NU411 Exam #4

Incidence of malaria in the US

-1700 cases approximately each year -many cases are imported -only 57 (6%) of pts infected had followed chemoprophylactic drug regimen recommended by CDC for the regions to which they had traveled -more than 2/3 cases were imported from Africa -many were military personnel from Afghanistan

quinine information

-1930s NY quinine used to cut heroin -addicts in the middle of Malaria epidemic had decreased malaria cases -quinine treats malaria -Tonic is a kind of quinine -it glows in a UV light, blue-ish color

Typhoid epidemiology

-22 million cases of typhoid fever and 200,000 deaths worldwide each year -300 cases in US each year: most recent in travelers -risk highest for Southern Asia -Also in Africa, Caribbean, Central/South American, Southeast Asia

What is the Global Treaty on Tobacco Control?

-endorses a global ban on tobacco ads and promotion to those under 18 years old -places strict restrictions on ads and promotion to adults -prohibits tax-free, duty-free sales -supports adoption of price and tax measures aimed at reducing consumption -ends subsidies for tobacco production -cracks down on cigarette smuggling -limits exposure to secondhand smoke -improves product labeling and warnings -encourages smoking cessation

Zika

-carried by similar mosquito as Dengue and Yellow Fever (aedes aegypti - day time) as well as aedes albopictus -range of these mosquitoes are from Chicago to New York to Florida to Texas -fever, rash, joint pain, red eye -U/S shows microcephaly

What are the risk factor categories that are found to be associated with overall health?

-childhood and maternal undernutrition -other nutrition-related risk factors and inactivity -addictive substances -sexual and reproductive health -environmental health

Zika sx for longterm survivors of Zika infection in utero

-chronic issues -may have normal head size or microcephaly -blindness -deafness at birth -learning and behavior difficulties in childhood -Guillan barre

Dengue prevention

-clothing, mosquito repellent, and netting can help reduce exposure to mosquitoes -get rid of standing water -traveling during periods of minimal mosquito activity can also be helpful (avoid dawn to dusk) -mosquito abatement programs may reduce the risk of infection -genetically modified mosquitoes

What is the United Nations Children's Fund (UNICEF)?

-concentrates its efforts in maternal and child health -agency of the UN focus: -communicable diseases -primary prevention -fresh water -safe food supplies -health education for mothers of children -education for girls -immunization programs

worldwide initiatives at overcoming nutritional deficits

-control of infectious diseases -nutritional education -control of intestinal parasites -micronutrient fortification of food -food supplementation -food price subsidies

What are IGRA's?

-detect an immune response in blood to M. tuberculosis -specifically: interferon gamma (IFN-y) plays a role in regulating cell-mediated immune responses to M. tuberculosis infections. IGRA's measure IFN-y release in response to antigens of M. tuberculosis (if they are in the blood)

What are neglected tropical diseases?

-diverse group of communicable diseases in tropical and subtropical conditions in 149 countries -affect more than one billion people -cost developing economies billions of dollars every year -populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock are the worst affected "super zebras" *considered neglected because there isn't much research, funding or treatment

Advice for travelers

-drink only water that you have boiled or treated with chlorine or iodine -other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice -eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself -avoid undercooked or raw fish or shellfish, including ceviche -make sure all vegetables are cooked... avoid salads -avoid foods and beverages from street vendors -do not bring perishable seafood back to the US -a simple rule of thumb: boil it, cook it, peel it, or forget it.

Molecular detection of drug resistance

-drug resistance is caused by mutation in specific M. TB genes -several molecular assays and tests can detect mutations -molecular detection should be used for pts with high risk for rifampin resistance (MDR TB) -conventional drug susceptibility testing should be done in conjuction with molecular tests

Challenges with TB medications

-drugs are misused -drugs are mismanaged -wrong drugs are rx -right rx, wrong length of tx -wrong doses -supply of drugs unavailable -rx poor quality -rx not taken regularly -rx not completed -pt develops TB after having taken rx in past -pt comes from country endemic for drug resistant TB -pt has spend time with someone who is resistant

How to prevent HIV infection

-emphasize testing to ID infected people -ensure access to appropriate medical care, tx and prevention services -wear gloves -cover cuts, sores or breaks on caregiver's and pts body -disinfect surfaces -dispose of sharps appropriately

Cholera epidemiology

-endemic in much of Africa, south and Southeast Asia -US: 10 years approx 60 cases acquired abroad -type O blood pts are twice as likely to develop cholera compared to other blood types -1 in 7 yemenese has cholera

What is the Bill and Melinda Gates Foundation?

-endowed initially by $220 million donated by Bill and Melinda Gates -in 2006, Warren Buffet donated 34.7 billion worth of shares -annual budget for global health alone is $800 million (same as WHO) -works on diseases that are prevalent -funds research all over the world with the aim of improving vaccines

Role of nursing in international health

-epidemiologic studies -communicable disease control -health planning -education of nurses and other health workers

What is the Carter Center?

-established by President Jimmy Carter -committed to promoting human rights and improving health -improving food production Because of him, now parts of the world are free of filariasis

Major threats in the war... what do health care professionals have to deal with?

-fatal injuries -infectious diseases -disruptions in food supply -lack of sanitation and water supply -rebuilding health care services

Dengue fever complications

-febrile convulsions -can get really sick -severe dehydration -can die with complications

What is dengue fever characterized by?

-fever -rash -muscle and joint pains

Dengue sx

-fever (often 104 to 105*) -rash -fatigue -headache (esp behind the eyes) -joint aches -muscle aches -nausea -swollen lymph nodes -vomiting -1% develop hemorrhagic manifestations (thrombocytopenia, hemorrhagic diarrhea, shock) -muscle spasms! (can lead to breakbone fever)

What is the World Health Organization?

-intergovernmental agency to lead and coordinate worldwide health activities -established just after world war 2 -have made it their mission to help the poorest of the poor -associated with the UN, but has it's own budget

What are the predictions of the leading causes of diseases or injury worldwide?

-ischemic heart disease -major depression -road traffic accidents -cerebrovascular disease (Stroke) -COPD -lower resp infections -TB -war, diarrhea diseases -HIV -perinatal conditions -violence -congenital anomalies -self-inflicted injuries -trachea, bronchus, and lung cancer

Current Anti-TB drugs

-isoniazid (INH) -rifampin (RIF) -pyrazinamide (PZA) -ethambutol (EMB) -rifapentine (RPT) -streptomycin (SM) -cycloserine -capreomycin -p-aminosalicylic acid -ethionamide

Malaria prevention

-long-lasting insecticidal nets -indoor residual spraying -artemisinin-combination therapies -intermittent preventive tx in pregnancy -vaccines currently being tested -consideration of intermittent preventive tx for children under 5 years in high-risk areas

Global environmental change and pollution

-loss of biodiversity -increase in invasive species -impairment of food production -chemical pollution of air, water, soil, and food -increase in waterborne diseases

TB Sites of disease

-lungs: most common site; usually infectious -miliary: occurs when bacilli spread to all parts of the body... rare, but fatal with no tx -CNS: usually occurs as meningitis, but can occur in brain or spine -extrapulmonary: usually not infectious unless person has concomitant pulmonary disease, extrapulmonary disease in oral cavity or laryx, or extrapulmonary disease with open site, esp with aerosolized fluid

health issues in war regions

-mass immunization needs -long-term malnutrition and dehydration -uranium exposure -landmines -child soldiers -displaced persons -mental health issues -rape

Cholera sx

-may be asymptomatic or mild gastroenteritis -severe cholera (approx 1 in 20): acute profuse watery diarrhea... rice-water stools -vomiting, dehydration, tachycardia, loss of skin turgor, dry mucous membranes, hypotension -muscle cramps: electrolyte imbalances -volume depletion can lead rapidly to hypovolemic shock and death

Laboratory diagnosis of malaria

-microscopic examination of a blood smear -antigen detection with "rapid diagnostic test" (detects parasites but can't determine species) -molecular dx using polymerase chain rx PCR test (takes longer so limited for acute dx; most useful for definitive ID of species of parasite -travel with CDC malaria hotline number

What are some world population challenges?

-migration from rural areas to urban cities -stress of the global environment (warming, population growth, resource consumption, deforestation, decreases in water and cropland) -increased demand for family planning -pregnancy and childbirth complications -lack of prenatal care -skilled birth attendants -HIV/AIDS

Chikungunya virus

-mortality 1 in 1000 -sx begin within 3 to 7 days -no vaccine or preventative medication -avoid mosquito bites -aedes aegypti and aedes albopictus (same as dengue - can get both at the same time) -do not use NSAIDs -if you do not have muscle aches and spasms, you probably have chikungunya (rather than dengue)

child mortality incidence

-mortality is greatest in the first 24 hours -up to 70% of deaths could be prevented with good neonatal care

Yellow fever sx

-most are asymptomatic -influenza-like syndrome: fever, chills, headache, backache, myalgias, nausea and vomiting improvement then 15% progress to a more serious form of the disease with jaundice, hemorrhagic sx, shock and multisystem organ failure (20 to 50% mortality rate for severe cases) 3 to 6 day incubation period -hepatitis-type sx.... attacks the liver. Be aware of liver issues.

Plasmodium vivax

-most geographically widespread of the species -produces less severe sx -relapses can occur for up to 3 years -chronic disease is debilitating -now mostly found in tropics, esp throughout Asia -can wall up in liver and then reoccur -the person may feel find between attacks, even w/o tx -paroxysms subside in a few weeks

yellow fever period of intoxication

-multi-organ dysfunction occurs -may include... heart, liver, and kidney failure -bleeding disorders, hemorrhage, and brain dysfx -delirium, seizures, coma, shock and death

What is Hanson's disease?

-mycobacterium leprae -droplet spread -Asia & Africa have most cases -runny nose is common (not during flu season) -looks kind of like ring worm, but no feeling in the middle of the ring (affects nerves) -5 kinds, depending on how the immune system reacts to it -can cause disfigurement r/t feeling in feet, gait changes, massive sores (smelly)

What do a majority of complications of pregnancy occur from?

-no prenatal care -early marriage -poor nutrition 68,000 women die from unsafe abortions

Dengue tx

-no specific tx --prevent dehydration --acetaminophen for fever --avoid ASA and NSAIDS

Latent TB infection characteristics

-no sx, not infectious -immune system stops multiplication of bacilli -10% of latent cases will develop active TB within their lifetimes -most likely to progress: recent converters, HIV infected, young kids, hx of previous TB, IV drug users

TB medication adherence

-nonadherence results in inadequate tx -can lead to tx failure, relapse, ongoing transmission, and drug resistance -clinician responsible for completion of therapy -to ensure adherence, provide education, case management, DOT, incentives and enablers, and combo pills -if these fail, take more restrictive actions **Adherence is important

Plasmodium malariae

-not only produce typical malaria sx but can also persist in the blood for very long periods (possibly decades) w/o producing sx -an asymptomatic person can infect others - either through blood donation or mosquito bites -has been wiped out from temperate climate, but persists in Africa

yellow fever epidemiology

-occurs in sub-Saharan Africa and tropical South America -in Africa, natural immunity accumulates with age; infants and children are at highest risk -in South America, occurs mostly in unimmunized young men working in forested areas -the elderly have a higher risk of severe infection. If a person is bitten by an infected mosquito, sx usually develop 3 to 6 days later *if you don't get the vaccine, and visit somewhere with endemic yellow fever, you won't be able to come back into the US

Typhoid rose spots characteristics

-often on the abdomen -accompanied by high fever, crankiness, and tummy aches -the rash blanches

Dengue outbreak in the United States

-outbreak in Hawaii (over 50 cases last November, 2015) -dengue now exists endemically in Key West, Texas, Florida, and Hawaii -global warming: moving further from equator! -bite faster/mature faster in the heat

Typhoid fever sx

-sustained high fever -weak, stomach pains, headache, loss of appetite -rash of flat, rose-colored spots -untreated lasts up to a month, serious complications can include intestinal hemorrhage or perforation (not common) *commonly seems to just run its course. There are abx available.

what are malaria prevention measures?

-take a prescription anitmalarial drug -use insect repellent and wearing long pants and sleeves to prevent mosquito bites -DEET and 0.5% permethrin -sleep in air-conditioned or well-screened rooms or using bednets

What are sustainable development goals?

-through the WHO - goals set for the world -promote prosperity while protecting the planet -recognize that ending poverty must go hand-in-hand with strategies that build economic growth and addresses a range of social needs -all "absolute" goals *not legally binding, governments are expected to take ownership and establish national frameworks for the achievement of the 17 goals

Reading the TST

-trained health care worker assesses rxn 48 to 72 hours after injection -palpate injection site to detect raised area -measure diameter of induration across forearm (transverse); only measure induration, not redness -record size of induration in mm; record 0 if none found

Treatment for Latent TB Infection (LTBI)

-tx is essential to controlling and eliminating TB disease -reduces risk of LTBI to TB progression -use targeted testing to find persons at high risk for TB who would benefit from LTBI tx -several tx regimens available

Typhoid fever prevention

-typhoid vaccine if traveling to at risk areas -protect 50 to 80% of recipients, not 100% effective -oral live vaccine and IM attenuated vaccine available -not for children under 6

Malaria sx

-usually appear 10 to 16 days after the infectious mosquito bite, can develop several months or more after exposure -sx coincide with RBC cell rupture at known time pattern -typically produces a string of recurrent attacks or paroxysms, each of which has three stages severe cases: seizures, confusion, kidney failure, ARDS, coma, death

Dengue tests and vaccines

-vaccine in progress, but issues with it -tests can include: --CBC --antibody titer for dengue virus types --serology studies to look for antibodies to dengue viruses

BCG vaccination

-vaccine made from live, attenuated (weakened) strain of M. bovis -early version first given to humans in 1921 -many TB prevalent countries vaccinate infants to prevent severe TB disease -not used in US -given on upper arm, looks kind of like a small pox vaccine may give to: children exposed to adult with MDR TB or health care workers exposed to a large population of MDR TB *do not give to pregnant women or immunosuppressed pts *for approx 5 years post vaccine, be aware that you may get a false positive TST rxn (some people have lingering positives for years)

yellow fever transmission

bite of infected mosquito (aedes or haemagogus spp) nonhuman and human primates are reservoirs -virus between primates and mosquitoes in forest canopy, then via mosquitoes from monkeys to humans when they enter the jungle -also urban transmission between humans and urban mosquitoes -bloodborne transmission is theoretically possible through transfusion or needle sticks **very effective vaccine available

What is the leading cause of death in the world?

cardiovascular diseases

Who is often called the father of public health?

Winslow

What is the demographic and health survey program?

conducted at the household level to evaluate the health of a nation -helps track global health indicators -conducted every 3 to 4 years conducted to describe the health of a country and define specific demographics that then can be compared to each other to determine specific transitions.

What is Hanson's disease treatment?

dapsone (DDS) antibiotic applied on the skin

as the need for formal education increases, fertility rates tend to...

decrease

What is breakbone fever related to?

dengue you bones can actually break from the muscle spasms

Free-market Healthcare Systems

depend more on individual or employer and employee contributions than on taxes ex: US

Grade 2 emergency

single or multiple country event with moderate public health consequences that requires a moderate WCO response and/or moderate international WHO response *Hurricane in Puerto Rico

yellow fever agent

single-stranded RNA virus

Typhoid fever dx

stool samples or blood test for presence of S. Typhi

HIV sx

sx may be absent in the early stages as the infection progresses, the immune system becomes more compromised and the person becomes more susceptible to opportunistic infections

What are Care Delivery Value Chains (CDVCs)?

targeted at a specific problem, can create a system that engages all aspects of care toward one outcome. elements: -monitoring and prevention -diagnosing -preparing -intervening -recovering and rehabilitation -monitoring and managing overall outcomes

education relationship to health

the better education the population is, the better the health of the popualation

What does the probability of a person who is exposed to M. tuberculosis will become infected depend on?

the concentration of infectious droplet nuclei in the air and the duration of exposure to a person with infectious TB

What government spends more money on health per person than any other country in the world?

the government of Luxembourg

Demographic and epidemiologic transitions

the improvement in global health indicators

extreme poverty definition

the inability to meet the basic needs of adequate nutrition, safe drinking water, basic education, and primary health services, and livelihood that can generate the means to secure the basic needs

What body systems is malaria really hard on?

the lysised RBCs clog up the spleen and a placenta if the pt is pregnant it is also hard on the liver because that is where it initially travels

What is black water fever?

the pt infected by malaria pees out black-colored urine. It is d/t all the lysised RBCs that the body is trying to get rid of

Global burden of disease

the risks to health and health outcomes in different demographic populations and social settings r/t a set of diseases and injrueis *there are 18 components to GBD

How is Guinea being wiped out?

through filtering water and changing people's behavior Carter Center is playing a big role

What is the Revised Recommendations for HIV Testing?

through the CDC advocates routine voluntary HIV screening as a normal part of clinical practice and are targeted to subpopulations of persons at higher risk for HIV

four common behavioral risk factors r/t noncommunicable diseases

tobacco use, excessive alcohol consumption, poor diet, lack of physical activity

What causes the "rice stools" of cholera

total GI collapse... it is actual pieces of intestine coming out... the body is no longer able to absorb nutrients because it is just decaying

What is the World Bank?

major resource for developing countries to provide safe environment for people -safe water, adequate housing, proper agricultural techniques, improved sanitation, infrastruction -loans with 35 to 40 year repayment period and 10 year grace period -offers loans to governments/agencies began in 1946

Who is killed most often in very poor nations in road injuries?

men and boys

How many people cross national boundaries daily?

more than 2 million people

chikungunya tx

no treatment no vaccine no locally acquired cases in US

HIV transmission

unprotected sexual contact with an infected person, sharing needles and/or syringes with an infected person, or, very rarely, in countries where blood is not screened for HIV antibodies, through transfusions *NOT transmitted through insects or insect bites

How can you differentiate the infectious malaria agent?

use a blood smear to look for different bugs in the blood (sometimes you can find them, sometimes not... depends on the stage the cells are in)

What contributes to more than a third of all child deaths?

vitamin A and zinc deficiencies...r/t inadequate breast-feeding

How does global warming impact illnesses?

water gets warmer... therefore more water-borne and food-borne illnesses

Who are the majority of clients of microfinance?

women

Who does HIV primarily target?

young and middle-aged adults MSM continue to bear the greatest burden of HIV infection African Americans continue to be disproportionately affected Males account for 79% of all diagnosed HIV infection

Malaria stages

chills, followed by fever, and then sweating. Along with chills person is likely to have a headache, malaise, fatigue, muscular pains, occasional nausea, vomiting, and diarrhea . Within an hour or two, the body temperature rises and then skin feels hot and dry. then, as the body temp falls, a drenching sweat begins. The person, feeling tired and weak, is likely to fall asleep . Develops anemia & jaundice

What is the burden of disease largely affected by?

climate, public policy, aging of the population, socioeconomic conditions, and risk factors

How soon can a physician have HIV test results?

clinicians can make an accurate presumptive dx of HIV infection within half an hour... d/t the advent of HIV rapid serologic tsting

How much of the developing world population uses the internet?

31%

TB global prevalence

1/3 of the world's population is infected -leading killer of people who have an HIV infection -most cases in US occur in foreign-born persons

How many men are born for every 100 women?

105

Categories of health indicators

1. morbidity and mortality 2. risk factors 3. health service coverage 4. health system resources

What domains encompass the key determinants of health as told by Skolnik?

1. physical environment 2. social environment 3. health behaviors 4. individual health

How much more likely are children in low-income countries to die before reaching the age of 5 than children in high-income countries?

16 times

How many of the Healthy People 2020 objectives are focused on HIV?

18 out of 600

Malaria incidence

-10% of world infected this year -most people dying under 5's children and pregnant women

Maternal health prevalence

-31 million women experience acute complications of pregnancy with over a half a million women die in child birth -UNICEF estimates that about 1 in 10 school-age African girls do not attend school during menstruation or drop out at puberty because of the lack of clean and private sanitation facilities in school -poor sanitary facilities in schools also affect women teachers' experiences. Given the unavailability of substitute teachers d/t teacher shortages all over the developing world, this lead to reduced teacher's instruction time by 10 to 20%

Malaria epidemiology

-350 to 500 million infections per year -1 million annual deaths -weather, mosquito vector density, prevalence of infections markedly changes, consult CDC before traveling -Africa, Central/South America, parts of Carribean, Asia

Positive IGRA result or a TST reaction of 5 or more mm of induration is considered positive in...

-HIV infected persons -recent contacts of TB case -persons with fibrotic changes on chest radiograph consisted wtih old TB -organ transplant recipients -persons who are immunosuppressed for other reasons (long-term prednisone)

What is multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB?

-MDR TB caused by bacteria resistant to best TB drugs, isoniazid and rifampin -XDR RB caused by organisms resistant to isoniazid and rifampin, plus fluoroquinolones and one or more of the 2 injectable second line drugs

Tobacco use prevalence and facts

-Tobacco related illnesses are the leading cause of death in industrialized nations -deaths predicted to reach 10 million worldwide annually by 2020 -preventable deaths -recognized by WHO as one of its primary health objectives -the Global Treaty on Tobacco Control is a first step

What are vaccination program examples?

-WHO -CDC -Rockefeller Foundation -Gates Foundation -Rotary International -American Red Cross/Red Crescent -World Bank

Dengue epidemiology

-WHO estimates 50 million cases/year, 500,000 serious -occurs in over 100 countries -spread is similar to malaria, but unlike malaria, often found in urban and residential areas of tropical nations -dengue fever is being seen more in world travelers -aedes aegypti and aedes albopictus -very debilitating disease

Is a vaccine available to prevent cholera?

-a recently developed oral vaccine for cholera is license and available in other countries -the vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine -CDC does not recommend vaccine for most travelers

Typhoid fever tx

-abx: ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin treatment course: -person given abx usually begin to feel better within 2 to 3 days -death rarely occurs -persons who do not get tx may continue to have fever for weeks or months, and as many as 20% may die from complications stool cultures should be tested when course of tx has been completed

Malaria tx

-algorithm from CDC (super complicated) -drug therapy depends upon species and drug resistance patterns -hx of quinine (tx) -supportive care -give off distinctive "breath print"... could be used as a test for the disease -falciparum may be life-threatening and require ICU care -tx depends on country

What is the Agency for International Development (USAID)?

-arm of the US State Department -advances US national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience -provides expertise and funding to countries needing economic development -most activity r/t agriculture and infrastructure development (Safe water, sanitation) very politically oriented

How to avoid typhoid fever

-avoid risk food and drinks -get vaccine *boil it, cook it, peel it, or forget it

Dengue transmission

-bite of female mosquitoes (aedes aegypti) -exposure to infected blood (transfusions, transplants, vertical from mom to fetus, needle sticks) on the rise all over the world *furthest north this mosquito has been found is Chicago

Malaria modes of transmission

-bite of pregnant female anopheles mosquito -can occur through blood transfusion, organ transplantation, needle sharing, or congenitally from mother to fetus *one mosquito can have multiple types of malaria

What is Doctors Without Borders?

-founded in France in 1971 -provides medical care to people in more than 80 countries -provides both health personnel and supplies to people in wars, refugees, displaces persons, and victims of natural disasters -provides long-term assistance in countries with little or no health care delivery systems such as Sudan and Ethiopia -Staff is composed primarily of volunteers: doctors, nurses, and other medical professionals

What are negative aspects of globalization?

-global warming -cross border pollution -financial crises -spread of HIV/AIDS -international crime -rapid movement of people and food products results in new emerging diseases -sexual slavery

Active TB characteristics

-granulomas break down to produce TB disease -TB bacteria are active and multiplying... contagious! sx: -3 or more weeks of a bad cough -night sweats -periods of chill and fever -chest pain -blood in sputum (late sign) -fatigue -weight loss -loss of appetite

Yellow fever early stage

-headache -muscle and joint aches -fever -flushing -loss of appetite -vomiting -jaundice after approximately 3 to 4 days, often sx go away briefly (remission)

What are the main causes of maternal mortality?

-hemorrhage -sepsis -hypertensive disorders -abortion complications -obstructive labor

Mental illness incidence

-important to personal, economic and political stability -accounts for 30% of disability worldwide -some 450 million suffer from 7 common mental illnesses -one million people commit suicide each year -20 million attempt suicide -increasing lifespans leads to increasing Alzheimer's -poor people have higher rates of depression -their children have increased stress from malnutrition, exhaustive work schedules and other abuse -refugees have higher rates of mental illness (PTSD) -more than 40% of countries have no mental health treatment system -can be a stigma

What does the WHO consider to be important requirements for the effective management of heath workforce shortage?

-increased investment in education and training -national health workforce plans -more efficient use of existing human resources -protection and fairer tx of health workers -access to HIV prevention and tx for health workers in affected countries -attracting women to health professions and addressing retirement -comprehensive preparedness for a workforce response to outbreaks and emergencies in every country -career incentives to attract health workers to rural and disadvantaged areas -health promotion and prevention strategies to reduce demand for health services

Administering the TST

-inject 0.1 ml of PPD (5 tuberculin units) into forearm between skin layers -produce wheal (raised area) 6 to 10 mm in diameter -follow universal precautions for infection control -usually given 2 fingers below the elbow *can be given in the back of the arm if the forearm is compromised

Adverse rxns to INH

-peripheral neuropathy: give vitamin B6 if pt has risk factors or if sx develop -fatal hepatitis: pregnant/postpartum women at increased risk; monitor closely -elevated liver enzymes: d/c INH if liver enzyme levels exceed 3x normal with sx, or 5x normal with no sx

Positive IGRA result or a TST reaction of 15 or more mm of induration is considered positive in...

-persons with no known risk factors for TB *although skin testing should only be conducted among high-risk groups, others may be required for employment or school attendance

Most common causes of child mortality

-preterm births -severe infections -asphyxia -congenital abnormalities -infant abandonment -diarrheal disease

What is the Centers for Disease Control and Prevention (CDC)

-provides expertise in controlling and preventing disease -works through the International Health Program Office -available for consultation during emergencies -experts are dispatched to country in need -consult and provide equipment and health resources to develop a comprehensive plan for disease control and/or elimination

What does the WHO do?

-provides technical support and health services to member nations with emphasis on poorer countries -directs and coordinates international health projects -collaborates about health care programs -monitors and reports on world-wide disease conditions -leads the effort to establish international standards for vaccines and medications -operates thousands of individual country projects

Mantoux Tuberculin Skin Test (TST)

-purified protein derivative (PPD), derived from tuberculin, is injected between skin layers using the mantoux technique -infected person's immune cells recognize TB proteins in PPD, respond to site, causing wheal to rise -takes 2 to 8 weeks after exposure and infection for the immune system to react to PPD -reading and interpretation of TST must be done within 48 to 72 hours.

What is the Pan American Health Organization?

-quasi-independent branch of WHO -25 member countries in Western Hemisphere mission: strengthen international and local health systems to improve health -disease and environmental management -research and scholarship -monitors disease focus is really on the America's

Neglected tropical diseases examples

-rabies -chaga's disease -dengue -Hanson's -Guinea

Plasmodium ovale

-rare -can cause relapses -generally occurs in West Africa

Positive IGRA result or a TST reaction of 10 or more mm of induration is considered positive in...

-recent immigrants (<5 years) from high-prevalence countries -injection drug users -residents and employees of high-risk congregate settings (jails, nursing homes, shelters, hospitals,etc). -mycobacteriology lab personnel -children under 4 years or children and adolescents exposed to adults in high-risk categories

Plasmodium falciparum

-responsible for most malaria deaths, esp in Africa -can develop suddenly and produce several life-threatening complications -with prompt, effective treatment, it is almost always curable -likely to feel miserable between attacks, and die w/o treatment

Yellow fever tx

-rest, fluids, analgesics, antipyretics (No ASA or NSAIDs) -if you will be traveling where yellow fever is common: sleep in screened housing, use mosquito repellents, wear clothing that fully covers your body -there is an effective vaccine (YF-Vax) ... if received at least one week before exposure -- get another dose every 10 years -ask your doctor at least 10 to 14 days before traveling if you should be vaccinated against yellow fever

Pros and Cons of IGRAs for TB testing

-results can be available within 24 hours without need for second visit -not subject to biases and errors associated with PPD placement and reading -cost is substantially greater than PPD

What can poor nutrition lead to?

-stunting -susceptibility to disease -susceptibility to intestinal parasites -anemia -lethargy and apathy

What is the Expanded Testing Initiative aimed at?

1. significantly increasing the number of persons tested in jurisdictions with a high rate of HIV among disproportionately affected populations 2. support implementation of the revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings

About how many smokers are on the planet?

1.3 billion

How much of the world's land do women own?

1%

What are two international nursing organizations?

1. International Council of Nurses (ICN) 2. Sigma Theta Tau

Four interventions known to affect both diarrhea and pneumonia

1. breast feeding 2. breast feeding education 3. WASH interventions 4. zinc supplementation

What are the four models of health as identified by Smith?

1. clinical model: elimination of disease or sx 2. role-performance model: health that involves a match between people and social roles 3. adaptive model: involves adaptation to the environment 4. eudaimonistic model: actualization or realization of human potential

United Nations Milennium Development Goals and Targets

1. eradicate extreme poverty and hunger 2. achieve universal primary education 3. promote gender equality and empower women 4. reduce child mortality 5. improve maternal health 6. combat HIV/AIDS, malaria, and other diseases 7. ensure environmental sustainability 8. develop a global partnership for development **framework for achieving the right to health for all.

Diagnosing TB

1. medical hx: sx, exposure, past TB tx, demographic risk factors, immunosuppressed 2. physical exam 3. TST/IGRA's 4. CXR: lesions (but these have many different causes, need more evidence) 5. bacteriologic exam: acid fast bacilli in sputum (fast, 24 hour result, but other organisms present). Culture ID, drug susceptibility testing

treatment of uncomplicated active TB

2 month initial phase of INH, rifampin, pyrazinamide, and ethambutol, followed by a choice of several options for the continuation phase of either 4 or 7 months *for children whose visual acuity cannot be monitored, EMB is not recommended

Dengue fever agent

4 dengue viruses -flavovirus (like Yellow fever, west nile & zika)

What is the polio incubation period?

7 to 35 days (average 7 to 14 days)

What country has the highest infant mortality rate?

Afghanistan

What country did we learn is rape incredibly prevalent?

Congo

What are Polio outbreak countries?

Congo, Syria, Kenya, Somalia (vaccine-acquired)

What is DOT?

Directly observed therapy nurse watches the patient take the medication and ensures that they swallow it

What is the leading cause of adult death in Africa?

HIV/AIDs

What other disease could a positive TST indicate?

Hanson's disease (Leprosy) .... any other type of mycobacterium *this is testing for mycobacterium bacteria, not any strain in particular

LTBI tx regimens

ISONIAZID (INH) -9 month daily regimen of INH is preferred: 270 doses within 12 months --effective for HIV infected as well and HIV uninfected --an be given twice weekly via DOT: 76 doses within 12 months --preferred for children 2 to 11 years INH-RIFAPENTINE (RPT) regimen -12 dose regimen... 12 once-weekly doses under DOT -offers equal option to 9 months daily INH, but does not replace other tx options -recommended for treating LTBI in otherwise healthy people >12 years old who had recent contact with infectious TB, or who had TST conversion or positive blood test **Depending on who you are and the type of TB you have, another drug may be added into the regimen

Cholera agent

bacterial infection: vibrio cholera *different strains but serogroups 01 and 0139 associated with epidemics

Where is polio endemic?

Nigeria, Pakistan, and Afghanistan -Pakistan extremists continue to kill Polio workers

Typhoid fever agent

bacterium Salmonella enterica serotype typhi

When is World Toilet Day?

November 19th a United Nations observance ... highlights a serious problem: 2.5 billion people in the world do not have access to proper sanitation

What are reasons for the high numbers of missing women?

Over 100,000,000 missing females in the world -land inheritance (in some countries, women are not able to inherit land) -worship of ancestors (has to be done by the men in the household) -resource allocation (boys will stay in family home, they will try to marry the girls off) *it is highly related to the prioritization of the parents when raising their children - these are very important reasons in some family/cultures to consider genders

Where is chikungunya locally acquired?

Puerto Rico

Where is the burden of TB the highest?

Southeast Asia and Africa

TB Diagnostic tests

TST (TB skin test) AKA PPD TB blood test AKA interferon-gamma release assays (IGRAs) -QuantiFERON-TB Gold -T-sport *good for those who cannot come back for TST *preferred for some who have received BCG

What is artemisinin?

a drug known for its ability to swiftly reduce the number of plasmodium parasites in the blood of pts with malaria

What is the International Council of Nures?

a federation of national nursing organizations -representatives from 120 countries -advancement of nursing as a profession -reduction of health disparities by working for change

What determines how and when a person may seek assistance from the healthcare systems and may ultimately affect the outcome of long term health?

a person's definition of health

Grade 1 emergency

a single or multiple country event with minimal public health consequences that requires a minimal WCO response or minimal international WHO response *Superstorm Sandy

Grade 3 Emergency

a single or multiple country event with substantial public health consequences that requires a substantial WHO response and/or substantial international WHO response *gas attack in Syria, Bangladesh crisis

What does the WHO define as health

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity this definition encompasses the highest level of health, include self-actualization

What are millennum development goals?

a way for the world to join together in promoting health for all human beings 147 nations agreed to an outline of a wide range of commitments in human rights, good governance, and democracy.

Yellow fever period of remission

after 3 to 4 days... -fever and other sx go away -most people will recover at this stage -others may move onto the third, most dangerous stage (intoxication stage) within 24 hours

About how much of the world's adult population has diabetes?

almost 10%

Ungraded emergency

an event that is being assessed, tracked, or monitored by WHO, but that requires no WHO response at the time

About how many countries are involved in the WHO?

approximately 193 countries

When does the male to female ratio normally even out?

around 25 years old

When does the male to female ratio indicate a higher number of females?

around 60's and 70's r/t cardiovascular disease, etc.... men dying

life expectancy at birth

average number of years a newborn is expected to live if the current mortality rates continue to apply

Health-adjusted life expectancy at birth (HALE)

average number of years that a person can expect to live in full health by taking into account years lived in less than full health d/t disease and/or injury

TB pathogenesis

droplet nuclei containing tubercle bacilli are inhaled, enter the lungs, and travel to the alveoli tubercle bacilli multiply in the alveoli (typically you don't know anything is going on at this point) a small number of bacilli enter the bloodstream and spread throughout the body. The tubercle bacilli may reach any part of the body, including areas where TB disease is more likely to develop (brain, larynx, lymph node, lung, spine, bone, kidney) within 2 to 8 weeks, macrophages ingest and surround the tubercle bacilli. The cells form a barrier shell, called a granuloma, that keeps the bacilli contained and under control (LTBI) if the immune system cannot keep the bacilli under control, they begin to multiple rapidly. This can occur in different areas in the body.

How is TB spread?

droplet transmission can stay suspended in the air for several hours, depending on the environment

Primary healthcare definition

essential health care based on practical, scientifically sound and socially acceptable methods and technology, many universally accessible to individuals and families in the community

Typhoid transmission

fecal-oral acquired through consumption of water or food that has been contaminated by feces of an acutely infected or chronic, asymptomatic carrier rare transmission through sexual contact (anal intercourse) have occurred

cholera mode of transmission

fecal-oral found in fresh and brackish water associated with zooplankton, shellfish, aquatic plants transmitted by drinking water where it is found naturally or contaminated from feces of an infected person

What are the goals of the Bill and Melinda Gates Foundation?

focus on global health and global development -reduce the disease burden in developing countries -prevention and treatment of HIV -vaccine improvement -research on new vaccines -improvement of prenatal and infant care -financial services for the poor -agricultural development

What is global goal #5?

gender equality

Why invest in women and girls?

girl's education leads to.... -increased income (10 to 20% per yr primary ed) -increased farming productivity -smaller, healthier, and better-educated families -girls and women standing up for themselves and resisting violence -greater political stability of the country as a whole -empowerment of women when you are teaching girls, you are also teaching boys

What is global goal #3?

good health and well-being

What are the most common causes of disability?

hearing loss, vision problems, and mental disorders

National Healthcare Systems

highly regulated, tend to have salaried physicians, involve relatively high taxes ex: UK, Spain

What is Sigma Theta Tau International

international honor society of nursing -supports nursing leadership, research and clinical excellence -reduction of health disparities -improvement of health throughout the world

How long can it take for an HIV-infected person to develop AIDS?

it can take 10 to 15 years *antiretroviral therapy (ART) can slow down the process even further *AIDS is now considered a chronic and controlled disease

What is the most common cause of death from cancer?

lung cancer

What is the WHO Born Too Soon?

outlines steps that can improve preterm birth and prevent causes of stillbirth, such as maternal malnutrition

What is the agent for malaria?

parasitic protozoan species: plasmodium -p. falciparum -p. vivix -p. ovale -p. malariae

What population can a 2-step TST be especially helpful for?

people with a "sluggish" immune system ex: elderly *the first dose can "rev up" the immune system to ensure it responds appropriately the second time

Risk factors definition

personal habits and behaviors, environmental conditions, or inborn or inherited characteristics that are known to affect a health-related condition

What is Halbert Dunn's role in public health?

placed health on a continuum, ranging from premature death to wellness to high-level wellness (which can be equated to self-actualization)

What is the global code of practice of the recruitment of health personnel?

promotes ethical recruitment of personnel and provides a focus on health work force development and health systems sustainability and strengthening local health systems

disability-adjusted life years (DALYs)

quantifying the burden of disease to a healthy life. The loss of years r/t burden of disease. The gap in years reflects the current state of health versus and optimum state of health of a nation.

What is the purpose of the disease control priorities project?

review, generate, and disseminate info that contributes to the scientific evidence base for improving population health in developing countries.

HIV dx

serologic tests that detect antibodies against HIV-1 and HIV-2 virologic tests that can detect HIV antigens antibody testing begins with sensitive screening test

Sickle Cell Trait r/t malaria

sickle cell anemia is protective against malaria because the abnormally formed blood cell does not allow malaria parasite to enter

How long has the US been free of indigenous polio?

since 1979