Community Final (Overview)

History of Public Health and Public and Community Health Nursing: New Resources and New Communities- The 1960s and Nursing - In _____, Congress amended the Social Security Act to include health insurance benefits for older adults (______), and increased care for the poor (_______). Unfortunately, the revised Social Security Act did not include coverage for preventive services, and home health care was reimbursed only when orders by the physician. - This prompted the rapid increase in for-profit _____ health care agencies. - Many local and state health departments rapidly changed their policies to allow the agencies to provide reimbursable home care as bedside nursing. This often resulted in reduced health promotion and disease ______ activities.

1965, medicare, medicaid, home, prevention

History of Public Health and Public and Community Health Nursing: District Health Nursing and Settlement Houses (2 of 2) Rural Nursing Service- - The ____ _____ _____, through its Rural Nursing Service (later the _____ and _____ Nursing Service), provided a framework to initiate home nursing care in areas outside larger cities. Occupational Health Nursing- - Occupational health nursing began as ________ nursing and was a true outgrowth of early home-visiting efforts. - in 1895, Ada Mayo Stewart began work with the employees and families of the Vermont Marble Company of Proctor, Vermont. As a free service for the employees, Stewart provided obstetric care, sickness care (e.g., for typhoid cases), and some post surgical care in worker's homes. Unlike contemporary occupational health nurses, stewart provided very few services for work-related injuries.

American Red Cross, town and country, industrial

Communicable and Infectious Disease Risks: Hepatitis Non-ABC Hepatitis: - very uncommon in the US - Hepatitis D (HDV) is chronic or acute, and only occurs in those already infected with _____, there is no vaccine - Hepatitis E (HEV) is an acute infection transmitted by ____-_____ route, there are no chronic carriers, and there is no vaccine - Hepatitis G (GB virus C) does not cause acute or chronic hepatitis: virus has been isolated in patients with _____-______ hepatitis

HBV, fecal-oral, post-transfusion

Communicable and Infectious Disease Risks: HIV Infection HIV Testing- _______ _______ Test- - the most commonly used screening test for determining infection. - The test does just as its name implies; it does not reveal whether an individual has symptomatic AIDS, nor does it isolate the virus, it simply indicates the presence of the _______ to HIV. - the most commonly used form of this test is the enzyme-linked immunosorbent assay (EIA), which effectively screens blood and other donor products. __________ _________- - this test is done as a confirmatory test to verify the results in order to minimize false-positive results Routine Testing and Voluntary Screening- - routine HIV testing is recommended for all clients attending health department STD clinics, family planning clinics, community health clinics, and primary care offices. - voluntary screening programs may for HIV may be either _______ or ________: this process is unique for each, with the first identifying the person's name and other information, while the second is not linked to any identifying information. ______ HIV Antibody Testing- - uses oral fluid samples and is 99% accurate with results in 20 minutes

HIV antibody, antibody, western blot, confidential, anonymous, rapid

Public Health Nursing Practice and the Disaster Management Cycle: The Disaster Management Cycle Prevention (Mitigation and Protection)- - ____-____ _________ (protection, prevention) is an emergency management term for reducing risks to people and property from natural hazards before they occur. - the ability to provide primary prevention through national missions of prevention, mitigation, or protection can include ________ measures such as protecting buildings and infrastructure from the forces of wind and water, and _____-_______ measures such as land development restrictions - prevention also includes ______-made hazards and the ability to deter potential terrorists, detect terrorists before they strike, and take decisive action to eliminate the threat. prevention activities for terrorism ma include heightened inspections; improved surveillance and security operations; public health and agricultural surveillance and testing; immunizations; isolation; quarantine; or halting of chemical, biological, radiological, nuclear, and explosive (CBRNE) threats

all-hazards mitigation, structural, non-structural, human

Public Health Nursing Practice and the Disaster Management Cycle: Role of Public Health Nursing In Disaster Recovery Ongoing Community ________- - the reality of the recovery effort is that the rapid needs assessment continues into an ongoing community needs assessment. to determine effective interventions to ensure the best possible outcomes, it is essential to have ongoing accurate data about the population. Community ___________- - the public health nurse understands that resilient community is interconnected; it has strong horizontal and vertical relationships among its residents. ___________ Support- - the psychological stress of cleaning and/or moving can cause feelings of severe hopelessness, depression, and grief in the disillusionment phase. - nurses need to help make referrals to mental health professionals

assessment, resilience, psychosocial

Public Health Surveillance and Outbreak Investigation: Displaying of Data - data displays are a step in analysis that shows graphically what is happening - it reduces ________ made about the event and provides a means for describing the event using _______ data - data help in stating your hypothesis, or best guess, about what is happening

assumptions, quantitative

Communicable and Infectious Disease Risks: HIV Infection Transmission- - HIV is transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and ______ _______. - Those who have had blood, sexual, or needle-sharing exposure with an HIV-infected person are at risk for contracting the virus. - HIV is not transmitted through ______ contact such as hugging or touching someone who has HIV, or through mosquitoes or other insects

breast milk, casual

History of Public Health and Public and Community Health Nursing: The Rise of Chronic Illness - between 1900 and 1955, the national crude mortality rate decreased by 47%. Many more Americans survived childhood and early adulthood to live into middle and older ages. - The leading causes of death changed from communicable. diseases (e.g., pneumonia) to ______ diseases (e.g., heart disease). - As the _____ population grew, so did the prevalence of chronic illness. - Some visit nurse associations adopted coordinated _____ care programs to provide complex, long-term care to the chronically ill, often after long-term hospitalization - the increased prevalence of chronic illness also encouraged a resurgence in combination agencies- the joint operation of official (city or county) health departments and voluntary agencies

chronic, aged, home

History of Public Health and Public and Community Health Nursing: Public Health Nursing From the 1970s into the 21st Century (1 of 4) 1970s- - During the 1970s, nursing was viewed as a powerful force for improving the health care of ________. - Nurses made significant contributions to the hospice movement, the development of birthing centers, day care for older adults and disabled persons, drug abuse programs, and long-term rehabilitationf care.

communities

History of Public Health and Public and Community Health Nursing: Public Health Nursing From the 1970s into the 21st Century (3 of 4) 1990s- - The health care debate in the 1990s focused on _____, _____, and _____ to direct care services. - The core economic debate emphasized ______ of medical care rather than comprehensive changes in health promotion, disease prevention, and health care. In 1991, the ANA, the American Association of Colleges of Nursing, the National League for Nursing, and more than 60 other specialty nursing organizations joined to support health care reform. The coalition organizations emphasized key health care issues of access, quality, and cost and proposed a range of interventions designed to build a healthy nation through improved primary care and PH efforts.

cost, quality, access, reform

History of Public Health and Public and Community Health Nursing: Nightingale and the Origins of Trained Nursing (1 of 3) Need for Nurses- - previous caregiving structures, which relied on assistance of family, neighbors, and friends, became inadequate in the early nineteenth century because of human migration, urbanization, changing ______, and an increasingly complex practice of medicine. Origins of Organized Nursing- - Nightingale carefully studied nursing "system and method" by visiting _____ ______ ______ at his deaconess training school in Kaiserwerth, Germany. - Nightingale implemented her ideas about nursing during the _____ _____. She progressively improved soldiers' health outcomes by using a _______-based approach that strengthened environmental conditions and nursing care. Using simple epidemiologic measures, she documented decreased mortality rate from 415 per 1000 at the beginning of the war to 11.5 per 1000 at the end.

demand, pastor theodor fliedner, crimean war, population

History of Public Health and Public and Community Health Nursing: Nightingale and the Origins of Trained Nursing (3 of 3) William Rathbone- - Nightingale's contemporary and friend, British Philanthropist William Rathbone, founded the first ______ ______ association in Liverpool, England. - Rathbone's wife had received outstanding nursing care from a Nightingale-trained nurse during her terminal illness at home. He wanted to offer similar care to relieve the suffering of poor persons unable to afford private nurses. - Together Rathbone and Nightingale recommended steps to provide nursing in the _____, leading to the organization of district nursing in England. Florence Sarah Lees Craven- - Florence Sarah Lees Craven shaped the ______ nursing profession through her book A Guide to District Nurses, which highlighted, for example, that nursing care during the illness of one family member provided the nurse with influence to improve the entire family's health.

district nursing, home, district

Environmental Health: Vulnerable Populations - many of the social determinants of health continuer to the risk levels associated with environmental exposures. _______ Factors- - poor people who live in low-income communities are more often housed in substandard housing, live in close proximity to pollution sources, employed in more dangerous occupations, and have less access to healthy foods. _____ _____ Factors- - the very young and very old populations are more vulnerable due to less efficient body systems - for more information about the special vulnerabilities of the elderly, the EPA created the report titled "Growing Smarter/Living Healthier: A Guide to Smart Growth and Active Aging"

economic, life cycle

History of Public Health and Public and Community Health Nursing: The Profession Comes of Age National Organization for PHN (NOPHN)- - overall goal was to standardize PHN ________ - the NOHPN sought to "improve the educational and services standards of the public health nurse, and promote public understanding of and respect for her work." Lillian Wald was elected as the first president. - membership included both nurses and their lay supporters - in 1914, there was the first post-training school course in PHN, and in the 1920s to 1930s many newly hired PHNs had to verify completion in a certificate program in PHN American Public Health Association (APHA)- - established in 1972 to facilitate _______________ ________, and to promote the practical application of public _______ (ex: public health issues including sewage and garbage disposal, occupational injuries, and STDs)

education, interprofessional teamwork, hygiene

Public Health Nursing Practice and the Disaster Management Cycle: The Disaster Management Cycle Response- - the first level of response to any event occurs at the local level with the mobilization of _____ ______ such as fire department, law enforcement, public health, and emergency services. - the National Response Framework (NRF) was written to provide an approach to domestic incidents in a unified, well-coordinated manner, enabling all responding entities the ability to work together more effectively and efficiently. It includes 15 emergency support functions (ESFs) - The National Incident Management System (NIMS) is a comprehensive approach to incident management, and consists of concepts and principles that guide management of all types of incidents. - response to biological incidence is handled by ________ programs, which help public health professionals mount a proactive response to these events

first responders, biodefense

History of Public Health and Public and Community Health Nursing: Public Health Nursing From the 1970s into the 21st Century (2 of 4) 1980s- - in the 1980s there were ______ challenges - concerns grew about the _____ costs of healthcare - programs for health promotion and disease prevention received less priority as funding was shifted to meet the escalating costs of ______ hospital care, medical procedures, and institutional long-term care. - The National Center for Nursing ______ (NCNR) was established in 1985 within the federal National Institutes of Health (NIH), and had major impact on promoting the work of nurses. Through research, nurses analyze the scope and quality of care provided by examining the outcomes of cost-effectiveness of nursing interventions. - The Institute of Medicine's report The _____ of Public Health (1988) found the US's PH system in disarray and concluded that, although there was widespread agreement about what the mission of PH should be, there was little consensus on how to translate that mission into action. - ______ _______ initiative began and proposed a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases

funding, high, acute, research, future, healthy people

Public Health Nursing Practice and the Disaster Management Cycle: Community's Stress Reactions - communities reflect the individuals and families living in them, both during and after a disaster incident. - four community phases are commonly recognized, which are (1) _______, (2) ________, (3) _________, and (4) __________. - the first two phases are often associated with response efforts, and the latter two phases are often linked with recovery. - the first phase is an overwhelming need for people to do whatever they can do to help others survive the disaster - in the second phase survivors may be rejoicing that their lives and the lives of their loved ones have been spared - in the third phase, time elapses and people notice that additional help and reinforcement are not coming as quickly as in the initial response, which may lead to fatigue, gloom, and exhaustion. - the last phase is the longest, where things will be rebuilt and reestablishesd.

heroic, honeymoon, disillusionment, reconstruction

History of Public Health and Public and Community Health Nursing: PH During America's Colonial Period and the New Republic - in the early years of America's settlement, as in Europe, the care fo the sick was usually informal and was provided by _______ members, almost always women, which meant more than nursing them in sickness and during childbirth. She was also responsible for gathering healing herbs for use throughout the year. for the increasing numbers of urban residents in the early 1800s, this traditional system became insufficient. - England's ________ _____ _____ of 1601 guaranteed medical care for poor, blind, and "lame" individuals, even those without family. Colonial America's ideas of social welfare and care of the sick were strongly influenced by this law. 1751 Pennsylvania Hospital was the first hospital in what would become the US. - Early colonial _____ _____ efforts included the collection of vital statistics, improvements to sanitation systems, and control of any communicable disease introduced through seaports. Colonists lacked a mechanism to ensure PH efforts would be supported and enforced. Epidemics taxed the limited organization for health during the seventeenth, eighteenth, and nineteenth centuries.

household, elizabethan poor law, public health

Public Health Nursing Practice and the Disaster Management Cycle: Disaster Facts - disasters can affect one family at a time, as in a house fire, or they can kill thousands and result in economic losses in the millions, as with floods, earthquakes, tornadoes, hurricanes, tsunamis, and bioterrorism Disaster Events- - range from affecting _______ to entire ________ - continue to rise worldwide - disproportionately strike at-risk individuals - consistently more costly to recover from

individuals, communities

History of Public Health and Public and Community Health Nursing: School Nursing in America - in 1902, more than 20 percent of children might be absent from school on a single day. the children suffered from common conditions of pediculosis, ringworm, scabies, inflamed eyes, discharging ears, and infected wounds. - ______ ______ became the first US school nurse, and found out that ______ was often not the reason for absence. The school nurses found that "many children were absent for lack of shoes or clothing, because of malnourishment, or because they were serving their families as babysitters" - the school nurse experiment made such as significant and positive impact that the innovation became permanent, and school nursing soon spread to more major cities.

lina rogers, illness

History of Public Health and Public and Community Health Nursing: PHN in Official Health Agencies and in World War I - in the late 1800s, ______ health departments were formed in urban areas to target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties - in 1912 the federal government redefined the _____ of the US Public Health Service, empowering it to "investigate the causes and spread of diseases and the pollution and sanitation of navigable streams and lakes" - World War I depleted the ranks of Public Health Nurses, and the Red Cross agreed that the greatest patriotic duty of PHNs was to stay at home. - in 1918, the influenza pandemic swept the US within 3 weeks. houses, churches, and social halls were turned into hospitals to care for the immense numbers of sick and dying.

local, role

Public Health Nursing Practice and the Disaster Management Cycle: National Disaster Planning and Response - the ______ _____ ______ _____ is the most important system to know. This is a unified, all-discipline, and all-hazards approach to domestic incident management. it was established to provide a common _______ and structure enabling all those involved in disaster response to communicate with each other more effectively and efficiently

national incident management system, language

Public Health Nursing Practice and the Disaster Management Cycle: Defining Disasters - A disaster is any ______ or ______-made incident that causes disruption, destruction, or devastation requiring external assistance - in the disaster response phase, the incident ____ and ______ predict subsequent injuries and illnesses - disasters with little or no advance notice, such as terrorism events, will often have more casualties because those affected have little time to make evacuation preparations. - disasters with warnings also carry their own dangers, because individuals can be injured attempting to prepare for the disaster or while evacuating

natural, human, type, timing

History of Public Health and Public and Community Health Nursing: Between the Two World Wars - The economic depression of the 1930s deeply influenced the development of nursing. Agencies and communities were unprepared to address the increased _______ and numbers of the impoverished, and decreased _______ for nursing services reduced the number of employed nurses in hospitals and in community agencies. - Agencies created to support nurse employment included the Federal Emergency Relief Act (FERA), Works Progress Administration (WPA), Relief Nursing Service, and Civil Works Administration (CWA) programs. - an 1932 survey of PH agencies found that only 7% of nurses working in PH were adequately prepared

needs, funding

Public Health Nursing Practice and the Disaster Management Cycle: Recovery - recovery is about returning to the new _____, a community balance of infrastructure and social welfare that is near the level that it would have been if the event had not occurred - the recovery phase is often the hardest part of a disaster, as it involves ongoing work beyond preparedness and the response rush - after a large-scale incident, the federal government provides _________ with rebuilding property, restoring lifelines, and restoring economic institutions. - there is a gradual shift in support from short-term aid to long-term support for communities: sustainment of efforts

normal, assistance

Public Health Nursing Practice and the Disaster Management Cycle: How Disasters Affect Communities- - _____ ______ recognizes that the health of humans is connected to the health of animals and the environment, and the One Health concept integration in disaster preparedness and response requires interprofessional efforts at global, national, and local levels. The spread of infectious diseases and the relationship among ______, ______, and the ______ is at the core of One Health. Stress Reactions in Individuals- - a traumatic event can cause moderate to severe stress - people who are affected by a disaster often will have an exacerbation of a ______ disease - older adults' reactions to disaster depend a great deal on their physical health, income, strength, mobility, and independence. - the effect of disasters on young children can be especially disruptive, and they may respond with ________ behaviors such as thumb-sucking, bedwetting, crying, and clinging to parents.

one health, humans, animals, environment, chronic, regressive

History of Public Health and Public and Community Health Nursing: Public Health Nursing From the 1970s into the 21st Century (4 of 4) 2000s- - The Health Care Reform was passed in 2010 with the passage of the federal ______ _____ and ______ ______ Act. - PHN organizations developed ______ ______ on the following: graduate education for advanced practice PHN, faculty qualifications for community/public health nursing educators, and importance of PHN within PH systems.

patient protection and affordable care act, position papers

Public Health Nursing Practice and the Disaster Management Cycle: The Disaster Management Cycle Preparedness- - public health nurses play a key role in community preparedness, but they must accomplish the critical elements of personal and professional preparedness first _________ Preparedness- - disaster kits for home, workplace and care __________ Preparedness- - nurses who seek increased participation or who seek a better understanding of disaster management can become involved in any number of community organizations. - the national disaster medical system (NDMS) provides nurses the opportunity to work on specialized teams such as the disaster medical assistance team (DMAT) - the medical reserve corps (MRC) and the community emergency response team (CERT) provide opportunities for nurses to support emergency preparedness and response in their local jurisdictions

personal, professional

Public Health Nursing Practice and the Disaster Management Cycle: Role of the Public Health Nurse - public health nurses bring leadership, policy, _______, and practice _______ to disaster preparedness and response. - public health nursing roles in disaster are generally consistent with the scope of public health nursing practice, but that practice is often provided in chaotic surges - some of these roles include first responder, epidemiology and ongoing surveillance, rapid needs assessment, disaster communication, disaster response ethics, and sheltering

planning, expertise

History of Public Health and Public and Community Health Nursing: Public Health Nursing Today - In the last decades, new and continuing challenges have triggered growth and change in nursing. - New _________ in communities continue to challenge schools of nursing, health departments, rural health clinics, and migrant health services to provide the range of services to meet specific needs, including the needs of new immigrants. - Nurses ________ PHN for higher salaries has also been a challenge. The Association of Community Health Nurse Educators calls for increased graduate programs to educate public health nurse leaders, educators, and researchers. - ________ disasters (such as floods, hurricanes, and tornadoes) and ______-made disasters (including explosions, building collapses, airplane crashes, and bioterrorism) require innovative and time consuming responses, and an increased demand for well-prepared nurses.

populations, leaving, natural, human

Environmental Health: Environmental Health Risk Reduction - apply basic principles of disease _______, which is a core goal in PHN Every nurse's role in risk reduction- - shift to electronic records, thus avoiding the use of paper. when paper is a must, use products that are made from recycled ingredients - recycle: paper, glass, cans, plastic, small batteries, blue wrap, electronic equipment - work with suppliers to get products with minimal packaging and the safest ingredients possible - promote the use of green cleaners - go fragrance free - turn off lights, computers, patient monitoring equipment, etc. when rooms are not being used - report leaky sinks, toilets, and other plumbing sources - promote the purchase of local, sustainably grown foods - start a Green Team - create community while doing these activities and build relationships- it makes the whole process more meaningful and fun

prevention

Public Health Nursing Practice and the Disaster Management Cycle: The Disaster Management Cycle and Nursing Role - disaster management includes four stages: ________ (including mitigation and protection), ________, ________, and _________ - nurses have unique skills for all aspects of disaster, including assessment, priority setting, collaboration, addressing both preventive and acute care needs. - additionally, public health nurses have a skill set that serves their ________ well in disaster, including health education and disease screening, mass clinic expertise, an ability to provide essential public health services, community resource referral and liaison work, population advocacy, psychological first aid, public health triage, and rapid needs assessment - nurses have been serving in disasters for more than a century, and to this day, provide a significant resource to both the employee and volunteer disaster management workforce, unmatched by any other profession

prevention, preparedness, response, recovery, community

History of Public Health and Public and Community Health Nursing: After the American Revolution - After the American revolution, the threat of disease, especially yellow fever epidemics, encouraged public support for new government-sponsored, official boards of health. - US _____ ______ ______ (PHS) was established 1798 as the Marine Hospital Service - During the early 1800s, experiments in providing nursing care at _____ focused on moral improvement and less on illness intervention. The Ladies' Benevolent Society of Charleston provided charitable assistance to the poor and sick beginning in 1813. Lay nurses care for postpartum women and newborns in their homes. The Roman Catholic Sisters of Charity began a visiting service in 1854. - The _____ _____ was published in 1850 by the Massachusetts Sanitary Commission with an emphasis on the public's health. The report called for major innovations: the establishment of a state health department and local health boards in every town; sanitary surveys and collection of vital statistics; environmental sanitation; food, drug, and communicable disease control; well-child care; health education; tobacco and alcohol control; town planning; and the teaching of preventive medicine in medical schools. However, these recommendations were not implemented in Massachusetts for 19 years, and in other states much later.

public health service, home, shattuck report

History of Public Health and Public and Community Health Nursing: Nightingale and the Origins of Trained Nursing (2 of 3) Principles of Nursing- - nightingale emphasized _____ _____ nursing: "the health of the unity is also the health of the community. unless you have the health of the unity, there is no community health" - she also differentiated "sick nursing" from "health nursing." the latter emphasized that nurses should strive to _____ health and ______ illness. - nightingale stated that proper nutrition, rest, sanitation, and hygiene were necessary for health

public health, promote, prevent

Environmental Health: Children's Environmental Health - children's bodies operate differently that adult, putting them at. a potentially increased risk for toxic exposure. - children have increased ________ _____ which translates to a proportionately greater exposure to air pollutants - they have an immature blood-brain barrier which allows more toxic things to cross - they have less effective kidneys at _______ undesirable chemicals

respiratory rate, filtering

History of Public Health and Public and Community Health Nursing: Increasing Federal Action for the Public's Health - The ______ ______ Act of 1935 was designed to prevent reoccurrence of the problems of the Depression. - It provided funding for expanded opportunities for health protection and promotion through _______ and employment of PH nurses. - It also funded assistance to states, counties, and medical districts in establishing adequate health services - It also provided funds for ______ and investigation of disease

social security, education, research

History of Public Health and Public and Community Health Nursing: African American Nurses in PHN - African Americans experienced wage discrimination in the ______, and were paid significantly lower salaries than their white counterparts for the same work. - the National Health Circle for Colored People (1919) was established to promote public health work in African American communities in the south. It provided _______ to assist African American nurses to pursue university-level public health nursing education. ______ ____ was the first recipient. - In 1936, the US public health service and the medical college of Virginia established a PHN ________ program for African American nurses - nursing education continued to be segregated in the south until the _______

south, scholarships, bessie hawes, certificate, 1960s

Public Health Nursing Practice and the Disaster Management Cycle: Psychological Stress of Disaster Workers - disaster relief work can be challenging and stressful, and workers are at risk for ______ reactions - during an assignment, responders may be exposed to chaotic environments, loud noises, inadequate workspace, physical danger, and stimulus overload, especially exposure to death and trauma - they may not recognize the need for self-care and to monitor their own physical and emotional health - symptoms that may signal a need for stress management _________ include the following: being. reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risk-taking activities; difficulty communicating thoughts, remembering instructions, making decisions or concentrating; engaging in unnecessary arguments; having a limited attention span; refusing to follow orders - physical symptoms can also occur such as tremors, headaches, nausea, and colds or flulike symptoms

stress, assistance

History of Public Health and Public and Community Health Nursing: Change and Continuity - Although ______ to health have changed overtime, the foundational principles and _____ of public health nursing have remained the same. - many communicable disease, such as diphtheria, cholera, and typhoid fever have been largely controlled in the US, but others continue to affect many lives across the globe, including HIV, poliomyelitis, tuberculosis, and coronavirus. - health concerns are ________. emerging and re-emerging communicable diseases, for example, influenza subtypes, poliomyelitis, and the Ebola virus underscore the global nature of health concerns.

threats, goals, international

History of Public Health and Public and Community Health Nursing: District Nursing and Settlement Houses (1 of 2) - Deplorable environmental conditions for immigrants in urban tenement houses and sweatshops were common across the northeastern US and upper midwest. People living in poor housing conditions were ravaged by epidemics of communicable diseases. - ______ nurses became key to the prevention of communicable disease education campaign - public health nurses also established _______ homes, which were neighborhood centers that became hubs for health care, education, and social welfare programs - for example, _____ _____ established the Henry Street Settlement and the Visiting Nurse Service of New York City to help the poor. - _____ ______ emerged as the established leader of public health nursing during its early decades (founder of public health nursing)

visiting, settlement, Lillian Wald, Lillian Wald,

Environmental Health: Climate Change - According to WHO, "climate change is a significant and emerging threat to public health, and changes the way we must look at protecting _________ populations." Nurses' Main Roles- - _________: working at individual, community, institutional, and governmental levels to ensure energy-concerning policies and practices - ________: public health nurses must be prepared for increased fire- and storm-related disasters. Greenhouse Gases- - climate change is the result of the earth's warming because of the blanketing effect that is occurring from gases that are primarily man-made and collectively referred to as greenhouse gases - the ________ effect is the warming from manmade gases, and the _______ effect is due to manmade gases going into the atmosphere and blocking the effects of the sun

vulnerable, mitigation, response, blanketing, greenhouse

Environmental Health: Community Wide Environmental Health Assessment Tools - A ______ ______ is a helpful first step in understanding the potential environmental health risks in a community. In urban communities you want to note proximity to factories, dump sites, major transportation routes, and other sources of pollution. In rural communities you want to note if and when there are aerial and other types of pesticide and herbicide spraying; if people rely on wood-burning stoves; if there are industrial-type agricultural practices and/or contaminated waterways - ______-______ disorder was coined by author Richard Louv in his book Last Child in the Woods to describe what happens to young people who become disconnected from their natural world. He links the lack of nature to some of the most disturbing childhood trends such as rises in obesity, attention disorders, and depression - ________ environmental factors are factors that can positively contribute to a community's health such as green spaces, bike paths, and walkable communities.

windshield survey, nature-deficit, positive

History of Public Health and Public and Community Health Nursing: America Needs Trained Nurses Need for PH Nursing- - as urbanization increased during the Industrial Revolution in the 1800s, the number of occupations open to ______ rapidly increased - trained nurse graduates of early schools for nurses usually worked in _____ ______ nursing or held the few positions as hospital administrators or instructors - private duty nurses might live with families of clients receiving care, to be available 24 hours a day. The cost of private duty nursing care for the sick at home was prohibitive for all but the wealthy. - the care of the sick poor at home was made more economical by having ____-_____ nurses attend several families in a day rather than attend only one patient as the private-duty nurse did

women, private duty, home-visiting

Communicable and Infectious Disease Risks: Sexually Transmitted Diseases Genital Herpes: - two types of herpes simplex viruses (HSV-1 and HSV-2) cause genital herpes, but the majority of cases are caused by _____-___, although there is an increasing number of cases caused by _____-___ - there is no _____ Transmission- - direct exposure; infects genitalia and skin - virus can remain ______ and reactivate periodically HSV-2 Occurrence- - of particular concern to women and children - linked with the development of _____ cancer - increased risk of _____ newborn infection during vaginal delivery with active lesions

HSV-2, HSV-1, cure, latent, cervical, fatal

Environmental Health: Individual Environmental Exposure History - when working with individuals, it is important to include environmental health risks as part of a client's history - A helpful pneumonic was developed to assist health professionals in remembering the areas of concern when taking an environmental history, which is "__ ________" - I: _______ ________ ________- Have you ever felt sick after coming into contact with a chemical, such as pesticide or other substances? Do you have any symptoms that improve when you are away from your home or work? - P: _______ _______- Are you exposed to solvents, dust, fumes, radiation, loud noises, pesticides, other chemicals? Do you know where to find material safety data sheets for chemicals with which you work? Do you wear PPE? Are work clothes worn home? Do coworkers have similar health problems? - R: _______- When was your residence built? What type of heating do you have? Have you recently remodeled your home? What chemicals are stored on your property? Where is the source of your drinking water? - E: _______ ______- Are there environmental concerns in your neighborhood (e.g., air, water, soil)? What types of industries or farms are near your home? Do you live near a hazardous waste site or landfill? - P: _______ _______- What are your past work experiences? What job did you have for the longest period of time? Have you ever been in the military, worked on a farm, or done volunteer or seasonal work? - A: ________- What activities and hobbies do you and your family pursue? Do you burn, solder, or melt any products? Do you garden, fish, or hunt? Do you eat what you catch or grow? Do you use pesticides? Do you engage in any alternative healing or cultural practices? - R: Referrals and Resources- Environmental protection agency, agency for toxic substances and disease registry, etc. - E: ________- Are materials available to educate the client? Are alternatives available to minimize the risk of exposure? Have prevention strategies been discussed? What is the plan for follow-up?

I PREPARE, investigate potential exposures, present work, residence, environmental concerns, past work, activities, educate

Public Health Surveillance and Outbreak Investigation: Purposes of Surveillance The overall purposes of surveillance are as follows- - _______ public health status - ______ public health priorities - _______ programs - _______ research - surveillance helps public health departments identify trends and unusual disease patterns, set priorities for using scarce resources, and develop and evaluate programs for commonly occurring and universally occurring diseases or events - surveillance falls under the _______ core PH function

assess, define, evaluate, stimulate, assessment

Infectious Disease Prevention and Control: Transmission of Communicable Diseases - the transmission of communicable diseases depends on the successful interaction of the infectious _____, the ______, and the ______. These three factors make up the _______ _______. - Changes in the characteristics of any of these factors may result in disease ___________

agent, host, environment, epidemiologic triangle, transmission

Epidemiology: Basic Concepts In Epidemiology Epidemiologic Triangle- - epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. these three elements, ______, ______ and ______, are traditionally referred to as the epidemiologic triangle - the model was originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases. changes in one of the elements of the triangle can influence the occurrence of disease by increasing or decreasing a person's risk for disease. - specific characteristics of agent and host, as well as the interactions between the agent and host, are influenced by the environmental context in which they exist, and may in turn influence the environment. - examples of agent: infectious agents (e.g., bacteria, viruses, fungi, parasites), chemical agents (e.g., heavy metals, toxic chemicals, pesticides), and physical agents (e.g., radiation, heat, cold, machinery) - examples of host: genetic susceptibility, ________ characteristics (e.g., age, sex), acquired characteristics (e.g., immunologic status), and lifestyle factors (e.g., diet, exercise) - examples of environment: climate (e.g., temperature, rainfall), plant and animal life (e.g., agents, reservoirs, habitats for agents), human population distribution (e.g., crowding, social support), socioeconomic factors (e.g., education, resources, access to care), and working conditions (e.g., levels of stress, noise, satisfaction)

agent, host, environment, immutable

Communicable and Infectious Disease Risks: Tuberculosis Transmission- - usually occurs through exposure to the tubercle bacilli in ______ _______ from persons with pulmonary tuberculosis who cough, talk, or sneeze Common Symptoms- - cough, fever, fatigue, hemoptysis, chest pains, weight loss Epidemiology: - WHO reports 12 million cases in 2012 and 1.3 deaths due to TB - Southeast Asia and western pacific region account for 58% - africa accounts for 25% of cases - in the US, half of new cases are in NY, FL, TX, and CA Drug-Resistant TB- - __________ resistant TB is resistant to rifampin and isoniazid - _________ drug-resistant TB is resistant to rifampin and isoniazid, plus added resistance to fluoroquinolones, and at least 3 injectable second-line drugs (e.g., amikacin, kanamycin, and capreomycin)

airborne droplets, multidrug, extremely

Infectious Disease Prevention and Control: Vector Borne Disease - vector-borne diseases refer to illnesses for which the infectious agent is transmitted by a carrier, or vector, usually an arthropod (mosquito, tick, fly), either biologically or mechanically. - With _______ transmission, the vector is necessary for the developmental stage of the infectious agent. examples include mosquitoes that cary Zika virus and the fleas that transmit plague - ________ transmission occurs when an insect simply contacts the infectious agent with its legs or mouth parts and carries it to the host. for example, flies and cockroaches may contaminate food or cooking utensils. Lyme disease- - usually occurs in the _______ during tick season in rural and suburban areas of the northeast, mid-atlantic, and north-central states, particularly Wisconsin and Minnesota Rocky Mountain Spotted Fever- - most commonly occurs in the ______, Oklahoma, Kansas, and Missouri Prevention and Control of Tick-Borne Diseases- - measures for preventing exposure to ticks include reducing tick populations, avoiding tick-infested areas, wearing protective clothing when outdoors (long sleeves and long pants tucked into socks), using repellants, and immediately inspecting for and removing ticks when returning indoors

biological, mechanical, summer, southeast

Communicable and Infectious Disease Risks: Sexually Transmitted Diseases Syphilis: - syphilis is caused by a member of the treponema group of spirochetes called Treponema palladium, which infects moist mucous or cutaneous membranes. Direct Contact- - syphilis is spread through direct contact, usually by sexual contact or from mother to fetus. transmission via _____ ______ may occur if the donor is in the early stages of the disease. Highest Rates- - ____ having sex with men; recently the number of women infected has increased Clinical Signs- - the clinical signs of syphilis are divided into primary, secondary, and tertiary infections. - primary: usually single, painless chancre: if untreated, heals in a few weeks - secondary: low-grade fever, malaise, sore throat, headache, lymphadenopathy, and rash - tertiary: occurs in about 1/3 of ______ syphilis patients, which can lead to blindness, congenital damage, cardiovascular damage, etc. _________ Syphilis- - is transmitted transplacentally, and if untreated, can cause premature stillbirth, blindness, deafness, facial abnormalities, crippling, or death

blood transfusion, men, untreated, congenital

Communicable and Infectious Disease Risks: Hepatitis Hepatitis B Virus (HBV) - spread through _____ and _____ ______ - remains alive outside the body for at least 1 week High-Risk Groups: - users of injections drugs - persons with STDs or multiple sex partners - immigrants/refugees and their descendants who came from areas with a high endemic rate - _____ _____ workers - clients on hemodialysis - inmates of long term correctional institutions Acute or Chronic Infections- - the acute infection is self limited: individuals develop an _______ to the virus and successfully eliminate the virus from the body. they subsequently have lifelong immunity against the virus - chronically infected individuals are unable to rid. their bodies of the virus and remain lifelong carriers of the hepatitis B surface antigen. as carriers, they can transmit the virus to others. they may develop hepatitis carcinoma or chronic active hepatitis Prevention- - there is a ______ available - _______ regulations mandate specific activities to protect workers from HBV and other blood borne pathogens. requires employers to identify the risk of blood exposure to various employees. if employees perform work that involves a potential exposure to others' body fluids employers are mandated to offer the vaccine at the employers expense and to offer educational programs on prevention. employees do have the risk to refuse the vaccine

blood, body fluids, health care, antibody, vaccine, OSHA

Epidemiology: Basic Concepts of Epidemiology Web of Causality- - a two-dimensional _____ web that considers _______ factors that affect health and disease - reflects the more complex interrelationships among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease - associations are sometimes mutual, with lines of causality going in both directions (looks like a spider web) - researches have suggested that induction to researching the relationships within the web, we need to look for "the spider," that is focus on the larger factors and contexts that influence or create the causal web itself

causal, multiple

Environmental Health: Environmental Health Services Toxicology- - Toxicology is the basic science that contributes to our understanding of health effects associated with ______ exposures, which was historically referred to as the "study of poisons." - In toxicology, only the ______ effects of chemical exposures are studied. - Both pollutants and drugs can enter the body from a variety of routes, such as lungs, GI tract, skin, etc. - Most chemicals cross the placental barrier and can affect the fetus, just as most chemicals cross the blood-brain barrier. In addition to direct damage to cells, tissues, organs, and organ systems, there can be changes to the _____ from chemical exposures that can chance gene expression which, in turn, can predict disease. The latter effect is the focus of a relatively new biological study, ______ - individuals have unique responses to chemical exposures due to a variety of things such as age, weight, other drugs taken, and underlying health conditions - chemicals that are similar are often grouped into categories or "families" so that it is possible to understand the actions and risks associated with those groupings

chemical, negative, DNA, epigenetics

Infectious Disease Prevention and Control: Historical and Current Perspectives - in the US, at the beginning of the 20th century, infectious diseases were the leading cause of death. respiratory diseases (e.g., tuberculosis), and diarrheal diseases were major killers - infectious disease is still a leading cause of death in ________ worldwide; and the second-leading cause of death overall - current concerns include HIV, pneumonias and influenzas, VRSA and MRSA, and severe acute respiratory syndrome (SARS). Although MRSA is still largely a health-care associated infection, a ________-associated form of the disease is becoming more common with outbreaks frequently associated with school athletic programs and prison populations

children, community

Infectious Disease Prevention and Control: Burden and Financial Impact of Infectious Diseases - worldwide, infectious diseases are the leading killer of ________ and are responsible for almost half of all deaths in low-income countries - of these infectious disease deaths, the majority result from five causes: acute lower respiratory infections, diarrheal diseases, TB, HIV disease, and malaria - Because of the morbidity, mortality, and associated cost of infectious diseases, the national health promotion and disease prevention goals outlined in healthy people 2020 list a number of objectives for reducing the incidence of these illnesses in a variety of the sections, including __________ and infectious disease

children, immunization

Communicable and Infectious Disease Risks: Hepatitis Hepatitis C Virus (HCV)- - most common ______ ______ infection in the US - spread rapidly during 1980s Transmission- - _____ or _____ _____ of an infected person enter an unaffected person - there is a 2 week-6 month ______ period where they may not have symptoms, making it more likely to be spread High-Risk Groups- - health care workers and emergency personnel who are accidentally exposed - infants who are born to infected mothers - injection drug users, particularly those who share needles or other drug use equipment - those born between 1945 and 1965 - do not need to be screened unless high risk Chronic Liver Disease from HCV- - the twelfth leading cause of death in adults in the US - most common reason for _____ ______

chronic blood borne, blood, body fluids, incubation, liver transplant

Communicable and Infectious Disease Risks: HIV Stage 3 (AIDS) in the Community - AIDS is a _____ disease, so individuals continue to live and work in the community. When ill, much of their care is provided in the _____, where the nurse teaches families and significant others about personal care and hygiene, medication administration, etc. - ______ to HAART is critical for clients because administration must be consistent to be effective - the Americans with Disabilities Act of 1990 and other laws protect persons with asymptomatic HIV infection and AIDS against ________ in housing, at work, and in other public situations. - Mental Health issues such as depression, substance abuse, and bipolar disorder, often present in someone newly diagnosed with HIV. these conditions must be addressed prior to or simultaneously with HIV treatment to be effective. - HIV Infected children should attend school because the benefit of ________ far outweighs the risk of transmitting or acquiring infections.

chronic, home, adherence, discrimination, attendance

Environmental Health: Environmental Health Sciences Geographic Information Systems - a relatively new research tool for environmental health studies is geographic information systems (GISs), which provide a methodology for ______ data so that it is related ______ to a place on earth ("mapping") - Community-based maps, created using GIS technologies, are helpful in ________ community members and policy makers because people can easily see familiar locations and where health and environmental exposures may be the most serious. It helps to provide _______ depictions of public health problems. - For example: nurse researcher Mona Choi used GIS to study the relationship between air pollution and emergency visits for cardiovascular and pulmonary diagnosis.

coding, spatially, educating, graphic

Epidemiology: Analytic Epidemiology - analytic epidemiology seeks to discover the determinants of outcomes, or the how and the why (i.e., the factors that influence observed patterns of health and disease and increase or decrease the risk of adverse outcomes) - the ______ study is the standard for observational epidemiological studies, coming closest to the ideal of a natural experiment. a cohort refers to a group of persons (generally sharing some characteristic of interest) enrolled in a study and followed over a period of time to observe some health outcome. - in the _____-______ study, participants are enrolled because they are known the have the outcome of interest (cases) or they are known not to have the outcome of interest (controls) - the _____-______ study provides a snapshot, or cross-section, of a population or group.

cohort, case-controlled, cross-sectional

Public Health Surveillance and Outbreak Investigation: Investigating Patterns of Disease Occurrence - patterns of occurrence can be identified when investigating disease or event. these patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem - a ______ source outbreak refers to a group exposed to common noxious influence such as the release of noxious gases - in a _____ source outbreak, all persons exposed became ill at the same time, during one incubation period - a ________ outbreak is "when a victim of a common source epidemic has person-to-person contact with others and spreads the disease, further propagating the health problem," as in spreading the flu - ________ or continuous source cases may be exposed over a period of days or weeks, as in food poisonings from restaurants - a __________ outbreak does not have a common source and spreads gradually from person to person over more than one incubation period, such as the spread of tuberculosis from one person to another. - causal factors from the epidemiological triangle include infectivity (capability of agent to produce infection), pathogenicity (proportion of infected people who develop the disease), virulence (the proportion of people with clinical disease who become ill or die)

common, point, mixed, intermittent, propagated

Epidemiology: Applications of Epidemiology in Nursing - _______-______ epidemiology: nurses are often involved in environmental health issues, where they play important roles not only as epidemiologists but also as community liaisons. the role of community liaison involves observation, data collection, consultation, and interpretation. - ________ epidemiology: a form of epidemiology in which lay people gather scientific data as well as mobilize knowledge and resources of experts to understand the occurrence and distribution of a disease or injury

community-oriented, popular

Public Health Surveillance and Outbreak Investigation: Steps in an Investigation - first ______ the existence of an outbreak - _____ the diagnosis/define a case - _____ the number of cases - orient data collected to person, place, and time - develop and evaluate a _______ - finally ______ control measures and share findings

confirm, verify, estimate, hypothesis, institute

Environmental Health: Introduction to Environmental Health - an estimated 24% of the global health burden of disease and 23% of all deaths can be attributed to environmental factors - The Who defines different environmental factors as physical, chemical, biological, social and psychosocial - besides using these Who factors, we can also divide and examine the environment from the perspective of the media in which environmental __________ takes place: air, water, soil, and food. - and a third approach would be to divide environmental _______ into categories: biological, chemical, and radiological

degradation, exposures

Public Health Surveillance and Outbreak Investigation: Disease Surveillance Definitions - _______ _______ is the ongoing systematic collection, analysis, interpretation, and dissemination of specific health data for use in public health - surveillance is important because it generates knowledge of a disease or _______ outbreak pattern (including timing, geographic distribution, and susceptible populations) - surveillance focuses on the collection of two types of data. _______ data focuses on what is done (i.e., services provided or protocols for health care delivery), and _______ data focuses on changes in health status. - _________ is defined as "the intentional use of microorganisms or toxins derived from living organisms to cause death or disease in humans or the animals and plants on which we depend on" - ______ ______ is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing

disease surveillance, event, process, outcome, bioterrorism, chemical terrorism

Epidemiology: Basic Concepts in Epidemiology Social Epidemiology- - is a branch of epidemiology that studies that social _________ and social ________ of health and disease - focuses on the roles and mechanisms of specific social phenomena (e.g., socioeconomic stratification, social networks and support, discrimination, and work and employment demands) - examines social _________ and data related to neighborhoods, communities, employment, and family conditions to analyze health issues and to design appropriate and feasible public health interventions

distribution, determinants, inequalities

Public Health Surveillance and Outbreak Investigation: Types of Surveillance Systems - informatics is essential to the mission of protecting the public's health - surveillance systems are designed to assist PH professionals in the _____ detection of disease/event outbreaks in order to intervene and reduce the potential for morbidity or mortality, or to improve the public's health status - surveillance systems in use today are defined as ______, _____, _____, and _____

early, passive, active, sentinel, special

Environmental Health: Environmental Health Sciences Multidisciplinary Approaches- - In addition to toxicology and epidemiology, there are a number of _______ sciences that help us understand how pollutants _______ in air, water, and soil. Geologists, meteorologists, physicists, and chemists all contribute information to help explain how and when humans may be exposed to hazardous chemicals, radiation, and biological contaminants. - Key _____ ______ professionals include food safety specialists, registered environmental health specialists, radiation specialists, and industrial hygienists. - PH Professionals: we might also add a health ______ and outreach worker to educate the family and encourage compliance with environmental health behaviors and clinical treatments. Finally, we may need to work with public health lawyers to address noncompliance.

earth, travel, public health, educator

Epidemiology: Ecological studies - an epidemiologic study that is a bridge between descriptive and analytic epidemiology is the ecological study - the descriptive component involves examining variations in disease rates by person, place, or time; the analytic component lies in the effort to determine if there is a relationship between disease rates and variations in rates for possible risk (or protective) factors - ecological studies are attractive because they often make use of existing, readily available rates, and are therefore quick and inexpensive to conduct. however, they are subject to ______ ______, which are associations observed at the group level that may not hold true for the individuals who make up the groups, or associations that exist may be masked in the grouped data.

ecological fallacies

Communicable and Infectious Disease Risks: Nurse's Role in Providing Preventive Care for Communicable Diseases Primary Prevention- - assessment: client's risk level, sexual history, and partner notification - interventions: client __________ and other actions aimed at prevention - community _______: to reach those who do not seek care on their own - community ________: spreading information about modes of transmission, testing, vaccine availability, and early symptoms - evaluation: to determine whether adequate vaccination occurs, whether risky behavior changes to safe behavior, whether illness is prevented Secondary Prevention- - testing and counseling for HIV to ensure early identification - post-test counseling - partner notification and contact tracing Tertiary Prevention- - managing symptoms, maintaining psychosocial support - _____ _____ ____ programs for TB medication, nurses observe and document individual clients taking their TB drugs. Standard Precautions- - client and family education about infection control in the home - dispelling myths and fears about transmission of HIV

education, outreach, education, directly observed therapy

Epidemiology: Experimental Studies - Studies in which the investigator initiates some treatment or intervention that may influence the risk or course of disease are called intervention, or experimental studies - such studies test whether interventions are ________ in preventing disease or improving health - Intervention/Experimental studies are of two general types: clinical trials and community trials - Clinical Trials: the research issue is generally the _______ of a medical treatment for disease, such as a new drug of an existing drug used in a new or different way, a surgical technique, or another treatment. - Community Trials: they are similar to clinical trials in that an investigator determines the exposure or intervention, but in this case the issue is often _______ ______ and disease _______ rather than treatment of an existing disease

effective, efficacy, health promotion, prevention

Epidemiology: Definitions and Descriptions of Epidemiology - __________: the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems - _______ ________: seeks to describe the occurrence of a disease in terms of person, place, and time - __________ of health events are factors, exposures, behaviors, contexts, and characteristics that determine (or influence) the patterns (answers the how and why); may be individual, relational, social, communal, or environmental - ________ _______: focuses on investigation of causes and associations - ______ _______: the broad consideration of many levels of potential determinants - ___________: determine patterns of who has the disease and where and when it occurs - _________: occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition

epidemiology, descriptive epidemiology, determinant, analytic epidemiology, ecologic approach, distribution, epidemic

Communicable and Infectious Disease Risks: Hepatitis Hepatitis A Virus (HAV): Transmission- - HAV is most commonly transmitted through the ____-____ route. - sources may be water, food, feces, or sexual contact Prevention- - the _______ for hepatitis A has been available since 1995, making it a completely preventable disease. Since then the incidence has declined 92%. - can get _____ _____ if exposed to HAV High-Risk Groups- - travelers to countries with high rates of the disease - children living in areas with high rates of HAV infection - injection drug users - MSM - persons with clotting disorders or chronic liver disease

fecal-oral, vaccine, immune globulin

Communicable and Infectious Disease Risks: Sexually Transmitted Diseases Human Papillomavirus (HPV): - HPV results in _____ _____, and can infect the mouth, genitals, and anus - HPV is the most common STD in the US, although it is not _______ Transmission- - direct contact with HPV-associated warts FDA-Licensed Vaccines- - 9-valent HPV vaccine, which is given in a 2-or 3-dose schedule, depending on the patient's age Complications- - two specific types of HPV (HPV 16 and HPV 18) are linked to ______ cancer, accounting for 70% of cases - other cancers: vaginal, anal, and oropharyngeal

genital warts, reportable, cervical

Epidemiology: Basic Methods in Epidemiology Comparison Groups- - The use of comparison groups is at the heart of the epidemiological approach. - the ideal approach would be to compare one group of people who all _____ a certain characteristic, exposure, or behavior with a group of people exactly like them, except that they all _____ that certain characteristic, exposure, or behavior - in the absence of that ideal, researchers either randomize people to exposure or treatment groups in experimental studies, or they select comparison groups that are comparable in observational studies - advances in statistical techniques now make it possible to control for differences between groups, but these advanced techniques are only effective in reducing the bias that results from confounding by measured variables

have, lack

Infectious Disease Prevention and Control: Universal Precautions - in response to concerns regarding the transmission of HIV infection during health care procedures, the CDC recommended a universal precautions policy for all _____ _____ settings - this strategy requires that blood and body fluids from _____ clients be handled as if infected with HIV or other blood borne pathogens - when in a situation where potential ______ with blood or other body fluids exists, health care workers must always perform hand hygiene, wear gloves, masks, protective clothing, and other indicated personal protective barriers. - needles and sharp instruments must be used and disposed of properly

health care, all, contact

Epidemiology: Definitions of Health and Public Health - ________: a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and the attainment of the highest possible level of health is a most important world-wide social goal - _________: the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human illness and injury, and advocacy in the care of individuals, families, communities, and populations. - _______ _______: the health status of the public; a system and social enterprise; a profession; a collection of methods, knowledge, and techniques; governmental health services, especially medical care for the poor and underserved

health, nursing, public health

Epidemiology: Historical Perspectives - the roots of epidemiology trace back to Ancient Greece. In the fourth century BC, ________ maintained that to understand health and disease in a community, one should look to geographic and climatic factors, the seasons of the year, the food and water consumed, and the habits and behaviors of he people - Modern epidemiology did not emerge until the nineteenth century, with one of the most famous studies being conducted by ______ _____, often credited as being the "father of epidemiology." he studied a cholera outbreak, demonstrating a connection between a water supply and cholera, and developed what epidemiologists call a ____ ______. - Two refinements in research methods in the eighteenth and nineteenth centuries were critical for the formation of epidemiological methods: (1) the use of a _____ group, and (2) the development of ______ techniques (numeric measurements or counts)

hippocrates, John snow, natural experiment, comparison, quantitative

Infectious Disease Prevention and Control: Health-Care Associated Infections - Health Care Associated Infections are those transmitted during ___________ or developed within a hospital or other health care setting - they may involve hospitalized clients/patients (things such as invasive procedures and immunosuppressant drugs can may them more vulnerable), health care workers, visitors, or anyone who has contact with a hospital or doctor's office

hospitalization

Infectious Disease Prevention and Control: Parasitic Diseases - parasites are organisms that depend on a ______ to survive Intestinal Parasitic Infections- - greater concern in developing countries - pinworm is the most common helminthic infection in the US, usually in schools, institutions, or overcrowding Parasitic Opportunistic Infections- - more frequent or severe in ________ Control and Prevention- - early diagnosis - improved ______ and vector control - education and environmental improvements

host, immunocompromised, hygiene

Epidemiology: Basic Concepts in Epidemiology Measures of Morbidity and Mortality- - an ________ ________ quantifies the rate of development of new cases in a population at risk, whereas an ______ _______ indicates the proportion of the population at risk who experience the event over some period of time - the _______ ________ is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population) - the _____ ______ is defined as the proportion of persons who are exposed to an agent and develop the disease; is often specific to an exposure

incidence rate, incidence proportion, prevalence proportion, attack rate

Communicable and Infectious Disease Risks: Sexually Transmitted Diseases - the number of new cases (the __________) of STDs, such as gonorrhea, syphilis, chlamydia, genital herpes, and HPV continues to increase - _______ is the most commonly reported infectious disease - _______ is the second most common reported infectious disease - because of the impact of STDs on long-term health and the emergence of eight new STDs since 1980, continued attention to their ________ and treatment is vital - the number of _____ cases in the community is incidence, and the number of _______ cases in the community is prevalence

incidence, chlamydia, gonorrhea, prevention, new, existing

Infectious Disease Prevention and Control: Emerging Infectious Diseases - emerging infectious diseases are those in which the __________ has actually increased in the past several decades or has the potential to increase in the near future; may be new or known infectious diseases Emerging Factors- - these are factors that can _______ the emergence of new infectious diseases - societal events such as economic impoverishment, population growth and migration, etc. - health care factors such as new medical devices, drugs causing immunosuppression, widespread use of abx, etc. - food production resulting in changes of food processing and packaging, etc. - human behavior: sexual behavior, drug use, travel, diet, outdoor recreation, childcare facilities, etc. - environmental factors such as deforestation, changes in water ecosystems, famine, etc. - public health factors such as reduction in prevention programs, inadequate surveillance, lack of trained personnel, etc. - microbial adaptation causing changes in virulence and toxin production, development of drug resistance, etc.

incidence, influence

Infectious Disease Prevention and Control: Transmission of Communicable Disease Disease Development- - exposure to an infectious agent does not always lead to an infection and vice versa - the development of infection depends on things such as the infectious agent, the infectious dose, the immunity of the host, etc. - _______ refers to the entry, development, and multiplication of the infectious agent in the susceptible host - ________ is one of the possible outcomes of infection, and it may indicate a physiological dysfunction or pathological reaction - The ________ period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease - The __________ period is the interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person

infection, disease, incubation, communicable

Epidemiology: Basic Concepts in Epidemiology Ecologic Model - this approach expands epidemiological studies both upward to broader contexts such as neighborhood characteristics and social context, and downward to the genetic and molecular level - like the web of causality model, the ecologic model recognizes multiple determinants of health and treats them as __________ and acting synergistically (or antagonistically), rather than as a list of discrete factors - the ecologic model spans a much broader spectrum of system and etiologic factors than the more traditional web of causality model, and it encompasses determinants at many levels; biological, mental, behavioral, social, and environmental factors, including policy, culture, and economic environments - another way of thinking of this is that the ecologic model moves from a two-dimensional perspective to a ____________ perspective

interrelated, multidimensional

Environmental Health: Healthy People 2020 Objectives for Environmental Health - eliminate elevated _____ blood levels in children - minimize risks posed by hazardous sites - reduce significant pesticide exposures - reduce the amount of _____ pollutants - reduce indoor allergen levels - decrease lead-based paint or related hazards

lead, toxic

Epidemiology: Historical Perspectives Cont. - Development and application of epidemiological methods in the twentieth century were stimulated by dramatic changes in society and population dynamics, including in ______ ________, and an increase in _______ ________

life expectancy, chronic diseases

Communicable and Infectious Disease Risks: Hepatitis - viral hepatitis refers to a group of infections that primarily affect the ______. these infectious have similar clinical presentations but different causes and characteristics - the different viruses include Hepatitis A, Hepatitis B, Hepatitis C, and Non-ABC Hepatitis

liver

Public Health Surveillance and Outbreak Investigation: Uses of Public Health Surveillance - to estimate the _______ of a problem (how many people are being affected, how widespread it is, etc.) - to determine geographic _________ - to portray the natural history of a disease - to detect epidemics and define a problem - to generate _______ to simulate research - to evaluate control measures - to monitor ________ in infectious agents - to detect changes in health practices - to facilitate planning

magnitude, distribution, hypotheses, changes

Environmental Health: Environmental Health: Environmental Health Assessments - There are a number of ways to assess environmental health risks in a community Risks can be categorized as follows- - _______: air, water, soil, or food - ______: chemical, biological, or radiological - _______: urban, rural, or suburban - ______ ______: home, school, workplace, or community

medium, type, setting, functional location

Epidemiology: Basic Concepts in Epidemiology Measures of Morbidity and Mortality- - _______ _________ are informative only for fatal diseases and do not provide direct information about either the level of existing disease in the population or the risk of contracting any particular disease. many commonly used mortality rates are in fact proportions, not true rates. they are also calculated for specific groups (e.g., age-, sex-, or race- specific rates) Two specific measures should be distinguished from the cause-specific mortality rate- - the ______ _______ ______ is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period of time (may be interpreted as an estimate of the risk of death within that period for a person newly diagnosed with the disease) - _______ _______ _______ is the proportion of all deaths that are attributable to a specific cause

morality rates, case fatality rate, proportionate mortality ratio

Infectious Disease Prevention and Control: Agents of Bioterrorism - the agents most likely to be used in a bioterrorism attack are those having both the potential for high ______ and early dissemination Anthrax- - anthrax is an acute disease caused by the spore-forming bacterium Bacillus anthraces - may manifest in one of three syndromes: cutaneous, gastrointestinal, and respiratory (or inhalation) - the vaccine is not recommended for the general public Smallpox- - susceptibility is 100% in the unvaccinated and the fatality rate is estimated at 20 to 40% or higher - many HCP may not identify the disease because many have not seen it - vaccine is available, but is not recommended to the general public Plague- - vector borne disease transmitted by rodent fleas - initial s/s are nonspecific: myalgia, malaise, fever, chills, sore throat, headache - others include tularemia and hemorrhagic viruses

mortality

Public Health Surveillance and Outbreak Investigation: Data Sources for Surveillance ________ Data- - vital statistics reports (ex: death certifications, medical examiner reports, and birth certificates) - are often the only source of health-related data available for small geographic areas ________ Data- - notifiable disease reports - laboratory reports - hospital discharge reports - billing data - outpatient health care data - specialized disease registries - injury surveillance systems - environmental surveys - sentinel surveillance systems

mortality, morbidity

Environmental Health: Historical Context of Environmental Health and Nursing - __________ promoted the use of clean water and safe sanitary conditions and connected these elements to disease prevention - _____ ______, who coined the name "public health nurses," spent her life improving the environment of the Henry Street neighborhood and encouraging her broad network of influential contacts to make changes in the physical environment, as well as social conditions that had direct health impacts. - the most common way in which the relationships between chemical exposures and health risks are identified is when toxicologists study the effects of chemicals on animals and then use models to estimate what the effects may be on humans. This estimation is called _________. - In ______, the CDC began __________, which is the testing of human fluids and tissues for the presence of potentially toxic chemicals.

nightingale, Lillian Wald, extrapolation, 2001, bio monitoring

Environmental Health: Applying the Nursing Process to Environmental Health - If you suspect that a client's health problem is being influenced by environmental factors, follow the nursing process, and note the environmental aspects of the problem in every step of the process - Assessment: use your _______ skills (e.g., windshield surveys)' interview community members; ask you individual clients; and ask the families of your clients. Review Web-based date on existing exposures, such as air and water pollution monitoring data, drinking water testing, and contaminated soil. Relate the disease and the environmental factors in the diagnosis. - Planning: look at community policy and laws as methods to facilitate the care needs for the client; include ________ health personnel in planning. - Intervention: ___________ medical, nursing, and public health actions to meet the client's needs. ensure that the affected person or family is referred for appropriate clinical care. - Evaluation: examine criteria that include the immediate and long-term responses of the client as well as the recidivism of the problem for the client

observational, environmental, coordinate

Epidemiology: Surveillance - the systematic collection, analysis, and interpretation of data related to the ________ of disease and the health status of a given population - surveillance systems are classified as either active or passive - _______ surveillance is the more common form used by most local and state health departments (health care providers in the community report cases of notifiable diseases to public health authorities through the use of standardized reports) - ______ surveillance is the purposeful, ongoing search for new cases of disease by public health personnel, through personal or telephone contacts or the review of laboratory reports or hospital or clinic records

occurence, passive, active

Epidemiology: Basic Concepts in Epidemiology Levels of Prevention- - Primary Prevention: refers to interventions aimed at preventing the __________ of disease, injury, or disability. Interventions at this level of prevention are aimed at individuals or groups who are susceptible to disease but have no discernible pathology (ex: counsel clients about low-fat diet and regular physical exercise) - Secondary Prevention: encompasses interventions designed to increase the probability that a person with a disease will have that condition __________ at a stage when treatment is likely to result in cure (ex: implement blood pressure and cholesterol screening; give treadmill stress test) - Tertiary Prevention: includes interventions aimed at disability limitation and ________ from disease, injury, or disability (ex: provide cardiac rehabilitation, medication, or surgery)

occurrence, diagnosed, rehabilitation

Public Health Surveillance and Outbreak Investigation: Types of Surveillance Systems Special Systems- - special systems are developed for collecting ______ types of data, and may be a __________ of active, passive, and/or sentinel systems - examples include PulseNet system, BioNet, Laboratory Response Network (LRN), Syndromic surveillance systems (bioterrorism), and Enhanced Surveillance Project (ESP)

particular, combination

Communicable and Infectious Disease Risks: Perinatal and Pediatric HIV Infection Perinatal Transmission- - perinatal transmission accounts for nearly all HIV infection in _____ and can occur during pregnancy, labor and delivery, or breastfeeding. - the effectiveness of _______ therapy in pregnant women and newborns in preventing transmission from mother to fetus or infant has made pediatric HIV rates decline sharply Recommendation- - on the basis of the effectiveness of antiviral therapy, it is recommended that HIV testing be a ______ part of prenatal care and t hat all pregnant women be tested for HIV Pediatric Infection- - despite having an HIV-infected mother, many children do not acquire HIV - however, one or both parents may die, thus indirectly affecting the health of the child

pediatric, antiretroviral, routine

Epidemiology: Descriptive Epidemiology - descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to _____, ______, and _____, providing a picture of how things are or have been (The Who, where, and when of disease patterns) Person- - personal characteristics of interest in epidemiology include race, ethnicity, sex, age, education, occupation, income (and related socioeconomic status), and marital status). As noted previously, the most important predictor of overall mortality is _____. Place- - when considering the distribution of a disease, geographical patterns come to mind: does the rate of the disease differ from place to place (e.g., with local environment). Time- - in relation to time, epidemiologists ask these questions: is there an increase or decrease in the frequency of the disease over time? are other _________ (and spatial) patterns evident? temporal patterns of interest to epidemiologists include secular trends, point epidemic, cyclical patterns, and event-related clusters. - long-term patterns of morbidity or mortality rates (i.e., over years or decades) are called ______ ______. they may reflect changes in social behavior or health practices. - one temporal and spatial pattern of disease distribution is the point epidemic - in addition to secular trends and point epidemics, there are also _____ time patterns of disease. One common type of cyclical variation is the seasonal fluctuation seen in a number of infectious illnesses - a fourth type of temporal pattern is nonsimultaneous, ______-related clusters. these are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time

person, place, time, age, secular trends, cyclical, event

Infectious Disease Prevention and Control: Transmission of Communicable Diseases Horizontal Transmission- - horizontal transmission is the _____-to-______ spread of infection through one or more of the following four routes Four Routes- - _______/_______: such as sexual contact, which is direct, or through clothing, toys, etc., which is indirect - ________ ________: transportation of infectious agent from an infected host to a susceptible host via food, water, or body fluids - _________ - ________-________: arthropods such as ticks and mosquitoes or other invertebrates such as snails that transmit the infectious agent by biting or depositing the infectious material near the host

person-to-person, direct/indirect, common vehicle, airborne, vector-borne

Environmental Health: Environmental Carcinogens - environmental exposures are rarely limited to one location or one source - for example, the broad category of ________ includes the insecticides used in homes, the herbicides used in gardens, the pesticide residues on fruits and vegetables, and antimicrobial soaps. each of these forms of pesticides comes with a potential health risk. - other chemical carcinogens include things such as lead and radiation

pesticides

Environmental Health: Environmental Exposures by Media (1 of 2) - many of the environmental protection regulations are based on the "medium" in which pollutants are carried- air, water, and soil. Air- - Air pollution is divided into two major categories. ______ sources are individual, identifiable sources such as smokestacks. ____-____ sources come from more diffuse exposures, for instance, the largest source is from mobile sources such as trucks and cars. - the _____ _____ Act regulates air pollution from point and non-point sources. - The ______ Air Quality (IAQ) is a growing public concern in homes, offices, and schools and is reflected in the alarming rise of asthma in the US Water- - In the US, all public water suppliers must test their water in accordance with the EPA's safe drinking water standards, and they must summarize the results of their testing annually and make the summaries available to their customers. These reports are known as the Consumer Confidence Reports (CCRs) - Pollutions discharges into water bodies from ________ and from wastewater treatment systems can contribute to the degradation of water quality. - an additional source of pollution in our waters is pharmeceuticals used for humans and animals. - water quality is also affected by non-point sources such as storm water runoff, soil erosion, etc.

point, non-point, clean air, indoor, industries

Epidemiology: Basic Methods in Epidemiology Rate Adjustment- - rates, which are of central importance in epidemiologic studies, can be misleading when compared across different _________. (for example, the risk of death increases rather dramatically after 40 years of age, therefore a higher crude death rate is expected in a population of older people compared with a population of younger people) - there are methods that adjust for such differences in populations, such as age adjustment - age adjustment is based on the assumption that a population's overall mortality rate is a function of the age distribution of the population and the age-specific mortality rates, and can be performed by direct or indirect methods

populations

Epidemiology: Basic Concepts in Epidemiology Measures of Morbidity and Mortality- - a _______ is a type of ratio in which the denominator includes the numerator; often expressed as a percent (for example, there were 2,744,278 deaths in the US, 635,260 were due to heart disease; so deaths attributable to heart disease was 635,260/2,744,278 = 0.231 or 23.1 percent) - a ______ is a measure of the frequency of a health event in a defined population, usually in a specified period of time; a measure of how rapidly something is occurring - _____ refers to the probability that an even will occur within a specified period of time

proportion, rate, risk

Environmental Health: Social Determinants of Health and Environmental Justice - increasing attention to the social determinants of health is helpful when addressing the interaction between race, economics, and environmental exposures. - ______ and ______ is highly associated with health disparities and environmental exposures. It is linked to having substandard housing, living closer to hazardous plants and waste sites, working in more hazardous jobs, having poorer nutrition, and having less access to quality health care (particularly preventive services). - the term _______ _______ refers to the disproportionate environmental exposures that poor people and people of color experience in the US and elsewhere, including lead exposure, the presence of pests (resulting in increased use of pesticides), and the use of supplemental heating sources that may cause dangerous carbon monoxide exposures. These combined circumstances multiply the risk for health disparities

poverty, race, environmental justice

Infectious Disease Prevention and Control: Prevention and Control of Communicable Diseases Goal- - infectious disease can be prevented and controlled. the goal of prevention and control programs is to reduce the _______ of a disease to a level at which it no longer poses a major public health problem. in some cases, diseases may be eradicated or eliminated. Prevention- - primary prevention can be used to prevent the ________ of disease including things such as responsible sexual behavior, flu shots, using repellents for vector-borne diseases etc. - secondary prevention can be used to prevent the ________ of disease including things such as post-exposure prophylaxis, quarantine, tuberculosis screening for health care workers, etc. - tertiary prevention can be used to reduce complications and disabilities through ________ and rehabilitation such as PCP chemoprophylaxis in people with AIDS, or regular inspection of hands and feet in those with leprosy who have lost sensation. Role of Nurses- - prevention is at the center of public health, and nurses perform much of this work. examples include immunizations, surveillance, teaching controls, prevention, and screening and treatment Multisystem Approach- - because illness from communicable disease results in an ________ in the host-environment-agent relationship, any approach to controlling infection must consider multiple systems.

prevalence, occurrence, spread, treatment, imbalance

Public Health Surveillance and Outbreak Investigation: Investigation Objectives - any unusual increase in disease incidence (new cases) or an unusual event in the community should be investigated The objectives of an outbreak investigation are as follows- - to control and ______ disease or death - to identify factors that ______ to the outbreak of the disease and the occurrence of the event - to implement measures to prevent _________ Defining the Magnitude of a Problem/Event- - the following definitions provide a way to describe the level of occurrence of disease or event for the purposes of communicating the magnitude of the problem - _______: a disease or event that is found to be present (occurring) in a population - _______: there is an unusually high number of cases persisting in the community - _______: problems that occur with an irregular pattern, with occasional cases found at irregular intervals (ex: 10 times every 5 years) - ______: occurrence of a disease within an area is clearly in excess of expected levels for a given time period - ________: the epidemic spread of a disease across multiple countries - _______: a highly prevalent problem that is commonly acquired early in life (prevalence of this problem decreases as age increases)

prevent, contribute, occurrence, endemic, hyperendemic, sporadic, epidemic, pandemic, holoendemic

Infectious Disease Prevention and Control: Surveillance of Communicable Disease - surveillance gathers the "who, when, where, and what"; these elements are then used to answer "why." a good surveillance system systematically collects, organizes, and analyzes current, accurate, and complete data for a defined disease condition. the resulting information is promptly release to those who need it for effective planning, implementation, and evaluation of disease _________ and control programs. Elements of Surveillance- - infectious disease surveillance incorporates and analyzes data from a variety of sources, including mortality registration, morbidity reporting, laboratory reporting, surveys, etc. Surveillance for Agents of Bioterrorism- - since 9/11, increased emphasis has been placed on surveillance for any disease that might be associated with the ________ release of a biological agent - because of the heightened concern about possible bioterrorism attacks, various sorts of _______ surveillance systems were developed by public health agencies across the country. these systems incorporate factors such as temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms), with the goal of detecting ______ signs of diseases that could result from a bioterrorism-related attack. may include tracking emergency room visits, school absenteeism, sales of OTC medications, etc. List of Reportable Diseases- - a notifiable disease is one for which regular, frequent, and timely information regarding individual cases is considered ________ for the prevention and control of the disease. These cases should be reported through the National Notifiable Disease Surveillance System (NNDSS)

prevention, intentional, syndromic, early, necessary

Communicable and Infectious Disease Risks: HIV Infection Natural History of HIV- The natural history of HIV includes three stages: - (1) ________ infection: within about 1 month of contracting the virus. this state may go unrecognized, but the person may experience mononucleosis-like syndrome - (2) ______ _____: when the body shows no symptoms. use of highly active antiretroviral (HAART) has greatly increased survival time of persons with HIV/AIDs. - (3) ________ disease (AIDS): CD4 T-lymphocyte count is less than _____/mL with documented HIV infection. will also have AIDS-related opportunistic infections in this stage such as Pneumocystis jiroveci pneumonia, oral candidiasis, pulmonary tuberculosis, invasive cervical cancer, and recurrent pneumonia

primary, clinical latency, symptomatic

Environmental Health: Risk Assessment - the term risk assessment refers to a process to determine the ________ of a health threat associated with an exposure There are four phases of a risk assessment- - (1) assess toxicology and epidemiological data to determine whether a chemical is known to be associated with ______ health effects (in animals or humans) - (2) determine whether the chemical has been ______ into the environment (the air, water, soil, or food) - (3) estimate how _____ and by which route of entry the chemical might enter the human body - (4) characterize the risk assessment ______ by taking into account all three of the previous steps - a risk assessment is subject to interpretation

probability, negative, released, much, process

Environmental Health: Right to Know - several environmental statutes give the ______ the right to know about hazardous chemicals in the environment. - under one of the "right to know" laws, health professionals and community members can easily access information by zip code regarding major sources of pollution that are being emitted into the air or water in their community. - Nurses can access drinking water _______ ______ reports, sometimes known as "right to know" reports, to determine what pollutants have been found in the drinking water. - _____ ______ Standard requires employers (including hospitals) to maintain a list of all of the hazardous chemicals that are used on site (material safety data sheet)

public, consumer confidence, hazard communication

Epidemiology: Levels of Preventive Interventions Screening- - The precision, or ________ of the measure (i.e., its consistency or repeatability) and its ________ or accuracy (i.e., whether it really measures what it is supposed to be measuring, and how exact that measurement is) are important characteristics for any measurement. - Validity in a screening test is measured by sensitivity and specificity. sensitivity quantifies how accurately the test identifies those _____ the condition or trait (true positives), while specificity indicates how accurately the test identifies those ______ the condition or trait (true negatives) - a third measure associated with sensitivity and specificity is the ________ _____ of the test. the positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease. the negative predictive value is the proportion of persons with a negative test who are actually disease free.

reliability, validity, with, without, predictive value

Communicable and Infectious Disease Risks: Sexually Transmitted Infections Chlamydia: - the most common ______ infectious disease Bacterium- - infects genitourinary tract and rectum of adults - causes _______ and _______ in neonates - if left untreated, can result in ____ - often _______ in women Transmission- - mucous membrane contact with mucopurulent discharge from infected site

reportable, conjunctivitis, pneumonia, PID, asymptomatic

Communicable and Infectious Disease Risks: HIV Infection HIV Surveillance- - A study of diagnosed cases of AIDS does not reveal current HIV infection patterns because of the interval between infection with HIV and the onset of clinical disease - moreover, the effectiveness of anti-retroviral drugs given early in the HIV infection before symptoms start provides impetus for early identification of infection - thus in 2008, confidential laboratory _________ of HIV positive status by name was required in all 50 states and in DC

reporting

Epidemiology: Basic Methods in Epidemiology Sources of Data- - there are three major categories of data sources commonly used in epidemiological investigation - (1) ___________ Collected Data: includes data such as census data, vital records (birth and death certificates), and surveillance data as carried out by the CDC - (2) Data collected for other purposes, but useful for epidemiological research includes things such as medical, health department, and insurance records. - (3) ________ Data: original data collected for specific epidemiological studies

routinely, epidemiologic

Public Health Surveillance and Outbreak Investigation: Types of Surveillance Systems Active System- - in the active system, public health nursing begins a _______ for new cases through contacts with local health care providers and health care agencies. - in this system, the nurse names the disease or an event and gathers _____ about existing cases to try and determine the ______ of the problem (how widespread it is)

search, data, magnitude

Epidemiology: Levels of Preventive Interventions Screening- - screening, a key component of many ________ prevention interventions, involves the testing of groups of individuals who are at _____ for a certain condition, but are not yet ___________. the purpose is to classify these individuals with respect to the likelihood of having the disease, but it is not a _______ test.

secondary, risk, symptomatic, diagnostic

Public Health Surveillance and Outbreak Investigation: Types of Surveillance Systems Passive System- - in the passive system, case reports or laboratory reports are _____ to local health departments by health care providers (physicians, public health nurses, etc.) - case reports are summarized and forwarded to state health department, national government, or organizations responsible for monitoring the problem - the National Notifiable Disease Surveillance System (NNDSS) is a voluntary system monitored by the CDC and includes a total of 682 infectious diseases or conditions with case definitions considered _________ to public health

sent, important

Communicable and Infectious Disease Risks: HIV Resources - as the number of individuals with HIV/AIDS has increased, services to meet those individuals have grown __________ Organizations- - voluntary and faith-based service organizations, such as community- based organizations or AIDS support organizations have developed in many localities to address these needs. - these services may include counseling, support groups, legal aid, personal care services, etc. - nurses collaborate with workers from community-based organizations in the client's home and may advise these. groups in their supportive work Toll-Free Numbers and Websites- - the federal government and many other organizations have established toll-free numbers and websites to provide information

service

Epidemiology: Levels of Preventive Interventions An Intervention _________ - the standard classification of preventive measures in public health is composed of the primary, secondary, and tertiary levels of prevention - recent revisions to these standard classifications aim to refine and tailor the application to diverse settings and health issues (for example, in the field of cancer, this potential for preventive intervention is conceptualized across the entire continuum of care) - nurses have a critical role in prevention at all points across the intervention spectrum

spectrum

Public Health Surveillance and Outbreak Investigation: Case Definitions - criteria for defining cases of different diseases are essential for having uniform, ________ method of reporting and monitoring diseases - a case definition provides an understanding of the data that are being collected and reduces the likelihood that __________ criteria will be used for reporting similar cases of a disease - cases may be classified as either _______, _______, or ______, depending on the strength of the evidence supporting the case criteria

standardized, different, suspected, probable, confirmed

Epidemiology: Causality - Causality: the existence of a _______ ________ does not necessarily mean that there is a causal relationship or that causality is present. the observed association may be a random event (caused by chance), or may be attributable to _____ from cofounding or from flaws in the study design or execution. - Statistical Association: exists when the probability of of a disease is affected by the presence or level of the factor. - Bias: a systematic error resulting from the study, design, execution, or confounding

statistical association, bias

Environmental Health: Environmental Health Sciences Epidemiology- - Epidemiology is the science that helps us understand the _______ of the association between exposures and health effects. - Epidemiology is often used for ________ related illnesses, but has been used less often to study environmentally related illnesses - the epidemiological triangle is a simple model that belies the often complex relationships among agent, which may include chemical mixtures (i.e., more than one agent); host, which may refer to a community with people of multiple ages, genders, ethnicities, cultures, and disease states; and environment, which may include dynamic factors, such as air, water, soil, and food, as well as temperature, humidity, and wind.

strength, occupationally

Infectious Disease Prevention and Control: Transmission of Communicable Diseases Disease Spectrum- - persons with infectious diseases may exhibit a broad spectrum of disease that ranges from _______ infection to severe and _____ disease - at the community level, the disease may occur in endemic, epidemic, or pandemic proportions - ________ refers to the constant presence of a disease within a geographic area or a population (ex: pertussis in the US) - _________ refers to the occurrence of disease in a community or region in excess of normal expectancy (ex: a new case of polio, which is a disease considered eliminated in the US, would be this) - _________ refers to an epidemic occurring worldwide and affecting large populations (Ex: covid)

subclinical, fatal, endemic, epidemic, pandemic

Environmental Health: Environmental Exposure by Media (2 of 2) Land and Soil- - current and past land use can affect a community's health. - ______ sites are highly contaminated sites, with associated health threats that are designated by the EPA - ______ sites is land that has been previously used, which is now slated for redevelopment, that may have contaminated soil. Food- - many health risks are associated with food and food production - _______ causes include E. coli, Salmonella, pesticides, and GMOs - _______ causes include pesticides and antibiotics in animals

superfund, brownfield, pathogenic, environmental

Communicable and Infectious Disease Risks: HIV Infection Epidemiology of HIV/AIDS - the first cases of AIDS were identified in 1981 - worldwide about 36.7 million persons live with HIV infection, with Sub-Saharan Africa accounting for more than 70% of all HIV infections. the epidemic is also growing in Central Asia, the Middle East, and Eastern Europe. - The _________ of HIV infection has been given higher priority (over prevention), and the use of HAART is at 53% for those who need it - the prevalence of AIDS has ________ from 2010 to 2015, reflecting increased life expectance from the use of anti-retroviral therapy

treatment, increased

Public Health Surveillance and Outbreak Investigation: Types of Surveillance Systems Sentinel System- - in the sentinel system, ______ in commonly occurring diseases or key health indicators are _______ - a ______ may be a disease, an event, or a population - for example, certain providers/agencies in a community may be asked to report the number of cases of influenza during a given time to make projections about the severity of the "flu season"

trends, monitored, sentinel

Communicable and Infectious Disease Risks: Tuberculosis Diagnosis- - the standard and preferred TB screening test is the _____ ______ ______ - previously referred to as the purified protein derivative (PPD) test - this test is used for ______ screening, and will be followed by chest x-ray for persons with positive skin reaction and pulmonary symptoms Treatment- - prompt treatment with _______ antimicrobial drugs is needed - US drug regimens include isoniazid and sometimes rifampin - treatment failure may be due to lack of client adherence, which can result in drug resistance

tuberculin skin test, initial, multiple

Communicable and Infectious Disease Risks: Sexually Transmitted Diseases Gonorrhea: Bacterium- - infects mucous membranes of the genitourinary tract, rectum, and pharynx Transmission- - it is transmitted through genital-genital contact, oral-genital contact, and anal-genital contact Uncomplicated vs. Complicated- - gonorrhea is identified as either uncomplicated or complicated - __________ gonorrhea refers to limited cervical or urethral infection. - _______ gonorrhea includes salpingitis, epididymitis, systematic gonococcal infection, and gonococcal meningitis - gonorrhea often is ________ and may not be recognized until PID occurs, meaning that it will continue to be spread through sexual activity Highest Incidence in the US- - African Americans, persons in the south, and women 15 to 24 years of age Rise of Antibiotic Resistant Cases- - antibiotic resistance has continued to develop, which gonorrhea becoming resistant to every antibiotic used for treatment - combination therapy using ______ IM combined with oral _________ is the most reliably effective treatment for uncomplicated gonorrhea

uncomplicated, complicated, asymptomatic, ceftriaxone, azithromycin

Public Health Surveillance and Outbreak Investigation: Notifiable Diseases National Notifiable Diseases- - data is published weekly in the Morbidity and Mortality Weekly Report (MMWR) State Notifiable Diseases- - although each state differs in the list of reportable diseases, the usefulness of the data depends on the _________, _________ and ________

uniformity, simplicity, timeliness

Public Health Surveillance and Outbreak Investigation: When to Investigate Disease Occurrence - when a population experiences an ________ increase in a specific disease, it should be investigated - the amount of effort that goes into an investigation depends on the severity or _______ of the problem, the numbers in the population who are affected, the ________ for spreading the disease, and the availability and effectiveness of intervention measures to resolve the problems - most of the outbreaks of diseases occur naturally and/or are _______ when compared with the consistent patterns of previous outbreaks of a disease. - when a disease or an event outbreak occurs as a result of purposeful introduction of an agent into the population, such as _________, then predictable patterns may not exist

unusual, magnitude, potential, predictable, bioterrorism

Infectious Disease Prevention and Control: Vaccine Preventable Diseases - vaccines are one of the most effective ways in preventing and controlling communicable diseases - the recommended routine childhood immunization schedules are regularly _________ - some of the vaccines recommended include MMR for Measles and Rubella, TdAP for pertussis, and influenza vaccine

updated

Infectious Disease Prevention and Control: Diseases of Travelers - individuals traveling outside the US need to be aware and take precautions against potential diseases to which they may be exposed - which diseases and what precautions depend on the individual's health status, the travel destination, and the reason for and the length of travel. persons who plan to travel in remote regions for an extended period of time may need to consider rare diseases and take special precautions that would not apply to the average traveler - malaria is the most common ______ disease of travelers - food borne and waterborne disease such as Hepatitis A and Cholera of concerns, and diarrheal disease, acute or bacterial, such as E. coli - on returning from visiting exotic places, travelers may bring back with them an unplanned souvenir in the form of disease. therefore, in a presenting client, it is important to ask about a ____ ______

vector, travel history

Infectious Disease Prevention and Control: Zoonoses - a zoonosis is an infection transmitted from a _________ animal to a human under natural conditions. the agents that cause zoonoses do not need humans to maintain their life cycles; infected humans have simply managed somehow to get in their way - means of transmission include animal bite (bats and rabies), inhalation (rodent excrement and hantavirus), ingestion (milk and listeriosis), direct contact (rabbit carcasses and tularemia), and arthropod intermediates Rabies (hydrophobia)- - transmitted via animal ______ or ______ - it has the highest case ______ rate of any known human infections, essentially 100% - best protection remains vaccinating domestic animals (dogs, cat, cattle, and horses)

vertebrate, saliva, scratch, fatality

Infectious Disease Prevention and Control: Transmission of Communicable Diseases Modes of Transmission/Transportation- - infectious diseases can be transmitted horizontally or vertically. - ________ transmission is the passing of the infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth - _________ transmission is the person-to-person spread of infection through one or more of the following four routes: direct/indirect contact, common vehicle, airborne, or vector-borne - _______ ______ refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, blood, serum, saliva, or plasma. (ex: hepatitis A can be transmitted through. contaminated food and water, and hepatitis B can be spread through contaminated blood) - ________ are arthropods such as ticks and mosquitoes or other invertebrates such as snails that transmit the infectious agent by biting or depositing the infective material near the host.

vertical, horizontal, common vehicle, vectors