Abstract
In the scientific article considered the importance of background factors in development of the domestic traumas, the existence of background factors increase probability of emergence, and absence reduces degree of traumatization risk. During problem studying we made the classification of background factors. Established that between individual background factors and emergence of domestic traumas (р< 0,001) there is a direct link. Between external factors and the number of injuries founded weak inverse statistically unreliable relationship. At the same time, the prevention has to consider external contributing factors.
Key words: domestic traumas, background factors, risk degree, differentiation of domestic traumas.
Relevance of a problem
Trauma is one of the leading public health problems and the most common avoidable cause of death among children and adults up to age 45 years. The World Health Organization (WHO)reports that more than five million people die from injuries annually, accounting for nine percent of global mortality (1,2,3,4). As for traumatism structure, in the 2012 year the 84, 3 % made by domestic and street traumas among all of types, fixedly take a leading place. Due to complexity of differentiation and variety of the reasons and the conditions leading to domestic traumas, in our opinion, it is expedient to talk not about the reasons, but about background (contributing) factors of domestic traumatism. After all, for example, ice doesn't lead, and only promotes receiving a trauma. Consequently, the presence of background factors increases the probability of domestic injury and, conversely, their absence reduces the risk of injury. The manifestation of background factors is implemented with the direct effects of triggering factors. The last represent inadequate actions of the person and conditions, at which to arise domestic injuries.
Methods and Materials
On the basis of this observation in 1071 studied cases of a domestic injury. Differentiation of home injuries was conducted in accordance with the previously proposed criteria [5,6,7]. For processing of the received results used correlation and dispersive analysis. Background factors of the domestic traumatism were classified by us on external and individual.
In the 1st group were: 1) malfunction of household goods; 2) insufficient illumination of a landing, apartment, sidewalk, yard territory etc.; 3) ice and snow cover; 4) the clutter of a workplace; 5) do not accomplishment the yard; 6) unsuccessful design of household appliances; 7) low level of vital conveniences; 8) bad quality of a floor in the house (apartment); 9) defects in an electrical wiring isolation.
The 2nd group included: 1) defects of vision; 2) incaution; 3) sleep debt, exhaustion; 4) influence of climatic conditions; 5) age; 6) mental and somatic diseases, existence of anatomic (physical) defects; 7) previous events; 8) reception of medicines and tonics; 9) nature of relationship in a family.
Main scientific results
Individual background factors are established in 64,52+1,48% of cases. Individual factors include cases of domestic trauma where absent external factors. In the presence of at least one external factor, and the latter combined with a personal, background factors were classified as external.
The approximate estimation of the relationship between background factors and the number of home injuries received on the basis of the Spearman rank correlation coefficients (Table 1) shows that between the individual factors and the occurrence of home injuries there is a high direct link (p <0.001). With external factors established a weak reverse correlation (p> 0.05).
At calculation of pair coefficients of Pearson correlation received similar results (see tab. 1). Direct high correlation was noted between individual background factors and the number of home injuries (p <0.001). Between external factors and the number of injuries is detected weak, reverse statistically unreliable relationship (p> 0.05).
The determination coefficient characterizing a share of influence of individual factors is equal 0,701. Therefore, the share influence of individual factors in probability of receiving home accidents account 70,1%. Among the individual factors, the most frequently makes felt not getting enough sleep. This category includes cases where sleep duration was less than 8 h per day. Sleep was considered optimal if its duration was 8 hours a day or more. Sleep duration of less than 8 h was observed in 66,25 ± 2,16% affected. Sleep debt in affected ranged from 3 to 7 hours, with the largest specific weight on sleep duration equal to 7 h (41,51 ± 2,76%) and 6 h (36,16 ± 2,69%). To determine the influence of sleep duration grade (the organized factor) on quantity of the received home accidents (the resultative factor) we used the dispersive analysis.
Calculations show that influence of sleep duration on the number of home damages considerably and compose 71,0%. Confidence limits of influence force of sleep duration at a significance level p = 0.05 (Table Ғ. = 4.96) constitute 0,710 ± 0,144. Only 29,0% fall to the share of all other unaccounted influences in this research. However the sleep debt not only leads to receiving bigger number of home injuries, but also influences on their specific weight. So, the affected who have sleep debt, 2 times more often receive fractures (p <0.001) and injuries (p <0, 001). Significant proportion of them constitutes various wounds.
Second place among the individual factors takes vision defect, marked at 52,12 ± 1,5% of the victims. With it installed high direct correlation (see Table. 2). Among anomalies of different types of a refraction the greatest specific weight is occupied by an average degree of hypermetropia. To its share falls up to 39,85±3,00% of all refraction pathology. Other types of violations of a refraction were distributed in the following sequence: hypermetropia of weak degree (30,45±2,82 %), miopiya low (21,43±2,52 %) and average (3,76±1,17 %) degrees, hypermetropia (3,01±1,05 %) and miopiya
(1,50±0,74 %) of high degree. Full sight is noted at 47,88±1,55% of victims. Direct average correlation link is available between quality of a sleep and quantity of traumas. The bad quality of a sleep, which is expressing in difficulty of a falling asleep, repeated awakening, noted 25,21±1,98% of victims during the night preceding a trauma. 74,79±1,98% had a good sleep. In day of receiving a trauma of 36,25±2,19% of victims noted the feeling sick, characterized various complaints. However communication between pathological symptoms and number of home injuries is statistically doubtful. The most frequent complaints of general weakness, headache, retardation. Much less often victims showed complaints to heartbeat, drowsiness, dizziness, joint pains, slackness.
For cupping this symptoms 13,75±1,07% of victims several hours before receiving a trauma took the appropriate medicines. More often they used hypotensive (18,88±3,27%) and sedative (18,18±3,22%) preparations. In 15,38 ± 3,02% of cases accepted coronaroactive drugs, in 12,59 ± 2,77% - analgesics, in 4,19 ± 1,67% - antispasmodics. The "other" group forms 30,77±3,86%. Between reception of medicines and number of injuries identified statistically significant correlation.
Smaller prevalence of pathology is noted concerning the organ of hearing. Reduced hearing marked only in 17,21 ± 1,17% and very bad - at 0,48 ± 0,21% of the respondents. The overwhelming majority (82,31±1,18%) victims had normal hearing. The violations of a vestibular apparatus, estimated by the tremor of hands in a quiet state, meet seldom (4,23±0,62%).
In the vast majority (95,77±0,62%) these violations were absent. Analysis of the subjective assessment of working capacity, which took place before the trauma, shows that the majority of victims (63,36 ± 1,49%) estimated the working capacity as "usual", 29,23±1,41% noted "little tired"; 5, 58 ± 0,71% described it in words "unworkable, very tired", and only 1,83 ± 0,41% indicated "very good working capacity".
Studying the scale characterizing the mood on the eve of a trauma, established that 74,23±1,36% defined it as "good". In 15,58 ± 1,12% of cases affected rated it as "not very good". "Very good" mood noted 8,65 ± 0,87%. Small amount (1,54 ± 0,38%) pointed to "very bad" mood.
The analysis the scale of events evaluation, that could affect the overall condition of the victim, testifies their absence in 87,02 ± 1,04% of cases. Events (12,98%) occurred on the day of a trauma, were distributed as follows: "small troubles" — 5,86±0,73%, "joyful events" — 5,00±0,67%, "serious troubles" — 1,54±0,38%, "tragic events" — 0,29±0,17%, "very joyful events" — 0,29±0,17%.
External background factors as it was already noted, contributed occurrence of home accidents for 35,48±1,48% of cases. As a whole external background factors were distributed as follows: insufficient illumination — 40,65±2,56%; ice and snow cover — 22,25±2,43%; clutter, crude surface of a place of work and premises — 14,80±1,25%; malfunction of household goods — 12,63±1,84%; do not
accomplishment the yard — 8,05±0,94%; unsuccessful design of household appliances— 0,78±0,05%, low level of vital conveniences ; bad quality of a floor in the house (apartment) - 0,38±0,03%, defects in an electrical wiring isolation -0,46±0,03%.
Connection intensity between external background factors and occurrence of domestic trauma is shown in tab. 3. Summing up the results of the studying of background factors of domestic traumatism, it should be noted that in modern conditions the leading role in the occurrence of home accidents belongs to group of the individual factors which are strongly mediating influence of background factors.
This moment, in our opinion, has fundamentally importance in respect of prevention and decreasing the level of household traumatism. At the same time preventive work should be carried out in the direction of reducing traumatic environment, full elimination of external background factors of household traumatism.
LITERATURE
- Kerstin Prignitz Sluys Dult and pediatric trauma outcomes and healthrelated quality of life,Stockholm, 2012.
- Borovkov V.N. The frequency and consequences of traumatism in Russia in the 1990s (complex socio- hygienic research): Abstract - Moscow, 2002 .
- Zhuravlev S.M. Medical and demographic aspects of injuries related to motor- accidents / / Journal of Traumatology and Orthopedics. N.N.Priorova . - 1996. - № 3.
- Lutkovsky O.A. Medical ensuring the impact of road traffic injuries in Moscow in 1999 - 2003 years. / / Problems of Social Hygiene, health and medical history. - 2005. - № 2.
- Mikhailov Y.V., Sohov S.T., Dejurnyi L.I., Son I.M., Lysenko K.I. Medical and social consequences of road traffic injuries. - M., Public Health Institute. 2007.
- Revich B., Reshetnikov K. Cause of death: car accident / / Population and Society. - 2000 . - № 51.
- Salahov E.R., Kakorina E.P. Injury and poisoning in Russia and abroad / / Problems of soc. Hygiene, health and medical history. - 2004 - № 4.