Public Health (Chap 9-13)

what are sources of indoor air pollution?

"Sick building syndrome" - spend more time indoors than out. - Tobacco smoke - Wood-burning stoves and fireplaces - Gas ranges and furnaces - Radon gas (seeps up from soil and rock) - Formaldehyde (from insulation, plywood, floor coverings, textiles - regul by Dept. of Housing and Urban Development - Consumer products (pesticides, dry-cleaning solvents, paint/thinners, hair spray, air fresheners - Microbes (Legionella) - Allergens (mold, house mites, animal dander)

what is the 3rd leading cause of injury death?

*Firearms* -60% suicides, 37% homicides, rest unintentional -homicide rates are 2-5x higher in U.S. -residents of a household with a gun are 3x more likely to die in a homicide.

what are the 4th and 5th actual leading cause of death?

*Microbial Agents* • Encompassed the top three killers of 1900. • Hasnt been conquered. • Could move to a higher position in future (from drug resistance, re-emerging infectious disease) *Toxic Agents* • Were making some successes in envi health (clean air/water, less pollution)

how does population growth affect environment?

• "demographic transition" - birth and falling death rates with PH • Excess population settles in cities, ↑homelessness, shantytowns, poor sanitation. Depletion of Global Resources • Fresh water • Fuel (deforestation leads to degradation of land) • Arable land (decreasing land under cultivation) • Food from the sea (decline of fish and shellfish harvests)

describe dangers of arsenic

• "the king of poisons." • private wells may have 50-90 μg of arsenic/L • Long-term exposure- risk of DM and cancer. • Sx: abd pain, V, D, pain/swelling in hands and feet, skin eruptions, progression to NS deterioration and death. • *Acute hemolytic anemia* is a sequelae • Tx of acute arsenic toxicity is supportive

what are common MH disorders in adults? what personality traits contribute to MH illness? what can help?

• *Anxiety disorders* - most prevalent in adults. • *PTSD* - emphases Tx strategy for managemt • *Schizophrenia* - affects 1% of population • *Mood disorder* (depression, bipolar disorder) ---prevalent in women > men ---depression suicide is highest in older adult due to risk factors of medical conditions, Rx, living conditions, psychosocial stressors self-esteem, optimism, and resilience are needed to deal with stressful life events -one's own ability to cope -psychotherapy & meds -schizo - Tx includes Rx, psychotherapy, and family intervention.

what is the issue surrounding climate change?

• *Climate change* is most threatening effect of population growth. • Greenhouse effect from burning fossil fuels. • Earth has risen by 1°F during 20th century. ---predicted 3-7°F rise during the 21st century. -U.S. has 5% of world population but contributes 16% of greenhouse gases. -China (19.3% of the world's population), is leading emitter, 26% of greenhouse gases.

what are the major categories of MH disorders?

• Anxiety - Physiological response to situations - ie: phobias, panic attacks, OCD, PTSD • Psychosis - Disorders of perception and thought process - ie: schizophrenia, severe mood disorders: hallucinations/delusions • Disturbances of Mood - depression, bipolar disorder, - associated with disturbances in appetite, sleep, energy level, concentration, memory, suicide • Disturbances of Cognition - Inability to organize, process, and recall information, as well as to execute complex sequences of tasks. - ie: Alzheimer's disease, dementia. -----AD can cause Dementia -----AD is non-reversible; Dementia is reversible

describe radiation

• Artificial radiation often worries people. • Sun's UV causes skin cancer & melanoma. • *Radon gas* is naturally radioactive and potentially causes lung cancer. • Scandals with radium in Rx led to regulation. • Chronic exposure to x-ray used in medicine and dentistry cause cancer. • As healthcare providers, should order less imaging studies

what are the issues for the aging population?

• Av age of Americans is increasing. • Baby boomers are starting to retire. • Older people tend to be in poorer health ---growth in cost of Medicare is unsustainable. • Quality of life in later years depends on lifestyle in youth and middle age. • People are living longer due to advance in medical technology (MID 80s) • "young old" (65 to 74); "aged" (75 to 84); "*oldest old*" (85 and older) Challenge for PH is two-fold. - Improve health of older people by prevention of disease and disability. - Confront the issue of how costs can be controlled in an equitable and humane way.

what are examples of infectious agents?

• Bacteria (ie: Tb, cholera, typhoid, tetanus, diphtheria, dysentery, syphilis, streptococci, staphylococci ) • Viruses (ie: smallpox, poliomyelitis, hepatitis, measles, rabies, AIDS, yellow fever) • Parasites (ie: malaria, cryptosporidiosis, giardiasis, round/tape/hook/pinworms) • Fungi (ie: yeast and mold)

describe the PH viral threat of Ebola

• Began in Africa (Zaire and Sudan) 1976 then disappeared due to PH measures; Another epidemic in Africa (Zaire) 1995 & 2014 with few cases arrived in US • Sx: F, V, diarrhea, bleeding from various orifices • infects monkeys and apes as well as humans • drugs help Sx, but no cure • 10/2014 NY/NJ require mandatory quarantine for 21 days (e.g: at home)

what were the major killers of infectious disease in the past? (*SICk BoDY MaTT*) what helped to conquer infectious diseases in 1960s?

• Bubonic plague ("Black Death") • Yellow Fever • Diphtheria • Tuberculosis • Measles • Smallpox • Influenza • Cholera • Typhoid • Immunization • Antibiotics • PH measures --purification of water, proper disposal of sewage, pasteurization of milk, improved nutrition and personal hygiene

describe the PH viral threat of Monkey Pox

• Caused by a virus, similar to small pox (but milder Sx: fevers, aches, rashes) • Affected by contacting prairie dogs (rodents) • PH identified in Africa; known to infect monkeys, but primary hosts are rodents • Outbreak in May & June 2003 in Illinois & Wisconsin and spread to 72 people in six Midwestern states • No one died • June 2003 U.S. govt banned import of all rodents from Africa-- no more cases since

what are the steps of an outbreak investigation?

• Confirm the existence of an outbreak (and verify the working diagnosis). • Construct a working case definition. • Find cases systematically - apply active surveillance • Ask who, where, & when Q to describe the epidemic by person, place, & time-- consider the incubation period • Look for a common exposure. • Analyze data-- implement control measures

what are regulated contaminants of water? what are dilemmas in compliance of this?

• EPA set standards for 87 contaminants. • 2° standards set for 15 that may affect taste, odor, color, or cause teeth discoloration • CDC collects data on water-borne disease outbreaks. Regulated Contaminants - Disinfectants: chlorine - Disinfection byproducts: chlorite - Inorganic chem: metals, asbestos, cyanide - Organic chem: herbicides, pesticides, PCBs - Microorganisms: bacteria, viruses, cryptosporidium - Radionuclides - Turbidity Dilemmas in Compliance • Resistance from local cities & govt due to $ • Disinfectants may make harmful byproducts. ---same chem used to kill microbes in water may themselves be harmful to health • concern of trace amounts of hormones, Rx, and household chem in waterways.

what are PH Response to Emerging Infections?

• Global surveillance • Improved PH capacity • Veterinary surveillance • Reduction of inappropriate use of antibiotics Institute of Medicine recommendations: - New vaccines & antimicrobial drugs - Measures against vector-borne diseases

describe CV disease?

• Heart disease and Stroke • Atherosclerosis is part of development; plaque begins at an early age in U.S • Diet, HTN*, DM, smoking cause injury of artery walls Prevention strategies - Exercise ↓total cholesterol, ↑HDL - Smoking ↓HDL - Moderate alcohol consumption ↑HDL; heavy drinking damages heart - Statins for 2° prevention

what is the 2nd leading cause of injury death? what measures are being done to prevent this?

*Motor vehicle injury* • alcohol plays a major role in fatal crashes. • 2nd leading factor is youth/inexperience. • distracted driving contributes to crashes. - National Highway Traffic Safety Administration (NHTSA) set standards for autosafety (ie: seat belts, laminated windshields, collapsible steering assemblies, dashboard padding) - changes to make cars and highways safer - edu and enforcement (speed limit, sea belts) - graduated driver's licenses - zero tolerance for blood alcohol

what is the leading cause of injury death? what measures are being done to prevent this?

*Poisoning* (ie: unintentional deaths, recreational use of Rx pain relievers, inappropriate Rx of controlled substances, suicide with psychoactive drugs) - regulation by DEA - online drug tracking system that would reduce risk of pt obtaining multiple Rx for opiate drugs.

who share the primary responsibility for ensuring foods are safe, wholesome, and properly labeled? what do they do?

*U.S. Department of Agriculture (USDA)* - regulate meat, poultry, processed eggs, prepared products w/ 2%+ of cooked meat - *~20%* of federally regulated foods, & 26% of foodborne illness outbreaks *FDA* - responsible for all other foods, including seafood and produce - bc of budgetary constraints, can only inspect food-processing facilities 1/10yr - *~80%* of federally regulated foods, & 66.5% of foodborne illness outbreaks - regulates imported food (80% seafood, 50% fruits, 20% vegetables) - FDA issues regulations for State and local govt to follow when regulating stores, restaurants, institutions (ie: handwashing and temp control) -States regulate shellfish

what is the leading actual cause of death? what does it cause? what are some harmful effects?

*tobacco* -causes cancer, CV disease, COPD, low birthweight deaths, burns -nicotine is an addictive drug that ↑BP & HR, may cause spasms in heart blood vessels -tars condenses in lungs, damage cilia and irritate respiratory tract; major source of carcinogenicity -CO interferes with blood's O2 carrying capacity -other ingredients are also carcinogenic (e.g., arsenic and benzene) which alter clotting properties of blood, ↑cholesterol & ↓ HDL

what is "compression of mortality"?

- A reduction in variability of mean age at death; increase in life expectancy - The time between onset of chronic disease to death has shortened; reducing the time a person who is near end of life, spends being sick or disabled.

describe the chain of infection what are PH measures to control the spread of disease?

- Infectious agent - Reservoir - Means of transmission - Susceptible host -aim at interrupting the chain of infection at whichever links are most vulnerable. • Kill pathogen with antibiotics. • Eliminate reservoir (ie: wildlife w/ rabies) • Prevent transmission (ie: hand washing, quarantine, condoms) • Immunization (↑resistance of host)

what laws are empowering federal govt to set standards for chemical testing?

- Occupational Safety and Health Act - Toxic Substances Control Act - Federal Insecticide, Fungicide, and Rodenticide Act - Clean Air Act (monitor and regulate criteria air pollutants) Standard setting is slow and controversial - The National Toxicology Program can only test a few dozen agents each year - Toxicity testing on any single chemical can be expensive and time-consuming • Over-regulation = Under-regulation by spending too much effort on one chemical • Risk must be balanced against other societal goals including economic well-being. • Political groups sometimes favor economic and business interests over envi and PH. • *hope for the current administration is to put more priority on PH*

what are criteria air pollutants? NP S COOL

- Particulate matter - Sulfur dioxide - Carbon monoxide - Nitrogen oxides - Ozone - Lead

what is an indicator of the health status of a population? what are the social factors of it? what are the top causes of infant mortality in US?

infant mortality rate (IMR) -US ranks 27th -more than double for US blacks than whites #1 risk factor is poverty - Environmental hazards - Poor nutrition - Maternal risk behaviors (smoking, alcohol, illegal drugs) - Social factors (young, violence, out of wedlock birth, stress, lack of social support) - Lack of prenatal care -*birth defects* are the leading cause -*prematurity and low birth wt* (leading in black) -SIDS is a leading specific cause

what is the number one cause of death between 1-44y/o? what is its epidemiology?

injuries -*4th leading cause of death* in US -higher injury rates exist for lower SES groups -many injuries arent fatal, but fatal ones are most reliably reported -injuries (e.g head & spinal cord) resulting in long-term disability are costly to society -males have higher injury rates than females -blacks have *lower injury mortality* than whites, but *higher homicide* rates

what are the categories of injuries? what are the leading causes? *PMF* describe the injury pyramid

non-fatal fatal (un/intentional: homicide, suicide) 1) Poisoning 2) Motor vehicle injuries 3) Firearm injuries • Falls • Suffocation • Drowning • Fires/burns • Cuts/pierces death < hospital discharges < ED visits < injuries reported

a majority of drug overdoses involve which drug? which specialties dispense the most opioids? which providers dispense the most opioids? which subgroups are more likely to use Rx opioids?

opioids (heroin, methadone, fentanyl, tramadol) pain med, surgery, rehabilitation primary care physicians older adults (40+) > (20-39) women > men non-hispanic whites > hispanics non-hispanic whites = non-hispanic blacks

what factors lead to emerging diseases? what are emerging viruses? what are new bacterial threats?

• Human activities that cause ecological damage and close contact with wildlife • Modern agricultural practices • International travel, distribution of food and exotic animals • Less social restraints on sexual beh & IV drugs Emerging viruses: Ebola, Monkey pox, Hantavirus, Other hemorrhagic fevers, West Nile virus, SARS, Zika Bacterial threats: Legionnaire's, Lyme disease, Group A streptococci, E. coli O157:H7 in food; Antibiotic resistance (from improper medical use, agriculture, MRSA, VRE)

what are sanitary landfills? alternative methods?

should be dry, impervious clay soil. ---appropriately situated ---allows for proper drainage of liquids ---vented to control explosive gases ---when reached capacity, it is covered with 2ft layer of soil reduce, reuse, recycle/compost waste-to-E incineration - pollution concern

what are principles of emergency preparedness?

• Impt of advance planning involving all agencies, practice at least once. • Impt of good communication and coordination • *Incident Command System* - puts a single person in charge at the scene. • National Incident Management System (NIMS) - standardizes the organizational structures, processes, and procedures that communities should employ; developed by Federal Emergency Management Agency (FEMA) • Federal govt funds states/metropolitan areas for planning • Strategic National Stockpile of medical supplies, antibiotics, vaccines, antidotes for chemical agents

describe DM

• Inability to metabolize sugar. • Type 1, "childhood onset," is insulin production failure. • Type 2, "adult onset," is insulin resistance. ---Prevalence is rising in U.S. along obese. ---Lack of access to routine medical care contributes to DM as a PH problem • Complications (blindness, kidney failure, poor wound healing, amputations) -ophthalmologist and podiatrist -HbA1c every 3 months, flu vaccine, BP and cholesterol control, monitor finger sticks

describe the PH viral threat of Influenza

• Influenza is an RNA virus like HIV. • Virus is constantly mutating, so vaccine must be changed frequently; new lethal strains appear periodically • 1918-1919 Epidemic killed 20-40 million in world • Bird flu and H1N1 are concerns

what are routine PH functions in disaster response? what responses are expected for *predictable natural disasters* & *less predictable technological/terrorist* disasters?

• Issued death certificates and burial permits. • Monitored safety of food/water served to emergency workers. • Cleaned up food in abandoned restaurants. • Sampled dust and debris to assess risk. • Surveyed cleanup workers and residents for Sx. • CDC sent officers to monitor hospital ER for patients with unusual Sx • Arranged for MH counseling. both predictable natural disasters & less predictable technological/terrorist disasters *require response planning* - search and rescue - Tx and evacuation of injured - food, water, and shelter for survivors - minimizing environmental hazards

describe cancer

• It is not one disease but many, each with different risk factors, treatments, etc. • Cancer arises from mutations in DNA caused by chemicals, viruses, radiation. • Foods may contain carcinogens • Hormones stimulate/inhibit cell growth • Tobacco use causes 1/3 of cancer deaths.

water pollution incidents and federal legislation?

• Lake Michigan, Chicago—*cholera*, 1885 • Minamata Bay, Japan—*mercury*, 1950s • Hudson River, New York—Polychlorinated biphenyl (*PCB*), 1970s • Lake Superior, Duluth—*asbestos*, 1970s • James River, Virginia—*Kepone (insecticide)*, 1960s • Cuyahoga River, Ohio—*oil caught fire*, 1969 • Lake Michigan, Milwaukee—*cryptosporidiosis*, 1993 Federal Legislation • Clean Water Act—1972, 1977, 1987 ---lakes and rivers should be fishable and swimmable. ---all pollution discharges should be elim • Safe Drinking Water Act—1974, 1996 ---*EPA* should *set standards* for local systems. ---*States* should *enforce* the standards.

describe the dangers CO

• highly toxic gas mostly produced in motor vehicle exhaust. • esp. harmful to patients with CV disease. • causes H/A and impairs mental processes. CO Poisoning • Prehospital Tx: remove from area, O2, intubate if needed, measure CO levels • ER Tx: O2, Cardiac monitoring, monitor pulse Ox, frequently assess neurological status; imaging (CT/MRI of brain)

describe dangers of pesticides and industrial chemicals

- Rachel Carson's Silent Spring in 1962 launched an environmental movement. - Dichlorodiphenyl-trichloroethane (DDT), a pesticide for insect control, and some other pesticides are now banned in US. - Endocrine disrupters affect reproduction, NS, and immune system, may cause cancer. - Polychlorinated biphenyl (PCB) production halted in U.S. by 1977. ---Japanese & Chinese PCB "Coca-Cola babies" - dark and lasting neurological issues - Bisphenol A (BPA) can mimic estrogen, causing early puberty in females and abn in male and female sex organs. - Phthalates interfere with testosterone synthesis in males causing low sperm counts and abn development of male sex organs ---BPA and phthalates both leach into liquids and are found at low levels in humans; FDA declared them safe but is reconsidering.

what are some occupational cancers?

- Scrotal cancer in chimney sweeps - Bladder cancer in dye factory workers - Lung and lymphatic cancer from arsenic (copper smelters)

what is a "case definition" describing?

- include info about time & place of exposure, lab findings, and clinical Sx - definition may change as new info becomes available (from general to specific)

what are the most dangerous occupations? what injuries are the leading cause of occupational injury death? what agencies are trying to work on this problem?

- logging and fishing - motor vehicle injuries (highway crashes, overturned farm or industrial vehicles, falls, falling object/equipment, caught in equipment, electrocution) - Regulatory agency: Occupational Safety and Health Administration (OSHA) - Research agency: National Institute of Occupational Safety and Health (NIOSH)

describe HTN

-"Essential hypertension" has no known cause. -Risk Factors: obesity, smoking, stress, salt -Borderline high is 140/90 -2° prevention is effective.

describe traumatic brain injuries

-*mild TBI* is a concussion -*severe TBIs* can lead to thinking, sensation or language changes, may cause permanent disability -PH focuses on Primary Prevention

what happens with misuse of *alcohol*?

-3rd actual leading cause of death -results in motor vehicle fatalities (35-40%, ↓ since 1990 from drunk-driving laws) -chronic liver disease, cirrhosis, home/job injuries, drownings, fire, cancer (3-5%) -underage drinking (impaired driving, fighting, poor school performance, sex, smoking); responsible for >4300 deaths in US/year

what are healthy eating suggestions and factors?

-Federal Dietary Guidelines: more fruits and vegetables, whole grains, low-fat milk and dairy products; less refined grains, added sugar, salt, saturated and trans fats -only 1-3% of Americans eat recommended -fruits are most commonly omitted item. -main veggies are iceberg lettuce, potatoes (including chips & fries), canned tomatoes. -intake of sweetened beverages ↑, milk ↓ -social, cultural, and economic factors contribute to dietary patterns. -enhance self-efficacy & provide social support. -California's "5-A-DAY" Campaign for Better Health to ↑ fruit & vegetable consumption to 5 servings/day -↑ access to healthier foods options. -2014, Berkeley, California, became first U.S. city to tax sugary drinks; then followed Philadelphia, SF, Oakland, Albany, Cook County in Illinois -suggestion: food labeling, limit ads of unhealthy options; encourage breast feeding

what are the medical costs of the elderly?

-Medicare enrollment has more than doubled since 1966 and will continue to grow. -cost/enrollee is rising, even faster than healthcare costs in general. ---more of costs are being shifted to individ ---Medicare does not pay for LTC ---Medicaid does, but cause straining on state budgets -changes in family structure mean families are less able to care for elderly relatives. -integration of PH and medical services to reduce demand for medical care: ---prevents and postpones chronic illness. ---reduces risk factors.

strategies for motor vehicles?

-Tailpipe emissions limits -Vapor recovery systems on gasoline pumps -Inspection and maintenance requirements -Requirements that auto makers develop zero-emission vehicles -Public transportation -Encourage carpooling -Many states with anti-idling laws

what is the epidemiology of MH?

-account for more disability in developed countries than any other illnesses -nearly 1/2 Americans will develop at least one mental illness during lifetime. -difficult to track due to overlap of symptoms -National Comorbidity Survey assess mental disorders -lifetime prevalence of most common MH are: ---35% substance disorder (more M) ---31% anxiety disorder (more F) ---25% impulse control disorder (more M) ---21% mood disorder (more F) -more prevalent in populations <60yo -SE states have highest levels (most likely associated with chronic diseases including obesity, diabetes, and CV)

what are the risks surrounding obesity? how is it measured?

-associated w/ CV disease, DM, cancers, arthritis -wt-associated health risks begin to appear at a BMI of about 25, rise more signif above 30 -NIH and CDC established the BMI ranges -Waist-to-hip ratio - measures fat distribution; apple shaped body have greater health risks ---men with WHR >1.0 and women >0.8 are at greater health risk (when compared to risk based on weight alone)

what are the reasons that an high-priority agent's organism can pose a risk to national security? what are examples of Category A agent/diseases?

-easily disseminated from person to person -cause high mortality; potential major PH impact -may cause panic and social disruption -require special action for PH preparedness

describe physical activity and health epidemiology and suggestions

-exercise promotes health; wt control works best when healthy eating is combined with physical activity. -more physical live longer (exercise helps to prevent CV disease, HTN, cholesterol, DM2, reduces colon & breast cancer risk) • Children = 60 min+ daily. • Adults = 150 min/week (30 mins, 5 days/week). • 46.5% American adults fail to meet guidelines. • Lower SES is associated with more inactivity. • Children get less exercise as they get older. • Obesity in children is correlated with time using TV, computer, and video games. • Utilize social ecological model, intervening at numerous levels of influence (public policy, community, organizational, interpersonal, individual) • Remove envi barriers; add sidewalks, walking trails, bikepaths; use pedometers, ↑physical activity and ↓ BMI & BP • ↑safety with police and neighborhood watches in high-crime areas. • Develop habits of exercise in children; PE classes should focus on activities that can be practiced throughout one's lifetime.

describe HIV/AIDS & transmission?

-first recognized in US in 1981; now worldwide -caused by a retrovirus that attacks immune sys -screening test recognizes antibodies; we can measure viruses in blood; drugs are available but no cure • Sexual contact: Homosexual (common in US) & Heterosexual (common in world) • Sharing needles: IV drug use; medical use of unsterile needles • Mother-infant: Prenatal, birth, breastfeeding • Blood transfusions • Circumcision studies show it helps protect men from women, but doesn't protect women from men; mixed results between men-to-men.

what did John Snow help do?

-first use of epidemiology to study and control cholera -London had Cholera epidemics in mid-1800s -Snow suspected an association Thames River -"natural experiment", talked to households where cholera death occurred -most deaths were associated with one water supply company

how are we confronting the obesity epidemic? medical interventions?

-if not addressed: could reverse PH improvements achieved in 20th century; life expectancy will decline from obesity. -overweight/obesity diseases account for 20.6% of the U.S.'s total medical expenditures. -bariatric surgery helps lose wt and control DM -effective diet pills help but less drastically. ---*B*elviq - work on *b*rain to activate hunger control ---Qsy*mi*a - appetite suppressant, *mi*graine, epilepsy drug ---Orli*stat* - inhibits *fat* abs ---Fen-*ph*en - stopped bc caused heart valve problems & *p*ulmonary *H*TN.

what conditions will make eradication possible? what has been eradicated already?

-if there is *no nonhuman reservoir* and if a *vaccine exists* -Smallpox was eradicated in 1977 -Polio was eradicated from Western Hemi -Measles is next target (now no longer endemic in U.S.)

what is role of govt in envi issues? what are common hazards?

-local govt provide clean water and disposal of wastes. -1960s and 1970s, state and federal govt took more responsibility -world population growth led to depletion of the earth's ozone layer and accumulation of greenhouse gases -EPA sets standards for exposure limits, monitors, and enforces. Environmental hazards include - Radiation - Mercury - Lead - Arsenic - Asbestos - Pesticides and industrial chemicals

common issues in old age?

-metabolize drugs less actively. -risk of drug interactions is higher. -osteoporosis increases risk for broken bones leading to disability (esp in women post menopause) ^risk is increased by smoking and EtOH -falls lead to serious injury 1/10 times ^risk factor: 4+ meds -impairment of vision and hearing ^sensory loss leads to social isolation ^glaucoma, diabetic retinopathy, macular degeneration, cataracts from sun exposure ^asso. with depression & cognitive impairment -tooth loss, periodontal disease, etc. -Medicare does not cover dental care, eyeglasses, or hearing aids.

What are some causes of MH illness? what risk factors should be targeted for prevention?

-most are unk -biological -psychological -sociocultural -genetic (schizo, bipolar disorder, autism, ADHD) -individual, family, community factors -for children: biological and psychosocial exp ^common: autism, mood disorder, ADHD (usually includes disruptive beh, not just active) ^impt for accurate Dx and prevention strategies

what are the second and most impt actual cause of death?

-poor *diet & inactivity* -(obesity, heart disease, stroke, DM, cancer)

describe Alzheimer's & Dementias

-risk increases with age -delaying onset by a few yr could substantially reduce financial & personal burden. -risk factors: genetic and non-genetic factors -physical exercise has protective role -medications delay progression. ---experimental vaccine in progress. ---beta-amyloid into mice was success to reduce plaques, led to exp trials in humans

what are response requirements for bioterrorism?

-surveillance -lab capability -PH laws enabling authorities to take action to protect public and contain outbreak of infectious disease -coordination b/w PH and law enforcement -unsure if uninsured will seek care is a problem

what is the importance of epidemic surveillance?

-system created to control spread of known disease; and recognizing new disease. -↑importance with threat of bioterrorism

describe dangers of asbestos

-used for strength and fire resistance; roofing, gaskets, and brake linings -fibrous dust causes scarring of lungs (asbestosis) and mesothelioma -Manville Corporation went bankrupt in 1982 due to lawsuits concerning workers injured -Libby, Montana - population severely affected by mining. -WTC clean-up and rescue workers were affected.

what is the prevalence of smoking? what laws are helping?

-women started smoking later than men; lung cx surpassed breast cancer -AA men, A Indians, Alaskan natives have ↑rate -strong association with lack of edu -20% US adults smoke -most smokers begin in their teens -ads focus on young, women (wt loss) -need to recruit 2million/yr to replace dead Family Smoking Prevention & Tobacco Ctrl Act • passed by Congress in 2009. • Authorizes FDA to regulate tobacco products and to restrict ads and promotion. • Requires larger, more graphic warning, & disclosure of ingredients • Forbids company from sponsoring sporting

what are examples of PH interventions?

1) education -informs public about healthy/unhealthy beh ---smoking's bad effects ---recommended dietary allowances -health education in schools -physicians' recommendations -use of ads/social media (social norms approach) 2) regulation -warranted when its intent is to restrain people from harming others. -PH laws include: ---laws against murder and assault ---traffic regulations ---restrictions on alcohol, drugs, tobacco ---laws to prevent minors from unhealthy beh ---laws requiring vaccination ---sexual behavior is hard to regulate (maybe premarital screening for STDs) 3) prohibition -against drugs such as heroin, marijuana, and cocaine is generally accepted. -prohibition approach to regulating behavior appears to have mixed results

what is the Ecological Model of Health Behavior?

5 levels of influence that det health-related behavior (target for health promotion intervention) • Intrapersonal - Psychology • Interpersonal - Family, friends, coworkers • Institutional - School, workplace • Community - Churches, community orgs • Public policy level - Govt regulations

describe the issues around e-cigs

According to CDC, between 2010 and 2013, - E-cig awareness grew 80% and use more than doubled among U.S. adults. - They are heavily marketed on television. - Not regulated by FDA at the time - Concern for children due to flavors, and containers not required child-proofing • Aug 2016, FDA began to apply and enforce key provisions of Family Smoking Prevention and Tobacco Control Act on sales, marketing and manufacturing of e-cig • NYS - included in Smoke-Free Air Act

what can cause foodborne illnesses?

Bacteria • Salmonella: eggs, poultry, meat • E. coli O157:H7: ground beef, alfalfa sprouts, unpasteurized apple juice, raw milk, lettuce Viruses • Hepatitis A: green onions from Mexico, shellfish • Norwalk virus: shellfish Parasites • Cyclospora: raspberries from Guatemala • Sushi, sashimi, etc

what are common foodborne-illness causing organisms?

Campylobacter jejuni -cause Campylobacteriosis -D (maybe bloody), cramps, F, V -from raw and undercooked poultry, unpasteurized milk, contaminated water Norovirus -viral gastroenteritis, winter diarrhea, acute non-bacterial gastroenteritis, food poisoning/infection -N, V, cramps, D, F, H/A -from raw produce, drinking water, uncooked food, contact with infected handler, shellfish Salmonella -cause Salmonellosis -D, F, V, cramps -from eggs, poultry, unpasteurized milk/juice, cheese, contaminated raw fruits, veggies Shigella -cause Shigellosis, or Bacillary dysentery -cramps, F, infectious D (may have blood & mucus) -raw produce, drinking water, uncooked food, contact with infected handler Staphylococcus aureus -cause Staphylococcal food poisoning -sudden N, V, cramps, maybe D, F -improperly refrigerated meats, potato/egg salad, cream pastries

how to det if its an OUTBREAK or BIOTERRORIST attack?

Continuous monitoring of: - ER visits - Calls to 911 and poison control centers - Pharmacy records - Veterinary diseases

define endemic, hyperendemic, sporadic

Endemic - amount of a particular disease that is *usually* present Hyperendemic - refers to *persistent* high levels of disease Sporadic - disease that occurs *infrequently/irregularly*

define epidemic, outbreak, pandemic

Epidemic - often sudden increase in cases above normal expectancy in that population in that *area* Outbreak - same as epidemic, but seen in a *more limited* geographic area Pandemic - epidemic that has *spread over several countries/continents*, usually affecting a large # of people

T/F: FDA regulates herbs and food supplements

FALSE -Dietary Supplement Health & Education Act 1994 forbids FDA from regulating -FDA can only remove from market after proven harmful (ie: Ephedra) -2007 law requires manufacturers to report serious adverse effects to FDA

T/F: cosmetics are heavily regulated by FDA

FALSE -loosely regulated -no safely testing required, but need to give warning label that product is untested -if ingredient are found harmful, they may be prohibited by law (ie: chlorinated compounds, color additives, mercury)

T/F: FDA tests drugs themselves

FALSE • must file a new drug application (NDA) • if approved, go through 3 phases of trial ---SAFETY: small # of subjects to measure abs, distribution, metabolism, and excretion; look for side effects and toxicities ---EFFECTIVNESS: large # ---CLINICAL trial • Companies are required by law to conduct tests and submit evidence • FDA will review data and det if evidence supports new drugs' safety and efficacy. • *Postmarketing Surveillance* - when risk of drug is discovered after drug is on market

T/F: there is mandatory reporting of adult domestic violence in NYS?

False NYS Penal Law says its mandatory to report to: - *police*: 1) all injuries resulting from firearm, 2) all potentially life-threatening injuries inflicted by a knife or sharp object, - *Office of Fire Prevention and Control* in writing within 72 hours: 1) all 2nd/3rd degree burns 5%+, 2) all respiratory tract burns, 3) all burns which might result in death, - all such reports must be made by MD or manager in charge of the case-- intentional failure to report is a *class A misdemeanor*! ---this applies for reporting child abuse too ---civilly liable for damages proximately caused by such failure

T/F: changing individual behavior is easiest way to solve PH issue

False Changing the Environment is more effective • shifts focus from blaming the victim. • concept was pioneered in injury control programs. • its effective in tobacco control programs. • its now being considered for improving diet and increasing physical activity.

what are methods for improving food safety?

Hazard Analysis Critical Control Point (HACCP) - Clinton admin implemented a new preventive approach for meat & seafood safety - responsibility on food businesses to analyze their procedures (food production, processing, and preparation) and requiring govt inspectors to verify compliance (less need for inspections) - involves identifying potential sources of contamination and devising ways to avoid them • Irradiation- kills bacteria, parasites, pests • Refrigeration- <40°F • Heating- >140°F • Ongoing active surveillance- CDC on food-borne disease

EPA sets tolerance levels for pesticide residues. what are some contaminants and additives in food?

Hormones -estrogen is banned in chickens. -bovine growth hormone is allowed for cows' ↑milk production (wont enter milk) Antibiotics Organic foods -USDA standards: no Abx, GH, Pesticides, synthetic fertilizer Additives -prevent deficiency; ie: iodine w/ goiter, Vit D w/ rickets, etc -preservatives to improve color, flavor, texture -FDA must approve them (or should have been on the "Generally Regarded as Safe" list)

what was the costliest natural disaster in US?

Hurricane Katrina -deadliest since 1928 -lack of planning for special needs, poor communication, little help, displaced population; Rita came and interfered w/ response activities

describe the Transtheoretical Model (TTM) *PC PAM*

Involves progress through 5 stages of change. - Precontemplation - Contemplation - Preparation - Action - Maintenance

what is the most important predictor of health?

SES • Nutrition • Sanitation • Conditions of physical environment • Levels of healthy behavior • Access to medical care • Health is also affected by gender, marital status, race, and ethnicity. • U.S. minorities have poorer health than whites.

what is the most dreaded possible bioterrorism agent?

SMALL POX -eradicated in 1970s -highly contagious -no immunity in population ~30% of infected die -there was failed vaccination campaign for military and health worker before Iraq war; ppl were worried about side effects and uncertainty of risk with the vaccine

what are some p*s*ychological factors on health?

Stress - ↑mortality after death of a spouse, loss of a job, divorce, etc. - ↑risk of heart disease and common cold - ↑daily hassles at lower SES Social support - Alameda County in Cali study found individ's health status & risk of dying were strongly associated w/ extent/nature social network. - social support act as a stress buffer

How was AIDS prevention program in San Francisco in the 1980s done?

Targeted different levels of influence - Intrapersonal level • I am susceptible to infection. • Theres something I can do to lessen threat. • I am capable of making these changes. - Interpersonal level • My peers support new behavior. - Community level • Edu programs for bartenders in gay establishments • Distribution of condoms - Public policy level • Free, confidential HIV testing

what is PH approach to injury control ? what are the types of preventions available? what are the Three E's?

chain of causation: host, agent, environment • Primary- Condit prevailing before the event • Secondary- Condit prevailing during the event • Tertiary- Availability, promptness, and quality of EMERGENCY care (special trauma centers, use of helicopters, well trained EMT, well equipped ambulances) • Education • Enforcement (ie: traffic regulations) • Engineering (ie: safe shielding needles)

what is the leading causes of death and disability?

chronic diseases -not deadly in short run but has impacts on quality of life -gradual onset allows early det (2° prevention)

who labels food and drugs?

food nutrients/recom - as ordered by Pure Food and Drugs Act 1906; *FDA* Rx drugs - *FDA* OTC drugs - *Federal Trade Commission*

what are the leading (non-genetic) causes of death? what are the leading actual causes of death? *T DAM T*

heart disease, cancer, chronic lower respiratory disease, unintentional injuries, cerebrovascular disease, Alzheimers, DM, Flu/Pneumonia, kidney disease, suicide *accounts for 1/2 of deaths, preventable, premature, mostly from indivud beh, theyre targets for PH intervention *1* tobacco, *2* diet & inactivity, *3* alcohol, *4* microbial agents, *5* toxic agents, vehicles, firearms, sex beh, illicit drugs

how are birth defects prevented? what are facts about low birth wt/preterm?

prenatal care ^the *most PH-oriented care* medical professional provides ^data is collected by state and federal govt --- provides women with information. --- problems are diagnosed early with genetic and newborn screening. --- poor are often linked with social services. - FDA regulation of teratogenic drugs - Warnings against alcohol for pregnant women - ↓pain med Rx during pregnancy (↑risk of congenital heart & neural tube defects) - Folic acid - Immunizing children against rubella - gum disease is associated with preterm; but 1/2 were born from low-risk mothers - recently due to multiple births because of reproductive technology - prevent with prenatal care & reduction of adolescent pregnancy (US has highest rate; ACA mandates for covered birth control) - SIDs is common with low birth wt & infants of smokers/drug users ---"back to sleep"/"safe to sleep" campaign

describe dangers of mercury

• Mercury causes neurological damage • Emissions from coal-burning power plants pollute water and air, contaminating fish. • Nursing mothers and young children should not eat fish with high mercury content. • Fever and school lab equipment are exposure concerns. Tx of mercury toxicity consists of: ---removal of patient from exposure, supportive care, and chelation therapy (activated charcoal). ---pt with cognitive and emotional sequelae may require psychotropic medications. Dx through: ---lab test: assess levels ---nerve biopsy ---1/2 life is ~44 days in blood ---imaging (X-Rays, MRI)

describe the PH viral threat of Hantavirus

• Named after Hantaan River in Korea; 1950s - responsible for kidney disease in Korean soldiers • 1993 - 2 healthy individuals in same household died with acute respiratory distress (lungs filled with fluid) • Virus was found to be carried by deer mice • The CDC declared hantavirus pulmonary syndrome (HPS) a notifiable disease in 1995 - As of the end of 2013, 606 cases had been reported in 34 states

how was solid and hazardous waste before 1970s?

• Open dumps: ---large populations of vermin and toxic contaminated groundwater. ---outlawed by Resource Conservation and Recovery Act (RCRA) in 1976 • Garbage was burned in incinerators or in the open. ---outlawed by Clean Air Act of 1970. • Garbage poured into rivers, lakes, oceans. ---Outlawed by Clean Water Act (1972) & Marine Protection, Research, & Sanctuaries Act (1972). • we dispose ~250 million tons of municipal solid waste each year • In 2013, this amounted to 4.40lb/person/d

epidemiology of obesity

• Prevalence of overweight/obesity have been increasing since 1960s • 69% adults in U.S. are overweight/obese. • Black women > white women; White men > black men to be overweight/obese. • ↑SES is associated with lower rates of overweight/obesity, esp among women. • ↑Prevalence of overweight among 6-19yo, from <5% in 1960s to 16.9% in 2011-2012. • ↑Prevalence in Mexican A boys and AA girls • Children overweight/obese are likely to remain in adulthood, suffering risks of chronic disease • DM2 is being Dx in children.

what are the challenges for 21st century?

• Renewed threats from infectious diseases • Climate change • Rising costs of HC for aging • Understanding and altering human behavior • Need to strengthen PH system • Persistent disparities in health *To educate public and policy makers about role of nonmedical factors in det health *To foster national debate on priorities that will bring spending on HC more in line with its value in assuring health

what are the top 10 PH achievements of 20th century?

• Routine use of vaccination • Improvements in motor vehicle safety • Safer workplaces • Control of infectious diseases • Decline in deaths from heart disease/stroke • Safer and healthier foods • Healthier mothers and babies • Access to family planning and contraceptives • Fluoridation of drinking water • Recognition of tobacco use as a health hazard

what happens with fear of vaccines?

• Rumors of vaccines causing autism & SIDS • Some parents refuse to accept risks. • Herd immunity is lost if many dont get vaccine • Pharmaceutical companies are reluctant to develop vaccines (low profits & risk of lawsuits)

strategies for industrial sources?

• Scrubbers on smokestacks to clean fumes/ smoke before releasing in environment • Less polluting fuels (limits high-sulfur coal) • Implement policies • Emergency Planning and Community Right-to-Know Act (1988) - req reporting locations and quantities of chemicals stored at sites; helps with planning in event of emergency

what govt nutrition programs are out there?

• WIC (pregnant/lactating Women, Infant, Children <5yo) • School Meals Program • Summer Food Service Program • Supplemental Nutrition Assistance Program (SNAP) - former Food Stamp Program.

describe dangers of Ozone

• colorless gas produced by sunlight acting on other air pollutants • protective component of upper atm, but at low altitudes its effects are harmful • indicator of various other chems produced by motor vehicles • often used as a measure of air pollution. • irritates eyes and respiratory system. • ↑mortality from CV and respiratory diseases

describe the dangers of sulfur dioxide

• combustion of sulfur-containing fuels, esp. coal • irritation/damage of respiratory tracts • potential to cause *acid rain* • levels were highest in vicinity of large industrial facilities, declined by 81% 1980-2013

describe dangers of lead

• damages NS, blood, & kidneys • harmful to brain and NS ---poses special risk to development of children's intellectual abilities • has caused poisoning since Roman Empire. • water gets contaminated by lead pipes and lead solder used on copper pipes. • gasoline emitted lead air pollutant until 1980s • paint was used until 1977; threat in old houses • children should be screened for lead levels • toxicity causes *hypochromic microcytic anemia* and basophilic stippling of RBCs ---*iron-deficiency anemia*, often coexists with lead toxicity.

describe the PH viral threat of Zika

• discovered in 1947; named after Zika Forest in Uganda. • 1952 - first human cases of Zika were detected and since then, outbreaks have been reported in tropical Africa, SE Asia, and Pacific Islands • before 2007, at least 14 cases of Zika had been documented • transmitted through mosquitoes, mother to fetus, during sex, blood transfusion • Sx: conjunctivitis, fever, rash, joint pain • can cause microcephaly and other fetal brain defects (eye, hearing, growth) • increased reports of Guillain-Barre syndrome (an uncommon sickness of nervous system, in areas affected by Zika.) • Dx by Sx, travels history, blood or urine test • Tx - supportive measures • Prevent by mosquito control

issues with pollution?

• factory farm animals produce air pollution (ammonia, hydrogen sulfide, methane) and water pollution after rain. • weather atmospheric inversion and smog in London, Donora-Penn, LA • Clean Air Act of 1970 set air quality standards, limited some major pollutants, and mandated emission reduction of autos and factories. ---1st emission standards for automobiles were passed in 1965 • Air pollution has decreased 54% since 1970. • Cali, worst pollution, has instituted many regulations and incentives with some success. • Acid rain damages forests and crops, turns lakes and rivers acidic, and kills fish and plants. • Depletion of ozone layer is an effect of certain air pollutants. • CO2 produced by burning fossil fuels causes greenhouse effect and global warming.

describe the PH bacterial threat of Tb

• leading cause of infectious-disease death (1/3 of world population is infected) • There was a resurgence in U.S. in early 1990s; majority of Tb cases reported in US are found among foreign-born persons • People with HIV are at much higher risk. • Tb is transmitted by aerosol. • Fatality rate is 50% for untreated Tb. • Antibiotics are effective but must be taken for months; improper use can lead to resistance (then mortality rate can exceed 50%) • *Directly observed therapy* - best approach for preventing antibiotic resistance. • In 2007, CDC required for overseas medical screening of applicants for immigration to U.S.

describe dangers of particulate matter

• most visible air pollution form (ie: smoke, soot, ash - typical of Industrial Rev.) • air pollutants can be combustion products • death rates higher in most polluted cities. • Small particles penetrate deeper into lungs. • Lung cancer, other lung diseases, and heart disease are proportional

describe the dangers nitrogen oxides

• sources: motor vehicle exhaust, off-road equipment, and power plant emissions. • responsible for yellowish-brown smog. • contribute to: respiratory tract irritation, acid rain, ozone formation

what issues of politics are involved with FDA?

• subject to political pressures. • problems exist with the way trials are reported • FDA is too slow in approving drugs; so companies pay a fee to speed up review • complaints say FDA is too cozy with industry. • many drugs are found to be unsafe only after approved for marketing. ---Fen-phen diet pill - caused heart valve problems ---Vioxx pain med - ↑risk of MI and stroke ---Antidep. for children - ↑suicidal ideation

when do eating disorders usually appear? what can cause it? what can it lead to?

• typically appear b/w teen-young adulthood. • complex interactions of genetic, biological, behavioral, and psychosocial factors. • boys who want to "bulk up" are also affected. • can lead to anorexia nervosa, bulimia nervosa, binge-eating disorder

dangers of coal ash?

• waste from coal-burning power plants are stored in open dumps, often near rivers. • heavy metal contaminants leach into nearby water; unregulated by EPA. • spill in 2008 on banks of Tennessee River brought attention to coal ash. • has also been used for construction landfill, mine reclamation, and "improvement" of soil for agricultural and golf courses. • The Obama admin announced new regulations on coal ash in December 2014.