facebook
twitter
vk
instagram
linkedin
google+
tumblr
akademia
youtube
skype
mendeley
Wiki

AN INTEGRAL APPROACH TO PLANNING REGIONAL-POPULATION RESEARCHES ON BONE TISSUE PATHOLOGY IN CHILDREN AND ADOLESCENTS: EXPERIENCE AND PROSPECTS

Автор Доклада: 
Frolova T., Okhapkina O., Barska L.
Награда: 
AN INTEGRAL APPROACH TO PLANNING REGIONAL-POPULATION RESEARCHES ON BONE TISSUE PATHOLOGY IN CHILDREN AND ADOLESCENTS:  EXPERIENCE AND PROSPECTS

 

 

УДК 616.71-007.23-008-053.2

 

AN INTEGRAL APPROACH TO PLANNING REGIONAL-POPULATION RESEARCHES ON BONE TISSUE PATHOLOGY IN CHILDREN AND ADOLESCENTS: EXPERIENCE AND PROSPECTS

 

Frolova Tеtiana Volodymyrivna, MD, PhD, Professor
Okhapkina Olga Volodymyrivna, MD, PhD, assistant professor
Barska Lina Yakivna, PhD
Kharkiv National Medical University

 

The problem question of planning of regional-population researches of bone pathology prevalence have been taken up among children who live in different ecological conditions, the algorithm of forming of representative and own results of expeditionary investigations were shown with the use of densitometry diagnostics of structional-functional state of bone tissue. 

Key words: children, osteopenia, prophylaxis, nutrients, ecology.

 

Modern approaches to the assessment of the state of health are based on clinical-population principles in the analysis of the prevalence of diseases and pathological states, it being the most significant for children’s population [1, 2]. In the past time, the clinical-etiological aspect of the formation of the structural-functional state of the bone tissue (SFSBT) is assigned the leading part in the paediatric practice [2, 3]. Peculiarities in the industrial-economic development of populated areas and separate regions are formed under the influence of ecological factors, which, not without any reason, are considered as the etiological or triggering factor for SFSBT disorders [4, 5]. Just therefore, planning of mass-scaled researches on SFSBT should integrally take into account ecological, demographic and other peculiarities of children’s population groups [6].

The available data about the prevalence of the osteopenic syndrome and osteoporosis are in favour of a significant rate of these manifestations among children; these data require systematization and standardization in the context of the consideration of the effect, produced by social, ecological, alimentary, hygienic and other factors, and perfection of the methods and technologies for diagnosis, pathogenetical correction and assessment of the efficacy of the prevention and treatment [7-10].

The present study was made within the framework of the research work conducted by Kharkiv State Medical University (“The Medical-Biological Adaptation of Children with Somatic Pathology in Modern Ecological Conditions”, State Registration No. 0105U002756, 2004-2006) and is a fragment of a thesis.

The purpose of the research was to scientifically ground an integral approach to the study of regional peculiarities in the prevalence of SFSBT disorder among children and adolescents of the Kharkiv Region. An ecological-etiological clustering of the Kharkiv Region districts was performed. The significance of certain ecological factors was identified with the index of correlation between the OP morbidity rate and the index, which characterized the environmental state. The conducted study of correlations between OP morbidity rate indices among the children’s population of the Region and environmental characteristics resulted in a correlation grid (Table 1), which demonstrates a relationship between the OP prevalence and certain environmental factors.

By the results of the analysis, the most significant environmental factors were excess in the content of heavy metals in the paraterrestrial atmospheric interlayer (rXY = +0.70; rank 1) and excess in the content of heavy metals directly in the soil(rХ= +0.65; rank 2), as well as presence of proving grounds for disposing solid household, industrial or agrochemical waste in the living area (rХY = +0.64; rank 3).

Table 1

Correlations between ecological factors and OP morbidity rate among children’s population of the Kharkiv Region

It is clear that the environmental influence on the process of OP formation in children is a system of a mainly external effect; combining and interrelating among themselves, environmental factors can create “external preconditions” for a clinical manifestation of osteopenic disorders, while the nosological kind, severity and degree of the influence on the quality of health of healthy children and those with chronic diseases can create individual ones.Along with the above agro- and aeroecological environmental factors, a reliable effect on the OP morbidity rate is produced by hydroecological factors, first of all it being caused by the influence of the intensity of contaminated industrial wastewater disposal (rХY = +0.59), the intensity of contaminated domestic wastewater disposal (rХY = +0.47), and the intensity of contaminated drainage wastewater disposal (rХY = +0.37).

The reflection of the relationship between environmental factors and the spread of OP among the children’s population was examined in the aspect of a multicomponent loading and ecological-etiological factors, which belong to four groups: aeroecological, hydroecological, agroecological, and those of the anthropogenic loading on the natural components. It was found out that the level of OP spread in children was characterized by a direct, moderately and highly strong relationship with ecological factors which form several groups: agroecological, aeroecological, hydroecological, and those of the anthropogenic loading on the natural components; the component contribution of the above groups of ecological factors differs, it being explained by their total nonspecific influence and selective preponderance of the influence of some ecological factors or this complexes in concrete conditions of the children’s life.

In order to perform a medical-ecological classification of the Region districts, the methodology of cluster analysis and a generalized quantitative criterion were used [6, 7]. In the process of district clusterization to different classification groups an intracluster variety between different districts within the same classification group (within one cluster) was allowed, but it does not interfere with objectification of the qualification estimates[6, 7, 8].

The regional analysis of the prevalence and severity of OP among children in relationship with ecological factors made it possible to qualitatively classify the children’s population. The use of the cluster analysis method for making a multidimensional polythetic quantitative classification of the children’s population of the administrative districts of the Region made it possible to receive a generalized estimate of the OP prevalence in the children’s population by three groups, clusters: ЕCD-1 (2 districts), ЕCD-2 (3 districts), ЕCD-3 (22 districts). We used the methodology of division into districts with respect to the children’s population of 27 administrative districts of the Kharkiv Region (the total number is 257,877 people aged up to 17 years). The first group included 2 districts with a high level of ecological trouble (25,664 children), the second one had 3 districts with a moderate level (32,546 children), the third one, of a relative ecological well-being, consisted of 22 districts (199,667 children). We made a district-by-district distribution of the children’s population by аn integral index of the environmental qualityIt enabled us to determine the size of sampled groups for performing densitometry and reflecting population peculiarities in the structural-functional state of the bone tissue (Table 2).

Table 2

The representative size of sampled population groups for in-depth study of the rate and character of disorders in the structural-functional state of the bone tissue in the children of the Region

Ecological clusters of the Region(groups of districts)

Boys

Girls

Total

9-12 yr

13-16 yr

9-12 yr

13-16 yr

the 1st group of districts (ЕCD-1)

21

22

21

23

87

the 2nd group of districts (ЕCD-2)

27

29

24

26

106

the 3rd group of districts (ЕCD-3)

47

69

54

72

242

Total

95

120

99

121

435

The methodology of research planning, worked up by us, was used for studying OP prevalence among the children’s population with regard for ecologically caused differences. The raw material was collected by the method of expedition examinations of organized collectives of children aged 9-16 years (their distribution by age and sex is shown in Table 2).

Our complex study involved 1,126 children: 516 constant dwellers of Kharkiv (4 administrative districts) and 610 children living in rural districts of the Kharkiv Region. The children’s population groups were stratified by such indices as their age (9-12 and 13-16 years) and the ecological cluster of the area. The expedition examination programme for the representative number of children from the administrative districts of the City of Kharkiv structurally consisted of several fragments: clinical-anamnestic testing, densitometry, anthropometry, study of the alimentary provision of nutrient homeostasis and (in some cases) taking blood and hairs for their subsequent analysis.

The study of the structural-functional state of the bone tissue was made with help of Sonost-2000 supersonic densitometer on the hill of the children from the stratified population groups (SPG). In order to assess densitometry results by the WHO’s international standards (bone tissue density, which corresponds to 1.0 SD (standard deviation)), grade I of osteopenia was diagnosed when the index decreased down to 1.0 ÷ 1.5 SD, grade II down to 1.5 ÷ 2.0 SD, grade III down to 2.0 ÷ 2.5 SD. The structural-functional state of the bone tissue (elasticity, density, quality, strength of bones) was assessed in compliance with methodological recommendations of the Ministry of Health of Ukraine [10].

The spread of osteopenic disorders in the structural-functional state of the bone tissue in children (9-16 years) of a big industrial region is 20.5 ± 1.1 % and ranges depending upon the age, sex and residence from 14.6 ± 2.3 % to 30.3 ± 4.0 %. Among the region’s children, the spread of osteopenia degree I is 9.3 ± 1.1 %, that of degree II is 7.1 ± 0.8 %, and that of degree III is 4.1 ± 0.5 %. Hence, disorders of degree I are the most common variant of osteopenia and make up 43.3 % in the structure of osteopenia cases, while expressed osteopenic disorders (degree III) occur in 20.0 %.

Table 3

Distribution of the examineés by the age, sex and ecological clusters of the Region

Distribution of the children’s population of the districts by the sign of their belonging to the ECD

boys

Girls

total

9-12 yr

13-16yr

9-12 yr

13-16yr

9-12 yr

13-16yr

ECD-1

41

43

46

45

87

88

 

 

ECD-2

ECD-2.1

42

41

40

41

82

82

 

ECD-2.2

ECD-2.2.1

34

33

31

32

65

65

ECD-2.2.2

30

31

33

30

63

61

ECD-2.2.3

31

32

35

31

66

63

ECD-2.2.4

31

34

32

36

63

70

ECD-3

54

81

61

75

115

156

The total number of examined children

263

295

278

290

541

585

558

568

1126

ECD-1 – sampled totality of the children’s population of the Novovodolazhsky District

ECD-2 – sampled totality of the children’s population of the Kharkiv rural district (2.1) and Kharkiv City districts (2.2): Moskovsky (2.2.1), Kyivsky (2.2.2), Dzerzhinsky (2.2.3), Frunzensky (2.2.4)

ECD-3 – sampled totality of the children’s population of the Zmiivsky District

The age-sex-related differences in the osteopenia spread indices among the region’s children are characterized by prevalence of its frequency rate in the young group (9-12 years) over the older one; this fact manifests itself to the largest measure in girls (24.8 ± 1.8 % and 18.2 ± 2.0 % respectively; р < 0.05), owing to higher frequency rate of osteopenia degree III (6.4 ± 1.2 % and 3.5 ± 0.8 %, respectively; р < 0.05). Besides, and in the CIS on the whole, the total spread of osteopenia is reliably (р < 0.05) higher in the young SPG versus the older one (22.4 ± 1.8 % and 18.7 ± 1.5 %, respectively).

Table 4

The prevalence of osteopenia (Р ± m, %and variants of its severity in the children of the Region

Stratified population groups of the children of the Region

Decreased bone tissue density

Total prevalence of osteopenia

Stage І

Stage ІІ

Stage ІІІ

Total for the Region

boys, 9-12 yr

10.0 ± 2.4

7.5 ± 1.7

2.5 ± 0.8

20.0 ± 2.4

girls, 9-12 yr

10.7 ± 2.5

7.7 ± 1.7

6.4 ± 1.3

24.8 ± 2.6

totalchildren, 9-12 yr

10.4 ± 1.8

7.6 ± 1.2

4.4 ± 0.7

22.4 ± 1.8

boys, 13-16 yr

7.7 ± 2.2

7.7 ± 1.7

4.2 ± 1.0

19.6 ± 2.3

girls,13-16 yr

8.6 ± 2.0

6.1 ± 1.3

3.5 ± 0.8

18.2 ± 2.0

totalchildren, 13-16 yr

8.3 ± 1.5

6.7 ± 1.0

3.7 ± 0.6

18.7 ± 1.5

boys, 9-16 yr

8.9 ± 1.6

7.6 ± 1.2

3.2 ± 0.6

19.7 ± 1.7

girls, 9-16 yr

9.5 ± 1.6

6.7 ± 1.0

4.7 ± 0.7

21.0 ± 1.6

All in all

9.3 ± 1.1

7.1 ± 0.8

4.1 ± 0.5

20.5 ± 1.1

The boys of the rural settlements showed spread of osteopenia on the level of 15.7 ± 2.1 % and its somewhat higher prevalence in boys (9-12 years), than in the age group of 13-16 years (respectively, 16.5 ± 3.0 % and 15.2 ± 2.8 %; p > 0.05). It is also worth noting that the youngest group reveled the minimum number of cases and, consequently, the lowest spread of osteopenia degree III (2.8 ± 1.1 %). The spread of osteopenia in children aged 9-12 years was 18.0 ± 2.2 %, and structurally by 51.1 % it consisted of osteopenia degrees II-III. The share of osteopenia variants of degrees II-III in the group of children aged 13-16 years increases up to 54.8 % owing to light variants.Among the girls of the Region districts, the spread of osteopenia was revealed at the level of 16.7 ± 1.9 %, it being somewhat higher among the girls aged 9-12 years, than in the age group of 13-16 years (respectively, 19.7 ± 3.3 % and 14.6 ± 2.3 %; р > 0,05). The younger age group of the girls demonstrated a higher spread of osteopenia degrees I (9.4 ± 3.3 %) and III (6.4 ± 1.7 %), while in the older group a relationship between indices of the spread of these variants of osteopenia was less.

Conclusions.

1. The planning of regional-population studies of SFSBT in children should foresee a possible effect of the environment and rest on principles of proof-based medicine, particularly on grounding of the quantitative filling of the age-sex groups, thereby making it possible to take into account peculiarities in the children’s growth and development.

2. The methodology of ecological-etiological division into districts makes it possible to take into consideration regional peculiarities, when studying the spread of OPS and OMR, and can become a precondition for perfecting the population health monitoring in relationship with environmental factors.

3. The use of the sample method and expedition forms for collecting raw material in the above research made it possible to ensure a standardized analysis of OPS spread regularities in children.

4. The spreads of OPS are characterized by the rate of 20.5 ± 1.1 % and ranges depending the children’s age and sex: 19.7 ± 1.7 % in boys and 21.0 ± 1.6 % in girls. By the severity of disorders, osteopenia degree I prevails (9.3 ± 1.1 %), whereas more severe osteopenia degrees II and III are less common: 7.1 ± 0.8 % and 4.1 ± 0.5 %, respectively.

5. The variety of environmental effect on the formation of osteopenic disorders should be taken into account, when planning and conducting population studies, as well as perfecting the system of giving primary medical-sanitary aid.

References:

  • 1. Остеопороз: эпидемиология, клиника, диагностика, профилактика и лечение: Монография /Акад. мед. наук Украины; под ред. Коржа Н.А., Поворознюка В.В., Дедух Н.В., Зупанца И.А.. – Х.: Золотые страницы, 2002.– 648с.
  • 2. Щеплягина Л. А., Моисеева Т. Ю. Проблемы остеопороза в педиатрии : возможности профилактики //Русский медицинский журнал.-2003.-т. 11.-№27(199).-с.1554-1556.
  • 3. Щеплягина Л.А., Моисеева Т.Ю. и др. Минерализация костной ткани у детей // Рос. педиатрический журнал .-2003.-№3.-с. 16-22.
  • 4. Спилиотина Т.В., Бакаева М.В., Ермак Т.А., Шевченко Н.С. Содержание минералов и минеральной плотности костной ткани у детей и подростков. //Второй Рос. симпоз. по остеопорозу: Тез. лекций и докл.– Екатеринбург, 1997. – С.132–133.
  • 5. Дедух Н.В., Шевченко Н.С., Ермак Т.А., Шевченко С.Д. Содержание минералов в кости и минеральная плотность костной ткани у детей и подростков //Проблеми остеологiї .– 1998.–Т.1, №2–3.–С. 29–31.
  • 6. Фролова Т.В., Шкляр С.П. Популяційний аналіз частоти і тяжкості остеопенічних порушень у стратифікованих групах дітей великого промислового міста // Експериментальна та клінічна медицина. – 2006. - №1. – С. 108-112
  • 7. Фролова Т.В., Шкляр С.П. Регіонально-популяційний аналіз частоти та тяжкості остеопенічних порушень у дітей сільських районів Харківської області // Медицина сьогодні і завтра. – 2005. - №4.- С. 75-80
  • 8. Фролова Т.В., Охапкина О.В., Терещенкова І.І. Состояние здоровья школьников, проживающих в крупном промышленном районе г.Харькова // Здорова дитина: здоровій дитині – здорова родина: Матеріали ІІІ міжнародної науково-практичної конференції. – Чернівці, 2005. – С. 115-116
  • 9. Branca F.,Vatuena S., Calcium, physical activity and bone mass - building bones for a stronger future.//Public Health Nutr.-2001.-v.4.-No.la.-p. 117-123.
    10. Фролова Т.В., Корж М.О., Шкляр С.П. Оцінка структурно-функціонального стану кісткової тканини дітей шкільного віку та підлітків за результатами ультразвукової денситометрії //Метод. рекомендації МОЗ та АМН України.- Харків, 2006.-20 с.

 

5
Your rating: None Average: 5 (1 vote)
PARTNERS
 
 
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
image
Would you like to know all the news about GISAP project and be up to date of all news from GISAP? Register for free news right now and you will be receiving them on your e-mail right away as soon as they are published on GISAP portal.