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Objective: To investigate the relations among entertainment screen-based sedentary behavior, educational sedentary behavior, and inhibitory control in school-aged children. Methods: A total of 700 Chinese school-aged children (10-15 years old) were recruited. The Adolescent Sedentary Active Questionnaire was used to assess total sedentary time, entertainment screen-based sedentary time, and educational sedentary time. Executive function was measured by the Stroop task. Results: There were significantly negative associations between entertainment screen-based sedentary time and the accuracy of Stroop task in the congruent and incongruent condition (β = 0.15, 0. 18), while there was significantly positive association between educational sedentary time and the reaction time of Stroop task in the incongruent condition (β = 0.09). Conclusion: The relationship between sedentary behavior and inhibitory control may vary depending on the type of sedentary behavior. Moreover, special emphasis should be placed onlimiting the entertainment screen-based sedentary behavior to promote cognitive development in school-aged children. [ABSTRACT FROM AUTHOR]

Introduction: The high level of food insecurity in Bushehr has made it necessary to identify the factors related to food insecurity in families. This study is conducted to determine the relationship between received social support and household food security from the perspective of mothers with 7-12 children. Methods: In this controlled comparative study with a cross-sectional design, 153 mothers with children between 7-12 were selected with quota sampling method. First, First, the 18-item food security questionnaire regarding the United States Ministry of Agriculture was completed by mothers to create two safe and unsafe groups, and then, the social support questionnaire was completed by them. was completed, To analyze the results, the researchers applied logistic regression, descriptive statistics, chisquare and t-test. The level of significance was set at 0.05. Results: Of the 153 mothers who participated in the study, 36/6% had high-school education, and only 22/2% were employed. The families of mothers with higher education tended to be in secure food group (p=0/05, x2=10/22). Moreover, in the families with food security, the children’s average age was less than the families with food insecurity (P-value=0/03, t=-2/13). In 74.5% of the mothers, the amount of the received support was found to be high. Logistic regression showed a relatively insignificant and positive relationship (OR=1/02 and p=0/002) between the received support and food security from the mothers' point of view. Conclusion: Considering the insignificant relationship between household food security and the mothers’ received social support, other factors related to food insecurity, e.g. perceived social support and received social support in families aided by social service organizations should be explored. [ABSTRACT FROM AUTHOR]

BackgroundAlthough it has been recommended that schools be the hub of efforts to improve child nutrition, research describing school nutrition environments in US public schools and their associations with child health is limited.ObjectiveThis study aimed to evaluate the applicability of factor analysis methods to characterize school nutrition environments by identifying underlying factors, or dimensions, in the observed data and to examine the relation between school nutrition environment dimensions and child anthropometric and dietary outcomes.MethodsThis study examined a cross-sectional sample of 4635 US children aged 4-15 y from 386 US elementary and middle schools from the Healthy Communities Study (2013-2015). Data collected from schools were used to create 34 variables that assessed the school nutrition environment. To identify dimensions of school nutrition environments, exploratory factor analysis was conducted with orthogonal rotation, and factor scores were derived using methods to account for sporadic missing data. Mixed-effects regression models adjusted for child- and community-level variables and clustered by community and school examined the associations of school nutrition environment dimensions with child anthropometric and dietary outcomes.ResultsSix dimensions of school nutrition environments were derived: nutrition education, food options, wellness policies, dining environment, unhealthy food restriction, and nutrition programs. The unhealthy food restriction dimension was negatively associated with added sugar intake (β = -1.13, P

Lexipontix is a structured therapy program for school-age children who stutter. It is based on theoretical principles and clinical practices of cognitive behavioral therapy, parent–child interaction therapy, solution-focused brief therapy, fluency shaping, and stuttering modification. A case example of a school-age child who stutters and his family who participated in the Lexipontix program is illustrated to highlight the theoretical principles, structure, content, and clinical tools of the assessment and therapy process of the program. The Lexipontix program addresses the stuttering experience of the child and family in a holistic way. The child and family are assisted in facilitating changes in all components of the International Classification of Functioning, Disability, and Health model (i.e., body function, personal factors, activity and participation, environmental factors), which help them move toward their "best hopes" (i.e., personally meaningful change) from therapy. The role of the clinician in facilitating change is also considered. Therapy outcomes for the specific case example are presented and discussed in relation to data from a retrospective chart review. The mechanisms underlying the effectiveness of the program are explored and discussed. [ABSTRACT FROM AUTHOR]

Background Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper respiratory tract mucosa. Methods In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6–15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper respiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a questionnaire. Results In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). Conclusions Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria. [ABSTRACT FROM AUTHOR]

Background Many adolescents experience mental health problems which may have serious consequences for short- and long-term health and wellbeing. This study investigates socioeconomic inequality in emotional symptoms, self-efficacy and social competence. Further, whether self-efficacy and social competence reduce socioeconomic inequalities in emotional symptoms. Methods Data stem from the cross-sectional Danish Health Behaviour in School-aged Children Methodology Development Survey 2012. Data were collected among all schoolchildren in grades 5–9 (11–15-year-olds) in 23 public schools in two municipalities. Participation rate was 76.8% (n = 3969). Analyses of the associations between daily emotional symptoms, occupational social class, self-efficacy and social competence were performed through logistic regression analyses using SAS version 9.3. Multilevel logistic regression analyses were used to study effect modification. Results Schoolchildren from lower socioeconomic positions have higher odds for daily emotional symptoms and lower levels of high self-efficacy and high social competence compared to schoolchildren from higher socioeconomic positions. High self-efficacy and high social competence buffer the association between socioeconomic position and emotional symptoms, i.e. they seem to protect children and adolescents from lower socioeconomic strata against the higher risk of daily emotional symptoms. Conclusions High self-efficacy and high social competence buffer the negative effects of low socioeconomic status on emotional symptoms among schoolchildren. Self-efficacy and social competence can be promoted e.g. through school-based initiatives and may be an effective way to improve mental health and reduce socioeconomic inequality in emotional symptoms among children and adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Youth with autism spectrum disorder (ASD) face high rates of unemployment, with unique challenges for military-dependent and -connected youth with ASD. This paper reports preliminary findings from Year One of a randomized waitlist controlled trial investigating the efficacy of the Project SEARCH + ASD Supports (PS + ASD) intervention model for military-dependent and -connected youth with ASD.Methods: Treatment group participants (n = 6) participated in internships at a military installation in the southeastern United States; waitlist group participants (n = 8) received special education transition services at their local high schools. Employment outcome data were collected at 12 months for both groups.Results: Fourteen unique internship experiences were developed across seven business partner organizations on the military installation during Year One. Five of six PS + ASD treatment group participants obtained competitive integrated employment for an overall employment rate of 83.3%. Four of the positions were federal jobs. None of the waitlist group participants obtained competitive integrated employment during the same period.Conclusions: Initial results are promising and suggest that the PS + ASD model may help to meet the transition needs of military-dependent and -connected youth with ASD and the employment needs of local military communities. [ABSTRACT FROM AUTHOR]

Background: Child rearing is a generic term that refers to the upbringing of children by providing them with food, shelter, and clothing and encircled with socialization, shaping their personality, character, talents, cultural and moral values as well as their physical and emotional well-being. Research studies in India indicate that fathers are participating in children's lives in many ways, and are far from being uninvolved., Materials and Methods: This was a cross-sectional study conducted among school-going children aged between 11-15 years at a selected school, Mangaluru in January 2022. Ninety-six study participants were recruited using a disproportionate stratified random sampling technique. Data were collected using a self-structured four-point Likert scale under six domains. The obtained data were analyzed using descriptive and inferential statistics., Results: The study results revealed that 84.6% had poor perception and 16.4% had good perception regarding paternal involvement in child-rearing. There was a significant association found between the educational status of the father and the type of family with perception score, at P < 0.05 level of significance., Conclusion: This study concluded that, even though fathers are more contributing, the children of the newer generation could not understand their father's involvement in their lives., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Aim: To investigate teachers' knowledge and preparedness of schools about food allergy and anaphylaxis in elementary schools in Edirne city. Material and Methods: The study was performed as a cross sectional survey study. Questionnaires were answered by 560 teachers, all of them were working in 35 public elementary schools in Edirne. In addition to questions concerning food allergies, teachers were asked about their attitudes in the case of a life-threatening food-induced allergic reaction. The presence of a nurse or other trained personnel, an action plan for management of anaphylaxis, and/or epinephrine availability and use in these schools in the case of such a reaction were also evaluated. Results: The vast majority of teachers (97.3%) reported they had not been informed about food allergies, and only 19.1% stated that "shock" may be related to a food allergy situation. Only 4 schools (11.4%) employed a nurse. Examination of school drugs cabinets revealed no epinephrine in any school, and none of the students were found to carry epinephrine autoinjectors. Furthermore, none of the schools had an emergency action plan related to food-induced allergic reactions. Conclusion: The current study revealed an urgent need to inform elementary school teachers of Edirne about food allergies and their treatment and to improve access to emergency treatments and action plans. [ABSTRACT FROM AUTHOR]

Objective The literature supports using tests developed in high-income countries to assess children in low and lower-middle income countries (LMICs) when carefully translated, adapted, and applied (Holding et al. 2018; Mitchell et al. 2017). Research has shown the Mullen Scales of Early Learning (MSEL) to have adequate validity and sensitivity when used in LMICs (Bangirana et al. 2014; Koura et al. 2013), as well as equivalency to the American normative sample in lower risk populations (Bornman et al. 2010). Here, we describe the pattern of MSEL results in rural Guatemala. Participants and Method Children (n = 842; M enrollment age = 15.9 months; range 0-5 years) enrolled in an observational study of postnatal Zika exposure in rural Guatemala were administered an adapted and translated version of the MSEL (Connery et al. in press). To date, 352 children completed one, 393 children completed two, and 97 children completed three MSELs, for a total of 1,429 administrations. Results MSEL composite scores were similar to the American normative sample in children <12 months (M = 93.3, SD = 11.1), but lower for children ages 1-5 years (mean = 71.1, SD = 15.1, p < 0.0001). Moreover, lower scores were observed in children ages 1-5 years for all MSEL subscales, with the largest differences observed in receptive language (<12 years: mean = 47.8, SD = 7.1; 1-5 years: mean = 35.1, SD = 10.0, p < 0.0001). Conclusions Results are consistent with research that demonstrates a widening gap in test performance over time between children from higher and lower risk communities (Fernald et al. 2011; Paxson et al. 2005; Schady et al. 2015). Although findings are not meant to diagnose individual children, they highlight population changes in neurodevelopmental skills and the need for a better understanding of developmental patterns in LMICs. Future analyses will evaluate the impact of developmental risk factors over time and the performance of the MSEL in this population. References Bangirana, P. Opoka, R. O. Boivin, M. J. Idro, R. Hodges, J. S. Romero, R. A. ... John, C. C. (2014). Severe Malarial Anemia is Associated With Long-term Neurocognitive Impairment.  Clinical Infectious Diseases ,  59 (3), 336–344.  https://doi.org/10.1093/cid/ciu293. Bornman, J. Sevcik, R. A. Romski, M. & Pae, H. K. (2010).  Successfully Translating Language and Culture when Adapting Assessment Measures, ppi_254 111.118. Retrieved from  https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1741-1130.2010.00254.x. Fernald, L. C. H. Weber, A. Galasso, E. & Ratsifandrihamanana, L. (2011). Socioeconomic gradients and child development in a very low income population: Evidence from Madagascar.  Developmental Science ,  14 (4), 832–847.  https://doi.org/10.1111/j.1467-7687.2010.01032.x. Holding, P. Anum, A. van de Vijver, F. J. R. Vokhiwa, M. Bugase, N. Hossen, T. ... Gomes, M. (2018). Can we measure cognitive constructs consistently within and across cultures? Evidence from a test battery in Bangladesh, Ghana, and Tanzania.  Applied Neuropsychology: Child ,  7 (1), 1-13  https://doi.org/10.1080/21622965.2016.1206823. Koura, K. G. Boivin, M. J. Davidson, L. L. Ouédraogo, S. Zoumenou, R. Alao, M. J. ... Bodeau-Livinec, F. (2013). Usefulness of child development assessments for low-resource settings in francophone Africa.  Journal of Developmental and Behavioral Pediatrics : JDBP ,  34 (7), 486–93.  https://doi.org/10.1097/DBP.0b013e31829d211c. Mitchell, J. M. Tomlinson, M. Bland, R. M. Houle, B. Stein, A. & Rochat, T. J. (2017). Confirmatory factor analysis of the Kaufman assessment battery in a sample of primary school-aged children in rural South Africa.  South African Journal of Psychology , 1–19.  https://doi.org/10.1177/0081246317741822. Paxson, C. Schady, N. Izquierdo, S. León, M. Lucio, R. Ponce, J. ... Hall, W. (2005).  Cognitive Development among Young Children in Ecuador The Roles of Wealth, Health, and Parenting. Retrieved from  http://econ.worldbank.org. Schady, N. Behrman, J. Araujo, M. C. Azuero, R. Bernal, R. Bravo, D. ... Vakis, R. (2015). Wealth gradients in early childhood cognitive development in five Latin American countries.  The Journal of Human Resources ,  50 (2), 446–463. Retrieved from  http://www.ncbi.nlm.nih.gov/pubmed/25983344. [ABSTRACT FROM AUTHOR]

Five major challenges experienced while conducting a study regarding the neurobehavioral developmental trajectories of primary school children in Trinidad and Tobago are reviewed. 1. Governing Principles. Institutional review of the scientific rationale for the work and safety of participants is required for research activities in any/all settings. 2. Design/Methodology. Cultural beliefs/values/goals shape the research endeavor from recruitment strategies, informed consent, research design, and data collection to outcome monitoring. 3. Participants. Research studies involving children are closely scrutinized. Children need additional protections because they cannot give informed consent. Who speaks for children and how? Children must be recruited via guardians - who may not be parents but societal institutions functioning as "proxy guardians". The relationships between parents and different "proxy guardians" respond to cultural beliefs/values. 4. Behavioral Measurement-Tests. American psychology has been severely critiqued as focusing on a circumscribed sector of the population while neglecting 95% of the global community. A core concern is the use, in non-United States settings, of behavioral measures developed and normed in the U.S. No measure can be truly culture free: all brains are sculpted by interactions not only with the physical world but also with the psychological world of their own cultural heritage. 5. Behavioral Measurement-Rating Scales. In transferring research across cultures, language/dialect differences are frequently highlighted. Differences in literacy can be even more challenging. Lack of literacy cannot be used to exclude persons from potential research benefits, nor for the failure to conduct effective informed consent processes. Cultural variations in the value/use of the written word have direct impact on research design/methodology, data collection/quality, the training/conduct of research personnel, and on funding. Implications for the mounting research in international settings are discussed. [ABSTRACT FROM AUTHOR]

Background The concept of health literac y (HL) may help us to better understand the mechanisms leading to health disparities, and to focus on the factors that can be influenced. However, not much is yet known about how HL is related to health disparities, or whether the association exists among adolescents. The aim of the study was to examine the associations between structural stratifiers, HL and health indicators among adolescents. Methods The nationally representative Finnish Health Behaviour in School-aged Children survey data (n =3833) were collected from 13- and 15-year-old pupils in the spring of 2014. Pearson correlation coefficients were calculated, and separate path models were estimated for the perceived health and health behaviour measures. Results HL was found to be an independent factor explaining disparities in health. Higher HL was related to positive health outcomes. HL also acted as a mediator between health behaviours and structural stratifiers, except for gender. School achievement and educational aspirations were among the factors explaining the HL level, which in turn, explained the health indicators. Conclusion The concept of HL is of use in understanding health disparities. In particular, HL provides a mechanism via which school achievement and educational plans affect health outcomes. Low HL places adolescents who have poor school achievement and who do not intend to continue on an academic path in an unequal position with respect to their health. [ABSTRACT FROM AUTHOR]

Background Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years. [ABSTRACT FROM AUTHOR]

Background Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusions HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents. [ABSTRACT FROM AUTHOR]

Aim: Pediculus capitis (P. capitis) is a prevalent contagious parasitosis disease worldwide. It is a serious public health problem because of its high prevalence in school-age children. This study was planned to determine the prevalence of P. capitis and the personal hygiene status of the students in different vocational high schools. Methods: The data were collected from 491 high school students using a Personal Hygiene Questionnaire between September-December 2018 and by the screening of P. capitis. Results: P. capitis was detected in 51.9% of the cases. The prevalence of pediculosis was higher in the female children (236/491) than that in the male children (19/491). This difference was found to be significant according to gender (p<0.001). There was a statistically significant difference between the schools in terms of pediculosis prevalence according to the status of washing hands before meals and cutting nails (p<0.05). There was a significant difference between the children's P. capitis positivity according to their level of knowledge about P. capitis (p<0.05). Conclusion: P.capitis remains a prevalent endemic problem in school-age children in Turkey. Providing education in schools, raising awareness of parents and ensuring cooperation will contribute to the decrease of P. capitis endemics. [ABSTRACT FROM AUTHOR]

Introduction: We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh-a country with laws against smoking in public places.Methods: A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL.Results: Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure.Conclusions: Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children.Implications: Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS. [ABSTRACT FROM AUTHOR]

Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children's self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research. [ABSTRACT FROM AUTHOR]

Aims Diagnosis of fetal alcohol spectrum disorder (FASD) is complex and difficult. The estimated number of unreported FASD is thus assumed to be substantial. In our cross-sectional study, we aimed to identify possible metric differences in philtrum depth in children with fetal alcohol syndrome (FAS) compared to healthy controls based on non-invasive 3D facial scanning in order to provide an objective, metrical tool improving FASD diagnosis. Methods Twenty-five children with confirmed FAS and 30 healthy school children without FAS, both in the mixed dentition, were prospectively recruited and 3D facial scans were performed after recording body length, weight and head circumference. Philtrum surface data were extracted and metric philtrum depth was determined at four geometrically defined measuring points (P1–P4) along the vertical length of the philtrum. Results Philtrum depths at P1 (P = 0.025), P2 (P = 0.001), P3 (P < 0.001) and P4 (P = 0.001) as well as mean philtrum depth P1–P4 (P < 0.001) differed significantly between patients with and without FAS. Compared to controls, the philtrum was shallower in patients with FAS by on average 0.4 mm at each of the respective points. Whereas no differences could be determined for body height and weight, head circumference was significantly smaller in patients with FAS (P = 0.001), particularly in girls (P = 0.008). Conclusions Apart from head circumference, philtrum depth is significantly reduced in children with FAS and can thus be used as diagnostic indicator to aid and confirm FAS diagnosis. In contrast to visual assessments, 3D face scan methods allow a more objective quantification and can thus provide additional evidence in FAS diagnosis. [ABSTRACT FROM AUTHOR]

Background Schools are crucial settings for young people's development. Rare studies have examined the impact of perceived school-climate and academic well-being on young people's self-rated health in joint analyses. This study focuses on the role of perceived school-climate and academic well-being for young people's self-rated health and examines whether school climate is mediated by indicators of academic well-being. Methods Data were obtained from the German National Educational Panel Study, including seventh grade students (n = 6838) aged 11–12, nested in 710 classes within 277 schools. Indicators of school climate (teacher control, demands, autonomy, interaction, goal setting and orientation, teaching quality) and academic well-being (satisfaction with school, helplessness in major school subjects) were reported from students. Multilevel modelling was used to analyze the relative importance of perceived school-climate and academic well-being on school-aged children's self-rated health. Results Results showed that academic well-being is strongly related to self-rated health. The better students perceive their academic well-being, the lower the likelihood of poor self-rated health. In contrast, indicators of perceived school climate are only indirectly related to self-rated health, mediated by academic well-being or are not at all associated with self-rated health. Conclusions This study suggests that school climate is important for academic well-being but not as important for students' self-rated health as academic well-being. Health promotion initiatives in schools have to ensure that school climate serves to enhance students' academic well-being to avoid health problems in the long-run. [ABSTRACT FROM AUTHOR]

Background Obesity puts a great health burden in the world. Previous studies suggest that caesarean section (CS) may increase the risk of obesity in children, but it is still uncertain whether this association is causal or due to residual confounding by medical indication. Aim To assess the association between CS, CS without medical indications in particular and the risk of overweight and obesity in school-aged children. Design Cross-sectional survey. Methods The 2014 Shanghai Child Health, Education and Lifestyle Evaluation was a large population-based survey with cluster random probability sampling in 26 primary schools in Shanghai, China, in 2014. The mode of delivery was reported by parents. The height, weight and waist circumference of the children were measured. Logistic regression models with SURVEYLOGISTIC procedure were used to estimate the risk of childhood obesity. Pupils delivered vaginally were served as the reference group. Results A total of 17 571 pupils completed this survey, and 13 724 of them who were singleton, born term and between 5 and 13 years old were included in our analysis. CS was associated with increased risks of overweight and obesity (BMI: adjusted OR = 1.28 [95%CI 1.13–1.45] and 1.44 [1.26–1.66], respectively; weight for height ratio [WHtR] >0.46: 1.33 [1.20–1.48]). Similar results were found in CS without medical indication (BMI: overweight = 1.24 [1.05–1.47], obesity = 1.43 [1.19–1.72]; WHtR > 0.46: 1.30 [1.13–1.50]). Conclusions CS overall and CS without medical indications were associated with increased risks of overweight and obesity in primary school children. [ABSTRACT FROM AUTHOR]

Millions of dollars have been spent on the design and dissemination of educational materials to improve handwashing to prevent infectious diseases. School-age children have been the focus of many of these efforts; yet little is known about the content of these materials. This study uses content analysis to examine the theoretical and motivational trends as well as the communication approach used in a sample of hand hygiene intervention materials targeting elementary-age children. Two trained coders analyzed 144 communication materials. Study results indicate that educational materials infrequently exhibit information consistent with theories of communication for behavior change, commonly use fear-based messaging, and rarely recommend using technology in the design of the interventions. Implications for future research and the design of more strategic, child-focused hand hygiene interventions are discussed. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to construct and validate a questionnaire to assess emotion coaching of mothers with school-age children in Korea. Methods: A total of 573 mothers of children in the 1st~4th grade in elementary school in Seoul and Gyeonggi area participated in the study. Maternal emotion coaching, meta-emotion, and emotional intelligence were assessed by self-report. Data from sample 1 (n=349) were used to extract factors and items with exploratory factor analyses, and then data from sample 2 (n =244) were used to confirm factor structures with confirmatory factor analysis and estimate reliability statistics as well as validity coefficients. Results: First, the Maternal Emotion Coaching Questionnaire (MECQ) consisted of 26 items with five factors including maternal awareness, guidance, attention, acceptance, and empathy. Second, the MECQ demonstrated adequate internal consistency, split-half reliability and retest reliabilty. Third, maternal emotion coaching was strongly related to maternal empathic acceptance and sensitivity of awareness as well as emotional intelligence, which supported the construct validity. Conclusions: The results indicate that the MECQ is a valid and reliable scale to assess the level of maternal emotion coaching. The MECQ can be a useful tool in parent education to assess the strengths and weaknesses of specific components of maternal emotion coaching. [ABSTRACT FROM AUTHOR]

Background Measles is an infectious disease providing lifelong immunity. Epidemics periodically occur among unvaccinated orthodox Protestants in the Netherlands. During the 2013/2014 epidemic, 17% of the reported patients was over 14 years old. Apparently, they did not catch measles during the previous 1999/2000 epidemic and remained susceptible. We wanted to identify risk factors for this so-called persisting measles susceptibility, and thus risk factors for acquiring measles at older age with increased risk of complications. Methods A case-control study was performed among unvaccinated orthodox Protestants born between 1988 and 1998; cases had measles in 2013/2014, controls during or before 1999/2000. Associations between demographic, geographical and religion-related determinants and persisting measles susceptibility were determined using univariate and multivariable logistic regression. Analyses were stratified in two age-groups: infants/toddlers and primary school-aged children during the 1999/2000 measles epidemic. Results In total, 204 cases and 563 controls were included. Risk factors for persisting measles susceptibility for infants/toddlers in 1999/2000 were belonging to a moderately conservative church, absence of older siblings and residency outside low vaccination coverage (LVC)-municipalities. Risk factors for primary school-aged children were residency outside LVC-municipalities and attendance of non-orthodox Protestant primary school. Conclusion Unvaccinated orthodox Protestant adolescents and adults who resided outside the LVC-municipalities, did not attend an orthodox Protestant primary school, had no older siblings and belonged to a moderately conservative church were at risk for persisting measles susceptibility and, thus, for acquiring measles at older age with increased risk of complications. For this subgroup of orthodox Protestants targeted information on vaccination is recommended. [ABSTRACT FROM AUTHOR]

Background Universal school lunch programmes are expected to cover all children equally, compared with selective programmes that may stigmatize socially vulnerable children. However, the effectiveness of universal programmes in closing dietary disparity has not been empirically proven. We evaluated whether Japan’s universal school lunch programmes contribute to a reduction in the socioeconomic status (SES)-related gradient in fruit and vegetable intakes. Methods We analyzed data for 719 school children aged 6–12 years in a population-based survey conducted in the greater Tokyo metropolitan area. We measured dietary intakes using a validated self-administered brief diet history questionnaire for young children (BDHQ-10 y). We assessed parental education, annual household income and maternal employment status as SES indicators of children. We used multiple regression to estimate mean fruit and vegetable intakes by parental education and household income, and the contribution of school lunch to reducing the SES-related gradient in fruit and vegetable intakes. Results Compared with children with high maternal education (>15 years), those with low maternal education (<13 years) had less vegetable intake by 22.3 g/1000 kcal (95% confidence interval = 12.5, 32.2) and less fruit intake by 7.5 g/1000 kcal (95% confidence interval = −2.4, 17.3). However, fruit and vegetable intakes from school lunch did not vary by SES, indicating that school lunch intake alleviated the SES-related gradient of total vegetable intake by 9.9% and that of fruit intake by 3.4%. Conclusions Universal school lunch programmes can partially contribute to a reduction in the SES-related gradient in dietary intakes. [ABSTRACT FROM AUTHOR]

Background This study assesses socio-economic health inequalities (SEHI) over primary school-age (4- to 12-years old) across 13 outcomes (i.e. body-mass index [BMI], handgrip strength, cardiovascular fitness, current physical conditions, moderate to vigorous physical activity, sleep duration, daily fruit and vegetable consumption, daily breakfast, exposure to smoking, mental strengths and difficulties, self-efficacy, school absenteeism and learning disabilities), covering four health domains (i.e. physical health, health behaviour, mental health and academic health). Methods Multilevel mixed effect (linear and logistic) regression analyses were applied to cross-sectional data of a Dutch quasi-experimental study that included 1403 pupils from nine primary schools. Socioeconomic background (high-middle-low) was indicated by maternal education (n = 976) and parental material deprivation (n = 784). Results Pupils with higher educated mothers had lower BMIs, higher handgrip strength and higher cardiovascular fitness; their parents reported more daily fruit and vegetable consumption, daily breakfast and less exposure to smoking. Furthermore these pupils showed less mental difficulties and less school absenteeism compared with pupils whose mothers had a lower education level. When using parental material deprivation as socio-economic indicator, similar results were found for BMI, cardiovascular fitness, sleep duration, exposure to smoking and mental strengths and difficulties. Socio-economic differences in handgrip strength, cardiovascular fitness and sleep duration were larger in older than in younger pupils. Conclusions Childhood SEHI are clearly found across multiple domains, and some are larger in older than in younger pupils. Interventions aiming to tackle SEHI may therefore need a comprehensive and perhaps more fundamental approach. [ABSTRACT FROM AUTHOR]

Background In spite of many positive trends that have emerged in the health of young people, adolescents from more affluent groups continue to experience more favourable health outcomes. There are no groups that are more vulnerable than those who report very poor (‘bottom-end’) indicators of health behaviour. The present study investigated the role of socio-economic factors as potential determinants of bottom-end health behaviours pertaining to physical activity and diet. Methods Our analysis incorporated health data for some 700 000 15-year-old adolescents in 34 countries. The data source was four cycles of the Health Behaviour in School-aged Children (HBSC) study (2001/2002, 2005/2006, 2009/2010 and 2013/2014). As per UNICEF precedents, adolescents whose health behaviour scores were below the mean of the lower half of the distribution fell into the ‘bottom-end’ on this indicator. Results Adolescents from less affluent families were much more likely to report being in the bottom-end of the distribution of these health indicators. Large, persistent and widespread socio-economic gradients existed for physical activity and healthy eating, while the findings were mixed for unhealthy eating. Such socio-economic inequalities were largely stable or widened for physical activity and healthy eating, while inequalities in unhealthy eating narrowed. Conclusion Although it is important to continue monitoring average levels of adolescent health, national and international policies need to pay attention to the concentration of poor health outcomes among adolescents from less affluent families and to redress social inequalities in adolescent health behaviour. [ABSTRACT FROM AUTHOR]

Background: A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized.Objectives: To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public.Methods: Five databases were searched between 2000 and 2016 for interventions to change the public's AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesized narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016050343).Results: Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed material interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes or the public's antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have notable potential, but for the general public the picture is less clear.Conclusions: Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required. [ABSTRACT FROM AUTHOR]

Background: Dietary iodine requirements are high during pregnancy, lactation, and infancy, making women and infants vulnerable to iodine deficiency. Universal salt iodization (USI) has been remarkably successful for preventing iodine deficiency in the general population, but it is uncertain if USI provides adequate iodine intakes during the first 1000 d.Objective: We set out to assess if USI provides sufficient dietary iodine to meet the iodine requirements and achieve adequate iodine nutrition in all vulnerable population groups.Methods: We conducted an international, cross-sectional, multicenter study in 3 study sites with mandatory USI legislation. We enrolled 5860 participants from 6 population groups (school-age children, nonpregnant nonlactating women of reproductive age, pregnant women, lactating women, 0-6-mo-old infants, and 7-24-mo-old infants) and assessed iodine status [urinary iodine concentration (UIC)] and thyroid function in Linfen, China (n = 2408), Tuguegarao, the Philippines (n = 2512), and Zagreb, Croatia (n = 940). We analyzed the iodine concentration in household salt, breast milk, drinking water, and cow's milk.Results: The salt iodine concentration was low (<15 mg/kg) in 2.7%, 33.6%, and 3.1%, adequate (15-40 mg/kg) in 96.3%, 48.4%, and 96.4%, and high (>40 mg/kg) in 1.0%, 18.0%, and 0.5% of household salt samples in Linfen (n = 402), Tuguegarao (n = 1003), and Zagreb (n = 195), respectively. The median UIC showed adequate iodine nutrition in all population groups, except for excessive iodine intake in school-age children in the Philippines and borderline low intake in pregnant women in Croatia.Conclusions: Salt iodization at ∼25 mg/kg that covers a high proportion of the total amount of salt consumed supplies sufficient dietary iodine to ensure adequate iodine nutrition in all population groups, although intakes may be borderline low during pregnancy. Large variations in salt iodine concentrations increase the risk for both low and high iodine intakes. Strict monitoring of the national salt iodization program is therefore essential for optimal iodine nutrition. This trial was registered at clinicaltrials.gov as NCT02196337. [ABSTRACT FROM AUTHOR]

Objective To analyze the deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heat rate variability (HRV) in obese school-age children, and to observe the correlations of BMI with DC, AC, and HRV in these children. Methods A total of 108 obese school-age children were selected, including 75 cases of ortholiposis and 33 cases of dyslipidemia. A total of 103 healthy school-age children were selected as control group. All the subjects underwent 24-hour ambulatory electrocardiography. The comparisons of DC, AC, and HRV were made between the obese and control groups, as well as between children with ortholiposis and dyslipidemia in the obese group. The correlations of BMI with DC, AC, and HRV were analyzed in the obese group. Results The obese group showed lower DC, standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of the average normal-to-normal intervals (SDANN), root mean square of successive differences (RMSSD), low-frequency power (LF), and high-frequency power (HF) than the control group. The AC of the obese group was significantly higher than that of the control group (P<0.05). In the obese group, children with dyslipidemia had significantly lower DC, SDNN, SDANN, RMSSD, LF, and HF, but significantly higher AC and BMI, as compared with those with ortholiposis (P<0.01). In the obese group, BMI was negatively correlated with DC, SDNN, SDANN, RMSSD, and HF (P<0.05), but positively correlated with AC (P<0.05). Conclusions Obese school-age children have impaired autonomic nerve function, presenting with reduced vagal tone, which is particularly prominent in those with dyslipidemia. The more obese the children, the lower the vagal tone, which may increase the risks of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background The severity of airway obstruction can be accurately determined on spirometry in children with asthma. Other assessments may include peak expiratory flow and pulse oximetry. In the present study, we evaluated the validity and reliability of oxygen saturation/minute heart rate (SpO2/ MHR) index in the prediction of degree of severe airway obstruction in children with asthma. Methods This was a retrospective study of children aged 7-17 followed for asthma at Mersin Women and Children's Hospital. The study compared SpO2/ MHR ratio with forced expiratory volume in 1 s ( FEV1) measured on spirometry, an important indicator of small airway obstruction. A total of 296 patients were included in the study, and classified either as having normal FEV1 ( FEV1 > 80% of predicted, n = 178) or severely reduced FEV1 ( FEV1 < 60% of predicted, n = 118). Positive and negative predictive values ( PPV and NPV), sensitivity and specificity of SpO2/ MHR index in predicting low FEV1 were calculated on receiver operating characteristics analysis. Results An SpO2/ MHR ratio cut-off <0.90 was associated with a PPV of 83.14%, NPV of 71.77%, sensitivity of 80.34% and specificity of 75.42% in predicting low FEV1. Conclusions SpO2/ MHR ratio appears to be a highly useful index to assess airway obstruction in older children with asthma. Thus, it can be used as a marker of airway obstruction severity when spirometry is not available. [ABSTRACT FROM AUTHOR]

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991–2014. The analysis included 18 996 11–15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality. [ABSTRACT FROM AUTHOR]

Background and Aims. Diet and lifestyle in school-age children have a particularly large impact on health, as well as various consequences in future. The objective of this papers it to assess the relationship between lifestyle and daily diet and the effects of an unhealthy diet. Material and Methods. An observational cohort study was conducted in Bucharest, in three schools and one high school on 100 children, between 2011 and 2013. The criterion for inclusion was the appropriate age (school-age). The protocol consisted in clinical examination, body mass index (BMI) calculation, questions about diet, physical activity and time spent watching television (TV). Results. Most children do not respect a schedule of meals and snacks (78%). Unhealthy diet (fast food, carbonated beverages, chocolate) registered higher preferences. Mean TV time was 2.32 hours/day (SD=1.92) and a strong evidence on relationship between age and number of hours allocated to TV was discovered (p< .01). Four percent of children were found to be under the 5th percentile (underweight), 18% between 85th and 95th percentile (overweight) and 14% above 95th percentile (obesity). Conclusions. A sedentary life in this case was mainly determined by the time spent daily in front of the television rather than lack of exercise. [ABSTRACT FROM AUTHOR]

Children school meals acceptance is needed for a good performance in school. The aim of this study was to evaluate the acceptance of school meals. A descriptive cross-sectional study with students aged 7 to 10 years was developed. Students (n = 189) of both genders from an elementary school in Macaé-RJ, Brazil took part in the study. The menu of the school served to the children was evaluated for 22 days. Results have shown that, on average, menus were not accepted. Better results were observed through face hedonic scales method rather than acceptance through the residuals index method. The school meals adherence index was 64.5% (medium). Finally, it was observed that menu adherence and the number of meal repetitions were significantly higher when dishes were prepared properly. [ABSTRACT FROM AUTHOR]

Objective: To present outcomes of an asthma self-management educational intervention delivered to children (grades 2-5) at school and to parents in a home visit. Methods: The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models. Results: Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy. Conclusions: The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group's asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction. [ABSTRACT FROM AUTHOR]

Abstract: Children with intellectual disabilities show deficits in cognitive abilities and adaptive behavior which increase the risk of psychopathological disorders. This exploratory study aims at delineating profiles of children based on their cognitive functioning and adaptive behaviors, and to compare them on psychopathological manifestations. A cognitive assessment and an evaluation of adaptive behaviors are conducted with 52 school-age children receiving services from a rehabilitation center for people with intellectual disabilities. Adaptive behaviors are evaluated by a special educator and a questionnaire concerning psychopathology is filled out by a parent and a teacher. Cluster analyses highlight three profiles among children: Performing, Uncooperative and Non-performing. They differ on cognitive functions, collaboration and in terms of practical abilities of adaptive behaviors. Chi-square tests show significant differences in social competences, but not in problematic behaviors, according to the viewpoint of parents and teachers. Potential explanations are provided to understand the absence of significant differences in problematic behaviors between the three profiles. [Copyright &y& Elsevier]

The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30–36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood. [ABSTRACT FROM AUTHOR]

Screening for hematuria was carried out in 3000 school-age children (6 to14 years old) in Gorgan, Iran, using a fresh morning urine sample. At the initial step, 208 (6.8%) had positive dipstick tests for blood, which decreased to 35 (1.2%) at the second step. Of the 35 children with hematuria, 27 (77.1%) were girls and 8 (22.9%) were boys. Twenty-six children were further evaluated of whom 5 had normal findings, and 7 had hypercalciuria, 13 had nephrolithiasis, and in 1 had a large cystic lesion on ultrasonography, ultimately diagnosed as oncocystoma. [ABSTRACT FROM AUTHOR]

Background Developmentally-appropriate disclosure of human immunodeficiency virus (HIV) status to children living with HIV (CLWH) is essential to achieve optimal health outcomes, but stigma and fear result in delaying disclosure into adolescence. The American Academy of Pediatrics recommends disclosure of HIV status to school-age children. The objective of this quality improvement (QI) project was to increase the proportion of CLWH > 10 years of age who are disclosed about their HIV status from 57% to 80% by 18 months. Methods The Institute for Healthcare Improvement's Model for Improvement was utilized for this QI project. This model accelerates quality improvement by implementing Plan-Do-Study-Act (PDSA) cycles to determine whether changes lead to improvement. The target population included CLWH followed at an urban pediatric HIV clinic. The primary outcome measure was the proportion of children > 10 years of age who are disclosed about their HIV status. PDSA cycles included monthly clinic check-ins to discuss new disclosures, quarterly team meetings to discuss implementation of new changes to improve disclosure and modifying a note template to prompt providers to document disclosure status and plan for undisclosed patients. Our process measure was the proportion of undisclosed children who have a documented disclosure status/plan. Annotated run charts were used to track the data. Results Prior to our first PDSA cycle, 57% of CLWH > 10 years of age were disclosed to about their HIV status, and none of the undisclosed children had a disclosure status/plan documented in their medical record. The proportion of CLWH disclosed to about their HIV status increased to 66% since meeting with the team regularly to discuss disclosure status (figure). Four months after introduction of the modified note template, the proportion of CLWH with documentation of their disclosure status and plan increased to 54%. Conclusion Team awareness of the importance of disclosure and a modified clinic note template were associated with increases in the proportion of CLWH with age-appropriate HIV disclosure and documentation of disclosure status. Future interventions will include adapting methods of step-wise disclosure which have been proven effective in other settings. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]