Chronic disease: A disease that persists for a long time.

A chronic disease is one lasting

3 months or more, by the definition of the U.S. National Center for Health Statistics.
Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor
do they just disappear. Eighty-eight percent of Americans over 65 years of age have at
least one chronic health condition (as of 1998). Health damaging behaviors - particularly
tobacco use, lack of physical activity, and poor eating habits - are major contributors to
the leading chronic diseases.
Chronic diseases tend to become more common with age. The leading chronic diseases in
developed countries include (in alphabetical order) arthritis, cardiovascular disease such
as heart attacks and stroke, cancer such as breast and colon cancer, diabetes, epilepsy and
seizures, obesity, and oral health problems. Each of these conditions plague older adults
in the US (and other developed nations).
Arthritis and related conditions are the leading cause of disability in the US affecting
nearly 43 million Americans. Although cost-effective interventions are available to
reduce the burden of arthritis, they are underused. Regular, moderate exercise offers a
host of benefits to people with arthritis by reducing joint pain and stiffness, building
strong muscle around the joints, and increasing flexibility and endurance.
Cardiovascular disease is a growing concern in the US. Heart disease is the nation's
leading cause of death. Three health-related behaviors--tobacco use, lack of physical
activity, and poor nutrition--contribute markedly to heart disease. Modifying these
behaviors is critical for both preventing and controlling heart disease. Modest changes in
one or more of these risk factors among the population could have a profound public
health impact.
Cancer is the second most common cause of death in the US. Cancer is largely
controllable through prevention, early detection, and treatment. Reducing the nation's
cancer burden requires reducing the prevalence of the behavioral and environmental
factors that increase cancer risk. It also requires ensuring that cancer screening services
and high-quality treatment are available and accessible, particularly to medically
underserved populations.
Chronic disease: A disease that persists for a long time. A chronic disease is one lasting
3 months or more, by the definition of the U.S. National Center for Health Statistics.
Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor
do they just disappear. Eighty-eight percent of Americans over 65 years of age have at
least one chronic health condition (as of 1998). Health damaging behaviors - particularly
tobacco use, lack of physical activity, and poor eating habits - are major contributors to
the leading chronic diseases.
Chronic diseases tend to become more common with age. The leading chronic diseases in
developed countries include (in alphabetical order) arthritis, cardiovascular disease such
as heart attacks and stroke, cancer such as breast and colon cancer, diabetes, epilepsy and

seizures, obesity, and oral health problems. Each of these conditions plague older adults
in the US (and other developed nations).
Arthritis and related conditions are the leading cause of disability in the US affecting
nearly 43 million Americans. Although cost-effective interventions are available to
reduce the burden of arthritis, they are underused. Regular, moderate exercise offers a
host of benefits to people with arthritis by reducing joint pain and stiffness, building
strong muscle around the joints, and increasing flexibility and endurance.
Cardiovascular disease is a growing concern in the US. Heart disease is the nation's
leading cause of death. Three health-related behaviors--tobacco use, lack of physical
activity, and poor nutrition--contribute markedly to heart disease. Modifying these
behaviors is critical for both preventing and controlling heart disease. Modest changes in
one or more of these risk factors among the population could have a profound public
health impact.
Cancer is the second most common cause of death in the US. Cancer is largely
controllable through prevention, early detection, and treatment. Reducing the nation's
cancer burden requires reducing the prevalence of the behavioral and environmental
factors that increase cancer risk. It also requires ensuring that cancer screening services
and high-quality treatment are available and accessible, particularly to medically
underserved populations.
Coronary artery disease (CAD), ischemic stroke, diabetes, and some specific cancers,
which until recently were common only in high-income countries, are now becoming the
dominant sources of morbidity and mortality worldwide (WHO 2002). In addition, rates
of cancers and cardiovascular disease (CVD) among migrants from low-risk to high-risk
countries almost always increase dramatically. In traditional African societies, for
example, CAD is virtually nonexistent, but rates among African Americans are similar to
those among Caucasian Americans. These striking changes in rates within countries over
time and among migrating populations indicate that the primary determinants of these
diseases are not genetic but environmental factors, including diet and lifestyle. Thus,
considerable research has been aimed at identifying modifiable determinants of chronic
diseases.
Prospective epidemiological studies, some randomized prevention trials, and many shortterm studies of intermediate endpoints such as blood pressure and lipids have revealed a
good deal about the specific dietary and lifestyle determinants of major chronic diseases.
Most of these studies have been conducted in Western countries, in part because of the
historical importance of these diseases in the West, but also because they have the most
developed research infrastructure. A general conclusion is that reducing identified,
modifiable dietary and lifestyle risk factors could prevent most cases of CAD, stroke,
diabetes, and many cancers among high-income populations (Willett 2002). These
findings are profoundly important, because they indicate that these diseases are not
inevitable consequences of a modern society. Furthermore, low rates of these diseases can
be attained without drugs or expensive medical facilities, an outcome that is not

surprising, because their rates have historically been extremely low in developing
countries with few medical facilities. However, preventing these diseases will require
changes in behaviors related to smoking, physical activity, and diet; investments in
education, food policies, and urban physical infrastructure are needed to support and
encourage these changes (see box 44.1

Symptoms
The signs and symptoms of acute coronary syndrome, which usually begin abruptly,
include the following:

Chest pain (angina) or discomfort, often described as aching, pressure, tightness

or burning
Pain radiating from the chest to the shoulders, arms, upper abdomen, back, neck
or jaw
Nausea or vomiting
Indigestion
Shortness of breath (dyspnea)
Sudden, heavy sweating (diaphoresis)
Lightheadedness, dizziness or fainting
Unusual or unexplained fatigue
Feeling restless or apprehensive

While chest pain or discomfort is the most common symptom associated with acute
coronary syndrome, signs and symptoms may vary significantly depending on your age,
sex and other medical conditions. People who are more likely to have signs and
symptoms without chest pain or discomfort are women, older adults and people with
diabetes.
When to see a doctor
Acute coronary syndrome is a medical emergency, and chest pain or discomfort can
indicate any number of serious, life-threatening conditions. Call 911 or get immediate
emergency services to get a prompt diagnosis and appropriate care. Do not drive yourself
to an emergency department.

Causes
Acute coronary syndrome usually results from the buildup of fatty deposits (plaques) in
and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to
heart muscles.
When a plaque deposit ruptures or splits, a blood clot forms. This clot obstructs the flow
of blood to heart muscles.

When the supply of oxygen to cells is too low, cells of the heart muscles can die. The
death of cells resulting in damage to muscle tissues is a heart attack (myocardial
infarction).
Even when there is no cell death, an inadequate supply of oxygen still results in heart
muscles that don't work correctly or efficiently. This dysfunction may be temporary or
permanent. When acute coronary syndrome doesn't result in cell death, it is called
unstable angina.

Risk factors
The risk factors for acute coronary syndrome are the same as those for other types of
heart disease. Acute coronary syndrome risk factors include:

Older age (older than 45 for men and older than 55 for women)
High blood pressure
High blood cholesterol
Cigarette smoking
Lack of physical activity
Unhealthy diet
Obesity or overweight
Diabetes
Family history of chest pain, heart disease or stroke
For women, a history of high blood pressure, preeclampsia or diabetes during
pregnancy

2.4 Prevention
A new oral vaccine, called Dukoral is available in other countries, but prophylactic usage
is not currently recommended for routine use by the Centers for Disease Control and
Prevention (CDC) because of incomplete protective effects (WHO, 2008). The CDC
therefore recommends:
Sterilization: Proper disposal and treatment of all materials that come in contact with
cholera patients should be sterilized by washing in hot water using chlorine bleach if
possible.

Sewage: anti-bacterial treatment of general sewage by chlorine, ozone, ultra-violet light

or other effective treatment before it enters the waterways or underground water supplies
helps prevent undiagnosed patients from inadvertently spreading the disease.
Sources: Warnings about possible cholera contamination should be posted around
contaminated water sources with directions on how to decontaminate the water (boiling,
chlorination etc.) for possible use.
Water purification: All water used for drinking, washing, or cooking should be
sterilized by either boiling, chlorination, ozone water treatment, ultra-violet light
sterilization, or anti-microbal filtration in any area where cholera may be present.
Chlorination and boiling are often the least expensive and most effective means of halting
transmission.
Sensitive surveillance: Surveillance systems can provide early alerts to outbreaks,
therefore leading to coordinated response and assist in preparation of preparedness plans.
Understanding the seasonality and location of outbreaks provide guidance for improving
cholera control activities for the most vulnerable. According to (Bertranpetit & Calafell,
1996) this will also aid in the developing indicators for appropriate use of oral cholera
vaccine.
2.5 Treatment
Because death from cholera is a consequence of dehydration, the disease is treated using
oral rehydration therapy (ORT). ORT is highly effective, safe, and simple to administer.
In situations where commercially produced ORT sachets are too expensive or difficult to

obtain, alternative homemade solutions using various formulas of water, sugar, table salt,
baking soda, and fruit offer less expensive methods of electrolyte repletion. Severe cases
of cholera require intravenous fluid replacement. Antibiotics can shorten illness, but ORT
is still necessary even when antibiotics are used. Tetracycline is typically used as the
primary antibiotic, although some strains of V. cholerae have shown resistance. Other
antibiotics that have been proven effective against V. cholerae include cotrimoxazole,
erythromycin, doxycycline, chloramphenicol, and furazolidone (Molson Medical
Informatics, 2007). According to Krishna & Chandrasekhar (2006), Fluoroquinolones
such as norfloxacin also may be used, but resistance has been reported. Use of antidiarrheal medicines is not recommended since they prevent flushing of the bacteria out of
the body.