Transcript Bild 1

Quiz week 2
Determinants of health, the disease
burden and health care services
Anna Sidorchuk and Emilie Agardh
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Question 1
 Short-term exposure to air pollution is associated with
increased cardiovascular morbidity and mortality
 Long-term exposure to ambient air pollution appears to
increase cardiovascular mortality in adults, allergic
wheezing and sensitization among children
 Exposure to environmental noise is associated with
hypertension
Name Surname
21 July 2015
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Short-term effects by air pollution on
cardiovascular endpoints
 Mortality
 Morbidity
 Cardiac arrhythmia
 Inflammation
Göran Pershagen
21 juli 2015
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Exposure 1:st
year of life.
Outcome up to
4 yrs of age
Odds Ratio (95% CI)
Sensitization in relation to air pollution
exposure among children in Stockholm
4
2
1
.6
ORs calculated for a
change in pollution
level from the
5th to the 95th percentile
From: Nordling et al. 20
Göran Pershagen
21 juli 2015
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OR (95% CI)
Risk of non-fatal MI, fatal MI in or outside
hospital in relation to air pollution exposure
4 NO2 from traffic
4 CO from traffic
2
2
1
1
4 PM10 from traffic
4 SO2 from heating
2
2
1
1
Göran Pershagen
21 juli 2015
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Prevalence of hypertension in relation to road
traffic noise and factors affecting exposure
Residential time
<10 yr
>10 yr
Type of window
double
triple
Bedroom window
Street
Other
From: Bluhm et al. 2007
Göran Pershagen
21 juli 2015
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Question 2
 Describe in your own words why asthma and allergic
disease in children are nowadays defined as one of the
“major public health problem” in many countries of the
world, in particular in industrialized countries
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Childhood asthma and allergy – public health problem
 Asthma and allergic disorders (in total) affect approx. one
of four schoolchildren worldwide
 It reduces quality of life and may impair school
performance
 There is a risk of severe reactions and, in rare cases, death
 Allergy is a multi-system disorder, and children often have
several co-existing diseases, i.e. allergic rhinitis, asthma,
eczema and food allergy
Childhood asthma and allergy – public health problem
 By the end of 20th century, descriptive data on asthma
and allergic diseases indicated a substantial and persistent
increase in prevalence
 The increase appeared particularly strong in industrialized
countries, especially among children
 There is an increase in the prevalence of allergic disease
from south-eastern Europe where it is relatively low (e.g.
in Albania) to the northwest (e.g. the United Kingdom).
Scandinavia has a middle position between these two
extremes
Childhood asthma and allergy – public health problem
 In parallel with this increase the possibilities of treating
allergic disorders have improved appreciably
 The development of steroid preparations for inhalation in
the treatment of asthma, and the development of
effective anti-histamine preparations for the treatment of
allergic rhinitis have been particularly important
Childhood asthma and allergy – public health problem
 The existence of allergic disorders was originally described
among economically privileged people in England during
the nineteenth century
 Certain allergic problems are still more prevalent among
higher social groups than at other levels of society
 Studies have also shown that asthma disease more
frequently causes severe symptoms and hospitalization
among children in exposed social circumstances than
among other children
What is a public health problem?
 Needs to affect more than 1% of the defined population
 Should be associated with serious consequences for;
 Health
 Economy
 The social life
 Contribute to inequalities in health
 Should be possible to prevent
Adopted from the “Health in Sweden: The National Public Health Report 2005”, The National Board of Health and
welfare/Centre for Epidemiology (Scand J Public Health Suppl. 2006;67:11-265).
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Question 3
 Malaria is a blood disease caused by a parasite. Is it true that malaria
 is transmitted to humans by the bite of an infected mosquito?
 that malaria can be transmitted without mosquito?
Name Surname
21 July 2015
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Malaria transmissions

Malaria transmission most often occurs through the bite of an Anopheles
mosquito. This type of mosquito becomes infected with one of the four
Plasmodium parasites that cause malaria in humans, through a previous
blood meal from an infected person.

Can also be acquired by transmission of parasites from mother to child
(congenital malaria) during pregnancy or perinataly during labour. Studies
from a variety of sites in Africa suggest that 7 to 10 per cent or more of
newborns may have malarial parasites in their cord blood, although they do
not all get ill with malaria. It is estimated that approximately 6 per cent of all
infant deaths in malaria-endemic areas of the world are a result of a malaria
infection that took place during the child’s prenatal life.

In addition, malaria can be transmitted by transfusion of blood from infected
donors.
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Question 4
 Psycho-social stress is a potential risk factor for type 2 diabetes
Name Surname
21 July 2015
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Psychosocial stress as a risk factor for
type 2 diabetes
 Psycho-social stress has a negative influence on glucose tolerance on
people with already diagnosed diabetes and there is an increasing
amount of epidemiological studies showing that psycho-social stress
is associated with an increased risk of type 2 diabetes
 Although the mechanisms are most plausible:
 Cortisol levels are chronically elevated under chronic psycho-social stress
and increased cortisol levels can interfere in the normal regulation of
blood glucose by altering the body’s release and sensitivity to insulin.
More clinical studies in this area is needed, and further
epidemiological studies using various ways of measuring psychosocial stress to ascertain that stress causes diabetes.
Psychosocial stress as a risk factor for
type 2 diabetes
 In order to test whether stress is causally associated with incident
type 2 diabetes, a large randomized controlled trial is suggested,
testing whether adequate stress-reduction, probably over a long
period, is associated with a reduction in the incidence rate of type 2
diabetes.
 Such a trial could also explore the potential psychophysiological and
behavioral mechanisms that can link stress with the development of
type 2 diabetes.
Question 5
 We can say for sure that type 2 diabetes incidence is associated with
high socioeconomic position in low-income countries.
Socioeconomic-position
and type 2 diabetes
 Many cross-sectional studies show that type 2 diabetes prevalence is
associated with high socioeconomic position in low-and middleincome countries.
 However, there are very few (in some countries no) published studies
investigating the incidence of type 2 diabetes in low-and middleincome countries.
 Type 2 diabetes incidence is associated with low socioeconomic
position in high-income countries
Question 6
 DALY is an example of SMPH (summary measure of population
health) that measures health gaps. Which of the following is true:
 DALY combines information on both mortality and ill health into one
single measure
 Disability weights account for time lived in health states worse than ideal
health
 DALY is and estimate of the gap between the current population health
and a normative goal for population health
Name Surname
21 July 2015
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DALY- an example of SMPH
 DALY is a combined measure on the disease burden that describes ill
health in the population by combining information on both mortality
and morbidity. The purpose of combining mortality and morbidity is
to get an objective measure that also account for those diseases that
people suffer from but not necessarily die from (ex depression).
 Disability of diseases is graded on a scale from 0 to 1, where 0 is
complete health and 1 is death. It should be regarded as the loss of
function that a disease causes, which is assumed to be the same for
all people.
 The normative goal is living in complete health until you die at the
age of 80 (or the age with highest life expectancy in the world). DALY
measure the gap between this goal and the actual current population
health.
Name Surname
21 July 2015
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Question 7
 The concept of avoidable deaths/mortality can serve as an indicator
for the quality of effective health care. Is it true that avoidable
mortality include all deaths potentially avoidable from any
intervention?
Name Surname
21 July 2015
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Avoidable deaths
 Avoidable deaths serves as an indicator for the quality of medical care
(avoidable causes of death using existing forms of health care), and
therefor includes those deaths with causes susceptible for prevention
or treatment through the health care system and/or through health
related policies.
 Examples includes deaths that should not occur if care is adequate, such
as for example deaths from vaccine preventable disease, deaths after
routine surgery, deaths due to shortage of for example insulin etc.
Name Surname
21 July 2015
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