Donkey-assisted rehabilitation program for children: a pilot study

Bonding with animals grants access to the sphere of affectivity and facilitates therapeutic engagement. The methodological approach of donkey-assisted programs is based on mediation, which is characterized by multidirectional relationships (patient-donkey-therapist). The donkey is an excellent facilitator in the motivation-building process, being able to stimulate the child's development by way of active and positive forces that foster psycho-affective and psycho-cognitive development processes. Results of this study, which focused on the child's approach to the donkey, indicate that while communicating with the animal, children rely more on physical expressions than on verbal language. Donkey-assisted rehabilitative sessions can help in identifying children's strong points, on which motivation could be built.     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

Assessing an intensive school-based assistance program to enroll uninsured children

Children eligible but not enrolled in subsidized health insurance programs, such as Medicaid and S-CHIP, received considerable outreach activity in recent years. Schools in low-income and middle-income communities often are cited as excellent places to find and reach parents. This study assessed the cost and effectiveness of contacting parents through schools, educating them about health insurance programs and preventive care, and assisting them with insurance applications. The accumulative cost per enrolled child was $75, and schools were able to locate and assist large numbers of uninsured children who had failed other outreach methods. School-based application assistance and parent education succeeded in improving child access to care and utilization of services.     

Addressing asthma in Texas: development of a school-based asthma surveillance program for Texas elementary schools

To address asthma in the state, in October 2000, the Texas Department of State Health Services (DSHS) and the American Lung Association of Texas held a joint meeting of asthma professionals from across the state, with a primary purpose of identifying major issues and potential strategies and actions to be taken. These discussions became the basis of the 2001 Texas State Asthma Plan, which has since been adopted to guide state efforts in asthma surveillance, management, education, and advocacy. The primary purpose of this project, which was conducted with and funded by the DSHS and the Centers for Disease Control and Prevention, has been to develop and implement an asthma surveillance program for Texas school-aged children. The program has been implemented with a sample (n = 42,409) of students from the Texas Education Agency's region IV. An important goal has been to determine the feasibility of conducting school-based statewide asthma surveillance and assist with establishing a network for ongoing, systematic collection, analysis, interpretation, and dissemination of asthma data. This project is expected to become part of a wider asthma surveillance network that will include mortality, hospital discharge, and Behavioral Risk Factor Surveillance System (BRFSS) data. It will also provide information not typically captured by surveillance programs, including the BRFSS, which rely heavily upon a previous diagnosis of asthma to determine both lifetime and current prevalence of asthma. Results from this project indicate that such reliance on a previous diagnosis may considerably underestimate the prevalence of disease-particularly in the Latino population     

Development of a health education program for parents of preschool children with asthma

This paper presents the development and pilot testing of a self-management education program for parents of preschool children (0-4 years) with asthma, involving general practitioners, asthma nurses, community nurses and doctors of child health centers. The program intends to integrate education in the medical care provided to the child (and the parent). The program contains four manuals, one for each group of health care providers, and a booklet for parents. The manuals identify the educational tasks per discipline and regulate referral from one discipline to another. The booklet provides written information for parents. In the development of the program, representative from both the target population and the providers of the education were involved in needs assessment surveys. Findings of these surveys were integrated into the design of the program. Then, a pilot study was conducted to test the efficacy of the program during group sessions. Findings indicate that the variables measured (knowledge, attitude, self-efficacy and self-management behaviors) improved significantly from pre- to post-test. Finally, the program was revised for the next phase in which the program will be evaluated in primary health care with a controlled trial.     

Development of a school-based prevention program for children in alcoholic families

The systematic development of a preventive intervention for elementary-aged children of alcoholics (COAs) is described. First, the risk status of children of untreated alcoholics was established. Second, risk and protective factors that appeared to be mediators of mental health status for COAs were identified. Third, a preventive intervention was designed to teach coping skills and enhance self-esteem. Fourth, the intervention was pilot tested to assess its feasibility and potential. Finally, plans for a large scale experimental field trial of the revised curriculum are outlined. The advantages of following a systematic intervention development plan are demonstrated.Work on this study was funded in part by the National Institute of Mental Health Grant P50-MH39246 to Support a Preventive Intervention Research Center and T32-MH18387-02 Postdoctoral Prevention Training Grant. The authors wish to recognize the significant contributions of our Community Advisory Board, composed of Laurel Cappo, Frank Diaz, Julie Edmonson, and Joyce Heddleson, to the development and implementation of this prevention program.     

劝导模型在青少年进食障碍预防教育中的应用探索

【目的】为有效改善学校健康教育,探索使用精确概率劝导模型对健康教育实施前评价。【方法】以针对儿童青少年进食障碍预防为例,对490名被试学生就相关的健康教育核心信息进行评价。【结果】不同的信息对被试的作用效果不同。影响青少年对预防进食障碍的健康教育核心信息的评价因素涉及信息本身的特征和受试者的特征信息。低焦虑、低抑郁、高自尊、身体不满程度较轻的学生,受信息作用效果更好。【结论】预先对健康教育信息进行评价是提高学校健康教育效力的有效方法,并能够有助于调整被干预对象达到接受干预的最佳状态。     

Evaluation of a school-based education program to promote bicycle safety

Of the 500,000 children in the United States who are injured in bicycle crashes annually, 252 die--97% of whom were not wearing a helmet. Although many intervention programs promote the use of helmets by children, a paucity of school-based evaluation studies exist that report students' knowledge retention or behavioral changes. The purposes of this study were to identify associations between student-reported knowledge of safety-related behaviors, reports of current safety-related practices, and students' participation in the Safety Central program while in the 4th grade. The sample consisted of 284 students currently enrolled in 5th and 6th grades. Findings showed a statistically significant association between participation in the Safety Central program and retention of knowledge and enactment of safety messages after a 1- and 2-year period. Motivators and barriers for helmet use were also identified. Implications for modifications to the content and delivery of the program and future evaluations are addressed.     

某农村地区学校预防性侵犯教育对儿童知识和技能的影响

评价学校预防儿童性侵犯教育对农村学龄儿童自我保护知识和技能的影响,为今后在农村地区开展预防儿童性侵犯教育提供参考.方法 本研究在东北某农村地区2所学校二至五年级进行,儿童以班级为单位分为教育组和对照组,由学校教师进行教育.分别于教育前和教育后对学生进行问卷调查,通过比较2组教育前后知识和技能得分的变化评价教育效果.有365名学生参与并完成了教育前后问卷调查.二至五年级学生分别为110,104,88和63名;教育组171名,对照组194名.结果 与教育前比较,教育后教育组和对照组知识和技能得分均有显著增长(P值均<0.01).教育后教育组儿童知识、告诉技能和总技能得分增长值分别为(3.49±3.50)(1.54±1.98)(1.99±2.51),明显高于对照组的增长值[分别为(1.05±3.64)(0.61±1.78)(1.11±2.23)],差异有统计学意义(t值分别为6.50,4.67,3.50,P值均<0.01).结论 学校预防儿童性侵犯教育有助于提高农村儿童的自我保护知识和技能水平.应继续完善预防儿童性侵犯教育和评价方法.     

The Breathmobile: a novel comprehensive school-based mobile asthma care clinic for urban underprivileged children

Urban minority children have higher rates of asthma morbidity due to multiple factors. Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings.     

Partners in school asthma management: evaluation of a self-management program for children with asthma

The "Partners in School Asthma Management" program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools with probable asthma; 835 (96% Hispanic or African American) joined the study. Baseline, posttest, and follow-up measures of asthma knowledge, self-efficacy, and self-management behavior were obtained from the children, and data on symptoms, emergency department visits, and hospitalizations were obtained from their parents. The schools provided data on grades and absences. Each school had a baseline and follow-up environmental assessment. The children in the intervention group showed greater increases in knowledge, self-efficacy, and some aspects of self-management. No differences between groups were found in health status variables, school performance, attendance, or levels of environmental allergens in schools. In 15 schools, an enhanced intervention allowed children and their parents to meet with a project physician, develop an asthma action plan, and receive a 1-month supply of medication; the project physician then followed up with the child's community physician. Children participating in this enhanced intervention had better school performance and fewer absences than the comparison group. Overall, the program was effective in improving children's asthma self-management but not in improving their health status. While the case-finding, computer-based self-management training program and linkage system were successfully implemented, the program failed in creating needed changes in the medical (action plans by community physicians) and physical environments (reduced school allergen levels) of the children.     

Testing anonymous link procedures for follow-up of adolescents in a school-based trial: the EU-DAP pilot study

OBJECTIVE: To study the feasibility of an anonymous coding procedure linking longitudinal information in a multi-center trial of substance abuse prevention among adolescents. METHODS: A school-based survey with re-test procedure was conducted among 485 students (mean age 13.8 years) from three countries at four study centers in order to study accuracy and repeatability of a self-generated anonymous code. RESULTS: Errors affected 18% of codes and 3% of all digits required for the code generation, with highest figures for two of the seven generation items. Sixty-one percent of the codes generated at the test were repeated identically at the re-test. Seventy-six percent of the codes could be linked excluding the 2 digits with the highest error rate in code generation, while 92% were linked using the best combination of the remaining seven or six digits. There was substantial variation between the centers in the results. CONCLUSIONS: Self-generation of anonymous codes is a feasible, but not a very efficient procedure to link longitudinal data among adolescents. Easy derivation and iterative matching procedures are crucial for achieving high efficiency of this type of anonymous linkage.     

A pilot study of a headache program in the workplace. The effect of education

Headache is a frequent problem in the workplace and contributes to absenteeism and productivity loss. Disease-management programs targeting headache may reduce its impact on employees, employers, and society. A pilot study was conducted in an employer setting (J.P. Morgan & Co., Incorporated; four locations in New York City and two in Delaware) to evaluate a multimedia computer-based (kiosk) headache program. Study objectives included assessing the effect of the program on participant outcomes and evaluating the educational component of the program. Through the kiosk, participants were questioned about the types, severity, and frequency of their headaches; the impact of headaches on their daily activities; and lost workdays as a result of headache. All participants received personalized reports about their headaches, and the participants in New York were given access to an on-site neurologist and additional educational information. A follow-up assessment was requested 3 months after the baseline screening to evaluate the effect of the program. A total of 185 participants completed both a baseline and follow-up session. Of 177 evaluable participants, 19% saw a physician for headache after their initial kiosk session. Fifty-six percent of evaluable participants reported overall improvement in headache symptoms at follow-up (P < 0.01), with decreased headache frequency and better understanding of headache most often selected as reasons for improvement. Participants also reported higher satisfaction with headache management after using the program and fewer urgent care/emergency room visits for headache (P < 0.01). For participants who reported lost workdays because of headache, the number of days missed had decreased by the follow-up. The results of this study indicate that the headache program improved outcomes. Because all participants received educational materials, it is likely that education played a role in the improvements observed. These results are encouraging and warrant further study in larger, controlled trials.     

The effect of a patient education program on emergency room use for inner-city children with asthma.

An educational program for children with asthma designed to reduce emergency room (ER) use enrolled all eligible children (n = 253 primarily low-income Black) within a health maintenance organization (HMO) who had used the hospital or ER for asthma during the pre-enrollment period and randomized them into two groups. Twenty-four of the experimental group patients had 55 ER visits and 18 of the control patients had 39 ER visits during the first 12 months post-intervention. This program did not achieve its goal.     

An evaluation of a school-based AIDS/HIV education program for high school students.

The effect of a 1-hr school-based AIDS/HIV education program on the knowledge and attitudes of high school students was evaluated with a modified version of the Centers for Disease Control Health Risk Survey. One urban and one suburban school each were randomly assigned to an educational intervention (n = 535) or a control group (n = 659). All students received a posttest 2 weeks after the intervention. Knowledge was based on responses to 12 true-false questions (pretest alpha = .76, posttest alpha = 0.81). Principal components analysis was used to develop three attitude scales and risk-taking behavior was assessed by self-report. Data were analyzed with Kruskall-Wallis analysis of variance (ANOVA) and multivariate ANOVA. The groups did not differ in knowledge level at pretest. At posttest the education group had significantly (p < or = 0.006) higher knowledge even after controlling for the effects of previous AIDS education (p < or = 0.019), gender (p < or = 0.007), and Hispanic ethnicity (p < or = 0.048). After the education program, students were less worried about exposure to the AIDS virus, but were more worried (p < or = 0.048) about AIDS acquisition during their adult life. Although single school-based AIDS/HIV education programs may increase knowledge, more extensive education may be needed to change the behavior and attitudes of older high school students.