Environment versus Genetics in Population Health: Responding to Essentials of Baccalaureate Education for Professional Nursing Practice Diane Cocozza Martins, PhD. R.N. University of Rhode Island, Kingston, R.I. Jackie Janicki, MS, R.N. Salve Regina University, Newport, R.I.
Presenter Disclosures Diane Cocozza Martins, PhD, RN The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose
Objectives 1. Describe a teaching strategy to increase appreciation of environmental and genetic factors in health histories by CHN/PHN. 2. Discuss genetic and environmental health web sites related to population health. Images: www.cdc.gov/ncbddd/bd/genetics.htm http//healtheducationfilms.com/images/s uperstock_1296r-256.medium.jpg
Rationale Public health nursing students can appreciate the dual impact of genetics and environmental exposures on population health problems. The Essentials of Baccalaureate Education for Professional Nursing Practice (2008) describes the outcomes expected of graduates of baccalaureate nursing programs related to genetics and the environment. Essential VII: Clinical Prevention and Population Health. States the baccalaureate program prepares the graduate to: 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. 2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems.
Teaching strategy: Debate The teaching strategy selected to address Essentials VII was the debate. Examples from history utilized to stimulate interest in the debate. PANEL TO SCRUTINIZE AUTISM CASES TASK FORCE TO DETERMINE IF LEOMINSTER OCCURRENCES ARE LINKED TO WASTE SITE (August 11, 1990)
Occupational Hazards and Poor Health Coal workers' pneumoconiosis was the term British investigators used for the first time in 1942 to identify a type of dust disease observed in coal miners. Shipyard Workers - Mesothelioma and Asbestos Exposure Risks
Debates will provide students an opportunity to critically analyze issues impacting the nursing care of populations from an environmental vs. a genetic/biological perspective Debate
Debate Topics Childhood Asthma Acute lymphoblastic leukemia Pancreatic Cancer Breast Cancer Ovarian Cancer Bladder Cancer Macular degeneration Type II Diabetes: Adults Lung cancers Attention Deficit Disorder Type II Diabetes: Children Bone Aging/Osteoporosis Autism Obesity Hypertension Birth defects Schizophrenia Brain cancers or glioma in children Alzheimer s Psychological Disorders: select one
Environmental Perspective http://envirn.umaryland.edu/ http://www.who.int/topics/environ mental_health/en/ http://www.nih.gov/ http://cancer.gov/
Genetic Perpective CDC Public Health Genomics-National Office of Public Health Genomics (NOPHG) promotes the integration of genomics into public health research, policy, and practice to prevent disease and improve the health of all people. Genomics and Health Autism Breast and Ovarian Cancer Heart Disease Iron Overload Lynch Syndrome/Colon Cancer Mental Health Obesity Sickle Cell Disease Stroke
Family History Shared
Pancreatic Cancer: Genetic Factors Genetic alterations involved in pancreatic cancer (PC) include activation of the Kras oncogene The Kras gene is abnormal in 95% of all patients with PC. Genetic alteration in PC also has inactivation of tumor-suppressor genes such as p16 and p53.t he p53 gene that is abnormal in 75% of all PC. Recent studies have suggested that BRCA-2 genes may also play a role in the development of PC. I http://healthmad.com/conditions-and-diseases/human-nightmarethe-worst-killer-cancers/
Pancreatic Cancer: Environmental Factors People that are exposed to carcinogens have a higher risk for developing pancreatic cancer. asbestos pesticides dyes petrochemicals/ petroleum compounds http://www.mskcc.org/mskcc/html /1038.cfm
Bladder Cancer GENETICS Studies suggest that certain genetic traits cause some individuals to detoxify carcinogens more slowly than others, possibly increasing their risk of developing the disease ( Sloan-Kettering Cancer Center, 2010). ENVIRONMENT Occupations have been linked to an increased risk for bladder cancer. People who work in the textile, dye, rubber, leather, printing, or paint industries are at higher risk for the disease because of their exposure to a class of organic chemicals called aromatic amines.
Ovarian Cancer GENETICS Women who have any of the following risk factors have a lifetime risk of up to 1 in 2: mutation in either the BRCA1 or BRCA2 genes mismatch repair gene mutation in either the MLH1, MSH2, or MSH6 genes, ( Sloan-Kettering, 2010). ENVIRONMENT Factors under investigation : solvents, dyes, organic dusts (paper dust, wood dust), triazine herbicides, and talc (when used in the genital area). Occupations with higher rates of ovarian cancer.-working in the graphics and printing industries Studies linking work in the telephone industry with an increased risk of ovarian cancer have raised questions about electromagnetic field (EMF) exposures.
Autism GENETICS Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria (PKU). ENVIRONMENT heavy metals such as mercury), which are more prevalent in our current environment than in the past. http://www.autismsociety.org/site Image from http://www.adoptiondna.com/images/adn_nurture _vs_nature_baby_in_mans_ar ms_0309_01.jpg
The Discussion
Current Research: Toxic Childhood Our children enter the world with more than 200 chemicals in their bodies. They are born prepolluted. What impact is this toxic mix having on the health of our kids? Fifteen percent of children have at least one developmental problem. We have seen relationships between the air pollutants and chromosomal abnormalities, a red flag that there has been some change that could increase risk of cancer later on. Dr. Frederica Perera research at Columbia University's Center for Children's Environmental Health (CCCEH:12 year landmark study)
Backpack Study CNN June 6, 2010 Dr. Frederica Perera followed hundreds of pregnant women as they navigated NYC streets, measuring their exposure to toxic substances, vehicle emissions, pesticides, second-hand smoke. Findings: 100 percent of moms had detectable levels of at least one pesticide and the air pollutants. CCCEH study suggests moms are passing on those toxic chemicals to their babies. So far, the toxics measured in the backpacks match what scientists are finding in the cord blood of the babies once they are born. For fetuses, infants, and children, the primary health effect of methylmercury is impaired neurological development.
Analysis: Individual Behavioral Health Focus to Population Focus Behaviorism and Blaming the Victim Upstream Thinking Critical Social Perspective
The strategy allowed students to understand that genetics and environment may account for more health problems than those caused by negative health behaviors. It also made them realize that health histories need to go beyond individual behaviors.
Questions?
References http://www.cdc.gov/genomics/ http://www.ornl.gov/sci/techresources/human_gen ome/home.shtml http://www.chem-tox.com/cancerchildren/#nytimes http://www.cancer.gov/newscenter/benchmarksvol4-issue3 http://www.genetics.emory.edu/resources.php#facts heets http://www.genome.gov/18016863 http://www.personalityresearch.org/bg.html
Grading The day of your debate, your team must submit a 8 page paper* Title page (APA Format) Abstract and Introduction to the environmental and genetic position. Two pages summarizing the environmental position with references Two pages summarizing the genetic position with references One page with concluding remarks One page of references (a minimum of six professional references) ATTACH FULL ARTICLES from References *APA format required