Association of School Infrastructure on Health and Achievement Among Children With Asthma.

OBJECTIVE: To determine whether school infrastructure is associated with health and academic outcomes among elementary school children with asthma. METHODS: We conducted a retrospective cohort study of linked medical, academic, and facilities data from a large mid-Atlantic school district of the United States. All K-5 students with asthma who were enrolled under the state's Children's Health Insurance Program were included. We estimated associations of the infrastructure quality of the student's school, as assessed by an engineering firm in Summer 2011 and represented by the Facility Condition Index (FCI), with asthma health outcomes, absenteeism, and standardized test scores in math and reading in the 2 academic years thereafter. RESULTS: A total of 6558 students were identified, the majority non-Hispanic Black, across 130 schools. Most schools (97/130, 75%) were in very poor or worse condition. In cluster-adjusted models accounting for demographics, grade, school-specific area deprivation, and inhaled corticosteroid use, a one standard deviation increase in FCI, corresponding to greater infrastructure deficiency, was associated with higher rates of asthma-related hospitalizations (incidence rate ratio [IRR] 1.16; 95% confidence interval [CI] 1.03, 1.32), more absenteeism (IRR 1.05; 95% CI 1.01, 1.08), and lower scores in math (mean difference [MD] -3.3; 95% CI -5.5, -1.2) and reading (MD -3.0; 95% CI -5.1, -0.9). There were no differences in rates of asthma-related emergency visits or steroid prescriptions. CONCLUSIONS: Children with asthma attending schools with poorer infrastructure had worse health and academic outcomes. Public policy emphasizing reinvestment in school infrastructure may be a potential means of addressing asthma disparities.

Indoor Air Quality Prior to and Following School Building Renovation in a Mid-Atlantic School District.

Children spend the majority of their time indoors, and a substantial portion of this time in the school environment. Air pollution has been shown to adversely impact lung development and has effects that extend beyond respiratory health. The goal of this study was to evaluate the indoor environment in public schools in the context of an ongoing urban renovation program to investigate the impact of school building renovation and replacement on indoor air quality. Indoor air quality (CO2, PM2.5, CO, and temperature) was assessed for two weeks during fall, winter, and spring seasons in 29 urban public schools between December 2015 and March 2020. Seven schools had pre- and post-renovation data available. Linear mixed models were used to examine changes in air quality outcomes by renovation status in the seven schools with pre- and post-renovation data. Prior to renovation, indoor CO measurements were within World Health Organization (WHO) guidelines, and indoor PM2.5 measurements rarely exceeded them. Within the seven schools with pre- and post-renovation data, over 30% of indoor CO2 measurements and over 50% of indoor temperatures exceeded recommended guidelines from the American Society of Heating, Refrigerating, and Air Conditioning Engineers. Following renovation, 10% of indoor CO2 measurements and 28% of indoor temperatures fell outside of the recommended ranges. Linear mixed models showed significant improvement in CO2, indoor PM2.5, and CO following school renovation. Even among schools that generally met recommendations on key guidelines, school renovation improved the indoor air quality. Our findings suggest that school renovation may benefit communities of children, particularly those in low-income areas with aging school infrastructure, through improvements in the indoor environment.

Asthma and Attendance in Urban Schools.

INTRODUCTION: Asthma is linked to student absenteeism, a risk factor for poor achievement and school dropout. Studies of asthma and absenteeism have common limitations, including relying on parent-reported asthma, which may be unreliable and prone to selection, and inadequately accounting for confounding health and social risks. Therefore, the rate of absenteeism attributable to asthma and the extent to which better asthma control would translate into better attendance remain unclear. METHODS: Participants were 1,194 students in 2 large urban US schools (1 elementary, 1 middle) in 2016-2018. Student asthma was assessed based on parent report on health forms, student-reported asthma-related emergency department/hospitalization or medication use, and school health center record of asthma. Multiple imputation was used to reduce selection from missing asthma reports. The relationship between asthma and school district-reported days absent was estimated using Poisson random intercept regression, accounting for health and demographic covariates. RESULTS: Parent-reported ever asthma (27%) was not associated with absenteeism in adjusted models. Student-reported asthma health care or medication use (16%) and school health center record of asthma (17%) were associated with higher absenteeism (incidence rate ratio [IRR], 1.16; 95% confidence interval [CI], 1.01-1.35 and IRR, 1.21; 95% CI, 1.09-1.34, respectively). Student-reported asthma and school health center record of asthma were associated with 1.9 and 1.5 absences per year, respectively. CONCLUSION: Student-reported and school health center record of asthma explained 14% to 18% of student absenteeism, even after accounting for other health and social risks. When possible, student reports should supplement parent reports to ensure that students with asthma are identified and obtain access to care.

Introduction: U.S. Homophile Internationalism.

This article introduces "U.S. Homophile Internationalism," a special issue of the Journal of Homosexuality. The introduction provides a broad overview of the "U.S. Homophile Internationalism" archive and exhibit, which was published on the Outhistory Web site in 2015. The archive and exhibit consists of more than 800 U.S. homophile magazine articles, letters, and other items that referenced non-U.S. regions of the world from 1953 to 1964. The essays in the special issue focus on (1) Africa; (2) Asia and the Pacific; (3) Canada; (4) Latin America and the Caribbean; (5) the Middle East; and (6) Russia, the Soviet Union, and Eastern Europe. There is also an article that addresses the public history and digital humanities dimensions of the project. The introduction concludes by discussing the essays' common goals, themes, and concerns.

Sex With Neighbors: Canada and Canadians in the U.S. Homophile Press.

This article examines U.S. homophile magazine contributions from and representations of Canada from 1953 to 1964. Drawing on 240 articles, letters, and other items that were published in ONE, Mattachine Review, and The Ladder, the essay first reviews Canadian-authored materials and then shows that U.S. gay and lesbian movement periodicals depicted Canada as more sexually conservative than the United States in three ways and more sexually liberal in one way. The magazines presented Canada as more sexually conservative in its failure to develop an organized gay and lesbian movement, its policies and practices of sexual censorship, and its opposition to progressive homosexual law reform. They portrayed Canada as more sexually liberal in the ways that its mainstream media covered homosexuality. The essay argues that U.S. homophile representations of Canada participated in the ongoing construction and reconstruction of U.S. nationalism. In demonstrating that the magazines generally represented Canada as more sexually conservative than the United States in the years from 1953 to 1964, the essay also shows that more recent depictions of Canada as more sexually liberal are relatively new.

The clinical relevance of microbiologic testing. Part 2: a comparative analysis of microbiologic samples secured simultaneously from the same sites and cultured in the same laboratory.

A field study using four different private periodontal practices and two independent laboratories was conducted to compare two microbiologic cultures sampled simultaneously from the same sites in 20 individual patients. Both paired samples were submitted separately to one of the two independent laboratories for bacterial identification and antibiotic sensitivity testing. The results from the two samples were quite variable. In only two instances did both specimens reveal the presence of identical bacterial species, but these specimens differed in both threshold levels and antibiotic sensitivity. When only bacteria above threshold levels were compared, total agreement was found in 11 of 20 cases. When examining antibiotic sensitivity, using 100% kill as the ideal, agreement between the two specimens was inconsistent The use or nonuse of tetracycline was in agreement 85% of the time, amoxicillin 75% of the time, metronidazole 70% of the time, and amoxicillin-metronidazole in combination 85% of the time. The two specimens agreed on the empirical use of amoxicillin 45% of the time, tetracycline 60% of the time, and metronidazole 60% of the time. The empirical use of amoxicillin-metronidazole in combination yielded 80% agreement when the results of both specimens were combined. The empirical use of amoxicillin-metronidazole combination therapy may be more clinically sound and cost effective than culturing and antibiotic selection based on the culture from any single microbiologic testing laboratory. This supports the data from a previous study that examined specimens secured simultaneously from the same site and submitted to two different testing laboratories. The failure of microbial testing to achieve a higher level of consistency between samples leaves the clinical efficacy of microbial testing in question.