Jason Chen, Brooke Grigsby, Krista Ico, Chris Nguyen, Ruolong Zhu

Brooke Grigsby (BSPS student), Krista Ico (BSPS candidate), Jason Chen (BSPS candidate), Christopher Nguyen (BSPS candidate), Ruoling Zhu (BSPS candidate)

The Centers for Disease Control and Prevention (CDC) defines chronic diseases broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.

Chronic diseases have become a global health issue due to the lack of education to avoid these issues. Some come from living a lazy lifestyle and not taking care of ourselves. Some come from old age, genetics, or pathogens in the environment and cannot be avoided.

Regardless of the source for these chronic diseases, they have not been taken as seriously as they are taken today.

In this monograph, we will cover the following chronic diseases: pain management, STDs/HIV, Alzheimer’s, diabetes, and chronic depression

G L O B A L C O S T S

In the United States, 84% of health care costs are related to chronic disease In the United Kingdom, 78% of primary health care consultations are related to chronic conditions

QUICK FACTS

Six in 10 adults in the United States have a chronic disease Chronic diseases are the leading cause of death and disability in the United States

Background

HIV infection

AIDS = late-stage HIV infection

One of four incurable STDs first case reported in 1981 in U.S.

Ryan White: • from Kokomo, Indiana • one of the frst children to have AIDS diagnosed on December 17th, 1984 at 13 years old after a blood transfusion

Who is affected

The first reported case of AIDS was in 1981 in the United States when the CDC published that it was a disease affecting homosexual men. Since then, this has been disproven as the disease has affected millions internationally - regardless of sexual orientation, race, ethnicity, gender, age, environment, etc. However, there are alarming geographical trends that can be seen with the prevalence of the disease, and it is evident that there needs to be more done in underdeveloped countries to address the testing, diagnoses, and treatment of HIV/AIDS.

HIV/AIDS in underdeveloped countries:

Since AIDS affects those who are immunocompromised, those with the greatest risk are people living in developing countries, because they are exposed to other infections and there is a lack of accessibility to health care services and information about AIDS. Since COVID, there has also been major disruptions in third world countries access to testing for the disease.

Solutions & Personal Opinion

AIDS became considered a public health crisis in 1986, and by 1994 was the leading cause of death for all United States citizens aged 25-44. However, a solution was not proposed until 1996 with the formation of UNAIDS and their 90-90-90 targets. These goals have not been met by the majority of the world, and the disruption from the COVID-19 pandemic threatens to derail the targets by another 10 years. There must be a solution to supply more HIV tests and information about AIDS to those underdeveloped nations, particularly in sub-saharan Africa, where in 2020, girls/women aged 1524 years old made up 25% of HIV infections globally. There is a significant need for a solution that increases access to self-testing in sub-saharan Africa and the rest of the world. In my opinion, the best solution would be to provide self-tests across the country, focusing on distribution in health care facilities. - BG

Goals: Progress:

Pain management relation to opioid abuse

Pain management is becoming an increasingly prevalent aspect of modern societies as certain populations begin to experience aging. The rise in chronic diseases necessitates the need for effective pain management treatments to enhance an individual's quality of life. Opioids are potent medications that are frequently used to treat pain that has seen increased usage correlating with the rise in chronic diseases and pain. This has led to the growing opioid crisis in the United States where opioid users are becoming addicted to their medications.

Pain management in undeveloped countries

Wealthy countries enjoy an abundance of medications capable of treating various ailments, medications which are much harder to acquire in poorer countries. Pain management is common enough in the United States that it is actually causing issues in the form of the opioid crisis. Conversely, undeveloped countries desperately need medications to treat people with debilitating pain.

Populations most susceptible to opioid abuse

Pain management is a universal concept that every individual has to deal with during their lives, but it is most apparent in the elderly, which are more likely to have chronic diseases and require a means to handle their pain. For some, the pain can only be handled through the use of opioids. With their usage comes the risk of inadvertent abuse.

Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2013. Global comparison of morphine consumption.

American Medical Association, 2021. Reductions in opioid prescribing have not led to reductions in drug-related mortality.

Attempted solutions and issues

Efforts to combat opioid abuse lie in improved anti-abuse drug formulations and better patient monitoring strategies. Drugs can be formulated to be unable to be dissolved and injected. Patients are monitored more closely via testing to determine they are strictly following their medication schedule. The issue is that while this stops the abuse of these medications, it also fast-tracks the shift towards black-market synthesized opioids which are far less safe and much more potent.

Personal Opinion

Unfortunately, our efforts to solve the opioid crisis have inadvertently resulted in an unprecedented growth in the production of illegal and more lethal unregulated opioids. Our efforts should concentrate more on improving patient access to treatment and recovery. - Christopher Nguyen

References:

1.Rajbhandari-Thapa, J., Zhang, D., Padilla, H. and Chung, S., 2019. Opioid-Related Hospitalization and Its Association With Chronic Diseases: Findings From the National Inpatient Sample, 2011–2015. Preventing Chronic Disease, 16. 2.van Amsterdam, J., Pierce, M. and van den Brink, W., 2021. Is Europe Facing an Emerging Opioid Crisis Comparable to the U.S.?. Therapeutic Drug Monitoring, 43(1), pp.42-51. 3.Jayawardana, S., Forman, R., Johnston-Webber, C., Campbell, A., Berterame, S., de Joncheere, C., Aitken, M. and Mossialos, E., 2021. Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study. eClinicalMedicine, 42, p.101198. 15

B A C K G R O U N D

Age-related, neurodegenerative Leads to 60–70% of cases of dementia.* Symptoms may include memory loss, problems with language, disorientation. Treatments can only relieve the conditions but will not stop or reverse its progression.

*Dementia is the condition when the brain is damaged by injury or a disease.

S I G N I F I C A N C E

Starts slowly and progressively worsens, thus accessibility to longterm care and relief treatments must be ensured. Creates an enormous strain on the healthcare system, families, and the federal budget. Affects at least 50 million people worldwide.

Alzheimer's Disease has become a global health issue:

As of 2020, approximately 50 million people worldwide are diagnosed with AD, with no treatment to reverse but to relieve. The number is expected to rise to 152 million by 2050. Additionally, the estimated total healthcare costs for the treatment of Alzheimer's disease in 2020 are estimated at $305 billion, with the cost expected to increase to more than $1 trillion as the population ages.

Who is affected:

Alzheimer's Disease is prevalent on the continent of Noth America, Western Europe, and Oceania among people in the age group of 75 and above. For instance, in the United States, the disease prevalence rate is 5.3% for those in the 60-74 age group; 13.8% for those in the 74-84 age group; and 34.6% for those who are 85 years and older. However, prevalence rates in some less developed regions around the globe are lower.

What efforts have been made:

By 2022, there is at least one Alzheimer's disease organization per major continent in the world. Patients and caregivers in North America and Europe are receiving extra support from multiple organizations that provide nonprofit advocacy and education on disease prevention, or conduct government-funded Alzheimer's research. In the hope to improve the Alzheimer’s Act (S. 880/H.R. 1873), the National Institutes of Health (NIH) secured an extra $300 million of funding at the end of 2020 to bring to a total of $3.1 billion in government investment every year, to allocate to different research institutes in the United States.

Personal opinion:

Although the causes and risk factors of Alzheimer's Disease are not clear and the research for medical cures is still ongoing, I stay positive and believe that this disease will be conquered in the near future since massive attention is given to the patients, their families, and all caregivers, while the research is moving forward in a mindful manner with solid monetary support from governments across the globe.

Deaths per million persons in 2012 due to dementias including Alzheimer's disease. Red indicates 376–1266 counts, lighter color indicates fewer counts in the representation of lower prevalence rates. https://commons.wikimedia.org/wiki/File:Alzheimer%27s_disease_and_other_de mentias_world_map-Deaths_per_million_persons-WHO2012.svg

References: JC

Background Information

Major Symptoms include periods of fatigue, irritability, and sadness lasting for two years or more Emphasizes mood and personal relations over physical symptoms compared to major depression More disabling than major depression in some cases

Chronic Depression Starts to Get Global Attention Because:

Dysthymia is about as common as major depression. Given its chronic nature, it is one of the disorders most often seen by psychotherapists. Globally, depressive disorders are ranked as the single largest contributor to non-fatal health loss, according to WHO. Over 300 million people are estimated to suffer from depression worldwide, equivalent to 4.4% of the world’s population. There is a range of severity within these overall estimates of prevalence, with at least one-third of symptomatic cases following a moderate-severe course. Although 70% recovered in an average of about four years, 50% had a recurrence with an average time of nearly six years.

Who May encounter Chronic Depression?

Dysthymia can affect children and adolescents. Data from NIMH shows that depressive disorders affect approximately 11.2% of 13 to 18-year-olds and that girls are more likely than boys to experience a depressive disorder.

More than half of people with dysthymia eventually have an episode of major depression, and about half of patients treated for major depression are suffering from this double depression.

Personal Opinion

Although depression is a pervasive mental disorder globally and affects us all, practical solutions for depression are available. Efficacious and cost-effective treatment can be used to improve the health and life expectancy of patients worldwide who are suffering from dysthymia. I think it is time to educate ourselves about chronic depression and support those who are currently suffering from this mental disorder.

Prevalence of Depressive Disorders in 2015 Source: Global Burden of Disease Study 2015 (http://ghdx.healthdata.org/gbd-results-tool)

Possible Treatments and Solutions Between Cultures

One of the main differences seen across cultures is how anxiety and depression are expressed. Feelings are sometimes even better explained by religious or spiritual beliefs. Instead of seeking help from a mental health professional, this person will probably seek counsel from their spiritual guide. In other cases, doctors may use psychotherapy (talk therapy), medications such as antidepressants, or a combination of these therapies. Often, dysthymia can be treated by a primary care physician.

Cases of Depressive Disorders in 2015

Source: Global Burden of Disease Study 2015 (http://ghdx.healthdata.org/gbd-results-tool) RZ

Reference

Diabetes is a chronic disease affecting millions worldwide. It is a disease that affects the way your body breaks down food into sugar to use as energy. Normally, the body breaks down the food into sugar (glucose) that gets released into the bloodstream. When blood sugar levels increase, the pancreas releases insulin that helps the body use the sugars as energy. With diabetes, this process has a fault either in the way the body produces insulin or reacts to insulin. There is no cure for diabetes, but drug developments have made this a livable condition. Diabetes can lead to a number of other complications including but not limited to: early death, lower quality of life, nerve damage, heart disease, stroke, kidney failure, and many more.

10% of diabetic population Diagnosed early in life Characterized by no functioning insulinsecreting pancreatic beta cells of the pancreas; glucose intolerance Most common among non-Hispanic Caucasians, African Americans, and Hispanic Americans Two types: non-obese (10%) and obese (80%) Diagnosed later in life Due to insulin resistance, tissues not responding as well to insulin as they normally do, or low insulin secretion Most common in China, India, and the United States due to their large populations

T Y P E 1 T Y P E 2

Cost and Treatment of diabetes:

People with diagnosed diabetes have an average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. The treatment for diabetes depends on which type the person has. For Type 1, the main treatment is to take insulin injections or use an insulin pump. It involves frequent blood sugar level checks and food awareness. For Type 2, treatment is dependent on how severe the case is. This can range from simple lifestyle changes to needing an insulin pump and other medications.

Cost breakdown of diabetes https://www.diabetes.org/about-us/statistics/cost-diabetes

Efforts for a Cure:

At the moment, there is no cure for either type of diabetes. Most current treatment options help patients manage the effects of diabetes and other health problems it can cause. For Type 1, cell therapy and bio-engineered mini and artificial organs are being researched and in clinical trials. For Type 2, drugs targeting insulin secretion, drugs targeting blood sugar levels, and fecal transplants are being researched and in clinical trials.

Personal Opinion:

The current efforts being made are giant steps in the great direction. Even if a cure is not found, scientists will find a way to make living conditions even better for patients with diabetes; however, I am confident that the people working on these projects will be able to come up with a solution for both types of diabetes in the years to come. - K. Ico

References: