Pulse
New Twist on School Screening
Those of us who grew up in Minnesota may recall the day when we were marched down to the school nurse’s office and queued up for scoliosis screening. One by one, we’d bend at the waist, with our knees straight and our arms hanging down, while the nurse looked at our backs. A few weeks later, a girl might show up in school wearing a back brace.
Although common across the state in the 1960s and 1970s, when schools had full-time nurses on staff, scoliosis screening has always been a voluntary undertaking. Today, with budgets that require school districts to share nurses among several buildings, scoliosis screening is less common. In fact, it’s controversial. The U.S. Preventive Services Task Force doesn’t recommend it, while groups such as the American Academy of Pediatrics aren’t ready to give up on the practice. Critics of the school screenings say they result in too many false-positive results that lead to unnecessary stress and radiation exposure for kids. And even the proponents admit that only 3 percent of children are found to have scoliosis and only a fraction of those need treatment. But some still believe schools are the right place to screen for scoliosis, given that it often develops during preadolescence, when children have less contact with their physicians than they used to.
Two years ago, the controversy prompted the Minnesota Department of Health to review its recommendations for school scoliosis screening, which hadn’t been updated since 2003. A task force came out with a new set of guidelines targeting only the population most likely to have scoliosis. The new recommendations call for screening of girls in the fall of fifth grade and spring of sixth grade (previously, the recommendation was to screen girls and boys and to screen eighth graders as well); using a scoliometer rather than a physical exam to measure trunk rotation; and referring children with a trunk rotation at or great than 6 degrees to a primary care provider, rather than rescreening those within the 5- to 6-degree range.
The thrust of the new recommendations is to make screening simpler for school nurses to perform, says Sarah Gutknecht, D.N.P., a pediatric nurse practitioner in orthopedics at Gillette Children’s Specialty Healthcare in St. Paul, who was a member of the committee that developed them. They’re a compromise, she says, between what might be ideal and what’s realistic. Although Gutknecht knows that many school nurses still won’t do scoliosis screenings—“they don’t have the time, they don’t have the resources,” she says—she still thinks they’re valuable. “I see the kids who were missed, and now they have to have a big spine surgery,” she says. “They wouldn’t have had to go through that.” –Carmen Peota
Academics Argument
In May, Gov. Tim Pawlenty signed the “Healthy Kids/Physical Education Bill” that, among other things, directs Minnesota schools to adopt National Association for Sports and Physical Education standards.
A 2003 law change had allowed individual districts to adopt their own standards. But as schools became strapped for cash, physical education was getting cut, according to Rachel Callanan, J.D., who leads the American Heart Association’s policy work on childhood obesity. “Our goal was to pass these standards to discourage school districts from seeing [physical education] as one of the areas to cut.”
Callanan says that although similar proposals had consistently met with resistance in the past, this year was different. A coalition of advocates (including the MMA) argued that childhood obesity not only has health implications, it affects learning. “There is a growing body of research that demonstrates that if kids are physically active, they do better in school,” Callanan says, noting that this year advocates stressed the academic success argument rather than the health argument. “The schools’ interest is academic performance,” she explains. She also notes that the bill provided no funding for school districts and that they were given three years to adopt the national standards.
Callanan sees the bill’s passage as the start of, rather than the end of, the state’s work on addressing childhood obesity. “This was the first year we made significant headway,” she says. “It’s a hopeful first step.”–Carmen Peota
Hospital Helps School Districts
When it comes to health class, it’s up to school districts in Minnesota to decide which subjects to teach and how many hours of instruction students should receive. “Minnesota is one of three states in the country that do not have state health [curriculum] standards,” says Jan Braaten of the Minneapolis Public Schools. “Districts are to come up with their own standards.”
Braaten, who led an initiative to revise her district’s standards and adopt a new curriculum in 2008, says even within the Minneapolis district, what was taught in elementary and middle schools varied, if health was taught at all. In order to make it easier for school districts in the Twin Cities metro area to provide—and pay for—health education, Children’s Hospitals and Clinics of Minnesota began underwriting the cost of an online curriculum last year. “Some health curricula isn’t as robust as it used to be. We felt this was an opportunity to fill in some gaps,” says Scott Leitz, director of child health policy and advocacy at Children’s.
The curriculum, called HealthTeacher, provides K-12 teachers with lesson plans on alcohol and other drugs, physical activity, anatomy, family health and sexuality, mental and emotional health, nutrition, and other topics. Leitz says one reason why Children’s chose it was because the curriculum is evidence-based. “It teaches things we know from the scientific research,” he says.
Braaten says the high schools and middle schools in Minneapolis began using HealthTeacher in the spring of 2010. The elementary schools will start using it this fall. “The health teachers loved it,” she says. “It gives them a resource at their fingertips. They can go in and find the lessons, materials, assessments.” Braaten likes the fact that the web-based curriculum is continuously updated. “You’re not dealing with a textbook that’s 10 years old.”
Leitz says 17 school districts in the metro area are using HealthTeacher. In the spring, Children’s surveyed teachers and found that 72 percent were satisfied or very satisfied with the curriculum. “We found that teachers have increased their own knowledge from working with HealthTeacher,” he says. “So it’s been effective for both teachers and kids.” –Kim Kiser
Summit Kicks Off Prevention Effort
On August 3, more than 200 doctors, teens, teachers, community leaders, and others from around the state convened in St. Paul and via teleconference to brainstorm ideas for combating the state’s chlamydia epidemic. The incidence of the sexually transmitted disease doubled in the last dozen years, peaking in 2008 with 14,350 new cases.
Ideas suggested at the summit include improving sex education in schools, increasing access to reproductive health care for teens, mandating routine testing, and focusing on treatment of sexual partners. A handful of work groups will use those ideas to develop a statewide prevention strategy by the end of the year.
Among the summit attendees was family physician Amy Gilbert, M.D., M.P.H., medical director of the Annex Teen Clinic in Robbinsdale. Gilbert says 14 to 18 percent of the young men and 8 to 10 percent of the young women who come to her clinic test positive for chlamydia. The clinic is one of a few in the state that routinely tests patients for chlamydia regardless of the reason for their visit.
Gilbert would like to see all of the state’s physicians keep chlamydia in their sights. “Too often doctors are saying, ‘Oh, my patients don’t have this; this isn’t in my population; my patients don’t need testing,’” she says. She points out that only a third of the state’s cases are in Minneapolis and St. Paul. “Doctors do not recognize how often this is a silent disease, how prevalent it is, and how widespread.”–Carmen Peota