بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم • الحمد لله رب العالمين والصلاة والسلام علي سيدنا محمد الصادق الوعد الأمين ، اللهم أخرجنا من ظلمات الجهل والوهم ، إلى نور المعرفة والعلم..

2. Non-Communicable Diseases Chronic degenerative diseases

3. Importance of NCD • Non communicable diseases are the leading cause of functionary impairment and death worldwide. These conditions have been the leading cause of death in the United States and other high-income countries over the last fifty years, and they are emerging as a leading cause of death in low-to middle-income countries.

4. Deaths across the globe: an overview • Imagine a diverse international group of 1000 individuals representative of the women, men and children from all over the globe who died in 2004. Of those 1000 people, 138 would have come from high-income countries, 415 from middle-income countries and 447 from low-income countries.

5. What would be the top 10 causes of their deaths?

8. The major non communicable diseases are : • Cardiovascular Diseases. • Chronic Obstructive Pulmonary Disease • Diabetes • Hypertension • Cancers • Accidents in its different types

9. Non communicable diseases also include injuries, which have an acute onset, but may be followed by prolonged convalescence and impaired function, as well as chronic mental diseases.

10. Chronic diseases have been defined as : Chronic illnesses. • Non-Communicable. • Degenerative.

11. Characteristics: • Uncertain etiology. • multiple risk factors. • long latency period . • Prolonged course of illness. • non- contagious origin. • functional disability and sometimes incurability .

12. Latency period is the period between contact of the causative agent with susceptible host to the onset of first sign a symptoms. • The cause of many chronic diseases remains obscure, but risk factors identified for some of the leading chronic diseases. The most important among these risk factor is Tobacco use especially in COPD .

13. Strategies for the prevention • Approach to prevention of chronic diseases can be considered under three headings :

14. 1-Primordial prevention: • prevention or avoiding the development of risk factors in the community to prevent the disease in the population and as such protects the individuals. This involves the avoidance of risk behaviors.

15. prevention of disease occurrence by altering susceptibility of the host or reducing exposure of susceptible persons to the risk factors • Examples : immunization , good nutrition , health education , • counseling, environmental sanitation, purification of water , protection against accidents at work place and seat belts.

16. Requires : accurate knowledge of causative agent and process of disease.

17. 2-Primary prevention : • Modifying or reducing the risk factors associated with the development of a disease in individuals with or without the use of interventions, It involves modification of established risk behavior and risk factors with specific interventions to prevent clinically manifest disease

18. That is by early detection , screening by examinations altering the course of disease • Examples : high blood pressure , T.B. Diabetes , Cancer of the breast , Cancer of the cervix colo-rectal cancers, lung cancer etc.

19. 3- Secondary prevention : • Modifying the risk factors in the presence of the manifested disease by changes in lifestyle and/or use of drugs.

20. 4- Tertiary Prevention : • alleviation and limitation of disability improvement of quality of life , Rehabilitation and follow up.

21. Out of all non-communicable illnesses, cardiovascular diseases stay as the leading cause of morbidity and mortality , especially in developed and rich countries. All over the world, almost 1.5 million adults and elderly died in 1995 from heart disease, stroke or other forms of circulatory disease.

22. Cancer is a growing health problem in developing countries, where more than half of the global total of six million deaths occur.

23. Chronic Diseases 2: • Disability or chronicity may be the outcome of many of these chronic diseases and they will not be accounted for by using the mortality indicators as the only indicators for chronic and degenerative diseases :

24. Examples :1- Musculo-sketelal problems • Artihritis and osteoarthritis which may reach in old age a prevalence of 600/1000 persons, and over 300/1000 persons in males. • Rheumatoid arthritis • Low back pain • Foot problems in old age • Scoliosis in children • Congenital hip dislocation • Osteoporosis

25. 2- Neurological disorders • Cerebral palsy • Mental retardation • Epilepsy and other seizure disorders • Headache and migraine • Multiple sclerosis • Alzheimer and dementia • Parkinson disease

26. 3- Psychiatric disorders: • Deppression,Compulsive Obsessional Neuroses and Shcizophrenia. • 4- Other disorders – cataract , glaucoma • 5- Vision and hearing disorders • 6- Genetic disorders – Down’s syndrome,Cystic Fibrosis.

27. We examined the burden of NCDs in the Hashemite Kingdom of Jordan. We computed the projected prevalence of diabetes, hypertension, and high blood cholesterol. All of these risk factors are associated with an increased risk of cardiovascular disease (CVD) — the leading cause of death in Jordan — and increased health care use.

28. In 2005, Jordan’s population was approximately 5.5 million. By 2050, the population is expected to increase to between 8.5 and 14.8 million people. (2) The proportion of older people (aged 60 years or older) is expected to be 15.6% (or approximately 1.8 million people) in 2050, more than 3 times that in 2000 (2).

29. Noncommunicable diseases (NCDs) are a global challenge. During the next several decades, NCDs will govern the health care needs of populations in most low- and middle-income countries because of declines in communicable diseases, conditions related to childbirth and nutrition, changes in lifestyle factors (eg, smoking), and population aging (1).

30. During 2005, NCDs accounted for more than 50% of all deaths in Jordan. Heart disease and stroke (International Statistical Classification of Diseases, 10th Revision, codes I00-I99) accounted for 35% of all deaths; malignant neoplasms (C00-C97) were responsible for 13% of deaths (3).

31. Hypertension • Prevalence: • Hypertension is estimated to cause 4.5% of current global disease burden and is as prevalent in many developing countries, as in the developed world. Blood pressure-induced cardiovascular risk rises continuously across the whole blood pressure range. Countries vary widely in capacity for management of hypertension, but worldwide the majority of diagnosed hypertensive are inadequately controlled.

32. Hypertension affects one in four adults, putting them at higher risk for heart • attacks, kidney disease, atherosclerosis, macular degeneration and stroke. It is • often termed the "silent killer" because as many as 35% of those who have • hypertension do not realize it.

33. More than 60% of all women over age 65 have hypertension. Women over age 75 are much morelikely to develop the disease than men..

34. Coronary heart disease ( CHD) • is the leading cause of death in Industrialized countries • CHD is also called Ischemic heart disease or coronary artery disease . These are several disorders that reduce the blood supply to the heart muscle . The underlying impairment is the atherosclerosis which remains sub clinical .

35. High risk groups: • Men have a higher CHD mortality rates than women twice for men than women , never the less, CHD is the single greatest mortality risk in women : 3 times the risk of breast cancer. • Age : CHD is the leading cause of death for men and women over 65 years of age. • For men- major increases in CHD begin in 35-44 year age group. • For women – marked increase is delayed until after menopause

36. Sub- clinical CHD is more prevalent in older than younger persons. • Black women die at a higher rate than white women from CHD • The Asians in American have approximately half( ½) the CHD mortality than white Americans.

37. Risk factors: • Coronary risk factors are modifiable and non-modifiable . • Modifiable : • Most important factors are : • elevated blood cholesterol • physical in activity • smoking

38. Non- modifiable risk factors are : • Ethnicity. • age. • gender. • socioeconomic status

39. Classification of risk factors by magnitude of the risk • moderate relative risk : high B.P  140/90 • : cigarette smoking • : elevated cholesterol ( 200mg) • : diabetes FBS  140 mg

40. Other modifiable include : • diabetes • obesity • elevated blood homocysteine • dietary factors and inactivity

41. Weak relative risk • obesity • physical in activity • environmental tobacco • smoke exposure

42. Possible relative risk : • alcohol use • elevated plasma homocysteine • infectious agents

43. Selected Risk factors: • Cigarette smoking is a major cause of CHD among men and women • Smokers have twice the risk of heart attack than non-smokers. • Risk of sudden death from heart attack 2-4 times higher in heavy smokers than the risk of non-smokers, CHD death is 2-3 times than non-smokers

44. Stop smoking : rapid reduction of CHD mortality it takes 10 years to become normal. • Passive smoking – increased risk of CHD than non-exposed. • Arteriography of non-smoking exposed women with CHD showed number of stenotic arteries correlated with exposure.

45. Cholesterol : CHD increases steadily with increase of cholesterol blood level. • < 200 mg : low risk of CHD •  240 mg : risk doubles.

46. High levels of LDL are leading factor in progression of atherosclorosis and development of CHD. • Evidence supporting the association of elevated blood triglycerides and CHD has been mounting in recent years. The level of HDL is inversely related to CHD however the lower level of HDL < 35mg increases the risk of CHD.

47. Diabetes is considered a major CHD risk factor CHD is the most common cause of morbidity and mortality among diabetics – 2-4 times higher than non-diabetics. • Risk is higher in diabetic women than diabetic men. • Homocysteine , increased attention as a potential modifiable risk factor for acute CHD. • Plasma levels of homocysteine , positively associated with risk of CHD.

48. Homocysteine : an inborn metabolic error leads to extremely high levels of homocysteine people with this error, have strokes before age 30 years . • People with moderately high homocysteine levels have not been shown to be at increased risk of CHD.

49. Obesity : . Body mass index (kg/m2) BMI ( weight) • ratio of weight to height > (height ) 2 • Overweight : BMI > 27.8 kg/m2 in males • : BMI > 27.3 kg /m2 in females

50. prevalence of overweight increased dramatically in the USA • Poverty is related to obesity in women • Death from CHD is associated with obesity at the upper range of body weight BMI  30 kg/m2 . • Under the age of 50 years, men and women with relative weight of 130% or more – associated with two fold increase in risk of CHD.