CHRONIC DISEASE

What is Chronic Disease? According to the World Health Organization, it is: Chronic diseases are diseases of long duration and generally slow progression. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 63% of all deaths.

AGE Older persons are at greater risk for hypertension than younger persons. HIGH SALT INTAKE Excessive salt intake does not cause hypertension in all people, nor does reducing salt intake reduce BP in all hypertensives. Some people are more susceptible than others to effects of increased salt intake. OBESITY Risk for hypertension is two times greater among overweight/ obese persons compared to people of normal weight, and three times more than that of underweight persons. EXCESSIVE ALCOHOL INTAKE As much as 10% of hypertension cases could be related to alcohol consumption. Regular consumption of 3 or more drinks per day increased risk of hypertension. Systolic pressures were more

LIST OF MAJOR NONCOMMUNICABLE/CHRONIC DISEASES

A. DISEASES OF THE HEART AND BLOOD VESSELS (CARDIOVASCULAR DISEASES) Hypertension Description Hypertension or high blood pressure is defined as a sustained elevation in mean arterial pressure. Etiology In terms of etiology, hypertension is classified into primary and secondary hypertension. Primary hypertension has no definite cause. It is also called essential hypertension. Secondary hypertension is usually the result of some other primary diseases leading to hypertension such as renal disease. For the rest of these session, we will be focusing on primary hypertension, which is more common. Risk Factors Risk factors include family health history, advancing age, race and high salt intake. Other lifestyle factors interact with these risk factors and contribute to the development of hypertension such as obesity, excess alcohol consumption, intake of potassium(diet high in sodium is generally low in potassium; increasing potassium in diet increase elimination of sodium), calcium, and magnesium, stress, and use of contraceptive drugs. Family History People with a positive family history of hypertension are twice at risk than those with no history.

markedly affected than diastolic pressure. KEY AREAS FOR PREVENTION OF CAD Promote regular physical activity and exercise; exercise increases HDL, prevent obesity and improves optimum functioning of the heart. Encourage proper nutrition particularly by limiting intake of saturated fats that increased LDL, limiting salt intake and increasing intake of dietary fiber by eating more vegetables, fruits, unrefined cereals and wheat breads. Maintain body weight and prevent obesity through proper nutrition and physical activity/ exercise. Advise smoking cessation for active smokers and prevent exposures to second-hand smoke by family members, friends and co-workers of active smokers. In general, promote a smoke- free environment through advocacy and community mobilization. Early diagnosis, from prompt treatment and control of diabetes and hypertension; these diseases are risk factors and contribute to the development of coronary artery disease.

Cerebrovascular disease or stroke Description Stroke is the loss or alteration of bodily function that result from insufficient supply of blood to some parts of the brain. For human brain to function at emboli. Cocaine use has been closely related to strokes, heart attacks and a variety of other cardiovascular complications. Some of them have been fatal even in first time cocaine users. Key areas for Prevention of Stroke Treatment and control of hypertension- many people believe that effective treatment of high blood pressure is a key reason for the rapid decline in the death rates for stroke. Smoking cessation and promoting a smoke-free environment. Prevent thrombus formation in rheumatic heart disease and arrhythmias with appropriate medications. These medications are usually taken on a daily basis. Health workers need to remind these persons to take their medications as prescribed. Limit alcohol consumption for women, not more than one drink per day, and for men, not more than two drinks per day. Avoid intravenous drug abuse and cocaine. Prevent all other risk factors of atherosclerosis.

Effect of carcinogenic agents usually depend on the dose or amount of exposure; the larger the dose or the longer the exposure, the greater the risk of cancer.

Many cancers are associated with lifestyle risk factors such as smoking, dietary factors and alcohol consumption.

Chemicals And Environmental Agents Polycyclic hydrocarbons are chemicals found in cigarette smoke, industrial agent, or in food such as smoke foods. Polycyclic hydrocarbons produced from animal fat in the process of broiling meats and are present in smoked meats and fish. Aflatoxin is found in peanuts and peanut butter. Other includes benzopyrene, nitrosamines, and a lot more. Benzopyrene Produced when meat and fish are charcoal broiled or smoked(e.g tinapa or smoked fish). Avoid eating burned food and eat smoked foods in moderation. Also produced when food is fried in fat that has been reused repeatedly. Avoid reusing cooking oil. Nitrosamines These are powerful carcinogens use as preservatives in food like tocino, longganisa, bacon and hotdog. Formation of nitrosamines may be inhibited by the presence of antioxidants such as Vit. c in the stomach. Limit eating preserved food and eat more vegetables and fruits that are rich in dietary fiber. Radiation Radiation can also cause cancer including ultraviolet rays from sunlight, x-rays, radioactive chemicals and other forms of radiation. Viruses a virus can enter a host cell and cause cancer. This is found in cervical cancer(human papilloma virus), liver cancer( hepatitis B virus), certain leukemias, lymphoma an nasopharyngeal cancer( epstain barr virus).

B. Cancer Causes of Cancer Normal cells transform into cancer cells because of damage to DNA. People can inherit damage DNA which account for inherited cancers. Many times though, a persons DNA becomes damaged by exposure to something toxic in the environment such as chemicals, radiations or viruses. Carcinogens a carcinogen is an agent capable of causing cancer. This maybe a chemical, an environmental agent, radiation and viruses.

Risk Factors of Cancer risk factors for cancer include a person's age, sex and family medical history. Other are linked to cancer thus causing factors in the environment. Still others are related to lifestyle factors such as tobacco and alcohol use, diet and sun exposure. Lung Cancer Tobacco use, including cigarettes,cigars,chewing tobacco nad snuff. Radiation exposure Second-hand smoke

Occupational exposure:dry es,solvents Chronic bladder inflammation

Esophangeal Cancer Tobacco use(cigarette,cigar,pipe,smokeless tobacco) Gender: 3 times more common in man Alcohol Diet: low in fruits and vegetables

Breast Cancer Early menarche or late menopause Age- changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause High fat diet Obesity Physical inactivity Some studies have also shown a connection between alcohol consumption and an increase risk of breast cancer Liver Cancer Certain types of viral hepatitis Cirrhosis of the liver Long- term exposure to aflatoxin ( carcinogenic substance produced by a fungus that often contaminates peanuts, wheat, soybeans, corn and rice Prostate Cancer While all man are at risk, several facctors can increase the chances of developing the disease, such as advancing age, race and diet Race: more common among African- American man than among white man Man with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves Skin Cancer Unprotected exposure to strong sunlight Fair complexion Occupational exposure

Oral Cancer Tobacco use(cigarette,cigar,pipe,smokless tobacco) Excessive alcohol use Chronic irritation(e.g. Ill-fitting dentures) Vitamine A deficiency

Laryngeal Cancer Tobacco use(cigarette,cigar,pipe,smokless tobacco) Poor nutrition Alcohol Weakened immune system Occupational exposure to wood dust,paint fumes Gender:4-5 times more common in man Age:more than 60 years

Renal Cancer Tobacco use(cigarette,cigar,pipe,smokeless tobacco):increase risk by 40% Obesity Diet: well cooked meat Occupational exposure: asbestos organic solvents Age: 50- 70 years old

Cervical Cancer use(cigarette,cigar,pipe,smokeless tobacco) Human papillomavirus infection Chlamydia infection Diet: low in fruits and vegetables Family history of cervical cancer

Bladder Cancer Tobacco use(cigarette,cigar,pipe,smokless tobacco)

Colonic Cancer Personal or family history of polyps High fat diet and or low fiber diet History of ulcerative colitis Age: >50 years

diabetes that develops during pregnancy. It may develop into full-blown diabetes. NIDDM is more common, occurring in about 90-95% of all persons with diabetes. It is also more preventable because it is associated with obesity and diet. Type I DM Characterized by absolute lack of insulin due to damaged pancreas, prone to develop ketosis, and dependent on insulin injections. Genetic, environment, or may be acquired due to viruses (e.g. mumps, congenital rubella) and chemical toxins(e.g. Nitrosamines). Type II DM

KEY AREAS FOR PRIMARY PREVENTION OF CANCERS Smoking Cessation Encourage Proper Nutrition Drink alcoholic beverages in moderation. Avoid/control obesity through proper nutrition and exercise. The sooner a cancer is diagnosed and treatment begins, the better the chances of living longer and enjoying a better quality of life. C. Diabetes Mellitus Diabetes mellitus (DM) is one of the leading causes of disability in persons over 45.More than half of diabetic persons will die of coronary heart disease. CAD tends to occur at an earlier age and with greater severity in persons with diabetes. It also increases the risk of dying of cardiovascular disease like heart attack or stroke among women. Description Diabetes mellitus is not a single disease. It is genetically and clinically heterogeneous group of metabolic disorders characterized by glucose intolerance, with hyperglycemia present at time of diagnosis. Etiology/Causes Specific cause depends in the type of diabetes, however it is easier to think of diabetes as an interaction between two factors: Genetic Predisposition (diabetogenic genes) and Environment/Lifestyle(obesitity, poor nutrition, lack of exercise) TYPES OF DIABETES Type I diabetes is insulin-dependent diabetes mellitus (IDDM) and Type II is noninsulin dependent diabetes mellitus (NIDDM). Gestational Diabetes is

Characterized by fasting hyperglycemia despite availability of insulin.

Possible causes include impaired insulin secretion, peripheral insulin resistance and increased hepatic glucose production.

Usually occurs in older and overweight persons (about 80%).

Risk Factors of Type 2 DM Family history of diabetes (i.e., parents or siblings with diabetes)

Overweight (BMI 23 kg/m ) and obesity (BMI > 30 kg/m ) Sedentary lifestyle Hypertension HDL cholesterol < 35 mg/dl (0.90 mmol/L) and/or triglyceride level > 250 mg/dl (2.28mmol/L) History of Gestational Diabetes Mellitus (GDM) or delivery of a baby weighing 9 Ibs (4.0 Kgs) Previously identified to have Impaired Glucose Tolerance (IGT)

Complications Acute comlications include diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic nonketotic

coma (HHNK) and hypoglycemia especially in type I daibetics Chronic complications cause most of the disability associated with the disease. These include chronic renal disease (nephropathy), blindness (retinopathy), coronary artery disease and stroke, neuropathy and foot ulcers KEY AREAS FOR PREVENTION AND CONTROL OF DIABETES Maintain body weight and prevent obesity Encourage proper nutrition Promote regular physical activity and exercise Advise smoking cessation for active smokers and prevent exposure to secondhand smoke. D. CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. COPD is currently the fourth leading cause of death in the world, and more cases and deaths due to COPD can be predicted in the coming decades because of smoking. Description COPD is a disease state characterized by airflow limitation that is not fully reversible. Causes and Risk Factors COPD is usually due to chronic bronchitis and emphysema, both of which are due to cigarette smoking. Cigarette smoking is the primary cause of COPD. Diagnosis A diagnosis of COPD should be considered in any patient who has symptoms of cough, sputum production, or dyspnea, and/or a history of exposure to risk factors for the disease. The diagnosis is confirmed by spirometry. Complications Respiratory failure In advanced COPD, peripheral airways obstruction, parenchymal destruction, and pulmonary vascular abnormalities A.

reduce the lungs capacity for gas exchange, producing hypoxemia and, later on, hypercapnia. Cardiovascular disease Pulmonary hypertension, which develops late in the course of severe COPD), is the major cardiovascular complication of COPD and is associated with the development of cor pulmonale and a poor prognosis. E. BRONCHIAL ASTHMA Asthma is a chronic disease. It is an inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation causes an associated increase in airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. Causes and Risk Factors Asthma development has both genetic and environment component. Host Factors: predispose individuals to protect them

from developing asthma Genetic predisposition Atopy or allery Airway hyperresponsiveness Gender Race/Ethnicity B. Environmental Factors: Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air pollution Respiratory infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity Asthma triggers Triggers are risk factors for asthma exacerbations. These cannot cause asthma to develop initially, but

can exacerbate established asthma. They induce inflammation and/or provoke acute bronchoconstriction. It involves further exposure to causal factors(allergens and occupational agents) that have already sensitized the airways of the person with asthma. Other form of triggers are irritant gases and smoke, house dust mite found in pillows, mattresses, carpets; respiratory infection, inhaled allergens,
Risk factors Elevated blood lipid (Hyperlipidemia) High intake of fatty foods Inadequate intake of dietary fiber Key Areas for Prevention

weather changes, cold air, exercise, certain foods, additives and drugs. Key areas for Primary Prevention and Exacerbation of Asthma Recognize triggers that exacerbate asthma Avoid these triggers if possible, particularly smoking Promote exclusive breastfeeding as long as possible; early introduction to cows milk may predispose baby to allergies and possible asthma

PROMOTE PROPER NUTRITION Limit intake of fatty, salty and preserved foods Increase intake of vegetables and fruits Avoid high caloric low-nutrient value food like junk food, instant noodles, softdrinks Start developing healthy habits in children ENCOURAGE MORE PHYSICAL ACTIVITY AND EXERCISE Moderate physical activity of atleast 30 minutes for most days Integrate physical activity and exercise into regular day today activities Walking is one form of exercise that is possible for including older persons and persons with cardiovascular disease PROMOTE SMOKE-FREE ENVIRONMENT Smoking cessation for active smokers to reduce risk Prohibit smoking inside living areas, houses and closed areas DISCOURAGE EXCESSIVE DRINKING OF ALCOHOLIC BEVERAGES

Overweight and Obesity Sedentary lifestyle

Smoking, both active or passive /second-hand

Excessive use of alcohol

Hyperlipidemia, Hypertension, Diabetes Mellitus

EARLY DIAGNOSIS AND PROMPT TREATMENT

Recommendation Government population focus addressing the life continuum prevention at the population, community and individual levels early detection (screening) of chronic diseases in the well population management of diagnosed conditions working in partnership client and family-centered quality care evaluation framework Personal *Provide healthy choice *Enable sustainable practices *Increase choice, not restricted choice The Wagner Model for Improving Chronic Care

The model has six interdependent elements for improving chronic care. They are: 1. Community resources and activities that provide ongoing support for people with chronic disease/s. 2. Health systems support prepared and proactive practice teams. 3. Self-management support empowers and prepares clients to manage their health and health care. 4. Delivery system design assists care teams to deliver systematic, effective, efficient clinical care and self-management support. 5. Decision support including design, systems and tools to ensure clinical care is consistent with evidence-based guidelines. 6. Clinical information systems including data systems that provide information about the client population, reminders for review and recall, and monitor the performance of care teams.