Intro to Public Health Final (Midterm 1, Midterm 2, and Tobacco Unit Questions)

Describe why breastfeeding helps to lower diarrhea-related morbidity, as well as other common childhood illnesses?

- Breast Milk and colostrum are very rich in sIgA antibodies - Secretory immunoglobulin A (sIgA) is main antibody that protects mucosal surfaces - Ingested sIgA coats intestinal tract and provides passive protection against intestinal microbes - A portion of ingested sIgA can be absorbed from the intestinal tract and transported to other mucosal sites like the respiratory tract

Why is childhood diarrhea considered such a major public health problem?

- Huge burden of disease: 1.7 billion episodes annually, 400,000 deaths per year - Children under 5 in low/middle income countries experience 2-3 episodes of diarrhea per year

Major Causes of the Obesity Pandemic

- Human innate preferences for fat and sugar - Higher incomes lead to higher fat and sugar purchases - Urbanization linked causes - Lower food prices, especially vegetable oil - Globalization/centralization of the media to promote certain aspects of food culture - Technological factors that affect work and leisure, productivity, and effort - Other changes in household purchasing patterns and time (more meals eaten outside of home)

Describe the relationship between malnutrition and diarrhea.

- Malnutrition increases the likelihood that a child with diarrhea will die or develop persistent diarrhea - Diarrhea has a negative impact on growth

How does rotavirus attack enterocytes, and thereby promote malabsorption diarrhea?

- Targets the mature enterocyte cells located in the upper areas of the intestinal villi - Infection results in cell death and villous atrophy → villous shedding → malabsorption diarrhea

How does mismatch increase a child's risk of obesity and chronic diseases in adulthood?

- The baby predicts a sparse environment, so the body prepares for that. The body is not prepared for a nutritionally rich environment. - There is an increasing risk of metabolic disease in a nutritionally rich adult environment that corresponds with how sparse the predicted environment was. - More sparse = more risk.

What major types of pathogens are responsible for diarrheal infections?

- Viral, bacterial, and parasitic - Rotavirus, enterotoxic e. coli, Shigella species, Campylobacter jejuni, cryptosporidium parvum - Rotavirus: leading cause of non-bloody diarrhea in infants - Cholera: Vibrio cholerae - Bloody diarrhea: mostly shigella

how the negative consequences of disease can be recurring with a "poor start to life" both in terms of undernutrition and over-nutrition?

- Women malnourished, low pregnancy weight gain → suboptimal fetal development → obesity, insulin resistance → gestational diabetes → large babies → obesity, insulin resistance → large babies → overweight mothers → obesity, insulin resistance → premature death and morbidity → maternal morbidity → women malnourished, low pregnancy weight gain - Women malnourished, low pregnancy weight gain → suboptimal fetal development → premature death and morbidity → maternal morbidity → women malnourished, low pregnancy weight gain - Women malnourished, low pregnancy weight gain → suboptimal fetal development → women malnourished, low pregnancy weight gain

What specific features of secretory IgA antibodies enable them to avoid digestion/denaturation in the GI tract?

- sIgA molecule is a dimer antibody joined together by the "J" piece with an associated "secretory" component - Secretory component protects immunoglobulin from digestions by proteolytic enzymes in GI tract, allowing sIgA to survive in GI tract environment and provide protection against intestinal microbes

Stages of nutrition transition

1. Hunter-gatherer: High in CHO, protein and fiber, low in fat. High activity, lean body 2. Agrarian, food insecure. Low calories, protein and fat. High activity, childhood malnutrition, lean body. 3. Increasing consumption of F&V, animal protein, increasing inactivity. 4. Increasing affluence, fat intakes, stress. Markedly sedentary lifestyle, overweight in greater quantities than underweight. 5. Awareness of benefits of balanced diet and activity. Healthy behavior adapted initially by affluent educated people.

Severity of clean water access issue

2.2 billion lack access to safely managed drinking water 2.6 billion lack access to safely managed sanitation services

What proportion of worldwide child mortality is attributable to childhood diarrhea?

20-25% of all deaths among children under 5

BMI classification for overweight

25-29.9

Which age range is most at risk for diarrheal infection?

6-11 months of age

BMI classification for obesity

>30

Percent body fat classifications for obesity in men and women

>30% body fat in females, >25% body fat in males

Market Power

Ability of a market to raise the price of a good/service beyond its competitive level (i.e. monopolies) However, some food prices are going down, which make it easier for us to over eat (Finkelestien's argument here is weak) Healthy food prices are going up and are harder to access for low-income communities (gov't intervention here may be necessary)

Types of diarrhea

Acute watery diarrhea, acute bloody diarrhea, persistent diarrhea, diarrhea with severe malnutrition

When does Executive Order 12866 justify regulation in the absence of clear market failures?

Any proposed regulation should clearly explain whether the action is intended to address a significant market failure If not, then to address a market failure the agency must demonstrate a compelling public need for intervention

basic, underlying, and immediate causes to the situation of a high prevalence of child-related deaths from diarrheal disease in low-and-middle-income countries.

Basic Causes: poverty and inequality, poor governance and weak healthcare systems Underlying Causes: Poor WASH, inadequate nutrition, limited healthcare access, failure to improve access to safe drinking water and improve availability and use of improved sanitation facilities Immediate causes: infectious pathogens, poor immune system function, inadequate treatment and care

What features of breastfeeding make it such an important health behavior?

Breastfeeding boosts a child's immune system with the sIga secretions present in it.

Describe two major global trends in obesity.

Childhood obesity rates are rising, with boys often having higher rates than girls in many regions The prevalence of obesity is rising fast among women in certain regions, particularly in low and middle income countries (cultural and economic factors influence dietary habits)

economic, dietary, and physical-activity related factors that influence the development of the Dual Burden of Disease is occurring in LMICs

Children in low and middle income countries are more vulnerable to inadequate prenatal, infant, and young child nutrition. Also exposed to high-fat, high-sugar, energy-dense, and micronutrient-poor foods, which tend to be both lower in cost and lower in nutrient quality. Dietary patterns + lower levels of physical activity → sharp increases in childhood obesity while undernutrition issues remain unsolved

What is SDG #6?

Clean water and sanitation

Coverage in relation to essential interventions for diarrheal preventions

Coverage: extent to which diarrheal interventions and preventions are implemented Coverage of zinc treatment, ORT, sanitation initiatives, etc. some places have high coverage and some have extremely low coverage

IF YOU SEE THIS

DO THE MATCH REVIEW GAME!!!!

specific nutrient deficiencies that increase diarrhea-related morbidity and mortality

Deficiencies in Vitamin A and zinc are associated with increased morbidity and mortality from diarrheal disease

Where did ORT originate?

Developed in Bangladesh

How have diarrheal-related deaths changed over the past 30 years?

Diarrheal-related deaths have declined significantly over the past 30 years

Do cause-specific characteristics of diarrheal pathogens influence the approach to case management and prevention of diarrhea?

Different pathogens have different transmission routes and severities. There are different treatments for different causes of diarrhea. Parents who want diarrhea to stop might lie to doctor in order to get a specific treatment

key health promotion motivations necessary to address to promote hand washing with soap

Disgust and affiliation (social norm) are good candidates for motivations Comfort is a motivation for handwashing: people value having a skin that is free not just of disgusting substances but also of matter such as earth, charcoal, wetness, stains, or oily residues. Comfort resided both in being able to sense cleanliness directly, but also as a state of mind: being clean implied inner comfort, freshness, readiness for anything, confidence and purity

Middle level of 3 level model

Emerging sense of control, begin to question things as they are

Key features of empowerment/adult learning theories

Empowerment Framework for how adults process and learn new information emphasizing self-directed learning, drawing on prior experiences, and prioritizing relevance to the learner's life to motivate them to take ownership of their learning process

Exclusive breastfeeding

Feeding your baby only breast milk, not any other foods or liquids (including infant formula or water), except for medications or vitamin and mineral supplements

What are some ways in which social norms can be changed to promote HWWS?

Focus on health outcomes, storytelling & testimonials, use of media influence of leaders and celebrities, peer influence

Public Goods

Goods are available for everyone to consume regardless of who does or does not pay for them (ex. public parks) Difficult for the private sector to provide, because they are not profitable (ultimately require citizens to pay through taxes) Finkelestien claims the lack of public goods is not responsible for obesity rates

from an economic perspective, when should governments become involved in re-allocating resources?

Government policy should be limited to addressing areas where private markets fail to reach optimal allocation of resources

essential caregiver behaviors necessary to accomplish 4 key diarrheal-related interventions

Handwashing needs to be integrated into the habitual, motivated, and planned activities of the everyday lives of child caretakers in their own domestic environments exclusive breastfeeding, frequent handwashing with soap, correct use of oral rehydration salts, and zinc administration.

Key general improvements that are pursued in the sanitation and drinking water sectors?

Improve access to safe drinking water Improve availability and use of improved sanitation facilities

critical consciousness

In-depth understanding of the forces that changes one's life space, become an active agent in constructing a different, more just reality

Secretory Diarrhea

Increased GI secretion and decreased water intake, decreased water reabsorption and increased fecal water

Major diseases related to visceral fat accumulation

Insulin resistance, diabetes mellitus, dyslipidemia, left ventricular dysfunction, hypertension, coronary artery disease, sleep apnea syndrome

causes of acute bloody diarrhea (dysentery)

Intestinal damage (shigella)

How does the quality of the developmental environment (and socioeconomic development) influence the risk of disease?

It is an upward parabola shape. When socioeconomic development happens, migrants to cities consume a high fat, high GI diet, and less physical activity. - There is then a greater mismatch; inadequate response to environment; greater risk of disease

Least aware level of 3 level model

Magic, fatalistic consciousness, external forces are in charge, nothing can be done to change things as they are

Diarrhea w/ severe malnutrition

Marasmus or kwashiorkor

biologic and social pathways that increase obesity risk for children exposed to poor uterine environments

Maternal Influences: In women who eat a poor diet before conception and during gestation, late gestation fetus directs more blood to the liver and lays down more fat through epigenetic and direct nutrient flows through the placenta

general global distribution of deaths related to diarrhea disease

More than 99% of deaths related to diarrheal disease are in low and middle income countries, especially in sub-saharan Africa

Why are glucose and salt both used in ORT?

Na+ gets back into the blood, drawing water with it. Sodium ions are passed through the Na+ - glucose symporter into the epithelial cell. Sodium ions can only get through the symporter if it is going along with glucose. Sodium ion concentration gradient (high concentration in lumen, lower concentration in epithelial cell) is what drives transport. Glucose uses sodium concentration gradients to be pumped.

negative externalities

Negative externalities: side effects of a market that spill over the society at large (pollution). Obesity in pregnancy raises risks for any health outcome: delayed diagnosis, ineffective ultrasounds, need for cesarean delivery, preeclampsia, gestational diabetes, blood loss, neural tube defects, spina bifida, heart defects, delivery-related neonatal mortality Maternal supply + fetal demand → fetal nutritional status

What is the effect of obesity on all-cause mortality?

Obesity increases the risk of all-cause mortality

What are the markets for the products and services that influence our weight?

People's preferences create demand for certain products and services. Businesses act in response to market demands Diet companies (weight loss supplements, protein shakes), exercise and fitness (fitbits, exercise equipment), food and beverage industry (low-cal foods, fast food restaurants), weight loss meds, weight loss surgery

Key features of behaviorist theory

Planning, motivation, and habit

Market Failure

Private sector cannot reach optimal allocation of resources on its own occurs when there is an inefficient allocation of resources in a market, can be complete, where there is no supply of product, or partial, when the supply or pricing is inadequate can occur in explicit or implicit markets four types: negative externalities, market power, public goods, asymmetric information

Clinical manifestations of cholera diarrhea

Produces an enterotoxin that causes a copious, painless, watery diarrhea that can quickly lead to severe dehydration and death if treatment is not promptly given, vomiting occurs in most patients

Evidence of health-related disparities related to race/ethnicity

Racial segregation, chronic stress, genetic predisposition, and income level all are associated with body weight status. In high-income countries, the less-educated are more obese. Black Americans experience higher rates of chronic diseases like hypertension, heart disease, and stroke

Dual burden of disease

Rapid nutrition transition leads to co-existence of undernutrition and overnutrition and the double burden of infectious and chronic diseases Countries must deal with infectious diseases and undernutrition AND a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight It is common to find undernutrition and obesity co-existing within the same country, the same community, and the same household

Key Prevention Strategies identified in UNICEF/WHO 7-point plan

Rotavirus and measles vaccinations, promotion of early and exclusive breastfeeding and Vitamin A supplementation, promotion of handwashing with soap, improved water supply quality and quantity (including treatment and safe storage of household water), community wide sanitation promotion

Key factors involved in body weight regulation

SET POINT THEORY But also... Energy intake, energy balance, simple theory of energy metabolism (incorrect and incomplete), endocrine regulation of body lipid stores and behavioral processes (appetite control) that vary with food intake, glucose homeostasis, and lipid metabolism

Oral Rehydration Therapy (ORT)

Simple cost-effective treatment used to prevent and treat dehydration caused by diarrhea, especially in treatment. Mixture of water, sodium, glucose, and sometimes potassium that helps replenish lost fluids and electrolytes. First line treatment, 93% effective at preventing diarrhea mortality

concept of health education in relation to key health behaviors necessary for diarrhea prevention

Simply health education won't cut it Large-scale handwashing promotion programs are needed that move away from the simplistic assumption that imparting knowledge about germs and disease will change behavior Exclusive breastfeeding (6 months) and hand washing after using the toilet, before eating, and before feeding a child educational videos, Peer group health education, Telephone health education, and Internet-based training

Empowerment

The expansion of the assets and capacities of poor people to participate in, negotiate with, influence, control, and hold accountable institutions that affect their lives Focuses on external forces that constrain agency; internal forces may be equally powerful and synergistic with external forces

What are the general trends in obesity among adults and children in the United States?

US Children living in rural areas tend to be more likely to be overweight, less physically active, and less food secure. Obesity rates are rising among adults and children

Pathway for visceral fat accumulation related diseases

Visceral fat accumulation → altered fat cell secretions → hypertension, diabetes, dyslipidemia → cardiovascular disease

Asymmetric Information

When one person (group) in a transaction has better information than the other party, and other party cannot acquire information at a reasonable cost Much action taken (some mandated, some market driven) that has increased nutrition information to be provided to consumers → this does not always have a large impact on consumption Market can be self-correcting (as consumer demand rises)

Dyslipidemia

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels

Cholera

acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae, short incubation period, see clinical manifestations

kilocalorie (kcal)

amount of energy needed to raise 1 L of water 1 degree celsius

What is diarrhea due to?

an imbalance between secretion and absorption at the intestinal level

Optimal breastfeeding

breastfeeding within one hour of birth (early initiation of breastfeeding (EIBF)), breastfed exclusively for the first six months of life, and continues to be breastfed up to two years of age

What actual causes of death can be linked to obesity/excess body weight?

cardiovascular disease (heart disease and stroke), type 2 diabetes, certain cancers (colon, breast, kidney), respiratory problems like sleep apnea, chronic kidney disease, and some forms of liver disease

How can the diarrheal-malnutrition cycle be broken?

continuing to give nutrient-rich foods - including breast milk - during an episode, and by giving a nutritious diet - including exclusive breastfeeding for the first 6 months of life - to children when they are well

All-cause mortality

death from any cause

Demographic Transition

declining fertility rate and longer life expectancy

Epidemiologic Transition

declining infections disease and increases non-communicable diseases

Energy intake

energy expenditure + change in body stores of energy Typically measured food intake in grams and energy intake in kilocalories U.S. gov't states that average man needs 2,700 kcal/day and the average woman needs 2,200 kcal/day Needs vary considerably by body size, physical activity level, and age

Energy balance

energy intake - energy expenditure = 0

Clinical manifestations of Rotaviral diarrhea

fever greater than 37.9 degrees celsius of 100.2 degrees fahrenheit, vomiting 1-2 days, diarrhea for an average of 4 days (1-16 days), loss of 5 ml to >200 ml/kg body weight/day, 4 day average for duration of hospitalization (2-14 days), dehydration, malnutrition

Key Treatment Strategies identified in UNICEF/WHO 7-point plan

fluid replacement to prevent dehydration (ORT) and zinc treatment

Food desert

geographic area where access to affordable, nutritious, and fresh food is limited or nonexistent, often due to the absence of grocery stores, farmers' markets, or other healthy food outlets within a reasonable distance. Food deserts are more common in low-income urban and rural areas, where transportation may also be a barrier to accessing healthier food options.

Set point theory

how the body attempts to regulate its weight Body resists weight loss and weight gain Upregulates energy expenditure if overeat: increased thermogenesis and physical activity, decrease next meal Down regulates energy expenditure if undereat: decrease thermogenesis and physical, increase consumption at next meal Genetic variation in how much excess energy is stored as adipose tissue: each person is not created equal in terms of energy expenditure and efficiency of fat storage

Malabsorption Diarrhea

in is mostly water intake and some GI secretion, out is half water reabsorption (decreased water reabsorption) and half fecal water

Normal Homeostasis

in is mostly water intake and some GI secretion, out is mostly water reabsorption and a very small bit of fecal water

Simple theory of energy metabolism (incorrect and incomplete)

increased food intake over energy expenditure yields weight gain decreased food intake below energy expenditure yields weight loss Fails to recognize endocrine regulation of body lipid stores and behavioral processes (appetite control) that vary with food intake, glucose homeostasis, and lipid metabolism

Nutrition Transition

increasing consumption of foods high in fats and sugars, declining intake of cereals, intake of fruits and vegetables remains inadequate

diabetes mellitus

insulin is not secreted adequately or tissues are resistant to its effects

Freire's 3 Levels of Conscientization

least aware level, middle level, critical consciousness

Influence of food deserts on obesity

limited access to healthy foods, higher consumption of processed and fast foods, economic barriers to healthy eating, learned behaviors and food preferences across generations, increased healthcare burden

Planning

long-term cognitive process

Optimal Allocation

occurs at price where amount of product or service consumers demand is equal to amount that supplies wish to provide

What does zinc treatment do?

reduces diarrhea severity and duration

Motivations

refer to the internal drives, desires, or reasons that prompt an individual to take action. They are psychological and emotional factors that influence a person's decision to perform certain behaviors.

Capacities

resources, skills, knowledge, or abilities that enable an individual to actually perform a health behavior. They are more about what a person is able to do.

Rotavirus

see clinical manifestations, immature enterocytes are deficient in secretion of lactase → milk intolerance (can persist for several weeks), recurrence of mild diarrhea often follows the reintroduction of milk to child's diet, due to bacterial fermentation of lactose in intestinal lumen, normal digestive function returns only when the villus epithelium has fully recovered (at least 5-7 days in absence of additional injury), mainly transmitted through fecal-oral route, common infections in children and adults (no clinical effects in adults, severe clinical diarrhea in children with high case of fatality with no treatment), nosocomial rotavirus infections occur frequently in contaminated nurseries, levels of serum (IgG type) antibodies have no associated with rotavirus protection, but levels of mucosal antibodies (sIgA) have been demonstrated to provide good immunity against rotavirus infection (acquired through passive ingestion of maternal colostrum & milk or acquired through active intestinal infection)

Causes of persistent diarrhea (>14 days duration)

severe undernourishment, AIDS

Motivation

short-term cognitive or emotional process

Relative risk

the ratio of the probability of an event occurring with an exposure versus the probability of the event occurring without the exposure

Causes of acute watery diarrhea

too much secretion (v. cholera, e coli.) or lack of absorption (rotavirus)

Mismatch

when a child's prenatal environment does not match post-natal or adult environment

Habit

without thinking