medea chikava m.d., ph.d the university of georgia social services actions for prevention of...

Social Services Actions for Prevention Of Digestive

Disorders Among Adolescents

Medea ChikavaMedea Chikava M.D., Ph.DM.D., Ph.D

THE THE UNIVERSITYUNIVERSITY Of Of GEORGIAGEORGIA

Among the greatest advances in elucidating the determinants of disease over the recent period has been the identification of social conditions that seem to influence morbidity. While planning social services it is important to determine the impact level of each social risk factor on disease development in order to form prevention measures ranked list and outline the priority problems.

Despite all the achievements of the contemporary Medicine, improvement of prevention

of Digestive Disorders (DD) still remain a priority objective, since there is a trend of uncontrolled growth of these disorders in the World.

Adolescence is one of the most critical periods of the human postnatal ontogenesis and one of the most difficult periods of psychological development. That is why so important is timely development of the effective, scientifically sound model of prevention of these disorders among adolescents, based on the evaluation of social risks that have impact on them.

This is the first study in Georgia that using the two step model epidemiological research

defines pathogenic strength and prognosed values of social and other risk factors.

The Objective of the ResearchThe Objective of the Research

_ _ to study the role of micro-social environment in formation of DD among adolescents of Georgia aged 14-21; _ to establish which factors have more negative influence on the development and progression of DD in adolescents; _ what measures will be more effective to be

conducted during the delivery of social services.

Materials and MethodsMaterials and Methods

One stage epidemiological research was conducted among

1. the medium (14-16 years old) 2. late (17-21 years old) period adolescents population of Georgia. We developed:

1. primary questionnaire for DD morbid forms screening 2. specialized map-questionnaire of epidemiological research of DD

Statistical study of DD was conducted not as Statistical study of DD was conducted not as complete study of “general entity” but with “partial” complete study of “general entity” but with “partial” method. To receive statistically reliable values, the value of method. To receive statistically reliable values, the value of “selection entity” was defined by the method, accepted on “selection entity” was defined by the method, accepted on the tenth report of the WHO Experts’ Committee, the the tenth report of the WHO Experts’ Committee, the following formula [143]: following formula [143]:

n = t2 * P * (100 – P ) / ∆ 2 n = t2 * P * (100 – P ) / ∆ 2 where:where: n – is needed number of observations;n – is needed number of observations;

P = P = 13,25% 13,25% – distribution of disease, expressed in %– distribution of disease, expressed in % (prevalence index of DD, received as a result of epidemiological (prevalence index of DD, received as a result of epidemiological

research, conducted in 2003in adolescents aged 15-18);research, conducted in 2003in adolescents aged 15-18);

t = 1,96 – reliability coefficient (95% accuracy);t = 1,96 – reliability coefficient (95% accuracy); ∆ ∆ = = 3,25 3,25 – limiting error of index.– limiting error of index.

n = n = 1,962 * 13,25 * 86,75 / 3,252 = 4181,962 * 13,25 * 86,75 / 3,252 = 418

I groupI group II groupII group

adolescents with adolescents with DDDD

( ( nn1 1 = 84 )= 84 )

conditionally conditionally health adolescentshealth adolescents

( ( nn2 2 = 346 )= 346 )

The epidemiological research _

430 adolescents

I step _ the screening questionnaires

II step _ the map-questionnaires

Each map contained questions to study psychosocial, alimentary and other risk factors. Data, received as a result of research, was

statistically processed by the SPSS program

application, Excel, using contemporary biostatistics techniques.

The risk factors significances were studied

by the Case-Control Study method.

For each risk factor For each risk factor 1. 1. pathogenic strength _pathogenic strength _

Relative Risk (RR)Relative Risk (RR) 2. 2. prognosed valuesprognosed values – –

Relative Intensity coefficient (K)Relative Intensity coefficient (K)

RR evaluates level of impact of the RR evaluates level of impact of the risk factors on DD development.risk factors on DD development.

K evaluates level of impact of the K evaluates level of impact of the risk factors on DD progression.risk factors on DD progression.

In order to define

sequence of the preventive measures which are recommended to be conducted during the

delivery of social services in the groups ranking of the risk factors was held according to decrease of RR, K values:

1. for the conditionally healthy adolescents (II group) – according to RR was defined ranked list of DD predictors;

2. for the adolescents with DD (I group) – according to K was defined rank of risk factors that help the progress of these disorders in case of already developed disease

Results and Discussion

The prevalence of DD in adolescents population was stated – 19,5% (95%CI: 17,6-21,4);

from which 10,5% were girls and 9,0% were boys ((diagram 1).

Among 84 adolescents with DD 45 were girls and 39 were boys, 53,6% (95%CI: 48,1- 59,1) and 46,4% (95%CI: 40,9-51,9), respectively ((diagram 2).

DD

DiagramDiagram 1 1The The prevalence of Digestive Disordersprevalence of Digestive Disorders in

Adolescents According to Intensive IndicesIntensive Indices

9

80,5

10,5

boys girls

DiagramDiagram 2 2 The The prevalence of Digestive Disordersprevalence of Digestive Disorders in

Adolescents According to Extensive IndicesExtensive Indices

46,4

53,6boys

girls

DiagramDiagram 3 3 The The structurestructure of Digestive Disordersof Digestive Disorders

in Adolescents

0

1

2

3

4

5

6

7

8

1 2 3 4

girlsboys

1. Esophageal disordersdisorders2. Stomach and duodenal disordersdisorders3. Hepatobiliar and pancreatic system disordersdisorders

4. Intestinal disordersdisorders

0

5

10

15

20

25

14-16years old

17-21years old

girlsboys

Diagram 4Diagram 4TheThe prevalence of Digestive Disordersprevalence of Digestive Disorders in Adolescents According to Age and Sex

I groupI group II groupII group

Adolescents with Adolescents with Digestive DisordersDigestive Disorders

(DD)

((nn11=84)=84)

Conditionally Conditionally Healthy Healthy

AdolescentsAdolescents

((nn22=346)=346)

Table 1 The The social Risk Factors Impact On Adolescents

Digestive DisordersDigestive Disorders Development

The risk factors of micro-social environment

Frequencies (%)

Z p RR

Rank

K

I group II group

adolescents chronic overload 96,4 ± 2,0 63,6 ± 2,6 5,89 <0,0001 11,6 1 1,52

adolescents bad habits 55,0 ± 5,7 19,2 ± 2,3 6,43 <0,0001 3,42 2 2,87

unsatisfactory living conditions 46,4 ± 5,5 18,8 ± 2,1 5,3 <0,0001 2,72 3 2,47

excessive use of computer, TV 66,7 ± 5,2 42,2 ± 2,7 4,03 <0,0001 2,26 4 1,58

the majority of familiars smoke 53,8 ± 5,5 30,8 ± 2,5 3,95 <0,0001 2,14 5 1,75

parents separation 14,3 ± 3,8 6,59 ± 1,3 2,32 0,0102 1,89 6 2,17

passive smoking more than 2 years

55,0 ± 5,5 40,0 ± 2,6 2,48 0,0066 1,62 7 1,37

Table 2 The The impact chronic overload On Adolescents

Digestive DisordersDigestive Disorders Development

Risk factors

Frequencies (%)

Z p RR

Ran

k

K

I group II group

Adolescents chronic overloads

96,4±2,0 63,6 ± 2,6 5,89<0,0001

11,6   1,52

adolescents study overloads 61,0±5,42 11,5±1,73 9,86 <0,0001 5,85 1 5,3

conflict situations at the family 54,6±5,46 16,7±2,04 7,26 <0,0001 3,75 2 3,28

difficulties in communicating with peers

61,9±5,33 29,8±2,46 5,5 <0,0001 2,88 3 2,08

negative emotions during eating 32,1±5,13 14,6±1,9 3,75 <0,0001 2,15 4 2,2

conflict situations at the school 32,5±5,26 16,9±2,07 3,11 0,0009 1,92 5 1,91

In contrast to

chronic psychological overloads,

a healthy lifestyle

has positive impact on DD development among adolescents.

Diagram 5Diagram 5Irregular Consumption of Food Products

among Adolescents Population (%)

1. 1. plural vegetables (except potatoes); plural vegetables (except potatoes); 5. 5. macaroni, plural grouts;macaroni, plural grouts;

2. 2. fishfish;; 6. 6. butterbutter;;

3. 3. milk and dairy producmilk and dairy producttss; ; 7. 7. meat;meat;

4. 4. fruit and fruit and berryberry; ; 8. 8. egg.egg.

0

20

40

60

80

1 2 3 4 5 6 7 8

Unhealthy diet is risk factor for DD development:

1. overweight eating of carbohydratic food (bread and bread products, potatoes and sweets) – RR=2,98 (95%CI: 2,29-3,88);

2. irregular consumption of milk and dairy products – RR=1,82 (95%CI: 1,38-2,49),

3. insufficient use of fruit and berry RR=1,41 (95%CI: 1,06-1,85).

DiagramDiagram 5 5 The The frequencies of active and passive lifestyle

among adolescents population (RR=1,46)

37,8 40,532,4

25,8

29,7

24,8

0

10

20

30

40

50

60

70

I group II group I group II group

mainly stands

mainly sits

trains, dances or takes part in sporting activity

Table 2 The The social Risk Factors Impact On Adolescents

Digestive DisordersDigestive Disorders Development

The risk factors of micro-social environment

Frequencies (%)

Z p RR

Rank

K

I group II group

adolescents chronic overload 96,4 ± 2,0 63,6 ± 2,6 5,89 <0,0001 11,6 1 1,52

adolescents bad habits 55,0 ± 5,7 19,2 ± 2,3 6,43 <0,0001 3,42 2 2,87

unsatisfactory living conditions 46,4 ± 5,5 18,8 ± 2,1 5,3 <0,0001 2,72 3 2,47

excessive use of computer, TV 66,7 ± 5,2 42,2 ± 2,7 4,03 <0,0001 2,26 4 1,58

the majority of familiars smoke 53,8 ± 5,5 30,8 ± 2,5 3,95 <0,0001 2,14 5 1,75

parents separation 14,3 ± 3,8 6,59 ± 1,3 2,32 0,0102 1,89 6 2,17

passive smoking more than 2 years

55,0 ± 5,5 40,0 ± 2,6 2,48 0,0066 1,62 7 1,37

The unhealthy habits _

RR=3,42

1. smoking _ RR=2,27

2. excessive consumption of alcohol _ RR=1,87

DiagramDiagram 6 6 The The frequencies of bad habits _ RR = 3,42

(smoking _RR- 2,27, alcohol consumption RR- 1,87)

among adolescents population

38,7

26,9

17,613,8

0

10

20

30

40

50

si gar et i s moweva al kohol i s mi Reba

I j gufi II j gufi

The fact, that the majority of familiars smoke (RR=2,14), is one of the less significant risk factors. The correlation coefficient between this factor and adolescents’ bad habits is 0,4 (r=0,4). This average correlation indicates that unhealthy microsocial environment imfluences on the adolescents in this way that they early begin to smoke. Passive smoking more than 2 years time (RR=1,62) also has impact on DD development, but to less considerable degree.

The unsatisfactory living conditions (RR=2,72) have very important negative influence on children’s and adolescents’ development and these occupy the third place among the social risk factors after the bad habits.

Excessive Use of New Information Technologies _

RR=2,26

1. Excessive use of computer _ RR=2,14

2. Excessive use of TV _

RR=1,67

The parents separation has low average correlation with presence of DD among adolescents (r=0,39).

So it also influences on DD development among them (RR= 1,89).

The use of computer has different impacts on the I and II groups adolescents. On the question ’’what do you feel after using computer?’’, adolescents of I and II groups, respectively, answered:

’’weakness’’ – 6,8% and 2,3%;

’’exhaustion’’ – 13,8% and 3,4%,

’’has worst influence’’ – 3,4% and 2,3%.

Overall, the computer negatively influences on 24,0% of adolescent with DD and 8,0% of others (p<0,05). 25% of the whole population feels tired after using the new information technologies and it has the positive impact on 18,4% of conditionally healthy adolescents, but nobody feels the same in the I group.

Just because adolescent has one or more risk factors doesn’t mean he will definitely develop poor digestive health. Knowing one’s risk factors to his digestive health can guide him into making the best choices for himself – whether it’s making lifestyle changes or other changes.

Conclusions

Thus, according to the obtained results from the epidemiological research the prevalence of digestive disorders in adolescents population is more high among girls, than _among boys and it has tendency of growth by age. Accordingly, the influence of micro-social environment is more negatively represented on the pubertative age girls health, than on the boys of the same age.

The results obtained indicates that while planning social services for preventing development of DD in adolescents first of all the following actions are recommended to be implemented:

1. the reduction of chronic overload (RR=11,6), especially study overload (RR=5,85)

2. and conflict situations in family (RR=3,75);3. explanation of bad habits negative role to the

adolescents (RR=3,42); 4. improvement of living conditions (RR=2,72);5. moderately use of computer, TV (RR=2,26).

For right prevention of adolescents DD it’s important to provide rational using of nutritional resources by adolescents, especially by girls:

1. milk and dairy products (RR=1,82),2. fruit and berry (RR=1,41).

It’s essential to limite the consumptionof bread and bread products, potatoes andsweets (RR=2,98).

The results of our research show the risk factors the modification of which is the most important during delivery of social services.

Based on the results of our research it is possible to develop scientifically approved model of prevention DD among adolescents.

This shall be much cheaper than treatment expenses.

ThANK YOU FOR ThANK YOU FOR

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