TENDENCIES AND FEATURES OF SEPARATE TYPES OF MORBIDITY IN THE DIFFERENT REGIONS OF THE WORLD, COUNTRIES (SOCIALLY-MEANINGFUL AND DANGEROUS DISEASES: ILLNESSES OF THE BLOOD CIRCULATION SYSTEM, MALIGNANT NEW FORMATIONS, AIDS)
From all diseases as it has already been said, certain groups of diseases are allocated which have special influence on public health and demand purposeful medico-social measures.
According to the social importance among these diseases the first place is occupied by cardiovascular diseases.
They are on the first place among the reasons of mortality rate of the population (more half of all death rate), on the first place among the reasons of proof disability (20-22 %), on the second place among the reasons of the general morbidity of the population (22 %) and effect people, mainly of middle and old age.
They are named the “Plague” of XX century , emphasizing the exclusive role which they play , first of all, among the reasons of death of people.
In Ukraine the value of people died of diseases of the blood circulation system for the last decade is more than 60,0 %, and on every 100 thousand inhabitants more than 710 person die annually.
Diseases of heart and vessels are the principal reason of physical inability of people. Its result consist 20-22 % of all cases of proof disability .
Cardiovascular diseases affect mainly people of middle and old age . It is that part of the population which is marked not only of significant work capacity, but experience as well.
Therefore, of losses (first of all economic) in which these diseases result, essentially exceed their specific part among this contingent of patients.
Sexual features of mortality rate and cardiovascular diseases are the following: average parameters of mortality rate from cardiovascular diseases of men and women are approximately identical, standardized – in men almost twice higher in comparison with women.
In particular, significant advantage men have before women concerning such reason of death, as ischemic heart disease. Here advantage reaches more than two times, and the mortality rate of men from a heart attack of a myocardium in the age of 30-59 years is in 3-6 times is higher in comparison with women.
Average parameters of general morbidity of diseases of blood circulation system by women almost twice higher in comparison with men, and standardized – approximately identical, in particular by hyper tonic disease and vascular defects of brain.
Standard parameters of the general morbidity of ischemic heart disease are higher in men, in particular in the age of 40-59 years.
Nevertheless , rheumatism is almost twice higher at women.
Value of diseases of system of blood circulation indefatigably grows with age of people. Mortality rate from cardiovascular diseases in the age of 60 years and more senior in 67.0-74.0 times above in comparison with the age under 20 years.
Growth of mortality rate from ischemic heart disease carries exponential character as in every five years age group mortality rate roughly twice exceeds a parameter of previous age group (at young age – at 5-10 times).
Much more slowly in comparison with mortality rate the general morbidity grows: in the age of 70 years and senior it exceeds 30 times morbidity in the age of 15-19 years.
As to ischemic disease of heart, morbidity growth here is much higher: in 70 years it and senior it is in 75.0 times more, than in 25-29 years.
Dynamics. Since the second half of 60th two opposite tendencies in distribution of diseases of heart and vessels were determined. Mortality rate advanced in the countries of Europe and
It was the result of the thought over and consistently introduced system of primary and secondary prophylaxis of these diseases and their consequences .
In
So, from 1975 till 1985 mortality from diseases of blood circulation system has increased from by 556,4 up to 757,8 died inhabitants by 100 thousand.
After significant falling in 1986 (up to 678,4 on 100 thousand) it has risen up to
Mortality rate from a heart attack of a myocardium steadily grew, from hyper tonic disease was stabilized, from vascular defects of brain, as well as from a heart attack of a myocardium, grew.
Dynamics of primary mortality almost repeated dynamics of mortality rate. The bases groups of cardiovascular diseases for the last years ,grew: a heart attack of a myocardium – from
Social features.
In separate social layers of a society essential differences of diseases by cardiovascular diseases are observed.
So, among countrymen these diseases were found out twice more often in comparison with city.
In particular , there is a great difference concerning hyper tonic disease (in 2,8 times), ischemic heart disease of (in 2,1 times), vascular defects of brain (in 2,1 times).
In separate age groups this difference is still big. So, in the age of 20-39 years hyper tonic disease among countrymen makes 38 ‰, city – 13,8 (in 2,8 times is higher), in the age of 40-59 years accordingly 142,1 and 54,9 ‰ (in 2,6 times is higher).
Vascular defects of brain in the age of 40-59 years at countrymen meet in 3 times more often in comparison with city.
Diseases of system of blood circulation system among mothers of incomplete families is in 2,1 times higher in comparison with complete, including concerning rheumatism – in 4,9, ischemic heart disease of – in 2,7, vascular defects of brain – in 2,0, diseases of arteries and veins – in 2,1, than hyper tonic disease – in 1,9 times is higher.
Regional features.
Mortality rate from cardiovascular diseases has essential regional differences.
In the east – central region of Ukraine which has the worst integrated parameter of health, mortality rate under this reasons is the highest and for last decade on 28,2 % mortality rate prevailed in the most optimal western region .
It concerned also the separate reasons, for example, from hyper tonic disease (on 15,7 %), vascular defects of brain (on 172,7 %).
If we consider separate areas of
Concerning the separate reasons differences were even more bigger:
so, mortality rate from rheumatism in Vinnytsya area was by 72,9 % higher, than in Mykolaiv, from hypertonic disease in the Kharkiv area in 4,5 times higher, than in Chernivtsi, from vascular defects of a brain in the Sumy area in 4,3 times higher, than in Ivano-Frankivsk and from a heart attack of a myocardium in Republic of Crimea in 2,5 times higher , than in Khmelnytsky areas.
Unfortunately, the official reporting often changes a technique of data presentation about diseases of system of blood circulation and their prevalence. Concerning separate diseases it is necessary to note, that regional differences of morbidity are even more significant in comparison with mortality rate.
So, for the last decade general morbidity of vascular defects of brain in the east – central region was higher in comparison with western in 2,4 times, at the same time general morbidity of rheumatism, on the contrary, in the western region was on 40,9 % higher , than in east – central.
General morbidity of rheumatism was higher in the Zakarpatya area in comparison with Kharkiv in 3,1 times, hypertonic disease in Zhytomyr area in comparison with Zaporizhya – in 2,3 times, of vascular defects of a brain in the Sumy area in comparison with Ternopil – in 5,4 times, and of heart attack of a myocardium in Republic of Crimea in comparison with Zhytomyr area – in 2,2 times.
Among the social – medical reasons of cardiovascular diseases are following : insufficient physical activity and the use of tobacco , poor nutrition which result in excessive weight and psychoemotional overstrain.
In what measure these differences are predetermined by social, ecological, sexual and age factors ,a level of availability and quality of medical care is the task of social medicine (medical science ).
HEART DISEASE
A. Epidemiology
1. Mortality rate
a. Coronary heart disease (CHD) is the leading cause of death in the
b. Mortality rate from CHD is more than 250 individuals per 100,000 population in the
c. Twenty-five percent of CHD deaths occur in individuals under the age of 65 years.
2. Morbidity. CHD accounts for about 1.5 million myocardial infarctions (Mis) each year,
3. Prevalence
a. About 4.6 million Americans have CHD.
b. The gender differential is much more prominent in white populations; white men are more likely than white women to suffer Ml and sudden death. In general, women have a greater risk of angina pectoris; men have a greater risk of Ml and sudden death.
4. Time trends. Age-adjusted CHD death rates in the United States for the decade ending in 1985 declined by more than 30% over the previous decade. This recent decline in CHD mortality is related to:
a. Improvements in life-style and related CHD risk factor levels (e.g., reduced cholesterol, reduced smoking, possibly increased exercise)
b. Better diagnosis and treatment (e.g., coronary care units, coronary artery bypass grafts, treatment of hypertension)
B. Costs. The cost of cardiac care for CHD, including lost productivity, was estimated to be $80 billion in 1986.
C. Causal and risk factors. Heredity, sex, and aging explain approximately 50% of cardiovascular deaths. Risk factors for cardiovascular disease modifiable by life-style change or drug treatment account for the remainder.
1. Smoking places individuals at an increased risk for developing and dying from CHD. The relative risk for CHD is increased by about 20% for smokers. Smoking kills almost as many individuals by cardiovascular deaths as by lung cancer deaths.
2. High levels of serum cholesterol and low-density lipoprotein (LDL) are tied to the frequency, cholesterol and LDL, at least through middle age. Risk of coronary disease may be mechanisms, and causation of CHD. Longitudinal studies of blood lipids in healthy adults show consistent and linear increases in individual risk of CHD, as indicated by high levels of total serum increased as much as 1 % for each 1 mg/dl increase in cholesterol.
3. Elevated blood pressure, as indicated by increasing levels of systolic or diastolic blood pressure, is a major contributor to CHD risk. Over 37 million Americans have significant (moderate or severe) high blood pressure (blood pressures greater than 150/90 mm Hg recorded once a week at this level for at least 2 weeks in a row).
a. Race. Blacks are almost twice as likely as whites to be hypertensive. Hypertension more frequently leads to congestive heart failure in blacks than in whites.
b. Age. Hypertension is age-related. Approximately 50% of the geriatric population is hypertensive.
4. Lack of moderate exercise has been established as a risk factor for CHD deaths.
Percentage of all cancers
5. Obesity, especially among sedentary individuals, seems to be a minor independent contributory cause of heart disease.
6. Oral contraceptive use, especially among women who are over age 35 or who smoke, has been linked, although weakly, to an increased incidence of CHD.
7. Family history of early CHD is a well-known risk factor.
D. Prevention
1. Primary prevention should include screening for hypertension, high serum cholesterol, and behavioral factors (e.g., smoking, diet, exercise).
a. Blood pressure. The Canadian Task Force (1979) recommends screening for hypertension at least every 5 years for men and women 16-64 years of age and every 2 years after age. 65. The
b. Cholesterol. Physicians should counsel all patients regarding the fat content of their diets. Decreased consumption of whole milk, butter, eggs, and animal fats results in lower cholesterol levels.
(1) Testing of serum blood cholesterol is most important for middle-aged men, especially , if there is evidence of CHD. Testing should be done at least every 5 years, using an accredited laboratory. Non fasting blood may be used. Individuals with cholesterol above 200 mg/dl should be rechecked more frequently.
(2) Recommendations. The U.S. Preventive Services Task Force (1989) recommends drug treatment if cholesterol is above 240 mg/dl with two other risk factors or if cholesterol is above 265 mg/dl without other factors.
c. Smoking. Physicians must counsel their patients to stop smoking and must provide support and motivation through regularly scheduled visits. Early and complete cessation is associated with maximal effectiveness. However, the 20% decrease in smoking in the
d. Physical exercise. Epidemiologic evidence suggests a protective effect against CHD and coronary deaths from regular physical activity; even walking vigorously 30 minutes three times a week has a major effect on the conditioning associated with reduced coronary risks. The protective effects of regular physical activity are independent of the presence of other unfavorable risk factors, such as hypercholesterolemia, hypertension, smoking, and family history.
e. Education
(1) In the 1970s, the National High Blood Pressure Education Program formulated rational objectives to raise patients’ awareness of hypertension. Programs were developed to keep hypertensive patients on appropriate therapy and to encourage them to follow their physician’s advice. Results suggest that the percentage of hypertensive subjects controlling their blood pressure more than doubled, from 16.5% to 34.1%. Today, it is estimated that more than 40% of hypertensives are treated and controlled and a similar percentage are treated but uncontrolled (i.e., they have the potential to be controlled if patient compliance or the proper mix of medication is achieved).
(2) Patient education should continue to be targeted to high-risk groups, such as black males, who have both higher rates of hypertension and lower control rates than other groups.
2. Secondary prevention. The US Preventive Services Task Force (1989) recommends second-ary prevention (screening) with electrocardiogram (EKG) only for men over age 40 who have more than two risk factors; who are about to begin a vigorous exercise program; or who are public safety risks, such as commercial pilots.
Cancer
Problem № 2 of public health is a cancer. In general, among 50 million people which die in the world each year, 5 millions die from cancer. In the advanced countries the part of cancer among the reasons of death reaches 20 %.
In
Cancer are one of principal reasons of physical inability. Their part is almost the same , as diseases of blood circulation system (19-20 %).
Primary morbidity of cancer is rather small: for the last decade it has made in Ukraine 271,1 cases on 100 thousand inhabitants; general morbidity – 1206,9; a so-called index of accumulation (the rate of general morbidity and primary = 4,5).
So, at rather small prevalence of cancer, they have heavy consequences.
Sexual features of mortality rate and morbidity of cancer are the following: mortality rate among men is higher in comparison with women in all age groups, and this index depends on age .
So, if in the age of 30th years it makes almost 20 %, in the age of 70 years and older – almost 100 %.
Indices of morbidity of men and women is different. Under the age of 50 years disease among women (on 20-30 %) prevails due to diseases of female genitals; after 60 years disease of men considerably exceeds same at women ( by 70-100 %).
With the years, mortality rate and morbidity of cancer promptly grows, so in the age of 70 years and older , in comparison with the age under 30 years, mortality rate increases in 95 times, disease – in 90 times.
Dynamics.
According to the data of the WHO, for last 40 years age parameters of mortality rate among men testify reduction of mortality rate from a cancer of a stomach and a gullet, increase – from cancer of respiratory system and stabilization from other kinds of cancer.
In general parameters have increased due to predominant increase of mortality e from a cancer of respiratory system . At women ,age parameters of mortality from cancer of respiratory system, stomach and the cancer of cervix and uterus have decreased.
At the same time mortality rate from cancer of respiratory system in women is grew. Nevertheless, in general, in women the great increase of mortality rate from cancer hasn’t taken place.
In Ukraine the general parameters of mortality from cancer are grew in the following rates (by 100 thousand inhabitants): 1975 – 140,6; 1980 – 149,5; 1985 – 168,8; 1990 – 195,4; 1995 – 200,8.
At the end of 70th the tendencies of mortality from cancer of a stomach and organs of respiratory system were crossed at the certain decrease in mortality rate from a cancer of a stomach (1975 – 33,3; 1980 – 30,5; 1985 – 30,6; 1990 – 29,8; 1995 – 28,1) and prompt growth of mortality rate from a cancer of respiratory system organs (1975 – 28,3; 1980 – 32,6; 1985 – 39,7; 1990 – 49,1; 1995 – 47,2).
Mortality from cancer of respiratory system achieved also a step rise
(1975 – 8,1; 1980 – 9,3; 1985 – 11,3; 1990 – 13,1; 1995 – 15,1).
Primary morbidity rate of cancer is also steadily proving :
in 1985 it has made 275,2 cases on 100 thousand inhabitants, in 1990 – 301,2; in 1995 – 308,1.
Social features. Mortality rate from cancer among social layers of the society have not been investigated till now.
The official statistical reporting doesn’t assume such studies because special researches demand very large value of population which are rather difficult for carrying out in practice.
Statistics of mortality from cancers among city and rural population isn’t true due to the fact died countrymen practically do not give in to pathologo-anatomical research, (it reduces real values of mortality).
Below the results of special research of morbidity of cancer among some social layers of a society are given diagram .
As we can see , among countrymen in comparison with city dwellers and among incomplete families in comparison with complete, levels of morbidity are much higher.
To give an exhaustive explanation to these differences is impossible meanwhile. The new profound researches are necessary. Among risk factors of cancer the most investigated is the role of nicotine and lacks of nutrition .
Morbidity risk of cancer of respiratory system on person who abuse tobacco, is in several times higher in comparison with those who does not use tobacco. Besides, 96 % persons die of a cancer of lungs – those who used tobacco.
On development of cancer are also influence such factors, as solar and other radiation, contaminated air, filled with so-called carcinogenic substances, first of all exhaust gases of automobiles, late marriages, abortions, an early excommunication or a complete excommunication of infant.
In general, more and more certificates are gathering that the way of life essentially influences morbidity of cancers and confirmation to this are regional features of morbidity and mortality from cancer.
Except for the data which were mentioned above, we may add the following information .
For the last decade mortality from cancer in the east – central region of Ukraine is 189,2 died inhabitants per 100 thousands, and in western – 123,3 that is on 53,4 % lower, primary disease accordingly – 278,0 and 206,9 or on 34,4 % is lower.
There is interesting data concerning some kinds of cancer.
Mortality from cancer of respiratory system in the east – central region of republic is on 64,2 % higher in comparison with western and if to study separate areas in Zaporizhya – in 2,4 times is higher, than in Zakarpatya.
Morbidity from those diseases is accordingly higher on 38,8 % (and in the Dnipropetrovsk area is in 2 times higher in comparison with Rivne).
Morbidity of a cancer of skin in the east – central region is on 46,2 % higher, than in western (in
Mortality from a cancer of respiratory system in the Kharkiv area is also in 2,8 times higher than in Zakarpatya.
Among the bases social factors which affect distribution of cancer are : lack of nutrition , smoking, psychoemotional overstrain , radiating pollution, air pollution by exhaust gases, artificial interruption of pregnancy, etc.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
A. Epidemiology
1. Mortality rate
a. The 1986 death rate for COPD was 26.5 individuals per 100,000 population. Deaths from COPD and related conditions constituted 3.6% of all deaths in the
b. Approximately 60,000 deaths per year in the
2. Prevalence
a. II has teen estimated that 16 million Americans have chronic bronchitis, asthma, or emphysema,
b. Approximately 14% of adult men and 8% of adult women have chronic bronchitis, obstructive airways disease, or both.
3. Time trends. Deaths attributed to COPD are increasing; the age-adjusted death rate rose 28% between 1968 and 1978, during which time the overall death rate declined by 22%.
B. Costs
1. The estimated cost of COPD to the national economy in 1979 was $6.5 billion. Of this amount, $ 2,3 billion was for health care, and the remainder was for the indirect costs of morbidity and premature mortality.
2. The total cost of respiratory disease in the United States has been estimated at $25 billion an-annually—that is, $7 billion for direct costs, $12 billion for the indirect costs of morbidity (e.g., loss of productivity), and $6 billion for the indirect costs of mortality.
C. Causal and risk factors
1. Smoking. It has been demonstrated repeatedly during the past 20 years that smoking, particularly cigarette smoking, is the most important cause of COPD. The risk is related to the number of cigarettes smoked daily and to the duration of the smoking.
2. Occupational exposure, especially among tin, copper, and coal miners; chemical workers; foundry workers; cotton textile workers; and others engaged in certain heavy industry, increases the risk of COPD. This is especially true for smokers. The effect is usually considered additive but is considered by some to be multiplicative.
3. Air pollution, including indoor pollutants, has been demonstrated to be harmful at high levels; whether or not exposure to low levels of pollutants has a significant health effect has not yet been determined.
4. Chronic exposure to ETS in healthy nonsmokers leads to a reduction of small airway lung function resembling that of light smokers.
Among children, exposure leads to more respiratory infections, increases in Incidence of bronchitis and pneumonia, and a smaller rate of increase in lung function. ETS seems to worsen the acute symptoms of individuals with preexisting chronic health conditions such as asthma.
5. Sex. Men are at a higher risk than women of developing emphysema and COPD, but not chronic bronchitis; risk differences between the sexes increase with age. Older men are at much greater risk than older women, possibly because of occupational exposures.
6. Socioeconomic factors. Morbidity and mortality from COPD generally are higher in blue-collar workers than in white-collar workers and in people with few years of formal education. These associations likely are related to smoking and occupational exposure.
7. Family history. Offspring of affected parents and brothers and sisters of affected siblings are more likely to develop COPD.
D. Prevention
1. Primary prevention appears to be the only effective approach to COPD. Cessation of smoking before symptoms and incapacitation develop reduces the risk of developing COPD. Abstinence from smoking is associated with absence or low frequency of airway obstruction and respiratory disease mortality.
2. Secondary prevention, or early detection, is useful only if associated with smoking cessation and with avoidance of additional pulmonary tissue damage.
a. Chest x-rays have not proven to be cost-effective as a screening method for identification of individuals with COPD.
b. The most useful screening test is the forced expiratory volume (FEV), usually measured over 1 second (FEV1).
CIRRHOSIS
of the liver, a scarring of tissue and malfunction in the liver that can lead to death, is the most serious of several liver problems brought on by excessive alcohol consumption.
A. Epidemiology. The 1986 death rate from cirrhosis was 10.9 individuals per 100,000 population. These deaths constituted 1.2% of all deaths in the
B. Causal and risk factors. Excessive regular, if not daily, consumption of alcohol for many years places certain individuals who consume alcohol at increased risk for developing cirrhosis. In the -United States, excessive consumption of alcohol is the primary cause of cirrhosis; in other countries, especially non industrialized countries, chronic hepatitis is also a cause.
1. Sex
a. Men who consume more than 40 ml/day of ethanol for many years have an increased chance of developing cirrhosis.
b. Women who consume more than 20 ml/day of ethanol for many years have an increased
chance of developing cirrhosis.
2. Genetics. Evidence suggests that many aspects of alcoholism—which is linked with heavy drinking and thus cirrhosis—are inherited (see Ch 1 III A). Rates of alcohol elimination can vary as much as threefold among individuals.
3. Nutrition. Nutritional deficiencies, especially of proteins, may promote the toxic effects of alcohol by depleting hepatic amino acids and enzymes. Lack of dietary protein hinders proper liver function, whether alcohol is present or not.
B. Prevention
1. Primary prevention
a. Health protection measures are recommended by alcoholism researchers and, thus, are not specific for cirrhosis. Those measures, which are not of proven value, include legislative and regulatory controls on:
(1) Prices of alcoholic beverages
(2) Types and locations of liquor outlets
(3) Hours and days of liquor sales ;
(4) Drinking age
(5) Alcohol content of beverages
(6) Differential taxation of various beverages
(7) Alcohol distribution systems
b. Health promotion measures include:
(1) Public education programs
(2) Specifically targeted preventive programs
(3) Beverage substitution initiatives
(4) Anti-alcohol promotion and marketing measures
2. Secondary prevention for alcoholism, which is being used increasingly by business and industry, entails the early identification of alcohol abusers through the administration of brief questionnaires to high-risk individuals and periodic unscheduled testing of blood and urine among certain groups of workers.
3. Tertiary prevention entails intensive treatment to aid the drinker with either moderating intake for total abstinence. Results have not been very encouraging; dropout, treatment failure, and recidivism are all high.
DIABETES
is a primary disorder of carbohydrate metabolism with multiple etiologic factors that generally involve absolute or relative insulin deficiency, insulin resistance, or both. All causes lead to hyperglycemia, the hallmark of the disease. The different types of diabetes are: insulin-dependent (type I) diabetes mellitus (IDDM) (formerly known as juvenile onset or ketosis prone diabetes); on insulin-dependent (type II) diabetes mellitus (NIDDM) (formerly known as adult-onset, maturity-onset, or nonketotic diabetes]; secondary diabetes (e.g., due to pancreatic disease); impaired glucose tolerance (formerly subclinical diabetes); and gestational diabetes (i.e., glucose intolerance with onset during pregnancy).
Epidemiology
I. Mortality rate
a. The 1986 death rate for diabetes was 15.4 individuals per 100,000 population. These deaths (38,000) comprise 1.8% of all deaths in the
b. Of those diagnosed with diabetes before the age of 30, median survival age is 10-15 years less then that of the general population; end-stage renal disease(VIII) develops in 40 % of these patients, and in remainder, early death usually results from CHD.
2. Morbidity. Secondary problems associated with diabetes include:
a. Blindness (approximately 6000 new cases every year) due to retinopathy. Diabetes is the leading cause of blindness in the
b. Cardiovascular disease. Diabetes is an important risk factor for CHD and peripheral vascular disease. Diabetic vascular disease is the major cause of amputation (50 000 per year).
c. Nephropathy. Diabetic nephropathy occurs in approximately 10% of diabetic and accounts for 25% of dialysis patients. Hypertensive nephropathy is also a risk.
3. Prevalence. There are approximately 11 million diabetics in the
B. Costs. The cost of diabetes is estimated to be $10 billion per year, including medical care and lost productivity.
C. Causal and risk factors
1. Deficiency in the action of the hormone insulin – which may result from aquantative deficiency of insulin, an abnormal insulin resistance to its action, or a combination of deficit — is believed to be the cause of diabetes.
2. Obesity. Although etiology of both IDDM and NIDD Mis poorly understood, studies have shown that approximately 80% of people with NIDDM are obese.
3. Family history. A family history predisposes individuals to diabetes. This predisposition is related to the gene loci HLA DR3/DR4.
4. Sex. Males and females have about the same risk for developing IDDM.
5. Racial and ethnic factors
a. The incidence rate for IDDM among whites is about 1.5 times the rate for black.
b. The incidence of NIDDM is very high among Native Americans, black women, Mexican americanus.
6. Socioeconomic factors. Changes in socioeconomic status have been shown to lead to a marked and rapid increase in the incidence of NIDDM. The reasons for this interesting phenomenon are speculated to be:
a. More plentiful food sources may lead to rapid rise in body weight and corresponding increased risk for developing NIDDM
b. Increase in socioeconomic status is generally associated with a decline in the overall level of physical activity.
c. Prevention. Currently, there is no primary prevention.
d. Secondary prevention is possible and may be cost-effective in high-risk groups.
1. Routine screening for diabetes be use of urine tests for glucose after fasting and by postprandial blood glucose tests can lead to early treatment, which may help to reduce secondary complication. Screening is recommended for those who:
a. Have a family history of diabetes
b. Have glucose abnormalities associated with pregnancy
c. Have physical abnormalities, such as circulatory dysfunction and frank vascular impairment.
d. Are markedly obese.
2. Treatment of asymptomatic individuals with abnormal blood sugar has not been shown to be effective in controlling complications. Diabetes itself is not preventable, but secondary complications such as neuropathy and nephropathy may be preventable.
3. Modification of cardiovascular risk factors such as weight, blood pressure, cholesterol, and smoking are the recommended approaches to prevention of complications.
4. Home health aides to assist patient with diet, medication assistance and instruction, urine testing, and monitoring of vital signs have been reported to lead to modest improvements in blood sugar levels for low-income and poorly educated patients.
RENAL DISEASE
A. Epidemiology
1. Mortality rate. The 1983 death rate for renal disease was 9.0 individuals per 100.000 population. These deaths accounted for 1,0 % of all deaths in the
2. Incidence.
Annual incidence rates of end-stage renal disease ranging from 50-95 individuals per 1 million population have been reported. In one study, the annual incidence rate increased from35 cases per 1 million population in 1973to 59 cases per 1 million in 1979.
a. Race
(l)Black men have the largest increase in the incidence of end-stage renal disease; the incidence for black women has also increased dramatically over the past 20 years. (2)White men and women showed an increased incidence from 1973 and 1977 and then stabilized.
b. Age Individuals 65years of age or over experienced the greatest increase in incidence, increasing tenfold in the past 20 years, with no indication of stabilization or decline.
B. Costs. The cost of end-stage renal disease, including dialysis programs and transplantations, is estimated to be over $4 billion. Medicare coverage, which pays for the end-stage renal disease programs, has greatly increased both the availability of dialysis programs and their total cost.
C. Causal and risk factors
1. Immune injury, predominantly as a result of previous streptococcal infection, is the most frequent cause of glomerulonephritis.
2. Occupational exposure. Exposure to industrial solvents and gasoline by certain occupational groups (e.g., painters) is a much less frequent cause of renal disease.
3. Race. Black adults are more likely to develop renal diseases, in particular hypertensive nephropathy.
4. Sex. Men are 20 %-30 % more likely then women to develop renal disease.
5. Age. Individuals over 45 years of age are more likely to develop renal disease then those under age 45 years.
6. Diabetes. Diabetic nephropathy and hypertensive nephropathy are major causes of morbidity and mortality among diabetics.
D. Prevention.
1. Primary prevention.
a. Control of hypertension. Antihypertensive drugs have been shown by clinical trials to be effective in reducing morbidity and mortality due to renal failure.
b. Routine screening for bacteriuria. Pyelonephritis (bacterial infection of the kidney), bacteriuria (bacteria in the urine), and other urinary tract infections can lead to chronic pyelonephritis, although this is uncommon in the absence of structural or neurologic abnormalities or states, such as diabetes or pregnancy.
c. Avoidance of improper exposure to hydrocarbons, industrial solvents, paints, and gasoline can help to prevent renal disease.
2. Secondary prevention. Better understanding of the immune process and of methods to arrest the progression of glomerulonephritis are both major areas of research.
a. Drug treatment of hypertension in diabetic patients may reduce the progression of renal failure. It is unclear whether vigorous control of blood sugar in diabetics also reduces the probability of developing renal failure.
b. Dialysis and transplantation are the only ways to prevent imminent death once end-stage renal disease develops.
PEPTIC ULCER DISEASE
A. Epidemiology
1. Mortality rate. The death rate for peptic ulcer disease is approximately 2.0 individuals per 100,000 population (1.1 gastric ulcer and 0.9 for duodenal ulcer). Approximately 6000 deaths per year (0.3%) are due to peptic ulcer disease (3000 gastric ulcers and 3000 duodenal ulcers) in the
2. Incidence and prevalence
a. An annual incidence rate of 3 per 1000 population leads to approximately 350,000 new cases per year.
b. The lifetime prevalence of peptic ulcer disease is 5 %-l0 %. The 1-year prevalence of self-reported peptic ulcer disease in the
3. Time trends
a. Although overall prevalence has remained stable, rates for men and women show opposite patterns; rates for men have decreased from 2.3% to 1.8%, while rates for women have increased from 1.1 % to 1.7%. The reason is not established but may be due to changed smoking habits and stress associated with increased involvement in the workplace.
b. The death rate for peptic ulcer disease has decreased by 30 % since 1950.
B. Costs. It has been estimated that, in 1995, the cost of ulcer disease in the
Tj– causal and risk factors listed, which are due to socioeconomic, mental, ethnic, or racial circumstances, are accepted as true but are based on weak evidence. Similarly, the preventive measures recommended have “o” been rigorously established..
C. Causal and risk factors. Factors such as cigarette smoking, regular use of aspirin, prolonged use of large doses of steroids, and family history have been associated with ulcer disease. Less conclusive associations have been reported for alcohol, caffeine, diet, and stress.
1. Smoking. Men who smoke cigarettes have higher peptic ulcer mortality rates than nonsmokers; strong conclusions cannot be made for women smokers.
a. Prospective studies show that smokers of cigarettes, pipes, or cigars have a 33% increased risk of developing an ulcer later in life when compared with nonsmokers of similar socioeconomic status.
b. Retrospective studies show that cigarette smokers arc about twice as likely to have ulcers as nonsmokers. Men who smoke have a 2.1 times greater percentage of peptic ulcer dis ease, and the prevalence in women who smoke is 1 times greater than ionsmokers. The percentage of people with ulcers increased significantly with the number of cigarettes smoked per day.
c. Recurrence of ulcers is markedly increased for smokers.
2. Aspirin or acetaminophen use is associated with a three to six times higher prevalence of gas peptic ulcer disease. There is not a clear association with ibuprofen.
3. Family history. Family studies have shown that peptic ulcers occur 2—2.5 times as frequently
among first-degree relatives of patients with ulcer disease as compared to relatives of those without ulcer disease. The increased risk is only for the same kind of ulcer.
4. Individuals with blood type O, regardless of Rh factor, are about 37% more likely to develop a duodenal ulcer than people with other blood types.
D. Prevention
1. Primary prevention. Avoidance of the agents known to increase the risk of ulcer disease is the basis for prevention.
a. Initial occurrence. A nutritious diet, avoidance of nicotine, and temperance in the use of caffeine and alcohol will decrease the risk of developing duodenal ulcer disease.
b. Recurrence of gastric ulcer may be avoided through avoidance of mucosal-disrupting sub stances, such as salicylates, nonsteroidal anti-inflammatory drugs, and oral corticosteroids, and, most importantly, by the cessation of smoking.
2. Secondary prevention. There are no current tests for determining a pre-ulcerous condition in
asymptomatic individuals.
3. Tertiary prevention
a. Treatment entails:
(1) Neutralization of gastric acid
(2) Reduction of gastric acid output
(3) Increasing the integrity of the gastric and duodenal mucosa
b. Intensive antacid therapy and parenteral cimetidine given intravenously or intramuscular have been shown to be effective in preventing recurrence of stress ulcerations. Cimetidine is also effective in preventing recurrences of duodenal ulcer when given in a dose of 300-400 mg at bedtime for 3 months.
ANEMIA
is a reduction in either the volume of red blood cells or the concentration of hemoglobin in a sample of peripheral venous blood when compared with similar values from a reference population. There are four broad classifications: hyperproliferative anemias (e.g., marrow aplasias, myelophthisic anemias, anemias with blood dyscrasias), maturation defects (e.g., cytoplasmic, nuclear), hyperproliferative (e.g., hemorrhagic, hemolytic) and dilutional (pregnancy, splenomegaly).
A. Epidemiology
I. Mortality rate. Anemias were the thirteenth leading cause of death of children under the age of
2. Prevalence. The prevalence of anemia from 1976 to 1980 ranged from 2.3 % to 5.9 % in a study conducted by the Second National Health and Nutrition Examination Survey.
a. Prevalence rates in children ranged from 5.7 % in infants 1-2 years of age to 2.8 % in children 9-11 years of age, including girls and boys of all races.
b. Children 6-8 years of age and boys and men 12—44 years of age had the lowest prevalence rates (2.3 % and 2.9 % respectively).
c. The highest prevalence rates, aside from infants, were experienced by girls 15-17 years of age (5.9 %), young women (4.5 %), and elderly men (4.8 %).
B. Causal and risk factors
1. Familial predisposition
a. Sickle-cell anemia is caused by a lack of hemoglobin A; a deprivation of oxygen results in crescent-shaped red cells. This disorder is almost entirely confined to blacks.
b. Thalassemia is a type of anemia caused by partial or complete interference in synthesis of one of the normal hemoglobin peptide chains. Characteristics include unusually thin red corpuscles. This anemia occurs primarily in individuals of Italian, Greek, Syrian, or Armenian heritage, although there is also high incidence in
2. Iron deficiency
a. Children may experience iron deficiency anemia at a time when increased iron is required” for rapid growth.
b. Women are susceptible to iron deficiency due to menstrual blood loss and the iron losses associated with pregnancy.
c. Individuals of low socioeconomic status are more likely to develop anemia due to the absence of an iron-rich diet because of poverty or ignorance.
3. Vitamin B12 deficiency. Pernicious anemia is caused by insufficient intestinal absorption of vitamin B12– It primarily affects individuals over the age of 30, and incidence increases with age. Individuals of northern European descent are more likely to develop pernicious anemia; it is less common among Asians and blacks.
4. Sex and age. In elderly men, anemia may be linked to a decrease in the androgen stimulation of erythropoiesis that began during puberty; in otherwise healthy subjects, anemia may indicate an overall reduction in hematopoietic reserve.
C. Prevention
1. Screening by hematocrit is considered cost-effective for target populations and, thus, is recommended for the following high-risk groups:
a. Premature infants.
b. Infants born of a multiple pregnancy or an iron-deficient woman.
c. Individuals in low socioeconomic circumstances
2. Iron supplements in foods, primarily cereal products, have been shown to decrease the prevalence of anemia among women in
3. Dietary iron and vitamin B12. Consumption of foods that are high in iron [e.g., red meats, organ meats (especially liver)] and leafy green vegetables that are high in B vitamins is recommended for those at high risk and those previously diagnosed with anemia.
INTRODUCTION. This chapter provides background on the prevalence and risk factors for selected chronic diseases in the U.S. population in the 1990s. Temporal trends in incidence, the financial burden to society, population subgroups who are particularly at risk, and recommended preventive activities are considered for each condition.
A. Prevention. Recommendations for screening and preventive measures constantly change. Specific recommendations for prevention will not be agreed upon by all clinicians, investigators, or administrative groups; thus, this chapter presents areas of general consensus and emphasizes preventive measures—whether primary, secondary, or tertiary—that are appropriate for primary care providers to consider. Recently, the U .S. Preventive Services Task Force, a, blue ribbon committee formed by the U.S. Department of Health and Human Services (USDHHS), produced a Guide to Clinical Preventive Services (1989). The guide was the result of exhaustive literature reviews, formal debates, and multiple expert reviewers.
B. Statistics. Incidence and mortality rates for the diseases discussed in this chapter are summarized in Figures 5-1 and 5-2 and in Table 5-1.
In Ukraine more than one hundred thousands AID patients are registered.
Every year their value grows.
The important social – medical problem are accidents, poisonings and traumas.
They occupy the III place among the reasons of mortality reasons and the same place among the reasons of proof disability (9-10 %).
The bases social reasons of the accidents and traumas are alchogolism, social and economic disorders, the insufficient organization of the safety precautions at production.
Each fourth inhabitant suffers from mental disorders. Most of them neurological diseases on the basis of which the different somatic diseases arise often and chronic alcocholism. Only In Ukraine more than one million chronic alcoholics are registered. The narcotism and glue sniffing are distributed, almost 400 thousand addicts and glue sniffers are now registered.
The bases social reasons of this phenomenon are low culture, family disorders, insufficient education, psychoemotional overstrain, traditions, etc.
From all diseases as it has already been said, certain groups of diseases are allocated which have special influence on public health and demand purposeful medico-social measures.
