The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers. INTRODUCTION IN 1997, THE World Health Organization declared obesity a global epidemic with major health implications. 1 According to the 1999 -2000 National Health and Nutrition Examination Survey (www.cdc.gov/nchs/nhanes.htm), the prevalence of overweight or obesity in children and youth in the United States is over 15%, a value that has tripled since the 1960s. 2 The health implications of this epidemic are profound. Insulin resistance, type 2 diabetes mellitus, hypertension, obstructive sleep apnea, nonalcoholic steatohepatitis, poor self-esteem, and a lower health-related quality of life are among the comorbidities seen more commonly in affected children and youth than in their unaffected counterparts. [3][4][5][6][7] In addition, up to 80% of obese youth continue this trend into adulthood. 8,9 Adult obesity is associated with higher rates of hypertension, dyslipidemia, and insulin resistance, which are risk factors for coronary artery disease, the leading cause of death in North America. 10 Assessment of OverweightIdeally, methods of measuring body fat should be accurate, inexpensive, and easy to use; have small measurement error; and be well documented with published reference values. Direct measures of body composition, such as underwater weighing, magnetic resonance imaging, computed axial tomography, and dual-energy radiograph absorptiometry, provide an estimate of total body fat mass. These techniques, however, are used mainly in tertiary care centers for research purposes. Anthropometric measures of relative fatness may be inexpensive and easy to use but rely on the skill of the measurer, and their relative accuracy must be validated against a "gold-standard" measure of adiposity. Such indirect methods of www.pediatrics.org/cgi

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses. SCHOOL NURSE DEFINITION The National Association of School Nurses defines school nursing as:A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning. 1

The American Academy of Pediatrics continues to believe that adolescents should not be drug tested without their knowledge and consent. Recent US Supreme Court decisions and market forces have resulted in recommendations for drug testing of adolescents at school and products for parents to use to test adolescents at home. The American Academy of Pediatrics has strong reservations about testing adolescents at school or at home and believes that more research is needed on both safety and efficacy before school-based testing programs are implemented. The American Academy of Pediatrics also believes that more adolescent-specific substance abuse treatment resources are needed to ensure that testing leads to early rehabilitation rather than to punitive measures only.

developed severe hyponatremia with C N S symptoms while having high concentrations of sodium i n the urine. P a t i e n t s with mild t o moderate pain and/or i n f e c t i o n were studied.0n admission t o t h e h o s p i t a l 10/51 p a t i e n t s had sodium concentrations i n serum below 135mEq/l. The mean osmolality of serum of 28 p a t i e n t s was 278mOsd1, with 7/28 below 271mOdl. The urine osmolality was g r e a t e r than the serum osmolality i n 19/20 with a mean urine osmolality of L36mOdl and a ran e of 265 t6 673nOsdl. The r a t i o of sodium concentration i n t f e urine to t h a t i n the plasma(U/P) was g r e a t e r than 0.95 i n 10/3 p a t i e n t s with a mean of 0.73.Creatinine clearances were normal o r increased; f r e e water excretion was reduced, and Na clearances were u s u a l l y very high d e s p i t e hyponatremia. These r e s u l t s i n d i c a t e t h a t the r e n a l d e f e c t i n s i c k l e c e l l disease i s n o t hyposthenuria, b u t r a t h e r a narrow range of s o l u t e concentration,with l i m i t e d d i l u t i n g a s well a s concentrating capacity. These p a t i e n t s have a tendency t o l o s e excessive amounts o f e l e c t r o l y t e i n t h e u r i n e , p a r t i c u l a r l y during c r i s i s , and a r e unable t o handle a water load a t these times. These findings have s i g n i f i c a n t implications f o r supportive therapy. The 6rognosis of p o l y a r t e r i t i s in children i s poor, ' p a r t i c u l a r l y i f complicated by e a r l y renal f a i l u r e . Three s i r l s . 9 t o 10 years of age, have been treated with a combina t i o n of c o r t i c o s t e r o i d s and cyclophosphamide. A complete remission of the disease ensued in a l l three cases. IMPROVED PROGNOSIS OF POLYARTERITISAn e a r l y diagnosis has been made by biopsies of the kidney or skin. All three p a t i e n t s i n i t i a l l y were severely i l l presenting with high fever, skin and j o i n t manifestations, hypertension, and seizures. Additional complications included renal f a i l u r e in two g i r l s , primary pulmonary i n f i l t r a t e s in one, hallucinations in one. All three p a t i e n t s were s t a r t e d on Prednisone treatment (1.5-2 mg/kg) and a f t e r two t o four weeks cyclophosphamide treatment (2 mg/kg) was added. After an i n i t i a l l y stormy course a l l c l i n i c a l symptoms gradually subsided and the renal function improved. Cyclophosphamide t r e a tment was continued f o r up t o 12 months. All three patients a r e now off medication f o r periods of I5 t o 24 months with no o r minimal residual symptoms. The c r e a t i n i n e clearance has returned t o normal in two g i r l s , proteinuria i s s t i l l present in two patients. The additional administration of cyclophospl~a-mide seems t o e f f e c t i v e l y influence the disease proces? of p o l y a r t e r i t i s leading t o a resolution of i n f i l t r a t e s and necrosis which have not been accessible t o therapy previously.CLINICOPATHOLOGICAL SIGNIFICANCE OF...

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