Community Exam 2 Flashcards
Environmental Factors
WHO, 1993
Physical Chemical Biological Social Psychosocial
Environmental Exposures
Herbicides Pesticides Other chemical carcinogens Lead Radiation
Healthy People 2020 Objectives for Environmental Health
Eliminate elevated lead blood levels in children.
Minimize risks posed by hazardous sites.
Reduce significant pesticide exposures.
Reduce the amount of toxic pollutants.
Reduce indoor allergen levels.
Decrease lead-based paint or related hazards.
clean water and sanitation
nightingale
Henry Street neighborhood
Lillian Wald
Testing of human fluids and tissues for presence of potentially toxic chemicals
biomonitoring
Sometimes called the study of poisons
Negative effects of chemicals
toxicology
Studies the strength of association between exposures and health effects
Epidemiology
Epidemiologic triangle
Agent
Host
Environment
Relates it to a place on Earth (“mapping”)
coding data
GIS (geographic information systems) community-based maps can be used to:
Educate communities and local policy makers
Provide graphic depictions of public health (PH) problems
example of GIS
Hill and Butterfield’s model of environmental risks
Earth sciences that show how pollutants travel
Geologists
Meteorologists
Physicist
Chemists
Key public health (PH) professionals:
¬ Food safety specialist
¬ Sanitarians
¬ Radiation specialists
¬ Industrial hygienists
WHO: “____ ____ is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations.”
Climate change
nurses main role in climate change
mitigation and response
working at individual, community, institutional, and governmental level to ensure energy-conserving policies and practices
Mitigation:
Response: public health nurses must be prepared for increased____ and ____ related disasters
fire- and storm-
Risks can be categorized as follows:
medium
type
setting
functional location
ex of medium
air
water
soil
food
ex of type
chemical
biological
radiological
ex of setting
urban
rural
suburban
ex of functional location
home
school
workplace
community
information sources
national library of medicine (NLM)
safe cosmetics database
“right to know”
Household Products page
Environmental pages
ToxTown
is an American Nurses Association (ANA) environmental health principle that recommends access to all information necessary to make informed decisions to protect our health.
“Right to Know”
Use of the “I PREPARE”mnemonic device
Investigate potential exposures Present work Residence Environmental concerns Past work Activities Referrals and resources Educate
Features that can positively contribute to a community’s health
Green space, bike paths, walkable communities
point sources of pollution in the air
identifiable (smokestacks)
non-point sources of pollution in the air
mobile (cars and trucks)
sources of pollution in the water
Waste from industry, pharmaceuticals
Storm runoff, erosion, especially due to loss of 80% of the world’s forests leading to massive erosion
contaminated land designations
superfund site
brownfield site
pathogenic causes of food contamination:
e. coli
salmonella
pesticides
genetically modified organisms (GMOs)
68-page final decision from EPA about levels of dioxins in area—May 2011
mossville
Calcasieu Estuary—
Bayou Verdine
Several environmental statutes give the public the ____ __ ___ about the hazardous chemicals in the environment.
right to know
Process to determine the probability of a health threat associated with an exposure
risk assessment
four phases of the risk assessment
Assess toxicology and epidemiologic data.
Has the chemical been released?
How much and by which route of entry of the chemical?
Risk assessment process
: lower-income clients are at increased risk for _____ _____
health problems
why are lower-income clients are at increased risk for health problems
Live in substandard housing
Live in close proximity to pollution sources
Employed in more dangerous occupations
Have less access to healthy food options
Very ____ and very ___ are more vulnerable
young and old
Children’s bodies operate differently than adults, putting them at potentially increased risk for ____ _____.
toxic exposure.
reasons children are increased risk for toxic exposure?
increased RR
immature BBB
kidneys are less effective
A “______ ______” advised when animal research and other indicators demonstrate a possible toxic relationship between a chemical and health effect
“precautionary approach”
______ is a core goal in PHN.
Prevention
Every nurse’s role in risk reduction
Shift to e-records to avoid paper Recycle Promote minimal packaging and green wrappers Go fragrance free Turn off equipment not used Report dysfunctional plumbing Promote local sustainable foods (organic) Start a Green Team Create community
Three Rs to reduce environmental pollution
Reduce
Reuse
Recycle
includes all the principles of good communication in general.
Risk communication
Risk communication is a combination of the following:
the right information
to the right people
at the right time
Created to coalesce nurses and nursing organizations around relevant issues
2008—Alliance of Nurses for Healthy Environments
Certain environmental health risks disproportionately affect poor people and people of color in the United States.
1993: Environmental Justice Act was passed
1994: Executive Order 12898, “Federal Actions to Address Environmental Justice in Minority Populations”
Chemicals that do not decompose
Also referred to as persistent organic pollutants (POPs)
Persistent Bioaccumulative toxins (PBTs)
Pollutant created by health care industry
Created by incineration of chlorine
Dioxin
ANA was a founding member of this campaign.
Health care without harm
υ Goals of Epidemiology
υ Monitor the health of the population
υ Understand the determinants of health and disease in communities
υ Investigate and evaluate interventions to prevent disease and maintain health.
υ So WHAT kind of Diseases are we talking about?
υ COMMUNICABLE DISEASES
, “father of epidemiology”
υ John Snow
How to measure mortality rate
υ Proportionate mortality ratio (PMR)
υ A two-dimensional causal web that considers multiple levels of factors that affect health and disease
υ Web of Causality
Ð Determining the relationships between the different causes of disease is important to PH practitioners who seek to prevent, diagnose, and treat disease.
¥ Establishing causality:
what two ways to establish causality
screening and surveillance
screening tests a group of individuals who are
υ At risk for a certain condition
υ As yet asymptomatic
screening is not a _____ test.
diagnostic
reflects the more complex interrelationships among the numerous factors interacting, sometimes in subtle ways, to increase risk of disease.
web of causality
precision
its consistency or repeatability
reliability
accuracy
whether it really measures what we think it is measuring and how exact the measurement is
validity
validity is measured by?
sensitivity and specificity
quantifies how accurately the test identifies those with the condition or trait
sensitivity
true positives
indicates how accurately the test identifies those without the condition or trait.
specificity
true negatives
descries the distribution of disease, death, and other health outcomes in the population according to PERSON, PLACE, AND TIME providing a picture of how things are or have been–the who, where, and when of disease patterns.
descriptive epidemiology
searches for the determinants of the patterns observed–the HOW AND WHY
Analytic Epidemiology
person with descriptive?
race ethnicity sex age education occupation income socioeconomic status marital status
place with descriptive?
does the rate of disease differ from place to place?
time with descriptive?
is there an increase or decrease in frequency of the disease over time?
Investigating a link between exposure and disease
Think of the maps you pull up on Google when you are trying to find something.
cluster investigations
examples of analytic epidemiology
cohort studies
case-control studies
cross-sectional studies
ecologic studies
a group of persons who are born at about the same time
cohort
is the standard for observational epidemiological studies, coming closest to the ideal of a natural experiment
cohort study
participants are enrolled because they are known to have the outcome of interest (cases) or they are know not to have the outcome of interest (controls)
prone to bias
case-control studies
provides a snapshot or a population or a group.
very FAST
Cross sectional study
both descriptive and analytic
looks at disease rates by person, place, and time (descriptive)
relationship between disease rates and risk or protective factors (analytic)
ecologic (correlational) studies
associations observed at the group level may not hold true for the individuals who make up the groups, or associations that actually exist may be masked in the grouped data
ecologic fallacy
uses an intervention
experimental studies
ex of experimental studies
clinical trials
community trials
in ____ _____ the research issue is generally the efficacy of a medical treatment for disease, such as a new drug or an existing drug used in a new or different way.
clinical trials
♣ Health promotion and disease prevention
♣ Large scale trials
♣ Mainly Pharmaceutical (Fluoridation of water), but usually involves:
♣ educational, programmatic, or policy interventions.
community trials
Phocomelia from thalidomide was what?
prescribed for morning sickness for PG women
Phocomelia means?
sealed limbs
NO legs or arms
The relationship between an event (the cause) and a second event (the effect), where the second event is a consequence of the first.
causality of disease
υ Establishing Causality
υ Seven criteria establish the existence of a cause and effect relationship:
- Strength of association
- Consistency with other studies
- Biological plausibility
- Demonstration of correct temporal sequence
- Dose-response
relationship - Specificity of the association
- Experimental evidence