Application of Components of the Massachusetts' Sports Concussion Regulations to All Students With Concussion: A Survey of School Nurses.

Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state's sports concussion regulations to all students with concussion, not just student athletes. We surveyed high school nurses in Massachusetts to examine (1) the extent of this practice and (2) the extent to which protocols for all students with concussion are included in school policies. Of 168 (74%) responding, 94% applied the return-to-learn and play, and medical clearance requirements to all students with concussion, regardless of how or where the concussion occurred and 77% reported their school's policy required these protocols for all students with concussion. A significant association (odds ratio: 13.3, 95% confidence interval [2.4, 72.8], p <.01) existed between the two measures. These findings have important clinical and academic implications.

Evaluation of Implementation of Massachusetts Sports Concussion Regulations: Results of Focus Groups With School Nurses and Athletic Trainers.

In 2015, the Massachusetts Department of Public Health conducted focus groups with school nurses (SNs) and athletic trainers (ATs) from Massachusetts middle and high schools to assess implementation of legislated regulations relative to the management of students' head injuries incurred during extracurricular sports. Four tape-recorded focus groups were conducted by experienced facilitators. Lists of themes were synthesized by investigators for each focus group. Participating SNs and ATs supported the sports concussion legislation, felt that implementation had gone well, indicated that the law empowered them in managing return-to-school/play for students with concussion, and experienced support from their school administrators. Some SNs reported that they had applied relevant procedures to all students with head injuries, regardless of how or where the injury occurred. Challenges identified included protocols for away games, inconsistent concussion care by physicians, and a need for teacher education. Further research is required to quantify these findings.

Declining Trends and Widening Disparities in Overweight and Obesity Prevalence Among Massachusetts Public School Districts, 2009-2014.

OBJECTIVES: We evaluated the overall and sociodemographic disparities in trends in prevalence of childhood overweight and obesity in Massachusetts public school districts between 2009 and 2014. METHODS: In 2009, Massachusetts mandated annual screening of body mass index for students in grades 1, 4, 7, and 10. This was part of the statewide Mass in Motion prevention programs. We assessed trends in the prevalence of overweight and obesity between 2009 and 2014 by district, gender, grade, and district income. RESULTS: From 2009 to 2014, prevalence decreased 3.0 percentage points (from 34.3% to 31.3%) statewide. The 2014 district-level rates ranged from 13.9% to 54.5% (median = 31.2%). When stratified by grade, the decreasing trends were significant only for grades 1 and 4. Although rates of districts with a median household income greater than $37, 000 improved notably, rates of the poorest remain unchanged and were approximately 40%. CONCLUSIONS: Although overall prevalence began to decrease, the geographic and socioeconomic disparities in childhood obesity are widening and remain a public health challenge in Massachusetts. Special efforts should be made to address the needs of socioeconomically disadvantaged districts and to narrow the disparities in childhood obesity.

Cost-benefit study of school nursing services.

IMPORTANCE: In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. OBJECTIVE: To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. DESIGN, SETTING, AND PARTICIPANTS: Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. INTERVENTIONS: School health services provided by full-time registered nurses. MAIN OUTCOMES AND MEASURES: Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. RESULTS: During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. CONCLUSIONS AND RELEVANCE: The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

The evolution of school nursing data indicators in Massachusetts: recommendations for a national data set.

The National Association of School Nurses' research priorities include the recommendation that data reliability, quality, and availability be addressed to advance research in child and school health. However, identifying a national school nursing data set has remained a challenge for school nurses, school nursing leaders, school nurse professional organizations, and state school nurse consultants. While there is much agreement that school nursing data (with associated data integrity) is an incredibly powerful tool for multiple uses, the content of a national data set must be developed. In 1993, recognizing the unique power of data, Massachusetts began addressing the need for consistent school nurse data collection. With more than 20 years' experience--and much experimentation, pilot testing, and system modification--Massachusetts is now ready to share its data collection system and certain key indicators with other states, thus offering a beginning foundation for a national school nursing data set.

The Role of Social Support vs. Modeling on Adolescents' Diet and Physical Activity: Findings from a School-based Weight Management Trial.

OBJECTIVE: Social influences play an important role in shaping adolescents' dietary and physical activity behaviors. We examined the role of perceived modeling and perceived social support from family and friends on diet and physical activity behaviors among overweight and obese adolescents participating in a weight management trial. METHODS: Six high schools were randomized to a school-nurse delivered behavioral weight management intervention or an information attention-control. Data on perceived support and modeling of healthy eating and physical activity from family and friends and dietary and physical activity behaviors were obtained from participants (N=82) at baseline and 2- and 6-months follow-up. RESULTS: Linear mixed models were used to examine associations between social factors at baseline and diet and physical behaviors at 6 months. Friend support was correlated with increased fruit and vegetable consumption (0.4 servings/day) and decreased added sugar intake (-14.2 grams/day) (p's<0.05). Family support for physical activity, friend support for physical activity, and family modeling of physical activity were associated with increased number of days/week active for ≥ 60 minutes/day (0.7 days/week; 0.6 days/week; and 0.4 days/week, respectively, p's<0.05). CONCLUSIONS: Among overweight and obese high school adolescents, support from family and friends was associated with a greater number of improvements in diet and physical activity at follow-up than modeling. Strategies to solicit support may maximize efficacy of adolescent obesity intervention efforts.

Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity.

OBJECTIVE: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. SETTING AND PARTICIPANTS: Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff. MAIN OUTCOME MEASURE: Stakeholders' perceptions. ANALYSIS: Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories. RESULTS: Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies. CONCLUSIONS AND IMPLICATIONS: Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials.

Factors influencing the development of a hepatitis C exercise protocol: a literature review.

Chronic hepatitis C (HCV) varies greatly in its course and outcomes. Reports of fatigue and other symptoms are common during treatment and when patients are not receiving treatment. Exercise as a form of treatment for HCV-related fatigue has had little attention in research studies, yet data from studies in closely related chronic conditions consistently report the value of exercise for maintaining and improving health and reducing risk factors. This article examines the factors influencing the development of an exercise protocol as an adjunct to health promotion in patents with HCV. A review of the current literature summarizes findings from the areas of exercise in chronic illness states, exercise measures, and exercise prescription as treatment for chronic illnesses, with a focus on HCV. Nurses should consider these factors when developing an exercise protocol as an alternative treatment for side effects and symptoms related to hepatitis C and other chronic conditions. More research on specific exercise prescriptions should be undertaken and reported in the literature.