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Non communicable diseases part 1

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part 1 NCDS

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Non communicable diseases part 1

  1. 1. EPIDEMIOLOGY OF NON COMMUNICABLE DISEASES (NCDS) PART 1 Zagazig university By Alaa Nouh Under supervision Of Prof Dr. Mona Aboserea
  2. 2. LEARNING OBJECTIVES: 1. To understand the definition, risk factors & prevention of the NCDs & to recognize the epidemiology of some common NCDs. 2. To understand the types, risk factors & prevention of accidents. 3. To Recognize the definition of mental health &mental illness, to describe the risk factors affecting mental health, to identify the interaction between physical and mental illness, & to understand different levels of prevention in mental health. 4. To understand the magnitude, new trends in Egypt, risk factors, consequences, and prevention of substance abuse.
  3. 3. DEFINITION OF NCD Non-infectious & Non- transmissible between persons. Mostly chronic diseases of long duration & slow progression which require chronic care management.
  4. 4. CVDs 56%Cancer 25% Resp.dis. 14% DM 5% The leading causes of NCD deaths in 2008
  5. 5. 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
  6. 6. 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.
  7. 7. 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
  8. 8. 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”
  9. 9. • 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
  10. 10. 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
  11. 11. 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
  12. 12. Environmental changes
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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).
  17. 17. HPN DM CVDs Cancer cervix Cancer breast Cancer liver Screening tests
  18. 18. EGYPT NATIONAL MULTISECTORAL ACTION PLAN FOR PREVENTION & CONTROL OF NCD 2018-2022 (EGYPT MAP-NCD) Framework Element Baseline Target 2021 Target 2025 Premature mortality from NCD 25% 15% relative reduction 20% relative reduction Physical inactivity 32.1% 5% relative reduction 10% relative reduction Salt/sodium intake 12.8 g/day 20% relative reduction (10.0 g/ day) 10% relative reduction (9.0 g/ day) Tobacco use 24.4% 10% relative reduction (22.0 %) 20% relative reduction (20 %) Raised blood Pressure 39% 15%relative reduction (33%) 10 %relative reduction (30%) Diabetes & obesity 17.2% DM 31.3% Obesity Halt the rise in DM & obesity Drug therapy to prevent CVD *N/A % 10 % coverage 15% coverage Essential NCDs medicines & basic technologies to treat major NCDs 60% 70% availability 80 % availability *As there is currently no available baseline data, the approach will be piloted in selected PHC settings.
  19. 19. HYPERTENSION
  20. 20. Hypertension “HPN” is one of the major risk factors for CVDs.
  21. 21. 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.
  22. 22. 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.
  23. 23. COMPLICATIONS
  24. 24. 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
  25. 25. DIABETES MELLITUS
  26. 26. 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)
  27. 27. 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
  28. 28. Non-modifiable RF for T2DM Modifiable RF for T2DM
  29. 29. LABORATORY DIAGNOSIS OF DM
  30. 30. 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.
  31. 31. HEALTH TECHNOLOGY & DIABETES MANAGEMENT Continuous glucose monitoring (CGM) technology: helps improve glycemic control for adults with T1DM starting at age 18.
  32. 32. 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.
  33. 33. 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.
  34. 34. 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.
  35. 35. RISK FACTORS • Age: >40 years. • Sex: males. • Residence: urban. • Genetic & familial susceptibility. Demographic or personal factors • Food. • Smoking “30%”. • Obesity. • Alcohol. Life style • Human papilloma virus. • HCV, HBV & bilharziasis. • Helicobacter pylori. Infectious agents • Drugs (OCPs) & hormones (estrogen replacement therapy). Drugs & hormones • Asbestos & Pesticides • Radiation • Pollution • Fungi (Aflatoxin in grains & peanuts). Environmental & Occupational risks
  36. 36. 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.
  37. 37. BRONCHIAL ASTHMA
  38. 38. 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
  39. 39. SECONDRY PREVENTION
  40. 40. TERTIARY PREVENTION Breathing exercises Psychological support Rehabilitation
  • drazeem1

    Jun. 12, 2021

part 1 NCDS

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