Creating health-promoting schools in rural China: a project started from deworming

Intestinal helminth infection is highly endemic in rural areasof China. This project was implemented to determine if dewormingefforts through schools could reduce helminth infections andsuccessfully serve as an entry point for developing a more comprehensiveapproach to school health, i.e. the components of ‘health-promotingschools’. Six primary and junior secondary schools with6188 students were involved in the project. Major interventionsin four experiment schools included: examination and treatmentof helminth infections; health education; improvement of schoolphysical environment; establishment of relevant school policiesand regulations; and strengthening relationship between schooland community. The only intervention taken by the other twoschools as controls was deworming. After 1 year of implementation,helminth infection in students and environmental contaminationby helminth eggs in experiment schools decreased by ~80%, significantlyhigher than that in control schools. Remarkable improvementsin students' knowledge, behaviour and skills of health protection,in school physical facilities, in school/community relationship,and in relevant policies and practices, were also observed inthe experiment schools. The conclusions are that the conceptof the health-promoting school has been well accepted by thestudents, teachers, parents and local government officers, andthat helminth reduction is an effective and feasible entry pointfor establishing health-promoting schools in rural areas wherehelminth infection has been an important public health problem.     

Evaluating health-promoting schools in Hong Kong: development of a framework

Health-promoting schools (HPS)/healthy schools have existed internationally for about 15 years. Yet there are few comprehensive evaluation frameworks available which enable the outcomes of HPS initiatives to be assessed. This paper identifies an evaluation framework developed in Hong Kong. The framework uses a range of approaches to explore what schools actually do in their health promotion and health education initiatives. The framework, which is based on the WHO (Western Pacific Regional Office) Guidelines for HPS, is described in detail. The appropriate instruments for data collection are described and their origins identified. The evaluation plan and protocol, which underpinned the very comprehensive evaluation in Hong Kong, are explained. Finally, a case is argued for evaluation of HPS to be more in line with the educational dynamics of schools and the research literature on effective schooling, rather than focusing primarily on health-related measures.     

The status of health-promoting schools in Hong Kong and implications for further development

An evaluation framework, called the Hong Kong Healthy Schools Award, has been developed to enable comprehensive collection and analysis of data reflecting the status of health-promoting schools (HPS) in Hong Kong. The key findings revealed a high prevalence of emotional problems, unhealthy eating habits, physical inactivity and risk-taking behaviours, leading to both intentional and unintentional injuries among students with higher prevalence among secondary school students. The results indicated a substantial lack of health policies in schools; it also indicated health services in schools not readily accessible to students and staff, and insufficient staff training in health promotion and education. However, most schools have made initiatives in environmental protection, established safety guidelines and strategies for managing students with emotional problems. The success of HPS depends largely on teachers' understanding of its building blocks. Evidence from the comprehensive mapping of the status of HPS in Hong Kong and from student surveys does show encouraging outcomes as well as identifying priority issues to be addressed in the next 5 years.     

Building capacity for the continuous improvement of health-promoting schools

BACKGROUND: There has been much educational verbosity over the past decade related to building capacity for effective schools. However, there seems to be a scarcity of clarification about what is meant by school capacity building or how to accomplish and sustain this process. This article describes the preexisting conditions and ongoing processes in Pueblo, Colorado School District 60 (Pueblo 60) that built capacity for the development and continuous improvement of health-promoting schools. METHODS: Capacity building strategies and a program-planning model for continuous improvement for health-promoting schools were used that included: (a) visionary/effective leadership and management structures, (b) extensive internal and external supports, (c) development and allocation of adequate resources, (d) supportive policies and procedures, and (e) ongoing, embedded professional development. RESULTS: Pueblo 60 strategically developed an infrastructure through which they successfully delivered a wide array of health programs and services. CONCLUSIONS: Through building organizational capacity at the school district and school level, additional school health programming can be developed and sustained.     

Children's eating behavior: the importance of nutrition standards for foods in schools

BACKGROUND: To enhance the impact of school nutrition programs on children's health, more information is needed on the associations between healthy and unhealthy food offerings during school lunch periods and children's eating behavior. The purpose of this study is to evaluate the contributions of food offerings and participation in school lunch programs on children's overall (both in‐ and out‐of‐school) eating behavior. METHODS: A cross‐sectional observational study was conducted in which 2039 students in 12 elementary and 10 middle schools reported their eating behavior and the frequencies with which they purchased meals and à la carte items in the school cafeteria. Food service managers from each school provided information on the availability of foods and beverages during school lunch periods. Multilevel regression analyses were conducted to identify school‐ and student‐level predictors of children's eating behavior. RESULTS: The availability of nutritious foods during school lunch periods was associated with healthier eating behavior among students. However, this effect was observed only among children who infrequently purchased à la carte food items, and not among those who were frequent purchasers. CONCLUSION: Increased availability of fruits, vegetables, whole grains, and low‐fat dairy products as components of school meals may be an effective strategy to promote healthy eating behaviors among children. Improving the nutrition standards for foods offered in competition with federally reimbursable school meals may enhance the positive effects of school meal programs on student eating behavior.     

Developing a nutrition and health education program for primary schools in Zambia

School-based health and nutrition interventions in developing countries aim at improving children’s nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.     

Nutrition education in primary schools in Hampshire

A random sample of headteachers in 150 primary schools in Hampshire were sent a questionnaire on nutrition teaching and use of tuck shops. The response rate was 90%. Nutrition was taught either directly or indirectly in 96% of the schools, although only 33% of schools had a policy concerning nutrition education. Having a policy was related to the aspects of nutrition which were taught and the subject areas where nutrition was included. Sixty-nine per cent of headteachers felt that staff would like more information or advice on nutrition education and this may have affected the low numbers of schools involved in taking any new initiatives to promote nutrition and healthy eating. Children were allowed to bring sweets in to 30% of schools and tuck shops were available in 22%. However, in 61% of schools children were only allowed to bring in fruit or vegetable snacks (apart from a packed lunch). It appears that schools are teaching nutrition but many lack information to help with the teaching.     

Prospective study on nutrition transition in China

The aim of the prospective study reported here was to examine the effects of social and economic transformation on dietary patterns and nutritional status in China. The study began in 1989 and continued with follow-ups in 1991, 1993, 1997, 2000, and 2004. A total of 5000 subjects aged 18–45 years from 4280 households in nine provinces were included. Weighed records and three consecutive 24-h recalls were used. Over the study period, average consumption of all animal foods except milk increased, while cereal intake decreased. The proportion of animal protein and fat as a percentage of energy also increased. However, vitamin A and calcium intake did not increase and remained low. Child height and weight increased while undernutrition decreased and overweight increased. The results indicate that rapid changes in dietary pattern are associated with economic reforms in China.     

脑卒中再住院患者病耻感对健康促进生活方式的影响研究

目的了解脑卒中再住院患者病耻感对健康促进生活方式的影响,为改善临床脑卒中患者健康教育提供依据。方法采用便利抽样方法,选取2017年3月至2019年3月到宁波市某三级甲等医院就诊的273例脑卒中再住院患者为研究对象。应用一般资料调查问卷、慢性疾病病耻感量表、健康促进生活方式量表进行调查。结果脑卒中再住院患者的病耻感评分为(46.79±16.57);健康促进生活方式评分为(125.93±35.82),二者呈负相关(r=-0.299,P<0.05)。脑卒中再住院患者的婚姻状况、病耻感、家庭人均月收入和脑卒中复发次数是健康促进生活方式的主要影响因素(P<0.05)。结论脑卒中再住院患者的健康促进生活方式处于较低水平。临床工作中,应重点关注脑卒中再住院患者的健康促进生活方式,根据每个患者的情况采取针对性地行为指导和干预,提升患者的健康促进生活方式水平,避免或减少脑卒中复发。     

Helping schools to become health-promoting environments--an evaluation of the Wessex Healthy Schools Award

The concept of the health-promoting school embodies a holistic,whole school approach to personal and community health promotion.Healthy school award schemes, which are increasing, are seenas one way of helping schools to become health promoting. Manyare based on the Wessex Healthy Schools Award scheme (WHSA)which was established in 1993. This paper outlines a 3-yearevaluation study of the effectiveness of the WHSA interventionin changing health promotion policy and practice in school,and in influencing health-related knowledge, attitudes and behaviourof pupils. The study design was quasi-experimental, and wasconducted in 11 intervention secondary and five control schools.It involved pupils, teachers, support staff, parents, schoolgovernors, health promotion officers and education advisers,using a range of quantitative and qualitative tools. The Awardprocess, which is linked to nine key areas of health, lasted15 months. Changes in school health promotion were assessedby audit; pupils' health-related knowledge, attitudes and behaviourthrough self-administered questionnaires; and attitudes andperceptions of staff, parents and governors from semi-structuredinterviews. The results showed that audit scores for all areas,except physical activity and taking responsibility for health,increased in intervention schools, indicating positive Award-relatedchanges. There was little improvement in healthy food choices,smoke-free environment and developing community links. Pupils'knowledge, high at the baseline, remained unchanged. Positiveeffects on smoking uptake and drug use were seen, but littlechange in healthy eating and physical activity. Older girlsmade greater progress in all areas. Parents and non-teachingstaff strongly supported school health promotion, perceivedmany benefits of the Award, and wished to be more actively involved.The Award positively influenced the development of a health-promotingschool, perceived as an important component of education. Furtherresearch is needed into ways of improving pupils' diet and activitylevels, how schools can implement a smoke-free environment,the development of community links, and ways in which a wholeschool approach can be achieved.     

Measuring the 'obesogenic' food environment in New Zealand primary schools

Childhood obesity is an increasing health problem in New Zealand and many other countries. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. The aim of this study was to identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. A self-completion questionnaire was developed for assessing each school's nutrition environment and mailed to a stratified random sample of New Zealand schools. The responses from primary schools (n = 200, response rate 61%) were analysed. Only 15.5% of schools had purpose-built canteen facilities and over half ran a food service for profit (31% profit to the school, 24.5% profit for the contractors). Only 16.5% of schools had a food policy, although 91% of those rated the policy as effective or very effective. The most commonly available foods for sale were pies (79%), juice (57%) and sausage rolls (54.5%). Filled rolls were the most expensive item (mean dollars 1.79) and fruit the least expensive (mean dollars 0.47). The ratio of 'less healthy' to 'more healthy' main choices was 5.6:1, for snacks it was 9.3:1 and for drinks it was 1.4:1. In contrast, approximately 60% of respondents said that nutrition was a priority for the school. Only 50% felt there was management support for healthy food choices and only 39% agreed that mainly nutritious food was offered by the food service. 'Less healthy' choices dominated food sales by more than 2:1, with pies being the top selling item (>55000 per week). We found that the food environment was not conducive to healthy food choices for the children at New Zealand schools and that this was reflected in the high sales of relatively unhealthy foods from the school food services. Programmes that improve school food through policies, availability, prices and school ethos are urgently needed.     

Nutrition policies for schools

In Britain, Canada and the United States, the impetus for initiating school nutrition policies has come primarily from health, not education, agencies. These agencies define the nutrition problems of school students as both under‐ and over‐nutrition, and, to solve them, advocate the development and implementation of policies to combat health and learning problems associated with poor nutrition. Health, rather than educational, agencies are also more likely to formulate school nutrition policies; such policies commonly address the dietary principles of access, adequacy, and moderation. Within countries, the adoption of school nutrition policies varies considerably. Moreover, the degree to which such policies have been implemented is unclear, because of a lack of research to evaluate their process and impact. To enhance the successful development and implementation of school nutrition policies, greater partnership between health and education agencies is recommended throughout the policy process.     

社区糖尿病患者生命质量及健康促进生活方式研究

目的 通过调查了解社区2型糖尿病患者的生命质量及健康促进生活方式,为科学开展健康干预提供参考依据。方法 于2017年8－10月对某社区117名2型糖尿病患者进行问卷调查,收集患者一般情况、患病情况,并采用SF-36量表及健康促进生活方式量表(HPLP)调查患者生命质量及健康促进生活方式信息,分析患者的生命质量、健康促进生活方式得分及关系。结果 117例调查对象生命质量总分为(620.09±113.95)分,各维度得分由高到低依次为:生理职能(87.39±26.99)分、生理功能(85.98±13.59)分、社会功能(85.47±17.88)分、活力(82.91±29.88)分、情感职能(75.21±15.91)分、精神健康(74.94±15.63)分、躯体疼痛(66.47±17.67)分、总体健康(61.71±16.88)分。健康促进生活方式总分得分率为62.61%,各维度由高到低依次为:营养行为72.02%、人际支持行为62.61%、生命欣赏行为61.54%、健康责任行为61.0%、压力处置行为60.85%、运动行为60.75%。 经逐步回归分析,在调整了年龄和其他慢性疾病的影响后,生命欣赏行为(β=6.388,P=0.008)和运动行为(β=5.298,P=0.024)与社区2型糖尿病患者生命质量正相关。结论 社区2型糖尿病患者健康促进行为执行不理想;运动行为及生命欣赏行为影响社区2型糖尿病患者生命质量,应采取健康教育干预重点提高运动行为及乐观心态。     

Critical processes for creating health-promoting sporting environments in Australia

The reach of sporting organizations into the community makes them an ideal vehicle through which to promote health to the general population. There are now a number of documented examples demonstrating that sponsorship can lead to improvements in the health of the sporting environment, but relatively little is known as to why some sponsorships are more successful in achieving these structural changes than others in ostensibly similar sports. The purpose of this study was to identify the processes required for health promotion agencies and sporting organizations working in collaboration to implement structural changes in sporting settings such as smoke-free environments, provision of healthy food choices, responsible alcohol management and sun protection, along with the factors that facilitate and hinder this from being achieved. We conclude that such changes are difficult to achieve, especially in the absence of a programmatic approach to health promotion.     

Encapsulation of health-promoting ingredients: applications in foodstuffs

Many nutritional experts and food scientists are interested in developing functional foods containing bioactive agents and many of these health-promoting ingredients may benefit from nano/micro-encapsulation technology. Encapsulation has been proven useful to improve the physical and the chemical stability of bioactive agents, as well as their bioavailability and efficacy, enabling their incorporation into a wide range of formulations aimed to functional food production.

There are several reviews concerning nano/micro-encapsulation techniques, but none are focused on the incorporation of the bioactive agents into food matrices. The aim of this paper was to investigate the development of microencapsulated food, taking into account the different bioactive ingredients, the variety of processes, techniques and coating materials that can be used for this purpose.     

Developing the ‘health-promoting school’—a national survey of healthy schools awards

The concept of the ‘Health Promoting School’ has been widely advocated as an approach to enhancing public health through school based health promotion. In many areas ‘Healthy Schools Award’ schemes have been set up to support the development of this concept, but there is no information on how widespread this practice is in the UK, how standards are evaluated, and what effect Healthy Schools Awards may have on young peoples' health. This UK national survey aimed to determine the extent and nature of existing award schemes and how they were being evaluated. A postal questionnaire was sent to all 200 health promotion units in the UK; the response rate corrected for mergers of units was 78.5%. Sixty-eight respondents (51%) were involved with an award scheme and 28 (21%) were planning them. Current award schemes were mostly jointly run by the health and education sectors, encompassing 845 participating schools of which two-thirds were primary schools. The most common issues addressed were; standard chronic disease risk behaviour, the environment and health education in the national curriculum; less frequently addressed were mental health, accident prevention, staff health and developing links with the wider community. Evaluation was usually by target setting and assessment of progress over a two year period. However, evaluation was rarely external or independent, raising doubts about the standards obtained and validity of the approaches. This survey highlights the rapid growth of healthy schools award schemes and the need for wider exchange of information on good practice. In particular there is a need for more explicit and measurable standards of achievement to ensure the quality of award schemes, and further research into their effectiveness.     

Nutrition teaching in European dental schools

A survey has been carried out on nutrition teaching in European dental schools. Whilst The Netherlands and some Scandinavian countries report high levels of teaching with 40 or more hours on average devoted to the subject, others report little or none. With the exception of the former, the extent of teaching of this subject is very varied and in the majority of cases, inadequate.
Only 5 schools reported separate courses in nutrition; elsewhere the hours refer to information related to nutrition included in other courses in the curriculum. Whilst current curriculum revision in some countries may improve the situation, in the absence of either European or national guidelines, amelioration will continue to depend on enthusiasm within individual dental schools and medical faculties.     

4所小学学生5种常见病调查分析

通过对城镇4所小学学生5种常见病连续3年调查,初步掌握了学生5种常见病的患病情况。结果:营养不良、肥胖、视力不良、龋齿、沙眼3年平均患病率为:24.99%、5.93%、11.51%、65.58%、4.31%。经比较营养状况、视力女生差于男生。同时分析了学生营养状况、常见病产生原因,为今后预防提供线索。