KAUNAS UNIVERSITY OF MEDICINE
Kornelijus ANDRIJAUSKAS
Continuous (permanent) prevention of chronic
non-communicable diseases in the rural community
Summary of the doctoral dissertation
Biomedical Sciences, Public Health (10 B)
The doctoral dissertation was prepared in 2004-2005 at Kaunas University
of Medicine.
Dissertation is defended extramurraly.
Scientific Consultant:
Prof. Dr. Leonas Valius (Kaunas University of Medicine, Biomedical
Sciences, Public Health – 10 B)
The dissertation will be defended at the Council of Public Health of
Kaunas University of Medicine
Chairman:
Assoc. Prof. Dr. Habil. Regina Reklaitiene (Kaunas University of
Medicine, Biomedical Sciences, Public Health – 10 B)
Members:
Prof. Dr. Habil. Vilius Grabauskas (Kaunas University of Medicine,
Biomedical Sciences, Public Health – 10 B)
Prof. Dr. Habil. Ramune Kalediene (Kaunas University of Medicine,
Biomedical Sciences, Public Health – 10 B)
Prof. Dr. Habil. Algirdas Juozulynas (Vilnius University, Biomedical
Sciences, Public Health – 10 B)
Prof. Dr. Habil. Julius Kalibatas (Institute of Hygiene, Biomedical
Sciences, Public Health – 10 B)
Opponents:
Dr. Habil. Juozas Kurtinaitis (Vilnius University, Biomedical Sciences,
Public Health – 10 B)
Prof. Dr. Habil. Apolinaras Zaborskis (Kaunas University of Medicine,
Biomedical Sciences, Public Health – 10 B)
The dissertation will be defended at the open session of the Council of Public
Health of Kaunas University of Medicine on February 24, 2006 at 11:00 a.m., in
the 422 room of the Training-laboratorial building.
Address: Eiveniu str. 4, LT-50166, Kaunas, Lithuania.
The summary of doctoral dissertation was sent on January 24, 2006. The
dissertation is available in the library of Kaunas University of Medicine.
KAUNO MEDICINOS UNIVERSITETAS
Kornelijus ANDRIJAUSKAS
Tęstinė (nuolatinė) lėtinių neinfekcinių ligų profilaktika kaimo
bendruomenėje
Daktaro disertacijos santrauka
Biomedicinos mokslai, visuomenės sveikata (10 B)
Disertacija rengta 2004-2005 metais Kauno medicinos universiteto Šeimos
medicinos klinikoje.
Disertacija ginama eksternu.
Mokslinis konsultantas:
prof. dr. Leonas Valius (Kauno medicinos universitetas, biomedicinos
mokslai, visuomenės sveikata 10 B).
Disertacija ginama Kauno medicinos universiteto Visuomenės sveikatos
mokslo krypties taryboje
Pirmininkas:
doc. habil. dr. Regina Rėklaitienė (Kauno medicinos universitetas,
biomedicinos mokslai, visuomenės sveikata – 10 B)
Nariai:
prof. habil. dr. Vilius Grabauskas (Kauno medicinos universitetas,
biomedicinos mokslai, visuomenės sveikata – 10 B)
prof. habil. dr. Ramunė Kalėdienė (Kauno medicinos universitetas,
biomedicinos mokslai, visuomenės sveikata – 10 B)
prof. habil. dr. Algirdas Juozulynas (Vilniaus universitetas, biomedicinos
mokslai, visuomenės sveikata – 10 B)
prof. habil. dr. Julius Kalibatas (Higienos institutas, biomedicinos mokslai,
visuomenės sveikata – 10 B)
Oponentai:
habil. dr. Juozas Kurtinaitis (Vilniaus universitetas, biomedicinos mokslai,
visuomenės sveikata – 10 B)
prof. habil. dr. Apolinaras Zaborskis (Kauno medicinos universitetas,
biomedicinos mokslai, visuomenės sveikata – 10 B)
Disertacija bus ginama viešame Kauno medicinos universiteto Visuomenės
sveikatos mokslo krypties tarybos posėdyje 2006 m. vasario 24 d. 11 val. KMU
Mokomojo-laboratorinio korpuso 422 kab.
Adresas: Eivenių g. 4, LT-50166, Kaunas, Lietuva.
Disertacijos santrauka išsiųsta 2006 m. sausio 24 d.
ABBREVATIONS
CND chronic non-communicable diseases
RF RF
ABP arterial blood pressure
BMI body mass index
IHD ischemic heart disease
AH arterial hypertension
DM diabetes mellitus
CI confidence interval
INTRODUCTION
Chronic non-communicable diseases (CND) become the reason of 50 percent of deaths in the welfare societies. The World Health Organisation (WHO) has indicated that in the 2025 CND, especially cardiovascular diseases will remain the most important health problem in Europe and in the world [The World health Report, 1998]. The mortality rates from IHD, as well as overall mortality in Lithuania, increased since 1995, a tendency for decrease during the last decade has been observed. According to the Lithuanian Statistics, the mortality rate from IHD in 2001 was 628.2/100000 inhabitants per year [Lithuanian Ministry of Health, 2004]. It decreased almost by quarter as compared to 1995; nevertheless, the mortality rates from IHD in Lithuania exceed the average (mean) of the European Union countries nearly by two fold [WHO Data Base, 2003]. The investigations in the world, as well as in
Lithuania have shown that the risk factors (RF) of the CND are common for all the CND [V.Grabauskas, 1995, IU.Haq, 1999]. In Lithuania the epidemiological research on CND has
been performed in the context of the international integrated preventive program on non-communicable diseases (CINDI) [J.Petkevičienė, 1994, J.Klumbienė, 1999]. Therefore, the role of the family doctor in the primary prevention of CND, especially the ischemic heart disease (IHD), becomes very important in a certain community. The investigation in Lithuanian have shown that every second 35-64 year old man or woman suffers from arterial hypertension (AH), every tenth has ischemic heart diseases, every second man and every eighth women smokes, more than 4/5 of the population consume alcohol, ¾ men and women have elevated blood cholesterol level, etc. [J.Petkevičienė, 1997, J.Klumbienė, 2002, A.Tamošiūnas, 1999, 2005].
AH as one of the main RF of the cardiovascular diseases accounts for 20-50 percent of overall mortality [The World health Report, 1998]. Epidemiological studies have demonstrated a
strong association between the AH and the cardiovascular risk [T.Jackson, 2000]. Hypertensive
persons more often suffer from myocardial infarction, stroke, atherosclerosis of extremities as compared, to normotensive ones [D.Satkienė, 2001]. AH very often is accompanied by the
other RF: dyslipidemia, smoking, overweight, glucose intolerance. AH, together with the other RF, ten times increases the mortality from IHD rates [W.B.Kannel, 1996, 2000].
The important objective of the primary health care reform is health training and diseases’ prevention. The institution of the family doctor (family doctor in a team) has the possibilities to fulfil this task: the accessibility of the population with all health problems, high clinical competence, facility succession, orientation to personality needs, holistic approach to personal health problems, permanent and immediate contact with the community, cooperation with a patient and, finally, - the role of "scapegoat" in the Lithuanian health care system - increase the level of personal and the communities’ health problems acknowledgement and the possibilities to influence them. The prevention is less consuming than healing the diseases and complications. It is more cost effective for the state to resource the institution of family doctor to embrace the person and the community to take care of health and to prevent the development of the CND. We found a lack of the investigations in the field of the efforts of the family doctor in health promotion and the prevention of the diseases, especially working in a team, in the integral prevention of the CND, covering all age categories from birth to senescence. By the way, the composition of the family physician’s team in Lithuania is not determined and the model of the activities in health training and prevention in the community is not created.
permanent integrated CND RF correction and the efforts for detection and the correction of the CND RF. This preventive action should be carried out by the family physician’s teams, according to science and practice based methods.
THE AIM OF THE STUDY
The aim of the study was to assess the possibilities of the family physician’s
institution to implement the permanent integrated prevention of the chronic non-communicable diseases and health promotion in the rural community.
Objectives:
1. To assess the self-rated health of the Kaltinėnai community, its dynamics and the relationship with sociodemographic and chronic non-communicable diseases risk factors in 2004 by implementing the permanent chronic non-communicable diseases prevention using team work approach.
2. To determine and assess the prevalence of the chronic non-communicable diseases risk factors in the Kaltinėnai children and adults’ population in 2002-2004.
3. To compare and evaluate frequency of provided recommendations by primary health care
team on non-communicable diseases risk factors and healthy lifestyle principles, and prevalence of risk factors and their average scores in the intervention and the control groups.
4. To assess the effectiveness of primary health care team activities according to the
population attitudes towards nutrition and the prevalence of the chronic non-communicable diseases risk factors and changes in their average scores in the six year period (1998-2004).
The scientific novelty of the study
MATERIAL AND METHODS
Study population
The investigated contingent comprised 1200 inhabitants in the Kaltinėnai settlement 18 years and over who were prescribed in the Kaltinėnai primary health care centre in 1998 and 670 children 6-18 years of age, prescribed in the Kaltinėnai primary health care centre in 2002. The persons (N=800) additionally prescribed in the Kaltinėnai primary health care centre during the first quarter of 2002 (to provide the reorganization of primary health care institutions in the rural region, connecting rural medicine stations of outlying region in the distance of about 10-15 km from the Kaltinėnai primary health care centre) composed the control group.
The study was performed in 1998, 2000 and 2004 years. From investigated population (N=1200) in 1998 participated in the study 1161 persons - 474 (40.8%) men and 687 (59.2%) women (response rate – 96.8%), in 2000 participated in the study 1056 persons - 446 (42.2%) men and 610 (57.8%) women (response rate – 88.0%) and in 2004 1019 persons 396 (38.9%) men and 623 (61.1%) women) of Kaltinėnai 18 years and over participated in the study (response rate 84.9%). In 2004 562 children of Kaltinėnai rural community (258 (45.9%) boys and 304 (54.1%) girls) 6-18 years of age participated in the study (response rate 83.9%). The control group composed 368 persons, randomly selected from the additionally prescribed persons (N=800) (sorting every second). 32 (8.7%) persons of the control group (dead or leaving from this rural region) were excluded from the analysis. The control group did not participate in the primary CND prevention program from 1998 to 2005. The average age of the control and intervention groups did not differ significantly and was 56.8±0.94 and 58.01±0.54 years (p=0.07), respectively. The sociodemographic data (marital status and education) of the control and intervention groups did not differ significantly.
Methods and criteria
The data analysed in the study comprised: 1) socio-demographic variables: gender, marital status, education, occupation 2) anamnesis data: self-perceived health status, anamnesis of the main CND RF, 3) examination on possible RF (Arterial blood pressure (ABP), BMI, cholesterol level) and behavioural RF, nutritional status, and etc., 4) the possibilities of family physicians’ and patients’ self-control of the ABP, body weight, nutrition habits 5) the patients’ knowledge about the CND RF and tendencies in their attitudes towards the impact of primary health care institutions in the correction of the CND RF.
I Stage. Primary interview of the population. In 1998 the questionnaire interview
has been performed. The questionnaire information covered the attitude of the rural community towards health status, absence of the measured and declared CND RF (ABP, BMI, smoking, immoderate alcohol consumption, occupational status). After the primary data analysis the meeting with the Kaltinėnai community was organized and the results were presented: 1) prevalence of CND RF, 2) nutritional habits in the community, 3) the methods of CND RF prevention and correction were displayed, 5) the members of the rural community were invited to the active participation in resolving their health problems.
II Stage. Primary health care team training before starting the preventive program of the CND RF. Preparing for impact – primary health care team approach
Training seminars covered 13 academic hours (the seminars were organized in Kaltinėnai primary health care centre in 1998 January-April). Every three months the community nurses were invited to participate in reflection meetings, resolving certain situation. 2 academic hours per month were devoted to the additional individual consultations. Besides, twice a year the meetings of the primary health care team with the members of the Family medical clinic of the University of Medicine have been organized and the problems in the prevention program of the CND in the rural community have been discussed. The seminar practice showed that the theoretical information is not sufficient for qualitative work performance, therefore the team gathered monthly in 1-2-hours meetings. Consultants were available in the resolving of complicated methodological difficulties (once a quarter the first year and 1-2 times per year later, the last 2 years the consultants arrived once a year).
III Stage. Control of CND RF. Since 1998 when the CND prevention program
started the rural community experienced those methods of prevention: 1) impact to the whole community, training in healthy lifestyle, 2) determination and evaluation of RF, 3) choice of preventive methods: individual or group work with the inhabitants in RF correction, 4) preparation and application of preventive measures: letters, press, lectures, seminars, 5) preventive work with definite groups: adults, children, adolescents, 6) individual work with persons, possessing RF.
IV. Stage: Final stage, final screening and the evaluation of the preventive program‘s results. In the CND preventive program evaluation process, every person during
the visit to the primary health care centre in 2004 was asked to fill in the additional questionnaire, as well as persons visited at home by the community nurse. Data was stored in the data set, created with the help of MS Access.
The principle of independence was set in the work organization of the family doctor and the community nurses. Previous position of the community nurse as the doctor‘s assistant or in the narrow field (as physiotherapist nurse, paediatrician, obstetrics or reception) was changed. The community nurse was educated to take the partial responsibility, to fulfil the independent job, full of creativity. Family doctor was responsible for early diagnosis of arterial hypertension: adults were assigned individual pharmaceutical and non-pharmaceutical recommendations; children – were investigated seeking to disclose the primary reason of the AH development (diagnosis of symptomic AH, after exclusion – methods of correction). Every nurse was retrained to a community nurse according to the foreseen schedule. The community nurses divided all the inhabitants according to districts, in families. The place of residence of the community nurse was as close as possible to the attendant territory.
Methods of communication with the population: individual (every meeting). The
community nurses are supplied with the prepared recommendations on AH, nutrition habits, adapted for the rural population; community meetings in church after prayer, school meetings, etc. lectures, discussions about health, local media (2 articles have been prepared in the first year, afterwards – 1 article every year). In 2001 a letter has been published with wide description of the purposes of the prevention, the results obtained, and practical recommendations.
Intersectorial collaboration. Representatives of church were included into the
The CND prevention program in the rural community in 2002 included children and adolescents as well. They were investigated in respect to possible RF, e.g., they were asked on smoking habits, alcohol consumption, nutritional habits, physical activity, perceived health, diagnosed AH, family anamnesis on AH. The measurement of ABP has been performed. The adopted by prof. A.Zaborskis WHO questionnaire on the determination of the possible RF was used for children as well as for adults. Twice a year the meetings with the children and adolescents were arranged (often at school), they were informed about the possible harmful effects of the CND RF on young organism, the advantages of healthy lifestyle for personal and public health. Hypertensive pupils were investigated twice a week. Children with AH underwent special preventive program with the optimisation of physical load and rest, regulation of nutritional habits. Pupils with secondary AH were sent to specialist examination. Since the beginning of the program, the school nurse was included in the prevention, since 2003 – the school public health specialist. Twice a year in the meetings of pupils and their parents the lectures on CND and the RF were offered. Data on children health status were disclosed in the seminars; discussions on health problems and health improvement were arranged.
When the community nurses detected CND RF, they invited those persons to visit the family doctor in the Kaltinėnai primary health care centre. Consultations were accompanied by the examinations, e.g. measurement of the cholesterol and glucose level, intraocular pressure. The pharmaceutical as well non-pharmaceutical measures were prescribed. The community nurses followed the patients according to the instructions of family doctor, took responsibility for the continuous and permanent care, consulted on the principles of healthy nutrition, non-pharmaceutical methods of the CND RF correction. The community members had the possibility in ABP measurements and CND RF correction at home. For this purpose the community nurses devoted 1 hour (from 2 hours in the work schedule) for the needs of the community.
To ensure the active participation of the community in the process, the Kaltinėnai primary health care centre team organized and is organizing the meetings with the community. The meetings take place twice a year: before the spring jobs and after autumn jobs. In the meetings they have lectures and discussions about CND RF, harmful health effects, the personal and communal possibilities in their correction; the team approach of the primary health care centre is being disclosed. The primary health care centre staffs, representatives of municipal and non-governmental organizations (church, school) are participating in the discussions.
The teamwork organizational principle includes the working hours of the family doctor and the community nurses in the primary health care centre and visiting the people at home twice a year. During the visits the measurements of the ABP have been performed, the BMI was evaluated, health behaviours, nutrition, occupation type were analyzed.
measurement facility, accuracy by 0.5 cm. Incapable to visit the primary health care centre evaluated their weight and height subjectively and noted in the questionnaire. The BMI was calculated as ratio weight/height² [kg/m²]. Overweight was assessed, if the BMI exceeded ≥25.0 kg/m2 and obesity – if the BMI exceeded ≥30.0 kg/m2. Persons with the AH and one CND RF, were investigated on the blood cholesterol level. The procedure was performed taking samples of finger blood 9−12 hours before eating by „Clin-chek“ equipment (Hospitex). The level of cholesterol was measured in 397 persons (128 men and 269 women). The dyslipidemia has been assessed according to the criteria of the European Atherosclerosis Association. Normal level of cholesterol has been evaluated when the blood cholesterol level was <5.0 mmol/l, elevated blood cholesterol level (5.0−6.49 mmol/l), high cholesterol level (≥6.5 mmol/l). Data on smoking, alcohol consumption, physical activity, nutrition and occupation type were obtained during the interview. Regularly smoking was assessed in the action of smoking of 1 cigarette per day. Physically active were assessed the persons with daily working or bicycle driving more than 1 hour per day, with leisure time exercises (minimum 30 minutes, with pulse, breathing acceleration, sweat) once per week.
The occupation type was evaluated: heavy physical work (work, that heavy working more than half of all working time), movable work, than many walking (moderate heavy work, than more than half of all working time walking), sitting and/or standing work, than rather moving (work, than less half of all working time sitting and (or) standing and rather moving) and permanent sitting work (than more a half of all working time are sitting).
Statistical analysis
RESULTS
1. Self-rated health among the study population in 2004
The inhabitants of the settlement Kaltinėnai were asked to evaluate their health status themselves. The results showed that half of the respondents (48.9%) assessed their health as ”moderate”; as “fair” and “poor” was evaluated by every tenth respondent. Every fourth respondent assessed health as “good”. Differences in sex in the evaluation of health status among the population of Kaltinėnai were statistically significant (χ2=23.49, p=0.0001). Female respondents of Kaltinėnai significantly evaluated their health as “fair“ and “poor“ as compared to male ones (Fig. 1.).
28.8 21 44.2 3 3 21.3 14.8 51.8 4.7 7.4 0 20 40 60 80 100
Exelent Good Moderate Fair Poor
Self-rated health evaluation
% Men Women *
*
28.8 21 44.2 3 3 21.3 14.8 51.8 4.7 7.4 0 20 40 60 80 100Exelent Good Moderate Fair Poor
Self-rated health evaluation
%
Men Women
*
*
* - p<0.05 as compared women with men
Figure 1. The distribution of the respondents by self-rated health and sex
The analysis of age in the subjective evaluation of health showed the significant differences (χ2=268.19, p=0.000001). Elder inhabitants of Kaltinėnai more often rated their health as “fair“ and “poor“ (Fig. 2).
66.3 21.1 12.6 0 0 32.4 21.8 40.4 2.8 2.6 5.2 10.8 67 6.4 10.6 0 20 40 60 80 100
Exelent Good Moderate Fair Poor
Self-rated health evaluation
% 18-34 35-64 65 and older &
*
# 66.3 21.1 12.6 0 0 32.4 21.8 40.4 2.8 2.6 5.2 10.8 67 6.4 10.6 0 20 40 60 80 100Exelent Good Moderate Fair Poor
Self-rated health evaluation
%
18-34 35-64 65 and older
&
*
#Sociodemographic and behavioral factors and self-rated health
The effect of sociodemographic and behavioral factors on the self-rated health was evaluated in the multivariate regression analysis. In the analysis of the effect of the above mentioned RF on the self-rated health, statistically significant differences in self-rated health among the population of the Kaltinėnai community were found for age, smoking, BMI and AH. Age increase in one year was followed by 10% per year increase in negative evaluation of the self-rated health (p=0.0001); daily or occasional smokers rated their health as “excellent“ and “good“ by 1.7-fold (p=0.03) more often as compared to non-smokers and ex-smokers; persons with overweight and obesity rated their health as “excellent“ and “good“ more sparse by 30% as compared to persons with normal BMI (p=0.047); the presence of AH increased the negative self-rated health assessment in the Kaltinėnai community by 4-fold (p=0.0001). Other sociodemographic and behavioral RF (immoderate alcohol consumption, elevated blood cholesterol level, nutritional habits, and occupational environment) had no significant effect on the self-rated health in the Kaltinėnai community (Table 1).
Table 1. The odds ratios of the sociodemographic and behavioral risk factors for self-rated health (Multivariate regression analysis)
Health as “moderate“, “fair“ and “poor“ Health as “excellent“ and “good” Risk factor N Proc. N Proc. Odds ratio 95 % CI Age 0.9 0.93-0.95 Alcohol consumption Moderate Immoderate 563 34 59.5 46.6 383 39 40.5 53.4 1 1.7 0.90-3.40 Smoking
Non-smokers and ex-smokers
Daily and occasional smokers 510 87 64.0 39.2 287 135 36.0 60.8*** 1 1.7 1.00-2.70 BMI Normal Overweight and obesity 181 416 51.6 62.3 170 252 37.748,4 *** 1 0.7 0.46-0.99 Arterial hypertension No Yes 453 57 25.7 75.8 165 145 24.274,3 *** 0.25 0.17-.38 1 Hypercholesterolemia1 <6.5 mmol/l ≥6.5 mmol/l 230 45 38.2 75.0 107 15 31.8 25.0 0.92 1 0.47-1.80 The effect of hypercholesterolemia on self-rated health was calculated separately, not in the model of the multivariate regression analysis, because only 1/3 of the investigated underwent the measurement of the blood cholesterol level
All RF were dichotomized.
Body mass: 0 – normal (BMI<25.0 kg/m2), 1 – overweight and obese (BMI≥25.0 kg/m2). Smoking: 0- non-smokers and ex-smokers, 1 – daily and occasional smokers.
Alcohol consumption: 0 – moderate, 1 – immoderate. Arterial hypertension: 0 – no, 1 – yes.
2. The prevalence of chronic non-communicable diseases risk factors in 2004
Arterial hypertension was prevalent among the population of the Kaltinėnai community by 72.9% (68.5% among males and by 75.3% among females). The differences of AH in respect to sex were statistically significant (χ2=4.30, p=0.04). AH was more prevalent among women than among men (Fig. 3).
31.5 68.5 24.7 75.3 0 20 40 60 80 100 < 140/90 mm Hg =>140/90 mm Hg Arterial blood pressure
% Men Women * 31.5 68.5 24.7 75.3 0 20 40 60 80 100 < 140/90 mm Hg =>140/90 mm Hg Arterial blood pressure
%
Men
Women *
* - p<0.05 as compared women and men
Figure 3. The prevalence of arterial hypertension among the investigated persons by sex
Overweight was statistically significantly associated with age (χ2=180.53, p=0.0001). AH was also associated with age. Elder people were significantly more hypertensive. The prevalence of AH in the 18-34 years age group was 19.4%, in the 35-64 years age group was 64.1%, in the age group ≥65 years it was 92.1% (Fig. 4).
80.6 19.4 35.9 64.1 7.9 92.1 0 20 40 60 80 100 < 140/90 mm Hg =>140/90 mm Hg Arterial blood pressure
% 18-34 35-64 65 and older * # 80.6 19.4 35.9 64.1 7.9 92.1 0 20 40 60 80 100 < 140/90 mm Hg =>140/90 mm Hg Arterial blood pressure
% 18-34 35-64 65 and older * #
* - p<0.05 as compared 65 and over age group with other age groups # - p<0.05 as compared 35-64 age group with other age groups
Figure 4. The prevalence of arterial hypertension among the investigated persons by age
with the prevalence of AH (χ2=30.99, p=0.0001). AH was more prevalent among non-smokers as compared to daily and occasional non-smokers. AH was significantly associated with salt consumption (χ2=24.57, p=0.0001) as well. The prevalence of AH was higher among persons, not using the additional salt in nutrition as compared to persons, consuming additional salt in the preparation of meals. In the analysis of the associations between AH and sort of fat in meals, significant differences were found (χ2=13.85, p=0.001). AH was less prevalent among consuming animal fat to compare with consumers of vegetable and mixed fat. The prevalence of AH was significantly associated with the occupation type (χ2=17.12, p=0.0001). Persons with sedentary type of job were diagnosed AH more often as compared to light physical and manual occupations.
In the analysis we found that persons with AH were significantly more often obese and had a tendency for the increased blood cholesterol level, elder persons with AH were obese, widowers and had primary education, simultaneously. Smokers and daily alcohol consumers with AH were more often obese. Salt and animal fat consumers were more prevalent among persons with AH. Persons with sedentary type of job and AH more often had increased blood cholesterol level.
In the investigation of the associations of AH with other RF, we found that AH tended to be more prevalent among immoderate alcohol consumers as compared with moderate alcohol consumers, respectively 80.4% and 72.4% (p=0.2). AH was less prevalent among daily and occasional smokers as compared to non-smokers and ex-smokers, respectively 54.8% and 76.9% (p=0.00001). AH was more often diagnosed among the rural population with overweight as compared to persons with normal BMI, correspondingly 77.6% and 63.8% (p=0.0001).
In the analysis of the prevalence of overweight among the Kaltinėnai community, we found that obesity was prevalent by 24.1%, (16.2% among males and 29.2%among females). Overweight was found among 41.4% of the investigated; almost every second man (46.7%) and 38.0% of women were overweight. 1/3 of the investigated had normal BMI, 37.1% among males and 32.7% among females. The significant association of overweight was found with sex (χ2=22.83, p=0.0001) (Fig. 5). Women with obesity were more prevalent as compared to men. 37.1 46.7 16.2 32.7 38 29.2 0 20 40 60 80 100
Normal Overweight Obesity Body mass % Men Women * * 37.1 46.7 16.2 32.7 38 29.2 0 20 40 60 80 100
Normal Overweight Obesity Body mass % Men Women * *
* - p <0.05 as compared men with women
Figure 5. The prevalence of overweight among the investigated persons by sex
49.5 35.8 14.7 29.4 46.6 24 37 36.6 26.4 0 20 40 60 80 100
Normal Overweight Obesity
Body mass % 18-34 35-64 65 and older * 49.5 35.8 14.7 29.4 46.6 24 37 36.6 26.4 0 20 40 60 80 100
Normal Overweight Obesity
Body mass % 18-34 35-64 65 and older *
* - p <0.05 as compared 18-34 yrs age group to 35-64 yrs and 65 yrs and over age group Figure 6. The prevalence of overweight among the investigated persons by age
We analyzed the prevalence of overweight among the investigated persons in respect to smoking habits and found the significant associations between the overweight and smoking (χ2=22.53, p=0.001). Obesity persons were found more often among non-smokers and ex-smokers than among daily smokers, respectively 27.0%, 27.4% and 12.0%. In the analysis of overweight among the population in respect to sort of fact in their nutrition, we found that significant associations (χ2=10.41, p=0.03). Consumers of mixed fat (animal fat and oil) were more often obese as compared with persons, consuming only vegetable oil, respectively 29.4% and 21.8% (p<0.05). In the analysis of the prevalence of overweight among the investigated persons in respect to occupation type, we found significant associations between overweight and occupation type (χ2=12.48, p=0.05). Persons with obesity were found more often among sedentary jobs as compared to manual workers.
We analyzed the prevalence of smoking in the Kaltinėnai community and found that 13.9% of the investigated were daily smokers, 31.3% among men and 29.0% among women (p<0.05). 7.9% of the investigated persons were occasional smokers, 10.1% among men and 6.4% among women. Every ninth respondent was ex-smoker (23.0% among men, and 3.5% among women). 2/3 of the investigated were non-smokers, 35.6% among men and 87.2% among women). We found significant associations between smoking and sex (χ2=322.98, p=0.0001). Men smoked more often than women (Fig. 7).
35.6 23 10.1 31.3 87.2 3.5 6.4 2.9 0 20 40 60 80 100
Never Smoking, but quit Ocasionally smoking Smoking daily % Men Women *
*
*
35.6 23 10.1 31.3 87.2 3.5 6.4 2.9 0 20 40 60 80 100Never Smoking, but quit Ocasionally smoking Smoking daily % Men Women *
*
*
* - p <0.05 as compared men and women
We analyzed the prevalence of smoking among the investigated in the Kaltinėnai community in respect to age and found the significant associations between smoking and age (χ2=64.80, p=0.0001). Daily and occasional smoking was more prevalent in younger age groups (18-34 yrs and 35-64 yrs) non-smoking was more prevalent in elder age group (≥65 yrs) (Fig. 8). 66.3 5.3 13.7 14.7 58 11.6 10.6 19.8 78.1 11.8 3.3 6.8 0 20 40 60 80 100 Never Smoking, but quit Ocasionally smoking Smoking daily % 18-34 35-65 65 and older * 66.3 5.3 13.7 14.7 58 11.6 10.6 19.8 78.1 11.8 3.3 6.8 0 20 40 60 80 100 Never Smoking, but quit Ocasionally smoking Smoking daily % 18-34 35-65 65 and older *
* - p <0.05 as compared 35-64 yrs age group to 18-34 yrs and 65 yrs and over age group Figure 8. The prevalence of smoking among the investigated persons by age
We analyzed the prevalence of smoking among the investigated persons in respect to marital status and found significant association between smoking and marital status (χ2=48.73, p=0.0001). Daily and occasional smoking was more prevalent among the divorced group, non-smoking – in the widower’s group. We analyzed the prevalence of smoking among the investigated persons in respect to education and found significant association between smoking and education (χ2=47.21, p=0.0001). Daily smokers were more prevalent in the group of incomplete secondary education; non-smokers were more prevalent among persons with higher and primary education. We analyzed the prevalence of smoking among the investigated persons in respect to age and found that smoking was significantly more prevalent in the younger age group (18-34 yrs) as compared to middle age (35-64 yrs) (z=-2.88, p=0.004) and elder age group (≥65 m.) (z=-7.06, p=0.00000). We analyzed the prevalence of smoking in respect to marital status and found that widowers significantly smoke more often smoked as compared to married, single and divorced persons, respectively (z=-5.15, p=0.00000, z=-3.43, p=0.001 and z=-4.89, p=0.00000). We analyzed the prevalence of smoking in respect to education and found that persons with high education smoked significantly more rarely as compared to persons with incomplete secondary education (z=-3.01, p=0.003), persons with primary education smoke more often as compared to persons with higher, secondary and incomplete secondary education (z=-4.21, p=0.00003, z=-4.19, p=0.00003 z=-5.79, p=0.00000).
30.5 56.3 13.3 21.2 62.8 16.0 0 20 40 60 80 100
<5.0 mmol/l 5.0-6.5 mmol/l >6.5 mmol/l Blood cholesterol concentration %
Men Women
Figure 9. The prevalence of hypercholesterolemia among the investigated persons by sex
We analyzed the prevalence of hypercholesterolemia among the investigated persons in respect to age and found no significant association between the blood cholesterol level and age (χ2=3.61, p=0.5) (Fig. 10). 31.8 63.6 4.6 22.0 63.7 14.3 25.1 58 16.9 0 20 40 60 80 100
<5.0 mmol/l 5.0-6.5 mmol/l >6.5 mmol/l Blood cholesterol concentration %
18-34 35-64 65 and older
Figure 10. The prevalence of hypercholesterolemia among the investigated persons by age
In the analysis of the prevalence of hypercholesterolemia among the investigated persons in respect to marital status we found the significant associations between blood cholesterol level and marital status (χ2=19.28, p=0.004). Elevated blood cholesterol level or hypercholesterolemia was more prevalent among the divorced persons and widowers, whereas normal blood cholesterol level was more often found for single persons. In the analysis of the prevalence of hypercholesterolemia among the investigated persons in respect to education no significant associations were found between the blood cholesterol level and education (χ2=4.76, p=0.8). Significant association was found between blood cholesterol level and occupation type (χ2=13.71, p=0.03). Hypercholesterolemia was more prevalent among the persons with sedentary type of job and/or standing with little moving, whereas normal blood cholesterol level was found in manual occupations.
men 8 times more often than women, respectively 8.3% and 1.1%. Twice or three times a week consumed alcohol every tenth person, 25.0% of men and 10.4% of women, ex-drinkers comprised 4.4%, 6.6% of men and 3.0% of women, several times per year consumed alcohol 41.2% of the investigated, every third man (34.8%) and nearly half of women (45.3%). 27.2% of the investigated persons never consumed alcohol, 11.6% of men and 37.1% of women. The association between alcohol consumption and sex was statistically significant (χ2=173.55, p=0.0001). Men more often consumed alcoholic drinks than women. The association between alcohol consumption and age was statistically significant as well (χ2=163.42, p=0.0001). Daily and 2-3 times per week alcohol consumers were more prevalent in the age group of 35-64 years, whereas never drinkers were more prevalent in the elder age group. The significant association was found between alcohol consumption and marital status (χ2=114.96, p=0.0001). Daily and 2-3 times per week alcohol consumption was more prevalent among divorced persons, whilst in the never-drinkers group prevailed widowers. The significant association was found between alcohol consumption and education (χ2=143.27, p=0.0001). Daily and 2-3 times per week alcohol consumption was more prevalent among persons with secondary and incomplete secondary education, whilst never drinkers were more prevalent among persons with primary education. Kruskal-Wallis test showed that daily alcohol consumers and daily smokers were males, widowers and primary educated.
We investigated the nutritional habits in the Kaltinėnai community and found that every fifth man (19.4%) and 44.3% of women never used additional salt (p<0.05), whereas 3.3% of men and 0.8% of women consumed much salt in their meals (without tasting). We investigated the above mentioned data in age groups and found that in elder group (65 years and over) there were significantly more persons, never consuming salt as compared to other age groups: 52.4%, 20.0.% in the 18-34 years age group and 22.4% in the 35-64 years age group (p<0.05).
We found that 47.5% of men and 60.5% of women consumed vegetable oil, whereas animal fat have consumed by every fifth man (21.0%) and every ninth woman (11.6%) (p<0.05). In the evaluation of these data in age groups, we found that in the elderly group (65 years and over) every tenth (10.6%) of the respondents consumed animal fat, whereas in the age group of 18-34 years animal fat was consumed by 21.1%, and in the 35-64 years age group – 18.0% (p<0.05). Nearly every second man and women (47.0% and 47.8%) consumed vegetables 3-5 times per week, 8.6% of men and 11.2% of women consumed vegetables daily. In the elderly group (65 years and over) daily consumers of vegetables were met significantly more rarely as compared to younger age groups, respectively 6.8%, 15.8% and 12.0% (p<0.05). Nearly every second man (43.4%) and woman (47.7%) consumed fruits and berries 1-2 times per week, whilst daily consumers of fruits and berries were found in 8.8% among men and 12.7% among women (p<0.05). We determined that middle age group (35-64 years) consumed vegetables and berries significantly more often than youngest and oldest age groups, respectively 16.2%, 5.3% and 6.6% (p<0.05).
3. The prevalence of chronic non-communicable diseases risk factors among the schoolchildren in the Kaltinėnai community in 2004
We investigated the prevalence of the CND RF in the pupils‘ population and found that 13.7% of pupils had elevated ABP. A tendency for boys to have more often elevated blood pressure as compared to girls was found, respectively 16.7% and 11.2% (χ2=3.55, p=0.07). The level of ABP among children increased with age (χ2=8.18, p=0.04). In the 6-9 years age group elevated blood pressure was found by 7.8%, in the 10-12 years age group – 11.9%, and in the 13-15 years age group nearly every fifth pupil (19.0%) had elevated blood pressure. In the group of adolescents (16-18 years) elevated ABP was found by 13.4%.
Increased BMI was found equally among boys (6.6%) and girls (7.2%). We found no associations between BMI and age (χ2=0.83, p=0.7). We investigated the prevalence of smoking among the 6-18 years Kaltinėnai schoolchildren and found that every fifth (18.8%) boy and every eight (11.9%) girl smoked (χ2=5.13, p=0.02). Smoking increased with age among the rural population of schoolchildren (χ2=147.75, p=0.0001). In the 10-12 years age group smoked only 1.3% of children, in the 13-15 years age group – smoked 14.7%, whilst in the 16-18 years age group smoked every second pupil (50.0%). Every fourth (25.9 %.) investigated pupil (26.5% of boys and 25.3% of girls) consumed light alcohol drinks (χ2=0.09, p=0.8). Alcohol consumption significantly increased with age (χ2=202.8, p=0.0001). In the 10-12 years age group 4.6% of pupils consumed light alcohol drinks, in the 13-15 years age group every third pupil (32.1%), and in the 16-18 years age group even ¾ of pupils (72.9%) were light drinkers. We analyzed the associations of the prevalence of AH with other RF and found that elevated blood pressure was more prevalent among smokers than among non-smokers, respectively 22.6% and 12.0% (χ2=6.85, p=0.009). We found no associations between light drinking and elevated blood pressure (χ2=2.04, p=0.2). Children, using additional salt (lack when tasting) in preparing meals more often had elevated ABP as compared to children, not using additional salt and children with additional salt (even not testing), respectively 17.7%, 10.6% and 7.1% (χ2=6.77, p=0.03). Physical activity among children was not associated with elevated blood pressure. Pupils with anamnesis of the elevated ABP in their families significantly more often were diagnosed elevated ABP as compared to pupils with negative anamnesis of AH in their families, respectively 35.6% and 9.5% (χ2=43.29, p=0.0001). Pupils with increased BMI more often were diagnosed elevated ABP as compared to pupils with normal BMI, respectively overweight pupils had AH by 37.0%, obese – 75.0%, with normal BMI – 11.1% (χ2=53.59, p=0.0001).
4. The frequencies of the administered by the primary health care team recommendations about the main chronic non-communicable diseases risk factors and prevalence of chronic non-communicable diseases risk factors and average levels of risk
factors in the intervention and control groups
During two years period, we evaluated the frequencies of the administered by the primary health care team recommendations about the main chronic non-communicable diseases risk factors and the prevalence of main CND risk factors among 18 years and over persons in the intervention and control groups. The prevalence of AH and smoking indicators in the intervention and control groups among the persons of 18 years and over and found no significant differences between the groups (χ2=1.10, p=0.3 for AH and χ2=0.61, p=0.5 for smoking). Overweight was found more often among persons in the control group as compared with persons in intervention group (χ2=46.79, p=0.0001), 65.6% and 84.5% (p<0.05), respectively. 65.6% of persons in the intervention group and 84.5% of persons in the control group with AH were overweight or obese (p=0.0001) (table 2).
recommendations of non-pharmaceutical ABP correction received 73.6% of the hypertensive persons in the intervention group and 26.9% of persons with AH in the control group (p=0.0001). Persons significantly more often used the antihypertensive drugs in the intervention group to compare with persons in the control group, 87.8% and 34.1%, respectively (p=0.0001). ABP effectively was controlled in 23.6% of person in the intervention group, whilst in the control group only in 11.6% of cases (p=0.01) (table 2).
Table 2. The frequencies of the administered by the primary health care team recommendations about the main chronic non-communicable diseases risk factors among 18 years and over persons in the intervention and control groups
Intervention group Control group Features
N % N % P
Persons with AH and recommended for non-pharmaceutical ABP control
measures
N=598
440 73.6 N=279 75 26.9 0.0001 Persons with AH and recommended
for pharmaceutical ABP control measures
N=598
525 87.8 N=279 95 34.1 0.0001 Persons with AH and recommended
to limit the salt intake
N=440
390 88.6
N=279
85 30.5 0.0001
Persons with AH, recommended to
change nutrition N=296 296 100.0 N=279 75 26.9 0.0001 Persons with AH and overweight,
recommended to control their body weight
N=319
237 74.3 N=244 86 35.2 0.0001 Persons with overweight and
recommended to control their body weight
N=390
284 72.8 N=311 111 35.7 0.0001 Smoking persons, recommended to
stop smoking
N=92
48 52.2
N=73
15 20.5 0.0001
88.6% of persons in the intervention group and 30.5% of persons in the control group (p=0.0001) were recommended to reduce their salt intake. Every person wit AH in the intervention group was recommended to change the nutrition habits, whilst only 26.9% of persons with AH in the control group received this recommendation (p=0.0001).
We found statistically significant differences between the intervention and control groups for persons with AH and overweight to receive the recommendations to reduce their body mass index, 74.3% and 35.2% (p=0.0001), respectively. The recommendations to reduce the body weight were offered significantly more often to the persons in the intervention group to compare with persons in the control group, 72.8% and 35.7% (p=0.0001), respectively. The recommendations of smoking cessation were offered significantly more often to the persons in the intervention group to compare with persons in the control group, 52.2% and 20.5% (p=0.0001), respectively.
Table 3. The means of systolic, diastolic arterial blood pressure and body mass index among 18 years and above persons in the intervention and control groups
Groups Systolic ABP mm Hg Diastolic ABP mm Hg Body mass index kg/m2 Intervention group (n=1019) Control group (n=368) 138.49 149.65 83.96 88.99 27.58 28.95 p mean 0.0001 0.0001 0.0001
5. Variations in self-rated health and chronic non-communicable diseases risk factors in the adults and children populations of the Kaltinėnai rural community
in 1998-2004
The permanent preventive program of the CND RF leads to find variations in self-rated health in the Kaltinėnai community. The number of persons with self-self-rated health as „good“ increased in 2004 as compared with data in 1998 or 2000. Simultaneously the number of persons with self-rated health as “poor“ decreased. Clear variations were found in the female population of the Kaltinėnai community. The prevalence of persons in the Kaltinėnai community with self-rated health as “poor“ significantly decreased from 14.0% in 1998 to 9.5% in 2004 (p<0.05). The same tendency was found among men and women (Fig. 11 and 12). 9.5 41.1 49.4 5,1* 44.4 50.5 6.0 44.2 49.8 0 20 40 60 80 100 % 1998 2000 2004 Poor Averaged Good * 9.5 41.1 49.4 5,1* 44.4 50.5 6.0 44.2 49.8 0 20 40 60 80 100 % 1998 2000 2004 Poor Averaged Good * * - p<0.05 as compared data in 2000 to 1998
Figure 11. Self-rated health among the male population of the Kaltinėnai community in 1998, 2000 and 2004 17.3 51.8 30.9 13.8 56.2 30 12.1 51.8 36.1 0 20 40 60 80 100 % 1998 2000 2004 Poor Averaged Good
*
17.3 51.8 30.9 13.8 56.2 30 12.1 51.8 36.1 0 20 40 60 80 100 % 1998 2000 2004 Poor Averaged Good*
* - p<0.05 as compared data in 2004 to 1998 and 2000
We evaluated the variations in systolic blood pressure in the adults‘ population of Kaltinėnai in 1998-2004 and found that systolic blood pressure means in 2000 and 2004 were significantly lower as compared to 1998. In 1998 systolic blood pressure means among men and women were 168.7 and 168.1 mm Hg, correspondingly, and in 2000 and 2004 systolic blood pressure means were 146.5 and 145.9 mm Hg, 144.1 and 142.5 mm Hg, correspondingly (p<0.0001). Systolic blood pressure means were significantly lower in all age groups in 2000 and 2004 as compared to 1998 (Fig. 13).
168.7 146.5 144.1 168.1 145.9 142.5 120 130 140 150 160 170 180 mm Hg Men Women 2004 2000 1998
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998 ### - p<0.0001, as compared 2004 to 2000 *** *** *** *** ### ###
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998 ### - p<0.0001, as compared 2004 to 2000 *** *** *** *** ### ###
Figure 13. Systolic blood pressure means in the Kaltinėnai population in 1998, 2000 and 2004
93.5 86.8 86.4 93.4 86.5 87 80 85 90 95 mm Hg Men Women 2004 2000 1998
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998
***
*** ***
***
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998
***
*** ***
***
Figure 14. Diastolic blood pressure means in the Kaltinėnai population in 1998, 2000 and 2004
We found that means of BMI in 2000 and 2004 were significantly lower as compared to 1998. In 1998 means of BMI among the Kaltinėnai men and women were 28.4 and 30.8 kg/m2, correspondingly, in 2000 and 2004 means of BMI were 27.8 and 30.3 kg/m2, and 27.9 and 30.3 kg/m2, correspondingly (p<0.0001). The means of BMI were statistically significant in all age groups in 2000 and 2004 as compared to 1998 (Fig. 15).
28.4 27.8 27.9 30.8 30.3 30.3 26 27 28 29 30 31 32 kg/m2 Men Women 2004 2000 1998 *** ***
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998
*** *** 28.4 27.8 27.9 30.8 30.3 30.3 26 27 28 29 30 31 32 kg/m2 Men Women 2004 2000 1998 *** ***
*** - p<0.0001, as compared 2004 and 2000 yrs to 1998
***
***
In the evaluation of smoking habits among the Kaltinėnai population in 1998-2004 we found that the prevalence of smoking statistically decreased in the 6 year period, correspondingly 47.1% in 1998, 43.5% in 2000 and 31.3% in 2004. It did not differ significantly among the Kaltinėnai women. If in 1998 nearly every second man in the Kaltinėnai settlement smoked, after the 6-year period of the CND primary prevention program smoked every third man (31.3%) (Fig. 16.).
47.1 2.3 43.5 2.0 31.3 2.9 0 20 40 60 80 100 % 1998 2000 2004 Men Women * 47.1 2.3 43.5 2.0 31.3 2.9 0 20 40 60 80 100 % 1998 2000 2004 Men Women * * - p<0.05 as compared 2004 to 1998 and 2000
Figure 16. The prevalence of smoking in the Kaltinėnai community in 1998, 2000 and 2004
The nutritional habits in the Kaltinėnai community improved in the 6-year period. The inhabitants started to use less salt and animal fat, the consumption of vegetables increased (Fig. 17, 18 and 19.).
37.3 54.5 34.6 56.4 42.1 63.6 6.3 3.4 1.8 0 20 40 60 80 100 1998 2000 2004 % Never If lack salt Allw ays * 37.3 54.5 34.6 56.4 42.1 63.6 6.3 3.4 1.8 0 20 40 60 80 100 1998 2000 2004 % Never If lack salt Allw ays * * - p<0.05 as compared 2004 to 1998
44.1 61.9 55.5 4.7 6.9 29.3 51.2 31.2 15.2 0 20 40 60 80 100 1998 2000 2004 % Vegetables oil Vegetables and anim al fat Anim al fat * * 44.1 61.9 55.5 4.7 6.9 29.3 51.2 31.2 15.2 0 20 40 60 80 100 1998 2000 2004 % Vegetables oil Vegetables and anim al fat Anim al fat * * * - p<0.05 as compared 2004 to 1998
Figure 18. The consumption of fat in the Kaltinėnai community in 1998, 2000 and 2004
3.5 1.3 2.2 53 45.9 40.3 38.8 43.5 47.6 4.7 9.3 9.9 0 20 40 60 80 100 1998 2000 2004 % Never 1-2 days 3-5 days 6-7 days * 3.5 1.3 2.2 53 45.9 40.3 38.8 43.5 47.6 4.7 9.3 9.9 0 20 40 60 80 100 1998 2000 2004 % Never 1-2 days 3-5 days 6-7 days * * - p<0.05 as compared 2004 to 1998
Figure 19. The consumption of vegetables in the Kaltinėnai community in 1998, 2000 and 2004
In the period of 2002-2004 we observed the stabilization or decrease of the CND RF in the Kaltinėnai schoolchildren population.
community were corrected effectively. In 2004 43.0% of persons with AH passed through the correction of the ABP by means of pharmaceutical and non-pharmaceutical methods, though only in half of cases (54.9%) it was corrected effectively. In 2004 only 4.3% of the investigated persons did not know about the AH, every third (29.1%) were aware about the AH, but did not undergo the correction. Thus, in 2004 in 23.6% of the Kaltinėnai population the AH was corrected effectively (Fig. 20).
56.0% 21.0% 21.8% 1.2% 5.2% 26.7% 51.6% 16.5% 1998 year (n=1161) 2000 year (n=1056) * 56.0% 21.0% 21.8% 1.2% 5.2% 26.7% 51.6% 16.5% 1998 year (n=1161) 2000 year (n=1056) *
Not aware about AH
Aware about AH, but not treated Treated AH Treated AH effective 4.3% 29.1% 43.0% 23.6% 2004 year (n=1019) *
Not aware about AH
Aware about AH, but not treated Treated AH Treated AH effective 4.3% 29.1% 43.0% 23.6% 2004 year (n=1019) * * - p<0.05 as compared 2004 and 2000 to 1998
Figure 20. The control of arterial hypertension in the Kaltinėnai rural community in 1998, 2000 and 2004
In conclusion, in the period of 6 years the team of family doctor carried out the permanent primary prevention program of the CND RF and succeeded in the effective AH correction in every fourth inhabitant of the Kaltinėnai rural community. The percentage of the effective AH correction increased from 1.2% in 1998 to 16.5% in 2000 and 23.6% in 2004 (p=0.001).
Table 4. The frequencies of the proposed recommendations among the inhabitants of the Kaltinėnai community in 2004 (n=724)
Proposed recommendations The frequencies of the recommendations (%)) Body mass regulation
Decrease in salt consumption Increase physical activity Relaxation
Decrease of alcohol consumption Stop smoking 43.4 65.3 34.9 3.9 15.9 9.9
Besides the preventive recommendations the pharmaceutical methods were administered to nearly half of the study participants (41.4%), and every fifth inhabitant (28.7%) was advised to take non-pharmaceutical AH correction recommendations. Nearly 2/3 (60.1%) of the respondents with advised recommendations are following them till now.
The ABP measurements were performed by community nurses in 59.7% of cases and by family doctor in 25.8%, whereas every twelve person measured the ABP themselves (8.1%) or with the help of other persons (nearly 6%). The medical doctor always informed the patients about the ABP level in 84.1% of cases; in 12.0% of cases the doctor informed them often. The majority of patients (90.5%) responded that they would like to know about their ABP level, though 8.4% answered that it is not necessary.
The respondents were asked about the normal systolic blood pressure level and 27.9% of them answered that it might be 140 mm Hg, 30.5% - 130 mm Hg, and 14.9% answered, that it might be 20 mm Hg; only every fifth of the respondents (21.8%) did not know the standard level of the systolic blood pressure. The respondents were asked about the norms of the diastolic blood pressure and nearly half (45.7%) of them answered it might be 80 mm Hg, every fifth (20.3%) indicated the level of 90 mm Hg and 22.0% of the respondents did not know about the standard norms of the diastolic blood pressure.
Nearly every fifth respondent had the instrument for the measurement of the ABP and the same numbers of the respondents (19.5%) were able to perform the measurements themselves. In the fifty percent of cases they were taught to perform the measurements by the community nurses, 5.8% by the family doctor and in 3.7% of cases by non-medical staff. More than half of all the respondents (54.8%) perform the measurements of the ABP in the period of their health status worsening, nearly 1/3 (30.5%) under the instructions of the family doctor and nearly 8.0% in occasional cases, 2.6% when remember and 3.0% of the respondents perform the blood pressure measurements in suitable time. 2/3 of the respondents (66.4%) expressed the opinion that it is necessary to have the instrument for the ABP measurements at home.
CONCLUSIONS
1. Nearly half of the investigated inhabitants (48.9%) in the Kaltinėnai community rated their health as “moderate”, every tenth respondent rated their health as “fair and “poor” and every fourth person rated their health as “excellent“ and “good”. The persons with negative self-rated health were older, widowers and less educated, besides, they had more often chronic non-communicable diseases risk factors. In the six-year period of prevention (1998-2004) a statistically significant increase in self-rated health as „good“ was observed.
a. the prevalence of arterial hypertension among adults was 72.9%, every fourth person (24.1%) had obesity, overweight was found among 41.4% of persons, daily smokers comprised 13.9%, elevated and high blood cholesterol concentration was found in 60.7% and 15.1%, respectively, daily or 2-3 times weekly alcohol consumers comprised 7.2%. The risk factors were more often prevalent among men, divorced and primary educated persons.
b. the prevalence of arterial hypertension among the 6-18 year old children was 13.7%, overweight – 6.9%, smokers comprised 15.0%, light alcohol consumer, was every fourth (25.9%) investigated child. The pupils with arterial hypertension more often were overweight, smokers; their parents more often had elevated arterial blood pressure.
3. In the two year period the frequency of the provided recommendations by the primary health care team about the main chronic non-communicable diseases risk factors was significantly higher in the intervention group as compared to the control group; the average scores of the systolic and diastolic arterial blood pressure and the average score of body mass index were significantly lower in the intervention group as compared to the control group, and were respectively 138.49 mm Hg and 149.65 mm Hg (p=0.0001), 83.96 mm Hg and 88.99 mm Hg (p=0.0001), 27.58 kg/m2 and 28.95 kg/m2 (p=0.0001). 4. In the process of the implementation of the prevention and health education in the
Kaltinėnai rural community by team work approach during 1998-2004 period, positive changes in the population attitude towards nutritional habits as well as the prevalence and average scores of the chronic non-communicable diseases risk factors were observed:
a. the inhabitants of the Kaltinėnai more often consumed healthy products, less consumed salt and animal fat, more often consumed fresh vegetables and fruits, b. the prevalence of arterial hypertension in the period of 1998-2004 did not change
significantly, but in the period of six year prevention the average level of the systolic and diastolic blood pressure significantly decreased: in men systolic from 168.7 mm Hg to 144.1 mm Hg (p=0.0001), diastolic from 93.5 mm Hg to 86.4 mm Hg (p=0.0001), in women – systolic from 168.1 mm Hg and 142.5 mm Hg (p=0.0001), diastolic from 93.4 mm Hg to 87.0 mm Hg (p=0.0001),
c. the significant changes in the effective control of the arterial hypertension were observed (in 1998 the arterial hypertension was effectively corrected in 1.2% of cases, in 2004 – 23.6%, p<0.05),
d. the prevalence of overweight in the 1998-2004 year period remained stable, but the significant decrease in the average scores of the body mass index in the Kaltinėnai adult population was observed: among men it was from 28.4 to 27.9 kg/m2 (p=0.0001), among women – from 30.8 kg/m2 to 30.3 kg/m2 (p=0.0001), e. during the six year (1998-2004) period of prevention activities the prevalence of
smoking decreased significantly among the Kaltinėnai male population from 47.1% in 1998 to 31.3% (p<0.05) in 2004., though the prevalence of smoking among women remained stable,
f. the prevalence of the main chronic non-communicable diseases risk factors in the Kaltinėnai children population in the period of 2002-2004 remained stable.
RECOMMENDATIONS
1. Implementation of the team work approach of family physician’s institution in the rural communities should involve children population into the health promotion process. Implementing the continuous integrated CND preventive program could increase the level of the population health knowledge and health culture, and improve the chronic non-communicable diseases risk factors’ detection and control.
2. The team approach in the primary health care work should be included into the universities Family medicine residency training programs or the programs of vocational training of family physicians. This principle should be included into the community nurses’ educational programs and vocational training courses for community nurses as well.
3. On purpose reduce CND morbidity, early detect of the risk factors, better control of CND risk factors in the community the Ministry of Health and Health insurance authorities should actively motivate family physicians to use the team work approach. 4. Seeking to control the CND risk factors effectively, the holistic attitude and impact on
the whole family, as the community comprising cell, in the formation of the healthy lifestyle and healthy behaviour is of great importance.
LIST OF PUBLICATIONS
1. Kornelijus Andrijauskas. Prevalence of arterial hypertension and its correction possibilities among Kaltinenai rural community. Lithuanian general practicioner 2005;9(12):814-819. (in Lithuanian)
2. Kornelijus Andrijauskas, Leonas Valius, Danutė Ugintienė, Violeta Raitelaitienė, Inga Motiejūnaitė. Primary health care service accessibility relationship to first medical care service requirements in the Kaltinenai primary health care centre. Lithuanian general practitioner 2003;7(9):562-565. (in Lithuanian)
3. Kristina Borkienė, Kornelijus Andrijauskas. The possibilities of primary health care to control effectively on communicable diseases RF of country's community. 4th Baltic conference of family medicine "Management of infectious diseases in primary health care", 2003, University of Tartu. Tartu, 2003. p. 30.
4. Kristina Borkienė, Kornelijus Andrijauskas. Chronic non-communicable diseases risk factors primary prevention working in the primary health care centre in team approach. Lithuanian general practitioner 2003;7(2):100-103. (in Lithuanian)
5. Kornelijus Andrijauskas. Analysis of activities for Šilalė district Kaltinenai primary health care institution. Lithuanian general practitioner 2001;5(1):8-9.
SANTRAUKA
Šis darbas skirtas ištirti lėtinių neinfekcinių ligų rizikos veiksnių paplitimą, jų profilaktikos bei korekcijos galimybes šeimos medicinos institucijos pagalba kaimo bendruomenėje, nustatyti sveikatos mokymo ir profilaktikos reikšmę. Kaimo sąlygoms pritaikyta PSP komanda bei sumodeliuotas komandinis darbo principas integruotai LNIL profilaktikai vystyti nuolat plėtojamas bei tobulinamas. Šis darbo principas leidžia įtraukti į procesą visą populiaciją, neišskiriant ir vaikų, kadangi šeimos gydytojas savo gyventoją nuolatos stebi nuo pat gimimo iki mirties. Panaudojant integruotą LNIL profilaktikos modelį pereinama nuo asmens sveikatos prie visuomenės sveikatos bei gyvenimo kokybės gerėjimo kaimo bendruomenėje.
Šio darbo tikslas buvo įvertinti šeimos gydytojo institucijos galimybes vykdyti tęstinę integruotą lėtinių neinfekcinių ligų profilaktiką bei sveikatos stiprinimą kaimo bendruomenėje.
Uždaviniai:
1. Įvertinti Kaltinėnų kaimo gyventojų požiūrį į savo sveikatą, jo dinamiką ir sąsajas su sociodemografiniais bei lėtinių neinfekcinių ligų rizikos veiksniais 2004 m., vykdant tęstinę lėtinių neinfekcinių ligų profilaktiką komandiniu principu.
2. Nustatyti ir įvertinti lėtinių neinfekcinių ligų rizikos veiksnių paplitimą Kaltinėnų kaimo vaikų ir suaugusiųjų populiacijose 2002-2004 metais.
3. Palyginti bei įvertinti pirminės sveikatos priežiūros komandos rekomendacijų, apie lėtinių neinfekcinių ligų rizikos veiksnius ir sveikos gyvensenos principus, pateikimo dažnį, ir rizikos veiksnių paplitimą bei vidutines reikšmes poveikio bei kontrolinėje grupėse.
4. Įvertinti pirminės sveikatos priežiūros komandos profilaktinės veiklos veiksmingumą, remiantis gyventojų požiūrio į mitybą ir lėtinių neinfekcinių ligų rizikos veiksnių paplitimo bei vidutinių reikšmių pokyčiais per šešerius metus (1998-2004 m.).
Tiriamąjį kontingentą sudarė 1200 Kaltinėnų bendruomenės narių vyresnių nei 18 metų prisirašiusių Kaltinėnų pirminiame sveikatos priežiūros centre 1998 m. ir 670 6-18 metų amžiaus vaikų, prisirašiusių Kaltinėnų pirminiame sveikatos priežiūros centre 2002 m. pradžioje. Asmenys (n=800), papildomai prisirašę prie Kaltinėnų pirminio sveikatos priežiūros centro per 2002 m. pirmąjį ketvirtį (vykdant pirminių sveikatos priežiūros įstaigų reorganizaciją kaimo vietovėje, prijungiant atokesnių vietovių kaimo medicininius punktus, nutolusius 10-15 km. atstumu, prie Kaltinėnų PSPC), sudarė kontrolinę tiriamųjų asmenų grupę.
