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Objectives:-
At the end of this session, student will be aware of:-
1. Definition of chronic diseases
2. Acute/subacute & chronic diseases
3. Problem size
4. Common types
5. Major risk factors
6. Chronic Disease Clinic
7. Comprehensive & integration care
8. Health promotion & prevention.
Definition:-
• Chronic Disease is a long-lasting condition that can be controlled but not cured.
• Any condition that requires ongoing adjustments by the affected person & interactions with the health care system
Difference between acute & chronic - An acute disease lasts for just a short time but can begin
rapidly and have intense symptoms. By contrast, a chronic disease produces symptoms that last for three months or more.
• An acute disease can be mild, severe or even fatal e.g. colds, influenza and strep throat.
- Chronic• A chronic disease is persistent. It lasts for a long period of
time and might recur. Like an acute disease, a chronic disease can be mild, severe or fatal. Unlike an acute disease, a chronic disease is likely to develop over time instead of having a sudden onset
Subacute Diseases
• Diseases that fall between acute diseases and chronic diseases are sometimes referred to as subacute diseases.
• A disease might be considered acute at first, then subacute after a few days or a few weeks. If the disease continues for several months, it might then be called a chronic disease.
• There are no standard time periods that are used to determine whether a disease is acute, subacute or chronic.
Problem Size
• Chronic disease is the leading cause of death and disability. It accounts for 70% of all death.
• Data from the World Health Organization show that chronic disease is also the major cause of premature death around the world even in places where infectious disease are rampant.
• Although chronic diseases are among the most common and costly health problems, they are also among the most preventable and most can be effectively controlled.
In Saudi Arabia
• In Saudi Arabia, chronic diseases accounted for 69% of all deaths in 2002.
- Total deaths 97,000
- Deaths from chronic diseases 67,000
Deaths by cause, all ages (SA-2002)
CVD 35%
Cancer 11%
CRD 02%
DM 05%
Other CD 16%
Communicable disease 15%
Injuries 16%
Prevalence of OverweightMen/women > 30 Ys. 2005 – 2015 (SA)
• Men 2005
• Men 2015
Overweight Not overweight
72% 28%
Overweight Not overweight
72% 28%
Case Scenario
Um-Khalid is 55 Ys-old; a house-wife and a mother for 8 children, her husband is a taxi-driver.
- She is known of type 2 DM, hypertension & dyslipidaemia for the last 10 Years, her BMI is 34.
- Today, her main complaint is of her right knee pain.
- She is on maximum dose of oral hypoglycemic tablets + 2 antihypertensive medications & antilipids drug.
- Her HGA1c is 14.5, BP 160/95
Most prominent chronic diseases:-
1. CVD,
2. Cancer,
3. Chronic obstructive pulmonary disease and
4. Type 2 diabetes.
Others
• Bipolar mood disease• Brochiectasis• Chronic kidney disease• Crohn's disease• Epilepsy• Glaucoma• Haemophilia• HIV• Hyperlipidaemia (high cholesterol)
• Hypertension (high blood pressure)• Hypothyroidism (inactive thyroid gland)• Multiple sclerosis• Parkinson's disease• Rheumatoid arthritis• Schizophrenia• Systemic lupus erythematosis• Ulcerative colitis
Causes of Chronic Disease
• Four common modifiable health risk behaviors:
I. lack of physical activity,
II. poor nutrition,
III. tobacco use, and
IV. excessive alcohol consumption
Socioeconomic, cultural and environmental determinants.
• Globalization
• Urbanization
• Population ageing
Chronic Disease Clinic (CDC)
• Chronic disease clinics see thousands of patients repeatedly over long periods of time with many repeated tasks associated with each patient.
Comprehensive & integration care
- Why?• Almost half of all people with CD have multiple
conditions.• Practitioners not following guidelines.• Lack of care coordination• Lack of active follow-up.
The Forms
• Adult DM/HTN Flow sheet• HTN Flow Sheet• CDC HBA1c Sheet• Bronchial Asthma Flow Sheet• Asthma Control Test• Multidisciplinary Patient & Family Education
Form
The Forms
• Referral to Integrated Medical Care Form• Referral from CDC to Specialist Clinic• Health Education Referral Form• Referral to Clinical Pharmacist Form• Diabetic Nurse Educator Referral Form• CDC Documents Checklist
1- NCDs account for 63% of all deaths.
Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out
57 million global deaths)
5- NCDs are largely preventableNoncommunicable diseases are preventable through effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol
6- NCDs are not only a health problem but a development challenge as well.Noncommunicable diseases force many people into, or entrench them in poverty due to catastrophic expenditures for treatment. They also have a large impact on undercutting productivity
9- Tobacco use kills nearly 6 million people a year.
By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths
10- Eliminating major risks could prevent most NCDs.
If the major risk factors for noncommunicable diseases were eliminated, at around three-quarters of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented
Health promotion & prevention.
• Health promotion:- “the process of enabling people to increase control
over their health and its determinants, and thereby improve their health”(WHO) 2005
- Is the process of empowering people to make healthy lifestyle choices and motivating them to become better self-managers e.g.
- Patient education, counselling and support tools that promote physical activity, improve nutrition or reduce the use of tobacco, alcohol or drugs.
Prevention:
- Health promotion and disease prevention
strategies focus on keeping people well and preventing diseases from occurring. These strategies are referred to as primary prevention activities.
- Secondary and tertiary prevention activities focus on maintaining the health of individuals with chronic conditions, delaying progression of their conditions, and preventing complications.
Assignments:-
Um-Khalid is 55 Ys-old; a house-wife and a mother
for 8 children, her husband is a taxi-driver.
- She is known of type 2 DM, hypertension & dyslipidaemia for the last 10 Years, her BMI is 34.
- Today, her main complaint is of her right knee pain.
- She is on maximum dose of oral hypoglycemic tablets + 2 antihypertensive medications & antilipids drug.
- Her HGA1c is 14.5, BP 160/95
G 1
I. What might be the causes for the poor control of Um-Khalid condition?
II. What are the possible complications for Um-Khalid condition?
III. What investigations you asked for?