1. Medea Chikava M.D., Ph.D THE UNIVERSITY Of GEORGIA Social Services Actions for Prevention Of Digestive Disorders Among Adolescents Medea Chikava M.D., Ph.D THE UNIVERSITY Of GEORGIA

2. Among the greatest advances in elucidating the determinants of disease over the recent period has been the identification of social conditions that seem to influence morbidity. While planning social services it is important to determine the impact level of each social risk factor on disease development in order to form prevention measures ranked list and outline the priority problems. Despite all the achievements of the contemporary Medicine, improvement of prevention of Digestive Disorders (DD) still remain a priority objective, since there is a trend of uncontrolled growth of these disorders in the World.

3. Adolescence is one of the most critical periods of the human postnatal ontogenesis and one of the most difficult periods of psychological development. That is why so important is timely development of the effective, scientifically sound model of prevention of these disorders among adolescents, based on the evaluation of social risks that have impact on them. This is the first study in Georgia that using the two step model epidemiological research defines pathogenic strength and prognosed values of social and other risk factors.

4. The Objective of the Research The Objective of the Research _ _ to study the role of micro-social environment in formation of DD among adolescents of Georgia aged 14-21; _ to establish which factors have more negative influence on the development and progression of DD in adolescents; _ what measures will be more effective to be conducted during the delivery of social services.

5. Materials and Methods

6. One stage epidemiological research was conducted among 1. the medium (14-16 years old) 2. late (17-21 years old) period adolescents population of Georgia. We developed: 1. primary questionnaire for DD morbid forms screening 2. specialized map-questionnaire of epidemiological research of DD

7. Statistical study of DD was conducted not as complete study of “general entity” but with “partial” method. To receive statistically reliable values, the value of “selection entity” was defined by the method, accepted on the tenth report of the WHO Experts’ Committee, the following formula [143]: n = t2 * P * (100 – P ) / ∆ 2 n = t2 * P * (100 – P ) / ∆ 2 where:n – is needed number of observations; where:n – is needed number of observations; P = 13,25% – distribution of disease, expressed in % P = 13,25% – distribution of disease, expressed in % (prevalence index of DD, received as a result of epidemiological research, conducted in 2003in adolescents aged 15-18); (prevalence index of DD, received as a result of epidemiological research, conducted in 2003in adolescents aged 15-18); t = 1,96 – reliability coefficient (95% accuracy); t = 1,96 – reliability coefficient (95% accuracy); ∆ = 3,25 – limiting error of index. ∆ = 3,25 – limiting error of index. n = 1,962 * 13,25 * 86,75 / 3,252 = 418

8. I group II group adolescents with DD ( n 1 = 84 ) conditionally health adolescents ( n 2 = 346 ) The epidemiological research _ 430 adolescents I step _ the screening questionnaires

9. II step _ the map-questionnaires Each map contained questions to study psychosocial, alimentary and other risk factors. Data, received as a result of research, was statistically processed by the SPSS program application, Excel, using contemporary biostatistics techniques. The risk factors significances were studied by the Case-Control Study method.

10. For each risk factor For each risk factor 1. pathogenic strength _ 1. pathogenic strength _ Relative Risk (RR) Relative Risk (RR) 2. prognosed values – 2. prognosed values – Relative Intensity coefficient (K) Relative Intensity coefficient (K) RR evaluates level of impact of the risk factors on DD development. RR evaluates level of impact of the risk factors on DD development. K evaluates level of impact of the risk factors on DD progression. K evaluates level of impact of the risk factors on DD progression.

11. In order to define sequence of the preventive measures which are recommended to be conducted during the delivery of social services in the groups ranking of the risk factors was held according to decrease of RR, K values: 1. for the conditionally healthy adolescents (II group) – according to RR was defined ranked list of DD predictors; 2. for the adolescents with DD (I group) – according to K was defined rank of risk factors that help the progress of these disorders in case of already developed disease

12. Results and Discussion

13. The prevalence of DD in adolescents population was stated – 19,5% (95%CI: 17,6-21,4); ( from which 10,5% were girls and 9,0% were boys (diagram 1). ( Among 84 adolescents with DD 45 were girls and 39 were boys, 53,6% (95%CI: 48,1- 59,1) and 46,4% (95%CI: 40,9-51,9), respectively (diagram 2).

14. D Diagram 1 The prevalence of Digestive Disorders Intensive Indices D Diagram 1 The prevalence of Digestive Disorders in Adolescents According to Intensive Indices

15. Diagram 2 The prevalence of Digestive Disorders Extensive Indices Diagram 2 The prevalence of Digestive Disorders in Adolescents According to Extensive Indices

16. Diagram 3 The structure of Digestive Disorders Diagram 3 The structure of Digestive Disorders in Adolescents disorders 1. Esophageal disorders disorders 2. Stomach and duodenal disorders disorders 3. Hepatobiliar and pancreatic system disorders disorders 4. Intestinal disorders

17. Diagram 4 The prevalence of Digestive Disorders The prevalence of Digestive Disorders in Adolescents According to Age and Sex

18. I group II group Adolescents with Digestive Disorders Adolescents with Digestive Disorders (DD) ( n 1 =84) Conditionally Healthy Adolescents ( n 2 =346)

19. The Digestive Disorders Table 1 The social Risk Factors Impact On Adolescents Digestive Disorders Development The risk factors of micro- social environment Frequencies (%) ZpRR Rank K I group II group adolescents chronic overload96,4 ± 2,063,6 ± 2,65,89<0,000111,611,52 adolescents bad habits55,0 ± 5,719,2 ± 2,36,43<0,00013,4222,87 unsatisfactory living conditions46,4 ± 5,518,8 ± 2,15,3<0,00012,7232,47 excessive use of computer, TV66,7 ± 5,242,2 ± 2,74,03 <0,0001 2,2641,58 the majority of familiars smoke53,8 ± 5,530,8 ± 2,53,95<0,00012,1451,75 parents separation14,3 ± 3,86,59 ± 1,32,320,01021,8962,17 passive smoking more than 2 years 55,0 ± 5,540,0 ± 2,62,480,00661,6271,37

20. The Digestive Disorders Table 2 The impact chronic overload On Adolescents Digestive Disorders Development Risk factors Frequencies (%) ZpRR RankK I group II group Adolescents chronic overloads 96,4±2,063,6 ± 2,65,89 <0,0001 11,6 1,52 adolescents study overloads 61,0±5,4211,5±1,739,86<0,00015,8515,3 conflict situations at the family 54,6±5,4616,7±2,047,26<0,00013,7523,28 difficulties in communicating with peers 61,9±5,3329,8±2,465,5<0,00012,8832,08 negative emotions during eating 32,1±5,1314,6±1,93,75<0,00012,1542,2 conflict situations at the school 32,5±5,2616,9±2,073,110,00091,9251,91

21. In contrast to chronic psychological overloads, a healthy lifestyle has positive impact on DD development among adolescents.

22. Diagram 5 Irregular Consumption of Food Products among Adolescents Population (%) 1. plural vegetables (except potatoes); 5. macaroni, plural grouts; 2. fish ; 6. butter ; 3. milk and dairy products ; 7. meat; 4. fruit and berry ; 8. egg.

23. Unhealthy diet is risk factor for DD development: 1. overweight eating of carbohydratic food (bread and bread products, potatoes and sweets) – RR=2,98 (95%CI: 2,29-3,88); 2. irregular consumption of milk and dairy products – RR=1,82 (95%CI: 1,38-2,49), 3. insufficient use of fruit and berry RR=1,41 (95%CI: 1,06-1,85).

24. Diagram 5 The Diagram 5 The frequencies of active and passive lifestyle among adolescents population (RR=1,46)

25. The Digestive Disorders Table 2 The social Risk Factors Impact On Adolescents Digestive Disorders Development The risk factors of micro- social environment Frequencies (%) ZpRR Rank K I group II group adolescents chronic overload96,4 ± 2,063,6 ± 2,65,89<0,000111,611,52 adolescents bad habits55,0 ± 5,719,2 ± 2,36,43<0,00013,4222,87 unsatisfactory living conditions46,4 ± 5,518,8 ± 2,15,3<0,00012,7232,47 excessive use of computer, TV66,7 ± 5,242,2 ± 2,74,03 <0,0001 2,2641,58 the majority of familiars smoke53,8 ± 5,530,8 ± 2,53,95<0,00012,1451,75 parents separation14,3 ± 3,86,59 ± 1,32,320,01021,8962,17 passive smoking more than 2 years 55,0 ± 5,540,0 ± 2,62,480,00661,6271,37

26. The unhealthy habits _ RR=3,42 1. smoking _ RR=2,27 2. excessive consumption of alcohol _ RR=1,87

27. Diagram 6 The Diagram 6 The frequencies of bad habits _ RR = 3,42 (smoking _RR- 2,27, alcohol consumption RR- 1,87) among adolescents population

28. The fact, that the majority of familiars smoke (RR=2,14), is one of the less significant risk factors. The correlation coefficient between this factor and adolescents’ bad habits is 0,4 (r=0,4). This average correlation indicates that unhealthy microsocial environment imfluences on the adolescents in this way that they early begin to smoke. Passive smoking more than 2 years time (RR=1,62) also has impact on DD development, but to less considerable degree.

29. The unsatisfactory living conditions (RR=2,72) have very important negative influence on children’s and adolescents’ development and these occupy the third place among the social risk factors after the bad habits.

30. Excessive Use of New Information Technologies _ RR=2,26 1. Excessive use of computer _ RR=2,14 2. Excessive use of TV _ RR=1,67

31. The parents separation has low average correlation with presence of DD among adolescents (r=0,39). So it also influences on DD development among them (RR= 1,89).

32. The use of computer has different impacts on the I and II groups adolescents. On the question ’’what do you feel after using computer?’’, adolescents of I and II groups, respectively, answered: ’’weakness’’ – 6,8% and 2,3%; ’’exhaustion’’ – 13,8% and 3,4%, ’’has worst influence’’ – 3,4% and 2,3%. Overall, the computer negatively influences on 24,0% of adolescent with DD and 8,0% of others (p<0,05). 25% of the whole population feels tired after using the new information technologies and it has the positive impact on 18,4% of conditionally healthy adolescents, but nobody feels the same in the I group.

33. Just because adolescent has one or more risk factors doesn’t mean he will definitely develop poor digestive health. Knowing one’s risk factors to his digestive health can guide him into making the best choices for himself – whether it’s making lifestyle changes or other changes.

34. Conclusions Thus, according to the obtained results from the epidemiological research the prevalence of digestive disorders in adolescents population is more high among girls, than _among boys and it has tendency of growth by age. Accordingly, the influence of micro-social environment is more negatively represented on the pubertative age girls health, than on the boys of the same age.

35. The results obtained indicates that while planning social services for preventing development of DD in adolescents first of all the following actions are recommended to be implemented: 1. the reduction of chronic overload (RR=11,6), especially study overload (RR=5,85) 2. and conflict situations in family (RR=3,75); 3. explanation of bad habits negative role to the adolescents (RR=3,42); 4. improvement of living conditions (RR=2,72); 5. moderately use of computer, TV (RR=2,26).

36. For right prevention of adolescents DD it’s important to provide rational using of nutritional resources by adolescents, especially by girls: 1. milk and dairy products (RR=1,82), 2. fruit and berry (RR=1,41). It’s essential to limite the consumption of bread and bread products, potatoes and sweets (RR=2,98).

37. The results of our research show the risk factors the modification of which is the most important during delivery of social services. Based on the results of our research it is possible to develop scientifically approved model of prevention DD among adolescents. This shall be much cheaper than treatment expenses.

38. ThANK YOU FOR ATTENTION