{"id":299,"date":"2023-05-07T09:46:36","date_gmt":"2023-05-07T07:46:36","guid":{"rendered":"https:\/\/mattirimpela.fi\/?p=299"},"modified":"2023-05-07T11:56:08","modified_gmt":"2023-05-07T09:56:08","slug":"vaitos-helsingin-yliopistossa-12-5-2023-pitaisiko-maaraaikaisista-koululaakarintarkastuksista-luopua-kohdennetuista-tarkastuksista-enemman-hyotya","status":"publish","type":"post","link":"https:\/\/mattirimpela.fi\/index.php\/2023\/05\/07\/vaitos-helsingin-yliopistossa-12-5-2023-pitaisiko-maaraaikaisista-koululaakarintarkastuksista-luopua-kohdennetuista-tarkastuksista-enemman-hyotya\/","title":{"rendered":"V\u00e4it\u00f6s Helsingin yliopistossa 12.5.2023. ”Pit\u00e4isik\u00f6 m\u00e4\u00e4r\u00e4aikaisista koulul\u00e4\u00e4k\u00e4rintarkastuksista luopua? Kohdennetuista tarkastuksista enemm\u00e4n hy\u00f6ty\u00e4”"},"content":{"rendered":"

Terveyspalvelujen arvioinnissa yksi keskeisist\u00e4 kysymyksist\u00e4 on ollut palvelujen suuntaaminen: Tulisiko niit\u00e4 suunnata my\u00f6s koko v\u00e4est\u00f6\u00f6n (universaalipalvelut, v\u00e4est\u00f6strategia) vai olisiko tehokkaampaa suunnata voimavarat riskitekij\u00f6iden ja tautien tunnistamiseen ja hallintaan (riski\/ongelmasuuntautuneet palvelut).<\/span><\/h3>\nN\u00e4m\u00e4 kysymykset nousevat ajankohtaisiksi, kun Helsingin yliopistossa tarkastetaan 12.5.2023 v\u00e4it\u00f6stutkimusta. Kirsi Nikander ROUTINE GENERAL HEALTH CHECKS BY SCHOOL PHYSICIANS IN PRIMARY SCHOOLS: NEEDS AND BENEFITS.\n\n”The objective of this thesis was to evaluate the benefts and harms of school physician routine health checks in primary school grades one and fve (at ages seven and eleven years) and to explore whether school physician expertise could be targeted to those children that parents, teachers, or school nurses are concerned about.” \u201dThe concerns remaining after the school nurse health check could be the basis for multidisciplinary evaluation of the most suitable professional\/professionals to provide help instead of all children and families meeting a physician.\u201d\n\n\u201dIn my opinion, the law change should be implemented in such a way that physicians are not reduced from school health care. When targeting the amount of school physicians per region, service organisers should take into account the educational level of the guardians, the income level of the families and the immigrant background of the children of each school. The school nurses can strengthen the resources, health and well[1]<\/span><\/span>being of every child and family. The school physician\u2019s assessment should be aimed at those who need it most in all age groups.\u201d\n\n\n

Pit\u00e4isik\u00f6 m\u00e4\u00e4r\u00e4aikaisista koulul\u00e4\u00e4k\u00e4rintarkastuksista luopua? Kohdennetuista tarkastuksista enemm\u00e4n hy\u00f6ty\u00e4 | Helsingin yliopisto (helsinki.fi)<\/a><\/p>\nAlussa esitetyst\u00e4 enemm\u00e4n esimerkiksi: Susan B. Rifkin, Gill Walt: Why health improves: Defining the issues concerning \u2018comprehensive primary health care\u2019 and \u2018selective primary health care\u2019. Social Science & Medicine<\/span><\/a>. Volume 23, Issue 6<\/span><\/a>, 1986,\nPages 559-566: \u201dThe purpose of this paper is to explore these questions in depth. It begins by giving the background to the debate, then examines the origins of two concepts which have dominated the field, those of \u2018primary health care\u2019 and \u2018selective primary health care.\u2019 On this basis it suggests areas of differences in the two concepts and discusses the policy and practical\nimplications of confusing the two approaches. The paper suggests that the differences are firstly who controls the outcome of technological interventions and the perceived time frame in which plans can be carried out.\u201d\n

Yliopiston tiedote<\/h3>\nYliopiston tiedotteessa v\u00e4it\u00f6stutkimuksen tulosten tulkinta on tiivistetty otsikkoon ja t\u00e4smennet\u00e4\u00e4n n\u00e4in: ”Helsingin yliopistossa valmistuneessa tuoreessa v\u00e4it\u00f6stutkimuksessa selvitettiin alakouluik\u00e4isten m\u00e4\u00e4r\u00e4aikaisten l\u00e4\u00e4k\u00e4rintarkastusten hy\u00f6tyj\u00e4 ja haittoja. Tulosten mukaan m\u00e4\u00e4r\u00e4aikaisista koulul\u00e4\u00e4k\u00e4rintarkastuksista on hy\u00f6ty\u00e4 vain osalle oppilaista. Alakouluik\u00e4isten l\u00e4\u00e4k\u00e4rintarkastukset kannattaisi tutkimuksen mukaan kohdentaa oppilaisiin, joista vanhemmilla tai ammattilaisilla on huolta. N\u00e4in koulul\u00e4\u00e4k\u00e4riresurssia vapautuisi todettujen ongelmien hoitoon.”\n\n”Tutkimuksessa kartoitettiin vanhempien, opettajien ja kouluterveydenhoitajien kokemaa huolta lapsista kyselylomakkeilla<\/span><\/em>, jotka he t\u00e4yttiv\u00e4t kouluterveydenhoitajan tarkastuksen j\u00e4lkeen. Noin puolesta lapsista oli jokin merkitt\u00e4v\u00e4 huoli. Kolme suurinta huolta olivat joko kasvu tai fyysinen oire tai molemmat, tunne-el\u00e4m\u00e4 ja keskittymisen haasteet.\n\n\n

L\u00e4\u00e4k\u00e4rit tekiv\u00e4t tarkastuksensa kaikille oppilaille normaalin k\u00e4yt\u00e4nn\u00f6n mukaisesti tiet\u00e4m\u00e4tt\u00e4 lomakkeiden sis\u00e4lt\u00f6\u00e4. Sen j\u00e4lkeen\nl\u00e4\u00e4k\u00e4rit arvioivat tarkastuksen hy\u00f6ty\u00e4 tai haittaa ennalta annettujen kriteereiden mukaan.<\/i> Toimenpiteet, jotka kouluterveydenhoitaja olisi pystynyt hoitamaan tai joiden hoitamatta j\u00e4tt\u00e4misest\u00e4 ei olisi seurannut merkitt\u00e4v\u00e4\u00e4 haittaa,<\/i> luokiteltiin kategoriaan ei hy\u00f6ty\u00e4<\/span><\/em>. \u201dL\u00e4\u00e4k\u00e4rit arvioivat vain noin 40 prosenttia l\u00e4\u00e4k\u00e4rintarkastuksista hy\u00f6dyllisiksi,<\/span><\/em> Nikander kertoo.\u201d<\/p>\n\n

Tutkimuksessa tarkasteltiin aikuisten kyselylomakkeisiin kirjaamia huolia ja arvioitiin l\u00e4\u00e4k\u00e4rintarkastuksen tarvetta niiden\nperusteella. Kyselylomakkeiden avulla m\u00e4\u00e4ritelty l\u00e4\u00e4k\u00e4rintarkastuksen tarve ennusti hyvin koulul\u00e4\u00e4k\u00e4rin arvioimaa hy\u00f6ty\u00e4 tarkastukselle. \u201dVanhempien ja ammattilaisten t\u00e4ytt\u00e4m\u00e4\u00e4 ennakkokysely\u00e4 voisi k\u00e4ytt\u00e4\u00e4 tunnistamaan ne lapset, jotka voivat hy\u00f6ty\u00e4 l\u00e4\u00e4k\u00e4rintarkastuksesta ja siten vapauttaa koulul\u00e4\u00e4k\u00e4riresurssia l\u00e4\u00e4k\u00e4rin ammattitaitoa vaativien ongelmien selvittelyyn\nja hoitoon, Nikander summaa.”<\/p>\n\n

Keskeisist\u00e4 k\u00e4sitteist\u00e4<\/h3>\n

Aloittaessani uuden tutkimuksen lukemisen yrit\u00e4n ensiksi l\u00f6yt\u00e4\u00e4 otsikosta ja tiivistelm\u00e4st\u00e4 sen keskeisimm\u00e4t k\u00e4sitteet.<\/i><\/b>\nN\u00e4in etsittyn\u00e4 t\u00e4ss\u00e4 tutkimuksessa ensimm\u00e4iseksi tulee ”routine general health check”. <\/i><\/b>Hakutermin\u00e4 se tuotti tutkimusraportista kaksi tekstiosumaa: Ensimm\u00e4inen metodipohdinnassa sivulla 65: ”The data were collected before the COVID-pandemic with a high participation rate in a normal setting of children\u2019s routine general health checks.” Ja toinen p\u00e4\u00e4telmien yhteydess\u00e4 sivulla 69:”Parent, teacher, and nurse concerns are valuable predictors of school physician actions in routine general health checks. ”<\/p>\nGoogle Scholarista sama hakutermi tuotti ilman aikarajausta 61 osumaa. Vuosilta 2019\u20132023 l\u00f6ytyi 12 osumaa, joista nelj\u00e4 oli v\u00e4ittelij\u00e4n tutkijaryhm\u00e4n julkaisuja.\n\nSeuraavaksi hain tutkimusraportista osumia ’routine health check” <\/i><\/b>hakutermill\u00e4. Tekstiosumia tuli yhdeks\u00e4n. Huomioni kiinnittyi kolmanteen ja viidenteen tutkimuskysymykseen: ”What actions do school physicians undertake in routine health checks? (Study III)\u201d ” How are parent, teacher, and nurse concerns associated with schoolphysician actions? (Study IV).\n\nN\u00e4m\u00e4 tutkimuskysymykset palauttivat mieleen johdannon ensimm\u00e4isen kappaleen sivulla 12: ”School health services provide an excellent opportunity to prevent, detect, and treat precursors to future disorders in close collaboration with the educational sector. This may improve both health and education outcomes and be cost benefcial (7\u201314). Actions that infuence the home, communities and schools are required (15). In 2016, the Lancet commission on adolescent health and wellbeing highlighted that the most effective actions for adolescent health and wellbeing are intersectoral and multicomponent (16)”\n\n”Actions” tuli keskeisten k\u00e4sitteiden joukkoon. <\/i><\/b>Yksin\u00e4\u00e4n se tuotti raportista 66 osumaa useissa eri yhteyksiss\u00e4. Muutama\npoiminta: Sivu 14: ”The professionals recommended scientifc research on the effectiveness of sc<\/strong><\/em>hool health care actions <\/b><\/i>on\nchildren\u2019s health and estimating the unintended efects of school health care actions.”\n\n\n

Sivu 20: ”However, the border between secondary and tertiary prevention and treatment of diseases may be difcult to distinguish and cause diferences between municipalities in providing actions related to health checks<\/b>.\u201d<\/p>\n

Sivut 36\u201337: \u201dAn electronic report for physicians to report all<\/i><\/b> their actions during the health check<\/i><\/b> and their evaluation of the beneft or harm of the health check was developed (Tables 3-5). Patient-reported experience measures (PREMs) for the parent and child to evaluate the beneft or harm of the physician\u2019s health check without previously defned criteria were developed (Table 6)\u201d<\/p>\n

Sivu 39: \u201d The trainings included description of the background and aim of the study, material and methods, and of the specifc\nactions required from each professional<\/i><\/b>. The main topics of school physician training included reporting school physician actions <\/i><\/b>and the criteria of beneft.\u201d<\/p>\n

Sivu 41: \u201dAfter each health check the physicians had 5-minutes of extra time to report electronically the details of the actions they undertook during the health check and to evaluate the beneft or harm of the health check according to given criteria<\/i><\/b>.<\/p>\n\n

Sivu 43: \u201dWe categorised the school physician actions into six groups<\/i><\/b>: instructions and\/or signifcant discussions,  prescriptions, laboratory tests and\/or medical imaging, scheduling of follow-up appointments in school health services, referrals to other professionals and referrals to specialised care.\u201d<\/p>\n

Sivu 48: \u201dThe physicians conducted actions <\/i><\/b>for 78% of the 1013 children.\u201d<\/p>\n

Sivu 54: Physicians considered 52% of the health checks with any action <\/i><\/b>benefcial (quite a lot of beneft or a great deal of beneft) and none of the health checks with no actions<\/i><\/b> benefcial.\u201d<\/p>\n

Sivu 54: \u201dPhysicians conducted actions <\/u><\/i><\/b>in four fifths of the health checks. Most actions<\/u> focused on physical health.\u201d<\/b><\/i><\/p>\n

Sivu 55: \u201dPhysicians reported half and parents almost 90% of the health checks with actions<\/i><\/b> benefcial. Both physicians and\nparents more often estimated the appointments with actions <\/i><\/b>benefcial than the appointments without actions.<\/p>\n

Sivu 63: \u201dThe appointments with actions <\/i><\/b>that usually require medical training (prescriptions, laboratory tests and\/or medical imaging, and referrals to specialised care) were most strongly associated with physician-evaluated beneft. The physicians estimated none of the health checks without actions benefcial<\/b>.\u201d<\/p>\n

Sivu 65: \u201dCriteria for physician evaluated beneft of the health check were based on actions that require physician\u2019s expertise<\/i><\/b>.\u201d\u2019<\/p>\n

Sivu 68: \u201dPhysicians particularly valued the health checks where actions required their medical competence.\u201d<\/p>\n

Sivu 66: Further studies on the long-term efectivenessand cost-efectiveness of school nurse and physician actions are needed<\/p>\n

\u201dBenefit\u201d ja \u201dneed\u201d olivat my\u00f6s keskeisi\u00e4 k\u00e4sitteit\u00e4<\/u><\/i><\/b>. Edellinen tuotti 150 osumaa ja j\u00e4lkimm\u00e4inen 95. Vain muutama\npoimintaa molemmista:<\/p>\n

\u201dBenefit\u201d<\/i><\/b>\nSivu 34: \u201dIn Finland, scientifc evidence regarding the benefts of school physicians assessing the health of all children in addition to health checks by school nurses is lacking<\/i><\/b>. Evidence on whether school physician assessments could be ofered as targeted actions in response to the concerns of parents, teachers, and school nurses is needed.\u201d<\/p>\n

Sivu 45: \u201dWhat is the beneft or harm of the school physician health check according to predetermined criteria<\/i><\/b> used by school physicians and the patient-reported experience measures of parents and children? How is study-questionnaire-assessed need associated with school physician-evaluated beneft<\/i> of routine health checks? (Study II) 7) How are school physician actions associated with the beneft of the health check assessed by school physicians and parents<\/i><\/b>?<\/p>\n

Sivu 43: \u201dThe beneft\/harm of the appointment was estimated by the physicians<\/i><\/b> on a seven[1]<\/span><\/span>point Likert scale according to the predetermined criteria shown in Table 2 of Study I. The physicians estimated quite a lot or a great deal of beneft if they considered the physician\u2019s role irreplaceable by nurse.\u201d<\/p>\n

Sivu 61: \u201dParents evaluated most health checks as benefcial.\u201d <\/i><\/b><\/p>\n

Sivu 62: \u201dPhysicians estimated half of the health checks where they undertook actions benefcial<\/i><\/b>. The physicians may have\nconsidered that the school nurse or another professional could have conducted the action as well. \u201d<\/p>\n

Sivu 63: \u201d The appointments with actions that usually require medical training (prescriptions, laboratory tests and\/or medical\nimaging, and referrals to specialised care) were most strongly associated with physician-evaluated beneft<\/em>.\u201d<\/p>\n

\u201dNeed\u201d<\/i><\/b>\nSivu 6: \u201dWe assessed the need for a health check<\/i><\/b> by the physician based on the respondents\u2019 concerns using predetermined criteria<\/i><\/b>.\u201d<\/p>\n

Sivu 10: \u201dWhat is the need for school physician health check? Altogether, 20-25% of the children had no need for a school\nphysician health check<\/i><\/b>.\u201d<\/p>\n

Sivu 11: \u201dHow is study-questionnaire-assessed need associated with school physician-evaluated beneft of routine health checks? The need for a health check was associated with physician-evaluated beneft of the health check<\/i><\/b>.\u201d<\/p>\n

Sivu 18: \u201d The health checks aim for 1) strengthening the resources, health and well-being of the child and the whole family, 2) early  identifcation of needs for support<\/i><\/b>, 3) ensuring timely provision and organisation of support, and 4) preventing marginalisation and enhancing health equity .\u201d<\/p>\n

Sivu 35: \u201dWhat is the n<\/i><\/b>eed for school physician health check based on study questionnaires <\/i><\/b>that assess the concerns of\nparents, teachers, and school nurses? (Study II)\u201d \u201dHow is study-questionnaire-assessed<\/b> need associated with school\nphysician-evaluated beneft of routine health checks? (Study II)\u201d Sivut 41\u201342: We estimated the need for a health check<\/i><\/b>\nbased on the categorisation of study questionnaire responses of parents, teachers, and nurses\u201d \u201dWe also performed an exploratory analysis of the need for a health check by a school physician according to the final wish-question of the study questionnaires.<\/i><\/b> For parents, the question read: \u201cDo you wish to speak with the school doctor about these concerns or some\nother concern related to the child\u2019s well-being?\u201d For teachers and nurses, the question was: \u201cDo you wish the school doctor to address these concerns or some other concern related to the well-being of the pupil?\u201d<\/p>\n

Sivu 47: \u201dTaking into account all questionnaire responses, 212 children (20.9%) had no need for a health check by a school\nphysician.\u201d<\/i><\/b><\/p>\n\n

Mit\u00e4 viel\u00e4?<\/h3>\n

T\u00e4m\u00e4n vaiheen j\u00e4lkeen tarkistin viel\u00e4 pari k\u00e4sitett\u00e4, jotka tuntuivat minusta mielenkiintoisilta t\u00e4m\u00e4n tutkimuksen\nyhteydess\u00e4:<\/i><\/b><\/p>\n

\u201dQuality of school health\u201d -> kolme tekstiosumaa<\/p>\n

\u201dQuality of health check\u201d -> nolla osumaa<\/p>\n

\u201dQuality of action\u201d – > nolla osumaa<\/p>\n

\u201dHealth education\u201d -> viisi tesktiosumaa<\/p>\n

\u201dFamily\u201d -> 43 osumaa<\/p>\n

 <\/i><\/b><\/p>","protected":false},"excerpt":{"rendered":"

Terveyspalvelujen arvioinnissa yksi keskeisist\u00e4 kysymyksist\u00e4 on ollut palvelujen suuntaaminen: Tulisiko niit\u00e4 suunnata my\u00f6s koko v\u00e4est\u00f6\u00f6n (universaalipalvelut, v\u00e4est\u00f6strategia) vai olisiko tehokkaampaa suunnata voimavarat riskitekij\u00f6iden ja tautien tunnistamiseen ja hallintaan (riski\/ongelmasuuntautuneet palvelut). …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-299","post","type-post","status-publish","format-standard","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/posts\/299","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/comments?post=299"}],"version-history":[{"count":11,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/posts\/299\/revisions"}],"predecessor-version":[{"id":318,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/posts\/299\/revisions\/318"}],"wp:attachment":[{"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/media?parent=299"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/categories?post=299"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mattirimpela.fi\/index.php\/wp-json\/wp\/v2\/tags?post=299"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}