psm topic NON-COMMUNICABLE DISEASES WITH REFERENCE TO OBESITY AND CA CERVIX

1. NON-COMMUNICABLE DISEASES
WITH REFERENCE TO OBESITY AND
CA CERVIX
PRESENTED BY: -
ATTINDER PAL SINGH

2. INTRODUCTION
Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration (3months of more)
and are the result of a combination of genetic, physiological, environmental and behavioural factors.
These diseases have gained pace due to rapid unplanned urbanization, globalization of unhealthy lifestyles and population
ageing.
NCDs include cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as
chronic obstructive pulmonary disease and asthma), diabetes, renal, nervous, mental diseases, musculoskeletal like
arthritis, permanent result of accidents, senility and blindness
Characteristics of NCDs
 Complex aetiology (causes)
 Multiple risk factors
 Long latency period
 Non-contagious origin (noncommunicable)
 Prolonged course of illness
 Functional impairment or disability

3. GLOBAL TREND
NCDs kill 40 million people each year, equivalent to 70% of all deaths globally.
Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 80% of these "premature"
deaths occur in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths 44% people annually, followed by cancers 22%, respiratory
diseases 10%, diabetes 4%.
These 4 groups of diseases account for over 80% of all premature NCD deaths.

4. INDIAN TREND
The probability of dying between ages 30 and 70 years from
the 4 main NCDs is 26%

5. RISK FACTORS
NON-MODIFIABLE RISK FACTORS
 Age: B.P. rises with increasing age.
 Sex: higher rate of obesity in women than in men
 Race: black population tend to have higher B.P.
 Family history(genetics): diabetes runs in family

6. MODIFIABLE RISK FACTORS
Behavioural risk factors
 Tobacco: Smoking is estimated to cause about 71% lung cancer,42%COPD and 10%cvs disorder
 Insufficient physical activity: Regular physical activity reduces the risk of CVS disorder including
hypertension, diabetes, breast colon cancer
 Alcohol: Accounts for 3.8% of all deaths in the world more than half of this from cancers, CVS disorder and
liver cirrhosis
 Unhealthy diet: Adequate consumption of fruit and
vegetables reduce the risk of CVS disorder, stomach and colorectal cancer

7. Metabolic risk factors
Raised blood pressure: major risk factor for CVS disorder
Raised total cholesterol: increases risk of heart disease and stroke
Elevated glucose: Lowering blood sugar levels could reduce the risk of coronary heart disease in both diabetics and non-
diabetics
Overweight and obesity: raised bmi increase risk of certain cancers, stroke diabetes and heart disease
Misc.
Cancer associated infections: 18% of global cancer burden are attributable to a specific chronic infections like HPV
,Hepatitis c, Hepatitis b and H. pylori
Environmental risk factors: occupational hazards, air and water pollution and possession of destructive weapons in case of
injuries, terrible roads

8. PREVENTION
LEVELS OF PREVENTION
1. Primordial prevention- Prevention of the emergence or development of risk factors in countries or population
groups in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful
life styles.
2. Primary prevention- Action taken prior to the onset of disease which removes the possibility that the disease will
ever occur. Can be divided into population & high-risk strategy.
Intervention- 1 Health promotion ,2 Specific protection ,3 Adequate nutrition ,4 Safe water and sanitation
3.Secondary prevention- Action which halts the progress of the disease at its incipient stage and prevents
complications. Mostly curative. Disadvantage - patient has already suffered mental & physical anguish & community to
loss of production. Often more expensive &less effective.
Intervention – EARLY DIAGNOSIS AND TREATMENT
4.Tertiary prevention- All measures available to reduce impairments & disabilities, minimize suffering due to
departure from good health & promote patient’s adjustment to irremediable conditions.

9. NATIONAL PROGRAMMES FOR NCDs
 National Tobacco Control Programme(NTCP)
 National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases & Stroke (NPCDCS)
 National Programme for Control Treatment of Occupational Diseases
 National Programme for Prevention and Control of Deafness (NPPCD)
 National Mental Health Programme
 National Programme for Control of Blindness

10. CA CERVIX
Cervical cancer is the fifth most common cancer in humans, the second most common cancer in women worldwide and the
most common cancer cause of death in the developing countries. Sexually transmitted human papilloma virus (HPV) infection is
the most important risk factor for cervical intraepithelial neoplasia and invasive cervical cancer
Epidemiology
 Preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available,
and the treatment of pre-invasive lesions is effective.
 It is estimated that 30% cervical cancer cases will occur in women who have never had a Pap test. In developing countries,
this percentage approaches 60%.
 The worldwide incidence of invasive disease is decreasing, and cervical cancer is being diagnosed earlier, leading to better
survival rates .The mean age for cervical cancer in the United States is 47 years, and the distribution of cases is bimodal,
with peaks at 35 to 39 years and 60 to 64 years of age.

11. Risk Factors
 Young age at first intercourse (<16years), multiple sexual partners, cigarette smoking,
race, high parity, and lower socioeconomic status.
 Oral contraceptives may increase the incidence.
 Many of these risk factors are linked to sexual activity and exposure to STD.
 Infection with human papillomavirus (HPV) has now been determined to be the
causal agent.
 The role of human immunodeficiency virus (HIV) in Ca Cx is thought to be mediated
through immune suppression.

12. PREVENTION
Vaccination:
Gardasil™ HPV serotypes 16, 18, 6 and 11. three doses at 0, 2 and 6 months .This vaccine confers protection against both
cervical cancer and genital warts.
Cervarix™ HPV serotypes 16 and 18. three doses at 0, 1 and 6 months This vaccine confers protection only against cervical
cancer.

13. Early detection and treatment
1. Screening for cancer cervix : prolonged early phase of cancer in situ can be detected by the Pap smear. all women should
have a Pap test (cervical smear} at the beginning of sexual activity, and then every 3 years thereafter A periodic pelvic
examination is also recommended.
Visual inspection based screening tests such as visual inspection with 5 per cent acetic acid {VIA}, VIA with magnification
{VIAM}, and visual inspection post application of Lugol's iodine .
The present strategy is to screen women using visual inspection after application of freshly prepared 5 per cent acetic acid
solution {5 ml of glacial acetic acid mixed with 95 ml distilled water}. Detection of well-defined opaque acetowhite lesions
close to the squamo-columnar junction, well defined circum-orificial acetowhite lesion or dense acetowhitening of
ulceroproliferative growth on the cervix constiute a positive VIA or VIAM. The test is followed by a single visit approach for
further investigation and management at district hospital. The management at district hospital is planned in such a way that
the treatment based on colposcopy is offered in the same visit. Pap smear and biopsy are the investigations that are done to
ensure that there are cytological and histopathological back-up for the interventions

14. Treatment:
 Surgery, such as a hysterectomy and removal of pelvic
lymph nodes with or without removal of both ovaries and
fallopian tubes.
 Chemotherapy.
 Radiation therapy.

15. OBESITY
Defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (hypertrophic obesity) or an
increase in fat cell number (hyperplastic obesity) or a combination of both.
Epidemiology
Overweight and obesity are the fifth leading risk of global deaths ,44 per cent of the diabetes burden, 23 per cent of
ischaemic heart disease burden and between 7 to 41 per cent of certain cancer NON-COMMUNICABLE DISEASES
burdens are attributable to overweight and obesity

16. Risk factors
• AGE : Obesity increases with age. Infants with excessive weight gain have an increased incidence of obesity in later life
• SEX : Women generally have higher rate of obesity than men, although men may have higher rates of overweight.
• GENETIC FACTORS: Twin studies have shown a close correlation between the weights of identical twins even when they
are reared in dissimilar environments
• PHYSICAL INACTIVITY : sedentary lifestyle particularly sedentary occupation and inactive recreation such as watching
television promote it, physical activity and physical fitness are important modifiers of mortality and morbidity related to
overweight and obesity

17. • SOCIO-ECONOMIC STATUS There is a clear inverse relationship between socio-economic status and obesity. Within
some affluent countries, however, obesity has been found to be more prevalent in the lower socio-economic groups.
• EATING HABITS : A diet containing more energy than needed may lead to prolonged post-prandial hyperlipidaemia and
to deposition of triglycerides in the adipose tissue resulting in obesity
•
• PSYCHOSOCIAL FACTORS : Psychosocial factors
• (e.g., emotional disturbances) are deeply involved in the aetiology of obesity.
•
• FAMILIAL TENDENCY Obesity frequently runs in families (obese parents frequently having obese children), but this is
not necessarily explained solely by the influence of genes.
• ENDOCRINE FACTORS : These may be involved in occasional cases, e.g., Cushing's syndrome, growth hormone
deficiency. ·
•
• ALCOHOL the relationship between alcohol consumption and adiposity is generally positive for men and negative for
women
•
• DRUGS : cortico-steroids, contraceptives, insulin, adrenergic blockers, etc.

18. Assessment of obesity
most widely used criteria are :
1. BODY WEIGHT
Body weight, though not an accurate measure of excess fat, is a widely used index. In epidemiological studies it is conventional
to accept + 2 SD (standard deviations) from the median weight for height as a cut-off point for obesity.
For adults, various other indicators
such as :
(1) Body mass index (Quetelet's index)
Weight (kg)/Height2(m)
(2) Ponderal index
Height (cm)/Cube root of body weight (kg)
(3) Brocca index
= Height (cm) minus 100
(4) Lorentz's formula
(5) Corpulence index
The body mass index (BMI) and the Brocca index are
widely used.

19. 2. SKINFOLD THICKNESS It is a rapid and "non-invasive" method callipers (e.g., Harpenden skin callipers) are available for the
purpose. The measurement may be taken at all the four sites mid-triceps, biceps, subscapular and suprailiac regions. The sum
of the measurements should be less than 40 mm in boys and 50 mm in girls
3. WAIST CIRCUMFERENCE AND WAIST HIP RATIO (WHR) Waist circumference is measured at the mid point between the lower
border of the rib cage and the iliac crest.

20. Prevention
Weight control i.e. Range of body mass index of 18.5 to 24. 9 kg/m2.
strategies: -
(a) DIETARY CHANGES: the proportion of energy-dense foods such as simple carbohydrates and fats should be reduced;
the fibre content in the diet should be increased adequate levels of essential nutrients in the low energy diet.
(b) INCREASED PHYSICAL ACTIVITY: Regular physical exercise is the key to an increased energy expenditure.
(c) OTHERS: Appetite suppressing drugs and Surgical treatment (e.g., gastric bypass etc)