Missed School Days Research Articles

School-Based Health Centers, Access to Care, and Income-Based Disparities

School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. County-by-year SBHC adoption. Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.

Hearing Impairment and School Engagement Outcomes in US Children

Ensuring appropriate school engagement for deaf or hard of hearing (DHH) children in the US is important for improving their long-term outcomes as they grow into adults. To examine the associations between hearing loss (HL), its sequelae (speech and/or language disorders, behavioral and/or conduct problems, and neuropsychiatric and/or learning disorders), and various school engagement measures among school-aged children in the US. This cross-sectional study combined data from the nationally representative 2016-2021 National Survey of Children's Health. A total of 155 178 randomly selected children (weighted, approximately 49 340 700 children) aged 6 to 17 years with a parent or caregiver who responded to an address-based survey by mail or online were included. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population-based estimates representative of all noninstitutionalized school-aged US children and adolescents residing in housing units. Diverse school engagement measures, including extracurricular participation in sports, clubs, paid work, volunteer work, and organized lessons, as well as educational performance variables, including missed school days, not caring about doing well in school, not doing required homework, grade repetition, and parent or guardian contacted by school. Of the estimated 49 340 700 children aged 6 to 17 years (41.1% aged 6-10 years; 51.1% male; 54.7% without underrepresented minority status), an estimated 1.4% (95% CI, 1.2%-1.5%) were reported by their parent or guardian to have deafness or hearing problems. Having DHH status was associated with significantly worse outcomes on 8 of 10 school engagement measures (eg, participation in sports: adjusted odds ratio [AOR], 0.75 [95% CI, 0.60-0.93]; missed school days: AOR, 2.98 [95% CI, 2.21-4.00]), even after adjustment for age, sex, underrepresented minority status, highest educational level of parent or guardian, federal poverty level of the household, and primary language in the household. Moreover, although subgroup analyses of DHH children with and without HL sequelae revealed significant differences (speech and/or language disorder: AOR, 5.83 [95% CI, 4.31-7.89]; behavioral and/or conduct problem: AOR, 2.75 [95% CI, 2.10-3.60]; neuropsychiatric and/or learning disorder: AOR, 3.06 [95% CI, 2.39-3.91]), HL sequelae only partially mediated the associations between these disparities. In this cross-sectional study, DHH status itself may have been the primary factor directly associated with school engagement disparities. These findings suggest the need for greater emphasis on educational accommodations and support for hearing status itself, independent of the presence or absence of HL sequelae.

Menstruation hygiene management among secondary school students of Chitwan, Nepal:a cross-sectional study

BackgroundDespite significant progress in reproductive health, many societies still treat menstruation as disgraceful and shameful process and relate it with negative consequences. This belief and attitude may increase the incidence of reproductive tract infection, leading to significant negative impact on women’s health. To manage menstruation hygienically and with dignity, it is essential that women and adolescent girls have sufficient knowledge on menstruation hygiene management. Thus, this study aims to identify the knowledge, associated factors related to menstrual hygiene management (MHM) and effectiveness of health education on MHM.MethodsA school-based study was conducted between August 2021 to April 2022 among 400 secondary school girls. The sampling unit was selected by using systematic random sampling method. Health education was given in the interval between the pretest and posttest of knowledge assessment on MHM. Logistic regression analysis and Wilcoxon rank test were applied to identify predictors and to evaluate the effectiveness of health education.ResultsOverall, 57.7% of the girls had unsatisfactory level of knowledge. Around two third (61.4%) missed school days during the menstrual period. Almost 99.5% had experienced some form of cultural restrictions during the menstrual period. After imparting health education, the level of knowledge on menstruation hygiene had significantly improved (z = 17.129, p = < 0.001) to satisfactory compared to the baseline knowledge level (42.3% vs. 92.5%). During multivariate analysis, factors such as having studied in public schools (AoR = 1.7, p = 0.026), having no or one close female friend (AoR = 2.2, p = 0.011), caste other than Brahmin/Chhetri (AoR = 1.4, p = 0.05) and factors such as living in joint family (AoR = 1.6, p = 0.048) were significantly associated with unsatisfactory level of knowledge on MHM.ConclusionsA substantial number of respondents had unsatisfactory level of knowledge on MHM. Factors such as ethnicity status, types of family, number of close female friends, types of schools and mothers’ education were associated with unsatisfactory level of knowledge. School absenteeism and cultural restriction were found to be common/frequent. Imparting of health education was found to be an effective measure to enhance knowledge on MHM.

Improvement of quality of life in a family of a child with asthma after using the Written Asthma Action Plan (WAAP)

ABSTRACT Background: Asthma is a common childhood disease that leads to impairment of quality of life (QOL) of both the children affected by the disease and their caregivers. Management of asthma includes pharmacotherapy along with education about asthma and its self-management, which is most often given verbally. There is limited evidence regarding the benefits of using a written asthma action plan (WAAP) that has been improved using pictorial representation. Objective: The study aimed to assess the effectiveness of a WAAP in improving the QOL of children with bronchial asthma and also of their caregivers. It also educates the patients and families about various triggers and danger signs of an acute attack of asthma. Methods: This was an interventional study with the aim of improving the quality of asthma management. Children of age group 7–17 years in whom the diagnosis of asthma was made and those parents and children who could read and answer the questionnaire (mini-PAQLQ and PACQLQ) were included in the study. Subjects were randomized into Case and Control groups. The intervention was to give the randomly selected patients (Case group) an individualized WAAP along with standard asthma care to both groups. Both groups were followed up to assess and record variations in the quality of life. Results: The P value was highly significant in the following parameters post-intervention: missed doses of controller medication (P value = 0.001), need for rescue medication (&lt;0.001), ACT score (0.001), total PAQLQ (&lt;0.001), and PACQLQ (&lt;0.001) score. Though statistical significance was not established, improvement was also observed in the number of unscheduled OPD visits (P value = 0.082) and hospitalization events (P value = 0.554). Conclusion: On being provided with the WAAP, the frequency of acute asthma events, treatment compliance, and QOL improved. There was a significant increase in the primary outcomes-PAQLQ and PACQLQ scores. Significant improvement in the secondary outcomes-number of missed school days, missed doses of controller medication, need for rescue medication, and ACT score was also observed.

Evaluation of "Test to Return" after COVID-19 Diagnosis in a Massachusetts Public School District.

Per Centers for Disease Control and Prevention guidance, students with COVID-19 may end isolation after 5 days if symptoms are improving; some individuals may still be contagious. Rapid antigen testing identifies possibly infectious virus. We report on a test-to-return (TTR) program in a Massachusetts school district to inform policy decisions about return to school after COVID-19. During the 2021-2022 Omicron BA.1 surge, students with COVID-19 could return on day 6-10 if they met symptom criteria and had a negative rapid test; students with positive rapid tests and those who declined TTR remained isolated until day11. TTR positivity rates were compared by grade level, vaccination status, symptom status, and day of infection. 31.4% of students had a positive TTR rapid test; there were no differences by grade or vaccination status. Ever-symptomatic students were more likely to have a positive rapid test (75/174 [43.1%] vs 18/104 [17.3%]). For ever-symptomatic students, TTR positivity decreased by day of infection. A substantial proportion of students may still be contagious 6 days after onset of COVID-19 infection. TTR programs may increase or reduce missed school days, depending on when return is otherwise allowed (day 6 or 11). The impact of TTR programs on school-associated transmission remains unknown.

Excessive Electronic Screen Exposure and Headache in Teenagers

Background: Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. Electronic screens are becoming increasingly important in the lives of preteens and teens. Objective: Study was conducted to find the relationship between electronic screen exposure and headaches in teenagers. Methods: This was a cross-sectional study. Data was collected 300 teenagers from district Mandi-bahu-Din. Convenient sampling was applied. Teenager aged between 12-19 years, physically and mentally healthy and both genders were selected to include in study. Person with history of head injury, hypertension and systemic disease-causing headache were excluded from study. data was collected through using 2 reliable questionnaires; Headache impact test-6 and Screen time survey questionnaire. Data was analyzed using statistical package for social sciences (SPSS) V 23. Descriptive statistics in form of frequency and percentages was presented. Bar and pie charts were plotted. To find association between screen time and headache Pearson correlation was applied. Results: There was significant (P=0.021) correlation between screen time and headache with coefficient of correlation r= 0.414.Excessive electronic screen exposure is negatively impacting the life of 46% (n=139) teenagers. Mean age of participants was 14.95±1.88. Mean and SD of screen time is 5.15±1.73. Mean and SD for headache is 54.9±4.93. There were 45% males and 55% female participants. Practical implication: Different types of electronic screen media have repeatedly been linked to impaired health; yet, how different uses of electronic media are linked to headache has received much less attention. Currently, the role of chronotype in these associations is understudied. To address these gaps, this study examined how different uses of screen media are linked to headache, and whether these associations were accounted for or differed across chronotype. Conclusion: It was concluded that screen time and headache have significant correlation with each other. Keywords: Headache, Screen Time, Electronic Screen Exposure.

Improving Pediatric Asthma Care Through Asthma Apps: A Narrative Review

Asthma is the most common chronic disease of childhood. Clinicians frequently do not adhere to clinical practice guidelines for the management of asthma, leading to emergency department visits, hospitalizations, missed school days, and missed work for parents and caregivers. Incorporating telehealth interventions into asthma management improves patient outcomes. Of the available telehealth interventions, pediatric-specific asthma apps show the most promise for improving patient outcomes. Asthma apps have been shown to improve asthma control, increase adherence to medications, and reduce asthma exacerbations. Providers can easily vet asthma apps by using the Mobile Application Rating Scale and determine the app’s use of behavioral change techniques.

The Effect of Health Insurance Status on School Attendance.

Introduction Educational achievement is impacted by a student's ability to be present and motivated in the classroom. Since health and education influence one another, disparities in health insurance status amongchildren may exert educationally relevant consequences. However, the association between health insurance coverage and school absenteeism remains poorly understood. Our study aims to assess the association between not having/having gaps in health insurance coverage and an increased number of missed school days. Methods A historical cohort study was performed via secondary analysis of data collected as part of the 2018 National Survey of Children's Health (NSCH). We included children enrolled in school between the ages of 6-17 yearsand who provided answers to survey questions involving our two variables of interest: health insurance status and missed school days. Our data analysis included 1) a descriptive analysis of the baseline sample characteristics, 2) a bivariate analysis to determine the association between baseline characteristics/confounding variables and the outcome, and 3) a multivariable regression analysis using logistic regression to determine the association of interest while controlling for potential confounding variables. Results A total of 21,498 respondents were included. The unadjusted odds of chronic absenteeism were found to be 16% (OR=1.16) higher in children without insurance or with gaps in insurance compared to children with consistent insurance throughout the year, but the association was not statistically significant (95% CI 0.74 - 1.82, p=0.051). After adjustment by age, sex, race, Hispanic ethnicity,and confounding variables, the odds of chronic absenteeism in children without insurance or with gaps in insurance remained statistically insignificant (aOR=1.05; 95% CI 0.64 - 1.73, p=0.848) compared to those with consistent insurance coverage. Conclusions According to our analysis, the data do not support our hypothesis of a significant difference in missed school days (greater than or equal to 11 missed days of school) among those children who had health insurance compared to those without health insurance/had gaps in insurance coverage.

Predictors of missed school days among military connected families: A feasibility study.

There is a paucity of research specific to military children's health, especially those with special needs. This may be partly attributed to the difficulty in accessing military connected families as a population. Yet, given the recognized importance of military connected families to the national security agenda, a need exists for studies to explore factors underlying child and family health. We sought to identify factors among a sample of military children with special health care needs (CSHCN) predictive of missed school days, a commonly used measure of health and one used by NPs to monitor chronic conditions management success. We used a secondary data analysis design and multivariable logistic regression with a subsample of military connected families from the National Survey of CSHCN identified by their reported insurance type. We identified 1,656 military CSHCN. According to the adjusted model, hours of care per week, family work hours change, and activity limitations for the child were positive predictors of ≥4 missed school days per year. Our models identified important predictors of missed school days among military children that may inform assessments, interventions, and referrals by nurse practitioners caring for them. We identified a robust sample of military CSHCN from the National Survey of CSHCN by using self-reported insurance, a novel and simple approach to conducting a focused study of this population. Although feasible, this sampling approach was not without limitations. We advocate for including military connected families within sampling frameworks of national surveys to ensure that studies with this critical and unique population continue.

Effect of School Integrated Pest Management or Classroom Air Filter Purifiers on Asthma Symptoms in Students With Active Asthma: A Randomized Clinical Study

To determine if environmental control measures (1) school-wide integrated pest management (IPM) program and/or (2) use of high-efficiency particulate air (HEPA) filter purifiers in inner city elementary school classrooms would reduce asthma morbidity in students with active asthma.Forty-one inner city elementary schools in the Northeastern United States were recruited for this study. There were 236 students with active, physician-diagnosed asthma randomized to IPM (by school) and/or HEPA filter purifiers (by classroom). Physician-diagnosed asthma was defined as the child having had unscheduled doctor visits, hospitalization, corticosteroid bursts, symptoms, or controller medication use in the past year. Fifty seven percent of the children were Hispanic and 24% were Black. Mean age was 8.1 years, 48% female, mean FEV1 97% to 99.7% predicted at randomization. Forty-fifty percent of the children were using short acting β agonists alone and the rest were on inhaled corticosteroids and/or leukotriene modifiers. The study was conducted during the school years 2015 to 2020.All students with active physician-diagnosed asthma had a screening visit with questionnaires, skin testing, and spirometry as well as 2 follow-up visits with the same assessments during the year. Baseline environmental assessment for a panel of allergens (mouse, rat, dust mite, cockroach, cat, dog, Alternaria alternate, and Aspergillus fumigatus) were conducted at the schools by collecting a 1-week air sample, immediately followed by vacuum–settled dust samples from each students’ primary classroom and in the participants homes. The allergens were analyzed using a multiplex assay (MARIA, Indoor Biotechnologies). Follow-up environmental assessment after randomization took place once each winter and spring during the school year.The allocation to free standing classroom HEPA filter purifiers, active or sham, was blinded to the participants and those assessing the outcomes. The IPM program consisted of application of rodenticide, sealing entry points, trap placement, targeted cleaning, and brief educational handouts for the school staff. Infestation was assessed every 3 months and IPM reapplied as needed. Trained pest management specialists providing the school-wide IPM program were unblinded, but the student participants and trial investigators remained blinded throughout the trial.Four groups of 59 students each were randomized using a factorial design to either intervention alone, both interventions together, or neither for the entire school year. Classroom and home allergen and particle levels at randomization were balanced between the 4 groups.The asthma-related health outcomes of the students were assessed by parent survey at baseline and every 2 months until the end of the school year. The primary outcome was the number of symptom-days with asthma during a 2-week period assessed over the 10 months of randomization. Prespecified secondary outcomes were school absences, Composite Asthma Severity Index score, healthcare utilization, and spirometry measurements.Ninety eight percent of the classrooms had detectable levels of mouse allergen and 26% of the participants were sensitized to mouse allergen. More than 90% of baseline classroom allergen levels for cockroach, rat, Alternaria, Aspergillus and dust mite were undetectable.Use of the school-wide IPM program resulted in a mean of 1.5 symptom-days with asthma during a 2-week period versus 1.9 symptom-days for no IPM; use of HEPA filter purifiers resulted in a mean of 1.6 symptom-days with asthma versus 1.8 symptom-days for sham HEPA filter purifiers; neither comparison was statistically significant. Other prespecified secondary outcomes, including healthcare utilization or missed school days because of asthma also did not differ significantly between the intervention groups. The HEPA filter purifiers significantly reduced mouse and dog allergens in the classrooms. The IPM program did not significantly reduce concentrations of any of the allergens or particles measured. A post hoc exploratory analysis found a statistically significant association of reduction in asthma symptoms with the school wide IPM program but only for a limited time (mid-November to February).In an inner-city population of elementary school students with active asthma, use of a school-wide IPM program or HEPA filter purifiers in the classrooms did not significantly reduce symptom-days with asthma.It is possible that these children had asthma that was too mild to see a significant difference in these environmental interventions. Also unclear is whether resources to perform environmental control measures are best used at the school level or at home. As an accompanying editorial notes, “as allergen sensitization is related to the pathogenesis and pathophysiology of childhood asthma,” allergen avoidance should still be a basic tenet of treatment and worth continued investigation.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1001/jama.2021.11559

Unmet health care needs in children of parents with poor self-rated mental health: justification for a “think-family” approach

ABSTRACT Associations between parents’ self-rated mental health status and children’s (0–17 years) unmet health care needs were examined in the 2019–20 National Survey of Children’s Health. Compared to parents with excellent/very good mental health, parents with poor/fair mental health were more likely to report children as having unmet health care needs, more missed school days due to illness/injury, and poor/fair general health. Problems paying for health care, transportation or childcare, lack of parenting support, parenting stress and parents’ own physical health problems were identified as barriers. Parents with poor mental health may benefit from programs that provide parenting support.

Test-to-Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2.

Test-to-stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K-12) school settings following household SARS-CoV-2 exposure. Three hundred twenty-two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post-exposure. Analysis-eligible participants completed the 15-day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within-school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants. Seventy-three of 265 analysis-eligible participants tested positive for SARS-CoV-2 (secondary attack rate of 28% [95% CI: 16-63%]). Among 77 within-school close contacts, 2 were positive (TAR=3% [95% CI: 1-5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved. TTS facilitates continued in-person learning and can greatly reduce the number of missed school days. Within universally masked K-12 schools, TTS is a safe alternative to school exclusion following household SARS-CoV-2 exposure.

Association of Promis Pediatric Profile Parent Proxy 25 with Clinical and Functional Outcomes in Pediatric Sickle Cell Disease Patients

Background: Patient reported outcomes (PROs) can be critical in allowing the clinical team to understand patients' perspectives on their quality of life (QoL) and functioning. PROs can serve as a basis for fostering shared decision making and individualized care. Patients with sickle cell disease (SCD) often experience a high symptom burden and PROs can be an important tool for improving patients' health. In the case of pediatric patients, guardian proxy reports may give additional insight since children may be too young to complete assessments themselves. Additionally, guardian perceptions can influence healthcare-related decision making. Understanding the relationships between guardian-reported PROs with clinical outcomes, such as healthcare utilization, and functional impairment may provide a valuable tool for shaping clinical decisions. Here, we examine the relationships between the six domains of QoL using the parent proxy version of the Patient Reported Outcome Measurement System (PROMIS), healthcare utilization and functional limitations in children with SCD. Methods: Pediatric patients and their guardians between the ages of 5 and 18 were approached while attending outpatient appointments at Children's Hospital of Richmond Comprehensive Sickle Cell Clinic. Children who were ill or in pain were excluded from enrollment during that visit. Consented guardians (n=43) completed a demographic questionnaire that included questions on recent healthcare utilization followed by the PROMIS Parent Proxy Pediatric Profile-25 with short forms assessing depression and sadness, pain interference, fatigue, anxiety and fear, mobility, and peer relations during the prior seven days. Outcome variables of interest included emergency department (ED) utilization and hospitalizations in the previous six months; acute SCD-related events in the prior year (acute chest syndrome, right upper quadrant syndrome, skeletal and joint issues, hand/foot issues, CNS involvement, acute anemia, sepsis, priapism), missed school days/planned activities due to SCD pain in the prior 30 days as well as academic performance. Counts and percentages were used to describe characteristics of children and guardians; t-tests were used to examine the relationship between domains of the PROMIS and outcome variables of interest. Specifically, we dichotomized all outcomes of interest, and then examined the means and 95% confidence intervals of the dichotomized groups for each of the PROMIS domains. Results: Demographic characteristics of both guardians and children are described in Table 1. Thirty five percent of participants had a hospitalization and 44% had an ED visit in the previous six months, 33% had an acute SCD event in the prior year, 62% reported one or more missed days of school/activities and 38% reported grades lower than a B. Healthcare utilization (ED visit and hospitalization) and acute medical events were all significantly associated with higher levels of proxy-reported pain interference, fatigue, and anxiety/fear; ED visits was also associated with higher levels of proxy-reported depression and sadness (Table 2). Missed days of school were associated with greater proxy-reported pain interference and decreased mobility while none of the domains were associated with grades achieved. Conclusions: Despite being administered during non-sick visits, multiple PROMIS Parent Proxy Pediatric Profile-25 domains that assessed QoL in the past seven days were associated with previous healthcare utilization in the past six months, acute medical events in the past year and missed school days in the past month. PROs can provide valuable information to clinicians, suggesting both the importance of addressing QoL outcomes for patients with recent healthcare events and the usefulness of guardian responses. The association of these PROs with clinical outcomes suggests that the PROMIS may be used prospectively to help identify and prevent further disease-related impairment and healthcare use. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Utility of illness symptoms for predicting COVID-19 infections in children

BackgroundThe Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that symptomatic children remain home and get tested to identify potential coronavirus disease 2019 (COVID-19) cases. As the pandemic moves into a new phase, approaches to differentiate symptoms of COVID-19 versus other childhood infections can inform exclusion policies and potentially prevent future unnecessary missed school days.MethodsRetrospective analysis of standardized symptom and exposure screens in symptomatic children 0–18 years tested for SARS-CoV-2 at three outpatient sites April to November 2020. Likelihood ratios (LR), number needed to screen to identify one COVID-19 case, and estimated missed school days were calculated.ResultsOf children studied (N = 2,167), 88.9% tested negative. Self-reported exposure to COVID-19 was the only factor that statistically significantly increased the likelihood of a positive test for all ages (Positive LR, 5–18 year olds: 5.26, 95% confidence interval (CI): 4.37–6.33; 0–4 year olds: 5.87, 95% CI: 4.67–7.38). Across ages 0–18, nasal congestion/rhinorrhea, sore throat, abdominal pain, and nausea/vomiting/diarrhea were commonly reported, and were either not associated or had decreased association with testing positive for COVID-19. The number of school days missed to identify one case of COVID-19 ranged from 19 to 48 across those common symptoms.ConclusionsWe present an approach for identifying symptoms that are non-specific to COVID-19, for which exclusion would likely lead to limited impact on school safety but contribute to school-days missed. As variants and symptoms evolve, students and schools could benefit from reconsideration of exclusion and testing policies for non-specific symptoms, while maintaining testing for those who were exposed.

The Association Between Pediatric Asthma and Missed School Days: A Sex-Stratified Secondary Analysis From the Indonesian Family Life Survey.

The Association Between Pediatric Asthma and Missed School Days: A Sex-Stratified Secondary Analysis From the Indonesian Family Life Survey.

Current Evidence Demonstrates That Monkeypox Is a Sexually Transmitted Infection.

Current Evidence Demonstrates That Monkeypox Is a Sexually Transmitted Infection.

Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.

We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.

Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review.

Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.

The Impact of Biopharmaceutical Innovation on Disability, Social Security Recipiency, and Use of Medical Care of U.S. Community Residents, 1998-2015.

This study seeks to analyze the overall impact that biopharmaceutical innovation had on disability, Social Security recipiency, and the use of medical services of U.S. community residents during the period 1998-2015. We test the hypothesis that the probability of disability, Social Security recipiency, and medical care utilization associated with a medical condition is inversely related to the number of drug classes previously approved for that condition. We use data from the 1998-2015 waves of the Medical Expenditure Panel Survey and other sources to estimate probit models of an individual's probability of disability, Social Security recipiency, and medical care utilization. The effect of biopharmaceutical innovation is identified by differences across over 200 medical conditions in the growth in the lagged number of drug classes ever approved. 18 years of previous biopharmaceutical innovation is estimated to have reduced: the number of people who were completely unable to work at a job, do housework, or go to school in 2015 by 4.5%; the number of people with cognitive limitations by 3.2%; the number of people receiving SSI in 2015 by 247 thousand (3.1%);and the number of people receiving Social Security by 984 thousand (2.0%). Previous innovation is also estimated to have caused reductions in home health visits (9.2%), inpatient events (5.7%), missed school days (5.1%), and outpatient events (4.1%). The estimated value in 2015 of some of the reductions in disability, Social Security recipiency, and use of medical care attributable to previous biopharmaceutical innovation ($115 billion) is fairly close to 2015 expenditure on drug classes that were first approved by the FDA during 1989-2006 ($127 billion). However, for a number of reasons, the costs are likely to be lower, and the benefits are likely to be larger, than these figures.

Feasibility, Acceptability, and Preliminary Efficacy of an Intensive Clinic-Based Intervention for Children With Poorly Controlled Type 1 Diabetes

ObjectiveTo evaluate the feasibility, acceptability, and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia, as detected based on the measurement of hemoglobin A1C (HbA1C). MethodsForty participants with T1D for >1 year and an HbA1C level of ≥9.5% (80 mmol/mol) enrolled for a multidisciplinary intervention that included pediatric endocrinologists, pediatric psychologists, and a certified diabetes care and education specialist (CDCES). The CDCES-integrated medical management, while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals and reviewed medication adjustments. The feasibility was assessed based on enrollment targets; acceptability based on retention rates; and preliminary efficacy based on changes in HbA1C levels, quality of life, diabetes-related strengths and resilience, hospital admissions, emergency room visits, and missed school days. ResultsOf 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention, and 31 completed full 8 months of follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. The HbA1C level reduced significantly from baseline to 4 months (12.1% ± 1.6% to 11.0% ± 1.9%, P = .001) and was sustained at 8 months (10.7% ± 1.9%, P < .001). The participants reported significant increases in diabetes-specific quality of life (P < .05) and diabetes-related strength and resilience (P = .003). The missed school days reduced from 7.23 ± 7.5 days to 1.55 ± 1.9 days (P < .001), and the diabetes-related hospitalizations decreased from 0.4 ± 0.6 to 0.1 ± 0.3 (P = .009). ConclusionPreliminary data suggest that a multidisciplinary intervention leveraging a team-based approach with a physician, psychologist, and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with T1D with an HbA1C level above the target.