CLINICAL EXAMINATION OF THE CHILDREN'S POPULATION BY AN OUTPATIENT OPHTHALMOLOGIST: ITS EFFECTIVENESS AND EXPEDIENCY
Секция: MEDICAL SCIENCES
Аннотация и ключевые слова
Аннотация (русский):
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.

Ключевые слова:
clinical examination, preventive examination, children's population, preschool, myopia, hyperopia
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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 

3.1 

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 

2.1 

 

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.

Список литературы

1. Ulumbekova G.E., Vlasov V.V. Clinical examination of the population of Russia and its prospects. Bulletin of HSOMHC. 2017; 4(10):36-42.

2. Rubleva LV, Shunin KA Features of the work of an ophthalmologist at the polyclinic level, city level. Materials of the All-Russian scientific forum with international participation "Week of Youth Science - 2021" dedicated to medical workers providing assistance in the fight against coronavirus infection (Tyumen, March 26-28, 2021). Tyumen: RIC "Ivex", 2021. P. 438.

3. Avetisov S.E., Kashchenko T.P., Shamshinova A.M. Visual functions and their correction in children. Medicine, 2005. - 872 P.

4. Fomina E.V. Trends in the spread of congenital pathology of the organ of vision in Tyumen Oblast in 2003-2017. E.V. Fomina, E.M. Pochinok. Medical science and education of the Urals. 2018. №4. P. 152-157

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.

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