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Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
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Does Socioeconomic Status Account for Racial and Ethnic
Disparities in Childhood Cancer Survival?
Rebecca D. Kehm, PhD 1; Logan G. Spector, PhD 2; Jenny N. Poynter, PhD 2; David M. Vock, PhD 3;
Sean F. Altekruse, PhD 4,5; and Theresa L. Osypuk, SD 1
BACKGROUND: For many childhood cancers, survival is lower among non-Hispanic blacks and Hispanics in comparison with non- Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies
have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival. METHODS: This study used population-based cancer survival data from
the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000-2011 (n 531,866). Black-white and Hispanic-white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by
SES, which was measured with a validated census-tract composite index. RESULTS: Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity–survival association for acute lym-phoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma; SES reduced the original association
between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect – log hazard ratio direct effect)/log hazard ratio total
effect). CONCLUSIONS: SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity–survival association explained by SES varies between black-white and Hispanic-white com- parisons for some cancers, and this suggests that mediation by other factors differs across groups.
2018 American Cancer Society .
KEYWORDS: cancer survival, childhood cancer, mediation, racial and ethnic disparities, socioeconomic status.
INTRODUCTION
Despite improvements over the last 4 decades in cancer survival in the US pediatric population, marked racial and ethnic
disparities persist. 1Compared with non-Hispanic white (white) children, non-Hispanic black (black) and Hispanic chil-
dren experience lower survival from many cancers, including leukemias, 2,3 lymphomas, 4,5 central nervous system (CNS)
tumors, 6and extracranial solid tumors. 7-9 The underlying causes of racial/ethnic survival differences are not well under-
stood and may vary by cancer type. As outlined in Figure 1,bothbiologicalandsocioeconomicpathwayshavebeenpro-
posed in the literature. 10,11 Underlying genetic variations associated with ancestry may lead to differences in tumor
biology and pharmacogenetics for some childhood cancers. 10 However, race/ethnicity is a socially constructed taxonomy
that is not synonymous with ancestry. 12 Race/ethnicity is highly correlated with socioeconomic status (SES), especially in
the United States, where embedded, institutionalized racism continues to place racial and ethnic minorities at high risk for
low SES. 13 Because of emerging evidence for a positive association between SES and survival from some childhood can-
cers, 11racial/ethnic survival disparities may also be explained by socioeconomic differences.
Quantifying the relative role of SES in explaining racial/ethnic survival disparities will help to inform practice and
intervention efforts. If SES accounts for racial/ethnic survival differences, then interventions addressing social and eco-
nomic barriers to treatment and care are warranted. However, if SES does not fully account for survival differences by
race/ethnicity, then other social factors (eg, immigration) and biological mechanisms (eg, tumor biology) must be consid-
ered. To date, formal mediation methods have not been used to disentangle racial/ethnic disparities in childhood cancer
Corresponding author: Rebecca D. Kehm, PhD, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 13,000 South Second Street, West Bank Office Building, Minneapolis, MN 55455; kehmx003@umn.edu
1Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota; 2Division of Epidemiology and Clini- cal Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; 3Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota; 4National Cancer Institute, Bethesda, Maryland; 5Epidemiology Branch, Prevention and Population Sciences Program, Division of Cardio- vascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Seeeditorialonpages thisissue. Additional supporting information may be found in the online version of this article.
DOI: 10.1002/cncr.31560, Received: December 8, 2017; Revised: January 11, 2018; Accepted: February 2, 2018, Published online Online Library (wileyonlinelibrary.com)
Original Article
Cancer 2018;124:40 –
Cancer October 15, 2018 4090
August 20, 2018 in Wiley
90
4097.
VC
3975-8, survival. Therefore, we conducted a mediation analysis
using population-based data, representative of the US
pediatric cancer population, to measure the role of SES in
racial and ethnic childhood cancer survival disparities. We
assessed survival from several childhood cancers to deter-
mine whether mediation by SES differs across cancer
types.
MATERIALS AND METHODS
Study Population
We obtained population-based cancer registry data from
the Surveillance, Epidemiology, and End Results (SEER)
18 database; the Alaska Native Tumor Registry was
excluded. We restricted the analysis to black, Hispanic,
and white cases aged 0 to 19 years with microscopically
confirmed first primary malignancies. Race was assigned
in SEER through medical record abstraction. 14,15 His-
panic ethnicity was assigned in SEER on the basis of self-
report/guardian report of Spanish origin in the medical
record or by a computer algorithm that searches surnames
and maiden names to determine Spanish origin. 14,16 We
assessed race/ethnicity with mutually exclusive categories
(non-Hispanic white, non-Hispanic black, and Hispanic);
individuals of Spanish origin were categorized as His-
panic, regardless of racial background. SES data were
available in SEER for diagnostic years 2000-2012. There-
fore, we restricted our sample to cases diagnosed in 2000-
2011 and followed through December 31, 2012, to allow
for at least 1 year of follow-up. We excluded 45 cases with
in situ tumors, 707 cases with missing/zero months of
follow-up, and 725 cases missing SES data. We assessed
cancers with 200 cases for each racial/ethnic group; they
were classified with the International Classification of
Childhood Cancer, third edition. 17 Our final analytic
sample consisted of 31,866 cases. This study was
approved by the Surveillance Research Program in the
National Cancer Institute’s Division of Cancer Control
and Population Sciences.
Measures
Overall survival was calculated in SEER as months from
the date of the cancer diagnosis to the date of death from
any cause or was censored at the date of last contact.
SES was measured at the neighborhood level (based
on the residential address at the date of the cancer diagno-
sis) with a validated census-tract composite index. 18 As
described in the prior literature, 19 the index was con-
structed through a factor analysis of nationwide 2000
decennial census data and 2005-2009 American Commu-
nity Survey data. 18 Seven indicators of neighborhood
SES, previously specified by Yost et al, 20 were included in
the index: proportion employed in working-class occupa-
tions, proportion aged 16 years or older and unemployed,
aThe stage at diagnosis is N/A for leukemias.bHigher quintiles represent higher SES (ie, Q1 is the lowest SES quintile, and Q5 is the highest SES quintile).
4093 Cancer October 15, 2018
Mediation of Childhood Cancer Survival/Kehm et al race-survival association if the indirect effect of race on
survival operating through SES was statistically signifi-
cant. SES significantly mediated the black-white survival
disparity for acute lymphoblastic leukemia (ALL;
indirect-effect hazard ratio [iHR], 1.17; 95% confidence
interval [CI], 1.07-1.28; P<.01; 44% reduction from
the total effect to the direct effect of the racial disparity in
mortality), AML (iHR, 1.15; 95% CI, 1.03-1.29;
P 5 .01; 28% reduction), and neuroblastoma (iHR, 1.17;
95% CI, 1.03-1.33; P5 .02; 49% reduction). SES was a
marginally significant mediator of the black-white sur-
vival disparity for non-Hodgkin lymphoma (NHL; iHR,
bly, SES significantly mediated both the racial and ethnic
disparities in survival for the same 4 cancers.
Secondary Analyses
Except for NHL, the mediating effect of tract-level SES
was greater than the mediating effect of health insurance
status among black-white and Hispanic-white compari-
sons (Supporting Table 3). For example, the indirect
effect of tract SES on the black-white mortality disparity
for ALL was 1.22 (95% CI, 1.01-1.48; P5 .04; 44%
reduction), whereas the indirect effect of health insurance
was 1.09 (95% CI, 0.94-1.27; P5 .24; 19% reduction).
Among cancers with significant SES indirect effects, SES
was not associated with the stage at diagnosis (Supporting
Table 4). The exclusion of the stage at diagnosis from
IOW models did not lead to notably stronger indirect
SES effects (Supporting Tables 5 and 6).
DISCUSSION
This is the first study to use formal mediation methods to
unpack childhood cancer survival disparities by race/eth-
nicity, and it generated several findings. We replicated
TABLE 2. Mediation by SES of Racial (Black vs White) Survival Disparities Among Childhood Cancer Cases
Aged 0 to 19 Years and Diagnosed in 2000-2011 in the SEER 18 Registries
Cancer Type
Total Effect of Race on Survival Through All Medi- ating Pathways
Direct Effect of Race on Survival After Blocking SES Pathway
Indirect Effect of Race on Survival OperatingThrough SES Pathway Reduction From Total Effect to Direct Effect, % b MortalityHR a 95% CI P Mortality HR a 95% CI P Mortality HR a 95% CI P
Germ cell tumors 0.98 0.57-1.69 .94 Not applicable c
Abbreviations: b, log hazard ratio; CI, confidence interval; CNS, central nervous system; HR, hazard ratio; SEER, Surveillance, Epidemiology, and End Results; SES, socioeconomic status; STS, soft-tissue sarcomas.aAdjusted for age, sex, and stage at diagnosis (stage not applicable for leukemias). Bootstrapping was used for standard errors.b( btotal –bdirect )/btotal). cDirect and indirect effects were not estimated for cancers with a statistically nonsignificant total effect ( P>.05); bootstrapping was not used.
4094 Cancer October 15, 2018
Original Article results from prior studies showing that whites have a sig-
nificant survival advantage over blacks and Hispanics for
several childhood cancers, including leukemias, 2,3 lym-
rhabdomyosarcoma soft-tissue sarcomas. 9In no instance
was survival among whites significantly worse than that of
either black or Hispanic children. Racial and ethnic sur-
vival differences were not uniform across cancers, and
some variability between black-white and Hispanic-white
comparisons was observed.
We demonstrated that SES significantly mediates
racial/ethnic survival disparities for several childhood can-
cers, including ALL, AML, neuroblastoma, and NHL.
For these cancers, indirect hazard ratios fell within a nar-
row range (1.13-1.17) for both black-white and Hispanic-
white comparisons. This suggests that the association
between SES and survival is not modified by, and may be
shared across, race/ethnicity. Conversely, the proportion
of the overall survival disparity explained by SES (ie, the
percent reduction) did vary by race/ethnicity for some
cancers. For example, among AML cases, SES explained
only 28% of the black-white survival disparity but 73% of
the Hispanic-white disparity. This may suggest a differen-
tial role of other mediating factors across racial/ethnic
groups for some cancers. For example, prior evidence sug-
gests that, among AML cases, a significantly lower pro-
portion of black children have matched family donors
available in comparison with white and Hispanic chil-
dren. 29Among other cancers with significant racial/ethnic
survival disparities (eg, CNS tumors and soft-tissue sarco-
mas), we found no significant evidence of mediation by
SES. Thus, for these cancers in particular, we cannot rule
out mediation by other factors such as differences in
tumor biology, pharmacogenomics, health care quality,
and other social factors not captured by the SES index (eg,
racism). 30
Because SES did not uniformly influence survival
across different types of childhood cancer, the mecha-
nisms through which SES influences survival may be
cancer-specific. For example, the strong association
between SES and ALL survival may be explained by differ-
ences in treatment adherence. 10 Unlike treatments for
other childhood cancers, the treatment of ALL requires a
prolonged maintenance phase composed of the oral
administration of antimetabolites, which may be difficult
for low-SES families to adhere to because of social and
economic constraints. 10 This is supported by prior evi-
dence of lower treatment adherence among children with
ALL living in a single-mother household versus a 2-parent
household. 31 Other cancer-specific mechanisms through
which SES may influence survival are less understood.
Secondary findings from this study suggest that factors
beyond health insurance status and stage at diagnosis con-
tribute to the SES-survival association, at least for some
TABLE 3. Mediation by SES of Ethnic (Hispanic vs White) Survival Disparities Among Childhood Cancer
Cases Aged 0 to 19 Years and Diagnosed in 2000-2011 in the SEER 18 Registries
Cancer Type
Total Effect of Ethnicity on Survival Through All Medi- ating Pathways
Direct Effect of Ethnicity on Survival After Blocking SES Pathway
Indirect Effect of Ethnicity on Survival OperatingThrough SES Pathway Reduction From Total Effect to Direct Effect, % b MortalityHR a 95% CI P Mortality HR a 95% CI P Mortality HR a 95% CI P
Abbreviations: b, log hazard ratio; CI, confidence interval; CNS, central nervous system; HR, hazard ratio; SEER, Surveillance, Epidemiology, and End Results; SES, socioeconomic status; STS, soft-tissue sarcoma.aAdjusted for age, sex, and stage at diagnosis (stage not applicable for leukemias).b( btotal –bdirect )/btotal). cDirect and indirect effects were not estimated for cancers with a statistically nonsignificant total effect ( P>.05); bootstrapping was not used.
4095 Cancer October 15, 2018
Mediation of Childhood Cancer Survival/Kehm et al childhood cancers. Additional research is needed to fur-
ther unpack the association between SES and childhood
cancer survival.
Limitations
We relied on an area-based variable as our primary measure
of SES because of the lack of individual-level SES measures
in SEER data; moreover, we selected an SES index to oper-
ationalize the SES construct over a meaningful period of
time. Although this improves upon many prior
population-based cancer studies that lacked any measures
of SES or relied on county-level measures, tract-level SES is
still a proxy for individual-level SES in this study because
we could not comprehensively control for SES at the indi-
vidual level. 32,33 Furthermore, we used a fairly crude mea-
sure of individual-level health insurance status (private vs
otherwise) in our secondary analysis. Because the tract-level
SES index was available in SEER only for the years 2000-
2012, the sample size and the follow-up time were limited.
This prevented us from testing more homogenized cancer
and racial/ethnic subgroups or stratifying by age. Addi-
tional research is thus needed for other smaller populations
of racial and ethnic groups not considered in this analysis
because of the rarity of childhood cancer, which limited
power. We also lacked geographic variables to explore
potential spatial variations in survival. Furthermore, the
lack of clinical data in SEER limited our ability to account
for diagnostic, therapeutic, and biological factors, such as
cytogenetic or molecular features. Finally, there is the
potential for differential loss to follow-up by race and SES.
In conclusion, through the application of formal
mediation methods, we have demonstrated that SES signif-
icantly contributes to racial and ethnic survival disparities
for several childhood cancers, including ALL, AML, neuro-
blastoma, and NHL. Thus, for these cancers in particular,
racial/ethnic survival disparities could theoretically be
addressed through initiatives that reduce social and eco-
nomic barriers to effective care. Such efforts may include
expanded health insurance coverage, improved patient care
coordination, increased health literacy, and supplementa-
tion of transportation and childcare costs during treatment.
However, because SES did not fully account for survival
disparities, we cannot rule out the potential role of other
mediating pathways, including tumor biology, pharmaco-
multipronged intervention approach that both addresses
socioeconomic barriers to care and invests in personalized
treatment regimens may ultimately be needed to fully elim-
inate childhood cancer survival disparities.
FUNDING SUPPORT
This work was supported by a National Institutes of Health
Translational Pediatric Cancer Epidemiology Training Grant
(T32CA099936).
CONFLICT OF INTEREST DISCLOSURES
The authors made no disclosures.
AUTHOR CONTRIBUTIONS
Rebecca D. Kehm : Conceptualization, data curation, formal anal-
ysis, methodology, writing–original draft, and writing–review and
editing. Logan G. Spector : Conceptualization, methodology, and
writing–review and editing. Jenny N. Poynter : Conceptualization,
methodology, and writing–review and editing. David M. Vock :
Conceptualization, methodology, and writing–review and editing.
Sean F. Altekruse : Conceptualization, methodology, and writing–
review and editing. Theresa L. Osypuk : Conceptualization, meth-
odology, and writing–review and editing.
REFERENCES
1. Howlader N, Noone A, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2010. Bethesda, MD: National Cancer Institute;2013. 2. Bhatia S. Influence of race and socioeconomic status on outcome of children treated for childhood acute lymphoblastic leukemia. Curr Opin Pediatr. 2004;16:9-14. 3. Hossain MJ, Xie L, Caywood EH. Prognostic factors of childhood and adolescent acute myeloid leukemia (AML) survival: evidencefrom four decades of US population data. Cancer Epidemiol. 2015; 39:720-726. 4. Grubb W, Neboori H, Diaz A, Li H, Kwon D, Panoff J. Racial and ethnic disparities in the pediatric Hodgkin lymphoma population.Pediatr Blood Cancer. 2016;63:428-435. 5. Kent EE, Breen N, Lewis DR, de Moor JS, Smith AW, Seibel NL. US trends in survival disparities among adolescents and young adultswith non-Hodgkin lymphoma. Cancer Causes Control. 2015;26: 1153-1162. 6. Austin MT, Hamilton E, Zebda D, et al. Health disparities and impact on outcomes in children with primary central nervous systemsolid tumors. J Neurosurg Pediatr. 2016;18:585-593. 7. Henderson TO, Bhatia S, Pinto N, et al. Racial and ethnic dispar- ities in risk and survival in children with neuroblastoma: a Child-ren’s Oncology Group study. J Clin Oncol. 2010;29:76-82. 8. Johnson KA, Aplenc R, Bagatell R. Survival by race among children with extracranial solid tumors in the United States between 1985and 2005. Pediatr Blood Cancer. 2011;56:425-431. 9. Waxweiler TV, Rusthoven CG, Proper MS, et al. Non-rhabdomyo- sarcoma soft tissue sarcomas in children: a Surveillance, Epidemiol-ogy, and End Results analysis validating COG risk stratifications. Int J Radiat Oncol Biol Phys. 2015;92:339-348. 10. Bhatia S. Disparities in cancer outcomes: lessons learned from chil- dren with cancer. Pediatr Blood Cancer. 2011;56:994-1002. 11. Gupta S, Wilejto M, Pole JD, Guttmann A, Sung L. Low socioeco- nomic status is associated with worse survival in children with can-cer: a systematic review. PLoS One. 2014;9:e89482. 12. Jorde LB, Wooding SP. Genetic variation, classification and ‘race’. Nat Genet. 2004;36:S28-S33. 13. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212-1215. 14. Adamo M, Dickie L, Ruhl J. SEER Program Coding and Staging Manual 2016. Bethesda, MD: National Cancer Institute; 2016. 15. Surveillance, Epidemiology, and End Results. SEER race recode. http://seer.cancer.gov/seerstat/variables/seer/race_ethnicity. AccessedJanuary 2, 2018.
4096 Cancer October 15, 2018
Original Article 16. NAACCR Race and Ethnicity Work Group. NAACCR Guideline for Enhancing Hispanic/Latino Identification: Revised NAACCR Hispanic/Latino Identification Algorithm [NHIA v2. 2.1]. Spring- field, IL: North American Association of Central Cancer Registries;2011. 17. Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International Classification of Childhood Cancer. Cancer. 2005;103:1457-1467. 18. Yu M, Tatalovich Z, Gibson JT, Cronin KA. Using a composite index of socioeconomic status to investigate health disparities whileprotecting the confidentiality of cancer registry data. Cancer Causes Control. 2014;25:81-92. 19. Kish JK, Yu M, Percy-Laurry A, Altekruse SF. Racial and ethnic dis- parities in cancer survival by neighborhood socioeconomic status inSurveillance, Epidemiology, and End Results (SEER) registries. J Natl Cancer Inst Monogr. 2014;2014:236-243. 20. Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/eth-nic groups. Cancer Causes Control. 2001;12:703-711. 21. Liu L, Deapen D, Bernstein L. Socioeconomic status and cancers of the female breast and reproductive organs: a comparison acrossracial/ethnic populations in Los Angeles County, California (UnitedStates). Cancer Causes Control. 1998;9:369-380. 22. Young J, Roffers S, Ries L, Fritz A, Hurlbut A. SEER Summary Staging Manual 2000: Codes and Coding Instructions. https://seer.cancer.gov/tools/ssm/. Accessed January 2, 2018. 23. Tchetgen Tchetgen EJ, Shpitser I. Semiparametric Estimation of Models for Natural Direct and Indirect Effects. Cambridge, MA: Harvard Uni- versity; 2011. Harvard University Biostatistics Working Paper 129. 24. Tchetgen Tchetgen EJ. Inverse odds ratio–weighted estimation for causal mediation analysis. Stat Med. 2013;32:4567-4580.
25. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173-1182. 26. Nguyen QC, Osypuk TL, Schmidt NM, Glymour MM, Tchetgen Tchetgen EJ. Practical guidance for conducting mediation analysiswith multiple mediators using inverse odds ratio weighting. Am J Epidemiol. 2015;181:349-356. 27. Pearl J. Direct and indirect effects. In: Breese J, Koller D, eds. Pro- ceedings of the Seventeenth Conference on Uncertainty in ArtificialIntelligence. San Francisco, CA: Morgan Kaufmann Publishers Inc; 2001:411-420. 28. StataCorp. Stata Statistical Software. College Station, TX: StataCorp; 2011. 29. Aplenc R, Alonzo TA, Gerbing RB, et al. Ethnicity and survival in childhood acute myeloid leukemia: a report from the Children’s Oncology Group. Blood. 2006;108:74-80. 30. Kawachi I, Daniels N, Robinson DE. Health disparities by race and class: why both matter. Health Aff (Millwood). 2005;24:343-352. 31. Bhatia S, Landier W, Shangguan M, et al. Nonadherence to oral mercaptopurine and risk of relapse in Hispanic and non-Hispanicwhite children with acute lymphoblastic leukemia: a report fromthe Children’s Oncology Group. J Clin Oncol. 2012;30:2094- 2101. 32. Krieger N. Overcoming the absence of socioeconomic data in medi- cal records: validation and application of a census-based methodol-ogy. Am J Public Health. 1992;82:703-710. 33. Geronimus AT, Bound J. Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol. 1998;148:475-486.
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CHC43415 Certificate IV in Leisure and Health (Release 2) E1320 HLTAAP002 Confirm physical health status Written assessment Student name: XXXXXX Student number: XXXXXX Assessment number: 35123/02
Instructions to the learner To help Open Colleges manage your assessment, please use the following file-naming convention when you save your Microsoft Word document. Your file should be named and saved to your computer hard drive using your: [Student number]_ [assessment] _ [assessment number].docx For example: 12345678_21850a_01.docx If, for any reason such as size of file, you need split one document into several different documents ensure you identify them as Part A, Part B etc. This will ensure the Assessor can mark sequentially. For example: 12345678_21850a_01_Part A.docx 12345678_21850a_01_Part B.docx Assessment submission Prior to submitting your assessment ensure that your name and student ID are included on the front cover page as well as in the footer of each page. If this is not done the assessment may be returned to you for authentication. If there is a video or audio recording as part of this assessment you must have an introductory statement stating your name, student ID, Qualification and assessment number, along with the task or question you are responding to. When you are ready to submit your assessment, upload the file to OpenSpace using the Assessment Upload links in the relevant module of your course. The ‘Support’ tab provides further assistance. Uploading assessments to OpenSpace will enable Open Colleges to provide you with the fastest feedback and grading on your assessment. It is important that you keep a copy of all electronic and hardcopy assessments submitted to Open Colleges. Competency details HLTAAP002 Confirm physical health status This unit applies to workers assisting in leisure and health activity programming in a range of contexts. It describes the skills and knowledge required to obtain and interpret information about client health status and to check a client’s physical health. It requires a detailed knowledge of anatomy and physiology.
Introduction This document is Assessment 2 of the two assessments you are required to complete, together with structured workplace learning, for HLTAAP002 Confirm physical health status This assessment is designed to gather evidence of competence, specifically to: • Obtain information about physical health status • Check physical health status • Identify variations from normal physical health status Assessment 2 Description 35123/02 Written assessment
Assessment 2 For this assessment, you will need to read each case study below and address each question in detail, demonstrating your skills and knowledge when confirming the physical health status of clients, relevant to your own work role. Case Study 1: Julio Julio’s job role requires him to meet and obtain physical health status information before delivering a health service to his clients. Julio has several methods which he uses to obtain information on the health status of his clients and then enters his findings and notes straight into the computer program designed to record health information. This morning, Julio has met with a female, aged 42, with very fair skin and freckles. She presented in reasonable physical health and as they discussed her health issues, Julio referred to the notes taken from the last appointment. During the process of obtaining information from the client, Julio is shown a small raised, rough area of skin on the top of her ear that was flaky and red. She has also asked Julio about skin cancer and how it develops.
Provide an example of how Julio can obtain accurate information about the physical health status of this client while conducting his assessment using: • Observations (approx. 50-80 words) • Questioning (approx. 50-80 words) • A review of documentation (approx. 50-80 words) Observation Questioning A review of documentation
What could Julio ask to gather further information about the lesions on the ear? (minimum of three questions) (approx. 200-300 words)
3. a. List the necessary information should be recorded in a health and medical history document and why? (approx. 100-150 words) b. Is it necessary for Julio to note the additional health issue he identified with the skin lesion – provide your reasoning. (approx. 100-150 words)
Continuing from the client’s question regarding the small raised, and rough area of skin on the top of her ear that was flaky and red. How should Julio manage the conversation in relation to: a) What further assessment/s should be made to establish the condition and who should he refer the client to in this situation? (approx. 20 words) b) What happens to the normal functioning of cells when they turn into a cancer or tumour including the loss of normal control mechanisms? (approx. 50-80 words) c) Explaining two types of cell adaptions the body will perform when environmental changes occur. (approx. 50-80 words) d) Outlining the environmental hazards that can increase the risk of cancer. (approx. 50-80 words)
Case Study 2: Annemarie Annemarie has a client in her care that has been recently diagnosed with atherosclerosis after experiencing some angina pain. This client is a 55-year-old male, and from his health and medical history records, Annemarie can see that he is not an active person and is overweight. Annemarie knows that she needs to setup an individual plan to encourage more exercise and health lifestyle to support her client. He does not seem to have a clear understanding of his condition and how he can aid in the management of it. Provide detailed responses to the following questions to assist Annemarie with this client
Atherosclerosis is described as a ‘degenerative’ disease. Explain what a degenerative disease is. (approx. 50-100 words)
To provide the client with the best care service, briefly outline the role of nutrition in preventing Atherosclerosis. (approx. 80-150 words)
How might the client’s metabolism be involved in the physical health status findings in this case study? (approx. 80-120 words) Physical Health status What is the impact due to a low metabolism
Case Study 3: Antonella Antonella has reacted badly to news from her doctor that she has contracted a health condition whilst overseas. The condition has some serious symptoms and will require long term treatment. One of the symptoms includes a malfunction in Antonella’s ability to regulate temperature; for example, she may have sporadic sweating/fever like symptoms. Her health care worker, Karen, is doing a physical health assessment for another intervention and Antonella is telling Karen about her concerns for her health.
Antonella’s response to her diagnosis was very negative and angry. a. Explain why it is important for Karen to clarify the significance of Antonella’s health status. (approx. 50-80 words) b. Outline how you would help Antonella understand the importance of her health status. Ensure your response contains positive thinking patterns regarding her health to minimise trauma? Give at least two examples of how negative emotional responses can impact on health. (approx. 50-80 words)
Provide two (2) examples of how negative emotional responses can impact on health. (approx. 50-80 words)
Case Study 4: Alex Alex has had a lot of experience assessing the health status of people with health care needs. He has a current certificate in First Aid and has worked in the field for five years. He is always very thorough with recording information in documentation. Alex maintains a high level of alertness when conducting an assessment conducting observations and using effective questioning techniques. He feels confident that his methods to obtain all the relevant information are sufficient, this based upon his professional development throughout his career. Alex regularly attends meetings and is up to date with the organisation’s policies and procedures. Recently a person attended the clinic who was very unwell, he had a temperature, and felt faint, and Alex had to rely on his training in the organisation’s emergency procedures to be able to deal with the adverse physical health condition seen in the person.
List the steps that should be taken before beginning the delivery of a health service or intervention. a. Explain why is it important to do this? (approx. 200-250 words) b. If Alex overlooked an important factor of a physical health assessment, what could happen if an intervention or delivery of a health service went ahead. (approx. 20 words)
Why is it important for Alex to be familiar with his job role and scope of practice, to effectively assess and confirm the physical health status of this client? (approx. 80-100 words)
Why is it important to undertake training in organisation’s policy and procedures for ‘emergency health situations’? (approx. 150-200 words) Checklist You must complete and submit the following. Assessment 2
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Q1. Consult current literature to further explore the status of WiMAX technology. Describe any barriers to commercial use, and the applications that show the most promise. Explain which countries expect to benefit the most and why. Be sure to cite your sources. If your discussion includes terms not used in the text, be sure to define them.
Note: 250 words with intext citations and 2 references must.
Subject – Internship
Q2. Review and describe the application development and sustaining (AD&S) methodology your company implemented.
Note: 175 words with intext citations with references must.
Q3. List 3-5 documentations that are critical to the success of implementing AD&S along with description of each document and who uses those documents.
Note: 175 words with intext citations with references must.
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Instruction: The project will entail a through data analysis of the data provided using appropriate regression models. You may use SAS software for your data analysis and estimation.
Suggested title:
Predictors of Tumor Status among Breast Cancer Patients: Can the Fine Needle Aspiration (FNA) Technique be used as a Substitute for Biopsy?
The project has the following outcome (Y) and predictors (Xi) variables:
Outcome: Y = tumor status
Predictors: X1 – X9
Research question
(1) Do the cell features allow us to predict tumor status? That is, can we use FNA as an alternative to the biopsy procedure for future patients?
(2) What are the sensitivity and specificity of the FNA based on the model?
(3) What features are the predictors of tumor status?
Develop your hypotheses based on the predictor variables you are interested to test and investigate.
Make a decision which variables to retain in the final model based on the results of a detailed analysis.
Submit a 10 page well written paper based on the methods applied and your findings. Attach summary results in the form of tables. Also attach your codes and final results as Appendix.
The paper has to be double-spaced using Times New Roman 12pt. Sound analysis and correct interpretation of the key results is expected.
The written report should include: (1) Introduction; (2) purpose of the study and research questions to be addressed; (3) hypotheses to be tested; (4) brief description of the data; (5) statistical methods applied including their full specifications; (5) results and interpretations; (6) summary and conclusions; and (7) limitations if any and suggestions how to improve the project for future analysis.
Dataset
The data is from the Wisconsin Breast Cancer which consist of 683 cases of potentially cancerous tumors. Traditionally whether a tumor is malignant or benign is determined with an invasive surgical biopsy procedure. An alternative less invasive technique called “fine needle aspiration” allows examination of small amount of tissue from the tumor. (FNA). For the Wisconsin data, FNA provided nine cell features for each case; a biopsy was then used to determine the tumor status as malignant or benign.
Don’t forget to start with simple analysis tools and build your final models step by step.
You may use the 5% level of significance for your hypothesis testing.
Managers at each level of the organization use a type of SWOT analysis to identify strategies that will best position the company to achieve its mission and goals. The first step in a SWOT analysis is to identify an organization’s strengths and weaknesses that characterize the present state of the company. The next step requires managers to identify potential opportunities and threats in the environment that affect the organization in the present or possibly in the future. When the SWOT analysis is complete, managers begin developing strategies. These strategies should allow the company to attain its goals by taking advantage of opportunities, countering threats, building strengths, and correcting organizational weaknesses.
Use the company and SWOT analysis you selected in Week 1 for this assignment.
Congratulations! You’ve been hired as a manager and have been asked to analyze the current status of your new company.
Review your company’s SWOT analysis and other available sources to evaluate the strategic needs of the organization within a changing global environment. Use the Wk 2 Apply Worksheet for your evaluation.
Note: This type of information is often found in the company’s annual report.
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Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:
Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.
Part 1 attached, please use the paper from part 1 to answer and respond for this paper.