PHE 101 Final Project Template Walsh (1)

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1 [Crohn's Disease] [CHRISTINA WALSH] SOUTHERN NEW HAMPSHIRE UNIVERSITY PHE 101: INTRODUCTION TO PUBLIC HEALTH

An ongoing gastrointestinal inflammatory disease is known as Crohn's disease. You and your loved ones can handle the uncertainty that comes with a new diagnosis by having a better understanding of Crohn's disease. Crohn's disease is an inflammatory bowel disease that causes chronic inflammation of the GI tract, which extends from your stomach all the way down to your anus. IBD affects an estimated one in 100 Americans. Unfortunately, the causes of Crohn’s disease are not yet well understood. That’s why the Crohn’s & Colitis Foundation is working to further research about Crohn’s disease and find a cure. 2 Background (Milestone One)  Crohn's disease Or inflammatory bowel disease  IBD affects an estimated one in 100 Americans.

Employed people with CD frequently face short- and long- term disability spells that restrict them from working, incurring indirect costs for the person as well as perhaps for others like employers. In addition to the physical effect s of the illness, Crohn's and colitis can have a big influence on social life, including bull ying, mental health, and body image. Stress plays a significant role in the lives of IBD patients as well. 3 Background (Milestone One)  Nearly 1 in 100 Americans are diagnosed w ith IBD. Men and w omen are equally likely to be affected by Crohn's disease.  The disease can occur at any age, but Crohn’s disease is most often diagnosed in adolescents and adults betw een the ages of 20 and 30.  Crohn’s disease can affect people from all ethnic backgrounds. The disease is more common in Caucasians, though the rates of Crohn’s disease have increased among Hispanics and Asians in recent years.  Medication t reat ing Crohn’s disease is designed t o suppress your immune syst em’s abnormal inflammat ory response t hat is causing your sympt oms. Suppressing inflammation not only offers relief from common symptoms like fever, diarrhea, and pain, it also allow s your intestinal tissues to heal.  W hile Crohn’s disease may not be t he result of bad react ions t o specific foods, paying special attention to your diet may help reduce symptoms, replace lost nutrients, and promote healing.

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The majority of Crohn's disease patients are diagnosed before the age of 30. Ethnicity. Although Crohn's disease can affect people of any ethnicity, whites are at the highest risk, particularly those of Eastern European (Ashkenazi) Jewish origin. The exact cause of Crohn's disease is uncertain. Stress and diet were suspected. Its development is most likely influenced by a number of factors. The immune system. A virus or bacterium could cause Crohn's disease; however, scientists have yet to uncover such a trigger. When your immune system attempts to combat an invading pathogen or environmental stimuli, an unusual immune response prompts the immune system to attack digestive tract cells as well. Heredity. Crohn's disease is more common in persons who have a family member who has it, suggesting that genes may play a role in making people more prone to develop IBD. However, most Crohn's disease patients do not have a family history of the condition. While Crohn's disease causes digestive problems, abdominal pain, and weight loss. The disease is potentially fatal in severe situations. Crohn's disease patients typically experience flare-ups of disease activity followed by a period of remission. People with Crohn's disease have also been reported to have mental health issues. You may be 4 Who, What, Where, Why, and When (Milestone Two)  Crohn's & Who it effects  Gentetic-Enviromental-Immune  Tissue Swelling & Mental Effects

concerned about having urgent, bloody diarrhea or flatulence during a flare. You may be concerned about your ability to locate a restroom in time. You may be embarrassed by your symptoms. You may experience body image concerns, causing you to retreat from social situations. 4

While Crohn's disease is more common in the Jewish and Caucasian populations Socioeconomic, racial, and ethnic differences in Crohn's disease are becoming more widely recognized as the disease's prevalence is increasing in racial and ethnic minority groups in the United States. There is still little research on how social determinants of health affect Crohn's. The majority of societal hurdles were reported by non-Hispanic Blacks, followed by Hispanic patients. Financial difficulties (38.4%), such as food shortages, delays in receiving medical care (30%), and low educational attainment (26.8%) were common social impediments. Low educational attainment, inadequate health literacy, and financial insecurity were social barriers linked to poor IBD outcomes. Higher SBS levels were linked to worsening depressed symptoms. In the United States, non-Hispanic Blacks and Hispanics had disproportionately lower rates of Crohn's care. Compared to white people, black people with Crohn's are more likely to visit the hospital for a condition-related reason. The likelihood that you'll visit the hospital for a Crohn's-related issue decreases as your income increases. One explanation for this could be that having a larger income might enable you to access healthcare services more frequently, preventing hospitalization. When it comes to outcomes, those with 5 Who, What, Where, Why, and When (Milestone Two)  Food-Housing-Transportation  Hospitalizations-Surgeries

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the disease who have a median income below average have an almost 30% increased risk of dying in a hospital. People of race with lower earnings who end up having Crohn's disease surgery are typically less likely to receive it. Whether the patient is unwilling to have surgery, it is not advised, or it is necessary. Whether surgery is not recommended, the patient doesn’t want it, or they’re not offered it, we don't quite know. 5

Treatment consists of anti-inflammatory medications Crohn's disease cannot be cured. Medications such as steroids and immunosuppressants are used to slow the progression of disease. If these aren't effective, a patient may require surgery. Additionally, patients with Crohn's disease may need to receive regular screening for colorectal cancer due to increased risk. Tertiary prevention refers to utilization of measures to reduce the impact of long- term disease and disability. In CD, ongoing inflammation can lead to development of strictures, which may cause obstruction and require bowel resection surgery. Additionally, inflammation can progress to fistulizing disease, including abnormal connections between the bowel and other organs. These fistulas can result in abscesses and other complications ultimately often requiring surgery. In UC, ongoing inflammation can increase the risk of colon cancer and dysplasia. Additionally, disease can extend from only left-sided involvement to pan-colonic involvement over time. Therefore, by intervening early and treating inflammation, with a goal of mucosal healing, we can potentially prevent these morbid and potentially life- threatening, complications of IBD. 6 Public Health Interventions (Milestone Three)  Medication  Location-Extent-Risk  Primary Treatment  Can help with Anxiety effects

These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone. Immune system suppressors include: • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting. By trying this method it can elviate the need for surgery and the scaring that can some with the surgery. 7 Public Health Interventions (Milestone Three)  Immune System Suppressor  Reduce Inflamation- Target Immune System  Secondary  Body Image

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The Crohn's & Colitis Foundation of America (CCFA) is a non-profit, volunteer-driven organization dedicated to finding the cures for Crohn's disease and ulcerative colitis and improving the quality of life of children and adults affected by these diseases. The Crohn's & Colitis Foundation maintains informal partnerships with a variety of inflammatory bowel disease-related organizations around the world. The European Federation of Crohn's & Ulcerative Colitis Associations (EFCCA) represents 46 national Crohn’s and Ulcerative Colitis (collectively known as Inflammatory Bowel Disease or IBD) patient associations. We are an organisation of people united in our commitment to improve the life of over 10 million people living with IBD worldwide (3.4 million in Europe alone) and to give them a louder voice and more visibility. The International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) is the only international worldwide organization devoted to these chronic and sometimes disabling diseases involving different parts of the gastrointestinal tract. Cron's & Colitis Foundation has many services and campaigns such as the following. 8 Public Health Response (Milestone Four)  Crohn's & Colitis Foundation  European Federation of Crohn's and Ulcerative Colitis Associations  International Organization of Inflammatory Bow el Disease (IOIBD)  International Ostomy Association  Leading critical research in our search for better treatments and cures

venture philanthropy program, IBD Ventures, continues to advance novel treatments and products for inflammatory bowel disease (IBD). Nearly half a billion dollars invested in research to date In 2022, we invested $2.4 million in potential discoveries that hold promise to change patients’ lives, including: A targeted drug to reduce gut inflammation A drug that blocks the development of fibrosis An oral peptide (a small protein-like molecule) for gut barrier restoration A monoclonal antibody drug to lead to mucosal healing IBD Plexus®, our scientific network and transformational platform that makes millions of data points and hundreds of thousands of biosamples MyIBD Health Study, a new IBD patient registry available to researchers to help speed the pace of discovery. plans to launch a groundbreaking research project — MyIBD Health Study. This new patient registry, which aims to recruit more than 100,000 patients, will help accelerate IBD research. A blood test that predicts the course of the disease in newly diagnosed patients. Recruiting for clinical trials for an IBD blood test Thanks to Foundation funding, a U.S.-based trial called PRECIOUS is currently recruiting IBD patients. A wearable device that can measure IBD biomarkers. Our Precision Nutrition initiative is helping to uncover how personalized diet and nutrition can give patients information to help them manage what they eat. 8

A population-based study investigated the outcome of first steroid treatment in CD patients and revealed that 80% of the patients had a primary response within 30 days of therapy (48% with complete remission; 32% with partial response). Of those, 55% had prolonged response within 1 year. However, 45% had either a course of relapses or stayed steroid dependent In clinical trials, patients are stratified into mild, moderate, or severe disease activity at a certain point in time with clinical scoring systems, for example, CD activity index. However, these scores do not assess overall disease burden and the patient’s risk profile. Clearly, there is a need for validated indices of severity WHO Conceptual SDOH Framework. The WHO Conceptual SDOH framework demonstrates how social, economic, and political factors such as income, education, occupation, gender, race, and ethnicity influence a person's socioeconomic position which, in turn, plays a role in determining health outcomes. 9 Effectiveness  80% of the patients had a primary response within 30 days of therapy  In clinical trials, patients are stratified into mild, moderate, or severe disease activity  WHO Conceptual SDOH Framework.

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The IBD literature shows that Black/African American adults with IBD often have worse outcomes across the IBD care continuum than White peers, with higher hospitalization rates, longer stays, increased hospitalization costs, higher readmission rates, and more complications after IBD surgery. Unequal access to specialized IBD care is a factor, with Black/African American patients less likely to undergo annual visits to a gastroenterologist or IBD specialist, twice as likely than White patients to visit the emergency department over a 12- month period, and less likely to receive treatment with infliximab. What we know now. CCFA remains at the forefront of IBD research and continues to propel the field forward. CCFA-supported research studies have helped: • Identify over 160 genes associated with IBD. Investigation of these genes will revolutionize our understanding of Crohn’s disease and ulcerative colitis and form the basis for discovering new drugs and 10 Ethical Reflection The incidence of inflammatory bowel disease (IBD) is on the rise among racial and ethnic minority groups in the United States, and social determinants of health (SDOH) contribute to disparities in IBD care and outcome [. CCFA remains at the forefront of IBD research and continues to propel the field forward. CCFA-supported research studies have helped:

diagnostics. Highlights FACT BOOK • Determine that the gut microbiome (the bacteria and viruses that inhabit the gut) is a key link between genetic susceptibility and IBD onset/progression. By identifying the bacteria and viruses that play a role in IBD, researchers can create medications that specifically manipulate these microbial targets. 10

Use APA style 11 References  Overview of Crohn’s Disease . (n.d.). Crohn’s & Colitis Foundation. https://www.crohnscolitisfoundation.org/what- is-crohns-disease/overview  Crohn’s disease (2022) Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/crohns- disease/symptoms-causes/syc- 20353304#:~:text=Most%20people%20who%20develop%20Crohn’s,European%20(Ashkenazi)%20Jewish%20descent  Social barriers influence inflammatory bowel disease ... - sage journals. Available at: https://journals.sagepub.com/doi/10.1177/17562848221079162  Crohn’s disease: How your race might affect your care (no date) WebMD. Available at: How Race Might

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