|
House Passes Bill to Bar Schools from Requiring Medication of Students The United States House of Representatives voted May 21 to prohibit school personnel from requiring a child to obtain a prescription for a controlled substance as a condition of attending school. State education agencies would be required to develop policies and procedures to prevent schools from making such requirements. The bill passed by the House, H.R. 1170, the Child Medication Safety Act of 2003, would permit teachers and other school personnel to consult with parents or guardians about a student’s academic performance or behavior in the school, or the need for evaluation for special education, but would protect parents from being "coerced" by school personnel into medicating their children. In a report on the legislation, the House Committee on Education noted that it was concerned especially about the appropriate role of prescription medication in treating children diagnosed with attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). "The Committee has been made aware of situations where parents have voiced concern that local educational agency officials have required them to place children on psychotropic medication in order to attend school or receive services." "School officials should not presume to know what medication a child needs, or if the child even needs medication," the committee said in its report. "Only medical personnel have the ability to determine if a prescription for a psychotropic drug is appropriate for a child." The committee said it recognizes the validity of research showing that psychotropic drugs such as Ritalin "can be beneficial to some individuals when properly diagnosed and the medication is properly administered and monitored," but said it is concerned that "too often the easy answer of medication is utilized as a response for too many children." It also noted that treatment is improved by educational as well as medical interventions. The committee report stressed that the new legislation is not intended "to stifle appropriate conversation between school officials and parents about the behavior and academic achievement of the child." "School personnel spend many hours a day with a child and are able to observe a variety of situations and behaviors. When parents seek to discuss their child with a teacher or school official, school personnel should continue to be free to discuss their observations with the parent to ensure that the parent has sufficient information to make appropriate decisions regarding their child’s medical needs. However, the Committee cautions that such discussions should be mutual consulting conversations that describe and identify areas of concern, but which are not followed by recommendations of school personnel that would be construed as a medical diagnosis or a condition of attending school." The House-passed bill calls for a study by the General Accounting Office (GAO), the investigative arm of Congress, of:
The Controlled Substances Act (21 U.S.C. 812(c)) lists drugs in Schedules I, II, III, IV, or V, depending on the extent to which they have a medical use, are likely to be abused, and are likely to become addictive. As an example, Ritalin (methylphenidate, a central nervous system stimulant) is a Schedule II drug. The House-passed bill, H.R. 1170, must be approved by the Senate
and signed by the President before it can become law. The House Education
Committee’s report on the bill is H.Rept. 108-121. Texts of both
the bill and the committee report are available on website http://thomas.loc.gov.
Journal Summarizes What’s Known About Pediatric Food Allergy In a supplement to its June 2003 issue, the journal Pediatrics summarizes the current state of knowledge about food anaphylaxis in children, including clinical manifestations of allergies and emergency treatment of anaphylaxis. Noting that food allergies seem to be increasing in prevalence, the journal points out that such allergies are the most frequent cause of anaphylaxis outside of hospital settings. The American Academy of Allergy, Asthma and Immunology defines anaphylaxis as "a collection of symptoms affecting multiple systems in the body." The most dangerous symptoms include breathing difficulties and a drop in blood pressure, or shock, which are potentially fatal. Symptoms of anaphylaxis may develop within seconds or a few hours after ingestion of a food allergen, with the vast majority of reactions developing in the first hour. In general, the longer it takes for symptoms to develop, the less severe the reaction. One-third of children will experience a "biphasic response" in which they seem to recover and may be asymptomatic, and then experience a recurrence of symptoms. Fatal reactions have been reported after premature discharge from an emergency room in such a second-stage response. The intervening "quiescent" period generally lasts for one to three hours, so children should be observed for at least four hours after initial symptoms subside The list of foods implicated in anaphylactic reactions is unlimited, the supplement points out, though a few foods seem to provide the vast majority of severe allergic reactions in school-age children—primarily peanuts and tree nuts, fish (e.g., cod, whitefish), and shellfish (shrimp, lobster, crab, scallops, oysters). Those foods may cause fatal or near-fatal reactions, and they also tend to induce "persistent sensitivity" in most patients, in contrast to other foods such as milk, eggs, and soybeans, which are frequently associated with milder reactions and are usually "outgrown." There has been increased understanding during the past decade of the immunopathogenesis of food-allergic disorders, and that carries crucial lessons for diagnosing the disorders, the journal notes. "Most reports suggest that the earlier epinephrine is administered in the course of anaphylaxis, the better the chance of a favorable outcome. Although there are no specific guidelines, epinephrine for self-administration (EpiPen) should be prescribed to any individual at high risk of severe food-induced anaphylactic reactions, the supplement advises. Preloaded syringes with epinephrine are recommended for use in emergency situations, where families or caregivers may be distraught and the situation chaotic. Most authorities agree that any food-allergic child who is experiencing severe symptoms should be given intramuscular epinephrine and transported to a hospital immediately. A number of factors may lower the threshold for when to administer epinephrine (e.g., if nonmedical personnel are caring for the child or the child is more than 15 minutes from a medical facility)." In the school context, the supplement stresses the importance of having an EpiPen readily available and not locked away where only one or two individuals have access to it. But the life-threatening nature of anaphylaxis "makes prevention the cornerstone of therapy," the journal cautions. That means identification and complete avoidance of the responsible food allergen, particularly for children with a history of anaphylactic reaction, or allergy to peanuts, nuts, fish, or shellfish, Also in special need of prevention are allergic teenagers and patients on beta-blockers or enzyme inhibitors. The Pediatrics supplement includes articles on diagnostic evaluation
of food allergies; nutritional management of food hypersensitivity in
children; skin and respiratory manifestations of food allergies; and
daily coping strategies for patients and their families. Publication
was sponsored by the Food Allergy and Anaphylaxis Network and Jaffe
Food Allergy Institute of the Mount Sinai School of Medicine, New York,
NY. Reprints of the supplement are available from hugh.Sampson@mssm.edu.
IN CONGRESS The House of Representatives has passed one piece of school health legislation (see first article in this issue) but many other health-related bills are pending in Congress. Here is some of the legislation that has been introduced, which may or may not pass in this congressional session. Access to Dental Services A bill introduced in the Senate May 23 by Senator Jeff Bingaman (D-NM) and cosponsors would allow states to provide low-income families with wraparound dental coverage through the State Children’s Health Insurance Program (SCHIP) without having to drop their private insurance. Noting that children covered by Medicaid often have trouble finding dentists to care for them, the Bingaman bill would also provide $50 million annually as financial incentives to states to improve dental health services to Medicaid-eligible children and $40 million to community health centers to hire additional dental health professionals to serve low-income populations. The bill, S. 1142, Children’s Dental Health Improvement Act of 2003, has been referred to the Senate Committee on Finance. Vision Improvement The Children’s Vision Improvement and Learning Readiness Act of 2003, H.R. 2173, introduced in the House May 20 by Representative Bill Pascrell, Jr. (D-NJ), would establish a grant program to provide comprehensive eye examinations to children identified or considered at high risk of vision impairment, with priority given to school-based programs for children under the age of nine. The bill would also provide funding for subsequent treatment or services to correct vision problems and to develop materials on recognizing signs of visual impairment in children. Introducing his legislation, Pascrell noted that one in 20 preschoolers and one in four school-age children is estimated to have vision problems, but only 14 percent of children under the age of six receive a comprehensive eye examination and only one-third of children have had an eye exam or vision screening prior to entering school. Insuring Pregnant Women A group of House members is proposing to expand or add coverage of pregnant women under Medicaid and the State Children’s Health Insurance Program (SCHIP). The Start Healthy, Stay Healthy Act, H.R. 2268, specifies that "Any reference in this title to a targeted low-income child is deemed to include a reference to a targeted low-income pregnant woman," and "Any reference to a child is deemed a reference to a woman during pregnancy"—apparently a response to a Bush administration plan to insure unborn children, but not pregnant women, under SCHIP. Under the bill, introduced by Representative Ted Strickland (D-OH), children born to pregnant women receiving pregnancy assistance would automatically be enrolled at birth in a state’s child health plan, and the woman would receive postpartum care for at least 60 days following the last day of her pregnancy. Obesity Prevention An Obesity Prevention Act, H.R. 2227, introduced in the House May 22, would incorporate obesity prevention treatment and services into State Children’s Health Insurance Programs (SCHIP) and would provide nutrition and health education in after-school programs. Local education agencies would be eligible to apply for pilot project grants to promote healthful eating, increase opportunities for physical exercise, and provide nutrition education to teachers, coaches, food service staff, athletic trainers, and school nurses. Funds could not be used to "disparage an agricultural commodity, food, or beverage." Emergency Contraception Legislation introduced in the Senate in April would establish a public education and awareness program relating to emergency contraception, the regimen of birth control pills that can prevent pregnancy when taken within 72 hours of unprotected sex. The bill’s sponsor, Senator Patty Murray (D-WA) noted that emergency contraception does not cause abortion and will not interrupt an established pregnancy, but she pointed out that nine in ten women of reproductive age in the United States remain unaware of the method. The Senate bill is S. 896, and identical legislation introduced in the House by Representative Louise Slaughter (D-NY) is H.R. 1812. All bills referred to in this article may be read in full and tracked
on the Congressional Record website http://Thomas.loc.gov.
WORTH NOTING Researchers Look at Relationship of Condom Availability to Sexual Behavior A survey of 4,166 adolescents in Massachusetts high schools found adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in schools with condom availability programs were twice as likely to use condoms as their peers in schools where condoms were not available, but they were less likely to use other contraceptive methods, possibly accounting for the fact that researchers found no difference in pregnancy rates between the two types of schools. Importantly, the researchers said, sexual intercourse rates were not higher in schools where condoms were made available, "which supports recent research suggesting that condom distribution in schools does not lead to initiation of sexual activity." Researchers from the George Washington University School of Public Health and Health Services, the Academy for Educational Development, and the Massachusetts Department of Education conducted their study four years after Massachusetts adopted a state policy that explicitly encouraged school board consideration and public discussion of condom availability programs and instruction. Reprints of their article, "Condom Availability Programs in Massachusetts High Schools: Relationships with Condom Use and Sexual Behavior," which appeared in the June 2003 issue of the American Journal of Public Health, are available from smblake1@aol.com. A Study of Health-Related Quality of Life in Urban School Children A study that asked children in second, third, and fifth grades in six urban K-8 schools and their parents to rate their health-related quality of life found that "healthy" young urban children see their health-related quality of life as poorer than that of children with known chronic health conditions. "It is possible," researchers said, "that the psychosocial and emotional well-being of urban children is so poor that as a group they function similarly to children with chronic illness." Noting that schools "are pivotal to children’s intellectual, social, and emotional development," the researchers looked at school connectedness--measured by absences, feeling safe at school, getting along with others, and how much students feel teachers care for them--as a factor in children’s perceptions of their well-being. They concluded that although many of the predictors of low health-related quality of life are not modifiable, school connectedness is a potentially modifiable factor. "Health and educational programs and school health services provided through school-linked and school-based health centers may be one mechanism to improve a child’s attachment to school with concurrent reduction in risk-taking behaviors," they concluded. Reprints of the article, "Health-Related Quality of Life in Urban Elementary Schoolchildren," which appeared in the June 2003 issue of the journal Pediatrics, are available from Mona.monsour@chmc.org. A Ten-Year Follow-up Finds Early Drinkers Have Later Problems Individuals who became drinkers in seventh grade were more likely than nondrinkers to report academic problems, substance use, and delinquent behavior in both middle school and high school; and by young adulthood, early alcohol use was associated with employment problems, other substance abuse, and criminal and violent behavior, according to a study by RAND. Researchers who followed to age 23 individuals who began drinking at seventh grade level in 30 California and Oregon schools concluded that "Early drinkers do not necessarily mature out of a problematic life style as young adults." The researchers recommended that interventions for these high-risk youth should start early and address their other health problems, particularly their tendency to smoke and use other illicit drugs. Noting that seventh-grade drinkers generally have many other problems, the researchers suggested that efforts to curb early drinking may be more effective if they also address the co-occurring problems, which often include poor academic performance, absence from school, violent and criminal behavior, illicit drug use, and risky sexual behavior. The RAND study was published in the May 2003 issue of the journal Pediatrics. Reprints of the article, "Ten-Year Prospective Study of Public Health Problems Associated with Early Drinking," are available from phyliss.ellickson@rand.org. May News Alerts The following information appeared during the month of May 2003 in the News Alerts section of this website. World Asthma Day 2003 The United States May 6 joined a worldwide effort to increase public awareness of the burden imposed by asthma and to promote better diagnosis and treatment. In the U.S. asthma is the most common chronic health condition; more than 20 million Americans, including 6 million children, suffer from it. At all ages, African-Americans are most likely to visit emergency rooms, be hospitalized, and die from asthma. The National Heart, Lung, and Blood Institute of the National Institutes of Health is the U.S. coordinator for World Asthma Day and has established "Communities Working for Life and Breath" as the national theme to emphasize that asthma affects all members of the community, not just those with the condition, and that communities must fight the potentially life-threatening illness if progress is to be made. In a separate but related announcement, the American Lung Association in a report released this month noted that nearly half of all Americans breathe air that is polluted with ozone (smog), which leads to major respiratory problems especially for children with asthma and people with chronic bronchitis and emphysema. The report, "State of the Air, 2003," is available on the Lung Association’s website at http://lungaction.org/reports/stateoftheair2003.html. Head Lice and the Individuals with Disabilities Education Act A disabled student receiving special education was not entitled to compensatory education when she was excluded from school for 19 days for head lice, the Commonwealth Court of Pennsylvania decided April 4. Although the Individuals with Disabilities Education Act (IDEA) requires that compensatory education be provided if a student receiving special education is suspended or expelled from school for more than 10 days, that applies only when the student is out of school for disciplinary reasons, the court said. Lizzy S. was sent home not as a disciplinary measure but in conformance with the school district’s "no lice/no nits" policy; and she was therefore not entitled to compensatory education during or after the exclusion, the court held. The ruling applies only in Pennsylvania but may be cited as precedent by other state courts. The case was Souderton Area School District v. Elisabeth S., in the Commonwealth Court of Pennsylvania, No. 2379 C.D. 2002. Report Cites Role of School Food in Obesity While schools and school food programs cannot be expected to solve the problem of childhood obesity alone, some school actions may be contributing to the problem, according to a report released May 9 by the U.S. General Accounting Office (GAO). The report notes that a relatively small percentage of school districts have policies in place that require the sale of healthful choices or restrict sale of foods with little nutritional value. Only about 19 percent of districts require schools to offer fruit and vegetables as a la carte items, and only 23 percent of districts require schools to prohibit the sale of foods that have little nutritional value as a la carte items. Half of school districts have a contract that gives a company rights to sell soft drinks at schools in the district, and most of those districts receive a percentage of the sales receipts or other incentives. Also, in most schools, organizations such as student clubs, sports teams, and parent-teacher associations sell food to raise money, and the food is typically high in fats and sugars. In the regular, USDA-reimbursed school food program, school food officials are often reluctant to offer new and more healthful foods on the grounds that students may not buy them, thereby reducing the reimbursement the schools will receive from the Department of Agriculture. Schools that allow sale of alternative fast foods in their cafeterias in competition with more healthful school lunches told the GAO they needed the money to help balance their budgets. On another point –whether schools are offering classroom education about healthful eating—school officials told the GAO that the current emphasis on making sure students meet academic standards is leaving little time for subjects not on the state academic standards test. Legislation introduced in the U.S. Senate May 7 by Senators Leahy, Lugar, Bingaman, Dodd, and Jeffords cites the obesity crisis and urges the Secretary of Agriculture to investigate the sale of foods that are outside the federal meal programs and issue regulations or enforce restrictions now in place on the sale of competitive foods from other sources, such as vending machines. In introducing his bill, S. 1007, Senator Leahy said, "We canot sell our children’s health to the highest bidder on a sodas contract." Random Testing Doesn’t Deter Student Drug Use, Study Finds Although the United States Supreme Court has twice ruled that it isn’t unconstitutional for schools to conduct random testing of students for drugs, even when there is no reason to suspect individual students of drug use, a federally funded study now concludes that the threat of random, suspicionless testing has little or no effect on students’ attitudes about drugs. Conceding that their study has some flaws, including that they got their data on testing from administrators—usually principals—and not from students themselves, researchers at the Institute of Social Research at the University of Michigan said they found no statistically valid difference between student drug use in schools that had testing programs and those that did not. In two rulings—the Vernonia case in 1995 and the Earls case in 2002—the Supreme Court cited its expectation that random testing of athletes and students involved in extracurricular activities would deter drug use. Only a small fraction, about five percent, of schools—usually high schools—are currently believed to conduct random, suspicionless testing for drugs, and in those that do there are many opportunities for mistakes, the researchers said, ranging from sloppy procedures to students’ skills at faking test results. Drug testing is costly; a single standard test to detect marijuana, tobacco, cocaine, heroin, opiates, amphetamines, barbiturates, and tranquilizers can range from $14 to $30 per test, while a test for steroids costs $100. The article, "Relationship Between Student Illicit Drug Use and School Drug-Testing Policies," appeared in the April 2003 issue of Journal of School Health. Survey Finds Misperceptions about AIDS Vaccine Research to find a vaccine to prevent the human immunodeficiency virus (HIV) is under way in more than 60 medical research centers in the United States, but many Americans are convinced that such a vaccine already exists, according to the National Institute of Allergy and Infectious Diseases (NIAID) in the National Institutes of Health. Twenty percent of adults in the general population and almost half of African Americans and a quarter of Hispanics surveyed believe an HIV vaccine is being kept secret. To try to clear up the misperceptions, the NIAID and 100 organizations gave special recognition May 18 to the contributions of researchers and volunteers who are currently participating in HIV vaccine development and testing. In the United States, an estimated 900,000 people are living with HIV, and new infections occur at the rate of 40,000 a year, half of them in people of color. Young people under the age of 25 account for half of all new HIV infections in the United States. Information on HIV vaccine research is available at www.hvtn.org.
-----------------------------------------------------------------
|