HNI 469 Chapter 7 & 8

Descriptive studies,
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including prevalence and correlation studies, customarily describe the amount and distribution of disease within a population. This approach relies primarily on collection of existing data and answers the following questions:
• Who is affected (person)?
• Where is the disease distributed in the human population (place)?
• When is the disease present (time)?
• What is the overall effect of the disease (population)?
use observational methodology that begin to answer questions about cause-and- effect relationships between a potential risk factor and a specific health phenomenon or disease condition. Hypotheses, which are statements of possible relationships, are used to predict the causal association among the variables. Being able to predict risk thus points to factors that, if changed, may prevent the disease from occurring or reduce its risk. The hypotheses are tested through studies using cohort or case- control designs, and these studies may be retrospective or prospective.
If the evidence suggests that some relationships are appropriate for further study to confirm cause and effect a study may be conducted.
-always begin with carefully designed questions, hypotheses, and research protocols that specify the criteria for selection of the people (subjects) to be studied, the methods for random assignment of subjects to the experimental and control groups, the treatment procedure, the follow-up of subjects, and the details of the data analyses.
-the researcher always manipulates variables, such as a nursing intervention or a health-teaching approach, in the experimental and control groups.
-encompasses the stages of susceptibility and adaptation.
-Although factors are present that increase risk during the period of pre- pathogenesis, no disease exists.
-For example, obesity in combination with a sedentary lifestyle and smoking increases a person's chances for developing coronary heart disease. - -Because some risk factors can be altered, understanding the natural history of a disease is important.
-Awareness of the presence of risk allows the nurse to initiate preventive measures against the disease or limit its development.
Causative agentsmay include biological, physical, chemical, nutritional, genetic, or psychological factors that have the ability to affect health and disease in the person.The environmentincludes anything external to the person or agent, including the presence of other persons or animals that potentially affect health and diseaseMultiple Causation of DiseaseThe theory is critical to understanding epidemiological problems. - In epidemiology the interactions of the agent, person (host), and environment are analyzed by statistical methods to determine whether a causal relationship exists between various factors and health status. -Understanding these interactions and relationships is even more important and complex as one considers the natural history of noninfectious diseases, chronic conditions, and the health and well-being of a population. -multiple causes or factors are usually interacting to affect health statusHost Factors that Affect HealthDemographic characteristics: age, sex, ethnic background, race, marital status, religion, education, and economic status Level of health: genetic risk factors, physiological states, anatomical factors, response to stress, previous disease, nutrition, fitness Body defenses: autoimmune system, lymphatic system State of immunity: susceptibility versus active or passive immunity Human behavior: diet, exercise, hygiene, substance abuse, occupation, personal and sexual contacts, use of health resources, food handlingAgent Factors that Affect Health(Presence or Absence) Biological: viruses, bacteria, and fungi and their mode of transmission, life cycle, virulence Physical: radiation, temperature, noise Chemical: gas, liquids, poisons, allergensEnvironmental Factors that Affect HealthPhysical properties: water, air, climate, season, weather, geology, geography, pollution Biological entities: animals, plants, insects, food, drugs, food source Social and economic considerations: family, community, political organization, public policy, regulations, institutions, workplace, occupation, economic status, technology, mobility, housing popu- lation density, attitudes, customs, culture, health practices, health servicesBEINGS model of disease causes• (B) Biological factors and behavioral factors • (E) Environmental factors • (I) Immunological factors • (N) Nutritional factors • (G) Genetic factors • (S) Services, social factors, and spiritual factorsPrimary preventionis aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease. -includes general health promotion and specific protective measures in the prepathogenesis stage, which are designed to improve the health and well-being of the populationSecondary preventionis aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications. -Screening programs in which asymptomatic persons are tested to detect early stages of a disease are the most frequent form of secondary prevention. - Early case finding and prompt treatment activities are directed toward preventing the transmission of communicable diseases, such as the spread of impetigo in a schoolTertiary preventionis aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for persons who have experienced a loss of function resulting from a disease process or injury. -Nursing activities include education to prevent deterioration of a person's condition, direct nursing care, and referrals to resources that can help clients minimize the loss of function.Health information systems-are data collection systems for gathering health statistics and other health-related information at the population level and may include collection of vital statistics, surveillance, surveys, and records.Vital statisticsis the term used for the data collected from the ongoing registration of vital events, such as death certificates, birth certificates, and marriage certificates.Surveillanceis the ongoing systematic collection, analysis, and dissemination of health information for the purpose of monitoring and containing specific, primarily contagious, diseases. =An example of a surveillance and response system is the WHO's Global Outbreak Alert and Response Network, a group of collaborating institutions formed to rapidly identify, confirm, and respond to internationally important disease outbreaks, such as avian influenzaDEMOGRAPHIC DATAAge, sex, race, ethnicity, social class, occupation, and marital status are demographic characteristics that are frequently used when describing human populations. These factors contribute to variations in health status, health-related behaviors, and use of health care servicesLeading Cause of Death for Children1 Unintentional injury 2 Malignant neoplasms 3 Congenital anomalies 4 Homicide 5 Diseases of heart 7 Suicide 6 Pneumonia and influenza 8 Chronic lower respiratory 9 Septicemia 10 Certain conditions originating in the perinatal periodLeading cause of death Young AdultsMotor vehicle accidents Homicide SuicideLeading cause of Death Adults (25-65)Preventable health problems: Cholesterol levels, smoking, alcohol, seat belts, etc. Smoking related to cancer deaths Colon cancer: Associated with diet Lifestyle patternsJacob Henledeveloped scientific criteria to link organism to specific disease: (1) identify organism, (2) isolate it, and (3) use the organism to generate dis- ease. This approach remains a basic principle used by public health personnel to investigate new diseases and illnessesState Health Departments?In 1869, the first was established in Massachusetts; health departments in other states soon followed.Marine Hospital ServiceIn 1872, forerunner of the Public Health Service, was founded by an act of Congress. In 1912, the Marine Hospital Service officially became the Public Health Service (PHS), and states were held responsible for reporting statistics to the federal government via the PHAmerican Public Health Association1872 was established. The American Public Health Association provided a forum for physicians and other public health workers to set standards of care.Quarantine ActIn 1878 twas passed, granting the federal government the power to impose quarantine.National Institutes of Health (NIH)In 1930, the Ransdell Act established the (NIH), which continues to be the major source of research for the PHS. Federal support for research assistance in communicable disease control.Centers for Disease Control and Prevention (CDC),In 1946, the CDC (formerly known as Communicable Disease Center), was established. -original mandate was control of infectious diseases. - the scope of the CDC has expanded to include noninfectious diseases and environmental issues. - is responsible for collecting morbidity and mortality statistics on reportable infectious diseasesSuccesses in Communicable Disease Control-measures such as creating safer environmental conditions and providing treatments and vaccines as soon as they become available. - Water quality regulations, sewage regulations, and food-handling regulations have decreased the incidence of enteric diseases. - water is chlorinated, milk is pasteurized, preservatives are added to foods, and safe sewage plants are built. -Antibiotics help reduce the spread of communicable diseases (e.g., rheumatic fever, TB, syphilis) by lessening the time during which infected persons are contagious9th Leading Cause of DeathWhen considered as a group, three infectious diseases—pneumonia, influenza, and HIV infectionDrug-Resistant Diseases• Neisseria gonorrhoeae—resistant to fluoroquinolone; • Neisseria gonorrhoeae—resistant to azithromycin in a small but growing number of cases in the United States • Staphylococcus aureus—commonly resistant to methicillin and now becoming resistant to vancomycin, the last currently known drug treatment choice • Salmonella—a new strain, is resitant to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline; strain is common in the United Kingdom and has now spread to the United States • Shigella sonnei (gastroenteritis)—resistant to ampicillin and trimethoprim-sulfamethoxazoleGroups at Risk: Tuberculosis• Individuals with human immunodeficiency virus infection • Prisoners and homeless persons • Poor urban individuals • Minorities (Native Americans and Alaska Natives, Asians, Pacific Islanders, African Americans, Hispanics) • Health care workers ** TB is the leading infectious cause of death worldwideGroups at Risk: Sexually Transmitted Disease• Adolescents • Young adults • Persons with multiple sex partners • Persons engaging in drug-related activities • Prostitutes • Minority groups (African Americans and Hispanics) * Most common: Chlamydia, HPV and trichomoniasis * Most infected ppl are symptom free, so remain untreated and can continue to spread diseaseGroups at Risk: Human Immunodeficiency Virus Infection• Persons with multiple sex partners • Intravenous drug users • Prostitutes • Minority groups (African Americans and Hispanics) • Bisexual and homosexual males *Second leading cause of death among ppl age 25-44Groups at Risk:Hepatitis• Persons with poor personal hygiene or living in poor conditions (overcrowded or unsanitary conditions) • Persons who emigrate from areas where hepatitis B virus infection is common (Africa, Asia, South America) • Travelers to areas where hepatitis is endemic • Intravenous drug users • Persons with multiple sex partners • Alaska Natives • Health care workersHepatitis TypesA: Fecal-Oral rt: Vaccine B: Blood/body fluids: Vaccine C: Blood/body fluids: No vaccine D: Blood/Body fluids: No vaccine E: Fecal-oral rt: No vaccineNorwalk-like Virus Infection- (NLVs) or Noroviruses have occurred over the years. - The latest outbreaks have occurred on cruise ships and in other areas -transmitted through contaminated food and water - NLVs are highly infectious. -in epidemic situations person-to-person contact, droplets, and contaminated environmental objects such as doorknobs, utensils, and bed linens can transmit the virusesFood-borne Infections-Symptoms are generally mild to severe diarrhea. -serious complications such as hemorrhagic colitis, septicemia, meningitis, and kidney failure are less common. -Children 5 years old and under have the highest incidence of food-borne illness but senior adults (60 and older) and those with compromised immune systems are at highest risk of hospitalization and death from food-borne infections. -Salmonella is the most common of the food-borne infections, causing approximately 1.2 million illnesses each yearWest Nile VirusWNV is a vector-borne virus spread by infected mosquitoes. The virus has been found in wild birds, chickens, horses, dogs, and squirrels, as well as humans. The incidence of WNV has dropped by over 68% since 2006. There were only 1021cases reportedDaycare- Approximately 7 million children under the age of five are now in daycare -These children are at greater risk of enteric infections (hepatitis A, cryp- tosporidiosis), respiratory tract infections, and middle ear infections.SARSSevere acute respiratory syndrome is a viral respiratory disease of zoonotic origin caused by a coronavirus (SARS-CoV).traveler-related illnessSARS in 2003, cholera, a new form of leishmaniasis,, and 1125 cases of dengue fever - Fifty-seven percent of the cases of measles in the United States are brought in from other countries - malaria have been brought in -Plague, pertussis, yellow feverPOPULATION SAFETY VERSUS INDIVIDUAL RIGHTS-public health officials have struggled with the problem of balancing individual rights with the right of the community to be protected from infection. As a general rule, the safety of populations has taken precedence over individual rights. To reduce the risk of exposure in populations, individual rights have been curtailed or revokedinfection control nursesemployed in hospitals or in large institutional settings. -concerned primarily with protecting staff and clients from communicable and infectious organisms by developing and monitoring infectious control practices and educating staff and clients.Contact investigation- .Community health nurses interview infected persons to help identify contacts placed at risk by exposure to infected individuals. - also perform home visits to monitor persons under treatment and ensure compliance with the accepted treatment protocolEpidemiological IvestigationsNurses employed in special settings may also engage in epidemiological investigations of new diseases or outbreaks of recognized illnesses, for example, Hantavirus disease in the Southwest and food poisoning outbreaks such as a Salmonella- caused episode in four states that resulted from the consumption of unpasteurized milk.Epidemiological Principles and Methods- knowledge about the links in the chain of infection. -relationships and interactions among the infectious agent, the host (human or animal incubating the agent), and the environment, that is, the components of the epidemiological triangle, are important. -disease control depends on discovering the weak link in the triangle and developing measures that attack and reduce or eliminate that threat.Control efforts- include prevention activities and efforts to reduce the seriousness of an illness as measured by the severity, the length of illness, the cost of treatment, the short- and long-term effects, and the risk of deathCommunicable Disease Investigation1) identifying the disease, 2) isolating the causative agent 3)determining the method of transmission 4) establishing the susceptibility of the populations at risk, 5) estimating the impact on the population.Primary Preventionimmunizations and EducationSecondaryScreening and case findingtertiary preventionactions taken to contain damage once a disease or disability has progressed beyond its early stagesWhat strategy can be used to safeguard a community against communicable diseaseAdministering influenza vaccine can be used to safeguard a community against communicable disease. Influenza is a communicable disease that is transmitted from person to person, and administering the vaccine can help prevent the disease from occurring or spreading. Teaching about heart disease and encouraging use of safety goggles are not topics related to communicable disease. Planning a health fair will help increase the knowledge about various health practices in the community; however, it will probably not stop the spread of communicable diseaseshe primary strategy that a nurse can use to control communicable disease is to provide education aboutTeaching about proper handwashing and other measures of proper hygiene is a primary focus in the control of communicable disease. Disease reporting is an important function of the community health nurse. However, reporting a disease does not help control the spread of the communicable disease. Safe food preparation is also important, but is not a primary strategy used to control communicable disease. Teaching about safety in the home does little to prevent the spread of communicable diseaseSecondary prevention is used when a nurseScreening for tuberculosis is an intervention at the secondary level of prevention. Secondary prevention includes measures directed at early detection of disease in order to provide early treatment, ensure treatment effectiveness, and minimize the spread of disease within the population. Immunization is an intervention used at the primary level of prevention. It is used to prevent the disease from occurring. Education and counseling are not secondary prevention measures.