Week 6: Chronic illness (HIV & Cancer) Flashcards
Health promotions and public health programs?
Promote positive health behaviours and reduce harmful health behaviours
Improve attitudes, beliefs and behaviours that contribute to ill health
What is epidemiology?
Deals with incidence, distribution, and possible control of diseases and other factors relating to health
Why have public health challenges increased?
Have increased because of chronic disease being on the rise
What is chronic disease?
Diseases lasting 3 months or more
Generally cannot be prevented by vaccines or cured by medication nor do they just disappear on its own
What is a non-communicable disease?
a non-infectious health condition that cannot be spread from person to person
Historically, why weren’t HIV and cancer considered chronic diseases?
They were considered terminal illnesses and were feared!! they weren’t considered chronic because people typically died from them fairly quickly
What is HIV?
Lentivirus - slow virus
Binds to T helper cells in the immune system and causes a progressive failure of the immune system that allows life threatening opportunistic infections and cancers to thrive
Is there a cure for HIV?
No - have it for life
What happens if HIV remains untreated?
Leads to AIDS
What are some of the symptoms of HIV?
Fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, mouth ulcers
Explain the stages of HIV
Acute infection: very contagious - can be asymptomatic
Chronic infection: Progresses and the immune system becomes overloaded - this is how AIDS develop
AIDS: Most severe stage, really damaged immune system, opportunistic infections, very infectious. Without treatment you survive approx. 3 years
How can you prevent AIDS?
Limiting number of sexual partners - using condoms every time
Never sharing needles
HIV preventative medication?
PrEP (pre-exposure prophylaxis) - medicine taken daily by people without HIV who are at very high risk from acquiring it from sex (99% effective) or injection drug use (74% effective). Stops HIV from taking hold and spreading throughout the body.
PEP (post-exposure prophylaxis) - must be started within 72 hours after exposure. Should only be used in emergency situations
Is HIV considered a chronic illness?
Yes - now it is.
Mortality rates have decreased
Roughly how many people die from HIV/AIDS every year?
Nearly 1 million people
Roughly how many people are living with HIV/AIDS worldwide?
37 million adults and children
Majority in low and middle income countries
Which people are at risk but hard to reach?
Sex workers
People in prison
Men who have sex with men (but don’t identify as gay)
Transgender people
Which group are being increasingly affected by HIV?
Young girls and women (15-24)
Account for 1 in 4 HIV cases (Africa)
Lifestyle factors that speed up progression from HIV to AIDS?
Drug use
Unsafe sex
Unhealthy behaviours
Stress
Explain macro and micro risk environments and HIV
Micro-risk: focuses on personal decisions and influence of community-level norms and practices
Macro-risk: structural factors eg. Laws, government policies, economic conditions, wider cultural beliefs
HIV treatment allows….
Individuals to live well into old age
Also reduces viral load to undetectable levels which reduces onward sexual transmission
Stages of change model and HIV?
HIV prevention interventions mapped on to an individual or population’s readiness or stage of change.
Used to model and encourage women’s movement form their current stages to the next stage in terms of safe sex practices
AIDS Risk Reduction model
Incorporates variables from other behaviour change theories
Provides a framework for explaining and predicting behaviour change efforts - especially sexual transmission
3 stages:
- labelling of high‐risk as problematic
- Making a commitment to changing high risk behaviours
- seeking and enacting solutions directed at reducing high risk activities
Also considers: knowledge of risks, susceptibility, costs and benefits, self efficacy, emotional states, social factors
Explain risk compensation
individual’s perception that receiving HIV treatment or another preventive intervention renders HIV transmission less likely therefore the individual “compensates” by engaging in higher‐risk behaviour.
‘okay i’m on medication now, i’m fine’ - higher risk behaviour. problematic because we know medications don’t completely protect
notion of reduced risk is so POWERFUL that studies have shown that the mere promise of expanded access to treatment is associated with significant increases in risk behaviour
How much adherence to medication is required for viral suppression and reduced infectiousness?
85-95%
How much adherence to reduce early mortality?
95%
what are the barriers to adherence?
- Can be patient related (eg. self efficacy)
- Medication related (eg. regimen complexity)
- Schedule related (eg. chaotic daily schedule)
- Social related (eg. poor social support)
Predictors for better HIV outcome?
Being employed, higher income, better social support, spiritual beliefs, engaging in active coping, physical activity and exercise,
Cognitive behavioural stress management?
Focus on reducing stress and teaching cognitive coping skills, enhance perceived environmental control, self efficacy and perceived social support
Which people are more likely to engage in high sexual risk behaviour?
Individuals who experience multiple comorbid conditions
Meaning-focussed coping?
Meaning-focused coping involves searching for meaning in adversity and drawing on values, beliefs, and goals to modify the meaning given to and personal response to a stressful situation.
What factors are linked by most studies as risk factors for cancer?
Poor diet, physical inactivity, smoking, stress and social involvement
What actually is cancer?
A progressive loss of cell shape and function with a potential to spread in uncontrollable ways.
These cells invade and destroy surrounding healthy tissue, including organs
Cancer disease staging?
Early stage - better prognosis and survival rate than cancers that may have spread
Regional/advanced
Advanced - has spread throughout the body (end stage)
Cancer treatment?
Based on stage. But may involve:
- Surgery
- Radiation
- Chemo
- Hormone treatment
- Stem cell transplant
- Combinations
What are immune checkpoint inhibitors?
They allow the immune cells to respond more strongly to cancer
Checkpoint inhibitors work by releasing a natural brake on your immune system so that immune cells called T cells recognise and attack tumours
What is T cell transfer therapy
Cells taken from tumour, enhanced and put back in - makes stronger
What are monoclonal antibodies?
Immune system proteins created in the lab to bind to targets on the cancer cells
targeted therapy for cancer?
Targets proteins that control cell growth through small molecular drugs or monoclonal antibodies
- enhances the immune system to be able to destroy cells
- stops signals for cell growth and those that form blood vessels to feed tumours
- deliver toxins to cancer cells
- cause cancer cell death
- reduce hormones that feed cell growth
What is precision medicine? (cancer)
Personalised medicine
Treatments tailored to genetic changes in each persons cancer
Usually for people with advanced stage disease
Common physical side effects for cancer surgery?
Loss of organ or limb Loss of organ function Pain Fatigue Lymphodema Scars
Common physical side effects of cancer radiation?
Burning on skin or internal organ
Fatigue
Changes to personal hygiene
Common physical side effects of chemotherapy?
Nausea, vomiting, temporary hair loss, changes in appetite, membrane breakdown, changes in smell and taste, loss of organ function, reduced immunity
Common physical side effects of hormone therapy?
Femenisation, Masculisation
weight gain, bloating
reduced mental alertness
sometimes other organs are affected
What is psycho-oncology?
Exploration of psychological and social factors associated with cancer adjustment
What are some short term experiences of cancer adjustment?
Mood and sleep disturbances
Worries re prognosis, body image etc
Adjustment problems in partner
What are some long term experiences of cancer adjustment?
Mood improves in most PTSD Sexual dysfunction Poor body image Existential concerns
Effects of exercise while having cancer treatment?
- improves marrow recovery and decreases complications during peripheral bloodstem transplantation
- decreases fatigue and other symptoms associated with radiation therapy and chemotherapy
- Improves quality of life and fatigue
What did CBT studies with breast cancer patients find?
- reduced moderate depression
- enhanced benefit finding
- increased generalised optimism
- effect was greatest for women with lowest levels of optimism at baseline
