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Don’t forget the basics : Health

Don’t forget the basics : Health. Malmö, September 26, 2013 Stefan Kling, MD City of Malmo , Sweden s tefan.kling@malmo.se. The European health report 2005 Public health action for healthier children and populations. The Scandinavian Welfare societies.

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Don’t forget the basics : Health

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  1. Don’tforget the basics: Health Malmö, September 26, 2013 Stefan Kling, MD City ofMalmo, Sweden stefan.kling@malmo.se

  2. The European health report 2005 • Public health action for healthier children and populations

  3. The Scandinavian Welfare societies • Belief in social engineering • Contractbetweencitizens and state: stateprovides social and economicsecurity, but has a certain right tointrudeinto the private sphere for controlofmisuse and reliable statistics as a base for health and social policy.

  4. Personal ID number (PNR) • All nordiccountrieshave a unique personal ID number for its residents • Makes it easytofollowindividuals over time in national registers and healthrecords • Makes it easytolink data from different sourcestoindividuals

  5. I. Childrens Health in Sweden –What do weknow? • 2 million children • 60-70% live withbothparents • Majority – goodpsychosocialhealth • Psychosocialhealth and wellbeingamongschoolchildrenworsenacrossages • Students not livingwiththeirparents – mostvulnerable

  6. II. Childrens Health in Sweden –What do weknow? Majorityofchildren – goodpsychosocialhealth Percievedphysicalimpairment– 14 % of students -allergiesor asthma - overweight - visualand/or hearing impairments - ADHD - chronicdisease; epilepsyor diabetes - dyslexia (Swedish National Institute of Public Health, 2009; National Board of Health and Welfare, 2009)

  7. The Swedish schoolsystem • Preschool for all from 3yearsof age (not compulsory, butincludes >95% of resident children) • Optional preparatory year from age 6 (preeschoolclass) • A unitarycompulsoryprimaryschoolofnineyears from age 7 to16. • A diverse secondaryschool from age 16.

  8. Health Care System for Children • Child Health Service, age 0-5 • School Health Service, age 6-18

  9. Child Health Service • Developmentassement visits • Growth checks • Vaccination schedule • Parental support

  10. School Health Service • Health profiles (preschool, grade 2-4-8, upper secondary school) • Growth checks (incl. BMI) • Vision • Hearing • Back checks • Vaccination schedule • Individual health talks

  11. Substitute CareAny kind of custodial or residential care for a child that is ordered or otherwise sanctioned by the court, and in which a child does not continue to live with either of the birth parents.

  12. How many are they? 4% of all Swedish children are taken into care during their childhood 1% spend at least 5 years in the care system 2/3 are teenagers when they first enter care

  13. Care for younger children • Usually foster care • Foster homes are more and more often mini-institutions (HVB-hem), with one family caring for 3-5 children. Many are integrated into companies with many homes, run by the municipalities or private entrepeneurs

  14. Care for older children • A mix of foster homes and institutions • Many institutions mix children with diverse problems, and include both genders • Foster homes are more and more often mini-institutions (HVB-hem), with one family caring for 3-5 children. Many are integrated into companies with many homes, run by the municipalities or private entrepeneurs

  15. Physicalhealth - Scandinavian studies. • Swedish National Board of Health and Welfare: 2/3 of 108 children in foster carereported at leastonephysicalhealth problem (Socialstyrelsen, 2000) • Longitudinal Danishstudy: At 7 yearsof age disabilities and chronicdisorders aremuchmore common than in the general population At 11 yearsof age difference in health status remain (Egelund et al. 2008)

  16. Physicalhealth- International studies I • 92% havesomephysical ”abnormality” • 35% a chronic disorder N= 1.407 Chernoffet al, 1994, USA

  17. Physicalhealth- International studies II • High prevalence of untreated acute conditions, chronic illnesses, poor nutritional status, and inadequate immunization coverage (Hochstadt, Jaudes, Zimo, & Schachter, 1987; Simms & Halfon, 1994;). • Very few children in foster care are noted to have normal physical examinations(Silver et al., 1999)

  18. Physicalhealth- International studies III • 97% ofthe samplereportedlevelsofphysicaldiscomfort • 45% ofthe youthhadsomemedicalcondition Health status ofyoungoffenders and theirfamilies(SheltonD, 2000), Maryland, USA

  19. Physicalhealth- International studies IV • Extremelyhigh rates of co-occurringhealth risk behaviours • Lacking access to the healthcare system • Extremelyhigh rates ofphysical and sexual health problems The health status ofyouth in juvenile detentionfacilities (Golzari et al, 2006), California, USA

  20. Howaboutimmunizations? • Spanishstudy (Olivian, 2001) 17 % ofadolescents, age 13-17, hadincompleteimmunizations on medical examination • Canadianstudy (Bartlett et al, 2008) 73 % ofadolescents, age 12-17, incomplete vaccinations

  21. …………and oral health? A majorityofdetainees in thisstudyhadunmet dental treatmentneeds. (Bohlin, 2006), Texas, USA

  22. What happens if society takes responsibility and steps in to protect the child? • When society takes the role of the parent? • What is the role of health care then?

  23. AAP Guidelines2002 – childrenshouldreceive and be assigned…….. • a healthevaluationshortlyafter, if not before, entering foster caretoidentifyanyimmediatemedicalneeds; • a thoroughpediatricassessmentwithin 30 daysofentry; • a consistent source ofmedicalcare (referredto as a “permanent medicalhome”) toensurecontinuityofcare; • ongoingdevelopmental, educational, and emotional assessments.

  24. Fosterbarns Hälsa – Malmö 2010Children i Foster Care - a retrospectivereview • Children, age <16, n= 121 (121/223, 54 %) • Retrospectivestudy • Data obtained from Health records: Child Health Care School Health Care (Kling et al, 2010)

  25. Results Child Health Care • 15 % incompleteimmunizations • 50% missing screening test for vision, age 4 School Health Care • 10 % incompleteimmunizations • 10 % missing screening tests for hearing and vision • 15 % missinghealthdialogue

  26. Conclusions Highrates ofmissing screening tests for hearing and vision Highdrop-out rates for healthdialouges Highpercentageofincompleteimmunizations.

  27. Summary I • Monitoringchilddevelopment, preventive medicine, immunizationagainst preventable diseasesis a complex process. • Optimallyeffectivehealthcare is based on activecollaborationbetweenfamilies and healthcareprofessionals.

  28. Summary II • National Guidelinesfor health supervision provides effectiveapproachestocaring for children and familieswhosehealth and adaption arethoughtto be in the normal range.

  29. Summary III • The highincidenceofsomatichealth problems amongchildrenin care is welldocumented in international litterature. Differentiatingbetweenphysical symptoms oforganic cause and symptoms of a psychosocialnatureis a professionalchallenge

  30. Summary IV • A pediatrichealth supervision visit, includingmedicalinterview, physical examination and screening procedures is an opportunitytoexploreissuesofphysical symptoms and tomanagefailureofpreviousattemptstoaddresshealth prevention and medical problems.

  31. Summary V • All children in foster careneedtoreceive initial health screenings and comprehensiveassessmentsoftheirmedical, mental, dental health and developmental status. • Resultsoftheseassessments must be included in the court-approved service plan.

  32. Yourssincerely –stefan.kling@malmo.se

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