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      Rethinking the role of the school after COVID-19

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          Abstract

          Closure of schools and the psychological impact on children and adolescents' health, resulting from staying at home for several weeks with uncertain perspectives for the near future, is a crucial issue. 1 The worst consequences of this temporary shutdown are experienced by the most vulnerable children who already rely on school for educational, nutritional, and health needs due to their socioeconomic disadvantages or disabilities. In addition to the possible lack of parental support at home, major inequalities arise in the access to digital learning resources. With the aim of ensuring continuity, inclusion, and equity for all students, the UN Educational, Scientific and Cultural Organisation (UNESCO) has launched the Global Education Coalition, calling for coordinated and innovative actions to support students through remote learning and to guide the school reopening phase, thanks to the involvement of public and private stakeholders. The COVID-19 crisis highlights that school fulfils not only an educational mission of knowledge acquisition, but it also satisfies the socialisation needs of young people. With students at home, the school community is absent and despite the virtual interactions and learning opportunities provided by the internet and social networks, a barrier is created in the educational relationship between pupils and teachers. Moreover, children are missing a physical space in which to share interests, thoughts, hopes, and emotions among peers. School provides a structured setting in which children can learn and develop social competencies, such as self-confidence, friendship, empathy, participation, respect, gratitude, compassion, and responsibility. Social and emotional learning is important for young people to become conscious members of a solidarity-based community. 2 Learning objectives can be achieved remotely (and evaluated to some extent), but the core mission of any school system also comprises the promotion of students' wellbeing, which is closely related to school performance.2, 3 The COVID-19 crisis gives us the opportunity to re-assess what type of school we want for the future. Paakkari and Okan 4 recently highlighted the need to improve health literacy. Teachers should act as health promoters for their students from a young age, by actively fostering healthy habits (physical activity, good personal hygiene, and balanced diet) and raising awareness of the consequences of risky behaviours. For a more inclusive and student-centred education, didactic methodologies, such as cooperative learning (based on student collaboration), should be used to convey health topics among students, to encourage personal reconstruction of knowledge, and to engage them with adopting healthy lifestyles. A wide range of participatory activities can be used, including debates, small working groups, authentic learning activities (concerning real-life situations), storytelling, role playing, educational games and simulations, audio and visual laboratories, or arts, music, theatre, and dance. Health literacy should be integrated into school curricula, either within scientific subjects or as extracurricular matter. Medical professionals, pedagogists, and psychologists could support teachers in this task. Moreover, educational interventions that aim to promote children's wellbeing in the school setting might also represent the most effective anti-bullying strategy and are expected to facilitate the scholastic pathway of children belonging to the most disadvantaged socioeconomic groups. 5 The UNESCO Chair on Health Education and Sustainable Development strongly believes that education is health. Wellbeing promotion in the school setting, resulting from a process of meaningful and transformative learning, can represent the lever for a knowledge-based health culture, impacting not only the behaviours of students, but also those of their families and communities.

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          Mitigate the effects of home confinement on children during the COVID-19 outbreak

          In response to the coronavirus disease 2019 (COVID-19) outbreak, the Chinese Government has ordered a nationwide school closure as an emergency measure to prevent spreading of the infection. Public activities are discouraged. The Ministry of Education estimates that more than 220 million children and adolescents are confined to their homes; this includes 180 million primary and secondary students and 47 million preschool children). 1 Thanks to the strong administrative system in China, the emergency home schooling plan has been rigorously implemented. 2 Massive efforts are being made by schools and teachers at all levels to create online courses and deliver them through TV broadcasts and the internet in record time. The new virtual semester has just started in many parts of the country, and various courses are offered online in a well organised manner. These actions are helping to alleviate many parents' concerns about their children's educational attainment by ensuring that school learning is largely undisrupted. Although these measures and efforts are highly commendable and necessary, there are reasons to be concerned because prolonged school closure and home confinement during a disease outbreak might have negative effects on children's physical and mental health.3, 4 Evidence suggests that when children are out of school (eg, weekends and summer holidays), they are physically less active, have much longer screen time, irregular sleep patterns, and less favourable diets, resulting in weight gain and a loss of cardiorespiratory fitness.3, 5 Such negative effects on health are likely to be much worse when children are confined to their homes without outdoor activities and interaction with same aged friends during the outbreak. Perhaps a more important but easily neglected issue is the psychological impact on children and adolescents. Stressors such as prolonged duration, fears of infection, frustration and boredom, inadequate information, lack of in-person contact with classmates, friends, and teachers, lack of personal space at home, and family financial loss can have even more problematic and enduring effects on children and adolescents. 4 For example, Sprang and Silman 6 showed that the mean posttraumatic stress scores were four times higher in children who had been quarantined than in those who were not quarantined. Furthermore, the interaction between lifestyle changes and psychosocial stress caused by home confinement could further aggravate the detrimental effects on child physical and mental health, which could cause a vicious circle. To mitigate the consequences of home confinement, the government, non-governmental organisations (NGOs), the community, school, and parents need to be aware of the downside of the situation and do more to effectively address these issues immediately. Experiences learned from previous outbreaks can be valuable for designing a new programme to tackle these issues in China. 7 The Chinese Government needs to raise the awareness of potential physical and mental health impacts of home confinement during this unusual period. The government should also provide guidelines and principles in effective online learning and ensure that the contents of the courses meet the educational requirements. Yet it is also important not to overburden the students. The government might mobilise existing resources, perhaps involving NGOs, and create a platform for gathering the best online education courses about healthy lifestyle and psychosocial support programmes available for schools to choose from. For example, in addition to innovative courses for a better learning experience, promotional videos can be useful to motivate children to have a healthy lifestyle at home by increasing physical activities, having a balanced diet, regular sleep pattern, and good personal hygiene. 8 To make these educational materials truly effective, they must be age-appropriate and attractive. They require professional expertise and real resources to create. Communities can serve as valuable resources in managing difficulties of family matters. For instance, parents' committees can work together to bridge the needs of students with school requirements and to advocate for children's rights to a healthy lifestyle. Psychologists can provide online services to cope with mental health issues caused by domestic conflicts, tension with parents, and anxiety from becoming infected. 7 Social workers can play an active role in helping parents cope with family issues arising from the situation, when needed. Such a social safety net could be particularly useful for disadvantaged or single-parent families, 9 but action is needed to make it accessible to them. Schools have a critical role, not only in delivering educational materials to children, but in offering an opportunity for students to interact with teachers and obtain psychological counselling. Schools can actively promote a health-conscious schedule, good personal hygiene, encourage physical activities, appropriate diet, and good sleep habits, and integrate such health promotion materials into the school curriculum. 3 A Chinese child studies from home during the COVID-19 outbreak © 2020 Fan Jiang 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. In the event of home confinement, parents are often the closest and best resource for children to seek help from. Close and open communication with children is the key to identifying any physical and psychological issues and to comforting children in prolonged isolation.10, 11 Parents are often important role models in healthy behaviour for children. Good parenting skills become particularly crucial when children are confined at home. Besides monitoring child performance and behaviour, parents also need to respect their identity and needs, and they need to help children develop self-discipline skills. Children are constantly exposed to epidemic-related news, so having direct conversations with children about these issues could alleviate their anxiety and avoid panic.10, 11 Home confinement could offer a good opportunity to enhance the interaction between parents and children, involve children in family activities, and improve their self-sufficiency skills. With the right parenting approaches, family bonds can be strengthened, and child psychological needs met. 12 Since the COVID-19 epidemic is no longer confined to China, 13 school closure and home confinement-related issues also become relevant in other affected countries. As children are vulnerable to environmental risks and their physical health, mental health, and productivity in adult life is deeply rooted in early years, 14 close attention and great efforts are required to address these emergency issues effectively and avoid any long-term consequences in children. Any sustainable programme must involve local professionals to culturally adapt the interventions to the administrative system and to the regional and community environment, and it must develop contextually relevant material for children and adolescents. 7 Finally, children have little voices to advocate for their needs. The latest Commission 14 on the future of the world's children urges a holistic strategy in preparing for the uncertainty that all children are facing. It is the responsibility and keen interests of all stakeholders, from governments to parents, to ensure that the physical and mental impacts of the COVID-19 epidemic on children and adolescents are kept minimal. Immediate actions are warranted.
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            COVID-19: health literacy is an underestimated problem

            Rapid development of coronavirus disease 2019 (COVID-19) into a pandemic has called for people to acquire and apply health information, and adapt their behaviour at a fast pace. 1 Health communication intended to educate people about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how to avoid getting or spreading the infection has become widely available. Most valuable information is created in an easy-to-understand manner that offers simple and practical solutions, such as washing hands, maintaining physical distance 2 , and where to find information about the latest recommendations, and advice. Unfortunately, there is also complex, contradictory, and false information. 1 Similarly, individuals are considered able to acquire, understand, and use this information in a sound and ethical manner—ie, to be health literate. However, the COVID-19 infodemic 1 has highlighted that poor health literacy among a population is an underestimated public health problem globally. For instance, in Europe, nearly half of adults reported having problems with health literacy and not having relevant competencies to take care of their health and that of others. 3 Health literacy is already seen as a crucial tool for the prevention of non-communicable diseases with investments in education and communication sought to be sustainable, long-term measures starting early in the life course. 4 However, when COVID-19 emerged rapidly, two aspects became striking. First, globally, health literacy is as important for the prevention of communicable diseases as it is for non-communicable diseases. Second, along with system preparedness, individual preparedness is key for solving complex real-life problems. In this pandemic, it is difficult, yet possible, to take the time to enhance health literacy because immediate action is required by governments and citizens. For countries to secure health-care services for the most susceptible individuals, many people have adopted policies that restrict physical contact by banning events, sizing limits for group gatherings, and even issuing stay-at-home orders. Governments and health authorities are pleading for individual responsibility in avoiding all unnecessary risks for infection with or spread of SARS-CoV-2. During these times, the discussion around human rights and personal freedom, democracy, social responsibility, and public health action are put to the test. Amid the pandemic, it is difficult to agree with the argument made by Wikler 5 that “if people know they are taking risks but accept them as the price of pursuing goals to which they assign higher priority, then it is not the business of public health to insist that health be valued above all”. 5 This argument might be true under different circumstances, but now, irrational behaviour in non-compliance with COVID-19 policies, which might be motivated by misperception of risks 6 or other personal priorities, allows a so-called free rider problem. 7 This issue has been widely discussed in the context of vaccination, 8 but it can also occur during the COVID-19 outbreak by deliberately neglecting precautions and protective behaviour. Most people act in a socially responsible way and with solidarity, thus creating a collective good of infection-free space and decreased infection risk. The so-called free riders enjoy the benefits themselves of others complying with the given policies (ie, decreasing risks) 7 ; however, they travel, hang around in groups, and ignore pleas for protective and preventive behaviour, feeling a false sense of invulnerability. 9 Nonetheless, as the risk of becoming infected is dependent on other people's compliance with the guidelines and the risk of others is dependent on commitment to joint efforts, unwillingness to contribute to collective good is unfair on other members of society.8, 10 In the COVID-19 pandemic, this behaviour does injustice, especially to high-risk groups, people with diseases, and the health workforce trying to treat these patient groups and save their lives. Health literacy might help people to grasp the reasons behind the recommendations and reflect on outcomes of their various possible actions. However, taking social responsibility, thinking beyond personal interests, and understanding how people make choices—aspects such as ethical viewpoints and behavioural insights—should also be considered within the toolbox of health literacy. Solidarity and social responsibility should not only be accounted for by the general population and decision makers, but also by those individuals who produce and share misleading and false information about SARS-CoV-2. The development of health literacy is even more topical than ever to prepare individuals for situations that require rapid reaction. Above all, health literacy should be seen in relation to social responsibility and solidarity, and is needed from both people in need of information and services and the individuals who provide them and assure their accessibility for the general population.
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              The Scientific Base Linking Social and Emotional Learning to School Success

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                Author and article information

                Contributors
                Journal
                Lancet Public Health
                Lancet Public Health
                The Lancet. Public Health
                The Author(s). Published by Elsevier Ltd.
                2468-2667
                25 May 2020
                25 May 2020
                Affiliations
                [a ]UN Educational, Scientific and Cultural Organisation (UNESCO) Chair on Health Education and Sustainable Development, Federico II University, Naples 80131, Italy
                [b ]Italian Society of Environmental Medicine, Milan, Italy
                [c ]Human Relations Sciences, University of Bari Aldo Moro, Bari, Italy
                [d ]Department of History, Society, and Human Studies, University of Salento, Lecce, Italy
                [e ]UNESCO Assistant Director General for Education, Paris, France
                Article
                S2468-2667(20)30124-9
                10.1016/S2468-2667(20)30124-9
                7247785
                32464100
                9814f571-62c2-49ab-a216-eefcff786f1a
                © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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