Number Of School Days Research Articles

“Heely”-related injuries in children

Background:“Heelys”, or shoes with an integral wheel embedded into the heel, are becoming increasingly popular among children in the UK. Despite the manufacturer’s claims about their safety, increasing numbers of...

School quality and learning gains in rural Guatemala

I use unusually detailed data on schools, teachers and classrooms to explain student achievement growth in rural Guatemala. Several variables that have received little attention in previous studies – including the number of school days, teacher content knowledge and pedagogical methods – are robust predictors of achievement. A series of decompositions by student ethnicity and type of school shed some additional light on important questions in the Guatemalan context, and beyond. The large indigenous test score gap is not explained by differences in an extensive list of observable features of schools. The large effect for community characteristics suggests peer group effects or more general institutional differences related to services or labor markets. PRONADE community schools are associated with moderate gains vis-à-vis public schools in areas related to utilization of capacity, such as days worked. But these gains are largely offset by lower teacher capacity, which highlights the challenge of improving school quality in poor, rural areas.

Impact of vitamin A supplementation on health status and absenteeism of school children in Sri Lanka.

The objective of this study was to determine the impact of Vitamin A supplementation on health status and absenteeism of school children. A randomized double blind placebo controlled trial over a period of 13 months was conducted in a rural area of Sri Lanka involving 613 school children attending Grades 1-5 (aged 5 to 13 years). Children were assigned to either 200,000 IU of Vitamin A (n=297) or placebo (n=316) once every 4 months. Socio-demographic data were obtained at baseline, and anthropometry and haemoglobin concentrations were assessed at baseline and post intervention. Serum vitamin A concentrations were assayed by HPLC in a subgroup of children (n=193) before administration of each dose. School absenteeism was recorded. The two groups of children were similar at baseline in all variables. The subgroup of children was comparable to the main study population. The prevalence of vitamin A deficiency (< 20 microg/dL) in the subgroup of children was 8.2%. Changes in anthropometric indices and haemoglobin concentrations were similar in the two groups. The major causes for absenteeism were non-health causes and supplemented children lost a fewer number of school days due to illness than placebo children (p=0.053). Vitamin A concentrations improved with each dose and the improvement was greater with better compliance. Vitamin A supplementation with 200,000 IU every 4 months over 13 months improved vitamin A status and school attendance but not anthropometric status of these children.

Persistent Cough Points to Pertussis

Source: Harnden A, Grant C, Harrison T, et al. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006;333:174–177; doi:10.1136/bmj.38870.655405.AEInvestigators from the Universities of Oxford and Auckland evaluated 179 (of 289 eligible) children between 5 and 16 years of age with cough of ≥14 days seen in 18 primary care offices in Oxfordshire, England between October 2001 and March 2005. They determined the prevalence of recent pertussis infection in these children by measuring IgG titers to pertussis toxin. Recent pertussis was diagnosed if there was a 4-fold antibody titer rise in paired sera drawn 4 to 6 weeks apart or a single test >100 ELISA units/ml. Of the 172 children who consented to have blood drawn, 64 (37.5%) were diagnosed with a recent pertussis infection. Of those with recent pertussis infection 32% were exposed to environmental tobacco smoke versus 42% of those who did not have pertussis. There was no gender or age difference in children with or without recent pertussis. However, those with the diagnosis of recent pertussis were significantly more likely to have whooping (50% vs 27%), vomiting (70% vs 39%), and productive cough (70% vs 56%), and less likely to wheeze (30% vs 44%). The mean duration of cough at presentation was not different in those with and without the diagnosis of recent pertussis (45 vs 44 days). However, the total duration of cough was significantly higher in those with pertussis compared to those with negative serologies (median 112 [range, 38–191] vs 58 [24–192] days). Two months after the start of symptoms 85% (46 of 54) of subjects with pertussis were still coughing compared to 49% (45 of 92) who did not have pertussis (P=.001). There was no difference between the 2 groups with regard to the number of school days missed by children or work days missed by parents.Dr. Rathore has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.This study investigated the common complaint of cough in school-age children. It offers convincing evidence that prolonged cough is often attributable to pertussis in this age group. All clinicians who care for patients of any age group, whether or not they have been immunized, should consider the diagnosis of pertussis in patients presenting with prolonged cough. Although antibiotic treatment may not decrease the severity or duration of the illness, early diagnosis of pertussis may prevent further spread of the infection if prophylaxis is started expeditiously. Until pertussis booster immunization is routinely implemented in early adolescence, pertussis will remain an important public health issue. A high index of suspicion, rapid diagnosis (using molecular techniques), and prophylactic antibiotics are critical in preventing and controlling pertussis outbreaks. (See also AAP Grand Rounds, Nov 2004;12:60–61.1)This study joins many others demonstrating that symptomatic infection with Bordetella pertussis is ubiquitous in all age groups. Nonetheless, clinicians who care for patients, be they pediatric, geriatric, or somewhere in between, too often fail to consider whooping cough when considering the cause of cough illness – often diagnosed as “bronchitis” – even among healthcare workers. Such failures contribute to the spread of infection in families, schools, and hospitals and to the delayed diagnosis of secondary cases. In addition, many clinicians are unfamiliar with or do not have ready access to diagnostic tests such as PCR, FA (fluorescent antibody staining), culture, or serology. Next time you see your internist or family practitioner – when you request your own Tdap booster – ask when they last diagnosed pertussis and if they have nasal swabs in their office. Although the advent of an effective vaccine for adolescents and adults holds great promise, increased awareness of the prevalence of this disease seems a prerequisite to better control.

Post-tonsilelectomy morbidity — do steroids help

A prospective randomized controlled study was conducted in 50 patients evaluating the effect of single intra - operative intravenous dose of dexamethasone on post - operative morbidity. Dexamethasone was found to significantly reduce the incidence of vomiting in 1(st) 24 hrs, trismus. pain, time for 1(st) solid intake, need to administer rescue analgesic and fever. Besides the number of school days lost in study group were less compared to control due to earlier feeling of well being.

An analysis of California Assembly Bill 2185: mandating coverage of pediatric asthma self-management training and education.

To summarize for the California Legislature the evidence on the medical effectiveness of pediatric asthma self-management training and education (PASMTE), including the use of peak flow meters, spacers, and nebulizers and the impact that mandated coverage of these services and devices under Assembly Bill (AB) 2185 would have on total health care expenditures, monthly premiums, health services utilization, and the public's health. The review of the literature finds that PASMTE is medically effective and has favorable effects on the health of children with symptomatic asthma, as well as reduces asthma-related emergency room visits and hospitalizations. There was inadequate evidence to assess the effectiveness of the three medical devices independently of PASMTE. One-hundred percent of children in health maintenance organization (HMO) plans in California are already covered for PASMTE, with fewer having coverage for the specific medical devices. However, despite full coverage of PASMTE in HMOs, these services are underutilized. We expect that the enactment of AB 2185 would increase utilization of PASMTE among children who are currently covered by 10 percent as a result of increased awareness of current coverage by all HMOs and increased awareness of the importance of these services. We estimate that this increased utilization by children who are already covered may result in a total statewide premiums increase of $170,000 or 0.006 percent, equal to one to two cents per member per month (PMPM). It is estimated that the public health impact of the mandate, as a result of new utilization of PASMTE by 10 percent of children who are already covered, would reduce the number of school days missed because of asthma per year by 158,000; the number of children reporting restricted activity days by 6,020; the number of emergency department visits by 350; and the number of hospitalizations by 1,105. AB 2185 passed the legislature after being amended six times. The bill as it was signed into law did not mandate coverage for PASMTE, as all HMOs in California presently reported covering these services. However, the bill retained the mandate for coverage of the three medical devices, as their coverage was not as universal across health plans.

Malaria infection and its consequences in school children

To evaluate the prevalence and consequences of malaria infection in school children in the Muea area and its environment. A cross-sectional study. Muea area, South West Cameroon. Two hundred and fourty six randomly selected school children aged three to sixteen years. Prevalence of malaria in the Muea area. Determination of parasitaemia. Measurement of haematocrit (PCV) values. Species identification. Consequences of malaria infection in terms of school days lost. Prevalence of malaria was 98% and highest prevalence rate (100%) and geometric mean parasite density (1520 parasites/microl of blood) occurred in the < or = 5 years age group. Prevalence of anaemia was generally low (10.8%) and there were no cases of severe anaemia (PCV < 20%). P. vivax-like parasites were detected for the first time in this area. Plasmodium falciparum was the predominant species (93%) followed by P. malariae (52%), P. ovale (42.7%) and P. vivax-like parasites (33.3%). Mixed infections also occurred. Fifty three out of 144 (36.8%) children lost a number of school days ranging from 0.5-14 days, with each child losing an average of 1.53 school days in a month. The prevalence of asymptomatic malaria in the Muea area is very high. P. vivax parasites were observed for the first time in the area, but this needs to be confirmed by molecular methods in future studies. Children lost school days as a consequence of malaria infection.

Delayed prescribing of antibiotics increased duration of acute otitis media symptoms in children but reduced diarrhoea

Design Randomised (unclear allocation concealment), unblinded, controlled trial with about 1 week of follow up. Setting General practices in south west UK. Patients 315 children aged 6 months to 10...

Oral-steroid sparing effect of inhaled fluticasone propionate in children with steroid-dependent asthma

To evaluate the oral steroid-sparing effect of inhaled fluticasone propionate (FP) in eight children with steroid-dependent asthma. Treatment protocol study at a tertiary pulmonary care centre at a children's hospital. Eight children with severe persistent steroid dependent asthma (mean age 11.6 years [range 10 to 13 years], mean duration of asthma 8.37 years [range three to 11 years]) were enrolled in the study. Inhaled FP 880 mug/day (two puffs of 220 mug/puff, two times a day) was added to the children's asthma treatment, and attempts were made to reduce the dose of oral steroids by 20% every two weeks over a six-month period. After this six-month period, in the patients responding to inhaled FP, the dose of inhaled FP was reduced to 440 mug/day (two puffs of 110 mug/puff, two times a day) for the next six months. The mean percentage predicted values for forced expiratory volume in 1 s (FEV(1)) and maximal mid-expiratory flow rate (FEF(25%-75%)) were compared during the first month, at two to six months, and at seven to 12 month intervals before and after starting FP. The number of asthma exacerbations, emergency room visits, hospital admissions and number of school days lost were also compared. Within three months of starting inhaled FP, the mean alternate-day oral steroid dose decreased from 38 mg to 2.5 mg. In addition, six patients (66%) were able to discontinue the use of oral steroids. There was significant improvement in the number of mean emergency room visits per patient (P=0.016), mean asthma exacerbations per patient (P=0.016), mean hospital admissions per patient (P=0.016) and mean number of school days lost per patient (P=0.004) while patients were receiving high dose inhaled FP compared with oral steroids. There was no deterioration of any of the above mentioned parameters during the six month period when the dose of inhaled FP was reduced. The mean FEV(1) and FEF(25%-75%) during the two- to six-month and seven- to 12-month periods showed significant improvement, while the patients were receiving FP compared with oral steroids (P<0.05 for both parameters for both time periods). High dose inhaled FP 880 mug/day has an important oral steroid-sparing effect. After oral steroids are tapered, patients maintain adequate control of asthma with low dose inhaled FP. These findings suggest that FP may control asthma better than oral steroids.

Childhood Asthma in Low-Income Hispanic and Non-Hispanic White Families in a Rural State: The Impact-on-Family Scale

We measured the impact on family functioning reported by low-income Hispanic and non-Hispanic White parents of children (N = 415, mean age 8.7 years) with asthma living in a rural state. A number of factors were associated with impact, using the Impact-on-Family Scale (Stein & Jessop, 1985). In order of importance, the factors were number of school days missed, nighttime symptoms, number of as-needed medications, and Spanish version of the tool. These factors accounted for approximately 13 % of the variance in total impact score. There were no differences in impact score between urban and rural parents or by ethnicity. The findings indicate that perceived parental impact is not strongly associated with commonly measured demographic and morbidity measures. The relation of these data to the recommendations of the National Asthma Guidelines (National Heart, Lung, and Blood Institute, 1997) is discussed.

Emergency department visits by urban African American children with asthma

Background: Asthma morbidity among African American children has been identified as a significant national health concern. High emergency department use is one index of this morbidity and may reflect disease severity, disease management, and social factors. Objective: This study examined the prevalence and correlates of emergency department use and other indices of asthma morbidity among a sample of urban, low-income, African American children. Methods: Parents of 392 elementary school children with asthma who had consented to participate in an asthma education program were interviewed by phone according to a standardized protocol. Results: Children had a mean of 6.2 days of restricted activity (SD 8.1) and 7.9 symptomatic nights (SD 8.1). The mean number of school days missed because of asthma was 9.7 (SD 13.5). Among children with asthma symptoms in the past 12 months, 73.2% could identify a specific physician or nurse who provided asthma care. For those families without an identified asthma primary care provider, 39.3% received their usual asthma care from the emergency department. A total of 43.6% of the children had been to the emergency department for asthma care without hospitalization in the previous 6 months. Close to 80% of children reported using one or more prescribed asthma medication, and of these only 12% reported using inhaled anti-inflammatory medications. Families of children who had used the emergency department in the prior 6 months reported more asthma symptoms, lower social support, problems paying for health care, and the absence of a hypoallergenic mattress cover and that they had seen a physician for regular asthma care in the past 6 months. Conclusions: We conclude that asthma management for children in the inner city relies on episodic care and emergency care, that asthma medication management does not conform to current guidelines, and that asthma symptoms resulting in school absences and workdays lost are prevalent. (J Allergy Clin Immunol 2000;105:83-90.)

Association of Being Overweight with Greater Asthma Symptoms inInner-City Black and Hispanic Children

Luder E, Melnik TA, DiMaio MJ Pediatr.1321998699703The prevalence of both asthma and obesity have been increasing over recent years, and are higher among minorities. The aim of this study was to observe whether the weight status of inner-city minority asthmatic children differed from that of their nonasthmatic peers, and to determine if overweight asthmatic children experienced more severe asthma.The study group was composed of 209 black and Hispanic children between the ages of 2 and 18 who carried the single diagnosis of asthma, and who had not received chronic oral steroids or more than 4 short courses of oral steroids within the past year. The control group consisted of 1017 black and Hispanic children enrolled in New York City schools.Information obtained from the patient record and an interview was used to determine asthma severity. This information included peak expiratory flow (PEF) records, number of medications used, number of emergency visits or hospitalizations, number of school days missed, and ability to participate in play or sports activities. PEF rate was measured at enrollment in patients who were at least 6 years old and could perform a good effort. Standing height and weight were measured in the patients. Height and weight measurements for the control group were available for comparison. Body mass index (BMI) was calculated and used as the indicator of weight status. Differences in BMI between the asthmatic children and their peers were determined, and the relationship between high BMI and the various measures of asthma severity was examined.The percentile distribution of BMI for the children with asthma was compared with that of the control group as well as the established reference population. The BMI distribution for the asthmatic patients as well as the controls was skewed towards the higher percentiles compared with the reference population, but was skewed to a greater extent for the asthmatics. The asthmatic children had a relative risk of 1.34 of having a BMI at 85th percentile or greater compared with the peer group (P = .06). The relative risk for asthmatics of having a BMI at 95th percentile or greater was 1.51 (P = .03). The risk of being overweight (based on a BMI of 85th percentile or greater) was found to be significantly associated with days of school missed (30 days or more missed per year), PEF rate of ≤60% predicted, and three or more prescribed asthma medications. The risk of being overweight was not significantly associated with number of hospitalizations, number of emergency visits, or level of sports participation.The prevalence of being overweight was significantly higher in asthmatic children compared with their peers. Being overweight was significantly associated with severity of asthma as measured by PEF rate, days of school missed, and number of asthma medications.The authors mention that the findings of this study do not allow us to determine whether asthmatic children are more overweight because of a decreased activity level, or if being overweight actually leads to increased severity of asthma. Asthmatic children may be held back from participating in sports by their parents and thus become overweight because of inactivity. Alternatively, overweight children might spend more time indoors, thereby being exposed to greater amounts of indoor allergens, leading to increased asthma. The latter explanation might be more of an issue in inner-city environments.

Analgesic rebound headache in children and adolescents.

For more than a decade, the frequent use of analgesics has been recognized to lead to daily headaches in adults. To date, no studies on the occurrence of analgesic rebound headache have been done on the pediatric population. We retrospectively reviewed all charts of patients with the diagnosis of headache seen in our pediatric headache clinic between January 1996 and May 1997. Among the 98 patients seen, 46 (47%) suffered from daily or near daily headaches; 30 of them were consuming daily analgesics. Twenty-four patients (mean age 12.1 years, and mean follow-up 6.2 months) successfully discontinued their analgesics. Twenty-two patients were also placed on amitriptyline. A significant reduction in the frequency (80%), severity (47%), and number of school days missed (74%) were seen. In conclusion, this data is comparable to previous observations reported in adults, and suggests that the daily use of analgesics might result in daily or near daily headaches in the pediatric population. Discontinuing daily analgesics, with the concomitant use of amitriptyline, is an effective treatment for analgesic rebound headache in this population.

Association of being overweight with greater asthma symptoms in inner city black and Hispanic children

Objective: To determine whether the weight status of inner city black and Hispanic children with asthma differs from that of their peers and to assess whether overweight asthmatic children experience greater asthma symptoms.Study design: A cross-sectional study in an ambulatory chest clinic of an inner city medical center. Methods: We studied black and Hispanic children aged 2 to 18 years ( n = 209) with the single diagnosis of asthma. The peer control subjects consisted of a sample of black and Hispanic children aged 6 to 13 years ( n = 1017), enrolled in the New York City schools. Asthma symptoms, the number of asthma medications prescribed, and peak expiratory flow rate (PEFR) measurements were used to classify asthma severity and relate to body mass index (BMI). Bivariate categorical analysis and χ 2 tests were performed to examine the relationship between high BMI and the individual measures of asthma severity. Results: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers. The risk of overweight based on a BMI in the 85th percentile or greater was significantly associated with the following measures of asthma severity: (1) the number of school days missed per year; (2) a PEFR less than or equal to 60% of the predicted PEFR; and (3) the number of asthma medications prescribed. Conclusions: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers, and being overweight was associated with significantly more severe asthma symptoms. Further studies in overweight asthmatic children are needed, including the effect of weight loss on lung function and other markers of asthma severity. (J Pediatr 1998;132:699-703.)

The impact of prophyactic treatment on children with severe haemophilia.

Twenty-seven children with severe haemophilia receiving regular prophylactic factor concentrate were evaluated to examine the overall effectiveness of prophylaxis in modern haemophilia care. The median age at the start of prophylaxis was 6.2 years (range 1.3-15.9 years) and the cumulative length of follow-up was 808 months (mean 30, rang 7-76 months). Nine patients required a central venous catheter for venous access (age range 1.3-5.2 years), eight boys could cannulate themselves and in 10 the parents performed regular venepuncture. The mean dose of concentrate given at the time of study was 31.8 U/kg three times weekly (range 12.5.6 U/kg) or 4900 U/kg/year (range 1900-8200). None developed an inhibitor on prophylaxis, though four had previously had an antibody. The median average annual number of bleeds in the 27 patients prior to prophylaxis was 14.7 (range 3.7-35.4). On prophylaxis this fell to 1.5 (range 0-12.5) (P<0.001) and in the group as a whole the frequency of bleeds diminished in successive years on prophylaxis. All 20 children with evidence of arthropathy improved on prophylaxis and eight had reversal of chronic damage such that their joints appeared normal at the time of study. There were reductions in the need for walking aids, in hospital admissions, and in numbers of school days lost for bleeding episodes. All families feel that prophylaxis has brought about an improvement in quality of life.

Home management of sickle cell-related pain in children and adolescents: natural history and impact on school attendance

Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home-based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. Pain was reported on 30% of days and was managed at home nine-tenths of the time. Girls reported more days with pain than did boys, and age was positively correlated with the length of the painful episodes. The pain affected school attendance and sleep. Patients were absent from school on 21% of 3186 school days, with half of the absenteeisms on days with reported pain. Of the pain-associated absenteeisms, two-thirds occurred when pain was managed at home, and one-third when patients were hospitalized. The average consecutive number of school days missed was 2.7. These findings have implications for developmentally critical activities.

Results of Endoscopic Sinus Surgery in Pediatric Patients With Chronic Sinusitis and Asthma

To determine the efficacy of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. Patients were selected from the tertiary care practice of a pediatric pulmonologist (R.S.) and immunologist (R.L.W.); all underwent sinus surgery at Children's Medical Center at Dallas (Tex). Fourteen pediatric patients aged 3.5 to 13 years with severe asthma requiring at least intermittent systemic steroid therapy. All patients had a history of sinusitis aggravating asthma and all had computed tomographic evidence of chronic sinus disease. All patients underwent endoscopic sinus surgery consisting of bilateral total ethmoidectomies and middle meatus antrostomies at a minimum. The period 12 months prior to surgery was compared with 12 months postoperatively with regard to total hospitalization days for asthma treatment, number of school days missed, pulmonary function test results, and systemic glucocorticoid medication requirements. Symptom scores for asthma and sinusitis were assessed via parental questionnaire both preoperatively and postoperatively. No significant difference was found for pulmonary function test results. Eleven of 14 patients demonstrated a significant reduction in hospitalization and school days missed. Twelve of 14 patients experienced a reduction in glucocorticoid requirements. Eleven of 14 and 13 of 14 patients experienced a significant improvement in asthma and sinusitis symptom scores. Endoscopic sinus surgery was effective in reducing sinusitis and improving the overall management of asthma in a majority of study patients.

Cost-Effectiveness of Erythromycin Versus Mupirocin for the Treatment of Impetigo in Children

A new topical antibiotic, mupirocin, has been found to be as effective as erythromycin for the treatment of impetigo, but concerns about its expense have been raised. This controlled clinical trial sought to compare the cost-effectiveness of erythromycin (E) and mupirocin (M). Ninety-three children, aged 3 months to 16 years, were randomly assigned to receive 10 days of oral erythromycin (n = 46) or topical mupirocin (n = 47). Costs and effects were measured through structured interviews. Cost per case differed significantly by group (E = $56.85; M = $62.30; P less than .05) due chiefly to extra visits and medication changes needed by those treated with mupirocin. Erythromycin and mupirocin were equally effective. The likelihood of side effects (E = 43%, M = 22%) approached significance (P less than .07); those treated with erythromycin were willing to pay more for a different medicine to avoid the side effects experienced (P less than .05). Working parents and school-age children were more likely to alter their daily activities when the patient was taking erythromycin (P less than .04). Compliance and parental satisfaction did not differ by treatment group; however, parents of children treated with erythromycin were more likely to prefer the alternate drug regimen. It is concluded that the type of medication prescribed can be based on parental preference because the increased cost of mupirocin is offset by increased side effects and number of schooldays and workdays lost with erythromycin.

Gender Differences in Adolescent Health Concerns and Self-Assessed Health

Gender has been shown to be an important variable in studies of health status and illness behaviors of adults. This study of 745 rural eight grade students examined gender differences in the reported health concerns, self-assessed health status, and illness behaviors of young adolescents. A 28-item health concern inventory was used to measure emotional, social, physical, and drug-related health concerns. For girls, emotional and social concerns were highly associated with poorer perceived health, while for boys, physical concerns differentiated those in fair or poor health from those who saw themselves as healthy. Physical concerns were significantly associated with reported school absenteeism due to illness, attendance of school when ill, and physician visits for both boys and girls. Emotional concerns were related to greater numbers of school days missed or days attended when ill for girls but not for boys.

ECONOMIC PERSPECTIVES ON EDUCATIONAL POLICY: INTRODUCTION

The two papers that follow both deal with prospects for achieving efficiency in education. Psacharopoulos identifies the extent of government‐induced distortions directly or indirectly related to education, and assesses the likely effects of such distortions on social welfare. He concludes that, among other things, governments should not attempt directly to provide or manage schooling services. Levin's article focuses upon one particular management decision…namely, extending the length of the school day and increasing the number of school days per year. He argues that mechanically increasing school sessions through legislative acts or through administrative mandates does not appear, in itself, to be a promising use of scarce resources.