PART 1

Assurance

Interventions or treatments that are applied by health professionals to address health concerns or problems that exist in the community or local environment.
-Departmental programs
-Health interventions
-Program evaluations
-Quality assurance

Capacity

Refers to resources or relationships that are necessary to accomplish the core functions of public health.

Morbidity Rate

Number of individuals who develop a disease in a given time period is the numerator, and the number of people in the population at risk for the disease is the denominator
-Incidence Rates
-Prevalence Rates

Incidence Rate

The direct estimate of a probability or risk of developing a disease during a specified period of time.
-The IR is the rate of new disease cases during a particular period of time.

Health

Not merely the absence of disease but a state of complete physical, mental, and social well-being (WHO)

Illness

Not merely referring to the physical presence or diagnosis of a disease state. Illness may exist without a physical manifestation of disease.

Disease

Physical or mental disease state. Manifestation of some type of physiological injury or state.

Precursor Prevention

-Factors and interventions that may prevent disease
-considers societal, cultural, & systematic factors that can prevent onset of disease states
-Occurs before a person is even at risk for a disease

Primary Prevention

-Deals with prevention of disease or infirmity when people are at-risk of the disease.
-Interventions are specifically targeted toward a disease state.
-Individuals my be at-risk for disease state.

Secondary Prevention

Individual already has a disease state
-seeks to alleviate or lessen symptoms
-seeks to stop progression

Tertiary Prevention

Individual has been cured of disease
-prevention of recurrence

Clinical Prevention

Programs or interventions that target individuals. A program can target individuals, as well as target communities and the individuals in those communities

Community prevention

Programs or interventions that are targeted toward the entire community. The targeted unit is the entire community not the individual.

Population-based prevention

Public-sector services that target the entire population beyond the community-level
-State health insurance programs like SCHIP

Health promotion

Activities or interventions targeting health behaviors that can improve or influence positive health outcomes
-Local community clinic offers blood pressure screenings and provides weekly cooking classes

medical practice

Any services or activities provided by and monitored by medical personnel such as a physician or nurse.

long-term care

Care dealing with population with special needs. Care can be provided in professional health facilities or implemented in the home setting.

Incidence rate

The direct estimate of a probability or risk of developing a disease during a specified period of time
-The rate of new disease cases during a particular period of time.

Prevalence rate

The number of cases present at a particular period of time
-The total number of cases that do exist at a particular period of time.

Morbidity Rates & Populations

Number of individuals who develop a disease in a given time period is the numerator, and the number of people in the population at risk for the disease is the denominator

LPHAs

Local public health agencies
-Lead to the development of self-assessment tool, appraisal form

Appraisal form

-Birth and death records
-Vaccinations & immu records
-Health-problems in school aged children
-Laboratory tests

Thimerosal

-no evidence to suggest it causes health problems in children or adults

Epidemiology

scientific analysis of disease etiology, patterns of infection, and disease prediction among the general population.
-investigation seek to determine what is causing the disease, how the disease is spreading, and who is at risk of the disease.

H1n1

swine flu

SARS

Severe acute respiratory syndrome
-high fever, chills, general discomfort, body aches
-10-20% required mechanical ventillation
-unknown corona virus

West Nile

-single-stranded RNA virus
-transmitted from birds by mosquitoes

Avian Influenza A

bird flu (H5N1)
-no vaccine available

Natural disasters

-Earthquakes, fires, wildfires

Mitigation

measures employed before an incident occurs to minimize damage

Preparedness

activities conducted before disaster to improve readiness

Response

actions dealing with consequences during the disaster

Recovery

procedures that help restore business operations to normal

Bio-terrorism emergencies

the intentional use of microorganisms or toxins to produce death or disease in humans, animals or plants

Guarded

blue

Elevated

yellow

High

orange

Severe

red

Imminent threat

warns of credible, SPECIFIC & IMPENDING terrorist threat against the US

Elevated threat

warns of credible terrorist threat against the US

compounds in tobacco

Carbon monoxide
Hydrogen cyanide
ammonia
benzene
Formaldehyde
Nicotine
Nitrosamines
Lead
Cadmium
Polonium-210

Anthrax (Bacillus anthracis)

- Bacteria
- 1-7 day incubation
- Aerosol, ingestion, or cutaneous contact spreads B. anthracis
- No person to person transmission

Anthrax symptoms (inhalation)

Flu-like symptoms
Nausea
Chest pain (only different sx from GI)
Vomiting
Abdominal pain
Fever
Respiratory distress

Anthrax symptoms (cutaneous)

Initially itching papule, progresses to:
1-3 cm ulcer
Necrotic center
Fever

Anthrax symptoms (GI)

N/V
Loss of appetite
fever
Abdominal pain
Severe diarrhea (only sx differentiating it between GI and inhalation)

Anthrax treatment

Mechanical ventilation
Cipro 500mg BID x60d OR
Doxycycline 100 mg BID x60d

Mortality:
- Inhalation: 75% with tx
- GI: 25-60% with tx
- Cutaneous: 20% w/o,

Botulism

Biological toxin
Incubation is 12-72 hours
Transmitted via aerosol inhalation and ingestion
No person to person transmission

Botulism symptoms

Paralysis
Difficulty swallowing/speaking
Systemic weakness
Respiratory dysfunction
(No fever or sensory dysfunction)
Paralysis may last for weeks
Mortality: 5-10% of cases

Plague (Yersinia pestis)

Bacterial infection
Incubation 2-6 days
Transmitted by flea bites and break in victim's skin
Does not transmit person to person (pneumonic may)
Occurs as bubonic, septicemic, and pneumonic

Plague (Yersinia pestis) Bubonic Symptoms

Swollen lymph glands (called buboes)
HA
Fever/chills
Weakness

Plague (Yersinia pestis) Bubonic Treatment

Duration is 10-14 days
Treatment is antibiotics (streptomycin/gentamicin)
Mortality:
60% if untreated
15% if treated

Plague (Yersinia pestis) Pneumonic

Incubation is 2-6 days
Transmission is airborne (can be person to person, may progress from bubonic/septicemic)

Plague (Yersinia pestis) Pneumonic Treatment

Early antibiotics are essential (within 18 hours), streptomycin and gentamicin preferred
Mortality:
50-90% if untreated
15% with tx

Plague (Yersinia pestis) Septicemic

Incubation 2-6 days
Transmitted by bite/cut
Can occur as complication of bubonic or pneumonic
No person/person transmission

Smallpox

Viral infection
Incubation is 12-14 days
Person/person, airborne, clothing, and fomite transmission
Eradicated (last case in 1977 in Somalia)

Smallpox symptoms

Fever
Myalgia
Pruritis
Uniform rash on face, hands, feet, and extremities
Delirium
Abdominal pain

Smallpox treatment

Duration is ~24 days
No specific tx, preventable by vaccination
Mortality rate is 30%
Vaccine no longer available to general public

Tularemia

Bacterial infection
Incubation 3-5 days
Transmitted via inhalation, ingestion, contact with skin
No person/person transmission

Tularemia Symptoms

Fever, cough, chest tightness, cutaneous lesions
Rarely pleuritic pain and hemoptysis

Tularemia Treatment

Duration ~18 days
Treatment with antibiotics (streptomycin or gentamicin)
Mortality:
33% untreated
4% with tx

Hemorrhagic Fevers

Viral infections
Ebola, arenavirus, filovirus
Incubation 2-21 days
Transmitted person/person, indirect contact, airborne in some cases

Hemorrhagic Fevers Treatment

None outside of supportive care (some may respond to ribavirin)
Mortality:
5-90%, depending on virus

Nonpharmacologic therapies for smoking cessation

Cold turkey
Unassisted tapering
Assisted tapering: quit key

Pharmacologic treatments

NRT
Sustained-release bupropion
Chantix

NRT

Nicotine replacement therapy

Buproprion

psychotropic

Chantix

psychotropic

5 A's

ASK
ADVISE
ASSESS
ASSIST
ARRANGE

Ask

ask about tobacco use

Advise

advise tobacco users to quit

Assess

Assess readiness to make a quit attempt

Assist

assist with the quit attempt

Arrange

arrange follow-up care

Assess Readiness to quit

Stage 1: Not ready to quit in the next month
Stage 2: Ready to quit in the next month
Stage 3: Recent quitter

Readiness Stage 1

Not ready to quit in the next month

Readiness Stage 2

Ready to quit in the next month

Readiness Stage 3

Recent quitter

Readiness Stage 4

Former tobacco user \>6m

Methods for increasing motivation

The 5 R's
1. Relevance
2. Risk
3. Rewards
4. Roadblocks
5. Repetition

Nicotine Gum: dosing

\>25 cig/day \= 4mg

Nicotine Lozenge

*dosage based on time to first cig*
-first cig w/in 30 mins of waking: 4mg
-first cig more then 30 mins after waking: 2mg
weeks 1-6: 1 q1-2h
weeks 7-9: 1 q2-4h
weeks 10-12: 1 q 4-8h
no more the *20*/day

Transdermal Nicotine Patch

Nicotine Nasal Spray

-Start w/ 1-2doses/hr (1 dose \= 2 0.5mg sprays)
-Do not use more than 80sprays (40mg)/day
-use 8 doses daily for 6-8 weeks

Nicotine Inhaler

-start w/ 6 cart/day
-may increase to 12 cart day
-use for 3-12 weeks

Bupropion SR (Zyban)

Initial treatment: 150mg qAM x 3d
then... 150mg bid x 7-12 w
*begin tx one week prior to starting treatment*

Clonidine

2nd line Tx

Nortriptyline

2nd line Tx

Chantix dosing

Days 1-3: 0.5 mg qd
days 4-7: 0.5 mg bid
day 8-EOT: 1 mg bid
*pts should be treated for 12 weeks*

A suspension of liquid particles in the air; many infectious diseases of the respiratory system are transmitted when an infected person coughs or sneezes

Aerosol

Aspects of human health, diseases, and injury determined by factors in the environment, study of direct effects of chemicals, physical, social, and biological agents

Environmental Health

Instruction that promotes healthy behaviors by informing and educating individuals through the use of materials and structured activities

Health Education

Responsible for prevention and cleanup of water and air pollution, control of toxic substances, and environmental contaminants

EPA

Disease with recurrent exacerbation of airway constriction, mucous secretion, causing symptoms of wheezing, cough, chest tightness, and dyspnea

Asthma

A state of physical, mental, and social well-being and not merely the absence of disease and infirmity

Health

Planned combination of educational, physical, regulatory, and organizational support for actions and conditions of living conducive to good health

Health Promotion

Limit of population size that the environment can support without being degraded

Carrying capacity

Group of chemicals that are common environmental pllutants

PCBs-Polychlorinated Biphenyls

Top 2 \___________ of Death:
1. Heart Disease
2. Cancer

Leading Causes

Top 2 \___________ of Death:
1. Tobacco
2. Poor Diet & Physical Inactivity

Actual Causes

Account for half of all deaths, are preventable, are targets for intervention, and caused by behavior

Actual Causes of Death (not Leading causes)