CC BY
16
DOI 10.26724/2079-8334-2019-3-69-128-133 UDC 616.857-08
O.S. Nikiforova. M.Yii. Delva I krainian Medical Stomatological Academy. Poltava
MIGRAINE PRODROMAL FEATURES IN ABDOMINALLY OBESE PATIENTS
e-mail: [email protected]
Nowadays, it has been found that abdominal obesity (AO) can modify migraine clinical course. The purpose of the work was to study and to assess migraine prodrome characteristics in abdominally obese patients with episodic and chronic migraine. There were 96 episodic and chronic migraineurs examined with normal body weight and AO. Data were collected using structured questionnaires. In 76 cases (78.5%) migraine prodrome had been reported. Abdominally obese patients compared to normal body weight migraineurs had a higher rate of prodromal symptoms (83% vs. 75%) and experienced statistically higher mean number of prodromal symptoms per patient (4.0 (4.0-6.0) vs 6.0 (5.4-7.0). p<0.05). Abdominally obese migraine patients had increased risk of premonitory «hunger» (OR, 7.4; 95% CI, 2.2-25.2; p<0.01) as well as premonitory «food craving» (OR, 9.2; 95% CI, 2.7-31.3; p<0.01). Presence in abdominally obese migraineurs such prodromal signs as «hunger» and «food craving» were associated with increased risk of cutaneous allodynia - OR 6.0 (CI, 1.2-30.6; p=0.03) and OR 7.4 (CI, 1.3-43.0; p=0.01), respectively. In abdominally obese migraineurs intensities of prodromal eating behavior disorders had direct correlations with severity of cutaneous allodynia and migraine headache. AO is associated with statistically more frequent hunger feeling and food craving as prodromal signs. Presence and severity in abdominally obese migraineurs prodromal hunger feeling and food craving are associated with increased risk of cutaneous allodynia. In abdominally obese migraineurs intensities of prodromal eating behavior disorders had direct correlations with severities of allodynia and migraine pain.
Key words: migraine, prodrome, abdominal obesity.
The work is a fragment of the research project "Clinical and pathogenetic optimization of diagnosis, prognosis, treatment and prevention of complicated central nervous system's disorders and neurological impairments due to therapeutic pathologies", State registration No. 0116U004190.
Migraine is one of the most common forms of primary headache that affects 14.4% of adult population [14]. Migraine had been recognized as the sixth most disabling disease in the world [14].
Many authors consider migraine as a complex primary neurological process, where headache is the core and the only therapeutic goal. However, the migraine attack is a sequence of three main phases: prodrome, ictal phase and postdrome. The international classification of headache disorders - 3rd edition (ICHD-3, 2018) defines the prodrome as a symptomatic phase, lasting up to 48 hours, occurring before the onset of pain in migraine without aura or before the aura in migraine with aura. Among the common prodromal symptoms are fatigue, elated or depressed mood, unusual hunger and cravings for certain foods [7]. The scrutiny of the migraine prodromal symptomatology could be useful for deeper understanding of early abortive therapy for pain attacks.
Recent studies reveal the associations of abdominal obesity (AO) with some clinical peculiarities of migraine attacks (frequency, headache severity, associated symptoms, etc). These two pathological conditions can be aggravated by each other through various phenomena (biological, psychological, behavioral) [1, 5]. However, up to now there is no consistent data about the prodromal symptoms in abdominally obese migraineurs and there is limited understanding of prodromal symptoms management.
The purpose of the present study was to assess migraine prodrome characteristics in abdominally obese patients with episodic and chronic migraine.
Materials and methods. Patients were included in the study if they had migraine without aura or migraine with aura (according to ICHD-3, 2018), agreed to participate in the study and provided the informed consent.
Exclusion criteria were depressive and anxious disorders (Hospital Anxiety and Depression Scale scores more than 10 for both pathologies) [15], severe dependence on analgesic drugs (Leeds Dependence Questionnaire score more than 22) [6], pathological conditions that could complicate the diagnosis of skin allodynia (skin disease, neuropathy, etc.), treatment with botulinum toxin within the last three months.
Due to the frequency of migraine paroxysms we isolated patients with episodic migraine (EM) and chronic migraine (CM). According to waist circumference all patients were divided as abdominally obese (cut-off 102 cm for males and 88 cm for females) and with normal weight.
Data were collected in the face-to-face interviews using structured questionnaires. Premonitory symptoms questionnaire included most common prodrome signs: hunger, food craving, nausea (not associated with gastrointestinal disease), frequent urination, increase/decrease libido, sleep disorders (difficulty falling asleep, frequent waking, etc.), drowsiness, tiredness/weariness, difficulty with concentration, mood changes, anxiety, excess energy, euphoria, yawning, increased light sensitivity,
© O.S. Nikiforova, M.Yu. Delva, 2019
increased sound sensitivity, increased smell sensitivity, neck stiffness, and any other sign that had been described by patient as premonitory symptom.
In the questionnaire patients were asked to notice the presence (absence) of a premonitory symptom, its frequency (less/more than in half of migraine attacks), its intensity ("+" - mild, "++" -moderate, "+++" - severe), its duration (hours and/or minutes).
Migraine characteristics included average headache duration (hours), headache intensity (using a 100-mm visual analogue scale (VAS)). Quantitative and qualitative characteristics of the skin allodynia (mechanical, dynamic, thermal) were evaluated by using Allodynia Symptom Checklist-12 during headache attacks [8].
Distributions of continuous variables were checked by Shapiro-Wilk test. Parametric variables were represented as mean (M) and standard deviation (m), non-parametric - as mediana (Me) and interquartile (25%-75%) range (Q1-Q3). Categorical data were represented by number (n) and percentage. Differences in categorical variables were compared using Fisher's exact test. Univariate logistic regression analysis was performed to analyze the odds ratio (OR) with 95% confidence intervals (CI). A /»-value <0.05 was considered statistically significant.
Results of the study and their discussion. Among 96 examined migraineurs, in 76 cases (78.5%) had been reported prodrome. This value roughly coincides with the data of the previous studies devoted to migraine prodromal symptoms frequencies [12].
Throughout patients with migraine prodrome there were 22 patients with EM and normal weight, 20 - with EM and AO, and two groups of 17 chronic migraineurs each with normal weight and AO. Patients' age ranged from 18 to 56 years (mean age - 37.8±9,0 years). There were 13 (14%) males and 83 (86%) females.
In common, the presence of prodromal symptoms in abdominally obese patients was a bit higher compared to normal body weight migraineurs (83% vs. 75%).
Table 1
Mean number of prodromal symptoms per migraineur who had prodromal phase, Me (Q1-Q3)
Patients' groups Mean number of prodromal symptoms
EM, normal weight 4.0 (4.0-6.0)
EM, AO 6.0 (5.4-7.0)*
CM, normal weight 4.0 (3.0-5.0)
CM, AO 8.0 (7.0-8.0)**
* - significant differences (p<0.05), according to the Mann-Whitney U test, compared with patients with EM and normal weight; ** -significant differences (p<0.05), according to the Mann-Whitney U test, compared with patients with CM and normal weight.
As can be seen from table 1, AO was associated with statistically higher average number of prodromal symptoms per patient in comparison with the normal body weight migraineurs. This regularity
was present regardless of migraine chronifi cation.
Table 2
Frequencies of prodromal migraine symptoms, n (%)
Prodromal symptom Patients' groups
EM, normal weight EM, AO CM, normal weight CM, AO
hunger 2 (9%) 8 (40%)* 2 (12%) 9 (53%)**
food craving 2 (9%) 9 (100%)* 2 (12%) 10 (59%)**
nausea 4 (18%) 5 (25%) 4 (24%) 5 (29%)
frequent urination 3 (14%) 3 (15%) 3 (18%) 3 (18%)
increase/decrease libido 2 (9%) 3 (15%) 2 (12%) 2 (12%)
sleep disorders 6 (27%) 6 (30%) 4 (24%) 5 (29%)
drowsiness 3 (14%) 3 (15%) 3 (18%) 2 (12%)
tired/weary 5 (23%) 6 (30%) 3 (18%) 4 (24%)
difficulty with concentration 6 (27%) 5 (25%) 3 (18%) 5 (29%)
mood change 7 (32%) 7 (35%) 4 (24%) 5 (29%)
anxiety 6 (27%) 7 (35%) 6 (35%) 6 (35%)
excess energy, euphoria 6 (27%) 6 (30%) 6 (35%) 5 (29%)
stiff neck 5 (23%) 7 (35%) 5 (29%) 5 (29%)
yawning 7 (32%) 8 (40%) 5 (29%) 6 (35%)
light sensitivity 7 (32%) 5 (25%) 3 (18%) 5 (29%)
sound sensitivity 2 (9%) 2 (10%) 3 (18%) 2 (12%)
smell sensitivity 4 (18%) 3 (15%) 3 (18%) 3 (18%)
* - significant differences (p<0.05), according to Fisher's exact test, compared with patients with EM and normal weight; ** - significant differences (p<0.05), according to Fisher's exact test, compared with patients with CM and normal weight.
Commonly, among the most spreading prodromal symptoms were: mood changes (43%), yawning (34%), anxiety (32%), food craving (30%), hunger (28%). It's necessary to emphasize that food behavior changes, as premonitory sings, statistically more often occurred in abdominally obese migraineurs compared to normal weight ones: univariate logistic regression analysis showed that episodic migraineurs with AO had increased risk of premonitory "hunger" and "food craving" compared to normal weight patients with EM - OR 6.7 (CI, 1.2-36.7; p=0.03) and OR 8.4 (CI, 1.5-48.9; p=0.02), respectively. Moreover, above mentioned regularities were also present in chronic migraineurs - OR 8.2 (CI, 1.5-44.8; p=0.02) and OR 10.7 (CI, 1.8-62.5; p=0.01), respectively. So, positive associations between AO and increased frequency of premonitory food behavior changes are much or less similar irrespective of migraine type. Finally, combined cohort of abdominally obese migraine patients had increased risk of premonitory «hunger» (OR, 7.4; 95% CI, 2.2-25.2; p<0.01) as well as premonitory «food craving» (OR, 9.2; 95% CI, 2.7-31.3; p<0.01) in comparison with combined cohort of normal weight migraineurs.
Next step was to analyze severity and frequency of prodromal migraine symptoms. For this purpose we dichotomized all prodromal cases as «non-severe» («+» and «++») and «severe» («+++»). For analyzing of prodromal migraine symptoms frequency we also dichotomized cases when each prodromal symptom occurs in more than half (less than half) of all migraine attacks.
According to the obtained results throughout abdominally obese migraineurs there was only tendency (without reaching statistical threshold) to have more frequent and more severe prodromal «hunger» and «food craving» compared to the normal weight patients. Anyway, this questions needs to be solved in future studies.
Table 3
Migraine attacks characteristics, Me (Q1-Q3)
Patients' groups Characteristics
VAS (points), Me (Q1-Q3) Duration (hours), Me (Q1-Q3) Cutaneous allodynia, n (%)
no mild moderate severe
EM, normal weight 7.0 (6.0-8.0) 10.0 (8.0-11.8) 7 (32%) 8 (36%) 6 (27%) 1 (5%)
EM, AO 8.0 (7.0-8.3)* 14.0 (10.0-15.5)* 4 (20%) 4 (20%) 2 (10%) 10 (50%)
CM, normal weight 7.0 (6.0-8.0) 15.0 (11.0-17.0) 8 (47%) 2 (12%) 2 (12%) 5 (29%)
CM, AO 7.0 (6.0-8.0) 15.0 (9.0-18.0) 3 (18%) 1 (6%) 3 (18%) 10 (58%)
* - significant differences (p<0.05), according to the Mann-Whitney U test, compared with patients with EM and normal body weight.
The table 3 shows that AO is associated with statistically more severe EM clinical course. In abdominally obese episodic migraineurs average headache duration is significantly longer and headache intensity is also statistically higher than in normal weight episodic migraineurs. Interestingly this pattern doesn't apply to CM patients.
Next step was to define possible interconnections between premonitory symptoms and headache characteristics.
According to univariate regression logistic analysis, presence in combined group of abdominally obese migraineurs such prodromal signs as «hunger» and «food craving» are associated with increased risk of cutaneous allodynia - OR 6,0 (CI, 1.2-30.6; p=0.03) and OR 7,4 (CI, 1.3-43.0; p=0.01), respectively.
According to the Kendall rank correlation, in abdominally obese migraineurs intensities of prodromal «hunger» and «food craving» had direct correlations with cutaneous allodynia severity - t=0.46 (p=0.02) and t=0.52 (p=0.01), respectively. Also, intensities of prodromal «hunger» had direct correlation with migraine headache severity, according to VAS, - t=0.41 (p=0.03).
Migraine, as a clinical phenomenon, is characterized by pronounced phenotypic variability. The clinical heterogeneity of migraine is the result of complex interactions of genotype with environmental factors and various comorbid conditions. Recent studies revealed the existing relationship of migraine with general obesity and, especially, with visceral fat localization [4].
Migraine paroxysm starts as early as the prodrome phase begins (this statement is clearly defined in ICHD-3, 2018), develops over certain period of time and results in a full-scale migraine attack if a critical physiological threshold is reached. To date, the prodromal symptoms have not received much attention in the literature, and they have been considered rather as an insignificant condition than as the earliest stage of the migraine attack. However, based on our results and on results of some previous studies, it can be concluded that migraine prodrome plays an important diagnostic, prognostic and therapeutic role, at least in patients with AO [12].
An extensive and heterogeneous set of the clinical manifestations of prodrome we conditionally divided into 5 groups: 1) disorders of the eating behavior, 2) genitourinary dysfunction, 3) violations of the "sleep-wake" cycle, 4) psycho-emotional disorders, 5) impaired perception of external stimuli. In
group of abdominally obese patients the most common and most severe prodromal signs were eating behavior disorders - feeling of hunger and food craving. Based on our findings we can assume that the prodromal symptoms have quite specific functions and each prodrome type is specific for each individual patient. For example, prodromal hunger and food craving in the abdominally obese patients are much more common than in the normal weight migraineurs. Moreover, presence of these symptoms has statistical associations with cutaneous allodynia, and ultimately, with an increased risk of disease chronification.
Clinical, population-based and basic science research shows multiple overlaps between central and peripheral mechanisms regulating feeding and headache pathophysiology [3, 4]. Given the striking similarity between nutrition control processes and pathogenic mechanisms of headache it is highly probable that further study of these links will be a significant step towards to understanding the complex migraine pathophysiology. Several hypothalamic peptides, proteins and neurotransmitters (serotonin, orexin, adiponectin and leptin) are particularly important in the migraine pathogenesis and participate in the feeding control [13]. In addition, excessive accumulation of adipose tissue inducts the synthesis of multiple pro-inflammatory cytokines and adipocytokines that through promotion of local and systemic inflammation make migraineurs more susceptible to the normal triggers, and eventually lead to more frequent and more severe migraine attacks [11].
According to the modern concept of the hypothalamus role in the migraine, the most of the prodromal symptoms can be recognized as clinical analogues of hypothalamic dysfunction [9]. Various aggregations of the hypothalamic cells (in particular, nucleus tractus solitarii, suprachiasmatic nucleus) are ideally located to mediate the integration of the trigemino-vascular system with feeding fluctuations. A complex network of the connections between brainstem regions (periaqueductal gray matter, rostral ventromedial medulla, locus coeruleus, superior salivatory nucleus) and diencephalic nuclei (hypothalamus, thalamus, and cortex) is the cause of migraine pathogenesis complexity and variety of migraine phenotypic expressions [10]. In other words, migraine is a consequence of dysfunction of brainstem and hypothalamus nuclei that are responsible for modulation or controlling of sensory inputs with overactivation of sensory systems [6]. Continuing dysfunction entails the development of central sensitization, the latter is manifested by skin allodynia in the cephalic and extracephalic regions and eventually can lead to disease chronization [2].
From a scientific perspective, revealing pathophysiological pathways that underlie the prodromal symptoms (particularly in abdominally obese patients) can provide insight into dysfunction of brain structures involved in the early stages of migraine attacks, and finally can contribute to the identification of pre-headache abortive approach.
From a practical point of view, due to high prevalence of prodromal symptoms among migraineurs, prodrome evaluation should be used in routine clinical practice.
Explanation to patients of migraine prodrome symptomatology could help to minimize individual migraine triggers (skipping meals, sleep deprivation, alcohol intake, etc.), to take an abortive drug at the beginning of headache onset (that would ensure its highest efficacy), to diminish physical and mental stress for the rest of the day, so on.
1. Migraine prodrome is a quite common entity that occurs in 78.5% migraineurs.
2. AO is associated with statistically more frequent hunger feeling and food craving as prodromal
signs.
3. Presence and severity in abdominally obese migraineurs such prodromal signs as hunger feeling and food craving are associated with increased risk of cutaneous allodynia as well as with increased risk of allodinya severity.
4. In abdominally obese migraineurs intensities of prodromal eating behavior disorders had direct correlations with severities of cutaneous allodynia and migraine pain.
Future studies should be directed towards to investigation of molecular mechanisms that are responsible for prodrome peculiarities in abdominally obese migraineurs.
The research described in this paper was performed within the framework of scientific plan of neurological department with neurosurgery and medical genetics at Ukrainian medical stomatological academy "Clinical and pathogenetic optimization of diagnosis, prognosis, treatment and prevention of complicated central nervous system's disorders and neurological impairments due to therapeutic pathologies" (state registration number 0116U004190).
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2. Nikiforova OS, Delva MYu. Osoblyvosti klinichnoho perebihu ta prohresuvannya mihreni u patsiyentiv z abdominalnym ozhyrinnyam. Aktualni problemy suchasnoyi medytsyny. 2018; 2(62):75-9. [in Ukrainian]
3. Bigal ME, Liberman JN, Lipton RB. Obesity and migraine: a population study. Neurology. 2006; 66:545-50. 2
4. Bond DS, Roth J, Nash JM, Wing RR. Migraine and Obesity: Epidemiology, Possible Mechanisms, and the Potential Role of Weight Loss Treatment. Obesity Rev. 2011; 12(501):362-71.
5. D'Andrea G, Leon A. Pathogenesis of migraine: from neurotransmitters to neuromodulators and beyond. Neurol Sci. 2010; 31(1): 1-7.
6. Ferrari A, Cicero A, Bertolini A, Leone S, Pasciullo G, Sternieri E. Need for analgesics/drugs of abuse: a comparison between headache patients and addicts by the Leeds Dependence Questionnaire (LDQ). Cephalalgia. 2006; 26(2):187-193.
7. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38(1):211.
8. Lipton RB, Bigal ME, Ashina S, Burstein R, Silberstein S, Reed ML, et al. Cutaneous allodynia in the migraine population. Ann Neurol. 2008; 63(2):148-58.
9. Maniyar FH, Sprenger T, Monteith T, Schankin C, Goadsby PJ. Brain activations in the premonitory phase of nitroglycerin triggered migraine attacks. Brain. 2014; 137:232-42.
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References
Реферат
КЛ1Н1ЧН1 ОСОБЛИВОСТ1 продромально!'
ФАЗИ М1ГРЕН1 У ПАЦ1еНТ1В З АБДОМ1НАЛЬНИМ ОЖИР1ННЯМ Шюфорова О.С., Дельва М.Ю.
На тепершнш час встановлено, що абдомшальне ожиршня може впливати на юпшчний перебш мпреш. Метою роботи було ощнити особливост продромально! симптоматики у пащенив з етзодичною та хрошчною м^енню, що мають абдомшальне ожиршня. Обстежено 96 пащен™ з етзодичною i хрошчною м^енню з нормальною масою тша та абдомшальним ожиршням. Даш були зiбранi з використанням структурованих анкет. 76 пащен™ (78,5%) повщомляли про наявшсть м^енозного продрому. Пащенти з абдомшальним ожиршням, в порiвняннi iз пащентами з нормальною масою тша, мали бшьш високу частоту продромальних м^енозних симпташв (83% проти 75%) i вщчували статистично вишу середню юльюсть продромальних симптомiв на одного пащента (4,0 (4,0-6,0) проти 6, 0 (5,4-7,0), р <0,05). У пащен™ з абдомшальним ожиршням та м^енню тдвищувався ризик такого продромального симптому, як «шдвищення апетиту» (ВШ, 7,4; 95% Д1, 2,2-25,2; р <0,01), а також «змша смакових вподобань» (ВШ, 9,2; 95% Д1, 2,731,3; р <0,01). Наявшсть у пащен™ з м^енню та абдомшальним ожиршням таких продромальних симпташв, як «шдвищення апетиту» i «змша смакових вподобань», були пов'язаш з тдвищеним ризиком розвитку шюрно! алодинй - ВШ 6,0 (Д1, 1,2-30,6; р = 0,03) i ОШ 7, 4 (Д1, 1,3-43,0; р = 0,01) вдаовщно. У пащен™ з абдомшальним ожиршням та м^енню штенсивтсть продромальних розладiв харчово! поведшки мала прямi кореляцй зi ступенем вираженосп шюрно! алодини i м^енозно! цефалги. Абдомiнальне ожиршня асощюеться зi статистично бiльш частими продромальними симптомами «пiдвишення апетиту» i «змiна смакових вподобань». Наявнiсть i вираженiсть у пащенив з м^енню та абдомiнальним ожирiнням таких продромальних симптсмв, як «пiдвишення апетиту» i «змiна смакових вподобань», пов'язанi з тдвищеним ризиком розвитку шюрно! аллодинии. У пащен™ з м^енню та
КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ПРОДРОМАЛЬНОЙ ФАЗЫ МИГРЕНИ У ПАЦИЕНТОВ С АБДОМИНАЛЬНЫМ ОЖИРЕНИЕМ Никифорова Е.С., Дельва М.Ю.
В настоящее время установлено, что абдоминальное ожирение может влиять на клиническое течение мигрени. Целью работы было оценить особенности продромальной симптоматики у пациентов с эпизодической и хронической мигренью, имеющих абдоминальное ожирение. Обследовано 96 пациентов с эпизодической и хронической мигренью с нормальной массой тела и абдоминальным ожирением. Данные были собраны с использованием структурированных анкет. 76 пациентов (78,5%) сообщали о наличии мигренозного продрома. Пациенты с абдоминальным ожирением, по сравнению с пациентами с нормальной массой тела, имели более высокую частоту продромальних мигренозных симптомов (83% против 75%) и испытывали статистически достоверно большее среднее количество продромальных симптомов на одного пациента (4,0 (4,0-6,0) против 6, 0 (5,4-7,0), р <0,05). У пациентов с абдоминальным ожирением и мигренью повышался риск такого продромального симптома, как «повышение аппетита» (ОШ, 7,4; 95% ДИ, 2,2-25,2; р <0,01), а также «изменение вкусовых предпочтений» (ОШ, 9,2; 95% ДИ, 2,7-31,3; р <0,01). Наличие у пациентов с мигренью и абдоминальным ожирением таких продромальных симптомов, как «повышение аппетита» и «изменение вкусовых предпочтений», были связаны с повышенным риском развития кожной аллодинии - ОШ 6,0 (ДИ, 1,2-30,6; р = 0,03) и ОШ 7, 4 (ДИ, 1,3-43,0; р = 0,01) соответственно. У пациентов с абдоминальным ожирением и мигренью интенсивность продромальных расстройств пищевого поведения имела прямые корреляции со степенью выраженности кожной аллодинию и мигренозной цефалгии. Абдоминальное ожирение ассоциируется со статистически более частыми продромальными симптомами «повышение аппетита» и «изменение вкусовых предпочтений». Наличие и выраженность у пациентов с мигренью и абдоминальным ожирением таких продромальных симптомов, как «повышение аппетита» и «изменение вкусовых предпочтений» связаны с повышенным риском развития кожной аллодинии. У пациентов с мигренью и абдоминальным ожирением интенсивность
абдомшальним ожиршням штенсивнють продромальних симптомiв у вигляд розладав харчово! поведiнки мала прямi кореляци з тяжюстю шюрно! алодини i м^енозно! цефалги.
Kro40Bi слова: м^ень, продром, абдомiнальне ожиршня.
Стаття надшшла 8.10.18 р.
продромальных симптомов в виде расстройств пищевого поведения имела прямые корреляции с тяжестью кожной аллодинии и мигренозной цефалгии.
Ключевые слова: мигрень, продром, абдоминальное ожирение.
Рецензент Катеренчук 1.П.
DOI 10.26724/2079-8334-2019-3-69-133-136 УДК 34; 159.92
О.П. ........... Л.Ю. Малина1. . I.M. < пи.ова1. Д.В. {озуш1
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ЗДОРОВ'Я ЛЮДИНИ ЯК НАЙВИЩА СОЦ1АЛЬНА Ц1НН1СТЬ
e-mail: [email protected]
Стаття присвячена питання здоров'я людини як найвищо! соцiальноi цiнностi. Аргументовано, що з правового погляду здоров'я, точнше - об'ектом права на здоров'я е немайнове благо «здоров'я фiзичноi особи», зважаючи на те, що власне здоров'я е об'ектом нематерiального св^у. Норми рiзних галузей права (конституцшного, адмiнiстративного, фiнансового, кримiнального, цившьного права) так чи iнакше регулюють питання, пов'язанi iз реалiзацiею, охороною та захистом права на здоров'я. Тим самим ще раз тдкреслюеться конституцiйне положення про те, що здоров'я е однieю з найвищих соцiальних цiнностей в нашiй державД. Наголошуеться, що здоров'я мае бути стратегДчним напрямом життя людини, за допомогою чого забезпечуеться пiдвищення життестшкостД органiзму, природнiй опiр органiзму стресовим явищам i депресивним станам. I тут слДд враховувати, що стан здоров'я визначаеться кДльюсними та якДсними медичними показниками. Вiдсутнiсть таких показникДв, небажання чи визначення особою за непотрiбне 1х знати, жодним чиною не означае, що людина е здоровою. Про здоров'я треба думати, ним слДд тклуватись. Але це вже питання суб'ективного ставлення особи до само! себе. Водночас, особа мае усвДдомлювати, що власним здоров'ям можна не займатись (у разi виникнення якихось хвороб - не лДкуватись), до тих пДр, поки це не шкодить Днтересам Днших.
IGii040Bi слова: здоров'я людини, благополучия, ¡деал здоров'я, сощальна цшшсть.
Робота е шщативною.
ЗгДдио Дз ст. 3 конституцп Украши здоров'я людини, разом Дз И життям, честю, гДдиДстю, иедоторкаииДстю, безпекою визиаються в УкрашД иайвищою соцiальиою цшшстю, тобто тим, що мае певну матерДальиу АБО ДУХОВНУ ВАРТ1СТЬ. ЦДкавою е думка про те, що «в цивДлДзоваиому суспДльствД Ддеал здоров'я мае стати иайважливДшим елемеитом загальиоиацюиальио! ще!. ЗрозумДло, що для полДпшеиия здоров'я населения иеобхДдио проводити вДдповДдиу державиу полДтику, яка мае характеризуватися комплексиДстю й адекватиим фДиаисовим забезпечеииям» [2]. Водиочас дуже спДриим е питания «Ддеалу здоров'я», адже у рДзиих крашах, якД можуть бути иавДть подДбиД за сво!м полДтичиим устроем, якД можуть бути иевизиаиД Дишими державами, можуть створювати таю умови для життя сво!х громадян, якД остаииДми сприймаються як иалежиД, як достатиД. Громадяии екоиомДчио i соцДальио добре розвииеиих кра!и сприймають таю умови, як иеиалежиД, як таю, що обмежують !х права та свободи. Отже, питания «Ддеалу здоров'я» ие варто використовувати у середовищД i тим бДльше - у закоиодавствД.
Метою роботи було дослДдити питания здоров'я людиии як найвищо! соцДальио! цДииостД та формулювання иа цДй осиовД авторських пропозицДй.
Резульхахм дослщження ха Тх обговорення. ВДдповДдио до ст. 3 [4] з подальшими змДиами та доповненнями, здоров'я - це стаи повиого фДзичиого, психДчиого i соцДальиого благополуччя, а ие тДльки вДдсутнють хвороб i фДзичиих вад. Даие законодавче положения грунтуеться иа положениях Статуту (Конституцп) Всесвгтиьо! оргаиДзаци охороии здоров'я вДд 22 липия 1946 р. [6], де у преамбул також зазначаеться, що «Мати иайвищий досяжний рiвеиь здоров'я е одиим з основних прав кожно! людиии незалежно вiд раси, релДги, полiтичиих переконань, екоиомiчиого чи соцiальиого положения. Здоров'я всДх иародiв е осиовиим фактором у досягиеииД миру i безпеки i залежить вДд самого повиого ствробДтництва окремих осiб i держав. Досягнення будь-яко! держави в галузД полiпшеиия та охороии здоров'я е цшшстю для всДх». Тобто людина мае право иа «иайвищий досяжний рiвень здоров'я». Тут виникае запитання: як слiд розумiти «иайвищий рiвень»? «як цього рiвия можна досягти»? ЦД питания е вкрай складними, оскДльки для рДзиих верств населения, для рДзиих соцiальиих i вДкових груп, зиову ж таки - для рДзиих иародiв такий рiвень ие е одиаковим i визначити його практично иеможливо. У статуи використано оцДиочиу категорiю, яку можиа тлумачити залежио вДд обставии по-рДзиому. ЗвДсио, держава, И керДвиицтво мають всДляко забезпечувати таке право людиии i прагиути до того, щоб люди могли якиайдовше бути у такому стаиД, щоб самостДйио забезпечувати всД сво! життевД потреби. Проте в силу певиих обставии (матерДальио-техиДчиих, фДиаисових, кадрових) Диколи таке право порушуеться.
© О.П. Орлюк, Л.Ю. Малюга,, 2019
