Datagrams. Planned expansion of medical school enrollment.
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PURPOSE: This study examined the influence of school enrollment on the spectrum of adolescent problems seen in emergency department. METHODS: Medical charts of all adolescent patients presenting to an urban general emergency department for 2 years (1991-1993) were retrospectively reviewed. Data obtained included date, time, and means of arrival, triage acuity score, primary diagnosis with disposition, and whether enrolled in school. RESULTS: Of 3,269 charts reviewed, 36% of visits were the result of injuries and 64% owing to acute medical complaints. Of all visits, 7% were for sexually related complaints. A total of 86% of adolescent patients had no medical insurance or federal assistance. Based on emergency department triage criteria, 40% of all visits were judged nonemergency. Ambulance arrivals accounted for 4%, admissions 4%, and those not currently enrolled in school 40%. Adolescents not enrolled in school had a similar spectrum of medical illnesses and significantly more injuries (45% vs. 30%), and were triaged as emergency (8% vs. 4%) or nonemergency (48% vs. 34%) significantly more often than adolescents enrolled in school. There were no significant differences by sex or race. CONCLUSIONS: Adolescents use the emergency department as a source of primary care and injury treatment. Adolescents presenting to the emergency department who are not enrolled in school have significant differences in diagnosis and severity of illness compared with adolescents enrolled in school. General emergency departments must be prepared to deal with the unique needs of all adolescents, especially those not enrolled in school, including nonemergency primary care and injury management.
UNLABELLED: School health programmes have been identified as a cost-effective strategy to reduce morbidity due to soil-transmitted helminths in the school-age population, but the low rate of school enrollment in developing countries is a major factor limiting their success. OBJECTIVE: The present study was conducted to identify reasons for non-enrollment and to evaluate differences in the occurrence of helminth infection between enrolled and non-enrolled children in Zanzibar, United Republic of Tanzania. METHOD: A questionnaire was submitted to 520 households to obtain information about enrollment and other socio-economic indicators. In addition, one school-age child was randomly selected in each household and investigated for soil-transmitted helminth infection. RESULTS: Overall, 71% of school-age children were enrolled. Enrollment increased with age. Only 41% of children under 9 years of age were enrolled compared to 91% in children older than 12 years. Enrollment is delayed because of an insufficient number of schools. Among non-enrolled school-age children, the proportion of heavy intensity infections was twice that of enrolled school-age children. CONCLUSIONS: Most of the non-enrolled school-age children live together with enrolled siblings in the same household, thereby representing an important opportunity for effective outreach activities. The effectiveness of the school-based helminth control programme in reducing the intensity of infection was confirmed. The significant gains achieved by enrolled school-age children in this study must be viewed as an attainable goal for the important numbers of non-enrolled school-age children in endemic areas. Decision-makers must ensure that outreach activities are included in helminth control programmes targeted to school-age children.
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The physical examinations at school enrollment of the years 1999 to 2004 were subjected to comparative analysis to help clarify whether children's language performance at enrollment has significantly decreased in recent years or not. This question has indeed been a matter of public debate for some time. Furthermore, potential influencing factors, in particular social environment, were to be examined as regards their effects on language performance. The results indicate that the children's performance level has not significantly decreased over the six-year period of observation. Instead, rather an increase can be observed over this period of time. If, nevertheless, more and more and, in particular, more significant language deficits continue to be observed, one explanation for this may be seen in a changing assessment of children's needs for therapy or remedial education. The performance level of children who were recommended therapy or means of remedial education in 2004 is significantly higher than that of children for whom such recommendations were given in 1999 or 2000. Perhaps an increased sensitivity for those performance areas where performance levels are found to be deficient should be postulated, and, consequently, a more differentiated assessment of diagnostic findings should be assumed. The results of the examinations once again demonstrate the enormous influence that social factors have on language performance. Children growing up in a less advantaged social environment tend to achieve significantly lower performance marks in language tests than children from more privileged social environments. Also the duration of kindergarten education appears to be relevant to children's language performance: children who have visited institutions of preschool-education for three or more years achieve higher performance marks than children who have spent no ore only little time in these institutions. When seen against the background of circa one in four children with a migration background (around 8% of persons of the same age in Münster's population) having unsatisfactory knowledge of German at school enrollment, there appear to be efficient prevention measures available here.
Adoption has increased in China since 1980 when the government started the one-child policy. There were approximately six million adopted children living in China in 1988. The objective of this study was to compare adopted and biological children in one-child families across a number of measures of physical well-being and school enrollment. The 1992 National Sample Survey on the Situation of Children provided data on 2458 adopted and 194,760 biological children aged 0-14 years living in one-child families. Logistic regression models were used to adjust for confounders. We found that adopted children were not significantly different from biological children in reported diarrhea and nutritional outcomes (stunting, underweight, wasting) after controlling for other known demographic, socioeconomic and geographic correlates. However, there was evidence of significantly higher odds of never being immunized and not being currently enrolled in school, and evidence of slightly lower odds of having fever or acute respiratory infections among adopted children compared to biological children. These results suggest that adopted children were as healthy and well-fed as biological children, but adopted children aged 7-14 years were less likely to be enrolled in school than biological children.
We examine the impact of orphanhood on children's school enrollment in 10 sub-Saharan African countries. Although poorer children in Africa are less likely to attend school, the lower enrollment of orphans is not accounted for solely by their poverty. We find that orphans are less likely to be enrolled than are nonorphans with whom they live. Consistent with Hamilton's rule, the theory that the closeness of biological ties governs altruistic behavior, outcomes for orphans depend on the relatedness of orphans to their household heads. The lower enrollment of orphans is largely explained by the greater tendency of orphans to live with distant relatives or unrelated caregivers.
"This paper has two related purposes. The first is to present an argument for the systematic use of public school enrollments data to study family mobility at the community level. The second is to demonstrate the utility of these data for mobility research. This is accomplished with case studies, chosen for distinctive patterns of movement which have produced observed changes in enrollments data, and which correspond to migration patterns of interest to research. The case studies are illustrative of the potential for the use of these data to illuminate patterns of movement that might otherwise go largely undetected."
Perceptions of an impending oversupply of physicians have prompted proposals to reduce medical school enrollments in a number of states. Most of these states are also concerned with improving the specialty and geographic distribution of their medical manpower. The present study provides estimates of the effects of reduced numbers of in-state medical school graduates upon the future supply of physicians in Texas, and examines the medical school origin, medical specialty, and practice location of selected groups of Texas physicians. The results suggest that in Texas enrollment reductions would have no significant impact on physician supply over the next 15 years, and might actually prove counterproductive in altering physician distribution. The analysis of Texas data illuminates the unintended consequences likely to accompany a policy option that has been widely embraced by state officials largely on the basis of its intuitive appeal.
The search for policy options to contain health-care costs has sparked renewed national interest in reducing medical school enrollments. Concurrently, the goals of improving the specialty and geographic distribution of physicians have proved elusive both at the state and national levels. This study reexamines and reaffirms the conclusions of an earlier study that suggested enrollment reductions in Texas might decrease rather than increase the supply of primary care and rural physicians.
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OBJECTIVE: To determine the prevalence of neurofibromatosis 1 (NF1) among 6-year-old children in Germany. SETTING AND PATIENTS: A total of 152819 children aged 6 years in 6 German states were screened for NF1 during routine medical examinations at elementary school enrollment in cooperation with local health departments in 2000 and 2001. MAIN OUTCOME MEASURE: The prevalence of NF1 among 6-year-old German children was estimated to be 1:2996 (95% confidence interval, 1:2260 to 1:3984). RESULTS: Fifty-one NF1 cases were identified and confirmed by evaluation by appropriate medical specialists. Seven other children were found to have multiple cafe au lait spots without other apparent features of NF1. A minimum estimate of the crude prevalence was 3.0 per 10 000 (95% confidence interval, 2.3-4.0 per 10 000 population). The incidence of NF1 in this population was probably in the range of 30 to 38 cases per 100 000 live births. CONCLUSION: Our study obtained a nearly unbiased birth incidence of NF1 of approximately 1 in 2600 to 1 in 3000 and demonstrates that NF1 can be diagnosed by age 6 years in most cases by routine physical examination with special attention to the disease-associated skin stigmata.
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OBJECTIVE: Naevus density in children depends both on constitutional factors (see below) and on previous (solar) UV exposure, which is a well-known risk factor for malignant melanoma. Secular trends of childhood UV exposure - e. g., due to intervention programmes - can be monitored by repeated, standardised cross-sectional studies assessing naevus density in children. METHODS: The 'CMONDE-Study (childhood monitoring of naevus density)' appears as a suitable instrument, introduced into the process of school enrollment for children of the years 1999 and 2000 in Göttingen. RESULTS: Analyses are based on 3883 children. Median age was 6.25 years, the proportion of girls 47 %. Median naevus density was 5.8/m(2), with an increase of density from 'Fitzpatrick skin type' IV to II, but marked decrease in type I. Similarly, naevus density increased with increasing lightness of hair colour, but was very low in red-haired individuals. While the number of freckles was also strongly associated with naevus density, the association between iris colour and skin darkness, respectively, was weak. CONCLUSION: To meet the objective of continual monitoring, further comparative cross-sectional studies are needed.