School Medical Service Research Articles

School Medical Service: Strategies to Promote Psycho-Physiological Well-Being.

Schools represent the ideal setting for educating children about the acquisition of active lifestyles seen not only from a health point of view but also from psycho-pedagogical and social perspectives. Based on evidence from scientific literature, there is a need to include physical activity in school routines, especially in primary schools, where the habits learned by children stay with them in their later years and adulthood. With the support of the school medicine service, schools become a favorable context for planning health education sessions aimed at students, with particular reference to prevention. Within teaching, it is necessary to consider the motor area as a fundamental tool for acquiring correct lifestyles, facilitating cognitive development, inclusiveness, and psycho-emotional and socio-relational factors. Schools can play a fundamental role, becoming the key to promoting physical activity at different times of the day, such as during class hours (with active breaks), during breaks, before and after lessons, and by integrating movement into teaching. This review is the result of an in-depth overview of the available literature on the relationship of schools with health and health promotion from a preventive perspective, with awareness of how the issue is being approached and the need for further future reflections that will go hand in hand with the coming changes.

New perspectives for the school medical service in Italy

New perspectives for the school medical service in Italy

Problems and Strategies of Allocating Public Service Resources in Rural Areas in the Context of County Urbanization.

Imbalances in allocating public service resources are a universal problem worldwide, especially in urban and rural areas. As a developing country with a significant imbalance between urban and rural areas, China is representative of the unbalanced allocation of public service resources. Presently, China has entered the county urbanization stage. Therefore, this study can provide a new way to realize the equalization of urban and rural public services with the county as the basic unit. Taking counties as the primary study area, this paper analyzes the new trends of population mobility in China's counties. It combines large-scale questionnaires and field surveys to investigate the new demand of rural residents for public services and the shortcomings of public service resource allocation. First, the county seat attracts a concentration of the county's rural residents and returning population, whose high expectations for the county seat's education and medical services have not yet been met. Second, the township assumes the vital function of elementary school education and medical services in rural areas, and the rural children have a great demand for elementary school education services in the township. However, there are still apparent shortcomings in support of teaching facilities and the quality of education services. Third, the problem of aging and hollowing out in rural areas is serious, and the education, medical and elderly service needs of left-behind children and the elderly are difficult to be guaranteed. Finally, this paper proposes targeted planning strategies and policy recommendations for allocating county public service resources at three levels based on the "county-town-village" hierarchy.

Про перспективи розвитку шкільної медицини в Україні

The article presents the history of the development of school medicine in Ukraine, the birth of national school hygiene as an independent science. It was emphasized that school medical services are very important both in maintaining the health of the younger generation and in providing the best conditions for its formation, health promotion, and prevention of pathological conditions. In 1922–1935, institutes of health care for children and adolescents and institutes for the protection of motherhood and childhood were opened in Ukraine for the scientific development of health care issues for schoolchildren and adolescents. In October 1922, the first Ukrainian State Institute for Maternal and Child Health was opened in Kharkiv, which is now called SI «Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine». The Institute has become a leading research institution in Ukraine, which coordinates research on «Health Care of schoolchildren and adolescents», trains highly qualified personnel, publishes methodological and informational materials for implementation in practice, conducts scientific and practical conferences, and scientific symposiums on topical issues, including school medicine. According to the Resolution of the Cabinet of Ministers of Ukraine № 31 of January 20, 2021 «On approval of the Procedure for providing medical care to students of general secondary education» medical care for students is now provided by a medical worker who is a member of the educational institution. Ways to improve the organization of medical care for students in secondary schools for more effective development of school medicine, the expediency of using the resources of the SI «Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine» are presented. Therefore, only the combined work of educational and health care institutions can provide the most favorable conditions for maintaining the health of students.

Factors Related to Gender Violence and Sex Education in Adolescents: A Cross-Sectional Study.

Background: For school medical services and the staff responsible for sex education for adolescents, it is important to understand the factors that may influence gender violence. The aim of this study is to determine whether the presence of sexist attitudes, double standards and/or romantic myths contributes to the risk of gender violence. Methods: This cross-sectional study was carried out at five secondary schools in the province of Malaga (Spain). In total, 879 adolescents aged 12–18 years were included, studying years 1–4 of compulsory secondary education. Their attitudes were measured on the following scales: Ambivalent Sexism Inventory (ASI), Double Standard Scale (DSS) and Romantic Love Myths Scale (EMA). Results: Significant differences were observed among the age/year groups for the mean scores obtained on each of the above scales (DSS, p < 0.01; EMA, p < 0.01; ASI, p < 0.01). By gender, the boys recorded higher scores for ASI and lower ones for DSS (p < 0.01). The Spearman’s rho value revealed significant relationships between the presence of sexual double standards and that of romantic myths and ambivalent attitudes (p < 0.01). Conclusions: Adolescents commonly express romantic love myths, sexist attitudes and sexual double standards. These three factors, which are significantly correlated, influence the presence of violence in dating relationships.

Locally implemented prevention programs may reverse weight trajectories in half of children with overweight/obesity amid low child-staff ratios: results from a quasi-experimental study in France

BackgroundThe aims of the present study were to assess changes in weight status between the first and last year of primary education among children with overweight/obesity in response to locally implemented school-based prevention programs, and to assess the influence of process indicators, expressed as child-staff ratios (CSRs), on these changes.MethodsTo meet the study objectives, a quasi-experimental design was used. Four municipalities that systematically monitored the weight status of schoolchildren and participated in the “Vivons en Forme” program agreed to provide the data available in their school medical service records. The local implementers involved in training sessions were mainly municipal staff in charge of serving midday school meals, which is compulsory in France, and those in charge of designing and facilitating creative, interactive activities at school between and after classes. CSRs were determined by occupation (school catering service/facilitator of extracurricular activities) and training session (healthy eating/physical activity) in each municipality program, and classified as low (1–5 children per adult) or moderate.ResultsDuring the 4 years of primary education, weight status improved in half of the children with overweight/obesity, and worsened in 6.6% of children with overweight/normal weight. In children who remained overweight, the BMI z-score diminished over time. Estimates of the positive 4-year weight changes were related to low CSRs in locally implemented variations of the program. Estimates increased with age and were significantly higher in low-to-moderate CSR multicomponent interventions than moderate CSR single-component intervention (reference). The moderate CSR multicomponent intervention had a similar effect as the reference. The estimated negative weight change decreased with age.ConclusionsOur findings suggest that training ancillary school staff in experiential-focused interventions for healthy eating and physical activity in locally implemented school-based programs contributed positively to reducing childhood obesity during the four years of primary education without interfering with educational activities. The results also provide preliminary evidence that low CSRs could be pivotal for optimal outcomes, especially in deprived areas.

Consolidation and development

The 1950s were a period of consolidation after the upsets of the war years, and the continuing staff shortages up to the end of the 1940s. In 1952 the section of the Annual Report of the Chief School Medical Officer on child guidance in Sheffield was for the first time attributed to the Psychologist in Charge, Mr N. Whilde who had occupied the post since 1940. He notes that the referrals to the service had settled down to a pattern that changed little from one year to the next - boys were referred more than girls, a ratio of around 2:1; schools referred more than 50 per cent of cases and in terms of difficulties; Intellectual and behavioural difficulties accounted for around 80 per cent of referrals. The report also notes that for the first time in many years the service had a psychiatric social worker. The 1953 report notes that for the first time since 1945 the service was fully staffed. However, this was short-lived as two educational psychologists and a social worker resigned at the end of the year. For most of 1954 the service was one psychologist short and had no social workers. There was a vacancy for a senior psychologist, but with no suitable applicants, an assistant psychologist was appointed.At a national level in 1950 the government had commissioned a committee to look at treatment and provision for maladjusted children. Under the chairmanship of Dr Underwood, the committee produced their report that was published in 1955 (Ministry of Education, 1955). The committee consisted of 17 members, mainly medical doctors working in school medical services, a few head teachers and just one psychologist. Dr Alexander, Sheffield’s Chief Education Officer (see Chapter 1) gave evidence to the committee on behalf of the Association of LEAs, and Mr N. Whilde gave evidence on the incidence of maladjustment in the area covered by the Sheffield clinic (Sheffield, West Riding, Rotherham and Doncaster). Sheffield was well represented.Amongst its many recommendations, the Underwood Report recommended that all LEAs should have a child guidance clinic with an educational psychologist, psychiatrist and a social worker, and that each should have a school psychological service. It also wanted child guidance clinics to accept referrals of all individuals up to the age of 18, whether or not they were in full-time education. The report suggested that across England and Wales 280 educational psychologists would be needed to work in child guidance clinics, as well as those posts within school psychological services. They noted the need for an expansion of training in psychology at undergraduate level as well as in the postgraduate training of educational psychologists.The staff shortages in the Sheffield child guidance clinic and school psychological service described above continued throughout the 1950s. An advertised post for a senior psychologist in 1954 failed to attract any suitable applicants, and instead a newly qualified psychologist, Peter Portwood, was appointed as assistant psychologist. Peter remained in the service until 1959 when he moved to Cornwall to become the senior psychologist there, and eventually Principal Educational Psychologist, taking up some important posts in the BPS Division of Education and Child Psychology. His account of the Sheffield Service was written in the 1990s and appears below. Peter died in 2005.

School medical inspection and the “healthy” child in the Netherlands, 1904-1970

PurposeThe purpose of this paper is to explore the meaning of child health as applied by school doctors in the Netherlands and the way it was adapted to the rapidly improving standard of living and the increasing importance of mental health after the Second World War. The extension of the concept beyond physical health into emotional and social well-being is particularly interesting as the school medical inspection was the only public child-hygienic service in a country where religious groups opposed the extension of public hygienic care into parenting and the family.Design/methodology/approachOn the basis of secondary literature, the paper discusses the early development of Dutch school medical inspection from a comparative perspective. Changes in the national authority’s and the school doctors’ concepts of what a “healthy” child was between the 1930s and 1970 are examined using a variety of primary sources. These concern both the national discourse and sources that shed light on the daily practice of school medical inspection from the single province for which these are available.FindingsAlthough they adopted a new and more inclusive concept of health in theory, school doctors in the Netherlands were reluctant to actually take up issues of mental health in their daily practice. This reluctance was inspired by the fear of losing their pivotal role in child hygiene and their status as public servants.Originality/valueStudies in the history of school medical services have focussed mainly on their establishment and development as an institution. They seldom extend into the post-war era and do not discuss the extension of the inspection into mental health.

Early Measures for School Hygiene in Greece: Between Nationalism and Modernization (1890-1920).

Compared to other European and Balkan countries, the first institutions for the medical inspection of student health were established relatively late in Greece. Following several European and Balkan examples, Greek doctors and educators began an information campaign during the late 19th century to establish a School Medical Service. The Greek state's emerging interest in children's health was dependent upon a number of factors. Networks of experts played a considerable part in shaping a public discourse on childhood. National defeats generated a discourse that denounced the state's indifference to the degeneration of the younger generation. Finally, European paradigms may have influenced the establishment of the School Medical Service through the experiences gained abroad by doctors and high state officials.

Vision Screening in Zurich

In the city of Zurich, vision screening is performed by school medical services as part of the legally compulsory preventive medical examinations. We retrospectively evaluated the results of the 2011-2012 school year. Preventive medical examinations by the school medical services were performed in all kindergartens. The examinations were mandatory for first, second and eighth grade children, whilst those for the fourth grade were voluntary. The basic diagnostic testing consisted of monocular visual acuity (Snellen E chart) for all age groups and the stereopsis test (TNO test) in kindergartens. Vision screening was performed on 7499 children. 1471 first graders (55 %), 201 fourth graders (11 %) and 211 eighth graders (12.3 %) did not pass the examinations. In 33.7 % of the children who underwent the follow-up examination from an ophthalmologist, amblyogenic potential was found. Vision screening by the school medical services enrols most of the children from a single age group. The Snellen E charts used for the monocular distance acuity, together with the TNO stereo test, appear to constitute an effective testing combination. Ophthalmological follow-up examinations of the affected children revealed that one third were afflicted by amblyogenic factors.

Education of Tubercular Children in Northern Ireland, 1921 to 1955

This paper looks at the education of tuberculous children in Northern Ireland from 1921 to 1955. It shows that there were regional differences and deficiencies in the extent of provision in Northern Ireland. Although rates of tuberculosis were higher for Irish children than their English counterparts, the Irish School Medical Service was not developed until at least 16 years later than in England and Wales. Other regional differences are revealed in the paucity of open-air education. This was considered the ideal but places were available for comparatively few children. Many continued to attend the same school as before their diagnosis whilst others were nursed at home and did not receive any schooling. We can obtain a much deeper picture of the impact of these deficiencies on tuberculous children and their families by supplementing the documentary sources with evidenceobtained from oral interviews.

The dangers of schooling: the introduction of school medical inspection in the Netherlands (c.1900)

In this article the authors address the question of why school medical inspection in the Netherlands developed not only considerably slower than the British service but did so also on a more modest scale in terms of the impact on children’s lives. In the Netherlands school doctors were not allowed to treat children’s illnesses and therefore never opened clinics of their own. Likewise, they did not become part of the school system or even join forces in a national school medical service. To explain this the authors discuss the history of school hygienic concern since the mid‐nineteenth century, the respective roles played and arguments provided by the medical and teaching professions in the process of claiming the necessity for school medical inspection, and the conditions that have determined the appointment and instructions of school doctors since 1904. They draw the conclusion that the rapidly growing power of religious groups has limited the expansion of the medical regime. In the Netherlands schoolchildren did not become part of the ‘social body’ because of national fitness, but because society no longer accepted the inadequacy of the protection of pupils’ health against the dangers of schooling, especially after compulsory education was introduced.

De gevaren van het schoolgaan. Over het ontstaan van de schoolgezondheidszorg in Nederland (ca. 1900)

The dangers of attendance. About the Genesis of Health Care in Dutch Schools (c. 1900) In this article, the authors discuss the origins of the school medical service in the Netherlands. They focus on the period of transition from nineteenth-century concern for school hygiene – focusing on the improvement of buildings, school desks and timetables – to twentieth-century prevention of diseases and infirmities through medical inspection of pupils’ health by school doctors. The research shows that in the Netherlands, when compared to Belgium and England, the state played only a minor role in this respect, as no legislation was introduced. Moreover, the instructions of the first generation of municipal school doctors were limited to medical examination; treatment of the illnesses they found continued to be the privilege of private practitioners. The sectarian character of Dutch society around 1900 seems to have been an important circumstance, stimulating restraint from interfering with religion-based education and its pupils in particular on the part of the government. School doctors’ limited instruction appears to have been crucial for the acceptance of the service for denominational groups. Teachers’ organisations welcomed the service, as they admitted their own lack of hygienic knowledge and the service did not interfere with teaching itself. Nevertheless, compulsory education seems to have ruled out other solutions to reduce the dangers of classroom education, particularly catching contagious and other ‘school’ diseases. The medical profession did not have to act as imperialists to become the protector of children that were forced to go to school. In the Netherlands, school medical inspection was created by a society that no longer accepted the health hazards of classroom education.

A brief history of the rise and fall of the School Medical Service in England

The paper tracks the history of the School Medical Service over 150 years. The service has changed markedly during this period, with some cyclical recurrence of practice and policy. By 2006, the health of schoolchildren is of major concern, particularly the rise in nutrition-related problems including obesity: the demise of the School Health Service may well be a matter for serious regret to future generations.

A brief history of the rise and fall of the School Medical Service in England

As a commentary on the excellent paper by Dr. Peter Gardner entitled ‘The rise and fall of the School Medical Service’, we should like to offer ‘A way forward’. This is based on the Joint Working Party report on health needs of school age children chaired by Prof. Leon Polnay, published in 1995. He has given verbal permission for a summary of the last chapter to be included with Dr. Gardner’s paper. ‘The way forward—agenda for action’ is as relevant, if not more so, to the current needs of school-age children. It is essential that good information is collected and collated at local level. The data about each school or family of schools should form the backbone to an annual report to the school governors and the director of public health to give information on the health of the school population, to point out local problems and to put forward plans to address the unmet needs. It should be a local responsibility to have oversight of health and to deliver a programme of care. This would facilitate alliances between school governors, school nurses and paediatricians. A district factfile, similar to the handicapped registers kept by health authorities in

The Gloucestershire Extension of Medical Services Scheme: An Experiment in the Integration of Health Services in Britain before the NHS

One of the animating beliefs of British health service reformers in the first half of the twentieth century was that delivery would improve if greater co-ordination was imposed over disparate providers. The fundamental divisions were between the voluntary, public and private sectors. Voluntary provision predominantly meant acute care hospitals, but also included a range of other therapeutic and clinical services. The public sector delivered general practitioner (GP) services to insured workers through the state national health insurance (NHI) scheme, while the remit of local government covered environmental health, isolation and general hospitals and a wide range of personal services addressing tuberculosis, venereal diseases, mental illness, and maternity and child welfare. Finally, the private sector provided nursing homes and GP attendance at commercial rates. Within each area there were tendencies towards independent rather than co-operative working. Voluntary hospitals often lacked any mechanism for conferring with neighbouring institutions and the competitive logic of fund-raising enforced an individualistic ethic. In the public sector health responsibilities were dispersed across various agencies: local authority health committees, advised by the county or borough Medical Officer of Health (MOH), oversaw sanitation, hospitals and personal health services; education committees were responsible for the School Medical Service (SMS), whose remit was the compulsory medical inspection and treatment of elementary schoolchildren; the Poor Law provided institutional care either in workhouses or separate infirmaries, although after the 1929 Local Government Act the boards of guardians were broken up; their powers were then transferred to the public assistance committees of local authorities, however these remained distinct from health committees. GP services accessed through the state NHI system were overseen by local insurance committees separate from local government. Private practice co-existed with NHI and doctors tended to prioritize fee-paying rather than panel patients.

Overt and Relational Victimization Among Children with Frequent Abdominal Pain: Links to Social Skills, Academic Functioning, and Health Service Use

Chronic abdominal pain is linked with school absenteeism and diminished social competence; yet, little is know about the extent to which negative peer encounters contribute to symptoms and functioning in youth with abdominal pain. This study compared children with frequent abdominal pain with a pain-free control group on measures of overt and relational victimization and examined the link between abdominal pain and school-related functioning. Participants were 60 children with frequent abdominal pain and 60 gender- and age-matched peers. Child, peer, and teacher reports were used to assess abdominal pain, peer victimization, use of school medical services, social skills, and academic competence. Children with frequent abdominal pain experienced higher levels of victimization than their pain-free peers, with boys in the pain group rated highest in overt victimization. For children in the pain group, overt and relational victimization made incremental contributions to outcomes and moderated the link between pain- and school-related functioning. Overt and relational victimization may increase risk of concurrent adjustment problems among youth with frequent abdominal pain; thus, it may be useful to assess peer relationships when working with this population.

Just a Breath of Fresh Air in an Industrial Landscape? The Preston Open Air School in 1926: A School Medical Service Insight

Historians who have studied the early twentieth-century development of the open air school movement for physically debilitated children have largely maintained that the therapeutic benefit of the fresh air environment in such schools was the predominant emphasis of the movement. It is suggested that this stemmed from the movement's belief that, although other factors such as poverty and poor diet may have contributed to it, the greater cause of physical debility amongst working-class children was the lack of fresh air within crowded industrial towns and cities. Such debility was sometimes identified as a ‘pre-tuberculous’ condition, possibly leading to tuberculosis. This article provides a local dimension to the discussion, through an appraisal of the operation and philosophy of the Preston Open Air School in 1925–6, as revealed in a review of the school undertaken by the Preston School Medical Service in 1926. In assessing the priorities that prevailed here, the wider open air school movement's background and the particular influences of Preston and its school medical service are considered. The article concludes that care philosophy at the Preston Open Air School was holistic rather than concentrated on fresh air. It also confirms the view that such schools set patterns for future educational welfare.

School-Entry Hearing Screening: An Audit of Referrals in a Three Year Period

A recent National Health and Medical Council (NHMRC) project reviewed the literature on child health screening and surveillance and concluded that there was insufficient evidence to make a recommendation for or against school-entry hearing screening. However, unrecognised and unmanaged hearingimpairment can have a significant detrimental effect on a child's educational, social and psychological progress. In the Hornsby and Kuringgai local government areas in New South Wales (NSW), a longstanding school-entry hearing screening program that aims to identify previously unsuspected hearing problems, is conducted each year. Strict program guidelines are in place, and subject to review. In view of the NHMRC findings, it was decided that an audit of audiology referrals from the Hornsby and Kuringgai local government areas' screening program was timely. Accordingly, records of school-entry hearing screening for the calendar years 2000, 2001 and 2002 were obtained from the School Medical Service team, and all records of audiology assessment identifiable as School Medical Service referrals to audiology for the same years extracted from the Audiology Unit files. The audiology assessments were categorised to be comparable with data previously reported in the literature, and compared with the school-entry screening information. The resulting data have been analysed in order to evaluate the program's effectiveness. While areas requiring improvement emerged, the number of relevant children identified compared with the number referred suggests that the program definitely has value and warrants consideration to repeating elsewhere.

Anne Borsay (ed.), Medicine in Wales, c. 1800–2000: public service or public commodity?, Cardiff, University of Wales Press, 2003, pp. x, 253, £40.00 (hardback 0-7083-1824-X).

As Anne Borsay and Dorothy Porter recognize in the introduction to this edited collection, Welsh historiography has been slow to respond to the emergence of the history of medicine. Conversely, most studies of medical history and healthcare devote little space to Wales, except when using it as an example of a depressed area. Although in recent years there has been a significant increase in research into Welsh medical history, with many good studies, Medicine in Wales is a welcome addition to what is still a limited historiography. As the editor makes clear, Medicine in Wales is designed to “illustrate the growing corpus of research-based material” (p. 2) on the social history of medicine and health in Wales. Its content is deliberately diverse. The contributors draw on a range of sources from documentary records to oral testimony to film to examine the relationship between the public and private provision of healthcare since c. 1800. This relationship provides the intellectual context for the volume. Drawing on Jurgen Habermas's notion of the public and private sphere, the contributors raise questions about the utility of this approach by examining issues of class, gender, participation and citizenship, and the role of the state. David Hirst, for example, in his chapter on the school medical service, highlights how the relationship between family and state was unresolved in the service, and how the state remained ambivalent about offering medical care. Steven Thompson in examining the provision offered by medical aid societies shows how they created a forum for participatory democracy that represented a “proletarian” public sphere, one that effectively determined the nature of local medical care and authority. Borsay on the other hand demonstrates how in the treatment of industrial accidents in the 1940s independence suffered when the state intervened. Chapters by Sara Brady on nursing at the King Edward VII Hospital and Susan Pitt on midwifery in post-war Swansea point to how there is no simple equation between gender and the public/private sphere. In questioning the boundaries between the public and private provision of healthcare, the contributors offer a critique that supports the concept of a mixed economy of welfare and a “moving frontier” between private, voluntary and public provision of medical care. However, this is a mixed collection. Aside from Pamela Michael, Thompson and Borsay, many of the contributors pass little comment on Welsh national identity, or look at what Gwyn Williams has referred to as the “Welsh effect”. Indeed, some of the contributors appear to push Wales into the background. For example, in the chapter by Hirst, and in the contribution by Richard Coopey and Owen Roberts on the municipalization of water, the Welsh dimension is subordinate to a metropolitan or English history. David Greaves in his synthesis of debates about inequalities in health and medical care makes little reference to Wales despite the problems the region faced. Given the peculiar economic, social, and political milieu of Wales, this seems a missed opportunity. Despite this criticism, the volume has its strengths. For example, Michael in her telling analysis of suicide in north Wales examines how the Denbigh asylum came to replace the family as a source of care and how suicide was medicalized. Coopey and Roberts add further weight to the need to revise the heroic historiography of state intervention. They demonstrate how local authorities were important in shaping local initiatives and how the nature of satisfactory water remained a contested commodity. Borsay suggests how documentary film could push the boundaries of the public sphere, helping to construct citizenship around stereotypes of masculinity and femininity. Questions are also raised about the nature of rural services and the urban/rural divide that shaped medical provision in Wales. The volume demonstrates that medicine and health in Wales cannot be reduced to a simple equation between public service and private commodity. In raising questions about the public sphere, and in highlighting the rich medical history of Wales, Medicine in Wales suggests that the “Welsh context” offers a vibrant and under-researched field for the study of the history of medicine.