Exam 1 Flashcards
What are the core functions of public health?
Assessment
policy development
assurance
What is the purpose of public health?
prevent epidemics and spread of disease
protect against environmental hazards
prevent injuries
promote and encourage healthy behaviors
respond to disasters and assist communities in recovery
assure the quality and accessibility of services
What are the 10 essential public health services ?
monitor health status
diagnose and investigate
inform, educate, and empower
mobilize community partnerships
develop policies and plans
enforce laws and regulations
link people to needed personal health services
assure a competent workforce
evaluate
research
How are public health and medical care different/ similar?
public health - diagnoses, 3% of funding spent on this, prevention
medical care- cure
Disciplines of public health
epidemiology
statistics
biomedical sciences
environmental health science
social and behavioral sciences
health policy and mgmt
chronic disease
conditions lastin 1/+ years and require ongoing medical attention, limit daily activities or both
health promotion
Occurs while individuals are healthy to improve overall health, reduce risks, and increase resistance if exposed
activities often target entire populations (non smoking)
exposures/risk factors
factors that increase the risk of a disease developing in a person
disease prevention
activities focused on prevention of an illness, target populations consist of at risk individuals
what are the steps to the public health approach?
define the health problem
identify risk factors
develop and test community-level interventions to control/prevent the cause of the problem
implement interventions
monitor for effectiveness
What’s the difference between prevention and intervention?
prevention- before it happens
intervention- when it happens
Primordial prevention
designed for risk factor reduction
targets social and environmental conditions, children
improving access to safe sidewalks to promote physical activity
primary prevention
targets susceptible populations or individuals
prevents a disease/injury from occurring
immunizations
secondary prevention
early disease detection
targets sub clinical stages of disease
screenings
tertiary prevention
targets both the clinical and outcome stages of disease
reduce effects of disease when established in individual
rehab efforts
what is the chain of causation?
agent, host, environment
interventions can focus on any of these targets
What are some examples of pharmacist and public health activities
Immunizations
health promotion and disease prevention
disease state management
MTM
covid-19 testing
HIV preventions
harm reduction strategies
medication safety
intimate partner violence
Father of Epidemiology
John Snow
First epidemiologist
Hippocrates
What was the Framingham study and what 3 risk factors did they identify?
prospective cardiovascular disease study
1st major epidemiological study of chronic disease
high blood pressure, high cholesterol, and smoking
What happened in Tuskegee?
Syphilis investigation
involved 600 african american men
despite discovery of penicillin, men were never offered treatment
Incidence rates
number of new cases of a disease in a population within a specified time period
Divisions of department of health and human services
AHQR
ATSDR
CDC
FDA
HRSA
IHS
NIH
SAMHSA
CMS
ACF
AoA
US Department of Health and Human Services
primary federal agency for public health with 11 divisions
national private organization
sets priorities for health and public health, supports and funds programs and research, monitors nation health, interacts with international partners to promote health
What is police power and an example of it?
allows states to pass legislation to take actions to protect the common good
establishment of health and safety standards, seatbelts
Which ethical issues lead to the Belmont Report?
Tuskegee and Nuremberg
What was the Belmont report and the 3 principles relevant to the ethics of research?
ethical principles and guidelines for the protection of human subjects research
autonomy, beneficence, justice
autonomy
people empowered to make their own decisions concerning their actions and wellbeing
beneficence
do not harm, maximize possible benefits, minimize possible harms
assessment of benefits and risks
justice
equitable distribution of burdens and benefits
What is the IRB?
Institutional Review Board
approves research studies before they begin
Human Subject
any individual who engages in an experiment
What are the responsibilities of the IRB?
ensure ethical conduct of research
assure protections of human rights and welfare
use framework set by the Belmont Report
What is informed consent? What reading level should it have?
patient having all the knowledge they need to make their own decisions
8th grade
NHANES
assess health and nutritional status of adults and children in the United States
combines interviews and physical exams
exams a nationally representative sample of about 5000 people per year
determines prevalence of disease and risk factors
Healthy People 2030
goals for US population to
- achieve high quality longer lives free of preventable disease
- achieve health equity, eliminate disparities
- create social and physical environments that promote good health
- promote quality of life, healthy development and healthy behaviors
What are some examples of risk factors
smoking
hypertension
alcohol consumption
sexual practices
drug use
physical fitness and activity
weight
dietary intake
can be unmodifiable/modifiable
USPSTF
The US preventative Service Task Force
16 volunteer experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services
Health literacy risk factors
elderly
ethnic/racial minority
limited education
low socioeconomic status
people with chronic disease
complex health system
reliance on written words for patient instruction
health literacy red flags
making excuses
perceived resistance
has no questions
frequently missed appointments/tests
non-adherent with meds or treatment
What are some ways to work with individuals with low health literacy
convey an attitude of helpfulness, caring and respect
slow down
use plain, non-medical language
use analogies and pictures
limit to 1-3 concepts
repetition
chunk and check
ask patients to demonstrate understanding
use patient friendly materials and forms
Ask Me 3
What is my main problem?
What do I need to do?
Why is it important for me to do this?
What was inadequate health literacy related to in patients with diabetes
poor glycemic control and higher rates of retinopathy
What are the formal assessments of health literacy
The Rapid Estimate of Adult Literacy in Medicine
The Test of Functional Health Literacy in Adults
The Newest Vital Sign
What are the indicators of readability?
The Flesh-Kincaid Readability Test
The Fry Readability Formula
The Simplified Measure of Gobbledygook
Prose literacy
ability to follow written instructions
Numeracy
ability to understand numbers or frequency
Document Literacy
ability to follow instructions verbally
What is the reading level and size of the font that should be used for patient information?
5th grade
12 font or larger
What is the first step in cultural competency?
being self-aware
What is the LEARN model?
Listen and understand patients perception of the problem
Explain your perceptions of the problem and your strategy of treatment
Acknowledge and discuss the differences and similarities between these perceptions
Recommend treatment while remembering the patient’s cultural parameters
Negotiate agreement
What does it take to be a culturally competent clinician?
being aware and accepting of cultural differences
understanding the dynamics of difference
assessing cultural knowledge
be able to adapt to diversity
Ethnocentrism
how someone interprets other cultures/co-cultures; view that ones own group or the groups way is superior to others
Attitudes
represent our preferences- our likes and dislikes
beliefs
what we hold to be true/false
values
express judgements between what is desirable/undesirable, right/wrong/ good or evil
bias
unjustified negative attitude
stereotyping
process by which people use social categories in acquiring, processing, and recalling information about others
Pharmacogenomics
broader-based term that encompasses genome wide differences that may determine drug response; study of relationship between variations in a large collection of genes and variability in drug disposition,response, and toxicity
What’s the difference between pharmacokinetics and pharmacodynamics ?
kinetics- what body does to drug
dynamics- what drug does to body
What are the 4 types of metabolizers for codeine and what happens to them?
ultra rapid- possible toxicity
extensive metabolizer- normal morphine formation
lntermediate metabolizer- reduced morphine formation
poor metabolizer - avoid codeine use due to lack of efficacy
What is CLAS?
Culturally and Linguistically Appropriate Services
guidelines for providing culturally competent care, language access services, organizational supports for cultural competence
if you receive federal funds you have to provide language services
What were the conclusions of the Native American Cancer Study? How could interventions be introduced into this population?
Patients with lower health literacy had more negative attitudes towards cancer and a more progressive form of the disease
screenings and education
What are the 5 key determinants of health from the CDC
biology & genetics
individual behavior
social environment
physical environment
health services
Pharmacogenetics
study of variability in metabolism due to heredity
What has happened to nutritional guides over the years?
Food guide pyramid -> MyPyramid -> MyPlate
adherence to guidelines is suboptimal
How much exercise should children get? Adults?
children - 60 min/day
adults- 150 min/week moderate activity OR 75 min/week of vigorous activity
What is excessive alcohol use?
For women- 4/+ drinks consumed on one occasion or 8/+ drinks a week
For men- 5/+ drinks consumed on one occasion or 15/+ drinks per week
Who would be considered for unsafe use of e-cigs?
youth, young adults, pregnant women, non-tobacco users
What are the main components of socioeconomic status?
level of income
educational attainment
occupational status
What are the differences between social and environmental contributors?
social- conditions which people are born, grow, live, work and age
environmental- physical, chemical and biological factors
What are the steps required to appropriately access healthcare services?
gain entry into the health care system
access a health care location where needed services are provided
finding a provider with whom the patient can communicate and trust
What are the CDC’s 10 great public health achievements?
vaccine-preventable disease
tobacco control
prevention and control of infectious diseases
maternal and infant health
motor vehicle safety
cardiovascular disease prevention
occupational safety
cancer prevention
childhood lead poisoning prevention
public health preparedness and response
National Childhood Vaccine Injury Act (NCVIA) of 1986
ensures an adequate supply of vaccines, stabilizes vaccine costs, and established a forum for injury
What is required for documentation during the process of vaccination?
VIS edition date
date VIS provided
name, address, and title of person administering
date the vaccine is administered
vaccine manufacturer and lot number
Zoster Vaccination Issues
Zostavax confusion with Varivax and Shingrix
live vaccine not available anymore
vaccine supply issues when approved
Various allegations in vaccine controversies
MMR vaccine causes autism- FALSE
mercury based preservative in thimerosal causes autism/neuro-developmental disabilities - FALSE
influenza causes GBS - RISK INCREASES
vaccines can cause chronic diseases of autoimmune etiology - FALSE
HPV vaccines may increase risk of autoimmune and other disorders - FALSE
Aluminum can cause autoimmune/other disorders like MMF - FALSE
Too many vaccines may overwhelm the immune system - FALSE
What issues have led to the resurgence of preventable disease?
social media
promotion of natural lifestyles and clean living
online communities
generations removed from pre-vaccine era
inconsistent use of mandates and exemptions
some vaccines wane in effectiveness over time
new cultural norms evolving from COVID-19 pandemic
loss of trust in institutions to provide guidance
Increasing Vaccination Model Components
What people think and feel
social processes
motivation
practical issues
vaccination
How have tobacco warnings on packages changed over time in the US?
caution-> warning-> SURGEON GENERAL’S WARNING
Family Smoking Prevention and Tobacco control act of 2009 created graphic labels - these got challenged
proposed new labels that occupy 50% of front/rear panel on cigarette packages, 20% of area in advertisement
What has been the influence of tobacco taxation on tobacco use?
for every 10% increase in prices reduces
- youth smoking reduced by 7%
- total cigarette consumption reduced by 4%
Pennsylvania Clean Indoor Air Act
regulates smoking in public places/workplaces
exemptions:
- full service truck stops
- tobacco shops, manufacturers, wholesalers and importers
- private clubs and cigar bars
- 25% of casino gaming floors
- drinking establishments/restaurants where food is less than or equal to 20% of the revenue
Meningococcal Vaccination issues
2 serocoverage types with different recommendations
difficult to measure effectiveness given decline in outbreaks
no effect on herd immunity, protection aimed at high-risk period
Pneumococcal vaccination issues
4 licensed vaccines
serotype coverage expanding over time
immunogenicity of polysaccharide vaccines in infants
Influenza vaccination issues
changes in formulation and effectiveness each year
need for revaccination every year
getting the flu from the flu vaccine
prevention of complications vs disease
concerns over egg allergies
HPV vaccination issues
previously available versions
parental concerns over sexual behavior
safety/adverse effect information on social media
first/second cancer vaccine
Td/Tdap vaccination issues
12 licensed combination vaccines
lawsuits related to DPT adverse effects led to NCVIA
vaccination recommended during pregnancy to protect post-birth
MMR vaccination issues
passive immunity from mother
recent outbreaks in under vaccinated communities
concerns over thimerosal and autism
National Vaccine Injury Compensation Program (NVICP)
no-fault alternative to for resolving vaccine injury claims
funded by a tax on each dose of vaccine
use of vaccine injury table and FAQs
Vaccine Adverse Event Reporting System (VAERS)
joint program of the CDC and FDA
post-marketing safety surveillance program for adverse events that occur after administration of vaccines
healthcare professionals are required to report
Vaccines for Children
program that provides vaccines at no cost to children who might not otherwise be vaccinated
social justice
approach views the equitable distribution of health as a social responsibility
market justice
approach emphasizes individual rather than collective responsibility for health
CDC
main epidemiological and assessment agency for the nation
collects data
have centers to address infectious disease, chronic disease, injury preventions, and other issues
NIH
greatest biomedical research complex in the world
has labs in Bethesda, MD
tests experimental therapies
enjoys strong congressional support
State Health Departments
multiple divisions
connection between local and federal groups
has police power that it can delegate to local departments
State Health boards
provide oversight of state-level departments
health officer usually appointed by the governor
Tribal Health Department
state level organziation
advisory functions may be provided by mechanisms other than a health board
Prevalence Rates
number of existing cases of a disease in a population regardless of how long individuals have been ill
Reportable/notifiable disease
usually infectious diseases, monitored in a population
labs and health care workers can notify the local health department
Sentinel Case
first case of a disease in an outbreak
Endemic
disease that occurs in a population at a low but consistent and persistent levels so that a limited number of cases occur each year
Epidemic
When a disease outbreak spreads to many individuals in
one or more populations across two or more geographic areas
Pandemic
disease outbreak that involves many people and many
countries around the globe.
