Health Issues Final

What are 4 factors of this socioeconomic health disparity?

1. Quality of care

2. Accessibility

3. Utilization

4. Benefits derived from medical care

What 2 causes of death were lower for African Americans?

Suicide and cirrhosis (liver disease)

What is an example of a diminishing return on health?

Infants born to Black mothers with college degrees and presumably more affluence have higher mortality rates than white women who have less than a high-school diploma

The range of disparities includes the following:

Poverty, poor dietary habits, lack of minority providers, distrust of the healthcare system, chronic stress, diminishing returns, weathering

What is prevalence of a disease?

The number of current cases, old and new, of a disease in a specified time period

The prevalence of a disease has the following characteristics:

Measures of all the current cases in a community, dependency upon duration of illness, can be used to determine healthcare needs of a community, dependency upon incidence of a disease

What is epidemiology?

Refers to the study of medicine dealing with causes, distribution, and control of diseases in a defined population

Epidemiological principles are used to:

Evaluate drug therapy, plan future health needs of a community, and help establish a diagnosis

Epidemiology CANNOT

Determine the prognosis of a disease process in a particular patient

1st step in conducting an epidemic investigation and why

Verifying the diagnosis, so that establishment of a clinical lab can determine an accurate case count and establish the existence of an epidemic

Epidemiological triangle

Host, agent, environment

A disease is never caused by one event, but rather…

A chain of events forming a web because its complexities can never be fully updated

Control of diseases is based on 2 fundamental assumptions

1. Diseases do not occur by chance

2. Diseases are not randomly distributed in the population

Criteria for epidemiological screening

Natural history of condition must be understood, condition must represent an important health problem, suitable screening tests must exist, accepted treatment must be available

Medicare is an insurance program for:

1. People age 65 or older

2. People under age 65 with certain disabilities

3. People of all ages with End-Stage Renal Disease

4. People who are blind or in long-term care

Currently, new changes in the Medicare program target…

Reducing costs and focusing on quality improvements

Medicare does NOT cover the following:

Opticians, hearing aids, dental work, overseas care, podiatry, cosmetic surgery, chiropractic care, massage therapy, nursing home care, concierge care

Both Medicare and Medicaid do NOT

Reimburse health providers through intermediaries like Blue Cross Insurance

Medicaid must cover:

1. Pregnant women and children with incomes 205% of the poverty line

2. Children under 19 with incomes 355% higher than the poverty line

3. Caretakers = legal guardians who take care of children under 18 or 19 if still in high-school

10 unhealthy habits to change

No breakfast, overeating, smoking, high sugar consumption, air pollution, sleep deprivation, head covered while sleeping, working brain during illness, lacking in stimulating thoughts, talking rarely

Liver damaging habits

Sleeping/waking late, not urinating in the morning, too much eating, skipping breakfast, too many meals, too much preservatives/colors/sweeteners, unhealthy cooking oils

What are dioxins?

Harmful chemicals found in frying oils and sugars which damage the function of the brain in memory, as well as increasing likelihood of breast cancer

Cancer cells and sugar substitutes

They are made with aspartame, a carcinogenic compound

Issues with table salts

• they are bleached and stripped of natural minerals

• contain anti-caking calcium silicate

Cancer thrives in what type of environment, which comes from what?

An acidic environment; comes from a meat-based diet

Reasons to limit red meat (3)

It contains antibiotics, growth hormones, and parasites

Cancer cells CANNOT thrive in what type of environment?

An oxygenated environment; it is healthy to go outside, exercise, or do oxygen therapy

Good and bad about sugar intake from beverages nowadays

Good: fewer people are drinking soda

Bad: soda is being replaced with other sugary drinks

Sugar and nutrition labels

FDA has made new percentage for “added sugar” values; however, sugar is indicated in grams, while minerals are listen in milligrams

Benefits of watercress

Contains iron and calcium; inhibits breast cancer; reduces DNA damage to red blood cells

Benefits of beets

Contains iron and folic acid for physical healing; immunity booster and colon cancer protector; has 0 trans fats, preventing heart disease

What is lead poisoning?

The presence of too much lead in our bodies, which have no use for lead

Long-term risks of lead poisoning

• permanent damage to the brain, kidneys, blood

• hypertension

• learning and behavioral issues

• mental retardation

• coma

• anemia

• death

Who is most at risk for lead poisoning?

Children, because they put items in their mouths

Lead poisoning and pregnancy complications

• miscarriage

• premature birth

• developmental issues

Symptoms of lead poisoning

• stomach/headache

• cramps/constipation

• nausea/vomiting

• fatigue

• vision issues

• appetite loss

• sleepiness

Impact of lead poisoning in NJ

Had the greatest number of minorities while simultaneously having the largest percentage of lead poisoning

Where is lead found?

Schools, playgrounds, factories, houses, water, soil

Why and how did lead get there?

Shiny white lead paint was used as a privilege indicator for single and double family homes, rather than government-funded complexes

What is lead dust?

It is dust created when a surface coated with lead rubs against another

Lead poisoning and disparities link (2)

There is evidence linking childhood lead exposure to increased likelihood for violent crime, and lower rates of highschool graduation

What do we know now about lead poisoning?

There is no safe level of lead, and lead does not naturally break down

What is the most impacting factor of lead poisoning?

Our own public perception that the lead problem has been solved

What is sickle cell disease?

An inherited red blood cell disorder coming from abnormal Hemoglobin S

What is hemoglobin?

A protein found in red blood cells which carries oxygen throughout the body

Typical red blood cells shape

Disc-shaped so that they can be flexible & move through small and large blood vessels

Issues with sickle cells

Due to their crescent shape, they can form rods which make red blood cells inflexible and stick to walls. May cause stroke, acute chest syndrome, organ disabilities, or premature death

Race and SCD

There is a higher prevalence in the Middle East, India, Mediterranean, and Africa due to malaria

Information about malaria

A mosquito-born disease coming from a parasite transmitted through saliva; the parasite is able to infect sickle cells because of their shapes & increase rates of phagocytosis

Symptoms of SCD

• yellow eyes

• pale skin

• dark urine

• hand/foot swelling

• stunted growth

• stroke

• pain episodes

Diagnosis of SCD

All US newborns are tested, as symptoms can begin as early as 4 months. Can be identified before birth through testing a sample of amniotic fluid

Treatment of SCD

There is no standard treatment, but medication like hydroxyurea or blood transfusions may help. Stem cell transplants are available, but they pose high risks

Can SCD be cured?

NO; a child may need to take oral medication for upwards of 10 years to prevent life-threatening infections, and then focus on pain management

Complications of SCD

• stroke

• increased vulnerability to infection

• pulmonary hypertension

• acute chest syndrome

What is a sickle cell crisis?

Anything that lowers the amount of oxygen in the body - also called exacerbation (exercise, mountain climbing)

What is lupus?

A chronic inflammatory disease in which the body’s own immune system attacks its tissues and organs; affects the joints, skin, heart, lungs, kidneys, brain

Causes/triggers of lupus

The cause is unknown, but 3 potential triggers are:

• sunlight

• medication

• infection

Symptoms of lupus

• butterfly rash

• fatigue

• fever

• white/blue fingers

• chest pain

• dry eyes

• headache/confusion

• skin lesions

• shortness of breath

4 types of lupus and their characteristics

1. Discoid: marked by a rash on the face, neck, and scalp

2. Systemic: has effects on the joints, lungs, kidneys, blood, etc

3. Drug-induced: specifically from procainamide and hydrazine

4. Neonatal: acquired from passage of maternal autoantibodies, persists within first weeks of life

Lupus treatments

• medications that reduce inflammation may cause pain, fever, or swelling

• some meds suppress the overactive immune system

• both can be combined to control the disease

What is the prostate?

A small gland located below the urinary bladder, which functions to produce nutrients that aid in the viability of sperm

What is prostate cancer?

It comes from an abnormal growth which enlarges the prostate, obstructing the urethra and blocking typical urine flow

What is prostatic hypertrophy?

Enlargement of the prostate due to aging or testosterone levels; can inflate prostate to the size of a grapefruit; does NOT mean cancer is present

What is benign prostate hyperplasia (BPH)?

Non-cancerous urological disease frequently impacting men over 50 years old; may lead to irreversible kidney or bladder damage; treated with iTind, UroLift, or Rezum Therapy

Symptoms of prostate cancer

• painful urination/ejaculation

• frequent urination

• inability to hold urine

• blood in urine

• pain in the lower back, hips, upper thighs

• sensation of incompleteness upon emptying bladder

Early diagnosis of PC

All males over the age of 40-50 should consider getting a prostate exam as part of an annual physical

What is used to treat BPH?

Minimally invasive laser procedure

What is PVP?

Photoselective vaporization of the prostate; utilizes a high-powered laser to vaporize enlarged tissues

What is proton therapy?

A general treatment for cancerous tumors which kills carcinogenic cells by preventing them from dividing and growing

What is CyberKnife?

Robotic, image-guided radiation therapy used to treat prostate cancer

Why and when should men be tested for PC?

Why: leading form of cancer in men

When: at age 50, get a DRE and PSA antigen test annually

Why and when should men be tested for cholesterol levels?

Why: indicator of heart disease which may develop in men in their 40s

When: using a blood test to measure LDL, HDL, and triglycerides

• 21-40 yrs: every 5 years

• 41-50: every 2 years

Why and when should men be tested for blood pressure?

Why: it is an indicator of heart disease; 1 in 4 men over the age of 55 has hypertension

When: using a standard arm-cuff test starting at 20 years old

• if normal, every 2 years

• if high, every 2 months

When and why should men be tested for colon cancer?

Why: 28k men die yearly from colorectal cancer

When: starting at age 50,

• barium enema X-ray every 5 years

• colonoscopy every decade

When and why should men be tested for diabetes?

Why: rates are rising in men, causing blindness, impotence, etc

When: at 45 years, a blood glucose test

• every 3 years if normal

• every year if abnormal

What is a diaphragm and the associated risks?

Small, flexible silicone/latex cup inserted in the vagina to block sperm from reaching the eggs. Less effective than pills and IUD methods

Risks:

• toxic shock syndrome

• irritation

• UTI

Info on Depo-Provera

An injection made of a hormone similar to progesterone. Can work for up to 12-14 weeks, but must administer an injection every 12 weeks.

Risks:

• loss of bone density

Info on Implant

Placed under skin and releases a certain type of progesterone called etonogestrol. The 2 available in the US are Implanon and Nexplanon. Can be used for up to 3 years

Risks:

• bruising

• swelling

• redness

• infection

• irregular cycle

• vaginitis

Info on BC pills

Oral medication taking daily which stops body from ovulation through inhibiting hormones, changing cervical mucus, or changing the womb lining. Contains drospirenone, which increases the risk of blood clots

Risks:

• weight gain

• swollen breasts

• nausea

• lighter periods

Plan B info

Emergency contraception taken after unprotected sex. It may delay or interfere with egg fertilization.

Side effects:

• vomiting

• abdominal pain

• unexpected bleeding

• menstrual changes

• breast tenderness

Info on IUD (intrauterine device)

Prevents pregnancy by stopping sperm from reaching fertilized eggs.

Rare but serious side effects:

• ectopic pregnancy

• uterine infection

• ovarian cysts

• punctures in uterine wall

Info on Vasectomy

Permanent male birth control. Vas deferens from each testicle is cut and sealed to prevent sperm from mixing with semen from the penis. Testicles still produce sperm, but it is reabsorbed by the body.

Risks:

• regrowth of vas deferens

• bleeding under the skin

• infection at incision

Info on Tubal Ligation

Permanent female birth control which is caused by tying the fallopian tubes together.

Risks:

• heavy blood loss

• general anesthesia issues

• organ injury during surgery

Main disadvantages of BC

• does not protect against STDs

• less effective when taken w/ certain drugs

• require prescription and can be expensive

Past views on BC

Many Black people were suspicious of the government’s encouragement of BC clinics, fearing it was an attempt to limit Black population growth. 1967 Newark Black Power Conference

BC and Black Women

• have disproportionate rates of teenage childbirth, unintended pregnancy, and abortion — should insist on getting full info from healthcare providers

• oral BC usage is linked to an increase in triglycerides, insulin resistance, and glucose intolerance

• extended use of oral BC can lead to clogged arteries = increases stroke and heart attack risks

• issues with the surgical removal of capsules can result in keloid formation

3 Advancements in BC

1. Miudella: 1st hormone-free IUD in 40 years

2. Opill: 1st OTC oral birth control (progestin only)

3. Plan A: research into male contraceptive injections

Background Info on Diabetes

When we digest food, carbohydrates are converted into glucose in our bloodstream. The pancreas then releases insulin to reduce this spike in blood sugar, and the glucose is converted to energy.

Type 1 diabetes info

• the body produces NO insulin

• pronounced and sudden symptoms

• most victims are under 40 and thin at the time of diagnosis

• obtain insulin through injections

Type 2 diabetes info

• the body produces insulin, but not enough or not in an effective way to funnel glucose

• symptoms are less obvious and appear over a long period of time

• most are over 45 and overweight at the time of diagnosis

Symptoms of diabetes

• frequent urination

• painful ejaculation

• excessive thirst

• extreme hunger

• unusual weight loss

• increased fatigue

• irritability

• blurred vision

Complications of diabetes

• nerve damage

• dyslipidemia = too much fat in blood

• hypertension

• stroke

• cardiovascular disease

• kidney disease

• vision issues/blindness

• amputations

How to control/treat diabetes?

• healthy diet

• regular exercise

• blood glucose testing

• medication/insulin therapy

What is a diabetic blood test?

Monitors the amount of glucose in the blood, which should be done regularly by a diabetic patient

What is an insulin pump and who is it for?

A catheter is placed at the end of the pump and inserted through a needle into abdominal fat to inject an appropriate amount of insulin in a controlled manner; for Type 1

What is DexCom?

A continuous glucose monitoring system that tracks blood sugar levels in real-time for diabetics; sends data to physicians through an app

What are GLP-1 medications?

They are injections used to treat Type 2 diabetic patients with poorly controlled diabetes; they mimic the GLP-1 and GIP receptors to enhance insulin secretion, metabolic function, and promote weight loss

Why do so many AA have diabetes but are unaware of it?

• lack of awareness

• socioeconomic pressures

• obesity

• lack of physical activity

Long-term diabetic damage to feet

Due to diabetic nerve damage affecting the ability to detect injuries, as well as poor circulation due to hardening of the arteries

Long-term diabetic damage to the eyes

High sugar levels damage the vessels that bring oxygen and nutrients to the retina. Diabetic retinopathy is a progressive, permanent vision loss