A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: realistic synthesis of the evidence

Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Barabas's Fall

Early modern play-texts present numerous puzzles for scholars interested in ascertaining how plays were (or may have been) staged. the principal evidence of course for a notional "reconstruction" of practices is the apparatus of stage directions, augmented by indications in the dialogue. in conjunction a joining-of-the-dots is often possible, at least in broad-brush terms. But as is well known, the problem is that stage directions tend to be incomplete, imprecise, inaccurate ­ or missing altogether; more significantly, even when present they offer only slight and indirect evidence of actual stagecraft. Some stage directions are rather more "literary" than "theatrical" in provenance, and in any case to the extent that they do serve the reader (early modern or modern) they cannot be regarded as providing a record of stage practice. After all, words can be no more than imperfect substitutes for (and of another order from) the things they represent. For the most part directions serve as a guide that provides the basis for reasonable interpretation informed by our knowledge of theatre architecture, technology, and comparable play-situations, rather than concrete evidence of actual practice. Quite how some stage business was carried out remains uncertain, leaving the scholar little option but to hypothesize solutions. One such conundrum arises in christopher Marlowe's The Jew of Malta. the scenario in question is hardly an obscure one, but it has not been examined in detail, even by modern editors. the purpose of this essay is to explore what sense might be made of the surviving textual evidence, in combination with our knowledge of theatre architecture and playmaking culture in the late sixteenth century.

Teaching English as an additional language: a MESHGuide

This guide has been co-authored by Naomi Flynn, an Associate Professor at The University of Reading, working with Chris Pim and Sarah Coles who are specialist advisory teachers with Hampshire’s Ethnic Minority and Traveller Achievement Service (EMTAS). It was constructed with the support of teachers in primary and secondary schools in Hampshire, selected for their existing expertise in teaching EAL learners, who used the guidance for action research during the spring and summer of 2015. The guide is written principally to support teachers and learning support assistants working with EAL learners in any educational setting and who are at any stage of fluency in the learning of English. It will also support senior leaders in their strategic response to the EAL learners in their schools. As with all MESH guides it seeks to share knowledge with professionals in order to support the growth of evidence informed practice that works in promoting the best in pupil outcomes

The history of the practice of strategy from Antiquity to Napoleon

This chapter outlines the history of the practice of strategy, predating the introduction of the term. It homes in on episodes of European history since Antiquity for which historians claim to have found evidence of the practice of strategy, defined by Kimberly Kagan as ‘the setting of a state’s objectives and of priorities among those objectives’ in order to allocate resources and choose the best means. While focusing only on Europe, this chapter covers case studies over nearly 2500 ranging from the wars of Ancient Greece, of the Romans to Medieval warfare (here with a focus on English history), the warfare of Philip II of Spain, Louis XIV of France, Frederick II of Prussia, the French Revolutionaries and Napoleon.

Mapping Educational Specialist knowHow (MESH): the building of a knowledge management system for research informed practice

In this invited article the authors present an evaluative report on the development of the MESHGuides project (http://www.meshguides.org/). MESHGuides’ objective is to provide education with an international knowledge management system. MESHGuides were conceived as research summaries for supporting teachers’ in developing evidence-based practice. Their aim is to enhance teachers’ capacity to engage actively with research in their own classrooms. The original thinking for MESH arose from the work of UK-based academics Professor Marilyn Leask and Dr Sarah Younie in response to a desire, which has recently gathered momentum in the UK, for the development of a more research-informed teaching profession and for the establishment of an on-line platform to support evidence-based practice (DfE, 2015; Leask and Younie 2001; OECD 2009). The focus of this article is on how the MESHGuides project was conceived and structured, the technical systems supporting it and the practical reality for academics and teachers of composing and using MESHGuides. The project and the guides are in the early stages of development, and discussion indicates future possibilities for more global engagement with this knowledge management system.

Endocrine disrupters and human health: Could oestrogenic chemicals in body care cosmetics adversely affect breast cancer incidence in women? A review of evidence and call for further research

In the decade that has elapsed since the suggestion that exposure of the foetal/developing male to environmental oestrogens could be the cause of subsequent reproductive and developmental effects in men, there has been little definitive research to provide conclusions to the hypothesis. Issues of exposure and low potency of environmental oestrogens may have reduced concerns. However, the hypothesis that chemicals applied in body care cosmetics (including moisturizers, creams, sprays or lotions applied to axilla or chest or breast areas) may be affecting breast cancer incidence in women presents a different case scenario, not least in the consideration of the exposure issues. The specific cosmetic type is not relevant but the chemical ingredients in the formulations and the application to the skin is important. The most common group of body care cosmetic formulation excipients, namely p-hydroxybenzoic acid esters or parabens, have been shown recently to be oestrogenic in vitro and in vivo and now have been detected in human breast tumour tissue, indicating absorption (route and causal associations have yet to be confirmed). The hypothesis for a link between oestrogenic ingredients in underarm and body care cosmetics and breast cancer is forwarded and reviewed here in terms of. data on exposure to body care cosmetics and parabens, including dermal absorption; paraben oestrogenicity; the role of oestrogen in breast cancer; detection of parabens in breast tumours; recent epidemiology studies of underarm cosmetics use and breast cancer; the toxicology database; the current regulatory status of parabens and regulatory toxicology data uncertainties. Notwithstanding the major public health issue of the causes of the rising incidence of breast cancer in women, this call for further research may provide the first evidence that environmental factors may be adversely affecting human health by endocrine disruption, because exposure to oestrogenic chemicals through application of body care products (unlike diffuse environmental chemical exposures) should be amenable to evaluation, quantification and control. The exposure issues are clear and the exposed population is large, and these factors should provide the necessary impetus to investigate this potential issue of public health. Copyright (C) 2004 John Wiley Sons, Ltd.

Conjugated linoleic acid and human health: a critical evaluation of the evidence

Purpose of review: This review critically evaluates studies investigating the effects of conjugated linoleic acid on human health, including effects on body composition, blood lipids, liver metabolism, insulin sensitivity and immune function. It focuses mainly on human intervention studies, but includes some reference to animal and cellular studies which provide insight into potential molecular mechanisms of action of conjugated linoleic acid. Recent findings: Human studies continue to report inconsistent effects of conjugated linoleic acid on human health. Some of these reports are based on overinterpretation of marginal effects of supplementation. Recent data suggest that the effects of the substance may be isomer dependent and that cis-9, trans-11 and trans-10, cis-12 conjugated linoleic acids have opposing effects on blood lipids and on metabolism in adipocytes and hepatic cells. Summary: Claims that conjugated linoleic acid is beneficial for health remain as yet unconvincing. Human studies investigating the effects of conjugated linoleic acid supplements have tended to use mixtures of isomers and have been inconsistent. More recent studies have attempted to use relatively pure preparations of single isomers and these studies suggest that the effects of conjugated linoleic acid may be isomer-specific. These recent data suggest a relative detrimental effect of trans-10, cis-12 conjugated linoleic acid on blood lipids. There appears to be little effect of conjugated linoleic acid on immune function and the effects on insulin sensitivity remain unclear.

Weight of evidence needed to substantiate a health effect for probiotics and prebiotics: regulatory considerations in Canada, EU, and US

Successful and responsible introduction of probiotic and prebiotic products into the worldwide marketplace requires labelling for health benefits that meets consumer needs, adheres to regulatory standards and does not overextend scientific evidence. Regulations differ among countries, but underlying all is an emphasis on scientific credibility of any statements of health benefits. This paper considers the value of different types of evidence offered in substantiation of efficacy and reviews different regulatory approaches to labelling for health claims. Limitations of in vitro, animal and different types of human studies used for efficacy substantiation for probiotics and prebiotics are discussed.

Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Background: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. Design: Systematic review with discussion of evidence gaps and future research. Data sources: Published and unpublished studies ( any language) from electronic databases ( inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. Review methods: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. Results: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. Conclusions: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

Mental health of parents caring for infants

The postpartum period is a sensitive time due to the presence and demands of the developing infant. The care provided by a mother to her infant during this period may be compromised if she is suffering from postnatal depression or postpartum psychosis. Evidence has been emerging which suggests that postnatal depression and postpartum psychoses have adverse effects on the quality of the mother-infant relationship and also on the infants subsequent cognitive and emotional development. Presented is a review of the literature relating to how these conditions impact on parenting and infant outcomes, what measures are in place to detect these conditions and evidence-based models of best clinical practice are proposed.