HLTB21H3 Lecture 10: lecture 10

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rosemuskrat776

2 Nov 2010

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Some date back to the 15th century. Most are specific to the 19th century -- time when the "germ theory" won the battle. Red rash on the neck, the body. Pelle agra - italian for "skin rough" Appears first as a skin rash, skin then crusts and peels away. Clinical symptoms -- 4 ds: dermatitis, diarrhea, dementia, death. 1909 epidemic in the us, reported in 26 states. 1912 high fatality rates, 40% in south america. 20th century 3 million cases in the us and 100 000 deaths. Belief that pellagra was an infectious disease specific to the poor. By 1939, evidence established that disease was due to niacin-deficiency (a water soluble b vitamin - vitamin b3) Niacin needed for normal oxidative metabolism of sugars. 1943 - less than half of original deaths, 1948 - mandatory enrichment in 22 states. 1616 as a neurological disorder characterized by paralysis of the hands and feet.

Related Questions

QUESTION 6

Reducing the incidence of a disease in a specific area to zero is termed:

A. Elimination

B. Control

C. Eradication

D. Extinction

QUESTION 7

What are common mental health problems among adolescents?

A. Conduct disorders

B. Anxiety

C. Depression

D. All of these are correct.

QUESTION 8

What causes the most neonatal deaths globally?

A. Preterm birth complications

B. Malaria

C. Sepsis

D. Pneumonia

QUESTION 9

What is not a consequence or complication of vitamin A deficiency?

A. Asphyxia

B. Xerophthalmia

C. Immune system compromise

D. Measles

QUESTION 10

What is not a leading cause of death among adolescents in high-income countries?

A. Self-harm

B. Lower respiratory infections

C. Road injury

D. Interpersonal violence

QUESTION 1 1. The relative importance or burden of a disease within a population will depend on a number of factors including : A. Disease frequency B. Disease severity C. Disease consequences D. All of the above

QUESTION 2 1 . With the epidemiologic transition, there is a reduction in malnutrition and _____ . A. Communicable diseases B. Injuries C. Non-communicable chronic diseases D. Mental health disorders

QUESTION 3 1. A major challenge to developing a burden of disease profile in low and middle-income countries relates to A. Unwillingness to share complete information B. Conflicting disease definitions C. Challenges obtaining information related to cause of death D. All of the above

QUESTION 4 1. The demographic transition describes which of the following changes to society A. Changes in birth and death rates that reflect a modern society B. Declines in mortality followed by a reduction in fertility C. A change in the age structure of the population D. All of the above

QUESTION 5 1. Measures of health status that combine mortality and morbidity data A. Facilitate comparisons both within and across populations B. Help estimate the quantitative health benefits from interventions C. Serve as tools to assist with resource allocation D. All of the above

QUESTION 6 1. The disability-adjusted life year is defined as A. A health gap population summary measure that combines time lost due to disability with that lost due to death B. A measure to compare the gap between the current situation to that of an ideal situation C. A measure that combines the amount of healthy life lost due to morbidity with that lost due to injury. D. Answers B and C

QUESTION 7 1. True or false? A key limitation to mortality-based indicators is that they fail to account for the morbidity caused by disease. True False

QUESTION 8 1. The most widely used composite measure of population health is the DALY, and this epidemiological measure is the sum of morbidity and ________data. A. Years of life lost (YLL) B. Morbidity C. Infant mortality rates (IMR) D. none of the above

QUESTION 9 1. What would be the best source of information on adult and infant mortality (in high income countries)? A. Disease registers B. Vital statistics C. Special survey study D. Hospital clinic statistics

QUESTION 10 1. Which term is best used to describe the proportion of people in a population who have a defined disease at a specific point of time? A. DALY B. Incidence C. Mortality rate D. Prevalence

QUESTION 11 1. Which term is best used to describe new cases of disease occurring in a population? A. DALY B. Incidence C. Mortality rate D. Prevalence

QUESTION 12 1. Which term is used to describe the absence or presence of illness or disease? A. Demography B. Morbidity C. Mortality D. Vitality

QUESTION 13 1. Mortality (death indicators) include: A. Mortality rate B. Infant mortality rate C. Neonatal morality rate D. All of the above

QUESTION 14 1. True or false? The value of life is often implicit in the way resource allocation decisions are made, which suggests that these decisions should be as explicit, open, and transparent as possible. True False

QUESTION 15 1. _________________is projected as the number one leading cause of disease burden in 2030. A. Ischemic heart disease B. Diabetes mellitus C. HIV/AIDS D. Unipolar depression

QUESTION 16 1. Some of the negative aspects of globalization include A. Greater insecurity of employment B. Poorer housing and sanitation due to rapid urbanization C. Greater vulnerability to environmental degradation D. All of the above

QUESTION 17 1. Current concerns about climate change focus on several developments including A. Rising global average land and sea surface temperature B. Increasing frequency of extreme weather conditions C. Both A and B D. None of the above

QUESTION 18 1. True or false? Diseases carried by mosquitoes are especially sensitive to meteorological conditions because they are vulnerable to changes in the ambient temperature. As a result of changing temperatures, infectious diseases such as malaria and dengue have decreased in incidence and geographic range. True False

QUESTION 19 1. True or false? International cooperation of infectious disease control has a long history that includes obligatory reporting of outbreaks of specific diseases. However, compliance with obligatory reporting has been poor due to economic consequences that have often accompanied notification of disease outbreaks. True False

QUESTION 20 1. True or false? Globalization is a relatively new phenomenon that began in the mid-20th century. True False

The people of Malaysia belong to three communities: the local people called Malays, immigrants from South India called Tamils, and immigrants from China. During the early 20th century, the Malays lived mainly in coastal villages, the Tamils worked on rubber estates, and the Chinese worked in tin mines. In general, the people were very poor and they consumed a limited variety of foods.[1] Rice was the staple diet of all three communities and therefore the key source of caloric and nutrient content. Malays typically grew their own rice and dehulled it before consuming it; dehulling partially removes the aleurone layer of the rice seed. Following their South Indian food habits, the Tamils ate parboiled rice, and the Chinese ate polished white rice imported from Thailand. It was found that among the three Malaysian communities, the Chinese community was much more prone to suffer from some degree of sub-optimal thiamin intake. Out of every 1,000 Chinese inhabitants, about 120 had mild thiamin deficiency, about 80 had severe thiamin deficiency, and about 16 people had died of it. Suboptimal intake of thiamin was rare in Malays and was not reported at all in Tamils.[1] Thiamin, also called Vitamin B1, is required for all tissues, and its deficiency causes the disease Beriberi. Less severe deficiency results in non-specific symptoms such as weight loss, malaise, irritability, and confusion. Although the origin of the word Beri-beri is disputed, it is believed to be a Philippine word meaning âI canât, I canâtâ and was probably coined to refer to the lack of neuromotor coordination in people afflicted with this disease.[2] Thiamin is water-soluble and is stable in the acidic medium. It is unstable to heat, oxygen, and UV light in neutral and alkaline medium. The active form of thiamin is thiamin pyrophosphate (TPP). This active form is a cofactor for pyruvate dehydrogenase and transketolase enzymes that are involved in the metabolism of carbohydrates. These enzymes play an important role in the biosynthesis of a number of cell constituents such as neurotransmitters, pentoses, and reduced equivalents, used in oxidant stress. The human body cannot store thiamin and therefore requires a continuous supply of the vitamin. The thiamin in an individual on a thiamin-free diet typically depletes in fewer than two weeks. Thiamin absorption is affected by compounds, called thiamin antagonists or anti-thiamin factors, that alter the structure of thiamin. These compounds include alcohols, polyphenols, flavonoids, and thiaminase, a heat labile enzyme found in certain foods.[2] In affluent countries, where the diet is rich in thiamin, the most common cause of thiamin deficiency is excessive alcohol consumption. Alcohol intake affects thiamin status in two ways. First, alcoholics get a significant percentage of their daily energy intake from alcoholic beverages, which are nutrient deficient. In other words, alcoholics replace their consumption of nutrient dense foods that are part of their normal diet with the consumption of nutrient deficient alcohol. Second, alcohol inhibits the intestinal ATPase involved in the absorption of thiamin.[4] Sub-clinical thiamin insufficiency associated with excessive alcohol consumption produces an encephalopathy called Wernicke-Korsafoff syndrome. Patients with this syndrome have a higher than normal incidence of abnormal transketolase, which has a very low binding affinity to TPP. This problem can be overcome by putting patients on high-dose thiamin therapy. Some patients, however, might have a form of abnormal transketolase that does not bind at all with TPP. Such people do not respond to high-dose thiamin therapy.[4] Thiamin deficiency is observed in individuals who have low thiamin intake and a diet rich in polished rice, especially if their diet also consists of anti-thiamin factors such as tea, coffee, raw fermented fish, and betel nuts. The minimum amount of thiamin needed by the body can increase because of increased physiological or metabolic demands arising from pregnancy and lactation, heavy physical exertion, illnesses like cancer, liver diseases, hyperthyroidism, and surgery. Since TPP is required for carbohydrate metabolism, the recommended dietary allowances for thiamin are based on the assumption that its intake is related to total energy intake. The recommended dietary allowance in the United States is 0.5 mg/1000 Kcal.

Questions
1. Thiamin deficiency was observed only in the Chinese community even though all three
communities had the same staple (rice) diet. Explain.
2. On packages of enriched rice sold in supermarkets, the rice preparation directions state that the
rice should not be washed before cooking. Explain.
3. Severe metabolic acidosis caused by high levels of lactate is often associated with thiamin
deficiency. Explain.
4. Provide two plausible explanations for what might cause above normal levels of pyruvate in blood
and urine. How can one determine which of the two explanations is correct?
5. Why does thiamin utilization increase among cancer patients?
6. A negative correlation exists between the need for thiamin and the amount of fat in the diet.
Explain.

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HLTB21H3 Lecture 10: lecture 10

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