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Posts Tagged ‘hypertension’

Obesity is a major factor (be flexible) that affect blood pressure and also the development of hypertension. Approximately 46% of patients with a BMI of 27 are hypertensive. Framingham study has found that an increase of 15% body weight can cause an increase in systolic blood pressure by 18%. Compared with those who have normal weight, people who are overweight with excess body weight by 20% have a risk eight-fold greater against hypertension.

Hypercholesterolemia and Obesity
Abnormal levels of  blood lipids closely associated with obesity. Approximately 38% of patients with a BMI of 27 is patients with hypercholesterolemia. In this condition, the ratio between HDL (High Density Lipoprotein) and LDL (Low Density Lipoprotein), tends to decrease (which generally increased triglyceride levels) that increase the risk of Atherogenesis.
Framingham study showed that for every 10% increase in body weight there was an increase of plasma cholesterol by 12 mg / dL.
From NHANES II data also found that the risk of hypercholesterolemia (serum cholesterol 250 mg / dL) on Americans who are overweight is 1.5 times greater than in normal individuals aged 20 to 75 years.

Comorbidity

• Coronary Heart Disease (PKH): Approximately 40% of CHD events occur in someone with a BMI above 21, so the disease is actually preventable.
• Stroke: Overweight is a major risk factor for stroke. Obesity (especially around the stomach / abdomen) may increase the risk of stroke (this condition does not depend on the amount of BMI).
• Pouch Disease Gall: The obese tend to be more susceptible to gallstones.
• Osteoarthritis (OA): Overweight associated with OA in the hand and knee joints. However, the limited ability to exercise in patients with osteoarthritis also to the role of the incidence of overweight.
• Cancer: Obesity can increase the risk of certain cancers. A study conducted by the American Cancer Society explained that the deaths caused by prostate cancer and rectal-colon (colorectal) increased in obese men, whereas endometrial cancer, uterus, cervix (cervical), and ovary (ovaries) increases in obese women. Compared with normal weight women during the post-menousal, obese women have a higher risk of breast cancer.
• disorders (disorders) such as: Obesity is also associated with varieses vein, several hormonal disorders and infertility.

Overweight and Obesity is closely associated with an increased risk of several complications that can occur alone or concurrently. As mentioned earlier, it can be comorbid hypertension, dyslipidemia, cardiovascular disease, stroke, diabetes type II, gallblader disease, respiratory dysfunction, gout, osteoarthritis, and certain types of cancer. Chronic disease that most often accompanies obesity is type II diabetes, hypertension, and hypercholesterolemia. Data from NHANES (National Health and Nutrition Examination Survey) III, from 1988 to 1994, showed that two-thirds of adults overweight and obese patients (BMI 27) suffered from at least one of the many chronic illnesses and 27% of them suffer from two or more diseases.

Furthermore, the impact of obesity is growing komorboditas in line with the increase in BB patients, be it the risk of incidence, prevalence and severity, which generally deal directly with BMI. Epidemic studies have found a linear relationship between body weight and the risk of increased mortality and morbidity. In fact, comorbid chronic disease is a major risk.

Obesity and Type 2 Diabets

NHANES III states that approximately 12% of people with a BMI of 27 have Type 2 diabetes. Type 2 diabetes is a type of diabetes is most often encountered, which is about 85% – 90% of all diabetics. Obesity is a major risk factor in type 2 diabetes. As many as 80% of obese patients suffering from the disease.

“The prevalence rate (for diabetes type 2) increases with increase of age and increased BMI, both in women and in men.”

The level of risk also increases with increasing BMI in adult patients (see picture above). For example, one study in women aged 30 to 50 years – the age susceptible to type 2 diabetes – showed that the rate of type 2 diabetes risk in women with a BMI of 22 is 15.8, to 27.0 BMI is 28.9, and for BMI 31.0 – 32.9 is 40.3. Compare these figures in women with a BMI of 35.0 which is much higher, namely 93 times, against the promotion / development of type 2 diabetes.
For those who are overweight around the abdomen (abdominally obese), one of the mechanisms thought to be a predisposition to type 2 diabetes, is the release of free fatty acids rapidly, which originated from an enlarged visceral fat. This process describes the circulation of high levels of free fatty acids in the liver so the liver’s ability to bind and extract the insulin from the blood is reduced. This can lead to hyperinsulinemia. Another result is an increase in gluconeogenesis – which increase blood glucose.

The second effect of increased free fatty acids is inhibited by glucose-making muscle cells, thus, walalupun insulin levels increased, but remained abnormally high blood glucose. This explains a physiological resistance to insulin as found in type 2 diabetes.
The above situation is part of a complex metabolic disorder called insulin resistance syndrome, or syndrome X. In the case of insulin resistance, its features are hyperglycemia, hypertension and changes in lipoprotein levels and composition – which increases the risk of coronary heart disease.

A chronic illness is one that for a long period of time or over a longer period again and again occur. Some of the most common chronic illnesses are asthma and high blood pressure (hypertension).

# What are chronic diseases?
# The prevention and treatment at the level of primary
# Asthma: prevention, treatment and control
# Hypertension: prevention, treatment and control

WHAT IS CHRONIC DISEASES?

Chronic diseases can be hereditary, but it is known that various lifestyle and environmental factors such as smoking, inappropriate diet, lack of exercise and excessive alcohol consumption risks are significantly increased. These factors are to some extent within the control of a well-informed person, but there are often other factors such as poverty, malnutrition during pregnancy and the babajare, genetic susceptibility / predisposition and age, which the individual is little or no control not.

Besides early diagnosis, treatment and control of damage is the focus of the service largely on preventing disease and promoting healthy behavior.

Chronic diseases that priority is high blood pressure or hypertension, asthma, epilepsy, stroke, kidney disease, cancer, obstructive lung disease and Diabetes Type 2. (Diabetes Type 1, which are mostly in early childhood is diagnosed, are less common.) Most of these diseases is langtermynsiektes and, although many of them can be cured, they can be controlled.

People of all ages are affected by chronic diseases, but the risk of a chronic disease development is higher among the elderly, so the likelihood of chronic illness to physical disability may result.

PREVENTION AND TREATMENT ON THE LEVEL OF primary

At the level of primary health care service based on prevention, by people on the benefits of a healthy lifestyle to educate. Each clinic has a staff that has the skills to manage chronic conditions in patients of all ages to diagnose and to treat them. It is possible for patients to achieve the same nurse for follow-up visits to see if they will set the kliniekdag for diabetes, hypertension or asthma report. They receive a special card or sticker on their file that is used to ensure ongoing health. Counselling and pasiëntsamewerking also part of the service. Doctors / medical officers visit from time to time, clinics for patients with chronic diseases to evaluate.

Arrangements by the clinic patient taken to the minimum (especially for the elderly) through a stock means to write one to three months will hold. The staff often facilitate the formation of clubs and special support groups for people with chronic diseases. This is a patient the opportunity to learn about special care and health education about their condition, respectively.

If complications arise, be patient to the next level of health care related.

Examples of how chronic diseases management and treatment are given below

Asthma affects adults and children. It is a chronic inflammation of the airways and by an allergic cause. Asthma is not cured, but can be effectively treated by daily preventative medication to take. The evaluation and treatment of adults found at primêregesondheidklinieke place where clients are examined, special investigations performed and treatment prescribed. Clients are educated about how to manage their asthma and informed about factors that could worsen as cigarette smoking, lack of exercise and huisstofmyte. For customers who are serious asthma attacks, have to emergency treatment and referral to a hospital required.

Hypertension or high blood pressure is a lewenstylsiekte found and can be treated. If blood pressure remains high for too long, can cause serious complications. This could be the blood vessels, heart, kidneys and eyes affect. The effects of hypertension can be stroke, heart disease or kidney failure and even death included. At the level of primary customers will with high blood pressure be informed of how their general health improvement and other risk factors for heart disease reduction, eg. exercise to get the smoking to abandon the use of alcohol and drugs to stop, and to reduce salt intake. If blood pressure remains high after this, treatment will be prescribed. For regular investigations and medication should customers clinic visit. Serious complications as stroke, heart disease and renal failure should be treated at hospital.
Chronic health services at all three levels – primary, secondary and tertiary – facilitate the delivery of welsynsdienstoelaes to people who need them.
Instructions:
These services are available at all clinics and hospitals throughout the Western Cape is available. If you are a new visitor to the clinic or secondary or tertiary hospital, you will be asked to create a form, after which a file is opened for you to be. You must remember your ID book to bring together. When you visit a hospital, a referral from the clinic is required. The hospital also require your most recent payslip or income tax assessment (IRP5). If you are already at the hospital is registered, bring your hospitaalkaart together.

Introduction:

Chronic diseases are the leading cause of death worldwide, and continues to impact on the health of the world’s population is increasing. Die approximately 17 million people around the world each year as a result of chronic diseases.

In the past, rich and civilized communities are most at risk of high blood pressure, high cholesterol, tobacco use and excessive consumption of alcoholic drinks and the prevalence of obesity and lifestyle based on lack of exercise and physical activity. However, these risks and associated diseases is spreading in middle-income countries or low,

No longer limited to rich countries as it was widely believed in the past. Even more than that, it cause the double burden of developing countries is added to the burden of infectious diseases that continue to affect strongly on the poorest countries in the world.

Can be for one or more of the risk factors listed above contribute to the onset of any chronic diseases, which include diabetes and cardiovascular disease (including hypertension and strokes), cancers and chronic lung diseases. The increasing prevalence of these diseases are responsible for about 60% of deaths in the world (31.7 million deaths) and 43% of cases of the disease in the world. The share of middle-income countries or low 77% of the total deaths and 85% of the total conditions linked to chronic diseases. The mortality and morbidity of these has been growing in the world with what was done to the inherent dangers of the economic and social development of the various peoples of the world, along with the cause of disability and mortality of millions of people. It is clear that the increasing impact of these diseases is linked to the change on the patterns of global nutrition and increased consumption of processed foods with a high content of fat, salt and sugar. The noted Palestinian Ministry of Health in its annual report for 2003 that it considered that chronic diseases caused by nutrition, unhealthy eating habits are no longer as serious as diseases resulting from lack of nutrition.
The development of chronic diseases in Palestine:

Palestine undergoing transition in terms of epidemic diseases, as well as in terms of food consumption patterns, which accompanies the aggravation of the impact of chronic diseases on Palestinian society, especially diabetes, hypertension, cardiovascular disease, cancer and others. While this continues, it is still suffering from the traditional communicable diseases and environmental problems.
The risk factors related to chronic diseases common in the Palestinian society. Tobacco consumption is one of the highest in the world, as well as spreading food intake rich in saturated fats and simple sugars, as well as lower consumption of foods rich in fiber and whole grains and complex carbohydrates.

There is evidence of high prevalence of some chronic diseases in Palestine. The prevalence of type II diabetes is estimated at about 10%. In the absence of any detailed and reliable data on the prevalence of chronic diseases and risk factors of injury in Palestine, the data collected through medical relief services are frighteningly relevant to the prevalence of these diseases. These data were the result of five years of work in the Ramallah area (mainly in the villages), where a team of a program for the prevention of chronic diseases will collect data on these diseases and risk factors related to it. Frequency of the service people over the age of 35 years on a voluntary basis were examined sugar in their blood, as well as the level of fat, blood pressure, weight, height and other risk factors. After collecting data for about 6000 people and analyzed (Fig. men 69% of the total and women 31%), the data indicate the presence of hypertension in 27% of them, and type II diabetes in 18% of them, with the back of disorder level of fat in 40%.

Chronic diseases are the leading cause of death among adults in the Palestinian society. The report of the Ministry of Health in 2001 indicates that diabetes, cancers, cardiovascular diseases, including hypertension and stroke, contribute to more than 50% of the causes of death among adults. If we take into account the current situation of health services and high levels of poverty, it becomes clear to us how much is imperative that special attention is paid to disability resulting from chronic diseases.

Chronic disease program in medical relief:

Established a medical relief program in 1999 in response to the growing need to combat chronic diseases. The program focuses on early detection of chronic diseases and improve the practices used in dealing with them. It was in 2000, and the generous support of the Austrian Government, the establishment of pilot follows an integrated approach in dealing with chronic diseases. In 2005, the Austrian Government supported a new phase in the work of the Centre and the Programme of chronic diseases. This represents an extension phase of the achievements that have already been achieved in the past five years, which will expand chronic disease management services to include new centers for primary health care. The evaluation team felt that the values of the Austrian program in 2004 that medical relief has largely succeeded in building a health model for prevention of chronic diseases can be implemented and integrated in all primary health care centers easily.

The program provides its services through:

• mobile clinic, which focuses on screening and early detection of chronic diseases and risk factors. Working in the Ramallah area and contribute to the delivery of services to the villages and sites disadvantaged and remote areas or those living in difficult circumstances closures and curfews.
• Centre of chronic diseases in Ramallah, which works to adapt a holistic approach in the management of chronic diseases.
• Dealing with chronic diseases in primary health care centers of medical relief in various parts of the West Bank, with the hope of expanding this service to include the Gaza Strip as well.

The number of visits to the beneficiaries of the program’s services to primary health care centers 7000 visit of both sexes. The program began implementation of the plan to better control diabetes in three locations, is the authorization and Aboud, Sinjil. Within the plan, to be followed up 400 patients in these three clinics, and hold them to check your blood sugar free, as are follow-up cases, depending on community participation in the Plan of case management.

Accordingly, the formation of groups of patients and their families and their members to work together to improve awareness and control of the disease in these patients. Although it is too early to judge the experience, but that the results of tests after three months and six months indicates an improvement in the situation of patients compared with the results of preliminary tests.
Centre for Chronic Diseases:

The Center is one of the best-equipped health centers in the Ramallah area and has the technical capacity available to serve as a diversion for patients with chronic diseases. The work of the Centre on prevention, early detection and proper management of chronic diseases.
The members of the crew of the center of scientific competence and the overall experience required by the program. They received the necessary training to their work, and they keep in touch with an academic at the Institute of Community and Public Health at Birzeit University.

Strategy:

The overall objective of the program: to contribute to reducing economic and social burden of chronic diseases on Palestinian society.
End of the program: develop the capacity of 60 clinics to primary health care in the prevention of chronic diseases, early detection and management to become a model in the proper handling of chronic diseases in Palestine.

Output of the program:

1. Develop the capacity of 60 doctors and a doctor and 120 nurses and health worker in the 60 clinics (including the centers of primary health care of the Ministry of Health and institutions of another civil), including help to improve the treatment of chronic diseases through a holistic approach and provide guidance for patients with chronic diseases.
2. System for transfer of patients to the center of chronic diseases.
3. Raise the level of community awareness about chronic diseases in 60 locations in four large-scale campaigns.
4. The introduction of chronic disease management programs in the policies and strategies of the main subject (the other parties to provide health care) in a clear and explicit.

Program Description:

The program will seek to build on the accomplishments already achieved in the period 2000-2004 through the work of medical relief on the implementation of the previous phase of the program. During that period, the medical relief succeeded in building a model for the prevention of chronic diseases and provide care for the target groups. Also succeeded relief to build on the rich experience in working with rural and urban populations using a holistic approach that combines preventive and curative services at primary, secondary and promotion of healthy lifestyles, taking into account the circumstances of psychological pressure constant caused by the political situation an emergency and cultural considerations of the Palestinian society.

Components of the second phase of the program:

Program strategy consists of three major components contribute to jointly build the capacity of primary health care centers to deal with chronic diseases.

Focus of the first component of the program to build technical capacity and logistics in 60 clinics over three years. This includes providing support and training for doctors, nurses and health workers on best practices in dealing with chronic diseases. In addition, the program will contribute to provide clinics target equipment, equipment, manuals and medical reference on prevention and early detection of chronic diseases.

The program will also transfer system for cases that can not be dealt with at the level of the targeted clinics, so it is converted to the center of chronic diseases in Ramallah. It is worth mentioning that the program has developed a computerized management information system to improve communication, reporting and collection of data regarding the management of chronic diseases.

The second component includes activities aimed at raising community awareness about domestic measure of chronic diseases. The implementation of these activities in parallel with capacity-building activities to ensure coordination and complementarity in the efforts to achieve the overall objective of the program.
The third component aims to improve the level of coordination among the providers of health care in Palestine will contribute to the improvement of dealing with chronic diseases. This coordination aims mainly to facilitate the transfer of knowledge accumulated by the medical relief during the past five years in the management of chronic diseases so that the benefit of primary health care facilities run by other national health institutions. This will be coordinated with the component-oriented activities to build capacity.

Heart disease in children (congenital heart disease):

It is estimated that one child out of every 1000 children born alive to suffer from congenital heart disease. Although the magnitude of this health problem and cause suffering, but it does not exist in Palestine of a specific policy to deal with them.

Our program has sought to deal with this issue since 2002 in order to alleviate the suffering of sick children and their families, through the introduction of specialist visits and sending children for treatment abroad.

Has been since the beginning of this year, the organization of the jurisdiction of a monthly clinic to serve these patients, offering early detection of congenital heart disease, diagnose, and assist in providing opportunities for surgical treatment and provide follow-up mechanisms. To this end, the Palestinian doctor from the city of Nazareth, a specialist heart disease in children visited the center in Ramallah for the detection of these children.

This service has helped reduce the burden on the families of these children and provided them traveling to Nazareth in order to detect when the doctor in charge. This doctor detects 10 to 14 children at each visit. Is also providing the necessary services to a number of additional patients by heart disease clinic run by the Centre within his habitual