This document discusses chronic diseases, specifically obesity, coronary heart disease, hypertension, and diabetes mellitus. It defines each condition, discusses their prevalence, risk factors, measurement, prevention, and management. Obesity is defined by BMI measurements and poses health hazards like increased mortality and morbidity. Prevention focuses on diet, exercise, and lifestyle modifications. Hypertension is a major risk factor for other diseases and its management requires patient education and controlling risk factors through medication and lifestyle changes. Diabetes mellitus can be prevented through identifying at-risk groups and promoting healthy behaviors.
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
How can we improve the quality of life of an aging person? How can a geriatric physician and a geriatric counselor can work as a team. Who else are the other professionals to be included in the geriatric care team? What are the problems faced by the elderly? These are some of the questions we are trying to find an answer for. Caring for elder persons is getting more and more importance as the number of old people are increasing these days. Relatives alone can't meet the challenges of caring for the old. You need professional who can understand and render proper help in this regard. So geriatric counseling is getting more and more acceptance. Alzheimer's Syndrome, senile dementia, rheumatic pains, feeling of alienation etc are some of the problems counselor have to cope up with.
Ageing is an important physiological phenomenon faced by all living individuals that is multifactorial and complex. The causation is still a matter of controversy. There is a lack of consensus regarding the appropriate age of ageing, though most of the countries uses chronological ages.
This presentation is regarding active ageing that builds up framework that will help the elderly mass to live a disease free active life with active participation and security in life.
This presentation also describes the different challenges faced by the elderly population for active ageing.
Government of India has been working for the aged population and there has been a number of policies and programmes that are solely dedicated to the elderly masses that has been also described here.
These slides give an overview of public health and the role of local public health departments in keeping people healthy, presents housing, health and some of the vulnerable populations who are the primary focus of our work, and shows the Healthy Chicago Public Health Agenda - the blueprint for our work at the Chicago Department of Public Health. Lastly, it highlights some of our work and accomplishments with vulnerable groups.
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
How can we improve the quality of life of an aging person? How can a geriatric physician and a geriatric counselor can work as a team. Who else are the other professionals to be included in the geriatric care team? What are the problems faced by the elderly? These are some of the questions we are trying to find an answer for. Caring for elder persons is getting more and more importance as the number of old people are increasing these days. Relatives alone can't meet the challenges of caring for the old. You need professional who can understand and render proper help in this regard. So geriatric counseling is getting more and more acceptance. Alzheimer's Syndrome, senile dementia, rheumatic pains, feeling of alienation etc are some of the problems counselor have to cope up with.
Ageing is an important physiological phenomenon faced by all living individuals that is multifactorial and complex. The causation is still a matter of controversy. There is a lack of consensus regarding the appropriate age of ageing, though most of the countries uses chronological ages.
This presentation is regarding active ageing that builds up framework that will help the elderly mass to live a disease free active life with active participation and security in life.
This presentation also describes the different challenges faced by the elderly population for active ageing.
Government of India has been working for the aged population and there has been a number of policies and programmes that are solely dedicated to the elderly masses that has been also described here.
These slides give an overview of public health and the role of local public health departments in keeping people healthy, presents housing, health and some of the vulnerable populations who are the primary focus of our work, and shows the Healthy Chicago Public Health Agenda - the blueprint for our work at the Chicago Department of Public Health. Lastly, it highlights some of our work and accomplishments with vulnerable groups.
Presented by Prof. Adrian Bauman, Director, Prevention Research Centre, Sydney University, Australia at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 on 5 July 2013 in Vienna, Austria.
Disclaimer: WHO is not responsible for the content of presentations made by external speakers at its meetings and conferences. This presentation is published here with the speaker's consent, only for information purpose.
Strengthening ncd surveillance in malaysia, asean ncd forum 2013Feisul Mustapha
Zainal Ariffin Omar and Feisul Idzwan Mustapha. Strengthening NCD Surveillance in Malaysia. 15 September 2013. Working paper presented at the ASEAN Regional Forum on NCDs. Manila, Philippines.
Goal driven , compassionate professional pusuing masters in hospital management ,looking for working in hospital as trainee/employee in accreditated hospital
kita akan mempelajari tentang Surveilans Epidemiologi.
Pada bab awal telah dijelaskan bahwa Epidemiologi merupakan suatu studi tentang distribusi dan determinan terkait permasalahan kesehatan di daerah tertentu atau kejadian yang spesifik dalam suatu populasi dan aplikasi penelitian ini yakni sebagai upaya untuk mencegah dan mengendalikan permasalahan kesehatan (4) Ahli epidemiologi tidak hanya berfokus pada permasalahan yang terkait dengan kematian, penyakit dan kecacatan saja, tetapi juga pada isu kesehatan positif yang bertujuan untuk meningkatkan kesehatan pada suatu negara. Salah satunya adalah surveilans epidemiologi,
Lalu, apa yang dimaksud dengan surveilans ? Dan apa kaitannya dengan pencegahan penyakit ? Kita akan memahaminya pada sesi ini.
http://rajagrafindoonline.com/kesehatan/buku-epidemiologi-untuk-mahasiswa-kesehatan-masyarakat-pengarang-najmah-skm-mph
Najmah, 2015, Epidemiologi untuk mahasiswa kesehatan masyarakat. Penerbit: Raja Grafindo Jakarta
Surveilans merupakan suatu proses yang sistematik meliputi pengumpulan, pemeriksaan, analisis data serta diseminasi informasi pada waktu dan orang yang tepat sehingga dapat dilakukan tindakan lanjutan.
menurut WHO, surveilans merupakan ciri penting dalam praktik epidemiologi. Keutamaan dari kegiatan monitoring terhadap fakta adalah merupakan suatu proses dan berkelanjutan dimana monitoring merupakan kegiatan berselang dan tidak disengaja.
prevention of heart attacks is the theme on this world heart day.heart disease is increasing in india like an epidemic & affecting younger people with more mortality
CAD is spreading like an epidemic in south east Asia,esp india where its affecting younger ppl with grave prognosis. due to limited resourses, primary prevention becomes the most important tool to arrest this epidemic
Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian...EsserHealth
Learn about the leading chronic diseases in America and how Lifestyle Medicine can radically shift the burden of disease in your life and western society at large.
Epidemiology of chronic non communicable diseases.pptxRomy Markose
Epidemiology of chronic non communicable diseases is the 5th unit in community health nursing subject of 2nd year BSc Nursing students according to their curriculum. this ppt helps to understand regarding the condition, etiological factors, risk factors, signs & symptoms, management at each health care level & prevention.
نظرية التطور عند المسلمين (بروفيسور محمد علي البار
ويقدم فيها سردا تاريخيا لنظريات نشأة الخلق وخلق آدم وكيف ان نظرية التطور هي نظرية علمية وليس دينية لكن تم استغلالها لمحاربة الكنيسة
Ethical considerations in research during armed conflicts.pptxDr Ghaiath Hussein
My talk @AUBMC Salim El-Hoss Bioethics Webinar Series. In this webinar, we have discussed the following points:
1- How armed conflicts affect the planning and conduct of research?
2- What is ethically unique about research during armed conflicts?
3- How did my doctoral project approach these ethical issues both at the normative and the empirical levels?
4- What are the lessons learned from the conflicts in the middle east (Sudan, Syria, Yemen, etc.) and how do they differ from the situation in Ukraine?
Acknowledgement: This talk is based on my doctoral thesis (http://etheses.bham.ac.uk/8580/), which was fully funded by Wellcome Trust, UK.
Research or Not Research? This Is Not the Question for Public Health Emergencies
November 17, 2021 @ 4:00 pm - 5:00 pm EST
Speaker:
Ghaiath Hussein, Assistant Professor, Medical Ethics and Law, Trinity College Dublin, Ireland
About this Seminar:
Public health emergencies, whether natural or man-made, local or global, in peacetime or during armed conflicts are always associated with the need to collect data (and sometimes biological samples) about and from those affected by these emergencies. One of the central questions in the relevant literature is whether the activities that involve the collection of data and/or biological samples are considered ‘research’, with the subsequent endeavour to define what ‘research’ is and whether they should be submitted for ethical approval or not. In this seminar, I will argue that this is not the central question when it comes to research/public health/humanitarian ethics. Using the findings of a systematic review on the research conducted in Darfur and findings from a qualitative project that aimed at defining what constitutes ‘research’ in public health emergencies I will, alternatively, present what I refer to as the ‘ethical characterization’ of these research-like activities and how they can be ethically guided.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Prevention and control of chronic diseases
1. Prevention & Control of
Chronic Diseases
Dr. Mohammad Abdurrahman
Family & Community Medicine Practitioner
Health Insurance Specialist
1
2. The chronic non-communicable
disease
is defined as “an impairment in body
function or structure that necessitates a
modification in person’s life-style or has
persisted for a long length of time.”
2
4. Obesity
• Is a type of malnutrition that is
characterized by abnormal growth of
adipose tissue.
• This can occur due to increase in size
and! or number of the fat cells.
• BMI > 30 in males and 28.6 in females is
indicative of obesity.
4
5. Aetiology OF Obesity
• 1. Age: increases with the age. Overweight infants are
more likely to be obese adults,
• 2. Sex: Post-menopausal women are more likely to gain
weight. In men, obesity occurs a decade earlier than
females.
• 3. Sedentary Life Style:
• 4. Genetic Factors:
• 5. Diet:
• 6. Psychosocial Factors:
• 7. Endocrine Factors:
5
6. Measurement of Obesity :
• 1/ The Expected BW = Height in cm — 100
• 2/ Body Mass Index (BMI):
BMI = W I H
Here W = weight in Kg, and H = Height in meters.
The desirable range of BMI is:
• Males: 20.1- 25
• Females: 18.7—23.8
• A person is considered obese if BMI is above 30.0
in males, and 28.6 in females.
6
7. Measurement of Obesity
• 3/ Skin Fold Thickness: Measurement of skin
fold thickness at mid-triceps, biceps, subscapular region, and supra-iliac regions are
used for this purpose. However, this method is
not popular due to lack of standardization, poor
repeatability, and technical problems involved in
the measurement.
7
8. Hazards of Obesity:
Mortality: Obesity is a known risk factor for
mortality in IHD, hypertension, and renal
diseases.
Morbidity: Obesity is a risk factor for:
hypertension, lHD, gallstones, and osteoarthritis.
In addition, obese persons carry higher risk of
post-operative complications and accidents.
8
9. Prevention and Control:
1. Diet: Reduction in fats and carbohydrates in the diet,
(especially refined foods, sweets, oils etc) is
recommended both for treatment as well as prevention.
Increase in consumption of dietary fibers is un-refined
foods the other side of the coin.
2. Physical Exercise: Regular physical exercise
like fast walking, playing out-door games like tennis, and
swimming are necessary adjuvant to diet.
3. Other Measures: These include use of drugs, removal
of excess fat by surgery, gastric bypass etc are tried, but
have limited value.
9
10. Coronary Heart Disease CHD/IHD
Definition:
impairment of the heart function due to
inadequate blood flow to the heart,
compared to its needs, caused by
obstructive changes in the coronary
Arterial circulation to the heart.
10
11. CHD may manifest itself in many
presentations:
a) Angina pectoris on effort.
b) Myocardial infarction.
c) Heart irregular rhythms.
d) Cardiac failure.
e) Sudden death.
11
12. Magnitude and burden of CHD:
• cause of 1/4 deaths in industrialized countries.
• first leading cause of death in the world.
•
25 to 28% heart attacks die suddenly instantly or within
24 hours
• 55% of all cardiac deaths, mortality occurs within the first
hours.
• 17 million people die annually due to CHD.
• Masked by other causes.
• Problems in diagnosis and reporting also play a role.
• Declining in USA, due to improve prevention & education
• Singapore, death rate doubled ,within 20 years
12
13. Epidemiology
• Person:
more among the middle- aged and older men.
•
due to accumulation of hazards.
• men have more CHD death rates than women
• more among CHD family histories
• hypertension and diabetes mellitus prone CHD
• life styles and habits
• type A personalities more prone to CHD.
• high social class in the 1950’s; however, since the
1970’s it became more among lower classes.
13
15. Aetiology and risk factors CHD:
• Multifactorial.
• The greater the factors present the more CHD.
• Non- modifiable factors (i.e. risk markers): age,
sex (male), FH, genetic and personality
• Modifiable factors (i.e. risk factors):smoking,
hypertension, cholesterol , diabetes , obesity,
sedentary habits and stress).
15
16. 1. Smoking:
•
•
•
•
Major CHD risk factor.
responsible for 25% deaths under 65 men.
The risk is directly related to No/day
Synergistic with other risk factors
16
17. 2. Hypertension:
• Accelerates the atherosclerotic process,
especially if hyperlipidaemia present
• SBP better predictor CHD than DBP.
• However, both are important risk factors.
17
18. 3. Serum cholesterol:
• Population with CHD have high
cholesterol
• Cholesterol important risk factor for CHD
• LDL most directly related to CHD.
18
19. Lipids Level and Classification
LDL Cholesterol (mg/dL)
<100
100–129
130–159
160–189
≥190
Optimal
Near optimal/above optimal
Borderline high
High
Very high
19
21. Classification of Serum Triglycerides
•
•
•
•
Normal
<150 mg/dL
Borderline 150–199 mg/dL
High
200–499 mg/dL
Very high ≥500 mg/dL
21
22. •
•
•
•
•
•
Causes of Elevated Serum Triglycerides :
Obesity and overweight
Physical inactivity
Cigarette smoking
Excess alcohol intake
High carbohydrate diets (>60% of energy
intake)
• Several diseases (type 2 diabetes, chronic
renal failure, nephrotic syndrome)
• Certain drugs (corticosteroids, estrogens,
retinoids, higher doses of beta-blockers)
22
• Various genetic dyslipidemias
23. 4. Other risk factors:
• DM: CHD is 2- 3 times higher in diabetics
• FH CHD increase the risk of premature death.
• Physical activity
• Type A personality
• High alcohol intake
• Oral contraceptives
• Hormones: difference between men and women
23
24. Prevention of CHD:
• CHD is preventable.
I. Primary prevention:
1. Control of risk factors among populations:
a) Dietary changes:
- Reduction of fat intake (saturated, cholesterol )
- Avoid alcohol consumption.
b) Smoke free society
c) Blood pressure:
d) Physical activity:
2. Identification of high risk groups: specific
advice.
24
25. Prevention of CHD:
II. Secondary prevention:
Prevent recurrence and regression of CHD:
a) Screening high risk groups & suitable Rx.
b) Drugs, coronary surgery, pace- makers.. etc.
c) Control of risk factors i.e. smoking, HTN, DM
diets, exercise... etc.
25
26. Prevention of CHD:
• III Tertiary prevention:
Rehabilitation irreversible limitations of cardiac
function through:
• changes in behavior, habits, life- styles, diets,
• use of drugs,
• occupational rehabilitation,
• control of risk factors
• psychological rehabilitation
26
28. Magnitude of The Problem
1. Public and professional awareness is
lacking greatly
2. In our country (and many other developing
countries) this issue is not adequately
addressed by any organization
28
29. 3. Open market for all possible drugs
4. Many misconceptions regarding
hypertension and its treatment by the
public, too much trust into herbs.
5. Medical professionals belong to too many
“schools” with diverse treatment traditions
and standards.
6. Risk for other diseases: like CRF, Stroke,
and MI
29
30. Prevalence, Awareness, Treatment and Control
of hypertension in the US Adult
And KSA
%
KSA
1976-80
1999-2000
Prevalence
32
18
20%
Awareness
51.0
70
27%?
Treated
31.4
59
?
Controlled
9.9
34
20%?
Worldwide :
20% of Adults.
50 % over 60 Years.
30
31. Socioeconomic implications of
untreated hypertension
• In USA Cost of Hypertension: $47.2
billion (NHLBI 2003). In 50 million people.
• In KSA let say we pay ½ of this for 4
millions of Saudis = 8 billion SR???
31
32. Where do we see the problems?
• Awareness: Severely lacking among public
and professionals despite the significance of
the disease for public health.
• Treatment: guidelines exist, but not applied.
• Control: Small percentage of those identified
and treated are controlled (20%!)
• Holistic approach in management with
consideration of co-morbidities and risk
factors are inconsistent
32
33. What is needed?
• Educate the professionals on
prevention and treatment of HTN.
• Improve the teaching on life stylemodifications to the medical and
general public
• Improve the general public awareness
of the importance of normalized BP.
33
34. What we need?
• Cooperate with policy makers to project
multitudes of actions to fight HTN through out
the society all year long
• Develop training packages for health care
providers in prim. care centers.
• Cooperate with national and international
organizations to learn from each others experience.
34
35. Management Plan
•
•
•
•
•
•
•
•
Establish Good patient relationship.
Educate patient & family on the consequences
Encourage Self monitoring.
BP goal.
Non pharmacological therapy.
Pharmacological therapy.
Simplify drug regimen.
Elderly.
35
36. Diabetes Mellitus (DM)
• It is a chronic disease due to deficiency or
diminished effectiveness of insulin. The
disease affects the metabolism of
carbohydrates, proteins, fats, water and
electrolytes.
36
37. Classification DM:
• I. Diabetes mellitus:
1. Insulin dependant = Juvenile onset (IDDM,
type 1).
2. Non insulin dependant DM = Maturity onset
(NIDDM, type II).
II. Impaired glucose tolerance:
intermediate state between DM and normality,
pregnancy state, obesity and stress may
precipitate this condition.
III. Gestational DM:
Pregnancy induced.
37
38. Diagnostic criteria for Type II DM
Diabetes
Impaired glucose
tolerance
Normal
Biochemical
Index
>7mmol/L
>126 mg/dl
6.9-6.1 mmol/L
111-125 mg/dl
< 6.1mmol/L
110 > mg/dl
FBS
(Fasting Blood Sugar)
>11.1mmol/L
>200 mg/dl
7.7-11mmol
140-200mg/dL
<7.7 mmol/L
< 140 mg/dL
2hr OGTT
> 11.1mmol/L (>200mg/dl + symptoms)
Random BS
38
39. Severity DM:
• IDDM(Type1) is the most lethal form,
abrupt onset, Less than 40 years old.
• NIDDM(Type 2) is the commonest
presentation above than 40 years old
- with gradual onset.
- mild nature of the disease.
- compatible with long living with
adequate control.
39
40. Magnitude of DM:
• Most common metabolic diseases of human
beings.
• DM is the most common cause of RF.
• Higher rates of occurrence are found in
developed countries
• Developing countries, DM masked by
communicable diseases as well as malnutrition.
• DM is the eighth leading cause of death in USA.
• Diabetics are incapacitated by many serious
complications as atherosclerotic diseases, renal
failure, neuropathy blindness & amputation.
40
41. Aetiology DM:
• The fundamental cause unknown.
• Several theories suggest different causative
mechanisms.
• Inherited & exposure factors accumulate to produce
DM.
• The primary agent is insulin deficiency, genetic,
pancreatic.
• Insulin available in normal amounts but of defective
nature.
• Peripheral tissues may have decreased sensitivity to
it.
41
42. Diabetes in relation to pregnancy:
Gestational DM that disappears with the end
of pregnancy.
Complications for the mother and baby.
Incidence rates of diabetes in pregnant
women range from 0.1 to 0.5 every 100
pregnancies.
42
43. Epidemiology DM:
• Person:
NIDDM increases with age.
• IDDM,rises gradually from early childhood to a peak at
10-12, then starts to decline from early adolescence.
• There are more young male diabetics than females.
• In middle age, women are more affected because of
pregnancy.
• Genetic: Undisputed aggregation of cases in families
are found in DM.
• - Immune mechanism: Cell mediated
• - Body weight: obesity.
• - Diet:
43
44. Epidemiology DM:
• II. Place:
DM is commoner in developed countries.
• different age structure of population
• better facilities of diagnosis
• stress
• sedentary occupations.
44
45. Epidemiology DM:
• III. Time
1 DM is on the increase due to prolongation of
life span, changing life styles, better diagnosis
and improved medical care
• 2 Seasonality: IDDM peak incidence is recorded
in winter months (suggesting flactulating viral
diseases).
45
46. Prevention DM:
•
I. Primary Prevention:
A) Identification of those at risk:
• 1. Individuals with positive family history
• 2. Those over 40 years of age.
3. Obese individuals.
4 Females with suggestive obstetric history
• 5. Cases with premature atherosclerosis.
B) Health education:
• I Maintenance of optimal body weight
2. Promotion of physical exercise.
3. Diet modification.
• 4.Avoidance of diabetogenic drugs. e.g. contraceptive pills, corticosteroids.
5.Family life education.
• 6. Prevention of complicated pregnancy.
46
47. Prevention DM:
• II. Secondary prevention:
a) Screening: The preventive significance of early detection is
two fold:
• 1.Discovery of the disease in its pre-symptomatic state if
followed by adequate treatment minimize the danger of
complications such as coma and infection.
• 2.Early therapy reduces the progress of disease and may
reverse the pathologic changes.
• Chronic hyperglycemia exhausts the already weak islets of
Langerhans (insulin producing cell).
• Diabetics with no or minimal complications at the time of
diagnosis have a death rate less than one third that of patients
with serious complications at time of diagnosis.
• All risk groups should be screened periodically.
47
48. Prevention DM:
• II. Secondary prevention:
a) Screening:
Tests for screening:
Detection of glucose in urine two hours after a meal are
considered diabetics unless proved otherwise.
• Mild cases may escape diagnosis when there is no glucostirea.
This lack of sensitivity may miss up to 50% of cases (false
negative).
• Reliable results are obtained two hours after 75 grains oral
glucose. 180 rng/dl blood is threshold value for diagnosing
diabetes.
• Any organized group of the community can be the target of a
screening program for diabetes. Example: Workers covered by
health insurance, mothers attending MCH centers, school
children, labourers in factories . . . etc.
48
49. Prevention DM:
II. Secondary prevention:
b) Treatment:
Aim is to maintain serum glucose within normal:
1.by diet modification alone,
2.diet and oral hypoglycemic drugs
3.or diet and insulin.
N.B. controlled diabetics life expectation is
approximating that of general
49
50. Prevention DM:
• II. Secondary prevention:
c) Health education:
as in counsellig individual patients or Group education in
organized session it should cover the following: .
1. Maintain the ideal body weight
• 2. Train diabetic for self care as it is crucial for good
prognosis.
•
to stick to treatment measures
•
to detect dangerous signs and symptoins.
• The diabetic should be able to test his blood, choose his
diet, regulate his physical activities, administer his own
-and even adjust- his daily insulin dosage.
• 3. Health education should also stress the use of
diabetic cards.
50
51. Prevention DM:
III. Tertiary prevention:
Treat complications and rehabilitate patient to
lead a life as normal as possible.
• periodic checkups for visual acuity (retinopathy),
renal functions (nephropathy), and testing
peripheral nerves sensation (neuropathy
• Diabetics cards which provide information
needed for emergency situations as
hypoglycemic and ketoacidotic episodes.
51
52. Cancer
• Cancer emerges as a major public health
problem not only in developed countries,
but also in many developing countries.
52
53. Cancer
• Definition:
cancer can be regarded as a group of
diseases characterized by the following:
1. Abnormal growth of cells.
2. Ability to invade adjacent tissues and
even distant organs.
3. The eventual death of the affected
patient if the tumor has progressed
beyond that stage when it can be
successfully removed.
53
54. Magnitude of the CA problem:
• All forms are causing 9% of deaths
throughout the world.
• At the beginning of this centuary, sixth
cause of death in developed countries.
• Today, it is the second leading cause of
death next to cardiovascular diseases in
these countries.
• In developing world, it ranks fourth as a
cause of death.
54
55. Magnitude of the CA problem:
• There is a steady increase in incidence
and mortality. This could be explained by :
1.Techniques for case-finding & detection.
• 2. Control of communicable diseases .
• 3. Marked demographic aging.
• 4 .Changes in life style and environment
55
56. Geographic distribution &place CA:
• The international variations in pattern attributed to multiple
factors such as environmental, food habits, life style, genetic
inadequacy in detection and reporting ,population structure.
• For example, cancer of the stomach is common in Japan,
and has a low incidence in United States.
• Or the other hand, breast cancer is common in United States
and has a low incidence in Japan.
• In Egypt & Sudan, due to the prevalence of bilharzia, cancer
bladder is more common than in areas where there is no
bilharzia.
Also it was observed that cancer mortality is highest in urban
and industrial communities, and lowest in mountain areas.
56
57. Person characteristics and CA
• Age:
Mortality is low during infancy and preschool
years, and drops to its minimum level during
subsequent childhood period.
• At older ages the rate rises consistantly to a
peak.
• More than half the cancer deaths today are
persons aged 65 years and over.
57
58. Person characteristics and CA
• Sex:
In general more frequently in females than in males. But,
the following is observed:
• a) Incidence of cancer lip, larynx, lung, bronchus,
tongue, pharynx and esophagus is higher among males
than females.
b) Cancer of thyroid and biliary passages is more among
females.
c) Gastro-intestinal tract cancer is equally distributed
among males and females.
• D) Breast cancer more common in unmarried women.
58
59. Person characteristics and CA
• Socio- economic status:
inverse association between cervical cancer and
socio- economic status
• On the contrary, breast cancer was found to
occur more commonly among women of high
social standards.
• This differences may be due to differences in the
life style, dietary pattern, marital practices,
fertility pattern and personal hygiene.
59
60. Etiology of cancer:
• As with other chronic diseases, cancer has a
multifactorial aetiology.
• I . Genetic factor
• 2. Personal habits
• 3. Dietary factors
• 4. Occupational exposures
• 5. Infection
• 6. Physical agents
• 7. Chemical agents
60
61. Cancer prevention
• a series of measures based on medical
knowledge in the fields of prevention,
detection, diagnosis, treatment, after care
and rehabilitation.
• This aimed at reducing the number of new
cases, increasing the number of cures and
reducing the invalidism due to cancer.
• It is estimated that at least one third of all
cancers are preventable.
61
62. Cancer prevention
• 1. Primary prevention:
• a) Health education: tobacco and alcohol ,
hygiene , immunization , detection and
treatment
• b) Industrial and occupational control:
• c) Environmental pollution:
62
63. Cancer prevention
•
•
•
•
•
2. Secondary prevention
a) Early detection of cases
b) Treatment
3. Tertiary prevention:
a) Pain relief
b) Rehabilitation and psychological
support
63
64.
65. “About twelve million people die
every year of heart problems, but
up to half of them could be
saved if better prevention
programs
were in effect.”
70. Take home point
• The flipside of the coin !
•
1.
2.
3.
4.
5.
6.
By exercise ,you can eliminate :
Heart disease
Diabetes mellitus
Osteoporosis
Cancer
Anxiety
Depression
71. “Inactivity is as detrimental as
smoking or having high
cholesterol levels.”
72. Benefits of Exercise
1. Circulation 1) blood pressure –down 2) pulse
–down
2. Mind: well-being, endurance, efficiency,
depression, stress, sleep
3.
4.
5.
6.
7.
Cholesterol- down
Weight- down
Immune system- up
Insulin requirement-down
Bone-strengthened
74. • Let’s consider the benefits of exercise on the heart and
• circulation.3Exercise lowers high blood
pressure, protecting the heart and
• blood vessels.
• It improves
circulation and thus promotes
clearer minds, better
• sleep and faster recovery from sickness or
injury.
• Exercise lowers cholesterol levels,
decreasing the risk of heart
• attacks and strokes
• Exercise lowers the heart rate at rest.
76. • If your normal pulse rate at rest is 80
beats per minute, and by
• regular exercise it comes down just
• ten beats to 70, you will spare your heart
beating some