Samenvatting
Summary PAICD
- Instelling
- Universiteit Leiden (UL)
Summary of all lectures, all seminars and selected chapters of the book
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Voorbeeld van de inhoud
Chronic Disease Prevention, HR-QOL and Self-Management
LECTURE 1 + SEMINAR 1 + CHAPTER 3
Introduction
Previously, most people died from acute infections and life expectancy was too short to
develop chronic disease. Nowadays, life expectancy is longer which increases the likelihood
of developing chronic disease.
Chronic diseases are defined as those that persist indefinitely, cannot be prevented by
vaccines, and cannot be cured by medication. Such prolonged illness leads to ongoing pain,
suffering, disability and diminished quality of life.
The chronic diseases that are the leading causes of death in the US are respectively heart
disease, cancer, stroke, chronic respiratory diseases and diabetes. There is often comorbidity
of chronic diseases.
Contributing factors to the rise in chronic diseases include tobacco use, pervasive obesity,
sedentary lifestyle, poor diet, larger food portion sizes, longer life expectancy, etc.
Although it is likely the result of a complex interaction of genetic, behavioural and
environmental influences, the rate at which chronic diseases have risen may suggest that
behavioural and environmental influences have played a larger role than biological changes.
Prevention levels
Disease prevention involves three
levels:
o Primary prevention: directly
addresses the mediating causes
of diseases and is carried out
before the onset of disease,
thereby preventing its
occurrence
o Secondary prevention: involves
early detection and treatment of
a disease before a full-blown
illness develops
o Tertiary prevention: attempts to
prevent recurrence or
progression of a disease that has
already occurred
Majority of chronic diseases could be prevented or delayed by lifestyle behaviour and
screening, but most patients are not seen until the disease has progressed, when treatment
is expensive and outcomes limited.
Chronic diseases have both genetic and modifiable risk factors.
,Four pillars of primary prevention
There are four primary prevention interventions that
significantly impact the diseases presented: tobacco
cessation, weight loss, healthy diet and regular exercise
(support healthy lifestyle)
The 4Ps form the basis of primary prevention but are
also useful in secondary and tertiary prevention.
The 4Ps have both an direct and indirect effect on
disease, which each having its own impact on the
prevention of disease
As those who live a healthy lifestyle still can develop
chronic disease (genetic factors), it is better to consider
the 4Ps as a strategy to reduce the probability of
developing chronic disease
Leading causes of death
Cardiovascular disease
Cardiovascular disease (CVD) encompasses both heart disease (most common = coronary
heart disease (CHD), the leading cause of death) and stroke, the third leading cause of death.
Major modifiable risk factors for CVD include the 4Ps, hyperlipidaemia, hypertension and
diabetes. Tobacco smoke can cause build-up of cholesterol on artery wall and can promote
the formation of blood clots. Weight gain increases other associated CVD risk factors.
Hypertension increases the risk of CHD and stroke by putting increased pressure on the
artery walls. Diabetes contributes to the development of atherosclerosis (hardening of the
arteries) and increases blood pressure and cholesterol levels.
An estimated 80% of heart attacks can be prevented or delayed through lifestyle changes.
Cancer
Cancer is the second leading cause of death in the US. The most common cause of cancer
death is lung cancer. Smoking is responsible for approximately 90% of lung cancer deaths.
More than 50% of cancers can be prevented through tobacco cessation and healthier diet.
Exercise and weight control also contribute to cancer prevention, especially for breast cancer.
Therefore, the 4Ps play a crucial role in primary cancer prevention, with an emphasis on
tobacco cessation.
Secondary prevention is highly important as greater use of screenings could prevent at least
half of the deaths from cancer (e.g. mammograms, pap tests (HPV), blood tests and
endoscopy).
Chronic obstructive pulmonary disease
One of the most common forms of chronic respiratory diseases is COPD, a leading cause of
death.
Smoking tobacco (cigarette, cigar and pipe) and second-hand smoke are the leading causes
of COPD. So, tobacco cessation is the most effective intervention to prevent COPD
development or progression.
The effectiveness of interventions such as pulmonary rehabilitation and other treatment
regimens for COPD are dependent on abstinence from tobacco use.
Type II diabetes mellitus
Diabetes is the sixth leading cause of death and leading cause of non-traumatic amputations,
blindness and end-stage renal disease. T2DM is now being diagnosed in children and
adolescents more frequently, which is attributed to the rise in paediatric obesity. Diabetes
causes high blood glucose levels from insufficient insulin production or action, which can lead
to additional serious health problems.
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, Modifiable risk factors for T2DM include the 4Ps and control of blood pressure and cholesterol
levels. Weight is the greatest modifiable risk factor. Smoking lowers insulin levels while
increasing blood glucose.
Primary prevention of T2DM must include lifestyle changes addressing the 4Ps, especially for
those with pre-diabetes or impaired glucose tolerance that has not reached diabetic levels.
Diagnosis is made by two different blood tests (fasting plasma glucose (FPG) test; oral
glucose tolerance test (OGTT)).
Exercise, diet and weight loss are essential in preventing and managing diabetes. Effective
glucose control requires daily monitoring of blood glucose levels. Control of blood pressure
and cholesterol levels are also important secondary prevention strategies. Yearly eye and
foot exams are needed as well.
Hyperlipidaemia
High blood cholesterol can increase the risk of hypertension, CHD and stroke because it
causes atherosclerosis. Optimal LDL cholesterol is below 100 mg/dL, optimal HDL cholesterol
is above 60 mg/dL, and total cholesterol should be below 200 mg/dL. HDL cholesterol helps
protect against heart disease by removing LDL cholesterol from the blood
Three of the 4Ps (weight loss, regular exercise and dietary change) are modifiable risk
factors.
Hypertension
Hypertension, or high blood pressure, can cause atherosclerosis, forcing the heart to work
harder to pump blood through the arteries, thereby increasing the risk of CVD. In fact,
hypertension is the leading cause of congestive heart failure, haemorrhagic stroke, ischemic
coronary disease and cerebrovascular disease. It is known as the silent killer because there
are usually no symptoms.
Blood pressure is the force in the arteries when the heart beats
(systolic) and when the heart is at rest (diastolic). Primary
hypertension is caused by a combination of genetic and
environmental factors and secondary hypertension is the
result of another medical condition or medication.
There are numerous antihypertensive medications to lower
blood pressure (beta-blockers, calcium channel blockers), but adherence to prescription
regimens is often a barrier. However, even a slight decrease in blood pressure can reduce the
risk of CVD.
While the exact cause of hypertension is unknown, modifiable risk factors include three of
the 4Ps: weight loss, exercise and diet with limited salt intake. Smoking does not directly
contribute to the development of hypertension, but it can exacerbate its effects.
The role of stress remains unclear. Nevertheless, stress management programs that address
both cognitive and physiological responses to stress through a variety of techniques
(progressive muscle relaxation, diaphragmatic breathing, problem solving, cognitive
restructuring) are important adjuncts to any lifestyle change because many people adopt
unhealthy behaviours as coping mechanisms. Stress activates the sympathetic nervous
system, thereby causing physiological arousal, such as increased heart rate, peripheral
vasoconstriction and blood pressure. Prolonged and chronic stress may therefore negatively
impact the heart and blood vessels.
Disparities
Minority groups and those with lower socioeconomic circumstances are at greater
disadvantage for chronic disease risk factors and are overrepresented in chronic disease
populations.
Disparities are in part attributed to lack of insurance, poverty, language barriers and racial
discrimination.
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