HEALTH RISKSSCHOOL

HEALTH PROMOTION

Dagmar SchneidrováDep. of Child and Youth Health

3rd Faculty of MedicineCharles University in Prague

School stress

Interaction between demands put on a child and his/her capacity to cope with demands

Demands intensity duration Capacity to cope with demands inborn preconditions learned skills and experience Conditions of the school environment

Eustress - Distress

• Eustress (positive stress) School demands are adequate to the

capacity of the child to master them• Distress (negative stress) School demands are inadequate

(higher or lower) than the capacity of the child

Sources of stress

Personality of a childLearning processPersonality of a teacherSocial role of a studentSchool as an institutionFamily attitudes to education, school

Personality of a child • Development (school readiness)• Personality and intellectual capacity• Health handicap (sensory, physical,

mental)• Learning disorders (e.g. dyslexia, ADHD)• Behaviour disorders (e.g. bullying)

School readiness

SR is an important precondition for effective school functioning.

SR is evaluated at the 5th year (pediatric preventive examination).

SR is assessed at different levels of functioning:- Physical (growth charts, physical, auditory, vision

examination);- Cognitive (Jirasek screening test - figure drawing test,

copying a sentence, a figure);- Verbal fluency and capacity (screening interview);- Social and emotional (observation, interview with the

child, parent, teacher). Delay in the development may require postponing school attendance and specific interventions (educational, psychological, etc.).

Learning process

• Content of instruction amount of knowledge comprehensibility, logic link up • Form of instruction sustained concentration time pressure induced rhythm of work length and form of recreation daily, weekly changes in efficiency

Teacher´s personality

• demands vs. capacity of students • evaluation of students

(competitive vs. collaborative environment)

• relationships, support of students• psychodiagnostic skills• stress management skills

WHO (HBSC, 2004)

50,8

37,934

73,8

52,1

36,4

79

63,6

53,9

68,7

58

49,9

38,6 3933,7

0

10

20

30

40

50

60

70

80

%

encourage are just help concerned high demands

TEACHERS' BEHAVIOUR

age 11 age 13 age 15

Social relationships at school

• schortcomings in communication• shortcomings in behaviour• unjust treatment• aggressive behaviour• bullying

WHO (HBSC, 2004)

61,6

49,8

41

56

40,6

33,8

76,9

71,3 70,7

16,9 17,114

9,8

17,520,1

9,4 10,8 10,6

0

10

20

30

40

50

60

70

80

%

enjoy beingtogether

help each other respect eachother

was bullied bullied others feel lonely

RELATIONSHIPS AMONG SCHOOLMATES

age 11 age 13 age 15

School - institution

• conditions for school work organisation,

equipment indoor environment • conditions for leisure time activities• communication between school and

parents

Parents attitudes towards education

• inappropriate demands age capacity health status of a child • lack of time• lack of concern, support

Parents concern about school problems of their

children %Encouraging 87,4Helping 78,9Communicating with teachers 61,0Rewarding 32,8Punishing 8,2Putting high demands 32,9 Not interested 6,0

WHO International SurveyHealth Behaviour in School-aged

Children(HBSC)

2001/2002 HBSC survey in 35 countries in the WHO European Region and North America

2002/2004 survey in the Czech Republic:

5187 children - 11, 13, 15 years old 80 randomly selected elementary schools

WHO questionnaire• Socioeconomic data, conditions• school environment, workload• leisure time• family• nutrition, eating habits• harmful behaviour• satisfaction with life• health and psychosomatic status

Subjective evaluation• Concern of the family• Relationship to school• Relationships among peers• Teachers behaviour• Mood and emotions in last months

9,4 10,8 10,6

30,632,4 31,7

18,6

24,3

28,7

44,8

57,2

54,448,9

60,7

53,6

28

34,5

28,4

56,5

61,860,8

0

10

20

30

40

50

60

70

%

feelinglonely

headache feeling down feeling bad feelingnervous

feelinganxious

feeling tired,exhausted

MOOD IN LAST 6 MONTHS

age 11 age 13 age 15

Morning fatigue once a week or more

boys % girls %

11 years 32,7 31,013 years 33,7 32,415 years 39,1 32,5

29

34,1

12,5

27,1

48,8

70,3

54,9

68,9

26,7

39,3

63,8

75,2

0

10

20

30

40

50

60

70

80

%

headache feeling down feeling bad feelingnervous

feelinganxious

feeling tired,exhausted

MOOD IN LAST 6 MONTHS

students like school students dislike school

Physical and mental symptoms x subjective perceptions

Feelings of satisfaction exclusion

helplessness

Headache - *** +*** +*** Stomachache - *** +*** +*** Backache - *** +*** +*** Feeling down - *** +*** +*** nervous - *** +*** +*** tense - *** +*** +*** Sleeping problems - ** +*** +*** Weariness - *** +*** +***

Using medicaments in the last month (%)

head stomach sleep nervousness

ache ache problems tension

Boys 11 years 26,1 18,1 11,4 13,4 13 years 21,8 11,2 4,5 7,1 15 years 22,2 8,0 3,4 4,1

Girls 11 years 26,8 17,9 8,5 12,2 13 years 31,5 21,2 6,8 7,4 15 years 36,6 35,2 3,7 7,8

CONSEQUENCES OF SCHOOL STRESSLOSS OF MOTIVATION FOR SCHOOL WORK

LOW ACHIEVEMENT, SCHOOL FAILURE

LOW SELF-CONFIDENCE

SENSITIVITY TO EVALUATION

FEELINGS OF EXCLUSION, HELPLESSNESS

SCHOOL AVOIDANCE (ANXIETY, PHOBIA)

BEHAVIOURAL DISORDERS (MISBEHAVIOUR)

HEALTH PROBLEMS

HEALTH PROBLEMS

RECURRENT RESPIRATORY INFECTIONS AND COMPLICATIONSSTOMACHACHE, NAUSEA, VOMITINGHEADACHE, BACKACHE, ILL POSTUREHIGH BLOOD PRESSUREDISORDERS OF TERMOREGULATIONFATIGUE

EATING DISORDERSSLEEPING DISORDERS, NIGHTMARES, ENURESISTICS, STUTTERING

DISORDERS OF CONCENTRATION, MEMORY, INEFFICIENCY

IRRITABILITY, RESTLESSNESS, IMPULSIVE AND AGGRESSIVE BEHAVIOUR

ISOLATION, APATHY, PASSIVE BEHAVIOURSCHOOL, SOCIAL ANXIETY, DEPRESSION

LACK OF SOCIAL SKILLS RISK TAKING BEHAVIOUR IN PEER GROUPS (SMOKING, DRUGS, VIOLENCE)

POSSIBLE CONSEQUENCES IN

ADULTHOOD

• LACK OF COMMUNICATION SKILLS

• SOCIAL ANXIETY, SOCIAL BEHAVIOUR

• LOW SELF-CONFIDENCE, EMOTIONAL

PROBLEMS

• LACK OF STRESS MANAGEMENT SKILLS

• HEALTH PROBLEMS

Prevention of Health Problems

Role of the Teacher • Early identification of a child at risk (observation,

teachers scales of school anxiety and behaviour)• Cooperation with parents• Cooperation with school psychologist,

pediatrician, child psychiatrist, social worker, etc.• Providing specific educational intervention • (e.g. extra classes for children with dyslexia, ADHD)

Prevention of Health ProblemsRole of the

Pediatrician/Practicioner• Assessment of school readiness

(preventive examination at the 5th year )• Early detection of school related health

and mental problems and referal to a specialist (psychologist, psychiatrist, neurologist, ortophonist, etc.)

• Medical consultant to school health promotion programmes

• Cooperation with parents, teachers

Prevention of Health ProblemsRole of the Public Health

Officer• Regular assessment of school

environment according to hygienic standards and regulations (microclimate – temperature, ventilation, illumination, noise, cleanliness of the facility, etc.)

• Consultant or coordinator of school health promotion programmes

I. Construction, technical and microclimatic conditions

• Law No.183/2006 on district planning and construction regulations

• Directive No.268/2009 on general technical requirements on buildings

• CSN 73 4108 – cloakrooms, washrooms and toilets

• CSN 730580-1,2,3- daily illumination

• CSN EN 12464-1 – artificial illumination

• Law No.258/2000 on public health

protection

• Directive No.6/2003 on hygienic limits of chemical, physical and biological indicators for ambient environment (related to §6 of Law No.258/2000)

• Government directive No.272/2011 on health protection against adverse effects of noise and vibrations (related to §30 – §34 Law No.258/2000)

Air quality

• Directive No. 268/2009 - max. concentration of CO2 acceptable for ambient environment - 1000ppm.

- Increased values - fatigue, lack of concentration, low achievement, headaches.

- Health risk limit - 5000ppm (Survey in the classroom - 6700 ppm)• Regular ventilation recommended!

Ambient temperature

• Direct. No. 343/2009 – defines measures in higher values (ventilation, heating regulation) and lower values in the classroom (3 days below 18oC or 1 day below 16oC – school attendance is stopped)

Illumination

• CSN EN 12464-1 – recommended values for white

boards 300lx and blackboards 500lx)

- Recommended light fitting placement

II. Health aspects and risks of a pedagogical process

Prevention of overload/distress: • respecting daily and weekly biorhytms

(efficiency increasing during the morning with the peak between 9 and 11 hours, then decreasing with the minimum between 13 and 15 hours, afternoon increasing with the peak around 18 hours)

• Weekly efficiency is decreasing from Monday to Friday

• Adapt the schedule to the efficiency, do not start before 8:00, include relaxation activities, Wednesday without homework

Design of the lesson:

• First half – examine and explain new knowledge

• Divide the lesson to parts respecting age related capacity to concentrate

- the youngest pupils - 10-15min. - 1st graders up to 25 min. - 2nd graders up to 30 min.• Change regularly working position

Working position

• 40% pupils have ill posture• Increase between 7 and 11 years• RF = an ergonomically not suitable

working place not respecting growth of pupils

• Manipulation with heavy bags • Insufficient compensation of static

load

Guidelines for working place/height

Physical exercise during the lesson

• short physical exercise (2 – 3 minutes) should be included into every lesson (at least once)

Functions: • compensation of static overload during

sitting (stretching muscles around backbone)

• prevention of ill posture• relaxation (breathing exercise, eye

movements)• Increasing capacity to concentrate

Recreations/breaks

Purpose:

a) Relaxation of pupils and teachersb) Spontaneous PA outside, inside

(space for exercise, stretching)c) Time for eating and drinkingd) DO NOT SHORTEN!!e) Lunch break min. 1 hour

Physical activity

• Use efficiently regular hours of physical activity (2 hours/week)

• Offer space and opportunities for physical activities in leisure time esp. using outside facilities

School Health Promotion

Health education curriculum1. Personal health care – incl. hygiene and dental health

2. Personal and human relationships incl. sexual education

3. Nutrition education/healthy eating

4. The use and abuse of medicaments and drugs – tobacco, alcohol, illegal drugs

5. Environment and health (e.g. nuclear energy)

6. Safety education and accident prevention incl. first Aid

7. Consumer education

8. Community health care and its use

9. Family life

10. Prevention and control of disease (HIV/AIDS/STDs)

11. Violence and injuries

References• Bencko, V. et al.: Hygiene and Epidemiology. Charles

University in Prague. Selected Chapters. The Karolinum Press, Prague 2011.

• Mangham, C.: Health Promotion and Education. International Summer School on Prevention of Noncommunicable disease. Halifax, Nova Scotia, 1993.

• Mental Health Promotion and Mental Disorder Prevention. A policy for Europe. Radboud University Nijmegen, the Netherlands, 2005. (http://www.imhpa.net)

• Pencheon, D., Guest, Ch., Melzer, D., Gray Muir J.A.: Oxford Handbook of Public Health Practice. Oxford University Press, 2001.

• Schools for Health in Europe – http://www.schoolsforhealth.eu