بنام خدا

1. بنام خدا

2. بیماری مزمن همه کاستی ها یا انحراف ها از حالت عادی که یک یا چند تا از ویژگیهای زیر را داشته باشد: • دائمی باشد. • پس از آنها ناتوانی برجای بماند. • به سبب تغییرات بیماری شناختی بازگشت ناپذیر ایجاد شده باشد. • بازتوانی بیمار آموزش های ویژه لازم داشته باشد. • مدت زیادی سرپرستی، مشاهده یا مراقبت لازم داشته باشد.

3. بیان مسئله : • بیماری های مزمن و غیر واگیر هم در کشورهای پیشرفته و هم در کشورهای در حال توسعه در بین بزرگسالان اهمیت بیشتری دارند. • این بیماری ها در بسیاری از کشورها روند صعودی دارند: • افزایش طول عمر • تغییر الگوهای زندگی و رفتاری مردم • پیشرفت علم پزشکی و پیدایش مراقبت های نوین پزشکی

4. عوامل خطر : • مصرف سیگار و سایر اشکال دخانیات • اعتیاد به مشروبات الکلی • نارسایی یا ناتوانی در دسترسی به خدمات بهداشتی برای پیشگیری • دگرگونی های سبک زندگی • عوامل خطر زیست محیطی ( خطرات شغلی، آلودگی آب و هوا، ... ) • عوامل مربوط به استرس

5. What are DALYs? • DALYs = Disability Adjusted Life Years • A common measurement unit for morbidity and mortality • Facilitates comparisons of all types of health outcomes

6. The DALY: A Comparative Tool to Measure Health One Disability Adjusted Life Year “One year lost to poor health.”

7. How are DALYs constructed? • A DALY is a health outcome measure with two main components • Quality of life reduced due to a disability • Lifetime lost due to premature mortality.

8. DALYs DALYs = YLL + YLD Disability Years of Year Adjusted Life Lived with Life Lost Disability Years Mortality Morbidity

10. Chronic Respiratory Disease Cardiovascular Type 2 Diabetes Cancer Chronic Diseases result in percent of deaths 4 52 EMR Adult Population

11. EMR/NCD RISK FACTORS • Smoking 16-65% • Hypertension 12-35% • Diabetes 7-25% • Over weight-obesity 40-70% • Dyslipidemia 30-70% • Physical Inactivity 80-90%

12. Prevalence of Smoking according to STEPwise Survey in EM countries %

13. Prevalence of diabetes based on stepwise surveys • Jordan: 12% • Iraq: 10.4% • Syria: 20.5% • Saudi Arabia: 17.9% • Iran: 10.3% • No available data from other EM countries

14. Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors

15. Total deaths around the world: 58 million

16. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million

17. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million

18. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated 14 million

19. NCD deaths are projected to increase by 15% globally between 2010 and 2020. The greatest increases will be in Africa, the Eastern Mediterranean, and South-East Asia, where they will increase by over 20%

20. The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 milliondeaths, 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.

21. In low- and middle-income countries, 29% of NCD deaths occur among people under the age of 60, compared to 13% in high income countries

22. Risk factors Dr Z Farajzadegan Tobacco use, Physical inactivity, Unhealthy diet and The harmful use of alcohol

23. four key metabolic/physiological changes Dr Z Farajzadegan Raised blood pressure, Overweight/obesity, Hyperglycemia Hyperlipidemia.

24. Attributable deaths, the leading NCD risk factor globally Dr Z Farajzadegan Raised blood pressure (to which 13% ) Tobacco use (9%), Raised blood glucose (6%), Physical inactivity (6%), Overweight and obesity (5%)

25. Modifiable behavioral risk factors Dr Z Farajzadegan Tobacco Insufficient physical activity Harmful use of alcohol Unhealthy diet

26. If no serious action is taken, annual tobacco related deaths are projected to increase to 8 million by 2030, accounting for 10% of all deaths Dr Z Farajzadegan

27. Insufficient physical activity Approximately 3.2 million deaths each year are attributable to insufficient physical activity Dr Z Farajzadegan

28. Raised blood pressure Dr Z Farajzadegan Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all annual deaths . This accounts for 57 million DALYs or 3.7% of total DALYs. Raised blood pressure is a major risk factor for coronary heart disease and ischemic as well as hemorrhagic stroke

29. Overweight and obesity Dr Z Farajzadegan Worldwide, 2.8 million people die each year as a result of being overweight (including obesity) and an estimated 35.8 million (2.3%) of global DALYs are caused by overweight or obesity

30. Dr Z Farajzadegan There is increased risk of co-morbidities for BMIs in the range of 25.0 to 29.9 kg/m2, and moderate to severe risk of co-morbidities for a BMI greater than 30 kg/m2

31. In 2008, 35% of adults aged 20 years and older were overweight (BMI ≥ 25 kg/m2) (34% men and 35% of women). The worldwide prevalence of obesity has nearly doubled between 1980 and 2008.

32. Dr Z Farajzadegan In 2008, 10% of men and 14% of women in the world were obese (BMI ≥30 kg/m2), compared with % of 5% for men and 8% for women in 1980. An estimated 205 million men and 297 million women over the age of 20 were obese in 2008 – a total of more than half a billion adults worldwide.

33. The fastest rise in overweight among infants and young children is in lower-middle income countries Dr Z Farajzadegan

34. Raised cholesterol Dr Z Farajzadegan Raised cholesterol levels11 increase the risks of heart disease and stroke .Globally, a third of ischemic heart disease is attributable to high cholesterol. Overall, raised cholesterol is estimated to cause 2.6 million deaths (4.5% of total) and 29.7 million DALYs, or 2.0% of total DALYs

35. Dr Z Farajzadegan A 10% reduction in serum cholesterol in men aged 40 has been reported to result in a 50%reduction in heart disease within five years

36. What are Chronic Diseases?

38. Noncommunicable DiseasesDeath trends (2006-2015) (WHO Chronic Disease Report, 2005) WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries.

39. Nearly half of Americans have one or more chronic diseases Total U.S. population 45% -- 133 million Americans – have one or more Source: Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

40. Many cases of chronic diseases go undiagnosed Total U.S. adults with diabetes = 18 million One-third of people with diabetes, or nearly 6 million people, don’t know they have it 33% undiagnosed A survey conducted by the Centers for Disease Control and Prevention (CDC) found that nearly one third of people with diabetes don’t know they have it Centers for Disease Control and Prevention , Prevalence of Diabetes and Impaired Fasting Glucose in Adults - United States, 1999-2000, MMWR, 2003. Vol. 52(35), p. 833.

41. Other cases of chronic disease are diagnosed, but not well-controlled Percent of U.S. adults with hypertension Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Original sources: NHANES

42. And in other cases, chronic disease risk factors are starting to be better diagnosed and treated, although there is still room for improvement Percent of U.S. adults with high cholesterol 1988-94 1999-2004 Please note that percentage is slightly more than 100 due to rounding Source: Presentation by David Cutler. Alliance for Health Reform Novartis/NIHCM Briefing. March 28, 2008. Original sources: NHANES

43. The increase in childhood obesity is placing the next generation at great risk for developing chronic diseases earlier in life Children born in the U.S. in 2000 One third = portion of who will develop diabetes over their lifetime, given current trends in the share who are overweight or obese *childhood overweight and obesity Source: Laino C. One in three kids will develop diabetes. Web MD. June 16, 2003. Available at: http://www.webmd.com/content/article/66/79851.htm. Accessed July 31 ,2006.

44. Chronic diseases are the leading cause of death in the U.S. Chronic disease accounts for four of the top five causes of death Chronic disease is responsible for seven out of every 10 deaths each year Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007. Source: Centers for Disease Control and Prevention. Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#summary

45. Family caregivers are a critical support structure for Americans with chronic illnesses, and the U.S. health care system In any given year, more than 50 million Americans find themselves in a caregiving role Family caregivers provide the vast majority (80 percent) of all long-term care services for those with a chronic illness or disability Almost one in five (17 percent) family caregivers provide 40 hours of care a week or more Source: Thompson L., “Long-term care: Support for family caregivers [Issue Brief].” Washington, DC: Georgetown University, 2004 and U.S. Agency for Healthcare Research and Quality. Long-Term Care Financing Project, Long-term Care Users Range in Age and Most Do Not Live in Nursing Homes. November 8, 2000.

46. But simple changes in behaviors could lead to significant decreases in cases of common and costly chronic diseases The Centers for Disease Control and Prevention (CDC) estimates up to… …could be prevented if only Americans were to do three things: • Stop smoking • Start eating healthy • Get in shape 80% of heart disease and stroke 80% of type 2 diabetes 40% of cancer Source: Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health Webinar. May 23, 2006. Available at: http://www.businessgrouphealth.org/opportunities/webinar052306chronicdiseases.pdf. Accessed April 17, 2007.

47. There is also substantial room for improvement in treating chronically ill patients to prevent further complications Only half receive appropriate preventive care Chronically ill patients receive only 56% of the clinically recommended preventive health care services Source: McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine 2003;348:2635-264.

48. Patients with chronic illness often see multiple health care providers, and this can make coordination of care complicated Number of different physicians seen by people with serious chronic conditions Source: Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

49. Prevalence of diabetes based on stepwise surveys • Jordan: 12% • Iraq: 10.4% • Syria: 20.5% • Saudi Arabia: 17.9% • Iran: 10.3% • No available data from other EM countries

50. Main Causes of Death, Worldwide, all ages