ASSIGNMENT COVER SHEET Course NameINTRODUCTION TO HOS.docx

ASSIGNMENT
COVER SHEET
Course Name:
INTRODUCTION TO HOSPITAL EPIDEMIOLOGY
Course Number:
PHC-231
CRN:
Presentation title or task:
(You can write a question)
Paper Assignment Topic
1. Discuss Central Line-Associated Bloodstream Infection
(CLABI) "or" Ventilator-Associated Pneumonia (VAP) outbreak
in long-term acute care hospital settings. Address the following
in your report:
a) Characterize the epidemiology and microbiology
b) Describe the agent, and identify the host and the environment
that is favorable for the infection.
c) Discuss how the infections spread and the types of prevention
and control measures
d) Identify a population and develop a hypothesis about possible
causes in a testable format with standard statistical notation (the
null and the alternative)
e) Explain how you would choose controls to test this
hypothesis?
Student Name:
Student ID No:
Submission Date:

Release date: Sunday, March 15, 2020 (12:01 AM)
Due date: Thursday, April 02, 2020 (11:59 PM)
To be filed by the instructor
Instructor Name:
Instructor's Name
Grade:
…. Out of 10
Submission Guidelines:
1. Font should be 12 Times New Roman
2. Heading should be Bold
3. The text color should be Black
4. Line spacing should be 1.5
5. Avoid Plagiarism
6. Assignments must be submitted with the filled cover page
7. Assignments must carry the references using APA style.
Please see below web link about how to cite APA reference
style. Click or tap to follow the link:
https://guides.libraries.psu.edu/apaquickguide/intext.
|---Good Luck---|
Page 2 of 2
Gender as Social Determinant of Health

ObjectivesDifferentiate between sex and gender
Consider the importance of sex and gender as health
determinantsImpact on health outcomes Gender identity and
sexual identity impact on health
Sex: biological and physiological characteristics of males and
females, such as reproductive organs, chromosomes or
hormones.It is usually difficult to change.Example: only women
bear children, only men have testicular cancer
Gender: norms, roles and relationships of and between women
and men. It varies from society to society and can be changed.
Sex and Gender
Gender is socially constructed
Components of gender
Socialization process
Gender Norms
Gender Roles
Gender Relations
Gender Stereotypes
Gender-based division of labor
Gender Norms
Beliefs about women and men
Are passed from generation to generation through the process
of socialization
Change over time
Religious or cultural traditions contribute to defining expected
behavior of men and women at different ages
Many men and women consider gender norms to be the “natural

order of things”
Gender norms lead to inequality if they reinforce:
mistreatment of one group or sex over the other
differences in power and opportunities
Gender roles and relations
Gender roles
What men and women can and should do in a given society
Explain what women and men are responsible for in
households, communities and the workplace
Gender relations
Social relations between and among women and men
Can determine hierarchies between groups of men or women
based on gender norms and roles
Can contribute to unequal power relations
Gender stereotypes and Labor division
Gender stereotypesImages, beliefs, attitudes or assumptions
about certain groups of women and menUsually negative and
based on assumed gender norms and roles
Gender-based division of laborWhere, how and under what
conditions women and men workIncludes formal and informal
market activitiesIncludes work outside the home and tasks in
the community and household (paid or unpaid)

Different roles are not the cause of inequality; it is the value
placed on these roles that leads to inequality.Most societies
ascribe a higher value to masculine norms and roles.
Gender norms, roles and relations affect women and men
differently.Norms and roles that undervalue women often lead
to:social exclusiondecreased access to important resources to
protect their health.Many norms encourage men and boys to
engage in high-risk behavior that harms both themselves and
others.
Pathways to inequality
Gender:
Social Determinant of Health “… taking action to improve
gender equity in health and to address women’s rights to health
is one of the most direct and potent ways to reduce health
inequities and ensure effective use of health resources.”
“Gender inequality damages the health of millions of girls
and women across the globe. It can also be harmful to men’s
health despite the many tangible benefits it gives men ….
These benefits to men do not come without a cost to their own
emotional and psychological health …”
Sen G, Östlin P for the Women and Gender Equity Knowledge
Network. Gender inequity in health: why it exists and how to
change it. Final report to the WHO Commission on Social
Determinants of Health. Geneva, World Health Organization,
2007.
Health DifferencesWomen live longer than men, an average of 5
years longer, but they tend to be “sicker” than men When social
discrimination decreases, women’s life expectancy increases

Men have higher rates of fatal illnesses
Men have more toxic occupational exposure
Men have higher rates of injuries (both intentional and non-
intentional)
Gender inequality
High gender equality is associated with:
Low child mortality, low rates of stunting and wasting
Higher rates of health care utilization for maternal, child, and
reproductive health services (including STI/HIV)
Lower rates of maternal mortality
Lower rates of gender-based violence
High gender inequality is associated with lower health outcomes
Gender Inequality is a driver of many health outcomes such as,
global AIDS epidemic
The reason we must think about gender and M&E is because it
has a powerful impact on health status outcomes. Studies for 25
years have documented that gender, measured in a variety of
ways, influences a range health outcomes, including HIV/AIDS.
This effect has shown to be independent of other factors.
In other words, these health outcomes are influenced by gender
equality regardless of economic and educational status, age,
religion, urban or rural residence and a host of other factors.
These factors mediate the effect of gender. For example, in the
Indian state of Uttar Pradesh, it was observed that poor women
with low autonomy are less likely to use antenatal and delivery
care than are their wealthier counterparts with low autonomy,

but poor women with higher autonomy were more likely to use
maternal health services than richer women with low autonomy.
This applies to almost any health outcome studied. We next
focus on HIV/AIDS.
*
Sex/Gender Differences in Cardiovascular Disease
Figure 1. Annual number of adults having diagnosed heart
attack or fatal coronary heart disease (CHD) by age and sex.
Mosca, L., Barrett-Connor, E., & Kass Wenger, N. (2011).
Sex/gender differences in cardiovascular disease prevention:
what a difference a decade makes. Circulation, 124(19), 2145-
2154.
*
Women’s Health InitiativeOriginally enrolled 161,808 women
aged 50-79 between 1993 and 1998. Now extended to 2020.

Regitz-Zagrosek V. (2012). Sex and gender differences in health
Science & Society Series on Sex and Science. EMBO
reports, 13(7), 596-603.
Gender and health carehttps://youtu.be/GjINFuwLGvQ
Gender Disparities and society
Gender Pay Gap
Gender gap in pension plan
Employment
What is Gender Analysis?
Gender analysis draws on social science methods to
examine relational differences in women’s and men’s and girls’
and boys’

roles and identities
needs and interests
access to and exercise of power
and the impact of these differences in their life and health.
*
Refer to what participants have shared, and note that in short,
gender analysis is the process of identifying gender inequalities
and determining their programmatic and developmental
implications. That is, gender analysis identifies and examines
the social constructions of what it means to be a woman and girl
or man or boy and how these impact the lives and health of
women and girls and men and boys.
To understand gender relations …
Examine different domains of gender relations
Practices, Roles, and Participation Knowledge, Beliefs, and
Perceptions Access to Resources Rights and Status
POWER
POWER
*
To understand gender relations more concretely, gender analysis
approaches (and tools) often choose to focus on specific
“aspects” or “slices” of social and cultural relations in a given
context. The specific “aspects” or “slices” of social and cultural
relations chosen for focus in an analysis are referred to as
“domains.” Domains frequently analyzed in reproductive health
programming include practices, roles, and participation;

knowledge, beliefs, and perceptions (many of which are
normative—that is, provide norms for what is appropriate
behavior for women and men); access to assets; rights and
status; and (related to all of these) power.
Note: PEPFAR also has specified key areas of gender relations
that need to be addressed to meet PEPFAR goals. These areas
highlight specific concerns related to these broader domains.
[Note to facilitator—if PEPFAR and HIV programming is a
focus for participants, add a slide after this one that outlines the
focus areas in the new legislation.]
Different Contexts
Gender constraints and opportunities need to be
investigated in specific contexts, as they vary over time and
across …
Social RelationshipsPartnerships HouseholdsCommunitiesCivil
society and governmental organizations/institutions
Sociocultural ContextsEthnicityClassRaceResidenceAge
*
Remind participants that although we have been talking about
gender and power relations, gender relations are linked to a host
of other power relations at work in a specific context—such as
power relations of ethnicity, class, race, and age. Gender
relations also vary by context—that is, the type and degree to
which a woman (or man) experiences gender constraints may be
very different in a household and in a work context.
Thus, gender relations and gender analysis vary according to the
specific context in which they are occurring. Therefore,

although some gender patterns may appear remarkably similar
across contexts, it is critical to understand the specific relations
(and ongoing changes and contradictions in these relations)
across time, in different organizational contexts, and in
different sociocultural contexts.
Power
Gender relations influence people’s ability to freely decide,
influence, control, enforce, and to engage in collective actions.
Decisions about … One’s bodyChildrenAffairs of household,
community, municipality, and stateUse of individual economic
resources and income Choice of employmentVoting, running for
office, and legislatingEntering into legal contractsMoving about
and associating with others
*
Power
Taken together, these four domains ultimately affect the ability
of people to decide, influence, control, and enforce a decision—
that is, the ability of people to have the power to make
decisions freely and to exercise power over one’s body and
within an individual’s household, community, municipality, and
the state. This includes the capacity of adults to decide about
the use of household and individual economic resources,
income, and their choice of employment. It also encompasses
the right to engage in collective action, including the
determination of rights to and control over community and
municipal resources. Finally, it includes the capacity to exercise
one’s vote, run for office, be an active legislator, and to enter
into legal contracts.
Specific areas of control over decisions includeOne’s
bodyChildrenAffairs of the household, community,

municipality, and stateThe use of individual economic resources
and income Choice of employmentVoting, running for office,
and legislatingEntering into legal contractsMoving about and
associating with others
Are there any other domains of decision making that are not
included on this list but may impact on (the area of reproductive
health being considered for the training, such as safe
motherhood), as well as broader health and well-being?For
instance, how do power relations—or constraints to the ability
to make decisions—affect (the program areas being considered,
such as safe motherhood)? What are some examples from the
cases already discussed in the training and in participants own
experiences of a lack of power and control? How do these
affect (the program area being considered, such as safe
motherhood)?How does gender-based violence relate to power
and control? How does it impact (the program area being
considered, such as safe motherhood)?
In short, Gender Analysis reveals …
= gender relations
(in different domains) that facilitate men’s or women’s access
to resources or opportunities of any type.
= gender relations
(in different domains) that inhibit men’s or women’s access to
resources or opportunities of any type.
Gender-based Opportunities
Gender-based Constraints
*

Summarize that, in short, gender analysis seeks to
systematically reveal the gender-based constraints (and
sometimes opportunities) to achieving a particular program
objective. To systematically reveal these constraints and
opportunities, gender analysis usually focuses on specific
domains (such as the 4 we have just reviewed).
Gender Analysis Example: AIDS
U.S. President's Emergency Plan for AIDS Relief (PEPFAR):
Five Key Legislative Issues
Increasing gender equity in HIV/AIDS
activities and services
Reducing violence and coercion
Addressing male norms and behaviors
Increasing women’s legal protection
Increasing women’s access to income and productive resources
*
The five cross-cutting, strategic areas reflect language in the
original PEPFAR legislation from 2003.
Specifically, PEPFAR asks that programsIncrease gender equity
in HIV/AIDS programs;Reduce violence and coercion;Address
male norms and behaviors;Increase women’s legal rights;
andIncrease women’s access to income and productive
resources.
Interventions in these areas are described in the COP activity
narratives and coded by area.

PERFAR
Increased gender equity: PEPFAR-supported programs should
promote proactive and innovative strategies to ensure that men
and women and girls and boys have access to prevention, care,
and treatment services. This includes tailoring services to meet
the unique needs of various beneficiary groups.
2. Addressing male norms and behaviors: Men can play a
critical role in promoting gender equity, preventing violence,
and promoting sexual and reproductive health. Recognizing
that men can either impede or promote health interventions,
PEPFAR encourages country teams to develop programs that
promote positive male engagement and behavior change.
PERFAR
3. Reducing violence and coercion: Women who live in fear for
their lives (and their children’s lives) and who are unable to
make their own decisions about sex are at a greatly increased
risk of becoming infected with HIV. … Reducing violence
against women increases their access to services and their
ability to negotiate safer sex and take advantage of education
and employment activities.
4. Increasing access to income and productive resources:
PEPFAR recognizes that women’s and girl’s lack of economic
assets increase their vulnerabilities to HIV. Providing women
with economic opportunities (increasing access to employment,
training, and microfinance activities) empowers them to avoid
high-risk behaviors, seek and receive healthcare services, and
better care for their families.

PERFAR
5. Increasing legal protection: Many of the norms and
practices that increase women’s vulnerability to HIV and limit
their capacity to deal with its consequences are reinforced by
policies, laws, and legal practices that discriminate against
women. Women denied enforceable legal rights and protections,
including property and inheritance rights, are often unable to
meet the basic needs of survival for themselves and their
children, increasing their vulnerability to HIV.
Gender / Sexual identities
Gender Expression: External appearance of one's gender
identity, usually expressed through behavior, clothing, haircut
or voice, and which may or may not conform to socially defined
behaviors and characteristics typically associated with being
either masculine or feminine.
Gender Identity: One's innermost concept of self as male,
female, a blend of both or neither – how individuals perceive
themselves and what they call themselves. One's gender identity
can be the same or different from their sex assigned at birth.
Sexual orientation: An inherent or immutable enduring
emotional, romantic or sexual attraction to other people.
Transgender: An umbrella term for people whose gender
identity and/or expression is different from cultural
expectations based on the sex they were assigned at birth. Being
transgender does not imply any specific sexual orientation.
Therefore, transgender people may identify as straight, gay,
lesbian, bisexual, etc.
Gender Identity Development
Gender identity is developed in three stages:
Construction (ages 0–5 years)

Consolidation (ages 5–7 years)
Integration (ages 7 years and up)
Some research suggests that three external factors may
influence how a person develops and ultimately expresses their
gender identity:Centrality Evaluation Felt pressure
During construction, children seek information about gender
and do not necessarily react strongly to norm violations (e.g., a
boy may play with a Barbie doll). In the consolidation phase,
children have well-developed gender stereotypes and show
rigidity about their gender beliefs (e.g., a boy may avoid or
refuse to touch a Barbie doll). Lastly, in the integration phase,
children may show more flexibility and individual differences
in how they think about gender (e.g., a boy may choose to play
with certain types of dolls).
REFERENCES:
Lurye, L.E., Zosuls, K.M., & Ruble, D.N. (2008). Gender
identity and adjustment: Understanding the impact of individual
and normative differences in sex typing. In M. Azmitia, M.
Syed, & K. Radmacher (Eds.), The Intersections of Personal and
Social Identities: New Directions for Child and Adolescent
Development, 120, 31–46.
*
Health concernsMSM and other LGBT people have similar
health concerns as others, as well as some additional
concernsImportant to engage the whole person, not a collection
of risk factors Important to
understand that LGBT life issues are similar to others, but also

unique:
Families, Coming Out
Long Term Relationships
Reproduction, Parenting
Mental Health
Chronic Diseases
Communicable Diseases
LGBT Disparities: Healthy People 2020
LGBT youth
2 to 3 times more likely to attempt suicide.
More likely to be homeless (20-40% are LGBT)
LGBT populations have the highest rates of tobacco, alcohol,
and other drug use
Gay men are at higher risk of HIV/STDs, especially among
communities of color.
Lesbians are less likely to get preventive services for cancer.
Lesbians and bisexual females are more likely to be
overweight or obese.
*
LGBT Disparities: Healthy People 2020Transgender individuals
have a high prevalence of HIV/STI’s, victimization, mental
health issues, and suicide. They are less likely to have health
insurance than heterosexual or LGB individuals.Elderly LGBT
individuals face additional barriers to health because of
isolation and a lack of social services and culturally competent
providers.

Mental HealthA study that examined the risk of psychiatric
disorders among individuals with same-sex partners found that,
during the previous 12 months, women with same-sex partners
experienced more mental health disorders–such as major
depression, phobia, and post-traumatic stress disorder–than did
women with opposite-sex partners. Studies have found that
lesbians are between 1.5 and 2 times more likely to smoke than
heterosexual women.A number of studies have also suggested
that lesbians are significantly more likely to drink heavily than
heterosexual women.Bisexual women report more hazardous
drinking than heterosexual or lesbian women.
Many factors affect the mental and emotional health of lesbian
women. For example, a research study found that adverse,
punitive, and traumatic reactions from parents and caregivers in
response to their children’s sexual orientation were closely
correlated with poor mental health and an increase in substance
use.
Studies have found that lesbian and bisexual women consult
general practitioners for emotional reasons more often than
heterosexuals if their primary care physician is aware of their
sexual orientation. However, not all lesbian and bisexual women
want to disclose their sexual orientation.
REFERENCES:
Ryan, C., Huebner, D., Diaz, R.M., Sanchez, J. (2009). Family
rejection as a predictor of negative health outcomes in White
and Latino lesbian, gay, and bisexual young adults. Pediatrics,
23(1), 346–352.

Gilman, S.E., Cochran, S.D., Mays, V.M., Hughes, M., Ostrow,
D., & Kessler, R.C. (2001). Risk of psychiatric disorders among
individuals reporting same-sex sexual partners in the national
comorbidity survey. American Journal of Public Health, 91,
933–939.
King, M., & Nazareth, I. (2006). The health of people classified
as lesbian, gay, and bisexual attending family practitioners in
London: A controlled study. BMC Public Health, 6, 127.
*
Suicide
Results from an anonymous survey administered in 33
healthcare sites across the United States found that:
Lesbian and bisexual women who were “out” experienced more
emotional stress as teenagers and were 2 to 2.5 times more
likely to experience suicidal ideation in the past 12 months than
heterosexual women; and
Lesbian and bisexual women who were not “out” were more
likely to have attempted suicide than heterosexual women.
This survey also showed that sexual orientation was associated
with higher levels of emotional stress and other types of mental
health disorders.
REFERENCES:
Koh, A.S., & Ross, L.K. (2006). Mental health issues: A
comparison of lesbian, bisexual and heterosexual women.
Journal of Homosexuality, 51(1), 33–57.
*

Substance AbuseSome studies show that gay men use
substances, including alcohol and illicit drugs, at a higher rate
than the general population.Many studies also indicate that gay
men use tobacco at much higher rates than straight men—
reaching nearly a 50 percent difference in some cases.
Recent studies have improved our understanding of substance
use in the gay community. Higher substance abuse rates have
been found among gay men in many places, not just in larger
communities such as New York, San Francisco, and Los
Angeles.
REFERENCES:
Ostrow, D.G., & Stall, R. (2008). Alcohol, tobacco, and drug
use among gay and bisexual men. In Wolitski, R. J., Stall, R., &
Valdiserri, R. O., (Ed.) Unequal opportunity: Health disparities
affecting gay and bisexual men in the United States. New York:
Oxford University Press.
Centers for Disease Control and Prevention. (2010). CDC fact
sheet, substance abuse among gay and bisexual men. Atlanta:
Author.
Irwin, T.W., Morgenstern, H., Parsons, J.T., et al. (2006).
Alcohol and sexual HIV risk behavior among problem drinking
men who have sex with men: An event level analysis of timeline
follow-back data. AIDS and Behavior, 10(3), 299–307.
Wong, C.F., Kipke, M.D., Weiss, G. (2008). Risk factors for
alcohol use, frequent use, and binge drinking among young men
who have sex with men. Addictive Behaviors, 33(8), 1012–
1020.

Stall, R., Paul, J.P., et al. (2001). Alcohol use, drug use and
alcohol-related problems among men who have sex with men:
The Urban Men’s Health Study. Addiction, 96(11), 589–601.
Padilla, Y., Crisp, C., & Rew, D.L. (2010). Parental acceptance
and illegal drug use among gay, lesbian, and bisexual
adolescents: Results from a national survey. Social Work, 55(3),
265–275.
Halkitis, P.N., Mukherjee, P.P., & Palamar, J.J. (2009).
Longitudinal modeling of methamphetamine use and sexual risk
behaviors in gay and bisexual men. AIDS and Behavior, 13(4),
783–791.
Lee, J.G., Griffin, G.K., et al. (2009). Tobacco use among
sexual minorities in the USA, 1987 to May 2007: A systematic
review. Tobacco Control, 18(4), 275–282. From
http://tobaccocontrol.bmj.com/content/18/4/275.long (accessed
June 1, 2011).
Gruskin, E.P., Greenwood, G.L., Matevia, M., Pollack, L.M., &
Bye, L.L. (2007). Disparities in smoking between the lesbian,
gay, and bisexual population and the general population in
California. American Journal of Public Health, 97(8), 1496–
1502.
Greenwood, G.L., Paul, J.P., et al. (2005). Tobacco use and
cessation among a household-based sample of U.S. urban men
who have sex with men. American Journal of Public Health,
95(1), 145–151. From
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449276/pdf/095
0929.pdf (accessed June 1, 2011).
*

ConclusionsDevelop indicators for analysis, monitoring and
evaluationData disaggregated by sex and analyzed from a
gender perspectiveDisseminate information on gender and
healthTrain health workers to employ a gender
perspectiveIncrease women’s participation in:
Defining health priorities
Planning solutions, policies and programs
Demanding accountability
*
Instructions
General Guidelines:
Writing 20%
• Paper meets APA/Graduate School standards; in-text citations
and references are properly documented in APA format.
• Paper includes a minimum of fifteen (15) (double-spaced,
numbered) pages and at least fifteen scholarly sources.
• Paper is organized; each paragraph flows logically into the
next paragraph. Headings and sub-headings are utilized.
• Appropriate terminology it used; writing is clear and concise.
• Proper spelling and grammar is used; sentences are properly
constructed.
• Appropriate font (Times New Roman) and font size (12 point
font).
• The paper is written in a professional tone. Familiar language
is avoided.
Content 80%
• The paper has a strong introduction, main body, and
conclusion.
• The topic is introduced, a purpose is clearly evident and an
overview of the paper is provided; includes a brief history of
the topic/issue, and the importance of studying the topic/issue.

• The research paper goes from general ideas to specific
conclusions within each paragraph. Transitions tie sections
together, as well as adjacent paragraphs. The paper flows
logically from one idea to the next.
• Scholarly research is utilized and effectively described in the
main body of the paper; information is synthesized throughout
the paper; includes a relevant and thorough discussion of
sources that relate to the topic/issue and purpose of the paper.
• The paper demonstrates critical and creative thinking skills.
• Concluding paragraphs provide a summary of key points,
connects to the introduction, and offers suggestions for future
research and/or recommendations for policy
changes/considerations.
Week 7 Written Assignment Rubric (Research Paper)
___/20: Writing/format/title page/length.
___/10: Introduction/purpose/importance.
___/10: Organization/transitions.
___/25: Synthesis of scholarly research.
___/25: Critical and creative thinking.
___/10: Conclusions/recommendations.

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