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46 Cards in this Set

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  • Back
Nutrition Transition
Change from high prevalences of infectious diseases and consequences of malnutrition to non-communicable, chronic diseases
Seen w/economic development, occuring at different rates globally
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)
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)
4 drugs, 6 months, 95% success for $10-15
Necessary to avoid MDRTB
Vertical Transmission
MTCT transmission
Factors increasing risk for:
-Maternal viral load
-Severity of ruptures
-Form of delivery
Measure of body composition based on height and weight
-May underestimate body fat in elderly, persons w/low muscle mass
-May overestimate body fat in athletes
-Does not account for posisible genetic differences between ethnic groups
Disease Burden
Takes both mortality and consequences/adverse effects of morbidity and lack of productivity into account
Amount of fat (adipose) tissue in the body
DALYs (Disability-Affected Life Years)
Measure of disease burden; attaches US$ 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
Amount of disease in plasma, genital tract
Affects transmission rates; higher viral load indicates more advanced disease
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
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
Mechanisms leading to antibiotic resistance:
-Alter/Protect Target site
-Enzymatic destruction
-Efflux mechanisms
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
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
Treatment for communicable diseases, viruses/infectious
Diabetes Mellitus
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
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
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
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
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
% 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
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
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
Transmission from:
unprotected sex; IV drug use; blood transfusions-increased w/high higher viral loads
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
Condom use (increased w/education)
Viral load (decreased w/treatment)...
HAART and Alteration of HIV Growth Rate
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
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
Nutrition Transition
Change from diets high in complex carbs and fiber to more varied diets with increased fat, sat fat and sugar intakes
Income inequality and health
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
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
Crowding/poor ventilation in infected areas
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
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
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
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