150 Cards in this Set
| Front | Back |
|---|---|
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20th
|
Mistrust of Immunization:
|
|
pertussis
|
-Long-standing opposition to vaccination against smallpox going back to 19th century.
-Early __th century successes with diphtheria and tetanus vaccines, followed by mid-century successes with pertussis, polio and measles vaccines created an era of vaccine acceptance.
-As vaccine-preve…
|
|
mercury
intestinal
|
THE ROLE OF AUTISM:
-Autism is diagnosed in early childhood, not long after receiving vaccines. The apparent rise in autism frequency led people to connect vaccines with autism.
-The first concern was ______ in vaccines, found in the preservative thimerasol. Although it was shown tha…
|
|
2000
unvaccinated
|
MEASLES:
-Measles was declared eradicated in US in _____, meaning there was no indigenous transmission.
-US averaged about 100 annual cases of measles 2001- 2013. All outbreaks originated outside the US and affected mostly unvaccinated children.
-In 2014, the US had 644 cases of me…
|
|
orthopox
largest
chickenpox
17
|
THE SMALLPOX VIRUS:
-Double-stranded DNA virus of the _____ family
-Smallpox is the _____ known virus
-Many closely related animal pox viruses (but not ______, which is a herpes virus)
-Stable and retains some infectivity outside host
-Highly contagious, but mostly to family and ho…
|
|
respiratory
less
|
Smallpox Transmission:
-Person-to-person via the _____ route is most important
+Inhalation of droplets, more rarely, via aerosol
-Direct contact ____ common
+With infected body fluids
+With smallpox scabs
+With contaminated objects such as bedding, clothing, bandages
|
|
2
|
Smallpox Transmission:
To sustain itself, the virus must pass from person to person in a continuing chain of infection and is spread by inhalation of respiratory droplets, typically within __ meters or less.
-CDC: "Generally, direct and fairly prolonged face-to-face contact is requir…
|
|
Prodrome
10
scablargest
|
Smallpox Transmission:
-Transmission is always from another smallpox case (no animal reservoir)
+______ phase (fever, but no rash) is less contagious
+Most contagious with rash onset, especially first 7-__ days
-Continues to be contagious until last ___ falls off
|
|
move
|
Smallpox Transmission:
A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash (during the first 7-10 days). At this stage the infected person is usually very sick and not able to _____ around in…
|
|
communicability
|
Clinical Course PROGRESSION OF SMALLPOX:
1. Infection (7-17 days)
2. Incubation (7-17 days)
3. Prodrome (2-3 days, _______ begins)
4. Eruption (1-2 days)
5. Papules (1-2 days)
6. Vesicles (2-3 days)
8. Pustules (5-8 days)
9. Crusts (5-7 days)
10. Desquamation (weeks)
|
|
CONFLUENT
FLAT
HEMORRHAGIC
|
______ SMALLPOX:
HIGH MORTALITY
_____ SMALLPOX: VERY HIGH MORTALITY
_______ OR "BLACK" SMALLPOX: NEARLY ALWAYS FATAL
|
|
VARIOLA MINOR
|
OR ALASTRIM = A MILD STRAIN
OF SMALLPOX
|
|
trunk
|
Chicken pox occurs mostly on the ____ and not the extremities and small pox occurs mostly on the extremities. This is how you make a distinction between the two.
|
|
Africa
|
Small Pox History:
-First appeared in Northeastern ____ around 10,000 BC
-Skin lesions on mummies
+1570-1085 BC
Ramses V (lesions on cheeks may be smallpox)
Smallpox is believed to have appeared around 10,000 BC during the first agricultural settlements in northeastern Africa. T…
|
|
SOPONA
|
______= THE YORUBA
SMALLPOX GOD (NIGERIA)
|
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SITALA
|
____ MALA= THE HINDU GODDESS
OF SMALLPOX
|
|
PAN-CHEN
|
___-____= THE GOD PRAYED TO IN CASES OF BLACK (HEMORRHAGIC) SMALLPOX
|
|
Amherst
blankets
18
|
Early use of smallpox in warfare:
-1763, Sir Jeffrey ______ recommends giving Indians smallpox infected ______
-Some evidence that this was carried out in the __th century
-Not clear what effect would have been. Might have been inoculating, rather than infecting
|
|
blind
|
The devastating effects of smallpox gave rise to one of the first examples of biological warfare. In a letter written in 1763, Sir Jeffrey Amherst, commander-in-chief of British forces in North America, suggested grinding the scabs of smallpox pustules into blankets that were to be distri…
|
|
INOCULATION
|
VARIOLATION, ALSO KNOWN AS _______
|
|
China
India
Turkey
|
VARIOLATION OR INOCULATION:
-The artificial production of smallpox via inoculation of smallpox material immune into susceptible
-An ancient practice, found in many cultures
-Ground scabs, pus, vesicles used to inoculate
+____, powdered scabs blown into nostrils
+____, application…
|
|
immune
oral
|
Physicians realized that smallpox survivors became ______ to the disease. Thus the method of variolation was started. This involved taking samples (vesicles, pus, ground scabs) from benignly diseased patients and introduce the material into susceptible patients via the nose or skin. In Ch…
|
|
INSUFFLATION
|
______= THE TRADITIONAL
CHINESE METHOD
OF SMALLPOX
INOCULATION
|
|
Montague
England, murderers
London
|
VARIOLATION IN EUROPE:
-Variolation introduced to Europe in 1720's by Lady Mary Wortley _____, wife of ambassador to Turkey, who learned of inoculation there
-Her two children inoculated in Turkey
-First clinical trial of variolation in _____ was performed on convicted ______. All su…
|
|
first
|
The English aristocrat Lady Mary Wortley Montague was responsible for the introduction of variolation into England. She had an episode of smallpox in 1715 that disfigured her beautiful face. She was so determined to prevent the ravages of smallpox and so impressed by the Turkish method th…
|
|
21
George Washington
2
|
VARIOLATION IN THE US:
-Variolation first used in U.S. in 17__.
-Supported by leading physicians
-Supported by Cotton Mather and other influential ministers
-_____ _____ had all soldiers variolated in 1777 (american rev. success?)
-But variolation had problems - notably a risk of d…
|
|
Boylston
Fewster
|
-Variolation soon reached the New World, and in 1721, Dr. Zabdiel ______ used the technique to stop the smallpox epidemic in Boston.
-In 1765, Dr. ______ of Thornbury, Gloucestershire, wrote to the Medical Society of London to report that variolation induced no reaction in persons who ha…
|
|
Jenner
milkmaids
|
VACCINATION:
-Edward _______, country practitioner in Gloucester published his work on vaccination in 1798
-Member of Royal Society, expert on birds, friend of John Hunter, leading surgeon and medical educator of the time
-Noted that ______ often got cowpox, but rarely got smallpox
…
|
|
TOUCH
HANDS
|
COWPOX IN A MILKMAID:
BECAUSE COWPOX WAS COMMUNICATED
DIRECTLY BY _____, LESIONS WERE OFTEN FOUND ON THE ____ OF MILKMAIDS
"VACCINATION FROM ONE ARM TO ANOTHER"
|
|
PARIS
|
MASS
VACCINATION IN ____
WITH
VACCINIA
VIRUS GROWN
ON COW
OMENTUM:
|
|
ENGLAND
|
DECLINES
IN SMALLPOX
MORTALITY
IN _____
AFTER VACCINATION
|
|
SWEDEN
|
DECLINE
IN SMALLPOX
MORTALITY
IN _____
AFTER VACCINATION
BECAME
REQUIRED BY
LAW
|
|
four
stronger
|
VACCINATION SIDE EFFECTS:
If the vaccination is successful, a red, itchy bump develops at the vaccine site in three or ___ days.
-In the first week, the bump becomes a large blister, fills with pus, and begins to drain.
-During the second week, the blister begins to dry up and a sc…
|
|
none
Eczema
12
|
CONTRAINDICATIONS TO VACCINATION:
____ if exposed to a smallpox case
If pre-event:
-Severe allergic reaction to vaccine component
-Immunosuppression or immuno-suppressed household contact
-Pregnancy
-______, history of eczema, or household contact with eczema or history of eczem…
|
|
INADVERTENT
|
_______ AUTOINOCULATION= THE VACCINATION SITE IS ITCHY, AND
CHILDREN WOULD SOMETIMES TOUCH
THEIR EYES AFTER SCRATCHING,
CAUSING OCULAR VACCINIA.
|
|
IMMUNOSUPPRESSED
|
GENERALIZED VACCINIA:
GENERALLY NOT TOO SERIOUS, UNLESS CHILD IS _________
|
|
NECROSUM
|
THE REASON WE DO NOT VACCINATE CHILDREN WHOSE IMMUNE SYSTEM
IS SUPRESSED
|
|
ECZEMA
|
THE REASON WE DO NOT VACCINATE PEOPLE WITH ECZEMA OR EVEN
FAMILY CONTACTS OF PEOPLE WITH ECZEMA
____ VACCINATUM= A DANGEROUS COMPLICATION OF VACCINATION
|
|
19
|
THE PROBLEM OF IMPORTED OUTBREAKS:
-An engineer returning from Pakistan was admitted on January 10th,1970 to Meschede Hospital, Germany for fever.
-Patient was isolated, as suspect typhoid fever case.
-Rash appeared January 13th , smallpox was diagnosed January 15th and patient was …
|
|
Air
|
THE EXTRAORDINARY CONTAGIOUSNESS OF SMALLPOX:
-The patient was on the first floor only, in isolation.
-4 individuals were infected on the first floor
-6 people were infected on the second floor
-7 people were infected on the third floor
-2 additional people were infected by contact…
|
|
1966
minor
|
The last outbreak of smallpox in England: Lancashire and Wales 19__ (March-July)
-First case was a photographer who worked at the University of Birmingham medical school.
-He infected his fiancee, his parents and a schoolteacher at a folk-dance evening
-Photographer's fiancee infecte…
|
|
1980
Henderson
Bedson
|
THE WHO INTENSIFIED SMALLPOX ERADICATION CAMPAIGN 1967 - 19_0
-DA Donald _____ leader of the eradication campaign
-Henry ____, virologist, a leading authority on the smallpox virus
-Others who were key:
+Frank Fenner, Australia
+Zdenek Jezek of Czechslovakia
+Ivan Ladnyi of …
|
|
United States
|
It is important to note that the areas that had eliminated smallpox did not re-establish infection in this time frame (1967-80). The ____ ____ had not had a case of smallpox since 1949
|
|
mass vaccination
Mecca
Refugees
diffusion
auto
|
Major focus of the first phase of the eradication campaign was on ____ _______.
Challenges:
-the Haj in ____
-______ from the
Pakistan-Bangladesh war
of 1971
-Widespread ______ of
Smallpox epidemics
-Transportation (bad bridge)
+CDC class for doctors on ____ repair
-Gettin…
|
|
Freeze
bifurcated
pedal
500
1,000
|
Keys to control:
1. _____-dried Vaccine:
Eliminated need for maintaining a "cold chain"
2. The ______ Needle: made mass immunizations very feasible at low cost
3. Development of the ____-powered Jet Injector in 1965: +Pedal-operated, did not need electrical supply
+Can give ___ dose…
|
|
once
intramuscular
|
Smallpox Vaccination Using the Bifurcated Needle:
Hold the needle perpendicular to the site of insertion. Resting your wrist on the arm of the patient will maintain a firm position. Make 15 rapid insertions into an area less than 5 mm in diameter. The punctures should evoke a trace of …
|
|
cycle
|
Small pox feature of importance to control: The ____ of
smallpox epidemics
|
|
animal
scar
close
|
OTHER FEATURES OF SMALLPOX AND THE VACCINE THAT INDICATED THAT ERADICATION MIGHT BE FEASIBLE:
SMALL POX FEATURES
1. No _____ reservoir
2. People with smallpox easily identifiable by the lay public
VACCINE FEATURES
1. Highly effective vaccine
2. Vaccinees also easily identifiabl…
|
|
identifiable
|
Eradication of smallpox was made possible for several reasons:
1. There was a good, protective vaccine available
2. There was no animal reservoir, vaccinees were easily identifiable and could "vaccinate" friends and family through contact
3. Those who acquired smallpox were easily _…
|
|
Ethiopia
1975
|
THE LAST FRONTIERS:
India, E____, and Somalia
-By 19__, smallpox had dwindled to sporadic cases in Bangladesh, Nepal, India, and Somalia.
|
|
ring
|
THE BIG CHANGE IN SMALLPOX CONTROL STRATEGY:
Moving from mass vaccination to ___ vaccination
|
|
twice
once
5
|
Ring Vaccination:
Identify every case of smallpox and create three rings or zones around the patient.
ZONE A
-Isolate patient
-24-hour guards
-Vaccinate all residents and visitors
-Inspect for fever and rash ____ a day
ZONE B
-Vaccinate all residents
-Inspect for fever and…
|
|
effective
|
The ring vaccination strategy is the strategy that will be used if a case of smallpox were to break out in the U.S. Contacts of the case will be found and vaccinated, as will contacts of those contacts. This appears to be the most _____ way to contain an outbreak. There is currently enoug…
|
|
Cash
|
Teaching the public to recognize cases of smallpox:
-____ prizes were given for identifying smallpox cases
|
|
nomadic
|
Guarding a hut in which a person with smallpox is being cared for. These huts were built specially for _____ people away from population areas. Thorn bushes keep away visitors and wild animals.
|
|
homeless
secondary
|
VERY LAST CASE IN INDIA:
-The very last person to have smallpox in India was a _______ beggar who lived on the platform of a railway station for the first 4 days of her illness
-During those 4 days, 9 trains had stopped at the station, and 4,535 tickets had been issued to 68 towns in …
|
|
Somalia
|
World's very Last case of naturally occurring Smallpox, which was variola minor, October 1977. This case occurred in _______.
|
|
300 million
2003
|
Smallpox Eradication officially announced by WHO on December 9, 1979:
Cost of program 1967-1980 $_00 million
-$24 billion to put a man on the moon
1967
-10 million cases
-2 million deaths (20% deaths from infected cases)
1972
-Last U.S. vaccination
(until 200_)
|
|
discontinued
|
Between 1967 when WHO began the smallpox eradication campaign, and 1980, when smallpox was officially eradicated, the total cost was $300 million. It cost $24 billion for the U.S. to put a man on the moon. In 1967 is was estimated that there were 10 million cases and 2 million deaths. The…
|
|
England
|
A NASTY SURPRISE: Eradicated?
-11 August 1978 - Janet Parker, a woman living in ____, developed a headache and muscle pain.
-15 August - She developed a rash
-16 August - She and visited her doctor, who prescribed an antibiotic. Two days later, he stopped the antibiotic stopped beca…
|
|
died
|
FURTHER CASES:
-1 September - Janet Parker's father developed a fever, but no rash
-5 September - Janet Parker's father died of a heart attack
-8 September - Janet Parker's mother diagnosed with smallpox
-11 September - Janet Parker ___ of smallpox.
-22 September - Janet Parker's…
|
|
photographer
|
Janet Parker was a medical ______ in the Anatomy Department at the University of Birmingham Medical School.
-The medical photographer who had been the first case of smallpox in the 1966 Birmingham outbreak had worked in the SAME room as Janet Parker.
AIR VENTS AIR VENTS AIR VENTS!
…
|
|
Bedson
|
THE LAST VICTIM:
-On 2 September 1978, after the Government announced an investigation into the outbreak, Henry _____, director of the poxvirus laboratory, went into the shed at the bottom of his garden and cut his throat. He died five days later.
The main thing to note from these l…
|
|
human
|
Forensic (Medico-Legal) Investigation of Death:1979 Definition
(focus was on _____ ID)
-T. Dale Stewart......
Identification of "more or less" skeletonized human remains for legal purposes;
-Elimination of non-human elements;
-Establishment of age, sex, stature, race;
-"Other" cha…
|
|
medicolegal
|
Forensic (Medico-Legal) Investigation of Death: 2009 Definition
(broad ______ contexts)
-American Board of Forensic Anthropology (within AAFS)
+Judging time (postmortem interval) and manner of death (MOD);
+Involved in humanitarian initiatives (e.g., human rights violations);
+Shif…
|
|
witness
|
Health department must report all cases of X disease by law
-solved at federal level: federal tax dollars. Can't handle large outbreaks at the community level and this is why they get bumped up to the state and federal level.
-MI has seven state forensic labs that deal with outbreaks
+…
|
|
Cause (COD)
|
Cause vs. Manner of Death:
_____ (_OD): The disease or injury responsible for initiating the sequence of events, brief or prolonged, that result in death.
|
|
Manner
PUBLIC HEALTH
|
Cause vs. Manner of Death:
_____ (_OD): "The fashion in which the cause of death comes into being ."
(Spitz and Fisher, 1980, Medicolegal Investigation of Death, 2nd edition. Springfield, IL" C.C. Thomas.)
5 recognized MOD categories:
-- natural (infectious dz ex.)
-- accidental
…
|
|
Medicolegal
death
|
The ______ System:
-The primary role of the (MLS) is ____ investigation.
-Medicolegal (ML) refers to the application of medical science to law.
-The ML System (MLS) refers to the formal mechanism for death investigation and certification within a specific geographic area. This MLS is…
|
|
Coroner
funeral
|
Comparison of Role of Coroner and ME:
_______=
-An elected or appointed public official;
-Need NOT be a physician;
-Does not necessarily attend or perform autopsies;
-If not a licensed pathologist, the autopsy must be performed by certified pathologist, who reports the autopsy find…
|
|
Medical Examiner
|
Comparison of Role of Coroner and ME:
_____ ______=
-An appointed public official;
-MUST be a licensed, board- forensic pathologist;
-Perform autopsies;
-Overseen by the National Association of Medical Examiners (NAME).
|
|
Inquests
|
_____: (both blanks)
-Both coroners and MEs can convene an ____ (e.g., inquiries or fatality inquiry hearings).
-An inquest is an inquiry by the ML authority, in the presence of a judge (and sometimes a jury), into a death that is suspicious in circumstances, or in prison, or whose id…
|
|
1
|
When is a ML Investigation Warranted?
-All non-natural deaths (e.g., homicides, suicides, accidents);
-All suspicious deaths, such as those occurring outside of a doctor's care;
-Sudden deaths of individuals < 50 yo;
-Deaths occurring in nursing homes, state-run facilities, and pris…
|
|
michigan
|
When is a ML Investigation Warranted? (cont.):
-Not followed by all states but most. ____ follows
-Deaths occur in nursing homes, state-run facilities, and prisoners in custody because they generally are contained and don't leave therefore disease is easy and likely to spread because …
|
|
problematic
tests and signs
|
Definitions of Death:
-Cultural and religious definitions of death are highly variable, and there continues much debate among scholars and theologians as to what constitutes death.
-Even from a medical perspective, it can be ______ to clearly define when an individual is legally dead.…
|
|
Cerebral
pupils
reflexes
respiration
spontaneous
|
Definitions of Death Example:
____ death: cessation of all brain function and the condition is irreversible. Clinically evident through a flat brain wave reading. In the field, the following 4 criteria are often used...
1. Bilateral dilation and fixation of the ____;
2. Absence of …
|
|
Primary
Secondary
|
Biological Profile and Individualization:
Biological Profile:
-_____ Profile
+Age
+Sex
+Stature
+"Race"
-________ Profile
+Weight
+Handedness
+Pathologies
+Injury patterns -- MOD
+SES
|
|
Individualization
|
Biological Profile and Individualization:
__________: Who is it?
-who did they come into contact with?
|
|
Ante
Peri
Post
TEETH
|
Explaining injuries before, during, and after death is important to connection with infectious diseases and public health risks.
+___-mortem= before death (injuries or disease processes before death)
+___-mortem= at or around the time of death (injuries or diseases during death)
+___…
|
|
Night Blindness
|
Video: Vitamin A deficiency and Pellagra Notes:
• ____ _____- caused by a deficiency of vitamin A. Has to do with the rods in these children's eyes. Without vitamin A they can't produce rhodopsin which helps us see light at night. If the condition goes untreated then the children go co…
|
|
Sommer
|
Video: Vitamin A deficiency and Pellagra Notes:
• Alfred _____- Eye doctor in Baltimore that night blindness caught his attention.
o Began his work in Indonesia.
o Extreme poverty population was the highest at risk
o He tried treating children with injections of vitamin A. This was …
|
|
oral
|
Video: Vitamin A deficiency and Pellagra Notes:
Sommer:
o He then tried ____ drops of vitamin A.
• The results were beyond what he expected.
• Most children could see perfectly the next day.
• Even children with their corneas already starting to go healed as well.
o Night blind ki…
|
|
twice
|
Video: Vitamin A deficiency and Pellagra Notes:
o Sommer assembled Indonesian children to test.
• The children who did not get vitamin A were nearly ____ as likely to die as the children who did.
• This showed that vitamin A could not only save children's sight but their lives.
|
|
Nepal
epithelial
|
Video: Vitamin A deficiency and Pellagra Notes:
o Finally goes to ___ to prove his case right.
• Skepticism of the Nepali parents. They were afraid they didn't know what the capsules were.
• After getting the Vitamin, the kids could see, they had more energy etc.
• Found that childr…
|
|
Goldberger
rash
corn
|
Video: Vitamin A deficiency and Pellagra Notes:
• In 1915 Joseph ______ was trying to solve the mystery of the disease called Pellagra.
o It was found in institutions and in southern poor people.
o People with the disease often started with a ___
o He knew it wasn't infectious becau…
|
|
Niacin
|
Video: Vitamin A deficiency and Pellagra Notes:
Goldberger Cont.:
o Went to some farm institution and experimented on the inmates. Ranking State Prison (farm)
• He made some sick and some not sick.
• He made them eat the southern poor diet which was corn based.
• Within days of the…
|
|
Outcome
Exposure
|
Nutrition Epidemiology:
As an _____:
Deficiency Diseases
As an ______:
Food/drink 10-12 times/day for a lifetime
Supplements
Brief Descriptions of:
-Nutritional Science
-Dietary Supplements as an exposure
-Important considerations for interpretation of epidemiologic studie…
|
|
misnomer
50 year
1912
1964
nutrients
Dietary
13
|
Nutrition OUTCOME Epidemiology:
Diseases of Nutritional Deficiency
-"Vital amines" (______)
-All the vitamins were described in ~__ year period
+Thiamin (19__)
+B-12 (~19__)
-Beri-beri (Thiamine- B1), pellagra (Niacin), scurvy (Vitamin C), rickets (Vitamin D)
-Sub-clinical defic…
|
|
pica
Environmental
|
Nutrition EXPOSURE Epidemiology:
Dietary intake
-Food
+Nutrients
+Non-nutritive substances
+Environmental contaminants/__
-Supplements
+Nutrients
+Non-nutritive substances
+_______ contaminants
Nutritional status
-Individual variation
+Absorption/Bioavailability
+Physiol…
|
|
Macro
Micro
Alcohol
|
Nutrition:
____nutrients supply ENERGY:
-Carbohydrate
-Fat
-Protein
___nutrients:
-Vitamins
-Minerals
The quickest summary of nutrition science you'll ever get! _____ also supplies energy, but it's not required so it's not called a nutrient.
|
|
Vitamin
parenteral
|
What is a _____?:
Classic Definition: Carbon-containing compound essential in small quantities for normal functioning of the body
-In other words, nutrients your body can't make and you must get from food (or supplements) or you'll...die (eventually)!
"Eventually" turns out to be t…
|
|
Dietary Supplement
DSHEA 1994
food
|
What is a "_____ ______"?:
Defined by Congress:
-Dietary Supplement Health and Education Act (_____) 19__= Intended to supplement the diet
-Contains one or more dietary ingredients
(vitamins; minerals; herbs or other botanicals; amino acids; and other substances...or their constitue…
|
|
increased
advertising
|
DSHEA History:
Dietary Supplement Health and Education Act (DSHEA) 1994
~1990 Congress was considering 2 health fraud bills
-One _______ FDA powers and penalties for violating the Food, Drug, and Cosmetic Act
-The other Amended the Federal Trade Commission Act to prohibit ______ of …
|
|
vitamins
|
DSHEA History:
A compromise bill was passed:
Dietary Supplement Health and Education Act (DSHEA) 1994!!!
-Passed after an outpouring of public outrage from consumers who were convinced the government was going to take away their right to buy ______
-General disappointment in the sci…
|
|
sulfanilamide
animals
pregnancy
|
Why Regulate Health Fraud?
Elixir of _______ poisoning: > 100 deaths
-Food, Drug, and Cosmetic Act of 1938
Required safety testing (on _____)
Thalidomide during _____
-Kefauver-Harris Amendments to that Act in 1962
-Must prove safety and effectiveness with well-controlled trials…
|
|
Food and Drug Administration
Drugs
Dietary Supplements
|
Who Regulates Supplements?:
-US ____ and _____ ______ (FDA)
-Supplements are regulated by the FDA as FOODS
+But differently from other foods
+And differently from drugs
-____ must be approved for safety and effectiveness before receiving FDA approval
-___ _______ are not actively …
|
|
50,000
billion
50%
adults
60
10
|
How Many Supplement Products Are On The Market Today?:
- > _0,000
-$26.9 ______ in Sales (2009)
-~_0% are supplements users in US
WIDESPREAD! The 50% estimate includes children. Includes ALL types of supplements—single nutrient, MVM, herbals, etc. Survey estimates of supplement us…
|
|
BMI
Moderate
|
NHANES 2007-2010:
-48.8% of US adults were supplement users
-Lower ___
-_____ alcohol use
-More exercise
-Non-smokers
-Health Insured
WIDESPREAD! The 50% estimate includes children. Includes ALL types of supplements—single nutrient, MVM, herbals, etc. Survey estimates of supple…
|
|
DSHEA
|
NIH Office of Dietary Supplements:
-The mission of ODS is to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and educating the public to foster an enhanced quality o…
|
|
contaminants
|
Consumer Watchdogs:
CENTER FOR Science IN THE Public Interest (consumer lab)
CL is a well-respected group that independently tests supplements to determine: 1) if they contain what the label says they contain; and 2) if they contain ______.
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website
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Recent Recalls and Warnings (2012):
Go to the CL _____ for details (may need to purchase a subscription). Point is that there are this many recalls and warnings so far in 2012.
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manufacturing
different
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Vitamin Supplements:
-Things to keep in mind when assessing results from epidemiological studies on vitamin supplement intake:
+Good _______ practices
++Is what's on the label actually in the product?
++Are there additional contaminants?
-Lots of people take them for lots of differ…
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cellular
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Why Take Vitamin Supplements?:
To optimize normal ____ function
-Low dietary intake of nutrients
+Inadequate food intake
+Poor selection/availability of foods
-Increased requirements
+Lifestyle (smokers; athletes)
+Life cycle (pregnancy; aging)
Pharmacological Effects
-Dose
…
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Exposure
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Vitamin Supplements as an ______ Variable
-Not tightly regulated; thus
+What's on the label may not always be what's in the product
+In some cases, products will contain additional contaminants
-Two general reasons to take supplements
+To optimize normal cellular function with low …
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Multivitamin
least
40%
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_______ Supplements= Dietary supplements that contain a combination of vitamins and usually minerals and sometimes other ingredients
-1/3 Americans take a multivitamin/mineral (MVM)
-¼ of young children
-Adolescents ____ likely to take them
-Use increases with age until adulthood
-By…
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Insufficient
seniors
low
eating
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MVM Recommendations:
US Preventive Services Task Force
-______ evidence to recommend for or against
American Medical Association
-Recommends for _____ who have generalized decreased food intake
American Dietetic Association
-Advises ___-dose MVM depending on individualized die…
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Confounding
Heterogeneous
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MVM Evidence:
Largely observational but some trials
-_______ variables not often considered in early work
-Ill-defined exposures
-Different outcomes
_______ populations worldwide
-Age; Gender; Country; Cultural Factors; Health Behaviors; Health-Care Access
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cancer
CVD
high
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MVM Evidence Report:
CONCLUSIONS on MVM use:
-Heterogeneity in study populations limits generalization to the US pop'n
-May prevent ____ in individuals with suboptimal nutritional status
-Conferred no benefit in preventing ___ or cataract
-May prevent age-related macular degenerati…
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Prospective
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DESIGN=_______ observational (11 y follow up)
POP'N=182,099 adults (45-75 y) in Hawaii and California
ETHNICITY=African-American, Native Hawaiian, Japanese American, Latino, or White
EXPOSURE=Regular long-term MVM use
OUTCOMES=Death and Cancer Incidence
CONFOUNDERS=Tobacco …
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NO
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__ associations were found between MVM use and:
-All-cause mortality
-Hazard Ratio Men=1.07, 95% CI 0.96, 1.19
-Hazard Ratio Women=0.96, 95% CI 0.85, 1.09
-Cardiovascular diseases
-Cancer
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20
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DESIGN=Prospective observational (>__ y follow up)
POP'N=38,772 elderly white women(mean age=61.6 y) in Iowa
EXPOSURE=Regular long-term MVM use
OUTCOMES=Death
CONFOUNDERS=Tobacco use; age; BMI; alcohol intake; education; physical activity; preexisting illness; single supplemen…
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DOSE RESPONSE
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Associations between 15 types of supplements and mortality:
-MVM: HR=1.06, 95% CI 1.02, 1.10
-Vitamin B6: HR=1.10, 95% CI 1.01, 1.21
-Folic Acid: HR=1.15, 95% CI 1.00, 1.32
-Iron: HR=1.10, 95% CI 1.03, 1.17 (___ ____)
-Magnesium: HR=1.08, 95% CI 1.01, 1.15
-Zinc: HR=1.08, 95% CI 1.…
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Iowa
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Flawed ____ Women's Health Study Used to Discredit Supplements: Don't Believe It!
By Charles Poliquin (10/17/2011)
"How Did Researchers Account for Quality in Supplements Used by the Women? They didn't! Researchers note they did not have any details of the type or quality of the nutri…
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placebo
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Long-term Antioxidant Supplementation has No Effect on Health-related Quality of Life: International Journal of Epidemiology. 2011;40(6):1605-1616.
-Supplement Trial (~6 years)
-Antioxidant supplements had no effect on quality of life.
-Subjects who thought they were getting the supp…
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CHILDBEARING
EARLY
phytochemicals
|
Should I take supplements?:
Supplements are important and strongly recommended for certain people
-ALL WOMEN OF ______ AGE should take a folic acid supplement (strong protective association between supplemental folic acid taken VERY _____ in pregnancy and neural tube defects in the ba…
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Confounding
Baseline
four
erectile
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Final Words:
Be an informed consumer of professional and lay literature. Consider:
-Study design
-______ variables
-______ nutritional status
-Make scientific discoveries!
Consumer Watchdogs: General Findings from Supplement Testing:
-One out of ____ has a quality problem
#1. …
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sick-user
|
Do multivitamin supplements increase mortality risk? Article
• Perhaps another explanation for the mortality effect is that sicker people more commonly take vitamin and mineral supplements than healthy people. In the Iowa Women's Health Study, the researchers statistically accounted fo…
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foods
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Do multivitamin supplements increase mortality risk? Article
• The American Heart Association recommends that healthy people get adequate nutrients by eating a variety of ____ in moderation, rather than by taking supplements (8). They emphasize that:
Vitamin or mineral supplements are…
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Pellagra
Rosa
leprosy
|
Goldberger website
• _____ was first identified among Spanish peasants by Don Gaspar Casals in 1735. A loathsome skin disease, it was called Mal de la ___ and often mistaken for ______. Although it was not conclusively identified in the United States until 1907, there are reports of il…
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dermatitis, dementia
three
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Goldberger website
• In the United States, pellagra has often been called the disease of the four D's -- ______, diarrhea, ______, and death. National data is sketchy, but by 1912, the state of South Carolina alone reported 30,000 cases and a mortality rate of 40 percent. While hardly …
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engineering
Marine
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Goldberger website
• A product of New York's public schools, Joseph Goldberger entered The City College of New York with hopes of a career in ______. However, in 1892 Goldberger heard a lecture at Bellevue by physiologist Dr. Austin Flint, Jr. that changed his plans. Perhaps entranced …
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yellow
typhoid
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Goldberger website
• Between 1902 and 1906, Goldberger heroically battled epidemic diseases. He fought _____ fever in Mexico, Puerto Rico, Mississippi, and Louisiana, contracting the disease himself His efforts earned him a promotion to the rank of Passed Assistant Surgeon in 1904 and …
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Shamberg's
Brill's
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Goldberger website
• Goldberger made several important epidemiological discoveries during this period of his career. In 1909, he published his research on ______ disease, an ailment characterized by continuous itching and elaborate skin eruptions similar to those of smallpox. An acarin…
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weevils
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Goldberger website
• Angry and frustrated, Goldberger would not give up trying to persuade his critics that pellagra was a dietary disorder, not an infectious disease. He hoped that one final dramatic experiment would convince his critics. On April 26, 1916 he injected five cubic centi…
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black
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Goldberger website
• The Great Mississippi Flood-- During the 1920s, Goldberger continued research to identify what he called the "pellagra preventive factor." He learned that small amount of dried brewer's yeast prevented the disease as effectively and more cheaply than fresh, lean me…
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niacin
tryptophan
|
Goldberger website
• During the next decade, Conrad A.Elevjhem learned that a deficiency of nicotinic acid, better known as B vitamin _____, resulted in canine black tongue disease. In studies conducted in Alabama and Cincinnati, Dr. Tom Spies found that nicotinic acid cured human pell…
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digestive
rapidly
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Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Statistics indicate that pellagra, a disease caused by a deficiency of niacin (a B-complex vitamin) in the diet, was perhaps the most severe nutrient deficiency diseas…
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1960
peasant
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Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Pellagra was virtually eradicated in the United States by 19__.
• In fact, few physicians in the US recognized the disease, which had long been associated with _____ …
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Fears
South
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Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• ___ of contagion have also resulted in the spatial segregation and containment of those perceived to jeopardize the prevailing moral imperative, such as prostitutes or…
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Georgia
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Regional conflicts were reinforced with the emergence and spread of pellagra. The disease was first noted in the South when a case of pellagra in _____ was brought to …
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corn
pellagraphobia
Niles
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• A ____ based diet was considered the problem, although later the more popular belief was that the disease resulted from the consumption of moldy or spoiled corn. In ef…
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Sydenstricker
1907
cotton
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Edgar _______ (1915), statistician for the pellagra studies in South Carolina mill towns, pointed out that the phenomenal increase in the incidence of pellagra followe…
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cereals
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Abject poverty prevented many people in rural areas from eating nutritious meals. Most pellagrins subsisted on diets composed of poor quality ______ that were protein-…
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whites, blacks
blacks
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• In the early years of the epidemic, reports and studies indicated that _____ suffered from pellagra more than _____. Inquiries made of physicians in the South elicited…
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segregation
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• In a study conducted under the auspices of the New York Graduate School of Medicine, the Thompson-McFadden Commission, leaning towards the idea of pellagra as an infec…
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Twice
childbearing
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• _____ as many females died from pellagra as did males even for the period 1928-1932, and women of ________ age were at greater risk than males in the 15-45-year age gr…
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African-American
|
Understanding the Geography of Pellagra in the United States: The role of social and place-based identities Article:
• Along with region and socio-economic status, race and gender evidently played profound roles in the prevalence of pellagra. Although, eventually, the greater number of…
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Viruses
Bacteria
|
Communicable diseases:
Organisms on the edge of life
-V_____
-Prions
Prokaryotes
-B_____
Eukaryotes
-Unicellular - protozoa
-Fungi - Candida
-Plants
-Animals
+Worms
+Humans
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Antibiotic
resistance
resistance
|
Communicable diseases:
______/antimicrobial is a molecule that inhibits or kills microbes
Antimicrobial ________ is ability of a microbe to survive exposure to an antimicrobial
+When humans provide selection pressure on the microbe by taking antimicrobials, this stress selects for …
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life expectancy
|
Communicable diseases:
In the past 60 years, antibiotics have been critical in the fight against infectious diseases caused by bacteria and other microbes
-Antimicrobial chemotherapy has been a leading cause for the dramatic rise of average ____ _______ in the Twentieth Century.
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Community
|
Communicable diseases:
Infections with resistant bacteria can occur in two settings:
1. _______
2. Hospital/health care
Infections with resistant bacteria have become more common in both settings.
|
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limited
|
Communicable diseases:
Many bacteria have become resistant to more than one type or class of antibiotic
+Including staphylococci and pneumococci which are causes of disease and mortality.
-Consequently, doctors and nurses today are faced with treating infections where antimicrobial…
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economic
|
Communicable diseases:
Microbial development of resistance, as well as _______ incentives, has resulted in research and search for new antimicrobials to maintain a pool of effective drugs at all times.
-While the development of resistant strains is inevitable, the ways that we admini…
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Fleming
Penicillium
1940-1960
1947
|
Communicable diseases: Short History of Antimicrobials
-1929 Sir Alexander _____, a Scottish physician, left a plate of Staphylococcus aureus open and a mold grew on the plate.
-He noticed that the bacteria didn't grow well next to the mold; mold was called ______ notatum.
-Penicill…
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|
methicillin
Gentamicin
Vancomycin
|
Communicable diseases:
-1959 We were smart, we developed a drug that doesn't bind to penicillinase - ___cillin
-1961 first isolates of methicillin-resistant Staph aureus found
-_____micin has new target - alters the bacterial ribosome; resistance develops
-___mycin, discovered in th…
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sale
|
Communicable diseases: Current Situation
-High cost of discovering new antibiotics & limited ___ potential by pharmaceutical companies have reduced the search for new antimicrobials
-Importantly, appeared that methods used to find and cultivate new antimicrobials were no longer effect…
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|
cell walls
|
Communicable diseases:
-Penicillin inhibits an enzyme that links molecules in some bacterial ___ ____.
-With a poorly-constructed cell wall, these bacteria can die.
-Thus, the poor growth of the Staph aureus that Sir Alexander Fleming noted was the result of penicillin made by the Pe…
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Antimicrobials
|
Communicable diseases:
______ work by inhibiting some essential bacterial process
+For example, cell-wall synthesis, protein synthesis, ribosome function, etc.
+Once the process is inhibited, the bacteria don't grow well or die.
|
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Resistance
70
|
Communicable diseases:
_______ occurs when a microbe previously sensitive to an antimicrobial develops resistance to its effect, rendering it ineffective.
-About __ percent of the bacteria that cause infections in hospitals are resistant to at least one of the drugs most commonly used…
|
|
enzymatic
|
Communicable diseases: Mechanisms of Resistance
-The most common mode is ______ inactivation of the antimicrobial.
-An existing cellular enzyme is modified to react with the antimicrobial in such a way that it no longer affects the bacteria.
-An alternative strategy utilized by many…
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Study Guide: Exam 1