CPHMLS - Lesson 4

Noncommunicable Diseases

NON-COMMUNICABLE DISEASES

Are chronic conditions that are not caused by acute infections and generally have long durations, slow progression, and are strongly influenced by lifestyle, environmental, genetic, and metabolic factors.

NON-COMMUNICABLE DISEASES

are the leading cause of morbidity and mortality worldwide.

NON-COMMUNICABLE DISEASES

are caused by lifestyle, environment, genetic, metabolic, physiological factors

pathogens

Pano daw tayo nakakakuha ng sakit? Through

bacteria, viruses, fungi, parasites

4 pathogens

environmental exposure, occupational exposure, accidental exposure

How do we get exposed to those pathogens? Through

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NON-COMMUNICABLE DISEASES

• Account for over __% of global deaths.

low- and middle-income countries (LMICs)

NON-COMMUNICABLE DISEASES

• Occur in ________________________________________ due to epidemiological transition, rapid urbanization, and changing lifestyles.

NON-COMMUNICABLE DISEASES

Contribute significantly to healthcare costs, lost productivity, and socio- economic burdens.

I. Integrated community-based non-communicable diseases (NCD) prevention and control program aimed at preventing the 4 major NCD or chronic diseases or lifestyle-related disease

1. Cardiovascular diseases

2. Cancer

3. Chronic Obstructive Pulmonary disease 

4. Diabetes mellitus

II. Prevention and control of other NCD particularly mental disorders, blindness, renal disease and programs for persons with disabilities

DOH approach to NCDs

Cardiovascular diseases

Cancer

Chronic Obstructive Pulmonary disease

Diabetes mellitus

What are the 4 major NCD or chronic diseases or lifestyle-related diseases?

• These are widely recognized as the principal non-communicable diseases in the Philippines and are mostly lifestyle-related like pagyoyosi, unhealthy diet, physical inactivity, and harmful use of alcohol.

• Cancer is an exception because it can be genetical

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NCDs in the Philippines

• NCDs now account for about __% of all deaths in the Philippines.

Ischemic heart diseases (heart attacks and related)

Neoplasms (cancers)

Cerebrovascular diseases (stroke)

Another type of cardiovascular disease

Diabetes mellitus

NCDs in the Philippines

• Top causes of death in 2023 were (5)

ischemic heart disease, cancer, cerebrovascular diseases

NCDs in the Philippines

• In 2024, preliminary figures for January–May still show _______________________, at the top, with ______ and ________________________ continuing as leading causes, followed by other chronic conditions.

NCDs

2020s

• ~70% of all deaths are due to ____ such as heart disease, cancer, stroke, and diabetes.

ischemic heart disease, cancer, cerebrovascular disease, and diabetes

2020s

• The top killers remain _________________________________________________________ based on recent PSA data.

lifestyle, behavioral

2020s

• NCDs are still strongly linked to ______ and ________ risk factors

30-70

2020s

• There is a risk of premature NCD mortality between the ages __-__ yrs old

cardiovascular diseases

2020s

• Top killers are

Modifiable

Non-Modifiable

Risk Factors of NCDs (2)

Modifiable

Risk Factor of NCDs

• Changeable, habits can be broken

• Behavioral Risk Factors

Non-modifiable

Risk Factor of NCDs

• Hindi mababago

Tobacco smoking

Physical inactivity

Unhealthy diet

Harmful Alcohol use

Behavioral Risk Factors (4)

Tobacco smoking

Which Behavioral Risk Factor

• Associated with cardiovascular disease, COPD, cancer

Physical inactivity

Which Behavioral Risk Factor

• Obesity, cardiovascular diseases, Type II diabetes

Unhealthy diet

Which Behavioral Risk Factor

• Obesity, lipidemia, hypertension, insulin resistance

end-stage

Through the years nag bbuild up ang cardiovascular disease, pag nagmanifest na, ibig sabihin ________ na siya

Obesity, Hypertension, Dyslipidemia, hyperglycemia, chronic inflammation

Metabolic/Physiological Risk Factors (5)

Metabolic/Physiological Risk Factors

these are clustered in individuals as metabolic syndrome and greatly magnify the risk of getting a disease

Modifiable

Metabolic/Physiological Risk Factors: Obesity, Hypertension, Dyslipidemia, hyperglycemia, chronic inflammation

Modifiable or non-modifiable?

Age

Genetics and Family history

Sex

Ethnicity

Non-Modifiable (4)

Reduce the toll of morbidity, disability and premature deaths due to chronic, NCD, lifestyle related disease

What is the goal of the Risk Factors of NCDs?

Analyze the social, economic, political and behavioral determinants of NCD that will serve as bases for:

• Developing policy guidelines

• Providing financial measures to support NCD

Reduce exposure of individuals and population to major determinants of NCD

Strengthen health care for people with NCD through health sector reforms and cost effective interventions

What are the objectives of the Risk Factors of NCDs?

HEALTH EDUCATOR

• Essential tool to achieve community health

• Concern with promoting health as well as reducing behavior-induced diseases

• goal is to let people become aware about these diseases

curative

preventive

• Ang role ng physicians is ________, may particular person kang ginagamot

• Ang goal sa CPH is __________, bago pa magkasakit dapat may awareness na ang mga tao via methods like seminars or programs

inform the people

Motivate the people

Guide the people into action

Health educator aims to:

CARDIOVASCULAR DISEASES

CANCER

DIABETES MELLITUS

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

CAUSES AND RISK FACTORS OF MAJOR NON-COMMUNICABLE DISEASES

CARDIOVASCULAR DISEASES

• Disease of the heart and blood vessels

1

CARDIOVASCULAR DISEASES

Number _ cause of death globally.

blood thinners

• Image shows a progressive thickening of plaque in the heart through the yrs, hanggang di na makaflow ung blood

• Need daw dito is ______________ such as: Warfarin, Coumadin, Aspirin

• Kada quadrant sa heart, dapat may good flow, if may isang portion na infarct (may bara), titigil ang pagtibok ng puso

one-third

CARDIOVASCULAR DISEASES

Epidemiology:

• Account for roughly _________ of all global deaths.

Ischemic heart disease (coronary artery disease)

Stroke

Heart failure

Hypertensive heart disease

CARDIOVASCULAR DISEASES

Most common forms: (4)

HYPERTENSION (HPN)

• is defined as sustained elevation in mean arterial pressure. It is not a single disease state but a disorder with many causes, a variety of symptoms and a range of responses to therapy

There is no single cause for HPN

HYPERTENSION (HPN)

what is the single cause for this?

family history

age

high salt intake

obesity

excessive alcohol intake

HYPERTENSION (HPN)

several risk factors have been implicated in its development (5)

Family History

HYPERTENSION (HPN)

Several risk factors have been implicated in its development:

• people with positive family history of HPN are twice at risk than those with no history

Age

HYPERTENSION (HPN)

Several risk factors have been implicated in its development:

• older person are at greater risk

Obesity

HYPERTENSION (HPN)

Several risk factors have been implicated in its development:

• risk is twice greater among overweight/obese

Excessive alcohol intake

HYPERTENSION (HPN)

Several risk factors have been implicated in its development:

• regular consumption of 3 or more drinks per day increases risk of HPN.

Encourage proper nutrition

Prevent becoming overweight/obese

Smoking cessation

Identify people at risk and encourage regular check-up

Key areas for prevention of HPN: (4)

CORONARY ARTERY DISEASE (CAD)

• It is a heart disease caused by impaired coronary blood flow

Ischemic Heart disease

CORONARY ARTERY DISEASE (CAD)

• It is known as __________________

angina

CORONARY ARTERY DISEASE (CAD)

• When the coronary arteries become narrowed or clogged, supply of blood and oxygen to the heart muscle is affected.

• When there is decreased oxygen supply to the heart muscle, chest pain occurs (______)

myocardial infarction (heart attack)

arrhythmias

heart failure

sudden death

CORONARY ARTERY DISEASE (CAD)

• CAD can cause (4)

false (through the years)

CORONARY ARTERY DISEASE (CAD)

plaque builds up overnight (true or false)

atherosclerosis

CORONARY ARTERY DISEASE (CAD)

Etiology/cause:

• The most common cause is the thickening of the inside wall of the arteries due to deposition of fat-like substance (_______________).

high levels of cholesterol

CORONARY ARTERY DISEASE (CAD)

Etiology/cause:

• It usually occurs when a person has _______________________ in the blood.

HDL

good cholesterol

LDL

bad cholesterol

High lipid and cholesterol level in the blood=high HDL

Smoking

Obesity

Physical inactivity or sedentary lifestyle

Stress

CORONARY ARTERY DISEASE (CAD)

Risk factors:

• Modifiable risk factors (5)

Hereditary or family history

Gender

Age

CORONARY ARTERY DISEASE (CAD)

Risk factors:

• Non Modifiable risk factors (3)

  • Hereditary or family history

  • Gender

  • Age

Promote regular physical activity and exercise

Encourage proper nutrition by limiting intake of saturated fats that increase LDL, limiting salt intake and increasing intake of dietary fibers

Prevent becoming overweight

Key areas for prevention of CAD: (3)

lipid profile

test for CAD

• requires 10-12hrs fasting, ito kc may triglyceride, cholesterol, LDL & HDL

CEREBROVASCULAR DISEASE OR STROKE

• Loss of alteration of bodily function that results from an insufficient supply of blood to some parts of the brain.

blood

CEREBROVASCULAR DISEASE OR STROKE

• If _____ is obstructed for more than several minutes, injury to the brain cells becomes permanent and tissue dies in the affected region resulting in cerebral infarction.

Thrombotic stroke

Embolic stroke

Hemorrhagic stroke

Three types of stroke

Thrombotic stroke

CEREBROVASCULAR DISEASE OR STROKE

Type of stroke

• usually occurs in atherosclerotic blood vessels commonly seen in older people.

• A subtype of ischemic stroke

• Artery has fats

• Older people are usually hypertensive and have hyperlipidemia and correlate with diabetes mellitus, which is why they are susceptible to this

• is a gradual onset and may be preceded by an ischemic attack

Embolic stroke

CEREBROVASCULAR DISEASE OR STROKE

Type of stroke

• caused by a moving blood clot usually from a thrombus in the left heart that becomes lodged in a small artery through which it cannot pass

• Mainly an ischemic stroke

• Sudden onset

• Clots can originate from other parts of the body, for example if clots come from lower extremities (foot), it may get stuck in the lungs. If it comes from the upper body, it may get stuck in the brain.

Hemorrhagic stroke

CEREBROVASCULAR DISEASE OR STROKE

Type of stroke

• most fatal type of stroke, rupture of intracerebral blood vessel

• Rupture, which causes internal bleeding

• How it ruptures, 2 types: Intracerebral, Subarachnoid hemorrhage. Bat nagkakaroon ng 2? Through the years may chronic hypertension, may Cerebral aneurysm and arteriovenous malfunction

embolus (blood clot)

CEREBROVASCULAR DISEASE OR STROKE

Type of stroke

Embolic stroke

• Caused by

Increasing age

Sex-women

Heredity and race

Hypertension

Cigarette smoking

Diabetes mellitus

heart disease

High RBC count – thicken the blood and make clots more likely

Season and climate

Socio-economic factors

Certain kinds of drug abuse

CEREBROVASCULAR DISEASE OR STROKE

Risk factors: (11)

Treatment and control HPN

Smoking cessation

Limit alcohol consumption

Avoid intravenous drug abuse

Prevent all other risk factors of atherosclerosis

CEREBROVASCULAR DISEASE OR STROKE

Key areas for prevention of stroke: (5)

CANCER

• ______ develops when cells in a part of the body begin to grow out of control. ______ cells continue to grow and divide even when there is no need to do so. Instead of dying they outlive normal cells and continue from new abnormal cells. They compete with normal cells for the blood supply and nutrients.

metastasis

CANCER

• Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue, __________

Stage 0 (In situ)

Stage 1 (Localized Spread)

Stage 2 & 3 (Regional Spread)

Stage 4 (Distant Spread)

4 stages of cancer

Stage 0 (In situ)

Which stage of cancer?

• Cancer cell begins to grow in healthy tissue (non detectable by body; NK cells recognize it as healthy cells as it originated from inside the body)

Stage 1 (Localized Spread)

Which stage of cancer?

• cancer begins to spread on localized tissue (still not detectable)

Stage 2 & 3 (Regional Spread)

Which stage of cancer?

• cancer spreads to lymph vessel palabas ng local tissue, ready to invade other cells, is now metastasizing meaning kumakalat (Detectable by body, malala na ang cancer, slow detection is why mabagal prognosis natin sa cancer) 

Stage 4 (Distant Spread)

Which stage of cancer?

• cancer now harboring other tissue

Hereditary/family history

Carcinogens

Causes of Cancer: (2)

Polycyclic hydrocarbons

Benzopyrene

Nitrosamines

Radiation

Viruses

Aflatoxin

Causes of Cancer:

Carcinogens (6)

carcinogens

agents capable of causing cancer, maybe chemical, environmental agent, radiation

Polycyclic hydrocarbons

Causes of Cancer:

Carcinogens

are chemicals found in cigarette smoke, industrial agents and in smoked foods.

Benzopyrene

Causes of Cancer:

Carcinogens

produced when meat and fish are charcoal broiled or smoked, also produced when food is fried in fat that has been reused repeatedly

Nitrosamines

Causes of Cancer:

Carcinogens

powerful carcinogens used as preservatives in foods like tocino, longanisa, bacon, hotdogs

Radiation

Causes of Cancer:

Carcinogens

UV rays from sunlight, x-rays

Aflatoxin

Causes of Cancer:

Carcinogens

found in peanuts and peanut butter

1. smoking cessation

2. encourage proper nutrition

• increase intake of dietary fibers

• limit consumption if smoked, charcoal-broiled, salt cured foods.

3. drink alcohol beverages in moderation

4. control obesity

5. early diagnosis and prompt treatment

Key areas for primary prevention of cancers (5)

DIABETES MELLITUS

• Genetically and clinically heterogeneous group of metabolic disorder characterized by glucose intolerance with hyperglycemia present at time of diagnosis

• Has chronic and a lifelong course, strongly linked to lifestyle and genetic factors, requires long term management and monitoring

• Results in significant morbidity and mortality, can cause disability

• May cause other complications such as heart disease, brain damage or stroke, nephropathy (kidney failure), blindness, stroke, neuropathy, etc.

Insulin & Glucagon

regulates blood sugar level (Pancreas)

2

DIABETES MELLITUS

Epidemiology:

• One of the fastest-growing NCDs worldwide.

• The majority (>90%) of cases are type _ DM.

• Common in regions experiencing lifestyle changes and aging populations.

TYPE I- Insulin dependent Diabetes Mellitus (IDDM)

TYPE II- Non-insulin Dependent Diabetes Mellitus (NIDDM)

Types of Diabetes Mellitus (2)

TYPE I- Insulin dependent Diabetes Mellitus (IDDM)

Type of Diabetes Mellitus

• Pancreas fails to produce insulin

• Characterized by absolute lack of insulin due to damaged pancreas

• Dependent on insulin injections

• Pancreas transplant is possibly needed 

• Genetic, environmental or maybe acquired

• May occur at any age

• May be autoimmune, immune system attacking pancreas Beta-cells

TYPE II- Non-insulin Dependent Diabetes Mellitus (NIDDM)

Type of Diabetes Mellitus

• More common, 90-95% of all person with obesity and diet

• Possible causes include impaired insulin secretion and increased hepatic glucose production

• Usually in older and overweight persons

• Pancreas produces insulin, but insulin receptor rejects it, may resistance

• May develop in older and overweight people if your lifestyle isn't so good, strongly linked to lifestyle

• May also be seen as early as teenage years

• Fasting Blood Sugar ang test dito

GESTATIONAL DIABETES

• develops during pregnancy and may lead to type II DM

• Normally happens after mapanganak si baby

• If nanganak, tumaas blood sugar tas di bumalik to normal, may type II DM na siya

encourage proper nutrition

maintain body weight and prevent obesity

promote regular exercise

smoking cessation- DM patients who smoke have higher risk of heart attack and stroke

Key areas for prevention and control of diabetes: (4)

MODY

Other Specific Types of Diabetes

• ____ is a monogenic form of diabetes caused by mutations in a single gene affecting insulin production.

Maturity Onset Diabetes of the Young

Other Specific Types of Diabetes

MONOGENIC DIABETES

• MODY - _____________________________

MONOGENIC DIABETES

Other Specific Types of Diabetes

• Usually seen in non-obese, symptoms are mild glycemia, can be managed by an oral agent in some cases

• Usually autosomal dominant inheritance

• Before 25-35 years of age

• Not autoimmune (unlike type 1 diabetes)

SECONDARY DIABETES

Other Specific Types of Diabetes

• Diabetes that develops secondary to another condition, disease, or factor that impairs insulin production or action.

• May come from conditions like heart, pancreatic disease, endocrine disorder, genetic syndrome, infection, etc.

• For example may pancreatitis ka, nagpagamot ng steroids, immunosuppressants, or anti-psychotic drugs, usage may lead to endocrine disorder and can bring insulin resistance