Week 12: Diseases with Complex Biological Etiology

Question 1

Define etiology.

Answer 1

Etiology: the study of the causes or origins of diseases

Question 2

Define simple and complex etiology.

Answer 2

Simple Etiology: diseases caused by a single factor (e.g., infectious diseases caused by a specific pathogen)

Complex Etiology: diseases resulting from the interplay of multiple genetic, environmental, and lifestyle factors

Question 3

Why is etiology important in public health?

Answer 3

Understanding etiology aids in disease prevention, management, and policy formulation

Question 4

Define diabetes mellitus.

Answer 4

A metabolic disorder of multiple etiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both

Question 5

What is diabetes mellitus characterized by?

Answer 5

High levels of blood glucose resulting from defects in insulin production, insulin action, or both

Question 6

What are the long-term effects of diabetes mellitus?

Answer 6

Long–term damage, dysfunction, and failure of various organs

Question 7

What are 4 facts about the history of diabetes mellitus?

Answer 7

Diabetes mellitus has an ancient recorded history dating to 5th century BC Indian texts

Early historical writings show that tasting urine was the first diagnostic diabetes test

In the 19th and early 20th centuries, the first quantitative clinical and diagnostic tools were developed to test for elevated sugar in the urine (glycosuria) and blood (hyperglycemia)

The later discovery of insulin forever transformed type 1 diabetes from a rare and fatal disease to one where prolonged survival was possible

Question 8

What are potential characteristic symptoms of diabetes mellitus?

Answer 8

May present with characteristic symptoms such as thirst, polyuria, and/or blurring of vision

Question 9

What can occur in diabetes mellitus’ most severe forms?

Answer 9

Ketoacidosis or a non–ketotic hyperosmolar state may develop and lead to stupor, coma and, in absence of effective treatment, death

Question 10

What are 2 details about diabetes mellitus symptoms?

Answer 10

Often symptoms are not severe, or may be absent

Consequently hyperglycaemia is sufficient to cause pathological and functional changes may be present for a long time before the diagnosis is made

Question 11

What are 4 facts about the burden of diabetes?

Answer 11

The development of diabetes is projected to reach pandemic proportions over the next 10-20 years

By 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%

In most Western societies, the overall prevalence has reached 4-6%, and is as high as 10-12% among 60-70-year-old people

The annual health costs caused by diabetes and its complications account for around 6-12% of all health-care expenditure

Question 12

What are the 3 types of diabetes?

Answer 12

Type 1 Diabetes Mellitus

Type 2 Diabetes Mellitus

Gestational Diabetes

Question 13

What are 3 details about the diagnosis of diabetes?

Answer 13

Several blood glucose tests are available for the diagnosis of diabetes

The fasting plasma glucose test is currently considered the diagnostic test of choice for diabetes

A random blood glucose test may be used as a screening test if diabetic symptoms are present

Question 14

What are 4 details about random blood glucose tests?

Answer 14

A random blood glucose test may be used as a screening test if diabetic symptoms are present

This test assumes a non-fasted state and therefore allows for higher glucose values

A test result of 200 mg/dL or higher warrants further testing using one of the clinically recommended diagnostic blood glucose tests

Hemoglobin A1c test

Question 15

What are the AIC levels for normal, pre diabetes, and diabetes?

Answer 15

Normal: less than 5.7%

Prediabetes: 5.7% to 6.4%

Diabetes: 6.5% or higher

Question 16

What are the 3 major components of diabetes treatment?

Answer 16

Diet and exercise

Oral hypoglycemic therapy

Insulin therapy

Question 17

What are 6 details about cardiovascular diseases?

Answer 17

“Cardiovascular disease has the same meaning for health care today as the epidemics of centuries had for medicine in earlier times: 50% of the population in developed countries die of cardiovascular disease”

Someone has a heart attack every two minutes (British Heart Foundation)

Leading cause of mortality in developed countries and a rising tendency in developing countries (disease of civilization)

Significantly contributes to morbidity and death rates in the middle aged population: potential life years lost, common cause of premature death, labor force (economic costs), family life

Morbidity: nearly 30% of all disability cases

Contributes to deterioration of the quality of life

Question 18

What are the 7 types of cardiovascular disease?

Answer 18

Coronary heart disease

Atherosclerosis

Cerebrovascular disease (stroke)

Hypertensive heart disease

Rheumatic heart disease (streptococcal infection)

Congenital heart disease

Cardiomyopathies

Question 19

What are the 8 major risk factors for CVD?

Answer 19

Tobacco Addiction

Elevated LDL Cholesterol

Low HDL Cholesterol

High blood pressure

Elevated Blood Glucose

Obesity

Physical Inactivity

Dietary Factors

Question 20

What are 3 details about atherosclerosis?

Answer 20

Characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the artery

Hyperlipidemia: abnormally high blood lipid level

Plaque: buildup of deposits in the arteries

Question 21

What are 3 details about myocardial infarction?

Answer 21

Myocardial infarction is the interruption of blood supply to part of the heart causing a portion of the myocardium to die

Myocardial infarcts are most commonly due to occlusion of a coronary artery caused by atherosclerosis or following the rupture of a vulnerable atherosclerotic plaque

The resulting ischemia and oxygen shortage if left untreated for a sufficient period of time can cause infarction of the myocardium and often results in death of the patient

Question 22

What are 4 details about the diagnosis on myocardial infarction?

Answer 22

Myocardial infarction presents with sudden chest pain typically radiating to the left arm or left side of the neck in combination with shortness of breath, nausea, vomiting, heart palpitations, sweating and anxiety

Approximately 25% of myocardial infarctions occur without warning in the absence of prior chest pain or other symptoms

Often, the onset of myocardial infarction is gradual over several minutes providing time for emergency treatment.

The diagnosis of myocardial infarction is inferred by electrocardiogram abnormalities and confirmed by elevated blood biomarkers of myocardial necrosis such as creatine kinase and troponin

Question 23

What are 3 details about primary preventions of myocardial infarction?

Answer 23

Since the major risk factors are modifiable, myocardial infarction is preventable

Primary prevention is the reciprocal of exposure to proven risk factors

Avoid tobacco, eat a heart healthy diet, maintain blood pressure, blood glucose and blood lipids (cholesterol) within normal limits, exercise daily, and maintain optimal weight for height

Question 24

What are 3 details about strokes?

Answer 24

Occurs when blood flow is interrupted, the brain cannot get the glucose or oxygen it needs

The mitochondria that rely on O2 can not produce the ATP needed to maintain the electrical state of the neuron

This change in the electrical state cause communication between cells to cease, as well as trigger apoptosis

Question 25

What are the 2 major types of strokes?

Answer 25

Ischemic stroke: blood flow to the brain region is interrupted due to a blockage in the artery; accounts for the majority, approximately 80-85% Hemorrhagic stroke: is due to a rupture of the blood vessel; is a result of such things as hypertension, bleeding disorders, tumors, and amyloid vascular disease

Question 26

What are 6 details about hypertension/renal failure?

Answer 26

In a healthy adult, blood pressure is about 120/80 mmHg Systolic pressure refers to the level of blood pressure while the heart is contracting and is represented by the top number (120 mmHg) Diastolic pressure, the level of blood pressure in between heart contractions, is represented by the bottom number Hypertension is sustained high blood pressure Called the “silent killer” because it has no symptoms Greater risk for CVD symptoms

Question 27

What are the 2 types of hypertension?

Answer 27

Essential Hypertension constitutes 90-95% of cases; no specific cause is identifiable in essential hypertension Secondary Hypertension constitutes 5-10% of cases; a definitive specific cause (usually a hormonal disorder) is readily identifiable in secondary hypertension

Question 28

What are examples of prevention strategies for diseases with complex biological etiology?

Answer 28

Primary prevention: prevent the onset of disease by eliminating risk factors or increasing resistance Smoking cessation programs Healthy diet initiatives Vaccination programs Physical activity promotion Pollution control measures Occupational health and safety Secondary prevention: detect and address existing diseases in early stages to halt or slow progression Cancer screenings Blood pressure and cholesterol control Using risk assessment tools Health education Tertiary prevention: manage established disease to prevent complications and improve quality of life Chronic disease management programs Rehabilitation services

Question 29

What are 3 ways to address complex diseases?

Answer 29

Health Promotion and Education: Effective health promotion requires empowering individuals and communities to take control of their health by addressing underlying determinants and promoting healthy behaviors Policy Development: Policy interventions at the local, national, and global levels are crucial in creating environments that support health and reduce disease burden Addressing Health Disparities: Reducing health disparities is essential for achieving health equity and requires targeted interventions to address the needs of vulnerable populations

Question 30

What are the effects of insulin on glucose uptake and metabolism?

Answer 30

Pancreatic cells release insulin, which acts on the receptors of the cells Once insulin binds with the receptor, it triggers a cascade of signaling pathways downstream within the cell that can lead to transportation of GLUT4 molecules to the cell surface that results in the intake of glucose Glucose is then taken up from the blood and into the cells where it is either stored as glycogen or used for energy production

Question 31

How do Type 1 and Type 2 diabetes differ regarding insulin?

Answer 31

Type 1: Insulin production is decreased and is not taken up into the cells, resulting in elevated blood sugar levels Type 2: Insulin production is decreased and is not taken up into the cells, resulting in elevated blood sugar levels Insulin resistance also occurs, which means that it may not bind to receptors properly and inactivate/not active signaling pathways