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Global Health Diseases > Non-communicable Diseases > Flashcards

Non-communicable Diseases Flashcards

1
Q

What is the difference in cancer prevalence expected to be in the next 20 years?

A

New cases rise by 70%

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2
Q

What is the global spread of cancer?

A

> 60% new cases and >70% of deaths happen in Africa, Asia and central and South America

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3
Q

What are the common tenets of all cancers?

A
  • sustained proliferative signalling
  • evading growth suppressors
  • Activating invasion and metastasis
  • resisting cell death
  • inducing angiogenesis
  • Enabling replicative immortality
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4
Q

What are the types of cancer?

A
  • carcinoma
  • sarcoma
  • leukaemia
  • myeloma
  • brain and spinal cord cancers
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5
Q

What are the stages of cancer?

A

Early/advanced

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6
Q

What are the different cancer settings?

A

Primary/metastatic

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7
Q

What are the different grades of cancer?

A

Low/high

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8
Q

What are the treatment options for cancer?

A

Chemo
Surgery
Radio
Hormone therapies
Targeted drugs
Immunotherapies
Palliative treatment

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9
Q

What are the types of chemo and what do they do?

A

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

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10
Q

What are the modifiable risk factors of cancer?

A

Smoking
Alcohol
Overweight
Unhealthy diet
Physical inactivity

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11
Q

What are the cancer-specific challenges in global health?

A

Heterogenous populations and patterns of disease
Specialised equipment
Sophisticated drugs
Policy
High cost

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12
Q

What are the most common cancers in continents?

A

Australia = melanoma (sun)
Europe = lung cancers (smoking)
Asia = oesophageal cancers (hot drinks -milk)
Sub-Saharan africa = schistosomiasis (freshwater)

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13
Q

What is the issue with anti cancer drugs?

A

Very expensive

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14
Q

Who records the incidence of cancer?

A

IARC

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15
Q

Who records the cancer mortality?

A

WHO

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16
Q

Who records cancer survival?

A

CONCORD study (followed by CONCORD-2 and -3)

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17
Q

Where is the 5 year cancer survival highest?

A

USA, Canada, Australia, New Zealand, Finland, Iceland, Norway, Sweden

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18
Q

Why was the cervical cancer prevention programme successful in Zambia?

A
  • new scheme uses same infrastructure as current HIV infrastructure
  • linked screening to treatment
  • task shifting
  • education and monitoring
  • utilising the local community
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19
Q

What did the cervical cancer prevention programme in Zambia involve?

A

Increased screening centres
Same-day treatment
Quick testing (acetic acid on the cervix to see pathologically abnormal areas)

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20
Q

How many new cancer cases worldwide in 2020?

A

19.3

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21
Q

What is the most commonly diagnosed cancer worldwide?

A

Breast

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22
Q

How many cancer deaths worldwide were there in 2020?

A

9.96 million

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23
Q

What is the estimated infection - attributable cancer burden?

A

2.2 million

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24
Q

What are the cancer cases associated with alcohol consumption?

A

741000

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25
Q

How many children/year develop cancer?

A

400,000

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26
Q

Why is the global cancer burden increasing (particularly in LMICs)?

A

Environmental and lifestyle changes
Ageing population
Increased testing

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27
Q

What does palliative care do (WHO definition)?

A

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

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28
Q

What is the theory of total pain?

A

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

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29
Q

Why is organ failure hard to carry out palliative care for?

A

Has dips so its hard to know which will be the fatal dip

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30
Q

What are the validated scales for use in palliative care measurement?

A

African APCA POS - African palliative care association palliative outcome scale
IPOS used in this country

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31
Q

What does the African APCA POS do?

A

Measure symptom burden over time

Validated in the population its used in

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32
Q

In 2015, how many people experienced serious health-related suffering?

A

61 million

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33
Q

What proportion of serious health related suffering associated deaths occurred in LMICs?

A

81%

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34
Q

Is the palliative care provision based on economics?

A

No bc Uganda is green

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35
Q

What is the UK model of palliative care?

A

Universal coverage
Hospital, hospice and homecare
Vast majority happened in people’s homes
Majority NHS funded
Specialist teams

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36
Q

What is the Uganda model of palliative care?

A

Home based
Weekly review of patients within a 20km radius
Mobile clinics
In-reach to teaching hospitals

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37
Q

Why is there no inpatient care in Ugandan palliative care?

A

Too expensive and the family are expected to do lots of basic nursing care

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38
Q

What is the model of palliative care in Kerala, India?

A

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

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39
Q

What are the barriers to palliative care?

A

Resource allocation
Lack of clear policies
Lack of palliative care skill set
Lack of opioid access
Based in wider inequalities

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40
Q

What is TB?

A

Contagious, debilitating bacterial disease spread by airbourne droplets from an infected person

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41
Q

Why dont normal antibiotics kill TB?

A

Slow growing, difficult to kill, waxy coat

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42
Q

What is the R0 of TB?

A

10-15

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43
Q

What is the 10 year mortality of TB before antibiotics?

A

70%

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44
Q

What are the early TB symptoms?

A

Cough that wont go away (non-productive -> productive)
Fatigue
Weight loss
Appetite loss
Fever
Night sweats

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45
Q

What are the TB sites of infection?

A

85% pulmonary
15% extra-pulmonary
HIV is only 30% pulmonary

46
Q

What is miliary TB?

A

Small leisions almost everywhere in the body

47
Q

What is the Mantoux test?

A

Inject purified protein derivative of TB into the arm and then test the immunological response
- would’ve been big if infected by TB

48
Q

What proportion of the worlds population is infected with latent TB?

A

1/3

49
Q

What are the risk factors for reactivation of latent TB?

A

Malnutrition
Poverty
Immunosuppression
Old age
Poor health
HIV

50
Q

What is the vaccine for TB?

A

BCG

51
Q

What are the issues with the BCG vaccine?

A

Only effective in children and for like 5 years

52
Q

How do you diagnose pulmonary TB?

A

Blood (INF-gamma test
Sputum (PCR or smear and culture)
Bronchoscopy
Biopsy
Chest X-ray

53
Q

How do you treat TB?

A

Antibiotics

54
Q

What antibiotics are used in TB treatment?

A

Used to be streptomycin but now resistant
4 drug combination trials:
- isoniazid
- rifampicin
- pyrasinamide
- ethambutol

55
Q

Why is TB so good at becoming resistant?

A

So many organisms in one person its really easy for it to mutate

56
Q

In 2021, how many new TB cases were there?

A

10.6 million

57
Q

How many deaths from TB were there in 2021?

A

1.4 million

58
Q

What are the 2030 TB milestones?

A

90% reduction in TB deaths
80% reduction in TB incidence rates

59
Q

Which antibiotics are mainly resistant in multiple drug resistant TB?

A

Rifampicin and isoniazid

60
Q

What are the issues with MDRTB?

A

Requires use of reserve drugs
Empirical therapy
More costly
More toxic side-effects
Up to two years

61
Q

What are the cure rates for MDRTB?

A

50-70%

62
Q

What is the global burden of MDRTB?

A

46500 cases

63
Q

How much more likely are people coinfected with TB/HIV to develop active TB?

A

20 times

64
Q

What is the most common presenting illness in HIV?

A

Tb

65
Q

What proportion of TB/HIV coinfected cases occur in africa?

A

70%

66
Q

Why is HIV/MDRTB really complicated to treat?

A

Significant drug interactions
Increased risk of adverse effects

67
Q

What are the general challenges in treating HIV/MDRTB?

A

Conflict
Corruption
Weak/fragmented leadership

68
Q

What are the health system challenges in treating HIV/MDRTB?

A

Geography
Financing
HR
Infrastructure
Reliable supplies
Cold chain supply

69
Q

What are the patient related challenges in treating HIV/MDRTB?

A

Poverty
Malnutrition
Co-morbidities
Late presentation
Stigma

70
Q

What are the three I’s for HIV/TB?

A

Intensified TB case-finding
Isoniazid preventative therapy
Infection control for TB

71
Q

What are the current global health vaccines?

A

BCG
DTP
Polio
Measles
(+/- HepB/yellow fever/JE)

72
Q

Why can pneumococcal conjugate vaccines be found in LICs, even though they’re really expensive?

A

Accelerated vaccines introduction initiative

73
Q

What can vaccine schedules be used to give?

A

Other necessary molecules like vitamin A

74
Q

What are the early signs of Diptheria?

A

Mild fever
Swollen neck glands
Malaise
Anorexia
Cough

75
Q

What is Diptheria?

A

Infectious respiratory disease caused by toxigenic strains of bacteria

76
Q

How is Diptheria transmitted?

A

Airbourne

77
Q

What is the incubation period of Diptheria?

A

2-7 days

78
Q

How long might you be infectious for with Diptheria?

A

Up to four weeks

79
Q

What are the severe symptoms of Diptheria?

A

Toxin can travel through bloodstream causing
- extensive organ damage
- neurological complications
- heart complications

80
Q

What is the Diptheria vaccination coverage worldwide?

A

C.85%

81
Q

What is tetanus caused by?

A

Bacteria

82
Q

Is tetanus communicable or non-communicable?

A

Non-communicable

83
Q

How is tetanus spread?

A

Spores that can survive in the environment

84
Q

What is the incubation period of tetanus?

A

4-21 days

85
Q

What are they symptoms of tetanus?

A

Muscle stiffness in Jaw
Neck stiffness
Difficulty swallowing
Stomach muscle stiffness
Muscle spasms
Sweating
Fever

86
Q

what are the complications with tetanus?

A

Fractures
Hypertension
Laryngospasm
Pulmonary embolism
Aspiration
Death

87
Q

What causes neonatal tetanus?

A

Infection of the umbilical cord stump

88
Q

How can you stop neonatal tetanus?

A

Maternal vaccination

89
Q

What diseases come under the umbrella term of CVD?

A

Coronary heart disease
Cerebrovascular disease
Peripheral arterial disease
Rheumatic heart disease
Congenital heart disease
DVT and PE

90
Q

What proportion of CVD is linked to coronary artery disease and cerebrovascular disease?

A

66%

91
Q

What are the non-modifiable risk factors for atherosclerotic plaques?

A

Age
Gender
Ethnicity
Genetics
Family history

92
Q

What are some modifiable risk factors for atherosclerotic plaques?

A

Smoking
Hypertension
Diabetes
Dyslipidaemia
Physical inactivity
dietary habits

93
Q

What are the principles of treatment in HICs?

A

Prevention
Treatment of risk factors and CVD
Treatment of event (open blocked artery)

94
Q

What are the pharmacological treatment of risk factors for CVD?

A

Anti-hypertensives
Statins
Prevent thrombosis

95
Q

Why is CVD still a problem in HICs?

A

Many patients present late
Treatment ≠ cure
Not all treatments are 100% effective
Treatments are expensive

96
Q

What are the financial impacts of CVD?

A

Direct (hospitalisation, treatments, outpatients, nursing homes)
Indirect (on the household, lack of income, savings, cost of insurance)

97
Q

How many deaths from CVD in 2019?

A

18 million

98
Q

What proportion of global deaths are CVD?

A

30%

99
Q

What are the stages of epidemiological transitions?

A

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

100
Q

What are the life expectancies in each of the stages in epidemiological transitions?

A

Stage 1 = 35
Stage 2 = 50
Stage 3 = >60
Stage 4 = >70

101
Q

What are the main causes of death in stage 1?

A

Infection and malnutrition

102
Q

What are the main causes of death in stage 2?

A

Emergence of CVD risk factors

103
Q

How can LMICs treat CVDs?

A

Drugs
Testing
Education and public policy

104
Q

Why is there the perfect storm of factors for the increasing incidence and prevalence of CVD in LMICs?

A

Diet/lack of exercise
Tobacco
Ageing society
HIV survivors
Air pollution
Rural-> urban migration
Psychosocial/economic stressors
Climate change

Limited national resources
Economic constriants

105
Q

What is the trend in total cholesterol levels?

A

Increasing

106
Q

What is the trend in BMI?

A

Increased but levelled off/decreasing

107
Q

Why has smoking increased in LICs?

A

Cheap cigarettes and urbanisation

108
Q

What can be done about increasing CVD in LICs?

A

Individual based inventions (treat individuals with disease)

Population wide inventions (reduce risk of future disease in healthy populations

109
Q

What education and public policy can be used in LICs to decrease CVD?

A

Decreased smoking
Decreased Salt/fat intake
Community interventions

110
Q

What testing can be used in LMICs to reduce CVD?

A

BP monitoring
Smoking prevention
Diabetes
Lipids
Family history
Salt
Limited resources

Global Health Diseases (3 decks)

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