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      Utilization of paediatric and general medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

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          Abstract

          In Germany, specialists in paediatrics and general medicine in private practices provide the bulk of outpatient treatment. Data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) surveyed the ambulatory attendance of paediatric and general medical services for 0- to 17-year-old children and adolescents. During the last 12 months, 72.8% of girls and 72.7% of boys have made use of outpatient paediatric treatment and 25.9% of girls and 24.6% of boys have made use of outpatient general medical services. Attendance rates in paediatric practices decrease with age, whereas those of general medical practices increase. While no relevant differences between genders exist, rural areas evidence significantly lower paediatric practice and significantly higher general medical practice attendance rates. Compared to the data collected in the previous KiGGS studies, the trend over the last ten years approximately indicates an increase in the use of paediatric services and a decrease in the use of general medical services.

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          Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?

          The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
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            Mental health surveillance among children--United States, 2005-2011.

            Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%-20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994-2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12-17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005-2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.
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              The rise in chronic conditions among infants, children, and youth can be met with continued health system innovations.

              Since the early twentieth century, medical and public health innovations have led to dramatic changes in the epidemiology of health conditions among infants, children, and youth. Infectious diseases have substantially diminished, and survival rates for children with cancer, congenital heart disease, leukemia, and other conditions have greatly improved. However, over the past fifty years chronic health conditions and disabilities among children and youth have steadily risen, primarily from four classes of common conditions: asthma, obesity, mental health conditions, and neurodevelopmental disorders. In this article we describe the epidemiological shift among infants, children, and youth and examine sociodemographic and other factors contributing to it. We describe how health systems are responding by reorganizing and innovating. For children with rare complex conditions, concentrating subspecialty care at regional centers has been effective. For the much larger numbers of children with common chronic conditions, primary care providers have expanded diagnosis, treatment, and management options in promising ways.
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                Author and article information

                Journal
                J Health Monit
                J Health Monit
                JoHM
                Journal of Health Monitoring
                Robert Koch Institute (Nordufer 20 13353 Berlin, Germany )
                2511-2708
                12 December 2018
                December 2018
                : 3
                : 4
                : 52-61
                Affiliations
                Robert Koch Institute , Berlin, Department of Epidemiology and Health Monitoring
                Author notes
                Corresponding author Stefanie Seeling, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail: SeelingS@ 123456rki.de
                Article
                10.17886/RKI-GBE-2018-099
                8852780
                35586147
                64a73b82-4317-4945-98da-8c2b55e18e63
                © Robert Koch Institute. All rights reserved unless explicitly granted.

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 31 July 2018
                : 01 October 2018
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 27, Pages: 10
                Funding
                Funded by: Federal Ministry of Health
                Award Recipient : KiGGS
                Funded by: Robert Koch Institute
                Award Recipient : KiGGS
                KiGGS is funded by the Federal Ministry of Health and the Robert Koch Institute.
                Categories
                Fact Sheet

                children and adolescents,utilization of outpatient services,paediatrics,general medicine,health monitoring

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