Week 7: Chronic illness (CHD and obesity) Flashcards
What is cardiovascular disease?
It is a broad category that involves diseases affecting the heart and blood vessels
What is coronary heart disease (also known as coronary artery disease)?
This occurs when the walls of the coronary arteries become narrowed by the gradual build up of fatty material
What is the fatty material that builds up in the arteries called?
Atheroma
What are the main forms of coronary heart disease?
Angina (pain in chest, sometimes extending down left arm)
Acute Myocardial Infarction (heart attack)
Sudden cardiac death (commonly occurs after heart attack)
Heart failure (heart not pumping properly)
What is the leading cause of death (globally)?
Coronary heart disease and predicted to remain so for the next 10 or so years
Are there any gender differences in CHD prevalence?
Yes. Men (6.5%) have it more than women (4.8%)
Is age a factor for CHD?
Yes it seems to be.
1 in 4 of those aged 75 and over
Is the risk of CHD increased for indigenous Australians?
Yes.
Hospitalisations and death rates were 50% higher for indigenous Australians than non-indigenous
Any difference in CHD prevalence for remote areas vs major cities?
CHD hospitalisations 30% higher among remote areas compared to major cities
What kinds of stress has an impact on CHD onset?
Personal, work and family-related stress
How does work stress contribute to risk of CHD?
Job insecurity (increases CHD) and working long hours (increases risk of stroke)
What are the conventional risk factors of CHD?
Smoking
High cholesterol
Hypertension
Physical inactivity
The prognosis of CHD is associated with which psychosocial factors?
Depression
Social isolation
Lack of quality of social support
May also combine with conventional factors
Which risk factors do public health interventions focus on?
Approaches to coronary heart disease have largely focussed on the modification of conventional factors
What is the most common co-occurring disease with CHD? and why?
Diabetes - most likely to have certain conditions or risk factors that increase the chances of having CHD such as high blood pressure or high cholesterol
CHD causes almost 60% of deaths in those with diabetes as they go on to develop these problems because of it
Why is more research needed for the heart-brain connection?
CHD is progressively associated with increased odds of cognitive impairment or dementia
Are there any studies looking at mass media education and a CVD prevalence?
Yes - Stanford community study
Delivered messages via media to try and reduce fat intake
After 2 years - reduced daily fat intake from 25g down to 3g
Smart phone interventions can be used to provide individually tailored, self‐monitoring feedback & communication on specific health behaviours - what are the results of these?
Can be used for a range of behaviours that need improving eg. Weight loss, smoking, sunscreen use
Results: short to medium term evidence of effectiveness for reducing BMI, increasing and maintaining physical activity and weight loss
Web/internet based interventions?
Feature:
- Enriched information
- Monitoring individual progress with tailored feedback etc
- Access to expert advice (face-face or online)
All studies bar one found a statistically small but significant effect on health related behaviours
Which patients reported lower PHYSICAL HEALTH related quality of life? (CHD)
Older
Unemployed
Lower baseline physical QOL
Lower self confidence in meeting daily physical health recommendations
No intentions of physical activity in next six months
Which patients reported lower MENTAL HEALTH related quality of life? (CHD)
Younger Lower baseline mental health More sedentary Depressed Lower social support
What does pre-surgical depression predict?
Predicts cardiac hospitalisation, continued surgical pain, failure to return to previous activity and depression at six months
How many patients with heart failure were found to have depression?
Clinically significant depression was present in at least one in five patients with heart failure
The relationship between depression and poorer heart failure outcomes is consistent and strong across multiple endpoints
What have studies found regarding heart attack and social support?
Having low social support networks was a predictor of 1-year mortality following acute myocardial infarction
What have studies compared low social support to in relation to CVD?
They have claimed it to be equivalent to many classic risk factors such as elevated cholesterol levels, tabacco use and hypertension
Anger and hostility is another significant predictor of mortality in CHD - how and why?
High levels of hostility put individuals at a 58% risk of secondary events
The association was mainly moderated by poor health behaviours, specifically physical inactivity and smoking
How are positive psychological attitudes associated with superior cardiac outcomes?
Especially optimism!!
Associated with increased participation in cardiac health behaviours (e.g., healthy eating, physical activity) linked to beneficial outcomes
Evidence for direct effect ‐ positive psychological states and biomarkers of cardiac health (e.g., inflammatory markers) is mixed, not as strong
Explain planning
Is a prospective self‐regulatory strategy, a mental simulation of linking concrete responses to future situations
What is action planning?
Can help initiate action by specifying when, where
and how to act
Synonymous with implementation intentions
What is coping planning?
Can help a person to overcome obstacles and cope with difficulties by anticipating situations that put intended behaviour at risk
How are action and coping planning beneficial for long term lifestyle change?
Study - CHD rehab (needed to adhere to physical activity increase)
Action plans were more influential early in the rehabilitation process, whereas coping plans were more instrumental later on.
People with higher levels of coping planning after discharge were more likely to report higher levels of exercise four months after discharge
SMART goals?
Specific Measurable Attainable Relevant Time-based
What does obesity put you at risk of?
It is a major risk for CVD, type 2 diabetes, some musculoskeletal conditions and some cancers
What is the most widely used method to measure someones weight?
BMI
weight (kg)/height(m squared)
What BMI score is considered NORMAL?
between 18.5 and 24.9
What BMI score is considered OVERWEIGHT?
between 25 and 29.9
What BMI score is considered OBESE?
between 30 and 34.9
What BMI score is considered SEVERELY OBESE?
between 35 and 39.9
What BMI score is considered MORBIDLY OBESE?
40+
Where is obesity particularly on the rise?
Low income countries!
Particularly urban settings
In 2014 - how many adults were overweight or obese?
1.9 billion
in 2014 - how many children were overweight or obese?
41 million
In relation to food - why is obesity rising?
There is a rising cost of healthy food as well as food scarcity in developing countries
What are the top 3 ranked obese countries?
- Nauru (61% of population have BMI larger than 30)
- Cook islands (55.9% of the population)
- Palau (55.3% of the population)
What do health programs target with targeting obesity?
- Healthy diet
- Physical exercise
- Depression management
What does an obesogenic environment look like?
Sedentary lifestyle, less manual labour, more car use, remote controls, mobile phones, more fast food and less cooking as well as more snacking
What is the average weight loss from behavioural interventions after 12 months?
-2.8kg
Which behavioural approaches for weight management were effective?
Calorie counting, contact with a dietician, and use of behaviour change techniques that compare participants’ behaviours with others were associated with greater weight loss
What is the effectiveness of school‐based interventions for reducing children’s excessive weight gain?
Evidence suggests school‐based interventions that target enjoyable physical activity are generally effective in reducing excessive weight gain
However:
Need more research on Interventions that target broader behaviours such as diet and maintenance of weight reduction
Effects of Mindfulness training on weight loss & health‐related behaviours in overweight & obese adults?
No significant effect on weight loss
But:
Short term effectiveness for reducing impulsive eating & binge eating as well as short term increases in physical activity
Is relapse an issue with weight loss programs?
Yes it is a significant problem
which psychosocial factors predict better maintenance & reduced relapse after intervention?
- Higher levels of motivation
- Self-efficacy for coping with barriers
- Self-regulation skills
- Positive body image
Which certain elements of a built environment encourage physical activity?
Facility accessibility (e.g.,cycle paths, access to local parks)
Opportunities for being active (e.g.,home equipment, local area opportunities for physical activity)
Safety (e.g. local neighbourhoods safe from crime)
Aesthetics (e.g.,enjoyable scenery)
What is the diabetes prevention program?
A comprehensive array of behavioural techniques
Individual case management by “lifestyle coaches” who also delivered the intervention.
10 years: Continued to have delay in development of diabetes by 34% compared with participants who took a placebo
15 years: Program continued to have a delay in development of diabetes by 27%
people who are at high risk for type 2 diabetes can prevent or delay disease by losing a modest amount of weight through lifestyle changes (dietary changes and increased physical activity).
Taking metformin, a safe and effective generic medicine to treat diabetes, was also found to prevent the disease, though to a lesser degree
Look AHEAD (Action for Health in Diabetes) study
8 year weight losses achieved
Comprehensive behavioural weight loss counselling over the 8 years
Look AHEAD’s produced clinically meaningful weightloss (≥5%) of initial weight at year 8 in 50% of patients with type 2 diabetes
26.9% lost ≥10% of initial weight
May be used to manage other obesity‐related co‐morbid conditions
