School Health Care Research Articles

Integration of Oral Health Interventions in the Health Promoting Schools Program in Iran: A Multi-Stakeholder Feasibility Assessment

Objectives: Based on the recommendations of the World Health Organization, we investigated the feasibility of oral health interventions (OHIs) as part of Health Promoting Schools (HPS) program in Karaj city elementary schools. Materials and Methods: OHIs were accepted to be integrated into the components of HPS program by using the nominal group technique (NGT) and semi-structured interviews. Three NGT meetings were held with the faculty members of the School of Dentistry, Tehran University of Medical Sciences, and Karaj elementary school health care providers. Semi-structured interviews were held with school health executives of the Ministry of Health and Medical Education. The expert panel edited the OHIs and corrected the fragmentations, overlaps, and duplications. OHIs were sent to 24 individuals in six multi-stakeholder groups (faculty members of pediatric dentistry and community oral health departments, elementary school administrators, executive managers of Ministry of Health and Medical Education, elementary school dean and school healthcare providers). They were asked to score the feasibility of each intervention on a scale of 0 to 10. Results : Based on the mean score of feasibility (threshold: 8) the OHIs were divided into two groups of feasible and infeasible. Eighty-six interventions were feasible, with a total mean score of 8.83±0.59 out of 10. The highest feasibility score was related to “comprehensive school health education”. Conclusion: Integration of OHIs in HPS program is acceptable and feasible. The results can help policy-makers support the integration of OHIs in HPS program and encourage them to implement the program at the national level.

Assessing sense of coherence as an element of primary‐focused health services in schools for children and adolescents with complex health care needs

This study aimed to clarify if sense of coherence (SOC) could be used as an element of primary-focused health services in schools. The United Arab Emirates (UAE) is striving to develop a high-quality, primary-focused health care system. School health care services are well established in the UAE but have not yet been fully used to play a key role in this development. This is a cross-sectional survey study to explore adolescents' SOC and their behavioural, psychosocial and clinical outcomes. A total of 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviours and fewer conduct problems. Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary health care services for this population. Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students' SOC and, finally, they should assess and build awareness of SOC and associated tools among school nurses and primary health care providers.

Knowledge and self-reported practice of primary schools' health care teachers on emergency management of traumatic dental injuries in Karaj in 2020

Introduction: Dental injuries are very common event in childhood and have the negative impacts on their life. Proper emergency management is depended on the knowledge of non-professionals, such as health care teachers’ who are present at the scene. The aim of this study was to assess the knowledge and self-reported practice of primary school health care teachers on the emergency management of traumatic dental injuries in Karaj in 2020. Methods: In this cross-sectional analytic study, an anonymous online questionnaire containing questions related to demographic information, history of previous exposure to traumatic dental injuries and caregivers' practice in dealing with traumatic dental injuries was placed in health care teachers’ virtual groups. Health care teachers were given one week to complete the questionnaires. Descriptive statistics and linear regression were performed to analyze the data via SPSS software version16. Results: A total of 189 questionnaires were completed (response rate of 80.77%). The mean score of their knowledge out of 10 achievable scores was 5.63 ± 1.98 and their mean score of practice was 4.48 ± 1.86 out of 7 scores. The results of unadjusted linear regression analysis showed that only the previous information of caregivers had an effect on their level of knowledge (p<0.001) and by adjusting the effect of demographic variables, the results of this test showed that the work experience of health care teachers had an effect on their knowledge score (p=0.009). However, the self-reported practice score of health care teachers was not affected by any of the demographic variables. Conclusion: This study revealed that insufficient knowledge and self-reported practice exists among primary school teachers on emergency management of traumatic dental injuries.

Schulgesundheitspflege in Deutschland.

In the last six years, a large number of initiatives and model projects have been registered in numerous federal states with the aim of employing so-called school health professionals in public schools in Germany. The nurses are expected to improve health care, learning conditions and health literacy in schools. This article explores the question of what challenges nursing professionals face from a professional-theoretical perspective in view of this horizon of expectations. Using literature on professional theory and initial evaluation results from current pilot projects, considerations are made on the role of nursing as a profession in the school system, on processes of professionalization and on questions of professional action in the school setting. The results show the necessity of a strong mandate and professional legal protection of the range of school nurse activities, a high demand for qualification measures as well as a necessary educational-systematic positioning of qualification. Overall, school health nursing as a sub-field of community health nursing will be shown to make an important contribution to the structural development of schools in the direction of a health-promoting setting.

Psychometrics of three Swedish physical pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)\xae: pain interference, fatigue, and physical activity

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS®) aims to provide self-reported item banks for several dimensions of physical, mental and social health. Here we investigate the psychometric properties of the Swedish pediatric versions of the Physical Health item banks for pain interference, fatigue and physical activity which can be used in school health care and other clinical pediatric settings. Physical health has been shown to be more important for teenagers’ well-being than ever because of the link to several somatic and mental conditions. The item banks are not yet available in Sweden.Methods12- to 19-year-old participants (n = 681) were recruited in public school settings, and at a child- and psychiatric outpatient clinic. Three one-factor models using CFA were performed to evaluate scale dimensionality. We analyzed monotonicity and local independence. The items were calibrated by fitting the graded response model. Differential Item analyses (DIF) for age, gender and language were calculated.ResultsAs part of the three one-factor models, we found support that each item bank measures a unidimensional construct. No monotonicity or local dependence were found. We found that 11 items had significant lack of fit in the item response theory (IRT) analyses. The result also showed DIF for age (seven items) and language (nine items). However, the differences on item fits and effect sizes of McFadden were negligible. After considering the analytic results, graphical illustration, item content and clinical relevance we decided to keep all items in the item banks.ConclusionsWe translated and validated the U.S. PROMIS item banks pain interference, fatigue and physical activity into Swedish by applying CFA, IRT and DIF analyses. The results suggest adequacy of the translations in terms of their psychometrics. The questionnaires can be used in school health and other pediatric care. Future studies can be to use Computerized Adaptive Testing (CAT), which provide fewer but reliable items to the test person compared to classical testing.

Communication Between Schools Nurses and Health Care Providers on Students with Asthma: An Integrative Review

School-based asthma programs have been proven to lessen the burden of pediatric asthma. There is a lack of successful care coordination between school nurses and primary care providers. This review examined strategies to increase communication and identified gaps in the literature. Databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and The Cochrane Library, were searched to identify relevant articles. This review included 12 articles consisting of randomized controlled trials, quasi-experimental studies, mixed method studies, qualitative studies, and other non-research articles. Four key findings emerged, including limited availability of asthma action plans, inclusion of parents in the communication triad, school nurse outreach to providers, and improved communication leads to positive outcomes for students with asthma including decreased use of emergency medication and increased self-management of asthma. Further research is needed to develop evidence-based interventions that can be implemented to improve communication between school nurses and primary care providers.

Contemporary Aspects of Training in Vocational Secondary Schools and Students’ Health

Introduction: Current vocational secondary education (VSE) in Russia is characterized by a focus on practical training (as part of dual training) aimed at improving professional competencies of graduates. It also demonstrates negative trends in adolescent health, which requires optimization and development of specific algorithms of medical support for students aged 14–22 years and older appropriate to their academic and practical workload. Objective: To assess adaptation of college students to learning conditions, depending on their health status, and to substantiate ways of improving their health care. Material and methods: We retrieved and analyzed information from the database of multicenter studies conducted within the unified program of the National Medical Research Center for Children’s Health of the Russian Ministry of Health. Our sample included 197 first- and second-year college boys from the cities of Omsk and Moscow studying to become welders and auto mechanics. The quality of life, health and well-being indicators were evaluated according to the International Medical Outcomes Study 36-item short-form (MOS SF-36). The students were divided into subgroups based on their health status. The statistical processing complied with modern requirements and criteria of evidence-based medicine. Results: We established that vocational schools admitted a significant number of applicants with the above specialty preferences suffering from chronic diseases (21.1–26 %). Results of the questionnaire-based survey of future welders and car mechanics revealed difficulties in adaptation to the educational process of the students with chronic disorders expressed by lower quality of life indicators, frequent health complaints and feelings of fatigue, especially in second-year students who experience an increasing academic and practical workload. Conclusions: Students with chronic diseases mastering professions with hazardous working conditions represent population at risk, require health monitoring, determination of professional suitability, and control over the working conditions in industrial practice. The importance of protecting health of future professionals is determined by implementation of practice-based training in 42 % of vocational schools. Models of school medicine proposed to optimize health care in comprehensive schools can be adapted to conditions of secondary vocational facilities. Foreign studies have proved feasibility of an early onset of work-related diseases in certain occupations, even before completion of training, thus necessitating vocational guidance, professional medical advice, and development of an effective system of medical support for adolescents and students.

Медична допомога дітям у навчальних закладах: стан, проблеми та перспективи розвитку

В статті проведено аналіз систем медичного забезпечення дітей шкільного віку, особливостей організації. Міжнародний досвід свідчить, що існують різні моделі медичного забезпечення дітей у навчальних закладах: відмінності щодо підпорядкування шкільної служби (структурам охорони здоров’я або освіти), фінансування, підготовки кадрів та найбільш — щодо профілактичної спрямованості: обсягу та терміну проведення профілактичних медичних оглядів. Всесвітня організація охорони здоров’я наголошує, що поки оптимальної моделі шкільної охорони здоров’я в світі не визначено. Загальними проблемами шкільної охорони здоров’я є недостатнє фінансування, нерівномірний доступ дітей до медичних послуг. Наведено стан медичного забезпечення школярів у країнах пострадянського простору, результати змін у галузі охорони здоров’я дітей, що стосувалися реформування системи санітарно-епідеміологічних закладів, модернізації їх функцій, створення нових вертикальних структур, функціями яких є розробка національних і регіональних програм щодо пропаганди здорового способу життя, медичної освіти та комунікаційна діяльність. Проаналізовано розвиток системи шкільної медицини в Україні з позиції «Концепції стандартів якості шкільних медичних послуг і компетенцій» Європейського союзу шкільної та університетської медицини. Окреслено перспективи шкільної медицини в Україні, а саме: потреба у розробці і запровадженні нової української моделі шкільної медицини, адаптованої до європейських стандартів, та інтегрування її у систему громадського здоров’я, що затверджено в Україні; оновлення нормативно-правової бази; розвиток кадрового потенціалу; формування нових професійних компетентностей медичних працівників шкільної медицини в Україні; посилення міжвідомчої взаємодії в питаннях допомоги збереження здоров’я дітям і підліткам, які навчаються.

Mediation of outcomes for cognitive behavioral therapy targeted to parents of children with Functional Abdominal Pain Disorders

ObjectiveThere is a large body of evidence for the efficacy of Cognitive Behavioral Therapy (CBT) in treating Functional Abdominal Pain Disorders (FAPD) in children. In most CBT interventions for FAPD, parents participate together with their children. However, only one study to date has examined targeting parents alone for treatment. The aim of the current study was to examine mediators of a parent-only CBT treatment incorporating social learning (SLCBT) for FAPD in children. MethodsWe examined mediators of child outcomes in an existing randomized controlled trial (n = 316) of parent-only social learning CBT compared to an education condition. Hypothesized mediators (parental protectiveness, perceived threat of pain, catastrophizing) were assessed at 3 months post-treatment, and outcomes (parent ratings of disability, quality of life, school absences, and health care visits) were assessed at 6 months post-treatment. Mediation analyses were performed using Hayes' PROCESS macro. ResultsPain catastrophizing significantly mediated treatment effects for all outcomes (B ranged from −1.65 to 2.22). Reduction in pain threat was a significant mediator for all outcomes (B ranged from −1.84 to 3.13) except school absences and health care visits. Decrease in parental protectiveness mediated effects on disability and missed school (B ranged from −1.47 to 1.34). Mediation effects did not differ by in-person or remote delivery of SLCBT. ConclusionChanges in maladaptive parental thoughts and behaviors following parent-only SLCBT intervention appeared to mediate the effects of the intervention. Parental catastrophizing appears to be a particularly important target given that decreases in that variable mediated all outcomes.

The PRU: The Solution for Whom?

In Sweden, pupil referral units (PRUs) have been recommended by the government, suggesting that “inclusion has gone too far”. This governmental recommendation is not based on research focusing on PRUs, as such research is sparse. Furthermore, there has been a lack of evaluations of the efficacy of PRUs, and no national evaluations of such provision have been undertaken. Furthermore, more attention must be paid to PRU students’ own perspectives and experiences as we lack knowledge of their needs and situation. This study aimed to investigate how educational needs have been and should be addressed in one PRU according to nine stakeholder groups, for example, current students, former students, parents, school staff, and various groups of people who, in their work, were responsible for deciding about the PRU (e.g., chief education officers or politicians) or supporting the PRU (e.g., school healthcare unit staff). Comparative analysis of all groups’ perceptions considered similarities and differences of views of this topic. Preliminary results indicate substantial between- and within-group variation concerning the purpose of the PRU and uncertainty about educational quality, partly due to insufficient documentation. Some students described a “Catch-22”: having been told to catch up educationally with peers and that PRU placement would help in this, they were disappointed, as the emphasis on non-educational practices impeded catching up.

Prevalence of overweight and obesity from 5 to 19years of age in Gothenburg, Sweden.

The aim of this study was to present prevalence data for overweight and obesity across school age in a large, recent, population-based cohort of children in Gothenburg, Sweden. We included 66,807 children (48.5% girls) aged 5-18.9years who had their height and weight measured in school health care 2015-2018. The BMI values were categorised according to the age-dependent cut-offs for overweight and obesity from the International Obesity Task Force (IOTF). Overall, the prevalence of overweight and obesity for girls and boys was 18.1% and 18.0%, respectively. We observed increasing proportions of overweight (girls 11.5-17.1% and boys 8.4-17.4%) and obesity (girls 3.0-4.2% and boys 2.7-6.1%) with increasing age (p<0.001 for trend in both sexes). Moreover, girls had higher prevalence of overweight during ages 5.0 to 8.9years compared with boys (p<0.001), while boys had higher prevalence of obesity 15.0-18.9years compared with girls (p<0.001). In conclusion, we demonstrate increasing prevalence of overweight and obesity across the entire school age range, as well as differences in prevalences between boys and girls, in a population-based sample of 67,000 children in Gothenburg city, Sweden. Continuous monitoring of schoolchildren, together with effective preventive measures, is crucial to curb the obesity epidemic and its consequences.

The health of children and adolescents in school ontogenesis as a basis for improving the system of school health care and sanitary-epidemiological wellbeing of students

Introduction. Against the background of socio-economic transformations and the digitalization of education, the health indicators of students are changing, which requires in-depth research. Aim of the study: based on the longitudinal observation of the health of schoolchildren, to identify the patterns of its formation for the scientific justification of improving the medical care of students. Material and methods. From the 1st to the 11a grade (2005-2015), the same students (199 boys and 227 girls) of 4 Moscow schools were examined annually with the performance of anthropometry, electrocardiography, functional tests, and questionnaire to identify complaints and anamnesis; specialist doctors carried out 25,298 examinations. In addition to the analysis of morbidity, a qualitative analysis of the course of pathological processes in students was carried out to determine positive and negative dynamics. Results. Over 11 years, the prevalence of functional disorders increased by 14.7%, chronic diseases by 52.8%, the frequency of visual disturbances, diseases of the musculoskeletal system, digestive organs, neurotic reactions increased; new forms of risk behaviour and information dependence appeared. An unfavourable period of development of pathological processes in schoolchildren is training in grades 9-11. Compared with the 1990 morbidity rates obtained by similar methods, there was an increase in the prevalence of functional disorders among adolescents by 2-3 times and chronic diseases by 20-70%. When comparing physical development with peers of the second half of the XX century, the observed schoolchildren increased the average values of body length and weight with a decrease in functional indicators. Distance learning during the first wave of COVID-19 in spring 2020 has increased the prevalence of computer vision, carpal tunnel syndromes, and neurotic reactions. Discussion. The main patterns of health formation in school ontogenesis, coinciding with the change of generations and the transition to the digitalization of education, are revealed. Conclusion. The study results allow predicting an increase in the prevalence of neuropsychiatric disorders, myopia, scoliosis, computer-visual and carpal tunnel syndromes. To preserve students’ health, to counteract COVID-19, a modern model of school health care is proposed.

Application of artificial intelligence to mental healthcare in primary and middle schools

Mental health services in primary and middle schools are facing multiple challenges, including dramatic increase in mental health support, low rate of mental health screening, high vigilance against psychological therapies, and lack of initiatives among students. The interdisciplinary integration of artificial intelligence (AI) and psychology in China, combined with biosensors, language recognition, blood spectrum sensing, and counseling big data, has pointed to a novel mental health service model. This new model, incorporating human-computer interaction and objective algorithm, fits the contemporary students' characteristics. Through monitoring real-time physiological status, regulating emotional responses, and modifying cognitive modes, AI to mental health services can work effectively in mental health screening and counseling in primary and middle schools. It may become an innovative approach to build artificial intelligence for mental health service in schools.

Development of a stand-alone index for the assessment of diet quality in elementary school-aged children.

To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ). In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis. Southwest and Eastern Finland. Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018. A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality. The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.

Conversations About Sexual and Reproductive Health and Rights-From a School Nurse Perspective.

Students have the right to receive education about sexual and reproductive health and rights (SRHR). The United Nations Agenda 2030 for sustainable development includes goals regarding SRHR, including the right to universal access to sexual and reproductive health care services and gender equality. The study used a qualitative design with an inductive approach. Data were collected through semistructured interviews. The results are presented in three categories and nine subcategories. The categories were "having an open attitude," "organizational prerequisites," and "challenging tasks." An open attitude was required to create confidence for both school nurses and students in SRHR conversations. Organizational prerequisites, such as planning SRHR education with others, were successful. Multicultural meetings and conversations regarding gender identity and sexual orientation were challenging tasks. Increased knowledge of SRHR and national standardized guidelines are suggested to achieve Agenda 2030 SRHR goals and to ensure equity in school health care.

Voices of Street Connected Children in Delhi during COVID-19

The study conducted by a non-governmental organisation ‘Butterflies’ describes the lived experiences of street children during COVID-19 in Delhi. It documents the effects of COVID-19 on their household food security, mental health, and schooling. Data was collected over 11 months through in-depth interviews and focus group discussions with 56 children. The data revealed that children were affected on a large scale, as families took loans from relatives and friends to buy food. Closure of schools resulted in the interruption of supportive services like mid-day meals, school health care and scholarships for children belonging to the below poverty line category. This pushed large numbers of families into extreme poverty, physical and mental health trauma and a corresponding increase in child labour.

Voices of Street Connected Children in Delhi during COVID-19

The study conducted by a non-governmental organisation ‘Butterflies’ describes the lived experiences of street children during COVID-19 in Delhi. It documents the effects of COVID-19 on their household food security, mental health, and schooling. Data was collected over 11 months through in-depth interviews and focus group discussions with 56 children. The data revealed that children were affected on a large scale, as families took loans from relatives and friends to buy food. Closure of schools resulted in the interruption of supportive services like mid-day meals, school health care and scholarships for children belonging to the below poverty line category. This pushed large numbers of families into extreme poverty, physical and mental health trauma and a corresponding increase in child labour.

Public health nurses' perceptions on promotive and risk factors for children's mental health: A qualitative interview study.

To describe promotive and risk factors for children's mental health at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment. A descriptive qualitative interview study. Data were collected in Finland during autumn 2019 via semi-structured interviews. Participants (n=23) comprised public health nurses who worked in child health clinics and school healthcare. Data were analyzed using inductive content analysis. Several promotive and risk factors were identified to have affected children's mental health. Intra-family factors were the most important in the opinion of public health nurses, and they were most concerned about family related risk factors. In addition, the descriptions of nurses revealed that children are in a socially unequal position in terms of their place of residence. It was also uncovered that there were fewer social and healthcare and leisure services in small municipalities, the distances to services were longer, which was perceived to complicate the use of services, and the fear of stigma was greater. According to public health nurses, factors at the individual, interpersonal, organizational, community and public policy levels of the socioecological environment affect children's mental health and overall well-being. Consequently, the promotion of children's mental health should be emphasized at every level of the society, considering the whole family. This study indicated the importance of considering factors that affect children's mental health at all levels of the socioecological environment. The results can be reflected in the relation of the socioecological model of health promotion and used in planning the work of nurses in primary healthcare and other relevant nursing settings to emphasize promotive and preventive work.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses.

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

The Effect of Children’s Sexual Health Education Program on Knowledge and Attitude of Primary School Health Care Providers

ABSTRACT School involvement is essential for providing Children’s Sexual Health (CSH), but Health Care Providers (HCPs) responsible for children’s health at schools are not sufficiently competent. This study aimed to determine the effect of the Children’s Sexual Health Education Program (CSHEP) on the knowledge and attitude of HCPs in elementary schools. Sixty HCPs were randomly assigned to two groups. The intervention was held in four 90-minute training sessions. Questionnaires were completed by the intervention and control groups in three stages (before, immediately after, and 4 weeks after the intervention). At the end of the intervention, a training session was held in the control group. CSHEP has been effective in improving the knowledge and attitude of HCPs about CSH. Given the important role of HCPs in CSH and their need for education, planning for continuing education courses to promote their knowledge and attitude seems essential.