Non-communicable Diseases Flashcards
What is the difference in cancer prevalence expected to be in the next 20 years?
New cases rise by 70%
What is the global spread of cancer?
> 60% new cases and >70% of deaths happen in Africa, Asia and central and South America
What are the common tenets of all cancers?
- sustained proliferative signalling
- evading growth suppressors
- Activating invasion and metastasis
- resisting cell death
- inducing angiogenesis
- Enabling replicative immortality
What are the types of cancer?
- carcinoma
- sarcoma
- leukaemia
- myeloma
- brain and spinal cord cancers
What are the stages of cancer?
Early/advanced
What are the different cancer settings?
Primary/metastatic
What are the different grades of cancer?
Low/high
What are the treatment options for cancer?
Chemo
Surgery
Radio
Hormone therapies
Targeted drugs
Immunotherapies
Palliative treatment
What are the types of chemo and what do they do?
Adjuvant (after surgery to decrease risk of reoccurrence)
Neoadjuvant (given before surgery to try and shrink tumour)
Palliative (same drugs but given over a long time)
Curative
What are the modifiable risk factors of cancer?
Smoking
Alcohol
Overweight
Unhealthy diet
Physical inactivity
What are the cancer-specific challenges in global health?
Heterogenous populations and patterns of disease
Specialised equipment
Sophisticated drugs
Policy
High cost
What are the most common cancers in continents?
Australia = melanoma (sun)
Europe = lung cancers (smoking)
Asia = oesophageal cancers (hot drinks -milk)
Sub-Saharan africa = schistosomiasis (freshwater)
What is the issue with anti cancer drugs?
Very expensive
Who records the incidence of cancer?
IARC
Who records the cancer mortality?
WHO
Who records cancer survival?
CONCORD study (followed by CONCORD-2 and -3)
Where is the 5 year cancer survival highest?
USA, Canada, Australia, New Zealand, Finland, Iceland, Norway, Sweden
Why was the cervical cancer prevention programme successful in Zambia?
- new scheme uses same infrastructure as current HIV infrastructure
- linked screening to treatment
- task shifting
- education and monitoring
- utilising the local community
What did the cervical cancer prevention programme in Zambia involve?
Increased screening centres
Same-day treatment
Quick testing (acetic acid on the cervix to see pathologically abnormal areas)
How many new cancer cases worldwide in 2020?
19.3
What is the most commonly diagnosed cancer worldwide?
Breast
How many cancer deaths worldwide were there in 2020?
9.96 million
What is the estimated infection - attributable cancer burden?
2.2 million
What are the cancer cases associated with alcohol consumption?
741000
How many children/year develop cancer?
400,000
Why is the global cancer burden increasing (particularly in LMICs)?
Environmental and lifestyle changes
Ageing population
Increased testing
What does palliative care do (WHO definition)?
Improves quality of patients life facing problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
What is the theory of total pain?
The pain you feel as a person is not as simple as just physical pain
It’s a mix of physical, psychological, spiritual and social
Why is organ failure hard to carry out palliative care for?
Has dips so its hard to know which will be the fatal dip
What are the validated scales for use in palliative care measurement?
African APCA POS - African palliative care association palliative outcome scale
IPOS used in this country
What does the African APCA POS do?
Measure symptom burden over time
Validated in the population its used in
In 2015, how many people experienced serious health-related suffering?
61 million
What proportion of serious health related suffering associated deaths occurred in LMICs?
81%
Is the palliative care provision based on economics?
No bc Uganda is green
What is the UK model of palliative care?
Universal coverage
Hospital, hospice and homecare
Vast majority happened in people’s homes
Majority NHS funded
Specialist teams
What is the Uganda model of palliative care?
Home based
Weekly review of patients within a 20km radius
Mobile clinics
In-reach to teaching hospitals
Why is there no inpatient care in Ugandan palliative care?
Too expensive and the family are expected to do lots of basic nursing care
What is the model of palliative care in Kerala, India?
State funded
Volunteers deliver home-based services
Volunteers trained to deal with social, spiritual and financial issues
Community run and operated and funded through local micro-donations
Also includes long-term chronically ill and mental health
What are the barriers to palliative care?
Resource allocation
Lack of clear policies
Lack of palliative care skill set
Lack of opioid access
Based in wider inequalities
What is TB?
Contagious, debilitating bacterial disease spread by airbourne droplets from an infected person
Why dont normal antibiotics kill TB?
Slow growing, difficult to kill, waxy coat
What is the R0 of TB?
10-15
What is the 10 year mortality of TB before antibiotics?
70%
What are the early TB symptoms?
Cough that wont go away (non-productive -> productive)
Fatigue
Weight loss
Appetite loss
Fever
Night sweats
What are the TB sites of infection?
85% pulmonary
15% extra-pulmonary
HIV is only 30% pulmonary
What is miliary TB?
Small leisions almost everywhere in the body
What is the Mantoux test?
Inject purified protein derivative of TB into the arm and then test the immunological response
- would’ve been big if infected by TB
What proportion of the worlds population is infected with latent TB?
1/3
What are the risk factors for reactivation of latent TB?
Malnutrition
Poverty
Immunosuppression
Old age
Poor health
HIV
What is the vaccine for TB?
BCG
What are the issues with the BCG vaccine?
Only effective in children and for like 5 years
How do you diagnose pulmonary TB?
Blood (INF-gamma test
Sputum (PCR or smear and culture)
Bronchoscopy
Biopsy
Chest X-ray
How do you treat TB?
Antibiotics
What antibiotics are used in TB treatment?
Used to be streptomycin but now resistant
4 drug combination trials:
- isoniazid
- rifampicin
- pyrasinamide
- ethambutol
Why is TB so good at becoming resistant?
So many organisms in one person its really easy for it to mutate
In 2021, how many new TB cases were there?
10.6 million
How many deaths from TB were there in 2021?
1.4 million
What are the 2030 TB milestones?
90% reduction in TB deaths
80% reduction in TB incidence rates
Which antibiotics are mainly resistant in multiple drug resistant TB?
Rifampicin and isoniazid
What are the issues with MDRTB?
Requires use of reserve drugs
Empirical therapy
More costly
More toxic side-effects
Up to two years
What are the cure rates for MDRTB?
50-70%
What is the global burden of MDRTB?
46500 cases
How much more likely are people coinfected with TB/HIV to develop active TB?
20 times
What is the most common presenting illness in HIV?
Tb
What proportion of TB/HIV coinfected cases occur in africa?
70%
Why is HIV/MDRTB really complicated to treat?
Significant drug interactions
Increased risk of adverse effects
What are the general challenges in treating HIV/MDRTB?
Conflict
Corruption
Weak/fragmented leadership
What are the health system challenges in treating HIV/MDRTB?
Geography
Financing
HR
Infrastructure
Reliable supplies
Cold chain supply
What are the patient related challenges in treating HIV/MDRTB?
Poverty
Malnutrition
Co-morbidities
Late presentation
Stigma
What are the three I’s for HIV/TB?
Intensified TB case-finding
Isoniazid preventative therapy
Infection control for TB
What are the current global health vaccines?
BCG
DTP
Polio
Measles
(+/- HepB/yellow fever/JE)
Why can pneumococcal conjugate vaccines be found in LICs, even though they’re really expensive?
Accelerated vaccines introduction initiative
What can vaccine schedules be used to give?
Other necessary molecules like vitamin A
What are the early signs of Diptheria?
Mild fever
Swollen neck glands
Malaise
Anorexia
Cough
What is Diptheria?
Infectious respiratory disease caused by toxigenic strains of bacteria
How is Diptheria transmitted?
Airbourne
What is the incubation period of Diptheria?
2-7 days
How long might you be infectious for with Diptheria?
Up to four weeks
What are the severe symptoms of Diptheria?
Toxin can travel through bloodstream causing
- extensive organ damage
- neurological complications
- heart complications
What is the Diptheria vaccination coverage worldwide?
C.85%
What is tetanus caused by?
Bacteria
Is tetanus communicable or non-communicable?
Non-communicable
How is tetanus spread?
Spores that can survive in the environment
What is the incubation period of tetanus?
4-21 days
What are they symptoms of tetanus?
Muscle stiffness in Jaw
Neck stiffness
Difficulty swallowing
Stomach muscle stiffness
Muscle spasms
Sweating
Fever
what are the complications with tetanus?
Fractures
Hypertension
Laryngospasm
Pulmonary embolism
Aspiration
Death
What causes neonatal tetanus?
Infection of the umbilical cord stump
How can you stop neonatal tetanus?
Maternal vaccination
What diseases come under the umbrella term of CVD?
Coronary heart disease
Cerebrovascular disease
Peripheral arterial disease
Rheumatic heart disease
Congenital heart disease
DVT and PE
What proportion of CVD is linked to coronary artery disease and cerebrovascular disease?
66%
What are the non-modifiable risk factors for atherosclerotic plaques?
Age
Gender
Ethnicity
Genetics
Family history
What are some modifiable risk factors for atherosclerotic plaques?
Smoking
Hypertension
Diabetes
Dyslipidaemia
Physical inactivity
dietary habits
What are the principles of treatment in HICs?
Prevention
Treatment of risk factors and CVD
Treatment of event (open blocked artery)
What are the pharmacological treatment of risk factors for CVD?
Anti-hypertensives
Statins
Prevent thrombosis
Why is CVD still a problem in HICs?
Many patients present late
Treatment ≠ cure
Not all treatments are 100% effective
Treatments are expensive
What are the financial impacts of CVD?
Direct (hospitalisation, treatments, outpatients, nursing homes)
Indirect (on the household, lack of income, savings, cost of insurance)
How many deaths from CVD in 2019?
18 million
What proportion of global deaths are CVD?
30%
What are the stages of epidemiological transitions?
Stage 1:
- age of pestilence and famine
Stage 2:
- age of receding pandemics
Stage 3:
- age of degenerative and man-made disease
Stage 4:
- age of delayed degenerative disease
What are the life expectancies in each of the stages in epidemiological transitions?
Stage 1 = 35
Stage 2 = 50
Stage 3 = >60
Stage 4 = >70
What are the main causes of death in stage 1?
Infection and malnutrition
What are the main causes of death in stage 2?
Emergence of CVD risk factors
How can LMICs treat CVDs?
Drugs
Testing
Education and public policy
Why is there the perfect storm of factors for the increasing incidence and prevalence of CVD in LMICs?
Diet/lack of exercise
Tobacco
Ageing society
HIV survivors
Air pollution
Rural-> urban migration
Psychosocial/economic stressors
Climate change
Limited national resources
Economic constriants
What is the trend in total cholesterol levels?
Increasing
What is the trend in BMI?
Increased but levelled off/decreasing
Why has smoking increased in LICs?
Cheap cigarettes and urbanisation
What can be done about increasing CVD in LICs?
Individual based inventions (treat individuals with disease)
Population wide inventions (reduce risk of future disease in healthy populations
What education and public policy can be used in LICs to decrease CVD?
Decreased smoking
Decreased Salt/fat intake
Community interventions
What testing can be used in LMICs to reduce CVD?
BP monitoring
Smoking prevention
Diabetes
Lipids
Family history
Salt
Limited resources
