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10the antimicrobial effect of which is enhanced by oxygenation of the solution, and the peritoneum is treated with a jet, which, in addition to a vibrating massage.
The rehabilitation operation is carried out by actively supplying antiseptic solutions to the peritoneal cavity, supporting their exposure and active evacuation using a device for active prolonged rehabilitation of the peritoneal cavity, allows for a rapid progressive reduction of microbial contamination of the exudate, reduce the incidence of intra-abdominal complications and increase the effectiveness of treatment of such patients.
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8. Полянський 1.Ю., Мороз П.В., Москалюк В.1., Андpieць В.В. Спосiб виконання повторних лапараскотчних мaнiпуляцiй. Патент № 118451 U Укра!ни № u201701711; БДМУ; заявл. 23.02.2017, опубл. 10.08.2017. Бюл. №15. 5 с.
BASIC REGULARITIES OF MORBIDITY, DISABILITY, MORTALITY FROM CARDIOVASCULAR DISEASES AND ARTERIAL HYPERTENSION IN COUNTRIES OF THE WORLD AND IN
UKRAINE
Navchuk I.,
Bukovina State Medical University, Ukraine
Navchuk G.,
Bukovina State Medical University, Ukraine
SobkoD.
Bukovina State Medical University, Ukraine
Abstract
The development, course and prevention of circulatory system diseases, in spite of many years of multidimensional research, remain the most important health problem in the countries of the world and in Ukraine in particular. Not an exception in this nosological group and arterial hypertension, which is the trigger mechanism for almost all pathologies of the heart and blood vessels of a person. Circulatory system diseases are ranked first in Ukraine among all the illnesses taken together.
Keywords: diseases of the blood circulation system, arterial hypertension, morbidity, disability, mortality, rural population.
The problem identified in the title is not new in terms of research and practical implementation, but is not considered to be studied until the end. This is evidenced by the data of the review of the world scientific information flow, as will be discussed further.
Diseases of the circulatory system are the main causes of mortality and disability in most countries of the world, including Ukraine (accounting for almost half of all deaths). The second place in terms of causes of death is cancerous diseases, which exceeds one fifth of all deaths. In developing countries, circulatory system diseases are ranked second among causes of death,
and they account for almost 25%, infectious and parasitic diseases (43%) are in the first place. In highly developed countries, the proportion of infectious and parasitic diseases as causes of death is negligible (less than 1%). Ukraine, on the basis of these parameters, occupies an intermediate position between developed and developing countries. In terms of the proportion of infectious and parasitic diseases, Ukraine is close to highly developed countries, in terms of the proportion of cancers - to developing countries. At the same time, the proportion of circulatory system diseases in Ukraine is the largest and accounts for almost half of all deaths.
Researchers focus on arterial hypertension, coronary heart disease, cerebral stroke and cerebrovascular diseases, among all circulatory system diseases. Why? Because they have a negative dynamics.
Data from the analysis of scientific information show that combating hypertension as a medical problem is not new. Back in the early 60's, a number of authors convincingly convinced that up to a quarter of the adult population could suffer from arterial hypertension in civilized countries. Particularly noticeable was the increase in morbidity in European countries during and after the war. Since the early 60's the problem of fighting hypertension has become relevant and has found a prominent place in the activities of treatment and prevention institutions and scientific institutions around the world.
In any case, special attention to arterial hypertension today is due to its complications. After all, scientists in the world have proved that arterial hypertension is a risk factor for stroke, and is also a completely unique trigger mechanism for coronary heart disease. A similar situation is in Ukraine.
25 - 30% of the population suffers from arterial hypertension in Europe. Over the past 20 years, the level of detection of arterial hypertension has increased in European countries from 17% to 34%. These data are based on studies conducted in 7 countries of the old continent. The fact of the increase in the incidence of this ailment, from the standpoint of some scholars, is the result of increasing the effectiveness of the detection of patients.
According to the United Nations, the number of elderly people in the world will increase from 600 million in 1999 to 2 billion in 2050, therefore the problem of the growth of diseases of the blood circulation system becomes a priority in the world dimension.
Diseases of the circulatory system have a complex nature of the course and are combined with other diseases, for example: Arterial hypertension is isolated in 30% of cases, ischemic heart disease - 17%. Most cardiovascular diseases are combined with diabetes, diseases of the digestive system, kidney diseases and respiratory diseases.
Arterial hypertension and other diseases of the blood circulation system lead to changes in the quality of life of patients, leading to certain biological, social and household constraints, and they are the main cause of persistent disability.
In Ukraine, according to scientists and the results of our study, the losses from arterial hypertension and other diseases of the circulatory system are larger than in European countries, with the exception of the Russian Federation, Belarus, Turkmenistan and Kazakhstan. The standard mortality rate in Ukraine is twice as high as in European countries. A significant place in the structure of the causes of death is the disease of the circulatory system, the likelihood of death from which in recent years has increased: more than half of men and almost two thirds of women die of them.
The leading cause of death from circulatory system diseases is coronary heart disease, and the second cause is vascular lesions of the brain. In the United
States and European countries, there has been a significant decline in the mortality rate of this pathology in recent years, and the gap between these indicators in Ukraine and the Western countries is increasing at all times. The standardized mortality rate for this reason in Ukraine was 5 times higher than in the developed world.
The dynamics of mortality from cardiovascular disease is largely influenced by the aging process of the population. Its impact on mortality increases, according to some studies, is 12%, the rest of the increase is due to an increase in age-related mortality from this class of causes of death.
The mortality rate from circulatory system diseases in recent years has increased in the vast majority of regions of the country, but most of all in the Cher-nihiv, Donetsk, Lugansk, Dnipropetrovsk oblasts and the Autonomous Republic of Crimea.
The highest mortality rate from ischemic heart disease (60%), of all its possible cases, is observed among rural residents, where it is almost twice as high as in urban areas. Thus, during the 1990s, the incidence of mortality from this disease increased rapidly and increased 1.6 times in both urban and rural areas.
Fighting diseases of circulatory systems primarily involves a positive solution to the problem of arterial hypertension. That is why here and in the future we will consider the problems of prevention of cardiovascular diseases and their complications on the example of this nosological form.
In our opinion, in resolving the strategic tasks of combating diseases of the blood circulation system, the scientific substantiation of the prevalence of these diseases is important, which ultimately involves the development and application of primary and secondary prevention technologies.
We turn to scientific literature on the patterns and peculiarities of the prevalence of arterial hypertension. Part of this question we discussed above, but it is worth adding to it interesting, in our opinion, the data. Patients with hypertension (essential hypertension) make up 9095% of all patients with arterial hypertension, and the rest - patients with secondary (symptomatic) arterial hypertension.
It has long been known that age, sexual and professional peculiarities affect the prevalence of arterial hypertension. Hypertension in the age of 40 to 59 years occurs in approximately 30,2% of men and women, and for every ten years life expectancy increases by 10%. For example, in the age of 50 - 59 years old, arterial hypertension occurs in 39% of the population (both men and women). Other data indicate that men with age are much more likely to suffer from hypertension than women (it is up to 40 years of age), but with age, the curve is growing more often among women than among men.
There is a certain difference for specialists in the incidence and prevalence of hypertension in mental and physical labor for the benefit of the latter. But there are other thoughts. In people who have a sedentary lifestyle, the risk of arterial hypertension is 20-50% higher than that of the physically active. Physical loads during hours of fulfilling professional duties contribute to an increase in blood pressure, and physical activity during
leisure - on the contrary. Regular aerobic exercise is a very effective means of non-medicated treatment for arterial hypertension.
In our view, different ideas about the specifics of the incidence and prevalence of hypertension are not an unexpected phenomenon, since the etiology of this disease has not been thoroughly studied. This, perhaps, is reflected in technologies for preventing the disease and its complications, which will be discussed further.
According to researchers and the results of our study, the final effect of arterial hypertension should be considered from the perspective of patient health, temporary disability, disability and mortality. The listed parameters, which are the result of the illness, determine the social weight of the latter and the technology of preventing its complications.
With regard to temporary disability, hypertension can give, depending on some conditions, from 64.0 to 79.1 days per 100 employees. It is clear that there are quite a lot of data on significant economic losses caused by arterial hypertension, which, according to its prevalence, complications in moral and material plans, is one of the main medical and social problems of domestic health care.
Research shows that most of the subjects (66.8%) suffered from coronary heart disease and arterial hypertension at the same time, with the highest number of patients at the age of 45 - 55 years, the disability was mainly due to stroke and myocardial infarction. Vascular brain lesions with hypertension are about 10%, myocardial infarction - 24,6%.
So the most frequent and most dangerous complications due to arterial hypertension are myocardial infarction and stroke of the brain. This is an undeniable fact that does not cause doubt to anyone. An analysis of foreign scientific literature suggests that today, even in the United States, where the health care system has sufficient funding, coronary heart disease and hypertension kill so many Americans as the rest of all the illnesses taken together. In the American Health Program up to 2000, it was determined that persons with high blood pressure have a 3 to 4 times more common ischemic heart disease and a 7-fold higher risk of cerebral stroke.
The situation in Ukraine with mortality from diseases of the circulatory system of the working age, which has increased by 1.55 times in Ukraine, is threatening in Ukraine, with the increase in deaths among men more than 65%. This suggests that men of working age from cardiovascular diseases die 4 times more than women. Compared to the countries of Western Europe, the mortality rate at the working age remains 2 to 4 times higher.
Calculations of the number of lost people-years of life of the working-age population as a result of mortality from circulatory system diseases conducted by researchers showed that these losses account for 17% of total losses in women and 22% in men. In general, the loss of male population is 4.6 times greater than that of women. In the structure of diseases of the circulatory system, the largest proportion of losses is for coronary heart disease (54.2% for men and 37% for women) and cerebrovascular diseases (20.6% for men and 31.2% for
women). If we talk about age groups, then the greatest losses are observed, as already mentioned, at the age of 40 - 49 years.
Constant growth of diseases of the circulatory system has led to the fact that since 2000, their proportion in the structure of general morbidity or prevalence in Ukraine has become the largest, pushing for the 2nd place of respiratory diseases, and accounts for almost a third of all diseases. It should be noted that in the structure of the primary disease of the diseases of the circulatory system occupy the second place.
Annually, about 2.4 million newly diagnosed patients register in health care institutions, and the total number of requests for cardiovascular disease reached 20.8 million.
The incidence and prevalence of circulatory system diseases among the Ukrainian population tend to increase. Primary morbidity in the 5-year period since 2002 has increased by 1.7 times, prevalence - by 1.6 times.
Among the diseases of the circulatory system, the most urgent is coronary heart disease. It manifests itself in the form of angina pectoris, myocardial infarction and heart rhythm disturbances. She is considered a real epidemic, as the incredibly fast increase in the number of patients, and more and younger.
The incidence of diseases of the circulatory system and mortality from them has distinct regional features. The highest prevalence of circulatory system diseases is observed in the Northeast (281.6 %o), Central (281.2 %o) and South-Eastern (260.0 %o) regions. To some extent, this may be due to the aging population, as evidenced by the average age, the highest in the NorthEast (39.3 years) and Central (38.1 years) regions. However, in the Southeast region, the highest level of severe complications of hypertension is myocardial infarction and stroke: 1.63 %% and 2.8 %o, respectively, against 1.37 %o and 2.2 %o in the whole of Ukraine. The data of other authors also confirm the high level of these diseases among employees of the heavy industry enterprises, which is very much in the South-East region.
Among the rural population of Ukraine, circulatory system diseases are also the most common pathology. Every year almost 750 thousand cases of the first detected diseases of the circulatory system are recorded, and the total number is 5.7 million. The leading nosological forms are, as has been mentioned many times, hypertonic disease, ischemic heart disease, cerebrovascular diseases. About 100 thousand adult rural population accounts for 44 thousand cases of diseases of the circulatory system, that is, they are found in almost half of the rural population. Particular concern is caused by high levels of disability and cardiovascular mortality. Almost two-thirds of all deaths in the countryside are caused by circulatory system diseases.
Conclusion. Consequently, the main features of the diseases of the circulatory system, primarily arterial hypertension, in Ukraine are: an increase in their mortality rate when this indicator is lowered in the countries of the European region, the northeastern vector of the prevalence of pathology, the higher level and rate of mortality in the rural population, the "rejuvenation" of
contingents patients, a leading role in the disability of the population, a significant level of morbidity, in particular with temporary disability, especially in men of working age. These features lead to an increase in the medical and social importance of arterial hypertension and other diseases of the circulatory system in Ukraine, as they cause significant economic losses to the state: financial expenses for diagnosis, treatment, rehabilitation of patients, etc.
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RISK FACTORS FOR ARTERIAL HYPERTENSION AND OTHER CIRCULATORY SYSTEM
DISEASES AND THEIR PREVENTION
Navchuk I.,
Bukovina State Medical University, Ukraine
Navchuk G.,
Bukovina State Medical University, Ukraine
SobkoD.
Bukovina State Medical University, Ukraine
Abstract
The fight against most non-communicable diseases, including those with arterial hypertension, is most effective, and in some cases - the only possible, only in the prophylactic plane. Thus, the implementation of a number of programs to combat cardiovascular disease as the most significant nosological group of diseases has shown that control of risk factors contributes to the reduction of morbidity, disability and mortality. World experience shows that preventive measures aimed only at lifestyle changes contribute to reducing the occurrence of new cases of arterial hypertension by 50% and prolonging life expectancy.
Keywords: diseases of the circulatory system, risk factors, arterial hypertension, prophylaxis.
The fight against most non-communicable diseases, including those with arterial hypertension, is most effective, and in some cases - the only possible, only in the prophylactic plane. Thus, the implementation of a number of programs to combat cardiovascular disease as the most significant nosological group of diseases has shown that control of risk factors contributes to the reduction of morbidity, disability and mortality. World experience shows that preventive measures aimed only at lifestyle changes contribute to reducing the occurrence of new cases of arterial hypertension by 50% and prolonging life expectancy.
The onset and progression of arterial hypertension are closely related to unmanageable and manageable risk factors. Uncertain risk factors are age, gender, racial and ethnic characteristics, heredity, etc.
Age. There is a direct relationship between arterial pressure and age. Thus, the level of diastolic blood pressure increases to 55 years, then changes little, and systolic blood pressure increases with age constantly. If we talk about age groups, we have the greatest number of patients and the greatest expenses are at the age of 40 - 49 years.
Sex. The average blood pressure and the prevalence of arterial hypertension in young and middle-aged women are somewhat lower than in men. With age, this addiction varies up to the reversal. We want to
note that women are more actively treated and engaged in the prevention of hypertension.
Heredity. This is one of the most influential factors for the future development of arterial hypertension. A close correlation between arterial pressure was found the closest relatives (parents, brothers and sisters). The presence of high blood pressure in a family history, according to literature, 51.7% of patients with arterial hypertension, do not have - 18.1%, according to the results of our study, given below. Heredity is associated with syndrome of family dislipidemic hypertension.
Genetic aspects. The generally accepted concept of the genetic basis of high blood pressure. Although some monogenic hypertension disorders are described in humans, however, in the majority of them, arterial hypertension is a polygenic disease. In our time, a number of genes are studied, which may be responsible for the origin of arterial hypertension. Probably, in the future, with the help of molecular biology, it will be possible to identify the propensity to develop arterial hypertension.
Controlled risk factors for arterial hypertension are features of the neonatal period, central obesity and metabolic syndrome, body weight.
Features of the neonatal period. The adverse environment in critical periods of fetal development and
