Public Health Final Exam

government health agencies

health agencies that are part of the government structure (federal, state, local) and that are funded primarily by tax dollars

World Health Organization

The most widely recognized international governmental health organization

Public health

the art and science of maintaining and protecting and prolonging the health of people through organized community effort

History of Governmental public health

before 1908

-no full time county health officer except in NYC

1910-1911

-epidemics of typhoid fever

between 1908&1934

-25% of county health departments

-full-time health officer

social security act (1935)

1960's

-prevention and medical care became more coordinated

-maternal and infant care program 1965

-more focus on underserved

national health objectives

-health strategy initiated in 1979

-healthy people

-objectives based on multiple determinants of health

-prevention strategies were targeted accordingly

-by 1987 half the objectives were met

-blood pressure

-immunization

-infectious disease

-unintentional injury

-behavioral

Healthy People

the Surgeon Generals report on health promotion and disease prevention

healthy people 2000

-319 objectives

-22 priority areas

-testimony from 750 people

-3 broad goals

1) increase healthy lifespan

2) reduce disparities

3) achieve access to preventive services for all

healthy people 2010

-467 objectives

-added area of infrastructure

1)skilled workforce

2)resources

3)research

4)public health organization

-10 leading health indicators

-Local public health indicators must be identified and prioritized

1)community assessments

2) public health program planning

3) internal assessments

4)APEX-PH, MAPP

-community health assessments required every 3 years by ACA

Institute of Medicine

-public health is disarray

-no clear universal mission

-tension between profession and politics

-tension between medicine and public health

-not many strategies to demonstrate expertise

-to counter attrition of vigilance

-collaboration between all players

-contributions of public health and current challenges

3 core functions of public health

1) assessment (evidence)

2)policy development (application)

3) assurance

Assessment (evidence)

-collect, assemble, and analyze

-make information available

-vital records

-morbidity

-epidemiology

-communicable disease

-lab analysis

-research

policy development (application)

-comprehensive PH policies

-based on scientific knowledge

-health assessments

-standards for local agencies

Assurance

-provide services to achieve goals

-by self or other agencies

-through regulation or direct services

-inspection

-licensing

-health education

-environment

-personal health

Public health in America

-prevents epidemics and the spread of disease

-protects against environmental hazards

-prevents injuries

-promotes and encourages healthy behaviors

-responds to disasters and assists communities in recovery

-assures the quality and accessibility of health services

vision of public health

healthy people in healthy communities

governmental public health

-funded largely by tax dollars

-managed by government officials

-different levels

1)international

2)Federal

3)State

4)local

international public health

-World Health Organization

-UN charter in 1945 established need

-begun in 1948-World Health day (April 7th)

-Attainment by all peoples of the best possible level of health

-organization

-open membership

-Geneva, Switzerland

-director general and 5 assistants

Federal Public Health

-Health and Human Services

-Principal agency for protecting health of all Americans

-12 operating divisions

-60,000 employees

-agencies: OSHA, EPA, Housing and urban development, Education, Labor

State public health

-promote, protect, and maintain health and welfare of citizens

-utilize core functions and 10 essential services

-primary responsibility belong to state

-23 states require senior administrator to be physician

-40 states have state boards of health

- >50% of state departments have district offices

local health public health

-local health department: an administrative and service unit of state or local government

-2,800-3,200 nationally

1) concerned with health

2) employing minimum 1 full time person

3) health of jurisdiction smaller than state

-565 towns in NJ

-600 Boards of education

-89 health departments

NJ health departments

-municipal

-regional health commission

-county

municipal health departments

-individual municipality or shared services

regional health commission

-two or more towns

-provides services to all member municipalities

county health departments

-countywide agency

-39 states have countywide system

Local Health-NJ

-NJ public health is regionalized

-majority departments serve

Boards of Health

-every municipality must have a board of health

-instrumental in delivery of public health

-Staffed with

1) health officer

2)Registered Environmental Health Specialist

3)health educator

4)public health nurse

5)others

-oversee day-to-day operations

-help develop policies

-meet regularly

-often medical professionals

Autonomous Board

-generally private citizens

-legal authority to set policy

-recommendation of health officer

-supervises health department

advisory board

-no legal powers of policy

-advises elected officials

-can develop but not write or form policies

NJ public health laws

1) State legislature passes statutes outlining policy

2) Appropriate agency promulgates codes and regulations

-explain how policy is to be implemented

-public health council

NJ minimum standards of performance

-every citizen has the right to minimum level of public health protection

-an important public health law but it has changed

-moving towards national model

-practice standards

-5 core areas

5 core areas of minimum standards of performance

1)administration

2)environmental health

3)communicable disease

4)maternal and child health

5)chronic illness

administration

services

employee supervision

health promotion

public health nursing

plan implement

budget

environmental health

retail foods

recreational bathing

youth camps, campgrounds

occupational health

day care

maternal and child health

childhood lead poisoning

infants and preschool children

chronic illness

adult health

cancer services

diabetes services

cardiovascular services

communicable disease

acute

immunizations

rabies and zoonosis control

TB and STD's

Practice standards of performance:benefits

-improved health

-emergencies

-data collection

-target areas of need

-recognize partners and resources

-infrastructure

-modernize system

practice standards of performance:challenges

-paradigm shift

-categorial vs. integrated

-system approach

-developing capacities

-evolving

-staffing and resources

Health Officer

-executive director of Health Department

-link between Board of Health and State

-oversees activities of health department

-masters degree in health sciences

-two years of administrative experience

-NJ health officers license

Registered Environmental Health Specialist

-day-to-day environmental control activities

1. retail foods

2. recreational bathing

3. childhood lead poisoning

4. day care centers

5. septic systems and development

6. well water protection

7. day camps, campsites, mobile home parks

8. pest control, nuisances, etc.

-Baccalaureate with minimum 32 credits math and science

-7 week training program through Cook College or acceptable coursework

-5 week internship

-NJ REHS license

Health Educator

-identifies community health needs

-develops programs for public

-attends screenings as needed

-vital liaison

-valuable resource for all activities

-masters degree including specific course work or baccalaureate degree including specific coursework plus 3 years of experience or baccalaureate degree and guidance from a qualified masters-trained health educator

public health nurse

-coordinates all clinical programs

-immunizations

-education for primary prevention

-screenings for secondary prevention

-clinics for tertiary prevention

-director must be RN with masters degree and specific coursework

-supervisor must be RN with baccalaureate degree and specific nursing/public health coursework

epidemiologist

-can be specialty for graduate degree

-can also be specialization added to another degree

-one infectious and vector borne disease

-now specializing in other areas

physician

-contracted or staff

-some are board-certified

-move away from physician leadership

Food safety statistics

-about 50 million people get sick from food borne illnesses

-375,000 hospitalizations

-costs billions per year

-2751 outbreaks, >50% underreported

-in 41% where cause was determined

-#1 cause of death and illness is salmonella

reasons for concern

-emerging and reemerging pathogens

-chronic conditions

-microbial adaptation

-human behavior

-international travel

-globalization of food supply

-changes in technology

-human demographics

-breakdown in surveillance

Types of food contamination

1) physical

2)chemical

3)biological

physical contamination

tacks, push pins, glass, metal filings, wood

chemical contamination

pesticides, toxic cleaners, poisonous metals, additives

biological contamination

viruses, fungi, parasites, rodents, insects, plants, fish

rodents

1)house mouse: smallest of all rodents

2)Norway rat: blunt snout, tail shorter than body

3)roof rat: tail longer than body, thin body

insects

flies, cockroaches, indian meal moth, flour beetle, ants

Bacteria

-salmonella

-staph

-Botulism

-E. coli

Bacterial Requirements

Food

Acidity

Time

Temperature

Oxygen

Moisture

Food

bacteria need a high protein, moist food

Acidity

4.5 pH level for bacteria growth

-mayo is not friendly to bacteria

-egg whites are friendly to bacteria

Moisture

-water activity of Aw of .85 or higher

Oxygen

Aerobic:require oxygen

Anaerobic: don't require oxygen

Facultative: either way

Temperature

DANGER ZONE: 41 degrees-135 degrees

-up within 2 hours

-down within 4 hours

Time

bring PHF's rapidly through danger zone

-cant be displayed or held>41 degrees for more than 4 hours

-cannot exceed 55 degrees at any time

-bacteria doubles every 30 mins

Salmonella

symptoms: abdominal pain, headache, nausea, diarrhea, fever

incubation period: 6-72 hours, 12-36 hours

-infection

-needs oxygen

-not a spore former

foods implicated: meat, poultry, eggs, dairy, fish, melons

control: proper cooking, cooling and reheating

-cook above 165 degrees

staphylococcus

symptoms: severe nausea, vomiting, cramps

incubation period: 1-6 hours

-intoxication: heat stable toxin

oxygen: facultative

-not a spore former

foods implicated: various salads, eggs, meat, poultry

control: hand washing, hygeine

Botulism

symptoms: blurred vision, vomiting, paralysis

incubation period: 12-36 hours

-intoxication

-does not need oxygen

-forms spores

-foods implicated: home canned foods, sausage, baked potatoes, garlic in oil

control: proper cooking and cooling, discard cans, kill toxin by boiling

E. coli

symptoms: bloody diarrhea, cramps

incubation period:2-8 days

-infection

oxygen: Facultative

-does not form spores

foods implicated: ground beef, raw milk, water

control: cook above 155 degrees, pasteurize milk, hand washing

-73,000 cases annually in U.S.

-2002 outbreak

-19 million pounds of beef recalled

temperature

-heating

-display

-cooling

-reheating

manual sanitation

1. wash: with detergent in 110 degree water

2. rinse: in clean hot water to remove food particles and detergent

3. sanitize: to kill disease-causing organisms

chemical sanitation

machine wash

-180 degrees machine water

-low temperature machine 75 degrees to 120 degrees

Hazard Analysis Critical Control Points (HACCP)

-developed by NASA

-7 steps

1. identify hazards

2. identify critical control points

3. establish critical limits for CCP's

4. monitor CCP's

5. take corrective action when critical limits have been exceeded

6. keep effective records

7. verify the system is working

-keeps going continuously

biological warfare history

-1346 Kaffa: attacking Tatar force catapulted cadavers of plague victims into city

-outbreak of plague led to defeat

-experiment with plant extracts or poisons

-1500: Spanish Conquistadors and smallpox laden clothes (phomite)

-1760: British brought smallpox to India

1754-1767: Fort Pitt, North America-blanket from smallpox provided to hospitals

-WWI: mustard gas

1932-1945 Japan (Unit 731)

-Japanese military physicians infected 10,000 prisoners with biological agents

Tokyo, Japan 1994

Aum Shinrikyo cult

releases sarin gas in subway

also aerosolized botulism toxin and anthrax spores

-5000 exposed

-12 deaths

-used for political gain

Anthrax attacks

-October- November 2001

-anthrax letters in Florid, NY and Washington D.C.

-23 cases

-government employee

why biological weapons

-unmatched destructive potential

-technology for dispersion more sophisticated

-incubation period longer than chemical exposures

-agents produced easily and cheaply

-easier to produce secretively than are either chemical or nuclear weapons

-urbanization provides targets

attractive characteristics

-stealthy

-inexpensive to mass production

-potential for massive casualties

-ability to produce lengthy illnesses requiring prolonged and intensive care

-ability of certain agents to spread via contagion

-presence of an incubation period

-ability to produce non-specific symptoms

-ability to mimiv endemic infectious diseases

methods of dispersion

1. point source dissemination: lethal to one person not many, food borne weapons

2. line source dissemination: aerosolized downwind, sensitive to weather

-good for large targets

Anthrax

-Bacillus anthracis (greek for coal)

-can survive in environment for long periods of time

-developed as bio weapon in later 1900s

-used to be spread through cattle and sheep

3 types:

1. Cutaneous

2.inhalation

3.intestinal

-colorless, odorless, invisible

-very small spores

Cutaneous (dermal) Anthrax

-itchy papule turns into black eschar

Inhalation Anthrax

-mild, non specific, develops into respiratory distress

intestinal Anthrax

- rare, abdominal distress

anthrax epidemiology

Agent: Bacillus Anthracis

Reservoir: Herbivores

transmission: contact, ingestion, or inhalation of infective spores, contaminated hides, wool, hair, bone, meat or other animal products

incubation period: 1-7 days

early symptoms: fever, cough

symptoms: skin ulcers, respiratory, GI

-death usually follows 1-3 days after symptoms

Botulism

-single most poisonous substance known

-major bioweapon threat

-3 epidemiological forms

1. food borne

2. infantile

3. wound

-can be delivered by aerosol and contaminated food or water supplies

Botulism Epidemiology

incubation period: 12-36 hours

symptoms: cranial nerve palsies, blurred vision, dry mouth and throat, paralysis

-progresses to respiratory failure

Plague

-caused by bacteria Yersinia pestis

-source of great pandemics

-among U.S. rodents (prairie dogs)

plague epidemiology

reservoir: rodents or their fleas

transmission: direct contact with infected animals and fleas, cat bite or scratch, airborne form people with pneumonia

Smallpox

Agent: Variola major

1796: vaccine

1967-1977; WHO eradication

Present: biological warfare threat

-exists in 2 places

1.Russia

2. CDC in Atlanta Georgia

-no treatment

-vaccination discontinued in 1980's

-Edward Jenner smallpox vaccination

Smallpox epidemiology

reservoir: humans

transmission: respiratory droplet: face to face

contact: contact, droplet, airborne, no transmission until onset of rash

fomites: inhalation of dusts form clothing, bed linen

incubation period: 7-19 days average 12 days

-spreads slowly

symptoms: malaise, fever, vomiting, headache, rash appears on face, hands and arms

-spreads quickly over body

-high case fatality

Detection of Outbreaks

-presence of unusual disease

-patient presenting with disease that is uncommon

-unusual increase in people seeking care

-large # ill with similar syndrome

-lower rates for those who'd been indoors

-dead animals of multiple species

-rapidly increasing disease incidence

-increase above 'expected levels'

-outbreak in non-endemic area

-presence of unusual disease

-unusual time or in unusual pattern

-clusters arriving from a single locale

-suspicious packages, odors, oils

-low clouds unrelated to weather

effects of housing

-3 million injuries, some disabling

-21,500 fatal accidents

-falls, fire, poisons, firearms

-access to medical care

-good nutrition

-social standards

-sanitation and environment

Areas of most concern

-older buildings and homes

-crowded areas

-lower income households/neighborhoods

crowding

minimum space

height requirements

-minimum 150 sq. unit ft.

-70 ft. high

disease

heating

-68/65 degrees in winter

-75 in summer

-CO, fires

water

supply

120 degrees -160 degrees

contamination

fire safety

-two exits in house

-detectors 1 in each bedroom and 1 on each floor

-codes

indoor air

-ventilation

-light

-CO2, CO, asbestos

-ETS, biologicals

-lead, radon

uses of lead

-batteries

-water pipes

-fixtures

-solder

-pottery

-crystal

-gasoline

-painted toys

-stained glass

-bullets

-mini blinds

-sinkers

symptoms of lead poisoning

no obvious symptoms

sources of lead exposure

friction points:

doors, windows, stairs, walls, toys, cribs

lead standards

-above .5% by weight

-above 1.0mg/cm^2 by XRP analyzer

secondary lead testing

-an at risk child should be tested at 6 months of age

-a child that is not at risk should be tested for the 1st time at age 1 and again at age 2

-simple blood test

-10 ug/dL blood lead level

primary lead prevention

test house