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Background: Schools are an attractive platform for improving the dietary knowledge, attitudes and behaviors of children and their families, yet limited nutrition knowledge amongst educators can impede nutrition education efforts. Information and communication technology (ICT) can potentially overcome this barrier, yet there is limited evidence for its effectiveness in school settings in low- and middle-income countries., Methods: We implemented a randomized field experiment in 50 schools in the North Region of Cameroon to assess the effectiveness of a school-based nutrition education program at improving the nutrition knowledge of fifth and sixth grade students and their parents. We evaluate the relative effectiveness of video-based versus typical classroom instruction. Nutrition knowledge is assessed using a pre-post questionnaire and analyzed using analysis of covariance., Results: We find that students exposed to the video treatment improved their nutrition knowledge scores by 0.45 standard deviation more (equivalent to an additional 1.3 out of 14 correct answers) than students that received traditional classroom instruction. There is no differential impact of video on the nutrition knowledge scores of parents., Conclusion: Videos can improve knowledge gains compared with typical classroom instruction, but questions remain as to the conditions under which videos and other ICT are most effective as instructional tools., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Core constructs such as working memory, task switching, and processing speed in cognitive psychology research have prominent predictive roles in K12 students' academic performance. Specifically, considerable empirical work shows that variability in such capabilities is linked to differences in numerous academic outcomes. Moreover, there is an increasing awareness and acceptance of the malleability of cognitive abilities. Thus, an emerging strand of research focuses on the use of computerized cognitive training to improve cognitive skills. This project addresses this issue with high-risk students attending community day schools. An in-school cognitive training program implemented (for 30 min per day) at each school site resulted in improvements for working memory, task switching, and processing speed after six total hours of participation. The current results provide evidence for the changeability of what were once thought to be static skills. Equally important, this study highlights the effectiveness of computerized cognitive training and critically extends intervention-based work to a student group that has received little attention. Implications of this work for cognitive research and educational support programs are discussed.

Introduction: The school environment remains unsafe for many trans people, where they are victims of discrimination, aggression, and bullying, resulting in socioemotional and physical harm to trans individuals. Intersectionality and minority stress are contributing factors in this already challenging education environment. In many cases, the voices of trans people are not heard or listened to at school; therefore, this study aims to listen to their school experiences in order to identify key areas for improvement., Method: This study implemented a narrative research approach where six in-depth interviews were completed with trans participants from the Basque Country, Europe, and the United States of America that focused on five dimensions: being a trans, the role of school, lack of teacher education and training, segregation by gender, and socioemotional wellbeing. The transcriptions of these interviews were coded using Nvivo software in categorical systems in a deductive and inductive way., Results: The results clearly showed that the binary society has a negative impact on trans people. In addition, the educational environment is still hostile for most of them, in which the lack of teacher training and gender identity content in the curriculum has a negative impact on trans people and their experiences at school., Discussion: The findings support the idea that socially ingrained binarism is detrimental to all those who step outside the norm. It can also be said that the earlier the transition is made, the better the effect (clinical as well as socioemotional) on their personal lives. For this early transition to occur, it is necessary to have access to information from an early age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Etxebarria-Perez-de-Nanclares, Vizcarra Morales, López-Vélez and Gamito Gómez.)

Introduction: The main aim of the present study was to examine whether the use of a low-tech tool, called click4all, inserted into cognitive and motor training can increase social interaction of patients with Rett Syndrome (RTT) with classmates in a school setting., Methods: Twenty-seven participants with RTT were randomly assigned to two groups: the experimental group received treatment with click4all, and the control group received traditional treatment without click4all. Parameters were measured before treatment (T1), 6 months after treatment (T2), 6 months after the second treatment phase (T3) and at the end of the third treatment phase (T4)., Results: The results demonstrated an increase in levels of social interaction among classmates and patients with RTT in the experimental group, over time, compared to the control group, 95% CI [5.20-15.30]. Classmates also showed a higher level of knowledge related to participants of the experimental group, and this increased over time, 95% CI [24.98-63.52]. The level of knowledge related to the control group was stable over time and lower than the experimental group., Discussion: This study demonstrated that the use of a low-tech tool can increase social interactions of patients with RTT in a school setting. This is important, as patients with RTT are often restricted in an isolation condition., Competing Interests: GZ was employed by Fondazione Asphi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Caprì, Dovigo, Semino, Lotan, Mohammadhasani, Zamarra and Fabio.)

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12-14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

School is one of the main settings where it is useful to guarantee health promotion actions, as it is well known that diet and eating habits that are shaped in the early stages of life are maintained through adulthood. The objective of this study was to carry out the "Healthy Snack" project to promote nutritional education in primary schools in the Province of Belluno in the 2022-2023 school year, in which 925 students were enrolled, and to evaluate the intervention in terms of changes in eating habits during their school breaks. Following the workshops performed by the healthcare workers (HCWs), medals were awarded, taking into account the quality of the participating students' mid-morning snacks, considering the food pyramid. The results collected in the annual survey period were related to the type and quantity of snacks consumed at school, and allowed students to gain a final score, comparing the period before and after the educational intervention to demonstrate the effectiveness of the actions promoted by HCWs and the increased nutritional quality of meals. In light of this evidence, public health strategies must continue to emphasize the importance of implementing health promotion interventions and actions aimed at children in order to prevent weight gain in this age group, and the potential development of cardiometabolic pathologies over their lifetime.

Critical neuropsychological capabilities such as working memory, cognitive flexibility, and processing speed are foundational to many daily activities. For children, such skills are essential for school success. Thus, children who demonstrate weaknesses in these abilities may experience impaired academic performance; this is especially true for students identified with learning differences who often exhibit less developed cognitive abilities. The purpose of this project was to examine the efficacy of a cognitive training program implemented during the school day to improve abilities predictive of academic achievement. Ninety-five children completed two training activities that were counterbalanced across participants. Analyses of baseline working memory, cognitive flexibility, and processing speed performance relative to those following training showed a strong treatment effect. Moreover, there is notable evidence of greater intervention efficacy with extended engagement with the training program. Implications for neuropsychological research and practice are discussed.

There are well-established benefits of social and emotional learning (SEL) programs for children within educational contexts. Combining social-emotional skills and compassion abilities has been seldomly done, and it may be valuable at individual and societal levels, for resilient, empathetic, and inclusive societies. This study explored the feasibility and efficacy of a program designed to promote socioemotional and compassion skills in children attending the 3rd and 4th grades, by using in-class dynamics complemented with serious games. This program, named "The Me and the Us of Emotions," is part of the Gulbenkian Knowledge Academies 2020 and consists of 10 group sessions embedded in the school curriculum. Using a cluster-randomized controlled trial design, school classes were allocated to intervention (classes, n  = 8; children, n  = 163) and control groups (classes, n  = 6; children, n  = 132). During the program, facilitators assessed adherence to the sessions' plan, attendance, dosage (i.e., how many sessions were delivered), and participant responsiveness. Children completed self-report measures of social-emotional skills and emotional climate at pre-, post-intervention, 3-month, and 6-month follow-ups. Results indicate that the program is feasible, with high adherence, high attendance rate, and participant responsiveness. Results also indicate empathy, soothing, and drive feelings to change from pre-intervention to all other assessment moments, for the intervention group only. Moreover, cooperation and threat changed over time for participants in both the control and the intervention groups. The current study offers empirical support for the feasibility and utility of a compassion-based social-emotional learning program on promoting children's empathy, and emotions of soothing and vitality in the school context. Thus, these findings contribute to recent research on the potential added value of compassion practices within an SEL program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Xavier, Vagos, Palmeira, Menezes, Patrão, Mendes and Tavares.)

Introduction: While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health., Methods: This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes., Results: Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work., Discussion: This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yao, Kowalczyk, Gregory, Cheatham, DeClemente, Fox, Ignoffo and Volerman.)

Objective: Children with disabilities (CWDs) having comorbidities face challenges in accessing and completing diagnostic hearing evaluations. This study was conducted to determine whether a tele-audiology diagnostic test battery can be administered to school-aged CWDs having comorbidities in a school-setting., Design: A proof-of-concept pilot study using a cross-sectional design., Study Sample: Ten typically developing children between 3 years 9 months and 10 years 9 months of age; mean age of 8 years 3 months (pilot-norm group) and seven CWDs having comorbidities between 3 years and 8 years and 1 month of age; mean age of 5 years and 2 months (CWD group) participated in the study. A diagnostic test protocol delivered via tele-audiology was first administered to the pilot-norm group to ensure its efficiency and suitability for use in the CWD group. Following modifications, the diagnostic test protocol was delivered for CWDs., Results: We identified key aspects, including the role of the facilitator in conducting a diagnostic test battery using tele-audiology on CWDs, the usefulness of having co-facilitators to support child-friendly testing, as well as technology-related requirements. With respect to tele-audiology diagnostic testing, it was possible to quickly assess peripheral hearing using synchronous tele video-otoscopy, tympanometry, and DPOAEs. We identified limitations in conducting behavioral audiometry and completing tone-burst ABRs in CWDs., Conclusion: Evidence was obtained from this exploratory pilot study that a tele-audiology diagnostic test battery can be administered in a school setting to school-aged CWDs having comorbidities. Tele-audiology can be considered to provide hearing healthcare services to school-aged CWDs who may otherwise not receive these services., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30-35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel's perspective. All primary schools in Denmark were invited to participate in the study ( n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.

Background: Adverse childhood experiences (ACE) can have negative effects on cognitive, social and emotion regulation abilities, which can threaten the child's school integration and capacity to learn. While steady relations to sensitive, understanding adults may moderate these negative outcomes, the difficulties of children with ACEs pose a major challenge for teachers, whose insufficient preparation may lead to career attrition. Objective: Psychoeducational trauma-informed care (TIC) interventions targeting teachers may strengthen teacher preparation and buffer the deleterious outcomes of ACEs, yet the evidence-base for these interventions is limited. Importantly, while minority groups are overrepresented among those with ACEs and additionally risk exposure to ethno-racial trauma, TIC interventions lack a social disadvantage/discrimination perspective. The Present trial addresses these issues. Method: The study protocol employs a quasi-experimental design for assessing effects of a psychoeducational TIC intervention carried out in Swedish schools by Save the Children, Sweden (SCS). We compare, for the first time, an intervention group ( N  = 160) and a control group ( N  = 160) over time (pre-intervention, immediately after, 6 and 12 months post-intervention), assessing teacher stress, compassion fatigue, self-efficacy and trauma-informed knowledge. We monitor teacher attitudes and attributions of students' academic weaknesses and behavioural and mental difficulties. The trial is preregistered (DOI:10.17605/OSF.IO/V7SH8). Results: We hope that the mitigating effects of the SCS-TIC school intervention may be independent of social category, and that the trial will additionally generate knowledge of how providers and recipients of TIC may respond to it differently depending on their social and cultural identities. As school-based TIC practices and interventions are expansively relied on as means of preventing teacher burnout and career attrition, and buffering negative consequences of ACEs for children, establishing their effects with methodological robustness is important and timely. Conclusion: Such knowledge may be used to tailor and target interventions to specific populations, while ensuring maximum effectiveness.

Insufficient consumption of fruit and vegetables was found in primary school children. To address this problem, a three-year school-based multicomponent intervention was conducted in 14 primary schools in the City of Zagreb. The aim of the study was therefore to evaluate one of the primary goals of the intervention—the increase in fruit and vegetable intake among primary school children. A total of 681 children were allocated to the intervention (n = 300 in the control group and n = 381 in the intervention group). The intervention included 23 interactive classroom workshops, 10 cross-curricular activities, 13 homework challenges, visual exposure with educational posters in classrooms, parent education via the website, and the implementation of new dishes into the school food system. Fruit and vegetable intake was assessed using a semi-quantitative food frequency questionnaire at baseline and after the intervention. Data were analyzed by per-protocol analysis. The study involved 259 children (50.2% girls; age 7.7 ± 0.4 years; n = 116 in the control group and n = 143 in the intervention group) who completed a food intake frequency questionnaire at both time points. Children in the intervention group showed a significant increase (p < 0.001) in total daily fruit and vegetable intake (before: 332.1 ± 164.9 g; after: 430.1 ± 186.7 g) compared to the control group (before: 350.2 ± 187.5; after: 382.6 ± 196.8) after the intervention. The increase in fruit and vegetable intake was achieved in 89% of children, while 25% more children reached the daily recommendation of 400 g. The use of the multicomponent intervention showed potential to increase fruit and vegetable intake in primary school children.

Bullying and violence are relevant issues in school settings and negatively impact students' well-being and mental health. Psychoeducation and anti-bullying programs may prevent violence among students by addressing emotional expression and regulation, alexithymia, and anger. We describe the impact of a psychoeducational intervention delivered to 90 male and 101 female school youths (N = 191), aged 12-14 years old, and aimed to improve their emotional recognition and regulation, as well as to reduce alexithymia in order to prevent aggression and bullying episodes. A psychological assessment has been performed before (T0) and after (T1) the intervention including levels of alexithymia, measured with the Toronto Alexithymia Scale-20 (TAS-20), the State-Trait Anger Expression Inventory (STAXI), Empathy Quotient (EQ), and the Emotion Regulation Questionnaire (ERQ). Females have shown higher levels of alexithymia at baseline whereas other characteristics (anger, empathy quotient and emotional regulation) did not differ among sex groups. The psychoeducational program significantly increased the empathy quotient (+10.2%), the emotional regulation reappraisal (+20.3%), and the assertive anger expression (+10.9%); alexithymia significantly decreased after the intervention in all the samples (-14.4%), above all among students scoring ≥61 at TAS-20 (-48.2%). Limitations include a small sample from a single school setting, the lack of a control group without psychoeducation, and an assessment based on self-reported measures. We may conclude that psychoeducation has significantly reduced levels of alexithymia and improved empathy and emotional regulation among adolescents.

Obesity bias is one of the main psychosocial consequences experienced by people who are overweight and people with obesity. Therefore, its study, especially during childhood, has become an emerging objective. The aim of this study is to examine obesity bias in children in the school setting. In total, 171 primary school students (Mean age: 10.68; SD: 0.63) from a school in Madrid (Spain) filled out a survey in which they indicated whether they would choose a classmate with obesity with whom they would carry out academic, social, and leisure activities. The rejection ratios of peers with obesity and other personal characteristics such as gender, nationality, or ethnicity were compared. The results indicate that more than half of the participants would not choose a partner with obesity to carry out any of the three activities suggested, and that obesity was the personal characteristic that elicited the highest rate of rejection, especially among females. The possible explanations for these findings are discussed, as well as why the school setting should be a nonaggressive but protective environment for children with obesity.

Physical activity has a variety of health benefits for young people. The World Health Organization (WHO) recommends that children and adolescents aged 5-17 years should be physically active for at least 60 min a day. This Health Impact Assessment (HIA) examined the potential impact of a daily physical activity unit in Austrian schools, with a focus on children and adolescents up to eighth grade. The HIA methodology systematically followed several stages: screening and scoping, appraisal, and formulation of recommendations. A literature review, an online survey ( n = 712), focus group discussions ( n = 4), and appraisal workshops ( n = 2) have been carried out. The analyzed results indicate a primarily positive impact on the individual health of children and adolescents, on social and community-related networks, on living and working conditions, and on the system level. Recommendations for the implementation include ensuring equal opportunities and support for disadvantaged children and schools. Furthermore, the comprehensible selection of pilot regions and the nationwide resource planning should be considered. Additional important factors include the education and further training of pedagogical staff and coaches, and the availability of sufficient infrastructure. In the long term, the fixed integration of five additional teaching units of physical activity per week, and an increased focus on the elementary/nursery school sector were identified as significant.

Our aim was to investigate the impact of the school psychosocial environment, including students' general attitude towards the school, perception of support from teachers and classmates as well as individual psychosocial factors including self-esteem and loneliness on life satisfaction (LS). Four repeated cross-sectional online questionnaire surveys were carried out between 2011 and 2014, inviting all students in one Hungarian high school. Health status and behaviour were assessed by the Hungarian version of the HBSC questionnaire. Results from the surveys were pooled for analysis (N = 3310 students). Heteroskedastic regression estimating robust variance was used to identify potential determinants of LS. Family wealth perceived to be well-off, self-esteem, and being perceived as a good student were identified to be the most important significant positive contributing factors of LS. Perceived good relations with classmates and teachers and an overall positive attitude to school had smaller but still significant positive effects on LS. Self-esteem was a significant moderator for the effect of perceived difficulty of schoolwork, relation with classmates, and gender. This paper shows that self-esteem is not only an independent factor but also a modifier of some school-related variables on LS. The complex interplay among school-related and individual potential determinants of LS should be taken into account in future research by controlling for their interactions.

A growing number of students with health conditions, many of which carry with them the potential for an emergency, increases the likelihood of adverse events occurring in the school setting. An adverse event can be either preventable or nonpreventable. This article reviews a preventable adverse event which took place in a second-grade classroom of a student with spina bifida. Children with spina bifida are at increased risk for the development of latex allergy and subsequent anaphylaxis. The seriousness of accumulated exposure to latex necessitated initiation of a quality improvement plan with the goal of decreasing the risk of future exposures and increasing the quality of collaboration among school staff in meeting student health needs. The article describes the adverse event and discusses the five factors that were addressed in the quality improvement plan: communication deficit, knowledge deficit, hierarchical culture, product labeling, and data collection.

School-based health promotion interventions have been shown to lead to measurable changes in the nutrition and physical activity behaviors. This study examines whether the impact of an intervention program on students’ healthy eating and physical activity was mediated by teacher training and engagement in health promotion. The trial was conducted in three phases: needs assessment of the baseline survey of teachers, mothers’ and children; intervention among seven randomly selected schools that included teacher training in healthy eating and physical activity; and a post-intervention evaluation survey. The SPSS PROCESS for Hayes (Model8) was used to determine moderation and mediation effects. The difference in difference (DID) was calculated for the three main outcomes of the study: eating breakfast daily (DID = 17.5%, p < 0.001); consuming the recommended servings of F&V (DID = 29.4%, p < 0.001); and being physically active for at least 5 days/week (DID = 45.2%, p < 0.001). Schoolchildren’s eating breakfast daily was mediated by their teachers’ training in nutrition (β = 0.424, p = 0.002), teachers’ engagement (β = 0.167, p = 0.036), and mothers preparing breakfast (β = 1.309, p < 0.001). Schoolchildren’s consumption of F&V was mediated by teachers’ engagement (β = 0.427, p = 0.001) and knowing the recommended F&V servings (β = 0.485, p < 0.001). Schoolchildren’s physical activity was mediated by their teachers’ training in physical activity (β = 0.420, p = 0.020) and teachers’ engagement (β = 0.655, p < 0.001). Health behavior changes in the school setting including improvements in eating breakfast, consuming the recommended F&V and physical activity was mediated by teacher training and engagement. Effective teacher training leading to teacher engagement is warranted in the design of health-promotion interventions in the school setting.

Students' use of working memory (WM) is a key to academic success, as many subject areas and various tasks school-aged children encounter require the ability to attend to, work with, and recall information. Children with poor WM ability typically struggle with academic work compared to similar-aged peers without WM deficits. Further, WM has been shown to be significantly correlated with inattention and disorganization in those with ADHD, and WM deficits have also been identified as a potential underpinning of specific learning disorder (SLD). As an intervention technique, the use of computerized cognitive training has demonstrated improved attention and working memory skills in children with WM deficits, and children that have completed cognitive training protocols have demonstrated performance improvements in reading and math. The current study aimed to examine the effectiveness of cognitive training (conducted in a clinical setting) for students diagnosed with ADHD and SLD. Using paired-samples t-tests and a psychometric network modeling technique, results from data obtained from a sample of 43 school-aged children showed (1) that attention and working memory improved following cognitive training and (2) that cognitive training might be related to cognitive structural changes found pre- to post-training among the variables being measured. Implications for clinical practice and school-based interventions are discussed.

The "11 for Health in Denmark" concept aims to enhance 10-12-year-old schoolchildren's physical activity levels and health knowledge through an 11-week football intervention and has been shown to induce positive effects in numerous areas. However, little is known about the implementation facilitation of this concept in schools. This case study therefore aims to gain a deeper understanding of the implementation facilitation of "11 for Health" in a Danish 5 th grade class comprising 22 schoolchildren (12 boys and 10 girls, M age 11.86±) and one teacher. Data were derived from multiple school situations using photographs and videos, observations, and informal interviews. Five themes were identified: (1) environmental and organizational factors impacting on the implementation; (2) familiarization with the concept for the teacher and schoolchildren; (3) previous clique formation; (4) the central role of the teacher; and (5) the importance of how praise partners are allocated. We found high adherence to the "11 for Health" concept, in which the teacher played a key role by applying an autonomy-supportive style of teaching and using the praise partner concept in a suitable manner. A clique of football-playing boys was a resource, as their praising of classmates encouraged adherence. However, familiarization with the "11 for Health" concept was a challenge and the clique's competitive nature occasionally built barriers to other schoolchildren without football experience, potentially leading to a more controlled form of motivation. Based on the results, we encourage teachers to apply autonomy-supportive teaching when applying the "11 for Health" concept., (© 2021 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: In 2014, the Danish Government introduced a wide-ranging school reform that applied to all public schools in Denmark. A distinctive feature of the reform was that it became mandatory to implement an average of 45 min of daily physical activity within the curriculum. Using the RE-AIM framework as an evaluation tool, the objective of the current study was to evaluate the reach, effectiveness, adoption, implementation, and maintenance of mandatory physical activity within the curriculum at ten Danish schools., Methods: A complementary mixed-methods approach using accelerometers, questionnaires, and semi-structured interviews was conducted. A total of 10 schools were invited to participate, including 846 students, 76 teachers, and 10 school managers on various levels. Students were invited to wear an accelerometer for seven consecutive days. Teachers were invited to participate in a questionnaire, and school managers were encouraged to take part in a semi-structured interview., Results: Results showed that, on average, 45.2% of the students were active at least 45 min daily within the curriculum. Teacher and school management interest in physical activity, competencies development, and shared decision-making were identified as central factors for adoption of the requirement. Scheduling physical activity within scheduels and collaborations with external parties were found to influence implementation. Finally, internal coordination, motivated school staff, and school management priority were identified as central factors for maintenance., Conclusions: This study provides an evaluation on a nationwide physical activity requirement in Danish public schools. When introducing a wide-ranging nation-wide requirement on physical activity within the curriculum, school managers need to prioritize and support the implementation process. Teachers need to be involved in the decision processes in order to ensure motivation and local ownership. The study also highlights the benefits of an internal coordinator as well as development of a shared strategy among schools, municipalities, and other stakeholders in order to succeed with the implementation., (© 2021. The Author(s).)

Children generally do not meet the recommendation of 60 min of daily physical activity (PA); therefore, active school transportation (AST) is an opportunity to increase PA. To promote AST, the involvement of parents seems essential. Using the theory of planned behavior (TPB), the aim was to develop and validate the PILCAST questionnaire to understand parents' intentions to let their child cycle or walk to school. Cross-sectional sampling was performed, where 1024 responses were collected from parents. Confirmatory factor analysis indicated acceptable fit indices for the factorial structure according to the TPB, comprising 32 items grouped in 11 latent constructs. All constructs showed satisfying reliability. The regression analysis showed that the TPB explained 55.3% of parents' intentions to let the child cycle to school and 20.6% regarding walking, increasing by a further 18.3% and 16.6%, respectively, when past behavior was added. The most influential factors regarding cycling were facilitating perceived behavioral control, positive attitudes, subjective and descriptive norms, and for walking, subjective and descriptive norms. The PILCAST questionnaire contributes to a better understanding of the psychological antecedents involving parents' decisions to let their child cycle or walk to school, and may therefore provide guidance when designing, implementing and evaluating interventions aiming to promote AST.

Introduction: Every year, 1/10,000 children experiences a food-anaphylactic reaction. Most of these events, including attack-related deaths, may happen during the school hours. In the current study, we assessed the influence of information and communication technologies (ICT) in the school-staff's education on food allergy and anaphylaxis (FAA)., Methods: The target population of this intervention was non-university teaching centers from the local Regional Education Council, including both state and private institutions. The digital intervention was supported by the free-of-charge and open-source learning-management Aulatic Educational Platform. Structured questionnaires were developed to evaluate the educators' knowledge, feelings, and self-efficacy on FAA, in addition to a satisfaction and quality survey of the training program., Results: A total of 1748 school-educators were virtually enrolled from May 2016 to June 2020 in one of the 8-week course editions, with 80.6% of attendees successfully completing the full training. All scores concerning school-staff's basic knowledge and self-efficacy on FAA significantly improved after the educational intervention, reaching a high level of satisfaction among participants (98.5%) over the 4-year educational program., Conclusion: Our results highlighted the effectiveness of a focused e-learning activity to improve teachers and school caretakers in the management of food allergic scholars and anaphylactic reactions during the school hours. The use of ICTs tools should become an integrated part of curricular frameworks in non-university education, leading to a better care of FAA school children., Competing Interests: All authors declare that there is no conflict of interest regarding the publication of this manuscript., (© 2021 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Background: Overweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology., Methods/design: A systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB Abstracts, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4-18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs., Discussion: This systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings., Systematic Review Registration: PROSPERO: CRD42020220451 .

Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology : We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results : 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion : A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.

Background: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools., Methods: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI)., Discussion: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools., Trial Registration: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.

Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-years-old works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented.

Background: The present study investigates the well-being effects for 10- to 12-year-old children  who participated in the school-based intervention "11 for Health in Denmark," which comprises physical activity (PA) and health education. Subgroup analyses were carried out for boys and girls., Method: Three thousand sixty-one children were randomly assigned to an intervention group (IG) or a control group (CG) by 5:1 cluster randomization by school. 2533 children (mean age 11.5 ± 0.4; 49.7% boys) were assigned to IG and 528 children (mean age 11.4 ± 0.5; 50.8% boys) were assigned to CG. IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education. CG did not participate in any intervention and continued with their regular education. Before and after the intervention period, both groups answered a shortened version of the multidimensional well-being questionnaire KIDSCREEN-27., Results: The "11 for Health in Denmark" intervention program had a positive effect on physical well-being in girls (IG: 48.6 ± 8.5 to 50.2 ± 9.3), whereas the improvement was not significant in boys. The program also had a positive impact on well-being scores for peers and social support (IG: 50.2 ± 10.2 to 50.8 ± 10.1), though when analyzed separately in the subgroups of boys and girls the changes were not significant. No between-group differences were found for psychological well-being or school environment., Conclusion: The intervention program had a positive between-group effect on physical well-being in girls, whereas the change was not significant in boys. The overall scores for peers and social support improved during the intervention period, but no subgroup differences were found., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: There is evidence suggesting that the school environment does have prominent contributions to the rise of childhood obesity., Aim: The objective of this study was to assess the school environment by interviewing the teachers and compare the school environment score between rural and urban schools in Terengganu, Malaysia., Methods: Thirty-two teachers from 16 primary schools in Terengganu were interviewed using a set of validated Malay version "School Environmental Mapping" questionnaire. A total of 76 items consisting of four domains of school environment factor: physical (what is available) with 41 items; economic (what the costs are) with nine items; political (what the rules are) with nine items; and socio-cultural (what the attitudes and beliefs are) with 17 items. Every item was questioned using an initial closed question followed by an open question when the criteria were not met or need further information regarding those particular items., Results: The present study revealed that the school environment of school in state of Terengganu is still low and not satisfied. Based on the schoolteacher's information and observation, there are significant barriers to promoting healthy eating and physical activity at school e.g. limited financial and budget allocation; lack of school facilities; lack of manpower to organise and monitor the programme; lack of participation and cooperation from parents; and no enforcement and serious action from authorized personnel on street hawkers near the school. This is reflected by the score achieved for 16 schools in Terengganu was only 63.05%. The political environment indicated the highest score among the domains, which was 77.78%, whereas, the lowest score was an economic environment (50.00%). Upon comparing between the urban and rural areas, the present study reported that there was a significant difference between school settings (p < 0.001) for an overall school environment, in which the rural areas had a significantly higher score than urban counterparts (64.86% vs 59.34%, p < 0.001). For each domain of the school environment, the findings showed that only two domains (physical and political environment) were significantly different between school settings., Conclusion: This study revealed that the level of a healthy school environment among schools in both settings is still not satisfied. Addressing the obesogenic elements of school environments is one of the strategies in prevention since the school environments exert a great influence on children's behaviour., (© 2020 Published by Elsevier Ltd.)

Background: Childhood obesity continues to be a global epidemic and many child-based settings (e.g. school, afterschool programs) have great potential to make a positive impact on children's health behaviors. Innovative and time-sensitive methods of gathering health behavior information for the purpose of evaluation and strategically deploying support are needed in these settings., Purpose: The aim is to (1) demonstrate the feasibility of mobile health (mHealth) for monitoring implementation of healthy eating and physical activity (HEPA) standards and, (2) illustrate the utility of mHealth for identifying areas where support is needed, within the afterschool setting., Methods: Site leaders ( N = 175) of afterschool programs (ASPs) were invited to complete an online observation checklist via a mobile web app (Healthy Eating and Physical Activity Mobile, HEPA m ) once per week during ASP operating hours. Auto-generated weekly text reminders were sent to site leaders' mobile devices during spring and fall 2015 and 2016 and spring 2017 school semesters. Data from HEPA m was separated into HEPA variables, and expressed as a percent of checklists where an item was present. A higher percentage for a given item would indicate an afterschool has higher compliance with current HEPA standards., Results: A total of 141 site leaders of ASPs completed 13,960 HEPA m checklists. The average number of checklists completed per ASP was 43 (range 1-220) for healthy eating and 50 (range 1-230) for physical activity. For healthy eating, the most common challenge for ASPs was 'Staff educating children about healthy eating', and for physical activity checklists, 'Girls only physical activity is provided at ASP'., Conclusion: HEPA m was widely used and provided valuable information that can be used to strategically deploy HEPA support to ASPs. This study gives confidence to the adoption of mHealth strategies as a means for public health practitioners to monitor compliance of an initiative or intervention.

Childhood obesity is an increasing threat to the health of primary school students in Hong Kong. Obesity results from energy excess from food relative to energy expenditure through physical activity. In Hong Kong, a whole day primary schooling policy has been implemented since 1993 and today most primary school students have their lunch on campus and some also purchase snacks and drinks from school tuck shops or vending machines. The EatSmart School Accreditation Scheme (ESAS) aiming at combating childhood obesity was launched in 2009/2010. Professional (health promotion, dietary, programme, etc.) support is provided to help schools formulate policies, introduce structures and implement measures to help students develop the habit of healthy eating. The aim of this study is to investigate the change of childhood obesity (including overweight) rates over time among schools awarded with ESAS accreditation. Seven-year retrospective data on obesity status were obtained for the period 2007/2008-2013/2014 (number of students = 113,322, number of measurements = 314,746) from all 105 ESAS-accredited schools. Before schools were geared up for the accreditation scheme obesity rates were fairly stable (slope test p > 0.05) among their student population ranging from 23.2% to 21.9%, whereas the rates dropped significantly (slope test p < 0.05) from 21.9% to 19.3% after intervention. For ESAS-accredited schools, there was an average annual reduction of 0.49% point in obesity rate which was 0.18% point higher than that of 0.31% point among non-ESAS-accredited schools. These results show that schools achieving ESAS accreditation are associated with a bigger improvement in the student obesity problem.

Objective: School summer holiday clubs in deprived areas of Wales were evaluated to examine opportunities for healthy eating and physical activity and explore delivery processes., Methods: Ten Food and Fun clubs participated in 2016. Quantitative data (child and parent surveys; N = 196, N = 84) assessed the opportunity to provide children with breakfast and lunch. A sub-sample of children wore an accelerometer (N = 41) to evaluate the opportunity for achieving 1-hour of moderate to vigorous activity (MVPA) at club. Features of successful club delivery were identified through; focus groups (child and parent; N = 74, N = 69) and interviews (staff/volunteer; N = 32)., Results: Opportunities for healthy eating were delivered with high fidelity: 86% of children reported breakfast consumption and 75% eating a healthy lunch. On club days, children reported consuming fewer sugary snacks (66%), fewer sugary drinks (81%), and more fruits and vegetables (67%). About 71% of children achieved the recommended MVPA at club, with children engaging in more MVPA (+17 minutes/day, p < .01) on average compared to non-club days. Successful delivery processes were: use of school facilities and staff; flexible partnership-working; and whole family involvement., Conclusions: Schools appear to provide a suitable setting for the delivery of healthy eating and physical activity opportunities during school summer holidays., (© 2019 The Authors. Journal of School Health published by Wiley Periodicals, Inc. on behalf of American School Health Association.)

Introduction:Anaphylaxis is a serious, life-threatening systemic allergic reaction that may occur in individuals not previously diagnosed with an allergy. Emergency first-line treatment of choice for acute anaphylaxis is intramuscular administration of epinephrine via an auto-injector. In the school setting, students with known allergies typically keep or carry an epinephrine auto-injector (EAI). For students who do not have a known allergy or for those whose personal EAIs are unavailable, an anaphylactic event could have serious adverse outcomes if an EAI is not available via an undesignated stock supply in the school., Methods:We searched the published literature from 2000 through 2018 in CINAHL, MEDLINE, and PubMed using the following search terms: anaphylaxis , school setting , epinephrine auto-injector , and food allergies . Throughout this article, undesignated stock EAIs, stock EAIs, EAI stock, and open-order EAIs are used interchangeably., Conclusion:Anaphylaxis is increasing worldwide as the incidence of food allergies increases. Although stock EAIs for students in schools can have important benefits, the availability of EAIs in the school setting is limited. Barriers to undesignated stock EAIs include the lengthy administrative process for developing school policies and protocols; gaps in nurses' self-perceived knowledge versus objective knowledge on the topic of anaphylaxis; limited resources in many school districts; and complex role demands, lack of confidence in trained staff, or insufficient school nurse staffing. It is important that epinephrine be readily available in schools. Barriers to facilitating stock EAIs include those that can be addressed directly by nurses and those that may require policy changes. Nurses, particularly those working in school settings or pediatrics, could take the lead in discussions about the benefits of stock EAIs in schools, advocating for policy changes as warranted. Fully informed nurses can be better prepared to serve as advocates in ensuring that EAIs are available in school settings., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Childhood obesity is of increasing concern in many parts of Africa. We conducted a systematic search and review of published literature on behavioural childhood obesity prevention interventions. A literature search identified peer-reviewed literature from seven databases, and unindexed African journals, including experimental studies targeting children age 2-18 years in African countries, published in any language since 1990. All experimental designs were eligible; outcomes of interest were both behavioural (physical activity, dietary behaviours) and anthropometric (weight, body mass index, body composition). We also searched for process evaluations or other implementation observations. Methodological quality was assessed; evidence was synthesised narratively as a meta-analysis was not possible. Seventeen articles describing 14 interventions in three countries (South Africa, Tunisia and Uganda) were included. Effect scores indicated no overall effect on dietary behaviours, with some beneficial effects on physical activity and anthropometric outcomes. The quality of evidence was predominantly weak. We identified barriers and facilitators to successful interventions, and these were largely resource-related. Our systematic review highlights research gaps in targeting alternative settings to schools, and younger age groups, and a need for more rigorous designs for evaluating effectiveness. We also recommend process evaluations being used more widely.

Implementing integrated online prevention to reduce the risk of both obesity and eating disorders, in the school setting, is a promising approach. The challenge is to develop highly user-friendly and motivating programs, to foster adherence and effectiveness. The purpose of this study was to evaluate the usability of such a universal prevention program for students aged 14⁻19 years, and to address engagement issues. A mixed-methods approach was chosen, consisting of a think-aloud task, a semi-structured interview, and a questionnaire including items on sociodemographic characteristics and the System Usability Scale (SUS). Usability tests were conducted in two rounds, with five adolescents participating per round. Mean score in the SUS was 92.5 of 100 points (range 85⁻100), in the second round, after some adaptations from the participants' feedback. In the course of the think-aloud tasks and interviews, five major themes emerged-visual design, navigation, mode of transfer, content, and engagement conditions. Interesting headlines, gamification, and monitoring tools are crucial for engagement. Apart from the importance of using the program during school hours, the study showed that problems currently perceived as important by the target group, need to be considered and addressed, prior to offering them prevention programs, which highlights the importance of a user-centered design.

Background: The Lower Quarter Y Balance Test (YBT-LQ) has been widely used in the field to assess dynamic balance performance in various populations. However, no study has demonstrated test-retest reliability of the YBT-LQ in adolescents including several age cohorts, even though reliability is necessary to provide repeatable performance data., Objective: Thus, we examined test-retest reliability of the YBT-LQ in healthy adolescents., Methods: In a school setting, 178 secondary school students (93 female, 85 male) in sixth to eleventh grades (11-19 years) performed the YBT-LQ twice, 7 days apart. Normalized maximal reach distances (% leg length) for all three directions (i.e., anterior, posterolateral, posteromedial) and both legs and the composite score were used as outcome measures. Intraclass correlation coefficient (ICC 3,1 ) and standard error of measurement (SEM) were calculated to assess relative and absolute test-retest reliability, respectively. Practical relevance of the YBT-LQ was determined by calculating the minimal detectable change (MDC 95% )., Results: Irrespective of grade, test-retest reliability for all distances reached was predominately "excellent" (i.e., ICC 3,1 > 0.75) and the rather small SEM values ranged from 1.77 to 5.81%. Depending on grade and reach direction, MDC values of 4.90 to 16.10% represent the minimum amount of change needed to identify clinically relevant effects in repeated measurements of the YBT-LQ performance., Conclusions: The observed values suggest that the YBT-LQ is a reliable test and suitable to detect changes of dynamic balance performance in healthy adolescents from grade six to eleven (i.e., aged 11-19 years)., (Copyright © 2018 Elsevier B.V. All rights reserved.)

School-age children experience trauma at alarming rates. Children's ability to attend, concentrate, and participate in the educational process can be adversely impacted by trauma. How can school staff, especially school nurses, best listen, support, and encourage a student with trauma in their lives? Link for Schools is an evidence-informed intervention program that provides information and training for school staff. Link provides tools for listening or responding to a traumatized student with a focus on the principles of trauma-informed care, psychological first aid, and elements of motivational interviewing. Link-trained staff are better equipped to develop a relationship with a student, but future research is recommended to supports its evidence base.

Documenting the implementation of effective real-world programmes is considered an important step to support the translation of evidence into practice. Thus, the aim of this study was to identify factors influencing the adoption, implementation and maintenance of the Svendborgproject (SP) - an effective real-world programme comprising schools to implement triple the amount of physical education (PE) in pre-school to sixth grade in six primary schools in the municipality of Svendborg, Denmark. SP has been maintained for ten years and scaled up to all municipal schools since it was initiated in 2008. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was applied as an analytic tool through a convergent mixed method triangulation design. Results show that SP has been implemented with high fidelity and become an established part of the municipality and school identity. The successful implementation and dissemination of the programme has been enabled through the introduction of a predominantly bottom-up approach combined with simple non-negotiable requirements. The results show that this combination has led to a better fit of programmes to the individual school context while still obtaining high implementation fidelity. Finally, the early integration of research has legitimated and benefitted the programme., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The control class (CG; n = 19) received lessons as usual. Standing time was assessed objectively (accelerometers) and subjectively (self-report sheets, external classroom observers). The impact of standing on the digit span task and Eriksen flanker task was analysed. The standing time of the IG was higher during the school day in comparison to the CG (lesson: p = 0.004; break: p = 0.003). The intra-class correlation coefficient between self-reports and external observation was high (ICC = 0.94). The IG improved slightly on the Digit Span Task compared to CG. Employing standing desks for at least 1 h per school day serves as a feasible and effective opportunity to improve cognitive function., Competing Interests: The authors declare no conflict of interest.

Background: The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents' subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physical activity interventions in improving adolescents' subjective sleep quality., Methods: In a three-week physical activity intervention, four Icelandic upper secondary schools were randomized to either an intervention group with pedometers and step diaries or a control group without pedometers and diaries. Out of 84, a total of 53 students, aged 15-16 years, provided complete data or a minimum of two days step data (out of three possible) as well as sleep quality measures at baseline and follow-up. Subjective sleep quality, the primary outcome in this study, was assessed with four individual items: sleep onset latency, nightly awakenings, general sleep quality, and sleep sufficiency. Daily steps were assessed with Yamax CW-701 pedometers., Results: The intervention group ( n = 26) had significantly higher average step-count ( p = 0.03, partial η 2 = 0.093) compared to the control group ( n = 27) at follow-up. Subjective sleep quality improved ( p = 0.02, partial η 2 = 0.203) over time in the intervention group but not in the control group., Conclusions: Brief physical activity interventions based on pedometers and step diaries may be effective in improving adolescents' subjective sleep quality. This has important public health relevance as the intervention can easily be disseminated and incorporated into school curricula.

School is an ideal setting to promote and increase physical activity (PA) in children. However, implementation of school-based PA programmes seems difficult, in particular due to schools' focus on academic performance and a lack of involvement of school staff in program development. The potential cognitive and academic benefits of PA might increase chances of successful implementation. Therefore, the aim of this qualitative study was: (1) to explore the perceptions of teachers and principals with regard to implementation of additional PA aimed at improving cognitive and academic performance, and (2) to identify characteristics of PA programmes that according to them are feasible in daily school practice. Twenty-six face-to-face semi-structured interviews were conducted with primary school teachers (grades 5 and 6) and principals in The Netherlands, and analysed using inductive content analysis. Teachers and principals expressed their willingness to implement additional PA if it benefits learning. Time constraints appeared to be a major barrier, and strongly influenced participants' perceptions of feasible PA programmes. Teachers and principals emphasised that additional PA needs to be short, executed in the classroom, and provided in "ready-to-use" materials, i.e., that require no or little preparation time (e.g., a movie clip). Future research is needed to strengthen the evidence on the effects of PA for academic purposes, and should examine the forms of PA that are both effective as well as feasible in the school setting., Competing Interests: The authors declare no conflict of interest.

Introduction: Drinking has adverse impacts on health, well-being, education and social outcomes for adolescents. Adolescents in England are among the heaviest drinkers in Europe. Recently, the proportion of adolescents who drink alcohol has fallen, although consumption among those who do drink has actually increased. This trial seeks to investigate how effective and efficient an alcohol brief intervention is with 11-15 years olds to encourage lower alcohol consumption., Methods and Analysis: This is an individually randomised two-armed trial incorporating a control arm of usual school-based practice and a leaflet on a healthy lifestyle (excl. alcohol), and an intervention arm that combines usual practice with a 30 min brief intervention delivered by school learning mentors and a leaflet on alcohol. At least 30 schools will be recruited from four regions in England (North East, North West, London, Kent and Medway) to follow-up 235 per arm. The primary outcome is total alcohol consumed in the last 28 days, using the 28 day Timeline Follow Back questionnaire measured at the 12-month follow-up. The analysis of the intervention will consider effectiveness and cost-effectiveness. A qualitative study will explore, via 1:1 in-depth interviews with (n=80) parents, young people and school staff, intervention experience, intervention fidelity and acceptability issues, using thematic narrative synthesis to report qualitative data., Ethics and Dissemination: Ethical approval was granted by Teesside University. Dissemination plans include academic publications, conference presentations, disseminating to local and national education departments and the wider public health community, including via Fuse, and engaging with school staff and young people to comment on whether and how the project can be improved., Trial Registration Trial: ISRCTN45691494; Pre-results., Competing Interests: EG is a reviewer for NIHR. DH was a member of the NIHR Health Services and Delivery Research Commissioning Board until December 2015, and is a subpanel member for NIHR Programme Grants for Applied Research from February 2016. EK is a funding board member of the NIHR Public Health Research funding board and the NIHR Senior Fellowships panel. EM is a subpanel member for NIHR Programme Grants for Applied Research. LV is a member of the NIHR Health Technology Assessment Clinical Evaluation and Trials Panel, NIHR Programme Grants for Applied Research Panel and Director of NIHR Research Design Service for the North East., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial. The programme consists of 12 units delivered by class teachers to adolescents 12-14 years old. It is a strongly interactive programme including a training of personal and social skills with a specific focus on normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution of the theories to the units, and the targeted mediators. The programme integrates several theories: Social Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour theory. Every theory contributes to the development of the units' contents, with specific weights. Knowledge, risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with stress, empathy, problem solving and decision making skills are the targeted mediators of the program., (© The Author(s) 2015.)

Background: Student-school connectedness is inversely associated with multiple health risk behaviors, yet research is limited on the relative contributions of a student's connectedness with school and an overall context of school social cohesion to peer victimization/bullying., Purpose: We examined associations of perceived school cohesion and student-school connectedness with physical victimization, verbal victimization, and social exclusion in the past six months in adolescents in grades 6-11 (N = 774) attending 11 public and private urban schools in Colombia., Methods: Cross-sectional data were collected via a self-administered questionnaire and analyzed using mixed-effects linear regression models., Results: Higher perceived school cohesion was inversely related with exposure to three bullying types examined (p < 0.05); student-school connectedness was negatively related to verbal victimization among girls only (p < 0.01). In full models, school cohesion maintained inverse associations with three bullying types after controlling for student-school connectedness (p ≤ 0.05)., Conclusion: Enhancing school cohesion may hold benefits for bullying prevention beyond a student's individual school connectedness., (© The Author(s) 2015.)

The American Academy of Pediatrics (AAP) recently published a clinical report recommending expanded options for seizure rescue medications in the school setting. School nurses rely on prescribing professionals for medical orders to manage children with epilepsy in the school setting. The report suggests additional medications beyond rectal diazepam gel along with discussing the purpose of the medications, the variations in prescribing practices for seizure rescue medications, inconsistencies in legislation based on jurisdictions, and the need for school medical orders for students with epilepsy. There are many issues faced by school personnel when caring for students with a diagnosis of epilepsy, chief among them the presence of licensed health professions for the school to be able to respond quickly and appropriately in the event of a seizure. School nurses can assist health care providers in determining the rescue medication most easily delivered and monitored in the variety of activities that are part of the school experience, including transportation to and from school, field trips, and before- and after-school activities, all beyond the regular classroom setting.

Background and Objectives: The main objective of the paper is to investigate perceptions and attitudes of school youth concerning risky driving behaviors (i.e.: Tafheet) in Saudi Arabia., Design and Setting: This was a school-based cross-sectional study of adolescents in Riyadh that employed a multistage probability sampling scheme., Subjects and Methods: The self-administered survey included questions adapted from the school-based studies conducted by the Centers for Disease Control and Prevention in the United States. The survey inquired about adolescents' behaviors and attitudes toward driving, perceptions of school and family, and leisure time activities., Results: Nearly 40% of the students surveyed reported engaging in the risky driving behavior called Tafheet. Fifty-one percent of those who engage in dangerous activities also reported engaging in Tafheet. A higher proportion (70%) among those who believe Tafheet is a talent or a cool activity also engaged in Tafheet. Multivariate analyses indicate that students who are willing to engage in dangerous activities even when they are known to be dangerous (OR = 2.7; 95% CI = 1.55-4.72), those who think there is no harm in not wearing seat belts are at higher speeds (OR = 2.77; 95% CI = 1.24-6.21), and those who use a mobile telephone while driving are nearly three times (OR = 2.96; 95% CI = 1.41-6.23) at risk for engaging in Tafheet. Lack of respect towards traffic laws is also a risk factor., Conclusion: Our study unequivocally points to pro-attitudes and behavior including a daring personality, not wearing a seat belt and using a mobile telephone while driving are significant factors associated with risky driving activity. Our study calls for a strategic intervention plan to change the culture of risky driving through a structured and stringent driving curriculum in school settings. A curriculum of this nature is currently non-existent in the Kingdom of Saudi Arabia (KSA). Multilevel and multifaceted interventions may hold great promise in reducing unintended motor vehicle injuries and changing the culture as a whole.

Recent studies indicate that a single bout of physical exercise can have immediate positive effects on cognitive performance of children and adolescents. However, the type of exercise that affects cognitive performance the most in young adolescents is not fully understood. Therefore, this controlled study examined the acute effects of three types of 12-min classroom-based exercise sessions on information processing speed and selective attention. The three conditions consisted of aerobic, coordination, and strength exercises, respectively. In particular, this study focused on the feasibility and efficiency of introducing short bouts of exercise in the classroom. One hundred and ninety five students (5th and 6th grade; 10-13 years old) participated in a double baseline within-subjects design, with students acting as their own control. Exercise type was randomly assigned to each class and acted as between-subject factor. Before and immediately after both the control and the exercise session, students performed two cognitive tests that measured information processing speed (Letter Digit Substitution Test) and selective attention (d2 Test of Attention). The results revealed that exercising at low to moderate intensity does not have an effect on the cognitive parameters tested in young adolescents. Furthermore, there were no differential effects of exercise type. The results of this study are discussed in terms of the caution which should be taken when conducting exercise sessions in a classroom setting aimed at improving cognitive performance.

Aims: The primary objective of this review is to assess the prevalence and quality of published studies on the effect of choice architectural nudge interventions promoting vegetable consumption among adolescents. Additionally, this review aims to identify studies estimating adolescents' attitude towards choice architectural nudge interventions., Methods: Web of Science, Scopus and PubMed were searched systematically for experimental studies with a predefined search strategy in the period November-December 2013. Publications were included following predetermined inclusion criteria. Studies were evaluated as of high, moderate or weak quality. Finally, studies were grouped by the type of intervention and underwent a narrative synthesis., Results: The search showed that only very few studies investigated the effects of choice architectural nudging interventions on vegetable consumption, and none of them had attitude towards behavioural interventions as an outcome measure. Twelve studies met the inclusion criteria. The results of the 12 studies were inconclusive, and the majority of studies were of weak or moderate quality., Conclusion: This review uncovers a gap in knowledge on the effect of choice architectural nudge interventions aiming to promote the intake of vegetables among adolescents in a school context. It also highlights that no previous studies have considered the attitudes towards choice architectural nudge interventions as a potential factor for their success - or lack thereof - in achieving the desired goal of increased vegetable consumption., (© Royal Society for Public Health 2015.)