HSC 170 Set 2

9/22/22

developing countries leading causes of death is:
- \
1. neonatal disease, 2. lower respiratory disease
- many communicable diseases
of top 10, top 5 are due to infectious disease (WHO)
infectious disease agents:
- bateria
- think staph infection, whooping cough
- unicellular
- minority of bacterial species are pathogens and cause disease
  - bacteria in the body is normal & healthy
- evolve quickly compared to larger organisms, but slow compared to viruses
- viruses
- think like influenza, COVID, etc.
- replicate inside living cell, not alive*
- carry DNA/RNA
- block immune responses
- protozoa
- fungi
- think athletes foot, and fungal pneumonia
- multicellular
- prions
- macroparasites
- nematodes (roundworms), from the environment; trematodes (flukes), from environment; ectoparasites (ticks, mites, etc.)
- helminths
- think hookworm
- can live inside the body
- common in developing countries

Infectious diseases throughout history

smallpox, malaria, polio, described in texts from ancient times
14th century - Black Plague up to 20mil. dead
20th century 1918 influenza may have killed up to 50mil

Transmission of infectious diseases

can be transmitted (modes)
- air, contaminated food/water, bodily fluids, direct contact with contaminants, etc.
consider things that can be done to prevent transmission
not sure if shows up later?**
- ==incubation period== = time between contact with disease and when you begin having symptoms (varies person to person)
- @@infectious period@@ = can pass along to someone else
- symptoms may not always match up with when you are infectious
- $age distribution$ = what ages are more likely to get/die from disease
modes of transmission
- %%direct transmission%% = person to person spread
- STI, skin contact, etc
- ^^indirect transmission^^ = through intermediary source
- vehicles = anything that provides environment in which agent can multiply or produce toxins
  - water, air, food, blood
- ==fomites = inanimate objects able to harbor and transmit disease agents==
  - clothing, sheets, utensils, keyboards, etc
- vectors = living organisms like insects or animals that do not cause disease
  - ticks, mosquitoes, etc.
portals/routes of entry = sites where infectious agent may enter body
- respiratory passage, mucous membranes, skin, blood, ingestion
portals/routes of exit = sites where infectious agents mat leave the body
- same as routes of entry, conjunctival exudate
- @@portals of entry & exit must be appropriate to the infectious agent@@

Reducing the spread of infectious diseases

vaccines, antimicrobial drugs, personal hygiene & sanitation, protect against mosquitoes, disinfectants, UV radiation

Quantification of disease outbreaks

infectivity
- propensity for transmission
- measured by $secondary attack rate$ in a household, school, etc
pathogenicity
- propensity for agent to cause disease or clinical symptoms
- measured by the %%apparent: inapparent infection ratio%%
virulence
- propensity for agent to cause severe disease
- measured by ^^case fatality ratio^^

9/27

measures of infectious disease outbreaks

\
- attack rate (A.R.)

new cases of disease/ unit population/ unit time

A.R. is used when occurrence of disease increases in population
secondary attack rate
- yields the index of the spread of a disease within a household or similar circumsized unit
- measures infectivity of the agent and effects of prophylactic agents
case fatality rate
- refers to the proportion of the number of deaths from a certain disease among those that have the disease, during an interval time
- provides index of leathality
- C.F.R. = # of deaths/ # of cases x 100%
- diseases with high rates are rabies, untreated bubonic plague, and untreated cholera
Chain of infection
- infectious agent - reservoir - portals of exit - means of transmission - portal of entry - susceptible host - back to beginning

if R0 < 1 then the disease will disappear
R0 = 1 then disease becomes endemic
R0 > 1 then an epidemic will occur in susceptible population
R0 is the product of three important parameters of infectious disease:
- B transmission probability per contact
- K number of contacts per unit time
- D duration of infectivity (measured in same unit as K)

epidemic curve

graphic representation of the time course of epidemic
types of outbreaks
- point source outbreak
- stop transmission and cases go down
  - whole family gets the flu, everyone then gets better
  - one curve
- continuous source outbreak
- up averages out
- person - to - person (propagated)
- many curves
==endemic== - disease that exhibits a relatively steady frequency over a long period of time in a particular geographic locale
@@sporadic@@ - when occasional cases are reported at irregular intervals
$epidemic$ - when prevalence of disease is increasing beyond what os expected
%%pandemic%% - epidemic across continents

Pathogen evolution

micro parasites have short evolution time and evolve rapidly
- 3 classes of evolution
- drug resistance
- immune escape
- adaptation to new hosts

^^Neglected diseases^^

Disease types that are common in other areas, but do not get. much research in the United States
protozoan infections
helminths infections
bacterial infections

community interventions

delay disease transmission
decompress peak burden on healthcare infrastructure
diminish overall cases and health impacts

9/29

Health care (ahahahaha)

traditionally health is view as the absence of disease.
in healthcare admin. principal concern is the healthcare systems; that is, systems composed of human beings, money (insurance), materials, equipments, and so on which are related in the accomplishment of some goal or goals
components of healthcare system
- consist of number of subsystems
- each has a purpose which if attained, aids the larger system I reaching its overall goal
elements of healthcare systems
- inputs (HR, material, tech, info)
- outputs (pt care, costs, training, etc.)
- process
- feedback
- outcome (improvement in infant mortality rate, life expectancy at birth)
Health care workers
- edu. & licensure
- Am. college of hospital administration 1933
- 51 program in 1983
- grad & undergrad
- personnel
- physicals & medical school numbers
- non-physicians, caregivers (dentist, nurses, technicians, etc)
- ==licensure==: process performed by government that allows someone to engage in an occupation after finding that applicant has achieved a certain minimum competency
- @@registration@@: qualified individuals are listed on an official roster maintained by a government or nongovernmental body (RN)
- $certification$ : nongovernmental agency or association grants recognition to someone who meets its qualifications
- nurses-midwives are certified
HSO environment
- to protect the health, safety, and public order and welfare
classifications of health care agencies
- class by ownership
- government
- nongovernmental
  - for profit & not for profit
- class by type of services
- general vs specialty
- community vs tertiary
- sub-acute care
- in-home care
- ambulatory care
- class by length of stay
- short stay (less than 24h)
- traditional acute care (greater than 24 less than 30 day)
- long term care (months to years)

10/4

Food Safety

food production chain
- land, production, distribution, consumption
History
- ==1906== Food and drug act and meat inspection act passed by congress
- the jungle by Upton Sinclair published
- 1938 federal food, drug, and cosmetic act
- required new drugs to be safe before marketing
- 1949 FDA publishes first guidance to industry
- @@1958@@ Delaney clause
- banned any food ingredient known to cause cancer no matter what the concntration
- 1959 Cranberry scare
- pointed out the weakness of the Delaney clause zero tolerance policy
- change in Delaney clause created
- 1990’s Delaney replaced with “negligible risk”
- risk reduced to manageable level
Modern food safety system
- 12 different agencies enforce 35 difference statutes
- fda, usda, cdc, homeland, deep of transportation, FTC
- USDA is meat, poultry, and eggs
Hazard analysis and critical control points $HACCP$
- management system where food safety is addressed through analysis and control of bio, chem, & physical hazards

10/6

substance abuse and addiction

addiction: chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences
- tolerance, withdrawal
- characteristics of addition
- loss of control
- preoccupation
- consequences of addiction
- physical health
  - organs, effect on others
- mental heath
- family
- work
- society
  - public health, crime, productivity
- general health impacts
- diseases, cancer, stroke, hep b&c, obesity, mental disorders
- health impacts of illicit drug use
- infections: HIV hepatitis
- Hep C: cirrhosis cancer
- peripheral vascular disease
- nasal septum perf
what social problems does drug addiction cause
- domestic violence, public violence, second hand smoke,
%%40% of all drug poisoning deaths wire due to opiod analgesics%%
- #1 cause
looking back - opiated
- 3400 BC opium poppy
- 460 BC Hippocrates dismisses magical attributes of opium, acknowledges usefulness
medicinal uses of opioids
- Dr. wood discovers technique of injecting morphine in 1843
- 3x more potent and instantaneous
- 1895 Heinrich Dreser dilutes morphine with acetyls produces drug w/o common morphine side effects (bayer aspirin company)
- 1898 production of drug is introduced diacetylmorphine
- 1902 side effects of using heroine as a step down from morphine
ways to control drug addiction
- thoughts: rehab, laws, regulations, taxes
- controlling addiction
- prohibition, DEA, DOJ, education, etc.
risk factors for addiction
- biology/genes, environment, brain mechanisms
^^syndemics^^: two or more afflictions interacting synergistically, contributing to excess burden of disease in a population
- related concepts include: linked epidemics, interacting epidemics, connected epidemics, co-occurring epidemics or morbidities, and clusters of health related crises
- substance abuse
- think about risk factors, domain, and protective factors

10/11

consumer product safety

consumer product safety commission
- exists to protect public from unreasonable risks of serious injury of death from more than 15k types of consumer products under the agency’s jurisdiction
- regulation
- public information
- compliance
- research
- import safety
consumer protection
- pressure to promote consumer interests
- how gov. protects consumers
- consumer privacy in the internet age
- product liability: special problem
- positive business responses to consumerism
- consumerism’s achievements
consumer product safety improvement act (CPSIA)
- 2008:
- 3rd party testing of children products
- certificate of conformance required for all consumer products
- requires different labels for choking hazard
goals of consumer laws
- provide consumers with better info when making purchases
- protect consumers against possible hazards from products that may purchase
- promote competitive pricing and consumer choice
- protect privacy
certification
- means that a product complies with certain requirement set by the govenment
- identify the product, manufacturer, or private labeler issuing the certificate and any third part on whose testing the certificate depends, by name address and phone number
- does not have to be given to consumer, but has to be distributed to retailer and must accompany each product or shipment of products covered by the same certificate
- all manufacturers must comply
- no requirement to file a certificate with CBP or any government agency as part of the entry process or otherwise
3 theories of liability
- ==warranty==
- implied or explicit claims by manufacturer or seller
- @@negligence@@
- conduct that a manufacturer did or failed to do that led to the failure
- $strict liability$
- manufacturers responsible for injuries resulting from use of their products, whether or not they were negligent or breached a warranty
- %%exceptions%%: misuse, failure to follow instructions, statute of limitations
^^caveat emptor^^
- let the buyer beware
- manufacturers were not subject to suits due to defective products “privity of contract“
- ended in the U.S. in 1916 with MacPherson vs. Buick
refrigerator safety act
- kids go in and door locks closed
- adjustment made so you can open fridge from inside if closed
top 5 hazards
- magnets
- recalled items
- tip over (tv heavy items)
- etc
\