Učestalost povreda kod intenzivno fizički aktivnih adolescenata

Abstract

Povrede adolescenata predstavljaju rastući javno zdravstveni problem. Iako fizička aktivnost ima dokazanu višestruku korist po zdravlje pojedinca, ona je povezana sa rizikom od povreda, posebno u zemljama sa nedovoljno razvijenim strategijama za prevenciju istih. Cilj istraživanja bio je da se utvrdi povezanost između intenzivne fizičke aktivnosti i povreda, da li nivo fizičke aktivnosti utiče na rizično i protektivno ponašanje adolescenata, i da se identifikuju okolnosti i okruženje u kom se povrede najčešće dešavaju. Za istraživanje je korišćena retrospektivno-prospektivna kohortna studija na odabranom uzorku adolescenata od 15-19 godina koji pohađaju srednju školu. Putem standardnog internacionalnog upitnika o fizičkoj aktivnosti IPAQ i dobijenog MET skora, izdvojen je deo kohorte adolescenata izložen intenzivnoj fizičkoj aktivnosti. Kontrolnu grupu činili su umereno fizički aktivni i neaktivni adolescenti. U periodu od 12 meseci registrovane su sve vrste povreda adolescenata putem upitnika o povredama. Povrede koje su zahtevale medicinski tretman registrovane su kroz zdravstvenu dokumentaciju školskog dispanzera, sportske ambulante doma zdravlja, hitne medicinske pomoći i urgentnog odeljenja opšte bolnice. Klasifikacija i analiza podataka o povredama izvršena je prema prirodi povreda (S00-T98) na osnovu Međunarodne klasifikacije bolesti (MKB-10, 1996.). Rizik za povrede bio je sedam puta veći u grupi intenzivno fizički aktivnih adolescenata u odnosu na kontrolnu grupu (RR: 7,041; 95%CI: 6,071; 8,187). Rizik za povrede koje su zahtevale medicinski tretman, prema rezultatima prikupljenim u zdravstvenim ustanovama, bio je 15 puta veći kod adolescenata koji se intenzivno bave fizičkom aktivnošću (RR: 14,717; 95%CI: 10,652; 20,592). Fizički aktivni učenici su se najviše povređivali na sportskim terenima, dok su se umereno aktivni i neaktivni najčešće povređivali u kućnom okruženju. Rizik da zadobiju sportske povrede bio je 11 puta veći kod fizički aktivnih ispitanika (RR: 11,212; 95%CI: 9,013; 14,074), sa značajno višom stopom incidencije kod muškaraca (82,9/100). Na treningu i utakmici povrede je zadobilo 85,2% fizički aktivnih adolescenata, dok su kod umereno aktivnih i neaktivnih sportske povrede najčešće registrovane u školskom okruženju (37,5%). Najviše povreda registrovano je u fudbalu (Inc. 4.44/1000 h), odbojci (Inc. 3.92/1000 h) i boksu/kik boksu (Inc. 3.75/1000 h). Intenzitet fizičke aktivnosti nije imao uticaja na smanjenje rizičnog ponašanja kod adolescenata, kao što je korišćenje alkohola, psihoaktivnih supstanci i nasilno ponašanje. Nivo protektivnog ponašanja bio je generalno nizak u obe grupe ispitanika. Korišćenje zaštitne kacige i zaštitne sportske opreme bilo je značajno zastupljenije u grupi intenzivno fizički aktivnih adolelescenata, ali nije utvrđen njihov uticaj na smanjenje rizika od povreda.

Injuries among adolescents represent growing public health issue. Although physical activity provides proven multiple benefits to the health of individuals, it is also associated with a risk of injuries, particularly in countries with less developed strategies for their prevention. The objective of the research was to determine the relation between vigorous physical activity and injuries, whether the level of physical activity affects the risk and protective behaviour among adolescents, and to identify the circumstances and environment in which the injuries most often occur. The research used a retrospective-prospective cohort study on a selected sample of adolescents aged 15-19 years attending secondary school. The part of the cohort of adolescents exposed to vigorous physical activity was separated through the standard international questionnaire on physical activity IPAQ and the resulting MET score. The control group consisted of moderately physically active and inactive adolescents. All types of injuries among adolescents within the 12 months were registered through a questionnaire. Injuries requiring medical treatment were registered through the health records of school and sports ambulances, emergency medical services and Emergency Department of the General Hospital. Classification and analysis of injury data was performed according to the nature of the injuries (S00 - T98) based on the International Classification of Diseases (ICD - 10, 1996). The risk of injury was seven times higher in the group of vigorous physically active adolescents than in the control group (RR: 7,041; 95%CI: 6,071; 8,187). The risk of injuries that required medical treatment was 15 times higher among adolescents who are intensively engaged in physical activity (RR: 14,717; 95%CI: 10,652; 20,592). Physically active students are most frequently injured on the sports fields, while moderately active and inactive students are most frequently injured in the home environment. The risk to suffer sports injuries was 11 times higher among physically active participants (RR: 11,212; 95%CI: 9,013; 14,074) with a significantly higher incidence rate among men (82,9/100). On training and during the game 85,2% of physically active adolescents suffered from injuries, while among inactive participants sports injuries were most often registered in the school environment (37,5%). The most injuries were registered in soccer (Inc. 4.44/1000 h), volleyball (Inc. 3.92/1000 h) and boxing/kick boxing (Inc. 3.75/1000 h). The intensity of physical activity had no impact on reducing risk behaviour among adolescents, such as the use of alcohol, psychoactive substances and violent behavior. The level of protective behavior was generally low in both groups. The use of protective helmets and protective sports equipment was significantly more frequently present among vigorous physically active adolescents, but their influence on reducing the risk of injuries was not determined.