Non Communicable Diseases II

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Non Communicable Diseases II

• CANCER

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Warning Signs

• Unusual bleeding/discharge
• A sore which does not heal
• Change in bowel or bladder habits
• Lump in breast or other part of the body
• Nagging cough
• Obvious change in moles
• Difficulty in swallowing

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Cancer Epidemiology

• 44 to 122 per 100,000 population in males
• 52 to 128 per 100,000 females
• Men - Lung, oesophagus, stomach, oral and
  pharyngeal cancers
• Women - cancers of cervix and breast, followed by
  those of stomach and oesophagus

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Distribution of Selected Cancers
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Cancer incidence rates in Thiruvananthapuram and
Karunagappally 1998 -2002 (per 100,000)
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Preventable Risk Factors

• Tobacco
• Alcohol
• Infections
• Dietary factors
• Other environmental factors

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Cancer Control

• Prevention and early detection are major pathways
  for cancer control
• Cancer registries provide leads for planning,
  implementation and evaluation of control
  programmes

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High Risk Groups

• All tobacco users
• Multiple sexual partners cervical cancer
• Obesity / High fat diet breast cancer, colon
  cancer

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Down Staging of Cancers

• Oral cancers
• Leukoplakia
• Sub mucous fibrosis
• Erythroplakia
• Breast cancers
• BSE
• Cervical cancers
• Pap smear

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Pap smear of 997 women
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Screening for Oral Cancer

• Oral Visual Inspection
• Sensitivity 58 94
• Specificity76 -98
• 5 to 20 of Leukoplakia and 10 to 20 of Sub
  mucous Fibrosis turn malignant
• Idukki
• Leukoplakia 12
• Oral Sub mucous Fibrosis 10

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Screening for Breast Cancer

• Breast Self Examination
• Mammography
• Issues
• Delay in seeking care

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• BLINDNESS / LOW VISION

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Definitions

• BLINDNESS
• Visual Acuity of less than 3/60 OR its
  equivalent.
• LOW VISION
• Visual Acuity of less than 6/ 18 but 3/60 OR
  corresponding to visual field loss to less than
  20 in the better eye with best possible
  correction.
• AVOIDABLE BLINDNESS
• Blindness that can be prevented or treated by
  effective methods.

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Major Causes

• CATARACT-62.6
• REFRACTIVE ERRORS-19.7
• GLAUCOMA-5.8
• POST. SEGMENT DISORDER-4.7
• SURGICAL COMPLICATION-1.2
• In Kerala degenerative diseases (Hypertension,
  Diabetes) are fast catching up with these causes

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Preventable Blindness

• Cataract
• Trachoma
• Onchocerciasis
• Childhood Blindness
• Refractive errors
• Glaucoma
• Diabetic Retinopathy

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Prevalence Estimates per 1000 population
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National Programme for Control of Blindness

• Vitamin A
• Cataract
• Trachoma (Mass treatment) historical importance
• Eye donation / Eye banks / Corneal transplants

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Vision 2020

• Diseases that fall under the priority of the
  Vision 2020 National Action Plan are
• 1. Cataract
• 2. Childhood blindness
• 3. Refractive errors and low vision
• 4. Corneal blindness
• 5. Glaucoma
• 6. Diabetic retinopathy
• 7. Trachoma (focal)

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National Level Study of Blindness 2005 with
72044 subjects

• Presenting vision ,6/60, in the better eye, was
  observed in 8.5 (95 CI 8.1 to 8.9).
• Age, sex, residence, literacy, and working status
  were associated with blindness. The highest risk
  was among those aged 70 and the illiterate.
• Cataract was responsible for 62.4 of bilateral
  blindness.
• Prevalence of cataract blindness was 5.3 (95
  CI 4.97 to 5.62).

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• INJURIES

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Injury is .

• Body lesion due to an external cause
• Mechanical
• Electrical
• Chemical
• Thermal
• Radiant

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Types

• Unintentional
• Falls
• Road traffic accidents
• Drowning
• Poisoning
• Animal related snakebite, others
• Intentional
• Assaults
• Homicide
• Suicide

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Special Categories

• Occupational
• Road Traffic Accidents
• Mental Ill Health

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Motorization in India
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Determinants of Injuries
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Determinants of Death in Injuries
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Deaths due to RTAs
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Injury Pyramid in India
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Suicides - State-wise distribution per Lakh
Population

• Pondicherry(50)
• Kerala (29)
• Karnataka (24)
• Tripura (25)
• Tamil Nadu (18)
• Maharashtra (15)
• West Bengal (17)
• Goa (17)
• Andhra Pradesh (13)
• Sikkim (15)
• National average rate of 11/100,000.
• 23 metropolitan cities of India contributed to 9
  of total suicides

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Control of Impact

• Acute Care
• Rehabilitation

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• Thank You!