Transcript INTRODUCTION TO PUBLIC HEALTH ANF INFECTIOUS DISEASE

PUBLIC HEALTH AND
INFECTIOUS DISEASE
CONTROL
June 2009
Mehdi Azimi, Ph.D.
[email protected]
Mehdi Azimi, Ph.D.
Introduction
 Definition of Public Health
 The Basis for Public Health and Prevention
 Mental Health and Psychoactive Substance
Abuse
 Infectious Diseases
 Acute Infectious Disease
 Chronic Disease
Mehdi Azimi, Ph.D.
Public Health
The application of preventive
medicine to a population—The
activities of government agencies or
community group that improve the
health status of a community or
individuals in the community.
PUBLIC HEALTH
 What is Public Health
all about?
 What does Public Health do?
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Provide disease control and prevention
Assure air and water quality
Promote healthy lifestyles
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Public Health achievements in the 20th century
Immunizations -have virtually
eliminated:
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Smallpox
Diphtheria
Pertussis
Tetanus
Polio
Measles
Rubella
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th century
Infectious Disease Control
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th century
Safe and healthier foods--are now
commonplace because of:
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Hand washing
Sanitation
Refrigeration
Pasteurization
Pest control
Healthier animal care, feeding, and processing
Improved food supply safety
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th century
Fluoridation
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Primary factor in the decline of tooth decay
Benefits all, regardless of age, education,
or income
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th
century
Coronary heart disease and stroke
The leading cause of death in the
U.S. despite a 60% decrease in
death rates since 1950.
Public Health achievements in the 20th
century
Motor vehicle safety
Public Health efforts have influenced:
• Increased seat belt use
• Vehicle safety improvements
• Traffic safety regulation & enforcement
• Improved streets and highways
Public Health achievements in the 20th
century
Mother and infant
Mortality rates
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Maternal mortality
rates down 99%
Infant mortality
rates down 90%
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th
century
Mother and infant
Mortality rates
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Improved standards
of living
Technological advances in medicine
Greater access to maternal and
well-baby care
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th
century
Family planning
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Desired birth spacing
and family size
Mehdi Azimi, Ph.D.
Public Health achievements in the 20th
century
Safer, healthier workplaces
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Mining safety
Industrial safety
Indoor air quality
Ergonomics
Mehdi Azimi, Ph.D.
Some top priority health issues in
U.S.A.
 Obesity
 Tobacco use
 Cardiovascular
 West Nile Virus
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disease
Diabetes
Poor nutrition
Lack of exercise
Environmental
health
Mehdi Azimi, Ph.D.
 Other communicable
diseases
 Access to dental
care
 Bio-terrorism
 Occupational safety
Definition
 Health: According to WHO of 1946, Health is a state
of complete physical, mental and social well being.
 Preventive Medicine: A branch of medicine
that focuses on keeping people well. It consists of
disease prevention and health promotion
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Disease Prevention:
Techniques that prevents the occurrence
of diseases or illnesses (physical, mental
or emotional) and/or early diagnosis
leading to therapy that may cure, prevent
or modify the progression of disease
Mehdi Azimi, Ph.D.
Basics of Prevention
 Primary prevention = prevent a
disease from occurring
 Secondary prevention = prevent
complications from a disease
 Tertiary prevention = restore and
maintain maximum function
Mehdi Azimi, Ph.D.
Health Promotion:
 Techniques that foster physical and emotional well-
being and increases the length and quality of life.
 The disease causing factors are not unknown or
unpredictable. Rather they cause by personal and life
style such as:
- poor diet
- lack of exercise
- unprotected sexual intercourse
- Lack of prenatal care
- failure to use seat belt
- use of tobacco, alcohol and drugs
- etc. which could reduce one-third of all acute
disability, two-third of all chronic disability & 40-70% of
all premature death
Mehdi Azimi, Ph.D.
Concept of Accident Prevention
 The goals of prevention is to:
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Promote health
Preserve health
Minimize suffering and distress.
Mehdi Azimi, Ph.D.
HEALTH HAZARDS
. Physical
. Chemical- Short & Long term
. Biological
. Radioactive
. Explosive
. Noise
. Ergonomics
. Temperature Extreme
. Poor Air Quality
. Etc.
Mehdi Azimi, Ph.D.
According to Sullivan-1990,
controlling of disease causing
factors could reduce:
 1/3 of all cases of acute disability
 2/3 of all cases of chronic disability
 40%-70% of all pre-mature deaths.
Mehdi Azimi, Ph.D.
Disease/Illness prevention &
Health Promotion Through
Risk Management of:
 Physical
 Chemical
 Biological
factors
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Classification of Hazardous
Materials:
 Flammable liquids, solids & gases
 Explosive
 Oxidizing
 Toxic
 Radioactive
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Chemical Exposures can be Classified
into Two Categories:
 Acute
 Chronic
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Health Promotion Through
Risk Management:
 Physical
 Chemical
 Biological
Factors
Mehdi Azimi, Ph.D.
Biological Hazards
Bloodborne Pathogens
Bloodborne pathogens are
microorganism such as bacteria and
viruses that are carried in the blood
stream and can cause illness and
disease in people. There are different
types of bloodborne pathogens, but
OSHA standards specifically addresses
Hepatitis B Virus (HBV) and Human
Immunodeficiency Virus (HIV)
Bloodborne Pathogens
 HIV: Human Immunodeficiency Virus is the virus
that can cause AIDS. HIV attacks the body’s
immune system, weakening it so that it can not
fight other disease. AIDS treatment is improving
 “Hepatitis” means “inflammation of the liver”,
These are viruses that attack the liver, causing
chronic liver disease, scarring of the liver, liver
cancer, liver failure and death. Hepatitis BVaccine available,
Mehdi Azimi, Ph.D.
Hepatitis: According to Center for Disease Control (CDC),
about 30% of persons have no signs or symptoms. Others
with acute or newly acquired hepatitis develop symptoms
that include:
 tiredness
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loss of appetite
nausea and vomiting
abdominal discomfort
dark urine
clay-colored bowel
yellowing of skin and eyes (Jaundice)
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Symptoms of Illness
HIV
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Rapid weight loss
Dry cough
Recurring fever or profuse night sweat
Profound and unexplained fatigue
Swollen lymph glands in armpits, groin, or neck
Diarrhea that lasts for more than a week
White spots or unusual blemishes on the tongue, in the mouth, or in
the throat
 Pneumonia
 Red, brown, pink, or purple blotches on or under the skin or inside
the mouth, nose, or eyelids
 Memory loss, depression, and other neurological disorders
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Transmission Modes:
HBV and HIV can be transmitted through the following
body fluids:
 Blood
 Body fluids containing visible blood
 Semen
 Vaginal Secretions
 Breast Milk
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According to CDC, The followings body fluids
are not considered potentially infectious,
unless they contain blood
 Feces
 Nasal Secretions
 Saliva
 Sputum
 Sweat
 Tears
 Urine
 Vomitus
Mehdi Azimi, Ph.D.
Unbroken skin is an impervious barrier against
bloodborne pathogens, but infected blood can
enter the body through :
 Cuts
 Open sores
 Acne
 Blisters
 Sever sunburn
 Abrasion
 Mucous Membrane of Eyes and Nose
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HBV is spread when blood or body fluids from an
infected person enter the body of unprotected
person who is not infected. Example includes:
 Unprotected sex
 Sharing drug needles
 Exposure to needlesticks or other sharps on the
jobs
 Through a mucous membrane
 From an infected mother to her baby during birth
Mehdi Azimi, Ph.D.
Unlike HIV, Hepatitis B Virus can survive outside of the
body, in the dried blood at room temperature on
environmental surfaces for at least 7 days and still be
capable of transmitting infection.
Thus, HBV infections that occur in an employee with no
history of occupational exposure might have resulted from
direct or indirect blood exposures that inoculated HBV
through scratches, abrasions, burns, other lesions or on
mucosal surface.
Mehdi Azimi, Ph.D.
According to the January 1, 2004 edition of
American Family Physician, Hepatitis B Virus
is 100 times more infectious than Human
Immunodeficiency Virus (HIV).
Mehdi Azimi, Ph.D.
Public Health
The application of preventive medicine to a
population—The activities of government
agencies or community group that improve the
health status of a community or individuals in
the community.
. Prevention
. Promotion
Disease Prevention:
Techniques that prevents the occurrence
of diseases (physical, mental or
emotional) and/or early diagnosis
leading to therapy that may cure, prevent
or modify the progression of disease
Mehdi Azimi, Ph.D.
Health Promotion:
 Techniques that foster physical and emotional well-being
and increases the length and quality of life.
 The disease causing factors are not unknown or
unpredictable. Rater they cause by personal and life style
such as:
- poor diet
- lack of exercise
- unprotected sex
- Lack of prenatal care
- failure to use seat belt
- use of tobacco, alcohol and drugs
Mehdi Azimi, Ph.D.
Levels of Preventions
 Primary Prevention: Prevention of disease or
injury.
. Health Education-- encourage people to develop good
health habits- nutrition, exercise, avoid harmful
substances (alcohol, tobacco and drug abuse), avid
harmful circumstances (drive while intoxicated), and
specific protective measure (immunization, condom
use).
. Environmental Modification– Reduces injuries (accidents,
fire), Safe drinking water and adequate sewer system,
clean air and toxic free environment.
Mehdi Azimi, Ph.D.
Levels of Preventions Cont..
 Secondary Prevention: Early detection and
prompt treatment of disease.
. Screening Program-- is used to detect diseases in early
preclinical stage, where effective therapy may either cure
or limit the progress—Pap test and Glaucoma test.
. Primary Medical Care– is the predominant form of
secondary prevention where most of the health care
dollars are spent on and most health care personnel are
employed in.
Mehdi Azimi, Ph.D.
Public Health
The application of preventive
medicine to a population—The
activities of government agencies or
community group that improve the
health status of a community or
individuals in the community.
Newsweek October 1, 2007
Mehdi Azimi, Ph.D.
Public Health Challenges
Promotion and practice of public health like
any other task deals with many
challenges:
 Obvious Issues
 Not So Obvious Issues
 Common Sense Issues
Mehdi Azimi, Ph.D.
Health Promotion:
 Techniques that foster physical and emotional well-being
and increases the length and quality of life.
 The disease causing factors are not unknown or
unpredictable. Rather they cause by personal and life style
such as:
- poor diet
- lack of exercise
- unprotected sexual intercourse
- Lack of prenatal care
- failure to use seat belt
- use of tobacco, alcohol and drugs
- etc. which could reduce one-third of all acute disability,
two-third of all chronic disability & 40-70% of all premature
death
Mehdi Azimi, Ph.D.
In 1797, Dr. Edward Jenner in England
heard from his neighbors that people who
caught cowpox did not get the more-lethal
smallpox very often.
He suspected that the first disease was
triggering the body’s defense against the
second. At the time there was no word for
the “immune system” and “germs”
Mehdi Azimi, Ph.D.
A mother of an eight years old boy
allowed Dr. Jenner to collect the
pus from an infected milkmaid and
shot it in the boy. After 8 weeks,
he injected the by with smallpox.
He waited some more until he was
sure the boy did not get sick.
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The announce the dawn of an
era. He had invented the
vaccine. Even though his
announcement sounded crazy,
it worked.
Mehdi Azimi, Ph.D.
Vaccine is one of the most
important innovation and costeffective medical treatment of the past two
centuries.—Vaccines do not cure disease;
they prevent it, which is better.
When you immunize 100 people, you not only
keep them healthy, but you stop them from
infecting thousand more.
Mehdi Azimi, Ph.D.
Epidemiology
 The science that forms the basis for
public health action.
 The study of the distribution and
determinants of diseases or condition in
defined population
Mehdi Azimi, Ph.D.
Infectious Diseases
Acute
Chronic
Mehdi Azimi, Ph.D.
Infectious Disease Process
The following factors are required to produced an
infectious disease:
 Etiological Agent
 Reservoir
 Port of Exit
 Transmission
 Portal of entry
 Susceptible host
Mehdi Azimi, Ph.D.
A. Etiological Agent:
Agent that can produce infectious disease
Protozoa- Unicellular parasites (animal
kingdom)- Amebae, Plasmodia
Mehdi Azimi, Ph.D.
Metazoa-
Multi-cellular parasite
(animal kingdom)-Tapeworms
Mehdi Azimi, Ph.D.
Fungi-
Unicellular structure
(plant kingdom)- Good (yeast),
Bad (ringworm)
Mehdi Azimi, Ph.D.
What is Mold?
 Molds are microscopic fungi that are found almost
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everywhere, indoor and outdoor.
The family of fungi includes mildews, yeasts,
mushrooms and mold.
For mold to grow, it needs an organic food source,
such as leaves, wood, or paper; a source of moisture
and a warm environment (40-100°F).
Molds reproduces through spores, which when
released, travel through the air and can be inhaled by
humans.
They produce mycotoxins.
Mehdi Azimi, Ph.D.
Other fungi are used in the manufacture of foods. Yeast, for example, is added to
fruit juice, which it ferments to produce wine. Yeasts also are used in the
manufacturing of beer, and they are added to dough to make bread rise, producing
more volume and a lighter texture in the final baked product. Certain molds are
Mehdithe
Azimi,characteristic
Ph.D.
used to ripen cheeses, such as Brie and
blue-veined Roquefort.
Stachybotrys Mold
 A Greenish-Black fungus found throughout
the world.
 It is typically wet and slimy to the touch.
 Thrives on materials high in cellulose and
low in Nitrogen content- wet leaves, straw,
carpet, wallboard, thermal insulation,
fiberboard, drywall, gypsum board, paper,
dust and hay.
Mehdi Azimi, Ph.D.
Mold & Indoor Air Quality
People are exposed to mold all the time without
much of adverse effect under normal condition.
Certain environmental condition in the building
such as high moisture/humidity cause rapid mold
growth, leading to high levels of airborne spores.
Inhalation of large quantities of spores above the
normal exposure, can lead to health problems in
sensitive individuals.
Mehdi Azimi, Ph.D.
The ill effects of molds:
 Allergies
 Infections
 Irritations
 Toxicities
Mehdi Azimi, Ph.D.
Symptoms of Excessive Mold
Exposure
Typical reaction to elevated levels of mold spores is an
allergenic reaction, similar to seasonal allergies many people
develop in fall when outdoor mold level are high such as:
sneezing, nasal and sinus congestion, irritation of eyes, nose
and throat and coughing. In sensitive individuals, more
serious problem may develop:
 Headaches
 Nausea and Dizziness
 Shortness of Breath
 Stress
 Frequent Headaches
 Asthma
 Trouble Concentrating
 Mood Changes
 Fatigue
 Skin Irritation
 Bloody Noses
Mehdi Azimi, Ph.D.
Sensitivity
 Pre-existing allergies or respiratory
conditions-Asthma, TB
 Infant, young children, elderly and
immune compromised patients
 Prolong exposure without pre existing
condition
Mehdi Azimi, Ph.D.
Fungus
Infections
Diseases are caused by the
growth of fungi in or on the
body. In most healthy people
fungal infections are mild,
involving only the skin, hair,
nails, or other superficial sites,
and they clear up
spontaneously. They include
the familiar ringworm and
athlete's foot.
Mehdi Azimi, Ph.D.
Bacteria- Unicellular structure that produces sexually
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or asexually
- Can live in an inanimate
environment
- Some enter dormant state
and form spore where
are protected from
environment and can
remain viable for years
Mehdi Azimi, Ph.D.
Bacteria Cont…
Pathogenic mechanism-- Bacteria can cause
disease in human By:
 Invading and multiply in a portion of the body
that is normally sterile such as long--TB
 Producing toxin or poison that can exert its
influence at a body site distant from where
bacterial replication is occurring. Tetanus is
caused by certain type of wound infection, but it
present clinically as a central nervous system
(CNS) disorder.
Mehdi Azimi, Ph.D.
Bacteria cont…
Bacteria for most part infect the
extracellular body space and have
different metabolic pathways from than
humans. Consequently, antimicrobial
agents have been developed that
selectively kills bacteria without harming
the host.
Mehdi Azimi, Ph.D.
Etiological Agent cont…
 Rickettsia- Microorganism between
bacteria and viruses in terms of size and
characteristics
 Like bacteria,
Rickettsia respond to some
antimicrobial agent
 In human, they must live interacelluarly, where
they borrow certain enzyme and coenzyme
which they can not make, from the cell. Usually
they infect the cells lining of the walls of the
blood vessels.
 They exist in nature in ticks and mites. Rocky
Mountain Spotted Fever are rickettsial infection
Mehdi Azimi, Ph.D.
Mehdi Azimi, Ph.D.
Etiological Agent cont…
 Viruses- Intercellular parasites, smallest of the biologic
agents known to infect humans, consists of encapsulated
genetic material (DNA or RNA)
 To infect a human, a virus must first attach to a cell, then
squirt its genetic material inside the cell. The genetic
material migrates to the nucleolus, where it combines with
the genetic material of the of the host cell and takes
control.
 Normal cell then cease, and the cell begins to exist for the
sole purpose of making more viral particle. Then cell
breaks and viral particles infect new cells.
Mehdi Azimi, Ph.D.
Mehdi Azimi, Ph.D.
Viruses cont…
 Viral infections are difficult to treat.
 Viruses destroy the cells, which result in
permanent damage. Polioviruses destroy
certain nerve cells that do not
regenerate. However the lining of
trachea, which can be destroyed by
influenza viruses, can be regenerated.
Mehdi Azimi, Ph.D.
B. Reservoir:
It must exist where the biologic agent can propagate (live,
multiply and die in natural state.
 Human Animals
 Environment
Mehdi Azimi, Ph.D.
Human reservoir: Certain biologic agents can
multiply only in human, causing either acute clinical or subclinical problems
 Clinical Cases: are not normally a
public health problem, since affected
individual stay home from work, school
or other activities and seek medical
treatment.
 Asymptomatic cases: are problematic.
These individuals may transmit the agent
to other without knowing that they are
infected—called carriers…
Mehdi Azimi, Ph.D.
Carriers: 4 types
 Sub-clinical cases: are patients who never develop
clinical symptom of disease-Hepatitis A virus (HAV)
 Incubatory carriers: Patients incubating a
communicable disease may transmit the infection
shortly before they become symptomatic—Chickenpox
 Convalescent carriers: Patients who have recovered
from an acute illness may continue to shed the
organism—Salmonella or Shigella
 Chronic carries: patient may develop chronic infection
and transmit it for a long period of time—HBV, HIV
Mehdi Azimi, Ph.D.
C. Portal of Exit:
There must be a port of exit from a reservoir in order for
the biologic agent to cause disease elsewhere.
 Respiratory Track- Influenza, TB
 Genitourinary Tract- Sexually transmitted diseasesLiptospirae are found in the urine of infected animals
 Alimentary tract- saliva- Rabies virus
 Skin- Impetigo, Syphilis, Chickenpox, HBV (bite)
 In utero Transmission- During pregnancy, certain
infections diseases such as Rubella and Syphilis from the
mother across the placenta to the developing fetus
Mehdi Azimi, Ph.D.
D-Transmission: An organism must be
transmitted, either directly or indirectly from
one place to another.
 Direct transmission
 Indirect transmission
Mehdi Azimi, Ph.D.
Direct transmission: occurs when
the reservoir and the susceptible host are
in close proximity—close than 6 feet.
 Direct contact transmission: occurs
from skin-to-skin (person-to-person)—
sexual transmitted diseases Syphilis,
herpes, HBV.
 Droplet spread: Occurs when infectious
aerosols produced by coughing, talking
and sneezing transmit infection to
susceptible hosts.—mumps, rhinovirus
(common cold)
Mehdi Azimi, Ph.D.
Indirect transmission: occurs when the
reservoir and the susceptible host are
separated—as small as 6 feet or as far as
thousands of miles.
 Vector spread: involves the transmission of an infectious agent in
or on an animate things.—mosquitoes, fleas, mites, and ticks. It can
be mechanical (on the feet or wing of the insect) or actually grow
and multiply in the vector—Malaria
 Vehicle spread: involves the transportation of the infectious agent
in or on animate objects-toys, school supplies, beddings,
contaminated food, water, milk
 Airborne spread: Involve droplet nuclei 1-5 micron in size which
are produced by talking, coughing, sneezing which float on air
currents over large distances for a varying period of time. Can also
be created by dentist’s drill and lab centrifuge- influenza and TBmost difficult to block.
Mehdi Azimi, Ph.D.
Mehdi Azimi, Ph.D.
E. Port of Entry- There must be a port of
entry. Similar to portal of exit
Mehdi Azimi, Ph.D.
F. Susceptible Host- There must
be susceptible host for disease
transmission to occur. Generally people
stay healthy because of their own host
defense mechanism
General factors of resistance:
 Intact skin- prevent most organism from entering the body
 The cough reflex eliminate organism from the lung
 Gastric Juice digest food as well as swallowed organism
 Diarrhea eliminate harmful agent from the gastrointestinal
tract
Mehdi Azimi, Ph.D.
 Active Immunity: occurs when the host
develops long-lasting antibodies to fight infection.
Antibody production results from either natural
disease or vaccine. It usually takes several weeks
of exposure or immunization before protective
antibody is produced.
 Passive immunity: Occurs when antibodies
are given to the host. It provides immediate
protection
Mehdi Azimi, Ph.D.
PATHOGEN
A pathogen or infectious agent is a
biological agent that causes
disease or illness to its host. The
term is most often used for agents
that disrupt the normal physiology
of a multicellular animal or plant.
 Pathogenicity- The ability of a
microorganism to cause disease
and/or the mechanism whereby the
microorganism causes disease.
 Virulence- Refers to the extent of
pathogenicity
Mehdi Azimi, Ph.D.
Infection vs Disease
 Infection-Successful persistence or
multiplication of a pathogen on or
within a host.
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You can be infected, but not have
disease!
 Disease-An infection which causes
damage to the host
Mehdi Azimi, Ph.D.
Types of Pathogens
 Primary Pathogen
 Primary pathogens regularly cause disease among
normal individuals.
 Opportunistic pathogens
 Cause disease only in immunocompromised
individuals.
 An opportunist in one host can be a
primary pathogen in another host.
Mehdi Azimi, Ph.D.
Primary vs. Opportunistic
 The survival of a primary pathogen
depends on the ability of the organism to
be transmitted to a new host.
 An opportunistic pathogen can survive
within a single host until the conditions
are right for causing disease.
Mehdi Azimi, Ph.D.
Pathogen Requirements
 Must be able to survive within the host.
 Must be able to avoid, circumvent or
subvert the host immune responses.
Mehdi Azimi, Ph.D.
Multiplication
 The pathogenic bacteria must find a way to become
bacterium (multiple bacteria).
 Must attain numbers sufficient to pass the disease on
to other individuals.
 The virulence of a pathogen is determined in large
part by the ability of the organism to be transmitted at
a high frequency.
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This can be accomplished by a large number of
organisms moderately efficient at transmission or by a
small number of organisms that are extremely efficient at
transmission.
Mehdi Azimi, Ph.D.
Entry into the Host
 A host must maintain contact with the
outside environment.
 These avenues of contact include
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waste disposal (anal or urethral contact) or
other environmental pollutants
breathing (respiratory tract),
food consumption (mouth),
sight (eyes), hearing (ears), etc.
Mehdi Azimi, Ph.D.
Other Mechanisms of Entry
 Trauma
 Clostridia can enter via deep puncture
wounds.
 Insect Bites
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Plague
Rocky mountain spotted fever
Typhus
 Sexually transmitted diseases
Mehdi Azimi, Ph.D.
ENVIRONMENT
is a complex, interconnected set of relationships and systems
involving all living things and their surroundings.
Pollution/Impurity is the introduction of substances or energy into the
environment, causing imbalance and result in deleterious effects of such a
nature as to endanger human health, harm living resources and ecosystems,
and impair or interfere with amenities and other legitimate uses of the
environment.
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Air Pollution,
Water pollution,
Soil contamination,
Radioactive contamination,
Noise pollution,
Light pollution,
Visual pollution,
Thermal pollution
Mehdi Azimi, Ph.D.
Protecting environmental values
while safeguarding the economic
interest requires technical
expertise as well as complex risk
management techniques
Mehdi Azimi, Ph.D.
Special Challenges of Environmental
Loss Control
 Accidental Events
 Technical demands
 Event/Loss Relationship
 Regulatory Changes & Complexity
 Difficulty in Evaluating Environmental Risk
 Limited Risk Financing Options
Mehdi Azimi, Ph.D.
Life Safety:
Deals with protecting people in a burning building
from injury or death. How buildings should be
designed for safe emergency evacuation during
fire and other emergencies.
Fire Safety:
All measures to prevent and/or minimize damage
to property and people because of hostile fire.
Mehdi Azimi, Ph.D.
Fundamental Consideration of Life
Safety:
Characteristics of Persons:
Age, Mobility, Awareness, Knowledge of
Environment, Density, Control of Occupants
Types of Buildings (Occupancy):
Assembly, Educational, Health Care,
Detention & Correctional, Residential,
Mercantile, Business, Industrial, Storage
Mehdi Azimi, Ph.D.
Control of Infection and
Disease-Terminology:
 Sterilization-complete killing or removal of all living organisms




from a particular location or material
Pasteurization- the use of heat at a temperature sufficient to
inactivate important pathogenic organisms. *Spores are not
killed
Disinfection- killing of pathogenic bacteria by a process that
fails to give total sterilization
Antiseptic- disinfecting agents that are used on body surfaces
to reduce numbers of normal flora and pathogens. These are
usually less toxic than disinfectants.
Asepsis-process designed to prevent microorganisms from
reaching a protected environment.
Mehdi Azimi, Ph.D.
Mechanisms of Sterilization






Heat
Autoclave (steam and heat)
Gas (ethylene oxide)
UV light (240 nm-280nm)-disrupts DNA which
absorbs UV light in this range.
Ionizing radiation
Filtration-removes bacteria directly based on
size, usually requires 0.2 micron filter
Mehdi Azimi, Ph.D.
Methods of Disinfection


Alcohols-denature proteins, isopropyl alcohol is
commonly used.
Halogens-iodine and chlorine
Mehdi Azimi, Ph.D.
Surface Active Compounds
 Surfactants-compounds with hydrophobic and
hydrophilic groups that disrupts various bacterial
components
 Soaps with anionic charge have very little effect on
bacteria.
 Cationic soaps with hydrophilic and lipophilic groups
react with the lipid membrane and disrupt bacterial
membranes stability.
Mehdi Azimi, Ph.D.
CHRONIC DISEASE
Chronic Disease
 More than 90 million Americans live with
chronic illnesses.
 Chronic diseases account for 70% of all deaths
in the United States.
 The medical care costs of people with chronic
diseases account for more than 60% of the
nation’s medical care costs.
 Chronic diseases account for one third of the
years of potential life lost before age 65.
Mehdi Azimi, Ph.D.
 Every year, chronic diseases claim the lives of
more than 1.7 million Americans. These
diseases are responsible for 7 of every 10
deaths in the United States. The medical care
costs for people with chronic diseases total more
than $400 billion annually, or more than 60% of
total medical care expenditures. However, in
1994, the public health expenditure targeting
chronic diseases was only $1.21 per person.
Mehdi Azimi, Ph.D.
Burden of Chronic Diseases on
Women and Racial Minority
Populations
 Chronic disease disproportionately affects women and
racial minority populations
 Women comprise more than half of the people who die
each year of cardiovascular disease.
 Deaths due to breast cancer are decreasing among
white women but not among African American women.
 The death rate from cervical cancer is more than
twice as high for African American women as it is for
white women.
Mehdi Azimi, Ph.D.
Mehdi Azimi, Ph.D.
Coronary Heart
Disease
Coronary Heart Disease
 Leading cause of death in the U.S.
 Risk factors include:







Smoking
Blood cholesterol
Blood pressure
Lack of exercise
Obesity
Oral contraceptive use
Family history
Mehdi Azimi, Ph.D.
Impact of Tobacco Use
 About 430,000 deaths are attributed to cigarette smoking
each year.
 Approximately one of every two lifelong smokers will
eventually die of smoking.
 If current smoking patterns continue, an estimated 25
million persons alive today, including 5 million children
younger than 18 years of age, will die prematurely of
smoking-attributable diseases.
Mehdi Azimi, Ph.D.
Smoking
 Smoking places individuals at an increased risk
for developing and dying from Coronary Heart
Disease
 The relative risk for Coronary Heart Disease is
increased by about 20% for smokers
 Smoking kills almost as many individuals by
cardiovascular deaths as by lung cancer
Mehdi Azimi, Ph.D.
Tobacco addiction can be treated successfully, with
potential to save lives and money. Surveys shows that
three-forth of smokers want to quit, but less than 10
percent who try actually succeed.
When organization sponsor cessation treatment
programs or behavior modification programs, it
becomes a win-win situation for both employee and the
company.
According to CDC, tobacco cessation counseling and
treatment is the highest ranked services with the lowest
costs.
Mehdi Azimi, Ph.D.
Elevated Blood Pressure
 Over 37 million Americans have
significant high blood pressure (blood
pressure greater than 150/90 mm Hg
recorded once a week at this level for at
least two weeks in a row)
Mehdi Azimi, Ph.D.
Elevated Blood Pressure
 Race.
 Blacks are almost twice as likely as whites to be
hypertensive. Hypertension more frequently
leads to congestive heart failure in blacks than in
whites
 Age.
 Hypertension is age related. Approximately 50%
of the geriatric population is hypertensive
Mehdi Azimi, Ph.D.
 Lack of moderate exercise has been established
as a risk factor for CHD deaths
 Obesity, especially among sedentary individuals,
seems to be a minor independent contributory
cause of CHD
 Oral Contraceptive use among women over 35
or who smoke has been linked to an increased
incidence of CHD
 Family history of early CHD is a well known risk
factor
Mehdi Azimi, Ph.D.
Heart Disease Prevention
 Primary prevention includes screening
for risk factors including serum
cholesterol and behavioral factors
(smoking, diet, and exercise)
 Secondary prevention includes an EKG
for men over 40 and have more than two
risk factors or are beginning a vigorous
exercise program
Mehdi Azimi, Ph.D.
Cancer
 Second leading cause of death
 50% of cancer cases are 65 years or
older
 Cancer is not caused by one agent,
many factors are involved
 Many cancers have a genetic
component
 Environmental exposures and diet are
very important
Mehdi Azimi, Ph.D.
Cancer Prevention
 Diet and lifestyle
 Genetic screening
 Clinical screening i.e. lung X-ray,
mammogram, prostate exam, pap smear
 Occupational exposure control i.e.
asbestos
 Environmental exposure control i.e.
radon
Mehdi Azimi, Ph.D.
Cancer
 Lung
 Breast
 Colon and rectum
 Cervix
 Prostate
Mehdi Azimi, Ph.D.
Lung Cancer
 Lung cancer is the number one cause of
cancer deaths, accounting for 25% of all
cancer mortality and 5% of all deaths in
the U.S.
 Leading cause of cancer deaths in both
men and women
Mehdi Azimi, Ph.D.
Lung Cancer Causal and Risk
Factors
 A) Smoking is the major causal factor in lung cancer
Mehdi Azimi, Ph.D.
Lung Cancer Causal and Risk
Factors
The lower risk for women is attributed to
the fact that women
 A) Began smoking later in this century
than men
 B) Traditionally started to smoke at an
older age than men
 C) Inhale less deeply than men
Mehdi Azimi, Ph.D.
Lung Cancer Causal and Risk
Factors
 Age
 The risk of lung cancer is influenced by
the age at which an individual begins to
smoke
 If smoking is not begun until the late
teens or early adulthood, the risk of
developing cancer at age 60-70 is
reduced by as much as 20%
Mehdi Azimi, Ph.D.
Lung Cancer Causal and Risk
Factors
 Occupational Exposure
 Industrial exposure to substances such as
asbestos, radon, nickel, chromium, and other
industrial agents, especially in combination with
cigarette smoking, leads to an increased risk of
lung cancer.
 The increased risk is dependent on length and
type of exposure
Mehdi Azimi, Ph.D.
Lung Cancer Causal and Risk
Factors
 Air pollution
 Air pollution is a suspected cause of lung
cancer, but evaluation is difficult n part
because the measurement of air
pollution is inexact
 Even in urban areas it is unlikely to be a
significant causal factor of lung cancer
Mehdi Azimi, Ph.D.
Breast Cancer
 Female breast cancer accounts for close
to 10% of all cancer deaths in the U.S.
 The mortality rate is approximately 15
per 100,000
 There are about 140,000 new cases
each year in the U.S. accounting for 28%
of female cancer
Mehdi Azimi, Ph.D.
Breast Cancer
 Sex--Breast cancer is distinctly
uncommon in males. The difference in
incidence and mortality between males
and females is believed to be related
more to hormonal and genetic factors
than to the amount of breast tissue
Mehdi Azimi, Ph.D.
Breast Cancer
Causal and Risk Factors
 Pregnancy
 Women who become pregnant for the first time after the
age of 30 have an increased chance of developing
breast cancer
 Women with a first full-term pregnancy before the age of
20 have a relative risk of breast cancer that is 1/3 that of
a woman whose first full-term pregnancy occurs after the
age of 35
 Pregnancies ending in abortion or miscarriage have not
been shown to reduce subsequent risk of breast cancer
Mehdi Azimi, Ph.D.
Breast Cancer
Causal and Risk Factors
 Family history
 The risk to women whose mothers or
sisters have had breast cancer is
increased twofold, and the risk to women
whose mother AND sisters have had
breast cancer is increased threefold
Mehdi Azimi, Ph.D.
Breast Cancer
Causal and Risk Factors
 Exogenous hormones
 Oral Contraceptives
 The connection between oral
contraceptive use and breast cancer is
controversial and inconsistent findings
have been reported
Mehdi Azimi, Ph.D.
Breast Cancer
Causal and Risk Factors
 Postmenopausal hormone replacement therapy
 This therapy is associated to breast cancer like
oral contraceptive use, inconclusively
 Radiation
 Exposure to ionizing radiation increases the
incidence of breast cancer
 The risk is significantly greater in women who
were irradiated during adolescence
Mehdi Azimi, Ph.D.
Breast Cancer
Causal and Risk Factors
Other Factors:
 High socioeconomic status
 Age over 40
 An early menarche
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
 Colorectal cancer is the second most common cancer in
the U.S.
 The mortality rate is approximately 25 per 100,000
 Age
 The age specific incidence rate of colorectal cancer
begins to rise at age 10 years. The rate of increase in
incidence continues until age 70-75 years, at which time
rectal cancer incidence rates increase more slowly and
then decline after age 85 years
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
Sex and Race:
 Men and women are affected almost
equally, although, among whites, the risk
for men is some what higher than for
women; among blacks, rates are nearly
equal for men and women
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
Causal and Risk Factors
Diet:
 Fiber deficiency and high dietary fat
consumption have been related to
colorectal cancer in many studies;
however no specific carcinogenesis
associated with the production,
preservation, and manufacture of food
has been clearly defined
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
Causal and Risk Factors
Physiologic Factors:
 Bacteria acting upon cholesterol and bile
acids in the intestines may produce
carcinogens that act either locally or
elsewhere in the body
 The mechanisms are poorly understood
and are far from being established
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
Causal and Risk Factors
Family predisposition:
 Heredity is a factor in the development of
colon cancer
 The relative risk for first-degree relatives
of someone with colon cancer is three
times that of the general population
Mehdi Azimi, Ph.D.
Colon and Rectum Cancer
Causal and Risk Factors
Alcohol consumption:
 Per capita beer consumption correlates
significantly with the colorectal cancer
mortality of men 35-45 years of age.
However alcohol is not a confirmed
causal factor for colon cancer
Mehdi Azimi, Ph.D.
Cervix Cancer
 Cervical cancer accounts for just under 1.5% of cancer
deaths in the U.S.
 In the past two decades there was a very slight increase
in the incidence and mortality rates of cervical cancer
observed in several western European countries and the
U.S.
 Increases are considered to be due, in part, to changes
in sexual practice, including non-monogamous sexual
activity, oral contraceptive use, and the incidence of
sexually transmitted diseases
Mehdi Azimi, Ph.D.
Cervical Cancer
Causes and Risk Factors
Sexual Activity:
 Multiple sex partners and STDs, such as herpes,
syphilis, and gonorrhea increase a woman’s risk
of cervical cancer
 Oral Contraceptives
 Use of oral contraceptives appears to be a risk
factor, although it is not clear whether oral
contraceptives increase the risk or whether
barrier methods decrease it
Mehdi Azimi, Ph.D.
Cervical Cancer
Causes and Risk Factors
Coital history:
 Age at first coital experience correlates
highly with the risk for cervical cancer
 Women who had first coitus before 20
years of age have a two- to threefold
increase in risk for invasive cervical
cancer, compared to women whose
sexual activity began later
Mehdi Azimi, Ph.D.
Cervical Cancer
Causes and Risk Factors
Smoking:
 Women who smoke have a relative risk of 3.0 for
developing cervical cancer compared to non-smokers
with 1.0
 Socioeconomic factors
 Cervical cancer has been associated with the
socioeconomic class of the patient’s husband, as
indicated by his occupation. Studies suggest that men
are a factor in cervical cancer, primarily due to penile
hygiene or circumcision. Partners of non-circumcised
males are at an increased risk for cervical cancer
Mehdi Azimi, Ph.D.
Prostate Cancer
 Prostate cancer accounts for more than 5% of
cancer deaths n the U.S.
 Prostate cancer is the most common cancer in
American Men
 Prostate cancer primarily affects elderly men
 The incidence increases with age more rapidly
than for any other cancer
 American blacks have the highest prostate
cancer incidence in the world
Mehdi Azimi, Ph.D.
Prostate Cancer
Causes and Risk Factors
 Although the cause of prostate cancer is
unknown, it has been associated with
testosterone level and sexual activity
 Diet
 Dietary fat appears to be related to
prostate cancer in much the same way it
is related to breast and colorectal cancer
Mehdi Azimi, Ph.D.
Prostate Cancer
Causes and Risk Factors
 Occupational Exposure
 Workers exposed to industrial
carcinogens, such as cadmium oxide
dust, reportedly have a higher incidence
of prostate cancer than expected
 Age
 The risk of developing prostate cancer
increases with age
Mehdi Azimi, Ph.D.
Prostate Cancer
Causes and Risk Factors
 Marriage
 Married men have higher frequencies of
prostate cancer than single men
 Rates are highest among widowed and
divorced men and among married men
with children
Mehdi Azimi, Ph.D.
Cerebrovascular Disease
 The word "cerebrovascular" is made up
of two parts "cerebro" which refers to the
large part of the brain and "vascular"
which means arteries and veins.
Together, "cerebrovascular" refers to
blood flow in the brain. The term
cerebrovascular disease covers acute
stroke and other diseases that may lead
to stroke, like carotid stenosis and
aneurysms.
Mehdi Azimi, Ph.D.
Cerebrovascular Disease
 There are approximately 500,000 new
episodes of cerebrovascular disease
each year
 The incidence of stroke doubles each
successive decade after age 45
 The chances of suffering a stroke before
the age of 70 are 1 in 20
Mehdi Azimi, Ph.D.
Cerebrovascular Disease
Causal and Risk Factors
 Old age is the most important risk factor for
stroke
 Hypertension markedly increases the risk of
stroke
 Hypertension is a major cause of
atherosclerosis, particularly in combination with
hyperlipidemia
 Hypertension is the most important modifiable
risk factor for stroke
Mehdi Azimi, Ph.D.
Cerebrovascular Disease
Causal and Risk Factors
 Smoking increases the risk of stroke
 Studies have shown increases in both stroke
incidence and stroke mortality
 CHD, atrial fibrillation, and diabetes mellitus are
all independent factors that have been
demonstrated to increase the risk of stroke
 Oral contraceptive use particularly by women
who smoke increase the risk of stroke
Mehdi Azimi, Ph.D.
Chronic Obstructive Pulmonary
Disease (COPD)
 It has been estimated that 16 million
American have chronic bronchitis,
asthma, or emphysema
 Approximately 14% of adult men and 8%
of adult women have chronic bronchitis,
obstructive airway disease or both
Mehdi Azimi, Ph.D.
(COPD)
Causal and Risk Factors
Smoking:
 It has been demonstrated repeatedly
that cigarette smoking is the most
important cause of COPD
 The risk is related to the number of
cigarettes smoked daily and to the
duration of the smoking
Mehdi Azimi, Ph.D.
(COPD)
Causal and Risk Factors
Occupational Exposure:
 Workplace exposures of tin, copper, and
coal miners; chemical workers, foundry
workers; and others engaged in certain
heavy industry, increases the risk of
COPD
 Smokers employed in these areas are
affected by the synergistic effect of
cigarette smoke and other exposures
Mehdi Azimi, Ph.D.
(COPD)
Causal and Risk Factors
Air Pollution and Indoor Pollutants:
 At high levels outdoor and indoor pollutants have been
determined to be harmful
 Sex
- Men are at a higher risk than women in developing
emphysema and COPD
 Older men are at a higher risk than older women,
possibly because of occupational exposures
Mehdi Azimi, Ph.D.
(COPD)
Causal and Risk Factors
Socioeconomic Factors:
 Morbidity and mortality from COPD
generally higher in blue-collar workers
and people with few years of education
than in white-collar workers
 These associations likely are related to
smoking and occupational exposures
Mehdi Azimi, Ph.D.
Cirrhosis
 Cirrhosis of the liver is scarring of tissue
and malfunction in the liver that can lead
to death, is the most serious liver
problems brought on by excessive
alcohol consumption and/or viruses
 Death rate from cirrhosis is 10.9
individuals per 100,000
Mehdi Azimi, Ph.D.
Cirrhosis
Causal and Risk Factors
 Excessive regular, if not daily, consumption of
alcohol for many years places certain individuals
who consume alcohol at increased risk for
developing cirrhosis
 In the U.S. excessive alcohol consumption is the
primary cause of cirrhosis; in other countries
especially non-industrialized countries, chronic
hepatitis is also a cause
Mehdi Azimi, Ph.D.
Cirrhosis
Causal and Risk Factors
Nutrition:
 Nutritional deficiencies, especially
proteins, may promote the toxic effects
of alcohol by depleting hepatic amino
acids and enzymes
 Lack of dietary protein hinders proper
liver function, whether alcohol is present
or not
Mehdi Azimi, Ph.D.
Cirrhosis
Causal and Risk Factors
Genetics:
 Evidence suggests that many aspects of
alcoholism (which is associated with
heavy drinking and thus cirrhosis) are
inherited
 Rates of alcohol elimination can vary as
mush as threefold among individuals
Mehdi Azimi, Ph.D.
Suicide
 It is estimated that 200,000 individuals in
the U.S. attempt suicide every year
 Approximately 30,000 Deaths from
suicide
 Guns and poison are the most common
means
 Suicides are generally considered to be
associated with chronic emotional
disturbance
Mehdi Azimi, Ph.D.
Suicide
Risk Factors:
 Conditions associated with increased risk of suicide
include:
 Chronic mental illness
 Substance abuse
 Feelings of helplessness and hopelessness associated
with divorce, separation, living alone, and grief
 Socioeconomic factors, especially unemployment
 Serious physical illness or handicap
Mehdi Azimi, Ph.D.
Suicide
People with increased risk for suicidal intent include:
 Males
 Divorced, separated and widowed individuals
 Whites
 Unemployed individuals
 Alcohol abusers
 Teenagers
 WAR VETERANS
Mehdi Azimi, Ph.D.
Homicide
 Homicide is the leading cause of death
for black American men 15-24 years,
approximately 5% of black men die from
homicide
 Homicide may be a result of chronic
social and societal problems
Mehdi Azimi, Ph.D.
Homicide
Homicides reported to the FBI:
 40% were committed by friends
 16% were committed by a member of
the victim’s family
 13% were committed by strangers
 31% were labeled as “relationship
unknown”
Mehdi Azimi, Ph.D.
Homicide
Causal and Risk Factors
Age:
 Individuals age 25-34 are most likely to
be victims of homicide followed by those
age 35-44 years, and then those age 1524
Sex:
 Men are four times more likely to be
victims of homicide than women
Mehdi Azimi, Ph.D.
Homicide
Causal and Risk Factors
Substance abuse:
 Excessive use of alcohol or other drugs by
either the victim or the offender has been
documented in 50% of homicides
 Socioeconomic factors
 There is evidence that individuals who feel
unable to cope with unemployment, poverty,
inadequate housing, and discrimination are a
higher risk group for either committing or being
the victim of a homicide
Mehdi Azimi, Ph.D.
Homicide
Causal and Risk Factors
 Lack of traditional support systems,
(such as family and religious institutions)
moral consciousness, and a sense of
identity have been associated with an
increased risk for committing or being
the victim of a crime
Mehdi Azimi, Ph.D.
Anemia
 Anemia is a reduction in either the
volume of red blood cells or the
concentration of hemoglobin in a sample
of peripheral venous blood when
compared with similar values from a
reference population
Mehdi Azimi, Ph.D.
Anemia
 Death often results due to compromised
oxygen delivery to tissues, especially in
cases of compromised cardiac output,
such as underlying vascular and cardiac
disease
Mehdi Azimi, Ph.D.
Anemia
Prevalence
 The highest prevalence rates occurs in
young women 15-17 years of age
followed
 The lowest prevalence rates occur in
boys and men 12-44 years
Mehdi Azimi, Ph.D.
Anemia
Causal and Risk Factors
Familial predisposition
 Sickle Cell Anemia is caused by a lack of
hemoglobin A; a deprivation of oxygen
results in crescent shaped red cells
 This disorder is almost entirely confined
to blacks
Mehdi Azimi, Ph.D.
Anemia
 Iron Deficiency



Children may experience iron deficiency anemia at
a time when iron is required for rapid growth
Women are susceptible to iron deficiency due to
menstrual blood loss and the iron losses associated
with pregnancy
Individuals of low socioeconomic status are more
likely to develop anemia due to the absence of an
iron-rich diet because of poverty
Mehdi Azimi, Ph.D.
Psychoactive Substance
Abuse
Drugs
 Nonfood chemicals that alter the way a person thinks,
feels, functions, or behaves
 Drugs are commonly taken for medicinal purposes
 Psychoactive drugs are taken to alter mood and mind
 Illicit drug use contributes to crime, unemployment,
and family disruptions
Mehdi Azimi, Ph.D.
Drug Use
 Physician’s prescription necessary to purchase
powerful and potentially hazardous drugs
 OTC drugs can be purchased without a prescription
 Many OTC remedies contain chemicals that have not
been evaluated scientifically
Mehdi Azimi, Ph.D.
Drug Misuse and Abuse
 Any drug can be misused or abused
 Misuse is the temporary and improper use of a legal
drug
 Abuse is the intentional improper or non-medical use
of any drug that negatively affects the health and
well-being of the user, his or her family, and society

Psychoactive drugs are more likely to be abused than
other drugs
Mehdi Azimi, Ph.D.
Comprehensive Drug Abuse
Prevention and Control Act of
1970
 Legal foundation for the enforcement of
narcotic usage in the U.S.
 Schedule I drugs are illegal to use, possess,
or sell
 The Drug Enforcement Agency (DEA)
evaluates information from DHHS and
classifies drugs with abuse potential as
“controlled substances”
Mehdi Azimi, Ph.D.
Psychoactive Drugs
 Opiates (heroin, morphine, codeine)
 Depressants (alcohol, Valium, Quaalude, Rohypnol)
 Stimulants (Caffeine, cocaine, methamphetamine, Ritalin)
 Hallucinogens (LSD, mescaline, STP, psilocybin, PCP,
Peyote, mushrooms)
 Marijuana (Pot, hash)
 Inhalants (Gasoline, paint thinners, freon, aerosols, butyl
nitrate)
 Drugs with mixed effects (nicotine, PCP, Ecstasy)
Mehdi Azimi, Ph.D.
Psychoactive Drugs
 Change the way the brain perceives and processes




information
Alters activity of message-carrying chemical
transmitters in the brain
Circulate through the bloodstream and small amounts
are excreted in urine, feces, and exhaled breath
Are detoxified in the liver
May be stored in body fat for days and possibly
weeks
Mehdi Azimi, Ph.D.
Terminology
 Intoxication = poisonous levels in the body
 Detoxification = conversion of harmful substances
into less dangerous compounds to be excreted
 Overdose = excessive amount of a drug that the body
cannot “detoxify” or eliminate rapidly
 Polyabuse = abusing more than one drug at a time
 Synergism = multiplied effects produced by taking
combinations of certain drugs
Mehdi Azimi, Ph.D.
Why People Use
Psychoactive Drugs
 Pleasurable experiences
 Inability to cope with problems, stress
 Escape from unpleasant aspects of their lives
 Experimentation and curiosity
 Enhance social interactions and relieve peer
pressure
Mehdi Azimi, Ph.D.
Patterns of Drug Use
 Experimentation and illegal use often occurs during
teen years
 Highest use is among 18-20 year olds
 Illegal drug use declines with increasing age as
people adopt traditional adult roles such as careers
and parenting
 Those over 30 are more likely to abuse prescription
medications than illicit drugs
Mehdi Azimi, Ph.D.
Drug Dependence
 A habitual pattern of drug-taking that produces a
compulsive need to use these substances
 Physical dependence is indicated by drug tolerance
and withdrawal symptoms
 Psychological dependence is indicated by cravings
that motivate drug-seeking behavior
Mehdi Azimi, Ph.D.
Risk Factors for
Drug Dependency
 Drug-using parents
 Mentally ill parents
 Ineffective parenting
 Lack of mutual child-parent attachments and
parental nurturing
 Inappropriately shy or aggressive behavior in
the classroom
 Poor school performance
Mehdi Azimi, Ph.D.
Risk Factors for
Drug Dependency (cont’d)
 Poor social skills
 Friendships with peers who use drugs
 Belief that parents, school, and community
approve of drug use
Mehdi Azimi, Ph.D.
Protective Factors:
Reduced Potential for Drug
Abuse
 Strong family and school ties
 Parental monitoring of behavior with clear
rules of conduct
 Parental involvement in life of child
 Academic success
 Belief that parents, school, and community
disapprove of drug use
Mehdi Azimi, Ph.D.
Routes of Drug
Administration
Mehdi Azimi, Ph.D.
Stimulants
 Amphetamines (e.g. Dexedrine) increase energy and
alertness, produce euphoria, and suppress appetite
 Methamphetamines (e.g. Ecstasy, crystal meth,
Special K) are more powerful forms of amphetamines
[oral, snorted, injected, or smoked]
 Cocaine is a highly addictive, powerful stimulant
 Caffeine causes limited dependence but improves
alertness and mood
Mehdi Azimi, Ph.D.
Some
Effects of
Cocaine
Use
Mehdi Azimi, Ph.D.
Depressants
 Slows activity of cerebral cortex, producing calming,





trancelike effects and drowsiness
Slows heart and respiratory rates
Alcohol, phenobarbital, Valium, rohypnol, GHB
Can be used for insomnia and mild anxiety
Tolerance and dependency occur with regular use
Withdrawal can cause mental confusion and seizures
Mehdi Azimi, Ph.D.
Opiates
 Relieve pain, induce sleep, induce euphoria,
slow intestinal activity
 Examples: Codeine, morphine, heroin,
Percodan, Demerol
 Highly addictive
 Tolerance and dependence develops in a few
weeks
 Overdoses can cause death
Mehdi Azimi, Ph.D.
Marijuana
 THC is the active ingredient
 Alters coordination, concentration, problem
solving, perception of time, and short-term
memory
 Hashish (dried flower resin) has a higher
concentration of THC than marijuana leaves
 Can cause psychological dependence
Mehdi Azimi, Ph.D.
Some
Effects of
Long-Term
Marijuana
Use
Mehdi Azimi, Ph.D.
Hallucinogens
 Abnormal and unreal sensations with
distorted and vivid images
 Frightening responses: anxiety, depression,
losing control
 Elevates BP, body temperature, and dilates
pupils
 LSD, mescaline, psilocybin, PCP
Mehdi Azimi, Ph.D.
Inhalants
 Gases that produce euphoria, dizziness, confusion,
drowsiness

Paints & fingernail polish containing acetone, butane
lighter fluid, Freon, glues, PVC cement, hair spray,
correction fluid
 Users may experience double vision, nausea,
vomiting, fainting, ringing in ears
 Risk of brain damage, irregular heartbeat, anemia,
liver damage, kidney failure, coma, and death
Mehdi Azimi, Ph.D.
Designer Drugs
 Substances made by “underground chemists”
 More toxic than compounds from which they were
made
 China white, MPPP, MDA, Ecstasy
 Ecstasy


produces hallucinogenic and stimulant effects
users may experience panic, anxiety, tremors, rapid
HR, loss of coordination, and psychotic behavior
Mehdi Azimi, Ph.D.
OTC Drugs
 In U.S. OTC must be safe and effective when the
product information is followed
 Weight loss aids have potential harmful effects
 Ephedrine can produce high BP, sleeplessness,
irregular and rapid HR
 Numerous herbs or plant extracts contain substances
that can produce harmful side effects when ingested
Mehdi Azimi, Ph.D.
Drug Treatment
 3 Major Long Term Strategies:



Methadone maintenance
Out patient drug free programs with counseling
and psychotherapy
Residential therapeutic communities
 Self-help groups, AA and NA, are useful
adjuncts to professional treatment
Mehdi Azimi, Ph.D.
Prevention Strategies
 Reduce the supply: destroy crops, stop illegal flow of
drugs, and prosecute drug manufacturers and
traffickers
• Reduce the demand: reduce poverty and
unemployment
• Educational programs to promote drug-free
lifestyles, especially among children and
young adults
Mehdi Azimi, Ph.D.
Drug Use Across the Lifespan
 Pregnant drug users risk miscarriages, stillbirths, and
underdeveloped infants
 Drug-exposed newborns may have cognitive deficits
and developmental delays
 Adolescent drug use risk factors include parents’ use
of drugs, latchkey status, and peer drug use
 Teens generally avoid using drugs who stay in
school, attend class, make good grades, and get
along with parents
Mehdi Azimi, Ph.D.
Uppers, Downers and
All Arounders
Mental Health and Drugs
Mental Health and Drugs: An Overview
 40 million Americans suffer from mental health issues
 7-10 million have mental health and substance abuse
issues
 Studies show that neurotransmitters affected by drugs
and alcohol are the same ones affected by mental illness
 Many people with mental health issues use psychoactive
drugs in an effort to rebalance their brain chemistry and
control



Agitation
Depression
Other problems
Mehdi Azimi, Ph.D.
Mental Health and Drugs: An Overview
 Heredity, environment and use of psychoactive drugs are
3 main factors that affect the central nervous system
 Heredity and mental balance

Closely linked to
 Schizophrenia
 Bipolar disorder
 Depression
 Anxiety
 Susceptible brain + hostile environment + drug or alcohol
use = increase risk of mental disorder

Doesn't mean it Will occur, just a greater risk
Mehdi Azimi, Ph.D.
Mental Health and Drugs: An Overview
 Environment and Mental Health


Closely related
Neurochemistry to extreme stress like physical or sexual
abuse can disrupt and unbalance reactions to normal
situations
 Psychoactive Drugs and Mental Balance




Nervous system impacted by enough psychoactive drugs can
cause individual to develop mental illness
Heavy use of alcohol, sedative-hypnotics or withdrawal from
stimulant drugs can aggravate depression
Brain predisposed to schizophrenia can develop it
Psychotic episode can be triggered by psychedelics
Mehdi Azimi, Ph.D.
Dual Diagnosis (Co-occurring Disorders)
 Definition

Refers to a co-occurrence of an interrelated mental disorder
and substance abuse disorder
 Two categories


Preexisting
 Schizophrenia, mood disorders and anxiety disorders
Substance Induced
 Stimulant induced psychotic disorders
 Alcohol induced depression
 Marijuana induced delirium
 Common for people to present with personality disorders,
particularly borderline and antisocial personalities
Mehdi Azimi, Ph.D.
Dual Diagnosis (Co-occurring Disorders)
 44% of Alcohol users and 64% of drug addicts
presented with one serious mental illness in
treatment
 Assessment



Important to assess for mental illness after the
client has had time to sober up
Substance abuse treatment centers without mental
health components are reluctant to admit persons
with mental illness
Mental health try to avoid persons who have
substance abuse issues in addition to mental illness
Mehdi Azimi, Ph.D.
Dual Diagnosis (Co-occurring Disorders)
 Integrated treatment is the best option for persons with
co-occurring disorders
 Best treatment programs have mental health and
substance abuse treatment
 Important to find linkages for programs that only
address one area
 Many substance abusers also have extreme health
problems






Chronic pain
Hepatitis
HIV/AIDS
Diabetes
High blood pressure
Kidney disease
Mehdi Azimi, Ph.D.
Preexisting Mental Disorders
 Schizophrenia (Thought Disorder)



Affects 1% of population
Believed to be inherited
Characterized by
 Hallucinations
 Delusions
 Poor
association
 Impaired ability to care for oneself
 Onset is late teens and early adulthood
 Cocaine, methamphetamines and steroids can cause
psychosis
 Paranoia caused by marijuana can be mistaken for
thought disorder & withdrawal from downers
Mehdi Azimi, Ph.D.
Preexisting Mental Disorders
 Major Depressive Disorder (Affective disorder)






Mood disorder
Bi-polar affective disorder
Dysthymia (mild depression)
15% of Americans in their lifetime
8.6 % in any year
Characterized by
 Depressed mood
 Diminished interest and pleasure in most activities
 Sleep & appetite disturbances
 Decreased ability to concentrate
 Feelings of worthlessness\suicidal thoughts
 Excessive use of alcohol, stimulant withdrawal
Mehdi Azimi, Ph.D.
Preexisting Mental Disorders
 Bi-polar Affective Disorder (Manic Depression)

Characterized by:
 Alternating periods of depression, normalcy and mania
 Untreated can cause suicide attempts
 Persistent elevated and irritated moods
 Increased self-esteem or grandiosity
 Decreased need for sleep
 Pressure to keep talking
 Excessive involvement in pleasurable activities that have
high potential for painful consequences
 Onset is in early 20’s
 Affects both men and women
 Toxic Effects of stimulants and psychedelic abuse can mimic
bi-polar disorder
Mehdi Azimi, Ph.D.
Other Mental Disorders
 Anxiety Disorder
 Most common
 Affects 16% of adults
 Includes PTSD
 Panic Disorder with or without agoraphobia
 Recurrent panic attacks
 Fear or discomfort in absence of real danger accompanied
by somatic, cognitive or physical symptoms
 Induced by stimulants, marijuana
 Agoraphobia (fear of open spaces)
 Social Phobia (fear of being seen by others)
 Obsessive Compulsive Disorder (uncontrollable intrusive
thoughts and irresistible often distressing actions)
 Generalized Anxiety (Unrealistic Worry about several life
situations)
Mehdi Azimi, Ph.D.
Other Mental Disorders
 Dementia
 Alzheimer’s Disease
 Heavy marijuana use and various prescription drugs can
mimic Alzheimer’s Disease
 Developmental Diseases
 Heavy and frequent use of psychedelics and PCP can be
mistaken for developmental disorders. ADHD, Mental
retardation, autism, communication disorders)
 Somatoform
 Physical symptoms without know causes
 Stimulants can cause delusion of skin infestations
 Personality Disorders
 Borderline and anti-social personality disorders are common
 Usually coexist with substance abuse
Mehdi Azimi, Ph.D.
Other Mental Disorders
 Eating Dusorders



Anorexia
Bulimia
Often found in conjunction to major depression and
PTSD
 Pathological Gambling


More common with alcoholics
Gamblers may use methamphetamine in gambling
trips to Casinos
Mehdi Azimi, Ph.D.
Substance Induced Disorders
 Alcohol Induced Disorders








Violence
Sleep disorders
Unsafe sex
High risk behaviors
45% present with major depressive disorders
After 6 weeks of sobriety on 6% present with
depression
Capable of causing dementia with prominent
cognitive deficits
May occur after decades of use
Mehdi Azimi, Ph.D.
PRINCIPLES OF TREATMENT FOR PSYCHIATRIC
AND SUBSTANCE USE DISORDERS
 Establish and Maintaining Therapeutic Alliance
 Managing Client’s Psychiatric or Substance Use
 Providing Education about Disorders and TX
 Determining need for medications (referrals)
 Developing and negotiating TX Plan
 Enhancing adherence to TX plan
 Helping the Client and family adapt to the psychosocial effects of the
disorders
 Helping client identify factors that precipitate or perpetuate these
disorders
 Initiating efforts to improve functioning
 Facilitating access to services and coordinating resources among
different service providers.
Mehdi Azimi, Ph.D.
STRATEGIES TO IMPROVE
TREATMENT ADHERENCE
 Prepare client for treatment participation
 Focus on enhancing the clients motivation to change
 Attend to the therapeutic relationship
 Facilitate the transition between levels of care
 Focus on the treatment process
 Elicit support from family or significant others
 Monitor major symptoms
 Monitor medication use, side effects, and potential
problems
 Incorporate systems changes in clinical care
Mehdi Azimi, Ph.D.
Clinical Guidelines
 Assess the cultural identity of the individual
(different cultural groups at risk)
 Assess the Cultural schemas regarding
substance use (reasons for using, religious,
social or economic)
 Assess substance use within the cultural and
psychological environment (social stressors and
motivations to use; self medicating behaviors,
race, class gender dominance)
Mehdi Azimi, Ph.D.
Clinical Guidelines
 Assess cultural Aspects of the Clinical
relationship


Clinicians need to critically reflect on own
concepts of mood altering substance use
American Disease Model should not be
used as the only approach Assess cultural
Aspects of the Clinical relationship
Mehdi Azimi, Ph.D.
Substance abuse is a major
public health problem
Chronic illness prevalence
P re v a le n c e (m illio n s )
S tro k e
Ad d ic tio n
Alc o h o lis m
D ia b e te s
H e a rt D is e a s e
S m o k in g
H y p e rte n s io n
0
10
20
30
40
50
60
Costs of chronic illnesses
A nnua l E x pe nditure s (billions )
D ru g Ad d ic tio n
Alc o h o lis m
S tro k e
S m o k in g
D ia b e te s
H e a rt D is e a s e
0
10
20
30
40
50
60
70
80
Productivity losses
Produc tivity L os s e s D ue to C hronic Illne s s e s
($ billions )
D ru g Ad d ic tio n
Alc o h o lis m
S tro k e
S m o k in g
D ia b e te s
H e a rt D is e a s e
0
10
20
30
40
50
60
70
80
BASIC DRUG FACTS
Drugs Are:
 Licit and illict
 Substance affecting the way a person:
Thinks
 Feels
 Acts

Six Types of Psychoactive
Substances
 Narcotics
 Stimulants
 Depressants
 Hallucinogens
 Inhalants
 Cannabis
Narcotics
 Lower perception of pain
 Include:





Opium
Morphine
Codeine
Oxycodone
Heroin
Narcotic Toxicity
 Tolerance/dependency
 Arrhythmia
 Irregular blood pressure
 Impotence
 Tracks/collapsed veins
 Blood clots/CVA
 Hepatitis/AIDS/other infections
 Respiratory depression/cardiac
arrest/coma/death
Stimulants
 Speed the action of CNS
 Include:




Cocaine
Methylphenidate
Amphetamines
Methcathinone
Methamphetamines
Ephedrine
- Ecstasy
Stimulant Toxicity
 Tolerance/dependence
 Anxiety/paranoia/violent behavior/delusions
 Hypertension/CVA/tachycardia
 Endocarditis (in IV users)
 Perforated nasal septum (snorting)
 Skin ulceration/infection
 Teratogenicity
 Hyperthermia
Nicotine
 Is a specific type of stimulant
 Toxicity Includes:





Tolerance/dependence
Cardiovascular disease
Pulmonary disease
Multiple cancers
Teratogenicity
Depressants
 Relax and slow CNS
 Include:



Alcohol
Barbituates
Quaaludes
- Chloral Hydrates
- GHB
- Rohypnol
Depressant Toxicity
 Tolerance/dependence
 Respiratory depression/failure
 Hypertension/cardiac arrest/CVA
 Depressed mental status
 Oral/esophageal cancer
 Hepatitis/cirrhosis/other liver diseases
Hallucinogens
 Affect serotonin levels
 Include:



LSD
PCP
Ketamine
- Psilocybin
- Mescaline (Peyote)
Hallucinogen Toxicity
For LSD, Psilocybin, and Mescaline


Acute anxiety
Flashbacks
PCP and Ketamine




Hyperthermia
Respiratory depression/death
Hypertension/CVA
Psychological dependence (Ketamine)
Inhalants
 Chemicals taken by inhalation
 Three main categories:



Nitrites (butyl or amyl)
Anesthetics (nitrous oxide, halothane,
ether)
Solvents, paints, sprays and fuels
Nitrites
 Relax the smooth muscles
 Toxicity:


Tolerance and withdrawal
Poisoning if accidentally ingested
Anesthetics
 Relax muscles, diminish pain, and lower
breathing and heart rate
 Toxicity

High overdose potential
Solvents, Etc.
 Chemically depress CNS
 Toxicity



Arrhythmia
Sudden Sniffing Death (SSD)
Damage to major organs
Cannabis
 Alters mood and perception of reality
 Includes:




Marijuana
THC
Marinol
Hash/hash oil
Marijuana Toxicity
 Anxiety/panic attacks
 Increased risk of heart attack
 Pulmonary disease
 Lowered sperm count
 Gynecomastia
THE CONTINUUM OF USE
The Continuum of Use
 Drug use can be mapped out on a
continuum:



Experimentation and recreational use
Habituation and abuse
Dependence/addiction
Experimental and Recreational
 Experimental – user tries drug out of
curiosity
 Recreational – use is infrequent but the
user seeks out the drug
Experimental and Recreational
 Frequency of use
 Sources of drug
 Reasons for use
 Effects of drug use
Habituation and Abuse
 Habituation - use becomes a definite
pattern.
 Abuse – use continues in spite of
impaired functioning.
Habituation and Abuse
 Frequency of use
 Sources of drug
 Reasons for use
 Effects of drug use
Dependence/Addiction
 Dependence /Addiction– use increases
with continued use in spite of impaired
functioning.
Dependence/Addiction
 Frequency of use
 Sources of drug
 Reasons for use
 Effects of drug use
Signs and Symptoms of Abuse
 Physical
 Behavioral
Physical Signs
 Change in appetite/eating habits
 Unexpected weight loss or gain
 Ataxia; lack of coordination
 Insomnia; awake at strange times;
lethargy
 Red, watery eyes; dilated/constricted
pupils; blank stare
 Cold, sweaty palms
Physical Signs
 Puffy, flushed, or pale face
 Smell of alcohol or drugs on breath,
body, or clothes
 Extreme hyperactivity/talkativeness
 Rhinorrhea; hacking cough
 Needle marks on lower arms or legs, or
on the bottom of the feet
Physical Signs
 Nausea; vomiting; diaphoresis
 Tremors of hands, feet, or head
 Arrhythmia
Behavioral Signs
 Change in overall attitude/personality
 Changes in friends
 Changes in activities/hobbies
 Drop in grades at school/performance at
work; skips/late for work/school
Behavioral Signs
 Change in habits at home
 Difficulty paying attention; forgetfulness
 An “I don’t care” attitude
 Sudden over-sensitivity, temper
tantrums, or resentful behavior
Behavioral Signs
 Moodiness/irritability/nervousness
 Silliness/giddiness
 Paranoia
 Excessive need for privacy; unreachable
 Secretive/suspicious behavior
 Car accidents
 Chronic dishonesty
Behavioral Signs
 Unexplained need for money; stealing
money/items
 Change in personal grooming habits
 Possession of drug paraphernalia
Recovery
 Addiction does not have to be the last
point on the spectrum
 Many people enter recovery
 Recovery means that the substance
abuser is not using drugs
 Relapse is a normal part of recovery
Relapse
 Normal, predictable part of the recovery
process
 Not all relapses are the same
 Relapse can occur at any time
The Role of Treatment
 Treatment does work
 Treatment has been shown to:





Reduce drug use
Improve mental/physical health
Reduce criminal activity
Reduce high-risk sexual behavior
Improve financial self-sufficiency
Understanding the
Face of Addiction
 Substance use and abuse crosses all
boundaries:




Gender
Age
Race and Ethnicity
Socioeconomic Class