L-10.

Non Communicable Diseases

 Communicable disease: a disease that can be spread to a person from another person, an
animal or object. Ex: common cold, influenza, tuberculosis, etc.

Sudden onset

Single cause

Short natural history

Short treatment schedule

Cure is achieved

Single discipline

Short follow-up

Back to normalcy

 Non-communicable disease a disease that can NOT be spread from person to person. Ex:
Cancer, Heart Disease, etc.

Gradual onset

Multiple causes

Long natural history

Prolonged treatment

Care predominant

Multidisciplinary

Prolonged follow up

Quality of life after treatment

NCDs

• Obesity
 • Diabetes

• Hypertension

• Coronary Heart Disease

• Stroke

• Cancers

• Blindness

• Psychiatric Disorder

• Others

Noncommunicable Disease Progress Monitor 2015(WHO)

 Each year, 16 million people die prematurely before the age of 70 from NCDs. Strikingly, 4 out
of 5 of these deaths occur in developing countries.

 The leading causes of NCD deaths in 2012 were Cardiovascular Diseases (17.5 million deaths, or
46% of all NCD deaths), Cancers (8.2 million, or 22% of all NCD deaths), and Respiratory
Diseases, including asthma and chronic obstructive pulmonary disease (4.0 million).

 Diabetes caused another 1.5 million deaths.

Effects of a Communicable Disease

 Several communicable diseases lead to NCD’s.

• Hepatitis B virus increases the risk of liver cancer.

• The high-risk Human Papilloma Viruses (HPV) are the cause of almost all cervical cancers, and
various other cancers.

• HPV is so common that nearly all sexually active people get it at some point in their lives. Some
types can cause health problems including genital warts and cancers.

• In 1994, the International Agency for Research on Cancer classified a stomach bacteria,
Helicobacter pylori as a cancer-causing agent, in humans.
Effects of a Communicable Disease…continue

• A type of the Escherichia coli bacteria can lead to a rare condition called haemolytic-uraemic
syndrome (HUS), which is characterized by anaemia, low levels of a type of blood cell called
platelets, and severe kidney failure.

• Infection with different types of a family of bacteria called streptococci, can lead to diseases like
a kidney disease called post-streptococcal glomerulonephritis (PSGN) from a skin infection,

• An auto-immune disease called acute rheumatic fever (ARF) from respiratory infection.

Disease of Civilization
Stress-related Diseases

• Epidemiologists have now identified a long list of stress-related diseases as “Diseases Of

Civilization” –Diabetes, Atherosclerosis, Asthma, Allergies, Obesity, Cancer and…..

• These diseases are rampant throughout the developed world, but virtually non-existent among
modern-day aboriginal peoples

Why Are We Getting Bigger?

• The study, conducted by researchers from York University in Toronto, Ontario, found that, “If
you are 40 years old now, you’d have to eat even less and exercise more than  if you were a 40
year old in 1971, to prevent gaining weight,”

 Factors Affecting Our Weight Gain

• Stress

• Environmental Factors

• Food Quality

• Prescription Drugs

• Gut Microbiome

• In 2008, more than 1.4 billion adults were overweight and more than 1/2 a billion were obese.
At least 2.8 million people each year die as a result of being overweight or obese.
 • The prevalence of obesity has nearly doubled between 1980 and 2008. Once associated with
high-income countries, obesity is now also prevalent in low- and middle-income countries

Obesity: Quick Facts and Figures

 Globally, over 40 million preschool children were overweight in 2008

----Overweight children are likely to become obese adults, who develops diabetes and cardiovascular
diseases

 Out of an estimated 43 million obese children worldwide in 2010, 81% were from developing
countries,

----1/2 of which (18 million) were reported to be living in Asia despite of huge burden of under-
nutrition.

----By 2020, it is estimated that the global prevalence of childhood obesity will reach approximately 60
million.

 Prevalence ranged from less than 1% to 17.9% with higher percentage amongst urban children
across different age groups and sexes.

 Overweight and obesity are defined as “abnormal or excessive fat accumulation that may impair
health”

 Body Mass Index (BMI) – the weight in kilograms divided by the square of the height in meters
(kg/m2) – is a commonly used index to classify overweight and obesity in adults.

 WHO defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or
more than 30.

• https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
  Factors contributing to the rising levels of childhood obesity in developing countries include…

 Socio-economic development

 Changes in lifestyle

 Physical inactivity

 Unhealthy diet

 Living patterns

 As overweight and obesity is likely to follow through into adulthood, in the longer term, there is
a greater risk of developing cardiovascular diseases

 Obesity at a young age seems to have substantial impact on reducing life expectancy

 Evidence also suggests a link between obesity in young girls with potential menstrual disorders,
hypertension in pregnancy and sub-fertility

Important Statistics for Bangladesh

 • Increasing prevalence of obesity, tobacco use, high intake of processed foods, and less physical
activity

• In general, 21.5% adults (male 21%, female 22%) have Body Mass Index (BMI) ≥25 kg/m2;
increased waist circumference is alarming especially in women (33.7%).

• Sedentary lifestyle is also responsible.

• 10.5 % men and 41.3% women were found to maintain low physical activity in a NCD Risk
Survey of 2010.

• Worldwide obesity has more than doubled since 1980

• In 2014 more than 1.9 billion adults, 18 years and older, were overweight, of these, over 600
million were obese

• 39% of adult aged 18 years and over were overweight in 2014, and 13% were obese

• Most of the world populations live in countries where overweight and obesity kills more people
than underweight

• 42 million children under the age of 5 were overweight obese in 2013. (Source: WHO)

L-10. Non Communicable Diseases

Obesity, Cardiovascular Disease, Diabetes Mellitus, Cancer

• Is a muscle the size of a clenched fist

• Is located behind the breast bone

• Pumps about 100,000 times per day

• Pumps about 7,600 liters of blood per day

• Pestilence and famine

• Heart disease >10%(RHD,CM)

• Receding Pandemic’s

• Urbanization

• Heart Disease 10%-35% (RHD,HTN,CAD and Stroke)

 • Age of degenerative

• Man made disease

• Heart disease 35%-65% (CAD and Stroke)

Risk Factor of Heart Disease

 Non Modifiable

• Family History

• Gender

• Age

 Modifiable

• Dyslipidemia Elevated Serum Cholesterol

• Smoking

• Hypertension

• Diabetes

• Obesity

• Serum Markers Such As Elevated Homocysteine

• Poor Diet, Lack Of Exercise

• Hypertension is a Hemodynamic disorder

• Evans and Rose “Hypertension should be define is the terms of blood pressure level above
which investigation and treatment do good more than harm”

• A patient is said to be hypertensive when his SBP>140mm Hg & DPB>90mm Hg provided that
the patient is not on antihypertensive drugs.

The Risk Factors for High Blood Pressure:

• Age
 • Race

• Family history

• Excess weight (>25 BMI or >25 %Body Composition)

• Inactivity

• Tobacco use

• Sodium intake

• Low potassium, calcium, magnesium intake

• Alcohol-even moderate intake for some

• Stress

Complication of Heart Disease

• Heart Failure

• Heart Attack

• Sudden Cardiac Arrest

• Stroke

• Peripheral Artery Disease

• Aneurysm

Heart Attack

•  A heart attack is the death of a segment of heart muscle caused by a loss of blood supply.

• The blood is usually cut off when an artery supplying the heart muscle is blocked by a blood clot

Ischemic Stroke

• A stroke caused by lack of blood reaching part of the brain is called an ischemic stroke.

• High blood pressure is a leading risk factor for ischemic stroke.

 • An ischemic stroke occurs when a clot or a mass blocks a blood vessel, cutting off blood flow to
a part of the brain

• South Asian refers to the individuals who originate from Indian Subcontinent or adjacent
countries

• Account for 17% of global population

Contributing Factors for CVD in South Asia

 A person’s genetic make-up

 The foundations of adult health are laid in early life

 Socioeconomic group

 Mental health

 Diet

 Overweight and obesity

 Inactivity

 Tobacco

 Alcohol

 Diabetes

 Globalization and urbanization

12 possible Heart Symptoms never to Ignore

1. Anxiety
2. Chest Discomfort

3. Cough

4. Dizziness

5. Fatigue

6. Nausea or Lack of Appetite

7. Pain in other Parts of the Body

8. Rapid or Irregular Pulse

9. Shortness of Breath

10. Sweating

11. Swelling

12. Weakness

13. Treatment of a Heart Attack

14. Take the patient to a hospital ASAP

 Heart attack <40 years 5 times more common in South Asians…

• India accounts for approximately worlds 60% heart disease burden. Number 1 cause of
mortality and a silent epidemic among Indians

• 50% of all heart attacks of Indian men occur under 50 years of age and 25% occurs under 40
years of age

• Indian women have high mortality rate in cardiac disease as well

• Only 7% of South Asian Women meet current recommended physical activity levels (30 minutes
of brisk walking, cycling or swimming at least 5 times a week)

• Only 18% of Bangladeshi men and 7% of women meet current recommended physical activity
levels (30 minutes of brisk walking, cycling or swimming at least 5 times a week)

 Bangladeshi Women…
  -Looking after young children (29%)

 -Insufficient time (26%)

 -Wont go to mixed sex facilities (20%)

 -Wont go to places where people show parts of their bodies (19%)

 -Fear of going out alone (17%)

o Language and culture

South Asian Foundation(UK). BMEG, 1994(HEA,2000)

NO FOOD,

AT LEAST 3-4 HOURS

BEFORE SLEEP

• Improves Diabetes

• Improves High Blood Pressure

• Improves Cholesterol

• Reduce Obesity

• Helps to Quit Smoking

• Helps to Control Appetite

• Reduces Stress

• Etc…Etc….Etc…

Diabetes Mellitus (DM)

• The various issues of diabetes mellitus and the contributing risk factors towards DM .

• The complications against diabetes mellitus, and how such diseases can be prevented.

• The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.

• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb
amputation.
 • In 2012, an estimated 1.5 million deaths were directly caused by Diabetes and another 2.2
million deaths were attributable to high blood glucose.

• WHO projects that Diabetes will be the 7th leading cause of death in 2030.

• Diabetes prevalence has been rising more rapidly in middle- and low-income countries.

• Diabetes Mellitus, often simply referred to as Diabetes—is a group of metabolic diseases in

which a person has high blood sugar, either because the body does not produce insulin, or
because cells do not respond to the insulin that is produced.

• Insulin is a hormone that regulates blood sugar produced by the Beta-cells of the Pancreas.

• Hyperglycaemia or raised blood sugar, is a common effect of uncontrolled diabetes and over
time leads to serious damage to many of the body's systems, especially the Nerves and Blood
Vessels.

 There are 2

major types of Diabetes:

 Type 1 Diabetes

 Type 2 Diabetes

 Other types of Diabetes

 Gestational Diabetes (GDM)

 Pre-Diabetes

1. Type 1 Diabetes

a. Type 1 Diabetes/ *IDDM (Insulin Dependent Diabetes Mellitus)/ Juvenile Diabetes

b. It is an Autoimmune disease.

c. Usually diagnosed in childhood

d. Sometimes there are no symptoms

e. Imperative to inject insulin daily because the body makes little or no insulin

f. Frequently called the ‘Insulin-dependent’ Group

 g. Patients with type 1 diabetes need insulin daily to survive.

 Warning signs of

Type-1 Diabetes:

 Extreme thirst

 Frequent urination

 Sudden weight loss

 Increased appetite

 Sudden vision changes

 Fruity odor on breath

 Nausea or vomiting

 Drowsiness, lethargy

 Heavy, labored breathing

 Stupor, unconsciousness

 Complications of

Type-1 Diabetes:

 Vision loss and blindness

 Kidney failure

 Stroke

 Cardiovascular disease

 Nerve damage

 Amputation

 Poor circulation in feet

  Feet Ulcers

 Feet Sores

 Type 2 Diabetes/ NIDDM (Non-Insulin-Dependent Diabetes)/ Adult onset Diabetes:

 Most common Non Communicable Disease

 Usually occurs in adulthood but gradually increasing in the younger generation

 Body is incapable of responding to insulin

 People are diagnosed diabetes in every 3 minutes.

Difference between
Type 1 & Type 2 Diabetes

Type 1

• Young age

• Normal BMI, not obese

• No immediate family history

• Short duration of symptoms(weeks)

• Can present with diabetic coma(diabetic ketoacidosis)

• Insulin required

• Middle age, elderly

• Usually over weight/obese

• Family history usual

• Symptoms may be present from months/years

• Do not present with diabetic coma

• Insulin not necessarily required

• Previous diabetes in pregnancy

3) Gestational Diabetes/ Pregnancy induced diabetes

 Blood sugar level is high during pregnancy in women

 Women who give birth to children over 9 lbs.

 High risk of type 2 diabetes and cardiovascular disease

4) Pre-diabetes:

 Above average blood glucose levels, not high enough to be classified under type 2
diabetes

 Long-term damage to body, including heart and circulatory system

 Starts with unhealthy eating habits & inadequate exercise

 At least 79 million people are diagnosed with Pre-Diabetes each year

Signs and Symptoms

 Dry skin

 Frequent infections

 Feet ulceration

 Loss of sensibility (legs)

 Erectile dysfunction

 Fatigue

Risk Factors

 Non Modifiable Factors

 Genetically

 Gestational Diabetes

 Family history of diabetes

 Modifiable Factors

 Lack of physical activity

  Sedentarism (person with little or no physical activity)

 Poor diet

 Excessive weight

 Consumption of alcohol and drugs

 Smoking

 Lack of knowledge on the disease

 No health care access

Complications

 Cardiovascular disease (Heart attack, hypertension, stroke)

 Kidney disease (diabetic nephropathy)

 Nerve disease (diabetic neuropathy)

 Eye disease (diabetic retinopathy)

 Pregnancy complications

 Feet ulceration and/or amputations

 Hyperlipidemia (cholesterol)

 Erectile Dysfunction

 Symptoms

– (suggest possible diabetes)

• High glucose in blood

– (confirm if higher than 126 mg/dl)

• Glucose in hemoglobin

– (indicates quality of diabetes control - higher than 7 mmol)

  Treatment depends on Types, Severity, Complications and Age

 Type 1 Diabetes: They need to inject insulin every day as well as diet and exercise.

 Type 2 Diabetes: This type can often initially manage their condition through exercise and diet.
--However, over time most people will require oral drugs and or insulin.

 Treatment depends on Types, Severity, Complications and Age

 Type 1 Diabetes: They need to inject insulin every day as well as diet and exercise.

 Type 2 Diabetes: This type can often initially manage their condition through exercise and diet.
--However, over time most people will require oral drugs and or insulin.

 To control Diabetes the recommendation is to increase physical activity, preferably every day
for 20 minutes.

 Lowers glucose levels in blood

 Improves blood circulation in the entire body

 Contributes to weight loss

 Improves physical and mental wellbeing

 Helps the body to utilize insulin more efficiently

The COLORS of RIBBON for the most common types of CANCER include:

• Lung Cancer: White

• Brain Cancer: Grey

• Breast Cancer: Pink

• Liver Cancer: Emerald Green

• Lymphoma: Lime Green

 • Prostate Cancer: Light Blue

• Stomach Cancer: Periwinkle Blue

• Bone Cancer: Yellow

• One of the most common disease in the world

• 1 in 4 death

• Lung Cancer is most common in Men

• Breast Cancer is in female

• There are 100 different form of Cancer

Risk factor: Obesity

• “Excess body weight contributes to 1 out of 5 of all Cancers related deaths”-American Cancer
Society

• Research shows that excess body fat increases the risk for several cancers, including colorectal,
Breast, Uterine, Esophageal, Kidney and Pancreatic cancers. (Professor Dr. Karen Basen-
Engquist, Ph.D., M.P.H., of Behavioral Science and the Director of the Center for Energy Balance
in Cancer Prevention and Survivor. University of Texas, MD Anderson Cancer Center).

• Cancer is the uncontrolled growth and spread of cells that arises from a change in one single
cell.

• The change may be started by external agents and inherited genetic factors and can affect
almost any part of the body.

• It is a multi stage process where growths often invade surrounding tissue and can metastasize
to distant sites.

• Any agent that causes cancer is called a Carcinogen and as described as Carcinogenic

• Cancer cells do not self destruct and continue to divide rapidly producing millions of new
Cancerous cells

Cancer: Interaction between a person’s genetic factors and any of three categories of external agents

1. Physical *Carcinogens, such as ultraviolet and ionizing radiation or asbestos.

2. Chemical carcinogens, such as components of tobacco smoke, **Aflatoxin (a food contaminant) and
Arsenic (a drinking-water contaminant); and
3. Biological carcinogens, such as infections from certain viruses, bacteria or parasites.

*Carcinogenesis or oncogenesis or tumorigenesis is the formation of a Cancer, whereby normal cells are
transformed into Cancer cells.

**Most chemicals to which people are exposed in everyday life have not been tested for their long-
term impact on human health.

Stages of Cancer

• There are Four stages of Cancer: Stage 0, Stage I, Stage II, Stage III, & Stage IV.

• Stage 0 means there's no cancer, only abnormal cells with the potential to become cancer. This
is also called Carcinoma in situ (CIS) (group of abnormal cells).

• Stage I means the cancer is small and only in one area. This is also called early-stage cancer.

• Stage II and III mean the cancer is larger and has grown into nearby tissues or lymph nodes.

• Stage IV means the cancer has spread to other parts of your body. It's also called advanced or
metastatic Cancer.

• Skin

• Bone

• Breast

• Brain

• AIDS related cancers

• Eye cancers

• Head and neck

• Renal cell (Kidney)

• Mouth

• Oral cavity

• Lung

• Stomach (Gastric)
 • Urethral

• Vaginal

• Most risk factors need 10+ years to develop into Cancer

• In general Risk Factors are responsible for 1/3 of all Cancers (outside of Genetic and Disease-
related Cancers)

 Sugar is a major cause of our leading killers

• Heart disease

• Cancer

• Alzheimer's

• Several investigation showed relation between fasting blood glucose and the incident of cancer.

• These findings provide further evidence that elevated blood glucose is associated with the
incidence of several types of Cancer in Men and Women

• Virtually all Cancer cells eat only Glucose (Sugar)

Cancers associated with

Poor Diets

• Colon/Esophagus Cancer

• Pancreas/Kidney Cancer

• Uterus/Rectal Cancer

Middle East Cancer rates

• The WHO estimated that there were 5,55,318 new cases of Cancer in 2012

• By 2030 WHO estimated that this could rise to 9,61,098 cases

• This would make Cancer rates the highest relative increase in all regions of the world

• Middle East Cancer rates expected to double in 20 years, says WHO

Root Causes and Co-factors of Cancer

• Obesity

• Type-2 Diabetes
 • Sedentary lifestyle

• Weak Immunity

• Poor diet

• Nutritional Deficiencies

 Macronutrient

 Vitamin deficiencies

 Minerals deficiencies (Selenium, Zinc)

• Chronic Inflammation

• Stress/Insomnia

• Pharmaceutical Drugs

• Toxicity/Acidity

• Environmental Toxins

• Smoking/Alcohol

• Genetics

 Tobacco use

 Reproductive factors

• Infections (hepatitis B, hepatitis C (liver cancer), human papillomavirus (HPV; cervical cancer),
Helicobacter pylori (stomach cancer)

Most Unhealthy Cancer Causing Food

• GMO

• Processed Meats

• Microwave Popcorn

• Soda

• Diet Food and Beverages

• Refined White Flour

 • Refines Sugar

• Non Organic Fruits

• Farmed Salmon

• Hydrogenated Oils

• WHO’s approach to cancer policy has….

….‘Four Pillars’:

1. Prevention

2. Early detection

3. Screening

4. Treatment (Palliative Care)

Exercise reduced Cancer risk:

Exercise has been strongly implicated in lowering risk for the following

• Colon cancer

• Kidney cancer

• Uterine cancer

• Stomach cancer

• Lung cancer

• Myeloid Leukemia

• Esophagus cancer

• Brest cancer

• Liver cancer

• Bladder cancer

• Rectal cancer

• Multiple Myeloma

 Exercise definition:
 • Vigorous exercise 3 days a week

• Moderate exercise 5-7 days a week

Or

• Vigorous exercise 75 minutes/week

• Moderate exercise 150 minutes/week

 This can be accomplished by walking on a lunch break 30 minutes for 5 days a week

Diet…..

• The Mediterranean Diet: Plant based foods, whole grains, legumes, fruits, vegetables

• New research study suggest that a compound abundant in the Mediterranean diet (APIGENIN)
takes away Cancer cells 'superpower’ to escape death. (Science Daily)

• Stop Smoking

• Change Your Diet

• Obtain Genetic Testing

• Exercise

o Get regular medical screening for…

Breast Cancer, Prostate Cancer, Colon Cancer, Lung Cancer, Diabetes, Obesity

What is Injury?

 Any damage to your body is an injury.

  Injuries can be caused by accidents or acts of violence, and may occur at home, work, or play.

 They can be due to impact from blunt objects or from objects that penetrate the body.

 Common types of injury include abrasions, lacerations, hematomas, broken bones, joint
dislocations, sprains, strains, and burns.

 Injuries are NOT accidents!

 Accidents: An unexpected occurrence, happening by chance

 Injury: A definable, correctable event, with specific risks for occurrence

Types of Injury

Intentional

 Homicide

 Suicide

 Rape

 Shootings

 Stabbing

 Domestic violence

 Child abuse

 Other assault

Unintentional:

 Motor vehicle crashes

 Pedestrian injury

 Motorcycle crashes

 Occupational injury
  Drowning

 Falls

Types of Specific Physical Injury

 Back injury

 Elbow injury

 Foot and ankle injuries

 Hand and wrist injuries

 Head injury

 Heap and groin injuries

 Knee injury

 Leg injury

 Neck and shoulder injuries

Cause of ladder accident

1. Selecting the Wrong Type of Ladder

2. Using Worn or Damaged Ladders

3. Incorrect Use of Ladders

4. Incorrect Placement of Ladders

What is Occupational Hazards

• An occupational hazard is a hazard experienced in the workplace

• Occupational hazard as a term signifies both long-term and short-term risks associated with the
workplace environment and is a field of study within occupational safety and health and public
health.

• Basically a hazard can cause harm or adverse effects (to individuals as health effect or to
organizations as property or equipment losses).

What Type of Hazards are There?

 Hazards generally fall into one of six groups:

 1. Biological: bacteria, viruses, insects, plants, birds, animals and humans, etc

2. Chemical: depends on the physical, chemical and toxic properties of the chemical

3. ***Ergonomic: repetitive movements, improper set up of workstation, etc

4. Physical: radiation, magnetic field, pressure extremes(high pressure or vacuum), noise, etc

5. Psychosocial: stress, violence etc

6. Safety: slipping/tripping hazards, inappropriate machine guarding, equipment malfunctions or

breakdowns,

***What is Ergonomics…

• Ergonomics is the study of the relationship between people and their environment

• The goal of ergonomics is to ‘make the work fit the worker’ instead of ‘making the worker fit
the work’

10 causes of workplace injury

1. Fatigue: If someone is pushed -- or pushes herself -- beyond reasonable limits to stay on top of
workload, the results often are physical and mental exhaustion.

2. Stress: Job security, finances, health issues, anxiety --heart attack, stroke or hypertension.

3. Lack of building safety measures

4. Slips

4. Trips

5. Toppling Objects

6. Hazardous Materials

7. Repetitive Motion: Carpal tunnel syndrome

8. Lifting

9. Workplace Violence

10. Collisions

Preventive Measures

1. Wear proper clothing

 2. Have regular medical check ups

3. Have careful and proper training

4. There should be a regular check up of all equipment,

5. Constantly check the temperature of the workplace. There is an ideal temperature for every
factory or bakery

6. Drink

7. Proper time management

8. The employers should give fire drills or earthquake drills.

1. Road traffic accidents

2. Domestic accidents

3. Industrial accidents

4. Railway

accidents

5. Violence

6. Homicide

18th November is the World Day of Remembrance for Road Traffic Victims.
More than 1.2 MILLION people die on roads each year.

• About 1.25 million die and 20 to 50 million suffer injuries globally

• Second leading cause of death for people between the ages 5 and 29, third leading cause for
people between the ages 30 and 44

• 73% death occur among male

• 500 children killed each day in road crashes

 • 90% of the world's fatalities on the roads occur in developing countries

• 96% total child deaths occur in developing countries

• In Bangladesh 8 persons die everyday

• 12,000 lives and 35,000 injuries annually(ARI,2011)

• Economic cost of 2% to 3% of the countries GDP, an enormous loss in health related cost (WHO,
2015)

 Roads and highways are more prone to road accidents in BD

• Number increases on the eve of festivals

• 21 years 84K road accidents occurred, killed 56K and injured 63K (BD Police 2015)

• PWAB revealed 8,642were killed and 21,855 injured in road crashed in 2015

• 10-15 people killed everyday in the year 2015

• 13.6 (every 100,000) are pedestrian, rate 45% of all type of RTA

• Child involvement 16-20%

• Bangladesh ranking in RTA is #109

Types Causes

Human Related Cause 1. Reckless driving and over speeding

2. Use of drug and alcohol

3. Incompetency of the driver

4. Illegal competition

Road Cause 1. Hazardous road

2. Lack of proper design and construction

3. Curve of the road

 4. Lack of safety measures

Socio-economic and Demographic Cause 1. Lack of roadway maintenance

2. Poor implementation of road traffic and regulation

3. Lack of awareness among people

4. License

 In many countries motor vehicle accidents rank first among all fatal accidents.

 In Developing countries road traffic accidents are common due to:

 Lack of proper planning

 Unskilled driver

 Unsatisfactory personal behavior

 Large number of slow and fast vehicles share the same road.

 Large number of old poorly maintained vehicles.

 Defective roads , poor street lighting.

 These 4 accidents types account for nearly 83% of the accidents

• Hit Pedestrian(43.7%)

• Rear End Collision(16.4%)

• Head On Collision(13.3%)

• Overturning(9.4%)

• Safety Education

• Availability of Safety Measures

• Alcohol Control Law

• Primary Care Service

 • Awareness

• Elimination of Causative Factors

• Enforcement of Law

• Rehabilitation Service

• Accidental Research

 Accident which takes place at home.

 The causes are:

1. Drowning –In Bangladesh and Maldives, death occur in ponds, rivers, during floods and
cyclones.

2. Burns -2/3 cases are of females,

3. Poisoning -drugs, insecticides

4. Falls- rooftops, balconies, windows, stair cases

5. Every day nearly 2,300 children and adolescents die from injuries they sustain as a result of
traffic accidents, drowning, poisoning, falls or burns and violence.

6. Most of these incidents occur in low- and middle-income countries.

7. Violence: 1.6 million persons died worldwide of which 3,86,000 were in South east Asian region

8. Suicide: Poisoning, hanging and drowning are the most common methods

What is Climate Change?

 “Any significant change in measures of climate, such as temperature, precipitation, wind, and
other weather patterns, lasting for decades or longer.”

 Overwhelming consensus of scientific studies is that climate change is Human caused and due
to increases in Greenhouse Gases from burning fossil fuel.

 Climate change is occurring now, in Bangladesh and around the globe.

What is Global Warming?

 Global warming is the increase of earth’s average surface temperature and its oceans due
to greenhouse gases released as people burn fossil fuels. These greenhouse gases such as
Carbon Dioxide and Methane absorb heat that would otherwise bounced off the Earth’s
surface.

 Global warming has emerged has one of the most biggest environmental issue in the last two
decades.

 As per NASA,, “the global average surface temperature rose 0.6 to 0.9 degrees Celsius (1.1 to
1.6° F) between 1906 and 2005, and the rate of temperature increase has nearly doubled in the
last 50 years.

What is Green House Effect?

 The greenhouse effect is a natural process that warms the Earth's surface. When the Sun's
energy reaches the Earth's atmosphere, some of it is reflected back to space and the rest is
absorbed and re-radiated by greenhouse gases (carbon dioxide, water vapor, methane, etc.) ...
The absorbed energy warms the atmosphere and the surface of the Earth…

Climate Risks in Bangladesh

 Stronger, longer heat waves

 More frequent/heavy precipitation events

 More frequent/severe droughts

 More frequent severe weather events

 Sea level rise/coastal flooding

Public Health Consequences

 Increase in health conditions associated with allergens

 Effects on the food supply

 Evacuation of health care facilities

 Disrupted access to emergency/routine medical care

  Mental/emotional health consequences

 Increase in heat-related morbidity/mortality

 Increase in vector, water and food-borne disease

 Loss of water supply and water quality

 Outcomes associated with loss of electricity

 Increase in adverse health outcomes associated with air pollution (e.g., asthma)

Mitigation & Adaptation

• Mitigation: actions/policies to reduce greenhouse gas emissions

– “40 to 30” and “80 to 50”

• Adaptation: actions/policies to prepare for climate change, to reduce its impacts and to take
advantage of new opportunities.

– occurs at individual, community, organizational, institutional levels

– calls for incorporating climate change information into planning & decision making

Climate Change and Bangladesh

 The flat topography makes a significant part of Bangladesh vulnerable to sea level change. The
active delta and dynamic morphology complicates the reliable estimation of vulnerability of tidal
floodplains to sea level rise.

 The net sea level rise would result in

 Inundation of coastal land

 Reduced drainage and hence prolonged flooding due to high backwater.

 Higher precipitation within GBM basin would result in greater flood magnitude and
frequency.

 Per capita emissions of CO2 is less than 0.2 ton annually in Bangladesh, compared to 1.6 tons in
the developed countries

• Human Health Impacts

• Ecosystem Impacts
 • Water Resources Impacts

• Future Environmental Impacts

Environment

Old French word, En=In; Viron = Circle.

The circumstances, objects, or conditions by which one is surrounded.

Or

Environment is the total of the natural conditions under which animals live, including climatic,
geographic, physiographic and faunal conditions; all that which is external to the individual human host.

Public Health Definition of Environment

• All that is external to the individual host. It can be divided into physical, biological, social, and
cultural factors, any or all of which can influence health status in populations.

Contributor to the Environment

• Physical:

– Air, water, soil, housing, climate, geography, heat, light, noise, debris etc.

– Air pollutants, toxic wastes, pesticides etc.

• Biological:

– Virus, bacteria and other microbes, insects, rodents, animals and plants

– Disease producing agents, reservoir of infection, intermediate host

• Social/Psychosocial/Socioeconomic:

– Culture, values/ morals, customs, habits,, religions, education, lifestyle, community life,
health services, social and political organizations.

Popular Customs and environment

• Increased demands for natural resources:

-Animal extinction-furs, skin

-Meat consumption-Inefficient use of calories

 • Pollution

-Waste-Discarding products, Packaging

-Emissions

Healthy Environment

 Clean air

 Safe and sufficient water

 Safe and adequate food

 Safe and peaceful settlements

 Stable global environment

 Scope of healthy Environment

 Water supplies

 Waste water treatment

 Waste management

 Vector control

 Prevention and control of land pollution

 Food hygiene and safety

 Air quality management

 Environmental radiation hazards

 Occupational health and safety


Water and HealthUses of Water
 • Domestic uses; Public purpose; Industrial purpose; Agricultural purpose; Hydropower
production.

 Source of Water

• Rainwater, Surface water; Ground water.

 Water Pollution

• Sewage, industrial and trade pollutants, agricultural pollutants, physical pollutants and
radioactive substances.

 Water Borne Diseases

• Viral: Viral Hepatitis A, Hepatitis E, Poliomyelitis, Rotavirus diarrhoea etc.

• Bacterial: Typhoid & Paratyphoid fever, Bacillary dysentery, Cholera, Esch. Coli Diarrhoea etc.

• Protozoal: amoebiasis, giardiasis.

• Helminthic: round worm, thread worm, hydiatid disease.

• Snail: schistosomiasis.

• Cyclops: guinea worm, fish tape worm.

Air pollution

 Automobiles: Co2, Co, Pb, No2, Black Smoke.

 Industries: So2, No2, Fly Ash, smoke, Hydrogen fluoride, HCl, Hydrogen sulphide, Ozone etc.

 Domestic Source: smoke, dust, So2, No2

 Miscellaneous: burning refuse, incinerator, pesticide, spraying, Natural source (fungi, bolds,
bacteria etc.)

 Co: Carboxyhaemoglobin

 So2: Acid rain

 Pb: Lead poisoning, decrease IQ level in young children

 Co2: global warming and climate change

 Hydrocarbon: Eye damage

 Cadmium: Cancer
  So2/H2S: unpleasant odour, conjunctival irritation, mental and neurological damage.

 Ozone: ozone layer depletion

 Polynuclear Aerometric Hydrocarbon(pah): Lung cancer

 Particulate matters: COPD, respiratory problems.

 Health Aspect

 Acute effect: ARI, Acute pneumonia, Acute bronchitis, immediate death by suffocation

 Chronic effect: COPD, Lung cancer, Emphysema, Respiratory allergy etc.

 Social and Economic aspect

 Destruction of animal and plant life

 Corrosion of metals

 Damages to buildings

 Cost increase in cleaning and maintenance

 Aesthetic nuisance

 Reduction of visibility of town

 Damage of soil,

 Damage of clothing

 Prevention and control of air pollution

WHO recommended procedure

1. Containment: Prevention of escape of toxic substance in atmosphere by enclosure, ventilation

and air cleaning

2. Replacement: replacement of coal, firewood, lead petrol by new technology e.g. electricity,
natural gases, central heating, solar power etc.

3. Dilution: self cleaning capacity of environment. E.g. establishment of greenbelt.

4. Legislation: Formulation, implementation and monitoring of environmental act and regulation

5. International Action: WHO established an international network of laboratories for the
monitoring and study of air pollution.

Medical Entomology

• A study of the arthropods of medical importance is known as medical entomology.

• Some arthropods are beneficial as they help in fertilization of flowers and crops and some are
harmful to human being as they are vector and reservoir of disease and also destroy crops and
foods.

Arthropods Borne Diseases

• Arthropods

• Mosquito Malaria, Filaria, JE, Dengue Fever, West Nile Fever, Yellow Fever etc

 Housefly Typhoid And Paratyphoid Fever, Diarrhoea, Dysentery, Cholera, Gastroenteritis,

Amoebiasis, Helminthes, Poliomyelitis, Trachoma, Conjunctivitis, Anthrax etc.

 Sandfly Kala- Azar, Oriental Sore, Sandfly Fever, Oraya Fever etc.

• Tsetse fly Sleeping sickness

• Louse Epidemic typhus, relapsing fever, trench fever, pediculosis etc.

 Rat flea Bubonic plague, epidemic typhus, chiggerosis, hymenolepsis diminuta etc.

• Black fly Onchocerciasis

• Reduviid bug Chagas disease

•
  Itch-mite Scabies

Principles of Arthropods control

1. Environmental control: Elevation of breeding places, filling and drainage operation, carefully planned
water management; provision of piped water supply; proper disposal of waste; proper house keeping
etc.

2. Biological control: It can be defined as the use of natural enemies to reduce the damage caused by a
insect pest population. Example: use of Lurvi vorous fish, frogs

3. Genetic control:

 Sterile/killing male

 Chromosomal translocations

 Cytoplasmic incompatibility

4. Integrated/Newer approach:

 Insect growth regulates

 Sex attractions or Pheromones

 Chemosterilants

Improper Disposal Of
Human Excreta and Sewage
- it has been responsible for
Many Epidemics….

• Human excreta is a important cause of environmental pollution and source of infection.

• Safe disposal of excreta is the responsibility of everyone.

• The hazards of improper disposal of excreta are:

– Soil pollution

– Water pollution
 – Food contamination

– Propagation of flies

• The disease caused by improper disposal of human excreta disposal are:

– Typhoid and Paratyphoid fever,

– Dysentery,

– Diarrhoea,

– Cholera,

– Round worm,

– Hook worm,

– Viral hepatitis and

– Other Intestinal infection.

1 in 5 of us may have mental health issues…..

23% Female and 17% of Males show the signs of mental health problems

 Mental illness is common 6 in 10 women and 4 in 10 men in Western Europe and North
America.

 Mental illness can affect

any one of us

 Mental illness occurs in

all societies and cultures

What is Mental Health?

 What does it mean to be mentally healthy?

• Mental health refers to your overall psychological well-being. It includes the way you feel about
yourself, the quality of your relationships, your ability to manage your feelings and deal with
difficulties.
  Good mental health is not just the absence of mental health problems.

 Being mentally or emotionally healthy is much more than being free of depression, anxiety, or
other psychological issues. Rather than the absence of mental illness, mental health refers to
the presence of positive characteristics.

 Mental illness refers to a wide range of mental health conditions

 Disorders that affect your mood, thinking and behavior.

• Classification of Mental Health Illness

• Affective Disorders/ The Neuroses: Depression, Anxiety, Mania, Obsessions and compulsions
(usually the patient retains insight and orientation; they experience deep distress and may
commit suicide

• The Psychoses: Schizophrenia, Hebephrenic ( Delusion/Hellucination) , Catatonic ( remain

speechless or motionless), paranoid (irrational behavior sometimes hyper activity), Puerperal
psychosis (the patient is disorientated, deluded, and lacking in insight).

• Organic states/ The Dementias: Delirium (Illusions/restlessness), dementia (temporary memory

loss) Progressive deterioration with loss of recent memory and deterioration of a normal
personality. They may be primary or more commonly secondary to another condition e.g.
alcohol, stroke

 Substance abuse problems

 Learning disorders

 Personality Disorder

Mental Health
Warning Signs!!

 Children and teens can develop the same mental health disorders and conditions as adults, but
their symptoms may be different or hard to identify.

 A child or teen might need help if he or she:

 Often feels very angry or very worried

 Can’t sleep or eat

  Is unable to enjoy pleasurable activities any more

 Isolates her/himself and avoids social interactions

 Feels grief for a long time after a loss or death

 Smokes, drinks, or use drugs

 Exercises, diets and/or binge-eats obsessively

 Hurts other people or destroys property

 Has low or no energy

 Feels like he or she can’t control own  emotions

 Has thoughts of suicide

 Harms her/himself, such as cutting or burning her/his skin

 Thinks his or her mind is controlled or out of control

 Hears voices

Mental Illness among adolescence ...

 The illnesses that most often begin during adolescence include:

 Major Depression (MD)

 Schizophrenia

 Bipolar Disorder (BD)

 Panic Disorder

 Social Anxiety Disorder

 Eating Disorders

 Obsessive Compulsive(OCD) Disorder

 Addictions

Risk Factors
Certain factors may increase your risk of developing mental health problems

 Having a blood relative, such as

a parent or sibling, with a mental illness

 Stressful life situations, such as financial problems, a loved one's death or a divorce

 An on going (chronic) medical condition, such as diabetes

 Brain damage as a result of a serious injury (traumatic brain injury), such as a violent
blow to the head

 Traumatic experiences, such as military combat or being assaulted

 Use of alcohol or recreational drugs

 Being abused or neglected as a child

 Having few friends or few healthy relationships

 A previous mental illness

 Rapid Social Change

 Stressful Work Conditions

 Gender Discrimination

 Social Exclusion

 Risks of Violence

 Physical ill-health

 Human Rights Violations

How it Happens ?

Inheritance-Genetics/Intra-uterine environment Schizophrenia

Upbringing

Mothering, education, parenting

Trauma/head injury

 Infections-HIV, Syphilis, CJD

 Nutrition/PCM
  Vascular-CVA

 Biochemistry/metabolic

 Porphyria, Diabetes

 Neurological diseases

 Multiple sclerosis, Brain tumor

 Drug abuse: Alcohol, Heroin etc

 There are several well known factors which determine mental illness

--Infections - Syphilis, HIV,

--Trauma- post head injury,

-- Neoplasm - Brain tumors may present with personality change and mental distress.

--Genetics- Huntington’s chorea and dementia

--Vascular- post stroke or intermittent arterial embolism

--Drug abuse- Korsakoff’s psychosis in chronic alcoholics but often there is no obvious cause

 Teen depression:

 Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term
bullying or academic problems.

• Having been the victim or witness of violence, such as physical or sexual abuse.

o Symptoms:

• Persistent sad, anxious or "empty" mood.

• Feelings of hopelessness, pessimism.

• Feelings of guilt, worthlessness, helplessness.

• Loss of interest or pleasure in hobbies and activities.

• Decreased energy, fatigue, feeling "slowed down"

 • Epidemiologists have now identified a long list of other stress-related diseases as “diseases of
civilization” – Diabetes, Atherosclerosis, Asthma, Allergies, Obesity And Cancer. These diseases
are rampant throughout the developed world, but virtually non-existent among modern-day
aboriginal peoples.

• And in the last 200 years, since the industrial revolution, our species has had to cope with what
Ildari calls “radical environmental mutation.”

• While our environment has radically mutated, our human genome is essentially the same as it
was 200 years ago, Ildari says. “That’s only eight generations. It’s not enough time for
significant genetic adaptations.”

• “There’s a profound mismatch between the genes we carry, the bodies and brains that they are
building, and the world that we find ourselves in,” he said. “We were never designed for the
sedentary, indoor, socially isolated, fast-food-laden, sleep-deprived frenzied pace of modern
life.”

Anxiety

 Nervousness, apprehension, and self doubt that may or may not be associated with real life
stresses.

 Common anxiety signs and symptoms include:

 Feeling nervous, restless or tense

 Having a sense of impending danger, panic or doom

 Having an increased heart rate

 Breathing rapidly (hyperventilation)

 Sweating

 Trembling

 Feeling weak or tired

 Trouble concentrating or thinking about anything other than the present worry

 Having trouble sleeping

 Experiencing gastrointestinal (GI) problems

 Having difficulty controlling worry

 Having the urge to avoid things that trigger anxiety

  The five major types of anxiety disorders are:

1) Generalized Anxiety Disorder

2) Obsessive-Compulsive Disorder (OCD)

3) Panic Disorder

4) Post-Traumatic Stress Disorder (PTSD)

5) Social Phobia (or Social Anxiety Disorder)

 Suicide is the 2nd leading cause of death - following motor vehicle accidents - among teenagers
and young adults. 

• Adolescents aged 15 to 19, annual suicide rate is 1 in 10,000 people.

• Among youths 12 to 16 year of age, up to 10% of boys and 20% of girls have considered suicide.

Problems Experiences Implications for Mental Health leading towards Suicide

 Teenage love -parents disagree to establishment

 Unwanted pregnancy

 Depression

 Emotional distress

 Sexual violence

 Social insecurity and instability

 Isolation from family members and society

 Anger and hostility

 Loss of autonomy

 Emotional distress, addiction

 Hopelessness
  Unexpected academic results

 Feeling of guilt

 Low socioeconomic status

 Unemployment

 Decline in social status

 Feeling of discrimination

Suicide in Bangladesh

 According to a report by the World Health Organization 19,697 people committed suicide

in Bangladesh in 2011.

• Of the 128.08 per 100,000 people who committed suicide in 2010, 89% were women and most
them were unmarried. 

• Statistics of Jatiya Mahila Ainjibi Samity, show that from 2006 to 2010, 40 girls committed
suicide as victims of stalking (Eve teasing)

• From 2001 to 2010, 4,747 women and girls committed suicide because of physical and domestic
violence

 Why?

 Inferior status in society

 Higher rate of illiteracy and

 Economic dependence on men

• Suicide is the fifth most common cause of death overall, and ranked number one among
adolescents (icddr,b 2003).

• In 1998, ESCAP(Economic and Social commission for Asia and Pacific) has shown in their Journal
that nearly about 30/100,000 of young adults every year have committed suicide in
rural Bangladesh.
Common Mental Health Issues and Addiction..

 Depression: An estimated 1 in 10 adults suffering from depression. Many people experiencing

depression try to self-medicate with drugs or alcohol.

 Bipolar disorder: About half of people with bipolar disorder also struggle with addiction. Drugs
and alcohol provide temporary relief from painful situations and manic episodes for people with
bipolar.

 Schizophrenia and addiction : An estimated 50% of individuals suffering from schizophrenia

have a history of substance abuse.

 Someone with existing genetic risk factors for the disorder may develop an active case of
schizophrenia after extended substance abuse.

 Using drugs, such as marijuana, cocaine and amphetamines, can also exacerbate schizophrenic

symptoms and worsen their severity.

 Ildari…‘How To Come Out Of This….is change in lifestyle.

 His six step program…

• 1. Exercise

• 2. Omega 3 Fatty Acids

• 3. Sunlight

• 4. Healthy Sleep

• 5. Anti-ruminative activity

• 6. Social connection

• He emphasized the importance of exercise and social connection, as they are two of the
hardest parts of the program for modern people.

Technology use can be Addictive

 Both hyper texting and hyper networking are strongly associated with a range of poor health
outcomes including substance abuse, sexual activity, absenteeism and fighting, according to a
study printed in The Nation’s Health in 2011.
  Teens send an average 60 text per day, with 20% of students reporting that they are hyper
textures, sending more than 120 texts per school day.

 More than 11% of students reported spending 3 hours or more a day on social networking sites.

 Other health concerns: Too much screen time.

 This is trickier to regulate, because that includes not just TV, gaming and social media time, but
also school work or even using an e-reader.

 Time spent in front of a screen means less time spent on other pastimes.

 Children today spend 50% less time outside than they did 20 years ago

 Studies indicate that all this time spent indoors might be affecting kids’ eyesight.

Health…

• Between 1970 and 2000, myopia — nearsightedness — prevalence in the U.S. rose from 25% to
nearly 42% among people ages 12 to 54

• Today’s kids are spending more time staring at screens up close instead of far off things outside

• A 2007 study found kids who spend more time outdoors are less likely to develop
nearsightedness.

• There are also possible correlations with obesity and the instant gratification of constantly
moving screens.

Brain

• The same brain circuits that are activated by eating chocolate and winning money are
activated when teenagers see large numbers of “likes” on their own photos or the photos of
peers in a social network, according to findings from a new study in which
researchers scanned teens’ brains while they used social media.

• The study is published in Psychological Science, a journal of the Association for Psychological

Science.(UCLA’s Ahmanson–Lovelace Brain Mapping Center)

• These brain regions are involved in decision-making and can inhibit us from engaging in
certain activities, or give us the green light to go ahead

Impact on Physical Health

 Social media can directly impact physical health. This is usually associated with the way you
use it.
 o For example:

• Carpal Tunnel Syndrome. If you do too much keying, you may experience problems that affect
your hands or wrists. There are also specific problems associated with keying on mobile
phones, which can strain the tendons of your fingers. These problems aren’t all caused by
social media.

• Eye problems

• Fatigue

• Lack of exercise

• Distraction. One of the most dangerous potential consequences of social media addiction is

driving while being distracted. As recent stories have confirmed, you can even get hurt texting
and walking.

• The above are harmful effects that aren’t caused by social media per se, but by overdoing it or
being online or texting while you should be concentrating on something else.

 Accessing Health Information

• There are innumerable places to get health information online

• On the other hand, if you accept everything you see on social media uncritically, you could end
up taking bad advice.

• You should never mistake a tweet or Facebook post as expert opinion.

• Even if it’s given by a qualified expert, that person hasn’t examined you.

• At most, you should use social media as the first stage of your research.

Ways Social Media Affects 0ur Mental Health

1. It’s addictive

2. Makes us compare our lives with others’

3. Makes us restless

4. Gives rise to cyber bullying

5. Glamorizes drug and alcohol use

6. Make us unhappy

7. Can lead to fear of missing out, aka FOMO

8. Often leads to multitasking

9. It triggers more sadness, less well-being

10. Comparing our lives with others is mentally unhealthy

11. It can lead to jealousy—and a vicious cycle

12. We get caught in the delusion of thinking it will help

13. More friends on social doesn’t mean you’re more social

 Research has shown that teenagers need 9.5 hours of sleep each night but on average only get
7.5 hours.

• A lack of sleep can make teenagers tired, irritable, depressed and more likely to catch colds, flu
and gastroenteritis. 

 A separate study by the National Citizen Service found that, rather than talking to their
parents, girls seek comfort on social media when they are worried

• The survey also suggests that girls are likely to experience stress more often than boys – an
average of twice a week.

 Pressure to be perfect.

• To look perfect, act perfect, have the perfect body, have the perfect group of friends, the
perfect amount of likes on Instagram.

• Perfect, perfect, perfect.

• And if you don’t meet these ridiculously high standards, then the self-loathing and bullying
begins.

 Cyber bullying and the Imposter Syndrome

• The other big danger that comes from kids communicating more indirectly is that it has gotten
easier to be cruel.

• “Kids text all sorts of things that you would never in a million years contemplate saying to
anyone’s face,” says Dr. Donna Wick, a clinical and developmental psychologist who runs “Mind
to Mind Parent”
• She notes that this seems to be especially true of girls, who typically don’t like to disagree with
each other in “real life.”

• Peer acceptance is a big thing for adolescents, and many of them care about their image as
much as a politician running for office, and to them it can feel as serious.

• The fact that kids today are getting actual polling data on how much people like them or their
appearance via things like “likes.”

• So kids can spend hours pruning their online identities, trying to project an idealized image.

• Teenage girls sort through hundreds of photos, agonizing over which ones to post online.

• Boys compete for attention by trying to out-gross one other, pushing the envelope as much as
they can in the already disinhibited atmosphere online.

• Kids gang up on each other.

• Peer acceptance is a big thing for adolescents, and many of them care about their image as
much as a politician running for office, and to them it can feel as serious.

• The fact that kids today are getting actual polling data on how much people like them or their
appearance via things like “likes.”

• So kids can spend hours pruning their online identities, trying to project an idealized image.

• Teenage girls sort through hundreds of photos, agonizing over which ones to post online.

• Boys compete for attention by trying to out-gross one other, pushing the envelope as much as
they can in the already disinhibited atmosphere online.

• Kids gang up on each other.

• 55% of participants were female, 1/3 born outside the USA and almost 1/2 had parents whose
primary language was not English.

• 67% of participants spent 2 or more hours on the computer daily, and 1/2 had a computer in
their bedroom.

• 21% of participants indicated they had been bullied online in the last three months, and 35%
indicated they had bullied others online.
 • Most bullying was perpetrated by and to friends and participants generally did not tell anyone
about the bullying.

• Participants were most likely to be bullied through instant messaging, social networking sites,
and Internet games.

• While 1/2 of participants indicated that being bullied online did not bother them, many felt
angry, sad, and depressed.

• Participants bullied others online because it made them feel funny, popular and powerful,
although 1/5th indicated feeling guilty afterwards.

• Younger students were more likely to be threatened online or to have someone pretend to be
them whereas older students were more likely to have private photos of them distributed
online or be asked to do something sexual online

(Prevalence and Impact of Cyber Bullying among Adolescents (PDF Download Available). Available from:
https://www.researchgate.net/publication/268158355_Prevalence_and_Impact_of_Cyber_Bullying_am
ong_Adolescents [accessed Oct 23 2017]).

Cyber Bullying among Adolescents(A study)..Continue..

 Girls were more likely to have rumors spread about them

 Receive sexual photos and

 Be asked to do something sexual online

 Boys were more likely to have threatened someone online

 Conclusions and Implications:

 Cyber bullying is a significant problem that must be understood within the context of the new
cyber world.

 While technology creates social and academic opportunities, it is concurrently utilized as a site
for bullying.

 Despite perceptions of anonymity, cyber bullying generally is not anonymous and occurs among
friends and classmates.
  Greater attention is required to understand and reduce cyber bullying within an ecological
systems approach, including the children's peers, schools and parents.

Adolescent Mental Health Illness

 It is definitely NOT easy being a teenager!

 Sometimes it’s tough to avoid feeling stressed, and pressure can build up in many areas of life
(socially, in school, at home, and while making big life decisions)

Worrying about these pressures is NORMAL.

But feeling VERY sad, hopeless or worthless might be a sign of a mental health problem.

There is Treatment for Mental Health Problems

 If you feel VERY sad, stressed or worried, it might help to talk to someone about how you are
feeling!

Do you ever…

 Often feel very angry or very worried?

 Do reckless things that could harm you or others?

 Feel grief for a long time after a loss or a death?

 Think your mind is controlled or out of control?

 Use alcohol or drugs?

 Exercise, diet and/or binge-eat obsessively?

 Hurt other people or destroy property?

 If you feel any of these things,

it might help to talk to a
parent, teacher, school
counselor or physician.
Steps Towards Positive Mental Health
Treatment..

 Re-claiming Health

1. Therapy and support group that identifies positive goals

2. Social/emotional development

Independent living skills.

3. Respite and other support classes for families for better interactions

4. Parent education and support services

5. Hospitalization and in-patient mental health support services

6. Drug treatment

7. Mentoring

8. Monitoring

Success of Treatment
(Rates & Ranges)

 Schizophrenia – 45 – 60%

 Major Depression – 65 – 80%

 Bipolar Disorder – 80%

 Panic Disorder – 70-90%

Prevention

 If you have a mental illness:

 Taking steps to control stress,

 To increase your resilience and

 To boost low self-esteem may help keep your symptoms under control.

 Follow these steps:

  Pay attention to warning signs

 Get routine medical care 

 Get help when you need it

 Take good care of yourself 

Benefits of Good Mental Health

 There is good quality evidence that improving well being, including mental wellbeing, has a wide
range of health, social and economic benefits. These include:

• Reduces risk of mental illness and suicide

• Improve physical health and life expectancy

• Better educational attainment

• Reduced health risk behavior such as smoking, alcohol, drug use

• Improve employment rates and productivity

• Reduces anti social behavior and criminality

• Higher level of social interaction and participation

• Supporting recovery and reducing stigma and discrimination faced by people with mental
health problems