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Informative methods of assessing indicators of physical development of children and adolescents at the individual level


(Kuchma V.R., Skoblina N.A., Pinelis V.G., Karganov M.Yu.)
Literature data indicate the relationship of physical development and the health status of children and adolescents: moreover, different authors question "what is primary?" It is decided differently.
V.N. Kardashenko, E.P. Stromskaya et al. (1982, 1985) note that the relationship between the characteristics of physical development and health remains insufficiently studied. Children with deviations from the age norms of development constitute a risk group. It is these children that require serious attention and follow-up observation, even if at the time of the examination they have not revealed a disease, a directed search for pre-disease and its prevention is necessary. Deviations in the timing of age-related development and disharmony of the morphofunctional state, as a rule, are combined with changes in children's health: the more significant the disturbances in physical development, the greater the likelihood of illness.
Today, it is important that in the work of practical doctors there are indications of a connection between physical development and health status. So, on the example of the Nizhneingashsky district of the Krasnoyarsk Territory, the chief doctor of the district hospital V.F. Kapitonov (2005) found that for many childhood chronic diseases there is no specific and specific symptomatology related to the initial period, but physical development disorders, in particular the ratio of body weight and length, growth inhibition, may already be nonspecific, but an important criterion of necessity in-depth examination of the child.
In our opinion, the child’s physical development is a “marker” of his state of health, and deviations in physical development reflect impaired health. Based on this assumption, the result of using the methodology for assessing physical development should be associated with the presence of functional disorders or chronic diseases in the child.
Therefore, the search for the most informative methodology for assessing the indicators of the physical development of children and adolescents at the individual level must begin by calculating the statistical relationships of the results of using various methods with the presence of a child
functional disorders and chronic diseases. Multiple regression was used to describe the multiple relationship of a characteristic with a set of indicators. The analysis was based on the “International Statistical Classification of Diseases and Health Related Problems” of the tenth revision (ICD-10), adopted by the 43rd World Health Assembly in 1989, put into effect by the Russian Ministry of Health in 1999 (R. Halfin ., Kakorina E.P., Maksimova M.V., 2005, Pigalov A.P., 2006).
Since there were no significant age-gender differences, generalized results are given (tab. 5.2.1, 5.2.2, 5.2.3, 5.2.4, 5.2.5, 5.2.6).
When using regional modified regression scales, the multiple correlation coefficient is R = 0.52, p <0.001 (see table 5.2.1). Standardized regression coefficients (Beta) indicate that the assessment of physical development by this method changes if children have: functional disorders of the endocrine system, nutrition, metabolism (0.48), and chronic diseases of the endocrine system, nutrition, metabolism (0, 19), functional disorders of the digestive system (-0.24), chronic diseases of the musculoskeletal system and connective tissue (-0.14), mental and behavioral disorders (0.14), functional disorders of the eye and adnexa (0.10), functional disorders of the genitourinary system (-0.09). The results obtained indicate that the physical development of the child has noticeable highly reliable relationships with the presence of functional disorders and chronic diseases in the child. The used methodology for assessing indicators of physical development can sensitively reflect the presence of functional abnormalities and chronic diseases in six classes of diseases.
Table 5.2.1
Multiple relationships of assessing children's physical development according to regional modified scales of body weight regression along body length with functional disorders and chronic diseases, R, Beta
Statistic
The value of the multiple correlation coefficient (R) 0.52
Fisher test 9.07
p 0.001



Statistic
Disease classes
Standardized Regression Ratio (Beta) Std.
Err.
(Beta)
t p
circulatory organs (functional disorders) 0,07 0.05 1.4 0.15
circulatory organs (chronic diseases) 0,03 0.04 0.7 0.43
digestive organs (functional disorders) -0.24 0.04 -5.6 0.001
digestive organs (chronic diseases) -0.06 0.04 -1.2 0.21
respiratory organs (functional disorders) 0.01 0.04 0.1 0.97
respiratory system (chronic diseases) 0.01 0.04 0.3 0.76
Mental and behavioral disorders (functional disorders) 0.14 0.04 3,1 0.001
Mental and behavioral disorders (chronic diseases) -0.11 0.05 -2.3 0.02
eye and adnexa (functional impairment) 0.10 0.04 2,3 0.02
eye and adnexa (chronic diseases) 0.04 0.04 0.9 0.32
genitourinary system (functional disorders) -0.09 0.04 -2.2 0,03
genitourinary system (chronic diseases) -0.06 0.04 -1.3 0.18
endocrine system, nutrition, metabolism (functional disorders) 0.48 0.04 11.9 0.001
endocrine system, nutrition, metabolism (chronic diseases) 0.19 0.04 4.8 0.001
skin and subcutaneous tissue (functional impairment) 0.02 0.04 0.5 0.61
skin and subcutaneous tissue (chronic diseases) -0.02 0.04 -0.3 0.72


musculoskeletal system and connective tissue (functional disorders) 0,07 0.04 1.4 0.13
musculoskeletal system and connective tissue (chronic diseases) -0.14 0.06 -2.3 0.02



Previously, using factor analysis N.A. Matveeva (1986) defined models of interaction between individual indicators of physical development and morbidity indicators that are found in certain nosological forms (diseases of the cardiovascular, digestive systems, posture, endocrine, nervous systems, skin, respiratory, ENT organs).
When using the complex scheme, the multiple correlation coefficient is R = 0.41, p <0.001 (see table 5.2.2). Standardized regression coefficients (Beta) indicate that the assessment of physical development by this method changes if children have: functional disorders of the endocrine system, nutrition, metabolism (0.31), and chronic diseases of the endocrine system, nutrition, metabolism (0, 23), functional disorders of the circulatory system (-0.10), chronic diseases of the circulatory system (0.10). Using this technique, statistical dependences were also identified, however, they are less pronounced and reflect the presence of functional deviations and chronic diseases in two classes of diseases.
Table 5.2.2
Multiple relationships of assessing the physical development of children in an integrated manner with functional disorders and chronic diseases, R, Beta
Statistic
The value of the multiple correlation coefficient (R) 0.41
Fisher test 4,58
p 0.001



Statistic
Disease classes
Standardized Regression Ratio (Beta) Std.
Err.
(Beta)
t p
circulatory organs (functional disorders) -0.10 0.05 -2.1 0.04
circulatory organs (chronic diseases) 0.10 0.05 2.1 0,03
digestive organs (functional disorders) -0.09 0.05 -1.8 0.06
digestive organs (chronic diseases) -0.03 0.05 -0.7 0.47
respiratory organs (functional disorders) 0.01 0.05 0.1 0.95
respiratory system (chronic diseases) 0.02 0.05 0.4 0.72
Mental and behavioral disorders (functional disorders) -0.07 0.05 -1.5 0.12
Mental and behavioral disorders (chronic diseases) -0.05 0.04 -1.1 0.29
eye and adnexa (functional impairment) 0.06 0.04 1.3 0.19
eye and adnexa (chronic diseases) -0.02 0.04 -0.5 0.61
genitourinary system (functional disorders) -0.01 0.04 -0.2 0.85
genitourinary system (chronic diseases) 0,07 0.04 1,6 0.10
endocrine system, nutrition, metabolism (functional disorders) 0.31 0.04 6.9 0.001
endocrine system, nutrition, metabolism (chronic diseases) 0.23 0.04 5.5 0.001
skin and subcutaneous tissue (functional impairment) -0.06 0.04 -1.3 0.21
skin and subcutaneous tissue (chronic diseases) 0.02 0.04 0.5 0.59


musculoskeletal system and connective tissue (functional disorders) 0,03 0.04 0.6 0.57
musculoskeletal system and connective tissue (chronic diseases) -0.03 0.06 -0.5 0.58


Table 5.2.3
Multiple relationships of assessing the physical development of children according to intergroup assessment tables with functional disorders and chronic diseases, R, Beta
Statistic
The value of the multiple correlation coefficient (R) 0.45
Fisher test 6.42
p 0.001



bgcolor = white> 0.1
Statistic
Disease classes
Standardized Regression Ratio (Beta) Std.
Err.
(Beta)
t p
circulatory organs (functional disorders) -0.07 0.04 -1.7 0.08
circulatory organs (chronic diseases) 0.24 0.04 5,6 0.001
digestive organs (functional disorders) 0,03 0.04 0.8 0.41
digestive organs (chronic diseases) -0.06 0.04 -1.5 0.13
respiratory organs (functional disorders) -0.07 0.04 -1.8 0.06
respiratory system (chronic diseases) 0.01 0.04 0.1 0.88
Mental and behavioral disorders (functional disorders) 0.01 0.04 0.88
Mental and behavioral disorders (chronic diseases) 0.01 0.04 0.2 0.80
eye and adnexa (functional impairment) 0.15 0.04 3.4 0.001


eye and adnexa (chronic diseases) -0.01 0.04 -0.1 0.95
genitourinary system (functional disorders) -0.01 0.04 -0.1 0.91
genitourinary system (chronic diseases) 0.01 0.04 0.1 0.87
endocrine system, nutrition, metabolism (functional disorders) 0.37 0.04 9.1 0.001
endocrine system, nutrition, metabolism (chronic diseases) 0.28 0.04 6.8 0.001
skin and subcutaneous tissue (functional impairment) -0.05 0.04 -1.4 0.15
skin and subcutaneous tissue (chronic diseases) -0.02 0.04 -0.4 0.67
musculoskeletal system and connective tissue (functional disorders) -0.01 0.04 -0.3 0.75
musculoskeletal system and connective tissue (chronic diseases) 0.06 0.05 1,1 0.23



When using intergroup assessment tables, the multiple correlation coefficient is R = 0.45, p <0.001 (see table 5.2.3). The standardized regression coefficients (Beta) indicate that the assessment of physical development by this method changes if children have: functional disorders of the endocrine system, nutrition, metabolism (0.37), and chronic diseases of the endocrine system, nutrition, metabolism (0.28 ), chronic diseases of the circulatory system (0.24), functional disorders of the eye and its adnexa (0.15). Using this technique, statistical dependencies are also identified and reflect the presence of functional abnormalities and chronic diseases in three classes of diseases.
When using the calculation of the body mass index, the multiple correlation coefficient is R = 0.49, p <0.001 (see table 5.2.4). It is significant that the technique widely used in endocrinology reflects only the presence of functional disorders of the endocrine system, nutrition, metabolism (0.39), and chronic diseases of the endocrine system, nutrition, metabolism (0.29) with a high probability (p <0.001) .
When using the Z-Score estimates, the multiple correlation coefficient turned out to be the lowest and amounted to R = 0.29, p <0.001 (see table 5.2.5). The standardized regression coefficients (Beta) turned out to be the smallest, which is probably due to the fact that the technique records only pronounced deviations in the physical development of children.
When using centile tables, the multiple correlation coefficient is R = 0.39, p <0.001 (see table 5.2.6). The standardized regression coefficients (Beta) indicate that the assessment of physical development by this method changes if children have: functional disorders of the digestive system (0.27), functional disorders of the respiratory system (-0.13), functional disorders of the endocrine system, nutrition, metabolism (0.12), functional disorders of the nervous system (0.12), functional disorders of the musculoskeletal system and connective tissue (0.09). The results obtained are of some interest, since functional deviations according to these classes of diseases are most often recorded at preschool age, and this methodology for assessing indicators of physical development can sensitively reflect their presence.
Table 5.2.4
Multiple relationships for assessing the physical development of children by calculating body mass index with functional disorders and chronic diseases, R, Beta
Statistic
The value of the multiple correlation coefficient (R) 0.49
Fisher test 9.07
p 0.001



Statistic
Disease classes
Standardized Regression Ratio (Beta) Std.
Err.
(Beta)
t p
circulatory system 0.02 0.04 0.5 0.55
(functional impairment)
circulatory system -0.06 0,03 -1.5 0.11
(chronic diseases)


bgcolor = white> genitourinary system (functional disorders)
digestive organs (functional disorders) -0.03 0,03 -0.9 0.33
digestive organs (chronic diseases) -0.03 0.04 -0.8 0.40
respiratory organs (functional disorders) 0.02 0,03 0.6 0.53
respiratory system (chronic diseases) -0.04 0,03 -1.0 0.28
Mental and behavioral disorders (functional disorders) -0.06 0.04 -1.5 0.11
Mental and behavioral disorders (chronic diseases) -0.01 0.04 -0.2 0.80
eye and adnexa (functional impairment) 0,03 0.04 0.8 0.37
eye and adnexa (chronic diseases) -0.01 0,03 -0.4 0.66
-0.07 0,03 -1.8 0.06
genitourinary system (chronic diseases) 0,03 0,03 1,0 0.31
endocrine system, nutrition, metabolism (functional disorders) 0.39 0.04 10,4 0.001
endocrine system, nutrition, metabolism (chronic diseases) 0.29 0.04 7.8 0.001
skin and subcutaneous tissue (functional impairment) -0.03 0,03 -1.0 0.30
skin and subcutaneous tissue (chronic diseases) -0.05 0,03 -1.2 0.20
musculoskeletal system and connective tissue (functional disorders) -0.04 0,03 -1.0 0.28
musculoskeletal system and connective tissue (chronic diseases) -0.09 0.04 -1.8 0.06


Table 5.2.5
Multiple relationships of assessing the physical development of children using the Z-Score assessment with functional disorders and chronic diseases, R, Beta
Statistic
The value of the multiple correlation coefficient (R) 0.29
Fisher test 2.71
p 0.001



Statistic
Disease classes
Standardized Regression Ratio (Beta) Std.
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