Background: Schools and school administrators need to promote training to review school safety plans and crisis management manuals to make school safety initiatives more effective, specify key indicators in plans to implement necessary measures, improve status management, and conduct training to enhance the knowledge and awareness of school safety among teachers and staff.

Objective: To ascertain issues with the safety school responses of classroom teachers and the content of school safety training for teachers and staff from the perspective of both school principals and school nurses by comparatively analyzing their open-ended responses regarding “near misses or close calls” in relation to the actions of classroom teachers.

Methods: School principals and school nurses at 2,992 schools, including elementary schools, middle schools, high schools, combined elementary and middle schools, and secondary schools, were surveyed over one month from February to March, 2019. Participants were asked to provide open-ended responses regarding incidents (near misses or close calls) involving classroom teachers that could have led to serious accidents related to the health and safety of students but which ultimately did not lead to serious accidents.

Results: Specific near misses or close calls as cited by school principals were identified in the following areas: “information sharing” among teachers within the school; and “communication with parents,” “food allergies,” including insufficient checking, confirmation, and response during field trips; and “serious accidents,” including responses to cardiac arrest, heat stroke, and the disposal of vomit. Correspondence analysis further revealed issues in elementary schools related to head injuries from trips and falls, in junior high schools related to head and eye injuries, and in both junior and senior high schools related to injury management during club activities to emergency transport.

Conclusion: The findings suggest that school safety training for teachers and staff should include the development checklists for information sharing and food allergy prevention across all school types, simulation training to teach actions from discovering students with food allergies, cardiac arrest, or heat stroke to transporting them to medical institutions, training on vomit disposal, and training for situations specific to each school type.

Background: The number of students suffering from allergic diseases including food allergy is increasing, probably reflecting environmental changes in their lifestyles. Teachers working in schools have reported various difficulties and anxieties in providing appropriate support to individual students.

Objective: The purpose of this study was to improve teachers' professional development regarding allergic diseases by understanding the current situation and challenges of school teachers in supporting students with allergic diseases.

Methods: A survey was conducted among teachers working in public schools in Prefecture A.

Results: A total of 4,313 teachers participated in the survey, and we obtained the following four findings. First, many teachers expressed anxiety regarding “emergency response”. Second, many teachers indicated a need for “basic knowledge about allergies”. Third, current training mainly focuses on food allergy and anaphylaxis, especially emergency responses. Fourth, reading and understanding the guidelines was associated with increased self-confidence in supporting students.

Conclusion: Based on teachers' current situation and challenges, we clarified the difficulties, anxieties, and needs of teachers regarding allergic diseases. This study suggests that comprehensive training on allergic diseases might contribute to improving the professional development of teachers to create a comfortable school-life for students with allergic diseases.

Background: Nonsuicidal self-injury (NSSI) in adolescence markedly increases the risk of suicide in adulthood. In Japan, approximately 10% of high school students report a history of NSSI, yet schools identify fewer than 1% of cases. There is an urgent need for a practical risk-stratification tool that can be used in one-to-one consultations by school staff.

Objective: To develop a decision tree-based classification standard that stratifies NSSI risk using a small number of questions during individual consultations conducted by teachers and school nurses.

Methods: After obtaining consent from parents or guardians, an anonymous questionnaire survey was administered to 10,152 students from 12 senior high schools in the southern area of Okayama Prefecture. The questionnaire comprised lifetime NSSI experience (outcome), eight items on impulsive aggressive behaviors in the past month, and nine items measuring current resilience. Using all 17 items as predictors, we built a Classification and Regression Trees (CART) model and evaluated performance using the receiver operating characteristic-area under the curve (ROC-AUC), recall, precision, F1 score, and Brier score.

Results: Of the 45 schools in the sampling frame, 20 (44.4%) were randomly selected, and 12 agreed to participate. In total, 6,525 students returned questionnaires (response rate = 64.3%); after excluding 129 students with missing data, 6,396 were included in the analyses. The optimal tree consisted of up to three sequential questions: (1) “piercing the skin with a sharp object,” (2) “hair pulling or skin scratching,” and (3) “understanding how unpleasant events affect one's feelings.” Model performance was as follows: ROC-AUC = 0.95, recall = 0.83, precision = 0.48, F1 score = 0.61, and Brier score = 0.04. Based on leaf-node probabilities and the elbow of the lift curve, students were stratified into high (≥90%, 10.4%), intermediate (20-90%, 12.5%), and low (<20%, 77.1%) risk groups. The high-risk group (≈10% of students) accounted for approximately 80% of all positive cases.

Conclusion: A concise three-question CART model enables efficient NSSI risk stratification in individual school consultations. Prioritizing approximately the highest-risk 10% for referral to specialists may concentrate limited resources and reduce workload. External validation and testing across different emotional contexts are warranted.