Experts in the field of science, biotechnology, and healthcare traditionally gathered at the Technoprom International Forum. Exhibitions, agreements, conferences…
One of the most interesting discussions took place among the events dedicated to the quality of life. The topic is "Public Health management: from current restrictions to new opportunities". This meeting of experts became especially interesting due to the active discussion of new approaches and a fresh look at the problem.
The speakers paid special attention to a promising concept, the essence of which is to modify risk factors for the development of chronic non-communicable diseases, that is, cardiovascular, oncological diseases, diabetes mellitus and others. What it is and how modern approaches can be applied in healthcare - read in our material.
WE NEED TO TRAIN DOCTORS
The topic of health saving is of particular importance in the light of the task set by Russian President Vladimir Putin - to increase life expectancy to 78 years by 2030.
How to achieve this? One of the ways is to reduce the influence of risk factors on the human body. An effective tool with proven effectiveness in identifying risk factors for the development of chronic non-communicable diseases that have a significant contribution to mortality is a set of preventive measures: preventive medical examinations, medical examination, medical supervision.
- During the medical examination and preventive medical examinations, a huge number of risk factors are revealed: each person has more than two of them. The most common in the Novosibirsk Region are irrational nutrition, low physical activity, overweight and obesity," Elena Dergacheva, Deputy director of the Regional Center for Public Health and Medical Prevention, said at the discussion.
What to do with the identified risk factors? How to reduce their negative impact? Of course, it is necessary to modify human behavior, since most of the risk factors are behavioral or controlled.
Agree that you can give up smoking, increase physical activity - it's enough to walk for 30 minutes every day, change your diet - reduce the amount of sugar, animal fats, exclude sugary carbonated drinks, give up alcohol.
- In every medical organization there are offices or departments of medical prevention, in some there are health centers, there are specialists who will advise on the correction of risk factors. But the task is quite difficult: specialists need to be able to convince, inform citizens why it is important to change the usual way of life. Therefore, one of the tasks of the specialists of the Center for Public Health and Medical Prevention is to train medical workers in preventive counseling technologies in accordance with modern methodological recommendations and global trends in approaches to correcting risk factors," explained Elena Nikolaevna.
REDUCE HARM BY 95%
Anna Chernova, Head of the Department of Science and Innovation of the Federal Siberian Scientific and Clinical Center of the FMBA of Russia, Professor of the Department of Faculty Therapy of the Krasnoyarsk State Medical University, member of the Association of Medical Specialists in Risk Modification, member of the Russian Society of Cardiology, MD, elaborated on the threats to the heart and blood vessels.
- The greatest contribution to the mechanisms leading to cardiovascular complications is given by such a risk factor as smoking. In addition to carbon monoxide, tobacco combustion products, so-called resins, are formed during the burning of cigarettes, which form a permanent chronic inflammation in the inner shell of the vessel," the cardiologist noted. Gorenje Gorenje. At the same time, nicotine, which is known to be responsible for the formation of addiction, is not the cause of the development of smoking-related diseases.
There is a solution. A solution that is already being used abroad. And Anna Chernova referred to him:
- Many patients are not motivated to quit smoking and are not ready to do it right now. In the current recommendations of the American College of Cardiology for heavy smokers who are not motivated to refuse, various modification options are offered. These are motivational conversations, risk analysis, offering free samples of products that contribute to stopping smoking or reducing the amount of tobacco smoked. Among the recommendations, the transition to low-risk products is also being considered. The main cause of diseases caused by smoking is associated with exposure to tobacco smoke. The transition to alternative nicotine-containing products, that is, low-risk products, reduces the impact of an array of harmful and potentially harmful substances compared to cigarette smoke due to the absence of the combustion process in such devices.Gorenje
Thus, according to the Food and Drug Administration (FDA), the transition from cigarette smoking to electronic tobacco heating devices is a reduction in the level of various harmful and potentially harmful substances by an average of 95%.
By the way, the scientific comparison of electronic tobacco heating systems (ESNT) with classical cigarettes is carried out not only abroad. So, in particular, the All-Russian Scientific Research Institute of Tobacco, Shag and Tobacco Products conducted a chemical analysis of the aerosol of the tobacco heating system in comparison with the smoke of the best-selling brands of cigarettes in Russia.
- It was found that the content of detectable toxic components in the ESNT aerosol is significantly lower compared to the control cigarette of the five best-selling cigarette brands in the Russian Federation, - concluded VNIITTI.
And Director of the Institute of Fundamental Medicine and Biology, Vice-Rector for Biomedical Direction of Kazan Federal University, corresponding member of the Academy of Sciences of the Republic of Tatarstan Andrey Kiyasov in an interview with Kommersant shared the results of clinical studies that were conducted at the Institute:
- There is extensive preclinical and clinical data confirming the potential of tobacco heating systems to reduce the risk of developing smoking-related diseases compared to continuing smoking traditional cigarettes. Our study found that, in general, ESTS are less harmful products compared to conventional cigarettes.
MAKE IMPORTANT POINTS IN CLINICAL RECOMMENDATIONS
The conversation about the principle of risk reduction was continued by the speech of Maxim Korolev, MD, Chief freelance rheumatologist of the Novosibirsk region, head of the Research Institute of Clinical and Experimental Lymphology - branch of the Federal Research Center Institute of Cytology and Genetics SB RAS, member of the Association of Medical Specialists in Risk Modification, rheumatologist of the highest category.
- The commitment of the population to a healthy lifestyle remains low. To increase it, a comprehensive interaction of the state, the medical community, people and business is required. In particular, it is extremely important for the state to introduce an integrated risk-based approach to regulation. On the part of the medical community, it is necessary to adapt clinical recommendations taking into account the scientific approach to reduce the burden of risk factors," Maxim Korolev emphasized. - From the point of view of fundamental science, the risk factor consists of a certain set of components that have very different levels of harm. Tobacco smoking is a vivid example of this, since the main harm to the smoker's body is caused by tobacco combustion products.gorenje And here the definition of the level of harm is at the heart of the concept of harm reduction. It would be difficult to talk about this without serious scientific research, but many studies have already been conducted, and they allow us to very clearly substantiate the concept of harm reduction.
Maxim Alexandrovich noted that the struggle for the population's refusal to smoke has reached a certain limit. There are people who are ready to quit a cigarette, and they quit. The rest stay with their habit.
- The unprecedented efforts of the state and the healthcare industry aimed at reducing smoking have their limits. We have achieved serious results and stopped: over the past 5 years, the proportion of smokers has not noticeably decreased. It is unlikely that we will be able to achieve the complete elimination of this risk factor by the methods studied. But it is possible to apply the concept of harm reduction through the use of special products: people who are not yet ready to completely give up tobacco and nicotine consumption will eliminate a certain set of harmful substances contained in classic cigarettes. And it will be a good help. It is very important. And this, in my opinion, is illogical not to use. Such initiatives are used by a number of professional communities, - said Korolev.
Special products in this case are electronic tobacco heating systems. The harm from them (this has already been mentioned earlier) is significantly less compared to continuing smoking. But in order for the doctor to offer the patient such an alternative, he needs grounds. Such grounds may be officially accepted clinical recommendations.
- Clinical recommendations that should directly regulate and create algorithms for the behavior of patients and medical professionals regarding tobacco dependence, at the moment in Russia do not take into account either the current situation with drugs on the market (for example, the absence of varenicline), or the part of patients who are not motivated to quit smoking. Perhaps separate recommendations are needed to regulate this process. Or they should be applied in each of the national recommendations for those diseases where the harm of tobacco is proven. Separately - in cardiology, rheumatology, oncology. Each niche has its own peculiarities," the speaker reasoned.
A LOT DEPENDS ON THE EMPLOYER
The head of the SMITRA clinic network, the head of the Health Committee of the Novosibirsk regional branch of the Support of Russia, Pyotr Smirenko, stressed that employers play an important role in protecting the health of Russians.
- We all spend a third of our lives at our workplaces in organizations. Therefore, the role of enterprises in human health and in the prevention of diseases should not be underestimated. Today, businesses and employers are interested in the health of employees. Here their interests intersect with the interests of the employee and the state," Smirenko believes.
The interaction of companies with clinics has not yet been established. And not all the valuable subtleties of the law are known to the heads of enterprises:
- For example, the Tax Code allows you to spend up to 6% of the company's payroll on medical services. And this money can be attributed to the costs of the company by reducing the income tax. It's a pity that not so many organizations know about this, but this is the way to supplement their programs and take care of the health of employees.
PATIENTS NEED INFORMATION
One of the important and, alas, negative factors is the lack of information. As many employers do not know about the same tax benefits for taking care of the health of staff, so many patients do not know how to reduce the health hazard.
This follows from the speech of the general director of the Medical Marketing Agency "Med", the author and organizer of the socially oriented educational project "Healthy Subbotnik" Irina Ovdina.
- People need information on all issues related to their health. Our project allows you to meet informally with a doctor, increases the literacy of the population in health care issues, allows people to get useful advice, specific tools and technologies. There are positive trends this year. The topic of health has become more important in the value system, especially after 2021. There are more advanced patients, - Irina Nikolaevna added.
She advocates for more thorough health awareness among the population. Many do not know how to reduce the threat to the body. But we would like to understand it.
- It's nice to realize that doctors and medical institutions have become more open in communication. And people are waiting for it. They want to communicate. The population has changed the attitude towards the doctor. Doctors are really respected, their opinions are listened to. People want to get reliable information, - Ovdina is sure. - It is important to develop communication technologies in every medical institution, including the state one. To do this, it is necessary to organize public relations departments that could regulate the flow of information in the open space.
DANGEROUS GOODS - OFF THE MARKET!
A representative of the business community, Executive Director of the Novosibirsk Regional branch of Opora Russia, head of the Committee on Trade and Excisable Goods Natalia Kosheleva, also spoke at the discussion.
- A risk-oriented approach in regulating the consumer market is important and necessary. Such an approach will indicate that the state is waiting for those innovative developments that have more valuable and useful characteristics, or developments with less harmful content of any components. The key condition: these properties must be unequivocally proven by science. There should be no politics, populism, there should be only scientific data, - Natalia Alexandrovna is convinced.
She stressed that among the electronic nicotine delivery systems (electronic cigarettes, vapes) there are many dangerous fakes with uncontrolled composition on the shelves. They need to be fought:
- If we are talking about nicotine-containing products, then there is a wide variety of so-called smokeless products on the market as an alternative to cigarettes. But a lot of violations are recorded. Basically, the products that are on the markets, in the transitions are illegal products with incomprehensible contents, without documents confirming the origin and safety of the products. It is important to eradicate illegal, dangerous products and support those who work according to the law. We need technical regulations, clear rules for the introduction of such products to the market and its turnover. To do this, it is necessary to comply with the existing legislation regarding the turnover of nicotine-containing products. And it is important to develop a protocol of scientific research that would make it possible to guarantee the fact of reducing harmful substances in products or, conversely, the non-compliance of such products with the requirements.
Kosheleva believes: it is necessary to emphasize the peculiarity of the products: the factor of reducing harmful substances in it or, conversely, the non-compliance of such products with the requirements.
- Science and independent research should be behind regulatory decisions regarding such products. The part of the products that is legal and meets the requirements can remain on the market. Everything that does not correspond should leave the market," Kosheleva summed up.
The participants of the discussion agreed. A tool such as risk factor modification should be used. The population in this part needs to be educated. And arm doctors with information, including updating clinical recommendations. Their addition in the light of new research has become one of the main theses of the discussion.
When Elena Dergacheva, Deputy Director of the Regional Center for Public Health and Medical Prevention, took the floor again, she, for her part, supported the initiative of colleagues on the need to improve work with nicotine-dependent patients:
- I really liked the idea of making changes and supplementing existing clinical guidelines for the treatment of tobacco addiction with new approaches to reduce risk.
The contribution of employers (their real concern for the health of employees) and educational projects for citizens can complement the efforts of doctors and the state.
As for alternative products to cigarettes, there are still tasks to combat counterfeiting (it is dangerous), and motivate businesses to sell less harmful goods. Incentives can occur through the policy of excise loyalty. At the same time, the order in the market will allow consumers to buy products that will really ensure the use of a risk-based approach to saving their health.
Following the discussion, the speakers formed a number of proposals to the federal authorities. They were sent to the addressees using the Technoprom appeals service.
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