Non communicable diseases 1

Introduction

• Non-communicable diseases are the leading killer today and are on the increase.

• Nearly 80% of these deaths occurred in low- and middle-income countries.

• More than nine million of all deaths attributed to noncommunicable diseases (NCDs) occur before the age of 60.

• Around the world, NCDs affect women and men almost equally.

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Introduction

• The leading causes of NCD deaths were: 1. Cardiovascular diseases (17 million deaths, or 48% of NCD

deaths); 2. Cancers (7.6 million, or 21% of NCD deaths); and 3. Respiratory diseases, including asthma and chronic obstructive

pulmonary disease (COPD), (4.2 million). 4. Diabetes caused an additional 1.3 million deaths.

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Cardiovascular diseases

• Cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure.

• Although heart attacks and strokes are major killers in all parts of the world, 80% of premature heart disease and stroke is preventable

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Cardiovascular diseases:Contributing factors

A person’s genetic make-up The foundations of adult health are laid in early lifeSocioeconomic groupMental healthDietOverweight and obesityInactivityTobaccoAlcoholDiabetesGlobalization and urbanization

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Cancer

• Cancer is the uncontrolled growth and spread of cells that arises from a change in one single cell.

• The change may be started by external agents and inherited genetic factors and can affect almost any part of the body.

• The transformation from a normal cell into a tumour cell is a multistage process where growths often invade surrounding tissue and can metastasize to distant sites.

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Common cancers in Malaysia

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Cancer: Interaction between a person’s genetic factors and any of three categories of external agents

• Physical carcinogens; such as ultraviolet and ionizing radiation or asbestos;

• Chemical carcinogens; components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking-water contaminant);

• Biological carcinogens; such as infections from certain viruses, bacteria or parasites.

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Cancer: risk factors for cancer

• tobacco use• unhealthy diet• insufficient physical activity• the harmful use of alcohol• Infections (hepatitis B, hepatitis C (liver cancer), human

papillomavirus (HPV; cervical cancer), Helicobacter pylori (stomach cancer) • Radiation• variety of environmental and occupational exposures of

varying importance

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Lung cancer

• The uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages.

• The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors.

• As tumors become larger and more numerous, they undermine the lung’s ability to provide the bloodstream with oxygen.

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Risk factors of lung cancers

• Carcinogen - Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes

• Genes

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Symptoms of lung cancer

• Persistent or intense coughing

• Pain in the chest shoulder, or back from coughing

• Changes in color of the mucus that is coughed up from the lower airways (sputum)

• Difficulty breathing and swallowing

• Hoarseness of the voice

• Harsh sounds while breathing (stridor)

• Chronic bronchitis or pneumonia

• Coughing up blood, or blood in the sputum

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Colorectal cancer

• Also known as bowel cancer, colon cancer or rectal cancer,

• Any cancer (a growth, lump, tumor) of the colon and the rectum.

• The second most common cancer worldwide, after lung cancer.

• The colon and rectum belong to our body's digestive system - together they are also known as the large bowel.

• The colon reabsorbs large quantities of water and nutrients from undigested food products as they pass along it.

• The rectum is at the end of the colon and stores feces (stools, waste material) before being expelled from the body.

Symptoms of Colorectal cancer

• Going to the toilet more often.

• Diarrhea.

• Constipation.

• A feeling that the bowel does not empty properly after a bowel movement.

• Blood in feces (stools).

• Pains in the abdomen.

• Bloating in the abdomen.

• A feeling of fullness in the abdomen (maybe even after not eating for a while).

• Vomiting.

• Fatigue (tiredness).

• Inexplicable weight loss.

• A lump in the tummy or a lump in the back passage felt by your doctor.

• Unexplained iron deficiency in men, or in women after the menopause.

Risk factors of colon cancer

• Being elderly - the older you are the higher the risk is.

• A diet that is very high in animal protein.

• A diet that is very high in saturated fats.

• A diet that is very low in dietary fiber.

• A diet that is very high in calories.• A diet that is very high in alcohol

consumption.• Women who have had breast,

ovary and uterus cancers.

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• A family history of colorectal cancer.

• Patients with ulcerative colitis.

• Being overweight/obese.

• Smoking. This study found that smoking is significantly associated with an increased risk for colorectal cancer and death.

• Being physically inactive.

• Presence of polyps in the colon/rectum. Untreated polyps may eventually become cancerous.

• Having Crohn's disease or Irritable Bowel Disease have a higher risk of developing colorectal cancer.

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Breast cancer

• Breast cancer is a kind of cancer that develops from breast cells.

• Usually starts off in the inner lining of milk ducts or the lobules that supply them with milk.

• 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.

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Symptoms of breast cancer

• A lump in a breast

• A pain in the armpits or breast that does not seem to be related to the woman's menstrual period

• Pitting or redness of the skin of the breast; like the skin of an orange

• A rash around (or on) one of the nipples

• A swelling (lump) in one of the armpits

• An area of thickened tissue in a breast

• One of the nipples has a discharge; sometimes it may contain blood

• The nipple changes in appearance; it may become sunken or inverted

• The size or the shape of the breast changes

• The nipple-skin or breast-skin may have started to peel, scale or flake.

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Risk factors for breast cancers

• Getting older

• Genetics

• A history of breast cancer

• Having had certain types of breast lumps

• Dense breast tissue

• Estrogen exposure - women who started having periods earlier or entered menopause later

• Obesity

• Radiation exposure

• HRT (hormone replacement therapy)

• Certain jobs

• Cosmetic implants may undermine breast cancer survival

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Chronic respiratory diseases (CRDs)

• Diseases of the airways and other structures of the lung.

• 235 million people have asthma, 64 million people have chronic obstructive pulmonary disease (COPD) while millions have allergic rhinitis and other often-underdiagnosed chronic respiratory diseases.

• Some of the most common are • chronic obstructive pulmonary disease (COPD), • asthma, • occupational lung diseases and • pulmonary hypertension.

• In addition to tobacco smoke, other risk factors include • air pollution, • allergen• occupational chemicals and dusts, and • frequent lower respiratory infections during childhood

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Chronic respiratory diseases

• According to the WHO Global Status Report on NCDs 2010, smoking is estimated to cause about 71% of all lung cancer deaths and 42% of chronic respiratory disease worldwide.

• Second-hand smoke causes severe respiratory health problems in children, such as asthma and reduced lung function

• CRDs are not curable

• Treatment helps dilate major air passages and improve shortness of breath can help control symptoms and increase the quality of life for people with the disease.

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Diabetes

• Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (a hormone that regulates blood sugar) or alternatively, when the body cannot effectively use the insulin it produces.

• The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

• About 347 million people worldwide have diabetes.

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Diabetes

• Total deaths from diabetes are projected to rise by more than 50% in the next 10 years.

• In developed countries most people with diabetes are above the age of retirement,

• whereas in developing countries those most frequently affected are aged between 35 and 64.

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Health Care System in Malaysia

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Malaysia Health Care System

• The Ministry of Health is the main government agency to provide health care services

• Other Ministries;• Ministry of Education• Ministry of Defense• Ministry of Internal Affairs• Ministry of Women, family and Community Development

• The health services is highly centralized

• Most planning and organization of health services being carried out centrally

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Health care services

• Four types of hospitals• District hospitals• State General Hospitals• National Referral Centre and Special Insitution• Non-MOH Hospitals

• The District Hospital have 100-200 beds run by 6-10 medical officers

• State General Hospitals have 500-1500 beds

• Each State has one General Hospitals but Sabah has two.

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Health Care Services

• The National Referral Centre is the highest level of hospital in the hierarchy

• This hospital has 2800 beds and is located in Kuala Lumpur

• IJN – National Referral Centre for cardiovascular diseases

• Selayang Hospital – National Referral Centre for Liver diseases

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Health Care Services

• The Special Medical Institutions (9)• One Rehabilitation Hospital, • One Women & Children Hospital, • One Leprosy Hospital, • One Respiratory/Tuberculosis Hospital, • One Cancer Hospital • Four Psychiatrics Institutions

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Health care system in Malaysia 30

Health care facilities31

Health care facilities32

Health care facilities

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Population measures

• Prevalence• Point prevalence• Period prevalence

• Incidence

• Attack rate

• Mortality• Crude death rate• Specific rate

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Prevalence

• Total number of cases of disease existing in a population

• Point prevalence

No. of person ill at a time point x 100

Total no. in the group at a time point

• Period prevalence

No. of person ill during a time period x 100

Average population during a time period

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Incidence

• A number of new cases in a defined population during a specified period of time

Num. of newly disease indv. for a specific time period

Total number of population-at-risk for same time period

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Attack rate

• Incidence rate observed for a short period such as epidemics or outbreak

No. of cases during the epidemic x 100

Total no. of exposed or at risk during the same period

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Crude Death Rate (CDR)

Total deaths per year X 1000

Average total population of that year

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Cause specific mortality rate (CSMR)

No. of death by certain disease/group/year X 100 000

Total mortality cause population in the same period

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Mental Health 40

Definition of Stress

• The Emotional state which results from discrepancy between the level of demand and the person’s ability to cope.

• Job Demands• Time Pressure• Deadline stress• Excessive workload• Conflicting demands

Lazarus and Folkman 1980

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Mental Illnesses

• Depression• a mood disorder that causes a persistent feeling of sadness and

loss of interest.

• Anxiety• unpleasant state of inner turmoil, often accompanied by nervous

behavior, such as pacing back and forth, somatic complaints and rumination

• Schizophrenia• A brain disorder in which people interpret reality abnormally

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Thank you 43