Predicting the effectiveness of rehabilitation treatment for obese children in a polyclinic
G.S. MASKOVA
Yaroslavl State Medical University, Yaroslavl
Contact details:
Maskova G.S. — PhD (medicine), Associate Professor of the Department of Pediatrics
Address: 5 Revolutsionnaya St., Russian Federation, Yaroslavl, 150000, tel.: +7 (485) 235-66-92, e-mail: [email protected]
The purpose — to create a model for predicting the effectiveness of rehabilitation of obese children based on the consideration of risk factors.
Material and methods. The study involved 250 children of 7–14 years old with obesity of 1–3 degrees, who received rehabilitation during 2 months in a children’s polyclinic. Before interventions, the children were assessed for anamnestic data, clinical status, dietary and physical activity stereotypes. The assessment of the rehabilitation effectiveness was carried out based on the clinical, functional and emotional status of the child and the calculation of the effectiveness of rehabilitation coefficient (ERC). A comparative analysis of the prevalence of risk factors in 2 groups of children was carried out, depending on the ERC: positive or negative. Statistical analysis was performed using the Kruskalm — Wallis and Kendall Tau methods, the risk and odds ratios were estimated, the ROC analysis procedure was performed. Statistical significance was p < 0,05.
Results. The factors influencing the rehabilitation effectiveness were as follows: obesity in first-line relatives; the body fat and body mass indices, abdominal obesity, thyroid enlargement, muscle strength endurance, systolic blood pressure, self-esteem of health, excess food intake, frequency of a weekly milk consumption, frequency of drinking water during the day, frequency of shopping, sleep regularity, and daily exercise. The model for predicting the rehabilitation effectiveness was created based on one-step accounting of risk factors, the predictive power of was 91%.
Conclusion. The оne-time consideration of risk factors allows identifying children with a positive and negative prognosis of rehabilitation.Children with a positive prognosis were directed to a polyclinic for rehabilitation, and among children with a negative prognosis, the reasons for the alleged failure were determined (secondary nature of obesity, insufficient physical activity of the offered programs, etc.).
Key words: children, obesity, rehabilitation prognosis, risk factors.
REFERENCES
- Informatsionnyy byulleten’, no. 355, Vsemirnaya organizatsiya zdravookhraneniya, 2017 [Newsletter No. 355. World Health Organization. 2017], available at: http://www.who.int/mediacentre/factsheets/fs355/ru/
- Informatsionnyy byulleten’ VOZ «Ozhirenie i izbytochnyy ves», Vsemirnaya organizatsiya zdravookhraneniya, 2016 [Fact sheet WHO Obesity and Overweight. World Health Organization. 2016], available at: http://www.who.int/mediacentre/factsheets/fs311/ru/
- Kartelishchev A.V., Rumyantsev A.G., Smirnova N.S. Ozhirenie u detey i podrostkov. Prichiny i sovremennye tekhnologii terapii i profilaktiki [Obesity in children and adolescents. Causes and modern technologies of therapy and prevention]. Moscow: Binom, 2013. 280 p.
- Daniel G., Robert Kushner Izbytochnyy ves i ozhirenie. Profilaktika, diagnostika i lechenie [Overweight and obesity. Prevention, diagnosis and treatment]. Moscow: BINOM, 2006. 240 p.
- Rekomendatsii po diagnostike, lecheniyu i profilaktike ozhireniya u detey i podrostkov: metodicheskie rekomendatsii [Recommendations for the diagnosis, treatment and prevention of obesity in children and adolescents: guidelines]. Moscow, 2015. 187 p.
- Federal’nye klinicheskie rekomendatsii (protokoly) po vedeniyu detey s endokrinnymi zabolevaniyami, pod obshch. red. I.I. Dedova, V.A. Peterkovoy [Federal clinical guidelines (protocols) for the management of children with endocrine diseases, ed. I.I. Dedov, V.A. Peterkova]. Moscow: Praktika, 2014. 442 p.
- Podrostkovoe ozhirenie i svyazannoe s nim povedenie: tendentsii i sotsial’nye neravenstva v Evropeyskom regione VOZ, 2002–2014 gg.: itogi sovmestnogo mezhnatsional’nogo issledovaniya VOZ «Povedenie detey shkol’nogo vozrasta v otnoshenii zdorov’ya» (HBSC), pod red. Jo Inchley, Dorothy Currie, Jo Jewell i dr. [Adolescent obesity and related behavior: trends and social inequalities in the WHO European Region, 2002–2014: Outcomes of the WHO cross-national health behavior in school-aged children (HBSC) study, ed. Jo Inchley, Dorothy Currie, Jo Jewell et al.]. VOZ, 2017. 100 p.
- Akhmedova R.M., Sofronova L.V., Trefilov R.N. Prevalence and gender characteristics of obesity in adolescents in Perm. Voprosy sovremennoy pediatrii, 2014, no. 13 (5), pp. 37–41 (in Russ.).
- Ustyuzhanina M.A., Kovtun O.P., Tsar’kova S.A. New paradigm of childhood obesity: role in the formation of cardiovascular pathology, approaches to prevention and treatment from the standpoint of evidence-based medicine. Ural’skiy meditsinskiy zhurnal, 2015, no. 4, pp. 84–92 (in Russ.).
- Kuprienko N.B., Smirnova N.N. Prevalence of arterial hypertension in school-age children with overweight and obesity. Profilakticheskaya i klinicheskaya meditsina, 2020, vol. 75, no. 2, pp. 64–69 (in Russ.).
- Kozhevnikova O.V., Smirnov I.E. Risk factors for cardiovascular pathology in children: properties of blood vessels and atherosclerosis. Rossiyskiy pediatricheskiy zhurnal, 2015, vol. 18, no. 4, pp. 36–42 (in Russ.).
- Doklad komissii po likvidatsii detskogo ozhireniya. Vsemirnaya organizatsiya zdravookhraneniya, 2016 [Report of the Commission on Ending Childhood Obesity. World Health Organization. 2016], available at: http://apps.who.int/iris/bit-stream
- Maskova G.S., Chernaya N.L., Shubina E.V., Aleksandrova S.V. Age features of obesity in children. Prakticheskaya meditsina. Pediatriya, 2014, vol. 85, no. 9, pp. 126–130 (in Russ.).
- Maskova G.S., Chernaya N.L., Mamontova O.K. et al. Monitoring of rehabilitation potential during clinical examination of children with chronic pathology. Prakticheskaya meditsina. Pediatriya, 2013, vol. 72, no. 6, pp. 113–118 (in Russ.).
- Stepanenko N.P., Lyzin I.A., Yumasheva A.L. Evaluation of the effectiveness of rehabilitation measures using an individual integral indicator of health. Mezhdunarodnyy zhurnal prikladnykh i fundamental’nykh issledovaniy, 2019, no. 10, pp. 179–183 (in Russ.).
- Fleischman A., Hourigan Sh.E., Lyon H.N. Creating an Integrated Care Model for Childhood Obesity: A Random-ized Pilot Study Utilizing Telehealth in a Community Primary Care Setting. Clin Obes, 2016, vol. 6 (6), rr. 380–388.
- Prikaz MZ RF «Ob utverzhdenii Poryadka organizatsii meditsinskoy reabilitatsii detey» ot 23.10.2019 no. 878n, prikaz vstupaet v silu s 1.01.2021 [Order of the Ministry of Health of the Russian Federation «On Approval of the Procedure for Organizing Medical Rehabilitation of Children» dated 23.10.2019 No. 878n, the order comes into force on 1.01.2021].
- Sreda, okruzhayushchaya rebenka: oprosnik dlya detey i roditeley v 11/12 let, ELSPAC [Child’s Environment: Questionnaire for Children and Parents at 11/12 Years, ELSPAC].Moscow, Yaroslavl, 2003. 54 p.
- Aleksandrov A.A., Kislyak O.A., Leont’eva I.V. Clinical guidelines. Diagnostics, treatment and prevention of arterial hypertension in children and adolescents. Sistemnye gipertenzii, 2020, vol. 17, no. 2, pp. 7–35 (in Russ.).