|
Finland
is divided into 16 regional districts, inter-municipal associations, which offer
among other things public medical services for intellectually disabled people. A
district centre includes an out-patient clinic, rehabilitation unit, psychiatric
and neurological departments. In general the customers have been satisfied
with the special services. However, the system is considered expensive and
division into inter-municipal associations may be history in near future. In
our country a child or adult neurologist, child, youth or adult psychiatrist or
pediatrician may achieve special competence in intellectual disability medicine
after working three years in public services and passing the examination held by
a board of examiners. The number of specialists in the field of intellectual
disability medicine is about 60. The
Finnish Society of Intellectual Disability Medicine has 120 members and was
founded in 1982. The society organises two annual congresses. Maria Arvio Aetiology
of intellectual disability – The Finnish classification: development of a
method to incorporate WHO ICD-10 coding M: Wilska & M.Kaski, Journal of Intellectual Disability Research 1999;43:242-2 This
article describes the Finnish classification
created twenty years ago after which it has been actively used by
physicians working in the field. There has been a need to have a systematic and
practical method to assess the aetiology, to reach the most important goal in
the work of
physicians. The
classification is based on timing and type of the injury to CNS. The main
divisions are: 1. Genetic causes, 2.CNS malformations and multiple malformation
syndromes of unknown origin, 3.External prenatal factors, 4. Paranatally
acquired disorders, (-1 to + 4 wks from delivery). 5. Postnatally acquired
disorders, 6. Untraceable or unclassified causes. These divisions are divided
into groups and subgroups. In the classification , the earliest CNS injuring factor is
the primary diagnosis. Later factors disturbing the functioning of the
individual must be added as secondary causes. The
parents’ most important question concerning
inheritance, can be answered after a rather simple first stage
workup. This is because at
least the timing of the injury can
be determined with detailed
history, careful physical examination with mapping of malformations, and rather
simple laboratory studies alone. These should include chromosomal studies if the
patient has dysmorphic features. FraX-DNA is indicated at least if no other
causes for ID is found. For
specific diagnosis, more detailed metabolic and DNA-examinations are
sometimes needed, as secondary stage assessment. Knowledge of the aetiology also
benefits the child many ways and is helpful for all those involved with the
patient, and even the society. When
the ICD-10 diagnostic coding was published in Finnish,
it was decided to reorganize the appropriate diagnoses to ease the work
of physicians who had been accustomed to think in the timed sequence. The list
of diagnoses has been published.
While doing this, an image of a
tree with large root network and multiply branched limbs became evident. When
causative diagnoses were placed at the correct locations, they appeared as root
nodules or leaves on the tips of the branches. This illustration has proven to
be valuable in teaching as well as in family counselling.
Prevalence, aetiology and comorbidity of severe and profound intellectual disability in Finland. Arvio
M & Sillanpää M, J Intellect Disabil Res 2003:47:108-12 |
|
web editor: administration@mamh.net |