Consider the circuit shown in Figure 2136. Find the current through each resistor using (a) the rules for series and parallel resistors and (b) Kirchhoffs rules.
Injuries ….Are notaccidents…. 1 Injury:Any damage to bodydue to acute exposure to amounts of energythat exceedindividual’s tolerance forsuch energy,ordue to absenceof suchessentialsas heat oroxygen Types ofenergy thermal, mechanical (kinetic orpotential) electrical, chemical energy Injuries occur whentissuesof human body absorb energy that isabove tissuethreshold Injuries: predictable outcomes offactors that can be controlled or prevented Intentional injury One that is purposelyinflicted, by oneselfor byanother person Unintentional injury Injury occurs when no harm is intended 3 Combination ofhuman and environmental factors ▪ Human factors include inner conditions or attitudes that lead to an unsafe state, whether physical, emotional, or psychological ▪ Age, alcohol use, gender etc ▪ Environmental factors include external conditions or circumstances ▪ Slippery road etc ▪ Also laws, socio- cultural influences – examples 4 5th leadingcauseof deathamongAmericans Leadingcauseof deathforAmericansunder age45 Injuries becomemost importantcauseof years of potentiallifelost (YPLL). Economiccost of injuries >more than$700 billioneachyear Leadingsourceof long-andshort-term disability. Injury severity is an important issue in injury monitoring Most injuries are relatively minor, & do not require any medical attention. Descriptive studies are the most common approaches in injury research. one example of a ▯descriptive study▯.mid of Injury US 2000 Requires aSystem forClassifying Injuries ICDCodes used DiagnosisCodes(N-Codes) Recordtheclinicalnature of theinjury andtheareaofthebody injured E-Codes Recordtheexternal cause oftheinjury Oftenmissinginthe medical record Leading cause of injury death Recentincreaselargelyfrom unintentionaldeaths, recreationaluse of Rx pain relievers In2008,#ofpoisoningdeaths exceeded the# of mstor vehicle traffic deaths for 1 time sinceat least1980. ▪ were causedbydrugsing deaths Inappropriate prescription of controlled substances Prevention Strict regulationby DEA Drug tracking nd 2 leading cause of injury death; ~34,000 deaths/year Motor vehicle fatalities decreased by >40% since 1968 despite more cars and more miles driven Trends due to age and gender remain Education and enforcement Speedlimits Seatbelts Alcoholplays a major role in fatal crashes Secondleading factor – youth and inexperience Graduateddriver’slicenses Zero tolerancefor blood alcohol Distracteddrivingcontributes to crashes– cellphoneuse, What does the chart indicate especiallytextmessaging Pedestrians – >4,000 deaths per year 19%are over 65years old Motorcyclists - 4,500 deaths 19 states andDCrequire helmets 28states require helmets for younger riders Bicyclists – about 600 deaths per year 11% are under age 16 21 states andDCrequire helmets for children 3 leading causeof injury death >31,000 deaths Almost60%suicides,37% homicides,others unintentional Homiciderates2-4 times higher inU.S.than other developed countries Guncontrol legislation stronglyopposed by National RifleAssociation, which has cloutinCongress 13 Prevention:includesefforts to reducerisks and severityof injury.Aimsto: Keep etiologic agent from reaching the potential host at all (i.e., preventing the interaction). Keep agent from reaching it at rates and in amounts that would produce damage (i.e., minimizing the consequences). Treatment:refersto post-eventeffortsto amelioratetheeffectsof injury through acute Institute of Medicine (1999) careandrehabilitation Education Enforcement Engineering Environment- road conditions, weather Time Host Agent human- age,sex,alcohol vehicle design, speed Pre-event phase, during which the energybecomes uncontrolled Briefevent phase, in which the uncontrolledenergy is transferred tothe individual, resulting in injuryif the energytransfer exceedsthe tolerance of the bodytoabsorb it Post-event phase, during which attempts canbe madeto restore homeostasis and repair the Figure 27.4. Sequence of Injury damage Incidence and Outcomes 18 Primary(Pre-Event):Goalto preventevents that might result ininjury. Whatcanbe doneto avoidthe injury before the event occurs. DUI checkpoint Reduce accessto weapons Non-combustibleconstruction material Secondary(Event):Goaldirected at modifying theconsequences of events inorder to prevent or reduce theseverity ofinjury . Safety belt use Lesslethal bullets Smoke detectors Tertiary (Post-Event):Goaltolimitlong-termimpairmentsanddisability. Accessto emergencymedical services 911 systems Accessto quality healthcare Bill Haddon 1926-1985 Haddon W. (1980). Advances in the as a Basis for Publicies Policy. Public Health Reports. 95(5):411-421 Prevailing scientific paradigm for studying causes and prevention The original hipster of injury Factors Individual Physical Socio-economic behavior Agent environment environment Pre-event Event PhaPost- event 21 22 Human Vector/Vehicle Physical/SocialEnvironment Pre-Event Intoxication TirePressure SpeedCameras SafetyBeltUse Brake Functioning Weather Speed I Beams SocialCulture Alertness/Sleepiness CrumpleZones Willingnesstoallow others to drive drunk Experience Event Frailty Speedof Impact Flammability Age Air Bags Guardrails Size Size Stiffnessof fixedobjects StiffnessofSurfaces Barriers StabilityControl Embankments Post-Event Body MassIndex Degreeof crush EMSresponse Age FuelSystemintegrity TraumaCenteravailability Co-morbid conditions RehabPrograms Rememberthe3 E’s : engineering,enforcement, education Injury-producing interactionscan be modified through changing behavior, products, or environments. Environmental changeshave potentialto protect greatest number of people. Effectiveinjury prevention requiresa mixture of strategiesand methods. Public participation isessentialforcommunity action. Cross-sectorcollaboration is necessary. Injury resultsfrom interactionsbetweenpeople and theenvironment. 23 GLOBALHEAL TH ISSUES AND STRUCTURES Global Health: Definition Definition: Health issues of major significance in both “industrialized” and “developing countries”E.g. HIV / AIDS Today’s global society has prompted development of interactions among cities, countries, ethnic groups, and other natural groupings “Health problems, issues, and concerns that transcend national boundaries, and may be best addressed by cooperative actions.” “America’s Vital Interest in Global Health” Institute of Medicine (IOM), 1997 3 Global Health :Access to Survival •Netmark website: •http://vimeo.com/56466620 •http://www.cultureunplugged.com/documentary/watch- online/play/10871/Access-to-Survival Millennium Development Goals (MDGs) The eight goals include: 1.Eradicate extreme poverty and hunger. 2.Achieve universal primary education. 3.Promote gender equality and empower women. 4.Reduce child mortality. 5.Improve maternal health. 6.Combat HIV/AIDS, malaria, and other diseases. 7. Ensure environmental sustainability. 8.Develop a global partnership for development. The measurable indicators being measured for health are to be achieved by 2015 for each goal. Let's Step Up #MDGMomentum •http://www.youtube.com/watchv=YfjdUcJla6s •The Millennium Development Goals (MDGs) are the most successful global anti-poverty push in history. Governments, international organizations and civil society groups around the world have helped to cut in half the world's extreme poverty rate. More girls are in school. Fewer children are dying. The world continues to fight killer diseases, such as malaria, tuberculosis and AIDS. As we approach the 2015 target date for the MDGs, there are less than 1,000 days to accelerate action on issues such as hunger, access to education Global Health Issues • Less wealthy countries have poorer infrastructures, human resource pools limited in numbers or specialized capacity, and few financial resources to compensate for those deficiencies • for example, difficulties in controlling the HIV pandemic in sub-Saharan Africa or including more costly vaccines for Haemophilus influenzae type B in childhood vaccines • Why does this mean for rest of region World Measures of Global Burden of Disease and Indicators of Progress •The Global Burden of Disease Project (GDBP) began in 1990, commissioned by the World Bank to provide a comprehensive assessment of disease burden. •measures known as disability adjusted life years (DALYs). measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death Infant Mortality Rate Uses : • easy to calculate; useful summary rate for comparisons across populations. • is the significant health status indicator; reflects health status of a nation. • reflects health status of mother and child throughout the pregnancy and birth process. the 10 Lowest Infant Mortality Rate (IMR, Deaths in Children 1 Year of Age per 1000 Live Births) Estimates from 2007, World Fact Book, Central Intelligence Agency Global Health : (<5 years of age) In low-income countries, malaria, diarrheal diseases, respiratory infections, and other infectious and parasitic diseases account for about 80% of all child (<5 years of age) deaths In 2005, WHO group estimated that 73% of the 10.6 million child annual deaths worldwide were from one of six causes: • pneumonia, • diarrhea, • malaria • •In sub-SaharanAfrica, single most important cause of death for children is malaria • neonatal sepsis, • preterm delivery • asphyxia at birth. Figure 30.4. Global Distribution of Cause-Specific Mortality Among Children Under Age Five Years • . Question of the DA Y •The life expectancy at birth in Sierra Leone is about 38 years. What can you infer about the population of Sierra Leone •A. About half of adults in Sierra Leone die in their 30s or 40s. •B. Few 50-year-olds in Sierra Leone will survive to their 60 birthdays. •C. There are a lot of infant and child deaths in Sierra Leone. Global Health: reductions in childhood mortality •Overall, among middle- and low-income countries, significant reductions in childhood mortality have been observed in Latin America, Middle East, and North and South Africa. • Exception is Angola, which is not considered a low-income country, had worst estimated IMR in the world in 2007 (according to World Bank). • Over 60 Angolan infants under age 1 die for every infant who dies in Hong Kong or Singapore. Focusing on Kenya, the World Bank was able to attribute 39% of the decline in child mortality and 58% of the decline in mortality of children prevent malaria.ased ownership of insecticide-treated bednets used to Major Diseases • The “Big 3” • Malaria • TB • HIV Neglected tropical diseases (NTDs) • have been neglected for decades, Table 1. Disease Burden of the Neglected Tropical initially as part of a general disregard Diseases in Deaths and DALYs for the developing world, and more recently due to the intensity of focus on HIV/AIDS, TB and malaria. • Poverty-promoting Infectious diseases that occur in underdeveloped, tropical areas of the world • principally impact world’s poorest people. • Chronic and disabling ancient conditions that have infected humans for centuries Programs for HIV/AIDS, Tuberculosis, and Malaria. PLoS Med 3(5): e102. doi:10.1371/journal.pmed.0030102lected Tropical Diseases with Most significant causes of mortality for children under 5 years, & most important public health interventions • Malaria • Insecticide-impregnated bednets. • Residual insecticide spraying near households. Adequate prompt diagnosis and effective treatment. Prevention of malaria infection in pregnant mothers. • Diarrheal diseases • Increase access to clean water and sanitary disposal of human waste. • treatment and prompt oral rehydration.ith adequate • Education • about water sanitation and personal hygiene • to maintain breastfeeding and sanitary formula preparation. • Nutritional supplementation with zinc and vitamin A. Most significant causes of mortality for children under 5 years, & most important public health interventions • Acute respiratory infections •Appropriate immunizations (measles, pneumococcus, Haemophilus influenzae type B). •Appropriate syndromic diagnosis and treatment. •Breastfeeding maintenance. •Nutritional supplementation with zinc and vitamin A. •Reducing household exposure to respiratory irritants such as tobacco or other smoke. Global Health:Adults • In low- and middle-income countries, 5 of 10 leading causes of death continue to be infectious in origin: • HIV/AIDS. • Acute respiratory Infections • Malaria • Acute and chronic diarrheal diseases • Tuberculosis • Excluding HIV/AIDS, 97% of deaths from communicable diseases occurred in low- and middle-income countries. Most common determinants of infectious diseases in low- and middle- income countries • Poor water and sanitation • Poor nutrition • Inadequate living conditions • Poor disease vector control • Lack of effective health care and public health measures • Lack of education of women Different Trends in Disease… • NON-COMMUNICABLE diseases (NCDs) such as CVDs diseases and Cancer are biggest killers worldwide, accounting for 63% of 56m deaths in 2008 •With exception of the African Region, NCD mortality exceeds that of communicable, maternal,perinatal and nutritional conditions combined •Of 36m people killed by NCDs, ~ 80% live in low- and middle-income countries. • These diseases associated with increased prosperity and longevity, and the results are costly. •World Economic Forum estimates that NCDs will cost low- and middle-income countries $7 trillion over the next 15 years. Most common determinants of chronic diseases in low- and middle- income countries •Diet •Smoking •Lack of access to health care •Poor environmental conditions •Exposure to toxics in urban crowded environments Injuries from occupational and road crashes Global HealthAgencies •World Health Assembly •United Nations Agencies (MDGs) •WHO & related partnerships •Multilateral Development Banks •E.g. Roll Back Malaria. •Unicef • E.g World Bank : loan $ •Bilateral Agencies •Universities • E.g US AID •Missionary groups •Foundations •NGOs / Non-Profits • Bill & Melinda Gates, Rockefeller •Other Special Programs •Public-Private Partnerships for •Global Fund to Fight Against AIDS, Health TB, & Malaria •Pharma WHOAgenda • Promoting development • Fostering health security • Strengthening health systems • Harnessing research, information and evidence • Enhancing partnerships WHO Member States are grouped into six • Improving performance regions. UNICEF www.unicef.org/ unicefusa.org •Child Survival and development •Basic Education and Gender Equality •HIV/AIDS and Children •Child protection •Policy Advocacy and Partnerships Non-GovernmentalOrganizations • CARE • Catholic Relief Services • Christian Children’s Fund • Doctors Without Borders • OXFAM • Partners in Health • Save The Children • World Vision World Bank… • Lends money • Emphasizes health areas • at reduced interest to countries •Development of Health Systems with a per capita income above a •Nutrition certain level •Maternal and Child Health •HIV/AIDS • interest free to poorest countries •Malaria • Lends about $20 Billion / year •TB •Tobacco Control Essentials of Global Health – R. Skolnik (2008) BilateralAgencies: USAID Promotes U.S. Foreign Policy Goals by advancing economic and social development all over the world. Provides Grants and Technical Assistance for •Health Services Improvement •MCH •HIV/AIDS •Other Communicable Diseases •Family Planning & Reproductive Health •Nutrition •Health Systems Foundations :TheBillandMelindaGatesFoundation 1. Define the problem and opportunity 2. Develop the strategy and agree on a budget 3. Make grants consistent with strategy 4. Measure results and learn 5. Adjust strategy Public– PrivatePartnerships:PartnershipsbetweenFoundations/ corporations/ and publicagencies • GAVI- Global Alliance for Vaccines & Immunization • Partnership of:WHO/ UNICEF/ World Bank/ Bill & Melinda Gates Foundation • Goals: • Improve ability of Health Systems for Immunization • Raise rates of key vaccine coverage in poor countries • Increase uptake of underused vaccines • Speed development of vaccines • Help ensure that vaccines are given safely Pharmaceutical Companies • Pharmaceutical companies have a decreased incentive to develop costly drugs for use in developing countries which cannot afford to pay the ‘normal’ costs for these drugs. • 3 ways Pharmaceutical Companies can contribute: • Donate Leprosy Drugs (Novartis) • Sell HIV drugs at discounted prices (Abbott., Bristol Myers Squibb, Merck) • Sponsor national HIV/AIDS Program (Merck – Botswana) Global Health: summary • Cooperation and Partnerships are key. • The worse the problem the more likely that different agencies will cooperate. • Usually one must overlook personal and political differences and appreciate what other players are bringing to the table. My career as a epidemiologist/zoologist/disease ecologist/rodent exterminator/public health researcher Lina Moses, PhD MSPH Tulane Lassa Fever Program Sierra Leone Options for this Discussion • Education and Training • What got me interested in what I do now • What I do now Education Training • Ba▯helor’s degree i▯ • Research coordinator Anthropology, Utah State – Genetic Epidemiology of University, 1997 cancers, neurodegenerative disorders • Masters of Science in Public Health, Tulane University, • Field studies 2005 – Arbovirus vectors, Guinea – Rodent-born viruses, New • Doctor of Philosophy in Orleans Public Health, Tulane – Lassa fever surveys (rodent University, 2012 and human), Sierra Leone What got ▯e i▯to what I do ▯ow… Undergrad • Health is fundamental for quality of life • Huge disparities exist in health, health systems, access to care, quality of care – Internationally, intranationally – Economics – Location • Infectious diseases are products of society/social interaction and require social interventions to break the cycle of transmission Undergrad Machupo Ebola • Disease emergence—social, economic, environmental, biological factors • Process of outbreak investigations In between degrees • Preferential treatment of the poor • Sustainability should be a challenge to address, but not an excuse to fail to act • Do▯’t take ▯o for a▯ a▯swer • Health programs need to be grassroots, community involvement in program development, locals are the and will work in their context Tulane Dept. of Tropical Medicine • Only department specializing in infectious diseases of developing countries at the time • Dan Bausch, new faculty from CDC – Emerging diseases – Health and human rights Guinea Guinea Doctoral Studies • Transdisciplinary program in Tropical Medicine, Community Health, Environmental Health • Lassa fever – Human rodent interactions – Rodent virus interactions 14 What I do ▯ow… I use methods and tools from epidemiology and population biology to answer questions about how viruses are transmitted from animals to humans. With these answers I develop new ways of preventing disease transmission in communities. This pays the ▯ills… So we ▯a▯ do this… • Sample collection • Lfor the entire countrye • Case investigations • Contact monitoring • Community education and disease prevention training EBOLA!!!! • It took several weeks for response in Guinea and Liberia • Because we had surveillance system in place and VHF ward, Sierra Leone had better control earlier in outbreak • At one point, 300+ being monitored by three people, case investigations by three people, two surveillance vehicles, two ambulances • We continue to work closely with MOHS in the Ebola response Questions Global Health Pierre Buekens Tulane School of Public Health and Tropical Medicine • Tulane opened as a Medical College in 1834 to study the transmission of tropical diseases • The School of Hygiene and Tropical Medicine was established in 1912 What’s in a name • 1912: Tropical Medicine • 1970s: International Health • 2010: Global Health Global Health: Definition “Health problems, issues, and concerns that transcend national boundaries, and may be best addressed by cooperative actions.” Institute of Medicine (IOM), 1997 Global Health Issues Health issues of major significance at a world-wide level. International Global Local Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions UN, DESA, 2008 Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions Non-communicable diseases Chronic diseases: - Diabetes - Cardiovascular diseases - Cancer Trauma: - Accidents - Violence Deaths by Cause Mexico, 1950-2010 90 80 70 60 Infectious 50 diseases % 40 Chronic diseases 30 and violence 20 10 0 1950 1960 1970 1980 1990 2000 2010 Bobadilla et al., 1993 Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions Obesity Trends Among Adults in Selected Countries (the annual percentage point increase in prevalence) 2.5 25<=BMI<30 M Male F Female BMI>30 2 1.40 BMI>=25 1.5 1 0.20 1.86 0.30 Percentage 0.70 0.5 0.28 1.00 0.30 1.10 0.20 0.07 0.80 0.20 0.80 0.33 0.32 0.40 0.30 0.30 0.40 0 M F F M F M F M F M F United States Mexico Brazil Morocco Thailand China 1999-2000 1999 1996-97 1998-99 1996 1997 GNP 3840 GNP 4630 GNP 1240 GNP 2160 GNP 750 Source: Popkin (2002) Pub Health Nutr. 5 :93-103. Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions EBOLAWild Life Cycle EBOLAHuman Outbreaks Global Warming Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions Tropical Storms Global Health: Background • Aging • Non-communicable diseases • Nutrition • Emerging infectious diseases • Environmental degradation • Inappropriate use of medical interventions Cesarean Sections in the Americas WHO, 2010 A Global Approach to Public Health • Addressing problems we have in common • Sharing expertise • Two-way win-win collaborations A Global Approach