LECOM public health 2019

What are patient oriented outcomes of studies

are those that would typically matter most to the patient because they reflect improved symptoms (versus, for example, improved lab results), quality of life, survival with minimal or no disability, best outcome for the cost, etc. Patient-Oriented Outcomes • morbidity • mortality • symptoms • quality of life • cost

What antimicrobial prevents malaria?

atovaquone/proguanil

Describe data displayed as an epidemic curve for a point source outbreak, including the average incubation period

chart

Descriptive Epidemiology

concerned with organizing and summarizing data regarding the persons affected (e.g., the characteristics of those who became ill), time (e.g., when they become ill), and place (e.g., where they might have been exposed to the cause of illness)

Analytic Epidemiology

concerned with why and how a health problem occurs. Uses comparison groups to provide baseline or expected values so that associations between exposures and outcomes can be quantified and hypotheses about the cause of the problem can be tested

What antimicrobial prevents gonoccocal ophthalmia neonatorum

erythromycin ophthalmic

Primary Prevention

intervening before health effects occur, through measures such as vaccinations, altering risky behaviors (poor eating habits, tobacco use), and banning substances known to be associated with a disease or health condition

What antimicrobial prevents TB?

isoniazid

Tertiary Prevention

managing disease post diagnosis to slow or stop disease progression through measures such as chemotherapy, rehabilitation, and screening for complications

Identify a chemical agent [or substance] associated with each of the following malignancies: mesothelioma, leukemia, liver angiosarcoma, nasal cavity cancer

mesothelioma: asbestos leukemia: benzene liver angiosarcoma: vinyl chloride nasal cavity cancer: chromium

What antimicrobial prevents tuberculosis and meningiococcal disease?

rifampin

Secondary Prevention

screening to identify diseases in the earliest stages, before the onset of signs and symptoms, through measures such as mammography and regular blood pressure testing. Also includes early preventive treatment of conditions identified by screening, before they develop into frank disease

Public health functions of Local health departments

the "front line" of public health agencies, executing missions directed by the state. Typical services include: - Communicable disease control - Screening and immunizations - Primary collection of vital statistics, health statistics and surveillance data - Health education services - Sanitary inspections - School health programs - Maternal and child health, public health nursing, and mental health services

Pathogenicity

the ability of an agent to cause disease after infection, measured as the proportion of persons infected by an agent who then experience clinical disease.

Infectivity

the ability of an infectious agent to cause infection, measured as the proportion of persons exposed to an infectious agent who become infected.

Virulence

the ability of an infectious agent to cause severe disease, measured as the proportion of persons with the disease who become severely ill or die.

Reservoir

the habitat in which an infectious agent normally lives, grows, and multiplies, which can include humans, animals, or the environment. (In some cases [e.g., rabies] a reservoir can also serve as a vector of the agent.)

Epidemic

the occurrence of more cases of disease, injury, or other health condition than expected in a given area or among a specific group of persons during a particular period. Usually, the cases are presumed to have a common cause or to be related to one another in some way. (Term used interchangeably with 'outbreak'—latter implying a more localized phenomenon in contrast to a more widespread 'epidemic'.)

Public health functions of State Government

through its police power (under Tenth Amendment to the Constitution: "to enact and enforce laws to protect and promote the health, safety, morals, order, peace, comfort, and general welfare of the people") Oversees environmental and educational services - Maintains public health surveillance system and provides epidemiological consultation - Responds to public health emergencies - Provides reference laboratory services for diagnostic support - Licenses the healthcare workforce

Identify diseases or infections for which the following drugs are used as preventive treatment: acetazolamide, low dose aspirin, statins, folic acid, and tamoxifen

acetazolamide: altitude illness (acute mountain sickness) low dose aspirin: cardiovascular disease & colorectal cancer (ages 50-59 yrs, at increased risk) and pre-eclampsia (pregnant women, at increased risk, after 12 wks gestation) statins: cardiovascular disease (ages 40-75 yrs, at increased risk) folic acid: neural tube defects (women capable of pregnancy) tamoxifen: breast cancer (women at increased risk)

Intermediate host

an organism that supports the immature (e.g., larval) or non-reproductive (asexual) forms of a parasite

Pandemic

-an epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population.

Enzootic

-of, relating to, or denoting a disease that regularly affects animals in a particular geographic area or at a particular season.

Endemic

-the constant presence of an agent or health condition within a given geographic area or population. Can also refer to the usual prevalence of an agent or condition.

Differentiate passive and active immunization

"Passive immunity is protection by products produced by an animal or human and transferred to another human, usually by injection." [i.e., injection of antibodies, that is, immune globulins] "Active immunity is protection that is produced by the person's own immune system." [including in response to administered vaccines]

Recognize criteria that would typically support a high strength of recommendation grade for a particular practice or intervention

- High quality studies (esp. randomized clinical trial, diagnostic cohort study or meta-analysis) with adequate: o size (statistical power) o spectrum of patients o blinding / concealed allocation o follow-up (e.g., <20% loss) - Consistency across studies - Patient-oriented evidence

List at least 3 significant, healthcare associated infection risk factors related to individual patient care

- Mechanical ventilator support - Central catheter in place - Urinary catheter in place - Dialysis - Larger hospitals - Critical care units - Greater length of stay

List at least 4 steps of an outbreak investigation

- Prepare for field work - Establish existence of an outbreak - Verify the diagnosis - Construct working case definition - Find cases & record information - Perform descriptive epidemiology - Develop hypothesis - Evaluate hypotheses epidemiologically - Re-evaluate or reconsider hypotheses - Reconcile with lab & environmental studies - Implement control & prevention measures - Initiate or maintain surveillance - Communicate findings

Identify the 4 most common reservoirs of rabies in the United States

- Raccoons - Skunks - Foxes - Bats

Describe how a percent agreement between two observers or tests is calculated

2 by 2 chart

Describe Antigenic DRIFT in relation to influenza viruses

A mechanism for variation by viruses that involves the accumulation of mutations within the antibody-binding sites so that the resulting viruses cannot be inhibited well by antibodies against previous strains making it easier for them to spread throughout a partially immune population. Antigenic drift occurs in both influenza A and influenza B viruses.

Describe Antigenic SHIFT in relation to influenza viruses

A sudden shift in the antigenicity of a virus resulting from the recombination of the genomes of two viral strains. Antigenic shift is seen only with influenza A viruses. It results usually from the replacement of the hemagglutinin (the viral attachment protein that also mediates the entry of the virus into the cell) with a novel subtype that has not been present in human influenza viruses for a long time. The source of these new genes is the large reservoir of influenza viruses in waterfowl. The consequences of the introduction of a new hemagglutinin into human viruses is usually a pandemic, or a worldwide epidemic.

Identify the diseases or conditions for which the U.S. Preventive Services Task Force recommends a particular screening test for men or women, or both, when they reach age 50 and when they reach age 65

Abdominal Aortic Aneurysm: Men aged 65 to 75 who have ever smoked (one-time ultrasonography ) Osteoporosis: Women > 65 years old or < 65 with 10 year fx risk > 65 y.o. white woman (no additional risk factors) Colorectal Cancer: Adults aged 50 to 75

Describe an ACTIVE surveillance systems

Active - The health agency solicits reports (e.g., by directly contacting providers or laboratories).

What are communicable diseases through Droplets

Via coughing or sneezing, or (in health care) during suctioning. Droplets are relatively large (>5 µm) and can be projected 3-5 feet. Examples: meningococcus, influenza, respiratory viruses. Precautions: masks, cover mouth, stand clear.

Identify appropriate immunizations for persons with anatomic or functional asplenia

Apart from ensuring routine immunizations are up to date, the following are given: Pneumococcal (PCV13, then PPSV23 after at least 2 months, then 2nd PPSV23 after 5 years) Meningococcal (2 doses MenACWY > 8 wks apart then 1 q 5 years, plus MenB series) Haemophilus influenza type b (1 dose if not previously vaccinated)

Describe how a standard population is used for direct age adjustment

Apply the age distribution of a standard population to the age specific rates of each of the populations of interest (and add up the resulting, weighted rates to obtain an adjusted, overall rate for each population). When comparing 2 or more populations' overall rates (of disease, injury, or death), differences in the age distribution (or other characteristics) among them may render the comparison invalid, due to confounding (by age, etc.). Direct age adjustment is commonly used to facilitate population comparisons. The age distribution of a standard population is used to weight the age-specific rates of each of the populations being compared. The standard population can be any one of the populations being compared, or the total of all populations being compared, or (as is often done) a separate, national population based on census data. Fictitious data below: Injuries among school-age children. Some townships have a significantly higher proportion of high school students compared to elementary and middle school students. Here is the direct adjustment of the overall injury rate for one township: Standard Population (e.g., entire state) Population of interest Age Group No. of students Proportion (A) Age-Specific Injury Rate per 100,000 (B) Weighted (A x B) 5-10 489,133 0.37 5,991 2,217 11-14 364,442 0.28 7,746 2,169 15-18 471,385 0.36 8,129 2,926 TOTAL 1,324,960 SUM (Age-Adjusted Rate) 7,312

Differentiate among CT scans, mammography, chest films, and bone scans (DXA) with respect to relative radiation doses

Approx. Eff. Dose (mSv ) Equiv. natural background for... DEXA bone 0.001 3 hrs. X-ray chest 0.1 10 days Mammogram 0.4 7 wks. CT head 2 8 mos. CT spine 6 2 yrs. CT chest 7 2 yrs. CT abdomen 10 3 yrs. CTA heart 12 4 yrs. PET/CT 25 8 yrs.

List the 3 core functions of public health

Assessment, Policy Development, Assurance

Attack Rate

Attack Rate = (new cases during specified time interval) / (population at risk or exposed at start of time interval)

Differentiate selected groups of communicable diseases on the basis of typical incubation periods, relative to each other

Bacterial Diseases: Viral Diseases:

Case fatality rate

Case fatality rate = (persons with a particular condition who die from that condition) / (persons with the condition)

Cause specific death rate

Cause specific death rate = (deaths assigned to a specific cause during a given time interval) / (mid-interval population)

Identify one or more deliberately released chemical or biological agents associated with Pulmonary edema within hours

Chemical: Chlorine (Cl) Phosgene (CG)

Identify one or more deliberately released chemical or biological agents associated with Flaccid paralysis

Chemical: Cyanide

Identify one or more deliberately released chemical or biological agents associated with Blisters & eye irritation

Chemical: Mustard (H) Lewisite (L) Biological: smallpox- pustular vesicles

Identify one or more deliberately released chemical or biological agents associated with Convulsions

Chemical: Tabun Sarin Soman (G) VX

What are communicable diseases through Physical Contact

Direct physical contact (body surface to body surface) between infected individual and susceptible host. Examples: infectious mononucleosis, chlamydia, also includes agents like influenza virus Precautions: hand hygiene. condoms.

Identify diseases or conditions for which the U.S. Prev. Svcs Task Force recommends all adults be screened

HIV Infection: Adolescents & adults aged 15 to 65, younger & older at increased risk, all pregnant women. Alcohol Misuse: Screen all adults. Brief behavioral counseling for those with risky or hazardous drinking. Tobacco Use: Ask all adults—including all pregnant women—about tobacco use, advise them to stop using tobacco, and provide behavioral intervention for cessation (and pharmacotherapy in non-pregnant patients) to those who use tobacco. Depression in Adults: Adults including pregnant & post-partum (with system in place for accurate diagnosis, treatment, follow-up). High Blood Pressure: All adults (and measurements outside clinic setting prior to starting treatment). Obesity: Adults (as well as children > 6 years old & adolescents). Refer for multicomponent behavioral intervention for adult BMI > 30 kg/m2

What contact precautions are applicable to all transmission based precautions?

Hand hygiene before & after touching patient, after contact with secretions, body fluids, contam. materials, and (for contact precautions) prior to wearing gloves & after removal of personal protective equipment (PPE). Notes: - Precautions applied to patients even if infection that prompts precautions is suspected (do not delay until definitive diagnosis). - For all precaution categories, use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus)

Recognize pulmonary pathogens as primarily healthcare associated or community acquired.

Healthcare-Associated: Pseudomonas aeruginosa Klebsiella pneumoniae Staphylococcus aureus (incl. MRSA) Community-Acquired: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis NOTE: The distinction among these etiologies with respect to the healthcare setting versus the community is not intended to suggest exclusivity in either category. In reality, there is some overlap. The distinction is only meant to familiarize students with examples of dominant species. A factor affecting susceptibility to gram-negative bacteria in both settings, but especially hospitals, is immunocompromise.

Identify appropriate immunizations for long term travelers to rural areas of developing countries

In addition to ensuring all routine immunizations (including influenza and Td booster) are up to date, consider the following in accordance with specific itineraries and risk factors: Vaccinations: hepatitis A & typhoid and (if tropical S. America or Sub Saharan Africa) yellow fever Other immunizations and medications depend on risk level, determined by specific areas to be visited, duration of stay, and types of activities or occupation. Long stays warrant consideration of other vaccinations: hepatitis B, pre-exposure rabies, meningococcal (for sub-Saharan Africa), and Japanese encephalitis (for East Asia). (Apart from immunizations, also consider Malaria chemoprophylaxis for risk areas, e.g., daily atovaquone-proguanil [Malarone], or daily doxycycline.)

Incidence Rate

Incidence Rate= (new cases during specified time interval) / (summed person-years of observation or average population during time interval)

Recognize regions of the world where yellow fever and malaria are endemic

YELLOW FEVER REGIONS MALARIA REGIONS

What are communicable diseases through Fomites

Infectious agent deposited onto an object or surface and survives long enough to transfer to another person who subsequently touches the object. Examples: RSV, noroviruses, rhinovirus, perhaps influenza. Precautions: sterilizing instruments, disinfecting surfaces and toys in school. What are communicable diseases through Vehicle- A single contaminated source spreads the infection (or toxin). This can be a common source or a point source. Examples: a) Point source: Food borne outbreak from infected batch of food, cases typically cluster around the site (such as a restaurant) b) Common source: The listeriosis outbreak in Canada in 2008 was linked to a meat production facility in Ontario. It caused 20 cases across five provinces. Cases may be widely dispersed due to transport and distribution of the vehicle. Precautions: food and water sanitation, normal safety and disinfection standards. (Deliberate contamination of Tylenol in 1982 led to the use of tamper-proof containers for medicines.)

List the appropriate number of doses of the following vaccines that should have been administered by age 6 for DTaP, MMR, varicella, IPV, hepatitis A & hepatitis B

MMR & Varicella: 2 doses each (These are the live virus vaccines for children.) ..PLUS the following: DOSES VACCINE 2 Hep A 3 Hep B 4 IPV 5 DTaP (Above list as a mnemonic: Almost spells out "A, B, C, D", except the "C" is for inactivated polio vacc.)

Recognize the types of lung disease associated with exposure to: organic dusts, inorganic dusts, and irritant gases

ORGANIC DUSTS: Wide variety of organic dusts, molds can cause Hypersensitivity pneumonitis (Farmer's lung, bagassosis, etc.). Cotton, flax, hemp, grain can cause Byssinosis (distinct pathology, some classify it as a pneumoconiosis but it is distinct) INORGANIC DUSTS Asbestos = Pneumoconiosis (asbestosis) Silica = Pneumoconiosis (silicosis) Coal, soots = Pneumoconiosis IRRITANT GASES Chlorine, phosgene, NOx*, SOx* = Chemical pneumonitis * Oxides of nitrogen, sulfur

Describe a PASSIVE surveillance system

Passive - Data are sent to the health agency without prompting (but may be expected or required by the health agency nonetheless, based on published standards—e.g., notifiable conditions).

What precautions are applicable Airborne Precautions

Patients with a pathogen transmissible by airborne route, including but not limited to: o tuberculosis o measles o chickenpox (till lesions crusted over) o herpes zoster: localized (immunocompromised patients) or disseminated (till lesions crusted over) • PPE: N 95 or higher level disposable respirator, if available, donned prior to room entry, removed after exit. If spraying of respiratory fluids anticipated, then also gloves, gown, goggles (or face shield). • Patient to avoid reception & registration area (enter through separate facility entrance, e.g., isolation entrance) • Place patient immediately in an airborne infection isolation room (AIIR). If AIIR not available, then: o Facemask (e.g., procedure or surgical mask) on patient & place immediately in exam room w/ closed door o Facemask stays on while in exam room (instruct pt.), change if it becomes wet (if possible) o Initiate protocol to transfer patient to facility with recommended infection-control capacity • Facemask on patient when exiting exam room, avoid their close contact with other patients, practice respiratory hygiene & cough etiquette (instruct pt.) • Once patient leaves, exam room to remain vacant for (generally) one hour before anyone enters

Vector

a living intermediary that carries an agent from a reservoir to a susceptible host, e.g., mosquitoes, fleas, or ticks. (In some cases [e.g., tickborne relapsing fever], the typical arthropod vector for an agent may also serve as its reservoir.)

What precautions are applicable Droplet Precautions

Patients with pathogen transmissible by droplet route, including but not limited to: o Respiratory viruses (e.g., influenza, parainfluenza, adenovirus, RSV, human metapneumovirus) o Bordetella pertussis o Neisseria meningitidis & group A streptococcus (for 1st 24 hours therapy) • PPE: Facemask (procedure or surgical mask), for close contact, donned upon entering exam room. If spraying of respiratory fluids anticipated, then also gloves, gown, goggles (or face shield). • Place patient in an exam room with a closed door ASAP (prioritize patients w/ excessive cough & sputum production), if room not available, facemask on patient & place in separate area (far from others as possible) while awaiting care. • Facemask on patient when exiting exam room, avoid their close contact with other patients, practice respiratory hygiene & cough etiquette (instruct pt.). Clean/disinfect exam room.

What precautions are applicable to Contact Precautions

Patients with stool incontinence, draining wounds, uncontrolled secretions, pressure ulcers, generalized rash or exanthems, or presence of ostomy tubes and/or bags draining body fluids. • PPE: Gloves when touching patient & patient's immediate environment or belongings. Gown if substantial contact with patient or their environment anticipated. • Prioritize placement of such patients in an exam room. • Instruct patients with infectious diarrhea to use separate bathroom, disinfect bathroom before used again. • Clean/disinfect exam room

Differentiate random sampling methods from non probability sampling methods

Probability (random) sampling is always preferred, such that every person has the same (and known) probability of being selected. Methods include: Simple Systematic Stratified Cluster (Less desirable, non-probability methods include Convenience & Respondent-Driven sampling.)

Proportionate mortality

Proportionate mortality = (deaths assigned to a specific cause during a given time interval) / (total number of deaths from all causes during the same time interval)

Identify the two factors multiplied to calculate Quality Adjusted Life Years (QALY)

Quality Adjusted Life Years = Life Expectancy x Utility Utility is a quality of life score ranging from 0 (death) to 1 (perfect health)

What regions of the United States do Rocky Mountain spotted fever predominate?

Rocky Mountain spotted fever and ehrlichiosis dominate farther to the south than Lyme disease.

Secondary attack rate

Secondary attack rate = (new cases among contacts) / (total number of contacts) For the secondary attack rate, think about a household exposed to a family member who contracts an infection outside the home. Remember to exclude the already affected family member from the denominator (i.e., from the size of the household or family).

List at least 4 criteria important for demonstrating causation

The Hill Criteria: - Strength of association - Consistency (other studies) - Specificity - Temporality (exposure then effect) - Biological gradient (dose-response effect) - Biological plausibility (theoretical) - Coherence - Experiment (evidence) - Analogy (given prior similar linkages)

What regions of the United States do Lyme disease predominate?

The eastern half of the United States, especially the Northeast and Mid Atlantic, and the Upper Midwest and Central Regions. Lyme disease and anaplasmosis dominate in the northern regions

Describe how analyzing for the cohort effect reveals information that is different from period and age effects

The figure below shows rates of death due to stroke among women, by age group and year of birth. Note that the age-specific death rates are lower for women who were born later. This illustrates the cohort effect. In the case of stroke, an explanation might be that- over the years- surviving a stroke has become more likely so that by the time women born later reach a particular age interval, their risk of a fatal stroke is less than that of their predecessors who reached the same age many years earlier.

Describe the epidemiologic triangle

The interdependent relationship among host, agent, and environment ,which may be represented as a triangle or Venn diagram to reflect how each component influences the others

Recognize the kappa statistic (Cohen's kappa coefficient) as a measure of inter rater reliability accounting for chance agreement

To quote the article by Viera & Garrett (Fam Med 2005 37(5):360-3) referenced at the above link/URL: "We may also want to know how different [an] observed agreement is from the expected agreement. Kappa is a measure of this difference, standardized to lie on a -1 to 1 scale, where 1 is perfect agreement, 0 is exactly what would be expected by chance, and negative values indicate agreement less than chance, i.e., potential systematic disagreement between the observers." Disease & Injury Dynamics

What are communicable diseases that are Vector borne

Transmission of the infectious agent by a living organism (e.g., insect, arachnid, animal) to another living organism (e.g., human or animal host). Example: mosquitoes as malaria vector, ticks as Lyme disease vector. Precautions: protective barriers (window screens, bed nets), insect sprays, culling animals.

What are communicable diseases that are Airborne

Transmission via aerosols (airborne particles <5µm) that contain organisms in droplet nuclei or in dusts. Can be spread via ventilation systems. Examples: TB, measles, chickenpox, smallpox (and maybe influenza: controversial, as more likely via droplets). Precautions: masks, negative pressure rooms in hospitals.

What antimicrobial prevents HIV infection?

Truvada

Identify diseases or infections for which the following drugs are used as preventive treatment: the antimicrobials Truvada, isoniazid, rifampin, atovaquone/proguanil, and erythromycin ophthalmic

Truvada: HIV infection isoniazid: tuberculosis rifampin: tuberculosis & meningococcal disease atovaquone/proguanil: malaria erythromycin ophthalmic: gonococcal ophthalmia neonatorum

What are the 2 principle sceening tests for latent tuberculosis infections? (test, technique, measurment)

Tuberculin skin test (TST) - Mantoux, Purified protein derivative (PPD) intradermal injection, Size of skin induration after 48-72 hours Interferon-gamma release assay (IGRA), ELISA (whole blood), Interferon-gamma level or ELISpot (whole blood), Interferon-gamma producing cell count [among periph. blood mononuclear cells (PMBC)] FDA-approved IGRAs: QuantiFERON®-TB Gold In-Tube test (QFT-GIT) & T-SPOT®.TB test (T-Spot)

Describe how efficacy is calculated as a relative risk reduction

Using Vaccine Efficacy, the calculation is: (This is really the only formula you need.) This is actually the same as subtracting the ratio of attack rates from unity. To obtain the percent efficacy, just multiply by 100

Public health functions of the Federal Government

through its power to (a) regulate interstate commerce and (b) tax and spend for the general welfare: Passes laws / regulations and sets policies / standards Conducts regulatory activities such as labeling hazardous substances and approving drugs Surveys population health status and health needs Supports biomedical and health services research Helps finance health services and provides direct care to military personnel and indigenous populations. Provides technical assistance and resources to state and local health systems Provides protection against global health threats and supports international public health efforts

Identify infections that are required as Nationally Notifiable

viral hepatitis (A, B, C) arboviral infections vaccine-preventable diseases sexually transmitted bacteria tuberculosis invasive, zoonotic & tickborne bacteria enteric bacteria & protozoa malaria the 1 mycosis the 1 helminthiasis. NOTE!!! Regarding objectives 54 and 55, you will not be asked to distinguish specific, individual diseases on the basis of whether or not they are nationally reportable. Rather, you may be asked to identify a grouping of diseases as reportable, compared to another group that includes no reportable diseases.

List the immunizations that should be offered to healthy adults after they reach the ages of 60 and 65

~Zoster (at age 60, either 1-dose ZVL or 2-dose RZV, latter preferred & may be given at age 50) ~Pneumococcal (at age 65, 1 dose each of PPSV23 & PCV13, given 1 year apart) ~Influenza (annually) ~Tetanus diphtheria booster (every 10 yrs, 1 dose should be Tdap if not previously received)

Identify the operating agencies of the U.S. Public Health Service

• AHRQ - Agency for Healthcare Research and Quality • ATSDR - Agency for Toxic Substances and Disease Registry • CDC - Centers for Disease Control and Prevention • FDA - Food and Drug Administration • HRSA - Health Resources and Services Administration • IHS - Indian Health Service • NIH - National Institutes of Health • SAMHSA - Substance Abuse and Mental Health Services Administration

Identify 3 agents of warfare and terrorism against which an effective vaccine is available

• Anthrax • Smallpox • Botulinum toxin

Identify the diseases or conditions for which the U.S. Preventive Services Task Force recommends all newborns be screened or treated

• Congenital Hypothyroidism • Phenylketonuria (PKU) • Sickle Cell Disease • Gonococcal Ophthalmia Neonatorum Prophylaxis

Identify 2 chronic diseases and 2 substance use disorders that can be mitigated by behavioral counseling interventions

• Diabetes mellitus • Cardiovascular disease • Alcohol use disorder • Tobacco use disorder Most of the evidence is in regard to having an impact on risk factors. In the case of preventing diabetes in overweight or obese individuals (by diet & physical activity), the evidence supports an impact on the disease itself. Also, regarding tobacco use in pregnant women, counseling was linked to a lower probability of low birth weight & premature birth

List 3 categories of preventive, workplace health interventions, from generally most to generally least effective

• Engineering controls (most effective) • Administrative controls • Personal protective equipment (PPE) There are more categories, two of which (elimination and substitution) are even more effective than engineering controls. For this course we will assume elimination and substitution for a particular work process are not feasible, we will roll process modification, isolation and ventilation into engineering controls, and we will not attempt to rank the importance of medical screening, dosimetry, etc., compared to PPE—except to note that engineering controls are still superior.

List 5 infectious diseases that are preventable by vaccination or immune globulin administration soon after exposure

• Hepatitis A • Hepatitis B • Measles • Varicella • Rabies

List the live virus vaccines

• Measles • Mumps • Rubella • Varicella • Zoster (Zostavax) • Rotavirus • Oral Polio • Intranasal Flu • Yellow Fever (Also, for completeness: vaccinia [smallpox vaccine])

List 3 common air pollutants that are known to aggravate chronic respiratory diseases

• Ozone - oxidative stress in bronchiolar epithelium • Particulate Matter - induction of inflammatory response • Nitrogen Oxides - airway inflammation • Sulfur Dioxide - bronchoconstriction

Identify the 3 categories of healthcare associated infections with the highest frequency of occurrence across the U.S.

• Pneumonia • Surgical Site Infection • Gastrointestinal Infection Adding urinary tract and bloodstream infections would constitute a 'top-5' list. In terms of total cost, bloodstream infections [CLABSIs] displace GI infections among the top three, so for cost the top 3 would be CLABSI, VAP and SSI- but for exam purposes just remember most frequent sites, as above.

What are Disease Oriented Outcomes of a study

• blood pressure • blood sugar • peak exp. flow rate • plaque thickness