ABSTRACT
At the end of the 19th century, the school entrance medical examination of all school beginners was established in Germany. The focus was on exclusion of infectious diseases and illnesses that could make school attendance more difficult or worsen during the school visit. In the middle of the 20th century the concept of "school maturity" came to the foreground. Different "school maturity concepts" were applied but abandoned because they could not withstand an evaluation. Meanwhile, the concept of "school maturity" has been replaced by the concept of "school ability". The question no longer arises as to whether or not a child can be taught at school, but rather the assistance and support with which this can be achieved. Today, the school entrance medical check-up in nearly all the federal states includes, in addition to a medical history, an assessment of the precautionary and vaccination status, a visual and hearing test as well as assessment of the development of the child and his/her individual support requirements, especially in the field of cognition and language. In almost all German federal states, the school entrance examinations use up considerable resources of the pediatric and adolescent services in the public health departments. In the paper presented, this is critically discussed, and a discourse is suggested as to whether these resources could be used more effectively in terms of child health considering changed social conditions, such as the mandatory health checks in childhood in many federal states, the increase of immigrants from other countries, in particular asylum seekers, or the "Inclusion", i. e. with closure of special-needs schools and the associated challenges in the regular schools.
Subject(s)
Preventive Health Services , Refugees , School Health Services , Adolescent , Child , Eligibility Determination , Female , Germany , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Male , Public Health , School Health Services/history , SchoolsABSTRACT
QUESTION: The medical investigation of school beginners is one of the essential tasks of the child and youth services of the health authorities. While in all federal states in Germany, the examination of all school beginners is legally clearly stipulated, the situation for "lateral entry", that is, children of school age, who are moving from a foreign country to a local German community and attending school there, is not clearly regulated in the respective school laws. This article presents the experiences of the lateral entry investigations in Frankfurt am Main. METHOD: All children of school age who moved to Frankfurt from abroad undergo a health check. This encompasses a standardized questionnaire-based history with the help of interpreters, including a review of the available vaccination document (case history sheets are available in different languages), an eye examination, hearing test and a physical examination. Children over the age of 15 who came from countries with a high prevalence for tuberculosis had chest x-ray. RESULTS: Between 2006 and June 2016, a total of 8245 children and adolescents were examined, in 4% of the children abnormalities in hearing, and in 22% in visual screening showed noticeable problems, with an increasing trend in recent years. The vaccination status was unknown in two-thirds of the children, one quarter of the children were sufficiently vaccinated against tetanus, diphtheria, polio and pertussis, and 19.5% were immunized against measles (vaccine or disease). Diseases of the respiratory tract, the heart and the circulation were predominant with a total of 4%, followed by musculoskeletal disorders with 3%. Lice infestation was found in 1.7% of children. In 0,7% of 2171 children with chest-X-rays, a conspicuous pulmonary lesion was diagnosed, but no tuberculosis. CONCLUSION: The focus of the lateral entrance examination is a school-related health status. On the basis of experience gained in Frankfurt am Main, it should be pointed out that investigations by the lateral entrants from other countries seem necessary, in particular visual and hearing screening, physical examination and checking the vaccination status, possibly in combination with vaccination. On the other hand, a detailed developmental screening does not appear to be urgent in the case of pupils who will be starting compulsory school, in whom there is no chance for additional encouragement before the start of school.
Subject(s)
Health Status , School Admission Criteria , Tuberculosis , Adolescent , Child , Germany , Humans , Mass Screening , Prevalence , Schools , Tuberculosis/diagnosis , Tuberculosis/prevention & control , VaccinationABSTRACT
In 2015, most of the refugees arriving in Germany originated from countries with poor hygienic and sanitary conditions. Stool samples of 1,230 minor refugees unaccompanied by adults were investigated for possible parasites. Giardia lamblia was by far the most frequently detected parasite (n=165); all other parasites were considerably less frequent and encountered in the following order: Hymenolepis nana (n=23), Entamoeba histolytica (n=17), Trichuris trichiura (n=8), and Blastocystis hominis (n=1). Ascaris lumbricoides was not detected among any of the screened refugees. Considerable differences in prevalence rates in refugees originating from different countries could be observed.
ABSTRACT
Many refugees arriving in Germany originate or have travelled through countries with high prevalence of multidrug-resistant Gram-negative organisms. Therefore, all unaccompanied refugee minors (<18 years-old) arriving in Frankfurt am Main between 12 October and 6 November 2015, were screened for multidrug-resistant Enterobacteriaceae in stool samples. Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) were detected in 42 of 119 (35%) individuals, including nine with additional resistance to fluoroquinolones (8% of total screened), thus exceeding the prevalences in the German population by far.
