Issues of consent and the primary-school medical. (73/3103)

This article discusses what level of consent is needed from a child or parent before a primary-school medical can take place (i.e. where children are aged under 12). It also considers whether there are occasions when a doctor can see a child if the parents have failed to give consent or have explicitly refused consent. Primary-school children are considered incompetent to make decisions about their own medical treatment and so their consent does not need to be gained before a medical takes place, although it is highly desirable to obtain it. However, a doctor cannot justify a decision to see a child purely in terms of the benefit conferred on the child. Parents can be wronged if their wishes are ignored and usually those wishes should be considered overriding. Normally, general consent, which need not be fully informed, is needed before a school medical. However, if a child is considered to be in danger of being harmed significantly or suspected to have a major medical condition, a medical should go ahead regardless of the level of consent obtained from the parent, so that a reasonable standard of health is maintained for the child.  (+info)

Application of a generalized random effects regression model for cluster-correlated longitudinal data to a school-based smoking prevention trial. (74/3103)

In cluster-randomized trials, groups of subjects (clusters) are assigned to treatments, whereas observations are taken on the individual subjects. Since observations on subjects in the same cluster are typically more similar than observations from different clusters, analyses of such data must take intracluster correlation into account rather than assuming independence among all observations. Random effects models are useful for this purpose. The problem becomes more complicated if, in addition, repeated observations are taken on subjects over time. This introduces intraindividual correlation, which is typical for longitudinal studies. The Waterloo Smoking Prevention Project, study 3 (WSPP3), 1989-1996, is a study giving rise to cluster-correlated longitudinal data, where schools were randomized to either a smoking intervention program or to a control condition. Smoking status was assessed on grade 6 students in these schools, with annual follow-up observations throughout elementary and high school years. The authors illustrate the use of a generalized random effects model for analyzing this type of data. This model obtains appropriate estimates and standard errors for both individual-level covariates and those at the level of the cluster.  (+info)

Fertility control methods: knowledge of adolescent girls in schools of Chandigarh. (75/3103)

The study was conducted in 4 schools (3 urban, 1 rural) in Union Territory of Chandigarh. Adolescent girls in the age group of 12 and 20 years were interviewed, thereby covering 316 in urban and 73 in rural areas. The knowledge regarding fertility control methods improved from 44.9% to 66.7% with increase in the age. The knowledge was higher (57.6%) in girls with college level education of mothers in comparison to 35.9% among illiterate mothers. Also children of working mothers, had better awareness (60.7%) than housewives (49.8%). Relationship with occupation of father and religion was also studied. It is important to educate the girls in adolescent age group regarding fertility control methods, so that they have better understanding of shaping their families in coming years.  (+info)

Epidemiological investigation of school-related injuries in Koprivnica County, Croatia. (76/3103)

AIM: To assess the prevalence of injuries in elementary schools and determine specific risk groups of school-age children. METHODS: According to the 1991 census, there were 6,398 children between 7 and 14 years of age in the study area of the former Koprivnica district. During the 1992-1997 period, 354 children were injured in school. The registration of injured children was performed via structured questionnaires filled out at the emergency clinic and outpatient surgical clinic of the General Hospital in Koprivnica. The mechanism of accident and activities preceding it were categorized according to the Nordic Medico-Statistical Committee classification. Chi-square test was used to determine groups of school children at specific risk and a classification tree was made on the basis of minimum entropy values for age, sex, activity, and mechanism of injury. RESULTS: The highest injury rate of was recorded in 12-year-olds (21.7%). Upper extremities were most common site of injury (52.8%), whereas the most common type of injury was contusion (45.2%). The rate of head injuries was 3.2 times higher in younger (aged 7-10) children, whereas the rate of sports injuries was 3.5-fold higher in older (aged 11-14) children (p=0.001). Entropy classification revealed younger school-age children to be at the highest risk of contusion due to a blow from a ball, an object, or contact during sports activities. CONCLUSION: In Koprivnica County, most school-related injuries occurred during sport activities (42%) and play during recess (55%), with specific differences in age and sex.  (+info)

The prevalence of asthma in children of elementary school age in western New York. (77/3103)

To determine the prevalence of caregiver-reported asthma in children 4 to 13 years old in metropolitan western New York State, surveys were conducted during 1997-1999 in the Buffalo, Niagara Falls, Iroquois, and Gowanda school systems. Questionnaires (3,889) were sent to the homes of elementary school children in nine schools in western New York. The caregivers were asked to complete a 13-item questionnaire for the child. Of the questionnaires, 60.5% (2,353/3,889) were completed. Of all children, 18% had physician-diagnosed asthma. Of children diagnosed with asthma, 86% were taking medication. Symptoms were consistent with suspected undiagnosed asthma for 13% of the children. Buffalo had the highest rate of diagnosed asthma (20%) for the age group. Gowanda had a prevalence of 18%, Iroquois 16%, and Niagara Falls 15%. Variations were observed in asthma prevalence rates among different racial/ethnic groups. In general, boys had a significantly (P = .001) increased odds of being asthmatic compared with girls. Overall, African-Americans and Hispanic/Latino children had significantly (P = .012 and P = .005, respectively) higher asthma prevalence rates, two to five times those of their Caucasian peers. In Gowanda, the prevalence of diagnosed asthma among Native American children was 23%, compared to 15% among Caucasian children. Of diagnosed Native American children, 71% were female. In Gowanda, a significant association (P = .007) of asthma among children in split-grade classes was observed compared to nonsplit grades. Of Native American children in split grades, 60% were diagnosed asthmatics. These observations reveal a high prevalence of asthma in the age group of 4 to 13 year olds in western New York. Local variations in potential triggers of asthma need to be considered when advising asthmatics. The results suggest that some grades have a disproportionate amount of children with asthma. The implications of asthma for children's early education need to be examined further.  (+info)

Evaluation of children in six blind schools of Andhra Pradesh. (78/3103)

PURPOSE: 1. To determine the anatomical site and underlying causes of severe visual impairment and blindness in children in special education in Andhra Pradesh, India. 2. To compare the causes of blindness in two different regions in the state. 3. To evaluate improvement with correction of refractive error and low-vision devices (LVDs). METHODS: Children in 6 schools for the blind and in 3 integrated education programmes were examined by one ophthalmologist, and were refracted and assessed for LVDs by an optometrist. The major anatomical site and underlying aetiology of severe visual impairment and blindness (SVI/BL; < 6/60 in the better eye) were recorded using the standardised WHO reporting form. RESULTS: Two hundred and ninety one students under 16 years were examined, and after refraction, 267 (91.7%) were classified as being severely visually impaired or blind. The most common anatomical sites of SVI/BL were retina in 31.1% children; cornea in 24.3%; and whole globe in 20.2%. The aetiology was unknown in 38.2%, hereditary in 34.8% and childhood causes in 24%. 114 children (39.2%) had functional low vision (i.e. visual acuity < 6/18 to light perception with navigational vision). In this group, 36 children improved with spectacles and 16 benefited by LVDs. 41 children (15.4%) were able to read N10 point though they were studying Braille. CONCLUSION: Overall 37.4% of children had "avoidable" causes of blindness. The major avoidable causes were vitamin-A deficiency and cataract. Vitamin-A deficiency and congenital anomalies were more common in the dry plateau areas of the state. One in seven children could read normal print with optical support.  (+info)

Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial. (79/3103)

OBJECTIVE: To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma. DESIGN: Cluster randomised controlled trial. SETTING: Six high schools in rural Australia. PARTICIPANTS: 272 students with recent wheeze, recruited from a cohort of 1515 students from two school years (mean age 12.5 and 15.5 years); 251 (92.3%) completed the study. INTERVENTION: A structured education programme for peers comprising three steps (the "Triple A Program"). MAIN OUTCOME MEASURES: Quality of life, school absenteeism, asthma attacks, and lung function. RESULTS: When adjusted for year and sex, mean total quality of life scores showed significant improvement in the intervention than control group. Clinically important improvement in quality of life (>0.5 units) occurred in 25% of students with asthma in the intervention group compared with 12% in the control group (P=0.01). The number needed to treat was 8 (95% confidence interval 4.5 to 35.7). The effect of the intervention was greatest in students in year 10 and in females. Significant improvements occurred in the activities domain (41% v 28%) and in the emotions domain (39% v 19%) in males in the intervention group. School absenteeism significantly decreased in the intervention group only. Asthma attacks at school increased in the control group only. CONCLUSION: The triple A programme leads to a clinically relevant improvement in quality of life and related morbidity in students with asthma. Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in adolescents.  (+info)

Health and education of children with albinism in Zimbabwe. (80/3103)

Albinism is a relatively common genetic condition in Zimbabwe, a tropical country in southern Africa. Those affected have little pigment in their hair, skin or eyes, in sharp contrast to the normal dark pigmentation. This article describes the responses to a self-report questionnaire covering health, social and educational aspects completed by 138 schoolchildren with albinism living in rural areas of Zimbabwe. They reported persistent skin and a myriad of eye problems. Relationships between siblings appeared good, although problems of antagonism, avoidance and fear were encountered among strangers. Knowledge about albinism was patchy; pupils were keen to be better informed. This research highlights the need for widespread dissemination of accurate information about the genetics and health management of albinism to counter the many myths and misconceptions surrounding this condition. A management programme to promote the health and education of these children in southern Africa is proposed. In conclusion, this study indicated that pupils with albinism could participate in mainstream education, with appropriate intervention to help them manage the problems associated with their low vision and sensitive skins.  (+info)