The varied circumstances prompting requests for emergency contraception at school-based clinics

BACKGROUND: Little is known about the circumstances that prompt teenagers to request emergency contraception (EC). This evaluation was designed to refine the EC clinical protocol and improve pregnancy prevention efforts in high school-based clinics by analyzing information on EC use and subsequent contraception use of EC patients. METHODS: Sites included 5 clinics located at mainstream, racially diverse, and urban high schools. Nursing staff documented all EC-related visits during the 2002-2003 school year on a standardized form. These forms and additional information were collected from chart reviews. RESULTS: EC was requested in 113 instances involving 91 students and dispensed in all but 4 instances. The most frequently reported circumstance prompting an EC request was the use of no protection (37.2%), followed by a condom mishap (27.4%) and questionable protection from a hormonal method (23.9%). Anxiety despite adequate protection from a hormonal method (9.7%) or a condom (1.8%) accounted for the remaining cases. Although the clinical protocol included a follow-up appointment 2 weeks after receipt of EC, 39.5% of EC users failed to keep this appointment. The chart review revealed that hormonal contraception was eventually initiated following two thirds (68.0%) of the EC instances that involved either no protection or only a condom. CONCLUSIONS: Because young EC seekers vary considerably in terms of sexual experience, contraceptive use consistency, and pregnancy risk, individualized risk assessment and counseling are essential. The EC visit may be an optimal time to encourage initiation or reinstitution of hormonal methods of birth control.     

Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers

BACKGROUND: The purpose of this study is to compare the mental health risk profile and health utilization behaviors of adolescent school‐based health center (SBHC) users and nonusers and discuss the role that SBHCs can play in addressing adolescent health needs. METHODS: The sample included 4640 students in grades 9 and 11 who completed the California Healthy Kids Survey between fall 2000 and spring 2005 at 4 high schools in Alameda County, California. Chi‐squared tests of significance and multivariate logistic regression were used to compare characteristics of SBHC users and nonusers and identify demographic, health status, and behavioral characteristics predictive of SBHC use. RESULTS: Controlling for demographic variables and general health status, students who reported frequent feelings of sadness, trouble sleeping, suicide ideation, alcohol or marijuana use, the recent loss of a close friend or relationship, or other difficult life event were significantly more likely to seek SBHC services than their peers. Neither health insurance status nor a student's “usual” source of health care was predictive of general SBHC use, but being on public assistance or having no insurance was predictive of a student seeking SBHC mental health services. CONCLUSIONS: These findings suggest that SBHCs are able to attract students with the most serious mental health concerns and can play an important role in meeting needs that might otherwise go unmet. The provision of SBHC mental health services in particular may fill a need among adolescents with public or no insurance.     

Quality improvement initiative in school-based health centers across new Mexico

BACKGROUND: Quality improvement principles have been applied extensively to health care organizations, but implementation of quality improvement methods in school‐based health centers (SBHCs) remains in a developmental stage with demonstration projects under way in individual states and nationally. Rural areas, such as New Mexico, benefit from the use of distance education techniques to reach providers throughout the state. METHODS: The Envision New Mexico (ENM) Quality Improvement Initiative involves training in quality improvement concepts and methods, identification of best practices for selected clinical services, and repeated use of data to measure changes leading to improvement. The ENM employs the Model for Improvement and the “Plan‐Do‐Study‐Act” tool, which enables providers to self‐evaluate, set goals, and assess results with their own data. RESULTS: Providers tend to overestimate their use of best practices. Contrasting these perceptions with findings from medical record reviews can provide impetus and focus for quality improvement through changes in specific clinical practices and management systems. Preliminary findings from New Mexico suggest that quality improvement interventions can be effective, with initial improvements over baseline reviews typically in the 20–40% range. CONCLUSION: Systematic efforts to enhance the quality of care can help improve both the effectiveness and efficiency of SBHCs, and provide evidence of the value of the care provided. Simple, efficient quality improvement techniques, with the use of distance learning technologies, can help achieve the full promise of expanded school‐based health care.     

Assessment of health issues and concerns of Israeli seventh graders during school physician examinations: a pilot study

BACKGROUND: The AMA Guidelines for Adolescent Preventive Services (GAPS) recommends annual medical evaluations during adolescence, emphasizing screening and counseling regarding psychosocial issues. In Israel, seventh graders undergo medical examinations within the school health services, focusing on the detection of physical conditions. We addressed the psychosocial issues of these students by introducing an expanded school physician evaluation. METHODS: Twelve school physicians performed structured expanded health evaluations for seventh graders in 11 schools. Each student completed a questionnaire (checklist) with 22 health topics "about which s/he may want to receive information." The physician then carried out a biomedical and psychosocial evaluation, physical examination, and offered counseling to the student. RESULTS: Two hundred and seventy-eight students were examined. The questionnaire required 1-2 minutes, and the physician's evaluation 20-25 minutes. Health behaviors revealed included: currently dieting (28%), no physical activity after school (35%), ever smoked cigarettes (3%), ever smoked a water pipe (9%), used alcoholic beverages (6%), and does not always use front (22%) or rear (55%) seat belt. Nine percent rated their mood as being less than 7 (on a scale from 1 to 10). The leading topics about which the students requested information were height (50%), acne (42%), weight (38%), nutrition/diet (37%), physical activity (35%), and menstrual period (29% of the girls). The physicians counseled the students on an average of 3.6 topics per visit. CONCLUSIONS: An expanded school physician examination identifies students with psychosocial problems otherwise undetected during standard physical examinations, and provides the opportunity to address their personal concerns.     

Overheard in the halls: what adolescents are saying, and what teachers are hearing, about health issues

BACKGROUND: Schools have long been recognized as an excellent place to offer health education and supportive services. Teachers are among the most important influences in the lives of school-aged children and can provide valuable insight into the health issues important to adolescents. The purpose of this study was to examine the potential role general academic teachers may play in facilitating adolescent health promotion efforts. METHODS: To determine what teachers think about the role of health promotion in schools and what tools and topics they would find most helpful as critical advisers to students, we administered a 28-question survey at staff development meetings in 4 New York City schools. RESULTS: Teachers agreed that schools were an important venue for discussing and providing health messages. More than half of those surveyed reported having overheard student discussions about health once a week or more, and 70% stated that they had been actively approached by students 1-3 or more times per semester with reports of personal problems or health issues. Teachers expressed concern about their ability to handle student mental, behavioral, and reproductive health problems and desired additional staff development workshops to address these needs. CONCLUSIONS: Teachers felt that schools were important places to promote dialogue about health and accept the importance of playing a broader role in the lives of youth beyond education. To enhance the prospect of health-promoting interactions between teachers and students, attention must be paid to developing the overall skill and comfort level of teachers with respect to adolescent health concerns.     

两种政府投入方式对村卫生室公共卫生服务影响分析

目的 探讨政府购买服务和直接投入两种方式对村卫生室的激励效应.方法 以贵州省24个县村卫生室为样本,了解政府购买服务和直接投入两种方式下村卫生室公共卫生服务开展情况及村民满意度.结果 除传染病报告、健康讲座、健康档案外,购买服务组的大部分公共卫生服务项目指标优于直接投入组(P＜0.05);两组除设施条件、服务态度的村民满意度评分差异无统计学意义外,购买服务组其他维度及综合评分均高于直接投入组(P＜0.05).结论 政府购买服务对提高村卫生室服务效率具有较大潜力,但需进一步打破垄断,合理确定购买项目和方式,并构建科学的监管机制,以达到激励相容效应.     

Building capacity for the continuous improvement of health-promoting schools

BACKGROUND: There has been much educational verbosity over the past decade related to building capacity for effective schools. However, there seems to be a scarcity of clarification about what is meant by school capacity building or how to accomplish and sustain this process. This article describes the preexisting conditions and ongoing processes in Pueblo, Colorado School District 60 (Pueblo 60) that built capacity for the development and continuous improvement of health-promoting schools. METHODS: Capacity building strategies and a program-planning model for continuous improvement for health-promoting schools were used that included: (a) visionary/effective leadership and management structures, (b) extensive internal and external supports, (c) development and allocation of adequate resources, (d) supportive policies and procedures, and (e) ongoing, embedded professional development. RESULTS: Pueblo 60 strategically developed an infrastructure through which they successfully delivered a wide array of health programs and services. CONCLUSIONS: Through building organizational capacity at the school district and school level, additional school health programming can be developed and sustained.     

The Relationship Between School-Based Health Centers and the Learning Environment

BACKGROUND: School-based health centers (SBHCs) have improved access to primary and preventive health care for underserved children and youth by bringing comprehensive health services into the schools while addressing critical health problems that make it difficult for students to learn. Despite the findings on the positive effects of SBHCs on health outcomes, the literature investigating the relationship between SBHCs and the learning environment is scant. This purpose of this study is to add to the literature by investigating the correlation between SBHCs and perceptions of the overall school learning environment. METHODS: This study investigates the relationship between SBHCs and the learning environment utilizing a retrospective quasi-experimental design. Researchers used secondary data from the 2007 Board of Education Learning Environment Survey (LES) of a large northeastern city to compare schools with SBHCs and schools without SBHCs. RESULTS: The findings demonstrate that the presence of a SBHC is associated with greater satisfaction in 3 out of 4 learning environment domains. CONCLUSIONS: Perhaps by helping to eliminate the barriers that affect lower-performing students' readiness to learn, while improving student and parent engagement, SBHCs can partner with schools to reach their performance and accountability goals.     

Building bridges between schools of public health and public health practice.

A 1988 Institute of Medicine report, The Future of Public Health, characterized the current public health system as fragmented, particularly with regard to relationships between public health agencies and academic institutions. As one response to the report, the Health Resources and Services Administration established the Center for the Development of Public Health Practice at the University of Illinois to advance linkages between schools of public health and public health agencies. Surveys of schools of public health and of state health agencies were conducted in 1992 to collect baseline data on the practice links between the two. Responses reveal that there is a substantial amount of informal collaboration between them. Formalization of collaborative activities between schools and agencies is beginning to occur and is expected to expand owing to increased focus on public health practice at schools of public health.     

张家港市校医队伍及卫生室现状调查

目的 了解张家港市校医、保健老师队伍及卫生室基本情况,为加强校医队伍建设提供参考,同时也为主管部门制定和完善相关管理规定、政策提供依据。方法 采用调查问卷对全市各中小学校校医、保健老师基本情况及学校卫生室承担职能、设施配备情况进行调查,调查数据通过Epidata3.1进行录入,使用Excel软件进行统计分析。结果 张家港市中小学学生数与校医配备比例是3 625:1,按照学校规模600:1配备校医、保健老师的中小学校合格率仅为7.4%; 88名校医、保健老师,女性占89.8%,平均年龄为40.6岁,从事学校卫生保健工作的平均年限为10.6年,教育类专业占48.9%,取得教育类专业职称占40.9%,本科学历占53.4%,正式在编人员占54.3%,兼职占47.7%;97.6%的学校配备了独立的卫生室和保健室;对84所学校的卫生室承担职责调查显示,能开设学生门诊,处治常见病、多发病的卫生室占32.1%,开展学生心理咨询的卫生室占25.0%。结论 根据张家港市中小学校校医、保健老师的调查现状,主管部门应按要求配置校医、保健老师,着力解决职称和待遇等切实问题,不断强化校医、保健老师队伍专业知识培训。     

Variation in school health policies and programs by demographic characteristics of US schools, 2006

BACKGROUND: To identify whether school health policies and programs vary by demographic characteristics of schools, using data from the School Health Policies and Programs Study (SHPPS) 2006. This study updates a similar study conducted with SHPPS 2000 data and assesses several additional policies and programs measured for the first time in SHPPS 2006. METHODS: SHPPS 2006 assessed the status of 8 components of the coordinated school health model using a nationally representative sample of public, Catholic, and private schools at the elementary, middle, and high school levels. Data were collected from school faculty and staff using computer-assisted personal interviews and then linked with extant data on school characteristics. RESULTS: Results from a series of regression analyses indicated that a number of school policies and programs varied by school type (public, Catholic, or private), urbanicity, school size, discretionary dollars per pupil, percentage of white students, percentage of students qualifying for free lunch funds, and, among high schools, percentage of college-bound students. Catholic and private schools, smaller schools, and those with low discretionary dollars per pupil did not have as many key school health policies and programs as did schools that were public, larger, and had higher discretionary dollars per pupil. However, no single type of school had all key components of a coordinated school health program in place. CONCLUSIONS: Although some categories of schools had fewer policies and programs in place, all had both strengths and weaknesses. Regardless of school characteristics, all schools have the potential to implement a quality school health program.     

Changing nutrition standards in schools: the emerging impact on school revenue

BACKGROUND: Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This review provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject. METHODS: A systematic review of the literature was conducted. Four peer-reviewed papers and 3 state-based reports were identified that assessed the impact on revenues of either targeted policy changes or overarching, district-wide changes in food-related policies. RESULTS: Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses. CONCLUSIONS: A renewed focus on school policies related to health provides the opportunity for researchers to investigate how nutrition-related policy change can affect, if at all, food service and overall school revenues.     

从村卫生室的运行机制谈农村卫生政策的断裂与弥合

近年来,国家及各级政府出台了多项卫生政策以惠及广大农民群众,但课题组实地观察后发现,村卫生室的实际运行情况与政策文件规定之间出现了裂痕。文章从村卫生室的用人机制、投入补助机制、绩效考核与激励机制、风险分担机制几方面深入分析村卫生室实际运行状况与相关政策文件规定之间的裂痕,进而探讨弥合裂痕的对策建议。     

Understanding pediatricians' views toward school-based BMI screening in Massachusetts: a pilot study

BACKGROUND: Massachusetts (MA) mandated body mass index (BMI) screening in schools in 2010. However, little is known about pediatricians' views on school‐based screening or how the pediatricians' perspectives might affect the school‐based screening process. We assessed MA pediatricians' knowledge, attitudes, beliefs, and practices concerning BMI screening. METHODS: An anonymous Web‐based survey was completed by 286 members of the MA Chapter of the American Academy of Pediatrics who provided primary care (40% response rate). RESULTS: Support for school‐based BMI screening was mixed. While 16.1% strongly supported it, 12.2% strongly opposed it. About one fifth (20.2%) believed school‐based screening would improve communication between schools and pediatricians; 23.0% believed school‐based screening would help with patient care. More (32.2%) believed screening in schools would facilitate communication with families. In contrast, pediatricians embraced BMI screening in practice: 91.6% calculated and 85.7% plotted BMI at every well child visit. Pediatricians in urban practices, particularly inner city, had more positive attitudes toward BMI screening in schools, even when adjusting for respondent demographics, practice setting, and proportion of patients in the practice who were overweight/obese (p < .001). CONCLUSION: These data suggest MA pediatricians use BMI screening and support its clinical utility. However, support for school‐based BMI screening was mixed. Urban‐based pediatricians in this sample held more positive beliefs about screening in schools. Although active collaboration between schools and pediatricians would likely help to ensure that the screenings have a positive impact on child health regardless of location, it may be easier for urban‐based schools and pediatricians to be successful in developing partnerships.     

郑州市乡镇卫生院卫生资源利用情况分析

[目的]分析2008年郑州乡镇卫生院卫生资源利用情况,提出有效利用郑州市乡镇卫生院资源的建议。[方法]搜集、整理相关卫生统计数据,进行描述性统计分析。[结果]郑州市大多数乡镇卫生院的工作效率和工作负荷偏低,临床医生的工作量不足;床位和医疗服务利用率低;设备环境较差;业务收入仍以药品收入为主。[结论]改变乡村卫生机构间的业务竞争关系;优化乡镇卫生院的资源配置;加强乡镇卫生院的内部管理。     

School superintendents' perceptions of schools assisting students in obtaining public health insurance

Background: Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined. Methods: A 4‐page questionnaire was sent to a national random sample of public school superintendents using a 4‐wave postal mailing. Results: Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources. Conclusions: Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.