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Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

This study is part of a larger project, which aims to develop medicine education materials for teachers. The aim of the present study was to discover children's interests in medicines and teachers' opinions on what should be taught about medicines to children of different ages. Furthermore, teachers' opinions were assessed about the importance of medicine education as a part of school health education. The aim of the recommendations, based on our research and the materials developed during this process, is to clarify what proper use of medicines can mean, and in this way help teachers fulfil the requirements of the new Finnish health education curriculum.

Twelve focus group discussions were conducted among a convenience sample of first‐graders (7‐8 years, n=23), fourth‐graders (10‐11 years, n=24) and seventh‐graders (13‐14 years, n=19). A national representative survey was conducted to gather data from the teachers (n=284, response rate 71 percent).

Children's interests and teachers' opinions on what could be taught about medicines to children of different ages were quite similar. However, fourth‐graders were interested in many topics which teachers considered suitable for older children, for example, how medicines work, how to avoid adverse reactions, and abuse of medicines. The vast majority of the teachers (93 percent) considered teaching about the proper use of medicines so important that it should be included in the national curriculum of health education. Of the children, fourth‐graders were the most interested in medicines.

This is one of the first studies, which combine the opinions of children and teachers, on what to teach children of different ages about the proper use of medicines. During the study, evidence‐based recommendations on what to teach children about medicines and teaching materials were created.

The purpose of this paper is to contribute to the development of medicine education by examining pupils’ perceptions of medicines and medicine use.

Fourth graders’ (n=51, aged 10-11) perceptions about medicines and their use were collected in one school through mixed-methods using a questionnaire, a drawing and discussions.

Listing several over-the-counter medicines, pupils most frequently perceived that medicines are meant for treating headaches, wounds or temporarily when they are sick or have some pain, and that medicines help to ease symptoms and speed recovery. Pupils mentioned getting information about medicines from the pharmacist, the internet, the physician, as well as from medical packages.

This study was carried out in one school context and is therefore not necessarily generalizable, it does, however, bring an awareness of concrete pedagogical needs to the debate on health education and was conducted using methods that, to some extent, can be transferred to any school setting.

These results show that medicine education should already be started in primary school, along with critical thinking skills related to use of the internet.

The development of medicine education may help improve the wellbeing of pupils.

The triangulation of data used in the paper are in the authors’ awareness unique in the context of medicine education. The results particularly highlight the role of the internet in medicine education, thus suggesting the importance of critical thinking.

The aim of this study is to investigate teachers' attitudes towards medicines and to determine what they are willing to teach children about medicines. This study is part of a larger project where medicine education materials accessible on the internet (www.uku.fi/laakekasvatus, in Finnish with English introduction) were designed, developed, and evaluated.

The data were collected from a convenience sample of primary (n=11) and junior secondary (n=3) schoolteachers who attended three focus group discussions (FGDs). Before the FGDs, the teachers had taught three medicine education sessions based on medicine education curriculum materials to their own classes.

Three different types of teachers were found: empowering (n=6), paternalistic (n=6), and material evaluating (n=2). An empowering teacher was ready to facilitate the empowerment of children as medicine users. A paternalistic teacher wanted to teach children the dangers of medicines and also the importance of a healthful lifestyle. The material evaluating type of teacher commented mainly on the usefulness of the medicine education materials without expressing any attitude towards medicines.

Because of the small number of teachers participating in this study, it may be regarded as a pilot study that generated a hypothesis. Results need to be verified with a larger sample of teachers and with quantitative research methods before generalizations can be made.

This study suggests a need to educate teachers about what medicine education is and how it could be taught with an empowering approach.

A medicine education web site was developed during a research project in 2002–2004 to help teachers in primary and junior secondary schools to teach children the proper use of medicines. However, there was a need to develop further the assignments for the youngest schoolchildren. The aim of this study is to evaluate the usefulness of three medicine education assignments created for seven to nine year‐old children, and to describe how children experienced them.

Triangulation of two methods was used: ten observed lessons and eight focus group discussions (FGD) with children (n=46). Two researchers observed medicine education lessons given by four primary school teachers. After these lessons, the children were interviewed in focus group discussions.

Teachers used the assignments in various ways. It became clear in the observations that the children enjoyed the assignments and that they did not feel embarrassed about the topics discussed. During the FGDs, they discussed topics related to learning objectives generally in a good and extensive way. Moreover, the children remembered the main messages to be learnt.

The medicine education assignments developed for seven to nine year‐old children are useful and feasible, and furthermore, they are flexible and can be used in different situations with different groups of children.

From an ethical point of view, the inclusion of children and young people in research is problematic due to their inability to give informed consent and meaningfully express their views. The ethical aspects of research are multiplied if the research participant might have experienced child abuse, neglect, exploitation, or other forms of violence or assisted in such acts. Talking about victimization might be difficult and generate a sense of betrayal of attachment figures. On the other hand, the usual ethical procedure of asking parents or other caretakers to give consent for their children to discuss issues of maltreatment gives them the power to act as gatekeepers to stop children from participating in research. Therefore, researchers should contemplate if parental consent should be waived and how research can be developed to mobilise children's agency and ensure their meaningful cooperation in researching different aspects of violence that affect them. This chapter presents and critically analyses different research examples and discusses their ethical dimensions from a children's rights perspective. The research questions start with discussing the utility of consulting children in research on maltreatment; the gatekeeping role of caregivers; the distress and harm eventually caused to children and young people by participation in research and the benefits of participation for children. The survey examples discussed lead to the conclusions that research on maltreatment might sometimes cause distress; caregivers' power to refuse consent for their children's participation in research on maltreatment can alter epidemiologic data and impede children's right to express their opinion on issues that are central to their lives and therefore, it should be waived; consulting children is essential for collecting data on and improving responses to child maltreatment; and children's contribution to research on maltreatment depends on the adopted methodologies of the research, more advanced forms of participation, and training children to express their opinions, thus enriching scientific knowledge and promoting change.

ADHD is the commonest neurodevelopmental disorder of children and adolescents. ADHD is no longer conceptualized as a predominantly childhood disorder but is a chronic disorder that persists into adolescence and adulthood. The paper aims to analyse the transitional care of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. The paper also seeks to review current practice and to design a multi‐disciplinary transitional care pathway to adult services for adolescents with complex health needs based on best practice and available clinical guidelines.

Adolescents diagnosed with ADHD from childhood who were eligible for transition to adult ADHD services and who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied by a retrospective analysis of their clinical records. The current transitional care pathway was reviewed and revised.

Out of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transition to adult services. A total of 19 patients (18 per cent) were referred to CAMHS. A total of 68 adolescents (65 per cent) were discharged from the paediatric services following voluntary discontinuation of medications and non‐attendance at follow‐up clinics. Only 16 patients (15 per cent) were successfully referred to the specialist adult ADHD services (three of them already discharged). A multi‐disciplinary transitional care pathway to adult services for young people with complex health needs and learning difficulties and information for the carers and young people have been designed and adopted in the local city borough, agreed by all the stakeholders.

A total of 73 per cent of eligible patients were either discharged or lost to follow‐up. There must be some flexibility in the referral pathway to the adult ADHD services to allow some of the adolescents who were previously lost to follow‐up to be re‐referred by other primary or secondary care healthcare professionals if the need arises in the future.

The paper shows that there is a high rate of discontinuation of medications, loss to follow‐up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood.