bluuebunny/crossref_metadata_2025 huggingface dataset:
Stoma Care in the School Setting
Authors: Gray Eileen H. , Blackinton Jodi , White Genevieve M.
Published: July 2008

An ostomy is an artificial opening in the body for the purpose of eliminating excretions from a working organ or for providing nourishment. Artificial openings may be from the stomach, intestine, urinary bladder, kidney, or trachea. The stoma is the terminal end of the ostomy, or the opening that is visible on the surface of the skin. This article will discuss stoma creation and the care of a stoma, as well as the complications and effects of living with one. Although the focus of this article is urinary stomas, the care is similar for all types. It is imperative that all care providers understand stoma care and potential problems that may arise. There are ongoing issues of quality of life for children with stomas, including body image and peer reaction. School nurses are in a unique position to educate children and families on the proper care of a stoma, to recognize potential complication, and to educate staff and student peers.
Teaching Children about Mental Health and Illness: A School Nurse Health Education Program
Authors: Desocio Janiece , Stember Lisa , Schrinsky Joanne
Published: July 2008

A mental health education program designed by school nurses for children ages 10–12 was developed in 2000–2001 and expanded with broader distribution in 2004–2005. Six classroom sessions, each 45 minutes in length, provided information and activities to increase children's awareness of mental health and illness. Education program content included facts about the brain's connection to mental health, information about healthy ways to manage stress, resources and activities to promote mental health, common mental health problems experienced by children, and how to seek help for mental health problems. Classes included a combination of didactic presentation and open discussion, encouraging students to ask questions and allowing the school nurse to correct misinformation. Analysis of pre- and posttests from 370 elementary and middle school students revealed statistically significant improvements in their knowledge of mental health and mental illness.
Young Caregivers: Effect of Family Health Situations on School Performance
Authors: Siskowski Connie
Published: July 2008

Recognition, assessment, education, support, and research of young caregivers is yet to be well established throughout the United States. Studies show that as a result of family caregiving, employees miss work, arrive late, have telephone interruptions, and pass up promotions. Education is essentially the work-life of a student. Research among 12,681 public school students in Palm Beach County, Florida, shows that more than 1 in 2 middle and high school youth (6,210) have the dual role of young caregiver and student; one third of all students (67.1% of young caregivers) miss school/after school activities, do not complete homework, and/or are interrupted in their studying—their work-life. As demonstrated in the United Kingdom, assessment, education, and support of young caregivers in school and in the community can improve education outcomes. Proactive school nurses have the opportunity to identify, assess, and promote the well-being and academic success of U.S. student-caregivers.
Comparison of Health-Related Quality of Life Among 10- to 12-Year-Old Children With Chronic Illnesses and Healthy Children: The Parents’ Perspective
Authors: Svavarsdóttir Erla Kolbrún , Örlygsdóttir Brynja
Published: July 2008

The purpose of this study was to evaluate mothers’ and fathers’ perception of their child’s health-related quality of life (HRQOL) among 10- to 12-year-old Icelandic children with or without chronic health condition or illness. A total of 912 Icelandic parents (510 mothers and 402 fathers) and 480 children (209 boys and 271 girls) participated in the study. The Icelandic fathers of children who visited the school nurse over a period of 1 week perceived HRQOL of their children to be significantly lower than the mothers. A gender difference was found between the parents; mothers perceived their children to have significantly higher school functioning than fathers. Both mothers and fathers of children with chronic health condition/illness perceived their children to have significantly lower HRQOL than did the parents of children without a chronic health condition. The findings underline the importance for school nurses to develop and test interventions for school-age children with chronic health conditions or illnesses.
Implementing and Evaluating the National Healthy School Program in England
Authors: Wicklander Molly K.
Published: July 2008

The purpose of this article is to trace development of the National Healthy School Program (NHSP) from a global concept to implementation at the local school level in England with a view toward clarifying and, more importantly, determining if implementation is proceeding as planned, as evidenced by the presence of process evaluation. The NHSP is designed to serve as a catalyst for health promotion in schools by identifying core health themes linked to evaluation principles in the whole-school approach. In this analysis, process evaluation of the NHSP whole-school approach indicates that program data are collected and recorded, but these data are not used to form an evidence-based program implementation strategy to transform the data into action. The NHSP brings valuable concepts to the global school health community that should be embraced because schools are increasingly being recognized as key settings for health promotion activities.
Acceptability of a School-Based Intervention for the Prevention of Adolescent Obesity
Authors: Mauriello Leanne M. , Driskell Mary Margaret H. , Sherman Karen J. , Johnson Sara S. , Prochaska Janice M. , Prochaska James O.
Published: July 2008

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60–4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.
The Healthy Learner Model for Student Chronic Condition Management—Part I
Authors: Erickson Cecelia DuPlessis , Splett Patricia L. , Mullett Sara Stoltzfus , Heiman Mary Bielski
Published: July 2008

A significant number of children have chronic health conditions that interfere with normal activities, including school attendance and active participation in the learning process. Management of students’ chronic conditions is complex and requires an integrated system. Models to improve chronic disease management have been developed for the medical system and public health. Programs that address specific chronic disease management or coordinate school health services have been implemented in schools. Lacking is a comprehensive, integrated model that links schools, students, parents, health care, and other community providers. The Healthy Learner Model for chronic condition management identifies seven elements for creating, implementing, and sustaining an efficient and effective, comprehensive community-based system for improving the management of chronic conditions for school children. It has provided the framework for successful chronic condition management in an urban school district and is proposed for replication in other districts and communities.
The Healthy Learner Model for Student Chronic Condition Management—Part II: The Asthma Initiative
Authors: Erickson Cecelia DuPlessis , Splett Patricia L. , Mullett Sara Stoltzfus , Jensen Charlotte , Belseth Stephanie Bisson
Published: July 2008

The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency of asthma care. The HLAI incorporated evidence-based practice and introduced the role of the asthma resource nurse. Leadership, capacity building, and strong partnerships among school nurses, students, families, and health care providers were essential to the implementation and sustainability of the HLAI. Professional school nursing and evaluation were defined as key requisites to a successful initiative. Evaluation results indicated positive effects on nursing practice, fewer asthma visits to the health office, and better attendance among students who received asthma care in the school health office. The HLAI provided the basis for development of the Healthy Learner Model for Student Chronic Condition Management.
The Experiences of School Nurses Caring for Students Receiving Continuous Subcutaneous Insulin Infusion Therapy
Authors: Darby Wendy
Published: July 2008

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses’ responses indicated that they were “scared” when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.
Increasing School Nurse Awareness of Turner Syndrome
Authors: Ardary Darlene A.
Published: July 2008

Turner syndrome, a genetic disorder that affects only females, can cause various physical, emotional, and educational disabilities. This disorder may go undiagnosed until school age or later. Short stature and lack of spontaneous puberty are common characteristics and can lead to teasing by peers. Some experience attention deficit and the inability to notice social cues that can be misinterpreted as behavioral issues. Others have visual-spatial deficits that can lead to math learning disabilities and difficulty driving. Because the child with Turner syndrome often has a higher verbal than nonverbal intelligence, learning disabilities may be difficult to identify and often are overlooked. The school nurse, through mandated screenings and routine student office visits, may be the first to recognize Turner syndrome. School nurses need to be aware of this disorder and related educational disabilities to provide early intervention to maximize student health and educational success.
Childhood Overweight: Parental Perceptions and Readiness for Change
Authors: Howard Kristen R.
Published: July 2008

Although the national health crisis of childhood obesity is a well-documented problem, few if any clinical interventions have had success in curbing its growth. In fact, childhood obesity, along with its associated morbidities, continues to climb even in the face of increased awareness. Research shows that factors contributing to obesity are almost entirely modifiable on some level. Furthermore, specific behavior changes have been shown to result in positive outcomes, yet these changes have not been widely implemented by practitioners, families, or individuals. The transtheoretical model of health behavior change offers insight into assessing individuals and targeting interventions for behavior change. This article focuses on guiding school nurses to assess parents of school-age children at risk for obesity for readiness for health behavior change, then choosing parent-focused interventions based on their stage of readiness for change.
Growing Up and Growing Older
Authors: McGuire Sandra L. , Mefford Linda
Published: July 2008

Americans are living longer than ever before. A child born today can expect to live 80 years, 90 years, or longer. Many of today’s children will live to be centenarians. Aging education to prepare people for the long life ahead has been endorsed since the first White House Conference on Aging in 1961. However, little is happening with aging education in our homes, schools, and communities. This article discusses the school nurse’s role in helping to prepare children for the long life ahead of them and presents aging education resources and activities. School nurses can help to create a generation of Americans who value older adults, have positive attitudes about aging, and plan for successful healthy aging.
An Intervention to Increase the Use of Asthma Action Plans in Schools: A MASNRN Study
Authors: Pulcini Joyce , DeSisto Marie C. , McIntyre C. Lynne
Published: July 2008

School nurses, in collaboration with primary care providers (PCPs), can work to better manage asthma by using the Asthma Action Plan (AAP) with peak flow monitoring. The aim of this pilot study was to determine the effectiveness of an intervention to increase the number of AAPs in schools for students with asthma by having school nurses provide the students’ peak flow measurements to their PCPs with a request for an AAP. The study found a significant increase in AAPs when school nurses provided PCPs with accurate peak flow data and requested an AAP from the PCP than when school nurses requested an AAP via the students’ parents and did not provide peak flow data to the PCP. This study provided data on the importance of collaboration with PCPs in order to affect better care for children with asthma.
Human Bites in the Classroom: Incidence, Treatment, and Complications
Authors: Conlon Helen Acree
Published: July 2008

It has been estimated that at least one half of the population will experience some type of bite in their lifetime. Human bites are the third leading cause of all bites seen in hospital emergency departments after dog and cat bites. Human bites can be the source of exposure to body fluids, transmission of communicable diseases, infections ranging from cellulitis to osteomyelitis, and joint deformity from septic arthritis. Approximately 10–15% of human bites will become infected. In the school setting, a teacher or other staff member can sustain a human bite while trying to protect a student from injury. Often the first responder to this type of incident is the school nurse. The role of the school nurse is to promote early reporting, accurate history taking of the time and mechanism of injury, administering immediate wound care, initiating early referrals to appropriate medical providers, and supporting proactive care in the form of adult hepatitis B immunization.
School Nurse Case Management: Achieving Health and Educational Outcomes
Authors: Bonaiuto Maria M.
Published: July 2008

Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management on attendance, behavior, academic performance, quality of life, and health compliance in a large southeastern urban school district. Recognizing a need for standardized practice, the School Health Leadership Team created a case management policy, procedures, forms, a data collection process, and ongoing education and mentoring. The policy enabled school nurses to select students with health and learning needs, target specific outcomes, implement interventions, and document the gains made. In the 4 years of this project, 84% of the students case managed improved in 1 or more of the 5 target areas.
Comparison of School Food Allergy Emergency Plans to the Food Allergy and Anaphylaxis Network’s Standard Plan
Authors: Powers Jill , Bergren Martha Dewey , Finnegan Lorna
Published: July 2008

Eighty-four percent of children with food allergies have a reaction in school, and 25% of first food reactions occur in schools. An evaluation was conducted comparing food allergy emergency plans to the Food Allergy and Anaphylaxis Network’s (FAAN) Food Allergy Action Plan. Of the 94 respondents, 60 provided food allergy emergency plans for comparison. Although two-thirds used food allergy plans, only 15% used the current FAAN plan. Plans were missing essential components, including emergency contact information, medication administration instructions, and health history information. School nurses must adhere to current clinical guidelines to provide an accurate resource for personnel in charge of a food allergy reaction in school. Professional associations and state school health agencies must create and market a resource that provides easy, one-stop access to current best-practice guidelines and tool kits.
The Presence of Family History and the Development of Type 2 Diabetes Mellitus Risk Factors in Rural Children
Authors: Adams Marsha Howell , Lammon Carol Ann Barnett
Published: July 2008

Type 2 diabetes mellitus is reaching epidemic proportions among children and adolescents. School health fairs offer an opportunity to identify children with risk factors for the development of type 2 diabetes mellitus. This study identified selected risk factors (i.e., high-risk racial/ethnic group, obesity, elevated blood pressure, elevated casual blood glucose, elevated total cholesterol, and the presence of acanthosis nigricans) for development of type 2 diabetes mellitus in rural children with or without a family history of diabetes during annual school health fairs. Of the children screened, 40% (673) presented with two or more of the identified risk factors for type 2 diabetes mellitus. The presence of multiple risk factors in participants reporting a positive family history of diabetes mellitus versus those with no family history was not statistically significant. Based on the study results, factors other than family history may be more predictive for the development of type 2 diabetes mellitus in rural school children.
Shared Vulnerability: A Theory of Caring for Children With Persistent Head Lice
Authors: Gordon Shirley C.
Published: July 2008

Head lice infestation is a worldwide phenomenon that affects persons of all ages. For reasons that are not entirely clear, a number of children experience persistent head lice infestations lasting weeks, months, or years. Little is known about the impact of caring for children with persistent head lice on parents/caregivers. The purpose of this grounded theory study is to explore how parents and caregivers manage caring for children with persistent head lice. Data were obtained through participant observation and in-depth interviews with a purposive sample of 20 parents/caregivers of school-age children with persistent head lice. The researcher identified a 4-stage process of shared vulnerability used by parents/caregivers to manage caregiver strain associated with caring for children with persistent head lice. The four stages included (a) being ostracized, (b) losing integrity of the self, (c) struggling with persistence, and (d) managing strain.
School Nurses’ Perceptions of Family-Centered Services: Commitment and Challenges
Authors: Concepcion Michelle , Murphy Susan , Canham Daryl
Published: July 2008

Family-centered service is a service delivery model that recognizes the central role of families, builds on their strengths, and seeks to fully involve them in all aspects of their child’s health, learning, and development. Family-centered service has been associated with positive outcomes in health and education and has been viewed as best practice. This study examined school nurses’ perceptions of their work practices with families and the implementation of family-centered services in the school health setting. An established instrument, the Measure of Processes of Care for Service Providers, was used to survey a convenience sample of school nurses practicing in California. Quantitative and qualitative results indicated that school nurses value family-centered service and use the core elements regularly in their work with families. Qualitative data further illustrated school nurses’ solid commitment to families even in the face of challenges such as high student-nurse ratios, lack of time, and limited support. Suggestions for overcoming these barriers include development of parent centers, employment of school social workers/case managers, and advocating for changes in legislation to support the hiring of more school nurses.
Evaluation of a Hand Washing Program for 2nd-Graders
Authors: Tousman Stuart , Arnold Dani , Helland Wealtha , Roth Ruth , Heshelman Nannatte , Castaneda Oralia , Fischer Emily , O’Neil Kristen , Bileto Stephanie
Published: July 2008

The purpose of this project was to determine if a multiple-week learner-centered hand washing program could improve hand hygiene behaviors of 2nd-graders in a northern Illinois public school system. Volunteers from the Rockford Hand Washing Coalition went into 19 different classrooms for 4 consecutive weeks and taught a learner-centered program. The program consisted of interactive class discussions and activities using GlitterBug®training devices and agar plate materials. A one-factor repeated measure analysis of variance indicated a statistically significant 34% decrease in the absenteeism rate for students in the intervention group. Chi-square analyses on agar plate data indicated that students had cleaner hands after washing. Qualitative data from parents and teachers indicated that a majority of the students were engaging in hand-washing behavior. These results indicate that integrating a learner-centered interactive program in a multiple-week structure can lead to improvement in hand hygiene behavior.
The Effect of School-Based Health Clinics on Teenage Pregnancy and Parenting Outcomes: An Integrated Literature Review
Authors: Strunk Julie A.
Published: July 2008

Teenage pregnancy outcomes have become an increasing concern in the United States. Education and support of pregnant teens are critical factors that may determine good or poor pregnancy outcomes. Poor outcomes may include low birth weight, developmental delays, and poor academic performance. Although the number of teenagers experiencing pregnancy and parenting has declined in the U.S., school-based health clinics can be used to provide support and guidance designed to avoid the negative outcomes associated with teenage pregnancy and parenting. By having school-based health clinics, nurse practitioners and school nurses can provide much needed services to pregnant and parenting teens. These services should include educational support, counseling, and community resources. This inquiry provides a metasynthesis of the literature and will review, examine, and summarize the literature relating to the effect of school-based clinics on teenage pregnancy and parenting outcomes.
Using Focus Groups for Program Planning and Evaluation
Authors: Wyatt Tami H. , Krauskopf Patricia B. , Davidson Rachel
Published: July 2008

School nurses often find themselves developing health-related programs for children and adolescents. One way to create compelling and interesting programs that meet the needs of students is to include them in the planning, development, and evaluation of such programs through focus groups. Children provide a perspective about their particular needs, interests, and understandings that cannot be obtained from adults or health care professionals. When children take part in program planning, the programs become more appealing to children because of the feedback from their perspective. This article describes ways focus groups can be used to examine the effectiveness and usability of health-related programs. Included is a discussion of the pros and cons of using focus groups with school-age children for planning and evaluating programs and guidelines for conducting focus groups.
Walking Out of One Culture Into Another: Health Concerns of Early Adolescent Latinos
Authors: Larson Kim L. , McQuiston Chris
Published: July 2008

Adolescence is considered a critical life transition that can lead to heightened vulnerability. Acculturation takes on increased importance during this period. The purpose of this study was to explore the relationship between acculturation and perceived health concerns of early adolescent Latinos in rural North Carolina. A qualitative descriptive design using gender-specific focus groups was conducted in the summer of 2001. Twenty-six Latino adolescents, predominantly from Mexico, participated in one of four focus groups. Acculturation was assessed using the Short Acculturation Scale ( Marin & Marin, 1991 ). The most prevalent health concern of the girls was unsolicited physical contact and aggressive male behavior. Boys expressed concerns about stress related to financial worries and drinking alcohol. A better understanding of where Latino adolescents are located in the acculturation process can assist school nurses in developing targeted school-based prevention programs that focus on building specific skills for Latino girls and boys.
Family Perceptions of Medication Administration at School: Errors, Risk Factors, and Consequences
Authors: Clay Daniel , Farris Karen , McCarthy Ann Marie , Kelly Michael W. , Howarth Robyn
Published: July 2008

Medications are administered every day in schools across the country. Researchers and clinicians have studied school nurses’ and educators’ experiences with medication administration, but not the experiences of children or their parents. This study examined medication administration from the child and parent perspectives to (a) determine problems children experience with medicines at school, (b) clarify risk factors for medication errors, and (c) examine the perceived impact of medication errors on school performance and social relationships. Participants included children ages 8 to 18 years ( n = 157) being treated at a large Midwestern Children’s Hospital in diabetes, asthma, and Attention Deficit Hyperactivity Disorder (ADHD) clinics. Findings suggest that forgetting a dose and running out of medication were the most common problems. Missing a dose was more frequent in students with ADHD than in students with diabetes or asthma. Medication nonadherence at school, which includes medication administration errors such as missing a dose, may potentially lead to a variety of educational, social/emotional, and physical consequences. These results indicate that the impact of missing medication on children with ADHD appeared to have a greater effect on schoolwork and friendships, while the physical consequences appeared to vary widely based on health condition. Interestingly, children with more self-responsibility for medications were less likely to report medication errors. School nurses will want to include students when planning for medication management at school.
The Effect of Rater Training on Reducing Social Style Bias in Peer Evaluation
Authors: May Gary L.
Published: July 2008

This study employed a quasiexperimental control group design in a university setting to test the effect of a rater-training program on reducing social style bias in intragroup peer evaluations after controlling for ability based on GPA. Comparison of rating scores of the test group to the control group indicated minimal social style rating bias in the test group, whereas significant bias was exhibited in the control group. Implications for college instructors who use peer evaluations for grading in team projects are discussed.
Somatosensory Pulsatile Tinnitus Syndrome: Somatic Testing Identifies a Pulsatile Tinnitus Subtype That Implicates the Somatosensory System
Authors: Levine Robert Aaron , Nam Eui-Cheol , Melcher Jennifer
Published: July 2008

A new tinnitus syndrome is described: high-pitched, cardiac-synchronous tinnitus, whose pulsations are suppressed by strong contractions or compressions of the neck and jaw muscles (somatic testing). 14 cases, 6 non-lateralized and 8 unilateral, are reported. In the non-lateralized cases, onset was bilateral. In the one intermittent case, while her tinnitus was absent her pulsatile tinnitus could be induced by somatic testing. No etiology was found from physical examination, imaging, or ancillary testing. Because these cases of pulsatile tinnitus can be both induced and suppressed by activation of the somatosensory system of the head or upper lateral neck, we propose that this syndrome is occurring from (a) cardiac synchronous somatosensory activation of the central auditory pathway or (b) failure of the somatosensory-auditory central nervous system interactions to suppress cardiac somatosounds.
Higher Plasma Concentration of Food-Specific Antibodies in Persons With Autistic Disorder in Comparison to Their Siblings
Authors: Trajkovski Vladimir , Petlichkovski Aleksandar , Efinska-Mladenovska Olivija , Trajkov Dejan , Arsov Todor , Strezova Ana , Ajdinski Ljubomir , Spiroski Mirko
Published: July 2008

Specific IgA, IgG, and IgE antibodies to food antigens in 35 participants with autistic disorder and 21 of their siblings in the Republic of Macedonia were examined. Statistically significant higher plasma concentration of IgA antibodies against alpha-lactalbumin, beta-lactoglobulin, casein, and gliadin were found in the children with autistic disorder. Plasma concentrations of IgG antibodies against alpha-lactalbumin, beta-lactoglobulin, and casein in participants with autistic disorder were significantly higher. IgE-specific antibodies (alpha-lactalbumin, beta-lactoglobulin, casein, and gluten), as well as plasma concentration of total IgE, also were statistically significantly higher in the participants with autistic disorder. Gender differences were found for select IgA, IgG, and IgE (but not for total IgE) food-specific antibodies (kU/L) in the participants with autistic disorder and their siblings.
A case of Fabry disease with central nervous system (CNS) demyelinating lesions: a double trouble?
Authors: Invernizzi P , Bonometti MA , Turri E , Benedetti MD , Salviati A
Published: July 2008

We present the case of a 36-year-old woman affected with Fabry disease (FD), with neuroradiologic and laboratory tests suggestive of a coexistent inflammatory demyelinating disease. Since the age of 23, she presented recurrent neurologic deficits, such as right limb paresthesias, diplopia, and right leg weakness. Magnetic resonance imaging revealed multiple demyelinating lesions in periventricular areas, corpus callosum, and spinal cord. Cerebrospinal fluid analysis showed the presence of oligoclonal bands, while visual-evoked potentials were delayed with preserved morphology. FD is usually considered as a differential diagnosis of multiple sclerosis, but we think that the best explanation of all pathological features in this case is the coexistence of the two diseases.
Prevalence of sleep problems in individuals with multiple sclerosis
Authors: Bamer AM , Johnson KL , Amtmann D , Kraft GH
Published: July 2008

Background

Sleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact.

Objective

To estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis.

Methods

A cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure.

Results

The prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men.

Conclusion

Sleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.
Complementary and alternative medicine for multiple sclerosis
Authors: Schwarz S , Knorr C , Geiger H , Flachenecker P
Published: July 2008

We analyzed characteristics, motivation, and effectiveness of complementary and alternative medicine in a large sample of people with multiple sclerosis. A 53-item survey was mailed to the members of the German Multiple Sclerosis Society, chapter of Baden-Wuerttemberg. Surveys of 1573 patients (48.5 ± 11.7 years, 74% women, duration of illness 18.1 ± 10.5 years) were analyzed. In comparison with conventional medicine, more patients displayed a positive attitude toward complementary and alternative medicine (44% vs 38%, P < 0.05), with 70% reporting lifetime use of at least one method. Among a wide variety of complementary and alternative medicine, diet modification (41%), Omega-3 fatty acids (37%), removal of amalgam fillings (28%), vitamins E (28%), B (36%), and C (28%), homeopathy (26%), and selenium (24%) were cited most frequently. Most respondents (69%) were satisfied with the effects of complementary and alternative medicine. Use of complementary and alternative medicine was associated with religiosity, functional independence, female sex, white-collar job, and higher education ( P < 0.05). Compared with conventional therapies, complementary and alternative medicine rarely showed unwanted side effects (9% vs 59%, P < 0.00001). A total of 52% stated that the initial consultation with their physician lasted less than 15 min. To conclude, main reasons for the use of complementary and alternative medicine include the high rate of side effects and low levels of satisfaction with conventional treatments and brief patients/physicians contacts.
Survival and cause of death in multiple sclerosis: results from a 50-year follow-up in Western Norway
Authors: Grytten Torkildsen N , Lie SA , Aarseth JH , Nyland H , Myhr KM
Published: July 2008

Background

Survival time among patients with multiple sclerosis (MS) has varied considerably according to previous reports.

Objectives

Survival and cause of death were analyzed among all patients with MS (878) with onset of MS in Hordaland County, Western Norway during 1953–2003, of whom 198 were dead at follow-up on January 1, 2005.

Methods

Standardized mortality ratios (SMRs) and relative mortality ratios (RMRs) were calculated based on observed mortality in MS and expected mortality.

Results

Median survival from onset was 41 years versus 49 years in the corresponding population, and mortality (SMR) was 2.7-fold increased in MS. The median survival was 43 years among women and 36 years among men, but women had higher relative mortality, when compared with the corresponding population, than men (RMR = 1.40). The median survival time was 45 years among young-onset patients (21–30 years) and 23 years among older-onset patients (51–60 years), but young-onset patients had higher relative mortality than older-onset patients, as shown by a significant reduction by 10-year interval of age at onset (RMR = 0.65). Median survival from onset was longer (43 years) among relapsing–remitting MS than primary progressive MS ([PPMS]; 49 years), and the relative mortality was higher in the PPMS group, (RMR = 1.55). According to death certificates, 57% died from MS.

Conclusion

Female patients and patients with young onset had longer median time to death but higher relative risk of dying compared with the corresponding population. PPMS had both shorter median time to death from onset and a higher relative risk of dying.
Dynamics and Dilemmas in Working with Families in Inpatient CAMH Services
Authors: Gross Vivienne , Goldin Jon
Published: July 2008

Working with the families of children and adolescents who are being treated in an Inpatient Child and Adolescent Mental Health facility can be both a vital part of the composite treatment package, and also a potential locus of tension, ambivalence and family—team rivalries. This article looks in detail at how collaborative principles put into practice in Inpatient CAMHS settings can benefit the children, adolescents, parents and siblings so that the family-plus-team system can be accessed as a working model for change in mutually desired directions. These principles include working in partnership with parents, being willing to learn from families and avoiding a culture of blame. The value of adopting a developmental perspective is also highlighted. Some thoughts on addressing stuck situations are shared and the importance of self-reflexivity in staff groups is emphasized. Case examples and clinical vignettes are included to illustrate both the difficulties and some experiences of their resolution on a particular children's inpatient unit.
Starving in the Midst of Plenty? A Study of Training Needs for Child and Adolescent Mental Health Service Delivery in Primary Care
Authors: Madge Nicola , Foreman David , Baksh Faiza
Published: July 2008

Current UK child mental health policy seeks to engage primary care personnel in improving service delivery under the heading of `Comprehensive CAMHS' but little is known about the size of this resource, the sufficiency of its training or its commitment to children's mental health. We surveyed local health, education and social services agencies within a UK Unitary Authority just outside London, using both questionnaire and focus group methodologies: 150 primary care personnel were identified in 14 teams. Of these 122 participated in the questionnaire survey, and 60 took part in focus groups. There was, approximately, one such team member for every 30 children with a mental health problem. Respondents reported deficiencies in skills and knowledge, but wanted training and support to increase their involvement provided it related to their daily practice, professional roles, and was developed in accordance with local needs and resources. Lack of training and organization impedes the effective deployment of a potentially huge resource for children with mental health problems. This could be addressed by appropriately tailored training courses, combined with managerial work on systems and remits. Such a programme would be needed to realize the National Service Framework's concept of a `comprehensive CAMHS'.
Mindfulness with Children and Adolescents: Effective Clinical Application
Authors: Thompson Miles , Gauntlett-Gilbert Jeremy
Published: July 2008

Mindfulness interventions within adult populations are becoming increasingly popular. Research suggests that mindfulness can deliver lasting improvements in self-awareness and emotional stability to adults with severe and chronic conditions. As yet, research within child and adolescent populations is in its initial stages, although mindfulness shows great clinical promise for young people. This article aims to provide an overview of mindfulness to professionals who are working in child or adolescent settings. Initially, it will provide the reader with some orientation to and definitions from the field, before summarizing the current evidence for the utility of the approach. The article recommends specific clinical modifications for mindfulness with children and adolescents, as well as reviewing how to monitor and enhance the development of this skill. Finally, it highlights important differences among mindfulness, relaxation and other meditative techniques.
Enhancing concentration, mood and memory in healthy individuals: An empirical study of attitudes among general practitioners and the general population
Authors: Bergström Lena Strand , Lynöe Niels
Published: July 2008

Aim: To study attitudes towards enhancing concentration, mood and memory in healthy individuals among the general public and general practitioners (GPs). Methods: A questionnaire consisting of vignettes including three cases dealing with enhancement of concentration, mood and memory was sent during 2006 to 1000 randomly selected people from Stockholm and 300 GPs. We asked about the use of pharmaceuticals for healthy individuals for the benefit of others and the benefit to oneself; we also asked whether or not society should pay the cost. Finally, we asked about enhancement of healthy people's concentration, mood and memory through the use of natural remedies. Results: Fifty-two per cent of the general public and 39% of the GPs responded. While the use of natural remedies was perceived as fairly acceptable, majorities in both groups were negative with regard to the use of pharmaceuticals to enhance concentration, mood and memory in a healthy individual. The general public tended to be less negative than the GPs. There was a significant difference between the reasons for providing enhancement; altruistic reasons seem to be more acceptable than egoistic ones. For both groups, enhancing mood was more controversial than enhancing memory. Conclusions: Despite the large dropout rate, the study indicates that enhancement by means of natural remedies of different human capacities is acceptable to the general public, while only small minorities of both groups are inclined to allow the use of pharmaceuticals. When compared to the egoistic reason, the altruistic one for enhancing concentration, mood and memory with pharmaceuticals seems to influence the general public's inclination to support prescriptions; this was also the case among the GPs, but only as regards mood enhancement.
Young people's use of sports facilities: A Norwegian study on physical activity
Authors: Limstrand Torgeir , Rehrer Nancy J.
Published: July 2008

In recent years, sports facilities have fomed part of Norwegian public health policies to increase physical activity among children and adolescents. Despite large sums of public money being spent on such facilities, information on usage is limited. Aims: Our aim was to study the effects of gender, age and relative activity level on young people's use of sports facilities. Methods: We explored 662 young people's (age 6—16 years) usage of 19 different kinds of sports facilities. A questionnaire was administered to students and teachers, and situation plots of students at recess were made. Results: The findings indicate that sports facilities in general were less used by girls, adolescents (14—16 years) and the least active (physically active ≤ 1 times/week outside school) than by boys, children (6—13 years) and the most active (physically active ≥ 4 times/ week outside school). More general, multifunctional facilities were used to a greater extent than specialized facilities, particularly by the least active. Distance to facility was important for the use of common facilities. Conclusions: These results raise the question of whether sports facilities significantly increase physical activity among ``all'' young people, which is the government's stated goal. More research on sports facilities use and physical activity levels among males and females of all ages is warranted.
Regional variations and determinants of direct psychiatric costs in Sweden
Authors: Tiainen Anne , Edman Gunnar , Flyckt Lena , Tomson Göran , Rehnberg Clas
Published: July 2008

Aim: The aim of the present study was to investigate socioeconomic and demographic determinants of direct costs for psychiatric disorders in Sweden. The cost categories were inpatient and outpatient costs, and costs for psychopharmacological drugs. Two consecutive years, 2001 and 2002, were chosen as the study period. Methods: The study included all costs for admissions, visits and prescribed drugs for adults aged ≥18 years in 2001 and 2002 in Sweden. These costs were aggregated and analysed at the county level. A multiple linear regression analysis was fitted to the data, and independent variables (i.e. predictors) were chosen on the basis of previous studies. All cost types (e.g. total, inpatient, outpatient and drug costs) were analysed separately in different models. Results: Large variations in total direct psychiatric costs were found between county councils (for example, the total costs varied between euro112 and euro195 per capita in 2001). The results indicate that psychiatric outpatient care is less utilized in rural than in urban areas, and drugs are more often prescribed in rural areas than in urban areas. Areas with a high proportion of women and people aged 65 years and over are strong predictors of mental healthcare costs, i.e. variables showing that the higher the proportion, the lower the direct costs. Conclusions: Factors such as urbanization, gender, age and number of immigrants are reasons for differences in psychiatric direct costs. On the basis of these findings, it seems plausible to conclude that women, older patients and immigrants may benefit from specialized psychiatry, but that such healthcare does not seem to be provided in all regions.
Job stress, sickness absence and sickness presenteeism in Nordic elderly care
Authors: Elstad Jon Ivar , Vabø Mia
Published: July 2008

Aims: Nordic elderly care has been restructured to obtain more efficiency. Among workers caring for the elderly, levels of perceived job stress could vary, due to understaffing and resource scarcity. This study examines how sickness absence and sickness presenteeism are associated with perceived job stress. Methods: Data were obtained by posting questionnaires to lower-level care staff in Sweden (n=483), Denmark (n=704), Finland (n=597), and Norway (n=663). Self-reports about job stress (four items), sickness absence and sickness presenteeism were analysed by cross-tabulations and logistic regression. Results: Each item of job stress was associated with sickness absence and sickness presenteeism in the samples from all four countries. With low levels of job stress, levels of reported sickness absence and sickness presenteeism were relatively moderate. With increasing levels of job stress, the level of sickness presenteeism rose more sharply than that of sickness absence. Conclusions: The results can be interpreted in the light of features inherent in care work. Owing to professional norms and moral obligations, care workers could lower their thresholds for taking sick leave when care organizations are understaffed, because absences will be particularly critical for care recipients in such circumstances. Thus, while increasing job stress tends to be accompanied both by more sickness absence and by more sickness presenteeism, sickness presenteeism rises particularly in cases of high levels of job stress. Owing to cross-sectional data and self-reported information, conclusions are tentative.