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2.2. The organisation of epidemiological research («ISAAC») and tayobakokurenija among teenagers, a general characteristic of the surveyed groups of teenagers, clinico-functional and laboratory methods issledovayonija

Epidemiological researches are executed in a countryside Aginyosky Buryat districts (Abo) of Transbaikalian edge. Danye about ethnic priyonadlezhnosti teenagers found out by interrogation, including indicatings on natsioyonalnuju an accessory of ancestors to III-V the generations, living in the given region.

For studying of prevalence of symptoms of a bronchial asthma at podyorostkov the report of the program standardised epidemiologiyo is used
cheskih researches of allergic diseases at children - International Study of Asthma and Allergy in Children («ISAAC» in Russia) [222], including 3 phases:

I phase - questioning of representative groups of the children's population (see enc. 1),

II phase - specification of the diagnosis on the basis of profound inspection of persons, poyodozritelnyh on presence of disease by results of questioning in I phase.

III phase provides repetition I-II of phases after a 3-year-old break for definition of a trend of prevalence of disease and its separate symptoms. Under regulations of research ISAAC questioning of children is spent at the age of 13-14 years, considered period of the termination of the childhood [the Standardized epidemiological researches of allergic diseases at children. AdaptaYOtsija programs "the International research of an asthma and an allergy at children (" ISAAC ")" in Russia, 1998] [100, 222].

Research is spent at teenagers at the age of 12-18 years in obshcheobrazovayotelnyh high schools of Abo of Transbaikalian edge in 2005 (n=2104) and in 2008 (n=2288). The insignificant number of teenagers of other nationalities is excluded From research. Distribution on national structure of the proquestioned teenagers is presented in table 8. The parity Buryats / Russian in predstavyolennoj to sample has made 2,7:1.

Table 8. National structure of the proquestioned teenagers (n=4092)

natsioyonal - nost Academic year
2005-2006 2008-2009 і t.
In total Young men Girls In total Young men Girls
Buryats 1511 726 785 1482 729 753
(73,9 %) (48,4 %) (51,6 %) (72,4 %) (49,2 %) (50,8 %)
Russian 533 268 265 566 269 297
(26,1 %) (50,3 %) (49,7 %) (27,6 %) (47,5 %) (52,5 %)
Total 2044 994 1050 2048 998 1050
(100 %) (48,6 %) (51,4 %) (100 %) (48,7 %) (51,3 %)

Statistical materials of regional committee zdrayovoohranenija about 2005-2008 given MZSR the Russian Federation about a case rate of the population of Russia in 2005 and in 2008 are used also.

The first stage of inspection included biographical screening with use of questionnaire ISAAC (researches are executed with Saburovoj T.V.'s participation).

For the second stage (clinico-functional and allergological obsleyodovanija) 130 teenagers at whom in the questionnaire presence astmopodobnyh symptoms for last 12 months has been noted have been selected

General characteristic of the surveyed groups of teenagers, klinikoyofunktsionalnyh and laboratory methods of research

Diagnosis BA is established at 62 teenagers (40 Buryat and 22 Russian) in 2005 the Bronchial asthma of easy severity level is diagnosed at 46 (74,2 %) (32 buyorjat and 14 Russian), moderate severity level - at 13 (21 %) (7 Buryat and 6 Russian), tjayozhelaja - at 3 (4,8 %) (1 Buryats and 2 Russian). At half of teenagers (at 31, i.e. 50 %) BA it was combined with an allergic rhinitis, at 3 - with atopicheskim a dermatitis, at 8 - are noted combination BA, an allergic rhinitis and atopicheskogo a dermatitis.

At the third stage in 3 years (in 2008) for comparison in dynamics of 2 first investigation phases have been completely repeated. Diagnosis BA has been confirmed at 119 teenagers (79 Buryat and 40 Russian). In 2008 g the bronchial asthma easy steyopeni gravities has been established at 110 (92,4 %) (74 Buryat and 36 Russian), moderate severity level - at 9 (6,9 %) (4 Russian, 5 Buryat). At 58 (at 49,1 %) teenagers BA it was combined with an allergic rhinitis, at 4 - combination BA, allergicheskoyogo a rhinitis and atopicheskogo a dermatitis is noted.

Clinical verification of the diagnosis and cupping of exacerbations BA were spent according to positions of the National program «the Bronchial asthma at children. Strategy of treatment and preventive maintenance» (2008) and Classification of clinical forms bronholegochnyh diseases at children (2009). The diagnosis SHOUT it was established according to positions of Nauchnoyopraktichesky programs «ORZ at children: treatment and preventive maintenance» (2002 [78].

Estimation of influence of a tobacco smoking on a current of a bronchial asthma. DiYOzajn comparative epidemiological research was based on printsiyope experience-control (in relation to smoking). Control group have made - non-smoking patients BA (56), and skilled - smoking teenagers with BA (63).

The teenagers living in a countryside, patients BA, with established during epidemiological research in 2008-2009 the diagnosis (119) were criterion of including.

For an estimation of prevalence of a tobacco smoking and respiratories simptoyomov and revealings of the most significant risk factors among patients BA, prozhiyovajushchih in a countryside of Abo of Transbaikalian edge in 2008 have applied the biographical screening modified by us on a basis: a global questionnaire of teenagers on a tobacco smoking [5], Burden of major Respiratory diseases who survey (CART) [84], ISSAC [100] (see enc. 2). The estimation of the status of smoking was spent in sootyovetstvii with methodical references «Practical guidance on leyocheniju tobacco dependence» and included: a smoking estimation as risk factor of development of disease, degree of nicotinic dependence by means of the test Fa - gerstrema, motivation degrees to stop to smoke, motivations of smoking [109]. The index of the smoking person (IKCH) is calculated under the formula: quantity of the cigarettes smoked in day h 12 (number of months in a year which the person smoked). Degree nikoyotinovoj dependences was estimated under test Fagerstrema (0-2 points - very weak dependence, 3-4-weak dependence, 5 points - average dependence, 6-7 points high dependence, 8-10 points - very high dependence). Degree motivayotsii to stop to smoke estimated on a score (more than 6 - high motivation to refusal of smoking, from 4 to 6 - weak motivation, below 3 points - absence motiyovatsii); similarly estimated motivation to smoking (weak motivation - to 7 points, average motivation-7-11 points, strong motivation - above 11 points) (see enc. 3).

Estimated age of the beginning of involving in smoking, the smoking experience, quantity of smoked cigarettes. An indicator "pack/years" at daily smokers counted under the formula: number of the cigarettes smoked in day h quantity of years
Smoking / 20. The indicator "pack/years" (quantity of years of the smoking, increased by an average of packs of the cigarettes smoked in month, and increased on 12 mes) in view of not so big experience in the best way reflects cumulative effect of smoking at teenagers.

Clinical features of a current of a bronchial asthma are in details analysed at 42 teenagers with an exacerbation of the illness, treated in the Regional hospital №2 g Chita. Design: the retrospective comparative research constructed by a principle save-pair (compared patients were identical on a sex, age, asthma severity level, the social status). Groups differed only concerning active smoking (21 smoker and 21 non-smoking). From clinical indicators estimated frequency of attacks of a bronchial asthma, triggers and the causally-significant allergens causing an exacerbation, dynamics of nuclear heating plant-test; tool data pikfloumetrii, roentgenographies of organs of a thorax, an electrocardiogram, FVD in assay with bronholitikom; laboratory indicators of a haemogram, rinotsitogrammy, IFA on atypical originators, the general IgE; results dermal skarifikatsionnyh assays. At dynamic observation over patients during time pristupnogo the period each 24 hours considered expression of clinical symptoms (in points from 0 to 3), data dynamic pifloumetrii. Estimated volume of spent broncholitic, antiinflammatory, antibacterial, mucolytic, symptomatic therapy.

The complex estimation of efficiency of vegetative inhibitors lejkotrienov (bosvellievyh acids) at teenagers with a bronchial asthma is spent. The preparation "Bronhodiol" (BUD, Open Society "Diode", Moscow) is used. Design of research: double, blind, comparative, platsebo supervised, with 3 monthly catamnesis. All children passed a rehabilitation course in out-patient conditions.

Criteria of including were: age of 12-18 years; presence of the diagnosis established at children easy or moderately severe a bronchial asthma; the consent of children and their parents to participation in research; absence of the serious accompanying
The diseases doing unacceptable participation in research, and also absence in the anamnesis of allergic reactions to the ingredients which are a part of a preparation.

The group has made 44 sick bronchial asthma at the age of 12-18 years (middle age 14,9±0,28 years), including 23 girls and 21 young man. Bronchial astyoma moderately severe it is defined at 7 teenagers; easy severity level - at 37 (an intermittent current - at 24 and persistent - at 13). At 25 persons imelyosja an accompanying allergic rhinitis. All sick randomizirovany a random sample method. From them received Platsebo - 21, Bronhodiol - 23 teenagers. Vozrastno-sexual structure of investigated groups and initial klinikoyoinstrumentalnye indicators did not differ. Bronhodiol it was applied in rekomenyodovannyh doses (on 2 capsules 3 times a day) within 21 days, are similar - PlaYOtsebo. From clinical indicators estimated frequency of attacks of a bronchial asthma, dynamics of nuclear heating plant-test, by-effects in the form of intolerance prepayorata, allergic reactions, negative subjective sensations. An estimation proyovodili in 3 weeks of treatment (for 21st day) and in a catamnesis in 3 months.

In quality mukoreguljatora at teenagers with BA used lizinovuju salt karbotsisteina (Fluifort). Surveyed 23 teenagers (18 - with easy, 5 - srednetjazheloj BA) at the age of 12-18 years with an exacerbation of a bronchial asthma against ORVI. Teenagers with ORVI have parted on 2 groups: the first group included activly smoking 11 teenagers c a bronchial asthma; in the second group - 12 non-smoking teenagers.

Criteria of including in research were: age of teenagers from 12 till 18 years; presence of an exacerbation of a bronchial asthma easy and moderate severity level against SHOUT; presence of the informed consent of parents, and also teenagers (aged is more senior 15 years).

Criteria of an exception of research were: presence of accompanying chronic diseases of a liver, kidneys; indicatings in the anamnesis on allergic reactions to preparations karbotsisteina; absence of the informed consent of teenagers and their parents.

To all teenagers are spent obshcheklinicheskie inspections (the anamnesis, survey, etc.). Expression of clinical symptoms defined on specially developed scale which included: an estimation (in points from 0 to 3) expressions of a body temperature, a dyspnea, tussis with unit of a sputum, rhonchuses in lungs, difficulties of nasal breath, intensity pathological vydeleny from a nose. Dynamics of clinical symptoms spent within the first 7 days of treatment daily, then for 10th, 14th and 21st day.

All patients received the standard treatment, including a dietetics, etiotropic treatment (antiviral, anti-infectives), physiotherapy (inhalation of 0,9 % of a solution of Sodium chloridum), massage, etc. Under indications prescribed basic (antiinflammatory) therapy. Along with the standard treatment teenagers received as Mucolyticum lizinovuju salt karbotsisteina - LKTS (Fluifort, «Dompe Farmacheutichi S.p. And», Italy). A preparation (in the form of a syrup) prescribed in the recommended age dosage: from 12 till 15 years on 10 ml 2-3 times a day, are more senior 15 years - on 15 ml 2 times a day. Duration of course of treatment has made 7 days.

For allergodiagnostiki used skarifikatsionnye assays with stanyodartnym a set of allergens: household (a house dust), epidermal (a wool of a cat, a dog, a porpoise), pollen (a birch, an alder, a wormwood, ovsjanitsa, timofeevka, a hedgehog, a hazel grove) (Stavropol, Russia); definition of the general IgE metoyodom tverdofaznogo IFA with application of sets of reagents of Joint-Stock Company "Vector-best" (Novosibirsk).

Functional methods of research respirations on the device (MiniSpir User Manual, Italy) included a function estimation vneshyonego. For an estimation obratimoyosti bronchial obstruction spent pharmacological assay with salbutayomolom according to operating references [62, 91].

For acknowledgement of active smoking defined the maintenance monooksida Carboneum (WITH) in exhaled air with the help With-analyzer «Micro CO», (Smoke Check - МICRO МEDICAL LTD., the Great Britain). WITH in exhaled air investigated at 104 patients BA, from them 60 smokers and 44 non-smoking.

Semiquantitative measurements of the device were interpreted as follows: value 0-6 ppm corresponded to low level (inherent non-smoking) and were designated in points, as 1; 7-10 ppm - to an average level - 2; 11­20 - to high level - 3; more than 20 ppm - to very high level - 4 points.

Laboratory methods of research.

Definition of concentration of proinflammatory cytokines IFN-y, IL-8, TNFa and antiinflammatory IL-4 at patients BA (n=81) is executed by a method tverdofaznogo IFA by means of double antibodies and application peroksidazy a horse-radish with use of sets of reagents of Joint-Stock Company "Vector-best" (Novosibirsk).

Definition of indicators of a secretory immunoglobulin And (sIgA) provoyodili in the admixed saliva collected at children, sick BA (n=97), on an empty stomach, without stimulation, in number of 5 ml. Used a set of reagents of Joint-Stock Company «Vector - Best» (Novosibirsk).

Definition kotinina in urine at 60 smokers and 44 non-smoking patients BA spent by means of test strias "Immunohrom-kotinin-express train" (Open Company manufactures «Industrial Bio-medical Technologies», Moscow).

2.3

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Scientific source BATOZHARGALOVA BAIRMA TSYDENDAMBAEVNA. CLINICO-EPIDEMIOLOGICAL, GENETIC And ETHNIC FEATURES of the BRONCHIAL ASTHMA At TEENAGERS of Transbaikalia. The dissertation on competition of a scientific degree of the doctor of medical sciences. Moscow - 2013. 2013

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Other medical related information 2.2. The organisation of epidemiological research («ISAAC») and tayobakokurenija among teenagers, a general characteristic of the surveyed groups of teenagers, clinico-functional and laboratory methods issledovayonija:

  1. THE TABLE OF CONTENTS
  2. CHAPTER 2. THE CHARACTERISTIC OF THE SURVEYED PATIENTS AND APPLIED METHODS OF INSPECTION
  3. a general characteristic of the surveyed groups of patients
  4. THE TABLE OF CONTENTS
  5. 2.2. The organisation of epidemiological research («ISAAC») and tayobakokurenija among teenagers, a general characteristic of the surveyed groups of teenagers, clinico-functional and laboratory methods issledovayonija
  6. Influence of a tobacco smoking on a current of a bronchial asthma at teenagers (according to clinico-epidemiological research)
  7. 1.6. Mediko-social problems of chronic hepatitises at children and teenagers.
  8. the general clinical methods of research of children
  9. Chapter 1 the literature Review
  10. the characteristic of the surveyed groups
  11. THE DISSERTATION GENERAL CHARACTERISTIC
  12. THE WORK GENERAL CHARACTERISTIC
  13. the Characteristic of disturbances of a hemostasis at the surveyed patients