Communication and education about asthma in rural and urban schools.

OBJECTIVE: To assess the quality of communication and education about asthma in Pennsylvania public schools. METHODS: Survey of a stratified random sample of school nurses in rural and urban Pennsylvania public schools (n = 996) concerning communication with school nurses about asthma by physicians and parents, nurses' perceived obstacles to asthma management at school, and utilization of and need for education about asthma. RESULTS: A total of 757 surveys were received (response rate 76%). Thirty-nine percent of school nurses rated their communication with physicians about asthma as either poor or very poor. Urban nurses were significantly more likely to report poor/very poor physician communication (P = .09). Fifty-two percent of the nurses overall (43% rural, 56% urban) also cited lack of communication with parents as an important obstacle to asthma management. Forty-nine percent of school nurses (43% rural, 52% urban) reported attending an asthma education program during the previous year, and 75% (83% rural, 71% urban) expressed interest in additional education. Education about asthma was provided for classroom teachers in 54% of schools (56% rural, 54% urban) and provided for students in 58% of schools (54% rural, 60% urban). CONCLUSIONS: These findings document need for improvement in communication about children's asthma between school nurses and physicians. Although communication appears better in rural relative to urban schools, it is a salient issue in both settings. Study findings also indicate the need for expanded professional education opportunities for school nurses and improved access to appropriate curricular materials for school staff, parents, and students.     

Epidemiology of injuries in a large, urban school district

Injuries represent the single greatest threat to the health and well-being of US children. A large number of childhood injuries are sustained in schools, yet little is currently known of the epidemiologic features of school-related injuries. A surveillance of injuries occurring in a large, urban school district during a 2-year period was conducted. Nurses in each of the district's 96 schools completed reporting forms on all injuries meeting standardized criteria, and both principals and nurses completed questionnaires on school characteristics that were judged potentially important to the injury rate in individual schools. A total of 5,379 injuries were reported, among the district's 55,000 students, for an overall injury rate of 49 injuries/1,000 student-years. Injury rates were higher for boys than girls at all age levels. Self-caused and sports-related injuries comprised nearly half of all those reported, and 14% were related to use of playground or sports equipment. Eighteen percent of injuries were severe, and playground- and equipment-related injuries were significantly more likely to be severe (P less than .001). Rates of injury among individual schools varied markedly, with schools at the two extremes separated by a 25-fold difference in rates. Higher overall injury rates were found in schools with longer hours, alternative educational programs, less experienced school nurses, and lower student-to-staff ratios (P less than .0001).     

十堰市茅箭区中小学生心理健康现状调查分析

目的了解十堰地区中小学生心理健康现状。方法采用国内修订版4套评估工具Achenbach儿童行为量表中国标准化版增订版、学习障碍筛查量表、Conners儿童行为问卷父母量表、教师量表及自行设计的一般情况调查表,采取随机抽样方式对十堰市茅箭区区属18所学校11611名中小学生、教师及家长发放问卷,进行调查测评分析。结果89.29%的中小学生具有远大理想和崇高追求,具有正确的人生观和价值观,10.71%的中小学生存在着较为严重的心理问题,主要表现为学习目的不明确,缺乏学习积极性及自觉性,自信心缺乏,自责倾向严重,心理承受能力差,冲动倾向严重,焦虑与情绪不稳定、孤独倾向造成冷漠、羞怯、与人交往困难。结论学校、家庭、社会全方位关注学生心理健康,才会促进中小学生心理向健康方向发展。     

Role of the school nurse in providing school health services

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses.     

Fathers' involvement in Swedish child health care - the role of nurses' practices and attitudes

Aim: To investigate how nurses in Swedish child health care perceived working with fathers, and to what extent they offered support to, and included fathers in clinical encounters. Methods: A random sample of all nurses in Swedish child health care, 499 nurses, were asked to complete a postal questionnaire. The response rate was 70%. Data were analysed with content analysis, the chi‐square test and logistic regression models. Results: Almost all of the nurses found working with fathers positive. Fathers’ participation in child health care was much lower than that of mothers’. Almost 90% of the nurses estimated that it rarely came to their attention that a father was distressed, and less than one of five nurses had offered supportive counselling to any distressed father in the previous year. Nurses with regular supervision on mental health issues and nurses with a paediatric specialization were more likely to offer supportive counselling to fathers. Approximately 50% of the nurses had an ambivalent attitude towards fathers’ caring capacity when compared to that of mothers. Conclusions: Fathers received less support from child health nurses, and many nurses were ambivalent about fathers’ caring abilities. Methods need to be developed to involve both parents in child health care.     

Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference?

BACKGROUND: About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome. OBJECTIVE: To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs. SETTING: Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs). PARTICIPANTS: Nine hundred forty-nine inner-city schoolchildren with asthma. DESIGN: To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information. RESULTS: Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high-during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively; P =.02). CONCLUSION: Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.     

Physical health and behavioral problems in two high schools in Holon, Israel

1320 students of two high schools were examined in Holon. Their physical and behavioral problems are summarized. These data serve to build the model of the medical profile of the adolescent in Israel, as a background to medical screening in school, which should be done at least every two years.     

The influence of school smoking policies on student tobacco use

OBJECTIVE: To investigate the association between smoking behavior among secondary school students and school smoking policies. DESIGN: Cross-sectional provincially representative study. SETTING: Quebec secondary schools. PARTICIPANTS: Complete data were available for 763 of 1058 students aged 13 years in 50 schools and for 768 of 1160 students aged 16 years in 57 schools. School principals provided data on school smoking policies. Main Exposure School smoking policies. Outcome Measure Student tobacco use. RESULTS: Of students aged 13 years, 3.8% of boys and 7.1% of girls smoked daily; 21.0% of boys and 25.2% of girls aged 16 years smoked daily. Of schools, 28.0% permitted staff to smoke indoors, 84.1% permitted staff to smoke outdoors on school grounds, and 83.2% permitted students to smoke outdoors on school grounds. Daily smoking was not associated with policies targeting student smoking or those targeting indoor smoking by staff. In multilevel analyses, girls aged 13 years were almost 5 times more likely to be daily smokers if they attended schools at which staff were permitted to smoke outdoors. CONCLUSIONS: Younger girls may be more susceptible to social influences at school related to tobacco use. School policies banning smoking by teachers and other school personnel within and outside the school should be an important component of comprehensive adolescent smoking prevention programs.     

Preventing adolescent health-risk behaviors by strengthening protection during childhood

OBJECTIVE: To examine the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on adolescent health-risk behaviors at age 18 years. DESIGN: Nonrandomized controlled trial with follow-up 6 years after intervention. SETTING: Public elementary schools serving high-crime areas in Seattle, Wash. PARTICIPANTS: Of the fifth-grade students enrolled in participating schools, 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years. INTERVENTIONS: A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1 through 3 and 5 through 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention, provided in grades 5 and 6 only, paralleled the full intervention at these grades. MAIN OUTCOME MEASURES: Self-reported violent and nonviolent crime, substance use, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average; California Achievement Test scores: and disciplinary action reports from school records. RESULTS: Fewer students receiving full intervention than control students reported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15.4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%; P=.02), having multiple sex partners (49.7% vs 61.5%; P=.04), and pregnancy or causing pregnancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention student group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence. CONCLUSIONS: A package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing violent behavior, heavy drinking, and sexual intercourse by age 18 years among multiethnic urban children. Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.     

Evaluation of neuropsychomotor development in first grade children and its relation with nutrition

OBJECTIVE: To investigate the neurological performance of elementary school students from the city of Porto Alegre, state of Rio Grande do Sul, Brazil, in order to assess the association of neurological development and nutritional status. METHODS: We carried out an observational, analytical, and crosssectional study on a random and proportional population sample selected out of all first-grade students (n=35,521) in the city of Porto Alegre for a total of 484 children, out of which 64.7% were enrolled in state public schools, 11.9% in city public schools, and 23.4% in private schools. Our sample size allowed for a precision of -/+ 3% (95% confidence interval) for an estimated prevalence of 10% of cortical dysfunction. Children were submitted to individual examinations at the school. We collected data regarding sex, age, color of skin, nutritional status, and school of origin. An informed consent was obtained from the State and City Departments of Education and from the principals of the private schools. Statistical analysis was carried out using the chi-square test and ANOVA. RESULTS: From 11.4% to 38.2% of children presented ENE results lower than expected according to their age. The most affected factors were sensory activity and gnosia (38.2%), and the least affected factor was motor persistence (11.4%). There were no statistically significant differences between boys and girls. We observed an association of children with low height-for-age and weight-for-age and cortical dysfunction. CONCLUSIONS: Chronic malnutrition is a risk factor for brain function performance.     

Collaboration with school nurses: improving the effectiveness of tuberculosis screening.

OBJECTIVE: To compare tuberculosis skin test (TST) reading rates between children whose tests were read by school nurses following specific requests by physicians and those who relied on their parents to get their tests read, either at school or at the physician's office. DESIGN: A randomized controlled trial. SETTING: An urban hospital-based pediatric practice. PARTICIPANTS: Healthy low-income Hispanic and African American children aged 5 to 17 years whose physicians ordered TSTs at their routine physical examinations. Subjects attended 1 of 68 public schools. Nurses at these schools were willing to read student TSTs, and received instructions about how to read and report the results back to the physician's office. INTERVENTION: Subjects were randomized to a control group (routine TST placement, with no physician-to-school nurse communication) or to an intervention group (routine TST placement, with physician-to-school nurse communication). MAIN OUTCOME MEASURES: Tuberculosis skin test reading rates between the 2 groups were compared. Impediments to TST reading and reporting were investigated. RESULTS: One hundred thirty-four children were enrolled, 54 (40%) in the control group and 80 (60%) in the intervention group. More patients in the intervention group had their TSTs read by 72 hours compared with those in the control group (74 [92%] vs 30 [56%]; P<.001). The low reading rate in the control group was best attributed to communication failures. CONCLUSION: Systematic collaboration with school nurses can increase TST reading rates.     

Current situation and comparison of school mental health in ASEAN countries

School‐based mental health interventions are considered to have potential for the promotion of mental health in developing countries. We held a workshop to discuss the promotion of mental health in schools in southeast Asian countries. This review report aimed to summarize the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop. To summarize the current situation of ASEAN countries in relation to school mental health, we qualitatively analyzed the content of the discussions from four perspectives: (i) laws and regulations: (ii) mental health services; (iii) teacher training on mental health; (iv) mental health education for students. With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers. Our results show that mental health services in schools are centered on professionals such as guidance counselors, although the coverage varied among the different ASEAN countries. Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited. Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.     

Prevention of spinal cord injuries caused by diving: evaluation of the distribution and usage of a diving safety video in high schools

OBJECTIVE: To determine and assess the distribution and use of Sudden Impact, a video designed by Think First and SportsSmart Canada, to help prevent spinal cord injury caused by careless shallow water diving among teenagers in the high risk group (15-24 years old). DESIGN: Survey of 92 public secondary schools in Toronto, Canada. SUBJECTS: The heads of the physical and health education departments of the 92 secondary public schools in the Metropolitan Toronto region. RESULTS: The response rate was 64% (59 schools), of which 76% (45) had actually received the video. Forty one schools (91%) of those that received the video reported using it. Eighty per cent of responding schools showed it to grade 11 students. Eighty per cent of schools with swimming pools used the video compared with only 42% of schools without swimming pools. CONCLUSIONS: There is a need for improvements in the system of distribution to ensure greater use of material such as this video. These may include direct distribution to principals, continuing contact with the schools, or mandatory inclusion of diving safety into the school curriculum.     

Compulsory educational mental health support system in Japan

Mental health problems among children present an important public health issue worldwide. Early detection, assessment, and support in schools might have a significant impact on mental health outcomes and child health and wellbeing. The purpose of this article is to show the mental health support system and its historical transition in Japan. In general, Japanese schools have a Yogo teacher (a school nurse) who works full time, as well as three types of mental health specialists who work part time: school counselors, advisors, and social workers. The regularity of visits from the three types of specialists depends on schools and regions. In general, school counselors visit schools more often than do other specialists, for approximately 4 h per week. The other specialists either visit the schools rarely or not at all because they are sometimes not hired. The strengths of the Japanese system included much provision of psychological consultations and a small budget compared to Western countries. Almost all school counselors are clinical psychologists with master’s degrees who are skillful at handling students’ mental problems. Moreover, they are capable of providing intensive psychological counseling in school settings in Japan. The weakness is that there is no specialist available who supports students’ academic or school life. General teachers take on the role of the Western countries’ “school counselors.” There are also few specialists who can be approached for social support compared to Western countries.     

Bullying, psychosocial adjustment, and academic performance in elementary school

BACKGROUND: Over the past decade, concerns about bullying and its role in school violence, depression, and health concerns have grown. However, no large studies in the United States have examined the prevalence of bullying during elementary school or its association with objective measures of school attendance and achievement. OBJECTIVE: To determine the prevalence of bullying during elementary school and its association with school attendance, academic achievement, disciplinary actions, and self-reported feelings of sadness, safety, and belonging. DESIGN: Cross-sectional study using 2001-2002 school data. SETTING: Urban, West Coast public school district. PARTICIPANTS: Three thousand five hundred thirty (91.4%) third, fourth, and fifth grade students. MAIN OUTCOME MEASURE: Self-reported involvement in bullying. RESULTS: Twenty-two percent of children surveyed were involved in bullying either as a victim, bully, or both. Victims and bully-victims were more likely to have low achievement than bystanders (odds ratios [ORs], 0.8 [95% confidence interval (CI), 0.7-0.9] and 0.8 [95% CI, 0.6-1.0], respectively). All 3 bullying-involved groups were significantly more likely than bystanders to feel unsafe at school (victims, OR, 2.1 [95% CI, 1.1-4.2]; bullies, OR, 2.5 [95% CI, 1.5-4.1]; bully-victims, OR, 5.0 [95% CI, 1.9-13.6]). Victims and bully-victims were more likely to report feeling that they don't belong at school (ORs, 4.1 [95% CI, 2.6-6.5] and 3.1 [95% CI, 1.3-7.2], respectively). Bullies and victims were more likely than bystanders to feel sad most days (ORs 1.5 [95% CI, 1.2-1.9] and 1.8 [95% CI, 1.2-2.8], respectively). Bullies and bully-victims were more likely to be male (ORs, 1.5 [95% CI, 1.2-1.9] and 3.0 [95% CI, 1.3-7.0], respectively). CONCLUSIONS: The prevalence of frequent bullying among elementary school children is substantial. Associations between bullying involvement and school problems indicate this is a serious issue for elementary schools. The research presented herein demonstrates the need for evidence-based antibullying curricula in the elementary grades.     

Children with chronic conditions: Educators' views

The purpose of this qualitative, exploratory study was to identify the concerns and resource needs of educators for effectively teaching children with chronic health conditions. Semistructured audiotaped telephone interviews were conducted with 23 teachers and six principals from urban and rural public schools, grades K-12. The interview included questions in four areas: (a) experiences with children with chronic health conditions, (b) concerns in providing educational services to these children, (c) resources used by educators, and (d) recommendations regarding how information and services can best be provided to educators. The most common concerns were unanticipated medical emergencies and increased absence rates. The major resource for these educators was the school nurse. Educators preferred information specific to a child in their class, provided to them by the school nurse. Results suggest that interventions for teachers are more likely to be effective when they are coordinated with the school nurse and focus on the impact of the condition on a child's ability to function in the classroom. Subsequent research is necessitated to determine effective strategies for specialty nurses to aid school nurses in providing optimum care for these children.     

Parent-reported food allergy requiring an avoidance diet in children starting elementary school

Aim: To evaluate the prevalence of parent‐reported food allergies requiring avoidance diet at early school age. Methods: The school health nurses interviewed, by using a structured questionnaire on the required diet at school, the parents of all the 1542 children starting elementary school in a Finnish town with 210 000 inhabitants. Results: An allergy to basic foods was found in 41 (2.7%) children: 1.5% to milk, 1.1% to eggs and 1.0% to grains. An allergy to nuts was present in 3.1% and to fruits and vegetables in 5.8%, both with known cross‐sensitization to pollens. In all, 9.2% of the children reported some allergy. Milk, egg and grain allergies were associated with soy, nut and spice allergies. Conclusion: Over 2% of the 1542 Finnish first‐graders reported allergies to basic foods (milk, eggs or grains) requiring special avoidance diets at school. The figure suggests that avoidance diets started in the first years of life still unnecessarily continued.     

Medical vocational guidance for adolescents–is it effective?

The outcome of school medical vocational guidance was studied in all 1595 students enrolled in 1987 in grade 9 in the primary schools of Linköping. In grade 9, the school health service had listed 249 students with a chronic disorder. These were sent a questionnaire which was answered by 235 students. Only 5/235 stated that vocational information from physicians and school nurses had been important for their choice of career. No more than 22/235 had chosen a medically ill-suited secondary school study course. This figure is close to the number expected, assuming that all choices of study courses are at random. At follow-up in May 1989, no one said that they had changed study course or work due to their medical disorder. Thus, school medical vocational guidance seems to have little effect on the vocational choices of adolescents with chronic disorders.     

Bullying in schools: prevalence and short-term impact

OBJECTIVES: To estimate the prevalence of bullying in school children and to examine its association with common symptoms in childhood. DESIGN: Prospective survey using a pre-tested questionnaire for conducting a semi structured health interview. SETTING: Randomly selected Public and private schools in a rural area. SUBJECTS: Children aged 8-12 years studying in three schools and their parents. RESULTS: Bullying was reported by 157 (31.4%) of the 500 children interviewed. There was no significant difference in the prevalence of bullying amongst boys and girls in co-education schools. However, it was significantly low in schools enrolling girls alone. Teasing and keeping names were the commonest forms noticed. Causing physical hurt was reported bv 25 (16%) students. Only 24 (24%) parents were aware that their children were being bullied. Feeling sad, preferring to stay alone and frequent tearing of clothes were almost exclusively noted in bullied children and bullied children were more likely to report symptoms such as school phobia, vomiting and sleep disturbances. CONCLUSION: Bullying is a common phenomenon amongst school going children. Frequent bullying is associated with certain symptoms and school absenteeism. Healthcare professionals. should be aware of this phenmnenon so that they can diagnose the underlying cause when these symptoms are reported and plan for appropriate interventions.