DiversityNursing Blog

By BENJAMIN MUELLER

In a case weighing the government’s ability to require vaccination against the individual right to refuse it, a federal judge has upheld a New York City policy that bars unimmunized children from public school when another student has a vaccine-preventable disease.

Citing a 109-year-old Supreme Court ruling that gives states broad power in public health matters, Judge William F. Kuntz II of Federal District Court in Brooklyn ruled against three families who claimed that their right to free exercise of religion was violated when their children were kept from school, sometimes for a month at a time, because of the city’s immunization policies.

The Supreme Court, Judge Kuntz wrote in his ruling, has “strongly suggested that religious objectors are not constitutionally exempt from vaccinations.”

The lawyer for the plaintiffs, Patricia Finn, said she plans to appeal the decision, announced this month. On Thursday, Ms. Finn asked the district court to rehear the case.

Amid concerns by public health officials that some diseases are experiencing a resurgence in areas with low vaccination rates, the decision reinforces efforts by the city to balance a strict vaccine mandate with limited exemptions for objectors. Pockets of vaccination refusal persist in the city, despite high levels of vaccination overall.

State law requires children to receive vaccinations before attending school, unless a parent can show religious reservations or a doctor can attest that vaccines will harm the child. Under state law, parents claiming religious exemptions do not have to prove their faith opposes vaccines, but they must provide a written explanation of a “genuine and sincere” religious objection, which school officials can accept or reject.

Some states also let parents claim a philosophical exemption, though New York does not. Some parents refuse to have their children vaccinated because of a belief that vaccines can cause autism, though no link has ever been proved.

Two of the families in the lawsuit who had received religious exemptions challenged the city’s policy on barring their children, saying it amounted to a violation of their First Amendment right to religious freedom and their 14th Amendment right to equal protection under the law, among other claims. Their children had been kept from school when other students had chickenpox, their suit said.

The third plaintiff, Dina Check, sued on somewhat different grounds, saying that the city had improperly denied her 7-year-old daughter a religious exemption. She said the city rejected her religious exemption after it had denied her a medical exemption, sowing doubts among administrators about the authenticity of her religious opposition. But Ms. Check said the request for a medical exemption had been mistakenly submitted by a school nurse without her consent.

After the school barred her daughter, Ms. Check home-schooled her and then moved her to a private school that accepted her daughter without the vaccinations. State vaccination requirements cover public and private schools, but in New York City, private schools have more autonomy in handling exemptions.

“Disease is pestilence,” Ms. Check said, “and pestilence is from the devil. The devil is germs and disease, which is cancer and any of those things that can take you down. But if you trust in the Lord, these things cannot come near you.”

In turning down all three families, Judge Kuntz cited a 1905 Supreme Court ruling that upheld a $5 fine for a Massachusetts man who disobeyed an order to be vaccinated during a smallpox outbreak, a case that helped establish the government’s right to require immunizations as a matter of public health.

Ms. Finn, the families’ lawyer, said that case should not be relevant. “There’s no way that court anticipated that children would be subjected” to the vaccines they must get today, she said.

In New York, the statewide mean religious exemption rate rose over the last decade, from .23 percent in 2000 to .45 percent in 2011, a 2013 study in the medical journal Pediatrics said.

New York City schools granted 3,535 religious exemptions in 2012-13, according to data from the state’s Health Department. Though city schools, public and private, have an overall immunization rate around 97 percent, according to the department, 37 private schools were below 70 percent. Health experts believe that above a certain immunization rate, outbreaks are limited because a disease cannot spread to enough people during its incubation period to sustain itself, a phenomenon known as “herd immunity.” For measles, which is highly contagious, that rate is believed to be 95 percent, according to Daniel Salmon, deputy director at the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

Though widespread vaccinations have practically eliminated diseases like measles and mumps from the United States, flare-ups have occurred. The 477 measles cases reported this year represent the worst year-to-date count since 1994, according to the Centers for Disease Control and Prevention.

Among the 25 people who contracted measles in New York City between February and April this year, two were school-age children unvaccinated because of parental refusal. When one of the children, who was being home-schooled, contracted the measles, city health officials barred that child’s sibling, who had a religious exemption, from attending school. The sibling eventually contracted measles as well. Health officials credited the decision to keep the second child out of school with stopping the spread of disease in that community.

Ohio, which granted more than three times as many religious and philosophical exemptions to kindergarten students last year as it did in 2000, is struggling to contain a measles outbreak that has recently spread to 339 Amish people who were largely unvaccinated, the state health department said.

Mr. Salmon said it can be difficult for states to balance an obligation to mandate vaccination with some leniency for families who have strong objections. Rules that force parents to articulate their beliefs and require public officials to educate them about the risks of exemption are states’ best defense against the spread of disease, he said.

Still, especially because parents who refuse vaccination tend to cluster geographically, it takes only a few unvaccinated children to start an outbreak, he said. At that point, even vaccinated children are at risk.

“Diseases have a way of finding our vulnerabilities,” Mr. Salmon said, “the kinks in our armor.”

We want to know what you think. Agree or disagree?

Source: nytimes.com

By Nurse.com

This fall, Duquesne University in Pittsburgh will become the first academic institution in the U.S. and globally to offer a dual degree in nursing and biomedical engineering for undergraduate students, according to a news release.

“Duquesne has pioneered the integration of clinical knowledge and patient care with engineering techniques in a single program, creating the first bachelor’s degree of its kind,” Provost Timothy Austin, PhD, said in the release.

The five-year program will provide students with a foundational body of knowledge that keeps patient care and practical application at the core of studies supporting innovations and technological advances.

The joint degree could prove a tremendous value to employers and patients, said John Viator, PhD, director of Duquesne’s biomedical engineering program. 

By gaining actual clinical experience, students also will develop new perspectives with respect to a patient’s health and functional needs. “Engineers do not always fully appreciate the hospital culture and the clinical needs of patients,” Mary Ellen Glasgow, RN, PhD, FAAN, dean and professor of the School of Nursing, said in the release. “This dual degree gives our students both the engineering and nursing perspectives to solve real world clinical problems.” 

In addition to learning engineering and nursing, students will benefit from class and clinical experiences that incorporate the Toyota Production System principles (used to address safety, cost and efficiency) and the American Association of Critical Care Nurses’ Synergy Model. 

Job opportunities for biomedical engineers are expected to grow 27% between 2012 and 2022, and nursing careers are expected to expand by 19% in the same timeframe, according to statistics from the Bureau of Labor Statistics. With the combined knowledge and skills of the two disciplines, opportunities may be limitless for the “nurse engineer,” Viator and Glasgow predict.

“Our students will begin their careers with the preparation, knowledge and worldview usually seen in those with years of experience in the field,” Austin said in the release. “This exciting BME/BSN partnership illustrates Duquesne’s innovative academic programs and the university’s focus on preparing students with the knowledge and skills to serve others.” 

Source: nurse.com

By Hannah Poturalski

A research effort underway at an area nursing home is testing out telehealth robots and other technology to enhance a patient’s ability to remain independent longer.

Students and faculty from the University of Cincinnati’s College of Nursing, as well as students from the colleges of medicine, engineering and allied health sciences, have partnered with Maple Knoll Village to develop innovative models using technology to help older adults stay independent and in their homes longer, said Tim McGowan, vice president of operations at Maple Knoll.

“The quicker we can develop the technology necessary to safely monitor them at home, the lower the cost of care will be and the quality of life for the patient returning home will improve,” McGowan said.

Every month more than a quarter-million Americans turn age 65. By 2015, for the first time in U.S. history, people age 65 and older will outnumber children under age five, according to the Council on Aging of Southwestern Ohio.

The partnership has opened a “smart house” on the Maple Knoll campus, formally called the Innovation Collaboratory House, inside an independent living unit for the UC students to conduct research and pilot new technologies.

Debi Sampsel, chief officer of innovation and entrepreneurship at UC, said the partnership developed in October 2012, and the smart house opened last spring for senior capstone classes in nursing and engineering.

Now hundreds of students are using the facility for education, research and translational practice.

“The house is about preparing them to come out into the community and hone in on their skills and techniques they’ll need in real positions,” Sampsel said. “We can start mirroring real life because they have to start thinking on their feet.”

A number of student-led projects are underway at the house, including the ability to control the temperature and lighting from a remote location, and motion detectors used to track patterns of activity in daily living to detect when an unexpected change in habit has occurred, said Megan Gresham, spokeswoman for Maple Knoll.

“Staff or family can be alerted if say they’re not getting out of bed at a certain time,” Gresham said.

Sampsel said students are also training on human simulators — with speech and movements controlled by a teacher in the next room — to learn the proper ways to take an IV, bathe a patient, take blood pressure and listen to the heart and lungs.

“This fits into our strategic plan to creatively leverage technology to change health care,” said Greer Glazer, dean of UC’s College of nursing.

After a public open house June 26, the UC students will start working with physicians on geriatric rounds at Maple Knoll. A large telehealth robot, called “Flo Bot,” will go along on the rounds and nurse practitioner students and college of medicine fellows will access the data remotely from UC.

A smaller telehealth system coined “Little Bot” will be used by students making rounds inside the independent living units of resident who have volunteered.

“I’m most appreciative for the resident support at Maple Knoll,” Sampsel said. “It really brings home what their (the students’) health care profession is going to be all about.”

Sampsel said the two entities are developing a formal agreement to be reached this summer.

Source: journal-news.com 

BY ROSE RUSSELL

Kevin Cischke left a music career after 25 years to pursue a new one in nursing, and it won’t bother him that he’ll be a man in a profession largely dominated by women.

As the face of the nursing profession slowly changes, Mr. Cischke, 45, is among the growing number of men signing up for the job. According to the U.S. Census Bureau, slightly less than 10 percent of the 3.5 million nurses in 2011 were men. That’s up from 1970, when only 2.7 percent of nurses were males.

For Mr. Cischke – who will receive a bachelor’s in nursing next year from Mercy College — nursing is in line with his interests. When introduced to nursing, the former organist and choir master for the Archdiocese of Detroit fell in love with it.

“A couple of my close friends who are nurses said I should look into this profession to see if it would interest me,” he said, during a break from his externship in the emergency room at Mercy St. Vincent Medical Center. “It was a whirlwind love affair that has not ended, and I don’t suspect that it will.”

Craig Albers, chief nursing officer and vice president of patient care services at Mercy St. Charles Hospital, said men in nursing offer an important component in the delivery of public health care.

“In the past, nursing was more of a pink collar profession and more of a career for women. A lot of times it’s seen as a profession for Caucasian women. Now, with large numbers of baby boomers retiring and seeking health care, we need a diverse workforce able to work with a diverse population,” said Mr. Albers.

A nurse himself since 1998, he began his college studies pharmacy. When he decided he needed more patient interaction, a professor suggested he look into nursing.

“I job shadowed an ICU nurse and the role really appealed to me. That’s what led me to the profession,” he said.

It was the patients who also attracted Mr. Cischke.

"I enjoy the patient-care side of things. I wanted hands-on patient care. That's what drives me, and the fact that I can continue to learn and grow fits my personality perfectly," he said.

He also liked contributing to the profession and addressing concerns of his male peers. In fact, when they discovered something missing in their nursing school experience, he led the way to establishing a local chapter of the American Assembly of Men in Nursing. The organization addresses issues that affect men in nursing. About 20 men and five women are members of the group.

"I continued to explore what the assembly had to offer, promote, and to accomplish and I realized that their goals aligned with what we needed to have at Mercy to support our male students," said Mr. Cishke, one of 116 male students in the nursing program.

The organization will also help groom male nurses for retiring baby boomers who increasingly use health care. Health professionals who deliver care to boomers must be on their toes.

"Our baby boomer population will be very informed and knowledgeable and Internet and computer savvy, and people going into the nursing profession will have to be extremely knowledgeable and confident and able to communicate with their patients because the patients are very knowledgeable," said Mr. Albers.

While male nurses' physical strength is also a plus for patient care, Mr. Albers said more men joining the field may pursue advanced fields in nursing, such as management, administration, business, and anesthetics. Those advanced career possibilities attracted Daniel Koehler to the profession.

He received a bachelor's in nursing from Lourdes University in December. Eight years ago, he obtained a bachelor's in human biology from Michigan State University. He then worked in the restaurant and fitness businesses before going to nursing school.

He wasn't intimidated by the predominantly female profession, and in fact received positive responses from others.

"Most guys don't grow up thinking they want to be nurses," as many girls do, said Mr. Koehler, whose mother was a nurse in Germany. "With the guys I've met in the profession, I think less of that stigma now days."

Though slightly less than 10 percent of ProMedica's nurses are men and slightly more than 8 percent of the nurses in the Mercy health system are men, the idea that nursing is a woman's job stopped Roberta Pratte's father and grandfather, both medics in the military, from continuing in the profession. As a teenager, Ms. Pratte — a Mercy nursing professor — recalls hearing her grandfather speak fondly about nursing.

"Back then it wasn't something that men talked about or thought about. I sensed that they regretted that they were not allowed to follow their dream," said Ms. Pratte, an instructor at Mercy College. She has been a nurse for 33 years, and her mother was also a nurse.

Large numbers of nurses are expected to retire soon, adding to the already critical nursing shortage. That's why the profession is pushing to attract men and women into nursing. As a matter of fact, the American Assembly for Men in Nursing is campaigning to increase the number of male nurses by 20 percent by the year 2020, said Ms. Pratte. She also said the Institute of Medicine and the Centers for Disease Control and Prevention are reviewing how to fill nursing positions to ensure that the public gets proper care.

Source: toledoblade.com

By Stacey Burling

The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.

"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.

The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.

Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.

Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.

Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.

Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.

The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.

The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.

Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.

An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.

The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.

Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.

Source: philly.com

Wolters Kluwer Health

Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article in the Journal of Christian Nursing by Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN. "This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public," they write. "The battle of pertussis is winnable through education, awareness, and vaccination."

Caused by infection with Bordetella pertussis  bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.

Why is pertussis on the rise? "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."

Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.

Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.

"Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines," Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.

The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. "These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations," the authors write. "Faith community nurses are in an ideal role to create and lead these partnerships."

Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime."

Source: infectioncontroltoday.com

By Jeffrey S. Solochek

TRINITY, Fla. (AP) — Evan Wolin sat patiently in his slightly oversized cap and knee-length black gown, waiting his turn.

One by one, the teacher called his classmates to the stage. Then, finally, she read his name.

Evan burst from his seat, sped to the front and grabbed his diploma, a huge smile eclipsing his face. He thrust the paper into the air with an extra arm pump, as his mom, Jessica, tried not to cry while she captured it all on her phone.

He was so ready for kindergarten.

____

Nearly three years ago, when Evan first entered Longleaf Elementary's preschool program for children with developmental delays, few predicted that this day would come.

At 2 1/2 years old, he had barely begun walking, hadn't started talking and coped daily with many medical problems stemming from being born a micropreemie.

"On paper, his medical diagnosis had us thinking, 'Oh, my,' " recalled school speech pathologist Janice Whittaker.

Since he still sometimes used a feeding tube, some of the staff at Longleaf thought Evan might be better suited for a program at Cotee River Elementary, which had dedicated nurses on staff. But his mom, a special-education teacher, and dad, a school administrator, did not want their son in a medical unit.

"I knew developmentally I wanted him in the area school. I knew that he had more in him," Jessica Wolin said. "Although he wasn't speaking, although he wasn't eating, I knew he was very bright. . I always wanted him to be challenged."

Teacher Heather Goldstein, also a neighbor of the Wolins who remembered seeing Evan come home as an infant "with every tube connected to him," committed to making her classroom work for his needs.

"As soon as they told me, I went right online to research everything," she said. "I thought, if he is coming I want to make sure I have everything in place."

Before he arrived, Goldstein reorganized the furniture in her book- and toy-filled classroom to make it easier for Evan to navigate. She continued to learn about his medical demands and prepare for his academic requirements, communicating with his family to keep them informed on daily activities.

Jessica Wolin praised Goldstein's dedication, saying the teacher went above and beyond to make Evan feel at home in school and to help ensure his success. District special-education prekindergarten coordinator Kelli Boles never doubted it.

Goldstein, Boles said, exemplifies what the school district wants from its teachers in the program, which is federally funded and guaranteed to all eligible children with special needs ages 3 to 5. When other educators need training or classroom ideas, Boles sends them to Goldstein.

"She knows where the kids are, what they need to work on," Boles said. "She's the model of what I would like to see for all classrooms."

Goldstein's overriding philosophy is simple: Treat all kids like typical kids, set high expectations and then help them get there. She's taught her special-needs preschoolers to read and write that way, not to mention how to speak and socialize.

____

During a recent class day, Goldstein had Evan working with pattern blocks, where he would match colored plastic shapes to a design on a paper. She had him count yellow hexagons to figure out how many he needed to complete the pattern. Then she turned to another set of pieces.

"What do we call the blue?" she asked. "We used to call them diamonds, but now that you're going to kindergarten we have to call them ..."

"Rom," Evan said, looking up at Goldstein for affirmation.

"Rhombus," she said, completing the word.

"I love rhombus," Evan said cheerfully, placing them on the pattern and then sweeping them all away to start again. "I did it!"

"What do you get to do now?" Goldstein asked.

"Build a tower!" Evan shouted. He started to stack pieces, knock them down and repeat.

____

Goldstein refuses to take full credit for Evan's progress. Parents must participate actively, she said, and the child must be determined, too, in order for them all to find success.

That collaboration shone through for Evan, she said. "He amazes me every year."

His mom feels much the same.

When he was born at 24 weeks weighing 1.5 pounds, some people wondered whether he would even survive. She kept the faith through illnesses and surgeries for short-bowel syndrome, months in the hospital, feeding tubes, therapists.

Would he walk? Would he talk? Would he eat?

Now he races around at breakneck speed, bouncing from his pet hamster to his stash of toy cars, climbing on furniture and jabbering nonstop. He loves bacon and pancakes (and syrup and eggs), and though he's still small for his age, he loves to play with as much abandon as any 5-year-old.

In April, he was named Longleaf's pre-K student of the month.

Program coordinator Boles had nothing but good to say about Evan's progress, which includes his move to a traditional kindergarten class in the fall.

"He is like the poster child of why we do this, because early intervention works," she said, expressing hope that more families would enroll their eligible children in the classes.

Jessica Wolin, meanwhile, looks forward to Evan's next adventure. Sure, she's nervous about kindergarten, just like she was about so many other steps in her son's life.

But "he's done all those things. I want to be surprised by him. I want to see the next surprise."

Source: ksl.com

By MICHELLE ANDREWS

School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.

And though school nurses see many students regularly, they don't always have the most up-to-date information about the students' health. School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.

"When things change, we don't always get told in a timely manner," says Nina Fekaris, a school nurse in the Beaverton, Ore., school district. "It works, but it takes a lot of coordination."

At the same time, school-based health care is unfamiliar territory to many medical professionals, who operate in a health care universe largely separate from school clinics and other community-based medical services.

In Delaware, "lots of nurses expressed that they had difficulty communicating with providers" at Nemours Health System, which serves children around the state, according to Claudia Kane, program manager of the Student Health Collaboration at Nemours.

In 2011, Nemours got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs. That includes conditions such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders or gastrointestinal problems.

Beth Mattey, a school nurse in Wilmington, says that now that she has access to the Nemours system, she can check the recent lab test results of a student who has diabetes. "It's helpful for me to monitor his [blood sugar levels] and work with him to make sure he's in better control," says Mattey, who is president-elect of the National Association of School Nurses.

When a student put a staple through his finger, Mattey was able to check to make sure he went to the doctor and got treatment. "Checking with him directly involves calling him out of class," she says.

Eventually, school nurses will be able to put information into the Nemours electronic records system as well, says Kane.

In the meantime, Nemours doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. Kane says it encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every few months for students who are part of the program.

The Nemours Student Health Collaboration project is operating in all Delaware public school districts as well as half of charter schools and about one-third of private schools. Kane says Nemours plans to extend the program to school-based health centers next.

Source: npr.org

Do you think they should have access to medical records?

By Alexandra Sifferlin

After six years of trying, scientists have discovered a way to genetically modify mosquitoes so they produce sperm that will only conceive male offspring.

Female mosquitoes are the ones who bite people and pass along malaria, so scientists think if they can significantly lower the number of female mosquitoes the rate of malaria will also go down. In their researchpublished in the journal Nature Communications, the researchers created a modified strain of mosquitoes that produced 95% male offspring.

When they introduced the strain to a five caged wild mosquito populations, the modified pests eradicated entire mosquito populations in four of them. There were too few females for the populations to survive. The researchers hope that this same scenario could happen in the wild, and malaria-carrying mosquitoes could die off.

Their findings are important because the scientists are the first to interfere in the sex ratios of mosquitoes, and their strategy could be successful in eliminating malaria, which remains a fatal disease in some sub-Saharan regions in Africa. Malaria prevention methods worldwide have brought down malaria mortality rates by 42%, but scientists are concerned over insecticide-resistant mosquitoes that pass along drug resistant malaria.

“The research is still in its early days, but I am really hopeful that this new approach could ultimately lead to a cheap and effective way to eliminate malaria from entire regions. Our goal is to enable people to live freely without the threat of this deadly disease,” said study author Roberto Galizi from the Department of Life Sciences at Imperial College London in a statement.

Source: time.com

By Karen Weintraub

The parents of children with autism often have to cut back on or quit work, and once they reach adulthood, people on the autism spectrum have limited earning potential.

Those income losses, plus the price of services make autism one of the costliest disabilities – adding $2.4 million across the lifespan if the person has intellectual disabilities and $1.4 million if they don't, according to a new study published in the journal JAMA Pediatrics.

"We've known for a long time autism is expensive, but we've really never had data like this to show us the full magnitude of the issue," said Michael Rosanoff, associate director of public health research for the advocacy group Autism Speaks, which funded the research. "These are on top of the costs to care for a typically developing individual."

Jackie Marks knows the problem firsthand. The Staten Island, N.Y., mom has 13-year-old triplets, all on the spectrum and all with intellectual deficits.

Everything about their care costs more money, she says, from the diapers and wipes she still has to buy to the specially trained babysitters she has to hire every time she wants to go out. For karate classes, she has to pay for one-on-one lessons; the therapist helping with social skills costs $150 an hour per child.

"I enjoy my children immensely," Marks said. "I have a wonderful husband. That, at the end of the day makes it all worth it. But is it like a typical experience? No."

Marks quit her job with the state as a bank auditor to care for Tyler, Dylan, and Jacob. Her husband's job not only has to cover day-to-day needs, but he has to put away enough money to pay for both her and the boys after he retires. She hopes the boys will be able to work someday, but they'll never have the kind of earnings that will sustain them, she said, and will probably receive modest Social Security benefits once they turn 18.

Four things need to change to bring down the cost of autism for families and society, according to David Mandell, director of research for the Center for Mental Health Policy and Services at the University of Pennsylvania.

Adults on the spectrum need more job opportunities. There are many small success stories of individuals or small groups of people with autism who are employed, but "we need to be more creative about thinking about employment on a large scale," Mandell said.

Adult care must be improved so only people who really need expensive residential care get it, and everyone else can find support in their own community, he said. "I think in too many cases, these residential settings represent a failure of our society to provide community-based, cheaper options," he said. "More flexible, cheaper options would be a way to bring these costs down."

Families with autism need more opportunities to stay in the workplace. "Issues that face autism ultimately face all families," Mandell said. "If we had more family-friendly workplace policies, we might see substantial change in the way families were able to manage the work-life balance when they had children with (all kinds of) disabilities."

Society needs to take the long view, he said. Spending money diagnosing and helping young children on the spectrum will probably save money when they are older, by reducing disability and improving employability. "We often talk about the cost of care, and we don't spend much time talking about the cost of not caring," he said.

NUMBERS:

•Cost of supporting someone with an autism spectrum disorder plus intellectual disability: $2.4 million in the USA and 1.5 million pounds in the United Kingdom ($2.2 million in U.S. dollars)

•Cost of supporting someone with an autism spectrum disorder but no intellectual disability: $1.4 million in the USA and .92 million pounds in the United Kingdom ($1.4 million)

Source: usatoday.com