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Izhodišča: Bolezni srca in ožilja (BSO) predstavljajo vodilni vzrok smrti v večini evropskih držav, njihovo preprečevanje pa predstavlja pomembno nalogo osnovnega zdravstvenega varstva. Ocena dejavnikov tveganja in usmerjene preventivne aktivnosti so posebej pomembne pri visokoogroženih bolnikih. Pomembno je poznati tudi dejavnike, ki vplivajo na uspešnost preventive teh bolezni.

Metode: V presečno raziskavo je bilo z naključnim stratificiranim vzorčenjem vključenih 36 slovenskih ambulant. Vsaka ambulanta je iz registra visokoogroženih vključila 30 bolnikov, ki so izpolnili vprašalnik o življenjskem slogu, kakovosti življenja, samooceni zdravja in o uporabi zdravstvenih storitev. Vir podatkov o dejavnikih tveganja BSO so bile kartoteke bolnikov, z vprašalnikom o ambulanti pa so bila pridobljena vprašanja o obremenjenosti, projektih kakovosti, izobraževanju, informacijski tehnologiji, o preventivnih aktivnostih.

Rezultati: Sodelovalo je 871 bolnikov iz 36 ambulant (80,6 % predvidenega vzorca), starih 62,4 leta (SD±8,6). 22,4 % je bilo kadilcev; priporočeno raven aerobne telesne aktivnosti je vzdrževalo 330 (48,8 %) sodelujočih, najmanj urejen dejavnik tveganja pa je bil indeks telesne mase (29,3kg/m2). V multivariatnem modelu so vsi dejavniki (ambulante, bolniki in zdravniki) statistično značilno napovedali urejenost dejavnikov tveganja (p<0,005, F=2,7, R2 =0,087). Neodvisne spremenljivke bolje urejenih dejavnikov tveganja so bile: ženski spol, višja starost in višja izobrazba bolnika, uporaba informacijskega sistema v ambulanti, organizacija srčno-žilne preventive in zdravnikova profesionalna aktivnost v projektih preventive.

Zaključki: Urejenost dejavnikov tveganja je v največji meri odvisna od značilnosti ambulante, predvsem organizacije na področju preventive, ter od strokovne aktivnosti zdravnika. Vplivajo tudi nekatere splošne značilnosti bolnika. Pomembni so še drugi dejavniki, ki niso bili vključeni v model.

Nutrigenomika: Interakcije Med Genskimi Polimorfizmi in Sestavinami Hrane

Meja med zdravjem in boleznijo je pogojena s kompleksnim ravnotežjem dveh elementov, genetike na eni strani in načinom življenja na drugi. Nutrigenomika je pristop, s katerim lahko prehranjevanje prilagodimo posamezniku, oziroma posamezniku priporočimo posamezna živila glede na njegov genetski ustroj. Namen preglednega članka je predstaviti posamezne interakcije in povezave med genskimi polimorfizmi in sestavinami hrane ter povečanim tveganjem za razvoj tako bolezni srca in ožilja kot rakavih obolenj. Poznamo namreč kar nekaj bioaktivnih sestavin v hrani, ki lahko pozitivno ali negativno vplivajo tako na potek ateroskleroze, kot tudi na pojav rakavega obolenja.

Moramo pa se zavedati, da čas individualizirane prehrane še ni napočil, potrebne so številne ponovitve obetajočih rezultatov na različnih populacijah. Preiti moramo tudi iz osnovnega, enostavnega eksperimenta (ena sestavina hrane, enojni nukleotidni polimorfizem, dejavnik tveganja) na resnične razmere, ki vključujejo medsebojno vplivanje številnih genov, sestavin hrane in dejavnikov tveganja. Če povzamemo, potrebne so večje populacijske in dobro standardizirane študije.

The effects of particulate matter air pollution on respiratory health and on the cardiovascular system

Particulate matter (PM) is a major component of urban air pollution and has a significant effect on human health. Natural PM sources are volcanic eruptions, dust storms, forest and grassland fires, living vegetation and sea spray. Traffic, domestic heating, power plants and various industrial processes generate significant amounts of anthropogenic PM. PM consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. The chemical composition of particles is very complex and depends on emission sources, meteorological conditions and their aerodynamic diameter. Several epidemiological studies have demonstrated that exposure to PM of varying size fractions is associated with an increased risk of respiratory and cardiovascular diseases. Adverse health effects have been documented from studies of both acute and chronic exposure. The most severe effects in terms of overall health burden include a significant reduction in life expectancy by a several months for the average population, which is linked to long-term exposure to moderate concentrations of PM. Nevertheless, numerous deaths and serious cardiovascular and respiratory problems have also been attributed to short-term exposure to peak levels of PM. Although many studies attribute greater toxicity to smaller size fractions, which are able to penetrate deeper into the lung, the molecular mechanisms and the size fractions of the PM that are responsible for the observed diseases are not completely understood.

Abstract

Background

Health-related quality of life (HRQoL) is measuring a patient’s experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.

Methods

A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient’s HRQoL as an independent variable.

Results

871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).

Conclusion

This study has been performed on a specific group of patients, not being “really sick”, but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.

Efficiency of community based intervention programme on keeping lowered weight

Objective: To establish the effectiveness of community based intervention on lowering and sustaining weight.

Methods: We performed a longitudinal retrospective study in three primary care centres in Slovenia. 333 men aged 35 to 65 and women aged 45 to 70 with body mass index higher than 25 kg/m2 and high risk for cardiovascular diseases or with body mass index higher than 30 kg/m2 were included. The data for the analysis were extracted from the forms of National cardio-vascular disease prevention programme. Long-term follow-up of their weight was performed 12 to 24 months after the intervention.

Results: The inclusion criteria fulfilled 250 (75%) participants. During the programme the participants' weight lowered by a mean 6.7 kg from 95.5±15.1 to 88.8±14.7 kg (7.1% of the entry body weight, 95% CI: -7.2 to -6.1 %). One to two years after the intervention 62.8% of the participants could not keep the weight they achieved during the intervention phase. Mean regain of the weight was 1.6 kg, (23% of the lost weight, 95% CI: 0.8 to 2.4 kg). Initial body weight of people, who long-term succeeded to keep achieved weight was higher than initial body weight of those people, who regained weight after the programme (t=3.490, P= 0.001) Gender and age did not show any statistically significant impact on long-term weight gain.

Conclusions: The intervention programme was successful by the criteria that weight reduction should be at least 5-10%. Majority of the participants could not sustain the reduced weight, but the mean weight gain was less than one fourth of the weight, lost in the intervention period. Besides the interventions for weight reduction also the longterm programmes for sustaining the achieved weight loss are very important.

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