2. DEFINITION OF NCD
Non-infectious & Non-
transmissible between
persons.
Mostly chronic diseases
of long duration & slow
progression which require
chronic care management.
6. COMMON RISK FACTORS OF (NCDS)
Almost all NCDs have unknown cause, but they have some related RFs.
• Genetics
• Age
• Sex
• Race
Non
modifiable
• Smoking
• Alcoholism
• Unhealthy diet
• Physical inactivity
• Stress
• Environmental pollution
• Socio-economic conditions
Modifiable
7. WHO global status Report 2014: identified 5 important RFs for NCDs
in the top 10 leading risks to health.
↑ Blood pressure ↑ Cholesterol level Tobacco use
Alcohol
consumption
Overweight
Insufficient
physical activity.
8.
9.
10. REASONS OF THE INCREASING PREVALENCE OF NCDS
Demographic
transition
Epidemiologic
transition
Nutritional
Transition
Multi-factorial
nature of RFs
Migration
International
communication
Environmental
changes
Epidemiology of
NCDs differs
across countries
Epidemiology of
NCDs changing
all the time
Limited use of
scientific
progress in
management
11. Transition
Items
Demographic Epidemiologic Nutrition transition
Past
situations
-↑ Fertility
-↑ Mortality
↑ Infectious diseases ↑ Under nutrition
Interventi
ons
-Family planning
-Prevention & control
of infectious disease
-Env. sanitation
-Immunization
-Antibiotics
-Insecticides
Food production
Reducing Famines
Shift To -↓ Fertility
-↑ Life expectancy
-Aging
-↓ Infectious diseases
-↓ Mortality from
infectious diseases
↑ intake of saturated fat
& refined carb. + ↓
dietary fibers
Present
situation
NCDs associated with
aging.
NCDs predominates ↑ Obesity “↑ fat &
carb. intake +
Sedentary life”
12. • Compared to communicable diseases are difficult to identifying the specific cause-
effect relationship.
• RFs Multiplicity limit the opportunities to have specific intervention for prevention
& control.
• RFs are difficult to be controlled by medical technology (in communicable diseases ,
immunization & antibiotics are effective in prevention & control of diseases)
• RFs are related to genetic, environmental, culture and behavior which represent a
challenging issue to public health programs.
Multi-factorial nature of the risk factors for NCDs
13. Migration from low risk culture (e.g. rural areas) to high risk culture
(e.g. Urban areas ) follow the new life style → ↑NCDs risk.
Migration of population across different cultures
14. International
communication,
multinational business &
new food technologies →
new life-style & new food
products.
Communication through
the mass media∕ satellites∕
internet, overseas travel,
and international food
marketing → Introduction
of different concepts &
dietary pattern.
Adolescents & youth are
population segments who
are exposed to such
modernization in concepts
and behavior.
Early exposure →
development of large
cohort with health
problems during
adulthood & older age.
International communication
16. Place
• Differences in prevalence of
RFs (genetic, environmental,
cultural & behavioral) across
countries → Limitations for
generalization.
• National Public health
specialists should have specific
surveillance system for different
NCDs (e.g. ↑ spicy food
→↑peptic ulcers & stomach
neoplasm).
Time
• Some countries succeeded in
improving pattern of some
NCDs (i.e. ↓ coronary heart
diseases by extensive anti-
smoking programs).
Epidemiology of NCDs differs across countries &changing all the time
17. Rapid & successful achievements in the science of risk detection, use
of medication & technologies to prevent & control NCDs.
However, in the developing countries high cost of NCDs prevention &
control programs is challenging.
Limited use of scientific progress in management of NCDs
18. 3ry
Rehabilitate the complicated cases
2ry
Early detection of cases “Screening tests” Proper management
1ry
Health promotion & Health
education
Healthy life style
Enhancing the role of laws &
governance
PREVENTION OF NCD
19. Health promotion &
Health education
Adopting healthy
life style
• Balanced diet
• Physical activity
• Social activity
• Avoid SAD
“Smoking, Alcohol,
Drugs”
• Living in a healthy
environment
Enhancing the role of
laws & governance
• Improving access to
ttt
• Addressing social
impacts of illness (↑
taxes on tobacco,
Smoking bans in
public places,
Improving food
labeling).
33. TYPES & RF OF HYPERTENSION
1ry
No identified
cause (in most
cases).
Genetic or
familial
tendency.
Middle age
Males but equal
sex incidence
after menopause.
↑Cholesterol &
LDL or ↓ HDL.
Unhealthy
lifestyle
Smoking
Alcohol intake
Physical
inactivity
Stress,
↑ Salt, ↓ K
intake
Obesity
DM
2ry
Renal &
endocrine causes
Hormonal &
drug intake.
34.
35.
36.
37. SCREENING TESTS FOR HPN
For screening purpose in the
community-based epidemiological
cross-sectional studies, these
standards could be used.
2 readings should be taken at least 5
minutes apart & average result
represents current Bl.Pr.
measurement
In the medical settings, diagnosis of
HPN depends on findings of Bl.Pr.
levels for >2 times few weeks apart.
39. Life style
modifications
(key management)
as ↓weight,
avoidance of
smoking & alcohol
intake, dietary salt &
fat restriction,
avoidance of stress
& keeping physical
exercise.
Early detection
Frequent blood
pressure
measurements after
age of 40 years.
Antihypertensive
drugs
If the lifestyle
modifications are
ineffective alone or
the level of HPN at
the start is so high.
Management of
causes of 2ry HPM.
Prevention
42. It is a common metabolic disorder of
impaired carbohydrate utilization by
the body due to insulin deficiency.
• Intermediate
conditions
between normality
& DM.
• At high risk of
progressing to
T2DM.
Impaired
Glucose
Tolerance
(IGT) &
Impaired
Fasting
Glycaemia
(IFG)
43.
44. Age
• IDDM: young age
• NIDDM and glucose
intolerance: old age .
Sex
• Both sexes are equal.
• Males “stress”
• Females “pregnancy &
obesity”.
Race/ethnicity
• Native American, African
American, Latino, Asian
American, Pacific Islander
Obesity
• 80% of NIDDM patients
are obese.
Genetic or familial
tendency
• Children whom parents are
diabetic.
Autoimmunity
• To islet cells of pancreas.
Stress
• Trauma, operation,
depression, anxiety or
severe infection.
Pancreatic disorder
• Viral Infection (mumps,
coxsackie, enterovirus)
• Cancer pancreas
• Pancreatectomy.
Drugs
• Diuretics
• Corticosteroids
• Contraceptive pills.
Hormone
disturbance
• ↑ Thyroid & Growth
hormones “insulin
antagonistic action”.
RFs
55. 1ry prevention: Prevent predisposing factors. Dietary
education. Screening youth: children & adolescents <18 years of
age who are overweight or obese (BMI >85th percentile for age
and sex, weight for height >85th percentile, or weight >120% of
ideal for height), & have one or more additional RFs.
2ry prevention: Early case finding by screening tests for
glucose intolerance, or during check up for at risk groups.
Proper management of diagnosed cases: health education for
adherence to diet & ttt to prevent complications. Frequent check
up on retina & renal functions every 6 months & diet regimen.
56.
57. HEALTH TECHNOLOGY & DIABETES MANAGEMENT
Continuous glucose monitoring (CGM) technology: helps improve
glycemic control for adults with T1DM starting at age 18.
58. DIABETES MANAGEMENT IN SPECIFIC GROUPS
Individualizing pharmacologic therapy for older adults to reduce the
risk of hypoglycemia, avoid overtreatment & simplify complex
regimens while maintaining personalized blood glucose targets.
59. New guideline recommends all
pregnant women with preexisting
T1DM or T2DM should consider
daily low-dose aspirin starting at the
end of the 1st trimester → ↓ the risk
of pre-eclampsia.
60.
61. DEFINITION
It is an abnormal proliferation of cells in any organ in the body forming
mass or tumor. It invades the surrounding tissues and destroys them.
65. PREVENTION OF CANCER
1ry
• Stop smoking & alcohol
drinking
• Avoid food preservatives,
spicy foods
• Proper storage of grains
& peanuts
• Avoid hormone intake
expect under medial
supervision
• Vaccination for HBV.
• Early ttt of any disease
• Control of environmental
pollution
• Encourage breast feeding.
2ry
• Early diagnosis:screening
tests for at risk groups.
• Breast self-examination
• Cervical smear
• Sputum or X-ray for
cancer lung
• Tumor markers
• Biopsy for benign tumors.
3ry
• Rehabilitation
• Psychological assurance
• Palliative ttt.
70. PRIMARY PREVENTION
Stop smoking
Control of
environmental pollution
Prevention of infection
Avoidance of allergic
foods
Pre-marital examination Physical exercise Early case detection. Skin tests
74. It is unexpected, unplanned event that produces injury, death, property
loss or damage.
• An increasing problem in both developed & developing countries.
• It is the 2nd leading cause of deaths in developing countries
Road traffic accidents Home accidents Occupational accidents Natural disaster
Birth injuries Sport injuries War accidents
75. ROAD TRAFFIC ACCIDENTS
Injuries such as laceration, contusions, bleeding, paralysis, fractures,
and amputation are common.
Death is commonly associated with road traffic accidents.
Egypt loses about 12 000 lives due to road traffic crashes every year. It
has a road traffic fatality rate of 42 deaths per 100 000 population.
76.
77.
78.
79.
80. RISK FACTORS
Road defects:
Narrow
Crowded
Inadequate
lightening
Lack of traffic
signs
Vehicle defects:
Old models
Bad maintenance
Variability in size.
Host factors
(driver):
Impaired alertness.
Inadequate
training.
Negligence of
wearing seat belts
or helmets.
Psychic upset.
Pedestrian:
Extreme of age
Impaired alertness
Negligence of
traffic signals
Obesity.
81. PREVENTION OF ROAD TRAFFIC ACCIDENTS
Roads:
Town planning.
Good lightening.
Sufficient traffic
signals.
Drivers:
Proper medical
examination
before license.
Sufficient
training.
Using seat belt,
wearing helmets.
Pedestrians:
Raising
awareness.
Vehicles:
Periodic
maintenance.
Strict legislations.
82. HOME ACCIDENTS
Burns
• Fire
• Boiling fluids
• Matches.
Falls
• On stairs
• Striking against
furniture
• Slippery floor.
Electric
shock
• Neglected
maintenance
• Exposed wire.
Wounds
• Sharp knives
• Pointed articles.
Chemical
poisoning
• Drugs
• Caustic soda
• Detergents.
Collapse of
old
buildings.
Animal bites
83. RISK FACTORS
Extreme of age. Epilepsy
Fainting
Loss of
consciousness.
Over
confidence in
repairing
electric
appliance.
Unsafe building
Bad
illumination
Slippery floor
or stairs.
84. PREVENTION
Storage of medications
& toxic substance in
closed places.
Close windows &
balcony
Matches, sharp knives
should be put in
hidden places.
Children should not
stay with mothers in
kitchens.
Proper arrangement of
furniture & using non
slippery tiles.
First aid must be
present in every house
Drying floor. Cover the electric plug
opening in the wall
85. OCCUPATIONAL ACCIDENTS
Accidents
occurring
during work
including acts
of violence
which result in
• a) fatal injury
• b) non-fatal injury.
At risk group
• Construction
workers,
agricultural
workers, miners,
industrial workers
etc…
Common body
parts injured
• Upper & lower
limbs, trunk, back,
head & neck.
Injury nature
• Cuts, lacerations,
contusions,
sprains, strains,
fractures, & burns.
86.
87. Personal
factors
• Age
• Sex
• Lack of training
• Negligence of
wearing PPE
• Poor physical &
mental health
Environmental
factors
• Poor ventilation
• Poor illumination
• ↑ or ↓ temperature
• Noise
• Crowded places.
Machinery
factors
• Unshielded
• Exposed
electricity
• Poor maintenance
• Lack of safety
measures.
Working
conditions
• Prolonged
working hours &
inadequate rest
hours.
• Lack of training.
• Lack of
supervision.
• Poor
communication
89. IMPACT OF ACCIDENTS ON WORKERS, INDUSTRY, AND ECONOMY
Impaired
health,
disability &
handicapping,
& death.
Psychic
problems
(PTSD).
↑ absenteeism
& ↓
productivity.
↑ expenses on
medical care,
rehabilitation
&
compensation.
90. PREVENTION OF OCCUPATIONAL ACCIDENTS
• Improving work environment.
• Good machinery design, safety & good maintenance.
• Health education of workers & proper training before work
• Prevention of fatigue & solving psychological troubles.
• ttt of any illness & good nutrition.
• Research studies.
1ry prevention
• 1st aid & emergency services for proper management of injuries at all work places.
2ry prevention
• Change the job of injured worker & proper training
• Artificial limb in amputation & special aids for handicapped workers.
3ry prevention
91.
92. IMPORTANCE OF MENTAL HEALTH
Nearly ½ the world's populations are
affected by mental illness (WHO)
Impact on their self-esteem,
relationships & ability to function in
everyday life.
Everyday stress & even rapid
technological advances make most
people under marked stress
Good mental health can enhance
one’s life, while poor mental health
can prevent someone from living a
normal life.
93. Mental Health
• State of well-being in which the
individual:
• Realizes his own abilities,
• Cope with normal stresses of life,
• Can work productively
• Able to make a contribution to
community.
Mental Illness
• Any disease or conditions that
affect way a person
• Thinks,
• Feels,
• Behaves
• Ability to relate to others & to
surroundings
94. CRITERIA OF INDIVIDUALS WITH GOOD MENTAL HEALTH
Emotional
balance.
Social
adjustment.
Perceiving
things the way
they are.
Achievements
consistent
with the
individual's
abilities &
opportunities.
95. RISK FACTORS OF MENTAL DISORDERS
Sex Infections Genetic predisposition Age
99. Mental illness & poor mental health are public problems
Great impact on:
THE IMPACT OF MENTAL DISORDERS
100. Individuals
• Distressing symptoms.
• Unable to participate in
work & leisure.
• Poor QoL: stigma &
discrimination.
Family
• Economic burden
• Disruption of house hold
routine & restricted
social activities.
• Lost work & social
opportunities.
Community
• Cost of providing care.
• Loss of productivity.
• Legal problems including
violence.
102. PRIMARY PREVENTION
Mental health
promotion
• Mental health educational
programs.
Genetic counseling,
antenatal & natal care
• Ensure normal fetal
development.
Public health-related
factors
• Education, employment,
social well-being
• Availability of suitable
food & housing
103. PRIMARY PREVENTION
Raising public awareness
• Patients need ttt & kind care.
Awareness of psychological
development
• Development of human
being's cognitive, emotional,
intellectual & social
capabilities.
Life skills education &
training
• Interpersonal communication
skills
• Decision-making & critical
thinking skills
• Stress management.
104. • Screening: Early
detection.
• Early diagnosis.
Detection of mental
disorders/illness in PHC
• Complete psychiatric
assessment.
• Counseling,
psychotherapy &
medical ttt.
• Admission to
psychiatric
word/hospital.
Proper management and/or
referral to a psychiatrist
• Wars, disasters &
crisis.
• Social support
improves the course
of the disease & ↓ its
duration & intensity
& enhances rapid
recovery
Crisis intervention
Intervention undertaken to reduce complications & all specific ttt.
SECONDARY PREVENTION
105. Needy/disabled
group
• ↑ Self-esteem & confidence.
• ↑ Opportunities for physical & socio-economic integration.
Family &
Community
•↑ Society understanding of causes of disabilities & abilities “Public
information campaigns →↓Stigmatization”.
•Communicate to parents about disabilities of their disabled children.
•Providing facilities/ services-day care centers & counseling sites to families &
Improve physical accessibility to public places.
•Create incentives for employers to hire disabled people.
•Training HCWs about their needs & Improving approach toward them.
Interventions that ↓ disability & all forms of rehabilitation + prevention of relapses of illness.
The integration of needy groups in the society is needed.
TERTIARY PREVENTION
106. MENTAL HEALTH PROGRAM IN EGYPT:
In Egypt the national mental health program focuses on:
Decentralization of MH care
& community care in
different governorates.
Inclusion of mental health in
PHC.
Training of family doctors to
deal with main mental
disorders.
Awareness-raising among
public regarding recognition
of mental disorders &
methods of referral.
The new policy may ↓ no. of psychiatric inpatients.
After-care services are still limited because of the poor understanding of most
people
109. Substance abuse “drug abuse”
• Any use of non prescribed, non controlled substances or drugs without medical
reason.
Drug Dependence
• State of psychic or physical dependence (or both) on a drug occurring after periodic or
continuous administration of that drug.
Tolerance
• Need for increasing the dose of a drug to reach the original effect of it.
Psycho Active Drugs
• Exogenous substances that affect CNS for calming, energizing or pleasurable.
• Excessive use of these drugs leads to tolerance.
Addicted Person
• Person who is unable to free himself from a harmful habit or he is unable to stop that
habit.
110.
111. In Egypt, drug abuse is considered one of the most serious public health
problems, especially among the young people at working ages.
In Middle Eastern Arab countries, there is scarce information on mental
health issues, including drug dependence. This is related to the context of
the conservative nature of these societies that reject disclosing about drug
intake as well as to stigmatization.
Magnitude of the problem
112.
113. Narcotics
• Morphine, Heroin & Codeine
• Strong psychic dependence & early physical
dependence & tolerance.
• Euphoria, ↓pain perception, nausea, constipation,
RC depression & visual disturbance.
Depressant
• Alcohol & Barbiturates.
• Psychic dependence, sedation, hypnosis,
anesthesia, muscle relaxation & sleep
Stimulants
• Amphetamine & Cocaine.
• Excitatory for CNS, alertness, euphoria,
motor activity, depression of appetite & large
doses cause convulsions
Hallucinogens
• LSD & Mascaline
• Distort perception of time & distance, induce
delusions & hallucination.
• Alter mood & may cause psychotic episodes
Cannabis
• Hashish & Marijuana & Bango.
• Affect cognition, memory & mood
• Deterioration of self perception & sensation of
time
TYPES OF PSYCHO ACTIVE DRUGS
114.
115. Risk factors of drug addiction
Drug pharmacological
effects, “highly
addictive drug”.
Availability & easy
accessibility of drugs.
Gender.
Psychic & neurological
illness.
Family history of
addiction.
Lack of family
involvement.
Anxiety, depression and
loneliness.
Peer pressure.
116.
117. IMPACTS OF DRUG ABUSE
Health problems &
Communicable disease
“HIV, HBV”.
↑ Accidents.
Unconsciousness, coma &
sudden death.
↑ Crime & Violence &
Suicide.
Family problems.
↓School performance &
motivation.
↓ Work performance + ↑
Absenteeism
Financial problems
118. PATTERN OF SUBSTANCE ABUSE IN EGYPT
• Cannabis, Opium, Hypnoseditives, Heroin, and Cocaine.
1980s
• Cannabis, Alcoholic beverages, Synthetic psychoactive drug.
1990s
• Cannabis became prevalent in the form of Bango “leaves of Cannabis sativa”.
• This plant is increasingly widely cultivated in Egypt, especially in Sinai Peninsula.
2nd half of the 1990s
• Tramadol “Scheduled drug”, milder synthetic opioid painkiller similar to morphine.
• Easily accessible at cheap costs from the black market
• 30% of males “14-30 years” “Students, laborers & professionals” use it regularly “For
Premature ejaculation & for extended orgasm & increase sexual pleasure”
Since 2007
119. 70 % of admissions to the addiction wing of Cairo’s massive Qasr el-Aini hospital
were linked to tramadol in 2014 alone.
121. PRIMARY PREVENTION
Empower laws
& legislations.
Health
education.
Encourage
youth for
physical
exercise & safe
recreation
activities.
Suitable
management of
family & social
problems.
Parental
supervision &
control
influence of
peers.
122.
123. SECONDARY PREVENTION
Early diagnosis &
continuous
supervision.
Hospitalization of
severe cases.
Hot line service “rapid
management &
confidential service”.
Follow up of
recovered cases.
Although the precise cause of mental illness isn't known, certain factors may increase risk of developing mental health problems, including:
Although the precise cause of mental illness isn't known, certain factors may increase risk of developing mental health problems, including:
All efforts should be involved in the treatment and prevention of addiction. Support from all agencies, health and social, religion, educators and community leaders.