National adherence to the recess recommendations of the Centers for Disease Control and Prevention (CDC) has not been comprehensively studied in the United States.
Data from 6 nationally representative data sets over the last decade (Classification of Laws Associated with School Students, Early Childhood Longitudinal Study, National Health and Nutrition Examination Survey, National Youth Fitness Survey, School Health Policies and Practices Survey, and the School Nutrition and Meal Cost Study) provided estimates for adherence to CDC recess guidelines.
While approximately 65-80% of elementary school-children receive the recommended 20+ minutes of daily recess according to parent-, principal-, and school-report, adherence declines by sixth grade, and little information is available for middle/high school students. Adherence to playground safety was high (90%), but adherence to recommendations about recess before lunch (<50%), withholding recess as punishment (∼50%), and training recess staff (<50%) were lower.
School policy and practice should align with CDC recommendations, with the aim of providing sufficient quality recess to all youth, K-12th grade. Comprehensive, on-going national surveillance of multiple recess domains is needed to inform policy and ensure equitable provision of recess.

Hot spot analysis of linked accelerometer and Global Positioning System data is often used to identify areas of high/low activity in the schoolyard. We illustrate the potential impact of a suite of methodological decisions (i) accelerometer metric; (ii) monitor epoch; (iii) number of recess periods/days and level of aggregation; (iv) sample size; (v) distance band; (vi) spatial versus spatiotemporal weighting scheme; and (vii) time band. Accelerometer metrics resulted in different clustering patterns. Longer epochs resulted in a less detailed picture of schoolyard behavior. Level of data aggregation impacted cluster patterns due to inter-period and inter-day differences, but clusters were consistent with increasing sample size. Use of spatiotemporal weight matrices resulted in better separation of hot and cold spots and revealed potentially important temporal clustering patterns. Increasing distance or time band resulted in reallocation of small clusters to larger clusters. Hot spot analysis decisions should be clearly reported in future studies.

BACKGROUND: School health curricula should help students choose health goals related to the Dietary Guidelines (DG) recommendations addressing obesity. We aimed to identify characteristics associated with choice of DG recommendation items.
METHODS: In 12 HealthCorps affiliated high schools, students completed a 19-item web-based questionnaire that provided a personalized health-behavior feedback report to guide setting SMART (Specific, Measurable, Action-oriented, Realistic, Time-bound) goals. We examined if gender, weight-status, and personalized feedback report messages were related to student-selected SMART Goals.
RESULTS: The most frequent SMART Goals focused on breakfast (22.4%), physical activity (21.1%), and sugary beverages (20.4%). Students were more likely to choose a SMART goal related to breakfast, sugary beverages, fruit/vegetable intake or physical activity if their feedback report suggested that health behavior was problematic (p<0.0001). Males were more likely than females to set sugary beverage goals (p<0.05). Females tended to be more likely than males to set breakfast goals (p=0.051). Students, who had obesity, were more likely than normal weight students to set physical activity goals (p<0.05).
CONCLUSIONS: SMART goals choice was associated with gender and weight status. SMART goal planning with a web-based questionnaire and personalized feedback report appears to help students develop goals related to the Dietary Guidelines recommendations.

The educational and social benefits provided by school far outweigh the risks of a possible COVID-19 contamination of children in school environments or in daycare centers. Following summer break, the back-to-school period in France is taking place in the context of an increasing viral spread and requires strict adherence to health measures to limit the risk of outbreaks in communities. Based on a critical update of the role of children in the transmission of the infection, and of children\'s susceptibility to infection, the French Pediatric Society published practical guidelines for school re-entry and the management of COVID-19 infections in schools.

Individuals with co-occurring hyperactivity disorder/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can have complex presentations that may complicate diagnosis and treatment. There are established guidelines with regard to the identification and treatment of ADHD and ASD as independent conditions. However, ADHD and ASD were not formally recognised diagnostically as co-occurring conditions until the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) was published in 2013. Hence, awareness and understanding of both conditions when they co-occur is less established and there is little guidance in the clinical literature. This has led to uncertainty among healthcare practitioners when working with children, young people and adults who present with co-existing ADHD and ASD. The United Kingdom ADHD Partnership (UKAP) therefore convened a meeting of professional experts that aimed to address this gap and reach expert consensus on the topic that will aid healthcare practitioners and allied professionals when working with this complex and vulnerable population.
UK experts from multiple disciplines in the fields of ADHD and ASD convened in London in December 2017. The meeting provided the opportunity to address the complexities of ADHD and ASD as a co-occurring presentation from different perspectives and included presentations, discussion and group work. The authors considered the clinical challenges of working with this complex group of individuals, producing a consensus for a unified approach when working with male and female, children, adolescents and adults with co-occurring ADHD and ASD. This was written up, circulated and endorsed by all authors.
The authors reached a consensus of practical recommendations for working across the lifespan with males and females with ADHD and ASD. Consensus was reached on topics of (1) identification and assessment using rating scales, clinical diagnostic interviews and objective supporting assessments; outcomes of assessment, including standards of clinical reporting; (2) non-pharmacological interventions and care management, including psychoeducation, carer interventions/carer training, behavioural/environmental and Cognitive Behavioural Therapy (CBT) approaches; and multi-agency liaison, including educational interventions, career advice, occupational skills and training, and (3) pharmacological treatments.
The guidance and practice recommendations (Tables 1, 4, 5, 7, 8 and 10) will support healthcare practitioners and allied professionals to meet the needs of this complex group from a multidisciplinary perspective. Further research is needed to enhance our understanding of the diagnosis, treatment and management of individuals presenting with comorbid ADHD and ASD.

School students in crowed environment are susceptible to tuberculosis(TB), often resulting outbreaks and public health emergencies. We give further advices on the investigation of index cases and their close contacts, diagnosis and treatment of active TB patients and latent TB infection and their standardized management, aiming at facilitating TB epidemiology investigation, scene disposal and related effect evaluation.
学校是人群密集的场所，容易发生结核病聚集性疫情甚至结核病突发公共卫生事件。本专家共识从学校结核病流行病学调查、现场处置及效果评估三方面，对指示病例及密切接触者调查方法、活动性结核病患者及结核潜伏感染者诊断治疗与管理等提出了相关建议。.

Food allergy and anaphylaxis is increasing in Australian children, and anaphylaxis is relatively common in Australian schools. This review aims to provide an overview of current policies and practices for anaphylaxis management in Australian schools, including approaches to risk mitigation and anaphylaxis training. We reviewed literature related to anaphylaxis training in the school setting published between 2010 and 2018. Current anaphylaxis policies/guidelines were obtained from Australian education and health departments, and reports of suspected anaphylaxis and adrenaline autoinjector (AAI) use for 2016-2017 were obtained from education departments where available. Our review of policies/guidelines across Australian jurisdictions indicates inconsistent approaches to anaphylaxis management training. Almost half of Australian school anaphylaxis events required a general-use AAI, administered to students not identified as at risk of anaphylaxis. Development of clear, evidence-based, consistent guidelines related to anaphylaxis management and training in the school setting is imperative to minimise risk.

OBJECTIVE: The objective of this study was to identify and describe management strategies to ensure safe return to activity (RTA) and return to school (RTS) of children with mild traumatic brain injury (MTBI) and determine whether they are evidence-based.
METHODS: A scoping methodology was conducted using research published between 1990 and 2013, gray literature and clinical expertise. Once the data had been charted, an expert panel of physicians and clinicians was consulted to inform and validate study findings. An analytical and thematic framework was used to examine the study findings.
RESULTS: A total of 400 potentially relevant published articles, 100 websites and 24 iPad Applications were found. Ten articles and three web-based resources met inclusion criteria and were included in the final review. Nine articles recommended a more conservative approach to RTA, as well as identified a step-wise or severity-oriented approach. General recommendations were also found regarding safe RTS. One study recommended a stepwise RTS protocol for children.
CONCLUSIONS: This scoping methodology determined that the most comprehensive guidelines for management are focused on adults. Evidence concerning prolonged recovery patterns in children and the impact of concussion on the developing brain suggests that pediatric-specific guidelines are needed for RTA and RTS after MTBI/concussion.
CONCLUSIONS: Although concussion in children is an increasing concern, it has been determined that the most comprehensive guidelines for management are focused on adults. These guidelines are primarily consensus-based and are not proven fact through quality research. Evidence concerning prolonged recovery patterns in youth and the impact of concussion on the developing brain suggest that pediatric guidelines should be more conservative than for adults. Therefore, pediatric-specific guidelines need to be developed for return to activity and return to school after MTBI/concussion.

Concussion research generally centers on physical challenges, though aspects such as social functioning and returning to school also warrant attention in pediatric populations. Restoring academic performance postconcussion remains a challenge. Here we provide recommendations addressing a uniform policy for pediatric concussion patients in academic institutions. Tools that may minimize difficulty with academic re-entry include independent educational evaluations, individualized educational programs (IEPs), student support teams (SSTs), letters of academic accommodation, time off, and 504 Plans. Recognition and treatment is crucial for symptom relief and prevention of functional disruption, as is specialist referral during the acute window. We recommend early intervention with a letter of academic accommodation and SST and suggest that 504 Plans and IEPs be reserved for protracted or medically complicated cases. Students with concussion should be observed for anxiety and depression because these symptoms can lead to prolonged recovery, decreased quality of life, and other social challenges.