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• Non Communicable Diseases (NCDs)


  Non infectious and non transmissible "lifestyle related disease" due to common risk factors like lifestyle
• Common NCDs


  • Cardiovascular disease (CVD)
  • Cancer (CA)
  • Cerebrovascular disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
• Chronic disease


  Mostly result of: unhealthy habits, behavioral and modifiable risks like smoking, alcohol abuse, too much fat, salt, sugar, physical inactivity
• Cardiovascular disease (CVD)


  • Involve heart or blood vessels (arteries, capillaries, and veins)
• Cerebrovascular disease or Stroke


  • Group of brain dysfunction related to disease of blood vessels supplying the brain
  • Most common causes are atherosclerosis & hypertension
• Hypertension


  Defined as systolic blood pressure equal to or above 140mmHg or a diastolic blood pressure equal to or above 90mmHg
• Atherosclerosis


  • A disease of blood vessels characterized by the deposition of fats and cholesterol within the walls of the artery
  • Uncontrolled atherosclerosis and hypertension leads to heart attack, stroke, kidney damage and a host of complications
• Screening


  Identification of an unrecognized disease by application of test, examination & other procedures; applied rapidly to help identify individual's chances of becoming ill
• Monitoring of Blood Pressure

  1. Use reliable aneroid devices such as sphygmomanometers calibrated every 6 months

  2. BP recorded twice daily in morning & evening for several days before a diagnosis of hypertension
• Classification of Blood Pressure

  • Normal: <120/80
  • Prehypertension: 120 to 139 / 80 to 89
  • Stage 1 Hypertension: 140 to 159 / 90 to 99
  • Stage 2 Hypertension: 160 to 179 / 100 to 109
  • Stage 3 Hypertension: >180 /110
• Screening for Elevated Cholesterol

  1. Take blood samples to determine total serum, cholesterol, low density lipoprotein (LDL), high-density lipoprotein (HDL)

  2. Withhold food or drinks for at least 8 hours to ensure accuracy of results in all adults aged 20 years or older

  3. Fasting lipoprotein profile should be obtained once every 5 years
• LDL (bad cholesterol)


  Increases the likelihood of plaque formation that can block blood flow in the arteries
• HDL (good cholesterol)


  Clears excess LDL in the arteries
• Total cholesterol


  • The sum total of all cholesterol (LDL/HDL and other cholesterol) at a given time
  • High total cholesterol or high LDL increases risk of developing CVD
  • The higher the HDL, the better the health of individual
• Leading causes of cancer by gender

  • Women: breast, lung, liver, corpus, uteri colon/rectum
  • Men: lung, liver, colon/rectum, prostate, stomach
  • Both sexes: breast, lung, liver, colon/rectum, stomach
• Malignant Neoplasm


  A group of various diseases involving unregulated cell growth. Cells divide, grow uncontrollably forming malignant tumors and invade parts of the body.
• Carcinogens


  Substances that cause some cells to undergo genetic mutations
• Lifestyle Related Factors for Cancer

  • Cigarette smoking
  • Unhealthy diet
  • Alcohol drinking
  • Physical inactivity
  • Overweight / obesity
• Cancer Warning Signals


  • Change in bowel or bladder habits
  • A sore throat that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast
  • Indigestion or difficulty of swallowing
  • Obvious change in wart or mole
  • Nagging cough or hoarseness
• Chronic Obstructive Pulmonary Disease (COPD)

  A disease of the lungs in which airways narrow over time, including chronic asthma and emphysema
• COPD


  • Strong Risk Factor: Smoking. Second-hand smoke and pollution also aggravate the problem.
• Diabetes


  A group of metabolic disease in which an individual has high blood sugar because the pancreas does not produce enough insulin or cells do not respond to the insulin produced
• Hyperglycemia


  High blood pressure, common effect of diabetes
• Diagnosis of Diabetes


  Fasting Blood Sugar (FBS) of >7.0mmol/l (120 mg/dl) or 2-hour blood sugar test of >11.11 mmol/l (200mg/fl)
• Symptoms of Diabetes


  • Increased frequency and amount of urination (polyuria)
  • Increase thirst (polydipsia)
  • Constants hunger (polyphagia)
  • Weight loss, vision changes and fatigue
• Complications of Diabetes


  • Heart disease
  • Neuropathies
  • Amputations
  • Dental disease
• Lifestyle Related Factors for Diabetes

  Unhealthy diet, overweight, and obesity
• Physical Inactivity


  Less than 5 times of 30 minutes of moderate activity per week or less than 20 minutes of vigorous activity per week or equivalent
• Cigarette Smoking


  • Damages the lining of blood vessels and lessens HDL cholesterol and oxygen in the blood
  • Chemicals found in cigarettes are carcinogens
• Unhealthy Eating


  High dietary intakes of saturated fats, trans- fat cholesterol and salt and low intakes of fruits and vegetables and fish are linked to overweight and obesity
• Excessive Alcohol Drinking


  • Ingestion of excessive alcohol may lead to metabolic and physiological effects on all organ systems such as: gastrointestinal and cardiovascular disturbances
  • Linked with colon & rectal cancer, cancer of breast, liver, esophagus, mouth and larynx
  • Cardiovascular disorders include dysrhythmias, cardiomyopathy, hypertension and atherosclerosis
  • Predict diabetes incidence by increasing blood glucose in blood
• Oncoviruses


  Viruses that are capable of causing cancer by breaking the normal cell's DNA chain during infection
• Oncoviruses linked to cancers

  • Human Papillomavirus (HPV) linked in cervical and vulvar cancer
  • Epstein Barr Virus linked in Nasopharynx Cancer and Anal Cancer
  • Human T-lymphotropic virus (HTLV-1) linked with non-Hodgkin lymphoma
  • Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV) linked with liver cancer
• Radiation


  • Energy emitted and transferred through matter and space, including Ultraviolet radiation (UV) and ionizing radiation
  • UV radiation unfavorably affects genes and the cell enzymes producing DNA mutation
  • Ionizing radiation causes tissue and cell harm by breaking the DNA molecule
  • Solar radiation is the chief source of UV radiation and the major cause of skin cancer
  • Ionizing Radiation comprises X-rays, gamma rays and particulate radiation from nuclear accidents, occupational exposure and treatments
• Physical Activity


  Any bodily movement produced by skeletal muscles; results in expenditure of energy and includes occupational, leisure-time and routine daily activities
• Exercise


  Subcategory of physical activity that is planned, structured, repetitive; aimed at improving or maintaining physical fitness or health
• Physical Fitness


  Measure of patient's ability to perform physical activities with vigor & alertness without undue fatigue & with ample energy to enjoy leisure-time pursuits & respond to emergencies. Requires endurance, strength, flexibility, balance, speed, reaction time & body composition.
• Levels of Physical Activity

  • Inactive
  • Low (less than 150 mins / week)
  • Medium (150 - 300 mins of moderate intensity / week or 75 - 150 mins of vigorous intensity physical activity)
  • High Activity of more than 300 minutes of moderate intensity a week
• Metabolic Equivalents (METs)


  The ratio of the rate of energy expenditure during an activity to the rate of energy expenditure at rest
• Examples of Physical Activity by Intensity

  • Low (<3.0 METs): Walking slowly, sitting, light work
  • Moderate (3.0 – 6.0 METs): Walking briskly, cleaning, playing badminton
  • Vigorous (>8.00 METs): Running, hiking, playing basketball