2 pages
CodyHaush
9781284118476_SLID_CH06.pptxChapter 6
Noncommunicable Diseases
Learning Objectives (1 of 2)
Describe the burden of noncommunicable diseases on mortality and morbidity in the United States
Describe the ideal criteria for a screening program
Explain why two or more tests are nearly always required to screen for asymptomatic disease
Explain the multiple risk factor intervention approach to control a noncommunicable disease
Learning Objectives (2 of 2)
Describe the meaning of “cost-effectiveness”
Describe several ways that genetic interventions can affect the burden of noncommunicable diseases
Describe approaches to reducing the adverse impacts of treatments, including overdoses of prescription drugs
Describe ways that population interventions can be combined with individual interventions to more effectively reduce the burden of noncommunicable diseases
Vignette 1
Sasha did not want to think about the possibility of breast cancer, but as she turned 50, she agreed to have a mammogram; as she feared, it was suspicious.
Waiting for the results of the follow-up biopsy was the worst part, but the relief she felt when the results were negative brought tears of joy to her and her family.
Then she wondered: Is it common to have a positive mammogram when no cancer is present?
Vignette 2
The first sign of Michael’s coronary heart disease was his heart attack.
Looking back, he had been at high risk for many years because he smoked and had high blood pressure and high bad cholesterol. His lack of exercise and obesity only made the situation worse.
Michael asked: What are the risk factors for coronary heart disease and what can be done to identify and address these factors for me and my family?
Vignette 3
John’s knee injury from skiing continued to produce swelling and pain, greatly limiting his activities.
His physician informed him that the standard procedure today is to look inside with a flexible scope and do any surgery that is needed through the scope.
It is simpler and cheaper, and does not even require hospitalization. “We call it ‘cost-effective,’” his doctor said.
John wondered: What does “cost-effective” really mean?
Vignette 4
Looking back, JoAnn realized she had been living with depression all her life.
As a teenager it affected her ability to form friendships and later an intimate personal relationship.
After the birth of her child, depression robbed her of much of the joy of motherhood.
As a maturing adult, she realized how much more she could be enjoying life. “Thank God I got help,” she said to herself, “or suicide could have been in my future.”
Vignette 5
Jennifer and her husband, George, were tested for the cystic fibrosis gene and both were found to have it.
Cystic fibrosis can lead to chronic lung infections and greatly shortens the length of life.
They now ask: What does this mean for our chances of having a child with cystic fibrosis? Can we find out whether our child has cystic fibrosis early in pregnancy?
Vignette 6
Fred’s condition deteriorated slowly, but persistently. He just could not remember anything and repeated himself endlessly. The medications helped for a short time, but before long, he did not recognize his family and could not take care of himself.
The diagnosis was Alzheimer’s, and many in the nursing home were affected. No one seems to understand the cause of Alzheimer’s disease.
The family asked: What else can be done, not only for Fred, but also for those who come after Fred?
Vignette 7
Alcohol use is widespread on your campus. You do not see it as a problem as long as you walk home or have a designated driver.
Your mind changes one day after you hear about a classmate who nearly died from alcohol poisoning as a result of binge drinking.
You ask yourself: What should be done on my campus to address binge drinking?
Questions-to-Ask (1 of 2)
What is the burden of noncommunicable disease?
How can screening for disease address the burden of noncommunicable disease?
How can identification and treatment of multiple risk factors be used to address the burden of noncommunicable disease?
How can cost-effective interventions help us address the burden of noncommunicable diseases?
Questions-to-Ask (2 of 2)
Can genetic counseling help predict disease and disease outcomes and allow more personalized medicine?
What can be done to prevent long-term mortality and morbidity from our treatments?
What can we do when highly effective interventions do not exist?
How can we combine strategies to address complex problems of noncommunicable diseases?
What is the Burden of Noncommunicable Disease?
Wide range of diseases
Cardiovascular disease, cancers, Alzheimer’s
Represent the majority of causes of death and disability in most developed countries
Chronic disabilities, largely due to noncommunicable diseases, are now the most rapidly growing component of morbidity in most developing as well as developed countries
Mental health conditions are major reasons for disability and morbidity
How Can Screening for Disease Address the Burden of Noncommunicable Disease?
Screening for disease can result in detection at an early stage, under the assumption that early detection will allow for treatment that will improve outcomes
Successful for colon cancer, vision, hearing, etc
Successful screening programs will reduce disability and/or death due to these diseases
Four Criteria for a Screening Program
The disease produces substantial death and/or disability
Early detection is possible and improves outcome
There is a feasible testing strategy for screening
Screening is acceptable in terms of harms, costs, and patient acceptance
Table 6.1: Examples of Screening Tests for Heart Disease and Cancer and Ideal Criteria
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How Can Identification and Treatment of Multiple Risk Factors be Used to Address the Burden of Noncommunicable Disease?
Multiple risk factor reduction is a strategy to intervene simultaneously on a series of risk factors, all of which contribute to a particular outcome
Most effective when there are constellations, or groups of risk factors that cluster in definable groups of people
Useful strategy when the presence of two or more risk factors increases the risk more than would be expected by adding together the impact of each risk factor
How Can Cost-Effective Interventions Help Us Address the Burden of Noncommunicable Disease? (1 of 2)
Cost-effectiveness combines issues of benefits and harms with issues of financial costs
Compares a new intervention to the current or standard intervention
Is the additional net-effectiveness of an intervention worth the additional cost?
Is a small loss of net-effectiveness worth the considerable savings in cost?
Figure 6.1 The Four Quadrants of Cost & Net-effectiveness
How Can Cost-Effective Interventions Help Us Address the Burden of Noncommunicable Disease? (2 of 2)
Applying cost-effectiveness analysis to routine clinical interventions is often coupled with efforts to better predict the outcome of disease and treatment
Improving the ability to predict the outcome of diseases and interventions can help us know when, how, and if to intervene
Can Genetic Testing Help Predict Disease and Disease Outcomes and Allow More Personalized Medicine?
Categories of potential uses of genetic testing:
Predicting the risk of a disease
Pharmacogenetic testing
Reproductive genetic testing
What Can be Done to Prevent Long-Term Mortality and Morbidity from our Treatments?
There has been a rapid increase in the number and types of interventions to improve health outcomes
Some interventions produce short-term benefits, but longer-term problems
What Can We Do When Highly Effective Interventions Do Not Exist?
Public health efforts encourage the use of existing interventions, especially when there is evidence that they allow individuals to function on their own or with limited assistance for longer periods of time
Additional epidemiological and biological research is needed to prevent progression, improve treatment, and understand the causes of a disease currently without effective interventions
How Can We Combine Strategies to Address Complex Problems of Noncommunicable Diseases?
Multiple interventions combining health care, traditional public health approaches, and social interventions are often needed
The population health approach requires the combined and integrated use of multiple interventions
