Exam 2

_____: how the microorganism travels from the source to the uninfected person

Human to human transmission

The occurrence of the number of NEW CASES of a disease or condition in a defined period of time, usually one year.

INCIDENCE

SIMPLE LOGIC MODEL --> problem assessed: I am thirsty: ____: WATER SOURCE ____: GO TO WATER ____: DRINK WATER ____:FEEL BETTER

INPUT ACTIVITY OUTPUT OUTCOME

equal and fair distribution of resources, based on analysis of benefits and burdens of decision.

Justice

are there laws/statue's allowing for the program to operate as planned

Legality

Infectious Disease Epidemiology Terms and Concepts (1): _____: ability of organism to cause serious disease

Virulence

visual display of the onset of illness among cases associated with an outbreak. Allows assessment of an outbreak

epi curve

look at pic- epidemiological triangle

epidemiological triangle

epidemiology powerpoint pt.1

epidemiology powerpoint pt.1

ability of an organism to infect large numbers of people

infectivity

______ engages intended members in dialog and helps uncover unsuitable aspects of material process helps identify that the message is well suited to the audience

learner verification

steps needed to get there

objectives

temporary resistance donated to host (host did not create antibodies on own) • mother-fetus --> why women get TDAP shot • transfusion -->IGG immunization/transfusion for people on chemo

passive immunity

_____ ability of an organism to produce disease in infected people the property of causing disease.

pathogenicity

Incidence Rate =

(# of new cases in a given period of time/ population at risk in same time period) x 1,000 (or 10,000; 100,000)

Now let's talk about RATES: rate =

(a count or # events over time/ specified population during that time) x k (constant) (k = 1,000; or 10,000; 100,000, etc.)

Putting Evidence-Based Public Health to practice: Applying program-planning frameworks = _____

(foundation in behavioral science theory)

Putting Evidence-Based Public Health to practice: Making decisions using best available peer-reviewed evidence = _______

(quantitative & qualitative research)

what are examples of indirect contact via common vehicle

(sneeze and blow ur nose into a tissue, then leave the tissue on counter, someone else comes and picks it up and then they are contaminated) can be surfaces such a door knobs, medical instruments, counters, light switches, etc

role of the community health nurse- strategies to assist community health nurses working with culturally diverse clients: - conduct a "culturological" assessment *_______ - seek knowledge about local clutlures - recognize ____ of culturally diverse groups - provide culturally competent care - recognize culturally _____ problems these you also want to include in a ____

*conduct a cultural self assessemt - political issues - health based cultural self assessment (provide conscious awareness of these things)

objectives should be (x4)

- Measurable - Specific - Quantifiable—used to measure successful outcomes - Use verbs, include specific conditions (how well/how many)

what are the 8 most important characteristics that can affect learning

- determining what the client needs to know - identifying motivating factors - stick with essentials - personalize health messages - summarize often - be creative - be encouraging - employ teach back methods

PILI 'Ohana Lifestyle Intervention: - culturally tailored lifestyle intervention - based on _____ prevention program - primary outcome weight loss - secondary outcome _____ - widely disseminated amount native Hawaiian pacific island communities

- diabetes - blood pressure

COMMUNITY/POPULATION ASSESSMENT: - Meet with group leaders of aggregate to clarify mutual ____ - Determine sociodemographic characteristics - Interview key informants - Consider both positive and negative factors - Compare the aggregate with the "____" - _____ - consider systemic influences on population health

- expectations - norm - Systems-thinking

cultural diversity: essential that nurses understand: - How cultural groups view _____ - How cultural groups define ___ and ___ - How ____ cure and care for members of their respective cultural groups - How the ___ of the nurse influences the way care is delivered

- life processes - health and illness - healers - cultural background

what are three things that make up a health education learning experience

- predispose - enable - reinforce voluntary behavior conducive to health in: individuals, groups, communities

Screening: is assessment for indicators that disease may be present: - Routine testing for patients without ____ but with risk factors (certain ages, conditions, exposures) - Referral for further testing if screening finds possible indicator of disease

- symptoms

transcultural nursing: uses world view, social structure, language, ethnohistory, environmental context, and generic or folk and professional systems to provide a comprehensive and holistic view of influences in cultural care and well being.... what are three thing that culture care lenses?

1. culture care preservation and maintenance 2. culture care accommodation and negotiation 3. culture care repatterining and restructuring

problem solving education: - active participation and ongoing dialogue - learners are critical and reflective about health issues - uses a participatory group process - involved activism on the part of the educator (x2)

1. facilitator educator is a resource person and is an equal partner with the other group members 2. leads to sustainable lateral relationships

what are four goals of health education

1. translate health knowledge into interventions for health enhancement, disease prevention, and chronic illness management 2. enhance wellness and decrease disability 3. actualize the health potential of individuals, families, communities, and society 4. influence individuals within their sociopolitical environment for improved heath and well being (place value on contributing of community member' strength)

do stakeholders, community accept it

Acceptability

Evaluation should include (x4)

Adequacy Efficiency Appropriateness Cost-benefit analysis

agreement to respect another's right to self-determine a course of action; support of independent decision making.

Autonomy

compassion; taking positive action to help others; desire to do good; core principle of our patient advocacy.

Beneficence

Disease transmission can be halted by breaking any one of the links in the chain of transmission

Chain of Infection

Infectious Disease Epidemiology Terms and Concepts (1): ______: symptoms vs. no symptoms and will not progress

Clinical vs. sub clinical disease

Consider factors when determining priorities: - _____: aggregate preferences - ____ of problem: # ppl in aggregate affected, severity of problem on aggregate health - ____: availability of time/skills/resources needed to address a problem

Community support Significance Feasibility

Assesses for current disease

Diagnostic Testing

does it makes sense, moves it forward does it fir program/ organization's mission

Economic Feasibility propriety

Spectrum of Disease Occurrence: _____: the disease is usually present within the community or region _____: the disease occurs occasionally in small pockets _____: increase is the usual number of expected cases _____: there is a clear excess of the disease across a large region _____: emergence of a new disease that spreads across multiple countries & large regions of the world

Endemic Sporadic Outbreak Epidemic Pandemic

Study of the distribution and patterns of disease within a population and those factors that influence health (illness or wellness)

Epidemiology

__________: - Strength of association - Dose-response relationship - Temporally correct relationship - Biological plausibility - Consistency with other knowledge - Specificity of association

Establishing Causation (link between risk factor and disease)

Process or outcome objective? By the year 2019, childhood vaccines for preventable diseases .......will be reduced to no more 100 per 100,000 in Hawaii as measured by DOH data.

Example of a SMART Objective

Process Objective (process): By June 1, 2021, conduct at least 10 informational sessions for parents about the risk and benefits of razor-riding, and the protective factors of helmets as measured by attendance records. Outcome Objective (summative): By October 1, 2021, the prevalence of helmets use for razor riders among 5 to 12 years of age at Manoa Community Park will increase from 20% to 85% as measured by Manoa park Staff.

Examples of Objectives:

diagnostic testing is for what kind of patients

For patients with symptoms, or screened positive for indicator

Evaluation: Reflect on each stage, determine strengths/weaknesses: - ____ evaluation = process evaluation (Typically process evaluations seek data with which to understand what's actually going on in a program (what the program actually is and does), and whether intended service recipients are receiving the services they need. Process evaluations are, as the name implies, about the processes involved in delivering the program) - ____ evaluation = product evaluation and outcomes (are conducted near, or at, the end of a program or program cycle, and are intended to show whether or not the program has achieved its intended outcomes (i.e., intended effects on individuals, organizations, or communities) and to indicate the ultimate value, merit and worth of the program)

Formative Summative

(study of the role of genetic factors in determining health/ disease in families and populations, & the interplay of such genetic factors with environmental factors)

Genetic epidemiology

where we want to be

Goals

____ - What we invest - program resources ($/people) ____ - What we do (verbs) ____ - Who we reach (target population) _____ - What results - Knowledge, Attitudes, Behaviors (KABs) - [short, medium, long term] _____ - Goal

INPUTS Activities Outputs OUTCOMES IMPACT

Components of a LOGIC MODEL (x5)

INPUTS - What we invest - program resources ($/people) Activities - What we do (verbs) Outputs - Who we reach (target population) OUTCOMES - What results - Knowledge, Attitudes, Behaviors (KABs) - [short, medium, long term] IMPACT - Goal

Research potential problems: - ____ health problems and needs - ____ the identified problems to create an effective plan

Identify Prioritize

what are the 5 objectives of epidemiology in healthcare

Identify the cause of a disease and its risk factors To determine the extent of disease in a population To study disease history and prognosis To evaluate existing and new preventive and therapeutic measures To guide the development of health care policy

what do you identify in the assessment phase in health planning (public health) Community/ population assessment: - Meet with group leaders of aggregate to clarify mutual ____ - Determine sociodemographic characteristics - Interview ____ Consider both positive and negative factors - Compare the aggregate with the "____" - ____ - consider systemic influences on population health

Identify the needs of the population, community, at-risk groups or targeted population - expectations - key informants - norm - Systems-thinking

Infectious Disease Epidemiology Terms and Concepts (1): _____: period from organism to host to clinical illness

Incubation period

Epi curve - visual display of the onset of illness among cases associated with an outbreak. Allows assessment of an outbreak: - _____ - first case in an outbreak - _____ - # of cases - _____ - distribution of cases over time - _____ - date with highest magnitude of cases - Derive inferences about outbreak's pattern of ____ & most likely time period of ____

Index case Magnitude of outbreak time trend Peak rate date spread, exposure

- Often the most enjoyable stage for the nurse and the clients - Implementation should follow the initial plan. - Include a variety of strategies - Prepare for unexpected problems - Consider using all types of media to disseminate information - Include the participant's verbal or written feedback and the nurses detailed analysis.... Communicate follow up recommendations

Intervention

"Clear ideas about what you plan to do and why - as well as an organized approach to capturing documenting, and disseminating program results - enhance the case for investment in your program" Kellogg Foundation

Logic Models Strengthen the Case for Program Investment

A picture of how your organization does its work - the theory and assumptions underlying the program... (Kellogg Foundation)

Logic model

_____ - An epi curve can also be used to make inferences about an outbreak's most likely mode of spread, suggesting how a disease is transmitted.

Mode of spread

Infectious Disease Epidemiology Terms and Concepts (1): ______: direct and indirect

Modes of transmission:

is a screen test considered a diagnostic test

NO! It is an assessment for INDICATORS that disease MAY be present

avoidance of harm or hurt; core of medical oath and nursing ethics

Non-maleficence

Ongoing systematic collection & analysis of data about health conditions to determine levels or changes in levels of specific diseases: - ____: information is sent into the DOH or other agency - _____: information is actually collected by the DOH or other agency - _____ case reporting: a clinician notices an unusual or significant case and reports it - this is how most epidemics are initially identified - _____: EMS cases, ED triage complaints, pharmacy sales of OTC or Rx drugs, hospital or insurance claims - _______ -individual or large data

Passive Active Sentinel System surveillance DOH data collection

Tuskegee Syphilis Experiment Stanford Prison Experiment Henrietta Lacks (Hela cells)

Past ethical violations

Using Epidemiological data: Epi curves Transmission occurs in the following ways: - _____: exposed over a brief time to the same source (ex: single meal) - _____: exposed over a brief time to the same source (ex: contaminated food source) - ______ (propagation): no common source because the outbreak spreads from person-to-person... ex: contaminated food source

Point source Continuous common source Person-to-person spread

degree to which a positive screening test actually indicates that disease is present

Positive Predictive value

does it fit program/organization's mission

Propriety

Causation of disease- eras: ____ era: disease is a result of god(s) ____ (sanitation) era: disease caused by miasma in the environment ____ era: disease caused by microorganisms ____ causation era: disease caused by many different factors ____ era: (today) disease caused by interplay of multiple causes. Sum is greater than the parts. "_____"

Religious Environmental Bacteriological Multiple Ecological, Web of causation

how infectious an agent is R0 describes the contagiousness of an infectious agent among susceptible people It is influenced by many factors, (biological, social and environmental factors) and because of this, it can change over time For example: The R0 for measles is 12-18, and in Hawaii the R0 for COVID-19 has changed over time.

Reproductive Number (R0):

are they available to address the problem are there laws/ statue's allowing for the program to operate as planned

Resources legality

what are the two kinds of aribone transmission

Respiratory droplet (direct) Respiratory droplet nuclei (aerosolized)

Screening tests vs. diagnostic tests: ______: is assessment for indicators that disease may be present

Screening

ability of a test to accurately identify those with (the marker for) a disease

Sensitivity

smart objectives: S M A R T

Specific Measurable Achievable/Attainable/Actionable Relevant Timely

ability of a test to accurately identify who does not have (the marker for) a disease

Specificity

How is the health of the public monitored?

Surveillance

Ongoing systematic collection & analysis of data about health conditions to determine levels or changes in levels of specific diseases

Surveillance

Why EVALUATION is important? - ______ - Evidence that demonstrates PHN interventions successes - _____ - Demonstrates what works and what needed to change - _____ - Evidence Base Practices/Best Practices

To know if you achieved your goals Secures Funding - Grants Program Sustainability

national panel of experts in prevention & EBP

USPSTF

____

______

body produces antibody against introduced antigen •Vaccine (this is artificial) •Natural immunity - response to infection

active immunity examples are active bc the body produces the response

____ learn better in a facilitative, nonrestrictive, non structured environment

adult learners

health program planning theory - Seeks to improve ____ health - Applies factors to larger aggregates within a systems framework (assessment -> planning -> intervention -> evaluation) Goal: to create significant measurable community change --> ____

aggregate --> community health impact

Putting Evidence-Based Public Health to practice: Engaging the community in ____-making Using data and information systems ____ Conducting sound evaluation Disseminating(spread) what is learned to key stakeholders ____ makers.

assessment/decision systematically decision

What can we do to disrupt disease transmission of dengue fever? host - human --> _____ vector- mosquito --> _____ agent- virus --> _____ environment --> ______

bug repellent clothing layers vaccine if there is one standing water, screens in houses, water treatments

Infectious Disease Epidemiology Terms and Concepts (1): _____: person with infection but no S/Sx. or illness

carrier

At the beginning of an epidemic the DOH or US CDC will establish a "______" makes a mold of what makes the disease such as symptoms, lab tests ex: what makes up COVID to get diagnosed by COVID https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/#:~:text=Case Classification-,Probable,testing performed for COVID-19.

case definition

Epidemiology and Preventive Actions: Observations have lead to effective preventive measures implementation through recent history: - Ignaz Semmelweiss and ____ - Edward Jenner and ____ - John Snow and ____ - Florence Nightingale

child-bed fever smallpox cholera

USPSTF makes recommendations about _____ services such as screening tests, counseling services and preventive medications

clinical preventive

_____ is a multifaceted and complex concept that refers to the differences among people especially those related to values, attitudes, beliefs, norms, behaviors, customs, and ways of living.

cultural diversity

_____ is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture

cultural imposition

_____ refers to the "particularistic values, beliefs, and patterning of behavior that tend to be special, 'local', or unique to a designated culture and which do not tend to be shared with members of other cultures

culture specific

______ refers to the "commonalties of values, Norms of behavior, and life patterns that are similar held among cultures about human behavior and lifestyles and form the bases for formulating theories for developing cross cultural laws of human behavior

culture universal

is screening or diagnostic testing more invasive and expensive

diagnostic is more expensive and more invasive

Human to human transmission: what are four ways?

direct person to person contact (most important) (direct transmission) airborne transmission indirect contract via a common vehicle fecal- (oral contaminated water food)

health education materials include websites before ______ them Materials should: - strengthen previous ____ - be used as an adjunct to ____ - be appropriate for intended audience in community education initiatives

disseminating them - teaching - health instruction

what are three things a community health nurse should consider

diversity, equity, inclusion

_____ is a person's tendency to view his or her own way of life as the most desirable, acceptable or best, and act in superior manner toward another culture

ethnocentrism

Types of objectives (linked to _____) Process Objectives: Task/Activities:(Formative evaluation measures): OUTPUTS: By __, __(how many) of ___(what) will be ____(provided) as measured by _______ Outcome Objectives: KABs (Summative evaluation measures): OUTCOMES: By __, ___% of (who) will ____ (gain, improve) in _____, as measured _____ (tool, test, measure).

evaluation

logic model: A picture of how your organization does its work - the theory and assumptions underlying the program... (Kellogg Foundation) - An ____ tool* that facilitates effective program planning, implementation, and evaluation - Graphic depiction demonstrating ____ of a program - What a proposed program will DO and what it will _____ - Links program ____ with OUTCOMES!

evaluation WHAT & WHY ACCOMPLISH ACTIVITIES

Illustration: H.pylori as causative agent in duodenal ulcers (DU): Strength of association: H. pylori found in 90% of pts. With DU Dose-response relationship: density of H. pylori higher in pts. With DU Replication of findings: many studies found same results Temporal relationship: 11% of chronic gastritis pts. Will develop DU. Biological plausibility: H. pylori has binding sites on antral cells and can follow into duodenum Consistency with other knowledge: Prevalence of H. pylori and DU is same in men and women Specificity of association: Prevalence of H.pylori in pts. with DU is 90-100%

example

human host vector aedes agent. environment den virus. standing water

example of epidemiological triangle

"Prevention of childhood dental caries": State the issue: seriousness, data, outlier of problems What is the problem Strategies to consider Resources available Contact information

example of logic model

Examples of some rates.. crude death rate: # of deaths in yr./ population at mid year X 100,000 cause specific death rate: # deaths from specific cause in 1 yr. / total population at mid year X 1,000... infant mortality rate: # deaths 1 yr and less in yr. / total live births in yr. X 1,000 Attack rate (or incidence proportion): # of new cases / total # people exposed Secondary attack rate: # of new cases among contacts / total number of contacts

examples!!

Evaluation: Include the participant's verbal or written ____ and the nurse's detailed analysis Communicate follow-up recommendations Reflect on each stage, determine strengths/weaknesses

feedback

Legal and ethical issues for epidemiology and nursing practice (x5)

genetic epidemiology privacy/ confidentiality community profiling infectious disease past ethics violations

who is Paulo Freire and what strategies did he bring to help the poor and oppressed

he is a Brazilian educator who brought empowerment among the poor and oppressed by promoting literacy

% of people in the population that are NOT susceptible

herd immunity

when determining the extent of disease in a population, you are looking to determine....

how to distribute health care resources

what is a vector transmission

human infected then infects animal, then infects human ex: mosquitoes- malaria, swine- blue (birds)

secondary prevention purpose

identify people with risk factors and diseases in their early stages

how to read the logic model: ____: what we invest - program resources ($/people) ____: what we do (verbs) ____: what results - knowledge, attitudes, behaviors (KABs)- short, medium, long term _____: goal

inputs activities outcomes impact

Case Definition: The criteria to call something a "case" Usually includes person, time, place and clinical features Early in the epidemic, it usually requires ____ confirmation But...as the number of cases increases, may switch to signs and symptoms present to count something as a "case"

lab test

what can stop the portal of entry for COVID-19

masks

what protect the portal of exit (if someone in infected)

masks, cant breathe out covid

Critical to identify risk factors, and ways to avoid them, in order to reduce: - ____ (rate/amount of disease in a population) - ____ (rate of death in a population)

morbidity mortality

when identifying the cause of a disease and its risk factors it reduces....

morbidity and mortality from disease

Health Planning: Needs Assessment phase: - research potential problems and ____ - consider ____ when determining priorities

needs factors

what is ethnocentrism and cultural imposition categorized as

positionally

what are the preventions of disease

primary (healthy) --> secondary (early disease) --> tertiary (chronic disease)

Health Planning:Planning, Implementation & Evaluation: Starts upon completion of ____ of problem/needs requiring intervention Determine desired ____ of intervention, and corresponding objectives to meet goals

prioritization goals/outcome

what kind of teaching style did he Paulo Freire use

problem solving approach to education: "banking education approach" --> which placed the learning in a passive roll participatory action research

Outbreak Investigation- A planned approach to determine: - If there is really an outbreak - Likely cause or agent - Mode of transmission and other causative factors - Number of cases - Best approach to contain and halt the spread ______: data is collected and analyzed

process used

...Selecting and carrying out a series of activities designed to achieve desired improvements (Issel, 2008)

program planning

Prioritizing health issues to focus on (x5)

propriety, economic feasibility, acceptability, resources, legality

assess _____ of education resources: - SMOG readability formula - Flesch- Kincaid formula (computers) - search "readability statistic"

readability

environment in which a pathogen lives and multiples (soil, water, humans, animals)

reservoir

_____ an exposure associated with a disease, variable that increase the rate of disease in people who have them - Genetic predisposition (gene) - Exposures (ex: infectious agent, diet, stress)

risk factor

- become a partner with individuals and communities - activate ideas - identify resources - serve as catalyst for change - offer appropriate interventions - facilitate group empowerment

role of a community health nurse

Other things to think about: - Stigma - Costs - Psychosocial impact - Validity of test - implications of false +/-

secondary prevention early detection and treatment

Plan adequate/appropriate follow up Risk vs benefit of test Existence of acceptable/medically sound tx and follow-up

secondary prevention: early detection and treatment screening programs

Secondary prevention: Detecting disease early: Screening Tests: Validity of screening tests are evaluated by 2 Components:

sensitivity, specificity

participatory action research (PAR): goal: _____ - embraces the use of community based participatory methods - participation and action from stakeholders and knowledge about conditions and issue help to facilitate strategies reached collectively

social change

sustain cognitive and behavioral changes by engaging learners to become partners in their own behaviors lifestyle accommodation

sustainable changes: PILI 'Ohana Lifestyle Intervention

"Let whoever is in charge keep this simple question in her head: Not, 'how can I always do this right thing myself,' but 'how can I provide for this right thing to be always done?'" - Florence Nightingale

systems thinking

NEED ASSESSMENT MAPUnmet Needs - Gaps of a Community: what are the four groups

teen moms, gang members, homeless/ mental illness, school dropout

when studying disease history and prognosis, it determines

the effectiveness of interventions

- gives precedence to understanding the cultural dimensions of human care and caring - describes, explains, and projects nursing similarities and differences focused primarily on human care and caring in human cultures

theory of culture care diversity and universality

- implicit bias - structural racism - historical/ cultural trauma - cultural awareness - cultural humanity - cultural safety

things to consider as a community health nurse

a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values, and practices with the goal of using this knowledge to provide CULTURE SPECIFIC AND CULTURE UNIVERSAL nursing care to people

transcultural nursing

is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice

transcultural nursing

uses world view, social structure, language, ethnohistory, environmental context, and generic or folk and professional systems to provide a comprehensive and holistic view of influences in cultural care and well being

transcultural nursing

what is cultural diversity related to

values, attitudes, beliefs, norms, behaviors, customs, and ways of living