Sociaal economische gezondheidsverschillen kunnen worden gereduceerd door het verminderen van gezondheidsrisico’s en het verhogen van onderwijskansen. Bij dit laatste is omvangrijk schoolverzuim een risicofactor. Door aandacht te besteden aan schoolverzuim wegens ziekte levert de jeugdgezondheidszorg een bijdrage aan de gezondheid, het welbevinden en de onderwijskansen van jongeren en daarmee aan het terugdringen van sociaal economische gezondheidsverschillen. De GGD West-Brabant heeft in een pilot de interventie M@ZL (Medische Advisering Ziekgemelde Leerling) voor de aanpak van ziekteverzuim door scholieren in het voortgezet onderwijs ontwikkeld. In dit artikel worden methodiek en pilotresultaten beschreven. Van de leerlingen met omvangrijk ziekteverzuim werd 98% bereikt door de jeugdarts of de leerplichtambtenaar; 50% had lichamelijke klachten, veel leerlingen hadden psychosociale problemen. Bij 63% van de leerlingen die in het begeleidingstraject kwamen nam de verzuimomvang af. Het ziekteverzuim op schoolniveau nam af met gemiddeld 1,1 ziektedagen per leerling per schooljaar. Uit de pilot wordt voorlopig geconcludeerd dat de interventie M@ZL veelbelovend is voor het terugdringen van ziekteverzuim op het voortgezet onderwijs. Er worden aanknopingspunten voor verdere ontwikkeling gegeven.
ABSTRACT
Medical advice for the sick reported student in secondary school by the youth health care physician (M@ZL): development of an intervention.
Socio-economic health differences can be reduced by decreasing health risks and increasing educational opportunities. In the latter substantial school absenteeism is a crucial risk factor. By addressing school absenteeism for medical reasons, youth health care makes a positive contribution to health, welfare and educational opportunities for young people and thereby to reduction of socio-economic health differences. The Regional Public Health Service (RPHS) West Brabant has developed M@ZL (medical advice for the sick reported student) to address school absenteeism for medical reasons by secondary school students. We present you with a description of M@ZL and data from the pilot study. Almost all students (98%) that missed a substantial number of schooldays due to illness were reached by the youth health care physician or school attendance officer. Half of the latter group showed physical symptoms, for many students psychosocial problems appeared to be the main cause for health-related absenteeism. The size of medical absence decreased in 63% of the students receiving guidance while on the school level it was reduced with 1,1 schooldays per student per year. It is concluded that M@ZL is a promising intervention for reducing secondary school medical absenteeism, leads for further development are therefore given.
LITERATUUR
NIPO het marktonderzoeksinstituut. Rapport: Schoolverzuim in het Voortgezet Onderwijs. Amsterdam: NIPO, 2002.
Weitzman M, Klerman LV, Lamb G, Menary J, Alpert JJ. School Absence: a problem for the paediatrician. Pediatrics 1982;69:739-64.
Klerman LV. School absence - a health perspective. Paed Clin N America 1988;35:1253-69.
Rumberger RW.Dropping out of middle school: A multilevel analysis of students and schools. Am Educ Res J 1995;32:583-625.
Michaud P, Piot-Delbos I, Narring FMD.Silent Dropouts in Health Surveys: Are Nonrespondent Absent teenagers Different From Those Who Participate in School-Based Health Surveys? J Adolescent Health 1998;22:326-33.
Eckstein Z, Wolpin KI.Why Youths Drop Out of High School: the Impact of Preferences, Opportunities and Abilities. Econom Society 1999;67:1295-1339.
Battin - Pearson S.Predictors of Early High School Dropout: A Test of Five Theories. J Educ Psychol 2000;9:568-82.
Christenson SL, Thrulow ML. School Dropouts: Prevention Considerations, Interventions, and Challenges. Am Psychol Soc 2004;13:36-9.
Kearney CA. School absenteeism and school refusal behavior in youth: A contemporary review. Clin Psychol Rev 2008;28:451-71.
Kearney CA. Bridging the Gap Among Professionals Who Address Youths With School Absenteeism: Overview and Suggestions for Consensus. Prof Psychol Res Pract 2003;34:57-65.
Thrane C. Explaining educational-related inequalities in health: Mediation an moderator models. Soc Sci Med 2006;62:467-78.
Cutler DM, Lleras-Muney A. Education and Health: Evaluating Theories and Evidence, National Poverty Center Working Paper Series Paper no. 12352, 2006.
Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis 2007;4:1-11.
Lundborg P. The Health Returns to Education: What Can We Learn from Twins? Discussion Paper Series paper no. 3399. Amsterdam: Free University Amsterdam, Tinbergen Institute, 2008.
Mackenbach JP. Health Inequalities: Europe in Profile, Tackling Health Inequalities: Governing for Health. Rotterdam: European Commission: 2006.
Woolf SH, Johnson RE, Philips RL, Philipsen M. Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances. Am J Public Health 2007;97:679-83.
Duckett P, Kagan C, Sixsmith J. Consultation and Participation with Children in Healthy Schools: Choice, Conflict and Context. Am J Commun Psychol 2010;46(1-2):167-78.
Rumberger RW. Why Students Drop Out of School and What Can be Done? Dropouts in America: How Severe is the Problem? What Do We Know about Intervention and Prevention? Harvard: Harvard University, 2001, p.1-45.
CBS. Jaarrapport landelijke Jeugdmonitor. CBS Den Haag/Heerlen, 2009.
Kolkman S.Begeleiden van leerlingen met langdurig ziekteverzuim in het voortgezet onderwijs door jeugdarts of jeugdverpleegkundige. Enschede: Gezondheidswetenschappen, Universiteit Twente, 2009.
Beker M, Maas CJ, Boelhouwer J, Hoff SJM. Rapportage jeugd. Rijswijk: Sociaal en Cultureel Planbureau, 1997, p.148.
Hockeday JM.Headaches in children. In: Rose FC (ed). Modern approach to headache. Oxford: Oxford University Press, 1985.
Jones R, Hoare P, Helton R, Dunhill Z, Sharpe M. Frequent medical absences in secondary school students: survey and case-control study. Arch Dis Child 2009;94:763-7.
Mitchell S, Shepherd M. Reluctance to go to school. Out of School - Modern Perspectives in Truancy and School Refusal. Edited by L. Hersov and I. Berg. Pp 7-24. Wiley: Chichester. 1980.
Kataoka S, Zhang L, Wells K. Unmet need for mental health care among US children: variation by ethnicity and Insurance status. Am J Psychiatry 2002;159:1548-55.
Kessler RC, Berglund P, Demier O, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national Co-morbidity Survey replication. Arch Gen Psychiatry 2005;62:593-602.
Theil A, Verkerk P, Buiting E. Snel terug naar school. Begeleiding jongeren met onbegrepen lichamelijke klachten moet beter. Med Contact 2007;62:31-2.
Anderson HR, Bailey PA, Cooper JS et al.Morbidity and school absence caused by asthma and wheezing illness. Arch Dis Childhood 1983;58:777-84.
Anonymous.Report of the state of young people’s health in the European Union. Brussels: European Commission, Directorate-General of Health and Consumer Protection, 2000.
Michaud P. Prevention and Health Promotion in School and Community Settings: A Commentary on the International Perspective. J Adolescent Health 2003;33:219-25.
Michaud P, Chossis I, Suris J. Health-related behaviour: Current situation, trends, and prevention. Handbook of Adolescent Development. New York: Psychology Press, 2006:284-300.
Millstein S, Petersen A, Nightingale E. Promoting the health of adolescents: new directions for the twenty-first century. Oxford: Oxford University press, 1993.
Löwe MD, Spitzer RL, Williams JB et al. Depression, anxiety and somatisation in primary care: syndrome overlap and fuctional impairment. Gen Hosp Psychiatry 2008;30:191-9.
Merikangas KR, Ames M, Cui L et al. The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Arch Gen Psychiatry 2007;64:1180–8.
Allen LA, Gara MA, Escobar JI et al. Somatisation: a debilitating syndrome in primary care. Psychosom 2001;42:63–7.
Michaud P, Narring FMD and Piot-Delbos I. Is school absenteeism really linked with health problems? J Adolescent Health 1994;18:154.
Breuner CC, Smith MS, Womack WM. Factors Related to School Absenteeism in Adolescents With Recurrent Headache. Headache 2004;44:217-22.
Besculides M, Hefferman R, Mostashari F, Weiss D. Evaluation of school absenteeism data for early outbreak detection, New York City. BMC Public Health 2005;5:105.
Vander Stoep A, Weiss NS, McKnight B, Beresford SAA, Cohen P. Which measure of adolescent psychiatric disorder-diagnosis, number of symptoms, or adaptive functioning-best predicts adverse young adult outcomes? J Epidemiol Comm Health, 2002;56:56-65.
Eaton DK, Brener N, Kann LK. Associations of health risk behaviors with school absenteeism. Does having permission for the absence make a difference? J School Health 2008;78:223-9.
Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental health. The future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. Pediatrics 2009;124:410-21.
Steeg M, Webbink D. Voortijdig schoolverlaten in Nederland: omvang, beleid en resultaten. Den Haag: Centraal Planbureau, 2006.
Baat MD. Wat werkt bij het voorkomen en verminderen van schoolverzuim? Utrecht: Nederlands Jeugd Instituut, 2009.
Nutbeam D. Evaluating health promotion: progress, problems and solutions. Health Promotion Int 1998;13:27-44.
Author information
Authors and Affiliations
Additional information
Correspondentieadres
Mw. Y.T.M. Vanneste, GGD West-Brabant, Postbus 3369, 4800 DJ Breda, tel. 076-5282000, e-mail: y.vanneste@ggdwestbrabant.nl
Rights and permissions
About this article
Cite this article
Vanneste, Y., Rots, C., van de Goor, I. et al. Medische Advisering Ziekgemelde Leerling door de jeugdarts (M@ZL). Tijds. gezondheids.wetenschappen 90, 412–419 (2012). https://doi.org/10.1007/s12508-012-0145-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12508-012-0145-2