Describing the epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts, Bac Ninh province in 2015. Analyzing some factors related to Chronic obstructive pulmonary disease in the studied area. Evaluating the effectiveness of a number of intervention measures against Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province.
1 INTRODUCTION 1. The urgency of the thesis Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease, characterized by airway obstruction, which progresses gradually to be more serious. According to the World Health Organization, COPD will stand by 2020. third in the causes of death and fifth in the global burden of disease. According to Dinh Ngoc Sy in 2009, Vietnam had about 1.4 million people with COPD, the disease tends to increase with age, related to smoking and use of organic burning fuel, while Phan Thu Phuong studied in Lang Giang , Bac Giang in 2009 showed that the prevalence of COPD was 3.85% and the smoking, age, and asthmarelated factors COPD is becoming a health concern for many countries around the world In addition to controlling related factors, managing COPD patients in the community, at the same time implementing policies related to control related factors such as increasing tobacco tax, banning smoking in public places, protecting the environment. If the school is living then it is important and necessary to develop COPD prevention measures in the community Bac Ninh is a northern delta province, where the land is crowded with people. In recent years, industrial development has been hot, causing environmental pollution, especially in the air pollution. Bac Ninh people have a long habit of cooking with straw, later honeycomb charcoal this is the cause for increased COPD. The district general hospital of Bac Ninh province is a class II hospital with about 200 beds So far, some non communicable diseases including COPD have been treated, but the results are modest. In order to have a scientific basis for COPD prevention in Bac Ninh, it is necessary to conduct research on this issue. The question is how is the current situation of COPD in Bac Ninh province? What is the incidence of COPD? And what is the appropriate solution to prevent COPD in Bac Ninh province? That's why we conducted the project titled “Epidemiological characteristics and effectiveness of Chronic obstructive pulmonary disease intervention in the two districts of Bac Ninh province” 2. Research objectives 1) Describing the epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts, Bac Ninh province in 2015 2). Analyzing some factors related to Chronic obstructive pulmonary disease in the studied area 3) Evaluating the effectiveness of a number of intervention measures against Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province 3. New contributions of the thesis: 1) Epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015: The overall prevalence of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts is 3.6%, specifically in Que Vo district, it is 3.9%, Thuan Thanh district is 3.2%. The percentage of people aged ≥60 years is higher than that of people 0.05) The proportion of patients with good knowledge is not high, which shows that it is necessary to strengthen health education for patients about COPD, thereby helping patients gain knowledge for selfprevention and care. and protect your health; avoid dangerous complications of the disease, and slow down the progression of the disease Attitudes of COPD patients: Our research results show that the proportion of patients who believe that COPD is preventable and believe that COPD exacerbations can be treated in Que Vo and Thuan Thanh districts is similar same Regarding COPD prevention practice of research subjects: it showed that only 15.4% of patients had proper practice on physical exercise and respiratory rehabilitation in COPD prevention, the remaining 84.6% disease is not good; Specifically, the rate of good practice of patients in Que Vo hospital was 17.3% and Thuan Thanh district was 13.4% but the difference was not statistically significant between the two districts. About the manifestations and related factors: among the symptoms, shortness of breath is the most important symptom for prognosis, indicating a decrease in respiratory function 4.3 Efficacy of some intervention measures to prevent Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province 4.3.1 The effectiveness of some communication solutions to prevent Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province The results of our study show that, during the outpatient treatment at the Que Vo district general hospital, patients are constantly changing their behavior about preventing Chronic obstructive pulmonary disease such as quitting smoking, practicing exercise regularly with your own strength, limit contact with charcoal smoke, honeycomb stoves and straw. Regarding general practice in COPD prevention, the intervention effect is very clear with the intervention effect up to 1666.7% The proportion of research subjects who practiced well before the intervention was only 2.3% a very low rate, which is a risk factor for aggravating the disease but after the intervention reached up to 41.9%. The control group also increased but not 23 significantly from 8.3% to 11.1% In our intervention program, including health counseling, health talk is integrated into the activities of the COPD club at Que Vo General Hospital Health communication and education activities are specifically planned and carried out regularly. Thanks to that, the intervention effect is very high With activities such as how to make the Chronic obstructive pulmonary disease a better living survey; overlap between asthma and COPD in the same patient, Chronic obstructive pulmonary disease and travel, identify when there is an acute Chronic obstructive pulmonary disease, initial treatment, Chronic obstructive pulmonary disease and cardiovascular disease, Some problems when using the drug in the elderly; how to use aerosol and inhalers for asthma and COPD treatment, benefits of influenza vaccination, pneumococcal disease for people with Chronic obstructive pulmonary disease together with questions and answers when club members need advice and in addition organize medical examinations and measurements of respiratory function for club members The club model is very helpful for the sick, giving the person the opportunity to share his or her condition, and to better understand his or her condition in a spirit of comfort, without fear or pressure. Help with doctors who are sick. The pulmonary rehabilitation program in the UK provided knowledge to patients during rehabilitation. The communication sessions were based on focus groups, conducted in 11 hospital and community programs with 25 health professionals and 57 patients with COPD. Results showed that the knowledge and ability to manage COPD of patients was very good Selfmanagement interventions are related to helping patients acquire and practice the skills necessary to implement specific treatment regimens, change health behaviors to adjust the patient's own roles for a The optimal way for improving and managing daily disease Selfmanagement also includes assessing progress, problems, setting goals, and solving problems While guidance, training the patient is necessary, as it is essential for the patient to develop Knowledge Patient education and training is meant to provide patients with information (documents and instructions) on the characteristics, circumstances of their illness and how to manage their disease 4.3.2 Efficacy of some solutions to improve the health of Chronic obstructive pulmonary disease in Que Vo district, Bac Ninh province Our research results show that, after implementing measures to 24 improve and improve the health of people with COPD, such as guiding patients to selfmanage the disease, communication, distributing leaflets on minimizing risk factors muscles, strengthen and choose the form of exercise, reasonable sports, rehabilitation (breathing, improving ventilation, coughing sputum ) has been quite effective with a knife intervention effect from 38.3 to 59.1% on the reduction of symptoms of shortness of breath, persistent cough and sputum. Specifically, in the group of outpatient patients at Que Vo district general hospital, the rate of dyspnea after intervention decreased from 62.8% to 23.3% with a statistically significant change with p 0.05. Preventing and reducing the degree of dyspnea also enhances the quality of the patient's living survey and is one of the important goals of the respiratory rehabilitation program According to Dinh Ngoc Sy in 2009, after 8 weeks of treatment and rehabilitation of the intervention group: there were no more patients at mMRC5, mMRC4 also decreased to 33.0%, over 50.0% at the point level. mMRC3 and mMRC2 have 4 cases. Meanwhile, the control group did not change any statistically significant prolonged cough manifestations in the intervention group decreased from 46.5% to 18.6% with p 0.05 With expectoration, this rate in the intervention group decreased from 65.1% to 27.9% with p 0.05. Our research results are also consistent with the goals of COPD treatment according to GOLD 2017, which is symptom relief including: reducing symptoms, improving exercise capacity and improving health status At the same time, the risk reduction includes prophylaxis of progressive disease, prevention and treatment of exacerbations and mortality Our research results show that the number of exacerbations in the intervention group significantly improved, the average number of exacerbations after intervention in the intervention group changed clearly from 1.26 exacerbations/year to 0.56 exacerbations/year with p 0.05. Chronic obstructive pulmonary disease exacerbated exacerbation or exacerbation of COPD is determined to be a change in the patient's difficulty breathing, 25 coughing, and/or sputum beyond the usual daily level and acute onset. Inpatient or outpatient treatment, depending on the severity of symptoms and coordinated diseases The research results also showed that the intervention effect to improve the health of patients was quite high, up to 73.7%. One of the goals of GOLD 2017 is to continue to adhere to treatment while combining nonpharmacological treatments such as stopping exposure to risk factors, rehabilitating and being able to get a flu shot. Once again our research confirms the role, importance and effectiveness of interventions that minimize symptoms, limit risk factors and improve the quality of life surveys for patient. From health education communication measures, to establishing patient clubs to help patients share and encourage themselves; at the same time to improve the capacity of health workers at grassroots levels, timely advice and timely detection at an early stage. Self management interventions involve helping the patient acquire and practice the skills necessary to implement specific treatment regimens, change health behaviors to adjust the patient's own role for a The optimal way for improving and managing daily disease 4.4. Limitations of the project If favorable conditions and good resources are available, we have to conduct community intervention That is, there must be intervention activities on prevention of COPD in the intervention communes. This is a primary prevention prophylactic intervention, that is, a room for healthy people at risk, not just a secondary prevention for patients as in the study. If level 1 prophylaxis is to enhance communication and prevention. Although we have conducted capacity building training for key community members such as community leaders, commune health workers, and village health workers. Behavior change of COPD risk subjects changes after 2 years of intervention. In addition to the resources to intervene in communication, KAP assessments for inputs and KAP outputs for the community are very expensive, and the research is not very cost effective With better conditions, we should intervene for the whole group of patients treated and managed at Que Vo General Hospital, and then have to evaluate the impact of the interventions on this whole patient population. This is an intervention for 133 patients, not just 43 patients at Que Vo Hospital. This limitation is partly due to our calculations that want to impact primarily on the group of patients screened in crosssectional surveys in the development of research plans. These limitations appear to be partly due to the initial orientation of 26 the research proposal but in large part to the resources of the researcher CONCLUSION 1) Epidemiological characteristics of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts of Bac Ninh province in 2015: The overall prevalence of Chronic obstructive pulmonary disease in Que Vo and Thuan Thanh districts was 3.6%, specifically in the district. Que Vo is 3.9%, Thuan Thanh district is 3.2%. The percentage of people aged ≥60 years is higher than that of people