Week 7: Chronic illness (CHD and obesity)

Question 1

What is cardiovascular disease?

Answer 1

It is a broad category that involves diseases affecting the heart and blood vessels

Question 2

What is coronary heart disease (also known as coronary artery disease)?

Answer 2

This occurs when the walls of the coronary arteries become narrowed by the gradual build up of fatty material

Question 3

What is the fatty material that builds up in the arteries called?

Answer 3

Atheroma

Question 4

What are the main forms of coronary heart disease?

Answer 4

Angina (pain in chest, sometimes extending down left arm)
Acute Myocardial Infarction (heart attack)
Sudden cardiac death (commonly occurs after heart attack)
Heart failure (heart not pumping properly)

Question 5

What is the leading cause of death (globally)?

Answer 5

Coronary heart disease and predicted to remain so for the next 10 or so years

Question 6

Are there any gender differences in CHD prevalence?

Answer 6

Yes. Men (6.5%) have it more than women (4.8%)

Question 7

Is age a factor for CHD?

Answer 7

Yes it seems to be.

1 in 4 of those aged 75 and over

Question 8

Is the risk of CHD increased for indigenous Australians?

Answer 8

Yes.

Hospitalisations and death rates were 50% higher for indigenous Australians than non-indigenous

Question 9

Any difference in CHD prevalence for remote areas vs major cities?

Answer 9

CHD hospitalisations 30% higher among remote areas compared to major cities

Question 10

What kinds of stress has an impact on CHD onset?

Answer 10

Personal, work and family-related stress

Question 11

How does work stress contribute to risk of CHD?

Answer 11

Job insecurity (increases CHD) and working long hours (increases risk of stroke)

Question 12

What are the conventional risk factors of CHD?

Answer 12

Smoking
High cholesterol
Hypertension
Physical inactivity

Question 13

The prognosis of CHD is associated with which psychosocial factors?

Answer 13

Depression
Social isolation
Lack of quality of social support

May also combine with conventional factors

Question 14

Which risk factors do public health interventions focus on?

Answer 14

Approaches to coronary heart disease have largely focussed on the modification of conventional factors

Question 15

What is the most common co-occurring disease with CHD? and why?

Answer 15

Diabetes - most likely to have certain conditions or risk factors that increase the chances of having CHD such as high blood pressure or high cholesterol

CHD causes almost 60% of deaths in those with diabetes as they go on to develop these problems because of it

Question 16

Why is more research needed for the heart-brain connection?

Answer 16

CHD is progressively associated with increased odds of cognitive impairment or dementia

Question 17

Are there any studies looking at mass media education and a CVD prevalence?

Answer 17

Yes - Stanford community study
Delivered messages via media to try and reduce fat intake
After 2 years - reduced daily fat intake from 25g down to 3g

Question 18

Smart phone interventions can be used to provide individually tailored, self‐monitoring feedback & communication on specific health behaviours - what are the results of these?

Answer 18

Can be used for a range of behaviours that need improving eg. Weight loss, smoking, sunscreen use

Results: short to medium term evidence of effectiveness for reducing BMI, increasing and maintaining physical activity and weight loss

Question 19

Web/internet based interventions?

Answer 19

Feature:

• Enriched information
• Monitoring individual progress with tailored feedback etc
• Access to expert advice (face-face or online)

All studies bar one found a statistically small but significant effect on health related behaviours

Question 20

Which patients reported lower PHYSICAL HEALTH related quality of life? (CHD)

Answer 20

Older
Unemployed
Lower baseline physical QOL
Lower self confidence in meeting daily physical health recommendations
No intentions of physical activity in next six months

Question 21

Which patients reported lower MENTAL HEALTH related quality of life? (CHD)

Answer 21

Younger 
Lower baseline mental health 
More sedentary 
Depressed 
Lower social support

Question 22

What does pre-surgical depression predict?

Answer 22

Predicts cardiac hospitalisation, continued surgical pain, failure to return to previous activity and depression at six months

Question 23

How many patients with heart failure were found to have depression?

Answer 23

Clinically significant depression was present in at least one in five patients with heart failure

The relationship between depression and poorer heart failure outcomes is consistent and strong across multiple endpoints

Question 24

What have studies found regarding heart attack and social support?

Answer 24

Having low social support networks was a predictor of 1-year mortality following acute myocardial infarction

Question 25

What have studies compared low social support to in relation to CVD?

Answer 25

They have claimed it to be equivalent to many classic risk factors such as elevated cholesterol levels, tabacco use and hypertension

Question 26

Anger and hostility is another significant predictor of mortality in CHD - how and why?

Answer 26

High levels of hostility put individuals at a 58% risk of secondary events The association was mainly moderated by poor health behaviours, specifically physical inactivity and smoking

Question 27

How are positive psychological attitudes associated with superior cardiac outcomes?

Answer 27

Especially optimism!! Associated with increased participation in cardiac health behaviours (e.g., healthy eating, physical activity) linked to beneficial outcomes Evidence for direct effect ‐ positive psychological states and biomarkers of cardiac health (e.g., inflammatory markers) is mixed, not as strong

Question 28

Explain planning

Answer 28

Is a prospective self‐regulatory strategy, a mental simulation of linking concrete responses to future situations

Question 29

What is action planning?

Answer 29

Can help initiate action by specifying when, where and how to act Synonymous with implementation intentions

Question 30

What is coping planning?

Answer 30

Can help a person to overcome obstacles and cope with difficulties by anticipating situations that put intended behaviour at risk

Question 31

How are action and coping planning beneficial for long term lifestyle change?

Answer 31

Study - CHD rehab (needed to adhere to physical activity increase) Action plans were more influential early in the rehabilitation process, whereas coping plans were more instrumental later on. People with higher levels of coping planning after discharge were more likely to report higher levels of exercise four months after discharge

Question 32

SMART goals?

Answer 32

``` Specific Measurable Attainable Relevant Time-based ```

Question 33

What does obesity put you at risk of?

Answer 33

It is a major risk for CVD, type 2 diabetes, some musculoskeletal conditions and some cancers

Question 34

What is the most widely used method to measure someones weight?

Answer 34

BMI | weight (kg)/height(m squared)

Question 35

What BMI score is considered NORMAL?

Answer 35

between 18.5 and 24.9

Question 36

What BMI score is considered OVERWEIGHT?

Answer 36

between 25 and 29.9

Question 37

What BMI score is considered OBESE?

Answer 37

between 30 and 34.9

Question 38

What BMI score is considered SEVERELY OBESE?

Answer 38

between 35 and 39.9

Question 39

What BMI score is considered MORBIDLY OBESE?

Answer 39

40+

Question 40

Where is obesity particularly on the rise?

Answer 40

Low income countries! | Particularly urban settings

Question 41

In 2014 - how many adults were overweight or obese?

Answer 41

1.9 billion

Question 42

in 2014 - how many children were overweight or obese?

Answer 42

41 million

Question 43

In relation to food - why is obesity rising?

Answer 43

There is a rising cost of healthy food as well as food scarcity in developing countries

Question 44

What are the top 3 ranked obese countries?

Answer 44

1. Nauru (61% of population have BMI larger than 30) 2. Cook islands (55.9% of the population) 3. Palau (55.3% of the population)

Question 45

What do health programs target with targeting obesity?

Answer 45

- Healthy diet - Physical exercise - Depression management

Question 46

What does an obesogenic environment look like?

Answer 46

Sedentary lifestyle, less manual labour, more car use, remote controls, mobile phones, more fast food and less cooking as well as more snacking

Question 47

What is the average weight loss from behavioural interventions after 12 months?

Answer 47

-2.8kg

Question 48

Which behavioural approaches for weight management were effective?

Answer 48

Calorie counting, contact with a dietician, and use of behaviour change techniques that compare participants’ behaviours with others were associated with greater weight loss

Question 49

What is the effectiveness of school‐based interventions for reducing children's excessive weight gain?

Answer 49

Evidence suggests school‐based interventions that target enjoyable physical activity are generally effective in reducing excessive weight gain However: Need more research on Interventions that target broader behaviours such as diet and maintenance of weight reduction

Question 50

Effects of Mindfulness training on weight loss & health‐related behaviours in overweight & obese adults?

Answer 50

No significant effect on weight loss But: Short term effectiveness for reducing impulsive eating & binge eating as well as short term increases in physical activity

Question 51

Is relapse an issue with weight loss programs?

Answer 51

Yes it is a significant problem

Question 52

which psychosocial factors predict better maintenance & reduced relapse after intervention?

Answer 52

- Higher levels of motivation - Self-efficacy for coping with barriers - Self-regulation skills - Positive body image

Question 53

Which certain elements of a built environment encourage physical activity?

Answer 53

Facility accessibility (e.g.,cycle paths, access to local parks) Opportunities for being active (e.g.,home equipment, local area opportunities for physical activity) Safety (e.g. local neighbourhoods safe from crime) Aesthetics (e.g.,enjoyable scenery)

Question 54

What is the diabetes prevention program?

Answer 54

A comprehensive array of behavioural techniques Individual case management by “lifestyle coaches” who also delivered the intervention. 10 years: Continued to have delay in development of diabetes by 34% compared with participants who took a placebo 15 years: Program continued to have a delay in development of diabetes by 27% people who are at high risk for type 2 diabetes can prevent or delay disease by losing a modest amount of weight through lifestyle changes (dietary changes and increased physical activity). Taking metformin, a safe and effective generic medicine to treat diabetes, was also found to prevent the disease, though to a lesser degree

Question 55

Look AHEAD (Action for Health in Diabetes) study

Answer 55

8 year weight losses achieved Comprehensive behavioural weight loss counselling over the 8 years Look AHEAD's produced clinically meaningful weightloss (≥5%) of initial weight at year 8 in 50% of patients with type 2 diabetes 26.9% lost ≥10% of initial weight May be used to manage other obesity‐related co‐morbid conditions