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Quality of Life and School Absenteeism in Children With Chronic Illness 慢性疾病儿童的生活质量和旷课率
Pub Date : 2016-08-01 DOI: 10.1177/1059840515615401
N. Emerson, Brian J Distelberg, Holly E. R. Morrell, Jackie Williams-Reade, Daniel Tapanes, S. Montgomery
Objective: Children and adolescents with a chronic illness (CI) tend to demonstrate diminished physical and social functioning, which contribute to school attendance issues. We investigated the role of social and physical functioning in reducing school absenteeism in children participating in Mastering Each New Direction (MEND), a family-based psychosocial intervention for youths with CI. Methods: Forty-eight children and adolescents with a CI (70.8% female, M age = 14.922, SD = 2.143) and their parent(s) completed a health-related quality of life (HRQOL) measure pre- and postintervention. Using multiple mediation, we examined whether parent- and child-rated physical and social HRQOL mediated the relationship between school attendance before and after MEND. Once the mediational model was not supported, we investigated whether HRQOL moderated the relationship between missed school days pre- and postintervention. Results: Neither physical nor social functioning mediated or moderated the relationship between missed school days pre- and postintervention. Instead, higher parent-rated physical functioning directly predicted decreased number of missed school days, while lower parent-rated social and child-rated physical functioning predicted increased missed school days. Conclusions: Parent-perceived HRQOL may have a direct effect on health-related behaviors such as school attendance. Future research should determine whether gains in parent-rated QOL are maintained in the long term and whether these continue to impact markers of functional well-being.
目的:患有慢性疾病(CI)的儿童和青少年往往表现出身体和社会功能的减弱,这导致了上学问题。我们调查了社会和身体功能在减少参加“掌握每个新方向”(MEND)的儿童缺勤方面的作用,这是一项针对CI青少年的基于家庭的社会心理干预。方法:48名儿童和青少年(CI 70.8%为女性,M年龄= 14.922,SD = 2.143)及其父母在干预前和干预后完成了与健康相关的生活质量(HRQOL)测量。采用多重中介,我们检验了父母和孩子评价的身体和社会HRQOL是否介导了MEND前后上学出勤率的关系。在不支持中介模型的情况下,我们研究了HRQOL是否调节了干预前后缺课天数之间的关系。结果:身体和社会功能都没有调节或调节干预前后缺课日之间的关系。相反,较高的父母评价的身体功能直接预示着缺课天数的减少,而较低的父母评价的社会和儿童评价的身体功能预示着缺课天数的增加。结论:父母感知的HRQOL可能直接影响与健康相关的行为,如出勤率。未来的研究应该确定父母评定的生活质量是否能长期维持,以及这些是否会继续影响功能健康的标志。
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引用次数: 55
Prevalence and Costs of Five Chronic Conditions in Children 儿童五种慢性病的患病率和费用
Pub Date : 2016-04-04 DOI: 10.1177/1059840516641190
Gabrielle F. Miller, E. Coffield, Zanie C. Leroy, R. Wallin
The objective is to examine the prevalence and health-care costs associated with asthma, epilepsy, hypertension, food allergies, and diabetes in children aged 0–18 years. Prevalence was calculated using 2005–2012 Medical Expenditure Panel Survey (MEPS) data, a population-based, nationally representative sample. Using MEPS, two-part models estimated the cost of each condition for all children while controlling for sociodemographic categories. Prevalence rates varied by race and ethnicity across conditions. Females had higher prevalence of all chronic conditions, except epilepsy. An additional US$1,377.60–US$9,059.49 annually were spent on medical expenses for children aged 0–18 years, with asthma, diabetes, or epilepsy compared to children without these conditions. This is the first study to examine the costs and prevalence of chronic health conditions in children and adolescents using a single data set. Understanding the odds of having a condition by sociodemographic categories highlights disparities that can potentially inform school nurses on the best allocation of resources to serve students.
目的是调查0-18岁儿童中与哮喘、癫痫、高血压、食物过敏和糖尿病相关的患病率和保健费用。患病率计算使用2005-2012年医疗支出小组调查(MEPS)数据,这是一个基于人群的,具有全国代表性的样本。使用MEPS,两部分模型在控制社会人口类别的同时估计了所有儿童每种疾病的成本。患病率因种族和民族而异。除癫痫外,女性在所有慢性疾病中的患病率均较高。与没有这些疾病的儿童相比,0-18岁患有哮喘、糖尿病或癫痫的儿童每年额外花费1 377.60 - 9 059.49美元的医疗费用。这是首个使用单一数据集检查儿童和青少年慢性健康状况的成本和患病率的研究。通过社会人口统计类别了解患病几率,可以突出差异,这可能会告诉学校护士如何为学生提供最佳资源分配。
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引用次数: 129
Barriers to Asthma Management as Identified by School Nurses 学校护士确定的哮喘管理障碍
Pub Date : 2016-04-04 DOI: 10.1177/1059840516641189
Judith E Quaranta, G. Spencer
Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors, and (c) determined the impact of barriers on importance ratings of asthma management behaviors, asthma self-efficacy, and asthma attitudes (N = 537). Results revealed 72% of the nurses reported at least one barrier. As numbers of barriers increased, performance of asthma management behaviors decreased. Significant relationships were found between specific asthma management behaviors and specific barriers. No significant relationships were found between barriers and asthma self-efficacy, asthma attitude, or importance ratings of asthma management behaviors. Removing barriers may allow the nurse to perform at greatest effectiveness, enhancing the positive outcomes that result from appropriate asthma management.
儿童哮喘发病率正在上升。学校护士有机会照顾患有哮喘的儿童,但需要克服影响他们在学校环境中管理哮喘能力的障碍。本研究(a)评估了学校环境中存在的障碍,(b)确定了障碍对哮喘管理行为表现的影响,(c)确定了障碍对哮喘管理行为重要性评级、哮喘自我效能和哮喘态度的影响(N = 537)。结果显示,72%的护士报告至少有一个障碍。随着障碍数量的增加,哮喘管理行为的表现下降。特定哮喘管理行为与特定障碍之间存在显著关系。未发现障碍与哮喘自我效能、哮喘态度或哮喘管理行为的重要性评分之间存在显著关系。消除障碍可以使护士发挥最大的效能,增强适当哮喘管理带来的积极结果。
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引用次数: 15
Negotiating Access to Health Information to Promote Students’ Health 协商获取健康资讯,促进学生健康
Pub Date : 2016-04-01 DOI: 10.1177/1059840515615676
Molly E Radis, S. Updegrove, Anne Somsel, A. Crowley
Access to student health information, such as immunizations, screenings, and care plans for chronic conditions, is essential for school nurses to fulfill their role in promoting students’ health. School nurses typically encounter barriers to accessing health records and spend many hours attempting to retrieve health information. As a result, nurses’ time is poorly utilized and students may suffer adverse outcomes including delayed school entry. In response to this pressing public health issue, a school medical advisor and director of school nurses in a local health department successfully negotiated access for school nurses to three health record systems: a state immunization tracking system, an electronic lead surveillance program, and an electronic health record system. This negotiation process is presented within a framework of the Theory of Diffusion of Innovation and provides a strategy for other school nurses seeking access to student health information.
获得学生健康信息,如免疫接种、筛查和慢性病护理计划,对于学校护士在促进学生健康方面发挥作用至关重要。学校护士通常会遇到访问健康记录的障碍,并花费许多时间试图检索健康信息。因此,护士的时间没有得到充分利用,学生可能遭受包括入学延迟在内的不良后果。为了应对这一紧迫的公共卫生问题,一位学校医疗顾问和当地卫生部门的学校护士主任成功地为学校护士谈判了三个健康记录系统:一个州免疫跟踪系统,一个电子铅监测程序和一个电子健康记录系统。这一谈判过程是在创新扩散理论的框架内提出的,并为寻求获得学生健康信息的其他学校护士提供了一种策略。
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引用次数: 4
Translational Science for School Nursing and School Health Services 学校护理和学校卫生服务的转化科学
Pub Date : 2016-04-01 DOI: 10.1177/1059840516634395
J. Cowell
Over 10 years ago, Dr. Elias Zerhouni, at the National Institutes of Health (NIH), challenged the biomedical researchers in the United States to translate their innovations to practice, thus advancing the nation’s health (Zerhouni, 2005). While there had been strategies for dissemination of innovations for years, this challenge created a focus at NIH to shorten the gap in time from discoveries to practice. Since that announcement by Dr. Zerhouni, the National Center for Advancing Translational Science has been established with funding mechanisms to promote tested innovations in the community (https://ncats.nih.gov/). Historically, biomedical research in laboratories leads to important discoveries about disease. The findings from laboratory studies are then tested in the clinical setting. There can be four phases of trials: Phase 1—initial safety study with a small sample; Phase 2—a test of effectiveness and additional safety study with larger sample; Phase 3— clinical trial that is double blinded, that is, the investigator nor patient know if they are receiving the experimental treatment. The sample size for Phase 3 trial is large, hundreds to thousands of participants. Phase 4—studies are conducted after the treatment is widely disseminated to determine the effects on diverse populations and to study long-term effects (https:// www.nlm.nih.gov/services/ctphases.html). The adoption of tested interventions into general practice takes decades. Translational research introduces new methods that accelerate the processes of biomedical research by the use of collaborative links that provide feedback. Thus, two new stages of research design shorten the phases of the traditional clinical trials. The new stages include the continuous refinement and evaluation of innovations across diverse populations. Additionally, feedback from the community is introduced from the initial creation of the innovation, the design to intervention testing (Grady, 2010). The use of community advisory groups has become common place at all stages of research, as translational science tenets become common place. Grady highlighted the importance of research that is multidisciplinary, that is, coordinated among scientists of different disciplines. She highlighted the fact that interdisciplinary research shows cooperation of scientists in addressing issue crossing boundaries. Finally, Grady promoted transdisciplinary efforts with collaborative projects that go beyond any one discipline (Grady, 2010). The core of the evidence-based practice movement and translational science movement has been to bring evidence to clinical practice (Pearson, Jordan, & Munn, 2012). Implications for Authors
10多年前,美国国立卫生研究院的Elias Zerhouni博士要求美国的生物医学研究人员将其创新成果转化为实践,从而促进国家健康(Zerhouni, 2005年)。虽然多年来一直有传播创新的策略,但这一挑战使NIH关注缩短从发现到实践的时间差距。自Zerhouni博士宣布这一消息以来,已经建立了国家促进转化科学中心,并建立了资助机制,以促进社区中经过测试的创新(https://ncats.nih.gov/)。从历史上看,实验室的生物医学研究导致了关于疾病的重要发现。然后在临床环境中对实验室研究的结果进行检验。试验可分为四个阶段:第一阶段——小样本的初始安全性研究;第二阶段——有效性测试和更大样本的额外安全性研究;第三阶段-临床试验是双盲的,也就是说,研究者和患者都不知道他们是否正在接受实验性治疗。第三阶段试验的样本量很大,有数百到数千名参与者。第四阶段研究是在治疗广泛传播后进行的,以确定对不同人群的影响并研究长期影响(https:// www.nlm.nih.gov/services/ctphases.html)。将经过检验的干预措施纳入一般实践需要几十年的时间。转化研究引入了新的方法,通过使用提供反馈的协作链接来加速生物医学研究的进程。因此,两个新的研究设计阶段缩短了传统临床试验的阶段。新的阶段包括不断改进和评估不同人群的创新。此外,从创新的最初创造、设计到干预测试,都引入了来自社区的反馈(Grady, 2010)。社区咨询小组的使用在研究的各个阶段已经变得普遍,因为转化科学的原则变得普遍。格雷迪强调了多学科研究的重要性,即不同学科的科学家之间的协调。她强调,跨学科研究表明科学家在解决跨界问题方面的合作。最后,Grady通过超越任何一个学科的合作项目促进了跨学科的努力(Grady, 2010)。循证实践运动和转化科学运动的核心是将证据带到临床实践中(Pearson, Jordan, & Munn, 2012)。对作者的启示
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引用次数: 1
Barriers to Asthma Management for School Nurses 学校护士哮喘管理的障碍
Pub Date : 2016-04-01 DOI: 10.1177/1059840515621607
Ellen Hanley Nadeau, C. Toronto
Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses’ expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting.
儿童哮喘是一个日益严重的健康问题。哮喘是儿童最常见的慢性疾病,也是急诊室就诊、住院和缺课的主要原因。学校护士在哮喘管理中发挥着重要作用。本综合综述的目的是检查学校护士在学校环境中哮喘管理的障碍。研究结果揭示了学校护士在管理哮喘时遇到的多重障碍。出现了六个主题,包括缺乏资源和支持、时间不足、沟通挑战、知识有限以及缺乏对学校护士专业知识的认识。学生、家长、初级保健医生、学校管理、工作人员和学校护士本身都在建立哮喘管理障碍方面发挥作用。学校护士和学校护士领导需要集中精力制定战略,以克服障碍,确保在学校环境中对哮喘进行循证的最佳实践管理。
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引用次数: 24
Presenteeism Attitudes and Behavior Among Missouri Kindergarten to Twelfth Grade (K–12) School Nurses 密苏里州幼儿园至12年级(K-12)学校护士出勤态度与行为
Pub Date : 2016-03-29 DOI: 10.1177/1059840516637651
T. Rebmann, James Turner, Allison K. Kunerth
Working while ill (presenteeism) with symptoms of influenza-like illness can contribute to outbreaks, but little is known about school nurse presenteeism. Missouri Association of School Nurses members (N = 396) were sent a survey in 2013/2014. A chi square test was conducted to compare having a school culture that encourages presenteeism versus actual sick leave policies. Multivariate logistic regression was conducted to delineate factors associated with presenteeism. In total, 133 school nurses participated (33.6% response rate). Almost half (42.1%, n = 56) reported presenteeism. Nurses were more likely to feel pressure to engage in presenteeism than reported punitive sick leave policies (14.3% vs. 3.8%, χ2 = 18.3, p < .001). Presenteeism was associated with perceived pressure, odds ratio (OR) = 4.8, confidence interval (CI) = [1.5, 15.8], p < .01, and having a mild illness, OR = 3.6, CI = [1.4, 9.7], p = .01. Many school nurses engage in presenteeism, and this appears to be associated with organizational cultural norms rather than established sick leave policies.
有流感样疾病症状的带病工作(出勤)可能导致疫情爆发,但对学校护士出勤知之甚少。于2013/2014年对密苏里州学校护士协会会员(396名)进行问卷调查。进行了卡方检验来比较鼓励出勤的学校文化与实际的病假政策。采用多元逻辑回归来描述与出勤相关的因素。共有133名学校护士参与调查,回复率为33.6%。近一半(42.1%,n = 56)报告出勤。与报告的惩罚性病假政策相比,护士更有可能感受到参与出勤的压力(14.3% vs. 3.8%, χ2 = 18.3, p < .001)。出勤与感觉压力相关,优势比(OR) = 4.8,可信区间(CI) = [1.5, 15.8], p < 0.01;与病情轻微相关,OR = 3.6, CI = [1.4, 9.7], p = 0.01。许多学校护士出勤,这似乎与组织文化规范有关,而不是既定的病假政策。
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引用次数: 18
Types and Influence of Social Support on School Engagement of Young Survivors of Leukemia 白血病青年幸存者社会支持类型及对学校投入的影响
Pub Date : 2016-03-23 DOI: 10.1177/1059840516635711
Anne‐Marie Tougas, S. Jutras, M. Bigras
The present study aimed to describe and explore the influence of social support on the school engagement of young survivors of pediatric leukemia. Fifty-three young Quebecers, previously diagnosed and treated for leukemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the support offered by four groups of relations with regard to school: parents, siblings, friends, and other nonprofessional relations. The interview responses revealed that parents were perceived to be the primary source of informational and emotional support, with support also provided to a lesser extent by friends, siblings, and members of the extended family. Inferential analyses indicated that young survivors report a higher school engagement score when they perceive themselves as receiving support from a greater number of groups of relations, especially from friends or siblings.
本研究旨在探讨社会支持对儿童白血病幸存者学业投入的影响。53名曾被诊断为白血病并接受过治疗的魁北克年轻人,完成了一份衡量他们在学校的参与程度的问卷,并参加了一项关于四组关系提供的支持的访谈:父母、兄弟姐妹、朋友和其他非专业关系。访谈结果显示,父母被认为是信息和情感支持的主要来源,朋友、兄弟姐妹和大家庭成员也提供了较少的支持。推断分析表明,当年轻的幸存者认为自己得到了更多关系群体的支持,尤其是朋友或兄弟姐妹的支持时,他们的学校参与度得分就会更高。
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引用次数: 6
Assessing the Impact of School-Based Health Centers on Academic Achievement and College Preparation Efforts 评估校本健康中心对学业成绩和大学准备努力的影响
Pub Date : 2016-03-23 DOI: 10.1177/1059840516634805
Melina Bersamin, S. Garbers, J. Gaarde, J. Santelli
This study examines the association between school-based health center (SBHC) presence and school-wide measures of academic achievement and college preparation efforts. Publicly available educational and demographic data from 810 California public high schools were linked to a list of schools with an SBHC. Propensity score matching, a method to reduce bias inherent in nonrandomized control studies, was used to select comparison schools. Regression analyses, controlling for proportion of English-language learners, were conducted for each outcome including proportion of students participating in three College Board exams, graduation rates, and meeting university graduation requirements. Findings suggest that SBHC presence is positively associated with college preparation outcomes but not with academic achievement outcomes (graduation rates or meeting state graduation requirements). Future research must examine underlying mechanisms supporting this association, such as school connectedness. Additional research should explore the role that SBHC staff could have in supporting college preparation efforts.
本研究探讨校本健康中心(shbhc)的存在与全校范围内的学业成就和大学准备努力之间的关系。加州810所公立高中的公开教育和人口统计数据与拥有shbhc的学校列表相关联。倾向评分匹配是一种减少非随机对照研究固有偏倚的方法,用于选择比较学校。在控制英语学习者比例的情况下,对每个结果进行回归分析,包括参加三次大学理事会考试的学生比例、毕业率和满足大学毕业要求。研究结果表明,shbhc的存在与大学准备结果呈正相关,但与学业成就结果(毕业率或达到州毕业要求)无关。未来的研究必须检查支持这种联系的潜在机制,比如学校联系。进一步的研究应探讨shbhc员工在支持大学准备工作方面可能发挥的作用。
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引用次数: 9
Using Puppets to Teach Schoolchildren to Detect Stroke and Call 911 用木偶教小学生检测中风和拨打911
Pub Date : 2016-03-23 DOI: 10.1177/1059840516636197
Sonya Sharkey, Linda Denke, M. Herbert
To overcome barriers to improved outcomes, we undertook an intervention to teach schoolchildren how to detect a stroke and call emergency medical services (EMS). We obtained permission from parents and guardians to use an 8-min puppet show to instruct the fourth, fifth, and sixth graders about stroke detection, symptomatology, and calling EMS. A pretest and three posttests—one immediately following the presentation, one at 3 months, and a third at 6 months—were administered. Responses from 282 students were evaluable. Significant improvements (p < .001) in knowledge were found through all posttests in identifying what parts of the body stroke affected and through the first two posttests in recognizing symptoms stroke victims experienced. Students demonstrated at pretest a high awareness of EMS and 911 (97.5%) and showed slight, but not significant, improvement over time.
为了克服改善结果的障碍,我们进行了一项干预措施,教学童如何检测中风和呼叫紧急医疗服务(EMS)。我们获得了家长和监护人的许可,用8分钟的木偶剧来指导四、五、六年级的学生关于中风的检测、症状学和呼叫EMS。研究人员进行了一次前测和三次后测——一次是在演讲之后,一次是在3个月时,第三次是在6个月时。282名学生的回答是可评估的。通过所有后测,在识别中风影响的身体部位和通过前两次后测,在识别中风患者经历的症状方面,发现知识有了显著改善(p < 0.001)。学生在测试前表现出对EMS和911的高度认识(97.5%),并且随着时间的推移表现出轻微但不显著的改善。
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引用次数: 7
期刊
The Academic nurse : the journal of the Columbia University School of Nursing
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