In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. We included 16 of 616 identified articles. School closures were deployed rapidly across mainland China and Hong Kong for COVID-19. However, there are no data on the relative contribution of school closures to transmission control. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2-4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.

as part of broader social lockdown measures during the COVID-19 pandemic may be associated with the health and well-being of children and adolescents.OBJECTIVE To review published reports on the association of school closures during broader social lockdown with mental health, health behaviors, and well-being in children and adolescents aged 0 to 19 years, excluding associations with transmission of infection.EVIDENCE REVIEW Eleven databases were searched from inception to September 2020, and machine learning was applied for screening articles. A total of 16 817 records were screened, 151 were reviewed in full text, and 36 studies were included. Quality assessment was tailored to study type. A narrative synthesis of results was undertaken because data did not allow meta-analysis. FINDINGS A total of 36 studies from 11 countries were identified, involving a total of 79 781 children and adolescents and 18 028 parents, which occurred during the first wave of the COVID-19 pandemic (February to July 2020). All evaluated school closure as part of broader social lockdown during the first COVID-19 wave, and the duration of school closure ranged from 1 week to 3 months. Of those, 9 (25%) were longitudinal pre-post studies, 5 (14%) were cohort, 21 (58%) were cross-sectional, and 1 (3%) was a modeling study. Thirteen studies (36%) were high quality, 17 (47%) were medium quality, and 6 (17%) were low quality. Twenty-three studies (64%) were published, 8 (22%) were online reports, and 5 (14%) were preprints. Twenty-five studies (69%) concerning mental health identified associations across emotional, behavioral, and restlessness/inattention problems; 18% to 60% of children and adolescents scored above risk thresholds for distress, particularly anxiety and depressive symptoms, and 2 studies reported no significant association with suicide. Three studies reported that child protection referrals were lower than expected number of referrals originating in schools. Three studies suggested higher screen time usage, 2 studies reported greater social media use, and 6 studies reported lower physical activity. Studies on sleep (10 studies) and diet (5 studies) provided inconclusive evidence on harms. CONCLUSIONS AND RELEVANCEIn this narrative synthesis of reports from the first wave of the COVID-19 pandemic, studies of short-term school closures as part of social lockdown measures reported adverse mental health symptoms and health behaviors among children and adolescents. Associations between school closure and health outcomes and behaviors could not be separated from broader lockdown measures.

Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people.

BackgroundFront of pack labelling (FOPL) provides visible nutritional information and appears to influence knowledge and reformulation. However, a recent Cochrane review found limited and inconsistent evidence for behaviour change. The present review aimed to examine studies published subsequent the Cochrane review, focusing on prepackaged foods, examining the impact of FOPL on purchasing and consumption.MethodsControlled experimental/intervention and interrupted time series (ITS) studies were included, with no age/geography restrictions. Exposures were FOPL with objectively measured consumption/purchasing outcomes. Thirteen databases were searched (January 2017 to April 2019) and forward citation searching was undertaken on the included studies. Purchasing data from experimental studies were meta‐analysed. Two series of meta‐analyses were undertaken; combined FOPL versus no‐FOPL and specific FOPL scheme versus no‐FOPL. Outcomes were sugar (g 100 g−1), calories (kcal 100 g−1), saturated fat (g 100 g−1) and sodium (mg 100 g−1).ResultsWe identified 14 studies, reporting consumption (experimental; n = 3) and purchasing (n = 8, experimental; n = 3, ITS). Meta‐analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no‐FOPL (−0.40 g sugar 100 g−1, P < 0.01; −24.482 mg sodium 100 g−1, P = 0.012), with a trend for lower energy and saturated fat (−2.03 kcal 100 g−1, P = 0.08; −0.154 g saturated fat 100 g−1, P = 0.091). For specific FOPL, products purchased by ‘high in’ FOPL groups had lower sugar (−0.67 g sugar 100 g−1, P ≤ 0.01), calories (−4.43 kcal 100 g−1, P < 0.05), sodium (−33.78 mg 100 g−1, P = 0.01) versus no‐FOPL; Multiple Traffic Light had lower sodium (−34.94 mg 100 g−1, P < 0.01) versus no‐FOPL. Findings regarding consumption were limited and inconsistent. FOPL resulted in healthier purchasing in ITS studies.ConclusionsThis review provides evidence from experimental and ‘real‐life’ studies indicating that FOPL encourages healthier food purchasing. PROSPERO CRD42019135743.