The Impact of Food and Nutrient-Based Standards on Primary School Children’s Lunch and Total Dietary Intake: A Natural Experimental Evaluation of Government Policy in England

In 2005, the nutritional content of children’s school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children’s total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4–7 years (n = 385 in 2003–4; n = 632 in 2008–9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children’s mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change −128 mg, 95% CI: −183 to −73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (−1.8%, −2.8 to −0.9) and saturated fat (−1.0%; −1.6 to −0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children’s total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children’s diet.     

A Population-Based Nationwide Cross-Sectional Study on Preventive Health Services Utilization in Portugal—What Services (and Frequencies) Are Deemed Necessary by Patients?

Background

Most of the strategies to induce a more rational use of preventive health services are oriented to the medical side of the doctor-patient relationship. However, the consultation model has changed, and patients now have a more important role in medical consultation. The aim of this study was to assess which healthcare services are deemed necessary, and with what frequency, by adults from the general Portuguese population.

Methods

Design: Population-based nationwide cross-sectional study Setting: Portuguese population Participants: One thousand Portuguese adults, surveyed by computer-assisted telephone interviewing and selected by a stratified cluster sampling design. Measurements: Proportions and population prevalence estimates were determined for each healthcare service, taking into account whether respondents considered them necessary, and with what frequency.

Results

Respondent ages ranged between 18 and 97 years, and 520 of 1000 (52%) respondents were women. Among Portuguese adults, 99.2% (95% confidence interval (CI): 98.5 to 99.6) believe that they should undergo general routine blood and urine tests, to be repeated every 12.0 months on average (95% CI: 11.4 to 12.6); 87.4% (95% CI: 85.3 to 89.3) of the respondents reported having actually performed these tests. Of the 15 services surveyed, 14 were considered periodically necessary by more than 60% of respondents. Among the respondents, 37.7% (95% CI: 34.5 to 41.1) reported using healthcare services by their own initiative.

Conclusions

The majority of Portuguese adults believe that they should utilize a great number of healthcare services, on a nearly annual basis; most actually follow this schedule. Our findings indicate a tendency towards the overuse of resources.Adequate patient-oriented strategies regarding the use of medical tests and preventive interventions—with appropriate information and discussion of risks and harms—are urgently needed, and crucial for achieving a more rational use of healthcare services and for preventing the consequences of over-testing.     

Housing of Pregnant Sows in Loose and Confined Systems–a Field Study. 3. The Impact of Housing Factors on Claw Lesions

The relationship of claw lesions to housing was studied in 36 sow herds. Eighteen herds with loose housing of pregnant sows and 18 herds with confined (stalled or tethered) pregnant sows, were followed over a 12 month period. Fifteen of the loose housing herds had partly slatted concrete floors, while 3 herds had other types of flooring. The mean herd prevalence proportion of sows with major claw lesions in loose housing herds with partly slatted floors was about twice as high as in the herds with confined sows. In the only loose housing herd with deep litter based on straw, the prevalence proportion of sows with major claw lesions was lower than any of the other loose or confined herds. Within herds with loose sows on partly slatted floors, the prevalence proportion of sows with major claw lesions seemed to be higher in the loose housing compartment than in the farrowing compartment. The prevalence proportion of sows with major claw lesions did not differ between loose herds with plastic slats and loose herds with concrete slats. kw|Keywords|k]pig; k]feet injuries; k]slatted floors; k]deep litter; k]epidemiology     

Correlates of Total Sedentary Time and Screen Time in 9–11 Year-Old Children around the World: The International Study of Childhood Obesity,Lifestyle and the Environment

Purpose

Previously, studies examining correlates of sedentary behavior have been limited by small sample size, restricted geographic area, and little socio-cultural variability. Further, few studies have examined correlates of total sedentary time (SED) and screen time (ST) in the same population. This study aimed to investigate correlates of SED and ST in children around the world.

Methods

The sample included 5,844 children (45.6% boys, mean age = 10.4 years) from study sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Child- and parent-reported behavioral, household, and neighborhood characteristics and directly measured anthropometric and accelerometer data were obtained. Twenty-one potential correlates of SED and ST were examined using multilevel models, adjusting for sex, age, and highest parental education, with school and study site as random effects. Variables that were moderately associated with SED and/or ST in univariate analyses (p<0.10) were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST.

Results

Children averaged 8.6 hours of daily SED, and 54.2% of children failed to meet ST guidelines. In all study sites, boys reported higher ST, were less likely to meet ST guidelines, and had higher BMI z-scores than girls. In 9 of 12 sites, girls engaged in significantly more SED than boys. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom.

Conclusions

In this global sample many common correlates of SED and ST were identified, some of which are easily modifiable (e.g., removing TV from the bedroom), and others that may require more intense behavioral interventions (e.g., increasing physical activity). Future work should incorporate these findings into the development of culturally meaningful public health messages.     

Estimates of Water Ingestion for Women in Pregnant,Lactating, and Non-Pregnant and Non-Lactating Child-Bearing Age Groups Based on USDA's 1994–96, 1998 Continuing Survey of Food Intake by Individuals

Women in the child-bearing age of 15 to 44 years and, in particular, pregnant and lactating women in this age cohort are considered a sensitive subpopulation when assessing risk from ingestion of water because water borne contaminants may pose a risk not only to the mother but to the fetus or infant. This article presents estimates of daily average per capita water ingestion for women of child-bearing age and in three subgroups: pregnant, lactating, and non-pregnant/non-lactating women. Estimates of means and upper percentiles of subgroup ingestion distributions were generated using participant responses and survey weights from the United States Department of Agriculture's (USDA) 1994–96 and 1998 Continuing Survey of Food Intake by Individuals (CSFII). The ingestion estimates are empirical and not based on an assumed parametric distribution of daily average amount of water ingestion. Water occurring naturally in foods or added by manufacturers to commercial products is not included in the estimates presented. These estimates of water ingestion by women of child-bearing age are compared to those attributed to Ershow and Cantor (1989) Ershow, A G and Cantor, K P. 1989. Total Water and Tapwater Intake in the United States: Population-Based Estimates of Quantities and Sources Washington, DC, , USA National Cancer Institute Order #263-Md-810264 [Google Scholar] by Burmaster (1998) Burmaster, D E. 1998. Lognormal distributions of total water intake and tap water intake by pregnant and lactating women in the United States. Risk Anal, 18(2): 215–9. [Crossref] [Google Scholar]. These estimates, based on data collected in 1978, were used by Burmaster to characterize the distribution of daily average per capita ingestion as lognormal. The lognormal estimates of total water ingestion are generally greater than the total water ingestion estimates based on the CSFII data. Possible explanations for the differences are discussed.