PUBH 201 FINAL (Ch. 16-31)

Rubella vaccination

Infection with the rubella virus (German measles), a common cause of deafness and mental retardation, is prevented by immunization

Inflammation

Inflammation - a major source of oxidants Inflammation activates the arachidonic acid cascades

intentional & unintentional injuries

Intentional: homicide and suicide More than half suicides, about 40% homicides, others unintentional

Repetitive motor injuries

Leading cause of Injury deaths: 1. Poisoning (unintentional, suicide, undetermined) 2. Motor Vehicle (unintentional) 3. Firearm (unintentional, suicide, homicide, undetermined) - firearms injuries had surpassed motor vehicle injuries as the leading cause of injury death - Analysis of motor vehicle injuries focused on the driver (host), making the vehicle (agent) safer and on developing safer highways (environment) - Prevention of motor vehicle injuries includes campaigns to change people's behavior by persuading them, or requiring them by law, to wear seat belts and helmets - National Highway Traffic Safety Administration (NHTSA) - Motor injuries are first category of injuries to be analyzed and subjected to systematic prevention efforts

Dementia

Mental impairment: senile dementia, Alzheimer's type -> half of all dementia -currently affecting an estimated 5.3 million people in the United States at a cost of an estimated $226 billion per year; much of this cost is for long-term care in nursing homes - unpaid care provided by family members - Alzheimer's is main cause, other causes are traumatic brain injury, certain infections, and certain toxic exposures, stroke

Alzheimer's

Mental impairment: senile dementia, Alzheimer's type > half of all dementia - Most dreaded afflictions of old age. It robs the individual of memory and individuality, and eventually reduces him or her to the helplessness of an infant - Alzheimer's is the most common cause of dementia in the elderly - Diabetes increases the risk of Alzheimer' •Risk increases with increasing age •Tremendous burden on caregivers •Costs up to $100 billion per year in long-term care •Biomedical research and epidemiologic studies are beginning to give clues on risk factors •No effective treatment known, but some studies are giving hope •Even delaying onset by a few years could substantially reduce the financial and personal burden

uninsured - disparities

Minorities receive less care in medical - Most of the uninsured are poor, and the percentage of uninsured citizens decreases as their income increases - Members of racial and ethnic minority groups are more likely to be uninsured than white Americans - Some low-wage workers may choose to remain uninsured because their share of the premiums is too high

Oxidative stress

Oxidative stress: inadequate dietary intake of antioxidant nutrients, or also chronic conditions as malabsorption syndrome

Three phases of trial

PHASE 1 - the new drug is given to a small number of people who are extensively tested to measure absorption, distribution, metabolism, excretion, and look for side effects and toxicities PHASE 2 - tests a larger number of patients for signs that the new drug is effective PHASE 3 - full-scale controlled trial in which patients are assigned randomly to two groups. People in the experimental group receive the new drug. Members of the control group receive either a placebo or standard treatment.

PPOs, HMOs

PPOs - •Patients must seek care from participating providers - Participating providers agree to provide services at lower rates HMOs - Acts as insurer and provider - Agrees to provide all required for a fixed payment - Physicians and other providers are on salary - Incentives to deny care deemed unnecessary - Incentives to limit access to specialists and technology - Incentives to provide preventive care

Right to die, Right to life

Right to die - Right to die" - Karen Ann Quinlan 1976 overdose from drugs and alcohol. able to breathe on her own, although she remained unconscious. She was transferred to a nursing home where she survived for 10 years in a persistent vegetative state. - Nancy Cruzan 1990 automobile crash. Supreme Court decided to set the standards for when life support could be removed. Cruzan's father move her to another state in order to remove the feeding tube and let her die - Terry Schiavo - eating disorders, 2005. Florida law provided that Ms. Schiavo's husband was entitled to decide that the feeding tube should be removed; he contended that she would not have wanted to be kept alive in this condition. However, Ms. Schiavo's parents objected, maintaining that she recognized them and that she might improve with treatment. Right to life - Abortion is one of the most controversial medico-legal issues, putting the "right to life" of the fetus against the right of the pregnant woman to control her own body

Three R's: Reduce, Reuse, Recycle

The only way to make landfills last longer Reduce: buy only the amount of a product that will be used, choose items without excessive packaging Reuse: use reusable napkins, towels, diapers, dishes, cups Recycle: collecting used, reused, or unused items that could be remanufactured into raw materials to produce new products. - More than 75% of MSW is recyclable EX: metals, glass, plastic, and paper ->Primary recycling: the waste is recycled into the same material (recycling newspapers into newspapers) ->Secondary recycling: waste is made into different products that may or may not be recyclable (recycling plastic bottles into fleece jackets) - composting of food scraps, yard trimming, and other organic materials to produce soil amendment that can be added to soil to help plants grow.

Physiological vs chronological age

The physiological age is not the same as chronological age

NIMBY

"not in my backyard." - People do not want a landfill in their neighborhood

osteoporosis

- 22 million Americans, 1.5 million fractures/year if > 45 years of age - caused by smoking - Risk of broken bones leading to disability - Elderly individuals need physical activity to maintain muscle strength, balance, and cardiovascular fitness, which protect them against osteoporosis and fall - bone loss, bones break easily - bone loss among women greatest in years following menopause - Hip fractures are most serious consequence - drinking milk and exercising during youth can protect

Dietary supplement health and education act

- A 1994 statute of U.S. Federal legislation which defines and regulates dietary supplements. - prohibits the FDA from regulating herbs and food supplements - signed by President Clinton - Congress in 1994 succumbed to intense lobbying by the health food industry

Pesticide

- A chemical intended to kill insects and other organisms that damage crops - Chemicals that can cause an intoxication - Pesticide resistance: target organisms are no longer affected by pesticides

Radon

- A colorless, odorless, radioactive element in the noble gas group. It is produced by the radioactive decay of radium and occurs in minute amounts in soil, rocks, and the air near the ground. - Radon gas is naturally radioactive and potentially causes lung cancer - Radon is a radioactive gas emitted by the decay of radium and uranium -Radon enters homes by seeping up from the soil and rock through dirt floors, crawl spaces, cracks in cement floors and walls, and through sump holes and floor drains. It may dissolve in well water and be released into the air during showers or baths

New Drug Application (NDA)

- A new drug application (NDA) for an investigational new drug, providing evidence that the drug has the desired effect in animals and satisfies some basic safety criteria. - If the FDA approves the NDA, the company is allowed to test the drug in humans in clinical trials

Controlling costs

- A number of attempts to impose cost-containment measures on medical care have been relatively unsuccessful in controlling costs. - Managed care organizations negotiate reduced payments to healthcare providers and employ various strategies to limit patients' access to treatments considered nonessential or too expensive for the expected benefit - requires the development of a procurement plan as well as the monitoring of the status of the project with updates made to cost estimates and the total cost baseline.

Radiation (Environmental Hazard)

- Artificially produced radiation often worries people. - Sun's ultraviolet light causes skin cancer and melanoma. - Radon gas is naturally radioactive and potentially causes lung cancer. - Early scandals with radium in patent medicines led to regulation. - Chronic exposure to x-radiation used in medicine and dentistry cause cancer. - Health effects of radiation were confirmed by long-term studies of survivors of atomic bombings in Japan. - cosmic radiation

Dr. Jack Kevorkian

- Assisted Suicide to mentally competent, terminally ill patients - 1990 - 1999 convicted of 2nd degree murder because he administered a lethal drug to a patient who wishes to die

Field of dreams effect

- Availability of services leads to more use of these services ->More back surgeons, more back surgeries ->More hospital beds, more hospitalizations ->More hospital beds, more patients die in hospital - Evidence in some cases that financial considerations may affect medical decisions

Baby boomers "young old" "aged" "oldest old"

- Baby boomers are approaching retirement - Only hope is for baby boomers to be healthier and more independent than past generations - Young old: 65 to 74, 80% are in good, very good, or excellent health - Aged: 75 to 84, 71% are in good, very good, or excellent health - Oldest old: 85 and older, 18% live in nursing homes; 15% require assistance

Aging population

- Because older people generally have a greater need for medical care, aging populations are driving up medical expenditures - needs more medical care

Benign prostatic hypertrophy

- Benign prostatic hypertrophy - high variation ->Watchful waiting vs. prostatectomy ->Prostatectomy - benefits are overstated, complications are understated ->Patients need to be informed so they can choose -> enlargement of the prostate gland -Benign prostatic hyperplasia (BPH), a common condition in older men that causes difficulties with urination.

Formaldehyde

- Common indoor air pollutant that is possibly a carcinogenic gas that irritates the respiratory system and is contained in insulation, particleboard, plywood, some floor coverings and textiles, and tobacco smoke - Formaldehyde is a significant problem in mobile homes supplied by the Federal Emergency Management Agency - formaldehyde more widespread in manufactured housing - common in prefabricated and mobile homes

Metabolic dysregulation

- Cumulative exposure to high levels of glucocorticoids - Exposure to higher omega-6 fatty acids with decline in beta-6 desaturation

demographic transition

- Demographic transition: refers to the transition from high birth and death rates to lower birth and death rates as a country or region develops from a pre-industrial to an industrialized economic system. - There is a causal link between modernization and declining birth and death rates - Undeveloped societies have High birth rates and infant and childhood mortality - Developed societies have Low birth rates and infant and childhood mortality - Birth rates tend to fall as a result of falling death rates - The concept of a stable, non-growing global population based on people freely choosing to have smaller families can become a reality. PHASES: Phase I: primitive stability: High BR is offset by high DR Phase II: epidemiologic transition: Declining DR, High CBR results in rapid population growth Phase III: fertility rates declining: Population growth is still significant Phase IV: modern stability is reached: DR and BR are both low

USDA (US Department of Agriculture)

- Department of Agriculture (USDA): meat, poultry, processed eggs - ensuring that foods are safe, wholesome, and properly labeled - responsible for the safety of meat and poultry, including prepared products that contain more than 2% of cooked meat or poultry and processed eggs - Has detailed laws on regulation of meat - estimates that foodborne illnesses cost $15.6 billion each year in the U.S. - USDA has bigger budget and more authority and regulates 20% of food.

Resource Conservation and Recovery Act (RCRA)

- EPA was mandated to regulate hazardous waste. - set standards for sanitary landfills - EPA's proposal included a category waste termed "special waste," which included wastes such as cement killing dust, mining and mineral processing waste, crude oil and natural gas waste, and fossil fuel combustion waste

Ecological model

- Ecological model of health behavior to create a social environment that favors healthier eating (making nutritious foods more readily available, providing a greater choice of low-fat and low-calorie foods, offer "heart healthy" selections on the menu, worksite and school cafeterias provide healthy food choices including salad bars) -Physical Activity Ecological Model: motivate individuals to be more active FOOF GUIDE PYRAMID: Grains, Vegetables, Fruits, Milk/Dairy, Meat and Beans

Benefits of exercise

- Exercise promotes health independent of weight control - prevent heart disease, high blood pressure/reduce blood pressure, improves cholesterol, diabetes, cancer - protects against cardiovascular disease, heart disease, stroke, atherosclerosis - reduce type 2 diabetes - improves survival and quality of life among individuals

FDA (Food and Drug Administration)

- FDA regulates labeling of foods with information on nutrients and recommended daily intakes. - regulates labeling of prescription drugs - In 2015, FDA banned adding trans fats to food - FDA has smaller budget and less authority. - Regulates 80% of food and imported food - regulation of food and drugs, cosmetics, medical devices, and feed and drugs for pets and farm animals POLICIES OF FDA: - FDA is subject to intense political pressures. - Complaints are that the FDA is too slow in approving drugs. - Drug companies pay a fee to speed up the review process. - Now complaints are that the FDA is too cozy with the industry. - Too many drugs are found to be unsafe only after approved for marketing. (Fen-phen, Vioxx, antidepressants for children) - Problems exist with the way clinical trials are reported. - There are calls for a database of all clinical trials, with the substance registered at the beginning of the trial, and with all trial results reported.

Free radicals

- Free radicals ->Atom with at least one unpaired electron, highly reactive, usually seeks other electron to become paired, ->If antioxidants unavailable: free radicals multiply, the cell's functioning disrupted, cell components are damaged, cell necrosis ->Free radical stress: lipid peroxidation, atherogenic activity, carcinogenic activity, ->Pro-oxidant effect: cigarette smoke, imbalanced diet, exhaustive exercise, environmental pollutants - Free radicals are present at higher levels in colon patients with ulcerative collitis

Medicare

- Growth in cost of Medicare is unsustainable - Medicare does not cover dental care, eyeglasses, or hearing aids - Medicare enrollment has doubled since 1967 and will continue to grow - Medicare does not pay for long-term care, Medicaid does

HIV/AIDS

- HIV/AIDS shortens life expectancies in Africa. The AIDS epidemic in Africa is waning, due to intensive efforts to provide antiretroviral treatment as widely as possible. In 2014, 41% of people infected with HIV were receiving therapy 4.8% of the adult population of sub-Saharan Africa is infected with HIV AIDS epidemic is so severe Africa that it has slowed population growth in those countries about 15 million African orphaned children by AIDS

teen pregnancy

- Harmful consequences: interference with the young mother's education and career prospects, economic hardship, and interference with the formation of a strong family, infant mortality - Teen mothers likely to seek prenatal care than older women and are more likely to have no care at all. They are more likely to smoke and less likely to gain adequate weight during pregnancy - Infants of teenage mothers are at risk of low birth weight, serious and long-term disability, and dying during the first year of life. These children are more likely to have lower school achievement, drop out of high school, be incarcerated, themselves become parents as teens, and face unemployment as young adults - 1950s: social pressure forced marriage on many girls who became pregnant, producing a more stable economic and family environment for the young child. - Today, most teenage mothers are unmarried, and a large increase in adolescent births in the late 1980s

Breastfeeding & obesity

- Health advantages for both mother and infant. - Breastfeeding has a long-term protective effect against obesity in children. - It also helps the mother to lose weight she gained during pregnancy - Breastfeeding can help protect children against being overweight

SES & overweight

- Higher SES is associated with lower rates of overweight and obesity, especially among women - Lower SES is associated with more inactivity - Higher injury rates in groups with lower SES - low SES increases risk: Environmental hazards, Poor nutrition, smoking, alcohol, illegal drugs, Social factors (young maternal age, violence, stress, lack of social support), Lack of prenatal care

Principles of Emergency Preparedness

- Importance of advance planning involving all agencies; practice at least once - Importance of good communication - Strategic National Stockpile of medical supplies, antibiotics, vaccines, antidotes for chemical agents - Incident Command System (ICS): puts a single person, who has responsibility for managing and coordinating the response, in charge at the scene. - Disaster response managed by authorities from local government agencies, because the response must be immediate and local authorities are closest to the scene and know the territory - The lead agency is fire/police department.The state and federal government provide technical assistance and backup resources. -National Incident Management System (NIMS): standardizes the organizational structures, processes, and procedures that communities should employ in planning for an emergency. It also provides guidelines and protocols for integration of all levels of government and the voluntary and private sectors in coping with a disaster

Low Birth Weight (LBW)

- Infants of teenage mothers are at risk of low birth weight - caused by preterm birth - Weight at birth of less than 2500 grams. Very low birth weight means a weight at birth of less than 1500 grams Preventing LBW: Prenatal care, Reducing adolescent pregnancy, Causes of low birth weight are not well understood, increases in LBW due to multiple births because of reproductive technology *The three leading causes of infant mortality overall are congenital anomalies, low birth weight, and SIDS*

1994 labeling regulations

- Labeling was one of the important provisions of the original Pure Food and Drugs Act in 1906. - Recommended daily allowances for nutrients became required on labels in 1994. EX: A form of labeling: Advertising of over-the-counter drugs

Small area analysis

- Large variations in practice style by geographical area - True of many medical conditions - More variation for conditions on which evidence for appropriate therapy exists - Sometimes more than one therapy may be appropriate - Doctors may adjust behavior when informed of other doctors' practice patterns

Lead (Environmental hazard)

- Lead is harmful to brain and nervous systems, especially in children. - It has caused poisoning since the Roman Empire. - Drinking water gets contaminated by lead pipes and lead solder used on copper pipes. - Gasoline emitted lead air pollutant until the 1980s when banned. - Lead paint was used until 1977 and is a threat in old houses' peeling paint and contaminated dust. - Children should be screened for lead levels in blood.

Medical Errors

- Medication errors, wrong side surgeries - Institute of Medicine report, 1999 - Errors cause 44,000 to 98,000 deaths per year - System is decentralized, fragmented, poor communication - focus on improving it - Recommendations ->Create Center for Patient Safety ->Set national goals, track progress, research ->Errors should be reported and investigated ->Drug naming, packaging, labeling should be changed to minimize confusion - medical errors were blamed on failures by individual doctors and nurses; practitioners who made mistakes were sued for malpractice, and some had even been prosecuted as criminals

Mercury (Environmental hazard)

- Mercury from mining, cholera in unsafe water, light and noise - Mercury causes neurological damage in workers. - Mercury discharged by a plastics factory into Japan's Minamata Bay causing deaths, paralysis and brain damage - Emissions from U.S. coal-burning power plants pollute water and air, contaminating fish. - Nursing mothers and young children should not eat fish with high mercury content. - Fever thermometers and school laboratory equipment are exposure concerns. - mercury in fish as a staple diet (tilefish, swordfish, king mackerel, and shark)

Indoor air pollution

- Most common indoor air pollutants are tobacco smoke, other products of combustion, radon gas, consumer products that release chemicals into the air, and biological pollutants, including bacteria, mold, dust mites, and animal dander. -Smoking also increases levels of carbon monoxide in indoor air and is a source of benzene, which is toxic and carcinogenic. -Other chemicals that may pollute indoor air include pesticides, dry-cleaning solvents, paints and paint thinners, carpet glues, hair spray, and air fresheners

Seat belts

- National Highway Traffic Safety Administration (NHTSA) set safety standards for new cars, such as installation of seat belts - The use of seat belts has been shown to reduce fatalities by 40 to 50% - Child safety seats can reduce the risk of a child's being killed during a collision or sudden stop by 71%

Newborn screening

- Newborn screening programs are designed to identify infants born with defects in body chemistry such as phenylketonuria and hypothyroidism that can be remedied by early diagnosis and treatment. Other congenital anomalies may be caused by known environmental exposures, such as tobacco smoke, viruses, heavy metals, or the use of legal or illegal drugs. - A public health program designed to screen infants shortly after birth for a list of conditions that are treatable, but not clinically evident in the newborn period. - prevent birth defects by newborn screening

Open dumps

- Outlawed by the Resource Conservation and Recovery Act (RCRA) in 1976. - Supported large populations of vermin and produced toxic leachates that contaminated groundwater. - Garbage was burned in incinerators or in the open and outlawed by the Clean Air Act of 1970. - Garbage was poured into rivers, lakes, or oceans and Outlawed by the Clean Water Act and the Marine Protection, Research, and Sanctuaries Act

Prenatal care

- Prenatal care provides women with information on how to have a healthy pregnancy and bear a healthy child - The lack of prenatal care has been linked with high risk of infant mortality - Provides women with information - Diagnose problems early - Can often link poor women with social services - Most states try to remove financial barriers - States and federal government collect data on prenatal care

Overweight in children

- Prevalence of overweight among 6- to 19-year-olds increased from 5% to 15% between 1960s and 2000 - High prevalence among Mexican American boys and African American girls - Type 2 diabetes is being diagnosed in children

Price controls

- Price controls tried in the 1970s: Limit new facilities and technology - certificate of need (planning) - First cost control effort by the federal government was the imposition of price controls by President Nixon from 1971 to 1974. Although the policy moderated cost increases temporarily, providers adapted to the lower fees paid for each service by increasing the quantity of services. Total spending continued to rise.

major sources of pollutants

- Primary pollutants: direct products of combustion and evaporation ->Particulates, VOCs, CO, NOx, SO2, lead, air toxics - Secondary pollutants: formed by primary pollutants ->Ozone, peroxyacetyl nitrates, sulfuric, nitric acids - Other types: ->Debris and grit:rags, plastic, sand, gravel ->Particulate organic matter: fecal matter, food wastes, toilet paper ->Colloidal and dissolved organic matter: fine particles of organic material ->Dissolved inorganic material: Nitrogen, phosphorus, and nutrients from wastes/ detergents ->pesticides, heavy metals, toxic compounds, Wastewater

Hepatitis A

- Raw clams and oysters are dangerous because they grow in shallow coastal waters, which are likely to be polluted, these shellfish carry cholera and related bacteria, hepatitis A virus - Hep A also transmitted by food handlers who are careless about hygiene EX: Hep A outbreak from Mexican green onions, Salmonella outbreak from Mexican peppers, and an outbreak caused by the parasite Cyclospora on Guatemalan raspberries in the 1990

Environmental modifications

- Remove environmental barriers and provide places to exercise - Suburban lifestyle - must drive everywhere - Build sidewalks, walking trails, bike paths, Mall walking in shopping malls - Police surveillance and neighborhood watches in high-crime neighborhoods

Challenges for the 21st Century

- Renewed threats from infectious diseases - Climate change - Rising costs of medical care for aging population - Understanding and altering human behavior - Need to strengthen public health system - Persistent disparities in health - To educate the public and policy makers about the role of non-medical factors in determining people's health - to foster a national debate on priorities that will bring spending on medical care more in line with its value in assuring health

Clean air act mandated

- Required the EPA to identify major sources of these emissions and to set emission standards for the source categories rather than for individual pollutants -established strict air quality standards, set limits on several major pollutants, and mandated reduction of automobile and factory emissions -strengthening air quality regulations, monitoring and regulation of 6 common air pollutants: particulates, sulfur dioxide, carbon monoxide, nitrogen oxides, ozone, and lead

Bioterrorism preparedness

- Same as preparedness for natural epidemics - Challenge to recognize an attack is occurring •- Public health surveillance is important - Need for laboratory capability - Need for public health laws enabling authorities to take action - Problem of whether uninsured will seek care - Need for coordination between public health and law enforcement

Hormones

- Sex hormone, diethylstilbestrol, a form of estrogen, used to be fed to chickens to promote their growth. Because of concerns that hormone residues in the meat might increase human breast cancer risk, the practice was banned in 1977 - 1994, the FDA approved the use of bovine growth hormone in dairy cows to increase their milk production, hormone residues not found in the milk - Melatonin, promoted as a sleep aid and treatment for jet lag, is sold as a nutritional supplement despite the fact that it is a hormone with unknown and potentially powerful effects on the brain and the reproductive and immune systems.

DDT

- Silent Spring called attention to the harmful effects of the virtually ubiquitous pesticide DDT - found in lakes and streams, plants, and insects - When eaten or drunk by fish and birds, it accumulated in their flesh, to be eaten in turn by predators, which concentrated these chemicals further in their own bodies. - The use of DDT was banned in the United States in 1972

Bioterrorism agents

- Smallpox - Anthrax - Plague - Botulinum toxin - Tularaemia bacteria - Hemorrhagic fever viruses

Licensing & regulation

- States license physicians, nurses, dentists - States can discipline practitioners for incompetence or misconduct - States license and regulate hospitals and nursing homes - JCAHO: Joint Commission on Accreditation of Healthcare Organization - Schools of medicine, nursing, public health seek accreditation as a measure of their quality

Clean Air Act of 1970

- The 1990 Clean Air Act amendments directed the EPA to set standards for 187 specific chemicals. - The Clean Air Act of 1970 required the EPA to develop a list of industrial pollutants that can cause serious health damage and set emission standards for them - introduced measures designed to speed up the process - established strict air quality standards, set limits on several major pollutants, and mandated reduction of automobile and factory emissions - require monitoring and regulation of six common air pollutants - directed the EPA to identify and set emissions standards

Vaccines for Children Program

- The Vaccines for Children Program will pay for poor and uninsured young people to be vaccinated - federal government provide free vaccines for children who were uninsured or whose insurance did not cover vaccines - Vaccines covered by the program: Haemophilus influenzae type b (spinal meningitis), varicella (chicken pox), pneumococcal disease, hepatitis A, influenza, meningococcal disease, rotavirus, and human papilloma virus

Occupational exposures - workers as guinea pigs..

- The effects of a number of cancer-causing and neurotoxic substances have been recognized because workers have served as "guinea pigs," the first humans to test the safety of new chemicals - Workers, exposed to larger quantities, may inadvertently serve as the guinea pigs that call attention to the dangers - Workers are effective though unintentional guinea pigs because exposure on the job is likely to be much higher than that in the general environment. - increased risk of cancer (Scrotal cancer - same carcinogens found in tobacco smoke, chemicals that are now known to cause lung cancer.) - Chemicals as carcinogens include: Benzidine (which caused bladder cancer in dye factory workers), Arsenic, (caused lung and lymphatic cancer in copper smelters), Vinyl chloride (used to make some plastics, which causes angiosarcoma, a rare cancer of the liver), Neurotoxins

Abstinence only programs

- The federal welfare reform bill that was implemented in 1998 included funding for programs that teach sexual abstinence only - Many states were reluctant to apply for the money because they believe such programs are much less effective than those that include education on contraception as well - teach that condoms are ineffective, encourage teenagers to sign virginity pledges - Abstinence promotion is a worthwhile goal, particularly among younger teenagers, however, it is insufficient to help adolescents prevent unintended pregnancies and sexually transmitted diseases

Fee-for-service

- The fee-for-service approach permits doctors to make decisions about a patient's care with no consideration of cost. - Most doctors and other providers are paid on a fee-for-service basis. - The patient is required to pay deductibles and copayments - doctors and hospitals are motivated to provide more services in order to increase their income

Surveillance

- The ongoing and systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know. The final link in the surveillance chain is the application of these data to prevention and control. - ongoing surveillance activities included sampling of dust and debris near the site to assess risk and monitoring of symptoms of cleanup workers and area residents. - Emergency room visits, Calls to 911 and poison control centers, Pharmacy records, Veterinary diseases -Surveillance activities include emergency room visits, calls to 911 and poison control centers, and pharmacy records to detect increased use of antibiotics and/or over-the-counter drugs.

Pure Food and Drug Act of 1906

- This law forbade the manufacture or transport or sale of mislabeled or adulterated food or drugs and poisonous patent medicines and gave the government broad powers to ensure the safety and efficacy of drugs in order to abolish the "patent" drug trade. It paved the way for the eventual creation of the Food and Drug Administration (FDA) still in existence as the FDA. - Recommended daily allowances for nutrients became required on labels in 1994.

Children's bureau

- U.S. Children's Bureau beginning in 1912 (children - a national resource and that their health - important for the progress of the society) - investigate and report on all matters affecting children and child life - children were a national resource and that their health and vigor were important for the progress of society

Biotechnology

- Unprecedented possibilities of genetic engineering, cloning, individualized medicines, etc. - Ethical and legal issues - Biotechnology promises to solve many medical problems with new drugs and procedures that will contribute to the spiraling costs of medical care - Human Genome Project allows the detection of individual differences in people's response to various drugs, with the promise that doctors can choose among medications to prescribe for a patient based on genetic tests. - Biotechnology offers even more unprecedented possibilities, such as that of choosing the characteristics of future children through genetic engineering and cloning or of slowing the aging process

Hazardous waste

- Waste with properties that make it capable of harming human health or the environment - Hazardous waste generated from many sources, ranging from industrial manufacturing process wastes to batteries and may come in many forms, including liquids, solids gases, and sludges. - Under Resource Conservation and Recovery Act (1976), EPA mandated to regulate hazardous waste. -Hazardous landfill - Designed to dispose hazardous waste. - Municipal solid waste landfill (MSWLF) or sanitary landfill - Designed to dispose MSW and other types of non-hazardous wastes

Well baby care

- Well-baby care is almost as important as prenatal care for child health, but children of poor families often miss out on these visits to the doctor for the same reasons that their mothers missed prenatal visits, including lack of affordable health care. - well-baby care include screening for tuberculosis, problems with vision and hearing, and scoliosis, or curvature of the spine. B

sanitary landfills

- a disposable method that take up a lot of space. - Municipal solid waste landfill (MSWLF) also known as a sanitary landfill designed to dispose MSW and other types of non-hazardous wastes - require wastes to be confined in a sealed area - Solid-waste disposal is now confined to sanitary landfills

"morning after pill"

- a form of emergency contraception, can be taken up to five days after unprotected intercourse to prevent pregnancy - preventing the release of a woman's egg for longer than usual and is at least 85% effective -There was considerable controversy in the 2000s about whether these medications should be available without a prescription, especially to teenage girls, but now most brands are available over the counter

State Children's health Insurance Program (SCHIP)

- a joint federal-state program which expands coverage to children in families that earn too much to qualify for Medicaid, uninsured children - provide medical care for poor children

Roe v. Wade

- abortion illegal until 1973 in most states - women have a constitutional right to an abortion, at least in the first trimester.

Federal Insecticide, Fungicide, and Rodenticide Act (1947) - settings standards

- amended several times that requires government approval of these substances before they can be used - Congress required federal agencies to set standards for exposure to toxic substances via various routes: The EPA, FDA, USDA, U.S. Department of Transportation, Nuclear Regulatory Commission, CPSC, and OSHA EXAMPLES of setting standards: - Clean Air Act required the EPA to develop a list of industrial pollutants that can cause serious health damage and set emission standards for them - The National Toxicology Program (NTP) can test only a few dozen agents each year - 80,000+ chemicals registered for use, toxicity testing on any single chemical can be expensive and time-consuming

access to care

- an individual's ability to receive medical care based on factors like availability, location, cost, and ability to pay - the ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner

Kyoto Protocol

- controlling global warming by setting greenhouse gas emissions targets for developed countries - reduce carbon dioxide (CO2) emissions and the presence of greenhouse gases (GHG) in the atmosphere

teratogenic drugs

- drugs that cause birth defects - Thalidomide, Accutane, Dilantin

Occupational Safety and Health Act of 1970

- empowered the federal government to set standards for workers' exposure to toxic substances - protect employees from hazardous working conditions

Salmonella

- foodborne bacteria - common contaminants of poultry, meat, eggs, viruses and parasites in fish and shellfish EX: Salmonella outbreak from Mexican peppers - Largest foodborne disease outbreak in the previous decade was attributed to Salmonella-contaminated jalapeño and serrano peppers imported from Mexico

BMI

- height (meters) divided by weight (kilograms) squared - Healthy BMI is below 25 - BMI between 25 and 29.9 is overweight - BMI of 30 and above is obese

Folic acid fortification

- if a woman takes dietary supplements of folic acid before conception and during early pregnancy, her infant's risk of devastating conditions is reduced. - Dietary supplementation with folic acid reduce the incidence of neural tube defects by 50% -prevent birth defects -FDA require that foods be fortified with folic acid

Minimata, Japan

- infant mortality is the epidemic of birth defects caused by mercury contamination/poisoning of the bay from an industrial source in Minimata, Japan - mental impairments, birth defects, and deaths were caused by mercury dumped in Minimata Bay by factory. Mercury entered humans through their diet

Fast food lawsuits

- lawsuit against McDonald's by obese teenagers was laughed out of court = lawyers see potential for challenging food companies on deceptive advertising and marketing practices - lawsuit against the Kellogg Company and the makers of the television show SpongeBob SquarePants for using the cartoon character to sell sweetened cereals, Pop Tarts, and cookies to children under 8. Kellogg then agreeing that foods advertised on media targeted at children should meet certain nutrition standards

Food insecurity

- limited or uncertain access to nutritionally adequate foods - Poor nutrition increases children's risks of stunting, inadequate cognitive stimulation, iodine deficiency, iron deficiency anemia, risk of overweight and obesity - Families headed by single women with children and black and Hispanic households are the most likely to experience food insecurity

Natural disasters

- many natural disasters are predictable - some unpredictable like earthquakes - hurricanes, blizzards, and forest fires - plans include prior evacuation of the population in affected areas to minimize negative health effects and loss of life - Search and rescue - Treatment and evacuation of injured - Food, water, shelter for survivors - Minimize environmental hazards

Smallpox

- most dreaded of the possible bioterrorism agents - smallpox disease is highly contagious, and there is no effective treatment. About 30% of those infected die - smallpox officially eradicated in the 1970 Preparedness - Highly contagious, no immunity in population - Dark Winter exercise - Public health is a major national security issue - An attack could cause massive civilian casualties, breakdown in essential institutions, civil disorder, etc. - Vaccination campaign - military and health workers - Resistance by civilians because of side effects and uncertainty of risk

Climate change

- nitrogen, oxygen, argon, and carbon dioxide is causing global warming due to the "greenhouse effect," in which the energy of sunlight is absorbed by carbon dioxide in the air and turned into heat rather than radiating back into outer space - climate change begun: The Earth's average combined land and ocean temperature had risen by well over one full degree Fahrenheit over the past century - Intergovernmental Panel on Climate Change (IPCC) the effects of global warming already felt. Sea levels rose, rise in glaciers and Arctic ice sheets melt -overpopulation, Increased atmospheric concentrations of greenhouse gases brought about by human activities are causing warming of the Earth's surface, melting of the polar ice caps and a rise in ocean levels, Weather patterns are already changing

S curve, J curve

- patterns of population growth S curve - By 2100, it may show an S-shaped, logistic curve J curve - Human population growth shows a J-shaped curve

fee-for-service

- permits doctors to make decisions about a patient's care with no consideration of cost. - patients must also pay a flat fee or a fixed percentage of the remainder of the bill - When covered individuals get sick, they go to the doctor or other medical provider of their choice, and that provider then sends them bills for services rendered

PCBs (polychlorinated biphenyls)

- potentially carcinogenic in humans and have negative effects on the intellectual development of children and adult - chemicals were used mainly in sealed systems (capacitors, transformers, and heat exchangers) but they were still entering the environment in large quantities and getting into the food chain - entered the environment through discharge of industrial wastes - Most widespread chemical contaminant worldwide - People exposed to large doses of PCBs by a number of industrial accidents were made ill by the chemicals EXAMPLES W PCBs 1975 - The contamination of New York's Hudson River with PCBs. Two General Electric Company (GE) capacitor plants that had been discharging large volumes of PCBs into the river for more than 25 years. Although the discharge was halted, the chemicals would persist in the soil of the riverbed indefinitely. Fish caught in the Hudson River still contain PCBs at concentrations 1968 - Western Japan: a leak at a cooking oil factory contaminated a batch of the rice oil with heat exchanger fluids containing PCBs. "Yusho" incident

Acid rain

- produced when sulfur dioxide and nitrogen dioxide react with water to form sulfuric acid and nitric acid -damages forests, reduces crop yields, and corrodes surfaces of buildings and statuary. It turns the water in lakes and rivers acidic, killing freshwater shrimp, wiping out bacteria on lake bottoms, and interfering with fish reproduction - nitrogen oxides are respiratory irritants that contribute to acid rain - cut emissions of particulate matter and diesel fuel contains high concentrations of sulfur, to reduce levels of sulfur dioxide in the air, helping to reduce acid rain - air pollution create acid rain

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

- provides vouchers for milk, fruit juice, eggs, cereals, and other nutritious foods for pregnant women, lactating mothers, infants, and children up to five years old. - Nutrition education is also provided, and WIC centers often become a source of many support services for poor, young families. T - WIC program found to be effective in saving medical costs for the women and infants who participated

Malpractice fears

- sue for malpractice when something goes wrong - fear of malpractice suits may affect a physician's decisions - system of malpractice compensation is inefficient and unjust. Most patients who are harmed by poor medical treatment are not compensated, and many patients who have suffered a bad outcome sue and win - winning a malpractice suit only way an injured patient will be able to pay for treatment of his injury. - malpractice suits lead to defensive medicine - Improper, illegal, or negligent professional activity or treatment, especially by a medical practitioner, lawyer, or public official.

Pretreatment

- the Clean Water Act requires pretreatment of industrial wastes that are discharged into sewers

Organic standards

- the FDA regulates food additives and chemical contaminants, food labeling and advertising. It sets standards for foods to be labeled "organic." - A law passed in 2014 expanded federal support for organic farming and encouraged consumer access to local produce - organic produce must be grown without pesticides, synthetic fertilizers, or sewage sludge. - organic meat, poultry, eggs, and dairy products must be grown without antibiotics or growth hormone

Carrying capacity

- the number of organisms that can be supported in a given environment without degrading that environment - once the carrying capacity is exceeded, the environment is degraded, and the carrying capacity is reduced carrying capacity for earth: 7.7 billion - Earth's carrying capacity: centered on food, supply of fresh water Factors limiting the capacity: availability of fresh water, the availability of fuel, the amount and productivity of arable land, and the amount and disposition of wastes.

compression of morbidity

- the rates of chronic disease and disability - improving quality of life for those who benefit from the compression of mortality that has already occurred - permitting people to remain healthy until shortly before they die - reducing the length of time a person spends sick or disabled. The idea is to maximize ​healthy lifespan and minimize the time spent less than well

Sudden infant death syndrome (SIDS)

- third leading cause of infant death overall - infant appeared to be healthy before he or she died, and an autopsy fails to establish the cause of death -SIDS is more common in infants of low birth weight and in infants of smokers or drug users - "Back to Sleep" - baby position- campaign or "Safe to Sleep" campaign, to educate maternity wards, doctors and nurses, and parents that infants should be put to sleep on their backs - Other risk factors: soft bedding, being overheated, and bed sharing - SIDS rate has fallen by over 50% *The three leading causes of infant mortality overall are congenital anomalies, low birth weight, and SIDS*

Technological disasters (manmade)

- unpredictable, although the potential can sometimes be identified and the possibility minimized through government regulation and community planning - technological disasters include industrial explosions, hazardous material releases, building or bridge collapses, and transportation crashes that may also cause a chemical or radioactive release - terrorist events, act of bioterrorism - Search and rescue - Treatment and evacuation of injured - Food, water, shelter for survivors - Minimize environmental hazards

Ozone layer depletion

-Depletion of the ozone layer is another manifestation of the global effects of certain air pollutants. Ozone is harmful to respiratory systems at ground level and is a natural component of the upper atmosphere that provides a layer of protection against ultraviolet radiation. -The detection of chlorofluorocarbons (CFCs) in the ozone "hole" which opened over Antarctica in the early 1980s convinced scientists that these chemicals, which were used as refrigerants and spray can propellants, were responsible for the breakdown of ozone - CFCs drift upwards to the ozone layer, where they may cause damage - The increased ultraviolet radiation that reaches ground level causes cataracts and skin cancer, harmful effects on other organisms, including food crops, major threat to life on the planet.

Uneven distribution of resources across globe

1. Fresh water: Uses include drinking, cooking, washing, agriculture, unevenly distributed, small percentage of the Earth's water is suitable for human use 2. Fuel: Deforestation leads to degradation of land. 3. Arable land: Amount of land under cultivation is declining. 4. Food from the sea: There is a decline of fish and shellfish harvests.

Top 10 Public Health Achievements

1. Routine use of vaccination 2. improvements in motor vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths from heart disease, stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Access to family planning and contraceptive services 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard

Healthy people 2010

2 goals: Increase quality and years of healthy life and Eliminate health disparities. -first goal placed a new focus on quality of life, and the second goal no longer set different targets for racial and ethnic minorities, aiming to ensure that all groups in the United States will be equally healthy. - organized into 28 focus areas - quality and years of healthy life, years of life continue to improve, especially in the older population, but measures of quality yielded mixed results. HEALTH PEOPLE 2020 GOALS - Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. - Achieve health equity, eliminate disparities, and improve the health of all groups. - Create social and physical environments that promote good health for all. - Promote quality of life, health development, and health behaviors across all life stages.

Contribution of medical care to health

47% - lifestyle 27% - genetic factors 16% - environment 10% - medical care - genetics, behavioral patterns such as diet, exercise, and substance abuse, social circumstances such as education and housing, and environmental pollution, in addition to medical care - medical care are far out of proportion to its contribution to health - identified that a shortfall in medical care is far from the most important cause of premature death

9/11 response

9/11 attacks was the recognition of weaknesses in coordination and communication of the emergency responders.

Managed care

A health care system whose goals are to provide cost effective quality care, reduce cost of healthcare - Employer-based private insurance plans have tried a number of approaches to limiting costs by bargaining with providers (doctors and hospitals)for discounts on services - providing them with a higher quality of care and more continuity of care - managed care has an advantage over fee-for-service in providing high-quality care - Incomes below the poverty level use managed care plans to provide medical care - slowed the growth in healthcare costs and become the dominant form of employer-sponsored health insurance - Reduced payments to healthcare providers and employ various strategies to limit patients' access to treatments considered nonessential or too expensive for the expected benefit.

Food stamps or Supplemental Nutrition Assistance Program (SNAP)

A third federal program designed to help low-income families afford adequate food -Based on the household's size and income, families are issued an electronic benefits transfer card that can be used like a credit card to buy nutritious foods at grocery stores. It cannot be used for alcohol, tobacco, or nonfood items.

CO2 & climate change

Carbon dioxide produced by burning fossil fuels causes greenhouse effect, global warming

HEALTHY MINDS: Disorders, Cause and Prevention, Treatment

Cause and Prevention: - The causes of mental disorders are viewed as a product of the interaction between biological, psychological, and sociocultural factors and environmental factors - (ex) PTSD is caused by exposure to an extremely stressful event, although not everyone develops PTSD after such exposure. - Prevention of mental illness depends on identification of risk factors that can be targeted, especially in children. Risk factors include individual factors, family factors, and community factors - An individual may be put at risk by neurophysiological deficits, difficult temperament, chronic physical illness, or below-average intelligence. - Family factors that increase risk are severe marital discord, social disadvantage, overcrowding or large family size, paternal criminality, maternal mental disorder, and admission into foster care - Community factors such as living in an area with a high rate of disorganization and inadequate schools may also increase risk.

JCAHO: Joint Commission on Accreditation of Healthcare Organization

To confirm that they provide high-quality care, healthcare institutions also may seek accreditation by a private organization - The Joint Commission

Toxic Substances Control Act of 1976

allowed the government to require testing of potentially hazardous substances before they go on the market and to ban them in certain instances

Superfund sites

areas designated by the EPA for cleanup of hazardous waste sites

Nat'l institute of occupational safety and health (NIOSH)

conduct research, recommend standards, and conduct hazard evaluations

Toxics Release Inventory

credited with reducing industrial releases of toxic chemicals in the U.S. by 54.5% between 1988 and 2001 and another 33% between 2001 and 2013 -local communities pressured the industry to cut back on their emissions

Occupational Safety and Health Administration (OSHA)

empowered to set standards, inspect workplaces, and impose penalties for workplace hazards

Relationship of health & wealth

health is proportional to wealth richer- > healthier

"midnight dumping"

legal disposal of hazardous waste is expensive so people illegally dump the hazardous waste

Planned pregnancy

occurs when the parents involved have discussed and then decided to conceive a child

Marine Protection, Research, and Sanctuaries Act (1972)

prohibited most ocean dumping

Contraception

reducing rates of unintended pregnancy and abortion -Female sterilization and vasectomy for men are the most effective methods of contraception, but they are permanent and thus inappropriate for young people. -Other effective methods for women are intrauterine devices (IUD) Hormonal implants and patches. - Equally effective when used correctly are combination oral contraceptives "the pill" - Hormonal contraceptives, such as Depo-Provera shots and the hormone-laden vaginal ring. - Pills must be taken every day - Male and female condoms and the female diaphragm - Spermicides/cervical cap - morning after pill

U.S. Consumer Products Safety Commission

regulates/monitors toys and children's furniture for safety hazards, issuing warnings and ordering recalls of products that are found to be dangerous to children.

Damage Theories, Program Theories

two major theories of aging

Oregon "experiment"

w/ Medicaid - goal to cover all citizens whose incomes below poverty level, medical necessities - spread its resources over a larger number of people by limiting the services for which it would pay. decided not to pay for organ transplant. - John Kitzhaber: new approach focused on life-saving treatments for serious conditions and tried to eliminate less effective therapies for less serious conditions - list undervalued the quality of life of people with disabilities - rich enough to provide necessary care for everyone; the need to ration care for the poor is a consequence of failures of the system to provide adequate and affordable care for everyone. - Health policy experts have praised the Oregon plan's focus on medical necessity so that all appropriate care and no inappropriate care is covered - Oregon Plan struggled and eventually collapsed - medical care costs began growing faster than the general economy, making the provision of health care for all economically and politically more difficult

E. coli O157:H7

widespread in beef, probably due to the way livestock are raised and processed, undercooked meat

Medicare & Medicaid

•Medicare and Medicaid - passed in the 1960s •19% of US population under 65 is uninsured MEDICARE: - Part of Social Security system - Mandatory insurance for all workers; workers and employers required to pay in - 65+ is eligible; younger people who are disabled - Part A: hospital insurance - Part B: voluntary, monthly premium; covers doctor bills and other outpatient costs - Prescription drug plan effective 2006 - Required to pay deductible and co-payments MEDICAID: - Welfare program for the poor - Costs shared by federal and state governments - Eligibility varies, determined by states - State Children's Health Insurance Program (SCHIP) for families earning too much to qualify for Medicaid - •Oregon experiment with Medicaid: tried to cover more people by limiting services

primary, secondary, & tertiary prevention of accidents

Primary prevention - conditions prevailing before the event (alcohol, anger,- defective breaks, - dark, rain...) Secondary prevention - conditions prevailing during the event (airbag, seat belt, divided highway) Tertiary prevention - availability and quality of emergency care

Risk-benefit analysis

Question: "How Safe?" - agree that absolute safety is an impossible goal and attempting to avoid risk of one sort may increase risks of other kind Question: "Does overregulation cause underregulation?" - too much effort is expended setting very strict standards for too few substances. battling to achieve zero exposure to one carcinogen, public health agencies may be neglecting to investigate other chemicals that are potentially more hazardous - aiming for looser, more easily achieved standards - prevention of risk must be balanced against other societal goals, including economic well-being - understanding that economic factors are significant to people's health and well-being led to greater willingness on PUBH advocates to consider costs and benefits in evaluating risks -George W. Bush administration favor economic and business interests in policy making on environmental and public health issues. - President Obama has placed a priority on many environmental issues, especially climate change

exercise and aging

Changes associated with aging that can be prevented or minimized with exercise: - Higher body fat, Lower lean body weight, Decreased muscle strength, Decreased flexibility, Decreased bone mass, Lower metabolism, Slower reaction times - exercise regularly. Muscle strengthening exercises can significantly increase their mobility, strength, and balance - Physical exercise protect against Alzheimer's - women who got the most exercise showed less cognitive decline over the years than less active women

Clean Water Act

Clean Water Act—1972, 1977, 1987 - All pollution discharges should be eliminated. - Lakes and rivers should be fishable and swimmable: - Point-source pollution +Requirements for treating wastewater +Sewage treatment plants or septic systems (Treat with chlorine or other disinfectants) +Sludge: Congress prohibited ocean dumping -Nonpoint-source pollution +Agricultural runoff, Urban runoff, Air pollutants deposited by rain -focused on cleaning up nonpoint-source pollution - the EPA regularly collects data from the states on water quality of rivers, lakes, and estuaries

injury pyramid: Deaths, Hospitalizations - include long-term disability, Emergency department visits, Episodes of injuries reported

Deaths - 192,945 Hospital discharges - 2.36 million Emergency Department Visits - 43.0 million Episodes of injuries reported - 82.6 million - The age group at highest risk for hospitalization and death from TBIs is individuals 75 years and older, while the greatest number of emergency department visits are by children aged 4 and under. Leading causes of injuries are falls, followed by being hit by an object and motor vehicle crashes, the latter including drivers, passengers, pedestrians, motorcyclists, and bicyclists

HEALTHY MINDS: Disorders, Cause and Prevention, Treatment

Disorders: 1. Anxiety - Physiological response to dangerous situations that prepares one to evade or confront a threat in the environment. others include OCD and PTSD 2. Psychosis - Disorders of perception and thought process. Symptoms are hallucinations, sensory impressions that have no basis in reality, delusions/false beliefs. Associated with schizophrenia. 3. Disturbances of Mood - a sustained feeling of sadness or hopelessness/major depression/extreme fluctuations of mood, bipolar disorder 4. Disturbances of Cognition - The ability to organize, process, recall information, execute complex sequences of tasks, may be disturbed in a variety of disorders. (Alzheimer's disease) *mental disorders broken down by types of disorder—anxiety disorders, mood disorders, impulse-control disorders, and substance disorders* 5. Austism - a severe, chronic developmental disorder characterized by severely compromised ability to engage in, and by a lack of interest in, social interaction. 6. Mood disorders - bipolar disorder, major depression, suicide 7. Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavior disorder of childhood and its prevalence has been increasing, treated with psychoactive stimulants 8. Disruptive disorders, such as oppositional defiant disorder and conduct disorder, frequently found in children who suffer from ADHD 9. Anorexia nervosa = more common in girls, sees herself as overweight when underweight, obsessed with food, weight, and weight control, and eats only certain foods in very small portions 10. Bulimia nervosa = obsessed with their weight, but they lack control over their eating, binge on food and then try to compensate by purging behaviors such as self-induced vomiting or excessive use of laxatives, by fasting, or by excessive exercise, tend to be of normal weight 11. Binge-eating disorder = people lose control over their eating, but they do not purge, often overweight or obese 12. Schizophrenia= disruption in cognition and emotion, affecting language, thought, perception, affect, and sense of self

3 E's: Education (alcohol consumption, manage anger...), Enforcement ( state and federal regulations on flammability of fabrics), Engineering (childproof caps, smoke detectors)

EDUCATION: - Injury control methods that target the driver depend on education (alcohol plays a major role in fatal crashes) - Poisoning: better communication and education of healthcare providers to warn them of the risks and inform them how to recognize patients who may be prone to abuse - violence prevention and youth development programs, education to promote nonviolent resolution of arguments - high-risk pregnancies are those common in poor neighborhoods: young maternal age and low maternal education ENFORCEMENT: - Injury control methods that target the driver depend on enforcement (alcohol plays a major role in fatal crashes) - Pedestrians, Motorcyclists, Bicyclists: stricter enforcement of speed limits, the rate of death and severe injuries among pedestrians fell by 60% - Poisoning: Drug Enforcement Agency, which registers physicians and pharmacies that handle opiates and tracks the buying and selling of these drugs ENGINEERING: - Engineering could protect occupants during a crash. It lead to automobile design (headrests that protect their occupants during rear-end collisions, strengthened sidebars to protect occupants during side crashes, and airbags) - Seat belts: engineering measures require people to use them correctly - Engineering has not been widely applied in the prevention of firearms injuries. Safety catches can be used to make guns childproof

New pyramid

Fruits, Grains, Vegetables, Protein, Dairy - half the plate should consist of fruits and vegetables, and at least half the grains should be whole grains

L. Hayflick

Gerontologist L. Hayflick: separated human cells in laboratory environment: 120 years

Groups at risk for injuries

Higher injury rates in groups with lower SES Males have higher injury rates than females Blacks have higher injury rates than whites

disuse syndrome

Identifying characteristics of aging and the "disuse syndrome" are: decrease in cardio- respiratory function, obesity, musculoskeletal fragility, premature aging

Criteria pollutants: Particulate matter, Sulfur dioxide, Carbon monoxide, Nitrogen oxides, Ozone, Lead particulates size

Particulate matter - the most visible form of air pollution. The smoke, soot, and ash that were so typical of the Industrial Revolution - Air pollutants can be products of combustion - respiratory and cardiovascular pathologies Sulfur dioxide - produced by combustion of sulfur-containing fuels, especially coal. Irritates the respiratory tract - leads to bronchitis (inflamed bronchi) - acid rain - causing respiratory damage Carbon monoxide - highly toxic gas, mostly produced by motor vehicle exhaust. Interferes with the oxygen-carrying capacity of the blood and other harmful side effects - reduces the oxygen-carrying capacity of the blood and leads to heart disease - harmful to patients with cardiovascular disease, causes headaches and impairs mental processes. Nitrogen oxides - the chemicals responsible for the yellowish-brown color of smog - impairs lung function and affects the immune system - Main sources are on-road motor vehicle exhaust, off-road equipment, and power plant emissions. - contribute to: Respiratory tract irritation, Acid rain, Ozone formation Ozone - a highly reactive variant of oxygen that is irritating to the eyes and respiratory. Chronic exposure lead to permanent damage of the lungs. - inflammation and scarring of the lungs - Produced by sunlight acting on other air pollutants - increases mortality from cardiovascular and respiratory diseases. Lead - Damages nervous system, blood, and kidneys. - Poses special risk to the development of children's intellectual abilities. - Was used in leaded gasoline but was banned in the 1980s. - Has decreased dramatically as an air pollutant

asbestos hazard emergency response act

Passed in 1986 - It required all primary and secondary schools to be inspected and, if loose asbestos was found, to carry out plans for removing, enclosing, or encapsulating material. - The removal was often done improperly, causing more asbestos to be released into the air than if the material had been left intact

WHR (waist/hip ratio)

Pear shape vs. apple shape Fat distribution is measured as a waist-to-hip ratio (WHR) waist measured at the smallest point and the hips at the widest point around the buttocks

Point source pollution

Point source pollution -Requirements for treating wastewater -Sewage treatment plants or septic systems -Treat with chlorine or other disinfectants -Sludge: Congress prohibited ocean dumping - Pretreatment of industrial wastes • Non-point source pollution -Agricultural runoff -Urban runoff -Air pollutants deposited by rain

Safe Drinking Water Act (1974)/ Community water treatment

Safe Drinking Water Act of 1974 - EPA should set standards for local water systems. - States should enforce the standards - specified 83 contaminants to be regulated by the EPA Community water treatment to produce potable water: -Coagulation and flocculation -Settling -Filtration -Disinfection

Irradiation

Safety measure that kills bacteria, parasites, pests EX: pasteurizing milk and canning fruits and vegetables - FDA has approved irradiation of many foods to kill microbial contaminants - irradiation would greatly improve the safety of our food supply

"back to sleep"

The American Academy of Pediatrics and the National Institute of Child Health and Human Development began a "Back to Sleep" campaign, or the "Safe to Sleep" campaign, to educate maternity wards, doctors and nurses, and parents that infants should be put to sleep on their backs. Since the campaign was launched, the number of deaths from SIDS has declined dramatically. The back sleeping position varies widely and was least common among young women, black women, and women with less education and lower incomes. The SIDS death rates for black and American Indian infants are more than double the rate for white infants. Public health agencies and medical care providers are working with minority communities to educate them about the importance of putting infants to sleep on their backs.

fishable and swimmable

The Clean Water Act specifies that lakes and rivers should be fishable and swimmable

Fen-phen

The diet drug known as "fenphen" was approved in 1996 but had to be recalled a year later because it caused serious heart valve problems

Tracking & permitting

Tracking requirement: mandates that paperwork document the progress of hazardous waste from its site of generation through treatment, storage, and disposal Permitting: any facility that treats, stores, or disposes of hazardous waste must be issued a permit from the EPA or the state; the permit prescribes standards for management of the waste

HEALTHY MINDS: Disorders, Cause and Prevention, Treatment

Treatment: - Most people with mental disorders do not seek treatment. because they do not know that there are effective treatments, fear of the stigma of acknowledging the problem, cost of care. Insurance coverage of mental health care is inferior to that of physical health - Hospitalization was the norm for serious mental illness. (Asylums) - where they endured poor and abusive condition. Patients became excessively dependent and lost connection to the community. - NOW inpatient units are used for crisis care, focusing on reducing the risk of danger to self or others and rapid return of patients to the community - Medications and Psychotherapy