Lifestyle Change Recommendations Research Articles

Physician recommendations for physical activity and lifestyle changes in pregnancies with fetal growth restriction: a survey.

Physician recommendations for physical activity and lifestyle changes in pregnancies with fetal growth restriction: a survey.

Current concept of osteoporosis diagnosis and treatment in children

Osteoporosis (OP) is a disease characterized by a decrease in bone strength, leading to an increased risk of fractures. Bone fragility in children may be due to genetic disorders, chronic underlying conditions or taking medications that negatively affect bone metabolism. The article considers the modern classification of OP in children, approaches to its diagnosis, the role of dual-energy X-ray absorptiometry for diagnosis.The main goal of OP prevention and treatment is to achieve a higher peak of bone mass, improve bone microarchitectonics, and, as in adults, reduce the risk of fractures, prevent skeletal deformities, improve mobility, independence and quality of life. Recommendations for lifestyle changes are presented, including adequate calcium intake and vitamin D, taking antiresorptive drugs, as well as prospective management of children with OP.

Оценка результатов сравнительного исследования эффективности и безопасности применения комплекса «Фосфалит®» у пациентов с фосфатной формой мочекаменной болезни.

Introduction. Urolithiasis is a widespread disease. The percentage of phosphate stones reaches up to 35% of all cases of all kidney stones. Patients with phosphate stones and with various urinary catheters in particular are a complex category of patients requiring the close attention of doctors. Phosphate urolithiasis clinical patterns create a constant search for various oral therapy options. The purpose of this study is to evaluate the effectiveness of the Phosphalit complex as an optional drug for metabolic disorder correction in phosphate kidney stones. Materials and methods. The prospective randomized control study included 135 patients, 131 people returned for a second visit. All the patients were divided in 4 groups: patients with phosphate urolithiasis who received Phosphalit® on a regular basis, 2 capsules 2 times a day; patients with phosphate urolithiasis who received general recommendations for lifestyle and diet changes; patients with phosphate urolithiasis against the back- ground of existing permanent urinary catheters, receiving the drug Phosphalit® on a regular basis, 2 capsules 2 times a day; patients with phosphate urolithiasis on the background of permanent urinary catheters, who received general recommendations for lifestyle and diet changes. The duration of observation and intervention was 90 days. Results. The total effectiveness of Phosphalit® in reducing the level of phosphates in the blood in both groups of patients (with and without catheters) was 90.1%, and in reducing the excretion of phosphates in urine – 93.3%. The dynamics of the degree of crystalluria and the stone size also showed positive dynamics in all the studied groups. Conclusions. Phosphalit® is an effective and safe remedy in the treatment of the phosphate urolithiasis, including patients with urinary catheters.

A critical review of health and financial implications of obesity during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900,000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271,700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest CT were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing body mass index (BMI). Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Stress-induced arterial hypertension in the ESH Guidelines for the Management of Hypertension 2023

New ESH data on risk factors for arterial hypertension are presented. The article examines the mechanisms of the relationship between stress and arterial hypertension, the relationship of stress with white coat hypertension and masked arterial hypertension, perioperative hypertension. A brief review of the results of clinical studies on the relationship between chronic stress and arterial hypertension, including stress at work and in everyday life, is presented. Modern approaches to the prevention and treatment of stress-induced hypertension are considered, which include recommendations for lifestyle changes, stress management methods, and drug therapy.

Lived Experience in Lifestyle Modification of Patients with Old Myocardial Infarction at the University Hospital in Bangladesh

Realizing the advantages of lifestyle modification after myocardial infarction (MI) requires active lifestyle change. Sometimes patients find it difficult to follow the recommendations for lifestyle changes, which are crucial for all MI patients to implement in order to lower the risk of secondary attack. This study aimed to explore the real-world experiences of post-MI patients who had changed their lifestyles at a university hospital. This qualitative study was conducted among 20 purposively selected post-MI patients. The patients who had confirmed medical diagnosis as old MI, had been admitted to Bangabandhu Sheikh Mujib Medical University Hospital for more than a week, and had been willing to participate in this study were considered as the study subjects. Data was collected through an open ended semi-structured questionnaire by face-to-face interview. Using qualitative content analysis, the interview transcripts were examined at the same time as the data was being gathered. Out of 20 study subjects, 55% were male and 60% were Muslim. Participants age was ranging from 36-70 years. Two themes, namely adjustment with modified life and maladjustment with normal life emerged as the lived experiences of lifestyle modification of patients with old Myocardial Infarction. It is concluded that patients with post-MI can have both good and bad experiences during the period of lifestyle modification.

Lived Experience on Lifestyle Modification of Patients with Old Myocardial Infarction at a University Hospital in Bangladesh

Background: Realizing the advantages of lifestyle modification after myocardial infarction (MI) requires active lifestyle change. Sometimes patients find it difficult to follow the recommendations for lifestyle changes, which are crucial for all MI patients to implement in order to lower the risk of secondary attack. This study aimed to explore the real-world experiences of post MI patients who had changed their lifestyles at a university hospital. Methods: This qualitative study was conducted among 20 purposively selected post MI patients. The patients who had confirmed medical diagnosis as old MI, had admitted in Bangabandhu Sheikh Mujib Medical University Hospital for more than a week, and had willingness to take participation in this study, were considered as the study subjects. Data was collected through an open ended semi-structured questionnaire by face to face interview. Using qualitative content analysis, the interview transcripts were examined at the same time as the data was being gathered. Results: Out of 20 study subjects, 55% were male and 60% were Muslim. Participants age was ranging from 36-70 years. Two themes namely adjustment with modified life and mal-adjustment with normal life were emerged as the lived experiences on lifestyle modification of patients with old Myocardial Infarction. Conclusion: It is concluded that patients with post-MI can have both good and bad experiences during the period of lifestyle modification.

Possibilities for the use of ursodeoxycholic acid in the treatment of patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease

To investigate the effect of ursodeoxycholic acid (UDCA) on the degree of steatosis, indicators of carbohydrate, lipid metabolism, body weight in patients with type 2 diabetes mellitus (DM) in combination with non-alcoholic fatty liver disease (NAFLD). A prospective cohort comparative study included 36 patients with DM and NAFLD. Patients received UDCA at a dose of 15 mg/kg/day for 6 months, and also followed the recommendations for lifestyle changes through diet and exercise. To compare the results obtained during the study, a control group of patients was recruited that met the criteria for inclusion in the study. The statistical analysis included an assessment of the normality of the distribution of quantitative indicators, followed by the determination of the mean values and standard deviation or medians and quartiles, depending on the nature of the distribution, the reliability coefficient was determined by the Student, by Wilcoxon. Statistical processing was carried out in the Statistica 10 program. According to the results of the study, a positive trend was noted in the change in the severity of fatty hepatosis. During the study, a statistically significant decrease in the level of ALT, AST was achieved in the group receiving UDCA (Ursofalk). The results of our study showed that the inclusion of UDCA (Ursofalk) in complex hypoglycemic therapy provides an additional improvement in carbohydrate metabolism. The obtained indicators in the course of the study demonstrate the positive effect of UDCA on weight loss. The greatest result was achieved in reducing waist, which is a positive prognostic factor in reducing the development and progression of NAFLD, diabetes and cardiovascular diseases. Positive changes were observed in relation to the lipid profile. The study demonstrated the positive effect of the drug UDCA (Ursofalk) on reducing the degree of liver steatosis, on carbohydrate, lipid metabolism, body weight in patients with DM in combination with NAFLD.

Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation. Purpose The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement. Methods In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals. Results All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (>68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2). Conclusions The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.

Epidemiology of cardiovascular risk factors and the medical care appealability

Highlights. Unique epidemiological data were obtained on the effectiveness of preventive services of healthcare organizations in relation to cardiovascular diseases, adherence to lifestyle modification recommendations, and presence of risk factors for cardiovascular diseases in these citizens.Aim. To assess healthcare services uptake in large industrial Siberian region, as well as the adherence of population to lifestyle modification recommendations (epidemiological data).Methods. The study included 729 residents of Kemerovo and Kemerovo region. The assessment of the main risk factors for cardiovascular diseases was carried out in accordance with the Russian recommendations for cardiovascular prevention. Uptake and adherence to lifestyle modification recommendations was assessed using the Health System Assessment Questionnaire of the International Prospective Study of Urban and Rural Epidemiology.Results. Among the 729 study participants, the urban population is represented by 67.3%, rural – 32.6%. The population was majority represented by women (69.7%). The mean age of participants was 59.0 (51.0; 65.0) years. Smokers accounted for 18.6% of the participants, the majority represented by men (p = 0.000). Excessive weight was more often observed in women (p = 0.013), the mean body mass index in women was 29.5 kg/m2 . The mean values of the analyzed laboratory parameters (cholesterol, low- and highdensity lipoprotein cholesterol, triglycerides, glucose) were within the range of normal values. Previously diagnosed hypertension was noted in 64.6% of the participants, diabetes in 12%, coronary heart disease in about 7%, stroke in 1.6% of the participants. Assessment of cardiovascular risk according to SCORE scale showed that 17% of participants were at low risk, 50% – moderate risk in, and 29.2% – high-very high risk. Upon visiting healthcare provider, only 38.1% of subjects received recommendations for lifestyle changes. Respondents were frequently given recommendations to adjust their diet, followed by recommendations regarding weight loss, increased physical activity; smoking cessation and lower alcohol consumption were recommended less often. Respondents changed their lifestyle significantly more often in accordance with the recommendations received at the time of visit (p = 0.000); out of them, 56.7% had moderate cardiovascular risk, 26.7% had high and very high risk, and low risk according to SCORE – 16.7%. However, study participants were more likely to not follow received recommendations (p = 0.000).Conclusion. Due to high uptake of healthcare services in the population, high prevalence of risk factors and low adherence of the population to prevention, it can be concluded that the current model of prevention does not work. Innovative tools are needed to manage risk factors for cardiovascular diseases and positively change a person`s lifestyle.

EFFICACY OF COMPREHENSIVE TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH PREDIABETES.

The aim: To evaluate the effectiveness of the proposed treatment recommendations, which included lifestyle changes, as well as the treatment with ursode¬oxycholic acid, rosuvastatin, and omega-3 PUFA, on the severity of cytolytic and cholestatic syndromes in patients with NAFLD and prediabetes. Materials and methods: Fifty-five patients with confirmed prediabetes and concomitant NAFLD underwent a comprehensive clinical examination and were treated with rosuvastatin 10 mg/d, omega-3 PUFA at a dose of 1000 mg/d and ursodeoxycholic acid at a dose of 10 mg/kg/d. Results: The data obtained after 12 months of proposed treatment revealed a statistically significant improvement of indicators of cytolytic syndrome in patients with prediabetes and NAFLD. There was no significant difference between mean values of ALT and AST of treated patients and the corresponding indicators of apparently healthy persons, which confirms the effectiveness of the recommended treatment. Conclusions: Proposed therapy which included recommendations for lifestyle changes and treatment with ursodeoxycholic acid, rosuvastatin and omega-3 PUFA significantly improved hepatic steatosis and cytolytic syndrome in patients with prediabetes and NAFLD.

Analysis of lifestyle modifications and antihypertensive therapy in patients with arterial hypertension and chronic kidney disease (data from the national registry)

The aim is to study the characteristics and quality of drug therapy and recommendations for lifestyle changes in patients with chronic kidney disease and arterial hypertension and, separately, chronic kidney disease and resistant arterial hypertension, observed in primary health care.Materials and methods. The study was carried out on the basis of the AH registry data (N = 43133; 2005-2019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc).Results. Less than half of all patients reached the target SBP values. ACE inhibitors/ARBs were not prescribed as first-line antihypertensive therapy in 18% of patients with stage 3 CKD. ACE inhibitors were more often prescribed to men than women (70,6% and 66,5%), and ARBs (11,9% and 15,6%). The frequency of prescribing ACE inhibitors, thiazide and thiazide-like diuretics remained practically unchanged at GFR ≥ 60 and 60 ≥ GFR < 30 ml/min/1,73m2, while the frequency of prescribing ARBs, CCBs, loop diuretics increased with a decrease in glomerular filtration rate. Approximately 60% of patients with hypertension were given advice on nutrition and normalization of body weight (among patients with obesity), about 50% — advice on physical activity and ~50% of smokers received advice on smoking cessation. In patients with hypertension and GFR below 60 ml/min/1,73m2, primary care physicians gave advice on lifestyle changes more often than patients with higher GFR. In men with hypertension and 3 stage CKD the incidence of coronary artery disease (2 times), CHF (1,5 times), the incidence of myocardial infarction in history (3,4 times), the incidence of stroke in history (1,9 times) higher than in women. The frequency of the presence of probable resistant hypertension increased up to 23,9% with a decrease of eGFR among patients with uncontrolled hypertension and up to 11% with controlled.Conclusion. For patients with hypertension and CKD, it is necessary to achieve target values of blood pressure, conduct drug therapy aimed at blocking the RAAS (ACE inhibitors /ARBs), select drugs from the CCB group and diuretics as second and third line therapy. In patients with resistant hypertension the addition mineralocorticoid receptor antagonists is necessary.

Gut Microbiome Analysis for Personalized Nutrition: The State of Science.

Whereas most concepts of personalized nutrition (PN) in the past, included genotyping, recent years have brought new approaches that include microbiome analysis to optimize recommendations for diet and lifestyle changes. The new approach, offered by companies, that microbiome analysis provides a real benefit to either more concise recommendations or for increased compliance to PN, is largely lacking scientific validation. Although the microbiome field shows enormous proliferation, it has some major flaws that make its use in the public health domain currently critical. Starting with the quality and representative character of the stool samples, its processing and analysis as well as assembly of metagenome data and the interpretation. Moreover, there is still no consensus of what constitutes a "normal/healthy" microbiome, nor what features characterize a dysbiotic microbiome. And, based on hundreds of individual parameters and environmental factors, the intestinal microbiome shows a huge variability and consequently changing one factor-such as food intake-is likely to have a limited impact in achieving optimized health. The present review intends to summarize the state of consolidated knowledge on human gut microbiome in the context of diet and disease, its key features, and its influencing factors as well as its "add-on" quality for PN offers.

Changes in Lifestyle and Risk of Colorectal Cancer in the European Prospective Investigation Into Cancer and Nutrition.

We investigated the impact of changes in lifestyle habits on colorectal cancer (CRC) risk in a multicountry European cohort. We used baseline and follow-up questionnaire data from the European Prospective Investigation into Cancer cohort to assess changes in lifestyle habits and their associations with CRC development. We calculated a healthy lifestyle index (HLI) score based on smoking status, alcohol consumption, body mass index, and physical activity collected at the 2 time points. HLI ranged from 0 (most unfavorable) to 16 (most favorable). We estimated the association between HLI changes and CRC risk using Cox regression models and reported hazard ratios (HR) with 95% confidence intervals (CI). Among 295,865 participants, 2,799 CRC cases were observed over a median of 7.8 years. The median time between questionnaires was 5.7 years. Each unit increase in HLI from the baseline to the follow-up assessment was associated with a statistically significant 3% lower CRC risk. Among participants in the top tertile at baseline (HLI > 11), those in the bottom tertile at follow-up (HLI ≤ 9) had a higher CRC risk (HR 1.34; 95% CI 1.02-1.75) than those remaining in the top tertile. Among individuals in the bottom tertile at baseline, those in the top tertile at follow-up had a lower risk (HR 0.77; 95% CI 0.59-1.00) than those remaining in the bottom tertile. Improving adherence to a healthy lifestyle was inversely associated with CRC risk, while worsening adherence was positively associated with CRC risk. These results justify and support recommendations for healthy lifestyle changes and healthy lifestyle maintenance for CRC prevention.

Analysis of adherence to treatment in patients with rheumatoid arthritis

Patients' adherence to drug therapy, medical support and implementation of the doctor's recommendations for lifestyle changes can affect the effectiveness of therapy and quality of life in patients with rheumatoid arthritis (RA).Objective: to analyze adherence to treatment, medical support and implementation of recommendations for changing the lifestyle in RA patients, including those with and without low-energy bone fractures.Patients and methods. The study included 88 women with a definite diagnosis of RA. All patients were followed up for a long time (on average 8.45±1.34 years) at V.A. Nasonova Research Institute of Rheumatology. All patients underwent clinical, radiological and laboratory examinations, and a questionnaire for the quantitative assessment of adherence to treatment was completed.Results and discussion. The integral indicator of adherence to treatment in 30 (34%) patients corresponded to a low level, in 51 (58%) – to an average level, and in 7 (8%) – to a high level. Low adherence to medical support was more often determined in patients with anxiety (p=0.02) and depression (p=0.04). The intake of oral glucocorticoids (GC) was associated with a high adherence to drug therapy (p=0.01). Adherence rates in the group of RA patients with and without bone fractures did not differ significantly. Functional disorders and the severity of radiological changes also did not differ significantly in patients with different levels of adherence.Conclusion. Patients with RA had predominantly an average level of adherence to drug therapy, medical support, and a low level of adherence to recommendations for lifestyle changes. Oral GC were associated with high adherence to drug therapy, while low adherence to medical support was associated with anxiety and depression. Treatment adherence rates in the group of RA patients with and without bone fractures did not differ.

CORRECTION OF HORMONAL DISORDERS IN WOMEN WITH ABNOMAL UTERINE BLEEDING AND CHRONIC PSYCHO-EMOTIONAL STRESS

The aim of the research was to evaluate the effectiveness of the optimized treatment in the correction of hormonal disorders in women with abnormal uterine bleeding (AUB) and chronic psycho-emotional stress.
 Materials and methods. 100 women of reproductive age with AUB and chronic psycho-emotional stress were examined. I group included 50 patients who received complex optimized treatment, II group included 50 persons who received standard treatment. The control group included 30 healthy women without AUB and chronic psycho-emotional stress. The standard approach provided for diagnostic and therapeutic measures in accordance with the recommendations of the order of the Ministry of Health of Ukraine N 353 dated 13.04.2016. Inclusion criteria: AUB, age 18-45 years, satisfactory condition of the sample of the material from the uterine cavity for histological examination, chronic psychogenic stress, patient consent. Exclusion criteria: pregnancy, premenstrual dysphoric disorder, acute pelvic inflammatory disease, mental disorders, blood diseases associated with coagulation disorders, hypothyroidism, hyperthyroidism, hormonal adrenal tumors, chronic intestinal diseases, severe somatic pathology. Optimized treatment additionally included recommendations for lifestyle changes, melatonin, vitamin D, medicament’ correction of iron deficiency without anemia. Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, progesterone, prolactin, and cortisol levels were determined in all subjects.
 Results of the research. In the follicular phase of menstrual cycle after the standard treatment there is a positive dynamics of progesterone and FSH levels in the patients in the I and II groups whose concentrations reached the control group. However, LH level in patients in both groups and estradiol amount in the II group differed significantly from those in healthy women. After optimized treatment, the levels of prolactin and cortisol reached the amount of healthy women, while after the standard treatment the prolactin concentration was increased by 17.22 % (p=0.049), cortisol – by 43.84 % (p<0.001) compared with controls. In the luteal phase, the greatest correction of estradiol and progesterone concentrations in the I and II groups and prolactin level in women in the I group were determined. However, the amount of prolactin in patients of the II group remained high, exceeding the rate of healthy women by 33.64 % (p=0.007), while in the I group it corresponded to the control value. No significant changes in the concentration of FSH, LH and testosterone on the background of treatment in women of the two groups were observed, as their levels corresponded to the control group. FSH and LH levels in patients before and after the standard and optimized treatment were at the lower limit of healthy persons.
 Conclusions. The use of standard and optimized approaches in the management of patients with abnormal uterine bleeding and chronic psycho-emotional stress has been successful in normalizing in female sex hormones, but the standard approach has demonstrated an insufficient correction of stress-induced hormone levels, in contrast, the optimized treatment led to a more effective correction of all hormonal disorders.

The optimization of abnormal uterine bleeding treatment in women with chronic psychogenic stress

The objective: to assess the effectiveness of the complex optimized treatment approach to abnormal uterine bleeding (AUB) in women with chronic psychogenic stress on the quality of life.Materials and methods. We examined 100 women of reproductive age with AUB and chronic psychogenic stress, 50 patients of them consisted the I group and received the optimized treatment, and 50 persons (II group) received the standard AUB treatment. 30 women without AUB and chronic stress were included in the control group. The examination of all persons included: anamnesis, clinical and gynecological examinations, ultrasound examination, general blood test, blood ferritin, vitamin D in serum blood. The quality of life was determined according to the 36-Item Short Form Health Survey before treatment and after three months. The standard approach included diagnostic and therapeutic measures according to the recommendations of Order N 353 dated 13.04.2016 of the Ministry of Health of Ukraine. The optimized treatment additionally included recommendations for lifestyle changes, melatonin, the use of vitamin D depending on its level, the medicament correction of iron deficiency without anemia.Results. The results of the questionnaire 36-Item Survey scales indicate that in patients with AUB and chronic psychogenic stress there is a decrease in the scales relative to the values of healthy women, especially in psychological component. In the persons of the II group there was no significant dynamics of the scales “Bodily pain” and “Physical role functioning” relative to the indicators before treatment, while the scales “Physical function” (p<0,001) and “General health perceptions” (p=0.01) increased significantly. The optimized treatment lead to a significant increase in all physical component scales compared till normal indices. In patients of the II group the indicators of psychological scales after treatment were significantly lower than the average values of healthy women. Thus, the value of the scale “Mental Health” was lower by 14,34% relative to the control group (p=0,18), “Emotional role functioning” – 18,38% (p=0,007), “Social role functioning” – 15,46% (p=0,003), “Vitality” – 23,27% (p=0,005). In the women of the I group there was a significant increase in the indicators of the psychological scales, which after treatment reached the values of healthy women.Conclusions. In women with AUB and chronic psychogenic stress, there is an insufficient positive dynamics in improving the quality of life after the standard treatment, especially the scales of the psychological component. The optimized treatment approach leads to the improvement of all parameters of quality of life of the patients.

Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease.

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.

Выбор гипотензивной терапии у больных с сахарным диабетом 2 типа

This literature review is devoted to the issues of non-drug and drug treatment of arterial hypertension in people with type 2 diabetes mellitus. Type 2 diabetes mellitus is the cause of severe disabling complications and a significant factor in increasing mortality. Arterial hypertension and diabetes mellitus are often combined and mutually burden each other’s course. Arterial hypertension increases the risk of formation and the rate of progression of micro- and macrovascular complications of diabetes. The presence of diabetes mellitus increases the risk of complications of hypertension by about 2 times. Achievement and stable maintenance of target blood pressure levels in people with diabetes and hypertension is one of the most important components of improving the prognosis. To do this, it is important to follow the recommendations for lifestyle changes, as well as the use of antihypertensive drugs. The article presents general issues of epidemiology and principles of determining the target level of blood pressure in different groups of patients. The issues of lifestyle changes and the choice of tactics for prescribing medications are discussed in detail, a brief description of the main groups of antihypertensive drugs is given.

Correction of eating habits in patients with carbohydrate metabolism disorders

The International Diabetes Federation estimates that approximately 10% of the adult population in Ukraine has prediabetes. According to many studies, prediabetes is observed in every second obese patient, and later prediabetes can progress to type 2 diabetes mellitus. Therefore, timely detection of early disorders of carbohydrate metabolism is very important, as well as implementation of recommendations for lifestyle changes, the use of modern drugs to prevent type 2 diabetes and cardiovascular diseases. In recent years, increasing attention is drawn to dietary fibers as an integral part of a healthy diet. They help prevent obesity, metabolic syndrome and adverse changes in the gut, and also help increase the population of beneficial bacteria in the gut. That is why nutritionists recommend that obese people include dietary fibers in their diet. One of the most famous dietary fibers is psyllium, which comes from the husk of plantain seeds (Plantago ovata). Numerous studies show that psyllium has a positive effect on the functioning of many organs and systems, including the pancreas, intestines and heart muscle. Psyllium also lowers glucose and cholesterol and is an effective way to lose weight for people who are overweight. Fibolex® plant complex contains dietary fibers (psyllium and natural wheat fibers) and green tea extract. Due to the combined herbal composition, Fibolex® can be used in obese people, patients with prediabetes, metabolic syndrome, type 2 diabetes and other metabolic disorders for the correction of eating habits in order to improve carbohydrate and lipid metabolism.