Child health surveillance.
Child health surveillance.
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儿童健康监测。
DOI：
10.1136/bmj.299.6712.1351
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发表时间：
1989
影响因子：
--
通讯作者：
L. Polnay
中科院分区：
文献类型：
--
作者：
L. Polnay
本港现时的儿童健康服务，是在本世纪初奠下基础的。1922年，诺丁汉的县医疗官员在他的年度报告中写道："1897年，人们对儿童福利没有任何兴趣，社区满足于每1000个出生的孩子中有152个在一年内死亡。三年后，这个数字达到了161。去年，每1000名新生儿中只有69名死亡。但与此同时，已经任命了两名医生、10名全职女卫生视察员和15名兼职卫生视察员，他们正在与13个儿童福利中心合作。"67年后，婴儿死亡率低于每1000名新生儿10人，从事儿童健康监测工作的医生和护士人数增加了10倍。我也愿意相信，我们的儿童健康服务是这种改善的主要力量，但很难获得证据。1922年，该服务的重点是“提供医疗，特别是卫生咨询。""由此发展出一种定期检查儿童的制度，我们现在称之为儿童健康监测。在谢尔顿报告中，儿童保健服务的职能被列为对被认为健康的儿童进行例行体检;婴儿营养和卫生;发现缺陷-身体障碍、智力迟钝和情绪健康;父母咨询;健康教育;测量;免疫接种;以及福利和专利食品的销售。[2]从那以后，1967年报告中建议的一系列检查几乎毫无疑问地被重复了一遍。在减少检查频率方面已经做了一些改变，但是曾经的创新已经成为传统，有时似乎不受我们知识的改进或导致我们儿童健康服务诞生的批判性思维或原创想法的影响。然而，我们终于对儿童健康监测进行了新的、受欢迎的审查。"人人享有健康"是一个联合工作组两年工作的成果，该工作组代表英国儿科协会、皇家全科医师学院、英国医学协会全科医疗服务委员会、保健访问者协会和皇家护士学院。3报告有三大要点。首先，它认为，筛选方案的内容应取决于我们对所寻求的条件、测试的有效性以及管理方案的可用性的了解。其次，它强调了一个很好的证据，即在早期诊断各种障碍方面，父母比专业人员更有效。7第三，报告强调并澄清了监测计划的健康教育内容。对于报告的每一部分，工作组审查了现有的证据，并提出了实践和研究的建议。一揽子建议被浓缩为出生时、出院时、6周、8个月、21个月、39个月、5岁和学龄时的检查。在体格检查中，报告建议继续筛查先天性髋关节脱位、先天性心脏病和隐睾。这些案例很有说服力，但成功的项目取决于临床技能和良好的组织框架。即使对于这些情况，报告指出我们缺乏关于先天性髋关节脱位的自然病程或重复检查在减少晚期诊断方面的假定价值等方面的信息。不建议对高血压、哮喘和青少年脊柱侧凸进行筛查。筛查...
The foundations of our current child health services were laid at the beginning of this century. In 1922, the county medical officer for Nottingham wrote in his annual report:" In 1897 no interest had begun to be taken in Child Welfare, and the community was content that 152 out of every 1000 children born should die within the year. Three years later the numbers reached 161. Last year only 69 children died out of every thousand born. But in the meantime, two doctors, 10 wholetime women Health Visitors and 15 part time Health Visitors have been appointed and are working in connection with 13 Child Welfare Centres." Sixty seven years later infantmortality is less than 10 per 1000 births, and the number of doctors and nurses working in child health surveillance is 10 times higher. I, too, would like to believe that our child health services are a major force in this improvement, but proof is difficult to obtain. In 1922 the emphasis of the service was to" provide medical and especially hygiene advice."'From this developed a system of regular checks on children that we now call child health surveillance. In the Sheldon Report the functions of the child health service were listed as routine medical examinations of children presumed to be healthy; infant nutrition and hygiene; detection of defects-physical disorders, mental retardation, and emotional health; parental counselling; health education; measurements; immunisation and vaccination; and the sale of welfare and proprietary foods. 2The series of checks recommended in this 1967 report has been repeated with almost unquestioning faith ever since. Some changes have been made in terms of less frequent checks, but what was once innovation has become tradition and sometimes seemingly immune to improvements in our knowledge or to the type of critical thought or original ideas that led to the birth of our child health services. At last, however, we have a new and welcome review of child health surveillance. Health for All Children is the result of two years' work by a joint working party representing the British Paediatric Association, the Royal College of General Practitioners, the General Medical Services Committee of the British Medical Association, the Health Visitors' Association, and the Royal College of Nurses. 3 The report has three broad thrusts. Firstly, it argues that the content of the screening programme should be determined by our state of knowledge about the conditions sought, the effectiveness of the test, and the availability of programmes for management. Secondly, it emphasises the good evidence that parents are far more effective than professionals in the early diagnosis of a wide range of handicaps. 7 Thirdly, the report underlines and clarifies the health education content of the surveillance programme. For each section of the report the working party reviewed current evidence and made recommendations forpractice and research. The package of recommendations is condensed into checks at birth, at discharge from hospital, 6 weeks, 8 months, 21 months, 39 months, and 5 years and school age. In physical examination the report recommends the continuation of screening for congenital dislocation of the hip, congenital heart disease, and undescended testes. The case for these is strong, but successful programmes depend on clinical skills and a good organisational framework. Even for these conditions the report points to our lack of information on aspects such as the natural course ofcongenital dislocation of the hip or the assumed value of repeated examinations in reducing late diagnosis. Screening is not recommended for hypertension, asthma, and adolescent scoliosis. Screening for …