CHS 345 Exam II Study Guide

Ways to prevent falls?

Talk to your doctor, do strength and balance exercises, have your eyes checked, make your home safer, etc.

From the in-class group activity, what role do the CPSC and FDA play in keeping us safe (know what each does)?

The Consumer Product Safety Commission seeks to promote the safety of consumer products by addressing risks of injury and developing safety standards. The US Food and Drug Administration is responsible protecting and promoting public health through the control and supervision of food safety and pharmaceutical drugs among others.

From the videos and slides linked in the PowerPoint, what is HIPAA (1996)?

The Health Insurance Portability and Accountability Act, sets the standards for protecting the privacy, confidentiality, and security of health information.

Living Will Lock Box

The Living Will Lockbox is a simple & secure approach to ensure that your medical wishes are followed. Maintained by the Secretary of State's office, a copy of your advance directive will be kept confidentially and readily available to you and your health care provider, when needed, 24-7.

What is the Public Health Service Act of 1944 and what did it do?

The act clearly established the federal government's quarantine authority for the first time. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States.

What are Nevada's laws relating to isolation and quarantine?

The county board of health may establish and maintain an isolation hospital or quarantine station when necessary; restrain, quarantine and disinfect any person sick with or exposed to any contagious or infectious disease that is dangerous to the public health; and appoint quarantine officers when necessary to enforce a quarantine. A health authority may issue an order requiring the isolation, quarantine or treatment of any person or group of persons if he believes that such action is necessary to protect the public health.

What are the origins of the idea and movement?

The first steps toward environmental justice were taken by Rev. Dr. Martin Luther King in 1968, the very week he was assassinated. He had come to Memphis to assist Black sanitation workers striking for equity in pay and working conditions. In partnership with academic researchers, these groups demonstrated how negative environmental impacts disproportionately impact low income people and communities of color.

What does the United Nations Convention on the Rights of the Child include, and which countries have not ratified it?

The rights defined by the Convention establish the essential and holistic conditions required to ensure that children achieve an optimal state of well-being. The United States and Somalia have not ratified it.

What strategies (recommendations) could help eliminate them?

The root causes of health disparities must be addressed.

What is the "Rule of Rescue"?

The rule of rescue describes a powerful impulse to attempt to save those facing death, no matter how expensive or how small the chance of benefit.

What are the root causes?

The sources of these disparities are deeply rooted in inequities in social and environmental determinants of health (poverty, income inequality, maldistribution of educational and other resources, racism, and environmental injustice) and the failure of public policies to address them.

Participation

Those affected by an environmental decision can shape how it is made.

What is utilitarianism?

Utilitarianism seeks to maximize overall benefits at the societal level.

Be prepared to answer questions relating to the case study used for the group exercise in class about rationing flu vaccines (the link is still in the PowerPoint): The article asks, what is a fair method of distributing vaccines?

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Be sure to use specific examples from the readings, presentations, or video from that day's topic and the 6 step ethical decision-making framework we've used throughout the class.

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Considering the main topics that were discussed in class during the second part of the semester (the bolded titles in the list above), which was the most important to you and why? (HIPPA, confidentiality, privacy, infectious disease control, protection & injury prevention, vulnerable or marginalized populations, conflicts of interest research, health care costs, profits, rationing, infants & children, the elderly, end of life decisions, environmental justice, global health)

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From the videos in class, discuss which groups are most disadvantaged by environmental hazards and how (examples).

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In class, we watched a 60 Minutes program that contained the story of a woman, her father, and her court case. Be prepared to discuss the ethical and legal issue in that video.

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Is the government morally responsible for assuring there is an adequate vaccine supply or appropriate distribution plan, or should it be left up to individual pharmacies and distributors to create the rules that make sense for their supply?

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One of the articles discussed the ethical implications of the growing commercialization of health care, where profits or people were posed as in conflict. Be prepared to discuss the ethical dilemmas relating to this topic, such as the values of freedom, free enterprise, justice, utilitarianism, and beneficence.

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The Elderly Elder abuse is a growing public health concern, as discussed in the Medscape article. Be prepared to discuss autonomy/self-determination, beneficence, nonmaleficence, paternalism, justice, and preventive ethics in the context of elder abuse.

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What did you learn that was new, particularly relevant to your interests or future career, and what do you plan to do to help further positive change in that area in the future?

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What ethical principles are often in conflict in this issue (e.g., autonomy, beneficence, justice, utilitarianism, paternalism, etc.).

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When faced with an ethical dilemma relating to that issue, what information or evaluation skills will you use to help you make a decision about how to act?

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When supplies are scarce, should healthy people with money be able to buy it over those who are at more at risk due to medical conditions or age?

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What are the six domains contained in their blueprint for action that could help prevent those injuries?

1) Data and Surveillance 2) Research 3) Communication 4) Education and Training 5) Health Systems and Healthcare 6) Policy

What are the "Three Es" that can help prevent these injuries?

1) Education 2) Enforcement 3) Engineering

The video in class revealed 10 tips to keep your baby safe. Be able to explain at least 3 of them in detail (what is the advice and why does it keep the baby safe - what could happen if the advice is not heeded?).

1) Get a crib that meets CPSC (Consumer Product Safety Commission) safety-standards. They don't have drop sides, are sturdier, and are required to be tested before being sold. In June of 2011 the new safety standards became mandatory. 2) "Bare is best." When sleeping in a crib, everything besides the sheet should be taken out of the crib. All comforters, quilts, and blankets should be out of the baby's way and space. 3) Always place a baby on their back in their crib or play area. Never place the baby on pillows or additional padding to avoid deadly situations.

What are 3 of the leading causes of unintentional child injuries?

1) Motor Vehicle 2) Suffocation 3) Drowning

The video explained 10 of the worst epidemics in History. Choose 3 and be able to explain them as the video did.

1) The Third Cholera Pandemic: diarrhea, vomiting, and dehydration as the main symptoms. It had the most deaths of any 19th century epidemic. It began in India and spread across Asia, Europe, North America, and Africa. Tainted water was to blame. 1 million people in Russia alone died. 2) Antonine Plague: came to the Roman Empire by way of soldiers returning from fighting in Western Asia. Cough, runny nose, high fever of 104 degrees, and rash were the main symptoms. 5 million in total died from this plague. 3) HIV/AIDS: this virus spread from primates to humans in the 20th century. In the early 1980s the disease was detected and named in the United States. There have been about 36 million deaths. Scientists have come up with treatments and vaccines to treat HIV/AIDS.

Read a case study and answer questions: Be prepared to use the 6 steps of analyzing an ethical dilemma that we have used all semester, and be able to discuss the concepts of autonomy, beneficence, paternalism, and utilitarianism within the context of the case study.

1. Identify the Ethical Problem(s) related to the Decision 2. Assess the Factual Information Available to the Decisionmaker(s) 3. Identify the "Stakeholders" in the Decision 4. Identify the Values at Stake in the Decision 5. Identify the Options Available to the Decisionmaker(s) 6. Consider the Process for Making the Decision and the Values that Pertain to the Process

POLST

A Physician Order for Life-Sustaining Treatment (POLST) is a medical order that states what kind of medical treatment patients want toward the end of their lives. The form is printed on bright pink paper and signed by both a doctor and patient, POLST helps give seriously ill patients more control over their end-of-life care.

Durable Power of Attorney for Health Care

A document in which you designate someone to officially represent your views.

What is environmental justice?

A fair distribution of the benefits and burdens within society, across all groups.

What is the penalty in Nevada for not complying?

A person who violates the provisions after service upon him of a warning from a health authority is guilty of a misdemeanor.

Sufficiency

All forms of life are entitled to enough goods to live on and flourish.

Advance Directives

An advance directive is generally a written statement, which you complete in advance of serious illness, about how you want medical decisions made.

Terminal Condition

An incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician, result in death within a relatively short time.

One of the readings discusses how environmental justice as an anthropocentric ethic or way of looking at the environment - what does this mean?

Anthropocentric ethic means that human beings are the central moral concern.

Explain the United Nations' definition of disability.

Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.

Be able to explain the conflict between autonomy, family interest, societal interest, beneficence, and nonmaleficence in laws relating to euthanasia or physician-aided dying (also know the difference between these).

Autonomy: when a person wants to make independent decisions. Beneficence: Beneficence is action that is done for the benefit of others. Nonmaleficence: avoidance of harm or hurt.

Living Will

Briefly states your wishes regarding treatment that "only prolongs the process of dying." A living will ONLY takes effect when you are declared terminal.

What is the CDC's role in quarantine and isolation?

CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases. CDC routinely monitors persons arriving at U.S. land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of communicable diseases.

Right to Die

Cases and statutes which recognize in some instances the right of a dying person to decline extraordinary treatment and the right of such a person's guardian to ask the court to substitute its judgment for that of the dying person who no longer has the mental capacity to make such judgment.

Compassion

Compassion extends the notion of sufficiency to the Earth.

Explain the problem of disparities in the health and well being of children.

Disparities are often described in relation to socioeconomic position, ethnicity, race, geography, gender, and age, or in the context of a combination of these and other factors.

What do the terms "disparity" and "inequity" mean and how are they different?

Disparity: lack of similarity or equality. Inequity: lack of fairness or justice.

What is egaliterianism?

Egalitarianism emphasizes the equal moral status of individuals by trying to provide equal opportunity to have the basic goods in life.

Justice

Equals should be treated equally unless there is a sufficient reason to treat anyone (or anything) unequally.

Discuss the danger of falls in the elderly.

Falls can cause serious injuries such as broken bones, hip fractures, or head injuries. Falls can also be costly, with medical costs for fall injuries totaling $31 billion annually.

Who is most at risk?

Fatal crash rates increase noticeably starting at ages 70-74 and are highest among drivers 85 and older.

According to the World Health Organization (WHO) article, what are some key ethical issues in public health globally?

Harm prevention, public good and individual liberty, Treatment and prevention, health promotion and equity.

Discuss the difference between impairment and handicap under this definition.

Impairment: any loss or abnormality of psychological, physiological, or anatomical structure or function. Handicap: A disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfillment of a role that is normal, depending on age sex, social and cultural factors, for that individual.

How big is the problem of older adult drivers?

In 2012, more than 5,560 older adults were killed and more than 214,000 were injured in motor vehicle crashes. This amounts to 15 older adults killed, and 586 injured in crashes on an average day.

Solidarity

Invites us to consider how we relate to each other in community.

How is isolation the same/different from quarantine?

Isolation separates sick people with a contagious disease from people who are not sick, and Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

What is isolation?

Isolation separates sick people with a contagious disease from people who are not sick.

DNR Order

It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.

Which children are most at risk?

Living in severe and chronic poverty, From racial and ethnic minority groups, affected by drug and alcohol abuse, in foster care and public institutions, disabled and living with special health care needs that impair functions, living with violence, incarcerated in adult facilities or juvenile detention, from homeless families and/or live as homeless teenagers, from immigrant and refugee families, uninsured and/or without access to health, mental health, and dental care.

What conditions make them more likely to fall?

Lower body weakness, vitamin d deficiency, difficulties with balancing and walking, use of certain medicines, vision problems, foot pain or poor footwear, broken or uneven steps, rugs or clutter that can be tripped over, no handrails along stairs, etc. These are all considered to be risk factors, as they contribute to falling.

Sustainability

Meeting the needs of the present generation without compromising the ability of future generation to meet their own needs.

What are the conflicts between efficiency, equity, and the rule of rescue?

People generally prioritize treatment that can be made available to everyone, but this view is tempered by impulses to maximize usefulness, and to rescue those in need.

In the CDC's National Action Plan for Child Injury Prevention, who are the most vulnerable populations according to gender, race/ethnicity, age, socioeconomic status, and geography?

Poverty, crowding, young maternal age, single parent households, and low maternal educational status all confer risk and make children more vulnerable to injury.

What principles could guide rationing (how could decisions be made fairly)?

Principles of distributive justice: (1) to each person an equal share, (2) to each according to need, (3) to each according to effort, (4) to each according to free market conditions, (5) to each so as to maximize overall usefulness.

What is prioritarianism?

Prioritarianism attempts to help those who are considered the worst off by giving them priority in situations in which all cannot receive a particular resource.

Where/how did it begin, and what was the history of its use in early America and the late 19th Century?

Quarantine began in the 14th century in an effort to protect coastal cities from plague epidemics. Ships arriving in Venice from infected ports were required to sit at anchor for 40 days before landing. This practice, called quarantine, was derived from the Italian words quaranta giorni which mean 40 days.

What is rationing?

Rationing is the distribution of scarce resources, which in health care necessarily entails withholding potentially beneficial treatments from some individuals.

Is it avoidable?

Rationing is unavoidable because need is limitless and resources are not.

How can older driver deaths and injuries be prevented?

Seat belt use, driving when conditions are the safest, and a lower incidence of impaired driving will all prevent deaths and injuries among older drivers.

What is Quarantine?

Separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

What diseases are covered by the current Executive Order of the President?

Severe acute respiratory syndromes, which are diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.

What are the ethical dilemmas involved in the social justice movement?

Social justice refers to the fair distribution of resources.

Who (which level of government) is in charge of making decisions about when to use quarantine?

States have laws to enforce the use of isolation and quarantine.