EOH 3401 PRINCIPLE OF HEALTH

1. EOH 3401 PRINCIPLE OF HEALTH By dr. irnizarasdi

2. TITLES • Non-communicable diseases • Health Care system in Malaysia • Population measures • Mental Health

3. NON COMMUNICABLE DISEASES

4. Introduction • Non-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.

5. Introduction • The 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.

6. 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

7. Cardiovascular diseases:Contributing factors • 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

8. Common cancers in Malaysia

9. Cancer • Definition – a large group of diseases characterized by the uncontrolled growth and spread of abnormal cells • Types of cancers • Neoplasm – new growth of tissue that serves no physiological function • Tumor – clumping of neoplasmic cells • Malignant - cancerous • Benign - noncancerous

10. Difference between cancer and non cancer cells Normal cells Cancer cells Does not know when to stop growing and proliferating Can travel (metastasize) from organ of origin to any place within the body • Knows and stays in its place of origin • Knows when to replicate and when to die

11. Classification of cancer • 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 • Sarcomas– Cancers that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments). • 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. • 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.

12. Cancer: risk factors for cancer • tobacco use • unhealthy diet • insufficient physical activity • the harmful use of alcohol • Infections (hepatitis B, hepatitis C (liver cancer), human papillomavirus (HPV; cervical cancer), Helicobacter pylori (stomach cancer) • Radiation • variety of environmental and occupational exposures of varying importance

13. Cancer: Interaction between a person’s genetic factors and any of three categories of external agents 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.

14. 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

15. Diabetes • Diabetes 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.

16. Diabetes • Type I • The body does not produce insulin. • 10% of all diabetes cases • usually develop before their 40th year, often in early adulthood or teenage years. • Type II • The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin • 90% of all cases of diabetes worldwide • People with central obesity, belly fat, or abdominal obesity, are especially at risk • Gestational Diabetes • affects females during pregnancy. • 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. • baby may be bigger than he/she should be

17. Diabetes Main symptoms

18. Complication of diabetes • Eye 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

19. HEALTH CARE SYSTEM IN MALAYSIA

20. Health Care System in Malaysia

22. Health care system in Malaysia

23. Health Care System in Malaysia • Malaysia has 143 public sector hospitals • Three university teaching hospitals under the Ministry of Higher Education are • the University Malaya Medical Centre (UMMC), • UniversitiSainsMalaysia Medical Centre (USMMC) and • Hospital UniversitiKebangsaanMalaysia (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

24. Health Care system in Malaysia • The Ministry of Health hospitals are classified in five levels: • small district hospitals (visiting specialists only); • larger district hospitals with resident specialists; • state-level general hospitals with resident specialists; • hospitals with multiple specialties including regional hospitals (that cover several states) and national hospitals; and • specialist hospitals or institutions (e.g. for cancer or leprosy).

26. Health Care system in Malaysia • More 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.

28. Level of diseases prevention • Primary prevention • Secondary prevention • Tertiary prevention

29. 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 cancer • Wearing a seatbelt to prevent injury

30. 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

31. Secondary prevention: Activities that take place once the disease has already occurred to help treat, reverse, or stop the illness. For example: • Testing for certain diseases like scoliosis. • Treating diseases with medicine, like diabetes and high cholesterol.

32. 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

33. 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

34. Tertiary prevention: Rehabilitation activities that will help the patient lead a normal life once the disease has already caused illness or injury. For example: • Physical therapy after an accident • Oxygen for those with breathing problems • Asthma treatments

35. POPULATION MEASURES

36. Population measures • Prevalence • Point prevalence • Period prevalence • Incidence • Attack rate • Mortality • Crude death rate • Specific rate

37. Prevalence • Total 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 periodx 100 Average population during a time period

38. Incidence • A 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

39. 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

40. 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

41. 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

42. Case Fatality Rate • The 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

43. MENTAL HEALTH

44. 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.

45. Factors that affect mental health • Both physical and mental health are the result of a complex interplay between many individual and environmental factors, including: • family history of illness and disease/genetics • lifestyle and health behaviours (e.g., smoking, exercise, substance use) • levels of personal and workplace stress • exposure to toxins • exposure to trauma • personal life circumstances and history • access to supports (e.g., timely healthcare, social supports) • coping skills

46. Definition of Stress • The 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

47. 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

48. Stressors • School • Work • Family • Relationships • Legal • Finances • Health/illness • Environment • Living Situation

49. Negative Effects of Stress 1. 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)

50. 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?