[01.13] CMD - Patient Education and Lifestyle Intervention V2.pdf

41 million

How many people die each year from non-communicable diseases (NCDs) according to WHO 2023 data?

74%

What percentage of all global deaths are caused by NCDs?

Low- and middle-income countries

In which types of countries do 86% of premature NCD deaths occur?

Ischemic heart diseases

What is the number one cause of mortality in the Philippines as of 2023?

Neoplasms

What is the number two cause of mortality in the Philippines, which was not in the top three in the past?

Pneumonia

What disease used to be the leading cause of NCD mortality worldwide before the development of strong antibiotics and vaccines?

Modifiable risk factors

What did the Interheart study specifically look at across 52 countries in relation to myocardial infarction?

Abnormal cholesterol, smoking, hypertension, abdominal obesity, psychosocial factors, and diabetes

What are the six risk factors identified by the Interheart study as being associated with 90% of acute myocardial infarctions?

Fruits, vegetables, physical activity, and regular (limited) alcohol consumption

What are the three protective factors identified in the Interheart study?

One drink per day

What is the alcohol limit for females to be considered a protective factor?

Two drinks per day

What is the alcohol limit for males to be considered a protective factor?

80%

What percentage of heart disease risk is accounted for by smoking, healthy weight, blood pressure, physical activity, and diet?

History of hypertension

What is the top risk factor for stroke identified in the Interstroke study?

Ischemic and intracerebral hemorrhagic

What two types of stroke were examined in the Interstroke study?

1948

In what year did the Framingham Heart Study begin?

Cardiovascular disease risk genes

What did the Framingham study begin identifying in the 2000s at the genomic level?

4.8x

How much does the risk of adenocarcinoma of the esophagus increase with severe obesity?

7x

How much does the risk of endometrial cancer increase with severe obesity?

5-unit increase in BMI

For breast and ovarian cancers, the risk increases for every what?

Microbiome alterations, epigenetic changes, and cellular stress

According to the Lifestyle Medicine Research Summit, what three biochemical changes can lifestyle factors cause before complications arise?

90-95%

What is the total decrease in heart disease risk if a patient implements all six major lifestyle changes?

Primordial

Which level of prevention aims to prevent the development of risk factors by modifying eating patterns and environmental determinants?

Primary

Which level of prevention focuses on preventing disease in individuals who already have one or more risk factors?

Secondary

Which level of prevention involves screening asymptomatic individuals to treat disease early, such as a colonoscopy?

Tertiary

Which level of prevention focuses on minimizing complications and improving quality of life for those with an established illness?

Mainstay of treatment

How should lifestyle change be categorized in relation to medication?

Adjunct

In most management guidelines, how is medication considered in relation to lifestyle changes?

Implement lifestyle modifications

What is the first step recommended for all adults over 18 with hypertension according to JNC 8?

In all stages

At what stages of hypertension management should a clinician reinforce lifestyle and adherence?

Lifestyle therapy and glucose monitoring

What two things should be prioritized regardless of whether a patient is nondiabetic, prediabetic, or diabetic?

Group 1

Under which IARC classification are processed foods, tobacco, and alcohol placed?

Group 2A

Which IARC group contains red meat and foods cooked at high temperatures?

Group 2B

In which IARC group is lead and gasoline engine exhaust placed?

Coffee

Which substance is in IARC Group 3 but is considered controversial because it is protective for some cancers and a risk for others?

Lack of training, time, and effort

What are three reasons doctors often cite for not recommending lifestyle interventions?

Not included in insurance packages

What is a major economic reason why lifestyle interventions are often overlooked?

Perception

What is the driving force behind the Health Belief Model?

Perceived Susceptibility

Which HBM construct involves the patient's belief about their risk of getting a disease?

Perceived Severity

Which HBM construct involves the patient's assessment of how serious a condition is?

Benefits minus barriers

According to the HBM, the likelihood of action is determined by perceived what?

Cues to action

Media, physician advice, or a family member's illness serve as what in the Health Belief Model?

Self-efficacy

What is the term for a patient's confidence in their ability to take action or change their life?

Fatigue, lack of equipment, and addiction

What are three physical barriers to lifestyle change?

Sense of hopelessness, denial, and social pressure

What are three psychological barriers to lifestyle change?

Intentions

According to the Theory of Reasoned Action, what is the most important determinant of behavior?

TRA plus Perceived Behavioral Control

How is the Theory of Planned Behavior defined in relation to TRA?

Habitual behaviors

What type of behaviors are not accounted for by the TRA or TPB because they are not subject to reasoning?

Integrated Behavior Model

Which model is an extension of TRA and TPB that includes habits and environmental constraints?

Experiential attitude

In the IBM, what term refers to the emotional response to the idea of a behavior?

Instrumental attitude

In the IBM, what term refers to the belief about the consequences of a behavior?

Injunctive norm

Which type of norm refers to what others expect of you?

Descriptive norm

Which type of norm refers to what others in your social network are actually doing?

Social Cognitive Behavioral Theory

Which theory emphasizes the interaction between internal individual factors and the social/physical environment?

Mastery experiences

What is the most effective way to increase self-efficacy in Social Cognitive Theory?

Social modeling

What term refers to being motivated by watching others, such as through social media?

Establishing rewards

What is a key strategy for self-regulation to enhance confidence for behavior change?

Socioecological Theory

Which theory looks at levels of influence from intrapersonal to public policy?

Lobbying for smoking ordinances or helmet laws

What is an example of an action at the Public Policy level of the Socioecological model?

Encouraging bike paths and local safety

What is an example of an action at the Community Norms level of the Socioecological model?

Transtheoretical Model of Change

What is the other name for the Stages of Change model?

Precontemplation

In which stage does a person say "I won't" or "I can't"?

Contemplation

In which stage is a person thinking "I might" change in the next six months?

Preparation

In which stage does a person have a plan to change within the next month?

Action

In which stage has a person made changes for less than six months?

Maintenance

In which stage has a behavior change been in effect for at least six months?

Not "one-size-fits-all"

Why is it important to know a patient's stage of change?

Self-reevaluation

What process in the stages of change involves asking "What will happen to you if you don't change?"

Self-liberation

Which process involves choosing a commitment to act and building confidence?

Helping relationships

Which process involves identifying support systems in the community?

Counterconditioning

What is the term for substituting healthy alternatives for problem behaviors, like drinking water instead of alcohol?

Stimulus control

What process involves avoiding triggers that lead to problem behaviors, like removing cigarettes from the house?

Goal setting and implementation intention

What two things turn intentions into behavior in theory-based interventions?

Implementation intention

What is the term for setting a specific time and place for a behavior using "if-then" statements?

Counseling

In which approach does the doctor act as the expert and focus on fixing a problem?

Coaching

In which approach is the patient the expert of their own life and the focus is on optimum performance?

How

What type of questions are focused on in coaching rather than "Why" questions?

Empowerment

What is the goal of coaching to ensure patients commit to lifestyle change?

Empathy

The Five-Step Collaboration Cycle starts and ends with what?

Confidentiality

What must a clinician remind the patient of to create a "safe space" for empathy?

Align Motivation

Which step of the collaboration cycle asks for the patient's "Why"?

Rulers

What tool is used to build confidence by asking a patient to rate their readiness from 1 to 10?

Specific, Measurable, Attainable, Realistic, Time-Bound

What does the acronym SMART stand for in goal setting?

Exciting and Reward

What do the extra letters in "SMARTER" goals stand for?

Accountability

Which step of the collaboration cycle involves tracking, monitoring, and follow-up?

Catharsis

Which part of the CEA model involves clarifying the problem and allowing the patient to vent?

Education

Which part of the CEA model requires speaking the patient's language and using analogies?

Action

Which part of the CEA model involves a plan agreed upon by both the doctor and the patient?

Goal, Reality, Options, Way Forward

What does the acronym GROW stand for in the coaching flow?

Open-ended

What type of questions are considered a "powerful tool" in coaching to create awareness?

Agenda mapping

What technique in the "Focusing" process involves asking the patient for permission to prioritize topics?

Change talk

What are the signals or phrases that a physician must catch indicating a patient is ready to change?

Sustain talk

What is the opposite of change talk, where the patient provides reasons for not changing?

Desires, Ability, Reason, Need

What four categories of preparatory change talk exist?

Commitment, Activation, Taking Steps

What are the three categories of mobilizing change talk?

Change talk bouquet

What summary should a physician offer before the "Planning" stage of motivational interviewing?

1-2 pounds per week

What is considered a normal and healthy rate of weight loss?

Gallstones

What is a major medical risk of rapid weight loss programs?

Confrontational

What tone should a physician avoid because it impedes clinical care and puts patients on the defensive?

Pre-contemplation to contemplation

In the "Effective Physician" video, what stage movement did the patient demonstrate?

DOH Omnibus Guidelines 2023

What is the current primary guideline for primary care service packages in the Philippines?