Community Schools: A Public Health Opportunity

Community schools link students, families, and communities to educate children and strengthen neighborhoods. They have become a popular model for education in many U.S. cities in part because they build on community assets and address multiple determinants of educational disadvantage. Since community schools seek to have an impact on populations, not just the students enrolled, they provide an opportunity to improve community health. It has been proposed that community schools influence the health and education of the area residents through three pathways: building trust, establishing norms, and linking people to networks and services. However, no research has been published exploring how community schools may be influencing these pathways. The aims of this research were three-fold: AIM 1: Develop an inventory of NYC community schools using a database that includes school characteristics (e.g., types of programs and services) and population characteristics of students, their families, and the communities in which the schools exist (e.g., level of instruction, demographic breakdowns, and poverty level). Explore if certain essential components of community schools exist that influence educational outcomes. AIM 2: Identify if there is a relationship between health (e.g., vaccination rates, health insurance rates, chronic disease management) and social characteristics (e.g., crime rates) of NYC community districts and density of established community schools (established CSs defined as established 1992-2006; new CSs defined as established 2007-present). AIM 3: Through a series of in-depth interviews, investigate the possible pathways through which community based organizations (CBOs), as official partners of community schools, address the neighborhood-level social processes shown to influence educational and health outcomes. Findings revealed that the current model of community schools in New York City may not be emphasizing the most effective components of community schools and therefore are not showing the anticipated association between health and academic outcomes. However, the density of community schools within community districts appear to influence certain neighborhoods in New York City more than others. Community schools may be most effective in neighborhoods with certain characteristics such as concentrated poverty or high rates of homelessness. Qualitative research suggests community-influence is due to a community school’s ability to build trust among parents and between parents and schools. Recommendations for future research to further these findings are outlined. This collection of research suggests that community schools offer a new way to use an established institution to widen their influence on health and educational outcomes from just students within their walls to entire communities that surround the school building mainly through building trust, but also through creating and revealing common norms and linking residents to networks

Adductor focal laryngeal Dystonia: correlation between clinicians’ ratings and subjects’ perception of Dysphonia

Background Although considerable research has focused on the etiology and symptomology of adductor focal laryngeal dystonia (AD-FLD), little is known about the correlation between clinicians’ ratings and patients’ perception of this voice disturbance. This study has five objectives: first, to determine if there is a relationship between subjects’ symptom-severity and its impact on their quality of life; to compare clinicians’ ratings with subjects’ perception of the individual characteristics and severity of AD-FLD; to document the subjects’ perception of changes in dysphonia since diagnosis; to record the frequency of voice arrest during connected speech; and, finally, to calculate inter-clinician reliability based on results from the Unified Spasmodic Dysphonia Rating Scale (USDRS) (Stewart et al, J Voice 1195-10, 1997). Methods Sixty subjects with AD-FLD who were receiving ongoing injections of BoNT participated in this study. Subjects’ mean age was 60.78 years and their mean duration of symptoms was 16.1 years. Subjects completed the Disease Symptom Questionnaire (DSQ) (specifically designed for this study) and the Voice Handicap Index-10 (VHI-10) (Jacobson et al, Am J Speech Lang Pathol 6:66–70, 1997) to measure the symptoms of their dysphonia and the impact of the disease on their quality of life. Two speech-language pathologists and two laryngologists used the Voice Arrest Measure (VAM) (specifically designed for this study) and the USDRS to independently rate voice recordings of 56/60 subjects. Results The mean VHI-10 score was 21.3 which is clinically significant. The results of the DSQ and the USDRS were highly correlated. The most severe symptoms identified by both subjects and clinicians were roughness, strain-strangled voice quality, and increased expiratory effort. Voice arrest, aphonia, and tremor were uncommon. Subjects rated their current voice quality at the time of reinjection (i.e., at the time of the study) as significantly better than at the time of their initial AD-FLD diagnosis (p < 0.0001). Inter-clinician reliability on the USDRS was significant at the 0.001 level. Conclusions The findings from the VHI-10 suggest that AD-FLD has a profound impact on quality of life. The results of the DSQ and the USDRS suggest that there is a strong correlation between subjects’ perception and clinicians’ assessment of the individual symptoms and the severity of the dysphonia. The findings from the VAM suggest that voice arrests are infrequent in subjects with AD-FLD who are receiving ongoing BoNT injections. The strong inter-clinician reliability on the USDRS suggests that it is an appropriate measure for identifying symptoms and severity of AD-FLD

Quality of life, characteristics and survival of patients with HIV and lymphoma

We sought to compare the quality of life (QOL), characteristics, and survival of patients with non-Hodgkin lymphoma (NHL) with and without human immunodeficiency virus (HIV) infection. Using the population-based cancer registry for Orange and San Diego Counties, We recruited 50 patients with HIV and systemic NHL (cases) and 50 age, sex and race-matched NHL patients without HIV (controls) diagnosed with NHL during 2002–2006. Patients completed a medical history survey and QOL instrument, the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) for cases and Functional Assessment of Cancer Therapy-General (FACT G) for controls. HIV-infected patients had worse overall QOL and survival than uninfected patients. QOL differences were more marked in the areas of functional, physical and social well-being than in the area of emotional well-being. HIV-infected patients had lower income and were less likely to have private insurance and more likely to have diffuse large B cell histology than uninfected patients. HIV-infected NHL patients had worse QOL and survival than uninfected patients, due to a combination of co-morbidity, aggressive histology and lack of social support. However, their emotional well-being was comparable to that of uninfected NHL patients and better than historical norms for the HIV-infected

Realising the Ambition - Being Me : National Practice Guidance for Early Years in Scotland

Since 2013 there has been a determined focus by the Scottish Government to work towards realising the ambition for Scotland to be the best place for children to grow up in and learn. Changes to the Children and Young People (Scotland) Act 2014, have resulted in our youngest children, particularly those from birth to starting school, being at the heart of significant new developments. In 2014 Scottish Government started to increase the number of hours of funded provision to 600 hours for 3 and 4 year olds and some two year olds. The national practice guidance, “Building the Ambition” was commissioned at this time to complement the new policy developments and to support practitioners. The further expansion of funded Early Learning and Childcare (ELC) to 1140 hours per year for all 3 and 4 year olds, and for around a quarter of 2 year olds will be available from August 2020. This expansion to 1140 hours seeks not only to extend funded places, but to also improve the quality of our ELC provision across Scotland. We know that the earliest years of life are crucial for every child. Evidence tells us that, if our early learning and childcare offer is to help children fulfil their potential and contribute to closing the poverty related gap in children’s outcomes, it has to be high quality. To support the expansion it was decided to refresh the original Building the Ambition, incorporating and updating relevant aspects of the Pre-Birth to Three guidance and extending across the child’s learning journey into the early years of primary school. This new guidance, Realising the Ambition: Being Me, reflects the original principles and philosophy of Building the Ambition and complements the current policy direction of ELC and early primary education. It aspires to support practitioners in delivering what babies and young children need most and how we can most effectively deliver this in Scotland to give children the best start in life. The practice guidance aims to support anyone who works with and for babies and young children across all areas of Scotland. It has been designed to: build confidence and capability of those who work with children and families from pre-birth to starting school and beyond; make links between practice, theory and policy guidance to reinforce aspects of high quality provision and the critical role practitioners play; clarify some aspects of current practice and provide a reference which practitioners can easily use; support improvement and quality by encouraging discussion, self reflection and questioning about relevant practice in each setting, and; provide advice on achieving the highest quality of ELC and early primary provision that will enable young children to experience and to play their own part in Scotland being the best place in the world to grow up