Burden Final Exam Review
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- Nutrition Transition
- Change from diets high in complex carbs and fiber to more varied diets with increased fat, sat fat and sugar intakes
- Obesity
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Defined by BMI > 30
Leads to higher risks of non-communicable diseases
Seen increasingly w/economic development: postitive correlation in increases in GNP per capita up to $1500 - HAART (Highly Active Anti-Retroviral Therapy)
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Cocktail of 3-4 anti-retroviral meds given often to pregnant women in order to prevent MTCT
MTCT rates w/HAART dropped from 25-35% to 1-2%
Each treatment unique for each infected individual, protects against developing resistant strains, as well - DOTS (Directly Observed Therapy, Short-Course)
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4 drugs, 6 months, 95% success for $10-15
Necessary to avoid MDRTB - Vertical Transmission
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MTCT transmission
Factors increasing risk for:
-Maternal viral load
-Severity of ruptures
-Form of delivery - BMI
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Measure of body composition based on height and weight
Limitations:
-May underestimate body fat in elderly, persons w/low muscle mass
-May overestimate body fat in athletes
-Does not account for posisible genetic differences between ethnic groups - Disease Burden
- Takes both mortality and consequences/adverse effects of morbidity and lack of productivity into account
- Adiposity
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Obesity
Amount of fat (adipose) tissue in the body - DALYs (Disability-Affected Life Years)
- Measure of disease burden; attaches US$ value to each year of life both lost due to premature mortality/morbidity and gained due to health improvements
- QALYs (Quality-Affected Life Years)
- Measure of disease burden looking at quality of life lost due to disease
- Viral load
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Amount of disease in plasma, genital tract
Affects transmission rates; higher viral load indicates more advanced disease - Praziquantal
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Currently, most effective treatment for schistosomiasis
Oral medicine ruptures schistosome's outer membrane, schistosome is flushed out of body in feces (back into environment)
Problematic: needs to be readministered w/each new infection-difficult to distribute enough - Microbicides
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Preventive measure against HIV/STIs
Acts as lubricant, can stand in for condom use - Thrifty Genotype
- Due to cultural histories, energy efficient metabolisms have been favored through natural selection: Now, w/greater abundances of food, these genetic characteristics are contributing to the epidemic of obesity (Samoa)
- Resistance Mechanisms
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Mechanisms leading to antibiotic resistance:
-Alter/Protect Target site
-Enzymatic destruction
-Efflux mechanisms - Poverty
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Defined as <$2/day
Increases risks for infectious diseases
Decreases accessability of health services
Increases likelihood of poor sanitation, lack of clean water -> greater risk - Biological gradient
- Greater risk of contracting disease w/increased exposure
- BCG
- Active TB vaccine w/high rates of success in children, but this result may be contributable to multiple factors, as lack of any success seen w/adults
- Vaccine
- Treatment for communicable diseases, viruses/infectious
- Diabetes Mellitus
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Hormone maladjustment where there is too little insulin/too much sugar in the blood stream
Contributes to risk for cardiovascular disease, obesity, other 'western' diseases - Antenatal Care
- Care provided to a mother prior to the birth of the child to ensure satisfactory health of child and mother
- Lifecycle of A. lumbricoides
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Adults in human small intestine-lay eggs (up to 20,000/day)-Some fertilized, all excreted into environment
If environment ideal (moist, warm soil), fertilized eggs develop
Humans consume infected soil, larvae travel to stomach, small intestine
THrough lumen into blood stream, travel to lungs where they develop further (10-14 days), then burrow through alveolar wall, and are coughed up in fluid
Coughed into throat, swallowed, back into small intestine where they remain - Lifecycle of S. japonicum
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Humans excrete fertilized eggs into fresh water, where mercidiae infect intermediate host (snail)
Develop into cercaria in snail, return to soil-can now penetrate skin
Penetrate human feet, into blood stream-travel passively to lungs
Coughed up into throat, swallowed, to small intestine where they finally develop and remain - Lifecycle of Hookworm
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Infectious filariform larvae enters human host via mouth or skin
In blood stream, carried to lungs, coughed up and swallowed
In small intestine, attaches to lumen wall and develops to adult (feeds on blood meal)-mating occurs, eggs passed out in feces-develop in ideal environment - DALYs as composite indicator of Disease Burden
- DALYs take into account not just consequences of premature mortality, but also adverse effects on quality of life and productivity from morbidity
- Clinical Trial Phases
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Phases 1-3 required for FDA approval; Phase 4 takes place after approval
Phase 1: small number health adults to test adverse effects, safety
Phase 2: small number of adults including a few infected to test efficacy
Phase 3: larger number of infected adults to test safety, side effects, efficacy
Phase 4: long term, huge number of those taking treatment to see long-term effects, ensure safety - Pre-epidemiologic transition health problems
- malnutrition and its consequences; infectious diseases (diarrhea, TB, etc); injury
- Post-epidiologic transition health problems
- Overnutrition and the related chronic diseases (cardiovascular disease, cerebrovascular disease, diabetes, hyptertension); injury
- Modernization indicators
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% men working
% women working in home
% one or two room houses
% w/electricity/television/regriferator/indoor plumbing
% w/automobile - Cardiovascular disease risk factors and Samoa
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Increasing positive energy balances consumed
Decreased physical activity w/modernization
Increased consumption of high-energy foods (often from America) - Epidemiology of Tobacco and cigarette smoking
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4 stages:
1. Male smoking high, female low; both mortalities low
2. Male rates high, female rates increasing; male mortality increasing, female mortality still low
3. Male rates stable high, female rates high; male mortality high, female mortality increasing
4. Male and female rates comparable; mortalities comparable, too - HIV Transmission and Prevention
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Transmission from:
unprotected sex; IV drug use; blood transfusions-increased w/high higher viral loads
Prevention:
Decrease host susceptibility:
-Treat STI
-Condom/microbicide use
Decrease probability of transmission
-Decrease viral load in genital tract (ARV)
-Treat STIs
Alter social environment
-Decrease stigma re: condom use
-Couples interventions
-Structural changes - Components of HIV epidemic growth rate
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Condom use (increased w/education)
Viral load (decreased w/treatment)... - HAART and Alteration of HIV Growth Rate
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HAART decreaess viral load
-lower rates of transmission -> lower rates of transmission through sex and MTCT
longer time infectious -> greater risk of transmission w/o condom use - STD and HIV interactions
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STD infections make an individual more susceptible to contracting HIV through:
-Decreasing mucosal integrity
-Increasing genital ulcers
-Recruiting activated target cells
Increase HIV shedding
-Genital secretions
-Recovery of HIV in genital ulcers - Post-Exposure Prophylaxis
- Preventative treatment administered after possible infection/contact w/infected individual, needle, or blood
- Demographic Transition
- Change from high fertility, high mortality, to high fertility, low mortality, to low fertility to low mortality
- Income inequality and health
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Increased income inequality leads to worse health conditions for teh poor: if rich have money, they can access private health care, so government has less incentive/need to provide public health care
Also: poor have less access to medicines, treatments due to financial constraints - Implications of resistance
- Higher mortality from disease, greater spread to wider swath of population because more drugs needed to treat
- Methods to decrease resistance
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Stop use of non-medical antibiotics (agricultural pesticides)
Greater following of treatment
Quicker diagnosis of MDR diseases so as to slow their spread - Issues allowing TB's persistence
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Crowding/poor ventilation in infected areas
Poverty
Lack of spread in developed world -> no incentive for MDC drug companies to invest in treatment - Health transition in Samoa
- INcreasing rates of obesity, hypertension, CVD, etc, due to nutrition transition and economic development
- MTCT and Prevention
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Transmission from mother to child during:
antenatal period (30%); intrapartum (70%)
To decrease:
-Pre-scheduled Caesarean section
-HAART treatment for both
-Post-exposure prophylaxis for infant - Issues surrounding comdom use
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Stigma attached
Less worry re: future b/c of harshness of present
Concept of masculinity idealizes bravery, flesh-to-flesh
Lack of timely treatment/diagnosis - Globalization
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Increasing connections world-wide
health impacts: faster spread of disease from region to regoin
-Epidemics sprout up in new regions from increased connections
Possible benefits: irenewed efforts on part of developed nations to find treatments for more diseases