Pathophysiology of Brain & Body - USSJJQ-20-3

1. Pathophysiology of Brain & Body - USSJJQ-20-3 Introduction 2013/14

2. Staff Dr Rosie Jones (Bristol U/Frenchay)Dr Bahareh Vahabi (UWE)Dr Lynne Lawrance (UWE) Prof Julie Mcleod (UWE)Me (Dave Lush)

3. Support http://www.rags.profile.ac.uk/ modules/2013/PBB (link in Blackboard) Tutorial support for exam Practice exam paper with 1 Q from real exam ‘Skim-feedback’ of draft answers, if possible

4. Delivery ‘The half-flipped classroom’ HCS students Sem 1: 2h lecture + 1h ‘tutorial’ on previously-viewed 2h screencast non-HCS students Sem 1: 2h lecture Sem 2: 1h ‘tutorial’ on previously-viewed 2h screencast

5. Assessment 60% Exam (3 from 6Q, 3h) HCS – Jan; non-HCS - May40% CW (2 essays)HCS - (weeks 14 and 18) –TBCnon-HCS - (weeks 18 and 33) –TBC

6. Pathophysiology “The study of the nature of suffering” Woody Allen…“Life is hard, then you die.”“It’s not that I’m afraid to die. I just don’t want to be there when it happens.”

7. Proposed Syllabus Lectures (sem 1) Intro: Major Health Burdens Neuroanatomy Movement Disorders 1 Movement Disorders 2 Drugs of Abuse 1 Drugs of Abuse 2 Dementias 1 Drugs of Abuse 3 Ageing Respiratory Infections Dementias 2 Inborn Errors Screencasts/tutorials (sem 1 or 2) Intro Blood Pressure Regulation Hypertension Atherosclerosis Coronary Heart Disease/Stroke Congestive Heart Failure Diabetes 1 Diabetes 2 Respiratory: COPD Respiratory: Asthma Renal Failure Exam prep

8. Death rate… indexmundi.com

9. How we die…

10. How others die…

11. Death by broad cause/region/gender…

12. Deathby broad cause/region, 2000 % 75 50 25 Source: WHO, World Health Report 2001 EMR SEAR WPR EUR AFR AMR Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries

13. Deathby broad cause/region, 2000 % 75 50 25 Source: WHO, World Health Report 2001 EMR SEAR WPR EUR AFR AMR Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries

14. The ‘Burden’ of Disease • The high death toll associated with disease is not the whole story • At any one time, hundreds of millions of people worldwide are… • requiring treatment • recovering • permanently disabled • Developing world – communicable disease • Developed world – diseases of affluence • Beyond the burden of personal suffering, society also ‘suffers’ • Economic impact of repeated episodes of illness and long-term disability is substantial

15. Global Burden of Disease (WHO) • Comprehensive and comparable assessment of mortalityandloss of health due to diseases, injuries and risk factors for all regions of the world. • Assessed using the disability-adjusted life year (DALY), a time-based measure that combines • years of life lost (YLL) due to premature mortality • years of ‘healthy’ life lost due to time lived in states of less than full health, but not dead

16. Comparison of the proportional distribution of deaths and YLL by leading cause of death, 2004

18. % Ischaemic heart disease 12.2 Cerebrovascular disease 9.7 Lower respiratory infections 7.1 COPD 5.1 Diarrhoeal diseases 3.7 HIV/AIDS 3.5 Tuberculosis 2.5 Trachea, bronchus, lung cancers 2.3 Road traffic accidents 2.2 Prematurity, low birth weight 2.0 % Lower respiratory infections 6.2 Diarrhoeal diseases 4.8 Depression 4.3 Ischaemic heart disease 4.1 HIV/AIDS 3.8 Cerebrovascular disease 3.1 Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma 2.7 Road traffic accidents 2.7 Neonatal infections and other 2.7 Leading Causes of Mortality and Burden of Diseaseworld, 2004 Mortality DALYs

19. Risk Factors and % Mortality • Maternal and Childhood Under-nutrition

20. Risk Factors and % Mortality • Other nutrition-related risk factors & physical activity

21. Risk Factors and % Mortality • Addictive substances

22. Risk Factors and % Mortality • Environmental risks

23. Risk Factors and % Mortality • Unsafe sex

24. Mortality in Developed Countries • Inactivity, obesity, glucose, cholesterol, blood pressure, tobacco, air pollution • Major determinants relate to Eating, Drinking and Moving • Diet and physical activity key determinants of public health in developed countries! • Long-term influence  chronic conditions • In developed countries chronic diseases of affluence >> communicable diseases • eg cardiovascular disease…

25. CVD Deaths by Region, 2000 (WHO) % Deaths 30 20 10 EMR SEAR WPR EUR AFR AMR Strokes Heart attacks Source: WHO, World Health Report 2001

26. Developing Countries • Circa 7 billion people in world • 5.75 billion live in developing countries • Disease does not recognise national borders, but… • Pattern of disease influenced by… • Geographical/Environmental factors • Socio-political factors (inc GDP) • Population age distributions

27. Population Age Distributions • Developing countries are ‘young’ • increased early mortality  high YLL

28. Per cent distribution of age at death by region, 2004

29. Socio-political: Health & Wealth • 1/3 of World population live on <$1 per day • more than 2 billion people • 1/3 children are malnourished • 1/5 not fully immunised by their first birthday • 1/3 lack access to essential drugs • Mass population movements disrupt healthcare • 2011, UNHCR estimated 10.5m refugees • Densely populated cities with unsafe water and poor sanitation • Generally do not apply to developed world • so what drives mortality in developed countries?

30. Lifestyle & Mortality in Developed Countries • Major determinants relate to Eating, Drinking and Moving – ieLifestyle • mainly diet and physical (in)activity • Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes ‘avoidable’ through changing lifestyle factors? • About 1/3rd of cancers could be prevented by • healthy eating • maintaining normal weight • physical activity throughout the life span • Control of communicable diseases plus time to develop chronic disease  different age distribution of disease burden…

31. Age distribution of burden of disease by income group, 2004

32. Adult Mortality by Cause & Region, 2004

33. Child Mortality by Cause & Region, 2004

34. The Role of Communicable Diseases • Worldwide, infections are biggest killers of children/young adults • ~13 million deaths per year • 1,500 die per hour • 1/2 under five years old • Also, chronic diseases (inc cancers) linked to infection (not necessarily chronic)

35. Communicable Diseasesin Developed Countries • Under-vaccination  outbreaks • 1996 polio epidemic in Greece and Albania • MMR avoidance in UK • Increased drug resistance • Emergence of new pathogenic strains • eg bird flu • Air travel/immigration facilitate transport of infections • A different picture in developing countries…

36. Distribution of child deaths for selected causes by selected WHO region, 2004

37. Communicable Disease – Major Culprits • Six diseases cause 90% of infectious disease deaths (all ages) • HIV • Pneumonia • Tuberculosis • Diarrhoeal disease • Malaria • Measles

38. HIV • Human Immunodeficiency Virus (HIV) • Attacks cells of the immune system  increased susceptible to other infections • Major cause of death is TB • Estimated 34 million people infected worldwide • Though many will not even know it yet • http://www.avert.org/worldstats.htm • 23.5 million people in Africa are infected • 3x increase in China and E Europe since 2000 • Circa 2.5 million new infections and 1.7 million deaths from HIV (2011)

39. Pneumonia • Kills more children than any other infectious disease • children of low birth weight • those with immune systems damaged by malnutrition etc • Many causes are treatable or preventable • But 99% of the deaths occur in developing countries

40. Tuberculosis • Spread in droplets • coughing, sneezing, speaking, kissing, spitting • Someone with active TB may infect 10-15 people per year • “At risk” populations… • areas where TB is common • drug users • health-care workers (inc drug-care) • People who are immunosuppressed

41. Diarrhoea • > 2 million deaths per year, mostly children • lower than before (now saved by oral rehydration therapy) • Leads to rapid fluid loss and death • Colitis, pneumonia, sepsis, hypoglycaemia ,hypokalaemia • 1.5 billion bouts of illness a year in children alone • Multiple causes… • viruses (eg rotavirus), • bacteria (eg campylobacter, salmonella, cholera, shigella) • parasites (eg. Entamoeba) • Cholera and dysentery (shigella) affect adults as well as children • Typhoid and rotavirus mainly affect children • Burden is highest in areas with poor sanitation

42. Malaria • Vector borne infectious disease • Transmitted by female Anopheles mosquito • Caused by protozoan parasites • Very common infectious disease • No vaccine available • Treated with derivatives of quinine or artemisinin • drug resistance, worryingly, is increasing • Estimated 216 million episodes in 2010 • 81% in African region • Estimated 655,000 deaths in 2010 • 90% in Africa • 86% children < 5 years

43. Measles (Rubeola) • Possibly the most contagious human disease • 2008: 164,000 deaths • Prior to 1980, ~2,600,000 deaths (before global vaccination push) • Rubeola virus directly responsible for more child deaths than any other single microorganism • Also causes blindness, deafness, brain and lung damage, stunted growth and development • Societal ‘burden’

44. Global Trends

45. Global projections for selected causes, 2004 to 2030 • Cancers • Ischaemic HD • Stroke • Acute respiratoryinfections • Road trafficaccidents • Perinatal • HIV/AIDS • TB • Malaria • Updated from Mathers and Loncar, PLoS Medicine, 2006

46. Projected deaths by cause and income, 2004 to 2030 • Intentional injuries • Other unintentional • Road traffic accidents • Other NCD • Cancers • CVD • Mat//peri/nutritional • Other infectious • HIV, TB, malaria

47. Ten leading causes of burden of disease, world, 2004 and 2030

48. Prevalence of Diabetes in Adults(millions of people, by WHO Region) Source: World Health Report, 1997

49. So, a good time to be alive? Yes! • 3000 BC - 18 years • 275 BC - 26 years • 1900 AD - 49 years • 1980 AD - 76 years • 2002 AD - 85 years • 2020 AD - 90 years?