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Public Health > Non- communicable disease > Flashcards

Non- communicable disease Flashcards

1
Q

List the NCDs

A
  1. Cancer
  2. Diabetes mellitus
  3. Chronic respiratory diseases
  4. Cardiovascular disease
  5. Mental health and neurological conditions
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2
Q

What are Non-Communicable Diseases (NCDs)?

A

Non-Communicable Diseases (NCDs), also known as chronic diseases, are illnesses that cannot be spread from person to person

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3
Q

What are the characteristic features of NCDs?

A

NCDs typically have a long duration, slow progression, and a complex etiology.

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4
Q

What factors contribute to the development of NCDs?

A

NCDs result from a combination of genetic, physiological, environmental, and behavioral factors. These include both modifiable (such as diet and physical activity) and non-modifiable (such as age and genetic predisposition) risk factors.

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5
Q

Characteristics of NCD

A
  • Complex etiology,, multiple risk factors and non- contagious origin
  • long latency period
  • prolonged course of illness
  • often incurable
  • causes of reduced QoL
  • causes increased premature morbidity and mortality
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6
Q

CD vs NCD onset

A

CD- sudden onset

NCD- gradual onset

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7
Q

CD vs NCD no. of causes

A

CD- single cause

NCD- multiple causes

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8
Q

CD vs NCD length of natural history

A

CD- short natural history

NCD- long natural history

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9
Q

CD vs NCD length of treatment time

A

CD- short treatment schedule

NCD- prolonged treatment

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10
Q

CD vs NCD Cure vs Care

A

CD- cure is achieved

NCD- care predominates

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11
Q

CD vs NCD no of disciplines involved

A

CD- single discipline

NCD- multidisciplinary

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12
Q

CD vs NCD follow up

A

CD- short follow up

NCD- prolonged follow up

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13
Q

CD vs NCD goal of treatment

A

CD; back to monarchy

NCD- quality of life after treatment

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14
Q

System response is different for NCDs

A

Shared risk factors
Screening is key
Lifelong treatment

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15
Q

Which four NCDs account for more than 80% of all premature NCD deaths globally?

A

Cardiovascular diseases (such as heart attacks and strokes)

Cancer (various types
)
Chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma)

Diabetes (primarily type 2 diabetes)

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16
Q

What characterizes the complex aetiology of Non-Communicable Diseases (NCDs)?

A

The development of NCDs is multifactorial, involving an interplay between modifiable (e.g., lifestyle factors like diet, exercise) and non-modifiable (e.g., genetic predisposition, age) risk factors.

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17
Q

How can addressing modifiable risk factors impact the development of NCDs?

A

Addressing modifiable risk factors can decrease the risk of developing NCDs in susceptible individuals and prevent the worsening or augmentation of the illness.

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18
Q

How are injuries classified as NCDs?

A

Some injuries, particularly those with prolonged recovery times and impaired function, are classified as NCDs due to their chronic impact on health and well-being

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19
Q

Can you provide examples of NCDs that have an infectious origin?

A

Examples of NCDs that have an infectious origin include:

  1. Hepatocellular carcinoma (liver cancer) caused by chronic hepatitis B or C infection.
  2. Gastric cancer associated with Helicobacter pylori infection.
  3. Cervical cancer caused by human papillomavirus (HPV) infectio
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20
Q

Risk factors for NCDs

A

tobacco use
alcohol use
physical inactivity
unhealthy eating
air pollution

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21
Q

Why are NCDs important

A

Poverty, rapid urbanization, industrialization, population aging, globalization of marketing and trade and poorly developed health systems are some of the social, cultural and commercial determinants of health contributing to the rising incidence of NCDs.

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22
Q

What is a risk factor?

A

A risk factor is an aspect of personal behavior/lifestyle, environmental exposure, or heredity that is associated with an increased occurrence of disease, injury, or other health conditions.

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23
Q

Modifiable risk factor

A

A risk factor that can be reduced or controlled by intervention, thereby reducing the probability of disease

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24
Q

Examples of modifiable risk factor

A
  • tobacco use
    -alcohol use
    -physical inactivity
  • unhealthy diet
  • environmental risk factors (e.g. air pollution)

intermediate risk factors
- overweight and obesity
- high blood pressure

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25
Q

non modifiable risk factors

A

a risk factor that cannot be reduced or controlled by intervention

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26
Q

example of non- modifiable risk factors

A
  • age
  • sex
  • family history (genetics factors)
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27
Q

Categorization of risk factors

A
  • environmental risk factors
  • behavioral risk factors
  • biological risk factors
  • chronic NCD
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28
Q

What is the life course approach to health?

A

The life course approach to health is born out of the need to understand how health and well-being depend on multiple factors, and how the risk of ill health accumulates across life stages and generations.

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29
Q

What are the objectives of the life course approach to health?

A

The life course approach aims to:

  1. Optimize the functional ability of individuals throughout their lives.
  2. Enable well-being and 3. the realization of rights.
  3. Recognize the interdependence of individual, intergenerational, social, environmental, and temporal factors
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30
Q

How does resilience to ill health relate to the accumulation of risk throughout life and across generations?

A

Resilience to ill health is influenced by the accumulation of risks encountered throughout life and across generations. This accumulation of risk can significantly impact health outcomes over time.

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31
Q

How does adolescence impact preventable deaths from Non-Communicable Diseases (NCDs)?

A

Seventy percent of preventable deaths from NCDs in adults have been linked to risks and behaviors encountered during adolescence, highlighting the critical period for health interventions.

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32
Q

When do a significant percentage of mental health problems typically become established?

A

Approximately 50% of mental health problems are established by the age of 14, underscoring the importance of early intervention and support.

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33
Q

Why are the number and sequence of exposures to risk, and periods of increased susceptibility important?

A

The number and sequence of exposures to risk, along with periods of increased susceptibility, play crucial roles in determining health outcomes and disease prevention strategies.

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34
Q

How are individual good and social good mutually dependent?

A

Individual well-being and social well-being are mutually dependent, both relying on the physical environment and societal factors for support and sustainability.

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35
Q

What does the demographic transition describe?

A

The demographic transition describes the population change over time, specifically accounting for changes in birth and death rates that result in shifts in population size and age structure.

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36
Q

How does the demographic transition affect population size?

A

Initially, population size increases due to drops in mortality rates, leading to longer life expectancy and population growth.

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37
Q

How does the demographic transition impact the average population age?

A

Average population age increases due to a drop in fertility rates that typically occur after the decline in mortality rates.

38
Q

What drives the drop in mortality and fertility rates during the demographic transition?

A

The drop in mortality and fertility rates is primarily due to social and economic development, including improvements in healthcare, education, and economic opportunities.

39
Q

What are the five stages of demographic transition?

A

The five stages of demographic transition are:

Stage 1: High birth and death rates, leading to low population growth.

Stage 2: Decline in death rates, leading to rapid population growth.

Stage 3: Decline in birth rates, slowing population growth.

Stage 4: Low birth and death rates, resulting in low or zero population growth.

Stage 5: Possible future stage with very low birth rates, leading to population decline in some countries.

40
Q

Reason for high birth rate

A

Lack of family planning
High infant mortality
Children viewed as economic assets

41
Q

Reason for high death rate

A

High levels of disease and famine
Lack of sanitation and health care
War
Lack of education

42
Q

Reason for decline in death rate

A

Improved hygiene
Decreased infant mortality
Improved healthcare (e.g. smallpox vaccine

43
Q

reason for stage 3

A

Birth rate starts to fall
Family planning

Death continues to fall
Lower infant mortality
Increased standard of living
Changing status of women

Population rising

44
Q

reason for stage 4

A

Birth rate and death rate low
Socio-economic developments

Population plateau

45
Q

What does the epidemiological transition describe?

A

The epidemiological transition describes changes in the burden of disease over time within populations. It accounts for shifts influenced by biological, social, economic, and psychological factors during transitional processes.

46
Q

How does the epidemiological transition relate to the demographic transition?

A

While the demographic transition focuses on population changes (birth and death rates), the epidemiological transition focuses on changes in the patterns of disease and health within populations over time.

47
Q

What factors influence the epidemiological transition?

A

The epidemiological transition is influenced by the rate of fertility decline, distribution of risk factors (such as lifestyle behaviors), incidence of diseases, and the capacity of health systems to respond to changing health profiles

48
Q

How does the epidemiological transition correlate with increasing life expectancy?

A

As countries progress through different stages of the epidemiological transition, there is often an associated increase in life expectancy due to improvements in healthcare, disease prevention, and treatment of chronic conditions.

49
Q

Why do different countries experience different stages of epidemiological transition?

A

Variability among countries in the epidemiological transition is influenced by differences in healthcare infrastructure, socioeconomic development, public health policies, and the distribution of risk factors across populations.

50
Q

The social- ecological model: a framework for prevention

A

individual
relationship
community
societal

51
Q

What does socio-ecological theory conceptualize?

A

Socio-ecological theory conceptualizes health by focusing on how health is influenced by the interaction between the individual, the community, and the physical, social, and political environments.

52
Q

What is the role of context in the socio-ecological theory of health?

A

Context plays a crucial role in the development of health problems and the success or failure to address these problems effectively within communities and populations

53
Q

How is socio-ecological theory used to develop approaches to disease prevention and health promotion?

A

Socio-ecological theory informs approaches that address disease prevention and health promotion at multiple levels—individual, community, and societal—by considering the influence of various environments and their interactions.

54
Q

How can the same environment impact individuals’ health differently?

A

The same environment may impact individuals’ health differently depending on factors such as socioeconomic status, access to resources, social support networks, and personal health behaviors.

55
Q

What are examples of multiple environments that influence health according to socio-ecological theory?

A

Multiple environments such as the workplace, neighborhood, educational settings, and healthcare systems can influence each other and collectively impact individuals’ health outcomes.

56
Q

How do personal and environmental leverage points impact health and well-being?

A

Personal and environmental leverage points, such as access to resources, social norms, and policy frameworks, play critical roles in shaping health behaviors and outcomes within socio-ecological frameworks.

57
Q

Primordial prevention

A

targets social and economic policies affecting health

58
Q

primary prevention

A

targets risk factors leading to injury/ disease (safety belt laws or vaccinations)

59
Q

secondary prevention

A

prevents injury/ disease once exposure to risk factors occurs but still in early, preclinical stage

60
Q

tertiary prevention

A

rehabilitating persons with injury/ disease to reduce complications

61
Q

What is screening?

A

Screening is the systematic application of a test or inquiry to identify individuals who are at sufficient risk of a specific illness, who have not yet sought medical attention for their symptoms, in order to benefit from further investigation or preventative action

62
Q

What is the purpose of screening

A

early detection of:
- susceptibility of disease
- precursors of disease
- disease

63
Q

The purpose of screening is to:

A

Reduce morbidity and mortality from specific illnesses by detecting them early.

Improve the quality of life among those screened.

Use relatively simple and inexpensive tests to classify individuals based on their likelihood of having a specific condition.

Identify individuals at increased risk for the presence of disease who may require further investigation. Note that screening does not diagnose disease but identifies those who may need additional diagnostic procedures.

64
Q

mass screening

A

population wide testing of apparently healthy individuals for a disease (independent of risk)- e.g. screening of neonates

65
Q

selective screening

A

testing of patient populations though to be at increased risk of a disease either because of pathophysiology (e.g. TB screening in people with HIV) or shared characteristics (e.g. TB screening among homeless people)

66
Q

types of case finding

A

active case finding
passive case finding

67
Q

active case finding

A

using existing data to go out and look for people with known risk factors for screening

68
Q

passive case finding

A

wait for people to come to the clinic

69
Q

surveillances goal

A

Goal is to provide health information about disease or risk factors in the population

Ongoing systematic collection of data

70
Q

goal of screening

A

Goal is to benefit the individual being screened

71
Q

screening test vs diagnostic test purpose

A

ST- to detect potential disease indicators

DT- to establish presence/ absence of disease

72
Q

screening test vs diagnostic test target population

A

ST- large numbers of asymptomatic, but potentially at risk individuals

DT- symptomatic individuals to establish diagnosis
-asymptomatic individuals with a positive screening test

73
Q

screening test vs diagnostic test test method

A

ST- simple, acceptable to patients and staff

DT- may be invasive, expensive but justifiable as necessary to establish diagnosis

74
Q

screening test vs diagnostic test positive test threshold

A

ST- generally chosen towards high sensitivity not to miss potential disease

DT- chosen towards high specificity (true negative)
- more weight given to accuracy and precision than to patient acceptability

75
Q

screening test vs diagnostic test positive result

A

ST- essentially indicates suspicion of disease that warrants confirmation

DT- results provides a definite diagnosis

76
Q

screening test vs diagnostic test cost

A

ST- cheap, benefits should justify the costs since large numbers of people will need to be screened to identify a small number of potential cases

DT- higher costs associated with diagnostic test may be justified to establish diagnosis

77
Q

Screening for NCDs- The disease

A
  • the disorder should be an important public health problem
  • known to cause significant suffering, disability or death if detected late
  • an early asymptomatic stage should exist
78
Q

Screening for NCDs- The test

A
  • there is a simple and cost effective screening test
    -acceptable
    -safety
    -good sensitivity, specificity and PPV
    -(not a diagnostic test)
79
Q

Screening for NCDs- The follow up

A
  • the diagnosis can be confirmed
  • treatment is available
80
Q

Screening for NCDs- The outcome

A

there is evidence that early treatment during the asymptomatic stage improves long term outcome

81
Q

good screening program features

A

-Disease is important to the individual and community
-Natural history adequately understood
-Recognizable latent/early asymptomatic stage
-Suitable screening test with adequate follow up
-Economically beneficial
-Acceptable and affordable treatment more effective when started early

82
Q

What do sensitivity and specificity measure in a screening test?

A

Sensitivity and specificity measure a test’s ability to correctly classify individuals as having or not having a disease

83
Q

Sensitivity

A

A highly sensitive test has few false negative results, meaning it correctly identifies most individuals who have the disease (true positives).

84
Q

Specificity

A

A highly specific test has few false positive results, meaning it correctly identifies most individuals who do not have the disease (true negatives).

85
Q

What is the trade-off associated with sensitivity and specificity in screening tests?

A

There is always a trade-off:

For Screening: Ideally, you want a highly sensitive test to minimize false negatives and ensure that individuals with the disease are not missed. However, increasing sensitivity may lead to more false positives, which can result in unnecessary follow-up tests, treatments, and emotional burden for patients.

86
Q

Positive predictive value

A

proportion of individuals who test positive who actually have the disease

87
Q

negative predictive value

A

proportion of individuals who test negative who don’t have the disease

88
Q

How are PPV and NPV determined in screening tests?

A

PPV (Positive Predictive Value) and NPV (Negative Predictive Value) in screening tests are determined by the sensitivity, specificity, and the prevalence of the disease in the community

89
Q

When does PPV increases

A

Increases with increasing prevalence
Increases with increasing specificity

90
Q

When does NPV increase

A

Increases with decreasing prevalence
Increases with increasing sensitivity

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