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265 Cards in this Set
- Front
- Back
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A localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin (s)
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Hospital Associated Infection (HAI)
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From the patient's own body?
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Endogenous
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Where are 4 places an exogenous HAI could come from?
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Personnel
Equipment Visitors Hospital environment |
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Hand washing in the obstetric unit
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Semmelweis
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1st standards of infectious control
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Semmelweis
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Used carbolic acid to chemically sterilize surgical equipment and bandages
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Lister
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Most common HAI?
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UTI (catheters)
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Most serious illness and death of the HAI?
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Surgical Sites
Pneumonia Bloodstream |
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3 most common Gram + microbes?
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Staphylococcus aureus
Coagulase negative staph (S. epidermidis) Enteroccci sp. |
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4 most common Gram - microbes?
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Klebsiella pneumoniae
Enterobacter sp. E. coli Pseudomonas aeruginosa |
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Patients most at risk for C. Diff?
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Hospitalized patients on antibiotics
Greater than 65 years old |
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Gram + spore former and toxin producer whose severity and incidence has increased recently?
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C. Diff
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What does C. Diff cause?
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diarrhea and pseudomembranous colitis
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Important in care of C. Diff infected people?
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Hand washing with soap and water
Contact isolation |
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3 factors involved in HAI?
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1.Antimicrobial use (resistance)
2.Failure of basic inf control 3. Immunocompromised |
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What did the CDC develop with regard to HAIs?
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Hand Hygiene
Guidelines for prevention Maintains National Healthcare Safety Network |
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Most common mode of transmission of pathogens?
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Hands
(causes infections and spreads resistance) |
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An infectious disease that has newly appeared in a population or that has been known for some time but is rapidly increasing in incidence or geographic range?
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Emerging Infectious Disease
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# of new cases within a specified time period
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Incidence
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Total # of cases in a given time period
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Prevalence
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The cause?
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Etiology
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The number of cases resulting in illness/poor health?
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Morbidity
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The number of cases resulting in death?
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Mortality
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Present in a low but constant level in an area?
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Endemic
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An occurrence of disease greater than would be expected in a particular time and place (community)?
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Outbreak
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An outbreak that spreads throughout the area (for example statewide)?
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Epidemic
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Epidemic that spreads throughout the world?
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Pandemic
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Which types of disease must be reported?
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Easily transmitted
Potentially severe |
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Distinguish between endemic and epidemic?
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Surveillance
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What agencies keep track of EID?
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Local->State->CDC
and WHO |
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The ability of a population to resist serious epidemics because a significant proportion of its population is immune.
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Herd Immunity
(vaccinations) |
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What determines the rate of transmission of EID?
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Population Density
Proportion of members susceptible to the disease |
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Need to know 4 of the 8 theories of/why EIDs exist.
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Going underdeveloped areas
Population growth Increased travel and trade of imported foods, plants and animals. Immigration Inadequacy of public health hygiene systems Overuse/misuse of antibiotics Evolution/mutations of microbes |
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Progression of SARs Outbreak?
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Reported in Feb 2003 to WHO (Urbani)- new and deadly dx
Traveled to Asia to investigate Urbani dies in March March-May: outbreak 8098 cases,774 deaths in total (28 countries and 3 continents) |
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What contributed to the SARs outbreak?
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China didn't report to WHO for 3 mo
TRAVEL! High speed transportation (planes) 1 person infected 16 on hotel floor |
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Symptoms of SARs
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Fever >38 °C
Lethargy Myalgia Cough Sore throat Diarrhea Difficulty breathing |
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What stopped SARs?
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Education (symptoms, treat, prevent)
Quarantine Cooperation Collaboration Travel restrictions |
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7 characteristics of SARs?
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Coronaviridae family
+ ssRNA Enveloped Large Aerosol spread Winter mo-infection Infects nasal epithelium |
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Leading cause of death in ALL age groups?
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Heart Disease
Cancer |
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Life Expectancy for males and females?
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Males: 75.7 yrs
Females: 80.6 yrs |
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What cause of death is decreasing in age 1-14?
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Unintentional injuries
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What cause of death decreased in 25-44?
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Cancer
HIV |
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What cause of death decreased in 45-64?
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Cancer
Heart Disease |
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What cause of death decreased in 65+?
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Heart Disease
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Leading cause of death from 1-44?
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Unintentional injuries
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Leading cause of death from 45-64?
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Cancer
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Leading cause of death in 65+?
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Heart Disease
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Cigarette smoking decreased in what age group?
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males and females in 9-12th grade
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Rate of childhood obesity?
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1 in 5 of kids over 5
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Rate of adult obesity?
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1/3 (another 1/3 are overweight)
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What is trend in serum cholesterol and statin use in 45+?
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High serum cholesterol has declined
Statin use increased 10 fold |
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Percentage of people who engage in aerobic and muscle building activities?
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Less than 20%
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Why is there a delay in seeking medical care?
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COST!
(private insurance and uninsured) |
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What is the trend in health coverage?
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Private health insurance decrease
Uninsured increase |
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Continuous evaluation of osteopathic clinical practice, utilizing evidence-based medicine approaches to develop best practices that will result in optimal patient care
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Practice-based learning
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The candidate must be able to articulate and apply fundamental epidemiologic concepts to practice-based learning and improvement
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4.1, Fundamental Epidemiologic Concepts
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interpret features and meanings of different types of data, including quantitative and qualitative, and different types of variables, including nominal, dichotomous, ordinal, continuous, ratio, and proportion
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4.1.1
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interpret measures of central tendency, including mode, median, and mean, and measures of variability, including variance and standard deviation
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4.1.2
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articulate and interpret measures of frequency of disease, injury or death in forms of rate, ratio, and proportion, including incidence and prevalence, and common health rates
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4.1.3
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assess accuracy and usefulness of screening and diagnostic tests by using indices of sensitivity, specificity, positive and negative predictive values, likelihood ratio, and odds ratio
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4.1.4
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interpret common statistical analytical methods, including independent and dependent t-tests, chi-square test, analysis of variance, correlation, and linear regression
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4.1.5
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differentiate observational and experimental studies; interpret common research designs, including cohort studies, case-control, nested case-control, randomized controlled clinical trials, and randomized controlled field trials; and perform critical review of research designs and findings, including sample size, power, decision errors, and intentional and unintentional bias
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4.1.6
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A collection of observations (as from a survey or experiment)
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Data
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What is the goal of descriptive statistics?
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Organize
Summarize information |
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What is a way to display data?
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Frequency distribution
Bar chart (histogram) Line graph (freq polygon) Bar chart |
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Each observation is a word or code that represents a class or category
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Qualitative
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2 types of qualitative data?
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Nominal
Ordinal |
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Each observation is a number that represents an amount or count
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Quantitative
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2 types of quantitative data?
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Interval
Ratio |
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A single number to represent the entire distribution of observations
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Measure of Central Tendency
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the value of the most frequently occurring observation
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Mode
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the middle value when observations are ranked from most to least (or vice versa) for ordinal
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Median
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sum of all observations divided by number of observations
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Mean
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Can be used for all levels of measurement (including nominal)
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Mode
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Can be used with ordinal or interval/ratio data; should be used if interval/ratio data is skewed.
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Median
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Can be used with interval/ratio data; sensitive to outliers
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Mean
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Measures of variation
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Range
Standard Deviation |
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Calculate deviation score
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Specific Score - Mean
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Square the deviation scores, then average them
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Variance
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Square root of variance?
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Standard deviation
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Standard deviation is related to?
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Normal curve
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Steps to calculate Standard Deviation
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Specific Number - Mean (deviation score)
Deviation Score squared and averaged (variance) Square root of variance (SD) |
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Useful percentages in a normal curve?
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68% of population w/in 1 SD
95% of population w/in 2 SD 99% of population w/in 3 SD |
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Mode = Median = Mean
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Normal curve
(related to mean and SD) |
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related to direction of asymmetry
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Skewness (+ and -)
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related to peakedness or flatness
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Kurtosis (leptokurtic and platykurtic)
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Measures on more than one variable for each subject
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Multiviarant
Bivariant (distinguish association and causation) |
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measures the strength & direction of the association
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Correlation analysis (r=+/-1)
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measures the impact of one variable on the other: amount of variation in the dependent variable explained by the independent variable
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Regression analysis (R2)
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Measure of disease frequency
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Incidence
Prevalence |
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Measures of Diagnostic Certainty
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Sensitivity
Specificity PPV NPV Likelihood ratio |
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Sensitivity equals
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A/A+C
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Specificity equals
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D/B+D
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PPV equals
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A/A+B
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NPV equals
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D/C+D
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The ability of a test to identify correctly those who have the disease
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Sensitivity
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Number of people affected by the disorder who are detected, in relation to all individuals affected
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Sensitivity
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The proportion of people with disease who are correctly identified as positive by screening test
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Sensitivity
(rule out) |
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The ability of a test to identify correctly those who do not have the disease
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Specificity
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The number of people not affected by the condition who are detected in relation to all non-affected individuals
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Specificity
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The proportion of people without disease who are correctly identified as negative by the screening test
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Specificity
(rule in) |
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What affects sensitivity and specificity?
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The test itself
The cutoff score The stage of disease Other conditions |
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The ability to predict the presence or absence of a disease from test results
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Predictive Value
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The likelihood that a positive test is predictive of the disease
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Positive Predictive Value
(true positives) |
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The proportion of nondiseased individuals among all those who have negative test results
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Negative Predictive Value
(true negatives) |
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What affects predictive value?
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Sensitivity
Specificity Prevalence of the disease |
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The likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the disorder
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Likelihood Ratio
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How much more likely is a positive test to be found in a person with the condition than in a person without it?
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Likelihood Ratio of Positive Test
Sensitivity/(1-Specificity) |
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How much more likely is a negative test to be found in a person without the condition that in a person with it?
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Likelihood Ratio of Negative Test
(1-Sensitivity)/Specificity |
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Measures of therapeutic efficacy
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Absolute Risk Reduction
Relative Risk Reduction Number Needed to Treat Number Needed to Harm Odds Ratio |
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n with event / total
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Event rate
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How much more likely is a negative test to be found in a person without the condition than in a person with it?
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Likelihood Ratio of Negative Test
(1-Sensitivity)/Specificity |
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Measures of therapeutic efficacy
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Absolute Risk Reduction
Relative Risk Reduction Number Needed to Treat Number Needed to Harm Odds Ratio |
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n with event / total
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Event rate
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2 event rates?
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Control event rate (CER)
Experimental event rate (EER) |
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Absolute risk reduction
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difference in two event rates
CER - EER = ARR |
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Relative risk reduction
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proportion of control rate
CER-EER / CER = RRR |
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Measure of effectiveness of therapy
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Number needed to treat
(inverse of absolute risk reduction) |
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Number of patients treated to produce the adverse effect in one patient
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Number needed to harm
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Your decisions using the Number Needed to Treat and Number needed to Harm will be based on
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Severity of outcome
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Similar to relative risk
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Odds Ratio
(do not need to know prevalence) |
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Formal, logical procedure for making inferences based on sample data
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Hypothesis Testing
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6 steps in hypothesis testing?
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State the research question
Formulate null and alternative hypotheses Establish a decision rule Do the research Make a decision Interpret |
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μTreatment = μNo Treatment
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Null Hypothesis
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μTreatment ≠ μNo Treatment
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Alternative Hypothesis
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Ho: μTreatment = μNo Treatment
H1: μTreatment ≠ μNo Treatment |
Non-directional
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Ho: μTreatment ≥ μNo Treatment
H1: μTreatment < μNo Treatment |
Directional
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What probability of being wrong (a particular type of wrong) are we willing to tolerate (ie p=0.05)?
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Decision Rule
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Concluding there is a treatment effect when there really is not (incorrectly rejecting the null hypothesis)
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Type I Error (alpha)
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Failure to detect experimentally an effect that really does exist in the population (failure to reject null hypothesis)
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Type II Error (beta)
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The ability of a statistical test to find a difference if one really exists
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Power (1 – β)
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What is power related to ?
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α
N Effect size |
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t set of curves that are almost normal but with fatter tails
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Means of 2 groups
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Analysis of variance (ANOVA)
F statistic |
Means of 3 or more groups
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Categorical data
Χ2 (Chi-square) |
Contingency Table
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If p < 0.05
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The null hypothesis of “no treatment effect” is rejected which we interpret to mean that the treatment makes a difference
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If p > 0.05
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The null hypothesis cannot be rejected which we interpret to mean that the treatment makes no difference
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Prospective
Gold Standard, random assignment of subjects to treatment and control groups Not always possible for practical and/or ethical reasons |
Randomized Control Trial
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Retrospective
Find cases Identify healthy controls Look back to identify factors in history that may account for different outcomes |
Case Control
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Investigator does not control assignment to groups
Follow patients prospectively to assess differences in outcomes |
Cohort Study
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is the standard deviation of all sample means over all possible samples drawn from the population.
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Standard Error of the Mean
(Justified by the Central Limit Theorem) |
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Types of Bias
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Selection bias (volunteer and nonrespondent)
Measurement bias (instrument bias, insensitive measure bias, expectation bias , recall or memory bias, attention bias, and verification or work-up bias) Intervention (Exposure) Biases (contamination bias, co-intervention bias, timing bias(es), compliance bias, withdrawal bias, and proficiency bias) |
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2 components of public health?
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Prevention
Population |
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Comprehensive science with broad spectrum coverage
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Public Health
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The practice of preventing disease and promoting good health within groups of people, from small communities to entire countries
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Public Health
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Rely on policy and research strategies to understand issues such as infant mortality and chronic disease in particular populations
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Public Health
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The science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention
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Public Health
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Analyze the effect on health of genetics, personal choice, and the environment in order to develop programs that protect the health of your family and community
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Public Health
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Disciplines of public health
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Infectious disease
Environmental health Biostats Epidemiology Public Health Policy |
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Early examples of public health
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Immunization of smallpox (cowpox and variolation)
Quarantine and burning-Black Death John Snow and cholera |
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How does modern public health differ from early public health?
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Focus on chronic disease more now
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Modern examples of public health
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Cancer and heart disease
Infectious disease in developing countries EIDs |
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5 key focus areas in CDC's Emergency Preparedness Plan?
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Preparedness and prevention
Detection and surveillance Diagnosis and characterization of biological and chemical agents Response Communication |
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Key focus area: Develop public health guidelines, support, technical assistance
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Prepare and prevent
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Key focus area: Integrated surveillance for reporting of illnesses from biological and chemical terrorism
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Detect
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Key focus area: Creation of multilevel laboratory response network for bioterrorism (LRNB)
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Diagnosis
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Key focus area: Epidemiologic investigation, medical treatment, prophylaxis
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Response
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Key focus: Rapid notification and information exchange
Dissemination of diagnostic results and information Coordination of emergency response activities |
Communication
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Quick effect of terrorism with chemical attack thru inhale/skin with immediate and obvious symptoms: more concern and immediate response
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Overt attack
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Overt terrorism agents?
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Bombs
Chemical attacks 911 |
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Overt terrorism first responders?
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Police
Fire EMS |
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Delay between exposure and onset of illness (incubation)
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Covert attack
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First responders in covert terrorist attacks?
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Doctors
PCPs |
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Steps in preparing for a biological attack?
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Communication programs (educate and train)
Enhance epidemiologic capacity to detect and respond to biological attacks (diagnosis, surveillance strains, vaccines) |
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Easily disseminated or transmitted between people
High mortality rates |
Category A
(public health preparedness) |
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Moderately easy to disseminate
Moderate morbidity and low mortality rates |
Category B
(CDC diagnostic criteria) |
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Availability, easily produced and disseminated
Potential for high morbidity and mortality rates |
Category C
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6 Category A Agents (blood or respiratory transmission)
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Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers |
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Prepare for chemical attacks?
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Educate
Detect/prevent |
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Types of chemical agents
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Blood and Blister
Corrosives Dioxins Explosive Flammable Nerve Metals Volatile Poisons Pulmonary |
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Foundation of public health (6 pillars and 3 categories)?
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Category A (epidemiology and stats)
Category B (biomedical and environmental health sciences) Category C (Social and medical care system) |
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Deliberate release of viruses, bacteria, or other agents used to cause illness or death in people, animals, or plants
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Bioterrorism
(disseminated thru air, water, and food) |
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6 things about anthrax?
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Spores in soil
Gram + rods Long serpentine chains Aerobic Category A Antiphag capsule |
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Greatest potential for mass casualties and civil disruption
Death w/in 48 hrs if not treated |
Anthrax
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How is anthrax disseminated?
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Inoculation (most common)
Inhalation Ingestion (infected animals) |
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How is anthrax diagnosed, treated, and prevented?
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Diagnosis: Nonspecific media culture, serology, inc mediastinum on CXR
Treat:Ciprofloxacin and doxycycline Prevent: vaccine only for military |
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4 things about botulism?
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Gram +
Anaerobic Heat-labile neurotoxin (Ach) Paralysis |
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How is botulism transmitted?
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Food (home canning and honey)
Inhalation (not diagnosed) |
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How is botulism treated?
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Treat: antitoxin, respiratory and stomach lavage
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4 things about the pneumonic plague?
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Gram - rod
Caused by yersinia pestis Category A Dead in 2 days (90%) |
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How do you diagnosis and prevent pneumonic plague?
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Gram stain of LN aspirate
Isolate pts, public health officials notified (vac no longer available) |
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How is smallpox transmitted?
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Respiratory droplets
(outbreaks-30% mortality) |
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How is smallpox prevented?
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Vaccine (Stopped in 1980 with eradication)
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2 Category C?
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Nipah virus
Hantavirus |
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How is tularemia spread?
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Inhalation of bacilli
(pneumonia and ARDS) |
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How is tularemia diagnosed?
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Gram - stain of sputum (aerobic)
Grows on Buffered Charcoal Yeast Extract agar |
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How is Brucellosis spread?
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Category B
Aborted fetuses Inhalation of aerosol |
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How is Brucellosis treated?
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Doxycycline + rifampin
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How is Q fever (Coxiella) spread?
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Found in placenta and feces of infected livestock
Inhalation (hepatitis and pneumonia) |
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How do you diagnosed Q fever?
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Serology (Phase I and II antigens)
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How do you treat Q fever?
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Doxycycline for acute, combination for chronic
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What causes Glanders and Meliodosis?
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Category B
Burkholderia (Nonmotile, nonsporulating, obligate aerobic, Gram-negative rods) |
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How is Glanders spread?
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Human infection from direct contact with secretions from infected animal
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How is Melioidosis (Whitmore) spread?
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Human infection with direct contact from contaminated source
(soil in Middle East, India, and China) |
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How is glanders and melioidosis diagnosed?
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Gram stain of sputum, urine, skin lesions (gram -)
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How is glanders and melioidosis treated?
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Amoxicillin and clavulanate
Doxycycline TMP-SMX |
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Addresses all physical, chemical, biological factors external to a person, and all related factors impacting behaviors
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Environmental Health
(natural or artificial) |
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What does environmental health focus on?
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identification and control/prevention
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Concerns of environmental health?
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What is the cause?
Where contacted the contaminant? Others at risk? |
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Found in old paint, soil, various products (exhaust from gasoline)
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Inorganic Lead
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Found in gasoline before 1976?
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Organic Lead
(more toxic!) |
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Areas of environmental health concern?
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Air quality
Water and food quality Toxic chemical exposure Radiation Waste management Noise pollution Vector control |
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Types of ionizing radiation?
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Alpha (2 neutrons and 2 protons/paper)
Beta (e-/metals) Gamma ray (photons/penetrate/thick lead) |
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Protect safety, health, and welfare of people engaged in work or employment
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Occupational Health
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Role is to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance
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Occupational Safety and Health Administration (OSHA)- Part of the Dept of Labor
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What 3 things does risk assessment include?
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Hazard (cause harm if not controlled)
Outcome (the harm that would result) Risk (probability and severity) |
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5 steps of risk assessment?
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1.Identification of hazards
2.Identification of affected workers 3.Evaluation of the risk 4.Identification of control measures 5. Can be quantitative (by assigning #) or qualitative (description) |
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4 types of workplace hazards?
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Physical (noise or mechanical)
Biological (blood/air borne pathogens) Chemical (acids, solvents, metals, fumes, asbestos) Psychosocial |
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Material Safety Data Sheet contains?
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Important info of a substance
Safe use and hazards (mp, bp, tox, 1st aid, storage, disposal, spills) Needed for hazardous chemical |
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Basic science of public health that studies anything affecting population~first indication of nature of new disease
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Epidemiology
(begins w outbreak and identify exposures) |
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One of most important methods of public health research (risk factors, treatment, prevention)
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Epidemiology
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Study of patterns of health and illness and associated factors at population level (infectious and non-communicable diseases)
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Epidemiology
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Father of Epidemiology (endemic and epidemic)
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Hipprocrates
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Founding event in epidemiology: chlorine in cholera water
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Snow
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Biostatistics used to identify probability of association between cause and disease outcome
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Causality
(association does NOT always equal causality) |
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Qualitative studies?
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Case studies
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Quantitative studies?
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Case-control
Cohort |
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Qualitative study of one pt or small group of pts with similar disease: Compare pt exposure periods to periods when they are unexposed
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Case Series Studies
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Study is retrospective study that looks in pt’s past for possible exposures that may have been encountered: people diagnosed with the disease vs people without the disease
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Case Control Studies
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What statistic do you use to analysis Case-Control Studies?
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Odds Ratio
(If OR >1, then exposure likely associated with disease) |
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Prospective studies that select participants based on exposure status
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Cohort Studies
(smokers) |
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What statistic do you use to analyze Cohort Studies?
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Relative Risk = (A/A+B)/(C/C+D)
(more powerful than OR) |
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Steps in outbreak investigation?
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1. Prepare for fieldwork
2. Establish existence of outbreak 3. Verify diagnosis 4. Define and identify cases 5. Describe data in terms of time, place, person 6. Develop hypotheses 7. Evaluate hypotheses 8. Refine hypotheses, carry out additional studies 9. Implement control and prevention measures 10. Communicate findings |
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Outbreak exists if observed # of cases > expected #
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Establish existence of an outbreak
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Review clinical findings and lab results
Visit with patients to get history |
Verify the diagnosis
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4 components of case definition?
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Clinical information
Characteristics about pts affected Information about location or place Time during which outbreak occurred |
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Confirmed cases must have?
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Lab verification
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typical symptoms, no lab confirmation
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Probable cases
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Few typical symptoms
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Possible cases
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Regardless of the disease, what information should be collected?
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Identifying Info
Demographics Clinical Info Risk Factors (can use line listing) |
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What do you use to describe data in terms of time?
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Epi Curve
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What does an epi curve tell us?
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Where we are in the epidemic
Est probable time period of exposure Shape determines pattern of epidemic, exposure time, incubation |
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Steep up slope and gradual down slope
People exposed to same source over brief period |
Single source epidemic
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Series of progressively taller peaks 1 incubation apart
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Person-to-person spread
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What do you use to describe data in terms of place?
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Spot map
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What is included in describe data in Terms of Person
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Personal characteristics
Exposures |
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Epi curve may show?
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Narrow period of exposure
Geographic distribution Groups with particular age, sex, other characteristic |
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What should a hypothesis address?
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source of agent, mode of transmission, possible exposures
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What studies are best for small, well-defined outbreak
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Cohort studies
(find attack rate for exposed and unexposed people) |
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What do you use to describe data in terms of place?
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Spot map
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What is included in describe data in Terms of Person
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Personal characteristics
Exposures |
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Epi curve may show?
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Narrow period of exposure
Geographic distribution Groups with particular age, sex, other characteristic |
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What should a hypothesis address?
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source of agent, mode of transmission, possible exposures
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What studies are best for small, well-defined outbreak
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Cohort studies
(find attack rate for exposed and unexposed people) |
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study that is best for outbreak in large population
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Case Control Studies
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Aimed at specific links in chain of infection, agent, source, reservoir
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Implement control and prevention measures
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Bradford-Hill Criteria for assessing evidence of causation
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Consistency / Coherence
Analogy Specificity Temporality Strength Biological gradient Experiment Plausibility |
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International agency that monitors global health and assist countries in handling public health issues
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WHO
(part of UN) |
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What are WHO's core functions?
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Provide leadership on global health matters
Shape health research agenda and stimulate generation and dissemination of valuable knowledge Set norms and standards Articulate evidence-based policy options Providing technical support to countries Monitoring and assess health trends |
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U.S. government’s agency for protecting health of all Americans that works closely with state/local governments
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Dept of Health and Human Services (11 divisions)
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Responsible for promoting economic and social well-being of families, children, individuals, communities
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Administration for Children and Families
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develop comprehensive, coordinated and cost-effective system of home and community-based services to help elderly individuals maintain health and independence in their homes and communities
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Administration on Aging
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To improve quality, safety, efficiency, and effectiveness of health care for all Americans
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Agency for Healthcare research and quality
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serve public through responsive public health actions to promote healthy and safe environments and prevent harmful exposures: regulating public health effect of hazardous substances in environment
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Agency for Toxic Substances and Disease Registry
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CDC 5 strategics areas
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Support state and local health departments
Improve global health Decrease leading causes of death Strengthen surveillance and epidemiology Reform health policies |
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Prevent, Promote, Prepare agency
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CDC
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collaborating to create expertise, information, and tools that people and communities need to protect their health
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CDC
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to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries
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Centers for Medicare and Medicaid Services
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responsible for protecting American people from unsafe or mislabeled food, drugs, and other medical products and to make sure consumers have access to accurate, science-based information about the products they need and rely on every day
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Food and Drug Administration
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To improve health and achieve health equity through access to quality services, skilled health workforce and innovative programs: improving access to health care services for people who are uninsured, isolated, medically vulnerable
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Health Resources and Services Administration
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to raise physical, mental, social, spiritual health of American Indians and Alaska Natives to highest level
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Indian Health Service
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to seek fundamental knowledge about nature and behavior of living systems and application of that knowledge to enhance health, lengthen life, and reduce burdens of illness and disability (improve health and save lives)
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National Institutes of Health
(medical research agency) |
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assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance
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Occupational Safety and Health Administration
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Where is lead found in the environment?
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Paint in old homes
Workplaces (automobiles) Contaminated water or food Commercial products/cosmetics |
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Clinical disease of Glanders and Meliodosis
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Ulcers
Pulmonary Dx Septicemia (g-1 wk and m-48 hrs death) |
