A non-communicable disease, or NCD, is a disease caused by something other than a pathogen,

which is not contagious. Risk factors such as a person's lifestyle, genetics, or environment are

known to increase the likelihood of certain non-communicable diseases. Of these three risk

factors, 50% of all non-communicable diseases are a result of poor lifestyle choices such as drug

use, alcohol and tobacco use, diet, lack of exercise or stress management. Examples of non-

communicable diseases include heart disease, hypertension, cancer, asthma, diabetes, allergies,

stroke, and more.

Sixty percent of the deaths in The Bahamas are related to chromic non-communicable diseases

(CNDCs) such as hypertension, and cancer. Just mention the word cancer, and so many dreadful

feelings are conjured up by our Bahamian society. No other disease has had such a profound

affect (next to the HIV virus) on the human psych like cancer to the point where scientists

around the world are literally working day and night to find a cure.

Here in The Bahamas, Breast Cancer has become the most common form of cancer found in

women. In men, it is Prostate Cancer. This mysterious disease has been the centre of many

worthy causes by a number of committed civic organizations (e.g. The Cancer Association),

whose goal is to educate the public and to provide encouragement on the best available care and

treatment for those who are diagnosed with it. For Cancer, a recent study discovered that a

significant percentage of Bahamian females possess an abnormal gene that exposes them to

cancer, and according to what was found, their condition has been ranked the highest in the

world. This of course, has led medical experts in the country to step up their efforts and is

reportedly getting ready to conduct a final round of cancer testing around the Family Islands.

The statistics have shown that many of the illnesses that we refer to today are related to chronic

non-communicable diseases and or their consequences. These statistics show that approximately

120 new cases of breast cancer are diagnosed annually, as well as 80 to 100 new cases of

prostate cancer in men. The latest statistics show approximately 1,153 men in The Bahamas have

prostate cancer and 1,530 women have breast cancer.

What is blood pressure?

Blood pressure is the pressure exerted on the artery tube when blood flows through the arteries.

The pressure exerted when the heart contracts and sends out the blood is called systolic (highest)

blood pressure. The pressure when the heart dilates and blood flows into the heart is called

diastolic (lowest) blood pressure. Blood pressure is normally measured at the brachial artery.

What Causes Hypertension?

The cause of primary hypertension in the majority of people is not known. This condition can be

the result of a variety of causes. However, there are risk factors that contribute to this disease.

Risk factors include:

Age and Sex-The risk of developing high blood pressure increases as you age. Most

cases of high blood pressure are diagnosed in men, until the age of 45. From age 45 to 54,

men and women are equally at risk for high blood pressure. After the age of 54, women

are actually more likely to have high blood pressure than men. This may suggest that

estrogen has a protective role in blood pressure. It is thought that estrogen helps keep

blood vessels flexible. Estrogen may also work with other hormones to reduce the risk of

high blood pressure in younger women.

Family History-People with relatives who have high blood pressure are more likely to

develop high blood pressure.

Ethnicity-People of African American and Native American ethnicity have very high

rates of high blood pressure, and the situation appears to be a growing problem.

Compared with Caucasians, African Americans develop hypertension earlier in life, and

their average blood pressures are much higher.

Diet-People who regularly eat foods that are high in salt are more susceptible to high

blood pressure.

Obesity-People who are overweight are at risk for many illnesses, including high blood

pressure.

Stress-Studies have shown that people with heightened anxiety, intense anger, and

suppressed expression of anger are more at risk of developing high blood pressure.

Symptoms of High Blood Pressure

One of the most dangerous aspects of hypertension is that you may not know that you have it.

There are generally no symptoms of high blood pressure, so you usually don't feel it. In fact,

nearly one-third of people who have hypertension don't know it. The only way to find out if you

have high blood pressure is to get your blood pressure checked on a regular basis. This is

especially important if you have a close relative who has high blood pressure.

If your blood pressure is extremely high, there may be certain symptoms to look out for,

including:

Severe headache

Fatigue or confusion

Vision problems

Chest pain

Difficulty breathing

Irregular heartbeat

Blood in the urine

Pounding in your chest, neck, or ears

If you have any of these symptoms, see a doctor immediately. You could be having a

hypertensive crisis that could lead to a heart attack or stroke.

Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney

failure and eye problems.

How can you prevent Hypertension?

Lifestyle changes can help you prevent high blood pressure. These changes are especially

important for people who have risk factors for high blood pressure that cannot be changed,

including family history, race, or age.

Lifestyle changes include:

Staying at a healthy weight, with a body mass index (BMI) of 18.5 to 24.9.

Reducing sodium in your diet to less than 2,300 mg a day, which is about 1 teaspoon of

salt.

Exercising, such as brisk walking, that raises your heart rate. Aim for at least 2½ hours of

moderate exercise a week.

Limiting alcohol drinks to 2 drinks a day for men and 1 drink a day for women.

Following a diet that is rich in fruits, vegetables, and low-fat dairy products, with reduced

amounts of saturated and total fats.

Diagnosis and Treatments

Treatment for high blood pressure depends on the severity of the disease and whether you have

other health problems, such as heart failure or diabetes. Your doctor may want you to try lifestyle

changes first, including losing weight, increasing activity, and eating a balanced diet. If your

blood pressure is above a certain level, your doctor may prescribe medicine along with the

lifestyle changes.

Some people may only need lifestyle changes to control their high blood pressure, while others

need medicine as well. Either way, treating high blood pressure usually is a lifelong process.

Treatment of primary high blood pressure, especially moderate or severe high blood pressure,

decreases the risk of heart failure, coronary artery disease, heart attack, abnormal heartbeats,

stroke, and kidney disease, and it reduces the risk of death from these conditions.

Overall, goals of treatment are to:

Prevent death and disease associated with high blood pressure (heart disease, stroke, and

kidney disease).

Reduce systolic blood pressure below 140 millimeters of mercury (mm Hg) and diastolic

blood pressure below 90 mm Hg. The blood pressure goal may be lower, less than 130/80

mm Hg, for people with certain health conditions like diabetes, kidney disease, heart

failure, or coronary artery disease.

Control other risk factors, such as smoking, lack of exercise, and high cholesterol that can

lead to complications such as a heart attack and stroke.

Minimize side effects of medicines.

Live a full and active life.

Initial treatment

If you fall into the pre-hypertension range (120–139/80–89), your doctor will likely recommend

lifestyle changes, including:

Losing excess weight.

Exercising.

Limiting alcohol to 2 drinks a day for men and 1 drink a day for

women.

Cutting back on salt.

Quitting smoking.

Following the Dietary Approaches to Stop Hypertension diet.

Consider an eating plan that is a low-fat and low-saturated-fat diet that emphasizes eating more

fruits, vegetables, whole grains, and low-fat dairy foods. If you have high blood pressure (140–

159/90–99 mm Hg) and you do not have any organ damage or other risk factors for heart disease

(this is called uncomplicated high blood pressure), your doctor will likely recommend lifestyle

changes and possibly medicines. Most people with high blood pressure will need two or more

medicines, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mm

Hg, which is the goal for people with uncomplicated hypertension. If you have other conditions,

such as diabetes, heart failure, coronary artery disease, or chronic kidney disease, your doctor

may recommend that your blood pressure should be less than 130/80. If your blood pressure is

160–179/100–109 mm Hg or higher, you may need to try various combinations of medicines to

find what works best for you. You will also need to make aggressive lifestyle changes.

Treatment of secondary high blood pressure varies depending on the cause. For example,

treatment of high blood pressure caused by kidney disease will also include treating the kidney

problem. If you have secondary high blood pressure, you may have to take blood pressure

medicine long term, even if the condition that is causing your high blood pressure is treated.

People with high blood pressure who require special treatment considerations include:

Older adults

African Americans

Children

Pregnant women

Ongoing treatment

Most cases of high blood pressure cannot be cured but can be controlled with lifestyle changes

and medicine. Treatment is a lifelong process.

You may need to try several different medicines or combinations of medicines, such as ACE

inhibitors and diuretics, before finding the right combination that lowers your blood pressure to a

safe level. If you have secondary high blood pressure, you may need treatment for the condition

that is causing your high blood pressure.

It is important to follow the lifestyle changes your doctor recommends for the rest of your life to

reduce your risk of heart disease and stroke.

People with heart disease and high blood pressure have a high risk for future heart problems and

need aggressive treatment.

Treatment if the condition gets worse

Untreated high blood pressure can lead to fatal heart attacks or strokes. The higher your blood

pressure the greater your risk for these complications. Lowering blood pressure reduces the risk

of damaging blood vessels and developing atherosclerosis.

As your high blood pressure rises, you may need to take higher doses of medicine or a

combination of medicines. Many people take a combination of several medicines.

What to Think About

In older adults, even small decreases in systolic blood pressure may be enough to prevent

complications, if their diastolic blood pressure is normal.

People who have high blood pressure are encouraged to make lifestyle changes and stay with

these changes for the rest of their lives to reduce their blood pressure. Lifestyle changes such as

eating a low-fat diet, quitting smoking, and exercising will help reduce the overall risk of heart

disease and stroke and may reduce blood pressure significantly.

Cancer is the second most common cause of death, after heart disease. Cancer is the

abnormal, uncontrolled growth of cells which, if left untreated, can ultimately cause death.

Cancer refers to any one of a large number of diseases characterized by the development of

abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal

body tissue. Cancer also has the ability to spread throughout your body. But survival rates are

improving for many types of cancer thanks to improvements in cancer screening and cancer

treatment.

Cancer develops when cells in a part of the body begin to grow out of control. Although there

are many kinds of cancer, they all start because of the out-of-control growth of abnormal cells.

Because cancer cells continue to grow and divide, they are different from normal cells. Instead

of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells

develop because of damage to DNA. This substance is in every cell and directs all the cell’s

activities. Most of the time when DNA becomes damaged, the body is able to repair. In cancer

cells the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for

inherited cancers. Many times though, a person’s DNA becomes damaged by exposure to

something in the environment, like smoking.

Causes

Cancer is caused by damage (mutations) to the DNA within cells. Your DNA contains a set of

instructions for your cells, telling them how to grow and divide. Normal cells often develop

mutations in their DNA, but they have the ability to repair most of these mutations. Or, if they

can't make the repairs, the cells often die. However, certain mutations aren't repaired, causing the

cells to grow and become cancerous. Mutations also cause cancer cells to live beyond their

normal cell life span. This causes the cancerous cells to accumulate.

In some cancers, accumulating cells form a tumor. But not all cancers form tumors. For example,

leukemia is a cancer that involves blood, bone marrow, the lymphatic system and the spleen, but

doesn't form a single mass or tumor.

The initial genetic mutation is just the beginning of the process by which cancer develops.

Scientists believe you need a number of changes within a cell in order to develop cancer,

including:

An initiator to cause a genetic mutation: Sometimes you're born with this genetic

mutation. Other times a genetic mutation is caused by forces within your body, such as

hormones, viruses and chronic inflammation. Genetic mutations can also be caused by

forces outside of your body, such as ultraviolet (UV) light from the sun or cancer-causing

chemicals (carcinogens) in your environment.

A promoter to cause rapid cell growth: Promoters take advantage of genetic mutations

created by initiators. Promoters cause cells to divide more rapidly. This could lead to an

accumulation of cells, such as a tumor. Promoters could be inherited, could come from

inside your body or could come from outside your body.

A progressor to cause cancer to become aggressive and spread: Without a progressor

a tumor may remain benign and localized. Progressors make cancers more aggressive,

more likely to invade and destroy nearby tissue, and more likely to spread to other parts

of your body. Like initiators and promoters, progressors could be inherited or they could

come from environmental sources.

Your genetic makeup, forces within your body, your lifestyle choices and your environment can

all set the stage for cancer or help complete the process once it's started. For instance, if you've

inherited a genetic mutation that predisposes you to cancer, you may be more likely than other

people to develop cancer when exposed to a certain cancer-causing substance. The genetic

mutation begins the cancer process, and the cancer-causing substance could play a role in further

cancer development. Likewise, smokers who work with asbestos are more likely to develop lung

cancer than are smokers who don't work with asbestos. That's because tobacco smoke and

asbestos both play roles in cancer development.

Risk Factors

While doctors have an idea of what can put you at risk of cancer, the majority of cancers occur in

people who don't have any known risk factors. Factors known to increase your risk of cancer

include:

Your age: Cancer can take decades to develop. That's why most people diagnosed with cancer

are 55 or older. By the time a cancerous mass is detected, it's likely that 100 million to 1 billion

cancer cells are present, and the original cancer may have been growing for five years or more.

While it's more common in older adults, cancer isn't exclusively an adult disease — cancer can

be diagnosed at any age.

Your habits: Certain lifestyle choices are known to increase your risk of cancer. Smoking,

drinking more than one drink a day (for women) or two drinks a day (for men), excessive

exposure to the sun or frequent blistering sunburns, and having unsafe sex can contribute to

cancer. You can break these habits to lower your risk of cancer — though some habits are easier

to break than others.

Your family history: Only about 10 percent of cancers are due to an inherited condition. If

cancer is common in your family, it's possible that mutations are being passed from one

generation to the next. You might be a candidate for genetic screening to see whether you have

inherited mutations that might increase your risk of cancer. Keep in mind that having an

inherited genetic mutation doesn't necessarily mean you'll get cancer.

Your health conditions: Some chronic health conditions, such as ulcerative colitis, can

markedly increase your risk of developing certain cancers. Talk to your doctor about your risk.

Your environment: The environment around you may contain harmful chemicals that can

increase your risk of cancer. Even if you don't smoke, you might inhale secondhand smoke if

you go places where people are smoking or you live with someone who smokes. Chemicals in

your home or work place, such as asbestos and benzene, also are associated with an increased

risk of cancer.

Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected.

Some general signs and symptoms associated with, but not specific to, cancer include:

Fatigue

Fever

Lump or thickening that can be felt under the skin

Pain

Weight changes, including unintended loss or gain

Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal,

or changes to existing moles

Changes in bowel or bladder habits

Persistent cough

Difficulty swallowing

Hoarseness

Persistent indigestion or discomfort after eating

Common Cancer

The cells in malignant tumors can invade and damage nearby tissue and organs. Cancer cells can

also break away from a malignant tumor and travel through the bloodstream or lymphatic system

to form new tumors in other parts of the body. Most cancers are named for the organ or type of

cell in which they begin. For example, cancer that begins in the lung is lung cancer, and cancer

that begins in cells in the skin known as melanocytes is called melanoma. When cancer cells

spread (metastasize) from their original location to another part of the body, the new tumor has

the same kind of abnormal cells and the same name as the primary tumor.

Primary bone cancers (those that originate in the bone) represent less than 0.2 percent of all

cancers. The most common types occur most frequently in children and adolescents and are

especially rare in middle-aged adults. The most common form of bone sarcoma in adults is

chondrosarcoma. It usually occurs in adults between the sixth and eighth decades of life. This

form of cancer is treated by surgery alone, as radiation therapy and chemotherapy are not

effective for this entity.

Brain cancer, or a primary brain tumor, is a cancer that begins in the tissues of the brain.  It

rarely spreads to other parts of the body, although if not treated, it will grow and the symptoms

will worsen over time.  Brain cancer is a leading cause of cancer-related deaths, but research has

produced new, more effective treatment methods.  Surgery, radiation and chemotherapy are the

most commonly used treatments.

Breast cancer, a disease in which malignant cells form in the tissues of the breast, is the most

common type of cancer (other than skin cancer) among women.  Less than 1 percent of breast

cancers occur in men. The risk of getting breast cancer increases with age, and inherited gene

mutations or a family history of breast cancer may increase the risk.

Lung cancer is cancer that begins in the lungs.  It is the leading cause of cancer deaths in both

men and women, although the survival rate has improved slightly in recent years.  Cigarette

smoking is the most common risk factor for lung cancer, with almost 90 percent of all lung

cancers attributable to smoking or secondhand exposure to cigarette smoke.

The prostate, part of the male reproductive system, is a gland located under the bladder and in

front of the rectum.  Prostate cancer usually begins in the gland cells and grows slowly, so

many men have prostate cancer but are unaware of it.  Sometimes, however, prostate cancer will

grow and spread quickly.  Prostate cancer is highly curable when detected and treated early.

Skin cancer is a disease in which cancer cells grow in the tissues of the skin.  There are two

major groups:  nonmelanoma and melanoma.  Nonmelanoma skin cancers are by far the most

common types of cancer, with more than 1 million new cases diagnosed annually, and most are

highly curable.  Melanoma is much less common, but more serious.  Melanoma is highly curable

in its early stages, but may spread to other parts of the body.

Preventions

There's no certain way to prevent cancer. But doctors have identified several ways of

reducing your cancer risk, such as, stop smoking, avoid excessive sun exposure, eat a healthy

diet, exercise most days of the week, maintain a healthy weight, schedule screening exams, and

by asking your doctor about immunizations. If you smoke, quit. If you don't smoke, don't start.

Smoking is linked to several types of cancer, not just lung cancer. Quitting now will reduce your

risk of cancer in the future. Harmful ultraviolet (UV) rays from the sun can increase your risk of

skin cancer. Limit your sun exposure by staying in the shade, wearing protective clothing or

applying sunscreen. You should choose a diet rich in fruits and vegetables and select whole

grains and lean proteins. Regular exercise is linked to a lower risk of cancer, as well. You should

aim for 30 minutes of exercise most days of the week. If you haven't been exercising regularly,

start out slowly and work your way up to 30 minutes or longer. Being overweight or obese may

increase your risk of cancer. Work to achieve and maintain a healthy weight through a

combination of a healthy diet and regular exercise. Talk to your doctor about what types of

cancer screening exams are best for you, based on your risk factors. Certain viruses increase your

risk of cancer. Immunizations may help prevent those viruses, including hepatitis B, which

increases the risk of liver cancer, and human papillomavirus (HPV), which increases the risk of

cervical cancer and other cancers. Ask your doctor whether immunization against these viruses is

appropriate for you.

Diagnosis

Diagnosing cancer at its earliest stages often provides the best chance for a cure. With this in

mind, talk with your doctor about what types of cancer screening may be appropriate for you.

For a few cancers, studies show screening tests can save lives by diagnosing cancer early. For

other cancers, screening tests are reserved for people with the highest risk. Doctors recommend

screening for the following cancers in adults considered to have an average risk of cancer:

Type of cancer Who should consider screening?

Breast cancer Women 40 and older

Cervical cancerWomen 21 or older, or beginning three years after first sexual intercourse

Colon cancer Men and women 50 and older

Prostate cancer Men 50 and older

Screening tests and procedures have risks and benefits. Discuss these with your doctor to

determine whether screening is right for you.

Most cases of cancer are detected and diagnosed after a tumor can be felt or when other

symptoms develop. In a few cases cancer is diagnosed incidentally as a result of evaluating or

treating other medical conditions. Diagnosis begins with a thorough physical examination and a

complete medical history. Your doctor may feel areas of your body for lumps that may indicate a

tumor. During a physical exam he or she may look for any abnormalities, such as changes in skin

color or enlargement of an organ that may indicate cancer.

Laboratory studies of blood, urine and stool can detect abnormalities that may indicate cancer.

When a tumour is suspected, imaging tests such as X-rays, computerized tomography (CT),

magnetic resonance imaging (MRI), ultrasound and fibrotic scope examinations help doctors

determine its location and size. Imaging tests allow your doctor to examine your bones and

internal organs in a noninvasive way.

To confirm the cancer diagnosis, a biopsy is performed: a tissue sample is surgically removed

from the suspected malignancy and studied under a microscope to check for cancer cells. During

a biopsy, your doctor collects a sample of cells for testing in the laboratory. There are several

different ways of collecting a biopsy sample. Which biopsy procedure is right for you, depends

on your type of cancer and its location. In most cases, a biopsy is the only way to definitively

diagnose cancer. In the laboratory, doctors look at biopsy samples under the microscope. Normal

cells look uniform, with similar sizes and orderly organization. Cancer cells look less orderly,

with varying sizes and without apparent organization.

Cancer Stages

Once cancer is diagnosed, your doctor will work to determine the extent, or stage, of your

cancer. Your doctor uses your cancer's stage to determine your treatment options and your

chances for a cure. Staging tests and procedures may include imaging tests, such as a bone scans

or X-rays to see if cancer has spread to other parts of the body. Cancer stages are generally

indicated by Roman numerals (I through IV), with higher numerals indicating more advanced

cancer. In some cases, cancer stage is indicated using letters or words.

Treatment

Many cancer treatments are available. Your treatment options will depend on several factors,

such as the type and stage of your cancer, your general health and your preferences. Together

you and your doctor can weigh the benefits and risks of each cancer treatment to determine

which is best for you. Goals of the treatment of Cancer are to use treatment to kill or remove

cancer cells (primary treatment), treatment to kill any remaining cancer cells (adjuvant therapy),

and treatment to manage side effects of cancer and its treatment (palliative care). The goal of a

primary treatment is to remove the cancer from your body or kill the cancer cells. Any cancer

treatment can be used as a primary treatment, but the most common primary cancer treatment for

the most common cancers is surgery. If your cancer is particularly sensitive to radiation therapy

or chemotherapy, you may receive one of those therapies as your primary treatment. The goal of

adjuvant therapy is to kill any cancer cells that may remain after primary treatment. Any cancer

treatment can be used as an adjuvant therapy. Common adjuvant therapies include

chemotherapy, radiation therapy and hormone therapy. The goal of palliative care is to decrease

pain or other symptoms and help you maintain quality of life during and after cancer treatment.

Palliative treatments may help relieve side effects of treatment or signs and symptoms caused by

cancer itself.

Methods or Treatments

Doctors have many tools when it comes to treating cancer. There are four standard methods of

treatment for cancer: surgery, chemotherapy, radiation therapy, immunotherapy and biologic

therapy. Clinical trials may be an option for some as cancer treatment who meet certain study

criteria. Surgery can be used to prevent, treat, stage (determine how advanced the cancer is), and

diagnose cancer. In relation to cancer treatment, surgery is done to remove tumors or as much of

the cancerous tissue as possible. It is often performed in conjunction with chemotherapy or

radiation therapy. For those whose cancer is not treatable, palliative surgery may be an option to

relieve pain that may be caused by the cancer. Palliative surgery is not intended to treat or cure

the cancer, or even to prolong life, but more to lessen discomfort.

Chemotherapy is a type of cancer treatment that uses of drugs to eliminate cancer cells. Unlike

surgery, chemotherapy affects the entire body, not just a specific part. It works by targeting

rapidly multiplying cancer cells. Unfortunately, other types of cells in our bodies also multiply at

high rates, like hair follicle cells and the cells that line our stomachs. This is why chemo can

cause side effects like hair loss and an upset stomach. Chemotherapy is most commonly given by

pill or intravenously (IV), but can be given in other ways. A single type of chemotherapy, or a

combination of drugs, may be prescribed for a specific length of time. Like surgery,

chemotherapy can be prescribed alone, in conjunction with radiation therapy or biologic therapy.

Radiation therapy uses certain types of energy to shrink tumors or eliminate cancer cells. It

works by damaging a cancer cell's DNA, making it unable to multiply. Cancer cells are highly

sensitive to radiation and typically die when treated. Nearby healthy cells can be damaged as

well, but are resilient and are able to fully recover. Radiation therapy may be given alone, along

with chemotherapy, and/or with surgery. The decision to combine radiation therapy with other

types of treatment depends on the stage of cancer and other factors.

Biologic therapy is a term for drugs that target characteristics of cancerous tumors. Some types

of targeted therapies work by blocking the biological processes of tumors that allow tumors to

thrive and grow. Other types of therapies cut off the blood supply to the tumor, causing it to

basically starve and die because of a lack of blood. Targeted therapy is used in select types of

cancer and is not available for everyone. It is given in conjunction with other cancer treatments.

For clinical trials, research studies of the latest drugs and therapies against many types of cancer

are continuously being conducted. This type of research requires human volunteers to test the

safety and effectiveness of new therapies. Volunteers must meet the criteria of each study to

participate. When initially diagnosed with cancer, a cancer specialist, an oncologist, will provide

you with the cancer treatment options. He or she will recommend the best treatment plan based

on your type of cancer, how far it has spread, and other important factors like your age and

general health.

Cancer and Depression

Chances are you will know someone affected or suffering from this disease and yes, you can

help. When someone learns that they have cancer, they can go through a period of grief and

sadness. They are grieving the loss of being a healthy person and the loss of certainty in their

lives. This period of sadness may seem like clinical depression, but it is not the same. Grieving

(experiencing sadness, fear, anger, or crying spells) is normal, and a healthy reaction to learning

of a serious health concern. It usually does not last a long time and it is a normal reaction to a

profound change in a person’s life. About one in four people (25%) develop clinical depression.

Sometimes depression can make it hard for a person to follow his or her medical treatment

because symptoms can include very low energy and motivation, difficulty making decisions

about treatment, and feelings uselessness or helplessness.

Here is where we can help – someone may be embarrassed to ask for help. Cancer affects the

entire family and friend and not just the person who has been diagnosed. We must assure the

person that clinical depression is not a sign of weakness, nor is it anyone’s fault. It may also be

helpful to know that it can be treated with medicines, counseling, or a combination of both.

Treatment for depression can help the person feel better fairly quickly and help them regain a

sense of control and hope for the future.

The term "diabetes mellitus" refers to a group of diseases that affect how your body uses blood

glucose, commonly called blood sugar. Glucose is vital to your health because it's the main

source of energy for the cells that make up your muscles and tissues. It's your body's main source

of fuel.

If you have diabetes, no matter what type, it means you have too much glucose in your blood,

although the reasons may differ. Too much glucose can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible

diabetes conditions include prediabetes — when your blood sugar levels are higher than normal,

but not high enough to be classified as diabetes — and gestational diabetes, which occurs during

pregnancy.

Symptoms

Diabetes symptoms vary somewhat, depending on what type of diabetes you have. If you have

prediabetes or gestational diabetes, you may not experience symptoms. Or you might experience

some or all of the symptoms of type 1 and type 2 diabetes:

Increased thirst

Frequent urination

Extreme hunger

Unexplained weight loss

Fatigue

Blurred vision

Slow-healing sores

Frequent infections, such as gum or skin infections and vaginal or bladder infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or

adolescence. Type 2 diabetes, the most common type, can develop at any age and is often

preventable.

Causes

To understand diabetes, first you must understand how glucose is normally processed in the

body.

How glucose normally works

Glucose is a main source of energy for the cells that make up your muscles and other tissues.

Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar

is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When

you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a

key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the

amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of

insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing center. When you haven't eaten in a

while, for example, your liver releases stored glucose to keep your glucose level within a normal

range.

Causes of type 1 diabetes

In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses —

attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no

insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become

resistant to the action of insulin, and your pancreas is unable to make enough insulin to

overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although excess fat — especially abdominal fat — and

inactivity seem to be important factors.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones

make your cells more resistant to insulin. As your placenta grows larger in the second and third

trimesters, it secretes more of these hormones — making it even harder for insulin to do its job.

Normally, your pancreas responds by producing enough extra insulin to overcome this

resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets

into your cells and too much stays in your blood. This is gestational diabetes.

Risk factors

Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, family history may play a role. Your

risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1

diabetes. Other factors have been proposed, as well, such as exposure to a viral illness.

Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and

others don't. It's clear that certain factors increase the risk, however, including:

Weight. The more fatty tissue you have, the more resistant your cells become to insulin.

Inactivity. The less active you are, the greater your risk. Physical activity helps you

control your weight, uses up glucose as energy and makes your cells more sensitive to

insulin.

Family history. Your risk increases if a parent or sibling has type 2 diabetes.

Race. Although it's unclear why, people of certain races — including blacks, Hispanics,

American Indians and Asian-Americans — are at higher risk.

Age. Your risk increases as you get older, especially after age 45. Often, that's because

you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes

is increasing dramatically among children, adolescents and younger adults.

Gestational diabetes. If you developed gestational diabetes when you were pregnant,

your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to

a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.

Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a

common condition characterized by irregular menstrual periods, excess hair growth and

obesity — increases the risk of diabetes.

Other conditions associated with diabetes include:

High blood pressure

High levels of low-density lipoprotein (LDL), or "bad," cholesterol

Low levels of high-density lipoprotein (HDL), or "good," cholesterol

High levels of triglycerides, another fat in the blood

When these conditions — high blood pressure, high blood sugar and abnormal blood fats —

occur together with obesity, they are associated with resistance to insulin.

Risk factors for gestational diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than

are others. Risk factors for gestational diabetes include:

Age. Women older than age 25 are at increased risk.

Family or personal history. Your risk increases if you have prediabetes — a precursor

to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2

diabetes. You're also at greater risk if you had gestational diabetes during a previous

pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.

Weight. Being overweight before pregnancy increases your risk.

Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or

Asian are more likely to develop gestational diabetes.

Complications

Diabetes complications vary depending on the type of diabetes you have.

Complications of type 1 and type 2 diabetes

Short-term complications of type 1 and type 2 diabetes require immediate care. Left untreated,

these conditions can cause seizures and a state of unconsciousness (coma).

High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons,

including eating too much, being sick or not taking enough glucose-lowering medication.

Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for

energy, your body may begin to break down fat. This produces potentially toxic acids

known as ketones.

Low blood sugar (hypoglycemia). If your blood sugar level drops below your target

range, it's known as low blood sugar. Your blood sugar level can drop for many reasons,

including skipping a meal and getting more physical activity than normal. However, low

blood sugar is most likely if you take glucose-lowering medications that promote the

secretion of insulin or if you're receiving insulin therapy.

Long-term complications of diabetes develop gradually. The earlier you develop diabetes — and

the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes

complications may be disabling or even life-threatening.

The government will consider legislating a ban on smoking in public places, improve

physical education facilities at public schools and provide tax incentives for the creation of on-

the-job exercise facilities, all as part of its ongoing commitment to stemming the incidences of

chronic non-communicable diseases (CNCDs) in The Bahamas, Prime Minister Hubert Ingraham

said Saturday. Prime Minister Ingraham’s remarks came during an interview with Trinidad and

Tobago’s C-News Station at CARICOM’s Summit on Chronic Non-Communicable Diseases –

diseases the Caribbean Community has dubbed one of the greatest threats to development in the

region.

Back in 2001, CARICOM Heads adopted the Nassau Declaration that The Health of the

Region is the Wealth of the Region, which was designed to accelerate the response to various

health conditions facing the region. The 2007 summit in Trinidad was the result of progress from

the Declaration adopted in The Bahamas. “Specifically, we have a problem with respect to

hypertension,” Mr. Ingraham indicated. “We have high levels of diabetes. Apart from the fact

that were are going to put in place a national programme for the provision of medicines for all

persons irrespective of ability to pay for their prescriptions, we are going have a major effort in

terms of prevention.”

Diseases such as hypertension, heart disease, diabetes and cancer, coupled with obesity

and a lack of physical activity, are the leading cause of death and disability in The Bahamas,

with the summit revealing that Bahamians are ten-times more likely to die of hypertension than

their Canadian counterparts. Highlighting the government’s recent announcement of a new

dietary programme for all public schools, the prime minister also foreshadowed improvements to

public school exercise facilities, adding that the government is going to seek to have health

promotion as a major part of initiatives within the public health sector.

The Prime Minister said, “We are going to seek to duplicate what we have in a few

government offices, that is rooms with exercise equipment in many more government facilities

and we are going to seek to encourage employers to do so by providing incentives and tax

exemptions for them to acquire equipment to be able to facilitate people engaging in exercise.”

Emphasizing that most CNCDs can be prevented through lifestyle changes in diet and

exercise, the Trinidad summit also placed emphasis on the role of tobacco consumption in the

incidences of cancer and heart disease in the region, and the need to enact tobacco control

measures such as increased import taxation and the prohibition of smoking in public places.

A 2005 Ministry of Health study on CNCDs revealed that just over seven percent of the

Bahamian population smokes cigarettes. The Prime Minister pointed out that The Bahamas

currently has a 200 percent tax on cigarettes and that during its previous terms in office, his

government made the now Lynden Pindling International Airport a smoke-free environment. He

indicated that decisions will now have to be made regarding the way forward for tobacco control

measures in The Bahamas. So, therefore, after all that has been said, the Bahamas’ government is

now going to consider banning [smoking] in public places period. We have casinos and we have

conflicting views as to whether or not a casino should be exempted from a policy. The

government said that it is going to make some decisions about that but it can be assumes that at

the end of day we will either have a total ban on smoking in all public places, or the number of

public places will be very minimal and even if that happens that will have to be for a minimal

period of time.

Also, the Declaration also called for the mandating of the re-introduction of physical

education in schools where necessary; provide incentives and resources to effect this policy and

ensure that our education sectors promote programmes aimed at providing healthy school meals

and promoting healthy eating.