PUBLIC HEALTH TEST 3 – 7/5/07



PUBLIC HEALTH TEST 3 – 7/5/07

Drug Abuse: Billions of dollars are spent dealing with drug abuse each year. 60-70% of drugs with abuse potential (or more) end up in the United States. Some pharmaceutical drugs have abuse potential, but they have medicinal value. The problem has left many people addicted. Many people suffer clinical symptoms and problems. There is tremendous loss of potential. The loss of potential is immeasurable financially. We spend over $50 billion per year to deal with the drug abuse problem. There are counties whose economies survive based on the drugs produced (like opium).

The US government has classified the drugs into 5 categories: 1. CSA (controlled schedule act) Schedule 1 2).CSA Schedule 2 3). CSA Schedule 3 4). CSA Schedule 4. 5). CSA Schedule 5. Class 1 have no medicinal value and extremely high risk for abuse (physical and psychological). Class 5 have low potential for abuse and do have capacity for helpful medical treatments. Some examples of Class 5 drugs are valium, thorazine and some tranquilizers. They have medicinal value, but do have some abuse risk potential. This is a controversial subject. Many tranquilizers are linked to abuse. Some medical professionals (doctors) actually abuse tranquilizers.

The DEA (Drug Enforcement Agency). This agency is different from the FDA (Food and Drug Agency). The DEA deals with drug abuse. The DEA checks for people as well as doctors who abuse drugs.

***Know underlined info on handout…Slang names are not that important…Know medicinal use…Know long term symptoms of abuse…This topic is a self study…Take the test in the handout and look at the answers on the last page and look at why they are correct…***

PUBLIC HEALTH – 7/6/07

????? – Not sure about this day’s notes – We may have reviewed for the exam on Monday 7/9/07

PUBLIC HEALTH – 7/9/07

***Exam #2 – Public Health***

PUBLIC HEALTH – 7/12/07

***Topics for today – Test Review, Food Safety, China***

Article in USA Today—“China executes the former director of food, drug safety”…Many imported foods from China are contaminated. The director took bribes to allow food and drugs to pass.

2nd article .. “Buying only US food is a tall order”…We depend on food from all over the world. We produce and export DDT but have banned the use of DDT in the US. This is hypocritical.

***We will not be responsible for the info on the two articles – per Dr. Anand***

Injuries from Accidents: Every 3 minutes there is 2 million dollars spent on consequences of accidents. We can save lots of money if we pay attention. Accidents is defined as an event which is unpredictable that occurs. When people analyze accidents and generate reports, they find in 90% of the cases that accidents are preventable. Thinking of things ahead of time will prepare you against an accident.

***See handout for statistics***

There is a huge scope. Simple things like paying attention matter.

There are about 13,000 deaths due to falls. This mostly affects older people. The bathroom is the most common place for falls to occur. There are about 53,00 deaths due to motor vehicle accidents. 90% of the accidents are preventable. Those that are not preventable are tornadoes, floods, hurricanes. This is less than 10%. According to Dr. Anand,…what happened in New Orleans was to some degree preventable.

1993 Floods of Mississippi/Missouri River – Chesterfield Airport was covered in 10 feet of water or more. The levies are now better. Climate changes can cause serious havoc.

The single greatest factor in accidents is alcohol consumption. 50% of all accidental deaths are blamed on alcohol consumption. 1 out of every 50 cars is driven by a person not in control/drunk. Alcohol is a depressant. Alcohol is one of the most commonly abused drugs. 5 or more people who die in a single event is referred to as a catastrophe. Some of the worst events in the US have been linked to alcohol. The Exxon Valdez oil spill has been linked to alcohol. Captain Hazelwood had twice the legal limit. He was not charged with a crime.

There was a skyway/highway in St. Petersburg was broken due to a ship running into it. The captain was drunk. This put 35 cars in the water. The captain later would run into the same bridge twice (twice he was drunk). There were many deaths

Occupational Hazard: The jobs are hazardous by the nature of task to be performed. Several federal agencies are responsible for making our workplace safe.

PUBLIC HEALTH – 7/13/07

***Per Dr. Anand, it does not matter if you know how drunk the Captain of the Exxon Valdez is, despite 2 statistics given in our notes***

Accidents: Every 3 seconds a person is seriously hurt. Every 5 minutes there is a death. Every 3 minutes is costs 2 million. The number one cause of death in the 15-25 year olds is accidents. The human element is an unpredictable factor in accidents or people cause accidents. Teenagers cause the most car accidents. Doctors as a group are second. Each teenage driver in the first year causes about 3 accidents. The insurance rates are reasonably high till 25 because more experience as a driver can mean safer. Accidents per 100,000 miles – older people get into more accidents by driving less miles (best drivers above 25-65). Younger people (less than 25) get into more accidents by driving more miles. The worst drivers are below 25 and above 65.

There are 3 million fires in the United States. Not every fire is deadly. Improperly working alarms are a major reason for death from fires.

Ingestion of food and choking: is 3,000 deaths.

Alcohol is a main factor is accidents. The chart in the handout gives alcoholic beverages in a 2 hour period with affect on BAC. Today’s legal limit is 0.08%. Some states have lowered it even further.

***Know that a 160 lb person will need 4-5 drinks in a 2 hour period to get to a BAC of .10***

***Know from the Data – MVA accidents and # of deaths (About 50,000)…Know falls, drowning and fires***

Drunk drivers: Tthink they can handle machinery/equipment/vehicles better. They cannot because alcohol depressant. It is a legal responsibility of a bartender not to serve a person whom they feel is over the legal limit. About 50% of deaths due to accidents is due to alcohol.

Speed: Also plays a factor in deaths. The increase of speed limits has caused more deaths overall.

Use of seatbelts: Saving lives has been proven. Every state has a seat belt law.

Accident proneness: Difficult thing to explain but records show some people more accident prone than others. Mostly individuals from strict homes resented-authority, hate their bosses, don't like police and other symbols of authority, escape responsibility. As adults they respond to stimulation with action rather than thought to look to accidents as solution to their personal emotional torment.

One of the best cars in the world is a Corvette. This car comes to a complete stop – stops quickly. IN general, a good car is a car that is kept in good working order. Proper maintenance of a car is important.

BAC handout and effect ***Know the effect of certain BAC’s & symptoms*** Very high BAC’s can produce death (.45 or higher). In some countries, the punishment for drunk driving is very high. IN El Salvador, the first conviction is death/execution by firing squad. ***Know el Salvador, Bulgaria, Turkey*** In Turkey, people are taken outside town and are forced to walk back home under police escort.

Occupational Hazards: ***Be able to distinguish between accidental and occupational hazards***….There was a time where there was no watch on industry. Today we are protected by regulations from Congress and enforcement of the law. This cuts down the # of occupational hazards. The present law enforced was created in 1970. This created OHSA (Occupational Safety and Health Act). This administration enforces the law. This agency certifies and inspects every workplace with 12 or more workers per business. Each workplace is inspected for occupational hazards. OHSA makes calls to business stating that they are coming for an inspection. There is an 800 number 800-555-1212 number that you can call (for employees). If you feel that the workplace is not compliant, you can file a complaint anonymously. Within a month or so, OHSA will inspect and close the business. OHSA as an agency is under the direct control of the Department of Labor. OHSA complains that they do not have the funds to hire inspectors to keep up with the demand for inspections. Major companies have some of their own inspectors and are required to report the data for occupational hazards and injuries. NIOSH (National Institute of Occupational Safety and Health) is located outside of Philadelphia, Pennsylvania. This institute is a research organization under the control of the CDC. The CDC is located in Atlanta. This is part of the US Public Health Service and part of the US Department of Health. NIOSH carries on research by issuing grants. NIOSH gives grants to prevent occupational hazards. NIOSH also does some of its own research. NIOSH does not have subpoena powers (court orders to inspect and collect evidence). OHSA does have subpoena powers.

***read handout and know some of the occupational hazards…skin, hair, cataracts, garlic breath (from thalium metals)***

As a doctor, you have the responsibility to document signs and symptoms and report these to the US Department of Labor.

The skin is the most common site where things can fall on you – per Dr. Anand.

***Know the 5 leading occupational hazards*** Most common diseases are lung associated diseases. Pneumoconisiosis is the presence of foreign matter in the lungs that can lead to chronic irritation and respiratory symptoms. Asbestosis (exposure to asbestos)…Pyssinosis (cotton fibers)…Silicosis (Sand blasting and stone workers – chert workers)

Raynaud’s is a tingling sensation in the body due to vibrations of the jackhammers and equipment. This may be due to damage of small vessels.

Caisson’s disease is due to pressure (scuba divers and submariners) due to nitrogen accumulation in the lungs and body. This present with aches and pain in the joints.

Baker’s can have asthma/respiratory trouble due to flour.

Railroad workers can contract cancer due to creosote.

PUBLIC HEALTH – 7/16/07

Substance Abuse: Article on College Drug Use, binge drinking rise…Fetal Alcohol Syndrome and Consequences (Handout)…

Occupational Hazards: Some chiropractors have made a career of studying occupational hazards and ergonomics. If you can show by your chiropractic training, that you can reduce injuries or bring people back to work quicker, if can be a good career move.

Unrelated Material (tangent)---National Institute of Complementary and Alternative Medicine (NICA) is an institute that issues grants for alternative medicine (chiropractic, acupuncture, etc.). The NIH (National Institute of Health) is a similar agency comparable to the NICA.

Caisson Disease, Raynaud’s Phenomenon, Occupational Cancers, Exposure to Chemicals…Caisson’s is commonly known as the “Bend’s.” Pain in the limbs and abdomen due to nitrogen bubbles in the blood and tissues due to rapid change in pressure. This occurs in scuba divers, submariners, and people who work on oil rigs. Automobile workers are likely to be exposed to lead and asbestos….Painters, Plumbers, Felt Makers, Dye Makers, Ceramic workers, Cement Workers Carpenters….Sand blocks are melted into dyes. Sand dust and silicosis can cause pneumoconiosis – dyeing refers to making molds and patterns in the sand blocks…

***Know the Handout of Examples of Occupational Lung Diseases***…Coal Dust can cause black lung. Exposure to silica occurs in chert workers (monument workers) and sand blasters, this can also cause pneumoconiosis.

OHSA has strict regulations that have to be adhered to. Lots of jobs are flooding to China and other countries. One reason is because the laws are very tough and this makes it not very cost beneficial to keep jobs in the United States.

Cancer: 2nd largest killer in the USA….It kills about 500,000 per year. A biological phenomenon where a cell in the body mutates. It goes into a transformation phase and becomes a transformed cell that doesn’t abide by typical cellular restrictions. The cell multiplies unrestricted and can spread across the body. This process is called cancerous transformation. We are looking for causes and don’t have all the answers.

We now recognize that more people are afflicted with cancer. More years have been added to the average person’s life span. This translates into more potential candidates that can be afflicted with cancer. The recognition of cancer and early intervention to treat cancer have been successful in increasing the life expectancy of a cancer patient. The most talked about cancer, breast cancer, is treatable with early detection and early intervention.

The major indicators of cancer (7 signs): 1. Change in bowel or bladder habits 2. A sore that does not heal 3. Unusual bleeding or discharge 4. Thickening 5. Indigestion or difficulty in swallowing 6. Obvious change in wart or mole 7. Nagging cough or hoarseness

There are more incidences of skin cancer than any other cancer. Over the past thirty years, skin cancer is the number 1 most increasing type of cancer. There were 200,000 cases of skin cancer in 1970 with over 600,000 in 2000….Benign tumors are restricted to a particular area and not harmful. Sometimes benign tumors can change to malignant. Malignant tumors are often not confined to a particular area and spread quickly.

Reducing Risk:

1.Avoid excessive exposure to sunlight. The lighter the skin, the greater the chance for damage. Use sunscreen and sunblock to protect your skin. The damage to the ozone layer allows more harmful rays to earth.

2. Quitting or never smoking decreases chances severely. Estimates say that 80% of lung cancers would be prevented if smoking was given up. This is a struggle between the tobacco industry and our government and people. Every day there are 1,600 new smokers that start the habit.

3. Avoid X-rays, if possible. The will help reduce the chances of thyroid, breast and lung cancer.

4. Reduce the ingestion of foods with preservatives (particularly nitrites and nitrates). This may require a change in lifestyle.

5. Cut down on fatty meats. Breast cancer has been directly linked to fat consumption. We consume over 150 grams of fat per day. We need 1/3 of that.

6. Go easy on sweeteners. These sweeteners can cause cancers. Canadian research has shown links between sweeteners and cancers in animals.

7. Refuse to take drugs that are dangerous (drugs with estrogen and acids).

8. Live in a city or rural area with little smog.

9. Choose a job in an industry with no carcinogens or use adequate protection in industries with carcinogens.

***Know the top 7 types of cancers….Know the first 5 in proper sequence…Know the most frequent cancers in males and females…Know the most deadly cancers for males and females***

PUBLIC HEALTH – 7/19/07

PUBLIC HEALTH – 7/20/07

Cardiovascular diseases: It costs more than 300 billion dollars a year and claims more than 760,000 lives per year. There are many things that can be done. Some of these things are not very difficult. Some major risk factors are hypertension, high cholesterol, obesity and smoking. If a patient does not have any of these factors, 1st age of appearance of risk will be 70 years. If a patient has a risk factor it lower the span by 10 years. Example – Hypertensive 70-10 = 60 years of 1st risk … Hypertensive and Cholesterol 70-10-10=50 years…

Genetic factors and personality: also play a role. Type A personality (high stress, workaholics) is a risk factor for heart disease.

Cigarette smoking and people who live with smokers (2nd hand smoke sufferers) can cause plaque formation. Smoking alone is responsible for around 200,000 deaths per year. Plaque formation is linked with cardiovascular disease. Plaque can also form from improper nutrition, lack of exercise, etc. Plaque narrows the artery. This is due to fat accumulation in the lining of the arteries. The platelets will accumulate at the damaged artery. The final outcome is a blockage of the artery by plaque. Smoking is a major risk factor.

Smoking: Is also a major risk factor for lung cancer. A single cigarette will take away 6 minutes of life. Knowing how many cigarettes a person will smoke can help determine their death age (premature death age). The tobacco industry over the years has done a good job promoting cigarettes and keeping cigarettes on shelves to be sold.

Benign Hypertension: Hhas been linked to 60,00 deaths per year in the US. It is a cause of 500,000 heart attacks per year. Hypertension is known as the “Silent Killer.” 150/90 is the new standard for treatment of blood pressure. The old standard was 160/95 for treatment. More than 60 million people in the United States (1/5 the population) is on antihypertensive drugs. Typically, normal BP should be 120/80. Experts want new standards for BP to be below 120/80. One of the major factors in regulating BP is regulating appropriate body weight. We are the worst in the world with highest category of being obese. 60-70% of Americans are in the obese category according to BMI.

***Know how to calculate BMI = (weight in pounds * 700)/(height in inches) squared***

The US has been gaining on average about 1 lb per year for the past 20-30 years (the average weight across the United States has increased 1 lb). A person must remain physically active to decreased risk factors.

25-30 years ago cardiovascular disease wasn’t as talked about, but now it is very important. There is some controversy because some people live with high cholesterol and some people with lower cholesterol have suffered from heart attack. The statistics show to maintain a cholesterol reading of 200 mg/mL of blood. This is the “ideal” figure. HDL has been considered as “good cholesterol.” LDL has been considered “harmful/enemy.” If a person has 200 mg/mL blood with 60 HDL and 140 LDL, this person will have greater risk than a person with 80 HDL and 120 LDL. The goal is to reduce the total amount of cholesterol along with increasing the HDL and decreasing the LDL. Reducing saturated fat is a key to improving health. Losing weight, exercising, consuming as little cholesterol as possible, increasing intake of soluble fiber (fiber decreases fat absorption and rate of fat absorption) all with help decrease the risk of cardiac disease and help to lower cholesterol.

There is tremendous competition amongst cholesterol reducing drugs ***Read the handout*** Lowering the cholesterol by 1%, but decrease the risk of heart disease by 2% (example -- 10% reduction, this will decrease risk by 20%).

Dean Ornish was a bold man that came up with the idea that people suffering from heart disease or artery block don’t need surgery. Surgery is unnecessary and expensive. He showed that by taking people that were surgical candidates and putting them on a strict diet and exercises program could clear arteries. He showed the incidence of heart attacks and death in these patients could decrease risk. He put them on 10% of total calories of fats. He’s a friend of chiropractic (Dean Ornish – reduction of heart disease by diets).

Conservative means can control heart disease. Patients with bypass surgeries can remain healthy for a couple of years, but later may need to get back on the table.

PUBLIC HEALTH – 7/23/07

PUBLIC HEALTH – 7/26/07

Various Agencies: Private vs. Government…Private Agencies…Some countries have a ministry of health, some have health departments. The purpose is to provide services that need to be provided to the citizens. Some private agencies: March of Dimes. March of Dimes has had success in the area of polio research and polio vaccination. This is a great success story of a private agency. Muscular Dystrophy society, American Heart and American Lung Association are other private agencies. There are more than 100,000 such agencies that enjoy a tax free status. They raise more than 100 billion dollars a year to aid with various causes.

WHO: Some International Agencies are very important like the WHO. The WHO is an agency by itself. It is not run by any government. It is an agency where many countries, almost all of the countries participate. This agency does not have boundaries. Some countries have tried to manipulate the WHO for political purposes. It is a non-profit organization that expects all countries to participate. This agency has done very well. It was created in 1945 as part of the United Nations (UNO – United Nations Organization). There was a meeting in San Francisco where Brazil proposed this. The WHO was seconded by the USA. The charter for this agency was to help those in need. The WHO is no longer part of the United Nations and has its headquarters in Geneva, Switzerland. The purpose is to provide, health and health related services to those in no boundaries. There are regional headquarters. Members nations are expected to contact the regional headquarters for help. The US headquarters is in Washington DC. Washington, DC serves North and South America. Alexandria, Egypt and Brazzaille in Africa. Delhi – India & China & part of Asia (serves 3 billion or more people), Manilla (Pacific Islands & Australia), Copenhagen (Europe)….The WHO insists and forces vaccinations. It also aids to provide clean water. The US as a nation is not very dependent on the WHO except for some research projects done in conjunction with the WHO. The US is a major supporter of the WHO. The WHO is very unhappy with the US because of political and financial reasons. WHO is not owned by any country or government and not part of the United Nations. Some functions are clean water, clinics for health care treatments (Asia, South America, and Africa), training fellowships for doctors in impoverished countries (Asia, South America, Africa). The US has been unhappy with the chief of the WHO, since it is a major contributor and the dollars aren’t spent as the US wants it to.

***Know the 10 Purposes of the WHO***

Red Cross Society: is a private agency. It is a quazi-governmental in the US. The chief of the state may be made chief of the red cross. In some countries, the president can be made chief of Red Cross. It was started in 1864 by Henry Dunant, a soldier who witnessed brutality during wars. He wanted provisions made for sick and suffering soldiers (both enemy soldiers and soldiers from your own country). There was a worldwide movement to recognize this to support the sick and suffering people of war and the citizens of the world. The American Red Cross started in 1881 through the efforts of Clara Barton (originated the Red Cross in the US). The US Congress ratified the charter for the Red Cross in the US also in 1881. She started promoting the idea to support the sick and suffering individuals here in the US. The world headquarters of the Red Cross is in Geneva Switzerland. The President of the US is the president of the Red Cross. The red cross has expanded its functions over the years. One of the major functions is for blood drives & blood bank (providing blood to hospitals and those requiring blood). They do a good job of performing this function. Blood banking is carried on during peacetime and wars. Services have been extended to disaster relief, earthquakes, hurricanes, floods, tornadoes. In some cases, be cautious of bogus organizations claiming to help in disasters (they want money and to use the non-profit tax free status). Disaster relief is another big function of the Red Cross. Ambulance services, CPR, nursing services, medical assistance where needed are also provided by the Red Cross. The red cross also performs community services (volunteer services to hospitals, etc). One other major function of the red cross is to maintain diplomatic communication between enemy countries (exchange of prisoners negotiated by the Red Cross). Red Cross are not supposed to be attacked. It is a neutral group. The Red Cross knows no boundaries. The WHO and Red Cross have their own task forces to raise money for HIV and AIDS.

Governmental Agencies:…see chart in handout…HEW (Health Education Welfare), HHS (Health and Human Services)—deals with human services, welfare, social security….The Department of Health has 8 major components which play an important role. The department of Health is headed by the secretary of health. The US Department of Health spends 300-400 billion annually. This 300-400 billion is not the total amount of US health expenses. Our total health care costs is 1.5 trillion including the 300-400 billion by the government. A lot of money is spent for drugs, pharmaceuticals, private companies, insurance, etc. The total of 1.5 trillion includes aspirin, eye drops, and any health care product or service.

Each agency (of the 8) carries on specific functions.

FDA: The main purpose of the FDA is to certify all the drugs sold on the market, food for purchase, of things in the grocery stores. It does not certify produce. It certifies items to be sold. The FDA has become very controversial. 1200-1500 items have been taken back by the FDA each year as ineffective or harmful. Drug companies and consumers put pressure on the FDA to release drugs and products to the market. The FDA is supposed to protect the consumer. Toxicology is a major function of the FDA. It has regional toxicology labs where chemicals are measured for efficacy. The FDA has subpoena powers. It has inspectors to provide inspections. It makes sure what is being sold in the drugstores and markets is truly what it is. Pharmaceuticals, biologic products, and medical devices are inspected by the FDA.

There are at least 10 regional department of health centers. The purpose of the regional headquarters are to represent the US government. The regional headquarters for Missouri is Kansas City (Nebraska, Iowa, Missouri, and Kansas … also Dallas & San Francisco are regional headquarters. The regional centers make sure that there are adequate facilities in each state. To get permission to open a hospital, you must convince a regional headquarters that you can do this safely. The regional headquarters must grant approval. Licenses are watched by the regional headquarters. The regional headquarters serves as a liaison to the federal government.

CDC: (Center for Disease Control and Prevention)…Atlanta Georgia…It is a foreign wing of American public health service. It contributes to other countries and assists to the WHO. Our contribution to the WHO goes through the CDC. The CDC is very big. There are more than 25 buildings in Atlanta for the CDC. One important role is to provide services to diagnose difficult to diagnose disease. Anyplace on the earth can send samples from across the globe. Millions of samples are analyzed from across the globe. The service used to be free, but now there is a small fee associated with the diagnostic tests.

***The agency on the back of the handout are NOT part of the US Public Health Service***

PUBLIC HEALTH – 7/27/07

USPHS: The US Public Health Service has 8 important organizations responsible for the public health of its citizens. There are also some agencies indirectly involved with public health.

10 Regional Centers in the Countries with a liaison between states and Federal Department of Health in Washington DC. 300 Billion is allocated to the Department of Public Health. The regional centers make sure the health needs are met in the states they serve. Licensing of health professionals, equipment checks, hospital checks and licensing are functions. Kansas City is our regional center serving Iowa, Nebraska, Missouri and Iowa. Dallas is another regional center.

CDC: The CDC predicts what strains on influenza will appear in the next year. The CDC performs this responsibility and tracks epidemiology and outbreak of disease. The alert the government and helps to make proper vaccines. Each state has a direct connection with the CDC should a disease outbreak occur. The “watch” for disease is provided by CDC. In 1993, there was an outbreak of hantavirus that was solved by CDC. In 1976, Legionella outbreak in Philadelphia was solved by the CDC. The CDC has been very helpful in tracking outbreaks and predicting diseases, warning the states, etc. The CDC puts out the publication “Morbidity, Mortality Weekly Report” (MMWR). This publication is weekly report that shows statistics on different states with different diseases and the frequency. This was a free publication, but now is not free anymore. The website is where you can obtain much information on diseases from the CDC. The CDC plays a role in diagnosis of difficult diseases. The CDC analyzes millions of samples from across the world. It used to be a free service, but now they charge money for the service of analyzing microorganism samples. The CDC has many task forces. The CDC has a bureau under its jurisdiction, Bureau of Smallpox, even though small pox is almost gone. The CDC maintains samples of small pox in the event an outbreak occurs. The job of the CDC is a double-edged sword. If they predict a disease and it doesn’t occur, then it looks bad, but if they get it right (then it adds to credibility). The CDC carries on research, but it is not an exclusive research entity. The major research agency in the US is the NIH (National Institute of Health).

NIH: Exclusively a research entity. It has the National Institute of Research, with many research facilities on the campuses of many universities. Bethesda, Maryland is one of the richest towns in the nations. Bethesda is near Washington, DC.

**See list of agencies in handout***

Each part of the NIH performs research. Some of the 300 billion spent by the US government maintains research. The National Institute or Center for Alternative and Complementary Medicine has chiropractic underneath. Chiropractic is trying to pressure the government to have a separate institute for chiropractic, but this has not happened. The bad thing is that chiropractic has a lot of politics and divisions and do not work together. Also, falling underneath the Alternative and Complementary Medicine is acupuncture, yoga, etc.

The NIH has specialized institutes for each of the areas. Research is carried on by campuses and by universities, colleges, and private practitioners. They encourage grants and some other people from other countries with special expertise to work for the NIH. NIH provides more than 25,000 grants in the US and in foreign countries. Scientists from other countries can be brought in and work in the US. Many Noble Prize winners have worked in the US through the NIH and NIH funding. NIH carries on medical research and also provides services. They seek subjects for diseases and experiments.

***List of Websites on Handout**

SAMHSA: Substance Abuse and Mental Health services Administration…Used to be called ADAMHA (alcohol, drug abuse, mental health administration). It is now combined with other agencies and is now called SAMHSA. There was a lot of abuse in the area of mental health. President Reagan eliminated the old agency and created the new agency. A lot of money was used to rehab drug addicts and people suffering from addictive diseases. There was a lot of abuse in the previous system. There was opposition to President Reagan’s plan. SAMHSA works to improve treatment, prevention, and provides mental health services. It has 3 centers: Center for Mental Health services, the Center for Substance Abuse Prevention, the Center fro Substance Abuse treatment. The agency was established in 1992. The previous agency was started in 1974. This agency awards grants, but grant money has decreased since 1992. 10% of the grants submitted are approved for funding. There is still sentiment that not enough is being done. SAMHSA has clinics in inner cities. Help is available from this agency without being criminally charged. If you check yourself in, you can receive treatment without fear of being arrested.

ATSDR: It is involved with prevention of exposure to hazards of dump/waste sites. This agency takes care of dump sites. They recognize the location and finds/develops ways so that deterioration of the environment is halted.

AHRQ: We still have 13-14% increase in health care each year. This agency is responsible for cost-cutting and cost containment. For example, CT scans can range from 700-15,000 dollars (no explanation for this). For an aspirin, no charge – 7 dollars per aspirin. There is published information that an X-ray can cost from minimal charge to 1500 dollars. The organization tries to contain cost for health care procedures. The cost is so different across the board. Greed runs rampant and increased the cost of health care.

IHS: Indian Health Service….serves people on reservations. Blindness by trachoma is seen most frequently on Indian reservations. Tuberculosis is seen most frequently on Indian reservations.

HRSA: Health Resources and Services administration…The agency that watches health care resources, looks at underserved areas, and encourages people to work in underserved areas (by granting funds and tuition). The primarily goal is to build health care resources (stockpiles of medicines, vaccines and health products). Secondarily they provide health services. They have many clinics in poor areas taking care of children, older people, pregnant women, and others. This agency gives grants. Dr. Clayton Skaggs from Logan works with Washington University and has obtained a grant from this agency (HRSA) using chiropractic treatment to prevent back pain in pregnant women (post-child birth back pain). The agency 144 primary health programs and 643 treatment centers to treat.

PUBLIC HEALTH – 7/30/07

Indian Health Services: See handout for statistics….It operates 37 hospitals, 60 health centers, etc. ***See statistics***

Army, Navy, Air Force: Have their own structure and hospitals. Veteran’s hospitals and facilities take care of people who have served in the armed forces.

Department of State: The department that takes care of diplomatic personnel.

Coast Guard: Has their own facility for health.

Department of Justice: Takes care of health or prisoners and members of the department of justice

Almost 47 million do not have health insurance. These people are a liability on the social system that we have. We (the US) fail to meet the definition of health that is a fundamental right to all individuals. It seems that only the rich people can meet the best health care and that poor, unemployed suffer.

State Health Department: Ex.-Missouri, Illinois, New York – Every state has their own department. Generally, the governor of the state is in charge. Different states have different structures. The Public Health Officer of the state is the highest health position. It is appointed by the governor. It is appointed along with the board of health of the state. The board of health is usually an odd number. This allows for a decision to be made (based on the odd number – no ties in the vote). The governor can veto the board, and appoint a public health officer based on his/her choice. The board of health is a policy making body. The board of health controls other smaller boards (licensing, chiropractic, etc.). The governor can approach the chairman of the board for info and to take of health matters.

Cities, villages, counties have elected supervisors. The county supervisor is an elected position or mayor can act like a “governor” in that they can select/appoint the public health officer of the city or the county. The flow of information is from the city public health officer to mayor/ county supervisor to the state public health officer to the registrar of state and then to the CDC (if necessary).

Health Resources and Services Administration: has a separate institute of health statistics. The CDC uses stats from this agency. The flow of information goes from local level to the HRSA (National Institute of Statistics – part of the HRSA) and is shared by the CDC.

HHS: Health and Human Services...The department puts out information for goals of health for the next 10 years…The latest set of goals in place is called “Healthy People 2010.” At the end of 10 years, the goals are reevaluated and set for the next 10 years. Our goals are set with great expectation and analyzed. We have failed repeatedly. This process has occurred since 1970. These goals are put together by hundred’s of experts from health related fields. Health care workers, private practitioners and governmental health employees make these goals. They make 2 books of goals. It is expected that all health care workers will participate in helping to meet these goals.

In 1990, the objectives for 2000 were made. This included 24 nutrition objectives. This was a continuation of the process started in 1980.

***See list of goals for 2000***

Nutrition is a major problem. There is 467 objectives to accomplish by 2010 with 28 focus areas for anyone that works in the area of health. The goals are created by a board of experts from many sectors related to health. These objectives are based on success achieved in the past, 20th century, planning efforts.

Adults who smoke in 2000 is 24% by 2010 we want 12% smoking. Adolescents who smoked is 35% (in 2000) vs. expected in 2010is 16%.

20 minutes of vigorous activity 3 times a week adolescents today (2000) is 65% vs. by 2010 is 85%. Adults today exercising vigorously 3 times a week (by 2000) is 15% vs. by 2010 is 30%.

Use of alcohol and drugs (drug free): Adolescents today 79%(drug free) by 2010 (89% drug free)…Adults binge drinking toady 17% by 2010 6% (binge drinking)…Drug Use 6% today & 2% by 2010.

Responsible sexual Behavior (No sex or use of condoms) – 85% today and 95% by 2010….Unmarried Women (18-44 years undergoing responsible sexual behavior) 23% today and 50% by 2010

***See Handout for more stats***

Access to health care: Today 87% vs. 2010 the goal is 96%.

Females who receive prenatal care in 1st trimester: today 83% vs. 2010 90%. One of the risks of not seeking prenatal care is infant mortality. The rate of infant mortality is .07% or 7 over 1000. The rate is small, and one reason why is seeking prenatal care.

Proper nutrition, exercise, mental state of mind are responsible for making a healthy body. Dr Weil is one of the most listened to individuals.

***Next class session will be Dr. Weil’s video***

PUBLIC HEALTH – 8/2/07

***There will be questions on the exam from the video. The video will be in the library.***

Video – “Eating Well for Optimum Health”

Dr. Andrew Weil, MD…Diet, Health, Food, Nutrition are the topics

Botanist (from Harvard) and MD (from Harvard)…practices integrative medicine…Dr. Weil looks at healthy diets from across the world, patient care, dietary changes in his patients, and his botany/MD background.

Goals of His Presentation

Basic Facts of Human Nutrition: Importance of Carbs, Proteins, and Fats

How To Read Labels

How to Enjoy Preparing Food

How to Recognize Unhealthy Diets

How to Plan an Optimum Diet

Principles of Eating Well:

1. Eat to live

2. Plants are a source of energy

3. Plants Provide Energy for Animals

4. Healthy Eating Gives Pleasure

5. Eating is an Important Source of Interaction – How we eat helps define our social and cultural personality. There are cultural specific foods. It helps to define who we are.

6. Nutritional Medicine – Dietary manipulations can treat medical conditions. Nutrition is not taught in medical school

7. Designing on Optimum Diet

8. Treating a Disease Condition based on Dietary changes

Eating is a primary reinforcer. Animal trainers shape behavior by food as a primary reinforcer. Eating is a source of pleasure and can be an addictive behavior. Food addiction is more difficult to treat than drug addiction. Eating has important effects on brain behavior, decrease anxiety, treat depression, etc. Eating is a primary source of pleasure.

Many experts that tells us how to eat don’t enjoy food. Enjoying food is important!

7 key areas of lifestyle

1. Diet

2. Use of Dietary Supplement

3. How you Relax (Neutralize Stress): Breathing Exercises, Meditation

4. Exercise and Physical Activity: Intense Isolated Workouts are not the most important, but increasing overall activity is very important

5. “Connectedness”: Living in isolation promotes illness…Psychological and Physical Problems

6. Enjoy Work and Play: Play is important. Get satisfaction from your work.

7. Adequate Rest: Learn how to clear your mind

Read Labels: It is important to read labels. You don’t want a lot of products on the label. Put them back on the shelf.

Check the Total Calories…Check the Serving Size…Check Total Fat Content…..Check Saturated Fat (Artificially hardened fats are very bad – partially hydrogenated can promote heat disease and cancer)…Avoid Partially Hydrogenated Anything!

Microwaving is not safe for long cooking, but is good for heating and defrosting…AVOID EXCESSIVE COOKING WITH MICROWAVES….Don’t microwave in plastic (it drives plastic into food…Use Ceramic and Glass).

Macronutrients: Carbs-Fats-Proteins…..Carbs: The most specialized cells are brains cells. Brain requires a constant, steady supply of glucose. If it stops, unconsciousness can prevail. We have been told that it is bad to eat simple carbs and good to eat complex carbs. This is a bad way of viewing carbs. We should look at how fast different carbs are converted to blood sugar. This way is called the Glyceminc Index. This is the rate at which the carb is converted to glucose to use. High levels of sugar in the blood the more toxic it is. High Glycemic Index is glucose (100).. Under 55 is low glycemic index. Table Sugar (fructose and sucrose) puts table sugar in the intermediate range. Table Sugar has moderate levels. Rice Cakes have very high levels. Eating high glycemic foods correlates with obesity, insulin resistance, diabetes, and heart disease. Bottom line, pay attention to glycemic index. Pasta has a slower glycemic index. Cook pasta al dente (slower conversion to blood sugar). To cut out carbs, is not healthy long term. Products sweetened by high fructose corn syrups can be very detrimental. The syrup is high in fructose. It is a very sweet and cheap sweetener. Avoid High Fructose Corn Syrup. 50-60% Daily Calories should be Carbs

Fats: The truth about fat, we need it in our diet. It is suitable for long term stores. Some tissues are good at burning fats. The kinds of fat we eat is very important. Saturated Fat is very bad for health (mostly animal fat – milk fat, beet fat, poultry fat). These fats have a high correlation of CVD. In some populations, the amount of total fat is very high. The Mediterranean Diet – Cretan’s eat 40% fat in the diet, but have low rates of CVD. The need for Essential Fatty Acids. There is more evidence that you can eat nuts, because nuts contain essential fatty acids. If you get total dietary fat, below 10% you may have problems. Fat is the vehicle of taste. Fat carries the taste. Fat is important to pleasure of foods. Dr. Weil recommends 30% fat in diet. Dr. Weil says monounsaturated fat (olive oil, avocado, nuts). Monounsaturated fats lowers bad cholesterol and raises good cholesterol. Polyunsaturated oil avoid it (corn oil, sesame oil, etc.). Most people are very deficient in Omega 3 (salmon, mackerel, flax seeds, walnuts). A deficiency can impact health. Some eggs can now contain omega 3 (chickens are being fed algae with omega 3). Increase Consumption of Omega 3.

Protein: Elasticity of Skin, contractility of Muscles, Burns Enzymes

PUBLIC HEALTH – 8/3/07

***Video continued***

Most people are eating more protein today. More protein than what we need, the excess is burned as fuel. The efficiency of protein as a fuel is not as good at carbohydrates. Meat has similar proteins to our proteins, which is more useable to the body. Meat accumulates toxins as you go up the food chain. Animal proteins are very dense. Asian cultures use meat for small amounts mixed with vegetables. Our culture use meat as the center piece. Milk and milk products are a source of protein, and promoted as healthy. Milk and milk products has indigestible sugars. Fat in milk is the most saturated in the diet (it is worse than meat). Cheese is a major source of saturated fat. Cheese should be eaten modestly. Vegetable protein like soy and soy foods are beneficial. The optimum diet has the right amounts of carbs – proteins – fats.

Examples of Diets:

1. The Paleolithic Diet: A low carbohydrate diet. Game was eaten mostly. Some wild fruits and nuts were eaten. The animal foods eaten had higher essential fatty acids. It was low in processed foods. Processed Foods should be eaten in moderation. Paleolithic Diet is not for Americans today.

2. Raw Foods Diet: Many healthy elements in food can be available after cooking. Carotenoids are not very available pre-cooking or in raw foods. Toxins (natural toxins) are broken down by cooking.

Eat a mix of raw and cooked foods.—Dr. Weil’s suggestion

Vegan Diet: You can’t get all the elements needed by a vegan diet. You can’t get B12. B12 is not found in plants only animal products.

Japanese Diet: Insufficient Protein, not many fresh vegetables…Low fat percent (10%) and the food was tasty. The principal carbohydrate was rice. Fish, soy vegetables, fruit, sea vegetables, green tea were included in the diet. The diet is not very transportable to the Western World. It also takes a lot of work to prepare the food. There is a variety of vegetables. There is artful presentation of food (visual presentation). There is very little sweet foods.

Mediterranean Diet: Crete…Eat good fat, vegetables, fruits, fish, little meat, whole grain breads. Tasty foods, easy to prepare and relatively healthy. These people have strong social connections and good physical activity.

Use the Right Kinds of Fat and proper micronutrients.

Weight and Weight Loss: The goal is not health and longevity, but simply weight loss. The secret to losing weight is to eat less and increase activity. Drastic changes in the diet should not occur. Maintain the balance, but decrease the calories. There is no magic solution. Obesity has increased, due to decreased physical activity. Our population is more sedentary. Computers, television and video games have sucked young people in sedentary lifestyle. There is more snack foods. Avoid snack foods which contain sugars, fats, and unhealthy calories.

The French Paradox – Not many Fat French people vs. many fat people in the US. They healthy snack are more active and eat less fast food.

It is important to develop good eating habits in children. Habits persist throughout life. Set good role models by eating good healthy food yourself. Involve kids in food preparation.

Eating well for optimum health…The main thing is a healthy diet. Make sure the optimum diet also includes eating for pleasure.

PUBLIC HEALTH – 8/6/07

***Last Day of Notes for Public Health***

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