Mild traumatic brain injury, especially sport-related concussion, is common among young persons. Consequences of transient pathophysiologic dysfunction must be considered in the context of a developing or immature brain, as must the potential for an accumulation of damage with repeated exposure. This review summarizes the underlying neurometabolic cascade of concussion, with emphasis on the young brain in terms of acute pathophysiology, vulnerability, alterations in plasticity and activation, axonal injury, and cumulative risk from chronic, repetitive damage, and discusses their implications in the context of clinical care for the concussed youth, highlighting areas for future investigation.

The present study examined the effects of a 9-month randomized control physical activity intervention aimed at improving cardiorespiratory fitness on changes in working memory performance in preadolescent children relative to a waitlist control group. Participants performed a modified Sternberg task, which manipulated working memory demands based on encoding set sizes, while task performance and the contingent negative variation (CNV) event-related brain potential were measured. Analyses revealed that the physical activity intervention led to increases in cardiorespiratory fitness and improved Sternberg task performance. Further, the beneficial effects of the physical activity intervention were greater for a task condition requiring greater working memory demands. In addition, the intervention group exhibited larger initial CNV at the frontal electrode site, relative to the waitlist group at post-test; an effect not observed during the pre-test. These results indicate that increases in cardiorespiratory fitness are associated with improvements in the cognitive control of working memory in preadolescent children.

To be successful takes creativity, flexibility, self-control, and discipline. Central to all those are executive functions, including mentally playing with ideas, giving a considered rather than an impulsive response, and staying focused. Diverse activities have been shown to improve children's executive functions: computerized training, noncomputerized games, aerobics, martial arts, yoga, mindfulness, and school curricula. All successful programs involve repeated practice and progressively increase the challenge to executive functions. Children with worse executive functions benefit most from these activities; thus, early executive-function training may avert widening achievement gaps later. To improve executive functions, focusing narrowly on them may not be as effective as also addressing emotional and social development (as do curricula that improve executive functions) and physical development (shown by positive effects of aerobics, martial arts, and yoga).

The debate about a possible relationship between aerobic fitness and motor skills with cognitive development in children has recently re-emerged, because of the decrease in children's aerobic fitness and the concomitant pressure of schools to enhance cognitive performance. As the literature in young children is scarce, we examined the cross-sectional and longitudinal relationship of aerobic fitness and motor skills with spatial working memory and attention in preschool children. Data from 245 ethnically diverse preschool children (mean age: 5.2 (0.6) years, girls: 49.4%) analyzed at baseline and 9 months later. Assessments included aerobic fitness (20 m shuttle run) and motor skills with agility (obstacle course) and dynamic balance (balance beam). Cognitive parameters included spatial working memory (IDS) and attention (KHV-VK). All analyses were adjusted for age, sex, BMI, migration status, parental education, native language and linguistic region. Longitudinal analyses were additionally adjusted for the respective baseline value. In the cross-sectional analysis, aerobic fitness was associated with better attention (r=0.16, p=0.03). A shorter time in the agility test was independently associated with a better performance both in working memory (r=-0.17, p=0.01) and in attention (r=-0.20, p=0.01). In the longitudinal analyses, baseline aerobic fitness was independently related to improvements in attention (r=0.16, p=0.03), while baseline dynamic balance was associated with improvements in working memory (r=0.15, p=0.04). In young children, higher baseline aerobic fitness and motor skills were related to a better spatial working memory and/or attention at baseline, and to some extent also to their future improvements over the following 9 months. clinicaltrials.gov NCT00674544.

This is a brief review of current evidence for the relationships between physical activity and exercise and the brain and cognition throughout the lifespan, in non-pathological populations. We focus on the effects of both aerobic and resistance training, and provide a brief overview of potential neurobiological mechanisms derived from non-human animal models. Whereas research has focused primarily on the benefits of aerobic exercise in youth and young adult populations, there is growing evidence that both aerobic and resistance training are important for maintaining cognitive and brain health in old age. Finally, in these contexts, we point out gaps in the literature and future directions that will help advance the field of exercise neuroscience, including more studies that explicitly examine the effect of exercise type and intensity on cognition, the brain, and clinically significant outcomes. There is also a need for human neuroimaging studies to adopt a more unified multi-modal framework, and for greater interaction between human and animal models of exercise effects on brain and cognition across the lifespan.

This experiment tested the hypothesis that exercise would improve executive function. Sedentary, overweight 7- to 11-year-old children (N = 171, 56% girls, 61% Black, M ± SD age = 9.3 ± 1.0 years, body mass index [BMI]= 26 ± 4.6 kg/m², BMI z-score = 2.1 ± 0.4) were randomized to 13 ± 1.6 weeks of an exercise program (20 or 40 min/day), or a control condition. Blinded, standardized psychological evaluations (Cognitive Assessment System and Woodcock-Johnson Tests of Achievement III) assessed cognition and academic achievement. Functional MRI measured brain activity during executive function tasks. Results: Intent to treat analysis revealed dose-response benefits of exercise on executive function and mathematics achievement. Preliminary evidence of increased bilateral prefrontal cortex activity and reduced bilateral posterior parietal cortex activity attributable to exercise was also observed. Consistent with results obtained in older adults, a specific improvement on executive function and brain activation changes attributable to exercise were observed. The cognitive and achievement results add evidence of dose-response and extend experimental evidence into childhood. This study provides information on an educational outcome. Besides its importance for maintaining weight and reducing health risks during a childhood obesity epidemic, physical activity may prove to be a simple, important method of enhancing aspects of children's mental functioning that are central to cognitive development. This information may persuade educators to implement vigorous physical activity.

BACKGROUND A growing body of research has detailed the beneficial relation of chronic participation in--and acute responses to--physical activity on aspects of cognition that underlie scholastic achievement. Here, we review the relevant neuroelectric findings on this beneficial relation in children, providing support for the influence of physical activity on specific cognitive processes that comprise academic performance. METHOD A review of studies examining physical activity and neuroelectric concomitants of cognition during childhood is described. When applicable, research involving adult populations is also described to better inform on this relationship in children. RESULTS Collectively, the data support a beneficial relation of chronic and acute participation in physical activity to brain health and cognition. The results suggest more effective allocation of cognitive processes involved in stimulus engagement and action monitoring during tasks requiring variable amounts of cognitive control in children. CONCLUSION Physical activity may influence brain health and cognition in children, leading to enhanced scholastic performance and greater overall effective functioning across the lifespan.

BACKGROUND This study examined associations of fitness and fatness with cognitive processes, academic achievement, and behavior, independent of demographic factors, at the baseline of an exercise trial. METHODS Overweight, sedentary but otherwise healthy 7-11 year olds (N=170) participated in a study of health, cognition and achievement in the Augusta, GA area from 2003-2006. Children underwent evaluations of fatness and fitness, psychological assessments of cognition and academic achievement, and behavior ratings by parents and teachers. Partial correlations examined associations of fitness and fatness with cognitive and achievement scores and behavior ratings, controlling for demographic factors. RESULTS Fitness was associated with better cognition, achievement and behavior, and fatness with worse scores. Specifically, executive function, mathematics and reading achievement, and parent ratings of child behavior were related to fitness and fatness. Teacher ratings were related to fitness. CONCLUSION These results extend prior studies by providing reliable, standardized measures of cognitive processes, achievement, and behavior in relation to detailed measures of fitness and fatness. However, cross-sectional associations do not necessarily indicate that improving one factor, such as fatness or fitness, will result in improvements in factors that were associated with it. Thus, randomized clinical trials are necessary to determine the effects of interventions.

To support curriculum and policy, a midwest city school district assessed the association of selected categories of nutrition and physical activity (NUTR/PA) behaviors, fitness measures, and body mass index (BMI) with academic performance (AP) for 800 sixth graders. Students completed an adapted Youth Risk Behavior Surveillance Survey (NUTR/PA behaviors), fitness assessments (mile run, curl-ups, push-ups, height, and weight) with results matched to standardized scores (Measures of Academic Progress [MAP]), meal price status, and gender. Differences in mean MAP scores (math and reading) were compared by selected categories of each variable utilizing 1-way analysis of variance. Associations were determined by stepwise multiple regression utilizing mean MAP scores (for math and for reading) as the dependent variable and NUTR/PA behaviors, fitness, and BMI categories as independent variables. Significance was set at α = 0.05. Higher MAP math scores were associated with NUTR (more milk and breakfast; less 100% fruit juice and sweetened beverages [SB]) and PA (increased vigorous PA and sports teams; reduced television), and fitness (higher mile run performance). Higher MAP reading scores were associated with NUTR (fewer SB) and PA (increased vigorous PA, reduced television). Regression analysis indicated about 11.1% of the variation in the mean MAP math scores and 6.7% of the mean MAP reading scores could be accounted for by selected NUTR/PA behaviors, fitness, meal price status, and gender. Many positive NUTR/PA behaviors and fitness measures were associated with higher MAP scores supporting the school district focus on healthy lifestyles. Additional factors, including meal price status and gender, contribute to AP.

Because children are becoming overweight, unhealthy, and unfit, understanding the neurocognitive benefits of an active lifestyle in childhood has important public health and educational implications. Animal research has indicated that aerobic exercise is related to increased cell proliferation and survival in the hippocampus as well as enhanced hippocampal-dependent learning and memory. Recent evidence extends this relationship to elderly humans by suggesting that high aerobic fitness levels in older adults are associated with increased hippocampal volume and superior memory performance. The present study aimed to further extend the link between fitness, hippocampal volume, and memory to a sample of preadolescent children. To this end, magnetic resonance imaging was employed to investigate whether higher- and lower-fit 9- and 10-year-old children showed differences in hippocampal volume and if the differences were related to performance on an item and relational memory task. Relational but not item memory is primarily supported by the hippocampus. Consistent with predictions, higher-fit children showed greater bilateral hippocampal volumes and superior relational memory task performance compared to lower-fit children. Hippocampal volume was also positively associated with performance on the relational but not the item memory task. Furthermore, bilateral hippocampal volume was found to mediate the relationship between fitness level (VO(2) max) and relational memory. No relationship between aerobic fitness, nucleus accumbens volume, and memory was reported, which strengthens the hypothesized specific effect of fitness on the hippocampus. The findings are the first to indicate that aerobic fitness may relate to the structure and function of the preadolescent human brain.

The relationship between aerobic fitness and executive control was assessed in 38 higher- and lower-fit children (M-sub(age)= 9.4 years), grouped according to their performance on a field test of aerobic capacity. Participants performed a flanker task requiring variable amounts of executive control while event-related brain potential responses and task performance were assessed. Results indicated that higher-fit children performed more accurately across conditions of the flanker task and following commission errors when compared to lower-fit children, whereas no group differences were observed for reaction time. Neuroelectric data indicated that P3 amplitude was larger for higher- compared to lower-fit children across conditions of the flanker task, and higher-fit children exhibited reduced error-related negativity amplitude and increased error positivity amplitude compared to lower-fit children. The data suggest that fitness is associated with better cognitive performance on an executive control task through increased cognitive control, resulting in greater allocation of attentional resources during stimulus encoding and a subsequent reduction in conflict during response selection. The findings differ from those observed in adult populations by indicating a general rather than a selective relationship between aerobic fitness and cognition.

PURPOSE We investigated the relation between aerobic fitness and interference control--one component of executive control--in 74 children between 7 and 12 yr of age. METHOD Participants completed a paper-and-pencil version of the Stroop color-word task and the FITNESSGRAM, a valid and reliable test measuring different components of physical fitness (i.e., aerobic, muscle, and body composition). During each condition of the Stroop task (word, color, color-word), participants were instructed to read aloud as many items as possible in 45 s. Data were also collected on IQ and personal and health demographics to account for other factors influencing the relationship between fitness and executive function. RESULTS Older children and those with higher IQ responded to more items correctly during each of the three conditions. Greater aerobic fitness was also associated with better performance on each of the three Stroop conditions independently of the other variables. CONCLUSION These findings suggest that increased levels of fitness may be beneficial to cognition during preadolescent development.

PURPOSE We investigated the relationship between age, aerobic fitness, and cognitive function by comparing high- and low-fit preadolescent children and adults. METHOD Twenty-four children (mean age = 9.6 yr) and 27 adults (mean age = 19.3 yr) were grouped according to their fitness (high, low) such that four approximately equal groups were compared. Fitness was assessed using the Fitnessgram test, and cognitive function was measured by neuroelectric and behavioral responses to a stimulus discrimination task. RESULTS Adults exhibited greater P3 amplitude at Cz and Pz sites, and decreased amplitude at the Oz site compared with children. High-fit children had greater P3 amplitude compared with low-fit children and high- and low-fit adults. Further, adults had faster P3 latency compared with children, and high-fit participants had faster P3 latency compared with low-fit participants at the Oz site. Adults exhibited faster reaction time than children; however, fitness interacted with age such that high-fit children had faster reaction time than low-fit children. CONCLUSION These findings suggest that fitness was positively associated with neuroelectric indices of attention and working memory, and response speed in children. Fitness was also associated with cognitive processing speed, but these findings were not age-specific. These data indicate that fitness may be related to better cognitive functioning in preadolescents and have implications for increasing cognitive health in children and adults.

The global epidemic of childhood obesity has become a major public health concern. Yet, evidence regarding the association between childhood obesity and cognitive health has remained scarce. This study examined the relationship between obesity and cognitive control using neuroelectric and behavioral measures of action monitoring in preadolescent children. Healthy weight and obese children performed compatible and incompatible stimulus-response conditions of a modified flanker task, while task performance and the error-related negativity (ERN) were assessed. Analyses revealed that obese children exhibited a longer reaction time (RT) relative to healthy weight children for the incompatible condition, whereas no such difference was observed for the compatible condition. Further, obese children had smaller ERN amplitude relative to healthy weight children with lower post-error response accuracy. In addition, healthy weight children maintained post-error response accuracy between the compatible and incompatible conditions with decreased ERN amplitude in the incompatible condition, whereas obese children exhibited lower post-error response accuracy for the incompatible relative to the compatible condition with no change in ERN amplitude between the compatibility conditions. These results suggest that childhood obesity is associated with a decreased ability to modulate the cognitive control network, involving the prefrontal cortex and anterior cingulate cortex, which supports action monitoring.

Standardized tests have been used to forecast scholastic success of school-age children, and have been related to intelligence, working memory, and inhibition using neuropsychological tests. However, ERP correlates of standardized achievement have not been reported. Thus, the relationship between academic achievement and the P3 component was assessed in a sample of 105 children during performance on a Go/NoGo task. The Wide Range Achievement Test - 3rd edition was administered to assess aptitude in reading, spelling, and arithmetic. Regression analyses indicated an independent contribution of P3 amplitude to reading and arithmetic achievement beyond the variance accounted for by IQ and school grade. No such relationship was observed for spelling. These data suggest that the P3, which reflects attentional processes involved in stimulus evaluation and inhibitory control may be a biomarker for academic achievement during childhood.

Adiposity may be negatively associated with cognitive function in children. However, the findings remain controversial, in part due to the multifaceted nature of cognition and perhaps the lack of accurate assessment of adiposity. The aim of this study was to clarify the relation of weight status to cognition in preadolescent children using a comprehensive assessment of cognitive control, academic achievement, and measures of adiposity. Preadolescent children between 7 and 9 years (n = 126) completed Go and NoGo tasks, as well as the Wide Range Achievement Test 3rd edition (WRAT3), which measures achievement in reading, spelling, and arithmetic. In addition to body mass index (BMI), fat mass was measured using dual X-ray absorptiometry (DXA). Data were analyzed with multiple regression analysis, controlling for confounding variables. Analyses revealed that BMI and fat mass measured via DXA were negatively associated with cognitive control, as children with higher BMI and fat mass exhibited poorer performance on the NoGo task requiring extensive amounts of inhibitory control. By contrast, no relation of weight status to performance was observed for the Go task requiring smaller amounts of cognitive control. Higher BMI and fat mass were also associated with lower academic achievement scores assessed on the WRAT3. These data suggest that adiposity is negatively and selectively associated with cognitive control in preadolescent children. Given that cognitive control has been implicated in academic achievement, the present study provides an empirical basis for the negative relationship between adiposity and scholastic performance.

Standardized tests have been used to forecast scholastic success of school-age children, and have been related to intelligence, working memory, and inhibition using neuropsychological tests. However, ERP correlates of standardized achievement have not been reported. Thus, the relationship between academic achievement and the P3 component was assessed in a sample of 105 children during performance on a Go/NoGo task. The Wide Range Achievement Test - 3(rd) edition was administered to assess aptitude in reading, spelling, and arithmetic. Regression analyses indicated an independent contribution of P3 amplitude to reading and arithmetic achievement beyond the variance accounted for by IQ and school grade. No such relationship was observed for spelling. These data suggest that the P3, which reflects attentional processes involved in stimulus evaluation and inhibitory control may be a biomarker for academic achievement during childhood.

The present study examined the effects of a 9-month randomized control physical activity intervention aimed at improving cardiorespiratory fitness on changes in working memory performance in preadolescent children relative to a waitlist control group. Participants performed a modified Sternberg task, which manipulated working memory demands based on encoding set sizes, while task performance and the contingent negative variation (CNV) event-related brain potential were measured. Analyses revealed that the physical activity intervention led to increases in cardiorespiratory fitness and improved Sternberg task performance. Further, the beneficial effects of the physical activity intervention were greater for a task condition requiring greater working memory demands. In addition, the intervention group exhibited larger initial CNV at the frontal electrode site, relative to the waitlist group at post-test; an effect not observed during the pre-test. These results indicate that increases in cardiorespiratory fitness are associated with improvements in the cognitive control of working memory in preadolescent children.

OBJECTIVE This present study examined time spent in the target heart zone (THZ) and its relationship to tasks requiring variable amounts of executive control function in prepubescent children participating in a 9-month randomized controlled physical activity program. METHODS A sample of 59 participants performed the Stroop Color-Word Test and the Comprehensive Trail Making Test cognitive assessments. Heart rate data were collected during participation in the physical activity program using E600 heart rate monitors (Polar, Finland). RESULTS There was a significant difference, F(1, 58)=7.44, p <.009, between males and females for relative VO2max, but not absolute (p=.69) or percent VO2max (p=.73). Regression analysis identified KBIT, age, and mean time above the THZ as significant predictors of performance in the Stroop Color-Word condition, F(1, 56)=5.21, p=.02. KBIT and mean time above the THZ were significant predictors for Trails B, F(1, 56)=7.60. CONCLUSIONS These results suggest that heart rate, as a measure of physical activity intensity, should be closely monitored during research that is intended to make inferences about its effects on cognitive performance as participation in vigorous activities may have specific benefits over lower intensities among prepubescent children.

the neurocognitive benefits of an active lifestyle in childhood have public health and educational implications, especially as children in today's technological society are becoming increasingly overweight, unhealthy, and unfit. Human and animal studies show that aerobic exercise affects both prefrontal executive control and hippocampal function. This investigation attempts to bridge these research threads by using a cognitive task to examine the relationship between aerobic fitness and executive control of relational memory in preadolescent 9- and 10-yr-old children. higher-fit and lower-fit children studied faces and houses under individual item (i.e., nonrelational) and relational encoding conditions, and the children were subsequently tested with recognition memory trials consisting of previously studied pairs and pairs of completely new items. With each subject participating in both item and relational encoding conditions, and with recognition test trials amenable to the use of both item and relational memory cues, this task afforded a challenge to the flexible use of memory, specifically in the use of appropriate encoding and retrieval strategies. Hence, the task provided a test of both executive control and memory processes. lower-fit children showed poorer recognition memory performance than higher-fit children, selectively in the relational encoding condition. No association between aerobic fitness and recognition performance was found for faces and houses studied as individual items (i.e., nonrelationally). the findings implicate childhood aerobic fitness as a factor in the ability to use effective encoding and retrieval executive control processes for relational memory material and, possibly, in the strategic engagement of prefrontal- and hippocampal-dependent systems.

Objective. To evaluate the characteristics of a cohort of master of pharmacy (MPharm) students upon entry into the program and examine associations between entry qualifications, type of secondary school attended, socioeconomic status, age, and academic performance in the MPharm program.Methods. A retrospective cohort analysis was conducted of student data for graduates of the Aston University MPharm program during the 5-year period 2005-2006 through 2009-2010 (n=644).Results. MPharm entrants were disproportionately drawn from socioeconomically deprived areas and independent (private) schools. Achievement prior to admission was related to the type of school attended but not to socioeconomic status. Performance in the program was not related to type of school or socioeconomic status but was strongly correlated with prior academic achievement.Conclusions. Prior academic achievement was the most important predictor of performance in the MPharm program; however, the superior prior achievement of students who attended independent secondary schools was not seen at the point of graduation. These findings may have implications for admissions policies.

OBJECTIVES To test the impact of provider performance pay for anaemia reduction in rural China. DESIGN A cluster randomised trial of information, subsidies, and incentives for school principals to reduce anaemia among their students. Enumerators and study participants were not informed of study arm assignment. SETTING 72 randomly selected rural primary schools across northwest China. PARTICIPANTS 3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study. INTERVENTIONS Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms:(a) an information arm, in which principals received information about anaemia;(b) a subsidy arm, in which principals received information and unconditional subsidies; and (c) an incentive arm, in which principals received information, subsidies, and financial incentives for reducing anaemia among students. Twenty seven schools were assigned to the control arm (1816 students at baseline, 1623 at end point), 15 were assigned to the information arm (659 students at baseline, 596 at end point), 15 to the subsidy arm (726 students at baseline, 667 at end point), and 15 to the incentive arm (743 students at baseline, 667 at end point). MAIN OUTCOME MEASURES Student haemoglobin concentrations. RESULTS Mean student haemoglobin concentration rose by 1.5 g/L (95% CI -1.1 to 4.1) in information schools, 0.8 g/L (-1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools. CONCLUSIONS Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical. TRIAL REGISTRATION NUMBER ISRCTN76158086.

Objectives. We assessed children's potential differences in academic achievement based on aerobic fitness over a 2-year period. Methods. The longitudinal study sample included 3 cohorts of students (n = 1725; 50.1% male) enrolled in a West Virginia public school system. Students received baseline fitness and academic assessments as fifth graders and at a 2-year follow-up assessment. We used FitnessGram to assess fitness in aerobic capacity and WESTEST, a criterion-based assessment, for academic performance. Results. Students who stayed in the healthy fitness zone (HFZ) had significantly higher WESTEST scores than did students who stayed in the needs improvement zone (NIZ). Students who moved into or out of the HFZ occasionally had significantly higher WESTEST scores than did students who stayed in the NIZ, but they were rarely significantly lower than those of students who stayed in the HFZ. Conclusions. Students' aerobic capacity is associated with greater academic achievement as defined by standardized test scores. This advantage appears to be maintained over time, especially if the student stays in the HFZ.(Am J Public Health. Published online ahead of print June 14, 2012: e1-e5. doi:10.2105/AJPH.2011.300515).

This study investigates the relationship between participating in a high school debate program on college-readiness in the Chicago Public School district over a 10-year period. At-risk school students were identified using an index including 8th grade achievement, poverty status, and enrollment in special education. Regression analyses were used to assess the association between debate participation and graduation and ACT performance. Overall, debaters were 3.1 times more likely to graduate from high school (95% confidence interval: 2.7-3.5) than non-debaters, and more likely to reach the college-readiness benchmarks on the English, Reading, and Science portions of the ACT. This association was similar for both low-risk and at-risk students. Debate intensity was positively related to higher scores on all sections of the ACT. Findings indicate that debate participation is associated with improved academic performance for at-risk adolescents.

Objective: To investigate the hypotheses that in elementary school students:(1) adiposity and academic achievement are negatively correlated and (2) physical activity and academic achievement are positively correlated. Methods: Participants were 1963 children in fourth to sixth grades. Adiposity was assessed by calculating body mass index (BMI) percentile and percent body fat and academic achievement with statewide standardized tests in 4 content areas. Socioeconomic status and age were control variables. A subset of participants (n = 261) wore an accelerometer for 3 days to provide objective measurement of physical activity. In addition, the association between weight status and academic achievement was examined by comparing children who could be classified as "extremely obese" and the rest of the sample, as well as comparing children who could be classified as normal weight, overweight, or obese. Extreme obesity was defined as ≥1.2 times the 95th percentile. Results: The results indicated that there were no significant associations between adiposity or physical activity and achievement in students. No academic achievement differences were found between children with BMI percentiles within the extreme obesity range and those who did not fall within the extreme obesity classification. In addition, no academic achievement differences were found for children with BMI percentiles within the normal weight, overweight, or obese ranges. Conclusions: These results do not support the hypotheses that increased adiposity is associated with decreased academic achievement or that greater physical activity is related to improved achievement. However, these results are limited by methodological weaknesses, especially the use of cross-sectional data.

PURPOSE To analyze the results of recall absent schoolchildren to eye health projects. METHODS Cross-sectional study. Visual screening was performed in schoolchildren attending 1(st) to 4(th) grades at public schools, from 7 to 10 years-old, to select and forward to complete ophthalmic evaluation. The projects were performed during weekends, at a public school, in the same municipality. Free transportation, food and eyeglasses were offered. A second opportunity of examination was offered to the students who were absent from the first call, with the same facilities. RESULTS 51,509 schoolchildren had their vision tested, 14,651 (28.4%) were referred for ophthalmic examination. Of these, 8,683 (59.3%) attended the first call, 2,228 (37.3%) attended the recall and 25.5% of parents did not take their children to ophthalmic examination. The need for eyeglasses for children who attended the examination was 23.8% and 32.0% in the first opportunity and recall, respectively. The recall increased the coverage in 15.2%(59.3% to 74.5%). CONCLUSION An expressive number of parents (25.5%) did not bring their children to be examined, even at a second opportunity of exam. The facilities offered: access, free examination, transportation and glasses. Children who were absent in the first opportunity and appeared at recall had a greater need for eyeglasses. Recall increased the coverage in 15.2%(59.3% to 74.5%) and it is not recommended when financial resources are limited.

The researchers investigated the effect of the Reread-Adapt and Answer-Comprehend intervention (Therrien, Gormley,& Kubina, 2006) on the reading fluency and achievement of d/Deaf and hard of hearing elementary-level students. Children in the third, fifth, and sixth grades at a state school for d/Deaf and hard of hearing students received a fluency intervention that was supplemental to their regular reading instruction. Significant improvement was found on a generalized measure of reading fluency after intervention. Though the researchers found no significant improvement in performance on a generalized measure of comprehension after intervention, the students demonstrated consistently good comprehension on both literal and inferential questions during the intervention sessions. The findings support the importance of incorporating a comprehension monitoring strategy in fluency instruction.

Epidemiologic studies have observed influences of the food environment near schools on children's overweight status but have not systematically assessed the associations by race, sex, and grade. The authors examined whether the associations between franchised fast food restaurant or convenience store density near schools and overweight varied by these factors using data for 926,018 children (31.3% white, 55.1% Hispanic, 5.7% black, and 8% Asian) in fifth, seventh, or ninth grade, nested in 6,362 schools. Cross-sectional data were from the 2007 California physical fitness test (also known as "Fitnessgram"), InfoUSA, the California Department of Education, and the 2000 US Census. In adjusted models, the overweight prevalence ratio comparing children in schools with 1 or more versus 0 fast food restaurants was 1.02 (95% confidence interval (CI): 1.01, 1.03), with a higher prevalence ratio among girls compared with boys. The association varied by student's race/ethnicity (P = 0.003): Among Hispanics, the prevalence ratio = 1.02 (95% CI: 1.01, 1.03); among blacks, the prevalence ratio = 1.03 (95% CI: 1.00, 1.06), but among Asians the prevalence ratio = 0.94 (95% CI: 0.91, 0.97). For each additional convenience store, the prevalence ratio was 1.01 (95% CI: 1.00, 1.01), with a higher prevalence ratio among fifth grade children. Nuanced understanding of the impact of food environments near schools by race/ethnicity, sex, and grade may help to elucidate the etiology of childhood overweight and related race/ethnic disparities.

BACKGROUND Throughout the United States, over 70% of public schools with 12th grade offer school-sponsored work (SSW) programs for credit; 60% offer job-shadowing programs for students. Wisconsin offers a variety of work-based learning programs for students, including, but not limited to, job shadowing, internships, co-op education, and youth apprenticeship programs. No research has compared workplace injury and school-based behaviors in students enrolled in SSW programs who work only 1 job compared with those who work multiple jobs. METHODS A total of 6810 students in the 5 public health regions in Wisconsin responded to an anonymous questionnaire that was administered in 2003. The questionnaire asked about employment, injury, characteristics of injury, and school-based behaviors and performance. RESULTS A total of 3411 high school students aged 14 to 18 reported they were employed during the school year. Among the working students, 13.5% were enrolled in a SSW program. Of the SSW students, 44% worked multiple jobs. SSW students who worked multiple jobs were more likely to do hazardous job tasks, to work after 11 PM, to work over 40 hours per week, to have a near-miss incident, to have a coworker injured, and to be injured at work. CONCLUSIONS SSW students who are working multiple jobs are violating labor laws that put their safety and their school performance at risk. The responsibilities of employers and schools have to be addressed to ensure that SSW students are abiding by labor laws when working multiple jobs.

BACKGROUND Obesity rates have reached epidemic proportions in the United States and California. Thus, the California Department of Education began a series of steps to address the increase in obesity and decline in fitness in the 6.3 million public school children in California. We evaluated serial changes in obesity and fitness in California school children following implementation of prevention steps in all California public schools. METHODS The California Department of Education implemented changes in school nutrition and exercise programs aimed at reducing obesity and improving fitness. Outcome results were monitored by performing Physical Fitness Testing on 8.4 million students (5th, 7th, and 9th grade) for body composition, aerobic capacity, flexibility, and upper body, abdominal, and truncal strength using the Cochran-Armitage trend test and multivariable logistic regression models. RESULTS Overall fitness improved from 2003 to 2008. Serial changes in body composition, aerobic capacity, flexibility, and upper body, abdominal, and truncal strength improved or remained stable within school as students progressed from 5th to 7th to 9th grade. However, students entering 5th grade were more obese every year, and this early obesity was not reversible within the school programs. CONCLUSIONS Following prevention measures within California public schools, obesity and fitness levels have stabilized. However, continued increases in early entrance (5th grade) obesity will require additional efforts directed at preschool and elementary students to completely stop and reverse this obesity epidemic.