disease. The QP note also includes an update on the upcoming roundtable discussion with stakeholders as part of the Lyme disease engagement strategy. Melissa has been working on Lyme disease policy for more than four years and her team’s energy and efforts will come to fruition during this roundtable discussion. Lyme disease is a rapidly growing public health challenge in Canada. The absence of a consolidated national response to Lyme disease led to the Federal Framework on Lyme Disease Act, which mandated the Minister of Health to call a national conference on the issue. The Public Health Agency of Canada developed the federal Action Plan on Lyme Disease on behalf of the Minister of Health. The Action Plan is based on three pillars—surveillance, education and awareness, and guidelines and best practices. Developing the plan requires comprehensive consultation with all stakeholder groups to ensure that diverse perspectives in policy development and implementation are incorporated. Stakeholder engagement in the implementation process is key to addressing the specific needs of at-risk groups and narrowing the gaps in current practices at the policy level. The purpose of this case is to underscore the importance of stakeholder analysis and management in defining future policy directions and successful program implementation. Incorporating the real-world perspectives of diverse stakeholders is an essential component of an effective policy-making process

Public health considerations for a potential Lyme disease vaccine in the United States: cost of illness, vaccine acceptability, and net costs of a vaccination program

2021 Spring.Includes bibliographical references.To view the abstract, please see the full text of the document