RESUMO
В Туркменистане высокий уровень преждевременной смертности от неинфекционных заболеваний (НИЗ). Вероятность преждевременной смерти (в возрасте 30–69 лет) от одного из основных НИЗ составляет 26,9%. Значительные социально-экономические последствия этой ситуации для развития страны обусловливают необходимость срочного укрепления потенциала системы здравоохранения для эффективного реагирования на растущее бремя НИЗ. В Туркменистане в этом направлении уже достигнут значительный прогресс, например, в решении проблемы распространенности поведенческих факторов риска и в модернизации инфраструктуры медицинских учреждений, имеется также политическая приверженность, однако показатели по контролю НИЗ все еще нуждаются в улучшении.В настоящем докладе приведен обзор проблем и возможностей системы здравоохранения Туркменистана применительно к наращиванию основных услуг профилактики, ранней диагностики и лечения НИЗ. Также освещены примеры передовой практики борьбы против табака. По результатам оценки сформулированы рекомендации для дальнейших действий.
Assuntos
Doença Crônica , Atenção à Saúde , Assistência de Saúde Universal , Promoção da Saúde , Atenção Primária à Saúde , Determinantes Sociais da Saúde , Avaliação de Programas e Projetos de Saúde , TurcomenistãoRESUMO
Premature mortality due to noncommunicable diseases (NCDs) is high in Turkmenistan. The probability of dying prematurely (between the ages of 30 and 70 years) from one of the major NCDs is 26.9%. This has significant socioeconomic consequences for the development of the country and calls for immediate strengthening of the health system to respond to the growing burden of NCDs. Despite political commitment and significant progress, for example in reducing the prevalence of behavioural risk factors and in upgrading the health facility infrastructure, the outcomes of NCDs could still be improved.This report reviews the challenges and opportunities of the health system in Turkmenistan for scaling up core services for the prevention, early diagnosis and management of NCDs. The report also provides examples of good practice in tobacco control. Policy recommendations are made for further action, based on the assessment.
Assuntos
Doença Crônica , Atenção à Saúde , Promoção da Saúde , Atenção Primária à Saúde , Determinantes Sociais da Saúde , Avaliação de Programas e Projetos de Saúde , Turcomenistão , Cobertura Universal do Seguro de SaúdeRESUMO
OBJECTIVE: Systemic sclerosis (SSc) is characterized by microvascular injury, fibrosis, and hypoxia of involved tissues. The vasoactive peptide endothelin-1 (ET-1) seems to be implicated in these events. Using nailfold videocapillaroscopy (NVC), we evaluated longterm effects of ET-1 antagonist treatment on nailfold microvascular damage in patients with SSc, over a 3-year followup period. METHODS: Thirty patients with SSc (mean age 64 ± 5 yrs, mean disease duration 8 ± 1 yrs) were recruited during their programmed standard treatment protocols. At baseline (T0), 15 patients with SSc (mean age 63 ± 15 yrs, mean disease duration 7 ± 3 yrs), already receiving cyclic intravenous infusion of iloprost (5 continuous days, average 80 µg/day, every 3 mo), continued the treatment for a further 3 years (ILO group). The remaining 15 patients with SSc (mean age 68 ± 13 yrs, mean disease duration 8 ± 4 yrs), although they continued the same cyclic intravenous iloprost treatment as the previous group, also received bosentan 125 mg twice a day for 3 years (ILO+BOS group). Qualitative analysis (scleroderma patterns) and semiquantitative scoring of the microvascular damage were performed by validated routine NVC methods. RESULTS: During followup, a statistically significant increase of capillary number was observed in the ILO+BOS group (p < 0.02), with a significant and progressive increase of angiogenesis (p < 0.01). In contrast, the ILO group showed a statistically significant decrease of capillary number (p < 0.05). After 3 years the number of capillaries was significantly higher in the ILO+BOS group than in the ILO group (p < 0.05). The score for giant capillaries decreased significantly in both groups of patients with SSc (p < 0.05). CONCLUSION: In this open study, longterm treatment with ET-1 receptor antagonist in combination with iloprost was found to interfere with progression of nailfold microvascular damage in patients with SSc, as assessed by NVC over a 3-year followup period.
