Exam I STUDY GUIDE
Exam I STUDY GUIDE SPHU 1020
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This 18 page Study Guide was uploaded by Eleni McGee on Friday September 25, 2015. The Study Guide belongs to SPHU 1020 at Tulane University taught by Dickey-Cropley, Lorelei in Summer 2015. Since its upload, it has received 172 views. For similar materials see Cell, Individual & The Community in Public Health at Tulane University.
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Date Created: 09/25/15
Eleni McGee SPHU 102002 STUDY GUIDE FOR EXAM 1 All material until Lecture 7 inclusive Lecture 1 Overview Health and Biological Determinants Key Concepts 0 The public health triad 0 Risk factors vs risk indicators 0 Determinants of health 0 Disease states and de nitions 0 Outbreak terminology Going in depth Public health the approach to medicine that is concerned with the health of the community or of a population Community people gathered together who are exposed to the same risk Ex Classroom country city etc Public health triad Host factors agents and environmental factors Health determinants Something that determines your level of health There is no single most important one 5 categories 1 Human biology and genetics a Risk indicators you already have them and can t change them age sex race geography genetics b Risk factors you don t already have them and you can change them obesity high blood pressure AIDS stress levels c Includes structural or physiological effects and pre disposition to pathological effects Note that risk indicators or markers unlike risk factors cannot be changed Risk factors are conditions or variables associated with a lower likelihood of positive outcomes and a higher likelihood of negative or socially undesirable outcomes Protective factors have the reverse effect they enhance the likelihood of positive outcomes and lessen the likelihood of negative consequences from exposure to risk Although an individual s genetic endowment is xed at birth its ultimate effects are not One s genetic endowment may lead directly to health problems expressed at birth or to later disease but increasingly genetic knowledge emphasizes the role of genetic predispositions or susceptibilities Whether or not they result in diseases or disorders depends critically on the environmental in uences and challenges experiences by the individual over his or her lifetime Genetic and environmental factors are therefore complementary and interacting in uences rather than competing ones as explanations for health differences among groups Behavior and Lifestyle a Personal health practices and coping skills nutrition exercise communication alcoholdrugs weight control harm reduction etc BE ABLE TO NAME A FEW Social a Societal norms socioeconomic status b NOTE different from behavior and lifestyle because behaviorlifestyle are more habits that you form your self rather than what other people your environment forms around you Environmental a Natural and manmade water air vehicles land lls climate etc Health care a Sometimes classi ed under social b Refers to what health care communities have access to wealthy Narrow income spread Japan experienced improvement in overall health industry poor narrow income spread Liberia Broad income spread US India Host factors what makes us get the disease it carries the disease Agent cause of the disease etiological agents Noninfectious agents asbestos Infectious agents virus bacteria NOTE vectors are NOT agents Vectors just carry the disease but do not actually get it Etiological causal 3 major communicable diseases globally 1 HIVAIDS 2 TB 3 Malaria Pathogenesis describes mechanism involved in the development of disease in the body Describes what happens when the disease enters Mechanisms that result in outcomes Note the natural history natural course of a disease differs depending on whether or not you treat that disease One example of when the natural history of the disease was drawn out is the Tuskegee experiments Black men in Alabama infected with syphillus and told that they were receiving treatment but they were not doctors were studying the natural history of the disease Disease States Signs vs Symptoms Signs something that a doctor can determine ex Heart murmur with a stethoscope Symptoms something that the patient experiences and is observable 0 Ex Fever pain lack of appetite clamminess Lesions of disease something that is a physical manifestation and visible to naked eye gross lesions or through a microscope histological lesions Ex Tumors chickenpox Acute vs Chronic Diseases Acute occurs and resolves over a short period of time have distinct clinical features Most infectious diseases are acute Exceptions HIV hepatitis TB Chronic occurs and evolves over a long period of time and does not have as distinct clinical features most noninfectious diseases are chronic Exceptions poisoning can be acute Epidemiological terms to know lncidence of new cases of a disease in a time period Prevalence all cases of a disease new and old within a time period Note od diagnosed and still going on in that time period Morbidity of people who get the disease Mortality of people who die from the disease Side note case fatality rate is of people who die out of of people who contract disease Outbreak sudden increase in of cases in a speci c population usually shortlived smaller more easily contained Epidemic when an outbreak case is prolonged and kept within a certain country meningococcal meningitis Pandemicwhen an outbreak spreads over areas bigger than just one country ebola SARS in uenza Endemic when a disease is always present in a community at a low level malaria in Africa Lecture 2 Concepts in Disease Biology and Global Health Key Concepts 0 Health 0 Levels of disease control 0 Impact of diseases Going in depth Health the state of complete physical mental and social wellbeing and not merely the absence of a disease or in rmity DALY Disabilityadjusted life year a time based measure that combined years of life lost due to premature mortality and years of life lost due to time lived in bad health states Assesses burden of disaease and determines costeffectiveness QALY quality adjusted life years corrects someones life expectancy based on levels of healthrelated quality predicted for them Levels of disease control 1 control low number of cases transmission reduced 2 eliminiation no new infections in a geographical area and transmission very low 3 eradication complete control no organism except in special labs We have only eradicated one disease smallpox Why was it easy to accomplish no animal reservoir easily recognizable good vaccine available good control strategy good political commitment good reporting and monitoring MAJOR NCDs non communicable diseases cardiovascuar diseases Diabetes chronic respiratory diseases cancer mental health Morbidity of people who get the disease Mortality of people who die from the disease Lecture 3 Cell Structure and Organization Key Concepts Levels of cellular organization E ukaryote vs prokaryote The cell membrane The central dogma and its processes Going in depth Cell basic unit of life capable of metabolism replication and responding to environment Levels of organization 1 Cells 2 Tissues a Groups of cells working together b Ex Muscle 3 Organs a Groups of tissues working together b Ex Heart 4 Organ systems a Groups of organs working together b Ex Cardiovascular skeletal nervous respiratory limbic systems Eukaryote membrane bound nucleus vs Prokaryote no nucleus Cell membranes regulate passage of substances into and out of cells 6 major functions of membrane proteins transport enzymatic activity signal transduction chemical detection Cellcell recognition lntercellularjoining Anchor to cytoskeleton and extracellular matrix made of a phospholipid bilayer with a hydrophilic polar head and hydrophobic nonpolar tail Animal cells have cholesterol in cell membranes Fluid allows proteins to move around within bilayer P P FP NE Nucleotides adenine guanine cytosine thymine A set of three nucleotides is a codon Each codon three nucleotides codes for a speci c amino acid There are 20 amino acids and 64 possible codon combinations DNA Adenine binds to thymine Guanine binds to cytosine Held together by hydrogen bonds weak Chromosomes DNA arranged in linear form Normally in chromatin with histones balllike proteins Double stranded helix RNA Has uracil instead of thymine ls single stranded and can move out of the nucleus THE CENTRAL DOGMA DNADRNADPROTEIN Transcriptiontranslation After translation a protein is folded this folding process is essential to the function of the protein Proteins can be structural be enzymes regulate be hormone receptors Each triplet codon codes for an amino acid Lecture 4 Cell and Molecular Biology Key Concepts 0 Replication transcription and translation 73pes of RNA Molecular applications biotechnology and genomics PCR DNA probes Genetic engineering Going in depth DNA replication DNA is duplicated before a cell divides repication bubbles form so that the process is more efficient DNA polymerase adds new nucleotides while DNA ligase joins the segments together EXACT copies are created Note introns are noncoding regions in DNA that are spliced out before translation Exons are coding regions 3 types of RNA mRNA copy of DNA that codes for the polypeptide made in translation rRNA ribosomal RNA tRNA transfer RNA that carries amino acids to the ribosome during translation 50 64 types of tRNA for 64 anticodons for each mRNA codon Mutation when a code doesn t copy properly so the protein isn t properly functioning Examples sick cell anemia down syndrome cancer cystic brosis There can also be external causes of mutation ex Radiation sunlight Biotechnology use of microorganisms cells or cell components to make a product MOLECULAR APPLICATIONS 1 Detecting and analyzing DNA RNA or protein a Biomarkers i Used to detect something in a person s uids blood urine Examples are metabolites proteins antibodies nucleic acids b Diagnosis detecting antibodies that are released in response to an antigen c Molecular epidemiology looking at different diseases and seeing how they are related How does region 1 relate to strains from region 2 2 Manipulating DNA Genetic Engineering a Recombinant DNA to produce insulin vaccines etc i Put DNA for desired protein into a living organism and watch living organism produce that protein b Gene therapy i Introducing a gene to a person when they are lacking the gene or have a defective gene DNA Probes very quick sensitive but very expensive probe specimen to look for a speci c sequence of DNA that you know is present in a certain virus this probe must be complementary to the gene that you are looking for and you must attach some signal ie uorescent light to detect it problems signal could be hard to nd DNA could be moving around PCR Polymerase Chain Reaction when you amplify a small fragment of DNA using primers so that you can analyze the DNA 3 steps 0 Denature at high temp use a speci c enzyme that will not be denatured along with the DNA at this temperature Taq polymerase o Anneal of primers at low temp Bonding with complementary primers 0 DNA synthesis at medium temp synthesize DNA amplifying it We are more con dent in PCR because so many copies are made After PCR we run the chain through gel electrophoresis and compare it to a DNA ladder to analyze it Advantages tolerates impure DNA very quick and sensitive Can analyze a few genes at a time Problems high risk of contamination Both PCR and DNA probes allow for early diagnosis Genetic Engineering using recombinant DNA Combine DNA from two different organisms by using plasmids Plasmids are circular extrachromosomal DNA that is present in bacteria and replicates independently It can jump from cell to cell Introduce new gene into plasmids so that the plasmid with the new gene will allow the bacterium to start making the desired protein NOTE Vectors in genetic engineering carry the target DNA the new plasmid Lecture 5 Immunology Key Concepts Lymphoid organs The three lines of defense Innate vs adaptive immunity Cell mediated vs humora response Hypersensitivity Autoimmunity Vaccination Passive vs active immunity Going in depth Immunity resistance to disease Major functions 1 Prevent disease 2 Eradicate established infections BASIC PRINCIPLE The immune system must be able to distinguish between self and nonself Hemopoietic stem cells red and white blood cells originate in bone marrow as stem cells They will be derived from lymphoid lineage T and B cells and myeloid lineage phagocytes 2 types innate not learned not speci c and adaptive learned speci c 0 Innate skin 0 Adaptive B cells T cells 0 3 lines of defense 1 Epithelial barriers skin mucous membranes cilia in respiratory tract low pH and lysozymes in stomach blocks entry of microbes 2 Leukocytes white blood cells a Phagocytosis i Neutrophils ii Mononuclear phagocytes monocytes in blood and macrophages in tissue b Natural killer cells are large granular lymphocytes 3 Adaptive Immunity a 3 key characteristics Adaptation can recognize and respond to any particular pathogen that invades Speci city speci c to pathogens Memory retain memory of invader so if it invades again there is a more ef cient immune response Cell mediated Antibody mediatec Cell T lymphocyte B lymphocyte Antigen Recognize a Recognize a NATURA PROCESSED antigen antigen Location Intracellular Extracellular Type of antigen Protein antigen Protein ca rb lipid an gen Antigen a foreign nonself substance that triggers an immune response Antigen processing when an antigenpresenting cell must process the antigen and present it to the T lymphocyte MHC Present in all antigenpresenting cells They must be antigen so that T cell can be activated They are used coupled with in crime lab Clone type of T or B lymphocyte selected to be cloned for an immune response Epitope smaller part of antigen that is important for binding Lymphocyte maturation Lymphocytes must be educated acquire speci c receptors eliminate cells that are nonself B cells educated in bone marrow T cells educated in thymus Once cells are immunocompetent they migrate to the secondary lymphoid organs and perform surveillance for pathogens Lymphoid organs 0 Primary 0 Bone marrow makes B lymphocytes 0 Thymus makes T lymphocytes 0 Secondary o Lymph nodes 0 Spleen Filters blood 0 Mucosal tissue tonsils adenoids Peyer s patches Located near gastrointestinal tracts Antibody mediated Humoral Antibodies unique molecules with speci c reactivity to epitopes Belong to one or more of ve immunoglobulin classes lgG lgA lgE lgD lgM Neutralization block attachment and invasion of host cells Complement activation series of plasma proteins that complement antibodies in ghting microbes Opsonization makes it easier for phagocytes ADDC kills target cell with help of antibody antigen 7 antigen bindingsite quot lbindingsite variable Fi region hisaw chain Cell mediated Cytotoxic T cells destroy w infected cells tumor cells involved in transplant rejection Helper T cells assist other cells become activated when they are presented with peptide antigens by an MHC They secrete cytokines Cytokines separated by different sets of immune cells for different responses Memory T cells persist long term Suppressor T cells regulatory T cells that keep the immune system in balance Undesirable consequences of immunity 1 Hypersensitivity treatment aimed at preventing degranulation of mast cells a 4 types i Seasonal allergies atopy a Production of lgE in response to antigen binding of lgE to Fc receptors crosslinking lMast cells in tissue contain granules that have in ammatory mediators ex HistamineWhen cell is activated by allergen mast cell degranulates releases histamines and cytokines and causes an in ammatory responselemines end mediators of in ammation anaphylactic shock asthma sinusitis hay fever food allergies etc ii Cytotoxic reactions iii Immune complex reactions iv Memory T helper cells mononuclear cells granuloma 2 Autoimmunity hypersensitivity to self antigens a During education T and B lymphocytes that recognize quotselfquot are eliminated with apoptosis programmed cell death b But autoimmunity is the breakdown of this system Examples lupus celiac disease SCID Immunode ciency components of immune system are missing i Primary born with it ii Secondary due to something like treatments or disease 99 3 Transplant rejection Immunizations and Vaccines Active you produce the immune response usually permanent response to infection natural produced by vaccine arti cial Passive somebodysomething else produces immune response and you receive it Mother to child natural preformed antibodies arti cial immunoglobulin arti cial Vaccines active response select main antigens that produce a good immune response 3 types 1 Live attenuated oral or nasal spray a Attenuated reduced virulence by repeated passage in culture bacteria genetic manipulation growing cells in organism Must be kept cold Can revert to virulent state and cause disease But much better immune response e Herd immunity possible polio example 2 Killed inactivated injected a lnactivated using heat or chemicals b Usually weaker needs a booster 3 Fractional injected a Toxoid toxin doesn t produce the disease only the immune response ex Tetanus shot b Subunit produced synthetically recombinant vaccines 106 Conjugate vaccines when more than one vaccine is combined for ease of administration or to increase potency Ex Pneumohib Notes on vaccines When incidence of disease is low risks of vaccination are higher Vaccination most effective when there is no reservoir and a high uptake Easier to make vaccine if pathogen is antigenetically stable once you get disease you are immune Once you eradicate a disease you vaccinate with a killedinactivated vaccme Lecture 6 Asthma Key Concepts 0 Risk factors Asthma as an atopc mechanism Mechanism of pathogenesis Asthma and the hygiene hypothesis Managing asthma Going in depth Asthma a life threatening chronic disease of the lungs that is recurring noninfectious can occur at any age It can be controlled but it cannot be cured Symptoms wheezing breathlessness chest tightness nighttime or early morning coughing What happens in an episode of asthma Lining of airways are swollen due to in ammation and coated with a thick mucous making it hard to breathe Mechanism of atopic sensitivity Atopy degranulation of mast cells releases histamines when triggered by lgE crosslinking with the antigen allergen o Atopic patients have higher lgE levels than rest of population susceptible to allergens Risk factors for developing asthma 1 genetic characteristics 2 occupational exposures 3 environmental exposures Factors that make asthma worse infections in upper airways changes in weather physical expressions of strong feelings stress anxiety laughter exercise feathers fur dust mites cockroaches poHens molds indoor and outdoor The hygiene hypothesis states that excessive cleanliness interrupts the normal development of the immune system and leads to an increase in allergies This is why when people move to more developed countries with better cleanliness they are prone to asthma Overstimulation of Th2 Helper T Cells Th1 ght disease and produce in ammatory response to kill intracellular parasites and Th2 ght allergies promotion of lgE and atopic responses Managing Asthma 1 public health interventions a medical management bschoo c education d environment 2 short term control a inhaler short acting beta agonists 3 long term control a inhaled corticosteroids to reduce in ammation b long acting betaagonists c leukotriene modi ers 4 Patient must self manage a Reduce their own exposure to certain allergens house dust tobacco smoke pets cockroaches mold Genetics study of inheritance of traits Genomics study of all genes in a person as well as the interactions of those genes with each other and with that person s environment Genome all of the genetic information in an organism All human beings are 999 identical genetically but the differences in the 01 hold important clues about disease Pharmacogenomics can help us understand if an individual s genetic inheritance affects a body s response to drugs We haven t reached a conclusion yet Single vs complex gene order Single diseases that result because one gene is altered or missing family inheritance plays a much bigger role in whether or not the gene is passed on Ex Hemophilia cystic brosis muscular dystrophy Huntington s down syndrome LOW prevalence LOW healthcare burden HIGH risk YOUNG onset Complex diseases that result because of multiple genes and multiple environmental factors Ex Diabetes HIGH prevalence HIGH healthcare burden LOW risk OLD onset Genetic susceptibility to noncommunicable disease Having certain genes can put people at a higher risk for non infectious diseases 0 Ex Lung cancer heart disease colon caner alzheimer s prostrate cancer breast cancer BRCA gene Racial connection 0 Ex Sickle cell diseases more prevalent in black race Genetic susceptibility to communicable disease Genetics can increase risk of infectious diseases So does genetics have an in uence l It could have been one of the major factors in uencing genes coding for the immune response through generations of natural selection but we have to take into account that effects of genetics are complicated by in uences of the environment genetic variations etc Sickle cell anemia KNOW THIS a mutation in the HBB gene hereditary that causes abnormal hemoglobin HbS instead of the normal HbA The cells are then sickled as a result Research showed that sickle cell anemia could increase chances of surving malaria Turns out that people who carry the HbS gene for sickle cell anemia have been naturally selected because the trait confers some resistance to malaria Their red blood cells tend to sickle when they come into contact with a malaria parasite The infected cells then cull through the spleen which then cuts them out because of their sickle cell shape which eliminates the parasite along with them In areas where the sickle cell gene is common it has an adaptive advantage but also a disadvantage because the likelihood of being born with sickle cell are pretty high For a child to have sickle cell heshe must have two copies of the gene one from each parent For parents who both carry the trait the chance of a child with sickle cell is 25 The chance that a child will carry the trait and be immune to malaria is 50 The chance the child will not carry and will not be immune is also 25 Malaria very common Sub Saharan Africa and Indian subcontinent A mosquito parasite that lodges itself in the liver Note that thalassemia and a G6PD de ciency have a similar effect as sickle cell people who have the gene can have some resistance against malaria For thalassemia Increased IgG binding sensitivity to oxidant stress For G6PD de ciency Sensitivity to oxidant stress Duffy antigen a red blood cell antigen that is a minor bloodgrouping antigen Malaria uses a duffy antigen as a mechanism of entry into the red blood cell Can cause a resistance to malaria when it is the P vivax strain Application of public health Once the genome is mapped Gene sequencingljl gene discovery gene characterization cinica utility public health utility Knowing family history is important because we can know if a single gene disorder runs in the family AND for complex gene disorders if certain environmental factors were present in the family s past that could in uence l brings up question of ethics Screening for genetic disease screen people who are at high risk because of family history Screening for infectious diseasescreen people who have come into contact with those who had that disease Genetic testing predictive gene testing that holds out the possibility of saving lives by prevention or early detection Types prenatal testing testing the fetus during pregnancy diagnostic testing testing people who have the symptoms for a certain disease predictive testing testing people who have relatives with a genetic disorder 0 presymptomatic when the gene mutation is present and the individual will de nitely develop the disease example Huntington s o predispositional when the gene mutation is present but the individual may or may not develop the disease example breast cancer 0 note that predictive testing is discouraged for normal children if there is no treatment available for that disease Newborn screening usually state run and performed routinely at birth unless refused by parents core panel for each state states may have additional testing PKU was the rst disease screened for
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