RESUMEN
Given the increase in the number of Canadian jurisdictions with school nutrition and/or physical activity policies, there is a need to assess the effectiveness of such policies. The objectives of this paper are to 1) provide an overview of key issues in monitoring and evaluating school nutrition and physical activity policies in Canada and 2) identify areas for further research needed to strengthen the evidence base and inform the development of effective approaches to monitoring and evaluation. Evaluation indicators, data sources and existing tools for evaluating nutrition and physical activity are reviewed. This paper has underscored the importance of identifying common indicators and approaches, using a comprehensive approach based on the WHO framework and ensuring that research capacity and funding is in place to facilitate high-quality evaluation efforts in the future.
Asunto(s)
Servicios de Alimentación/normas , Actividad Motora , Política Nutricional , Servicios de Salud Escolar , Canadá , Humanos , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
OBJECTIVES: School nutrition policies offer a promising avenue by which to promote healthy eating and reduce the risk of chronic disease. This article reviews policy components that could support healthy eating, examines their evidence base and suggests directions for future research. METHOD: Information was drawn from research and other literature written in English between 1994 and 2008. Guided by recommendations from the World Health Organization, evidence pertaining to five potential components of policies was identified and reviewed: foods available, the food environment, health education, health services and counselling, and family and community outreach. RESULTS: A limited number of evaluations have examined the impact of school nutrition standards and have shown a positive impact on food availability and student nutrient intake. Results have shown that behaviourally focused nutrition education, especially when combined with food services and other initiatives, may affect students' eating habits positively but may not decrease obesity levels. Evidence pertaining to other potential policy subcomponents, such as limiting food marketing in schools, coordinating all food services and providing nutrition-related health services, is limited or lacking. CONCLUSION: Conceptually, comprehensive school nutrition policies comprising all five policy components offer an integrated and holistic approach to school nutrition. They could provide an umbrella to guide all school actions pertaining to nutrition and serve as a framework for accountability. Does conceptualization match reality? Further research is needed to determine how policy components affect implementation and outcomes.
Asunto(s)
Dieta/normas , Promoción de la Salud/métodos , Política Nutricional , Adolescente , Niño , Servicios de Alimentación/normas , Humanos , Instituciones AcadémicasRESUMEN
Poststernotomy mediastinitis is a feared complication for patients undergoing cardiac surgery associated with high rates of morbidity and mortality. Approximately 15% of patients will ultimately be readmitted for a recurrent sternal wound infection. The objective of this study is to review a large single surgeon experience with sternal wound patients managed with a variety of soft tissue flaps to assess mitigating factors, involved organisms, and treatment protocols as related to specific cardiac populations. Records for 136 sternal reconstruction patients treated from January 2000 to July 2007 were evaluated. Patients underwent a variety of cardiac surgeries including coronary artery bypass grafting (CABG), valve replacement, aortic reconstruction, heart transplantation, lung transplantation, and combinations of these procedures. A total of 39.2% of patients developed a sternal wound during the same admission as their cardiac surgery, at an average of 16.1 days. This rate was only 6% for CABG-only patients and rose to nearly 50% in heart transplant and CABG + valve patients. A total of 78.6% of heart transplant patients with a sternal wound had a history of ventricular assist device and 41% of all patients had at least 1 previous sternotomy. Thirteen patients (9.6%) had 1 or more recurrent infections requiring surgery; 50% occurring in transplant patients, most of whom had diabetes and/or renal insufficiency. The most common presenting symptom was drainage (n = 75, 55.6%) or wound dehiscence (n = 22, 16.3%). Twenty-five different organisms were identified; 26 patients (18.5%) had multiple organisms. Staphylococcus species were most common. Plastic surgery intervention occurred on average 109.2 days after cardiac surgery. CABG and CABG + valve patients most frequently received right pectoralis muscle turnover flaps or left pectoralis muscle advancement flaps. Ten heart transplant patients (37.0%) underwent omental flaps. The 30-day perioperative mortality rate was 13 patients (9.6%).
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Mediastinitis/cirugía , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/cirugía , Esternotomía/métodos , Colgajos Quirúrgicos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Femenino , Humanos , Masculino , Mediastinitis/etiología , Mediastinitis/microbiología , Mediastinitis/mortalidad , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/mortalidad , Procedimientos de Cirugía Plástica/mortalidad , Estudios Retrospectivos , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/microbiología , Dehiscencia de la Herida Operatoria/mortalidad , Dehiscencia de la Herida Operatoria/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Although the majority of Canadian provinces have indicated that they have adopted new school nutrition policies, there have been few if any systematic evaluations of these policies. In Prince Edward Island, a nutrition policy for elementary schools was adopted province-wide in 2006. In the present study, we assessed the nutritional benefits of the new policy by examining changes in student food consumption prior to and one year following implementation of the policy. METHODS: We surveyed fifth and sixth grade children from 11 elementary schools in Prince Edward Island in 2001/02 (pre-policy implementation) and fifth and sixth grade children from the same 11 schools in 2007 (post-policy implementation). Food consumption was assessed using a self-administered validated food frequency questionnaire. We applied multilevel logistic regression to compare pre-/post-policy implementation differences in the proportion of students meeting Canada's Food Guide recommendations for vegetables and fruit (VF) and milk and alternatives (MA) and in the proportion of students consuming < 3 servings of low nutrient dense foods (LNDF) daily. RESULTS: Relative to students in 2001/02, students surveyed in 2007 were 2.14 (95% CI 1.62-2.82) times more likely to report consuming less than three daily servings of LNDF and were more likely to meet recommendations for VF (OR 1.44, 95% CI 1.00-2.07) and MA (OR 1.27, 95% CI 0.98-1.64). CONCLUSION: The present study is the first in Canada to show favourable changes in student food consumption that parallel the introduction of a school nutrition policy.
Asunto(s)
Conducta Alimentaria , Política Nutricional , Obesidad/prevención & control , Instituciones Académicas , Estudiantes , Índice de Masa Corporal , Niño , Intervalos de Confianza , Femenino , Promoción de la Salud , Humanos , Modelos Lineales , Masculino , Encuestas Nutricionales , Estado Nutricional , Obesidad/epidemiología , Oportunidad Relativa , Isla del Principe Eduardo , Servicios de Salud Escolar , Mercadeo Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Consumption of fruits and vegetables is often recommended to promote healthy weight. The purpose of this study was to examine associations between fruit and vegetable intake and common weight management behaviors among US high school students who were trying to lose or stay the same weight. METHODS: Data from the 1999, 2001, and 2003 national high school Youth Risk Behavior Surveys were combined and the analyses stratified by gender (females, N = 16,709; males, N = 10,521). We considered 3 common weight management strategies--being physically active (ie, moderate activity for 30 minutes on 5 or more days per week or vigorous activity for 20 minutes on 3 or more days per week), eating a reduced calorie or fat diet, and limiting TV viewing. Sufficient fruit and vegetable intake was defined as eating 5 or more servings per day. Odds ratios (ORs) were calculated using logistic regression. RESULTS: Only 21.3% of females and 24.7% of males ate sufficient fruits and vegetables. Being physically active was associated with sufficient fruit and vegetable intake. Eating a reduced calorie or fat diet and limiting TV viewing (among males) were associated with sufficient fruit and vegetable intake only among physically active students. The odds of sufficient fruit and vegetable intake were greatest among female (OR = 3.01) and male (OR = 2.91) students who combined all 3 strategies (31.5% of females, 21.6% of males). CONCLUSIONS: Interventions that promote fruit and vegetable intake within the context of healthy weight management may be more effective if they combine nutrition and physical activity strategies. Further research is needed to test this approach.
Asunto(s)
Dieta , Frutas , Sobrepeso/epidemiología , Instituciones Académicas , Verduras , Adolescente , Conducta del Adolescente , Índice de Masa Corporal , Restricción Calórica , Dieta con Restricción de Grasas , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Actividad Motora/fisiología , Sobrepeso/prevención & control , Prevalencia , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: As policy strategies are rapidly being developed to address childhood overweight, a system was developed to systematically and reliably classify state policies related to the school nutrition environment. This study describes the development process, the inter-rater reliability to code state policies enacted as of December 2003, and the variability in state policies related to the school nutrition environment. METHODS: The development of the School Nutrition Environment State Policy Classification System (SNESPCS) included a comprehensive review of published literature, reports from government and nongovernmental sources, input from an expert panel, and select experts. Baseline statutes and regulations for each of the 50 states and the District of Columbia were retrieved from Westlaw (data retrieved in 2005-2006 and analyzed in 2006) and pilot testing of the system was conducted. RESULTS: SNESPCS included 11 policy areas that relate to a range of environmental and surveillance domains. At baseline, states had no (advertising/promotion and preferential pricing) or modest (school meal environment, reimbursable school meals, coordinating or advisory councils, body mass index screening) activities in many of the policy areas. As of 2003, 60% of the states had policies related to the sale of foods in school that compete with the school meal program. CONCLUSIONS: Evaluation of policies that affect the school-nutrition environment is in its earliest stage. SNESPCS provides a mechanism for assessing variation in state policies that can be incorporated in an evaluation framework aimed at elucidating the impact of state policies on the school environment, social norms, and children's dietary behaviors in schools.
Asunto(s)
Servicios de Alimentación/clasificación , Política Nutricional , Instituciones Académicas , Gobierno Estatal , Adolescente , Niño , Bases de Datos Factuales , Humanos , Obesidad/prevención & control , Desarrollo de Programa , InvestigaciónRESUMEN
The implementation of school nutrition policies poses a challenge to dietitians as they work with schools to increase the availability of nutritious foods. An analysis of the implementation of the Food and Nutrition Policy for New Brunswick Schools, proclaimed by the department of education in 1991, revealed four factors that influenced implementation: selling food for profit, student choice, interpretation of the policy, and the approach to implementation. From 1997 to 1999, data were obtained from 50 participants at the provincial, district, and school levels through semi-structured interviews; supporting evidence was obtained through a review of pertinent documents. The policy goal was to develop good eating habits among schoolchildren. The policy objective to have all food services follow national guidelines for healthy eating was so controversial that implementation was inconsistent and had little impact on school foods. Opponents objected when the sale of certain foods was curtailed, felt the policy limited student choice, were unsure how to interpret it, and resented the department's top-down approach. Dietitians, who had minimal involvement with the New Brunswick policy, need to consider carefully how to work with educational agencies to combine support and pressure to foster the capacity and willingness of schools to implement nutrition policies.