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Exam 2 Study Guide

by: Courtney Notetaker

Exam 2 Study Guide EPI 390

Marketplace > Michigan State University > EPI 390 > Exam 2 Study Guide
Courtney Notetaker
GPA 3.3
Disease in Society

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Complete study guide based on the material from in class lecture
Disease in Society
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This 13 page Study Guide was uploaded by Courtney Notetaker on Sunday March 22, 2015. The Study Guide belongs to EPI 390 at Michigan State University taught by in Winter2015. Since its upload, it has received 203 views.


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Date Created: 03/22/15
Disease and Society EPI 390 Spring 2015 Review for Test 2 Thursday March 26 2015 Please Take Note 0 This is only a guide 0 Not every item that you may be tested on is listed below 0 As we have discussed please pay attention to the content of lecture presentations This includes examples and case studies used to illustrate main concepts links embedded within lectures and classroom discussion Osteoporosis OP continued from 1St exam Here are several older themes to review Risk factors Working de nition WHO diagnostic criteria Osteopenia vs osteoporosis Health and economic impact Why increased morbidity and mortality in certain individualsgroups Common fragility fracture sites and why What is the overall economic impact of OP Can you describe primary secondary and tertiary examples of OP Primary 0 Not catching the disease to determine a cause 0 Most people only know they have the disease when they don t start to feel well What are the current clinical screening OP guidelines Who came up with these Know the quotClassic OP Model The heightvelocity growth chart how can it be read in terms of recommendations for skeletal health Bone cells and functions Be able to label the essential regions of a bone in cross and in longitudinal section Strategies for optimizing peak bone mass What is a ROI Why is it important Your quotVitamin article by Chapuy et a and per instructions on the course web site weekly outline Smallpox Impact of vaccine mistrust Opposition to vaccination against smallpox dating back to the 19th century Early 20th vaccine success created an era of vaccine acceptance As vaccine preventable diseases disappeared the fear they had engendered also disappeared Occasional incidences of vaccine injury raised public concerns What s the issue with the MMR vaccine and autism Autism is diagnosed in early childhood not long after receiving vaccines The apparent rise in Autism frequency led people to make a connected with the vaccine Mercury in the vaccines found in preservative thimerasol Mercury was removed from all child vaccines in 1999 o This action had no effect on Autism prevalence In Britain concern focused on the combined measles mumps and rubella vaccine Wake eld MD seemed to nd measles vaccine virus in the intestinal cells of some children with Autism related concerns 0 Paper was found to be fraudulent Multiple reviews of large databases recording both vaccine history and Autism diagnosis have failed to nd an association between the two Clinical course of the disease Develops on all other areas but the trunk 25 mortality rate Scaring can occur from scratching the rash 0 Lesions in the eye that can lead to blindness Modes of transmission Person to person via the respiratory route is most important 0 Inhalation of droplets more rarely via aerosol Direct contact is less common 0 With infected body uids 0 With smallpox scabs 0 With contaminated objects such as bedding clothing bandages Transmission is always from another smallpox case no animal reservoir 0 Prodrome phase fever but no rash is less contagious 0 Most contagious with rash onset especially in the rst 710 days Continues to be contagious until the last scab falls off Basic biology of the disease Double stranded DNA in the orthopox family Smallpox is the largest known virus Many closely related animal pox viruses but not chickenpox which is a herpes virus Stable and retain some infectivity outside of the host Highly contagious but mostly to family and household Incubation period is 717 days Types of smallpox Con uent smallpox high mortality Flat smallpox very high mortality Variola minor or alastrim a mild strain VariolationInoculationInsuf ation Variolation the arti cial production of smallpox via inoculation of smallpox material immune to susceptible 0 Ground scabs pus vesicles used to inoculate China powdered scabs blown into nostrils India application of scab or pus to scarified skin Turkey pus immersed thread under the skin Inoculation take smallpox material and inoculate a fake disease into the individual to attempt to give life long protection 0 More in the upper classes than the lower classes History of Vaccination Edward Jenner published his work on vaccination Member of Royal Society expert on birds friend of John Hunter leading surgeon and medical educator of the time Noted that milkmaids often got cowpox but rarely got smallpox Use material from cowpox infections to inoculate several people including his son When challenged with smallpox inoculation vaccinated people did not get smallpox Important dates don t worry about I ll provide what you may need people do worry about and places do worry about Mass vaccination campaign Soviet Union was in a large support of the movement 12 million to one million people were dying of smallpox in other parts of the globe Cases were able to spread very rapidly o No vaccination very high risk Development to vaccine 0 Freezing allowed for the vaccine to be transported to the tropics o Bifurcated needle quick injections to more people 0 Jet injector 1000 peoplehour Effect of vaccination on smallpox mortality in EnglandSweden Declines in smallpox mortality in England after vaccination Decline in smallpox mortality in Sweden after vaccination became required by law Importance of cowpoxmonkeypox Because cowpox was communicated directly by touch lesions were often found on the hands of milkmaids Transmitting vaccination from one arm to the other Cyclicity of outbreaks Results of mandatory smallpox vaccination Decline in smallpox outbreaks What is vaccinia necrosum A dangerous complication of vaccination The reason why we do not vaccinate children whose immune system is surpressed You should know trends related to smallpox in the US in the 20th century a When in 20th century did cases reach a peak 1920 s b About how many deaths 448 c What are the deaths trends not the exact s by decade Decreased over time d When were there no more deaths 19050 s Problem of crossnational importation of the virus Engineer returning from Pakistan was admitted to a hospital in Germany for a fever Patient was isolated as suspect typhoid fever case Rash appeared smallpox was diagnosed two days later and the patient was transferred to smallpox hospital This case led to 19 further cases of smallpox in the hospital within other patients staff and visitors that came into contact Keys to control of outbreaks Freeze dried vaccine eliminated the need for maintain a cold chain The bifurcated needle made mass immunizations feasible at low cost Development of the pedal powered jet injector What characteristics made smallpox relatively easy in theory to eradicate Small pox features 0 No animal reservoir 0 People with smallpox easily identi able by the lay public Vaccine features 0 Highly effective vaccine 0 Vaccines also easily identifiable by the vaccine scar o Vaccines could quotvaccinatequot close contacts What is a quotcold chain A bifurcated needle Cold chain easy to transport the vaccine to the tropics because the maintaining of the cold chain does not need to be maintained The bifurcated needle allowed for low cost mass injections possible Eradication strategies WHO smallpox eradication Cost of the program was around 300 million 1972 the last vaccine of smallpox occurred until 2003 Importance of Birmingham England outbreak Transmission through the air ducts within the lab Smallpox virus was still alive and possible to contract What is a Ring Vaccination strategy When is it used Identify every case of smallpox and create three rings or zones around the patient Zone A o Isolate patient 0 24 hour guards o Vaccinate all residents and visitors 0 Inspect for fever and rash twice a day Zone B o Vaccinate all residents 0 Inspect for fever and rash once a day Zone C 0 Check every five days for fever and rash Historical signi cance of Henry Bedson The last victim of smallpox Are individuals previously vaccinated still protected Why yes or no Yes the smallpox virus is only in isolation in Geogria and Russia and is kept for quotjust in case reasons The vaccination has saved millions and millions each year Forensic Epi and Public Health What is a medicolegal ML investigation Refers to the application of medical science to law What is the primary role of a ML death investigation Formal mechanism for death investigation and certi cation within a speci c geographic area How can forensic epidemiologists contribute to the goals of public health If there are diseases of concern towards pubic health forensic epidemiologists will get involved Cause vs manner of death Cause of death COD 0 The disease or injury responsible or initiating the sequence of events brief or prolonged that result in death Manner of death MOD 0 The fashion in which the cause of death comes into being 0 5 recognized MOD categories Natural Accidental Suicide Homicide Undetermined Coroner vs medical examiner Coroner 0 An elected or appointed public official 0 Need not be a physician 0 Does not necessarily attend or perform autopsies o If not licensed pathologist the autopsy must be performed by certi ed pathologist who reports the ndings to the coroner o Coroners are often former law enforcement officers or funeral directors Medical examiner 0 An appointed public official 0 Must be licensed board forensic pathologist 0 Perform autopsies o Overseen by the National Association of Medical Examiners NAME Inquests and public health Both coroners and MEs can convene an inquest An inquest is an inquiry by the ML authority in the presence of a judge into a death that is suspicious in circumstances or in prison or whose identity is in question Proceedings may be open or closed to the public No one is accused of a crime and ndings don t result in penalties Inquests gather information that may be used at trail or held in the interest of public safety What is a biological pro le Primary vs secondary Primary 0 Age 0 Sex o Stature 0 Race Secondary Weight Handedness Pathologies Injury patterns MOD 0 SES Differentiation of ante peri and postmortem injury patterns Ante mortem 0 Before death Peri mortem 0 Body is still alive 0 White process 0 At or around the time of death Post mortem o No opportunity for vital reaction 0 After death 0 O O O Biomechanical compensatory skeletal changes and utility in ID Reconstruction of OA SES Occupation Look on lecture slides Vitamins ou have lecture ts an on line video and review notes ALREADY on the course web site Vitamin supplements as an exposure or as an outcome variable As an outcome vitamin supplements can be viewed as deficiency diseases As an exposure variable fooddrink 1012 timesday for a lifetime supplements Confounders People populations who take supplements are different ex income family history of disease health status health concernother health behaviors Baseline nutritional status rarely considered even in trials Explain the nutrient status vs physiological function graph Morris et a 201 1 JAMA article What is the issue with vitamin studies and study population heterogeneity Age gender country cultural factors health behaviors health care access Heterogeneity in study populations limits generalization to the US population Pellagra is Pica is Pellagra a disease that results from a diet deficient in niacin What is an MVM Multivitaminmineral Evidence for their effectiveness US Preventative Services Task Force 0 Insufficient evidence to recommend for or against American Medical Association o Recommends for seniors who have generalized decreased food intake American Dietetic Association 0 Advises low dose MVM depending on individualized dietary assessment American Heart Association 0 Emphasizes health eating patterns rather than supplementation with speci c nutrients Why might the Iowa Women s Health Study have a serious methodological aw Researchers were unable to account for the quality in the supplements used by the women There is a large variation in the quality and potency of supplements available on the market What are nonnutritive substances Substances that include ice clay laundry starch etc What are the 3 components of individual variation when it comes to nutritional status Absorptionbioavailability Physiological need Excretion Macro vs micronutrients Macro nutrients supply energy 0 Carbohydrate 0 Fat 0 Protein Micronutrients o Vitamins 0 Minerals A vitamin is a carbon containing compound essential in small quantities for normal functioning of the body Nutrients that your body can t make and you must get from food or supplements otherwise your body will not be able to survive A dietary supplement is intended to supplement the diet and contains one or more dietary ingredients Approximate gross sales 269 billion in sales 2009 Why take vitamin supplements anyway To optimize normal cellular function 0 Low dietary intake of nutrients Inadequate food intake Poor selectionavailability of foods 0 Increased requirements Lifestyle smokers athletes Life cycle pregnancy aging Pharmacological effects 0 Dose 0 Consider safety concerns Extreme vitamin de ciency vs insufficiency Deficiency o A state or condition resulting from the lack or inability to use one or more vitamins Insufficiency o The body is not able to perform certain functions due to the vitamin being in a condition of being insufficient History importance and role of the DSHEA 94 Intended to supplement the diet Contains one or more dietary ingredients Intended to be taken by mouth as a pill capsule tablet or liquid Labeled on the front panel as being a dietary supplement 1990 Congress was considering 2 health fraud bills 0 One increased EDA powers and penalties for violating the Food Drug and Cosmetic Act 0 The other amended the Federal Trade Commission Act to prohibit advertising of nutritional or therapeutic claims that were already not allowable on supplement labels DHSEA 1994 was passed after an outpouring of public outrage from consumers who were convinced the government was going to take away their right to buy vitamins General disappointment in the scienti c community about the ability to protect the public General delight in the supplemental business Thalidomide scare Kefauver Harris Amendments to the Act in 1962 0 Must prove safety and effectiveness with well controlled trials and have all marketing approved Potential researchrelated biases in those who take supplements No associations were found between MVM use and all cause mortality cardiovascular diseases and cancer Antioxidant supplements had no effect on quality of life Subjects who thought they were getting the supplement vs placebo reported a better quality of life Enrichment vs forti cation Enrichment adding micronutrients essential trace elements and vitamins to food Forti cation the process of adding essential vitamins and minerals to staple foods to improve their nutritional content Arch Intern Med article by Mursu et a on the Iowa Women s Health Study What did they do Main aims Be able to interpret the results if I provide them to you directly andor in table format What 23 main points do you take from the PLOSBlogs piece You show know all about Joseph Goldberger and his quotWar on Pellagra E Chacko article Great to read the entire document but be able to demonstrate indepth knowledge from the Abstract Introduction and Conclusion Prevention and Public Health De nition of prevention per M Porta 08 Actions aimed at eradicating eliminating or minimizing the impact of disease and disability The prevention trilogy consists of Primary Secondary Tertiary What does each strategy address Primary 0 Prevent the initial development of a disease 0 Goal decrease prevalence Secondary 0 Early detection of an existing disease 0 Goal reduce severity and complications reduce morbidity Tertiary 0 Reduce the impact of the disease 0 Goal reduce the number and complications of the disease 0 Often plays out in hospitals nursing homes and hospice care 0 Life changing consequences both medically and behaviorally Prevention approaches characteristics in apublic health Apply measure to the entire population Must be inexpensive non invasive and con dential b clinical environment Target a high risk group May be expensive and invasiveinconvenient How does the prevention trilogy quot tquot with Figure 181 What does the trilogy teach us about why prevention is so important to public health Be able to quotstagequot an examples within the Classic Trilogy Ex for PSA screening cholesterol control colon cancer etc What are the current guidelines for the primary prevention examples we discussed Infectious Disease Epi Stop at the blank slides 1 from each lecture What are some recent key advances in antibiotic science What is novel about Teixobactin What is meant by the term Antimicrobials AM and by AM Resistance AMR De nition of an AM A molecule that inhibits or kills microbes De nition of AMR Ability of a microbe to survive exposure to an antimicrobial Can you outline the quotshort history of discovery effectiveness and development of antimicrobials and of AM resistance 1929 Sir Alexander Fleming a Scottish physician left a plate of staphylococcus aureus open and mold grew on the plate He noticed that the bacteria didn t grow well next to the mold mold was called penicillium Penicillin was isolated from the mold and its structure was determined The Golden Age of antibiotics 19401960 1946 commercial availability of penicillin and huge success against staphylococcus aureus Many infections were successfully treated People lived through infections that would have killed them in the past 1947 bacterial resistance to penicillin rst noticed in staph aureus only one year after the commercial introduction to penicillin 1959 we developed a drug that doesn t bind to penicillinase methicillin 1961 rst isolates methicillin resistant staph aureus found Gentamicin was new target alters the bacterial ribosome resistance develops Vancomycin discovered in the soil in Borneo inhibits incorporation of some peptide units into cell wall Each discovery is great but the bacteria already or rapidly acquire tools to ght back e Know the evolutionary complexity of prokaryotic bacteria Antimicrobials poses a survival threat to bacteria Microbes respond by 0 Dying 0 Mutating their DNA so they become resistant to the antimicrobial o Obtaining chunks of DNA that contain instructions for inactivating the antimicrobial from other bacteria Genes with instructions on resistance are transmitted from one bacteria to another via plasmids Plasmids are circular pieces of DNA It a bacteria has a plasmid with several resistance genes it is called multi resistant or informally a superbug or super bacteria How do AMs work What are their actions Work by inhibiting some essential bacterial process 0 Example cell wall synthesis protein synthesis ribosome function etc Once the cell is inhibited the bacteria don t grow well or die What are their mechanisms of resistance The most common mode is enzymatic inactivation of the antimicrobial An existing cellular enzyme is modi ed to react with antimicrobial in such a way that it no longer affects the bacteria An alternative strategy utilized by many bacteria is the alteration of the antibiotic target site What is MRSA You don t need to know the detailed cellular biology Staphylococcus aureus 0 Normal ora of skin and mucus membranes 0 Staph can cause food poisoning toxic shock syndrome folliculitis wound infections bacteremia and endocarditis Major cause of both nosocomial and community acquired infections Most frequently identi ed antimicrobial drug resistant pathogen in US hospitals Community acquired MRSA has emerged as an epidemic that is responsible for rapidly progressive fatal diseases including necrotizing pneumonia severe sepis and necrotizing fasciitis What is a plasmid How antibiotic resistant genes are transmitted Circular pieces of DNA Can you explain bacterial conjugation in the context of AM resistance What is a nosocomial infection What is the role of Clostrjdjum dj i39cjle C diff in infectious disease epidemiology Antibiotic associated diarrhea and colitis were well established soon after widespread use of antibiotics In 1978 it was identi ed as the causative pathogen in the majority of cases and the earliest cases of C diff were attributed largely to clindamycin Between 1989 and 1992 a strain of C diff highly resistant to clindamycin was implicated in large outbreaks of diarrhea in four hospitals in the United States From 2003 to 2006 C diff infections were observed to be more frequent more severe more refractory to standard therapy and more likely to relapse than previously described This strain appears to be more virulent than other strains which may be attributable to increased toxin production Most patients recover and the diarrhea usually stops 14 days after discontinuing antibiotics Be able to generally outline what MRSA Enterococcj and VRE are What Is Clostrjdjum dj i39cjle Spore forming bacteria that normally grows in the human gestational tract It is a hospital pathogen that causes diarrheal disease in hospitals world wide What are microbes Viruses and bacteria that are used to cause illness or death in people animals or plants What does it mean to say they can potentially be used as Vectors of Bioterrorism BT What is the role of a biological agents in terms of weapons production Relatively easy and inexpensive to obtain or produce Can be easily disseminated Can cause widespread fear and panic beyond the actual physical damage they can cause Used to intentionally cause disease in civilian populations for the purpose of creating terror An epidemic may be the end result What are some characteristics of quotgoodquot agents of BT Agents are typically found in nature Agents have the potential to be modified to 0 Increase their ability to cause disease 0 Make them resistant to current medicines 0 Increase their ability to be spread into the environment Biological agents can be spread through air or water or in food They can be extremely difficult to detect and do not cause illness for several hours of days after exposure Some can be spread from person to person and some can not Can you outline the history of infectious agents in terms of terrorism Began with the Ancient Romans throwing feces at enemies Threat of spreading bubonic plague terror was used as a means to gain entrance to enemy cities Aggressors couldn t control their own biological weapons Primitive medical technology couldn t protect aggressors from the agent and agents spreading to a battle s surrounding geographical areas Inability to contain the infected enemies Victims of biological terrorism in fact became weapons themselves Possibly lead to widespread epidemics which had the ability to destroy a large portion of the population Biological warfare became more complex What is anthrax An acute disease caused by the bacterium bacillus anthracis How is it t transmitted Bacteria form spores When spores are inhaled ingested or come into contact with a skin lesion on a host they may reactivate and multiply rapidly Human infected via contact with contaminated animals or products What are the disease manifestations What is the US Biological Weapons Program American biological weapon development began in 1942 President Franklin D Roosevelt Were shut down by Nixon in 1969 Be able to outline the attacks in the US Oregon and Japan United States 0 Two college students wanted to poison the city s water supply with typhoid and other bacteria 0 A terrorist group was founded and cultures of the bacteria were grown 0 Were arrested in Chicago Oregon 0 Attempt to control a local election by incapacitating the local population 0 Done by infecting salad bars in eleven restaurants produce in grocery stores doorknobs and other public domains 0 Infected 751 people but there were no fatalities 0 First known bioterrorist attack in the 20th century Japan 0 Attempt to release anthrax into Tokyo 0 Foul odor was reported 0 The attack failed with no one infected Can you outline the quotClassification of Agents Category A o Pose a risk to national security 0 Can be easily transmitted and disseminated 0 Result in high mortality 0 Have potential major public health impact 0 May cause public panic o Require special action for public health preparedness Category B o Moderately easy to disseminate but with low mortality rates Category C 0 Includes emerging pathogens that Might be engineered for mass dissemination because of availability Are easy to produce and disseminate May possess high mortality or a major health impact Include emerging Viruses such as the Nipah Virus and hantaVirus Be able to provide examples of these agents within classi cations Examples to know Tularemia Category A Botulinium Category A Smallpox Category A Bubonic Plague Category A There will also be material on the exam from the lecture onTuesday 324


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