According to WHO forecasts, 60% of the worlds population (3.3 billion people) may be overweight (2.2 billion people) and obese (1.1 billion people) by 2030. Increased body weight and atherogenic dyslipidemia are independent risk factors for chronic non-infectious diseases, which, in turn, lead to premature mortality of the working population. Management of patients with increased body weight requires a complex change in their lifestyle and their consistent and sustained efforts. Taking into account the latest data on the contribution of abdominal obesity, dyslipidemia, fatty hepatosis to the risks for development of cardiovascular diseases, these patients are indicated the earliest therapeutic and preventive outpatient intervention. The success of treatment depends on the degree of motivation, the level of compliance of the patient and regular control throughout life. However, when a patient considers himself healthy, he hopes to solve the arising problems quickly and easily, which is often impossible for objective reasons. In this case, the fundamental attitude of the patient may be crucial in the success of treatment. In the article, a typical clinical case of overweight and of other risk factors for chronic non-infectious diseases at the stage of early clinical manifestations associated with increased risks of multiple comorbidities, is described. But the patient, considering himself quite healthy and the first clinical manifestations insignificant, faced with the necessity of regular medical monitoring and complex life-long intervention, partially follows doctors recommendations and eventually is shying away from solving problems. By focusing on a paternalistic or engineering model of relationships with the doctor, the patient significantly reduces the effectiveness of the earliest control of risk factors for chronic non-infectious diseases. Analyzing the presented clinical case, it is possible to draw attention of specialists to the necessity of rationalization of diagnostic and treatment programs in real outpatient practice.
Aim - to study the prevalence of syndromes of anxiety and depression in correlation with major risk factors (RF) of chronic noninfectious diseases among patients of the Samara region considering themselves healthy. Materials and methods. A comparative population-based cross-sectional study was based on a representative selection of patients (95 people) from the Samara region (rural and urban population) at the age of 19-68 years. Results. The study revealed a significant increase in the rates of fatigue, anxiety and depression in outpatients. The syndrome of anxiety of subclinical level was detected in 35.7% of patients, clinical level - in 23.2% of patients; the syndrome of subclinical depression was revealed in 21.0% of patients, and 4.2% had the clinical level. We discovered the correlation between the syndromes of anxiety and depression and the major RF of chronic noninfectious diseases and patient’s satisfaction with quality of medical care in the clinic. High levels of anxiety were more frequent in men, at older age, and were associated with physical inactivity. Severe depression more often occurred at older age and in the presence of hypercholesterolemia. The income level of the patient correlated with the level of stress exposure, physical activity and satisfaction with the work of the policlinics. We did not reveal the relationship between the syndromes of anxiety and/or depression and the level of income, degree of hypertension, social activity, smoking, alcohol consumption, and body mass index. Conclusion. The results indicate that the presence of the syndromes of anxiety and depression increases the risk of occurrence of other independent risk factors of chronic noninfectious diseases. The identified trends can serve as the basis for targeted screening programs for diagnostics and prevention of chronic noninfectious diseases.
The patient, who has risk factors but considers himself / herself to be healthy, does not consult a doctor, but is in a suboptimal status. The study of the patient’s health at different levels of physical activity is an important issue of preventive medicine.Material and methods. 351 people (133 men and 218 women) aged 18 to 75 years after obtaining voluntary informed consent to the study were examined. Patients were divided into 8 groups according to the international physical activity questionnaire (IPAQ). In addition to the classic clinical and laboratory examination, patients were interviewed using questionnaires: suboptimal health status (SHSQ-25), hospital anxiety and depression scale (HADS), stress susceptibility questionnaire (PSS). Statistical processing was carried out by programs Microsoft Excel 2010 and Statistica 10,0.Research result. When studying the values of discovering the fact of the differences in some indicators: increase of arterial pressure in 3 and 4 group physical activity, age of women, increasing of body mass in the 2, 3, 5 and 8 groups physical activity that proves the relationship of the presence of risk factors and physical activity level of the patient. Significant differences between the actual values of the mean age and the alarm level in groups with high and low suboptimal status were revealed. Significant differences in suboptimal status were revealed, which reflected the presence of risk factors for chronic noncommunicable diseases in groups with different physical activity (age of women over 45 years old, overweight, monthly use of alcohol, the presence of hypercholesterinemia and high level of depression). Significant differences in groups with high and low indicators of suboptimal status in the presence of risk factors for chronic noncommunicable diseases are revealed: age over 45 years, increased systolic and diastolic blood pressure, high levels of anxiety. Significantly differed in the indicators of suboptimal status of the group of physical activity: 2, 3, 6 and 7.Conclusion. In groups of patients who consider themselves healthy and do not see a doctor for 3 months or more, the risk factors of chronic non-communicable diseases, more common in groups of patients who are not engaged in physical activity, were identified. Differences in indicators of suboptimal health status in the presence of risk factors of chronic noncommunicable diseases are revealed. The SHSQ-25 questionnaire objectively reflected the main screening indicators of chronic disease risk factors, it is simple to use in primary health care, it is an economical and effective tool for screening subclinical, reversible stages of chronic diseases.
More than 40% of adult Russians periodically feel heartburn. Progression of the disease leads to a number of complications shortening patients life. However, patients try to cope with problems by themselves, without receiving adequate early treatment. Only when the life quality worsens, which evidences progression of the disease, they turn to a doctor. Success of treatment depends on the level of the patients compliance, life-long complete and regular adherence to treatment recommended by the doctor. With this, an outpatient with a chronic disease should provide the most part of the required medical service by himself. However, patients often change the therapeutic measures on their own impairing the result of treatment. The given below clinical case of patient Zh., 38 years old, with heartburn and existing risk factors of other non-infectious diseases is a typical illustration of the interaction of a general practitioner and an outpatient practicing self-treatment. Facing the situation of necessary regular medical monitoring and life-long complex intervention, the patient uses only easy-to-follow doctors recommendations and understandable for him treatment methods. Conclusion. On an example of this clinical case, a possible necessary and sufficient plan o f informing outpatient is presented containing information of the tactics of his behavior for full realization of medical recommendations. For successful adaptation of an outpatient with chronic health problems and harmonic attitude to the disease, the doctor should be maximally specific about necessary and adequate measures for correction of the patients behavior for the fullest realization of therapeutic recommendations. Recommendations should contain understandable information of basic medicinal and non-medicinal therapy in remission (the essential vital stereotypes work-rest regime, type and regime of nutrition, physical activity and principles of monitoring the condition), of signs of exacerbation and methods of therapy on demand and also information of symptoms requiring urgent assistance, of risks of self-treatment, of visiting the doctor in case new or vivid symptoms appear, of the dates of planned examinations by the doctor. These recommendations are not applicable to patients with severe and manifest course of the disease, with disharmonic attitude to the disease, and in case of inadequate organization capacities and low compliance of the patient.
Abstract. The essence of the economic category “quality of life” and “standard of living” is determined. The system of living standards recommended by the UN, the national matrix of quality of life indicators, the main international systems for assessing the population quality of life, the objective and subjective approach to its assessment are considered. The purpose of the study is to systematize indicators of the standard and quality of life of the population, the study of the demographic component of their assessment in the context of human development. It was found that today there is no single definition of “quality of life” (scientists supplement it based on the main purpose of their own research) and a single approach to its evaluation. It is determined that among the various methods and approaches to assessing the use of demographic indicators is quite limited. The characteristic of the basic demographic indicators which can be applied in research both standard and quality of life of the population is given. The main demographic indicators of measuring the quality of life of the population in Ukraine and in Mykolayiv region are determined and analyzed. Keywords: quality of life, standard of living; indicators; demographic characteristics; subjective assessments; objective assessments; natural decrease; life expectancy; birth rate; mortality.
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