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We evaluated the problems of physically disabled children in schools, and clarified the roles of school physicians and the appropriate state of child neurologists. The range and severity of disabilities of disabled children in schools have gradually been increasing. Although nurses were assigned to provide medical care, the roles of school nurses differ among schools. In addition, about 50% of primary care physicians for these children are not Board-Certified Child Neurologists. Therefore, the instructions of medical care by primary care physicians to teachers and nurses are not well structured, and increase the physical and mental stress of teachers and school nurses. Thus the importance of the roles of school physicians has been increasing. As a school physician, I would request the followings to the Japanese Society of Child Neurology: (1) a proposal concerning support for commuting methods, (2) further improvement in postgraduate education in medical care and support for physically disabled children, (3) the standardization of written instructions for school, and (4) a proposal concerning the roles of nurses in school for disabled children.

Purpose: The authors focused on preventing lifestyle-related diseases among schoolchildren on the basis of health surveys with blood examinations and questionnaires on lifestyle in collaboration with parents, YOGO teachers, and public health nurses. The present study purposed to evaluate this approach using the PRECEDE-PROCEED Model., Method: The authors inquired of schoolchildren's parents their awareness of their children's health through health surveys of their children. Additionally, changes in the role of YOGO teachers and public health nurses before and after our attempt were assessed. The significance and problems with our approach were then evaluated based on the PRECEDE-PROCEED Model., Results: Based on the PRECEDE-PROCEED Model, it was clarified that, for prevention of lifestyle-related diseases among schoolchildren, health surveys with blood examinations and questionnaires on lifestyle increased parents' interest in their children's health. On the basis of the results of health examinations, the role of YOGO teachers changed from leading figure for general health education to supporters of health promotion for individuals, with provision of health education classes in schools for this purpose. The role of public health nurses also changed from providing health education at the request of schools to supporting families to improve their lifestyle, including that of their children., Conclusions: In collaboration with children's parents, YOGO teachers and public health nurses, the present approach to prevent lifestyle-related diseases of schoolchildren on the basis of health surveys has advantages for increasing interest in schoolchildren's health, and should be useful for health promotion.

Objective: Principals of elementary schools and classroom teachers of classes for children with special needs were surveyed by questionnaire to identify the features of children with special needs in mainstream schools and the role of nursing teachers., Methods: Subjects in Y prefecture were asked to consider several items including the following: 1) presence in class of children with special needs; 2) presence of a child with special needs who was a target of a class or a school for children with special needs; 3) presence of education for special needs experience; 4) obstacles that such children face; 5) the relation with a nursing teacher from June to August in 1998., Results: 1. There was no class for children with special needs in 87 among 135 schools. Children with special needs were present in 27 out of 87 schools, and the frequency of children with special needs was about 0.3% in mainsteam classes. 2. The total number of children in classes for special needs was 177 including 142 (79.8%) with intellectual disabilities, 77 (43.3%) with complex disabilities and 61 (34.3%) requiring medical care. 3. Ninety percent of teachers of special needs classes asked a school nurse about health care for special needs and how to cope with matters relating to disabilities. 4. Ninety percent of teachers of special needs classes were concerned about matters such as the method of teaching and coping with matters relating to disabilities., Conclusion: The survey found that there are children with special needs in mainstream classes. The situation with the disabilities is an appreciable number of complex, so teachers of special needs classes had many concerns. Those teachers are inclined to be isolated in school. To achieve good educational outcomes for children with special needs it is important to develop a systematic network between school and experts such as medical doctors and educational professionals. Nursing teachers could play an important role in their relation, with medical specialists.

We investigated the status of the school life of 72 children with acquired brain damage attending to different schools: special schools (30 cases), special classes in an ordinary school (9 cases), and ordinary schools (33 cases). In the special school group, the main disorder was the sequelae of encephalitis/encephalopathy; there were 26 cases unable to walk, 29 with severe mental retardation, and 25 with epilepsy. In the ordinary school group, main problems were the sequelae of a cerebrovascular disorder or a traumatic brain injury. Impairment was mild in this group; only 2 cases were unable to walk, and only 4 were mentally retarded. However, many patients had learning difficulty and costed the families much work to achieve school lives. In all groups, the use of welfare equipments improved the activity of daily living. We emphasize that welfare equipments and community support systems should be utilized for these children.