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HEALTH SCREENING AT SCHOOL
1134
The prevalence was highest in those with continuous disease; periodic forms did not differ from normal controls, offering a laboratory distinction between the " process " and " schizophreniform " psychoses of Langfeldt. Relatives of the " process " group showed antibody-rates higher than in the control group, especially where these relatives had been assessed as having " personality disorders". Clearly, more will be heard from this area of research as well. The overworked term " breakthrough " could even apply, but why antibodies in only a third of
cantly.
"
process " schizophrenics ?
As to management, notes of caution were sounded. Dr. J. P. Leff (U.K.) noted that, though more than 300,000 patients throughout the world were receiving long-acting fluphenazine regularly, the evidence seemed to be that high-risk groups relapsed just as often with this preparation and low-risk groups did just as well without it. It must have been the intermediate group that accounted for the good results presented by others. Prof. Max Hamilton (U.K.) took an even firmer view, pointing out that the decrease in inpatient schizophrenics had antedated the use of drugs. Dr. Donal Early (U.K.) had serious doubts about the ability of psychiatric and social services in the U.K. to cope with the problem. The Victorian barracks, which most hospitals were, coped ill with the needs of when a patients, and Dr. Early looked to the time " " a campus spectrum of facilities would comprise with all kinds of living units such as bedsitters, flats, flatlets, hostels, group homes, and a wide range of industrial facilities. On the social-services side, he noted that the division between hospital, social services, and Department of Employment had fragmented an already inadequate service and that integration must be sought-an aim, curiously, which the Seebohm Report had tried to achieve, with little evident success so far. There was not much doubt about the reduction in inpatient population of schizophrenics, but the benefit in social and work prognosis remained highly doubtful, according to Dr. A. Alanen (Finland). At the end of the symposium one could but think back to the opening paper by Dr. Christian Scharfetter (Switzerland), who quoted Kraepelin in 1903 as saying that the essential nature of schizophrenia was still " entirely obscure ". It was, however, a concept which corresponded to clinical realities and one that remained indispensable.
a critical appraisal of the value of routine examinations in a number of situations, which is still
produced
worth study. The same theme is now discussed in the report of the chief medical officer of the Department of Education and Scienceswhich devotes a chapter to considering how best to use the limited manpower of the school medical service to fulfil its tasks, which are defined in some detail. Formerly regulations made under the 1944 Education Act stipulated that every child must have three medical examinations during school life-on entry to school during the last year at primary school, and in the last year at secondary school. These were superseded in 1959 by new regulations which no longer imposed requirements for universal examinations at prescribed intervals but left local authorities free to introduce instead selective examinations of children referred by parent, teacher, or school nurse. By 1968, 45% of local education authorities had introduced selective examinations (mainly based on a parental questionary); but, says the report: " Rather more than half the authorities in England and Wales have continued to organise periodic medical inspections of all pupils at specified periods in their school life when there is no valid evidence that this is the most effective use of limited personnel in meeting the needs of schoolchildren and when authorities have had plenty of opportunity to study alternative arrangements for the last 18 years."
How effective is the routine periodic medical examination as a means of health surveillance ? Does the yield in terms of defects discovered justify the time taken, or can the end be achieved in some more effective way ? The answers to these questions may well vary according to the nature of the group under surveillance and the reasons for the examination. A procedure which is suitable for determining fitness to drive a bus, for example, may not necessarily be the best way of safeguarding general health. Norman1
The report goes on to discuss the defects found by the two systems of examination, and their importance, and advocates a pattern of surveillance consisting of entrant medical examinations, follow-up visits to schools, subsequent medical examination on request, parent questionaries, and screening procedures (tests of visual and auditory acuity, measurement of height and weight, and survey of feet, back, skin, and hygiene). This screening does not need to be undertaken by a doctor, and it is a little surprising to infer from what is said that there is something novel about parts of it-audiometry, for instance-being undertaken by the school nurse. Industries with similar problems of health surveillance have long recognised this as part of the function of the occupational-health nurse. If this screening is done, together with the other measures advocated, it seems clear that additional routine physical examinations are a waste of the doctor’s time. The popular lay image of a " medical examination " is primarily of auscultation of heart and lungs by the stethoscope, and doctors themselves may have done something to foster it. But the number of conditions requiring attention which come to light for the first time as a result of applying this procedure to large groups is very small indeed, particularly in children. Perhaps the time is now ripe to impress upon councillors and administrators that too much should not be expected of the physical examination as a tool of preventive medicine, and, more important, that health screening procedures depend upon teamwork and not some special magic of the doctor and his implements.
Norman, L. G. in Modern Trends in Occupational Health (edited by R. S. F. Schilling); p. 268. London, 1960.
2. The Health of the School Child 1969-70. Department of Education and Science, 1972.
HEALTH SCREENING AT SCHOOL
1.
The prevalence was highest in those with continuous disease; periodic forms did not differ from normal controls, offering a laboratory distinction between the " process " and " schizophreniform " psychoses of Langfeldt. Relatives of the " process " group showed antibody-rates higher than in the control group, especially where these relatives had been assessed as having " personality disorders". Clearly, more will be heard from this area of research as well. The overworked term " breakthrough " could even apply, but why antibodies in only a third of
cantly.
"
process " schizophrenics ?
As to management, notes of caution were sounded. Dr. J. P. Leff (U.K.) noted that, though more than 300,000 patients throughout the world were receiving long-acting fluphenazine regularly, the evidence seemed to be that high-risk groups relapsed just as often with this preparation and low-risk groups did just as well without it. It must have been the intermediate group that accounted for the good results presented by others. Prof. Max Hamilton (U.K.) took an even firmer view, pointing out that the decrease in inpatient schizophrenics had antedated the use of drugs. Dr. Donal Early (U.K.) had serious doubts about the ability of psychiatric and social services in the U.K. to cope with the problem. The Victorian barracks, which most hospitals were, coped ill with the needs of when a patients, and Dr. Early looked to the time " " a campus spectrum of facilities would comprise with all kinds of living units such as bedsitters, flats, flatlets, hostels, group homes, and a wide range of industrial facilities. On the social-services side, he noted that the division between hospital, social services, and Department of Employment had fragmented an already inadequate service and that integration must be sought-an aim, curiously, which the Seebohm Report had tried to achieve, with little evident success so far. There was not much doubt about the reduction in inpatient population of schizophrenics, but the benefit in social and work prognosis remained highly doubtful, according to Dr. A. Alanen (Finland). At the end of the symposium one could but think back to the opening paper by Dr. Christian Scharfetter (Switzerland), who quoted Kraepelin in 1903 as saying that the essential nature of schizophrenia was still " entirely obscure ". It was, however, a concept which corresponded to clinical realities and one that remained indispensable.
a critical appraisal of the value of routine examinations in a number of situations, which is still
produced
worth study. The same theme is now discussed in the report of the chief medical officer of the Department of Education and Scienceswhich devotes a chapter to considering how best to use the limited manpower of the school medical service to fulfil its tasks, which are defined in some detail. Formerly regulations made under the 1944 Education Act stipulated that every child must have three medical examinations during school life-on entry to school during the last year at primary school, and in the last year at secondary school. These were superseded in 1959 by new regulations which no longer imposed requirements for universal examinations at prescribed intervals but left local authorities free to introduce instead selective examinations of children referred by parent, teacher, or school nurse. By 1968, 45% of local education authorities had introduced selective examinations (mainly based on a parental questionary); but, says the report: " Rather more than half the authorities in England and Wales have continued to organise periodic medical inspections of all pupils at specified periods in their school life when there is no valid evidence that this is the most effective use of limited personnel in meeting the needs of schoolchildren and when authorities have had plenty of opportunity to study alternative arrangements for the last 18 years."
How effective is the routine periodic medical examination as a means of health surveillance ? Does the yield in terms of defects discovered justify the time taken, or can the end be achieved in some more effective way ? The answers to these questions may well vary according to the nature of the group under surveillance and the reasons for the examination. A procedure which is suitable for determining fitness to drive a bus, for example, may not necessarily be the best way of safeguarding general health. Norman1
The report goes on to discuss the defects found by the two systems of examination, and their importance, and advocates a pattern of surveillance consisting of entrant medical examinations, follow-up visits to schools, subsequent medical examination on request, parent questionaries, and screening procedures (tests of visual and auditory acuity, measurement of height and weight, and survey of feet, back, skin, and hygiene). This screening does not need to be undertaken by a doctor, and it is a little surprising to infer from what is said that there is something novel about parts of it-audiometry, for instance-being undertaken by the school nurse. Industries with similar problems of health surveillance have long recognised this as part of the function of the occupational-health nurse. If this screening is done, together with the other measures advocated, it seems clear that additional routine physical examinations are a waste of the doctor’s time. The popular lay image of a " medical examination " is primarily of auscultation of heart and lungs by the stethoscope, and doctors themselves may have done something to foster it. But the number of conditions requiring attention which come to light for the first time as a result of applying this procedure to large groups is very small indeed, particularly in children. Perhaps the time is now ripe to impress upon councillors and administrators that too much should not be expected of the physical examination as a tool of preventive medicine, and, more important, that health screening procedures depend upon teamwork and not some special magic of the doctor and his implements.
Norman, L. G. in Modern Trends in Occupational Health (edited by R. S. F. Schilling); p. 268. London, 1960.
2. The Health of the School Child 1969-70. Department of Education and Science, 1972.
HEALTH SCREENING AT SCHOOL
1.