预防医学期末总结

1、营养学部分【lipid】1. 形式：游离: 游离脂肪酸、游离胆固醇 free form： free fatty acid, free cholesterol 酯化：单/双/三甘油酯，磷脂，胆固醇酯 Esterified form: mono-/di-/tri-glycerides, phospholipids, cholesterol esters2. 甘油三酯作用 triglycerides: 提供能量：provide energy for the body 储存能量：storing energy for late use 绝缘、保护身体：insulating and protecting

2、the body 运输脂溶性维生素：transporting fat-soluble vitamin3. 磷脂作用 phospholipid: 细胞膜和脑的组成部分 component of cell membrane and brain 乳化剂：亲水基-P/N 疏水基-脂肪酸 emulsifiers: loving water-phosphorus and nitrogen; fear water-fatty acid 4. 固醇作用 sterol 激素：皮质激素，雌激素，雄激素，Vd Hormone: corticosteroid, estrogen, testosterone, vita

3、min D 身体每天产生700mg 胆固醇，400用于合成胆汁酸（bile acid），50用于合成激素5. 分类：1) 链的长度：长链：12-26 C2) 饱和程度：饱和-棕榈酸酯，硬脂酸酯 palmitate, stearate 不饱和：多不饱和-w3 PUFA:DHA, ALA-亚麻酸, EPA w6 PUFA:AA, LA亚油酸, -亚麻酸 linolenic acid 可降低冠心病 单不饱和-油酸-棕榈油酸 oleic acid, palmitoleic acidW3:w6 最好在1:11:46. 必需脂肪酸 essential fatty acid人体不可缺少而自身又不能合成，必须

4、通过食物供给，包括亚油酸，-亚麻酸Fatty acids that humans and other animals must ingest because the body require them for good health but cannot synthesize them. Eg. -linolenic acid，linolic acidConditionally essential FAs: w3:二十二碳六烯酸 docosahexaenoic acid w6:-亚麻酸7. 反式脂肪酸 trans fatty acid: 直线 快餐 心血管疾病 94 Danish Nutrit

5、ion Council 首次提出2002 intitute of medicine report强调应尽量减少trans 摄入2004 US dietary guidelines adcisory committee 说摄入小于能量的1%1) 促进AS等cariovascular disease, prostate/breast cancer及diabetes, obesity,Alzheimers disease, infertility2) 降低HDL,升高LDL8. 选择怎样的脂类？通常：低饱和FA，高不饱和 高w-3 USFA, 低w-6 USFA 少或无trans FA9. 脂肪转运

6、：fat transporters:乳糜颗粒chylomicronsVLDLLDLHDL(好，从组织运到肝脏，应)10. 心血管疾病的危险因素 risk factors for cardiovascular diseases1) 总固醇 total chol200mg/d, LDL130mg/d2) HDL35mg/d3) Age4) Smoking5) Obesity6) inactivity11. 如何降低LDL1) 饱和脂肪酸和胆固醇2) 血中甘油三酯triglycerides3) 单不饱和和多不饱和4) 膳食纤维5) HDL(exercising, adequate alcohol)【

7、protein】1. 八种必须氨基酸：“借一两本，带色书来”：缬氨酸Valine、异亮氨酸Isoleucine、亮氨酸Leucine、苯丙氨酸Phenylalanine、蛋氨酸（甲硫氨酸）Methionine、色氨酸tryptophan、苏氨酸Threonine、赖氨酸lysine组氨酸Histidine是婴儿时期必需氨基酸2. 蛋白质作用 人体组成成分vital body constituents 激素和酶hormones and enzyme 免疫功能-免疫球蛋白 运输 体液、酸碱平衡 转化为糖 提供能量15%的能量3. Protein-energy malnutrition 蛋白质能量营

8、养不良症 消瘦 marasmus: 严重缺乏 severe energy and protein deficit 无皮下脂肪 subcutaneous fat 恶性营养不良病PEM、Kwashiorkor:中度moderate energy deficit with severe protein deficit 感染、无精打采listlessness、水肿、长不高不重 混合型4. 预防和治疗 提供足够营养，尤其是蛋白质摄入 主要预防措施：头六个月母乳喂养 breastfeeding 对于Kwashiorkor病人，应逐渐补充蛋白质gradually 对于消瘦Marasmus病人，不仅仅治病还要

9、治疗并发症，包括感染、脱水、循环疾病（这些易致死且易被忽略）【vitamins】1. 身体能合成的：Vd、Vk、niacin（烟酸）色氨酸（tryptophan）合成2. 脂溶性fat-soluble:A(retinol视黄醇)/D/E（tocopherol生育酚）/K3. 水溶性water-soluble ：B/C（抗坏血酸ascorbic acid） 易吸收 absorbed easily 不易储存 cannot be retained for a long period by the body(除Vb12) 易分泌 easily excreted in the urine wheneve

10、r plasma levels exceed re 易被烹饪损害4. 维生素A的功能 维持正常视觉 vision 促进细胞生长、分化 cellular growth and differentiation 增强免疫 immunity 细胞表面功能 cell surface function 其他：生殖、骨骼发育、抗癌 reproductive/bone development and maintenance/anti-cancer5. 维生素D来源 食物获取D3，主要有动物性食品及鱼肝油制剂（fish/egg/milk/soy beverages/margarine fortified wit

11、h Vd） 在阳光照射下，皮肤合成 produced naturally from sunlight by skins epidermis6. 维生素D的功能 骨骼：钙磷平衡；合适的矿化 bone: calcium and phosphate homeostasis; required for proper mineralization 甲状旁腺激素PTH：homeostasis 肌肉：钙运输；蛋白合成；肌肉收缩动力学 calcium transport; protein synthesis; kenetics of muscle contraction 免疫：内源性免疫 promotes i

12、nnate immunity 胰脏：胰岛素 promotes insulin secretion 心血管：负性调节肾素血管紧张素系统 negative regulator of the rennin-angiotensin system 细胞周期：抑制增殖，刺激分化Cell cycle: inhibits cell proliferation; stimulates differentiation7. 膳食参考摄入量dietary reference intakes 平均需求量Estimated average requirement(EAR) 膳食许可量Recommended dietary

13、 allowance(RDA) 适宜摄入量Adequate intake（AI） 可耐受最高摄入量Tolerable upper intake level(UL)8. IOM adequate intakel 5g(200IU) infant50l 10g（400IU）5170l 15g（600IU）709. Serum 25-OHD cut-offl 25-27.5 nmol/L Deficient l 37.5 nmol/L Inadequacy for bone health l 220 nmol/L “no observed adverse effects” (10,000IU)* l

14、 375500 nmol/L potentially Toxic 【water】【minerals】1. 特性properties 体内不能合成 粪、尿分泌，食物供给 安全范围窄，易超标造成毒性 中国人易缺钙、铁、锌、碘2. 分类 Macromineral常量元素:K/Ca/Na/Mg/S/Cl/P 钾钙钠镁硫氯磷 Trace element微量元素：必需微量元素:铜、铁、锌、碘、硒 Essential miroelements: copper, iron, zinc, iodine, selenium 可能必需微量元素： 潜在毒性但低剂量有必需功能:铅、砷 Minerals potentia

15、l toxicity: lead, arsenic3. 钙：占体重5%2%，99%是骨和牙齿，与甲状腺激素、甲状旁腺激素、Vd有关 RNI 1000mg/d作用： 骨和牙齿的矿化作用 mineralization 酶调节凝血 enzyme regulationclotting of blood 神经传导 nerve conduction 肌肉收缩 muscle contraction 膜渗透性 membrane permeability【营养调节】1. patient care: team approach 内科医师Physician 注册营养师Registered Dietitian 注册/

16、领照护士Registered Nurse, Licensed Vocational Nurse, Certified Nursing Assistant 药剂师Pharmacist 语言治疗师Speech Therapist 职业疗法专家Occupational Therapist 社工Social Worker 2. the nutrition care process: Identifying and meeting a persons nutrient and nutrition education neds. Five steps: 1. Assess Assessment of nu

17、tritional status 评定营养等级2. Analyze Analyze assessment data to determine nutrient requirements 分析评估数据决定营养需要3. Develop Develop a nutrition care plan to meet patients nutrient and education needs. 制定营养计划4. Implement: Implement care plan 实施5. Evaluate: Evaluate effectiveness of care plan: ongoing follow-

18、up, reassessment, and modification of care plan. 评价疗效和修订 3. assessing nutritional status Historical Information Physical Examination 体重Weight status 移动度Mobility 营养不良症状Signs of nutrient deficiencies/malnutrition: hair, skin 体液平衡Fluid balance(dehydration/fluid retention) Anthropometric Data 人体测量数据间接测量

19、身体成分和发展Indirect assessment of body composition and development 营养评估Used in Nutrition Assessment: 测量身高体重Measures using height and weight ：BMI 测量身体成分Measures of body composition (fat vs. lean tissue) l 体脂测量：皮肤褶，腰臀比，水下称重，生物电阻抗Body fat measurements: fatfold (skinfold) ,waist-to-hip ratios, hydrodensitom

20、etry (hydrostatic weighing), bioelectrical impedance l 中臂肌肉围度+三头肌皮褶Midarm muscle circumference+triceps fatfold Functional Measures Laboratory Analyses 蛋白质：体/血清蛋白Protein: somatic Serum: liver function/albumin/prealbumin/nitrogen balance(UUN) 免疫功能：白细胞、淋巴细胞Immune function: WBC, total lymphocyte count 血

21、液评估Hematology assessment: Hb, HCT, MCV 其他：glucose, creatinine, sodiumPpt- Air pollution and human health 1. 【air pollution】the introduction into theatmosphereofchemicals,particulates, orbiological materialsthat cause discomfort, disease, or death to humans, damage other living organisms such as food

22、 crops, or damage thenatural environmentorbuilt environment. any substance present in or released to the atmosphere that adversely affects environmental or human health is considered an air pollutant categories: primary/ secondary大气中化学、颗粒、生物材料/给人类造成不适、疾病、死亡，或损伤其他微生物，或损伤自然/建设环境任何存在于或释放到大气的会对环境和人类健康造成

23、不良影响的物质分为初级和次级污染【primary pollutant】 emitted directly into the atmosphere where they exert an adverse influence on human health or environment. such as ash from a volcanic eruption, the carbon monoxide gas from a motor vehicle exhaust or sulfhur dioxide released from factories. Of particular concern

24、are six primary pollutants emitted in large quantities： carbon dioxide, carbon monoxide, sulfur oxides, nitrogen oxides, hydrocarbons, and particulates. 直接释放到大气，给人类健康和环境造成不良影响 比如：火山喷发-CO，汽车尾气-硫氧化物 6种基本污染物：CO,CO2，硫氧化物，氮氧化物，碳氢化合物，颗粒【secondary pollutant】 Once in the atmosphere, primary pollutants may r

25、eact with other primary pollutants or atmospheric compounds such as water vapor to form secondary pollutants, eg. acid precipitation 初级污染物一旦排入大气会与其他初级污染物或大气成分（水蒸气）反应而形成，比如酸雨 a secondary pollutant formed when sulfur or nitrogen oxides react with water vapor in the atmosphere. 次级污染物通常为硫氧化物和氮氧化物与水蒸气结合【

26、photochemical smog】 a noxious smog produced by the reaction of nitrogen oxides with volatile organic compounds(VOCs) in the presence of ultraviolet light from the sun. 有害气体：氮氧化合物与VOCs在太阳紫外线照射下产生 the reaction is very complex 反应复杂 The products include ozone, peroxyl nitrates(PANs) and aldehydes 产物包括臭氧

27、、PANs和甲醛 more than 85% of the products is ozone85%是臭氧 is also known as brown smog because of its characteristic color, given to it by nitrogen dioxide, a brown gas又称为棕色烟雾，因为其颜色，源于二氧化氮的颜色 The incomplete combustion of fossil fuels, particularly from automobiles, is primary man-made source of volatile

28、organic compoundsVOCs的人为主要来源为汽车化石燃料的不完全燃烧【global warming】 an increase in the average temperature of the earths atmosphere (especially a sustained increase that causes climatic changes) 平均温度上升尤其是持续的改变 The most likely and most worrisome effects changes in rainfall patterns (some places will become muc

29、h dryer and others much wetter) 降雨格局的改变，有的地方多，有的少 changes in growing seasons 生长期改变 changes in arable land 耕地 Changes in rising sea levels and ocean current flow 海平面与洋流 Changes in ecosystem, economy, agriculture, industry, settlements and related to all these the health and living 生态系统、经济、农业、工业、居住等一系

30、列与健康生存有关的【greenhouse gas 】 a gas in an atmosphere that absorbs and emits radiation within the thermal infrared range. 大气中可吸收和释放红外线范围内辐射的气体 This process is the fundamental cause of the greenhouse effect 造成温室效应的基础原因 the most abundant greenhouse gases in Earths atmosphere are: water vapor carbon dioxid

31、e Methane nitrous oxide Ozone Chlorofluorocarbons 温室气体有：水蒸气，CO2，甲烷，氮氧化合物，臭氧，氯氟烃【greenhouse effect 】 the rise in temperature that the Earth experiences because certain gases in the atmosphere (water vapor, carbon dioxide, nitrous oxide, and methane, for example) trap energy from the sun. 地球正在经历的体温升高，

32、因为大气中某种气体（水蒸气、CO2、氮氧化合物、甲烷等）吸收来自太阳的能量 Without the greenhouse effect, the Earth would not be warm enough for humans to live. 没有温室效应，地球不能足够温暖以适宜人类居住 But if the greenhouse effect becomes stronger, it could make the Earth warmer than usual. 但是温室效应太强，可使地球异常变暖 Even a little extra warming may cause problem

33、s for humans, plants, and animals. 即使一点额外的变暖也能对人类、植物、动物造成问题2. anthropogenic sources of air pollution 人为因素造成的空气污染 mostly related to burning different kinds offuel 大多与燃烧各种燃料有关 various activities 固定污染源stationary sources 发电厂烟筒smoke stacks ofpower plants 生产制造工厂manufacturing facilities (factories) 废物焚烧炉wa

34、ste incinerators 各种燃料燃烧的炉子furnaces and other types of fuel-burning heating devices 不少发展中or贫穷地方，传统生物燃烧，包括木材、农田副产物、粪In developing and poor countries, traditional biomass burning is the major source of air pollutants; traditional biomass includes wood, crop waste and dung. 移动污染源mobile sources 机动车辆motor

35、 vehicles 海船marine vessels 飞机aircraft 农业、林业agriculture and forestry management 来自溶剂的烟气fumes from solvents 垃圾沉积waste deposition 形成甲烷 Methane 军事污染military ： 核武器nuclear weapons、毒气toxic gases 、细菌战germ warfare、 火箭学rocketry3. What factors affect the effects of air pollution on health? 影响空气污染对健康效果的因素 Diffe

36、rent groups of individuals are affected by air pollution in different ways. 不同人群接受空气污染的方式不一样 Some individuals are much more sensitive to pollutants than are others. 易感性 Young children and elderly people often suffer more from the effects of air pollution. 老人，小孩 People with health problems such as as

37、thma, heart and lung disease may also suffer more when the air is polluted. 健康问题：哮喘、心脏病、肺病 The extent to which an individual is harmed by air pollution usually depends on the total exposure to the damaging chemicals, i.e., the duration of exposure and the concentration of the chemicals must be taken

38、 into account. 损害程度取决于总暴露的化学物质、暴露时间、暴露浓度 Individual reactions to air pollutants depend on 个体对空气污染的反应取决于 the type of pollutant a person is exposed to 污染物种类 the degree of exposure 暴露程度 the individuals health status and genetics 个体情况：年龄、健康 age diseases 4. The deadly factor and climate condition of the

39、great smog in London in 1952. 致死因素：二氧化硫、硫酸，370吨二氧化硫被排放，与水蒸气组成800吨硫酸灼烧人们的眼睛和肺 Deadly factors: sulfur dioxide and sulfuric acid, 370 tons of sulfur dioxide were emittethe sulfur dioxide and other pollutants mixed with water particles to form 800 tons of sulfuric acid that burned peoples eyes and lungs

40、. 气温情况：空气高压，少风，气温逆转，冷the climate condition There was a high-pressure system holding air over the city there was very little wind There was temperature inversion It was very cold5. The adversely effects of ozone on human health. 【toxic】 Less than 1 part per million in air is poisonous to humans 空气中少于

41、一百万分之一对人体有毒性 occurring at ground level (anywhere between several feet and several miles high) irritates and possibly damages eyes, skin, and lungs 刺激并可能损伤眼睛、皮肤、肺 dries out the protective moist mucous membranes of the nose and throat 使鼻和喉的粘膜变干 interferes with the bodys ability to fight infections 感染机

42、体抗感染能力 causes short-term breathing difficulty and long-term lung damage Joggers and runners can damage lung tissue by exercising even when ozone levels are acceptable. 短期呼吸障碍，长期肺损伤 跑步爱好者 double a persons sensitivity to the allergens that cause asthma attacks 增加对过敏原的敏感性，造成哮喘6. The Effects of Global W

43、arming on Health. 全球变暖对健康影响 A report of the effects of global warming on health published by WHO, has estimated around 1,500,000 deaths every year due to global warming. 因为全球变暖，每年死亡1,500,000人 Further it declared that each year five million people are suffering from health problems and diseases cause

44、d for this global warming. 5百万人因为全球变暖遭受健康问题或疾病 Warmer world has created congenial atmosphere for the breeding and life expanse of various virus, bacteria and carriers of infectious diseases. 变暖的世界为各种病毒、细菌和感染性疾病携带证的繁殖和生活范围扩宽创造了合适环境 Evidences （可省） The vectors distribution of infectious diseases have b

45、een altered for global warming. 感染性疾病载体分布变化 Heat wave resulted for global warming are causing deaths. 热浪-死亡 The seasonal distribution of some species of allergenic pollen have been altered for global warming. 某些物种花粉的季节性分布 Various extreme conditions of global warming like droughts, heat and cold wave

46、, storm, flood, fire will increase the death tolls as well as injuries and diseases. 极端情况-死亡 Global warming will cause increase of malaria, diarrhea, cholera, dengue, encephalitis and other diseases. 使疟疾、腹泻、霍乱、登革热、脑炎发病率增加 There will be constant rising rate of mortality due to ground level ozone rela

47、ted diseases as well as high cardio respiratory morbidity for global warming.地面臭氧相关疾病的致死率与因为全球变暖患循环呼吸疾病概率一样高Thus global warming will affect human health in two major ways with extreme weather condition and with rising infectious diseases. 影响人类健康的主要方式是：极端气候条件和传染性疾病增加Ppt- preventive meidicine II hy一、

48、预防的定义：Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention行动/根除、消除、减少/疾病、残疾的影响程度分级：初级、二级、三级Actions aimed at eradicating, elim

49、inating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention不仅包括预防疾病发生，如降低危险因素；也包括阻止进展和降低结果二、 分级Primordial prevention describes efforts to reduce the onset of the risk

50、 factors known to predispose people（high risk children/adolescents/young adults） to certain diseases.Examples: nutrition/discourage smoking/regular physical activity(policy/education/economic and social support/strategies to encourage)原始预防：努力降低危险因素的开始，对于某些已知的对某一疾病有倾向性人群(儿童青少年青年)Strassers ideaPrimary

51、 prevention includes efforts to control the underlying cause or condition that results in disability. 初级预防：努力控制会导致残疾的潜在原因和条件Secondary prevention aims at preventing an existing illness or injury from progressing to long-term disability. 二级预防：阻止已存在疾病或损伤进展为长期残疾Tertiary prevention refers to rehabilitati

52、on and special educational services to mitigate disability and improve functional and participatory or social outcomes once disability has occurred三级：康复科和特殊教育机构使残疾缓和，一旦残疾发生，提高功能性的、与人分享的或社会性的效果三、 Responsibilities for primordial prevention Government Professional and non-governmental organisations Ind

53、ustry Hospitals, health clinics, health practitioners and health-care workers政府、专家和非政府组织、工厂、医院（临床工作者，健康从业者，健康照顾工作者）四、 Achievements of the 20th century: Improvements in hygiene practices /food handling (refrigeration)/Water and sewage treatment, Vaccination practices 提高：卫生习惯、食物处理（制冷）、水和污物处理，疫苗五、 Adva

54、nces in cancer care and cancer prevention will arise from:l Genetics, genomics, proteomics 基因、基因组学、蛋白质组学l Cell biology and immunology 细胞生物学、免疫l Molecular Epidemiology/biomarkers 分子流行病学l Bioinformatics 生物信息学l Behavioral Sciences 行为科学六、 环境的定义：“The environment is all the physical, chemical and biologic

55、al factors external to a person, and all the related behaviors.” (This definition excludes behavior not related to environment, as well as behavior related to the social and cultural environment, and genetics.)人类之外的物理、化学、生物因素和所有相关的行为七、 包括的环境因素l Pollution of air, water or soil with chemical or biological agents空气、水、土l UV and ionizing radiation 紫外线，放射线l Noise, electromagnetic fields 噪音、电磁场l Occupational risks 职业危险因素l Built environments, including housing, land use patt