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

Click icon to add picture

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

6

Cardiovascular diseases:Contributing factors

7

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

12

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

13

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

Click icon to add picture

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

Click icon to add picture

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

Click icon to add picture

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

Thank you