Teacher characteristics and knowledge of asthma

Abd A, Adnan Fawzi H. Awareness of asthma and its management in primary school teachers in Baghdad, Iraq

Background: Asthma is a major global health issue characterized by chronic airway inflammation. It is linked to a high disease burden and disproportionately high healthcare utilization in severe, uncontrolled cases compared to non-severe asthma. We aimed to conduct this survey among primary school teachers in Baghdad, Iraq, to assess their level of knowledge about asthma and confidence in managing school children with asthma. Methods: This was a cross-sectional study conducted in Baghdad. The study adopted a questionnaire for assessing the asthma knowledge and confidence scores regarding the management of asthmatic children. This questionnaire contained 29-multiple true-false questions based on different aspects, including facts about asthma and the management of asthma by teachers. The questionnaire for testing teachers’ knowledge of asthma and confidence scores regarding the management of asthmatic children was distributed to 150 teachers. Results: The questionnaire was completed by 103 teachers.. Approximately 71% of teachers answered the question ‘What are the three main symptoms of asthma?’ correctly i.e., answering either one symptom (35.9%) or two symptoms (35.9%) correctly. A relatively smaller number of teachers (16.5%) mentioned all three symptoms correctly. Across the 29-multiple true-false questions, more than 75% of teachers answered 11 questions correctly, 50-74% of teachers answered the rest of eight questions appropriately, and <50% of teachers answered the remaining 10 questions properly. The statistical evaluation indicated that the mean total knowledge score about asthma for all the teachers was 20.27 ± 2.97 and the mean total confidence score regarding the management of asthmatic children was 72.44 ± 13.61. Conclusions: This study suggests that teachers from the schools in Baghdad appear to be self-confident in their ability and knowledge to help and manage children with asthma.

Abd A, Adnan Fawzi H. Awareness of asthma and its management in primary school teachers in Baghdad, Iraq

Background: Asthma is a major global health issue characterized by chronic airway inflammation. It is linked to a high disease burden and disproportionately high healthcare utilization in severe, uncontrolled cases compared to non-severe asthma. We aimed to conduct this survey among primary school teachers in Baghdad, Iraq, to assess their level of knowledge about asthma and confidence in managing school children with asthma. Methods: This was a cross-sectional study conducted in Baghdad. The study adopted a questionnaire for assessing the asthma knowledge and confidence scores regarding the management of asthmatic children. This questionnaire contained 29-multiple true-false questions based on different aspects, including facts about asthma and the management of asthma by teachers. The questionnaire for testing teachers' knowledge of asthma and confidence scores regarding the management of asthmatic children was distributed to 150 teachers. Results: The questionnaire was completed by 103 teachers.. Approximately 71% of teachers answered the question 'What are the three main symptoms of asthma?' correctly i.e., answering either one symptom (35.9%) or two symptoms (35.9%) correctly. A relatively smaller number of teachers (16.5%) mentioned all three symptoms correctly. Across the 29-multiple true-false questions, more than 75% of teachers answered 11 questions correctly, 50-74% of teachers answered the rest of eight questions appropriately, and <50% of teachers answered the remaining 10 questions properly. The statistical evaluation indicated that the mean total knowledge score about asthma for all the teachers was 20.27 ± 2.97 and the mean total confidence score regarding the management of asthmatic children was 72.44 ± 13.61. Conclusions: This study suggests that teachers from the schools in Baghdad appear to be self-confident in their ability and knowledge to help and manage children with asthma.

Association between asthma and enamel defects in primary and young permanent teeth - A systematic review

Childhood respiratory diseases, such as asthma, are important public health problems worldwide and could be associated with tooth enamel defects. This study aimed to verify the relationship between asthma and enamel defects in teeth, to answer the following question: "Could asthma in children be significantly associated with enamel defects in deciduous dentition and young permanent teeth?." PUBMED-MEDLINE, EMBASE, LILACS, and COCHRANE databases were systematically searched and assessed articles (2000-2021) were cautiously scored according to a predetermined criterion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were considered. Twenty-two articles were critically appraised and used as a basis for conclusions. The relationship between asthma and enamel defects was confirmed in the majority of appraised papers, one with a high level of evidence, nine with a moderate level, and four with a low level. Out of the eight manuscripts investigating the influence of asthma medication on enamel defects, only three (one with high, one moderate, and another with a low level of evidence) suggested an association. It can be concluded that asthma is closely connected with enamel defects in young permanent teeth. However, as most of the papers appraised were of cross-sectional or case-control design, further well-designed clinical investigations with a prospective design are welcome to reinforce our findings.

School practices in supporting children with asthma in Malta

OBJECTIVE

The objective of this study was to obtain information about teachers' knowledge, attitudes, practices and beliefs about medication related to working with children having asthma in state primary schools in Malta. This study provides information about management in a country with a high prevalence of asthma among children, and limited availability of school nurses.

METHODS

A cross-sectional electronic survey investigating beliefs about medicines, asthma knowledge, attitude toward students with asthma, self-efficacy and practice in an asthma exacerbation, current practices, views, experiences and training relating to asthma was sent to all participating state primary schools in Malta.

RESULTS

A total of 167 teachers from 26 schools answered the questionnaire. The majority of respondents (56%) were unaware of children's conditions and limited information about children's asthma was provided to them. Only 20% of teachers reported receiving training on how to support children with asthma. Overall, teachers reported low asthma knowledge scores (mean score of 5.5 ± 3.3 out of a possible maximum of 14), and poor self-efficacy with only 6% agreeing that they can support a student having an asthma exacerbation on their own rather than sending the student to hospital. The study also demonstrated a strong interest by teachers to receive asthma education.

CONCLUSIONS

Interventions with regard to identifying students with asthma, asthma training for teachers, individualized asthma action plans, enhanced communication between school staff, parents and the medical team, and standard guidelines/policy are needed to provide a supportive school environment for primary school children with asthma.

Current Asthma Management Practices by Primary School Teaching Staff: A Systematic Review

BACKGROUND

The likelihood of children with asthma experiencing an exacerbation at school is significantly high when considering that they spend a substantial part of their day at school. This study, therefore, aimed to systematically review the literature to determine current asthma management practices by primary school teaching staff and any existing supporting legislation/policies/guidelines.

METHODS

Search terms were adapted to search literature across databases: CINAHL, Cochrane Library, Education Database-ProQuest, IPA, MEDLINE, SCI. Primary research studies, reviews, systematic reviews, and meta-analyses in English about primary school teaching staff dated between 2007 and 2017 were included. Primary outcomes comprised teaching staff' practices regarding asthma management and supporting guidelines, policies, or legislation.

RESULTS

Analysis of the 13 papers eligible for full review identified that: teachers were unable to deal with an asthma exacerbation; they lacked knowledge regarding exercise-induced asthma and that there was poor communication between schools and parents of children with asthma. The only documented relevant asthma legislation found pertained to New York schools.

CONCLUSIONS

Limited evidence regarding asthma management practices and inadequate asthma management knowledge amongst teaching staff highlight the need for supporting teaching staff with asthma policies and guidelines to minimize risks associated with inappropriate asthma management.

Improving teacher comfort and self-efficacy in asthma management

Background: Asthma is common among urban school-age children. Though teachers should be prepared to assist children during an asthma attack, studies show they lack self-efficacy in managing asthma.Objective: To assess feasibility of implementing an asthma workshop for elementary school teachers, describe themes of questions raised, and determine workshop's impact on teachers' comfort and self-efficacy in asthma management.Methods: We developed and implemented an asthma workshop for teachers from four Bronx elementary schools (2012-2014). Teachers completed a questionnaire evaluating their comfort and self-efficacy in asthma management before and after the workshop. Questions asked during the sessions were recorded and analyzed for themes. Paired t-test and McNemar tests compared before/after scores.Results: 65 out of 70 teachers (92.9%) participated in the educational sessions. Teachers asked questions about school policy for inhalers, medication administration guidelines, and physical activity and asthma. 64/65 (98.5%) teachers completed pre/post surveys (mean age 39.7 years; mean years at the school 8.0). Post-intervention, more teachers reported knowing how to manage an asthma attack (93.8% vs. 64.1%, p < .0001); and felt comfortable assessing (50.8% vs. 30.8%, p = 0.019) and handling an asthma attack (52.3% vs. 33.8%, p = .023). The overall mean self-efficacy score increased post-intervention (43.0 vs. 38.1, p < .0001), as did 8/12 individual self-efficacy items. Post-workshop, 95.3% of teachers agreed that teacher in-service asthma education should be done annually.Conclusions: An asthma workshop was successfully implemented in the school setting and improved teacher comfort and self-efficacy in managing asthma. Annual training may improve teachers' confidence in assisting students with asthma.

Asthma management in New York City schools: A physical education teacher perspective

OBJECTIVE

Physical education (PE) teachers may be the first to assist students with asthma attacks during PE class. This study explores the PE teachers' perspectives on in-school asthma management and barriers to physical activity (PA) in children with asthma attending urban elementary schools.

METHODS

We conducted qualitative semi-structured interviews with 16 PE teachers from 10 Bronx, NY elementary schools. Interviews were recorded, transcribed, and independently coded. Content analysis was used to identify 10 major themes common across interviews which were then categorized into 3 domains.

RESULTS

Three domains were identified: 1) school procedures and policies for asthma management; 2) role of PE teachers in asthma management; and 3) barriers to PA for students. Most PE teachers were unaware of written procedures for acute asthma management and did not receive asthma-specific training. Many PE teachers expressed confidence regarding asthma management. PE teachers identified students with asthma most commonly through communication with students. The PE teachers utilized various methods to manage asthma but all relied on the nurse to handle acute asthma symptoms. Several barriers to PA were determined, including PE teachers' unawareness of NYS PE requirements, lack of gym facilities, inclement weather, inconsistent PE class time, asthma diagnosis, and having no asthma inhalers at the nurse's office.

CONCLUSIONS

PE teachers' perspectives on asthma management may influence the way asthma is handled at school. The results from this study highlight several barriers that can be targeted in future interventions to improve asthma management.

Asthma management in school: parents' and school personnel perspectives

Objective: Effective asthma management at school can help students with asthma stay healthy, learn better and participate fully during their school day. This study sought to understand school-based asthma care from the perspective of parents and school personnel to improve asthma care at school. Methods: A cross-sectional study was conducted in Hartford, CT. School personnel from 59 schools and 322 parents/guardians were invited to participate. Four cross-sectional surveys using Likert-type scales assessed parental and school personnel satisfaction, confidence in managing asthma, policy awareness, management of asthma during physical activity, and perceived gaps surrounding school-based asthma care. Results: 263/322 (82%) eligible parents of children with asthma (mean age 8.5 ± 4.3, 56% Hispanic, 30% African American) completed surveys. Thirty six school nurses (62%), 131 teachers (8%), 14 coaches (14%), and 17 school principals (29%) participated. 90% of parents were satisfied with asthma management in school. School nurses were more aware of asthma policies than teachers (74% vs. 24%, p < 0.001). 34% of school nurses, 30% of teachers and 36% of coaches were unaware of asthma-related absences. 14% of physical education teachers/coaches reported no asthma training. Conclusion: In this convenience sample of parents and school personnel, parents reported overall satisfaction regarding the asthma care their children receive at school, yet a number of gaps pertaining to school-based asthma care were identified. Increased asthma training and enhanced communication among school personnel is needed to address these gaps. National guidelines and resources are readily available to improve asthma care at school.

Impact of scenario based training on asthma first aid knowledge and skills in school staff: an open label, three-arm, parallel-group repeated measures study

Objective: To test the hypothesis that scenario-based skills training is more effective than knowledge training alone in improving the asthma first aid skills of school personnel. Education developed specifically for non-primary caregivers such as school staff is vital to minimize the risk of mortality associated with asthma. Methods: Schools were allocated to one of three arms to compare AFA knowledge and AFA skills. Arm 1 underwent conventional asthma training, arm 2 underwent scenario-based training and arm 3 had a combination of the two. Conventional asthma training involved a didactic oral presentation. The scenario-based skills training required the participant to describe and demonstrate how they would manage a child having a severe exacerbation of asthma using equipment provided. Follow-up occurred at 3 weeks post baseline and again between 3-7 months after the first training/education visit. Results: Nineteen primary schools (204 participants) were recruited. One-way ANOVA and Bonferroni Post-Hoc Tests showed there was a significant difference in AFA skills scores between the study arms who underwent scenario-based training; arms 2 and 3 (91.5% and 91.1%) and arm 1 who underwent conventional asthma training (77.3%) (p < 0.001). AFA knowledge improved significantly in all study arms with no differences between study arms. Improvements seen in both AFA knowledge and AFA skills were maintained over time. Conclusions: Scenario-based training was superior to conventional didactic asthma training for AFA skills acquisition and overall competency in the administration of AFA and should be included in future asthma training programs.

Assessment of the knowledge of teachers about asthma and the availability of facilities for asthma care in public secondary schools in Lagos, Nigeria

Background

Asthma is a common chronic illness affecting young people. Asthma management at schools may be influenced by teachers' knowledge of the condition and the availability of treatment facilities.

Objectives

To assess the knowledge of secondary school teachers in Lagos, Nigeria, regarding asthma and to evaluate management options available at schools.

Methods

A descriptive cross-sectional study was conducted. Schools were selected by proportional sampling of the educational districts, followed by stratified single-stage cluster sampling. All consenting teachers in the 54 selected schools were recruited. A self-administered questionnaire was used for data collection. A composite score was calculated, with 32 as the maximum possible. Knowledge was regarded as poor if scores were <16, fair for scores between 16 and 21, and good if scores were ≥22.

Results

Results show that 475 (48.1%) of the respondents had poor knowledge, 414 (41.9%) had fair knowledge, and only 99 (10%) had good knowledge. Better knowledge about asthma was associated with personal experience (χ² =16.466; p=0.001) or history of a family member with the condition (χ² =6.412; p=0.04). Of the 54 schools surveyed, only 9 (16%) had a school clinic, while a school nurse was available at only 4 (7.41%) of the schools. None of the schools had access to a nebuliser in case of an asthma emergency.

Conclusion

Teachers in secondary schools in Lagos have unsatisfactory knowledge about asthma and are not equipped to support affected students during an asthma episode.

Systematic review and content analysis of asthma knowledge questionnaires: A focus on the knowledge surrounding acute exacerbation management

OBJECTIVES

Asthma education is a key component of asthma management. Asthma education around the management of a person who is having an acute exacerbation of asthma (often referred to as asthma first aid (AFA) training) is important, particularly in a school setting. There is no gold standard assessment of asthma knowledge and also there is no specific tool to measure the knowledge of AFA. Our aim was to identify asthma knowledge questionnaires and perform a content analysis. We were interested in evaluating the number, the type and the format of AFA questions.

METHOD

A literature search was performed to identify the instruments which were able to assess asthma knowledge of people with asthma and/or caregivers of people with asthma. An electronic database search was performed in EMBASE, IPA, MEDLINE and PUBMED. Articles which described the development or psychometric testing of an asthma knowledge questionnaire were included. The content of questions in each instrument was analysed and categorised using the NVivo software, and a secondary analysis was performed to identify knowledge questions relevant to the management of an acute asthma exacerbation.

RESULTS

Forty-four papers with 37 different instruments met the inclusion criteria. The majority of the instruments contained a relatively low proportion of questions related to the management of acute asthma, i.e., only 162 of the 780 questions (21%). No questionnaire had sufficient specific emphasis on acute asthma management knowledge to test the impact of AFA training.

CONCLUSION

There is a scope to develop an up-to-date validated acute asthma management knowledge questionnaire for use in research and clinical settings.

Perceptions about interpersonal relationships and school environment among middle school students with asthma

OBJECTIVES

To examine interpersonal relationships involving peers and teachers and perceptions about school environment among middle school students with asthma in comparison to their healthy counterparts. The study also assesses asthma prevalence in a large sample of middle school students representing different geographic locations.

METHODS

Cross-sectional data were collected from 1059 middle school students in grades 6-8 enrolled in schools in a northeastern region of the United States. Students reported their chronic health conditions including asthma and completed questionnaires measuring perceptions about their relationships with peers and teachers as well as school environment. Analyses of covariance (ANCOVAs) were used to compare students with asthma and their healthy counterparts in the study variables.

RESULTS

Asthma was reported by 16.5% of the sample (n = 169). The rate was higher among minority students (23%) than their white counterparts (15%). Greater proportion of urban students (28%) reported asthma than rural (18%) and suburban (14%) students. Students with asthma reported significantly poorer relationships with peers (B = -1.74, p <.001) and teachers (B = -1.41, p =.009), and their perceptions about overall school environment (B = -1.30, p =.009) were also lower than their healthy counterparts. Race showed no significant effects on school factors.

CONCLUSION

Overall asthma prevalence was substantially higher than the national average of adolescent asthma, particularly those residing in the urban area. Poor perceptions of interpersonal relationships with peers and teachers among students with asthma may indicate compromised quality of life. Suboptimal interpersonal relationships and school environment need to be identified and adequately addressed, given their implications for asthma management at the school setting among middle school students.

The school as a health promoter for children with asthma: The purpose of an education programme

BACKGROUND

Not only is asthma one of the leading causes of hospitalisation in children under 15 years and one of the main reasons for primary care outpatient visits, it also accounts for 13 million lost days of school annually, which can affect children's learning, integration at school and overall academic achievements.

MATERIAL AND METHODS

This review article highlights the important role of the school in helping children and adolescents to control and manage their asthma through integrated and coordinated actions of health professionals, school staff, family, and the community.

RESULTS

We recommended key elements for a multidisciplinary team asthma school programme that can be replicated and implemented especially in developing countries where children and adolescents are in a more disadvantaged environment.

CONCLUSION

This multidisciplinary asthma school intervention when demonstrated with efficacy can be applied in the context of the real world, where many children and families who need care the most currently do not receive it.

Knowledge of asthma in school teachers in nine Spanish cities

OBJECTIVE

To analyze the knowledge of asthma and its management in Spanish school teachers using the Newcastle Asthma Questionnaire (NAKQ).

DESIGN

Descriptive, observational prevalence study, using a self-report questionnaire on knowledge about childhood asthma and its management by teachers in pre-school, primary, and secondary schools in nine Spanish cities. Age, sex, academic training, teaching experience, courses in which they taught, and personal and family history of asthma, were collected from each teacher. For knowledge determination, the validated Spanish version of the NAKQ was used.

RESULTS

A total of 208 centers participated, including 7,494 teachers. The questionnaire was completed by 4,679 teachers (62.4%). The mean score of correct responses was 16.0 ± 4.8 points out of 31 (median = 17, range: 0-30). Only 6.8% of teachers were capable of pointing out the three main symptoms of the disease; 1.5% knew the triggering factors of an asthma attack; 8.6% knew two medicines useful during an asthma attack; 32.7% knew that inhaled medications had less side effects than pills, and only 3.8% knew of ways to prevent asthma attacks during exercise. In the multivariate analysis, variables significantly associated with a higher questionnaire score were a "lower age" (Beta coefficient = -0.09), "male gender" (Beta = 0.77), "being asthmatic" (Beta = 2.10), or "having close relatives with asthma" (Beta = 1.36) and "teaching in a private school" (Beta = 0.66) or in "compulsory secondary education" (Beta = 0.59).

CONCLUSIONS

Teachers have a low level of knowledge about asthma, with an important limitation in some aspects of the disease. They should be trained to recognize the main symptoms of the disease, on how to act in the event of symptoms, and the early identification of situations in which the pupils require health care assistance. Pediatr Pulmonol. 2016;51:678-687. © 2015 Wiley Periodicals, Inc.

Asthma management in New York City schools: A classroom teacher perspective

OBJECTIVE

Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management.

METHODS

We conducted key informant interviews with 21 inner-city classroom teachers from 3rd to 5th grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data.

RESULTS

Seven themes representing teachers' perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management; (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management.

CONCLUSIONS

Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students' asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.

Health-care conditions in elementary schools and teachers' knowledge of childhood asthma

BACKGROUND

For the adequate control of asthma in school-age children, it is recommended that teachers, school health personnel and administrators should have sufficient knowledge of how to manage asthma during school hours.

AIM

To investigate asthma health care in elementary schools, and teachers' knowledge of childhood asthma and its management.

METHODS

The extent of knowledge of childhood asthma in 2779 teachers in 141 elementary schools (children aged 6-14, grades 1-8) in Bursa, the fourth largest city in Turkey, was evaluated. Section I comprised questions about asthma health-care in schools, Section II teachers' knowledge of the main characteristics of asthma and Section III (Likert Scale) teachers' detailed knowledge of the signs, triggering factors, treatment and general knowledge of asthma.

RESULTS

The findings of Section I demonstrated that the organisation of health-care for asthma in schools was insufficient. Of the teachers questioned, 14·7% were not even aware and only 1% and 9·6% of the teachers had been made aware by school health personnel and school records, respectively, of asthmatic children. Only 27·3% of the teachers stated that they were responsible for the health of an asthmatic child. The majority of teachers (70%) said that asthmatic children could use the medication (e.g. inhalers) themselves. In Section II, there were between 44·1% and 75·5% correct answers, while in Section III this figure ranged from 3·3% to 78·4%. The correct answer rate was 60·4% for Sections II and III combined. The results of Sections II and III showed that the teachers' knowledge of asthma was poor in many respects. Teachers who stated that they had asthma or had first-degree relatives with asthma, or those with 10 or more years' experience provided significantly more correct answers in Sections II and III combined than did those without these characteristics (P<0·001).

CONCLUSIONS

There is a need to improve and standardise health care for asthma (asthma management policies) in schools. The implementation of asthma education programmes for teachers and other staff responsible for pupils' health should result in better control of this common disease.

Teachers' perspectives of supporting pupils with long-term health conditions in mainstream schools: a narrative review of the literature

Teachers are supporting an increasing number of pupils with long-term health conditions in mainstream schools. The aim of this literature review was to critically appraise and synthesise research that has examined teachers' perceptions of the key barriers and facilitators to supporting pupils with long-term conditions, teachers' training needs and interventions that aim to improve teachers' knowledge of long-term conditions, and teachers' confidence in supporting children and young people. A narrative literature review was conducted using a systematic search of computerised databases and manual searches of key journals and reference lists to retrieve studies published between 2003 and 2013. Studies were critically appraised and key themes across studies identified. In total, 61 papers from 58 studies were included in the review. The findings suggest that teachers receive little formal training relevant to long-term condition management and are fearful of the risks involved in teaching children and young people with long-term conditions. Communication between families, school and health and social care services appears to be poor. Educational programmes developed in conjunction with and/or delivered by healthcare professionals seem to have the potential to increase teachers' knowledge and confidence. This review suggests that healthcare professionals have an important role to play in supporting teachers in identifying and meeting the needs of pupils with long-term conditions. It is vital that pupils with long-term conditions receive appropriate care and support in schools to ensure their safety and help them to integrate with their peers and achieve their academic potential. Limitations in the current evidence are highlighted and implications for future research are identified.

Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review

Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s),” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.

Asthma interventions in primary schools--a review

OBJECTIVE

To explore, in depth, the literature for evidence supporting asthma interventions delivered within primary schools and to identify any "gaps" in this research area.

METHODS

A literature search using electronic search engines (i.e. Medline, PubMed, Education Resources Information Center (ERIC), International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Informit) and the search terms "asthma", "asthma intervention" and "school-based asthma education program" (and derivatives of these keywords) was conducted.

RESULTS

Twenty-three articles met the inclusion criteria; of these eight were Randomised Controlled Trials. There was much variety in the type, content, delivery and outcome measures in these 23 studies. The most common intervention type was asthma education delivery. Most studies demonstrated improvement in clinical and humanistic markers, for example, asthma symptoms medication use (decrease in reliever medication use or decrease in the need for rescue oral steroid), inhaler use technique and spacer use competency, lung function and quality of life. Relatively few studies explored the effect of the intervention on academic outcomes. Most studies did not report on the sustainability or cost effectiveness of the intervention tested. Another drawback in the literature was the lack of details about the intervention and inconsistency in instruments selected for measuring outcomes.

CONCLUSION

School-based asthma interventions regardless of their heterogeneity have positive clinical, humanistic, health economical and academic outcomes.

What do child daycare center teachers know about atopic dermatitis?

Atopic dermatitis (AD) is the most common childhood inflammatory skin disorder. The purpose of this study was to elucidate the knowledge level of daycare center teachers about AD and related factors. Study subjects were 297 teachers (287 female, 10 male) from 20 randomly selected daycare centers in Istanbul. The knowledge level of teachers was assessed using a questionnaire with 21 questions about AD. The teachers were asked nine additional questions about demographic and other characteristics of the child care centers and about themselves. The mean age of the teachers was 26.4 ± 8.1 years (range 20-53 yrs). The mean score for the 21 questions was 71.4 ± 12.1 (68%) from a maximum of 105 points. The response rate of teachers rate for each question ranged from 54% to 90%. The completely true response rate for each question ranged from 3.0% to 66.7%. The knowledge level of the teachers was related to the number of children in the daycare center, but not to sex, age, education level, family history of atopy, teacher's monthly salary, location, or whether the daycare center was public or private. Although teachers in daycare centers have some knowledge about AD, widespread educational programs for teachers about AD may help to improve the understanding of the disease and the quality of life of affected children in daycare centers.

Can asthma education improve the treatment of acute asthma exacerbation in young children?

Acute exacerbation of asthma requires timely and appropriate treatment. Young children are completely reliant on others in this respect. This paper aims to evaluate the effectiveness of staff asthma education programs in ensuring correct treatment for young children experiencing asthma exacerbations in formal care. A systematic review was undertaken of studies focusing on staff asthma education in relation to pharmacological treatment of acute asthma exacerbation. Three randomised controlled trials and seven uncontrolled pre- and post-test intervention studies were included for review. Asthma education was found to increase staff knowledge and confidence in managing asthma. There was a distinct lack of staff performance testing and studies undertaken in the pre-school setting. Staff asthma education appears effective in increasing asthma knowledge; however, utility of this measure is limited with respect to staff performance in treating acute asthma exacerbation. Further studies evaluating asthma education through performance are needed.

What level of knowledge do elementary school teachers possess concerning the care of children with asthma? A pilot study

A self-report questionnaire was used to assess the level of knowledge among a convenience sample of 34 elementary school teachers in a rural school district in Illinois. The questionnaire addressed general asthma knowledge and management, including signs and symptoms, triggers, and treatment. The results suggest a knowledge deficit among this sample of elementary school teachers; the average score was 75%. Teachers with an increased exposure/experience with asthma scored significantly higher than did those with limited exposure. Implications of these findings for schools in rural areas are discussed.

The international school nurse asthma project: barriers related to asthma management in schools

AIM

This article is a report of an international study of barriers to asthma care from the perspectives of school nurses in Reykjavik, Iceland and St. Paul, Minnesota, in the context of their schools, communities and countries.

BACKGROUND

Globally, asthma affects the health and school performance of many adolescents. School nurses play a key role by providing care to adolescents with asthma in school settings. Understanding universal barriers to asthma management in schools is important for developing interventions that are effective in multiple societal contexts.

DESIGN

Exploratory, descriptive study.

METHODS

Parallel studies were conducted from September 2008-January 2009, through six focus groups among school nurses (n = 32, in Reykjavik n = 17 and St. Paul n = 15) who were managing asthma in adolescents. Focus groups were audio-recorded and transcribed verbatim in English or Icelandic. The Icelandic transcripts were translated into English. Descriptive content analytic techniques were used to systematically identify and categorize types of barriers to asthma care.

RESULTS

School nurses in both countries identified common barriers, such as time constraints, communication challenges and school staff barriers. The primary difference was that St. Paul school nurses identified more socio-economic and health access barriers than school nurses in Reykjavik.

CONCLUSION

Greater cultural and linguistic diversity and socio-economic differences in the student population in St. Paul and lack of universal healthcare coverage in the US contributed to school nurses' need to focus more on asthma management than school nurses in Reykjavik, who were able to focus more on asthma prevention and education.

[Knowledge and attitudes of teachers on children with asthma]

INTRODUCTION

The right management of asthma in the school background is an important issue in order for the disease to make good progress.

AIMS

To find out the situation in schools in Tenerife, to identify the information teachers have about asthma in children, the origin of the information, experience, attitudes and the existence of working protocols in school centres, and educational needs.

INDIVIDUALS AND METHODS

284 teachers of 35 public, private and state financed schools. A survey with 11 questions was performed.

RESULTS

A total of 84% of the teachers were informed about the asthmatic pupils in class, of which. 27% attended to an asthma crisis during school hours. 64% admitted they did not know the main steps to control a seizure, and a 10% of this group had to attend to at least one (p<0.001). There were 58% who could help the child to administer the aerosol, but did not know the first steps on how to control a seizure, versus a 42%, who could not help and did not know those steps (p<0.001). Almost all (95%) expressed their intention to get such information.

CONCLUSIONS

The information and knowledge teachers have is limited and not recorded. The design of a program on educational intervention, as well as individualized information to teachers is needed, and must be suitable for those needs. The symptoms, first steps to stop a seizure and aerosol therapy technique should be considered as fundamental training.