[Deontological education of students in the Internal Medicine Department].
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Biomedical subjects
Publications and source records attributed to A A El'garov.
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The results of dynamic examination 842 high school students 10-17 years old, boys and girls, in the period of socioeconomic conversions in 1992-1998 are presented. An actual nutrition was studied by a reference method of diurnal inquiry. Expressed disbalancement in nutrition consisting in increased consumption of saturated fatty acids (13.3%), saccharum (15.8%) on a background of the decreased consumption of total carbohydrates (52.8%), oligosaccharides (6.2%), polyunsaturated fatty acids (4.5%), animal protein (6.7%), cellulose (2.6 g) and practically of all micronutrients is found. The low content in rations a fish, fruit, vegetables, nuts, dairy produce and high--confectionery, baked products, drinks is shown. Reduction of energy value of daily rations and their contents of series of alimentary substances have aggravated disbalancement of children's nutrition.
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The study covered influence of Isradipine (2.5 mg administered twice daily during 6 weeks) on blood circulation in the heart and occupationally important functions and traits among 30 drivers having mild and moderate arterial hypertension (AH). Systolic and diastolic pressure demonstrate reliable decrease in all the examinees with mild AH and in 93.8% of the examinees with moderate AH. Isradipine proved to influence positively decrease of hypertensive reactions and subclinical myocardial ischemia. Isradipine presented statistically significant improvement of the studied psychophysiologic parameters (quickness of latent and motor visual reaction, number of errors in color choice, exactness in following the mobile object). Thus, all above enables to recommend Isradipine (Lomir) as effective and safe method correcting arterial hypertension in drivers.
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Peculiarities of drivers' work require visual strain. The studies prove considerable changes in accommodation (value of absolute and resources of relative accommodation), muscular balance, visual performance in correction test, that prove visual fatigue of automobile drivers, especially aged 20 to 30.
Epidemiologic, electrophysiologic and psychophysiologic studies among urban and rural automobile drivers helped to reveal occurrence of coronary artery disease (CAD), arterial hypertension (AH) and their risk factors. In addition, special studies (monitoring of ECG in natural conditions) among 118 drivers diagnosed the signs of coronary failure and arrhythmias. Psychophysiologic studies among the individuals suffering from cardiovascular diseases (CAD, AH and arrhythmias) proved worse parameters important for occupational activities and for traffic safety.
Questionnaires were used to study the attitude of 4594 Nal'chik schoolchildren (86% of the representative population sample) to harmful habits to establish the incidence of the latter ones. 38.2% of the boys and 11.8% of the girls smoked, among them 24.2 and 2.7% respectively smoked on a regular basis (one cigarette a week). 39.5% of the boys and 25% of the girls took alcoholic drinks. This number did not include 11.4% of the boys and 3.6% of the girls who drank before but discontinued drinking completely for the last 12 months. The causes of tobacco-smoking and alcoholization turned varied, with the main of them being a wide prevalence of harmful habits among the adult population and extremely low knowledge of a real influence exerted by tobacco-smoking and alcohol on human body. It is significant that about 20% of the questioned failed to give a conclusive answer to the items of the questionnaire. In addition to the lack of health education, this may lead to an increase in the spread of harmful habits among schoolchildren. Based on the data obtained attempts are made to carry out a goal-oriented work aimed at the formation of a healthy way of life among school-children.
As a part of the cooperative programme "Epidemiology of IHD and atherosclerosis in different regions" blood lipids were measured in schoolchildren of Nal'chik (577 boys and 594 girls aged 11-14). Standard photometric methods were used to determine total cholesterol (TC), TC of high-density lipoproteins (HDL), triglycerides (TG). Levels of TC and HDL TC in Nal'chik schoolchildren proved lower than those in controls from other regions tending to rise with age in boys and to remain unchanged in girls. At the age of 11 TC levels in boys were similar to those in girls, whereas HDL CT remained higher. At the age of 14 the values rose higher in girls than in boys. TG concentrations and frequency of hypertriglyceridemia in 11-year-old boys were less than in girls, in 14-year-old children the differences disappeared. A relatively high incidence of hypo-alpha-cholesterolemia, typical for population of the region, manifested itself already in childhood.
The low incidence of coronary heart disease (CHD) was established in the course of a one-stage epidemiological examination of 2562 men aged 20-54 years (a random sample from an open city population). It was found to be associated with an insignificant prevalence of lipid metabolism abnormalities (excluding hypoalphacholesterolemia) and did not depend on the nature of labour (4.3% among white collars and 4.4% among blue collars). The incidence of overweight and high AP turned out approximately identical, whereas tobacco-smoking, hypercholesterolemia and hypertriglyceridemia were mostly recorded in blue collars. The prevalence of CHD and its risk factors increased with age, excluding tobacco-smoking. In the latter case, it reduced with age.
An epidemiological examination of 4323 motor transport workers made according to the program of the All-Union Cardiology Research Center, USSR AMS, revealed high arterial pressure (AP) in 22.6% of cases. The knowledge of hypertension was found to be low (34%) as was the coverage with hypotensive treatment (7.1%) and the efficacy of the latter one (1.8%). The follow-up studies (for 5 years) demonstrated the efficacy of non-medicamentous and medicamentous AP control exercised in motor transport workers. It was proved that in the principle AP might adequately be decreased and maintained for a long time at the safe level in the overwhelming majority of subjects with AP.
Serum lipids were studied in workers of a mining enterprise situated in mid-altitude areas who were affected by some unfavourable occupational factors (noise, vibration, dustiness, psychological and physical stresses). They were compared with those in a number- and age-matched group of employees of an instrument-making plant who resided in the plain and were unexposed to the above adverse factors. The miners were found to have greater mean levels of triglycerides and potentially atherogenic lipoprotein cholesterol. The mean lipid levels were higher with the miners' age and length of occupation whereas the duration of residence in mid-altitude areas had no noticeable influence on lipid levels.
Cross-sectional studies covered 2562 males (a urban population), 580 miners, 1126 agricultural drivers, 682 rural habitants and 4323 urban drivers. The mean blood pressures were basically identical in males of various occupations and age, except for urban and rural drivers aged 20-29 and 40-49 years who had significantly lower mean systolic blood pressures than those from the other groups under study. All the males showed elevation in systolic and diastolic blood pressures with age; the differences in blood pressures were insignificant only in rural drivers aged 30-39 and 40-49 years and miners aged 40-49 and 50-59 years. The incidence of arterial hypertension increased with age: from 3.2 to 7.7% in 20-29-year-old males to 34.2-37.2% in 50-59-year olds. Low (less that 50%) awareness of hypertension was identified in hypertensives. A prospective 5-year follow-up and implementation of prophylactic measures at the urban motor enterprises positively affected the incidence of hypertension and the level of hypertension awareness, and morbidity rates.
Studies were performed of the blood lipoprotein spectrum in 20-59-year-old truck-drivers working in Northern Caucasus rural areas, depending on the age, duration of work in the profession and nationality, in comparison with male workers of other professions in the same areas. It was established that, in indigenous male workers of other than truck-driver's profession, the average levels of different cholesterol lipoproteids were lower than in other ethnic groups, whereas the hypoalfacholesterolemia occurrence was two-fold. In truck-drivers of both indigenous and non-indigenous groups, the lipoprotein spectrum age-related changes were similar. In the non-indigenous drivers' group, hypercholesterolemia was highly prevalent, and hyperalfacholesterolemia was less prevalent than in other professional groups. Also, IHD cases were more characteristic of the indigenous drivers' group. The data obtained witnessed in favour of a differentiated approach in the planning of preventive activities with due account of the population's ethnic and occupational characteristics.
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