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but in practice it is not possible due to the
cost in manpower time and money The third
method is that of selective population
screening By this method a section of a
given population is identified in which the
likelihood of defects occurring is much higher
than average Once such a group is identified
the concentration of available medical resources
on this group would seem to be justified The
method of selective population screening is
the one used by local authorities who keep
observation registers but recently these
registers have been criticised The criticism
has been directed towards the size of the
registers in some areas 50% of the children
born in a year have been included but also
and more seriously towards the fact that a
sizeable proportion of children who are found
to have handicapping defects have not in
fact been placed on the observation register
Consequently the method of selective populascreening
is in danger of falling into disrepute
The workers on the project believe that
the concept of selective population screening
is basicallv sound but that in the past
insufficient attention has been given to the
criteria used for identifying the at risk
groups resulting in large registers and the
identification of a low proportion of children
with handicapping conditions The Joint
Obstetric-Child Health Project set up in
Hounslow aims to determine whether it is
possible for a method of selective population
screening to be effective or whether the
deficiencies inherent in the method and its
application are so great that total population
screening is the onlv method of value
During the study 2000 Hounslow children
born consecutivelv at Chiswick maternity
hospital or as the result of domiciliary
confinements within the borough are being
screened for developmental defects at regular
intervals until they are four years old During
the period of the project the observation
register will be maintained as at present all
the criteria or relevant risk factors having
been carefully defined
The group of children from the total 2000
thought to be at risk of developing a defect
will be placed on this register At the end of
the five year period it will be possible to
see whether the majority of children with
handicaps are to be detected as the result of
inclusion on an observation register or whether
thev are detected onlv as the result of total
population screening
Hounslow was chosen as the area best
suited for the purpose of the project as it has
an observation register already in operation
there is excellent liaison between the health
department general practitioners and hospital
obstetric services and the population is
relatively stable There is an outward removal
of some 7% annually of children under five
considerably less than that shown by other
London boroughs
The cost of the project over the five years
is to be met by a grant from the Department of
Health and Social Security The paediatrician
to the project is Dr Zinkin senior lecturer at
the Institute of Child Health overall direction
being given by Dr Holt from the Institute of
Child Health and by Dr Lindon There is a
full time research medical officer to the project
a full-time health visitor and a secretary The
obstetric direction of the project is under Mr
Matthews and Mr Dunsier of the West Middlesex
Hospital A great deal of information about each
child will be available information will be
computerised and a statistician to the project
has been appointed
The planning of such a project was extensive
A great deal of administrative work and the
clinical application of the screening tests used
in this project is being undertaken by the
borough medical officers under my guidance
Before the project was started an in-service
course in developmental paediatrics was run for
the medical officers of the borough attended by
representatives from the nearby boroughs who
it was hoped would be able to help trace families
who move into their areas
Meetings were held with the general practitioners
of the area and a course in developmental
paediatrics was held at the Post Graduate Centre
of the lAest Middlesex Hospital Several meetings
were held with the health visitors during the
first few months of the project the co-operation
between everybody concerned has been excellent
and most important of all there has been great
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