In this paper, we present a method to estimate the risk of reopening of schools illustrated with the case of the State of São Paulo, Brazil. The model showed that, although no death of children would result from the reopening of the schools in the three cities analysed, the risk of asymptomatic and symptomatic cases and secondary cases among teachers, school staff and relatives of the children is not negligible. Although the epidemic hit different regions with different intensities, our model shows that, for regions where the incidence profile is similar to the cities analysed, the risk of reopening of schools is still too high. This in spite of the fact that incidences in these cities were declining in the period of the time considered. Therefore, although we cannot extend the result to the entire country, the overall conclusion is valid for regions with a declining incidence and it is even more valid for regions where incidence is increasing. We assumed a very conservative level of infection transmissibility of children of just 10% as that of adults. In spite of the very low level of transmissibility is assumed, the number of secondary cases caused by infected children among teachers, school staff and relatives varied from 2 to 85. It is, therefore, too soon to have any degree of confidence that reopening of schools before the advent of a vaccine is the right decision to take. The purpose of our model and simulations is to provide a method to estimate the risk of school reopening, although we are sure it could be applied as a guide to public health strategies.

Australia regularly suffers floods, droughts, bushfires and cyclones, which are predicted to increase and/or intensify in the future due to climate change. While school-aged children are among the most vulnerable to natural disasters, they can be empowered through education to prepare for and respond to disasters. School disaster education is essential to raise awareness among students and their communities and to encourage preparedness action. However, evaluation of Australian school-based disaster education programs has been limited. This article presents the results of a critical literature review of peer-reviewed publications on disaster education programs in Australian schools conducted through Scopus, A Plus, PsycINFO and the Education Resources Information Center (ERIC) databases. Results highlight a significant dearth of studies examining disaster education programs in Australian schools. Recommendations for future research are proposed to bridge knowledge gaps and establish disaster preparedness resources that support children's knowledge and preparedness for disasters.

Both Fe deficiency and poor n-3 fatty acid status have been associated with behavioural changes in children. In the present study, we investigated the effects of Fe and DHA+EPA supplementation, alone or in combination, on physical activity during school days and on teacher-rated behaviour in healthy Fe-deficient school children. In a 2 × 2 factorial design, children (n 98, 6–11 years) were randomly assigned to receive (1) Fe (50 mg) plus DHA (420 mg)+EPA (80 mg), (2) Fe plus placebo, (3) placebo plus DHA+EPA or (4) placebo plus placebo as oral supplements (4 d/week) for 8·5 months. Physical activity was measured during four school days at baseline and endpoint using accelerometers, and data were stratified into morning class time (08.00–10.29 hours), break time (10.30–11.00 hours) and after-break class time (11.01–12.00 hours) for analysis. Classroom behaviour was assessed at endpoint using Conners’ Teacher Rating Scales. DHA+EPA supplementation decreased physical activity counts during morning class time, increased sedentary physical activity, and decreased light- and moderate-intensity physical activities. Consistently, DHA+EPA supplementation increased sedentary physical activity and decreased light-intensity physical activity during after-break class time. Even though there were no treatment effects found on teacher-rated behaviour, lower physical activity during morning class time was associated with lower levels of teacher-rated hyperactivity and oppositional behaviour at endpoint. Despite a positive association between Fe status and physical activity during break time at baseline, Fe supplementation did not affect physical activity during break time and class time. Our findings suggest that DHA+EPA supplementation may decrease physical activity levels during class time, and further indicate that accelerometry might be a useful tool to assess classroom behaviour in healthy children.

The macronutrient composition of a breakfast that could facilitate performance after an overnight fast remains unclear. As glucose is the brain's major energy source, the interest is in investigating meals differing in their blood glucose-raising potential. Findings vary due to unaccounted differences in glucoregulation, arousal and cortisol secretion. We investigated the effects of meals differing in glycaemic index (GI) and glycaemic load (GL) on cognition and mood in school children. A total of seventy-four school children were matched and randomly allocated either to the high-GL or low-GL group. Within each GL group, children received high-GI and low-GI breakfasts. Cognitive function (CF) and mood were measured 95–140 min after breakfast. Blood glucose and salivary cortisol were measured at baseline, before and after the CF tests. Repeated-measures ANOVA was used to identify differences in CF, mood, glucose and cortisol levels between the breakfasts. Low-GI meals predicted feeling more alert and happy, and less nervous and thirsty (P < 0·05 for each); high-GL meals predicted feeling more confident, and less sluggish, hungry and thirsty (P < 0·05 for each). High-GL (P < 0·001) and high-GI (P = 0·05) meals increased glucose levels 90 min after breakfast, and high-GI meals increased cortisol levels (P < 0·01). When baseline mood, glucose and cortisol levels were considered, low-GI meals predicted better declarative-verbal memory (P = 0·03), and high-GI meals better vigilance (P < 0·03); observed GI effects were valid across GL groups. GI effects on cognition appear to be domain specific. On balance, it would appear that the low-GI high-GL breakfast may help to improve learning, and of potential value in informing government education policies relating to dietary recommendations and implementation concerning breakfast.

Primary school children in the UK have the choice of a school meal provided by the school or a packed lunch provided from home. Currently, more than half of primary school children have a packed lunch. New food-based standards for school meals were introduced in English primary schools in 2006, followed by nutrient-based standards in 2008. No formal comparisons of primary school lunches by lunch type have been undertaken to date. The present review identified seven studies from 1990 to 2007 measuring lunchtime nutrient intake in children aged 5–11 years having a school meal and children having a packed lunch. Pooled estimates for each nutrient were as follows: energy intake was 543 (95 % CI 233, 854) kJ higher in packed lunches; total sugar intake was 14·0 (95 % CI 10·3, 17·7) g higher in packed lunches; non-milk extrinsic sugar intake was 11·7 (95 % CI 7·3, 16·2) g higher in packed lunches; saturated fat intake was 4·7 (95 % CI 2·4, 7·1) g higher in packed lunches and Na intake was 357 (95 % CI 174, 539) mg higher in packed lunches. Differences between school meals and packed lunches were larger for all nutrients after the introduction of food-based standards compared with the period of no standards. However, differences between before and after standards did not reach statistical significance. The nutritional quality of packed lunches is poor compared with school meals. The introduction of food-based standards for school meals in 2006 has moderately improved the nutrient content of school meals, slightly widening the nutritional gap between school meals and packed lunches.

Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India. School-based educative programmes greatly influence children's behaviour towards healthy living. We aimed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children. Benchmark assessment of parents and teachers was also done. We educated 40 196 children (aged 8–18 years), 25 000 parents and 1500 teachers about health, nutrition, physical activity, non-communicable diseases and healthy cooking practices in three cities of North India. A pre-tested questionnaire was used to assess randomly selected 3128 children, 2241 parents and 841 teachers before intervention and 2329 children after intervention. Low baseline knowledge and behaviour scores were reported in 75–94 % government and 48–78 % private school children, across all age groups. A small proportion of government school children gave correct answers about protein (14–17 %), carbohydrates (25–27 %) and saturated fats (18–32 %). Private school children, parents and teachers performed significantly better than government school subjects (P < 0·05). Following the intervention, scores improved in all children irrespective of the type of school (P < 0·001). A significantly higher improvement was observed in younger children (aged 8–11 years) as compared with those aged 12–18 years, in females compared with males and in government schools compared with private schools (P < 0·05 for all). Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children, parents and teachers. This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes.

A double-blind placebo trial was conducted to determine the effect of moderate to high loads of Trichuris trichiura (whipworm) infection on the cognitive functions of 159 school children (age 9–12 years) in Jamaica. Infected children were randomly assigned to Treatment or Placebo groups. A third group of randomly selected uninfected children were assigned to a Control for comparative purposes. The improvement in cognitive function was evaluated using a stepwise multiple linear regression, designed to control for any confounding variables. The expulsion of worms led to a significant improvement in tests of auditory short-term memory (P < 0.02; P < 0.01), and a highly significant improvement in the scanning and retrieval of long-term memory (P < 0.001). After 9 weeks, treated children were no longer significantly different from an uninfected Control group in these three tests of cognitive function. The removal of T. trichiura was more important than Ascaris lumbricoides in determining this improvement. The results suggest that whipworm infection has an adverse effect on certain cognitive functions which is reversible by therapy.

A study to compare the effects of different frequencies of targeted chemotherapy with levamisole (Ketrax: JAGAL Pharma, Lagos, Zeneca Pharmaceuticals UK) as an action for the control of Ascaris lumbricoides was carried out in 3 communities in rural Oyo State, Nigeria. The targeted group comprised children, aged 5 to 15 years, attending primary school within their village. Treatment was provided within the school with the assistance of the school teachers. Three frequencies of targeted treatment were offered. In one village targeted treatment was provided on 1 occasion in 1 year, in another village at two 6-monthly intervals and in the third village every 4 months. Prevalence and intensity (e.p.g.) of A. lumbricoides infection were determined immediately before and after the period of intervention using a modified Kato–Katz technique. In the villages which received treatment once and at 6-monthly intervals, a reduction in post-treatment intensity of A. lumbricoides was observed in the total population but this failed to attain statistical significance. In contrast, within the village which received 4-monthly targeted chemotherapy, a significant reduction in post-treatment intensity of A. lumbricoides was observed in the total population and in the targeted children. In general, reductions in the intensity of A. lumbricoides after intervention were not particularly pronounced in untreated children (aged 0–4 years) even in the 4-monthly targeted village, whereas in untreated adults, reductions approached statistical significance in villages which received targeted treatment once and at 4-monthly intervals.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Raven's Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school children's cognitive function.

The Ministry of Health in Sri Lanka commenced a vitamin A supplementation programme of school children with a megadose of 105 μmol (100 000 IU) vitamin A in school years 1, 4 and 7 (approximately 5-, 9- and 12-year-olds, respectively) in 2001. We evaluated the vitamin A supplementation programme of school children in a rural area of Sri Lanka. A cross-sectional study was conducted among children supplemented with an oral megadose of vitamin A (105 μmol; n 452) and children not supplemented (controls; n 294) in Grades 1–5. Children were clinically examined and a sample of blood was taken for serum vitamin A concentration estimation by HPLC. Socio-demographic information was obtained from children or mothers. Supplemented children had a higher proportion of males and stunted children, were younger and lived under poorer conditions as compared to controls. There was no difference in the prevalences of eye signs and symptoms of vitamin A deficiency in the two groups. Supplemented children had higher serum vitamin A concentrations than controls (1·4 (sd 0·49) μmol/l v. 1·2 (sd 0·52) μmol/l). The serum vitamin A concentrations were 1·6 (sd 0·45), 1·4 (sd 0·50), 1·3 (sd 0·44) and 1·1 (sd 0·43) μmol/l in children supplemented within 1, 1–6, 7–12 and 13–18 months of supplementation, respectively. Vitamin A concentrations were significantly greater than controls if supplementation was carried out within 6 months after adjustment. The oral megadose of 105 μmol vitamin A maintained serum vitamin A concentrations for 6 months in school children.

Food fortification is an important long-term strategy for addressing micronutrient deficiencies. Finding the ideal Fe fortification compound, however, remains a challenge. In the present study the effect of ferrous bisglycinate as fortificant in brown bread was compared with that of electrolytic Fe among Fe-deficient school children in a randomised controlled trial. Children (n 160), aged 6–11 years, with serum ferritin <20μg/l, were randomly assigned to one of three treatment categories: (i) standard unfortified bread; (ii) bread with electrolytic Fe as fortificant; and (iii) bread with ferrous bisglycinate as fortificant. Each child received four slices of bread (120g) on school days, which supplied an average of 3·66mg elemental Fe per intervention day for 137d (2·52mg/d for 75d and 5·04mg/d for 62d) over a period of 7·5 months. Hb, serum ferritin, serum Fe and transferrin saturation were measured at baseline and at the end of the intervention. Significant treatment effects were observed for Hb (P=0·013), serum Fe (P=0·041) and transferrin saturation (P=0·042) in the ferrous bisglycinate group, but not in the electrolytic Fe group. There were no significant intervention effects for serum ferritin in either treatment group. Overall, ferrous bisglycinate as Fe fortificant in brown bread performed better than electrolytic Fe in a group of Fe-deficient school children over a period of 7·5 months.

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35 000 per month. Three thousand children between the ages of 5–12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.

The National School Fruit Scheme (NSFS) provides one free piece of fruit each school day to children, aged 4 to 6 years, attending state schools in England. The aims of the present study were to determine if NSFS was associated with a higher fruit consumption in infant school children (4–6 years old), and to assess whether fruit consumption was higher in junior school children (7–8 years old) who had received free fruit as infants compared with those who had not. The present cross-sectional study involved seventeen schools, eight in the NSFS (study schools) and nine not in the NSFS (control schools). Study and control schools were selected in areas of similar levels of deprivation. All schools were on the outskirts of London in Southeast England. A retrospective 24 h food tick list was given to each pupil in Reception to Year 4 to take home for their parents to complete and return. Response rate was 51 %. Median total fruit consumption (excluding fruit juice) in infants receiving free fruit was 117 g/d compared with 67 g/d in infants not receiving free fruit (P<0·001). Median consumption in juniors who had received free fruit at school as infants did not differ from those who had not (83 g/d v. 86 g/d). The NSFS has increased fruit consumption in infant school children. It does not appear to have longer-term effects in junior school children. If the scheme is to affect dietary habits and improve health in the long term, further interventions will be needed.

This study's aim was to estimate the prevalence and describe the clinical characteristics of Tourette syndrome (TS) in 13–14-year-old schoolchildren attending mainstream secondary schools. A three-stage ascertainment procedure was used to identify those who had TS. First, all 1012 Year 9 pupils were screened for tics using validated self-report questionnaires, which were completed by parents, teachers, and pupils. Data were available from at least one informant for 918 (90·7%) subjects. Tics were identified in 189 (18·7%) pupils. Second, families were contacted and a semistructured interview was carried out to determine whether they had TS. Finally, to ensure that the diagnosis of TS was correct, all those assessed as having TS were systematically assessed by an expert clinician in the field of TS.

Seven young people were identified as fulfilling the criteria for TS, giving a minimum prevalence rate amongst 13–14-year-olds of 0·76% (95% CI 0·31 to 1·57) and a more realistic estimate of 1·85% (95% CI 1·00 to 2·95). Behavioural problems, in particular hyperkinetic disorder, were frequently associated with the TS group. These findings lend further support to the contention that the prevalence of TS in the community has hitherto been underestimated, though the symptoms may be generally milder than cases of TS presenting to clinics. This study supports the need for vigilance for TS in school-age children in primary care and in educational settings, so that children with this potentially serious disorder can be identified and assessed and effective management packages can be formulated to address their needs, when necessary.