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Îm b ă tr â nire s ă n ă toas ă î n Rom â nia: himer ă sau obiectiv realist pentru medicina de familie ?

Conferinta Asociatiei Medicilor de Familie Bucuresti – m artie 200 6. Îm b ă tr â nire s ă n ă toas ă î n Rom â nia: himer ă sau obiectiv realist pentru medicina de familie ?. Prof. Dr. Radu Negoescu Memb ru de onoare al Academ iei de Stiinte Medicale

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Îm b ă tr â nire s ă n ă toas ă î n Rom â nia: himer ă sau obiectiv realist pentru medicina de familie ?

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  1. Conferinta Asociatiei Medicilor de Familie Bucuresti – martie 2006 Îmbătrânire sănătoasăîn România: himeră sau obiectiv realist pentru medicina de familie ? Prof. Dr. Radu Negoescu Membru de onoare al Academiei de Stiinte Medicale Institutulde Sanatate Publica Bucuresti

  2. Romanian perspective on health and public health We understand, together with Prof. Iuliu Moldovan (1947 * – Institute of Hygiene in Cluj), “ that health not only includes the physical, mental, and moral taken together, and also not only the present, but also the future, embracing individual’s entire lifespan or series of generations to come - when we are thinking of family or nation. So that Public Health is the state of biological integrity: that is physical, mental and spiritual, not only in the present but also in the future, for the whole population of a country” *Compare with the definition in the 1949 Constitution of the World Health Organization (WHO) : “Complete wellness from the physical, mental, and social points of view”.

  3. Improvement or renewal of human being* become topical in the last decades for life sciences equally, particularly for preventive medicine. * Theologically it is considered the way to Salvation: “…you have to get clothed into the renewed man, that following God, that built into Rightness and sanctity of Truth” (Ephesians, 4, 24). The new public health

  4. The new public health Progress inHeAlthy Life Expectance (HALE)indices, that in developed countries are quite closely tracking the veryaverage life expectance at birth, sensibly displaced the object of medicine: from the despair zone neighboring irreversible suffering & announced death towards serenecontents of health. * for example, Canada features a HALE index of 72 for an life expectance near to 80 years (source: Pfizer),

  5. HALE in Central East-European Countries The proportion of elderly people in the populations of some CEE countries is almost 50% less than the average proportion in the EU and the percentage population age 65 and over in the CEE countries is predicted at only 14.5% for 2010. In 2000, the average figure for HALE in CEE countries is 63,17 years,that is significantly lower than the EU15 average of 69,83 years. (source: Pfizer 2003)

  6. New public healthversus old medicine • Notice that: • we provisionally used fitnessfor pointing to performance + fulfillment + • happiness + beatitude+ • Salvation. • 2. death is (strictly) individual, health has clear community co-notation while fitness has definitely a social significance. 3. whereas health is a normal point on a temporal axis, fitness is projected to the future while death retrogrades to the past. Thus, nowadays individuals and health systems change the orientationfrom disease to fitness, from conservation to improvementof human species, from the past to the future.

  7. Scope of healthy ageing programs: • Infuencing lifestyles towards behaviours known as decelerating ageing processes while maintaining intellectual capability and joy of living. • Giving elderly patients, and their families, the opportunity to live independent lives longer without the need for institutional care.

  8. Is Romania ready for healthy ageing? Lets look at life expectancy at birth on Euro background:

  9. How aged people are living in Romania ? CINDI* Pucioasa study may give some hints based on a sample of 600 from the 12,000 inhabitants of Pucioasa-town featured by mixed urban-rural life style, common in Romania. *Country-wide Integrated Non-communicable Disease Intervention – an West&East new public health program led by WHO EURO. Romania entered CINDI in 1999.

  10. CINDI - PUCIOASA 600 REZULTATE Date obiective: Eşantionul conţine 564 subiecţi 272 M-bărbaţi şi 292 F-femei - vârsta: 15-64 ani cu media ( SD) 43,814,6 ani 43,715,4 M şi 4414,7 F distribuţia de vârstă dominată de maturi-vârstnici - educaţia: 10,43,8 ani 10,93,7 M şi 10,03,7 F - starea sănătăţii: 47,5 % sănătoşi, resp. 52,5 % pacienţi cronici 52,6 % şi 47,4 % M 42,8 % şi 57,2 % F

  11. CINDI Pucioasa study:Age distributions Men mean age 43.715.4 years n = 272 Mean age = 43.814.6 y(SD) Women mean age 44.014.7 years n = 292

  12. CINDI - PUCIOASA 600 Eşantionul este caracterizat prin: a) BMI (indicele de masă corporală) =25,85,5 kg/m2 (25,14,7 M şi 26,46,1 F) cu 51,5 % peste 25,0 kg/m2 – n = 563 ss; b) TAS (tensiunea arterială sistolică) = 140,231,3 mm Hg (139,429,4 M şi 140,933,0 F) cu 39,4 % peste 140 mm Hg – n = 563 ss; TAD (diastolică) = 82,517,7 (81,616,6 M şi 83,218,6 F) cu 27,2 % peste 90 mm Hg – n = 563 ss;

  13. CINDI Pucioasa study – objective data Systolic blood pressure Age-standardized prevalence 15-64 y <140  69.3% 140-159  15.1% >160  15.6% MEN WOMEN Age-standardized prevalence 15-64 y <140  67.1% 140-159  12.1% >160  20.8%

  14. CINDI - PUCIOASA 600 c) glicemia = 83,020,9 mg/dl (84,318,1 M şi82,923,4 F)cu 4,6 % peste 115 mg/dl) – n = 558; d) trigliceridele (TRIG) = 107,079,7 mg/dl (110,596,7 Mşi 97,761,2 F) cu 16,3 % peste 150 mg/dl şi 9 % peste 200 mg/dl – n = 558; e) colesterolul seric total (COL) = 180,547,2 mg/dl (173,846,7 M şi 185,346,6 F) cu 29 % peste 200 mg/dl şi 7,4 % peste 250 mg/dl – n = 555; f) HDL-colesterol (parţial pentru colesterol > 200) = 41,523,0 mg/dl (37,922,9 M şi 44,9 22,8 F) – n = 79 ss

  15. CINDI - PUCIOASA 600 . Alcoolul este consumat zilnic de 27,6 % M şi 7,2 % F iar ocazional de 59,9 % M şi 56,2 % F (incluzând băutorii pur sezonieri); nebăutori sunt 13,6 % M şi 36, 6 % F. Băutorii cu date cantitative (zilnici şi pur sezonieri) sumează 30,0 l echivalent alcool pur/an M şi 7,7 l F. Consumul mediu anual de alcool pur pe locuitor (M şi F, băutori sau nu la un loc) a fost estimat (in ipoteza că descreşterea este aceeaşi între zilnici, sezonieri şi ocazionali) la 6 l/an(10,6 M şi 1,4 F). Date stil de viaţă: Prevalenţafumatuluieste de 48,9 % M şi 26,7 % F sau 37,8 % M+F.

  16. CINDI Pucioasa study : life study data Alcohol ingestion versus age prevalence in MEN n = 274 non drinker occasional drinkerr regular drinker prevalence in WOMEN n = 290

  17. CINDI - PUCIOASA 600 NUTRITIA Bilanţul glucidic este favorabil bărbaţilor la toate epocile de viaţă, iar întrasexe există o distribuţie credibilă cu epoca de viaţă. Bilanţul lipidic global este iarăşi în favoarea bărbaţilor dar diferenţa este sensibil redusă prin compensarea între aplecarea dominantă a F spre grăsimi vegetale faţă de cea a M spre grăsimi animale. Zahăruldirect (dizolvat) se găseşte aproximativ la jumătatea recomandărilor ISPB, sugerând o anumită insuficienţă. Cantitatea medie de zahăr dizolvat pe zi este: 37,4 g/zi zahăr M şi 35,2 g/zi zahăr F. Făinoaselese găsesc uşor sub recomandările ISPB (media este de 241 g echivalent făină/zi la F şi 333 g/zi la M), media M+F=285.5 g/zi, iar Lactatele(costuri mici în submontan) par a depăşi sensibil baremurile peste tot (media M+F este 1742 ml echivalent lapte/zi). Sarea în exces apare la 20,6 % M dar la numai 9,1 % F.

  18. CINDI Pucioasa 600 Prevalenţa postului ortodox : post riguros 7.8 % M şi 10.3 % F, post sporadic 17.4 % M şi 34.6 % F; nu ţin post 69.2 % M şi 55.1 % F.

  19. CINDI Pucioasa study: life study data FAT INTAKE FROM COOKED MEALS prevalence in MEN: vegetal = 48.2 % animal = 8.1 % mixed = 44.0 % n = 274 prevalence in WOMEN: vegetal = 57.4 % animal = 8.6 % mixed = 33.8 % n = 289

  20. CINDI Pucioasa study: life study data PHYSICAL ACTIVITY AT WORK prevalence in MEN: n = 266 very high high medium light prevalence in WOMEN: n = 277

  21. CINDI Pucioasa study: life study data PHYSICAL ACTIVITY IN SPARE TIME prevalence in MEN: n = 270 high medium none intense prevalence in WOMEN: n = 288

  22. CINDI - PUCIOASA 600 În profilul preliminar efortul global (profesional+timp liber) a fost neînsemnat la 31,9 % (22,0 % F, 9,9 % M), mediu la 52,1 % (26,1 % F, 26,1 % M) şi mare la 15,9 % (4,8 % F, 11,2 % M).

  23. CINDI - PUCIOASA 600 Prevalenţahandicapuluiminor este 6,2 % la M şi 11,0 % la F, iar 9,2 % pentru M+F. Bărbaţi Femei Prevalenţastresului psiho-social este 54,3 % stres major şi 19,3 % stres minor la M; 50,9 % stres major şi 22,2 % stres minor la F. Femei Bărbaţi

  24. CINDI Pucioasa study: life study data Life-stress balance versus age MEN minorvsmajor n = 207 WOMEN minorvsmajor n = 223

  25. CINDI Pucioasa study: life study data Major Stress factors: Loss of the job and Family dissolution versus age family dissolution 1.15% loss of the job 20.8% prevalence in men loss of the job = 21.9% family dissolution = 1.1% n = 274 Total prevalence in women loss of the job = 19.9% family dissolustion = 1.2% n = 290

  26. CINDI - PUCIOASA 600 Prevalenţabolilor psiho-somaticeeste: boli cardiovasculare 30,3 % (33,7 % F şi 26,8 % M), cancere 0,9 % (1,4 % F şi 0,4 % M), tulburările şi afecţiunile psihiatrice 5,0 % (6,2 % F şi 3,7 % M). Bărbaţi Femei

  27. CINDI Pucioasa study Main psycho-somatic diseases versus age prevalence in MEN CVD/Cancer/Psychiatric n = 274 prevalence in WOMEN CVD/Cancer/Psychiatric n = 290

  28. CINDI - PUCIOASA 600 CONCLUZII. Profilul FR la unui eşantion de vârstă mijlocie-crescută din Pucioasa, evidenţiat printr-un protocol de cost minimal, sugerează un stil de viaţă mai degrabă ostil sănătăţii, astfel:

  29. CINDI - PUCIOASA 600 Stres psiho-social major,

  30. CINDI - PUCIOASA 600 abuz de alcool la bărbaţi fumat excesiv la ambele sexe, în ciuda moderării sale în alte aspecte de veniturile mici şi habitatul semi+rural asociind efort fizic para-profesional.

  31. Assets for health ageing in Romania • Ageing amidst families as opposed to institutionalized ageing in many Western countries • Spirituality: living after life acts as a potent anti-depressive • Spirituality-related aspects of life-style, e.g. applied to nutrition, smoking, alcohol, stress.

  32. Drawbacks for healthy ageing in Romania • Bad habits* traditionally imbedded in local life-styles, e,g. fat & strong alcohols in Transylvania, smoking in Muntenia, reluctance to spare-time physical activity in Moldova. • Formal spirituality, i.e. not-applied in real-life behavior (schizoidic de-dublation of personality) • General poverty * Hierarchy of commomn risk factors for NCDs is in Romania: I. stress; II. smoking & alcohol; III. nutrition & sedentarism versus international CINDI scale topped by 1. smoking, 2. bad nutrition, 3. alcohol, 4. sedentarism, and 5. stress, in decreasing order of simnificance.

  33. Is there a public interested in healthy ageing in Romania? • Prejudgment: NO, Romanians are too poor think about it • Reality: living amides families under modest pensions, healthy elderly are by far more actively involved in social/economic activities than in Western countries So, recognizing revenue proportions, healthy elderly in Romania are perhaps more prone to add extra-revenues to pensions and to invest in maintaining their good shape.

  34. Who are healthy elderly in Romania? • Liberal professions (self-employed) • (cultural and arts) Intelligentia • Clergy • Some peasants • International residents: Romanians retired from abroad, mixed families, Western pensioners seeking more natural framework (this group will rapidly evolve after 2007)

  35. How can we reach them to encourage healthy ageing ? • Daily practice, both preventive and curative, of family physicians • Physical activities campaigns, e.g. “Put your heart on its feet this fall” • Quit&Win campaigns to abandon smoking • Seniors’ Club movement • Media health promotion for seniors: • Radio Romania, e.g. “Hour of Hope” (Romania Actuality), “Life and Health” (Romania Cultural) • Special Radios, e.g. “Vocea Sperantei” (confessional) • TV channels, e.g. “Mihai Gadea’s Hour of Health” on Realitatea TV

  36. Acknowledgements: We thank to many people of Bucharest and Pucioasa who made possible the Romanian CINDI venture.

  37. Asadar, îmbătrânirea sănătoasăîn România este ohimeră sau un obiectiv realist pentru medicina de familie ? • Raspunsul se gaseste in buna masura in mainile, dar mai ales in inimile si sufletele Dvs. • Va multumesc pentru raspunsul cel bun.

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