New Morbidity and Zeitgeist

2021 ◽  
pp. 89-105
Author(s):  
Franz Resch ◽  
Peter Parzer
Keyword(s):  
New Morbidity

Identification and Management of Psychosocial and Developmental Problems in Community-Based, Primary Care Pediatric Practices

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 480-485 ◽  
Author(s):  
Sarah McCue Horwitz ◽  
Philip J. Leaf ◽  
John M. Leventhal ◽  
Brian Forsyth ◽  
Kathy Nixon Speechley
Keyword(s):  
Primary Care ◽  
Child Behavior Checklist ◽  
Social Issues ◽  
Young Patients ◽  
Well Being ◽  
World Health ◽  
Developmental Problems ◽  
Active Intervention ◽  
Health Organization ◽  
New Morbidity

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problem in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P ≤ .05). The data suggest that, when asked to use a taxonomy appropriate for primary care, clinicians recognize problems in many 4- to 8-year-old children (515/1886; 27.3%). This rate is considerably higher than the rates previously reported. Further, many children with identified problems (56%) were reported by their clinicians to receive some form of active intervention. Characteristics of the visit (type of visit, clinician's knowledge of a child) that influence the recognition of problems were also identified. These results suggest that investigators must define what types of problems they are interested in and under what circumstances to determine accurately what pediatric practitioners know about psychosocial and developmental problems in their young patients and families.

Osteoporosis: A "New Morbidity" for Dieting Female Adolescents?

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 478-480
Author(s):  
Richard E. Kreipe ◽  
Gilbert B. Forbes
Keyword(s):  
Bone Mass ◽  
Thoracic Kyphosis ◽  
The United States ◽  
Female Adolescents ◽  
Vertebral Compression Fractures ◽  
Bone Bank ◽  
Physical Finding ◽  
Compression Fractures ◽  
Skeletal Mass ◽  
New Morbidity

Almost half of the adult skeletal mass is laid down during the adolescent years. The concept of the "bone bank" reminds us that "deposits" of calcium are normally made to the skeleton until about 35 years of age in females. Subsequently, there are continuous "withdrawals" of bone mineral and loss of skeletal mass, eventually resulting in osteopenia (significantly reduced bone mass) and osteoporosis (osteopenia associated with atraumatic fractures) in more than 20 million postmenopausal women, at an annual cost of $7 to 10 billion in the United States.1 Because there is no cure, prevention of the most common and conspicuous physical finding of adult osteoporosis, the so-called "dowager's hump" (marked thoracic kyphosis due to vertebral compression fractures), as well as the more serious complications, such as hip fractures, must focus on optimizing the peak bone mass and maintaining the skeletal mass.

Vaginal Discharge of `Beads' and the New Diapers

PEDIATRICS ◽  
1988 ◽  
Vol 81 (2) ◽  
pp. 332-332
Author(s):  
MARY ELLEN RIMSZA ◽  
JAMES J. CHUN
Keyword(s):  
Growth And Development ◽  
Vaginal Discharge ◽  
Good Health ◽  
New Morbidity

To the Editor.— We report on a "new morbidity" associated with "supra-absorbent" paper diapers, which we term "beaded" vaginal discharge. A 4-month-old girl was referred to Maricopa Medical Pediatric Gynecology Clinic because of "discharging clear beads" from her vagina. This discharge had been a daily occurrance. The beads were described by the mother as being approximately 1 mm in diameter, clear, colorless, firm, but compressible. The child had been in good health since birth. Growth and development were normal.

Diagnosing and Treating Health: Bright Futures

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 998-1000
Author(s):  
MORRIS GREEN ◽  
SAMUEL S. KESSEL
Keyword(s):  
Causes Of Death ◽  
The United States ◽  
Childhood Mortality ◽  
Contextual Influences ◽  
Childhood Diseases ◽  
Health Supervision ◽  
Bright Futures ◽  
Cursory Examination ◽  
New Morbidity ◽  
Century Health

As pediatric historian Tom Cone, Jr, has pointed out, at the beginning of the 20th century "health supervision of children—if it existed at all—consisted of a cursory examination to detect contagious disease. Physicians confined their efforts to the child when sick rather than the child when well."1 Of course, there has been much progress since the early 1900s. Today, for example, the childhood mortality rate is nearly 25 times less than it was in 1900, when the principal cause of death was infection. While many of the serious childhood diseases have all but disappeared as the chief causes of death in the United States, we have come to appreciate what Robert Haggerty termed the "new morbidity" largely resulting from social, behavioral, economic, psychosocial, and contextual influences.

The New Morbidity: Use of School and Community Health Care Resources for Behavioral, Educational, and Social-Family Problems

PEDIATRICS ◽  
1981 ◽  
Vol 67 (1) ◽  
pp. 53-60
Author(s):  
Philip R. Nader ◽  
Laura Ray ◽  
Susan G. Brink
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Care ◽  
Health Care Resources ◽  
Family Problems ◽  
Educational Personnel ◽  
School And Community ◽  
Use Of Services ◽  
New Morbidity ◽  
Demand For Health

The extent of the use of services for the new morbidity, that is, children's behavioral, educational, and family-social problems, has not previously been the subject of a community-based prospective study. The demographic characteristics and utilization of school and community health care resources over a two-year period are compared for two groups selected from a random sample (n = 671) of elementary school children. Twentyfour percent (n = 164) were observed to have behavioral, educational, or social-family problems requiring attention or intervention by health or educational personnel. This group was compared to their schoolmates (n = 507) not so identified. Although no overall differences in sex, ethnic background, or family structure were identified, the children with new morbidity problems were more frequently in the lowest socioeconomic group, and had lower reading achievement scores and higher rates of absenteeism. The new morbidity group also had higher rates of utilization of services both at school and at community sites of health care, not only for new morbidity complaints, but for other problems as well. The data suggest that this portion of the school-aged population places a significant demand for health care resources on both community and school sites. The findings support the need for training of physicians in the care and prevention of such problems.

Physician Involvement Strategies to Promote the Medical Home

PEDIATRICS ◽  
1990 ◽  
Vol 85 (1) ◽  
pp. 128-130
Author(s):  
CALVIN C. J. SIA ◽  
MARGO I. PETER
Keyword(s):  
Medical Home ◽  
Care Needs ◽  
Community Based ◽  
Special Health Care ◽  
Call To Action ◽  
Surgeon General ◽  
Childhood Morbidity ◽  
New Morbidity ◽  
Family Centered ◽  
Special Health

The changing nature of childhood morbidity has been addressed by a number of pediatricians.1-3 The "new morbidity" heralds an era of pediatrics characterized by prevention and early intervention strategies in the care of young children. In 1987, Surgeon General C. Everett Koop, MD, established a national agenda to promote optimal services for children with special health care needs.4 He issued a call to action for professionals to develop and provide services that are family centered, community based and coordinated. Richard M. Narkewicz, MD, immediate past president of the American Academy of Pediatrics (AAP), called this "a timely and commendable goal that the AAP shares" and advocated for pediatricians to provide a medical home for all children.5

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