The Role of Vegetative and Trophic Disorders in the Formation of Psychosomatic Pathology in Children of Social Risk Groups

The dissertation is devoted to the study of the role of vegetative and trophic disorders in the formation of psychosomatic pathology in children of school age belonging to social risk groups. The research was conducted in the Trans-Baikal region and, for the first time, differentially examines the late follow-up of children depending on the presence of various social risk factors, with particular attention being paid to the alcohol factor as the most significant among them. The work substantiates the necessity of a differentiated approach to observation and treatment of adolescents from social risk groups, taking into account the nature and degree of disorders of vegetative regulation and trophic processes.

The health of children and youth is an important component of societal well-being. Children and adolescents in particular are most sensitive to socioeconomic and ecological changes occurring in society [11, 14, 49, 75]. While in industrially developed countries child mortality is steadily declining, adolescent mortality in Russia has increased over the past 30 years and is now among the highest in the world. The dominant causes of child mortality in adolescence are: injuries, alcohol poisoning, and poisoning by narcotic and psychotropic substances [60, 168, 169]. The number of suicides among adolescents in the country has increased by a factor of 1.8 [36, 142].

At the present stage, negative trends in the health status of adolescents are observed, manifested by the growth of functional and organic pathology with early disability among the child population. In the structure of somatic disorders, diseases of the endocrine, urinary, nervous, and musculoskeletal systems predominate [18, 27, 29, 111, 145, 150].

Adolescence (11–15 years) is distinguished as an important critical period of development, characterized not only by growth but also by the maturation of all organs and systems. During this period, an exceptionally significant neuroendocrine restructuring of the adolescent organism takes place, which determines the level of health, quality of life, personality formation, and defines the future risk of developing many diseases [22, 25, 56, 117].

In the formation and development of diseases, a substantial role is played by risk factors of lifestyle and environment of residence. However, their contribution is not unambiguous. The social determinism of morbidity is confirmed by numerous studies [78, 85]. The most significant social risk factors are considered to be: material well-being, housing conditions, family completeness, and the presence or absence of harmful habits among parents. Recent studies convincingly have demonstrated that the factor of alcoholization makes a decisive contribution to the depopulation of the population of Russia [36].

In the Trans-Baikal region, large-scale research is currently being conducted dedicated to the influence of alcohol on various aspects of adult life and the mental health of children [128, 142]. However, these works concern certain age groups, leaving poorly studied the questions of late follow-up of children raised by parents abusing alcohol. Research investigating the negative influence of social risk factors on the health status of children are, in the overwhelming majority of cases, limited to the period of early age [33, 103, 110]. Scientific research in relation to this age group are few in number. Children who have reached school age and who have no congenital anomalies of development and embryopathies in early age are not given due medical attention during observation. At the same time, the number of data is increasing that in this group the number of functional and chronic diseases, nervous-psychic disorders, and suicides is growing.

Based on the above, it appeared expedient to study the influence of social risk factors as a whole, as well as the differentiated contribution of the alcohol factor to the psychosomatic status, adaptation, and individual components of quality of life of adolescents.

Objective of the research: to establish the influence of trophic and neurocirculatory disorders on psychosomatic morbidity in children of social risk groups in order to substantiate a complex of corrective measures.

Tasks:

1. To investigate the patterns of vegetative regulation in children taking into account social risk factors.

2. To assess the degree of trophic disorders in children taking into account social risk factors.

3. To characterize the psychosomatic status of children of social risk groups.

4. To evaluate the efficacy of the application of the protein-vitamin-mineral complex "Energy" in children with trophic syndrome and transcutaneous electroneurostimulation in children with neurocirculatory disorders.

Scientific novelty of the research. For the first time in the Trans-Baikal region, the late follow-up of school-age children has been studied in a differentiated manner depending on the presence of social risk factors.

Of priority are data on the most substantial negative contribution of the alcohol factor, among the studied social risk factors, to the realization of adaptive processes, predetermining the prospective forecast of the health level of children.

It has been shown that among adolescents from families with the presence of an alcohol factor, there are complex vegetative regulation disorders. The initial vegetative tone is presented by parasympathicotonia, which testifies to the inclusion of compensatory mechanisms providing a more economical mode of vegetatively dependent systems of the organism even at rest. The correlation between the sympathetic and parasympathetic divisions of the autonomic nervous system changes in the direction of decrease and testifies to dysregulatory disorders. In this group, anthropometric indicators and functional parameters of the respiratory, cardiovascular, and muscular systems are significantly reduced with the formation of a prognostically unfavorable leptomorphic somatotype. At the same time, other social risk factors (incomplete family, low educational level of parents, unfavorable family microclimate, unsatisfactory housing and living conditions, low financial provision of the family) exert a less substantial influence. The listed changes in vegetative regulation, trophic disorders, and functional changes in the respiratory, cardiovascular, and muscular systems lead to a reduction in the adaptive potential in children from families with the presence of an alcohol factor, whereas children with other social risk factors demonstrate quite satisfactory adaptation.

It has been shown for the first time that in the structure of psychosomatic diseases among children from social risk groups, diseases of the digestive organs, eating disorders, and metabolic disorders are registered more frequently. Among adolescents from families with the presence of an alcohol factor, an increase in mental disorders and behavioral disorders is noted.

A significant reduction in the quality of life of children from families with the presence of an alcohol factor has been established by certain components: physical and social activity, emotional state, and assessment of the intrafamily climate.

Practical significance of the research results. In the course of the research, a heterogeneous influence of social risk factors on vegetative regulation, the level of adaptation, quality of life, and psychosomatic disorders among adolescents has been established. When observing children from social risk groups in outpatient-clinic conditions, it is necessary to implement a differentiated approach. It is advisable to single out children from families with the presence of an alcohol factor into a separate risk group, with mandatory comprehensive examination and treatment in hospital conditions, including diagnostic-therapeutic and rehabilitative measures aimed at the correction of metabolic and dysregulatory disorders.

Children who initially have a trophic syndrome are indicated for the use of the cocktail "Energy"; when symptoms of vegetative dysfunction predominate, transcutaneous electroneurostimulation using the portable device "DENAS" is recommended.

Implementation of the results. On the basis of the conducted research, recommendations have been developed for the conduct of restorative treatment of prevalent health disorders among adolescents from social risk families in conditions of urban hospitals, educational institutions, and local sanatoriums of social protection. Theoretical provisions and practical recommendations of the dissertation work are used in training programs for students of the medical and dental faculties, the department of propaedeutics of children's diseases, and the department of pediatrics of the Continuing Professional Education and Advanced Training (FPK i PPP) of the Chita State Medical Academy; in the therapeutic process of the Oblast Clinical Hospital No. 2 of Chita.

Basic provisions of the dissertation to be defended:

1. Vegetative regulation in children from families with the presence of an alcohol factor is characterized by parasympathicotonia at rest and hypersympathicotonic vegetative reactivity in the state of functional load.

2. Trophic syndrome of varying degree of severity is present in all children of social risk groups, and in the presence of an alcohol factor it leads to a significant reduction in physical development and the formation of a prognostically unfavorable leptomorphic somatotype.

3. The presence of an alcohol factor in the family is a predictor of a reduced level of adaptation in children.

4. The method of transcutaneous electroneurostimulation leads to an improvement in hemodynamic parameters, increasing blood supply and eliminating its asymmetry in the vertebrobasilar basin. In children with trophic syndrome, the use of the cocktail "Energy" increases anthropometric and physiometric indicators.

Presentation of the work. The results of the work were discussed at conferences of the Children's Road Clinical Hospital of Chita-2 (2003–2004), the All-Russian Scientific and Practical Conference dedicated to the 50th anniversary of the formation of the Chita State Medical Academy (Chita, 2003), the All-Russian Congress "Man and Health" (Irkutsk, 2004), the International Congress "Health, Education, and Upbringing of Children and Youth in the 21st Century" (Moscow, 2004).

Publications. Eleven works have been published on the topic of the dissertation, including one article in a publication recommended by the VAK of the Ministry of Education of the Russian Federation.

Structure and volume of the dissertation. The dissertation consists of an introduction, a literature review, the results of original research with discussion by sections, a conclusion, conclusions, and a list of references. The dissertation is presented on 142 pages of text, contains 30 tables, 5 figures. The list of references includes 269 sources, of which 178 are domestic and 91 are foreign.