Final Exam Flashcards
Surveillance for Infectious and Communicable Diseases
To gather the who, when, what, and where to determine why
Systematically collect, organize, and analyze data for a defined disease
Surveillance for agents of bioterrorism—anthrax, smallpox
List of Reportable Diseases- varies by state
National Notifiable Diseases- infectious and non-infectious
Populations at increased risk for transmission and infection
Children
Older adults
Immunosuppressed
High-risk lifestyles
Travelers
Health care workers
most probable cause of the increase in new emerging infectious diseases
Activities or behavior of humans, including changes in the environment
Emerging infections
Those in which the incidence has increased in the past two decades or has the potential to increase in the future
Airborne infections examples
Measles
Chicken pox
TB
Pertussis
Influenza
SARS
Foodborne infections
Salmonella
Hepatitis A
Trichinosis
E. Coli
Norovirus
Botulism
Mercury poisoning
waterborne infections
Cholera
Typhoid
Dysentery (diarrhea with blood or mucus)
Giardia
Hepatitis A
Most who die from this are small children
vector borne infections
West Nile
Lyme disease
Malaria
Rocky Mountain Spotted Fever
direct contact infections
mono
lice
scabies
STDs
Vaccine preventable diseases
Measles
Mumps
Rubella
Pertussis
Influenza
Polio
Tetanus
Incubation/latency period
time interval between invasion by infectious agent and symptoms
Prodromal period
here the pathogen continues to multiply, and the host begins to experience general signs and symptoms of illness
Too general to know what it is that’s making you sick
Period of illness
the signs and symptoms of disease are most obvious and severe
Period of decline
treatment or sickness passed
Replication stops, the number of pathogen particles begins to decrease, and the signs and symptoms of illness begin to decline
communicable period
time interval during which an infectious agent may be transferred directly or indirectly from an infected person
Can happen in any stage
Active immunity
Antibodies synthesized by the body in response to antigen stimulation
NATURAL active immunity
contact with an antigen through exposure
ARTIFICIAL active immunity
immunization with an antigen
Passive immunity
antibodies produced in one individual and transferred to another
NATURAL passive immunity
immunity from the placenta transferred from mother to child
ARTIFICIAL passive immunity
injection of serum from an immune human or animal i.e. , gamma globulin
Herd immunity
Type of immunity in which a large proportion of people in a population are not susceptible to a communicable disease, and the few susceptible people will not be likely to be exposed and contract the illness
Flu
Influenza is a viral respiratory infection
Transmission is airborne
Vaccines available!
Symptoms of flu
temp 100+
cough
sore throat
underlying condition that increases risk
Tuberculosis
Caused by Mycobacterium tuberculosis
Transmission is usually by airborne droplets from persons with TB
Negative pressure room!
symptoms of TB
cough, blood-tinged sputum, fatigue, Gradual weight loss, low-grade fever, nocturnal diaphoresis
critical period and meds times with TB
Critical period 6-12 months after infection
4-9 months meds with annoying side effects, compliance is key!
Treatment of TB
Targeted tuberculin testing and treatment of latent tuberculosis infection
Contributing factors for TB
Overcrowding
Poor ventilation
Poor health
HIV/AIDS
Poor diet
Homelessness
TB blood tests
also called interferon-gamma release assays or IGRAs
measures how the immune system reacts to the bacteria that cause TB
by testing the person’s blood in a laboratory
IGRAs
QuantiFERON®–TB Gold In-Tube test (QFT-GIT)
T-SPOT®.TB test (T-Spot)
Positive IGRA
means the person has been infected with TB bacteria. Additional tests are needed to determine if the person has a latent TB infection or active TB disease. A healthcare worker will then provide treatment as needed
Negative IGRA
means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely
Who are IGRAs the preferred method of testing for
People who have received bacille Calmette–Guérin (BCG). BCG is a vaccine for TB disease.
People who have a difficult time returning for a second appointment to look for a reaction to the TEST
TB skin test
Intradermal injection in the forearm- 0.1 ml PPD
Read reaction 48-72 hours after injection
Measure and record results in millimeters of induration
An induration of 5 or more mm is considered positive in
HIV-infected people
People who have had a recent contact with another person with TB
People with fibrotic changes on chest radiograph consistent with prior TB
Patients with organ transplants
People who are immunosuppressed for other reasons (like taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-α agonists)
An induration of 10 or more mm is considered positive in
Recent immigrants (<5 years) from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings
Mycobacteriology laboratory personnel
Persons with clinical conditions that place them at high risk
Children <4 years of age
Infants, children, and adolescents exposed to adults at high risk for developing active TB
An induration of 15 or more mm is considered positive in
Any person, including people with no known risk factors for TB. However, targeted skin testing programs should only be conducted among high-risk groups
Treatment and prevention of TB
Long-course anti-TB medication - can be up to 6-12 months on meds for active disease
DIRECTLY OBSERVED THERAPY
Healthcare professionals observe clients to ensure that they ingest each dose of anti-TB medication to maximize the likelihood of completion of therapy.
CDC recommends video DOT (vDOT) as an alternative to in-person DOT for people in TB treatment
Examples of diseases of travelers
Malaria
Foodborne and waterborne diseases
Diarrheal diseases
Yellow fever
Hepatitis
Chikungunya
Other endemic diseases
Zoonosis
an infection transmitted from a vertebrate animal to a human under natural conditions- rabies (hydrophobia)
Parasitic diseases
more prevalent in tropical climates and countries with inadequate prevention and control methods
What are nosocomial infections
in the hospital
People coming in and out of hospital are at risk
What is an Emerging Infectious Disease
Newly appearing in a population or community that hasn’t existed before
Measles
An acute viral respiratory illness.
VERY CONTAGIOUS
Lives on surfaces 2 hours
1 person can infect 9-10 people
S/S of measles
fever (as high as 105°F) and malaise,
the three “C”s: cough, coryza, and conjunctivitis
Koplik spots - inside the mouth on the cheeks
followed by a maculopapular rash
Rash – flat, red spots that can become raised
Koplik spots – whitish-blue spots on the inside of the cheeks–followed by maculopapular rash
Mumps
A highly contagious viral illness in young adults
Transmission: coughing, sneezing, kissing, sharing food or drinks
Need to spend 9 days in isolation
No treatment or cure
S/S of mumps
Flu-like symptoms followed by painful swelling of one or both glands in cheek near jaw line**
It can start as an earache or tenderness along the jaw
Usually last for 9 days
What can mumps lead to
Meningitis
Painful swollen testicles
Painful swelling of ovaries and breasts
Pancreatitis
Permanent deafness
Spontaneous abortions
Rubella
It is a contagious viral disease that can cause a mild illness to serious health problems
Contagious for about a week before and a week after the rash appears
Transmission: coughing, sneezing, or touching contaminated surfaces
S/S of rubella
Mild fever
Headache
Sore throat
Red rash
Swollen lymph nodes.
The rash usually starts on the face and spreads to the rest of the body. About half of people who get rubella don’t develop a rash
Complications of rubella
If a pregnant woman gets rubella, she has a 90% chance of passing it to her fetus
Treatment of rubella
Usually resolves on own
Pain medications
Vaccination
pertussis
A bacterial infection that causes severe coughing fits and can be life-threatening for babies.
Spreads easily through coughing or sneezing
Babies may not cough much, or they may not cough at all. Instead, they may have apnea
If people are visiting newborn babies, make sure they’re vaccinated!
Treatment of whooping cough
Antibiotics
Rest, fluids, and avoid cigarette smoke
Vaccine
Polio (poliomyelitis)
A highly contagious viral disease that can cause paralysis and death.
Due to vaccination programs, it has been eliminated in many areas
Common S/S of polio
Fever
Headache
Fatigue
Vomiting
Muscle pain
In more severe cases, polio can cause paralysis, affecting the arms, legs, or both. Paralysis can occur within hours of infection and is usually permanent
Can cause respiratory failure and death
Transmission of polio
Person-to-person contact with infected feces, contaminated food or water, or through respiratory droplets from an infected person
Treatment of polio
No cure
Bed rest, pain relievers, muscle relaxers, and physical therapy
Tetanus
Bacterial
S/S of tetanus
Muscle spasms in the jaw, face, throat, chest, neck, back, abdomen, and buttocks
Fever
Trouble swallowing
Rapid heart rate
Incontinence
Treatment of tetanus
Focused on managing complications
Vaccination
Hepatitis
Viral hepatitis refers to a group of infections that primarily affect the liver. These infections have similar clinical presentations but different causes and characteristics
Hep A
It may last several weeks and can be debilitating, but most people recover
Affects the liver–jaundice, clay colored stools, dark urine
Vaccine preventable!!
Hep A route and transmission
Spread through fecal-oral route (when fecal matter enters the mouth)
Direct contact
Food and beverages
Cups and spoons
Objects handled by an infected person
Hep A S/S
N/V/D, stomach pain, anorexia, fever, fatigue, jaundice
Prevention of hep A
Hand hygiene education
Keeping toilets and bathrooms clean
Avoiding infected water sources
Peeling fruits and vegetables, and avoiding undercooked meat and fish
Drink bottled water or boil tap water before drinking
People at high risk of hep A
Daycare workers
People traveling to countries with high rates
IV drug users
homosexual men
anybody with chronic liver disease
Hep B
More self limited
Bigger ability to infect compared to HIV because it stays outside the body for longer
Vaccine-preventable
OSHA mandate requires healthcare workers to be offered scene at the expense of their employer
Hep B route and transmission
Spread through blood and body fluids
Hep B people at risk
IV drug users
immigrants
refugees
healthcare workers
hemodialysis patients
prisoners
persons with STDs
Hep B acute vs chronic
Acute: Will develop antibodies and rid the body of the virus on its own. You will have lifelong immunity to acute hep b
Chronic: Mostly seen in immunodeficiency, can’t rid self of virus so they will remain lifelong carriers. Can lead to hepatic carcinoma and chronic active hepatitis
Hep C and spread
Most common chronic blood-borne infection in the US
The leading cause of chronic liver disease, end-stage liver disease, liver cancer, and liver transplants. Very serious!
Spread through blood or body fluids
High risk of Hep C
healthcare workers
infants born to infected moms
IV drug users
persons with multiple sex partners
risk factors for STDs
younger than 25
minority
urban setting
poverty
using crack cocaine
older adults
Gonorrhea
Gram negative, goes for mucus membranes, affects anus, GU tract/genitals, pharynx
Can be spread from mother to child
Increased risk for PID in women
S/S of gonorrhea
Maybe no symptoms!
Abdominal pain or pain with intercourse
Vaginal discharge and bleeding
Infected kidneys
UTI (dysuria)
Burning sensation with urination
Inflammation of the penile
Swollen testicles
Green discharge from the penis
Syphilis
Risk is increasing
Babies can get this and die a lot from it
Stage 1 syphilis
Sore on entry site/chankra
Starts macular, will grow and ulcerate to create indented sore on back
30-90 days after exposure
Will go away into 3-6 weeks or continue into stage 2
Stage 2 syphilis
Body rash that starts on palms of hands and soles of feet, moves inward to trunk
Sore throat, fever, and swollen lymph nodes
4-10 weeks after initial infection
Stage 3 syphilis
Rare because of antibiotics
Affects internal organs
Can lead to blindness, psychosis, and cardiovascular damage
Can lead to death of babies, blindness, deafness, or premature birth
Meningitis, anemia, low birth weight, and death in babies born
3-15 years after initial infection
Chlamydia
The most common reportable STD in the US
About 70-80% of women with chlamydia don’t notice any symptoms
Cervix, rectum, or throat in women
Urethra, rectum, or throat in men
Treated with antibiotics
Exposure again can make you get it again
S/S of chlamydia
usually appear 1-3 weeks after exposure
Pain when urinating
Discharge
Urinary frequency
Pain in the lower abdomen
Pain in the testicles
Fever, nausea
Painful intercourse
Herpes
Can be passed in childbirth
Painful, no cure (chronic, has latency periods of dormancy and reactivation)
Linked to cervical cancer, spontaneous abortions, and high risk of transmission to newborns
Prodromal period before outbreak
Herpes treatment
Antiviral medications include acyclovir, famciclovir, and valacyclovir.
The World Health Organization (WHO) recommends starting treatment within the first three days of an initial outbreak
HPV
Genital warts found on shaft of penis or vulva/vagina/cervix and around anus
Viral infection
Caused by only a few of the 100+ strains of HPV
Transmitted by skin/skin contact in genital area
Treatable
Visual test
Common in young, sexually active women
Can cause cancer
Vaccine preventable
S/S of HPV
Genital warts
Cervical cancer
precancerous lesions
lesions of upper respiratory tract
Plantar warts
Usually no manifestations, they can be dormant and activate when there is a drop in immunity
Genital warts in HPV
Usually soft, fleshy, and moist. They may ooze, bleed, get pustular and itch, at times
In women, they can be seen on the labia majora, minora, cervix, vagina, and anus
In men, they mostly appear on the scrotum or penis
Cervical cancer in HPV
Persistent infection with high risk types of HPV increases the chances of developing cervical cancer
All cases of cervical cancer are caused by HPV infections
The high risk types of HPV can also cause cancer of the anus, mouth, and upper respiratory tract
Precancerous lesions in HPV
These are pre-cancerous affections, which can progress to invasive cancer, and are most commonly seen in the genital areas
These types of HPV cause cellular changes or dysplasia in the cervix or vagina
Such lesions can be easily detected on a PAP smear
Lesions of upper respiratory tract in HPV
Some strains of HPV can affect the mouth and upper respiratory tract
They could also give rise to HPV symptoms like warts on the tongue, tonsils, buccal cavity, larynx, and nose
These warts interfere with breathing and may require surgery
Plantar warts in HPV
These appear on the sole of the foot
They typically have a cauliflower appearance
They may ooze blood through capillaries when the surface is cut open
They spread on contact with the virus, through cuts and abrasions on the skin
Treatment of HPV
Chemotherapy, surgical removal of wart, pap smears, and HPV vaccine
Natural history of HIV
Transmission via semen, vaginal secretions, blood and breastmilk
HIV is not transmitted through casual contact, touching, coughing, office equipment, dishes, insects
Stages of HIV
- The primary infection (within about one month of contracting the virus)
- Clinical latency – a period with no apparent symptoms
- Final stage of symptomatic disease
Progression of HIV
Flu like symptoms at first that go undetected
lymphadenopathy, myalgias, rash, sore throat, and fever
AIDS is the last stage. It is life threatening and disabling, caused by HIV or a CD4 T-lymphocyte count <200 mLs with HIV
CD4
Good!
Between 500 and 1200: Usual for people without HIV
Below 200: Higher risk of illnesses and infections
Can also be a percentage. Above 90% is similar to above 500. Below 14% is similar to below 200
Viral load
Bad
Between 100,000 and 1 million: high
Below 10,000: For people with HIV not on treatment, this is low
Below 50: Known as “undetectable”. The aim of HIV treatment is to have an undetectable viral load
HIV testing
Antibody, antigen/antibody, and nucleic acid test (NAT)
Antibody test for HIV
looks for antibodies to HIV in your blood or oral fluid. Most rapid tests and the only HIV self-test approved by the FDA are antibody tests.
Can take about 90 days to be detected, tell patient to come after that amount of time to make sure they’re actually negative
Antigen/antibody test for HIV
Antigen/antibody test looks for both HIV antibodies and antigens. Blood draws from veins or also a rapid antigen/antibody test from a finger stick.
18-45 days from blood draw, 18-90 days from fingerstick
NAT for HIV
looks for the actual virus in the blood. Done via blood draw. Determines viral load. Fastest detection of HIV presence
PrEP for HIV
Oral=get tested every 3 months
Injection=get tested every 2 months
For HIV negative ppl high risk
If you are diagnosed, you are no longer on PrEP
Opportunistic infections
Occurs when immune system is vulnerable, specifically HIV
Pneumocystis carinii pneumonia- most common
Tuberculosis
Cryptococcal meningitis
Fungal infections
Kaposi sarcoma
What are Health Care Disparities?
Differences or inequalities in health care status due to gender, race/ethnicity, education, disability, geographic location or sexual orientation.
A goal in the United States is to eliminate health disparities by expanding access to health care for vulnerable or at-risk populations
Example: Rural residents have more chronic conditions such as diabetes and are more likely to die of heart attacks
Vulnerability
Susceptibility to actual or potential stressors that may lead to an adverse effect
Vulnerable population
Increased risk
Worse health outcomes
Disenfranchised
Those who are marginalized from society, disconnected from community which they live and work, whether because they move around, race, ethnicity, etc
Socially excluded
Excluded from getting goods or care
Resilience
Ability to resist vulnerability
Underserved populations
Subgroup of the population
Higher risk of developing health problems
Greater exposure to health risk because of marginalization (age/gender/ability to access resources)
Who suffers health disparities r/t the SDOH
High risk mothers
Chronically ill and disabled
HIV/AIDS
Mentally ill
Substance abusers
Homeless
Immigrants and refugees
Risks increasing vulnerability
Environmental hazards-lead exposure, mold, education, etc
Social hazards-crime, violence, isolation esp in elderly and rural
Personal behaviors-smoking, diet
Biological or Genetic make-up-immune state, vulnerability to disease, etc
Poverty/lack of health insurance
Poverty is defined by family income and the number of people in a family.
Primary cause of vulnerability to health problems
Poverty guidelines help determine financial eligibility for assistance
Income doesn’t increase but cost of living does
Anyone living in poverty with no health insurance is primary cause of vulnerability
Rural vs urban
Rural – fewer than 20,000 residents or fewer than 99 persons per square mile.
Makes up 20% of population rn, so 20% of population faces these vulnerabilities
Urban – higher population densities; population of at least 20,000
Rural populations
Higher proportions of whites in rural areas
Higher than average numbers of younger (6-17 years) and older (over 65 years)
People 18 and older are more likely to be or have been married
More likely to be widowed than urban counterparts
Fewer years of formal schooling
Tend to be poor
Higher risk of being uninsured or underinsured
High risk for injury
Health status in rural
Higher infant and maternal morbidity rates
Higher rates of diabetes
Higher rates of obesity
Higher rates of suicide
Higher rates of injury
Increased occupational risks
Less likely to seek preventative care
Poorer perceptions of health and health status
rural barriers to health
Distance
Lack of transportation
Unpredictable weather
Uninsured
Shortage of healthcare providers
Rural Health Care
Seven A’s of challenges to elders in rural
Availability
Accessibility
Affordability
Awareness
Adequacy
Acceptability
Assessment
Health professional shortage rural area
Geographic area, population group, or medical facility with shortages of health care professionals that may not allow a full complement of health care
Not enough people in one specialty
Also not enough facilities for rural areas
Medically underserved rural area
Area that is determined with a calculation of a ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population age 65 or above
Medically underserved rural population
US federal designation for those populations that face economic barriers (low-income or Medicaid-eligible populations) or cultural and/or linguistic access barriers to primary medical care services
Ranking of rural health priorities
Access to care
Nutrition and weight status
Diabetes
Mental health
Substance abuse
Heart disease and stroke
Physical activity and health
Concerns for the older adult
Maternal, infant and child health
Tobacco use
Migrant farm worker
one whose primary employment is agriculture on a seasonal basis, who has been employed within the last 24 months and who establishes a temporary abode for the purpose of that employment
Seasonal farm workers
work cyclically in agriculture but can migrate
Seasonal workers
Have temporary housing
Not covered under labor laws-no regulations
Use limited English
Have cultural practices/values
Migrant health issues
Dental ($$ and causes other health conditions)
TB (overcrowding)
Chronic diseases_STIs, HIV, infectious disease
Stress/anxiety
Anemias
Cancers (pesticides and chems)
No prenatal care
STI, HIV
Pesticide exposure- headaches, dizziness, dyspnea, eye/skin irritation, anemias and cancers in chronic use
No services or access
No PTO, sick time, etc
No medicaid
Long hours during the time clinics are open
Documentation and being illegal
Primary, secondary, and tertiary care for migrants and rural
Primary prevention- education, prenatal care, immunizations, dental care
Secondary- TB screenings, cancer screenings, lead screenings, pesticide exposure, illness
Tertiary- chronic conditions, treat for pesticide exposure, mobilize primary care services
Veterans
Under the Department of Veterans Affairs (VA)
Health Issues
Mental health- PTSD, substance abuse
Infectious disease–migration, exposed to elements, overcrowding
Chemical exposure
TBI (traumatic brain injury)
Hearing/vision impairments (guns/bombs/chems)
Amputations
* Coordination of care is important*
Teen pregnancy
At lowest rate since 1976
Area of public health concern
Higher rates for Black and Hispanic teens
May result in a cycle of poverty and school failure
Teens often feel invincible and may not recognize risks involved with behaviors
Teens often influenced by peer pressure
Risk factors of teen pregnancy
Sexual victimization–whether as a result or leads to increased risk taking and promiscuity
Family structure
Parenting style
Lack of communication and education about issues of sexuality
Post-effects of teen pregnancy
Limited education/job opportunities
Risk of poverty and homelessness
Risk of malnutrition- set up WIC program
Discrimination
All teen pregnancies are considered high risk*
Parental denial plays a major factor in prevention*
Correctional system
Addiction
Increased mental health disorders
Increased risk of sexual assault; violence
Increased risk of infectious diseases (TB, HIV, STIs, Hep C)
Upon release- mental health issues poverty, inability to find employment/housing, chronic disease, social injustice, economic problems
Illness and injury occur before the institution, at the institution, and trickles back out when they’re released
Most inmates are male and Hispanic or AA around 37yo. Around 75% are in for nonviolent crimes (drug possession, robbery, extortion, etc)
LGBTQIA biggest health problem
relationship between members of this population and the healthcare system
LGBT youth health problems
Suicide, depression, peer victimization, family rejection, physical health problems
Overall LGBT population problems
Homelessness, higher rates of tobacco, alcohol, and other drug use
Gay men risks
HIV/STDs, especially in communities of color
Lesbian risks
Less likely to get preventative services for cancer
Lesbian and bisexual females more likely to be overweight or obese
Transgender risks
High prevalence of HIV/STIs, victimization, mental health, suicide
Elderly LGBT issues
face additional barriers to health because of isolation and a lack of social services and culturally competent providers
Healthy people 2030 and LGBT
collecting data on LGBT health issues and improving the health of LGBT adolescents.
Adding questions related to sexual orientation and gender identity to surveys
School- and family-based interventions can help reduce bullying and decrease deaths associated with suicide and illegal drug use
Looking at the whole person in LGBT
It is essential to engage the whole person, not a collection of risk factors
It is important to understand that LGBT life issues are like others but also unique:
Families, Coming Out
Long Term Relationships
Reproduction, Parenting
Mental Health
Chronic Diseases
Communicable Diseases
Ending LGBT invisibility
Ask questions!!
Taking LGBT history
Same for all patients
Know them as a person
Inclusive and neutral language
Partner instead of husband/wife/bf/gf
No assumptions
Remember sexual health and high risk of HIV/STIs
Sex questions for LGBT history
Have you had sex with anyone in the last year?
Did you have sex with men, women, or both?
Have you had oral, vaginal, or anal intercourse?
How many partners did you have?
How often do you use condoms?
Have you exchanged sex for drugs, alcohol, housing, food, or money?
Has anyone ever forced you to have sex?
Why are families homeless
They don’t have enough money to afford housing!!
There is an affordable housing shortage throughout the United States.
The housing that does exist is very expensive
Families with children are the fastest growing segment of the homeless
More than 600,000 American kids will sleep in a shelter tonight
The average age of a homeless person: 9 years old.
The child who is homeless is more likely to have school absences
Reasons for homelessness
Deinstitutionalization efforts of the 1960s to mainstream the mentally ill and to society.
Closure of inpatient psych centers in units due to a lack of funding.
Unemployment or under-employment.
Domestic violence.
Abandonment.
Natural disasters and fires.
Disability.
Substance abuse and addiction.
Immigration.
Political unrest and wars
Other factors contributing to homelessness
Substance Abuse
Mental Illness
Domestic Violence
Family Strife
Unemployment
Disability
Infectious disease in homelessness
Crowded living arrangements with many other families means more bug sharing
Upper respiratory infections
Acute otitis media
Lice
Scabies
Others
Nutrition in homelessness
Income is associated with obesity for all age groups (unhealthy diet)
Homeless face additional problems in access to nutritious food
Homeless children and those in unaffordable housing situations have actually been shown to exhibit growth stunting due to malnutrition
Dental care in homeless
Access to dental care is a huge problem – Medicaid does not cover dental care for adults (children yes)
Nearly 50% of school-aged children have not seen a dentist in the previous year in one study
36% of homeless children have dental problems according to family surveys
Can lead to chronic diseases
Asthma in homeless children
Asthma rates are increased for children living in poverty in general, including homeless children
Associated with poor housing conditions:
Dust mites
Cockroaches
Molds
Rodents
URI’s as a trigger (increased due to crowding)
Nurses approach to homeless people
Show respect and use a positive approach, which builds trust.
Support primary (advocacy), secondary (tuberculosis screening), and tertiary (“detox” treatment) prevention to make it easier to cope with difficult, challenging lives
Factors that lead to increased violence
Inadequate social support
Feelings of powerlessness
Violence shown in the media
Living in a crowded environment
Physical violence
Kicking, slapping, hitting, punching, pushing, pulling, choking and property damage
Emotional abuse
Jealously, anger, intimidation, controlling, neglect, humiliation, threats, isolation and verbal abuse
Social abuse
Being stopped from meeting or seeing friends or family, not allowed to leave the home. Being stalked
Sexual abuse
Forcing and coercing sexual acts, rape and having sex without wanting to.
May not be disclosed, can’t assess for it
Economic abuse
Controlling access to money and other resources, forced to live without money
Seen in elderly by adult child by being controlling or stealing money
Indicators of violence
Physical injuries, no explanation for injuries or an incorrect one
Current or previous police involvements
Feelings of sadness or depression, low self-esteem , financial concerns, no social life, can’t go for healthcare, etc
Difficulty in concentration or focus
Being denied access to funds or resources and/or repeated requests for financial assistance
What can nurses do if they suspect violence
Nurses partnering with associations to provide alternative activities that improve social skills is one of the best ways to prevent violence
Report incidents to child protective services or other appropriate legal authorities
Comprehensive services in locations where people live and work
Advocacy
Social justice
Culturally and linguistically appropriate health care
Issues that impact on the incidence of violence in refugee/immigrant/migrant communities
Pre-arrival torture, trauma, rape, and sexual violence. These can also happen post-arrival
Post-traumatic stress disorder.
Problems experienced during resettlement
Racism
Loss of dreams
Loss of status
Outcomes of vulnerability
Outcomes of vulnerability can be negative, such as lower health status, or they may be positive with effective interventions
One vulnerability usually puts one at risk for another
Cycle of vulnerability
cycle of vulnerability
social isolation, hopelessness, chronic stress, powerlessness
Pneumocystis Carinii Pneumonia
People often die from this rather than the actual HIV
Airborne
Yeast like fungus but antifungals don’t work
Abx, and corticosteroids in severe cases
CD4 <200 is risk for HIV
External dyspnea, fevers, chills, weight loss, chest discomfort, nonproductive cough, nosebleeds (rare)
Before antiretroviral meds, 70-80% incidence per year
People in their 80s dying from HIV die from this PNA
Cryptococcal meningitis
CD4 of 100 or less is high risk
Fungal infection
Virus is seen in environment: soil and bird droppings
Inhalation → lungs, blood, spinal column, brain
Can infect lungs, or in severe cases, kidneys, skin, urinary tract, and lymph nodes
Kaposi sarcoma
Cancer in lymph cells and blood vessels among people with HIV
Lesions on chest, face, limbs,
Life threatening if in GI tract, liver, lungs
Cytotoxic drugs/chemo
Rare but be aware of side effects and symptoms in HIV
Primary prevention of HIV
teach safe sex, abstinence, monogamy, use and appropriate use of condoms, clean needle policy, prophylactic meds (primary prevention bc preventing but they’re at risk so secondary as well)
Secondary prevention of HIV
partner notification in people newly diagnosed, screenings, antibody/NAT testings for STDs, C-sections in HIV+ women to decrease transmission risk in baby
Tertiary prevention of HIV
antiretroviral meds, treatments, encourage healthy lifestyles in people with HIV, support services, resources
Rural health challenges
Limited access to healthcare and resources
Social isolation
scarcity of health professionals
Lack of knowledge (health literacy)
Poverty
Language and culture barriers between migrants, farmers, etc
Traveling time and or distance to care (no transportation)
Global health
the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide
we try to understand underlying issues of health such as different factors like biological, environmental, financial, etc
ENTIRE HUMAN POPULATION which is ONE GLOBAL COMMUNITY working together to stay healthy
Florence nightingale in global health
Through her life’s work, Florence Nightingale advocated for health at the personal, community, and global levels. In 1893 she stated, “Health is not only to be well but to use well every power we have.” As nurses we have power in numbers. But is important to remember that our power also resides in our strong caring beliefs and values
2 factors of the foundation of global health
Justice
human rights
WHO
Major international agency for health
Acts as a director and coordinator for international health work (domestic and worldwide)
Mission: “attainment by all peoples of the highest possible level of health” (WHO, 1948)
Premise: health is a public good requiring governmental action to achieve its objective
World health agency
Highest governing body within WHO. Agency that collaborates with the UN, involved with data gathering, research, and policy organization to help the WHO achieve its mission.
Publication called world health stats that look at diseases around the globe
Initiatives of WHO
Eradication/elimination programs for polio, leprosy, guinea worm and measles
Reducing transmission and incidence of HIV/AIDS (some countries don’t have vaccines!)
Launching a “Roll Back Malaria” Program
Stopping the transmission of tuberculosis
Increasing access to essential pharmaceuticals
Preventing and treating iron deficiency anemia
Reducing maternal morbidity and mortality
Promoting healthful lifestyles for all age groups
Establishing “Health Promoting Schools”
WHO definition of health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmary
USAID
Government agency primarily responsible for administering civilian foreign aid
Drawn on to manage U.S. Government (USG) programs to provide low-income countries for a range of purposes
Can be when another country has a natural disaster, war, political strife, etc.
AIHA
International nonprofit organization working to advance global health through locally driven, locally owned, and locally sustainable health systems strengthening and human resources for health interventions
Vision – a world with access to quality healthcare for everyone, everywhere, regardless of wealth or ability to pay
Mission – “to strengthen health systems and workforce capacity worldwide through locally driven, peer-to-peer institutional partnerships.
FORWARD THINKING…
Trying to work upstream
World bank
International financial institution that provides loans to countries of the world for capital programs
Stated official goal – reduction of poverty
Mission is to reduce extreme poverty and promote shared prosperity by lending money to developing countries, providing technical assistance, and by sharing knowledge and solutions
Nongovernmental organizations
Global health council
Center for international health and cooperation
CARE
Carter center
International council for nurses
Global health council
Dedicated to saving lives by improving health worldwide
US based nonprofit networking organization
Connects advocates, implementers, and stakeholders around global health priorities worldwide
Dedicated to advancing policies and programs that improve global health
Represents thousands of public health professionals from 150 countries
Increases investments, robust policies, and power of collective voice
Helps influence health policy
Center for international health and cooperation
Promotion of healing and peace in countries affected by natural disasters, armed conflicts, civil war, strife, and ethnic violence
Employs resources and personal contacts to stimulate interest in humanitarian issues and to promote innovative educational programs and training models
CARE
Respond to famine and disasters worldwide
Saves lives, defeat poverty, and achieve social justice
Seeks a world of hope, inclusion, and social justice where poverty has been overcome and all people live with dignity and security
After the world was recovering from WWII, some people sought to help the country from poverty, creating this organization
Carter center
Disease prevention and agriculture
Founded on fundamental commitment to human rights and the alleviation of human suffering
Seeks to prevent and resolve conflict, enhance freedom and democracy, and improve health
Believes that people can improve lives if provided necessary skills, knowledge, and access to resources (personal responsibility that this organization assists with)
Resolving conflicts, enhancing democracy in country, advancing human rights and giving economic opportunities
Helped prevent diseases, get mental health care and teaching farmers to increase crop production in highly agricultural countries
International council of nurses
Mission: to maintain the role of nursing in health care through its global voice
Serving to maintain role of nursing in healthcare through global voice
Membership includes 120 countries
Helps enhance nurses contributions, primary care, prevention, research, developing and implementing robust programs, innovation
Assists nurses in maintaining global voice
MDGs
8 international goals that all 193 United Nations member states and at least 23 international organizations agreed to achieve by the year 2015
Aim of MDGs
To encourage development by improving social and economic conditions in the poorest countries
What were the MDGs
eradicate extreme poverty and hunger
achieve universal primary education
promote gender equality and empower women
reduce child mortality rates
improve maternal health
combat HIV/AIDS, malaria, and disasters
ensure environmental sustainability
develop a global partnership for development
What was bad about the MDGs
uneven across regions and countries, leaving millions of people behind, especially the poorest and those disadvantaged due to sex, age, disability, ethnicity or geographic location. Targeted efforts will be needed to reach the most vulnerable people
Sustainable development goals
Set in january 2016 to banish a whole host of social ills by 2030
Replaces the MDGs
What are the sustainable development goals
No poverty, zero hunger, good health and well-being, quality education, gender equality, clean water and sanitation, affordable and clean energy, decent work and economic growth, industry innovation and infrastructure, reduced inequalities, sustainable cities and communities, responsible consumption and production, climate action, life below water, life on land, peace justice and strong institutions, partnerships for the goals
SDG 1 (no poverty) and 2 (no hunger)
Illnesses that are closely associated with poverty - tuberculosis, AIDS, malnutrition, severe dental problems - devastate the homeless population.
Health problems that exist quietly at other income levels - alcoholism, mental illnesses, diabetes, hypertension, physical disabilities - are prominent on the streets.
Human beings without shelter fall prey to parasites, frostbite, infections and violence
Nutrition, substandard housing, etc are issues
Absenteeism because children are behind on vaccinations
Kwashiorkor
Edema (swelling) of arms, legs, face
Weak muscles, pale hair/skin, enlarged liver
Swollen belly because of fluid retention and weak abdominal walls that allow internal organs to sag out
Common in children weaned early; low-protein diet
Severe malnutrition and low protein communities are at risk for this
Marasmus
Severe protein-energy malnutrition (PEM) – too little calories
Very low birth weight, weakness, organ failure
Skeletal appearance, wrinkled skin
Overnutrition
The average person needs about 1800 kcals/day
Extra calories = extra weight
Not just from too much food, also unhealthy food
Obesity increases the risk of type 2 diabetes, hypertension, gallstones, asthma, arthritis, heart disease, strokes, some cancers, etc.
SDG 4 (quality education)
Dynamic workforce and well-informed decisions
Helps with social and economic prosperity
Water impacts education (little girls carry water and miss school)
Girls don’t go to school when on period, 10-20% days missed
SDG 5 (gender equality)
Termination of girl pregnancies
Genital cutting and mutilation
Gender violence, abuse, and inequality
less access to information and stuff
Less women in parliament
wage gap
No autonomy because of spouse or God opinion
Myths about medication
Low access (distance)
UN and violence against women
UN declaration on the elimination of violence against women:
“Any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”
SDG 3 (good health and well-being)
Endemics and global diseases (Malaria, Measles, HIV, Ebola, Zika, COVID-19, River Blindness)
The Life cycle of malaria
Infected mosquito bites human
The parasite travels to the liver
Parasite rapidly reproduces in the liver, although some variables lie dormant for up to a year.
The parasite latches onto red blood cells, burrows into them and continues multiplying.
Infected cells burst, spreading the infection.
Fever sets in as red blood cell levels drop—circulation in vital organs clogs.
Parasites fill the bloodstream, infecting biting mosquitoes to complete the malaria cycle
Measles
Vaccine preventable
Educate on importance of vaccines and increase accessibility of vaccines to other countries
Ebola
Endemic mostly in Africa
From direct contact with :
Body fluids of a person who is sick with or has died from Ebola. (blood, vomit, urine, feces, sweat, semen, spit, other fluids)
Objects contaminated with the virus (needles, medical equipment)
Infected animals (by contact with blood or fluids or infected meat)
Ebola symptoms r/t transmission
Ebola can only be spread to others after symptoms begin. Symptoms can appear from 2 to 21 days after exposure.
Ebola only spreads when people are sick.
A patient must have symptoms to spread the disease to others.
After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola
MEN CAN TRANSMIT THIS THROUGH SEMEN FOR UP TO 7 WEEKS AFTER RECOVERY OF DISEASE
Early symptoms of ebola
Fever
Fatigue
Headache
Vomiting, Diarrhea, & Stomach Pain (symptoms of impaired kidney and liver function)
Unexplained bleeding or bruising
Muscle Pain
Labs: low WBCs and PLTs, high liver enzymes
Zika
Caused by the Zika virus (1947)
Spread through the bite of an infected Aedes species mosquito.
The illness is usually mild, with symptoms lasting for several days to a week after being bitten by an infected mosquito
s/s of zika
Fever, rash, joint pain, and conjunctivitis (red eyes)
What we know about zika
Although there is no test to determine if someone is protected against Zika, experts believe that once a person has been infected, they will likely be protected from future infections.
Can be transmitted from mother to child during birth and through sexual contact
There is a confirmed link between Zika and birth defects in babies born to mothers who are infected, including microcephaly.
There are no vaccines
Zika bites during daytime
COVID-19
A respiratory disease spreading from person to person
Between people in close contact (within about 6 feet).
Respiratory droplets are produced when an infected person coughs or sneezes.
These droplets can land in the mouths or noses of nearby people or possibly be inhaled into the lungs
When can COVID spread
They can spread it to others 2-3 days before symptoms start and are most contagious 1-2 days before they feel sick.
In some circumstances, these droplets may contaminate the surfaces they touch.
Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms
Prevention of COVID
Clean your hands often.
Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
Avoid touching your eyes, nose, and mouth with unwashed hands
River blindness
A parasitic disease caused by tiny worms and transmitted by flies.
Symptoms include eye and skin lesions leading to blindness and skin depigmentation
Water needs
Drinking
Cooking
Hygiene (hand-washing and bathing)
Cleaning (clothes, pots, homes)
Effects of not having clean water
diarrhea has killed more children than all the people lost to armed conflict since World War II
Diseases transmitted by water:
Cholera
Typhoid
Bacillary Dysentery
Infectious Hepatitis
Giardiasis
Diseases caused by lack of water:
Scabies
Skin sepsis
Ulcers
Leprosy
Trachoma
Dysenteries
Eradication
interruption of person-to-person transmission and limitation of the reservoir of infection such that no further preventive efforts are required; it indicates a status whereby no further cases of a disease occur anywhere (like smallpox, this is very hard to do)
Elimination
used when a disease has been interrupted in a defined geographical area (like polio in the US and other areas)
Control
indicates that a specific disease has ceased to be a public health threat
Global Burden of Disease
GBD
WHO study using quantifiable data demonstrating disparities in the burden of disease worldwide, especially in children
Disability Adjusted Life Years
DALY
summary measure that combines the impact of illness, disability and mortality on population health
A measure of overall disease burden, expressed as the cumulative number of years lost due to ill health, disability, or early death
Measures gap between health status and idea health situation where health population lives to advanced age with no illness or disability
Same as YLD (years lived with disability) + YLL (years of life lost)
