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NON-COMMUNICABLE DISEASES– LIFESTYLE RELATED DISEASES
IEC
WILMA N. BERALDE, RM, RN, MANNDP – BalatanNon – Communicable Disease Coordinator
4 MAJOR NCDs IN THE PHILIPPINES
• CARDIOVASCULAR DISEASES
• CANCERS
• CHRONIC OBSTRUCTIVE PULMONARY DISEASES
• DIABETES MELLITUS
The Philippines is one of the 23 selectedcountries contributing to around 80% of the totalmortality burden attributable to chronic diseasesin developing countries, and 50% of the totaldisease burden caused by NCDs worldwide(Lancet, 2007)
Epidemiology of the Major NCDs
Common Risk Factors Leading to Major NCDs
Risk FactorsCardiovascular
DiseasesDiabetes Mellitus
CancersChronic
Respiratory Diseases
Smoking
Diet/Nutrition
Physical inactivity
Obesity
Alcohol
Raised blood pressure
Raised blood sugar
Abnormal blood lipids
* coronary artery disease, hypertension, stroke**chronic obstructive pulmonary disease, asthmaSource: WHO STEPwise Approach to Surveillance of NCD Risk, 2003
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Coronary Artery Disease
Myocardial Infarction
Congenital Heart Disease
Congestive Heart Failure
Hypertension
Cardiovascular Disease
• describes a range of diseases that affect the heart and blood vessels and includes:
Stroke
Arrhythmias
others.
Description of Major NCDs
– Coronary artery diseases
– Hypertension
– Cerebrovascular diseases (stroke)
• increased total cholesterol, high LDL, low HDL, smoking, obesity/overweight, physical inactivity, diabetes
• Family history, age, high salt intake, obesity, excess alcohol intake
• Age, sex, heredity, hypertension, smoking, diabetes, heart disease, high RBC, excessive alcohol intake, drug abuse
Cardiovascular diseases and their risk factors
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
HYPERTENSIONAn increase in blood pressure ≥ 140/90 mmHg in two (2) or
more separate occasions. One of the leading causes of disability among Filipinos due to
stroke.
Classification of blood pressure for adults
BLOOD PRESSURE CLASSIFICATION
SYSTOLIC BP DIASTOLIC BP
NORMAL LESS THAN 120 mmHgLESS THAN 80
mmHg
PRE HYPERTENSION 120 - 139 mmHg 80 – 89 mmHg
Stage 1 Hypertension
140 – 159 mmHg 90 – 99 mmHg
Stage 2 Hypertension
160 mmHg or Higher100 mmHg or
higher
HYPERTENSIONRISK FACTORS
Smoking
Excessive alcohol consumption
Overweight
Family history of hypertension, heart disease, diabetes and kidney disease
Sedentary lifestyle
Chronic stress
Advancing age
PREVENTION
Regular exercise and eating”heart healthy” diet
Excessive alcohol consumption and cigarette smoking also increases the likelihood of hypertension
HYPERTENSIONUSUAL SIGN AND SYMPTOMS
NOT ALL HYPERTENSIVE PATIENTS HAVE SYMPTOMS….
Headache
Dizziness
Blurring of visions
Nape/ neck discomfort
EARLY DETECTION IS AN IMPORTANT FACTOR FOR PREVENTING FURTHER COMPLICATIONS……
POSSIBLE COMPLICATIONS
Chronic, undiagnosed and untreated hypertension may result to:
Heart attack stroke kidney failure loss of vision
Lifestyle modification to prevent and manage hypertension
LIFESTYLE MODIFICATION
RECOMMENDATION APPROXIMATE SYSTOLIC BP REDUCTION
Weight reduction Maintain normal body weight 5-20 mmHg
Adopt DASH eating plan (dietary Approach to stop hypertension)
Consume a diet rich in fruits, vegetables, and low fat dairyproducts
8-14 mmHg
Dietary sodium (salt) restriction
Reduce dietary sodium intake 2 – 8 mmHg
Physical activity Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)
4 -9 mmHg
Moderation of alcohol consumption
Limit consumption to no more than 2 drinks per day in most men and not more than 1 drink per day in women and lighter weight persons
2 -4 mmHg
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Type 1 Type 2
Body’s failure to produce insulin and usually sets in among the young population groups
Secondary to decreased activity of the insulin produced which results in increased blood sugar level and usually sets in among the older age groups
– Diabetes • Family history, overweight, lack of physical activity, hypertension, HDL < 35mg/dl, triglyceride >250mg/dl, history of gestational diabetes, with impaired glucose tolerance
Diabetes and its risk factors
Description of Major NCDs
DIABETES
group of metabolic disorders characterized by high blood sugar level on 2 separate occasions
results when the body cannot properly regulate the amount of sugar (e.g. glucose in the blood)
DIABETES
4 clinical types of diabetesType 1 : INSULIN DEPENDENT DIABETES
Type 2 : NON-INSULIN DEPENDENT DIABETES
who can be managed through oral anti-diabetic
medications but may eventually also require insulin
treatment to attain good blood glucose control
Type 3 : GESTATIONAL DIABETES
who were first diagnosed to have diabetes during pregnancy
Type 4 :SECONDARY DIABETES
acquired diabetes that may be drug or chemical-induced such as those who are being treated for AIDS or from other endocrine diseases such as hyperthyroidism.
Values for the diagnosis of diabetes and other categories of hyperglycemia
Type of Testing FBS Values ClassificationCriteria for
Diagnoses of Diabetes Mellitus
Fasting blood sugar (FBS) - no caloric intake for at least 8 hours which means no food, juices, milk, but water is allowed
2-hour blood sugar test: performed after using 75 g glucose dissolved in water or after a good meal
109 mg% Normal Any of the following:
Symptoms of diabetes plus RBS> 200 mg/dL (11.1 mmol/L)
FBS> 126 mg/ dL (7.0 mmol)
2-hr blood sugar >200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT)*
110- 125 mg% Impaired glucose tolerance
126 mg% Possible diabetes mellitus
* FPG estimation is the biochemical test of choice for screening in all age groups. In adults, FPG measurement has been found to be more reproducible than the 2-hour plasma glucose level following an OGTT.**OGTT is the gold standard for diagnosing diabetes and can be used as a screening test.
DIABETESRISK FACTORS FOR DIABETES
High blood pressure
High triglyceride levels
Giving birth to an 8 lb baby
Sedentary lifestyle
Obesity
Family history of type 2 diabetes mellitus among 1st
degree relatives
USUAL S/S OF DIABETES Fatigue excessive urination
Unexplained weight loss poor wound healing
Excessive thirst Excessive hunger
DIABETESPREVENTION
Diabetes , a lifestyle –related disease which can be prevented through regular exercise (at least 30 min every other day) and eating a “heart healthy” diet (i.e. low -salt ,low-fat diet)
Excessive alcohol consumption and cigarette smoking also increases the likelihood of diabetes
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Cancer warning signs
Guidelines for Common Screening Procedures for Major NCDs
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness in voice
Unexplained anemia
Sudden weight loss
– Oral cancer
– Breast cancer
– Lung cancer
– Cervical cancer
• Smoking, excessive alcohol use, chronic irritation, Vitamin A deficiency
• Early menarche/late menopause, high fat diet, obesity, physical inactivity, alcohol, family history
• Smoking, radiation exposure
• Smoking, HPV infection, chlamydia infection, low intake of fruits and vegetables, family history
Some cancers and their risk factors
Description of Major NCDs
Screening guidelines for breast cancer (targets 15-60 years old and above)
• Monthly breast self-examination• Breast examination by health worker (annually) for all child-bearing
woman• Annual mammography for women over 50 years old and above• For certain high risk women, baseline mammography at age 35 with
repeat upon recommendation of attending physician• Genetic screening and counseling for high risk patients or if
appropriate• Referral to hospital for further management if found positive (+) for
mass or any abnormalities
Guidelines for Common Screening Procedures for Major NCDs
Breast Self- Examination
Guidelines for Common Screening Procedures for Major NCDs
Stand in front of a mirror. Check each breast for anything unusual (dimpling,
discharge).
Clasp your hands behind your head and press hands forward.
Check contour of breast.
Breast Self- Examination
Guidelines for Common Screening Procedures for Major NCDs
Gently squeeze each nipple and look for discharge
While standing, raise one arm. Use finger pads to check the breast and
surrounding area – firmly, carefully and thoroughly.
Breast Self- Examination
Guidelines for Common Screening Procedures for Major NCDs
Lines
CirclesWedges
Breast Self- Examination
Guidelines for Common Screening Procedures for Major NCDs
Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder. This position
flattens the breast and makes it easier to check.
Changes in the breast that should be noted and reported to a physician
• Any lump or hard knot found in the breast or armpit
• Any lump or thickening of the tissue that does not shrink or lessen aftr her next period
• Any change in the size, shape, or symmetry of her breast
• A thickening or swelling of the breast
• Any dimpling, puckering, or indention in the breast
• Dimpling, skin irritation, or other change in the breast skin or nipple
• Redness or scaliness of the nipple or breast skin
• Discharge from the nipple (fluid coming from the nipples other than breast milk), particularly if the discharge is clear and sticky, dark or occurs without squeezing the nipple
• Nipple tenderness or pain
Guidelines for Common Screening Procedures for Major NCDs
– COPD
– Asthma
• Smoking
• Genetic predisposition, allergens, smoking, air pollution, respiratory infections
COPD and Asthma and their risk factors
Description of Major NCDs
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Chronic Respiratory Disease
• The most common morbid conditions suffered by Filipinos are respiratory diseases.
Major causes of death due to Respiratory
causes
• Chronic Respiratory Diseases (Asthma, COPDs)
• Pneumonia
Top leading Respiratory causes of
Morbidity
• Acute Respiratory Infection
• Acute Lower Respiratory Tract Infection
• Pneumonia
• Bronchitis
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Accidents are unintentional, unexpected and undesirable events while injuries are either intentional or unintentional events that result in damage or harm to a person (DOH, 2005).
Most accidents and injuries can be avoided. Their effects can be reduced through measures like road safety
education, installation of adequate walkways, streetlights, signages, and home safety management.
In high-income countries, road traffic injuries, self-inflicted injuries and interpersonal violence are the three leading causes of death among those aged 15 to 44 years. In the same age group, there are twice as many suicides and
three times as many traffic-related deaths as homicides.
NON-COMMUNICABLE DISEASES – LIFESTYLE RELATED DISEASES
CANCER HEART DISEASE LUNG DISEASE DIABETESACCIDENTS &
INJURIES
Key Areas for the Primary Prevention of the Major NCDs
Promote Proper Nutrition
Encourage more physical activity and exercise
Promote smoke-free individuals and environment
Discourage excessive alcohol drinking
Manage stress effectively
Maintain regular health check-up
• Smoking cessation for active smokers to reduce risk
• Prohibit smoking inside living areas, houses and closed areas
• Avoid smoke-filled places
• Advocate for implementation of policies that support smoke-free environment
• Support policies/ordinances/laws that limit access of cigarettes to children and youth
PROMOTE SMOKE-FREE INDIVIDUALS AND ENVIRONMENT
Key Areas for the Primary Prevention of the Major NCDs
• Discourage excessive alcohol drinking
• Regular health check-up for early diagnosis and prompt treatment
PROMOTE ALCOHOL-FREE ENVIRONMENT
Key Areas for the Primary Prevention of the Major NCDs
• Limit intake of fatty, salty and preserved foods
• Increase intake of vegetables and fruits
• Avoid high caloric low-nutrient value food like junk food, instant noodles, soft drinks
• Start developing healthy habits in children
PROMOTE PROPER NUTRITION
Key Areas for the Primary Prevention of the Major NCDs
• Moderate physical activity of at least 30 minutes for most days
• Integrate physical activity and exercise into regular day-to-day activities
• Promote walking as one form of exercise that is possible for all including older persons and persons with cardiovascular disease
ENCOURAGE MORE PHYSICAL ACTIVITY
Key Areas for the Primary Prevention of the Major NCDs
• Manage stress effectively
• Regular health check-up for early diagnosis and prompt treatment
PROMOTE A STRESS-FREE ENVIRONMENT
Key Areas for the Primary Prevention of the Major NCDs
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