Search

Background: Human metapneumovirus (hMPV) is an important cause of pediatric respiratory infection. We leveraged the Nicaraguan Pediatric Influenza Cohort Study (NPICS) to assess the burden and seasonality of symptomatic hMPV infection in children., Methods: NPICS is an ongoing prospective study of children in Managua, Nicaragua. We assessed children for hMPV infection via real-time reverse-transcription polymerase chain reaction (RT-PCR). We used classical additive decomposition analysis to assess the temporal trends, and generalized growth models (GGMs) were used to estimate effective reproduction numbers., Results: From 2011 to 2016, there were 564 hMPV symptomatic infections, yielding an incidence rate of 5.74 cases per 100 person-years (95% CI 5.3, 6.2). Children experienced 3509 acute lower respiratory infections (ALRIs), of which 160 (4.6%) were associated with hMPV infection. Children under the age of one had 55% of all symptomatic hMPV infections (62/112) develop into hMPV-associated ALRIs and were five times as likely as children over one to have an hMPV-associated ALRI (rate ratio 5.5 95% CI 4.1, 7.4 p < 0.001). Additionally, symptomatic reinfection with hMPV was common. In total, 87 (15%) of all observed symptomatic infections were detected reinfections. The seasonality of symptomatic hMPV outbreaks varied considerably. From 2011 to 2016, four epidemic periods were observed, following a biennial seasonal pattern. The mean ascending phase of the epidemic periods were 7.7 weeks, with an overall mean estimated reproductive number of 1.2 (95% CI 1.1, 1.4)., Conclusions: Symptomatic hMPV infection was associated with substantial burden among children in the first year of life. Timing and frequency of symptomatic hMPV incidence followed biennial patterns., (© 2022 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

As school health personnel respond to the changing needs of children, new models are being developed and traditional models are being reexamined. The role of the school nurse is expanding at the same time as school-based health centers are increasing in number. Partnerships between school-based health centers and school nurses are critical for the success of school-based health centers, and partnerships will enhance and expand roles for school nurses. This paper clarifies the role of each in three areas: collaboration, communication, and cooperation. In addition, obstacles to partnerships are examined. The goal of this collaboration is a shared vision for the continuum of school health services in which school nurse and school health center serve integral roles. Elements for successful collaboration between nurse and health center are reviewed, including clarifying roles, shared leadership and program ownership, cooperative training and continuing education, negotiating conflict, and most importantly, maintaining mutual support and respect.

Contemporary school-based health centers (SBHCs) face dwindling financial resources and pressures to maximize reimbursement. As managed care becomes the dominant system of health care financing, SBHCs must integrate their service delivery with managed care systems. In Massachusetts, through a combination of advocacy, state, and local collaboration, SBHCs successfully developed partnerships with managed care plans. Strategies include enhancing communication between SBHCs and health maintenance organizations, standardizing school-based care, and mandating integration of services through state contract language. This article delineates the process that occurred and key elements necessary for developing these relationships. This experience is a valuable resource for other states and school-based providers as Medicaid populations are funneled into managed care arrangements.

To understand school health service delivery models, and to plan for reorganization of a local school health service, a telephone survey of school-based health programs from around the country was conducted in 1992. Responses were elicited from 33 school departments in some of the largest American cities. Respondents described their current programs, obstacles they face, and approaches they have chosen to address the needs of urban schoolchildren. City size did affect amount of services provided overall, but a clear relationship existed between number of providers employed, and the number/amount of screening services available. Cities employed a range of strategies to enhance services, including collaboration with local health authorities, creation of school clinics, and billing for services.