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Background: Health and education are interrelated and influence social, economic and lifestyle perspectives. Children with chronic illnesses experience barriers in the educational system regarding school attendance and social isolation. Gaining knowledge of compulsory education and how children with chronic illnesses are supported is crucial for the implications of future education policy and legislation in Scandinavia. This study compares Scandinavian legislation frameworks on compulsory education, chronic illness and school absence to form the basis of future research on education for children with chronic illness., Methods: The study uses a comparative approach to explore the support of children with chronic illnesses in compulsory education across Norway, Sweden and Denmark. The documents included are 3 education acts and 15 secondary documents, which are notes and guidelines for the education acts. The data were analysed using a manifest content analysis., Findings: We found four categories and six subcategories: (1) school obligation and rights; (2) chronic illness; (3) school absence: (a) categorisation of absence; (b) registration of absence; and (c) sanction; and (4) education support: (a) Hospital school support; (b) Home instruction support; and (c) technological support., Conclusion: This study's findings demonstrate the similarities and differences in the Scandinavian compulsory education legislation and guidelines regarding chronic illness and school absence. We found similarities across the countries regarding chronic illness and school absence. Still, the findings showed differences in the systematic registration of school absence and requirements for attendance with compulsory education in Norway and Denmark compared with compulsory schooling in Sweden. This knowledge will inform and enlighten future discussions and decisions in education and public health. The results can contribute to awareness of the opportunities for educational support and perspectives about education for children with chronic illnesses. Future research focusing on the experience of children with chronic illness and educational support is needed., (© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance., Methods: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2-4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7-16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March-June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat., Results: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94-112), 5987 enrolled at study initiation (23rd November-22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71-1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84-1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83-1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0-100 scale; 95% CI 0.05-6.59), and no evidence of effects on other secondary outcomes., Conclusions: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes., Trial Registration: ClinicalTrials.gov, number NCT05024890., (© 2024. The Author(s).)

Purpose: The present study investigated school absence among 1,076 5-15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK., Methods: Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance., Results: During May 2021, 32% of children presented with persistent absence (missing ≥ 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers., Conclusion: COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship., (© 2023. The Author(s).)

Background: Middle and high school students who are involved in caregiving for aging, chronically ill, and/or disabled family members report more learning challenges compared to their non-caregiving peers. However, little is known about how many students miss school to take care of someone else, and which students are most likely to have this experience. Such knowledge could reveal an important, largely unrecognized reason for school absences and educational disparities., Methods: Our research-practice partnership surveyed middle-and-high schoolers across Rhode Island public schools in 2022., Results: Among 55,746 students (45% White non-Latinx; 21% Latinx; 45% girls), 13.80% reported they had missed school to take care of someone else, with up to 35% in some districts. Students who missed school for caregiving were disproportionately girls, non-binary, transgender, or preferred not to report gender, older youth, and from historically marginalized racial and ethnic groups, and from urban districts., Conclusions: Children's experiences caregiving for others may be an important and overlooked contributor to absenteeism and achievement gaps, especially in urban areas. We suggest school policies to better serve these students., (© 2024 American School Health Association.)

Aim: Adolescents' well-being and school absence are important factors for public health. The aim of this study was to examine the association between social well-being and problematic school absence among Danish adolescents in the ninth grade, as well as to examine potential sex differences, using a large cohort of adolescents., Methods: In this cross-sectional study, information on social well-being was obtained from the yearly Danish National Well-being Questionnaire mandatory in compulsory school. Data on school absence was obtained from the Ministry of Children and Education. The study population comprised 203,570 adolescents in the school years 2014/2015 to 2019/2020. The association between social well-being and problematic school-absence was analysed using logistic regression. A stratified analysis was made to investigate potential sex differences., Results: A total of 17,555 (9.16%) adolescents had problematic school absence, defined as >10% illegal absence and/or sickness absence in the ninth grade. Adolescents with low social well-being had higher odds for having problematic school absence compared with adolescents with high social well-being, adjusted odds ratio=2.22 (95% confidence interval 2.10-2.34). When stratifying for sex, the association was strongest for girls. The results remained after adjustment for parents' educational level and family structure., Conclusions: Associations between adolescents' social well-being and problematic school absence were found, where girls had the strongest association. These findings might provide knowledge about social well-being as an important factor for problematic school absence, while underlining the importance of early focus and prevention, which is of importance for both the adolescents and society., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Background: Neurodisability describes a broad set of conditions affecting the brain and nervous system which result in functional limitations. Children with neurodisability have more hospital admissions than their peers without neurodisability and higher rates of school absence. However, longitudinal evidence comparing rates of hospital admission and school absence in children with neurodisability to peers without neurodisability throughout school is limited, as is understanding about whether differences are greatest for planned care (e.g., scheduled appointments) or unplanned care. This study will describe rates of planned and unplanned hospital admissions and school absence due to illness and medical reasons throughout primary school (Reception to Year 6, ages 4 to 11 in England) for children with neurodisability and all other children, using linked individual-level health and education data., Methods: We will use the ECHILD (Education and Child Insights from Linked Data) database, which links educational and health records across England. We will define a primary school cohort of children who were born in National Health Service-funded hospitals in England between 1 st September 2003 and 31 st August 2008, and who were enrolled in Reception (age 4/5) at state-funded schools. We will use hospital admissions records to identify children who have recorded indicators of neurodisability from birth up to the end of primary school (Year 6, age 10/11)., Results: We will describe rates of planned and unplanned hospital admissions and health-related school absence for three groups of children: those with a neurodisability indicator first recorded before beginning primary school, those with neurodisability first recorded during primary school, and those without a record of neurodisability before end of primary school., Conclusions: We will further explore whether differences between these group vary across primary school years and by socioeconomic and demographic characteristics., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Gimeno L et al.)

Asthma can impact children's quality of life. It is unclear how asthma is associated with the developmental health (i.e. a broad range of skills and abilities associated with growth and development) of young children at school entry. The goals of this cross-sectional, population-level study were to: (1) investigate the association between teacher-reported asthma and children's concurrent indicators of developmental health (developmental vulnerability); and (2) explore whether school absences and functional impairments modified this association. Participants were a Canadian population-based sample of 564 582 kindergarten children (M age  = 5.71 years, SD  = 0.32, 51.3 % male) with data on the Early Development Instrument (EDI) collected between 2010 and 2015. Adjusted binary logistic regressions were conducted to address the objectives. From the sample, 958 (0.2 %) children were identified as having a diagnosis of asthma. These children were absent on average 9.4 days and 53.5 % had functional impairments (vs. 6.7 days absent and 15.9 % with functional impairments in children without asthma). After controlling for demographic characteristics, children with asthma had between 1.51 and 2.42 higher odds of being developmentally vulnerable. Only the presence of functional impairments modified this relationship and only for physical health and well-being. In this large, population-based sample of Canadian kindergarten children, few teachers reported knowledge of their students' asthma diagnosis. Among teacher-reported cases, asthma was a risk factor for developmental vulnerability in the domain of physical health and well-being only. Functional impairments may therefore be more detrimental for child development at school entry than asthma alone., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Magdalena Janus and Marni Brownell report financial support was provided by Canadian Institutes of Health Research. Magdalena Janus and Marni Brownell report a relationship with Canadian Institutes of Health Research that includes: funding grants. There are no other conflicts of interest to report., (© 2023 The Authors.)

Education is a central determinant of adolescent health. School absences and bullying involvement jeopardize wellbeing, mental health, and educational attainment. We analyzed time trends in school absenteeism over two decades and examined the association of absenteeism with bullying involvement.We analyzed data from the nationwide School Health Promotion study, with self-reported data from Finnish middle school students in grades 8 and 9 (ages 14-17, N = 1 000 970). Questionnaires assessed frequency of illness absences (IA), truancy, frequency of bullying victimization, bullying perpetration, and involvement in both bullying perpetration and victimization. Frequent school absences were defined as occurring on more than 3 days during the prior month (2000-2015), or at least weekly (2017-2019).Frequent IA increased from 12% to 2000 to 22% in 2015. In 2017-2019, frequent IA was reported by 3.5%. Frequent truancy declined from 9% to 2000 to 4% in 2015, and remained at 4% during 2017-2019. Bully victimization was reported at least weekly by 6.9%, perpetration by 5.4% and victimization-perpetration by 1.9% of participants in total. In a logistic regression model, every type of bullying involvement increased odds for both IA and truancy.Since bullying involvement was associated with both IA and truancy, particular concern should be raised for adolescents involved in bullying, and for their social and educational functioning. The concurrent increase in IA and decrease in truancy may reflect destigmatization of mental health problems or other changes in reporting absenteeism., (© 2023. The Author(s).)

Objective: To assess dental caries, periodontal status, malocclusion and absenteeism from school among 12-year-olds in Bhopal district, Central India., Materials and Methods: Two-stage random sample of 1238 school children. Decayed missing filled teeth (DMFT), Significant caries index (SiC), community periodontal index (CPI) and dental aesthetic index (DAI) were used to record dental caries, periodontal status and malocclusion. Information on absence from school in the previous year due to pain/discomfort in the teeth or mouth was collected via interviews. Generalized structural equation modelling (GSEM) examined the direct and indirect predictors of absence from school., Results: A total of 39.1%, 17.3% and 23.9% of children had dental caries, calculus and gingival bleeding respectively. Mean DMFT and SiC scores were 1.82± 1.36 and 3.15 ± 1.47. 5,127 school hours were missed due to oral health problems per 1,000 children. None of the studied variables predicted absence from school. Utilization of dental care was associated directly with gender and malocclusion (p⟨ 0.001). Periodontal status was associated with male gender, nuclear families, tobacco consumption, and malocclusion (p⟨ 0.001). Higher DMFT was associated with male gender, malocclusion and experience of pain/discomfort (p⟨ 0.001)., Conclusions: Poor oral health and a high prevalence of untreated dental caries were noted. Despite a considerable number of missed school hours reported due to dental conditions, none of the studied variables predicted absence from school., (Copyright© 2022 Dennis Barber Ltd.)

An underexamined consequence of childhood obesity is caregivers' missed work attributed to child absence from school due to a health condition. This secondary analysis ( N = 123) reported the frequency of missed work among caregivers of children with a body mass index (BMI) at or above the 75th percentile and examined associations with select child, parent, and household characteristics. Caregivers missed work 1.3 ( SD = 1.2) times in the past year with 41% reporting 2 or more times. A child visiting a health-care provider 2 or more times in the past year and parent perception of their child's health as good/fair/poor were significantly associated with caregivers' missing work 2 or more times in a year ( OR = 5.8 and OR = 3.0, respectively). A significant association between children's physical and psychosocial well-being and caregivers' missed work emphasizes the school nurse role working with children with high BMI and families to address student absenteeism and caregivers' missed work.

Background: Syndromic surveillance systems are an essential component of public health surveillance and can provide timely detection of infectious disease cases and outbreaks. Whilst surveillance systems are generally embedded within healthcare, there is increasing interest in novel data sources for monitoring trends in illness, such as over-the-counter purchases, internet-based health searches and worker absenteeism. This systematic review considers the utility of school attendance registers in the surveillance of infectious disease outbreaks and occurrences amongst children., Methods: We searched eight databases using key words related to school absence, infectious disease and syndromic surveillance. Studies were limited to those published after 1st January 1995. Studies based in nursery schools or higher education settings were excluded. Article screening was undertaken by two independent reviewers using agreed eligibility criteria. Data extraction was performed using a standardised data extraction form. Outcomes included estimates of absenteeism, correlation with existing surveillance systems and associated lead or lag times., Results: Fifteen studies met the inclusion criteria, all of which were concerned with the surveillance of influenza. The specificity of absence data varied between all-cause absence, illness absence and syndrome-specific absence. Systems differed in terms of the frequency of data submissions from schools and the level of aggregation of the data. Baseline rates of illness absence varied between 2.3-3.7%, with peak absences ranging between 4.1-9.8%. Syndrome-specific absenteeism had the strongest correlation with other surveillance systems (r = 0.92), with illness absenteeism generating mixed results and all-cause absenteeism performing the least well. A similar pattern of results emerged in terms of lead and lag times, with influenza-like illness (ILI)-specific absence providing a 1-2 week lead time, compared to lag times reported for all-cause absence data and inconsistent results for illness absence data., Conclusion: Syndrome-specific school absences have potential utility in the syndromic surveillance of influenza, demonstrating good correlation with healthcare surveillance data and a lead time of 1-2 weeks ahead of existing surveillance measures. Further research should consider the utility of school attendance registers for conditions other than influenza, to broaden our understanding of the potential application of this data for infectious disease surveillance in children., Systematic Review Registration: PROSPERO 2019 CRD42019119737., (© 2021. The Author(s).)

The effect of ambient air pollutants and Asian dust (AD) on absence from school due to sickness has not been well researched. By conducting a case-crossover study, this study investigated the influence of ambient air pollutants and desert sand dust particles from East Asia on absence from school due to sickness. From November 2016 to July 2018, the daily cases of absence due to sickness were recorded in five elementary schools in Matsue, Japan. During the study period, a total of 16,915 absence cases were recorded, which included 4865 fever cases and 2458 cough cases. The relative risk of overall absence in a 10-μg/m 3 increment of PM 2.5 and a 0.1-km -1 of desert sand dust particles from East Asia were found with 1.28 (95%CI: 1.15-1.42) and 2.15 (1.04-4.45) at lag0, respectively. The significant influence of PM 2.5 persisted at lag5 and that of desert sand dust particles at lag2. NO 2 had statistically significant effects at lag2, lag3, and lag4. However, there was no evidence of a positive association of O x and SO 2 with absence from school. These results suggested that PM 2.5 , NO 2 , and AD increased the risk of absence due to sickness in schoolchildren.

Background: A growing body of evidence supports the safety of the human papillomavirus (HPV) vaccines. However, concerns about autonomic dysfunction syndromes and non-specific symptoms continue to linger. These conditions are not easily captured by traditional diagnostic classification schemes and call for innovative approaches to the study of vaccine safety which take more general measures of all-cause morbidity into account., Methods: Taking advantage of the unique Danish registers, including regional registration of absence from school, we conducted a cohort study of 14 068 adolescent Danish girls attending 5th through 9th grade in public schools in the municipality of Copenhagen during 1 August 2013-23 January 2018. We obtained time-varying HPV vaccination status and demographic information from nationwide registers. Using Poisson regression with random effects, we estimated rate ratios (RRs) of absence due to illness, comparing HPV-vaccinated girls with unvaccinated girls with adjustment for grade, season, calendar period, demographic factors and random effects at the individual, class and school levels., Results: Our study included 6 206 188 school days with 213 221 days of absence from school due to illness (absence rate, 3.4%). Comparing absence rates due to illness in HPV-vaccinated and unvaccinated girls yielded an adjusted RR of 1.00 (95% confidence interval [CI], 0.98-1.03)., Conclusions: Our study provides an important and novel contribution to HPV vaccine safety. Using absence from school records, we were able to address important safety concerns without relying on medical diagnoses. We conclude that HPV vaccination does not increase the risk of morbidity in any manner that manifests as absence from school due to illness., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The current study, based on a survey of 1799 parents, explored parental perspectives of school absence in relation to approved grades, challenges, demands and obstacles in education for children with autism spectrum disorder. The results revealed a relatively high rate of school absenteeism for reasons other than illness. Girls had higher rates of absenteeism than boys for short durations of absence. Absenteeism was primarily caused by a lack of teacher competence regarding autism and inadequate adaptation of teaching. There were no significant differences between genders in approved grades, but the rate of failure to achieve approved grades was approximately 50%. The most common form of educational support was support from special needs teachers and adapted pedagogy.

Background: Asthma Action Plans (AAPs) are recommended for pediatric patients to help improve asthma control. Studies have shown variable results for unscheduled doctor and emergency room visits. AAPs may have an impact on parental self-efficacy for asthma management as well as on other daily living factors that are valuable for patients and families, such as the number of missed school days and parental workdays, and on school and caregiver management., Objective: The purpose of this study is to understand parent perceptions of AAPs. The goals of this analysis were threefold, including examining (1) the association between pediatric AAPs and parental self-efficacy, (2) parent perceptions of the helpfulness of an AAP for daily living factors, and (3) associations with the type of provider who gave the AAP (a primary care provider or an asthma specialist)., Methods: A national cross-sectional online survey was completed in October 2018 by parents of children with asthma aged 0-17 years. Survey questions included the presence or absence of a pediatric AAP, the Bursch Parental Self-efficacy for Asthma scale, parental perceptions of the AAP's helpfulness with regard to daily living factors ranked on a 5-point Likert scale, and the provider type who gave the AAP. Survey responses were summarized in terms of percentages or means and standard deviations. A 2-sample t test and analysis of covariance were used to compare self-efficacy for asthma and parental-perception-of-helpfulness scores between subjects with an AAP versus subjects without an AAP. All reported P values were 2-sided., Results: A total of 704 parents with a child with asthma completed the survey. The parents had a mean age of 37.5 years (SD 10.9), and 82% (577/704) were women and 18% (127/704) were men. Most (564/704, 80%) parents had an AAP for their child; 65% (367/564) were written, 51% (286/564) were online, and 84% (474/564) were available at school. The Bursch Self-efficacy scale was significantly higher for parents with an AAP (mean 57.7, SD 8.6) versus no AAP (mean 55.1, SD 9.9; P<.001). Parents reported that they agreed/strongly agreed that an AAP was helpful for daily living factors, including managing asthma (446/544, 82%), decreased parental missed workdays (367/544, 68%), decreased child missed-school days (396/542, 73%), and for when a child is at school (422/541 78%), with other caregivers (434/543, 80%), doing normal activities (421/540 78%), and leading a normal life (437/540 81%). Parents agreed/strongly agreed that an AAP was helpful from all provider types: a pediatric provider (583/704, 82.8%), a family practice provider (556/704, 79%), and an asthma specialist (594/704, 84.4%). There was no significant difference (P=.53) between the type of provider who gave the AAP., Conclusions: Parents who had pediatric AAPs for their children reported increased parental self-efficacy compared to those who did not have AAPs. Parents found AAPs helpful for decreasing missed time from work and school, and for asthma management when at home, school, and with other caregivers. Significant AAP helpfulness was seen regardless of the provider who gave the AAP, the parent's education, and income level. Findings support the usefulness of pediatric AAPs for families and the development of easily sharable electronic AAPs for children., (©Karen H Pletta, Bradley R Kerr, Jens C Eickhoff, Gail S Allen, Sanjeev R Jain, Megan A Moreno. Originally published in JMIR Pediatrics and Parenting (http://pediatrics.jmir.org), 09.11.2020.)

Background: Few studies have examined both medical and psychosocial outcomes of youth with psychogenic nonepileptic seizures (PNES). The current observational study aimed to fill this gap by examining changes in seizure frequency, school absences, emergency department (ED) visits, psychological functioning, and health-related quality of life (HRQoL) in youth attending a clinic for brief treatment of PNES., Methods: Nineteen youth with PNES and their families presented to an integrated clinic and received psychoeducation and recommendations by medical and mental health professionals. Patients returned to the clinic, on average six months later, for follow-up. Parent proxy-report and self-report measures of psychological functioning and HRQoL were collected at each visit, and medical data were extracted from patient charts., Results: Forty-six percent of youth in the study experienced a reduction in seizure frequency, and 58% reported improvements in school attendance. Emergency department visits decreased by over 50%, and significant improvements in parent proxy-report of depression and HRQoL were observed., Conclusions: Results provide valuable information regarding the clinical profiles of youth with PNES and demonstrate the possibility for improved medical and psychosocial prognoses in response to psychoeducation and treatment guidance. Information obtained in this study may aid in the design of future clinical trials and research, assisting in the development of appropriate interventions., Competing Interests: Declaration of Competing Interests The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: School attendance is an important functional marker in adolescence, and knowledge of the correlates of school absence is important to inform preventive efforts. The main aim of the present study was to investigate the association between symptoms of depression and school absence in late adolescence, adjusting for sociodemographic characteristics and externalizing problems., Methods: Data stem from the youth@hordaland-survey, a population-based survey of adolescents between 16 and 19 years old attending upper secondary education in Hordaland County, Norway, in spring 2012. Administrative data on school absence was provided for 8222 adolescents. In addition to days and hours absent the past semester, a variable of total absence was calculated and divided into quartiles of absence. Symptoms of mental health problems and sleep duration was based on adolescent self-reports., Results: Reports of depressive symptoms were significantly associated with school absence when investigated as continuous variables. The strength of the association attenuated but remained statistically significant when controlling for sociodemographic factors and externalizing problems. When investigating the association at different levels of school absence, adolescents in the second, third and fourth quartile of school absence reported significantly higher depression scores compared to adolescents in the first quartile. The association between reports of symptoms of depression and school absence was partially mediated by sleep duration., Conclusion: The association between reported symptoms of depression and school absence was evident even at low levels of school absence, indicating a role for universal prevention strategies. The findings suggest both depression and sleep problems as possible targets for intervention in late adolescence., (Copyright © 2020 Askeland, Bøe, Lundervold, Stormark and Hysing.)

Background: Asthma is epidemic in many locations in the United States. Asthma exacerbations pose serious health and education risks for students through school absences, school dropout, and introduction to the juvenile justice system. Accurate school district-level asthma data, currently in short supply, would enable early interventions that focus on specific geographic areas and racial and ethnic subgroups that have higher asthma prevalence., Methods: To support the development of better local level data systems, we used two California student databases, as well as state education and financial databases, to develop two models to estimate school absences and to extrapolate their economic impact in lost school revenue., Results: Analysis demonstrated subpopulations that are appropriate for early intervention: African American elementary school boys have 9.4 average absences per year, higher than other primary racial and ethnic groups. Students who miss ≥3 school days due to asthma account for $26 million of lost revenue., Conclusions: Accurate local level asthma data can identify subpopulations of students for whom environmental and treatment programs can be employed to reduce asthma absences and other related outcomes, and to reduce currently lost school revenues. Such programs also may diminish other asthma-related school inequities., (© 2020, American School Health Association.)

Objective: Effective asthma management at school can help students with asthma stay healthy, learn better and participate fully during their school day. This study sought to understand school-based asthma care from the perspective of parents and school personnel to improve asthma care at school. Methods: A cross-sectional study was conducted in Hartford, CT. School personnel from 59 schools and 322 parents/guardians were invited to participate. Four cross-sectional surveys using Likert-type scales assessed parental and school personnel satisfaction, confidence in managing asthma, policy awareness, management of asthma during physical activity, and perceived gaps surrounding school-based asthma care. Results: 263/322 (82%) eligible parents of children with asthma (mean age 8.5 ± 4.3, 56% Hispanic, 30% African American) completed surveys. Thirty six school nurses (62%), 131 teachers (8%), 14 coaches (14%), and 17 school principals (29%) participated. 90% of parents were satisfied with asthma management in school. School nurses were more aware of asthma policies than teachers (74% vs. 24%, p  < 0.001). 34% of school nurses, 30% of teachers and 36% of coaches were unaware of asthma-related absences. 14% of physical education teachers/coaches reported no asthma training. Conclusion: In this convenience sample of parents and school personnel, parents reported overall satisfaction regarding the asthma care their children receive at school, yet a number of gaps pertaining to school-based asthma care were identified. Increased asthma training and enhanced communication among school personnel is needed to address these gaps. National guidelines and resources are readily available to improve asthma care at school.

Objective: To evaluate whether school nurses can assist pediatricians in providing asthma care and reduce school absenteeism through a program called Easy Breathing for Schools (EzBfS), a 5-element school nurse-led asthma management program and the effectiveness in reducing school absenteeism., Methods: Fifteen public school nurses in an urban community implemented EzBfS during the 2015-16 and 2016-17 school years. Program elements included assessment of asthma risk and asthma control, asthma education, medication review, and a pediatrician communication tool. School absence for any reason was the primary outcome; absentee rates for students with asthma enrolled in the program were compared to students with asthma in the entire school population using negative binomial regression., Results: School nurses enrolled 251/2,126 students with physician-confirmed asthma (2015-16: n = 114 and 2016-17: n = 137). Sixty eight percent of participants were Latino and 25% were Black with a mean age of 8.7 ± 2.2 years. Absentee rates were higher in children with asthma compared to children without asthma (8.3% vs 7.0% absent, respectively P < .001). Students enrolled in the program experienced a 25% decrease in absentee rate after adjusting for age, sex, race/ethnicity, and school year (rate ratio = 0.75, 95% confidence interval, 0.67, 0.85) as compared to students with asthma not enrolled in the program. Participants also demonstrated improvement in inhaler technique score (P < .001). Ninety two percent of the nurses were satisfied with the program., Conclusion: EzBfS, a pragmatic, nurse-led asthma management program, was successfully implemented by school nurses and significantly decreased school absences among a sample of students with asthma., (Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

A growing proportion of adolescents struggle with school life and could benefit from special school programmes. School could be an arena for supporting such adolescents and, to meet these challenges, interprofessional collaboration (IPC) has been recommended for better health. The aim of the present study was to explore the experience of IPC in a special school programme offered to adolescents who struggle with school life - from the perspective of the professionals involved. Focus group interviews were carried out with four groups and fourteen participants, and the focus groups included two to five participants each. The focus group interviews were analysed using qualitative content analysis. The analyses from this study resulted in a main theme: IPC in the special school programme is unpredictable . Five categories emerged from the data, including: variations in initiative, significance of individual characteristics, informal and formal contact, lack of criteria and goals , and different obligations . The participants described IPC as differing from case to case, with a lack of criteria and goals for adolescents in the special school programme. They experienced the random nature of whoever took the initiative to collaborate, and that confidentiality and the different documentation requirements could affect IPC.

This study examines the association between school absenteeism, health-related quality of life (HRQOL) and happiness among young adults aged 16-26 years attending vocational education. Cross-sectional data from a survey among 676 young adults were analyzed. School absenteeism was measured by the self-reported number of sick days in the past eight weeks and hours of truancy in the past four weeks. HRQOL was measured by the 12-item Short Form Health Survey; physical and mental component summary scores were calculated. General happiness was assessed on a scale of 0-10, higher scores indicating greater happiness. Linear regression analyses were performed. The study population had a mean age of 18.5 years (SD 2.2); 26.1% were boys. Young adults with ≥5 sick days or ≥6 h of truancy reported lower mental HRQOL compared to young adults without sickness absence or truancy ( p < 0.05). Young adults with 1-4 and ≥5 sick days reported lower physical HRQOL compared to young adults who had not reported to be sick ( p < 0.05). Young adults with 1-5 h and ≥6 h of truancy reported higher physical HRQOL compared to young adults who were not truant ( p < 0.05). No associations were observed between school absence and happiness. Lower self-reported mental HRQOL was observed among young adults with more school absenteeism due to sickness or truancy. Sickness absence was additionally associated with lower physical HRQOL.

School staff have an important role to play in identifying and assisting pupils who require additional support to regularly attend school, but their beliefs about risk factors might influence their decisions regarding intervention. This qualitative study investigated educational practitioners' beliefs about risk factors for attendance problems. Sixteen practitioners from three secondary schools were interviewed via focus groups. Data were analysed using thematic analysis. Practitioners identified risk factors related to the individual, their family, peers and school. Poor mental health was identified as a risk factor, but practitioners primarily focused on anxiety rather than other mental health problems like depression or behavioural disorders. The overall perception was that school factors were less important than individual, family and peer factors. Implications include a need for increased awareness of the role of school factors in attendance problems, focus on promoting positive peer and pupil-teacher relationships, and collaborative working between young people, families and schools., (© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: It is well known that adolescents with chronic fatigue syndrome (CFS) experience greater school absenteeism compared to healthy adolescents. Less is known about other important aspects of school functioning including school participation, school connectedness, and academic performance in students with CFS. The aim of this study was to compare school functioning as a multifaceted construct in adolescents with CFS to healthy adolescent peers. We also explored whether illness factors were associated with school functioning in adolescents with CFS. Methods: Thirty-nine participants with CFS and 28 healthy controls (aged 13-17 years) completed a range of subjective and objective measures of school functioning, as well as measures of fatigue and emotional symptoms. Results: Adolescents with CFS demonstrated significantly higher rates of school absence, as well as poorer school-related quality of life, reduced school participation, poorer connectedness with school, and reduced academic performance. Fatigue severity and emotional symptoms were significantly associated with most aspects of school function. Conclusions: Adolescents with CFS are at increased risk for poor school functioning across a range of indicators which extend beyond school absenteeism.

Background: Previous studies have examined the association between childhood asthma and lost productivity; however, more data are needed to understand its impact., Methods: This was a retrospective analysis of cross-sectional data in the nationally representative 2007-2013 Medical Expenditure Panel Survey (MEPS). School-aged children (SAC), children (age 6-11), and adolescents (age 12-17) with asthma were compared to those without asthma to examine annual missed school days. Adult parents/caregivers of SAC with asthma were compared to those of SAC without asthma to examine missed work days. The cost of premature asthma mortality for SAC was also estimated. Negative binomial regression was used for missed school days, and a two-part model structure was used for missed work days. All analyses controlled for sociodemographics and other covariates., Results: There were 44,320 SAC of whom 5,890 had asthma. There were 43,496 employed adults with at least one child. SAC (6-17) with asthma missed 1.54 times the number of school days compared to SAC without asthma. Caregivers of SAC (6-17) with asthma missed 1.16 times the number of work days to care for others compared to caregivers of SAC without asthma. SAC in the USA missed an additional 7 million school days associated with asthma (3.7 million children and 3.3 million adolescent). There were 130 asthma deaths resulting in an annual cost of $211 million ($US 2015)., Conclusions: Childhood asthma is associated with a significant school absence and productivity loss in the USA. Better treatment and asthma management programs are needed to alleviate this burden.

Objective: We undertook this systematic review to explore the relationship between sanitation and learning outcomes, specifically cognitive development and absence., Methods: We searched leading databases to identify experimental and observational studies that address the effect of sanitation on our outcomes of interest. We identified 17 studies that met the review's eligibility criteria, four reporting on measures of cognitive development, 12 on school absence (with two studies reporting on school and work absence), and one study that reported on both outcomes. We assessed the risk of bias of individual studies as well as the overall strength of evidence for each outcome. Because of fundamental differences among the studies in terms of sanitation exposure and outcome measurement, pooling results via meta-analysis was deemed inappropriate so a descriptive review is presented., Results: Studies reported that access to household sanitation was associated with measures of improved cognitive ability in children. However, collectively these studies were rated by GRADE as poor methodological quality with significant potential for confounding and bias, including publication bias. Studies on the association between household, community or school sanitation and school absence yielded mixed results. Some sanitation studies reported lower absence while others reported higher absence. Only the two randomized controlled trials reported no overall effects on absence even when combining sanitation with water supply improvements and hygiene promotion. Study quality as assessed by GRADE was again generally poor., Conclusion: While studies to date provide some support for positive effects from sanitation on cognitive development, the effects on school absence are uncertain. Differences in effects may be due to differences in study settings, type of sanitation exposure and most notably in outcome definitions. Further research in multiple settings using rigorous study designs and measuring intermediate outcomes such as exposure can help determine the effects of sanitation on these important learning outcomes., (Copyright © 2017. Published by Elsevier GmbH.)

Background: School absence is associated with lower performance on standardized tests. Children born with orofacial clefts (OFC) are likely to have more absence than children without OFC; however, school absence for children with OFC has not been quantified. We aimed to describe school absence and its relationship with school performance for children with and without OFC., Methods: Population-based record-linked cohort study of children (402 with OFC, 1789 without OFC) enrolled in schools in Western Australia, 2008 to 2012. We compared median school absence rates using Wilcoxon rank tests, and investigated the impact of school absence on standardized scores from reading, numeracy, and writing tests, using multivariable models fitted by generalized estimating equations., Results: In Semester 1, at each primary school year level, children without OFC and children with cleft lip only or cleft palate only had similar median absence rates (approximately 1 week). Children with cleft lip and palate had significantly higher absence rates in Years 4 to 6 (between 1 and 2 weeks). During secondary school, median absence rates were higher (2 weeks) for all children, but not statistically different between children with and without OFC. Higher absence was significantly associated with lower standardized reading, numeracy, and writing scores. However, having a cleft of any type had little influence on the association between absence and test scores., Conclusion: School absence affected school performance for all children. Absence did not differentially disadvantage children born with OFC, suggesting current practices to identify and support children with OFC are minimizing effects of their absence on school performance. Birth Defects Research 109:1048-1056, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Study Objective: To establish the prevalence and impact on quality of life of dysmenorrhea among young adult Jordanian females., Design: Cross-sectional study based on quantitative self-reported anonymous questionnaire., Setting: University-based study., Participants: A total of 272 female medical students (aged 19-25 years)., Intervention: None., Main Outcome Measures: Self-reports of menstruation-related pain symptoms and methods of dealing with them., Results: Of study subjects 152/272 (55.8%) participants had moderate and severe dysmenorrhea. Of them, 55.8% had a family history of severe dysmenorrhea compared with 33.1% of those without dysmenorrhea (χ2 = 13.40, df = 1, P < .001). There was strong association between severity of dysmenorrhea and poor university attendance (χ(2) = 45.35, df = 2, P < .001), poor social activities (χ2 = 32.06, df = 2, P < .001), poor relationships with family (χ2 = 18.46, df = 2, P < .001) and friends (χ2 = 19.14, df = 2, P < .001), and poor sport activities (χ2 = 12.15, df = 2, P = .002). Dysmenorrhea worsens during examination periods in 50% of cases. The most common pain symptom was low back pain (60.2%). Body mass index, family monthly income and early age at menarche had no correlation with the occurrence of dysmenorrhea. Of those with dysmenorrhea, 69.4% were using analgesics. Mothers were the main source of information regarding menstruation., Conclusions: Dysmenorrhea is highly prevalent among young adult Jordanian females and seems to negatively affect quality of life, particularly as related to university attendance and performance and social relationships., (Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Background: We tested the hypothesis that classroom carbon dioxide (CO2 ) concentration is inversely related to child school attendance and educational attainment., Methods: Concentrations of CO2 were measured over a 3-5 day period in 60 naturally ventilated classrooms of primary school children in Scotland. Concentrations of CO2 were related to the class average annual attendance and proportions attaining a national standard for reading, writing, and numeracy, adjusted for socioeconomic status and class size., Results: The median (interquartile range, IQR) CO2 concentration averaged over the school day was 1086 ppm (922, 1310). In the model, Time Weighted Average CO2 concentrations were inversely associated with school attendance but not academic attainments. An increase of 100 ppm CO2 was associated with a reduced annual attendance of 0.2% (0.04, 0.4) roughly equivalent to 1 half day of school per annum, assuming schools are open on 190 days per year. Indoor temperature and relative humidity were not related to attendance or academic attainment., Conclusions: Inadequate classroom ventilation, as evidenced by CO2 concentration exceeding 1000 ppm, is not uncommon and may be associated with reduced school attendance. A relationship between inadequate classroom ventilation and adverse health outcomes in children may be present and this needs to be explored., (© 2014, American School Health Association.)

Objectives: To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism., Methods: We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm)., Results: Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (-25%, 95% confidence intervals [CI] = -37%, -2%), ARIs (-15%, 95% CI = -30%, -8%), school absences due to illnesses (-27%, 95% CI = -41%, -18%) and eye infections (-46%, 95% CI = -58%, -31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (-31%, 95% CI = -37%, -5%; and -14%, 95% CI = -23%, -6%, respectively), 6- to 15-year-olds (-30%, 95% CI = -39%, -7%; and -15%, 95% CI = -24%, -6%) and under 5 s (-32%, 95% CI = -41%, -4%; and -20%, 95% CI = -29%, -8%)., Conclusions: Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference., (© 2014 John Wiley & Sons Ltd.)

The current study is the first to examine the association between chronic loneliness and perceived health, school absence due to illness, sleep duration and disturbance, in a sample of pre-adolescents (N = 209). Loneliness was measured in three collection waves that were 18 months apart and covered the ages 8-11 years. Using growth mixture modeling, two groups were identified with discrete growth patterns of loneliness: (a) relatively high, reducing loneliness (48%), and (b) low, stable loneliness (52%). At age 11 years, those in the relatively high, reducing lonely group reported higher levels of depressive symptoms, poorer general health, took longer to get to sleep, and had greater sleep disturbance than children in the low, stable loneliness group. These findings suggest that there may be long-term health effects of experiencing high loneliness in middle childhood, even when loneliness levels reduce to normal levels at pre-adolescence., (Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Objectives: The objective of this study is to assess prevalence and extent of school absence due to toothache, dental caries, and Oral Health-Related Quality of Life (OHRQoL) in a subsample of the Thailand national oral health survey. In addition, associations of school absence as the outcome variable with explanatory behavioral and sociodemographic variables, dental caries, and OHRQoL were investigated., Methods: Study sample was half of the Sixth Thailand National Oral Health Survey sample (1,063 12-year-old and 811 15-year-old children). Children were orally examined and interviewed about OHRQoL using the Child Oral Impacts on Daily Performances or the Oral Impacts on Daily Performances indices. Children completed a sociodemographic and behavioral questionnaire on school absence due to toothache in current semester., Results: Over a 3-month period, 5.1 percent of 12- and 4.4 percent of 15-year-olds absented themselves from school due to toothache. The number of days absent in 12-year-olds was significantly higher than in 15-year-olds. For 12-year-olds, OHRQoL and toothache were significantly associated with school absence. Severe dental decay was the main dental factor related to school absence but not significantly associated with school absence in the adjusted analyses. Children in lower school grades and those who received dental treatment in current semester were more likely to miss school compared with their counterparts., Conclusions: About one in 20 of Thai school-aged children reported missing school due to toothache. School absence due to toothache was inversely associated with the current year of study and positively with recently receiving dental treatment and with OHRQoL and toothache in 12-year-olds., (© 2013 American Association of Public Health Dentistry.)

Objective: The objective of this cross-sectional study was to determine the mean period of school absenteeism (MPSA) among Questionnaire Diagnosed Asthmatic (QDA) Saudi schoolboys of Al-Khobar city and the factors associated with it., Methods: The methodology of this cross-sectional study included the distribution of a self-administered questionnaire, which was completed by the parents of 1482 schoolboys who satisfied the selection criteria of the study., Results: The prevalence rate of QDA was 9.5% (141/1482). MPSA among Questionnaire Diagnosed Asthmatic Boys (QDAs) was 13.6 ± 3.4 days compared to 3.7 ± 2.2 days among non-QDA boys (non-QDAs). Among QDAs, it was associated significantly and positively with those who were younger, with a decreasing level of socioeconomic class, history of pets at home, presence of a current smoker in the family (father or both parents), visit to a hospital emergency room, and admission to hospital. It was significantly and negatively associated with concomitant use of prophylactic medication(s), including those used appropriately. QDAs from middle and lower socioeconomic classes used less prophylactic medication(s) but had had more visits to an emergency room and had admissions to hospital. The multiple linear regression equation for the total period of school absenteeism (TPSA) during the current academic year was generated., Conclusions: QDAs have higher MPSA compared to their non-asthmatic classmates. The impact of this disease increases particularly among QDAs belonging to lower socioeconomic families.