T C N C Y H P h y trUdng 80 (3B) - 2 0 1 2
8. T r i n N g p c T ^ ( 2007). Mb hinh qudn 9. L e n n a E. (2000). Social policy for ly vd CSSK NCT tgi cbng d i n g huy0n T u Libm elderly in Sweden, report at National seminar - Thdnh pho Hd Nbi. Lu0n vdn T i l n s9 Y hpc, on policy for elderly in Viet Nam, Ha Npi.
Hgc vi0n Qudn Y.
S u m m a r y
USE OF H E A L T H SERVICE A N D U N D E R S T A N D I N G OF S O C I A L SERVICE AMONG ELDERLY P E O P L E IN A N L A O , B I N H LUC D I S T R I C T H A N A M IN 2011 Number of elderly person increase in all countries in the world due to life expectancy increase and bidh rate decrease. This is challenge to health care service for elderly. The study was to describe the use of health services and to identify knowledge about social sen/ice and participating in social activities among elderiy people in An Lao. Binh Luc distdct. Ha Nam In 2011. The results indicated that 63% of study subjects had health insurance. Communal health centre (42.3%) and self-treatment (35.7%) were commonly used. Chronic diseases of the musculoskeletal system (55%), hypertension (25%) were the most commonly reported diseases. Knowledge about social support programs (19.7%), health care policy for elderly (16.3%) was low. Only 3.7% knew about information channels for elderty people.
K e y w o r d s : e l d e r l y p e o p l e , h e a l t h s e r v i c e , s o c i a l s e r v i c e
THUC TRANG HUT THUbC LA VA TY LE MAC MOT Sb BENH LIEN QUAN TRONG NHOM NGUdi HUT THUbC TAI HUYEN
BAVi NAM 2010
N g u y e n PhU'O'ng H o a , Ph^m Thj Lan Tnrimg D^i hgcYHa Npi
Hut thuic li li mot trong muiri yiu ti nguy eo hing diu giy b$nh tit vi tu. vong trdn thi gidi. Nghiin cdv duvc thuc hien nhim md ti thuc trang hiit thuic li eua ngudi din huyin Ba Vi, Hi NQI vi xic dinh UU ngudi din tu khai bid di dupr: chin ddin mic mil s6 binh mi hut thuic li mil tmng cac yiu ti nguy cd.
Kel qui eho thiy 74,2% s6 hi gia dinh cd / ( n h i t mil ngudi hut thuic. Tl 1$ hut thuic d nam gidi la 61,9%
vinCr gidi la 0,7%. Tl ip cd tripu chung ho keo dii trin hai tuin a nhdm hut thuoc cao hryn nhdm khdng hilt thuic (3,4% so vdi 1,4%). Tl lift/ khai bio duvc chin doan mic banh ting huyit ip vi eic b$nh dudng hi hip nhu bpnh phii tic nghin man tinh (COPD), hen phi quin a nhdm hiit thuoc diu cao /ion so vdi nhim khdng hdt thuoc. Thdi gian hut thuic cd liin quan din nguy co bi mic mpt si binh ho hip vi tim macb.
cin triin khai cie chinh sich phdng ching thuic li vi ci nhOng chuang trinh can thipp nhim lim giim si b$nh nhan vi s6 ngudi tu vong do hut thuoc li.
Tl> k h d a : h i i t t h u o c , t\f k h a i b a o , b p n h t $ t
TCNCYH Phg trUdng 80 (3B) - 2012
I. BAT V A N Dfe
Khdi thuoc cd khoang 4000 hda chit khac nhau trong do co 43 chit gay ung thu va cac chat gay nguy h?i khac nhu': gay nghipn, nguy co cho bpnh tim mach, bpnh phoi man tinh, gay kich thich, gay ngp dpc va nhilu tripu chij'ng khac. Theo kit qua cua nhieu nghien cu'u, cac chat gay hai diln hinh cd trong thuoc la va khdi thulc Id phai k l din nhir la Nicotine, Carbon monoxide (CO), Hic in (Tar), Benzene, Nitrosamines, Ammonia, Fomialdehyde, Hydrogen Cyanide, Polycyclic aromatic hydrocarbon (PHA) [9],
Thulc la cd chija nicotine, mpt chit dupe cac t l chO'c quIc te xdc dinh la chit gdy nghipn. Sg phg thupc vdo thulc la da dupe lipt ke trong phSn lopi bpnh tpt QuIc te (ICD-10).
Nicotine la ylu to quyet dinh mlu chit cua su gay nghipn va sg phg thupc, nd chlng lai cdc CO gang bd thuoc, tac dpng den tri tup do hoat dpng ciJa ban than bp nao tpo ra. Hut thulc la se lam tang nguy ca mac ung thu' phli, nhieu nghien ci>u cho thay nguy ca bi mlc ung thu phoi d nhung ngudi hut thulc cao han nhu'ng ngu'di khdng hut thuoc tg 4 den 31 lln. Hut thuoc la cung la yeu t l nguy cc ciJa bpnh viem phi quan mpn va lao phoi [9].
(y Vipt Nam, tir nhu'ng nSm 1960, Hoang fiinh Cau va cpng sg da nghiSn ciiu moi lien quan giu'a ung thg phoi va nghipn thuoc la/
thuoc lao; trong so 389 b$nh nhdn ung thg phoi dupe phau thupt tpi vipn Lap va Bpnh phoi Trung gong cd tdi 68,6% bpnh nhan hilt thulc la/thulc ldo. Ngoai ra, viec hut thuoc cd thl gay ra mpt so lopi ung thu' a cic bp phpn khac cua ca the nhg: ung thg mipng, vdm hpng, thanh quan, thgc quan. Hiit thulc la lam tang nguy cc mlc cac bpnh tim mpch nhu'tang huyet ap, xavOa dpng mpch, chu'ng huyet khii, bpnh mpch vanh. Nguy ca mlc va t i vong do b$nh mpch vanh i> nggd'i hiit thuoc
la cao han a ngudi khdng hiit thuoc tCr 2,5 lan den 75 lln tuy theo md'c dd hiit thuoc, theo gidi va tuoi. Hut thuoc la lam giam kha nang sinh san d ca nam va nu' gidi. Nhieu nghien ciru da d l cip den nhu'ng anh hudng cua hut thuoc la va mdt s l vin d l sire khde sinh san nhu: say thai, cdc biln chu'ng khi sinh, suy dinh dudng bao thai, di dang bao thai, chit sa sinh, trd sinh ra chpm phat then thl chat va tinh thin, [1,2,91-
Hiit thulc la thu dpng la hit phai khdi thulc do ngudi khac hiit. Ngudi hiit thuoc la thg dpng cQng bi tang nguy ca mlc mpt so bpnh nhg nhu'ng ngudi hiit thuoc chii dpng. Nhieu nghidn ciru da chirng minh tdc hpi cOa vipc hut thulc la thu dpng d tre dudi 6 tuoi, ty Ip mlc cac tripu chirng hd hap d nhu'ng tre song trong gia dinh cd it nhlt mdt ngudi hiit thulc cao hon 40% so vdi tre song trong gia dinh khdng cd ngudi hiit thuoc [8],
o l i vdi loai thudc Id cd dlu Ipc nhu hipn nay, tinh trpng dpc hai cung khdng kem lopi thulc la khdng cd dlu Ipc. Theo phdn tich hoa hpc, thanh phan trong khdi thuoc la dau Ipc cd cac chit dcng vi phdng xa nhu Polonion 210 khdng he giam so vdi thulc la khdng cd dlu Ipc. Mli phut thuoc la lam cho 8 ngudi thi$t mang tren pham vi toan cau. Du bao den nam 2030 se cd khoang 10 tri$u ngudi tir vong hang nam do thulc la gay nen [9].
Chung tdi tiln hdnh nghien cu'u nay vdi myc tieu;
1. Md ta thgc trang hOt thuoc la cua ngudi dan huypn Ba Vi, Ha Npi nam 2010
2. xac dinh ti Ip mac mpt s l bpnh ma hilt thucc la mpt trong cdc ylu t l nguy ca do nggdi ddn tu khai bao.
II. B 6 | TU'ONG VA PHUONG PHAP Boi tup'ng nghien cifu: Titca nguai dan hipn dang sinh sing trpng dia bdn ca sa thuc 339
TCNCYH Phy trUdng 80 (SB) - 2012
dja FilaBavi ndm 2010. Ca sd FilaBavi duyc thdnh 10P tu ndm 1999, bao gim 71 eym (ban dlu Id 69 eym, din 2007 Id 71 eym dilu tra) thubc 29/32 xd ciia todn huy0n Ba VI, Hd Nbi.
Thiet k l nghien ciru: Nghibn euu mb td cdi ngang.
Dja bdn nghidn euu eua ca sd dich t l hgc FilaBavi bao gim 71 eym vdi ting s6 51024 ngudi ddn trong gin 13 000 hb gia dinh. Tgi FilaBavi, cdc dyt dilu tra theo dbi duye I0p Igi hdng quy d l ghi nhdn l i t cd cdc sy ki0n vd thay dii xdy ra trong hb gia dinh nhu tu vong.
sinh dd, hbn nhdn, di cu. tinh trgng I m dau...
Dia diem nghien cuu: Tgi ca sd thyc dia dich t l hge FilaBavi thugc huy0n Ba Vi, Hd Nbi.
Thu th0p so li0u tgi thyc dja duye thye hi0ntu thdng 7-9/2010.
Thu thgp so tipu: Phbng vin tryc tilp ngudi dgi di0n hg gia dinh bdng bg cdu hbi da duyc thilt k l d l thu thdp thbng tin v l tinh trgng hiit thuoc Id/ thuoe ldo eua tung cd nhdn trong h0 gia dinh vd ghi nh0n vipc mdc mbt s l b0nh (da duye y/bae sT chin dodn) thu|c h0 hb hip, tim mgeh vd ehuyen hba - ddy la m0t s l bpnh md hiit thuoc la la mgt trong cdc ylu t l nguy ca.
Bang 1. Ty Ip hut t h u l c theo
Cdc dilu tra vidn duyc t0p huln k^ ndng phbng vin thu th§p thbng tin.
Phdn tich sd Ii0u: Nghidn cdu sd dyng phin m l m Access 2000 d l nh§p s l li0u, phdn tich s6 Ii0u bdng phin mlm SPSS phl§n bdn 15.0. Thudt todn Khi binh phuang (x2) duyc sd dyng nhlm so sdnh sy khdc bi0t gida cdc nhbm. Nghidn cuu su dyng mue y nghTa a = 0,05.
III. KtT QUA
Thyc trgng hut thulc tgi Ba VI Qua phbng vin cde hb gia dinh ghi nh^n cb 11300 ngudi hiit thulc Id/thu6c ldo, ngubi trd tuli nhat cb hiit thulc Id Id 15 tuli. 6" thbi dilm dilu tra. tong s l ngudi td 15 tuli trd Idn d FilaBavi Id 37815 ngudi. Ndm 2010 tgi FilaBavi cb ting s l 12984 hb gia dinh, trong s l db eb 9634 hb gia dinh eb It nhlt mbt ngubi hilt thulc Id/thulc ldo, chilm ty 10 74,2%.
Kit qua dieu tra cho thiy trong s l 11300 ngudi hut thulc IdAhulc ldo dO tuli trung binh Id 45,3 tuli (SD =15 ndm). Tmng binh s6 ndm hut thulc cua mfii dii tuyng Id 20,8 ndm (SD
=12.6). Ngudi hiit nhilu nhlt dd duye 77 nam, vd It nhlt cOng duyc 7 thang. Cb tdi 60,7%
trong s611300 ngudi da hiit thuoe han 15 ndm.
gidi va nhbm tuSi tgi Ba Vi Tuoi
15-19 20-59
£60 Ting
"1 2388 13320 2302 18010
Nam hut thulc
141 9190 1826 11157
(%)
5,9 69.0 79,3 61,9
"2 2126 13903 3776 19805
NO hot thulc
3 73 67 143
(%)
0,1 0,5 1.8 0,7
n 4514 27223
6078 37815
Tong hilt thulc
144 9263 1893 11300
(%)
3,2 34,0 31,1 29,9 Bang 1 cho thiy ti ip hut thuoc a nam gid'i cao ban nhieu so vdi nCr gidi 6' mpi lira tuli {t^ 1$
hut thulc Chung d nam gidi la 61,9% so vdi 0,7% d nu' gidi, p < 0,001).
340
T C N C Y H Phg truong 80 (3B) - 2 0 1 2
Bang 2. Ty Ip ti^ khai bao mac mpt so Bpnh
Hen phi quan Viem phe quan
B^nh phoi t i c nghen mpn tinh (COPD) Ung thu phli
Tang huylt ap Dai thao dudng
Roi loan chuyin hda Lipid mau Bpnh lao
Bi ho tren 2 tuin
bpnh dup'C y/bac sT n 154 274 37 16 584 41 50 46 389
chan doan
%
1,4 2,4 0,3 0,1 6,2 0,4 0,4 0,4 3,4 Bang 2 cho thay trong s l nhu-ng n g g d i hiit thuoc, ty IJ m l c bpnh tang huyet ap c h i l m ti le cao n h l t 5,2%, t i l p theo la bi ho kdo dai trdn 2 tuan c h i l m 3,4%, viem phe quan 2,4% va hen phe quan la 1,4%.
B a n g 3. T y Ip t y k h a i b a o m a c m p t so b p n h dup'C y/bac sT c h a n d o a n
Bpnh Tren 15 n a m < 15 n a m OR (95% Cl) (n = 6855) (n = 4445)
n (%) n (%)
Hen p h i quan 132(1,9) 2 2 ( 0 , 5 ) 3 , 9 5 ( 2 , 4 5 - 6 , 4 1 ) Viem p h i quan 222(3,2) 5 2 ( 1 , 2 ) 2 , 8 3 ( 2 , 0 6 - 3 , 8 9 ) Bpnh p h l i t i c nghen man tinh (COPD) 2 9 ( 0 , 4 ) 3 ( 0 , 2 ) 2 , 3 6 ( 1 , 0 2 - 5 , 6 3 ) Ung t h u p h l i 14(0,2) 2 ( 0 , 0 4 ) 4 , 5 5 ( 0 , 9 8 - 2 9 , 3 3 ) Tang huyet ap ' 509(7,4) 7 5 ( 1 , 7 ) 4 , 6 7 ( 3 , 6 2 - 6 , 0 4 ) e a i thao d u d n g 3 0 ( 0 , 4 ) 11(0,2) 1 , 7 7 ( 0 , 8 5 - 3 , 7 8 7 R l i loan Lipid m a u 4 3 ( 0 , 6 ) 7 ( 0 , 2 ) 4 , 0 ( 1 , 7 2 - 9 , 8 1 ) Bphhiao 3 6 ( 0 , 5 ) 10(0,2) 2 , 3 4 ( 1 , 1 1 - 5 , 0 7 ) Bi ho tren 2 t u i n 333(4,9) 5 6 ( 1 , 3 ) 4 , 0 ( 2 , 9 7 - 5 , 4 0 )
K i t qua nghien cu'u cho t h i y thdi gian hut t h u l c tren 15 nam lam tang nguy c d m l c mpt s l bpnh thupc hp hd h i p va t u i n hoan (Bang 3). Trong dd cd nhOng benh cd nguy co bi mac cao hon tren 3 l l n n h u bi hen p h i quan (OR = 3,95; p < 0,06), ho keo ddi (OR = 4,0; p < 0,05), tang huylt ap (OR = 4,67; p < 0,05), roi lopn c h u y i n hda m d mau (OR - 4,0; p <0,05).
K i t qua dieu tra cOng cho t h i y cd su- khac bipt r l t Idn v l tj- Ip ho keo dai tren hai t u i n d nhung ngifdi hot t h u l c la va nhdm n g u d i khdng hiit t h u l c la (3,4% so vdi 1,4%, p < 0,001), (Hinh 1).
3 4 1
TCNCYH Phg truong 80 (3B) - 2012
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a Hut Uiuoc• Khflng hijl
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Hinh 1. Ty Ip bj ho keo dai cua nguai dan tpi FilaBavi nam 2010
Trong ting s l 37.615 ngudi tuli tir 15 tuli tra ISn tpi FilaBavi, ghi nhjn cd 765 b$nh nhSn c6 tripu chtrng ho kdo dai tron hai tuan (chiem 2,0%). Ty Ip ho kdo ddi b nam gidi cao ban nhieu so vdi nu-gidi (2,5% so vdi 1,6%, p < 0,05).
IV. BAN LUAN
Ty IJ hut thuoc la trong cpng ding hi$n nay dang van rat cao mpc du da cd nhilu ehiln dich truyin thdng phdng chong hut thulc Id da dupe triln khai nhung phan lan nam gidi vin chua thay dll dupe hdnh vi hut thulc la.
Kit qua trong nghien ciru nay cua chiing tdi cho thiy c6 74,2% trong s l 12.984 h | gia ainh tpi FilaBavi cd It nhlt mOt ngudi hOt thulc. Ty 10 ndy cao han kit qua cua Dilu tra y t l Quoc gia nam 2001 - 2002, cd 63% s l h | gia dinh cd ngu'di hiit thulc [3].
Kit qua nghidn ciru nay cho thiy tpi Ba V,l tl Ip hut thuoc b nam gidi la 61,9%, kit qua nay i;Ong cao han tl 1$ hut thulc cua nam gidi tren 15 tuoi trong Oilu tra y t l Quoc gia (56,1%) [3], Cung tren ciing mpt dia ban huypn Ba Vi,.
nam 2006 dilu tra cOa Hoang Van Minh va c|ng sg cho thiy cd 58% nam gldl b d l tuli lac (5|ng 24-64 hdt thuoc [7].
cac so lipu thong ke chi ra ring thgc trpng tieu thg thuoc la d Vipt Nam dang gia tang, vao nam 1998, ty Ip hOt thulc d nam gidi trud'ng thanh tpi Vipt Nam la 50% thi tdi nam 2002 ty 10 nay la 56% [2]. Kit qua Oilu tra yte Quic gia nam 2001 - 2002 (3) cho thiy d nam gidi lu'a tuli cd ty 1$ hut thulc cao nhlt la 36- 40 tuli (chiem 72,1 %) va b nO' gidi la tir 61-65 tuli (6,0%). Dilu tra QuIc gia v l vi thanh ni6n va thanh nidn nam 2003 cho thiy 43,6% nam (tuoi tu' 14 - 25) aa tirng hut thulc, vdi ty Ip hut thulc tdng theo nhdm tuli [4].
Khac vdl ngudi Idn cd t h l Iga chpn nen hay khdng nen b trong mdi trudng cd khdi thulc, trd em It cd khd nang Iga chpn dd. Theo kit qua Oilu tra yte QuIc gia nam 2001-2002, d Vipt Nam, ban 71,1% tr# em dudi 5 tuoi phai song chung vdi ngudi hiit thulc. Ty 1$
tre em dudi 5 tuli phai sing chung vdi ngu'di hut thuoc cao nhat d nhdm cd dilu kipn kinh t l nghdo va can nghdo. Kit qua m|t nghidn 342
TCNCYH Phy trUdng 80 (3B) - 2012 ciru d Hd Ngi cung cho thay han 50% tre em
dudi 5 tuoi vd 56% tre em tuoi di hgc (tu 5-14 tuoi) bi phai nhilm vdi khbi thuoc la. Mgc dii hut thuoc Id thy dgng eung rat nguy hilm doi vbi sue khbe nhung nhgn thdc ciia ngudi dan trong cgng dong ve tac hgi eiia hUt thuoc thy dpng cbn hgn ehl [8].
Hilt thule id Id y l u to nguy ea eua nhieu bgnh, trong do phai k l den cdc b0nh thubc h0 hb hap va tim mgch. Trong nghien cuu nay chiing tbi ghi nhgn ty 10 ty khai bao bi mlc mbt sb b0nh da duyc ede y/bdc sT chin dodn. Hiln nhien, ty 10 nay se thap han rat nhilu so vdi kit qua ciia eae dilu tra chii dgng phdt hi0n b0nh tgi cgng ding.
Trong nghien euu ndy ty 10 ho kdo dai tren 2 tuan cua nhbm ngudi eb hiit thuoc cao han nhieu nhbm khbng hiit thuoe (3,4% so vdi 1,4%, p < 0,001). Dieu nay li gidi cho tinh hinh mlc cde b0nh dudng hb hap d nhbm ngudi hut thuoc cao han rat nhieu so vdi nhung ngudi khbng hut.
Nguy ca mde mgt so b0nh dudng hb hap vd tim mgeh tang len theo thdi gian hOt thuoc.
Nghien cuu da cho thay cb sy khac bi0t eb •^
nghTa thing ke ve ty 10 mlc mgt so b0nh giua nhbm doi tuyng hut thubc tren 15 ndm so vdi nhbm cbn Igi.
Tang huylt ap da vd dang la mgt van de sde khbe nil cgm trong cbng dbng doi vdi ca eae nude dd vd cac nirde dang phdt triln, trong db eb Vi0t Nam. Theo kit qua nghien cdu cua Hoang Van Minh thi ti 10 bj tang huyet dp tgi cgng ding Id khd cao, khoang 14%, vd cb tdi 82% ngudi khbng bilt minh bj mdc b0nh tang huylt ap [7]. Nghien cdu ciia Nguyen Nggc Quang ndm 2005 ve ti Ig tang huyet dp tai Ba Vi cho thiy nam gidi'cb ty 10 tang huylt ap cao han d nd gidi trong dg tuoi lao dgng (15,6% so vdi 6,9%). Tae gia cung chi ra li 10
tang huylt dp duyc dilu tri chi chiem 8,6%
trong so ndy [5].
Ty 10 5,2% trong so 11300 ngudi cb hiit thule ty khai bdo bj mlc benh tang huyet ap thye ra ebn thip han nhieu so vdi eon so thye le do vi0e kham kiem Ira sdc khbe dinh ki ciia ngudi dan trong cgng dong hien nay hau nhu chua thye hien duye. Tuy nhien, ty 10 ty khai bao mlc b0nh ldng huyet dp d nhbm ngu'di hiit thuoc Id/ldo trong nghien cuu nay eao han so vdi ty 10 ty khai bao ciia ngudi ddn nbi chung trong cgng dong d nghien edu eiJa Nguyen Nggc Quang (chi eb 4% so doi tuyng dieu tra khai bdo da duye chan doan b0nh tu trude) [5].
Hign nay Vi0t Nam thugc nhbm cae nude eb ty 10 hilt thuoe d nam gidi cao tren t h l gidi.
Theo udc tinh eiia WHO, khoang han 8 tri0u ngudi Vi0l Nam (10% dan sb hien nay) se bj tu vong do cac can b0nh Hen quan den thubc Id, trong do mgt nua se td vong sdm [8, 9].
Oa eb mgt so nghien cuu de cap den mli lien quan giua thuoe Id vd b0nh tgt, tu vong. Mgt nghien cdu b0nh ehung ve hut thuoc Id va ung thu phoi tgi b0nh vi0n K Trung uang eho thay hot thuoc Idm tang nguy ca mdc ung thu phli cao han 5 lln va nguy ea mae ung thu phoi cung tang len theo thdi gian hut thuoc:
ngudi hiit thuoc tren 40 nam cb nguy eb bj ung thu phoi eao han ngudi khbng hiit thuoc 20 lln [1]. Qua nghien edu ldm sang va hinh anh chyp dbng maeh vanh chgn Igc eua 165 b0nh nhan thugc hai nhbm b0nhnhdn khbng vd cb hilt thuoc, cac bae sT Vi0n tim mgch Vi0t Ngm dua ra bdng chdng rang t^ le mdc b0nh nhli mdu ca tim, can dau thit ngyc, tang huyet dp, rbi logn Lipid mdu d nhbm hiit thuoc la cao han rb r0t so vdl nhbm khbng hut thuoe la. Ton thuang mgch vanh tang dan theo trung binh so luyng dilu thuoe la hut/
ngay va thdi gian hut [6].
343
TCNCYH Phu trUdng 80 (3B) - 2012
TAI LI$U THAM K H A O 1. Anh PH, Di>c N, Long B va cpng sif (2001). Kit qua budc dlu ciia nghidn cuu b^nh chu'ng v l hut thulc la va ung thu phli Ipi Bpnh vi0n K. Bao cao tpi hOi nghi ung thu. Ha N^i
2. Bp y »e (2006). Bao cdo v l y t l Vipt Nam: cdng bing, hi^u qua, phat triln trong tinh hlnh mdi. 106-110.
3. Bp y t l va Ting cgc thong ke (2003).
Bdo cao kit qua dilu tra y t l quIc gia 2001 - 2002. Nha xuat ban y hpc.
4. Bp y t l va Tong cgc thing ke (2005).
Dilu tra quIc gia v l vi thanh nldn va thanh ni§n Vi$t Nam lln thir nhlt. 55 - 72.
5. Nguyen Ngpc Quang (2010). Phan bo s l do huylt ap vi hinh thai tang huylt ap tpi Ba VI nam 2005. Tpp chi nghien ciru y hpc 71 (6): 77 - 83.
6. Trin Van Du'O'ng (2000). Oanh gia budc dlu mli tuang quan giua hiit thulc vdi bpnh tim mpch qua phan tich hinh anh lam sang va kit qua chgp mpch vanh b 165 bpnh nhan. Bao cao tai h$i nghj tim mpch todn quia Ha NOI
7. Hoang Van Minh (2006). Epidemiology of cardiovascular disease in rural Vietnam.
PhD thesis. Umea University, Sweden.
8. Path Canada (2004). Survey on passive smoking in Hanoi.
9. WHO (2011). Report on the global tobacco epidemic, 2011: warning about the dangers of tobacco.
Summary
SMOKING AND RATE OF SOME RELATED DISEASES AMONG SMOKERS IN BAVI DISTRICT IN 2010
rodacco is one factor among the ten of leading risk factors which causes diseases and death.
The study was to Identify rate of smoking and self-reported some diseases that tobacco is a nsk factor in Ba Vi district The results indicated that 74.2% of households had at least one smoker The rate at
Hilt thulc la la m^t trong nhu'ng nguydn nhan gdy nhilu b^nh t^t va lam tdng ty l | tCr vong. Hang nam, thulc la la nguySn nhan gay ra khodng 4,9 tri$u trudng hpp tij' vong trdn toan clu va con s l nay se tang Idn gip 2 lln nlu nhu cac bi^n phdp d p bach d l ngSn chdn, phdng chlng thulc la khdng triln khai kip thdi [9].
V. K^T LUAN
Tl IS hut thulc cOa nam gidi tpi huy0n Ba Vi Id 61,9% va d nO' gidi la 0,7%. Ty 1$ hilt thuoc la b nam gidi cao ban nu' b mpi nhdm tuoi (p < 0,05).
- Ti 1$ bi ho kdo ddi trdn hai tuin b nhO'ng ngudi hut thulc cao han nhdm khdng hut thulc (3,4% so vdi 1,4%, p < 0,001).
- TI Ip tg khai bdo duac chin dodn mlc bpnh tang huylt ap trong nhdm ngudi hut thIc la 5,2 %, cDng cao han nhilu so vdi cOng dong ddn cu ndi chung. TI Ip mlc cdc bpnh dudng hd hap (nhu COPD, hpn phe quan, ung thu phoi,...) trong nhdm hut thuoc cung cao hon khi so vgi nhdm ngudi khdng hut thuoc.
- Nguy cd mlc mOt s l bdnh tim mpch va hd hip tang theo thdi gian hut thuoc la
Vi$t Nam dd kl Cdng udc khung phdng chlng tdc hpi thulc Id nam 2004 vd dd ban hdnh mpt s l chfnh sdch. Cdc ban ngdnh lidn quan va todn xa hpi cin thgc hipn chinh sdch phdng chong thuoc Id todn dipn, cd nhtrng hdnh dpng quyet li$t va phii hpp d l hpn chl nhieu hon nOa tac hpi cua thuoc la.
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T C N C Y H Phy trUdng 80 (3B) - 2012
smoking among males was 61.9% and among females was 0.7%. The rate of cough with more than two i/ieeks among smokers was higher than non-smokers (3.4% vs. 1.4%). The proportion of self-reported of hypertension and respiratory diseases as COPD, asthma among smokers was higher than non-smokers.
The proportion of suffer from these diseases v\fas related with duration of smoking. In conclusions, tobacco control policy and appropriate activities are needed to implement for reducing number of patients and deaths due to tobacco.
Key virords: s m o k i n g , s e l f - r e p o r t e d , d i s e a s e s .
U CUON MACH DUdi MONG:
NHAN 5 TRUONG HOP
Tran T r u n g D u n g \ N g u y e n T h i Ngpc Lan ' , N g u y e n T h i Lieu ^, Trinh Tien Phong ^ I'l Truang Dai Hpc YHa Npi, '3 Benh viin Bpch Mai
U cupn mach dudi mdng li tin thuong hiem gap.
thuit thinh cdng, xin dupe gidl thiiu cac ca tim sing ton thuvng giii phau bpnh cua bpnh ly nay
Tip k h o a : U c u p n m p c h d u d ' i m d n g I. O A T V A N o e
U cupn mpch la khoi u phat tnen tir phirc hpp co-mach-thdn kinh. C l u tnjc nay la chd thdng n i l dpng tmh mpch ma khong qua hp thong mao mach. C l u true nay t h u d n g gap nhlt d a l u ngdn tay, ngdn chan vi b vi trl d u d i mdng d u p e cho Id cd vai trd h i t r p dieu hda tuan hodn a cac dau chi. U cupn mpch khong de Chan doan vi cdc tripu ehO'ng t h u d n g bi i n vdi cac tripu chu'ng ciJa bpnh IJ khac chu yeu la bieu hipn dau va tang nhpy cam dau ngon, hon n u a Id do it gpp nen cac bac sJ lam sang cd the khdng nghr d i n . Ben canh d d , cdc phtrang tipn c h i n dodn Ipi khd khan d d t i n thuang nhd. Nhan 5 t r u & n g hprp u cupn mpch du'di mdng d u p e c h i n d c d n vd d i l u tri thdnh cing, chiing tdi xin gidi thipu cdc ca ldm sdng nay vd d i l m Ipi y v d n v l tinh hinh chan doan va d i l u tri tren t h l gidi.
Nhan 5 trudng hpp dupe chin doan va dieu tri phau va diim lai y van vi ehin doan, dieu trl vi die diim
I I . G I O I T H I E U C A L A M S A N G Trong thai gian tir thang 5 nam 2009 den thang 12 nam 2010, chCing toi da c h i n doan va phau thupt cho 5 trudng hpp u cuon mach d u d i mdng, trong dd cd 3 n u va 2 nam. Trieu chirng Idm sang chCi yeu la dau khi kich thich vd khi t i l p xuc vdi Ipnh, vung d l u ngdn tay 3 bpnh nhan phdt hipn cd vung thay doi mdu sac tf d u d i mdng, 2 bpnh nhan khdng phat hlpn b i t t h u d n g . T i t cd cac bpnh nhan khdng cd thay doi ve hinh thai ciia mdng t a y Phim X quang khdng phat hipn b i t t h u d n g ve x u a n g d i t ngdn t a y C d 1 bpnh nhan d u p e phat hipn k h i i b i t t h u d n g d u d i mdng qua sieu dm. Tat ca cdc bpnh nhan d u p e chgp cpng h u d n g tir (MRI) 1.5 Tesia viing ngdn tay de xdc dinh c h i n dcdn t r u d c khi p h l u thupt. T h a i gian b i l u hipn tripu chirng d i n khi d u p e phdu thudt tu' 1 nam d i n 6 nam, da thdm khdm qua nhieu
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