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[4] Sala M.A., Matheus M., Valeri V." Regional variation in the frequency of fibrinoid degeneration in human term placenta." Z Geburtshilfe Perinatal. 1982; 186(2): 80-81.
[5] Hiden U., Glitzner E., Hartmann M., Desoye G. "Insulin and IGF system in human placenta of normal and diabetic pregnancies." J Anat. 2009; 215(1): 60-68.
[6] Elchalal U., Smith S.D., Schaiff W.T."Insulin and fatty acid regulate the expression of fat droplet associated protein
adipophilin in primary human trophoblasts." Am J Obstet Gynecol. 2005;193:1716-1723.
[7] Jone C.J., Desoye G. "Glycogen distribution in the capillaries of placental villus in normal, overt and gestational diabetic pregnancies." Placenta. 1993; 14: 505-517.
[8] Verma R. "Cellular changes in the placenta in pregnancies complicated with diabetes." Inter J Morphol. 2010; 28(1): 259264.
CARRYING OUT THE COMMON PREVENTIVE EXAMINATIONS OF PEOPLE OVER 18 IN BULGARIA - STATUS AND TRENDS
Kostadinova Penka Stefanova
doctorant. M U - Pleven, Faculty of Public Health, Department of « Public Health Sciences»
Kostadinov Sergey Deyanov
assistant professor. M U - Pleven, Faculty of Public Health, Department «General Medicine, Forensic Medicine and Deontology»
Simeonova Joana Ivanova
assistant professor. M U - Pleven, Faculty of Public Health, Department of « Public Health Sciences»
Stoilova Irena Jordanova
assistant professor. MU- Pleven, Faculty of Public Health, Department» Hygiene and Occupational Disease
ABSTRACT
One of the main activities of general practitioners (GPs) in Bulgaria is the annual holding of a general checkup of people over '18 prophylactic examination includes a basic package of activities and research based on who identify as persons with diseases and patients who are at increased risk for developing certain major diseases. The aim of this study was to determine the scope of the population and the views of patients and GPs for conducting check-ups. They are used official data from the National Health Insurance Fund and has held direct individual survey with 229 GPs from three areas of Bulgaria and 515 insured persons over 18 years. It was found that despite the mandatory nature of these reviews had a relatively low range of the underlying population -approximately 50% of adults annually performs check-up. Record the underfunding of this activity. Main drawbacks are indicated in surveys of doctors, insufficient awareness and motivation, and lack of time. The majority of patients consider that these examinations are carried out formally. No resistance, monitoring and reporting on the effect of these examinations.
Keywords: GPs, check-up.
Introduction: In Bulgaria after reforms in the health sector was perceived health insurance model and enhance the role of general practitioners (GPs) as a key figure for providing primary outpatient care (PIMP). One of the main responsibilities of GPs in execution of contracts with the Health Insurance Fund is carrying out preventive examinations compulsory insured persons over 18 and the formation of risk groups.
Since 2006, the total check-in GP is mandatory [1.2] for all insured persons, regardless of their health status. It is financed from the budget of the National Health Insurance Fund (NHIF)
Activities and studies included in the review in a prophylactic health insurance fund (NHIF)
and includes a basic package of activities and research (see Table. 1) [3]. Within these checks, GPs identified as individuals with diseases and patients who are at increased risk of developing certain socially important diseases, such as cardiovascular, malignant diseases (colon cancer, breast cancer and cervical cancer in women, prostate cancer in men) and diabetes. Patients with established high risk for these socially significant diseases subject to further consultation with a specialist and further research. [13]
Table. 1
of persons over 18 years, financed by the budget of the National
Age Activities and studies included in the prophylactic examination Frequency
over 18 years the calculation of body mass index, an assessment of mental status examination, vision acuity, measurement of blood pressure, electrocardiogram; study of urine for protein, glucose, bilirubin, urobilinogen/ketone bodies and pH (with test strip in Office); determination of blood sugar in the lab in the presence of risk factors. annually
from 30 to 45 years old. Women > = 30 Men > = 40 Complete blood count consisting of at least eight of the following indicators: or more hemoglobin, erythrocytes, leukocytes, platelets, hematocrit, MCV, MCH, MCHC. Manual examination of mammary gland cholesterol and triglycerides once every five years annually once every five years
From 46 to 65 Men > = 46 Women > = 50 Men > = 50 Complete blood count consisting of at least eight of the following indicators: or more hemoglobin, erythrocytes, leukocytes, platelets, hematocrit, MCV, MCH, MCHC. cholesterol and triglycerides cholesterol and triglycerides PSA once every five years once every five years once every five years once every two years.
Women from 50 to 69. incl. mammography of mammary glands once every two years.
Over 65 years old. Complete blood count consisting of at least eight of the following indicators: or more hemoglobin, erythrocytes, leukocytes, platelets, hematocrit, MCV, MCH, MCHC. Cholesterol and triglycerides annually once every five years.
The theme for the holding of a general checkup population is the subject of many studies. Still under discussion whether and to what extent should be carried out this review, what are the pros and cons, what is the effect of their implementation for the individual and society.
General health checks are designed to reduce morbidity and prolonging life. Theoretically there are many possible benefits. The discovery of some risk factors such as hypertension, hypercholesterolemia, cervical dysplasia and others. can lead to a reduction of disability and death by preventive treatment.
Also, it might be useful discovery of the signs and symptoms of the disease manifest, the person is not considered important. Some people can improve their lives by obtaining appropriate information and guidance. These general health checks, however, can lead to damage. Possible over-diagnosis, over-treatment, stress or injury of invasive follow-up tests, stress due to false positives, false confidence because of false negative results, which can lead to a continuation of adverse health behaviors, adverse psychosocial effects. Last but not least, organized programs for general medical examinations can be expensive and can lead to loss of opportunities to improve other areas of health.
Lasse and co-authors [18] gave a negative assessment of the effect of these examinations, but recommended a high-risk approach - «..steering to individual components of the medical examination, such as screening for cardiovascular disease, COPD, diabetes, etc.
To reduce the negative impact of demographic change on health and to feel its positive impact on other areas such as economic and socio-cultural sphere, it is necessary to invest in high-quality healthcare services and technologies for early
diagnosis and treatment of diseases, as and prevention, education of healthy lifestyles and the prevention of disease among the population.
Force in Bulgaria National programs in the field of protection of public health are oriented towards different age and social groups at risk. Funding for the implementation of these programs shall be set annually, but not sufficient [11]. The conflict between limited resources and the ever increasing needs of activities in health promotion and disease prevention, leading to insufficient effective system to limit morbidity and mortality of the most common socially significant infectious and non-infectious diseases.
According to the annual report on the state of health of the citizens for 2011 deaths in Bulgaria exceed the EU average by 17 different causes of death while five causes of death our country first - malignant neoplasms, diseases of the circulatory system, other diseases heart, cerebrovascular disease; some conditions arising during pregnancy and childbirth.
Objective: The aim of this study was to determine the scope of the population and the views of patients and GPs for conducting check-ups.
Material and Methods: were used official data from the National Health Insurance Fund and has held direct individual survey with 229 GPs from three areas of Bulgaria and 515 insured persons over 18 statistical processing of the raw data was carried out with software packages Microsoft Office Exel 2010 and SPSS for Windows v. 13.0.
Results: During the period 2006 - 2012, with the annual medical check-ups in the country is covered by 35.8% of eligible insured persons over 18 years to 48.3% in 2012 (fig.1) [12].
Fig. 1 Share of covered with aggravated checkup for the period 2006-2012
From the poll with 515 insured persons over '18 from Pleven region it is found that most of them go to the checkup with your doctor, but not every year - 45 %, and 15% never performed such a review [15]. In a study of reasons for recall checkup after groups of people walking irregular and did not attend to the prevention, showed a statistically significant difference in
terms of the lack of information (p = 0.0001), the leading cause of default of review. Default regularly and check-goers, besides the lack of information pointed to a lack of time, formal surveys, inclusion of studies that would go, and the absence of complaints and diseases (fig.2).
Other reasons I have ¿b roken health insurance lights Need to pay custom tee I b elie™ that thes e re visvs be cartied out formal^ I belies that when these reviews are not cartied out.. I dorit ha™ time I can commit to attending the review I think I need no^ as I ha™ no confJaints and diseases I have no infoimatian on the conduct of thes e reviavs
--1- -г -f
I ~
—ь
v-^-^ -^
0,0
10,0
20,0
30,0
40,0
50,0
Fig. 2 Main reasons for default of prophylactic examination of patients referred to the respondents who go irregular or not go to prophylactic examination
Respondents who have chronic diseases, high blood pressure family history and those without these risk factors rarely attend and high cholesterol more regularly attend check-up. Persons check-up.
with risk factors such as smoking, obesity and sedentary lifestyle, Compared with men, women respond more regular checkup
with your doctor (fig. 3).
Fig. 3 The distribution of respondents by gender, according to the frequency of check-ups
Age, residence and education significantly affect the attitudes of patients and recall them for check-GP.
Older patients are better covered with prophylaxis (p = 0.043). This can be explained by the fact that most older patients due to chronic illness, often going to his GP. Within their visit on another occasion be carried out and the annual check-up.
People living in rural areas are less covered with prevention -23.6% of respondents who live in villages never carried their fair checkup, while urban residents this percentage was 13.2.
There is a statistically significant relationship between education and the ratio of patients to ongoing screening. People
with lower education levels are less covered with preventive examinations (p = 0.001).
From the poll with general practitioners found that all surveyed GPs are convinced that it is necessary to perform annual check-ups of people over in '18, but only 31% consider that packages of prevention activities for different groups are well selected to be effective review [10].
In order to increase the scope of screening, 71% of respondents indicated a need for better awareness of the population, about 45% indicated the need for inclusion of new activities in preventive examinations, and approximately 50%
accept the imposition of sanctions on defaulting prophylactics as an appropriate measure (82% of respondents gave more than one answer). About two-thirds of doctors estimated pay GPs receive for carrying out prophylactic examination as insufficient.
More than half of the surveyed GPs do not support risk register, and 21% are not included in the risk register all persons who meet the criteria for an increased health risk for diseases identified by the NHIF. The main reasons for the poor maintenance of risk register are insufficient limit for consultation with a specialist and research - for 64.6% of respondents lack of clarity about the work on this program - at 49.3% and lack of motivation from both the patients and the GPs - in October 26%. More than half of physicians gave more than one reason.
Evidenced by the NHIF approved budgets in recent years, each year provide preventive tools for less than half of the adult population (47% in 2013).[6,7,8]
Conclusions: Despite the mandatory nature of prophylactic examinations of adults observed relatively low range - on - less than half of the underlying population annually appears in this review. No resistance, monitoring and reporting the effect of the program. Much of the population is not sufficiently informed about the conducted check-ups. A large proportion of people who believe that the prophylactic examination is necessary, but is formally done by GPs and that studies are insufficient. Doctors also cited as reasons for the failure of the program for prevention of elderly most often insufficient awareness of the population, insufficient time which remains prevention, insufficient limit allocated by the health fund for research to implement in full the program, as well as insufficient motivation of doctors and patients. And recognizing the lasting trend of default by the GP for at-risk population groups, as part of the maintenance of the elderly.
Conclusion: It is necessary to revise the package of activities and studies included in the general checkup to be held a massive information campaign and therefore to apply legal sanctions provided for patients who do not attend the annual check-up. To account for the effect of the program, it is necessary to introduce a monitoring reporting. It is necessary to improve and control the activities of APL for the pursuit of prevention in full, including a thorough risk assessment and subsequent monitoring of patients at high risk of developing major diseases.
References:
1. Health law .(http://www.nhif.bg)
2. Health Insurance Act. (http://www.nhif.bg)
3. Ordinance No. 39 for preventive checkups and dispensary; (http://www.nhif.bg)
4. Ordinance No 40 on the basic package health activities, guaranteed by the budget of the National health insurance fund; (http://www.nhif.bg)
5. Ordinance No. 41 of the Health ministry of 21.12.2005. Medical standards in general medical practice; (http://www.nhif. bg)
6. National Health Insurance Fund. Annual report on the activities of the national health insurance fund for 2007 (http:// www.nhif.bg/c/dokument_library/get_file?p_I_id=11276&fold erld=13219&name=DLFE-501.pdf)
7. National Health Insurance Fund. Annual report on the activities of the national health insurance fund for 2008 (http:// www.nhif.bg/c/dokument_library/get_file?p_I_id=11276&fold erld=13219&name=DLFE-4209.pdf)
8. National Health Insurance Fund. Annual report on the activities of the national health insurance fund for 2010 (http:// www.nhif.bg/c/dokument_library/get_file?p_I_id=11276&fold erld=13219&name=DLFE-4209.pdf)
9. Kostadinova P.S, Atanasova G., Deyanov S., Kostadinov S. Conducting a general checkup to seniors as part of prevention of cardiovascular diseases in Bulgaria. J Clinical & Experimental Cardiology. 2015; 6 (4) : 43. http://dx.doi.org/10.4172/2155-9880.S1.023
10. Kostadinova P.S, Velkova A., Hristova P., Simeonova J., Kostadinov S. D., Stoilova I., Naydenova G., Kostadinov S. S. A survey in regard to the opinion of GPs for the carried out prophylactic medical examinations of people over 18 years old. J Science & Technologies (online).2015; 5 (1) : 223- 226.
http://journal.sustz.com/VolumeV/Number1/Papers/ PenkaStefanova.pdf
11. Kostadinova P., Velkova A., Hristova P., Simeonova J., Kamburova M., Georgieva S., Kostadinov S.D., Stoilova I., Naydenova G., Kostadinov S.S. Financial security programs for the prevention of NHIF insured over 18 years performed by GPs. Jubilee international conference «Science and education - tradition and future,» SMS - Kardzhali, 2-3.10.2014, the Collection of Scientific Works, Volume V, pp. 296-300. ISSN 1314-3425
12. Kostadinova P., Velkova A., Georgieva S., Kostadinov S.D. Scope of compulsory check-ups with health insured persons over 18 years old, from Pleven region for the period 2006-2011, problems and trends. The fourth Balkan scientific conference «Science, education, art in the 21st century» Blagoevgrad, 2012 r. ISSN - 1313-5236 „Yearbook Of Science - Education -Art".2012; 6 (2) : 219-226, Union of scientists - Blagoevgrad.
13. Kostadinova P., Velkova A., Simeonova J., Kamburova M., Georgieva S., Kostadinov S. Kostadinov S.S. Formation of population groups at risk, as part of the preventive activities of general practitioners. International scientific magazine «Science and technology». 2013, Union of scientists - Stara Zagora; 3 (1) :351 - 355;
14. Kostadinova P., Velkova A., Hristova P., Simeonova J., Kostadinov S.D., Stoilova I., Naydenova G., Kostadinov S.S. A survey in regard to the opinion of GPs for the carried out prophylactic medical examinations of people over 18 years old. International scientific magazine «Science and technology». 2015,
Union of scientists - Stara Zagora; 5 (1) : 223- 226 http:// journal.sustz.com/VolumeV/Number1/Papers/PenkaStefanova. pdf
15. Kostadinova P., Velkova A., Simeonova J., Kostadinov S., Stoilova I., Kostadinov S.S. A survey regarding the opinion of the compulsory health insured people in the region of Pleven about the carried out prophylactic medical examinations of people above 18 years old by the general practitioners. Journal of Health Economics and management. 2013;
3 :84 - 88
16. Velkova A., Georgieva S., Kostadinov S.D, Kamburova M. Preventive examinations in compulsory insured persons over 18 years, realized by the GP. Trakia Journal of Scientists. 2008; 6 (2- suppl. 3), p.101-105.
17. Lasse T Krogboll, Karsten Juhl Jorgensen, Christian Gronhoj Larsen, Peter C Gotzscheq, General healt cheks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis, BMJ 2012; http://www. bmj.com/content/345/bmj.e7191
18. Lasse T Krogboll, Trial results "do not support the use of general healt cheks" warn experts. http://www.bmj.com/press-releases/2012/11/20
19. L. Ebony Boulware, MD, MPH; Spyridon Marinopoulos, MD, MBA; Karran A. Phillips, MD, et al. Systematic Review:
The Value of the Periodic Health Evaluation. Annals of Internal Medicine; 146 (4) file:///C:/Users/Administrator/ AppData/Local/Microsoft/Windows/INetCache/IE/SZ5QB1 KE/0000605-200702200-00008.pdf
FUNCTIONAL DEFICITS IN PATIENTS OVER 44 YEARS OF AGE AND THEIR EFFECT ON SELF-RATED HEALTH
Simeonova Joana Ivanova
Medical university, Department of Public health sciences, Pleven
Kostadinova Penka Stefanova2
Medical university, Department of Public health sciences, Pleven
Stoilova Irena Iordanova
Medical university, Department of Hygiene and occupational diseases, Pleven
ABSTRACT
Background: Many studies found significant association between the poor functional status of individuals and the negative self-rated health. The aim of that study was to identify the problems of functioning in patients and to establish their effect on self-rated health.
Methods: A cross-sectional study was carried out in 2014. Two hundred and twelve patients over 44 years of age were included in the study. The study was a part of the Project N0 11/2014 which was funded by the Medical University of Pleven.
Standardized questionnaire EQ-5D-3L was used to identify the functional deficits in patients. Self-rated health was measured by 5-ordinal scale including 3 positive categories (excellent health, very good health and good health) and 2 negative categories (fair health and poor health).
Data were processed by SPSS.v.19. Group differences were tested for statistical significance by Pearson's chi-square (p< 0.05).
Results: Most of the patients (42.5%) assessed their health as good. Almost 20% had poor health and only 2.3% - excellent health. Each of five dimensions significantly associated with self-rated health of patients. Many respondents who had the deficits with mobility, self-care, usual activity performance and experienced anxiety/depression or pain/discomfort, assessed more frequent their health as fair or poor (p<0.05).
Conclusion: Our study confirmed the findings by the other researchers. Deteriorated functioning in most patients had a significant role for the negative SRH. However, the predictive abilities of EQ-5D-3L regarding to self-rated health can be confirmed by longitudinal study.
Keywords: self-rated health, EQ-5D-3L, mobility, self-care, usual activity performance, pain/discomfort, anxiety/depression, functional deficits
Background: Many studies found significant association between the poor functional status of individuals and the negative self-rated health. The aim of that study was to identify the problems of functioning in patients and to establish their effect on self-rated health.
Methods: A cross-sectional study was carried out in 2014. Two hundred and twelve patients over 44 years of age were included in the study. The study was a part of the Project N0 11/2014 which was funded by the Medical University of Pleven. We selected 115 hospital patients and 97 patients from general practice setting. The age and sex distributions of Bulgarian population in 2013 were applied in the process of sampling. The patients were randomly selected. Written consent was obtained from every participant after being completely informed about the study.
Standardized questionnaire EQ-5D-3L was used to identify the functional deficits in patients in five dimensions: mobility, self-care, usual activity performance and experienced anxiety/
depression and pain/discomfort [6, 8 c.]. Each dimension included 3 levels: no problems, moderate problems, extreme problems. Because of the small part of respondents who had "extreme problems", that category of variable was combined with the second category in one category „functional deficits".
Self-rated health (SRH) was measured by 5-ordinal scale including 3 positive categories (excellent health, very good health and good health) and 2 negative categories (fair health and poor health). The respondent should be answering the question „How would you rate our health at present?" He should show one of these five categories of SRH.
Data were processed by SPSS.v.19. Group differences were tested for statistical significance by Pearson's chi-square (p< 0.05).
Results: The distribution of persons by gender and age was showed in Table 1. Almost 53percent were women, the mean age was 61 years old.
