School Health Blog http://schoolhealthblog.org Blog of the American School Health Association Fri, 05 Sep 2008 13:12:58 +0000 http://wordpress.org/?v=2.3 en Teen Pregnancy — A Teachable Moment http://schoolhealthblog.org/2008/teen-pregnancy-a-teachable-moment/ http://schoolhealthblog.org/2008/teen-pregnancy-a-teachable-moment/#comments Fri, 05 Sep 2008 13:12:58 +0000 swooley http://schoolhealthblog.org/2008/teen-pregnancy-a-teachable-moment/ .newl {display:none}
Governor Palin’s announcement of the unplanned pregnancy of her daughter has brought teen pregnancies renewed attention.  Given all the media attention, many students are talking about this issue.  Now might be a good time to take advantage of their interest and introduce the issue of unplanned pregnancies.      Some discussion points might be: 1.     What are the [...]]]> Governor Palin’s announcement of the unplanned pregnancy of her daughter has brought teen pregnancies renewed attention.  Given all the media attention, many students are talking about this issue.  Now might be a good time to take advantage of their interest and introduce the issue of unplanned pregnancies.   

 

Some discussion points might be:

1.     What are the options for a pregnant teen?  What are the pros and cons of each?

2.     Why are some teens sexually active and others abstinent? 

3.     What factors contribute to the choices teens make when they have the opportunity to be sexually active?

4.     What role should schools play in providing sexuality education?

5.     What does the term abstinence mean? What about the term sexually active or virgin?

6.     What role should parents play in providing sexuality education?

7.     What do you think is the best way to help teens postpone pregnancy and possible parenting until they are adults?

 

Questions such as those above are non-judgmental.  They allow discussion.  Whether you mention a specific individual is your choice, but not essential. 

 

The American School Health Association has an official position on quality sexuality education that you might also find valuable.

 

The discussion is going on.  The question is will you be part of it with your students?

 

Respond to this blog with what you are doing and how your students are responding.

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]]> http://schoolhealthblog.org/2008/teen-pregnancy-a-teachable-moment/feed/ Scholarships to ASHA conference for nurses http://schoolhealthblog.org/2008/scholarships-to-asha-conference-for-nurses/ http://schoolhealthblog.org/2008/scholarships-to-asha-conference-for-nurses/#comments Tue, 02 Sep 2008 18:03:08 +0000 swooley http://schoolhealthblog.org/2008/scholarships-to-asha-conference-for-nurses/ The American School Health Association is pleased to announce that School Kids Healthcare is providing 20 scholarships for school nurses to attend the 82nd Annual ASHA School Health Conference in Tampa, Florida, November 12 – 15, 2008.

 

This generous offer - available to school nurses practicing at the school or district level - includes complimentary registration, an ASHA Basic membership and complimentary continuing nursing education contact hours - a $365 value.

 Lodging, transportation and meal expenses are not included. 

Because of the value of this offer, we require that school nurses who apply attend the entire conference. For information about the ASHA conference, please go to:

www.ashaweb.org/conferences

 

Contact ASHA with your intent to apply for the School Kids Healthcare scholarship.  Please do not contact School Kids Healthcare - ASHA is coordinating the scholarships. 

 

E-mail Mary Bamer Ramsier at mbramsier@ashaweb.org.  Include your name, professional title, school or district address, daytime phone number and email address.  Respond no later than September 26, 2008. Applicants will be notified the first week of October so you can make your hotel reservations by October 13, 2008.

 

School Kids Healthcare - www.schoolkidshealthcare.com - offers a complete line of school nurse supplies and school nurse equipment to help school nurses fulfill their mission.

 

Act today! Scholarships will be awarded to the first respondents.

   

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]]> http://schoolhealthblog.org/2008/scholarships-to-asha-conference-for-nurses/feed/ Deaths from the Choking Game http://schoolhealthblog.org/2008/deaths-from-the-choking-game/ http://schoolhealthblog.org/2008/deaths-from-the-choking-game/#comments Thu, 27 Mar 2008 21:18:02 +0000 swooley http://schoolhealthblog.org/2008/deaths-from-the-choking-game/

The February 15, 2008 issue of the Center for Disease Control and Prevention’s MMWR reports on unintentional strangulation deaths from the “Choking Game” among youth aged 6 – 19.  The report tracks reported incidents from 1995 – 2007.  What I found alarming about this report was the age of those who died – most were in middle school.

 

Although strangulation (self or by someone else) with hands or a noose to cause an altered state of consciousness is not a new technique, it is one that many have never heard of.  What’s new about this latest version is that children are playing alone and playing with nooses, which seem to be what is making this version fatal.  The age of those who have died suggests a lack of understanding of the consequences of restricting oxygen to their brain and putting something around their neck.

 

Although I do not think that schools should teach students how to engage in self-strangulation or strangulation of someone else without causing death, they can take some actions –

1)     Educate staff to look for signs that students might be engaging in this activity,

2)     Educate students’ family members about the warning signs, and

3)     Educate students about the hazards of choking someone else.

 

Given that the CDC data shows multiple deaths among children as young as 9 years of age, educating students about the risks should begin no later than the intermediate grades (4-6) and definitely be part of the middle school curriculum.  The education could be in the context of violence prevention and the hazards of choking someone else, rather than in the context of the game.  Discussing the game itself could lead some young people who had not heard of it to try to game.

 

Most parents of those who died in the study had no idea their children were engaged in the activity until the death occurred.  Warning signs include

  • Talking about the game – common terms are choking game, pass-out game and space monkey
  • Bloodshot eyes
  • Marks on the neck
  • Severe headaches
  • Disorientation after spending time alone
  • Ropes, scarves, and belts tied to bedroom furniture, doorknobs, or found knotted on the floor
  • Unexplained presence of dog leashes, choke collars, or bungee cords
  • Using the Internet to find instructions on how to practice the game.

 

If you have developed or found any lessons about the choking game, please post a message on this blog with information about where to find the lesson or your experience using it or what you did with young people or school staff.  In addition to the deaths, disability can result from playing the game including neurologic damage (e.g., seizures), retinal hemorrhages, and broken bones from falls due to passing out. Although the number of deaths is not large, the consequences are significant. Each death represents the waste of potential among young people who had no plans to commit suicide or murder.

Susan Wooley

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]]> http://schoolhealthblog.org/2008/deaths-from-the-choking-game/feed/ Medication & ADHD or Biploar Diagnoses in Children http://schoolhealthblog.org/2008/medication-adhd-or-biploar-diagnoses-in-children/ http://schoolhealthblog.org/2008/medication-adhd-or-biploar-diagnoses-in-children/#comments Tue, 29 Jan 2008 16:35:22 +0000 swooley http://schoolhealthblog.org/2008/medication-adhd-or-biploar-diagnoses-in-children/ The PBS show Frontline recently aired a show on the Medicated Child (http://www.pbs.org/wgbh/pages/frontline/medicatedchild/).  The focus was on children medicated for AD/HD and bipolar disorder.  In interviews with parents and physicians, the show looked at the increasing tendency to medicate even young children for behavior-related disorders. 

 

A question often arises about whether there really are so many more children who have attention deficit/hyperactive disorder (AD/HD) or whether this diagnosis is being used for controlling the exuberant child or the child who does not conform to adult expectations for behavior.  The show also told about a recent trend positing that many cases of AD/HD are really bipolar disorder.  We know that children are not mini-adults and that their symptoms sometimes differ from those of adults.  This theory suggests that bipolar disorder in children manifests as AD/HD.  For those who subscribe to this theory, medication of children with medications for bipolar disorder has become more prevalent.  Yet, these drugs have not been approved for use with children nor have they been tested for effectiveness or safety on children. 

 

Any diagnosis of bi-polar for a child, especially if medication is recommended should be reviewed by a child psychiatrist as bi-polar disorder is considered very unusual below adolescence.  A diagnosis of AD/HD in young children usually depends on descriptions of the symptoms/behaviors and the absence of symptoms for other disorders that appear similar.  Usually a clinician would want to know whether the symptoms/behaviors occur in at least 2-3 different settings.  If the diagnosis is correct, stimulant medication trials usually result in significant behavioral changes quickly.  Over the past 20 years, the prevalence rate of AD/HD has not changed much (4-7%).  However, a higher rate in a community might call for an assessment of the quality of the diagnosis, and asking for second opinions.

 

Where do schools fit into all of this?  When it comes to medicating children for behavioral problems, parents ultimately make the decisions.  Sometimes teachers have insisted that parents medicate their children because their behavior is so disruptive that the teachers cannot handle them.  That is not an appropriate role for a school.  However, teachers could refer children to a school psychologist, counselor, social worker, or nurse for assessment.  Such school support services personnel could work with the parents and teacher(s) to develop a plan that all agree with.  If the child is in special education, that might be an individualized education plan (IEP).  However, not all children with behavioral issues received special education services.  Consistency of behavioral expectations between home and school are important for children with behavioral problems – whether they are mediated or not.

 

When there is a plan, schools have a role in implementing their part of the plan and monitoring the students’ behaviors.  Keeping lines of communication open with parents and health care providers can contribute to knowledge about what works and does not work.  School nurses should not only administer medications during the school day but monitor reactions to the medications and report any adverse effects.  School nurses might also notice if the prevalence of the diagnosis seems too high in the community.

 

Knowledge about brain chemistry and development is in its infancy.  Undoubtedly there are children whose developing brains do not function normally and how might benefit from medication.  For now, making the decisions about who needs medication and which medications is more an art than a science, especially in behavioral health.

 

What is your experience with medicating or not medicating children for behavioral problems?

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]]> http://schoolhealthblog.org/2008/medication-adhd-or-biploar-diagnoses-in-children/feed/ MRSA in schools http://schoolhealthblog.org/2008/mrsa-in-schools/ http://schoolhealthblog.org/2008/mrsa-in-schools/#comments Wed, 16 Jan 2008 16:08:15 +0000 swooley http://schoolhealthblog.org/2008/mrsa-in-schools/ A commentary by Linda Grant, M.D.

Media reports on MRSA or Methicillin Resistant Staphylococcus Aureus have been making headlines in the past few months, capturing school administrators and parent’s attention and elevating concerns… However, schools may be more well-prepared than they realize to address his issue. 

 

Schools have experience with minimizing risk of illnesses. Universal precautions are the infection control techniques that were recommended following the AIDS outbreak in the 1980s, when the concern was about transmission through bodily fluids. Universal precautions are essentially good hygiene habits, such as hand washing and the use of gloves and other barriers, when dealing with wounds and secretions. Recently, as schools began to prepare for pandemic flu, there was an increased emphasis on hand washing and hygiene as a way to decrease transmission of airborne organisms. In addition, schools often have relationships with local health departments in managing other disease outbreaks such as chicken pox or whooping cough. Thus school systems already have many of the basics for addressing and minimizing the risks of MRSA.

  

MRSA is a type of common bacterium, staphylococcus aureus or “staph”. Staph is found on the skin and in the nose of 30% of the population, most of whom have no symptoms. When staph infections do occur, most are mild, such as pimples or boils. Some infections can be more severe, such a pneumonia. MRSA behaves like this staph. It can be asymptomatic or cause infections. The factor that distinguishes MRSA from other staph is that MRSA is resistant to some medications. When a skin infection is not improving, a health provider may test for MRSA.

 

All staph, including MRSA, is spread by direct contact- either skin to skin or contact with items touched by someone with staph. The measures to control its spread are related to decreasing contact.

 

School –wide measures include:

·       Making hand washing part of the school day. If soap is not available, then using alcohol-based hand sanitizers is an alternative.

·       School cleaning should be routine, particularly areas that are damp and /or exposed to bodily fluids, such as showers, locker rooms and health service offices. School disinfectants should be reviewed for their effectiveness against MRSA

·       The cleaning schedule should include daily cleaning of locker rooms and regular, scheduled cleaning of shared athletic equipment.

·       Health education activities should reinforce these hygienic measures.

 

Students and staff should:

·       Avoid sharing personal hygiene items.

·       Wash their hands for 15-20 seconds frequently with warm water and soap.

·       Shower after every athletic activity using soap and clean towels

·       Maintain clean, dry bandages on all wounds.

·       Take responsibility for wiping down athletic equipment after personal use.

·       Refrain from contact sports activities if a wound cannot be adequately covered.

 

These measures should be followed whether there is a known case of MRSA in the school or not. These actions my also help reduce risk for many other communicable diseases.

 

A student with MRSA can attend school as long as the wound can be covered. Students with MRSA should inform the school nurse and the coaches/physical education teachers. Closing of schools is not an appropriate response to students with MRSA infections.

  

For more detailed information follow the links below

Resources

      

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]]> http://schoolhealthblog.org/2008/mrsa-in-schools/feed/ Safety belts in school buses http://schoolhealthblog.org/2007/safety-belts-in-school-ubses/ http://schoolhealthblog.org/2007/safety-belts-in-school-ubses/#comments Thu, 13 Dec 2007 14:52:47 +0000 swooley http://schoolhealthblog.org/2007/safety-belts-in-school-ubses/ The U.S. Department of Transportation recently proposed new rules that would require that all seats on school buses be four inches higher and that all small school buses (10,000 pounds GVWR or less) have 3-point safety belts.  They are also proposing to establish standards for 2 or 3-point safety belts on larger school buses. 

 

For years, I have wondered why school buses do not have safety belts.  When I asked the President of a major company that builds school buses, his reply was that without requirements for such if he installed safety belts his company would not be able to compete economically with those manufacturers that did not install safety belts.  He also pointed out that a seat belt alone (without shoulder harness) might increase injuries in the event of a crash because the seat backs are hard and the head of a child restrained at the waist would probably hit the hard seat back in the next seat.  Other arguments I have heard against safety belts in school buses are that the buckles could become weapons and the capacity of the buses might be less requiring schools to purchase more buses.  Other concerns include who would monitor compliance of usage and proper tension, if a school l required passengers to buckle up.  Would bus drivers have to get out of their seats and buckle children in?  If they unbuckled, would the bus driver have to pull over and enforce the rule?  Would buses need adult riders to ensure proper use?  There is also an argument that few students incur injuries while riding in school buses.

 

On the other hand, I have thought that from a role modeling perspective, no seat belts sends a message that seat belt usage is not important.  Furthermore, children who are strapped in would be less likely to engage in rowdy behavior that might distract a driver and cause a crash or cause injury to other passengers. 

 

I would be interested in hearing any experiences you have with school buses where safety belt usage was a factor.  I’d also be interested in whether you would support their installation in school buses and why or why not.

 

Susan Wooley

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]]> http://schoolhealthblog.org/2007/safety-belts-in-school-ubses/feed/ Requiring the HPV Vaccine for Public School Attendance—Considerations & Concerns http://schoolhealthblog.org/2007/schools-requiring-hpv-vaccine/ http://schoolhealthblog.org/2007/schools-requiring-hpv-vaccine/#comments Tue, 04 Dec 2007 17:46:43 +0000 shb http://schoolhealthblog.org/2007/schools-requiring-hpv-vaccine/ A commentary from: Lani Wheeler, MD, FAAP, FASHA Partially reprinted with permission from School Health Professional May 25, 2007.

 In recent months there has been much debate over requiring the new HPV vaccine (GARDASIL ™) for public school attendance. In one state the Governor issued an executive order requiring all girls entering the 6th grade to receive the vaccination prior to attending school. Texas Governor Rick Perry’s order was issued in February 2007 and was intended to be enforced by 2009.  However, on May 9, Perry’s order was overturned after a State House Bill was passed into law overriding his executive order. In other states, including New Hampshire and New Mexico, state legislators are actively debating whether to impose legislation requiring girls to be vaccinated as part of the required vaccination schedule for schools. The debate over mandating the HPV vaccine is complex. However, most health professionals believe that vaccination is certainly the best prevention against HPV infections that could potentially lead to cervical cancer. In addition, it is important to note that the CDC recommends that the vaccine be given to girls 11-12 years of age before they become sexually active (thus making the vaccine more effective).  Why should HPV Vaccine be considered for a school mandate?School mandates improve immunization coverage rates.  They can help to ensure payment by private health insurers when mandated vaccines are added to the insurers’ list of covered vaccines.  Mandating the vaccine is likely to protect many high risk girls from HPV infections and cervical cancer.  What other issues should be considered before establishing school mandates?

  • A vaccine should have a substantial safety and efficacy track record before it is mandated for school.  HPV vaccine was licensed in June 2006.
  • It is important to ensure an adequate supply, reimbursement and insurance coverage, (Vaccines for Children — VFC and private insurance), before such a mandate is established.  Some private payers do not cover the cost of the vaccine ($360.00 per series) leaving some families responsible for the total cost.  Free vaccine must be available for these students to prevent exclusion from school.  Adequate reimbursement must be available so that pediatricians can recoup the cost and administrative fees of the vaccine.  Adequate VFC supply and public health infrastructure (ie school nurses, immunization clinics, etc) must be available to ensure that a safety net is available for students unable to access vaccine privately as well as to monitor compliance rates to avoid excluding thousands of girls from schools.  Recent experience in Maryland with Hep B and varicella mandates indicates that jurisdictions with lower income populations are disproportionately affected by exclusion. 
  • Public and physician acceptance of a vaccine should be established prior to mandating a vaccine.  Adequate time for consumer education must be allowed to ensure such acceptance.   There is debate in the public and physician sectors regarding mandating a vaccine for a disease that is not typically transmitted among youth in the school setting.  The advantages and disadvantages of an opt-out provision for parents who “philosophically object” to the vaccine needs more discussion.
  • Additional recommendations may be announced soon due to the development of another slightly different vaccine and the investigation of vaccines in males.

What are the Recommendations of the Advisory Committee on Immunization Practices (ACIP)? The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11–12 years.  The vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13–26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

 

What do school health pediatricians recommend?The American Academy of Pediatrics supports the ACIP recommendations however, the AAP does not make national recommendations about any school vaccine mandates.  HPV should be included in routine adolescent health visits that are encouraged for all young adolescents.  School health pediatricians are not unanimous on the school mandate issue but most recommend addressing the above issues before issuing school mandates.   The Association of Immunization Managers developed a position statement that addresses many of these same concerns.

What is HPV?  Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. Although the majority of infections cause no clinical symptoms and are self-limited, persistent infection with oncogenic types can cause cervical cancer in women. In most people, HPV goes away on its own without any treatment and does not cause health problems.  Experts do not know why HPV goes away in some cases, but not in others.  HPV infection also is the cause of genital warts and is associated with other anogenital cancers. Cervical cancer rates have decreased in the United States because of widespread use of Papanicolaou testing, which can detect precancerous lesions of the cervix before they develop into cancer; nevertheless, during 2007, an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer. In certain countries where cervical cancer screening is not routine, cervical cancer is a common cancer in women.  What is the vaccine?  How well does it work?The licensed HPV vaccine (GARDASILTM) is composed of the HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein in yeast using recombinant DNA technology produces noninfectious virus-like particles (VLP) that resemble HPV virions. The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant. Clinical trials indicate that the vaccine has high efficacy in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among females who have not already been infected with the respective HPV type. No evidence exists of protection against disease caused by HPV types with which females are infected at the time of vaccination. However, females infected with one or more vaccine HPV types before vaccination would be protected against disease caused by the other vaccine HPV types.   For more information:HPV Vaccine Questions and Answers from the U.S. Centers for Disease Control and Prevention (CDC) .Human Papillomavirus (HPV) Infection from CDC .AAP HPV Policy Statement .

CDC’s National Center for Immunization and Respiratory Diseases Q & A.

 HPV and cervical cancer, the HPV vaccine, vaccine and implementation costs, and public acceptability – a background brief from the Kaiser Family Foundation.Q and A about the safety of Gardsil from CDC .

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]]> http://schoolhealthblog.org/2007/schools-requiring-hpv-vaccine/feed/ Welcome to the School Health Blog! http://schoolhealthblog.org/2007/welcome-to-the-school-health-blog/ http://schoolhealthblog.org/2007/welcome-to-the-school-health-blog/#comments Mon, 19 Nov 2007 15:47:28 +0000 shb http://schoolhealthblog.org/2007/welcome-to-the-school-health-blog/ The American School Health Association welcomes you to our blog. The purpose of the blog is to provide an opportunity for dialogue on health and safety-related issues that affect children and youth in grades pre-k through 12. Just as the American School Health Association is a multidisciplinary organization, this blog can bring to bear on such issues the perspectives of many who influence the health and safety of young people – including but not limited to administrators and policy makers, teachers, nurses, physicians, mental health providers, food service providers, safe and drug free schools coordinators, school resource officers, students, and their families. Please take a moment to review the ground rules for our blog.

This blog differs from our list serves, which are for members only. It differs from our peer-reviewed Journal of School Health in that issues that are new and emerging often have not had the solid research needed for a journal article, but readers can gain insights from the experiences of one another. It differs from the official position statements found on our web site in that postings have not gone through a vetting process and the ASHA Board.

As a blog of an association, not an individual even the initial postings will present a variety of voices. We welcome comments from anyone in response to a posting following the ground rules of the blog. Any ASHA member may submit an item for an original posting to swooley@ashaweb.org.

The breadth of school health and safety is so large; it is often hard to know where to start. I had a call recently from a physician who wanted to help the schools in his area address childhood obesity, but he did not know where to start. When I asked what they were doing already, he had no idea. I see this all the time Do you know if the school district where you live has a health or wellness advisory council? Do you know what programs and services the schools already have in place? Everyone wants what is best for young people, but few stop to ask: “What do children and youth think they need from adults?” Many want to work through schools, but few ask: “What are the schools already doing?” What has been your experience as a student in being heard? as someone working in a school in having offers of help? as someone in the community in working with schools?

Looking back on the past school year, what have been the toughest health and safety issues you have faced? What successes have you had? How are you planning for the next year?

Thanks for your interest in this blog. Feel free to respond and share your ideas, your successes and challenges. Don’t forget to indicate your title and position.

Posted by Susan Wooley, Executive Director of the American School Health Association.

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