Chronic Disease Prevention
& Management
Annotated Bibliography:
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Boehme, A.K., Esenwa, C., & Elking, M.S.V. (2017, February 3). Stroke risk factors, genetics, and prevention. Circulation Research, 120(3).
Retrieved from https://doi.org/10.1161/CIRCRESAHA.116.308398
This article categorizes the risk factors for stroke as modifiable and non-modifiable. The non-modifiable risk factors that are discussed include age, sex, and race/ethnicity. The main modifiable risk factors include hypertension, smoking, diet, and physical inactivity. In addition to differentiating risk factors based on being modifiable or non-modifiable, the authors also examined which triggers pose short-term risks versus intermediate or long-term risks. A short-term risk factor could be sepsis or stress. An intermediate-term risk factor may be hyperlipidemia. A long-term risk factor includes sex or race. Co-morbidities are important to consider when thinking about possible triggers for a stroke. Some of the more common problems in stroke patient’s medical histories have been found to be inflammatory disorders, infection, and cardiac atrial disorders. On an individual level, genetics play an important role as some rare genetic disorder have stroke as a primary manifestation. The author describes the importance of managing other medical conditions, such as hypertension and diabetes, to prevent stroke. Other stroke prevention strategies include lifestyle and behavioural modification. Examples of this are improving diet and smoking cessation. This article describes the differences and similarities for risk factors for hemorrhagic and ischemic strokes. Atrial fibrillation was attributed to higher risk of cardioembolic stroke. It is argued that developing countries, where hypertensive disorders are prominent, have an increased prevalence of hemorrhagic stroke. As Western style diets is introduced to these regions, the proportion of hemorrhagic strokes decrease and the amount of ischemic strokes as well as cardiovascular disease increases. Beijing, China was used as an example. The incidence of hemorrhagic stroke declined by 1.7% annually but the incidence of ischemic stroke increased by 8.7%, from 1984 to 2004.
Government of British Columbia (n.d.). Stroke and transient ischemic attack- acute and long-term management. Retrieved from
https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/stroke-
tia#Risk%20Factors%20&%20Primary%20Prevention
This provincial resource provides useful information about strokes. Epidemiology, risk factors, prevention, diagnosis, acute and long-term management are the main topics. There is also an explanation between strokes and transient ischemic attacks. The non-modifiable risk factors that were highlighted include age, previous stroke or TIA, gender, ethnicity, and family history. Modifiable risk factors that were found to be important were hypertension, hyperlipidemia, smoking, cardiovascular disease, and diabetes. The consequences of atrial fibrillation were also explained. Individuals with atrial fibrillation were found to be 3 to 5 times more likely to have an ischemic stroke. In general, more than 20% of strokes were attributed to atrial fibrillation. The recommendations for a healthy diet included a diet rich in fruits, vegetables and low-fat dairy produce. Further suggestions to living a healthy lifestyle included limiting the amount of alcohol consumed, smoking cessation, weight control, and aerobic exercise. This BC Guidelines website provides links to useful resources such as the Heart and Stroke Foundation, Canadian Stroke Network, and Stroke Services BC.
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Government of Canada (2019, December 9). Stroke in Canada: Highlights from the Canadian chronic disease surveillance system. Retrieved
from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/stroke-canada-fact-sheet.html
This website provides national data on stroke. In Canada, stroke is the third leading cause of death. Moreover, it is the tenth largest contributor to disability-adjusted life years. Stroke symptoms and causes are described. The modifiable risk factor for stroke that is deemed to be the most important is hypertension. Across all ages below 85 years, more men than women who’ve ever had a stroke die. More individuals above the age of 85 that have a history of stroke that die are female. The reason for this is felt to be due to women having a longer life expectancy. The Government of Canada encourage people to maintain a healthy weight, eat healthy foods, exercise regularly, control blood cholesterol, and avoid smoking, and to limit alcohol consumption. The source of the data and figures is the Public Health Agency of Canada. The data was collected from provinces and territories using the Canadian Chronic Disease Surveillance System.
Annotated Bibliography:
BC Epilepsy Society (n.d.) Women in mind. BC Epilepsy Society. Retrieved from http://bcepilepsy.com/programs/women-in-mind
The BC Epilepsy Society has a large amount of resources including support forums, factsheets, videos, presentations, and blog posts. This page in particular stresses the unique challenges that females face with epilepsy. The fluctuations in hormones during menstrual cycles, puberty, and menopause can have an impact on seizure frequency. Also, women that are going through menopause are more likely to have a fracture from a fall during a seizure. There is further information about bone health and how some anti-epileptic medications may decrease bone density, especially in women. Issues relating to reproductive health, including the use of anti-epileptic medications while using contraception or during pregnancy, are also discussed. This website provides factsheets outlining the risks on a developing child due to anti-epileptic medication as well as due to increased seizure frequency or severity. There are factsheet links that go into detail about female hormones as well as the different impacts of anti-epileptics on women compared to men.
Gilmour, H., Ramage-Morin, P. & Wong, S.L. (2016, September 21). Epilepsy in Canada: Prevalence and impact. Statistics Canada. Retrieved
from https://www150.statcan.gc.ca/n1/pub/82-003-x/2016009/article/14654-eng.htm
This national health report shows national data regarding epilepsy in terms of prevalence, comorbidities, medication, age of diagnosis, and impact of diagnosis. There are tables and figures to illustrate the data as well as brief summaries under different headers that specify the statistical analysis done in various studies and surveys. Although epilepsy was diagnosed at different stages of life for different patients, the vast majority of people were discovered to have epilepsy in childhood/young adulthood, with 75% being diagnosed before the age of 30. Interestingly, 39% of Canadians with epilepsy reported that they did not feel overall that their life was impacted. However, those that had a negative experience with epilepsy reported having negative interactions with others, trouble sleeping, restrictions on driving, employment difficulties, and educational limitations. Moreover, they were more likely to have a mood disorder or experience incontinence compared to the general population. This report also describes the consequences of social determinants of health on epilepsy. For instance, a consistent finding across studies is that people from lower income households are significantly more likely to have epilepsy than those from annual household incomes of $100,000 and above.
Healthwise Staff (2019, November 20). Epilepsy. HealthLinkBC. Retrieved from https://www.healthlinkbc.ca/health-topics/hw108148#show-all
This provincial resource provides details on various topics related to epilepsy. First, there is a general overview of epilepsy including causes, symptoms, and what a patient is likely to experience. Health tools are also mentioned as well as prevention and treatment options. The website describes antiepileptic medication and possible side effects. The various medications are listed (including generic and trade names) as well as which ones are commonly used for which type of seizure disorders. Moreover, if a patient has intractable epilepsy, there is information describing surgical intervention. The website mentions who is considered to be a good candidate for surgery. The other treatment options that are discussed include the ketogenic diet and vagus nerve stimulation. There are links to learning about how to help if you witness someone having a seizure as well. The diagnostic procedures are explained with a focus on electroencephalogram and imaging tests including magnetic resonance imaging and computed tomography.
Szaflarski, M. (2014). Social determinants of health in epilepsy. Epilepsy & Behavior, 41, 283-289. Retrieved from
https://doi.org/10.1016/j.yebeh.2014.06.013
This review examines the social factors that impact a patient’s experience with a diagnosis of epilepsy as well as the disparities in health outcomes among different groups or individuals. The author proposes a theoretical framework to study epilepsy from a perspective that targets social determinants of health. The main individual factors include socioeconomic status, race/ethnicity, age, gender, and behaviour (eg. adherence). Stigma, a psychosocial factor, is also highlighted as being a contributing factor to poor health outcomes for patients with epilepsy. Suggestions are made for how to minimize disparities relating to epilepsy. Importantly, the article describes how social determinants of health not only influence the likelihood of having a seizure disorder, but also have a major impact on hospitalizations, medication compliance, surgical interventions, and overall treatment outcomes. The author argues that many of the social factors are unjust and modifiable, in particular, access to health systems and structural context. Theory-based research is argued as being crucial to eliminating health disparities and improving efforts to provide the best care.
Annotated Bibliography:
Alzheimer Society (n.d.). Brain-healthy tips to reduce your risk of dementia. Alzheimer Society. Retrieved from https://alzheimer.ca/en/about-
dementia/how-can-i-prevent-dementia/brain-healthy-tips-reduce-your-risk-dementia
Each province has an Alzheimer Society, with specific programs and services. This webpage explains protective factors for brain health and how to minimize your risk of dementia. The tips and strategies are evidence-based, with links to useful resources. The sources for the information include Alzheimer Society of Canada, The Public Health Agency of Canada, peer-reviewed research, Government of Canada, Alzheimer’s Society UK, and Dementia Australia. This website empowers readers by encouraging a healthy, balanced lifestyle and stresses the importance of modifiable factors. For example, making conscious and safe choices can reduce some of the risk factors associated with dementia. This includes head injuries, high alcohol consumption, hearing loss, living near busy roads, and smoking. The conditions of the environment that a person lives in is argued to impact their safety and likelihood of getting dementia. Some of the questions to ask yourself are, do you live in an area exposed to loud sounds or vehicle pollution? Does your home have handrails or grab bars to help prevent falls? The role of the community and engagement with others is also an important social determinant of health. In fact, depression and social isolation increased the chances for dementia. Alzheimer Society believes an active social life will reduce stress, enhance your mood, and improve interpersonal relationships.
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Brennan, S. [Sabrina Brennan]. (2013, October 9). What can you do to keep your brain healthy? [Video]. Vimeo. https://vimeo.com/76537801
This short video illustrates the importance of staying active both physically and socially. Physical exercise was found to improve the size of the hippocampus, a brain structure that is involved with the formation of memories. Performing aerobic exercise for just 30 mins, 5 times per week, strengthens brain connections and promotes brain health. The video describes how the brain requires a protein called brain-derived neurotrophic factor (BDNF), in order to “fertilize” the brain for neuronal growth and brain cells. BDNF is created when a person does physical exercise. Tips to keep the brain active included challenging yourself, changing yourself with novel tasks, and learning something new. Cognitive decline is one of the consequences of loneliness. Therefore, avoiding social isolation and loneliness, particularly as you get older, can help minimize this risk. This video promotes active engagement in order to stimulate the brain and help prevent a poor brain health outcomes.
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Canadian Institute for Health Information (n.d). Dementia in Canada: Summary. Retrieved from https://www.cihi.ca/en/dementia-in-
canada/dementia-in-canada-summary
This website provides data about dementia and what has happened to seniors who have this diagnosis. Changes at the policy level have resulted in improvements in many jurisdictions. For example, the use of antipsychotics and restraints in long-term care facilities have been reduced. The Canadian Institute for Health Information has gathered data to show that hospitalization rates are 23% higher for seniors with dementia in low-income neighbourhoods compared to affluent areas. Individuals with dementia from lower-income neighbourhoods had higher rates of injuries related to falls. Biological sex is also explored, with studies showing that dementia is more prevalent among women than men. Another key finding was Canadians with early onset dementia, being diagnosed before the age of 65, faced special challenges. This cohort is more likely to encounter stigma and have the rare genetic forms of the disease. Many of them are likely to still be working which causes additional difficulties.
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MacDonald, J.P., Ward, V., Halseth, R. (2018). Alzheimer’s disease and related dementias in Indigenous populations in Canada: Prevalence and
risk factors. National Collaborating Centre for Aboriginal Health. Retrieved from https://www.nccih.ca/docs/emerging/RPT-Alzheimer-
Dementia-MacDonald-Ward-Halseth-EN.pdf
This document from the National Collaborating Centre for Aboriginal Health discusses the experience of Indigenous populations in Canada with Alzheimer’s disease and related dementias (ADRDs). The challenges of diagnosing ADRDs in this population group is highlighted. Typically, these communities have a lack of awareness and knowledge about dementias. This is in part due to a lack of geriatric care specialists in their area. Urban centres offer the specialized health care services, which requires people from Indigenous communities to travel to gain access to appropriate diagnostic tools. Barriers to accessible health care create delays in the timeline and prevents early interventions. From a social determinants of health perspective, there were several risk factors that were identified for ADRDs. The focus was on physical inactivity, diabetes, obesity, hypertension, diet, smoking, alcohol use, depression, chronic psychological stress, post-traumatic stress disorder, and low educational attainment. Research shows that individuals who have higher levels of education have an increased “cognitive reserve” and greater capacity to resist damage during aging. The accumulation of amyloid plaque and rate of hippocampal atrophy and was slowed in people with higher levels of education.
Annotated Bibliography:
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BC Centre for Disease Control (2021a). Chronic disease dashboard. Retrieved from http://www.bccdc.ca/health-professionals/data-
reports/chronic-disease-dashboard
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This website features an interactive tool that allows for statistical analysis of several non-communicable diseases and conditions within British Columbia. The data can be filtered by sex, rate type, age group, and year up until 2018, and health region. The health region can be as broad as to include the entire province, or as narrow as a specific city. Comparisons between health authorities can also be made. The ten leading conditions in British Columbia in recent years have been mood or anxiety disorders, hypertension, diabetes, osteoarthritis, ischemic heart disease, chronic obstructive pulmonary disease, osteoporosis, asthma, Alzheimer’s disease or other dementia, and chronic kidney disease. The data can be viewed as a bar chart, age sex chart, table, or geography. The maps show the crude incidence or crude prevalence (per 1000 population at risk) with varying intensity of colours. The trends over time can also be viewed, depicted in a line graph. For the changes over time, the data is categorized into female, male, or total.
BC Centre for Disease Control (2021b) Population & public health surveillance. Retrieved from http://www.bccdc.ca/our-
services/programs/population-public-health-surveillance
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This website focuses on population and public health surveillance. In British Columbia, the BC Centre for Disease Control is responsible for programs that collect, analyze, and share data about health status and chronic diseases among BC residents. The Population & Public Health (PPH) Program also focuses on protective and risk factors among British Columbians in relation to chronic diseases and health outcomes. Social determinants of health are a key area of interest for the PPH surveillance team including demographic factors and socio-economic status. This surveillance program uses health equity indicators to measure the performance of health systems. PPH plays a leadership role alongside the Ministry of Health to support Healthy Families BC (HFBC) action plans. HFBC views health promotion, such as food security initiatives, to be integral to chronic disease prevention. Healthy Communities and Healthy Schools were two provincial HFBC initiatives that have been a priority for chronic disease surveillance.
BC Ministry of Health Living and Sport (2010). Model core program paper: Chronic disease. CORE public health functions of BC. Retrieved
from https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/healthy-living-and-healthy-
communities/chronic_disease-model_core_program_paper.pdf
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This paper provides an overview of chronic disease in British Columbia including the burden, economic impacts, priority interventions, and management approaches. The roles and responsibilities in terms of prevention of chronic disease are discussed from all levels including international, national, provincial, and local. The goals and objectives are highlighted, with special consideration for aboriginal communities. In addition to cultural or ethnic groups, targeted initiatives for sex and gender-based inequalities are outlined. The protective factors as well as risk factors are mentioned across the life course with suggestions for multi-sectoral healthy living programs. The modifiable risk factors are described with information on how to reduce poor health outcomes. Self-care and self-management strategies are also viewed as key components to positive chronic disease management and prevention. An evidence-based approach is used to indicate supporting evidence for best practice as well as performance targets. This paper aims to support clinical prevention and promote healthy public policy.
Health Canada (2007, March). Primary health care transition fund: Chronic disease prevention and management. Synthesis series on sharing
insights. Retrieved from https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/prim/2006-
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This comprehensive document describes Canada’s approach to chronic disease prevention and management. The applications of the Primary Health Care Transition Fund (PHCTF) throughout the country are explained. British Columbia and Alberta are highlighted as national leaders in chronic disease prevention and management. Their efforts prior to funding as well as after receiving funding through PHCTF are discussed. An overview of the various envelopes of funding via PHCTF and initiatives is provided. The chronic care model as well as British Columbia’s expanded chronic care model are described. Challenges that certain provinces faced are mentioned as well as partnerships that were beneficial to achieving goals. The British Columbia Chronic Disease Management Toolkit was highlighted as being innovative and supportive, with many other regions adopting this toolkit. Primary care physician practices that help target chronic disease prevention were discussed. Areas for further improvement and key learnings from practice-level experiences were identified. Different frameworks and strategies were explained with an emphasis on projects with successful outcomes.
Healthy Families BC (2012). Welcome to Healthy Families BC! Retrieved from https://www.healthyfamiliesbc.ca/home/about-us
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This website supports families in their mission to maintain a healthy lifestyle. Links to many programs and resources are available such as Alcohol Sense and Healthy Start. There are many online tools that are featured, especially for young mothers. A main focus on many of the online tools is a healthy diet, with programs such as Sodium Sense to teach people the consequences of what they are eating and how to make healthier choices. HealthyFamilies BC is considered to be one of the country’s leading strategies in terms of health promotion. This comprehensive strategy is aimed to improve the lives of British Columbians at every stage of life, particularly targeting children and young families. Helpful resources for parents are available that teach them about improving their children’s mental and physical health. There are practical tips and supportive tools that address children’s challenging behaviours as well as programs to enhance coping skills.
Kothari, A., Gore, D., MacDonald, M., Bursey, G., Allan, D., Scarr, J. (2013). Chronic disease prevention policy in British Columbia and Ontario in
light of public health renewal: A comparative policy analysis. BMC Public Health, 13, 934-948. Retrieved from
http://www.biomedcentral.com/1471-2458/13/934
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This article presents the public health policies that target active living and healthy eating in British Columbia and Ontario. The underlying motivations between the provinces were compared as well as the development of public health renewal processes. The authors argue that differences in approaches are largely due to political beliefs, organizational or governance structures, and the populations that they serve. The differences in health outcomes between British Columbians and Ontarians are contextualized. Both provinces used supporting evidence to guide their decision-making process. Specific chronic conditions such as heart disease were examined in terms of intervention strategies and health outcomes between the provinces. The BC Healthy Living Program’s goals and core components were discussed in detail. The aim of this study is to analyze sustainability of local programs and services as well as inform future public health policy throughout Canada. The main areas to target for chronic disease prevention were felt to be health equity-based policies and public awareness campaigns that promote healthy choices.
Ministry of Health (2013, March). Promote, protect, prevent: Our health begins here. BC’s guiding framework for public health. Retrieved from
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The purpose of this guiding framework for public health in British Columbia is to create a long-term vision that identifies health priorities, supports health equity, and incorporates strong public health strategies to promote the best possible public health system. Key health challenges are described with suggestions for areas of focus and intervention such as strategic investments. The long-term vision depends on strategy alignment, inclusive decision-making process, health policy that responds to social determinants and equity. The foundational components in order to achieve the visionary goals include self care, primary care, clinical prevention, core public health functions, and modernized legislation. Partnerships and collaboration for effective public health action are described; this includes all sectors and levels of government, community-based programs, and non-governmental organizations. The strategic framework involves core programs in health improvement, public health emergency management, environmental health, and prevention of disease, injury or illness. Overall, this document describes how health surveillance, evaluation of evidence and innovation will lead to vibrant communities.
Provincial Health Services Authority (2021). Health status and chronic disease. BC community health data. Retrieved from
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This provincial resource provides information about health status and chronic disease. There is a search function to learn about a specific community’s health profile. This page explores Vancouver’s health data in terms of life expectancy, maternal and infant health, mental health, and chronic disease. The BC Ministry of Health created a line graph depicting the chronic disease incidence rates for several chronic diseases from 2001 till 2015. Their data came from Vancouver Coastal Health Authority. The chronic diseases included were asthma, diabetes, hypertension, chronic obstructive pulmonary disease, heart failure, anxiety and depression. The information is based on diagnosed cases and therefore does not include people that have yet to seek medical attention. In addition to the number of people being diagnosed with these chronic conditions in Vancouver each year, there are brief descriptions about these conditions. Risk factors are highlighted for diabetes, heart and circulatory illness, respiratory illness, and mental illness.