community exam 1

the patient protection and affordable care act of 2010 revised the IRS requirements for tax exempt healthcare facilities. what are these requirements?

must be transparent (share data and results), data is concrete and measurable, be accountable to identified needs; community assessments occur every three years, must have input from PHD, must have input from underserved/low income/minority populations, have written comments from the most recent community health nurse assessment

besides the IRS requirements, what are the other drivers regarding the community health needs assessment?

CDC grant requirements, state specific requirements (Ohio requires PHD to complete a community needs assessment), national voluntary requirements (public health accreditation board requires assessment every 5)

what is included in a community health assessment

demographics, health status, morbidity and mortality, socioeconomic characteristics, quality of life, community resources (food pantries, homeless shelters, parks, DV services), behavioral factors, environment (physical and built environment), social/structural determinants of health 

what are the hallmarks of a community health improvement plan

addresses public health problems, long term (every 3-5 years)

most assessment and planning frameworks include the following actions…

1. organize and plan

2. engage the community

3. develop a goal or vision (something sustainable)

4. conduct community health assessment 

5. prioritize health issues

6. develop community health improvement plan

7. implement and monitor community health improvement plan

8. evaluate process and outcomes

is survey data collected by you primary or secondary

primary

indicators are — data used to compare rates

secondary

what are the indicators that are secondary data used to compare rates in data

physical activity (aerobic activity), tobacco use, responsible sexual behavior (age 15-44), injury and violence, immunization, obesity (BMI 30+), substance abuse (% who use- 12+), mental health (suicide rate per 100 population), environmental quality (air quality, type of water), access to healthcare (% of people with a PCP)

what is a windshield survey

systematic observation of a community, quick assessment, first hand environmental assessment, assess visually social determinants of health, community engagement 

what is the public health approach

surveillance (what is the problem?), risk factor identification (what is the cause?), intervention evaluation (what works?), implementation (how do you do it?)

what are the course sciences of public health 

prevention effectiveness, surveillance, epidemiology, informatics, laboratory 

study of the distribution and determinants of health related states among specified populations and the applications of that study to the control of health problems

epidemiology 

what is purpose of epidemiology in public health practice

discover the agent, host, and environmental factors that affect health, determine the relative importance of causes of illness, disability, and death, identify those segments of the population that have the greatest risk from specific causes of ill health, evaluate the effectiveness of health programs and services in improving population health

what is the scientific approach epidemiologists use to solve health problems

step 1: data collection (surveillance, determine time, place, and person)

step 2: assessment (inference)

step 3: hypothesis testing (determine how and why)

step 4: action (intervention)

all of the following illustrate the purpose of epidemiology in public health, except:

a. identifying populations who are at risk for certain diseases

b. assessing the effectiveness of interventions

c. providing treatment for patients in clinical settings

d. determining the importance of causes of illness

c. 

disease occurrence among a population that is in excess of what is expected in a given time and place

epidemic or outbreak

group of cases in a specific time and place that might be more than expected; very specific to pace (such as suicides in hs)

cluster 

disease or condition present among a population at all times

endemic

a disease or condition that spreads across regions

pandemic

number of cases occurring during a specific period; always dependent on the size of the populating during that period

rate 

malaria is present in Africa at all times because the presence of infected mosquitos. malaria is — in africa

endemic

the ebola virus in parts of Africa is in excess of what is expected for this region. the virus is a/an —-

epidemic 

HIV/AIDS is one of the worst global diseases in history. it is a/an —-

pandemic

in march 1981, an outbreak of measles occurred among employees at Factory X in Fort Worth, Texas. this group of cases in this specific time and place can be described as a —-

cluster 

— help us compare health problems among different populations that include two or more groups who differ by a selected characteristic 

rates

to calculate a rate, we first need to determine the frequency of disease, which includes 

the number of cases of the illness or condition, the size of the population at risk, the period during which we are calculating the tole

if all people in a population were exposed to a disease, how many are going to get it

incidence proportion (attack rate)

if all people in a population were exposed to a disease, how many are going to die among those who get the disease 

case-fatality (death rate)

infant mortality is express in terms of —-

1,000s

all the cases of a specific disease during a period of time

prevalence (morbidity)

new cases or a spike/decline that occurs in a specific disease population

incidence

what are the hallmarks of an experimental epidemiology study

investigators can control the study from the very beginning (ex. vaccine efficacy study)

what are the hallmarks of an observational epidemiology study

cannot control the circumstances. descriptive is collecting information that summarizes the problem (when, where, who), analytic relies on comparisons between different groups (how, why?)

type of study designs where subjects are selected because they are members of a certain population subset at a certain time

cross sectional study

study design where subjects are categorized on the basis of their exposure to one or more risk factors 

cohort study

study design where subjects are  identified as having a disease or condition are compared with subjects without the same disease or condition

case control study

what type of study design is this: subjects with diabetes are compared with subjects without diabetes

case-control

what type of study design is this: a study of women aged 50-60 years in a community located close to a nuclear power facility 

cross sectional

what type of study is this: subjects who have received nutritional counseling and have exercised twice a week compared with subjects who have not

cohort 

what is the timeline of disease (natural history of disease)

stage of susceptibility, exposure, stage of subclinical disease, pathologic changes, stages of clinical disease, onset of symptoms (usual time of diagnosis), stage of recover, disability, or death 

what is the chain of infection 

mode of transmission, agent, portal of entry, host, reservoir, portal of exit

the model that identifies that there are many different causes of non communicable diseases 

web of causation 

what steps are involved in disease investigations

signal detection/surveillance, verifying the diagnosis, establish a case definition, conduct descriptive epidemiology, develop hypothesis, test hypothesis, use lab/biomedical evidence to support biological plausibility, assess causality, implement control/preventative policy measures, communicate findings

considers the social context in which health issues arise such as housing social policies. investigates how social conditions at various life stages impact health, explores the effects of stress and discrimination on well-being, integrates economic/sociologic/demographic factors with biological influences for a comprehensive health picture 

social epidemiology

made multiple contributions to public health as a scientist with epidemiology studies on how sanitation impacted health

florence nightingale

first national organization of public health nursing president and investigates immigrant Tennant building conditions in the Henry Street Settlement

Lillian Wald

frontier nursing service, first home health midwife in Appalachia who brought down infant and mother mortality 

Mary Breckinridge 

founded planned parenthood with the intentions of eugenics and spoke with the KKK

Margaret Sanger 

founded the Connecticut hospice program which aimed to demedicalize death and dying 

Florence wald 

ksu grads who founded rehab and SNF centers which revolutionized the business in West Virginia 

John and fonda Elliot 

a synthesis of general nursing practice and public health principles with a purpose of promoting and preserving the health of the population 

community health nursing

what are the hallmarks of population health

comprehensive (from public health prevention to disease management), diverse activities (health care research, population level data analysis/epidemiology, care coordination, health programming/spreading information), interdisciplinary 

what is the gold standard of research

randomized control trial

what are the components of population health

outcomes (assessment and evaluations), disparities (health inequities- these are preventable), determinants (factors that influence outcomes), risk factors (smoking, birth control pills)

what are the leading causes of death

heart disease, cancer, unintentional injury

what are years of life lost and what contributes to it

time of death compared to expected lifespan; unintentional injury

what promotes and protects the health of all people and their communities

public health 

speciality that focuses on improving the health of communities and populations through health promotion, disease prevention, risk reduction, community education, outbreak and epidemic management, and other initiatives 

public/community health nursing

what is at the center of the 10 essential public health services and what are the 3 categories that encompass it

equity; assessment, policy development, assurance

what are the levels of prevention in public health

primordial (makes healthy behavior a default pathway- policy change, ex. build parks), primary (affects at risk populations or environments by preventing problems, ex. vaccines), secondary (affects individuals by detecting conditions or needs, ex. early disease detection), tertiary (affects individuals by preventing or lessening negative impact, ex. pandemic response/quarantine)

what does community health nursing look like in practice

health promotion and education, social prescribing (referring pt to anything you don’t need an MD order for), community assessments, health advocacy (helping pt understand their disorder/connecting with care, helping receive a 2nd opinion), disease and disaster response

describe downstream, midstream, and upstream

downstream- individual impact: interventions that focus on the behavior of individual people to modify the risk of disease, prevent illness, or manage chronic conditions

midstream- organizational impact: approaches that happen within specific organizations to improve health outcomes

upstream- population impact: policies that change regulations, increase access, or provide economic incentives to impact health across a population 

higher education is associated with..

less hazardous work

what is the end of your 4th grade year reading level indicative of

if they will graduate HS

what is one of the most importance modifiable social determinants of health 

literacy 

listening and speaking skills, reading and writing skills, and cultural conceptual knowledge; comprehension!

literacy 

what is the main driver of economic stability

employment (long term and gainful)

in terms of housing stability, what is cost burdened

spending more than 30% of income on housing

in terms of housing stability, what indicates a severe cost burden

spending more than 50% of income on housing

what are upstream, midstream, and downstream examples of decreasing tobacco usage 

upstream: age restriction, cancer warnings, taxes 

midstream: expanding medicaid and insurance coverage for nicotine replacement therapy and counseling

downstream: ad campaigns

what is a midstream example of decreasing deaths from drunk driving

random DUI checks

what is an upstream example of increasing intake of fresh fruits and vegetables in adolescents 

offering at school lunches, WIC 

what is a midstream example of reducing the incidence of noise related hearing loss 

earplugs 

what is an upstream and midstream example if increasing the proportion of high school students who get enough sleep

upstream: start school later 

midstream: hourly work restrictions for underage workers, city imposed curfews