Epidemiology Flashcards
Epidemiology definition
Study of Distribution of determinants of health related states or events in specified populations and the application of the study to control health problems
Five questions to ask yourself in epidemiology
who has the health condition where is the health condition found when does the health condition occur why does the health condition exists how can Health condition be prevented
Three questions to ask yourself in disease specific epidemiology
What causes the disease
how is the disease transmitted
how do we break the transmission cycle
Objectives of epidemiology
Identify cause of health condition
determine extent of health condition in a community
study the natural history and prognosis of health condition
evaluate existing and newly developed preventive and therapeutic measures
provide foundation for public policy
Top 10 causes of death in Ghana
Malaria lower respiratory infection neonatal disorders ischemic heart disease Stroke HIV aids tuberculosis diarrheal diseases roads injuries diabetes
The five major cause of death in Ghana in children
Malaria diarrheal diseases respiratory infections anemia malnutrition
Type of prevention
primordial prevention
primary prevention
secondary prevention
tertiary prevention
Primordial prevention
You prevent occurrence of risk factors
Primary prevention
You prevent initial development of a disease
Secondary Prevention
You detect early existing disease to reduce severity and complications
Factors involved in interaction to form disease
Hosts
agents
environment
Host characteristics that could lead to disease formation
Age sex religion Occupation marital status genetic profile immune status
Type of agent that could lead to disease fornation
Biological agents
chemical agents
physical agents n
nutritional agents
Environmental factors that could lead to disease formation
Housing crowding neighborhood water source toilet facilities
Transmission
Mechanism by which an infectious agents is transferred from one person to another OR from one Reservoir to a new host
Type of mode of transmission
Direct indirect intermediate host vectors zoonosis
Direct transmission
From human to human or auto infection
Indirect transmission
From single, multiple, or continuous exposure to one common vehicle
Intermediate host transmission
Transmission from snails, copepods,animals, worms
Vector transmission
From an insect to man
Zoonotic Transmission
Animal disease now presents in man
Transmissible by bites or food
How can a host resist to a disease
Through acquired immunity like infection vaccination or passive immunity from mother to child
Factors that can Impact the hosts immunity
Age sex pregnancy nutrition trauma fatigue herd immunity
Type of environment
Physical
biological
social
Physical environments
Nonliving part like air water soil temperature
Biological environment
Living things like plants animals micro organisms
Social environment
Man-made lake community culture government
Factors that can affect environment
Climate like temperature
seasonality which includes interaction of climate food culture
education with knowledge that can cause modified behaviors
resources like poverty
Susceptibility to disease
Measure of a person risk of acquiring a disease
Factors that determine susceptibility to disease
Genetics
nutrition
immune system
Stages of disease
Preclinical
subclinical
persistent disease
latent disease
Clinical disease
Disease with signs and symptoms
Carrier status is
Individual has disease organism but is not infected as measured by serological studies or by evidence of clinical illness
Levels of disease
Sporadic endemic hyperendemic epidemic pandemic
Endemic disease
Is this a bit chilly present within geographical area
Epidemic disease
Excessive presents of a disease from what is expected
Pandemic
Worldwide epidemic
What can cause a disease outbreak
A common vehicle exposure
Characteristics of an outbreak from a common vehicle with single exposure
Explosive (Sudden and Rapids)
limited (Only people that share a common exposure)
Herd immunity
Resistance of a group of people to a disease because a large proportion of the members of the group are immune
Conditions for herd immunity
Disease agent only in single host species
Direct transmission
Solid immunity after infection
Incubation period
Time interval between contracting an infection and onsets of clinical illness
Epidemic curve
Distribution of time of onset of disease
Attack rate formula
Number of suspected person exposed to illness who became ill/ number of persons exposed overall
Case distribution
Case distribution on terms of time and place
Control measures of epidemics
Control of current outbreak
Prevention of future oitnreak
System used when there’s several possible causal agents to an outbreak
Cross tabulation in outbreak investigation
Prevention definition
Measures not only to prevent occurrence of disease such as risk factor reduction, arrest it’s progress , reduce its consequences once established
Levels of prevention
Primordial
Primary
Secondary
Tertiary
Primordial prevention
Prevention of risk factors
Change in social and environmental conditions
Primordial prevention important for what type of diseases
Chronic diseases
Primordial Prevention définition
Prevention of the emergence of living patterns that contribute to increased risk of disease
Types of primordial Prevention
Legislation taxation code of practice health promotion Avoidance of risks genetic counseling diet nutrition
Primary prevention Purpose
Limits the incidence of disease by controlling causes and risk factors
Two strategies of primary prevention
Average risk population strategy
high-risk individual strategy
Advantages of average risk population strategy
It’s radical
large potential for a whole population
behaviorally appropriate
Disadvantages of average risk population strategy
Small benefits to individuals

poor motivation of subjects
poor motivation of physicians
benefits to risk Ratio low
High-risk individual strategy advantages
Appropriate for individuals
subject motivation
physician motivation
favorable benefits to risk ratio
High-risk individual strategy disadvantages
Difficulty in identifying high-risk individual
temporary effects
limited effects
behaviorally inappropriate
Secondary prevention
Cure patients and reduce the more serious consequences of this is through early diagnosis and treatment
At what time In disease timeline do you use secondary prevention
During onset of diseaSe and normal time of diagnosis
What type some type of secondary prevention
Opportunistic or targeted screening
Improving uptake of services
allowing affordable self-care
Clinical services
What are the clinical services in secondary prevention
National technical guidelines
available clinical and preventive services
quality of care
institutional capacity
available and affordable drugs and diagnostic tests
quality of generic drugs
drugs prophylaxis
laboratory available
personnel available
Tertiary prevention
Reducing the progress of complication of an established Disease
Try to reduce impairment,
disabilities, suffering,
and promotes patients adjustments to incurable conditions
Some type of tertiary prevention
Surgery prosthesis occupational therapy physiotherapy speech therapy
What are the 3 steps in epidemiology
Count number of events in population
Divide number of events by number of person in that population
Compare rate from different population and infere about existing differences
Types of measures used in health and disease
Count Proportion Ratio Rate Prevalence Incidence Mortality rates Cumulative incidence Risk Incidence density Adjused rates Public health indices
What is count
Number of cases of a disease or health problen being studied
What is proportion
Fraction in which numerator is included in denominator
Usually expressed as percentage
Why are counts still useful in epidemiology
For some disease even one case is still a problem like smallpox
Can lead to investigations of usual disease
What is a ratio
Fraction in which the numerator is not included in the denominator
What is rates
Numerator over a denominator over a perdiod of time
What is prevalence
Proportion of individuals in a population who have the disease at a specific point in time or over specified period
Numerator has new and old cases
What is incidence
Number of cases at particular time who newly have the disease
Numerator has only new cases
When is prevalence useful
In case of chronic disease
When is points prevalence useful
In case of episodic prevalence
When is period Prevalence useful
In case of lifetime prevalence especially suitable for cases in which type of onset of illness is not known especially for psychiatric cases
Incidence rates definition
Number of new cases of disease in a group over a certain time. Over the amount of personal time during which the new cases arose
Why is it important to know characteristics of person and the time in the incidence rates
Because the denominator exclude any individuals had already disease of interest or are not capable of developing the disease in a specific period of time
What is incidence density
Number of new cases of disease in specified period of time over the number of person time at risk during the period
What is cumulative incidence
Number of new cases of disease in specific time over the total number of disease-free individuals at the beginning of the specified time
What is the probability that an individual disease-free beginning of time. Will develop the disease in that given period time
What is the relationship between prevalence and incidence
Prevalence depends on incidence rates and duration of the disease
What are two examples of public health rates
DALYs
QALYs
What is DALYs
Disability adjusted life years which is the measure of the burden of disease on a population and the effectiveness of intervention
What is QALYs
The quality adjusted life years which is the adjustment of life expectancy taking into account the presence of chronic conditions causing appointment disability or handicap
What is the only event in life with long-term probability of one with certainty for a living person’s
Death
Counts as a mortality measure
Count the number of deaths from particular disease
Rates in mortality measure
Number of deaths due to particular disease over a group over a period of time
What is the annual mortality rates
Is the all cause mortality rate for sub groups based on age or gender or area
What is the cause specific mortality rates
It is it is it specific mortality rates which is limited to a particular diagnosis
Case Fatality rates
Proportion of persons with a particular disease that die from the disease
Proportionate mortality
Proportion of all deaths caused by specific diseases in a period
Years of potential life lost
Measure of premature mortality
Mortality rates
Incidence rates of the witches number of deaths over mid yyear population
Crude mortality rates
Ratio of number of deaths during the year over average population in that year
Age specific mortality rates
Natality rate calculated for specific age bands
Age adjusted mortality rate
Process to even out the effect of different age distribution went to a more mortality rates from two different populations are being compared
Odds of disease
Number of new cases of disease in. Time over the number of persons with did not become a case during the time. But could have potentially become cases
What are some public health indices
Crude mortality rates birthrates fertility rates infant mortality rates neonatal mortality rates maternal mortality rates
What are the two big divisions of epidemiological studies
observational
experimental
What are the two division of observational epidemiological studies
Descriptive
analytical
What are the possible study done in descriptive observational epidemiological studies
Case Reports Case series Cross sectional Prevalence studies Ecological studies
What are the different type of observational analytical epidemiological studies
Case control
cohort studies
cross-sectional
What are the different type of experimental epidemiological studies
Clinical trials
field trials
community trials intervention
What are the different components of epidemiological studies about
Study factor
study subjects
exposure
Health outcome or disease
Is observational studies manipulated randomized?
Neither
Is experimental studies manipulated or randomized
Yes both
Is quasiexperimental studies manipulated or randomized
manipulated but not randomized
What factor can have a relationship with disease
Exposure
In observational studies who determines the exposure
The subjects
Why are most epidemiologic studies observational
Because experimental studies are mostly impractical and unethical
Advantages of observational studies
Natural setting No ethical concern Low Cost Convenience Data already existing
Disadvantages of observational studies
No randomization
What is descriptive studies
Study that presents occurence and distribution of disease
Organizes and summarizes data accordiing to person , place and time
3 questions in descriptive study
Who has been affected
Where have they been affected
When have they been affected
When is descriptive studies for individual useful
To show individuals healths characteristics
estimate disease frequency
extent of public health problem
identify populations at greatest risk
estimate time trends
planning and health care resource allocation
suggest hypothesis about causation
What’s do you use to perform descriptive study analysis
Tables
rates
Measures of central location of dispersion
graphic charts maps
How do you determines where whos at risk in descriptive study
Demographics (Age, sex,ethnicity) socioeconomic background (Education ,occupation ,access to services ) Other factors (blood group ,vaccination status ,smokers)
How do you present data from who is at risk in Descriptive study
Tables or graphs
How important is age in descriptive study and why
Very important as it reflects susceptibility, differences in exposure ,latency incubation period
How does sex play into descriptive study
Men and women are different in susceptibility physiological response exposure due to habits, occupation service utilization
How do you present that comparing men and women in descriptive study
table
What information does place gives in descriptive study
Geographic distribution
cluster of cases
dissemination route
What means of presentation do you use to show place impact in descriptive study
Maps
Charts
How does time play into descriptive study
Variation of a time of health events which could be annual seasonal daily hourly
interested in onset of symptoms date of reporting
How do you present time data in descriptive study
But using X and why system which shows magnitude of the problem ,trends and potential evolution ,type of transmission
How do you presents an outbreak
Epidemic curve
How do you present seasonal trends
Linear graphic over weeks months or year
How do you present secular trends
Using period Including several years which of those to predict evolution and study effective control measures over events
Characteristics used in case report in individual descriptive study
Person ,place and time
Characteristics used in case series in individual descriptive study
Age sex Place time numbers and proportions
Characteristics used in cross-sectional survey in individual descriptive study
Describe defined characteristics
Who isn’t of interest in a case reports
The individual is the units of observation available for study essentially the one with the unusual clinical picture
How do you form a case series
By compilation of additional case report when initial case report
What are the advantages of using case reports or case series
Use available clinical data
detailed individual data
suggest strong need for investigation
hypothesis generation
What are the disadvantages of case reports or case series
May only reflect experience of one person or 1 clinician
no explicit comparison group
How is the timing of cross-sectional study
Always retrospective
Variable measured in cross-sectional study
Prevalence studies
Useful for events like chronic ,common ,or not fatal disease
How do you classify participant in cross-sectional survey
By exposure and the disease status
How do you analyze data in cross-sectional study
Using 2 x 2 table
Benefits of cross-sectional study
Convenient
quick
inexpensive
can consider several exposures ,several disease
useful for Exploration
can generate hypothesis
can study entire population or a representative sample
provides estimates of prevalence for factors measured
standardize data collection tool I
access health studies and health care needs of a population
can be repeated to get trends
Disadvantages of cross-sectional study
Cannot study time sequence
cannot study causality
estimate prevalence not incidence
possible bias because of any survivors available
better for generating hypothesis not for for testing hypothesis
not good for rare disease or exposure
Who are the units of observation in ecological studies
Population or group of people
What are dara used in ecological study to describe disease rates
Incidence rates
Prevalence
Mortality rate
Data used to describe exposure rate in ecological study
Economic development measure
environmental measures
measures of lifestyle
Advantages of ecological studies
Easy to do use
available data
generate hypothesis for additional study
Disadvantages of ecological studies
Unable to examine data for individuals
no assurance that persons with exposure of interest are the same ones with the outcome of interest
association at the aggregate level may not reflect association of the individual level
No Adjustmentfor potential confounding factors
What is the ecological fallacy in ecological studies
Observation made a group devil may not represent exposure disease relationship of the individual level
When designing a cohort studies, what prefactor do you identify first in participants and what do you follow over time
You identify if they were exposed or not to something
You follow if they developed a specific disease over time or not
How do you calculate incidence rate in cohort study for people that were exposed
people exposed and had disease / total of people exposed
How do you calculate incidence rate in cohort study for people that were unexposed
people unexposed and had disease / total of people unexposed
How do you calculate relative risk in cohort study
Incidence rate of people exposed / incidence rate of people unexposed
Is there randomization in cohort study
No
Types of cohort study
Prospective cohort study
Retrospective cohort study
Combined retro and prospective cohort study
What is propesctive cohort study
Following actual population
What is retrospective cohort study
Using old data to study old population
What is combined prospective retrospective study
Use data collected in past to define population expose and unexposed
Follows population defined in future
Advantages of cohort study
High evidence rate
Clear time relationship established
Can study multiple outcome
Useful for rare exposures
Disadvantages of cohort study
Can’t study multiple exposure
Expensive
Can lose follow up
Take long for results
When is cohort study advised
Need longitudinal data overt time in sequence Exposure rare but outcome high Short time between exposure and outcome High funds available If minimized loss to follow up possible
Type of risk in cohort study
Absolute risk
Relative risk
Attributable risk
What is absolute risk in cohort study
Same as incidence rate in a group
What is relative risk in a cohort study
Ratio of incidence rate of exposed to unexposed
What is attributable risk
Increase in risk in exposed group compared to unexposed group
Incidence rate of exposed - incidence rate of unexposed
What is a bias in epidemiological studies
Systematic error in design , conduct or analysis of a study resulting in mistaken estimate of an exposure effect over a disease
Types of biases in cohort study
Selection bias Information bias Bias in assessment of outcome Non response bias Analytic bias
Selection bias in cohort study
Whether exposed or unexposed groups have same background characteristics
Information bias in cohort study
More information on diseased in restrospecive cohort study
Bias in assessment of outcome in cohort study
More Diagnostics applied to exposed in measuring outcomes
Non response bias in cohort study
People lost to follow up when not same disease experience as others
Analytic bias in cohort study
Analytic methods not defined beforehand
What is a cross sectional study
Observational study in which exposure and disease are determined at same point in time
Can you determine temporal relationship between disease and exposure Erin cross sectional study
No
Steps in designing cross sectional study
Define population Gather data on exposure and disease Create groups - exposed have disease - exposed, no disease - not exposed, have disease - not expose , no disease
What are the two ways to analyze cross sectional study
Prevalence of exposure in disease and no disease
Prevalence of diseases in exposed and not exposed
Formulas for prevalence of exposure in disease and not disease
Exposure and disease / disease present in both exposed and non exposed
exposed and no diseas / no disease in both exposed and non exposed
Formulas for prevalence of disease in exposed compared to not exposed
Exposed with disease / people exposed
Not exposed with disease / people not exposed
What type of calculations do you use in cross sectional studies
Odds ratio
Cross sectional studies usage
Determine prevalence of outcomes of interest
Determine burden of disease
Association between exposure and outcomes
Useful questions for further studies
National cross sectional studies
Ghana demographic and health surveys
Ghana maternal health survey
When do you do case control study
When cohort study not easily applicable
Definition of case control study
Comparison of exposures, characteristics and behaviors of population with a particular disease to the same population without the disease
In case control study is there
A - multiple outcome , one exposure
B - one outcome , multiple exposure
B
Steps of case control study
Identify disease
Identify control group - non diseased people
Document exposure among cases and controls
Calculate odd ratio
Perform statistics , confidence interval
How do you identify cases in case control study in health setting
Surveillance
How do you identify cases in case control study in planned study
Hospitals
Disease registries
Other
Do you use incident cases or prevalent cases in case control study
Incident
Factors in picking case in case control study
Clinical criteria
Time
Place
Person
Conditions to pick control in case control study
Should not have disease being studieD
Represent population of interest
Represent persons that could have been a case in the study if there is disease
Selected independently of exposure
Why are controls important in case control study
Estimation of prevalence of exposure in population
Expected prevalence of exposure among cases if no association
Sources of controls in case control study
Population based Hospital Clinic Neighbors Friends Other
Sampling method used to chose control in study control study in community
Advantages ? Disadvantages ?
Probability sample or Random digit dialing
Best representation
Least biased if high participation
Time consuming
Expensive
Low participation
Biased if poor participation
Advantages of choosing controls in same hospital or clinic as cases in case control study
Disadvantages ?
Convenient
Same catchment area
Control disease may be linked to exposure
Hospitalized control may differ from general population
Advantages and disadvantage of choosing controls in same neighborhood as cases in case control study
Inexpensive
Efficient
Confounding variables
Exposure related to neighborhood
Potential bias
Advantages and disadvantages of picking controls bases on friendship with case in case control study
Convenient t
Bias
May share same exposure
Advatanges and disadvantages of picking controls form hospitals and clinic in case control study
Easier to identify Less expensive Good participation rate Better recall of recent exposure Good source population
Difficult to chose appropriate conditions and illnesses for control
Advatanges and disadvantages of choosing neighbors or friend for case control study
High participation rate
Inexpensive
May Not representative
May Not suitable nominee
May not have name
May have common exposure
Factors affecting of number of control in case control study
Availability
Ratio controls / cases
Cost vs power
Power calculation
How to assess exposures in case control study
Questionnaires
Preexisting records
Biomarkers
Odds ration calculation in case control study
(Exposed case x unexposed control ) / (exposed control x unexposed case)
Statistics used to determine if odd ratio in case control study chance or accurate
P value from chi square
Confidence interval
Chi square , confidence interval
Go practice
Case control advantages
Quick Inexpensive good for rare disease Good for disease with long latency Study multiple exposure Fewer subjects Few ethical problems
Case control study disadvantages
Can’t measure disease risk
Determination , selection, enrollment of appropriate control group
Recall or records for info on past exposure limited
Not good for rare exposure
Less familiar to non epidemiologist
Non communicable disease definition
Chronic conditions that do not result from infection process and can’t be communicated
Characteristics of non communicable disease
Prolonged course Does not resolve spontaneously No complete cure Complex etiology Multiple risk factors Long latency period Non contagious origin Functional impairment or disability
Types of NCDs
CVDs Cancer Chronic respiratory disease Diabetes Chronic neurological disorders Arthritis / musculoskeletal diseases Unintentional injuries
Social class most affected by NCD by 2030
Middle class
Major NCD
Cardiovascular diseases
Risk factor definition
Aspect of personal behavior , lifestyle , environmental exposure or hereditary characteristics associated with increase in occurrence of a particular disease, injury, health condition
What is a modifiable risk factor
Behavioral risk that can be reduced or controlled by intervention which reduces risk of disease
Main 4 modifiable risk factor
Physical inactivity
Tobacco use
Alcohol use
Unhealthy diets
Non modifiable risk factors examples
Age
Sex
Race
Family history
Cardiovascular common risk factors
Tobacco
Diet unhealthy
Physical inactivity
Alcohol
Diabetes common risk factors
Tobacco
Diet unhealthy
Physical inactivity
Alcohol
Cancer common risk factors
Tobacco
Diet unhealthy
Physical inactivity
Alcohol
Chronic respiratory disease common risk factors
Tobacco
4 metabolic risk factors
Raised blood pressure Raise total cholesterol Elevated glucose Overweight Obesity
Main diseases of cardiovascular disease NCDs
Coronary heart disease
Cerebrovascular disease
Peripheral arterial disease
Congenital heart disease
What are coronary heart disease
Disease of blood vessels supplying heart muscles
What are cerebrovascular disease
Disease of blood vessels supplying the brain
What are peripheral arterial disease
Disease of blood vessels supplying arms and legs
What are congenital heart disease
Malformation of heart stricte existing at birth
Main cause of cardiovascular disease
Atherosclerosis with fat deposition in blood vessel s
Number 1 of cause of death globally
CVDs
7.3million persons died because of …. And 6.2 died because of …
Coronar heart disease
Stroke
Main economic classes exposed to CVD with 80% deaths pertaining to those grou0ps
Low and middle income
By 2030 , how many people will die from CVD
25 million
Major modifiable risk factors to CVDs
High blood pressure Abnormal blood lipids Tobacco Physical inactivity Obesity Diabetes Diet
Other less important modifiable risk factor for CVDs
Low economic status Mental illness Psychosocial stress Alcohol use Certains Medications Lipoprotein
Non modifiable risk factors to CVDs
Âge Hereditary or family history Gender Ethnicity Race
Novel risk factors for CVDs
Excess homocysteine in blood
Inflammatory markers like c reactive protein
Abnormal blood coagulation due to high fibrinogen
Diabetes definition
Metabolic Disorder of 4 types Type 1 Type 2 Gestational Pre diabetes
What causes type 2 diabete
Modifiable risk factors
Main type of diabetes
Type 2 - 90%
Number of people worldwide with diabetes
347m
Main economic classes that does because of diabetes
Low and middle
Projected increase of diabetes by 2030
2/3 more
How to prevent or delay diabetes
Healthy diet
Physical activity
Normal body weight
Avoid tobacco
Major modifiable risk factors for diabetes
Unhealthy diets Physical inactivity Obesity Overweight High blood pressure High cholesterol
Other modifiable risk factors for diabetes
Low socioeconomic status s Alcohol Stress High sugar intake Low fiber intake
Non modifiable risk factors for diabetes
Increased age Genetics Family history Race Fat distribution Low birth weight Autoantibodies
Cancer definition
Abnormal cells that grow beyond usual boundaries and invade adjoining parts of the body
Number of people that died due to cancer in 2008
7.6m
Main economic class concerned with cancer death
Low and middle income (70%)
Is it true that 30% of cancer attributable to behavior risk factors
Yes
Cancer with most incidence
Breast
Cancer with more mortality
Lungs
Cervical cancer definition
Cancer of female reproductive system which can be squamous and glandular
Main infection linked with cervical cancer
HPV (99%)
Risk factors of cervical cancer
HPV Smoking Immune deficiency Poverty No pap screening Family history
What is lung cancer
Cancer that forms in the lungs usually in cells lining air passages
Does lung cancer affect more women or men
Men
Two main types of lung cancer
Small cell lung cancer
Non small cell lung cancer
Lung cancer risk factors
Smoking (cigarettes, cigars, pipes ) Second hand smoke Radiation therapy to breast or chest Asbestos, radon, chromium , nickels, arsenic , soot, tar Air pollution
What is breast cancer
Cancer that forms in the tissues of the reacts usually in the ducts or in the lobules
Main sex affected by breast cancers
Women
1/8 women affected with breast cancer, T or F ?
True
Breast cancer risk factors
Hormone therapies Weight and physical activity Race Genetics Âge (most reliable )
2nd most common cancer amongst men
Prostate cancer
Risk factors of prostate cancer
Âge
Race
Obesity
Weight gain
3rd most common type of cancer
Colorectal cancer
Risk factors of colorectal cancer
Aging Black race Unhealthy diet Low exercise Diabetes Family history
Economic class of countries more prone to death with chronic respiratory disease
Low income countries (90%)
Risk factors of chronic respiratory disease
Cigarette Occupational dust and chemicals Environmental tobacco smoke Indoor and outdoor pollution Gènes Infections Socioeconomic status Aging population
COPD definition
Lung diseases that’s prevent proper lung inflation
Type of COPD
Chronic bronchitis
Emphysema
Number of people that died due to COPD
3millions
Asthma definition
Recurrent attacks of breathlessness and wheezing
Is asthma under diagnosed
Yes
Can medications help control asthma
Yes
Challenges in surveilling NCDs
Lag time between exposure and condition
Multiple exposure responsible for condition
One exposure leading to multiple conditions
How can you reduce NCDs
Attacking risk factors
Main risk factors leading to death
High bp Tobacco High blood glucose Physical inactivity Obesity
Tobacco kill 1/2 of its users, T or F
T
Expected deaths by 2030 due to tobacco
8m
80 % of smoker in which economical clas countries
Low and middle income countries
Health effects of tobacco for users
Cancer Coronary heart disease Disease of lungs Peripheral vascular disease Stroke Still birth Fetal complication
Health effects of second hand smoke
Heart disease
Heart attack
Lung cancer
Health effets of unhealthy diets
Coronary heart disease Stroke Cancer Type 2 diabetes Hypertension Liver gallbladder disease Obesity
Percentage of world population with not enough physical activity
31
Reasons for Low physical activity worldwide
Aging pop
Transportation
Communication technology
Health effects of low physical activity
Coronary heart disease TPE 2 diabetes Breast cancer Colon cancer Premature mortality
Percentage of world population that are episodic or heavy alcohol drinkers
11.5
Is consumption of alcohol increasing or steady with time
Steady
What is excessive drinking for a men ? A women ?
More than 2 beers per day for a men
More than 1 beer a day for a woman
What is harmful binge drinking for a men ? A woman ?
More than 5 beers men
More than 4 women
What is considered an excessive women drinker
8 or more drinks per week
What is considered excessive drinking for men
15 or more drinks per week
Immediate harmful effect of alcohol use
Reduced brain function Loss of body heat Fetal damage Unintentional injuries Violence Coma Death
Long term harmful effect of alcohol use
Liver disease Cancer Hypertension Git disorders Neurological issues Psychiatry issue
Metabolic risk factors
Hypertension Cholesterol Blood glucose Overweight Obesity
Normal blood pressure
Systolic less than 120
Diastolic less than 80
Prehypertensive measures
120-139
80-89
Hypertensive measures
More than 140
More than 90
Leading risk factors for stroke
High blood pressure
Complications of hypertension
Heart failure Peripheral vascular disease Renal impairment Retinal hemorrhage Visual impairment
Source of sodium intake in 75% of cases inn the US
Restaurants and processed foods
Source of sodium intake in 75% of cases inn the Japan , china
Cooking with high sodium products
Recommended salt intake per day
Less than 5g
Or 2000 milligram
Number of deaths due to high glucose
3.4m
Leading cause of renal failure
Diabets
Major cause of heart and renal diseases
Raised glucoses
What is overweight and obesity
Abnormal or excessive fat accumulation that presents a risk to health
BMI formula
Weight in kg / height in cm sqaured
Overweight bmi
25-29.9
Obesity bmi
More than 30
Assessment of obesity and overweight
Bmi
Skinfold thickness test
Waist to hip circumference ratio
Waist to hip circumference ratio for men and women
Men more than 102cm
Women than 88cm
Health effects of obesiy
Coronary hear disease
Type 2 diabetes
Hypertension
WHO global targets to reduce NCDs by 25%
Decreased blood pressure 25%
Smoking reduced by 30%
Reduce salt intake 30%
Increase physical activity 10%
Stomach cancer types
Adénocarcinoma
Risk factors stomach cancer
Smoking
Family history
H pylori
Diet
Liver cancer risk factors
Sex Âge Chronic hepatitis Diabetes Cirrhosis Heavy alcohol Obesity
