Population child health: understanding and addressing complex health needs.

Advances in paediatric care mean that more children with complex medical problems (heart disease, neurodevelopmental problems and so on) are surviving their early years. This has important implications for the design and delivery of healthcare given their extensive multidisciplinary requirements and susceptibility to poor outcomes when not optimally managed. Importantly, their medical needs must also be understood and addressed within the context of the child and family's life circumstances. There is growing recognition that many other factors contribute to a child's complex health needs (CHNs), for example, family problems, fragmentation of health and care provision, psychological difficulties or social issues.To facilitate proactive care for these patients, we must develop accurate ways to identify them. Whole Systems Integrated Care-an online platform that integrates routinely collected data from primary and secondary care-offers an example of how to do this. An algorithm applied to this data identifies children with CHNs from the entire patient population. When tested in a large inner-city GP practice, this analysis shows good concordance with clinical opinion and identifies complex children in the population to a much higher proportion than expected. Ongoing refinement of these data-driven processes will allow accurate quantification and identification of need in local populations, thus aiding the development of tailored services.

Relationships between Child Development at School Entry and Adolescent Health-A Participatory Systematic Review.

The relationship between child development and adolescent health, and how this may be modified by socio-economic conditions, is poorly understood. This limits cross-sector interventions to address adolescent health inequality. This review summarises evidence on the associations between child development at school starting age and subsequent health in adolescence and identifies factors affecting associations. We undertook a participatory systematic review, searching electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) for articles published between November 1990 and November 2020. Observational, intervention and review studies reporting a measure of child development and subsequent health outcomes, specifically weight and mental health, were included. Studies were individually and collectively assessed for quality using a comparative rating system of stronger, weaker, inconsistent or limited evidence. Associations between child development and adolescent health outcomes were assessed and reported by four domains of child development (socio-emotional, cognitive, language and communication, and physical development). A conceptual diagram, produced with stakeholders at the outset of the study, acted as a framework for narrative synthesis of factors that modify or mediate associations. Thirty-four studies were included. Analysis indicated stronger evidence of associations between measures of socio-emotional development and subsequent mental health and weight outcomes; in particular, positive associations between early externalising behaviours and later internalising and externalising, and negative associations between emotional wellbeing and later internalising and unhealthy weight. For all other domains of child development, although associations with subsequent health were positive, the evidence was either weaker, inconsistent or limited. There was limited evidence on factors that altered associations. Positive socio-emotional development at school starting age appears particularly important for subsequent mental health and weight in adolescence. More collaborative research across health and education is needed on other domains of development and on the mechanisms that link development and later health, and on how any relationship is modified by socio-economic context.

The missing piece of the body? Oral health knowledge and confidence of doctors.

Introduction Many patients present to doctors with oral health conditions and it is, therefore, important that they have the knowledge and skills to give advice and signpost appropriately. Aim To ascertain the baseline knowledge and confidence of doctors in managing oral conditions and to identify topic areas for training.Design A baseline survey was conducted. Two training programmes were then delivered based on the finding of this survey, followed by a post-training survey. Setting North West London training programme for foundation year 1 (FY1) doctors and general medical practitioner (GP) trainees. Intervention The FY1 doctors had a didactic teaching session. The GP trainees had a training session combined with foundation dentists (FDs), comprised of a lecture and small, mixed group work.Main outcomes measured i) post-training confidence in managing oral conditions, answering patients' questions regarding oral health and signposting patients; ii) the most useful and relevant topics of the training for their daily practice.Results The majority of the doctors had previously received no oral health teaching. Furthermore, the majority did not feel confident at managing oral conditions or signposting patients appropriately. Common topic areas were identified where doctors wanted more oral health teaching. Conclusions FY1 and GP trainees lack knowledge and confidence with regard to the management of oral health issues and recognise that there is a need to know about oral health. This work highlights the need for structured training to equip doctors with appropriate oral health knowledge and skills.