PD 3 Final Exam Flashcards
______ a human population distinguished as a more or less distinct group by genetically transmitted physical characteristics
race
______ a sizable group of people sharing a common and distinctive racial, national, religious, linguistic or cultural heritage
ethnicity
_____ the collection of beliefs, customs, traditions, arts, social hierarchies, societal norms, experience, values, attitudes, and material traits of a particular racial, religious, or societal group
culture
which of the following terms is behavior based? race, ethnicity or culture
culture is behavior based
______ a disproportionate number of health conditions and deaths compared with the general population
health disparity
What population group is the most likely to be uninsured?
hispanic women of reproductive age, especially if they are living in poverty
T/F: Black adults are more likely when compared to white adults to trust health care workers
FALSE! Black adults are LESS likely to trust healthcare workers
T/F: black adults are more likely to perceive discrimination in the US health care system
TRUE
_____ are a set of behaviors and attitudes and a culture within the business or operation of a system that respects and takes into account the person’s cultural background, cultural beliefs, and their values and incorporates it into the way healthcare is managed to that individual
cultural competency
How do Americans and eastern countries differ in terms of attitudes toward conflict?
Americans - face-to-face, direct approach
Eastern countries - open conflict may be seen as demeaning
How do asian and hispanic culture vs european and american cultures approach to completing tasks?
Asian and Hispanic - promote relationship development at the beginning of a project, focus on completion at the end
European and American - promote working on the task first and letting relationships develop secondarily
How does American and S. European/Latin American cultures differ in terms of different approaches to decision making?
American - Delegation of decisions
S. European, Latin American - Make decisions oneself
T/F: Some cultures consider it inappropriate to be frank about emotions, reasons behind a conflict, personal information
true
attitudes towards disclosure are vastly different
What are the 4 basic steps to consider when caring for all patients?
- Identify the core cross-cultural issues
- Explore the meaning of the illness
- Determine the social context
- Negotiate
What are 2 important questions to ask your patient when trying to find the meaning of the illness?
What do you think has caused your problem?
What worries you most about the illness?
_______ Comparative study of how different cultures view disease and how they treat or prevent it
ethnomedicine
What is the vision of Healthy People 2030?
a society in which all people can achieve their full potential for health and well being across the lifespan
______ is reduction in ability to perform usual activities. Personal care/hygiene, school or work, socialization
Activity Limitation
What is the US average life expectancy- “free of activity limitation” ?
67.1 years
male: 65.3 years
female: 68.9 years
What are the different versions of healthy life expectancy?
Life Expectancy at Birth - Free of Activity Limitation
Life Expectancy at Birth - Free of Disability
Life Expectancy at Birth - In Good or Better Health
______ limited ability to participate in society due to problems with 1+ of the skills below:
Hearing, vision, concentration, remembering/decision making, walking/climbing stairs, dressing/bathing, doing errands alone
disability
What is the US average age for “free of disability”?
65 years old
______ rating self as being in good or better health for your age in terms of chronic disease, activity level, etc.
good or better health
What is the US average life expectancy for “good or better health”?
70.1 years
What is the average US life expectancy for both healthy and unhealthy years?
78.6 years
What are the 6 determinants of health?
- Social Determinants
- Physical Determinants
- Personal Behavior
- Health Services
- Biology and Genetics
- Policies and Laws
What are some examples of social determinants?
Availability of resources to meet needs
Education, jobs, wages, food
Social support, norms, attitudes
Exposure to crime, violence, mass media, technology
Quality of schools and education
Access to healthcare
Internet access
General socioeconomic condition
_______ Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. What are the MC?
health care disparities
CVD, DM and cancer
What is the Hospital Survey and Construction Act (“Hill-Burton Law”)?
Only federal legislation in the 20th century that permitted use of federal funds to provide racially exclusionary services
Hospital segregation ended with President Johnson signing into law the _____ on July 9, 1965
Medicare bill
What pt population is MC to be uninsured for a year or longer?
young, hispanic, poor, sick and living in the south
A _______ is one that experiences health disparities as a direct result of a lack of resources and/or an increased health care risk
“vulnerable population”
______ are the #1 vulnerable population from lecture
immigrants and refugees
_______ A tendency to believe that some people, ideas, etc., are better than others that usually results in treating some people unfairly
bias
What are biases fueled by?
Stereotypes
Negative past experiences
Views of family, friends, society
______ include clothing, art, buildings, food, festivals, observable mannerisms
external culture
_____ include values, norms, worldviews, expectations, beliefs
internal culture
_______ Actively berating a person or community based on cultural background
cultural desctructiveness
_______ Willing to support culturally oriented practices yet unable to actually provide support
cultural incapacity
______ Attempting to treat everyone the same regardless of culture. Can miss key elements attributable to culture
cultural blindness
_______ Recognizes culture is influential
Attempts to make some improvements and adaptations
No continuous improvement plan
cultural precompetency
______ Values diversity
Continuously implements and evaluates new ideas to improve culturally related care
Actively educating on or researching cultural care
cultural proficiency
_____ True, 100% cultural competency can never be fully achieved!
There is always room for improvement and change
cultural competency
______ malfunctioning of physiologic and/or psychological processes in a patient
disease
______ psychosocial experience and meaning of perceived disease for patient, family and friends
illness
models of communication: __________ Method most providers are taught by and most comfortable with. Attributes symptoms and diseases to pathophysiologic or
etiologic causes
western biomedical model
models of communication: __________ 8 questions geared towards evaluating patient beliefs about illness, its etiology, the treatment they want and where they want to go next with their care
explanatory model
models of communication: __________ Designed to elicit the psychosocial context of a situation, or life in general. Acts as a rough screening test for anxiety, depression and situational stress.
BATHE model
aka good for psych illness
models of communication: __________ Similar to Explanatory Model; adds in explicit opportunity for patient to educate the provider and the opportunity to express empathy in the structure of the interview.
BELIEF model
models of communication: __________ Geared towards improving cultural competence in particular; invites discussion of alternative treatments and healers and negotiation of plan of care.
ETHNIC model
models of communication: __________ Geared towards improving cultural competence in particular; general framework of visit with multicultural patients including negotiation of treatment.
LEARN model
models of communication: __________ A pared-down version of the explanatory model.
“4 C’s” model
______ The search for meaning, purpose, and truth in life and the beliefs and values by which an individual lives
spirituality
______ Attempts to answer the search and questions posed by spirituality with a specific set of beliefs and practices
religion
What are the 3 spiritual models of communication?
HOPE
FICA
SPIRIT
Limited English Proficiency (LEP) patients have _____ and ____ with healthcare in general
more problems
less satisfaction
T/F: Providers who participate in Medicaid, Medicare or any other federally-funded program are required to provide oral language assistance
TRUE!!
What is the order of “best value” in terms of which translators types are preferred in the healthcare setting?
1 Bilingual clinician >
#2 in-person interpreter >
#3 remote (video / phone) interpreter >
#4 family/friend
What are the guidelines for choosing an interpreter for a pt?
Choose interpreter of same age/gender or older
______ often use natural materials, traditional knowledge passed down by other ______. May include herbalism, acupuncture, massage, religious ceremony, prayer, personal or family counseling, voodoo, spiritual leaders, herbalists, mediums, divination
traditional healer
Give two pros of working with traditional healers.
Healers often have influence in community and over both patients and family
Patients may feel more comfortable with healers
When considering fusing traditional and alternative medicine, Cases must be handled ____ and with ______
We can’t judge whether the healing helps! Only if it would cause _____
individually
great sensitivity
harm
______ medical and health care systems, practices, and products that aren’t part of conventional/allopathic medicine OR have historic origins outside of mainstream medicine. What is the difference between the two?
Complementary/Alternative Medicine
Complementary - used TOGETHER with conventional therapies
Alternative - used IN PLACE of conventional therapies
What is integrative medicine?
Evidence-based and patient-centered
Strong emphasis on foundational health with a holistic approach: goal is to prevent disease, not just to treat it
Incorporates CAM when clinically indicated, in a way that is safe and synergistic with conventional therapies
Who is the typical CAM pt? What organ system is MC?
Female
Middle-aged
Higher Educational Level
Multiple Medical Conditions
MSK and used complementary to standard medicine
Dissatisfaction with allopathic medicine
was _____ to predict greater CAM use
NOT FOUND
Health care workers may be (more/less) likely to use CAM than the general population
MORE LIKELY to use CAM
CAM is more common in patients with (higher/lower) education status
higher education status
What is the Mind-Body-Spirit Relationship?
the health of one part influences the other
_______ Behavioral, psychological, social and spiritual approaches to medicine not commonly used. What are some common forms?
Mind-Body-Spirit Medicine
Biofeedback
Hypnosis
Meditation
Relaxation techniques
Yoga, Tai Chi, Qi Gong
_______ Manipulation of soft tissue and bone. Treatment of wide range of diseases. Primarily musculoskeletal
Osteopathic medicine
_______ Emphasis on spinal manipulation.
Treat wide range of diseases
Primarily musculoskeletal. How long is the training?
chiropractic medicine
5 years of training
______ belief the body has powerful means of self-healing. How long is the training? What do they place emphasis on?
Naturopathy
4 years education is basic and clinical sciences
Emphasis on relatively low doses of drugs, herbal medications, special diets, exercises
What are the requirements for a Naturopathic Physicians (ND, NMD)?
4 yr graduate level program at an accredited school
Need bachelor’s degree and standard premed courses
What are the generic guidelines for traditional neuropaths?
Do not use prescription drugs, x-rays, surgery
Emphasize lifestyle changes and noninvasive tx
Not subject to licensing
Programs often distance learning, not accredited by a unifying body
What is functional medicine? What is the focus on?
Must already be a licensed practitioner (MD, DO, chiropractor, ND, dentist, NP, PA, RN, dietician, pharmacist, acupuncturist)
AND
must complete a series of training modules
Focus on personalized, pt-centered health with emphasis on poor nutrition, stress, toxic exposures, allergens, genetics, and the microbiome as the root cause of disease
______ is the organization that functional medicine providers must be members and maintain certification through
Institute for Functional Medicine
What are the generic guiding principles of functional medicine practice?
Still complete thorough H&P with emphasis on lifestyle, genetics, and environment
Can use labratory testing and diagnostic studies depending on their baseline degree and state laws/regulations
Treat with a combination of lifestyle changes (nutrition, exercise), medication, botanical medications/supplements, detoxification programs, and stress-management techniques
_______ Belief that a vital energy, chi, circulates in the body through 12 pathways (meridians). What are the training requirements?
acupuncture
Requires training, national exam, licensure
4 yrs of school for non-physicians
What are the training requirements for massage therapy?
500 hrs of training, exam and licensing
46 states and DC have laws for licensing
_______ Based on belief in opposing energies (“yin and yang”), life force energy (“qi”) and energy pathways in the body (“meridians”). Imbalanced energies or blocked flow of qi → illness
What are the training requirements?
oriental medicine
Training varies - many have completed masters/doctoral-level training
43 states require certification with the NCCAOM
______ “The Doctrine of Similars”
Compounds diluted to 10^60 or more
Accepted less in the US than other countries
homeopathy
______ used to tx benign prostatic hypertrophy (BPH)
Risks - dizziness, HA, hormonal effects
saw palmetto
_____ used to tx depression, topical antimicrobial
Risks - numerous DDIs, dizziness, serotonin syndrome
St. John’s Wort
_____ used to tx menopausal symptoms, PMS
Risks - stimulating hormone sensitive tissue (CA, endometriosis, fibroids)
Black Cohosh
_____ used to tx anxiety, insomnia
Risks - hepatotoxicity
Kava Kava
not sold legally in the US
Note: ALL herbal therapies carry the risk of _____, _____, and ______!
GI upset, DDIs and contamination/potency issues
____ used to tx joint pain/OA
Risks - D/C, drowsiness, warfarin DDI, shellfish allergy
Glucosamine and Chondroitin
_____ used to tx CHD, HF, HTN, hypertriglyceridemia
Risks - GI, oily stool, burping, bleeding
Fish oil
_____ used to tx insomnia, jet lag
Risks - fatigue, depression, drowsiness, irritability
melatonin
____ used to tx HF, HTN, statin-induced myopathy, migraine
Risks - mild heartburn, GI
Coenzyme Q10
_____ is reported to treat a wide variety of diease.
Good evidence for epilepsy
Mild evidence for insomnia, anxiety, chronic pain
No evidence for more grandiose claims (e.g., cancer, overall wellness)
What is the 2nd MC ingredient?
CBD
cannabis
______ essential oil can cause gynecomastia
lavender
________ Often touted as a panacea as well as a “wellness booster” and can be consumed in many ways
urine therapy
______ Also reported as a panacea - especially targeted at autistic pts, cancer pts and is essentially a bleach solution. life-threatening SE possible
“Miracle Mineral Solution”
_______ Often touted as a cancer remedy
Typically orally administered - apricot pits/kernels
Highly toxic - basically cyanide
Laetrile (“Vitamin B17”, “Amygdalin”)
______ Often seen as “natural” because it is based on an essential oil distilled from pine tree sap. Recommended for “Candidal infections,” but multiple benefits claimed. Can cause serious toxicity - as little as 1 tsp fatal in children, 3 tsp in adults
Turpentine
_______ Compound containing sanguaranine (bloodroot) and/or zinc chloride. Highly corrosive - often touted as a topical tx to “draw out” cancer and spare normal tissue
Black salve
_______ is the #1 reason CAM was not discussed with health care provider
health care provider never asked!
What are 5 simple chemistry facts that everyone should understand?
- Everything is made of chemicals, even that organic vegan spirulina hemp seed coconut milk smoothie.
- There is no such thing as a toxic chemical, only toxic doses; “The dose makes the poison.”
- There is no difference between “natural” and “synthetic” (lab-created) versions of the same chemical.
- “Natural” chemicals are not automatically safe, and “artificial” chemicals are not automatically bad.
- A chemical’s properties are determined by the other chemicals that it is bound to.
______ Concerned with the health effects of air, climate, water, sanitation, use of chemicals, radiation exposure, and aspects of cities and built environments
environmental health
What actually kills people?
tobacco use
poor diet/lack of exercise
alcohol use
infectious agents
pollutants/toxins
T/F: Pollution kills more people in developed countries than in developing countries.
FALSE! kills more people in DEVELOPING countries
Many pollutants induce signaling pathways that are _____ sensitive
oxidative-stress
What are some common cancer causes agents?
radon, asbestos, benzene, coal, soot and smoke, arsenic, triclosan
What chemicals can lead to Obesity/Metabolic Syndrome/Diabetes? By interfering with ______
herbicide, triclosan, flame retardants, stain repellents, nonstick compounds, DDT
interfere with thyroid function
_____ stored in fat released in blood with wt loss. may undermine further efforts to lose weight
xenobiotics
____ and ______ increase pancreatic oxidative stress and may contribute to DM
arsenic and cadmium
______ leads to oxidative stress which has a strong correlation w/development & progression of vascular diseases
toxic metals (heavy metals)
_______ daily intake of a chemical that appears to be associated with minimal to no risk over lifetime. ____ and ____ regulate it in the US
acceptable daily intake
FDA and Dept of Agriculture
______ ability of an agent to cause injury
hazard
_____ frequency of undesirable occurrence after exposure
risk
______ higher-than-usual prevalence or incidence of a disease in a group of patients with a common exposure
disease cluster
What are the 3 different routes of exposure?
industrial
atmospheric
water/soil
What is considered acute duration of exposure? chronic?
single or multiple over a brief period (seconds to 1-2 days)
chronic: multiple exposures over a longer period of time
______ intake of contaminant > ability to excrete or metabolize. chemicals that accumulate in living organisms
bioaccumulation
_____ increased concentration of a given contaminant as it goes up food chain
biomagnification
_____ resist environmental, and often metabolic, breakdown
persistence
______ rating based on repeated exposures which result in human or environmental adverse outcomes
toxicity
_______ monitors the air pollutants. What is the score that is considered the national standard
Air Quality Index
Score of < 100 is considered the national standard
carbon monoxide has ____ the affinity of O2. What are the s/s? What organs are commonly affected?
220X
Headaches, nausea, dizziness, LOC
brain and heart the most
______ Bluish irritant gas occurring normally in atmosphere → absorbs UV light. What are the s/s?
ozone
irritation of mucous membranes
think respiratory inflammation
What is the clinical impact of drinking contaminated water?
Waterborne infections - cholera, typhoid, amoebic dysentery
Chemicals and metals - arsenic, nitrates (fertilizers), pesticides, lead and other heavy metals
Halogenated Aliphatic Hydrocarbons includes _____ which is the best known solvent. Under what scenario is it mainly used? What does it pose a serious problem to?
chloroform
dry cleaning and degreasing
persistent water pollutants
_____ is an aromatic hydrocarbon. Where is it commonly seen?
benzene, toluene, xylene
combustion - volcanoes, forest fires, gasoline, tobacco smoke
common liquids - dyes, detergents, pesticides, cleaning, adhesives, lubricants, pharmaceutical solvent
common solids - plastics, resins, synthetic fibers
what are s/s of solvent toxicity?
CNS depression and cancer
Toxic to heart, liver, kidneys, bone marrow
Chronic → impaired memory, peripheral neuropathy
_____ is a common pesticide and is used to control mosquito populations. What are the s/s?
DDT
CNS stimulation: tremor, convulsions, dyspnea, lacrimation, confusion. May see long-term demyelinating neuropathy
______ is a chlorophenoxys and is especially associated with _____ and ______
agent orange
neurologic disease and cancer
______ : reduce to free radicals; have been ______ in humans. What are the s/s?
Bipyridyls
fatal
causes severe hemorrhage
_______ most widely used herbicide in world. Likely to cause irritation of _____ and ______. What is the tx for toxicity?
glyphosate
skin and eye irritant
NO TX!
_____ can have major effects at low levels. It is mainly absorbed through the ______. 99% binds to ___ and then transported to _____ then ______.
lead
LUNGS (rarely skin)
99% binds to Hb → transported to soft tissues, then bone
Can lead cross the placenta?
YES!! can cross placenta and affect fetus
What are s/s of lead toxicity? What is the tx?
neurotoxicity, anemia, fatigue, joint pain, abdominal pain (“lead colic”), HTN, cancer
chelation in acutely high levels, stopping exposure, symptomatic
Where are 3 places mercury is found?
Elemental - manufacturing; gold mining; dental amalgam (very low risk)
Inorganic Salts - chloralkali (bleach) industry, electroplating, laboratory reagents
Diet - predatory fish (tuna, shark, swordfish, marlin, mackerel)
Where is mercury absorbed? What are the s/s?
through lungs or GI/skin
nephrotic syndrome and CKD possible with both
What are the s/s of elemental mercury toxicity? salts?
Elemental - pneumonitis (acute), neurotoxicity (chronic)
Salts - hemorrhagic gastroenteritis (acute), chronic GI irritation
What is the tx for mercury toxicity?
chelation in acutely high levels, stopping exposure, symptomatic
_____ is naturally occurring contaminate in well water, rice, smelting, refining, mining, pesticides (pre-1990s). It is absorbed by the ______
arsenic
GI tract
What are some s/s of arsenic toxicity?
cancer, skin lesions, neurotoxicity, cardiotoxicity
Skin lesions - hyperpigmentation, hyperkeratotic papules
Salts - hemorrhagic gastroenteritis (acute), chronic GI irritation
_______ is added to plastics, foam and fabrics. widespread exposure in virtually all pts
brominated Flame Retardants (BFR)
What are ways to reduce BFR exposure?
avoiding torn/exposed foam, vacuuming, HEPA filters
____ and ___ are microplastics. ______ make plastic more flexible. _____ makes plastic clear
phthalates and phenols
Phthalates
phenols
______ are considered “forever chemicals”. Name 2 places these chemical are found
PFAs
stain and water resistance in carpets/fabrics
non-stick surfaces
____ are at the highest risk of chemical toxicity. ____ filters out lead
kids
kidneys
_____ and/or _____supplements (IV or oral) are used in functional medicine to help with detox
Glutathione and N-acetyl cysteine
What does occupational health focus on?
primary prevention of hazards
What is the goal of OSHA?
“Assuring safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.
What is the role of an Occupational Health Providers?
To assess whether the adaptation will occur automatically, or if any accommodations are necessary.
What is fitness to work examination?
Objective assessment of physical and mental health of employees in relation to requirements and working conditions of specific jobs
What are the different determination of fitness to work?
Fit to work (they can do the job)
Temporarily fit
Fit, subject to work modifications
Temporarily fit, subject to work modifications
Temporarily unfit
Permanently unfit
FtW: ______ Able to perform job without danger to self or others, without reservations or special restrictions
fit to work
FtW: _______ Able to perform job without danger to self or others, without reservations or special restrictions
Should be reassessed in a given time frame
temporarily fit
FtW: _______ Employee would be a hazard to self or others if employed in job as described
Would be fit to work without undue risk if certain conditions are modified
fit, subject to work modifications
FtW: _______ Employee would be a hazard to self or others if employed in job as described, but would be fit to work without undue risk if certain conditions are modified
Should be reassessed in a given time frame OR requirement for work conditions may be lifted if patient’s conditions are improved
Temporarily fit, subject to work modifications
FtW: ______ Unable to perform job without danger to self or others
Medical condition may improve over time, allowing return to work
Should be reassessed in a given time frame
temporarily unfit
FtW: _____ Unable to perform job without danger to self or others
permanently unfit
What are the 4 major categories of workplace hazards?
Physical Hazards
Ergonomic Hazards
Chemical Hazards
Biological Hazards
When do you need to consider that the disease might be occupational?
The disease fails to respond to standard treatment
The disease does not fit typical demographics
The disease is of unknown origin
