Purpose - to analyze the effectiveness of prophylactic medical examination of the child population by an ophthalmologist of a district polyclinic for three years. Material and methods. A retrospective analysis of the work of an ophthalmologist of the State Budgetary Healthcare Institution of Tyumen Oblast "Oblast Hospital No 19" (Tyumen) for 2018-2020 was carried out. Results. The structure of the child population of the analyzed polyclinic showed the general tendency of the medical and demographic situation in Tyumen Oblast - an increase in the child population subject to dispensary examination. The analysis of the revealed pathology during preventive examinations of the child revealed that most of it is accounted for by refractive pathology: myopia, hyperopia, violation of accommodation - in 2018 - 91.7%, in 2019 - 91.8%. In a detailed analysis of pathologies in preschool institutions, the first place is taken by hyperopia (36%). In second place is myopia (24-27%), in third place is accommodation disorder (17-25%). In school-age children, according to medical examinations, myopia is in the first place (46%). Conclusion. Analysis of the effectiveness of clinical examination in dynamics for 3 years in children revealed that the indicators of eye pathology are practically at the same level (consistently high), refractive and functional pathology prevails - myopia, hyperopia, and accommodation disorder. Conducting clinical examination contributes to the early detection of pathology at the stage of functional disorders, which are successfully amenable to conservative treatment.
clinical examination, preventive examination, children's population, preschool, myopia, hyperopia
Relevance. At the present stage, according to the order of the Ministry of Health of the RF of August 10, 2017 № 514n "On the Procedure for conducting preventive medical examinations of minors" (changes from 13.06.2019, order of the Ministry of Health of theRF № 396n), outpatient doctors are actively conducting clinical examination of the child population. In modern scientific literature, there are works devoted to the effectiveness of the ongoing medical examination, and the inexpediency of its implementation from an economic point of view [1, 2]. However, some authors talk about the need for early treatment of binocular vision pathology [3]. In addition, the increase in patients with refractive amblyopia, emphasizes the relevance of clinical examination, both in organized and unorganized populations in order to increase the diagnosis of refractive errors in childhood. This is necessary for early rehabilitation measures, both conservative and surgical methods of treatment [4]. The medical and demographic situation in Tyumen Oblast has undergone some changes: in general, the number of both children and adults and persons subject to prophylactic medical examination has increased [5].
The data obtained as a result of clinical examination can be used to make organizational decisions in order to increase the effectiveness of rehabilitation measures in the conditions of the polyclinic link, day and round-the-clock hospitals.
Purpose of the study. To analyze the effectiveness of prophylactic medical examination of the child population by an ophthalmologist at a district polyclinic for three years.
Material and methods. A retrospective analysis of the report of the ophthalmologist SBHCI TO "Oblast Hospital № 19" for 2018-2020 was carried out. The polyclinic serves 114,421 people, of which 27,723 (24.2%) are children aged 0 to 17 years. 31,152 (27.2%) people live in the service area of feldsher-obstetric stations. Among the child population, according to the order, 9725 (35.1%) were subject to medical examination in 2018, 9815 (35.4%) in 2019. Since March 2020, due to the COVID 19 pandemic, preventive examinations and medical examination of the population have not been carried out (only 300 preschool children were examined).
Results and discussion. The age structure of the child population examined by an ophthalmologist as part of a clinical examination is presented in tab. 1 and corresponds to the average statistical indicators for the Russian Federation [6].
Table 1 - Age composition of the child population examined by an ophthalmologist as part of a clinical examination
|
Years |
2018 |
2019 |
2020 |
|
Total |
9725 (100%) |
9815 (100%) |
300 (100%) |
|
Children 7-17 years old |
6125 (63%) |
6320 (64.4%) |
- |
|
Children 1-6 years old |
3600 (37%) |
3495 (35.6%) |
300 (100%) |
The structure of the child population of the analyzed polyclinic showed the general tendency of the medical and demographic situation in Tyumen Oblast - an increase in the child population subject to dispensary examination by 232 children (tab. 2). In the structure of the child population, 71.4% are children attending kindergartens and schools, the share of unorganized children is 28.6%.
Table 2 – The structure of the child population of the Tyumen region
|
Years |
2018 |
2019 |
2020 |
|||
|
Values |
Abs.n. |
% |
Abs.n. |
% |
Abs.n. |
% |
|
Total amount |
21871 |
100 |
21986 |
100 |
22103 |
100 |
|
Children under 1 year |
1320 |
6.0 |
1332 |
6.0 |
1354 |
6.1 |
|
Unorganized |
4934 |
22.6 |
4952 |
22.5 |
4976 |
22.5 |
|
Kindergartens |
5128 |
23.4 |
5179 |
23.6 |
5192 |
23.5 |
|
Schoolchildren |
9286 |
42.5 |
9301 |
42.3 |
9340 |
42.3 |
|
Adolescents |
1203 |
5.5 |
1222 |
5.6 |
1241 |
5.6 |
The analysis of the revealed pathology during preventive examinations of the child population showed that most of it is due to refractive pathology: myopia, hyperopia, violation of accommodation - in 2018 - 91.7%, in 2019 - 91.8%. The pathology of binocular vision accounts for - in 2018 - 4.5%, in 2019 - 4.3%. The indicators are presented in tab. 3.
Table 3 - The structure of the revealed pathology during preventive examinations
|
Years |
2018 |
2019 |
2020 |
|||
|
Values |
Abs.n. |
% |
Abs.n. |
% |
Abs.n. |
% |
|
Total |
3800 |
100 |
3890 |
100 |
97 |
100 |
|
Disturbance of accommodation |
585 |
15.4 |
589 |
15.1 |
10 |
10.3 |
|
Myopia |
1500 |
39.5 |
1570 |
40.4 |
35 |
36.1 |
|
Strabismus |
170 |
4.5 |
168 |
4.3 |
3 |
3.1 |
|
Hypermetropia |
1400 |
36.8 |
1412 |
36.3 |
34 |
35.1 |
|
Amblyopia |
130 |
3.4 |
135 |
3.5 |
13 |
13.4 |
|
CPVO |
15 |
0.4 |
16 |
0.4 |
2 |
2.1 |
In general, in the period from 2018-2019. there is an upward trend in eye diseases (by 90 people during 2019). The data for 2020 is not very informative, this situation is associated with the introduced quarantine measures in connection with Covid-19.
A detailed analysis of pathologies in preschool institutions (hereinafter PI) is presented in tab. 4, 5. The first place among the revealed pathology in preschool children is taken by hyperopia. In most cases, it is the physiological norm for the development of the visual system. In second place is myopia, in third place is a violation of accommodation. This can be explained by the early acquaintance of children with various gadgets, PCs, TVs, uncontrolled and prolonged use, inheritance of myopia.
Table 4 - Indicators of preventive examinations in preschool institutions
|
Years
|
Subject to examination |
Examined |
Med. examination coverage |
Children with diseases revealed, total |
|
|
Abs.n. |
Abs.n. |
% |
Abs.n. |
% |
|
|
2018 |
2500 |
2500 |
100 |
595 |
23.8 |
|
2019 |
2624 |
2624 |
100 |
684 |
26.1 |
|
2020 |
2491 |
300 |
12.0 |
97 |
32.3 |
Table 5 - The structure of the identified pathology in PI
|
Years |
2018 |
2019 |
2020 |
|||
|
Values |
Abs.n. |
% |
Abs.n. |
% |
Abs.n. |
% |
|
Myopia |
166 |
27.9 |
170 |
24.9 |
35 |
36.1 |
|
Hypermetropia |
253 |
42.5 |
270 |
39.5 |
34 |
35.1 |
|
Disturbance of accommodation |
104 |
17.5 |
171 |
25.0 |
10 |
10.3 |
|
Strabismus |
36 |
6.1 |
35 |
5.1 |
3 |
3.1 |
|
Amblyopia |
30 |
5.0 |
32 |
4.7 |
13 |
13.4 |
|
CPVO |
6 |
1.0 |
6 |
0.9 |
2 |
2.1 |
Analyzing the data of preventive examinations of schoolchildren (tab. 6.7), we can say that in children of this category, myopia is in the first place. This situation is associated, from our point of view, with the following factors:
- digitalization of education, carried out in the country since 2016, and since 2018 implemented within the framework of the national project "Digital School", has significantly intensified the use of digital teaching aids in schools (interactive whiteboards and panels, computers, electronic tablets, etc.);
- the use of electronic gadgets with liquid crystal screens (smartphones, computers, laptops, electronic tablets) at leisure and at home when preparing lessons, searching for information, electronic games, communicating on social networks;
- in connection with the Covid-19 pandemic, educational organizations in Russia switched to distance learning, which remained until the end of the 2019/2020 academic year. Long-term and irrationally organized use of electronic gadgets dramatically increases the load of the visual analyzer, which cannot but lead to the development of visual impairments and computer visual syndrome.
Table 6 - Indicators of preventive examinations by schools
|
Years
|
Subject to examination |
Examined |
Med. examination coverage |
Children with diseases revealed, total |
|
|
Abs.n. |
Abs.n. |
% |
Abs.n. |
% |
|
|
2018 |
6125 |
6125 |
100 |
2800 |
45.7 |
|
2019 |
6320 |
6320 |
100 |
2850 |
46.5 |
|
2020 |
5521 |
- |
- |
- |
- |
For the period 2018-2019, there is no significant dynamics in the detection of vision pathology. In the period 2020, clinical examination was not performed due to the introduced quarantine measures.
Table 7 - The structure of the revealed pathology in schools
|
Years |
2018 |
2019 |
2020 |
|||
|
Values |
Abs.n. |
% |
Abs.n. |
% |
Abs.n. |
% |
|
Myopia |
1300 |
46.4 |
1320 |
46.3 |
- |
- |
|
Hypermetropia |
800 |
28.6 |
770 |
27.0 |
- |
- |
|
Disturbance of accommodation |
500 |
17.9 |
563 |
19.8 |
- |
- |
|
Strabismus |
90 |
3.2 |
91 |
3.2 |
- |
- |
|
Amblyopia |
100 |
3.6 |
96 |
3.4 |
- |
- |
|
CPVO |
10 |
0.4 |
10 |
0.4 |
- |
- |
In the general picture, having analyzed the indicators of clinical examination for three years, it can be concluded that the indicators of the revealed pathology are practically at the same level (indicators are consistently high). In all age categories of children, refractive and functional pathology prevails - myopia, hyperopia, accommodation disorder.
Conclusions. In preschool children, hyperopia comes out on top, which, more often, is a natural stage of refractogenesis. In schoolchildren, myopic refraction comes first. This can be attributed to excessive eye strain while reading, watching TV and spending a long time at a PC and various gadgets. Conducting clinical examination contributes to the early detection of pathology at the stage of functional disorders, which are successfully amenable to conservative treatment.
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5. Konovalova O.S. et al. Organizational approaches to the prevention of chronic non-communicable diseases in migrants in the conditions of Western Siberia. Medical science and education of the Urals. 2015. V.16. №3(83). P. 98-100.
6. Guidelines for the prevention of diseases of the eye and its adnexa in students in educational institutions. Ministry of Health of the RF, 2021.
