OTHER CHRONIC DISEASES & CONDITIONS
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Transcript of OTHER CHRONIC DISEASES & CONDITIONS
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OTHER CHRONIC OTHER CHRONIC DISEASES DISEASES
& & CONDITIONSCONDITIONS
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“Our health always seems much more
valuable after we lose it.”
- Author Unknown -
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DIMENSIONS OF DIMENSIONS OF CHRONIC DISEASESCHRONIC DISEASES
EPIDEMIOLOGICAL OVERVIEWAffect women more often than they do men
Osteoarthritis, Rheumatoid Arthritis, Alzheimer Disease
1 in 2 women age 50+ will have an osteoporosis-related fracture in her lifetime
Diabetes affects 8.2% of all U.S. women
Lupus afflicts women 9X more often than men
Hypothyroidism is 50X more common in women
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ETHNIC & SOCIOECONOMIC DIMENSIONS
White and Asian women have osteoporosis more often than African American women
African American are more likely than white women to die following a hip fracture
Asian American women have lower rates of arthritis
African American women have highest prevalence rates of diabetes
African women have higher prevalence rate of lupus than white women
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ECONOMIC DIMENSIONSEstimated Annual Costs
CONDITION COSTHip Fractures $42 billion, worldwideArthritis $22 billion, U.S.Diabetes $50 billion, U.S.Alzheimer’s Disease $50 billion, U.S.
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OSTEOPOSROSISOSTEOPOSROSISHEALTHY BONE vs. OSTEOPOROTIC
BONE
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NON-MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS
Being female
Increased age/postmenopausal
Small frame and thin-boned
White or Asian
Family history of osteoporosis or fractures
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MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS
Diet low in Calcium and Vitamin D
Sedentary lifestyle
Cigarette smoking
Excessive use of alcohol
Certain medications
Glucocorticoids, Anticonvulsants
Amenorrhea
Anorexia nervosa or bulimia
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SCREENING & DIAGNOSIS FOR OSTEOPOROSIS
All postmenopausal women younger than age 65 who have one or more additional risk factors for osteoporosis besides menopause
All women age 65 and older
Postmenopausal women with fractures
Women who are considering therapy for osteoporosis or who want to monitor the effectiveness of certain osteoporosis treatments
Women Who Should Be Tested:
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Bone Mineral Density Tests:
Dual-energy x-ray absorptiometry (DXA or DEXA)
Single-energy x-ray absorptiometry (SXA)
Peripheral dual-energy x-ray absorptiometry (pDXA)
Radiographic absorptiometry (RA)
Dual-photon absorptiometry (SPA)
Single-photon absorptiometry (SPA)
Quantitative computed tomography (QCT)
Ultrasound
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TREATMENT & PREVENTION FOR OSTEOPOROSIS
Adequate supply of calcium
Vitamin D
Participate in weight-bearing and muscle-strengthening exercises
Estrogen replacement therapy
Drugs: Raloxifene, Fosamax, Calcitonin
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ARTHRITISARTHRITISHEALTHY JOINT vs. OSTEOARTHRITIC
JOINT vs. RHEUMATOID ARTHRITIS
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RISK FACTORS FOR ARTHRITISGender: women are 2-3X greater risk than men
Obesity
Infectious Diseases: Lyme Disease
Occupations
Excessive physical activity: Repetitive joint use
Hormonal levels: Higher estrogen levels
Diet: coffee and tea
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DIAGNOSIS FOR ARTHRITISNo single test can diagnose arthritis
Family history and physical exam to check joints, reflexes, and muscle strength
Radiographs
Blood tests
Joint aspiration
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TREATMENT AND PREVENTION FOR ARTHRITIS
Maintaining weight
Avoid injuries during physical activity
Avoiding contact sports
Avoid repetitive joint motion, wear braces, pads, proper shoes
Prevent lyme disease = vaccine, insect repellent
Drugs = NSAIDs, Corticosteroids, Hyaluronic Acid, Immunosuppressants
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DIABETESDIABETESTYPES OF DIABETES
Type 1: Insulin-Dependent Diabetes Mellitus (IDDM)
Type 2: Non-Insulin Dependent Diabetes Mellitus (NIDDM)
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SYMPTOMS FOR DIABETESType 1:
Frequent urination
Unusual thirst
Extreme hunger
Unusual weight
Extreme fatigue
Irritability
Type 2:
Any Type 1 symptoms
Frequent infections
Blurred vision
Cuts/bruises that are hard to heal
Numbness of hands/feet
Recurring skin, bladder infections
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RISK FACTORS FOR DIABETES
Having a first-degree relative with diabetes
Being overweight
Having hypertension
Abnormal high-density lipoprotein (HDL)
Racial groups: African American, Hispanics, Native Americans
Women who had gestational diabetes or delivered a baby more than 9 pounds
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COMPARISON OF LIKELIHOOD OF DIABETES ACROSS RACIAL
GROUPS
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COMPLICATIONS OF DIABETESHeart disease
Stroke
High blood pressure
Retinopathy
End-stage renal disease
Damage of the nervous system
Lower-extremity amputations
Periodontal disease
Congenital malformations
Neonatal mortality
Macrosomia
Diabetic ketoacidosis
Susceptibility to infections and illness such as pneumonia
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DIAGNOSIS OF DIABETES
Routine Tests:Fasting plasma glucose test
Oral glucose tolerance test
Blood sugar level above 140 mg/dL on at least two occasions
Normal sugar level = 70-110 mg/DL
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TREATMENT & PREVENTION OF DIABETES
Daily insulin injections
Diet control
Physical activity
Home blood glucose testing several times a day
Oral medications
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AUTOIMMUNE AUTOIMMUNE DISEASESDISEASES
FEMALE-TO-MALE RATIO OF CERTAIN AUTOIMMUNE DISEASE
Multiple Sclerosis 1.5 : 1Type I Diabetes 2 : 1Rheumatoid Arthritis 3 :1Scleroderma 3 : 4.1Grave’s Disease 7 : 1Sjogren’s Syndrome 9 : 1Hashimoto’s Disease 50 : 1
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CHARACTERISTICS OF LUPUSImmune system forms antibodies that target healthy tissues and organs
Primarily a disease of young women of childbearing age
Affects women 9X more often than men
Affects American women 3X more often than white women
Types
Cutaneous Lupus
Systemic Lupus
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SYMPTOMS OF LUPUSPainful, swollen joints
Skin rash
Butterfly-shaped across face
Triggered by sun exposure
Arthritis
Seizures
Psychosis
Raynaud’s phenomenon
Extreme fatigue
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RISK FACTORS OF LUPUSExact cause is unknown
Genetic factors
Occurs within families
Environmental factors
Infections
Exposure to sunlight
Stress
Certain medications
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DIAGNOSIS OF LUPUS
Take note of symptoms
Skin rash, joint pain, chest pain, seizures, photosensitivity, review of history of medications
Blood count
Antinuclear antibody test (ANA)
Urinalysis
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TREATMENT AND PREVENTION OF LUPUS
Avoid sun exposure and use sunscreen
Exercise
Non-steroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Antimalarial agents
Immunosuppressant drugs
Steroids
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THRYOID DISEASESymptoms of Hashimoto’s Disease and
Graves’ DiseaseHASHIMOTO’S DISEASE (Hypo) GRAVES’ DISEASE (Hyper)
• Weight gain • Weight loss
• Mental and physical slowing • Nervousness and irritability
• Dry skin • Increased energy expenditure
• Sensitivity to cold • Heat intolerance
• Constipation • Diarrhea
• Goiter • Bulging of the eyes
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RISK FACTORS OF THYROID DISEASE
Inherited
Family history of a family member with thyroid disease
Hashimoto’s occurs with greater frequency in people older than 60 years of age
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DIAGNOSIS OF THYROID DISEASE
Baseline testing to monitor thyroid function
Thyroid-stimulating hormone (TSH) test
Blood tests measuring levels of thyroxine (T4) can confirm presence of disease
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TREATMENT AND PREVENTION OF THYROID
DISEASE
Annual check-ups
Thyroxine for Hashimoto’s Disease
Antithyroid drugs for Graves’ Disease
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ALZEIMER’S DISEASEA Women’s Risk Doubles Every Five Years
Beyond Age 65
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RISK FACTORS FOR ALZEIMER’S DISEASE
Age
Genetic background
Lifestyle
Severe or repeated head injuries
Lower education levels
Environmental agents
Familial Alzheimer’s Disease (FAD)
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SYMPTOMS OF ALZEIMER’S DISEASE
Memory loss
Decline in ability to perform simple tasks
Think less clearly
Affected language and reasoning skills
Lack of ability to make judgments
Personality changes
Emotional outbursts
Wandering and agitation
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TREATMENT AND PREVENTION OF ALZEIMER’S
DISEASEControlling symptoms with drugs
Haloperidol (aggressive behavior)
Sertraline (depression)
Zolpidem, Diphenhydramine (insomnia)
Alzheimer’s Drugs
Cogrex, Aricept, Exelon
Antioxidants: Vitamin E (reduce nerve cell damage)
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SUMMARY Of MEDICATIONS USED TO TREAT CHRONIC CONDITIONS
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INFORMED INFORMED DECISION MAKINGDECISION MAKING
SECONDARY PREVENTION FOR SENIORS
Annual blood pressure screening
Cholesterol screening
Height:Weight Measurements
Clinical breast examinations annually
Cognitive function tests
Behavioral Assessment
Routine Mammography screening
Annual fecal occult blood test
Sigmoidoscopy every 5 years
Annual pap smear
Evaluation for hearing loss
Evaluation for visual acuity
Thyroid-stimulating thyroid test
Bone mineral density test