FINAL

Question 1

Discriminate populations at risk for development of chronic health conditions while associating the role of the Advanced Practice Nurse in levels of promotion.

Answer 1

Common risk factors: unhealthy diet, physical inactivity, and tobacco use

Childhood risk: There is now extensive evidence from many countries that conditions before birth and in early childhood influence health in adult life. For example, low birth weight is now known to be associated with increased rates of high blood pressure, heart disease, stroke and diabetes.

Risk accumulation: Ageing is an important marker of the accumulation of modifiable risks for chronic disease: the impact of risk factors increases over the life course.

Underlying determinants: The underlying determinants of chronic diseases are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, population ageing, and the general policy environment.

Poverty: Chronic diseases and poverty are interconnected in a vicious circle. At the same time, poverty and worsening of already existing poverty are caused by chronic diseases. The poor are more vulnerable for several reasons, including greater exposure to risks and decreased access to health services. Psychosocial stress also plays a role.

Question 2

Childhood risk

Answer 2

There is now extensive evidence from many countries that conditions before birth and in early childhood influence health in adult life. For example, low birth weight is now known to be associated with increased rates of high blood pressure, heart disease, stroke and diabetes.

Question 3

Risk accumulation

Answer 3

Ageing is an important marker of the accumulation of modifiable risks for chronic disease: the impact of risk factors increases over the life course

Question 4

Underlying determinants

Answer 4

The underlying determinants of chronic diseases are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, population ageing, and the general policy environment

Question 5

Poverty

Answer 5

Chronic diseases and poverty are interconnected in a vicious circle. At the same time, poverty and worsening of already existing poverty are caused by chronic diseases. The poor are more vulnerable for several reasons, including greater exposure to risks and decreased access to health services. Psychosocial stress also plays a role.

Question 6

social determinants that are related to health inequalities

Answer 6

poverty, educational level, racism, income, and poor housing

Question 7

National Partnership for Action (NPA) to End Health Disparities ( minorityhealth.hhs.gov/npa)

Answer 7

Started by the Office of Minority Health
to mobilize individuals and groups to work to improve quality and eliminate health disparities. The National Priorities includes key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end-of-life care, care coordination, patient safety, and population health.

Question 8

The Quality Alliance Steering Committee

Answer 8

Partnership of healthcare leaders who work to improve healthcare quality and costs. Various strategies to bridge the gaps in healthcare quality are available at the national level and may be applied or considered at the state, regional, or local level in collaboration with stakeholders as a means of decreasing health disparities.

Question 9

interventions to eliminate or reduce health disparities

Answer 9

• Advocating better health insurance coverage
  for poor and immigrant populations
• ensuring that sufficient services exist in
  underserved areas
• assessing the interaction among social environments, genetics,
  and population health
• encouraging minority participation in research studies with community-based participatory research and specifically with practice-based research networks
• using linguistically and culturally appropriate communication and written handouts
• promoting and facilitating community partnerships
• implementing strategies to encourage people from minority populations to become healthcare professionals

Question 10

Marginalization

Answer 10

major cause of vulnerability, which refers to exposure to a range of possible harms, and being unable to deal with them adequately.
• Variables: social class, race, homelessness, substance abuse, prison/offending, mental health problems, HIV positive
• Women are more likely to be marginalized than men, because of their gender. This is evident through the social, economic, and power imbalances that exist between men and women. For example, more women than men live in poverty, and men continue to have more secure, full-time jobs and higher income than their female counterparts.
• A woman can also be marginalized because on her HIV status, or HIV risk. She may experience even more stigma if she is also a part of other marginalized groups in relation to her race or sexual orientation. For example, a woman is gay and an immigrant may also experience homophobia and racism

Question 11

Populations at risk for marginalization

Answer 11

those without shelter in rural or urban areas, those living in remote parts of the country, families of lower socioeconomic status, disabled persons, recent immigrants and refugees, Indigenous populations, and seniors. Adequately identifying and gaining access to vulnerable communities are essential steps for the health system in order to recognize and address their unique health needs.

Question 12

Four dimensions that capture the principal determinants of health marginalization

Answer 12

residential instability
material deprivation
ethnic concentration
dependency

Question 13

confounding variables that result in subpar health communication

Answer 13

Low health literacy
cultural barriers
and low English proficiency

Question 14

basic organizing factors that must be assessed in order to provide care for culturally diverse patients

Answer 14

communication (verbal and nonverbal);
• personal space;
• social organization;
• time perception;
• environmental control; and
• biological variations

Question 15

Macro-scale influences on cultural awareness

Answer 15

Broad understandings of illness, suffering and healing, Social roles and the bureaucratic and economic context of health care services

Question 16

Micro-scale influences on cultural awareness

Answer 16

Face-to-face interaction at front-lines, Successful and failed communication
(week 5 lesson) The very essence of what health and disease denotes can vary from culture to culture. Therefore, there is a wide spectrum of what are considered appropriate interventions, which may not be compatible with Western medicine. Based on the cultures’ perceptions of disease causation, symptomatology, and pathology, appropriate interventions may diverge from Western medicine’s approach (Gesler & Kearns, 2002). The textbook provides many examples of the beliefs of direct cultures and the influence they play in healthcare. There are some long-standing health disparities in minorities. Minority health is often viewed as a variant form of Anglo-Protestant culture, with the scientific foundation and the principles of cause and effect as the basis of our healthcare

Question 17

four principles of cultural competence

Answer 17

• Care is designed for the specific client.
• Care is based on the uniqueness of the person’s culture and includes cultural norms and values.
• Care includes self-employment strategies to facilitate client decision making to improve health behaviors.
• Care is provided with sensitivity and is based on the cultural uniqueness of clients

Question 18

Cultural Awareness

Answer 18

Self-examination of one’s own prejudices and biases toward other cultures. An in-depth exploration of one’s own cultural/ethnic background

Question 19

Cultural Humility

Answer 19

A lifelong commitment to self-evaluation and self-critiques, redressing the power of imbalances in the patient- physician dynamic, developing mutually. Beneficial relationships

Question 20

Cultural Knowledge

Answer 20

Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism.

Question 21

Cultural Skill

Answer 21

Ability to collect culturally relevant data regarding the client’s health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner.

Question 22

Cultural Desire

Answer 22

Motivation of the healthcare provider to “want” to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commi tment and passion to caring, regardless of conflict

Question 23

Kleinman Explanatory Model

Answer 23

Gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Proposes that individuals and groups can have vastly different notions of health and disease. Instead of simply asking patients, “Where does it hurt,” the physicians should focus on eliciting the patient’s answers to “Why,” “When,” “How,” and “What Next.”
Model can be used to to determine how individuals make decisions.

Question 24

What are the social determinants of health?

Answer 24

Social determinants of health are economic and social conditions that influence the health of people and communities. They the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, housing, education, neighborhood, physical environment, employment, social support networks, access to public transportation, access to safe water, access to fresh food, as well as access to health care. They must be considered when interpreting epidemiological data on health disparities.
In addition to ethnicity, other characteristics also contribute to the presence of disparities or the achievement of good health such as gender, sexual orientation, geographic location, working environment, cognitive, sensory, or physical disability, and socioeconomic status.

Question 25

Apply social justice theory to the provision of care; what does social justice mean when applied to health care?

Answer 25

Social Justice Theory- addresses the availability of equal access to healthcare to all individuals and speaks to equal quality of care without prejudice. NPs should incorporate social justice and the ANA Ethical Statements to guide practice. Social justice is the view that everyone deserves equal rights and opportunities —this includes the right to good health. These inequities are the result of policies and practices that create an unequal distribution of money, power and resources among communities based on race, class, gender, place and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health AND equity.

Question 26

What data sources are used to assess determinants of health?

Answer 26

* Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool. * Surveillance and service provision data * Housing and labor data * Policy data * gender equity data * Cross Cultural Health Care Program (CCHCP) * The National Partnership for Action (NPA) to End Health Disparities * The National Priorities Partnership * The Quality Alliance Steering Committee * the Association of American Medical Colleges * The State of Health Equity Research: Closing Knowledge Gaps to Address Inequities * Another resource available to APRNs can be found at Quick Health Data Online * The CDC, WHO and Healthy People 2020 also provide useful information on determinants of health.

Question 27

Integrate risk / screening as it applies to genetics?

Answer 27

Gathering three generations of family history will help determine a patient’s risk for developing cancer. For example, if there is a family history of breast cancer this patient has a higher risk for developing breast cancer. The FNP should counsel the patient on risk factors and way to reduce their risk of developing cancer, making lifestyle choices. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies

Question 28

Absolute risk

Answer 28

probability of an event, such as illness, injury, or death, to occur In cohort studies: Risk that can be attributed to an exposure. AR = incidence in the exposed - incidence in the nonexposed • Absolute risk gives no indication of how its magnitude compares with others.

Question 29

Ratios

Answer 29

* Absolute risk gives no indication of how its magnitude compares with others. * The odds ratio closely approximates the relative risk if the disease is rare. * Odds ratio and the relative risk are used to assess the strength of association between risk factor and outcome. * Attributable risk is used to make risk-based decisions for individuals. * Population-attributable risk measures are used to form public health decisions

Question 30

What is genetic risk assessment? How is it determined?

Answer 30

What is genetic risk assessment? How is it determined? A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge, they need to make appropriate screening, prevention and lifestyle management decisions. This is not a test for cancer: it is a test that can tell you if a higher risk for breast, ovarian or colorectal cancer runs in your family. Family history is a valuable tool. Genetic (inherited) factors can contribute to the development of many diseases, and those at risk can often be identified early if information is collected, shared, and interpreted correctly. Conducting an accurate family history for three generations can reveal a wealth of information on which to base prevention strategies. If the information collected is used to counsel individuals on how to decrease risk with lifestyle modifications (before the patient has the disease) then the utilization of the family history would be considered a primary intervention. For example, if the family history identifies an increased risk for breast cancer, the patient is counseled to modify lifestyle choices to minimize risk. The information should also result in screening strategies that result in the early identification of the disease. The screening strategies would be considered secondary prevention strategies (Spector et al., 2009). Many experts recommend that genetic testing for cancer risk should be strongly considered when all three of the following criteria are met: The person being tested has a personal or family history that suggests an inherited cancer risk condition, The test results can be adequately interpreted (that is, they can clearly tell whether a specific genetic change is present or absent), & The results provide information that will help guide a person’s future medical care. • Genetic risk is the contribution our genes play in the chance we have of developing certain illnesses or diseases. Genes are not the only deciding factor for whether or not we will develop certain diseases and their influence varies depending on the disease • Etiological theory and empirical evidence indicate that large numbers of environmental and genetic factors contribute to common diseases. genetics can provide probabilistic information about risk. Current genetic discoveries may already furnish enough information to make incremental improvements in clinical risk assessments of adults • Genetics may provide a window into clinical heterogeneity: genetic information may be useful in understanding differences in the timing of onset, rate of progression, persistence, comorbidity, and response to treatment. • . At the population level, genetics can help to identify groups susceptible to developing a particular health problem. • Genetics can contribute to composite risk assessments that identify high- and low-risk segments of the population. Background genetic risk information can, in turn, inform investigations of other risk factors or of prevention • A sophisticated blood test tells patients if they have genetic risk factors and gives them the knowledge they need to make appropriate screening, prevention and lifestyle management decisions. Genetic testing analyzes your DNA to detect specific, inheritable, disease-related gene mutations that may increase the risk of certain cancers. It provides you with an in-depth cancer risk assessment.

Question 31

Genomics

Answer 31

The study of all genes in the human genome as well as their interaction with other genes, the individual’s environment, and the influence of cultural and psychosocial factors.

Question 32

Genetics

Answer 32

The study of individual genes and their impact on relatively rare single gene disorders.

Question 33

Pharmacogenomics

Answer 33

The study of how genes affect a person's response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person's genetic makeup. One of the additional responsibilities when possessing prescriptive authority is the necessity of having a thorough knowledge of pharmacogenomics. It has been acknowledged that the effect of medications has a range of therapeutic and nontherapeutic responses. Age, weight, ethnic background, and physiologic impairments associated with disease processes were often concomitant with these variations. Due to the recent genomic research, it is now acknowledged that genetic variations can affect mediation efficacy, toxicity, and drug interaction outside of the drugs themselves

Question 34

Genetic epidemiology

Answer 34

The link of epidemiology and genetics. Focuses on the risk of developing the disease, in populations that have a genetic basis, and is now recognized as a component of risk analysis. This chance of developing a disease, in the absence of other risk factors, gives credence to the potential of a genetic etiology

Question 35

Genomics in HP2020

Answer 35

genomics plays a role in nine of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes and Alzheimer’s disease. In addition, over 1,000 genetic tests were developed to facilitate diagnosis.

Question 36

Pedigree

Answer 36

A graphic illustration of a family health history for three generations

Question 37

What are the components of a genetic risk assessment?

Answer 37

* Medical history: A detailed review of your personal and family medical history and a counseling session is completed to determine your risk of developing cancer, the appropriate medical management, and if genetic testing is recommended to help clarify your cancer risk. * Testing: Genetic testing is analysis of a person’s genes (usually through a blood sample) to determine if you have a change in a gene, called a mutation, that increases the risk for cancer. A small blood sample is analyzed, looking for a change or mutation in the gene. Insurance companies typically cover the cost of testing if you have a personal or family history that is concerning for a hereditary cancer. Cost and insurance coverage for testing are discussed during your evaluation. * Counseling: Following the testing, you’ll receive comprehensive counseling based on your test results and family history. For those who are found to have a gene mutation or are at a higher risk of cancer, options for next steps are discussed. * Next steps: If you have a gene mutation and a higher risk of cancer, we’ll discuss your prevention options, which can include surveillance or prevention tactics. A patient’s choice is strictly a personal decision. Genetic counseling and testing provide the tools you need to make informed decisions. * Family Risk: If you test positive for a mutation, we encourage your other family members to be tested as well. The information from genetic counseling and testing enables family members to make decisions that could save their lives. It also can tell family members that they do not have the mutated gene.

Question 38

People with a personal or family history of any of the following genetic risk factors should consider genetic testing

Answer 38

* pre-menopausal breast cancer (under age 50) * ovarian cancer at any age, especially if there are also cases of breast cancer in the family * male breast cancer * both breast and ovarian cancer in the same person * two primary breast cancers in an individual * two or more breast cancers in a family, one under age 50 * a previously identified mutation in the family * ethnic background (Ashkenazi Jewish) * colorectal cancer diagnosed before age 50 * a history of colon, endometrial and other cancers (including ovarian, stomach, kidney, brain) in the family * history of multiple colon polyps (greater than 20 altogether) * history of childhood or rare type of cancers in the family

Question 39

Can you discuss the interplay between genetics and the environment, how do they influence one another? Do they?

Answer 39

Genetics and the environment are still in the beginning phases of exploring the possibilities. Attributable risk descriptors are often utilized to express the combination of genetic susceptibility enhanced by environmental risk factors. An example given between genetics and the environment is illustrated by PKU, a known autosomal recessive disease that prevents the metabolism of phenylalanine. Once phenylalanine is ingested the body is unable to metabolize and hyper-phenylalanine occurs which destroy brain matter. Once this was researched it was noted by limiting phenylalanine in the diet decreased the risk for developing mental retardation. The environment and genetics to influence one another as provided with the example above. All traits depend both on genetic and environmental factors. Heredity and environment interact to produce their effects. This means that the way genes act depends on the environment in which they act. In the same way, the effects of environment depend on the genes with which they work. For example, people vary in height. Although height is highly heritable , environmental variables can have a large impact. For example, Japanese-Americans are on the average taller and heavier than their second cousins who grew up in Japan, reflecting the effect of environmental variables, especially dietary differences. Phenylketonuria (PKU) is an excellent example of environmental modification of a genetically controlled effect. PKU is a form of mental retardation that results from toxic (~damaging) effects of abnormal breakdown of the essential amino acid, phenylalanine, which is found in all protein. The enzyme that breaks down phenylalanine is defective, so it accumulates and breaks down abnormally. So in PKU, a single gene can dramatically affect behavior: it is clearly a genetically influenced process. Genes alone do not determine our futures—environmental factors and chance also play important roles. Genetic variants that have evolved in one set of circumstances to be beneficial or neutral can be quite detrimental in other conditions. For example, many aspects of our metabolism evolved under conditions where calories were hard to come by. Now, in the environments of rich nations where calories are all too easy to acquire, these genetic factors contribute to obesity and other detrimental health effects. Sometimes, sensitivity to environmental risk factors for a disease are inherited rather than the disease itself being inherited. Individuals with different genotypes are affected differently by exposure to the same environmental factors, and thus gene–environment interactions can result in different disease phenotypes. For example, sunlight exposure has a stronger influence on skin cancer risk in fair-skinned humans than in individuals with darker skin.

Question 40

Genetics Nondiscrimination Act

Answer 40

The Genetic Information Nondiscrimination Act (GINA) of 2008 protects Americans from discrimination based on their genetic information in both health insurance (Title I) and employment (Title II). GINA prohibits health insurers from discrimination based on the genetic information of enrollees. Specifically, health insurers may not use genetic information to make eligibility, coverage, underwriting or premium-setting decisions. Furthermore, health insurers may not request or require individuals or their family members to undergo genetic testing or to provide genetic information. As defined in the law, genetic information includes family medical history, manifest disease in family members, and information regarding individuals' and family members' genetic tests. It prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future, and it bars employers from using individuals' genetic information when making hiring, firing, job placement, or promotion decisions. Genetics Information Nondiscrimination Act (GINA) was passed to offer some protection against the potential misuse of genetic information. However, it is important to note this nondiscrimination law does ***NOT cover life insurance, disability insurance, and long-term care insurance or the Military Health Service, Indian Health Service, or United States Department of Veteran’s Affairs. GINA makes it against the law for health insures to request, require, or use genetic information to make decisions about: eligibility for health insurance, your premiums and contribution amounts or coverage terms. It is also against the law to deny or request the genetic test result, they also cannot consider it a pre-existing condition or require that you obtain a genetic test, they are not able to discriminate against you. Called Gina is a federal law from 2018 that protects individuals from genetic discrimination in health insurance and employment. Gina makes it against the law for health insurers to request, require, or use genetic information to make decisions about one’s eligibility for health insurance or insurance premium price. This means that health insurance companies cannot use the results of a direct-to-consumer genetic test (or any other genetic test) to deny coverage or require you to pay higher premiums. ... Some of these companies request information about genetic testing as part of their application process, but others do not.

Question 41

Appraise global health problems considering the WHO SDG’s as well as related epidemiological data.

Answer 41

``` The health goal (SDG3) is comprehensive: ‘to ensure healthy lives and promote well-being for all at all ages. • 17 Goals 1. No poverty 2. Zero hunger 3. Good Health and Well- Being 4. Quality Education 5. Gender Equality 6. Clean Water and Sanitation 7. Affordable and Clean Energy 8. Decent work and Economic Growth 9. Industry, Innovation, and Infrastructure 10. Reduced Inequalities 11. Sustainable Cities and Communities 12. Responsible Consumption and Production 13. Climate Action 14. Life Below Water 15. Life on Land 16. Peace, Justice and Strong Institutions 17. Partnership for the Goals ``` • Most significantly, the MDGs made huge strides in combatting HIV/AIDS and other treatable diseases such as malaria and tuberculosis.

Question 42

How is the epidemiological triangle related to pandemics, outbreaks?

Answer 42

The epidemiological triangle explains causation. Causative agent (those factors for which presence of absence cause disease—biological chemical, physical, nutritional), susceptible host (such things as age, gender, race immune status, genetics), and the environment (including diverse elements as water, food, neighborhood, pollution.). Helpful when explain acute diseases. The World Health Organization defines a pandemic as a global epidemic that spreads to more than one continent.

Question 43

What is the WHO? What do the SDG’s (formerly MDG’S) mean?

Answer 43

World Health Organization (WHO) is an arm of the United Nations. It provides leadership to global health matters and technical support to countries, and monitors and assess health trends. Millennium Development Goals (MDG) transitioned to Sustainable Development Goals (SDG’s) represent an agreement among countries to achieve the MDGs by 2015 and “create an environment at the national and global levels alike- which is conductive to development and the elimination of poverty.” o 8 goals subdivided into 21 targets for achieving the goals. o The SDGs were adopted by the United Nations General Assembly in September 2015 and look to 2030. They are far broader in scope than the Millennium Development Goals (MDGs) which focused on a narrow set of disease-specific health targets for 2015. WHO’s primary role is to direct and coordinate international health within the United Nations system. Their main areas of work are health systems; health through the life-course; noncommunicable and communicable diseases; preparedness, surveillance and response; and corporate services. Working with 194 Member States, across six regions, and from more than 150 offices, WHO is an organization united in a shared commitment to achieve better health for everyone, everywhere. They strive to combat diseases – communicable diseases like influenza and HIV, and noncommunicable diseases like cancer and heart disease. The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected – often the key to success on one will involve tackling issues more commonly associated with another.

Question 44

Noticed health effects of climate change:

Answer 44

(Kurth 2017) Climate change is due to human activity, Trigger global migration and local relocation due to sea level rise, More frequent weather events, Direct heat effects the elderly and vulnerable, Spread of vector-borne diseases, Increase in psychiatric and mental health issues as they feel the stress from climate change, Changes in food availability and cost- new and widespread malnutrition, As ecosystem-stress-induced changes occur health systems need to anticipate and plan for them, plans Nurses can lead local and regional adaptation efforts partnering with local decision makers in the identification of at-risk populations, the creation of emergency plans, and monitoring and in the clinical environment as well as in community health roles, nurses provide direct guidance to patients and families (George 2017) heat stress exposure, more extreme hurricanes and thunderstorms, extreme drought desertification and flood areas, more frequent dust storms and wildfires, increase prevalence, mortality, and morbidity of asthma and copd, reduced lung function and physical activity, thunderstorm asthma, increase prevalence and virulence of resp. infections.

Question 45

A Call to Action-

Answer 45

(Kurth 2017) It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health, nurse is essential to every solution, The science, techniques, and interventions useful in patient-level health promotion are uniquely understood by nurses and midwives, These selfsame tools can inspire and illuminate health promotion of the planet and the critical systems on which human existence depends. (George 2017) Nurse scientists must contribute to the growing body of bench-to-bedside scientific evidence that documents the health impacts of climate change and evaluates the efficacy and effectiveness of interventions focused on reducing exposure or on reducing the health effects of unavoidable exposure, There is a need for nurses to help their patients develop adaptive strategies, which focus on modifying the built environment to respond to the negative impact of climate change that has already occurred, From a policy perspective, nurses might become involved in efforts to promote public transportation or increase urban tree canopy or may want to be involved in urban planning efforts to increase economic development and reduce economic disparities Climate change is expected to drive more extreme weather events, which have the potential to increase respiratory morbidity and mortality rates. Climate change produces several changes to the natural and built environments that may potentially increase infectious disease prevalence, morbidity, and mortality Climate changes may also influence the survival, reproduction, or distribution of allergens/pathogens (bacterial, viral, and fungal), vectors, hosts, and disease transmission. More frequent wildfires and dust storms can be anticipated due to increased drought and desertification resulting from climate change. “Call to action”- Nursing to assume a leadership role in addressing planetary health. Safeguarding human health requires a healthy planet. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one's university, hospital, and or health system levels

Question 46

How do you assess an area’s resources and its relationship to the health of a region?

Answer 46

Community assessments of various kinds often require us to use statistics and other information relating to a certain area. Usually, that area is a city, a county, or even a state. After analysis, you can understand where the real needs are, tailor problem solutions to the areas where they’re really needed and divide resources so that they will be as effective as possible. By comparing the statistics and resources of several regions, you may be able to see why a health condition exists in one region and not in another. For example, a nearby industrial facility may be the difference between an area of high childhood asthma rates and one where the rates are low. The U.S. government has programs for pandemic preparedness that move from federal to state and local levels. Gauging the impact of a pandemic is difficult but researching past statistics about rates of infection and the numbers of people that seek medical care have assisted in preparation.

Question 47

How is risk reduction, assessment, and outcomes related to public health policy?

Answer 47

Helping patients understand risk factors and take personal responsibility for lifestyle changes prevents disease, decreases risks, and promotes health that leads to improved outcomes, reduced costs, and an overall healthy population status.

Question 48

Ethics

Answer 48

(ANA) practices with compassion and respect. Is committed to patient, family, community, and population. Promotes, advocates for, and protects the rights, health, and safety of the patient. Establishes, maintains, and improves the ethical environment of the work setting that are conducive to safe quality health care. Advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Question 49

Fairness

Answer 49

the state, condition, or quality of being fair, or free from bias or injustice; evenhandedness (closely tied to justice). ALL people have a right to EQUALprotection and equal access to public health.

Question 50

Social justice

Answer 50

all human beings have the core entitlements essential to human fulfilment. The distribution of advantages and disadvantages within a society. fair and equitable treatment of people with direct implications for the improvement of the health of the public

Question 51

Determinants of health

Answer 51

The range of personal, social, economic, and environmental factors that influence health status ``` Policymaking Social factors Health services Individual behavior Biology and genetics ```

Question 52

Point source outbreaks

Answer 52

Common source outbreaks where the source has infected cases at one particular location, during a short period of time Usually have bell-shaped epidemic curve —> enables us to pinpoint moment of transmission

Question 53

Continuing common source outbreak

Answer 53

Cases infected by same source but over long time Eg source can be a lake Epidemic curve increases until it reaches a plateau. Stops when source is eliminated.

Question 54

Propagated outbreaks

Answer 54

Communicable diseases do not usually have a single source. Epidemic curve can vary and depends on contact pattern and proportion of susceptible individuals With naive populations and easy mode of transmission (airborne), epidemic curve increases sharply with little bumps, reflecting the generations of cases in population

Question 55

EGAPP

Answer 55

Evaluation of Genomic Applications in Practice and Prevention

Question 56

GAPPNet

Answer 56

Genomic Application in Practice and Prevention Network

Question 57

GEDDI

Answer 57

Genetics Early Disease Detection Intervention project

Question 58

HuGENet

Answer 58

Human Genome Epidemiology Network Helps translate genetic research findings into opportunities for preventive medicine and public health

Question 59

WHO Pandemic phases

Answer 59

1. No infection 2. Animal- based virus has caused infections in humans 3. Clusters of infected humans but no outbreak 4. Community outbreaks and sustained disease - consult with WHO 5. Human-to-Human soread in at least two countries; pandemic is imminent 6. Pandemic (phase 5 plus 1 more region)

Question 60

Pandemic severity index

Answer 60

Category: 1. Case fatality ratio < 0.1% & < 90,000 US deaths 2. 0.1-0.5% & 90-450,000 deaths 3. 0.5-1% & 450-900,000 deaths 4. 1-2% & 900,000-1.8 million deaths 5. > 2% &. > 1.8 million deaths