Few interventions have successfully promoted healthy eating and active living among children with effective changes in anthropometric health outcomes. Well-designed interventions involving multiple ...strategies to convert the knowledge already available into action are needed for preventing childhood obesity. In this study, an educational programme called “Planning Health in School” (PHS-pro) was designed, implemented and evaluated to contribute to the prevention of obesity in childhood. The PHS-pro aimed at improving the eating behaviours and lifestyles of Portuguese grade-6 children towards healthier nutritional status. This paper describes and evaluates the PHS-pro concerning: (i) the research design within the theoretical framework grounded on “The Transtheoretical Model” and the stages of change; (ii) the educational components and the application of the participatory methodology to engage children to meet their needs, as active participants in their change process; and (iii) the process evaluation of the intervention. The implementation of the PHS-pro took into account the views and inputs of the participants for evaluating the educational components that should be considered in the designing of interventions aiming to be effective strategies. From the health promotion perspective, this study is important because it examines new approaches and pathways to effectively prevent overweight and obesity in children.
Children and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes ...take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people.
Six databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis.
The systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions.
Identified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children's and young people's specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.
The ‘Planning Health in School’ programme (PHS-pro) is a behavioural change intervention to assess and improve the eating habits of children, particularly the intake of fruit and vegetables, and to ...guide them towards healthy choices. The programme and its educational components are based on the Transtheoretical Model of stages of change to integrate nutritional literacy and build up problem-solving and decision-making skills. Children (n = 240, ages 10–12) of one large suburban school in Porto’s metropolitan area (Portugal) were evaluated throughout PHS-pro implementation during one school year in a repeated time–series design. Children’s outcome evaluations were conducted through seven 3-day food records for nine eating behaviour, documented after each learning module and through participatory activities which analysed attitudes, preferences and expectations. Changes were observed in children’s eating behaviour, supported by changes in motivation as perceived in their attitudes and expectations. Significant changes were found in a higher consumption of vegetable soup (p = 0.003), milk products (p = 0.024), and fruit (p = 0.008), while the consumption of high-energy dense food (p = 0.048) and soft drinks (p = 0.042) significantly decreased. No positive effects on fried food, water, vegetables and bread consumption were found. The PHS-pro intervention proved to be effective in developing healthy eating behaviour in young people.
The influence of pulp carryover on the efficiency of the xylanase (X) treatment of industrial unbleached and oxygen-delignified eucalypt kraft pulps (A1 and A2 pulps, with kappa number (KN) values of ...16 and 10, respectively), collected at the same pulp mill, was studied regarding the consumption of bleaching chemicals and pulp bleachability. Another non-oxygen-delignified eucalyptus kraft pulp of KN 13 was received after the extended cooking from a different pulp mill (pulp B). The assays were performed with both lab-washed (carryover-free) and unwashed (carryover-rich) pulps. Both lab-washed and unwashed pulps with carryover were subjected to X treatment, the former being demonstrating considerably higher ClO
2
savings than the pulps containing carryover. The savings of bleaching reagents were higher when the X stage was applied to the A1 pulp than to the A2 pulp. This advantage of A1 pulp, however, was not confirmed when using unwashed pulps. In contrast, the gains obtained from the X treatment of unwashed pulp A2 were practically as high as those observed for the lab-washed A2 pulp. Furthermore, a similar effect in X stage was recorded for unwashed pulps having close KN: oxygen-delignified A2 pulp and non-oxygen-delignified B pulp. The results suggest that pulp carryover and initial pH were the key factors relating to the effectiveness of X treatment. The application of X treatment to the A2 unwashed pulp (after the oxygen stage) not only saved 20% of the ClO
2
and 10% of the sodium hydroxide, but also improved the brightness stability of the bleached pulp without affecting its papermaking properties.
Key points
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Xylanase treatment boosts kraft pulp bleaching
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Pulp carryover hinders the xylanase treatment
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Nearly 20% of ClO2 and 10% NaOH savings can be reached using xylanase
Effective interventions for guiding children to change behaviours are needed to tackle obesity. We evaluated the effectiveness of the 'Planning Health in School' programme (PHS-pro) on children's ...nutritional status. A non-randomised control group pretest-posttest trial was conducted at elementary schools of a sub-urban municipality in Porto's metropolitan area (Portugal). A total of 504 children of grade-6, aged 10-14, were assigned in two groups: children of one school as the intervention group (IG), and three schools as the control group (CG). Anthropometric measures included height, weight, waist circumference (WC), BMI and waist-to-height ratio (WHtR), and lifestyle behaviours (self-reported questionnaire) were assessed at baseline and after PHS-pro. IG children grew significantly taller more than CG ones (
< 0.001). WC had reduced significantly in IG (-0.4 cm) whereas in the CG had increased (+0.3 cm;
= 0.015), and WHtR of IG showed a significant reduction (
= 0.002) compared with CG. After PHS-pro, IG children consumed significantly fewer soft drinks (
= 0.043) and ate more fruit and vegetables daily than CG. Physical activity time increased significantly in IG (
= 0.022), while CG maintained the same activity level. The PHS-pro did improve anthropometric outcomes effectively leading to better nutritional status and appears to be promising in reducing overweight and obesity.
This case study describes the impact of the 'Planning Health in School' programme (PHS-pro) on the nutritional status and lifestyle behaviours of two twins with obesity. As part of a larger research ...project involving 449 adolescents in grade-6, PHS-pro aims at preventing obesity and guiding children towards healthy behaviours. Twins were evaluated for anthropometric measurements-height, weight, body mass index (BMI), waist circumference (WC), and lifestyle behaviours before (baseline) and after (8 months) PHS-pro and at a follow-up (one-year later). At the baseline, both twins were obese according to the international cut-off points of Cole. After PHS-pro, improvements in anthropometric parameters were found: the boy decreased his BMI by 10% and lost 9.0 cm in WC, while remaining obese; the girl decreased her BMI by 8% and lost 8.7 cm in WC, changing to the overweight category. At the follow-up, a slight increase in the anthropometric parameters was found in both twins; however, they did not return to the baseline values. The programme successfully promoted positive changes in behaviours and improved nutritional status, showing the long-term effects of the PHS-pro. Although it is a school-based intervention to prevent obesity, the PHS-pro is helpful in weight reduction even in children already with obesity.
Learning, leisure, social, and movement activities are essential facets of children´s development affecting their physical, mental, and social well-being. During the first Covid-19 lockdown and ...post-lockdown period, children´s everyday lives were disrupted and altered in significant ways for an extended period, raising several concerns regarding its negative effects. This study investigated children´s daily activities during the lockdown and post-lockdown period, considering child and family factors that influenced their participation, and the effects of daily activities on child well-being. Cross-sectional data were collected during June and July 2020 from a sample of 3
rd
and 4
th
graders (
n
= 110) and their parents. Participants reported the intensity of children´s weekly participation in various learning, leisure, socializing, and movement activities, child and family characteristics, and child well-being outcomes. Findings indicate an overall pattern characterized by a higher prevalence of sedentary behaviors (screen time) and a lower prevalence of active leisure and playing activities, particularly among socioeconomically vulnerable children. Compared to boys, girls were less physically active but engaged more in play and social activities. In addition, sleep, active leisure, playing and learning activities, and family coping strategies were linked to better overall child well-being. These findings help identify promising avenues for effective intervention strategies, at the family and community levels, aimed at promoting child well-being and mitigating harm during the present and future crises.
School-based programmes for preventing childhood obesity have been shown to be effective in improving eating habits and nutritional status, but few intervention programmes with a controlled design ...have included an economic evaluation. In this study, we conducted a cost-consequence analysis to evaluate the costs and the health benefits of the 'Planning Health in School' programme (PHS-pro) implemented in the Northern region of Portugal to 449 children of 10-14 years old. Previous study has showed that after PHS-pro, several anthropometric measures significantly improved in the intervention group (height, waist circumference and waist-height ratio) compared with the control group, followed by significant improvements on soft drinks, fruit and vegetables daily consumptions. Costs were estimated according the two phases of the programme: designing and preparation of schools, and school setting implementation, and included all the direct costs on human and material resources. PHS-pro total costs were estimated as 7915.53€/year with an intervention cost of 36.14€/year/child attending the programme. This is much lower than the direct costs for treating an obese adult in Portugal, which was calculated as 3849.15€/year. A scale-up costing projection for implementing the PHS-pro to a larger young population was estimated to be even lower: 18.18€/year/child. This cost-consequence analysis provided evidence that the PHS-pro was economically feasible especially if compared with the medical costs for treating adult obesity. The PHS-pro can be a beneficial investment and may give a promising contribution to addressing overweight over childhood and adolescence, which are developmental stages that determine adulthood chronic diseases.
Eucalyptus globulus (EGB) is well suited for kraft pulping due to its physicochemical properties, whereas more recalcitrant woods require harsher thermochemical conditions to attain identical ...delignification levels. The pulp and paper industry is increasingly seeking solutions to efficiently explore recalcitrant feedstocks while reducing chemical usage during pulping and bleaching. The present work aimed at assessing whether biological and mild alkali pretreatments are able to reduce eucalypt wood recalcitrance and increase kraft pulping and bleaching efficiency. EGB, Eucalyptus nitens (ENT), and Eucalyptus urograndis (EUG) woodchips were pretreated with white-rot fungi (WRF) and/or 0.1 M NaOH. Results suggested that these pretreatments mainly act by breaking ester bonds involved in cell wall polymer cross-linking, promoting deacetylation, lignin detachment, increased cellulose accessibility, and woodchip impregnation during pulping. Combined WRF and mild alkali pretreatments substantially reduced wood recalcitrance and improved pulp properties. Residual lignin content (K#) was reduced by up to 9% in EGB, 15% in ENT, and 16% in EUG, whereas ClO2 consumption during bleaching was reduced by up to 16% in EGB, 19% in ENT, and 13% in EUG. These pretreatments can substantially reduce chemical requirements and lead to higher relative yields, ultimately reducing costs and environmental impacts of kraft pulping and bleaching.
Life Skills have been central to Health Promotion interventions and programmes with children and adolescents for over 40 years. School is a strategic setting for Life Skills education. Recently, ...policy-and decision-makers have focused on Life Skills development for youth. Research on Life Skills has gained momentum. Different terms are used to discuss and define Life Skills. Research identifies a lack of conceptual definition. The purpose of this study is to identify the definitions in the literature in English and French, and to reach a conceptual and consensual definition.
The Scoping Review methodology was used. Three research questions aim to identify how Life Skills are defined in the field of health promotion at school, to see whether a conceptual and consensual definition exists, and, if relevant, to propose a conceptual definition. The search was conducted in 5 databases by 3 reviewers. This study focused on full-text publications in English or French, human studies, health promotion in school, school pupils, teacher training, and with a definition of Life Skills. Publications on after-school activities, higher education outside teacher training, adult education, other than peer-reviewed scientific papers were excluded.
48 publications were included in English and 7 in French. NVIVO was used to determine and compare the French and English terms used for Life Skills and their definitions. According to the three research questions, (i) the terms used to define Life Skills are diverse and numerous, with different purposes at school in relation to health promotion, and different taxonomies, and relate to different areas of research; (ii) no consensual, conceptual definition of Life Skills was found; (iii) further semantic, epistemological and ontological clarifications are required.
Some conceptual definitions of Life Skills exist without consensus. Life Skills being at the crossroads between different fields could explain this and is illustrated by the multiplicity and diversity of the terms employed, and the various taxonomies and purposes used at school in health promotion. This may also explain why they are difficult to evaluate. Defining Life Skills consensually cannot be achieved due to the diversity of research perspectives from different fields.
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