NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

JENNIFER S. CRUEL,RN,MN

Integrated Community Based Noncommunicable Disease Prevention and Control Program 4 major non-communicable disease
Also known as chronic diseases or lifestyle related diseases 1. Cardiovascular Diseases 2. Cancer 3. Chronic Obstructive Pulmonary Diseases (COPD) 4. Diabetes Mellitus

Daly (Disability Adjusted Life Year)

most widely used summary measure of the burden of disease Combines the number of years of healthy life lost to premature death with time spent in less than full health One lost DALY can be thought of as one lost healthy year of life

The projected burden of disease of these diseases is approximately half or 48% of the global burden of disease
Based on current trends, by the year 2020 these diseases are expected to account to 73% of deaths and 60% of the disease burden

Risk Factors Associated With Chronic, NonCommunicable Diseases

a. b. c. d. e. f. Physical inactivity Smoking Hypertension Hypercholesterolemia Obesity Diabetes 60.5% 34.8% 22.5% 8.5% 4.9% 4.6%

Healthy Lifestyle Is operationally defined as a way of life that promotes and protects health and well-being Among these are: - healthy diet and nutrition - regular and adequate physical activity and leisure - avoidance of substances that can be abused such as:
Tobacco, alcohol and other addicting substances

- adequate stress management and relaxation - practices that offer protection from health risks such as safe sex and immunization Approaches that can be utilize in order to control NCD: 1. Comprehensive Approach Focused on Primary Prevention a. prevention of emergence of risk factors referred to as primordial prevention

b. specific protection from NCD by removal of the risk factors or reduction in their levels 2. Community-based Approach a. active community participation b. involvement of community leaders, community committees and other community groups c. strong support and guidance from local governments and technical experts d. multi-sectoral collaboration

3. Integrated Approach Key Intervention Strategies: 1) Establishing program direction and infrastructure 2) Changing environments 3) Changing lifestyle 4) Reorienting health services

The Role of the PHN in NCD Prevention and Control Health Advocate 1. Informing the people about the rightness of the cause 2. Thoroughly discussing with the people the nature of the alternatives, their content and consequences 3. Supporting peoples right to make a choice and to act on the choice 4. Influencing public opinion

Health Educator 1.Inform the people 2.Motivate the people 3.Guide people into action Health Care Provider Community Organizer 1.Raising the level of awareness of the community 2.Organizing and mobilizing the community 3.Influencing executive and legislative

bodies to create and enforce policies Health Trainer Researcher

Causes and Risk Factors of Major NCDs

A. Diseases of the Heart and Blood Vessels (Cardiovascular Diseases) 1. Hypertension
Defined as a sustained elevation in mean arterial pressure It is not a single disease state but a disorder with many causes, a variety of symptoms, and a range of responses to therapy

Etiology / Cause In terms of etiology, HPN is classified into primary and secondary hypertension

Primary Hypertension has no definite cause It is also called as Essential HPN or Idiopathic HPN
Secondary Hypertension is usually the result of some other primary dses. leading to HPN such as Renal Disease

Risk Factors: 1.Family history 2.Advancing age 3.Race 4.High salt intake Other Lifestyle Factors that interact with these risk factors are: 1.Obesity 2.Excess alcohol consumption 3.Intake of potassium, calcium and magnesium

4. Stress 5. Use of contraceptive drugs

Key Areas for Prevention of HPN Encourage proper nutrition Prevent becoming over weight or obese Smoking cessation Identify people with risk factors and encourage regular check-ups for possible HPN and modification of risk factors

2. Coronary Artery Disease (CAD)

Is a heart disease caused by impaired coronary blood flow It is also known as Ischemic Heart Diseases When the coronary arteries become narrow or clogged, supply of blood and oxygen to the heart muscle is affected When there is O2 supplied to9 the heart muscle, chest pain (called angina) occurs CAD can cause MI (heart attack), arrhythmias, heart failure and sudden death

Etiology / Causes: Atherosclerosis (most common cause)

Thickening of the inside walls of arteries due to deposition of a fat-like substance Usually occurs when a person has high levels of cholesterol in the blood

Risk Factors of CAD: A. Modifiable

1. Elevated blood lipids and cholesterol level (hyperlipidemia) 2. hypertension

3. Smoking 4. Diabetes Mellitus 5. Obesity 6. Physical inactivity/sedentary lifestyle 7. Stress

B. Non-modifiable
1. Heredity/family history 2. Male sex 3. Increasing age

Key Areas for Prevention of CAD: 1.Promote physical regular activity and exercise 2.Encourage proper nutrition 3.Maintain body weight and prevent obesity 4.Advise smoking cessation 5.Early diagnosis, prompt treatment and control of diabetes and hypertension

3. Cerebrovascular Disease or Stroke

The loss or alteration of bodily function that results from an insufficient supply of blood to some parts of the brain It is one of the leading cause of disability Can lead to weakness or paralysis usually of one side of the body Often the person has slurring of speech or inability to talk (aphasia) If severe can cause death

Etiology / Causes: 3 TYPES OF STROKE BASED ON CAUSE:

1) Thrombotic stroke 2) Embolic stroke 3) Hemorrhagic stroke

Almost all strokes are caused by occlusion or cerebral vessels by either thrombi or emboli

Thrombi usually occurs in atherosclerotic blood vessels - usually seen in older people and may occur in a person at rest

Embolic stroke is caused by a moving blood clot usually from a thrombus in the left heart that becomes lodged in a small artery through which it cannot pass - its onset is usually sudden Intracerebral Hemorrhage most fatal stoke, that is rupture of intracerebral blood vessels

Predisposing Factors:
Hypertension (most common)

Other causes of hemorrhage:

Aneurysms Trauma Erosion of vessel by tumors Arteriovenous malformations Blood disorders

Risk Factors of Stroke:

1. Increasing age (55 and ) 2. Sex (more women die of stroke) 3. Heredity (family history) and race (africanamerican have much higher risk) 4. Hypertension (m0ost important risk factor for stroke) 5. Cigarette smoking (nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system) 6. Diabetes mellitus (independent risk factor for stroke) 7. Heart disease

8. high red blood cell count (more red blood thicken the blood and make clots) 9. season and climate (extremely hot or cold temperatures) 10. socioeconomic factors (lower income and educational level) 11. excessive alcohol intake 12. certain kinds of drug abuse (cocaine)

Key Areas for Prevention of Stroke:

Treatment and control of hypertension Smoking cessation and promoting a smokefree environment Prevent thrombus formation in RHD and arrhythmias with appropriate medications Limit alcohol consumption Avoid IV drug abuse and cocaine Prevent all other risk factors of atherosclerosis

B. CANCER
Is not a single disease Develops when cells in a part of the body begin to grow out of control Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue (process called metastasis)

Causes of Cancer
1. Heredity/Family History (ex. Breast CA) 2. Carcinogens
Is an agent capable of causing cancer They may be a
chemical an environmental agent radiation Viruses

A. Chemicals and environmental agents

Polycyclic hydrocarbons are chemicals found in cigarette smoke, industrial agents or in food such as smoked foods

Aflatoxin is found in peanuts and peanut butter Benzopyrene produced when meat and fish are charcoal broiled or smoked (e.g.tinapa or smoked fish) - also produced when food is fried in fat that has been reused repeatedly. Avoid reusing cooking oil Nitrosamines powerful carcinogens used as preservatives in foods like tocino, longganisa, bacon and hotdog Radiation ultraviolet rays from sunlight, xrays,radioactive chemicals and other

Viruses a virus can enter a host cell and cause cancer Cervical cancer human papilloma virus Liver cancer hepatitis B virus Leukemias, Lymphoma & Nasopharyngeal cancer epstein-barr virus

Risk Factors of Cancer:

1. Age 2. Sex 3. Family medical history

CANCER LUNG CANCER

RISK FACTORS Tobacco use, including cigarettes, cigars, chewing tobacco and snuff Radiation exposure Second-hand smoke Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Excessive alcohol use Chronic irritation (e.g. ill-fitting dentures) Vitamin A deficiency Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Poor nutrition Alcohol Weakened immune system Occupational exposure to wood dust, paint fumes Gender: 4-5 times more common in men Age: more than 60 years

ORAL CANCER

LARYNGEAL CANCER

BLADDER CANCER

Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Occupational exposure: dyes, solvents Chronic bladder inflammation Tobacco use (cigarette, cigar, pipe, smokeless tobacco): increase risk by 40% Obesity Diet: well-cooked meat Occupational exposure: asbestos, organic solvents Age: 50 70 years old Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Human papillomavirus infection Chlamydia infection Diet: low in fruits and vegetables Family history of cervical cancer Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Gender: 3 X more common in men

RENAL CANCER

CERVICAL CANCER

ESOPHAGEAL CANCER

Alcohol Diet: low in fruits and vegetables BREAST CANCER Early menarche / late menopause Age changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause High fat diet Obesity Physical inactivity Some studies have also shown a connection between alcohol consumption and an increased risk of breast cancer Women with a mother or sister who have had breast cancer are more likely to develop the disease Advancing age, race and diet Race: more common among AfricanAmerican men than among white men High fat diet Men with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves

PROSTATE CANCER

LIVER CANCER

Certain types of viral hepatitis Cirrhosis of the liver Long term exposure to aflatoxin (carcinogenic substance produced by a fungus that often contaminates peanuts, wheat, soybeans, corn and rice) Unprotected exposure to strong sunlight Fair complexion Occupational exposure

SKIN CANCER

COLONIC CANCER

Personal/family history of polyps High fat diet and/or low fiber diet History of ulcerative colitis Age: >50 years
Estrogen replacement therapy Early menarche / late menopause

UTERINE/ENDOMETRIAL CANCER

Key areas for Primary Prevention of Cancers

Smoking cessation Encourage proper nutrition

increase intake of dietary fiber Limit consumption of smoked, charcoalbroiled, salt-cured and salt-pickled foods

Drink alcoholic beverages in moderation Avoid/control obesity through proper nutrition and exercise Early diagnosis and treatment

C. DIABETES MELLITUS (DM)

Is not a single disease It is genetically and clinically heterogenous group of metabolic disorders characterized by glucose intolerance, with hyperglycemia present at time of diagnosis Is one of the leading causes of disability in persons over 45 More than half of diabetic persons will die of coronary heart disease

ETIOLOGY / CAUSES
Specific cause depends in the type of diabetes, however it is easier to think of diabetes as an interaction between two factors:
1. Genetic predisposition (diabetogenic genes) 2. Environment/lifestyle (obesity, poor nutrition, lack of exercise)

TYPES OF DIABETES
1. Type I (IDDM) Insulin Dependent Diabetes Mellitus
Characterized by absolute lack of insulin due to damaged pancreas, prone to develop ketosis, and dependent on insulin injections Genetic, environment, or may be acquired due to viruses (e.g. mumps, congenital rubella and chemical toxins (e.g. nitrosamines)

2. Type II (NIDDM) Noninsulin Dependent Diabetes Mellitus

More common, occurring in about 90-95% of all persons with diabetes More preventable because it is associated with obesity and diet Characterized by fasting hyperglycemia despite availability of insulin Possible causes include impaired insulin secretion, peripheral insulin resistance and increase hepatic glucose production Usually occurs in older and overweight persons (about 80%)

Gestational Diabetes diabetes that develops during pregnancy - it may develop into full blown diabetes

Risk Factors of Type II DM

Family history of diabetes (parents or siblings with diabetes) Overweight (BMI 23 kg/m) and obesity (BMI > 30 kg/m) Sedentary lifestyle Hypertension HDL cholesterol < 35 mg/dl (0.90 mmol/L) and/or triglyceride level > 250 mg/dl (2.82 mmol/L) History of GDM or delivery of a baby weighing 9 lbs. (4.0 kgs)

Previously identified to have Impaired Glucose Tolerance (IGT) Complications:

Acute complications:
Diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic nonketotic coma (HHNK) Hypoglycemia especially in Type I diabetics

Chronic complications:
Chronic renal disease (nephropathy) Bllindness (retinopathy) CAD Stroke Neuropathies Foot ulcers

Key Areas for Prevention and Control of Diabetes

Maintain body weight and prevent obesity Encourage proper nutrition Promote regular physical activity and exercise Advise smoking cessation

D. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Is major cause of chronic morbidity and mortality throughout the world 4th leading cause of death in the world Is a disease state characterized by airflow limitation that is not fully reversible The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles of gases

The lungs undergo permanent structural change, which leads to varying degrees of hypoxemia and hypercapnea
Causes & Risk factors:
Is usually due to chronic bronchitis and emphysema, both of which are due to cigarette smoking Cigarette smoking is the primary cause of COPD

Diagnosis:
Should be considered in any patient who has symptoms of:
1) 2) 3) 4) Cough Sputum production Dyspnea History of exposure to risk factors for the disease

Diagnosis is confirmed by spirometry

Complications:
1. Respiratory Failure (in advance COPD)
Peripheral airways obstruction Parenchymal destruction Pulmonary vascular abnormalities (reduce the lungs capacity for gas exchange) Producing hypoxemia (later) hypercapnea

2. Cardiovascular Disease
Pumonary hypertension (severe COPD) - is the major cardiovascular complication of COPD

E. BRONCHIAL ASTHMA
Asthma is a chronic disease It is an inflammatory disorder of the airways in which many cells and cellular elements play a role Chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or early in the morning

Causes and Risk Factors:

a. Host Factors predispose individuals to or protect them from developing asthma
Genetic predisposition Atopy or allergy Airway hyperresponsiveness Gender Race/ethnicity

b. Environmental Factors:
Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air pollution Respiratory infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity

Asthma Triggers Triggers are risk factors for asthma exacerbations (allergens and occupational agents) Other forms of triggers:
Irritant gases and smoke House dustmite found in pillows Mattresses Carpets Respiratory infection Inhaled allergens Weather changes

Cold air Exercise Certain foods Additives Drugs Key Areas for Primary Prevention and Exacerbation of Asthma Recognize triggers that exacerbate asthma Avoid these triggers if possible (smoking) Promote exclusive breastfeeding as long as possible

Common Risk Factors of Leading Noncommunicable Diseases

Condition Risk Factorsssss Cardiovascular Dses. + Diabetes Cancer Respiratory Conditions ++

Smoking
Nutrition/Diet Physical Inactivity

Obesity
Alcohol Raised blood pressure Blood glucose

Blood lipids

RISK ASSESSMENT & SCREENING PROCEDURES

Risk Factor Assessment: A. Cigarette Smoking
Assess by asking individuals whether they smoke or not Smoking status should be recorded and updated at regular intervals

B. Nutrition / Diet
Diet is a combination of related behaviors, which are often culture-specific Comprehensive nutritional assessment involves detailed recall methods (24 hr food diary)

Guidelines for adequate vegetable and fruit intake Eat 2-3 servings of vegetables each day, one serving of which is green or yellow leafy vegetables One serving means: raw vegetables 1 cup cooked veg. cup Eat at least 2 servings of fruit per day. 1 serving is a vitamin C rich fruit

C. Overweight / Obesity Body Mass Index (BMI) use in assessing body fat - correlates closely with total body fat in relation to height and weight Weight the use of wt-for-age or wt-for-ht tables will help determine the desirable wt either acdng. to age (children) or height (adults)

BMI is calculated using the ff. formula: BMI = weight in kgs / height in meters
Guideline Based on Asia-Pacific Obesity Guidelines:
BMI < 18.5 18.6 22.9 > 23.0 INTERPRETATION Underweight Healthy weight Overweight

23.0 24.9
25.0 29.9 >30.0

At risk
Obese I Obese II

Waist Circumference (WC) Is an accurate measure of the amount of visceral fat

Measuring waist circumference:

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