Natural Disasters

Natural disasters such as a tsunami, earthquake, hurricane or mudslide can trigger a cascade of social and health problems. Before the advancement of injury prevention, injuries were viewed as random, unavoidable accidents. Where a natural disaster is unavoidable, the injuries associated with them can be reduced through pre-event, event and post-event intervention. Injury intervention involves prevention/limitation of energy build-up, controlling circumstance of energy use to prevent release, modifying energy transfer to limit damage and improving emergency response, treatment, rehabilitative care to limit disability and promote recovery. 

Hurricane Katrina triggered a re-evaluation of the United States emergency response to natural disasters. The lives lost, homes destroyed and displacement of communities has had a huge impact on New Orleans and the surrounding area. Our nation is still responding to the aftermath of the hurricane. For instance, a deadly amoeba was found in St. Bernard that when inhaled through the nose causes a deadly meningitis. The free-living, Naegleria fowleri, amebic infection has claimed the lives of several individuals. The Lousiana Department of Health and Hospitals argue that the presence of amoeba found in chlorine treated water is a result of population decline after the hurricane. St. Bernard was a thriving 67,000 person community before the hurricane but the population has declined to almost 15,000 after Hurrican Katrina. The underuse of the public water system has allowed the chlorine to dissipate, allowing the pathogen to colonize and grow. An outbreak such as this can be hard to predict but disease and injury prevention methods that would require surveillance of the public water system may have prevented such an outbreak. 

Injury prevention in regards to a natural disaster include reduction in environmental impact, advancement in emergency response and limitation of disease occurence. Environmental protection including dams, reservoirs, wind protectors can reduce the structural damage often associated with a hurricane or tsunami. Increased adherence to emergency response pre-event can limit the number of people directly exposed to a hurricane or tsunami by evacuating the area. Pre-event emergency response also includes an evacuation plan and roads that can meet the needs of the community. Post-event emergency reponse includes better response time to emergency situations and quick transport time to a hospital. 

The recent mudslide in Washington state emphasizes the importance of occupational and environmental safety. Landslides and floods are unfortunatlely common and present a major public health concern. A total of 24 people have died from the mudslide and several are still unaccounted for. More than a square mile of a residential area along the bank of a river has been affected by the mudslide. Injury prevention would include evaluation of the soil and observation of rain levels to predict and prevent the impact of a mudslide. 

ADHD

The DSM-V defines Attention Deficit Hyperactive Disorder (ADHD) as having 5 or more of the listed symptoms including; difficulty with organization, losing or misplacing items, frequently forgetting information, distracted and failure to pay close attention to details. According to this definition myself
and the majority of the population should be diagnosed and treated for ADHD. 

It is well-known that the United States is the most medicated country in the world. Direct-to-Consumer advertising allows Big Pharma to push drugs into the marketplace. As pharmaceutical advertisements list the symptoms that this drug can treat, consumers begin to think that they have that disease and need that drug right away. No sooner than when the commericial ends, consumers are scheduling doctor appointments in hopes of a new prescription. Drugs are viewed as a quick fix and the demand continues to rise. 

I have seen ADHD medication misused and abused more than any other prescription drug. Individuals who are prescribed it will sell it to their peers during midterm and finals week. I have seen parents use it during the holiday season to cross off everything on their to-do list. Most alarmingly, I have witnessed individuals take it at parties claiming that it makes them more alert and sociable. 

In my opinion, there are two types of individuals who are diagnosed with ADHD: those who have a normal level of distraction or impulsiveness and those that have an underlying disorder. There are several conditions or disorders that can lead to symptoms that parallel ADHD symptoms including; sleep disorders, undiagnosed vision or hearing disorders, substance abuse, iron deficiency, bipolor or major depressive disorder, Obsessive Compulsive Disorder and learning disabilties such as dyslexia. 

The stimulants that are prescribed to ADHD patients are highly addictive, have negative side effects and only work short term. ADHD medication isn't a treatment option, it is a band-aid at best, simply masking the underlying effect of the disease. I cannot minimize the fact that some individuals are more distracted than others and have a hard time paying attention but in most cases there is another cause.  

Some of the side effects of stimulants include; increased anxiety, irritable, depressesion, severe weight loss due to appetite suppression and suicide. In a recent study, children treated with stimulants for ADHD experienced slower BMI growth followed by a rapid rebound that could continue to obesity. The rapid rebound occured in late adolescene after discontinuation. The study emphasized it was the stimulant that was associated with rapid rebound and not the disease as the stimulant can cause growth delays. 

Public health professionals should pay attention to the effect that stimulants can have on childhood obesity and should aim at restructuring the diagnosis and treatment of ADHD.  

Alzheimer Disease

Alzheimer Disease 

Magnolia's of Lancaster is a Senior Living Center for residents diagnosed with varying degrees of dementia. They offer a Memory Care Program for individuals with Alzheimer's Disease (AD) and dementia caused by blunt head trauma. I have the privilege of working there as a Resident Care Assistant assisting with ADL's and facilitating activities for the residents. It has been one of the most rewarding experiences I have ever had. These inspiring individuals who worked as teachers, nurses, and computer engineers have accomplished so many feats throughout their life but cannot remember their own success. My favorite part of my job is remembering it for them. Certain cues will help the residents remember parts of their life and it is so rewarding to see their faces light up as they relive one of their favorite moments. During our Christmas party this past year a resident who can barely speak was singing along perfectly with Jingle Bells. 

Of course there are many challenges associated with Alzheimer's Disease, one of them being the impact that the disease has on family members. It is heartbreaking to watch a resident have a conversation with their son or daughter without knowing who they are or how they know them. The devastating effects of the disease take a huge toll on family members. I found it inspiring that many of the managers and supervisors at Magnolia's of Lancaster had no previous professional experience with dementia or AD before they applied for the position but rather had personal experience with a parent or other family member who was diagnosed with AD. Individuals in the early stage of the disease are aware of what is happening to them and it terrifies them to witness other individuals suffering through the later stages. 

Similar to other mental illnesses, there was minimal amount of research done on AD until recently. Medication has been developed to slow the progression of the disease but there is a lack of scientific evidence for any preventive measures. As scientists develop a deeper understanding of the disease, they have started to make correlations between behaviors and have begun to identify protective factors and risk factors. 

The global prevalence of AD is estimated to be around 24 million and will continue to rise as the worldwide population continues to age. AD seems to be more prevalent in the United States compared to Africa, Asia and Europe which may have to do with methods of diagnosis. Some factors that are highly associated with AD include diabetes, smoking, hypertension and obesity. Education, increased leisure activity, a Mediterranean diet and more physical activity have been correlated with a decreased risk for AD. I find it incredible interesting that cognitive reserve can reduce an individuals risk for AD. Studies of "normal aging" indicate that higher educational or occupational attainment slow the progression of cognitive and functional decline. Although the etiology of AD remains unclear, Epidemiologists and Public Health professionals should be concerned with the genetic and environmental risk factors that may be associated with the disease. 

Traffic in the Dominican Republic

 Republic of the Dominican

This past winter break, I had the privilege of visiting Cap Cana in the Dominican Republic with my family. We had a beautiful time swimming in the Caribbean water, soaking up the sun and exploring the island. We ventured on a guided tour through "rural" Dominican Republic. We visited a local village where we met the teachers and school children before heading up to the top of a mountain to observe coffee bean production, cigar rolling and cocoa plants. I'm not convinced that we experienced the authentic Dominican lifestyle as the school was funded by the tour company and the farm on the mountain was owned and operated by affiliates of the company. Regardless, it was informational and we learned a lot about the culture of the Dominican Republic. 

Dominican Cocoa

Inside of a Cocoa plant

Cigar Rolling

Our tour guide talked a lot about how Dominican's make a living. Because of the tobacco, cocoa and coffee exports there is always opportunities in agriculture. Individuals will also commute from their villages for months at a time to work at resorts in Punta Cana, Cap Cana and the southern part of the Island as housekeepers and servers. Certain business laws prevent individuals from being able to purchase real estate for their business so many families sell products such as art and food right inside their own home. I noticed that residents of the Dominican Republic are always looking for ways to make money. Children will run up and down the beaches soliciting hats made from palm leaves and older gentlemen will sell wooden crafts. 

During the ride from our resort to the village, we traveled on main highways as well as dirt roads. The main roads were well-paved with lines drawn, traffic lights and for the most part people paid attention to traffic laws. Compared to the driving situation in India, it was much safer. I did notice 3, 4 even 5 individuals riding on motorcycles and several people riding in the flat bed of trucks. The passengers were almost exclusively men. Later on our tour guide mentioned that this is how some individuals earn a living in the Dominican. Many people commute to more urban areas for work or to other villages and don't have means of transportation. Therefore they rely on friends or family members to drive them there for a small fee. Our tour guide said that more often than not, the passengers are friends of the driver. They drove at or above the posted speed limit and none of the individuals wore seat belts. As discussed in class, this presents a major public health concern because of fatalities, medical costs, loss of productivity and implications on their village or family members. However, there is a lack of public transportation in the Dominican and residents must find a way to get back and forth from their job. Even if individuals were required to wear helmets or they restricted the passengers to 2, it would create a safer environment.

HIV/AIDS Testing Clinics

HIV/AIDS Testing 

Virginia Department of Health offers a wide variety of HIV awareness, prevention and testing programs:

HIV Prevention Among Communities of Color -  HIV prevention interventions within minority communities at increased risk for HIV infection. More than 30% of the grant award is for HIV prevention among Black and Latino men who have sex with men.  

 
AIDS Services and Education Grants - support outreach, innovative prevention interventions for hard to reach populations and supportive services for persons living with HIV, target transgender individuals.


 
Men who have Sex with Men HIV Prevention Program -addresses the disparity between the impact of the epidemic on gay and bisexual men and the amount of funding being targeted to this community.
 
African-American Faith Initiative - stemmed from request for faith-based HIV programs in minority communities.


Community HIV Testing Services- provides HIV antibody testing in outreach and non-invasive settings for men who have sex with men, injection drug users, sexual partners of these populations, high risk heterosexuals and incarcerated individuals.

Although these programs are available to the general population, they typically target individuals who are more susceptible to the disease. A staggering one in four individuals infected with HIV are not aware they have the virus. This presents a major public health concern to susceptible populations and has led to the installation of various testing and prevention programs. 

In Sub-Saharan Africa, less than 12% of people who want to be tested for HIV are able to do so currently. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS released an initiative the recommends HIV testing be a standard part of medical care in all African healthcare facilities regardless of the reason they came in for. I don't believe that mandatory HIV screening is financially or operationally feasible in Sub-Saharan Africa. Africa is plagued with Malaria, Tuberculosis, poverty, poor living conditions and malnutrition. Diarrhea is one of the biggest killers of children living in Africa. The AIDS/HIV epidemic should not be minimized and public health officials should continue to work towards eradication but HIV testing requires funding and support. In a previous blog post, I discussed necessary and sufficient causes of disease. If we used the HIV testing funds and operations staff to decrease malnutrition and provide safer water sources, individuals would be less susceptible to communicable diseases. Although HIV testing is necessary, it is not sufficient to eradicate HIV/AIDS.

HIV testing clinic in Sub-Saharan Africa

The HIV testing initiative in the United States has taken place in conjunction with increased access to treatment and care. The highly developed United States healthcare system permits discussion of mandatory vaccinations and HIV testing because of available resources. African countries do not have the time, resources or personnel to implement HIV testing. Even in the United States, the HIV testing initiative has met strong opposition. First, who will fund this project? Even insured individuals would have to absorb the cost of the test. Individuals in low socioeconomic classes are more susceptible to HIV/AIDS and may not be able to afford the test. Second, routine testing may lead to lower-quality or unethical testing programs. In an effort to increase the number of individuals testing for HIV, hospitals and clinics may sacrifice the integrity of their organization. Finally, individuals living with HIV, still face disease related stigma and discrimination. 






 

Polio in Syria

          Polio in Syria

What is Polio? 

Polio is a disease caused by a virus that is spread through oral-fecal transmission. Typically by eating or drinking items contaminated with feces from an infected individual. Most people with polio do not initially feel sick. They may experience minor symptoms, such as a fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. Most people recover from polio but in some cases, it can lead to permanent crippling of the arms and legs. Although polio has a lower R naught than measles and pertussis, it remains a major public health concern. 

Individual with severe crippling due to polio.

 

Values of R0 of well-known infectious diseases
Disease	Transmission	R0
Measles	Airborne	12–18
Pertussis	Airborne droplet	12–17
Diphtheria	Saliva	6–7
Smallpox	Social contact	5–7
Polio	Fecal-oral route	5–7
Rubella	Airborne droplet	5–7
Mumps	Airborne droplet	4–7
HIV/AIDS	Sexual contact	2–5
SARS	Airborne droplet	2–5
Influenza (1918 pandemic strain)	Airborne

Polio in the United States

The first case of polio was reported in the 19th century and it soon became one of the most dreaded diseases of the 20th century. Through the late 1940's and the early 1950's, 35,000 people were crippled by polio each year. Travel and commerce between affected cities was restricted and public health officials imposed quarantines on not only homes but entire towns. Through the development of vaccine and public health awareness, the disease has since been eradicated from the United States for over 30 years. 

Current Situation

According to the World Health Organization (WHO), 17 cases of polio have been reported in Syria as of November 2013. In March 2011, more than 90% of individuals were vaccinated but due to the civil unrest, immunization rates have dramatically decreased. Although not every individual had been vaccinated, herd immunity helped prevent the spread of the disease. Due to the conflict in the area, less than 68% of individuals are vaccinated, leading to the increase of polio cases. 

Oral polio vaccinations.

Government officials and public health officers have advocated for a vaccine drive but the political unrest and safety concerns pose a threat to both citizens and visitors of Syria. 

The polio outbreak in Syria is a reminder of the power of disease. Before the 2013 outbreak, there were no reported cases of polio in Syria since 1999. Epidemiologists and public health officials are still trying to determine the cause of this outbreak and mode of transmission. Some believe it spread from the Middle East or another African country. 85% of polio cases reported worldwide are found in Africa with the remaining cases isolated in the Middle East. This polio outbreak is an example of the impact that place of residence and the current state of the government can have on an individuals health. The outbreak of polio in Syria is one of the most challenging outbreaks since the eradication of polio. This outbreak exemplifies the damage that disorder in society can have on the infrastructure of a health system.

Syria isn't the only country that has experienced disease outbreak due to violence. Health professionals have been forced to flea certain territories because of civil unrest. This has led to fewer vaccinations, less health education and an increase in disease outbreak. We are faced with the challenging task of maintaining the health of a population in the presence of political dispute.

Necessary and Sufficient Cause of Disease

Necessary Cause of Disease

 A necessary cause of disease is always associated with a particular outcome because an exposure is required for a particular outcome. For example; HIV is a necessary cause of AIDS. An individual cannot be diagnosed with AIDS if they are not infected with HIV.

Sufficient Cause of Disease

A sufficient cause of disease is an exposure that may produce a particular outcome but may not be the only cause of that outcome. An example would include poor nutrition leading to obesity, however, sedentary lifestyle, stress and other factors could have also caused the disease.  

http://minorityhealth.hhs.gov/templates/content.aspx?ID=3024

According to the US Department of Health and Human Services, American Indians and Alaska Natives are twice as likely to develop diabetes than non-Hispanic white individuals. Risk factors associated with diabetes include hypertension, obesity, high cholesterol and tobacco use. Biologically, American Indians/Alaska Natives and non-Hispanic white individuals are equal. Non-Hispanic white individuals have not developed an immunity to hypertension or obesity. In fact, risk factors such as high cholesterol, hypertension and obesity plague every society, race and ethnicity. So why are certain ethnicity's more susceptible to diseases than others? 

Simply stated, social determinants of health impact disease prevalence. Social determinants of health include; gender, income level, place of residence, age, occupation, education level and socioeconomic status. The documentary series Unnatural Causes explores the topic of inequality and its effect on health. In the first episode, In Sickness and In Wealth, investigates the connection between physical health, wealth and race. After interviewing several individuals in different income brackets, they discovered that the individuals with the highest income were the most healthy. Reasons include; access to better housing, more comprehensive healthcare, better transportation and increased availability of healthy foods. Along the health-wealth gradient, they observed 5 to 10 year gaps between the cities rich, middle and working class neighborhoods. As indicated in this documentary series, social determinants of health can be a sufficient cause of disease. Individually they may not produce a particular outcome but collectively, determinants such as poverty, poor nutrition and increased stress can impact an individual's health. 

There are several determinants that play a role in the increased prevalence of diabetes in minorities including lack of proper nutrition and increased stress levels. American Indians, especially those living on reservations, are also challenged because of their place of residence and occupation. American Indians have typically made a living off growing and harvesting crops. Over the recent decades, water sources and irrigation systems have been rerouted in the mid-west to better accommodate bigger farms that produce more crops. Consequently, American Indians harvest less crops and therefore have minimal access to nutrient dense food. In an effort to preserve American Indian culture, the government has created  subsidized housing  and provided food to various reservations throughout the region. However, the food that they are providing is high in fat, sodium and cholesterol. As a result, there has a been a rise in obesity and diabetes among American Indians. In addition, there is a lack of health education and health promotion on reservations. This exemplifies the impact that occupation and place of residence can have on an individual's health.