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Population (Community) Health Midterm Review

by: Ally Marcello

Population (Community) Health Midterm Review 256

Marketplace > Catholic University of America > Nursing and Health Sciences > 256 > Population Community Health Midterm Review
Ally Marcello
GPA 3.6

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About this Document

This study guide covers exactly what Professor Durham has put on the study guide by using both the powerpoint lectures and some textbook information. There are many pictures and charts to help furt...
Population Health
Dr. Durham
Study Guide
Population Health, Community health, Health People, disaster management, disaster triage, Epidemiology, surveillance, Rates, Infectious Diseases, sexually transmitted diseases, STI, Global health
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This 29 page Study Guide was uploaded by Ally Marcello on Tuesday March 8, 2016. The Study Guide belongs to 256 at Catholic University of America taught by Dr. Durham in Spring 2016. Since its upload, it has received 82 views. For similar materials see Population Health in Nursing and Health Sciences at Catholic University of America.


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Date Created: 03/08/16
1 Pop Health Midterm Review Overview  Three strategies that stopped deaths from infectious disease historically were (1) safe water, safe and adequate food, (2) sewage disposal, immunizations, (3) and control of infectious disease o Nowadays we improved public health (mostly chronic disease) through increased activity, injury prevention, decreased BP, cholesterol and tobacco use  decreased the incidence of heart disease, cancer, and stroke  Leading causes of death 100 years ago were 1. pneumonia, 2. TB, 3. Diarrhea and enteritis  Leading causes of death now are 1. Heart disease, 2. Cancer, 3. stroke  According to the WHO, the three behaviors responsible for most of chronic disease are unhealthy diet, physical inactivity, and tobacco use. o If we target these behavioral issues, at least 80% of heart disease, stroke, and type II diabetes would be prevented.  Motto of discipline of Public Health- “Saving Millions at a Time!” o Modeled after John’s Hopkins School of Public Health in Baltimore o Public health looks at entire populations using certain tools: epidemiology, risk factors, demographic variables, and the environment and policy.  Goals of Public Health in US: o Prevent epidemics and the spread of disease o Promote and encourage healthy behaviors o Protect against environmental hazards o Prevent injuries o Respond to disasters and assist communities in recovery o Assure the quality and accessibility of health services  Bureau of Health Professions – Licensing  Federally Qualified Community Health Centers  Aggregate- a population of individuals with one or more personal or environmental characteristics in common o Examples: people living in the same geographic area, workers at the same worksite, Children in NYC under the age of 5yrs, etc.  The industrial revolution affected health in both the US and Europe at the same time. The IR led to the start of child labor because their tiny hands were good at fixing machines which caused many child deaths, there were also horrible working conditions (such as overcrowding and air contamination) that led to the deaths of many children and adults. Industries would also dump their waste into the near water systems which caused the contamination of drinking water, there was also poor sanitation in the cities with many open sewers. All of this plus the fact that there were untrained nurses led to a much shorter lifespan between 1750-1830. o On the other hand, there were some positives that came out of the IR  Florence Nightingale in 1850 from Europe. 2  She opened up sick rooms in order to get clean air into the room.  Florence also kept records that soldiers cared for by her methods had incredibly better outcomes, as opposed to soldiers cared for in the traditional way.  From the US you go the Shattuck Report  Lemuel Shattuck studied birth and death records in Boston and concluded that sanitary conditions affected death rate. This then resulted in the creation of the Health Department, pest control (rats), air and water pollution  He also instituted Occupational Health Education  **Lillian Wald (1893) established settlement houses (Henry Street Settlement House) and neighborhood centers, which became hubs for health care and social welfare programs *beginning of public health in US* o She visited the poor in NY’s Lower East Side o Through her efforts there was a 20% decrease in deaths of children <3yrs and a 7% decrease in mortality rate for policy holders o Fought for racial equality, the right to vote for women and rights for poor immigrants  “All they need is a fair chance.”  Ignaz Philipp Semmelweis July 1818 – 13 August 1865- Hungarian doctor, Early pioneer of antiseptic procedures especially in the prevention of childbirth fever through hand washing  John Snow 15 March 1813 – 16 June 1858- British doctor considered the Father of Epidemiology because of his work in tracing the source of a cholera outbreak in London in 1854. His findings inspired fundamental changes in the water and waste systems of London, which led to similar changes in other cities, and a significant improvement in general public health around the world.  Historically the single most important factor in improving population health is clean water!  Medical strategies that positively affected maternal mortality was penicillin, antibiotics, oxytocin, and better management of hypertension.  Public health part of Frontier Nursing Service’s role that are most responsible for saving so many lives of mother/babies were the Frontier Nursing Service, Maternal/Child Health Focus, and Mary Breckinridge who founded the Frontier. o Frontier Nursing Service delivered babies in back woods, chlorinating wells, and giving vaccinations. If there was a premature birth, they taught the mom to keep the baby warm and to feed it often in small amounts at a time.  Core functions of public health o Assessment  Data collection for the community & analysis, Monitoring population health status, Publishing health status information o Policy development  Policies that support public’s health using scientific knowledge base o Assurance 3  Making sure that essential services are available, Insurance – to provide access to care, Providing an adequate health care workforce  Elements of community assessment o Demographics- rural areas might not be near any hospitals or primary care o Communications- rural areas might not have wifi or good communication efforts o Vital Statistics o Recreation- used for physical activity o Education- are there many schools around? o Transportation- is there public transportation or their own cars to rely on in a medical emergency o Health Facilities & Services o Morbidity & Mortality Rates (per 100,000)- why people are dying and what is making them sick  Types of data collection used in community assessment o Primary (Direct) Data collection- community/”Windshield”/online surveys o Secondary (Indirect) Data Collection- Birth/death/marriage certificate, nationally collected data (census), Communicable Disease reports nd  Policies (2 crore function) that maintain public health o School immunizations, Head Start which helped kids catch up to those performing better in schools, PKU testing (to test for an enzyme for growth and development which could lead to mental retardation), Federal Funding, Syphilis Pre-natal Screening, Hep B screenings for healthcare workers, Decreasing County budgets.  Examples of how our nation provides assurance and accessibility of services and providers: o Local levels created Health Departments o State – State DHHS (Professional Regulation, Health Departments o National – Department of Health and Human Services - includes (CDC, PHS, HRSA) o International – WHO, NGOs, UNICEF o Private & Non-Profit Facilities  Essential public health services (10) o 1. Monitor health status to identify community health problems o 2. Diagnose and investigate health problems and health hazards & problems in the community o 3. Inform, educate, and empower people about health issues o 4. Mobilize people to address community health problems o 5. Research for new insights and interventions o 6. Develop policies and plans that support individual and community health efforts o 7. Enforce laws and regulations that protect health and ensure safety o 8. Provide health services and connect people who need the services o 9. Insure a competent public health workforce o 10. Evaluate effectiveness, accessibility and quality of personal and population-based health services 4  Define three types of prevention o Primary- actions to promote health and prevent the onset of disease or disability before the problem exists*  Ex: immunizations, watching hands, folic acid prior to getting pregnant o Secondary- focused on early detection and treatment to prevent disability and/or death  Ex: screenings o Tertiary- focused on the treatment, recovery, and rehabilitation  Ex: cardiac rehab after a heart attack, PT after a stroke,  Levels and definition of health care services o Primary- preventative care (dental care, flu shot) o Secondary- being treated at a clinic or hospital setting for something not critical o Tertiary- the highest level of acute care, also the most expensive Healthy People  Healthy People is a national agenda that communicates a vision for improving the health and achieving health equity through a set of specific, measurable objectives with targets to be achieved for the decade. o Guides national research, program planning, and policy efforts to promote health and prevent disease.  Healthy People Overarching goals of HP 2020 o Identify nationwide health improvement priorities. o Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress. o Provide measurable objectives and goals that are applicable at the national, State, and local levels. o Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge. o Identify critical research, evaluation, and data collection needs.  Healthy People 2020 new topic areas o Adolescent health, blood disorders and blood safety, Dementia (including Alzheimer’s) disease, Early and Middle Childhood, Genomics, Global health, Health care-Associated Infections, Health-related quality of life, LGBT health issues, Older adults, preparedness, sleep health, social determinants of health.  Healthy People Historical Perspective o 1979—ASH/SG Julius Richmond establishes first national prevention agenda: Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention o HP 1990—Promoting Health/Preventing Disease: Objectives for the Nation o HP 2000—Healthy People 2000: National Health Promotion and Disease Prevention Objectives o HP 2010—Healthy People 2010: Objectives for Improving Health o Healthy People 2020 – Launched December 2010  HP collaborating sectors outside health 5  Ways to use Healthy People 2020 (example with cancer) Objective Reduce the overall cancer death rate Target 160.6 deaths per 100,000 population Baseline 178.4 cancer deaths per 100,000 population occurred in 2007 (age adjusted to the year 2000 standard population) Target Setting Method 10% improvement Data Source National Vital Statistics Systems (NVSS), CDC, NCHS o Integrate Healthy People 2020 into your programs, initiatives, special events, publications, and meetings. o Use Healthy People as a tool to engage partners at all levels of government, across sectors, and in the community. o Use Healthy People 2020 in health program planning.  Ways to connect with Healthy People 2020 o Join the Healthy People Consortium, a diverse and dedicated group of organizations committed to achieving Healthy People 2020's health goals and objectives. o Learn about Healthy People activities at the Federal, State, local, and tribal levels. o Get guidance on how agencies or organizations can use Healthy People objectives to help their communities. o Gain access to timely information and resources. o Spread the word any way you can Disaster Management  There are 4 levels of disaster management o Prevention, Preparedness Response, Recovery  Prevention (mitigation)- reducing the risks to people and property from natural hazards before they occur.  Includes risk assessment, disaster-reinforced buildings, limiting buildings on the oceanfront, being able to detect and prevent terrorist attacks  Nurses are involved with awareness and educating the public through community meetings, through organizing and participation in mass vaccinations  Preparedness  You can prepare yourself personally by making sure you have a plan with your family. If you’re not prepared yourself, how can you help others? o Make sure you have a meeting place, a plan of communication if the phone lines can’t handle the volume of callers and texters, food, water (3 days worth), first aid kit, change of clothes, etc.  Make sure you are aware of, and understand, your workplace’s disaster plan. Know it well!  Public institutions can institute mass texts to prepare for eminent danger  You must be flexible and consider alternatives to plans as such. 6  Problem solve, together!  Everyone must be prepared in case the leader is injured or not there.  Join the Medical Reserve Corps in order to be called into an rea of disaster to provide medical assistance when needed.  Participate in practice drills held in cities to ready health care personnel and citizens for dispensing medication and general response to an emergency  Response- can be to natural disasters (earth quakes, Derecho) or to terrorists (9/11, Anthrax scares, and shooter)… see notes below  Nursing roles in disaster management include minimizing morbidity and mortality rates.  Medical Reserve Corps (MRCs) are volunteers that assist with activities to improve public health in their community by increasing health literacy, supporting prevention efforts and eliminating health disparities. In an emergency, local resources get called upon first, sometimes with little or no warning. As a member of an MRC unit, you can be part of an organized and trained team. You will be ready and able to bolster local emergency planning and response capabilities.  Disaster Medical Assistance Teams (DMATs) is a local and state response team within the U.S. Public Health Service. Specially trained civilian physicians, nurses, and other health care personnel are activated to supplement local and state medical care within hours of the disaster. o They have a medical response team, specially trained responders at all levels, specialized response equipment, specialized medical transport and treatment capabilities  National Disaster Medical System (NDMS)– created to address community health service needs during mass casualty events; they can also use military contingencies in order to control the masses, or they can provide the services needed to transport huge amounts or resources.  Disaster Mortuary Operational Response Teams (DMORTs)- responsibilities include: temporary morgue facilities, victim identification, forensic dental pathology, forensic anthropology methods, processing, preparation, and disposition of remains.  Strategic National Stockpile (SNS) has large quantities of medicine and medical supplies to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquakes) severe enough to cause local supplies to run out. o There is a 2 tiered deployment when contents of the SNS is needed:  12-Hour Push Packages are ready for employment to reach the area within 12 hours  Vendor Managed Inventory (VMI) Packages will be shipped to arrive within 24hour and 36 hour periods that are composed with pharmaceuticals and supplies that are delivered from 1 or more VMI source tailored to what the area needs.  There are 4 post disaster issues o Burial Practices do the people want to bury or cremate their loved ones, there has to be a management of human remains (can’t just leave body parts laying around) 7 o Reinstitution of services using sanitary services for clean water, will there be an access to prescription drugs, when will utilities be turned on? o Mental Health Issues Not only do victims need to have their mental health evaluated, but so do the staff and surprisingly the search dogs. There must also be a debriefing. o Interpreter Issues Interpreter issues (being able to help everyone at once)  Also keep in mind at adults and children react to these stressful situations in different ways  Adults could experience panic and fear, disbelief, a need to help others, blaming, insomnia, headaches, or eve depression  Children could experience a regression in behavior (thumb-sucking, bed- wetting), nightmares, or school-related problems  Disaster triage principles o Triage Is the process of separating casualties and allocating treatment on the basis of the victim’s potential for survival  Start where you are, then move in an orderly manner and deal with everyone in your path.  Triage Tags- two sided tags that have 3 basic components: A section informing medical personnel of the patient’s vital signs along with the treatment administered, A section on the patient’s demographics such as gender and residential address, and the patient’s medical history, A section with a full pictorial view of the human body- The medical personnel indicate which parts of the body are injured.  There are also triage colors to indicate how immediate the care should be given.  Black- deceased  Red- immediate (highest priority; have the most life threatening)  Yellow- delayed (could wait 45-60min)  Green- minor  Military Triage Principles o Limited resources vs. Multiple Casualties o No tertiary care- care for who you can save (May cause ethical conflicts) o Resources intensive injuries will/cannot be treated  Secondary Triage o More extensive care onsite in a designated area  National Incident Management System (NIMS)- The National Incident Management System (NIMS) is a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work together seamlessly and manage incidents involving all threats and hazards—regardless of cause, size, location, or complexity—in order to reduce loss of life, property and harm to the environment  Bioterrorism organisms are one of the most dangerous terrorist attacks in that it can spread to entire populations without an anecdote or vaccination. 8 o Anthrax  After 9/11 the news of deaths caused by deliberately contaminated letters changed our views of this infectious disease  It has a 95% mortality rate- when it is weaponized the spores have been made very tiny and there are no atmospheric warning signs, just a warning when you get the symptoms not spread from human to human  Symptoms: o Phase one – malaise, fever, non-productive cough o Phase two – active respiratory distress, hypoxia & cyanosis, diaphoresis, pleural effusion, crackles  Chest – x-ray findings are diagnostic sputum culture  Treatment: Cipro P.O. (by mouth) o Smallpox- considered eradicated since 1979  Could be a leading candidate as an agent of bioterrorism since susceptibility is 100% in the unvaccinated and fatality rate is 30% or higher  only defense is vaccination and isolation (vaccinations up to 4-5 days after exposure may protect against death  Transmission: spreads via air droplets (airborne), incubation period of 12-14days then a fever with aching and pain and prostration occurs. 2-3 days later, the rash appears. Death occurs during 2 week.  Recovery from the disaster o Returning to the new norm with the goal of reaching a level of organization that is near the level before the disaster as possible  Often the hardest part  Everyone comes together to help rebuild houses, buildings, and institutions Epidemiology  Epidemiology is the study of distribution, or patterns, of disease, injuries, or health-related problems in human populations. o It was originally used to track and describe outbreaks of infectious diseases o Current uses:  1. Identify causes of/risks factors for diseases  2. Study the natural history and prognosis of disease  3. Determine the effectiveness of therapeutic and preventative measures  4. Monitor local, regional and national health  5. Improve the health of the entire population  6. Provide a basis for making predictions about the future  7. Now includes chronic illness and occupational and environmental exposures and their effects  Surveillance- Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice 9 o State (regional)- Local units care for individuals which report to the State or District o Federal (National)- the states data to CDC, “Morbidity & Mortality Weekly Report” (MMWR) o International- Nations send data to WHO which is then report in the “Weekly Epidemiological report” o 10 basic elements of Surveillance:  1. Mortality Registration  2. Morbidity Reporting  3. Laboratory  4. Epidemic Reporting  5. Epidemic Field Investigations  6. Individual Case Investigations  7. Surveys  8. Use of Drugs  9. Distribution of Animal Vectors & Reservoirs  10. Demographic & Environmental Data  Sources of Data can come from Vital Statistics (Data collected from on-going records or registration of births, and deaths that are available online). You can also use Census data  Rates- percentages that measure frequency; describes an event and allow for comparison across different populations. o Rate= Actual number of cases/POPULATION AT RISK  the numerator must be part of the denominator (cases must be drawn from population AT RISK)! o Usually expressed per 100,000 persons, unless it is an infant mortality rate (which is per 1,000)  Computation tip: Reported rates must be multiplied by a constant (K), that is - multiply the numerator and denominator by the same number (which does not change the relationship), so that the denominator equals 100,000  o Incidence Rates are the number of new cases of a disease during a given period of time per the population at risk  Incidence = # New Cases Per Year X Constant o Population At Risk  44 new cases/7945 at risk= 0.005538 or553.8 o Prevalence Rates measure of existing disease in a population at a particular time  Prevalence= # existing cases Current population 10  55 existing cases/8000= 0.006875, or 687.5 per 100,000 (just multiply 0.006875 by 100,000 o Attack Rate- subset of incidence rate and only exposed persons are at risk for becoming ill calculates virulence basically  Attack Rate = # of persons who became ill # of persons exposed  Epidemiological Triangle – diseases result from complex relationships between the agent, host and the environment, and the triangle explains these relationships o Changes in one of these elements of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease  NOTE: Not every exposure results in illness ENVIRONMENT Physical, Psychological AGENT HOST Bacteria, Age, Edu., Parasite, Occu., Virus, other Behavior microbe. o  Agent Factors- an animate or inanimate factor that must be present or lacking for a disease or condition to develop. Different types: o Biologic- Bacteria, virus, Fungi, Insects, and parasites o Chemical- Liquids, Gases, Dust, fumes, inside the body (hormones, uric acid, serotonin), Outside the body (food additives, pesticides, drugs) o Physical- anything that causes injury to the human, automobiles, natural disasters o Psychological- stress, anxiety, etc. o Nutrient- to much fatty foods, deficiency in nutrients  Host Factors- living species (human or animal) that is internal or external to a given host or agent and that is influenced and influences the host and/or agent Physical Factors Lifestyle Factors Age Diet Gender Exercise 11 Race Sleep Patterns Immune Status Healthy or Unhealthy Habits Genetics (Heredity) o  Environment Factors- all that is internal or external to a given host/agent and that influences or is influenced by both the A and H basically, provides the conditions that make the connection between host and agent likely or unlikely o Includes physical conditions o Physical environment (such as temperature, chemical and physical ) o Biological environment (living organisms that contribute to the benefit or deterrent of the disease process) o Social Environment (includes cultural beliefs and practices, family influences, peer pressure) o Environment can increase risk when you breathe in air pollutants, water pollution, etc.  Application to a non-infectious disease situation: Automobile Accident o Agent: the car, which can include the safety features, whether there is shatter resistant glass, warning devices, etc. o Host: Driver, if they’re wearing a seatbelt, intoxication level o Environment: Road conditions; are there guardrails, is there traffic, is it slippery  How does Agent/host/environment apply to the natural history of disease (course of the disease process from onset to resolution)? o Well, overtime the environment changes (industrial revolution), there are more safety feature in cars, there are new vaccinations, and people’s immunity changes over time (now it is decreasing due to the over use of antibiotics)  Diseases progress through 4 stages: o 1. Pre-exposure o 2. Preclinical- after the exposure, but before clinical symptoms o 3. Clinical Stage- the actual ‘clinical picture’ of the disease o 4. Resolution Stage- when the recovery is obvious  Quarantine can occur if a disease is highly communicable through touch, air, or fomites.  Chain of Infection 12 Reservoir Infectious Agent Portal of Exit SuHosttible Transmission Portal of Entry o o Transmission occurs when the agent leaves its reservoir (or host- human to human, animal to human, etc.) through a portal of exit (which could be the mouth when coughing, the nose from a sneeze, etc.), which is then conveyed by some mode of transmission (airborne, (in)direct contact, etc.), and enters through an appropriate portal of entry (eyes, cracked skin, open wound, etc.) to infect a susceptible host.  Indirect contact is when the microorganism gets on a fomite (inanimate object), or a vector (living intermediate) and then you touch that area that was infected  Direct is like skin to skin contact, airborne, droplets  A susceptible host is someone whose own body defense mechanisms cannot withstand the invasion of the pathogens  Cancer patient, elderly, someone with AIDS  You can ‘break’ this chain of infection in several different ways o Controlling or eliminating agent at the source of transmission (cover your mouth and nose when you cough or sneeze) o Protecting portals of entry by not touching your eyes, washing your hands with soap and water for 20 sec. (best way to break the chain!), do not have open wounds o Increasing the host’s defenses by taking immunity vitamins, having plenty of vitamin C and sleep.  Screening tests – are used for early detection. There are certain requirements for screening tests o Must be low cost so that poor or uninsured can get screenings for prevention. o It must separate those who have the disease, versus those who do not  False negative are never acceptable o Must be a VALID test (accuracy-does it test what it’s supposed to test for)  Specific- those who do not have the disease will receive a negative (true negative)  Sensi+ive- those positive for the disease will receive a (+) positive (True positive)  Mammograms 13 o Must be RELIABLE- those who have the disease receive a positive for the test, and those that do not receive a negative for the test  There are certain factors that affect the reliability  Variation in the trait being measured, observer variation (taking BP- every nurse will be different), consistency in the instrument used (BP cuff vs. BP machine)  Epidemiological Investigation o Three types of epidemiological investigations  Descriptive- Describes what the disease or condition looks like in the population: Person (age, sex, race, etc.), Place (Urban, rural, regional, etc.), Time (seasonal trends like the flu, trends over time)  deals with distribution of health outcomes  Cross-sectional – cannot determine causality, a real pitfall, wrong placement test  Analytical- Determines what caused the disease  Retrospective Cohort- looking back in time; looking at medical records (Case Control Studies) o A cohort is a group of people that have the same characteristics of interest  Prospective Cohort- looking forward in time; begins of people, then follows them over time where info is collected periodically (longitudinal study)  Experimental- Clinical trials testing new treatments  Random assignment is important (like when Meredith ruined Derek’s clinical trial by giving Adele the Alzheimer’s drug)  Goal of clinical trial: to evaluate the effectiveness of an intervention, such as medical treatment for a disease, a new drug or existing drug used in a new way, a surgical technique, etc.  Disease spectrum – endemic> epidemic> pandemic o Endemic is the usual frequency of disease (colds, TB, Malaria) o Epidemic is when the disease exceeds the usual, or expected, frequency (sudden outbreaks) o Pandemic is when there is an epidemic that covers a large area of the world (1918 Spanish Flu, AIDS  Experimental Epidemiology: Treatment o Clinical trials, new treatments are tested against established treatments, and placebos (sugar pills) o Random assignment is important when conducting an experiment (the research gold standard) o Motivated and/or compliant subjects will often self-select themselves to receive a new treatment, but their results may not be representative of the entire population 14 o Only with random assignment for selection of the treatment group, can researchers say with greater confidence that the treatment will be beneficial to the larger population  Relative Risk – refers to the probability that healthy people exposed to a specific factor will acquire a specific disease pretty much the association between risk factors and disease o RR = Incidence of Disease in Exposed Group Incidence of Disease in Non-exposed Group Infectious Diseases  There are 5 different types of infectious diseases: o Vaccine preventable o Foodborne or Waterborne o Vector-borne o Nosocomial o Sexually transmitted infections  There is a web of different types of immunity to protect us from these infectious diseases: o o Innate immunity is what occurs naturally as a result of the person’s genes and does not arise from previous infection or vaccination  Also called genetic immunity, native immunity, nonspecific immunity o The adaptive immune, or specific immune, response consists of antibody responses and cell-mediated responses,  Natural Passive immunity is our immunity acquired from our mothers through gestation and nursing.  Natural active immunity is when you develop immunity from acquiring, and fighting off an infectious disease  Artificial Passive is when you’re given immune globulin or antibodies  Artificial Active is when you get a vaccination (since the vaccine isn’t natural and your body is actively making antibodies against it)  Major Causes of Infectious Disease due to a lack of antibiotics and such: o Pneumonia o Diarrheal disease- due to lack of clean water o Malaria o Measles o Neonatal tetanus- causes by unsterile tools being used to cut the umbilical cord o Pertussis (whooping cough) Death World Wide  Vaccine Preventable Disease o Vaccines are one of the most effective methods of prevention and control of communicable disease, where many are given as routine childhood immunizations  Hepatitis A & B  DTap immunization for: 15  Diphtheria  Tetanus  Pertussis- begins as a mild URI that progresses to an irritating cough, and in 1-2wks may become paroxysmal (series of repeated violent coughs)  MMR immunization used for:  Measles- acute, highly contagious respiratory disease. Symptoms: like a cold with a rash all over the body and white spots on the inside of the cheeks, mostly in children but can happen in adults.  Mumps  Rubella – German measles, causes a mild febrile disease characterized by large lymph nodes and a fine, pink rash; only moderately contagious  Polio - IPV  Haemophilus influenza type B  Meningitis  Varicella – Chicken Pox o Streptococcus pneumoniae – related illness o Rotavirus o Influenza  PCV o The recommended vaccine schedule is rather complex and frequently changing - the newest addition is the pneumococcal conjugate vaccine – PCV – 4 does beginning at 2mos of age. The 4 dose around one year  Clinical (Safety)Mix-up Be Careful o Diphtheria outbreaks still occur around the world o Diphtheria toxoid given with Tetanus injections o Intervals of every 10 years  D = children, d, adults o DT (Diphtheria & Tetanus) – no Pertussis – every 10 yrs. o DTaP (Diphtheria, Tetanus, Pertussis) for initial children’s immunizations vs. Tdap – ( Diphtheria, Tetanus, Pertussis booster) - ages 11 – 64 yrs Pertussis Outbreaks in U.S. o Because of the recent increase in Pertussis outbreaks in the US, the CDC now recommends that a Tdap booster for children going into middle school  Immunizations r/t Global Health  Vaccination Camps (done by groups like Doctors Without Borders) o Still in operation in developing countries o Large # of people immunized, however there is no written record of who received these vaccinations, so when these same people immigrate to the U.S. we basically have to start from scratch because we don’t have any way of knowing what they are immunized against. o Alternative: performing expensive titers on all of the immigrants, but it would be hard to get in touch with the person o Clients of these vaccination camos know that they have been immunized and may feel that they do not need more shots  Setbacks in Global Immunization Programs o CIA used cover of fake vaccination Campaign in Pakistan to gather info on Osama Bin Laden 16  Resulted in health organization having to withdraw foreign staff for safety reasons  Caused suspension of polio eradication efforts in Pakistan  Hastings Center reported that over 31 polio vaccination workers have been murdered by the Taliban since July 2012 in Pakistan alone.  Any state-centered security operation that undermines people’s trust in vaccines is a violation of international obligations.  What the CIA operation did was an assault on everything that we believe in in public health  White House pledges to end CIA use of vaccination programs  Testing for Hepatitis B Status o Doctors will run tests that look for the Hepatitis B Surface Antigen – HBsAg  Routine Testing for pregnant woman, and infants born to HBsAg mothers o If a woman is Hep B positive and if that women gives birth, her baby has a 90% chance of becoming chronically infected with Hep B  Her newborn must be given two shots in the delivery room - the first dose of hepatitis B vaccine and one dose of hepatitis B immune globulin (HBIG). which give the child antibodies against the disease until the child can build own immunity  If these two medications are given correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection.  The infant will need additional doses of hepatitis B vaccine at one and six months of age to provide complete protection. o Always Test pregnant women from countries with 8% indigenous population positive for Hep B o CDC has asked that we test women from countries where there is a 2% prevalence of Hep B o Several vaccines have been developed for the prevention of hepatitis B virus infection.  Geographic Distribution of Chronic HBV o The US has less that a 2% prevalence of HBV o Countries like Brazil, China and many countries of Africa have >8%  Measles 1944 – 2007 o Measles was endemic in the USA in 40s 50s & 60s o In the late 80s there was a resurgence of the disease.  That told us that the new vaccine did not give lifelong immunity and they children needed a booster. nd  now most children get their 2 measles vaccine before adolescence o HERD immunity is when enough people have been immunized, so it protects those few unimmunized from getting the disease/keeps it from spreading  H1N1/ Seasonal Flu 2010 o 5 target groups for H1N1 immunization  Pregnant women, health care personnel (from high risk of contact with the virus), 6 mo-24mo, those with chronic illness  Most of these have a higher risk for complications from the disease o New Policy – Universal coverage for all 17  Shows what happens when young people get H1N1  Pneumococcal Pneumonia o In Flu Clinics:  Pneumococcal pneumonia immunization is given to people 65 or >.  New JACHO guidelines – HC workers must ask every patient over 65 if they have had it  Also given to high risk persons  Those who are chronically ill  Anyone with COPD  General Immunization Guidelines o Check the actual schedule at your facility CDC has the official schedule  CDC schedule is the gold standard of care – agencies may differ but always go back to the CDC guidelines o Children or adults from another country may require large numbers of immunizations to “catch-up”; o Remember viral rule regarding timing and spacing of vaccines  If you ever have to administer an antibody to someone, the presence of the antibody in circulation may reduce, or completely eliminate, the immune response  Inactivated antigens are generally not affected by circulating antibody, so they can be administered before, after, or at the same time as the antibody.  Simultaneous administration of antibody (in the form of immune globulin) and vaccine is recommended for post-exposure prophylaxis of certain diseases, such as hepatitis B, rabies, and tetanus. o Live Injected Vaccines  Live vaccines must replicate in order to cause an immune response.  Antibody against injected live vaccine antigen may interfere with replication.  If a live injectable vaccine (measles-mumps-rubella [MMR], varicella, or combination measles-mumps-rubella-varicella [MMRV]) must be given around the time that antibody is given, the two must be separated by enough time so that the antibody does not interfere with viral replication.  If the live vaccine is given first, it is necessary to wait at least 2 weeks (i.e., an incubation period) before giving the antibody.  If the interval between the vaccine and antibody is less than 2 weeks, the recipient should be tested for immunity or the vaccine dose should be repeated. o HPV has been added to official guidelines policy implications  Vector-Borne Disease o Most Common Vectors in U.S. are ticks, mosquitos, and flies.  Certain disease are transmitted to people through a vector  Mosquitos can carry malaria, west Nile Virus  Tick - Lyme disease & Rocky mountain spotted fever  Flies - eat feces – land on food contaminate food and the bacteria multiples in the food and is transported to the person eats the food 18 o These diseases to not transmit from person to person  The vector is necessary for the infectious agent to develop  Lyme Disease o 7 on list of leading most reportable disease in the US o Identified in 1975 when Arthritis outbreak in boy scout troop in Connecticut o Most common tick-borne illness in the U.S.  Caused by bacteria carried by a tick o Vaccine off the market for people, but treatment is available for pets  Symptoms of Lyme Disease o Oblong circular rash with defined center (Bull’s Eye) usually on the back of the leg at knee joint or inside elbow  o Common flu symptoms o Painful joints (like arthritis) o Severe disease of other organs  Antibiotic therapy needed because once it is treated it will subside, but if left untreated it can become chronic o Bacteria can live years in body  Foodborne Diseases – Food Poisoning o 76 Million Cases per year in the U.S. o Labs report these outbreaks to Health Departments & the CDC o Examples of foodborne pathogens:  Salmonella, Campylobacter  E-coli (renal hemorrhage – some forms deadly)  Listeria (miscarriage)  Botulism  Norovirus  Tuberculosis Today o Fear of TB is pervasive in many foreign countries o Infection vs. disease is not clear too many people, so education is key o DOT – daily observation therapy  Compliance should be made mandatory o Prevention – masks with active cases for health care professionals, medication for infection and disease o Monitor liver function for those > 35 years  TB Incidence World Wide* WHO o USUs is at the rate 1-24 cases of TB per 100,000 population o Russia is at about 100-299 cases per 100,000 population o Part of Southern Africa are the worst with about 300 cases per 100,000 population  BCG (Bacillis Calmette-Gue’rin) TB Vaccine- o 77% effective if used in childhood  Does not provide herd immunity (80%) but it is used in countries with endemic TB, shows to be more effective in certain geographies o Effectiveness significantly decreases over time o Can make PPD results questionable, so the patient may need a second or a chest x- ray 19  X-rays always needed to confirm TB  If I had a child in a country where TB was indigenous, I would get the vaccine for my child; however, if a child has gotten the BCG vaccine he/she will test positive on the PPD TB skin test even when there is no disease. \  THIS IS A FALSE POSITIVE***  why might a PPD test produce a false positive if a child lives in a country where TB is indigenous  ANSWER: The skin test is a valuable tool, but it is not perfect. Several factors can lead to false-positive skin test reactions. Infection with nontuberculous mycobacteria can sometimes cause a false-positive reaction to the TST.  Another cause of a false-positive reaction is BCG (bacille Calmette- Guérin), a vaccine for TB disease that is rarely used in the United States. People who have been vaccinated with BCG may have a positive reaction to the TST even if they do not have TB infection. o In 1930 bad press on vaccine because it was given to infants and over 50% died – because the vaccine was accidentally contaminated by virulent strain.  Video on Polio  Nursing Role In Preventing and Treating Communicable Disease o Surveillance – Who, what, when & where? This answers “why”  The US Surgeon General’s office proclaimed that no health department, state or local can effectively prevent or control disease without knowledge of who, what, where, and when in order to answer the Why?  Without a good surveillance system cannot plan and without a plan cannot implement  Prevention is the center of public health – Public Health Nurses takes the lead o Delivery of immunizations o Monitor immunization status I clinics, daycare, schools and homes o Nurses do surveillance and control o Nurses teach and monitor blood-borne pathogens o Nurses advise on vector-borne disease o Nurses work in screening for communicable disease o They work in identification of contacts STDs Blood Bourne Pathogens  Incidence o According to the CDC there are about 20 million new cases of STDS in the US each year o This is a financial burden because it results in health care costs of about $16 billion dollars o Many cases go unreported because of the nature of the diseases o STDs are not limited by race, geography, or economic status o Age however is an important predictor because almost half of STDs occur in people ages 15 – 24 years because this is when most people are sexually active (CDC, 2015)  Slowing the Spread o Direct, individual medical treatment for all sexual partners 20  The key factor in slowing the spread of the STI o Most bacterial STDs can be cured by one visit to the doctor or clinic, however more is needed than the treatment of individual patients and their partners o The control must have an individual and societal (population) focus  Ways to Protect Society- Prevention o Make sufficient care available to treat infected people quickly, effectively, and affordably access to health care is a huge problem in the US, what do poor and/or uninsured people do? o Encourage the notification and examination of potentially infected sexual partners, including expedited partner therapy (Golden et al, 2015) o Teach people that barrier methods of protection (ie condoms), while not 100% effective, are essential safeguards during sexual contact.  Epidemiology of STDs o STDs are widespread and among the most common infectious diseases in the world o Countries in the developing world are especially hard hit (In some developing countries, HIV/AIDS has become the leading cause of death (WHO, 2015). o Anywhere where individuals live in less than ideal conditions , STDs are under diagnosed and under treated due to lack of access to health care  Victims therefore suffer serious, long-term health consequences – less access to education, resources and these shortages confound prevention and treatment o According to the WHO (2015):  498 Million people ages 15-49are infected every year with chlamydia, gonorrhea, syphilis or trichomoniasis  Gonorrhea alone can be cured by antibiotics, but left untreated leads to pelvic inflammatory disease, ectopic pregnancy, premature deliveries and infertility  Gonorrhea is beginning to show resistance to cephalosporin which is raising concerns that the infection will become untreatable (Bloomquist et al, 2014)  Other Sexually Transmitted Diseases o All sexually transmitted diseases (STDs) result from mucosa to mucosa spread  Mucosa is the thin, moist skin in the mouth and genital areas o STDs are not spread from toilet seats, but from direct person-to-person contact o Today, 50% of high school seniors in the U.S. have experienced oral sex.  Adolescent STD Study - CDC o Study of Adolescent Girls  One half of study participants admitted to having sexual contact, but 1 in 4 had an STD, including throat infections  Half of teen males and females have had oral sex  Of teens admitting to being sexually active, 40% had an STD  Extent of the Problem in the USA o 19.7 million newly occurring STDs annually in the USA – the highest in the developed world o The cost is approximately $15.6 billion/year for the eight most common new cases of STDs diagnosed in the US each year. Costs come from:  Infection prevention efforts including education about abstention and reducing the number of sexual partners, condom use and effective vaccines  Testing & prompt treatment  Life-long treatment of HIV and HPV related cancers (CDC, 2013) 21 o Adolescents and young adults acquire STDs at a disproportionately higher rate than the general population o 50% of sexually active adolescents will have at least 1 STD by age 25 years  Reasons  New and multiple or anonymous sexual partners  Concurrent illicit drug use  Men who have sex with men and unknown HIV status  Viral STDs do not produce overt symptoms  It is estimated that one fifth of the American population have viral STDs - HPV, HSV  General Diagnosis o Whether symptomatic or asymptomatic, a patient's medical care begins the same way – the initial work-up!  History – taking a history that puts emphasis on assessing for risk of having an STD  Begins with asking about the chief complaint o If the STD is symptomatic – usually complain of discharge from the urethra, vagina, penis and occasionally the rectum o The second common complaint is skin lesions causing pain, tenderness, bumps, & itching o Some STDs cause swollen lymph nodes in the groin area o Also there may be complaints of pain during intercourse, urination or defecation.  Questions to ask – the 5 P’s o Partners – must ask for a detailed description o Practices – To understand their risk, I need to understand the kind of sex you have had recently. Ask have they had vaginal, anal or oral sex. Do they use condoms – never sometimes, always o Prevention of pregnancy – What are they doing to prevent pregnancy o Protection from STDs – Get very specific. o Past history of STDs – Ask directly  Make sure the discussion is age appropriate, non-judgmental (vita for adolescents who might feel uncomfortable) o One study determined that adolescents liked short messages like in texting or social media  Explain confidentiality  Ask about and listen to the patient’s concerns  Physical Exam – Must examine the anogenital area, the mouth and pharynx thoroughly  Female Examination o Explain in detail what will be happening step by step with time for questions. o Position for a female is on her back in lithotomy position with patient’s legs in stirrups. 22 o Close inspection of external genitalia and rectal area looking for breaks in skins, rashes, lumps or any sign of discharge and then palpation of the entire area (feeling for lumps and tenderness.) o Next is the speculum exam – should be warmed – and should explain that this exam is necessary to inspect and swab the cervix o After removal of the speculum, the provider palpates the uterus, ovaries and lastly the rectum. This is done with one hand in the cervical canal and one hand on the lower abdomen.  Male Examination o Explain how exam will be conducted. o Usually the patient stands in front of the provider who is sitting on a low stool o Begins with inspection of the area looking for redness, rashes, ulcers, vesicles, warts or excoriations. This includes palpation along with palpation the e


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