Diet, Breakfast, and Academic Performance in Children

Abstract

Objective

To determine whether nutrient intake and academic and psychosocial functioning improve after the start of a universal-free school breakfast program (USBP).

Methods

Information was gathered from 97 inner city students prior to the start of a USBP and again after the program had been in place for 6 months. Students who had total energy intakes of <50% of the recommended daily allowance (RDA) and/or 2 or more micronutrients of <50% of RDA were considered to be at nutritional risk.

Results

Prior to the USBP, 33% of all study children were classified as being at nutritional risk. Children who were at nutritional risk had significantly poorer attendance, punctuality, and grades at school, more behavior problems, and were less likely to eat breakfast at school than children who were not at nutritional risk. Six months after the start of the free school breakfast programs, students who decreased their nutritional risk showed significantly greater: improvements in attendance and school breakfast participation, decreases in hunger, and improvements in math grades and behavior than children who did not decrease their nutritional risk.

Conclusion

Participation in a school breakfast program enhanced daily nutrient intake and improvements in nutrient intake were associated with significant improvements in student academic performance and psychosocial functioning and decreases in hunger.

Opini

Pada jurnal ini, dapat kita ketahui bahwa melalui program universal-free school breakfast program (USBP), sekolah mampu meningkatkan partisipasi siswa untuk mengikuti program sarapan di sekolah. Diantara manfaat riil yang diperoleh dari pelaksanaan program ini adalah : 

1. Perbaikan status gizi pada anak yang mengalami nutritional risk
2. Peningkatan kehadiran dan partisipasi program sarapan siswa
3. Penurunan kelaparan pada siswa
4. Peningkatan nilai matematika dan perilaku

Penerapan program sarapan gratis ini perlu diterapkan pada sekolah yang memiliki resiko gizi pada siswanya. Level ekonomi keluarga yang rendah membuat anak susah memperoleh asupan gizi dan nutrisi yang adekuat, terutama saat pagi hari ketika orangtua dan keluarga sedang sibuk mempersiapkan aktivitas harian. Di Indonesia, penerapan program sarapan gratis perlu melibatkan  pihak sponsor untuk membantu memberikan suplai dana terutama dalam penyediaan makanan. Salah satu caranya adalah dengan program subsidi silang dari keluarga siswa yang memiliki level ekonomi lebih tinggi. Selain itu, bisa diterapkan juga program pengalihan uang saku siswa, melalui koordinasi dengan orangtua siswa dan pihak kantin sekolah.

Reference

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275817/

A systematic review of Internet-based supportive interventions for caregivers of patients with dementia

ABSTRACT

Objective: Because of the expected increase in the number of dementia patients, the unlikelihood of a cure in the near future, and the rising cost of care, there is an increasing need for effective caregiver interventions. Internet interventions hold considerable promise for meeting the educational and support needs of informal dementia caregivers at reduced costs. The current study aims to provide an overview of the evidence for the effectiveness, feasibility, and quality of Internet interventions for informal caregivers of people with dementia.

Methods: A systematic literature search of five scientific databases was performed, covering literature published up to 10 January 2013. Twelve studies were identified. The quality of the included studies was assessed according to the Cochrane level of evidence and the criteria list of the Cochrane Back Review Group.

Results: The intervention types, dosage, and duration differed widely, as did the methodological quality of the included studies. The overall level of evidence was low. However, the results demonstrate that Internet interventions for informal dementia caregivers can improve various aspects of caregiver wellbeing, for example, confidence, depression, and self-efficacy, provided they comprise multiple components and are tailored to the individual. Furthermore, caregivers could benefit from interaction with a coach and other caregivers.

Conclusions: Internet interventions for informal dementia caregivers may improve caregiver well-being. However, the available supporting evidence lacks methodological quality. More randomized controlled studies assessing interventions performed according to protocol are needed to give stronger statements about the effects of supportive Internet interventions and their most promising elements. 

My Opinion

This study review twelve studies about the internet-based supportive interventions based on their inclusion criteria such as 1. reported the effects (quantitative and qualitative) of an intervention; 2. were Internet-based; and 3. were aimed at informal (nonprofessional) caregivers; of 4. patients with mild cognitive impairment/dementia.

The following intervention types were identified: a website with information and support on various aspects of caregiving, a website with additional caregiving strategies, a website combined with telephone support, a website with additional e-mail support, and a website with a combination of individual work.

From that review, this study stated that intetnet interventions for informal dementia caregivers can improve various aspects of caregiver well-being although the available supporting evidence lacks methodological quality.

In particular, multicomponent programs that combined information, tailored caregiving strategies, and contact with other caregivers resulted in positive effects on confidence, self-efficacy, stress, burden, and depression. Internet interventions that focused primarily on providing caregivers with information were less likely to improve caregiver well-being. This review might cause healthcare professionals to consider online support for informal dementia caregivers in addition to the already provided care as usual but, given the limited number of studies of high methodological quality, there is a need for further investigation.

Reference : https://www.researchgate.net/publication/256072220_A_systematic_review_of_Internet-based_supportive_interventions_for_caregivers_of_patients_with_dementia

School-based nutrition education: lessons learned and new perspectives

Abstract

Nutrition is a major environmental influence on physical and mental growth and development in early life. Food habits during infancy can influence preferences and practices in later life and some evidence suggests fair to moderate tracking of food habits from childhood to adolescence^1–4. Studies support that good nutrition contributes to improving the wellbeing of children and their potential learning ability, thus contributing to better school performance^5–7. Children and young people who learn healthy eating habits, are encouraged to be physically active, to avoid smoking and to learn to manage stress, have the potential for reduced impact of chronic diseases in adulthood^4–8. Nutrition education is a key element to promoting lifelong healthy eating and exercise behaviours and should start from the early stages of life^8–11; it should also address the specific nutritional needs associated with pregnancy, including reinforcing breastfeeding¹².

Food habits are complex in nature and multiple conditioning factors interact in their development¹³. Young children do not choose what they eat, but their parents decide and prepare the food for them. During infancy and early childhood the family is a key environment for children to learn and develop food preferences and eating habits. As they grow and start school, teachers, peers and other people at school, together with the media and social leaders, become more important. Progressively children become more independent and start making their own food choices. The peer group is very important for adolescents and has a major influence in developing both food habits and lifestyles¹³.

Community trials suggest that nutrition education is an accessible effective tool in health promotion programmes with a focus on the development of healthy eating practices^{14, 15}.

Opini

Pada jurnal ini, kita bisa memperoleh infromasi bahwa “nutrition education” merupakan salah satu materi yang penting untuk disampaikan pada generasi muda, khususnya pada siswa. Hal ini ditujukan sebagai bentuk edukasi dan promosi kesehatan terkait dengan diet dan aktivitas yang kedepannya diharapkan dapat mengurangi penyakit kronik saat menginjak dewasa atau tua. Sebagai anak, perilaku makan ini sangat terikat dengan budaya dan keadaan di keluarga. Akan tetapi, dalam perkembangannya anak akan memiliki preferensi makanan tersendiri diluar dari makanan yang disajikan di lingkungan keluarga. Diantara hal yang mempengaruhi adalah lingkungan sekolah dan pergaulan, termasuk di dalamnya adalah konsumsi makanan dari teman sebayanya yang juga dipengaruhi oleh iklan di media.

Pada anak usia sekolah dasar, pola makan ini akan sangat dipengaruhi oleh lingkungan sekolah dan teman sebaya. Oleh karen itu, sekolah sebagai sebuah institusi pendidikan yang didalamnya terdapat proses tumbuh kembang anak perlu memperhatikan edukasi bagi siswa-siswinya, termasuk di dalamnya adalah berkaitan dengan pola makan dan jenis makanan yang sebaiknya dikonsumsi. Melalui program sarapan sehat, pengelolaan kantin sehat, yang diikuti dengan regulasi, promosi, dan edukasi di sekolah diharapkan menjadi sebuah perpaduan program yang dapat meningkatkan kualitas gizi pada anak.

Diantara hal lain yang tidak boleh dikesampingkan adalah kerjasama antara pihak sekolah dan pihak keluarga. Hal ini dikarenakan kehidupan anak tidak hanya berada di lingkungan sekolah, namun juga di lingkungan keluarga.

Penyusunan kurikulum yang sesuai dengan perkembangan anak dan kebutuhan fisik biologisnya diharapkan mampu menjadi salah satu upaya untuk meningkatkan derajat gizi anak dan mencegah penyakit metabolik di kemudian hari.

References

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=558848&fileId=S1368980001000209

Mobile primary healthcare services and health outcomes of children in rural Namibia

Abstract

Introduction:  In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia.

Methods:  Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed.Results:  For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001).Conclusion:  Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.

Opini:

Jurnal ini menilai outcome dari program mobile clinic yang dijalankan di Nigeria, khususnya daerah terpencil. Daerah terpencil di Nigeria memiliki fasilitas kesehatan yang terbatas dan sangat sulit dicapai dengan outcome kesehatan masyarakatnya yang buruk. Jarak rerata desa dengan fasiliast kesehatan di daerah terpencil di Nigeria mencapai 63,5 km. Penelitian ini ditujukan kepada anak-anak yatim piatu dan vulnerable children.

Mister sister clinic merupakan mobile clinic yang digunakan di Nigeria. Mobile clinic ini dilengkapi dengan peralatan medis dan dijalankan oleh perawat yang memiliki kemanpuan dalam mendiagnosis dan merawat.

Outcome dari program yang dinilai pada jurnal ini adalah (i) immunization status assessed by examining children’s health records; (ii) number and frequency of referrals; (iii) clinical and laboratory presence of anemia (all children had blood tests for anemia at base line and at follow up only those anemic at baseline or who had clinical features of anemia in the follow-up months were reassessed with blood tests); (iv) clinical diagnosis of skin and/or intestinal parasitic infections; (v) presence of dental disorders; and (vi) nutritional status. Penelitian dilakukan selama 7 bulan dan outcome dinilai pada bulan ke 2-3 dan bulan ke 5-6 kemudian dibandingkan.

Dari total anak 1210 yang mengunjungi mobile clinic, dengan rentang usia 0-18 tahun, terdapat penurunan yang signifikan mengenai ketidakpedulian akan imunisasi (5% to 1% p<0.0001), infeksi parasites pada kulit dan intestinal (15.5% to 0.2% p<0.0001), and anak kurang gizi (26.9% to 14.2% p<0.0001). Jika dibandingkan dari 2 kali penilain outcome yaitu terdapat penurunan prevalensi anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001).

Jika dilihat dari hasil yang diperoleh dari penelitian tersebut dapat dikatakan bahwa program mobile clinic di Nigeria ini efektif dalam meningkatkan taraf kesehatan masyarakat daerah terpencil di Nigeria, khususnya pada anak-anak.

Kekurangan dari penelitian ini yaitu waktu penelitian yang sangat singkat serta sample penelitian yang hanya mencakup pada anak-anak sehingga kita tidak bisa menilai apakah program ini memberikan dampak yang positif juga bagi masyarakat dewasa.

Referensi:

http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2380

The Impact of Sex Education on Sexual Activity, Contraceptive Use, and Premarital Pregnancy among American Teenagers

Summary

Sixty percent of women and 52 percent of men now in their 20s took a sex education course by age 19, according to the 1984 National Longitudinal Survey of Work Experience of Youth. Whites are more likely than either blacks or Hispanics to have had a course by that age – 57 percent compared with 53 percent and 48 percent, respectively.

                The survey also shows that large proportions of teenagers initiate coitus before they have taken a sex education course. Among young women who first have sex at age 15 for example, only 48 percent have already taken a course (i.e., have taken it at a younger age or at the same age); and among young women who first have intercourse at age 18, the proportion is 61 percent. Young men are even less likely than young women to take a course before they begin coitus – at age 15, the figure is 26 percent, and at age 18, 52 percent.

                Adolescent women who have previously taken a sex education course are somewhat more likely than those who have not to initiate sexual activity at ages 15 and 16 (though they are no more likely to do so at age 17 and 18). However, the effect of prior sex education is small, and is weaker than that of virtually every other variable found to have a significant relationship with first intercourse at ages 15-16. Among the strongest determinants of first coitus at those ages are infrequent church attendance, parental education of fewer than 12 years and black race.

                Older sexually active girls who have previously had a course are significantly more likely to use an effective contraceptive method (73 percent) than are those who have never taken a course (64 percent). This relationship may offset any effect that a sex education course may have in raising the likelihood of early first coitus, since no significant association can be found between taking a sex education course and subsequently, becoming premaritally pregnant before age 20.

Opini

Artikel ini mengevaluasi efek pemberian pendidikan seks terhadap perilaku seksual pada remaja di Amerika Serikat. Topik-topik pendidikan seks yang diangkat dalam penilaian ini adalah siklus menstruasi, tipe kontrasepsi, di mana tempat untuk mendapatkan kontrasepsi, efek kontrasepsi, dan penyakit menular seksual.

Dari data yang telah dikumpulkan, kebanyakan remaja Amerika Serikat yang berusia 20 tahunan sudah aktif secara seksual sejak umur 19 tahun. Namun banyak di antara mereka yang tidak mengambil  pendidikan seks, 48% pria dan 40% wanita. Bagi yang menunggu hingga umur 18 tahun untuk aktif secara seksual, 61% wanita dan 52% pria sudah mengambil pelajaran tentang seks. Bagi yang sudah aktif secara seksual dari 16 tahun, pada kelompok pria, persentase yang sudah mengambil pelajaran lebih sedikit. Hanya 35% yang aktif secara seksual dari umur 18 tahun, pernah mendapat pelajaran mengenai kontrasepsi (termasuk cara mendapatkannya).

Sedikit dilema mengenai materi kontrasepsi dalam pendidikan seks. Apabila materi kontrasepsi tidak diberikan, kejadian kehamilan remaja berisiko meningkat. Apabila materi kontrasepsi diberikan, dikhawatirkan akan memicu aktivitas seksual dini dan mendorong persetubuhan dengan siapa saja.

Dari artikel ini dapat dilihat bahwa setidaknya remaja yang pernah mendapat pendidikan seks menunda waktu untuk aktif secara seksual dan menyadarkan akan pentingnya penggunaan kontrasepsi untuk mencegah kehamilan usia remaja.

Untuk keberhasilan suatu program, misalkan pendidikan seks, diperlukan penilaian berkala dengan indikator dan parameter yang jelas. Dengan demikian bisa ditentukan apakah program yang bersangkutan berhasil mencapai tujuan atau tidak. Seperti dalam artikel ini, program yang dimaksud adalah pendidikan seks, dan tolok ukurnya adalah perilaku seksual remaja, penggunaan kontrasepsi, dan kejadian kehamilan usia remaja.

Referensi

Marsiglio, W dan Frank L. Mott. The Impact of Sex Education on Sexual Activity, Contraceptive Use and Premarital Pregnancy Among American Teenagers. Family Planning Perspectives Vol. 18, No. 4 (Jul. - Aug., 1986), pp. 151-154+157-162. Available at www.jstor.org/stable/2135324?seq=1#page_scan_tab_contents [Accessed at August 30^th 2016]