Modern aspects in the formation of health in child population
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Секция 7. Медицина
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Frolova Tatyana Vladimirovna, Kharkov National Medical University, Doctor of Medical Science, Professor
E-mail: Frolovatv67@mail. ru Okhapkina Olga Vladimirovna, Kharkov National Medical University, Doctor of Medical Science, Professor
Siniaieva Iryna Revazovna, Kharkov National Medical University, Associate Professor Tereshchenkova Iryna Ivanovna, Kharkov National Medical University, Associate Professor Atamanova Elena Vladimirovna, Kharkov National Medical University, Candidate of Medical Science
Modern aspects in the formation of health in child population
Abstract: Unfavorable state of the environment and worse social-economic conditions of life produce a significant negative effect on the formation of health of pupils.
Keywords: social-economic conditions, children’s health, mineral profile, physical development.
Sensitivity of the child’s organism to the effect of various factors causes flexibility of all physiological and pathological processes, which take place in the child’s organism. That is the state of health in childhood directly depends upon the influence of social, economic, ecological and other exo- and endogenous factors [1, 22−25].
The unsatisfactory state ofhealth in modern pupils is caused by a catastrophic reduction of physical load and motor activity of children, improper nourishment, chronic stresses and bad habits, the latter being widely common in adolescents at present.
As for the state of environment, according to data of the Ministry of Ecology and Natural Resources of Ukraine (2013), the content of harmful substances in the atmosphere of the City of Kharkiv exceeds their standard values 3. 4- 5.4 times depending upon the City district. The discharge of harmful substances into the atmosphere is 356 000 tons- the air is polluted by 1200 enterprises and more than 500 000 vehicles .
The purpose of the study was to reveal the factors, which exert the largest influence on the formation of health in the child population of the Kharkiv Region.
Section 7. Medical science
Materials and methods of the study. The state of health of2700 children of school age, who are residents of the Kharkiv Region, was monitored during 10 years. This monitoring of the state of health was carried out by the method of expeditionary studies of a random sample of children at the age from 9 to 17 years. The expeditionary examination programme consisted of clinical-anamnestic testing, assessment of the physical development, study of the alimentary provision of nutrient homeostasis, clinical-instrumental and laboratory methods. In order to assess the microelement status of children, this study revealed the content of the basic essential (Са, Cu, Zn, Fe, Mg, Mn, Se, В) and potentially toxic (Si, Pb, Cr, Rb, Ti, Sr, As, Co, Br, Bi, Ni, Al, Mo) macro- and microelements in hair by the method of gamma activation analysis with slowing-down radiation from electron particle accelerator. In the process of the research the we followed international standards concerning information and consent of the parents for participation of their child in the examination.
The statistical analysis was carried out on the basis ofparametric and nonparametric tests («Student"-Fisher test, van der Waerden’s criterion, etc.), probabilistic distribution of signs and correlation analysis.
Results and their discussion. The results of the conducted monitoring demonstrate that during the past few years the level of health of modern pupils has undergone significant negative changes. Thus, within the above period the number of relatively healthy children has decreased by 32. 2% (respectively, from 18. 9% down to 12. 8% [p & lt- 0. 005]). At the same time, there were increases in the level of chronic somatic pathology in children of school age, who live in the Kharkiv Region, on an average by 14. 5%, the prevalence of osteopenia syndrome by 25. 5% and that of fibrillogenesis disturbances by 28. 9%.
Analysis of the state of children’s health showed that, in addition to a change in nosological pathology classes, significant changes took place in the mineral profile too. Thus, in 2004 virtually 95% of children had mineral imbalance, caused by a disturbance in calcium metabolism, and some accumulation of potentially toxic elements, while in 2013 this imbalance was characterized by reduction of the main essential elements (calcium, magnesium, zinc and potassium) against a background ofhigher levels of strontium, aluminium, chromium and lead. Only during a past decade, children of the Kharkiv population developed elevations in the levels of lead by 48% (p & lt- 0. 001), chromium by 31% (p & lt- 0. 001), nickel by 59% (p & lt- 0. 001), molybdenum by 18% (p & lt- 0. 001)
and aluminium by 54% (p & lt- 0. 001), as well as reliable decreases of the levels of copper by 39% (p & lt- 0. 001), zinc by 38% (p & lt- 0. 01), magnesium by 46% (p & lt- 0. 001), manganese by 50% (p & lt- 0. 001), calcium by 54% (p & lt-
0. 001), selenium by 44% (p & lt- 0. 001) and iron by 42% (p & lt- 0. 001). The above facts undoubtedly demonstrate the ecological state in the region and its influence on the state of health of child population.
The past few years have witnessed negative dynamics in the level of physical development. In 2004−2005, the mean level of physical development was in 43. 2% of pupils versus 32. 6% of children of the same age and sex in 2012−2013, the number of children with overweight or obesity increasing by 17. 5%.
Assessment of the dynamics in the increment of physical development indices, particularly the time-balanced cyclic process of growth directions, when the period of «rounding& quot- precedes that of «extension», is the most informative index of the physical development in children. Girls of the region are characterized by the presence of the maximum increment in the growth and body mass indices at the age of10−11 years, i. e., the periods of rounding and extension in girls of this age concur. Typical for the physical development dynamics in boys is the presence of the maximum increment in the mass index at the age of 9−10 years, and the growth index at 11 years, this fact corresponding to the adequate process of cyclicity in growth directions. Later the increment of anthropometric indices in boys is uneven, a reduced body mass increment is observed at the age of 13 years, while a deceleration of the linear growth rates is registered within the period from 14 to 15 years. In boys, the age of15 years is characterized by a simultaneous increase in the annual mass index increment and a very significant «growth jump». A considerable fluctuation in the increment dynamics of anthropometric indices of physical development, growth in particular, demands efforts of all systems in the child’s organism and creates certain conditions for pathology to develop and become chronic.
The diet of children of school age, who live in the Kharkiv Region, is characterized by the following peculiarities: the energy provision of the dietary intake has a deficit of30−40%, which, in its turn, is caused by protein deficiency- in these conditions, there is a sufficient intake of fats (95−105%) and an excessive intake of carbohydrates (over 20. 0%). Analysis of the monitoring of the actual children’s nourishment in our region revealed negative dynamics: the number of children, whose diet does not include milk and dairy products, has increased on average by 17%, this situation being typical for rural
Секция 7. Медицина
children too (this index has increased more than by 7%), rather than urban ones only. It should be noticed that only 1. 5% of the total number of children have medical contraindications for taking dairy products, particularly intolerance or allergic response. On the other hand, as result of negative social or economic conditions, which formed in some families, these products cannot be present in the family’s food basket. Besides, the number of children, whose everyday diet does not include fresh fruits and/or vegetables, has increased by 23% irrespective of their residence. The number of children, who live in rural areas, but take meat products only once a week, has doubled.
Alarm of parents, teachers and, of course, pediatricians is caused by a significant increase of bad habits in children and adolescents. Thus, today the prevalence of smoking among modern pupils is about 37%, it being 1.2 times more than before. Taking of alcoholic drinks by adolescents has risen by 25%, with increases both in the rate of taking and strength of the drinks, preferred by our children. One should take into account that the above data do not reflect the entire picture of this problem, since, as a rule, their weakness for bad habits is concealed by children, when they are questioned.
Among the children and adolescents, who live in the region at present, only 11. 3% lead an active lifestyle and regularly take in for sports, this value being 21. 3% less than in the preceding years. The number of children, who do some physical activity only within the framework of school curriculum, has decreased (respectively, 27. 1% versus 32. 8%). At present, 61. 6% of children do not attend physical education and/or sports classes, while 10 years ago this index was 52. 1%. Moreover, taking in for sports during a long period of time, that is more than
1 year, is reported only by 6. 5% of children. Though it is well known that one of the components of primary prevention for many diseases in children and adolescents consists just in age-adequate physical activity, namely attending of sports classes, sports or ballroom dances, regular classes of physical education in school or walks at least 2 hours a day.
In order to reveal the effect of the above factors, the coefficient of their influence on the child population health was calculated. Thus, pollution of the environment contributes to a decrease in children’s health by 20% (Fisher criterion = 19. 3211, p & lt- 0/05, R2 = 89. 96). It should be noticed that the dependence of manifestations increases with age- this fact is caused by the accumulation degree of the content of potentially toxic and toxic microelements. As for the influence ofworse nutrition, a lower level of physical development, hypodynamia and presence ofbad habits in children, the effects of these factors on the level of health is, respectively, 23%, 24. 2%, 21. 8% and 29. 6% (Fisher criterion [21. 2411−29. 5643], р & lt- 0. 05, R2 = 89. 96).
Thus, there is no doubt that an unfavourable state of the environment and worse social-economic conditions of life produce a significant negative effect on the formation of health of pupils in the Kharkiv Region. That is, it becomes evident that a gain of the child population’s health requires improvement of many determinants, including social-economic, ecological, educational, medical, etc. Moreover, in conditions of the reformation of the primary link of medical aid, all above aspects require solution of the problem of development of grounded preventive measures at the level of the whole country rather than only additional attention ofpediatricians and family doctors.
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2. Government site: http: //www. segodnya. ua/regions/kharkov/v-tsentre-kharkova-luchshe-ne-dyshat. html.