Preventive Health Care and Disease Prevention

In the last decades it was evident that the health problems worldwide could not be solved only by spending money for disease treatment but by creating and application of disease prevention strategies. The aim of this paper is to give a common understanding about the major tasks of the prevention medicine, about the types and activities of the prevention. It describes the differences between disease prevention and health promotion. The levels of the diseases prevention are presented. The strategies of preventive medicine, their advantages, disadvantages and interaction are explained. The paper gives information how the evaluation of possibilities for diseases prevention could be done. At the end, the reader will learn about the necessary premises for a successful preventive startegy in the policy of preventive medicine

Evolution of arterial hypertensions in children over a 25-year follow-up period

The purpose of the study is to follow the evolution of primary arterial hypertension (PAH) established in childhood in a 25-year period until adulthood and to shed light on 3 questions: dynamics of arterial pressure; changes in target organs; role of some main risk factors for the development of arterial hypertension.Material and methods: A prospective epidemiological study was conducted. The individual empirical information was collected in three consequtevie periods - in 1972-1973, 1982-1983 and 1997-1998. During the first stage, a cardiological screening and interview was conducted for 11,095 children aged 6-15, /a representative sample of the children living in the city of Sofia/. During the second stage, the evolution of PAH was followed in all children who showed increased arterial pressure in the first study. During the third stage /at the 25th year of the follow-up/, all persons with hypertension, established in the previous stages, who responded to the invitation (60.1%) were included. The examination was conducted according to a standard protocol: interview, physical examination, ECG, echocardiogram, biochemical analysis, fundoscopy. Statistical analysis includes: analysis of variance, correlation, t-test, Chi-square test, logistic regression analysis.Results:In the 11,095 children screened, aged 6-15, the following was found: arterial hypertension in 765 children - 6.89%; children with borderline hypertonia - 894 /8.06%/ and a group of hyperactive children - 1365 /12.33%/. All children from the three groups are practically healthy, with minimal vegetative dystonic complaints: irritability, headache, sweating, abdominal pain, poor sleep, etc. In the second study, a trend of retention of hypertension after 10 years was found in 111 persons with arterial hypertension registered during the screening, in 75 persons - with borderline values of arterial pressure and in 65 persons from the group of hyperactive children and normotonics, i.e. at the 10th year of follow-up, a total of 251 individuals remained with proven AH. When comparing the electrocardiographic, X-ray and the echocardiographic examination of the 10th year it was found that the echocardiographic examination has the greatest informativeness for early changes in the cardiovascular system.At the 25th year of follow-up, a high relative share of boys who retained high blood pressure values in adulthood (78.70%) was noted, compared to girls - (46.00%). Left ventricular hypertrophy (LVH) was found in 59.34% of respondents; angioretinopathy I and II degree in 37.77%; elevated cholesterol level (³ 6.20 mmol/l) – 38.61%; reduced levels of HDL-cholesterol (£1.00 mmоl/l) – 26.26%; elevated triglyceride levels (³ 2.3 mmol/l) in 12.12%. The results of the multivariate logistic regression analysis performed to assess the risk factors for the maintenance of AH showed that hypertension is more common with a combination of the risk factors: family history of hypertension, male gender, obesity and increased salt intake (RR = 11.38; 95% CI 1.26 - 22.89).Conclusion: PAH established in childhood persists in the following years of life until adulthood in one third of cases, with a slow course and progressive development of changes in the target organs. Main risk factors for the retention of AH are: family burden of AH, male gender, obesity and increased salt intake. These data indicate the need for strict control of body mass and nutrition in children with PAH who are offspring of hypertensive parents

Investing in Health and Market Regulation in the European Health Care System

The authors analyze the basic financial principles and the regulated entrepreneurship in the healthcare systems in Europe. They point out that the European countries organize, manage and finance their health care in different ways. Thus the health systems vary not only in the financial methods used, but also in the payment scheme of the insurance institution and the healthcare providers as well as the ways in which the state regulates the health services provision and the development of market relations in healthcare. Some of the most up-to-date challenges and opportunities in front of European healthcare systems are overviewed. An example case study is presented in order to illustrate the need for investing in health as well as for careful financial and regulatory planning and management

Preventive Health Care and Disease Prevention

In the last decades it was evident that the health problems worldwide could not be solved only by spending money for disease treatment but by creating and application of disease prevention strategies. The aim of this paper is to give a common understanding about the major tasks of the prevention medicine, about the types and activities of the prevention. It describes the differences between disease prevention and health promotion. The levels of the diseases prevention are presented. The strategies of preventive medicine, their advantages, disadvantages and interaction are explained. The paper gives information how the evaluation of possibilities for diseases prevention could be done. At the end, the reader will learn about the necessary premises for a successful preventive startegy in the policy of preventive medicine

Investing in Health and Market Regulation in the European Health Care System

The authors analyze the basic financial principles and the regulated entrepreneurship in the healthcare systems in Europe. They point out that the European countries organize, manage and finance their health care in different ways. Thus the health systems vary not only in the financial methods used, but also in the payment scheme of the insurance institution and the healthcare providers as well as the ways in which the state regulates the health services provision and the development of market relations in healthcare. Some of the most up-to-date challenges and opportunities in front of European healthcare systems are overviewed. An example case study is presented in order to illustrate the need for investing in health as well as for careful financial and regulatory planning and management

Cardiovascular risk assessment of Bulgarian urban population : cross-sectional study

To assess the total cardiovascular risk of the Bulgarian urban population. Methods A representative sample of Bulgarian urban population (n=3810, response rate 68.3%) from five Bulgarian cities was inlcuded in a cross-sectional observation study performed in 2005-2007. A detailed cardiovascular risk assessment was performed by general practitioners and a total 10-year risk of a fatal cardiovascular event was estimated according to the European Systematic Coronary Risk Evaluation (SCORE, HeartScore®). Results There were 48.7% of participants in the high risk group (SCORE≥5%), 24.3% aged 45-54 and more than half aged 55-64 years. Nearly a quarter of the sample had a total cardiovascular risk of over 10% (SCORE≥10%), whereas 10.1% of the sample had excessively high cardiovascular risk (SCORE≥15%). In the 65-75 age group, the prevalence of men with excessively high risk was 46.6%, compared with 6.0% in women (P<0.001). Most of the main cardiovascular risk factors were slightly increased or borderline in comparison with clinical thresholds. Conclusions Cardiovascular risk is high in a large proportion of Bulgarian urban population, especially in men aged over 65. These findings indicate that a comprehensive national strategy and program for management of cardiovascular diseases is urgently needed. The SCORE method can be well implemented if a higher threshold for a high risk group is defined and smaller target population is planned for extensive and expensive high risk preventive measures