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Chapter 4 Epidemiology Age adjusted rates: (also known as standardization of rates) method of reducing bias when there are differences in the age distributions of two populations being compared. Determines the rate for specific subgroups of a population and using a denominator that reflects only the subgroup removes age related bias. P. 56 Analytic epidemiology: method that investigates the causes of disease by determining why a disease rate is lower in one population group than in another. Descriptive epidemiology: a form of epidemiology that describes a disease according to its person, place, or time related to amount and distribution of disease. Crude rates: rates that summarize the occurrence of births (crude birth rate), deaths (crude death rates), or diseases (crude disease rates) in the general population. The numerator is the number of events, and the denominator is the average population size or the population size at midyear (usually July 1) multiplied by a constant. Can appear distorted because risk is not accounted for. Epidemiological triangle: an organized method of inquiry to derive an explanation of disease which analyzes three elements: agent, host, and environment.
Wheel model: Biological > Social> Physical environments around >Host w/ Genetic core Web of causation: a model that can be used to illustrate complex interrelationships of factors interacting with each other to influence the risk for, or distribution of, health outcomes. Surveillance: ongoing collection of community health information
Incidence: occurrence of new cases of a disease or condition in a community over a period of time relative to the size of the population at risk for that condition in that time period: # new cases at point in time X 1000 Population at risk at same point in time -particularly good for acute disease -may be the most sensitive indicator of the changing health of a community Prevalence: # existing cases a point in time Population at same point in time -often used in cross-sectional studies X 1000
Prospective studies: monitor a group of disease free individuals to determine if and when disease occurs. These individuals, or the cohort, share a common experience within a defined time period. It summarizes data collected over time by the incidence rates of new cases or relative risk= incidence rate among exposed Incidence rate among unexposed - (also called longitudinal, cohort, or incidence studies) they are advantageous because they obtain more reliable information about the cause of disease than do other study methods Retrospective studies: compare individuals with a particular condition or disease with those who don’t have it. They determine whether cases, or a diseased group, differ in their exposure to a specific factor or characteristic relative to controls, or a nondiseased group. Data collection extends back in time to determine previous exposure or risk factors. A greater proportion of exposed cases than controls suggests a relationship between the disease and the risk factor. Experimental studies: a type of analytic study. Investigations apply experimental methods to test treatment and prevention strategies. The investigator randomly assigns subjects at risk for a particular disease to an experimental group or a control group. Both groups are observed for occurrence of disease over time, but only the experimental group receives intervention. Cross-sectional: (prevalence) examines relationships between potential causal factors and disease at a specific time. Limitations in discovering etiology factors. Hypothesis generating studies. *Person place and time:* researcher try to identify common characteristics of people suffering from a disease and compare them with common characteristics of people who are healthy. (eg: age, wealth, health) They look to see if location/ living environment of the ill is a common factor. Researchers also evaluate common time factors. p. 51 Specificity: extent to which a screening tool can correctly identify those who don’t have a disease
Sensitivity: extent to which a screening tool can correctly identify those who do have a disease correctly Morbidity & mortality Chapter 11 Politics Coalitions: two or more groups join to maximize resources, thus increasing their impact and improving their chances of success in achieving a common goal. Epidemiological transition: the change in patterns of illness and death from acute to chronic conditions influenced by improvements in a country's economic status. WHO: an international agency of the UN founded after World War II to promote health around the world.
Public policy refers to decisions made by legislative, executive, or judicial branches at the local, state, or federal levels of government. Compliance by states to federal program standards is voluntary, but the advantage of the revenue, which states don’t get if they don’t comply, is generally enough incentive to have states participate. Common law is the body of law derived from judicial decisions rather than from statutes or constitutions. CDC Developed, developing, and underdeveloped Tobacco pandemic: established in 2003 under the auspices of the World Health Organization, it is the first legal instrument designed to reduce tobacco-related deaths and disease around the world. Among its many measures, the treaty requires countries to impose restrictions on tobacco advertising, sponsorship, and promotion; establish new packaging and labeling of tobacco products; establish clean indoor air controls; and strengthen legislation to clamp down on tobacco smuggling. Political action committee (PAC): $ often funds lobbyists to go to the legislature. Political action committees are nonpartisan entities that promote the election of candidates believed to be sympathetic to their interests. ANA: writes standards for nursing. Umbrella for state nursing organizations
Lillian Wald: early twentieth-century community health nurse and political activist who recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Health policy: public policies that pertain to or influence the pursuit of health, or a course of action to obtain a desired health outcome for an individual, family, group, community or society. Health policies influence health care through the monitoring, production, provision, and financing of health care services. The nursing workforce development programs administered by the Health Resources and Service Administration (HRSA) through Title VIII provide federal support for nurses' workforce development. Chapter 12 Cultural Diversity Culture represents a person’s way of perceiving, evaluating, and behaving within his or her world, and it provides the blueprint for determining his or her values, beliefs, and practices. It is learned from birth through language, socialization, and acquisition. It is shared by all members of same cultural group. It is adapted to the environment and resources. It is dynamic. Subculture: ethnicity, religion, occupation, health related characteristics, age, sex, geographical location etc. Lineal relationships: kinship ties- client may seek assistance from other members of family and allow a relative to make decisions about important health related matters. Collateral relationships: group goals, family honor Individual relationships: autonomy and independence. Individual goals dominate Ethnocentrism Poverty & generational poverty: Religion: an organized system of beliefs concerning the cause, nature, and purpose of the universe, especially belief in or the worship of god or gods. Spirituality: born out of the individual’s life experiences and personal effort to find purpose and meaning in life. Transcultural Nursing Theory: Madeline Leininger "a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values, and practices with
the goal of using this knowledge to provide culture-specific and culture-universal nursing care to people" (Leininger, 1978, p. 493). Space: Hispanics, east India, middle easterns invade personal space p.219 Yen-Yang: Asian belief of mind and body healing/ balance A culturologic assessment of the community is an important part of the overall assessment process that is essential to any effective community health efforts. A cultural self-assessment is necessary to identify personal beliefs, values, and attitudes that may interfere with the nurse's ability to see health issues from the perspective of those being served. Chapter 13 Environmental & Chapter 32 Global Issues Environmental health is a vast field of subcategories including living patterns, work risks, atmospheric quality, water quality, housing, food quality, waste control, and radiation risks. Critical theory is utilized to help community health nurses think about social, cultural, economic and political factors of health, thereby assisting him or her to attack the problem at its source and alter community-wide precursors of poor health. Health & justice Living Patterns: p.241 (eg: other countries walk places while we drive) the relationships among persons, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs. Living patterns is the area of environmental health that is being addressed. Living patterns are the relationships among people, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs. Examples of living patterns include driving while intoxicated, secondhand smoke, noise exposure, urban crowding, and technological hazards. Sick Building syndrome: a phenomenon in which public structures and homes cause toxic syndromes in their occupants because of building materials, poor ventilation, substances in furniture and carpeting, building operations, or cleaning agents. Housing issues: elevated indoor allergen levels, radon poisoning, lead paint, tobacco, availability, safety, cleanliness, location Atmospheric quality: the amount of protection in the atmospheric layers is diminishing. Devegetation of the earth is reducing the amount of CO2 that can be processed.
Water quality: a global problem (PAHO) Pan American Health Organization: an international public health agency working to improve the health and living standards of Americans. (UNICEF) United Nations International Children’s Fund: global health organization founded in 1964 to assist children in war-ravaged Europe. The World Health Organization (WHO) introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. UNICEF focuses on child and women's health. The World Bank strives to improve the health status of individuals living in areas that lack economic development. UNICEF works for children's survival, development, and protection by developing and implementing community-based programs. UNICEF achievements are well documented in child health, nutrition, education, water, sanitation, and progress for women. PAHO is an international public health agency that works to improve the health and living standards of the Americas. The World Health Organization (WHO) introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. Chapter 17 Senior Health Young old 65-74 Middle old 75-84 Old old 85-99 Elite old 100+ 10% live in poverty Advanced directives: a written document in which a competent person gives instructions about his or her health care that are to be implemented in the future if the individual is not able to make the decisions. The Patient Self-Determination Act requires health care facilities to inform patients in writing about their rights to execute advance directives. This is a federal law that applies to facilities that receive Medicare and Medicaid funds. A living will is a legal document whose purpose is to allow individuals to specify what type of medical treatment they want to receive if they are incapacitated. A durable power of attorney authorizes someone to act on an individual's behalf with regard to property and financial matters. A durable power of attorney for health care allows an individual to designate a health care proxy or surrogate to make decisions about medical care if one is unable to do so. Medicare: "Medicare Part B will pay for your doctor's visits." Medicare Part B covers the costs for physician and nurse practitioner services; outpatient services such as
diagnostic procedures, qualified physical, speech, and occupational therapy; ambulance services; durable medical equipment; and some home health services. Medicare Part A is a hospital insurance plan that covers acute care, short-term rehabilitative care, and some costs associated with hospice and home health care. Common problems: Glaucoma, Macular degeneration, Dental/nutrition, Suicide 19% of suicides, depression, agoraphobia, substance abuse, Elder abuse, Polypharmacy Stochastic theories generally describe aging as the effect of specific biologic process resulting in cellular impairment. Thus each individual will have a unique accumulation of the cellular processes resulting in aging. Nonstochastic theories describe life as a finite process, with defined cellular life processes, such as cellular division, defining the life span for a given species. According to 2004 federal statistics, individuals who survive to age 65 can expect to live an average of nearly 18 more years. If they are then healthy at 85 they will probably live 6-7 years longer. Elder abuse: Individuals who are most at risk for elder abuse include female widows age 75 and older, elders dependent on a caregiver for food and shelter, those with incontinence, and individuals who are frail or have illness or mental disability. Studies have described the typical abuser as a family member (typically a son or daughter) who is middle age or older with low self-esteem and low impulse control. The caregiver's perception of his or her own stress is strongly related to the risk of abuse. Elder abuse occurs at all cultural and socioeconomic levels. Chapter 23 Communicable Disease Acquired immunity: derived from actual exposure to the specific infectious agent, toxin, or appropriate vaccine. Active immunity: develops when the body can build its own antibodies that provide protection from a bacterial or other antigenic substance, such as the introduction of a vaccine or toxoid. Agent: causative factor invading a susceptible host through an environment favorable to produce disease, such as biological or chemical agent Chain of Transmission: Pathogenic agent > Reservoir > Portal of exit > Transmission > Portal of entry > Host susceptibility Direct transmission: immediate transfer of an infectious agent from an infected host or reservoir to a portal of entry Indirect transmission: spread of infection through a contaminant
Elimination: controlled within a specified geographical area and the prevalence and incidence of the disease is reduced to near zero. Eradication: world wide permanent elimination of the disease: smallpox Control: reduction of incidence or prevalence of a given disease to a locally acceptable level as a result of deliberate efforts. Endemic occur at consistent expected levels in a geographical areas Epidemic: unexpected increase of an infectious disease in a geographic area over an extended period of time. Pandemic: steady occurrence of a disease over a large geographic area Herd immunity: 80% of population must be immune to be reasonably well protected as is the unvaccinated population Latency period of replication before shedding Vector: a nonhuman organism, often an insect, that either mechanically or biologically plays a role in the transmission of an infectious agent from source to host. Incubation period: time from invasion to the time when disease symptoms first appear. Often communicable before this time. Live vs. inactivated vaccine Primary vaccine failure- didn't work at all Secondary vaccine failure- wears off with time Reemerging MMR and varicella vaccines are contraindicated during pregnancy. Polio and yellow fever are not recommended Chapter 26 Disasters Bioterrorism: flu like symptoms Triage colors: Black Red Yellow
Mass Casualty MA- Tech Disaster Push packs: 12 hours Nerve, radiation, water, aerosol Chapter 27 School Nursing Youth Risk Behavioral Survey: national state and local Youth Risk Behavior Surveillance System (YRBSS) developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the United States 1:750 Nurse to student ratio recommended 1:3000 is what TN has Give mostly ADD and asthma drugs EPSDT: The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate in Medicaid requires states to conduct regularly scheduled examinations (screens) of all Medicaid- eligible recipients under the age of 22 to identify physical and mental health problems. If a problem is detected and diagnosed, treatment must include any federally authorized Medicaid service, whether or not the service is covered under the state plan. If problems are suspected, an "interperiodic" screen is also required so the child need not wait for the next regularly scheduled checkup. * a program within Medicaid. It is a comprehensive child health program for uninsured under the age of 21. It includes health education, periodic screening, vision, dental, and hearing services. FERPA: The Family Educational Rights and Privacy Act protects the privacy of student education records. Parents or eligible students have the right to inspect and review the student's education records maintained by the school. ADA: Americans with disabilities act 1990 prohibits discrimination based on disability
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