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5.
Ташкина Е. Г. Синдром эмоционального вы
горания медицинских работников как объект
психологического
исследования
//
Вестник
Томского
государственного
педагогическо
го университета 2009. № 11 (89). С. 131-134.
[Tatkina Е. G. Burnout syndrome of medical work
ers as an object of psychological research //Bul
letin of the Tomsk State Pedagogical University>
2009. No. 11 (89). p. 131-134.
6.
Трущей ко M. H. К вопросу о синдроме выгора
ния: традиционные подходы исследования и
современное состояние проблемы // Психоло
гия: традиции и инновации: материалы межд.
науч. конф. - Уфа. - 2012. С. 1-8. [Truschenko
М. N On the issue of burnout syndrome: tradition
al research approaches and the current state of
the problem //Psychology: traditions and innova
tions: materials of the Int. scientific, conf. - Ufa.
- 2012. p. 1-8. (In Russ.)]
7.
Федоткина, Т.Ю. Личностные и профессио
нале- ные факторы риска возникновения син
дрома эмо- ционалъного выгорания у медсе
стер. // Проблемы и перспективы развития
сестринского дела в системе здравоохране
ния: мат-лы Межрегион, науч.-практ. конф,
с межд. участием. - Томск, 2009. С.133-137.
[Fedotkina, T.Yu. Personal and professional risk
factors for burnout syndrome in nurses. // Prob
lems and prospects for the development of nursing
in the health care system: materials of the Interre
gion. scientific- practical conf, from int. participa
tion. - Tomsk, 2009. p. 133-137. (In Russ.)]
8.
Хетагурова A.K., Касимовская H.A. Меди
ко-организационные
аспекты
профилактики
синдрома эмоционального выгорания у меди
цинских сестер в ЛПУ стационарного типа
// Сестринское дело. - №3. 2008. С. 17-20.
[Khetagurova А.К., Kasimovskaya N.A. Medical
and organizational aspects of the prevention of
burnout syndrome in nurses in inpatient hospitals
/7 Nursing. - No. 3. 2008. p. 17-20. (In Russ.)]
9.
Abushaikha, L. and Saca-Hazboun, H. Job
Satisfaction
and
Burnout
among
Palestin
ian Nurses. Eastern Medi- terranean Health
Journal, 2009. № 15, p. 190-197. https: doi.
org/10.26719/2009.15.1.190
10. Jeannie P, Cimiotti, Linda H., Aiken, L, Sloane
D. M., and Evan S Wu. (2012) Nurse Staffing,
Burnout, and Health Care-Associated Infection.
American Journal of Infection Control, 40, p.486-
. org/10.1016/j. ajic. 2012.02.029
11. Heather K. Spence Laschinger, Ashley L. Grau,
Joan Finegan, Piotr Wilk (2010) New Gradu
ate Nurses ’ Experiences of Bullying and Burn
out in Hospital Settings: Journal of Advanced
Nursing, 66, p.2732-2742.
/]. 1365-2648.2010.05420
12. Heather K. Spence Laschinger, Ashley L. Grau
The Influence of Personal Dispositional Factors
and
Organizational
Resources
on
Workplace
Violence, Burnout, and Health Outcomes in
New Graduate Nurses: A Cross-Sectional Study.
International Journal of Nursing Studies, 2012-
49, p. 282-291
2011.09.004
13.
Muhammad W.Darawad,HaniNawafleh,Mahmoud
Maharmeh,Ayman
M.
Hamdan-Mansour,Saleh
N. Azzeghaiby The Relationship between Time
Pressure
and
Burnout
Syndrome:
A
Cross-
Sectional Survey among Jordanian Nurses Health
Vol. 7No.l, January> 2015
health. 2015. 71003
УДК: 616-007.234:614.8. 2-614.8.026.1 -053.2
CONGENITAL ANOMALIES IN CHILDREN
REVALENCE AND RISK FACTORS
Mirzarakhimova K. R
Department of Public Health, Healthcan Management and Physical Education. Tashkent State Dental Institute
ABSTRACT
Congenital malformations have been in the focus
of physicians since ancient times, but despite their
centuries-old history, many aspects of the etiology
and pathogenesis of congenital malformations in
humans have not been adequately studied even
today.
Congenital
deficiencies
of
development
are defined as stable morphological changes that
go beyond the limits of structural variations of
members or parts of organs and disrupt their
function.Apply
the
term
"sporadic
the
defect
of
birth'’,meaningunknown
cause,
accidental
appearance and low riskreappearance have future
children. For 20-25% of anomalies more likely
"multi-factor”
reason
-
complexinteraction
many
small
geneticdefects
andrisk
factorsenvironmental
environment.
The
rest
10-13%
of
anomalies
associated with the influence environment. Only
12-25% of anomalies have purely genetic causes.
Key
words:
congenital
anomalies,
congenital
malformation,congenital
heart
defects,
perinatal
causes
38
MEDICINE AND INNOVATIONS |
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ПРОБЛЕМНЫЕ СТАТЬИ ИОБЗОРЫ
РЕЗЮМЕ
Врожденные пороки развития находятся в цен
тре внимания врачей с древних времен, но, несмо
тря на их многовековую историю, многие аспекты
этиологии и патогенеза врожденных пороков раз
вития человека до сих пор недостаточно изучены.
Врожденные пороки развития определяются как
стойкие морфологические изменения, которые вы
ходят за пределы структурных изменений членов
или частей органов и нарушают их функцию.К
ним применяют термин «спорадические дефекты
рождения», обозначающий неизвестную причину,
случайное возникновение и низкий риск повтор
ного возникновения у будущих детей. Для 20-25%
аномалий более вероятна «многофакторная» при
чина - комплексное взаимодействие многих не
больших генетических дефектов и факторов риска
окружающей среды. Остальные 10-13% аномалий
связаны с воздействием среды. Только 12-25% ано
малий имеют чисто генетические причины
Ключевые
слова:
врожденные
аномалии,
врожденные порок, врожденные пороки сердца,
перинатальные причины
Congenital malformations have been in the focus
of physicians since ancient times, but despite their
centuries-old history, many aspects of the etiology
and pathogenesis of congenital malformations in
humans have not been adequately studied even today.
Congenital deficiencies of development are defined
as stable morphological changes that go beyond the
limits of structural variations of members or parts of
organs and disrupt their function [1,7].
Significant achievements in the prevention and
treatment
of
infectious
parasitic
and
foodbome
diseases in our country in recent decades, as well as
modest success in preventing the birth of children with
congenital malformations, have led to the prevalence
of this common pathology in childhood morbidity,
disability and mortality. An average of 20% of
infant deaths occur due to the presence of congenital
malformations in the child [4,8]. Chronic diseases in
up to 20% of children are associated with congenital
malformations of organs and systems [17].
Congenital malformations have been in the focus
of physicians since ancient times, but despite their
centuries-old history, many aspects of the etiology
and pathogenesis of congenital malformations in
humans have not been adequately studied even today.
Congenital deficiencies of development are defined
as stable morphological changes that go beyond the
limits of structural variations of members or parts of
organs and disrupt their function [12].
According to many authors, congenital heart defects
are the leading cause of congenital malformations.
According to the latest statistics, the prevalence of
congenital circulatory defects tends to increase, from
499.1 in 2007 to 547.4 in 2019 per 100,000 eligible
population.
However,
the
variability
in
the
frequency
of
congenital
malformations
and
congenital
malformations of the face and neck in certain
years , neural tube defects, and multiple congenital
malformations .
Class
XVII
according
to
ICT-10
(congenital
anomalies
of
development,
deformities
and
chromosomal abnormalities), belongs to the junior
class Q20-Q28 (congenital malformations of the
circulatory system). [11,16]
Heart congenital deficiency sometimes occurs in
conjunction with defects of other systems. In clinical
practice, the occurrence of congenital heart defects in
combination with defects of other organs is observed
in about 10% of cases. Defects of the cardiovascular
system are a constant companion of chromosome
and gene-related syndromes. Chromosomal diseases
in congenital heart disease can occur in 3-4% of
cases, and in congenital syndromes in 26% of cases,
congenital heart disease [29].
Congenital
heart
defects
(Heart
congenital
deficiency) are the leading cause of all congenital
malformations (30%), are one of the leading causes of
the most common developmental defects, contribute
significantly to perinatal and infant mortality, lead to
disability, and lead to blindness, implementation and
significant social costs are required to provide social
assistance to children with disabilities.
Therefore,
preventive
measures
aimed
at
preventing the birth of children with congenital heart
defects, early detection of this pathology and surgical
correction are very relevant [1,28]. Monitoring of
congenital malformations (congenital malformations
of development) is one of the prophylactic measures,
which allows to determine the population frequency
of congenital heart defects, including congenital heart
defects, the impact of mass programs of primary and
secondary prevention on them.
However, according to various researchers, the
frequency of congenital heart disease is 4-17 per 1000
newborns, which may be due to the lack of a holistic
approach to data collection and recording, diagnosis
[19,21,32].
The clinical manifestations of congenital heart
defects are diverse: they may be the main cause
of infant mortality, an aggravating factor in the
accompanying disease, or a random finding that does
not affect the course of the underlying pathology and
may be asymptomatic [9, 20, 17, 22].
The fetal age of 23-25 days is a critical period
for the formation of major heart defects . Acute and
teratogenic terminological periods are of particular
importance in identifying and preventing the causes
of congenital heart disease.
39
ПРОБЛЕМНЫЕ СТАТЬИ ИОБЗОРЫ
The significant role of fetal period infections
(HDI) in the development of developmental defects
in children has been confirmed [12]. A significant
proportion of congenital heart defects, brain and other
organ defects are associated with HDI (17). XDI is
characterized by joint damage of several members
of the same system, as well as joint occurrence of
defects in the development of different systems,
which indicates evidence of polyorganic tropism of
pathogens.
TORCH-infections are particularly dangerous for
the fetus, among which the measles virus poses the
greatest risk for the development of congenital heart
disease [21]. Only 15-25% of children bom to mothers
with measles during pregnancy had congenital measles
symptoms, however, in 85-90% of these children,
congenital, slow, predominantly cardiac pathology
was confirmed [17].
It has been shown that the occurrence of defects in
23.3% is directly related to genetic factors, 50.8% to
the multifactorial group, and only 2% to the influence
of teratogenic factors (59). Ibe causes of other
deficiencies remain unclear.
In addition to risk factors for the development of
congenital heart disease, there are also factors that
play the role of protectors. In particular, the use of
multivitamins for 3 months before and after pregnancy
can prevent about 1 in 4 major heart defects. The intake
of multivitamins is highly effective in preventing
the development of major vascular anomalies and
interventricular barrier defects [7,15].
It should be noted that the antimutagenic properties
of tocopherol acetate, adenosine, and dimephosphones
are known [27]. In a number of cases, the effectiveness
of
antimutagenesis
is
so
high
that
individual
antimutagens
have
the
property
of
completely
preventing the mutagenic effects of xenobiotics. Data
from animal experiments suggest that the biomass
of pink rhodiola cells has the property of inhibiting
gene and chromosomal mutations. [7,12]. The use
of antimutagens is promising for genetic integrity
and prevention of diseases occurring in humans
under mutagenic influences. However, the use of
pharmacological antimutagens is difficult due to the
formal problems of prescribing drugs for prophylactic
purposes to healthy people [8]. Congenital disorders
of development Ways are being sought to perform
surgical correction during pregnancy.
Antenatal detection of congenital heart defects is
important in principle. Currently, a triad of research
methods for laboratory assessment of fetal status:
evaluation of «-fetoprotein, chorionic gonadotropin,
and free estriol in the blood of women in the second
half of pregnancy is widely used [21]. However, none
of the methods mentioned are considered specific for
the detection of congenital heart defects.
The diagnostic possibilities of fetal ultrasound for
the detection of congenital heart defects are currently
limited: such tests can detect only 30% of congeni
tal heart defects, including developmental anomalies
of the cardiovascular system [4.21]. Left ventricu
lar hypoplasia, a three-chambered heart, a common
atrioventricular nucleus, and marked obstruction of
the aorta and pulmonary artery are better diagnosed
[3,4,19].
In recent years, examination of the fetus using
NMR-tomography
has been
widely used,
which
allows to detect structural abnormalities that can not
be detected by UTT: small abnormalities of the brain,
tuberculous sclerosis, polycystic kidney disease [21].
NMR tomography is a promising non-invasive method
in the diagnosis of congenital heart disease and other
cardiovascular diseases [2,14]. However, this method
is not yet widely used in practice.
A certain tendency to increase the frequency of
detection of В 40 antigens in the group of children with
urinary tract pathology (renal aplasia and hesitation,
ureterocele) and A2 antigens in the group of children
with congenital heart defects (oval valve insufficiency,
hallo tetrad) was detected [7,9]. These data suggest
that genetic determinants in the pathogenesis of
congenital malformations are multigenetic in nature.
There are now grounds for an increase in the birth
rate of children with congenital heart disease in
relation to environmental pressure. Pollution of the
environment with substances with mutagenic and
teratogenic effects is increasing [21,31]
To
date,
strict
control
over
the
teratogenic
properties of new chemicals, including those widely
used in the national economy, has not been sufficiently
established
in
many
countries.
The
population's
exposure to ionizing radiation and chemical mutagens
is increasing.
It should be noted as a paradoxical fact that there
are always unjustified attempts to save any pregnancy
that is at risk of termination in the event of an increase
in the number of birth defects. The above example
strongly demonstrates that birth defects are not only a
medical but also a social problem.[12,31]
Thus, congenital heart defects are a topical and
unresolved problem. Numerous data on risk factors
for congenital heart disease do not give an idea of the
role of each factor in the emergence and development
of this pathology. This situation requires that the
mentioned factors need to be evaluated not only
qualitatively but also quantitatively.
Influence of socio-hygienic factors on the formation
of congenital defects
Health, including the health of the fetus and child,
is an integral quantity, determined by a number of
objective factors that are not dependent on human
influence and are related to its activities. The first
unrelated factors are the genetic code of the developing
40
MEDICINE AND INNOVATIONS |
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ПРОБЛЕМНЫЕ СТАТЬИ ИОБЗОРЫ
organism,
which
determines
the
following
vital
parameters: sex, growth and physical development
rates and levels, "binding'’ periods and activity of
key enzyme processes in the div, morphological
and functional functions of tissues, organs and
systems. The rate and level of maturation, the level
and quality of the interdependence of the div's
control mechanisms, the basis of the fetus's response
to external traumatic influences, as well as metabolic
and adaptive to extraterrestrial life in the first hours,
days and weeks of life and adaptive mechanisms,
later pathological conditions and genetically related
conditions that lead to disease, and so on. [6,8,17]
The second group of factors relates to factors
whose impact is related to human activity and can
be conditionally divided into non-medical and, in
particular, medical types.
Non-medical factors include social, societal, social,
religious, spiritual, and environmental factors that
affect the developing fetal organism and the newborn
organism. Their influence is realized through the
div, psyche, perception, lifestyle and activities of the
woman.
Depending on the situation, this condition can
mitigate and even flatten the negative impact on the
fetus and child, as well as increase and significantly
increase its impact. It should be noted that in addition
to environmental influences, these factors, which have
nothing to do with biology and medicine, still have
a large biological effect, because the child undergoes
processes of high intensity: growth, development and
perfection, a new form of human existence as well
as cases of reconstruction, which are very important
in terms of their level and importance, and so on.
Therefore, their medical and non-biological nature is
characterized by impaired growth and development
of the fetus, impaired organ and tissue maturation,
normal management processes in the div, the
formation
of
adaptive
mechanisms
for
survival
outside of pregnancy and their effects. Thus, non-
medical adverse factors affecting the health of the
fetus and newborn are considered to have genetic
and, in particular, biological effects no less than
medical factors. Understanding this situation by each
individual, the whole society and the state creates new
opportunities to improve the quality of health not only
of fetuses and newborns, but also of the population
of the whole country. This problem is undoubtedly of
independent political and state importance.[22,27,30]
Second, medical factors include women - maternal
pathology, pregnancy, obstetric pathology, diseases
acquired during pregnancy (fetal diseases), neonatal
diseases, and the quality of medical care for women,
fetuses, newborns. All these factors primarily affect
the growth, development and improvement of the fetal
organism in order to realize one of the most important
functions of the human div - an independent and full
life outside of pregnancy. [4]
Obviously, the health of the fetus and newborn does
not depend solely on any cause or factor, so it cannot
be the sole concern of the parents, only the family,
only medicine or society or the state. Their mutual
harmony is necessary for the normal development and
health of a person.
Nowadays, the importance of fetal pathology leading
to impaired or impossible adaptation of the child to
life outside of pregnancy is clearly increasing. These
problems
include
immunosuppressive
pregnancies,
congenital infections, respiratory distress syndrome,
and developmental defects. The nervous, endocrine,
and immune systems of the fetus and newborn are
immature and, accordingly, the most inefficient in
the implementation of adaptive mechanisms. It is
their functional deficiency that sometimes serves as
a starting point in the formation of pathology. These
deviations are the basis for the formation of functional
disorders and diseases. There is a fairly clear link
between the physical development of the fetus and
genetically related factors and the risk of developing
various pathological conditions. [1,2,4,7,9,21].
For example, chromosomal aberrations in children
with delayed gestational development occur in 7% of
cases (2 times more than in healthy newborns), while
developmental defects occur in 11% and 5% in healthy
newborns, respectively. These data require attention
to be paid to human development during pregnancy.
At the present time, there is a need to create a State
National Program aimed at building and assessing the
quality of fetal and child health in the new millennium.
This situation can be a serious basis for predicting
the formation of the nation's health, determining the
priorities for the development of science and applied
medicine. [8,12]
An analysis of the domestic and foreign literature
shows that changes in the chemical composition of
the human environment are one of the main causes of
birth defects in children.
There are currently more than 500 substances that
have a teratogenic effect. These include substances with
different chemical composition: ethanol, testosterone,
lead, chloroprene, mercury, ethyleneamine, benzene,
most pesticides, sulfur carbon, poor quality tumors,
and even some of the anti-diabetic drugs, even vitamin
D. Hybridization of representatives of one species
belonging to populations adapted to different natural
conditions has been proven to lead to high mortality of
the offspring, its high incidence of malignant tumors
and
other
undesirable
complications,
including
developmental anomalies. Such effects can often
be explained by the adaptive nature of organisms in
different environmental conditions.[2,7]
Identifying the causes of developmental anomalies
and the emergence of various diseases at this or that
41
ПРОБЛЕМНЫЕ СТАТЬИ ИОБЗОРЫ
stage of human life has led to the conclusion that there
are sensitive periods in human life to various factors
and substances: The first and most important period is
the period before egg fertilization. For at least 3 months
(depending on the dose under the influence of ionizing
radiation - several years) it is necessary to prevent
the entry of substances with teratogenic properties
into the div of the mother and father of the future
child. The second period is the period of embryogenic
development. During this period, especially in the
2-3rd week of pregnancy (when organogenesis is
active, ie the period when the foundation is laid for
various organs and systems of the div), the fetus
becomes very sensitive). For example, 300,000 nerve
cells are formed per minute. Naturally, the organ most
active in cell division during exposure to a teratogenic
substance is more likely to develop anomalies.
Congenital malformations include serious changes
in children's health that significantly affect their
morbidity and mortality. In recent years, there has
been an increase in the incidence of this type of
pathology among children and adolescents. In this
case, despite the development and improvement of
medical science, the number of primaryly detected
congenital anomalies among the population over 17
years of age, i.e. in the group of adolescents and adults,
did not decrease, but increased by 1.1%. There is a
tendency to increase infant mortality from congenital
anomalies. Areas with low rates of frequency of this
pathology are bordered by regions with high rates
of them. Questions arise about the reasons for these
discrepancies, the completeness and quality of the
diagnosis, and the primary accounting and collection
of data. In addition, given the diversity of natural and
socio-economic characteristics of the regions, the
influence of environmental factors on the formation of
congenital malformations is of interest.
Congenital and inherited diseases occupy one of
the leading positions in the structure of perinatal and
infant mortality.). Unfortunately, the CIS countries
are not yet involved in the International System of
Defects, which was established in 1974 and covers 27
countries. The form of state registration, introduced by
the former union Ministry of Health in 1989, directs
health authorities to only the total number of congenital
anomalies. However, in recent years, the epidemiology
of congenital malformations has become increasingly
important. This situation is due to a number of reasons.
First, information on the frequency and composition
of congenital malformations of development is used
in the development of organizational measures to
provide specialized medical care to children with
this pathology. Second, the prevention of congenital
malformations is not considered effective enough
without data on the epidemiology of congenital
malformations as one of the ways to reduce perinatal
and infant mortality. Third, the dynamic accounting
of the frequency of congenital malformations allows
us to assess the environmental situation in the region.
It has been proven that the frequency of congenital
malformations increases with the age of the mother.
According to the in Lipetsk region, 3% of children bom
to underage mothers with congenital malformations
were observed for 2 years, the mothers of children with
congenital malformations of 20% were over 30 years
old, including 7.1% were 35 years old. The younger
the marriage age of a woman, the greater the number
of births. The earlier young people start having sex, the
more likely it is that it will not be related to marriage,
as well as the risk of unplanned pregnancies, abortions
or unwanted births in adolescents with biological,
mental
and
social
disabilities.
For
adolescents
and women under 20 years of age, pregnancy and
childbirth itself can also be a risk factor: pathological
course of childbirth, cesarean section and subsequent
complications,
frequent,
pronounced
vegetative-
vascular dystonia syndrome, increased number of
gestoses (30-40 %).
It is known that alcohol serves as a direct cause
of every tenth embryonic pathology. For every 10
mentally immature children, 5 were bom to pianist
parents. Analysis of the questionnaires showed that
5.3% of mothers and about 50% of fathers smoked
alcohol, 6.6% of mothers and 61.7% of fathers smoked.
Mothers of children with congenital malformations
were more likely to have anemia, pyelonephritis,
cardiovascular disease, as well as pathology of the
thyroid gland, measles and venereal diseases. 53%
of women had a history of somatic diseases, 26.3%
had gynecological diseases, and in this regard, 50%
of women used drugs, including several drugs at the
same time. Prior to pregnancy, 37.4% of women and
33.4% of women during pregnancy were exposed to
harmful occupational conditions.
Based on an analysis of 207 birth histories of
children
with
congenital
and
inherited
diseases,
G.M. Saveleva and coauthors noted that MAT
developmental defects (22%) and congenital heart
defects (19%) predominated in the pathology. Defects
in the development of the gastrointestinal tract
and urogenital system were observed with almost
the same frequency (9.8% and 9.7%). Numerous
developmental anomalies have been identified in 2%
of newborns. Among the risk factors, the risk of early
termination of pregnancy (34%), spontaneous abortion
in the anamnesis (17%), occupational hazards and
environmentally unfavorable living conditions (17%)
were more frequent. Examination of alpha-fetoprotein
in the serum of pregnant women showed that in 10 of
them, including 2, an increase in its dynamics (18 and
22 weeks of gestation) was observed, which was an
indication for the implementation of amniocentesis.
Medical-genetic counseling is of great importance
in screening pregnant women at risk, as they set
42
MEDICINE AND INNOVATIONS |
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ПРОБЛЕМНЫЕ СТАТЬИ ИОБЗОРЫ
guidelines
for
detailed
screening.
Chromosomal
abnormalities detected during karyotyping in 12%
of pregnant women served as guidelines for fetal
karyotyping. In this case, 2/3 of the fetus has
different
chromosomal
abnormalities
(balanced
and unbalanced anomalies, Patau syndrome). The
authors conclude that the pathological karyotype in
the mother can be a risk factor in the formation of a
similar pathology in the fetus and requires mandatory
karyotyping. The data obtained are consistent with
the results of other studies (Kozlova VI and co
authors), which also included women at risk for the
successful implementation of the program for the
prevention of congenital and hereditary diseases from
the first trimester of pregnancy (medical-genetic),
counseling,
karyotyping
of
pregnant
women
if
necessary, determination of serum alpha- fetoprotein
levels, diagnosis of intrauterine infection, ultrasound
examination in the I and II trimesters of pregnancy,
strict adherence to the algorithm of examination
of invasive prenatal procedures (chorionic biopsy,
amniocentesis) which should be done without.
The lack of a single methodological approach
to the consideration of developmental birth defects
is one of the significant shortcomings in the study
of the dynamics of their prevalence. This makes it
more difficult to compare data obtained by different
researchers. This situation can be explained by the
breadth of the prevalence of congenital malformations,
which are covered in the local press in relation to
foreign scientific work. All of this does not allow
for real reasoning to think about situations in which
environmentally unfavorable areas arise.
According
to
IP
Bochkov
and
coauthors
,
retrospective analysis of medical records in different
regions does not provide accurate data on the
frequency of congenital malformations. This may
be due to hyper- and hypodiagnosis, inaccuracy in
the registration of passport data (possible changes
in the surname in the near future after delivery),
incomplete storage of medical documents (possibility
of transferring a medical document to a children's
hospital to continue treatment, loss of documents).
In Kazakhstan, they have studied the resources to
reduce infant mortality. Analysis of perinatal causes
of death showed that congenital malformations in
the structure of causes of death accounted for 10.5%.
According to the authors, infant mortality and stillbirths
are affected by relatively constant background factors
that are difficult to correct (socio-economic conditions),
conditionally
variable
(natural-climatic
conditions)
and a complex of compensatory mechanisms (health
system). If these factors are categorized according
to their importance and manageability, the first two
groups of factors belong to a group that is important
but conditional or unmanageable. In that case, the
threatening burden falls on the health care system,
the
existing
compensatory
mechanisms,
despite
their diversity, they are not very well developed and
can not ensure the stability of infant mortality rates
to the negative impact of factors. However, the
most compensatory option is unconditional primary
prevention, which in turn has insufficiently developed
theoretical and managerial aspects, which ultimately
leads to a decrease in the quality and effectiveness
of medical and social measures to prevent infant
mortality and stillbirth.
The
prevalence
of
congenital
malformations,
perinatal morbidity and mortality were studied in
Tashkent. Congenital malformations were observed in
2.5% of children, of which 93.9% were found alive and
6.1% were stillborn. The rate of perinatal morbidity
associated with congenital anomalies averaged 2.2-
2.6% among live births. The perinatal mortality rate
associated with congenital malformations was 7.1%.
Among the developmental defects, neural tube defects
(21.3%),
skeletal
system
developmental
defects
(21.3%) and multiple developmental defects (16.1%)
took the leading place. The majority of women
(90.9%) who gave birth to children with congenital
malformations were indigenous. Women aged 17-21
accounted for 31.3% and those aged 35 and over for
26.7%.
Hereditary and congenital diseases and heart defects
are serious problems not only in the health system but
also in the whole country, as their treatment, as well as,
unfortunately, the disability of children, requires large
material costs and is one of the causes of birth defects
- many married couples and do not want to have third
children.Although the relative proportion of these
diseases is small, the correction and treatment of these
diseases subsequently results not only in the incidence
rate but also in the disability of the population.
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УДК: 616.71 -008]-504.064.36
СОВРЕМЕННЫЕ МЕТОДЫ МОНИТОРИНГА ОСТЕОИНТЕГРАЦИИ
Б. Пулатов, Н.М. Алиева, М.У. Дадабаева
Ташкентский государственный стоматологический институт
Мониторинг остеоинтеграции имеет принципи
альное значение не только в период
приживления имплантата и определения кри
териев для передачи пациента на ортопедический
этап лечения, но необходим и в динамике наблю
дения при дальнейшей эксплуатации ортопеди
ческой конструкции. Суммируя многочисленные
обоснования и практики, С.С. Серегин (2016) [1]
указывает, что наиболее рациональным является
трехкратное наблюдение за пациентами с орто
педическими конструкциями с опорой на внутри
костные имплантаты в течение первого года после
их установки (например, через 3, 6 и 12 мес.), а в
дальнейшем - ежегодная диспансеризация. Эти ос
мотры должны включать элементы клинико-гигие
нического и рентгенологического контроля, а так
же, по возможности, сеансы профессиональной
гигиены полости рта. В то же время, автор не отри
цает, что сроки и методики обследования могут за
висеть от состояния органов полости рта и уровня
гигиены, а также от общего состояния здоровья па
циента, и это вносит индивидуальные коррективы
в план обследования. Следовательно, элементами
наблюдения за пациентами с несъемными зубны
ми протезами с опорой на внутрикостные имплан
таты во время периодических осмотров должны
стать, прежде всего, оценки состояния самого
протеза, имплантата и окружающей его костной
ткани. Практически все авторы, затрагивающие
в своих исследованиях вопросы гигиенического
ухода за полостью рта, подтверждают необходи
мость периодических сеансов профессиональной
гигиены полости рта для ухода за зубами, имплан
татами и супраконструкциями, что положительно
отражается на сроках использования протезов [2].
РЕЗОНАНСНЫЙ ЧАСТОТНЫЙ АНАЛИЗ
RFA является широко используемым методом
оценки первичной стабильности дентальных им
плантатов. Результаты RFA количественно ото
бражаются в виде коэффициента стабильности
имплантата (ISQ), значения которого могут варьи
ровать от 1 (предельно низкая стабильность) до
100 (высокая стабильность) [3].
Наиболее
распространенной
в
отечественной
практике системой для RFA является
«Osstell mentor», в котором используются маг
нитные штифты типа «Smartpeg», имеющие самые
различные винтовые соединения, так что исследо
вание можно проводить со всеми основными си
стемами
имплантатов
различного
производства.
Штифт можно обратимо присоединять к имплан
тату на любом этапе его приживления вплоть до
установки ортопедической конструкции, исполь
зуя обычный динамометрический ключ [4] Ста
бильность первичного имплантата является клю
чевым
фактором,
влияющим
на
выживаемость
этих имплантатов [5]. Она определяется как оцен-
45
