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Purpose This study sought to evaluate whether associations between adolescent combustible cigarette smoking and e-cigarette progression were explained by beliefs that e-cigarettes substitute for cigarettes in nonsmoking situations. Methods Adolescents (N = 1,799) from public high schools outside of Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade). Results A parallel process latent growth curve model revealed that the pathway from baseline smoking to e-cigarette use trend through baseline e-cigarette substitution beliefs was significant (B = .02, z = 2.16, p = .03), indicating that the positive effect of greater baseline cigarette smoking on the rate of e-cigarette progression was channeled through e-cigarette substitution beliefs. The indirect effect from baseline smoking to e-cigarette use trend via e-cigarette substitution beliefs trend was also significant, albeit negative (B = -.05, z = -2.61, p = .009). The negative indirect effect suggested that the strong positive effect of baseline cigarette smoking on baseline substitution beliefs was followed by a slowing of the overall rate of change from baseline. Given that the total effect from baseline smoking to e-cigarette trend was not significant (p = .91), the results suggested complete mediation. Conclusions Among adolescents with greater use of combustible cigarettes, beliefs regarding the substitutability of e-cigarettes in nonsmoking situations appear to foster progression in e-cigarette use. Addressing these beliefs in the school setting and through media campaign messaging early in adolescence may help to prevent the use of e-cigarettes and combustible cigarettes.

INTRODUCTION There is a wide variation in the knowledge related to oral radiology. This study aims to assess the prior knowledge of radiology among freshman dental students prior to beginning any formal dental school instruction. MATERIALS AND METHODS 139 newly matriculated freshman dental students were asked to complete a seven-question radiology take home survey regarding their prior knowledge. The questionnaire was built within their course site and was presented prior to beginning the radiology lectures. RESULTS The responses were varied for all seven questions based on previous experiences and existing knowledge. Significant variation was noted in responses to Q4, Q6, and Q7 as opposed to Qs 1-3 and 5. Many students believed that the acquisition of radiographs should be selective. The acquisition of radiographs in pregnant women yielded comments in line with the belief that dose and frequency of radiation exposure would impact the health of the pregnant woman and developing fetus. Additionally, many students agreed with the statement regarding orthodontists over-radiating children as reported in the New York Times. Perceptions based on social media and news outlets needs to be addressed and changed in a dental school setting based on evidence. CONCLUSION Dental school instruction must use the cues from surveys similar to that used in this research and structure their instruction to increase the critical teaching of radiology. The eventual goal of such an instruction would be to have a scientifically accurate information and remove the perceptions that the students came with when they began their dental education.

Introduction In the coronavirus disease 2019 era, debate around the risk of contagion in school is intense in Italy. The Department of Welfare and Health of Florence promoted a screening campaign with rapid antigen tests for all students and school personnel. The aim of this study was to assess the circulation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the school setting by means of mass screening in every primary and middle school in Florence. Methods All students and school personnel at primary and middle schools in Florence were asked to take part. The campaign started on 16 November 2020 and was completed on 12 February 2021. If a subject had a positive result on rapid antigen testing, a molecular test was performed to confirm the result. Results In total, 18,414 subjects were tested: 15,233 students (82.7%) and 3181 school personnel (17.3%). The rapid antigen test gave a positive result in 27 cases (0.15%). Of these, only 14 tests were confirmed to be positive on molecular testing. These results show a very low number of cases of SARS-CoV-2 among the study subjects (0.08%). Conclusions These results show that the spread of SARS-CoV-2 in the school setting was low in Florence during the screening period.

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

OBJECTIVES This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa. METHODS 513 children aged 4-8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed. RESULTS 513 children (d1-4 mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p

Do-it-yourself (DIY) artificial pancreas systems (APSs) are gaining popularity among children with type 1 diabetes. Little is known about how school systems provide care for children who use DIY APSs, and available guidance for schools is limited. This study explored school staff perspectives on DIY APSs through a national survey of school nurses about their current practices, beliefs, and attitudes toward DIY APSs. Although one-quarter (23%) of school nurses reported experience with DIY APSs in school, nearly half (46%) had no prior knowledge of this new technology. The majority (82%) reported that children should be allowed to use DIY APSs in school, although there was less consensus about school nurse responsibilities with these devices. Qualitative responses added context regarding potential barriers, including the need for more informed guidelines and training and fears of liability. Future development of school guidelines for DIY APSs is necessary and should incorporate stakeholder perspectives.

Background: School-based telehealth (SBTH) plays a valuable role in child asthma management, although nurses have concerns with caregiver engagement. Mobile technology (m-health) has potential to improve this engagement. Objective: We identified barriers and key desired features of an asthma m-health application as a supplement to an existing SBTH asthma program in rural settings. Methods: Multimethod design using school nurse surveys and interviews with school and SBTH personnel to describe processes related to implementation of an m-health application. Results: Nurses reported SBTH programs were an ideal setting to identify potential families for m-health. Benefits of caregiver education and engagement and barriers related to technology, smart phone data availability, and family buy-in were described. Desired application features included education on inhaler technique, asthma symptom, and medication adherence reports. Conclusions: The feedback identified from nurses can be incorporated into an asthma m-health program within an SBTH program to facilitate implementation.

BACKGROUND: Spinal pain is one of the leading causes of morbidity globally. There is an increase in the number of children and adolescents who experience spinal pain and the lifetime prevalence of adolescent spinal pain varies between countries. In Africa, one in two adolescents experiences spinal pain and the prevalence is increasing. OBJECTIVE: This study reports on the knowledge and perspectives of school-attending children, adolescents, teachers, and parents/guardians regarding spinal health. METHODS: We conducted a descriptive qualitative case study with an interpretative and phenomenological approach. Data coding, management and analysis was done using ATLAS.ti computer software. RESULTS: Ninety-three participants (66 women and 27 men) were enrolled in the study. The barriers associated with students’ spinal health were multifactorial, including low levels of physical activity, dangerous gameplay, sports risks, poor ergonomics, school bags, insufficient knowledge, and pregnancy risks. Participants proposed strategies to improve spinal health including the provision of students’ lockers, advice on appropriate school bag types, embedding spinal education in the curriculum, general advocacy for spinal health, and integration of technology in teaching and learning. CONCLUSION: There is a need for further engagement on school-based spinal health promotion programs that consider local socio-economic, educational, and cultural factors.

Background Overweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology. Methods/design A systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB Abstracts, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4–18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs. Discussion This systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings. Systematic review registration PROSPERO: CRD42020220451. Supplementary Information The online version contains supplementary material available at 10.1186/s13643-021-01661-1.

The importance of translated children's books to the literary and cultural development of children is well documented, and the study of other countries is an important part of the school curriculum across grade levels. Therefore, purposes of the research were (1) to share results of research on outstanding translated children's books published from 1990-2000; (2) to provide a bibliography of these books that can be used by librarians, teachers, and students in a study of other countries; and (3) to present an application of a collaborative study on the use of translated books by a middle school librarian with teachers in a real-life setting. An appendix contains a 72-item recommended list of translated children's books. (Contains 11 references and 4 tables.) (Author/RS) Reproductions supplied by EDRS are the best that can be made from the original document. r-Minor changes have been made to Cr) V21 improve reproduction quality. Using Outstanding Translated Children's Books in the School Setting to Promote an Understanding of Other Countries and Cultures Maureen White, Ph.D. University of Houston-Clear Lake Nancy Bluemel, Ph.D. Grapevine-Colleyville Independent School District U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received from the person or organization originating it. N Points of view or opinions stated in this document do not necessarily represent C/) official OERI position or policy. () BEST COPY AVAILABLE PERMISSION TO REPRODUCE AND DISSEMINATE THIS MATERIAL HAS BEEN GRANTED BY

Individuals with autism spectrum disorder (ASD) often have sensory processing difficulties, which impact their participation in daily occupations. This pilot study investigated a newly developed Re...

There is a pressing need for evidence-based scrutiny of plans to re-open childcare centres during the COVID-19 pandemic. Here we developed an agent-based model of SARS-CoV-2 transmission within a childcare centre and households. Scenarios varied the student-to-educator ratio (15:2, 8:2, 7:3), family clustering (siblings together versus random assignment) and time spent in class. We also evaluated a primary school setting (with student-educator ratios 30:1, 15:1 and 8:1), including cohorts that alternate weekly. In the childcare centre setting, grouping siblings significantly reduced outbreak size and student-days lost. We identify an intensification cascade specific to classroom outbreaks of respiratory viruses with presymptomatic infection. In both childcare and primary school settings, each doubling of class size from 8 to 15 to 30 more than doubled the outbreak size and student-days lost (increases by factors of 2–5, depending on the scenario. Proposals for childcare and primary school reopening could be enhanced for safety by switching to smaller class sizes and grouping siblings.

Mental health challenges (including mood, anxiety, and behavioral disorders) affect up to one-fifth of adolescents ages 13–18. Although these disorders are associated with impairments in psychological, academic, social, and family domains, they are often left untreated. Schools have great potential to address this service-underutilization gap by identifying those students at risk through mental health screening tools and by providing treatment at no cost for students. However, at the secondary level, school personnel partly expect high school students to initiate support for themselves. The present study advances research by exploring the variables related to adolescent mental health help-seeking intentions within the school setting. Specifically, this study assesses the utility of the theory of planned behavior in an effort to identify what factors relate to high school students' willingness to seek help at school. A secondary aim of this study was to examine why adolescent boys are consistently less willing to seek help for mental health problems than adolescent girls. Results of this study highlight important factors to target when developing interventions to increase help-seeking intent in high school students.

The effects of a multiple schedule of reinforcement for two children with autism spectrum disorder who engaged in problem behavior were evaluated in a school setting. Following functional behavior assessments, functional communication training was provided to teach a replacement behavior for requesting preferred items. Next, we introduced a fixed-sequence multiple schedule of reinforcement with one S-Delta within a reversal design. One child’s problem behavior was reduced with the initial treatment, but the other child required the addition of an alternative activity procedure. Resurgence of problem behavior was observed with the child whose treatment did not include an alternative activity procedure. Generalized responding across teachers and settings was demonstrated for one of the two children. The addition of an alternative activity was necessary for one child. The use of an alternative activity in a multiple schedule of reinforcement intervention may facilitate generalized responding.

Objectives The aim of this study was to identify perceptions of safety and effectiveness of a provincial type 1 diabetes school care plan, and to best inform future improvements in school care to accommodate the shifting needs of families, best clinical practices and new medical technologies. Methods A cross-sectional satisfaction and feedback questionnaire to inform quality improvement was offered to both families of children with type 1 diabetes who receive care at school through a Delegated Diabetes Care Plan and to their program coordinators during the 2017‒2018 school year. Results The response rate was 29.8% (160 of 537) for families and 68.2% (45 of 66) for coordinators. The majority of parents and coordinators reported that the care plan is meeting both safety and diabetes management needs. On a 7-point Likert scale, the safety score, expressed as mean (standard deviation), was 6.0 (1.2) by families and 5.7 (1.3) by coordinators, with higher scores reflecting greater satisfaction. Diabetes management was rated 5.6 (1.2) out of 7 by families, and 5.4 (0.8) out of 7 by coordinators. Families and coordinators expressed the need for individualization of care, and suggested modifications to how information is presented. There was near-unanimous support for future integration of continuous glucose-monitoring devices into the school setting. Conclusions British Columbia’s provision of diabetes care in the school setting is overall perceived to be safe and is generally well received by families and coordinators. In this study, we provide valuable information to improve the care of children with type 1 diabetes in schools, including support for further individualization of care and future integration of diabetes technology into the school setting.

Typically students in their final year of school report high levels of anxiety, depression and stress. This study evaluated Study without Stress, a group cognitive behavioural program to reduce student stress. Fifty-six final year students (77% female) from four Australian secondary schools were randomly allocated to Study without Stress delivered by school staff, or to an 8-week usual care condition. Changes in self-reported stress, anxiety, depression, self-efficacy, and teacher reported emotional problems were assessed pre to post-treatment using intent-to-treat analyses. Maintenance of changes were examined 3-months later. Compared to usual care, Study without Stress led to significant reductions in self-reported stress and distress, and increases in self-efficacy that were maintained over time, with no significant changes in anxiety, depression or teacher reported emotional problems. Study without Stress is beneficial for reducing academic stress and improving self-efficacy in final year students when delivered in a school setting.

Schools serve as the ideal location for implementing interventions to increase physical activity (PA) as children spend most of their day in the school setting. As adolescents become more and more sedentary and obesity statistics become more dire, efforts to increase physical literacy and PA should be heightened. Physical literacy is the ability for a child to understand the movement of their body and how it can be manipulated to increase activity for recreation or sports movement. When physical literacy is paired with school-based multi-component programs, children are more likely to make a behavior change. As educators know, children are more likely to make a behavior change when mastery of content is achieved, and the lesson is tailored to their needs. Even small changes, like moving a little more or adding an additional serving of vegetables to the diet, can make a profound impact. In the current review we discuss: 1) the state of PA within school systems; 2) provide a rationale for why school systems fail to meet said guidelines; and 3) suggest how guidelines can eventually be achieved through the promotion of physical literacy and effective school-based multi component programs.

Objective First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we supply practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. Data Sources An interdisciplinary working group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The group evaluated and further refined the action-oriented recommendations using the Delphi method. Conclusions Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.

Collaborating with parents is an important skill set for school-based mental health professionals. While school districts expect school psychologists and school counselors to facilitate family-scho...

This study examines the role of six popular social networking sites (SNSs)—Instagram, Snapchat, Facebook, Twitter, YouTube, and Pinterest—in a high school setting. Students, teachers, and administr...

Background Mathematical modeling studies have suggested that pre-emptive school closures alone have little overall impact on SARS-CoV-2 transmission, but reopening schools in the background of community contact reduction presents a unique scenario that has not been fully assessed. Methods We adapted a previously published model using contact information from Shanghai to model school reopening under various conditions. We investigated different strategies by combining the contact patterns observed between different age groups during both baseline and “lockdown” periods. We also tested the robustness of our strategy to the assumption of lower susceptibility to infection in children under age 15 years. Results We find that reopening schools for all children would maintain a post-intervention R0 0 of approximately 3.3 provided that daily contacts among children 10–19 years are reduced to 33% of baseline. This finding was robust to various estimates of susceptibility to infection in children relative to adults (up to 50%) and to estimates of various levels of concomitant reopening in the rest of the community (up to 40%). However, full school reopening without any degree of contact reduction in the school setting returned R0 virtually back to baseline, highlighting the importance of mitigation measures. Conclusions These results, based on contact structure data from Shanghai, suggest that schools can reopen with proper precautions during conditions of extreme contact reduction and during conditions of reasonable levels of reopening in the rest of the community.

Aggressive behaviour has negative consequences for students who are exposed to it and those who are aggressive. In addition to a number of negative consequences at the individual level aggression n...

Food allergy is a growing health and safety concern that affects up to 8% of school-age children. Because children spend a significant part of their day in school, and the overall number of school-age children with food allergy has been increasing, management of food allergies relies on the collaboration of allergists, families, and schools to treat and prevent acute allergic reactions. For schools, this involves policies centered on food allergen avoidance, preparedness with epinephrine autoinjectors, adequate school personnel training, and accommodations for an equal opportunity learning environment. Partnerships with allergists, primary care providers, students, families, school nurses, and school staff are vital for creating individualized and effective care plans that will allow all children, including those with food allergies, a safe and nurturing learning environment.

The advantages of continuous glucose monitoring (CGM) and insulin pump systems have increased the popularity of these devices among students in the school setting. The use of diabetes technology at school and school-sponsored activities strengthens the student’s consistent use of the technology and increases the overall beneficial effects. The school nurse has many considerations when supporting the student with diabetes technology. Integrating this technology into diabetes care at school can be complex with collaboration and safety considerations fundamental to success. This is the third article in a three-part series on the use of technology in managing diabetes in youth. The first article described CGM devices and provided tips for the school nurse in incorporating CGM into the student’s individualized healthcare plan. The second article summarized insulin pump technologies, from conventional insulin pump therapy to advance automated insulin delivery systems and described keys to success with insulin pump technologies. The purpose of this article is to address some special considerations for facilitating the use of diabetes technology in the school setting. Topics to be discussed are tips on including insulin pump therapy in the student’s individualized healthcare plan, safe use of diabetes technology during physical activity, and implications for school nursing practice.

PURPOSE This study was done to compare the survival rates of cast gold and ceramic onlays placed in a dental school setting. MATERIAL AND METHODS An electronic search was conducted in the patient records at Adams School of Dentistry, University of North Carolina at Chapel Hill for onlay codes that were in the database (From 1998 until 2018). Progress notes and radiographs were scrutinized to establish the survival time of the restorations. Any complications that occurred during the life time of the restorations were noted. The survival was summarized by categorization based on ranges of survival time in years; group 1: 1 to 5 years, group 2: 6 to 22 years. The mean survival time and standard deviation were calculated. One-way ANOVA was used to determine whether there was a statistically significant difference in the survival times between gold and ceramic onlays. RESULTS The mean survival rate of cast gold onlays (86.6%) was comparable to that of ceramic onlays (81.1%). The gold onlays in Group 1 had a higher mean survival time (2.43 years) than the ceramic onlays (2.03 years). This difference was statistically significant (p = 0.002). The ceramic onlays in Group 2 had a mean survival time of 19.75 years while gold onlays had a mean survival time of 17.63 years. This difference was not statistically significant (p = 0.91). CONCLUSION It was concluded that while the survival rate of ceramic onlays (81.1%) was inferior to that of cast gold onlays (86.6%), it was comparable.

As the primary healthcare professionals in the school setting, school nurses field questions about diet and exercise. Nurses’ familiarity with nutrition and dietary patterns can help them respond to student concerns. Plant-based diets, those which promote eating mostly fruits and vegetables with smaller portions of animal foods, have recently gained popularity in the United States. Most plant foods are rich in fiber, antioxidants, and complex carbohydrates, as well as vitamins and minerals that support good health and maintenance of a healthy weight. Most children and adolescents can meet their nutrient needs on a plant-based diet, but should be careful to include a wide variety of foods in the diet in order to achieve nutrient adequacy.

To date, little research has systematically considered the ways in which schools can better address the needs of immigrant-origin youth (IOY). Further, considering the increased negative attitudes toward and policies targeting IOY and families within the U.S., there is a need to go beyond targeting just IOY at risk for mental health concerns and promote a culture of inclusion throughout the school. The goal of this paper is to address ways in which schools can best attend to the mental health needs of IOY by systematically integrating prevention and intervention efforts across three tiers of support within the school setting. Specifically, we propose a three-tiered model of school based mental health services for IOY. Based on a thorough review of current literature, we propose universal, selective, and targeted programming to support the MH needs of IOY and families. We discuss implications for implementation as well as future directions for research.

The purpose of this study was to evaluate the usefulness of an intervention selection model on the outcomes of function-based interventions for escape-maintained problem behavior. The study included five children with Autism Spectrum Disorder and was conducted in a school setting. We conducted functional analyses to determine the function of problem behavior. BCBAs and special educators then independently used the intervention selection model to select an indicated intervention for each participant, with agreement as to the selected intervention in four of five cases. We then implemented identified function-based interventions resulting in reductions in problem behavior and acquisition of an appropriate replacement behavior for all participants. This study has implications for practitioners seeking to reduce problem behavior of students with ASD in school settings.

Mental health is a major component of overall health and is considered a contributor to the significant levels of disability in Saudi Arabia. Levels of mental health knowledge and awareness, particularly in the school setting, require investigation. The purpose of this study was therefore to explore the levels of mental health knowledge among secondary school female teachers, their readiness to support the mental health needs of their students, and the perceived barriers to supporting mental health. A cross-sectional study was conducted in 35 female secondary public schools in Riyadh between July and September 2019. A modified Knowledge, Barriers and Perceived Readiness Survey was distributed to female secondary school teachers. The primary outcomes were levels of knowledge, perceived barriers, and perceived readiness. Among the 431 participants who completed the survey, 84% were teachers of direct involvement with the students. Overall, participants showed poor knowledge, perceived their barriers as higher, and demonstrated poor readiness, as indicated by the percentage who scored below a 75th percentile cut-off point (74%, 64%, and 69%, respectively). The southern region of the city had lower levels of readiness (OR 3.34; 95% CI 1.547–7.447) compared to the eastern area of Riyadh. Our findings demonstrate that female secondary public school teachers and staff in Riyadh have low levels of mental health knowledge and readiness and perceive barriers with regard to mental health support and services. Focused awareness programs and campaigns, particularly in the eastern part of the city, may therefore be beneficial. Further implications are discussed.

Purpose : The purpose of this study was to examine educators’ and specialists’ provision of communication adjustments for students on the autism spectrum in mainstream and supported education settings. Method : Secondary analysis of data collected from educators and specialists in the Australian Autism Educational Needs Analysis was undertaken. Thematic analysis of adjustment descriptions identified 11 categories. The use of the 11 specific adjustment categories with reference to (a) participant group (educator versus specialists), and (b) setting (mainstream versus supported) were described and associations investigated using Chi-square analyses. Result : Only 32% of the 381 educators and specialists reported using adjustments. Of the adjustments reported, those categorised as “Multimodal Communication”, “Structured Teaching”, and “Assistive Technology” were frequently included by both groups. Significant associations were apparent between groups and the use of specific adjustments including naturalistic communication strategies. Significant differences were evident in the proportion of specific adjustments used by participants in supported as opposed to mainstream settings. Conclusion : Possible reasons for the differences in the adjustments reported by educators and specialists and the role that setting may play in these are discussed. These include resourcing, the choice of adjustment being driven by school setting rather than student need, and possible differences between professionals in describing the adjustments made.

Purpose The purpose of this study was to explore the extent to which child- and therapy-level factors contribute to gains in speech sound production accuracy for children with speech sound disorders in receipt of school-based services. Method Data were obtained from 126 kindergarten and first- and second-grade children currently in receipt of speech therapy services in their public school setting. Pretest and posttest measures of spontaneous speech production and language ability were collected at the beginning and end of one academic year. Using a spontaneous speech sample, percentage of consonants correct (PCC) was calculated for each child; a gain score was computed by subtracting the pretest PCC score from the posttest PCC score. The children's speech-language pathologist completed weekly therapy logs during business-as-usual therapy, indicating the frequency, duration, and group composition of services throughout the school year. Results Results supported that gain in PCC from pretest to posttest was predicted by several child- and therapy-level variables. Children's initial speech sound severity was negatively related to gains in PCC. Our results also supported that the total number of therapy sessions received in a year was positively predictive of PCC gain. Interestingly, the number of individual therapy sessions was negatively associated with PCC gain. Conclusion Several malleable therapy factors contribute to gains in speech sound accuracy for children with speech sound disorders. Speech-language pathologists should consider how these factors may be manipulated to best tailor treatment to the individual needs of the children on their caseloads.

The participant was a boy diagnosed with autism spectrum disorder (ASD) who displayed severe food selectivity, which raised concerns about imbalanced nutrient consumption. The intervention used combined stimulus fading with simultaneous stimulus presentation without escape extinction (EE) and was implemented by teachers in a school setting. In intervention I, which used only stimulus fade-in of non-preferred foods, favorable results were not obtained. In intervention II, simultaneous stimulus presentation of a preferred food combined with stimulus fade-in of non-preferred foods, Silva’s consumption was stabilized at 100% consumption of three non-preferred foods. When intervention II was terminated, the child’s mother requested the inclusion of two additional non-preferred foods, so the intervention was extended based on a fading protocol planned with and to be used by the mother. The effects of the intervention were maintained at the 3-month post-intervention follow-up. The child’s parents and teachers showed high acceptance of this intervention. The current study offers further evidence that combining antecedent-based interventions without EE has the potential to yield favorable results with some children.

Statement of problem The clinical survival of different types of post-and-core systems requires assessment. Purpose The purpose of this retrospective clinical study was to evaluate the clinical survival rate (CSR) of custom-fabricated cast metal and prefabricated (both metal- and fiber-reinforced composite resin post) post-and-cores as a function of patient- and restoration-related variables. Material and methods A retrospective analysis was conducted on electronic charts indicating that these patients had received some type of post-and-core between January 2003 and January 2018. A total of 754 records were included in the analysis based on the inclusion criteria. Data were analyzed by using the Kaplan-Meier and Cox proportional hazards analysis. Results Kaplan-Meier analysis demonstrated the mean survival time for each group to be 12.0 years for fiber-reinforced composite resin posts, 11.8 years for cast metal post-and-cores, and 10.2 years for prefabricated metal posts. Although the mean survival time differed by 1.8 years among groups, with prefabricated metal posts having a slightly higher risk of failure, this effect was not statistically significant (P=.067). The effect of post type also failed to reach significance when controlling for patient demographics and post position in a Cox proportional hazards analysis (P=.106). However, the Cox model did show that survival was associated with tooth position (P=.003), cement (P=.021), and type of restoration (P Conclusions Analysis showed no evidence that post-and-core survival was significantly associated with 3 types of post-and-cores (custom-fabricated metal, prefabricated metal, and prefabricated fiber-reinforced composite resin). The percentage of root in the bone, tooth position, cement, and type of restoration, however, were significantly associated with survival.

This article serves as a Position Statement of the Pediatric Pharmacy Association (PPA), which supports safe and effective medication use in schools. PPA recommends that schools develop comprehensive medication use policies to support safe and appropriate administration of both chronic and emergency medication in schools. These policies must address issues specific to pediatric patients, including off-label and over-the-counter medication use, various pediatric dosage forms, as well as appropriate medication storage, administration, and disposal practices. PPA also advocates for continued staff development and education regarding laws, regulations, and policies surrounding medication use in school to ensure safe and effective care of children and adolescents in the school setting.

Aim Regular physical activity and low levels of sedentary time have positive health effects on youth, and data are needed to base public health recommendations on. Here, findings of device-based physical activity and sedentary time in sixth graders are presented. Data below are presented as mean (SD). Subject and methods Three hundred and eight sixth-grade girls [11.6 (0.6) years] from the CReActivity study in Germany wore accelerometers (ActiGraph GT3X) for 7 consecutive days. Moderate to vigorous physical activity (MVPA), light physical activity (LPA), and sedentary time (ST) was obtained during school days with a focus on recess times. Results Girls spent 79.9 (23.2) minutes in MVPA and 9.4 (1.2) hours in ST during schooldays, of which 20.5 (8.2) minutes and 3.8 (0.4) hours respectively were accumulated during school hours. On average, students had 35.4 (4.5) minutes break, of which 6.3 (3.2) minutes (17.8%) were spent in MVPA activity and 16.5 (6.2) minutes (46.6%) in ST. Conclusion School setting is an important factor for physical activity and sedentary time. Therefore policy, curriculums, and school environment should promote physical activity und reduce sedentary time during school hours.

Background Young women and adolescent girls experience many challenges in their lives related to sanitation, hygiene, and menstruation. These challenges are often seen in a school setting and are more intense in peri-urban areas, where the infrastructure in educational institutions is often outpaced by the population, generating poor sanitary conditions. This can lead to adolescent girls contracting reproductive tract infections, such as candidiasis, as a result of poor menstrual hygiene. This study assessed menstrual hygiene management among students at a senior high school in the Volta Region, Ghana, in order to identify improvements to be made by school authorities to improve the health and comfort of students during menstruation. Methods This cross-sectional, descriptive study was conducted among 265 students aged 13–22 years, who had attained menarche. A pretested, structured questionnaire was used to collect data on their menstruation knowledge and practices, and the available sanitary facilities for menstrual hygiene management in the school. This was followed by an evaluation of the available facilities using a survey process. The Pearson chi-squared test was used to test the association between a student's year group and their knowledge and practices. Results The majority of the girls had accurate knowledge on menstruation (52.8% reported the correct length of a woman's menses, 74.7% correctly reported that a woman's menses comes once a month). However, the majority (63%) of participants reported the belief that menstrual blood is unhygienic and this belief was significantly associated with year group (PConclusions There is a need for Ghanaian educational institutions to provide proper sanitary facilities and for parents to provide sanitary pads or towels, which will allow girls who are menstruating to be comfortable and free of reproductive health infections. To achieve this, school authorities should be educated on the importance of providing the necessary sanitary facilities and parents should be educated on the necessity of provision of sanitary pads.

This study on Menstrual Hygiene Management (MHM) was carried out in two secondary schools in the Bamako district, “Chaine Grise” and “Cheick Modibo Diarra” located respectively on the right bank and the left bank depending on the geographic position of the Niger river. This work took place over a period of 6 months from January 2019 to June 2019. The objective of this study was to study menstrual hygiene management in school setting for girls aged 16 to 18 in two secondary schools in Bamako. It was a transversal and qualitative description. The study population consists of girls aged 16 to 18 years enrolled in one of the selected secondary schools. At the end of this study, we arrived at the following results: *50% of the girls in our study have poor knowledge about menstruation; *10% of girls miss school at least one day a month during menstruation; *90% of girls use hygienic cotton to absorb menstrual blood; *90% of the sources of supply for hygienic products are mothers. The unsanitary conditions of the toilets, lack of light and the non-separation of the toilets according to gender guidelines were found in 99% of the cases: *99% of girls say that the poor state of health infrastructures was one of the causes of genital infections linked to poor management of menstrual hygiene; *lack of water in the toilets (99%). Through these results, we conclude that, in our context, menstruation remains a taboo and shameful subject for girls. In addition, some of their menstrual hygiene practices are a real danger to their health.

Introduction: In Hungary vaccination against Hepatitis B is mandatory in 7th grade (age 12-13) and is given by the school doctor. In this pilot study, following the best practices for patient-centered communication, a program was organized when the school doctor met the classes prior to immunization for an interactive conversation. The aim of the program was to minimize the possible fears of the students about vaccination, to seek their assent to immunization, to get the adolescents involved in disease prevention, and to expand the protective effect of immunization by means of health education. Indirect aims were to facilitate responsible health behaviour and to improve vaccine adherence in the future. In association with the immunization against Hepatitis B, the program was focused on protecting the liver and health gen-erally. With the active participation of the students and a natural flow of questions several issues of health protection were reached. Method: To evaluate the success of the program described in the article, a question-naire was used. Results: Participation on the evaluation 8, 20 and 32 months after the program was 85%, 65% and 30% respectively, showing that it has reached the attention of the adolescents. On the question how the program influenced their attitude towards immunization, 63% of the answers indicated positive effect, 33% negated any change in attitude and 4 % had remaining questions or was still stressed about the immunization. Conclusion: At the mandatory vaccination of 7th graders against hepatitis B by the school doctor, the school setting provides efficient circumstances for interactive communication; vaccination against hepatitis B provides a unique starting point for health education. The pilot study has demonstrated that the program was able to raise the adolescents’ interest in topics of health protection with a lasting memory and that it could facilitate their assent to immunization. However, it has also proved that adolescents can be often stressed - and do have questions - about immunization and emphasises the need for programs to alleviate their stress and to answer their ques-tions. It might be an important factor to prevent vaccine hesitancy and improve vac-cine adherence in the future. Bevezetes: Magyarorszagon a Hepatitis B elleni vedőoltast iskolai kotelező kampanyoltas kereteben 7. osztalyos tanuloknak (12-13 eves kor) adjak az iskolaorvosok. Ebben a probakutatasban a paciens-kozpontu kommunikacio legjobb gyakorlatat kovetve olyan programot szerveztunk, melyen az iskolaorvos az oltas előtt egy interaktiv beszelgetesre talalkozott az osztallyal. A program celjai voltak, hogy minimalizalja a tanulok lehetseges felelmet az oltassal kapcsolatban, hogy megnyerje az ő tudatos bele-egyezesuket az oltashoz, hogy bevonja a fiatalokat a betegsegmegelőzesbe, es hogy kiterjessze az immunizacio vedő hatasat az egeszsegneveles modszere altal. Indirekt celok voltak, hogy elősegitse a felelős egeszseg-magatartast es javitsa a jovőbeni oltas-elfogadast. A Hepatitis B oltashoz kotődően a program fokusza a maj es altalaban az egeszseg vedelme volt. A diakok aktiv reszvetelevel es a kerdesek osszefuggő lancolataval a program az egeszsegvedelem szamos teruletet erintette. Modszer: A cikkben leirt program eredmenyessegenek vizsgalatara kerdőives felmerest hasznaltam. Eredmenyek: A kerdőives felmeresben valo reszvetel 8, 20 es 32 honappal a program utan 85%, 65% illetve 30% volt, ami azt mutatja, hogy sikerult felkelteni a diakok figyelmet. Arra a kerdesre, hogy hogyan befolyasolta a program az oltashoz valo hozzaallasukat, a valaszok 63%-ban pozitiv hatast mutattak, 33% tagadta, hogy valtozott volna a hozzaallasa, 4%-nak tovabbi kerdesei maradtak, vagy igy is stressznek eltek meg az oltast. Kovetkeztetesek: A 7. osztalyosok Hepatitis B elleni kampanyoltasa soran az iskola hatekony kornyezetet teremt az iskolaorvossal valo interaktiv kommunikaciora; a Hepatitis B elleni vedőoltas egyedulallo kiindulopontot nyujt az egeszsegneveleshez. A probakutatas bebizonyitotta, hogy a program felkeltette a diakok erdeklődeset az egeszsegmegőrzes temajaval kapcsolatban maradando emleket hagyva, es elősegitette a vedőoltashoz valo tudatos beleegyezesuket. Azt is igazolta azonban, hogy a serdulők sokszor stresszkent elik meg a vedőoltast es kerdeseik vannak ezzel kapcsolatban. Nyomatekositja tovabba olyan programok szuksegesseget, amelyek ezt a stresszt csokkentik, es a felmerulő kerdeseket megvalaszoljak. Utobbi fontos tenyező lehet a jovőbeni oltasellenesseg megelőzeseben es az oltasi hajlandosag javitasaban.

A major recovery milestone for youth affected by psychosis is reintegration back into a school setting, an important, attainable, treatment goal. The emergence of psychosis often results in either an onset or exacerbation of prior neurocognitive and learning challenges for affected students. Gold standard practice in clinical care for psychosis comprises comprehensive supportive educational services explicitly focused on successful academic reintegration and achievement. This article discusses how providers can guide school teams and their institutions to identify psychosis in their student populations along with a delineation of key educational programming that helps youth reintegrate back into school and achieve academic success.

There are a significant number of students on maintenance medications for chronic diseases or with diagnoses that may result in medical emergencies requiring administration of medications in school. With passing of legislation in all 50 states allowing self-administration of emergency medications for allergic reactions and asthma, the landscape of medication use in schools is changing. These changes have raised questions about the need for legislation or policy development relating to self-carrying and self-administration of medications for other disease states, undesignated stock of emergency medications, and administration of medications by non-medical personnel. Medication administration in the school setting has become a complex issue, and this review will discuss current legislation related to medication use in schools and provide best practices for administering medications to children and adolescents while at school.

There is a lack of training for parents, school staff, and residential staff aimed at helping persons with intellectual disabilities acquire menstrual self-care skills. This may be due in part to the sensitive nature of this topic, the aversion to performing menstrual care for individuals with a disability, and the lack of empirically supported training protocols. This chapter critically reviews behavior analytic research on menstrual care that has been published in peer reviewed journals. This is followed by a case illustration using behavior analytic methods to teach menstrual self-care skills for a student with autism spectrum disorder in a public school setting. Evaluated using a multiple baseline across behaviors design, it was shown that the student increased her independent performance of selected menstrual self-case skills.

The objective of this systematic review was to identify the association between overweight/obesity and level of physical activity in Brazilian children and adolescents in the school setting. For search strategy, the main reference databases (PubMed, LILACS, SciELO, SPORTDiscus, Web of Science, ERIC) were used. Baseline searches resulted in 3,265 potentially relevant titles (2,775 titles after removal of duplicate studies); 21 studies met all inclusion criteria and were included for analysis. Studies were carried out from 2007 to 2019; 47.6% of them were conducted in Southern Brazil, and only one study had nationwide approach. Prevalence from 5.4% to 21% was identified for overweight, 3.5% to 16.9% for obesity and 11.8% to 40.1% for overweight + obesity. According to results, 64.3% of overweight, 69.8% of obese and 37.7% of young overweight people were considered insufficiently active. The non-standardization of instruments to assess levels of physical activity and the lack of information regarding other Brazilian regions were classified as important limitations. The results reinforce the increase in the prevalence of overweight in Brazilian children and adolescents, and the high prevalence of physical inactivity among them. For every ten overweight children/adolescents, six are reported to be insufficiently active. O objetivo desta revisão sistemática foi identificar a associação entre excesso de peso, obesidade e nível de atividade física em crianças e adolescentes brasileiros, no ambiente escolar. A busca eletrônica foi realizada nas principais bases de dados de referência (PubMed, LILACS, SciELO, SPORTDiscus, Web of Science, ERIC). A pesquisas nas bases resultaram em 3265 títulos potencialmente relevantes (2775 títulos após análise duplicada); 21 estudos preencheram todos os critérios de inclusão e foram analisados. Os estudos foram realizados entre 2007 e 2019, 47,6 % deles foram realizados no sul do Brasil, e apenas uma pesquisa foi realizada a nível nacional. Foi identificado prevalências de 5,4% a 21% para sobrepeso, 3,5% a 16,9% para obesidade e 11,8% a 40,1% para excesso de peso (obesidade + sobrepeso). De acordo com os resultados, 64,3% dos jovens com sobrepeso, 69,8% dos obesos e 37,7% daqueles com excesso de peso foram considerados insuficientemente ativos. A não padronização dos instrumentos para avaliar os níveis de atividade física e a pouca representatividade de outras regiões brasileiras foram classificadas como lacunas importantes. Os resultados reforçam o aumento da prevalência de excesso de peso em crianças e adolescentes no Brasil, e a alta prevalência de inatividade física entre estes jovens. A cada dez jovens acima do peso, seis são insuficientemente ativos.

AIM Whilst prevalence of paediatric feeding disorders is high amongst children in specialist schools, there is little guidance for professionals supporting families with a child feeding orally with established risk of aspiration. We sought perceptions of the complex feeding decision-making process amongst health professionals supporting families in the specialist school setting in New Zealand. METHODS An observational, cross-sectional, national online survey of speech-language therapists was followed by in-depth interviews with seven health professionals associated with one specialist school. RESULTS Survey responses from 32 speech-language therapists showed inconsistency in assessment processes and how family, children and school staff are involved in feeding decisions, with 71% reporting a doctor had been involved. Respondents were not confident in their ability to predict aspiration risk, with 41% reporting that they could often determine risk, 41% sometimes and 16% never. Sixty-three percent of respondents indicated that level of risk was written in a report for a child and 50% reported that every child at high risk had a management plan. Speech-language therapists valued professional supervision, but it was not always available. Health professionals were broadly positive about the collaborative nature of decision-making in most but not all situations. They described communication, access/institutional and emotional barriers to timely, shared decision-making. CONCLUSION These findings demonstrate variability in how families are supported to make complex feeding decisions. Health professionals identified a need for clearer processes and strengthened communication between family, school and health professionals. Trusting relationships are critical if all families are to be well-supported.

Purpose This study aimed to investigate the prevalence of online and homeschool attendance in transgender and gender-diverse (TGD) youth. Methods Caregivers of 12- to 17-year-olds participated in a phone survey about school attendance. Subjects included TGD youth receiving care in a gender health clinic and youth receiving care in a pediatric endocrinology/diabetes (PED) clinic. Results Parents of 83 TGD and 83 PED youth participated in the study. Current/past enrollment in a nontraditional school setting was higher among TGD than PED youth (37.3% vs. 19.3%; p = .01). In addition, 14.5% of TGD and 7.2% of PED youth had transferred between traditional school settings (public, private, and charter) for psychosocial reasons. Conclusions Approximately half of the TGD youth had either attended a nontraditional school setting or changed schools for psychosocial reasons, compared with approximately one fourth of PED youth (51.8% vs. 26.5%, p = .001). This suggests that traditional school environments present significant psychological difficulties for TGD adolescents.

Violence in schools is a global issue. Approximately 32% of Mexican students have experienced some form of violence in the school setting in their lives. Previous research has tended to focus on the causes of violence and antisocial behaviors in offenders or adolescent samples and has found evidence to suggest the underlying role of environmental and personal factors. The present study investigates the effect of positive school environment and agreeableness as protective factors against antisocial behaviors in a sample of undergraduate and graduate students (n = 304) from northwestern Mexico. Our results demonstrate that a positive school environment has a negative effect on antisocial behaviors via mood and anxiety disorders as well as in interaction with agreeableness, suggesting an interplay between personality and environment. These findings can provide some basis for the development of university programs aimed at fostering positive environments that promote student mental health and protect against antisocial behaviors.

Introduction Every year, 1/10,000 children experiences a food‐anaphylactic reaction. Most of these events, including attack‐related deaths, may happen during the school hours. In the current study, we assessed the influence of information and communication technologies (ICT) in the school‐staff's education on food allergy and anaphylaxis (FAA). Methods The target population of this intervention was non‐university teaching centers from the local Regional Education Council, including both state and private institutions. The digital intervention was supported by the free‐of‐charge and open‐source learning‐management Aulatic Educational Platform. Structured questionnaires were developed to evaluate the educators' knowledge, feelings, and self‐efficacy on FAA, in addition to a satisfaction and quality survey of the training program. Results A total of 1748 school‐educators were virtually enrolled from May 2016 to June 2020 in one of the 8‐week course editions, with 80.6% of attendees successfully completing the full training. All scores concerning school‐staff's basic knowledge and self‐efficacy on FAA significantly improved after the educational intervention, reaching a high level of satisfaction among participants (98.5%) over the 4‐year educational program. Conclusion Our results highlighted the effectiveness of a focused e‐learning activity to improve teachers and school caretakers in the management of food allergic scholars and anaphylactic reactions during the school hours. The use of ICTs tools should become an integrated part of curricular frameworks in non‐university education, leading to a better care of FAA school children.

Child safety is a top priority in the school setting. Many accidents that occur on school playgrounds range from minor scrapes and bumps to fractures or other health problems that require quick medical response. Data can be a powerful tool for school nurses when seeking to promote changes in their schools.

Background:High-quality data in Electronic Dental Records (EDR) is essential for dental schools to provide high-quality patient care, improve dental students’ professionalism, and support a platform for research. Therefore, ensuring data quality in EDRs is extremely important.Objective:To perform a quality appraisal of EDRs by evaluating their accuracy and completeness.Methods:This was a Cross-sectional Observational Study conducted over four consecutive years in a dental school setting. Manual chart reviews were performed on an annual basis. EDR data were audited for accuracy and completeness. Accuracy was evaluated by comparing the entered data with an external source, where possible. An EDR data field was considered complete if it was not missing.Results:A total of 1,720 de-identified chart reviews were studied. The accuracy of the data to identify the patient was 93%. The completeness of the essential components of EDRs was 48-94%. Completeness was highest for documenting the patient’s chief complaint (94%) and the lowest for recall plan (48%). Completeness of data documenting social and behavioral determinants of health in EDRs was 36-77%, with the highest proportion of completeness in this domain being for oral hygiene habits, smoking habits, and social history.Conclusion:The quality appraisal of EDRs varied according to the data field. Understanding patterns of accuracy and completeness in EDRs will guide training and quality enforcement activities.