Biology

Global Health Final Exam Study Guide Spring 2015

GENERAL

-know the difference between a VIRUS, a BACTERIUM and a PROTOZOAN -if you don’t know the specific name of the causative agent, but know which type of organism it is, you will get part marks

-as you study each chapter, keep in mind how poverty can impact issues such as HIV/AIDS, disease in general, access to clean water, access to sanitation, nutrition, etc. and how these conditions/issues can lead to poverty) -arm yourself with specific examples illustrating this relationship

-be able to interpret a graph that you have never seen before…look at axes to figure out what is being measured, be able to identify important trends, to interpret the data -practice understanding graphs we’ve gone over in class…

INTRODUCTION

-be able to name a few low-income, middle-income and high-income countries -communicable vs non-communicable diseases -relative burden in high-income vs low-income countries -what are the 3 most populated countries? -differences between graphing absolute numbers of people affected vs percentage of the population affected -how % can mask large #s of people in need -define poverty (income / day) -define: -causative agent -infectious dose -host (primary vs secondary) -vector -reservoir -incubation period / latent period / infectious period -herd immunity vs ring immunity -modifiable vs unmodifiable risk factors -epidemiologic triad -primary / secondary / tertiary disease prevention (and examples of each) -quarantine vs isolation -zoonotic / nosocomial / person to person transmission *be able to use this terminology when you discuss specific diseases*

Q1. Compare and contrast the leading causes of mortality in low-income countries vs high- income countries. Provide an explanation for these observed differences, and comment on the double-burden that will soon exist in low-income countries.

GLOBAL BURDEN OF DISEASE

-data -types of data important for global health assessments -what are they used for? -challenges in acquisition

-morbidity vs mortality -how changes in mortality can affect morbidity -rates vs absolute numbers -disease-specific?

-incidence vs prevalence

-screening and diagnosis -sensitivity -specificity -gold standard vs rapid tests

-investigative studies (know these in very GENERAL terms) -correlational -case studies -cross-sectional study -observational -intervention

-causality -confounding variables -randomization -blinding (single vs double-blind studies)

-healthy life expectancy (HALE) vs life expectancy (LE)

-QALYs -how to measure? -used for? -limitations -DALYs -how to measure? -used for? -age weighting -limitations

Q1. Compare and contrast quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). What is the relationship between these 2 measurements?

SOCIOECONOMICS AND HEALTH

-what is the link between socioeconomic status and health? -identify vulnerable populations at risk for health disparities -how does a society’s culture influence its health?

HIV/AIDS

-what is a virus? -is it alive? -what are its components?

-causative agent -type or organism, name -special features (spike proteins, integrase, reverse transcriptase, RNA genome)

-describe key steps in viral replication

-disease caused -affects which cells/tissues -different phases (disease progression, link to antibody levels and HIV+/AIDS status) -symptoms (general) -opportunistic infections, different based on geographical location -mode of transmission

-affected populations (general) -why more prevalent in males? -why more prevalent in people of African descent?

-screening / diagnosis -treatment -drugs? -curative? -why drug combination? -increased morbidity, decreased mortality -prevention -most effective preventive measures -why is an HIV vaccine so elusive?

Q1. Screening for HIV during early stages of the infection may lead to false negative test results. Why does this happen? (hint: you will have to explain what the screening tests detect, and how the disease progresses).

Q2. Describe all possible routes of HIV transmission. Describe 2 measures that can be implemented to prevent or reduce disease transmission (be sure to indicate HOW they prevent transmission).

MALARIA

-causative agent -type of organism, name -special features

-disease caused -affects which cells/tissues -different phases (e.g. primary, latent, etc.) -symptoms (general) -role of vector in the life cycle of the pathogen (sexual reproduction, transmission)

-mode of transmission -role of vector -affected populations (general) -comorbidity (HIV + TB) -screening / diagnosis -treatment -drugs -length of treatment -drug resistance -prevention -preventive measures -perception of burden of malaria -is there a vaccine? are there issues coming up with a vaccine? why?

Q1. Epidemiologic triad for malaria. Describe the relationship between all of the components of the triad, and provide specific examples of interventions that could interrupt these interactions.

TUBERCULOSIS

-causative agent -type of organism, name -special features -disease caused -affects which cells/tissues -different phases (e.g. primary, latent, etc.) -symptoms (general) -mode of transmission -does everyone who gets infected develop TB? -affected populations (general) -comorbidity (HIV + TB) -screening / diagnosis -treatment -drugs -duration of treatment -is compliance an issue? -is resistance an issue? -prevention -preventive measures -is there a vaccine? are there issues coming up with a vaccine? why?

Q1. Epidemiologic triad for tuberculosis. Be able to describe relationships between items, and be able to provide examples of interventions that target specific junctions (e.g. host - agent; host - environment; etc.).

ANTIBIOTIC RESISTANCE

-what is meant by antibiotic resistance? -mechanisms of antibiotic resistance -what is a DNA mutation? -what causes DNA mutations? -understand how specific DNA mutations can lead to drug resistance -mechanisms by which bacteria acquire new DNA -examples of organisms that have high levels of drug resistance

Q1. How do bacteria become drug-resistant? (HINT: It’s not from being exposed to antibiotics) Q2. How does use of antibiotics select for drug resistant organisms in a population?

EBOLA

-causative agent -type of organism, name, subtypes and lethality -special features -disease caused -affects which cells/tissues -immune avoidance -symptoms (general) -disease progression (general) -mode of transmission -how it spreads -what the reservoir is -affected populations -screening / diagnosis -treatment -supportive -immune therapy -drug therapy

-prevention -is there a vaccine? are there issues coming up with a vaccine? why?

Q1. Why is current outbreak so much larger and lasting so much longer than previous outbreaks? Use as much specific information as you can.

NON-COMMUNICABLE DISEASES (NCDs, chronic diseases)

-distinguish between infectious diseases and chronic diseases -which 4 conditions account for the majority of the burden of NCDs

-for each of the top 4 conditions, be able to -describe the condition (what it is, what causes it) -what the risk factors are -be able to distinguish between modifiable and physiological risk factors for these diseases

-who is at risk? -what is the relative burden of NCDs in low-income vs high-income countries -why are these rates growing rapidly in low-income countries?

Q1. What is the link between infectious diseases and cancer? How and why does the incidence of these cancers vary between low-income and high-income countries?

NUTRITION

-macronutrient vs micronutrients -what they are -what they do

-undernutrition vs overnutrition -quantity vs quality

-undernutrition -causes -who is most at risk? -stunting vs wasting -protein-energy malnutrition -marasmus vs kwashiorkor vs marasmic kwashiorkor -micronutrient deficiencies -know a few examples -cycle of malnutrition

-overnourishment -overweight vs obese vs morbidly obese (BMIs) -causes -who is most at risk?

-nutritional transition

-prevention -preventive measures -education / breastfeeding -intervention -supplementation

Q1. The global nutritional crisis is changing, as some countries are simultaneously burdened by undernutrition and overnutrition. Compare and contrast undernutrition & overnutrition, commenting on the demographics of the affected populations, the urgency of the problem, the downstream benefits of addressing the problem vs the cost of not addressing the problem.

Q2. Compare and contrast macronutrient and micronutrient deficiencies. Include information about the causes, symptoms, diagnosis, and treatment (or prevention).

ENVIRONMENTAL HEALTH

Water -why our bodies need water? -physical vs economic water scarcity -water contaminants of concern

-different sources of drinking water -accessibility -year-round vs seasonal -contamination level -means of ‘harvesting’ -which source(s) are most often used in low-income countries?

-who lacks access to improved drinking water sources? (rural vs urban, low vs high-income countries)

Sanitation

-latrine vs cesspool vs septic vs sewer -comment on cost, availability, dependence on water

-what is most common sanitation solution in low-income countries? -challenges in providing sanitation to low-income countries

Air Pollution -why is particulate matter in the air of particular concern for health? -what are the main sources of ambient air pollution vs household air pollution? -who is at risk from exposure?

-comment on link between drinking water, sanitation, air quality and disease -how can exposure to air pollution be minimized?

Q1. Water treatment is a 3-step process. Describe each of these steps and include information about which contaminants are removed during each of these steps.

Q2. What is meant by adequate sanitation? How does inadequate sanitation in a population lead to increased disease burden? What is the link between adequate sanitation and clean drinking water?

HUMANITARIAN AID AND DISASTER RELIEF

-natural disaster vs complex emergency -examples of each -special concerns for each -priorities -ethical considerations

-causes of morbidity and mortality

-code of conduct for NGOs (e.g. Red Cross) -humanity, neutrality, etc.

-what information is helpful for an NGO coming in to a region in need (assessment)

-phases of disaster response -what to focus on when -sustainability -improve on existing situation -preparedness and prevention

-vulnerable populations, and what makes them vulnerable

Q1. Natural disasters and complex emergencies are equally dependent on humanitarian aid. Compare natural disasters and complex emergencies, in terms of the underlying cause, the most urgent needs, and the inherent challenges in delivering aid under each of these situations.