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Background Health literacy (HL) is closely associated with leading health indicators such as engaging in healthy behaviours and experiencing a healthy social environment. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but there are gaps in the available information and there is not any data available yet for the German context. Methods In preparation of an implementation study, a cross-sectional survey was conducted in 28 elementary and secondary schools in Germany. The parent questionnaire was completed by 4217 parents and included the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The child questionnaire examined children’s health knowledge, behaviours and outcomes. For children between 6 and 10 years, a parent reported on behalf of their children ( N  = 1518). Students 11 years and older completed a self-administered questionnaire ( N  = 2776). Bivariate and multivariate analyses were carried out. Spearman’s Rho correlations assess the relationships between household characteristics, parental HL and the health behaviour and outcomes in children. Results Among the participating parents, 45.8% showed problematic or inadequate HL. The major determinants of high parental HL were high socio-economic status (SES) (r = .088***, 95% CI [.052, .124]), living in West Germany (r = .064***, 95% CI [.032, .096]) and older parental age (r = .057**, 95% CI [.024, .090]). In the multivariate model, only SES remained significant. High parental HL was associated with positive health behaviours in children including healthier nutrition, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol, sexual activity among children and children’s weight were not significant. Conclusions The results confirm a relationship between low parental HL, SES and some child health behaviours likely to negatively impact their health and wellbeing including less healthy nutrition and less exercise. Strengthening the health knowledge and competencies of parents may contribute to improved child outcomes particularly in the areas of nutrition, exercise and dental health.

AimTo examine the demographic and social factors associated with myopia in schoolchildren in Ireland.MethodsThirty-seven schools participated, representing a mix of urban and rural schools and schools in socioeconomically disadvantaged and non-disadvantaged areas in Ireland. Examination included cyclopleged autorefraction (1% cyclopentolate hydrochloride). Height and weight of participants were measured. Parents filled in a participant’s lifestyle questionnaire, including questions on daily screen time use and daylight exposure. Myopia was defined as spherical equivalent ≤−0.50 D.ResultsData from 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), were examined. Myopia prevalence was significantly higher in children aged 12–13 years old (OR=7.7, 95%CI 5.1 to 11.6, p<0.001) and significantly associated with non-white ethnicity (OR=3.7, 95% CI 2.5 to 5.3, p<0.001). Controlling for age group and ethnicity, myopia prevalence was also significantly linked with height (p<0.001) and higher in participants in the following groups: using screens >3 hours per day (OR=3.7, 95% CI 2.1 to 6.3, p<0.001), obesity (OR=2.7, 95% CI 1.9 to 3.9, p<0.001), sedentary lifestyle (OR=2.9, 95% CI 1.9 to 4.4, p<0.001), frequently reading/writing (OR=2.2, 95% CI 1.4 to 3.5, p=0.001), less daylight exposure during summer time (OR=5.00, 95% CI 2.4 to 10.3, p<0.001), spring season births (OR=1.9, 95% CI 1.1 to 3.3, p=0.02), paternal history of myopia (OR=2.4, 95% CI 1.8 to 3.3, p<0.001) and bottle fed for the first three months of life (OR=1.7, 95% CI 1.3 to 2.5, p=0.02).ConclusionsThe associations found between myopia prevalence in schoolchildren in Ireland and demographic and lifestyle factors suggest that longitudinal research investigating the associations between myopia prevalence and these factors may be beneficial in advising preventative public health programmes.

The aims of this study were to evaluate oral health knowledge and assess the practice of preventive measures for oral health care among intermediate schoolchildren in Abha, Saudi Arabia. Information about oral health was collected through a questionnaire containing closed-ended questions, which was distributed to children of six randomly selected intermediate schools. Most (82.3%) of the schoolchildren were aware that good oral health is important for general health. The priority for oral health information was given to dentists (31.6%), whereas teachers were given the least priority (19.1%). About half (53.5%) of the schoolchildren reported that sweets are the cause of dental caries, and 47.1% of them related pain with dental caries. More than half (58.8%) took sweets between meals. Most of them (69.6%) visited a dentist because of pain. Two-thirds (66.9%) of the children did not brush their teeth daily, and most (78%) did not use dental floss. A large number (62.7%) of the schoolchildren stated that rinsing with water after each meal is the best way to keep their gums healthy. For boys in intermediate schools, properly designed oral health educational programs should be implemented to improve their knowledge and behavior toward oral health.

Achieving malaria elimination requires considering both Plasmodium falciparum and non–P. falciparum infections. We determined prevalence and geographic distribution of 4 Plasmodium spp. by performing PCR on dried blood spots collected within 8 regions of Tanzania during 2017. Among 3,456 schoolchildren, 22% had P. falciparum, 24% had P. ovale spp., 4% had P. malariae, and 0.3% had P. vivax infections. Most (91%) schoolchildren with P. ovale infections had low parasite densities; 64% of P. ovale infections were single-species infections, and 35% of those were detected in low malaria endemic regions. P. malariae infections were predominantly (73%) co-infections with P. falciparum. P. vivax was detected mostly in northern and eastern regions. Co-infections with >1 non–P. falciparum species occurred in 43% of P. falciparum infections. A high prevalence of P. ovale infections exists among schoolchildren in Tanzania, underscoring the need for detection and treatment strategies that target non–P. falciparum species.

AimTo report refractive error prevalence and visual impairment in Republic of Ireland (henceforth 'Ireland') schoolchildren.MethodsThe Ireland Eye Study examined 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), in Ireland between June 2016 and January 2018. Participating schools were selected by stratified random sampling, representing a mix of school type (primary/postprimary), location (urban/rural) and socioeconomic status (disadvantaged/advantaged). Examination included monocular logarithm of the minimum angle of resolution (logMAR) presenting visual acuity (with spectacles if worn) and cycloplegic autorefraction (1% Cyclopentolate Hydrochloride). Parents completed a questionnaire to ascertain participants’ lifestyle.ResultsThe prevalence of myopia (spherical equivalent refraction (SER): ≤−0.50 D), hyperopia (SER: ≥+2.00 D) and astigmatism (≤−1.00 DC) among participants aged 6–7 years old was 3.3%, 25% and 19.2%, respectively, and among participants aged 12–13 years old was 19.9%, 8.9% and 15.9%, respectively. Astigmatic axes were predominately with-the-rule. The prevalence of ‘better eye’ presenting visual impairment (≥0.3 logMAR, with spectacles, if worn) was 3.7% among younger and 3.4% among older participants. Participants in minority groups (Traveller and non-white) were significantly more likely to present with presenting visual impairment in the ‘better eye’.ConclusionsThe Ireland Eye Study is the first population-based study to report on refractive error prevalence and visual impairment in Ireland. Myopia prevalence is similar to comparable studies of white European children, but the levels of presenting visual impairment are markedly higher than those reported for children living in Northern Ireland, suggesting barriers exist in accessing eye care.

The goal of this research is to determine the structure and amount of physical activity for 11-14-yearold children during curricular and extracurricular hours. Research data: the research involves 252 fifth to ninth grade students ages 11-14 (122 boys and 130 girls) from general education schools in Chernivtsi, Ukraine. A technique developed by scientists from the Framingham State University (physical activity timing) is used to evaluate the level of physical activity. Findings: low-level physical activity has been found to prevail in children of all age groups of interest during curricular and extracurricular hours.

Training schoolchildren in basic life support (BLS) is strongly recommended to effectively increase bystander cardiopulmonary resuscitation (CPR) rates. Paediatricians and other health staff members used to be involved in BLS training, but the wide dissemination of BLS skills would need additional support; as a solution, schoolteachers might have enough knowledge necessary to help to achieve this goal. The aim of this cross-sectional survey study, which involved 3423 schoolteachers, was to evaluate the knowledge related to first aid (FA) and BLS of schoolteachers in Spain. In addition, the study aimed to evaluate the content taught to the schoolchildren regarding FA and teachers’ attitudes towards teaching FA. Three-quarters of the surveyed schoolteachers reported knowing FA, and 17% reported teaching it. The emergency medical telephone number and CPR were the subjects taught most often by schoolteachers. However, the schoolteachers demonstrated a lack of knowledge in the identification of cardiac arrest and in CPR. Ninety-eight percent of the respondents agreed with including FA training in schools and as part of university degree programmes and supported the KIDS SAVE LIVES statement. Teaching FA was a positive predictor to be willing to perform CPR (OR: 1.7; 95% CI 1.32–2.31) and to use a defibrillator (OR: 1.4; 95% CI 1.10–1.67).Conclusions: Schoolteachers are willing to teach FA in schools. However, more training and specific curricula are needed to increase the quality of schoolchildren’s CPR training. The training of schoolteachers in CPR might be the foundation for the sustainable transfer of CPR-related knowledge to schoolchildren. Therefore, the inclusion of FA and BLS in university degree programmes seems to be essential.What is Known:• Bystander cardiopulmonary resuscitation rates are associated with improved survival rates.• Resuscitation training in schools increases the bystander cardiopulmonary resuscitation rate.What is New:• Schoolteachers are willing to teach basic life support, but they need more and better training.• Schoolteachers agreed with the inclusion of first aid training in schools and university degree programmes aimed at training teachers/undergraduate teaching degrees.

The scope of this study was to analyze the hygienic-sanitary conditions in nine School Food and Nutrition Units (UANE) of a municipality in the state of Rio de Janeiro (Brazil). A Best Practices in School Food Checklist proposed and validated by Stedefeldt et al., containing items scored and grouped into six thematic blocks (BT) was applied. The total score (P) results per BT and the final score (PF) were obtained using the Best Practices in School Food software®. The P results in UANE were compared with the classification of Collegiate Board Resolution No. 275 of 2002 of the National Health Surveillance Agency2 and PF results were used for UANE classification. All the UANE results were partially suitable for BT building. For BT handlers, processes/procedures, environmental hygiene and equipment for controlled temperature, most had partially adequate and inadequate results. Most UANE were adequate for BT reception. The PF results classified most UANE (66.7%) as standard health risks, indicating the need for corrective measures for Best Practices in UANE and the supply of safe and healthy meals to schoolchildren.

Background Physical activity plays an important role in the maintenance of health, and it is especially important during childhood. However, the lack of information about differences in physical activity practice and sports preferences of children considering gender differences can result in non-effective policies that enhance inequalities between sexes. The aim of this study is to identify the sports preferences of Spanish schoolchildren and their physical activity practice behaviors depending on their sex and their parental care, analyzing the possible differences from a gender perspective. Method Three hundred sixty-four Spanish schoolchildren (179 girls, 185 boys) participated in this cross-sectional study. A daily physical activity questionnaire was used to evaluate physical activity level (PAL), moderate-to-vigorous physical activity (MVPA) and sports preferences and a socio-health questionnaire were used to collect data about parental care. Statistical analysis was performed using SPSS and applying Student’s T-test for normal variables, Mann-Whitney U-test for non-parametrical variables, and chi-square (χ2) test for categorical variables. Subsequently, odds ratios were used to analyze associations between the physical activity practice of the children and parental care. Results PAL and time spent in MVPA was significantly lower for girls compared to boys (1.44 ± 0.07 vs. 1.46 ± 0.07, p  < 0.001 and 0.74 ± 0.40 h/day vs. 0.90 ± 0.45 h/day; p  < 0.001, respectively). Dancing, rhythmic gymnastics, skating, and water sports were practiced more by girls, while football, wrestling sports, handball, and racket sports were practiced more by boys ( p  < 0.05). Children cared for by their fathers had higher odds for physical activity practice (OR = 1.995 (1.202–3.310), p  = 0.008). Conclusion Physical activity among girls was less frequent and less intense. Girls opted for individual sports with artistic connotations, while boys often practiced more team contact sports. Furthermore, children are more physically actives when their father is in charge of them.

Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors.BACKGROUNDWeb-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors.This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)-a self-administered, web-based time-use application to assess diet and movement behavior-and to evaluate its usability in schoolchildren in Singapore.OBJECTIVEThis study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)-a self-administered, web-based time-use application to assess diet and movement behavior-and to evaluate its usability in schoolchildren in Singapore.MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire.METHODSMEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire.The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate.RESULTSThe development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate.MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress.CONCLUSIONSMEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress.