Transcript Document

EOH 3401
PRINCIPLE OF HEALTH
BY DR. IRNIZA RASDI
TITLES
I.
Non-communicable diseases
II. Health Care system in Malaysia
III. Population measures
IV. Mental Health
NON COMMUNICABLE DISEASES
Introduction
Non-communicable diseases are the leading killer today and are on the increase.
Nearly 80% of these deaths occurred in low- and middle-income countries.
More than nine million of all deaths attributed to non-communicable diseases (NCDs) occur
before the age of 60.
Around the world, NCDs affect women and men almost equally.
Introduction
The leading causes of NCD deaths were:
◦ cardiovascular diseases (17 million deaths, or 48% of NCD deaths);
◦ cancers (7.6 million, or 21% of NCD deaths); and
◦ respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million).
Diabetes caused an additional 1.3 million deaths.
Cardiovascular diseases
Cardiovascular disease is caused by disorders of the heart and blood vessels
Types of cardiovascular diseases
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Heart attacks
Stroke
Hypertension
Heart failure.
Although heart attacks and strokes are major killers in all parts of the world, 80% of premature
heart disease and stroke is preventable
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Cardiovascular diseases:
Contributing factors
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A person’s genetic make-up
The foundations of adult health are laid in early life
Socioeconomic group
Mental health
Diet
Overweight and obesity
Inactivity
Tobacco
Alcohol
Diabetes
Globalization and urbanization
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Common cancers in
Malaysia
Cancer
Definition – a large group of diseases characterized by the uncontrolled growth and spread of
abnormal cells
Types of cancers
a.
b.
c.
d.
Neoplasm – new growth of tissue that serves no physiological function
Tumor – clumping of neoplasmic cells
Malignant - cancerous
Benign - noncancerous
Difference between cancer and non
cancer cells
NORMAL CELLS
Knows and stays in its place of origin
Knows when to replicate and when to die
CANCER CELLS
Does not know when to stop growing and
proliferating
Can travel (metastasize) from organ of origin
to any place within the body
Classification of cancer
1.
Carcinomas – Cancer of the glands and body lining (cells that cover the inside and outside
surfaces of the body) e.g. skin, lining of digestive tract and lungsthe
2.
Sarcomas – Cancers that form in bone and soft tissues, including muscle, fat, blood vessels,
lymph vessels, and fibrous tissue (such as tendons and ligaments).
3.
Lymphomas – Lymphoma is cancer that begins in lymphocytes. Lymphocytes are diseasefighting white blood cells that are part of the immune system. In lymphoma, abnormal
lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the
body.
4.
Leukemias - Cancers that begin in the blood-forming tissue of the bone marrow. These
cancers do not form solid tumors. Instead, large numbers of abnormal white blood cells
(leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding
out normal blood cells.
Cancer:
risk factors for cancer
tobacco use
unhealthy diet
insufficient physical activity
the harmful use of alcohol
Infections (hepatitis B, hepatitis C (liver cancer), human papillomavirus (HPV; cervical
cancer), Helicobacter pylori (stomach cancer)
Radiation
variety of environmental and occupational exposures of varying importance
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Cancer: Interaction between a person’s genetic factors and any
of three categories of external agents
Physical carcinogens; such as ultraviolet and ionizing radiation or asbestos;
Chemical carcinogens; components of tobacco smoke, aflatoxin (a food contaminant) and
arsenic (a drinking-water contaminant);
Biological carcinogens; such as infections from certain viruses, bacteria or parasites.
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Chronic respiratory diseases
According to the WHO Global Status Report on NCDs 2010, smoking is estimated to cause about
71% of all lung cancer deaths and 42% of chronic respiratory disease worldwide.
Second-hand smoke causes severe respiratory health problems in children, such as asthma and
reduced lung function
Indoor air pollution from biological agents related to damp and mould increases the risk of
respiratory disease
Diabetes
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin
(a hormone that regulates blood sugar) or alternatively, when the body cannot effectively use
the insulin it produces.
 The overall risk of dying among people with diabetes is at least double the risk of their peers
without diabetes.
About 347 million people worldwide have diabetes.
In Malaysia, an estimated 11.6% of the adult population have diabetes.
Diabetes
Type I
o The body does not produce insulin.
o 10% of all diabetes cases
o usually develop before their 40th year, often in early adulthood or teenage years.
Type II
o The body does not produce enough insulin for proper function, or the cells in the body do not react to
insulin
o 90% of all cases of diabetes worldwide
o People with central obesity, belly fat, or abdominal obesity, are especially at risk
Gestational Diabetes
o affects females during pregnancy.
o Some women have very high levels of glucose in their blood, and their bodies are unable to produce
enough insulin to transport all of the glucose into their cells.
o baby may be bigger than he/she should be
Diabetes
Main symptoms
Complication of diabetes
Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the
foot be amputated
Skin complications - people with diabetes are more susceptible to skin infections and skin
disorders
Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is
diminished
HEALTH CARE SYSTEM IN MALAYSIA
Health Care
System in
Malaysia
Health care system in Malaysia
Health Care System in Malaysia
Malaysia has 143 public sector hospitals
Three university teaching hospitals under the Ministry of Higher Education are
◦ the University Malaya Medical Centre (UMMC),
◦ Universiti Sains Malaysia Medical Centre (USMMC) and
◦ Hospital Universiti Kebangsaan Malaysia (HUKM).
Large district hospitals have at least 6 specialties (general medicine, general surgery,
paediatrics, orthopaedics, obstetrics & gynaecology and anesthesiology).
State-level hospitals have up to 15 specialty and subspecialty services
Health Care system in Malaysia
The Ministry of Health hospitals are classified in five levels:
I.
II.
III.
IV.
V.
small district hospitals (visiting specialists only);
larger district hospitals with resident specialists;
state-level general hospitals with resident specialists;
hospitals with multiple specialties including regional hospitals (that cover several states) and
national hospitals; and
specialist hospitals or institutions (e.g. for cancer or leprosy).
Health Care system in Malaysia
More complex care, such as cardiothoracic, neurosurgery and vascular surgery are provided in
regional hospitals in north, central, east and south Peninsular Malaysia and in Sabah and
Sarawak.
Designated specialty national and regional hospitals take referrals from around the country. For
example,
◦ Hospital Selayang specializes in microsurgery and in kidney and liver conditions
◦ Hospital Sungai Buluh provides trauma care and care for infectious diseases
Kuala Lumpur Hospital, the oldest and biggest hospital in Malaysia, has over 2000 beds and is a
national referral centre for advanced tertiary care.
Level of diseases prevention
1.
Primary prevention
2.
Secondary prevention
3.
Tertiary prevention
Primary prevention:
Activities that take place before a disease
or injury is present to prevent it from
occurring. For example:
Vaccination for chicken pox
Education on the dangers of smoking
Wearing sunscreen to prevent skin cancer
Wearing a seatbelt to prevent injury
Primary Prevention
Goal:
◦ Reduce number of new cases
Rationale:
◦ By reducing exposure rates and increasing resistance, can reduce number of new cases
Target population:
◦ Those who are most likely to be exposed and/or could increase their resistance
Typical activities:
◦ Remove or reduce source of the risk
◦ Educate and make aware of disease risk
◦ Include behavioral changes to reduce exposure
◦ Improve general health
Outcome measure: incidence of exposure; incidence of disease
Secondary prevention:
Activities that take place once the disease has already occurred to
help treat, reverse, or stop the illness. For example:
Testing for certain diseases like
scoliosis.
Treating diseases with
medicine, like diabetes
and high cholesterol.
Secondary Prevention
Goal:
◦ Reduce number of new cases; reduce number of severe cases
Rationale:
◦ By reducing number of exposures and early disease that progress to more severe disease, mortality and
morbidity can be reduced
Target population:
◦ Those who have been exposed to the disease-causing agent or have early symptoms of the disease
Typical activities:
◦ Screening for exposure and/or disease
◦ Post-exposure prophylaxis
◦ Early treatment to reduce impact of disease/reverse course
Outcome measure: incidence of disease
Tertiary Prevention
Goal:
◦ Reduce number of complications, deaths
Rationale:
◦ By reducing disease severity and increasing recovery, can reduce number of premature deaths or
complications
Target population:
◦ Those who have disease and need treatment
Typical activities:
◦ Treatment tailored to the patient
◦ Rehabilitation to promote recovery
Outcome measure:
disability
incidence of death and long-term
Tertiary prevention:
Rehabilitation activities that will help the patient lead a normal life
once the disease has already caused illness or injury. For example:
Physical therapy after an accident
Oxygen for those with breathing problems
Asthma treatments
POPULATION MEASURES
Population measures
Prevalence
o Point prevalence
o Period prevalence
Incidence
Attack rate
Mortality
o Crude death rate
o Specific rate
Prevalence
Total number of cases of disease existing in a population
Point prevalence (Existing cases present at a single time point)
No. of person ill at a time point
x
100
Total no. in the group at a time point
Period prevalence (Existing cases present within a time period)
No. of person ill during a time period
Average population during a time period
x
100
Incidence
A number of new cases in a defined population during a specified period of time
Num. of newly disease indv. for a specific time period
Total number of population-at-risk for same time period
Attack rate
Incidence rate observed for a short period such as epidemics or outbreak
No. of cases during the epidemic
Total no. of exposed or at risk during the same period
x 100
Crude Death Rate (CDR)
The total number of deaths per year per 1,000 people
Total deaths per year
Average total population of that year
X 1000
Cause specific mortality rate (CSMR)
the mortality rate from a specified cause for a population during a specified time period.
No. of death by certain disease/group/year
X
100 000
Total mortality cause population in the same period
For example, the tuberculosis death rate for Malaysian in 2010 was 0.3 per 100,000
Case Fatality Rate
The percentage of persons diagnosed as having a specified disease who die as a result of that
illness within a given period.
No. of person die because of specific diseases
No. of person have the specific diseases
X 100
MENTAL HEALTH
What is mental health?
Mental health is a state of well-being in which a person understands
his or her own abilities, can cope with the normal stresses of life, can
work productively and fruitfully and is able to make a contribution to
his or her community.
Factors that affect mental health
Both physical and mental health are the result of a complex interplay between many individual and
environmental factors, including:
a.
family history of illness and disease/genetics
b.
lifestyle and health behaviours (e.g., smoking, exercise, substance use)
c.
levels of personal and workplace stress
d.
exposure to toxins
e.
exposure to trauma
f.
personal life circumstances and history
g.
access to supports (e.g., timely healthcare, social supports)
h.
coping skills
Definition of Stress
The Emotional state which results from discrepancy between the level of demand and the
person’s ability to cope.
It is not a disease
Job Demands
◦ Time Pressure
◦ Deadline stress
◦ Excessive workload
◦ Conflicting demands
Lazarus and Folkman 1980
Is All Stress Bad?
Moderate levels of stress may actually improve performance and efficiency
Too little stress may result in boredom
Too much stress may cause an unproductive anxiety level
Stressors
School
Work
Family
Relationships
Legal
Finances
Health/illness
Environment
Living Situation
Negative Effects of Stress
1. Physical
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Weight gain/loss
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Unexpected hair loss
-
Heart palpitations
-
High blood pressure
2. Emotional
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Mood swings
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Anxiety
-
Can lead to depression
•
Can also lead to unhealthy coping strategies (i.e. alcohol,
drugs, etc)
Mental Illnesses
 Is it a disease, like diabetes or smallpox
Is it a form of deviant behavior—like being
rebellious, choosing to dress differently,
being extremely religious, being extremely
creative?
Mental Illnesses
Depression
◦ a mood disorder that causes a persistent feeling of sadness and loss of interest.
Anxiety
◦ unpleasant state of inner turmoil, often accompanied by nervous behavior, such as pacing back and
forth, somatic complaints and rumination
Schizophrenia
◦ A brain disorder in which people interpret reality abnormally
Thank you