Lasten monimuotoiset oireet Selvityshenkilöiden raportti

Sosiaali- ja terveysministeriö pyysi LT, lastentautien erikoislääkäri Elina Hermansonia laatimaan selvityksen monimuotoisista oireista kärsivien lasten hoitoon pääsystä, tarjotuista palveluista ja hoitovaihtoehdoista. Selvitys tehtiin yhteistyössä Newcastlen yliopistossa toimivan lastenneurologi Rob Forsythin kanssa. Tavoitteena oli selvittää ja tehdä ehdotuksia Suomen sosiaali- ja terveydenhuollon palvelujärjestelmän kehittämistarpeista monimuotoisesti oireilevien lasten ja nuorten hoidossa. Selvitykseen kerättiin tieto alan tutkimuksista ja eri maiden käytännöistä sekä kuultiin perheitä, hoitoon osallistuvia ammattihenkilöitä ja asiantuntijoita. Selvitys sisältää 17 selvityshenkilöiden kehittämisehdotusta. Keskeisintä niissä on koulunkäynnin varmistaminen ja lapsen kasvun ja kehityksen turvaaminen. Hoitoa tulee kehittää moniammatillisin menetelmin systemaattisesti ja yhdenmukaisesti, riittävän intensiivisesti ja pitkäjänteisesti. Hoitosuunnitelma on tehtävä yhteisymmärryksessä lapsen ja hänen huoltajiensa kanssa. Palveluketjuja rakennettaessa on turvattava 16 vuotta täyttäneiden hoidon jatkuvuus. Terveydenhuollon ammattihenkilöiden perus- ja täydennyskoulutukseen on lisättävä tietoa toiminnallisista häiriöistä. Kansainvälisen tutkimuksen ja hoitosuositusten seuraaminen on välttämätöntä. Vakiintumattomien ja kokeellisten hoitojen antaminen on syytä keskittää yliopistosairaaloihin tai mahdollisti perustettaviin toiminnallisten häiriöiden hoitoon keskittyneisiin keskuksii

Who benefit from school doctors’ health checks : a prospective study of a screening method

Abstract Background School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors’ skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors’ assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors’ routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors’ routine health checks can be omitted using study questionnaires. Methods This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor’s assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor’s health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor’s appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors’ interventions and follow-up plans. Discussion The study will increase our knowledge of the benefits of school doctors’ routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services. Trial registration ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017

Nuoruuden kehitys - mitä tapahtuu pinnan alla?

Teema : Nuorisolääketiede. English summaryPeer reviewe

Associating school doctor interventions with the benefit of the health check : an observational study

Background The benefits of school doctor interventions conducted at routine general health checks remain insufficiently studied. This study explored the associations of school doctor interventions with the doctor-evaluated and parent-evaluated benefits of routine health checks. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children from grades 1 and 5 from 21 Finnish elementary schools in 4 municipalities. Doctors routinely examined all children, who were accompanied by parents. The doctor-reported interventions were categorised into six groups: instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals and referrals to specialised care. Doctors evaluated the benefit of the appointment using predetermined criteria, and parents provided their subjective perceptions of benefit. Interventions and reported benefit were compared using multilevel logistic regression. Results Doctors reported 52% and parents 87% of the appointments with interventions beneficial. All interventions were independently associated with doctor-evaluated benefit (ORs: 1.91-17.26). Receiving any intervention during the appointment was associated with parent-evaluated benefit (OR: 3.25, 95% CI 2.22 to 4.75). In analyses of different interventions, instructions and/or significant discussions (OR: 1.71, 95% CI 1.20 to 2.44), prescriptions (OR: 7.44, 95% CI 2.32 to 23.91) and laboratory tests and/or medical imaging (OR: 3.38, 95% CI 1.34 to 8.55) were associated with parent-evaluated benefit. Scheduled follow-up appointments and referrals to other professionals showed no significant association with parent-evaluated benefit. Conclusions Doctors and parents valued the appointments with interventions. Parents especially appreciated immediate help and testing from the doctor.Peer reviewe

Parent, teacher, and nurse concerns and school doctor actions : an observational study of general health checks

Publisher Copyright: ©Objective To evaluate the association between the concerns of parents, teachers, and nurses regarding each child's well-being and the school doctor actions conducted in routine general health checks. Design A blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions. Setting 21 primary schools in four municipalities in Finland. Participants Between August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively. Outcome measures Outcome measures were the respondents' concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to Quite a lot or a great deal of concern' by at least one respondent. The school doctor actions included instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals, and referrals to specialised care. Results Altogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66-4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80-4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p<0.0001). Conclusions Health checks by school doctors may lead to referrals of children to other professionals especially for children's psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals. Trial registration NCT03178331.Peer reviewe

Who benefit from school doctors' health checks : a prospective study of a screening method

Background: School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors' skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors' assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors' routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors' routine health checks can be omitted using study questionnaires. Methods: This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor's assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor's health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor's appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors' interventions and follow-up plans. Discussion: The study will increase our knowledge of the benefits of school doctors' routine health checks arid assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services.Peer reviewe

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks : an observational study

Background In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child's physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. Results The participation rate was 75.5 %. According to all questionnaires, 20-25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41-5.17). Conclusions The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most.Peer reviewe

The perceptions of different professionals on school absenteeism and the role of school health care : A focus group study conducted in Finland

Purpose of the study School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. Materials and methods Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. Results Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. Conclusion Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.Peer reviewe

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study

Background In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child's physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. Results The participation rate was 75.5 %. According to all questionnaires, 20-25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41-5.17). Conclusions The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most.</p