N 309 - Exam 3

• Week 9: Health Behaviors

  *Recent research on diet has shown that half of global deaths are related to over or under-consuming which type of foods?

  Too much salt, lack of whole grains, lack of fruit
• Week 9: Health Behaviors

  * What are the four risk factors for NCDs, and which accounts for the most DALYS?

  Smoking, Alcohol, High Salt Intake, Activity
• Week 9: Health Behaviors

  *Is inactivity more prevalent in higher or lower income countries?

  High income countries
• Week 9: Health Behaviors

  *Is there an agreement about what constitutes healthy/safe drinking across countries?

  Varies by country

  United States: 1 drink per day for women and 2 drinks per day for men
• Week 9: Health Behaviors

  * What is the top cause of tobacco-related deaths?

  Lung cancer
• Week 9: Health Behaviors

  * What is/are key prevention strategies shared by the following: tobacco use, abuse of alcohol?

  Tax increases and bans of advertising
• Week 9: Health Behaviors

  * How does smoking tobacco on devices (hookah, shisha, etc.) compare to smoking cigarettes?

  Perceived as less harmful than cigarettes, but substantially more harmful to health
• Week 9: Health Behaviors

  What positive impacts did the tobacco intervention in Poland have on various key health indicators?

  • A reduction in deaths from lung cancer among men aged 20-44
  • A reduction in deaths from cardiovascular disease
  • A reduction in low body/birth weight
• Week 9: Health Behaviors

  * What are the key concepts in the health promotion theories, and how can these be used in influencing behavior change?

  • Perceived Susceptibility and Perceived Seriousness -> Perceived Threat -> Self-efficacy
  • Perceived Benefits and Perceived Barriers -> Outcome expectations -> Self-efficacy
• Chapter 10: Nutrition

  * What are emergency nutrition relief, desertification, hidden hunger, and food insecurity and their contributing factors?

  • Nutrition Relief - Providing food in nutritional global cirises 
  • Desertification - the process of turning productive land into desert 
  • Hidden hunger - sub-clinical nutrient deficiencies without overt clinical signs of undernutrition 
  • Food insecurity - when people do not have adequate physical, social, or economic access to sufficient, safe, and nutritious food
• Chapter 10: Nutrition

  *What are the following: low birth weight, underweight, stunting and wasting, and what types of undernutrition (acute, chronic) are associated with the latter?

  • Low birth weight = < 2500 grams 
  • Underweight = low weight for age z-score - 2 (commonly used to measure of weight) 
  • Stunting = height for age z-score -2 (sensitivie to chronic undernutrition) 
  • Wasting = weight for height z-score -2 (sensitive to acute undernutrition)
• Chapter 10: Nutrition

  *What percentages of children are underweight, stunted, or died of causes related to poor nutrition?

  • Underweight = 14% of children 
  • Stunted = 22% of children 
  • Related causes = 45% of children’s death
• Chapter 10: Nutrition

  *What are 3 ways to prevent early nutritional risk?

  • Breastfeeding
  • Appropriate complementary foods
  • Feeding foods rich in micronutrients like Vitamin A
• Chapter 10: Nutrition

  Effects of deficiencies in the following on the health of mothers and children

  • Vitamin A
  • Vitamin D
  • Iodine
  • Iron
• Chapter 10: Nutrition

  Vitamin A deficiency

  Causes impaired immune system response, child mortality, and blindness
• Chapter 10: Nutrition

  Vitamin D deficiency

  Causes skeletal disorders such as rickets
• Chapter 10: Nutrition

  Iodine deficiency

  Causes goiters and severe mental impairment
• Chapter 10: Nutrition

  Iron deficiency

  Causes anemia
• Chapter 10: Nutrition

  How Vitamin A affects the immune system

  • Reduction in growth and differentiation of B cells that depend on Vitamin A metabolites, so less antibody production
  • Reduction in the number of T cells or their functioning
• Chapter 10: Nutrition

  *What is a common measure weight status in adults and how are overweight and obesity defined? In what area of the world are there differing recommended definitions of obesity? 

  • BMI: body mass index, a standardized measure of weight that corrects for differences in height
  • Overweight = BMI > /= 25 
  • Obese = BMI > /= 30 
  • Area of the world
  • Middle East 
  • Central America 
  • Island Nation in the Pacific and Caribbean region
• Chapter 10: Nutrition

  *What was a key nutritional deficiency in China? What was the intervention? (Consider the material in Chapter 8, 243-244)

  • Iodine deficiency
  • National Iodine Deficiency Disorders Elimintaion Program 
  • Education campaign, supply of iodized salt, banned sale of non-iodized salt
• Week 11: Actors in Global Health: NGOs

  *Which are the key UN agencies that focus on health or health-related  problems and what is their focus?

  • World Health Organization 
  • “Providing leadership on global health matters” 
  • UN Children’s Fund (UNICEF)
  • “Overcome poverty, violence, disease… in a child’s path”
  • World Food Program
  • “World’s largest agency fighting hunger”
  • Programs on HIV/AIDS 
  • Global monitor/advocate concerning HIV/AIDS
• Week 11: Actors in Global Health: NGOs

  *What are aspects of NGOs to look at to evaluate and understand their work? 

  • What is their mission or values?
  • What do they do (services)?
  • How are they financed?
  • Use of funds shared (annual report)?
  • Do they work in partnership with those in need
  • Who their workers are? 
  • Criticism?
• Week 11: Actors in Global Health: NGOs

  *What were concerns about the role and effectiveness of NGOs in Haiti one year after the Earthquake?

  • Did not work effectively with the government 
  • No capacity building or empowerment 
  • No cooperation 
  • No or little partnering with government of Hati or its institution
• Week 11: Actors in Global Health: NGOs

  *What were features of the program to prevent river blindness shown in the video? 

  • Spread by a tiny black fly 
  • Merck gave free medication (ivermectin) 
  • Individual communities distribute by themselves without outside help 
  • Would dance and use music to get rid of river blindness (ward of demons)
• Week 11: Actors in Global Health: NGOs

  *What are complex humanitarian emergencies (CHEs)?

  A situation affecting large civilian populations which usually involves war or civil strife, food shortages, and population displacement, resulting in significant excess mortality
• Week 11: Actors in Global Health: NGOs

  *Be able to determine the difference between a refugee, an internally displaced person and an asylee, and implications for health.

  • Refugee 
  • A person outside of his/her country; fear of prosecution based on race, religion, nationality
  • Agency that helps protect the rights of refugees is the United Nations High Comissioner for Refugees 
  • Asylee 
  • A person who meets the definition of refugees but travelled on their own without immigration status 
  • Internally displaced person
  • Forced to leave their home but they remain in their own country, no agency to help them
• Week 11: Actors in Global Health: NGOs

  *Which has the greater effect on health: natural disasters or CHEs?

  
  

  Complex Humanitarian Emergencies
• Week 11: Actors in Global Health: NGOs

  *Identify key agencies responding to CHEs and who they serve.

  • UN High Commissioner for Refugees International 
  • Federation of the Red Cross/ Crescent - MSF: Doctors without Borders 
  • International Rescue Committee
• Week 11: Actors in Global Health: NGOs

  *What does a "Health in All Policies" approach mean?

  • Require all departments and ministries to review health impacts of any new policies: “health impact assessments” 
• Week 12: Environment and Disasters

  *How percentage of global disease burden is related to household air pollution, ambient air pollution, and unsafe water/sanitation?

  • Household air pollution = 4.3%
  • Ambient air pollution = 4.2% 
  • Unsafe water/sanitation = 0.9%
• Week 12: Environment and Disasters

  *What are key features of how cholera it makes you sick and how it is treated?

  • Large fluid loss from bacteria diarrhea
  • Vaccine gives short term immunity 
  • Makes you sick through contaminated water 
  • Treated by rehydration therapy and antibiotics
• Week 12: Environment and Disasters

  **Compare improving sanitation only or water only: which has the greatest impact in reducing morbidity due to diarrhea?

  Improving water
• Week 12: Environment and Disasters

  *What types of fuels and stoves increase indoor air pollution;  What are types of fuels and stoves that can decrease indoor air pollution?

  • Increase air pollution
  • Fossil/Biomass fuels and Unvented stoves 
  • Decreased air pollution
  • Use less smoking fuels like kerosene and gas, use vented stoves
• Week 12: Environment and Disasters

  *What populations and what areas are most vulnerable to outdoor (ambient) air pollution, and where in the world is outdoor air pollution the greatest?

  • Groups: people with asthma and younger/older groups 
  • Areas: South Asia and East Asia
• Week 12: Environment and Disasters

  *What are the two types of disasters caused by humans, and what was one the largest disasters caused (by neglect, etc.) by humans?

  • Unintentional (neglect or error)
  • Intentional (terrorism)
• Week 12: Environment and Disasters

  *What are health statistics related to disasters and how are these calculated?

  • Case fatality rate: the # of deaths from a specific disease over a certain period of time 
  • Attack rate: proportion of a population who became infected during a certain period of time * 100
• Week 12: Environment and Disasters

  *Be able to determine the best cost-effective approaches/solutions for disasters.

  Durable buildings and building materials
• Week 12: Environment and Disasters

  *Be able to identify selected ethical principles for responses to disasters.

  • Health burdens: death, injury, disability, mental health, homelessness, respiratory infections 
  • System effects: healthcare, sanitation, and roadway system
• Week 13: Injuries, Adolescent Health, Mental Health

  *Differentiate among: accidents, intentional, and unintentioanl injuries. Be able to apply to examples.

  • Accidents: nothing can be done to prevent injuries that are unintended 
  • Unintentional injuries: refocuses attention on what can be done in terms of prevention and safety (road traffic crashes and falls) 
  • Intentional: Purposely inflicted physical trauma