Prim. d-r PhD. spec. of sports medicine by Rabia06

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									          CINDI HEALTH MONITOR SURVEY -
           AN INTEGRATED PART OF CINDI
          CONCEPTUL MODEL IN MACEDONIA,
                       2002



            Prim. d-r                           PhD.
             spec. of sports medicine - nutritionist

       Lazar Licenovski 13 1000 Skopje phone ++389-02-225-402

                     mfh.cindi@makedonija.com



INSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIA

                                                                  1
 Community        and      primary     care-based
demonstration project for health promotion and
noncommunicable diseases (NCD) prevention has
been prepared as an integrated part of conceptual
model for CINDI National Programme.

    Republic of Macedonia is in the process of
joining CINDI and implementing the CINDI concept
through the process of health care reform.

     In focus of the reform in primary health care is
the implementation of health promotion and NCD
prevention measures in preventive practice of
“family” doctors.
                                                    2
    The purpose of the study:

1. To analize professional reasons that justify realization
of the CINDI Programme based on information of health
status in the Republic of Macedonia.

2. Assessment of national capacity in primary health
care to realize CINDI project on promoting healthy
nutrition and physical activity in different age groups.

 3. The role of National Health Autority in CINDI team
to confirm the Macedonian CINDI-Plan of action in
health promotion heart disease and other chronic disease
prevention in related to physical activity and nutrition
over the next 5 year.
                                                         3
  Methods:
  1.-Secondary data obtained from mortality/morbidity
statistics in the Republic of Macedonia (1990-2001).
     -The results for family aggregation of common risk
factors for chronic diseases obtained from medical research
(BMI Systolic/diastolic BP T.Chol. TG HDL LDL Glyc.
smoking decreased VO2max dietary habit and stress) in
randomized simples (Demonstation Projects 1990 and 1998).
  2. National capacity in primary health care obtained from
WHO questionnaire connected with “Assessment of national
capacity for noncomunicable disease prevention & control” in
2001 year.
   3. Protocol and quidelines about CINDI principles and
strategies for health promotion and disease prevention (WHO
CINDI publications).
                                                         4
    Results and Conclusions:
  1. NCD are the main cause of morbidity and mortality
during the last 10 years in the Republic of Macedonia.
    ( figures-1 and figure-2).

    In the last three decades the cardiovascular disease,
esspecialy coronary heart disease, malignant neoplasm's,
and diabetes mellitus remains the most common cause of
death for the Macedonian population.

      In 1972 mortality from them accounting for 37% from
total mortality, and year by year this percentage has
increasing significantly up to 55.6% in 2001 with
continuous trend to this days.
                                                      5
  Figure 1. Mortality rate from noncommunicable diseases
            in The Republic of Macedonia for the period 1991-
            2001 up to 100.000 population

500
450
400                        464.9      464.9     458.7     468.6
350
                 385.9
300    359.5
250
200
150
100                                   140.5     142.6     150.3
                           129.5
 50    108.3     111.4                                      KVB
  0
                                                            Cancer
       1991      1993       1995      1997      1999      2001

                                                                  6
Figure 2. Morbidity rate from circulatory diseases in the Republic
          of Macedonia up to 100.000 population

                                         Hypertensia
  25000                                  Ischemic hard disease
                                         Cerebro vascular
  20000                                  Circulatory diseases


  15000



  10000



   5000



      0
          1972 1978 1984 1990 1991 1992 1993 1994 1995 1997 1998



                                                                 7
    The results of common risk factors for
NCD include:
   1. BMI     distribution   varies    significantly
according to the stage of transition of a country.
     Figure-3 illustrates the tendency for rapidly
increase in the proportion of the population with
high BMI than the proportion of the population with
low BMI in the early stage of transition.
     The distribution of BMI tends to change again
in the later phases of transition with an increase in
the prevalence of high BMI among
 the poor.


                                                    8
Figure 3. BMI Distribution in adult population in Skopje
          in the last 10 years (1990-2000 year)




                                                           9
Figure 4. Prevalence of systolic and diastolic blood pressure
          in adult population in Skopje




       systolic BP                      diastolic BP
                                                                10
             Figure 5. Prevalence of risk factors for NCD in adult
                       population from central region in Skopje

80
                                                                                                                      75
%

60


40                                                                                                        35.9                         35.2
                                               28.8                                                                             28.2
                              23.8      23.4
20            14.2     18.2                                                   15.8           18.2
     12.5
                                                               3.7
                                                         2.5
0
                                                                                         0
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                                                                                                                                        11
   2. There are great potencial within primary
health care to realize CINDI project for health
promotion and the primary prevention of major
chronic diseases through changes of lifestyle
of the population such as increased physical
activity and balanced     diet (average 1488
population per one MD).

    The territory of Republic of Macedonia is
divided into five regions with distrinct centres
for the implementation of all NCD related
preventive activities ( figure 6).


                                                   12
Figure 6. Organizational         structure – CINDI
                                           HEALTH
MONITOR SURVEY CENTRES in the Republic of Macedonia



                                16
                                7    167
             1877
              1877

                     14
                     9    149

                                               15
                                               0     150


             38
       222   4

              389


                                                           13
  3. The role of the Macedonian Health Authority
in CINDI - team is to accept an alternative
classification system for prevention strategies aimed
at chronic multifactorial conditions.
   This is based on three levels of preventivntion
directed at everyone in the population (public health
promotion) an above/average risk groups (selective
prevention) and at high-risk individuals (targeted
prevention).
    In this new scheme promotion and prevention
are used to describe those action that occur before
the full development of the condition.


                                                  14
    This project form a link between precede
medical research and the application of new index
as mathematical model for predicting the effects
of non-pharmacological     interventions in   the
population at above/ average and high risk for
NCD such as truncal obese individuals with
atherogenic risk factors.

       Logistic model in form of equation is:
    ln “RR” =108.2588–1.7689  DKN-B in +1.7087 -
              BMI in+0.3993- Hb 2.9423-VO2max OPV
–
            10.5402 WHO in + 0.0770-50% kcal/h
                                                  15
   Exponent B can be interpreted in terms of relative risk
(“RR”) in cohort studies. The proposed non-pharmacological
intervention    is   hypocaloric hiperprotein  diets   of
1200kcal/d and 1400kcal/d (second phase) since the
relative risk is less than 1 (ln“RR”<1).
   Increased physical activity by the recommendations of
ACSM (1993) and CDC (2001)         statistically significant
promotes development of VO2max.
    Change in level of VO2max at 17.16% from baseline
promotes significant greater reduction in level of WHR OS
sm %fat (%M) body weight (TTkg) LBM kg BMR kcal/d
and LDL/HDL in PAD(physical activity and diet) than
those in D (diet) group obese subjects
(figure 7).

                                                        16
   Figure 7. Change in level of VO2max and “major” risk factors for NCD in FAD
          (physical activity and diet) and D (diet) group of truncal obese subjects

                                                                                                                      25 %
                                                                               VO2max
                                                                                17,1    14,8
                                                                       HDL                                            15
                                                                      10,4

                                                                                                                      5
  TT            %M         LBM       WHR           OS      LDL/HDL                             %FAI          BMR

                            -1.8                                                    VO2-OPV
                         -3,3             -3.3                                                                  -3.1 -5
       -5.3                        -4,5             -5.6                                                 -5,2
                  -6.3
-7,9                                             -9,5          -7.7     -9.3                   -10,2
              -10,3                                                                                                   -15


                                                                                                                      -25
                                                                                                       FAD
                                                           -28,6                                       D
                                                                                                                      -35


                                                                                                                 17
                     SINDI PROGRAMA VO MAKEDONIJA-KONCEPTUALEN MODEL

                                         Ministerstvo za zdravstvo
                                         Koordinativen SINDI Centar


                                                  Administrativen del


                                          INTERVENTNI         PROCESI

  primeneti         demonstaciono                                                           komunalno
                                                      primeneti
 od                     podra~je                                                               nivo
                                                     od SINDI
zdravst.             randomizirani                    programata                           populaciono
   slu`bi                 grupi
                                                                            nezavisni                    promenlivi
                grupi (pol vozrast)               -znaewe                  varijabli                     varijabli
               lokacija(u~ilkolekt)               -na~. na
                                                   odnes.
                                                   -semejstvo
inic. indikatori:                                                       -aktiviranost
                                                   -kultur. nivo
1.morfo-fiziolo{.                                                          na zaednica
                                                   -socij.podr{                                      1.li~ni zdravst.
 rizik-faktori :                                                        -masovno
BMI; WHR                      fin. indikatori:                                                          karakteristiki
                               1. rizik-faktori
                                                                        vklu~                        2.socio-demogr.
HTAmmHg; fc-mir/max                                                      organiz. grupi
Tot. holest; TG                2. morbiditet na                                                          karakteristiki
                                                                           i individui
HDL2-holest                     “major” HNB                                                         3.socij.okolina.
                                                                        -skrining na:
VO2 max METTs.                3. mortalitet                            rizik-faktiri
2.rizik- faktori
                                                                        edukac./promo         SINDI-Konceptualen model
 na odnesuvuvawe                                                        c                     Makedonija 2002 godina
:
                                        MONITORING II EVALUACIJA
                                                      EVALUACIJA                              Prim.dr Simovska Vera PhD
ishrana; pu{ewe
hipokinezija.                                                                                                   18

								
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