General Non Communicable Diseases PDF - Horus University in Egypt

General Non Communicable Diseases DefinitionofNCDs: Impairment in body function or structure that necessitates modification in person’s lifestyle or has persisted for a long length of time. Non-communicable diseases include: 1. Cardiovascular diseases(hypertension,coronarydisease,stroke)...

General Non Communicable Diseases DefinitionofNCDs: Impairment in body function or structure that necessitates modification in person’s lifestyle or has persisted for a long length of time. Non-communicable diseases include: 1. Cardiovascular diseases(hypertension,coronarydisease,stroke) 2. Cancer 3. Diabetes 4. Respiratory(asthma,emphysema,bronchitis) 5. Obesity 6. Renal(nephritis,nephritic syndrome) 7. Accidents 8. Nervous and mental (mania, depression) 9. Musculoskeletal(arthritis) 10. Degenerative disorders Magnitude of the problem of NCDs (Past,Present&future) Past :  Communicable diseases were main causes of death worldwide.  After the 2nd World War: Medical achievements: vaccination, antibiotics & improving life conditions. NCDs started to be major problems in developed countries especially:  By theendofthe20thcentury: NCDs were increasing in developing countries with double burden of infective & non-infective diseases in a poor environment & inadequate health systems. 1 Today:  Four diseases (CVDs,cancers,chronic respiratory diseases &DM)→36 million deaths each year.  Preventive measures can prevent : 1. %80 of Cardio vascular diseases (CVDs) & type 2 DM 2. %30 of cancers  The first cause of death globally is Cardio vascular diseases.  In developed countries, Cancer is the 2nd leading cause of death next to CVDs, compared to developing world, it is the 4th cause of death.  Estimated prevalence of hypertension in Egypt was26.3%.(Egyptian Health Issues Survey, 2020)  Estimated prevalence of DM in Egypt was16.6%(worldbankreport,2020) The future: - With increased life expectancy, the increasing prevalence of NCDs is a serious challenge. - Unless addressed, the mortality &disease burden from NCDs will continue to increase. Challenges for prevention of NCD: 1. The demographic transition: Decrease mortality result in increased life expectancy and proportion of the elderly. Non-communicable diseases are usually associated with aging. 2. The epidemiologic transition: There is shift from mortality from communicable diseases (due to the use immunizations and antibiotics etc.,) to non-communicable diseases which have specific genetic, environmental and behavioral risk factors. 3. NutritionTransition: Large shift in the pattern of nutrition to a diet high in total fat, sugar and other refined carbohydrates and low in polyunsaturated fatty acids and fibers, and often accompanied by increasing sedentary life. 2 Such pattern resulted in increasing the prevalence of obesity and contributing to degenerative non-communicable diseases. 4. The multi-factorial nature of the risk factors for NCDs. The multiplicity of the risk factors associated with specific disease limits the opportunities to have specific intervention for prevention and control. The types of the risk factors are difficult to be controlled by technology (in communicable diseases immunizations and antibiotics are of the technologies that are used to prevent the diseases). The risk factors are related to genetic, environment, culture and behavior which represent a challenging issue to public health programs. 5. Migration of population across different cultures 6. International communication: The individuals who migrate from low-risk culture (e.g. rural areas) to high-risk culture (e.g.urban areas)will follow the life-style of the new culture and demonstrate increased risk for the non-communicable diseases. Due to the progressive increase in urbanization, non-communicable diseases have shown increase in prevalence. RiskFactors :  Risk factors are defined as any attribute, characteristic or exposure of an individual, which increase the likelihood of developing a disease or injury. [I] Non-Modifiable risk factors: These factors can’t be changed.However,it is important to identify high risk groups. 1. Age: Atherosclerosis process progress with age. The risk increases among: - Males > 45 years & females 55 >years of age. Osteoporosis is common in older age > 65 years. 3  (Non communicable disorders increase in females after 55y ,after menopause) 2. Sex: Male sex is at a higher risk. Before menopause: - Women are at lower risk (male to female ratio 10:1). - This may be due to the protective effect of estrogen against atherosclerosis. After menopause: - ↑risk for females &by the age of 50 to55years,it equalizes that of males. - Atherosclerosis(MI):Male sex is at a higher risk than femalebefore menopause - Osteoporosis: 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 personality: Aggression, competition, impatience& time urgency. 4 [II] Modifiable Risk factors: A. Life style risk factors B. Diseases as risk factors: (1) Dietary factors: (1) Dyslipidemia: a) High proportions of dietary fat is 1. ↑ total Cholesterol. associated with atherosclerosis and coronary 2. ↑ LDL heart diseases , breast and colon cancer 3. ↑ Triglycerides. b) excess consumption of sugar : obesity 4. ↓ HDL. and dental diseases (2) Hypertension c) heavy salt consumption is associated - A major risk factor for some non with hypertension communicable diseases as CHD d) inadequate calcium intake is associated (3) Type 2 DM: with osteoporosis especially among - Diabetics have higher prevalence menopausal women of hypertension & obesity and (2) Physical inactivity & sedentary life: Coronary heart disease (CHD) (3) Mental stress: (4) Obesity: - Depression. – Anger. – Fear. central adiposity increase risk of: - Anxiety. - Lack of social support. - Type 2 DM. (4) Smoking: as in CHD and lung cancer - CHD (5) Alcohol consumption: ↑ risk of (5) Gout: hyperuricemia is a dyslipidemia, hypertension and some types risk for CHD of cancers Prevention: A-Primary prevention:(Prevention& management of risk factors) It is defined as interventions designed to modify adverse levels of risk factors once they are present(Prevention & management of risk factors Itincludes:  Life style modification  Prevention & control of any underlying medical condition (1)Life style modification It includes Comprehensive Prevention Programs(Population-based 5  interventions) :  Policies and strategies to prevent smoking(MPOWERpackage)  Policies and strategies to facilitate healthy eating  Policies and strategies to facilitate physical activity  Policies and strategies to address the harmful use of alcohol  Policies and strategies to prevent smoking (MPOWER package):. M.Monitor tobacco use and tobacco-prevention policies P.Protect people from tobacco smoke in public places and workplaces. O.Offer help to people who want to stop using tobacco W.Warn people about the dangers of tobacco E.Enforcebansontobaccoadvertising,promotionandsponsorship. R.Raise tobacco taxes and prices.  Dietetic recommendations to prevent cardiovascular diseases and facilitate healthy eating:  Reducing salt levels,  Eliminating industrially produced trans-fatty acids  Decreasingsaturatedfats  Limitingfreesugars,  Increasingintakeoffish,poultry,legumes,vegetables,fruitsandwhole grain  Policies and strategies to facilitate physical activity: It needs multisectoral approach i) Health sector:  Health professionals should encourage exercise habits to life time activity for all (30 min of moderate PE / day for at least 5 days per week.  Medical centres:staff and facilities for fitness and exercise prescription. ii) Education sector  School based programs; physical education and providing 6  greater opportunities for physical activities during school day iii) Urban design and transport  Design urban environment that encourage people to rely less on personal cars and prioritize walking and cycling;  Enforce security and road safety legislations  Designing natural recreational spaces iv) Workplaces:  Exercise breaks for sedentary workers  Fitness programs in the workplace Prevention& control of any underlying medical condition: ▶As HTN, DM,Obesity, Hypercholesterolemia B-Secondary Prevention: It includes:  Screening of high risk individuals.  Early and Proper treatment(DM, HTN)  Reassure the patient.  Follow up &assessment at periodic intervals. c-Tertiary prevention : - Prevention of long term complications. - Rehabilitation: of individuals with disability 7