Urban hospital's innovations save money, win support

Lutheran Medical Center (LMC) was a failing hospital in a depressed Brooklyn neighborhood until administrators and board members reassessed their purpose and goals. Now LMC is a community-oriented organization that offers acute hospital care for an urban population in excess of 350,000 people, provides cost-effective healthcare to more than 50,000 ambulatory patients a year, and has helped to revitalize its neighborhood. LMC's surprising range of accomplishments and activities include the following: Providing staff members to serve as resources and support staff for community groups; Organizing a neighborhood redevelopment committee, obtaining and administering grants, providing office space, and acting in an advisory capacity until the committee was able to separately incorporate; Creating an educational program for undereducated and underemployed area residents; Establishing a school health program to handle unmet routine healthcare needs of area children; Renovating an abandoned factory on the worst block in the community and relocating the hospital to that site; Founding the country's largest federally supported neighborhood health center; Signing a contract with New York state to provide healthcare for 10 percent less than the average cost of care for Medicaid patients.

Selective medical examinations on starting school

Selective medical examination of children starting school has been operated in Cramlington for five years, and the data for the school year 1984-85 are reported. It is argued that the 'routine medical' is an outdated concept and that its abolition would allow more time for more important aspects of educational medicine including help for adolescents, disabled children in school, and deprived children who have not received basic health surveillance.

A school health education program for children with asthma aged 8-11 years

It was hypothesized that a health education program for children with asthma aged 8-11 years that was delivered in elementary schools, would increase children's asthma management skills, self-efficacy and influence on parents' management decisions; reduce school absences and improve school performance. The study population consisted of 239 low-income, predominantly Hispanic and black children from 12 elementary schools (six experimental and six control) in New York City. Parents did not attend educational sessions but received written materials. The program emphasized the child's responsibility for recognizing symptoms and taking appropriate management steps. Follow-up data obtained one year after the program showed that compared to controls experimental group children had higher scores on an index of asthma management (p less than 0.05), greater self-efficacy with respect to asthma management skills (p less than 0.05), more influence on parents' asthma management decisions (p less than 0.05), better grades in school (p = 0.05), and fewer episodes of asthma (p less than 0.01) of shorter average duration (p less than 0.01). No differences were observed for changes in number of school absences. These findings show that asthma health education designed for delivery to children can significantly increase management skills, reduce symptoms of asthma, and improve school performance.

An outbreak of tuberculosis in an Oxfordshire school

A primary school teacher was found to have pulmonary tuberculosis. Subsequent investigations showed that nine of her 32 pupils had been infected. The problem is discussed in the light of current recommendations designed to protect schoolchildren.

Teaching about international health in United States public schools

This is a decade length study which will involve periodic surveys of curriculum directors and coordinators and review of health, social studies, and selected other curriculum documents. Curriculum directors and coordinators from 43 states responded to the Cissell International Health Curricula Questionnaire. Eighteen sent copies of their health curriculum documents. Ten sent copies of the social studies curriculum documents. Several indicated their curriculum documents could be purchased. Several others indicated their curriculum documents were being revised or reprinted. Solicitation of responses to the questionnaire and of additional copies of the curriculum guides will continue until curriculum directors or coordinators from all 50 states have responded and a copy of each of the published health and social studies curriculum documents has been received and analyzed or June 30, 1988. A second phase will be initiated in 1989 to solicit comparable information. Likewise, a third phase of the study will be initiated in 1994. Phases two and three will produce data that can be compared with the data obtained in phase one. In that way, any changes in school health curricula, as it relates to international health, should be evident.

Management of asthma in schools

A questionnaire on asthma in schools was circulated to 291 Nottingham schools. The response rate was 91%. Three areas of concern were identified: are schools aware of all their asthmatic pupils; should children have more access to their medications in school; and do teachers need more guidance in supervising illnesses.

Smokeless Tobacco Reduction Program

To reduce the incidence and prevalence of oral cancer, the Smokeless Tobacco Reduction Program will consist of a mass media campaign, public oral screening, and a week-long school health program for 350 students in the seventh, eighth, and ninth grades in Willows, Glenn County, CA. Mass media will include radio, television, newspapers, posters, and literature. The program will use resources of the public health department and junior high school; it will also depend on 8 teachers and 25 peer leaders, all trained in the program. Reducing the use of smokeless tobacco is the program's objective. If that goal is achieved, the program will reduce oral cancers in the target population by 75 percent within 10 years. The incidence of leukoplakia will be reduced by 50 percent within 3 years of the end of the program. By the end of the program, 90 percent of the target population will be able to identify warning signs of oral cancer and leukoplakia, and 85 percent of the students will no longer believe that use of smokeless tobacco is less harmful than smoking. As a result of the program, use of smokeless tobacco will not be viewed favorably by 80 percent of the target population; usage will be regarded as socially unacceptable.

The school entry medical examination

We describe our comprehensive examination of 5 year old school entrants. The examination includes a parental interview, measurements of growth and visual acuity, and an audiometric sweep test all carried out by the school nurse and a paediatric examination and neurodevelopmental assessment carried out by the school doctor. The continuing need for such an examination, at least in urban areas, is discussed and illustrated by some data from the North Paddington Primary School Study. We emphasise the practical use of the neurodevelopmental assessment.