«Revealing of risk factors, «Revealing of risk factors, principles of early principles of early diagnostics and preventive diagnostics and preventive maintenance of socially-maintenance of socially-significant diseases»significant diseases»

The lecturer: The lecturer: DMDM G.M.Muldaeva G.M.Muldaeva

Discipline «The general medical practice»Discipline «The general medical practice»

Speciality 051301 «the General medicine»Speciality 051301 «the General medicine»

Course Course VV

The purpose - to acquaint The purpose - to acquaint students with concept risk students with concept risk factor and principles of early factor and principles of early diagnostics and preventive diagnostics and preventive maintenance of socially-maintenance of socially-significant diseasessignificant diseases

The lecture plan: The lecture plan: Risk factor definition.Risk factor definition. Revealing of risk factorsRevealing of risk factors Risk factors ССЗRisk factors ССЗ

At Ivanov And. 38 years, the miner by a At Ivanov And. 38 years, the miner by a trade, at passage of annual preventive trade, at passage of annual preventive inspection to polyclinic have been registered inspection to polyclinic have been registered the HELL 145 and 95 мм.рт.ст. The patient of the HELL 145 and 95 мм.рт.ст. The patient of the raised food, conducts an inactive way of the raised food, conducts an inactive way of life, smokes 10-12 cigarettes in the day, the life, smokes 10-12 cigarettes in the day, the burdened anamnesis – mother long time burdened anamnesis – mother long time suffers АГ. suffers АГ. Define a problem of the patient?Define a problem of the patient? What factors influence a state of What factors influence a state of health of the patient?health of the patient? How it is possible to improve a How it is possible to improve a condition of the patient?condition of the patient?

Define a problem of the Define a problem of the patient?patient? Arterial hypertensiaArterial hypertensia

What factors influence a state What factors influence a state of health of the patient?of health of the patient? Risk factors - Risk factors - The raised food,The raised food, lack of lack of exerciseexercise, smoking, a heredity. , smoking, a heredity.

How it is possible to improve a How it is possible to improve a condition of the patient?condition of the patient? To eliminate risk factorsTo eliminate risk factors

Risk factorsRisk factors Formation of concept "risk" is connected in Formation of concept "risk" is connected in

medicine with reflexion medicine with reflexion The relativeThe relative, , Likelihood lawsLikelihood laws In organism ability to live In organism ability to live in interaction with the world surrounding in interaction with the world surrounding it. it. RelativityRelativity The nature finds expression The nature finds expression that any phenomenon in it arises with that any phenomenon in it arises with some probability, a relativity, exists in some probability, a relativity, exists in system of various relations with system of various relations with surrounding subjects and own history. For surrounding subjects and own history. For occurrence of any event there are, certain occurrence of any event there are, certain reasons and conditions reasons and conditions

ProbabilityProbability Is a measure which gives Is a measure which gives the quantitative characteristic of the quantitative characteristic of possibility of occurrence of the possibility of occurrence of the phenomenon or result realisation. phenomenon or result realisation. The probability varies from 0 when The probability varies from 0 when event never comes within the limits event never comes within the limits of certain system of relations, to 1 of certain system of relations, to 1 when it comes inevitably. when it comes inevitably.

Risk factor is a sign which so closely Risk factor is a sign which so closely associates with phenomenon associates with phenomenon occurrence that can be used for its occurrence that can be used for its prediction. prediction.

In a risk factor role act both external In a risk factor role act both external conditions, and internal features of conditions, and internal features of an organism.an organism.

Formation Formation Risk factorRisk factor It is It is connected first of all with necessity connected first of all with necessity of a prediction, the disease of a prediction, the disease forecast. It is necessary to be able forecast. It is necessary to be able to predict for purposeful correction.to predict for purposeful correction.

For carrying out of actions for For carrying out of actions for primary preventive maintenance primary preventive maintenance the knowledge of risk factors of the knowledge of risk factors of disease is necessary.disease is necessary.

It has been revealed, It has been revealed, That for forecast drawing up in some That for forecast drawing up in some

cases it is not obligatory to know the cases it is not obligatory to know the phenomenon reason, it is enough to phenomenon reason, it is enough to reveal communication between the reveal communication between the phenomena and to prove that it is not phenomena and to prove that it is not casualcasual

That it is possible to influence disease That it is possible to influence disease occurrence in the future, without occurrence in the future, without having its exact theoretical description having its exact theoretical description этиологических factorsэтиологических factors

Classical exampleClassical example - The prevention - The prevention in the last century of distribution in the last century of distribution of a cholera in London long before of a cholera in London long before its opening вибриона. It has been its opening вибриона. It has been made on the basis of supervision made on the basis of supervision I.SnoyI.Snoy, Shown necessity of , Shown necessity of isolationisolation

One of city sources водоSupply. One of city sources водоSupply.

In this case the use of water from the In this case the use of water from the given source was risk factor of given source was risk factor of distribution of a cholera as distribution of a cholera as associated with disease so thatassociated with disease so that

It could be used as the indicatorIt could be used as the indicator

For its forecasting and as a reference For its forecasting and as a reference point planning ways point planning ways профилактического interventions. профилактического interventions.

Revealing of risk factorsRevealing of risk factors

First, the assumption of risk factor First, the assumption of risk factor arises at revealing of unidirectional arises at revealing of unidirectional correlation between presence (or correlation between presence (or increase) a sign and presence (or increase) a sign and presence (or increase) the studied phenomenon. increase) the studied phenomenon. As an example direct dependence As an example direct dependence between level of cholesterol and between level of cholesterol and development ИБС serves. development ИБС serves.

Secondly, such communication should be Secondly, such communication should be consecutive on time. For its revealing consecutive on time. For its revealing carrying out проспективного researches carrying out проспективного researches is required, and as a measurement is required, and as a measurement measure use of frequency of occurrence of measure use of frequency of occurrence of new cases of disease for the certain period new cases of disease for the certain period of time, i.e. serves. of time, i.e. serves.

In one-stage research it is impossible to In one-stage research it is impossible to prove that the observable sign is risk prove that the observable sign is risk factor.factor.

The specified sequence can have double The specified sequence can have double value. value.

The first – carrying out The first – carrying out prospective prospective supervision promotes communication supervision promotes communication revealing between initial level of a sign revealing between initial level of a sign and demanded change of disease. This law and demanded change of disease. This law can be used for the forecast. can be used for the forecast.

The second – is required presence such The second – is required presence such prospective prospective the data in which the data in which communication between change of a sign communication between change of a sign and demanded change of disease comes and demanded change of disease comes to light.to light.

For example, struggle against smoking For example, struggle against smoking conducts to reduction of number of conducts to reduction of number of persons with the fingers which have persons with the fingers which have turned yellow from tobacco. After turned yellow from tobacco. After reduction of prevalence of the given reduction of prevalence of the given sign reduction of disease by a cancer of sign reduction of disease by a cancer of lungs follows. But it does not mean at lungs follows. But it does not mean at all that the first has resulted in the all that the first has resulted in the second that the turned yellow fingers of second that the turned yellow fingers of the smoker are the agent for a cancer the smoker are the agent for a cancer of lungs.of lungs.

The third is a stability, repeatability The third is a stability, repeatability of the revealed communication in of the revealed communication in identical conditions.identical conditions.

The fourth – the sign is considered The fourth – the sign is considered risk factor while its communication risk factor while its communication with disease appears as independent with disease appears as independent and independent. If second sign at and independent. If second sign at which account the first which account the first communication disappears it is communication disappears it is impossible to consider the first as impossible to consider the first as risk factor of illness though it and risk factor of illness though it and remains its indicator comes to light. remains its indicator comes to light.

The fifth is a presence of such size of The fifth is a presence of such size of risk which reaches some almost risk which reaches some almost significant threshold of selection. For significant threshold of selection. For example, such size of relative risk at example, such size of relative risk at which disease increases in can be which disease increases in can be criterion of a sign of risk criterion of a sign of risk

1,5-2 times in comparison With 1,5-2 times in comparison With reference reference the group which risk is the group which risk is accepted For unit. accepted For unit.

The sixth – the sign is called as risk factor The sixth – the sign is called as risk factor in those situations in which its in those situations in which its communication with disease remains till communication with disease remains till the end of not opened and is estimated as the end of not opened and is estimated as likelihood, statistical i.e. while some likelihood, statistical i.e. while some uncertainty of a prediction remains. If uncertainty of a prediction remains. If uncertainty acts in film, and the forecast uncertainty acts in film, and the forecast becomes rigidly determined, instead of becomes rigidly determined, instead of operating by risk factors absolutely exact operating by risk factors absolutely exact calculation based on absolute knowledge calculation based on absolute knowledge of cause and effect dependences is used.of cause and effect dependences is used.

For example, the cancer of lungs For example, the cancer of lungs arises in the conditions of arises in the conditions of multicomponent influence from multicomponent influence from environment on genetically environment on genetically heterogeneous population. All it heterogeneous population. All it does basically impossible does basically impossible formation absolutely unequivocal formation absolutely unequivocal deterministic deterministic its theories its theories population population the forecast.the forecast.

The seventh is a practical value of the The seventh is a practical value of the factor for the decision of problems of factor for the decision of problems of the forecast of disease or its the forecast of disease or its preventive maintenance. If such preventive maintenance. If such requirement is not present, the sign requirement is not present, the sign receives other designation, and receives other designation, and communication is estimated in communication is estimated in physiology terms, патофизиологии or physiology terms, патофизиологии or other not preventive disciplines. For other not preventive disciplines. For example, the body surface depends on example, the body surface depends on growth and weight, but it is not growth and weight, but it is not accepted to name them its risk factors.accepted to name them its risk factors.

Summarising the resulted criteria, it is Summarising the resulted criteria, it is possible to offer following short definition possible to offer following short definition of risk factor. of risk factor. Risk factorRisk factor Is a sign which Is a sign which is independently connected with is independently connected with probability of occurrence of event so that probability of occurrence of event so that can be used for its forecasting. can be used for its forecasting. Risk Risk factor of diseasefactor of disease Is the sign previous Is the sign previous disease, having with it independent, disease, having with it independent, steady, likelihood communication which steady, likelihood communication which possesses practical value at least for its possesses practical value at least for its preventive maintenance, forecasting.preventive maintenance, forecasting.

For example, spent to the world For example, spent to the world large-scale large-scale population population researches researches have visually shown importance of have visually shown importance of effective treatment АГ in decrease in effective treatment АГ in decrease in risk of cardiovascular disease and risk of cardiovascular disease and death rate, and also have allowed to death rate, and also have allowed to estimate quantitatively influences on estimate quantitatively influences on the forecast of a parity the HELL with the forecast of a parity the HELL with other risk factors.other risk factors.

On the basis of this On the basis of this data new data new classifications of an classifications of an arterial hypertensia arterial hypertensia have been have been developed, developed, necessary and necessary and sufficient target sufficient target levels of decrease levels of decrease the HELL are defined the HELL are defined at therapies, and at therapies, and also stratification of also stratification of risk levels of risk levels of development of development of cardiovascular cardiovascular complications in complications in patients with АГ is patients with АГ is made. made.

Risk factors Risk factors CVICVIAmong numerous risk factors ССЗ as the cores consider three – Smoking, The maintenance in blood atherogenic(Leading to an atherosclerosis) Fatty components (липидов), so-called dyslipidemia and an arterial hypertension (Level of pressure more than 140/90 мм.рт.ст.) as they are causally connected with development of these diseases and their prevalence among the population is great. Presence of a combination these three ФР increases risk of development ИБС at women by 40,0 %, at men on 100,0 % in comparison with persons at whom these ФР are absent

SmokingSmoking

According to World Health Organization, According to World Health Organization, 25%25% Death from ИБС it is caused by Death from ИБС it is caused by smokingsmoking, Reducing life expectancy of , Reducing life expectancy of smokers is elderly smokers is elderly 35-6935-69 Years, on the Years, on the average on average on 2020 Years. It is necessary for all Years. It is necessary for all smokers to know that the sudden death smokers to know that the sudden death among the persons smoking during the day among the persons smoking during the day a pack of cigarettes and more, is observed a pack of cigarettes and more, is observed in in 55 Time Time To thicket, than among the non- To thicket, than among the non-smoking. At the same time, among given up smoking. At the same time, among given up smoking the risk of occurrence ИБС smoking the risk of occurrence ИБС considerably decreases and in five years considerably decreases and in five years becomes same, as well as at those who becomes same, as well as at those who never smoked never smoked

dyslipidemiadyslipidemiaMaintenance disbalance in cholesterol blood, Maintenance disbalance in cholesterol blood, липидов low and very low density, липидов low and very low density, триглицеридов and липидов high density триглицеридов and липидов high density липиды high density towards increase "bad" липиды high density towards increase "bad" and-or decrease in "good" fats. and-or decrease in "good" fats. At presence At presence dyslipidemia dyslipidemia its correction begin its correction begin with a diet. If by means of a diet in a current with a diet. If by means of a diet in a current 33 Months it is not possible to lower Months it is not possible to lower lipidic lipidic a a blood spectrum, and the person blood spectrum, and the person simultaneously has other risk factors, simultaneously has other risk factors, medicamentous therapy is appointed.medicamentous therapy is appointed. Arterial hypertensionArterial hypertension

DiabetesDiabetesDiabetes presence considerably increases Diabetes presence considerably increases risk of development of diseases of heart, risk of development of diseases of heart, and at women in a greater degree, than at and at women in a greater degree, than at men. men. Risk increase is connected as with a Risk increase is connected as with a diabetes (in diabetes (in 2-42-4 Time), Time), And with большей And with большей prevalence at these people дислипидемии, prevalence at these people дислипидемии, an arterial hypertension, adiposity. an arterial hypertension, adiposity. Normalisation of level of sugar is necessary Normalisation of level of sugar is necessary for decrease in risk of development ССЗ and for decrease in risk of development ССЗ and their complications at sick of a diabetes in their complications at sick of a diabetes in blood and correction of other risk factors. blood and correction of other risk factors. Because possibility of development of a Because possibility of development of a diabetes with the years increases, at elderly diabetes with the years increases, at elderly and old people control over blood sugar is and old people control over blood sugar is obligatory. obligatory.

Superfluous weight of a bodySuperfluous weight of a bodyThe superfluous weight of a body The superfluous weight of a body raises risk of development ИБС and raises risk of development ИБС and other diseases connected with an other diseases connected with an atherosclerosis. So-called central atherosclerosis. So-called central adiposity when fat is postponed on a adiposity when fat is postponed on a stomach is more dangerous. It is stomach is more dangerous. It is possible to judge degree of the possible to judge degree of the central adiposity after a circle of a central adiposity after a circle of a waist and the relation of a circle of a waist and the relation of a circle of a waist to a circle of hips. Risk ССЗ waist to a circle of hips. Risk ССЗ raises at men with a circle of a waist raises at men with a circle of a waist more than 94 sm and especially more than 94 sm and especially increases at a circle more than 102 increases at a circle more than 102 sm, and at women – accordingly at a sm, and at women – accordingly at a circle of a waist more than 80 sm and circle of a waist more than 80 sm and more than 88 see more than 88 see

Low physical activityLow physical activityAt people with low physical activity At people with low physical activity ССЗ develop in 1,5-2,4 times more ССЗ develop in 1,5-2,4 times more often, than at the people conducting often, than at the people conducting physically active way of lifephysically active way of life. For . For preventive maintenance ССЗ and preventive maintenance ССЗ and health strengthenings most approach: health strengthenings most approach: fast walking, jogging, driving on a fast walking, jogging, driving on a bicycle, swimming, walking on skis, bicycle, swimming, walking on skis, etc. Frequency of employment by etc. Frequency of employment by physical exercises should be 4-5 times physical exercises should be 4-5 times week, duration of employment of 30-week, duration of employment of 30-40 minutes, including the warm-up 40 minutes, including the warm-up and "cooling" period. and "cooling" period.

Abusing alcoholAbusing alcohol

Death rate from ССЗ above at much Death rate from ССЗ above at much drinking. Besides, it is necessary to drinking. Besides, it is necessary to consider other effects of alcohol: increase consider other effects of alcohol: increase the HELL, risk of development of a stroke the HELL, risk of development of a stroke and sudden death, a cirrhosis, influence on and sudden death, a cirrhosis, influence on the mental status, and as high caloric the mental status, and as high caloric content of alcohol, especially to people with content of alcohol, especially to people with superfluous weight of a body. superfluous weight of a body.

At "combustion" At "combustion" 1 1 г ethanol (spirit) it is г ethanol (spirit) it is formed formed 77 Kcal, i.e. almost twice more than Kcal, i.e. almost twice more than at "combustion" of fibers and at "combustion" of fibers and carbohydrates.carbohydrates.

Proceeding their stated above, it is Proceeding their stated above, it is possible to ascertain that in a condition possible to ascertain that in a condition of functional pressure the great value is of functional pressure the great value is got by struggle against risk factors, got by struggle against risk factors, working out of actions for their working out of actions for their elimination. Therefore the important role elimination. Therefore the important role is played by direct connection research is played by direct connection research between risk factors and pathology between risk factors and pathology profiles that allows effectively and to profiles that allows effectively and to define individual improvingly-preventive define individual improvingly-preventive recommendations purposefully recommendations purposefully

ActionsOn change

To lower the HELL; Refusal of smoking; Normalisation of weight of a body

(ИМТ <25 kg/m. 2); Decrease in consumption of alcoholic

drinks <30 г alcohol a day for men Physical activity increase - regular

aerobic (dynamic) physical activity

The literatureThe literature

Aleksandrov O. A «the Complex Aleksandrov O. A «the Complex program of health». 1988.program of health». 1988.

«Valueology, diagnostics, means and «Valueology, diagnostics, means and ппрофилактика health maintenance», ппрофилактика health maintenance», S.-Peterburg, "Science", 1993.S.-Peterburg, "Science", 1993.

Bernhard Badura and Ilona Kickbusch Bernhard Badura and Ilona Kickbusch Healht Promotion rearch, Part 2, p.147-Healht Promotion rearch, Part 2, p.147-187; 313-341.187; 313-341.

Control questionsControl questions

What is the risk factorWhat is the risk factor With what risk factor formation is With what risk factor formation is

connectedconnected Specify risk factors of an arterial Specify risk factors of an arterial

hypertensiahypertensia What isWhat is dyslipidemia dyslipidemia Specify risk factors Specify risk factors CVICVI