Assessment of the Health Status and Rehabilitation of Organized Preschool-Aged Children

The dissertation is devoted to the assessment of the health status and rehabilitation of organized preschool-aged children. The research was conducted in municipal children's educational institutions in the Leninsky district of Perm, specifically in children's combinats No. 36 and 336. The work covers questions of morbidity among preschoolers, rehabilitation approaches, iodine sufficiency status, and allergic skin lesions in children.

The work examines clinical-laboratory and instrumental research methods and develops rehabilitation schemes incorporating iodine-containing preparations and multivitamin agents. Special attention is given to the effectiveness of rehabilitation measures for children with allergic skin lesions, including the use of the preparation "Dzhungli s mineralami" and local treatment with fossilized mud "Sapropel."

Relevance of the Problem.

The health status of children in recent years gives particular cause for concern. The majority of studies have established that already at preschool age, a significant proportion of children develop multiple functional disorders, and approximately 17% acquire chronic diseases. By the beginning of the school period, only one in three children remains healthy [26].

In the structure of morbido-functional pathology among preschoolers, the leading positions are occupied by disorders of the musculoskeletal apparatus, changes in the cardiovascular system, digestive organs, and allergic manifestations.

Over the past five years, a stable increase in diseases with an ecologically dependent nature has been observed in the city of Perm. First and foremost, these are diseases of the blood and hematopoietic organs — an increase of 14% compared to 1995, and a twofold increase over five years; diseases of the nervous system — an increase of 8% in 1996 and a 1.5-fold increase over five years; congenital malformations — an increase of 13% in 1996 and 34% over five years. The significant increase in cardiovascular diseases among children is alarming — an increase of 19% in 1996 and 48% over five years. Diseases of the musculoskeletal system have increased by 56% over the past five years. A significant influence on the rise in morbidity is also exerted by iodine deficiency in the environment [11, 30, 36, 42, 43, 49].

The prevalence of allergic diseases among children is high. In the structure of allergic pathology, allergic skin lesions occupy the leading position [9, 52, 91]. The frequency of detection of allergic dermatoses ranges from 40 to 80%, and among young children it constitutes 57–90% of all allergic pathology [101]. When studying the prevalence of allergic diseases among the pediatric population of Perm in 1992–1995, it was found that 25.5% of children suffer from atopic dermatitis [2].

The increase in allergic pathology among preschool-aged children is attributable to a variety of factors [1, 21, 31, 35, 90]. The role of heredity in the development of the allergic process has been noted by many authors [3, 6, 22, 134, 137]. The highest prevalence of allergic diseases is observed among children living in cities, with the highest indicators recorded in areas with massive pollution of the air environment by industrial waste and motor vehicle exhaust [2, 7, 8, 86, 125]. A significant influence on the increase in allergic and somatic pathology is also exerted by iodine deficiency in the environment and the organism [14, 56].

In Russia, more than 6.9 million children attend children's educational institutions (CEIs), many of which are municipal. Numerous studies in recent years indicate that the majority of children attending preschool institutions have health problems [10]. Therefore, one of the functions of CEIs is to strengthen children's health and, for this purpose, carry out various rehabilitation measures.

Using municipal children's educational institutions as an example, it was important to study the true morbidity of children, its structure, and to develop and implement modern therapeutic and health-improvement measures.

All of the above served as the basis for setting the goals and objectives of the present work.

Research Objective. To study the health status of organized preschool-aged children and develop effective rehabilitation schemes in the conditions of children's educational institutions. Research Tasks.

1. To study the health status indicators of organized preschool-aged children in the Leninsky district of Perm.

2. To analyze the morbidity of students of CEI No. 36 and 336 in the Leninsky district of Perm.

3. To assess the severity of iodine deficiency according to standard criteria among children attending CEI No. 36 and 336.

4. To develop a rehabilitation scheme incorporating iodine-containing preparations.

5. To evaluate the effectiveness of rehabilitation measures for children with allergic skin lesions.

Scientific Novelty.

For the first time, a comprehensive study of the health status of preschool-aged children was conducted in two organized collectives in the Leninsky district of Perm.

A specific rehabilitation scheme was proposed using the multivitamin preparation "Dzhungli s mineralami."

A new scheme for local therapy of allergic skin lesions in the conditions of children's educational institutions was developed and proposed.

Practical Value and Implementation of the Work.

The conducted studies made it possible to recommend, for widespread use, screening questionnaires for families to identify initial manifestations of iodine insufficiency and allergic skin lesions, based on a specially developed questionnaire.

Effective rehabilitation schemes for children in CEI conditions were proposed.

The obtained data are used in the practical activities of preschool educational institutions in Perm, in the work of the departments of the Perm City Clinical Emergency Children's Hospital No. 3, and in the educational process at the department of children's diseases of the medical and dental faculties.

It is recommended to use the results of the work in the practice of pediatric departments of polyclinics and in the work of children's preschool educational institutions.

Dissertation Material Presentation.

The materials were reported at the Russian National Congress "Man and Medicine" (Moscow, 2001), at the I All-Russian Scientific and Practical Conference "Health and Education of the Child" (Perm, 2002), and at city pediatric conferences (Perm, 2001, 2002, 2003, 2004).

Based on the dissertation materials, 5 printed works have been published, including 1 methodological recommendation.

Positions for Defense:

1. The results of parent questionnaires, analysis of outpatient records, and in-depth clinical examination demonstrated a high level of somatic morbidity and the necessity of developing economical rehabilitation methods.

2. Based on the examination of preschool-aged children, the severity of iodine deficiency was determined to be mild.

3. The rehabilitation scheme proposed by us using a multivitamin preparation is characterized by high effectiveness and makes it possible to increase the average health indicator by 2–3.5 times, and has an influence on the rate of biological development.

4. The use of fossilized mud "Sapropel" in the rehabilitation of children with allergic skin lesions yielded a positive clinical effect in 66.7% of cases. This method of local therapy can be used in the rehabilitation system for children with allergic dermatoses.