What are the most significant health challenges facing residents of insular areas of the Pacific?
• Health and economic status much worse than United States as a whole, with FAS worse than the territories.
• Health disparities related to urbanization, diet shifting from traditional, local foods to low-quality imported food products, social pathology due to breakdown of traditional systems, and environmental factors such as lack of clean water and proper sewer systems, pollution, and climate change.
• Some areas have high rates of infectious diseases that are rarely seen in developed countries: leprosy, dengue fever, Zika virus, measles, cholera, typhoid fever, TB, and syphilis.
• Micronutrient deficiencies and obesity are caused by poor diet and decreased physical activity.
• High prevalence of adult diabetes.
• USAPI leads the world in obesity-related illness.
• Marshall Islands: radiation exposure from U.S. nuclear testing.
• Frequent natural disasters: tsunamis, typhoons, drought, and rising sea levels.
• Limited capacity of health and relief services; staffing shortages and lack of equipment and supplies.
• Wide dispersion and remote location of populations make delivery of health services difficult; supply lines are logistically difficult and expensive over long distances.
• Limited telecommunications and technology.
• Treatment of chronic diseases requires referrals to other locations, draining health budgets.
• Poor sanitation.
• Epidemics of certain diseases can be more severe since the population in remote areas was not previously exposed.
• High rates of TB, lymphatic filariasis, leprosy, rheumatic heart disease, leptospirosis, intestinal helminths, and diarrheal diseases.
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A physician supervises the care of a 79-year-old woman who is receiving several different therapies at home. The patient is recovering from a fall from a kitchen stool, resulting in a broken ulna and sprained wrist
The physician coordinates the involvement and participation of a private physical therapist and the patient's adult daughter, the patient's power of attorney, and the private home aide who provides assistance with the patient's ADLs. According to the patient's daughter, the patient will not leave her home but received adequate care from the home aide, with positive results from the physical therapy. Over the course of 1 calendar month, the physician spends 35 minutes in supervision of documented physical therapy records, laboratory results, and telephone conference with the patient's adult daughter and home aide. Which of the following best reflects the service(s) provided?
a. Non–face-to-face physician services
b. Care plan oversight services
c. Case management services
d. Domiciliary, rest home (e.g., assisted living facility), or home care plan oversight services
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A. hazard B. triangle C. tetrahedron D. egress
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