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In the epidemiological transition, deaths from ____(2) have increased while ___ has decreased
circulatory disease, cancer; infectious disease
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Diseases of Civilization are characterized by (5)
Economic growth, demographic changes, relative income inequality and mental health morbidity, preventable disease, lifestyle related
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Neonatal, Postneonatal and infant mortality as well as fertility ___ with epi transition
decline
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4 Stages of Health Transition
Age of pestilence (infectious) and famine, age of receding pandemics (improved sanitation), age of degenerative and man- made diseases, age of delayed degenerative diseases
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Age of Pestilence and famine: Life Expectancy, Changes in broad disease categories
~30, infections, nutritional deficiencies
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Age of Receding Pandemics: Life Expectancy, Changes in broad disease categories
~ 30-50; improved sanitation, fewer infections, better nutrition (salt)
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Age of degenerative and man- made disease:Life Expectancy, Changes in broad disease categories
~50-55, increased lifestyle deaths (diet, activity, addiction)
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Age of delayed degenerative diseases: Life Expectancy, Changes in broad disease categories
~70, reduced risk behaviors, new treatments
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Of top killers in U.S. today, ___ of them, ____, were in top 8 of 1900.
4- heart disease (4), injuries (6), cancers (7)
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Most common cancers for males are _____, the first of which has seen a significant _____ since _____
lung/ bronchus, colon; increase; 1950
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Tobacco related deaths account for ____ each year
450,000 (more than homicide, suicide, accidents, HIV, Alzheimer's and diabetes combined)
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Cigarette smoking has generally declined except among ___
high school students in 1990's
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60% of 1-17 yr olds and ~50% of adults eat ___ meals in restaurants/ week; ~27% of middle aged adults eat ___
1-3 meals; 4 or more
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Almost __% of American adults and __% of children are overweight or obese
70%; 17%
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Consequences of Epi Transition and Chronic diseases
More chronic disease --> increased healthcare costs
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The most common source of activity limitation among adults due to chronic conditions is _, among older adults ___ is also problematic
arthritis/ musculoskeletal conditions, heart/ circulatory
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Consequences of Epi Transition on Mental Health
Increased economic development and life expectancy--> increased mental health morbidity
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The Health and Economic Effects of Mental Health Disorders, national substance abuse have ____ over past 20 years
greatly increased
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Anti- depressant use is more common among __ and ___. Use has ___ over past 15 years
Women, White, not hispanic. ~Tripled
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Life expectancy in developed regions has _____ relative to less developed regions
Stayed relatively constant
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Globally, noncommunicable disease accounts for __x the deaths of communicable
2 times
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3 Most burdensome causes of disease worldwide (measured in DALYs) in 1990 vs 2020:
LRI, diarrheal disease, perinatal disease; ischemic heart disease, unipolar major depression, road traffic accidents
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While rates of smoking have declined in __(3), they are rising sharply in __
USA, UK, Canada; Asia (developing world will account for almost 3/4 of smokers by 2030)
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Diabetes is expected to see a global ___ in next 20 years, esp in ___(3)
Middle East, India, SE Asia (Most of Asia and Africa, really)
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Some countries, such as India, are experiencing ____ transitions
heterogenous
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HIV Rates in South Africas Major cities have __
risen but stabilized at around 25%
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U.S. life expectancy is correlated with __(2)
Regions, smoking/ tobacco taxation rates
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Unintentional injuries are the _____ in some countries- high frequency among _____ people
leading cause of death; young and middle- aged
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Unintentional injuries are the __ largest contributor to the global disease burden/ U.S. mortality burden
5th
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Prevention: Motor Vehicle Accidents
Mandatory seatbelts, speeding laws, age limits, police enforcement, air bags and safety standards
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Prevention: Falls
Railings in homes/ public buildings, proper medication management
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Prevention: Domestic violence
criminalization, shelters
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The most common injury- related cause of death worldwide is ______, which cause ___ of all brain and spinal cord injuries worldwide.
Motor Vehicle Accidents- also the leading cause of death for ages 1-24
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Recommended Public Health Approaches to Motor Vehicle Safety (7)
Mandatory seatbelts, alcohol regulations, helmets for bicyclists, speed limits of 55 mph, minimum age requirements, training requirements, vehicle and road design standards
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Environmental conditions cause __ (3)
cancers, neurological disorders, chronic pain
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Environmental causes cause __ of all cancers in U.S. - especially dangerous because of ____
5%; long- latency periods
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William Farr
Helped environmental/ workplace safety movement, which started with British metal miners
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Types of environmental pollutants (3)
Chemical, heavy metals, radiation
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Types/ Effects of chemical pollutants
Pesticides; cancer
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Types/ Effects of Heavy Metals
Mercury, lead, arsenic; neurologic disorders, cancers
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Types/ effects of radiation pollutants
Magnetic fields, high- tension power lines; leukemia
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Types of Environmental Hazard Agents
Allergencs and molds, dusts (like coal dusts- cause silicosis, respiratory disease), physical mechanical vectors (industrial machinery--> hearing loss, mortality)
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Environmental Health: 4- step risk assessment process
1) Hazard identification 2/3) Dose- Response assessment; exposure assessment 4) risk characterization
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Classifications of Carcinogens
Category 1- shown to cause cancer in humans; Category 2- causes cancer in animal tests, probably in humans; Category 3: possibly carcinogenic but inconclusive evidence supporting conclusion
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Benzene
250,000 workers exposed annually, cause of acute or chronic neurological disorders, leading cause of leukemia
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Non- linear dose response relationship indicates __
threshold
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Workplace safety tree
Prevention--> Surveillance--> Chemical levels, Cancer rates. Prevention--> regulation--> biological wastes, agr chemicals
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Exposure to both radon and cigarettes causes ____
Multiplicative risk of lung cancer (9-24 for tobacco alone, 5 for radon alone)
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First mention of "passive smoking" in ____, Surgeon General's report on second hand smoke in _____- same year as causal link
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Landmark paper on second hand smoke pollution found ____, second major study in ____ found that ____
respirable suspended particles at 250-1000 times legal limit in many workplaces; Japan; SHS increased risk of disease in non- smoking wives in accordance to smoke habits of husband
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Causal relationship between smoking and ___ (2) found in over 40 studies
Lung cancer, heart disease
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Nonsmokers in households and workplaces with smoke are ___ more likely to get smoking related disease. Related to __ and ___
2-30, depending on smoke concentration; lower respiratory infections in infants; asthma
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Industry responses to SHS (4)
promote more vague critiques of indoor air pollution; emphasize "accommodations" (AC fans, etc..) create a bigger monster, fund convenience store and restaurant trade groups
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Love Canal and Radiation
54% of children born in 1970's in Love Canal had at least minor birth defects
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Asbestos is related to ___; Regulations against were initiated in ___
lung cancer, other cancers; 1980's
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Lead effects ___ children 1-5, compounds ___ and is most often found in
310,000; effects of hypertension, diabetes nervous system effects, African Americans
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