Som första barnklinik i Sverige startar Astrid Lindgrens Barnsjukhus ett barnskyddsteam. Teamet består av specialister som handlägger fall där man misstänker att barn försummats, misshandlats eller utsatts för sexuella övergrepp

Med start under våren, kommer barnskyddsteamet Mio att byggas upp under 2010. Barnskyddsteamet bygger vidare på det arbete som Mio-gruppen startade på Karolinska Universitetssjukhuset 2004, och som fungerat som ett nätverk av olika professioner med lång erfarenhet inom området. Barnskyddsteamet Mio kommer att kunna konsulteras via remiss när det gäller handläggning och utredning av barn som omfattas av socialtjänstlagens anmälningsplikt. I teamet ingår barnläkare, sjuksköterskor och socionom. De är placerade på Astrid Lindgrens Barnsjukhus i Solna, och fungerar som konsulter för dessa ärenden i hela Stockholms läns landsting.

I barnskyddsteamets uppdrag ingår dessutom att bemanna tre av Storstockholms barnahus, Kungsholmen, Huddinge och Sollentuna. Teamet bidrar då med särskild medicinsk och omvårdnadskompetens vid samråd med andra myndigheter, samt ansvarar tillsammans med Rättsmedicinalverket för de rättsmedicinska undersökningarna av barn där polisen utreder brott mot barnet.

Sedan flera år finns barnskyddsteam på barnsjukhusen (Child Protection Team) främst i Nordamerika och i England.

Children whose bones are “older” than their chronological age may be at an increased risk of hypertension, according to a study reported today (19 October) in Hypertension: Journal of the American Heart Association.(1) As a result, the investigators suggest that markers of biological maturity should be evaluated in hypertensive children, and that physical activity and diet may deter the accelerated development of biological maturity.

Behind the study lies the hypothesis that the origins of hypertension are associated with abnormalities of growth and maturation in childhood. This study compared bone age as a marker of biological maturation in hypertensive children with healthy controls closely matched for body mass index (BMI), age and sex, to assess the association between skeletal maturation and hypertension.

The investigators X-rayed the left-hand wrists of 54 untreated hypertensive Polish children (average age 14.2 years) and compared them to X-ray images of 54 children with optimal blood pressure. Both groups were compared with reference images and rates of maturity were defined as physiological, accelerated and delayed.

Results showed that the healthy controls had a mean bone age of 14.7 (±2.3 years), which was not significantly different from their mean chronological age. However, in the group with primary hypertension mean bone age was found to be 16.0 (±2.0) years, reflecting an accelerated rate almost two years more than their chronological age of 14.1 years. The rate of bone age was the strongest predictor of blood pressure status. The investigators proposed that that some lifestyle modifications, such as increased physical activity and diet, might influence both metabolic abnormalities and the tempo of biological maturity.

Commenting on the study on behalf of the European Society of Cardiology, Professor Giuseppe Mancia from the University of Milan-Bicocca in Italy says: “In the last few years there has been much attention given to the traits which may in children and adolescents predict what will happen to their cardiovascular system in later life. We now know, for example, that higher blood pressure values in children predict hypertension in adulthood – and this is also the case with other factors, such as excess body weight (even in neonates) and increased heart rate. So early phenotypes must be considered with great attention, and it is interesting in the present study that this includes bone maturation – that is, something apparently unrelated to cardiovascular and metabolic variables.

“The problem behind the findings on hypertension is when to start intervention, since it is now apparent that associated body changes are already present to some degree at an early stage of life. It is also clear that treatment in adult patients cannot normalise the risk, potentially because hypertension-related changes have already become, at least in part, irreversible. So there are grounds for earlier intervention, and serious implementation of lifestyle changes, such as weight control and exercise, appears justified.”

REFERENCES:

1. Pludowski P, Niemirska A, Sladowska J, et al. Accelarated skeletal maturation in children with primary hypertension. Hypertension 2009; DOI: 10.1161/HYPERTENSIONAHA.109.139949

Lack of health insurance might have led or contributed to nearly 17,000 deaths among hospitalized children in the United States in the span of less than two decades, according to research led by the Johns Hopkins Children’s Center.
According to the Hopkins researchers, the study, to be published Oct. 30 in the Journal of Public Health, is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States.
Using more than 23 million hospital records from 37 states between 1988 and 2005, the Hopkins investigators compared the risk of death in children with insurance and in those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying independent regardless of their medical condition, the study found. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of non-insurance could be even higher.
“If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance,” says lead investigator Fizan Abdullah, M.D., Ph.D., pediatric surgeon at Hopkins Children’s.

The researchers caution that the study looked at hospital records after the fact of death so they cannot directly establish cause and effect between health insurance and risk of dying. However because of the volume of records analyzed and because of the researchers’ ability to identify and eliminate most factors that typically cloud such research, the analysis shows a powerful link between health insurance and risk of dying, they say.
“Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not,” says co-investigator David Chang, Ph.D. M.P.H. M.B.A. “The point here is that a substantial number of children may be saved by health coverage.”
“From a scientific perspective, we are confident in our finding that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance,” he adds.
Given that more than 7 million American children in the United States remain uninsured amidst this nation’s struggle with health-care reform, researchers say policymakers and, indeed, society as a whole should pay heed to their findings.
“Thousands of children die needlessly each year because we lack a health system that provides them health insurance. This should not be,” says co-investigator Peter Pronovost, M.D., Ph.D., director of Critical Care Medicine at Johns Hopkins and medical director of the Center for Innovations in Quality Patient Care. “In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue,” he adds.
In the study, 104,520 patients died (0.47 percent) out of 22.2 million insured hospitalized children, compared to 9, 468 (0.75 percent) who died among the 1.2 million uninsured ones. To find out what portion of these deaths would have been prevented by health insurance, researchers performed a statistical simulation by projecting the expected number of deaths for insured patients based on the severity of their medical conditions among other factors, and then applied this expected number of deaths to the uninsured group. In the uninsured group, there were 3,535 more deaths than expected, not explained by disease severity or other factors. Going a step further and applying the excess number of deaths to the total number of pediatric hospitalizations in the United States (117 million) for the study period, the researchers found an excess of 16,787 deaths among the nearly six million uninsured children who ended up in the hospital during that time.
Other findings from the study:
• More uninsured children were seen in hospitals in the Northeast and Midwest than in the South and West. However, hospitals from the Northeast had lower mortality rates than hospitals from the South, Midwest and West.
• Insured children on average incurred higher hospital charges than uninsured children, most likely explained by the fact that uninsured children tend to present to the hospital at more advanced stages of their disease, which in turn gives doctors less chance for intervention and treatment, especially in terminal cases, investigators say.
• Uninsured patients were more likely to seek treatment though the Emergency Room, rather than through a referral by a doctor, likely markers of more advanced disease stage and/or delays in seeking medical attention.
• Insurance status did not affect how long a child spent overall in the hospital.
The research was funded by the Robert Garrett Fund for the Treatment of Children.
Co-investigators in the study include Yiyi Zhang, M.H.S.; Thomas Lardaro, B.S.; Marissa Black; Paul Colombani, M.D.; Kristin Chrouser, M.D. M.P.H.

Johns Hopkins Medicine