Analysis and a Review of Systematic Concept for Prevention and Health Promotion in Healthcare Sector of the Federation of Bosnia and Herzegovina

Margarita Strelcenia* , Gubkin S.V.
Corresponding Author: Mararita Strelcenia, M.D. Belarusian State Medical University, Minsk, Belarus. Email: [email protected]
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Abstract

Introduction and the goal: In time when healthcare budgets are reduced because of the rise of medical technology prices, demographic trends, and dominance of chronic diseases in morbidity and mortality of the population, prevention of diseases and promotion of health have become vital interests of the reform commitments and the imperative of the intersectoral development policy in the community. The goal of this work is the assessment of participation and the definition of the role of prevention and promotion of health in important strategic and legal documents in the Federation of Bosnia and Herzegovina.

Methods: In this research we used descriptive method, in which secondary source of data is used. Documents listed in the references are used as a base.

Results: In the last decade many relevant documents have been written, which affirm the importance of preventive interventions in relation to population groups and priority public healthcare challenges such as: Federal programme for prevention of alcoholism and drug addiction, Strategy for control of tobacco, Policy for food and diet, Strategy for improving sexual and reproductive health and rights, Policy of healthcare of youth, and Strategy for prevention of malignant neoplasm.

Conclusions: Analysis of the available documents indicates respectable systematic positioning of prevention and promotion of health in reform of healthcare services, education of healthcare workers, achieving quality and accreditation standards of good practice, together with the need for improving the education of public and patients about importance of partnership and active participation in improving health, and strengthening the concept of personal and social responsibility for health.

Keywords

Myocardial infarction, thrombolytic therapy, Alteplasa, Streptokinase

Introduction

Heart disease is a leading cause of death in many countries. Although deaths from heart disease have decreased considerably in the past 20 years. Around 1.5 million people experience AMI in the USA each year and about 600,000 people die from this condition. Acording to NICE (2002), 240,000 people experience AMI in England and Wales each year. Up to 50% of people who have an AMI die within 30 days of the event, and over half of these deaths occur before medical assistance arrives or the patient reaches hospital. And just around 50,000 AMI patients recieve thrombolytic treatment on time. Thrombolytic therapy should ideally be given as soon possible (normally up to 12 hours) after the onset of AMI symptoms.

Material and Method

The materials for investigation included 23 histories of patients' diseases, admitted to the 4th City Clinic Hospital in the first 6 hours from MI beginning in the period from December 2009 to January 2010. Patients were subdivided in two groups: in the first group 6 patients were treated with Alteplase, and in the second group 17 patients were treated with Streptokinase.
The diagnosis of AMI was based on WHO criteria, which included clinical symptoms (typically but not exclusively chest pain), typical changes in the 12-lead electrocardiogram (ST segment elevation, which provides the most immediate indication of the diagnosis of AMI for patients requiring thrombolytic therapy for AMI) and myocardial enzyme elevation (Creatine Kinase(CC-MB), Troponin). Male and female correlation was 14:8. An average was 64 years. 16 patients (70%) experienced AH, 3 patients (13%) - diabetes. One patient had died.
The efficiency of thrombolytic therapy was estimated using the following criteria: complete relief and lack of recurrence of pain, early more than 50% ST-segment return to baseline, complications in post-infarction period at the hospital stage.
As a theoretical basis for the effectiveness of TLT of acute myocardial infarction, the hypothesis of an "open coronary artery” of E. Braunwald (1989) was taken, based on three fundamental principles:
1) According to coronary angiography the total occlusion of coronary artery is found in 85% of patients with myocardial infarction. All this appears in the first 6 hours of AMI.
2) The introduction of the thrombolytic agent into the coronary or systemic circulation, promotes recanalization of thrombosed coronary artery.
3) Early recanalization of coronary artery provides a reduction in the amount of necrosis, left ventricular dysfunction, improvement of the immediate and remote results of treatment.

Results

A total of 23 patients underwent investigation, and the two groups were well matched with regard to baseline characteristics (Table 1). A total of 100 percent of patients had atherosclerosis of aorta and coronary arteries. The time from the onset of symptoms of myocardial infarction to the administration of thrombolytic agents was 6 hours. A total of 17 people received Streptokinase and only 6 people received Alteplase. Other thrombolytic agents were not used at the hospital that time. In conducting a comparative analysis of the clinical effectiveness of two thrombolytic agents, streptokinase and alteplase, it was found that TLT alteplase is more effective than TLT with streptokinase in the incidence of such complications of AMI as: postinfarction angina ( 18 percent in the group of Streptokinase and 3 percent in the group of Alteplase), life-threatening arrhythmia ( 41 percent in the group of Streptokinase and non in the group of Alteplase ), acute left ventricular failure ( 18 percent in the group of Streptokinase ) and in terms of a 30-day mortality (in the group with one patient died).

Discussion

Thrombolytic treatment given witin 12 hours of a heart attack saves between 30 and 30 lives per 1000, within the first hour it saves 65 lives per 1000, but within two hours only 37 lives per 1000 patients treated.
Every minute's delay costs 11 days of life.
Every half hour's delay is equivalent to a year of life lost. (The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology, 2003).
Recent trials have confirmed the importance of achieving early, complete, and sustained reperfusion after acute myocardial infarction.
It is very important to give trombolytic terapy on time. It should ideally be given as soon possible (normally up to 12 hours) after the onset of AMI symptoms.

Conclusion

The result of the following conclusions:
1) In conducting a comparative analysis of the clinical effectiveness of two thrombolytic agents, streptokinase and alteplase, it was found that TLT alteplase is more effective than TLT with streptokinase in the incidence of such complications of AMI as: postinfarction angina, life-threatening arrhythmia, acute left ventricular failure and in terms of a 30-day mortality (in the group with one patient died).
2) According to the literature by comparing two thrombolytic agents - streptokinase and TPA, it should be noted that in the first 3 hours of AMI incidence the level of recanalization is higher by treatment with tPA (81%) than treatment with streptokinase (60%). But in prescribing after 3 h of MI the chance of recanalization of the damaged coronary artery is almost the same (74 and 76%), which was confirmed in practice.
3) The most important factor determining the choice of treatment tactics and effectiveness of TLT is the time interval from the beginning of anginal attack prior to treatment. The sooner started TLT, the higher the efficiency is.

Conflict of Interest

None declared. (Or mention here if any)

References

1. T. P. J. Hirvonen, M. O. Halinen*, R. A. Kala? and J. T. Olkinuora? for the Finnish Hospitals? Thrombolysis Survey Group: Delays in thrombolytic therapy for acute myocardial infarction in Finland, 1998. European Heart Journal (1998) 19, 885?892

2. Frans Van de Werf, Chair*, Diego Ardissino, Amadeo Betriu, Dennis V. Cokkinos, Erling Falk, Keith A.A. Fox, Desmond Julian,Maria Lengyel, Franz-Josef Neumann, Witold Ruzyllo,Christian Thygesen, S. Richard Underwood, Alec Vahanian,Freek W.A. Verheugt, William Wijns: Management of acute myocardial infarction in patients presenting with ST-segment elevation, European Heart Journal (2003) 24, 28?66
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