Chronic non-communicable
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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