CASE 6

PUH 5301, Public Health Concepts 1

Course Learning Outcomes for Unit VI Upon completion of this unit, students should be able to:

1. Assess current public health developments in the community. 1.1 Describe the current contributors to chronic diseases that have plagued your community.

3. Discuss the different public health disciplines’ impact on population health.

3.1 Discuss how chronic diseases are handled and public health’s approach to protecting health in the community.

Course/Unit Learning Outcomes

Learning Activity

1.1

Unit Lesson Chapter 11: The Biomedical Basis of Chronic Diseases Video: Early Alzheimer's Symptoms Video: Diabetes: Definitions, Types, Characteristics, and Symptoms Article: “The Impact of Patients’ Chronic Disease on Family Quality of Life: An Experience From 26 Specialties” Unit VI Case Study

3.1

Unit Lesson Chapter 12: Genetic Diseases and Other Inborn Errors Video: Early Alzheimer's Symptoms Video: Diabetes: Definitions, Types, Characteristics, and Symptoms Article: “The Impact of Patients’ Chronic Disease on Family Quality of Life: An Experience From 26 Specialties” Unit VI Case Study

Reading Assignment Chapter 11: The Biomedical Basis of Chronic Diseases Chapter 12: Genetic Diseases and Other Inborn Errors Additional Required Materials: In order to access the following resources, click the links below. ITV (Producer). (1999). Early Alzheimer's symptoms (Segment 2 of 17) [Video file]. Retrieved from

https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=http://fod.infobase.com/PortalPla ylists.aspx?wID=273866&xtid=10002&loid=3141

To view a transcript of this video, click on the “Transcript” tab near the top right corner of the page. Video Education America (Producer). (2007). Diabetes: Definitions, types, characteristics, and symptoms

(Segment 1 of 6) [Video file]. Retrieved from https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=http://fod.infobase.com/PortalPla ylists.aspx?wID=273866&xtid=40270&loid=64376

To view a transcript of this video, click on the “Transcript” tab near the top right corner of the page.

UNIT VI STUDY GUIDE

Chronic Diseases and Their Impact

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Golics, C. J., Basra, M. K. A., Salek, M. S., & Finlay, A. Y. (2013). The impact of patients’ chronic disease on family quality of life: An experience from 26 specialties. International Journal of General Medicine, 2013(6), 787–798. Retrieved from https://www.dovepress.com/the-impact-of-patients39-chronic- disease-on-family-quality-of-life-an--peer-reviewed-article-IJGM

Unit Lesson The New Killer Diseases On February 14, 2018, a heavily armed Nikolas Cruz marched into his former high school, Marjory Stoneman Douglas High School in Parkland, Florida, and fired an AR-15 rifle, wounding and killing 17 fellow students (Laughland, Luscombe, & Yuhas, 2018). It was discovered that the 19-year old suffered from mental illness, mostly erratic and aggressive behavior. Mental health is a serious problem in the United States, affecting more than 50% of the population (Centers for Disease Control and Prevention [CDC], n.d.-b). In the United States, one of the most common causes of hospitalization between 18-44 years of age is depression, while those who suffer from any form of mental illness usually have their lifespan reduced by about 25 years (CDC, n.d.-b). As discussed in the previous unit, infectious diseases have been a threat to public health. However, chronic diseases, such as cancer, mental illness, and cardiovascular diseases, have now become the leading cause of mortality rates in the United States (Schneider, 2017). Some other diseases that are a public health concern are type 2 diabetes, Alzheimer’s, and arthritis; they are usually a concern as they affect the quality of the victims’ lives, causing disability (Schneider, 2017). Prevention has always been the ultimate goal for public health officials, but it has always been difficult to identify just one cause as opposed to infectious diseases. For example, cardiovascular disease has no single pathogen; it could result from obesity, hypertension, smoking, type 2 diabetes, and many other causes, which tend to develop over a long period. However, with early detection, heart diseases could be prevented; regular check-ups could provide secondary prevention. The National Institutes of Health (NIH) was created in 1887 to conduct research only on infectious diseases (Schneider, 2017). With the increase in chronic diseases, Congress created 27 more centers and institutes, each mostly focusing on a different chronic disease. One of such institutions is the National Heart, Lung, and Blood Institute (NHLBI). Other institutes concentrate on neurological disorders, stroke, arthritis, and type 2 diabetes. Research on chronic diseases, like infectious diseases, relies on laboratory and epidemiologic research. With ethical concerns on studying humans, the research depends on animals as stand-in models for humans (Schneider, 2017). Scientists work on the animals to clearly prove the cause-and-effect relationships of diseases. The animals mostly used are rats and mice, as they are mammals and their physiology is similar to humans. In addition, with their short lifespan, the researcher is able to monitor the exposure and intervention in their lifespan. Managing Chronic Diseases Cardiovascular or heart disease is one of the leading causes of death in the United States, killing more people than infectious diseases (Schneider, 2017). Some of the major risk factors that contribute to cardiovascular diseases are drinking, smoking, high blood cholesterol, and high blood pressure or hypertension. Atherosclerosis, a hardening of the arteries, is part of the cause of cardiovascular diseases. It is the building up of plaque containing clotting materials, cholesterol and fat, and blood cells (Schneider, 2017).

Common chronic diseases

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Research has proven that the unhealthy diet of humans, particularly from a young age, has increased the prevalence and incidence of cardiovascular diseases. People who have a family history of cardiovascular diseases are at risk, but the biggest culprit is an unhealthy diet of trans-fat, saturated fat, and a low intake of fruits and vegetables (Schneider, 2017). Therefore, in order to reduce the risks of cardiovascular diseases, certain precautions have to be taken into consideration.

 High blood cholesterol: Cholesterol levels should remain below 200 milligrams per deciliter of blood (mg/dL) to reduce the potential of developing high blood cholesterol.

 High blood pressure (hypertension): The systolic pressure and the diastolic pressure should be below or within 140/90 respectively.

 Smoking and alcohol: No smoking and little to no alcohol protects an individual from the potential of getting cardiovascular diseases.

 Type 2 diabetes: After a type 2 diabetes diagnosis, the patient should develop a healthier lifestyle to reduce the risk of potential cardiovascular diseases.

 A healthy diet with exercise: This lifestyle should be adopted at an early age. Another leading cause of death in the United States is cancer. Researchers are constantly amazed at the different manifestations witnessed among the various kinds of cancer; some are treatable and others terminal. Leukemia, lung cancer, and breast cancer, for example, are different in risk factors, response to treatment, and research. While they are different with different causes and outcomes, researchers encourage the absorption of dietary fiber in fruits and vegetables as well as exercise (Schneider, 2017). They also encourage little to no exposure to certain chemicals (vinyl chloride), radiation (ultraviolet radiation), and viruses (HPV). Type 2 diabetes is also a rising cause of death in the United States with an estimated 100 million adults living with type 2 diabetes or prediabetes (CDC, 2017). There are two main kinds of diabetes: type 1 and type 2. Type 1 diabetes is a result of the body attacking itself by mistake that stops the body from making insulin. About 5% of diabetic patients have type 1 with the majority being diagnosed as children. Type 2 diabetes, on the other hand, is mostly diagnosed among adults. Here, the body does not use insulin well and is incapable of keeping blood sugar at normal levels. About nine out of 10 diabetic patients have type 2, which usually develops over a period of time (CDC, 2017). Both types of diabetes also cause major disabilities if not properly monitored. They affect mostly the eyes and kidneys. They slow the healing of wounds that could cause potential amputation and may also lead to other problems like heart disease, stroke, and hypertension. The below video further explains the types of characteristics of diabetes: Video Education America (Producer). (2007). Diabetes: Definitions, types, characteristics, and symptoms

(Segment 1 of 6) [Video file]. Retrieved from https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=http://fod.infobase.com/PortalPla ylists.aspx?wID=273866&xtid=40270&loid=64376

To view a transcript of this video, click on the “Transcript” tab near the top right corner of the page. Mental health has become a major concern to public health officials especially with the emergence of mass shootings in the United States. Mental health involves the social, emotional, and psychological well-being of humans. While others are able to deal with the stressors of life, others many not, and it could manifest in various ways. Some of these ways are mental breakdown, aggressiveness, emotional withdrawal, and unhealthy choices. Some mental issues cause problems including eating disorders, posttraumatic stress disorder (PTSD), disruptive behavioral disorders, and depression. Treatment could be individualized or involve a support group, which would include rehabilitation, psychotherapy, counseling, and medication therapy (CDC, n.d.-c). It is difficult to pinpoint one problem that causes mental health disease. Life experiences like domestic abuse, abandonment,

Man with mental health problem in the psychiatrist studio

(Tommaso79, 2016)

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few or no friends, isolation or loneliness, chronic or life-threatening disease, recreational drug and alcohol abuse, and biological factors can influence one’s mental health (CDC, n.d.-c). As mentioned above, when there has been a mass shooting, the police and public health officials look for triggers in the person’s life that could have led to such erratic behavior. Alzheimer’s is the most common form of dementia that causes the patient to progressively lose his or her memory, communication skills, and environment recognition (CDC, n.d.-a). While there is no particular cause of Alzheimer’s, like any other chronic disease, some factors, such as family history and age, contribute to the disease. Researchers have posited that mental, social, and physical activities could reduce the risk and/or progress of Alzheimer’s. The below video covers some of the early symptoms of Alzheimer’s. ITV (Producer). (1999). Early Alzheimer's symptoms (Segment 2 of 17) [Video file]. Retrieved from

https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=http://fod.infobase.com/PortalPla ylists.aspx?wID=273866&xtid=10002&loid=3141

To view a transcript of this video, click on the “Transcript” tab near the top right corner of the page. Other diseases that are on a low rise are arthritis; neurological diseases, like amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease; and Parkinson's disease. Public health officials are especially worried about the fact that these diseases seem to kill faster than infectious diseases. Chronic Diseases in Infants About 4% of newborns are born with some kind of abnormality (Schneider, 2017). Some are hereditary; some from an infectious disease; or some from the abuse of alcohol, smoking, and recreational drugs. More public health officials have been on the mission to encourage healthy prenatal care among pregnant women, including heathy diets, healthy recreational habits, prenatal vitamins, and exercise. Some infectious diseases cause damage to the fetus. Syphilis, for example, leads to possible nerve damage, mental retardation, and blindness. Rubella causes deafness, and toxoplasmosis, a parasite mostly found in cat feces, causes neurological damage (Schneider, 2017). Congenital deformities increase the likelihood of disability and possible death in children. Some are the result of environmental agents called teratogens (chemicals, viruses, bacteria, certain drugs, alcohol, and radiation). Heavy alcohol intake has been the cause of many fatal pregnancies, so pregnant women are advised to avoid any form of alcohol during pregnancy. Other chemicals like smoking, heroin, and cocaine could cause neurological problems, low birth weight, and premature birth or death (Schneider, 2017). Other genetic problems arise during reproduction. A baby has 46 chromosomes from his parents (half from each parent). Down syndrome is the result of chromosome 21 producing an extra copy. Other genetic diseases include Huntington’s disease, hemophilia, and Duchene muscular dystrophy. This is the reason why prenatal testing is important to not only educate the parent who decides to keep the pregnancy but also prepare them emotionally, financially, and physically for what is to come. Doctors also encourage newborn screening in an attempt to treat any metabolic disorder immediately after birth. In 2017, the popular comedian Jimmy Kimmel explained that his son was born with tetralogy of Fallot, a rare form of heart defect. Risk factors include rubella, drinking alcohol, diabetes, or age that exceeds 40 years (National heart, Lung, and Blood Institute, n.d.). As a result of these birth defects, science has increased the use of genomic medicine, which studies the genetics of human beings and their DNA. This technology assists people in testing for the likelihood that they could inherit a disease. Many people test themselves for Alzheimer’s, breast cancer, and other genetic diseases. Angelina Jolie, for example, tested positive for the BRCA1 gene that could determine the probability of breast cancer. As a result, she had a double mastectomy to prevent the disease (Schneider, 2017). While it is a huge win in the public health sector for the use of genomics and genetics to treat and prevent disease, many people are still concerned about the scientific, social, legal, and ethical issues that comes with it. Many people, for example, are worried about giving the option to get an abortion after discovering that their children

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may have a birth defect. Others are worried about the efficiency of the tests for screening babies before and after birth. Conclusion Chronic diseases are on the rise, but the emergence of genomic medicine, despite the controversies, give people the confidence to live healthier lives and also to monitor their daily eating behaviors. It is important for public health officials to continue to increase the education and awareness needed for the community so that more lives could be saved and more people could avoid the disabilities that come with chronic diseases.

References Centers for Disease Control and Prevention. (n.d.-a). Alzheimer’s disease. Retrieved from

https://www.cdc.gov/aging/aginginfo/alzheimers.htm Centers for Disease Control and Prevention. (n.d.-b). Data and publications. Retrieved from

https://www.cdc.gov/mentalhealth/data_publications/index.htm Centers for Disease Control and Prevention. (n.d.-c). Learn about mental health. Retrieved from

https://www.cdc.gov/mentalhealth/learn/index.htm Centers for Disease Control and Prevention. (2017, July 18). New CDC report: More than 100 million

Americans have diabetes or prediabetes [Press release]. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Laughland, O., Luscombe, R., & Yuhas, A. (2018, February 15). Florida school shooting: At least 17 people

dead on 'horrific, horrific day.' The Guardian. Retrieved from https://www.theguardian.com/us- news/2018/feb/14/florida-shooting-school-latest-news-stoneman-douglas

National Heart, Lung, and Blood Institute. (n.d.). Tetralogy of Fallot. Retrieved from

https://www.nhlbi.nih.gov/health-topics/tetralogy-fallot#Causes Schneider, M.-J. (2017). Introduction to public health (5th ed.). Burlington, MA: Jones & Bartlett Learning. Tommaso79. (2016). Man with mental health problem in the psychiatrist studio (ID 82066423) [Photograph].

Retrieved from https://www.dreamstime.com/