Foundations of Public HealthPH-200 Fall 2008

Week 7

Nutrition and Food Safety

Escherichia coli 0157-H

http://www.scientiafoodsafety.com/super_safemark_classes

Outline

• 9:30 AM – 9:45 AM : Questions and Review

• 9:45 AM – 11:00 AM : Milestones: Nutrition

• 11:00 AM – 11:15 AM : Recess

• 11:15 AM – 12:15 PM : Theoretical Foundations – Natural Sciences

• 12:15 PM – 12:30 PM : Review

Pop-quiz• What is the leading cause of mortality/morbidity in Orange

County?

• How is the burden of disease associated with this cause distributed geographically/demographically in the County?

• What are the major explanatory factors for the distribution?

• What are the preventive strategies in place or that could be implemented to relieve the burden of these diseases in Orange County?

Course AgendaDATE EVENT/TOPIC ASSIGNMENTS DUESeptember 25 Introduction & Orientation -October 2 Essential Functions/Core

Courses/Cross-Cutting Themes-

October 9 Public Health & Law Symposium SUMMARYOctober 16 Causation/Global Burden of

Disease/National Public Health -

October 23 Regional Public Health -October 30 Local Public Health -November 6 Student Presentations in Class SCHOLARLY REVIEW PAPERS DUE

IN DROPBOX

November 13 Transdiciplinary Approaches in the Natural and Social Sciences

-

November 20 Transdisciplinary Approaches in Public Health Practice

-

November 27 THANKSGIVING HOLIDAY NO CLASSDecember 4 Discussion of Proposals in

class/Course Summary-

December 11 FINAL EXAMINATION GRANT PROPOSAL PAPERS DUE IN DROPBOX

Guidelines for Proposal WritingThe purpose of the proposal writing assignment is to build on the scholarly review assignment that focuses on understanding the state of knowledge about a particular disease burden within a socio-demographic scope. The scholarly reviews should reveal questions for further studies to address gaps in public health knowledge or practice.

The proposal should present a comprehensive strategy to advance knowledge in public health, or to translate current knowledge into practices that will improve the health of communities.

The National Institutes of Health (NIH) is the federal agency that supports fundamental and applied research in public health. In addition, NIH supports graduate fellowships and implementation projects.

Other federal agencies including the Environmental Protection Agency also support graduate fellowships on topics related to public health (e.g. see http://epa.gov/ncer/rfa/2009/2009_star_gradfellow.html). In addition, private foundations such as the Bill and Melinda Gates Foundation, and the Robert Wood Johnson Foundation also support public health research and practice.

Proposal Guidelines - continuedThe priority for this assignment is that each student learns the process of turning ideas in public health into substantial proposals that can win awards and help transform those ideas public health support infrastructures and processes.

Each student is free to identify a potential funding agency and structure their proposal writing to accommodate the guidelines of that particular agency. Therefore, please review the list of NIH agencies and read about the agency that most closely works on a topic of interest to you.

In order to ensure fairness in workload, proposals should be 7,000 +/- 500 words.

Feel free to use graphics and images. All proposals should have the following sections:

•Summary•Problem Statement•Hypothesis•Methods (including compliance with Human Subjects ethical treatment guidelines, where applicable)•Budget•Significance of Expected Results

National Institutes of HealthAWARDING COMPONENT (LINK TO WEB SITE)

TELEPHONENUMBER

Eunice Kennedy Shriver National Institute of Child Health and Human Development 301-496-0104

Fogarty International Center 301-496-1653 National Cancer Institute 301-496-3428 National Center for Complementary and Alternative Medicine 301-496-4792

National Center on Minority Health and Health Disparities 301-402-1366

National Center for Research Resources 301-496-6023 National Eye Institute 301-451-2020 National Heart, Lung, and Blood Institute 301-435-0260 National Human Genome Research Institute 301-496-7531 National Institute on Aging 301-496-9322 National Institute on Alcohol Abuse and Alcoholism 301-443-4375

National Institute of Allergy and Infectious Diseases 301-496-7291

National Institute of Arthritis and Musculoskeletal and Skin Diseases 301-594-2463

National Institute of Biomedical Imaging and Bioengineering 301-451-4792

National Institute on Deafness and Other Communication Disorders 301-496-1804

National Institute of Dental and Craniofacial Research 301-594-4800

National Institute of Diabetes and Digestive and Kidney Diseases 301-594-8834

National Institute on Drug Abuse 301-443-2755 National Institute of Environmental Health Sciences 919-541-7723

National Institute of General Medical Sciences 301-594-4499

National Institute of Mental Health 301-443-3367 National Institute of Neurological Disorders and Stroke 301-496-9248

National Institute of Nursing Research 301-594-6906 National Library of Medicine 301-496-4621 Center For Scientific Review 301-435-0715 Agency for Healthcare Research and Quality 301-427-1447

Coordinating Center for Health Information and Services 404-498-1186

Coordinating Center for Infectious Disease 404-639-3770 Coordinating Center for Environmental Health & Injury Prevention 770-488-4668

Coordinating Center for Health Promotion 770-488-8390 Office of Public Health Research 404-639-4621 National Institute for Occupational Safety and Health 404-498-2530

Procurement and Grants Office 770-488-2700 Food and Drug Administration 301-827-7185

Indian Health Service 301-443-0578 Agency for Toxic Substances and Disease Registry 404-842-6630

Office of Population Affairs 301-594-4004

Office of Family Planning 301-594-4008

Nutrition and Public Health• “Medical Geology”

– http://www.medicalgeology.org/welcome_to_the_home_page_of_the_.htm

• Balanced Diet (Building a Food Pyramid on “shifting sands’)

• Pathogens (From E. coli 0157H to Mad Cow Disease)

• Pesticides and Fertilizers– http://www.psrla.org/documents/pesticides_and_human_health.pdf

• Food import/export and Homeland Security– USDA (http://www.fsis.usda.gov/Food_Defense_&_Emergency_Response/index.asp)

• Food and Drug Administration– http://www.fda.gov/

Between deficiency and poisoning

• Natural trace chemicals, crop nutrient values and water supply

Essential

Non-Essential

Medical Geology

• Selenium distribution in the U.S.Selenium is a good antioxidant. Blueberries are good sources of selenium

Selenium-Accumulating Plants• Selenium is accumulated by a

number of plants in sufficient amounts to be toxic if consumed by livestock. Plants that accumulate high amounts of selenium and may require selenium for growth are often found in selenium rich areas. Historically these plants have been called indicator plants.

• The indicator plants include certain species of Astragalus, prince's plume, and some woody asters. The indicator plants may accumulate up to 3000 parts per million (ppm) selenium.

Selenium Toxicosis• Selenium is required in the diet of most animals. Concentrations of

0.3 ppm are recommended for most food producing livestock. Acute selenosis has been associated with ingesting large amounts of selenium such as would happen if animals eat indicator plants (>400 ppm).

• Oral selenium doses of between 1 and 5 mg/kg body weight are considered toxic. Lower doses of between 5 and 40 ppm in the diet for several weeks or months result in chronic poisoning, oftentimes called alkali disease.

• The mechanism of toxicity is not completely understood, but the clinical and morphologic lesions suggest glutathione depletion and secondary lipid peroxidation are important in pathogenesis.

Signs and Lesions of Poisoning • Acute Poisoning:

– Lethargy, nonresponsiveness – Dyspnea with abnormal posture – Unsteady gait – Diarrhea – Abdominal pain (teeth grinding) – Increased pulse, respiration rate and body temperature. – Prostration – Death (Sheep may not show signs and are found dead) – Necropsy and histologic lesions include pulmonary edema, hydrothorax, and pale myocardium. Additionally there

may be mild enteritis and passive congestion of the liver• Chronic Poisoning:

– Dullness – Rough hair coat – Emaciation – Lack of vitality, anemia – Lameness, joint stiffness – Hooves may become overgrown or deformed (circular bumps or breaks below coronary band) – Loss of long hair (horses commonly lose their mane and tail) – Histologic lesions variable but often include cardiomyopathy and liver cirrhosis – Reproductive losses in cattle

Bird flu and Selenium?

• Selenium and immunity

Iodine deficiency

Arsenic

Pellagra and Vitamin B (niacin) deficiency

• Pellagra, a loathsome skin disease, it was called mal de la rosa and often mistaken for leprosy. In the United States, pellagra has often been called the disease of the four D's -- dermatitis, diarrhea, dementia, and death.

Population-level “prevention”• Nutrient additives/supplements

• ITALIAN BREADEnriched flour (wheat flour, barley malt, niacin, iron, thiamin mononitrate, riboflavin, folic acid), water, sugar, contains less than 2% of the following: soybean oil, yeast, salt, wheat protein isolate, wheat gluten, dough conditioners (acetylated tartaric acid esters of mono- and diglycerides, ammonium sulfate, calcium sulfate, ascorbic acid, azodicarbonamide, potassium iodate, amylase [enzymes]), sodium stearoyl-2-lactylate, mineral oil.

“Cheap” public health interventions

• Folic acid deficiency = megaloblastic anemia.

• Riboflavin deficiency = Hypersensitivity to light; the skin becomes greasy, scaly, and dry. There may be cracks, or fissures, at the corners of the mouth, inflammation and soreness of the lips, and a smooth, reddish-purple tongue.

Metabolic Syndrome

Pathogens in Food• How did you vote on

California Proposition-2 (2008)?

• 76 million annual cases of food poisoning in the U.S.– 1/100 hospitalizations– 1/500 deaths

• Salmonella• E. coli O157-H7• Cyclospora

Fast Food Nation

Pesticides and Food Production– http://www.psrla.org/documents/pesticides_and_human_health.pdf

Child of farm workers, born with birth defects attributable to pesticides. Source: Sarasota/Manatee Farmworker Supporters

Genetically engineered foods

• International controversy, but not in the U.S.

What should be the position of public health

professionals?

Golden Rice and the Burden of Blindness

• Golden rice is a variety of rice (Oryza sativa) produced through genetic engineering to biosynthesize beta-carotene, a precursor of pro-vitamin A in the edible parts of rice.

• Vitamin-A Deficiency- VAD is responsible for 1–2 million deaths, 500,000 cases of irreversible blindness and millions of cases of xerophthalmia annually.

Food “security”

• Melamine (“fake” protein)

Regulations

• FDA• USDA• DHS• EPA

• FAO

Public Health Theory

• “You cannot get an ought from an is”– David Hume (1711-1776): Empiricist

• (Descriptive versus Prescriptive)

– critical realism is the theory that some of our sense-data can and do accurately represent external objects, properties, and events, while other of our sense-data (for example, those of secondary qualities and perceptual illusions) do not accurately represent any external objects, properties, and events. In short, critical realism refers to any position that maintains that there exists an objectively knowable, mind-independent reality, whilst acknowledging the roles of perception and cognition.

Induction• The cornerstone of Hume’s epistemology is the so-called Problem

of Induction: it has been argued that it is in this area of Hume’s thought that his skepticism about human powers of reason is the most pronounced.

• The problem concerns the explanation of how we are able to make inductive inferences.

• Inductive inference is reasoning from the observed behavior of objects to their behavior when unobserved; as Hume says, it is a question of how things behave when they go “beyond the present testimony of the senses, and the records of our memory”. Hume notices that we tend to believe that things behave in a regular manner; i.e. that patterns in the behavior of objects will persist into the future, and the unobserved present.

Causation• The notion of causation is closely linked, in Hume, to the problem of

induction. Hume saw induction as reasoning on the basis of patterns in the observed behavior of objects, and these patterns were essentially causal.

• However, Hume’s views on the concept of causation are much disputed. There are (at least) three interpretations in the literature: – (1) the logical positivist interpretation; – (2) the skeptical realist interpretation; and – (3) the quasi-realist interpretation.

• The major disagreement with the positivists focuses on the notion of necessary connection. According to the positivists, as we have seen, causation consists solely in regular succession; but skeptical realists point out that Hume also thought our concept of causation was of that of a necessary relation.

More public health theory please – but make it adequate

• Jim Connelly’s article in Journal of Public Health

• References 3, 4, 6, 8, 9, 12