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The aim was to study associations between dialkylphosphates (DAPs), organophosphate (OP) metabolites in urine, biomarkers of OP insecticide exposure, and respiratory symptoms among children in upper northern Thailand. We recruited junior high school children in randomly selected schools in four cities (N = 337), with repeated data collection in wet and dry seasons. Urine was collected and analyzed for six OP metabolites, with creatinine adjustment. Total DAP was expressed as sum of DAPs. Data on respiratory symptoms was collected by a standardized questionnaire. Associations were analyzed by multiple logistic regression. Totally 11.3 % lived in farm families. Total DAPs concentration was higher in dry season (p = 0.002) but did not differ between farm and non-farm children. Total DAPs in wet season was associated with current wheeze (p = 0.019), current asthma attacks (p = 0.012) and attacks of breathlessness in last 12 months (p = 0.021). Total DAPs in dry season was associated with current wheeze (p = 0.042), and associations between DAPs and respiratory symptoms were stronger for dimethylphosphate metabolites (DMPs) than for diethylphosphate metabolites (DEPs). DMPs are produced by certain OP pesticides. Biomass burning inside or outside the home, and dampness or mold at home, enhanced the association between total DAPs and attacks of breathlessness. In conclusion, OP pesticide exposure, measured as urinary DAPs, was higher in dry season and similar in farm and non-farm children. OPs exposure, especially to DMP related pesticides, can increase asthmatic symptoms, especially in wet season. Combined exposure to OP and smoke from biomass burning, or dampness and mold, can further increase the prevalence of attacks of breathlessness. There is a need to reduce OP insecticide and biomass smoke exposure among Thai children. Since different pesticides can be used in different seasons, studies on respiratory health effects of OPs pesticide exposure should be done in different seasons., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

This commentary discusses the history of ADHD and how it can inform contemporary debates about the disorder. It critiques retrospective histories of ADHD, which propose earlier origins for the disorder than match the historical evidence. It concludes by indicating when ADHD did emerge as a distinctive disorder and why it did so., (© 2024 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: Physical fitness (PF) offers numerous physical and mental health benefits, especially during childhood. Previous studies investigating trends in children's PF over the years reported contradictory findings., Objective: To identify and analyse secular trends in PF among Austrian schoolchildren from 2006 to 2023., Method: A repeated cross-sections design was used to examine the PF of children enrolling in sports schools between 2006 and 2023. During this period, a standardized eight-item motor performance testing battery was administered yearly to capture markers of strength, speed, endurance, agility and reaction time in Austrian schools., Results: A total of n = 3827 children (996 girls) with a mean age of 9.9 ± 1.0 years were included. Linear mixed models indicated significant declines in sprint performance (5, 10, 20 m), tapping, jump (long jump and drop jump), throwing (medicine ball), and agility (snake run). No changes were observed in cardiorespiratory fitness (8 min run) or reaction time., Conclusion: There has been a steady decline in PF among Austrian children attending sports schools. This finding underscores the need for enhanced PF monitoring and training in schools to improve public health outcomes., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. No financial disclosures were reported by the authors of this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: Individuals with dyslexia perceive and utilize statistical features in the auditory input deficiently. The present study investigates whether affected children also benefit less from repeating context tones as perceptual anchors for subsequent speech processing., Methods: In an event-related potential study, eleven-year-old children with dyslexia (n = 21) and without dyslexia (n = 20) heard syllable pairs, with the first syllable either receiving a constant pitch (anchor) or variable pitch (no-anchor), while second syllables were identical across conditions., Results: Children with and without dyslexia showed smaller auditory P2 responses to constant-pitch versus variable-pitch first syllables, while only control children additionally showed smaller N1 and faster P1 responses. This suggests less automatic processing of anchor repetitions in dyslexia. For the second syllables, both groups showed faster P2 responses following anchor than no-anchor first syllables, but only controls additionally showed smaller P2 responses., Conclusions: Children with and without dyslexia show differences in anchor effects. While both groups seem to allocate less attention to speech stimuli after contextual repetitions, children with dyslexia display less facilitation in speech processing from acoustic anchors., Significance: Altered anchoring in the linguistic domain may contribute to the difficulties of individuals with dyslexia in establishing long-term representations of speech., (Copyright © 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Blastocystis is one of the most common zoonotic intestinal protozoa with global distribution and can cause gastrointestinal syndrome mainly characterized by diarrhea. School children are the main susceptible population. No epidemiological data on Blastocystis among school children in Hainan, the only tropical island province in China. Between March 2021 and June 2023, 1973 fecal samples were collected from school children across three regions in Hainan province. Blastocystis was examined by amplifying the small subunit ribosomal RNA (SSU rRNA) gene via polymerase chain reaction (PCR), and subtypes were identified through DNA sequencing and phylogenetic analysis. The overall prevalence of Blastocystis was 7.3 % (144/1973). The differences in infection rates across different regions, nationalities, and educational stages are statistically significant (P < 0.001). Five subtypes were identified, of which ST3 was the dominant subtype (60.4 %; 87/144), followed by ST1 (27.8 %; 40/144), ST7 (10.4 %; 15/144), ST6 (0.7 %; 1/144), and ST2 (0.7 %; 1/144). 42 known sequences and 15 novel sequences were identified including eight new variations of the ST1 (ST1-16∼ST1-23) with similarities ranging from 98.3 % to 99.78 % and seven new variations of the ST7 (ST7-7∼ST7-13) with similarities ranging from 97.7 % to 99.79 % by intra-subtype genetic polymorphisms analysis. The results evaluate the public health risks of Blastocystis among school children in Hainan and the sources of infection were discussed, providing important basic data for the effective prevention and control of intestinal parasitic diseases in Hainan., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children. Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools. Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption. Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes.

Intestinal parasitic infections (IPIs) remain a significant contributor to morbidity and mortality globally, particularly in developing countries such as Ethiopia. Periodic assessments of IPI prevalence are essential prerequisite for effective control measures. Therefore, this cross-sectional study is aimed at determining the prevalence of gastrointestinal parasitic infections and associated risk factors among schoolchildren at Wonji Shoa Secondary School, East Shoa Zone, Adama district, Oromia region, Ethiopia, between January and June 2022. A simple random stratified sampling technique was employed to select participants. Sociodemographic and risk factor data were collected using a structured questionnaire. Stool samples were examined to identify parasites. Data were analyzed using SPSS version 20. Descriptive statistics, chi-square tests, and logistic regression were conducted to assess associations between variables and then the strength of the association. A p value < 0.05 was considered statistically significant. Of the 403 selected students, 330 completed the study that makes 81.89% response success. The overall IPI prevalence was 16.66% (55/330), with a higher prevalence among males (60%, 33/55) than females (40%, 22/55). Five parasite species were identified: two protozoa ( Entamoeba histolytica and Giardia lamblia ) with a combined prevalence of 9.70% (32/330) and three helminths ( Ascaris lumbricoides , Hymenolepis nana , and Taenia spp.) with a combined prevalence of 6.97% (23/330). Cysts were detected in 62.5% of E. histolytica cases (15/24), and eggs were detected in 76.92% of A. lumbricoides cases (10/13). The study revealed a substantial IPI prevalence (16.66%) among the students. This finding underscores the need for effective prevention and control strategies. The predominance of parasitic infections among males is notable requiring further investigation of the factors. The identification of multiple parasite species indicates a complex epidemiological scenario. The presence of protozoan cysts and helminthic eggs highlights the potential for fecal-oral transmission and the importance of improved sanitation and hygiene practices., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Abera Adugna et al.)

Background: Dental caries is a major, multifactorial oral condition that causes the demineralization of tooth enamel and impacts approximately half of the world's child population. This study aimed to determine the prevalence of dental caries among school-going children aged 7 to 13 years in Kabul city., Methods: This descriptive cross-sectional study was conducted with 491 students aged 7 to 13 years in Kabul during the first half of 2019. A multistage cluster sampling method was used, in which educational zones, schools, and classes were selected. The data were collected using pre-structured questionnaires through face-to-face interviews and oral examinations of students using dental probes and mouth mirrors while adhering to infection control protocols. The collected data were analyzed using Statistical Package for Social Science version 21.0, and a p-value < 0.005 was considered as statistically significant., Results: The average age of the study participants was 9.9 ± 1.8 years. Boys made up approximately 45% of the participants, while 54.8% were girls. The overall prevalence of dental caries was 78.8%, with 62.1% in deciduous teeth and 42.8% in permanent teeth. Among students who did not brush their teeth, the prevalence of dental caries was 84.8%, compared to 81.7% for those who brushed once daily, 78.7% for those brushing twice daily, and 67.4% for those brushing three times daily (p = 0.022). About 10% of students had dental calculus, with a prevalence of 17.0% among those aged eleven and older, 10.0% among students aged nine to ten years, and 5.9% among students aged eight and younger (p = 0.006). Poor oral hygiene affected nearly one-third of the students, with 34.2% among boys and 30.9% among girls. Poor oral hygiene was more prevalent in students aged eight and younger (38.8%) compared to those aged eleven and older (25.9%) (p = 0.023)., Conclusions: The prevalence of dental caries among students aged 7 to 13 years in Kabul schools was similar to that in most developing countries. The prevalence of dental calculus was greater among students aged eleven years and older. Over 99% of the students surveyed had not undergone any dental treatment., (© 2024. The Author(s).)

Background and Aim: Today's internet is an unavoidable component of educational sources, the entertainment field, and telecommunication processes. Internet usage is more likely among adolescents and young adults in the form of surfing, chatting, playing games, and fulfilling their social needs. The present study has been planned to assess the effect of internet addiction (IA) on sleep quality in school children., Methods: This cross-sectional school-based study was conducted among school students in Pondicherry. A total of 350 school students of both genders studying in grades six to 10 and having access to at least one device with internet for more than one year were recruited from government and private schools located in five randomly selected communes in Pondicherry by convenient sampling method. Assessment of IA was done using Young's Internet Addiction Test (YIAT). The Pittsburgh Sleep Quality Index (PQSI) questionnaire assessed the participants' sleep quality. All the data was tested for normality using the Kolmogorov-Smirnov test. Chi-square and unpaired t-tests were used for analysis., Results: The average age of the participants is 13 years. 49 (26.1%) are children and 139 (73.9%) are adolescents. The majority of them are females belonging to the adolescent age group (169, 89.4%). Around 17 (19.5%) children and 70 (80.5%) adolescents reported mild IA. Thirteen (59.1%) children and nine (40.9%) adolescents reported moderate IA. There is no significant difference in sleep quality between children and adolescents (4±2.33 vs. 3.62±2.61, p=0.37) but there is a considerable difference in their levels of IA (32.98±21.06 vs. 25.6±15.08, p=0.01).  Conclusion: This study found a significant relationship between IA and poor sleep quality among adolescents. Thus, adolescents, parents, school authorities, and researchers should understand the importance of regulating internet usage and encouraging sleep hygiene. Thus, appropriate measures should be taken to address the effects of IA on sleep quality., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institute Ethics Committee for Human Studies of Jawaharlal Institute of Postgraduate Medical Education and Research issued approval 454/IEC-37/PP-5/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Venugopal et al.)

Background: Peer bullying is widely observed across the world and continues to grow. Peer-bullying children and children exposed to peer bullying often display a fall in academic achievements, an increase in psychiatric problems, and problematic relationships with their parents., Objective: This study was conducted to identify the effects of demographic, health-related, and school-related characteristics in school-age children, including their grade, academic success, and status of liking their school, on their peer-bullying tendencies., Design and Methods: This study was carried out as a cross-sectional study. The study was conducted in September-November 2023 with sixth- and seventh-grade students at four middle schools in Turkey. The sample size was calculated as 750 in a 95% confidence interval and with a 5% margin of error. The data were collected using a Health-Related Descriptive Characteristics Form and the Swearer Bullying Scale., Results: Children who were seventh-grade students, those who had a family income above expenses, those who were obese, those who perceived their health status as good, those who had low academic achievement, and those who stated that they did not like their school had higher peer bullying tendencies (p < 0.05). In the multiple linear regression analysis, self-perceived health status, grade level, and academic achievement status were identified as factors that significantly affected the peer bullying tendencies of the children, and these factors explained 26.3% of the total variance in these tendencies., Conclusion: Self-perceived health status, grade level, and academic achievement status significantly affected the peer bullying tendencies of school children., Implications for Practice: To prevent peer bullying and mitigate its negative effects, it is extremely important that school nurses periodically identify the peer bullying tendencies of school children and associated factors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Vision screening during childhood is vital for the early detection and treatment of visual impairment that may significantly impact a child's development and quality of life. This nationwide cross-sectional study used data from Greenland's national electronic medical records, including 2,493 six-year-old children from July 2017 to July 2023, to evaluate the coverage rate of vision screening and the prevalence of low vision in Greenlandic schoolchildren. The participation rate in vision screening increased from 43% in 2017 to 61% in 2022, while referral rates to ophthalmologists decreased from 14% to 5%, despite a consistent prevalence of low vision. The mean prevalence of impaired vision (0.3 logMAR / ≤0.50 Snellen decimal) in the better-seeing eye at the vision screening throughout the study period was 3%. At the same time, it was 8% for the worse-seeing eyes, indicating a continuous need for ophthalmological evaluation of the Greenlandic children. This study highlights healthcare delivery challenges in Greenland's sparsely populated areas and emphasises the need for new national guidelines to optimise referral processes. Utilising other healthcare professionals, such as optometrists, for vision screenings and ensuring follow-ups are critical for improving the visual health outcomes of Greenlandic children.

Background: Anxiety and mood disorders are the main cause of illness in people under the age of 25, accounting for 45% of the global disease burden, whereas 4.6% of teenagers aged 15 to 19 are predicted to experience anxiety. Pakistan country, with a population of 200 million, has the worst mental health indicators and fewer than 500 psychiatrists. Despite the existence of various treatments for anxiety, this goes unrecognized and untreated. Due to a lack of awareness, evaluation, prevention, and interventional programs related to being implemented among adolescents in Pakistan, there is a rise in mental health issues in the earlier years of life. It calls for a critical need for indigenous, evidence-based interventions. The present study aimed to evaluate the feasibility of cognitive behavioral therapy (CBT)-based interventions to reduce anxiety symptoms among school children in Pakistan., Methods: This study was a pre-post design, two-arm, single-blinded, feasibility, randomized controlled trial. Thirty-four participants (experimental group, n = 17; control group, n = 17) were recruited from four semi-government schools in Rawalpindi with a mean age of 15 (M = 15, SD = 0.73). Two instruments Beck Anxiety Inventory for Youth (BAI-Y II) and BASC-3 Behavioural and Emotional Screening System Student (BESS-SF) were used to assess the severity of symptoms. Participants in the intervention arm received eight-group therapy CBT sessions. A two-way factorial analysis was used to examine the efficacy of CBT in reducing symptom severity., Results: This study's findings showed that in comparison to the wait-list control group, CBT successfully improved anxiety symptoms among school children while enhancing their social skills., Conclusion: This study will help improve the treatment for anxiety in Pakistan by prioritizing school-based intervention and group-based CBT intervention., Trial Registration: The trial has been registered at the American Economic Association's registry for randomized controlled trials., Rct Id: AEARCTR-0009551 . Registered 2022-07-04., (© 2024. The Author(s).)

Aim: To compare relative peripheral refraction (RPR) in Chinese school children with different refractive errors using multispectral refraction topography (MRT)., Methods: A total of 713 eyes of primary school children [172 emmetropia (E), 429 low myopia (LM), 80 moderate myopia (MM), and 32 low hypermetropia (LH)] aged 10 to 13y were analyzed. RPRs were measured using MRT without mydriasis. MRT results showed RPR at 0-15° (RPR 0-15), 15°-30° (RPR 15-30), and 30°-45° (RPR 30-45) annular in the inferior (RPR-I), superior (RPR-S), nasal (RPR-N), and temporal (RPR-T) quadrants. Spherical equivalent (SE) was detected and calculated using an autorefractor., Results: There were significant differences of RPR 15-30 between groups MM [0.02 (-0.12; 0.18)] and LH [-0.13 (-0.36; 0.12)] ( P <0.05), MM and E [-0.06 (-0.20; 0.10)] ( P <0.05), and LM [-0.02 (-0.15; 0.15)] and E ( P <0.05). There were also significant differences of RPR 30-45 between groups MM [0.45 (0.18; 0.74)] and E [0.29 (-0.09; 0.67)] ( P <0.05), and LM [0.44 (0.14; 0.76)] and E ( P <0.001). RPR values increased from the hyperopic to medium myopic group in each annular. There were significant differences of RPR-S between groups MM [-0.02 (-0.60; 0.30)] and E [-0.44 (-0.89; -0.04)] ( P <0.001), and LM [-0.28 (-0.71; 0.12)] and E ( P <0.05). There were also significant differences of RPR-T between groups MM [0.37 (0.21; 0.78)] and LH [0.14 (-0.52; 0.50)] ( P <0.05), LM [0.41 (0.06; 0.84)] and LH ( P <0.05), and LM and E [0.29 (-0.10; 0.68), P <0.05]. A Spearman's correlation analysis showed a negative correlation between RPR and SE in the 15°-30° ( P =0.005), 30°-45° ( P <0.05) annular ( P =0.002), superior ( P <0.001), and temporal ( P =0.001) quadrants., Conclusion: Without pupil dilation, values for RPR 15-30, 30-45, RPR-S, and T shows significant differences between myopic eyes and emmetropia, and the differences are negatively correlated with SE., Competing Interests: Conflicts of Interest: Hu HL, None; Li SZC, None; Feng AY, None; Zhong HX, None; Mu JF, None; Liu MZ, None., (International Journal of Ophthalmology Press.)

Objective: This study aimed to develop and validate a questionnaire to assess changes in dietary behaviors among school children in Jordan during the COVID-19 pandemic., Methods: A cross-sectional study used a convenience sample of 253 school-aged children from public schools across Jordan. The dietary and lifestyle behavior inventory (DLBI) was developed, incorporating cultural and regional dietary preferences. The questionnaire's validity and reliability were assessed using the content validity index (CVI) and Cronbach's alpha for internal consistency. Exploratory factor analysis (EFA) was conducted to evaluate the underlying factor structure., Results: The DLBI demonstrated excellent content validity with a scale content validity index (S-CVI) of 0.997 and a high level of agreement among expert reviewers (total agreement = 116). Reliability analysis showed high internal consistency for dietary behavior scales, with Cronbach's alpha values exceeding 0.9 for fruit (0.869) and vegetable (0.916) consumption scales. Factor analysis revealed strong associations between dietary behavior variables, with factor loadings ranging from 0.688 to 0.889. The study identified significant reductions in physical activity levels among children, with an average Cronbach's alpha of 0.835 for physical activity-related items. The average time to complete the questionnaire was 15 minutes (SD = 5 minutes), with a completion rate of 45.6%., Conclusions: The validated DLBI is a robust tool for assessing changes in dietary behaviors among school-aged children in Jordan during the COVID-19 pandemic. The findings highlight significant dietary patterns and physical activity shifts, emphasizing the need for targeted nutritional interventions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the National University of Malaysia issued approval JEP-2022-590. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alarsan et al.)

Myopia is the most frequent kind of refractive error and affects hundreds of millions of people. Growing evidence suggests that extended exposure to digital screens may exacerbate nearsightedness in children and young people. The purpose of this review is to compile data on the link between too much time in front of a screen and nearsightedness in young people so far. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided the methods used and the format of the resulting report. Articles published between January 1, 2000, and June 30, 2023, were found by searching Medline, PubMed, ScienceDirect, Google Scholar, CINAHL, the Cochrane Library, and Scopus. Studies reporting an association between myopia and time spent in front of screens in children and young adults were considered eligible. The initial search yielded a total of 1,251 studies. After eliminating duplicates and reviewing the titles and abstracts, 64 full-text articles were evaluated for eligibility. Ultimately, 15 of these studies were included in the final analysis. The 15 studies involved a total of 59,775 participants and were conducted in various countries, including China, Singapore, and the United States. Overall, the evidence did not support a significant association between screen time and myopia in school children and young adults. There is conflicting evidence on the link between screen time and myopia in children and adolescents. More research is needed to determine whether or not digital screen use is a risk factor for myopia. The complex association between screen time and myopia is not fully understood at this time because of the variability of the included studies. These results have significant public health implications since they may be used to guide recommendations for screen time use in children and the young population., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khalaf et al.)

This study examined the usefulness of drama and music therapies as communication strategies for reducing symptoms of post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD) among school children (aged 10-16) who were victims of the 2022 floods in Nigeria. The researchers randomly assigned the children to control (n = 122) drama therapy (n = 120) and music therapy (n = 120) groups. The result of the study revealed that after the intervention, school children in the drama and music therapies (unlike those in the control group) reported a significant reduction in their PTSD and GAD symptoms; the reduction achieved statistical significance (p = 0.001, η p 2  = 0.48). Further results revealed a significant interactive effect of gender (p = 0.001) with boys reporting a significant reduction more than girls. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing GAD symptoms. The difference did not achieve statistical significance (p = 0.23). The researchers conclude that both drama and music therapies were associated with reduced symptoms, indicating the interventions may be beneficial therapies., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The coronavirus 2019 (Covid-19) pandemic has affected both the private and public lives of people worldwide. Countries have chosen different strategies to reduce the spread of infection, including school closures and distance learning. This study aimed to describe school nurses' perceptions about the wellbeing of students during the Covid-19 pandemic in Sweden. Interviews in five focus groups and one individual were conducted with 17 school nurses in Sweden. The interviews were analyzed using a qualitative content analysis. According to the school nurses' perceptions, students were concerned about spreading infection, becoming infected themselves, their academic performances, and longing for socialization. The change in the school situation involved a slower pace and less anxiety for some students, more or less physical activity, and an increase in screen time., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Soil-transmitted helminthiases (STH) are among the neglected tropical diseases and infect more than 24% of the world population. The World Health Organization recommends regular monitoring of STH's prevalence and intensity following mass drug administrations to evaluate their effectiveness and inform future control strategies. This study evaluated the prevalence, intensity, and risk factors of STH infections among school children aged 6 to 14 years old in northwestern Tanzania. A cross-sectional study was conducted among 728 school children in the Kagera region in 2021. Participants were selected using a two-stage cluster sampling method. A questionnaire was used to collect data on the risk factors. Stool samples were examined using the Kato-Katz technique. The data were analysed using STATA. The overall prevalence of STH was 56.2% (95% CI: 52.5-59.8, 409/728). About 5.7% and 1.1% of the infected children had moderate-intensity infections with Ascaris lumbricoides and Trichuris trichiura, respectively. Risk factors included the mother's occupation as a farmer (aOR: 1.2, p = 0.002) and not washing hands with water and soap (aOR: 1.4, p = 0.035). Washing one's hands after using the toilet (aOR: 0.6; p = 0.024) is a preventive measure against STH infections. STH was prevalent in the study area. The mother's occupation (farmer) and the lack of handwashing with water and soap influenced STH transmission. Conversely, washing hands after visiting the toilet and after playing with soil reduced the risk of STH infection.

Objective: To study associations between fractional exhaled nitric oxide (FeNO) and asthma, airway symptoms, sensitization to common allergens, outdoor pollution and home environment among 380 students in eight junior high schools in two areas in Indonesia., Methods: Data on health and home were collected by a face-to face interview before measuring FeNO and performing skin prick test against common allergens. Exploratory linear mixed and logistic regression models were employed., Results: Geometric mean of FeNO was 17.8 ppb (GSD 2.09) and 139 students (36.6%) had elevated FeNO (>20 ppb). In total, 107 students (28.2%) were sensitized to house dust mite (HDM) (Der p1 or Der f1), 4 (1.1%) to cat and 3 (0.8%) to mold ( Cladosporium or Alternaria ). Moreover, 20 students (5.3%) had diagnosed asthma, 38 (10.0%) had current wheeze, and 107 (28.2%) had current rhinitis. HDM sensitization, diagnosed asthma, current wheeze, and current rhinitis were associated with FeNO. In total, 281 students (73.9%) had mold or dampness, 232 (61.1%) had environmental tobacco smoke (ETS) and 43 (11.3%) had other odor at home. Indoor mold or dampness and other odor at home were associated with FeNO. ETS was negatively associated with FeNO., Conclusion: HDM sensitization and elevated FeNO can be common among children in this part of Indonesia. The high prevalence of elevated FeNO indicate that undiagnosed childhood asthma is common. Dampness, mold and odor at home can be associated with increased FeNO while ETS can be associated with decreased FeNO.

Background: Streptococcus pyogenes is one of the major public health concerns causing human infections ranging from skin and throat infections to acute rheumatic fever and post streptococcal glomerulonephritis. Moreover, nowadays drug-resistant strains of S. pyogenes are emerging and can be transmitted through apparently healthy carriers to susceptible individuals., Objective: To assess the prevalence, antimicrobial susceptibility pattern and associated factors S. pyogenes among apparently healthy school children in Mekelle city primary schools, Northern Ethiopia., Methods: A cross-sectional study was conducted among 504 apparently healthy school children from February to May 2018. We used structured questionnaire to collect socio-demographic data. Throat specimens were collected using sterile cotton Swab and transported for culture, antimicrobial susceptibility and identification of S. pyogenes according to standard operating procedures. Data were analyzed using Stata 13 for descriptive statistics, bivariate and multivariate logistic regression. P -value <0.05 was declared statistically significance., Results: The mean age of the study participants was 11.5 years of which 55 % of them were females. The overall prevalence of S. pyogenes was 8.3 %. Being female, having low monthly income, weak personal hygiene, poor hand washing habit and crowded living style were significantly associated with the occurrence of S. pyogenes . The isolates of S. pyogenes showed resistance to Penicillin (69.1 %), Amoxicillin-Clavulanic acid (62 %), Ampicillin (54.6 %), Ceftriaxone (47.6 %), Tetracycline (14.4 %), Cefoxitin (7.2 %). About 57.15 % isolates were multidrug-resistant., Conclusions: This study revealed that some isolates of S. pyogenes among the apparently healthy school children were resistant to commonly prescribed antibiotic agents and associated with hygienic conditions and living style. Therefore, it is recommended to practice antimicrobial susceptibility test to maintain rational antibiotic use and improve hygienic and hand washing practices to decrease the likelihood of carriage rate., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Repetitive practice can become an exploratory activity where instruction and discovery are linked, allowing instruction and guidance through tasks that help to construct and acquire the knowledge and skills that make up the content. (1) Background: The aim of the study was to show how a teaching method based on guided discovery would affect the teaching of children's aquatic competence in schoolchildren with different levels of competence. (2) Methods: An observational study was conducted with 385 schoolchildren (195 boys and 189 girls) aged 3-5 years belonging to a charter kindergarten, using an Instrument for the Measurement of Aquatic Competence in Children (SMACC) consisting of 17 items grouped into three dimensions: socio-affective, cognitive, and motor. (3) Results: After measuring aquatic competence, all age groups and all variables (motor, cognitive, and socio-affective) showed differences between pre- and post-scores and a high magnitude of effect size. When the teaching intervention was analyzed according to the level of aquatic competence of the age group, improvements were found in all variables in both the low and high-competence groups. (4) Conclusions: This study describes how guided discovery instruction has equal effects at different levels of proficiency. Furthermore, when this type of instruction was used, aquatic competence was explained not only by the motor and socio-affective dimensions but also by the cognitive variable.

A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

Background Childhood obesity is one of the most prevalent nutritional disorders affecting children across the world, which further leads to diabetes, hypertension, coronary artery disease, and fatty liver disease in adulthood. The magnitude of this problem among Indian expatriates in the United Arab Emirates (UAE) has not been investigated before. This study delves into the prevalence of childhood obesity among this demographic and also provides a comparative analysis of the prevalence of obesity in UAE citizens and children in India. Methodology This is a cross-sectional study that investigates the prevalence of obesity in 3,698 students of a single Indian school in the UAE. Anonymous anthropometric data of these children of age range four to 18 years were analyzed. The International Obesity Task Force (IOTF), World Health Organization (WHO), and Centers for Disease Control (CDC) reference methods were used to calculate the prevalence of overweight, obesity, and extreme obesity. Results According to CDC guidelines, the prevalence of body mass index (BMI) ≥ 85th percentile, ≥ 95th percentile, and ≥ 99th percentile stands at 32.74%, 13.68%, and 5.1%, respectively. Children particularly boys aged more than 10 years are at a higher risk of being overweight, obese, and extremely obese (p = < 0.05). In children aged 10 years or less, as the age increases, they tend to have a higher BMI percentile and this is particularly prominent in boys (Pearson correlation coefficient 0.227). Conversely, in those over the age of 10 years, the BMI percentile decreases with age, particularly noticeable in girls, albeit without statistical significance. Conclusion Approximately one-third of school-aged Indian expatriates in the UAE are overweight, obese, or extremely obese. Our study, when contrasted with earlier studies, reveals that Emirati teenagers exhibit a higher prevalence of overweight and obesity compared to their Indian counterparts in the UAE. Similarly, the prevalence of childhood obesity among Indian expatriates in the UAE surpasses that among children residing in India., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee, Aster Medical Centre issued approval AJMC/MOM/EC/23/025. Since in this study, the researchers will be retrospectively analyzing anonymous anthropometric data of school children, it does not pose any risk to the children involved and thus the committee approves the research without any objection. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pandey et al.)

Data on the epidemiology of tinea capitis (TC), an infection of the scalp by dermatophytes, are scarce in Cameroon. This study aimed to determine the prevalence of TC among school-children in the Dschang Subdivision, Western Cameroon. A cross-sectional study was carried out in June 2021 in Dschang including pupils aged 5-13. First, a standardized questionnaire was administered to participant for the collection of sociodemographic data. Then, samples were collected and cultured onto Sabouraud-Chloramphenicol-Gentamicin Agar. The etiological agents were identified based on their morphological features and with MALDI-TOF mass spectrometry. A total of 1070 children were clinically examined and 108 (10.1%) children presented with TC lesions. The mean age of the 1070 participants was 8.3 ± 2.6 years (range: 5-13 years); 772 (72.2%) were males. The use of borehole water (OR = 0.01, 95% CI[0.001-0.03]), spring water (OR = 0.2, 95% CI[0.08-0.50]), rainwater (OR = 0.004, 95% CI[0.001-0.016]), and hairdressing salons visits (OR = 0.413, 95% CI[0.196-0.872]) were associated with a decreased TC risk in the multivariate logistic regression analysis. In contrast, sharing bed with siblings (OR = 4.48, 95% CI[2.095-9.60]) was associated with an increased TC risk in children. Among the 32 dermatophytes isolated in culture, Microsporum audouinii was the most frequent (43.8%), followed by Trichophyton rubrum (25.0%) and T. soudanense (25.0%). Microsporum canis and T. violaceum were both rarely isolated. Further studies are warranted to assess the association of TC with domestic water usage that has been highlighted in this study., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: The present study aims to assess PE teachers' perception about the use of teaching styles during curricular lessons., Methods: The sample involved a total of 83 PE teachers (M = 41, F = 42, main age = 43,74 ± 10,76) divided according to years of service (0-4 = 36%, 5-10 = 34%, and over 10 = 30%) and academic training (Higher Institutes of Physical Education = 44% and master's degree = 56%). Teachers complete a digitalized version of a self-produced questionnaire to assess how many times they use each teaching styles during the last month., Results: Results show that (a) reproduction rather than production teaching styles were often used, while reproduction teachings styles were most frequently used regardless of years of service., Discussion: Future research should investigate PE teacher's behavior to enhance the quality of physical education in school., 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., (© 2024 Monacis, Latino, d’Arando, Bibba, Annoscia, Pascali, Sannicandro and Colella.)

Background: Deteriorating global physical activity (PA) levels among children warrants new and sustainable approaches to increase PA levels. This study aimed to determine the immediate and sustainable influences of a 9-week movement program on the PA levels in 7 to 8-year-old school children in the Raymond Mhlaba Municipality in the Eastern Cape Province of South Africa., Methods: A randomized control trial including two groups (control group (CG) and intervention group (IG)), pre-post-retest (after six months of no intervention) design was used. Seventy school children, mean age 7.12 years (± 0.71) (n = 35 IG; n = 35 CG) participated in the study. A 9-week movement program was followed twice a week for 30 min during school hours. PA was measured for 7 consecutive days using a hip-mounted wGT3X-BT Actigraph accelerometer. The Test of Gross Motor Development-Third Edition (TGMD-3) was used to assess motor skills. Hierarchical Linear Modelling (HLM) was applied to analyze the data with time, sex, and group as predictors. Effect sizes were computed using Cohen's d-cut points to assess the practical significance of changes over time. Estimated regression coefficients were also computed to determine the strength of the relationship between moderate-to-vigorous physical activity (MVPA) and fundamental movement skills (FMS)., Results: Before the intervention, 60% of the IG met the 60 min of daily MVPA guideline, while light physical activity (LPA) per day was also higher than sedentary behavior (SB) in both groups. No immediate (p < 0.01) or sustainable (p < 0.01) increases in MVPA levels were found and no positive associations emerged between FMS and MVPA levels., Conclusions: This intervention had little to no effect on children's MVPA. More understanding of the activity behavior and interests of children is needed to improve their PA behavior through the content of movement programs. Strategies are also needed to communicate clear messages at a personalized but also parental level, focusing on enhancing health through regular PA, especially to promote PA in young children., (© 2024. The Author(s).)

This study aimed to investigate the impact of an 8-week aerobic dance intervention on postural balance in children. Forty-one children, aged 9 to 11, were randomly assigned to either an aerobic dance group (ADG) or a control group (CG) from a primary school. Postural balance was assessed using center of pressure (CoP) excursions before and after the 8-week intervention period. Evaluations were conducted on both firm and foam surfaces in bipedal and unipedal stances under open-eyes (OE) and closed-eyes (CE) conditions, as well as on both medial-lateral (ML) and anterior-posterior (AP) surfaces in a bipedal stance under OE conditions. The ADG exhibited significantly decreased CoP Vm values during firm bipedal CE, unipedal OE, foam bipedal OE and CE, and foam unipedal OE ( p < 0.005). This study suggests that aerobic dance intervention improved postural balance in children, showcasing adaptability and improved stability under various conditions.

Background: Limited studies have focused on recent trends in Asian American and Pacific Islander (AAPI) youth suicide. This study aimed to evaluate epidemiological trends in AAPI youth suicide and reports of depressive symptoms among Asian and Pacific Islander youth in the USA., Methods: This cross-sectional study analyzed mortality data from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and reports of depressive symptoms from the Youth Risk Behaviour Surveillance System (YRBSS). Data from 1999 to 2021 were analyzed for suicide rates and methods used among AAPI youth aged 5-24 years. YRBSS data from 1991 to 2021 were analyzed for depressive symptoms reported by Asian American (AA) 9th-12th graders., Results: From 1999 to 2021, 4747 AAPI youth died by suicide in the USA. Rates of suicide doubled from 3.6 to 7.1 per 100,000 during 1999-2021, with an increasing trend observed from 2014 onwards. The most common methods of suicide deaths in this population were suffocation, firearms and poisoning. Rates of suicide were higher among AA males than females, although more AA females reported depressive symptoms, including suicidal planning and attempts., Conclusion: This study shows a concerning increase in suicide rates among AAPI youth over 1999-2021. Suffocation, firearms and poisoning were the most common methods used. While more AAPI males died by suicide, AA females reported higher rates of depressive symptoms. These findings highlight the urgent need for targeted prevention strategies and clinical interventions for this vulnerable population. The study also emphasizes the importance of addressing mental health stigma to improve reporting and support for Asian American, Native Hawaiian and Pacific Islander (AANHPI) youth., (© 2024 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

An early detection of Neurodevelopmental Disorders (NDDs) is crucial for their prognosis; however, the clinical heterogeneity of some disorders, such as autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) is an obstacle to accurate diagnoses in children. In order to facilitate the screening process, the current study aimed to identify symptom-based clusters among a community-based sample of preschool and school-aged children, using behavioral characteristics reported by teachers. A total of 6894 children were assessed on four key variables: social communication differences, restricted behavior patterns, restless-impulsiveness, and emotional lability (pre-schoolers) or inattention and hyperactivity-impulsivity (school-aged). From these behavioral profiles, four clusters were identified for each age group. A cluster of ASD + ADHD and others including children with no pathology was clearly identified, whereas two other clusters were characterized by subthreshold ASD and/or ADHD symptoms. In the school-age children, the presence of ADHD was consistently observed with ASD patterns. In pre-schoolers, teachers were more proficient at identifying children who received a diagnosis for either ASD and/or ADHD from an early stage. Considering the significance of early detection and intervention of NDDs, teachers' insights are important. Therefore, promptly identifying subthreshold symptoms in children can help to minimize consequences in social and academic functioning., (© 2024 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Background: According to the World Health Organization, there is an explosion in the use of electronic devices, the internet, and gaming platforms. In many countries, it is a significant public health concern, prompting calls to identify adequate public policy. We aimed to investigate the prevalence of internet addiction (IA) among high school students and to assess the relationship between the internet addiction level of high school students and their demographic features with internet use., Materials and Methods: A cross-sectional study was conducted among 424 high school children studying in eighth standard-tenth standard. Among 121 public and private high schools listed by the BEO (Block Education Officer) Office in Kolar Taluk four high schools were selected by lottery method from July 2021 to August 2021. The Internet Addiction Test (IAT) by Young was used to assess the intensity of internet usage., Results: The mean IAT score of study participants was 29.6. The mean age of the study population was 14.4 ± 0.84 years. The odds of internet addiction among female students were 4.5 times higher than among male students. The majority (91.5%) of the students had used the internet for educational purpose and the other common reasons for internet usage is social media (43%), entertainment (43%), and gaming purpose (21%)., Conclusion: The prevalence of IA among high school students is 14.6% with the moderate-risk population was 12.5% and the high-risk population was 2.1%. Students using the internet for both academic and non-academic purposes were more internet addicted. The real challenge is to have control over the usage of social sites-the amount of time being spent and the type of activities adolescents are doing online., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Objectives: Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of Trichuris trichiura, there is a need to understand the drivers of persistent infection despite ongoing treatment programs., Methods: This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for T. trichiura . After this, we conducted a nested case-control study wherein all children positive for T. trichiura (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with T. trichiura were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of T. trichiura were investigated through multilevel logistic regression, considering clustering of infection., Results: Overall, 34.4% of the children were infected with at least one STH species; T. trichiura was the most common (28.3%), 89.1% of those with T. trichiura had light-intensity infections. The prevalence of T. trichiura was significantly higher in male children and was positively associated with younger age and number of people infected with T. trichiura in a household. The parasitological cure rate and egg reduction rate of T. trichiura were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and Ascaris lumbricoides (5.7%)., Conclusions: T. trichiura remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization-recommended thresholds. Because of the observed focal transmission of T. trichiura in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission., Competing Interests: Stella Kepha reports financial support was provided by African Research Network for Neglected Tropical Diseases. The remaining authors have no competing interest to declare., (© 2024 The Authors.)

Background: Oral health education programs have long been considered an essential part of oral health policies. This is important for reducing the risk of oral diseases through health enhancement and voluntary behavioral changes due to learning opportunities. This study aimed to evaluate the effects of school-based oral health education program on oral health in school children in Sudan., Methods: A quasi-experimental study was conducted at four governmental schools in Khartoum, Sudan, between August 2018, and March 2022. A total of 423 school children were randomly allocated into the control (n = 211) and study (n = 212) groups. An adapted questionnaire was administered to students before and after the intervention to assess their knowledge and practice of oral health. The study group participated in oral health education activities. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21., Results: The findings revealed that the mean knowledge at the pre-educational program was 9.3066 (SD = 3.91078) and the mean knowledge after the educational program was 21.2736 (SD = 2.13982). The scores indicated that the school children had significantly higher knowledge and practice scores after the oral health education program., Conclusion: The study concluded that education program on oral health improved students' oral health knowledge and practices. Imposing theoretical and practical lessons on oral and dental health in school curricula can motivate students to maintain oral health care, and this improves oral health status., Competing Interests: The authors declare no competing interests to be addressed., (© 2024 Albani et al.)

Purpose: This review systematically summarizes the studies of the relationship between primary-to-secondary school students' motor skills and academic achievement, and analyzes the relationship between gross and fine motor skills and performance in different subjects., Method: Five electronic databases, Web Of Science, PubMed, PsycINFO, SPORTDiscus, and Academic Search Premier, were searched in March 2023. Semi-quantitative assessment methods were used to analyze the results of the included studies., Results: Seventy-eight articles were included in this systematic review. The semi-quantitative assessment results showed that gross (+, 65.0/62.5%) and fine motor skills (+, 83.3/80%) were positively correlated with overall performance and language performance, with ≥60% of the associations in the same direction. For different subjects, fine motor skills were positively correlated with students' mathematics (+, 75.0%), reading (+, 72.7%), writing (+, 66.7%), and spelling (+, 60.0%) scores. However, the association between gross motor skills and students' mathematics achievement (?, 52.8%), reading (?, 53.8%), and spelling (?, 50.0%) is uncertain, with <60% of the associations in the same direction., Conclusions: It is wise to direct our gaze toward the evolution of motor skills among students, especially primary school students. Different motor skill intervention modes should be selected in a targeted manner according to different subject achievements.

Purpose: An acute conjunctivitis outbreak was investigated at a residential school in Naharlagun, Arunachal Pradesh, Northeast India, in July 2023. We aimed to identify the etiological agent and assess any complications in follow-up cases., Methods: We used a structured questionnaire to record clinical findings and followed up with cases one-month post-conjunctivitis. Sixty-one cases were examined and eight conjunctival and oropharyngeal swab samples were collected after obtaining informed consent from guardians/school authorities. We screened for 33 viral and bacterial pathogens using an IVD-approved Real-time PCR assay. Further, the samples were subjected to nucleic acid sequencing., Results: Among 465 screened students and staff, 80 individuals (approximately 17.2%) showed acute hemorrhagic conjunctivitis symptoms among which 61 cases were available for clinical examination. We identified the Enterovirus responsible by targeted sequencing using next-generation sequencing. The etiological agent was found to be Coxsackievirus A24, a member of Enterovirus C, in seven out of eight samples subjected to sequencing. Common symptoms included conjunctival hyperemia and foreign body sensation (100%), bilateral eye involvement (73.8%), eye pain (70%), watery discharge (49.2%), and eyelid swelling (38%). Only 6.5% had purulent discharge. Most cases resolved within 5-6 days, with only 9.8% reporting abdominal symptoms post-conjunctivitis. No serious complications occurred within one month. Throat swabs aided in diagnosing enterovirus infections alongside eye swabs., Conclusions: The outbreak of acute conjunctivitis was caused by Coxsackievirus A24, a member of Enterovirus C. Cases resolved spontaneously within 6-7 days, with no severe complications. Collecting oropharyngeal swabs alongside conjunctival swabs could improve enteroviral conjunctivitis diagnosis., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. B. Borkakoty reports financial support was provided by Department of Health Research., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Background: The School Feeding Programme if properly executed has the capacity to improve the nutritional status of the school children., Objective: To assess the nutritional status of school children in Ondo State Nigeria given that the National Home-Grown School Feeding Programme (NHGSFP) has been operational in the state for over five years., Methods: This was a descriptive cross-sectional study., Results: A total of 234 subjects from public schools and 227 subjects from private schools were enrolled in the study. Their mean age was 8.23 ± 1.92 years. Wasting, overweight, obesity, underweight, and stunting were noted in 19.4%, 11.4%, 0.4%, 5.0%, and 20.7% of the children, respectively. The prevalence of stunting (30.3%) and wasting (23.9%) was more among subjects from the public schools. A significant association was found between Weight-for-Age Z-score, Height-for-Age Z-score, and BMI-for-Age Z-score and the children's school type (p < 0.005)., Conclusion: Majority of the children showed normal growth, the rest were in both extremes of malnutrition, the subjects from private schools seem to present better nutritional status, although there is no baseline data to ratify this finding. A further study on this subject using the current finding as a baseline data is recommended., Competing Interests: The authors declared that they have no competing interests., (© 2024 Obembe TA et al.)

Study Design: Systematic review of Randomised controlled trials., Objectives: With the increasing incidence of back pain among children and its untold implications to their future, back education tailored in an effective way would be indicated. However literature appears unsettled. This study aims to review available literature to determine the effect of school-based back education in preventing and managing low back pain in school children., Methods: Randomized controlled trials carried out on elementary and secondary school children of ages 6 to 18 years and published in English language were included. Back education taught in hospitals or other settings were excluded. Primary outcome was back pain prevalence and secondary outcomes were constituted from the study characteristics of selected studies which includes: back behavior, knowledge, postural habits, physical activity, fear-avoidance beliefs, back pack carriage, pain intensity, skills and self efficacy. Databases searched were PEDro, HINARI, PubMed, Cochrane, and Google Scholar. Available stiudies from 2000 to March 2022 were retrieved. Quality of studies were assessed using the PEDro scale. Obtained studies were descriptively analyzed., Results: A total 8420 studies were retrieved and 8 studies (with 1239 participants) were included in this review. Four studies each assessed back knowledge and back behavior, and two assessed back pain prevalence. There were improvements in back knowledge and back behaviour, but effectiveness of back care education on back pain prevalence was not conclusive. Forms of education used involved the indirect method of conditioning the environment and the direct method which made use of theory, practical lessons and educational books and materials., Conclusion: Back care education programmes in schools are effective in improving back care knowledge, behavior and reduction in low back pain frequency. Reduction in back pain prevalence is not conclusive. Back care education could be incorporated as part of schools' education programmes. Limitations include exclusion of non English language studies and inconsistent outcome measures., Funding Source: None., Registration: This review protocol was registered under the International platform of Registered systematic review and meta-analysis protocol (INPLASY) with the registration number; INPLASY202310044 and DOI number; https://doi.org/10.37766/inplasy2023.1.0044., (© 2024. The Author(s).)

(1) Background: Childhood obesity and dental caries are common chronic conditions with multiple contributing factors, linked to negative health consequences and significant expenses in healthcare. The aim of this study was to assess the correlation between obesity and dental caries in school-aged children; (2) Methods: Data from 3323 6-12-year-old children from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 were analyzed. The NHANES was conducted at the Centers for Disease Control and Prevention (CDC) in the United States. The CDC standard was used to define obesity. Dental caries was measured during clinical examinations and summarized using DMFT scores for caries experience and prevalence (dt > 0) for untreated caries. The study examined the correlation between obesity and dental caries using regression models that considered demographic variables, family socioeconomic status, and the child's intake of added sugars as controlling factors; (3) Results: The association between obesity and dental caries was not significant in either unadjusted or adjusted models; and (4) Conclusion: The data indicate that untreated caries and caries experiences are not directly correlated with childhood obesity. There are, however, common causes of poor dental health and childhood obesity: culture, poverty level, lifestyle, and family traditions and habits. Dentists must be aware of factors influencing the development of childhood caries so that they can intervene as early as possible.

Background: Iron deficiency is one of the leading causes of anaemia, with those most affected being children and women of childbearing age, in Brazil there is a scarcity of studies involving the local prevalence of anaemia. Aim: To evaluate anaemia and associated factors in schoolchildren in Santa Cruz do Sul through the analysis of biochemical and haematological markers and parasitological examination of faeces. Subjects and methods: School children from 10 to 12 years of age were evaluated through complete blood count, serum ferritin, C-reactive protein and stool parasitological examination, as well as socio-demographic characteristics and prophylaxis with ferrous sulphate in childhood. Results: It was found that 13.0% of the population was anaemic, girls were very slightly overrepresented among the anaemic children. Only 5.3% had altered haematocrit levels; 26.6% had low Mean Corpuscular Volume levels; 18.4% had low ferritin levels; 2.4% had increased C-reactive protein levels, and 21.7% had altered eosinophils. As for the socioeconomic level, classes A2 and D presented lower haemoglobin levels, as well as class D presenting lower ferritin levels, although without statistical significance. Only 6.0% of the population presented iron-deficiency anaemia and 46.0% of the schoolchildren had used ferrous sulphate supplementation in childhood. Conclusion: The prevalence of anaemia in the studied municipality is low, probably due to the high municipal human development index. Epidemiological studies are essential to characterise the population in a systematic form, to prevent future problems.

Introduction Trauma involving anterior teeth stands as a prevalent type of dental injury among school-age children, impacting physical, psychological, and social well-being. This study aimed to assess the occurrence of fractures in anterior teeth among school children in Hyderabad and its associated risk factors. Materials and methods This research incorporated a cross-sectional analysis, involving 2046 children in the age group of 8 to 13 years from different schools in Hyderabad City. Alongside clinical evaluations, all participants completed a questionnaire regarding traumatic dental injuries.  Results Results indicated a prevalence rate of 8.5%, notably higher among younger boys. Factors such as lip competence coverage, increased overjet, and malocclusion with maxillary incisor proclination were associated with a heightened risk of such injuries. The peak incidence was observed at age 12, with fractures involving enamel and dentin being the most common type, predominantly affecting the maxillary central incisors. Conclusion The findings emphasize the significance of educational programs aimed at enhancing awareness and understanding of dental injuries among parents, students, and school staff., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bellamkonda et al.)

Purpose: Recent studies have shown that physical activity (PA) levels are low among children and adolescents globally. In order to reverse this trend, PA interventions are increasingly favoured. The school setting is the ideal place to address the issues that many children face. The purpose of this study was to (a) The primary focus of this study is to delve into the mediating role played by school-based rope skipping sports participation (SRSP) in the connection between social support and moderate to high-intensity physical activity (MVPA) among school children. (b) Additionally, this research aims to examine the moderating effect of within this pathway., Methods: We conducted a survey involving 721 adolescents residing in Changsha City. The participants' ages ranged from 8 to 12 years, with an average age of 9.84 ± 1.535 years. Out of these participants, 406 were boys, and 315 were girls. To assess variables such as social support and autonomous motivation, we employed standardized measurement scales. Subsequently, we analyzed the collected data using various statistical methods, including independent s-amples t-tests, bivariate correlation analysis, descriptive statistical analysis, structural equation modeling (SEM), and the Johnson-Neyman method., Results: An independent samples t-test revealed a statistically significant difference in MVPA between genders ( p  = 0.003 < 0.05), with boys exhibiting a higher level of engagement in MVPA compared to girls, Correlation analysis revealed significant positive associations among several key variables. Specifically, social support demonstrated a noteworthy positive correlation with autonomous motivation (r = 0.331, p  < 0.01) as well as school children's engagement in MVPA (r = 0.308, p < 0.01). Moreover, autonomous motivation displayed a significant positive correlation with school children's involvement in MVPA (r = 0.459, p  < 0.01). The moderating analysis revealed a significant influence of the interaction between increased participation in and social support on school children's engagement in MVPA., Conclusion: Social support and autonomy support have been proven effective in enhancing school children's engagement in MVPA. They exert their influence indirectly by fostering autonomous motivation. Notably, robust social support can significantly benefit MVPA school children with high activity requirements, particularly those regularly engaged in MVPA during the school day., 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 Qi, Yin, Wang, Zou and Liu.)

Objectives: In Alberta, Canada, the COVID-19 vaccination program for children aged 5-11 years was launched on November 26, 2021. Our objectives were to determine the cumulative vaccine coverage, stratified by age, during the first thirteen months of vaccine availability, and investigate factors associated with vaccine uptake., Study Design: This retrospective cohort study used population-based administrative health data., Methods: We determined cumulative vaccine coverage among 5-11 year olds, stratified by year of age, during the first thirteen months of vaccine availability and used a modified Poisson regression to evaluate factors associated with vaccine uptake., Results: Of 377,103 eligible children, 44.8 % (n = 168,761) received one or more doses of COVID-19 vaccine during the study period (9.7 % received only one dose, while 35.1 % received 2 doses). Almost 90 % of initial doses were received within the first two months of vaccine availability. We found a step-wise relationship between increasing child age and higher vaccine coverage., Conclusions: Plateaued vaccine uptake indicates a need to adapt programmatic efforts to encourage parents to act on positive vaccination intentions, and reach the large contingent of parents who have reported that they remain undecided. In order to promote vaccine uptake, messaging around vaccine safety and need should be tailored to child age, rather than uniformly applied across the 5-11 year age range., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment., Methods: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index (BMI) and PEFR. Independent t-test was performed to identify any differences in mean flow rate values between different ethnicities and genders. Correlation coefficients (r) were used to observe the relationship between PEFR and anthropometric measurements. A prediction equation by gender was generated using linear regression analysis. Statistical significance was set at the 5% level. All statistical data was analyzed using SPSS version 25.0., Results: The study involved 260 participants with a mean age of 9.5 years. Males were 51.2% and 65% of participants were of Asian ethnicity. PEFR was not observed to differ across the different ethnic groups and genders. Height was found to have the strongest correlation coefficient of 0.745, while BMI had the weakest correlation coefficient of 0.366. The strongest correlation was found with height for females (r = 0.787), while the weakest was with body mass index for boys (r = 0.203). The derived prediction equation for males was PEFR = 279.169 (Height of Student in meters) -134.12, while the predictive equation for females was PEFR = 318.32 (Height of Student in meters) -195.69., Conclusion: This study found a strong correlation between PEFR and anthropometric characteristics in school children from Dar es Salaam, Tanzania. A prediction equation by gender for PEFR was developed based on anthropometric characteristics. This equation may be applied in population-based studies or situations where peak flow meters are not readily available. Further research is needed to explore how well this prediction formula performs in other Tanzanian settings and to determine other factors that may affect lung function in this population., (© 2024. The Author(s).)

Introduction: The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life., Methods: Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations., Results: Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness., Discussion: Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders. Clinical trial registration: NCT04263558., 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 Martinsen, Lisøy, Wentzel-Larsen, Neumer, Rasmussen, Adolfsen, Sund and Ingul.)

Background: The number of inpatient mental health facilities for children and adolescents in the United States is growing rapidly. While undergoing inpatient treatment, children and adolescents can benefit from innovative play opportunities designed to foster social interaction and learning., Methods: The Playful Learning Landscapes (PLL) initiative is a group of projects designed to transform everyday spaces into opportunities for playful learning. As a part of this initiative, two designs-Lifesize Ruler and Jumping Feet-were installed in an inpatient mental health facility for children and adolescents in the Mid-Atlantic region of the United States., Results: Results of pre-installation and post-installation naturalistic observations suggested that social interactions, the use of STEM-related language and 21st century skills, including confidence, increased after interacting with the installations., Conclusions: While previous research on PLL projects has demonstrated the efficacy of transforming public spaces into places for playful learning, this research provides support that, even in private, targeted settings, using a trauma-informed approach, children and adolescents, can reap the benefits of playful learning., (© 2023 John Wiley & Sons Ltd.)

This study explores the complex relationship between traffic noise and school children's cognition, acknowledging existing empirical inconsistencies and aiming to contribute to a richer understanding of this pivotal issue. Schools adjacent to noisy roads were selected, and outdoor noise levels were measured employing a Kimo dB300 sound level meter, focusing on noise level indices L Aeq , L 10 , and L 90 . Subsequent calculations were performed to determine the noise pollution level (L np ), noise climate (NC), and traffic noise index (TNI), revealing a severe noise exposure when compared to standard guidelines. A perception questionnaire for various noise and acoustic factors influencing cognition was developed, and 1524 student responses were collected. Data analysis incorporated Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) for dimension reduction, revealing three latent factors labelled 'annoyance,' 'behaviour,' and 'cognition'. Further, Structural Equation Modeling (SEM) was utilized to explore multivariate relationships between variables and latent factors. Resultant path coefficients were obtained as 0.12, 0.98, and 0.10 for the impact of 'behaviour' and 'annoyance' on 'cognition' and the correlation between 'annoyance' and 'behaviour', respectively. Findings underscore a potent positive impact of annoyance, stemming from acute ambient noise exposure, on the deterioration of children's cognition. While suggesting that ambient noise may be correlated with adverse health impacts due to its influence on cognition, this study emphasizes the pressing necessity for noise mitigation in roadside schools and stringent enforcement of noise pollution guidelines in academic zones., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: MicroRNAs (miRNAs) can control several biological processes. Thus, the existence of these molecules plays a significant role in regulating human iron metabolism or homeostasis., Purpose: The study aimed to determine the role of circulating microRNAs and hepcidin in controlling iron homeostasis and evaluating possible anemia among school children., Methods: The study was based on a biochemical and cross-sectional survey study that included three hundred fifty school children aged 12-18 years old. RT-PCR and immunoassay analysis were accomplished to estimate iron concentration, Hgb, serum ferritin (SF), soluble transferrin receptor (sTfR), total body iron stores (TIBs), total oxidative stress (TOS), total antioxidant capacity (TAC), α-1-acid glycoprotein (AGP), high sensitive C-reactive protein (hs-CRP), and miRNAs; miR-146a, miR-129b, and miR-122 in 350 school adolescents., Results: Iron disorders were cross-sectionally predicted in 28.54% of the study population; they were classified into 14.26% with ID, 5.7% with IDA, and 8.6% with iron overload. The overall proportion of iron depletion was significantly higher in girls (20.0%) than in boys (8.6%). MicroRNAs; miR-146a, miR-125b, and miR-122 were significantly upregulated with lower hepcidin expression in adolescence with ID and IDA compared to iron-overloaded subjects, whereas downregulation of these miRNAs was linked with higher hepcidin. Also, a significant correlation was recorded between miRNAs, hepcidin levels, AGP, hs-CRP, TAC, and other iron-related indicators., Conclusion: Molecular microRNAs such as miR-146a, miR-125b, and miR-122 were shown to provide an additional means of controlling or regulating cellular iron uptake or metabolism either via the oxidative stress pathway or regulation of hepcidin expression via activating genes encoding Hfe and Hjv activators, which promote iron regulation. Thus, circulating miRNAs as molecular markers and serum hepcidin could provide an additional means of controlling or regulating cellular iron and be associated as valuable markers in diagnosing and treating cases with different iron deficiencies., (© 2023. The Author(s).)

Introduction and aim Headaches are one of the most prevalent childhood disorders. Primary and secondary headaches are the two types of headaches affecting kids and teenagers. The three most typical primary headache forms are tension-type headaches (TTH), migraine, and cluster headaches. This study sought to determine the relationship between puberty and types of headaches. Methods This cross-sectional study was conducted from May 18 to July 31, among female schoolchildren aged between eight and 15 years in the Eastern Province of Saudi Arabia. Respondents were recruited through face-to-face interviews. A self-administered questionnaire was utilized, mainly consisting of demographic data and questions related to diagnosing and managing the impact of puberty in girls on the prevalence of primary headache disorder. Results In total, 481 female schoolchildren were interviewed, mostly between 13 and 15 years old (65.9%). Last year prevalence of headaches was 65.5%, with a significant difference among those who lived in Dhahran (p=0.001) and those with a family history of headaches (p<0.001). The most common type of headache was frequent TTH (16.4%) and chronic TTH (16%). Chronic TTH (p<0.001), frequent TTH (p<0.001), and migraine without aura (p=0.005) were significantly more common among the older age groups.  Conclusion There was a high prevalence of headaches among female schoolchildren, with frequent TTH and chronic TTH being the most common. Furthermore, increasing age was associated with an increasing risk for chronic TTH, frequent TTH, and migraine headaches without aura. More epidemiological studies are necessary to determine the underlying causes of headaches among schoolchildren., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almuslim et al.)

The success of healthcare delivery systems depends on accessibility. This study aimed to assess parental and guardian perceptions of dental health service accessibility among primary school students in Riyadh, Saudi Arabia. A descriptive cross-sectional survey was conducted among the parents and guardians of primary school students. A 23-item questionnaire was developed on the basis of previous studies. Demographic information, accessibility details, and barriers to dental services were recorded. A total of 385 participants responded to the questionnaire. Approximately 46.2 % of students encountered barriers to accessing dental services. Eighty (20.8 %) male students visited dental facilities more often than female students (72 [18.7 %]) within a 6-month period. Approximately 21 % of students had never visited a dental facility. The lowest number of preventive treatments were administered (15.4 %). Parents and guardians reported that private dental facilities were more accessible (185 [48 %]) than government dental facilities. There was an association between dental facilities and difficulties in accessing dental care services (χ2(4) = 42.753; p  < 0.001). In conclusion, parents and guardians reported experiencing difficulties accessing dental services. However, parents and guardians must change their perspectives on accessibility, particularly for preventative care, because primary school children received the lowest., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Understanding of psychosocial factors of physical activity (PA) in children is crucial in encouraging sustained PA, which in turn is associated with important health outcomes. This study aimed to examine how children's attraction to physical activity (CAPA) is associated with PA., Methods: This cross-sectional study was conducted among 219 primary school children (105 boys; 114 girls) aged 7 years old-10 years old in Kuala Lumpur, Malaysia in 2016-2017. Children from three main ethnicities, namely Malay, Chinese and Indian, were recruited. Weight, height and waist circumference were measured; body composition was assessed by deuterium dilution technique. CAPA and level of PA were obtained through self-administered questionnaires and reported as CAPA and PA scores., Results: Median CAPA and PA scores were 3.40 (Q 1 = 3.00, Q 3 = 3.80) and 2.31 (Q 1 = 1.95, Q 3 = 2.74), respectively. Significant gender differences were found in CAPA and PA scores, with boys being more attracted to PA (3.16 [Q 1 = 2.90, Q 3 = 3.44]; P = 0.001) and more physically active compared with girls (2.47 [Q 1 = 2.07, Q 3 = 3.07]; P = 0.001). CAPA and PA scores correlated positively in both sexes. Boys scored higher than girls in 'liking of games and sports' (ρ = 0.301, P = 0.002) and 'liking of vigorous PA' (ρ = 0.227, P = 0.02) CAPA subscales, which also correlated positively with PA scores. Girls' PA scores correlated with 'peer acceptance in games and sports' (ρ = 0.329, P < 0.001)., Conclusion: Boys are more physically active and have higher attraction to PA compared with girls. Differences in PA scores between the sexes were related to gender differences in CAPA scores. Thus, attention should be given to gender differences in CAPA related psychosocial factors when planning interventions to promote PA among children., Competing Interests: Conflict of Interests: None., (© Penerbit Universiti Sains Malaysia, 2023.)

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term., (© 2023 British Nutrition Foundation.)