Frequent medical absences in secondary school students: survey and case-control study.

OBJECTIVE: To determine the prevalence of frequent absence (>20% of the school year) for reasons recorded as "medical" in secondary schools; to test the hypothesis that it is associated with physical symptoms and psychiatric disorder and not with serious organic disease; to assess unmet need for psychiatric management. DESIGN: Survey using routinely collected data and case-control study SETTING: Local authority secondary schools in Edinburgh, UK. PARTICIPANTS: School students in the first 4 years of secondary school: cases were those with frequent medical absence and controls those with a good attendance record (best 10% of year group), matched for age, gender and school class. MEASURES: Period prevalence of frequent absences. Cases and controls (students and their parents) completed questionnaires about the students' symptoms. Students were given a psychiatric diagnostic interview and a medical examination. The records of specialist medical services used by the students were reviewed. RESULTS: A substantial minority (2.2%) of students had frequent medical absences. Only seven of 92 (8%) cases had a serious organic disease and 10 of 92 (11%) had symptom-defined syndromes; the remainder had physical symptoms and minor medical illness. Frequent medical absence was strongly associated with psychiatric disorder (45% in cases vs 17% in controls, p<0.001, 95% CI for odds ratio 1.37 to 4.02). Only 14 of the 41 cases (34%) with a psychiatric diagnosis had attended NHS psychiatric services. CONCLUSIONS: Frequent absence for medical reasons is common, and more comprehensive management, including psychiatric assessment, is required to prevent long-term adverse consequences.

Questionnaire for teachers changes the outcome of school entrance medical examinations.

OBJECTIVE: To evaluate the impact of a teachers' questionnaire on the outcome of school entrance medical examinations (SEMs). METHODOLOGY: Retrospective audit. Routine SEMs in 17 primary schools before and after the introduction of the questionnaire. RESULTS: Primary outcome was teachers' concerns known to school doctors, which increased from 2% of pupils to 27% (P < 0.001). Secondary outcome measures increased significantly: new diagnoses made by school doctors (22-31%, P = 0.038) and follow-ups arranged (8-15%, P = 0.034). Medical or educational intervention was required in 17% of pupils identified by teachers' concerns over the subsequent 3 years. Used as an adjunct for selection for SEMs, the questionnaire would have reduced the number of children with problems overlooked by 60%. CONCLUSIONS: The questionnaire improves communication between teachers and school doctors. It significantly changed the short- and longer-term outcome of SEMs. The teachers' questionnaire provides a useful adjunct for selection for SEMs.

A comparison of hip guidance with reciprocating gait orthoses in children with spinal paraplegia: results of a ten-year prospective study.

Twenty-two children with spinal paraplegia were entered into a prospective randomised study to assess the efficacy of two reciprocating orthoses and to identify any prognostic factors that might affect continuing use of the devices. Thirteen received a hip guidance orthosis (HGO) and nine a reciprocating gait orthosis (RGO). They were followed for a mean of ten years. At one year follow-up there were three statistically significant differences between the two groups at the 5% level: repairs were commoner in the RGO group, the RGO group improved in their ability to walk over difficult outdoor surfaces and the HGO group improved more in their ability to rise from a sitting to standing position. At one year follow-up there was a positive parental and child's view of the benefits of the orthoses, but by ten years only 24% of the patients were still using the orthoses. We were not able to show any definite advantage of one device over the other or any statistically significant prognostic factors for walking in the longer term with a reciprocating orthosis. We question whether or not the routine provision of these types of orthosis is justifiable when it appears that, in the longer term, the patients we studied preferred wheelchair mobility.