Chronic non-communicable diseases
INTRODUCTION
Chronic
non-communicable diseases are assuming increasing importance among the adult
population in both developed and developing countries. Cardiovascular diseases and cancer are at
present the leading causes of death in developed countries accounting for
70-75% of total deaths. The prevalence
of chronic disease is showing an upward trend in most countries, and or several
reasons this trend is likely to increase.
CARDIAC
DISEASES
Congenital
and malformations of the heart and closely related vascular system are the
causes of over 90 percent of the death.
CLASSIFICATION
1.
Congenital Heart Diseases
a)
Cyanotic heart disease
Ø Tetralogy
of fallot
Ø Transposition
of great vessels
Ø Tricuspid
atresia
b)
Acyanotic heart disease
Ø Coarctation
of the aorta
Ø Stenosis
Ø Patent
ductus arteriosus
Ø Intra-atrial
Septal defects
Ø Intra-ventricular
Septal defect
Ø Pulmonary
stenosis
2.
Acquired Heart Diseases
1.
Pericarditis
2.
Myocarditis
3.
Sub-acute bacterial
endocarditis
4.
Rheumatic fever and rheumatic
heart disease
5.
Mitral stenosis
6.
Hypertension
7.
Ischaemic Heart Disease
8.
angina Pectoris
9.
Cardiac Arrythmias
10.
Congestive Heart Failure
PREVENTION
OF HEART DISEASE
Ø Immunization
against acute infectious
Ø Diseases
such as diphtheria, scarlet fever and measles.
Ø Primary
prevention include weight reduction and changes in the life styles of people.
Ø Monitor
blood pressure and weight
Ø Educate
about nutrition and antihypertensive drugs.
Ø Teaching
stress management technique.
Ø Promote
an optimum balance between rest and activity.
Ø Establish
blood pressure screening programme.
Ø Assess
the patients life style and promote life style changes
NATIONAL
CARDIOVASCULAR DISEASES, STROKE AND DIABETES CONTROL PROGRAMME
It is included
in 10th five year plan
objectives
Ø To
find out the prevalence / incidence in different regional groups regarding CVD
and diabetes and stroke in systemic way.
Ø To
create mass awareness amongst the general public about stress, tobacco smoking
/chewing, life style and obesity for prevention of diseases.
Ø To
create facilities for diagnosis and treatment.
Ø Production
and availability of antihypertensives and drugs to combat acute myocardial
ischemias to be ensured at all levels by promoting their production and
subsidization whenever necessary.
Ø To
create, support and strengthen the tertiary care facilities to deal with
complications of these diseases particularly end organ failures.
Ø To
develop and support the institutions and their activities for rehabilitations
of the terminal / disabled patients of these diseases.
Ø Periodical
surveys about the mortality, morbidity and other epidemiological data about CVD
/ stroke / diabetes to be carried out every five years.
2. CANCER
DEFINITION
Cancer can be defined as active and
uncontrolled proliferation of the cells of epithelial tissue of the body. Cancer may be regarded as a group of diseases
characterized by an
1.
Abnormal growth of cells.
2.
Ability to invade adjacent
tissues and even distant organs and
3.
The eventual death of the
affected patient if the tumour has progressed beyond that stage when it can be successfully
removed.
INCIDENCE
Developed
countries – 289 / 100,000 population
Developed
countries – 70 / 100,000 population.
In
CAUSES
OF CANCER
1. ENVIRONMENTAL FACTORS
Environmental
factors are generally held responsible for 80-90% of all human cancers.
a)
Tobacco
Tobacco
chewing and smoking is the major cause of cancers of the lung, larynx, mouth,
pharynx, oesophagus, bladder, pancreas and probably kidney.
b)
Alcohol
excessive
intake of alcoholic beverages is associated with oesophageal and liver cancer.
c)
Dietary factors
smoked
fish is related to stomach cancer, dietary fibre to intestinal cancer, beef
consumption to bowel cancer and a high fat diet to breast cancer.
d)
Occupational exposures
These
include exposure to benzene, arsenic, cadmium, chromium, vinyl chloride, asbestos,
polycyclic hydrocarbons etc.
e)
Viruses
The
virus like Hepatitis B and C and HIV are casually related to hepatocellular
carcinoma.
f)
Parasites
Parasitic
infections may also increase the risk of cancer, as for example,
schistosomiasis in middle east producing carcinoma of bladder.
g)
Customs, Habits and Life Styles
The
familiar examples are the demonstrated association between smoking and lung
cancer, tobacco and betel chewing and oral cancer.
h)
Others
Others
environmental factors such as sunlight, radiation, air and water pollution,
medications and pesticides which are related to cancer.
2) GENETIC FACTORS
Genetic
influences have long been suspected. For
example, retinoblastoma occurs in children of the same parent. Mongols are more likely to develop cancer
(leukaemia) than normal children. There
is probably a complex interrelationship between hereditary susceptibility and
environmental carcinogenic stimuli in the causation of a number of cancers.
CONTROL
MEASURES
1.
Primary prevention
a.
Control of tobacco and alcohol
consumption
b.
Personal hygiene
c.
Radiation should be reduce.
d.
Measures to protect workers
from exposure to industrial carcinogens should be enforced in industries.
e.
Immunisation against hepatitis
B virus.
f.
Foods, drugs and cosmetics
should be tested for carcinogen.
g.
Control of air pollution
h.
Treatment of precancerous
lesions
i.
Legislation
j.
Cancer education
2.
Secondary
prevention
a)
Cancer Registration
It
is a registration of all cases which provides a base for assessing the
magnitude of the problem and for planning the necessary services.
Ø Hospital
based registries
Ø Population
based registries
b)
Early Detection of Cases
Effective
screening programmes have been developed for cervical cancer, breast cancer and
oral cancer. Like primary prevention,
early diagnosis has to be conducted on a large scale, however, it may be
possible to increase the efficiency of screening programmes by focusing on high
risk groups.
c)
Treatment
treatment
facilities should be available to all cancer patients. Certain forms of cancer are amenable to
surgical removal, while some others respond favorably to radiation or
chemotherapy or both.
Regional
Cancer Centres
The
number of regional cancer centres in
Functions
1.
Cancer diagnosis, treatment and
follow-up.
2.
Survey of cancer mortality and
morbidity.
3.
Training of personnel both
medical and paramedical.
4.
Preventive measure with emphasis
on screening, health education and individual hygiene.
5.
Research
6.
Rehabilitation.
3.
DIABETES MELLITUS
Diabetes
mellitus is a disease resulting from a breakdown in the bodies to produce or to
utilize insulin.
Epidemiological
features
Agent
1.
Pancreatic disorders
2.
Defects in the formation of
insulin
3.
Destruction of beta cells.
4.
Descreased insuling sensitivity
5.
Genetic defects
6.
Autoimmunity
Host
1.
Age – Diabetes can occur at any
age
2.
Sex – Male and Female suffer
equally
3.
Genetic factors
4.
Immune mechanisms
5.
Obesity
6.
Environment risk factors
Types
of Diabetes mellitus
1.
Juvenile Diabetes or insuling
dependent diabetes mellitus (IDDM)
2.
Maturity onset diabetes or non
– insulin dependent diabetes mellitus (NIDDM)
CLINICAL
FEATURES
Juvenile
diabetes
Ø Weight
loss
Ø Weakness
Ø Polyuria
Ø Polydypsia
Ø Polyphagia
Maturity
onset diabetes
Ø Sweating
Ø Fatigue
Ø Irritability
Ø Itching
of the skin
Ø Blurring
of vision
Ø Muscle
cramps
Ø Nocturia
Prevention
Primary
prevention
It
is directed towards avoidance of obesity and weight reduction if necessary to prevent
the onset of NIDDM. Although hereditary
or genetic factors have a role in the development of IDDm and NIDDM genetic conselling is still not recommended
because of the unknown nature of the pattern of transmission.
Secondary
prevention
When diabetes is detected, it must be
adequately treated. The aims of
treatment are
1.
To maintain blood glucose
levels as close within the normal limits
2.
To maintain ideal body weight
3.
Diet and oral antidiabetic
drugs
4.
Diet and insulin, good control
of the blood glucose protects against the development of complications.
Self
care
A
crucial element in secondary prevention is self care, i.e., the diabetic should
take a major responsibility for his own care with medical guidance, e.g,
adherence to diet and drug regimens, examination of his own urine and where
possible blood glucose monitoring, self administration of insulin, abstinence
from alcohol, maintenance of optimum weight, attending periodic check ups
recognition of symptoms associated with glycosuria and hypoglycemia etc.
Home
blood glucose monitoring
Assessment
and control by home blood glucose monitoring. The patient should carry an
identification card showing his name, address, telephone number and the details
of treatment he is receiving.
Tretiary
prevention
The
main objective at the tertiary level is to organize specialized clinics and units.
Capable of providing diagnostic and management skills of a high
order. The tertiary level should be
involved in basic, clinical and
epidemiological research.
4.BLINDNESS
According
to WHO, the “Inability to count fingers in daylight at a distance of 3 meters”
to indicate blindness. In world an
estimated 180 million people are visually disabled, of whom nearly 45 million
are blind. It is estimated that there is
an annual incidence of 2 million cataract induced blindness in the country.
Epidemiological
factors
a)
Age –about 30 percent of the
blind in
b)
Sex – more in females than in
males
c)
Malnutrition - Protein energy malnutrition and vitamin A
deficiency are associated with blindness.
d)
Occupational – People working
in factories, workshops and cottage industries are prone to eye injuries
because of exposure to dust, airborne particles, flying objects, gases, fumes,
radiation, electrical flash etc.
e)
Social class – surveys indicate
that blindness is twice more prevalent in the poorer classes than in the well
to do.
Prevention
of Blindness
1. Primary level of prevention
A. Child Health Care in Growing
periods
1.
Before birth
Ø Nutrition’s
food rich in Vitamin A to the mother
Ø Regular
VDRL test for all pregnants to detect syphilis and regimen
2.
During Birth
Ø Safe
Delivery
Ø Care
of eyes of the newborn by instilling a drop of silver nitrate or pencillin to
protect against gonorrhoaeal ophthalmia.
3.
After birth
Ø Administration
of Vitamin A to prevent xerophthalmia.
Ø Timely
vaccination against small pox and other viral diseases.
B.Parent
Care in the Home
a.
Avoid ill-ventilated rooms,
smoke and flies
b.
Insist on children to read in
good light.
c.
Prohibit games having potential
danger in injuring eyes like bow and arrow.
d.
Avoid access to sharp objects.
e.
Keep poisonous drugs like
tincture iodine or any other toxic substance at a height with no access to
children.
f.
Avoid dangerous fireworks
during festivals
School
Health Care
a.
Proper care of eye to be
included in the curriculum of education of the school children.
b.
Regular eye examination of
pre-school and school children in detection of diseases leading to partial or
total blindness, teachers and volunteers being trained for screening such
cases.
c.
Teach and practice principles
of good posture, proper lighting, avoid glare, keep proper distance and angle
between the books and eye.
d.
Use of suitable types of letter
in the text books.
e.
Consult the doctor for
treatment in case of a red running eye.
f.
Health authorities to be
informed if there are large number of cases.
g.
Sufficient space for
polygrounds and encourage to play games which are not hazardous to eyes.
h.
Prohibit looking at the sun or
bright light and so on.
Public
Care
a.
Regular pruning of all trees an
shrubs on the road side and pathways to avoid ocular injuries.
b.
School children and public to
be taught regarding road sense keeping to the walkways, understand road signals
while crossing.
c.
Care while traveling in speedy
vehicles, use of belts and helmets.
d.
Good road kept properly
repaired with no pits, proper directions, good lighting, avoidance of curves,
adequate danger signals, speed breakers priority for school buses and red cross
vehicles.
Factories
Enforcement
of safety rules and protective glasses infactories and industries
Health
education
All
levels of dissemination of information about eye care through all media of mass
communication.
2.
Secondary Level of Prevention
1.
Early treatment will cure
trachoma before the eye is damaged.
2.
Administration of Vitamin A to
children will prevent xerophthalmia.
3.
Vector control will prevent
onchocerciasis.
4.
Provision of eye protection for
certain workers and insistence for the same.
5.
Improvement in safety of toys.
Disability
Limitation and Rehabilitation
1.
Cataract is well tackled by
organizing eye clinics and eye camps and measures in restoring eye sight to
them.
2.
Corneal grafting acts are in
force in many Indian states in establishing eye banks.
3.
Special schools in education of
the blind in Braille systems and other techniques.
4.
Utilisation of the services of
the blind after training in gainful employment.
5.
ACCIDENTS AND INJURIES
Definition
An
accident is that “occurrence in a sequence of events which usually produces
unintended injury, death or property damage”.
Types
of Accidents
1. Road accidents
In
the 20th century the epidemic of road accidents has become a great
problem. In
2.
Domestic Accidents
It
means an accident which takes place in the home or in its immediate
surroundings. Most frequent accidents
are poisoning, burns, drawing, falls, injuries from sharp or pointed
instruments etc.
3.
Occupational Accidents
The
main causes of industrial accidents are falls, moving objects, striking,
trapping and machinery accidents.
Injuries due to these occupations results in an estimated 120 million
injuries and 200000 deaths per year.
4.
Railway accidents
During
2000, about 16638 people died of railway accidents in
5. An estimated 1618000 persons died
in 2002 due to violence.
Prevention
Since
accidents have assumed the proportion of an epidemic, measures appropriate to
control and epidemic should be undertaken.
The various measures comprise the following.
1. Survey
The
causes must be determined by a survey which will indicate the appropriate measures
needed in a given situation.
2.
Education
Young
people need to be educated regarding risk factors, traffic rules and safety precautions. It has been apty said that “if accidents is a
disease, education is its vaccine”.
3.
Promotion of safety measures
Safety
measures like seat belts, safety helmets, door locks proper vehicle designs use
of laminated high – penetration resistance windscreen glass etc.
4.
Alcohol and other drugs
Alcohol
is the direct cause of 30-50 percent of severe road accidents. Drugs such as barbiturates, amphetamines and
cannabis impair ones ability to drive safety.
5.
Primary care
Emergency
care should begin at the accident site, continue during transportation and
conclude in the hospital emergency room.
6.
Elimination of causative factors
The
factors which tend to cause accidents
must be sought out and eliminated
e.g improvement of roads, imposition
of speed limits, making of danger points, reduction of electric voltage,
provision of fire guards, use of safety equipment in industries, safe storage
of drugs, poisons and weapons etc.
7.
Enforcement of laws
These
include driving tests, medical fitness to drive, enforcement of speed limits,
compulsory wearing of seat belts, and helmets, road – side breath testing for
alcohol etc.
8.
Rehabilitation services
The
aim of rehabilitation is to prevent, reduce or compensate disability and
thereby handicap.
9.
Accident research
The
future of accident prevention is in research.
The area how termed accidentology.
NATIONAL
PROGRAMMES AND ‘NCD’ CONTROL PROGRAMMES
1.
The National Iodine Deficiency
Disorders control Programme.
2.
The national programme for
control of Blindness
3.
National Cancer Control
programme
4.
Programme against Micronutrient
Malnutrition.
5.
National Mental Health
Programme.
6.
National Diabetes Control
Programme
7.
National Cardiovascular Disease
Control Programme.
8.
National Cardiovascular Disease
Control Programme.
9.
Prevention of Deafness and
Hearing Impairment
10.
Oral Health Programme
CONCLUSION
All
diseases not communicable are called as non communicable diseases. Almost all the non communicable diseases can
be controlled by the proper health education.
National programmes and non communicable disease control programmes
plays an important role in this.
REFERENCES
1.
K.Park, Park’s Text book of
preventive and social medicine, Edition 18th, Page.No.286-323.
2.
B.T.Basavanthappa, Community
Health Nursing, Edition 2nd Pg.No.794-824.
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