Transcript Intro to Patho Brain Bod

Pathophysiology of Brain & Body USSJJQ-20-3
Introduction
2015/16
Staff
Dr Rosie Jones (Bristol U/S’mead H)
Dr Bahareh Vahabi (UWE)
Dr Lynne Lawrance (UWE)
Me (Dave Lush)
Support
http://www.rags.profile.ac.uk/DL/
(link also in Blackboard)
@UWE_JJQ
Exams drawn from question-bank
Tutorial support for exam
‘Skim-feedback’ of draft answers, if possible
Delivery Patterns
‘The half-flipped classroom’
HCS students
Sem 1: 2h lecture + 1h ‘tutorial’ on previouslyviewed 2h screencast
non-HCS students
Sem 1: 2h lecture
Sem 2: 1h ‘tutorial’ on previously-viewed 2h
screencast
Assessment
60% Exam (3 from 6Q, 3h)
HCS – Jan; non-HCS - May
40% CW (2 essays)
HCS - (weeks 15 and 19) –
TBC
non-HCS - (weeks 19 and 33) –
TBC
Pathophysiology
“The study of the nature of suffering”
“Life is hard, then you die.”
“It’s not that I’m afraid to die. I just don’t want
to be there when it happens.”
“Live each day as if it’s your last, because one
day you will be right.”
“I don’t want to live forever, I just want to live to
see the end of the DFS sale.”
Proposed Syllabus
Lectures (Sem 1)
Intro: Global View
Neuroanatomy
CNS Disorders 1
CNS Disorders 2
Drugs of Abuse 1
Drugs of Abuse 2
Dementias 1
Drugs of Abuse 3
Coursework tutorial?
Respiratory Infections
Dementias 2
Inborn Errors
Screencasts/tutorials (Sem 1 or 2)
Blood Pressure Regulation
Hypertension
Atherosclerosis
Coronary Heart Disease/Stroke
Heart Failure
Diabetes 1
Diabetes 2
Respiratory: COPD
Respiratory: Asthma
Renal Failure
Review?
Review?
Death rate…
http://www.indexmundi.com/g/g.aspx?v=25&c=xx&l=en
Birth rate…
http://www.indexmundi.com/g/g.aspx?v=25&c=xx&l=en
http://www.who.int/entity/healthinfo/global_burden_disease/GHE_key_FiguresTables.ppt?ua=1
Deaths and Distribution of Age at Death, World, 2012
0-4 years:
6.6 million
(12%)
70 years and over:
25.1 million (45%)
5-14 years:
1.4 million
(3%)
15-29 years:
2.9 million
(5%)
30-69 years:
19.9 million (36%)
Total number of deaths:
55.9 million
10 |
HEALTH STATISTICS AND INFORMATION SYSTEMS
How everyone dies (56m in 2012)…
http://www.who.int/mediacentre/factsheets/fs310/en/
How we die (high income)…
http://www.who.int/mediacentre/factsheets/fs310/en/
How others die (low income)…
http://www.who.int/mediacentre/factsheets/fs310/en/
How we
got
to die
differently
(20th cent)
http://www.ons.gov.uk/o
ns/rel/hsq/healthstatistics-quarterly/no-18--summer2003/twentieth-centurymortality-trends-inengland-and-wales.pdf
How we got to die differently (20th cent)
http://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/no--18--summer2003/twentieth-century-mortality-trends-in-england-and-wales.pdf
Death by broad cause/region/year…
http://apps.who.int/gho/data/view.wrapper.MGHEREGIONv?lang=en
Death by broad cause/region, 2000
%
75
50
25
AFR
EMR
SEAR
Noncommunicable
conditions
WPR
Injuries
AMR
EUR
Communicable diseases, maternal
and perinatal conditions and
nutritional deficiencies
Death by broad cause/region, 2000
%
75
50
25
AFR
EMR
SEAR
Noncommunicable
conditions
WPR
Injuries
AMR
EUR
Communicable diseases, maternal
and perinatal conditions and
nutritional deficiencies
The ‘Burden’ of Disease


The high death toll associated with disease is
not the whole story
At any one time, hundreds of millions of
people worldwide are…






requiring treatment
recovering
permanently disabled
Developing world – communicable disease
Developed world – diseases of affluence
Beyond the burden of personal suffering,
society also ‘suffers’

Economic impact of repeated episodes of illness
and long-term disability is substantial
Global Burden of Disease (WHO)


Comprehensive and comparable assessment
of mortality and loss of health due to
diseases, injuries and risk factors for all
regions of the world.
Assessed using the disability-adjusted life
year (DALY), a time-based measure that
combines


years of life lost (YLL) due to premature mortality
years of ‘healthy’ life lost due to time lived in
states of less than full health, but not dead
http://www.who.int/gho/mortality_burden_disease/regions/mbd_006.jpg?ua=1
http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1
Comparison of the proportional distribution of
deaths and YLL by leading cause of death, 2004
Health Statistics and Informatics
Leading Causes of Mortality and Burden of Disease
world, 2004
Mortality
%
1. Ischaemic heart disease
12.2
2. Cerebrovascular disease
9.7
3. Lower respiratory infections
7.1
4. COPD
5.1
5. Diarrhoeal diseases
3.7
6. HIV/AIDS
3.5
7. Tuberculosis
2.5
8. Trachea, bronchus, lung cancers 2.3
9. Road traffic accidents
2.2
10. Prematurity, low birth weight 2.0
Health Statistics and Informatics
DALYs
%
1. Lower respiratory infections
6.2
2. Diarrhoeal diseases
4.8
3. Depression
4.3
4. Ischaemic heart disease
4.1
5. HIV/AIDS
3.8
6. Cerebrovascular disease
3.1
7. Prematurity, low birth weight 2.9
8. Birth asphyxia, birth trauma
2.7
9. Road traffic accidents
2.7
10. Neonatal infections and other 2.7
Risk Factors and % Mortality

Maternal and Childhood Under-nutrition
Sub-optimal
breastfeeding
Zinc deficiency
Vitamin A deficiency
High Income
Low Income
Iron deficiency
Underweight
0.0
5.0
10.0
15.0
derived from
http://www.who.int/entity/healthinfo/global_burden_disease/CRA_Dth_inc_2004.xls?ua=1
Risk Factors and % Mortality

Other nutrition-related risk factors & physical activity
Physical inactivity
Low fruit and vegetable
intake
Overweight and obesity
High Income
Low Income
High blood glucose
High cholesterol
High blood pressure
0.0
10.0 20.0 30.0 40.0
Risk Factors and % Mortality

Addictive substances
Illicit drug use
Alcohol use
High Income
Low Income
Tobacco use
0.0
10.0
20.0
30.0
40.0
Risk Factors and % Mortality

Environmental risks
Occupational risks
Global climate change
Lead exposure
High Income
Indoor smoke from
solid fuels
Low Income
Urban outdoor air
pollution
Unsafe water,
sanitation, hygiene
0.0
2.0
4.0
6.0
8.0 10.0
Risk Factors and % Mortality

Unsafe sex
Unsafe sex
High Income
Low Income
0.0
5.0
10.0
15.0
Mortality in Developed Countries





Inactivity, obesity, glucose, cholesterol, blood
pressure, tobacco, air pollution
Major determinants relate to Eating, Drinking
and Moving
Diet and physical activity key determinants
of public health in developed countries!
Long-term influence  chronic conditions
In developed countries chronic diseases of
affluence >> communicable diseases

eg cardiovascular disease…
CVD Deaths by Region, 2000 (WHO)
% Deaths
30
20
10
AFR
EMR
SEAR
WPR
Strokes
AMR
EUR
Heart attacks
Source: WHO, World Health Report 2001
Developing Countries




Circa 7 billion people in world
5.75 billion live in developing countries
Disease does not recognise national borders,
but…
Pattern of disease influenced by…



Geographical/Environmental factors
Socio-political factors (inc GDP)
Population age distributions
Population Age Distributions

Developing countries are ‘young’

increased early mortality  high YLL
http://www.who.int/entity/healthinfo/global_burden_disease/GHE_key_FiguresTables.ppt?ua=1
Distribution of Age at Death
by WHO Region and World Bank Income Categories, 2012
69%
42%
35 |
HEALTH STATISTICS AND INFORMATION SYSTEMS
Revisit - (How we got to die differently)
http://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/no--18--summer2003/twentieth-century-mortality-trends-in-england-and-wales.pdf
Socio-political: Health & Wealth

1/3 of World population live on <$1 per day





1/3 children are malnourished
1/5 not fully immunised by their first birthday
1/3 lack access to essential drugs
Mass population movements disrupt
healthcare



more than 2 billion people
2014, UNHCR  50m forced displacements
Densely populated cities with unsafe water
and poor sanitation
Generally do not apply to developed world

so what drives mortality in developed countries?
Lifestyle & Mortality in Developed Countries

Major determinants relate to Eating, Drinking
and Moving – ie Lifestyle



Up to 80 % of coronary heart disease and up
to 90 % of type 2 diabetes ‘avoidable’ through
changing lifestyle factors?
About 1/3rd of cancers might be prevented by




mainly diet and physical (in)activity
healthy eating?
maintaining normal weight?
physical activity throughout the life span?
Control of communicable diseases plus time
needed to develop chronic disease  different
age distribution of disease burden…
Age distribution of burden of disease by income
group, 2004
Health Statistics and Informatics
Adult Mortality by Cause & Region, 2004
http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf?ua=1
Child Mortality by Cause & Region, 2004
The Role of Communicable Diseases

Worldwide, infections are biggest killers of
children/young adults (WHO)

~13 million deaths per year



1,500 die per hour
1/2 under five years old
Also, chronic diseases (inc cancers) linked to
infection (not necessarily chronic)
Communicable Diseases in Developed Countries

Under-vaccination  outbreaks



Increased drug resistance


eg bird flu
Air travel/immigration facilitate transport of
infections


eg TB
Emergence of new pathogenic strains


1996 polio epidemic in Greece and Albania
MMR avoidance in UK
eg Ebola
A different picture in developing countries…
Distribution of child deaths for selected causes by
selected WHO region, 2004
Health Statistics and Informatics
Childhood (<5yrs) Deaths – Trends
http://www.who.int/immunization/diseases/tetanus/lancet-2012-global-child-mortality.pdf?ua=1
Communicable Disease – Major Culprits

Six diseases cause 90% of infectious disease
deaths (all ages)

HIV
Pneumonia
Tuberculosis
Diarrhoeal disease
Malaria
Measles





HIV


Human Immunodeficiency Virus (HIV)
Attacks cells of the immune system 
increased susceptible to other infections


Estimated 34 million people living with AIDS


does that include HIV positive?
23.5 million people in Africa are infected


Major cause of death is TB
3x increase in China and E Europe since 2000
Circa 2.5 million new infections and 1.7 million
deaths from HIV (2011)
http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/201
21120_UNAIDS_Global_Report_2012_with_annexes_en.pdf
Pneumonia

The leading cause of child death worldwide




children of low birth weight
those with immune systems damaged by
malnutrition etc
Many causes are treatable or preventable
Virtually all childhood deaths from pneumonia
occur in developing countries

2,000,000 vs 1,000
http://www.who.int/mediacentre/factsheets/fs331/en/
http://whqlibdoc.who.int/publications/2006/9280640489_eng.pdf?ua=1
Tuberculosis

Spread in droplets



coughing, sneezing, speaking, kissing, spitting
Someone with active TB may infect 10-15
people per year
“At risk” populations…




areas where TB is common
drug users
health-care workers (inc drug-care)
People who are immunosuppressed
Diarrhoea

> 2 million deaths per year, mostly children


Leads to rapid fluid loss and death







Colitis, pneumonia, sepsis, hypoglycaemia, hypokalaemia
1.5 billion bouts of illness a year in children alone
Multiple causes…


lower than before (now saved by oral rehydration therapy)
viruses (eg rotavirus),
bacteria (eg campylobacter, salmonella, cholera, shigella)
parasites (eg. Entamoeba)
Cholera and dysentery (shigella) affect adults as well
as children
Typhoid and rotavirus mainly affect children
Burden is highest in areas with poor sanitation
Malaria

Vector borne infectious disease





Treated with derivatives of quinine or
artemisinin


drug resistance, worryingly, is increasing
Estimated 216 million episodes in 2010


Transmitted by female Anopheles mosquito
Caused by protozoan parasites
Very common infectious disease
No vaccine available
81% in African region
Estimated 655,000 deaths in 2010


90% in Africa
86% children < 5 years
Measles (Rubeola)


Possibly the most contagious human disease
2008: 164,000 deaths


Rubeola virus directly responsible for more
child deaths than any other single
microorganism


Prior to 1980, ~2,600,000 deaths (before global
vaccination push)
(but didn’t I say pneumonia biggest child killer?)
Also causes blindness, deafness, brain and
lung damage, stunted growth and development

Societal ‘burden’
Global Trends
Global projections for selected causes,
2004 to 2030
12
Cancers
Deaths (millions)
10
Ischaemic HD
Stroke
8
6
Acute respiratory
infections
4
Road traffic
accidents
Perinatal
HIV/AIDS
TB
Malaria
2
0
2000
2005
2010
2015
2020
2025
2030
Updated from Mathers and Loncar, PLoS Medicine, 2006
Health Statistics and Informatics
Projected deaths by cause and income, 2004 to 2030
30
Intentional injuries
Other unintentional
Road traffic accidents
Deaths (millions)
25
Other NCD
20
Cancers
15
CVD
10
Mat//peri/nutritional
5
Other infectious
HIV, TB, malaria
0
2004
2015
2030
High income
Health Statistics and Informatics
2004
2015
2030
Middle income
2004
2015
2030
Low income
Ten leading causes of burden of disease,
world, 2004 and 2030
Health Statistics and Informatics
Prevalence of Diabetes in Adults
(millions of people, by WHO Region)
90
80
70
60
50
40
30
20
10
0
1995
2000
2025
AFRO
EURO
SEARO
WPRO
AMRO
EMRO
Source: World Health Report, 1997
So, a good time to be alive? Yes!
Average Life Expectancy
100
90
80
70
Years
60
50
40
30
20
10
0
-3000
-2000
-1000
0
1000
Date



3000 BC - 18 years
275 BC - 26 years
1900 AD - 49 years



1980 AD - 76 years
2002 AD - 85 years
2020 AD - ?? years
2000
Female Life Expectancy; selected countries