Abstract: Objective:The objective wasto reviewthe literature on school-based interventions during compulsory education (published in 2009-2013) that may be effective in increasing healthful nutritional outcomes in children. Specific strategies and their limitations will be identified.

Methods: A qualitative systematic analysis of seventeen school-based interventions applied to six-eleven year-old children, and published in peer-reviewed journals from 2009-2013 was carried out.

Results: These studies taken as a whole used a variety of fourteen strategies, such as provision of nutritional and gardening education; repeated exposure to vegetables (V); peer and adult modelling; chefs going into schools to teach healthy nutritional issues. These studies showed four types of limitations: limitations derived from the experimental designs and experimental procedures used and limitations affecting participant samples and data collection. Fifteen recommendations for overcoming the targeted research limitations were identified, such as applying the intervention during longer time intervals; examining the effectiveness of these interventions in different ethnicities and socioeconomic groups; including larger participant samples; using randomized designs. Finally, six new working hypotheses to guide future studies are proposed here. For example, a small number of V offered might lead to insufficient opportunities to learn to like the flavour of V; schools’ previous experience with these interventions might distort children’s post-intervention data related to their nutritional outcomes; providing children with nutritional and gardening education might increase their fruit (F) selection, consumption and preferences and application of evaluative conditioning under more appropriate experimental conditions might increase child V consumption.

Conclusion:seventeen school-based interventions were included. These studies taken as a whole used a variety of strategies (fourteen), and showed four types of limitations. Fifteen recommendations for overcoming the targeted research limitations as well as six new hypotheses are proposed here. Future research in this field should focus on overcoming its research limitations, such as the ones highlighted here, and building new working hypotheses, such as those proposed here.

Keywords: Children, vegetables, fruits, consumption, schools.

Abstract: Objective: To determine barriers related to metabolic control and diabetes care in Mexican children and their families.

Design: This was a cross-sectional study designed in two stages. First stage was an assessment of risk factors for inadequate metabolic control (HbA1c higher than ADA guidelines by age group) of diabetic children using a logistic regression model. The data sources were 91 clinical files provided by public health institutions at northwest Mexico. Second stage included the design, implementation and evaluation of an educational program (EP) based on the Medical Nutrition Therapy (MNT) and the Social Cognitive Theory (SCT), accounting for critical risk factors identified previously. Twenty five children (2 to 14 years old) with type 1 diabetes and their parents agreed to participate in the EP, which promoted healthy behavioral changes regarding diet, physical activity and medical treatment over a 4-month period.

Results: Metabolic control was related to the joint effects of families low socioeconomic level and mother’s low education attainment (OR= 8.5, CI95%: 1.73, 42.16), as well as following a conventional treatment (OR= 5.0, CI95%: 1.09, 22.82). After program implementation participants’ mean glycated hemoglobin (HbA1c) decreased (9.1%±1.8% to 8.3%±2%; P=0.06). Qualitative content analysis of post-intervention interviews showed that low income, clinical inertia, and lack of social support were barriers to metabolic control of diabetes.

Conclusion and Implications: Socioeconomic, educational, and healthcare factors are related to metabolic control in Mexican children with diabetes, although educational programs based on SCT can help increase self-efficacy in patients through modeling and reinforcing activities

Keywords: Physical activity, sedentary behaviors, Latino, children, WIC program.

Abstract: Obesity is a complex public health issue with increasing prevalence in childhood and with a large burden on physical and mental health. Recent data suggest the effectiveness of multi-component approach, of interventions aimed at changing parenting style, and of group educational sessions. In particular, interventions containing a family-behavioral component produce larger effect sizes than alternative treatment groups. Many models have been developed for the multi-component and multi-stakeholder treatment of childhood obesity, with a frequent discrepancy in the intensity of the treatment programme and in the resources available within clinics.Looking for effective strategies for the treatment of childhood obesity we built a Multi-component Obesity Group Experience (MOGE) model, analysing BMI and fat mass reduction as primary outcomes and qualitative improvements in the behavior towards nutrition and lifestyle as secondary one. Thirty-five consecutive obese children (20 girls, BMI z-score 2.1+0.2), were treated by MOGE model and the results were compared with 35 matched obese subjects of the same age (control group followed with a traditional treatment). After 3, 6 and 12 months of treatment it has been observed a significant reduction of BMI z-score and body fat mass. Moreover, a clinically significant psychological wellness was observed in children of MOGE group.

Keywords: Obesity, weight management, multi-component-group-programme, parenting style, behavior.

Abstract: Background: Though treatment of severe acute malnutrition cases in both the in-patient care and the out-patient care has been going on since 2011 at the Tamale Teaching Hospital, little is known about the clinical treatment outcomes and factors that may be associated with the recovery rate in the in-patient setting. This study investigated the clinical treatment outcomes and determinant factors likely to be associated with recovery rates at the Hospital.

Methods: We performed a retrospective chart review (RCR) of all pediatric patients aged (0-11 years of age) who were diagnosed of severe acute malnutrition between March 2011 and December 2013. Logistic regression modeling was used to determine the risk factors of severe malnutrition.

Results: Of the 630 cases that were reviewed, only 19.5 % recovered (having mid-upper-arm-circumference measure ≥125 mm, or oedema resolved, or gained 5g/kg/body weight for 2 consecutive days at the time of discharge), 1.7 % defaulted, and 65.2 % were referred to out-patient care units for continued treatment. The observed case fatality rate was 13.5 %. Marasmic cases had more chronic co-morbid conditions at admission compared to kwashiorkor patients (81.7% vs. 69.3%, p=0.01).

Conclusions: Case fatality rate in this population was quite high. Case referral to out-patient care unit was appropriately high. Malaria was the most common co-morbid condition diagnosed among the cases reviewed. Younger age, 15% or more increase in weight, and type of malnutrition were the main predictors of recovery from severe acute malnutrition in the in-patient care setting.

Keywords: In-patient care, severe acute malnutrition, under-five children, recovery rate, fatality rate, medical complications, Tamale Teaching Hospital, Northern Ghana.

Abstract: Background: The purpose of this study was to examine the feasibility of the Children’s Healthy Eating and Exercise Program (CHEE) in an afterschool program of an elementary school.

Methods:Students in a low-income elementary school were recruited to participate in the program. Thirty-three children were in the intervention group. Twenty-four children in the comparison group were recruited from after school clubs in the same elementary school.The CHEE Program consisted of 18 sessions, featuring nutrition (20 min) and physical activity (40 min) lessons. Nutrition lessons were adapted from the Traffic Light Diet. Other lessons included MyPlate, my refrigerator, my lunchbox, and a healthy foods tasting activity. Multiple physical activities were utilized in the program including soccer, dance, relay races, tag, and other fun games. Data were collected at the beginning and end of the program.

Results: Children in both groups reported eating more vegetables at the post-intervention measurement. Children in the intervention group indicated that they learned about healthy eating and new physical activities due to their participation in the program.

Conclusions: Future studies are needed to discover barriers to behavior change as well as apply a more rigorous design to examine the impact of the CHEE Program.

Keywords: Afterschool health education program, low-income children, healthy eating, nutrition education, physical activity.