LA 9-Chapter 25-Stamler Flashcards
- Describe four sub-disciplines of epidemiology and give a community health nursing practice example related to each function.
- public health epidemiology. CHN e.g., monitoring and tracking sexually transmitted infections over time
- exposure-oriented epidemiology. CHN e.g., studying the effects of a vegetarian diet on the health outcomes of children
- disease-oriented epidemiology. CHN e.g., studying the distribution of cervical cancer in social districts within a health region
- occupational epidemiology. CHN e.g., monitoring and tracking asbestos-related illnesses over time in a particular occupational group
- Describe three areas that Florence Nightingale addressed during the Crimean War that advanced the science of epidemiology. Give an example for each area that illustrates the relationship with current community health nursing practice.
- increased the recording of death statistics. CHN e.g., HHN provide information for the completion of the death certificates.
- used the death statistics to explain and publicize the reality of the horrid situation. CHN e.g., CHNs have been very vocal in publicizing the effects and causes of homelessness.
- used polar diagrams to demonstrate that what was killing the soldiers was contagious diseases. CHN e.g., CHNs can use Venn diagrams to illustrate the multiple host/agent/environmental factors influencing heart disease.
- implemented sanitation practices that proved to authorities that her ideas were correct. CHN e.g., CHNs educate people about how HIV is transmitted and correct myths about how it is not transmitted.
Choose any infectious disease, such as tuberculosis, sexually transmitted infection, influenza, leprosy, etc. Apply your chosen disease to the natural history of disease process and describe two interventions that could be done by CHNs in each of the five levels of preventive measures.
Sexually transmitted infections
Health promotion
- health education on human sexuality development
- social marketing campaign to promote healthy sexual choices, such as condom use, abstinence, and limited sexual partners
- specific protection
- accessibility to free condoms and sexual health counselling
Early diagnosis and prompt treatment
- STI testing at easily accessible free clinics
- treatment of STIs and case follow-up to treat contacts
Disability limitation
- testing of cure after STI treatment for high-risk persons
- counselling for people with nontreatable STIs such as herpes
Rehabilitation
- HIV/AIDS support agencies
- HIV/AIDS hospices
Define three of Timmreck’s criteria of causation. Give an example of where a CHN would apply each of the chosen criteria.
- consistency. CHN e.g., Everyone who drank the contaminated camp water got sick.
- strength. CHN e.g., People who drank the most water got the most sick.
- specificity. CHN e.g., Giardia parasites in the water made people sick with an enteric illness. Influenza virus in the water would not make people sick with an enteric illness.
- time relationship. CHN e.g., A person can’t get influenza until after exposure to the virus.
- congruence (coherence). CHN e.g., Since influenza can be transmitted through mucous membrane exposure, a person whose hands are contaminated with influenza virus and who rubs her eyes with her hands is more likely to get sick than someone does not touch her face with her hands.
- sensitivity. CHN e.g., The greater the discrimination between those who got sick from eating raw meat and those who got sick from eating cooked meat, the greater the sensitivity to the disease being spread through raw meat.
- biological/medical. CHN e.g., A child who plays with a child with chickenpox is more likely to get sick than one who plays with a child who is not sick.
- plausibility. CHN e.g., Research has demonstrated that moderate exercise may be more helpful to prevent cardiac disease.
- experiments and research. CHN e.g., Replicated studies over time add to the weight of evidence that smoking causes lung cancer.
- analogy factors (transfer of knowledge). CHN e.g., It is reasonable to develop a vaccine for the serotypes of HPV that cause cervical cancer, since other specific viruses have successfully been prevented through vaccination.
Calculate the odds ratio of developing colorectal cancer related to a low-fibre diet from the following example. Write a statement that would explain your results to a client.
Study group = 300
Risk factor = low-fibre diet
Disease = colorectal cancer
a) persons with low-fibre diet and colorectal cancer = 100
b) persons with high-fibre diet and colorectal cancer = 20
Total persons with colorectal cancer = 120
c) person with low-fibre diet and no colorectal cancer = 20
d) persons with high-fibre diet and no colorectal cancer = 160
Total persons without colorectal cancer = 180
OR = a/c divided by b/d = ad divided by bc = 100 x 160 divided by 20 x 20 = 40 In this study, people who ate low-fibre diets were 40 times more likely to develop colorectal cancer.
Identify four criteria that researchers and practitioners use to assess a causal relationship between a stimulus and the occurrence of a disease.
- temporal relationship-A person does not get the disease until after exposure to the cause.
- strength of association-Exposure to a specific stressor or cause is most likely to bring on the disease.
- dose-response-Persons who are most exposed to the contaminated food (e.g., ate the most) are the most ill.
- specificity-The cause is linked to a specific disease (e.g., Mycobacterium tuberculosis does not result in chickenpox).
- consistency-Everyone who eats contaminated food gets the illness. If other food in another time and place is contaminated with the same bacteria, the same illness occurs.
- biologic plausibility-Consistent with the biologic/medical knowledge that is known (new discoveries may precede biologic plausibility).
- experimental replication-Several studies done by different scientists in different places produce the same or similar results.
- A public health nurse has been contacted because 12 students living in a college dormitory are ill with bacterial meningitis. The cases have been confirmed to be caused by Neisseria meningitidis. Using the Venn diagram, describe the environmental characteristics in this scenario and the mode of transmission of this organism.
Venn diagram—Environmental Characteristics
Physical—weather (e.g., meningitis typically occurs in late winter or early spring)
Biological—microorganism (e.g., Neisseria meningitidis)
Social—housing (e.g., young people living in close quarters)
Mode of transmission: spread by droplet from mouth and nose usually through coughing, sneezing, or kissing
What term refers to “the study of the occurrence and distribution of health-related states or events in specified populations”?
a. Nosology
b. Epidemiology
c. Susceptibility
d. Biologic plausibility
Ans. B
- A nurse is working with the school-aged population during the prepathogenesis period. What primary prevention activity would promote the health of this population?
a. Case finding children who may have been exposed to a teacher with hepatitis A
b. Teaching handwashing and respiratory hygiene
c. Providing antimicrobials for newly diagnosed contacts
d. Advocating for testing of sexually transmitted infections (STIs) at a school-based clinic
Ans. B
- A nurse is working with a student nurse and explains that 12% of deaths were from colorectal cancer in 2010. What word is used to describe this type of statistical information?
a. Crude mortality
b. Potential years of life lost (PYLL)
c. Prevalence
d. Proportional mortality
Ans. D
- What statistic is used to answer the question, “How likely is it that I will die from this disease?”
a. Case-fatality rate
b. Specific mortality rate
c. Relative risk
d. Incidence
Ans. A
A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health.
(Refer to Case 1 above.) A PHN is comparing the incidence of childhood asthma in a population exposed to a certain air pollutant with the incidence in a population not exposed to that pollutant to determine relative risk. The PHN asks the student to select the statistic, which supports that the risk for asthma is greater in the exposed population. What is the correct answer?
a. 1.0
Ans. D
A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health.
(Refer to Case 1 above.) The PHN asks the nursing student to develop some questions for a survey about smoking behaviour. Which question would be best at eliciting information on period prevalence?
a. “Do you currently smoke?”
b. “Have you smoked within the last six months?”
c. “Have you ever smoked?”
d. “At what age did you start smoking?”
Ans. B
A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health.
(Refer to Case 1 above.) The nursing student wants to administer a survey about smoking behaviours to students in various grade levels within the school district to identify the best grade to initiate health education. A follow-up survey will be administered to assess the effectiveness of the educational program. What type of research design would be best at providing the epidemiological information needed in this scenario?
a. Cross-sectional study
b. Cohort design
c. Randomized control trial
d. Case-control methodology
Ans. A
A public health nurse (PHN) is explaining to a fourth-year nursing student how to use health statistics to understand population health.
(Refer to Case 1 above.) The PHN asks the nursing student how participant privacy will be managed in the study. What strategy presented by the student would be best at meeting this ethical concern?
a. Data will be used in a confidential manner.
b. The survey will be anonymous.
c. The participants will sign a consent form.
d. Ethics approval will be sought.
Ans. B
