TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending August 25, 1984 and August 27, 1983 (34th Week) Mortality data in this table are voluntarily reported from 121 cities in the United States, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed Fetal deaths are not included ** Pneumonia and influenza ↑ Because of changes in reporting methods in these 4 Pennsylvania cities, these numbers are partial counts for the current week Complete counts will be available in 4 to 6 weeks tt Total includes unknown ages. Campylobacter fetus - Continued abortion in animals (3) and was subsequently found responsible for both epidemic and sporadic abortion in cattle and sheep (4-6). This report adds to the growing body of evidence that C. fetus, subsp. fetus, also causes human abortion or premature labor with septicemia in the neonate (7,8). The incidence of maternal C. fetus, subsp. fetus, infection, leading to feto-placental involvement is not known. However, a greater awareness, earlier diagnosis, and appropriate treatment of this infection in pregnant women may prevent fetal loss. References 1. Karmali MA, Fleming PC. Campylobacter enteritis. Can Med Assoc J 1979;120:1525-32. 2. Bokkenheuser V. Vibrio fetus infection in man. I. Ten new cases and some epidemiologic observations. Am J Epidemiol 1970;91:400-9. 3. Great Britain. Board of Agriculture and Fisheries. Report of the Departmental Committee appointed by the Board of Agriculture and Fisheries to inquire into epizootic abortion. Part III. Abortion in sheep. McFadyean J, Stockman S. Appendix. 1913:1-29. 4. Plastridge WN, Williams LF, Petrie D. Vibrionic abortion in cattle. Am J Vet Res 1947; VIII: 178-83. 5. Jensen R, Miller VA, Hammarlund MA, Graham WR. Vibrionic abortion in sheep. I. Transmission and immunity. Am J Vet Res 1957;XVIII:326-9. 6. Smith T. Etiological relation of spirilla (Vibrio fetus) to bovine abortion. J Exp Med 1919;30:313-23. 7. Hood M, Todd JM. Vibrio fetus -a cause of human abortion. Am J Obstet Gynecol 1960; 80:506-11. 8. Eden AN. Perinatal mortality caused by Vibrio fetus. Review and analysis. J Pediatr 1966; 68:297-304. Current Trends School Health Assessment, Planning, and Evaluation Project New York City The School Health Assessment, Planning, and Evaluation (SHAPE) project, a survey of the health status of New York City school-aged children, was conducted during October 1983 and November 1983. Over 4,500 children in grades kindergarten, 1, 3, 7, and 10 were examined by the staff of the New York City Department of Health. They were selected from 12 different schools to represent high, middle, and low socioeconomic areas of the city from a total of 1,000,000 students and over 1,000 schools. The examination consisted of standardized height and weight measurements, visual and hearing acuity, dental and physical examinations, laboratory determinations of hematocrit and blood lead levels (in the elementary grades), and a nurse-administered history and/or record review. In addition, students in the seventh and 10th grades were given self-administered questionnaires to ascertain frequency of health-risk-associated behavior and to evaluate nutritional intake. Based on preestablished criteria, the health status of each child was determined. If objective or historic findings indicated a need for additional health evaluation, this was enumerated as a "referrable condition." These criteria were purposefully conservative; for example, a child with visual acuity corrected by glasses to 20/20 but without written evidence of a professional eye examination within the past year was deemed "referrable." The referrable conditions found included: vision-22.9% of students examined; hearing-7.0%; asthma-4.0%; cardiac-3.1%; orthopedic -2.3%; strabismus-2.0%; other -3.6%. Analyzing the frequency of risk-taking behavior documented the expected increase between the seventh and 10th grades (Table 1). The interpretation of the questionnaire responses must be guarded, since there probably were frivolous responses and some misinterpretation; however, the relative differences between grades is undoubtedly real, and the magnitude of the positive responses is considered meaningful. The increase between the seventh and 10th grades in risk-taking behaviors that contribute to health problems has led to two major changes in health-promotion activities: (1) the reintroduction of a required physical examination on entry to the seventh grade (state law mandates a physical examination at school entrance, fourth, seventh, and 10th grades, but New York City has had a waiver of this requirement) and (2) the development of a new health professional, the Health Resource Coordinator (HRC). Concurrent with the SHAPE study, there was an increase in the resources available for health services in the school system. Educators believed there should be a nurse in every school daily, and services should be primarily targeted to the elementary schools. The beliefs of administrators, both in the health programs and educational system, would have lead to widespread employment of aides to perform first aid and keep records. Fiscal realities and the SHAPE results, however, were used to allocate the new resources into areas that addressed needs identified in the SHAPE study. To deal with the high prevalence of visual and acoustic problems, specialized teams of paraprofessionals are being trained to perform hearing and vision testing in grades kindergarten, 1, 3, 7, and 10. This approach lends itself to quality-control mechanisms, which should prevent overreferrals. Screening had previously been the responsibility of classroom teachers or aides with very little training. The SHAPE questionnaire for students in the higher grades inquired about students' desires for additional services. Students indicated a need for counseling in addition to classroom education. To meet this need, the HRC position has been established by the Department of Health to concentrate further on behavioral risk factors. An HRC will be assigned to each junior high school over the next 2 years. During the first year, priority will be given to schools in areas designated at highest risk for health problems. The HRCs' duties will be to link young people to needed services in the community and to improve the health of the adolescents by encouraging voluntary behavior change. HRCs will concentrate on improving the students' knowledge on obtaining health information, interpreting such information, identifying options for health decisions, and asking for assistance. Nutrition, substance abuse, sexuality, and stress management will be the areas of primary concern. Additional pediatric nurse-practitioners, physicians, public health nurses, and public health assistants are to be deployed in the schools to assure a regularly scheduled health department TABLE 1. Examples of students' responses to risk-taking behaviors Risk factor Positive answer (%) 10th grade (895 students) Smoke cigarettes 10/day or more Use alcoholic beverages four drinks or more/week Use marijuana Use drugs Sexually active Seventh grade 5.7 15.7 |