PUBH7600 Introduction To Epidemiology

1. What would you advise the CEO about the benefits and downsides to screening all employees in this organisation each month. You should include in your advice the issues with screening programs in general, as well as the specifics of this screening program.

Identify at least 3 benefits and 3 downsides and discuss. 

 

2,The CEO is excited by this company’s test accuracy. What would you say to the CEO regarding this companies claim to be 95% accurate. 

 

3. You decide to do some further investigation into drug and alcohol screening tests and find a company whose test has shown to be quite reliable, with a 95% sensitivity, and a 86% specificity.

 

a. Explain these results to the CEO (1-2 paragraphs)

b. Based on other workplace screening programs, you anticipate a 0.001% prevalence of drug and/or alcohol in your workplace. Using these values, calculate the positive and negative predictive values if you were to use this test in your workplace. Provide an interpretation of these values in a language that would be appropriate to report back to the CEO. 

c. Would you recommend the use of this test as a monthly screening test in your workplace? Why or Why not? 

Epidemiology 

Introduction

Different companies have different policies that govern their employees. Such policies include regular screening of employees for drug as well as alcohol use (Bertholet et al., 2014). Some of the state laws as well as company policies recommend this to be done prior to employment while other recommend this to be done after employment so that there is monitoring of the employees (Edvardsen, Moan, Christophersen, & Gjerde, 2015). There are different tests that can be used to screen employees. Some of the notable tests however include urine drug tests, blood drug tests, the hair drugs test, breath alcohol tests, saliva drug testing and finally the sweat drug screens.

A blood drug test is used to screen illegal drugs among the employees. This test seeks to determine the presence of illegal drugs in blood at the time it is drawn. However, the blood tests are not commonly used as compared to the urine tests (Erdmann, Werner, Hugli, & Yersin, 2015). The reason is because when using a blood test, the remains of the illegal drug does not remain in the body after the effects of the drug have subsided. Studies therefore recommend the urinalysis test to be used always unless under extreme cases (Hoffman, 2016). The blood test can also be used at the expense of urinalysis when the aim of the screening test is to find out legal intoxication.

There are different drugs that are usually screened amongst different employees. The most common ones however include the amphetamines, cocaine, marijuana, methamphetamines, opiates, nicotine and finally alcohol (Maughan, Bachhuber, Mitra, & Starrels, 2015). Depending on the state law, the screening tests can be conducted before employment or randomly. The random tests are done to employees who hold sensitive dockets. Screening can also be done after an on job accident or injury (McHugh, Edwards, Jamison, Cornelius, & Weiss, 2015). Screening can also be done if the employer is suspicious with the conduct of the employees.

There are different reasons that warrant employers to conduct the drug and alcohol screening tests (McRae et al., 2015). One of the reasons is to inhibit the employees from using certain drugs that the employer feels may alter their productivity within the organization. The drug and alcohol screening tests can be done to avoid problems of reduced productivity at the workplace and they are also done to avoid hiring employees that use illegal drugs such as marijuana (Nagpal, Heiman, & Haymond, 2017)Screening tests are also carried out to refer certain employees who are in need of help regarding drug and alcohol abuse. Regular screening would also maintain a very safe working environment and that is why employers implement the regular screening (Nobles, Vilankar, Wu, & Barnes, 2015). Other reasons as to why drug and alcohol screening tests are done include minimizing the likelihood of legal claims due to employee impairment and protecting the general public. Finally, drug and alcohol screening is done to comply certain laws of the state.

Different drugs affect different people in different ways. There are different factors that determine the amount of time a drug can remain detectable in the blood and the urine (Phillips et al., 2015). One of the factors is the drugs half-life which is amount of time needed for the body to breakdown half of the quantity of the drug (Pidd & Roche, 2014). Other notable factors include the hydration of the client, how frequent the drug is used and finally the route of injection.

When using the blood test, the detection period is very short since majority of the drugs usually leave the body through urine. When using the urine test, it is possible to detect the drug after four days of exposure (Price, 2013). Chronic use of marijuana can however be detected in the urine for even up to six months from the last exposure .Other drugs such as the MDMA and the methamphetamines can stay in the body for only two days (Smith & Davidson, 2014). Cocaine can be detected after four days while Diazepam and other drugs with long half-life can stay in the body for long periods.

There are different issues that arise from the screening of drugs and alcohol such as the false positives and legal issues. False positives is the greatest worry while undertaking the screening tests (Steiker, 2018). In this case, the client is therefore supposed to provide all the complete prescriptions such over the counter as well as herbal medicines used. This is because some substances such as poppy seeds as well as dextromethorphan have been attributed to false positive with opiates (Taskinen et al., 2017). All employees for the federal, state and finally private employees should be legally tested and this is possible since the state laws are same to the federal statutes. However, the screening can be restricted in those that have already been offered the job.

1. Organizations experience different challenges. One of the biggest challenges according to studies is alcohol and drug abuse .Several studies have been conducted and established that excessive consumption of alcohol is associated with different problems (Waehrer, Miller, Hendrie, & Galvin, 2016). It leads to both mental and physical harm to the workers who take part in the habit. There is an organization with 3000 workers planning to conduct a monthly screening of workers. This program has both disadvantages and advantages that would be explained to the CEO of the organization. 

The benefits of the Alcohol screening program

The monthly screening program would provide the best forum to educate the workers on issues surrounding alcoholism. The screening program would involve one on one sessions between both the affected and those workers who are not affected with the healthcare professionals (Weiner, Horton, Green, & Butler, 2016). This then provides the best platform through which the addicts can be educated comprehensively on the harm associated with excessive drinking of alcohol. Studies indicate that majority of addicts suffer in silence due to lack of encouragement and education(Jackson, Felstead, Bhowmik, Avery, & Nelson-Hearity, 2016) .This therefore means that if the screening program is implemented, those gaps of lack of knowledge will be handled and the rate of excessive drinking of alcohol among the workers would reduce significantly in the organization.

The screening program can be used as a tool in formulating interventions. Interventions refers to the different means incorporated in providing care to the addicts to ensure they eventually quit the habit. The interventions usually vary depending on the level of dependence among the workers (Magar, 2015). It is therefore usually very difficult to initiate interventions without screening and finding out the extent or the nature of the addiction. Screening will therefore come in handy to bypass this hurdle since it will involve handling one patient at a time.

Screening will also assist the organization to know the prevalence of the alcohol and drug abuse. Screening involves determining if an individual is either affected by a certain practice/disease or not. At the organization, this would therefore bring out the exact number of those affected rather than just working by speculation. Getting the exact number of those affected makes the organization to be in a better place to plan for the costs of eradicating the vice.

Screening serves as a motivation. Regular screening programs would encourage or motivate those who are not affected by the habits. This is because they will get the necessary education or knowledge on the effects of excessive drinking and this will motivate them to totally stay away from the alcoholism.

The disadvantages of the monthly screening program

Regular screening is also associated with some disadvantages .There is cases of false negative and false positive results. The aim of the screening program is to find out those workers who are affected so that necessary safety measures can be put in place. However, in case the equipment used to screen the workers is faulty, chances are that there will be unreliable results ("Prevalence of fetal alcohol syndrome (FAS) in a population based sample of children living in Australia: The Lililwan project," 2015).. The unreliable results will therefore give a false impression of the workers at the organization.

It is not a cost effective exercise. From the information given, the organization has 3000 workers. To ensure that each worker is screened, it needs a very large capital outlay. This might not be economical to the organization especially if the results obtained are not reliable. Besides the extra costs incurred, it takes time to screen 3000 workers and this therefore means that a lot of time is wasted that would otherwise have been used in other important activities that would increase productivity within the organization. The CEO should therefore compare the two and chose if they have to proceed with the screening or not.

2. The CEO claims that they will be using a screening test that has an accuracy of 95%.This implies that the test would be faulty to every 5 people among the 100.My advice to the CEO would be to go against the test since faulty or unreliable results will not provide the true picture of the extent of the problem .I would further recommend a test that is 100% accurate. If we work with the values provided of 3000, this means that the only people we can get the correct or accurate results is 2850 while the remaining 150 will be false results.

 When we use the case provided with a sensitivity of 95% and the specificity of 86%, it means that there is 95 chances of getting a positive result when the patient is indeed affected or is a drug and alcohol addict/dependent. A specificity of 86% on the other hand implies that there is 86% chances to get a negative result in a person who is indeed not a dependent on alcohol and other drugs.

b)

Positive Numbers	Disease Numbers	Disease Negative	Total
Negative Numbers	2 (True positive)	2577(False positive)	2579(Total test positive)
	1(False negative)	420(True negative)	421( Total test negative)
	3 (Total disease positive)	2997(Total disease negative)	3000 (Total workers)

To get the total disease positive, we were given prevalence as 0.001%

Total disease=prevalence × Total population

=0.001× 3000

=3

Total disease negative

=3000-3

=2997

To calculate the True positive, false positive, false negative and true negative, we use the specificity and the sensitivity that was provided.

95%=True positive/ (Total disease) ×100

86%=true negative/ (Total Negative) ×100

That was the formula that was used to compute the remaining values so that we can calculate the positive and the negative predictive values.

Positive predictive value=True positive/Total test positive ×100

2/2597 ×100

=0.08%

Negative predictive value

=True negative/Total test negative ×100

=420/421 ×100

=99%

Interpretation

99% positive predictive value means that the 0.08% of the population who are alcohol and drug dependents will indeed test positive while a negative predictive of 99% means that 99% of the workers who do not depend on alcohol and other drugs will indeed test negative.

c. After calculating the positive and the negative predictive values, the best advice to the CEO is not to incorporate the screening test. This because the values are not desirable, especially the positive predictive value. A positive predictive value of 0.08% means that the chances of those positive testing positive is 0.08%.This is where the problem is and that is why I would not advice the CEO not to go ahead with the test .The CEO should therefore consider another test with high negative and positive predictive values.

The positive predictive value is usually influenced by a variety of factors. They include the specificity, the sensitivity and finally the prevalence of the condition that is being screened .It is true therefore to say that the low positive predictive value in this case was due to the very low prevalence of the condition which was 0.001% out of a possible 100%.A population of 3 with disease out of 3000 is of very little importance or significance. As the prevalence increase, the column with disease or condition also increase and this subsequently increases the positive predictive value .All in all, before any screening test is taken into consideration, it is very important to find out all the relevant parameters so that the organization can make conclusive interpretation after the test.

References

Bertholet, N., Adam, A., Faouzi, M., Boulat, O., Yersin, B., Daeppen, J., & Clerc, D. (2014). Admissions of patients with alcohol intoxication in the Emergency Department: a growing phenomenon. Swiss Medical Weekly. doi:10.4414/smw.2014.13982

Edvardsen, H. M., Moan, I. S., Christophersen, A. S., & Gjerde, H. (2015). Use of alcohol and drugs by employees in selected business areas in Norway: a study using oral fluid testing and questionnaires. Journal of Occupational Medicine and Toxicology, 10(1). doi:10.1186/s12995-015-0087-0

Erdmann, A., Werner, D., Hugli, O., & Yersin, B. (2015). Focused use of drug screening in overdose patients increases impact on management. Swiss Medical Weekly. doi:10.4414/smw.2015.14242

Hoffman, K. L. (2016). New dimensions in the use of rodent behavioral tests for novel drug discovery and development. Expert Opinion on Drug Discovery, 11(4), 343-353. doi:10.1517/17460441.2016.1153624

Jackson, L., Felstead, B., Bhowmik, J., Avery, R., & Nelson-Hearity, R. (2016). Towards holistic dual diagnosis care: physical health screening in a Victorian community-based alcohol and drug treatment service. Australian Journal of Primary Health, 22(2), 81. doi:10.1071/py15097

Magar, V. (2015). Gender, health and the Sustainable Development Goals. Bulletin of the World Health Organization, 93(11), 743-743. doi:10.2471/blt.15.165027

Maughan, B. C., Bachhuber, M. A., Mitra, N., & Starrels, J. L. (2015). Prescription monitoring programs and emergency department visits involving opioids, 2004–2011. Drug and Alcohol Dependence, 156, 282-288. doi:10.1016/j.drugalcdep.2015.09.024

McHugh, K., Edwards, R. R., Jamison, R. N., Cornelius, M. C., & Weiss, R. (2015). Distress intolerance and prescription opioid abuse in chronic pain patients. Drug and Alcohol Dependence, 156, e146-e147. doi:10.1016/j.drugalcdep.2015.07.400

McRae, M. P., Simmons, G. W., Wong, J., Shadfan, B., Gopalkrishnan, S., Christodoulides, N., & McDevitt, J. T. (2015). Programmable bio-nano-chip system: a flexible point-of-care platform for bioscience and clinical measurements. Lab on a Chip, 15(20), 4020-4031. doi:10.1039/c5lc00636h

Nagpal, G., Heiman, H., & Haymond, S. (2017). Interpretation of Urine Drug Screens. JAMA, 318(17), 1704. doi:10.1001/jama.2017.10910

Nobles, A. L., Vilankar, K., Wu, H., & Barnes, L. E. (2015). Evaluation of data quality of multisite electronic health record data for secondary analysis. 2015 IEEE International Conference on Big Data (Big Data). doi:10.1109/bigdata.2015.7364060

Phillips, J. A., Holland, M. G., Baldwin, D. D., Meuleveld, L. G., Mueller, K. L., Perkison, B., … Dreger, M. (2015). Reply to Goldsmith–Medical Marijuana in the Workforce. Journal of Occupational and Environmental Medicine, 57(11), e140. doi:10.1097/jom.0000000000000595

Pidd, K., & Roche, A. M. (2014). How effective is drug testing as a workplace safety strategy? A systematic review of the evidence. Accident Analysis & Prevention, 71, 154-165. doi:10.1016/j.aap.2014.05.012

Prevalence of fetal alcohol syndrome (FAS) in a population based sample of children living in Australia: The Lililwan project,” (2015). Journal of Pediatrics and Child Health, 51, 4-5. doi:10.1111/jpc.12913_12 (https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.12814)

Price, J. W. (2013). Dilution of Urine Drug Tests. Journal of Addiction Medicine, 7(6), 405-409. doi:10.1097/adm.0b013e3182a1d5f3

Smith, D. E., & Davidson, L. D. (2014). Strategies of Drug Prevention in the Workplace: An International Perspective of Drug Testing and Employee Assistance Programs (EAPs). Textbook of Addiction Treatment: International Perspectives, 1111-1127. doi:10.1007/978-88-470-5322-9_1

Steiker, L. K. (2018). Screening Substance Use and Misuse Among Middle and High School Students. Encyclopedia of Social Work. doi:10.1093/acrefore/9780199975839.013.1222

Taskinen, S., Beck, O., Bosch, T., Brcak, M., Carmichael, D., Fucci, N., … Weinmann, W. (2017). European guidelines for workplace drug testing in urine. Drug Testing and Analysis, 9(6), 853-865. doi:10.1002/dta.2178

Waehrer, G. M., Miller, T. R., Hendrie, D., & Galvin, D. M. (2016). Employee assistance programs, drug testing, and workplace injury. Journal of Safety Research, 57, 53-60. doi:10.1016/j.jsr.2016.03.009

Weiner, S. G., Horton, L. C., Green, T. C., & Butler, S. F. (2016). A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department. Drug and Alcohol Dependence, 159, 152-157. doi:10.1016/j.drugalcdep.2015.12.007