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CINDI HEALTH MONITOR SURVEY - AN INTEGRATED PART OF CINDI

SINDI MAKEDONIJA. Prim . d - r PhD . spec. of sports medicine - nutritionist Lazar Licenovski 13  1000 Skopje  phone ++389-02 - 225 - 402 mfh.cindi@makedonija.com. Prim. d-r VERA SIMOVSKA. CINDI HEALTH MONITOR SURVEY - AN INTEGRATED PART OF CINDI

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CINDI HEALTH MONITOR SURVEY - AN INTEGRATED PART OF CINDI

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  1. SINDI MAKEDONIJA Prim. d-r PhD.spec. of sports medicine - nutritionistLazar Licenovski 13 1000 Skopje phone ++389-02-225-402 mfh.cindi@makedonija.com Prim. d-r VERA SIMOVSKA CINDI HEALTH MONITOR SURVEY - AN INTEGRATED PART OF CINDI CONCEPTUL MODEL IN MACEDONIA, 2002 INSITUTE OF SPORTS MEDICINE, NUTRITION UNIT, SKOPJE, MACEDONIA

  2. 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.

  3. 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.

  4. 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). M e t h o d s :

  5. 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.

  6. Figure 1. Mortality rate from noncommunicable diseases in The Republic of Macedonia for the period 1991-2001 up to 100.000 population

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

  8. 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.

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

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

  11. Figure 5. Prevalence of riskfactors for NCD in adult population from central region in Skopje

  12. 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).

  13. Figure 6. Organizational structure – CINDI HEALTH MONITOR SURVEY CENTRES in the Republic of Macedonia 167 167 1877 1877 149 149 150 150 384 222 389

  14. 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.

  15. 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

  16. 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 recommendationsof 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).

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

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

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