The State of Health and Approaches to Rehabilitation of the Child Population of the Belgorod Region

The dissertation is dedicated to a comprehensive study of the state of health of the child population of the Belgorod Region and the development of measures for their rehabilitation in educational institutions. The work analyzes demographic indicators, the structure of morbidity, and physical development indicators of children of various age groups in different regions of the area, including ecologically unfavorable territories and areas affected by the Chernobyl accident. Special attention is given to chronic pathology, the thyroid status of newborns, and the identification of leading classes of diseases and risk factors for their formation.

Based on the conducted comprehensive examination, a system of measures aimed at preserving and strengthening children's health has been developed, including a rehabilitation program for students in grades 1-6. The program defines the content of physical culture and health-improving classes and was tested on experimental sites in three districts of the region. The obtained results are formatted as methodological recommendations and are applied in practical healthcare in the region.

Relevance of the Topic

The catastrophic deterioration of the state of health of the child population in the Russian Federation over the past 15 years is a reflection of negative processes and the crisis state of society as a whole. The socio-economic adversity of the population has manifested itself particularly strongly in the imbalance of medical-demographic processes, characterized by a sharp decline in birth rates, deterioration in the quality of health of pregnant women, newborn children, an increase in the prevalence of chronic diseases in childhood, and changes in body mass and growth indicators and ratios among school-age children (V.M. Studenikin, 1994; M.V. Antropova et al., 1997; O.V. Sharapova, 2000).

Analysis of scientific literature shows that the influence of technogenic contamination of natural environments on the population health of the younger generation in the 1970s and 1980s in a small part of the territories of Russia subsequently acquired clear adverse trends (S.V. Alekseev, 1998; A.A. Baranov, 2002). Among all age groups of the child population, there is an increase in chronic pathology, most pronounced in diseases of the respiratory organs, urinary and reproductive organs, digestive system, and musculoskeletal system. Already at that time, special concern was caused by the increase in the number of children with pathology of the nervous system, congenital developmental anomalies, and a decline in the health level of children at birth.

Comprehensive screening examinations of groups of sick children in the early 1990s showed that chronic pathology within the above range of diseases begins to form at an earlier age than was observed in the 1980s. As children grow older, the number of sick children increases, and by the end of school, 60% of children have some form of pathology.

Taking into account the changed political and socio-economic conditions, the Government developed the Federal Program "Children of Russia", approved by the Decree of the President of the Russian Federation in 1993. The plan of action for improving the situation of children in the Russian Federation for 1995-1997 was approved by the Government in 1996. Based on the Federal Programs, regional programs and plans have been developed that operate in many territories.

In this context, the relevant problem is the research of demographic indicators in individual regions of the country, the development, justification, and implementation of a system of measures aimed at preserving and strengthening the health of children, taking into account local features and conditions (L.V. Anokhin, 1984; V.S. Glushko, 1990). There is a need to establish a regional structure of morbidity, highlighting the most significant pathology; to identify the main causes of its formation; to determine risk factors for chronicity; to identify the most effective methods of rehabilitation of patients and principles of medical support (L.S. Baleva, 1994).

The insufficient scientific analysis of the state of health of the child population of the Belgorod Region impedes the full development of a forward-looking plan for further rehabilitation of children and does not allow objective conduct of further dynamic observation.

The goal of the research is to conduct a comprehensive assessment of the health of children of the Belgorod Region and to develop and implement measures for their rehabilitation in educational institutions.

Research Tasks.

1. To study and analyze the dynamics of demographic indicators and the structure of morbidity depending on the ecological state of the regions of the Belgorod Region.

2. To conduct a comprehensive assessment of the physical development of school-age children.

3. To conduct research on the thyroid status of newborns, its dynamics in various regions of the Belgorod Region.

4. To develop an algorithm of measures providing for the rehabilitation of the child contingent within the most commonly encountered classes of pathological conditions.

Scientific Novelty

For the first time, a comprehensive assessment of the state of health, analysis of the structure of morbidity and mortality of children in various regions of the Belgorod Region was conducted. The predominant pathology among children of various age groups was established. Ecologically "unfavorable areas" of the region were identified and a map of the prevalence of five classes of diseases was compiled: endocrine, urinary and reproductive system, circulatory system, digestive system, blood and hematopoietic organ diseases. For the first time, an analytical study of physical development parameters and their deviations among children of the Belgorod Region for the period from 1980 to 2000 was conducted.

A system of measures aimed at the rehabilitation of the child population of the region was developed.

Practical Significance of the Work

The identified dynamics of the growth of individual classes of diseases and the established indicators of physical development of children of various age groups are fundamental criteria for determining the strategy of medical service for children in the Belgorod Region, and above all in ecologically unfavorable zones.

A rehabilitation program for students of grades 1-6 has been developed, the content of physical culture and health-improving classes in educational institutions has been determined. The program allows solving the following tasks: strengthening health, enhancing the body's resistance to unfavorable environmental factors; forming needs and a stable interest in active physical culture and health-improving activity; contributing to harmonious physical development, increasing the functional capabilities of the body.

The rehabilitation program was tested on experimental sites in three districts of the region and approved at the collegium of the regional department of education.

The developed regional indicators of physical development of children serve as a benchmark for early correction of changes in children's health status.

Implementation of the Research Results. The materials of the research are formatted as methodological recommendations and are applied in practical healthcare in the Belgorod Region, namely:

- in the materials of a seminar on joint activities of education and healthcare bodies on improving the system of medical support for children in educational institutions of the Belgorod Region (November 1995, Belgorod);

- in the program and guide on physical culture and health-improving education of students in grades 1-6 (January 1999, Belgorod);

- in the guide on organizational forms of preventive and health-improving assistance to schoolchildren through the program of physical culture and health-improving education (January 1999, Belgorod). Main Propositions to be Defended

1. An increase in the number of children with chronic progressive pathology is registered; the leading classes of diseases have been identified in the structure of morbidity.

2. An increase in the number of children with diseases of certain classes of pathology: endocrine system diseases, blood and hematopoietic organ diseases, urinary and reproductive system diseases, digestive organ diseases, circulatory system diseases requires studying the factors and mechanisms of their formation.

3. A negative trend has been identified in the indicators of physical development of school-age children, and possible correction of mass-growth disorders in educational institutions has been identified.

Testing of Dissertation Materials

The results of the research were presented at:

1. A seminar on "Joint activities of education and healthcare bodies on improving the system of medical support for children in educational institutions" (Belgorod, 1995).

2. The regional scientific-practical conference on the topic "Protection of Life and Health of Children and Adolescents. Problems and Technologies of Solution" (Belgorod, 1998).

3. Materials of the interregional scientific-practical conference "Social-Hygienic Monitoring of the Child Population of the Belgorod Region" (Belgorod, 1998).

4. Materials of the Eighth Congress of Pediatricians of Russia "Features of Physical Development of Schoolchildren of the Belgorod Region" (Moscow, 1998).

5. Materials of the Congress of Pediatricians of Russia "Physical Culture and Health-Improving Education of Children in Educational Institutions" (Moscow, 1999).

6. At the All-Russian Scientific-Practical Conference "Strengthening Health in School" (Kazan, 2000).

7. Materials of the 3rd All-Russian Scientific-Practical Conference "Current Issues of Endocrinology" (Perm, 2000).

8. Materials of the Ninth Congress of Pediatricians of Russia "Markers" of Ecological Adversity in the State of Health of Children of the Belgorod Region" (Moscow, 2001).

9. Materials of the inter-university scientific-practical conference "Physical Culture and Sports in the System of Educational Institutions" (Belgorod, 2001).

10. In a collection of scientific works "Current Issues of Healthcare of Regions of Central Russia" (Lipetsk, 2001).

11. Materials of the 5th European Congress of Endocrinologists (Turin, Italy, 2001).

12. Materials of the All-Russian Scientific-Practical Conference "Children's Hospital of the XXI Century" (Kazan, 2002).

13. Materials of the International Conference "Methodology and Organization of the Educational and Training Process of Physical Culture and Sport" (Belgorod, 2002).

1. Literature Review