Oberklaid F
Department of Ambulatory Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia.
J Paediatr Child Health. 1990 Oct;26(5):244-51. doi: 10.1111/j.1440-1754.1990.tb01065.x.
School medical services in Australia have a long tradition of providing community-based services to school-aged children, and in some states to preschool children. Conceived as a public health measure early this century, doctors and nurses worked in schools to address the health issues of the time, which were largely to do with nutrition, hygiene, and infectious diseases. It was perceived that many children had poor access to medical care, and began school with unaddressed health problems which often had a deleterious effect on their learning. Doctors were often employed by education authorities and only transferred to health departments many years later. In some states the service was expanded subsequently to include preschool children, based on the concept that the earlier problems were detected the earlier they could be treated appropriately and the greater the benefits to the child. While social structures, community needs and paediatric morbidity patterns have changed dramatically over recent years, there is a widespread perception that in some states school medical services have not yet embraced fully the changing needs of the population of school children they are designed to serve. Hamstrung by political expediency (with decision-making driven by political rather than scientific considerations) and bureaucratic inertia, school nurses and doctors often operate in structures and systems that are urgently in need of review and reorganization. In this paper the rationale for current processes will be reviewed critically, a model of school health services focused on contemporary paediatric needs is proposed, and a set of factors which are considered essential to the development of the school health services of the future is outlined.
澳大利亚的学校医疗服务有着为学龄儿童提供社区服务的悠久传统，在一些州还为学龄前儿童提供服务。这项服务在本世纪初被视为一项公共卫生措施，医生和护士在学校工作以解决当时的健康问题，这些问题主要与营养、卫生和传染病有关。当时人们认为许多儿童难以获得医疗保健，入学时存在未得到解决的健康问题，这往往对他们的学习产生有害影响。医生通常受雇于教育部门，多年后才转至卫生部门。在一些州，后来基于早期发现问题就能更早地进行适当治疗、对儿童益处更大的理念，将服务范围扩大至学龄前儿童。尽管近年来社会结构、社区需求和儿科发病模式发生了巨大变化，但人们普遍认为，在一些州，学校医疗服务尚未充分满足其旨在服务的学龄儿童群体不断变化的需求。受政治权宜之计（决策由政治而非科学考量驱动）和官僚惰性的束缚，学校护士和医生常常在迫切需要审查和重组的结构与体系中开展工作。本文将批判性地审视当前流程的基本原理，提出一个关注当代儿科需求的学校健康服务模式，并概述一系列对未来学校健康服务发展至关重要的因素。
