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Chapter 29 Spatial Patterns of Health and Disease

Chapter 29 Spatial Patterns of Health and Disease. Foot-and-mouth disease. acute infectious viral disease causing fever, followed by the development of vesicles (blisters) affects cattle, sheep, pigs, and goats and other cloven-hooved animals

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Chapter 29 Spatial Patterns of Health and Disease

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  1. Chapter 29 Spatial Patterns of Health and Disease

  2. Foot-and-mouth disease • acute infectious viral disease causing fever, followed by the development of vesicles (blisters) • affects cattle, sheep, pigs, and goats and other cloven-hooved animals • airborne spread of the virus and occur in the salviva, exhaled air, milk and dung • Heat, sunshine and disinfectants will destroy the virus

  3. Foot-and-Mouth Disease Egypt:8 Georgia:1 Greece: 14 Turkey:138 UK: 2443 France: 2 Ireland: 1 Netherlands: 18 S. Korea:15,4/2000 Japan: 3, 5/2000 Mongolia: 3, 5/2000 Iran:455 Kuwait:22 Saudi Arabia:200 Kazarkstan:11 Russia:1 Tajikistan:2 Malaysia: 3, 3/2000 Phillippines: 732 Taiwan: 5, 2/2000 Brazil:54, 10/2000 Peru: 47, 10/2000 Argentina: 1 Uruguay: , 10/2000 Malawi:1, 5/2000 Namibia: 1, 8/2000 Swaziland: 2, 12/2000 Zambia: 5, 7/2000

  4. Introduction • 16% babies born in 90s were underweight , in poorer countries and millions do not survive 1st bday. • In US, the biggest problem - “Obesity” • “Medical Geography” -study of health in geographic context. • Contagious disease, location of hospital and environmental relationship between disease and demographic distribution

  5. Malnutrition and Child Mortality • Kwashiorkor - from protein-deficiency is directly related to child mortality rate. A malnutrition, not undernutrition, after stopping the breast feeding, child was put in a starchy diet. • “Marasmus” - lack of protein and calories, bony thin body, huge eyes

  6. Infant Mortality Rates (IMR) • Death during the first year. • Key factor - the health of the mother. • Other factors - poor sanitation, improperly weaned, don’t know how to deal with diarrhea…. • Map shows the relationship be/w social disorder and high IMRs, Highest IMR in Sierra Leone (195/1000) • Low IMRs - Japan (no other ethnic variations), Singapore, Sweden • US - various distribution within country. • In 90s, 25 countries with 100 or higher IMRs, 8 had rates > 125/1000, 1 in 8. IMR in the US

  7. Life Expectancy 4 yr in Europe, East Asia 3 in Subsaharan Africa 7 in S Am, 6 in N Am 14 in Russia Women outlive men World: 68/64 India - 59/59 US-79/73 Japan,Taiwan, S Korea all high China -72/68 Women/Men

  8. Life Expectancy • It might reach 85 yrs by the early 21st century, and • A trend of continued increase in life exp in poorer countries • Larger number of old people in the population, 9% (500 million) of the world pop - >60, by 2030 16% (1.5 billion) • In W Europe, 1/5 pop are 60+, by 2030, 1/3 are 60+ • Young be more productive, taxed more to support old.

  9. Major Types of Diseases Infectious-65% of human illnesses, eg Malaria Chronic/Degenerative- Cancer/heart diseases Genetic or Inherited- Homophilia, sickle-cell anemia Epidemic - outbreak of disease in a region Pandemic - outbreak spreads around the world Endemic- mononucleosis in campus (carried by some people without knowing having it)

  10. How Diseases Spread Smaller than bacteria, causing measles, influenza, polio, and maybe certain types of cancer Agents Bacteria Viruses Others Reservoir - large amount of hosts Not mutually exclusive Vectored diseases Nonvectored diseases Vehicles Agents Water, food, feces Host1 Host2 Host2 Host1 - common cold, measles, venereal diseases and mononucleosis House pets, mosquitoes, flies, worms, snails, ticks

  11. Malaria: Vectored Disease • Occurs throughout the world, except in higher latitude and drier environment • Not only human being, monkeys, rats, birds and snakes are infected too. • Three African mosquitoes as vectors. • Major factor in infant and child mortality • Abandoned ancient fertile lands could have been due to the spread of malaria. • Symptoms - recurrent fever and chills, anemia and enlarged spleen • 1955 WHO launched a program against malaria, successfully made Sri Lanka free of malaria (with DDT, carcinogen) • Genetic engineered mosquitoes to replace A. gambiae)

  12. Yellow Fever • In tropical and near-tropical areas (in S America and Africa) • Transmitted by mosquitoes carrying virus • Symptoms - high temp, headache, backache and vomiting, jaundice and deposition of bile pigment colors make eyes and skin yellow • Figures 29-3, 29-4

  13. Sleeping Sickness Infected Host people, livestock Symptoms: Human -fever, followed by swelling of the lymph nodes, spread into brain and spinal cord producing the lethargy and listlessness Animal - sick animal die within a year of infection trypanosome Potential Host people, livestock TSETSE Reservoir (wild animal)

  14. Schistosomiasis - bilharziaFigure 28-8 • A debilitating disease,transmitted by freshwater snails which sends the infected larva into still water and penetrates the skin and then, the eggs wreak havoc in the liver and other organs. • Construction of dams provided environments for the snails.

  15. West Nile virus • Summer of 1999, seven people died and more than 60 became infected by the virus, which can cause lethal brain disease. • transmitted via mosquito, is primarily a bird disease, which caused more than 10,000 crows died last year. • Birds can fly 300 miles/day, there is no safe place in the US. • virus in the US is genetically related to strains found in the Middle East • Symptoms - mild inflammation of the brain, fever, headaches, body aches, skin rash and swollen lymph glands

  16. Nonvectored Infectious Diseases1 - Cholera • Cholera - symptoms:diarrhea and dehydration, an ancient disease in India until 19th century • 1816 spread to China, Japan, East Africa and Mediterranean Europe • 1826 to 1837, second pandemic struck • 1842 to 1862, cholera crossed the Atlantic and attacked N Am. (reached New Orleans and New York first) • Recent cases: Naples, Italy in 1972, late 90s in Africa, 29 countries affected. • Cholera vaccine effective only for 6 months

  17. 2 - Influenza • Causes 20,000 death each year in US. • Once started, inhaling the airborne virus will cause influenza. Originally from Chinese influenza A • In 1997, new strain of influenza broke out in Hong Kong

  18. The Life Cycle of a New Strain of Influenza Virus New strains spreads to human population Influenza virus from farmers to pigs Influenza virus from ducks to pigs New strain infects farmers New strain results

  19. AIDS (Acquired Immune Deficiency Syndrome)Figure 29-13 • Originated from Africa in 1930s and stayed there until jet travel, big cities and the sexual revolution spread it worldwide • First recorded AIDS in 1981. • In Africa, 20.8 million HIV cases in 1998. • 1/3 babies born to infected women are infected with HIV. • Thailand - the country with most AIDS in Southeast Asia • Urban and rural areas in Africa are affected

  20. Africa:People with HIV/AIDS at the end of 1999 N Africa: 220,000 19,000 (new infections in 99) death in 99: 13,000 No. of AIDS orphans: 15,000 S. Africa: 23.3 million 3.8 million (new infections in 99) death in 99: 2.2 million No. of AIDS orphans: 10.7 million Percentage of deaths by disease, globally and in Africa

  21. Effect of HIV/AIDS on life expectancy (1995-2000 projection)

  22. AIDS in US -1 Men who have sex with men (MSM) The highest HIV infection prevalence rates among populations at risk for HIV nationwide were found among MSM attending sexually transmitted disease (STD) clinics. The median prevalence rate in these clinics was 19.3%. MSM represented the largest proportion (60%) of men diagnosed with AIDS in 1997. From 1996 to 1997, AIDS incidence among MSM declined 18% and deaths declined 49%. Injecting drug users (IDUs) Prevalence in IDUs varies by geographic region; the highest prevalence rates in surveyed drug treatment centers were in the Northeast, the South, and Puerto Rico. AIDS incidence and deaths among IDUs declined 15% and 45%, respectively, among men 12% and 33% among women. IDUs diagnosed with AIDS represented 24% of AIDS cases in men and 47% of those in women in 1997.

  23. AIDS in US-2 Racial/ethnic minorities HIV prevalence was higher in non-Hispanic blacks than in other racial/ethnic groups in most populations surveyed. Non-Hispanic blacks and Hispanics accounted for 47% and 20%, respectively, of persons diagnosed with AIDS in 1997, the highest proportions thus far in the epidemic. From 1996 to 1997, AIDS incidence and deaths declined in all racial/ethnic populations. Women HIV prevalence among women varies geographically in a pattern that reflects the prevalence rates among IDUs. From 1996 to 1997, AIDS incidence and deaths declined 8% and 32%, respectively, among women.

  24. AIDS in US-3 Youth Among youth in the Job Corps, HIV prevalence rates were higher in women than in men in the same age group. Youth aged 13 through 24 years accounted for 4% of AIDS cases reported during the 1-year period from July 1997 through June 1998. They accounted for 15% of HIV infection (not AIDS) cases reported during the same period. Children From 1996 to 1997, the number of children (under 13 years of age) who were diagnosed with AIDS declined 40%, principally reflecting the continued success of efforts to reduce perinatal transmission through promoting voluntary HIV testing and zidovudine therapy for pregnant HIV-infected women and their infants.

  25. AIDS in US-4 • Top five states with most reported AIDS cases, in 1997/98, NY(11,329, 6.23/10,000), CA(6,338, 1.97/10,000), FL(5,489, 3.77/10,000), TX(4,472, 2.3/10,000), NJ(2,507, 3.12/10,000), and • TN (694, 1.29/10,000) • Top five Metro areas with most reported AIDS cases NY (8,711), LA(2,248), Houston(1,759), Chicago (1,567) and Miami (1562).

  26. Chronic Disease • Leading causes of death in the US • Modernization brought new lifestyles, pressures, exposure to new chemicals (preservatives, sugar substitutes), we don’t know these how these affect our health. • Arteriosclerosis -from high cholesterol and sedentary habits of urban life • Lead-paint cause brain damage

  27. Genetic Diseases • Resulted from gene mutations or accidents to the chromosomes. • Mongolism - “Down Syndrome” mutation in the fetus before birth even if both parents are completely normal. • Radiation and viruses may damage a parent’s chromosomes. • Phenylketonuria occurs mostly among Europeans will cause mental retardation. • “Milk allergy” galactosemia, not enough enzyme to break down milk sugar lactose, need to supply calcium and an ancient custom of eating clay, called “geophagy”, especially in West Africa • Lactose Intolerance are found more often in African Americans than white; India and China have higher rate of lactose intolerance too.

  28. Down Syndrome • Cause-an extra chromosome(in 21st chromosome) in the fertilized egg creates abnormalities as the fetus develops. • Risk Factors: Pregnancy in females under age 16 or over 35, family history of Down Syndrome, Mother’s exposure to drugs, radiation, chemicals, or infections before pregnancy. :”anmniocentesis” procedure to detect this syndrome.

  29. Cancer fact (Figure 29-14) • Higher rates of breast cancer in the Northeast urban areas • Higher rates of prostate cancer in the Northeast and Great Lakes regions, but N Carolina is the highest in death rate even with lower incidence rate - 1) not getting to a doctor on time 2) Love affair with fat in the N Carolina diet. Highest in rural black men - twice as likely as whites. • Higher rates of leukemia in the Midwest, especially farmers (plus prostate, and stomach cancer) due to the applications of pesticides, DDT, 2,4-D

  30. Breast Cancer • Long Island - Nassau and Suffolk counties - the highest rates of breast cancer in the country. • White, higher socioeconomic groups, Ashkanazi Jewish background • 30% increase from 1970s to 1990s • What cause cancer? - Environment, genetic, and lifestyles

  31. Breast Cancer Mortality Rate by county, 1970-94, white females Female African Americans Cancer Mortality Rate, 1970-94 Male African American Cancer, 1970-94 Cancer Incidence Rate in Tennessee, 1996

  32. Cancer in Minorities • “In 2000, about 1,220,100 cancers are expected to be diagnosed in the US, and 552,200 Americans are expected to die of this disease” - American Cancer Society • Black Whites Hisp Asian/Pac Ame Indian • Incidence Rates(per 100,000) • 443 403 275 279 153 • Mortality Rates (per 100,000) • 223 167 105 103 104 • Mortality/Incidence • 50% 41% 38% 37% 68%

  33. Cancer in the U.S. • Mortality Rate Tennessee US Female Male Female Male 139.6 241.7 142.3 218.3 Higher cancer death rates of Lung/Bronchus (96.4 vs 73.4 per 100,000) a 32% more Much lower Stomach cancer death rate 5.4 vs 6.5 per 100,000, a 17% lower rate) Data from American Cancer Society

  34. Smoking in the US Population Tennessee - 26.1%, 44th in the country Lung/Trachea/Bronchus and Pleura, 1970-94, white males

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