Pathophysiology of Brain & Body - USSJJQ-20-3

1. Pathophysiology of Brain & Body - USSJJQ-20-3 Introduction

2. Staff Dr Rosie Jones (Bristol U/Frenchay)Dr Bahareh Vahabi (UWE)Dr Lynne Lawrance (UWE) Prof Julie Mcleod (UWE)Me (Dave Lush)

3. Assessment 60% Exam (3 from 6Q, 3h)40% CW (2 essays)Essay 1 (week 18) –Using disease examples of your choosing, evaluate the following statement – “By the time chronic conditions are diagnosed, it is too late to undo the damage or cure the patient”.Essay 2 (week 34) –TBC

4. Support http://www.rags.profile.ac.uk/ modules/2012/PBB (link in Blackboard) Tutorial support for CW and exam Practice exam paper with 1 Q from real exam ‘Skim-feedback’ of draft answers

5. Pathophysiology “The study of the nature of suffering” Woody Allen…“Life is hard, then you die.”“It’s not that I’m afraid to die. I just don’t want to be there when it happens.”

6. Proposed Syllabus SEM 1 Intro: Major Health Burdens Blood Pressure Regulation Hypertension Drugs of Abuse 1 Atherosclerosis Drugs of Abuse 2 Coronary Heart Disease/Stroke Drugs of Abuse 3 Congestive Heart Failure Metabolic Disorders: Diabetes 1 Metabolic Disorders: Diabetes 2 Metabolic Disorders: Inborn Errors SEM 2 Neuroanatomy Movement Disorders 1 Movement Disorders 2 Dementias Ageing Respiratory Infections Respiratory: COPD Respiratory: Asthma Renal Failure No timetabled class No timetabled class No timetabled class

7. Death rate… indexmundi.com

8. How we die…

9. How others die…

10. Death by broad cause/region/gender…

11. Deathby broad cause/region, 2000 % 75 50 25 Source: WHO, World Health Report 2001 EMR SEAR WPR EUR AFR AMR Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries

12. The ‘Burden’ of Disease • The high death toll associated with disease is not the whole story • At any one time, hundreds of millions of people worldwide are… • requiring treatment • recovering • permanently disabled • Developing world – communicable disease • Developed world – diseases of affluence • Beyond the burden of personal suffering, society also ‘suffers’ • Economic impact of repeated episodes of illness and long-term disability is substantial

13. Global Burden of Disease (WHO) • Comprehensive and comparable assessment of mortalityandloss of health due to diseases, injuries and risk factors for all regions of the world. • Assessed using the disability-adjusted life year (DALY), a time-based measure that combines • years of life lost (YLL) due to premature mortality • years of life lost due to time lived in states of less than full health

14. Comparison of the proportional distribution of deaths and YLL by leading cause of death, 2004

16. % Ischaemic heart disease 12.2 Cerebrovascular disease 9.7 Lower respiratory infections 7.1 COPD 5.1 Diarrhoeal diseases 3.7 HIV/AIDS 3.5 Tuberculosis 2.5 Trachea, bronchus, lung cancers 2.3 Road traffic accidents 2.2 Prematurity, low birth weight 2.0 % Lower respiratory infections 6.2 Diarrhoeal diseases 4.8 Depression 4.3 Ischaemic heart disease 4.1 HIV/AIDS 3.8 Cerebrovascular disease 3.1 Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma 2.7 Road traffic accidents 2.7 Neonatal infections and other 2.7 Leading Causes of Mortality and Burden of Diseaseworld, 2004 Mortality DALYs

17. Risk Factors and % Mortality • Maternal and Childhood Under-nutrition

18. Risk Factors and % Mortality • Other nutrition-related risk factors & physical activity

19. Risk Factors and % Mortality • Addictive substances

20. Risk Factors and % Mortality • Environmental risks

21. Risk Factors and % Mortality • Unsafe sex

22. Lifestyle & Mortality in Developed Countries • Major determinants relate to Eating, Drinking and Moving • Diet and physical activity are key determinants of public health in developed countries! • Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes ‘avoidable’ through changing lifestyle factors? • About 1/3rd of cancers could be prevented by • healthy eating • maintaining normal weight • physical activity throughout the life span • Diseases of affluence >> communicable diseases

23. CVD Deaths by Region, 2000 (WHO) % Deaths 30 20 10 EMR SEAR WPR EUR AFR AMR Strokes Heart attacks Source: WHO, World Health Report 2001

24. Developing Countries • Circa 7 billion people in world • 5.75 billion live in developing countries • Disease does not recognise national borders, but… • Pattern of disease influenced by… • Geographical/Environmental factors • Socio-political factors (inc GDP) • Population age distributions

25. Population Age Distributions • Developing countries are ‘young’ • increased early mortality  high YLL

26. Per cent distribution of age at death by region, 2004

27. Socio-political: Health & Wealth • 1/3 of World population live on <$1 per day • more than 2 billion people • 1/3 children are malnourished • 1/5 not fully immunised by their first birthday • 1/3 lack access to essential drugs • Mass population movements disrupt healthcare • 2011, UNHCR estimated 10.5m refugees • Densely populated cities with unsafe water and poor sanitation • Do not apply to developed world • so what drives mortality in developed countries?

28. Mortality in Developed Countries • Major determinants relate to Eating, Drinking and Moving – ieLifestyle • Diet and physical activity are key determinants of public health in developed countries! • Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes ‘avoidable’ through changing lifestyle factors? • About 1/3rd of cancers could be prevented by • healthy eating • maintaining normal weight • physical activity throughout the life span • Diseases of affluence >> communicable diseases

29. Age distribution of burden of disease by income group, 2004

30. Adult Mortality by Cause & Region, 2004

31. Child Mortality by Cause & Region, 2004

32. Communicable Diseases • Overall, infections are biggest killers of children/young adults • ~13 million deaths per year • 1,500 die per hour • 1/2 under five years old • Also, chronic diseases (inc cancers) linked to infection (not necessarily chronic)

33. Communicable Diseasesin Developed Countries • Under-vaccination  outbreaks • 1996 polio epidemic in Greece and Albania • MMR avoidance in UK • Increased drug resistance • Emergence of new pathogenic strains • eg bird flu • Air travel/immigration facilitate transport of infections • A different picture in developing countries…

34. Distribution of child deaths for selected causes by selected WHO region, 2004

35. Communicable Disease – Major Culprits • Six diseases cause 90% of infectious disease deaths • HIV • Pneumonia • Tuberculosis • Diarrhoeal disease • Malaria • Measles

36. HIV • Human Immunodeficiency Virus (HIV) • Attacks cells of the immune system  increased susceptible to other infections • Major cause of death is TB • Estimated 34 million people infected worldwide • Though many will not even know it yet • http://www.avert.org/worldstats.htm • 23 million people in Africa are infected • increasing prevalence in China and Eastern Europe • Circa 2.7 million new infections and 1.8 million deaths from HIV (2010)

37. Pneumonia • Kills more children than any other infectious disease • children of low birth weight • those with immune systems damaged by malnutrition etc • Many causes are treatable or preventable • But 99% of the deaths occur in developing countries

38. Tuberculosis • Spread in droplets • coughing, sneezing, speaking, kissing, spitting • Someone with active TB may infect 10-15 people per year • “At risk” populations… • areas where TB is common • drug users • health-care workers (inc drug-care) • People who are immunosuppressed

39. Diarrhoea • > 2 million deaths per year, mostly children • lower than before (now saved by oral rehydration therapy) • Leads to rapid fluid loss and death • Colitis,pneumonia,septicaemia,hypoglycaemia,hypokalaemia • 1.5 billion bouts of illness a year in children alone • Multiple causes… • viruses (eg rotavirus), • bacteria (eg campylobacter, salmonella, cholera, shigella) • parasites (eg. Entamoeba) • Cholera and dysentery (shigella) affect adults as well as children • Typhoid and rotavirus mainly affect children • Burden is highest in areas with poor sanitation

40. Malaria • Vector borne infectious disease • Caused by protozoan parasites • Very common infectious disease • Transmitted by female Anopheles mosquito • No vaccine available • Treated with derivatives of quinine or artemisinin • drug resistance, worryingly, is increasing • Precise statistics unknown • most cases are rural • distribution last mapped in the 1960s • About 500 million affected • 400-900 million fever cases/year • kills between 1-3 million per year

41. Measles (Rubeola) • Possibly the most contagious human disease • 2008: 164,000 deaths • Prior to 1980, ~2,600,000 deaths (before global vaccination push) • Rubeola virus directly responsible for more child deaths than any other single microorganism • Also causes blindness, deafness, brain and lung damage, stunted growth and development • Societal ‘burden’

42. Global Trends

43. Global projections for selected causes, 2004 to 2030 • Cancers • Ischaemic HD • Stroke • Acute respiratoryinfections • Road trafficaccidents • Perinatal • HIV/AIDS • TB • Malaria • Updated from Mathers and Loncar, PLoS Medicine, 2006

44. Projected deaths by cause and income, 2004 to 2030 • Intentional injuries • Other unintentional • Road traffic accidents • Other NCD • Cancers • CVD • Mat//peri/nutritional • Other infectious • HIV, TB, malaria

45. Ten leading causes of burden of disease, world, 2004 and 2030

46. Prevalence of Diabetes in Adults(millions of people, by WHO Region) Source: World Health Report, 1997

47. A Good Time to be Alive? • 3000 BC - 18 years • 275 BC - 26 years • 1900 AD - 49 years • 1980 AD - 76 years • 2002 AD - 85 years • 2020 AD - 90 years?