1970 British Cohort Study
Age 16 Survey (1986)
BCS70 Age 16 Medical Examination Form
bcs_86_me
YOUTHSCAN U.K.
An Initiative of the International Centre for Child Studies
MEDICAL EXAMINATION FORM
STRICTLY CONFIDENTIAL
Director: Professor Neville Butler MD, FRCP, FRCOG, DCH International Centre for Child Studies
PLEASE USE BLOCK CAPITALS
Teenager's Surname
Teenager's Forename(s)
Sex
Teenager's Home Address
Telephone Number
Postcode
Date of Birth
Health District
Today's date
Name of Examining Medical Officer:
Status: e.g. SCMO, CMO, etc.
INTRODUCTORY NOTES
May we take this opportunity to thank you for carrying out this examination on behalf of Youthscan UK.
For your assistance, a short instruction manual for health personnel is provided with this examination form. This includes an outline of the historical background of the Study, a near-vision test sheet and some procedural details.
You will need the following equipment for the medical examination:
PROCEDURE: EQUIPMENT RECOMMENDED:
Height: Steel/wooden measuring rod or steel tape measure. If not available, stadiometer on back of weighing machine should be used.
Weight: Beam balance, or other accurate apparatus. Please calibrate this to zero initially.
Head Circumference: Paper or plastic-covered tape measure.
Distant Vision: Standard Snellen Chart (or equivalent).
Near Vision: Near Vision card of Sheridan-Gardiner type, reproduced in instruction manual, by kind permission of the authors.
Blood Pressure: Mercury sphygmomanometer. Please use an adult-size cuff and not small cuff designed for children. The bladder within the cuff should be deep enough to cover about two-thirds of the length of upper arm and long enough to circle the arm completely.
Motor Co-ordination Tests: Tennis or rubber ball: a piece of chalk: stop-watch or a watch with second hand.
Audiogram: Audiometer for sweep audiogram. An audiogram form is provided on this form for recording result of sweep or pure-tone audiogram.
In addition, access to all the following will be needed for completion of medical examination form.
Completed Parental Interview Form: This will contain some medical and family details.
Health Records etc.: School medical record cards(s); any available screening records, assessment results, hospital reports, etc.; health file on any children with handicap or disability.
NOTE: IF ONE OR MORE OF THE ABOVE ITEMS IS NOT AVILABLE PLEASE COMPLETE THE MEDICAL EXAMINATION AS FAR AS POSSIBLE.
Introduction
Most, but not all, of the cohort and their parents have already participated in this Study, either in the perinatal period, intermediately, or at five or ten years.
At five and ten years, health visitors of your DHA caried out an extensive review of the health, development and pre-school care.
At ten years we were able, through your DHA, to identify members of the cohort who had health problems, disabilities and handicaps. Health Visitors and Community Medical Officers kindly conducted interviews and examinations.
Parents of the teenagers have this time received a letter explaining the 16 year Study, inviting their co-operation and ensuring them of confidentiality.
This time some of the mothers will already have been interviewed at home by a health visitor/school nurse; for the remainder, the home interview could be done subsequently, or accomplished at the same time as the medical examination provided that the mother agrees to attend at that time. The documents needed for the maternal interview consist of The Parental Interview Form (Document O), The Maternal Self-Completion Form (Document P) and The Teenage Leisure Diary (Document S). For the medical examination the following documents are needed (i) The Medical Examination Form (Document R), (ii) The Teenage Health Self-Completion Questionnaire, which should be completed by the teenager at the time of attendance for the medical examination (iii) The Information Manual for Health Personnel (Document N), includes the necessary instructions and contains a Sheridan-Gardiner Near Vision sheet for testing near vision.
Your Local Education Authority has kindly traced the whereabouts of the cohort in your DHA and has arranged a separate school educational assessment of each teenager, including tests of reading, vocabulary, mathematics, matrices and spelling; from this, it will be possible to identify slow learners and teenagers with educational as well as health problems.
THE MEDICAL EXAMINATION FORM IS IN THREE SECTIONS
Section 1. (A) Use of Service, (B) Disabilities ( pages 3 and 4)
In order to complete this section fully, you will need to assemble all the teenager's school medical records and all other relevant school health and educational documents. You are asked to pay particular attention to assembling complete records of any teenager who is handicapped, receiving special education, or who has been assessed for special educational needs. You will be asked to provide a summary from the notes of the progress and current status of each such teenager. Even if only partial records are accessible to you, please complete all Sections of this questionnaire as far as possible at the time of the medical examination.
Section 2. (A) Morbidity and Special Senses, (B) Medical Examination (pages 4-9)
Please make sure that the recommended equipment is available. Please read in advance if you have time, the medical history from the Parental Interview Form if already completed. Please read through the medical questions carefully before the examination. If you have time, please try out the co-ordination tests. The medical examination is structured to provide the maximum information while leaving you free to conduct the clinical examnation in any way you find optimal. Tests such as distant and near vision and measurements of height, weight, head circumference and blood pressure have been aggregated in the medical examination form, in case it proves expedient to carry these out just prior to the actual clinical examination. Please feel free to undertake the necessary measurements, in the order which best suits the facilities available to you and anyone helping you with the examination.
Section 3: Medical Summary. This is self-explanatory (pages 10 and 11)
Section 4: The Audiogram (page 12)
An Audiogram form is on the last sheet of the examination form. It is presumed that this will be done by sweep audiometry. The form also contains space in case pure-tone audiometry is used. You are asked to record whether the results of sweep audiometry are normal or abnormal and if sweep results are abnormal, to arrange to let us have details of pure-tone audiometry. In instance where sweep audiometry is impossible to arrange, or is delayed unavoidably,the remainder of completed health documents should be sent on to us in advance of the audiogram.
SECTION 1A. USE OF SERVICES
Where is this medical examination taking place?
Tick one box
Has this study teenager ever had school medical examination/developmental checks/vision or hearing tests)?
at what age(s) were procedures carried out Examinations
Tick all that apply on each line
at what age(s) were procedures carried out Development Checks
Tick all that apply on each line
at what age(s) were procedures carried out Vision Screenings
Tick all that apply on each line
at what age(s) were procedures carried out Hearing Tests
Tick all that apply on each line
at what age(s) were procedures carried out Other (What? ...)
Tick all that apply on each line
Is there any evidence that the study teenager has attended any of the following since 10 years old? Hearing clinic/consultant audiologist
Answer (a) - (f) and tick one box on each line
why?
Is there any evidence that the study teenager has attended any of the following since 10 years old? Eye clinic/consultant ophthalmologist
Answer (a) - (f) and tick one box on each line
why?
Is there any evidence that the study teenager has attended any of the following since 10 years old? Speech therapy
Answer (a) - (f) and tick one box on each line
why?
Is there any evidence that the study teenager has attended any of the following since 10 years old? Physiotherapy
Answer (a) - (f) and tick one box on each line
Is there any evidence that the study teenager has attended any of the following since 10 years old? Child and Family Guidance Service
Answer (a) - (f) and tick one box on each line
Is there any evidence that the study teenager has attended any of the following since 10 years old? Other psychological or psychiatric opinion or treatment
Answer (a) - (f) and tick one box on each line
why
Where does this study teenager live and what type of school does he/she attend?
Tick one box only
please give name, address and designation of school institutions.
Has a decision been reached by a local education authority that the teenager is in need of special education help/provision?
Tick one box
What help was given, why, when and what has been the result?
SECTION 1B. DISABILITIES
Is there any evidence that the study teenager has had any emotional or behavioural problem since 10 years?
Tick one box
please describe problem(s) and give age(s) when occurred
Is there any evidence that this teenager has now or has had in the past any significant illness, developmental problem, defect or handicap?
Tick one box
please summarise the major findings, clinical progress and present state, from records and all other sources.
Please include copies of relevant documentation, reports etc.
(if necessary, please continue on page 11).
SECTION 2A. MORBIDITY AND SPECIAL SENSES
In the light of your clinical examination and the records you have seen, do you consider that there is evidence of any current hearing loss?
Tick one box only
What is the probable cause?
Do you consider that the hearing loss will interfere with normal schooling or everyday functioning?
Tick one box
Does the teenager wear a hearing aid?
How intelligible have you found the teenager's speech?
Tick one box only
Answer (a)-(r) and tick all that apply on each line
Has this teenager ever had any of the following conditions? Mental or educational retardation (please specify ...)
Answer (a)-(r) and tick all that apply on each line
Has this teenager ever had any of the following conditions? Any other significant illness or disability (please specify (i) ... (ii) ... (iii) ...)
Answer (a)-(r) and tick all that apply on each line
Tick each line (a) - (f), and tick one box on each line
If YES to any of above, please describe
DISTANT VISION TEST
NEAR-VISION TEST
In the light of your examination and the records you have seen, would you consider that there is any current visual defect, and does it result in interference with normal schooling or everyday functioning?
Tick one box only
please describe below
SECTION 2B. MEDICAL EXAMINATION
INITIAL PULSE RATE
Before starting the Medical Examination, please settle the teenager for 2 minutes and take the pulse (over 1 minute) whilst the teenager is sitting. Pulse rate ... beats in 1 minute
HEIGHT
Recommended technique:
Please position the teenager upright against a flat wall or a door. Encourage him/her to stretch to full height, keeping heels on the floor. Heels and buttocks should be flush against wall or door. Place a hardboard/book on the teenager's head. Mark the position of the lower edge with a pencil and then measure the height from the ground with a wood or steel measuring rod or steel tape measure. Alternatively, use measuring device on the back of a weighing machine and observe precautions as above. NB. Remove shoes before height is measured.
Height in cm, to nearest 0.5 cm = ... cms.
Height in feet and inches, to nearest 1/4 inch = ... feet ... inches
HEAD CIRCUMFERENCE
Measure with a paper or plastic tape measure, fitted closely and horizontally around the head just above the eyebrows so as to obtain a maximum circumference.
Head circumferene in cm, to nearest 0.5 cm = ... cms. or = ... inches
WEIGHT (IN UNDERCLOTHES)
Please weigh on a beam balance, if possible. Please check that the balance is set at zero before weighing.
Weight in kilograms, to nearest 0.1 kg = ... kg.
Weight in pounds and ounces = ... pounds ... ounces
BLOOD PRESSURE
Please postpone to later in examination if you feel teenager is nervous.
Sphygmomanometer cuff must have bladder long enough to encircle the arm completely and be wide enough to cover two-thirds of the length of the upper arm. The cuff should preferably be at least 5 inches deep.
It is realised that you will be experienced in taking blood pressures, but we ask you to follow the instructions closely for uniformity: -
Sit subject on chair in as relaxed a state as possible. Wrap the cuff around the right upper arm, placing the rubber tubes from the bladder posteriorly for ease of access to right antecubital fossa. Palpate the right radial pulse and inflate the cuff to about 30mm.Hg. above the disappearance of the pulse. Slowly deflate till the pulse reappears. Deflate the cuff.
Place the stethoscope in the antecubital fossa over the brachial artery, but not in contact with any part of the cuff. Rapidly inflate the cuff to about 30mm.Hg. above the systolic pressure and then deflate at a rate of 2-3mm.Hg. per second.
The appearance of faint clear tapping sounds for 2 consecutive beats should be recorded as the Systolic Pressure.
Continue to deflate the cuff and the sounds will soften or may become swishing, then sharper sounds will reappear. With continuing deflation, there will be a sudden muffling of sounds, which will become soft and blowing. This is Korotkoff's 4th sound and represents the Diastolic Pressure. Do not wait until the point of complete disappearance of sounds.
Systolic pressure - taken by auscultation ... mm.
Diastolic pressure - taken by auscultation ... mm.
NOW PLEASE MAKE A GENERAL AND SYSTEMIC EXAMINATION OF THE TEENAGER AND ANSWER QUESTIONS BELOW BASED ON YOUR FINDINGS.
Answer (a)-(o) and tick one box per line
Answer (a)-(e) and tick one box on each line
Is there any evidence that this teenager has any past or present congenital abnormality? (Include both major and minor abnormalities).
Tick one box
please describe below:
On clinical impression, which of the following terms do you consider to be the most accurate description of the teenager?
Tick one box
E. MOTOR COORDINATION TESTS
The following four tests will identify a clumsy or inco-ordinate subject as far as this is possible on clinical examination. Such tests are non-specific and difficult to validate, but will be used in conjunction with other findings and the opinions of teachers and parents, recorded elsewhere. The results will inevitably be influenced by the effects of subject's skill and experience. At the end of the tests the examiner is asked to give a considered opinion as to the degree of clumsiness or inco-ordination.
Please test all Youthscan teenagers except those who are grossly handicapped or those who are incapable of understanding the test(s). In these instances, please enter the reason after question E4.
THROWING A BALL IN THE AIR
You will need a tennis ball, or a rubber ball of equivalent size and weight.
The important point about this test is to discover the subject's optimum performance. We would therefore be grateful if you would carry out the test in the following way:
Ask the subject to stand in a space so that he/she has room to move. Say 'I want you to show me if you can throw the ball up in the air and catch it'. Allow two or three initial attempts. If the subject fails to catch the ball, record the fact and do not proceed with the test.
If the subject can catch the ball, say 'Now throw the ball up in the air and clap your hands together once before you catch it'. Then repeat the procedure increasing the number of claps until the subject fails on two successive attempts. Record the greatest number of claps resulting in a successful catch.
If the greatest number of claps was 2 or more, ask him/her to repeat the test, catching with one hand only. Let him/her use preferred hand.
RESULT INITIAL THROW
If caught ball successfully, please continue with test and record the maximum number of claps achieved before catching with two hands ... claps
please continue test catching the ball with the preferred hand, and record the maximum number of claps achieved before catching with preferred hand ... claps
FIGURE DRAWING ON PALM OF HAND: (GRAPHESTHESIA)
You will need a blunt point, for example a biro with tip retracted.
Ask the subject to place both his/her hands on a table, palms uppermost. Using the blunt point, firmly describe a figure 8 on the subject's right palm. Take two seconds to draw it, and allow the subject to watch. Ask him/her what you have drawn.
Answer (a)-(h) and tick one box on each line.
STANDING ON ONE LEG: (30 SECONDS)
Please make sure the subject has no shoes on.
Ask the subject to stand on his/her right leg with the left foot against the knee of the right leg, hands on hips. Ask him/her to settle for a moment, then to keep the position for 30 seconds.
Watch the position of hands and feet and record how soon the hands move from the hips or the feet move. Repeat the test with subject standing on the left leg, and time in same way.
Right leg: 30 seconds Did foot/feet move before 30 seconds?
after how many seconds? ... secs
Right leg: 30 seconds Did hand(s) move before 30 seconds?
after how many seconds? ... secs
Left leg: 30 seconds Did foot/feet move before 30 seconds?
after how many seconds? ... secs
Left leg: 30 seconds Did hand(s) move before 30 seconds?
after how many seconds? ... secs
Comments, if any:
WALKING BACKWARDS (10 STEPS)
Please make sure the subject has no shoes on.
Find a straight line on the floor at least 4 metres long, e.g. the groove of a floorboard, or mark one out with chalk. Use a corridor if the examination room is not long enough.
Ask the subject to put his/her hands on hips and then to walk backwards along the line, placing one foot behind the other, toe-to-heel.
First demonstrate the test, saying 'I want you to walk like this. Remember your toes must touch your heel with each step you take. Keep your hands on your hips. Walk backwards in a straight line. You may glance behind you if it helps'.
Let the subject have two practices by asking him/her to walk backwards for 5 steps on each occasion.
Then ask the subject to walk backwards for 20 steps. Count the number of steps made before any error occurs. An error occurs if the subject ceases to maintain toe-to heel or deviates from the line or moves either hand from hips. If an error is made in the first 5 steps, continue to count the number of steps until the next error.
RESULT Number of consecutive steps taken before error (or between an error in the first 5 steps and the next error) ... steps
Comments, if any:
give reason
From your observations, which of the following phrases do you consider best describes the teenager?
Tick one box
PULSE RATE AT END OF EXAMINATION
Would you please settle the teenager and after at least 2 minutes take the teenager's pulse rate again for at least 60 seconds, with the teenager sitting. Pulse rate at end of examination ... beats in 1 minute
MEDICAL SUMMARY
SUMMARY OF CONDITIONS FOUND AND CONCLUSIONS
Have you found any evidence by examination or from history that this teenaer had/has any impairment, disability or handicap? Please include also educational and social problems/difficulties.
Has your medical examination and scrutiny of the teenager's documents revealed the presence of any abnormal condition(s) or symptom(s) which have not previously been diagnosed or are not already under observation?
Please list each problem/condition not previously diagnosed or not already under observation.
Do you consider that this teenager has any condition(s) requiring ongoing medical observation or treatment for any reason?
Please state condition(s) and give your recommendation(s) regarding necessary ongoing observation(s) or treatment for each condition.
ENTER IN THIS SPACE DETAILS OF CLINICAL PROGRESS AND MAJOR FINDINGS ON ANY DEFECT, DISABILITY OR HANDICAPPING CONDITION(S).
See questions B2 & 3. Please also append here or send to us any available copies of relevant child health reports and/or special educational documents relating to such condition(s).
PLEASE ADD HERE FURTHER ANSWER(S) TO ANY QUESTIONS WHERE THERE WAS INSUFFICIENT SPACE ON THIS FORM.
SPACE FOR ANY COMENTS BY SCM (CHILD HEALTH) OR PERSON WHO ACTS AS CENTRAL STUDY CO-ORDINATOR
Please include here any details from missing or centrally-held child health records.
Before signing the form would you please check that ALL QUESTIONS have been answered and suitably recorded.
Date
THANK YOU VERY MUCH FOR YOUR HELP.
SECTION 4. AUDIOGRAM
Teenager's Surname
Sex
Teenager's Forename(s)
Date of birth
Teenager's Home Address
Please check the teenager's hearing by using either sweep audiometry or pure-tone audiometry, and record the results below.
SWEEP AUDIOMETRY Right ear
Please tick one box in each row
Give reason
SWEEP AUDIOMETRY Left ear
Please tick one box in each row
Give reason
If carried out, please record results below for air conduction and bone conduction.
If carried out, please record results below for air conduction and bone conduction.
Please complete the details below for sweep audiometry, and for pure-tone audiometry if done.
Audiogram recorded at
Name of recorder
Date
Professional status
Make of audiometer
Level of sweep ... dB's
Frequencies tested by sweep
NOTE CAREFULLY
please enter date and result of most recent audiogram below, whether sweep or pure-tone. Alternatively, give result of recent clinical assessment, if any. Type of test
please enter date and result of most recent audiogram below, whether sweep or pure-tone. Alternatively, give result of recent clinical assessment, if any. Result
please enter date and result of most recent audiogram below, whether sweep or pure-tone. Alternatively, give result of recent clinical assessment, if any. Date tested
bcs_86_me
SECTION 1A. USE OF SERVICES
SECTION 1B. DISABILITIES
SECTION 2A. MORBIDITY AND SPECIAL SENSES
DISTANT VISION TEST
NEAR-VISION TEST
SECTION 2B. MEDICAL EXAMINATION
INITIAL PULSE RATE
HEIGHT
HEAD CIRCUMFERENCE
WEIGHT (IN UNDERCLOTHES)
BLOOD PRESSURE
E. MOTOR COORDINATION TESTS
THROWING A BALL IN THE AIR
FIGURE DRAWING ON PALM OF HAND: (GRAPHESTHESIA)
STANDING ON ONE LEG: (30 SECONDS)
WALKING BACKWARDS (10 STEPS)
PULSE RATE AT END OF EXAMINATION
MEDICAL SUMMARY
SECTION 4. AUDIOGRAM
BCS70 Age 16 Medical Examination Form