Pests (5 pts)

Map the Chain of transmission for Lyme disease indicating the following: * Etiological agent- spirochetes from the genus Borrelia burgorferi. Reduction of host population will limit the number of ticks. I.e. limit deer and rodent population. * Reservoir- ticks. Kill ticks using environmental insecticides. * Transmission- bite from tick carrying the borrelia bacterium in its gut. Use of skin repellants. * Portal of entry- skin -wear long and long sleeved shirts. Wear light colored clothing. * Susceptible host- dogs, deers, rodents. Spray dogs and deers. Reduce population of rodents and deers in the wild.
At each link insert some likely intervention that would prevent the development of Lyme disease.

Food (5pts)

List five consequences of under-nutrition? Osteoporosis, Intrauterine growth restriction, blindness from vitamin A deficiency, Kwashiorkor from protein deficiency, anemia from iron deficiency.

If you had hamburger that you know to be tainted with E. coli and you were stuck in a cave with no other foods and no access to leaving the area for several days, would you eat the hamburger?
I would eat the hamburger but only after I have taken measures to limit the amount of contamination I may be exposed to.
What would do to make the hamburger safe to consume? To make the hamburger safe I would start by making a fire and cooking the hamburger, not only until the pink is not visible in the middle of the meat patty, but until it is slightly charred.
A group of four people went for dinner at the same restaurant and eat from the same buffet line. One person became ill 3 days later. The others have no symptoms of food borne illness. Would you suspect food borne illness? Why or Why not? I would not suspect foodborne illness from the restaurant they all ate at because there is not telling what that one person may have been exposed to prior to coming to the restaurant. That person may have a hypersensitive system and, or a weaker immune system and maybe reacting to something he / she ate before dinner. Note that the pathogen causing the illness may not necessarily be something ingested but perhaps something he/she came in contact with prior to the dinner outing. One cannot determine what the causative agent was from this one person. If it were a foodborne illness then maybe other members of the group would have also become ill if they ate the same thing or came in contact with it.

Workplace (2 pts)

As of 2010 what percentage of the US workforce is women? (0.5 pts) As of 2010, women comprised nearly 47% of the US workforce, according to the Department of Labor.

Is there concern regarding exposure levels to women and fetuses in the workplace? (0.5 pts)
Yes there is a concern regarding exposure levels to women and fetuses in the workplace. There are many agents besides radiation, bacteria, and toxic metals which can affect fertility of cause fetal toxicity. One drug that affects DNA and has dangerous effects on pregnant women and their babies, is Pentamidine. This is an inhaled anti-microbial medication administered to treat Pneumocystis Carinii (now known as Jeravicii). The drug has been found in moderate concentration in the urine of healthcare workers who administered the drug. Because of this drugs effect on DNA, concern has been raise about its exposure to rapidly growly fetal cells (Smaldone et al. 1991). This has encourage nee policy procedure and changes to the equipment setup used to deliver the medication, thereby by limiting risk of exposure.

Lead has harmful effects on the human body especially women and children. The harmful dose is that of 80 µg/dL or more excessive exposure to lead was associated with increased rates of infertility, miscarriage, stillbirth, and poor infant outcomes. Associations between maternal lead exposure, even at low levels, and decreased birth weight or length of gestation have been consistent. There is also some evidence of increased risk for pregnancy related hypertension. These outcomes were noted with maternal BLLs as low as 12µg/dL (http://www.dhs.wisconsin.gov/lead/doc/Chap13Preg&Breast.pdf).

There are indoor air exposures which affect pregnant women and their fetuses too. Some of these include Trichloroethylene (TCE) in indoor air pollutant which is safe according to the EPA at levels of 8 µg/m3 but depending on the length and amount of exposure can cause malformations in fetal heart development in the first 8 weeks of pregnancy and compromises of the immune system (http://www.epa.gov/ttn/atw/hlthef/tri-ethy.html) .
Women who are pregnant stand the risk of birth defects and miscarriages if exposed to radiation in doses of 50-200msv depending on stage of pregnancy (https://hps.org/hpspublications/articles/pregnancyandradiationexposureinfosheet.html).

In many workplaces, the number of workers has been reduced; however, the amount of work being done has not been reduced proportionately. This often results in workers being asked to increase work output dramatically. Do you see any long term health impact that could result from this practice? (1 pt)
Increasing the workload for workers whose numbers have already been reduced to cut costs and save money creates a harmful cycle because worker retention reduces because of dissatisfaction. This means even fewer workers are left with an even heavier workload. Employee health, well-being and happiness drastically reduces thereby diminishing employee morale, productivity, motivation, endurance or retention. Overworked workers have high levels of stress which can lead to high blood pressure and depression, burnout from unrelenting work. Burnout can lead to more mistakes in work, absenteeism which further decreases productivity. This can ultimately lead to businesses closing down and worker being unemployed or workers having to be replaced. This can affect to stress induced by imbalances between work and family.

Ethics (2pts)

Identify one ethical issue that is/was occurring in your community, state or elsewhere.
An ethical issue in the healthcare field is withholding life sustaining therapy prematurely because the family demands so and the patient is unable to communicate their wishes. a. Are you able to identify the organizational ethical principle that was applied?
The organizational ethical principle addressed in this case is the conflict of interest. Something which is common in professional ethics
b. Are you happy/unhappy with the outcome? I usually happy with the outcome because the patient in a critical care setting are already vulnerable as it is. At times life-sustaining therapy means a long road to recovery for both patient and loved ones. The quality of life outside of the hospital is not what it used to be time prior to admission, so depression is often added to the patients list of clinical problem.
c. Was the principle right/wrong of itself or was it appropriately/inappropriately applied?
The principle is right and there are standards in professional ethics that create a framework for which one’s conduct must follow. Professional ethics require that one is impartial in this situation, one respect the family’s wishes even if it opposes our medical and evidence based opinion. As a healthcare provider I am constantly reminded that the patient is center of all focus but the family is part of the patient too. It is family that often comes back to express gratitude or discontent with care provided for their loved ones. Part of my professional responsibilities are withdrawing life support. Despite the families wishes it is my professional responsibilities to explain all the possible options.
d. What organizational principle would be more appropriate or how would the same principle be applied to produce the opposite outcome?
The professional organizational principle that could be applied to produce an opposite outcome would be to encourage thoughtful revision of the family’s decision and other medical interventions. Respecting the patient’s autonomy can be done by not withholding information to patient and family. The fiduciary responsibilities of non-maleficence and beneficence must always be maintained. Beneficence allows to be an advocate for the patient when they cannot communicate what they want themselves. Non-maleficence is a code of conduct that requires that all interventions do not impose any harm. Thoughtful revision of patients’ decisions and respect of autonomy helps ensure no harm is done to the patient and all decisions made are to benefit the patient.