View
225
Download
1
Category
Tags:
Preview:
Citation preview
Social Services Actions for Prevention Of Digestive
Disorders Among Adolescents
Medea ChikavaMedea Chikava M.D., Ph.DM.D., Ph.D
THE THE UNIVERSITYUNIVERSITY Of Of GEORGIAGEORGIA
Among the greatest advances in elucidating the determinants of disease over the recent period has been the identification of social conditions that seem to influence morbidity. While planning social services it is important to determine the impact level of each social risk factor on disease development in order to form prevention measures ranked list and outline the priority problems.
Despite all the achievements of the contemporary Medicine, improvement of prevention
of Digestive Disorders (DD) still remain a priority objective, since there is a trend of uncontrolled growth of these disorders in the World.
Adolescence is one of the most critical periods of the human postnatal ontogenesis and one of the most difficult periods of psychological development. That is why so important is timely development of the effective, scientifically sound model of prevention of these disorders among adolescents, based on the evaluation of social risks that have impact on them.
This is the first study in Georgia that using the two step model epidemiological research
defines pathogenic strength and prognosed values of social and other risk factors.
The Objective of the ResearchThe Objective of the Research
_ _ to study the role of micro-social environment in formation of DD among adolescents of Georgia aged 14-21; _ to establish which factors have more negative influence on the development and progression of DD in adolescents; _ what measures will be more effective to be
conducted during the delivery of social services.
Materials and MethodsMaterials and Methods
One stage epidemiological research was conducted among
1. the medium (14-16 years old) 2. late (17-21 years old) period adolescents population of Georgia. We developed:
1. primary questionnaire for DD morbid forms screening 2. specialized map-questionnaire of epidemiological research of DD
Statistical study of DD was conducted not as Statistical study of DD was conducted not as complete study of “general entity” but with “partial” complete study of “general entity” but with “partial” method. To receive statistically reliable values, the value of method. To receive statistically reliable values, the value of “selection entity” was defined by the method, accepted on “selection entity” was defined by the method, accepted on the tenth report of the WHO Experts’ Committee, the the tenth report of the WHO Experts’ Committee, the following formula [143]: following formula [143]:
n = t2 * P * (100 – P ) / ∆ 2 n = t2 * P * (100 – P ) / ∆ 2 where:where: n – is needed number of observations;n – is needed number of observations;
P = P = 13,25% 13,25% – distribution of disease, expressed in %– distribution of disease, expressed in % (prevalence index of DD, received as a result of epidemiological (prevalence index of DD, received as a result of epidemiological
research, conducted in 2003in adolescents aged 15-18);research, conducted in 2003in adolescents aged 15-18);
t = 1,96 – reliability coefficient (95% accuracy);t = 1,96 – reliability coefficient (95% accuracy); ∆ ∆ = = 3,25 3,25 – limiting error of index.– limiting error of index.
n = n = 1,962 * 13,25 * 86,75 / 3,252 = 4181,962 * 13,25 * 86,75 / 3,252 = 418
I groupI group II groupII group
adolescents with adolescents with DDDD
( ( nn1 1 = 84 )= 84 )
conditionally conditionally health adolescentshealth adolescents
( ( nn2 2 = 346 )= 346 )
The epidemiological research _
430 adolescents
I step _ the screening questionnaires
II step _ the map-questionnaires
Each map contained questions to study psychosocial, alimentary and other risk factors. Data, received as a result of research, was
statistically processed by the SPSS program
application, Excel, using contemporary biostatistics techniques.
The risk factors significances were studied
by the Case-Control Study method.
For each risk factor For each risk factor 1. 1. pathogenic strength _pathogenic strength _
Relative Risk (RR)Relative Risk (RR) 2. 2. prognosed valuesprognosed values – –
Relative Intensity coefficient (K)Relative Intensity coefficient (K)
RR evaluates level of impact of the RR evaluates level of impact of the risk factors on DD development.risk factors on DD development.
K evaluates level of impact of the K evaluates level of impact of the risk factors on DD progression.risk factors on DD progression.
In order to define
sequence of the preventive measures which are recommended to be conducted during the
delivery of social services in the groups ranking of the risk factors was held according to decrease of RR, K values:
1. for the conditionally healthy adolescents (II group) – according to RR was defined ranked list of DD predictors;
2. for the adolescents with DD (I group) – according to K was defined rank of risk factors that help the progress of these disorders in case of already developed disease
Results and Discussion
The prevalence of DD in adolescents population was stated – 19,5% (95%CI: 17,6-21,4);
from which 10,5% were girls and 9,0% were boys ((diagram 1).
Among 84 adolescents with DD 45 were girls and 39 were boys, 53,6% (95%CI: 48,1- 59,1) and 46,4% (95%CI: 40,9-51,9), respectively ((diagram 2).
DD
DiagramDiagram 1 1The The prevalence of Digestive Disordersprevalence of Digestive Disorders in
Adolescents According to Intensive IndicesIntensive Indices
9
80,5
10,5
boys girls
DiagramDiagram 2 2 The The prevalence of Digestive Disordersprevalence of Digestive Disorders in
Adolescents According to Extensive IndicesExtensive Indices
46,4
53,6boys
girls
DiagramDiagram 3 3 The The structurestructure of Digestive Disordersof Digestive Disorders
in Adolescents
0
1
2
3
4
5
6
7
8
1 2 3 4
girlsboys
1. Esophageal disordersdisorders2. Stomach and duodenal disordersdisorders3. Hepatobiliar and pancreatic system disordersdisorders
4. Intestinal disordersdisorders
0
5
10
15
20
25
14-16years old
17-21years old
girlsboys
Diagram 4Diagram 4TheThe prevalence of Digestive Disordersprevalence of Digestive Disorders in Adolescents According to Age and Sex
I groupI group II groupII group
Adolescents with Adolescents with Digestive DisordersDigestive Disorders
(DD)
((nn11=84)=84)
Conditionally Conditionally Healthy Healthy
AdolescentsAdolescents
((nn22=346)=346)
Table 1 The The social Risk Factors Impact On Adolescents
Digestive DisordersDigestive Disorders Development
The risk factors of micro-social environment
Frequencies (%)
Z p RR
Rank
K
I group II group
adolescents chronic overload 96,4 ± 2,0 63,6 ± 2,6 5,89 <0,0001 11,6 1 1,52
adolescents bad habits 55,0 ± 5,7 19,2 ± 2,3 6,43 <0,0001 3,42 2 2,87
unsatisfactory living conditions 46,4 ± 5,5 18,8 ± 2,1 5,3 <0,0001 2,72 3 2,47
excessive use of computer, TV 66,7 ± 5,2 42,2 ± 2,7 4,03 <0,0001 2,26 4 1,58
the majority of familiars smoke 53,8 ± 5,5 30,8 ± 2,5 3,95 <0,0001 2,14 5 1,75
parents separation 14,3 ± 3,8 6,59 ± 1,3 2,32 0,0102 1,89 6 2,17
passive smoking more than 2 years
55,0 ± 5,5 40,0 ± 2,6 2,48 0,0066 1,62 7 1,37
Table 2 The The impact chronic overload On Adolescents
Digestive DisordersDigestive Disorders Development
Risk factors
Frequencies (%)
Z p RR
Ran
k
K
I group II group
Adolescents chronic overloads
96,4±2,0 63,6 ± 2,6 5,89<0,0001
11,6 1,52
adolescents study overloads 61,0±5,42 11,5±1,73 9,86 <0,0001 5,85 1 5,3
conflict situations at the family 54,6±5,46 16,7±2,04 7,26 <0,0001 3,75 2 3,28
difficulties in communicating with peers
61,9±5,33 29,8±2,46 5,5 <0,0001 2,88 3 2,08
negative emotions during eating 32,1±5,13 14,6±1,9 3,75 <0,0001 2,15 4 2,2
conflict situations at the school 32,5±5,26 16,9±2,07 3,11 0,0009 1,92 5 1,91
In contrast to
chronic psychological overloads,
a healthy lifestyle
has positive impact on DD development among adolescents.
Diagram 5Diagram 5Irregular Consumption of Food Products
among Adolescents Population (%)
1. 1. plural vegetables (except potatoes); plural vegetables (except potatoes); 5. 5. macaroni, plural grouts;macaroni, plural grouts;
2. 2. fishfish;; 6. 6. butterbutter;;
3. 3. milk and dairy producmilk and dairy producttss; ; 7. 7. meat;meat;
4. 4. fruit and fruit and berryberry; ; 8. 8. egg.egg.
0
20
40
60
80
1 2 3 4 5 6 7 8
Unhealthy diet is risk factor for DD development:
1. overweight eating of carbohydratic food (bread and bread products, potatoes and sweets) – RR=2,98 (95%CI: 2,29-3,88);
2. irregular consumption of milk and dairy products – RR=1,82 (95%CI: 1,38-2,49),
3. insufficient use of fruit and berry RR=1,41 (95%CI: 1,06-1,85).
DiagramDiagram 5 5 The The frequencies of active and passive lifestyle
among adolescents population (RR=1,46)
37,8 40,532,4
25,8
29,7
24,8
0
10
20
30
40
50
60
70
I group II group I group II group
mainly stands
mainly sits
trains, dances or takes part in sporting activity
Table 2 The The social Risk Factors Impact On Adolescents
Digestive DisordersDigestive Disorders Development
The risk factors of micro-social environment
Frequencies (%)
Z p RR
Rank
K
I group II group
adolescents chronic overload 96,4 ± 2,0 63,6 ± 2,6 5,89 <0,0001 11,6 1 1,52
adolescents bad habits 55,0 ± 5,7 19,2 ± 2,3 6,43 <0,0001 3,42 2 2,87
unsatisfactory living conditions 46,4 ± 5,5 18,8 ± 2,1 5,3 <0,0001 2,72 3 2,47
excessive use of computer, TV 66,7 ± 5,2 42,2 ± 2,7 4,03 <0,0001 2,26 4 1,58
the majority of familiars smoke 53,8 ± 5,5 30,8 ± 2,5 3,95 <0,0001 2,14 5 1,75
parents separation 14,3 ± 3,8 6,59 ± 1,3 2,32 0,0102 1,89 6 2,17
passive smoking more than 2 years
55,0 ± 5,5 40,0 ± 2,6 2,48 0,0066 1,62 7 1,37
The unhealthy habits _
RR=3,42
1. smoking _ RR=2,27
2. excessive consumption of alcohol _ RR=1,87
DiagramDiagram 6 6 The The frequencies of bad habits _ RR = 3,42
(smoking _RR- 2,27, alcohol consumption RR- 1,87)
among adolescents population
38,7
26,9
17,613,8
0
10
20
30
40
50
si gar et i s moweva al kohol i s mi Reba
I j gufi II j gufi
The fact, that the majority of familiars smoke (RR=2,14), is one of the less significant risk factors. The correlation coefficient between this factor and adolescents’ bad habits is 0,4 (r=0,4). This average correlation indicates that unhealthy microsocial environment imfluences on the adolescents in this way that they early begin to smoke. Passive smoking more than 2 years time (RR=1,62) also has impact on DD development, but to less considerable degree.
The unsatisfactory living conditions (RR=2,72) have very important negative influence on children’s and adolescents’ development and these occupy the third place among the social risk factors after the bad habits.
Excessive Use of New Information Technologies _
RR=2,26
1. Excessive use of computer _ RR=2,14
2. Excessive use of TV _
RR=1,67
The parents separation has low average correlation with presence of DD among adolescents (r=0,39).
So it also influences on DD development among them (RR= 1,89).
The use of computer has different impacts on the I and II groups adolescents. On the question ’’what do you feel after using computer?’’, adolescents of I and II groups, respectively, answered:
’’weakness’’ – 6,8% and 2,3%;
’’exhaustion’’ – 13,8% and 3,4%,
’’has worst influence’’ – 3,4% and 2,3%.
Overall, the computer negatively influences on 24,0% of adolescent with DD and 8,0% of others (p<0,05). 25% of the whole population feels tired after using the new information technologies and it has the positive impact on 18,4% of conditionally healthy adolescents, but nobody feels the same in the I group.
Just because adolescent has one or more risk factors doesn’t mean he will definitely develop poor digestive health. Knowing one’s risk factors to his digestive health can guide him into making the best choices for himself – whether it’s making lifestyle changes or other changes.
Conclusions
Thus, according to the obtained results from the epidemiological research the prevalence of digestive disorders in adolescents population is more high among girls, than _among boys and it has tendency of growth by age. Accordingly, the influence of micro-social environment is more negatively represented on the pubertative age girls health, than on the boys of the same age.
The results obtained indicates that while planning social services for preventing development of DD in adolescents first of all the following actions are recommended to be implemented:
1. the reduction of chronic overload (RR=11,6), especially study overload (RR=5,85)
2. and conflict situations in family (RR=3,75);3. explanation of bad habits negative role to the
adolescents (RR=3,42); 4. improvement of living conditions (RR=2,72);5. moderately use of computer, TV (RR=2,26).
For right prevention of adolescents DD it’s important to provide rational using of nutritional resources by adolescents, especially by girls:
1. milk and dairy products (RR=1,82),2. fruit and berry (RR=1,41).
It’s essential to limite the consumptionof bread and bread products, potatoes andsweets (RR=2,98).
The results of our research show the risk factors the modification of which is the most important during delivery of social services.
Based on the results of our research it is possible to develop scientifically approved model of prevention DD among adolescents.
This shall be much cheaper than treatment expenses.
ThANK YOU FOR ThANK YOU FOR
ATTENTIONATTENTION
Recommended