NCD Midterm 2 – Flashcards
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What are some of the risk factors for asthma development?
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Genes (60-80%), obesity, vitamin D insufficiency, occupational exposure, SES, secondhand tobacco smoke in infancy and in utero, allergen exposure, urbanization, RSV infection, hygiene hypothesis, food/drug triggers
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What is the hygiene hypothesis?
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better hygiene, resulting in decreased microbial exposure, leads to an increase in allergic disease. Lower risk of asthma shown in children exposed to high levels of bacteria or endotoxin, large number of older siblings, child care early on, cat and dog exposure early in life, fewer antibiotics
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For which population is the burden of asthma the greatest (adults, children, etc)?
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prevalence rate highest in children 0 to 17 years of age (9.5%)
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What are some of the causes of the increase in chronic respiratory illnesses worldwide?
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indoor air pollution from solid fuels for cooking/heating; tobacco
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How would you characterize the global burden of chronic lung disease (populations at risk, low or middle income countries, etc)?
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Women and children are particularly vulnerable, especially those in low and middle income countries, where they are exposed on a daily basis to indoor air pollution
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How would you characterize the global COPD burden (in which population is mortality higher)?
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A leading cause of morbidity and mortality worldwide; mortality higher in whites compared with blacks, higher in males (though female mortality doubled over past 25 yrs)
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What are some of the obstacles of treatment of chronic lung disease in resource poor settings?
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low access to essential drugs; inadequate assessment of the severity of airway obstruction and /or inadequate or inappropriate therapy
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What is an Asthma Action Plan?
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Self-Management education is essential and should be integrated into all aspects of care; provide all patients with a written asthma action plan that includes 2 aspects 1) daily management 2)how to recognize and handle worsening asthma symptoms -regular review of patient's status (teach and reinforce); active partnership with patient and family -describe medicines to use and actions to take
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What are some triggers of asthma and how can they be controlled?
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common allergens, household dust mite (most common indoor allergen), cockroaches, animal sources (dander, dried saliva), fungi, indoor mold, outdoor allergens, tobacco smoke, air pollution -can be controlled through: vacuuming, avoid pollen and outdoor mold, respiratory infections (annual flu vaccine), keep food out of bedroom to avoid cockroaches, keep out indoor mold, clean animal dander/avoid carpets
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What are the signs/symptoms of asthma?
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Symptoms: coughing, wheezing, shortness of breath, chest tightness Symptoms occur or worsen in presence of known triggers or at night, awakening patient; cold that lasts >10 days; relief when medication is used; coughing or wheezing after physical activity
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What are some possible causes of asthma?
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likely a convergence of factors that can include genes (probably several) and various environmental and biological triggers (infections, dietary patterns, hormonal changes in women, allergens)
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What is a peak flow meter and how would you counsel someone on how to use their peak flow meter?
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Peak Expiratory Flow meters allow patients to assess the status of his/her asthma; people who use peak flow meters should do so frequently, many physicians require for all severe patients -People with moderate of severe asthma should take readings: every morning, every evening, after an exacerbation, before inhaling certain meds, helps establish "personal best" peak flow value
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What are the signs and symptoms of COPD?
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chronic and progressive dyspnea, cough, and sputum production that can be variable from day-to-day
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How does COPD mortality differ by gender and what are some of the reasons?
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Mortality has always been higher in men than in women, but since 2000, almost even mortality (graph of mortality from 1980-2000)
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Why is COPD increasing worldwide?
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Increase in exposure to risk factors (especially tobacco) in developing countries and in women; changing demographics globally with more of the population, especially in developing countries, living into the COPD age range
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What are the risk factors for COPD development?
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smoking (8/10 deaths are from smoking); occupation; indoor/outdoor pollution
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What are some of the global prevention initiatives for COPD?
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WHO leads the Global Alliance against Chronic Respiratory Diseases (GARD): voluntary alliance of national and international organizations, institutions, and agencies from a range of countries working towards a common goal of improving global lung health; WHO Framework Convention on Tobacco control
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What is the most common cancer in men and women globally?
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Lung and bronchus
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Which race and gender has the highest mortality rate from cancer in the United States?
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Black men
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What are some of the proposed risk factors for cancer development?
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high BMI, low fruit/vegetable intake, lack of physical activity, tobacco use, alcohol use (~1/3 of cancer deaths due to these); tobacco is most important RF (~20% of cancer deaths)
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What are some of the reasons for why there is a large difference in the mortality rate of certain cancers in economically developed and economically developing countries?
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lack of screening/treatment and differences in detection practice, awareness, and data quality
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In which group of individuals (race and ethnicity) does prostate cancer have the greatest burden?
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African American men
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What are some of the risk factors for prostate cancer development?
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Age, Race/Ethnicity, Family History, High Fat Diet Age (rare White>Hispanics>Asians>Native Americans); Family Hx (men with first degree relative who had prostate ca <50 have 2x risk); possible link between high fat diet and prostate cancer; BPH can complicate dx but does not increase risk; smoking and alcohol not associated with increased risk
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Is screening recommended for prostate cancer? If so, for whom is it recommended (ACS 2012 guidelines)? If not, why isn't it recommended?
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-Offering a baseline PSA and DRE at 40 yrs with annual evals beginning at age 50 to all men of normal risk with >10 yr life expectancy -Men at high risk (family hx <65, AA) start at 45 -Men at higher risk (multiple family hx <65) start at 40
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What is the PSA blood test and what does it measure? What are its benefits/limitations as a screening tool for prostate cancer?
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Glycoprotein produced by epithelial cells of prostate; specific for prostate, not specific for cancer (can be high with prostate infections and other prostate problems)
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What is the DRE and what are its benefits/limitations?
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Digital Rectal Exam (greater than 85% specificity); subject to variability among clinicians; used alone as a screening tool, has little effect on preventing metastatic prostate cancer
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For which of the cancers discussed in class has early screening been shown to be beneficial?
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colon and breast
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What are some of the possible reasons for the increase in breast cancer incidence rates in certain African and Asian countries?
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reasons not completely understood but likely reflect changes in reproductive patterns, obesity, physical activity
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What are the non-modifiable risk factors for breast cancer?
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Increasing age Gender (Female > Male) Race (White > African American > Asians), more frequent amongst women of higher SES Genetics (BRCA-1 and -2 mutations) Family History (One 1st degree relative = 2x increase, two 1st degree relatives= 4x increase) Prolonged estrogen stimulation (long menstrual history (early menarche 50) Long phases of uninterrupted ovulation (nulliparity or first pregnancy after age 30)
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What are the modifiable risk factors for breast cancer?
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Exogenous estrogen >5 years of oral contraceptives (controversial) Alcohol consumption (2-5 drinks/day) Diet (High fat intake) Obesity and BMI (association found in PMP women) Physical activity *not smoking
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Is breast cancer screening recommended? What are the ACS recommendations for early breast cancer detection?
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Yes. Women age 40 and older should have screening mammogram every year. Women in 20s and 30s should have a clinical breast exam (CBE) as part of a regular health exam by a health professional, preferably every 3 years. After 40, CBE every year
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What are the risk factors for colorectal cancer development?
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-Age >50 years old -Personal or family history of colon polyps or cancer -Pre-existing disease (20x increase; ulcerative colitis or Crohn's disease) -Genetic predisposition (FAP, APC gene mutation) -Diet high in fat, low in fiber -Alcohol (>2 drinks/day) -Type 2 DM -Smoking -Physical Inactivity
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Is colon cancer screening recommended? What are the ACS recommendations for early cancer detection of colon cancer?
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Yes. At age 50: annual fecal occult blood test (FOBT) yearly -or- Flexible sigmoidoscopy (FSIG) every 5 years -or- Colonoscopy every 10 years (more expensive, less convenient, need a skilled practitioner)
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Which screening method for colon cancer would be the most feasible in a resource poor setting?
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Fecal Occult Blood Test (FOBT), which is inexpensive and easy to perform
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What are the risk factors for lung cancer development?
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Smoking is the leading cause of lung cancer Radon--breakdown of uranium (second leading cause) Asbestos Diesel Exhaust Air pollution
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How would you characterize the global trends in lung cancer? What are the reasons for the differences?
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International variations in rates and trends largely reflect differences in the stage and degree of the tobacco epidemic -In several western countries (e.g. U.S.), rates decreasing in men and plateauing in women; in countries where the epidemic is more recently established and smoking has just peaked or continues to increase, lung cancer rates are increasing and are likely to continue to increase.
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Is lung cancer screening recommended? What are the ACS recommendations for lung cancer screening?
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Not really, does not reduce mortality
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What is the Framework Convention on Tobacco Control?
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Created May 2003 in response to global tobacco pandemic with objective of substantially reducing the worldwide prevalence of tobacco use and exposure to tobacco smoke. Provides a framework for national legislation and enforcement of tobacco control measures -As of Oct 2010, 168/195 eligible countries ratified the treaty
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What are some preventative measures resource poor settings can use to screen/prevent cancer?
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focus on increasing awareness of signs and symptoms of cancer in the general population leading to earlier diagnosis and treatment
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What are the diagnostic classifications for obesity?
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Underweight 40) For children: BMI at or above the 95th percentile of the same age and sex
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What are some of the obesity management strategies (behavioral, dietary, and physical activity) and how would you counsel someone on making some of these changes?
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Behavior modification: self-monitoring, problem solving, stimulus control, cognitive restructuring Dietary modification: balanced energy-restricted diet, reduce 500-1000 kcal/d, but not less than 800 kcal/d; 1000-1200 for women, 1200-1600 for men; extra fiber Exercise/Physical Activity modification: moderate levels of physical activity (use ~150 calories per day) for 30-45 min, 3-5 days/week ; long-term goal to accumulate 30 min of activity on most or all days Pharmacotherapy: may be used as adjunctive therapy in patients with BMI>=30 or >27 with comorbidity
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Prevalence of asthma by race
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Black > White > Hispanic?
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Prevalence of breast cancer by race
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White > Black > Asian
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Prevalence of Prostate cancer by race
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African Americans > Whites > Hispanics > Asians > Native Americans
