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402 THE JOURNAL OF SCHOOL HEALTH

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FOR THE MEDICAL DIRECTOR JOHN LAMPE, M.D. AND EVALYN GENDEL, M.D.

Some Refiections Upon the Beginning of a New School Year Alfred Lord Tennyson once said “the old order changeth, yielding

place to new . . .”. Those words are as pertinent to school health rn they are to all other things. We must be aware of changes, to anticipate them, and to structure them to the advantage of our efforts. A notable example occurs in the field of nutrition. The factors mediating change here are indeed diverse. Agronomy, economics, communication-are but a few of these factors. Whatever the cause it is our business to be aware of the effect and to deal with it as the need may be.

That there have been changes in the past several years we are all aware-what they have been is clarified by a brief review of the literature. Studies done in Boston, Cleveland, and most recently in Cincinnati indicate that approximately ten percent of the school-age population may be considered obese. The determination in the Cincinnati study (Rauh, et al,; Child Development, 38:2:515, June 1967) was based upon the Wetzel grid. This normative study is well known and well accepted. It offers a reasonable basis for such studies and is as generally acceptable and valid a basis as is available in pediatric practice. The Cincinnati study utilized a representative school population and when considered with other similar studies of recent date, is indicative of the change evidenced by growth in the school age population in this country.

When compared to the work of Stuart and Meredith, done in Iowa some twenty years ago, and highly regarded and widely quoted since it’s completion, the Cincinnati study indicates today’s children are both taller and heavier than were their predecessors.

Thus there are changes both in the normal and abnormal areas of growth. Obesity in children becomes more of a concern to those concerned with child health while a t the same time all children are becoming taller and heavier.

For those particularly interested, the details of the study by h u h are well worth reading. Other pertinent references include: 1. Cheek, D. B.; Mellits, D.; and Elliott, D.-Body Water, Height and Weight

During Growth in Normal Children-American Journal of Diseases of Children,

2. Falkner, F.-Some Physical Growth Standards for White North American Children-Pediatrics 29: 467474, 1962.

3. Johnson, M. L.; Burke, B. 5.; and Mayer, J.-Prevalence and Incidence of Obesity in Cross Section of Elementary and Secondary School Children-American Journal of Clinical Nutrition, 1966,4-231.

4. Pett, L. B.; and Ogilvie, G. F.-The Report on Canadian Average Weights, Heights, and Skinfolds-Canadian Bulletin on Nutrition, 1957, 5-1-81.

5. Stuart, H. C.; and Meredith, H. V.-Use of Body Measurements in a School Health Program-American Journal of Public Health, 1946, 36: 1365-86.

122, 312-317, 1966.

* * * * * Football Shoes

Athletic equipment has been altered and adapted in the interest of player safety considerably in recent years. Notable and now common-

THE JOURNAL OF SCHOOL HEALTH 403

place are the batting helmet in baseball, and the mouth piece in football’ Modifications of the helmet and face piece in football continue in an effort to minimize injuries. Recently attention has turned to the con- struction and function of the football shoe. There have been comments a t the national level and varying experience in local situations. This is being written to call attention to the matter and to share our experience with others.

Dr. Marcus J. Stewart, Professor of Orthopedic Surgery at the Uni- versity of Tennessee College of Medicine, spoke before the eighth National Conference on the Medical Aspects of Sports. He mid, “I am firmly convinced that if we would eliminate the cleats on the heels . . . we would save knees from injury.” Reviewing his experience with 356 major ligament injuries about the knee, Dr. Stewart explained, “There were 101 cases with anterior cruciate ligament injuries, 40 per cent of which were sustained without body contact. They were not the result of a block or clip as has been the theory for many years. It is my belief that most of these young men were running at full steam when they attempted to set their foot and turn or cut back. With their momentum forward, they shifted their body weight sideways or backward in a sudden turn. The foot being W y b e d by toe and heel cleats, the cruciate ligament had to give to this change in force. If the heel cleats were replaced by a simple rubber heel this momentum could be dissipated in a turning of the foot. This turn would occur with the toe cleats and still give the athlete proper traction for stepping off in a new direction.”

We had been aware of this concern and kept track of injuries among players in our school district during the 1966-67 season. More than half of our players went through the season with the conventional heel cIeats. The remainder had the heel modified in one of three ways- replaced by a standard rubber heel as worn on street shoes, replaced by a straight plastic bar attached as were the cleats by threads, or a semi- circular plastic bar affixed in the same fashion. Throughout the season there were 48 significant injuries to the knee or ankle reported. Of these 48, 45 were among players wearing standard cleats while 3 occurred to players wearing rubber, plastic bar, or plastic circle heels. Comments from the coaches and players were also of interest. These included the reaction that the rubber heel added unwelcome weight to the shoe; players favored the plastic heel bar over the rubber heel or plastic circle bar; after an injury players indicated that the rubber heel was an excellent aid toward decreasing the recovery time of the injury; finally after injury the use of a plastic bar or circle resulted in no further injury through the remaining season.

Comments such as those cited by Dr. Stewart as well as those of others, plus the experience from the 1966-67 season, suggest that heel cleats may soon be a thing of the past. * * * * *

Utilization o j Deuelopmemtal Knowledge In working with teachers to assist in understanding and planning

for optimal schooling of problem children, those of us in medicine have come to use and value the information made available by developmental studies. A history of the developmental milestones is frequently helpful in identification and in prognostication. While much knowledge is


available there continue to be refinements and additions that are helpful. Two such have recently come to the attention of the writer and are passed on in the hope that they may be of use to the reader.

The first is a schematic synopsis of the development of speech. It is the result of studies done by Duffy and Irvin, and appeared in the book Speech Disorders, Principles and Practices of Therapy by Berry and Eisenson, (Appleton-Century-Crof ts, Inc.) .

AQEINYEARS 1 1% 2 3 4 5

Size of 1 20-100 200-300 900 1MH) Vocabulary (in words)

Word Type nouns nouns nouns verbs verbs (in order of some verbs verbs nouns pronouns most common other parts other parts pronouns nouns we ) adjectives

Sentence 1 word 2worda 3word4 Length

Intelli ‘bility Of Chig’a Speech 25% 6Q% 90% 100%

The second is a study by Donoghue and Shakespeare done in Great Britain (Developmental Medicine & Child Neurology, 9: 3:299 June 1967) to determine the age of teething among retarded children. Parents are not altogether accurate in recalling milestones, particularly those to which they do not attach major significance. Frequently they do recall the appearance of the first tooth. Of what significance is inquiry in this regard when obtaining a history on a retarded child? The researchers found that retarded children do not teeth later than normal children, hence there is no reason to include a question regarding teething in obtaining a developmental history. The whole matter of teething is discussed and the paper well worth reading.

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Student Response to “ A Point of View” During the fall quarter 1965 students enrolled in the required health

education program at Peabody College were shown the film “A Point of View.” Because of the newness of the flm and its rather unusual approach to the smoking problem, student evaluations were solicited at the end of the viewing period. The intent of this project was to determine the extent to which college students (preponderantly freshmen) reacted to tb particular film.

Some comments of a general nature preceded the f h ’ s showing. Students were told that the film related to smoking, that it waa new, and that it wm produced and sponsored by the National Tuberculosis Associa- tion. Without undue emphasis, attention was drawn to the fact that “A Point of View” was characterized by a somewhat unusual, if not

THE JOURNAL OF SCHOOL HEALTH 405

(-1 (0) (+I Smoker 0 8 12

Non-Smoker 1 8 54

(++I 5 25

23 86

Total I 1 1 16 I 66 I 28 I 111

Frequently cited statements observed in the responses of the smoker

-unique approach (satire and humor) was really effective -humorous approach not as effective as a more factual, documented

-film shows the absurdity of smoking -not just a boring presentation of statistics -not persuasive enough to cause the smoker to stop smoking

-unique approach (satire and humor) was most effective -not just morbid, boring statistics -factual approach might be more effective -film shows the absurdity of smoking -there was too much humor -good look at “typical” Americans who smoke -list of endorsers was impressive

included :

approach

Non-smokers, on the other hand, most frequently included in their evalu* tions comments such as:


-possibly more appropriate for younger students Results of this project should provide useful feed-back to those who

are familiar with and have used the film, and possibly serve to encourage its continued use as an effective teaching aid by the college health educator. It is also possible that other users of the film might consider a similar evaluation project, at various age levels and with different subject populations. As more insight into student reactions to popular visual aids is gained, the health educator will be in a better position to use the aid more advantageously. After all, it is the student’s response that will in the final analysis determine a film’s ultimate worth as a teaching aid.

MINA THURMAN, Executive Secretary Davidson County Anti-Tuberculosis Association

Nashville, Tenn. and ROY PANGLE

George Peabody College for Teachers Nashville, Tenn. * * * * *

I I R E S E A R C H OF I N T E R E S T

Lome J. PEFERBON, ED. D., RUMELL F. WEALEY, M.P.H. Ph.D.,

Margolis, J., “Citation Indexing and Evaluation of Scientific Papers.” Science, 155: 3767 (March 10, 1967). 1213-1219.

With the vast number of publications today, more time and effort may be used in choosing what is to be read than in the actual reading, and it is becoming increas- ingly difficult to select the most relevant sources. A newcomer among reference tools is the Science Citation Index, which has given up subject indexing in favor of a novel approach that might well be called the “tell me whom you cite, and I will tell you your status as a researcher” method. The Science Citation Index starts out on the assumption that worthwhile up-to-date literature in a given field will refer back to significant and well-known earlier works. The names of the authors of these earlier works, succinctly identified bibliographically, are the ones that appear in the Index as “citations.” Each “citation” name is followed by the name or names of the authors (with equally condensed bibliographic information about their article) that have given this citation as a reference; these are the “sources.” As a starting point, the searcher must therefore be familiar with a few of the outstanding scholars in the field, but from there on, the Citation Index will carry through the whole network of inter-related articles. [Published first on an experimental basis for 1961, Science Citation Index has had regular annual volumes since 1964. It covers around 1500 scientific and technical journals and close to 300,OOO references. The annuel produc- tion includes four volumes of “citations” and another three volumes of “sources,” listing and authors and the full title of all the articles appearing in the journals, in contrast to the main “citation” section which does not list titles.] On the basis of a study of the 1961 and 1964 volumes, the author draws certain conclusions about citation habits, the impact of the Index on research, and the potentialities it offers as a tool for evaluating publications. In the discussion of citation habits, he notes that “. . . it would be preposterous to suggest that the most cited author would automatically receive the Nobel prize” and he states that “the healthy operation of citation indexing depends upon citation habits.” Haphazard reporting of familiar works, exaggerated special interests or loyalties, and ignoring pertinent literature may operate against an author. Judicious feeding of the Index enhances its self- organizing features. Citation indexing provides, aa a by-product, a measure of the impact of articles, authors and journals. Impact and quality, however, do not always go together. “he average citation reaches its peak during the third year and falls

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