PUBH 302 Exam 3

prevention strategies for tuberculosis

BCG vaccine: recommended for healthcare workers and infants -proper ventilation systems -international awareness and national TB day -WHO end TB strategy: barriers of weak health systems and lack of tools requires: commitment from gov't, improved detection, supervised support, extensive monitoring -South Africa: DOTs supporters, assist in TB control and diagnoses, works with community partners -RCSI new treatment: atra molecule, must be packaged appropriately and receive the particles through an inhaler -possible VPM 1002 drug used for COVID

example of health promotion: infant mortality

Birth Outcomes Initiative: SC efforts to tackle infant mortality, combination of multiple players, come at issue at multiple ways -milk banks: individual behavior (option to nurse), environmental policies -centering pregnancy: individual behavior, addressing lack of social support, social/family/community network -SBIRT: screening, brief intervention and referral to treatment; referral to treatment, indvid behavior and broader policy support/medical support -baby friendly hospitals: outermost ring, getting accredited; support breast feeding, delaying C sections as a policy -FMLA: lactation laws, working condition impact; have 12 weeks off and safe place to breast feed -WIC: broad programs with nutritious food, outermost policy ring -Nurse family partnership: coaching parenting skills, social support and individual behavior coaching

Paul Ehrlich

German scientist developed staining procedures to see how toxicants affected living organisms -understanding biological plausibility

priority diseases

WHO consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for: -Crimean-Congo haemorrhagic fever (CCHF) -Ebola virus disease and Marburg virus disease -Lassa fever -Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) -Nipah and henipaviral diseases -Rift Valley fever (RVF) -Zika -Disease X

Ebola Outbreak of 2014

West Africa: Guinea, Liberia, Sierra Leone -approximately 28,504 cases and 1/2 died -US had to jump in because of infrastructure, 4 people treated in the US -importance of PPE -challenges that US faced regarding personal practices because ebola spread through burial practices

infectious disease

a disease caused by a pathogen -disease producing germ/agent such as a virus or bacteria

non-infectious disease

a disease that is not caused by a pathogen, such as asthma, CVD, obesity

communicable disease

a disease that is spread from one host to another, does not have the same meaning as infectious -not all infectious diseases are communicable: infected cuts, tetanus, Lyme's

contagious disease

a very communicable disease capable of spreading rapidly from one person to another by contact or close proximity

program

also referred to as an intervention, must be well planned, geared towards a target group -may be a single event or a combination, thought of as a "treatment" -2 levels= macro and micro: *effective health promotion programs combine both*

Healthcare-associated infection (HAI)

an infection acquired within a healthcare setting during the delivery of medical care; concerns for how we provide healthcare -central line associated bloodstream infections -catheter associated utis -ventilator associated pneumonia -surgical site infections use of copper in equipment? need to develop anti bacterials as well as antivirals

health education

any combination of learning experiences designed to facilitate voluntary actions (behavior) conducive to health -focused on the individual level, embedded in larger health promotion efforts

environmental sustainability model

approaches problems from recognizing multiple influences in order to have a long term solution -overlap between economy, community/population, and environment -how policies affect well being, social norms influence a given issue -economic controversy: the importance of the economy, must share resources

vector host

asymptomatic carriers of pathogens such as ticks, mosquitos -vector carries parasite or pathogen from host to host

tuberculosis

been around for 70,000 years, bacteria first isolated by Robert Koch -communicable, transmitted by particles: particles must be ingested and can travel to the body in two types -top 10 cause of death worldwide, prefers those in poverty -outcomes vary based on geographical area: treatment is very expensive, drug resistance is increasing globally social determinants: disease of the poor -denser, urban areas of underdeveloped countries with high rates of HIV/AIDS -indoor/outdoor air pollution -malnutrition -poor sanitation -increases with severe budget cuts as well as immigration

health education vs health promotion

both utilize a combination of approaches, and focus on changing a behavior -health promotion: well planned lots of effort factors beyond the individual involuntary choice -health education: well planned, focuses on health and wellbeing directed at individual factors voluntary decision making

community based health promotion

comprehensive, long term with multiple approaches -influences cultural norms, enhancing environmental support -mobilizes the community leadership + assets: not just individual focus, needed to change problems (ex= not seeing smoking on tvs, businesses come together) -involves all levels: family, media, schools, worksites, faith-based orgs, gov't: takes everyone's action to change modern behaviors -important to include community members at all steps

what do health promoters do?

conduct needs and asset assessments using epi data, focused on helping people -use rates as a comparison tool -plan programs in a variety of settings: community, schools, churches -implement and evaluate programs: focused on the health of their employees, reaching intended population and not harming -act as a resource, educate policy makers -write grants, advocate for resources -create health education materials -use computers and other technologies -conduct research, work to identify priority population

infectious disease of ongoing concern

continue to pose major public health problems and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions includes: Dengue, yellow fever, HIV/AIDS, tuberculosis, malaria, influenza causing severe human disease, smallpox, cholera, leishmaniasis, West Nile Virus and plague

zoonotic disease

diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans -people who work closely to animals are likely to come into contact

direct routes of transmission

does not require object to transmit Skin-skin (Herpes type 1) Mucous-mucous (STIs) Across placenta (Rubella; HIV) Through breast milk (HIV) Sneeze-cough /Aerosolized from person to person (Influenza,TB)

system level thinking

factors are inextricably linked, issues are complex -multiple interacting parts: cannot separate for good, improvements -multiple stakeholders -not just people, organizations and political systems: must understand relationships between all parts -we live in a system/social networks

Paracelsus

father of modern toxicology, understood that dose makes the poison -right dose can be a poison or a remedy -magnitude of risk is proportional to the potency of the chemical and the extent of the exposure Miner's disease came from inhaling metal vapors, foundation for the field of chemotherapy

influenza

flu, respiratory illness can range from mild to severe (dependent on % age groups classified) -risk varies by age and other conditions -2 main types: A and B (mostly flu strain A) -can prevent by getting vaccine each year -variance in who is impacted, changes every year but do their best to predict

Healthy People 2030

focus on promoting healthier environment to improve health, increase water supply and safe drinking water -reduce exposure to lead, arsenic, mercury -promote healthier environments, decrease unhealthy air, decrease amount of toxic pollutants, increase proportion of schools with policies and practices that promote safety

food waste and the environmental sustainability model

food waste is the determinant linked to death 1. environmental: methane gas that is affecting the environment leads to climate change and death via unintentional injury, falling debris, drowning MALNUTRITION -cholera outbreaks the worst in Haiti after lack of sanitation or safe water -fertilizers, land use that is taking away nutrients 2. social: malnutrition and obesity -asthma and other lung diseases due to increased methane output -obesity= easier to make cheaper, healthier choices 3. culture: people see the perfect fruits and vegetables in the store, will not buy small blemished ones -sell and buy by dates affect restock times 4. economic: takes money to transport the food, is often easier to just throw it away

population health

founded on causes that are influenced by more than biology and behavior, -must involved both micro and macro level solutions

food waste in the US

good produce is thrown out due to size, coloring, dumped instead of donated due to costs -wasted energy in order to grow crops -ocean mist donates to food banks, some states allow tax breaks for donation -so many seconds: focused on imperfect produce delivered for cheaper -1500 a year per American family

benefits of vaccines

herd immunity, concept of protecting a community against certain diseases by having a high % of community population immunized -must have low cost, incentives for doctors and patients -must understand where vaccines wear off, vary on effectiveness, constant research and development

non-vector host

humans, other vertebrates, birds, bats

national toxicology program

identifies and sets priorities with other gov't agencies -what are concerns that could cause harm? current research areas: -endocrine disrupters= how can this cause harm to human health? BPA, interfere with natural hormones, can shut off/modify hormones -occupational mixtures and exposures: safe limits for people working with asphalt fumes, welding fumes, metal working -phototoxicology: how much radiation we are exposed to, looking into tanning beds -safe drinking water

OSHA

if someone is exposed, can go to them without being penalized -also works to prevent violence in the workplace -limiting repetitive motion, not just sitting -has the right to go in and inspect a workplace

prevention for malaria

indoor residual spraying, all houses must use this; nets, antimalaria drugs for pregnant women -insect killer and bedside nets are expensive WHO progress: 37% decline in cases, 10 new countries are malaria free -still not enough protection, financing must triple as well as uniting with partners

macro level intervention

interventions - for a group of people (e.g. community, society, etc.); not directed at individuals; population based -vaccine programs, back to sleep campaign

micro level intervention

interventions - for individuals (even though they may meet in groups); person based

isolation vs quarantine

isolation: separates sick people with a contagious disease from people who are not sick, is for people who are already sick quarantine: separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick

population tools for communicable disease

largely involuntary, focused on water treatment, vector control, rodent reduction, campaigns -isolation and quarantine, although US does not have broad powers -immunizations: introduce antibodies to stimulate immune system to produce its own antibodies -screening and treatment: making sure people are aware if they have a type of infectious disease, confidential interviewing of those who may be exposed -public health campaigns: pull on emotions, trigger actions in a population

Pott

linked scrotal cancer and soot in chimney sweeps

10 biggest global health threats of the decade

main obstacles= global warming, conflict zones, unfair healthcare provision, requiring international effort 1. elevating health in the climate debate: emissions kill more than 7 million, responsible for more than 1/4 deaths from diseases including heart attack/stroke -extreme weather events increase malnutrition 2. delivering health in conflict and crisis: those forced to flee cannot access healthcare, attacks on healthcare workers 3. making healthcare fairer: health-wealth gradient -rise in chronic diseases have a greater impact on low/middle income countries 4. expanding access to medicines: 1/3 do not have access, need to gain trust of providers 5. stopping infectious diseases: focus on prevention, greater funding/ political will is required for immunization programs 6. preparing for epidemics: must focus on preparing for future outbreaks and less on reacting to new strains of a virus 7. protecting people from dangerous products: promote healthy diets, work to combat obesity -reduce reliance on harmful foodstuffs 8. investing in the people who defend our health: shortage of workers in low income communities, properly train them and provide decent salaries 9. keeping adolescents safe: focus on mental health to avoid road accidents, suicides, HIV, focus on contraceptives 10. earning public trust -combat false social media, work with community partners and programs

National Environmental Policy Act

national policy "to create and maintain conditions under which humans and nature can exist in productive harmony, that permit fulfilling the social, economic and other requirements of present and future generations" -survival depends on the balance between humans and the environment, understanding our actions have broader consequences

qualitative data concepts

natural setting, experience is important for prevention strategies, must address barriers -understanding how, why, focus on meaning -open ended questions, must be flexible: talking to as many people until saturation (when there are no new themes emerging) -continuum across disciplines -requires: intuition, communication, love for people -across disciplines: may have different levels of control (more observation or more interaction)

pandemic influenza

of great concern because the outbreaks are unpredictable, global outbreak of a new influenza A virus that is very different from current circulating viruses -different animals are hosts that do not normally infect people (birds, pigs) -constantly changing, the key is early detection major pandemics: 1. Asian + avian flu (20th century) 2. swine flu in 2009

birth control access in developing nations

problem is magnified in poorer countries, 82% of unintended pregnancies -women of reproductive age die from illegal abortions, economics/personal freedom issue because women cannot choose their own life -main focus groups: ages 10-19, those over 40 risk factor: poverty, biggest risk factor for infant mortality -the age at which women become pregnant and the time between births can be controlled -main barrier= access, stigma against birth control and conservative beliefs -CDC: reproductive health division, improve knowledge and services -UNFPA: contraceptives to populations in need, gather data

Ramazzini

published "De Morbis Artificum", disease of workers -first to link hazards of dust, fumes, gases to lung disease in workers; asthma

qualitative vs quantitative data

quantitative: number based, broad and shallow information -focused on testing/confirming a hypothesis: deductive -potentially valid (accurate measure used) and reliable (consistency) qualitative: text based, narrow and deep information -exploratory, open ended: inductive -potentially valid and reliable neither is superior to the other, both strive to describe, understand, explain, and examine relationships in social phenomenon

underlying assumptions for data

recognizing that there is a world out there that can be studied: people are linked from their environments -qualitative helps to understand patterns -predictable patterns, emerges as a theme -dynamic and complex -we need to follow agreed-upon norms & practices -there is good and bad research

Radium girls

revolution of safety protection -handpaint faces of watches, had to lick brush tip and put it between their teeth -over time, radium had a harmful effect, bones dissolving -company did not treat them well

exposure concepts

routes of exposure: 1. absorption: skin 2. injection: bite, puncture, cut 3. inhalation 4. ingestion 5. mucosal membrane Different toxic response arise from different: -routes of exposure -frequencies of exposure -duration of exposure: det by dosage How the body metabolizes a toxin is key and highly variable from individual to individual multiple factors involved

seasonal vs pandemic flu

seasonal: -annually -usually some immunity from previous exposures and from vaccine -certain people/groups are high risk for complications (seniors, young kids, chronic, pregnant) -annual flu vaccine -hospitals can control need pandemic: -no immunity, rarely happens -healthy people of all ages can get sick -universal flu vaccine research -hospitals overwhelmed

indirect routes of transmission

something is required to get the agent into the body -food borne: salmonella -water borne: cholera (increases during times of civil unrest, natural disasters) -vector borne: malaria -air borne/aerosolized person to object: chicken pox, colds

severe acute respiratory syndrome (SARS)

spread from Hong Kong to Canada, resulted in a lack of trust of the Chinese government; resulted in travel advisories -caused by corona virus spread by a civet animal -spread by large respiratory droplets

West Nile Virus

spread to humans by the bite of an infected mosquito, ongoing concern with nearly all 50 states -impacts neurological function -vector control

behavior change process

stage 1: awareness -knowledge is necessary, but not sufficient for change stage 2: initiation/decision making -may need skills to make change, lack self efficacy -training in making+ maintaining sound decisions -successfully deal with barriers to make change stage 3: continuation -ongoing environmental support+ physical environment changes

Disease X

standard for the unknown, must be prepared for what is coming next -value in cross cutting research preparedness -pathology can be currently unknown

background on infectious diseases

still a leading cause of death worldwide, even though we have eliminated or eradicated some -diarrheal disease is the second leading cause of death in children under 5 -rise in strain and antibiotic resistance: food systems, bioaccumulation, many STIs are resistant to antibiotics, takes several decades to develop new antibiotics -PH effort to prevent and control are underfunded, sensitive topics to deal with people

linear thinking vs system thinking

system thinking: concerned with the whole, concerned with the process -are concerned with underlying dynamics, try to find patterns -must recognize people in their real lives, patterns of communication linear thinking: break things into component pieces, are concerned with the content -try to fix symptoms, are concerned with assigning blame -care only about the content of communication

health promotion

the combination of educational & environmental supports for actions and living conducive to health -involves a planned approach/intervention, is purposeful and organized -broader than health education, the macro components

Rachel Carson

the founder of our contemporary environmental movement -questioned pesticides, how it impacted birds and affected the industry -bioaccumulation: lower in the food chain could have harmful effects higher up

environmental health

the science and practice of preventing human injury and illness and promoting wellbeing by: -identifying and evaluating environmental sources and hazardous agents and -limiting exposures to hazardous physical, chemical, and biological agents in air, water, soil, food, and other environmental media or settings that may adversely affect human health

toxicology

the study of the effects of poisons, application of science to important social environmental and PH issues -understanding how something produces a toxic effect

health impact pyramid

top of the pyramid= counseling, clinical intervention: MICRO -can improve an individual's health, but a smaller number of people are impacted long term -long lasting protective (middle): vaccines, individual efforts but longer lasting -changing context to make default decisions healthy: less reliant on voluntary decision -bottom: socioeconomic factors= biggest population impact -efforts to improve incomes, health/wealth gradient

malaria

vector borne disease spread by mosquitoes, parasite feeds on human's liver/blood -67% of deaths are children under 5, another primary population is black men ages 25-44 first/second generation immigrants risk factors= economics, geography, education -causes school/work absence: less income and productivity -gov't must pay for distributions and low worker productivity -location: hot+ moist, stagnant water; deforestation, growing maize near home -education: important for mothers, congenital malaria

data is not enough

will not explain what is happening within a community, what are the challenges within a community? -importance of engaging stakeholders, have to recognize challenges -examine the "bigger picture" -need more context, do the priority population think the program is important? what are the assets within a community? often will require qualitative data

occupational health

works to assess safety concerns and threats on the job, ensuring that people have the right equipment, good ventilation systems -how can we protect people from exposure in the workplace, limit exposures on the job -field has evolved over time

types of toxic effects

•Death •Organ Damage - CNS, skin, eyes, reproductive, immune, liver, respiratory •Mutagenesis - changing DNA, genetic make-up* •Carcinogenesis - cancer causing, cell changes, tumor/mass growths •Teratogenesis - birth defects

determinants in the environment that influence health:

-air pollution: indoor/outdoor, linked to low income countries -water, waste removal -chemicals, radiation -community noise/light pollution -agricultural risks: around world, ends up in soil/water systems -changing weather: more damage from natural disasters

environmental factors that influence disease transmission

-altered environment: deforestation, climate change; people living in new places or in closer contact to animals -ownership of exotic pets -changes in food production, novel forms of diseases (antibiotic resistance) -global air travel and exotic journeys, unknown long term effects of new contacts -natural disasters: changed types of conditions that may be more likely, cholera in Haiti, in US power outages can cause outbreaks of disease -increased use of immunosupressives and antibiotics

health education philosophies

-behavior change (skills): teaching someone how to cook -cognitive-based learning (knowledge): knowing what is healthy -decision- making: offers people alternatives -freeing/functioning -social change/ justice

COVID 19

-coronaviruses are a large family of viruses that can cause illness in animals or humans -respiratory infection ranging from mild to severe -Wuhan China in Dec 2019 -spread via respiratory droplets -determinants: age, underlying conditions, obesity, diabetes, cancer, smoker -age considerations: 85+, 513 per 100,000 hospitalizations -comparison group: 18-29: -younger children lower risk, as age increases you increase the risk of death or hospitalization 40% of people have reported struggling with mental health

qualitative group techniques

-focus groups: bring group together, ask questions, themes emerge through conversations between group members -brainstorming: ask question then judge themes -community forum/meeting -nominal group process

personal prevention of communicable disease

-handwashing -personal protective equipment (PPE): masks, gloves, eye protection, avoid touching eyes/nose/mouth, boot wearing -get immunized -take care of immune system: sleep, diet -don't go to school or work if sick -see provider if symptoms worsen

characteristics of the agent

-infectivity: ability to infect -immunogenicity: likelihood of triggering an immune response -pathogenicity: ability to cause disease -virulence: ability to cause death -antigenic stability: long term immunity -survival: some can survive outside of the body

types of vaccines

-live-attenuated vaccines (MMR, chicken pox) -inactivated (dead) vaccines (Flu, polio) -subunit, recombinant, polysaccharide, and conjugate vaccines (HPV, Whooping Cough) -toxoid vaccines (Diptheria, Tetanus)

uses of qualitative methods in PH

-needs assessment, program planning -evaluating programs: process evaluation, evaluate outcomes -community asset assessments -evaluating program participants: knowledge, attitudes, beliefs (what did they benefit from, how could the people improve the program?)

qualitative data methods

-personal interviews: experiences working with people -case studies: one particular instance, how we can make changes in another place, how one place can achieve success with these new ideas -systematic observation: field notes/journals -participant observation: over/covert, how many minutes are spent doing certain activities -content analysis: journal articles, field notes

why some diseases can be eradicated and not others

-type of reservoir, can it live outside of humans? -disease itself produces long term immunity -ability to produce a vaccine: 80%+ need vaccines for herd immunity -how easy is the disease to change

assumptions of health promotion

1. Health status can be changed: empowering the individual 2. Disease occurrence can be understood: dose response 3. Prevention strategies can be developed for health problems. 4. Health is affected by multiple factors - not just lifestyle. 5. Changes in micro & macro level behaviors and factors can positively affect health. 6. People & communities can assume responsibility for their health. 7. Individual responsibility does not mean victim blaming 8. For permanent behavior change, people must be ready & motivated.

why is there individual variability in toxicity?

1. age/life stage, such as elderly or infant 2. gender: body weight, fat contents 3. form+ ability to be absorbed: powder, inhaled 4. metabolism: breaking down, some more harmful as they are metabolized 5. distribution within the body 6. excretion: underlying cause makes it hard, your health conditions could make it more difficult and the substance could stay in the body longer 7. nutritional status: things in diet could make it more susceptible 8. presence of other chemicals: more toxic effects 9. circadian rhythms: time of day the drug is administered, taken with or without food

sources of toxins

1. environmental 2. occupational 3. therapeutic 4. dietary/food 5. accidental 6. deliberate 7. in nature= animal, plant

epi triad for disease transmission

1. host: person or living organism that may be infected by an infectious agent, acts as a reservoir or niche that fosters the survival of an infectious disease agent -characteristics about humans that make them more susceptible: -age, gender, genetics, behavior, nutritional status, health status -includes domain in which the disease causing agent may exist or originate 2. environment: physical, biologic, social, economic components -weather/geography can put some environments at risk -housing, air conditioning, water access -occupational setting: need PPT in clinical settings -food: importance of plumbing away from food, contamination 3. agent: factor whose presence is essential for the occurrence of the disease

health promotion areas by level

1. individual: improving knowledge, empowering -KABS: knowledge, attitudes, skills, beliefs, self efficacy -efforts to improve attitudes, can be built through skills, result in gains of self efficacy, want them to believe that they will see improvements 2. interpersonal: social support, social norms -want to engage families 3. institutional: organizational characteristics, working conditions: safeway -importance of physical characteristics (onsite gym, farmer's market) 4. community: relationship between organizations -community rules/laws, support institutional rules -changes to physical environment of community: bike paths -recognizing relationship to create conditions necessary 5. public policy: laws and policies at the local, state, national levels -zoning laws -incentivize people, subsidize healthy products -must mirror bullseye: come up with solutions that acknowledge economic burdens + all levels

is this a public health problem?

1. what impacts quality of life, mortality, morbidity? 2. what are the determinants, both micro and macro level? 3. what are the controversies/and or political concerns? -individual liberty, economic, moral/values

types of agents

1.Bacteria - one-cell microorganism that multiply quickly & may release chemicals which can make you sick 2.Viruses - capsules that contain genetic material & use your own cells to multiply 3.Fungi - primitive vegetables, like mushrooms or mildew, mold, yeasts 4.Protozoa - one-celled animals that use other living things for food and a place to live 5.Helminths - parasitic worms that cause disease and illness in humans such as tapeworm, pinworm, and trichinosis.

other events in occupational health history

1950s: shoe salesmen -xrays of feet, high exposure was bad modern day occupations with the greatest risks: chemical/pharmaceutical •Chemical industries •Health care workers •Pharmaceutical/lab work •Rubber manufacturing •Furniture manufacturing Pesticides/exterminating

Zika Outbreak

2015-16, spread through sexual contact and can impact unborn babies (small head, neurological conditions) -spread from Brazil into US (FL) -spotted due to birth defects

environment impact on human health

24% of deaths resulting from the environment -#1= heart disease, may not have access to healthy options -#2= respiratory diseases -#4= unintentional injury, not the same strategies worldwide -#9= malaria, shelter and environmental determinants