What are the "Person Factors" that estimate risk (Who & What)?
3) Health Status
4) Psychosocial profile
7) Activity Level
What are the "Place Factors" that estimate risk (Where)?
1) Global position
2) Development & Stability
What are the "Time Factors" that estimate risk (When)?
2) Time of Day
This is raw data that MAY BE of interest to planners
This is analyzed and interpreted data THAT IS of interest to planners
What is the significance of medical intelligence?
Operational level- develop health service support strategies
What are the "Strategic Sources" of MEDICAL intelligence?
National Committee for Military Intelligence (NCMI) is the single authoritative producer of medical and technical intelligence on foregin health threats and other medical intelligence issues to protect and advance US interests worldwide
What are the "Tactical Sources" of MEDICAL intelligence?
S2/G2/J2 and special Military Intelligence units in combat zone
* What does the NCMI provide?
1) Trends and Forecasts (Indications & Warnings)
2) Health risk/Hazard assessments
3) Health services assessment
4) Facility Database
* What does the NCMI NOT provide?
1) Recommend medical treatment protocol
2) Approved/Authorized prophylaxis
3) Medical Policy
4) Medical doctrine
What is the focus of the NCMI Risk Assessment?
What the commander needs to know
- What percentage of personnel are likely to be affected by a disease?
- How many days will likely be lost per case?
* What are the assumptions underlying the National Committee for Military Intelligence (NCMI) risk assessment?
1) A healthy US military force (routine vaccines, but no immunity to most tropical diseases)
2) Field conditions (e.e tents, crowding, field sanitation, and vector exposure)
3) Access to local economy
4) Minimal contact with household-type exposure in the local population
* What is the Risk Level Matrix?
A tool that can be used to determine level of risk during an activity using levels of disease severity & levels of disease expectance in troops
What is residual risk?
Risk remaining after known threats have been mitigated
Describe the historical significance of Disease & Non-Battle injuries (DNBI)
DNBI can have a rapid and widespread impact on the effectiveness of military organizations (Look at the Civil War)
*This is the ongoing collection and analysis of health data dissemination of information
*What are the three generic "purposes" of medical surveillance?
1) Identify public health problems
2) Stimulate public health interventions
3) Suggest hypotheses for epidemiological research
* What are the important public health "functions" of medical surveillance?
1) Detection of epidemics
2) Identification of significant events
3) Detection of changes in disease agents
4) Plans & Priorities for interventions
5) Projection of future health problems
*What do these important public health "functions" of medical surveillance serve as?
An early warning system
*What are the "objectives" of medical surveillance?
1) Determine extent of disease occurence (Baseline rates and trends)
2) Detect and monitor outbreaks
3) Indentify contacts & administer prophylaxis
4) Increase knowledge of disease processes
5) Generate hypotheses about disease etiology
What are the two types of surveillance?
This type of surveillance is described as the following:
1) Provider Based
2) Mandated reporting
3) Most frequently used (local, state, public health systems, DoD)
This type of surveillance is described as the following:
1) Health agency or PM based
2) Periodic field visits by project staff
3) Involves interviews, record reviews, pre-generate reports, etc
What are the advantages of "passive" surveillance?
2) Easy to develop initially
3) Allows for internal comparisons
What are the drawbacks of "passive" surveillance?
2) Can miss local outbreaks - Underreporting - May miss a widespread problem if it is an internal system
What are the advantages of "active" surveillance?
1) Generally more accurate
2) Local outbreaks identified
What are the drawbacks of "active" surveillance?
1) More expensive
2) Difficult to develop initially
What is the TRISERVICE reportable events list?
1) Selected communicable and environmental diseases of military importance
2) Heat and cold injuries
3) Outbreak. generalized
There is a long list of diseases/events in the TRISERVICE reportable events. What diseases/events are NOT included in this list?
3) Occupational injuries/illnesses
~These are reported through other mechanisms
Describe the comprehensive military medical surveillance process
1) Threat/risk assessments
2) Hospital admission rates
3) Reportable medical events
4) DNBI rates
Communicable Disease Control
What are the 3 levels of prevention?
This level of prevention is prior to exposure to disease source; remove causes
What is included in Primary prevention?
1) Health promotion/education
2) Nutrition/diet supplementation
3) Adequate housing, recreation, agreeable working conditions
5) Environmental sanitation
6) Protection against occupational hazards
This level of prevention occurs after exposure, but prior to the onset of symptoms or complications of the disease?
What are the clinical effects of Choline under severe exposure??
1) Severe dyspnea at rest
2) May cause pulmonary edema within "30-60 min"
3) Copious upper airway secretions
4) Sudden death may occur from laryngospasm
What are the clinical effects of Phosgene under severe exposure??
1) Severe dry cough
2) Onset of pulmonary edema with "4 hours"
3) May produce laryngospasm
- Latent period (S/S onset more rapid with higher exposure)
- exacerbated by exercise
This pulmonary agent is an Organoflouride polymer (PFIB) - polytetrafluoroethylene "Teflon" - Many commerical uses - Used in armor vehicles and aircraft
*Toxic combustion by products
What is 10 times more potent than Phosgene?
PFIB (but patients will have a latent period of 1-4 hours, followed by dyspnea and edema. These patients usually recover within 72 hours w/o sequela
What are the Properties/characteristics of HC Smoke?
Obscurant smoke with many combustion products
What happens with mild exposure to HC smoke?
2) Lab findings normal (monitor x 4-6 hours)
What happens with moderate exposure to HC smoke?
1) Initial severe dyspnea, resolves spontaneously in 4-6 hours
2) Return of symptoms within 24-36 hours
3) CXR initially clear, later dense infiltrates
5) Bronchopnuemonia may lead to interstitial fibrosis
What happens with severe exposure to HC smoke?
1) Rapid onset; severe dyspnea
2) Paroxsymal cough with bloody sputum
3) Hemorrhagic ulceration of upper airway
4) Rapid onset pulmonary edema
5) Laryngeal edema/spasm, death
Describe ways to be exposed to nitrogen oxide (NOx)
1) High temp combustion (arc welding)
2) Nitrate-based explosives (enclosed spaces)
3) Disel engine exhaust
What are the clinical effects of Nitrogen Oxide(NOx)?
1) Similar to HC Smoke - May remit spontaneously - Exacerbated by exertion
2) Long latent period - may be asymptomatic for 2-5 weeks
3) Fibrotic changes may occur - Pulmonary Function Tests (PFTs) may show chronic airway obstruction
***Young person exhibiting COPD symptoms? ---> Think NOx exposure
What is the general therapy for pulmonary agents?
1) Terminate the exposure
2) Rescucitate- ABCs
3) Maintain strict bed rest
6) Observe for 6 hours - If abnormal, assess for additional 24 to 36 hours - provide supportive care
CBRNE (Medical Response to Bioterrorism)
What are the key features of biological weapons?
1) Availability or ease of production
2) Incapacitation and lethality
3) Appropriate particle size in aerosol
4) Ease of dissemination
5) Stability after production (as opposed to some volatile chemical weapons)
6) Susceptibility and Non-Susceptibility
What are the advantages of biological weapons?
1) Potentially deadly or incapacitating effects
2) Self-replicating capacity
3) Relative low cost
4) Insidious symptoms
5) Difficult to detect
6) Spares property and surroundings
What are the disadvantages of biological weapons?
1) Can affect aggressor force
2) Dependence on weather for dispersion
3) Effects of temperature, sunlight, etc on organism
4) Environmental persistence
5) Generation of secondary aerosols
6) Unpredictable morbidity and mortality
7) Relatively long incubation periods
8) Publics aversion to their use
What are the indications of a possible biological attack?
M-A-S-H A L-L-U-M-P
• Military & civilian casualties • Apparent aerosol route of infection • Sentinel dead animals • High morbidity or mortality • Absence of natural vector • Low attack rates in special populations • Localized illness • Unusual disease entity • Multiple diseases in the same patient • Point source outbreak
This category of the CDC's Critical Biological Agents is characterized as the following:
1) "Easily transmitted" or spread from person to person
2) "High Mortality", potential major public health impact
3) Might cause public panic and social disruption
4) Require special attention for public health readiness
What are some examples of "Category A" CDC Critical Biological Agents?
1) Variola Major (Smallpox)
2) Bacillus Anthracis (Anthrax)
3) Yersinia Pestis (Plague)
4) Clostridium Botulinium Toxin (Botulism)
5) Francisella tularensis (Tularemia)
7) Arena viruses
This category of the CDC's Critical Biological Agents is characterized as the following:
1) Moderately easy to disseminate
2) Cause "Moderate morbidity and low mortality"
3) Requires special enhancements's of CDC's diagnostic capacity and enhanced disease surveillance
What are some examples of "Category B" CDC Critical Biological Agents?
1) Coxiella burnetti (Q-fever)
2) Brucella species (Brucellosis)
3) Burkholderia Mallei (Glanders)
4) Alphavirses - VEE, EEE, WEE
5) Ricin toxin from Ricinus Communis (Castor Beans)
This category of the CDC's Critical Biological Agents is characterized as the following:
-Emerging pathogens that could be engineered fro mass dissemination in the future
What are some examples of "Category C" CDC Critical Biological Agents?
1) Nipah virus
3) Tickborne hemorrhagic fever viruses
4) Tickborne encephalitis viruses
5) Yellow fever
6) MDR Tuberculosis
What are the principles of consequence management?
2) Isolation and Quarantine
3) Mass patient care
4) Mass logistics
5) Mass prophylaxis
6) Mass fatalities
1) Overt release - Decon on site - Control access to "hot zone"
2) Covert Release - Protect facility and personnel - Notify Federal authorities
What are the considerations that need to be made with "Isolation and Quarantine?'
1) Is it warranted?
2) Is it feasible?
3) Benefits outweigh consequence?
What factors are included in "Mass patient care"?
3) Infection control
4) Surge capability (Patient transfers, Isolation wards, and cohorting, Ancillary care centers)
What are the factors of "Mass logistics"?
1) Local stock piles
2) Strategic National Stockpiles
What factors need to be considered with "Mass Prophylaxis"?
1) May be needed to be distributed in large numbers
2) It is the responsibility of every public health jurisdiction in the country to develop and maintain the capability to respond to bioterrorism events, dispense antibiotics, and carry out vaccination campaigns tailored to its local population
Who is involved in managing "Mass Fatalities"?
1) Healthcare organizations
2) Local medical examiners
What are the general medical management principles of dealing with a potential biological casualty?
1) Maintain a healthy index of suspicion
2) Protect yourself
3) Save the patient's life (primary assessment)
4) Disinfect/Decontaminate as appropriate
5) Establish a diagnosis (secondary assessment)
6) Provide prompt therapy
7) Institute proper infection control measures
8) Alert the proper authorities
9) Conduct an epidemiological investigation (& manage psychological aftermath of attack)
10) Maintain a level of proficiency
Emerging infectious diseases are among the most important future threats facing both military & civilian populations. Future threats are difficult to predict, but should include:
1) Molecular biology
2) Resurgence of old diseases
3) Genetic engineering
What are the unique challenges of radiation events?
1) Medical Response infrastructure untested for major radiological events in the U.S
2) Clinician inexperience with radiation injuries
3) Could be an exceptionally large number of casualties
4) Large numbers of concerned people with little or no exposure
5) Fear of radiation exposure expressed by public and caregivers
What are the different types of ionizing radiation?
1) Alpha - Internal hazard (toxic if swallowed), can be stopped by paper & skin
2) Beta - Internal & external hazard, can be stopped by clothes (e.g. ACUs/BDUs), skin burns may result from high dose/rate
o Exercise > 3 hours requires fluids, up to 90g carbs/hour (multiple transportable carbs)
The goals of Post-exercise supplements are to replenish & repair the body, what are they?
o Consuming carbs & protein after a hard workout will enhance recovery • Carbs - Glycogen replenishment, increase insulin levels • Protein - Halt protein degradation, May enhance protein synthesis, May assist with glycogen replenishment when carb intake is inadequate
o Fluids should replace weight lost during workout (24oz- 32oz for every pound)
If a soldier asks me what is the maximum amount of protein that they should consume in one sitting, what should I tell him?
20-25g. Anything more will be oxidized
Medical Preparation for deployment
What is deployment readiness processing?
The verification of an individual service member's readiness for deployment (NOT just a medical process)
What are the purposes of Medical/Dental Processing?
• To ensure that soldiers are "fit to deploy"
• To ensure that all "preventive measures" have been completed
• Establish a pre-deployment "medical baseline"
• For "forensic" purposes
• To "identify" any soldiers who are medically or dentally "non-deployable"
What are the conditions required for deployment of soldiers with pre-existing medical conditions?
• The condition is stable and NOT expected to be impacted by deployment conditions
• Unexpected worsening of the condition will NOT result in a medically grave outcome
• On-going health care needs & medications are available in theater and require no special handling or storage
• No duty limitations or accommodations required
What is the requirement for completing a pre-deployment health questionnaire and what is it called?
• DD Form 2795 - Pre-Deployment Health Assessment requirements @ Home Station/Processing Station o Completed/signed 30 days prior to deploying; MUST BE REVIEWED AND SIGNED BY PROVIDER; Positive responses MUST BE REFERRED to a health care provider for appropriate follow-up.
What is the immunology process and its relation to immunizations?
When can 2 or more "inactivated" vaccinations be administered?
They can be administered at the same time, or at any interval
When can 1 live & 1 inactivated vaccine can be administered?
They can be administered at the same time, or at any interval
When can 2 live vaccines be given?
They must be administered simultaneously, or have a 4 week (minimum) interval
Describe how PPD and live vaccines are given
- They can be administered on the same day (must apply PPD first)
- If live vaccine administered first, wait 4-6 weeks for PPD
What is the Vaccine Adverse Events Reporting System (VAERS)?
It is a national vaccine safety surveillance program that is co-sponsored by the CDC and FDA
What is the function of Vaccine Adverse Events Reporting System (VAERS)?
It is a early warning system (signal detection) for potentially clinically serious vaccine adverse events or health outcomes
Can anyone file a VAERS?
When is filing a VAERS mandatory?
o Hospitalization due to vaccine
o 24hr loss of duty from illness/injury/reaction to vaccine
o Event is on VAERS reportable events table
o Event is on the NVCIP vaccine injury table
o Contamination of vaccine lot is suspected
o Adverse Event results in a permanent medical exemption (MR)
What are Robust Take +/- systemic symptoms?
o Onset usually 8-10days
o Symptomatic treatment with rest, analgesics
o Usually resolves in 24-72 hours
o Not a reason to exempt from future vaccination
What are Local and Systemic Reactions?
1) Local reactions are the most frequently noted reactions among vaccines
2) Common systemic reactions • fever, headache, muscle aches
3) Usually responsive to symptomatic therapy (NSAIDS) within 72 hours
Describe Vaccine Hypersensitivity
History is crucial - Must meet immunologic criteria
Describe a bacterial infection with a Vaccinia-Specific adverse event (bacterial infection) "Vaccinia refers to the vaccination that eradicated smallpox"
1) Systemic Infection • Staph and strep are most likely culprits • Super infection of the Vaccination Site or Regional Lymph Nodes (< 0.5%) • The frequency is not truly known • Historically more common in children than adults • When in doubt, culture it
2) Robust Take • Robust Take seen in up to 15% • Onset typically 8-10 days • May be a viral cellulitis (NOT bacterial) due to viral replication while the immune system mounts a response • Majority "cellulitis" cases are robust takes
Describe satellite lesions from Vaccinia
o Frequency varies from 2.4-6.6% o Probably more frequent, but often mild so not documented o Follow normal healing progression o No special attention needed o Ask about site care • Patient using anything topically (which they should not) that might have spread some virus locally?
How should contact lesions be treated from vaccinia?
They need o be covered like a primary site vaccination
When does Non-Viral Pustulosis occur?
In primary vaccines; It is pruritic and usually occurs 7-14 days post vaccination. No evidence of vaccinia
Is Non-Viral Pustulosis contagious?
Describe the symptom associated with Non-Viral Pustulosis?
It can be VERY Pruritic
How is Non-Viral Pustulosis treated?
How does Non-Viral Pustulosis resolve?
It resolves spontaneously, but secondary infection due to scratching
What are Benign Papulovesicular Eruptions?
- They are eruptions that occur 10-18 days post vaccination and resolve in 14-70 days
What is the key clinical point with Benign Papulovesicular Eruptions?
The patient has other systemic symptoms indicating virus spread through the blood stream
Are Benign Papulovesicular Eruptions contagious?
What are the symptoms associated with Benign Papulovesicular Eruptions?
Itching; but no fever
Is myopericarditis common with smallpox?
No but it can happen
What are the "role"s for Occupational Health in the military setting?
1) ****To "protect DoD civilian workers" (contract workers are typically covered by their emplyer)
2) To protect the Soldiers, Sailors, and Airmen
3) Focuses on prevention
4) Public Health
What are the "reasons" for Occupational Health in the military setting?
1) Compliance with "laws", regulations, & exectutive orders
2) Maintain healthy workforce
3) Maintain productivity
4) Decrease organzation costs
What type of treatment is given in the "Program elements of Occupational Health"?
"Occupational" illness and injury
When is "Respiratory Protection" required?
It is required for "ANYONE" wearing a respirator
What are the elements of the Respiratory Protection Program?
1) Evaluation of workplace for respiratory hazards
2) Initial and annual evaluation and clearance for respirator use - OSHA mandated questionnaire - Spirometry and/or CXR if needed - "Use Test" if need
3) Recommendations fro hazard abatement
Describe the OSHA questionnaire
- If all elements (Question 1 to 9) are negative, no further evaluation is nexessary
- If questions are answered "yes' they must be addressed by the health care provider
In the Respiratory Protection Program, are PFTs, CXR or labs "required"?
NO! Use only if clinical judgement indicates
What makes the final decision in the Respiratory Protection Program?
The "USE TEST"
What is the "Use Test"?
Put the worker in the type of respirator to be used, with the same filters, and work them for 15 to 30 minutes
Again, what is the gold standard for the Respiratory Protection Program?
The "Use Test"
Who must be enrolled in the Hearing Convervation Program?
ALL personnel routinely exposed to "Hazardous noise" shall be placed in a hearing conservation program
- > 85 dB, 8 hour Time weighted average (TWA) - > 140 dB peak DoD components shall be issued personal hearing protectors free to those personnel
What must be included in the "written" Hearing conservation plan?
1) Noice exposure computation 2) Monitoring 3) Abatement 4) Hearing protectors 5) Hearing protector attenuation 6) Training 7) Audiometric Testing Requirements 8) Audiometric test rooms 9) Audiometers 10) Calibration of audiometers 11) Record keeping 12) Program Evaluation
What is done for a person enrolled in the Hearing Conservation Program?
1) Initial and annual audiogram 2) Hearing protection fitting and issue 3) Referral to audiology as needed 4) Evaluation of workplace for noise hazards 5) Recommendations for noise abatement 6) Education
* When should a Reference (Initial) audiogram be administered of initial exposure to hazardous noise?
Within 30 days
How long must a patient not be exposed to noise prior to the Reference (inital) audiogram?
How often is an audiogram required for all personnel routinely exposed to hazardous noise level?
Annually (All military personnel and Civilian workers)
When should a "termination" audiogram shall be conducted on each worker?
When the worker is about to stop working in designated "hazardous noise areas"
What is the primary purpose of medical surveillance program?
Prevention of disease
What is the workman's compensation for government employees (civilian)?
Federal Employee Compensation Act (FECA)
What are the benefits afforded to employees under FECA?
1) The worker is entitled to care by agency provider or by personal physician at worker's discretion.
2) FECA pays all hospital, physician, and medication bill
3) PLUS 75% of base pay "TAX FREE" while off work
What is the Primary Care Physician's role in FECA claims?
1) Initial evaluation
2) Fill out CA-16 (this authorizes treatment)
3) Follow up care if patient selects you as his/her primary physician
*NOTE* The Department of Labor DOES NOT accept PA signatures. All of the notes must be co-signed by a physician (MD or DO)
Healthy People 2020 Putting Prevention into Practice
Explain the development of Health People 2020
It is "national agenda" that communicates a vision for improving health, has a set of specific & "measurable objectives", and these objectives are organized within distinct "Topic Areas".
What are the most recent topic areas for Healthy People 2020?
• Adolescent health • Blood disorders & safety • Childhood (early & middle) • Dementias (including Alzheimer's) • Genomics • Global health • Healthcare-associated infections • Quality of life, Health-related • Lesbian, Gay, Bisexual, & Transgender health issues • Older adults • Preparedness • Sleep health • Social determinants of health
What are the goals of Healthy People 2020?
1) Attain high quality, longer lives free of preventable disease, disability, injury and premature death
2) Achieve health equality, eliminate disparities, and improve the health of all groups
3) Create social and physical environments that promote good health or all
4) Promote quality of life, healthy development and healthy behaviors across all life stages
What are the objectives of Healthy People 2020?
1) Represent quantitative values to be achieved over the decade
2) Organized within the topic areas
3) Managed by lead Federal agencies
4) Supported by scientific evidence
5) Address population disparities
6) Data driven and prevention oriented
What are some of the ways that healthcare providers can use Healthy People to improve population health?
1) Contribute to national progress on the Healthy People objectives by offering patients relevant counseling, education, and other preventative services
2) find objectives that pertain to your specific areas of specialization - Understand how your patient population compares with the U.S. Population as a whole - Learn about key issues within each topic area that are important to address on a national level
This is defined as improving the delivery of appropriate clinical preventative services with tools and resources to support healthcare organizations and engage the entire healthcare delivery system
Put Prevention into Practive (PPIP)
What is Put Prevention into Practive (PPIP)?
An Implementation program derived from recommendations of U.S. Preventative Services Task Force
What is the purpose of Put Prevention into Practive (PPIP)?
1) increase awareness of prevention
2) Increase appropriate use of clinical preventative services (screening tests, counseling, immunizations)
Why is Put Prevention into Practive (PPIP) needed?
1) Vast majority of premature death is preventable
2) Strong evidence shows that clinical preventative services can prevent some of the leading causes of death
3) Combat barriers to the effective delivery of preventative care
How was Put Prevention into Practive (PPIP) developed?
1) Lanched in 1994 to increase implementation of USPSTF recommendations
2) Management transferred to AHRQ in 1998
3) Cooperation of many public and private groups
4) Based on research-tested interventions for improving delivery of preventative services in primary care settings
5) Focused group tested with clinicians, office staff, patients
6) Ongoing consultation with users and potential users
What are the "patient barriers" to delivering clinical preventative services?
1) Lack of knowledge
2) Anxiety about procedures and results
What are the "clinical barriers" to delivering clinical preventative services?
1) Lack of prevention training and knowledge
2) Lack of confidence that prevention makes a difference
3) Lack of time
4) Inadequate reimbursement
What are the "office barriers" to delivering clinical preventative services?
1) Lack of knowledge
2) Lack of motivation, not ready for change
3) Lack of effective teamwork
4) Clinical setting focused on illness and treatment rather than wellness and prevention
5) Inadequate systems for delivery, tracking and followup for preventative services
Nutritional Management of Individuals in Humanitarian Circumstances
These are measurements to quantify the severity of the nutritional situation to allow planning and implementation of an appropriate response
What are the measurements of Anthropometrics?
1) Weight for Height % of median - Main indicator of acute malnutrition (<70% - severe malnutrition; 70-79% - moderate malnutrition) - Weight - Composite indicator for long-term & current malnutrition (Stunting & Wasting) - Height - Indicator of chronic malnutrition (Stunting)
2) Z-score - used in screening osteoporosis via DEXA scan; compares pt score to a young adult
3) Mid-upper arm circumference (MUAC)
4) Body mass index (BMI)
What is most common evidence of chronic malnutrition?
How will a patient that has "Stunting" Present?
1) Normal height/weight
2) No evidence of clinical malnutrition
3) Growth grossly retarded
This program adds foods and nutrients to an existing diet; non-targeted or targeted to vulnerable groups
Supplementary Feeding Program (SFP)
This program provides a carefully balanced and intensively managed complete dietary regimen accompanied by medical intervention to a severely malnourished child
Therapeutic Feeding Program (TFP)
In this program, the majority of the severely malnourished are treated at home; Uses outreach teams & aims to build community capacity; Provides therapeutic foods containing the right mix of nutrients; Ready-to-use Therapeutic Foods (RUTF) can be locally manufactured
Community Therapeutic Care (CTC)
What vitamin deficiency causes "Xerophthalmia"?
Vitamin A deficiency
What puts a person at risk for having a Vitamin A deficiency?
No fresh fruits, low fat
****What are the clinical manifestations of a Vitamin A deficiency?
1) Night blindness; Conjunctival, then corneal xerosis; Biots spots (Dry, dull, cloudy cornea); corneal ulceration; keratomalacia (Softening and subsequent ulceration and perforation of the cornea); Phrynoderna AKA "Toad Skin" (Marked follicular hyperkeratotic eruption on the arm)
- Once a patient has kertomalacia, it cannot be treated with vitamin A and the patient will lose their eye
2) Poor growth, impaired immunity, increased risk of persistent diarrhea
*****3) Measles more severe in a Vitamin A deficiency (because it depletes Vitamin A stores)
What vitamin deficiency causes Beri-Beri?
Vitamin B1 (Thiamine) Deficiency
What puts a person at risk for having a Vitamin B1 (Thiamine) Deficiency?
What is the clinical presentation of "Dry" Beri Beri?
Bilateral peripheral polyneuritis evolves to flaccid paralysis
What is the clinical presentation of "Wet" Beri Beri?
Cardiovascular syndrome with edema and heart failure, sudden death
What vitamin deficiency causes Pellagra?
Vitamin B3 (Niacin)
What puts a person at risk for a Vitamin B3 (Niacin) deficiency?
Maize-Based; Low protein diet
What is the clinical presentation of Pellagra?
3) Dermatitis: dark, dry skin lesions in sun-exposed areas
What puts a person at risk for Vitamin B6 (pyridoxine) deficiency?
Isoniazid (Pyridoxine antagonist)
What are the clinical manifestations of a Vitamin B6 (pyridoxine) deficiency?
4) Peripheral neuritis
Infants: Irritability, Convulsions, Anemia
What vitamin deficiences cause gloassitis?
2) Niacin (B3)
3) Thiamine (B1)
4) Riboflavin (B2)
7) Vitamin B6 (Pyroxidine)
What vitamin deficiency causes Scurvy?
Vitamin C (Ascorbic acid)
What puts a person at risk for a Vitamin C (Ascorbic acid) deficiency?
No/few fresh fruits and vegetables
What are the clinical manifestations of a Vitamin C (Ascorbic acid) deficiency?
1) Swollen, bleeding gums with loss of teeth
2) Swollen, painful joints
3) Internal hemorrhage
What vitamin deficiency cause Rickets?
Vitamin D deficiency
What puts a person at risk for a Vitamin D deficiency?
1) Little sunlight
2) Dark skin
3) Breast feeding
4) Poor diet
What is the clinical presentation of Vitamin D deficiency?
What vitamin deficiency causes anemia?
What puts a person at risk for an Iron deficiency?
1) Few animal products in diet
2) Parasitic Infection
3) Concomitant vitamin C or folate deficiency
What is the clinical manifestation of Iorn deficiency?
1) Fatigue, Pallor, Infection susceptibility
2) Lead poisoning
3) Poor learning and work capacity
What puts a person at risk an Iodine deficiency?
Food Grown in iodine deficient soil
What is the clinical manifestation for Iodine deficiency?
2) Reproductive failure to include increased risk of spontaneous abortion and stillbirth
3) Cretinism in children born to iodine-deficient mothers
What is the risk of a Zinc deficiency?
Low meat (low zinc), high grain (high phytate) diets
THIS IS A VAST PROBLEM
What are the effects of a Zinc deficiency?
1) Lower immune competence
2) Increases risk of: Diarrhea and Respiratory infection
What is the clinical manifestation of a Zinc deficiency?
1) Role in protection of cell membrane integrity" may be protective aganist free radical injury
2) Acrodermatitis enteropathica (Scaling plaques)
3) Alopecia, Glossitis, Nail dystrophy
4) Lethary, Anorexia
What are the benefits breast feeding?
1) Known nutritional and immunologic advantages
2) Maintain normal infant growth
3) Promote bonding
4) Maternal sense of empowerment, self esteem, and stress reduction
5) Conserve food within a household
6) Contributes to sustainable development and food security
What are the risks of bottle feeding?
1) High infection loads
2) Contaminatino of water supply
3) Lack of fuel for formula preparation
4) Disruption of the supply of commercial formula products
Can women breastfeed under stressful emergency conditions?
- Milk "production" is adequate under stress - MIlk "release" may be affected by stress
If a malnourished mother is breast feeding, who do we supplement? The mother or the infant?
Supplement the mother (supplementing the infant decreased suckling and milk production)