Prebeg Z
Skola narodnog zdravlja Andrija Stampar Medicinskog fakulteta Sveucilista u Zagrebu.
Lijec Vjesn. 1998 Sep;120(9):257-61.
Starting from the beginning of January 1998, school health service in Croatia became exclusively a preventive activity. This change provoked a lot of controversial discussions among general public and medical profession. This paper gives an outline of the historic course, the aims and content of school health in different countries. From its very beginning in the middle of the 19th century, school health started to develop as a preventive activity directed primarily towards organic etiology dominant in the morbidity of school children at that time (infectious diseases, tuberculosis, malnutrition). The morbidity has changed over time. Nowadays, the problems of psychosocial etiology have emerged into the first plane. Moreover, schooling has been prolonged. It covers a great part of childhood and almost the entire adolescence. The problems of adolescents are different and complex. Health care of school children and adolescents is functionally bound to the school as their natural environment. The most efficient health care is provided in close cooperation between medical personnel and teachers. Besides, the classical model of school health offers, particularly with respect to current problems, large possibilities for health promotion of children and adolescents, and in the long run, of the whole population. Health care of school children is not equally organized in different countries. The main difference depends on whether the school health team is directed only towards preventive and specific activities or towards comprehensive primary health care. In Croatia, traditionally, the integrated health care has developed. Beside preventive health care, the school doctors provided curative care for students in their schools. Within the reorganization of health care a new situation has arisen. Compulsory integration of preventive and curative activities at the school level is completely incompatible with the right to a free choice of primary care physician. However, by the strict interpretation of the principle of indivisibility of preventive and curative care, one school should cooperate with numerous personal doctors for its students. The essential principle of school health would be lost. The school represents a community which is exposed to the same health risks but keeps a great potential for health promotion. So, if this advantage is to be utilized, preventive care must be organized at the school level. This is the very nature of the reorganization in school health service which is performed in Croatia under the auspices of the Ministry of Health. Providing the preventive and specific health care for all school children and adolescents is the responsibility of school doctors who have become the employees of the Institutes of Public Health, while the curative care is provided by the personal physician of a student's or his parents' choice.
从1998年1月开始，克罗地亚的学校卫生服务完全成为一项预防性活动。这一变化在公众和医学界引发了诸多争议性讨论。本文概述了不同国家学校卫生的历史进程、目标和内容。自19世纪中叶诞生之初，学校卫生就开始作为一项预防性活动发展起来，主要针对当时在校儿童发病率中占主导的器质性病因（传染病、结核病、营养不良）。发病率随时间发生了变化。如今，社会心理病因问题已成为首要问题。此外，受教育时间延长了。它涵盖了童年的很大一部分以及几乎整个青春期。青少年问题各不相同且复杂。学童和青少年的医疗保健在功能上与学校这一自然环境紧密相连。最有效的医疗保健是通过医务人员与教师密切合作提供的。此外，学校卫生的经典模式，尤其是就当前问题而言，为促进儿童和青少年的健康，从长远来看，也为促进整个人口的健康提供了巨大可能性。不同国家对学童的医疗保健组织方式并不相同。主要差异在于学校卫生团队是仅针对预防性和特定活动，还是针对全面的初级卫生保健。在克罗地亚，传统上发展的是综合医疗保健。除了预防性医疗保健外，学校医生还在学校为学生提供治疗性护理。在医疗保健重组过程中出现了新情况。在学校层面强制整合预防和治疗活动与自由选择初级保健医生的权利完全不兼容。然而，严格按照预防和治疗护理不可分割的原则来解释，一所学校应为其学生与众多私人医生合作。学校卫生的基本原则将丧失。学校是一个面临相同健康风险但具有巨大健康促进潜力的社区。因此，如果要利用这一优势，就必须在学校层面组织预防性护理。这正是在克罗地亚卫生部支持下进行的学校卫生服务重组的本质。为所有学童和青少年提供预防性和特定医疗保健是已成为公共卫生机构雇员的学校医生的职责，而治疗性护理则由学生或其父母选择的私人医生提供。
