多策略干预以加强健康食堂政策的实施：一项随机对照试验。
Multi-strategic intervention to enhance implementation of healthy canteen policy: a randomised controlled trial.
作者信息
Wolfenden Luke, Nathan Nicole, Janssen Lisa M, Wiggers John, Reilly Kathryn, Delaney Tessa, Williams Christopher M, Bell Colin, Wyse Rebecca, Sutherland Rachel, Campbell Libby, Lecathelinais Christophe, Oldmeadow Chris, Freund Megan, Yoong Sze Lin
机构信息
Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales, 2289, Australia.
The University of Newcastle, C/O Hunter New England Population Health, Locked Bag 10 Longworth Ave, Wallsend, New South Wales, 2289, Australia.
出版信息
Implement Sci. 2017 Jan 11;12(1):6. doi: 10.1186/s13012-016-0537-9.
BACKGROUND
Internationally, governments have implemented school-based nutrition policies to restrict the availability of unhealthy foods from sale. The aim of the trial was to assess the effectiveness of a multi-strategic intervention to increase implementation of a state-wide healthy canteen policy. The impact of the intervention on the energy, total fat, and sodium of children's canteen purchases and on schools' canteen revenue was also assessed.
METHODS
Australian primary schools with a canteen were randomised to receive a 12-14-month, multi-strategic intervention or to a no intervention control group. The intervention sought to increase implementation of a state-wide healthy canteen policy which required schools to remove unhealthy items (classified as 'red' or 'banned') from regular sale and encouraged schools to 'fill the menu' with healthy items (classified as 'green'). The intervention strategies included allocation of a support officer to assist with policy implementation, engagement of school principals and parent committees, consensus processes with canteen managers, training, provision of tools and resources, academic detailing, performance feedback, recognition and marketing initiatives. Data were collected at baseline (April to September, 2013) and at completion of the implementation period (November, 2014 to April, 2015).
RESULTS
Seventy schools participated in the trial. Relative to control, at follow-up, intervention schools were significantly more likely to have menus without 'red' or 'banned' items (RR = 21.11; 95% CI 3.30 to 147.28; p ≤ 0.01) and to have at least 50% of menu items classified as 'green' (RR = 3.06; 95% CI 1.64 to 5.68; p ≤ 0.01). At follow-up, student purchases from intervention school canteens were significantly lower in total fat (difference = -1.51 g; 95% CI -2.84 to -0.18; p = 0.028) compared to controls, but not in energy (difference = -132.32 kJ; 95% CI -280.99 to 16.34; p = 0.080) or sodium (difference = -46.81 mg; 95% CI -96.97 to 3.35; p = 0.067). Canteen revenue did not differ significantly between groups.
CONCLUSION
Poor implementation of evidence-based school nutrition policies is a problem experienced by governments internationally, and one with significant implications for public health. The study makes an important contribution to the limited experimental evidence regarding strategies to improve implementation of school nutrition policies and suggests that, with multi-strategic support, implementation of healthy canteen policies can be achieved in most schools.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry ( ACTRN12613000311752 ).
背景
在国际上，各国政府已实施以学校为基础的营养政策，以限制不健康食品的销售。该试验的目的是评估一项多策略干预措施对增加全州健康食堂政策实施效果的影响。还评估了该干预措施对儿童食堂购买食品的能量、总脂肪和钠含量以及学校食堂收入的影响。
方法
设有食堂的澳大利亚小学被随机分为接受为期12 - 14个月的多策略干预组或无干预对照组。该干预措施旨在增加一项全州健康食堂政策的实施，该政策要求学校停止常规销售不健康食品（分类为“红色”或“禁止”食品），并鼓励学校用健康食品（分类为“绿色”食品）“丰富菜单”。干预策略包括分配一名支持人员协助政策实施、让学校校长和家长委员会参与、与食堂经理进行协商过程、培训、提供工具和资源、学术指导、绩效反馈、表彰和营销举措。在基线期（2013年4月至9月）和实施期结束时（2014年11月至2015年4月）收集数据。
结果
70所学校参与了该试验。与对照组相比，在随访时，干预学校更有可能拥有不含“红色”或“禁止”食品的菜单（相对风险 = 21.11；95%置信区间3.30至147.28；p≤0.01）并且至少50%的菜单项被分类为“绿色”（相对风险 = 3.06；95%置信区间1.64至5.68；p≤0.01）。在随访时，与对照组相比，干预学校食堂学生购买的食品总脂肪含量显著降低（差异 = -1.51克；95%置信区间 -2. Developmental changes in the brain have been associated with cognitive and behavioral changes. However, the specific mechanisms underlying these associations are not fully understood.
One hypothesis is that changes in synaptic plasticity play a crucial role. Synaptic plasticity refers to the ability of synapses to change their strength in response to activity. It is thought that during development, alterations in synaptic plasticity may lead to changes in neural circuits, which in turn affect cognitive and behavioral outcomes.
Another hypothesis involves the role of neurotransmitters. Neurotransmitters are chemical messengers that transmit signals between neurons. Changes in the levels or functions of neurotransmitters during development could impact neural communication and contribute to cognitive and behavioral changes.
Furthermore, epigenetic modifications have emerged as an important factor. Epigenetic modifications involve changes in gene expression without altering the DNA sequence itself. These modifications can be influenced by environmental factors and may play a role in regulating neural development and subsequent cognitive and behavioral phenotypes.
Understanding the mechanisms underlying the relationship between brain development and cognitive/behavioral changes is essential for advancing our knowledge of normal development and for developing interventions to address developmental disorders.
84至 -0.18；p = 0.028），但能量（差异 = -132.32千焦；95%置信区间 -280.99至16.34；p = 0.080）或钠含量（差异 = -46.81毫克；95%置信区间 -96.97至3.35；p = 0.067）没有显著差异。两组之间食堂收入没有显著差异。
结论
循证学校营养政策实施不力是国际上各国政府面临的一个问题，对公众健康有重大影响。该研究为关于改善学校营养政策实施策略的有限实验证据做出了重要贡献，并表明在多策略支持下，大多数学校能够实现健康食堂政策的实施。
试验注册
澳大利亚新西兰临床试验注册中心（ACTRN12613000311752）
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