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Determination of adequate school nurse staffing is a complex process. School nurse-to-student ratios and the health services school nurses provide to students should be considered. The purpose of this study was to examine the impact of North Carolina school nurse-to-student ratios and school nurse health services on the health and education outcomes (eg, absences, grades, self-management) of students receiving services for asthma and diabetes. This study of all 115 school districts in North Carolina used the Annual School Health Service
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