HEAL 230 Global Cattano Final Exam

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Effects of iodine deficiencyGoiter, spontaneous abortion, congenital abnormalities, brain damageEffects of iron deficiency anemiapreterm delivery, low birth weight, fetal deathEffects of zinc deficiencygrowth retardation, impaired immune response, damage to central nervous systemEffects of folic acid deficiencyneural tube defectsSolutions to Vitamin A deficiencybreastfeeding, supplements, fortificationSolutions to iodine deficiencyiodized saltSolutions to iron deficiencyincreased iron intake, infection control, improved nutritionSolutions to zinc deficiencyeating foods high in zinc ie: dairy and nutsSolutions to folic acid deficiencyeat foods high in folic acid ie: leafy greens, enriched breads and cerealsCommon locations of vitamin A deficiencyAfrica SE AsiaCommon locations of iodine deficiencyAfrica AsiaThe #1 most common micronutrient deficiency isIron deficient anemia4 primary ways people can get micronutrients1. balanced diet 2. supplements 3. food fortification 4. biofortificationFood fortificationadding vitamins and minerals to food staplesBiofortificationplant breeding for the specific purpose of enhancing the nutrition properties of crop varietiesSpecific solutions to micronutrient deficiencies1. Ready to use therapeutic food (RUTF) 2. Nutritional education 3. School feeding programs 4. Food subsidiesready-to-use therapeutic food (RUTF)highly caloric food products offering carbohydrate, lipid, protein, and micronutrients in a soft-textured paste used to promote rapid weight gain in malnourished people, particularly children used by UNICEF for severe acute malnutrition no need to mix with potentially contaminated watersevere acute malnutritionmalnutrition caused by recent severe food restriction; characterized in children by underweight for height (wasting)Nutritional education-school programs -dietary guidelinesGrowth MonitoringUse of weight-for-age and weight-for-height charts in infant and early child care to identify children who are malnourished, and thus, susceptible to disease.Functions of School Feeding Programs1. Promote education 2. Breaks cross-generational cycle of poverty 3. Provide structured market for local agricultureSchool Feeding Programs have...Take-home incentives so that families will receive food if their child regularly attends schoolFood subsidies-food stamps -conditional cash transfersconditional cash transfer (CCT)programs that provide cash grants to the poor and in exchange require particular beneficial behavior from the poor, such as children's attendance at school and visits to health clinicscommunicable diseasea disease that is spread from one host to anotheracute communicable diseasesCommon cold, pneumonia, mumps, measles, pertussis, typhoid fever, choleradefine acute communicable disease-severe -sudden onset -short durationChronic communicable diseasesAIDS, Syphilisdefine chronic communicable diseases-less severe -continuous duration -symptoms severe if left untreatedVirulencethe severity or harmfulness of a diseaseThe more virulent (severe) the pathogenthe LESS chance for transmission because person is so sick that they can't even leave their houseThe less virulent (severe) the pathogenthe MORE chance for transmission person is able to be out in public spreading itVirulence of TB over timeThe actual TB pathogen has evolved to ensure that its host lives longer so it can still be spread to others. Its in their advantage to keep their host alive longer.Types of transmission1). Person-to-person 2). Common vehicle 3). Zoonotic 4). VectorTypes of person-to-person transmission1. direct 2. indirectdirect person-to-person transmission1. vertical transmission 2. horizontal transmissionvertical transmission of diseaseTransfer of a pathogen from a pregnant women to the fetus, or from a mother to her infant during child birth or breast feeding.horizontal transmissionperson to personexamples of vertical transmission-gonorrhea -herpes -congenital syphilis -HIV -staphexamples of horizontal transmission-syphilis (sexual) -skin-to-skin contact -AIDS (sharing needles)indirect person-to-person transmission1. fomites 2. dropletsfomitescontaminated inanimate objectsdropletsparticles of liquids that are sprayed from the nose or mouth when a person sneezes, coughs, sings, talks, or laughscommon vehicle transmissiontransmission by means of contaminated items such as food, water, medications, devices, and equipment potential for widespread transmissionzoonosis transmissionvertebrate animals to humansexamples of zoonotic transmission-CJD (mad cow) -leprosy -lyme diseasevector transmissiontransmission of an infectious agent by a nonvertebral animal (insect, arthropod)examples of vector transmission-malaria -yellow fevorTypes of pathogensviruses, bacteria, parasites, fungiExamples of virusesEbola, HIV (AIDS), Herpes Simplex I & II, Rabies, Cold, InfluenzaExamples of bacterial diseasesStrep throat, pneumonia, leprosy, tuberculosis, Lyme diseaseExamples of parasitic diseaseAmoebic dysentery, malaria, African sleeping sicknesstypes of fungal diseases1. Systemic - through inhalation 2. Subcutanous - through wound, localized 3. Cutaneous - invade keratinized and cutaneous tissue, inflammatory response 4. Superficial - infections of skin and hair, innocuous, reappear, no inflammation 5. Opportunistic infections - look for vulnerable patients 6. MycotoxinsEmerging communicable diseasesnew diseases caused by exposure to a new agentexamples of emerging communicable diseases-lyme disease (suburbinization) -HIV -EbolaRe-emerging communicable diseaseexisting diseases that have increased in incidence or taken on new formsExamples of re-emerging communicable disease-malaria -TB -cholera -syphilisCause of re-emerging diseasesAntimicrobial resistanceantimicrobial resistancebacteria evolve to be resistant to antibioticsCause of antimicrobial resistance1. Overuse and overprescription of antibiotics 2. Patients not finishing treatment 3. Lack of hygiene and poor sanitation 4. Lack of new antibiotics being developedConsequences of emerging and re-emerging diseases1. Direct costs of treating disease increase when the case is drug-resistant 2. Indirect costs due to tourism and tradetropical diseasesa group of diseases that mainly occur in tropical and subtropical environments and are most common in countries where people lack access to safe water and sanitationexamples of tropical diseases-parasitic worms -LeprosyLeprosyA chronic, curable infectious disease mainly causing skin lesions and nerve damage.Risk factors of tropical disease1. Poverty 2. Lack of sanitation (many are waterborne and connected to vectors or have zoonotic origin)Solutions to tropical diseases1. SAFE Strategy (WHO) 2. Innovative and Intensified Disease Management 3. Vector control Not many solutions exist because many either don't have a cure OR we just don't know the biology behind them. This is due to underfunding, researchers not living in the area, and pharmacies seeing no profit.SAFE Strategy (WHO)Combined drug, hygiene, and environmental management. Gives people access to medication, sanitation, and helminth controlhelminthA parasitic roundworm or flatwormThe SAFE strategy has greatly reduced the global burden of what disease...TrachomaInnovative and Intensified Disease Managementencourages the development of better toolsVector controlreducing contact of vectors with susceptible populationsWhat does SAFE stand for?1. Surgery - treat blinding stage of disease 2. Antibiotics - clear infection 3. Facial cleanliness - reduce transmission 4. Environmental improvement - access to clean water and sanitationThe Global Fund to Fight AIDS, Malaria, and TuberculosisWHO agency that funds programs to address AIDS, TB, and MalariaFunction of Global Fund to Fight AIDS, TB, and Malaria-fundraising -working with NGOsHIV/AIDSVirus that destroys the immune systemHIV/AIDS transmission1.Blood transfusion 2.Sharing injecting devices 3.Vaginal intercourse 4.Receptive anal intercourse (more risk for tearing causes exposure to blood)cause of AIDShuman immunodeficiency virus (HIV)AIDS/HIV Symptoms1. primary infection (flu-like) 2. Asymptomatic stage 3. Symptomatic (breakdown of immune system) 4. Full-blown (CD4 count below 200(HIV/AIDS treatment1. Antiretroviral therapy (ART) 2. "3 by 5 initiative" by WHO and UNAIDSAntiretroviral therapy (ART)The use of several different antiviral medications to treat HIV infection; it does not cure HIV, but it can block HIV replications.3 by 5 initiativeextended treatment to 3 million LMICs in two yearsHIV/AIDS Prevention and Control-Education -Safer sex practices -Condom use -Partner restrictions, notifications -AbstinenceControversial prevention of HIV/AIDSTargets sexual behavior of females: 1. Abstinence-only programs 2. Virginity-testing before marriage 3. Virgin clubsHIV/AIDS diagnosisblood and salivaWhat country is HIV/AIDS most prevalent in?Sub Saharan AfricaIntellectual property rights of ART drugs...create barriers to accessing low-cost ARTs due to the exclusive right creators have over their product for a certain amount of time1997 South Africa Medicines ActReduced cost and increased availability of drugs Pharmaceutical companies fought to overturn it, causing there to now be regulations prohibiting them from fighting backTuberculosis (TB)Airborne contagious disease caused by a bacterial infectionCauses of TB1. Antimicrobial resistance 2. Malnutrition 3. HIV coinfection (weakens immunity)TB symptomsfever, night sweats, weight loss, hemoptysisTB transmissionairborneTB treatment1. Directly observed treatment (DOTS) 2. Vaccine for childrenDirectly observed treatment (DOTS)patients must be watched when taking medicine, which lasts for 6 monthsWhat is necessary for a successful DOTS program?1. appropriate diagnostic technology 2. regular supply of TB drugs 3. program evaluationTB prevention1.screening 2.quarantine 3.vaccinationTB diagnostic tests1.Sputum smear microscopy 2.Arm injection 3.Rapid test95% of deaths caused by _____ occur in LMICsTBTB challenges-Sputum smear can give false negatives -Sputum smear won't show different strains -Multi-drug resistant TB -HIV coinfectionWhat does multi-drug resistant TB entail?You don't want to give someone with drug-resistant TB the first line of treatment because the strain will become even more resistantMalariaprotozoan infectionMalaria risk factors-malnutrition -geographyMalaria signs and symptomsRecurrent cycles of intense chills and fever alternating with feeling healthyMalaria transmissionVector: Anopheles mosquitoMalaria treatmentEarly 1800s used Quinine Today we use Artemisinin-based combination therapies (ACTs)Artemisinin-based combination therapies (ACTs)medications that combine two or more drugs with different mode of action, currently the most effective drugs to treat malariaMalaria prevention-insecticide treated bed nets -indoor residual spraying -vector control -parasite control (taking ACTs before infection - received by all pregnant women)Malaria diagnostic testsBlood test70% of people infected with _____ are children under the age of 5malariaMalaria challenges1. Difficult to diagnose "great imitator" 2. Growing resistance to ACTs 3. Problems with insecticide treated bed netsNigeria case studyDiscovered problems with insecticide treated bed nets: 1. low usage rates 2. ineffective 3. needed to be retreated often 4. Organizations will give them out for free which causes people to not use them the way they're supposed toLatent TBnon-infectious, does not cause disease, occurs in 90% of infected people 25% of populationActive TBwill lay dormant in the lungs unless the immune system is compromised (can be due to HIV, tobacco, malnutrition)Global Outbreak Alert and Response Network (WHO)provide a rapid identification and response to outbreaks and alert the international communityproximal causescauses that have direct and immediate relations with their effectsdistal causesincrease the probability of getting a diseaseWhat are proximal causes of women's health issues?1. Reproductive biology (breast cancer, STIs, maternal mortality) 2. Malnutrition + pregnancyWhat are distal causes of women's health issues? (increase the probability of women getting diseases)1. Poverty 2. Less education 3. Low social status 4. Sexual division of labor 5. Early marriageWhy is poverty a distal cause of health issues among women?Women are more likely to direct their money towards their childrenWhat is the sexual division of labor?Women spend less time working for pay and make up for this time by doing unpaid labor within the homeKinship patternsThe study of the patterns of social relationships in one or more human cultures, or it can refer to the patterns of social relationships themselvespartilineal descentA system found in societies with fixed resources so that the eldest son will receive all of the family's belongings and the daughter will receive nothing since they do not carry on the family name.Where does patrilineal descent occur?cultures where women have the lowest statusPatrilineal descent occurs in ___% of the world's cultures45%Patrilocal residencesystem under which a bride lives with her husband's family after marriageDowrymoney or property brought by a woman to her husband at marriageWhy are sons preferred to daughters in India?-A son can continue the family name. -The family receives the dowryDowry deaths are a major problem facing women inIndia Pakistandowry deaththe bride is brutally beat or killed for her fathers failure to fulfill the marriage agreement____________ and __________ increase risk of dowry deaths.Patrilocality, dowrychild marriagea formal marriage or informal union before age 18, is a reality for both boys and girls, although girls are disproportionately the most affected.arranged marriagethe process by which senior family members exercise a great degree of control over the choice of their children's spousesConsequences of early/child marriage1. Maternal mortality 2. Domestic violence 3. Reduced educationHighest rates of child/early marriage by countryNiger and Chad in AfricaHighest rates of child/early marriage by incomepoor homes where people can't afford to take care of their own childmaternal mortalitydeath of a mother during pregnancy, childbirth or within six weeks (42 days) of deliveryMaternal Mortality RateNumber of deaths per thousand of women giving birth.In 2015, ____ women died for every 100,000 live births.216Causes of maternal mortalityhemorrhage, followed by infection, eclampsia and obstructed labor#1 global cause of maternal mortalityhemorrhage#1 cause of maternal mortality in developing countrieshypertensionSolution to maternal mortalityMisoprostol to stop hemorrhageMisoprostol complicationsMust be administered when 0.5 L of blood has been lostabsorbent delivery matdetermines amount of blood loss during birthMaternal morbidityillness or injury from the time of conception until the end of the puerperium and attributed to childbirth.obstetric fistulamedical condition in which a hole develops between either rectum & vagina or between bladder & vagina following prolonged or obstructed laborHighest prevalence of obstetric fistulas are in _______ and _______.Asia, Sub Saharan AfricaConsequences of obstetric fistulas-urinary/fecal incontinence -stigma or isolationSolutions to obstetric fistulas1. Safe abortion services 2. Family planning 3. Prenatal care (at least 8 visits) 4. Emergency transportation 5. Drugs and supplies 6. Skilled birth attendantsWhat are safe abortion services?Sterile environments with trained professionalsFamily planningProviding information, clinical services, and contraceptives to help people choose the number and spacing of children they want to have.Female genital cuttingtraditional practices that are all related to the cutting of the female genital organsTypes of female genital cutting-Clitoridectomy -Excision -Infibulation -Any type of manipulation of genitaliaHighest prevalence of female genital cutting is in _________ and _________.SE Asia, Sub Saharan AfricaPurpose of female genital cutting-Feminine symbol and ethnic identity marker for different tribes -Religious beliefsHighest prevalence of HIV/AIDS is in _________ and _________.Africa, SE Asia, AmericaHighest prevalence of Malaria is in _________.AfricaHighest prevalence of TB is in ....IndiaHealth risks of female genital cutting-hemorrhage -infection -ulceration -blood poisoningIssues with the PROCESS of female genital cutting-performed on girls aged 4-14 -performed by traditional practitioners -no consentSolutions to female genital cutting1.Consciousness raising -- talk about health issues and statistics 2.Create alternative rites of passage -- point out that there are other ways of marking womanhood 3.Work with healthcare providers 4.Legislation -- pass laws that ban the practiceskilled birth attendanttrained professional for managing pregnancies, childbirth, complications, etctraditional birth attendantmay not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensureWhy do majority of women in LMICs still turn to traditional birth attendants?1. Transportation issues 2. Sociocultural reasons 3. Lack of preparationNeonatalnewborn, first 27 daysPostneonatal28 days to 1 yearLeading causes of neonatal death1. Low birth weight 2. Prematurity 3. Maternal complications 4. Spina bifida 5. Bacterial sepsis (blood infection)Solutions to neonatal death1. Prevent low birth weight 2. Low-cost, low-tech interventions 3. Skilled birth attendantKangaroo mother careThe term used to describe a method of human infant care which involves extended skin-to-skin contact and breastfeeding on demand.Leading causes of postneonatal death1. Pneumonia 2. Diarrheal diseasepneumoniarespiratory infection caused by a virus or bacteria. Symptoms include cough, fever, difficulty breathing. Risk factors include second-hand smoke, indoor air pollution, pre existing conditions, malnutrition.diarrheal diseasesecond leading cause of death globally Common in developing countries and a result of: Inadequate sanitation Water filtration Food safety Deaths due to diarrheal disease 2.6 million & two thirds in children under 5 Result of bacterial, viral & parasitic infections Deaths can be prevented with access to simple toilets & clean waterPneumonia prevention1. Treatment 2. Environmental factors (indoor air pollution) 3. VaccinesDiarrheal Disease Treatment-oral rehydration therapy -zinc supplementation -antibiotics (rarely)oral rehydration therapy (ORT)a treatment involving the administration of a salt and sugar solution to a child who is dehydrated from diarrheaTop 4 causes of preterm birth and low birth weight:1. Malnutrition 2. Mother's age 3. Smoking 4. Stressexclusive breastfeedingFeeding with only breastmilk, no supplements of water, glucose water, artificial breastmilk, or foods for 6 monthscultural factors of exclusive breastfeeding-When weaning should occur -When complementary foods should be introduced -Type of complementary food introduced -Who can breastfeed and where -Breastfeeding schedulecultural practice of giving newborns sugar waterleads to diarrhea, practiced due to belief that water is necessary for life and treats many thingsBarriers to exclusive breastfeeding1. early marriage 2. less educated parents 3. male child 4. working mother 5. late initiation of breastfeedingUnsafe Abortiontermination of an unintended pregnancy by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both.noncommunicable diseasea disease that is not transmitted from one host to anotherexamples of noncommunicable diseasescancer, cardiovascular disease, chronic respiratory disease, diabetesrisk factors for noncommunicable disease1. Tobacco 2. High BP 3. Diet 4. Alcohol 5. Physical activity#1 cause of preventable deathtobaccoWHO Framework Convention on Tobacco Control (FCTC)taxes, public smoking bans, large health warning labels, ban on terms such as light, low tar, or mild, strong public education, restriction on youth marketdiabetesA condition in which the body is unable to produce enough insulin, the hormone required for the metabolism of sugartype 1 diabetes mellitusdiabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disordertype 2 diabetesprogressive disorder in which body cells become less responsive to insulinDiabetes damages what parts of the body?kidneys and nerves in the hands and feetcomplication of diabetesorgan failureKidney failure causes and treatmentcaused by type II diabetes and hypertension treated with dialysisLiver failure causescaused by hepatitis B & C and alcoholismHeart failure causescongenital heart failureChallenges of organ shortage in LMICs1. Sociocultural - People believe that belief that donating organs disrupts bodily integrity. After death if your bodily integrity has been disrupted, that disrupts your afterlife. 2. Legal - purchase or sale of organs is prohibited 3. Economic - cost of health careConsequences of organ transplants/shortage1. International organ trade 2. Transplant tourism 3. Recipients have medical complications 4. Donors experience depression and lack follow-up care 5. People must take immunosuppressants forever after transplantTop organ EXPORTING countriesIndia, Pakistan, ChinaTop organ IMPORTING countriesAustralia, Canada, Israel, USAWhat is the most widely transplanted organ?kidney due to diabetestransplant tourismAffluent patients visiting a country to search for "fresh" organs harvested from poor peopleSolutions to international organ trade1. treating diseases that lead to organ failure 2. implementing laws 3. upgrade facilities and standardize medical careWhat are the main mental health disorders?Depression Schizophrenia and other psychoses Associated with hallucinations Bipolar affective disorder DementiaChallenges to treating mental disorders1. Pay out of pocket 2. Under-diagnosis 3. Hard to estimate prevalence 4. Symptoms may vary cross-culturallyWhy are there so many under diagnosed mental disorders in LMICs?People don't have access to care to be diagnosed.Those exhibiting behaviors associated with _____ ______ are more likely to be seen by providers.psychotic disordersSolutions to treating mental disorders1. Diagnosis and intervention 2. Continuity of care 3. Wider range of services 4. Strengthened information systems#1 cause of death globallyCVDRisk factors of CVD1.Hypertension 2.High blood glucose 3.overweight/obesityCVD challenges in LMICs-Lack of access to integrated primary health programs for early detection and treatment -CVD places a heavy burden on the economies of LMICs -Poorest people are affected the most due to out-of-pocket expenditureWhat is the #2 cause of death globally?CancerMajor cause of death from cancer?metastasis (spreading to other parts of the body)Cancer risk factors-Tobacco use!!!! -Alcohol use -HPV -Hepatitis B and C -Lack of physical activity -Aging -High BMI -Unhealthy dietCauses of cancercarcinogensMost common cancers:Lung Breast Colorectal Prostate Skin cancer (non-melanoma) StomachCountry with highest rate of cancerAustralia70% of deaths from _______ occur in LMICscancerCancer: Challenges in LMICs-Lack of organized screening programs -Lack of treatment facilities -Lack of palliative care