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University of Calgary
NURS 287
Amanda O' Rae

Week 8 – Tuberculosis Prevalence  By 1950’s drugs to fight TB became available  1/3 of the world’s population is infected with the TB germ  Canada: higher rates among Aboriginal population  Calgary: higher rates among foreign born population What is TB?  TB caused by Mycobacterium tuberculosis  Spread when an infectious person coughs, sneezes, talks o Infectious: 1. They have active TB disease in the lungs or throat 2. In large enough numbers that their smear result is positive Cycle of TB  Transmission – airborne; only some of those exposed will become infected o Duration of exposure to susceptible individuals o Susceptibility of those exposed o Infectivity of one MTB strain vs. another  Latent Infection progressing to Disease o Germs ‘wake up’ o Depressed immune system; infants (<5 years), HIV infection, transplant, renal failure o Greatest risk in first 2 years after infection Latent TB Infection TB Disease  Healthy person  Germs active and causing damage  No symptoms  Can occur anywhere in the body  Germs present but dormant  Usually has symptoms  Cannot be spread  Pulmonary TB disease has the potential to Screening: be infectious  TST (Mantoux)  Always enters the body through the lungs  Quantiferon Gold TB test (GFT) blood test but travels through the lymph and blood Treatment: Symptoms:  1 month self-administered supply  Cough (>3 weeks), weight loss, fatigue, fever, night sweats, hemoptysis Screening:  Chest x-ray  Sputum collection Treatment:  Multiple drugs to which the organism is susceptible – Directly Observed Therapy (DOT)  Respiratory isolation  A contact investigation is always undertaken Current Issues:  TB/HIV co-infection – TB kills up to half of all AIDS patients worldwide  Drug-resistant and Multi-drug resistant TB – caused by poor TB control practices  Impact on poor and vulnerable populations – overcrowding, nutrition, access to HC Week 8 – STIs Reportable – fall under the Public Health Act and Communicable Disease Regulations  Who needs to be tested? - anyone sexually active  What should be tested for? – Chlamydia, Gonorrhea, Syphilis, HIV Non-Reportable – not routinely followed for treatment, partners, or matters of public health  Genital warts (HPV), herpes (HSV), molluscum, yeast, bacterial vaginosis (BV), scabies, crabs Chlamydia Gonorrhea  Bacteria  Bacteria  Generally asymptomatic  Commonly generates symptoms such as  Most common reportable STI painful urination, discharge,  Burning, itching, discomfort, discharge, lymphadenopathy, swollen testicles, PID pelvic inflammatory disease (PID)  Asymptomatic in throat or rectum  Alberta: increasing prevalence  37% Aboriginal, 37% Caucasian, 7% Black  Most common among Female, 20-24 years  Most common among Males, 20-24 years old old  Antibiotic resistance stemming from long  Tested by urine and/or cervical swabs ago and ineffective treatment  19% Aboriginal, 53% Caucasian, 4% Black Non-gonococcal Urethritis (NGU) Muco-purulent Cervicitis (MPC)  Any inflammation in the urethra with or  Inflammation at the cervix without discharge  Treated for Gonorrhea and Chlamydia  >50% of NGU cases are caused by  Strong decline in 2004, but the rates have Chlamydia not remained that low  Often symptomatic; treated for Gonorrhea  Most common 20-24 years old and Chlamydia  Rates declined around 2005, and are now gradually increasing  Most common 20-29 years old ** For Chlamydia and Gonorrhea infections a test of cure should be done 28 days after treatment is completed Syphilis  Strongly increasing up until 2009 and has since decreased  Most commong among men; 40-59 years old Stages of Syphilis  1° - chancre  2° – rash, alopecia, bone pain, condyloma lata  Latent – NO symptoms at all; this is how Syphilis usually presents itself  Tertiary o Neurosyphilis  Asymptomatic, Meningovascular, “Insane,” Tabes dorsalis, Gummatous neurosyphilis o Cardiovascular o Gummatous (benign late syphilis)  Congenital o Untreated primary or secondary syphilis in pregnancy infects ~100% of fetuses; this results in premature delivery or perinatal death Week 9 – Science of Health: Communities and Populations Developmental theory: Explains how we develop across the lifespan and the factor that influence this process  Piaget’s Theory of Cognitive Development o Refers to the manner in which people learn to think, reason and use language  Erikson’s Theory of Psychosocial Development o Self concept: How someone perceives their appearance, values and beliefs which impacts their behaviour. A person is not born with a self-concept but develops one as a result of social interactions. Healthy Child Development  What contributes to healthy child development? o Physical influences, psychosocial influences o Income, family functioning, supportive community  Domains: o Physical  Health indicators: height, weight, BMI, disease occurrence o Social  Health indicators: relationships with others, coping, support systems, interaction o Cognitive  Health Indicators: language, literacy, health behaviours  Why is it important? o Early life experiences have impact acro the entire lifespan  Approaches to action: o Socio-economic model (income) – human capital; income, ability to work, working policies o Health selection model (health) – social capital; sense of cohesion o The Keralan, India experience – addressing everyone with multiple strategies  Health Indicators: Human Capital o Educational attainment o Literacy levels o Employment opportunities o Overall physical and mental health  PH Action: o Target caregivers o Identify stressful environments o Provide health promoting information o Referrals to community resources Work & Working Conditions  WHO: Global Strategy Principles o Protection and Promotion: prevent and control occupational diseases and accidents o Development and Promotion: develop healthy and safe work and working environments o Enhancement: of physical, mental and social wellbeing of workers by supporting their working capacity as well as professional and social development for the worker o Enablement: of workers to conduct socially and economically productive lives for sustainable development  Health Indicators: o Benefits of employment  Income, life opportunity, sense of identity and purpose, social networks o Impact of unemployment  Reduced life expectancy, more health problems  In Canada, unemployment has decreased a little 0.1%  Women: the employment rate for women has been steadily on the rise o Representing the service sector, they are more exposed to discrimination and harassment  People in general are working longer and older  Enforcing higher education = higher income  Accepted Time loss due to injury has declined since 1982  How has our approach to occupational health changed and why? Review: Epidemiology  Why do statistics matter to us? o Because we need to compare and contract what we know o Statistics may indicate that occupational health efforts in Canada are effective o WHO recognized the work place as one of the most impactful settings Health Services as a SEDoH  Various perspectives o Access, utilization, appropriateness  Predisposing factors: demographic variables present before the onset of illness  Enabling factors: conditions that facilitate or impede service use o Education, English competency, monthly income, social supports, service barriers  Cultural factors: values and beliefs impacts health perceptions and behaviours o Religious affiliation, acculturation, health beliefs, ethnic identity, traditional practices Goldenberg, S. M. (2008). STI testing among young oil and gas workers: The need for innovative place- based approaches to STI control. Structural Socio-cultural  Opportunities to access  Rapport Building o Geographic location  “Rigger” Culture o Limited hours of service  “community” o Employee time  Follow-up Week 10 – Science of Health: Communities and Populations Physical Environment  What comprises the physical environment? o The home, the surrounding, your neighborhood, your proximity or accessibility to other neighborhoods, transportation, noise levels, clean water, access to health services and food  What health outcomes does our physical environment influence? o Our personal coping skills, meeting physiological needs  Environmental Health: all aspects of human health, disease, and injury that are determined by factors in the environment  PH Action: o Environmental health assessment: performed to examine possible links between environmental exposure and health outcomes  Risk assessment: Process used for describing and quantifying the level o exposure to particular substances/factors that will result in increased risks to health  Identifying risk through health indicators obtained from personal exposure, environmental epidemiology, environmental indicators  Risk management: Minimal and maximum intervention and evaluation of management options; ranges from awareness to regulation  Risk communication: Process of making risk assessment and management information comprehensible and taking the necessary steps to distribute and present that information accordingly  We are left to navigate this risk to determine the relevance and severity before we take action… this requires Health Literacy: the ability to access, understand, evaluate and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life-course  PH Action: Navigating Risk o Goal: increase capacity for health literacy in order to become knowledgeable consumers of information o Who is the target audience? – Measure their health literacy o Apply Health Behaviou
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