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Public Health: On the Verge of Discovery  Joseph J Grenier MD MPH Walden University: PhD in Epidemiology Program Walden Un...
What is Public Health? <ul><li>Scholarly pursuit of populational health, and administrative & scientific practice of the h...
Epidemiology: Definition <ul><li>The study of the incidence, prevalence, and geographical distribution of diseases in defi...
Statistics: <ul><li>Calculate attributable risk and use various tests such as students’ t test of significance and p value...
Short History of Public Health <ul><li>Sanitary Movement in the 1860s following the Civil War, focusing on clean drinking ...
Leading Names in Public Health <ul><li>1989 T cell retrovirus, the cause of AIDS by Joseph Gallo MD, NIH. </li></ul><ul><l...
Type 1 Diabetes Mellitus Familial, genetic susceptibility with childhood to young adult onset. Precipitated by a viral ill...
Type II Adult Onset Diabetes <ul><li>Etiology: overweight, obesity, genetics. </li></ul><ul><li>Symptoms: Polyuria, nausea...
Cancers <ul><li>Etiology: cig smoking, tobacco, genetics, radiation exposures, aging, immune system response mutations. </...
Infectious Diseases <ul><li>AIDS/HIV: antiretroviral therapy plus immune boosters. Safe-sex practices, sexual abstinence, ...
Infectious Diseases <ul><li>Surveillance for emerging & reemerging illnesses. Some random testing & periodic testing as wi...
Common Adult Diseases: <ul><li>Coronary artery disease w atherosclerosis. </li></ul><ul><li>Peripheral vascular disease. B...
Mental Disorders: <ul><li>Pharmacotherapy, psychotherapy, & church/community involvement.  Active lifestyle advocated. </l...
Mental/Substance Disorders: <ul><li>Depression, Manic-depression, Schizoaffective illnesses. </li></ul><ul><li>Schizophren...
Types of Mental/Substance Dis. <ul><li>Depression, Manic-depression, Schizoaffective illnesses. </li></ul><ul><li>Schizoph...
Environmental Teratogens: <ul><li>Syphilis, rubella, toxoplasmosis, mercury poisoning from fish. </li></ul><ul><li>Wasserm...
Genomic Medicine <ul><li>Breast cancer risk genes: BRCA1 & BRCA2. </li></ul><ul><li>Markers are used: phenylalanine in new...
Human Genome Project (NIH): <ul><li>Heart disease, some cancers, diabetes, Alzheimer’s disease are all related to inherite...
HIV & AIDS Cases in Iowa: 1 www.scottcountyhealthdepartment/iowa.com AIDS 2004 70 AIDS 2003 75 AIDS 2002 91 AIDS 2001 89 H...
AIDS in Iowa <ul><li>Moderate decrease in number of clinical AIDS cases with a moderate increase in number of HIV cases re...
  Obesity amongst college students in Scott County, IA & State of Iowa  1   Schneider MJ (2006) Introduction to Public Hea...
Obesity: State of Iowa vs Scott <ul><li>The relative incidence (% of population) of overweight is almost the same in Scott...
Infectious Diseases: Iowa State vs. Scott County (2001-2004) 1 www.scottcountyhealthdepartment/iowa.com 0 2 2 0 23 147 16 ...
West Nile Virus <ul><li>In 2003 West Nile Disease became of major public health problem in Iowa. </li></ul><ul><li>Scott C...
Conclusions: <ul><li>Bioterrorism is still a lurking nemesis which should be treated like emerging & re-emerging infectiou...
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Final Project

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Overview of the public health profession from an academic standpoint

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  1. 1. Public Health: On the Verge of Discovery Joseph J Grenier MD MPH Walden University: PhD in Epidemiology Program Walden University Online Essentials of Public Health: A Case Studies Approach Dr. T. Rhodes August 12, 2008
  2. 2. What is Public Health? <ul><li>Scholarly pursuit of populational health, and administrative & scientific practice of the health of populations, communities, and society with the goal to protect the health of individuals composing a community. </li></ul><ul><li>One of the goals is to safeguard the well-being of communities inc./ advancing positive social change. </li></ul><ul><li>Walden’s mission is to train health educators and practitioners protecting society’s health & effecting positive social growth & change with a reduction in health disparities amongst socioeconomic, cultural, and racial groups. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw-Hill Publishers, Inc. </li></ul>
  3. 3. Epidemiology: Definition <ul><li>The study of the incidence, prevalence, and geographical distribution of diseases in defined populations. </li></ul><ul><li>Prospective studies: following risk factors and disease incidence into the future. </li></ul><ul><li>Retrospective studies: looking for factors & risk factors in patients’ histories from present back into the past. </li></ul><ul><li>Cohort studies: following large numbers of cases in control & experimental groups looking at concurrent risk factors. Goal to calculate attributable risk. Relative risk is looked at concurrently. Calculate AR from RR. </li></ul><ul><li>Case control studies: usually double blind placebo controlled studies of clinical trials using a new experimental drug or pharmacologic agent. May test a combination of drugs in cases such as Caduet, a blood pressure & cholesterol combined pill. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2 nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  4. 4. Statistics: <ul><li>Calculate attributable risk and use various tests such as students’ t test of significance and p value. </li></ul><ul><li>Two sided alternative hypothesis: test statistic = (observed value – hypothesized value)/(standard error of observed value). </li></ul><ul><li>Determine null hypothesis H0. Decide on alternative hypothesis. </li></ul><ul><li>Standard error = (population standard deviation)/ square root of the sample size). </li></ul><ul><li>Logistic Regression is involved with a binary variable & a series of unknown exposures or risks taken in the presence or absence of disease. Log it(p) = a + b 1 x 1 + b 2 x 2 + b n x n </li></ul><ul><li>Cox proportional hazards or Cox regression is an app of the hazard, with a particular result (endpoint) given several variables of interest or several exposures in time: λ (t) = λ n (t) exp ( β 1x 1 + β 2x 2 + β nx n ) . </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2 nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul><ul><li>Feigin VL & DA Bennett (2007) Handbook of Clinical Neuroepidemiology, New York, NY, Nova Science Publishers, Inc. </li></ul>
  5. 5. Short History of Public Health <ul><li>Sanitary Movement in the 1860s following the Civil War, focusing on clean drinking water, clean streets, & proper disposal of waste. </li></ul><ul><li>Pre-1850s cholera and salmonella outbreaks were common. </li></ul><ul><li>July 1, 1879, the National Board of Health was founded. They had the right to set up quarantine hospitals in the light of outbreaks. </li></ul><ul><li>In the 1870s the American Public Health Association helped establish a Marine Hospital & joined with the AMA to create a national board of health. </li></ul><ul><li>In the 1880s, Dr. VC Vaughan (MI) & Dr. Charles Hewitt (MN) first pointed out the TB problem as a communicable illness. </li></ul><ul><li>After 1900, State & Local Boards of Health were established to focus on populational health & to begin to set standards for sanitation. </li></ul><ul><li>Diphtheria toxin/antitoxin vaccine used in 1920s to immunize children. </li></ul><ul><li>1950s-60s Sabin/Salk vaccine for polio. </li></ul><ul><li>1989 Discovery of T cell retrovirus HIV, the cause of AIDS, by NIH’s Joseph Gallo MD. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2 nd edition, Sudbury, MA, Jones & Bartlett Publishers. </li></ul><ul><li>2 Duffy John (1992) The Sanitarians: A History of American Public Health, Urbana, IL, The University of Illinois Press. </li></ul>
  6. 6. Leading Names in Public Health <ul><li>1989 T cell retrovirus, the cause of AIDS by Joseph Gallo MD, NIH. </li></ul><ul><li>1976 team led by David W. Frasier found Legionella pneumophila as cause of Legionairres’ Disease. </li></ul><ul><li>1865 Louis Pasteur (Fr) created a rabies vaccine for clinical use several years after having declared the Germ Theory of Disease. </li></ul><ul><li>1900 The Nobel Foundation was established shortly after which several Nobel Prizes in Medicine were awarded for infectious diseases in the years to follow. Emil von Behring won the first Nobel for development of antitoxic immunity with reference to the diphtheria vaccine. Emil also discovered the tetanus vaccine. </li></ul><ul><li>In 1996 Peter Doherty & Rolf Zinkernagel were both awarded the Nobel for immunity bases against viral infections. </li></ul><ul><li>In 1945, Alexander Fleming, Ernest Chain & Howard Florey won the Nobel for the discovery of Penicillin & its actions. </li></ul><ul><li>In 1952. Selman Waksman won a Nobel for the discovery of the actions of antibiotic streptomycin. </li></ul><ul><li>In 1939 Gerhard Domagk was awarded the Nobel & gold medal for the study of Prontosil’s antimicrobial action. </li></ul><ul><li>There have been many other discoveries in medicine, microbiology, & public health which have changed society and improved disability, mortality, and illnesses that have been left out. </li></ul><ul><li>1 Rifkind D, & GL Freeman (2005) The Nobel Prize Wining Discoveries in Infectious Diseases, New York, NY, Elsevier Science Inc. </li></ul>
  7. 7. Type 1 Diabetes Mellitus Familial, genetic susceptibility with childhood to young adult onset. Precipitated by a viral illness Weight loss, polyuria, polydipsia, nausea, vomiting as initial symptoms Labs: Hyperglycemia, hypoosmolality, hypoglycemia Treatment: Insulin: long, intermediate, & short acting forms Complications: nephropathy w renal failure, retinopathy, cataracts, neuropathy, coronary & peripheral vascular disease Education & preventive public health initiatives with individual approaches 1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. 2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc.
  8. 8. Type II Adult Onset Diabetes <ul><li>Etiology: overweight, obesity, genetics. </li></ul><ul><li>Symptoms: Polyuria, nausea, hypoglycemic attacks w dizziness/confusion </li></ul><ul><li>Treatment: Oral hypoglycemic agents: eg sulphonylureas </li></ul><ul><li>Preventive measures with education on weight, exercise, good nutrition, & compliance. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  9. 9. Cancers <ul><li>Etiology: cig smoking, tobacco, genetics, radiation exposures, aging, immune system response mutations. </li></ul><ul><li>Symptoms: organ specific, e.g. lung cancer w cough, hemoptysis, weight loss. </li></ul><ul><li>Treatment: resective surgery, radiation, chemotherapy, gene & oligo. Therapies. </li></ul><ul><li>Public health campaigns to quit smoking, good nutrition, weight loss, physical fitness, mental and emotional counselling through family doctor, psychiatrists, psychologists, & social workers. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  10. 10. Infectious Diseases <ul><li>AIDS/HIV: antiretroviral therapy plus immune boosters. Safe-sex practices, sexual abstinence, work on vaccines in research. </li></ul><ul><li>No multiple exposures. Automatic disclosure to health departments & sexual partners. </li></ul><ul><li>STDs: reportable to health departments and primary prevention with safe sex practices. Safe sex everytime, not some of the time. </li></ul><ul><li>Unusual diseases: West Nile Virus: spraying for mosquitoes; yellow fever: virus vaccine available: trips to Asia and India. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  11. 11. Infectious Diseases <ul><li>Surveillance for emerging & reemerging illnesses. Some random testing & periodic testing as with PrPc (Prion Protein Cellular Isoform) protective PrPSc (scrapie disease causing isoform. </li></ul><ul><li>Testing mosquitoes for West Nile Virus both seasonal & nonseasonal. </li></ul><ul><li>Salmonella outbreak: bioterrorism vs. sporadic? </li></ul><ul><li>Many garden vegetables tested in salmonella outbreak. Certain tomatoes & Mexican jalapenos implicated in over 1300 cases described. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  12. 12. Common Adult Diseases: <ul><li>Coronary artery disease w atherosclerosis. </li></ul><ul><li>Peripheral vascular disease. Both need adherence to food pyramid, exercise, & abstinence from cig smoking & tobacco. </li></ul><ul><li>Alzheimer’s disease: Aricept, fitness, active life style promotion. Reading helps severity & onset of disease. </li></ul><ul><li>Depression: counselling for children and combined approaches inc. pharmacotherapy for adults, e.g. SSRIs, atypical antidepressants: trazodone, effexor. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  13. 13. Mental Disorders: <ul><li>Pharmacotherapy, psychotherapy, & church/community involvement. Active lifestyle advocated. </li></ul><ul><li>Support groups: MDDA (Manic depressive & Depressive Association) </li></ul><ul><li>For the school age students rec. afterschool sports, social events, & community involvement. Boys & Girls Clubs of America, Girl Scouts, Cub Scouts. Parental involvement at social events, etc. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  14. 14. Mental/Substance Disorders: <ul><li>Depression, Manic-depression, Schizoaffective illnesses. </li></ul><ul><li>Schizophrenia, Autism, Impulse Control disorders, Adjustment reactions, Asperger’s syndrome. </li></ul><ul><li>Attention deficit Hyperactivity Disorder </li></ul><ul><li>Cocaine, methamphetamine, PCP, cannabis, & alcohol abuse </li></ul><ul><li>Obsessive compulsive disorder, behavioral disorders. </li></ul><ul><li>Management is primary, secondary, and tertiary prevention and active interventions. Supportive approach with families and avoidance of overinvolvement as the caveat. Financial support and community outreach programs involving socioeconomic support. </li></ul><ul><li>Raising funds for certain causes like diabetes, depression, breast cancer. Medication plays a key role now in adult management. Medication in children plays a role but is now more controversial. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  15. 15. Types of Mental/Substance Dis. <ul><li>Depression, Manic-depression, Schizoaffective illnesses. </li></ul><ul><li>Schizophrenia, Autism, Impulse Control disorders, Adjustment reactions, Asperger’s syndrome. </li></ul><ul><li>Attention deficit Hyperactivity Disorder </li></ul><ul><li>Cocaine, methamphetamine, PCP, cannabis, & alcohol abuse </li></ul><ul><li>Obsessive compulsive disorder, behavioral disorders. </li></ul><ul><li>Management is primary, secondary, and tertiary prevention and active interventions. Supportive approach with families and avoidance of overinvolvement as the caveat. Financial support and community outreach programs involving socioeconomic support. </li></ul><ul><li>Raising funds for certain causes like diabetes, depression, breast cancer. Medication plays a key role now in adult management. Medication in children plays a role but is now more controversial. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  16. 16. Environmental Teratogens: <ul><li>Syphilis, rubella, toxoplasmosis, mercury poisoning from fish. </li></ul><ul><li>Wasserman test for syphilis in premarital couples now eliminated by most states. </li></ul><ul><li>Fetal alcohol syndrome: microcephaly, mental retardation, & several other anomalies due to drinking during gestation. </li></ul><ul><li>Dilantin, DES, tetracycline, & accutane induce other birth defects. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  17. 17. Genomic Medicine <ul><li>Breast cancer risk genes: BRCA1 & BRCA2. </li></ul><ul><li>Markers are used: phenylalanine in newborns with Phenylketonuria (PKU). Urine test developed by Dr. Robert Guthrie. </li></ul><ul><li>T3, T4, & TSH test for thyroid disease in newborns. Hypothyroidism can lead to mental retardation &/or dwarfism. </li></ul><ul><li>Tandem mass spectrometry used in metabolic disorder screening. </li></ul><ul><li>Cystic fibrosis can be tested for but there are hundreds of genes involved. Sweat chloride test is used in childhood screening. Parents can be tested for carrier status. Tay-Sachs Disease in Jewish descendants can be tested for. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  18. 18. Human Genome Project (NIH): <ul><li>Heart disease, some cancers, diabetes, Alzheimer’s disease are all related to inherited/genetic markers & factors. </li></ul><ul><li>Implications for responsiveness to various medications. New drugs have extended lifespans for cancers, melanomas, and leukemias, & other major illnesses. </li></ul><ul><li>Huntington’s 30-50s yo onset w autosomal dominant inheritance; offspring 50% chance app of contracting the illness. Mental, psychiatric, and motor neurological symptomatology. </li></ul><ul><li>Some guidelines for testing: child at risk, prenatal tests accompanied by education & counselling before & after. High quality testing standards, more genetic education for the general public. </li></ul><ul><li>We have cloned the human genome and are sequencing it now. Functional genetics of various markers & polymorphisms offers great hope for future generations. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  19. 19. HIV & AIDS Cases in Iowa: 1 www.scottcountyhealthdepartment/iowa.com AIDS 2004 70 AIDS 2003 75 AIDS 2002 91 AIDS 2001 89 HIV 2004 104 HIV 2003 88 HIV 2002 65 HIV 2001 82
  20. 20. AIDS in Iowa <ul><li>Moderate decrease in number of clinical AIDS cases with a moderate increase in number of HIV cases reported. Mixed messages & interpretations from this interesting data. </li></ul><ul><li>Testing for HIV w Western Blot test or antibody test. </li></ul><ul><li>Few numbers for HIV cases increasing slowly. </li></ul><ul><li>Lower than National averages for other states. </li></ul><ul><li>Safe sex and parental guidance likely contributory factors in prevention in Iowa. Consistent with safe sex & sexual histories taken from high school students & grade school age adolescents. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  21. 21. Obesity amongst college students in Scott County, IA & State of Iowa 1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. 2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. 3.www.scottcountyhealthdepartment/iowa.com ++++ 21% 3-5X/wk +++ 26.8% 1-2X/wk +/_ 5.3% Never 23.4% Iowa State % obese 37.2% Scott Cty overweight 2002 QCA college students surveyed. How much per wk. do you eat fast food or junk food??
  22. 22. Obesity: State of Iowa vs Scott <ul><li>The relative incidence (% of population) of overweight is almost the same in Scott Cty vs. State of Iowa. </li></ul><ul><li>The relative incidence of obesity is almost the same in Scott vs. all of Iowa. </li></ul><ul><li>This suggests that obesity is a significant public health problem in this state & needs a plan of action. </li></ul><ul><li>In conclusion, obesity is a problem of childhood and adulthood and the approaches to its prevention and treatment need aggressive strategies. </li></ul><ul><li>Better exercise, better nutrition, and better sleep every night are proven factors which can deal with the problem. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  23. 23. Infectious Diseases: Iowa State vs. Scott County (2001-2004) 1 www.scottcountyhealthdepartment/iowa.com 0 2 2 0 23 147 16 0 West Nile 1 2 2 0 47 35 29 33 TB 0 0 0 0 2 3 7 5 RMSF 1 12 7 5 49 72 65 54 Lym 1 10 0 44 50 40 72 41 Hep A
  24. 24. West Nile Virus <ul><li>In 2003 West Nile Disease became of major public health problem in Iowa. </li></ul><ul><li>Scott County on the other hand only had a couple of cases in 2002 & 2003. </li></ul><ul><li>Scott County lies in the Mississippi River valley & is susceptible to flooding like happened in 1993 & 2008. Other areas of Iowa have major riverbeds so that they are at risk also. </li></ul><ul><li>Water reservoirs breed mosquitoes potentially so eliminating standing water should be done as much as possible. </li></ul><ul><li>West Nile Disease is one of those emerging Middle East derived illnesses which is a viral exanthem progressing eventually to neurologic involvement including in severe cases, encephalitis. It can be fatal. There is no treatment or vaccine. </li></ul><ul><li>1 Schneider MJ (2006) Introduction to Public Health 2nd edition, Sudbury, MA, Jones & Bartlett Publishers, Inc. </li></ul><ul><li>2 Braunwald, Fauci, et al. (2008) Harrison’s Principles of Internal Medicine New York, NY, McGraw Hill Publishers Inc. </li></ul>
  25. 25. Conclusions: <ul><li>Bioterrorism is still a lurking nemesis which should be treated like emerging & re-emerging infectious diseases. </li></ul><ul><li>AIDS remains the number one rife illness and HIV seropositivity is expanding in Iowa, suggesting that more could be incubating the retrovirus. </li></ul><ul><li>TB (Russia & eastern Europe mostly), rickettsial diseases (US primarily), and malaria (Africa, Asia, & South America) remain problems. </li></ul><ul><li>Genomic Medicine holds promise to extend the lifespan through disease marker identification & by stem cell/gene therapies. </li></ul><ul><li>The chief problem this year 2008 in Iowa is the massive flooding throughout the state which holds the potential for water born illnesses like fungal infections, West Nile Virus, & Cholera. </li></ul><ul><li>Overall, I give an A to the United States for dealing with disease, mental health, and natural disasters. </li></ul>

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