Medical-Social Prevention of Childhood Trauma in a Large City with Consideration of Family Type (Exemplified by the City of Kazan)

The dissertation is dedicated to the development of recommendations for improving medical-social prevention of childhood trauma in a large city, exemplified by Kazan, with consideration of family type. The study encompasses the analysis of prevalence and structure of trauma among children aged 0-17, identification of medical-social risk factors influencing the occurrence of injuries, and assessment of the organizational structure of the pediatric trauma service. The work examines the specifics of trauma in three types of families - complete, complex, and incomplete - and constructs correlation pairs of risk factors for each type of family. The obtained results are aimed at increasing the effectiveness of preventive work at the level of pediatric polyclinics, trauma stations, and educational institutions.

Relevance of the Study.

With each year, the health status of the pediatric population in our country is deteriorating. Particularly unfavorable is the fact that this occurs against the backdrop of an unnatural population decline. A decrease in health indicators among children inevitably results in negative medical-demographic processes. In this regard, the healthcare system faces the task of strengthening work aimed at ensuring the preservation of children's health.

According to the WHO (2004), over the next two decades, changes in the disease structure will occur, and non-infectious diseases and trauma will take leading positions.

In the Russian Federation, childhood trauma is already one of the progressing social dangers causing significant harm to health. However, despite this, interdepartmental commissions for combating childhood trauma have been abolished in almost all regions of the country, and the position of an external pediatric trauma specialist - orthopedist - has been eliminated in many territories. All this leads to a reduction of due attention to the prevention problem and an increase in injuries among the pediatric population.

The analysis of available literature conducted has shown that at present, increased attention is being paid to the problem of injuries among the adult population (Ibragimov V.R. 1998; Elistratov S.M. 1996; Maximenko I.I. 1999; Rozenfeld L.G. 1997; Berest L.P. 1998), while scientific research papers dedicated to the problem of childhood trauma are of an individual nature (Karatai Sh.S. 1978; Solovyova Yu.A. 1998).

Scientific research into new methods of disease prevention has led to a growing interest in recent years in studying the influence of family type on the formation of morbidity among the population and, in particular, among children.

The family, with its various aspects of activity - demographic, socio-economic, and moral-psychological status - exerts direct and indirect influence on the health of its members. It is a multifactorial institution and, as a rule, medical-social factors are realized in the sphere of the child's immediate environment, that is, in the family.

The works of Albitsky V.Yu. (1993) emphasize the necessity of studying the influence of socio-hygienic, biological, and other factors in the family. In the studies conducted by Galiullin A.N. (2004), it is proposed to consider family type when studying medical-social factors, as the manifestations of these factors differ and require, under modern conditions, the development of preventive measures at the family level.

A number of authors (Albitsky V.Yu. 1994; Ananin S.A. 1995; Berezina I.G. 2002) consider that the family should, in many respects, represent a kind of center of primary medical care with functions of upbringing, prevention, and rehabilitation of the child.

However, as literary data indicate, no scientific work examines the influence of family type on trauma, although the implementation of preventive measures at the family level has a pronounced medical and social effect.

The relevance of the chosen topic is confirmed by the constant tendency toward an increase in injuries among the pediatric population, both in the Russian Federation and in the Republic of Tatarstan. At present, the situation is aggravated by the fact that alongside the increase in injuries among the pediatric population, there is a tendency toward an increase in their severity (Gafarov Kh.Z., 2001; Lutkovsky O.A., 2005).

In the process of urbanization and technical progress, the growth in the frequency of trauma in large cities among children and adolescents is acquiring ever greater significance, among whom up to 40% of victims fall (V.R. Teslenko, 2001).

According to a number of authors (Mironov S.P. 2002; Kharisova I.M. 1998; Kornilov N.V. 1999; Gafarov Kh.Z. 2001), the implementation of preventive measures is possible only with a clearly organized trauma service system and an interdepartmental approach to this problem. However, at present, the trauma service in the Russian Federation experiences significant difficulties, both organizational and in terms of financial support.

All of the above reflects the necessity of studying the problem of trauma among the pediatric population in a large city.

Objective of the Study: to develop recommendations for improving the prevention of childhood trauma based on a comprehensive medical-social study of children injured as a result of trauma, with consideration of family type and the organizational structure of the pediatric trauma service of the city of Kazan.

Tasks of the Study:

1. To study the prevalence and structure of injuries among the pediatric population depending on sex and age.

2. To present a medical-social characterization of various types of families of a child who has sustained an injury.

3. To determine priority medical-social risk factors influencing trauma in children living in different types of families.

4. To assess the organizational structure of the pediatric trauma service and conduct an analysis of its key performance indicators.

5. To develop recommendations for the prevention of injuries among the pediatric population with consideration of family type and optimization of the work of the pediatric trauma service of the city of Kazan.

Scientific Novelty. Medical-social factors in various types of families of a child who has sustained an injury have been studied; a medical-social characterization of three types of families has been presented; priority risk factors influencing trauma in children, with consideration of family type, have been determined; correlation pairs of risk factors influencing the frequency of childhood trauma have been constructed for each type of family; an assessment of the key performance indicators of the pediatric trauma service of the city of Kazan has been conducted; recommendations for the prevention of childhood trauma have been developed with consideration of medical-social risk factors in various types of families, a system for monitoring childhood trauma, and an adapted structure of the pediatric trauma service of the city of Kazan.

Practical Significance. The identified medical-social risk factors of injury occurrence in children, with consideration of family type, as well as the proposed correlation pairs, will allow the development of effective preventive measures for medical-social prevention of childhood trauma at the level of pediatric polyclinics, trauma stations, and educational institutions of the city of Kazan.

The proposed structure of monitoring childhood trauma will allow the Department of Healthcare of the city of Kazan to carry out current control over the state of this problem and, based on the obtained data, conduct targeted preventive work with victims through trauma stations, pediatric polyclinics, and organizations interested in combating childhood trauma.

The developed and recommended system of childhood trauma prevention will allow increasing the effectiveness of preventive work in preventing injuries among the pediatric population and reducing the number of repeat injuries.

The recommended structure of the pediatric trauma service will allow, on its basis, to create a more effective treatment-preventive system for providing specialized medical care to the pediatric population.

Main Propositions to be Defended:

1. The introduction into practical healthcare of the proposed system of medical-social prevention serves as a foundation in the fight against childhood trauma.

2. The use of correlation pairs constructed for each type of family allows the identification of unfavorable factors with the aim of their further elimination or weakening of their impact.

3. The creation of the proposed, adapted to modern conditions of a large city, pediatric trauma service is a substantial condition increasing the social and medical effectiveness of this type of medical care.

Implementation of Research Results. Based on the materials of the study, methodological recommendations titled "Ways to Optimize the Pediatric Trauma Service of the City of Kazan and the Organization of Medical-Social Prevention of Childhood Trauma with Consideration of Family Type" have been developed and implemented, approved by the Department of Healthcare of the Executive Committee of the Municipal Formation of the City of Kazan.

The materials of the study are used in the work of the pediatric trauma station at MUZ "Children's City Hospital No. 1" of the City of Kazan, in the work of pediatric polyclinics of the Novo-Savinovsky District of the City of Kazan, the Department of Healthcare of the Executive Committee of the Municipal Formation of the City of Kazan, as well as in the educational process at the Department of Public Health and Organization of Healthcare with a course of Medical Informatics of the State Educational Institution of Higher Professional Education "Kazan State Medical University of the Federal Agency for Healthcare and Social Development."

Presentation of the Work. The main materials of the study were reported: at a meeting of the Department of Public Health and Organization of Healthcare with a course of Medical Informatics of the State Educational Institution of Higher Professional Education "Kazan State Medical University of the Federal Agency for Healthcare and Social Development"; at scientific-practical conferences of young scientists, Kazan: KGMU, 2004, 2005, 2006; at the All-Russian Inter-University Scientific-Practical Conference, Ufa: BGPU, 2003; at the All-Russian Scientific-Practical Conference dedicated to the 80th anniversary of the Department of Public Health and Organization of Healthcare of KGMU, Kazan-Moscow: KGMU, 2004.

Author's Contribution. The author personally performed the entire volume of studies, conducted their analysis and evaluation of results. The scientific propositions and conclusions of the dissertation are based on the results of the author's original research. A map for studying the prevalence and structure of childhood trauma in the city of Kazan was developed (4,495 maps were personally filled out by the author). A map for studying the influence of medical-social factors on childhood trauma was developed (785 maps were personally filled out by the author). Statistical processing of the obtained data, writing of five chapters of the dissertation were fully performed by the author.

Based on the dissertation, 16 printed works have been published, of which 7 are sole-authored (43%). One methodological recommendation.

Volume and Structure of the Work. The dissertation is presented on 187 pages of typed text. It consists of an introduction, a literature review, four chapters of original research, a conclusion, conclusions, practical recommendations, a list of references, and appendices. The bibliographic reference includes 302 sources, of which 263 are domestic and 39 are by foreign authors. The text is illustrated with 34 tables, 40 figures, and 6 schemes.