بخشی از پاورپوینت
اسلاید 2 :
مطالعات کوهورت بیماری های غیرواگیر
تلاش برای شناسایی و پیشگیری مهمترین بیماری های قرن
اسلاید 5 :
ریشه بیماری های غیرواگیر در زندگی داخل رحمی و رشد اولیه است. افزایش این بیماریها در کودکی و نوجوانی نیز دیده می شود. اهمیت رشد اولیه در بیماریهای غیرواگیر را با فرضیه Development plasticity توجیه می کنند. این پدیده زمانی اهمیت دارد که سلول ها تمایز پیدا می کنند که بیشتر در زمان بارداری است ولی در مواردی مانند کودکی، بلوغ و منوپوز نیز اتفاق می افتد این تغییرات سبب افزایش خطر بیماریها در سنین بالاتر از زندگی می شود.
منشا بیماری ها از زندگی داخل رحمی (1)
اسلاید 6 :
فاکتورهایی که در ابتدای زندگی بر پاسخ های فرد به محیط خود تاثیر می گذارند و او را به بیماری در زندگی آینده حساس می کنند Developmental origins of health & disease (DoHad) نامیده می شوند که از پروسه Developmental plasticity، که رشد وتوسعه فنوتیپ را مشخص می کند، به وجود می آیند. ماحصل شواهد اپیدمیولوژی و بالینی از مطالعات انسانی عبارتند از:
فرزندان زنانی که در زمان بارداری در قحطی بسر میبردند، درصد بالایی از خطر ابتلا به بیماری های متابولیک و قلبی عروقی دارند که در طول عمر ادامه می یابد.
سطح متیلاسیون برخی ژنها در موقع تولد با بروز چاقی کودکان ارتباط قوی دارد.
چاقی و دیابت در زمان بارداری عوامل خطر برای بروز بیماری های متابولیک در فرزندان است.
برخی عوامل خطر بیماریهای مزمن از نسلی به نسل دیگر انتقال می یابد (شواهد محدود)
منشا بیماری ها از زندگی داخل رحمی (2)
اسلاید 7 :
Developmental Origins of Health and Disease (DOHaD)
Chronic disease outcomes have their roots in fetal and early childhood development
The world faces a crisis of increasing chronic diseases reduction of health and welfare and increased financial burden of NCDs
This includes obesity, type 2 DM, insulin resistance, dyslipidemia, CVD and atherosclerotic disease
They are seen at a younger age as chronic disorders in childhood and adolescents
Serves as a framework to assess the effect of early nutrition and growth on long-term health
اسلاید 8 :
Effects of a sedentary lifestyle
اسلاید 9 :
Global Deaths According to Cause and Sex, 2008
Hunter DJ. N Engl J Med 2013; 369: 1336
اسلاید 10 :
Proportion of Deaths from Noncommunicable Diseases among Persons Younger than 60 Years of Age, According to Income Group of Countries
Hunter DJ. N Engl J Med 2013; 369: 1336
اسلاید 11 :
WHO 2012 World Health Statistics
(CVD) accounts for the majority of death from NCDs, causing 17 million deaths in 2008, or nearly half of all reported cases, and it is expected that by 2030, CVD death will reach 28 million. Cancer (21%), respiratory disease (12 %), and diabetes (3.5%)
Curr Hypertens Rep (2012) 14:475–477.
اسلاید 12 :
the probability of dying from an NCD during prime working years of 30 to 70 years of age is nearly two-fold higher (48 % vs. 26 %) in low-income and middle-income countries compared to wealthier nations. In addition, 80 % of all NCD deaths overall occurred in the lowest income nations. The problem for these nations,
therefore, is huge.
Curr Hypertens Rep (2012) 14:475–477.
WHO 2012 World Health Statistics
اسلاید 13 :
In contrast to hypertension, which showed overall worldwide improvement, the WHO Report notes concerning observations on metabolic syndrome and diabetes, which has been well correlated with obesity.
According to the WHO report, obesity rose from 5 % to 10 % in men worldwide, and from 8 % to 14 % in women. As reported elsewhere, during this same time frame, worldwide diabetes prevalence rose from 8.3 % and 7.5 % in men and women, respectively, in 1980, to 9.8 % and 9.2 % in 2008.
Curr Hypertens Rep (2012) 14:475–477.
اسلاید 14 :
Associations between poverty, non-communicable diseases (NCDs), and development goals MDG=Millennium Development Goal
Curr Hypertens Rep. 2012; 14(6):475-7.
اسلاید 15 :
Five priority actions by countries and international agencies for the non-communicable disease (NCD) crisis
Curr Hypertens Rep. 2012; 14(6):475-7.
اسلاید 16 :
Focus on behavioural change as the core component of all clinical programmes for the prevention and management of chronic disease.
Establish actual centres to design, implement, study and improve preventive programmes for chronic disease.
Use human-centred design in the creation of prevention programmes with an inclination to action, rapid prototyping and multiple iterations.
Extend the knowledge and skills of Sports and Exercise Medicine professionals to build new programmes for the prevention and treatment of chronic disease.
Mobilise resources and leverage networks to scale and distribute programmes of prevention.
Br J Spoorts Med. 2013; 47(16):1003-11.
Prevention of NCD
اسلاید 17 :
Most of the interventions advocated by WHO are nothing to do with doctors and health systems. Most of what needs to be done to counter NCDs lies outside the health systems.
We have strong evidence that we can prevent prediabetes and prehypertension progressing to the full blown conditions by helping people change their lifestyles and lose weight. Again, this is nothing to do with doctors and drugs. The programmers are unaffordable if they use doctors rather than community health workers.
BMJ .2011; 343
اسلاید 18 :
During the last decades, the incidence of NCDs increased worldwide and Population Based Cohort Studies designed to determine the risk factors of these diseases especially CVDs
اسلاید 19 :
Framingham Heart Study in US (1948)
Puerto Rico Heart Health program (1965)
Bogalusa Heart Study in US (1972)
Honolulu Heart Program among Japanese Americas (1980)
MONICA (multinational Monitoring of trends and determinants in Cardiovascular isease) in 21 countries (1980)
ARIC (Atherosclerosis Risk in Communities Study) in four US communities (1987)
CHS (Cardiovascular Health Study) in US (1989)
SHS (Strong Heart Study) in America Indians (1989)
Rotterdam Study in the Netherlands (1990)
AusDiab (Austrailian Diabetes, Obesity and Lifestyle Study) (1999)
TLGS (Tehran Lipid and Glucose Study) in Iran (1999)
Prospective Studies of Cardiometabolic Disease and Risk Factors
