700 resultados para health-promoting schools


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Background Sweet cherries (Prunus avium L.) are a nutritious fruit which are rich in polyphenols and have high antioxidant potential. Most sweet cherries are consumed fresh and a small proportion of the total sweet cherries production is value added to make processed food products. Sweet cherries are highly perishable fruit with a short harvest season, therefore extensive preservation and processing methods have been developed for the extension of their shelf-life and distribution of their products. Scope and Approach In this review, the main physicochemical properties of sweet cherries, as well as bioactive components and their determination methods are described. The study emphasises the recent progress of postharvest technology, such as controlled/modified atmosphere storage, edible coatings, irradiation, and biological control agents, to maintain sweet cherries for the fresh market. Valorisations of second-grade sweet cherries, as well as trends for the diversification of cherry products for future studies are also discussed. Key Findings and Conclusions Sweet cherry fruit have a short harvest period and marketing window. The major loss in quality after harvest include moisture loss, softening, decay and stem browning. Without compromising their eating quality, the extension in fruit quality and shelf-life for sweet cherries is feasible by means of combination of good handling practice and applications of appropriate postharvest technology. With the drive of health-food sector, the potential of using second class cherries including cherry stems as a source of bioactive compound extraction is high, as cherry fruit is well-known for being rich in health-promoting components.

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The first topic area of this thesis involved studies on the accumulation and translocation of glucosinolates (GSs), bioactive secondary plant compounds, in broccoli plants. Changes in GS accumulation and gene expression levels in response to exogeneous methyl jasmonate (MeJA) treatment were analyzed in different tissue types at different developmental stages of broccoli. Greater accumulation of GSs with MeJA treatment was observed in apical leaves of broccoli seedlings and florets of plants at harvest maturity. Increases in indolyl GS in apical leaves of seedlings and florets were coupled with the up-regulation of indolyl GS biosynthesis genes. The accumulation of indolyl GSs appears to be modulated by MeJA treatment in an organ-specific manner for optimal distribution of defense substances in the plant. Metabolic profiling of hydrophilic metabolites using GC-MS demonstrated increased accumulation of various phenolics, ascorbates and amino acids in broccoli tissues after MeJA treatment. Distinct changes in carbohydrate levels observed between different tissues (vegetative leaves and floret tissues) of broccoli plants after treatment suggest that carbon metabolism is differentially modulated by MeJA treatment in different tissue types depending on sink-source relationships. Reduced levels of hexose sugars and tricarboxylic acid intermediates after MeJA treatment may reflect the increased requirement for carbon and energy needed to drive secondary product biosynthesis to accumulate metabolites for defense against insects and other herbivores. Substantial increases of indolyl and aromatic GSs after exogenous treatment with MeJA in stem and petioles of seedlings and the existence of intact indolyl-GS forms in phloem exudates suggest enhanced de novo synthesis in combination with active transport. Indoly GSs share structural similarities with the auxin, IAA, and may interact with components of the auxin transport system for intra- and extra-cellular transport or translocation. Application of the auxin efflux inhibitor, 1-naphthylphthalamic acid (NPA) reduced MeJA-mediated accumulation of indolyl GSs in broccoli florets and seedling tissues. NPA did not inhibit expression of indolyl GS biosynthesis genes shown to be upregulated by MeJA treatment or the accumulation of tryptophan, the amino acid precursor of indolyl GSs. Exogenous application of benzyl GS to Arabidopsis roots induced ectopic expression of the PIN1 protein associated with the auxin transport system similar to treatment with NPA, again suggesting GS interaction with the auxin efflux carrier system. The inhibitory effect of NPA on MeJA-mediated accumulation of GS may be due to competitive binding of NPA to auxin efflux carrier components and that GS transport is mediated by the auxin transport system. The inhibitory effect of NPA on indolyl and aromatic GS accumulation and the bioactivity of exogenous treatment of these GS compounds in PIN1 localization, Arabidopsis root growth, and gravitrophic response suggest that indolyl and aromatic GSs may be antagonistic to IAA transport and biosynthesis. Indolyl and aromatic GSs can also be potentially converted into IAA by hydrolysis. This intrinsic feature of GSs may be the part of a sophisticated regulatory process where the metabolic pathways in the plant shift from active growth to a reversible defense posture in response to biotic or abiotic stress. It seems likely that indolyl and aromatic GSs are important compounds that provide connections between jasmonate and auxin signaling. Further studies are required to reveal the regulatory mechanism for crosstalk between the two hormones. The third part of this research was to investigate effect of selenium fertilization and MeJA treatment on accumulation of GSs in broccoli florets. Increasing dietary intake of the element selenium (Se) has been shown to reduce the risk of cancer. Simultaneous enhancement of both Se and GS concentrations in broccoli floret tissue were conducted through the combined treatment of MeJA with Se fertilization. A low level of Se fertilization (concentration) with MeJA treatment displayed no significant changes in total aliphatic GS concentrations with 90% and 50% increases in indolyl and total GSs concentrations, respectively. This result suggests that Se- and GS-enriched broccoli with improved health-promoting properties can be generated by this combined treatment. The second topic of this thesis was conducted to provide basic information required to improve biomass quality and productivity and develop tools for gene transformation in Miscanthus x giganteus. The perennial rhizomatous grass, Miscanthus x giganteus is an ideal biomass crop due to its rapid vegetative growth and high biomass yield potential. As a naturally occurring sterile hybrid, M. x giganteus must be propagated vegetatively by mechanicalling divided rhizomes or from micropropagated plantlets. The effect of callus type, age and culture methods on regeneration competence was studied to improve regeneration efficiency and shorten the period of tissue culture in M. x giganteus propagation. Seven lignin biosynthesis genes and one putative flowering gene were isolated from M. x giganteus by PCR reactions using maize othologous sequences. Southern hybridization and nuclear DNA content analysis indicated that the genes isolated from M. x giganteus exist in the genome of other Miscanthus species as multiple copies. Analysis of lignin content and histological staining of lignin deposition indicated that higher lignin content is found in mature stem node tissues compared to young leaves and apical stem nodal tissues. Cell wall lignification is associated with increasing tissue maturity in Miscanthus species. RNAi and antisense constructs harboring sequences of these genes were developed to generate Miscanthus transgenic plants with suppressed of lignin biosynthesis and delayed flowering.

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Investigar a qualidade de vida de pacientes com coinfecção HIV/ tuberculose e apreender as mudanças impostas para viver simultaneamente com estas doenças transmissíveis. Métodos: Pesquisa com abordagem qualiquantitativa, realizada em ambulatório especializado em Fortaleza, Brasil, entre 2009 e 2010, com 34 coinfectados. Para coleta de dados foi utilizada uma escala de qualidade de vida, denominada HAT-QoL que possui 42 itens e questões abertas para possibilitar perceber as mudanças em face das doenças. Resultados: A maioria dos participantes tinha tuberculose na forma pulmonar, eram homens, com pouca escolaridade. A qualidade de vida mostrou-se prejudicada nos domínios relacionados às questões econômicas, sexuais e de sigilo. Ainda, foi evidenciado, que a coinfecção impõe mudanças no cotidiano que corroboram e ampliam o comprometimento da qualidade de vida. Conclusão: Vivenciar a coinfecção, mesmo com terapêutica adequada, produz alterações na vida dos infectados, cujas repercussões podem ser amenizadas com intervenções que promovam a saúde

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Watercress (Nasturtium officinale R. Br.) is a semi-aquatic plant of the Brassicaceae family highly appreciated in the Mediterranean cuisine. It features sharp, peppery and slightly tangy taste and contains health-promoting phytochemicals. Its consumption as a fresh-cut product has increased in recent years, as well as the global market of minimally processed vegetables. This demand is driven by the growing interest in the role of food in promoting the human health and wellbeing and to meet consumer needs for fresh-like and more convenient foods. Due to the reduced shelf-life of this plant, the suitability of inert gas-enriched atmospheres and ionizing irradiation for preserving visual, nutritional and functional quality attributes during cold storage was studied. Watercress samples were gathered in the Northeast region of Portugal, rinsed in tap water and a portion was immediately analyzed (non-stored control). The remaining fresh material was packaged in polyethylene bags under N2- and Ar-enriched atmospheres, conventional atmosphere (air) and vacuum (no atmosphere). Samples under conventional atmosphere were irradiated at 1, 2 and 5 kGy of gamma-rays (predicted doses) in a 60Co experimental chamber. A non-irradiated control followed all the experiment. Then, all packaged samples were stored at 4 ºC for 7 days. The studied quality parameters included the colour that was measured with a Konica Minolta colorimeter, and total soluble solids and pH determined in squeezed juice. The proximate composition (moisture, proteins, fat, ash, carbohydrates and energy) was evaluated using the AOA C procedures. Organic acids, free sugars, fatty acids and tocopherols were analyzed by chromatographic techniques. Samples were also evaluated for its DPPH• scavenging activity, reducing power, and lipid peroxidation inhibition capacity trough the inhibition of the β-carotene bleaching and thiobarbituric acid reactive substances (TBAR S) formation. Differences among treatments were analyzed using the one-way analysis of variance (ANO VA) and a linear discriminant analysis (LDA ) was used to evaluate the effects on the overall postharvest quality. After evaluating the effect on the individual quality parameters, the LDA revealed that the Ar-enriched atmosphere and the irradiation at 2 kGy were suitable processing choices for preserving the integrity of the non-stored control samples during cold storage. Thus, these non-thermal treatments were highlighted for shelf-life extension of fresh-cut watercress.

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Food industry is focused on the development of novel functional foods containing health promoting natural ingredients. Natural antioxidants present important health benefits like the prevention of several diseases related to oxidative stress [1,2]. Foeniculum vulgare Mill. (fennel) is a source of those compounds with proved antioxidant potential [3]. Herein, after evaluation of 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity and reducing power of fennel (provided by Américo Duarte Paixão Lda.) decoction, we propose its incorporation into cottage cheese (produced by Queijos Casa Matias Lda.). Three groups of cottage cheese samples were prepared: control; samples with fennel decoction (incorporated at EC25 value=0.35 mg/mL, previously determined by DPPH assay); and samples with fennel powder (incorporated at 1.75 mg/mL, considering the decoction yield=20%). The samples were submitted to an evaluation of DPPH scavenging activity and reducing power immediately after the incorporations, and after 7 and 14 days of storage, at 4 ºC. The incorporation of fennel improved the antioxidant activity of cottage cheese. Samples incorporated with plant powder revealed higher antioxidant properties than samples incorporated with decoction, either in 0 or 7 days of storage. After 14 days, cottage cheese incorporated with fennel decoction gave the highest DPPH scavenging activity (46.72±0.09 mg/mL). A decrease in the antioxidant potential of the cottage cheese with fennel was observed along the shelf life. Nevertheless, it is important to highlight that the samples still display antioxidant properties. Studies regarding the effects of the incorporation of these natural ingredients on nutritional and chemical composition of cottage cheese are in course

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Opuntia spp. flowers have been traditionally used for medical purposes, mostly because of their diversity in bioactive molecules with health promoting properties. The proximate, mineral and volatile compound profiles, together with the cytotoxic and antimicrobial properties were characterized in O. microdasys flowers at different maturity stages, revealing several statistically significant differences. O. microdasys stood out mainly for its high contents of dietary fiber, potassium and camphor, and its high activities against HCT15 cells, Staphylococcus aureus, Aspergillus versicolor and Penicillium funiculosum. The vegetative stage showed the highest cytotoxic and antifungal activities, whilst the full flowering stage was particularly active against bacterial species. The complete dataset has been classified by principal component analysis, achieving clearly identifiable groups for each flowering stage, elucidating also the most distinctive features, and comprehensively profiling each of the assayed stages. The results might be useful to define the best flowering stage considering practical application purposes.

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O presente estudo teve por objetivo investigar os efeitos de uma intervenção psicoeducativa em grupo que foi planejada para fortalecer o autocuidado em idosos do sexo masculino. Participaram treze homens recrutados em um Centro de Convivência para Idosos em funcionamento em uma universidade privada localizada em Brasília, Brasil, com idades entre 62 e 78 anos (M= 69,5), todos eles casados, alfabetizados, aposentados e com doenças crónicas. Dados referentes aos hábitos de vida dos idosos foram obtidos mediante entrevistas individuais conduzidas antes e após o engajamento destes em nove encontros temáticos em grupo embasados no modelo cognitivo-comportamental. Os resultados evidenciaram o fortalecimento, no repertório comportamental dos participantes, da prática de exercícios físicos, de um padrão de alimentação saudável e de comportamentos assertivos, além da maior ênfase em crenças quanto aos benefícios de condutas promotoras de saúde. A intervenção mostrou-se vantajosa para maximizar hábitos de vida saudáveis, embora tenha evidenciado efeitos maiores para sensibilização e manutenção do que para modificação de comportamentos. _______________________________________________________________________________ ABSTRACT

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As perturbações psiquiátricas e os problemas de saúde mental infantojuvenil têm vindo a merecer especial atenção por parte da comunidade científica, não só pelo facto de se estimar que 10 a 20% das crianças apresentem um ou mais problemas de saúde mental, não só por estes valores terem tendência a aumentar, mas também pelo impacto humano e financeiro que acarretam para a sociedade. Em Portugal, o Plano Nacional da Saúde Mental 2007-2016 é categórico ao afirmar a necessidade de promover a saúde mental infantojuvenil junto da população e ao salientar a importância do envolvimento e articulação com outras estruturas comunitárias ligadas à saúde, educação e direito de menores. Este trabalho vai de encontro a estas linhas de orientação, na medida em que procura identificar, desenvolver e implementar diversos aspetos inerentes à vertente comunitária da saúde mental infantojuvenil. Numa primeira fase é realizado um levantamento das reais necessidades da população infantojuvenil do concelho de Odemira e é definida uma rede de articulação entre os serviços de saúde, escolas e outras entidades locais com competência nesta área. De forma a melhorar a prestação dos cuidados e a garantir respostas adequadas às necessidades identificadas, também se procurou o individual desenvolvimento de competências especializadas na área da saúde mental infantojuvenil. Por último, atendendo à importância da implementação atempada de medidas preventivas de determinados fenómenos psicopatológicos, procurou-se treinar e desenvolver a capacidade de sensibilização e reforço de competências de uma bolsa populacional específica: a comunidade escolar. De um modo geral, os resultados obtidos demonstram aplicabilidade na prática clínica dos cuidados, contribuindo para a melhoria dos mesmos. Algumas das estratégias utilizadas constituem-se como ponto de partida para projetos futuros, podendo ser replicadas e adequadas a outros contextos de intervenção; ABSTRACT: LINK HEALTH-SCHOOL: the intervention in the community context Psychiatric disorders and problems of youth mental health have been given special attention by the scientific community, not only because it is estimated that 10-20% of children present one or more mental health problems, not only because these values have tendency to increase, but also the human and financial impact to society. In Portugal, the Mental Health National Plan 2007-2016 is emphatic in affirming the need to promote the mental youth health within the population and to emphasize the importance of the involvement and coordination with other community entities related to health, education and minors rights. This paper follows these guidelines, it tries to identify, develop and implement various aspects related to the Community part of youth health. In the first phase is carried out a survey of the real needs of youth population of the Odemira County and defined a network between health services, schools and other local organizations with expertise in this area. In order to improve the delivery of health care and ensure appropriate responses to the identified needs, also sought the individual development of expertise in the area of youth mental health. Finally, given the value of timely implementation of preventive measures of certain psychopathological phenomena, it sought to train and develop the awareness and skills improvement of a specific population: the school community. In general, the results prove the applicability of the procedures in clinical practice, contributing to a practice improvement. Some of the strategies used are the Foundation for future projects, they can be replicated and adapted to other contexts of intervention.

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Este relatório destina-se a descrever as acções desenvolvidas no estágio, do 1º Curso de Mestrado em Enfermagem Comunitária, realizado na Escola Superior de Saúde de Portalegre. A intervenção comunitária, realizou-se na comunidade escolar de Portalegre, tendo tido duas vertentes: Educação sexual na adolescência; Promoção de comportamentos saudáveis nos estilos de vida dos adolescentes. As ações realizadas abordaram a educação sexual na adolescência, com base no diagnóstico de situação e, através da elaboração de um projecto de intervenção, aplicado em metodologia de planeamento em saúde. A intervenção comunitária teve como base a promoção de comportamentos saudáveis nos estilos de vida dos adolescentes, a alunos das escolas de Portalegre do 9º e 12º anos, na área de ciências e tecnologias. Todo este trabalho foi desenvolvido na fase teórica e suportou a nossa intervenção em estágio. Assim, após a conclusão deste diagnóstico, seguiu-se a fase de estabelecimento de prioridades, fixação dos objectivos, selecção de estratégias, preparação da execução e avaliação. Na adolescência, a educação sexual deverá ser orientada para a maturação psicossexual, para os afetos, para a contraceção e planeamento familiar e para a prevenção de doenças. É da responsabilidade dos profissionais de saúde, da escola, mas sobretudo da família, proporcionar um ambiente favorável à aprendizagem e ao diálogo. O realce da educação sexual, deverá ser colocado na igualdade de papéis, na tolerância face ao pluralismo de orientação e de condutas sexuais. Por outro lado, é também na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola e a família, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infecções sexualmente transmissíveis e cidadania

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A asma é uma doença crónica das vias respiratórias, normalmente associada a uma hiper- reatividade das vias aéreas e a uma obstrução variável do fluxo de ar. É um problema grave de saúde global e que se encontra associado a vários fatores como o envelhecimento, a pobreza, desemprego e condições de vida insalubres. A adesão ao tratamento é importante para que exista o bom controlo da asma, contribuindo dessa forma para a melhoria na qualidade de vida com redução dos custos associados à doença. A intervenção de uma equipa multidisciplinar, sistematizando conhecimentos em diversas áreas para a prevenção e educação na saúde, promovendo o reforço do poder e da responsabilidade do doente, contribuindo para a melhoria individual e coletiva dentro de um contexto de vida saudável, tem como objetivo incentivar alterações de comportamentos para a melhoria de estilos de vida mais saudáveis. A implementação da consulta de enfermagem surgiu da necessidade em acompanhar doentes com o diagnóstico de asma uma vez que só existe consulta médica. A consulta de enfermagem tem por finalidade reforçar a educação do doente e proporcionar maior segurança e aceitação na adesão e controlo da doença

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Bioactive compounds are extra nutritional constituents occurring naturally in plant foods in small amounts, however in quantities enough to produce bioactive effects. Among bioactive compounds the phenolic compounds are a very large set of molecules, which include several groups such as for example flavonoids, phenolic acids or tannins. Small fruits and berries include a wide diversity of fruits, like grapes, strawberries, blackberries, blueberries, raspberries, cherries, hardi kiwi, gooseberries, cranberries, currants (black, white, red), physalis, crowberries, açaí, elderberries, dates or goji berries, and these frequently have been reported as having particularly high concentrations of phenolic compounds with antioxidant activity. Hence, the objective of this chapter is to review the literature about the type and contents of different phenolic compounds present in small fruits and berries, as well as their bioactive properties, including antioxidant capacity. All the fruits and berries investigated in this chapter were particularly rich in bioactive compounds, including phenolic compounds that provide the fruits with high antioxidant properties. The most relevant health promoting effects include anti-cancer, anti-inflamatory, neuro protective, cardio protective or anti-diabetes, thus indicating that these foods are a valuable resource to prevent and treat diseases.

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Consumer interest in health-promoting food products is a major driving force for the increasing global demand of functional (probiotic) dairy foods. Yogurt is considered the ideal medium for delivery of beneficial functional ingredients. Gamma-amino-butyric acid has potential as a bioactive ingredient in functional foods due to its health-promoting properties as an anti-stress, anti-hypertensive, and anti-diabetic agent. Here, we report the use of a novel Streptococcus thermophilus strain, isolated from the digestive tract of fish, for production of yogurt naturally enriched with 2 mg/ml of gamma-amino-butyric acid (200 mg in a standard yogurt volume of 100 ml), a dose in the same range as that provided by some commercially available gamma-amino-butyric acid supplements. The biotechnological suitability of this strain for industrial production of yogurt was demonstrated by comparison with the reference yogurt inoculated with the commercial CH1 starter (Chr. Hansen) widely used in the dairy industry. Both yogurts showed comparable pH curves [ΔpH/Δt = 0.31-0.33 h-1], viscosity [0.49 Pa-s], water holding capacity [72–73%], and chemical composition [moisture (87–88%), protein (5.05–5.65%), fat (0.12–0.15%), sugar (4.8–5.8%), and ash (0.74–1.2%)]. Gamma-amino-butyric acid was not detected in the control yogurt. In conclusion, the S. thermophilus APC151 strain reported here provides a natural means for fortification of yogurt with gamma-amino-butyric acid.

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Syftet med studien är att öka förståelsen för vilka faktorer som kan leda till och påverka äldre personers deltagande i en social gruppaktivitet riktad till ensamma äldre. Då känslan av ensamheten kan ge stora negativa effekter för den äldre är det viktigt att öka förståelsen och kunskapen om de fenomen och faktorer som påverkar och leder till mer gemenskap och välbefinnande. Studien är en kvalitativ intervjustudie och det insamlade materialet har analyserats genom kvalitativ innehållsanalys med en induktiv ansats. Antonovskys salutogena perspektiv har använts som teoretisk referensram. Sex personer i åldern 75-90 år har deltagit i semistrukturerade intervjuer. Deltagarna ingick i frivilligorganisationen Äldrekontakts sociala gruppaktivitet vilket är riktad till ensamma äldre som söker gemenskap. I resultatet framkom tre olika teman vilket sammanfattar de faktorer som ledde till och påverkade de äldres deltagande i den sociala gruppaktiviteten. De teman som ingår är: förändringsgrunder, förutsättningar och fördelar. Temat förändringsgrunder belyser att motivet för de äldre att delta i aktiviteten grundar sig i en önskan om en ökad gemenskap då relationerna blivit färre och att det hade uppstått en känsla av ensamhet. Vidare framkommer att deltagarnas förhållningssätt riktades mot välbefinnande genom att vara aktiv, att ha en stärkande inställning och att våga exponera sig. Temat förutsättningar beskriver villkor för ett deltagande i aktiviteten. Yttre faktorer var stödet att komma till och från aktiviteten och att det var anspråkslöst att delta. Den inre faktorn var att deltagarna hade tillräckligt med ork så att aktiveten gick att genomföra. Temat fördelar visar på de vinster som uppkom i och med deltagandet i denna gruppaktivitet. Denna aktivitet berikade vardagen genom att det blev ett avbrott i det vardagliga livet och att det fanns något att se fram emot. Deltagarna blev sedda och hörda då det fanns någon att samtala med och något att prata om samt att det skapades nya bekantskaper. En känsla av att bli omhändertagen uppstod vilket uttrycktes genom en tacksamhet att få delta och att det kändes tryggt att medverka i aktiviteten. Resultatet har analyserats genom Antonovskys salutogena perspektiv och tre slutsatser har framtagits. Dessa tre teman har identifierats som en process. Temat förändringsgrunder har visat sig vara en grundförutsättning för resterande process och det har också framkommit att deltagarna har en hög känsla av sammanhang. Denna kunskap kan hjälpa de äldre och de som vill stödja ensamma äldre att ta steget från ensamhet till gemenskap.

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Purpose: The aim of this study was to verify the influence of preschool children participating in an oral health education programme on daily health practices of their families, through parent's perception. Methods: A sample of 119 parents of 5- to 6-year-old preschool children were selected. Data were collected using a structured open-closed questionnaire, self-administered. The questions focused on parents' knowledge about activities of oral health education conducted in school, the importance given by them to these activities, learning from their offspring and the presence of habit change at home. Results: In total, 63 (52.9%) parents agreed to participate. Ninety-eight per cent knew about educative and preventive activities developed at school and all of them affirmed that these activities were important, mainly because of knowledge, motivation and improvement in children's health. Ninety and half per cent of parents reported that they learned something about oral health from their children and, among these, almost half (47.8%) cited toothbrushing as the indicator for better learning. Besides this, 87.3% of participants revealed the change in oral health habits of their family members. Conclusion: Preschool children were able to transmit knowledge acquired at school to their parents that included change in oral health routine of their family members.

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While previous research clearly shows that handwashing with soap can prevent many serious illnesses and deaths among children in developing countries, handwashing rates remain low in countries like Kenya. This PhD study explored conditions needed for a successful handwashing with soap initiatives in primary schools in Kenya. It explored the use of puppetry as an approach in communicating hygiene messages as a form of interactive, community-driven method. The research considered a range of conditions that affect such interventions including infrastructure; hardware and software; policy that influence health programs; different actors who have a role to play; and factors affecting sustainability.