Routine School Research Articles

Membranous nephropathy associated with thyroid-peroxidase antigen

A 6-year-old previously healthy Japanese girl was found to have dipstick 2+ proteinuria and a goiter based on the results of a routine school medical examination. Her serum free-thyroxine level was 4.98 ng/dL (normal range 0.95-1.74 ng/dL), thyroid-stimulating hormone (TSH) was less than 0.003 microU/mL (0.34-3.88 microU/mL), anti-microsomal (anti-thyroid-peroxidase) antibody was 1600 T (up to 100), anti-thyroglobulin antibody was 400 T (up to 100), and TSH-receptor antibody was 84% (up to +/-10%). These results are consistent with a diagnosis of Graves' disease. Electron microscopy examination of a renal biopsy specimen revealed electron-dense deposits located in the subepithelial spaces, and immunofluorescence microscopy examination demonstrated bright granular stainings of immunoglobulin G along the glomerular capillary walls. These findings are characteristic of membranous nephropathy. To investigate the relationship between the membranous nephropathy and Graves' disease, we carried out a second immunofluorescence study, which revealed that the immunoglobulin G granular deposits corresponded to glomerular granular staining of thyroid-peroxidase, whereas staining for thyroglobulin was absent. It was therefore assumed that the deposition of immune complexes mediated by thyroid-peroxidase had caused the membranous nephropathy in this patient. This is the first report of membranous nephropathy associated with Graves' disease in which deposits of thyroid-peroxidase, rather than thyroglobulin, have been confirmed in the kidney.

Tinnitus in childhood

Tinnitus in childhood Ninety-three healthy children attending routine school and community medical examinations were questioned about tinnitus, 27 of them (29%) described tinnitus. Nine children (9.6%) were bothered by their symptom, the others were not. The incidence of tinnitus in this group was compared with that in a group of 109 children with ear disease. Forty-two children (38.5%) in this group reported tinnitus. This difference is not statistically significant. Details of children attending paediatric ENT clinics were recorded by two ENT surgeons. Four hundred and three children were seen during the study period and of these 13 (3%) reported tinnitus spontaneously. All these children had evidence of ear disease at the time of the consultation. The incidence of tinnitus in those members of this group with abnormal ears was significantly higher than in those children with no evidence of ear disease (P= < 0.02). Tinnitus may be a manifestation of ear disease in children, but may also be described by children with normal ears.

School screening for scoliosis in Sivas, Turkey

We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

An Investigation into Black Tooth Stain Among School Children in Chakkar Ka Milak of Moradabad City, India

ABSTRACT Background Tooth discoloration is a frequent dental finding associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location and severity. During routine school dental camps we found that there is black discoloration of tooth in children in a particular area of Moradabad city. Objective To assess the prevalence and to investigate the reasons for the black stains among school children of Moradabad city. Methods Three schools present in the municipal ward were selected for the study. All the children studying in the above schools were subjected to Type III investigation to identify the black stains. Out of 780 children 156 students showed black stains. Among them a sample of black stain scraping was taken from 5 students and it was subjected to analysis for trace elements. Trace elements analysis was done by (ICP) Inductively Coupled Photo spectrometry. Results Out of 5 scrapings 3 showed presence of ferrous ions of about 2.56%, calcium ions 17.15% and magnesium ions 0.72%, while the remaining 2 samples showed calcium 14.86%, magnesium ions 0.82% and no presence of ferrous ions. Conclusion Black extrinsic tooth stains were shown to be a form of dental plaque. The stains examined contained a black insoluble ferric compound.

A study of adolescent smoking and drinking in Korea

Purpose: Adolescence is a period of growth and development in body structure and physiologic, psychologic, and social functioning. Smoking and drinking in this period are very harmful and may lead to other forms of substance abuse. We surveyed the actual aspects of smoking and drinking among Korean adolescents and analyzed associated factors. Methods: A survey was performed among adolescents using a questionnaire about smoking and drinking. Data were collected from students who visited pediatric clinics for routine school examinations from July to November 2007. Results: A total of 2,546 adolescents (smoking 1,512; drinking 1,034) participated in the study. The overall smoking and drinking rates were 29.2% and 48.2%, respectively, and the mean age at the first instance of smoking and drinking was 13.8 and 14.1 years, respectively. Among drinking adolescents, 30.1% were offered a drink by their parents, although most adolescents were encouraged to smoke or drink by their friends. Dissatisfaction with family and school life, economic status, and school performance was associated with a higher smoking and drinking rate (P<0.001). Broken families were associated with a high rate of smoking, but peer satisfaction was not related to smoking or drinking. The frequency and amount of smoking and drinking in adolescents were as high as those in adults. Social sanctions seemed insufficient to keep adolescents from smoking and drinking. Conclusion: Adolescent smoking and drinking are highly influenced by family and school environments, so more active social sanctions are required, including parental involvement and legislation preventing adolescents from smoking and drinking. (Korean J Pediatr 2009;52:422-428)

Programa para mejorar marcadores de riesgo cardiovascular en escolares mexicanos

To assess the effect of a physical activity intervention on cardiovascular risk factors in Mexican school-age children. Children from two public schools in Queretaro (n=360, 8-14 years old) performed a 20-minute physical activity routine every school day during 16 weeks (February-May 2006). Anthropometric, blood pressure and biochemical assessment was done before and after implementation. Systolic blood pressure, triglyceride and total cholesterol levels decreased significantly. The decrease in lipid and lipoprotein levels was higher in children with high baseline levels. In high-risk girls, the cardiovascular risk cluster score decreased significantly. No change in BMI, waist circumference, or insulin was observed. A simple physical activity program modified several cardiovascular risk markers in school-age children. These results may be taken as a reference to develop better intervention programs directed toward preventing the effects of children obesity.

Social and emotional training in Swedish classrooms for the promotion of mental health: results from an effectiveness study in Sweden

Mental ill-health is a major problem worldwide. It includes depression, aggressive behavior, feeling down and alcohol and drug abuse. Since all children go to school, the school is an obvious arena for health interventions. A set of educational techniques named Social and Emotional Learning, based on the use by teachers of cognitive and behavioral methods, which teaches students self-control, social competence, empathy, motivation and self-awareness, has shown promising results in the USA. This paper reports on the application of similar techniques in Sweden (the Social and Emotional Training [SET] program). The study has a quasi-experimental longitudinal design, with two intervention and two control schools. A wide range of instruments, both Swedish and international, are employed. In this paper, results from the school years 1999-2000 (baseline) through to 2001-2002 are reported. Both the intervention and the data collection were performed by ordinary school staff in a routine school setting. Independent bi-annual ratings of teachers' performance were moderate to high, and teachers' perceptions of the program were generally, although by no means universally, high. However, their performance was poorer with regard to the collection of data. In terms of promotion, findings with regard to the impact of the program on mental health are generally favorable-in particular through the promotion of aspects of self-image, including well-being and the hindering of aggressiveness, bullying, attention-seeking and alcohol use. There was, however, no differential effect on social skills. It seems that SET has the potential to operate effectively as a health-promoting intervention during the school period, although its main impact may rather be to act as a brake on the deterioration in some aspects of mental health that is common during adolescence. Positively significant relationships were found on some but not all of the instrument scales, and effect sizes were medium.

Identification and follow-up of obesity in ten-year-old school children

Growth surveillance of children in school health services is a routine in Sweden. We describe the effect at follow-up of an overt identification of obesity in school children. Follow-up data were collected in two populations of ten-year-old children with obesity. Children in the study group belonged to a cohort born in 1990. Here the presence of obesity had been identified at the routine growth screening, and intervention activities against obesity had been actively offered. Controls belonged to a cohort born in 1989. Of the 176 children with obesity, 91 were in the study group (41 girls) and 85 (44 girls) in the control group. No differences were found between the groups in age, gender or body mass index at baseline. At follow-up, after one to two years, children in the study group had a modest but significantly more pronounced decrease in the relative body mass index, compared with controls. The mean difference between the populations in body mass index standard deviation score (z-score) after adjustment for baseline body mass index and follow-up time was -0.14 (95% confidence interval: -0.25 to -0.02; P=0.027). Socioeconomic status, gender, follow-up time and group were independent predictors for change in body mass index z-score. To identify children with obesity in a routine school health survey may be a crucial initial step in the management of childhood obesity.

E-Science in the classroom – Towards viability

E-Science has the potential to transform school science by enabling learners, teachers and research scientists to engage together in authentic scientific enquiry, collaboration and learning. However, if we are to reap the benefits of this potential as part of everyday teaching and learning, we need to explicitly think about and support the work required to set up and run e-Science experiences within any particular educational context. In this paper, we present a framework for identifying and describing the resources, tools and services necessary to move e-Science into the classroom together with examples of these. This framework is derived from previous experiences conducting educational e-Science projects and systematic analysis of the categories of ‘hidden work’ needed to run these projects. The articulation of resources, tools and services based on these categories provides a starting point for more methodical design and deployment of future educational e-Science projects, reflection on which can also help further develop the framework. It also points to the technological infrastructure from which such tools and services could be built. As such it provides an agenda of work to develop both processes and technologies that would make it practical for teachers to deliver active, and collaborative e-Science learning experiences on a larger scale within and across schools. Routine school e-Science will only be possible if such support is specified, implemented and made available to teachers within their work contexts in an appropriate and usable form.

Weighing in at school? The value of routine school based measurements in the fight against obesity

Weighing in at school? The value of routine school based measurements in the fight against obesity

Development and Predictive Validity of a Teacher Screener for Child Behavioral and Emotional Problems at School

A principal components analysis of the Teacher Rating Scale—Child (TRS-C) of the Behavior Assessment System for Children was conducted with a cross-sectional cohort of 659 children in Grades 1 to 5. A predictive validity study was then conducted with a 2-year longitudinal sample of 206 children. The results suggested that scores from the resulting 23-item screener had strong initial reliability and validity evidence. Predictive validity coefficients for the screener scores were acceptable for both behavioral and academic outcomes and equal to or better than those for the full TRS-C, comprised of 148 items. The practicality of the screener was documented by teachers' experiences. Administration time was less than 5 minutes per child, and no specialized teacher training was necessary. These results provide preliminary evidence that routine school screening via a brief teacher rating scale can increase the probability that children with behavioral and emotional problems may be validly identified for diagnostic and treatment services.

Evaluating health visitor parenting support: validating outcome measures for parental self-efficacy

Parenting support has become an increasing feature of child health services within the United Kingdom but typically, outcome measures available for testing the effectiveness of parenting interventions have been developed and validated elsewhere. This article reports the results of a feasibility study testing the Parenting Self-Agency Measure (PSAM) and subscales from the Self-Efficacy for Parenting Tasks Index (SEPTI) as outcome measures for UK-based parenting support programmes. Forty-six mothers and 10 fathers accessing routine health visitor and school nurse services participated in the test-re-test of the scales and commented separately on the acceptability of scale questions. Very large intra-class correlation results indicated good repeatability but alpha coefficient scores and factor analysis results suggest that UK respondents may not recognize SEPTI subscales items as measuring single dimensions. The PSAM was a more stable measure of parenting self-beliefs than the SEPTI subscales when tested with a UK sample of parents.

Prevalence of acquired undescended testis in 6-year, 9-year and 13-year-old Dutch schoolboys

Objective: To investigate the prevalence of acquired undescended testis (UDT) in Dutch schoolboys. Design and participants: As a part of routine school medical examinations, during a 2-year period (2001–3), testis...

A Randomized Trial of Primary Care Provider Prompting to Enhance Preventive Asthma Therapy

Purpose of the Study. To determine if systematic school-based asthma screening, coupled with primary care provider notification of asthma severity, would prompt providers to prescribe a new preventive medication or change a current dose. Study Population. The study included 151 children (aged 3–7 years) with mild persistent to severe asthma living in an urban setting. Methods. A routine school health-and-development form was sent to parents of schoolchildren. When asthma was indicated on this form, the parents were contacted by telephone. To be eligible for the trial, the child’s parent needed to report that a physician had diagnosed their child as having asthma, and the child’s symptoms needed to be consistent with mild persistent asthma or worse according to National Heart, Lung, and Blood Institute guidelines. The intervention arm of the study involved notification of the primary care providers via fax of the child’s symptoms and recommendations for action on the basis of national criteria. Confirmation of receipt was received from 90% of providers. In the control arm of the study, primary care providers were not contacted. Interviewers then contacted the parents 3 to 6 months later to determine if preventive actions were taken. Results. Children in the provider-notification group were not more likely to receive a preventive medication action than children in the control group (21.9% vs 26%). Additional preventive measures such as encouraging compliance with medications, recommending environmental modifications, and referrals to specialty care also did not differ between the 2 groups. The only factors that significantly predicted the occurrence of a preventive action were acute visits for asthma and baseline use of preventive medications. At the end of the study, 52.4% of children in both groups with no medications change were still experiencing symptoms. Conclusions. School-based asthma screening identified many symptomatic children in need of medication modification, but notification of their primary care providers did not improve preventive care. Reviewer Comments. Asthma is a complex disease, and there are many barriers to effective care. These barriers include steroid phobia, cost of medication, denial of the presence or severity of the disease, access to health care, exposure to asthma triggers, and poor adherence to treatment. It is concerning that another barrier to effective care of asthma, as illustrated by this study, is a poor response of health care providers to supportive education, such as treatment guidelines. In an effort to better understand this deficit, the authors queried the providers: “Was the information in the original notification helpful?” Only 27 of 73 providers responded: 10 said the information was helpful (7 changed medications); 9 replied that their patients had mild, intermittent asthma and did not need changes; 4 replied that their patients already were on preventive medications; and 4 replied that they were unable to contact their patients for follow-up.

Socialization of children and adolescents with cystic fibrosis: support for nursing care

The aim of this paper is to identify the routine (school, work, free time activities and relationships with friends and family) of children and adolescents with Cystic Fibrosis (CF) through their experiences and identify situations that can affect these routines. The objects of analysis of this research are children and adolescents with CF who attend a teaching hospital in a city of the State of São Paulo--Brazil. It is a qualitative research, with data collection based on open interviews and patient charts. The data brought the following themes: misleading knowledge about the disease, concern with self-image, search for self-care and hope of improvement in the future. The results evidence the repercussion of CF in those patients' socialization process, evidencing the importance of health professionals knowing about these demands and incorporating them into the care plan, with a view to effective interventions to promote infant-juvenile growth and development.

The Efficacy of Asthma Case Management in an Urban School District in Reducing School Absences and Hospitalizations for Asthma

Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically underserved inner-city children attending Memphis City schools. Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size, percentage of children with asthma enrolled, and percentage of children eligible for free or reduced-price lunch. Schools were randomized to either a nurse CM intervention or a usual care (UC) condition. The CM group included 115 students; 128 students were in the UC group. A longitudinal design was used to follow students' progress. Students were primarily African-American children diagnosed with asthma. In CM schools, nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum, followed up on students' school absences, and coordinated students' asthma care with families, school personnel, and medical providers. In UC schools, students received routine school nursing services. CM students had fewer school absences than their counterparts in UC schools (mean 4.38 vs 8.18 days, respectively) and experienced significantly fewer emergency department visits (p < .0001) and fewer hospital days (p < .05) than UC students. No such differences existed before program initiation. Replication and follow-up in year 2 showed continued significant improvements. School-based nurse CM can achieve significant improvements in school attendance and medical utilization.

Risk of Active Tuberculosis Among Schoolchildren in Hong Kong

To estimate the risk of active tuberculosis (TB) and its implication on preventive treatment among BCG-vaccinated schoolchildren. Cohort and case-control designs. Community settings in a high-prevalence area. Children in primary school. The main exposure was their tuberculin response. Of 94,928 primary schoolchildren tuberculin tested during a routine school revaccination program in 1999, 656 with a tuberculin response at 20 mm or more were followed up prospectively through the territory-wide TB registry up to December 31, 2003, for the development of TB. In a separate case-control analysis, the tuberculin responses of children who subsequently had active TB (at the age of 10-15 years) were compared with those of their sex- and age-matched classmates to ascertain the relative risks of TB for different tuberculin reaction categories. The absolute and relative risks were applied to the 1999 cohort for estimating the incidence of TB among different tuberculin reactors. The annual incidence (95% confidence interval) of active TB was estimated to be 13.4 (5.6-40.6) per 100,000 for the entire cohort and 7.5 (2.4-24.5), 7.5 (1.7-32.0), 16.0 (4.4-57.2), 92.6 (26.6-320.2), and 340.6 (163.3-626.4) per 100,000 for children with a tuberculin reaction at 0 to 4, 5 to 9, 10 to 14, 15 to 19, and 20 mm or more, respectively. By using 10 mm as the cutoff, 482 (95% confidence interval, 163-1391) children have to be treated to prevent a single case of active TB within 5 years. Treatment will cover 17.5% of the cohort, but prevent only 54.1% of all active TB cases. It is desirable to reexamine the existing screening method for BCG-vaccinated children from high-prevalence countries.

Zusammenhang zwischen Bioaerosolen aus Tierhaltungsanlagen und asthmatischen Symptomen bei Kindern

Although health effects of occupational exposures to livestock emissions are known, potential associations between living in the neighbourhood of intensive livestock facilities and the risk of developing respiratory or allergic diseases are still under discussion. During routine school entry examinations in selected rural districts in Lower Saxony we asked parents about respiratory and allergic symptoms of their 5-6 year old children. A questionnaire with standardised questions of the ISAAC-Studies for respiratory and allergic symptoms and corresponding risk factors was used. Complementarily the children were examined for visible signs of flexural dermatitis and in a subsample the SX1-test was used as an in vitro test for inhalative IgE mediated sensibilisations in capillary blood. Individual exposure to bioaerosols (endotoxin, fungi, bacteria and total dust) coming from livestock facilities was estimated using a Lagrange dispersion model based on the emission rates and locations of the lifestock facilities. A total of 7943 questionnaires (response rate over 85%) were analysed, of which 3867 could be used for the correlation analyses between exposition to endotoxin and asthmatic symptoms. Multivariate logistic regression models were analyzed, considering an atopic disease of the parents as a potential effect modifier and not as a confounder. The prevalence of allergic and asthmatic symptoms is similar to the results of other comparable studies, e. g. "wheezing in the last 12 months" 15.9% for boys and 12.9% for girls. An increase in the prevalence of asthmatic symptoms for higher endotoxin levels was observed only for children of atopic parents. The multivariate controlled odds ratio for one unit logarithm endotoxin concentrations is 1.15, p-value 0.016. Similar effects were observed for other asthma indicators, but not for subjective criteria of the exposition, e. g. the distance to the next large livestock facility guesstimated by parents. Among the overall analysed potential associations between exposition to bioaerosols and asthmatic and allergic symptoms only a few were statistically significant. The discussed association between endotoxin and asthmatic symptoms in predisposed children needs further investigation.

Familial Chiari type I malformation with syringomyelia in two siblings: case report and review of the literature

Familial cases of Chiari malformation with syringomyelia are rare. The majority of the reported series and case reports detail sporadic cases. The authors report two siblings who presented with Chiari type I malformation and syringomyelia (CMI+S). We report two sisters who each presented with scoliosis on routine school physicals. Their clinical examination was unremarkable; however, imaging studies demonstrated a Chiari malformation with syringomyelia. Both underwent cervicomedullary decompression, and follow-up imaging studies revealed resolution of the syringomyelia. A review of the literature reveals fewer than ten previous reports of familial CMI+S in the past 30 years. Although rare, the existence of familial cases of CMI+S suggests a genetic component to the pathogenesis of this condition in at least a proportion of patients. Neurosurgeons should be aware of the familial aggregation of CMI+S.

24-hour ambulatory blood pressure monitoring in children with familial dysautonomia

Familial dysautonomia (Riley Day syndrome) is a genetic disease. The present study of 24-hour ambulatory blood pressure monitoring in children with familial dysautonomia was carried out to investigate the pattern of blood pressure in this syndrome. To the best of our knowledge, this is the only description of patients with 24-hour blood pressure monitoring. Vasomotor instability reflected in extreme hypertension and hypotension was recorded by 24-hour ambulatory blood pressure monitoring in three patients with familial dysautonomia: a 16-year old girl, a 14-year old boy and a 3-year old boy. Recordings were taken on a routine school day in the first two patients and during hospitalization in the third. Patients 1 and 2 displayed circadian rhythm but with significantly higher than normal blood pressure and heart rate. Patient 3 exhibited these fluctuations to a lesser degree. Postural hypotension without compensatory tachycardia was frequently seen in all three patients. Unusual variability in blood pressure was recorded during routine activities in patients 1 and 2 and during an acute attack in patient 3. Close monitoring of antihypertensive therapy should be considered in familial dysautonomia patients in whom blood pressure reaches excessive levels.