أسئلة الثانية كوميونتي حورس
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Questions and Answers

Which factor most significantly increases the risk of atherosclerosis for women after menopause?

  • Increased estrogen production.
  • Increased testosterone production.
  • Decreased estrogen production. (correct)
  • Decreased testosterone production.

Which of the following personality traits is most associated with an increased risk of cardiovascular disease, according to the Type A personality profile?

  • Passivity
  • Patience
  • Relaxation
  • Competitiveness (correct)

At what age do men typically begin to face a heightened risk for atherosclerosis?

  • 45 years (correct)
  • 65 years
  • 35 years
  • 55 years

A patient with a family history of Coronary Heart Disease (CHD) and Diabetes Mellitus (DM) should be aware that they are at higher risk for which condition?

<p>Increased risk of atherosclerosis. (A)</p> Signup and view all the answers

How does the risk of atherosclerosis compare between men and women before menopause?

<p>Men have a significantly higher risk. (A)</p> Signup and view all the answers

A patient has been diagnosed with a condition that necessitates significant changes to their daily routine and is expected to last for the remainder of their life. Which of the following best describes this condition?

<p>A general non-communicable disease (A)</p> Signup and view all the answers

Following significant medical advancements after the Second World War, what shift was observed in the primary health challenges, particularly in developed countries?

<p>An emergence of non-communicable diseases as major health problems. (B)</p> Signup and view all the answers

In developing countries at the end of the 20th century, what unique challenge emerged regarding disease patterns?

<p>A 'double burden' of both infective and non-infective diseases compounded by poor environmental conditions. (D)</p> Signup and view all the answers

Considering global causes of death, which statement accurately reflects the current prevalence of cardiovascular diseases (CVDs)?

<p>CVDs rank as the leading cause of death worldwide. (B)</p> Signup and view all the answers

Egypt's health survey in 2020 reported specific prevalence rates for hypertension and diabetes mellitus (DM). Assuming a population of 1000 individuals, how many would be estimated to have hypertension?

<p>Approximately 263 individuals. (A)</p> Signup and view all the answers

Given the increasing life expectancy and the rising prevalence of non-communicable diseases (NCDs), what is the most likely future trend if these issues are not adequately addressed?

<p>A continued increase in mortality and disease burden attributed to NCDs. (B)</p> Signup and view all the answers

What is the primary association between demographic transition characterized by decreased mortality and increased life expectancy, and the prevalence of non-communicable diseases (NCDs)?

<p>NCDs are usually associated with aging populations, which result from increased life expectancy. (B)</p> Signup and view all the answers

Which of the following NCDs is least likely to be directly influenced by lifestyle modifications such as diet and exercise?

<p>Nephrotic Syndrome (C)</p> Signup and view all the answers

A diet high in dietary fat is most directly associated with which of the following conditions?

<p>Atherosclerosis (D)</p> Signup and view all the answers

Which of the following is a potential consequence of heavy salt consumption?

<p>Hypertension (D)</p> Signup and view all the answers

Inadequate calcium intake, particularly among menopausal women, is a risk factor for which condition?

<p>Osteoporosis (D)</p> Signup and view all the answers

Which of the following lifestyle factors most significantly contributes to the risk of developing dyslipidemia, hypertension, and certain types of cancer?

<p>Excessive alcohol consumption (C)</p> Signup and view all the answers

Increased levels of LDL-C, total cholesterol and triglycerides, alongside decreased levels of HDL-C, characterize which condition?

<p>Dyslipidemia (A)</p> Signup and view all the answers

Which of the following psychological states is least likely to be categorized as a modifiable risk factor contributing to non-communicable diseases?

<p>Contentment (B)</p> Signup and view all the answers

How does hypertension function as a risk factor in the context of non-communicable diseases?

<p>It is a major risk factor for coronary heart disease (CHD). (A)</p> Signup and view all the answers

How does a sedentary lifestyle primarily contribute to increased health risks?

<p>By increasing susceptibility to obesity and related metabolic disorders. (D)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to have a higher prevalence in individuals with diabetes?

<p>Hyperuricemia (A)</p> Signup and view all the answers

Which of the following is a direct risk associated with central adiposity?

<p>Type 2 Diabetes Mellitus (C)</p> Signup and view all the answers

Which strategy would be MOST effective for a community aiming to promote lifetime physical activity habits?

<p>Creating urban environments that prioritize walking and cycling, alongside workplace fitness programs and school-based initiatives. (D)</p> Signup and view all the answers

Which intervention is considered part of the 'MPOWER' package designed to reduce smoking?

<p>Offering cessation support to tobacco users (D)</p> Signup and view all the answers

A sedentary worker wants to incorporate the recommended amount of physical activity into their daily routine. Which approach aligns BEST with the guidelines?

<p>Accumulating at least 30 minutes of moderate-intensity physical activity on at least five days per week. (A)</p> Signup and view all the answers

Increasing taxation on tobacco products primarily aims to achieve what within a public health strategy?

<p>Discourage tobacco use through higher prices. (C)</p> Signup and view all the answers

Which dietary component should be INCREASED to prevent cardiovascular diseases, according to the recommendations?

<p>Legumes (B)</p> Signup and view all the answers

For an individual at high risk of developing cardiovascular disease, which action represents secondary prevention?

<p>Routine blood pressure screening and early treatment of hypertension. (A)</p> Signup and view all the answers

What is the PRIMARY focus of tertiary prevention strategies for chronic diseases?

<p>Managing long-term complications and promoting rehabilitation. (B)</p> Signup and view all the answers

To promote increased physical activity effectively, public health strategies require what type of approach?

<p>A multisectoral approach involving various areas (B)</p> Signup and view all the answers

According to the information, reducing salt levels in the diet helps prevent which disease?

<p>Cardiovascular diseases (C)</p> Signup and view all the answers

A community aims to reduce the burden of diabetes. Which of the following initiatives combines elements of both secondary and primary prevention?

<p>Screening high-risk individuals for elevated blood glucose levels and enforcing stricter food labeling laws. (A)</p> Signup and view all the answers

What is the main objective of primary prevention strategies?

<p>Modifying adverse levels of risk factors (B)</p> Signup and view all the answers

Which of the following best describes the epidemiological transition?

<p>A shift in the primary causes of mortality from infectious diseases to non-communicable diseases. (C)</p> Signup and view all the answers

What dietary changes are characteristic of the nutritional transition?

<p>Increased intake of total fat, sugar, and refined carbohydrates, with decreased consumption of polyunsaturated fatty acids and fiber. (A)</p> Signup and view all the answers

Why does the multiplicity of risk factors for NCDs create limitations for prevention and control efforts?

<p>It complicates intervention strategies and makes risk factors difficult to control with technology alone. (C)</p> Signup and view all the answers

How does migration from a low-risk to a high-risk culture typically influence the risk of developing NCDs?

<p>It tends to increase the risk of NCDs as individuals adopt the lifestyle of the new culture. (C)</p> Signup and view all the answers

Which of the following is the best definition of a risk factor in the context of NCDs?

<p>Any attribute, characteristic, or exposure that increases the likelihood of developing a disease or injury. (D)</p> Signup and view all the answers

Why is it important to identify non-modifiable risk factors for NCDs, even though they cannot be changed?

<p>To identify high-risk groups and tailor prevention strategies accordingly. (A)</p> Signup and view all the answers

What is a key difference in the controllability of risk factors between communicable diseases and non-communicable diseases, based on the information provided?

<p>Risk factors for NCDs involve genetic, environmental, cultural, and behavioral aspects, making them more challenging to control compared to communicable diseases, where immunizations and antibiotics are effective. (C)</p> Signup and view all the answers

Considering the interplay between epidemiological and nutritional transitions, what is a likely consequence of increasing urbanization in developing countries?

<p>An increase in NCD prevalence due to lifestyle changes and dietary shifts. (D)</p> Signup and view all the answers

What is the most significant challenge in implementing workplace fitness programs for sedentary workers?

<p>Difficulty in integrating exercise breaks into demanding work schedules. (C)</p> Signup and view all the answers

Which of the following strategies would be MOST effective in promoting long-term adherence to physical activity recommendations within a community?

<p>Creating opportunities for integrating moderate physical activity into daily routines, such as walking or cycling to work or school. (C)</p> Signup and view all the answers

How does the design of urban environments MOST effectively encourage a shift away from reliance on personal cars?

<p>By creating pedestrian-friendly zones and safe bicycle lanes. (B)</p> Signup and view all the answers

What is the MOST comprehensive approach to secondary prevention of cardiovascular diseases in high-risk individuals?

<p>Screening, early treatment, reassurance, and follow-up assessments. (B)</p> Signup and view all the answers

What is the ultimate goal of tertiary prevention strategies regarding chronic diseases?

<p>Preventing long-term complications and rehabilitating those with disabilities. (D)</p> Signup and view all the answers

Considering the interplay between age and sex in the development of atherosclerosis, which of the following statements is most accurate?

<p>Before menopause, women generally have a lower risk of atherosclerosis than men, but this difference diminishes and equalizes around the ages of 50-55. (C)</p> Signup and view all the answers

How does a family history of both Coronary Heart Disease (CHD) and Diabetes Mellitus (DM) uniquely amplify an individual's risk profile?

<p>It accelerates the onset of atherosclerosis and related cardiovascular events through compounded metabolic stresses. (B)</p> Signup and view all the answers

Given the information, how do genetic factors most directly influence the progression of cardiovascular disease?

<p>By playing a significant role in the development and severity of dyslipidemia, affecting cholesterol and triglyceride levels. (C)</p> Signup and view all the answers

Considering the multifaceted nature of risk factors, which of the following scenarios would indicate the highest overall risk for developing atherosclerosis?

<p>A 50-year-old woman past menopause with a family history of CHD and DM. (D)</p> Signup and view all the answers

If early menopause occurs at age 45, which of the following interventions would be most effective in mitigating the increased atherosclerosis risk in a woman with a family history of CHD?

<p>Prescribing hormone replacement therapy (HRT) and encouraging a diet low in saturated fats. (B)</p> Signup and view all the answers

Which dietary modification would most effectively address multiple risk factors associated with atherosclerosis, coronary heart disease, and hypertension simultaneously?

<p>Adopting a diet low in saturated fats and sodium, coupled with increased intake of fruits, vegetables, and whole grains. (A)</p> Signup and view all the answers

An individual exhibiting persistent anger, anxiety, and a lack of social support seeks to mitigate their risk of developing non-communicable diseases. Which comprehensive strategy would be most effective?

<p>Engaging in regular stress-reduction techniques, seeking social support networks, and considering professional counseling. (B)</p> Signup and view all the answers

To what extent does dyslipidemia directly contribute to the pathogenesis of coronary heart disease (CHD)?

<p>Dyslipidemia promotes the buildup of plaque in arterial walls, fostering atherosclerosis and subsequent CHD. (C)</p> Signup and view all the answers

What impact does heavy salt consumption have on blood pressure regulation and the subsequent risk of developing hypertension?

<p>Heavy salt consumption causes the kidneys to retain more water, elevating blood volume and blood pressure and consequently increasing the risk of hypertension. (C)</p> Signup and view all the answers

Which statement correctly describes the interrelationship between dyslipidemia and hypertension as risk factors for cardiovascular disease (CVD)?

<p>Dyslipidemia and hypertension can independently and synergistically increase the risk of CVD by promoting atherosclerosis and vascular damage. (D)</p> Signup and view all the answers

An individual with a sedentary lifestyle and a diet high in dietary fat and sugar is at increased risk for several health conditions. Which intervention strategy would yield the greatest overall reduction in their risk profile?

<p>Adopting a balanced diet and incorporating moderate physical activity into their daily routine. (A)</p> Signup and view all the answers

How does a sedentary lifestyle uniquely exacerbate the risk of developing cardiovascular diseases (CVDs), independent of other risk factors like diet and smoking?

<p>A sedentary lifestyle decreases insulin sensitivity, promotes weight gain, and impairs lipid profiles, collectively increasing CVD risk. (A)</p> Signup and view all the answers

What is the combined impact of smoking and alcohol consumption on cardiovascular health?

<p>Smoking and alcohol consumption synergistically increase the risk of cardiovascular disease by promoting inflammation and oxidative stress. (A)</p> Signup and view all the answers

Individuals migrating from rural environments with traditional diets to urban settings characterized by readily available processed foods are most likely to experience which health consequence?

<p>Elevated risk of NCDs as a result of dietary shifts and lifestyle changes associated with urbanization. (D)</p> Signup and view all the answers

Considering the complex interplay of genetic, environmental, and behavioral risk factors in NCDs, which public health strategy faces the greatest challenge?

<p>Developing a single, universally effective intervention for disease prevention and control. (D)</p> Signup and view all the answers

How does the nutritional transition, characterized by increased consumption of processed foods and sedentary lifestyles, influence patterns of morbidity and mortality?

<p>It elevates the prevalence of obesity and contributes to degenerative NCDs. (D)</p> Signup and view all the answers

Which of the following public health challenges is most directly amplified by the increasing rates of urbanization and globalization?

<p>The escalating prevalence of non-communicable diseases driven by lifestyle changes. (B)</p> Signup and view all the answers

What critical distinction differentiates risk factors for NCDs from those associated with communicable diseases in the context of public health interventions?

<p>NCD risk factors are often linked to lifestyle, culture, and environment, presenting complex challenges for public health programs. (D)</p> Signup and view all the answers

How does identifying non-modifiable risk factors contribute to developing effective strategies for managing and preventing non-communicable diseases?

<p>It enables personalized risk assessment and tailored prevention strategies for high-risk groups. (A)</p> Signup and view all the answers

Considering that genetic predisposition is a non-modifiable risk factor, what is the most effective public health approach for mitigating its impact on NCD development within a population?

<p>Focus on modifying environmental and behavioral risk factors to reduce the overall disease burden. (C)</p> Signup and view all the answers

In a population undergoing both epidemiological and nutritional transitions, which intervention strategy would likely yield the most significant long-term impact on public health?

<p>Comprehensive public health campaigns promoting balanced diets and increased physical activity. (D)</p> Signup and view all the answers

Which of the following factors most significantly contributes to the increasing prevalence of non-communicable diseases (NCDs) alongside the demographic transition?

<p>Changes in dietary habits and sedentary lifestyles associated with increased urbanization and economic development. (C)</p> Signup and view all the answers

What is the most critical implication of the 'double burden' of disease (both infectious and non-communicable) in developing countries with inadequate health systems?

<p>It strains already limited resources, diluting efforts to combat both types of diseases effectively. (D)</p> Signup and view all the answers

Considering that 80% of cardiovascular diseases and Type 2 Diabetes Mellitus, and 30% of cancers are preventable, what is the most strategic approach to reduce the global burden of NCDs?

<p>Focus on promoting public health initiatives targeting modifiable risk factors through lifestyle interventions. (D)</p> Signup and view all the answers

What is the most significant challenge in addressing the rising prevalence of NCDs, considering the current global health landscape?

<p>The complex interplay of multiple risk factors, many of which are driven by socioeconomic and behavioral changes. (D)</p> Signup and view all the answers

How have medical advancements following the Second World War MOST significantly impacted the global health landscape?

<p>They shifted the primary health challenges from communicable diseases to non-communicable diseases, particularly in developed countries. (C)</p> Signup and view all the answers

What is a key reason for the increased prevalence of non-communicable diseases (NCDs) in developing countries at the end of the 20th century, that distinguishes them from developed countries?

<p>Developing countries faced a 'double burden' of managing both infectious and non-infectious diseases with limited resources. (B)</p> Signup and view all the answers

Considering the epidemiological transition, what is the most likely long-term consequence of a continued rise in life expectancy and the elderly population globally?

<p>A shift in healthcare priorities towards managing and preventing non-communicable diseases (NCDs). (B)</p> Signup and view all the answers

Which statement best reflects the relationship between demographic transition and the increasing prevalence of non-communicable diseases (NCDs)?

<p>Decreased mortality and increased life expectancy are associated with an aging population and a higher prevalence of NCDs. (B)</p> Signup and view all the answers

Which condition associated with diabetes mellitus presents the greatest challenge due to its complex interplay with metabolic and vascular systems?

<p>Coronary heart disease (CHD) (D)</p> Signup and view all the answers

Beyond the commonly recognized metabolic impacts, how does central adiposity uniquely amplify the risk of cardiovascular diseases?

<p>Through increased secretion of inflammatory cytokines and altered lipid metabolism. (D)</p> Signup and view all the answers

How does hyperuricemia potentially contribute to the pathogenesis of coronary heart disease (CHD), beyond its more commonly known association with gout?

<p>Through inducing endothelial dysfunction and promoting vascular inflammation (B)</p> Signup and view all the answers

What critical distinction differentiates interventions defined as primary prevention from those aimed at secondary or tertiary prevention?

<p>The modification of adverse risk factors before the onset of clinical disease (D)</p> Signup and view all the answers

What key element must be integrated into dietetic recommendations to achieve optimal cardiovascular disease prevention from a public health perspective?

<p>Culturally sensitive strategies that address both food availability and dietary habits (D)</p> Signup and view all the answers

How do policies designed to promote physical activity need to be structured to address the multifaceted nature of sedentary behavior effectively?

<p>Through a multisectoral approach integrating urban planning, transportation, and workplace wellness programs (A)</p> Signup and view all the answers

What is the primary strategic goal of reinforcing bans on tobacco advertising, promotion, and sponsorship within the 'MPOWER' package?

<p>To denormalize tobacco use and reduce initiation rates, particularly among youth (B)</p> Signup and view all the answers

What is the long-term population-level impact of reducing salt levels in commercially processed foods, in addition to its direct effects on blood pressure?

<p>Shift in taste preferences, leading to decreased craving for salty foods and improved dietary habits (C)</p> Signup and view all the answers

Flashcards

Age and Atherosclerosis Risk

The risk of atherosclerosis increases with age, typically becoming more significant after 45 years for males and 55 years for females.

Sex Differences in Atherosclerosis Risk

Before menopause, males have a higher risk of atherosclerosis. After menopause, the risk for females equalizes with that of males by the age of 50-55.

Sex and Osteoporosis Risk

Females are at a higher risk of osteoporosis.

Family History in Disease Risk

A family history of coronary heart disease (CHD) and diabetes mellitus (DM) increases an individual's risk.

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Type A Personality Traits

Type A personalities are characterized by aggression, competitiveness, impatience, and a sense of time urgency.

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Epidemiological Transition

Shift in mortality from communicable to non-communicable diseases, often due to immunizations and antibiotics.

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Nutritional Transition

Shift towards diets high in fats, sugar, and refined carbs, and low in fiber, combined with sedentary lifestyles.

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Multi-factorial Nature of Risk Factors

Many risk factors (genetic, environmental, behavioral) contribute to a specific disease.

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Migration and NCD Risk

Moving from a low-risk culture to a high-risk culture increases the risk for NCDs.

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Risk Factor

Any attribute or exposure that increases the likelihood of developing a disease or injury.

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Non-Modifiable Risk Factors

Risk factors that cannot be changed (e.g., genetics, age).

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Urbanization and NCDs

Progressive increase in city populations leads to an increased rate of NCDs.

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Risk factors

Genetic, environmental, cultural and behavioral factors that are challenging for public health programs to control

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Non-Communicable Disease (NCD)

Impairment in body function/structure requiring lifestyle changes, persisting for a long time.

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Examples of NCDs

Cardiovascular diseases, cancer, diabetes, respiratory diseases, obesity, dyslipidemia, renal diseases, accidents, nervous/mental disorders, musculoskeletal disorders, degenerative disorders, sarcopenia & frailty.

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Medical Achievements Post-WWII

Improved vaccination, antibiotics, and living conditions reduced communicable diseases.

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Post-WWII Health Shift

Developed countries faced major problems with NCDs.

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Double Burden of Disease

Developing countries faced both infective and non-infective diseases.

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Top NCD Killers

CVDs, cancers, chronic respiratory diseases, and diabetes cause 36 million deaths per year.

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NCD Prevalence in Egypt (2020)

Hypertension prevalence is estimated at 26.3% and Diabetes at 16.6% in Egypt in 2020.

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Demographic Transition Effect

Increased mortality leads to increased life expectancy and a larger elderly population.

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Modifiable Risk Factors

Risk factors that can be changed through individual choices and public health interventions.

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Dietary Risk Factors

High intake of dietary fat, excess sugar, heavy salt consumption, and inadequate calcium intake.

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Risks of High Dietary Fat

Linked to atherosclerosis, heart disease, and certain cancers.

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Risks of Excess Sugar

Can lead to obesity and dental problems.

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Physical Inactivity

A sedentary lifestyle with little to no exercise.

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Mental Stress Factors

Depression, anger, fear, anxiety, and lack of social support.

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Dyslipidemia

Increased total cholesterol, LDL-C, triglycerides and decreased HDL-C.

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Hypertension Risk

A major risk factor for non-communicable diseases like coronary heart disease (CHD).

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Promoting Exercise Habits

Encouraging physical activity for everyone by promoting 30 minutes of moderate exercise most days of the week.

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Medical Center Fitness Role

Medical centers should offer qualified staff and facilities for exercise guidance.

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Urban Design for Exercise

Designing urban spaces and transport systems to encourage walking and cycling over driving.

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Secondary Prevention Focus

Focuses on early detection and proper treatment of conditions like diabetes and hypertension to prevent disease progression.

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Tertiary Prevention Goals

Aims to reduce long-term complications and rehabilitate individuals with disabilities.

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Diabetes Comorbidities

Higher occurrence of hypertension, obesity, and coronary heart disease.

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Central Adiposity Risks

Increased risk of type 2 diabetes and coronary heart disease.

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Hyperuricemia Risk

Hyperuricemia increases risk for coronary heart disease.

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Primary Prevention

Interventions to modify risk factors that are already present.

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Comprehensive Prevention Programs

Policies preventing smoking, diet recommendations, and physical activity strategies.

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MPOWER package

Monitor, protect, offer help, warn, enforce bans, raise taxes.

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Dietary Recommendations

Fish, poultry, legumes, whole grains, vegetables, and fruits.

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Dietary Restrictions

Reduce salt, saturated fats, trans-fatty acids, and free sugars.

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Age and Atherosclerosis

The risk of atherosclerosis is correlated with age, typically increasing after 45 years in males and 55 years in females.

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Sex and Atherosclerosis Risk

Before menopause, males have a higher risk of atherosclerosis. After menopause, females' risk equals that of males by age 50-55.

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Family Medical History

A family history of coronary heart disease (CHD) and diabetes mellitus (DM) increases an individual's risk.

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Type A Personality

Aggression, competition, impatience, and time urgency characterize Type A personalities.

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Multi-Factorial Risk Factors

Many risk factors (genetics, environment, behavior) contribute to diseases, complicating prevention.

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Migration & NCD Risk

Moving to a new culture can change lifestyle and raise the risk of NCDs.

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Urbanization & NCD Prevalence

Increasing urbanization is correlated with an increase in NCDs.

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Risk factors control

Factors related to genetics, environment, culture, and behavior that create challenges for public health programs to control

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NCD Definition

Impairment in body function or structure requiring lifestyle changes and persisting for a long time.

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Past causes of death

Worldwide communicable diseases were the main causes of death.

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Medical Achievements

Vaccination, antibiotics, and improved living conditions reduced communicable disease.

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Post-WWII Health

NCDs became major problems in developed countries.

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NCD Preventability

80% of CVDs & type 2 DM and 30% of cancers are preventable.

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Demographic Transition

Increased mortality leading to increased life expectancy and a larger elderly population where NCDs are usually associated with aging.

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Promote Exercise Habits

Promoting physical activity across all sectors of society to establish lifetime exercise habits.

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Medical Centers' Role

Medical centers providing qualified staff and facilities with capabilities for fitness assessment and exercise prescription.

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Urban Design for Activity

Designing urban environments to encourage walking and cycling over car use.

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Screening High-Risk Groups

Early identification of individuals at high risk of developing a specific disease.

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Preventing Long-Term Complications

Preventing or minimizing long-term disease complications through interventions.

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High Dietary Fat Risks

High intake of fats increases risk of atherosclerosis and some cancers.

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Risks of Heavy Salt Intake

High salt consumption is associated with high blood pressure.

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Risks of Low Calcium

Inadequate calcium intake may lead to osteoporosis, especially in menopausal women.

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Study Notes

  • General non-communicable diseases include impairments in body function or structure that necessitates modification in a person's lifestyle or that has persisted for a long time.
  • Categories of non-communicable diseases:
    • Cardiovascular diseases like hypertension, coronary disease, and stroke
    • Cancer
    • Diabetes
    • Respiratory diseases such as asthma, emphysema, and bronchitis
    • Obesity
    • Dyslipidemia
    • Renal diseases like nephritis and nephrotic syndrome
    • Accidents
    • Nervous and mental disorders including mania, depression, and cognitive impairment
    • Musculoskeletal conditions like arthritis, osteopenia, and osteoporosis
    • Degenerative disorders.
    • Sarcopenia and frailty

Magnitude of the Problem

  • Communicable diseases used to be the main causes of death worldwide
  • Medical advancements such as vaccinations and antibiotics improved living conditions
  • Non-communicable diseases (NCDs) became major problems in developed countries.
  • NCDs contribute to a double burden with infective and non-infective diseases with poor environments and inadequate health systems in developing countries
  • 4 diseases (CVDs, Cancers, chronic respiratory diseases, and Diabetes Mellitus) cause 36 million deaths each year.
  • 80% of CVDs and Type 2 Diabetes Mellitus can be prevented.
  • 30% of cancers are preventable.
  • CVDs are the first cause of death globally.
  • Cancer is the second cause of death in developed countries.
  • Cancer is the fourth cause of death in developing countries.
  • Estimated prevalence in Egypt in 2020:
    • Hypertension affected 26.3% of the population.
    • Diabetes Mellitus affected 16.6% of the population.
  • Increased life expectancy and the rising prevalence of NCDs pose a challenge.
  • If unaddressed, the mortality and disease burden from NCDs will continue to increase.

Challenges for Prevention of NCDs

Demographic Transition

  • Mortality decreases and life expectancy increases along with the proportion of elderly people
  • NCDs are associated with aging.

Epidemiological Transition

  • Shift in mortality from communicable to non-communicable diseases is due to immunizations & antibiotics.
  • NCDs have specific genetic, environmental & behavioral risk factors.

Nutritional Transition

  • Large shift in nutrition with a diet high in total fat, sugar and refined carbohydrates and low in polyunsaturated fatty acids and fibers, accompanied by sedentary life.
  • This pattern has resulted in increased prevalence of obesity

Multi-factorial Nature of Risk Factors for NCDs

  • Multiplicity of risk factors associated with specific diseases limits opportunities for specific intervention for prevention & control
  • NCD risk factors are difficult to control through technology in comparison to communicable diseases managed by immunization and antibiotics.
  • Risk factors are related to genetic, environmental, cultural & behavioral factors, and represent a challenging issue to public health programs

International Communications & Migration

  • People who migrate from low-risk cultures to high-risk cultures adopt lifestyle of the new culture and demonstrate increased NCD risks.
  • Progressive urbanization is associated with increased prevalence of NCDs.

Risk Factors of NCDs

  • Any attribute, characteristic or exposure of an individual, which increases the likelihood of developing a disease or injury.

Non-Modifiable Risk Factors

  • These factors can't be changed, it is important to identify the high risk groups.
  • Age increases risk of:
    • Atherosclerosis (progresses with age): > 45 years for males and > 55 years for females
    • Osteoporosis: > 65 years
    • NCDs: > 55 years (after menopause)
  • Gender
    • Males are at a higher risk for atherosclerosis.
    • Higher risk of atherosclerosis before menopause.
    • By the age of 50-55, risk equalizes that of males possibly due to estrogen
    • Osteoporosis is more prevalent in females

Modifiable Risk Factors

  • Lifestyle risk factors include:
    • High proportions of dietary fat leading to Atherosclerosis, Coronary heart diseases, and breast and colon cancer
    • Excess consumption of sugar leads to obesity and dental diseases
    • Heavy salt consumption associated with hypertension
    • low calcium intake leads to osteoporosis
  • Sedentary lifestyle.
  • Psychological issues: Depression, anger, fear, anxiety or lack of social support.
  • Smoking causes CHD (coronary heart disease) and lung cancer.
  • Alcohol Consumption increases chances of dyslipidemia, hypertension and some types of cancer.

Diseases as Risk Factors

  • Dyslipidemia has increased total cholesterol, LDL-C, triglycerides and decreased HDL-C
  • Hypertension is a major risk factor for non-communicable diseases like Coronary Heart Disease (CHD).
  • Diabetics have higher prevalence of hypertension, obesity, and coronary heart disease (CHD).
  • Central adiposity increases risk of:
    • Type 2 DM
    • CHD
  • Hyperuricemia increases risk for CHD

Prevention

  • Defined as interventions designed to modify adverse levels of risk factors once they are present.

Primary Prevention

  • Comprehensive prevention programs include:
    • Policies and strategies to prevent smoking (MPOWER package)
      • M: Monitor tobacco use & tobacco-prevention policies.
      • P: Protect people from tobacco smoke in public places and workplaces.
      • O: Offer help to people who want to stop using tobacco.
      • W: Warn people about the dangers of tobacco.
      • E: Enforce bans on tobacco advertising, promotion, & sponsorship.
      • R: Raise tobacco taxes and prices.
    • Dietetic recommendations to prevent cardiovascular diseases and facilitate healthy eating:
      • Increase consumption of: fish, poultry, legumes, vegetables, fruits, and whole grains
      • Decrease consumption of: salt, saturated fats, and free sugars
    • Policies and strategies to facilitate physical activity include a multisectoral approach.
    • Health professionals should encourage life time exercise habits for everyone
    • 30 min of moderate physical exercise each day for at least 5 days/ week.
    • Medical centers staff & facilities for fitness and exercise prescription
    • School based programs and physical education should focus on providing greater opportunities for physical activities during the school day.
    • Design urban environment that encourages people to rely less on personal cars prioritizing walking and cycling, enforce security & road safety legislations and create natural recreational spaces
    • Workplaces should design exercise breaks for sedentary workers and design fitness programs.

Secondary Prevention

  • Aims to prevent any underlying medical conditions such as HTN, DM, Obesity, and Hypercholesterolemia
  • Involves:
    • Screening of high-risk individuals
    • Early and proper treatment (DM - HTN).
    • Reassuring the patient.
    • Following up and regular assessment.

Tertiary Prevention

  • Focuses on:
    • Preventing long-term complications.
    • Rehabilitation of individuals with a disability.

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