Medical & social aspects of people’s health. The GP's role in popularization of Healthy lifestyles.

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Theme 4
Medical and social aspects of people’s health. The GP’s role in popularization
of healthy lifestyle, prevention and clinical examination.
1. Give the definition of “health”, intermediate state” or “pre-illness” and
“illness”.
Nowadays it is considered incorrect to definite “health” only as the absence of
illness. Health isn’t considered to be only a medical problem but a complex of
problems, a meaningful complicated global phenomenon .So, health is determined
as the philosophical , social, economic, biological and medical categories , the
object of consuming , the invested capital, individual and the public value, the
phenomenon of a system character, dynamic, constantly interacted with the
environment .
Generally “health” is the natural state of a human organism which is
characterized by its equilibrium with environment and absence of worsens .The
human health is determined with the complex of biological (heredity and acquired)
and social factors. The last once are so important for health support and illness
development that it is written preamble of the charter of World Health Care
Organization:” Health is a state of the physical, spiritual and social welfare and
not only the absence of illnesses and body failure”
Pre-illness or an intermediate state or pre-morbidity state which is
characterized by the decrease of functional abilities of a human organism
declare themselves as two stages, such as:
1) the stage of nonspecific advantages with saving the homeostasis of vitally
important organism system;
2) the stage of specific changes inside the exact organs and systems which have
damaged homeostasis but because of the compensation machinery of disease
manifestation the illness can declare itself differently: at the sufficient
compensation it is in the initial phase, at the insufficient compensation its
clinical severity depends on functional reserves . These functional stages
develop and proceed on the background of overstrain asthenia exhaustion of
regulatory machinery.
This state belongs to ages, drug addicted and alcohol addicted people, people
who have malnutrition, hypodynamia and are overweight.
Till the time when the organism, using the adaptation machinery , is able to
provide the internal environment stability in a case of changes in external it is in
a sate which can be estimated as healthy. When the organism gets into the
conditions when the intensity of external environment factors influence expels the
capabilities of its adaptation , it ensues the state which is opposite to health which
is called an illness or pathology.
2. What is risk factor? What are the classifications of risk factors (on
example of cardiovascular system)?

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The risk factor is something like a harmful habit (for example, smoking) or a
bad influence of harmful things which are in external environment and cause the
development of any disease. This connection is one of possible causes of he
development of illnesses, that’s why it must be differentiated from the casual
factor.
The risk factors can be divided into modified (which we can influence on) and
unmodified (which we can’t influence on) and also exogenous (external) and
endogen ( internal) .
Unmodified risk factors (on example of the diseases of cardiovascular
system):
 Sex. Among people of a young and middle ages men have myocardium
infarction much more often than women. By aging the probability of
myocardium infarction among women increases. They become sick after
menopause because it lessens the discharge of female hormones (estrogens)
which protects the vessels against atherosclerosis. At the age of 65-84 the
rapidity of cardiovascular diseases is almost the same.
 Age. The threatening of cardiovascular diseases depends on age. During the
life the heart is thickening and the muscle can’t completely relax, the
contraction lessens. At the same time it lessens the elasticity and sclerosis.
 Heridity. The cardiovascular diseases ( ischemic heart disease, hypertonia)
are family’s diseases.If t he person has more riskfactors he has more chances
to get sick.
But it is not enough to have all mentioned above modified factors for
the development of myocardial infarction and other illnesses. We can influence
on this factors. If a person avoids of them he will lessen a risk of the
development of a disease.
Modified riskfactors:
1) Smoking. The diseases which are caused by smoking are myocardial infarction
, arterial hypertension different kinds of cancer, mos o the chronic lung disease,
discharge of metabolism , impotence etc.
2) Alcohol . Using the alcohol in a quantity of ethanol more than 30ml a day is
dangerous and harmful for health because it causes the increase of cardial
diseases , hypertonic disease , insult, the liver is damaged etc
3) High arterial preasure . Uncontrolled arisen of AP is extremely dangerous . It
threatens to cause myocardial infarction and insult , and provides the
progression of impaired cardial function and renal insufficiency. Where does
hypertension come from? It is caused by a range of factors such as overweight,
alcohol abuse, hypodynamia, wrong diet, stress, heredity etc..
4) Pancreatic diabetes (PD) It is said, if the contain of sugar in blood on an empty
stomach i 6,1 and more .PD is a disease which causes another illnesses ,firstly
cardiovascular ( ischemic heart disease, cerebral atherosclerosis and low
limbs).WHCO considers this disease to be the disease of civilization. It means
that PD is initiated by modern lifestyle and affects more and more people every
time.

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5) Overweight .Over weight increases the development of a lot of illnesses such
as Ischemic heart disease , hypertonic disease, PD, deforming arthrosis of
joints, trombophlebitis of the deep venous of limbs, cholelythic, fatty
hepathosis, osteochandrosis. The main parameter for overweight estimation is
the index of body weight .It is th weight of body in kg divided into height in
SQR
The normal body weight is considered if this index is 20-25kg/m2, insufficient
if it is less than 20, overweight 25-30 kg/m2 which threatens the persons health.
6) The prearrangement of lipids. The high level of atherogenic lipoproteins (of
low thickening) which deliver cholesterol from the liver into tissue and lessen
the level of protective lipoproteins ( high thickening) which evacuate tissue
from cholesterol-the main risk factor of atherosclerosis and sever
cardiovascular disease.
7) Stress. Stress is a reaction of a human organism to the environment. It is
conscious, emotional or physiological reaction of a person to irritations,
difficulties, danger of his life.
1) a bad sleep;
2) troubled slumbr;
3) nightmare;
3) feeling of muscle constrain and a headache after awakening;
4) bad relations with friends or colleagues etc.
Except for negative influence on cardiac system( a rapid heartbeat, high AT,
blood thickening which threatens to make thrombus), also stress causes:
1)maldigestion
2 ) hormonal and nervous disturbance,
3) mental disturbance;
4) faints;
5) skin disease.
.
3. What are the internal and external riskfactors of illnesses?
Another classification divides risk factors into external and internal risk
factors.
1. External risk factors
 Environmental pollution-water pollution, air pollution with chemical and
radioactive substances have a bad influence on health of people.
 mental and emotional constrain-if it repast very often, it can exhaust the
functional abilities of adrenal glands, that weaken the adaptable abilities
of human organism.
 The inactive lifestyle. Hypodynamia –insufficient muscle activity which
is especially in the early childhood or before school age because it delays
IBW= BW(kg)/H(m)*SQR

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the development of child’s organism. As for adults, hypodynamia results
the development of cardiovascular diseases.
 Harmful habits –smoking, using drugs or alcohol have a harmful
influence on humans body and are obstacles to such components of
healthy lifestyle as having an active rest, doing sports etc.
2. Internal risk factors.
 Genetic risk-lots of illnesses are hereditary. It is known about 3000
hereditary diseases or genetically determined syndromes. A genetic factor
has a key role in the development of most diseases.
 Constitution. The constitution of the whole complex of features of a human
organism have developed on a hereditary basis and their interaction with
external environment that determines their ability to react. For example,
cardiac and vessels diseases mostly happen to people with hypersthenes
constitution. However, people with asthenias constitution of body usually
have hypotonic. The asthenias constitution of body is often associated with
ulcer. People who have hypersthenes constitution of body are resistant to
tuberculosis, people with asthenias constitution of body tend to have
tuberculosis though.
4. What are the main aspects of overcoming the risk factors?
1) Fight against smoking
The GP must persuade his patients to give up harmful habits such as
smoking and drinking alcohol. He must find a strong motivation. If the patient isn’t
able to give up a harmful habit himself the doctor should involve an expert in
narcology , psychotherapeutics or use coding.
2) An active life style.
The doctor must persuade his patients to do sports because doing sports
three times reduces the risk of ischemic heart disease.
 morning exercises 15-20 min , in the well ventilated room, starting with little
loads and steadily increasing them; they shoul be done regularly, breakers
cause overtraining. The physical exercises should increase the heart
beating but no more than 80-90%.
 walking- a minimum daily load for practically healthy people is 5-6 km in
an hour.
 hardening - it is the coplex of methods of purposeful increasing of
functional reserves of a human organism and its resistance to harmful
influence of physical factors of the environment ( high and low pressure,
high or low air and water temperature etc) by the system training and
graduated influence of this factors.
The most widespread forms of hardening are sponge down, douche, feet
bath with reducing the water temperature and shortening the duration of procedure
and they are used at the beginning stages of hardening. When the human organism

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is used to the regular douche it is allowed to start hardening by having a contrast
shower
Contrast shower is a particular kind of water motions when hot water of
(40-45) alternates with cold one (10-20). The sense of its action is that the sudden
momentary cooling activates protective abilities of a human organism. Such kind
of shower influence on vessels and join tissue .Warm water relax and cold water
increase the muscles and vessels tonus. The contrast shower trains the
thermoregulation systems, ligaments and vessels like physical exercises train
muscles.
3) Health meal and fight against overweight.
The atherosclerosis and ischemic heart disease prevention is closely connected
with overwight.10 % lose of body weight reduces 20% of cardiovascular disease.
The general principles are:
 the best way to lose body weight is the stepwise limitation of diet and active
mobility;
 the body weight should be loosen gradually ( no more than 1 kg a week)In a
case of fast loss of body weight it will be complicated to keep it in balance;
 caloric intake and expenditure of energy must be in balance , it is the most
important condition which allows to keep a constant weight .To lessen the
body weight you should get less calories with food than spend them during
your physical or mental activity.
 as for a healthy person it is recommended to have meal 3-4 times a week ,
moreover lunch should be the most sifted meal and dinner or supper should
be the lightest one. The stretch of time between meals shouldn’t be very
long;
 in a case of overweight it would be very useful to have(1 day a week) fasting
days(fruit, vegetable, kefir);
 if your patient prefers to count kilogram calories(kcal) you should multiple
the number of body weight on an index which shows his active physical
capacity. For people who lead a sitting life style it equals 25, in a case of a
moderate active life style-30, in a case of intensive physical activity-35;
 the level of arterial pressure is closely connected with a body weight. To
normalize the blood pressure, for some patients it would be enough to lose
the body weight;
 salt rises AP , that’s why not to add more salt into the dish, not to use
marinade, pickle, canned or smoked food. This food consists of 90% of
hidden salt which we eat.
 Cholesterol is a riskfactor which caused cardiovascular diseases .
The basis of all diets which provides cholesterol dropping is:
-To lessen using animal fats (fatty meat, butter, fatty dairy products, fatty sorts of
cheese, fancy cakes etc)
-More of animal fats alternates with sunflower , olive or corn oil.
-It can be moderately used non-fatty meat .It is preferred to use chicken, turkey,
beef, fish especially sea fish.

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- it is allowed to use a moderate quantity of low –fatty dairy products (no more
than 30%), bakery with using oil, fried in oil potato. It is allowed to eat only
boiled eggs and no more often than two times a week.
- it is often used products which provide cholesterol dropping and leads to its
evacuation: plain bread , cereals (oat flakes), different vegetable and fruit dishes,
(plumps, apples and different berries), beans and peas
4) Fight against stress and negative emotions.
Any emotions , at the first rate the negative ones, bring on the increasing
vascular tone and arterial pressure, simultaneously fat and carbohydrates, which
are necessary for intensive muscle activity, get into blood , this process has been
the main way to discharge the emotional strain during the previous years of the
development of a human organism. Unloading emotion is very dangerous because
it makes a heart burden and can cause ischemic heart disease.
The very important things for emotional discharging are :
 the culture of personal relations ( it a protective power which makes a
person resistant to conflicts and troubles) includes a humane attitude to each
other, respect for to a personality, patience , sensibility and an aversion for
boorishness.
 intensive muscle activity: physical work , fast walking, jogging.
 there is one more method to rid of negative emotions and stress is to follow
such adice:
1. First of all you should refuse to do any activity which destroys your strength ,
especially harmful habits (don’t drink strong coffee or tea, don’t abuse alcohol,
don’t smoke)
2. Make your scheduled to have enough time to renew your organism or to relax.
3. Try to respect yourself and another people. Your opinion, thoughts and believes
are as important as another people ones. You have a right to share your opinion,
you have a right to be mistaken, you have a right to say “no” or “I don’t
understand”
4. Keep your family and friendly relations, be ready to help another people.
Feeling that somebody needs us rise our self estimation and let us overcome our
own troubles.
5. More often we are troubled with uncompleted affairs or work. So, we should
complete our big and little undertaking to the end .This is one of the secrets of
stress decline. Be happy about all completed stage and only then start doing
another one. When you are doing something concentrate your attention on it, don’t
dissipate your attention.
However there can be situations when it is impossible of to avoid of
irritation. In such occasions you should do following things:
Verbal relaxation .Sit comfortably and close your eyes. Breathe calmly
and silently repeat the words which are pleasant for you ( it can be a prayer, a
proverb, or an extract of a song or a poem)

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Deep breathing. During the inspiration puff up your belly. Then the
diaphragm goes down and lungs will be able to catch more air. Then take the
expiration counting from one to five. It would be better to do it near the open air.
Monotonous work. Doing chores helps to make your nervous calm and be
out of surroundings.
It should be simple and very monotonous (washing up, ironing).
Counting . Close your eyes and count from one to ten, later on formulate a
statement for yourself (for example “I am calm and nothing troubles me“) Repeat
it several times, then count from one to ten.
5. What does the prophylaxis mean ? What are the main tendencies
towards the prophylaxis? What kind of prophylaxis exist?
Medical prophylaxis in accordance to contemporary conceptions is a
system of state, social , hygienic and medical measures which are directed to
provide a high level of a person or people’s Health, and also illness precautions.
As much narrower conception it’s a kind of Health Care Service activity of the
primary link , which is directed to reduce the development of illnesses, and also to
reduce external and internal factors negative influence on human health.
There are such tendencies towards medical prophylaxis:
1. Individual and family technologies of disease –preventive aid which take
into consideration such characteristics as susceptibility to illness and risk of its
development, including medicogenetic consulting.
2. Sanitary and hygienic technologies: hygienic rate setting of physical,
chemical , biological and social conditions of life and human activity , and also the
technologies of environment and antiepidemic protection.
3. Medical and social measures which provides a sufficient level of health
culture among the population on abasis of methods of hygienic education, disease-
preventive education using the professional resources of the system of education,
health care and mass-media.
In conformity with population groups medical prophylxis can be
determined as individual, group, mass.
Being depended on state of health and availability of riskfactors or
obvious pathology it has been determined several kinds of prophylaxis. A range
of authors divides it into primary and secondary.
 A primary prophylaxis as a system of medical prophylaxis is a complex of
specified measures which have a mission to keep and improve human health,
by ridding of exogenous and endogenous factors and harmful habits.
Otherwise , these are measures against harmful factors influence on a human
organism, forming the paradigm of healthy life style , the harmful factors
which are discoved during the medical check –up, holding
immunoprophylaxis( vaccination) among the different groups of population,
measures of somatic and mental disease prevention and injuries sanitation of
a separated groups of people which are under influence of harmful factors.
 The secondary prophylaxis is a complex of medical, social ,sanitary and
hygienic, psychological measures directed towards the active early discovery

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of aggravation precautions and after affects, and also the precaution of work
capacity decline, including disability and untimely death.
6. What does the clinical examination mean? What is its purpose? The
first stage of the clinical examination: which contingents of people as the
subjects of clinical examination?
Clinical examination is a system of disease –preventive measures which
includes the active supervision of certain groups of people, study the conditions
of their life, work etc., providing their physical development and health care, an
also disease prevention by taking all necessary disease-preventive, sanitary and
hygienic and social measures.
The basis of clinical examination is a service of pertaining to prophylaxis
people .
 The purpose of clinical examination of pertaining to prophylaxis healthy
people is to provide health care , correct physical and mental development,
normal working conditions , the diagnostics of an illness at its early stage,
prevention the disease development and preservatyion of work capacity.
 The purpose of clinical examination of pertaining to the prophylaxis sick
people to embrace with a dynamic medical supervision of sick people at the
early stage of their illness, prevention from aggravations and complications
the pathologic process , to reduce the number of illnesses which leads to
incapacity for work and disability, extension and improvement the quality of
sick people life and term of their active work capacity.
The stages of clinical examination service
The first stage the selection of contingents pertaining to the prophylaxis
1. In accordance to a treaty about clinical examination there are such
people pertaining to the obligatory prophylaxis:
 children at the age before14 years old;
 teenagers and men called up for military service;
 students of th vocational schools, colleges ,technical schools and high
educational establishments;
 workers of children ; municipal and public catering establishments;
 all women at the age before 30 ( who work or don’t work)
 people who work in unhealthy trade,
 the participants of liquidation of radium accident at Chernobyl nuclear
power station ;
 medical workers.
2. Moreover, there are such internal diseases pertaining to the
prophylaxis as
 Cardiovascular system diseases: hypertonic disease, an acute and chronic
ischemic heart disease, rheumatism.
 the respiratory diseases: chronical lungs obstruction, bronchial asthma,
bronhiectactic disease, lung abscess, pneumoconiosis, lung emphysema;

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 alimentary canal diseases : chronic gastritis, stomach and duodenial ulcer,
chronic hepatitis, hepatosrosis, cholelithic. Crohn’s disease.
 Kidney diseases: chronic glomerulonephritis, chronic pyelonephritis;
 endocrinic system diseases: diabetes mellitus, diffuse goiter with thyroid
gland disturbance;
 blood disease, oncologic and allergic diseases.
To find out the patients timely at the early stages of their illnesses medical
workers use outpatient appointments, visiting the patients at home, medical check-
up, outpatient - and inpatient cards analysis, giving sick-leaves etc.
The registration is considered to be timely when the patient is taken under
control not later than in 30 days after he has been diagnosed .
7. The first stage of mass clinical examination : how many groups of
people are pertaining to the prophylaxis? What contingents of people do they
consist of ?
The next important task for medical workers at the first stage of mass
clinical examination is to divide people into groups pertaining to the prophylaxis:
 I - healthy people who don’t have any complaints or symptoms during the
examination and before it.
 II - people who considered to be healthy, they have the records about their
diseases in their anamnesis and risk factor of a certain pathology but t the
present moment they don’t have any complaints.
 III - patients with chronic diseases at the stage of compensation.
 IV- patients with chronic diseases at the stage of subcompensation.
 V - patients with chronic diseases at the stage of decompensation.
The outpatient card of a patient who has been registered as a person
pertaining to the prophylaxis is marked with the letter “D”(dispensary) and a
control card of clinical examination ( form 30) they put down the following
information in it: complaints, disease and life anamnesis, the information about
lab analysis and instrumental (surgery) examination.
Diagnosis is written down in conformity with International Diseases
Classification taking into consideration all changes of nosology and
recommendations for a period of time before next examination.
It is marked a group which the patient belongs to, the date of his
registration and his next clinical examination. The cards are kept in the index card
of the doctor who supervise the patient.
8. What do we need the secondary stage of mass clinical examination
for? What are the sanitary and health improving factors in the process of mass
clinical examination?
The secondary stage of mass clinical examination is the execution of
measures which have been planned at the stage of selections of healthy and sick
people with a purpose of registration them as pertaining to he prophylaxis.

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There are three important factos in this process-clinical, sanitary and
health- improving and psychological.
 CLINICAL FACTOR includes a detailed examination of a patient,
application of treatment, Referral to the specialized clinics , diagnostic centers
etc., the supervision, the determination of the incapacity for work degree,
explanatory work. The repeated check-up( once a year for healthy people,
twice a year for sick people ) regularly and according to the plan or the
patient’s state of health
 SANITARY AND HEALTH-IMPROVING FACTOR includes such
disease-preventive measures as sanation nidus of chronic infection, (dental
sanation, tonsillitis, adnexitis) , special methods of treatment, therapeutic
physical training , reflaxotherapy, diet and health resort improvement.
 PSYCOLOGICAL FACTOR is the doctor’s ability to persuade the patient
to take a good care of his health( to give up harmful habits etc.) and patient’s
responsibility for his own health.
9. What do we need the third stage of mass clinical examination for?
What are the criteria of efficiency of the mass clinical examination?
The third stage of mass clinical examination includes the mass clinical
examination.
There are such criteria of the efficiency( for the patients of III, IV,V group
1) to consider a patient to be healthy in a case of complete recovery
without recurrence within two last years.
2) the stable improvement of the state of patients health there weren’t
any aggravations within a year , the results of lab analysis or other examinations
prove it,
3) temporary improvement of the state of patient’s health – only during
te process of treatment and disease aggravation between treatment courses but
recurrences are easier,;
4) the patient’s state of health is constant, the treatment gives a short-
term result;
5) deterioration of the patients state of health –pathology is in progress
despite of treatment
6) temporary incapacity for work as a result of aggravation and
complication of illness work capacity renews in 3-4 months;
7) constant incapacity for work and primary disablement;
8) strike off the register in case of moving to another place or death
10. How to form the medical and social health passport?
 The health passport is formed during the process of mass clinical
examination;

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 It has a such information as: The patient’s name and surname, birth date,
home address, insurance policy, medical establishment which the patient
belongs to and the name of GP who supervise the patient;
 blood group and Rh, drug intolerance and allergy;
 it is marked the patients belonging to a group pertaining to the prophylaxis
according to the year of registration;
 the main indexes of the state of health (height, body weight, AP, heart beats
etc.) and all risk factors;
 the results of lab analysis;
 functional examinations (e. g. x-ray, ECG, mammography)
 diseases discovered during the process of clinical examination ( with a date
of diagnosis un accordance to the International Diseases Classification);
 the resolution of consultants (surgeon, obstetrician – gynecologist,
ophthalmologist, neurologist and other);
 the resolution of GP and group which the patient belongs to.