Chronic Diseases

Question 1

Which are the 12 chronic diseases abundant in Australia?

Answer 1

1. Ischaemic Heard Disease (CHD)
2. Stroke
3. Lung Cancer
4. Colorectal Cancer
5. Depression
6. Type 2 Diabetes
7. Arthritis
8. Osteoporosis
9. Asthma
10. Chronic Obstructive Pulmonary Disease (COPD)
11. chronic kidney disease
12. oral disease

Question 2

Name 7 modifiable risk factors for chronic diseases

Answer 2

1. high blood pressure
2. poor diet
3. excess weight
4. physical inactivity
5. tobacco
6. Alchohol
7. High blood cholesterol

Question 3

Name the prevalence of risk factors in Australia

(except from diet / exercise)

Answer 3

1. tobacco: 17% > 14y
2. high blood cholesterol: 50% in >25y
3. high blood pressure: 30% > 25y
4. alcohol: 10% drink alcohol at risky levels
5. excess weight: 60%

Question 4

The four most expensive chronic dieseases and their cost

Answer 4

1. CHD
   * 7.74 billion = 10.4% of Health budget*
2. Oral health
   * 7.18 billion = 9.7%*
3. Mental disorders
   * 6.38 billion = 8.6%*
4. Musculoskeletal
   * 5.67 billion = 7.6%*

Question 5

Which four diseases pose the biggest burden in Australia?

Answer 5

1. Cancer
2. CHD
3. Mental Disorders
4. musculoskeletal disorder

Question 6

What is DALY?

Answer 6

Disability Adjusted Life Years
1993 by world bank

How many life years somebody lost due to sickness and early death

DALY =
YLL (Years of Life Lost Due to Disease)
+

YLD (Years of Life Spent with Disability)

Question 7

What has changed btw 1990 and 2010?

Answer 7

A larger fraction now caused by ill-health rather than premature death

Not CHD the biggest burden, but Cancer and Musculoskeletal diseases

while both smoking and dietary risk factors among top three, today excess weight took over from high blood pressure

Question 8

CVD Prevalence

I. heart, stroke and blood vessel disease kills one Australian every ___

II. affects ___ people in Australia

III. how many death in 2008?

IV. How did the prevalence of heart, stroke and vascular diseases change over the last decade?

Answer 8

I. 11min

II. 3.4 millions

III.46,000 (33%)

IV. rise by 18.2%

Question 9

Name the three categories of risk factors for CVD

Answer 9

1. Age, gender, sociocultural risk factors
2. biological and lifestyle factors
3. Type A behaviour
   * show under stress more reactivity (higher blood pressure, catecholamine, corticosteroid levels)*

Question 10

Name three heart/ blood vessel diseases

Answer 10

• *1. Artherosclerosis**
• blood vessels become narrow by plaque. Brief or incomplete blockage leads to angina pectoris.*
• *2. Ischemia**
• insuffient supply of blood to an organ, usually due to a blocked artery.*
• *3. Myocardial Infarction**
• severe or prolonged block (“heart attack”)*

Question 11

Medical treatment and rehabilitation
of cardiac patients

Answer 11

• Initial medical treatment for heart attack
– Clot-dissolving (thrombolytic) medication
– Coronary care unit may closely monitor
– Balloon angioplasty: balloon is inflated in artery to open the bloodvessel
– Bypass surgery: diseased vessel replaced by a healthy one
• High anxiety in first few days of coronary care

• Rehabilitation for cardiac patients
– Info on symptoms, medications & risk factors
– Stress management lowers mortality
– Patients may resent the restrictions necessary for recovery
– Exercise is introduced and becomes more vigorous
– Exercise adherence is related to psychosocial adjustment; 50% discontinue in six months
• Only 40% quit smoking - anxious + lower occupational / educational group less likely

Question 12

Definition Stroke

Answer 12

A disruption in the blood supply to the brain
→ a cerebral artery is blocked by thrombus or embolus

as a consequence the blood vessel either rupture or haemorrage

Question 13

Risk factors of stroke

Answer 13

Age, gender, and sociocultural risk factors
higher for:
• Men
• Indigenous people
• Those older than 55 years
• Lower socioeconomic groups
• European-born Australians

Lifestyle and biological risk factors for stroke
smoking, hypertension, heart disease, diabetes, obesity, physical inactivity, family history, high red blood cell count and transient ischemic attacks

Question 14

The effects of stroke and
rehabilitation

Answer 14

• Extent & type of impairment depends on size and
location of lesion
• Improvement is possible, especially for the young,
and in those strokes due to haemorrhages
– Motor impairment is the most common
– Cognitive impairment may include receptive
and expressive aphasia
– Visual disorders are common with right brain
stroke
– Emotional effects may depend on area of the
brain damaged, includes phenomena such as
pseudobulbar lability of affect

Question 15

Definiton of Cancer

&

4 Types of Cancer

Answer 15

Unrestricted cell proliferation, which may form a malignant neoplasm.

4 types of cancer:

• *Carcinomas**
• cancers of the skin and organ linings*
• *Lymphomas**
• cancers of the lymphatic system*
• *Sarcomas**
• cancers of the muscle, bone or connective tissue*
• *Leukaemias**
• cancers of the blood forming organs*

*!: *Cancer cells can metastasise - spread through blood or lymph

Question 16

With which three methods is cancer diagnosed?

Answer 16

• urine / blood (hormones, enzymes)
• radiological imaging (x-ray)
• biopsis

Question 17

which three methods exist to treat cancer?

Answer 17

1. surgery
2. internal / external radiaton
3. chemotherapy
   medi that kills rapidly dividing cells. as a result anticipatory nasea and food aversions.

Question 18

Name the five most abundant cancers in Australia

Answer 18

colorectal, lung, breast, prostate, melanoma

Question 19

Diabetes Risk Factors

Answer 19

• Overweight & obesity is rising (in males & females)
• Physical inactivity: over 70% of Australian > 15y did little/ no exercise in 2010–11
• Unhealthy eating
• Tobacco:2.8 million Australians > 14 smoked daily in 2007
• high total cholesterol levels: 50% > 25y in 1999–2000
• high blood pressure: steadily declined btw 1980 - 2000 in urban areas of Australia

Question 20

Factors of Self Management

Answer 20

Involves the individual engagin in activities that protect & promote health, by:

1. being able to make or participate in informed decisions
2. building partnerships with others
3. managing the impacts on functioning, emotions & interpersonal relationships
4. monitoring and managing symptoms and signs of illness and chronic conditions

Question 21

Define Self Management

Answer 21

“Self-management is the by people
in their own health care. Self-management
incorporates health promotion and risk reduction,
informed decision making, following care plans,
medication management, and working with health
care providers to attain the best possible care and
to effectively negotiate the often complex health
system.”

+

about enabling: that patients can make informed choces, to adapt new perspectives and generic skills…

Question 22

Common sense model of Self-Regulation (CSM)

Answer 22

Leventhal et al.

5 attributes: identity (name & perceived symptoms), timeline, cause, consequences, cure/controllability

all of them are

1. abstract conceptual
2. concrete perceptual

Question 23

Support Services for chronic conditions

Answer 23

include:
- information
- respite centres
- support groups
- promotion of correct care

+

Behavioural methods for compliance

Question 24

Inital Reactions to a chronic illness

Answer 24

• *1. Shock**
• stunned, behaving in an automatic fashion, feeling a sense of detachment from the situation*
• *2. Encounter reaction**
• disorganised thinking, feelings of loss, grief, helplessness, despair, being overwhelmed by reality*
• *3. retreat**
• use of denial, may be used to control emotions*

4. retreat gradually gives way to reality with adjustment

Question 25

Crisis Theory

Moos, 1982

Answer 25

Adjustment depends on a variety of three factors:

• *Influencing Factors:**
  1. Illness-related Factors
  2. Background and personal Factors
  3. physical and social environmental factors

Coping
• Begins with a cognitive appraisal
Coping involves carrying out two types of adaptive tasks:

– Tasks related to illness or treatment
• Coping with the symptoms/ disability
• Adjusting to the hospital & medical procedures needed
• Developing & maintaining good relationships with health
practitioners

– Tasks related to general psychosocial functioning
• Control negative feelings & retaining a positive outlook
• Maintain satisfactory self-image & sense of competence
• Preserving good relationships with family and friends
• Preparing for an uncertain future

Question 26

National Chronic Disease Strategy
Four Key Action Areas

Answer 26

• Prevention across the continuum
• Early detection and early treatment
• Integration and continuity of care
• Self-management

Question 27

The Common Sense Model of Self-
Regulation (CSM)

Answer 27

Leventhal and colleagues (1992; 2000; 2003)
• Self-regulation = behaviour directed to achievement
and maintenance of personal goals
• Aims to understand the individual’s perception of
illness and how this affects their health behaviours,
illness outcomes, and emotional outcomes
• Individuals are active in trying to understand and
manage their health

Question 28

Quality of life

Answer 28

is the appraised degree of
satisfaction/excellence a person’s life contains

Question 29

Name the cognitive adjustments to chronic illness

Answer 29

• Cognitive adjustments to chronic illness include trying
– To find meaning in their illnesses
– To gain a sense of control
– To restore their self esteem

Question 30

Kubler-Ross proposed a sequence of five
stages:

Answer 30

Denial, Anger, Bargaining, Depression
and Acceptance