بنام خدا

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. بیماری مزمن

- 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 بیان مسئله :

1. مصرف سیگار و سایر اشکال دخانیات 2. اعتیاد به مشروبات الکلی 3. نارسایی یا ناتوانی در دسترسی به خدمات بهداشتی برای پیشگیری 4. دگرگونی های سبک زندگی 5. عوامل خطر زیست محیطی ( خطرات شغلی، آلودگی آب و هوا،... ) 6. عوامل مربوط به استرس عوامل خطر :

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

One “One year lost to poor health.” DisabilityAdjustedLifeYear The DALY: A Comparative Tool to Measure Health 6

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. 7

DALYs DALYs =YLL + YLD Disability Years ofYear AdjustedLifeLived with LifeLostDisability Years MortalityMorbidity 8

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

EMR/NCD RISK FACTORS Smoking 16-65% Hypertension 12-35% Diabetes 7-25% Over weight-obesity40-70% Dyslipidemia30-70% Physical Inactivity 80-90%

Prevalence of Smoking according to STEPwise Survey in EM countries %

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

Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors Tobacco Use Unhealthy diets Physical Inactivity Harmful Use of Alcohol Cardio- vascular Diabetes Cancer Chronic Respiratory

Total deaths around the world: 58 million

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

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

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

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

The leading causes of NCD deaths in 2008 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.

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

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

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

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

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

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

Dr Z Farajzadegan Raised blood pressure 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

Dr Z Farajzadegan Overweight and obesity 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

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

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.

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 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.

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

Dr Z Farajzadegan Raised cholesterol 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

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

What are Chronic Diseases?

(cumulative) Geographical regions (WHO classification) Total deaths (millions) NCD deaths (millions) Trend: Death from infectious disease Trend: Death from NCD Africa %+27% Americas %+17% Eastern Mediterranean %+25% Europe %+4% South-East Asia %+21% Western Pacific % Total %+17% Noncommunicable Diseases Death trends ( ) 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. (WHO Chronic Disease Report, 2005)

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

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

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

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

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 *childhood overweight and obesity One third = portion of who will develop diabetes over their lifetime, given current trends in the share who are overweight or obese Source: Laino C. One in three kids will develop diabetes. Web MD. June 16, Available at: Accessed July 31,2006.

44 Chronic diseases are the leading cause of death in the U.S. Chronic disease is responsible for seven out of every 10 deaths each year Top 5 Causes of Death (1980, 2004) Heart disease 2Cancer 3Cerebrovascular diseases (Stroke, hypertension) 4Unintentional injury Chronic lower respiratory diseases 5Chronic obstructive pulmonary disease Unintentional injury Chronic disease accounts for four of the top five causes of death Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: Accessed April 6, Source: Centers for Disease Control and Prevention. Health, United States,

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 type 2 diabetes 40% of cancer 80% of heart disease and stroke Source: Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health Webinar. May 23, Available at: Accessed April 17, 2007.

47 There is also substantial room for improvement in treating chronically ill patients to prevent further complications 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: Only half receive appropriate preventive care

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

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

Main Causes of Death, Worldwide, all ages

Global Distribution of Chronic Diseases Deaths

The Impact of Chronic Disease in the Iran Total Deaths in Iran (2002)= Total Deaths related to Chronic Diseases =