Adherence of Brazilian Minors to the 24-Hour Movement Guidelines after In-Person School Return.

The levels of adequacy of movement behaviors after returning to in-person school activities following the COVID-19 pandemic are not yet well understood. This study aimed to assess the adherence of Brazilian minors to the recommendations of the 24-Hour Movement Guidelines (moderate to vigorous physical activity, recreational screen time, and sleep duration), as well as overall adherence to these guidelines, after the relaxation of COVID-19 social isolation measures and the resumption of in-person schooling. A cross-sectional study was conducted with parents or guardians (39 ± 7.8) of minors aged up to 18 years of age (3.8 ± 2.5). A total of 172 individuals responded to the questionnaire. Data were compared with those obtained in the Survey of the Adequacy of Brazilian Children and Adolescents to the 24-Hour Movement Guidelines before and during the COVID-19 Pandemic. There was an 18.6 percentage decrease (p-value < 0.001) in overall adherence to the 24-Hour Movement Guidelines when comparing the periods before the COVID-19 pandemic (March 2020) and after the return to in-person schooling (March 2021). The largest percentage drop in adherence between these periods was observed for moderate to vigorous physical activity (27.4%; p-value < 0.001) and the lowest for sleep (10.5%; p-value < 0.001). Adherence to the 24-Hour Movement Guidelines did not return to pre-pandemic levels with the resumption of in-person school activities.

Examining for gender differences in return to learn following sport-related concussion in high school student athletes.

OBJECTIVE: Prior studies have investigated associations between gender, symptom resolution, and time to return to play following sport-related concussion (SRC). However, there is a notable gap in research regarding the association between gender and return to learn (RTL) in adolescents. Therefore, this study 1) compared the patterns of RTL between boys and girls who are high school student athletes, and 2) evaluated the possible association between gender and time to RTL after adjusting for covariates. METHODS: A retrospective cohort study of a prospective surveillance program that monitored concussion recovery of athletes in high schools throughout the state of Maine between February 2015 and January 2023 was performed. The primary independent variable was gender, dichotomized as boys and girls. The primary outcome was time to RTL, defined by the number of days for an athlete to return to school without accommodations. Mann-Whitney U-tests were used to compare RTL between the boys and girls. Each athlete's RTL status was dichotomized (i.e., returned vs had not returned) at several time points following injury (i.e., 1, 2, 3, and 4 weeks), and chi-square tests were performed to compare the proportions who achieved RTL between groups. Multivariable linear regression analyses were performed to evaluate the predictive value of gender on RTL. Covariates included age, number of previous concussions, history of learning disability or attention-deficit disorder or attention-deficit/hyperactivity disorder, history of a psychological condition, history of headaches or migraines, initial Sport Concussion Assessment Tool (SCAT3/SCAT5) score, and days to evaluation. RESULTS: Of 895 high school athletes, 488 (54.5%) were boys and 407 (45.5%) were girls. There was no statistically significant difference in median [IQR] days to RTL between genders (6.0 [3.0-11.0] vs 6.0 [3.0-12.0] days; U = 84,365.00, p < 0.375). A greater proportion of boys successfully returned to learn without accommodations by 3 weeks following concussion (93.5% vs 89.4%; χ2 = 4.68, p = 0.030), but no differences were found at 1, 2, or 4 weeks. A multivariable model predicting days to RTL showed that gender was not a significant predictor of RTL (p > 0.05). Longer days to evaluation (ß = 0.10, p = 0.021) and higher initial SCAT3/SCAT5 scores (ß = 0.15, p < 0.001) predicted longer RTL. CONCLUSIONS: In a cohort of high school athletes, RTL did not differ between boys and girls following SRC. Gender was not a significant predictor of RTL. Longer days to evaluation and higher initial symptom scores were associated with longer RTL.

Describing High School Stakeholders' Preferences for a Return-to-School Framework Following Concussion.

BACKGROUND: Return to school supports are recommended to facilitate adolescents' re-entry to school following a concussion. However, little is known as to what school stakeholders prefer for a return-to-school process. This study sought to describe the preferences of high school students, parents, and educators for a Return-to-School Framework for adolescents following a concussion. METHODS: We conducted qualitative semi-structured, 1-on-1 or group interviews with high school students (n = 6), parents (n = 5), and educators (n = 15) from Calgary, Canada. Interviews aimed to describe participants' preferences for a Return-to-School Framework for students following a concussion. Interviews were analyzed using conventional content analysis. RESULTS: We organized the data into 4 main themes: (1) purpose of the Return-to-School Framework; (2) format and operation of the Return-to-School Framework; (3) communication about a student's concussion; and (4) necessity of concussion education for students and educators. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: A Return-to-School Framework following concussion should be developed in consultation with families, educators, and students and supports should be tailored to each student. CONCLUSIONS: Participants preferred a standardized and consistent Return-to-School Framework including ongoing communication between stakeholders as well as feasible and individualized school supports.

Delirium following traumatic brain injury in adolescents: Symptomatology and prediction of ability to return to school or employment 1-year post-injury.

BACKGROUND: There is a limited evidence-base describing clinical features of delirium in youth. What is known is largely extrapolated from studies of adults or samples with heterogeneous etiologies. It is unclear if the symptoms experienced by adolescents differ from those experienced by adults, or the degree to which delirium impacts the ability of adolescents to return to school or work. OBJECTIVE: To describe delirium symptomatology among adolescents following a severe traumatic brain injury (TBI). Symptoms were compared by adolescent delirium status and across age groups. Delirium and its relationship with adolescent employability 1 year post-injury was also examined. DESIGN: Exploratory secondary analysis of prospectively collected data. SETTING: Free-standing rehabilitation hospital. PATIENTS: Severely injured TBI Model Systems neurorehabilitation admissions (n = 243; median Glasgow Coma Scale = 7). The sample was divided into three age groups (adolescents, 16-21 years, n = 63; adults 22-49 years, n = 133; older adults ≥50 years, n = 47). INTERVENTIONS: Not applicable. MEASURES: We assessed patients using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria and the Delirium Rating Scale-Revised 98 (DRS-R-98). The employability item from the Disability Rating Scale was the primary 1-year outcome. RESULTS: Most items on the DRS-R-98 differentiated delirious from non-delirious adolescents. Only "delusions" differed among age groups. Among adolescents, delirium status 1 month post-TBI provided acceptable classification of employability prediction 1 year later (area under the curve [AUC]: 0.80, 95% confidence interval [CI]: 0.69-0.91, p < .001). Delirium symptom severity (AUC: 0.86, 95% CI: 0.68-1.03, SE: 0.09; p < .001) and days of post-traumatic amnesia (AUC: 0.85, 95% CI: 0.68-1.01, SE: 0.08; p < .001) provided excellent prediction of outcomes for TBI patients in delirium. CONCLUSIONS: Delirium symptomatology was similar among age groups and useful in differentiating the delirium status within the adolescent TBI group. Delirium and symptom severity at 1 month post-TBI were highly predictive of poor outcomes. Findings from this study support the utility of DRS-R-98 at 1 month post-injury to inform treatment and planning.

Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program.

Objective: To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life. Design: Retrospective cohort study. Setting: Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs. Patients: Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021. Interventions: None. Measurements and Main Results: One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation. Conclusions: Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.

The impact of core self-evaluation on school adaptation of high school students after their return to school during the COVID-19 pandemic: the parallel mediation of positive and negative coping styles.

Background: To explore the direct effect of core self-evaluation and the indirect effects of positive and negative coping styles on school adaptation of high school students after their return to school during the COVID-19 pandemic. Methods: The Core Self-Evaluation Scale, Simple Coping Style Scale, and School Adaptation Questionnaire were used for the psychometric analysis of 500 high school students (229 males and 271 females) one month after their return to school. The bootstrap method was applied for mediation analysis. Results: A positive correlation was noted between core self-evaluation and school adaptation (r = 0.56), and the predictive effect was significant (ß = 0.43). Core self-evaluation positively predicted positive coping styles, which positively predicted school adaptation, while core self-evaluation negatively predicted negative coping styles, which negatively predicted school adaptation. Positive and negative coping styles played a significant mediating role between core self-evaluation and school adaptation. The mediating effect included the indirect effects generated by two pathways: core self-evaluation → positive coping style → school adaptation (95% CI [0.08-0.19]) and core self-evaluation → negative coping style → school adaptation (95% CI [0.03-0.11]). Conclusion: There is a positive association between the core self-evaluation and school adaptation of high school students after their return to school during the COVID-19 pandemic. It may directly or indirectly affect the school adaptation of high school students after their return to school through positive or negative coping styles. After returning to school, educators should guide students to view themselves positively, cultivate healthy core self-evaluation, and enable them to have good school adaptation.

Desempenho de pré-escolares em vocabulário e habilidades preditivas no ensino híbrido / Preschool performance in vocabulary and predictive skills in blended learning / Desempeño de preescolares en vocabulario y habilidades predictivas en aprendizaje combinado

Introdução: O ensino remoto limitou a vivência de experiências concretas em espaços coletivos de formação de conhecimentos e intensificou a vulnerabilidade infantil quanto à educação formal, em especial as crianças em fase inicial de alfabetização. A partir deste panorama, tornou-se fundamental investigar o desempenho de escolares em busca de informações sobre a repercussão ocasionada pela pandemia de COVID-19 ao desenvolvimento infantil. Objetivo: Verificar o desempenho de pré-escolares em vocabulário e habilidades preditivas no ensino híbrido, frente aos impactos da pandemia de COVID-19. Método: Participaram deste estudo 12 escolares, com idade entre 5 a 6 anos, pertencentes ao terceiro período da educação infantil. Para a avaliação foram selecionados o Protocolo de Identificação Precoce dos Problemas de Leitura, e os Testes de Vocabulário Auditivo e de Vocabulário Expressivo. Resultados: Os dados obtidos demonstraram significância estatística para as provas de Vocabulário Receptivo em relação ao Expressivo, Nomeação Automática Rápida e Conhecimento do Alfabeto, Segmentação Silábica e Produção de Rima, acertos para Vocabulário Expressivo e Conhecimento do Alfabeto, assim como para a quantidade de erros em Vocabulário Expressivo e para a Nomeação Automática Rápida. Conclusão: O sucesso almejado para o ingresso no 1º ano do Ensino Fundamental dependerá das variações individuais de cada aluno quanto ao desempenho dos aspectos avaliados neste trabalho e à qualidade dos estímulos recebidos. (AU)

Introduction: Remote teaching limited the experience of concrete experiences in collective spaces for the formation of knowledge and intensified children's vulnerability in terms of formal education, especially children in the initial phase of literacy. From this panorama, it became essential to investigate the performance of students in search of information about the impact caused by the pandemic of COVID-19 on child development. Objective: To verify the performance of preschoolers in vocabulary and predictive skills in hybrid teaching, given the impacts of the COVID-19 pandemic. Method: Participated in this study 12 schoolchildren, aged between 5 and 6 years, belonging to the third period of early childhood education. For the evaluation were selected the Protocol for Early Identification of Reading Problems, and the Auditory Vocabulary and Expressive Vocabulary Tests. Results: The data obtained showed statistical significance for the tests of Receptive Vocabulary in relation to Expressive, Rapid Automatic Naming and Alphabet Knowledge, Syllabic Segmentation and Rhyme Production, correct answers for Expressive Vocabulary and Alphabet Knowledge, as well as for the number of errors in Expressive Vocabulary and for the Automatic Rapid Naming. Conclusion: The desired success for entering the 1st year of Elementary School will depend on the individual variations of each student regarding the performance of the aspects evaluated in this work and the quality of the stimuli received. (AU)

Introducción: La enseñanza a distancia limitó la vivencia de experiencias concretas en espacios colectivos de formación de saberes e intensificó la vulnerabilidad de los niños frente a la educación formal, especialmente de los niños en fase inicial de alfabetización. A partir de este panorama, se hizo imprescindible investigar el desempeño de los escolares en busca de información sobre el impacto que la pandemia de la COVID-19 provocó en el desarrollo infantil. Objetivo: Verificar el desempeño de preescolares en vocabulario y habilidades predictivas en aprendizaje semipresencial, ante los impactos de la pandemia del COVID-19. Método: Participaron en este estudio 12 escolares, con edades comprendidas entre los 5 y 6 años, pertenecientes al tercer ciclo de educación infantil. Para la evaluación se seleccionaron el Protocolo para la Identificación Temprana de Problemas de Lectura, y las Pruebas de Vocabulario Auditivo y Vocabulario Expresivo. Resultados: Los datos obtenidos mostraron significancia estadística para las pruebas de Vocabulario Receptivo en relación con Expresivo, Denominación Automática Rápida y Conocimiento del Alfabeto, Segmentación Silábica y Producción de Rimas, aciertos para Vocabulario Expresivo y Conocimiento del Alfabeto, así como para el número de errores en Vocabulario Expresivo y para Nomenclatura Automática Rápida. Conclusión: El éxito deseado para el ingreso al 1° año de la Enseñanza Fundamental dependerá de las variaciones individuales de cada estudiante en cuanto al desempeño de los aspectos evaluados en este trabajo y la calidad de los estímulos recibidos. (AU)

Clinical recovery from concussion-return to school and sport: a systematic review and meta-analysis.

OBJECTIVE: To define the time frames, measures used and modifying factors influencing recovery, return to school/learn (RTL) and return to sport (RTS) after sport-related concussion (SRC). DESIGN: Systematic review and meta-analysis. DATA SOURCES: 8 databases searched through 22 March 2022. ELIGIBILITY CRITERIA: Studies with diagnosed/suspected SRC and interventions facilitating RTL/RTS or investigating the time and modifying factors for clinical recovery. Outcomes included days until symptom free, days until RTL and days until RTS. We documented study design, population, methodology and results. Risk of bias was evaluated using a modified Scottish Intercollegiate Guidelines Network tool. RESULTS: 278 studies were included (80.6% cohort studies and 92.8% from North America). 7.9% were considered high-quality studies, while 23.0% were considered high risk of bias and inadmissible. The mean days until symptom free was 14.0 days (95% CI: 12.7, 15.4; I2=98.0%). The mean days until RTL was 8.3 (95% CI: 5.6, 11.1; I2=99.3%), with 93% of athletes having a full RTL by 10 days without new academic support. The mean days until RTS was 19.8 days (95% CI: 18.8, 20.7; I2=99.3%), with high heterogeneity between studies. Several measures define and track recovery, with initial symptom burden remaining the strongest predictor of longer days until RTS. Continuing to play and delayed access to healthcare providers were associated with longer recovery. Premorbid and postmorbid factors (eg, depression/anxiety, migraine history) may modify recovery time frames. Though point estimates suggest that female sex or younger age cohorts take longer to recover, the heterogeneity of study designs, outcomes and overlap in CIs with male sex or older age cohorts suggests that all have similar recovery patterns. CONCLUSION: Most athletes have full RTL by 10 days but take twice as long for an RTS. PROSPERO REGISTRATION NUMBER: CRD42020159928.

Why Psychosocial Care Matters: Parent Preparedness and Understanding Predict Psychosocial Function When Children Return to School After Cancer.

Introduction: Psychosocial impacts of cancer are well-recognized for pediatric patients but few studies examine challenges specific to schooling after diagnosis and caregiver-related factors that may influence coping. This study describes caregiver experiences of school-related psychosocial functioning and how caregiver preparedness and understanding of these challenges influence coping. Methods: Caregivers of 175 childhood cancer survivors completed a nationally disseminated survey related to caregiver preparedness, clinician-provided education, and school-related experiences. Caregiver-reported preparedness and understanding were evaluated as predictors of psychosocial coping; factor analysis was performed to identify compound scales of preparedness and understanding. Results: Caregivers reported that the cancer treatment experience resulted in their children being more stressed and anxious about returning to school (60.2% and 70.2%, respectively) and more sensitive to peers (73.4%). It also made it harder for them to socialize and fit in with peers (58.2% and 49.7%, respectively). Caregiver preparedness and understanding predicted improved psychosocial coping with regard to child stress regarding socialization, fitting in, and anxiety but not sensitivity to peers. Teacher supportiveness and caregiver perception of clinician understanding also correlated with function. Discussion: Findings highlight the importance of caregiver education and preparedness as these reliably predict child psychosocial function and coping as they return to school after a cancer diagnosis and that all children are at risk for psychosocial challenges following a cancer diagnosis. Opportunities exist for clinicians to provide more education and anticipatory guidance to families as a potential means to reduce poor coping when a child returns to school following cancer.

Perceived Benefits and Barriers of a COVID-19 Test to Stay Program in a School District Serving Black or African American People With Low Income, December 2021.

OBJECTIVES: Quarantine after exposure to COVID-19 has resulted in substantial loss of in-person learning in schools from prekindergarten through grade 12. Test to Stay (TTS), a strategy that limits the spread of SARS-CoV-2 while prioritizing in-person learning, requires substantial investment in resources. The objective of this study was to assess the perceived benefits, barriers, and facilitators of implementing TTS in an urban school district in the Midwest serving primarily Black or African American people with low income. METHODS: In December 2021, we used a concurrent mixed-methods approach to understand perceived benefits, barriers, and facilitators of implementing TTS by combining quantitative analysis of telephone surveys conducted with parents (n = 124) and a qualitative inquiry involving key informants from the school district and local health department (n = 22). We analyzed quantitative data using descriptive statistics. We used thematic analysis to analyze qualitative data. RESULTS: Quantitative findings showed that parents supported TTS because it was convenient (n = 83, 97%) and effective (n = 82, 95%) in keeping students learning in person (n = 82, 95%) and preventing the spread of COVID-19 (n = 80, 93%). Qualitative interviews with informants found that having a clear protocol and assigning staff to specified tasks allowed for successful TTS implementation. However, insufficient staffing and testing resources, parent mistrust of testing, and lack of communication from schools were perceived barriers. CONCLUSION: The school community strongly supported TTS despite the many implementation challenges faced. This study emphasized the importance of ensuring resources for equitable implementation of COVID-19 prevention strategies and the critical role of communication.

Return to School After Traumatic Brain Injury: Description of Implementation Settings.

OBJECTIVE: Children who experience traumatic brain injury (TBI) of any severity may need accommodations when they return to school-the setting that manages academic achievement and learning. However, variations exist in current return to school (RTS) programs that address a child's transition to school following TBI. This article describes some of these return to school (RTS) programs and how they vary by setting. DESIGN: This article provides insights from a modified evaluability assessment that examined RTS programs and their readiness for rigorous evaluation. A secondary analysis was conducted to better describe the types and location of programs examined. RESULTS: Differences exist in program structure, access, and how care for children is monitored over time. RTS programs that serve children following TBI are located in healthcare settings, schools, and state agencies and vary in models of care due to their location and organizational structure. CONCLUSIONS: Children who experience TBI benefit from a healthcare assessment and follow-up upon RTS that includes parental involvement. Models of care for this process vary based on program location and organizational structure. Further research and program evaluation are needed to better understand effectiveness and how to optimally monitor and care for children returning to school after a concussion or TBI.

Attitudes and practices of specialty physicians regarding the return to school process after pediatric acquired brain injury.

PURPOSE: More than 50,000 children are hospitalized yearly in the U.S. for acquired brain injury (ABI) with no established standards or protocols for school re-entry and limited resources for hospital-school communication. While ultimately the school has autonomy over curricula and services, specialty physicians were asked about their participation and perception of barriers in the school re-entry process. METHODS: Approximately 545 specialty physicians were sent an electronic survey. RESULTS: 84 responses (43% neurologists and 37% physiatrists) were obtained with a response rate of ∼15%. Thirty-five percent reported that specialty clinicians currently make the plan for school re-entry. The biggest challenge for school re-entry noted by physicians was cognitive difficulties (63%). The biggest gaps perceived by physicians were a lack of hospital-school liaisons to help design and implement a school re-entry plan (27%), schools' inability to implement a school re-entry plan (26%), and an evidence-based cognitive rehab curriculum (26%). Forty-seven percent of physicians reported that they did not have adequate medical personnel to support school re-entry. The most commonly used outcome measure was family satisfaction. Ideal outcome measures included satisfaction (33%) and formal assessment of quality of life (26%). CONCLUSION: These data suggest that specialty physicians identify a lack of school liaisons in the medical setting as an important gap in hospital-school communication. Satisfaction and formal assessment of quality of life are meaningful outcomes for this provider group.

Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury.

Importance: Determining how the timing of return to school is related to later symptom burden is important for early postinjury management recommendations. Objective: To examine the typical time to return to school after a concussion and evaluate whether an earlier return to school is associated with symptom burden 14 days postinjury. Design, Setting, and Participants: Planned secondary analysis of a prospective, multicenter observational cohort study from August 2013 to September 2014. Participants aged 5 to 18 years with an acute (<48 hours) concussion were recruited from 9 Canadian pediatric emergency departments in the Pediatric Emergency Research Canada Network. Exposure: The independent variable was the number of days of school missed. Missing fewer than 3 days after concussion was defined as an early return to school. Main Outcomes and Measures: The primary outcome was symptom burden at 14 days, measured with the Post-Concussion Symptom Inventory (PCSI). Symptom burden was defined as symptoms status at 14 days minus preinjury symptoms. Propensity score analyses applying inverse probability of treatment weighting were performed to estimate the relationship between the timing of return to school and symptom burden. Results: This cohort study examined data for 1630 children (mean age [SD] 11.8 [3.4]; 624 [38%] female). Of these children, 875 (53.7%) were classified as having an early return to school. The mean (SD) number of days missed increased across age groups (5-7 years, 2.61 [5.2]; 8-12 years, 3.26 [4.9]; 13-18 years, 4.71 [6.1]). An early return to school was associated with a lower symptom burden 14 days postinjury in the 8 to 12-year and 13 to 18-year age groups, but not in the 5 to 7-year age group. The association between early return and lower symptom burden was stronger in individuals with a higher symptom burden at the time of injury, except those aged 5 to 7 years. Conclusions and Relevance: In this cohort study of youth aged 5 to 18 years, these results supported the growing belief that prolonged absences from school and other life activities after a concussion may be detrimental to recovery. An early return to school may be associated with a lower symptom burden and, ultimately, faster recovery.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses.

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

Double Vision and Light Sensitivity Symptoms are Associated With Return-to-School Timing After Pediatric Concussion.

OBJECTIVE: To determine the association between academic time loss postconcussion and vision symptoms/impairments among pediatric patients. DESIGN: Cross-sectional. SETTING: Sports medicine clinic. PATIENTS: Pediatric patients seen for care in a sports medicine clinic between the ages 6 and 18 years (n = 212; mean age = 14.3, SD = 2.4 years; 48% female) were evaluated within 21 days of concussion (mean = 9.8, SD = 5.7 days). INDEPENDENT VARIABLE: Patients were grouped based on academic time loss (missed >5 days vs ≤5 days of school) at their initial postconcussion evaluation. OUTCOME MEASURES: Patients rated concussion symptoms using the Health and Behavior Inventory (HBI) and underwent near point of convergence (NPC) testing. We compared groups on specific HBI symptom ratings of dizziness, blurry vision, seeing double, and light sensitivity, as well as NPC break and recovery point distances. RESULTS: Two hundred twelve patients were included; n = 36 (17%) who reported missing >5 days of school. After adjusting for time since injury, parental education level, mechanism of injury, and preinjury anxiety, patients who reported missing >5 days of school had higher ratings of double vision (ß = 0.27; 95% confidence interval [CI], 0.01-0.53; P = 0.04) and light sensitivity (ß = 0.506; 95% CI, 0.061-0.951; P = 0.02), but not dizziness (ß = 0.390; 95% CI, -0.047 to 0.827; P = 0.08) or blurry vision (ß = 0.026; 95% CI, -0.352 to 0.404; P = 0.89). CONCLUSION: Missing >5 days of school was associated with worse double vision and light sensitivity symptoms. Given the importance of vision in learning, assessing postconcussion vision symptoms may facilitate a successful return to school. Clinicians should assess a wide spectrum of vision-specific symptoms to ensure appropriate support during the return-to-school process.

Time to return to school following ACL reconstruction: influence of the COVID-19 pandemic.

INTRODUCTION: ACL reconstruction is commonly performed in school-aged patients for whom missed time from school can have an impact on their education. Additionally, the COVID-19 pandemic has led to different ways of accessing school content. We sought to determine how many days of school school-aged patients should expect to miss following ACL reconstruction and how the availability of remote learning during the COVID-19 pandemic affected this. METHODS: We evaluated 53 ACL reconstruction patients in grades 7-12 undergoing surgery during the school year. Demographic, medical, and educational information were collected. Patients were placed into 1 of 2 cohorts: Group A (surgery before the COVID-19 pandemic) or Group B (surgery during the COVID-19 pandemic). We calculated days missed from school after surgery until return to either virtual or in-person school. RESULTS: Overall, patients returned to school after missing an average of 4.4 (SD, 3.0) days of school after ACL reconstruction surgery. Patients in Group A missed an average of 5.5 (SD, 2.9) school days, while patients in Group B missed an average of 2.3 (SD, 1.4) school days (p <.001). Eighty-nine percent of Group B patients first returned to school utilizing a virtual option. Among those returning virtually, these patients missed an average of 1.9 (SD, 0.9) school days. CONCLUSIONS: A virtual distance learning option results in fewer missed days of school post ACL reconstruction. When given this option, school-aged patients can expect to return to school within two days post-op. Otherwise, patients should expect to miss about one week of in-person schooling. In this regard, the COVID-19 pandemic has positively impacted educational opportunities for students post-surgery, and physicians should advocate for continuing virtual options for students receiving medical treatment.

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)