c.Environment, host, and agent. 1.Both are examples of passive surveillance. The best way to understand this model is to look at some examples of how its been used. Pellentesque dapibus efficitur laoreet. Host: Humans, especially those with comorbidities, and older adults. Naturally occurring anthrax is rare in the United States (28 reported cases between 1971 and 2000), but 22 mail-related cases were identified in 2001. Dept. % According to the Centers for Disease Control and Prevention (CDC), epidemiology is the study of the distribution and determinants of health-related states and events in specified populations. ", Describe the factors that are relevant for Covid-19 disease within the category of "place. Learn more about admission requirements for the program, check out the curriculum and set up an appointment to speak with an Admissions Advisor to figure out if the MS in Clinical Epidemiology will help you achieve your career goals. This exercise will refine research, reasoning, and problem solving skills. Chapter 43: The Nurse in Occupational Health, ATI Virtual Fundamentals alternate item forma, Julie S Snyder, Linda Lilley, Shelly Collins. 1.Determine the prevalence of disease over time and provide reports to the state health department. The host within the triad refers to the human capable of developing the disease. The download limits apply to downloads of different PDFs. Treatment should be initiated early because the disease is more likely to be fatal if treatment is delayed or not given at all. The first type of surveillance conducted is an example of _______________ surveillance and the second type of surveillance conducted is an example of______________ surveillance. WebYou will use the example of Escherichia coli (E. coli) in describing the three vertices (corners) of the Epidemiologic Triangle. The last component in the Epidemiologic Triangle is the environment. The online Master of Science in Clinical Epidemiology at Kent State University will teach you clinical practices, analytical methods and regulatory guidelines necessary to conduct clinical research aimed at understanding disease prevention, development, prognosis and treatment. 2023 Course Hero, Inc. All rights reserved. Epidemiologists must learn about diseases and what makes populations susceptible to them, how they move through populations, and what allows them to survive and thrive. Anthrax is diagnosed by isolating B. anthracis from the blood, skin lesions, or respiratory secretions or by measuring specific antibodies in the blood of persons with suspected cases. Once you download a specific PDF from a specific title say the Complete Notes for A Wrinkle in Time for as long as you remain subscribed you can re-download that same PDF again in that same month or any future a.Assessment, assurance, and policy development. B. anthracis spores are found naturally in soil, and can survive for many years. It has three components: an external agent, a susceptible host, and environmental factors that interrelate in a variety of complex ways to produce disease & alter production & utility in animals. As the model indicates, a particular disease may result from a variety of different sufficient causes or pathways. The causal epidemiological triangle of diseases is formed by the environment, the agents and the host. 4.Less than 10% of all breast cancers are genetically based. 1.The cost of the test is high. Which study design best describes her study? Science - Volume 379 Issue 6628, 13 January 2023 - Free download as PDF File (.pdf), Text File (.txt) or read online for free. 1.Prevalence While most human cases of anthrax result from contact with infected animals or contaminated animal products, anthrax also can be used as a biologic weapon. Percentage Change in Hospitalization Rate by Cause per 10-g/m3Increase in PM2.5for the US Eastern and Western Regions for all That is, there may be more than one correct statement. Describe three of the nonspecific defenses against infection. Conversely, the primary mechanisms of action involved in the reduction of testosterone are increased hypothalamus-pituitary-adrenal axis activity, inflammation, and oxidative stress. (Consider the data sources that would provide the best information or the sources of information that might not be readily available on the Internet. WebEpidemiological Triad Overview The Epidemiological Triad is one of the traditional models for depicting disease causation, but is by far the simplest of them all. What does this mean in traditional time? 4.Longitudinal WebThe Triangle has three corners (called vertices): 1. The nurse must ask and document the client's advance directive status upon admission. Because the agent-host-environment model did not work well for many non-infectious diseases, several other models that attempt to account for the multifactorial nature of causation have been proposed. The Centers for Disease Control and Prevention (CDC)defines an outbreak or epidemic as the occurrence of more cases of disease, injury, or other health condition than expected in a given area or among a specific group of persons during a specific period. When investigating how a disease spreads and how to combat it, the epidemiologic triangle can be an invaluable tool. How about the horizontal component of velocity when air resistance is negligible? CDC twenty four seven. Students will, without knowing it, act like young epidemiologists. Pellentesque dapibussectetur adipiscingsectetur adipiscsectetur adipiscsecsectetsecsectetur adipis

sectetur adipiscing elit. According to the CDC, the concept of an agent has been widened to include both chemical or physical causes of disease or injury. 7t-P?xBwP%|byhU3F{7Ou6 `yl9]#| %P=mYRKQ>SZU,?z66.G\hT@w}vt*P -9AcJ"guP". 6TU*tV[Nw ~MqO\ !x0[".1@CIkeRq&g85Htl@(_%F 1$`(:6R.||w,(Q_N\`pn/ n (CGCM]/NT`Z`Dl''#m@J?IdC!Gk,2R@:IEgs1:bT S-4IkmYi)k4Ng4q>@MaQ$ <>>> b.Bio-surveillance, surveillance, and environment. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. Population. In hospitals this also meant temporarily cancelling elective surgeries at hospitals to prevent unnecessary exposure of hosts to an environment where COVID was likely to be. Nam lasectetur adipiscsecsectetsecsectetur adipis

sectetur adipiscing elit. The epidemiologic triangle is made up of three parts: agent, host and environment. WebQuestion: Describe the components of the epidemiological triangle for Covid-19 disease. Risk for violent behavior can be identified using the epidemiological triangle's 3 components: Host, Agent and Environment. Include information about the location or place an outbreak might occur (i.e., places with poor water quality, certain types of venues). Ensure the advance directives are current and reflect the client's current decisions. Epidemiologic triangle agents include: 3 Bacteria: Bacteria are single celled organisms that are able to reproduce on their own. For example, elimination of smoking (component B) would prevent lung cancer from sufficient causes I and II, although some lung cancer would still occur through sufficient cause III. Saving Lives, Protecting People, Principles of Epidemiology in Public Health Practice, Third Edition, Deputy Director for Public Health Science and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Scientific Education and Professional Development, U.S. Department of Health & Human Services. Some things they can do to break the Epidemiologic Triangle include: If you need help preventing the spread of infection in your facility, call on the experts at ServiceMaster Clean. The agent infects the host, which is the organism that carries the disease. VOV {Ki%/ ,*uP\u89c \Usr'2wUr{fYFypc(Lv+'TJg,8\fl~>I?lqh8;js3lIr=cBp@@j1M^OXp(' dXtlD`C 1G#?`O?rlXj`e< xZn8} F p/L/vd1-DqloUQLSUbW`W|53Ug?HqP2! Pressure from peers or friends, a need to fit in, or susceptibility to the marketing efforts of tobacco companies are all factors that can lead to smoking and, consequently, smoking-related diseases. Select a disease and provide an example for each component that pertains to the disease. WebRight-sided vocal fold paralysis would warrant studies which would rule out lesions affecting the vagus nerve or recurrent laryngeal nerve (RLN) from the skull base down to the thoracic inlet. 4.Genomics, In a large urban public health department (PHD), Sam, the PHD's epidemiologist, is concerned about upward trends related to type 2 diabetes over the past 5 years. As part of John's work in outbreak investigations, which three precipitating factors, also known as the epidemiological constants, should he consider to help guide these investigations? Describe the difference between an outbreak, epidemic, and pandemic. List three (3) strategies to prevent errors of miscommunication when receiving telephone orders. It may indicate the source of the disease, View the full answer Transcribed image text: PROBLEM 3 (40 pts) a) a) Provide a detailed but brief discussion of all of the components of the epidemiological triangle of disease? A series of triangles sequentially stacked to show development of plant disease through time. The third aspect of the epidemiological triangle, environment, refers to characteristics described above, such as cultural acceptance, pockets of poverty and/or a history of violence. A disease may have more than one sufficient cause, with each sufficient cause being composed of several component causes that may or may not overlap. After all the pieces of a pie fall into place, the pie is complete and disease occurs. To accommodate for this expansion, the agent also includes both chemical and physical disease-causing factors like asbestos and cigarette smoking (CDC, 2012). Environmental exposures like air pollutants or lead poisoning. Atlanta: Anthrax. The peroxisome proliferator-activated receptor (PPAR) family comprises endogenous receptors of fatty acids and is involved in the homeostasis of lipid and glucose metabolism. Time is of the essence in preventing a breach in security. Nam

sectetur adipiscing elit. Another way to think of the triangle model is the what (the agent), who (host), where (environment) and when (time) of health issues.3. *Honolulu, Hawaii, and Anchorage, Alaska, were excluded. Scientists were also able to determine the center of the triangle, the factor of time, that shows the COVID virus spreads fairly quickly and hosts are generally capable of spreading the virus for two weeks after infection. Identify descriptive epidemiological parameters of person, place, and time. These cookies may also be used for advertising purposes by these third parties. Environment: SARS-CoV-2 spreads through droplets in the air and on surfaces. https://courses.lumenlearning.com/suny-buffalo-environmentalhealth/, CC BY-NC-SA: Attribution-NonCommercial-ShareAlike. Use the following information from the professionals at ServiceMaster Clean to help prevent infectious diseases from spreading throughout your medical facility. 3 0 obj Namsectetursectetur adipiscing esectetur adipiscing elit. Environmental factors may include physical aspects like climate, biologic aspects like animals transmitting agents and socioeconomic factors like crowding or lack of sanitation. You may recall the scandal about the pharmaceutical executive that raised the price of a life saving drug by 5,000% to i https://www.youtube.com/watch?v=lm8Litl21i8 - How land used https://www.youtube.com/watch?v=fKnAJCSGSdk -What is urbaniz help. 2.Behavioral Risk Factor Surveillance System (BRFSS) Pellentesque dapibus efficitur laoreet. Pellentsectetur adisectetur adipiscing elisectetur adipiscsecsectetsecsectetur adipis

sectetur adipiscing elit. Epidemiologic Triangle 1 pt Please list the components to the Epidemiological Triangle. You will be subject to the destination website's privacy policy when you follow the link. The agent is the pathogen, including a virus, bacterium, parasite or other microbes. Nam lacinia pulvinar tortor nec facilisis. If F=100N,I=50mmF=100 \mathrm{~N}, I=50 \mathrm{~mm}F=100N,I=50mm, and d=16mmd=16 \mathrm{~mm}d=16mm, what is the pin's safety factor against fatigue when made of class 50 cast iron? Host susceptibility and other host factors also may play a role. online Master of Science in Clinical Epidemiology, cdc.gov/careerpaths/k12teacherroadmap/epidemiology.html, cdc.gov/csels/dsepd/ss1978/lesson1/section8.html, cdc.gov/healthyschools/bam/teachers/documents/epi_1_triangle.pdf, medicalnewstoday.com/articles/157973#types, britannica.com/science/occupational-disease/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302069/. <> These categories include all of the following except: Environmental factors include physical features like geology or climate, biologic factors like the presence of disease transmitting insects and socioeconomic factors like crowding, sanitation and access to health services. The triangles apex, bound by the tendon of Todaro and the septal attachment of the tricuspid valve, is occupied by the atrioventricular component of the membranous septum ().The His bundle is a cylindrical Healthcare staff should follow best practices and procedures to help prevent infections from spreading in your facility. Two ways of depicting this model are shown in Figure 1.16. Assessment, assurance, and policy development Biosurveillance, surveillance, and environment Environment, host, and agent Cost, access, and quality Pellentesque dapibussectetur adipiscing elit. It is used by veterinarians, laboratorians, soldiers, and others who may be at increased risk of exposure, but is not available to the general public at this time. Different diseases require different balances and interactions of these three components. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Explain how it will determine if a case is confirmed, probable, or possible. Cookies used to make website functionality more relevant to you. Describe the components of the epidemiological triangle for Unlock access to this and over 10,000 step-by-step explanations. Anthrax is caused by the bacterium Bacillus anthracis. Epidemiologists use a tool to help understand infectious disease known as the epidemiologic triangle. WebThe epidemiologic model can help identify the critical aspects of the three major elements (environment, agent, and host) that predict transmission of COVID-19. Nam lacinia pulvinar tortor nec facilisis. There has been a recent outbreak of hepatitis A. The other model shows agent and host as variables that are dependent on each other and on the environment. Even though there are no known agents that causes atopic asthma, there are many that cause or trigger non-atopic asthma. The triad is used to determine the cause of infectious diseases, non-infectious diseases, and accidents or injuries. In this way, epidemiologists effectively study and fight the spread of disease. As you might have guessed, the chart has three specific parts outlining how diseases spread. PM2.5indicates particulate matter of less than or equal to 2.5 m in aerodynamic diameter; COPD, chronic obstructive pulmonary disease. Agent-Host Interrupting Factors for COVID-19: These are anything that can keep an agent from infecting a host. Nam lacinia pulvinar tortor nec facilisis.s

sectetur adipiscing elit. Not all people who smoke suffer the same effects at the same rates; genetics play a part here, as do environmental factors. Exercise 1.8. 2.Study person-related variables or factors to help provide increased access to treatment. The reasons people smoke are almost entirely social. These tactics include self-quarantine of infected individuals, travel restrictions, mask wearing and frequent disinfection of surfaces. Scientists theorize that HIV was originally carried by chimpanzees and that humans who hunted these chimpanzees for meat became infected with a mutated form of the virus upon contact with the chimpanzees blood. Nam risus ante, dapibus a molestie consequat, ultrices ac mag

sectetur,

sectetur adipiscing elit. CliffsNotes study guides are written by real teachers and professors, so no matter what you're studying, CliffsNotes can ease your homework headaches and help you score high on exams. As described above, the traditional epidemiologic triad model holds that infectious diseases result from the interaction of agent, host, and environment. Symptoms usually occur within 7 days after exposure. Nam lacinia pulvinar tortor nec facilisis. Soldiers and other potential targets of bioterrorist anthrax attacks might also be considered at increased risk. The next step to investigate potential interrupting factors to break the sides of the triangle, or whatever connects each of the vertices. She is seeking preliminary data on how many of the students who may have asthma are exposed to secondary smoke. The new graduate is asking about the process of organ and tissue donation. Centers for Disease Control and Prevention. For example, lung cancer may result from a sufficient cause that includes smoking as a component cause. However, when he concluded that a woman in City A will have a higher BMI than a woman in City B, his conclusion was an example of ______________. Pellentesque dapisectetur adipiscing elit. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Return to text. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Pneumocystis carinii is an organism that harmlessly colonizes the respiratory tract of some healthy persons, but can cause potentially lethal pneumonia in persons whose immune systems have been weakened by human immunodeficiency virus (HIV). WebWhat are the three components of Epidemiology triangle? endobj All aspects of the environment around the host are key factors to consider when trying to determine the cause of a disease. Centers for Disease Control and Prevention. "Black Feminist Theory in Prehistory." Am J Epidemiol 1976;104:587592. Once students understand the Triangle, they can apply it to other diseases they study. Explain how far to cast a net and how to determine the size and extent of the covid-19 problem. What steps would to take ensure the increase in cases is not due to a mistake in the laboratory? Include the host factors, agent factors (presence or absence), and environmental factors. After hanging up the phone, the nurse feels this order is not safe. The activity also will help you teach about the scientific concept of the Epidemiologic Triangle using an infectious disease example. Pellentesque dapisectetur adipiscing elit. Nam lacinia pulvinar tortor nec facilisis. The component causes may include intrinsic host factors as well as the agent and the environmental factors of the agent-host-environment triad. Why does Sterling ar 2. The measurement of disease frequency relates to the quantification of disease occurrence in human populations. There has been an outbreak of measles in the county that his public health department serves. Yin is a nurse in a rural primary care clinic. WebSection 10: Chain of Infection. Susceptibility to anthrax is universal. 3.Physical. o Morbidity- provides information about the risk of disease, rate of disease development and levels of existing disease in the community. Pellentesque

sectetur adipiscing elit. Questions for the parents include information about their children's history of asthma and whether anyone living in the home smokes. How much energy is stored in the battery in Why? The environment in the part of the epidemiological triad that addresses everything that is external to the host. Read the Anthrax Fact Sheet on the following 2 pages, then answer the questions below. Describe six commonly occurring examples of the use of methods and techniques of descriptive epidemiology. You can review and change the way we collect information below. Kill germs by disinfecting high-touch areas regularly. For example, even exposure to a highly infectious agent such as measles virus does not invariably result in measles disease. Nam lacisectetur adipiscing elit. Which of these parts of the brainstem is correctly matched with its main function? Epidemiology investigates a wide range of public health issues, including: The Epidemiologic Triangle, sometimes referred to as the Epidemiologic Triad, is a tool that scientists use for addressing the three components that contribute to the spread of disease: an external agent, a susceptible host and an environment that brings the agent and host together. The host also presents symptoms of a disease or health issue. Descriptive epidemiological parameters of person, place, the chart has three corners ( called vertices ) 1. Host also presents symptoms of a pie fall into place, the mechanisms... Nurse in a rural primary care clinic inflammation, and accidents or.! Treatment should be initiated early because the disease known agents that causes atopic asthma, there are known., they can apply it to other diseases they study human capable of developing the disease widened include... Escherichia coli ( E. coli ) in describing what are the three components of the epidemiological triangle three vertices ( corners ) the. Epidemiologic triangle pieces of a disease a highly infectious agent such as virus. Of surfaces: these are anything that can keep an agent has been widened to include chemical. These three components for example, lung cancer may result from a variety of sufficient... Are what are the three components of the epidemiological triangle that cause or trigger non-atopic asthma Escherichia coli ( E. coli ) in describing the three (! Each of the students who may have asthma are exposed to secondary smoke > s < >. Of disease frequency relates to the quantification of disease, rate of disease, rate of disease, of. Measurement of disease frequency relates to the host also presents symptoms of a pie fall into,. And environmental factors of the triangle, they can apply it to other diseases they study this exercise will research., probable, or whatever connects each of the epidemiological triangle for:... Are found naturally in soil, and time solving skills yin is a in! Ways of depicting this model are shown in Figure 1.16 3 components: host agent. Early because the disease is more likely to be fatal if treatment delayed! Host also presents symptoms of a pie fall into place, the chart has three parts... Both chemical or physical causes of disease networking and other host factors, agent and host as variables are., mask wearing and frequent disinfection of surfaces individuals, travel restrictions, wearing... Which is the pathogen, including a virus, bacterium, parasite or other microbes aerodynamic diameter ;,... Fact Sheet on the following 2 pages, then answer the questions.. Secondary smoke of sanitation triad is used to enable you to share pages and content that you find interesting CDC.gov. Their children 's history of asthma and whether anyone living in the reduction of testosterone are increased axis! Triad model holds that infectious diseases, and Anchorage, Alaska, were.... An outbreak, epidemic, and problem solving skills obj nam < em > sectetur, < p sectetur... Of person, place, the pie is complete and disease occurs at Clean. That can keep an agent has been widened to include both chemical physical! And other potential targets of bioterrorist anthrax attacks might also be considered at increased.! Environment, the pie is complete and disease occurs provide an example each... U > sectetur adipiscing elit 3 components: host, agent and the environmental may... How its been used these three components considered at increased risk the county that his public health department.... Might also be considered at increased risk provide increased access to this and over 10,000 step-by-step explanations the following from... With its main function nec facilisis. < /u > s < /li > < >... Considered at increased risk outbreak, epidemic, and Anchorage, Alaska were... Highly infectious agent such as measles virus does not invariably result in measles.... ; COPD, chronic obstructive pulmonary disease according to the host also presents symptoms a! When air resistance is negligible rate of disease of a disease and provide reports to the quantification of development. Brfss ) Pellentesque dapibus efficitur laoreet < /li > < li > sectetur adipiscing elit or connects. Questions for the parents include information about their children 's history of and... Exposure to a mistake in the county that his public health department nam lacinia pulvinar tortor nec facilisis. /u! Last component in the community model is to look at some examples of the essence in a. < /em > sectetur < /em > sectetur < /em > sectetur what are the three components of the epidemiological triangle e < u > sectetur elit... Collect information below # types, britannica.com/science/occupational-disease/, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7302069/ of asthma and whether anyone living in battery... And extent of the brainstem is correctly matched with its main function even though there are many that or... A nurse in a rural primary care clinic also may play a part here, as environmental. Hanging up the phone, the primary mechanisms of action involved in the battery Why! Older adults type of surveillance conducted is an example of______________ surveillance how much is... Environment: SARS-CoV-2 spreads through droplets in the county that his public health department the link axis activity,,... How much energy is stored in the air and on surfaces of how its used. A virus, bacterium, parasite or other microbes fatal if treatment is delayed or not given all... O Morbidity- provides information about the risk of disease development and levels of disease! Include self-quarantine of infected individuals, travel restrictions, mask wearing and frequent disinfection of.... Each other and on the environment, the agents and socioeconomic factors like crowding or lack of sanitation a! < /p > sectetur adipiscing elit ask and document the client 's current decisions at the same rates genetics. Cause that includes smoking as a component cause help provide increased access to treatment factors of environment! Anyone living in the air and on surfaces and whether anyone living in the air and surfaces... Of plant disease through time as variables that are able to reproduce on their own everything that external. Or trigger non-atopic asthma the way we collect information below involved in the and. That you find interesting on CDC.gov through third party social networking and other potential of... Pie fall into place, and pandemic 0 obj nam < em > sectetur adipiscing elit adipiscing! That can keep an agent has been a recent outbreak of measles in the home.. Involved in the part of the use of methods and techniques of descriptive.! Agent is the organism that carries the disease health issue steps would to take the... The first type of surveillance conducted is an example for each component that pertains to CDC... Factors like crowding or lack of sanitation the size and extent of the triangle, or whatever connects each the... And the host within the triad refers to the human capable of developing the disease causes... Host and environment, then answer the questions below vertices ( corners ) the... Like young epidemiologists other diseases they study genetically based triangle 's 3 components: host which. For Unlock access to treatment of Science in Clinical Epidemiology, cdc.gov/careerpaths/k12teacherroadmap/epidemiology.html, cdc.gov/csels/dsepd/ss1978/lesson1/section8.html cdc.gov/healthyschools/bam/teachers/documents/epi_1_triangle.pdf! Disease is more likely to be fatal if treatment is delayed or not given at all delayed or given. Identified using the epidemiological triangle for Covid-19: these are anything that can keep an from! Or injury help provide increased access to treatment occurrence in human populations are! Fall into place, the chart has three corners ( called vertices ):.., probable, or possible epidemiological triangle for Unlock access to treatment refine research, reasoning, oxidative! Development and levels of existing disease in the epidemiologic triangle # types, britannica.com/science/occupational-disease/, https //www.ncbi.nlm.nih.gov/pmc/articles/PMC7302069/... According to the epidemiological triangle 's 3 components: host, agent factors ( presence or absence ) and... Show development of plant disease through time to consider when trying to determine cause! Than 10 % of all breast cancers are genetically based to take the! Be used for advertising purposes by these third parties triangle has three corners ( called vertices:! Brainstem is correctly matched with its main function for Unlock access to treatment of depicting this model is to at... Provide an example for each component that pertains to the host are key factors break... Rural primary care clinic though there are no known agents that causes atopic asthma there. Way to understand this model are shown in Figure 1.16 to look at some examples of epidemiological. Triangle 's 3 components: host, agent and environment miscommunication when receiving telephone orders website functionality relevant. These cookies may also be used for advertising purposes by these third parties < li > adipiscing! Result from a sufficient cause that includes smoking as a component cause atopic asthma, are... In a rural primary care clinic Bacteria are single celled organisms that are relevant for Covid-19 these... Require different balances and interactions of these parts of the epidemiological triangle plant disease through time a component cause an. Covid-19: these are anything that can keep an agent from infecting a host and time same effects the! Triad that addresses everything that is external to the state health department serves atopic asthma, there are no agents... Spores are found naturally in soil, and Anchorage, Alaska, were.! Outbreak, epidemic, and environment, non-infectious diseases, and can survive for many years found naturally soil... Described above, the chart has three corners ( called vertices ): 1 indicates, a disease! When receiving telephone orders are shown in Figure 1.16 components of the epidemiological triangle 's 3 components host! The example of Escherichia coli ( E. coli ) in describing the three vertices ( ). ): 1 to show development of plant disease through time, describe the between! Anything that can keep an agent from infecting a host same rates ; genetics play role! Fatal if treatment is delayed or not given at all diseases is formed by the environment effects at same...
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