Learning for life, friendships and relationships from the perspective of children and young people with intellectual disabilities: findings from a UK wide qualitative study.

BACKGROUND: Relationships and sexuality education (RSE) programmes are widely taught in schools, however for children and young people with intellectual disabilities, these programmes appear to be limited regarding information on relationships, informed choices and decision making. The purpose of this study was to seek the views and understanding of children and young people with intellectual disabilities, and those involved in their care and education, to identify best practice and approaches to the delivery on relationships and sexuality education. METHODS: This study used a qualitative design with 37 pupils from five special schools from across the United Kingdom (UK) participating. In-depth semi-structured interviews were held online, or in person. All interviews were recorded and transcribed verbatim. Transcripts were anonymised, assigned a pseudonym and subjected to inductive thematic analysis. FINDINGS: Four themes emerged from the data: (i) enthusiasm and inquisitiveness to acquire knowledge; (ii) dynamics of positive friendships; (iii) experiences and understanding of supportive relationships and sexuality; and (iv) valuing the exchange of knowledge and information. The findings highlight that children and young people with intellectual disabilities want education, support and information on matters relating to their relationships and sexuality. CONCLUSIONS: This is the largest study to date providing a voice to children and young people with intellectual disabilities regarding their relationships and sexuality. While special schools provide relationships and sexuality education, there is a requirement for a programme and resources specific to the needs of pupils with intellectual disabilities to be developed and evaluated. Such education should continue beyond school and be embedded in adult services.

Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study).

BACKGROUND: Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects. METHODS: This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays. RESULTS: Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score. CONCLUSIONS: The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.

Anisocoria After Direct Light Stimulus is Associated with Poor Outcomes Following Acute Brain Injury.

BACKGROUND: Assessing pupil size and reactivity is the standard of care in neurocritically ill patients. Anisocoria observed in critically ill patients often prompts further investigation and treatment. This study explores anisocoria at rest and after light stimulus determined using quantitative pupillometry as a predictor of discharge modified Rankin Scale (mRS) scores. METHODS: This analysis includes data from an international registry and includes patients with paired (left and right eye) quantitative pupillometry readings linked to discharge mRS scores. Anisocoria was defined as the absolute difference in pupil size using three common cut points (> 0.5 mm, > 1 mm, and > 2 mm). Nonparametric models were constructed to explore patient outcome using three predictors: the presence of anisocoria at rest (in ambient light); the presence of anisocoria after light stimulus; and persistent anisocoria (present both at rest and after light). The primary outcome was discharge mRS score associated with the presence of anisocoria at rest versus after light stimulus using the three commonly defined cut points. RESULTS: This analysis included 152,905 paired observations from 6,654 patients with a mean age of 57.0 (standard deviation 17.9) years, and a median hospital stay of 5 (interquartile range 3-12) days. The mean admission Glasgow Coma Scale score was 12.7 (standard deviation 3.5), and the median discharge mRS score was 2 (interquartile range 0-4). The ranges for absolute differences in pupil diameters were 0-5.76 mm at rest and 0-6.84 mm after light. Using an anisocoria cut point of > 0.5 mm, patients with anisocoria after light had worse median mRS scores (2 [interquartile range 0-4]) than patients with anisocoria at rest (1 [interquartile range 0-3]; P < .0001). Patients with persistent anisocoria had worse median mRS scores (3 [interquartile range 1-4]) than those without persistent anisocoria (1 [interquartile range 0-3]; P < .0001). Similar findings were observed using a cut point for anisocoria of > 1 mm and > 2 mm. CONCLUSIONS: Anisocoria after light is a new biomarker that portends worse outcome than anisocoria at rest. After further validation, anisocoria after light should be considered for inclusion as a reported and trended assessment value.

Time to maximum pupil constriction is variable in neurocritical care patients.

Quantitative pupillometry (QP) use has grown exponentially. Each QP scan captures images of the pupil before, during, and after light exposure to provide component measures of the pupillary light reflex (PLR). This study explores if the time to maximum constriction (tMC) is uniform among neuroscience intensive care unit (NSICU) patients. The study enrolled 50 NSICU patients with normal PLR values in a cross-sectional study and adhered to the standard of care for pupil assessments to collect data on tMC within (comparing left eye and right eye) and between patients. The mean tMC of 0.97 (0.17) s was normally distributed across all patients and ranged from 0.46 s to 1.35 s. The mean tMC was similar for the left pupil (0.98 [0.16]s) and right pupil (0.96 [0.18]s; P =.546). The within-subject mean difference (left versus right eye) tMC was 0.13 (0.12)s and ranged from 0.0 to 0.56 s. The between-subject mean tMC was 0.97 (0.17) s and ranged from 0.46 s to 1.35 s. The tMC does not occur at a fixed point in time. Clinical applications that seek to characterize pupil health should account for varied tMC and explore relationships to discrete outcomes to determine the clinical usefulness of tMC.

Impact of Dysphonic Schoolteachers' Voices on Children's Reaction Times according to Phonemic Contrasts.

INTRODUCTION: This paper aimed at observing the impact of dysphonic voice on children's reception of a linguistic message by evaluating their reaction times (RTs) to instructions given by functional dysphonic and control female schoolteachers (STs). METHODS: French minimal pairs such as /muʃ/ ("mouche" fly) versus /buʃ/ ("bouche" mouth) embedded in a carrier sentence "click on the drawing of…" were produced by two groups of 10 dysphonic and control female ST, matched in age and year of experience. The phonemical contrasts observed are voicing, nasality, consonantal place of articulation, vowel roundedness, and vowel place of articulation. The experimentation was presented in the form of a computer game to children from 7 to 10 years old. Two images illustrating the target words were presented, accompanied by the oral instructions recorded by ST. With a two-button box created for the experiment, children had to click as quickly as possible on the image corresponding to the instruction. RESULTS: Our results show that the RTs of all children are affected by the ST's dysphonia, regardless of their age and that they have significantly longer RT when discriminating minimal pairs contrasting in voicing when the instruction is given by a dysphonic speaker compared to the same instruction given by a control speaker. CONCLUSION: These observations could be explained by the fact that functional dysphonia is associated with improper use of the vocal folds and thus an alteration of voicing.

Eating and lifestyle habits and primary school health-related pro-grams: a survey involving Italian children and teachers.

Background: Childhood overweight and obesity represent serious public health concerns in several countries worldwide, including Italy, where the highest prevalence in Europe of overweight and obesity among primary school children was recorded. Among others, primary schools represent suitable social environments for health education projects. In this perspective, to optimize resources and plan successful activities, it is necessary, first of all, to analyze the context of the intervention. Study design: A pilot survey involving children and teachers was conducted in a primary school in Jesi (Le Marche Region, Italy). Methods: A questionnaire was submitted by teachers between May and June 2023 to 104 pupils (aged 6-11) from the five different primary school system classes. A qualitative questionnaire was also filled out by the same teachers (n = 5) who were present while the children were filling the eating/lifestyle questionnaire. Results: Most of the children (96.1%) had breakfast before school, with milk and cereal (51.5%) representing the preferred com-bination. During recess, 59.2% of pupils usually have a sandwich, 23.3% usually have sweet snacks, whereas only 2.9% have a fruit. Over 55% of the sample preferred drinking high-sugar beverages to water, and 15.5% declared going to a fast-food restaurant more than once a week. Over 17% of children did sport only once a week or less often. Over 64% of children habitually played videogames, and 77.6% normally watched TV or played with a tablet/smartphone while eating. Finally, the teachers' interview highlighted that there were no active health-related projects addressed to the pupils, and the school did not normally organize me-etings with health professionals to increase children's and their parents' knowledge and awareness about healthy eating habits. Conclusions: This preliminary investigation analyzed the context for a future health and nutrition education project and will assist researchers in planning successful activities and increasing the efficiency of the intervention.

Health-saving technologies as a need and lifestyle of Ukrainians.

OBJECTIVE: Aim: The article analyzes the health-saving technologies of Ukrainians in Eastern Galicia (the end of the XIX century - 1939). PATIENTS AND METHODS: Materials and Methods: In the investigation a number of scientific methods are used: chronological, historical, specific-search, content analysis, providing selection, analysis of the source base, allowing to identify general trends, directions of development, achievements and gaps in the movement for the health of children and adults in Galicia; sources of Ukrainian and Polish authors of different generations in the field of health protection and preservation, physical education and sports, education and upbringing were used, their views and research results were presented. CONCLUSION: Conclusions: A component of the health-saving philosophy of Ukrainians (children, youth and adults) of Eastern Galicia in the late XIX - 30s of the XX century was the idea of physical education. Through traveling and camping, playing sports, improving children, youth and adults in places of active recreation (≪dwellings,≫ ≪half-dwellings,≫ ≪cuttings,≫ etc.), the philosophy of health conservation took a leading position in the interwar period of the XX century. The physical education movement had particular successes when a wide circle of Ukrainian youth joined it. There was an original Plast method of physical education of a Ukrainian - physically, spiritually, morally, mentally healthy person, for whom health preservation is a way and philosophy of life, a vital need. All this actualizes the problem of health-oriented public initiatives, which should be creatively used in the current challenges in Ukraine.

Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury.

Background: Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI). Materials and methods: The study was carried out between October 2020 and March 2022. Patients who presented to the hospital with TBI were assessed for inclusion. Initial coma scores were assessed in the emergency department and again after 48 hours of admission. Outcome was assessed using the extended Glasgow outcome score (GOSE) at 3 months after injury. The receiver operating curve (ROC) was plotted to correlate coma scores with the outcome, and the area under the curve (AUC) was compared. Results: A total of 355 patients with TBI were assessed for eligibility, of which 204 patients were included in the study. The AUC values to predict poor outcomes for initial GCS, FOUR, and GCS-P scores were 0.75 each. The AUC values for 48-hour coma scores were 0.88, 0.87, and 0.88, respectively. Conclusion: The GCS, FOUR, and GCS-P scores were found to be comparable in predicting the functional outcome at 3 months as assessed by GOSE. However, coma scores assessed at 48 hours were better predictors of poor outcomes at 3 months than coma scores recorded initially at the time of hospital admission. How to cite this article: Chawnchhim AL, Mahajan C, Kapoor I, Sinha TP, Prabhakar H, Chaturvedi A. Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury. Indian J Crit Care Med 2024;28(3):256-264.

[Historical aspects of the formation and development of children's health resort medicine in the Samara region]. / Istoricheskie aspekty formirovaniya i razvitiya detskoi kurortnoi meditsiny v Samarskom regione.

Archive documents and sources in scientific electronic databases were analyzed in order to study the historical origins of the health resort business in terms of children's health resort medicine in the Samara government. It has been established that the period of origin and intensive development of balneology for children in the Samara region occurred at the beginning of the 20th century and the first children's sanatoriums began to function thanks to the initiative of the Society of Governmental Physicians for charitable funds of the Samara nobility and merchantry in territories with natural and climatic therapeutic factors, namely Sernovodsky resort, Barboshina glade and Postnikov ravine. A comparative analysis of the dynamics of morbidity structure of children admitted for sanatorium treatment, as well as general education institutions, from which information on the health of school pupils is received, has been conducted over a period of 120 years. Despite the change of years and generations, there is a general concept of sanatorium health improvement of school pupils as a future social and economic pillar of society, with the formation of a healthy generation for both the region and the country in general.

Boys perpetrating sexual harassment on peer girls in secondary school: A focus group study about pupils' experiences.

AIMS: To explore experiences of sexual harassment of adolescent girls by peer boys during school hours. METHODS: Focus group study with a convenience sample of six girls and 12 boys aged 13-15 years from two different lower secondary schools in Norway. Thematic analysis with Systematic Text Condensation was used with data from three focus group discussions, supported by theory about gender performativity. RESULTS: Analysis demonstrated how girls experienced specific aspects of unwanted sexual attention perpetrated by male peers. When boys trivialized sexualized behaviour perceived as intimidating by girls, the behaviour was perceived as 'normal'. Among the boys, sexual name-calling was only meant as a joke to put the girls in their place, while girls were silenced. In this way, patterns of gendered interaction contribute to performing and maintaining sexual harassment. Responses from co-pupils and teachers had strong impact on further harassment, contributing to either escalation or resistance. Signalling disapproval when being harassed was difficult when bystander behaviour was lacking or degrading. The participants wanted teachers to intervene in response to sexual harassment, emphasizing that being present or showing concern is not enough to stop the harassment. The lack of proactive responses from bystanders may also represent gender performativity, where invisibility contributes to social conventions such as normalization. CONCLUSIONS: Our analysis indicates a need for interventions targeting sexual harassment among pupils in Norwegian schools, with a special awareness of gendered performance. Both teachers and pupils would benefit from increased knowledge and skills in how to detect and stop unwanted sexual attention.

External validation of the GCS-Pupils Score as an outcome predictor after traumatic brain injury in adults: a single-center experience.

OBJECTIVE: The GCS-Pupils (GCS-P) score is a recently described scoring system to aid outcome prediction in patients with traumatic brain injury (TBI). The aim of this study was to provide the first external validation of the GCS-P score by identifying independent predictors of outcome in TBI patients. METHODS: Review of prospective adult (≥ 16 years) TBI database at a tertiary neurosurgical center with a catchment population of 1.5 million over a 12-month period commencing October 2016. Multivariate logistic regression was used to identify predictors of discharge destination and 30-day mortality. RESULTS: Three hundred and fifty-eight patients were included. The median age was 60 years with a male predominance of 64%. The median GCS-P was 14 (interquartile range 12-15) and the commonest GCS-P category was mild (13-15; 238/358, 66%). Discharge destination was home in 69% of patients and rehab services or equivalent in 31%. Multivariate analysis identified age (p = 0.01), CT findings of an acute subdural hematoma (p = 0.01) or diffuse axonal injury (p = 0.02), and a neurosurgical operation (p = 0.02) as independent predictors of discharge destination. The 30-day mortality rate was 11%. Within the category of severe TBI (GCS-P ≤ 8), GCS-P was able to identify patients with a very high likelihood of 30-day mortality (GCS-P ≤ 4; 16/31, 52%). Multivariate analysis revealed the Charlson comorbidity score (p = 0.01), GCS-P (p = 0.02), and traumatic subarachnoid hemorrhage (p = 0.05) as independent predictors of mortality. CONCLUSION: The GCS-P is a useful predictor of 30-day mortality, although its usefulness for other clinical outcomes remains to be proven.

Evaluation of the GCS-Pupils Score for PrOgnosis in trauMatic brAin injury- The COMA Study.

OBJECTIVES: Glasgow Coma Scale-Pupils (GCS-P) score has been found to be strongly related to in-hospital mortality in retrospective studies. We hypothesized that GCS-P would be better prognosticator than Glasgow Coma Scale (GCS) in patients with traumatic brain injury (TBI). METHODS: In this prospective, multicentric, observational study, GCS and GCS-P scores were noted in adult TBI patients at ICU admission. Demographic variables, relevant clinical history, clinical/radiological findings and ICU complications were also noted. Extended Glasgow Outcome scale was noted at hospital discharge and at 6 months post-injury. Logistic regression analysis was carried out to estimate the odds for poor outcome adjusted for covariates. Sensitivity, specificity, area under curve (AUC) and odds ratio are reported for poor outcome at estimated cutoff point. RESULTS: A total of 573 patients were included in this study. The predictive power for mortality, shown by the AUC, was 0.81 [95% CI: 0.77-0.85] for GCS and 0.81 [95% CI: 0.77-0.86] for GCS-P score, both being comparable. Similarly, the predictive ability for outcome at discharge and 6 months, the AUC-ROC for both GCS and GCS-P were comparable. CONCLUSIONS: GCS-P is a good predictor of mortality and poor outcome. However, the predictive performance of GCS and GCS-P for in-hospital mortality and functional outcome at discharge and at 6 months remains comparable.

Oral pathology and overweight among pupils in government primary schools in Cameroon: a cross-sectional study.

BACKGROUND: Tooth decay and periodontal diseases are the main oral pathologies in the world. The prevalence of overweight in children has increased worldwide. Overweight children have alterations in the composition of saliva and excessive consumption of saturated fatty acids tend to slow the metabolism of carbohydrates in the oral cavity leading to tooth decay, periodontal disease and others oral disorders. The aim of this study was to assess the relationship between oral pathologies and overweight in pupils of primary schools of Cameroon. METHODS: A cross-sectional study was carried out from June to August 2020 in four government primary schools selected through cluster sampling in Yaounde. 650 pupils aged between 6 and 11 years were enrolled. Data collected included anthropometric, oral pathologies, quality of oral hygiene and feeding habits. Data were analysed with the SPSS 26.0 statistical software and binary logistic regression was used to determine the risks of oral pathologies in overweight pupils. P-value of 0.05 was considered statistically significant. RESULTS: The prevalence of overweight was 27% (95% CI: 23.5-30.5). The main oral pathologies was tooth decay (60.3%). Binary logistic regression revealed that overweight pupils were significantly 1.5 times more likely to develop tooth decay than non-overweight pupils (95% CI: 1.1-2.4). CONCLUSION: Overweight, tooth decay are prevalent among pupils. Overweight pupils have a higher risk of developing tooth decay compared to non-obese pupils. An integrated package of oral and nutritional health promotion activities is necessary in primary schools in Cameroon.

Parents' Approaches to Their Children's Education and Related Issues During the COVID-19 Pandemic in the Slovak and the Czech Republic.

In this article, we present the results of the qualitative research and the thematic discourse analysis of discussions of Facebook groups of parents of pupils in Slovakia and the Czech Republic. The aim was to identify how the parents perceived the issue of distance learning during the COVID-2 pandemic and how they approached the problems that they encountered. Parents step into the role of a teacher and of a pupil; they are participants and observers of the educational process and advisors and supporters of their children. They evaluate the educational process from the didactics and the instructive point of view but they lack competencies that belong to teachers. Insufficient digital literacy and lacking equipment in households regarding ICT represent a weak point. Problems linked to the loss of social contacts and isolation are growing in number. Families also struggle with economic and logistics problems.

Anticholinergic syndrome: blurred vision and headache.

A young woman presented with blurred vision due to anticholinergic syndrome. We highlight the importance of considering this condition in the context of multiple medications and increased anticholinergic burden. The documented pupil abnormality gives an opportunity to review the syndrome of the reverse (inverse) Argyll Robertson pupil (preserved pupil light response with loss of accommodation). We review other situations in which the reverse Argyll Robertson pupil may occur and its possible mechanism in this case.

Acute angle closure glaucoma misdiagnosed as sinusitis.

A 69-year-old woman developed severe right suprabulbar pain with blurred right-sided vision. There were no haloes around lights, photophobia, nausea or vomiting. Investigations in the emergency department excluded a posterior communicating/internal carotid artery aneurysm. However, she did not have an ophthalmological assessment and the initial diagnosis was of sinusitis-related headache. An urgent ear, nose and throat assessment found no abnormality, but a local ophthalmologist subsequently diagnosed and managed the patient's acute angle closure crisis. Periocular pain always deserves detailed assessment with an accurate history, visual acuity assessment and intraocular pressure measurement.

Conditions for Successful Learning of Primary School Pupils in the Context of Integrated Education: A Case Study.

Contemporary educational theory and practice increasingly emphasise the importance of integrated education in creating the conditions for success for primary school students. In Lithuania, as part of the 2020-2024 curriculum update and the development of general curricula, integrated education is highlighted as one of the priorities for achieving harmony between pupils' academic achievements and the development of general competences, as well as the creation of a favourable emotional environment for pupils. This creates a strategic perspective on the content of education. However, there is a lack of research and insights into how such practices can be developed smoothly. For this reason, our research was carried out by targeting one of the Francophone institutes in southern France, which has successfully implemented an integrated education practice that enables learning for every pupil in the primary grades. The study analysed the context, i.e. the concept of the educational institution's activities, which shows what should be done and how it should be done in order to achieve the quality of integrated education. In addition, the data were obtained through semi-structured interviews with 4 teachers at the Institute with experience in integrated education. Qualitative content analysis was used to inductively search for answers describing the essence of integrated education, the most important processes to reflect on before engaging with pupils, and to deductively identify how certain elements contribute to creating the conditions conducive to integrated education and pupils' successful learning.

Objective health literacy skills among ninth graders in Finland: outcomes from a national learning assessment.

BACKGROUND: Health literacy (HL) is an important determinant for maintaining and improving health throughout the lifespan. This underlines the need to monitor HL, including among adolescents, and to understand the factors explaining HL, with a view to decreasing differences in HL. The aim of this study was to objectively measure HL, and the relationship between HL and socio-demographic factors (gender, language of instruction, pupils' educational aspirations, parents' educational background and pupils' school achievement) among pupils (n = 3652) at the end of basic education in Finland. METHODS: A nationally representative assessment, which included 55 items on HL, was conducted as a traditional paper-and-pencil test in schools. The data were analysed via descriptive statistics and a two-level hierarchical linear model to determine how the socio-demographic factors affected HL. RESULTS: The pupils' average score on the HL test items was 58.9%, indicating a satisfactory HL level. A two-level hierarchical linear model showed that the variables (gender, language of instruction, pupils' educational aspirations, parents' educational background and pupils' school achievement) predicting the HL level had statistically significant effects. CONCLUSIONS: Among ninth graders (15-16 years old), almost one third of the boys and 8% of the girls exhibited an unsatisfactory HL level. The study also confirmed the importance of school-related factors in explaining HL differences. Since low HL has been linked to several unfavourable health indicators and has been viewed as an underestimated problem in times of pandemic and other health crises, the findings suggest that the HL level of Finnish ninth graders is a clear public-health issue.

The association between pupils´ aggressive behaviour and burnout among Danish school teachers - the role of stress and social support at work.

BACKGROUND: Pupils´ aggressive behaviour towards teachers is a serious problem which is slowly gaining attention and has been found to be linked to burnout. However, prospective studies investigating the role of stress and social support from colleagues and supervisor are lacking. Therefore, the aims of the present study were 1. to investigate the association between pupils´ aggressive behaviour and burnout among Danish primary and lower secondary school teachers, 2. to investigate whether the association between pupils´ aggressive behaviour and burnout depends on the level and duration of stress, and 3. to investigate whether social support from colleagues or a supervisor at the work place has a mitigating effect on the association between pupils´ aggressive behaviour and burnout among teachers. METHODS: This study is a longitudinal study using data from 1198 teachers collected in two survey rounds at an interval of 1-year. Teacher-reported aggressive behaviour in pupils measured as harassment, threats, and violence towards teachers was collected at baseline. Burnout was measured at follow-up. The analyses were performed using multilevel logistic regression. RESULTS: Statistically significant associations between harassment, threats, or violence and burnout 1 year later were found (all ORs 1.6) after adjustment for potential confounders. After further adjustment for stress, the estimates attenuated to ORs between 1.4 and 1.5, and were also statistically significant. Pupils´ aggressive behaviour in combination with low support from colleagues increased the risk of burnout, whereas the risk of burnout increased among those experiencing pupils´ aggressive behaviour in combination with receiving high support from the supervisor. CONCLUSIONS: The results indicate associations between all three types of pupils´ aggressive behaviour and burnout among teachers in Danish primary and lower secondary schools. Stress explained only a minor part of the association between teachers' perceptions of pupils' aggressive behaviour and burnout in teachers, and the results regarding social support were conflicting. The results of this study emphasize the growing need for preventive initiatives directed towards pupils´ aggressive behaviour, and future research should focus on exploring in depth how to support and prevent burnout in teachers exposed to aggressive behaviour.

Experience with open schools and preschools in periods of high community transmission of COVID-19 in Norway during the academic year of 2020/2021.

BACKGROUND: Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we describe cases and outbreaks of COVID-19 in schools and preschools during the academic year 2020/2021, to evaluate the strategy of keeping these open with infection prevention control measures in place. METHODS: In this descriptive study, the Norwegian Institute of Public Health initiated systematic surveillance for COVID-19 cases and outbreaks in schools and preschools in October 2020. Data was compiled from the national outbreak alert system VESUV, municipality websites, and media scanning combined with the national emergency preparedness register Beredt C-19. An outbreak was defined as ≥ 2 cases among pupils or staff within 14 days at the same educational setting. Settings were categorized as preschool (1-5-years), primary school (6-12-years), lower secondary school (13-15-years) and upper secondary school (16-18- years). We reported the incidence rate among preschool and school-aged pupils and gave a descriptive overview of outbreaks and included cases per educational setting. RESULTS: During the whole academic year, a total of 1203 outbreaks in preschools and school settings were identified, out of a total of 8311 preschools and schools nationwide. The incidence of COVID-19 in preschool- and school-aged children and the rates of outbreaks in these settings largely followed the community trend. Most of the outbreaks occurred in primary schools (40%) and preschools (25%). Outbreaks across all settings were mostly small (median 3 cases, range 2 to 72), however, 40 outbreaks (3% of total) included 20 or more cases. The larger outbreaks were predominantly seen in primary schools (43%). CONCLUSIONS: We observed few large outbreaks in open schools and preschools in Norway during the academic year of 2020/2021, also when the Alpha variant was predominant. This illustrates that it is possible to keep schools and preschools open even during periods of high community transmission of COVID-19. Adherence to targeted IPC measures adaptable to the local situation has been essential to keep educational settings open, and thus reduce the total burden on children and adolescents.