预防医学考试必背.doc

PART 11. HealthHealth is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.2. Environment addresses all the physical, chemical, biological and social factors external to a person, which may interact directly or indirectly with organisms.3. Preventive medicine is a study of medicine which aims at population, and studying the disease distribution, influence factors by applying biomedical, environmental medicine and social medicine, making up the preventive measures for population health.Environmental medicine: a multidisciplinary field involving medicine, environmental science, chemistry and others. It involves the study of interactions between environment and human health4. Public health is the science and art of preventing disease, prolonging life, promoting physical health and efficiency through organized community efforts. is what we , as a society, do collectively to assure the conditions for people to be healthy.5. Public health service6. Core of public health (functions)1) Assessment: means the assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities.2) Policy development means the formulation of public policies designed to solve identified local and national health problems and priorities.3) Assurance means to assure that all populations have access to appropriate and cost-effective care, which includes health promotion and disease prevention services, and evaluation of the effectiveness of the care.7. Compare public health and medical care8. Science of public health concerns six areas:EpidemiologyStatisticsBiomedical sciencesEnvironmental scienceSocial and behavior scienceHealth policy and management or health administration9. Prevention on three levels:1) Primary prevention:Avoid occurrence of an illness and injury by preventing exposure to risk factors2) Secondary prevention:Minimize the severity of illness or damage3) Tertiary prevention:Minimize disability by providing medical care and rehabilitation service10. Why is public health controversial1) Economic impact: has a negative effect2) Individual liberty3) Moral and religious opposition11. Great changes in public healthPeople are healthier todayClean water, air, foodSafe disposal of sewageBetter nutritionEducation concerning healthy behaviors12. 10 great public health achievements of last centuryVaccinationMotor-vehicle safetySafer workplaceControl of infectious diseasesDecline in deaths from coronary heart disease and strokeSafer, healthier foodHealthier mothers and babiesFamily planningFluoridation of drinking waterRecognition of tobacco use as a health hazard13. Current challenges of Chinese public health1) The hazards of infectious and parasitic diseases remain serious2) Increasing of hazards of non-communicable disease (NCD)3) Issues of food safety4) China is the most severely country affected by endemic in the world5) The grim situation of occupational diseases6) The adverse effects on health by bad behavior and life style have become prominent7) Population aging is a growing problems8) Environmental pollution and its damage to health 14. Communicable diseases:1) Emerging infectious disease (EID): infectious diseases caused by a new species or a new pathogenic micro-organisms2) Reemerging infectious disease (REID): infectious diseases which have been basically brought under control are once again becoming popular.15. Health problems resulting from the urbanization developmentLight pollution, air pollution, urban raw sewage is discharged directly into river, traffic jams16. Challenges in community health services in China1) Imbalance of health development between urban and rural area2) Health issues of floating populationUnhealthy behaviorDifficult to managePoor immunization protectionUnsanitary living environment3) Health problems resulting from urbanization development17. Current health work policy in China1) Stress the health work in the rural areas2) Put the prevention first3) Lay equal stress on the western and Chinese traditional medicine4) Rely on the science and education5) Mobilized the participation of the whole societyPART 21. Environmental health addresses all the physical, chemical and biological factors external to a person, and all the related factors impacting behaviors. encompasses the assessment and control of those environmental factors that can potentially affect health targets towards preventing disease and creating health-supportive environments. excludes behavior not related to environment, as well as behavior related to the social and culture environment, and genetics.2. Air pollution1) is the invasion into the atmosphere of chemicals, particulates, or biological materials that cause discomfort, disease, or death to humans, damage other living organisms such as food crops, or damage the natural environment or built environment.2) Resources & features:a. combustion: Coal and other solid fuels: smoke (containing polycyclic aromatic hydrocarbons, PAH)sulphur dioxideCoal and other solid fuels, liquid petroleum products (carbon monoxide, oxides of nitrogen, other agent)Industry and incineration (oxides of sulphur and nitrogen, polycyclic aromatic hydrocarbons, dioxins, etc. )Fossil fuel (particulate matter, carbon dioxide, benzene, lead, secondary pollutants. )b. Other sources:Large scale industrial releases, natural phenomena, pesticide sprays with organophosphates.3) The adverse effect of air pollutiona. Asthma, bronchitis, and similar lung diseasesb. Good evidence relating an increased risk of symptoms of these diseases with increasing concentration of sulphur dioxide, ozone and other pollutantsc. Pollution from particulate matter at levels hitherto considered “safe” is associated with an increased risk of morbidity and mortality from cardiopulmonary disease especially in people with other risk factors (such as old age, or heart and lung disease)4) Indirect effect on healtha. Greenhouse effectb. Ozone deletionc. Acid raind. Atmospheric brown clouds, ABC3. Water pollution1) Is the contamination of water bodies. It occurs when pollutants are directly or indirectly discharged into water bodies without adequate treatment to remove harmful components.2) Diseases:Leach lead from pipesneurological functionChemicals added to the water:Chlorination of waterpossible increased cancer risksFluoridemottling of the teethNitrateincrease the risk of methaemoglobinaemia (blue babies) in bottle fed infantsPesticides4. Biological hazards1) Produce adverse health effects through infection ways:Water contamination: cholera, coliformsLegionellaClinical waste2) Produce adverse effects in non-infective (allergic) ways:Grass pollen grains, or faecal material from house dust mites asthma or hay fever (allergic rhinitis)Synergistical effects: Airborne chemical pollution Naturally occurring allergens Result in effects on lung function at concentrations lower5. In which regions of the world is health most affected by environmental factors, and how?1) Developing regions carry a disproportionately heavy burden for communicable diseases and injuries.2) No overall difference between developed and developing countries in the fraction of non-communicable disease attributable to the environment was observed.3) Children suffer a disproportionate share of environmental health burden6. Environmental epidemiology is a study of the relationship between environmental exposures and human health.Observational studyLimitation: the inability to use experimental study designsAdvantage: directly observe effects on human health rather than estimating effects from animal studies.7. Exposure science study human exposure to environmental contaminants by both identifying and quantifying exposures. is used to support environmental epidemiology, identify common exposures, and risk assessmentLimitation: not generate any information about health outcomesAdvantage: accurately quantify exposures to specific chemicals.8. Toxicology study how environmental exposures lead to specific health outcomesGenerally use animals, as a mean to understand possible health outcomes in humans.Limitation: uncertainty when interpreting the results of animals studies for their implications for human health.Advantage: being able to conduct randomized controlled trials and other experimental studies.9. Soil pollution is the pollution caused by man-made chemicals or other harmful alteration in the natural soil environment, which increase the health risks directly or indirectlyThe severity depends on the amount and poison of pollution, and the clarifying capacity of the soil.10. Eutrophication is the ecosystem response to the addition of artificial or natural substances, such as mitrates and phosphates, through fertilizers or sewage, to an aquatic system. The result of eutrophication is the excessive growth of freshwater algal bloom, and the accumulation of toxin in the water, and eventually harms human and other organism health.PART 31. Nutrition is the science of foods and the nutrients they contain. It studies the action of foods and the nutrients in the body, and the relationship between diet and health.The actions in the body include: ingestion, digestion, absorption, transport, metabolism, excretion.2. Nutritional goals:Quality: intake that allows you to function at your best and promotes health.Quantity of intake that promotes a healthy body weight.3. Food philosophyCharacteristics of a healthy diet: adequate, moderate, balanced, varied, nutrient dense.4. ProteinSecond most abundant substances in humans1) Functions:Key to every cell, antibodies, enzymes, and hormonesTransport oxygen and nutrientsRole in developing/repairing bone, muscle, skinVital for human lifeProvide energyRole as nitrogen source2) TypesComplete proteins: food that contain all the essential amino acids, e.g. fish, meat, egg, milk, cheeseIncomplete proteins: food that missing some essential amino acids, e.g. legumes, nuts, whole grains.5. Polysaccharide is polymeric carbohydrate molecule composed of long chains of monosaccharide units bond together by glycosidic bonds, e.g. fiber, starches.6. Dietary fiber is the indigestible portion of food derived from plants. There are two main components: soluble fiber and insoluble fiber. Dietary fiber cannot be digested or absorbed, but can benefit health in several ways, such as speeding the passage of foods through digestive system, and attract water to form viscous gel so that the empty of stomach can be slowed down. Insoluble Found in bran, whole-grain breads, most fruits and vegetables Found to reduce risk for several forms of cancer Soluble Oat bran, dried beans, some fruits and vegetables Helps lower blood cholesterol levels Helps reduce risk for cardiovascular diseaseProperty: consists of non-starch polysaccharides such as cellulose, and many other plant components such as resistant starch, inulin.Function: production of healthful compounds during the fermentation of soluble fiber, and insoluble fibers ability to increase bulk, soften stool, and shorten transit time through the intestinal tract, prevent cancer, cardiovascular diseases and obesity.7. Fatobtaining essential nutrient1) Avoiding trans-fatty acidsCreated by process of making liquid oil into a solidIncrease LDL levels while lowering HDL levelsFound in many margarines, baked goods and restaurant deep-fried foodsFood labels listing no trans-fats can still contain less than 500mg/servingHigh risk of CHD, sudden cardiac death2) Still need essential fatty acidsEat fatty fishUse healthier oils (including olive oil)Eat green leafy vegetablesWalnuts, walnut oilGround flaxseed3) Use moderation with fat intakeRead food labelsUse olive oil for cooking8. VitaminsPotent, essential, organic compounds: promote growth, help maintain life and health.Two types: fat soluble (ADEK), water soluble (B-complex and C)9. Mineralsl Inorganic, indestructible elements that aid the body.l Vitamins cannot be absorbed without mineralsl Macrominerals are needed in large amounts (sodium, calcium, phosphorus, magnesium, potassium, sulfur, chloride)l Trace minerals are needed in small amounts (iron, zinc, copper, iodine, manganese)1g carbohydrate = 17KJ = 4 kcal/g1g protein = 17 KJ = 4 kcal/g1g fat = 37KJ = 9 kcal/g1g alcohol = 29KJ = 7 kcal/g10. CalciumCalcium plays an important role in building stronger, denser bones early in life and keeping bones strong and healthy later in life.99% of bodys calcium is stored in the bones and teeth, while the rest has other important uses, such as some exocytosis, and muscle contraction.Long-term calcium deficiency can lead to rickets and poor blood clotting and even osteoporosis.RAIs: 1000mg/d.Milk and cheese are well-known source of calcium.Functions: 1) Form bones and teeth2) Participate in muscle actions and nervous activity3) Promote activities of enzymes in metabolism4) Blood coagulation and secretion of hormones, acid-base balance, maintain the stability of cell membrane11. Nutrition densityThe ratio derived by dividing a foods contribution to energy needs.When its contribution to nutrient needs exceeds its energy contribution, the food is considered to have a favorable nutrient density.12. Essential nutrientsNutrients the body either cannot make or cannot make enough to meet the needsE.g.: Vitamins, calcium, iron, and other minerals, some of the amino acids.l To be classified as an essential nutrient:The biological function of the nutrient is knownOmission from the diet leads to a decline in a biological functionReturn of the nutrient restores the biological function13. Nonessential nutrientBody can make from other nutrients ingested.E.g.: cholesterol, some amino acids.14. Dietary reference intakes (DRIs) setting nutrient needs1) EARs, estimated average requirement is the nutrient intake that is estimated to meet the needs of 50% of the individuals in certain age and gender group.2) RNI, recommended nutrient intake=RDAs, recommended dietary allowancesNutrient intake that is sufficient to meet the needs of nearly all individuals (about 97%) in certain age and gender group.3) ALs, adequate intakesNutrients for which there is not enough information to establish an EAR are assigned an AI.AIs are based on the observed or experimentally determined estimates of average nutrient intake that appears to maintain a defined nutritional state.4) Tolerable upper intake level (UL) is the highest average daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases above the UL, the risk of adverse effects increases.15. Medicinal value of food1) Compelling evidence that diet may be as effective as drugsFunctional foods, antioxidants, carotenoids2) Folate:Form of vitamin BFolate fortification 1998Neural tube defectsHeart disease3) ProbioticsFound in fermented milk products4) Dietary supplementsProducts taken by mouth to supplement existing dietsIf in doubt about supplements, simple eat from the major food groupsPART 41. Occupational health: = occupational hygiene?The science and art devoted to the anticipation, recognition, evaluation and control of factors and stresses (arising in or from the workplaces), which may cause sickness, impaired health and well-being or significant discomfort, and inefficiency among workers.2. Occupational medicine:The medicine specialty devoted to treatment, prevention and management of occupational injury, illness, and disability; and promotion of health and productivity of workers.The goal of occupational medicine:* To reduce industrial accidents* To prevent occupational hazards/ diseases/ injuries* To achieve maximum work efficiency* To get a proper treatment and compensation.3. Emerging risks and new challenges* Traditional risks continue to take a heavy toll on workers health* Technological, social and organizational changes in the workplace due to rapid globalization have been accompanied by emerging risks and new challenges* New forms of occupational diseases, such as musculoskeletal and mental health disorders, are increasing without adequate preventive, protective and control measures.MSDs: includes carpal tunnel syndrome.4. Work-related stressDiseases without causal relationship with work but may be aggravated by occupational hazards to health.Psychosocial risks and work-related stress have emerged as matters of great concern.Workers may turn to unhealthy behaviors in an attempt to cope with work-related stress.5. In particular, what are we facing in china is a big country, making a great number of products in the world.More factories, more workers.Now materials, new technologies.insufficient precaution to the occupational hazards, particularly in workers from rural areas. insufficient medical care: only a small fraction occupational disease is covered by medical care, and only a small fraction of people suffering from occupational illnesses ever receives workers compensation benefits.6. Occupational diseases refer to diseases having a specific or a strong relation to occupation generally with only one causal agent recognized.It covers any disease contracted as a result of exposure to risk f