RESUMEN

In the early days of health education, people depended on health education specialists to provide information about diseases and their prevention. The differentiation between health promotion and health education, and the emphasis on the settings approach have resulted in the inclusion of a wide range of people and professions into these activities. This has raised the question of the protection of consumers, and the issue of accountability has become a major focus. This paper briefly traces the history of health education and promotion, with particular emphasis on the way people have dealt with accountability in the past as a platform for the future. The Polish model of hepatitis B vaccination is used to illustrate these developments.

Asunto(s)

RESUMEN

The proportion of elderly people grows rapidly both in Croatia and worldwide, posing great health care, psychological, social, economic and other problems. In the elderly, cardiovascular diseases, especially coronary (ischemic) heart diseases, account for approximately 50% of all deaths. In contrast to previous opinions, recent studies show that aging per se does not substantially diminish the efficacy of heart pump unless affected by diseases, primarily atherosclerosis (atherothrombosis). Atherosclerosis, however, is not an inevitable component of old age, but a disease that can to a great extent be prevented, and hopefully even defeated in the near future. Of paramount importance is elimination of the major risk factors: cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, obesity, and physical inactivity, preferably in the form of primary prevention, primarily by the hygienic-dietetic measures, and by medication (antihypertensives, hypolipidemics), if necessary. The prevention should be initiated early enough to prevent the development of subclinical forms of the disease, because clinical manifestations (angina pectoris, myocardial infarction, serious ventricular arrhythmias, sudden death) occurring unexpectedly ('like a bolt from the blue') reflect a very advanced coronary disease. The management of these late complications, however admirable it may be (coronary dilatation--stents, coronary surgery, thrombolysis, resuscitation, electrotherapy, etc.), is only partially successful and in fact unavailable to the majority of the population, even in developed countries. Therefore, every individual should be informed about the main characteristics of the issue to be able to take active participation in the programs of primary prevention. Although the relative importance of particular risk factors decreases in old age, these factors are present in a higher number in the elderly which, along with the generally greater mortality rate, points to the need of all measures (primary and secondary) of prevention to be as carefully carried out in the elderly as in younger individuals.

Asunto(s)

RESUMEN

In 71 patients with a myocardial infarction (MI) (anterior in 27, inferior in 44 patients) global (GEF) and regional (REF) left ventricular ejection fractions were determined by radionuclide ventriculography and estimated from a 12 lead electrocardiogram (ECG), using Selvester's QRS score, during the early phase of a MI (15 to 21 days following MI). Global ejection fractions determined by radionuclide ventriculography and from ECG using Palmeri's method were: for all MI 40.8 +/- 12.6% vs 39.6 +/- 11.4%; in the group of anterior MI 32.0 +/- 10.0% vs 30.0 +/- 9.7% and in the group of inferior MI 48.9 +/- 12.0% vs 45.1 +/- 8.2%. A good correlation was found between global ejection fractions determined by radionuclide ventriculography and ECG, as well as between radionuclide GEF and ECG score. A weaker correlation was found between radionuclide GEF and enzymes among all MIs and in the group of anterior MI, while in the group of inferior MI this correlation was insignificant. The analysis of REF determined by radionuclide ventriculography and ECG showed the greatest abnormalities in the infarct region, but in the group of anterior MI, dysfunction was present in the whole left ventricle. The comparison of infarct-related REF derived from radionuclide ventriculography, with the QRS score showed a significantly higher correlation than the comparison with enzymes. ECG estimation of REF from a modified Palmeri's equation showed a better correlation with radionuclide REF than did GEF derived from the standard Palmeri's equation: anterior MI; r = 0.90 vs r = 0.82, inferior MI; r = 0.84 vs r = 0.69, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

RESUMEN

Quantitative and qualitative analyses of Q waves and QRS scores were performed on 69 patients during the early phase of first myocardial infarction (MI) and 6 months subsequently. The regression of ECG signs of MI were compared with the enzymatically estimated size of MI, the location of MI, and with the changes of global ejection fraction (GEF) assessed by radionuclide ventriculography. Among 57 patients with Q wave MI a complete disappearance of ECG signs of MI was found in 9 (15.7%). Patients with MI of inferior location showed a significantly higher reduction of Q waves (p < 0.001) and QRS scores (p < 0.001) than the anterior MI group. In the group of 12 patients with non Q wave MI, 11 demonstrated complete regression of MI signs. Among all Q wave and non Q wave MIs, the authors found no significant difference in the size of MI between patients with and without complete regression of ECG signs of MI. The median of the percent of change of the QRS score was significantly higher (p = 0.04) in the group of patients with improved GEFs than in the group of patients with decreased or unchanged GEFs 6 months following acute MI. The sensitivity, specificity, and predictive values for improved left ventricular function according to the change of Q waves and ECG scores were 91%, 32%, and 62%; for changes of Q waves, 81%, 40%, and 63%; and for changes of ECG scores, 91%, 36%, and 64%, respectively. In the group of patients with non Q wave MI these values were 100%, 50%, and 91% as a result of ST-T disappearance.

Asunto(s)

RESUMEN

In 60 patients myocardial infarction size was determined by electrocardiogram (ECG) using Selvester's QRS scoring system. These values were compared with the size of infarction as determined enzymatically using gram equivalent isoenzyme MB creatine kinase (gEq) and using maximum values of isoenzyme MB-CK. The results showed no statistically significant difference between the size of anterior and inferior infarction determined by gEq (25.19 +/- 13.59 vrs 22.48 +/- 14.04; p = 0.12 NS) and by maximum MB-CK (125.5 +/- 76.0 vrs 98.4 +/- 60.7; p = 0.12 NS). The size of myocardial infarctions determined by ECG was significantly larger anteriorly compared with the inferior infarcts (9.6 +/- 2.9 vrs 4.5 +/- 2.6; p = 0.001). In patients with anterior infarcts good correlations between the size of infarction determined by QRS scoring system and by gEq or maximum MB-CK were found (r = 0.69; p = 0.004 and r = 0.72; p = 0.001). In patients with inferior infarcts the correlations between QRS score and gEq or maximum MB-CK were poor (r = 0.37; p = 0.02 and r = 0.45; p = 0.15). The causes of weak correlations in the results of described methods in inferior infarcts are discussed. Thus QRS scoring system provides new noninvasive and simple possibilities in determining the size of anterior and in inferior infarctions of the left ventricle.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

A study was conducted on a sample of pregnant women. The study had two aims: to develop a method of measuring social expectations (norms) and to find out how far women conform in their behaviour to these norms. The areas of behaviour were smoking, exercise, diet, alcohol, and medication. Pregnancy was found to be appropriate for this study because of the high degree of formalisation that this state enjoys in our society. The methods used for measuring norms in this study are an improvement on earlier methods, but further refinements are needed. The findings show that women generally do conform to the social expectations and that their behaviour is in accordance with three types of norms--that is, general, specific, and transitional. The implications for health education interventions are discussed.

Asunto(s)

RESUMEN

Differences between various models in the organization of health education services are explored. New developments in health education approaches used in training, career structures, and job definitions in some European countries are summarized. Problem areas have been defined and recommendations have been produced by numerous activities of the World Health Organization in recent years. At a 1974 symposium, it became obvious that no planned manpower development is feasible without a job definition of the health educator as an educational product. The need to specify the aims of future developments requires taking a critical view of past developments and spelling out existing differences.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)