non communicable diseases - dr. anindya
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Dr. Anindya Debnath
Medical Officer
India
NON-COMMUNICABLE DISEASES
April 10, 2023NCDS- DR. ANINDYA 2
1. Objectives
2. Introduction
3. Magnitude Of The Problem
4. Age Distribution of NCDs
5. Common Risk Factors
6. Coronary Heart Disease
7. Hypertension
8. Stroke
9. Obesity
10. Diabetes
11. Accidents and Injuries
12. Malignancies
13. Blindness
14. Psychiatric disorders
15. Other NCDs Among Elderly
16. Prevention of NCDs
INDEX
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OBJECTIVES
• To get an idea about the magnitude of the problem
• To know the risk factors responsible
• Methods of prevention of NCDs
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INTRODUCTIONSynonyms: “Chronic” diseases”,
“Lifestyle Diseases”
With rapid urbanization, industrialization and increasing level
of affluence (the so called “modernization”), the price that the
society is paying is a tremendous load of “Non - Communicable”
diseases.
Global phenomena -not simply restricted to the developed, rich countries.
In the context of our country, too, the problem of lifestyle and its
consequent diseases is assuming the position of a new “EPIDEMIC”.
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MAGNITUDE OF THE PROBLEM
• Prevalence is INCREASING in most of the Developed as well as Developing Countries. A New “Epidemic” REASON?
• Cardiovascular Diseases and Cancer - Leading causes of death in most of the developed countries (70 to 75% of total Deaths).
• Developing Countries- Following the same steps to the trap(!!) in a far more pitiable fashion. HOW?-Cause, we have CDs, NCDs and Poverty- all 3 burdens to be taken SIMULTANEOUSLY.
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Younger Age-group• Accidents and Injuries
• Rheumatic Heart Disease
• Diabetes
• Blindness
• Psychiatric disorders
Elderly• Hypertension
• Coronary Heart Disease
• Diabetes
• Stroke
• Malignancies
• Obesity
• Blindness
• Psychiatric disorders
• Others
AGE DISTRIBUTION OF NCDS
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NON-MODIFIABLE• Age
• Sex
• Family History
• Genetic Factors
• Personality
MODIFIABLE• Cigarette Smoking
• Alcohol Abuse
• Dyslipidemia
• Sedentary Life Style
• Stress
• Environmental Risk Factors
• Inability to avail preventive health care services
COMMON RISK FACTORS
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CORONARY HEART DISEASE
• Problem Statement: 30% of deaths in men; 25% of death in female in Western Countries.
• INDIAN SCENARIO: Leading cause of death and disability in our country, by the year 2025.
• Presentations:
Angina Pectoris
Myocardial Infarction
Arrhythmia
Cardiac Failure
Sudden Death
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HYPERTENSION
• Classification:Category Systolic BP Diastolic BP
(mm Hg) (mm Hg)
Normal <130 <85
High Normal 130-139 85-90
Hypertension
Stage 1(Mild) 140-159 90-99
Stage 2(Moderate) 160-179 100-109
Stage 3(Severe) >180 >110
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HYPERTENSION (CONTD..)
• GLOBAL BURDEN: About 10% to 20% population.
• INDIAN SCENARIO:
Male Female
Urban 6% 7%
Rural 3.5% 3.6%
Urban Rural01234567
MaleFemale
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HYPERTENSION (CONTD..)
Rule of Halves.
Non hypertensive
Hypertensive (Not diagnosed)
Diagnosed but Untreated HypertensiveInadequately Treated Hypertensive
Adequately Treated Hypertensive
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HYPERTENSION (CONTD..)
• “Tracking” of Blood Pressure.
Bloo
d Pr
essu
re
Time
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STROKE
• Problem Statement: 10% to 12% of all deaths in Developed Countries.
• In India: Over all prevalence of stroke appears to be comparatively less (1.54/1000 against 0.2-2.5/1000 world-wide)
BUT
The proportion of stroke among young age-group is significantly more.
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STROKE (CONTD..)• Etiopathological types:
Hemorrhagic
Thrombotic
Embolic
• TRANSIENT ISCHEMIC ATTACKS (TIA)
Sudden onset
Focal
Reversible neurological deficit
Duration<24 hours
Cause: Micro-emboli
Significance: WARNING SIGN OF STROKE!!!
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OBESITY
• Abnormal growth of adipose tissue.
OBESITY
Hypertrophic Hyperplastic
OBESITY
Android Gynoid
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OBESITY (CONTD..)• Magnitude: (Developed Countries)
Adults 20% to 40%
Children 10% to 20%
• Assessment of Obesity:
BMI
Skinfold Thickness
Waist Circumference & WHR
Others (Total body Water
Total body Potassium
Body density
Measuring fat cells)
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OBESITY (CONTD..)
• Complications of Being an Obese:
• Hypertension
• Dyslipidemia
• Glucose intolerance
• Coronary heart disease
• Arthritis
• Breast, colon carcinoma
• Gall stone diseases
• Depression and Withdrawal into self
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DIABETES
• Around 150 million Diabetic World-wide. Predicted to DOUBLE by 2025.
• 20% of them in SEAR.
• Screening Methods:
Venous Blood Sugar testing
Random
Fasting
Post-prandial Urine Glucose Examination
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ACCIDENTS AND INJURIES
• What is Accident?
-Unpremeditated event resulting in recognizable damage.
• A significant cause of morbidity, mortality, disability among the productive age group population of a country.
• Etiological factors:
Irresponsible usage of machines
Risk-taking behavior
Weak legislation
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ACCIDENTS AND INJURIES (CONTD..) Driving vehicles under influence of alcohol
Poor maintenance of machines/vehicles
Over-crowding, poor illumination, inadequate layout in the road
Low driving standards
Not using protective measures
Lack of concentration while operating machines/vehicles.
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MALIGNANCIES• An important cause of mortality, disability world-wide.
(10 million mew cases diagnosed/year, 6 million die of cancers/annum)
• 3 most common malignancies worldwide:
1. Lung cancer (12.3% of all cancers)
2. Breast cancer (10.4%)
3. Colorectal cancer (9.4%)
• Top 3 “killers” among the malignancies:
1. Ca Lung
2. Ca Stomach
3. Ca Liver
• Ca cervix most common cancer among the Indian woman
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BLINDNESS
• WHO defines Blindness as:
“Visual Acuity of less than 3/60 (Snellen) or its equivalent in the better eye”.
• Low Vision:
Visual acuity poorer than 6/18 but better than 3/60.
• In India 0.7% people are blind. Among them, 62.6% are due to Cataract.
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BLINDNESS (CONTD..)
• Other important causes (in decreasing order of prevalence):
1. Refractive error
2. Glaucoma
3. Posterior segmental pathology
4. Corneal opacity
5. Miscellaneous
• Vision 2020: “Right to sight”
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PSYCHIATRIC DISORDERS
• With the ever-increasing stress in today’s day-to-day life, psychiatric disorders are assuming more significant dimension.
• Prevalent almost in all age-groups.
• Increased life expectancy
More population reside in the elderly group
Hence problems of poor mentation (Alzheimer’s, Dementia, Insomnia, Irritability etc.) warrant special attention.
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OTHER NCDS AMONG ELDERLY
• Arthritis
• Osteoporosis
• Chronic Respiratory Diseases (e.g. Chronic Bronchitis, Emphysema, Asthma)
• Renal Failure
• Chronic liver diseases
• Hearing Impairment
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PREVENTION OF NCDS
Prevention
Primary Secondary Tertiary
Prevention Prevention Prevention
Population High Risk
Strategy Strategy
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EXERCISE RECOMMENDATION FOR WEIGHT CONTROL• 4 to 5 sessions per week,
• MET level 5 to 8 (moderate intensity exercises )
• 45 to 60 minutes/session.
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OTHER ACTIVITIES AND MET LEVELS
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JUST A MOMENT…..
“….The Japanese smoke a lot and suffer fewer heart attacks than Australians or New Zealanders;
The French eat a lot of fat and suffer fewer heart attacks than Australians or New Zealanders;
The Italians drink a lot of wine and also suffer
fewer heart attacks than Australians or New Zealanders…..”
(Conclusion : NEVER COPY OTHERS’ BAD HABITS BLINDLY; DIFFERENT POPULATION HAS DIFFERENT LEVEL OF SUSCEPTIBILITY !!!!!!!!)
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BIBLIOGRAPHY
• Text book of Preventive and Social Medicine-PARK.
• AFMC Textbook of Community Medicine.
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THANK YOU
That’s It …