Non-communicable Disease Prevention And Control 491a5k

By: Maria Christina E. Bay, RN, MAN

NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

I. INTEGRATED COMMUNITY BASED NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL PROGRAM Four major non-communicable diseases(also known as chronic diseases or lifestyle related diseases): -cardiovascular diseases -cancer -chronic obsructive pulmonary diseases -diabetes mellitus 

-IN 2005, IT WAS ESTIMATED THAT 35 MILLION DEATHS WOULD HAVE OCCURRED DUE TO THESE DISEASES, CONTRIBUTING 60% OF DEATHS WORLDWIDE. -THE MOST WIDELY USED SUMMARY MEASURE OF THE BURDEN OF DISEASE IS THE DISABILITY ADJUSTED LIFE YEAR OR DALY, W/C COMBINES THE NUMBER OF YEARS OF HEALTHY LIFE LOST TO PREMATURE DEATH WITH TIME SPENT IN LESS THAN FULL HEALTH. ONE DALY CAN BE THOUGHT OF AS ONE LOST HEALTHY YEAR OF LIFE.

-IN THE PHILIPPINES, INCREASING LIFE EXPECTANCY, URBANIZATION AND LIFESTYLE CHANGES HAVE BROUGHT ABOUT A CONSIDERABLE CHANGE ON THE HEALTH STATUS OF THE COUNTRY. -GLOBALIZATION AND SOCIAL CHANGE HAS INFLUENCED THE SPREAD OF NON-COMMUNICABLE OR LIFESTYLE/DEGENERATIVE DISEASES BY INCREASING EXPOSURE TO RISK.

-THE LIFE EXPECTANCY OF FILIPINOS IN 2002 HAS GONE UP TO 69.6 YEARS. THE PROCESS OF AGING BRINGS OUT PROBLEMS THAT ARE DEGENERATIVE IN NATURE. -MORTALITY STATISTICS IN 2002 SHOWED THAT 7 OUT OF 10 LEADING CAUSES OF DEATHS IN THE COUNTRY ARE DISEASES W/C ARE LIFESTYLE RELATED: 1.DISEASES OF THE HEART AND THE VASCULAR SYSTEM 2.CANCERS 3.COPD 4.ACCIDENTS 5.DIABETES 6.KIDNEY PROBLEMS

-MORBIDITY STATISTICS IN 2002 ALSO SHOWED THAT HYPERTENSION AND DISEASES OF THE HEART ARE AMONG THE TOP TEN LEADING CAUSES OF ILLNESSES IN THE COUNTRY. -THESE DISEASES ARE LINKED BY THREE MAJOR RISK FACTORS: 1.TOBACCO SMOKING 2.PHYSICAL INACTIVITY 3.UNHEALTHY DIET -THE RESULT OF THE NATIONAL NUTRITION AND HEALTH SURVEY CONDUCTED IN 2003 CONCLUDED THAT PRESENTLY 90% OF FILIPINOS HAS ONE OR MORE RISK FACTORS ASSOCIATED W/ CHRONIC, NON-COMMUNICABLE DISEASES.

-A MAJOR STRATEGY TO PREVENT THESE DISEASES IS HEALTH PROMOTION. -ADDRESSING THE MAJOR RISK FACTORS SHOULD BE GIVEN THE HIGHEST PRIORITY IN THE PREVENTION AND CONTROL OF LIFESTYLE RELATED DISEASES. HEALTHY LIFESTYLE-IS OPERATIONALLY DEFINED AS A WAY OF LIFE THAT PROMOTES AND PROTECTS HEALTH AND WELL-BEING.

HEALTHY LIFESTYLE: -INCLUDE PRACTICES THAT PROMOTES HEALTH SUCH AS HEALTHY DIET AND NUTRITION, REGULAR AND ADEQUATE PHYSICAL ACTIVITY AND LEISURE, AVOIDANCE OF SUBS., ADEQUATE STRESS MANAGEMENT AND RELAXATION, AND PRACTICES THAT OFFER PROTECTION FROM HEALTH RISKS LIKE SAFE SEX AND IMMUNIZATION.

APPROACHES TO CHARACTERIZE THE PROGRAM(NCD’S)

1.Comprehensive Approach Focused on Primary Prevention -includes: a.Prevention of emergence of risk factors referred to as primordial prevention b.Specific protection from NCD by removal of the risk factors or reduction in their levels.

2. COMMUNITY-BASED APPROACH -COMMUNITY-BASED NCD PREVENTION AND CONTROL PROGRAM RECOGNIZES PEOPLE AS THE CENTER OF ANY HEALTH AND DEVELOPMENT EFFORT. -KEY INGREDIENTS TO SUCCESSFUL AND SUSTAINABLE COMMUNITY-BASED HEALTH INITIATIVES: 1.ACTIVE COMMUNITY PARTICIPATION 2.INVOLVEMENT OF COMMUNITY LEADERS, COMMITTEES, AND GROUPS 3.STRONG AND GUIDANCE FROM LOCAL GOVERNMENTS AND TECHNICAL EXPERTS 4.MULTI-SECTORAL COLLABORATION

3. INTEGRATED APPROACH -A HEALTHY COMMUNITY CONTRIBUTES TO THE SOCIO-ECONOMIC DEVELOPMENT OF THE COMMUNITY. KEY INTERVENTION STRATEGIES: 1.ESTABLISHING PROGRAM DIRECTION AND INFRASTRUCTURE-COMMUNITY DIAGNOSIS, ESTABLISHING A TEAM 2.CHANGING ENVIRONMENTS-ESTABLISHING PARTNERSHIP AND INTERSECTORAL COORDINATING MECHANISM 3.CHANGING LIFESTYLE-RAISING PUBLIC AWARENESS THROUGH MASS MEDIA AND OTHERS. 4.REORIENTING HEALTH SERVICES-HEALTH SERVICE DELIVERY

THE ROLE OF PUBLIC HEALTH NURSE IN NCD PREVENTION AND CONTROL

1.Health Advocate -PHN promote active community participation in NCD prevention and control through advocacy work. -involves in informing the people about the rightness of the cause (problem);discussing with the people the nature of the alternatives, their content and consequences; ing people’s right to make a choice and to act on the choice; imnfluencing public opinion.

2. HEALTH EDUCATOR -HEALTH EDUCATION IS AN ESSENTIAL TOOL TO ACHIEVE COMMUNITY HEALTH -CONCERNED WITH PROMOTING HEALTH AS WELL AS REDUCING BEHAVIOR-INDUCED DISEASE. -HEALTH EDUCATION FOCUSES ON ESTABLISHING OR INDUCING CHANGES IN PERSONAL AND GROUP ATTITUDES AND BEHAVIOR THAT PROMOTE HEALTHIER LIVING. -AIMS TO: 1.INFORM THE PEOPLE 2.MOTIVATE THE PEOPLE 3.GUIDE PEOPLE IN ACTION

3. HEALTH CARE PROVIDER -EMPHASIS OF CAREIS ON HEALTH PROMOTION AND DISEASE PREVENTION FOCUSING ON PROMOTION OF RATIONAL DIET AND PHYSICAL ACTIVITY AND CESSATION OF SMOKING AND ALCOHOL DRINKING. -IN THE DOMAIN OF CLINICAL MEDICINE, SEEKS TO RELIEVE PAIN, ARREST OR CURE THE DISEASE AND PREVENT DISABILITY AND DEATH THROUGH PROVISION OF ACTIVITIES.

4. COMMUNITY ORGANIZER -THE ULTIMATE GOAL OF THE PHN IS COMMUNITY HEALTH DEVELOPMENT AND EMPOWERMENT OF THE PEOPLE. 5. HEALTH TRAINER -PROVIDES TECHNICAL ASSISTANCE IN THE ASSESSMENT OF SKILLS OF AUXILLARY WORKERS 6. RESEARCHER -CONDUCTS COMMUNITY ASSESSMENTS, EPIDEMIOLOGICAL STUDIES, AND INTERVENTION STUDIES

II. CAUSES AND RISKS FACTORS OF MAJOR NCD’S

Five major NCDs: A. Diseases of the Heart and Blood vessels(CVD) 1.Hypertension-major risk factor for dev’t.of coronary heart dse and stroke Classification: a.Primary-also called essential hpn or idiopathic hpn. 90% of hypertensives. b.Secondary-result of other primary dses like renal dse.

RISK FACTORS: 1.FAMILY HISTORY-TWICE AT RISK THAN THOSE WITH NO HISTORY 2.AGE-OLDER PERSONS ARE AT GREATER RISK 3.HIGH SALT INTAKE-ELEVATION IN BLOOD VOL. 4. OBESITY-TWO TIMES GREATER AMONG OVERWEIGHT/OBESE 5.EXCESSIVE ALCOHOL INTAKE-REG.CONSUMPTION OF THREE OR MORE DRINKS PER DAY LEAD TO HPN.

KEY AREAS FOR PREVENTION OF HYPERTENSION  

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Proper nutrition-reduce fat and salt intake Prevent overweight or being obese-exercise, nutrition Smoking cessation-tobacco use leads to atherosclerosis Identify people with risk factors and encourage reg.check-ups

2. CORONARY ARTERY DISEASE(CAD) 

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Also known Ischemic Heart Disease Caused by impaired coronary blood flow Can cause MI,arrhthmias, heart failure, and sudden death Most common cause is atherosclerosis or thickening of the inside walls of arteries due to deposition of a fat-like subs.

RISK FACTORS OF CAD: 1.ELEVATED BLOOD LIPIDS/CHOLESTEROL -HIGH LDL(LOW-DENSITY LIPOPROTEIN)LEVEL IS A RISK FACTOR OF CAD -BAD CHOLESTEROL HDL-PROTECTIVE FACTOR 2.SMOKING/TOBACCO USE -RISK OF DEATH FROM CAD IS 70-200 TIMES GREATER FOR MEN THAN THOSE WHO DO NOT SMOKE. -RISK IS MOST SEEN 50 YEARS OLD BELOW.

KEY AREAS OF PREVENTION OF CAD

Reg.exercise and physical activity  Proper nutrition  Maintain body weight  Smoking cessation  Early diagnosis, prompt treatment and control 

3. CEREBROVASCULAR DISEASE OR STROKE (CVA)

Insufficient supply of blood to the brain.  Leading cause of disability  Three types based on cause: -thrombotic stoke -embolic stroke -hemorrhagic stroke The most fatal is due to intracerebral hemorrhage 

RISK FACTORS: 1.INCREASING AGE 2.SEX 3.HEREDITY AND RACE 4.HYPERTENSION 5.CIGARETTE SMOKING 6.DIABETES MELLITUS 7.HEART DISEASE 8.HIGH RED BLOOD CELL COUNT 9.SEASON AND CLIMATE 10.SOCIOECONOMIC FACTORS 11.EXCESSIVE ALCOHOL INTAKE 12.CERTAIN KINDS OF DRUG ABUSE

KEY AREAS FOR PREVENTION OF STROKE Tx or control of hpn  Smoking cessation  Appropriate medications to prevent thrombus formation  Limit alcohol consumption  Avoid IV drug abuse and cocaine  Prevent other risk factors of atherosclerosis 

B. CANCER Not a single disease  Many types of cancers as there are many types of tissues in the body  Develops when cells in a part of the body begin to grow out of control  Immune system play a role in devt.of cancer 

CAUSES OF CANCER/RISK FACTORS 

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Heredity/family history Carcinogens Chemicals and environmental agents-polycyclic hydrocarbons found in cigarette smoke, smoked foods, industrial agents.Aflatoxin in peanuts. Benzopyrene-smoked fish Nitrosamines-preservative foods like tocino. Inhibit Vit.C in the stomach. Radiation Viruses

RISK FACTORS OF CANCER Include persons age, sex, and family medical history  Different kinds of Cancer: 1.Lung cancer 2.Oral cancer 3.Laryngeal cancer 4.Bladder cancer 5.Renal cancer 6.Cervical cancer 7.Esophageal cancer 8.Breast cancer 9.Prostate cancer 10.Liver cancer 11.Skin cancer 12.Colonic cancer 13.uterine/endometrial cancer 

KEY AREAS FOR PREVENTION OF CANCERS

Smoking cessation  Proper nutrition  Alcoholic beverages in moderation  Control obesity  Treatment begins once diagnosed. 

C. DIABETES MELLITUS One of the leading causes of disability in persons over 45.  More than half of diabetic persons will die of coronary heart disease  DM is not a single disease.  Characterized by glucose intolerance  Etiology/causes: 2 factors: -genetics(diabetogenetic genes) -environment/lifestyle 

TYPES: 1.IDDM 2.NIDDM GESTATIONAL DIABETES KEY AREAS: -MAINTAIN BODY WEIGHT -PROPER NUTRITION -REGULAR PHYSICAL ACTIVITY/EXERCISE -SMOKING CESSATION

D. CHRONIC OBSTRUCTIVE PULMONARY DISEASE9COPD) -major cause of chronic morbidity and mortality throughout the world -fourth leading cause of death in the world-because of smoking -characterized by airflow limitation that is not fully reversible -causes-cigarette smoking -diagnosis-symptoms and spirometry -complications-respiratory failure Cardiovascular dse

E. BRONCHIAL ASTHMA 

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Chronic disease Inflammatory disorders of the airways with wheezing, breathlessness, chest tightness, coughing. Causes/risk factors:genetic and environmental components Triggers are risk factors for asthma exacerbations. Provoke bronchoconstrictions. Causal factors are allergens and occupational agents

KEY AREAS FOR PREVENTION AND EXACERBATION OF ASTHMA

Recognizes triggers  Avoid these triggers  Promote exclusive breastfeeding as possible 

II.RISK ASSESSMENT AND SCREENING PROCEDURES 

The basis of non-communicable disease prevention is the identification of the major common risk factors and their prevention and control.

RISK FACTOR ASSESSMENT   

A. Cigarette Smoking-smoker or not B. Nutrition and diet- having 24-hour food diary w/c includes vegetables, fruits, fats, sodium taken. Guideline: C. Overweight/Obesity-getting the BMI(Body Mass Index) and waist circumference.

-weighing is the simplest way of knowing if energy balance is achieved.

BODY MASS INDEX(BMI) 

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Is calculated using this formula: BMI= weight in kgs/height in meters Waist circumference(WC)-is accurate measure of the amount of visceral fat. that central obesity is a significant risk factor to heart disease and stroke. Obesity guidelines:

CLINICAL THRESHOLDS: Men<90cm(35 inches)  Women<80cm(31.5 inches) -greater than this is not normal. Degree of Risk on Body Mass Index and Waist Circumference: Waist Hip Ratio(WHR)-another useful measure of obesity obtained by dividing the waist circumference at the narrowest point by the hip circumference at the widest point. 

FORMULA: WHR WHR=waist circumference(cm) ____________________ hip Circumference(cm) WHR interpretation: 

D. Physical inactivity/Sedentary lifestyle-type of work, means of transportation, lesure.  Guideline:  E. Excessive alcohol drinking-habitual alcohol intake and risky behavior 

SCREENING 

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According to WHO, it is the presumptive identification of unrecognized disease or defect by the application of tests, examination or other procedures which can applied rapidly. Primary goal is to detect the disease in its early stages to be able to treat it and prevent further development. DOH name this lifestyle diseases like CVD and hypertension, DM, cancer, COPD,asthma.

A. Screening for hypertension-systolic of 140mmhg or more and diastolic of 90mmhg. -most accurate and reliable is auscultatory method. Mercury or aneroid BP apparatus. B. Screening for elevated cholesterol in the blood -taking a small blood sample and testing for total blood cholesterol. 

C. Screening for Diabetes Mellitus -hallmark of dx is presence of hyperglycemia. -FBS -2 hour blood sugar test D. Screening for cancer -early detection and prompt tx -CURE RATE- depends on the type of cancer -CAUTION US-cancer warning signals 

E. Screening for COPD -characteristic symptoms: -cough -sputum production -dyspnea upon exertion Spirometry-det.degree of obstruction F. Screening for Asthma -hallmark is demonstration of reversibility of airway obstruction. -suspect asthma of cardinal sxs like dyspnea, cough, wheezing, chest discomfort 

ROLE OF THE PUBLIC HEALTH NURSE IN RISK ASSESSMENT AND SCREENING Educate on the warning signs  Educate to prevent NCD  Assessment of the presence of risk factors and early signs of NCD  Train other health workers If risk factors are present:  Confirm/advise retesting  Explain the significance of findings  Educate to modify risk factors  Monitor and ff-up schedule  Refer for confirmation of diagnosis 

IV. PROMOTING PHYSICAL ACTIVITY AND EXERCISE

Physical activity-done at home like washing dishes, sweeping, cleaning the house  Exercise-planned, structured, and repetitive movement done to improve or maintain one or more components of physical fitness. Like walking, jogging, aerobics. 

ROLE OF PUBLIC HEALTH NURSE 

Has the responsibility of increasing their knowledge and skills needed to engage in physical activities and exercise and motivate them to be physically active.

V. PROMOTING PROPER NUTRITION

Eating a balanced diet  Nutrition-related problems that lead to NCD: -obesity -increased fat intake -increased salt intake -inadequate dietary fiber 

STRATEGIES TO PROMOTEVHEALTHY-NUTRITIONRELATED PRACTICES

ABC:  Aim for ideal body weight  Build healthy nutrition-related practices  Choose foods wisely Nutritional guidelines for Filipinos

ROLE OF PUBLIC HEALTH NURSE Educate on a balanced and healthy diet  Assess for weight problems and unhealthy practices  Screen  Advise and counsel  Make referrals  Advocate for a ive environment 

VI. PROMOTING A SMOKE-FREE ENVIRONMENT Smoking is the most common of all major factors that lead to the dev’t of NCD’s.  Development of smoking-related diseases are associated with: -no.of cigarettes smoked -duration of smoking -age started smoking -pattern of inhaling 

Harmful substances in Tobacco: -tar -nicotine -carbon monoxide Tobacco contains more than 4000 chemicals, 43 of w/c have been proven carcinogenic. Quitting can reduce risk. 

ROLE OF THE PUBLIC HEALTH NURSE

Assisting smokers to quit  Promoting a smoke-free environment 

VII. PROMOTING STRESS MANAGEMENT Stress management techniques: -spirituality -self-awareness -scheduling: time management -siesta-taking a nap, short rest, a break for relaxation -stretching -sensation techniques -sports -socials -sounds and songs -speak to me -stress debriefing -smile 

II. PROGRAMS FOR THE PREVENTION AND CONTROL OF OTHER NON-COMMUNICABLE DISEASES

National prevention of blindness program  Vision/mission,goals and objectives  Interventions by eye disorder: -cataract -errors of refraction -childhood blindness 

MENTAL HEALTH AND MENTAL DISORDERS WHO define mental health as a state of well-being where a person can realize his or her own abilities to cope with normal stresses of life and work productively.  Four facets of public health burden: -burden, undefined burden, hidden burden, future burden NCMH-acute cases 

Nursing responsibilities and functions: -mental health promotion -in prevention and control -rehabilitation -in research and epidemiology Pointers for having mental health 

RENAL DISEASE CONTROL PROGRAM(REDCOP)

National Kidney and Transplant Institute(NKTI)main implementing agency  Kidney diseases: 

COMMUNITY BASED REHABILITATION PROGRAM Creative application of the PHC approach in rehabilitation services for persons w/ disabilities.  Involves measures.  Program components: -social preparations -services preparation -training -information education and communication -monitoring, supervision, and evaluation 

LEGAL BASIS 

Republic Act No.7277, otherwise known as the Magna Carta for Disabled Person provides rehabilitation, self-development, and self-reliance of disabled persons. This act ensures full participation of non-government organization and other private factors.