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Community Final

Terms in this set (102)

epidemiology
the study of the occurrences and distribution of health-related states or events in specified populations, including the study of determinants influencing such states and the application of this knowledge to control the health problems-
Epi =upon Demi=people ology=study
Descriptive Epidemiology (Getting Started)
1. Examines disease patterns according to "person," "place," and "time";
2. Compares affected groups and unaffected groups;
3. Suggests hypotheses for further study;
4. Descriptive studies usually precede analytic ones;
Analytic Epidemiology (Going In-depth)
1. Addresses the "how" and the "why" of health and disease;
2. Attempts to determine causality;
3. Tests hypotheses or seeks answers to specific questions;
4. Can be retrospective or prospective in design.
Primary Prevention
◦ General health promotion, such as nutrition, hygiene,
exercise, and environmental protection;
◦ Specific health promotion (e.g., immunizations);
◦ Less costly than treating disease and conditions after
they occur.
Secondary Prevention (Screening)
◦ Early detection and treatment of adverse health conditions;
◦ May result in cure of diseases that are incurable at later stages, prevention of disability,
and confinement of spread of communicable diseases;
◦ Examples: Pap smear for cervical cancer and skin test for tuberculosis.
Secondary Prevention (Screening)
◦ Early detection and treatment of adverse health conditions;
◦ May result in cure of diseases that are incurable at later stages, prevention of disability,
and confinement of spread of communicable diseases;
◦ Examples: Pap smear for cervical cancer and skin test for tuberculosis, BP for elderly
incidence rate
# of new cases per population at risk in a
given time period.
In a defined population.
In a specific time.
IR=new cases X K (100,000)
Population
prevalence
number of cases who have the condition at one time
# of cases X 100,000
persons
specific rates
segments groups of the population example sex age race cause of death cancer site
Adjusted-
rates are standardized to control a population
Association
refer to the statistical dependence between two variables
the presence of an association... And no ways implies that they observe relationship is one of cause and effect

1. Association is strong;
2. Association is consistent;
3. Association is temporally correct;
4. Association is specific;
5. Association is not the result of a
confounding variable;
6. Association is plausible and consistent
with current knowledge.
Causation
indicates that one event is the result of the occurrence of the other event;
9. Understand the key criteria for determining causation;
criteria to provide epidemiologic evidence of a causal relationship between a presumed cause and an observed effect. (For example, he demonstrated the connection between cigarette smoking and lung cancer.)
Understand the web of causation view of a health condition;
◦ Views health problems as complex
interrelationships of numerous factors;
◦ Attempts to identify all possible
influences on health and illness processes;
◦ Synergism: The whole is more than the
sum of its separate parts.
independent variable
variable that does not depend on the outcome of the other, not the cause, or the contributor
◦ Dependent variable
: Outcome, ◦ Example
The relationship between alcohol use and cognitive, value depends on other
functioning among Chinese elders with diabetes.
What is the independent variable? alcohol
What is the dependent variable? diabetes
agent-
types of infection that cause death (infant mortality)
host
population affected (infants in infant mortality),
environment
surroundings (mother in an infant death)
Understand the difference types of public policy with examples;
Medicare 65 and older,Medicaid low income US citizens and some 65 years and older disabilities, children's State health insurance program- s c h i p doctor visit immunizations hospitalizations emergency room visits, temporary assistance to needy families- TANF financial and medical assistance to needy dependent children and parents or relatives to whom they are living with, women infant children WIC supplemental food nutrition referrals to healthcare pregnant breastfeeding postpartum.
Understand the process of policy making;
Public policy is formulated by governmental bodies and frequently restricts personal choice to
improve public welfare, such as fines for unsafe driving.
Additional examples of public policy include seat belt laws for both children and adults and
legislation that regulates where and to whom tobacco products may be sold and the fines or
penalties that apply with failure to comply.
1. Problem recognition and definition;
2. Policy formulation;
3. Policy adoption;
4. Budgeting and policy implementation;
5. Policy evaluation.
or ADPIE
Assessment.
Diagnosis. ...
Planning. ...
Implementation. ...
Evaluation.
Understand whom children's health insurance program target; CHIP
Children under 19 from families who earn too much to qualify for Medicaid but who meet eligibility and are not covered by other insurance, US citizen or legal immigrant
...
...
Understand Agent Specific and All Hazards Approaches;
Agent specific most likely threats ALL hazards include five categories:
natural or accidental
Traumatic
Nuclear
Biological
chemical
2. Understand the process of disaster plan;
Simple, clear, realistic, flexible, easy, should be tested and updated regularly, should be easily accessible to all staff at workplace
Understand disaster paradigm;
DISASTER- Detect, incident command, scene security and safety, assess hazards, support, triage and treatment, evacuation and transport of victims and casualties, recovery
4. Understand the simple triage and rapid treatment process;
As the first step of the start process, Rescuers instruct persons at the scene of the incident to move to a designated area away from the scene. Those able to move to the designated area are considered to need Minor Care on the assumption that their care can be delayed. Rescuers then move systematically through persons unable to move alot 60 seconds or less per patient, performing assessments, and designating patients to a general category based on patient treatment needs. The triage assessment is to locate patients in the immediate care party address Airway or severe bleeding issues, a plan intermediate tied and then move on to the next victim. And online CERT training course is available Triage continues until all or seen.
5. Understand how to tag victims based on symptoms severity;
Green is minor, black is deceased, red is immediate, yellow is delayed
6. Understand the stages of infection;
All disease is multi-causation: the interaction of
Person, Environment, and Infectious Agent;
Stages of infection:
1. Latency (replication period before shed);
2. Communicable;
3.Incubation (invasion to time before symptoms
develop).
Understand the chain of transmission;Breaking the Chain of transmission requires
controlling the pathogen
eradicating nonhuman reservoir
controlling the nonhuman reservoir
controlling portal of exit and entry
improving host resistance
General transmission- abiotic environment factors when water inhalation of spores entry into skin, animal factors such as mosquitoes fleas. human-to-human transmission- direct contact, indirect contact, droplets, airborne, fecal-oral
Primary prevention
STD teach safe sex practices condom machines
diseases caused by bloodborne pathogens teach barrier precautions dangers of sharing needles, adequate supply of gloves Sharps container initiate Citywide needle exchange programs and methadone programs
vaccine preventable diseases ensure that all children who come in the clinic have immunizations Community groups to sponsor clinics at low rates
hepatitis A, GI infections- teach safe food handling, license restaurants for safe food handling
Hepatitis A and B globulin after exposure and mandate health care workers to get immunized
Secondary prevention
TB screening- for persons in contact - yearly testing treatment free of charge at workplace
HIV AIDS testing antiviral therapy local Health Department to surveillance of population by reporting
meningitis prophylactic treatment 2 person exposed in schools following exposure
tertiary prevention
provide therapy for active TB patients antibiotics and monitor adherence initiate. Program and shelters in jails and Community campaigns about drug resistance
endemic
-Occur at it consistent expected level in a geographic area such as the case with some STDs and with TB, regularly expected in this area
...
...
outbreak
-Refers to the unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time example pertussis and salmonella,
pandemic
The steady occurrence of disease over a large geographic area/worldwide such as malaria in Africa
epidemic
refers to the unexpected increase if an infectious disease in a geographical area over an extended period of time example-smallpox;
Understand the features of infectious disease outbreak
(unexpected, limited
area, and limited time period);
Verify the diagnosis and establish a case definition
confirm the existence of an outbreak
identify the characteristics of the affected persons
Define and investigate the population at risk
investigate the outbreak and formulate a hypothesis as to exchange of transmission
determine the most effective control measures based on the chain of transmission and Implement control measures
Understand major pollutant mechanisms;
Chemical nature, concentration, and persistence
pollutants are classified based on their persistence
degradable pollutants- breaks down into a pollutant plastics, polythene, bags, insecticides
biodegradable pollutants- garbage, sewage, feces, urine
slowly degradable pollutants-(persistent); Takes decades or longer to decay
plastics, DDT
non degradable pollutants-Cannot be broken down naturally
lead, arsenic
bioaccumulation-
Increase in concentration of a pollutant in an organism like little fish eat bigger fish eats bigger fish
biomagnification;
increase in concentration of pollutants in the food chain the Big Bird eats the caterpillar that eats the small bird that eats the worms
Understand basic principles of ecology;
relationship of organizm to surroundings- There are certain basic fundamental ecological principles which describe various aspects of living organisms e.g. evolution and distribution of plants and animals, extinction of species consumption and transfer of energy in different components of biological communities, cycling and recycling of organic and inorganic substances, interactions and inter-relationships among the organisms and between organisms and physical environment etc.
4. Understand the root of pollution (population growth);
All pollution is a result of population growth
demographic changes alter stress inflicted on the environment
as population grows, stress increases
when population moves, nature and intensity of environment problem shift
5. Understand nursing interventions to decrease pollution;
Primary prevention
-reduce eliminate environmental hazards enforce legal codes and standards
-educate Community residence business owners and government officials how to avoid environmental hazards such as sunscreen ear plugs and safety glasses
-become involved with political action that provides two strategies
-promote routine immunizations To minimize disease caused by biological agents
Secondary prevention
-monitor for signs of hazardous environmental conditions such as blood lead levels
-assess for signs of illness related to hazards such as asthma and mental retardation
-Decrease environmental pollution
-treat and monitor environmental conditions such as asthma and blood levels in children
Tertiary prevention
eliminate hazards to prevent reexposure example removing asbestos lead and mold from buildings
help communities to manage long term effects of conditions caused by these hazards Extra Care cost associated with mental retardation and asthma
participate in political activity that reduces hazards strict adherence to admissions regulations and air and water quality standards
6. Understand Florence's environmental theory (emphasis on cleanness);
Pure air, pure water, efficient drainage, cleanliness, light
Ethics
1. Considers people inherently "good";
2. Propose what a person should do;
3. No definite sanctions for an ethical violation.
Law
what people must do; clear
punishment.
Deontology(action based)
Study of natural duty- refers to an ethical theory or
perspective based on a set of
rules such as ANA, code of
ethics for nurses, etc.
Deontology(action based)
Study of natural duty/ obligation- refers to an ethical theory or
perspective based on a set of
rules such as ANA, code of
ethics for nurses, etc.
Understand the three frameworks of healthcare roles;
-Paternalism is action limiting a person's or
group's liberty or autonomy which is intended
to promote their own good.
-Contractualism means shared decision making.
-Consumerism means consumers is in clear
control of making choices for themselves.
4. Understand the 3 roles in healthcare professional;
1. Advocacy: Understand the world view,
resources, circumstance, priorities and
explore options with patients in light of
their preference;
2. Catalyst: contain all the qualities and
resources and to promote changes.
seven ethical principles essential to healthcare with examples;
• Autonomy
• Respect for people
• Beneficence/doing good
• Non-maleficence
• Justice
• Veracity/accuracy
• Fidelity/faithful
ethical analysis framework;
Self-actualization- morality creativity spontaneity problem solving lack of prejudice acceptance effects
esteem- self esteem confidence achievement respect of others respected by others
love and belonging- friendship, family, sexual intimacy
safety- security of body employment resources morality the family health property
physiological- breathing food water sex sleep homeostasis excretion
ethics challenges often encountered by community residents
(autonomy, respect for people, and nonmaleficence);
Quandaries regarding autonomy and the public good, respect for people, autonomy and beneficence respect for people access- 2c are example: extreme sports-the cost of medical care and search and rescue for these with high risk behaviors is an ethical challenge
.The right of individuals to self-determination is a core value of Western European and American law and ethics decision should be made by those most affected, individuals families groups or communities umbrella concept
community-as-partner model centers around "autonomy"
.The right of individuals to self-determination is a core value of Western European and American law and ethics decision should be made by those most affected, individuals families groups or communities umbrella concept
community-as-partner model centers around "autonomy"
Understand what does community program succeed entail?
• Partnership;
• Community Involvement and
Commitment;
• Community Ownership and Control of
Program;
• Continual Relationship Building;
• Capacity Building of Community by
learning knowledge and skills;
• Feedback mechanisms to ensure
understanding.
what is the right-relationship between community health nurse and people in communities.
• Types of relationships (faith, hope, and trust)
• Right-relationship (Non-judgmental, generate selfactualization,
and dynamic)
concept of pedagogy of the oppressed;
Weird movie about the rich are smarter?
Trust in governmental change instituted by the
people. Community partnerships develop through
a process of empowerment.
• Four characteristics of an empowered community
(conceptualized from Paulo Freire's [1997]
Pedagogy of the Oppressed) follow: 1, trust
established through dialogue; 2, faith in people;
hope in positive transformations benefiting the
community as a whole; and 3, discussions
grounded in critical thinking without fear of
repercussions by those who are in power.

First published in Portuguese in 1968, Pedagogy of the Oppressed was translated and published in English in 1970. Paulo Freire's work has helped to empower countless people throughout the world and has taken on special urgency in the United States and Western Europe, where the creation of a permanent underclass among the underprivileged and minorities in cities and urban centers is ongoing.
participatory research
a form of emancipatory inquery that addresses inequalities and Injustice is in health and Society. this is a research method Community Health nurses May employ an empowering a community to focus on health problems. It incorporates conversations that produce both collaboration and self-awareness between nurses and their community. The method of participatory research incorporates scientific research, education, and political action developed primarily out of works of Freire.
process and principles of participatory research; how it differs from academic research.
1, participants determine research question that is their concern;
2, Participants determine research methods and way of evaluation;
3, Purpose is social change, not just to advance scientific knowledge;
4, Emphasize on partnership, democracy, and collective building;
5, Community health nurses provide knowledge and resources to empower community
Members.
nurses' role in empowering communities (catalyst and advocate).
• Help communities identify, understand, and find solutions;
• Determine common goals in resolving community
problems;
• Use our expertise and interpersonal skills;
• Help awaken the spirit of social change in minds of people
who are vulnerable in the community;
-solve problems!
Understand the problem need to be coming from community residents. Finally, a mutual goal should be achieved;
• In instituting participatory research
programs, nurses help communities
identify, understand, find solutions,
and determine common goals in
resolving community problems.
• The problems examined through
emancipatory inquiry are those that
community members believe are
important and not necessarily those
identified by health professionals in
the community.
Ethnocentric
evaluating other peoples and cultures according to the standards of one's own culture.
2. Understand what does cultural competence entails for community health nurses
Express an awareness of one's culture, to recognize the difference between oneself and
others, and to adapt behaviors to appreciate and accommodate the differences.
■ More than a person's ethnicity, but also people's gender, age, education, environment,
family, life circumstance, etc.
■ Willingness to learn one's culture; commitment to incorporate the importance of culture
at all levels of care, and make adaptations.
Acculturation
The adoption of cultural traits, such as language, by one group under the influence of another.
definition of "at-risk"; ?
those at risk- Relative Risk
◦ E.g. of exposure:
smoking, alcohol,
sedentary life styles,
interventions, etc..
you want to compare mortality rate among newborns removing effects of geographic differences and parental nutrition status
Adjusted rate
Disability rate among women of childbearing age is an example of?
Specific rate
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
ex: infant mortality= race economic status, maternal age, parity, marital status, premature, prenatal car, low birth weight, malformations, anoxia, SIDS, infections and accidents
ecological model for child dev
inward out wheel=
child, =
microsystems = family classroom, sibllings, peers=
exosystems= are extended family school board, neighborhood, mass media, parent work. Macrosystems=laws, culture, history, social systems, economic systems
RR (relative risk)
In epidemiology, risk ratio or relative risk is the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group. It is computed as I e/ I u, where I e is the incidence in the exposed group, and I u is the incidence in the unexposed group. Together with risk difference and odds ratio, risk ratio measures the association between the exposure and the outcome.
epidemiolgy rates
number of people experiencing a problem over population at risk x 1000 (K)
Prevalence
# of existing dz old and new cases
incidence
# of new cases
ratio
A comparison of two quantities by division
proportion
An equation stating that two ratios are equal, it is a percentage
rates
measure the amount of disease, injury, disability or dealth within a unity of population and within a unity of time
odds ratio
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed ex: if greater than one you prove that the exposure has an assoc w the dz
examples of ecological studies-relating to or concerned with the relation of living organisms to one another and to their physical surroundings.
Cholera study (John Snow), UV radiation and cancer, Diet and Alzheimers, UV radiation and Flu (china kids took Vit D and less flu outbreaks0
example of descriptive epidemiology
all cases range age from 2 months to 6 years, plus one 17 year old
example of analytical epidemiology
2 groups get immunization (one group real shot and other placebo) study who gets the dz and who doesn't
Case and control study
Case are those that have the dz, control are those that have the same exposure but don't have the dz= Odds ratio (food borne example)cheap!
cohort study
RR- relative risk those exposed to dz and those that were not- expensive cause over long period of time. (smoking causes cancer took years to follow)$$$
control study
2 groups, one recieves the (vaccine, med) and one doesn't all unknown to participants or investigators (double blinding)=study outcome$$$
Blood pressure on elderly is example of?
secondary
Demography
◦ Statistical study of human populations
with reference to size and density,
distribution and vital statistics;
◦ Examples: age, gender, sex, education,
ethnicity, socioeconomic status,
geographic, birth, death, marriage
status;
Descriptive Measures of Health
1. Morbidity and Mortality
2. Incidence
3. Prevalence
4. Odds and Odds Ratio (OR)
5. Attributable Risk (AR) and Attributable Risk Percentage
odds ratio
The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed
Attributable risk
AR = [a/a + b] − [c/c + d]n epidemiology, attributable risk or excess risk is a term synonymous to risk difference, that has also been used to denote attributable fraction among the exposed and attributable fraction for the population.
attributable risk percent
in the exposed group represents the excess risk in the epxosed population that can be attributed to the risk factor. It can be easily derived form the relative risk using the formula

ARP = 100 x (RR-1)/RR
crude rate
Pop B has greater % of old people we know that cancer increases with age regardless of environment
Incident rate (IR)
is the number
of new cases per population at risk in a
given time period.
- In a defined population.
- In a specific time.
At risk
able to experience and measure the outcome of interest
biological considerations- susceptibility ex. no immune to agent or
have the target organ
ie. women have uterus that can get cancer
at risk
woman would not be at risk prior to menses, while pregant or after menopause, if using contraceptives properly
prevalence
total # of people in the population that have the condition at given time
Incidence
number of new cases
You are asked to determine the number of patients with active cases of the flu in a longterm
care setting on February 9, 2015. What is this is an example of?
prevelance
You want to compare __ mortality
rate among newborns removing
effects of geographic differences
and parental nutrition status;
crude rate
Disability rate among women of
childbearing age is an example of
___ rate;
Specific rate
relative risk
A ratio of the probability of the event (outcome variable) occuring in the exposed (risk factor) group to the probability of the outcome occurring in a non exposed (no risk factor) group.
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