502 GM Study Guide B
P1: Aging
I.
Main points
a.
In developing nations, why is a growing aging population most problematic?
a.i.
a.ii.
a.iii.
a.iv.
b.
Additional strain on limited resources
Discrimination against the elderly
Female elderly outnumber male elderly
Young adults tire of their elderly parents
In which type of nation are sex differences in aging more drastic? Why?
b.i.
b.ii.
b.iii.
b.iv.
Developed; increased maternal mortality in developing nations
Developed; decreased maternal mortality in developing nations
Developing; increased maternal mortality in developing nations
Developing; decreased maternal mortality in developing nations
c.
d.
e.
f.
g.
h.
i.
j.
Successful aging is increasing the age at which the elderly have independence
k.
Antibiotics should be considered the least preferred intervention because prevention strategies are better than treatment
strategies
l.
The efficacy of interventions should always be tested before implementation as some interventions may have an effect while
others might not (i.e. beta carotene has shown to have no immune enhancing effect so administering it as a supplement
would not be useful)
m.
n.
In developed countries there is a lack of professionals in geriatrics and gerontology
o.
Differences in diseases that become more prevalent with aging in developed versus developing countries
6 countries have 54% of the worlds elderly: China, US, India, Japan, Germany, Russia
Lowest life expectancy in Africa and Southeast Asia
Highest life expectancy in Canada, Western Europe, Japan, Australia, and New Zealand
By 2050, number of elderly people aged 60+ projected to triple
Generally, elderly are more likely to live in rural areas
More elderly women live in urban areas than men
There is a lack of data with respect to prevention/treatment of diseases that affect the elderly in comparison to the younger
population (aka the "knowledge shadow")
In developing countries, improvements in sanitation and water supply, fortification of food, and community caregiver
initiatives can reduce burden
o.i.
Developing countries
o.i.1.
o.i.2.
o.ii.
TB
Shingles
Developed countries
o.ii.1.
o.ii.2.
o.ii.3.
o.ii.4.
o.ii.5.
o.ii.6.
o.ii.7.
o.ii.8.
Respiratory infections (influenza, pneumonia)
Osteoporosis (hip fractures)
Chronic conditions (diabetes, obesity)
Cancer
Autoimmune disease
Cardiovascular disease
Mental illness (Alzheimers, dementia)
General impairment
o.ii.8.a.
o.ii.8.b.
o.ii.8.c.
p.
Visual changes (cataracts)
Arthritis
Cognitive slowing (decreased ability to deal with change and loss)
Single most significant risk factor for breast cancer is age
q.
Undernutrition/malnourishment is a significant factor in exacerbating loss of immune function in the elderly in developing
countries
r.
Inflammation factors can significantly impact healthy aging
r.i.
Can worsen or initiate Alzheimers, atherosclerosis, diabetes, sarcopenia, and osteoporosis
P2: Infant mortality
I.
Main points
a.
b.
c.
d.
e.
f.
99% of neonatal deaths occur in low and middle-income countries
70% occur in just two WHO regions (SEAR & AFR)
Top 3 causes of infant mortality globally: pneumonia, diarrhea, malnutrition
Top 3 causes of infant mortality in the US: congenital malformations, low birth-weight, other causes
Barriers to seeking health care: distance, quality of care, costs, lack of maternal education/awareness
Home-Based Newborn Care Model (part of Saving Newborn Lives funded by the Bill and Melinda Gates Foundation)
f.i.
Training of community health workers (CHWs) in safe delivery and newborn care practices such as clean
delivery, use of skilled birth attendants, newborn resuscitation, encouragement of immediate and exclusive
breastfeeding, keeping the newborn dry and warm, and clean cord care (use of a sterile blade to cut cord)
g.
Risk factors of infant mortality: time since birth, income, level of education, genetics, level of nutrition, and availability of
healthcare
h.
Coverage gap
h.i.
h.ii.
h.iii.
i.
j.
The difference between less developed and highly developed countries is almost two orders of magnitude
Highest gap: Chad, Ethiopia, Nigeria
Lowest gap: Turkmenistan, Peru, Egypt
Neonates are most at risk for infant mortality
The SEAR has had the most drastic improvement in infant mortality rates
P3: Cancer
I.
Main points
a.
What is the most economically devastating cause of death?
a.i.
a.ii.
a.iii.
a.iv.
Cancer
AIDS
Heart disease
Asthma
b.
True or False: Women in developing countries have higher incidences of cervical cancer than women in developed
countries.
c.
Even though there are many different types of cancers, what is thought of as the common feature of cancer cells?
c.i.
c.ii.
c.iii.
c.iv.
d.
Uncontrolled growth of abnormal cells with no physiological function
Cancer cells have a finite lifespan
Cancer cells grow into other tissues in different parts of the body
_______________ is the process where cancer cells travel to other parts of body via bloodstream or lymph vessels.
d.i.
d.ii.
d.iii.
d.iv.
e.
Cancer cells replace worn-out or dying cells, by repairing the damaged cell DNA
Apoptosis
Expansion
Metastasis
Disease
On a worldwide basis, this is the biggest risk factor for developing lung cancer.
e.i.
e.ii.
e.iii.
e.iv.
Regular use of a tanning bed
Indoor cooking with an unventilated cooking stoves
Eating a Brunch Burger
Smoking cigarettes
f.
g.
True or False: Screening for lung cancer dramatically decreases mortality from this disease.
This bacterium is currently linked as a major cause of stomach cancer.
g.i.
g.ii.
g.iii.
g.iv.
h.
H. pylori
Previous stomach surgery which leads to decreased acid production and increased presence of bacteria
Gender (males)
Age (>50, average age of diagnosis is 70)
Ethnicity (Hispanic, Blacks, Asians)
Family history, occupations
Tenth; ninth
Eleventh; tenth
Fourth; second
Fifth; sixth
Cervical cancer
Prostate cancer
Stomach cancer
Breast cancer
Changes in reproductive patterns, obesity, physical inactivity, and some breast cancer screening activity reflect a
_____________ in cancer rates in __________________.
k.i.
k.ii.
k.iii.
k.iv.
l.
m.
None of the above. The major cause of stomach cancer is due to a retrovirus.
What is the most frequently diagnosed cancer in women?
j.i.
j.ii.
j.iii.
j.iv.
k.
Staphylococcus aureus
On a worldwide basis, stomach cancer is the ____________ most common cancer; however, stomach cancer is the
____________ most common cancer causing death.
i.i.
i.ii.
i.iii.
i.iv.
j.
Helicobacter pylori
Risk factors for stomach cancer
h.i.
h.ii.
h.iii.
h.iv.
h.v.
h.vi.
i.
Clostridium difficile
Decline; Africa, Asia, and India
Rise; Africa, Asia, and India
Decline; US, UK, and Australia
Rise; US, UK, and Australia
Incidence and mortality now decreasing in Westernized countries
Highest incidence of breast cancer in North America, Argentina, Western Europe, and Australia
P4: Diabetes
I.
Main points
a.
The following are types of diabetes mellitus
a.i.
a.ii.
a.iii.
a.iv.
b.
c.
Type 2 non-insulin dependent
Gestational diabetes
B and C
True/False: Type 1 diabetes is insulin dependent.
Diagnostic criteria for diabetes is:
c.i.
c.ii.
c.iii.
c.iv.
d.
Type 1 non-insulin dependent
Fasting blood glucose greater than 7 mmol/L
Fasting blood glucose between 6.1 and 6.9 mmol/L
Fasting blood glucose greater than 4 mmol/L
None of the above
What are the risk factors for type 2 DM?
d.i.
Weight, diet, obesity, inactivity, family history, race, age, pre-diabetes, gestational diabetes
e.
What are the preventive strategies for DM?
e.i.
e.ii.
e.iii.
e.iv.
f.
Physical activity
Drug metformin
Poverty
Globalization of unhealthy diets, physical inactivity, smoking, and alcohol use,
In what areas do most people with diabetes live?
g.i.
h.
Lifestyle intervention
Why is DM more prevalent in developing countries?
f.i.
f.ii.
g.
Dietary modification
>80% of diabetes occur in low to middle income areas
Although most diabetics live in low to middle income areas, why is diabetes a part of the top ten leading causes of death in
high income countries?
h.i.
h.ii.
Better reporting
Death certificates specify diabetes rather than comorbidities as cause of death
i.
What levels, economically, can diabetes impact?
j.
According to the WHO Prevention program, when would monitoring the disease be more effective?
k.
l.
m.
n.
o.
Largest number of people with diabetes: China, India, US
i.i.
j.i.
Individual, national healthcare system, and economy
At the end, after the other 5 steps have been measured
Currently accounts for 11% of global healthcare expenditure
Hyperglycemia is 3rd leading risk factor for mortality and 8th leading risk factor for DALYs
7th leading cause of death in the US
Predictions include 51% increase in prevalence, 7th leading cause of death in the world by 2030, 10th leading cause of
DALYs by 2030
P5: Atherosclerotic heart disease
I.
Main points
a.
b.
c.
The leading cause of death worldwide is coronary heart disease
Atherosclerosis can lead to cardiovascular disease (CVD), which accounts for 31% of deaths and 10% of DALYs globally
The majority of risk factors for atherosclerosis are also risk factors for causes of death worldwide (7/10)
c.i.
d.
Hypertension, tobacco, hyperglycemia, physical inactivity, obesity, hypercholesterolemia, alcohol
In all the regions of the world, except Sub-Saharan Africa, cardiovascular disease is the number one cause of death
d.i.
In Sub-Saharan Africa, leading cause of death is HIV/AIDS
e.
Main reasons why deaths due to atherosclerosis have declined in the US is due to decrease in smoking and average levels
of blood cholesterol
f.
Deaths due to coronary heart disease have greatly increased in developing countries like India due to life expectancy surge,
decline of deaths in infants, children, and adolescents, economic success and increase in per capita, and more effective,
public health responses to perinatal, infectious, and nutritional deficiency
g.
>60% of global burden of heart disease occurs in developing countries, and >80% of CVD deaths take place in low- and
middle-income countries
h.
i.
Developing countries will contribute a greater burden of coronary heart disease than developed countries
j.
Policies and legislation are a primary source of influence in controlling preventative measures, such as smoking, in a
country
k.
Overall atherosclerosis is a preventable disease, which has risks that can be minimized or avoided through multiple routes
Health education on CVDs can help decrease the global burden by teaching preventative measures and healthier lifestyle
choices to the community
P6: Stroke
I.
Main points
a.
Risk factors
a.i.
a.ii.
b.
c.
Which of the following is false about how stroke affects the entire global community?
c.v.
it is the 2nd leading cause of death worldwide
it is the 2nd leading cause of disability in low-middle income countries
1/3 of those who experience stroke are left permanently disabled, while another 1/3 die from it
2/3 of stroke occurs in low-middle income countries, which is also where the majority of the aging population
resides
REASON: See slide 14, 15, and 16. Stroke is the THIRD leading cause of death worldwide, 1st is CHD and 2nd
is cancer
Which of the following is not considered a region with the highest stroke mortality rate according to WHO statistics?
d.i.
d.ii.
d.iii.
d.iv.
d.v.
d.vi.
e.
f.
Preventable: smoking, cholesterol/DM/HTN, alcohol
15 million people per year, 5.5 million die, leading cause of death for >age 60
c.i.
c.ii.
c.iii.
c.iv.
d.
Not preventable: age, gender, race, genetics
North Asia
Central Africa
South America
South Pacific
Eastern Europe
REASON: See map of regions most affected slide 17 South America's statistics do not show a severe (red)
mortality rate as seen in other regions
Highest stroke mortality rate in Eastern Europe, North Asia, Central Africa, and the South Pacific
The relationship between risk factors and healthcare access is crucial to understanding the health disparity in the global
burden of stroke. This is reflected in
f.i.
f.ii.
The higher prevalence of risk factors (such as diabetes, tobacco use, and higher average systolic blood
pressure) yet lower incidence of stroke mortality and DALYs in high-income countries
The higher prevalence of risk factors (such as diabetes, tobacco use, and obesity) yet lower incidence of stroke
mortality and DALYs in high-income countries.
f.iii.
f.iv.
f.v.
f.vi.
g.
h.
Incidence rates in higher income countries have declined as a result of access to and use of measures to
control high blood pressure
A and B
B and C
REASON: see slide 19 and chart on slide 20 The average systolic blood pressure throughout low-mid-and
high income countries is about the same, but diabetes, tobacco use, and obesity are higher in high-income
countries
Diabetes, tobacco use, alcohol use, and obesity higher in developed countries, BP and serum cholesterol about the same
The photo essay about Roberto's life after stroke in Sao Paolo, Brazil reflects the heightened burden of stroke in low-middle
income countries because
h.i.
h.ii.
In impoverished areas where rapid access to treatment is difficult, people experiencing a stroke are more likely
to either die or survive the stroke with more severe disability
The people who are most vulnerable to stroke are older gentlemen, who are often the breadwinners and
decision-makers in the household
h.iii.
h.iv.
h.v.
h.vi.
i.
The strong stigma against people with disability often isolates permanently disabled stroke survivors into poor
health facilities and nursing homes, which is often an extra economic burden for the family
A&C
REASON: See outline notes in slide 23
All of the following are used interchangeably with the term stroke as discussed in the presentation except
i.i.
i.ii.
i.iii.
i.iv.
j.
A&B
Cerebrovascular accident
Cerebral infarction
Cerebral interruption
Cerebral hemorrhage
A subarachnoid hemorrhage is best described as
j.i.
j.ii.
j.iii.
j.iv.
k.
Administration of tPA
Thrombectomy
Neurosurgical intervention
Oral hydration therapy
MRIs are more sensitive for diagnosing ischemic stroke
Cost can be a barrier to patients receiving a CT or MRI scan
Some areas of the world do not have the appropriate number of CT and MRI scanners
Computed tomography is not helpful in diagnosing stroke
Of the following, which is not included in the NIH Stroke Scale?
Level of consciousness
Language
CT Scan
Facial Palsy
NIH Stroke Scale includes level of consciousness, visual, facial palsy, motor, language, and attention
All of the following are barriers to stroke treatment except
p.i.
p.ii.
p.iii.
p.iv.
q.
Systemic hypoperfusion causing a reduced volume of blood flow to brain
MRIs more sensitive than CTs for ischemic stroke, CTs and MRIs equally effective for diagnosing intracranial hemorrhaging
n.i.
n.ii.
n.iii.
n.iv.
o.
p.
Due to accumulation of a pool of blood in the cerebrum as a result of vessel rupture
Which of the following is not true regarding CT and MRI scans for stroke?
l.i.
l.ii.
l.iii.
l.iv.
m.
n.
Due to accumulation of a pool of blood in the subarachnoid space in the brain
Which of the following possible treatment interventions are often indicated for patients suffering from a subarachnoid
hemorrhage?
k.i.
k.ii.
k.iii.
k.iv.
l.
A result of an embolized blood clot to the blood vessels supplying the brain
Low incidence of stroke worldwide
Non-recognition of stroke symptoms
Lack of ambulance services
The high cost of the drug tPA
Barriers to stroke treatment
q.i.
q.ii.
q.iii.
Pre-hospital delay (non-recognition of stroke symptoms, lack of ambulance services)
Financial constraints (cost of tPA)
Infrastructure (poor road conditions, less hospitals)
P7: Mental health
I.
Main points
a.
b.
The definition of mental health: an abnormal psychological pattern that is associated with distress or disability
c.
d.
4/6 leading causes of YLD are due to neuropsychiatric disorders (depression, alcohol, schizophrenia, and bipolar disorder)
Depression is the mental disorder that causes the most morbidity in years lived with disability (33% of all YLD are due to
mental illnesses and 12.15% of those are specifically due to depression)
The causes of mental illnesses are a combination of three factors
d.i.
d.ii.
d.iii.
Bio (genetics, neurotransmitter imbalance)
Psycho (abuse, neglect)
Social (changes in life)
e.
Mental illnesses are the most prevalent source of disability for young, working class people worldwide. This is important in
that it affects the economy.
f.
People generally have mental disorders in compound to other more physical medical illnesses. Know which medical
illnesses are most commonly seen with mental disorders
f.i.
f.ii.
Tuberculosis
HIV/AIDS
g.
What are some factors contributing to the unaddressed nature of mental illnesses?
g.i.
g.ii.
g.iii.
h.
Treatment fees and payments
Inability to find or maintain employment
Loss of work productivity
Loss of family, friends, coworkers productivity
Substance abuse
Prevention (need awareness and education)
Address social stigma
Provide more access to healthcare
Name some programs that are effective for prevention in adults and the elderly with mental disabilities
j.i.
j.ii.
j.iii.
j.iv.
k.
Mental illnesses are overlooked when found in comorbidity with other diseases
Describe three main targets in battling mental illnesses
i.i.
i.ii.
i.iii.
j.
Social stigma
Describe the potential financial burdens of having a mental disorder
h.i.
h.ii.
h.iii.
h.iv.
h.v.
i.
2/3 of people with known mental disorders never seek help
Suicide prevention
Marital/relational/occupational therapy
Stress management
Drug/alcohol intervention
Suicide is the number one most likely cause of mortality in people with mental illnesses. Programs targeted at suicide
prevention and education are needed for these patients.
P8: Influenza
I.
Main points
a.
b.
1 billion cases and 300,000-500,000 deaths annually
c.
The highly pathogenic strain of H5N1 Avian Influenza has caused the largest number of severe cases and deaths in human;
this strain may result in a pandemic if human to human transmission is achieved
d.
e.
H5N1 mortality rate 60%
f.
g.
GISN analyzes specimens for antigenic differences, resistance to therapy, and for population response to vaccines
h.
The CDC Influenza Division International Program gives funding support and technical support to establish surveillance,
pandemic preparedness, and to inform policies internationally
i.
Newer and next generation methods for developing vaccines should be faster and more efficient therefore lowering their
cost
j.
Resistance towards current drug therapies is on the rise and solutions must be found, an HA (hemagglutinin) inhibitor for
instance
The high risk populations for influenza are children under 5, adults over 65, pregnant women, American Indians and Alaskan
Natives, and people with certain medical conditions
The WHO Global Influenza Surveillance Network monitors changes in influenza viruses and recommends vaccines twice a
year based on prevalence of circulating influenza virus strains
Samples received by GISN only representative of 20 countries and there is a disproportion of samples from young children
compared to elderly
h.i.
j.i.
k.
Program expanded from just Southeast Asia to Sub-Saharan Africa, Latin America, and Eastern Europe
Current drugs include adamantanes (amantadine, remantadine) and neuraminidase inhibitors (oseltamivir,
zanamivir)
Allowing countries to produce drugs for themselves for a much cheaper price along with surveillance systems would help to
better control influenza outbreaks
P9: Maternal mortality
I.
Main points
a.
You would expect to find the highest rate of maternal mortality in which of the following countries?
a.i.
Brazil
a.ii.
a.iii.
a.iv.
South Korea
Uganda
Sweden
b.
c.
Highest maternal mortality in Sub-Saharan Africa and Southeast Asia
d.
Which of the following is NOT a cause of maternal mortality?
True or false: Urban areas have higher rates of maternal mortality over rural areas.
c.i.
d.i.
d.ii.
d.iii.
d.iv.
False
Endocrine disruption
Post partum hemorrhage
Obstructed labor
Sepsis
e.
True or false: If a woman who is 8 months pregnant is killed by a drunk driver it is still considered maternal mortality
because she was pregnant.
f.
Which of the following is the #1 cause of maternal mortality worldwide?
e.i.
f.i.
f.ii.
f.iii.
f.iv.
g.
False
Sepsis
Post partum hemorrhage
Unsafe abortion
Obstructed labor
Young teenage girls will most likely experience which of the following?
g.i.
g.ii.
g.iii.
g.iv.
Sepsis because their uterus has not developed the necessary antibodies to prevent post partum infection
Unsafe abortion because they are more likely to obtain them because of social stigma surrounding teenage
pregnancy
Eclampsia because of poor regulation of her blood pressure
Obstructed labor because her pelvis is not fully developed
h.
True or false: It is estimated that 1,000 women die each day from complications due to pregnancy or labor.
i.
Obstetric fistulas are caused by
h.i.
i.i.
i.ii.
i.iii.
i.iv.
True
Post partum hemorrhage
Obstructed labor
Sepsis
Unsafe abortions
j.
True or false: the unmet need for family planning strongly correlates with maternal mortality.
k.
UNICEF has been criticized for
j.i.
k.i.
k.ii.
k.iii.
k.iv.
True
Annoying fundraising techniques
Embezzling money
Taking credit for improvement of maternal and infant mortality because they control the data collection
High overhead costs
P10: TB
I.
Main points
a.
What is the average length of a short course of therapy?
a.i.
a.ii.
a.iii.
a.iv.
b.
6 months
1 month
3 months
12 months
About how many days do you have to wait before you read a TST test?
b.i.
b.ii.
b.iii.
b.iv.
c.
2-3 days
There is no wait
4-5 days
7 or more days
Why is TB transmission so hard to contain?
c.i.
c.ii.
c.iii.
c.iv.
It is easy to contain
It is an STI with few signs and symptoms
Fomite transmission
Droplet nuclei can remain suspended in the air for hours and travel over 100 feet
d.
True or false: there are no bacteria in the body during latent tuberculosis.
e.
Which region among the WHO six regions has already met the MDG target of reducing TB prevalence by 50%?
d.i.
e.i.
e.ii.
e.iii.
e.iv.
f.
The Americas
Africa
Southeast Asia
Asia and Africa
Africa and Europe
Africa and Eastern Mediterranean Region
Asia and Eastern Mediterranean Region
Which one of the following is not one of the high MDR-TB burden countries?
g.i.
g.ii.
g.iii.
g.iv.
h.
i.
Western Pacific
Most of the estimated number of TB cases in 2010 occurred in
f.i.
f.ii.
f.iii.
f.iv.
g.
False
The Russian Federation
China
Indian
Australia
Highest of burden MDR-TB in Russia, Southeast Asia, Sub-Saharan Africa
Which is NOT a strategy listed by WHO and the STOP TB Partnership?
i.i.
i.ii.
i.iii.
i.iv.
DOTS expansion
Address vulnerable populations
Empower people with TB
Raise $1 billion in funds
j.
WHO and STOP TB Partnership strategies include DOTS expansion, address TB/HIV, MDR-TB, and vulnerable
populations, primary care, engage providers, empower people with TB, and promote research
k.
By 2015, the MDG 6 goal is to reduce the prevalence and death rates of TB by how many percent?
k.i.
k.ii.
k.iii.
k.iv.
l.
m.
0%
50%
100%
MDG 6 also aims to eliminate TB as a public health problem by 2050 (<1/1,000,000 cases per year)
By the end of 2011, the Global Fund programs detected and treated how many people with TB?
m.i.
m.ii.
m.iii.
m.iv.
P11: Ethics
15%
100,000
8.6 million
700million
2 billion
I.
Main points
a.
Research is done abroad for two main reasons
a.i.
a.ii.
b.
Regulation is more lenient abroad
What are the major differences researchers should consider when conducting research abroad?
b.i.
b.ii.
b.iii.
b.iv.
c.
It is overall cheaper
Western philosophy vs. traditional views
Individual vs. community
Secular views vs. religious views
Education levels and language barriers
What are some recommendations researchers should think about to make their research more socially ethical?
c.i.
c.ii.
c.iii.
c.iv.
Community involvement
Form partnerships and collaborations
Ensure benefits to participants and the community
Have more rigorous review over private sector research
d.
Informed consent is defined as a participant receiving information regarding the research, understanding that information,
and making a voluntary decision to participate or not
e.
Voluntary consent may be hindered in developing countries with societies who have a community leader, panel of elders,
and/or traditional sex roles where women do not have autonomy
f.
Written consent is difficult to obtain in societies that speak a different language, are not educated, or where a third party
translator is used which increases the possibility of misconstruing information
g.
What is the focus of the institutional review board?
g.i.
Rights and welfare of human research subjects with respect to informed consent, assessment of risks versus
benefits, and equitable choice of subjects
h.
Which of the following is a risk to human subject participants that is a result from the current IRB structure?
i.
What methods can be used to make committees more efficient, allowing them to be less overworked?
h.i.
i.i.
i.ii.
i.iii.
j.
Vast majority of IRBs are overworked, leading to more error in evaluation of proposal validity
Separate IRB into sub-committees, based on level of risk to human participants, because different risk levels
require different perspectives and considerations by the reviewer
Reducing subjectivity of the evaluation process
Mandatory education and self-evaluation program
Who holds authority on ethical validity of a research proposal?
j.i.
Both the country of the research sponsor and the country hosting the research
P12: Cholera
I.
Main points
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
Cholera can cause large epidemics due to its short incubation period
Caused by lack of basic sanitation, eating and drinking contaminated food and water
Epidemics fueled by environmental changes or political unrest
Serovar O1 is responsible for most epidemics, O139 is localized to Southeast Asia
John Snow discovered the cause of cholera to be a water source from a sewage line, dubbed father of epidemiology
3-5 million cases are reported each year
25-50% of typical cholera cases are fatal if left untreated
Immunocompromised populations are more prone to severe dehydration
Reported cholera outbreaks 2010-2011 in Haiti and Dominican Republic, Sub-Saharan Africa, Southeast Asia
Haiti's outbreak is responsible for more than half of all cholera cases worldwide
Use of ORT (oral rehydration therapy) has been correlated with lower diarrheal death rates
Only 33% of children with diarrheal diseases in developing countries currently receive ORS treatment
The two oral cholera vaccines currently approved by the WHO, Dukoral and Shanchol, are costly
P13: Marijuana
I.
Main points
a.
Effects of THC
a.i.
a.ii.
a.iii.
b.
c.
d.
Neutral: tiredness, lethargy, increased appetite, mouth dryness
Negative: upper respiratory irritation, paranoia, anxiety, tachycardia
Global estimates of marijuana use 130-190 million (2.9 4.3%)
Top countries New Zealand, Australia, US, UK, and Switzerland
The three strains of Cannabis.
d.i.
e.
Positive: euphoria, relaxation, stress reduction, increased awareness of senses, pain relief
Indica, sativa, ruderalis
Franklin Delano Roosevelt signed the Marihuana Tax Act, thus outlawing marijuana, in what year?
e.i.
1937
f.
This president began the War on Drugs, which was aimed against marijuana.
g.
The conservative estimate of revenue from marijuana legalization in the U.S.
h.
The number of people that have overdosed or died from cannabis.
i.
The percentage of American high school seniors with easy access to marijuana, under the current model of prohibition.
j.
The number of Americans who have tried cannabis, according to independent public polls.
k.
l.
15 million Americans (16%) define themselves as regular users
m.
The average potency of THC on a yearly basis.
n.
The number of U.S. states with current medicinal marijuana laws.
f.i.
g.i.
h.i.
i.i.
j.i.
Richard Nixon
$14 billion/year
0
85%
115 million
The percentage of Americans who have tried crack and heroin, using marijuana as gateway drug.
l.i.
m.i.
n.i.
3.6%, 1.6% respectively
5%
16 + D.C.
P14: Polio
I.
Main points
a.
Most commonly, polio results in what outcome for the patient?
b.
What percentage global decrease in prevalence has been achieved since the introduction of the polio vaccine?
c.
What three countries currently house polio endemics?
d.
In what demographic is polio most commonly seen?
a.i.
b.i.
c.i.
d.i.
e.
Children under the age of 5
VDPV
Yes
For every case of paralysis how many children can be infected without symptoms?
g.i.
h.
Afghanistan, Nigeria, and Pakistan
Can polio spread from endemic countries to their neighbors and beyond?
f.i.
g.
99%
What are major problems with polio vaccination and immunity?
e.i.
f.
Disability
Between 200 and 1000 children
How many different types of vaccines are used throughout the world?
h.i.
i.
What is the best national defense against polio?
i.i.
j.
4
Routine Immunization
What is the most common route of transmission?
j.i.
Fecal-oral transmission
P15: Alcoholism
I.
Main points
a.
All of the following would put you at a risk of developing alcoholism except
a.i.
a.ii.
a.iii.
a.iv.
b.
A and B
Blood testing
Physical exam
Questions and history
Medical imaging
Advertising
Taxation
Minimum age regulations
Health education
Alcoholic anonymous
Brief intervention
AUDIT
Taxation
True
0.5 billion
1.0 billion
2.0 billion
3.0 billion
What income group is most affected by alcohol use in terms of DALYs?
h.i.
h.ii.
h.iii.
i.
Drinking alcohol
According to WHO 2002 reports, how many people consume alcohol globally?
g.i.
g.ii.
g.iii.
g.iv.
h.
Environmental factors
(T/F) Light and moderate drinkers collectively are responsible for the largest share of alcohol's burden in society
f.i.
g.
Genetic factors
Which of these does not count as part of direct intervention alcohol policy
e.i.
e.ii.
e.iii.
e.iv.
f.
Anxiety and depression
What is the most cost effective measure in a population based alcohol policy
d.i.
d.ii.
d.iii.
d.iv.
e.
Attending university
When diagnosing an alcoholic individual, physicians mostly depend on
c.i.
c.ii.
c.iii.
c.iv.
d.
Constant stress
Alcoholism is caused by
b.i.
b.ii.
b.iii.
b.iv.
c.
An alcoholic mother
High income
Middle income
Low income
What is the most common disease burden of harmful alcohol use?
i.i.
i.ii.
Neuropsychiatric disorders
Cardiovascular disease
i.iii.
i.iv.
j.
Cirrhosis
Cancer
(T/F) Alcoholism is a dual disease
j.i.
True
P16: Malaria
I.
Main points
a.
b.
c.
d.
e.
f.
g.
h.
i.
RTS,S is designed to help the people with the highest burden of disease; children
j.
In order to effectively reduce Malaria levels control measures must be successfully implemented on a large scale for at least
15-20 years
RTS,S targets the most virulent form of malaria P. falciparum
RTS,S is currently in Phase III of clinical trials and is set to be released by 2015
Racial composition is not a risk factor for Malaria but temperature, land usage and vector type all are risk factors
Children under 5 years of age in endemic areas are the population group most at risk for Malaria
The estimated number of acute cases of Malaria per year is 200-300 million
The global funding gap does NOT include household spending which is a serious barrier to prevention and treatment
Monotherapies of anti-malarial drugs are no longer recommended due to the associated problem of drug resistance
Malaria prevention & treatment saves more lives per dollar spent & has a greater impact on health in Sub-Saharan Africa
than all other health interventions except childhood immunization
P17: HIV
I.
Main points
a.
What is the most common route of HIV transmission?
a.i.
a.ii.
a.iii.
a.iv.
b.
Sub-Saharan Africa
Latin America
Caribbean
False
True
False
What group represents the second largest group of people living with HIV/AIDS?
g.i.
g.ii.
g.iii.
g.iv.
h.
Southeast Asia
(T/F) Abstinence based HIV prevention programs are effective long-term.
f.i.
g.
True
(T/F) The WHO 3 by 5 initiative did not meet their goal of 3 million people by 2005.
e.i.
f.
By ordinary contact (e.g. kissing, hugging)
(T/F) PEPFAR adapted and redefined the ABC approach with an emphasis on condoms.
d.i.
e.
Through sex
The region with the highest burden of people living with HIV/AIDS is
c.i.
c.ii.
c.iii.
c.iv.
d.
From mother to child (vertical transmission)
(T/F) The risk factors for HIV are having unprotected sex, having another STD, using intravenous drugs, and an
uncircumcised man.
b.i.
c.
Sharing needles contaminated with infected blood
Sub-Saharan Africa
Latin America
Caribbean
Southeast Asia
What is the leading cause of HIV infection in Eastern Europe/Central Asia?
h.i.
h.ii.
MSM
Blood transfusion
h.iii.
h.iv.
i.
Heterosexual contact
What is the primary mode of transmission in the Caribbean?
i.i.
i.ii.
i.iii.
i.iv.
j.
Injection drug use
Unprotected sex
Injection drug use
Blood transfusion
MSM
Which of the following is NOT a future initiative for HIV?
j.i.
j.ii.
j.iii.
j.iv.
Topical microbicides
Post exposure prophylaxis
Pre exposure prophylaxis
HIV vaccine
P18: Road Traffic Injuries
I.
Main points
a.
Which region of the world has the highest mortality rate (per 100,000) from road traffic injuries?
a.i.
a.ii.
a.iii.
a.iv.
b.
Mode of travel
Land use\urban planning
Alcohol\drug usage
Low income countries
Middle income countries
High income countries
None of the above; on average, low, middle, and high income countries are all seeing an increase in road traffic
injury mortality rate
The Washington Post
The Guardian
Johnson & Johnson
Make Roads Safe Fund
Road Safety Fund
World Health Organization
In Africa, which of the following kills the most 5-14 year old children?
f.i.
f.ii.
f.iii.
g.
Road design
Which organization is in charge of fundraising for the Decade of Action for Road Safety?
e.i.
e.ii.
e.iii.
f.
Asia
Who recently received a grant to help focus the worlds attention on global road traffic deaths and injuries?
d.i.
d.ii.
d.iii.
e.
Europe
Which countries are seeing a decrease in road traffic injury mortality rate (per 100,000)?
c.i.
c.ii.
c.iii.
c.iv.
d.
The Americas
Which of the following does NOT affect the exposure to risk of road traffic injuries?
b.i.
b.ii.
b.iii.
b.iv.
c.
Africa
HIV
Malaria
Cars and trucks
Which of the following is not a component of the Haddon Matrix?
g.i.
g.ii.
g.iii.
Agent
Barriers
Physical environment
g.iv.
h.
Which of the following was not a successful policy?
h.i.
h.ii.
h.iii.
h.iv.
i.
Vehicle speed regulators
Reduction in speed limits
Lengthening the license renewal period
Daytime running lights
Daytime running lights were developed
i.i.
i.ii.
i.iii.
i.iv.
j.
Social environment
The US
The UK
Switzerland
Scandinavia
Delaying licensing will help which section of the Haddon Matrix?
j.i.
j.ii.
j.iii.
j.iv.
Primary - agent/vehicle
Secondary - host
Primary - social environment
Tertiary - physical environment
P19: Obesity
I.
Main points
a.
Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health and is
measured by
a.i.
a.ii.
a.iii.
a.iv.
b.
Type 2 diabetes
Cardiovascular disease
Hypertension and stroke
Decreased risk of premature death
Cancer
Healthy eating habits
Exercise
Nutrition lacking, energy dense diets
A and B
True
False
Which 3 countries have the highest distribution of obesity in adult males?
e.i.
e.ii.
e.iii.
e.iv.
f.
Weight
In 2030 it is expected that the burden of global obesity will be on the decline
d.i.
d.ii.
e.
Body mass index
Factors leading to childhood obesity include
c.i.
c.ii.
c.iii.
c.iv.
d.
Height
All of the following are a major risk or consequence for serious diet related chronic diseases in people who are obese
except
b.i.
b.ii.
b.iii.
b.iv.
b.v.
c.
Mass
Japan, Nigeria, Iran
United States, Canada, Australia
Russia, Brazil, Iraq
Peru, China, India
Which of the following is the 5th leading cause of global death?
f.i.
f.ii.
Zinc deficiency
Unsafe health-care injection
f.iii.
f.iv.
g.
It will decrease
It will stay the same
It will more than double
None of the above
Why is the topic of global obesity so important?
h.i.
h.ii.
h.iii.
h.iv.
h.v.
i.
Overweight and obesity
How will the rates of diabetes change by 2030 as a result of obesity?
g.i.
g.ii.
g.iii.
g.iv.
h.
High blood pressure
Obesity causes different secondary diseases like diabetes in different countries
Obesity is the most common cause of bullying worldwide
People in general are obsessed with being thin
It can lead to chronic health problems like heart disease, atherosclerosis, and diabetes
None of the above
What is the purpose of Icon Fitness?
i.i.
i.ii.
i.iii.
i.iv.
i.v.
j.
To make more profit by selling outside of the US to other countries
All of the above
To compete for the same customers as the other companies involved in this fitness organization
To have major health based corporations and sponsors become more involved in the global distribution of their
fitness equipment
None of the above
First Lady Michelle Obama proposed and eventually had her Child Nutrition Law signed into law by which President?
j.i.
j.ii.
j.iii.
j.iv.
j.v.
President Clinton
President Carter
President Bush (father or son)
President Mandela
President Obama
P20: Hepatitis
I.
Main points
a.
Which country has the greatest number HBV infections?
a.i.
a.ii.
a.iii.
a.iv.
b.
c.
China
Vietnam
Which of the following does HBV not increase the risk for?
Hepatocellular carcinoma (liver cancer)
Arthritis
Cirrhosis
Glomerulonephritis
In areas of high HBV prevalence (greater than 8%), which is the primary method where HBV is spread?
d.i.
d.ii.
d.iii.
d.iv.
e.
f.
India
Top three countries with HBV infections are China, India, and Indonesia
c.i.
c.ii.
c.iii.
c.iv.
d.
Indonesia
Vertical transmission from mother to child
Commercial sex workers
Sharing needles from injection drug users
Contaminated food and drinks
In areas of low HBV prevalence, unprotected sex and needles are the primary modes of transmission
Which country currently has a large endemic HCV infection (greater than 14%)?
f.i.
f.ii.
f.iii.
f.iv.
g.
True
Pregnant women
MSM
IVDU
Patients with co-infection of HIV
False
Which of the following is NOT a way to prevent hepatitis A and E infections?
k.i.
k.ii.
k.iii.
k.iv.
l.
True
Incidents of hepatitis A and E have been increasing in the United States. True or False?
j.i.
k.
China
Hepatitis E causes the highest mortality among which group?
i.i.
i.ii.
i.iii.
i.iv.
j.
Thailand
Coordinated efforts between HBV and HIV programs would decrease HCV global burden? True or False?
h.i.
i.
Egypt
Screening blood is a good way to decrease global HCV infection. True or False?
g.i.
h.
India
Adequate chlorination of water
Boiling or cooking food to at least 185 degrees
Good personal hygiene
Vaccinating for HCV
Who is at risk for HDV infection?
l.i.
l.ii.
l.iii.
l.iv.
IVDU
Promiscuous heterosexual and homosexual groups
People exposed to unscreened blood
All of the above
P21: Chagas and Schistosomiasis
I.
Main points
a.
b.
c.
d.
e.
f.
g.
The vast majority (over 90%) of the global burden of Schistosomiasis is in Africa
h.
i.
Insecticide spraying, improving housing, and screening of blood donations are important steps to control Chagas
j.
k.
For both diseases, vector control represents a promising strategy
Pathology caused by Schistosomiasis is a result of the bodys immune response to the eggs, not the eggs themselves
Those most at risk for getting Schistosomiasis are fishermen, children, and mothers/infants
It is important to avoid freshwater in areas where Schistosomiasis is commonly found
The main source of T. cruzi transmission in non-endemic countries is due to blood transfusions
Increasing global prevalence of Chagas disease is due to migration from endemic to non-endemic areas
Chagas disease is often asymptomatic; however, chronic symptomatic disease is frequently manifested by cardiac
complications
The drug of choice when treating schistosomiasis is Praziquantel and has helped decrease the incidence of the disease in
many countries
Transmission of Chagas
k.i.
Vector, blood transfusion, vertical transmission, organ transplants, oral transmission
P22: Tobacco
I.
Main points
a.
In developing nations, the epidemic shift of deaths attributed to tobacco is said to be
a.i.
a.ii.
20%
50%
a.iii.
a.iv.
b.
Indonesia
Russia
United States
Second hand smoke
Coronary heart disease
Ischemic heart disease
Lung cancer
Stress
Amphetamines
Epigenetics
Alcohol Use
Epigenetic predisposition
SES
Stress
Social norms
Smoking during pregnancy
Alcohol Use
False
First-hand smoke
Second-hand smoke
Third-hand smoke
All of the above
Both A and B
Certain cigarette companies specifically target particular audiences
i.i.
i.ii.
j.
India
Which of the following are dangers of tobacco use?
h.i.
h.ii.
h.iii.
h.iv.
h.v.
i.
China
True or False: Increasing taxes on cigarettes has been one of the most effective strategies in declining smoking rates
g.i.
h.
Eastern Europe and the Soviet Union
Predispositions to tobacco use
f.i.
f.ii.
f.iii.
f.iv.
f.v.
f.vi.
g.
Middle East and Africa
Which of the following is NOT a predisposition to tobacco use?
e.i.
e.ii.
e.iii.
e.iv.
f.
Asia and Australia
In the United States, what is the number one cause of tobacco related death?
d.i.
d.ii.
d.iii.
d.iv.
e.
The Americas
Areas most affected
c.i.
c.ii.
c.iii.
c.iv.
c.v.
d.
There is no epidemic shift in tobacco deaths
Worldwide, which geographic region has the highest tobacco consumption rate?
b.i.
b.ii.
b.iii.
b.iv.
c.
>80%
True
False
Which of the following has NOT implemented some sort of ban on tobacco use?
j.i.
j.ii.
j.iii.
j.iv.
China
Iran
Canada
Brazil
k.
What does the P in WHOs MPOWER strategy stand for?
k.i.
k.ii.
k.iii.
k.iv.
l.
Protect people from tobacco smoke
Promote healthy alternatives to using tobacco
Partner with other anti-tobacco organizations
Of WHOs MPOWER strategy, which of the following is responsible for covering the largest population of people?
l.i.
l.ii.
l.iii.
l.iv.
m.
Prevent people from purchasing tobacco products
M (monitoring)
W (warning labels)
E (enforcing bans)
R (raise taxes)
WHOs MPOWER strategy implemented in 2008
m.i.
m.ii.
m.iii.
m.iv.
m.v.
m.vi.
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
P23: Visual Impairment
I.
Main points
a.
Risk factors for cataracts
a.i.
b.
Blindness is defined as?
b.i.
c.
Cataracts
What is the leading cause of visual impairment?
d.i.
e.
20/200 or worse
What is the leading cause of blindness?
c.i.
d.
Tobacco, BMI, DM, UV light exposure
Refractive errors
Which WHO region has the highest direct and indirect costs due to visual impairment?
e.i.
AMR (Americas region)
f.
Which WHO region has the highest amount of DALYs due to visual impairment?
g.
True or False: The global economic burden of visual impairment will increase by 2020.
h.
Of the four components that comprise global economic spending on visual impairments (direct costs, deadweight welfare
loss, productivity lost, informal care costs), which costs the most?
f.i.
g.i.
h.i.
i.
Direct costs
To provide the necessary tools, training, and technology for local partners to develop their own eye care
services
What is the mission of VISION 2020?
j.i.
k.
True
Whats the mission of ORBIS?
i.i.
j.
SEAR (Southeast Asia region)
To eliminate the main causes of all preventable and treatable blindness by the year 2020
What does the SAFE strategy for trachoma stand for?
k.i.
Surgery, antibiotics, facial cleanliness, environmental change
P24: Malnutrition
I.
Main points
a.
98% of world hunger occurs in developing countries
b.
c.
d.
e.
Despite vulnerability to iron toxicity, iron deficiency is the most prevalent form of malnutrition worldwide
f.
g.
Poverty is an underlying risk factor for malnutrition in the developing world
h.
i.
j.
Each UN Millennium Development Goal either directly or indirectly works toward decreasing the burden of malnutrition
k.
l.
Malnutrition and hunger-related diseases cause 60% of deaths
Asia and the Pacific region houses nearly 2/3 of the worlds hungry people
Women and children are high risk groups for malnutrition, and malnutrition is propagated through these two populations
There is equilibrium between inadequate dietary intake and disease. Insufficiency in dietary intake will cause disease, and
disease will affect proper nutrition
Communicable diseases are more common in undernourished populations, while noncommunicable diseases due to
overnutrition are more common in the developed world
Globalization is a challenge to overcoming overnutrition in developed countries
While genetically engineered foods help relieve the burden of undernutrition, they contribute to an increased burden of
overnutrition
Groups at increased risk for micronutrient deficiency and/or toxicity include the elderly, pregnant women, alcoholics, and
children