Exam 2
_____: how the microorganism travels from the source to the uninfected person
Human to human transmission
The occurrence of the number of NEW CASES of a disease or condition in a defined period of time, usually one year.
INCIDENCE
SIMPLE LOGIC MODEL --> problem assessed: I am thirsty: ____: WATER SOURCE ____: GO TO WATER ____: DRINK WATER ____:FEEL BETTER
INPUT ACTIVITY OUTPUT OUTCOME
equal and fair distribution of resources, based on analysis of benefits and burdens of decision.
Justice
are there laws/statue's allowing for the program to operate as planned
Legality
Infectious Disease Epidemiology Terms and Concepts (1): _____: ability of organism to cause serious disease
Virulence
visual display of the onset of illness among cases associated with an outbreak. Allows assessment of an outbreak
epi curve
look at pic- epidemiological triangle
epidemiological triangle
epidemiology powerpoint pt.1
epidemiology powerpoint pt.1
ability of an organism to infect large numbers of people
infectivity
______ engages intended members in dialog and helps uncover unsuitable aspects of material process helps identify that the message is well suited to the audience
learner verification
steps needed to get there
objectives
temporary resistance donated to host (host did not create antibodies on own) • mother-fetus --> why women get TDAP shot • transfusion -->IGG immunization/transfusion for people on chemo
passive immunity
_____ ability of an organism to produce disease in infected people the property of causing disease.
pathogenicity
Incidence Rate =
(# of new cases in a given period of time/ population at risk in same time period) x 1,000 (or 10,000; 100,000)
Now let's talk about RATES: rate =
(a count or # events over time/ specified population during that time) x k (constant) (k = 1,000; or 10,000; 100,000, etc.)
Putting Evidence-Based Public Health to practice: Applying program-planning frameworks = _____
(foundation in behavioral science theory)
Putting Evidence-Based Public Health to practice: Making decisions using best available peer-reviewed evidence = _______
(quantitative & qualitative research)
what are examples of indirect contact via common vehicle
(sneeze and blow ur nose into a tissue, then leave the tissue on counter, someone else comes and picks it up and then they are contaminated) can be surfaces such a door knobs, medical instruments, counters, light switches, etc
role of the community health nurse- strategies to assist community health nurses working with culturally diverse clients: - conduct a "culturological" assessment *_______ - seek knowledge about local clutlures - recognize ____ of culturally diverse groups - provide culturally competent care - recognize culturally _____ problems these you also want to include in a ____
*conduct a cultural self assessemt - political issues - health based cultural self assessment (provide conscious awareness of these things)
objectives should be (x4)
- Measurable - Specific - Quantifiable—used to measure successful outcomes - Use verbs, include specific conditions (how well/how many)
what are the 8 most important characteristics that can affect learning
- determining what the client needs to know - identifying motivating factors - stick with essentials - personalize health messages - summarize often - be creative - be encouraging - employ teach back methods
PILI 'Ohana Lifestyle Intervention: - culturally tailored lifestyle intervention - based on _____ prevention program - primary outcome weight loss - secondary outcome _____ - widely disseminated amount native Hawaiian pacific island communities
- diabetes - blood pressure
COMMUNITY/POPULATION ASSESSMENT: - Meet with group leaders of aggregate to clarify mutual ____ - Determine sociodemographic characteristics - Interview key informants - Consider both positive and negative factors - Compare the aggregate with the "____" - _____ - consider systemic influences on population health
- expectations - norm - Systems-thinking
cultural diversity: essential that nurses understand: - How cultural groups view _____ - How cultural groups define ___ and ___ - How ____ cure and care for members of their respective cultural groups - How the ___ of the nurse influences the way care is delivered
- life processes - health and illness - healers - cultural background
what are three things that make up a health education learning experience
- predispose - enable - reinforce voluntary behavior conducive to health in: individuals, groups, communities
Screening: is assessment for indicators that disease may be present: - Routine testing for patients without ____ but with risk factors (certain ages, conditions, exposures) - Referral for further testing if screening finds possible indicator of disease
- symptoms
transcultural nursing: uses world view, social structure, language, ethnohistory, environmental context, and generic or folk and professional systems to provide a comprehensive and holistic view of influences in cultural care and well being.... what are three thing that culture care lenses?
1. culture care preservation and maintenance 2. culture care accommodation and negotiation 3. culture care repatterining and restructuring
problem solving education: - active participation and ongoing dialogue - learners are critical and reflective about health issues - uses a participatory group process - involved activism on the part of the educator (x2)
1. facilitator educator is a resource person and is an equal partner with the other group members 2. leads to sustainable lateral relationships
what are four goals of health education
1. translate health knowledge into interventions for health enhancement, disease prevention, and chronic illness management 2. enhance wellness and decrease disability 3. actualize the health potential of individuals, families, communities, and society 4. influence individuals within their sociopolitical environment for improved heath and well being (place value on contributing of community member' strength)
do stakeholders, community accept it
Acceptability
Evaluation should include (x4)
Adequacy Efficiency Appropriateness Cost-benefit analysis
agreement to respect another's right to self-determine a course of action; support of independent decision making.
Autonomy
compassion; taking positive action to help others; desire to do good; core principle of our patient advocacy.
Beneficence
Disease transmission can be halted by breaking any one of the links in the chain of transmission
Chain of Infection
Infectious Disease Epidemiology Terms and Concepts (1): ______: symptoms vs. no symptoms and will not progress
Clinical vs. sub clinical disease
Consider factors when determining priorities: - _____: aggregate preferences - ____ of problem: # ppl in aggregate affected, severity of problem on aggregate health - ____: availability of time/skills/resources needed to address a problem
Community support Significance Feasibility
Assesses for current disease
Diagnostic Testing
does it makes sense, moves it forward does it fir program/ organization's mission
Economic Feasibility propriety
Spectrum of Disease Occurrence: _____: the disease is usually present within the community or region _____: the disease occurs occasionally in small pockets _____: increase is the usual number of expected cases _____: there is a clear excess of the disease across a large region _____: emergence of a new disease that spreads across multiple countries & large regions of the world
Endemic Sporadic Outbreak Epidemic Pandemic
Study of the distribution and patterns of disease within a population and those factors that influence health (illness or wellness)
Epidemiology
__________: - Strength of association - Dose-response relationship - Temporally correct relationship - Biological plausibility - Consistency with other knowledge - Specificity of association
Establishing Causation (link between risk factor and disease)
Process or outcome objective? By the year 2019, childhood vaccines for preventable diseases .......will be reduced to no more 100 per 100,000 in Hawaii as measured by DOH data.
Example of a SMART Objective
Process Objective (process): By June 1, 2021, conduct at least 10 informational sessions for parents about the risk and benefits of razor-riding, and the protective factors of helmets as measured by attendance records. Outcome Objective (summative): By October 1, 2021, the prevalence of helmets use for razor riders among 5 to 12 years of age at Manoa Community Park will increase from 20% to 85% as measured by Manoa park Staff.
Examples of Objectives:
diagnostic testing is for what kind of patients
For patients with symptoms, or screened positive for indicator
Evaluation: Reflect on each stage, determine strengths/weaknesses: - ____ evaluation = process evaluation (Typically process evaluations seek data with which to understand what's actually going on in a program (what the program actually is and does), and whether intended service recipients are receiving the services they need. Process evaluations are, as the name implies, about the processes involved in delivering the program) - ____ evaluation = product evaluation and outcomes (are conducted near, or at, the end of a program or program cycle, and are intended to show whether or not the program has achieved its intended outcomes (i.e., intended effects on individuals, organizations, or communities) and to indicate the ultimate value, merit and worth of the program)
Formative Summative
(study of the role of genetic factors in determining health/ disease in families and populations, & the interplay of such genetic factors with environmental factors)
Genetic epidemiology
where we want to be
Goals
____ - What we invest - program resources ($/people) ____ - What we do (verbs) ____ - Who we reach (target population) _____ - What results - Knowledge, Attitudes, Behaviors (KABs) - [short, medium, long term] _____ - Goal
INPUTS Activities Outputs OUTCOMES IMPACT
Components of a LOGIC MODEL (x5)
INPUTS - What we invest - program resources ($/people) Activities - What we do (verbs) Outputs - Who we reach (target population) OUTCOMES - What results - Knowledge, Attitudes, Behaviors (KABs) - [short, medium, long term] IMPACT - Goal
Research potential problems: - ____ health problems and needs - ____ the identified problems to create an effective plan
Identify Prioritize
what are the 5 objectives of epidemiology in healthcare
Identify the cause of a disease and its risk factors To determine the extent of disease in a population To study disease history and prognosis To evaluate existing and new preventive and therapeutic measures To guide the development of health care policy
what do you identify in the assessment phase in health planning (public health) Community/ population assessment: - Meet with group leaders of aggregate to clarify mutual ____ - Determine sociodemographic characteristics - Interview ____ Consider both positive and negative factors - Compare the aggregate with the "____" - ____ - consider systemic influences on population health
Identify the needs of the population, community, at-risk groups or targeted population - expectations - key informants - norm - Systems-thinking
Infectious Disease Epidemiology Terms and Concepts (1): _____: period from organism to host to clinical illness
Incubation period
Epi curve - visual display of the onset of illness among cases associated with an outbreak. Allows assessment of an outbreak: - _____ - first case in an outbreak - _____ - # of cases - _____ - distribution of cases over time - _____ - date with highest magnitude of cases - Derive inferences about outbreak's pattern of ____ & most likely time period of ____
Index case Magnitude of outbreak time trend Peak rate date spread, exposure
- Often the most enjoyable stage for the nurse and the clients - Implementation should follow the initial plan. - Include a variety of strategies - Prepare for unexpected problems - Consider using all types of media to disseminate information - Include the participant's verbal or written feedback and the nurses detailed analysis.... Communicate follow up recommendations
Intervention
"Clear ideas about what you plan to do and why - as well as an organized approach to capturing documenting, and disseminating program results - enhance the case for investment in your program" Kellogg Foundation
Logic Models Strengthen the Case for Program Investment
A picture of how your organization does its work - the theory and assumptions underlying the program... (Kellogg Foundation)
Logic model
_____ - An epi curve can also be used to make inferences about an outbreak's most likely mode of spread, suggesting how a disease is transmitted.
Mode of spread
Infectious Disease Epidemiology Terms and Concepts (1): ______: direct and indirect
Modes of transmission:
is a screen test considered a diagnostic test
NO! It is an assessment for INDICATORS that disease MAY be present
avoidance of harm or hurt; core of medical oath and nursing ethics
Non-maleficence
Ongoing systematic collection & analysis of data about health conditions to determine levels or changes in levels of specific diseases: - ____: information is sent into the DOH or other agency - _____: information is actually collected by the DOH or other agency - _____ case reporting: a clinician notices an unusual or significant case and reports it - this is how most epidemics are initially identified - _____: EMS cases, ED triage complaints, pharmacy sales of OTC or Rx drugs, hospital or insurance claims - _______ -individual or large data
Passive Active Sentinel System surveillance DOH data collection
Tuskegee Syphilis Experiment Stanford Prison Experiment Henrietta Lacks (Hela cells)
Past ethical violations
Using Epidemiological data: Epi curves Transmission occurs in the following ways: - _____: exposed over a brief time to the same source (ex: single meal) - _____: exposed over a brief time to the same source (ex: contaminated food source) - ______ (propagation): no common source because the outbreak spreads from person-to-person... ex: contaminated food source
Point source Continuous common source Person-to-person spread
degree to which a positive screening test actually indicates that disease is present
Positive Predictive value
does it fit program/organization's mission
Propriety
Causation of disease- eras: ____ era: disease is a result of god(s) ____ (sanitation) era: disease caused by miasma in the environment ____ era: disease caused by microorganisms ____ causation era: disease caused by many different factors ____ era: (today) disease caused by interplay of multiple causes. Sum is greater than the parts. "_____"
Religious Environmental Bacteriological Multiple Ecological, Web of causation
how infectious an agent is R0 describes the contagiousness of an infectious agent among susceptible people It is influenced by many factors, (biological, social and environmental factors) and because of this, it can change over time For example: The R0 for measles is 12-18, and in Hawaii the R0 for COVID-19 has changed over time.
Reproductive Number (R0):
are they available to address the problem are there laws/ statue's allowing for the program to operate as planned
Resources legality
what are the two kinds of aribone transmission
Respiratory droplet (direct) Respiratory droplet nuclei (aerosolized)
Screening tests vs. diagnostic tests: ______: is assessment for indicators that disease may be present
Screening
ability of a test to accurately identify those with (the marker for) a disease
Sensitivity
smart objectives: S M A R T
Specific Measurable Achievable/Attainable/Actionable Relevant Timely
ability of a test to accurately identify who does not have (the marker for) a disease
Specificity
How is the health of the public monitored?
Surveillance
Ongoing systematic collection & analysis of data about health conditions to determine levels or changes in levels of specific diseases
Surveillance
Why EVALUATION is important? - ______ - Evidence that demonstrates PHN interventions successes - _____ - Demonstrates what works and what needed to change - _____ - Evidence Base Practices/Best Practices
To know if you achieved your goals Secures Funding - Grants Program Sustainability
national panel of experts in prevention & EBP
USPSTF
____
______
body produces antibody against introduced antigen •Vaccine (this is artificial) •Natural immunity - response to infection
active immunity examples are active bc the body produces the response
____ learn better in a facilitative, nonrestrictive, non structured environment
adult learners
health program planning theory - Seeks to improve ____ health - Applies factors to larger aggregates within a systems framework (assessment -> planning -> intervention -> evaluation) Goal: to create significant measurable community change --> ____
aggregate --> community health impact
Putting Evidence-Based Public Health to practice: Engaging the community in ____-making Using data and information systems ____ Conducting sound evaluation Disseminating(spread) what is learned to key stakeholders ____ makers.
assessment/decision systematically decision
What can we do to disrupt disease transmission of dengue fever? host - human --> _____ vector- mosquito --> _____ agent- virus --> _____ environment --> ______
bug repellent clothing layers vaccine if there is one standing water, screens in houses, water treatments
Infectious Disease Epidemiology Terms and Concepts (1): _____: person with infection but no S/Sx. or illness
carrier
At the beginning of an epidemic the DOH or US CDC will establish a "______" makes a mold of what makes the disease such as symptoms, lab tests ex: what makes up COVID to get diagnosed by COVID https://wwwn.cdc.gov/nndss/conditions/coronavirus-disease-2019-covid-19/case-definition/2020/#:~:text=Case Classification-,Probable,testing performed for COVID-19.
case definition
Epidemiology and Preventive Actions: Observations have lead to effective preventive measures implementation through recent history: - Ignaz Semmelweiss and ____ - Edward Jenner and ____ - John Snow and ____ - Florence Nightingale
child-bed fever smallpox cholera
USPSTF makes recommendations about _____ services such as screening tests, counseling services and preventive medications
clinical preventive
_____ is a multifaceted and complex concept that refers to the differences among people especially those related to values, attitudes, beliefs, norms, behaviors, customs, and ways of living.
cultural diversity
_____ is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture
cultural imposition
_____ refers to the "particularistic values, beliefs, and patterning of behavior that tend to be special, 'local', or unique to a designated culture and which do not tend to be shared with members of other cultures
culture specific
______ refers to the "commonalties of values, Norms of behavior, and life patterns that are similar held among cultures about human behavior and lifestyles and form the bases for formulating theories for developing cross cultural laws of human behavior
culture universal
is screening or diagnostic testing more invasive and expensive
diagnostic is more expensive and more invasive
Human to human transmission: what are four ways?
direct person to person contact (most important) (direct transmission) airborne transmission indirect contract via a common vehicle fecal- (oral contaminated water food)
health education materials include websites before ______ them Materials should: - strengthen previous ____ - be used as an adjunct to ____ - be appropriate for intended audience in community education initiatives
disseminating them - teaching - health instruction
what are three things a community health nurse should consider
diversity, equity, inclusion
_____ is a person's tendency to view his or her own way of life as the most desirable, acceptable or best, and act in superior manner toward another culture
ethnocentrism
Types of objectives (linked to _____) Process Objectives: Task/Activities:(Formative evaluation measures): OUTPUTS: By __, __(how many) of ___(what) will be ____(provided) as measured by _______ Outcome Objectives: KABs (Summative evaluation measures): OUTCOMES: By __, ___% of (who) will ____ (gain, improve) in _____, as measured _____ (tool, test, measure).
evaluation
logic model: A picture of how your organization does its work - the theory and assumptions underlying the program... (Kellogg Foundation) - An ____ tool* that facilitates effective program planning, implementation, and evaluation - Graphic depiction demonstrating ____ of a program - What a proposed program will DO and what it will _____ - Links program ____ with OUTCOMES!
evaluation WHAT & WHY ACCOMPLISH ACTIVITIES
Illustration: H.pylori as causative agent in duodenal ulcers (DU): Strength of association: H. pylori found in 90% of pts. With DU Dose-response relationship: density of H. pylori higher in pts. With DU Replication of findings: many studies found same results Temporal relationship: 11% of chronic gastritis pts. Will develop DU. Biological plausibility: H. pylori has binding sites on antral cells and can follow into duodenum Consistency with other knowledge: Prevalence of H. pylori and DU is same in men and women Specificity of association: Prevalence of H.pylori in pts. with DU is 90-100%
example
human host vector aedes agent. environment den virus. standing water
example of epidemiological triangle
"Prevention of childhood dental caries": State the issue: seriousness, data, outlier of problems What is the problem Strategies to consider Resources available Contact information
example of logic model
Examples of some rates.. crude death rate: # of deaths in yr./ population at mid year X 100,000 cause specific death rate: # deaths from specific cause in 1 yr. / total population at mid year X 1,000... infant mortality rate: # deaths 1 yr and less in yr. / total live births in yr. X 1,000 Attack rate (or incidence proportion): # of new cases / total # people exposed Secondary attack rate: # of new cases among contacts / total number of contacts
examples!!
Evaluation: Include the participant's verbal or written ____ and the nurse's detailed analysis Communicate follow-up recommendations Reflect on each stage, determine strengths/weaknesses
feedback
Legal and ethical issues for epidemiology and nursing practice (x5)
genetic epidemiology privacy/ confidentiality community profiling infectious disease past ethics violations
who is Paulo Freire and what strategies did he bring to help the poor and oppressed
he is a Brazilian educator who brought empowerment among the poor and oppressed by promoting literacy
% of people in the population that are NOT susceptible
herd immunity
when determining the extent of disease in a population, you are looking to determine....
how to distribute health care resources
what is a vector transmission
human infected then infects animal, then infects human ex: mosquitoes- malaria, swine- blue (birds)
secondary prevention purpose
identify people with risk factors and diseases in their early stages
how to read the logic model: ____: what we invest - program resources ($/people) ____: what we do (verbs) ____: what results - knowledge, attitudes, behaviors (KABs)- short, medium, long term _____: goal
inputs activities outcomes impact
Case Definition: The criteria to call something a "case" Usually includes person, time, place and clinical features Early in the epidemic, it usually requires ____ confirmation But...as the number of cases increases, may switch to signs and symptoms present to count something as a "case"
lab test
what can stop the portal of entry for COVID-19
masks
what protect the portal of exit (if someone in infected)
masks, cant breathe out covid
Critical to identify risk factors, and ways to avoid them, in order to reduce: - ____ (rate/amount of disease in a population) - ____ (rate of death in a population)
morbidity mortality
when identifying the cause of a disease and its risk factors it reduces....
morbidity and mortality from disease
Health Planning: Needs Assessment phase: - research potential problems and ____ - consider ____ when determining priorities
needs factors
what is ethnocentrism and cultural imposition categorized as
positionally
what are the preventions of disease
primary (healthy) --> secondary (early disease) --> tertiary (chronic disease)
Health Planning:Planning, Implementation & Evaluation: Starts upon completion of ____ of problem/needs requiring intervention Determine desired ____ of intervention, and corresponding objectives to meet goals
prioritization goals/outcome
what kind of teaching style did he Paulo Freire use
problem solving approach to education: "banking education approach" --> which placed the learning in a passive roll participatory action research
Outbreak Investigation- A planned approach to determine: - If there is really an outbreak - Likely cause or agent - Mode of transmission and other causative factors - Number of cases - Best approach to contain and halt the spread ______: data is collected and analyzed
process used
...Selecting and carrying out a series of activities designed to achieve desired improvements (Issel, 2008)
program planning
Prioritizing health issues to focus on (x5)
propriety, economic feasibility, acceptability, resources, legality
assess _____ of education resources: - SMOG readability formula - Flesch- Kincaid formula (computers) - search "readability statistic"
readability
environment in which a pathogen lives and multiples (soil, water, humans, animals)
reservoir
_____ an exposure associated with a disease, variable that increase the rate of disease in people who have them - Genetic predisposition (gene) - Exposures (ex: infectious agent, diet, stress)
risk factor
- become a partner with individuals and communities - activate ideas - identify resources - serve as catalyst for change - offer appropriate interventions - facilitate group empowerment
role of a community health nurse
Other things to think about: - Stigma - Costs - Psychosocial impact - Validity of test - implications of false +/-
secondary prevention early detection and treatment
Plan adequate/appropriate follow up Risk vs benefit of test Existence of acceptable/medically sound tx and follow-up
secondary prevention: early detection and treatment screening programs
Secondary prevention: Detecting disease early: Screening Tests: Validity of screening tests are evaluated by 2 Components:
sensitivity, specificity
participatory action research (PAR): goal: _____ - embraces the use of community based participatory methods - participation and action from stakeholders and knowledge about conditions and issue help to facilitate strategies reached collectively
social change
sustain cognitive and behavioral changes by engaging learners to become partners in their own behaviors lifestyle accommodation
sustainable changes: PILI 'Ohana Lifestyle Intervention
"Let whoever is in charge keep this simple question in her head: Not, 'how can I always do this right thing myself,' but 'how can I provide for this right thing to be always done?'" - Florence Nightingale
systems thinking
NEED ASSESSMENT MAPUnmet Needs - Gaps of a Community: what are the four groups
teen moms, gang members, homeless/ mental illness, school dropout
when studying disease history and prognosis, it determines
the effectiveness of interventions
- gives precedence to understanding the cultural dimensions of human care and caring - describes, explains, and projects nursing similarities and differences focused primarily on human care and caring in human cultures
theory of culture care diversity and universality
- implicit bias - structural racism - historical/ cultural trauma - cultural awareness - cultural humanity - cultural safety
things to consider as a community health nurse
a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values, and practices with the goal of using this knowledge to provide CULTURE SPECIFIC AND CULTURE UNIVERSAL nursing care to people
transcultural nursing
is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice
transcultural nursing
uses world view, social structure, language, ethnohistory, environmental context, and generic or folk and professional systems to provide a comprehensive and holistic view of influences in cultural care and well being
transcultural nursing
what is cultural diversity related to
values, attitudes, beliefs, norms, behaviors, customs, and ways of living
