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THE CONCLUSION

During last quarter of the century steady growth of number of diseases of organs MVS in which basis the pathology urodinamiki the bottom departments of urinary ways lays is observed. It promoted the beginning of search new, ordering, improvement and modernisation of already existing methods of treatment of disturbances MI which would combine in itself high efficiency, a pathogenetic orientation, complex influence, the minimum invasiveness, and also possibility of psychological aftertreatment of the patient. Among disturbances MI more often others are diagnosed NDMP, meeting at 9-10 % of the children's population and more than for half of patients nefrourologicheskogo a profile. During too time according to observations of last years, leading positions in structure of pathology MI began to occupy disturbances of functional character, that in larger degree is caused by modern features of psychosocial influence on the child.

Disturbances MI, and also NDMP, interfaced with diskoordinatsiej works detruzora, necks and-or an external sphincter of MT, can often be shown in the form of an urine incontience (during a dream and-or wakefulness). The urine incontience often leads to development of pathological psychological features of the child, sharply reduces quality of his life, leads partial or full social dizadaptatsii. During too time of disorder MI enlarge risk of formation of deviations in psychological development of the child and occurrence in it patoharakterologicheskih lines of the person. Features of a children's organism are that, that an available somatopathy does not stop psychological development of the child, more often, however it changes, slows down and deforms its course, influences development of an internal picture of illness (VKB). Last years in a number of literature sources the formation problematics patoharakterologicheskih lines of the person at children with various disturbances MI, including with an incontience of urine during a dream and-or wakefulness was widely shined. However only in individual foreign and, unfortunately, domestic works influence of various kinds of therapy on transformation patoharakterologicheskih lines of the person and VKB during treatment and after recover of the patient is shined.

For today in connection with appreciable prevalence of pathology MI among children, and also selection of adequate schemes of treatment of the given disturbances which would combine in itself diagnostic, medical and rehabilitational possibilities becomes its leading part in formation of secondary changes MVS (a relapsing chronic cystitis, a vesicoureteral reflux, an ureterohydronephrosis, a pyelonephritis, a nephrosclerosis, an arterial hypertensia, chronic renal insufficiency), economically active groups of citizens leading to an early invalidism, more and more actual.

The basic directions of correction of disturbances MI at children at the present stage are medicinal preparations, FZT, surgical treatment, and also not medicamental and maloinvazivnye influence methods among which the leading place is occupied with FBU-THERAPY. Prevalence among disorders MI (about 90 %) functional disturbances considerably dilates possibility of the doctor effectively to use at a stage of treatment and aftertreatment of children medicamental and not medicamental kinds of therapy. However follows
To consider, that various kinds of therapy, having high clinical efficiency, can negatively influence psychological development of the child, worsening available psychoemotional background, negatively to influence on VKB.

Hence, only complex studying of clinico-psychological given children with disorders MI which receive various kinds of treatment, allows to define the optimal way of therapy and aftertreatment of patients that is an actual problem nefrourologii at the present stage.

As it became perceptible above, within last 15-20 years accents in treatment and aftertreatment of patients with disturbances MI (including with an uracrasia) are more and more applied non-invasive and not medicamental techniques, therapy without medicines which FBU-THERAPY concerns. In our country and abroad in treatment and aftertreatment of children with various implications of disorders MI use FBU-THERAPY in regimen EMG (it - "MIO") more often. However abroad FBU-THERAPY "MIO" is prime way of treatment, and in our country - exclusively therapy of a choice, and minor. Domestic pediatrists, nephrologists and urologists give the greatest preference to medicamental ways of correction of disturbances MI, and to FBU-THERAPY address seldom when medicamental treatment, FZT, other methods have not rendered the due expressed effect. The big desire to help children with disturbances MI, desire to change the approaches which have developed in our country to therapy of this pathology and also to place priorities in use and is proved to prove efficiency of FBU-THERAPY "MIO" in correction of disorders MI at our small patients has served as stimulus to creation of this dissertational work. And the enormous experience which has been saved up for 10 years (2003-2013) applications FBU - therapies "MIO" in treatment and aftertreatment of children with disturbances MI and SNFTO within the precincts of Izmajlovsky DGKB, and also methodical operating time for this period has helped us with it.

FBU-THERAPY "MIO" is a system of exercises on training of muscles tazovogo bottoms which is carried out in the interactive game form. It is carried out under control LDAKK FbU-terapi. From other kinds of treatment FBU-THERAPY "MIO" is distinguished by a unique combination of diagnostic and medical possibilities that allows already during trainings in a regimen of real time to trace effect and if necessary to correct influence (a dose, force, frequency rate, frequency etc.).

We one of the first began to apply FBU-THERAPY in regimen EMG to treatment and aftertreatment of children with disturbances MI, and processing of great volume of the saved up statistical data, has allowed to draw conclusions on degree of efficiency of a method, both from clinical positions, and from the point of view of psychocorrecting influence on an organism of the child. By us have comprehensively been studied, estimated and in a complex analysed influence of some factors (a current of pregnancy and sorts, burdeness of the family anamnesis, anomaly of structure MVS, psychological features of patients etc.) on occurrence, dynamics clinical and urodinamicheskih implications of pathology MI. Taking into consideration, that pathology MI concerns group of psychosomatic diseases, clinical and psychological implications of these disturbances at children (for example, volume and frequency characteristics MI have been studied,
Level of uneasiness and level of a self-rating of children, and also their mothers etc.), data GEMGr, their communication with data urodinamicheskogo inspection and psychological testing of patients in dynamics before and after FBU-THERAPY sessions "MIO". It has allowed to estimate comprehensively efficiency of FBU-THERAPY "MIO" and to prove its application taking into account clinical and psychological influences on an organism of children with disorders MI both in the form of monotherapy, and as a part of complex treatment. It is necessary to underline, that earlier such researches were not spent to pediatrics.

The purpose of the given dissertational work was the substantiation of application of a method of functional biological management taking into account its clinical and psychological influences on an organism at children with pathology MI for rising of efficiency of treatment.

According to an object in view following problems have been defined:

1. To estimate a role of provoking factors (the accompanying pathology MVS, the burdened family anamnesis, an accompanying pathology of organs MVS and GASTROINTESTINAL TRACT) in occurrence clinical and urodinamicheskih implications of pathology MI at children.

2. To prove necessity of carrying out of FBU-THERAPY for regimen EMG at children with pathology MI on the basis of an estimation of their psychological features.

3. To study and estimate clinical and psychological implications of pathology MI at children in dynamics before and after FBU-THERAPY sessions in regimen EMG.

4. To estimate efficiency of FBU-THERAPY in regimen EMG in treatment and aftertreatment of children with pathology MI.

5. To offer references on FBU-THERAPY application in regimen EMG in practical public health services for treatment and aftertreatment of children with pathology MI taking into account them klinikoyopsihologicheskih features.

For the decision of tasks in view, we execute research which consisted of two stages.

1st stage included the analysis of materials of observation and inspection of 153 children (66 boys and 87 girls) at the age from 7 till 18 years (middle age 10,3 yo 2,9 years, r = 0,05) with disturbances MI of the inorganic genesis, receiving FBU-THERAPY in regimen EMG, and also materials of psychological testing of patients and their mothers from 2003 on 2013 153 children have made OG, they joined in research in the presence of the informed consent of parents (the appendix № 1).

At 2nd stage the retrospective analysis of case histories and results of inspection of 2043 children (887 boys and 1156 girls) from 7 till 18 years (middle age 9,8 yo 3,4 years, r = 0,05), observed in 20032013, for the purpose of an estimation of efficiency of diagnostics and treatment of pathology MI at the present stage, and also for working out of optimum schemes of treatment of this pathology was carried out.

To children the full complex of diagnostic actions according to standards of diagnostics of disorders MI, including ultrasonic and urofluometricheskie researches was carried out. According to medikoyoekonomicheskim to standards of rendering of medical aid, inspection of children with disturbances MI was
All-round and complex, it included obshcheklinicheskie methods (the anamnesis collecting, physical inspection, laboratory blood analysises, urine, a feces), ultrasonic of kidneys and MT, a X-ray-urological of research of organs mochevydelitelnoj systems (ekskretornaja urography and cystography) with a contrast agent ("Omnipak", "Vezipak", "Ultrawhist", "Skanljuks", "Urografinum"), UFM, an electrocardiogram, consultation of experts (the neurologist, the urologist, the gynecologist), consultation of the clinical psychologist (conversation with the child and his parents, filling of specialised psychological questionnaires, performance of psychological tests and tasks). In the presence of indications to children tool methods of research (retrograde tsistomanometrija, profilometrija, cystoscopy), and also UFM with carrying out of pharmacological assays were carried out.

According to research problems complex psychological testing of children with disorders MI (OG and GS) was spent by means of various projective techniques the Magic country of feelings on Zinkevich - Evstigneevoj (the appendix № 2), the Nonexistent animal (the appendix № 3), the Kinetic drawing of a family (the appendix № 4) - risunochnyh tests, universal for all age groups. Techniques on estimations of uneasiness of children, as important integrativnogo an indicator of their psychosomatic condition were used. The uneasiness estimation was spent is differentiated taking into account age of children: at patients of 7-10 years - a scale of obvious uneasiness CMAS (The Children's Form of Manifest Anxiety Scale), developed for children in 1956 the American psychologists A. Castaneda, B. R. McCandless, D. S. Palermo on the basis of a scale of obvious uneasiness of adults J. A. Taylor, at schoolboys (11-14 years) - a scale of personal uneasiness A.M. The parishioners, framed in 1980-1983 By a principle Scales of socially-situational pavor, alarm O.Kondasha in two forms ("And" - for children of 11-12 years and - for children of 13-14 years). The test of an estimation of uneasiness C.D.Spilbergera modified in 1975-76 of JU.L.Khanin was applied to an estimation of level of uneasiness of mothers. Research of a self-rating of children, and also estimations mothers of children (an expert estimation) it was spent by means of a technique on Dembo-Rubinshtejn to updatings A.M. Parishioners. For definition detsko - parent relations in a family as a whole and style of education the technique of diagnostics of parent relation Varga-Stolina in particular has been used.

For the purpose of an estimation and the control of results of the spent researches it has been typed GS, consisting of 102 children (43 boys and 59 girls), at the age from 7 till 18 years with disorders MI, receiving metabolic therapy (pikamilon and group vitamins In in age dosages 1 mes), statistically homogeneous OG on a floor and age (p> 0,05).

At children surveyed by us, clinical implications of disturbances MI have been presented: an incontience of urine during a dream (night and-or day), wakefulnesses, change of characteristics of frequency and a desire to miktsii (an imperative, stressful incontience of urine, imperative desires on MI, a pollakiuria, rare miktsii in great volume), and also their various combinations among themselves.

According to the received data, at children from OG the incontience of urine during a dream (uracrasia), becoming perceptible at 122 persons (79,7 %) prevailed. And it has been presented practically fifty-fifty at boys and at
Girls (a parity 1:1) (> 0,1). On the second place on frequency of occurrence there were disturbances MI during the wakefulness, taped totally at 97 patients (63,4 %). From them, more than half of cases it was necessary on THESE which has been diagnosed for girls in 2,4 times more often, than at boys (r 0,1). Joint implications of an uracrasia, SNM and kalomazanija became perceptible only at 2 boys at the age of 7-10 years.

On the second place on frequency of occurrence was tetrada symptoms SNFTO in the form of an uracrasia combination, THESE, SNM, kalomazanija and a chronic constipation. It was defined at 19 persons (30,1 %), without statistically significant differences between girls and boys (> 0,1). More than half of cases symptomatic tetrad fell to an uracrasia combination, SNM, kalomazanija and the chronic constipation, taped at 12 patients (63,2 %). At other patients from the given group (36,8 %) the uracrasia combination, by THESE, kalomazanija and a chronic constipation is taped.

So-called clinico-symptomatic duets (dyads) have been diagnosed for 15 patients (23,8 %) with SNFTO in the form of various combinations of an uracrasia, by THESE, SNM, kalomazanija and a chronic constipation, without statistically significant differences between boys and girls (> 0,1). The combination of an uracrasia and kalomazanija has been taped at 4 patients, an uracrasia and a chronic constipation - at 3 persons. The combination THESE and kalomazanija became perceptible at 2 persons, THESE and a chronic constipation - at 2 persons, SNM and kalomazanija - at 2 persons, SNM and a chronic constipation - also at 2 patients.

The data testifying to features of a current of pathology MI and SNFTO depending on age are not less interesting. So, the children become more senior, the less various and is more rare diagnosed there will be implications of disorders MI and SNFTO (r

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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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