Public Health section Flashcards
What is public health the science and art of?
- Preventing disease 2. Prolonging life 3. Promoting health and efficiency through organized community effort
How did Hippocrates attempt to explain disease?
From a “scientific” perspective (not supernatural)
Hippocrates recognized association of disease with what?
Environmental factors
What did Hippocrates recognize the difference between?
Endemic and epidemic
What is an endemic?
Disease outbreak restricted or peculiar to locality or region
What is an epidemic?
Disease outbreak affecting or tending to affect a disproportionately large number of individuals within a population, community, or region AT THE SAME TIME
Who recorded a major epidemic of influenza in 412 BC?
Hippocrates
Who recorded one of the earliest descriptions of malaria?
Hippocrates
What did the intro of gunpowder lead to in military hygiene?
Change in wound care
Who did most of the military amputations in the 1600s-1700s?
Barbers
What was the Elizabethan Poor Act?
Defined “poor” and services that they were to receive. Outdoor and Indoor relief
What led to the establishment of the Elizabethan Poor Act?
The feudal system collapse, which led to an increasing number of poor. Crowded cities and towns
What was “Outdoor relief”?
Poor were left in their own homes and given “dole”
What was “Indoor relief”?
Poor taken to almshouse, sick to hospital, orphans to orphanages, idle poor to workhouses.
Who established the Bills of Mortality?
John Graunt
What are the Bills of Mortality?
first vital statistics ever recorded
What are vital statistics?
Recording birth and death of individuals within a government’s jurisdiction
What was the result of urbanization?
Conditions of streets/cities was deplorable. Wastes tossed into streets
What happened to pauper children during the Industrial Revolution?
indentured to owners of mines and factories. (apprentice slavery)
What were workhouses?
Indoor relief for those too old or poor to support themselves
How were workhouse inmates segretate?
Into 7 classes (aged/infirm men, able bodied men & boys >13, boys 7-13, aged/infirm women, able bodied women and girls >13, girls 7-13, and children)
What was Oliver Twist by Charles Dickens used for?
Bring public’s attention to various contemporary social evils, including workhouse conditions/child labor
When was public health first recognized in England?
First sanitary legislation enacted in 1837
Who was Edwin Chadwick?
Wrote “Report on an Inquiry Into the Sanitary Conditions of the Labouring Population of Great Britain”
What did Edwin Chadwick’s call for reforms lead to?
Establishment of General Board of Health
What legislation was passed following Edwin Chadwick’s report?
Factory management, child welfare, and care of the aged legislation.
Why did Florence Nightingale enter the nursing profession?
In response to a pauper’s death in a workhouse in London
Where did Florence Nightingale gain fame?
in the Crimean War
How were the native American people affected by new diseases?
Introduced by Europeans, native people nearly eliminated by smallpox
Who was Jeffery Amherst?
A general of the British Forces in the French and Indian war - infected Ottawa tribe using smallpox-tainted blankets
What effect did smallpox have on American colonies?
Suffered significantly - Jamestown from 500 to 50 people in one winter
Why did incidence of disease in early America increase?
Due to increased immigration
When were local health agencies formed?
In response to increased populations
Why was the first federal health agency established?
To serve merchant seamen that did not have permanent homes
What was the Marine Hospital Fund?
Federal health agency established by first congress - physicians in each port to care for seamen
What was the Marine Hospital Service?
National agency - supervising medical officer, later became surgeon general.
What was the Port Quarantine Act of 1878?
Due to yellow fever outbreak - immigration restricted to ports
Why was immigration restricted to ports?
Physicians could control local outbreaks - applied bacteriology
What did the Marine Hospital Service become in 1912?
US Public Health Service (USPHS)
Who is the director of USPHS?
Surgeon general
What was USPHS dedicated to?
Exploration of disease in laboratory and field.
Who established the National Leprosarium in Carville, LA?
USPHS
Who was responsible for examination of all immigrants at Ellis Island?
USPHS
Why did the USPHS establish an agency for veneral disease in 1918?
First World War = large number of draft-age men infected with syphillis
Why was the narcotics division of USPHS established?
In response to opium use and recognition of addiction
What did USPHS become part of in 1917?
Military service
What was the Hospital Services and Construction Act of 1946?
At end of WWII congress gave USPHS responsibility for nationwide program of hospital and health center construction
Who established the first public health nursing program?
Lillian Wald
Who established the Frontier Nursing Service (FNS) in 1925?
Mary Breckinridge
Why was the FNS established?
To provide professional health to Appalachian mountains (poor, isolated regions)
What was the Social Security Act of 1935?
Response to Great Depression - provided funding for health protection and promotion, provided money to poor, elderly, disabled, unemployed, and funding for priority diseases
What is Medicare?
National health plan
Who first asked congress for national health plan?
Harry Truman
Who signed Medicare and Medicaid into law?
Lyndon Johnson
What are the factors affecting development in developing countries?
Agricultural underdevelopment, Poverty, Malnutrition, Parasitic infection, Social injustice, Suppression of women, and Racism/religious intolerance
What are the 4 International Health Organizations?
World Health Organization (WHO), Pan American Health Organization, United Nation’s Children’s Fund (UNICEF), Agency for International Development (USAID)
What is the WHO?
Agency of the UN
What is the basic idea of WHO?
Health is a basic human right
What is the Pan American Health Organization?
Regional office of WHO
What is the goal of Pan American Health Organization?
To improve health and living standards in the Americas
What is UNICEF?
Part of UN that protects the rights of children.
What is USAID?
Govt. organization responsible for most non-military foreign aid
What is the US Dept of Health and Human Services (USDHHS)?
largest health program in the world
What is the USPHS part of?
DHHS
What office does USPHS include?
Office of Public Health and Science
What is the FDA?
Food and Drug Administration
What is the FDA responsible for?
Protecting public health by assuring safety, efficacy, and security of human and veterinary drugs, , biological products, medical devices, food supply, cosmetics, and products that emit radiation
What is the CDC?
Center for Disease Control and Prevention
What is the purpose of the CDC?
Principal agency in the US Govt for protecting the health and safety of all Americans
What is the NIH?
National Institutes of Health
What was the origin of the NIH?
Originally laboratory of hygiene in Marine Hospital Service
What does NIH fund for research every year?
$6 billion
What is primary health care?
Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in community
What is Healthy People 2020?
Program managed by Office of Disease Prevention and Health Promotion - Science based, 10-year national objectives for improving the health of all Americans
What is the American Public Health Association (APHA)?
Largest organization of public health professionals
What is the chiropractic health care section of APHA?
25th section established in 1995.
What is the purpose of the chiropractic health care section of APHA?
To increase impact on society by adding chiropractic skills and knowledge to those of the rest of the public health community
What are the achievements of Public Health?
Control of infectious disease, impact of vaccinations, motor vehicle safety, workplace safety, decrease in CHD death, safer food, healthier moms/kids, family planning, tobacco as health hazard, Importance of fluoride for teeth
What is epidemiology?
Study of distribution and determinants of health related states or events in specified populations, and application of this study to control of health problems
What is Etiology?
Study of why things occur/causation
Who was Edward Jenner?
observed that cowpox and smallpox are closely related - prevention by vaccinating with cowpox
Who was John Snow?
Observed outbreak of cholera linked to public water pump - removed pump handle
What are the 3 necessary elements for disease transmission?
Pathogen, susceptible host, environmental conditions
What are the 3 means of disease transmission?
Direct, indirect, vector
What is direct transmission?
Person to person, or carrier
What is indirect transmission?
Contaminated food/water, or contact with inanimate objects (fomites)
What is vector transmission?
Insects and arachnids
What are the 3 patterns of relationships?
Mutualistic, commensal, parasitic
What is a mutualistic relationship?
Both organisms benefit
What is a commensal relationship?
Neither organism benefits
What is a parasitic relationship?
One organism benefits at the expense of the other
What is a reservoir?
Long term host of pathogen of infectious disease, usually without injury to itself. Serves as a source where other individuals can be infected.
What is a primary reservoir?
Microbes are viable and multiply (food, soil)
What is a secondary reservoir?
Microbes are viable but do not multiply
What are the 2 types of living reservoirs?
Humans (Carriers) and animals
What is zoonosis?
Any infectious disease that can be transmitted from animals to humans.
What are the disease risk factors?
Age, gender, ethnicity, nutrition, pre-existing disease, occupation, food and water
What does endemic mean?
Infection maintained in population without need for external inputs. CONSTANTLY PRESENT
What does epidemic mean?
Appears as new cases at rate that substantally exceeds what is “expected’. HIGHER INCIDENCE
What is an outbreak?
Small and localized epidemic
What is a pandemic?
global epidemic of an infectious disease that affects people or animals over an extensive geographical area
What is herd immunity?
Critical portion of the population is immune to disease = inability of infectious disease to spread
What is BOD?
biochemical oxygen demand = assesses quantity of oxygen needed by microbes in water
What is the goal of coliform testing?
Goal # of coliforms in drinking water is zero
What is the goal of water treatment?
Decrease BOD
What is primary water treatment?
Physical process, Sedimentation tanks remove 50 % of solids - remaining = EFFLUENT
What is secondary water treatment?
Biological process, 2 methods - trickling filter or activated sludge process
What is a trickling filter?
Spray effluent over rocks, organic material adheres to rocks and is digested by microbes present in tank
What is activated sludge process?
Slime forming bacteria added to effluent and stirred in aeration tanks. Bacteria digest remaining organic material - reduces BOD 95%. After aeration, water is treated chemically or with UV light
What is tertiary water treatment?
Add lime or alum to remove nitrates and phosphates. EXPENSIVE - not required
What are septic tanks?
Anaerobic digestion of organic material, effluent overflows into drain field of soil or gravel
What is pasteurization?
Originally 30 minutes at 62 degrees C, now 72 degrees C for 15 seconds
What is the phosphatase test?
Used to test effectiveness of pasteurization- enzymes should be destroyed by the treatment
What are harm studies used for?
To assess the causal relationship between exposure (treatment) and disease
What is a confounder?
anything that independently affects the exposure and the outcome
What are Hill’s Criteria for Causality?
temporal relationship, experimental evidence, dose response relationship, statistical significance, consistency across studies, plausibility
Cohort study - prospective or retrospective?
Prospective (can be retrospective)
Case control - prospective or retrospective?
Retrospective
What are cohort studies useful for studying?
Interactive causes of harm
What type of study is more ethically permissable?
Cohort study
When are case control studies useful?
if the outcome or interest is rare or takes a long time to develop
What do you calculate in cohort studies?
Relative risk
What do you calculate in case control studies?
Odds ratio
What does it mean if RR is = 1.0?
Risk is equal, no association
What does it mean if RR is > 1.0?
Exposure increases disease risk
What does it mean if RR is < 1.0?
Exposure decreases disease risk
What does it mean if OR = 1.0?
Risk is equal, no association
What does it mean if OR > 1.0?
Exposure increases disease risk
What does it mean if OR < 1.0?
Exposure decreases disease risk
Why can’t true risk be calculated in case control studies?
Because it is a retrospective study
Who was Ambroise Pare?
Discovered alternative to using boiling oil to cauterize wounds
Who was James Lind?
Developed trial with series of test groups to determine if lime juice treated scurvy
What is morbidity?
Measurement of incidence of disease. Measures NEW events, so also measure risk
What is mortality?
Death rate due to given disease
What is prevalence?
Number of individuals affected at a specific time
What is Eutrophication?
Aging of a body of water due to high BOD
What are droplet nuclei?
particles 1-10 micrometers in diameter, implicated in spread of airborne infection
What are clinical carriers?
Symptomatic
What are subclinical carriers?
Mild symptoms, not yet clinical
