Does school breakfast benefit children's educational performance?

This article reviews several research studies on the impact of the lack of breakfast among students. Recent data reveal that about 20% of Nigerian children were wasted or had weight-for-height measurements under the 5th percentile of the US National Center for Health Statistics (NCHS) standard. In Ghana, 41% of children were underweight or had a weight-for-age under -2 standard deviations of the NCHS standards. In Tanzania, about 34% of children were underweight. Many more students in Africa are attending school, but many are leaving primary school early or failing secondary school examinations. It is argued that poor nutritional status affects children's ability to learn. Research reveals several hypotheses about how breakfast affects children's cognition, behavior, and school performance. Children may not attend school at all due to the inability to purchase food to eat at school, or insufficient food resources at home to provide sufficient energy to walk long distances to school. In four studies, two in the USA and the others in Peru and Jamaica, findings reveal that when undernourished children missed breakfast, they performed worse in tests of cognition. Adequately nourished children's performance was unaffected by missing breakfast. A study in four Jamaican schools found that children had more creative ideas when they received a breakfast for 2 weeks than when they did not receive breakfast. Two Swedish studies found that children with a high-calorie breakfast improved in cognition compared to those receiving a low-calorie breakfast. One study found that children in well-equipped classrooms paid more attention in class after having breakfast. Children in overcrowded classes and poorly equipped schools were less likely to pay attention after breakfast. Long-term effects are less well studied, but findings clearly support the benefits of breakfast.     

Supplement use: is there any nutritional benefit?

OBJECTIVE: To examine the role of dietary supplements in improving total nutrient intakes in adults. DESIGN: Dietitian-administered 24-hour recalls (of intake including supplements) were conducted in 1997 and 1998. Supplement users were categorized into groups based on the types of supplements used and nutrient intake was examined. SUBJECTS: Using a multistage, stratified random sampling, 1,530 Canadian adults aged 19 to 65 years were surveyed. STATISTICAL ANALYSES PERFORMED: Intakes from diet, supplements, and diet plus supplements were examined by age/gender stratification. RESULTS: Supplement users had dietary intakes, from food alone, similar to nonusers with mean intakes in some age/sex groups below the Recommended Daily Allowance (RDA)/Adequate Intake (AI) for iron, calcium, and folate. Multivitamin users had mean intakes (from diet plus supplement) of folate above the RDA and iron intakes also increased to RDA levels among women aged 19 to 50 years. Calcium supplement users had lower calcium and vitamin D intakes than nonusers from diet alone in some age/sex groups. Calcium tablets increased mean calcium intakes to AI levels among all age/sex groups. Many supplement users exceeded the new Upper Limits of safe intake; 47% in the case of niacin. APPLICATIONS: Supplements are commonly used and can help some persons adhere to Dietary Reference Intake recommendations concerning intake of folate, calcium, vitamin D. and iron. We found multivitamin users to have higher total intakes of folic acid, iron, calcium, and vitamin D. Also, targeted use of calcium supplements effectively enhanced intakes. However, concurrent vitamin D supplementation is important and awareness of product composition with respect to Upper Limits is essential.     

Can biomedical researchers benefit from political science methodologists?

The purpose of this monograph is to introduce the work of a group of political science methodologists, who created a series of models for estimation and prediction. It refers to the work of Gary King and his collaborators at Harvard University's Department of Government. They developed a set of computer-intensive simulation techniques, along with the corresponding public domain software. Their paper, "Making the most of statistical analyses: improving interpretation and presentation." and the corresponding software, Clarify (Tomz et al., 1999) are the basic sources. The use of statistical simulation has become a standard practice with the advent of fast and low cost modern computing. The reader can appreciate the usefulness in biomedical research of Clarify. It can be of much help on the statistical analysis of many biomedical problems.     

Bayesian bivariate subgroup analysis for risk–benefit evaluation

Subgroup analysis is a frequently used tool for evaluating heterogeneity of treatment effect and heterogeneity in treatment harm across observed baseline patient characteristics. While treatment efficacy and adverse event measures are often reported separately for each subgroup, analyzing their within-subgroup joint distribution is critical for better informed patient decision-making. In this paper, we describe Bayesian models for performing a subgroup analysis to compare the joint occurrence of a primary endpoint and an adverse event between two treatment arms. Our approach emphasizes estimation of heterogeneity in this joint distribution across subgroups, and our approach directly accommodates subgroups with small numbers of observed primary and adverse event combinations. In addition, we describe several ways in which our models may be used to generate interpretable summary measures of benefit-risk tradeoffs for each subgroup. The methods described here are illustrated throughout using a large cardiovascular trial (\(N = 9361\)) investigating the efficacy of an intervention for reducing systolic blood pressure to a lower-than-usual target.     

Clinical inquiries. Does blood pressure screening benefit children?

Screening may not show benefits in childhood but could pay off for adults. Although major professional organizations recommend measuring blood pressure (BP) at every clinic visit for all children older than 3 years (strength of recommendation [SOR]: C, expert opinion), scant evidence links earlier detection and treatment of childhood hypertension with improved patient-oriented outcomes. However, detecting childhood hypertension may help identify adults who would benefit from earlier treatment. Children with elevated BP have a more than 60% chance of being hypertensive as young adults (SOR: B, prospective cohort study). Children with systolic BP above the 95th percentile had a more than 4-fold increase in coronary artery disease as adults compared with children below the 95th percentile (SOR: B, retrospective study). Identifying hypertension in children is associated with a 15-fold greater likelihood of hypertension in their parents (SOR: B, case series).     

Can privatising selected services benefit the public healthcare system?

The evaluation of empirical data concerning private physician consultations in public hospitals in Greece suggests that privatisation of selected public services can increase patients' freedom of choice and also improve efficiency and quality of services, thus strengthening the supply side in a mixed healthcare system. The 2001 NHS health reform in Greece provides financial incentives to public hospital physicians to consult patients 'privately' at the outpatient clinics, while remaining restrained by certain provisions regarding fees. Competition between public and private hospitals is centrally regulated, and in this case cumulative data show success for the public sector. At the same time, patient satisfaction with the new arrangement measured in this study was very high. It could be argued that, under certain conditions, attracting private funds into a public health system constitutes an opportunity to reinforce the public provision of the system.     

Elder care: the employee benefit of the 1990s?

Long-term care is costing companies significantly in lost employee productivity. Case management services offer employers a way to ease the burden for employees with relatives who are chronically disabled and minimize disruption at work.     

Do recommended high-risk adults benefit from a first influenza vaccination?

It is unknown whether a first influenza vaccination protects high-risk adults from severe morbidity and mortality during influenza epidemics. As part of the PRISMA nested case-control study, we aimed to evaluate the effectiveness of first-time and repeat influenza vaccinations in adult persons recommended for vaccination aged between 18 and 64 years during the 1999-2000 influenza A epidemic. After adjustments, 69% of hospitalizations for acute respiratory or cardiovascular disease or death were prevented in first-time vaccinees (95% percent confidence interval [95% CI]: 8-90%). The corresponding figure in persons who were vaccinated before was 85% (95% CI: 36-96%). Adult persons with high-risk medical conditions can substantially benefit from a first and repeat influenza vaccination prior to an epidemic.