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EOH 3401 PRINCIPLE OF HEALTHBY DR. IRNIZA RASDI
TITLES I. Non-communicable diseases
II. Health Care system in Malaysia
III. Population measures
IV. Mental Health
NON COMMUNICABLE DISEASES
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IntroductionNon-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.
IntroductionThe 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◦ 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
Common cancers in Malaysia
CancerDefinition – a large group of diseases characterized by the uncontrolled growth and spread of abnormal cells
Types of cancersa. Neoplasm – new growth of tissue that serves no physiological functionb. Tumor – clumping of neoplasmic cellsc. Malignant - cancerousd. Benign - noncancerous
Difference between cancer and non cancer cellsNORMAL 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 cancer1. 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 disease-fighting 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
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tobacco useunhealthy dietinsufficient physical activitythe harmful use of alcoholInfections (hepatitis B, hepatitis C (liver cancer), human papillomavirus (HPV; cervical cancer), Helicobacter pylori (stomach cancer) Radiationvariety of environmental and occupational exposures of varying importance
Cancer: Interaction between a person’s genetic factors and any of three categories of external agents
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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.
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
DiabetesDiabetes 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.
DiabetesType Io The body does not produce insulin.o 10% of all diabetes caseso usually develop before their 40th year, often in early adulthood or teenage years.
Type IIo 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 worldwideo People with central obesity, belly fat, or abdominal obesity, are especially at risk
Gestational Diabeteso 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
DiabetesMain symptoms
Complication of diabetesEye 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
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Health Care System in Malaysia
Health care system in Malaysia
Health Care System in MalaysiaMalaysia 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 MalaysiaThe Ministry of Health hospitals are classified in five levels:
I. small district hospitals (visiting specialists only); II. larger district hospitals with resident specialists; III. state-level general hospitals with resident specialists; IV. hospitals with multiple specialties including regional hospitals (that cover several states) and
national hospitals; and V. specialist hospitals or institutions (e.g. for cancer or leprosy).
Health Care system in MalaysiaMore 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 prevention1. 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 cancerWearing 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:
Testing for certain diseases like scoliosis. Treating diseases with medicine, like diabetes and high cholesterol.
Activities that take place once the disease has already occurred to help treat, reverse, or stop the illness. For example:
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: incidence of death and long-term disability
Tertiary prevention:
Physical therapy after an accident
Oxygen for those with breathing problems
Asthma treatments
Rehabilitation activities that will help the patient lead a normal life once the disease has already caused illness or injury. For example:
POPULATION MEASURES
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Population measuresPrevalenceo Point prevalenceo Period prevalence
Incidence
Attack rate
Mortalityo Crude death rateo Specific rate
PrevalenceTotal 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 x 100
Average population during a time period
IncidenceA 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 x 100
Total no. of exposed or at risk during the same period
Crude Death Rate (CDR)
The total number of deaths per year per 1,000 people
Total deaths per year X 1000
Average total population of that year
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 RateThe 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 X 100
No. of person have the specific diseases
MENTAL HEALTH
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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 StressThe 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 Stress1. Physical
- Weight gain/loss
- Unexpected hair loss
- Heart palpitations
- High blood pressure
2. Emotional
- Mood swings
- 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
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