Features of the Health Status of Young Men Who Have Experienced Perinatal Lesions of the Central Nervous System at the Stage of Preparation for Military Service

The dissertation is devoted to the study of features of the health status of young men aged 15-17 who have experienced perinatal lesions of the central nervous system at the stage of preparation for military service. The research analyzes somatic pathology, physical, sexual, intellectual, and personality development of this group of adolescents, as well as the state of the vegetative nervous system, cerebral hemodynamics, and mental work capacity. The author compares the indicators of young men with perinatal lesions of the CNS and their peers without such anamnesis, identifying differences in the adaptive capabilities of the organism.

The work develops a system of preventive observation and monitoring of the formation of health of young men with perinatal lesions of the CNS in the conditions of an educational institution prior to conscription for military service. Prognostic tables for assessing the risk of development of deficit of body weight, delay of sexual development, and low level of nonverbal intelligence have been proposed, as well as additions to the scheme of preventive examinations aimed at early diagnosis of deviations and timely conduct of corrective measures.

Relevance of the Scientific Research.

The problem of adolescent health formation remains one of the leading issues in pediatrics. Significant restructuring occurs in physical and sexual development, neuroendocrine status during adolescence, which determine the specificity of morbidity at this age. All these changes occur against the background of socio-psychological adaptation of the forming personality, therefore this age is referred to as critical in terms of health formation.

Negative trends in health status during the adolescent period are observed both among girls and young men (O.M. Fil'kina, 2000; G.L. Onshchenko, 2001, T.E. Shanina, 2001, O.V. Sharapova, 2002, L.M. Sukhareva and al., 2002, A.A. Baranov and al., 2005; A.G. Ilyin, 2005). An unfavorable picture of the health status of young men can be judged from the results of the work of draft commissions of military commissariats, which are one of the structures of medical provision of adolescents from the standpoint of their preparation for military service. Every third young man upon initial registration for military service is recognized as needing additional examination and treatment, more than 40% of them have diseases that in half of the cases prevented conscription for military service (N.N. Davydov, 2000; V.I. Groshev, 2001, B.A. Yadchuk, 2004).

The formation of children's health, including adolescents, is influenced by a complex of factors that can be divided into three large groups: environmental, biological, and social (Yu.Ye. Veltishchev, 1994).

Among biological factors, in recent times, perinatal lesions of the central nervous system (CNS) have acquired considerable weight.

At present, many works devote considerable attention to studying deviations in the development of children who have experienced perinatal lesions of the CNS of varying severity. These investigations are predominantly devoted to early and preschool age. In most studies, the dynamics of neurological disorders in such children has been traced. It has been shown that the symptomatology and severity of neurological outcomes of CNS damage depend on the severity of hypoxia (N.N. Volodin and al., 2001, K.S. Olimova, 2002), its duration of action on the fetus (Ye.V. Shnitkova, 1999), the degree of maturity (T.V. Ryabchikova, 1996, Ye.M. Burtsev and al., 1998), and the gestational age of newborns (V.Yu. Albitsky, 1993, S.Ya. Volgina, 1997, Y.V. Cheung et al, 2002).

In addition, in children who have experienced perinatal lesions of the CNS, deviations in physical development are observed subsequently with high probability (V.I. Grishchenko, 1990, L.I. Ilyenko and al., 1996, N.N. Volodin, 1999, M.D. Vasilyev, 2000, N.S. Chinenova, 2001) and the formation of a contingent of frequently ill children in early and preschool age (Ye.I. Kapranova and al., 1994, Ye.V. Shnitkova, 1999), violations of intellectual development and the development of speech pathology (M.Ya. Malyksoо, 1988, Ye.A. Bochарova and al., 2003, T.S. Krivonogova and al., 2003), visual disturbances (N.Yu. Shubina, 1998, E. Mercuri et al., 2004) in preschool and junior school age.

All this often leads to social maladjustment, manifested primarily in difficulties in acquiring school skills and behavioral disorders (N.N. Zavadenko and al., 1998, V.N. Turchina, 1998, Yu.I. Kravtsov and al., 2001).

In children with perinatal lesions of the CNS in anamnesis, features have been identified in the structure of somatic morbidity: often skin and respiratory allergies are detected (B.R. Yaremenko and al., 1999, T.A. Markova, 2003, I.I. Balabolkин and al., 2003), chronic diseases of the digestive organs (A.B. Gorelov and al., 2005), pathology of the musculoskeletal system (A.Yu. Ratner, 1990, B.R. Yaremenko and al., 1996, M.V. Vorobushkova and al., 2004).

The question of the health status of children who have experienced perinatal lesions of the CNS in adolescence has been partially studied. These investigations were limited to the age of 14-15 years. In adolescence, upon neurological examination, minimal cerebral dysfunction is most often diagnosed in them against the background of non-severe neurological symptomatology (M.S. Filosofova, 1999, V.V. Lin'kov and al., 2002, Ye.A. Gorbunova, 2004, G.V. Klitochенко). At the same time, it is established that by this age, 37% of children with perinatal lesions of the CNS in anamnesis have a deficit of body weight and 20% have low growth, with lower growth indicators being detected more often in boys (L.S. Malygina and al., 1999, K.S. Olimova, 2002), an asthenic type of constitution is often formed (Ye.V. Shnitkova, 1999), neurocirculatory dystonia, functional cardiac murmurs are often detected (I.N. Kumanysova, 1998, T.A. Nagаeva and al., 2005), cerebral hemodynamics disturbances are noted (Ye.A. Gorbunova, 2004, T.L. Uspenskaya, 2004). In the anamnesis of school-age children with psychosomatic diseases, perinatal lesions of the CNS are detected in 87% of cases, with 2-4 psychosomatic diseases being noted in combination (M.D. Mitish, 2004).

Undoubtedly, the degree of impact of biological factors at different age periods is not the same. In the opinion of a number of authors, their impact weakens with age, and a large influence on the formation of health up to adolescent age is exerted by social factors (G.N. Serdyukovskaya, A.G. Sukhareva, 1986, Ye.A. Vorob'eva, 1998, Zhdanova L.A. and al., 2000). Other researchers (M.Ya. Studenikin, 1994, V.N. Shestakova, 2000, Yu.A. Alekseeva, 2002) maintain that biological factors retain high significance in school age, including the adolescent period. At the same time, in the age from 15 to 18, processes of biological maturation intensify, restructuring of regulatory mechanisms occurs, and the mental sphere of the adolescent is being formed.

The study of remote consequences of perinatal lesions will make it possible to optimize the complex of health-improving measures for young men who are in an educational institution, at the stage of their preparation for military service.

The above data determined the choice of the goal and objectives of this research.

Goal of the research.

Identify the features of somatic pathology, physical, sexual, mental development, state of the vegetative nervous system and cerebral hemodynamics in young men aged 15-17 with perinatal lesions of the CNS in anamnesis, supplement the system of monitoring the formation of their health at the stage of preparation for military service.

Tasks of the research:

1. Identify the features of somatic pathology, physical, sexual, intellectual development, and personality characteristics in young men aged 15-17 with perinatal lesions of the CNS in anamnesis.

2. Establish the features of mental work capacity, emotional status, state of the vegetative nervous system, and cerebral hemodynamics in young men aged 15-17 with perinatal lesions of the CNS in anamnesis.

3. Clarify social and biological risk factors for violations of physical, sexual, and intellectual development of young men who have experienced perinatal lesions of the CNS.

4. Supplement the system of preventive observation of young men aged 15-17 with perinatal lesions of the CNS in anamnesis at the stage of their preparation for military service.

Scientific novelty of the research.

- A large proportion of violations of physical and sexual development, pathology of the musculoskeletal system has been established in young men aged 15-17 with perinatal lesions of the CNS in anamnesis, compared with young men without perinatal lesions of the CNS in anamnesis.

- Features of intellectual development and personality characteristics of young men aged 15-17 with perinatal lesions of the CNS in anamnesis have been identified, characterized by a lower proportion of above-average level of general and nonverbal intelligence, lower sociability and activity, greater introversion.

- In young men aged 15-17 who have experienced perinatal lesions of the CNS, features of the state of the vegetative nervous system, cerebral hemodynamics, and mental work capacity have been identified, which indicate lower adaptive capabilities.

- The prognostic significance of social and biological risk factors for the development of deficit of body weight, delay of sexual development, low level of nonverbal intelligence in young men of pre-draft age who have experienced perinatal lesions of the CNS has been determined.

Practical significance of the research.

- Tables for forecasting the risk of development of deficit of body weight, delay of sexual development, low level of nonverbal intelligence in young men of pre-draft age who have experienced perinatal lesions of the CNS have been developed.

- Additions to the scheme of preventive examinations of adolescents aged 15-17 for young men with perinatal lesions of the CNS in anamnesis have been proposed, improving the quality of diagnosis of health status deviations in this group of adolescents and allowing timely conduct of a complex of corrective medico-psychological-pedagogical measures.

Presentation of the results of the work.

The main provisions of the work were reported and discussed at the Congress of Pediatricians of Russia "Actual Problems of Pediatrics" (February 10-12, 2004, Moscow), All-Russian Scientific-Methodological Conference "Scientific-Methodological Foundations of Studying the Adaptation of Children and Adolescents to Conditions of Life Activity" (May 31, 2005, Moscow), Republican Scientific-Practical Conference "Organization of Medical Care for Children of Adolescent Age" (May 27-29, 2003, Ivanovo), City Conference "Health-Saving Technologies in Education: Interdisciplinary Resources, Practice of Their Use" (March 29, 2005, Ivanovo), final scientific session of young scientists of Ivanovo Research Institute of Motherhood and Childhood named after V.N. Gorodkov (Ivanovo, 2004).

Based on the dissertation, 9 scientific works have been published.

Propositions to be defended:

1. Young men aged 15-17 who have experienced perinatal lesions of the CNS are characterized by a greater proportion of formation of musculoskeletal system pathology, physical development with deviations, delay of sexual development; a lower proportion of above-average level of general and nonverbal intelligence.

2. Young men aged 15-17 who have experienced perinatal lesions of the CNS, compared with adolescents without perinatal lesions of the CNS, are characterized by lower adaptive capabilities of the organism, based on features of the state of the vegetative nervous system and cerebral hemodynamics.

3. Young men aged 15-17 who have experienced perinatal lesions of the CNS need differentiated observation, conducting additional diagnostic measures, including detection of neurotic disorders, in-depth functional examination.