Risk factors of chronic non-communicable diseases and the role of educational programmes in the prevention and treatment of arterial hypertension

The dissertation is devoted to the study of the prevalence and structure of risk factors of chronic non-communicable diseases among the organized population, as well as to the evaluation of the effectiveness of educational programmes in the prevention and treatment of arterial hypertension. On the basis of a comprehensive clinical-epidemiological examination of industrial enterprise workers and medical workers, an analysis was carried out of the frequency of such risk factors as arterial hypertension, smoking, excess body weight, low physical activity, anxiety, and low adherence to drug therapy. Particular attention is given to the development and implementation of various types of educational programmes ("in-person cardio-school," "distance cardio-school," "Year of Health" school) aimed at the formation of compliance, the improvement of quality of life, and the enhancement of the psycho-emotional state of patients with arterial hypertension.

The practical significance of the work is determined by the possibility of using the proposed training programmes in the system of clinical screening of the working population for the primary prevention of chronic non-communicable diseases and the correction of behavioural risk factors, as well as for increasing patient adherence to treatment and to medical recommendations.

Relevance of the problem. Among therapeutic-profile diseases, respiratory, circulatory, and digestive diseases predominate in terms of morbidity and mortality. Epidemiological studies conducted since the early 1970s have demonstrated the wide prevalence in the adult population of risk factors common to many non-communicable diseases (Chekhonadskaya N.I., 2003). Modern living conditions influence the growth of psychosocial and behavioural factors contributing to the development of diseases. According to the data of Ivchik T.V. (2003), representatives of low-income groups and persons engaged in heavy physical labour, especially in cold climatic conditions, as well as smokers, more frequently suffer from obstructive airway diseases. It is known that in persons with low physical activity, coronary heart disease develops 2.5 times more often than in persons leading an active lifestyle (Oganov R.G., 2005). At present, among outpatients there is a low level of adherence to physicians' recommendations in chronic non-communicable diseases, which in foreign practice is defined by the concept of compliance. It is known that compliance directly determines the effectiveness of treatment (Belevsky A.S., Meshcheryakova N.N., 2003; Neitel J., 2003). The low adherence to systematic medication intake and to a healthy lifestyle in patients with arterial hypertension necessitates the development of non-pharmacological methods for the correction of risk factors. Participation of patients in an educational programme shapes a proper understanding of the disease itself, of the risk factors for the onset and progression of arterial hypertension, and also teaches control over treatment and promotes the correct fulfilment of medical recommendations. One of the progressive methodological approaches, as well as being associated with the new healthcare concept of clinical screening of the working population, is the development and introduction of technologically new methods for the prevention of non-communicable diseases in the form of various educational programmes. To achieve this goal, taking into account foreign experience as well, we attempted to adopt the positive features of existing educational programmes and to fill the missing data with our own research.

Aim of the study. To evaluate the effectiveness of correction of the main risk factors of chronic non-communicable diseases among the organized population using different types of educational programmes in patients with arterial hypertension.

Tasks

1. To establish the frequency of the main risk factors of chronic non-communicable diseases among the organized population and to identify the characteristics of these indicators.

2. To determine the relationship of a number of risk factors (excess body weight, smoking, anxiety, adherence to drug treatment, asthenia, etc.) in persons with different attitudes towards physical culture and sports.

3. To evaluate the clinical effectiveness and impact on risk factors of different types of educational programmes in patients with arterial hypertension.

4. To identify the influence of different types of educational programmes on the psycho-emotional sphere and on quality-of-life indicators among school attendees.

Scientific novelty. Based on the results of a comprehensive clinical-epidemiological examination, a high frequency of risk factors of the main chronic non-communicable diseases has been revealed, as has low awareness among workers of industrial enterprises about the presence of arterial hypertension, the harm of smoking, alcohol abuse, and excess body weight, and a direct relationship between psychological status and the presence of disease has been established. Persons with low physical activity display a high level of personal and situational anxiety, physical and mental asthenia, and a low level of adherence to the prescribed drug therapy. Specific features of the psychological type of smoking have been identified: among industrial enterprise workers the "relaxation" type predominates, while among medical workers the "support" type predominates.

The various types of educational programmes that were developed and conducted ("in-person cardio-school," "distance cardio-school," "Year of Health" school) have demonstrated their effectiveness — a decrease in the level of arterial hypertension in patients and an improvement in their adherence to treatment were observed. It has been established that the most effective influence on the formation of a healthy lifestyle, adherence to treatment, and quality of life was found among attendees of the "in-person cardio-school."

Practical significance. The identified characteristics of risk factors of chronic non-communicable diseases constitute the scientific basis for the development of measures for primary prevention and their correction. The revealed specificity of behavioural risk factors, including those related to the level of anxiety, the type of smoking, and compliance, determines the need for appropriate psychological support from the attending physician. The developed educational programmes for patients with cardiovascular diseases contribute to the reduction of clinical manifestations of diseases, to a positive attitude towards the fulfilment of medical recommendations, to an improvement in quality of life, and to an improvement in the psycho-emotional sphere of the patient. A methodology for the prevention of arterial hypertension has been developed in the form of different types of training — "in-person cardio-school," "distance cardio-school," "Year of Health" school — for the implementation of educational programmes in patients with different opportunities to attend the polyclinic.

Statements submitted for defense

1. A high frequency of CND risk factors has been revealed: arterial hypertension, smoking, excess body weight, a sedentary lifestyle, a low level of knowledge about arterial hypertension, and a low level of adherence to treatment among the organized population.

2. The developed educational programmes of various types reduce the frequency of the main risk factors of cardiovascular diseases and increase the compliance of school attendees.

3. The implementation of educational programmes among patients with arterial hypertension revealed that the most effective is training in the "in-person cardio-school" compared with the "distance cardio-school" and the "Year of Health" school.

Implementation of the study results into practice. The results of the study are used in the clinic of the Bashkir State Medical University, in City Clinical Hospitals No. 13 and No. 15 of the city of Ufa, and in the educational process of the Department of Polyclinic Therapy of the Bashkir State Medical University.

Approval of the work. The main propositions of the dissertation were presented at: the Conference of Scientists of the Republic of Bashkortostan "Scientific Breakthrough 2002" (Ufa, 2002), the All-Russian Scientific and Practical Conference "Actual Problems of Non-Communicable Diseases" (Moscow, 2003), the XIII National Congress on Respiratory Diseases (Saint Petersburg, 2003), the Republican Scientific and Practical Conference "Life Safety and Environmental Protection" (Ufa, 2003), the IX All-Russian Scientific and Practical Conference of Young Scientists "Young Scientists in Medicine" (Kazan, 2004), the 3rd Congress of the European Region of the International Union against Tuberculosis and Lung Diseases (IUATLD) (Moscow, 2004). The work was approved at a joint meeting of the Department of Criminology, Psychology and Medical Training of the Ufa Law Institute of the Ministry of Internal Affairs of Russia and the departments of the therapeutic profile of the Bashkir State Medical University on 21 March 2006.

Scope and structure of the work. The dissertation is presented on 126 pages of computer text and includes an introduction, a literature review, materials and methods of the study, the results of original research, a discussion of the obtained results, conclusions, practical recommendations, and a list of references. The work is illustrated with 20 tables and 18 figures. The bibliography contains 258 sources, of which 169 are domestic and 89 are foreign authors.