Non-Communicable Diseases Lecture Notes PDF

GENERAL NON COMMUNICABLE DISEASES DEFINITION  Impairment in body function or structure that necessitates modification in person’s lifestyle or has persisted for a long length of time. ❶ Cardiovascular diseases (Hypertension – Coronary disease –...

GENERAL NON COMMUNICABLE DISEASES DEFINITION  Impairment in body function or structure that necessitates modification in person’s lifestyle or has persisted for a long length of time. ❶ Cardiovascular diseases (Hypertension – Coronary disease – Stroke). ❷ Cancer. ❸ Diabetes. ❹ Respiratory (Asthma - Emphysema - Bronchitis). ❺ Obesity. ❻ Dyslipidemia ❼ Renal (Nephritis - Nephrotic syndrome). ❽ Accidents. ❾ Nervous and mental (Mania – Depression – Cognitive impairment). ❿ Musculoskeletal (Arthritis – Osteopenia/Osteoporosis). ⓫ Degenerative disorders. ⓬ Sarcopenia & Frailty Dr. Strange Page 1  Community - Horus Semester 6 – Lecture 2 (Past - Present - Future)  Communicable diseases were main causes of death worldwide.  After the 2nd World War… ◈ Medical achievements: Vaccination - Antibiotics - Improving life conditions. Past ◈ NCDs started to be major problems in developed countries especially…  By the end of the 20th century… ◈ NCDs were in developing countries with double burden of infective & non-infective diseases in a poor environment & inadequate health systems. 4 disease (CVDs - Cancers - Chronic respiratory diseases – DM) → 36 million deaths each year.  These diseases are preventable: ▪ 80% of CVDs & Type 2 DM. ▪ 30% of cancers.  Causes of death: Today CVDs ▪ 1st cause of death globally ▪ 2nd cause of death in developed countries Cancer ▪ 4th cause of death in developing countries  Estimated prevalence in Egypt of: ▪ Hypertension → 26.3% “Egyptian Health Issues Survey, 2020” ▪ DM → 16.6% “Egyptian Health Issues Survey, 2020”  with ⮅ life expectancy, the increasing prevalence of NCDs is a serious challenge. Future  Unless addressed, the mortality & disease burden from NCDs will continue to ⮅. Dr. Strange Page 2  Community - Horus Semester 6 – Lecture 2  DEMOGRAPHIC TRANSITION ◈ ⮇ Mortality ⇢ ⮅ life expectancy & proportion of the elderly. ◈ NCDs are usually associated with aging.  EPIDEMIOLOGICAL TRANSITION ◈ Shift in mortality from communicable diseases to non-communicable diseases.  Due to use of immunizations & antibiotics. NB: NCDs have specific genetic, environmental & behavioral risk factors.  NUTRITIONAL TRANSITION ◈ Large shift in pattern of nutrition to a diet… ▪ High in Total fat - Sugar - Other refined carbohydrates ▪ Low in Polyunsaturated fatty acids - Fibers ◈ Accompanied by ⮅ sedentary life. ◈ Such pattern resulted in ⮅ prevalence of obesity & contributing to degenerative NCDs.  MULTI-FACTORIAL NATURE OF RISK FACTORS FOR NCDS ◈ Multiplicity of risk factors associated with specific disease EFFECT ▪ Limits opportunities to have specific intervention for prevention & control ▪ Types of the risk factors are difficult to be controlled by technology. NB: in communicable diseases immunizations & antibiotics are of the technologies that are used to prevent the diseases. CONTROL ▪ Risk factors: - are related to → Genetic – Environment – Culture – Behavior. - which represent a challenging issue to public health programs. INTERNATIONAL COMMUNICATIONS  & MIGRATION OF POPULATION ACROSS DIFFERENT CULTURES ◈ The individuals who migrate from low-risk culture (e.g., rural areas) to high-risk culture (e.g., urban areas) will follow life-style of new culture & demonstrate ⮅ risk for NCDs. Progressive in ⮅ urbanization ⇢ ⮅ prevalence of NCDs Dr. Strange Page 3  Community - Horus Semester 6 – Lecture 2  Any attribute, characteristic or exposure of an individual, which ⮅ the likelihood of developing a disease or injury.  NON-MODIFIABLE RISK FACTORS  These factors can’t be changed.  However, it is important to identify high risk groups. ⮅ Risk of… Atherosclerosis > 45 years > 55 years 1) AGE (progress with age) Osteoporosis > 65 years > 55 years NCDs (After menopause) Generally, Male sex is at a higher risk. ① Atherosclerosis (MI) At higher risk At lower risk BEFORE MENOPAUSE 2) SEX 10 :1 --- ⮅ risk for females AFTER MENOPAUSE By the age of 50-55 years, it equalizes that of males May be due to protective effect of estrogen against atherosclerosis.. ② Osteoporosis is more in Female sex. 3) FAMILY HISTORY ◈ Higher risk in individuals with a history of CHD and DM. 4) GENETIC FACTORS ◈ Play a role in dyslipidemia. 5) TYPE A ◈ Aggression - Competition - Impatience - Time urgency. PERSONALITY Dr. Strange Page 4  Community - Horus Semester 6 – Lecture 2  MODIFIABLE RISK FACTORS  Lifestyle risk factors Associated diseases ▪ Atherosclerosis ⎚ High proportions of dietary fat ▪ Coronary heart diseases ▪ Breast and colon cancer ▪ Obesity 1) DIET ⎚ Excess consumption of sugar ▪ Dental diseases ⎚ Heavy salt consumption ▪ Associated with hypertension ▪ Osteoporosis “especially among ⎚ Inadequate calcium intake menopausal women” 2) PHYSICAL ◈ Sedentary life. INACTIVITY 3) MENTAL STRESS ◈ Depression - Anger - Fear - Anxiety - Lack of social support. 4) SMOKING ◈ As in CHD and lung cancer 5) ALCOHOL ◈ ⮅ risk of Dyslipidemia - Hypertension and some types of cancers Dr. Strange Page 5  Community - Horus Semester 6 – Lecture 2 ❷ Diseases (as risk factors) ◈ ⮅ Total Cholesterol ◈ ⮅ LDL-C (low density lipoprotein cholesterol) 1) Dyslipidemia ◈ ⮅ Triglycerides ◈ ⮇ HDL-C (high density lipoprotein cholesterol) 2) Hypertension ◈ A major risk factor for some non-communicable diseases as CHD. ◈ Diabetics have higher prevalence of ▪ Hypertension 3) Type 2 DM ▪ Obesity ▪ Coronary heart disease (CHD) ◈ Central adiposity ⮅ risk of: 4) Obesity ▪ Type 2 DM ▪ CHD ◈ Hyperuricemia is a risk for 5) Gout ▪ CHD  PRIMARY PREVENTION (Prevention & management of risk factors)  It is defined as interventions designed to modify adverse levels of risk factors once they are present.  Lifestyle modification Comprehensive prevention programs (Population-based interventions) ① Policies and strategies to prevent smoking (MPOWER package) ② Dietetic recommendations to prevent cardiovascular diseases and facilitate healthy eating ③ Policies and strategies to facilitate physical activity ④ Policies and strategies to address harmful use of alcohol Dr. Strange Page 6  Community - Horus Semester 6 – Lecture 2 ① Policies and strategies to prevent smoking (MPOWER package): 1) Monitor tobacco use & tobacco-prevention policies. 2) Protect people from tobacco smoke in public places and workplaces. 3) Offer help to people who want to stop using tobacco. 4) Warn people about the dangers of tobacco. 5) Enforce bans on tobacco advertising, promotion, & sponsorship. 6) Raise tobacco taxes and prices. ② Dietetic recommendations to prevent cardiovascular diseases and facilitate healthy eating:  Fish  Vegetables ⮅  Poultry  Fruits  Legumes  Whole grain  Salt levels  Saturated fats ⮇  Industrially produced trans-fatty acids  Free sugars ③ Policies and strategies to facilitate physical activity → It needs multisectoral approach. ◈ Health professionals should encourage exercise habits lifetime activity 1) Health FOR WHOM ▪ For all sector DURATION ▪ 30 min of moderate PE/day for at least 5 days/ week ◈ Medical centers: staff & facilities for fitness and exercise prescription ◈ School based programs 2) Education ▪ Physical education. sector ▪ Providing greater opportunities for physical activities during school day. ◈ Design urban environment: That encourages people to rely less on 3) Urban design personal cars and prioritize walking and cycling & transport ◈ Enforce security & road safety legislations. ◈ Designing natural recreational spaces ◈ Exercise breaks for sedentary workers. 4) Workplaces ◈ Fitness programs in workplace. Dr. Strange Page 7  Community - Horus Semester 6 – Lecture 2 ❷ Prevention & control of any underlying medical condition  As HTN - DM - Obesity - Hypercholesterolemia  SECONDARY PREVENTION ❶ Screening of high-risk individuals ❷ Early and Proper treatment (DM - HTN). ❸ Reassure the patient. ❹ Follow up & assessment at periodic intervals.  TERTIARY PREVENTION ❶ Prevention of long term complications. ❷ Rehabilitation: of individuals with disability. Dr. Strange Page 8