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7The main factors in reducing mortality due to circulatory system diseases in the United States are: reduced smoking among people over the age of 18 from 42% (1965) to 25% (1995); lowering of average blood pressure levels among the population; an increase in the number of hypertensive patients who are being adequately monitored and treated; reduction of average blood cholesterol levels among the population; changes in the diet of Americans (a gradual decrease in consumption of foods with saturated fats and cholesterol since 1999); improvement of medical care (achievements in diagnosis and treatment, development of effective means of treating hypertension and hypercho-lesterolemia, increasing the number of specialists in cardiovascular diseases and improving their skills, etc.).
In 1999, the financial costs associated with morbidity and mortality from cardiovascular disease, including medical expenses and disability, amounted to $ 286.5 million in the United States.
Researchers explain the negative trends in mortality from cardiovascular diseases in Ukraine and Eastern European countries by the following reasons: lifestyle, socio-economic conditions, level of social protection, psychological factors, state of medical care of the population. The economic crisis in these countries and in Ukraine, in particular, declining living standards, unemployment, and political instability negatively affected the health of the population. The unhealthy way of life, including tobacco and alcohol abuse, poor nutrition, and lack of physical activity, has spread significantly. This is accompanied by an untimely request for medical assistance, lack of effective medical treatment,
a lack of knowledge of many doctors of modern treatment regimens of patients, and ineffective rehabilitation measures. In addition, less than a third of patients agree on modern treatment, because it is expensive.
Consequently, world experience shows that fighting most non-communicable diseases, including those with arterial hypertension, is most effective, and in some cases - the only possible, only in the prophylactic plane.
References
1. Golyachenko OM, Shulgay AG, Punchyshyn NJ. 3. Health of the rural population and factors that determine it: (review of literature). Bulletin of Social Hygiene and Health Care Organizations of Ukraine. 2007; 2: 7-11.
2. Moskalenko VF. Principles of building an optimal health care system: the Ukrainian context. Eastern European Journal of Public Health. 2008; 3: 55-67.
3. Klymenyuk VP. Assessment of the factors of the formation of the severity of the course and consequences of the diseases of the villagers (according to a sample survey in the Zhytomyr region). Ukraine. The health of the nation. 2007; 3-4: 52-60.
4. Klymenyuk VP. Amounts and quality of provision of medical and health care to the villagers of Zhy-tomyr region. Bulletin of Social Hygiene and Health Care Organizations of Ukraine. 2007; 3: 50-54.
5. Knight IV. Epidemiological features of circulatory system diseases, their dynamics in Ukraine and Chernivtsi region. Clinical and Experimental Pathology. Chernivtsi 2009; 8 (1): 41-46.
TECHNOLOGIES OF PRIMARY PREVENTION OF ARTERIAL HYPERTENSION IN THE RURAL
POPULATION
Navchuk I.,
Bukovina State Medical University, Ukraine
Navchuk G.,
Bukovina State Medical University, Ukraine
SobkoD.
Bukovina State Medical University, Ukraine
Abstract
It is common knowledge that arterial hypertension is ranked first in the distribution of circulatory system diseases and an important place among the causes that lead to disability in the population. In addition, arterial hypertension and its complications cause the society not only severe medical consequences, but also significant material damage. Therefore, today it is recognized that the most promising direction of reducing the incidence of arterial hypertension and other diseases of the circulatory system, disability and mortality from them is, first of all, primary prevention, based on the elimination of risk factors or reduction of their impact on a person, the formation of a healthy lifestyle as the most important means primary prevention of arterial hypertension and its consequences - diseases of the circulatory system.
Keywords: arterial hypertension, prophylaxis, rural population, circulatory system diseases, healthy lifestyle.
Given that primary prophylaxis should prevent the onset of diseases and is aimed at a conditionally healthy organism, its technologies include measures of influence on factors that are significant for the human body. Important are measures aimed at the formation of a healthy lifestyle, that is, the awareness of the need for active activity of the individual (society) in order to preserve and improve their own health.
The main purpose of promoting healthy lifestyles among the population is the correction of behavior in the direction that ensures the preservation and strengthening of the population and individual potential of physical health and reduction of psychoemotional stress on the basis of their determination in connection with the conditions of material and social well-being,
the presence and degree of reflection internal, external and behavioral risk factors.
In our opinion, the formation of a reasonable attitude towards the health of citizens should be based on recognized psychology, the algorithm of the process of education - "knowledge - belief - certain actions". Only one information provided by physicians to patients, without convincing them of the vital need for changes in habits, lifestyle and regulatory motivation to do so, will not provide appropriate targeted action. This conclusion is made during the analysis of the results of our study.
The process of forming a belief is subject to the laws of formation and change of conditioned reflexes and in its development has three stages. At the first stage of such a process, the convictions are not stable, they are situational in nature, in the second stage they are more stable, but due to lack of formation, the volitional component is realized only in some cases. At the third stage, beliefs are transformed into principles that govern human behavior in all situations. This should be taken into account when planning and conducting general sanitary-educational work and on the prevention of arterial hypertension and other diseases of the circulatory system. Absolute education beyond concrete connection with the life and behavior of specific patients does not contribute to the formation of belief. Do not be limited to the haste with advice given. It is necessary to persuasively explain the vital necessity of systematic control of arterial pressure, body mass, measures for their normalization, as well as the utility of increasing to a reasonable limit of motor activity.
On the basis of our research, we have developed the means of influence that medical practitioners should usually use in practice, carrying out sanitary and educational propaganda:
- on an individual level - conversations and short-term interventions on healthy lifestyle during admission, dispensary examinations, prophylactic visits, visits to patients at home, as well as delivery of sanitary and educational materials (sights, leaflets, booklets, etc.); answers by phone trust;
- on a group level - practical classes in schools, universities, health lectures at outpatient departments, veterans' homes, health and educational institutions, at work, rest or residence, listening and answering sessions, and visual propaganda;
- on the population level - informing the population through mass media.
Here's an algorithm we developed and recommended for use in methodological guidelines issued in 2003.
In any case, it is necessary to follow the general methodological principles related to the psychological peculiarities of the perception of information - it should have a positive character, a certain degree of novelty, be correlated at least with the knowledge of the audience on this issue, emotionally painted. The tips and recommendations we propose are constructive, not prohibitive, they include gender, age, education, occupation and health, as well as social and labor characteristics.
Promotion on the individual and group levels will promote the implementation of the proposed one: groups of practically healthy persons without factors or risk factors, persons with initial manifestations of diseases. The main accents should be placed:
- in the first group - on behavioral correction in order to increase the physical health potential close to the safe level, preventing the occurrence of internal, external and behavioral risk factors (primary prefactor prophylaxis);
- in the second group - on the correction of behavior in order to completely eliminate or significantly mitigate the effects of the identified risk factors for circulatory system diseases (primary "factor prevention"). It is advisable to form groups for conducting classes, consultations in the presence of a specific risk factor;
- in groups for patients, emphasis should be placed on adherence to the general principles of a healthy lifestyle in order to prolong the period of stable remission of existing pathology and prevention of relapse, the definition of medical treatment, the frequency of communication with the doctor, the possibilities of self-regulation of behavior, depending on the state of health, as well as on signs, with the appearance who need urgent medical treatment for secondary prevention technologies.
Heads of power structures, enterprises, institutions and institutions of all forms of ownership and public organizations know that medicine is not able to compensate for the negative impact on a person of adverse external, internal, behavioral and socio-economic factors of the risk of blood circulation diseases that can successfully be prevented by them. to be achieved with a comprehensive approach to solving problems with the creation of preconditions and the formation of a healthy lifestyle among the general population. They realize that without their active participation, it is impossible to achieve positive changes in the level, quality, style and way of life of both the population as a whole and regions, territories, its separate groups at the place of work, study, and residence.
Communicating doctors with patients at the time of admission, during their visits to the last at home, creates conditions for the implementation of sanitary and educational measures aimed at preserving and strengthening their health at the individual level. No doctor should leave the patient without recommendations for lifestyle correction. It should be guided by the attitude of people to their own health, therefore, first of all, should pay attention to patients who are passive to their own health. During the meeting, you must carefully explain the main internal and behavioral factors of risk of arterial hypertension (excessive body weight, inadequate physical activity, smoking, psycho-emotional stress, alcohol and salt abuse); to teach patients the methods of self-monitoring the potential of physical health for O.Pyrogova and co-authors, the level of psychosocial stress for L.Rider, body weight and determine their own risk of the onset and development of coronary heart disease by body mass index (body mass index).
We provide an algorithm for the actions of family physicians and district therapists to detect and prevent
arterial hypertension and its complications in the rural population taking into account risk factors.
Technology of propaganda of physical activity among the rural population.
It is known that under the influence of motor physical activity, the level of blood pressure decreases (3 mm of mercury column in normotonics, 10/8 mm of mercury column - in hypertonics), normalizes the content in the blood of cholesterol, increases the vital capacity of the lungs, reduces the susceptibility to emotional stress, increases metabolism, body weight normalization, skeletal muscle, strengthens mood, develops a sense of self-esteem and self-confidence.
It has been proved by science that the health-improving, training effect provides only motor physical activity in free time from work with an energy consumption of at least 2000 kcal per week (300 kcal per day). It is well-known, but little is said about the technologies of upbringing physical activity in the rural population suffering from arterial hypertension.
What should you start with physical training? What physical exercises can and should be recommended to rural patients? What intensity of load, regularity of training, their duration are the most optimal? The answers to these questions became the basis of our development.
So, first of all, it is necessary to determine the potential of physical health and to adhere to the following basic principles:
- the lower the individual potential of physical health, the greater should be the multiplicity of training per week, their lower intensity, but longer duration in time;
- physical activity should be increased gradually and only after the body is fully adapted to less intense loads;
- Individual physical training for persons with low physical training, it is advisable to start with a healing walk - 3 times a week for 15 - 30 minutes. and with a heart rate that is 60% of the maximum age.
We offer the training frequency of heart rate, considering the age, as follows:
a) For persons under the age of 49, we determine the maximum age-based heart rate by subtracting from 220 numerical markers for the age of the particular patient. The next step is to determine the maximum heart rate, which should be 75% of the calculated maximum heart rate and the minimum heart rate, which should be 60%, respectively;
b) for persons aged 50 and older, as well as those with cardiovascular pathology, the maximum age-based heart rate is calculated by subtracting from 180 numerical denotations of age or from 170 half the numerical denotation of the age of a particular person. The maximum heart rate is 75%, and the minimum is 60% of the maximum heart rate.
Consequently, the rational multiplicity of physical training for the elderly who have a low or lower than average level of physical health potential is at least 5 times a week with a duration of 40 - 60 minutes, for persons with an average level of physical health potential I - 3 - 4 times a week, lasting 20 - 30 minutes. To
maintain high and higher than average levels of physical health potential, it is enough to 2-3 high intensity training sessions per week.
Feeling of mild fatigue combined with mood improvement (mild euphoria) after a workout indicates that the choice of intensity and duration of training is correct.
The above-mentioned algorithm is an aspect of education of physical activity in the population of rural regions and is presented by us in the methodological recommendations "Methods, means and content of propaganda of a healthy way of life for the purpose of prophylaxis of arterial hypertension".
Of the many physical means of physical training, the most dynamic are dynamic loads, in which large groups of skeletal muscles are involved in the work, with the intensity at which the heart rate reaches optimal training values. The best are walking, recreational jogging, cycling, rowing, swimming, rhythmic gymnastics, fast dancing, mobile sports games, etc. Moderate physical activity is recommended to all, regardless of age, only to the extent.
Propaganda of balanced nutrition. The purpose is to convince patients of the vital need for a balanced diet, to provide information about the basics of balanced nutrition, to teach them to analyze their dietary habits and peculiarities of alimentary behavior and to make corrections in the initial forms of excessive body acuity.
Tips for nutrition should be realistic, acceptable and understandable to a rural dweller. It is not advisable to advise expensive, inaccessible, unknown to patients food products, to abuse the special terms (trace elements, grams, calories, nutrients, etc.). Instead of the latter, you can use the following words: "portion", "plate", "unit", "piece", "glass", "spoon", as well as the names of food groups: meat, fish, dairy, vegetables, fruit .
The most expedient for realization in the countryside is a regime with 3 - 4-time meals. The last meal should be 2 to 3 hours before bedtime. It is important to eat slowly, to observe the ratio between the number of chewing and swallowing movements of 20: 1. In order to reduce the level of cholesterol in the daily diet it is necessary to advise to limit the consumption of foods rich in cholesterol, in particular chicken eggs - up to 13 per week, cream butter - up to 30 g per day, animal fats - to the amount that provides 20% of daily requirement in energy It is useful to consume 20 to 25 g of soy products daily containing all the necessary amino acids, as well as potassium, calcium, phosphorus, iron and vitamins (B, C, D, E), but soy has no cholesterol. Moreover, it binds blood cholesterol and promotes its excretion from the body.
The main mistake in nutrition is the abuse of high-calorie and refined carbohydrates, in particular bakery products, sugar, and jam; insufficient consumption of fresh vegetables, fruits, seafood and products of rough meal flour; as well as additional salting of food and drinking alcohol that occurs in the countryside.
Anti-nicotine propaganda. The goal is to completely abandon smokers, prevent smoking by those who do not yet smoke, and create an environment free
from smoking. Doctors, other health care providers should support a personal example of non-smoking citizens. Awareness of health workers about the problem of smoking and their awareness of their importance in combating this risk factor is a prerequisite for a successful intervention aimed at stopping smoking.
It is known that there is no more difficult implementation of the recommendation, especially for the rural population. However, there is something that can make this technology more effective. The fact is that among rural women, smoking is almost not widespread. Therefore, technologies for combating this factor of arterial hypertension are aimed primarily at men, but consider this fact as a vivid example (for comparison) and, as a consequence, are more effective and effective.
The professional duty of health workers is to explain to smokers why they should give up smoking; give tips, hand out memorabilia or smoking pamphlets to visitors, and assign them a time of control meeting. During a re-visit of a patient, the doctor should ask whether the refusal of smoking is given in force. Particular attention should be paid to: children and adolescents; pregnant women; women who want to have children; adults, whose families have newborns and young children; persons with elevated blood pressure, cholesterol in the blood, cardiovascular disease, excessive body weight and lack of motor physical activity, as well as members of families with newborns and small children. Do not leave out the attention of those who gave up smoking. You can also send patients (at their request and consent) to group sessions or to specialists in smoking problems.
For those who choose to quit smoking, it is advisable to recommend actions that will help them not to smoke, namely: to develop a habit of exercising, to drink more fruit juices and water, to reduce the consumption of alcoholic beverages, not to drink coffee, to do new hobbies. In addition, it is advisable to establish controls so that, in the event of failure, they will again encourage patients to attempt to abandon smoking later.
We borrowed a way to assess the degree of dependence of a smoker on nicotine and recommend it to use it among rural smokers who have arterial hypertension (Phagextreme test), asking the patient to answer three simple questions (uniquely "yes" or "no"): 1) whether he smokes per day more than 20 cigarettes; 2) whether it stretches for a cigarette for 30 minutes. after awakening and 3) did he feel strong traction during the previous attempt to quit smoking. Positive answers to these questions indicate a high probability of dependence on nicotine. The degree of dependence on nicotine can also be determined by the smoker's index, which is equal to the number of smoked cigarettes per day, multiplied by 12. Index greater than 200 indicates a high dependence of the smoker on nicotine.
The algorithm of the doctor's actions regarding a patient who is not ready to give up smoking (5 international principles: urgency, risk, rewards, obstacles, repetition) in: a) explaining to the patient the reasons for stopping smoking (harmful habit) for him personally (family or social circumstances, medical indications, etc.); b) informing the smoker about the harmfulness of
smoking for health in general and everyone in person; c) discussing the potential benefits of non-smoking (economic, physical factors, appearance, etc.); d) clarification of the obstacles preventing the patient from abandoning smoking (fear of refusal syndrome, loss of satisfaction from smoking, etc.). It should be noted that in many countries of Europe and Ukraine, legislation on the inadmissibility of smoking in the premises, where the problem of passive smoking arises or may arise, has been adopted. During the formation of our own algorithms and technology models, we borrowed the data obtained in the spectrum of evidence-based medicine. Stopping smoking is not only the prevention of the disease, but also one of the mandatory appointments of the doctor to the patient in the process of treatment and rehabilitation.
Prevention of alcohol abuse. Doctor, recommending not to abuse alcohol, should be guided by the WHO slogan: "The less it is, the better." In practice, this should not mean that absolutely everyone should be advised to completely stop drinking alcohol. The use of men up to 20, and women and elderly people up to 14 units of alcohol per week (1 unit equals 10 grams of absolute alcohol corresponding to 25 grams of vodka or 100 grams of wine or 250 grams of beer) is considered as the limit of the lowest risk. In such cases, the doctor may be limited to providing individual advice, guided by the physical condition of patients, body weight, metabolic characteristics, etc. So, in women with low body weight, even 10 g of alcohol per day can increase the risk of breast cancer. In order to minimize the risk of developing alcohol addiction, it is necessary to focus on the fact that patients must be at least one day a week without using any alcohol at all. At the same time, individuals who lead a sober lifestyle or drink alcohol from time to time, do not recommend increasing the use of alcohol to safe doses.
Consequently, the methods of propaganda of physical activity, balanced nutrition, non-alcohol abuse, refusal of smoking and correction of behavior in patients with arterial hypertension are formed and implemented by us. They will help preserve and strengthen the potential of their health.
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