Urban health educators' perspectives and practices regarding school nutrition education policies

Although nutrition-related health education policies exist at national, state and local levels, the degree to which those policies affect the everyday practices of health education teachers who are charged with executing them in schools is often unclear. The purpose of this study was to examine the nutrition-related health education policy matrix that affected one urban school district, the health education teachers' awareness of those policies, the impact of nutrition policies on teachers' instruction and challenges teachers perceived in executing comprehensive nutrition education. The study used interpretive ethnography to examine the educational contexts and perspectives of 27 health educators from 24 middle schools in one urban district in the Midwestern United States. Data were collected through school observations, interviews with key personnel and document collection. We found that a network of nutrition-related education policies governed health education teachers' instruction, but that teachers were uniformly unaware of those policies. Without institutional coherence and clear directives, health education teachers taught little nutrition content, primarily due to poor training, professional development, instructional resources and administrative accountability. The results are discussed in light of the enormous challenges in many urban schools and the need for nutrition education professional development.     

Can improvements in water supply reduce childhood diarrhoea?

The effects of improving the water supply on the incidence ofdiarrhoea in 1096 children from three neighbouring villagesof the Kirotshe rural health district. Northern Kivu, Zairewere investigated. Two of these villages had piped water, whilethe third village had no such facility. Children aged underfour years on registration were visited fortnightly for oneyear. Median diarrhoea incidence per two weeks proved to besignificantly lower in the two intervention villages than inthe control village. In the two intervention villages, mediandiarrhoea incidence per two weeks was halved in children wholived in households located less than a five-minute walk fromthe public standpipe, or in households using more than 50 litresof water a day. The association between diarrhoea incidenceand facility use did not differ after stratification by socioeconomicvariables. These findings underscore the fact that children in householdsthat use standpipes are exposed to a lower risk of diarrhoea.Therefore, it is important to stress that those in charge ofthe planning and implementation of water supply interventionsinvestigate the access to, and use of, water amongst the targetpopulation.     

Is birthweight a good marker for gestational exposures that increase the risk of adult disease?

There is much evidence of a link between low birthweight and elevated risk of adult cardiovascular disease, from humans and experimental animals. However, if one relies on data linking birthweight to coronary heart disease to estimate the public health implications of this association, the effects are likely to be modest. The focus on birthweight may be misplaced, because reduced size at birth may not be in the causal pathway linking gestational factors to disease in adult offspring. We need to know more about this before we can estimate the public health implications of gestational factors and assess the potential for intervention. The most studied gestational factor is maternal nutrition. We review here evidence for and against birthweight being in the causal pathways between suboptimal maternal nutrition and increased risk of adult disease in the offspring and provide evidence suggesting that birthweight is not in all of them. From a public health point of view, we suggest that future research in this field should focus on modifiable gestational exposures that may be linked to adult disease, whether or not they influence size at birth.     

Woodlands Wisdom: a nutrition program interfacing indigenous and biomedical epistemologies

The Woodlands Wisdom Nutrition Project represents a proactive approach of Tribal Colleges to address food and health concerns of indigenous communities. Befitting the unique mission of Tribal Colleges, Woodlands Wisdom has created a food and nutrition curriculum where local tribal culture and knowledge interfaces with nutrition science principles. A conceptual model of this approach is presented and discussed within a cross-cultural context. Although student outcome data are not yet reported, the model offers several considerations for nutrition educators working within cross-cultural contexts.     

A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation

Theory-based intervention programmes to support health-related behaviour change aim to increase health impact and improve understanding of mechanisms of behaviour change. However, the science of intervention development remains at an early stage. We present a causal modelling approach to developing complex interventions for evaluation in randomized trials. In this approach a generic model links behavioural determinants, causally through behaviour, to physiological and biochemical variables, and health outcomes. It is tailored to context, target population, behaviours and health outcomes. The development of a specific causal model based on theory and evidence is illustrated by the ProActive programme, supporting increased physical activity among individuals at risk of Type 2 diabetes. The model provides a rational guide to appropriate measures, intervention points and intervention techniques, and can be tested quantitatively. Causal modelling is critically compared to other approaches to intervention development and evaluation, and research directions are indicated.     

因果图模型及其在营养流行病学研究中的应用

不良饮食是慢性非传染性疾病最重要的可控危险因素之一,但通过随机对照试验定量阐明具体饮食因素与健康结局的因果关联面临很多困难。近年来,因果推断的迅速发展为充分利用和发掘观察性研究数据,产生高质量的营养流行病学研究证据提供了有力的理论和方法工具。其中,因果图模型通过整合大量先验知识将复杂的因果关系系统可视化,提供了识别混杂和确定因果效应估计策略的基础框架,基于不同的因果图,可选择调整混杂、工具变量或中介分析等不同的分析策略。本文对因果图模型的思想和各种分析策略的特点及其在营养流行病学研究中的应用进行介绍,旨在促进因果图模型在营养领域的应用,为后续研究提供参考和建议。     

Fetal origins of adult disease: tracing and recruitment of offspring whose mothers participated in a trial of nutritional supplementation during pregnancy – the Sorrento experience

Summary  It has been proposed that fetal nutrition is an important determinant of adult health and of inequalities in health between different social groups. Evidence for the 'fetal origins' hypothesis, currently, comes almost exclusively from observational studies relating indices of birth size (which in part reflects fetal nutrition) to adult disease or disease risk markers. Observational associations may not be causal and may have arisen through confounding by factors associated with both smaller size at birth and later disease risk. An experimental study conducted in Birmingham 25 years ago showed that protein-energy supplementation amongst nutritionally at risk mothers increased offspring birth size. The experimental design means that this association is unlikely to have arisen through confounding. Adult offspring of mothers participating in this study are now being assessed to determine effects of supplementation on their current health. This will provide important evidence of the potential to improve public health through improving the nutrition of pregnant women.     

Plan régional d’amélioration de la qualité : démarche de soin diététique au sein des établissements de santé du Réseau des comités de liaison alimentation nutrition Champagne-Ardenne

Difficulties in the management of malnutrition in hospitals are multi causal. Although responsibilities are shared, dieticians are nonetheless very concerned by this situation. In some French area, i.e. Champagne-Ardenne, dietitians are organized within networks of committees responsible for the liaison between health staffs in charge of patient nutrition. This organization is engaged in a plan to improve the quality of care approach for malnourished patients. Through a process of evaluation of professional practice, an improvement plan and a new evaluation phase for four months, this committee prove that, despite an unsatisfactory initial inventory, an improvement plan lead them to take new requirements into consideration and to improve the nutritional management of malnourished patients.     

Eating environment in the aged‐care residential setting in New Zealand: Promoters and barriers to achieving optimum nutrition. Observations of the foodservice,menu and meals

Aim: To investigate the foodservice, menu and meals in the aged‐care residential setting to identify promoters and barriers to achieving optimum nutrition. Method: An observational study conducted by the University of Otago Dietetic Training Programme. Rest home dietitians around New Zealand identified a final convenience sample of 50 facilities. Ten final‐year student dietitians each spent two days in their designated rest homes, administering a 19‐item questionnaire to ascertain practices relating to staffing, dining environment, menu, meals, snacks, feeding assistance, fluids, special diets, nutrition care, medications, nutrition policy and access to sunlight. Observations describing foodservice and meal‐related activities only are reported in this paper. Results: Most rest homes had the ability to provide for the needs of residents. Ninety per cent of facilities offered menu cycles of at least four weeks long. Potential barriers to meeting needs were inadequate amounts of protein‐rich food for numbers served and lack of perceived choice in menus and meal service. Lack of foodservice staff training and poor uptake of training opportunities contributed to these barriers. Conclusions: This is the first such study conducted in New Zealand. Results should be of interest to the Ministry of Health and district health boards that are charged with the responsibility to ensure that meals in long‐term care facilities meet the nutritional needs of this potentially vulnerable population. Shortcomings identified in the present study require a multidisciplinary approach that should include district health boards, auditing agencies, aged‐care organisations, training providers and dietitians.     

The role of health promotion in prevention policy against cardiovascular diseases in Hungary.

The development of public health has been a high priority in recent years in Hungary. In spite of concentrated efforts to establish a more advanced health service, the health status of the population has not improved and trends in mortality and morbidity are still unfavourable. Risk factors from the environment and from health-damaging behaviour are generally accepted as the main causes of cardiac diseases, yet lay people still think that progress in therapy can compensate for the effects of an unhealthy, overstrained and self-exploiting way of life. We might have well-educated experts and well-equipped institutes but two in three victims of myocardial infarction do not even reach hospital. A reorientation of health policy to a more prevention-focused approach and joint activities of all administrative, economic and social sectors coordinated at government level are necessary to put health in a more favourable position in the pattern of values in our society. The medical and sociological research work and the community level prevention activities began in 1982 in the 17th district of Budapest. The data of 1,611 residents of the district aged 25-64 were analysed. From data on nutrition, leisure-time physical activity, obesity, blood pressure distribution, and smoking habits it was established that socially unfavourable conditions cause a higher risk of cardiovascular diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

The role of health promotion in preventive policy against cardiovascular diseases in Hungary

The development of public health has been a high priority inrecent years in Hungary. In spite of concentrated efforts toestablish a more advanced health service, the health statusof the population has not improved and trends in mortality andmorbidity are still unfavourable. Risk factors from the environment and from healthdamaging behaviourare generally accepted as the main causes of cardiac diseases,yet lay people still think that progress in therapy can compensatefor the effects of an unhealthy, overstrained and self-exploitingway of life. We might have well-educated experts and wellequippedinstitutes but two in three victims of myocardial infarctiondo not even reach hospital. A reorientation of health policyto a more prevention-focused approach and joint activities ofall administrative, economic and social sectors coordinatedat government level are necessary to put health in a more favourableposition in the pattern of values in our society. The medical and sociological research work and the communitylevel prevention activities began in 1982 in the 17th districtof Budapest. The data of 1 611 residents of the district aged25–64 were analysed. From data on nutrition, leisure-timephysical activity, obesity, blood pressure distribution, andsmoking habits it was established that socially unfavourableconditions cause a higher risk of cardiovascular diseases. The rate of multilaterally-endangered residents is 7.2% whileonly one fifth of the population has not reached critical levelsof blood pressure, serum cholesterol and obesity. Prevention efforts focused on school children in elementaryschools aimed mainly at healthy nutrition, regular physicalactivity and smoking prevention. A health centre was built forthe adult residents of the district. The intervention strategy was based on the philosophy of healthpromotion and ensured the participation of local communitiesas well as the availability of community resources. Future evaluationwill show how the results and experiences can be used in a nationwideproject for the prevention of cardiovascular diseases.     

Personalized nutrition: nutritional genomics as a potential tool for targeted medical nutrition therapy

An emerging goal of medical nutrition therapy is to tailor dietary advice to an individual's genetic profile. In the United States and elsewhere, "nutrigenetic" services are available over the Internet without the direct involvement of a health care professional. Among the genetic variants most commonly assessed by these companies are those found in genes that influence cardiovascular disease risk. However, the interpretation of DNA-based data is complex. The goal of this paper is to carefully examine nutritional genomics as a potential tool for targeted medical nutrition therapy. The approach is to use heart health susceptibility genes and their common genetic variants as the model.     

2017年北京市东城区中小学生营养知识及饮食行为现状

目的为了解和掌握北京市东城区中小学生营养相关认知和饮食行为的现状,制定营养教育、营养干预策略从而改善辖区中小学生营养状况。方法采用PPS(规模比例抽样)、两阶段分层整群随机抽样的方法抽取746名中小学生,进行营养知识和饮食行为的自填式问卷调查。结果调查全部答题得分折合为百分制,全部调查者得分平均值为55.27±22.98。22.3%的被调查学生认为自己现在的营养和食品安全知识足够。76.0%的学生能够每天吃早餐,能否每日吃早餐受到学段、是否住宿和父母学历的影响。32.7%的学生从不剩饭,是否剩饭与学段、性别有关系。学生经常喝的饮料前三位为:鲜榨果汁/蔬菜汁、无碳酸含糖饮料和碳酸饮料;30.0%的人每周喝4次以上。经常吃的零食前三位为:水果、面包饼干和奶制品。结论东城区学生营养相关知识还欠缺,每日早餐率和剩饭情况需要改善,饮料和零食的选择需要正确引导;卫生与教育部门需要开展社会、家庭和学校全方位的营养健康促进工作,提高中小学生的健康素养。     

Organization of a fluoridation program with fluoride gel within the scope of a systematic quality assurance concept in dental health promotion

It is known from epidemiological studies that besides the instruction in oral hygiene and healthy nutrition the application of fluorides mainly contributes to improved oral health. In the district of Tuttlingen a fluoride varnish and a fluoride gel are used in oral prevention. The gel is applied every 14 days in collaboration with 207 parents and teachers. This cooperation should improve oral self-care and lead to an increased consciousness of preventive measures. The entire programmme is part of the concept of quality management in oral prevention in the district. Based on health reporting, sanitary priorities and targets are described with the period of time required for attaining the set targets. The achieved preventive measures are evaluated with regard to their effectiveness and efficiency for an optimised use of the available means and resources.     

Integrierte Ansätze zu Ernährung, Bewegung und Stressbewältigung

Epidemiological data relating to the health of children and adolescents in the areas of nutrition,physical activity and stress regulation show incipient health deficits which may manifest themselves later in life, usually as chronic illnesses. An early interventional approach is therefore required. Basic health deficits in the above areas are described. Interactions between behaviour relating to nutrition,physical activity and stress are presented in a working model. The exercise taken by children and adolescents acts as the central point of these interactions. This model will be used to develop an integrated, interventional approach which will, with the aid of additional measures, employ the targets group's orientation towards their experiencesto achieve a lasting effect.The theoretical model will be illustrated using two practice-based examples.     

Starting down the right path: nutrition connections with chronic diseases of later life

Thirty years have been added to the average life expectancy of Americans over the past century. It is a reasonable expectation that Americans will achieve an average life span of > or =100 y within this century. The most dramatic decreases in early-life and midlife mortality coincided with advances in medicine; curative medicine has played a lesser role. The aging of the population alone has already increased health care costs, and as we move toward even longer lives, these costs will likely increase even more. Therefore, establishing and safeguarding optimal health from early life must become increasingly important concerns for governments and health care providers if they are to allocate resources wisely and ensure and maintain a high quality of life in the population. A prevention-oriented, life cycle approach is critical to establishing and maintaining health throughout life. This approach can delay and compress morbidity and the social toll associated with chronic disease and disability for as long as possible into old age. Good evidence exists that early nutrition affects key risk factors for chronic degenerative diseases of middle and later life, such as osteoporosis and cardiovascular disease. The influence of nutrition on health status and morbidity supports primary, secondary, and tertiary prevention of disease and intervention strategies at each point in the process. The objective of such a prevention-oriented model is to enable people to live well for longer, while minimizing chronic disability. Starting down the right path with appropriate nutrition and staying on it by eating well are important components of healthy aging.     

Markers for nutrition studies: review of criteria for the evaluation of markers

Introduction

Markers are important tools to assess the nutrition status and effects of nutrition interventions. There is currently insufficient consensus in nutrition sciences on how to evaluate markers, despite the need for properly evaluating them.

Objectives

To identify the criteria for the evaluation of markers related to nutrition, health and disease and to propose generic criteria for evaluation.

Method

The report on “Evaluation of Biomarker and Surrogate Endpoints in Chronic Disease” from the Institute of Medicine was the starting point for the literature search. Additionally, specific search strategies were developed for Pubmed.

Results

In nutrition, no set of criteria or systematic approach to evaluate markers is currently available. There is a reliance on the medical area where statistical methods have been developed to quantify the evaluation of markers. Even here, a systematic approach is lacking—markers are still evaluated on a case-by-case basis. The review of publications from the literature search resulted in a database with definitions, criteria for validity and the rationale behind the criteria. It was recognized that, in nutrition, a number of methodological aspects differ from medical research.

Conclusions

The following criteria were identified as essential elements in the evaluation of markers: (1) the marker has a causal biological link with the endpoint, (2) there is a significant association between marker and endpoint in the target population, (3) marker changes consistently with the endpoint, e.g., in response to an intervention, and (4) change in the marker explains a substantial proportion of the change in the endpoint in response to the intervention.     

Iodine Nutritional Status Among Neonates in the Solan District,Himachal Pradesh,India

Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). According to WHO, if more than 3 % of the neonates have TSH levels of 5 mlU/l and more in a population, it indicates presence of iodine deficiency (ID). Iodine deficiency is an endemic health problem in Solan district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. The aim is to determine iodine nutrition status of neonates of Solan district. In Solan district, six hospitals/community health centers providing obstetric services and conducting more than 100 deliveries per annum were identified and enlisted. Two hospitals were selected keeping in view of operational feasibility. A total of 683 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. It was found that 63.2 % of the neonates had TSH levels of more than 5 mlU/l indicating iodine deficiency in the Solan district. Iodine deficiency was a public health problem in Solan district, HP.     

深圳市宝安区流动儿童保健现状及健康状况分析

目的 了解目前深圳市宝安区流动儿童保健现状及健康状况,为促进流动儿童保健现状的改变提供基础。方法 在深圳市宝安区流动人口较集中的街道中随机选取的2个街道,对符合条件的805名0~36月龄流动儿童的监护人进行调查。结果 宝安区流动儿童健康体检率为60.7%,6月龄以下儿童纯母乳喂养率为69.9%,儿童营养性疾病(中/重度营养不良,肥胖,缺铁性贫血)的检出率为22.7%;不同年龄的儿童体检率及贫血检出率差异有统计学意义(χ²=45.4和6.6,P值均<0.05)。 结论 深圳市宝安区流动儿童保健现状不容乐观,儿童营养性疾病的检出率较高,应重点加强对监护人进行辅食添加及1岁以上儿童健康体检、饮食营养等宣传。     

Whither goest nutrition?

Three aspects of nutrition are identified. They are food, its production and availability, eating, human metabolism. Nutrition is multifactorial. Medical men are not taught about nutrition. They are concerned with illness, not health. Science, caught up in a Cartesian dichotomy, is hampered by a reductionist approach. The World Health Organisation recommends that nutrition should be approached from the standpoint of health promotion. The implications of such an approach are expounded.