Unit 5 - Chronic Disease

Unit 5 - Chronic Disease Prevention and Management

Resources for chronic diseases related to neonatology:

Bronchopulmonary Dysplasia:

Bronchopulmonary dysplasia (BPD) is a condition in which normal lung development is stunted in newborns due to the use of high-pressure ventilation and supplemental oxygen use. BPD is common in premature infants who require respiratory support for long periods of time. BPD can result in chronic lung disease and structural abnormalities that continue well beyond infancy. The Canadian Paediatric Society recommends the following guidelines for BPD management: Low dose hydrocortisone may be used for infants at the highest risk of developing BPD (<28 weeks gestation) for 10 days, beginning 24 to 48 hours after birth. Routine use of dexamethasone, prolonged use or hydrocortisone, and inhaled corticosteroids are not recommended.

Retinopathy of Prematurity:

Retinopathy of prematurity (ROP) is a problem with retinal development that can occur in premature infants. Supplemental oxygen use in infants can lead to abnormal retinal blood vessel growth. This can cause complications such as complete retinal detachment, resulting in severe visual impairment or blindness. The Canadian Paediatric Society guidelines state that every infant born at less than 31 weeks gestation or less than 1250 grams will be screened until retinal blood vessel growth is complete. Treatments for ROP are laser therapy and injections of anti-growth factor into the retina. Babies with ROP (whether treated or not) often have long-term side effects, including strabismus, cataracts, amblyopia, and refractive errors, and must be followed by an ophthalmologist.

Image retrieved from: https://www.rnib.org.uk/eye-health/eye-conditions/retinopathy-of-prematurity

Fetal Alcohol Spectrum Disorder:

Fetal alcohol spectrum disorder (FASD) is a condition that results from drinking alcohol during pregnancy. Approximately 9 in every 1000 babies in Canada are born with FASD. People with FASD may have learning and/or social difficulties. They may also have skeletal and organ abnormalities, OCD, or depression as a result of their FASD. There is no cure for FASD and affected individuals have it for their lifetimes. The Government of Canada has initiated public health programs to help decrease the rate of FASD births, as well as programs to help improve the quality of life for FASD-affected individuals.

References:

Canadian Paediatric Society. (2020). Position statement: Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants. Retrieved from https://www.cps.ca/en/documents/position/postnatal-corticosteroids-to-prevent-or-treat-bronchopulmonary-dysplasia-in-preterm-infants

Canadian Paediatric Society. (2016). Retinopathy of prematurity: An update on screening and management. Retrieved from https://www.cps.ca/en/documents/position/retinopathy-of-prematurity-screening

Government of Canada. (2017). Fetal alcohol spectrum disorder. Retrieved from https://www.canada.ca/en/health-canada/services/healthy-living/your-health/diseases/fetal-alcohol-spectrum-disorder.html

Chronic Disease in Ontario:

Prevention:

Cancers, cardiovascular disease, chronic lower respiratory diseases, and diabetes cause about two-thirds of all death in Ontario. Modifiable risk factors for these diseases include tobacco smoking, alcohol consumption, physical activity, and unhealthy eating.

Population-level interventions to decrease the incidence of modifiable risk factors include:

For tobacco use:

-2011 Smoke-Free Ontario Strategy:
-Tobacco tax
-Tobacco cessation system present in hospitals, primary care and community facilities
-Educational social marketing campaign encouraging users to quit
-Smoking banned in bars and patios

For alcohol consumption:

-Price policies for buying alcohol
-Controlling alcohol availability by regulating alcohol sale hours, per capita density of outlets selling alcohol, banning “off-premise” sales
-Policies on alcohol advertisements
-Wide availability of counselling services for unhealthy alcohol use

For physical activity:

-Physical education is required through grades 9-12 for high school graduation
-Daily physical activity policy in elementary schools
-Funding provided for walking and cycling infrastructure

For healthy eating:

-Ontario Food and Nutrition Strategy to improve healthy food access, food literacy & skills, and healthy food systems
-Compulsory teaching of food skills in elementary and secondary education
-Promotion of healthy eating in provincial workplaces and provincially funded institutions
-Mandatory menu labelling in all large-scale food operations in Ontario

Screening Programs:

Ontario Breast Screening Program:
-Encouraging average-risk Ontario women age 50 to 74 to have a mammogram every 2 years
-Screening for high-risk women age 30-69 with both mammography and MRI

Ontario Cervical Screening Program:
-Regular screening for all women with Pap tests
-Program sends letters to women reminding them to be tested and providing them with results

Ontario Colorectal Screening Program:
-Average-risk Ontarians age 50-74 are screened through a fecal immunochemical test every 2 years, or with a sigmoidoscopy every 10 years if they choose
-High-risk patients with family members who have had colorectal cancer are screened by colonoscopy every 5 or 10 years, depending on the age their family member was diagnosed
-The program sends letters to patients inviting them to be screened and sends results

Funding:

-The Ontario Ministry of Health and Long-Term Care funds public health units’ mandatory programs up to 75%. Municipalities provide the other 25% of funds.
-Over $1 billion is spent annually on Ontario public health-related programs and services, 2% of overall provincial health expenditures.
- In 2016/17, per capita funding per public health unit averaged $64.40

References:

Cancer Care Ontario. (2020). Screening programs. Retrieved from https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs

Cancer Care Ontario, Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2012). Taking action to prevent chronic disease: Recommendations for a healthier Ontario. Queen’s Printer for Ontario. Retrieved from https://www.publichealthontario.ca/-/media/documents/t/2012/taking-action-chronic-diseases.pdf?la=en

Ontario Food and Nutrition Strategy Group. (2017). Ontario food and nutrition strategy: A comprehensive evidence informed plan for healthy food and food systems in Ontario. Retrieved from https://sustainontario.com/work/ofns/wp-content/uploads/sites/6/2017/07/Ontario_Food_and_Nutrition_Strategy_Report.pdf

Ontario Ministry of Health and Long-Term Care. (2017). Public health: Chronic disease prevention. Retrieved from https://www.auditor.on.ca/en/content/annualreports/arreports/en17/v1_310en17.pdf