1Bioengineering and World HealthGeoff PreidisMD/PhD candidateBaylor College of [email protected] Three:Leading Causes of Mortality, Ages 15-44A Malaria Vaccine Breakthrough??http://www.sanaria.com/http://www.cdc.gov/malaria/images/graphs/malaria_lifecycle.gifReview of Lecture Two:Leading Causes of Mortality, Birth-Age 4 Developing world1. Perinatal conditions2. Lower respiratory infections3. Diarrheal diseases4. Malaria Developed world1. Perinatal conditions2. Congenital anomalies3. Lower respiratory infections4. Unintentional injuriesRatio of Mortality Rate0.01.02.03.04.05.06.07.00-4 5-14 15-29 30-44 45-59 60-69 70-79 80+Age GroupMortality Rate in Developing Countries / Mortality Rate in Developed Countries WHO, 20021. Perinatal Conditions Question: What is the #1 way to prevent septicemia in a newborn in the developing world?22. Lower Respiratory Infections Question: How can a busy health worker (or a parent) quicklyscreen for pneumonia in a child?3. Diarrheal Diseases Question: What is the #1 way to prevent diarrheal illness in a newborn?4. Malaria Question: How was malaria eradicated from the southern U.S.? What are the challenges with implementing this technology in less developed countries?Leading Causes of Mortality Ages 15-44 Developing World1. HIV/AIDS2. Unintentional injuries3. Cardiovascular diseases4. Tuberculosis Developed World1. Unintentional injuries2. Cardiovascular diseases3. Cancer4. Self-inflicted injuries1. HIV/AIDS Burden of HIV/AIDS Pathophysiology of HIV Clinical course of HIV/AIDS Highly Active Antiretroviral Therapy Prevention of Mother to Child Transmission (PMTCT)Burden of HIV/AIDS Worldwide 33.2 million people are living with HIV/AIDS 20 million people have been killed by the disease 2007: 2.1 million deaths 2.5 million new HIV infections 17% of new infections occurred in children (<15 yrs) 2/3 of those with AIDS and 3/4 of all AIDS deaths are in sub-Saharan Africa 6800 new infections per day 96% in low- and middle-income countries 1200 childrenSource: 2007 AIDS Epidemic Update, UNAIDS/WHO3AIDS has Reduced Life ExpectancyBurden of HIV/AIDS in the U.S. 1.2 million people have HIV/AIDS (prevalence) 30,000-40,000 new infections per year (incidence) Only 7 countries in the world have more people living with HIV than the U.S. Routes of transmission: Unsafe sex between men (53%) Unprotected heterosexual intercourse (32%) Non-sterile drug injection equipment (18%)Source: 2007 AIDS Epidemic Update, UNAIDS/WHOBurden of HIV/AIDS in the U.S. Racial and ethnic minorities are disproportionately affected: 48% of AIDS diagnoses are African-Americans (15% pop) The rate of new HIV diagnoses was 21x higher in African-American women than in Caucasian women Women are increasingly affected: The proportion of women among new HIV/AIDS diagnoses have risen from 15% to 26% in 10 years Question: Why is the prevalence of HIV in the U.S. continuing to increase?Source: 2007 AIDS Epidemic Update, UNAIDS/WHOPathophysiology of HIV/AIDSPathophysiology of HIV/AIDShttp://bayloraids.org/curriculum/Integrase InhibitorsFusion InhibitorsPathophysiology of HIV/AIDShttp://bayloraids.org/curriculum/4Clinical Course of HIV/AIDS Clinical Course of HIV/AIDShttp://hivinsite.ucsf.edu/topics/aids_basicsClinical Course of HIV/AIDShttp://bayloraids.org/curriculum/HIV/AIDS Therapy Reverse Transcriptase Inhibitors (1987) Enzyme is specific to HIV Combinations of RTIs appear effective HIV Protease Inhibitors (1995) HIV proteases are distinct from mammalian proteases Most significant advance in HIV therapy yet Highly Active Antiretroviral Therapy (HAART) Combination of three or more drugs Fusion inhibitor (2003) Integrase inhibitor (2007)HIV/AIDS Therapy HIV can rapidly mutate to quickly develop resistance to a single drug Resistance develops much more slowly to drug combinations Goal of HAART: Reduce viral levels to undetectable levels Has reduced death rate in US and Europe by 80%5www.npr.org/templates/story/story.php?storyId=47243686 million people living with AIDS are in need of HAART. 90% are in just 34 developing countriesPrevention of Mother to Child Transmission (PMTCT) 3 routes of transmission: Parentally (during pregnancy) Perinatally (during delivery) Breast feeding (through milk) 4 Core interventions: HIV testing and counseling ARV prophylaxis (ZDV, NVP) Safer delivery practices Safer infant-feeding practices Reduces transmission from 30-40% to 4-6%2. Unintentional Injuries Burden of Unintentional Injuries Accident Physics Slowed Driver Reaction Time Prevention of Road Accidents2. Unintentional InjuriesBurden of Unintentional Injuries More than 1.25 million people ages 15-44 die from unintentional injuries each year 1 million deaths in developing countries, 1/4 million in developed countries 40x this number are injured Major cause of disability Leading cause is road accidents: 500,000 deaths per year in this age group 90% of these deaths occur in developing countries Road Accidents in the U.S. Rates declining steadily A leading cause of potential years of life lost 2006: 42,642 Americans killed 2,699,000 Americans injured Fatal accident rates 3X higher for males than for females Motorcycles: 40X higher death rate per mile traveled 39% of fatalities related to alcohol useBurden of Unintentional Injuries6Accident Physics Newton’s 2ndLaw: F = m a a = dv/dt a = initial velocity/time to come to rest In a crash: Velocity slows to zero in a very short time Generates large forces How can we reduce these forces?1. Reduce initial velocity of impact2. Extend time that it takes passengers to come to restAccident Physics1. Reduce initial velocity of impact Excessive speed contributes to: 30% of deaths in developed countries 50% of deaths in developing countriesSlowed Driver Reaction Time When drivers anticipate a crash, they have time to brake and reduce initial velocity Factors which slow driver reaction time: Alcohol use Mobile phone use Poor visibility Driver inexperienceSlowed Driver Reaction Time Alcohol impaired drivers have 17X increased risk of being in fatal crash Alcohol use increases risk more in younger drivers 1 in 5 Americans will be involved in an
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