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Certified dietary managers (CDMs) lead their food services team by ensuring food quality, safety, and palatability while applying nutrition principles to food purchasing, storage, preparation, and service. Despite labor shortages and forecasted growth in both healthcare and food services management jobs, approximately 30% of credentialing exam candidates forego their exam within the first year after completing a didactic career technical education program approved by the Association of Nutrition and Foodservice Professionals. Moreover, very few return to pursue their exam after the first year. This study explored, through the lens of the theory of planned behavior, the perceived obstacles contributing to CDM program graduates' reluctance to sit for the national board certification. Semi-structured interviews were conducted with a purposive and convenience sample of eight participants from various regions of the United States to gain insight into internal and external factors contributing to their exam hesitancy. Thematic analysis yielded several themes, including a lack of control over internal and external barriers to taking the exam. Participants reported facing family and work constraints exacerbated by the pandemic and the lack of financial resources to meet exam preparation and registration costs. They expressed feelings of exam-related anxiety, being ill-prepared, unsupported by their programs and employers and discouraged by the observed stressful working conditions of current CDMs. This study helps establish a foundation for remedial action by stakeholders, educational program leaders, and CDM employers in support of certification candidates. Findings raise questions about the prevalence of credentialing exam barriers in other disciplines and pave the way for future investigations about exam hesitancy.

As part of developing the University of Arizona Cooperative Extension 4-H Common Measures system, we created resources for communicating results to stakeholders with research-based visual tools. We outline the creation of two tools that may be useful to CE personnel to use evaluation findings to better "tell their story" to a variety of stakeholders. Effectively telling this story often means addressing the question "so what?". These tools, 1) Outcome Linkages and 2) Infographics can translate the program's "so what?" in easily interpretable and visually engaging ways. Step by step processes are reviewed to guide creation and use of both tools.

Under-education in Cameroon significantly hampers the nation's socio-economic development. Addressing this issue is crucial for enhancing the overall quality of life and economic growth of the country. This study identifies and analyses the primary factors contributing to under-education, offering actionable solutions to improve educational outcomes and promote sustainable development. The study employed a mixed-methods approach combining quantitative and qualitative data. Surveys were conducted with 1,000 households across urban and rural regions, alongside in-depth interviews with 50 educators, policymakers, and community leaders, and field observations in 20 schools. Structured questionnaires, semi-structured interview guides, and observation checklists were used. Advanced statistical techniques, including regression and factor analysis, were applied.

While strategies may differ across geographical regions, FACS Extension professionals work to enhance nutrition education and increase food security in their communities. The four dimensions of food security developed by The Food and Agricultural Organization were reconceptualized to understand food security on an individual or at a community level. Using experiences from a summer internship with two urban counties, the EEUESA Model described here was designed to aid FACS Extension professionals in their efforts for nutrition education and to better understand how programming targets food security in their communities.

The 2020 Dietary Guidelines for Americans now include recommendations for infants and toddlers. Extension educators can use these expanded guidelines to provide feeding recommendations for caregivers of infants/toddlers. The purpose of this study was to explore 1) the infant and toddler feeding topics that Extension educators discuss with caregivers through formal curricula and informal conversations, 2) educators' perceived barriers to teaching and discussing topics with caregivers, and 3) the optimal format of resources for educators and the communities they serve. Findings from this study confirmed a need among educators for infant/toddler feeding programs and resources offered through Extension.

The aim of this study was to investigate the effects of Ramadan-intermittent fasting and different times of the day on the physical parameters of taekwondo athletes. A total of 15 professional Taekwondo athletes, 8 male and 7 female, participated in the study. Performance tests were performed one week before Ramadan (BR), the second week of Ramadan (SWR) and the end of the fourth week of Ramadan (ER) at 07:00 and 17:00. The descriptive statistics of the participants were as follows: mean age 21.131.90 years, height 169.53±8.64, weight 64.80±18.48 in BR and 62.33±16.91 in ER. Speed (30m), agility (hexagon), lower extremity flexibility (hip flexion angle=ROM), and vertical jump strength (counter movement jump=CMJ) performance determination tests were performed. Goniometer was used for lower extremity flexibility measurement and My Jump2 application, which has been proven to be valid and reliable, was used for CMJ performances. The data obtained were evaluated in the statistical package programme (SPSS) at a significance level of 0.05 using parametric (independent t-test) for agility and nonparametric (Mann-Whitney U) test for other tests according to normality test. It was observed that morning and evening hours of different days had no significant effect on speed, agility, flexibility and jumping force values (p>.05), agility test data differed only before and after Ramadan and this difference was in favour of after Ramadan. At the same time, it was observed that the values obtained from the agility test were higher in the morning before Ramadan (11.20 sec) and in the evening before Ramadan (11.28 sec) than in the evening after Ramadan (10.06 sec). As a result, we can say that long-term malnutrition of athletes does not have a positive or negative effect on many performance characteristics. It is thought that learning the findings obtained in this study and future studies by the coaches may provide important contributions to the coaches to prepare and organise more appropriate training programmes for the athletes.

As roughly 7.3 million students in rural school districts head back to school this fall, they remain largely unaware that the Agriculture Improvement Act of 2018 (2018 Farm Bill) is due to expire on September 30, 2024 (Hartman et al., 2023). Enacted on December 20, 2018, and temporarily renewed in September 2023, this critical piece of legislation consistently has offered robust support to rural communities through various safety net measures, farm loans, conservation initiatives, and disaster assistance programs. As the September 30, 2024, deadline nears, people in rural communities should take action to push for the renewal of the Farm Bill and stay informed about possible changes. Although the Farm Bill is already a year overdue, this situation is a chance for involvement and advocacy, highlighting the urgent need for swift action from the U.S. Senate.

This study is the first phase of an on-going study. It shows the first implementation of a teaching-learning sequence designed to facilitate the understanding of the notion of a living being in initial teacher training using modelling approaches. It aims to analyse the knowledge progression of the participants (N=51) through a retrospective analysis, employing an open-ended questionnaire and a rubric. To achieve this, a comparative pre-test-post-test design was used, utilising an open-ended questionnaire. The results show progression in the management of the living being model after comparing knowledge before and after implementation. The results suggest the usefulness and interest of the modelling approaches in teaching this topic, while also highlighting the need for modifications to the didactic sequence employed.

In this practice-based pedagogical paper, we, the university faculty of Education, Food and Nutrition, Sociology, and History in the U.S., describe how we started a Reflective Practice Teaching Circle at our institution for interdisciplinary dialogue about the effective use of social media (SM) for teaching and learning. Our discussions led to the design of the Social Media Entry Model that educators can use for decision-making. We begin this paper with a brief synthesis of scholarly literature describing students' SM use and how higher education faculty use SM to support 21st-century skills development. Next, we describe the institutional, individual, and pedagogical barriers that prevent faculty from embracing SM as a teaching and learning tool. Based on our shared vision and praxis, we present the Social Media Entry Model and describe how educators can use it when deciding how to integrate SM into the formal or informal curriculum. Through our narratives, we illustrate how we use a variety of SM platforms and different entry points in the model to enhance students' 21st-century skills. We also discuss the legal and ethical issues that educators must consider to ensure that university students use SM in a socially responsible manner.

To achieve better quality and efficiency of care and services for clients, social and health care professionals should be educated to adopt an interprofessional way of working and thinking. This requires the development of an interprofessional identity alongside a professional identity. The process must be facilitated comprehensively in social and health care operations. The aim of this observational and cross-sectional mixed-method study was to investigate readiness and perceived development needs concerning interprofessional work among social and health care students and professionals. Furthermore, the aim was to examine the formation of an interprofessional identity in relation to the theoretical framework of interprofessional socialization. In our results, development needs, expressed by the respondents, were categorized at the system, profession, and individual levels of social and health care. Although, positive attitudes were established among students and professionals, our findings demonstrate that the formation of an interprofessional identity requires comprehensive support from social and health care operations. Interprofessional identity can be enhanced especially by applying and developing interprofessional education and lifelong learning.

Nutrition facts are the details on food packaging that describe its nutritional value, including serving size, calories, macronutrients like carbohydrates, protein, and fat, and micronutrients such as vitamins and minerals. These facts have mathematical concepts that can be utilized as a context for prospective teachers to create mathematical problems. By leveraging this real-world data, educators can contribute to multiple Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), by promoting nutritional awareness, and SDG 4 (Quality Education) by enhancing student engagement and understanding through relatable examples. This study examines the profile of mathematical tasks created by prospective mathematics teachers using nutrition facts as a context that meets numeracy task criteria. Data were collected from 62 mathematical tasks created by 31 prospective teachers attending a realistic mathematics education course on numeracy based on a problem-posing task at a public university in Surabaya, Indonesia. The posed tasks were categorized into solvable or unsolvable tasks and the domains of the level of context use and the level of cognitive processes. Results revealed that the level of context use in the posed tasks varied from zero to second order. Surprisingly, most of the tasks were in the first-order level context. Most posed tasks reached the application level, with only a few identified as reasoning tasks. Interestingly, some tasks coded as second-order context were classified as reasoning tasks. The study provides implications for designing numeracy tasks using nutrition facts and interventions in teacher education related to numeracy task design.

This study investigated the digital existence of the food bank users in a university town in Texas, and subsequently, aligned with the research's pragmatic focus, the researchers designed a training model for these food bank users. Two research questions guided the study: What are the digital existence levels of the food bank users, and what training model would best serve these food bank users? Data were collected by means of a survey from 230 individual food bank users representing households. Additional data included observations and conversations with food bank staff, and documents and materials from the site which provided deeper insights. The study found that the food bank users (1) had little to no broadband connectivity; (2) possessed limited digital devices which revealed significant barriers to their digital existence; and (3) had feelings of desperation, vulnerability and isolation. Regarding training offered at no cost, the food bank users did not show much interest, which was attributed to the food bank users' insufficient digital knowledge. The three-level training model was designed with the following objectives: (1) Prepare participants for training; (2) introduce the concept of "digital;" and (3) teach basic computing and cybersecurity skills. To implement this training, an interactive learner-centric model was created demonstrating collaboration among university instructors, volunteer students and the food bank staff. The study concluded that to exist in digital societies affordable broadband connectivity, needs-based devices, and continual support and training were needed for such underserved groups.

About 20% of the U.S. population identifies as Latine. To engage these audiences, many Extension nutrition education programs have translated curricula and other resources into Spanish. Culturally responsive programs need to move beyond translation and address critical issues and needs specific to Latine audiences. We conducted focus groups with 118 foreign-born Latine adults across one state. Participants were interested in nutrition education programs involving the entire family including children offered by bilingual educators. They also wanted programs that focused on healthy meals that included foods from their culture of origin with common US foods.

The Choose Health Action Teens (CHAT) program of Cornell Cooperative Extension engages teens to teach a nutrition curriculum to younger youth, with the goal of enhancing the leadership skills and health behaviors of the teen teachers. Due to COVID-19, an in-person CHAT program in New York City was converted to virtual and implemented online during Summer 2020. Twelve teens, mentored by eight college interns, taught youth virtually in their homes. Quantitative and qualitative assessments demonstrated improvement in teen leadership and facilitation skills and health behaviors, and suggest that converting this type of programming to a virtual environment can be successful.

Objectives: This study aimed to assess the impact of an educational intervention on middle-aged women's knowledge and behaviour regarding various aspects of a healthy lifestyle. Design: Quasi-experimental study involving 150 middle-aged women (divided into experimental and control groups). Setting: Participants were selected from health centres of Tehran, Iran. Method: Data collection included demographic information, knowledge of a healthy lifestyle and healthy lifestyle behaviour. Participants in both the intervention and control groups completed the questionnaires before and 2 months after the educational intervention. The intervention involved 10 minutes of face-to-face training followed by distribution of training booklets provided by the Ministry of Health in Iran. Statistical analyses were conducted using SPSS. Results: Within the intervention group, significant differences were observed in total healthy lifestyle knowledge and subscales for physical activity knowledge, anthropometry knowledge, healthy diet knowledge, and smoking knowledge, between the pre- and post-intervention periods. Other than for smoking behaviour, there was no significant difference in healthy behaviours pre- and post-intervention for the experimental and also the control group. Conclusion: While there was an increase in knowledge about healthy lifestyles following the intervention, this knowledge increase was not associated with a change in healthy lifestyle behaviours. Attention should therefore be given to other influences including socio-economic factors, mental health status, environmental factors, cultural influences, duration of the intervention and psychological factors if changes in healthy behaviour are to be achieved

Autism spectrum disorder is a neurodevelopmental disorder characterized by a wide range of behavioral alterations, including impaired social interaction and repetitive behaviors. Numerous pharmacological interventions have been developed for autism spectrum disorder, often proving ineffective and accompanied by a multitude of side effects. The gut microbial alterations observed in individuals with autism spectrum disorder, including elevated levels of "Bacteroidetes," "Firmicutes," and "Proteobacteria," as well as reduced levels of "Bifidobacterium," provide a basis for further investigation. Recent preclinical studies have shown favorable outcomes with probiotic therapy, including improvements in oxidative stress, anti-inflammatory effects, regulation of neurotransmitters, and restoration of microbial balance. The aim of this review is to explore the potential of probiotics for the management and treatment of autism spectrum disorder, by investigating insights from recent studies in animals.

The proportion of infants in the United States who are breastfed at 1 year remains well below the Healthy People 2030 target. The health implications of suboptimal breastfeeding durations are significant, including increased risk of childhood leukemia and maternal Type 2 diabetes. Prenatal breastfeeding education provides an opportunity to improve breastfeeding self-efficacy among pregnant individuals and to establish their coping skills in case future breastfeeding problems arise. Although prenatal breastfeeding education is known to improve breastfeeding self-efficacy, characteristics of prenatal breastfeeding education interventions that are successful at increasing breastfeeding duration have not been well defined. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Health Action Process Approach, we conducted a systematic review of the literature examining the impact of prenatal breastfeeding education interventions on breastfeeding duration measured at least 12 weeks postpartum. Twenty-one studies were identified. Prenatal breastfeeding education was most likely to increase breastfeeding duration when education interventions integrated psychological components (Health Action Process Approach coping planning) or were paired with in-person postpartum breastfeeding support. Additional research is needed to examine the role of psychological components in breastfeeding education interventions in diverse populations and to determine the specific psychological intervention components with the greatest impact on breastfeeding duration.

Physical health habits including physical activity and nutrition are essential for numerous health benefits. However, beginning in childhood, individuals with intellectual disability engage in lower levels of physical activity and healthy nutrition habits compared to individuals without intellectual disability, a trend that carries on into adulthood. Researchers continue to examine the effectiveness of interventions to increase engagement in physical health habits and improve health outcomes for individuals with intellectual disability, with an increased focus on technology-based interventions. This scoping review aimed to describe how technology was being utilized within interventions to improve health-related outcomes for adults with intellectual disability. We described the technology being used, who used the technology, and the feasibility of the interventions. Forty-one studies met criteria, with a total of 698 adult participants with an intellectual disability. While no studies on nutrition were located, technology was used in various physical activity interventions, with the most common being preferred stimulus access, exergaming, and video-based instruction. Most studies took place at day or rehabilitation centers, were implemented by research teams, and either did not discuss cost or were vague in their description related to cost. Implications, limitations, and future research directions are discussed.

This pilot study investigates the feasibility and assesses the impact of "Lactobacillus plantarum" PS128 probiotics on the neurological function in Rett syndrome. We conducted a randomized, double-blind, and placebo-controlled trial on Rett syndrome with MECP2 mutation aged between 1 and 50 years in Taiwan. In this pilot study, twice-daily "L. plantarum" PS128 or placebo was administered for 16 weeks. In addition to feasibility, we also assessed the changes utilizing the Mullen Scales of Early Learning. In total, 36 participants were finally randomized into "L. plantarum" PS128 (n = 18) or placebo (n = 18) groups. At the end of intervention, the retention rates were 100% for "L. plantarum" PS128 and 94.44% for placebo, with withdrawal rates of 5.56% for the placebo group. Both groups tolerated well, except for one "L. plantarum" PS128 participant who reported loose stool. The probiotic group showed a change of 2.19 ± 3.76, while the placebo group had -0.85 ± 5.09 (p = 0.051) in the total age-equivalent scores of Mullen Scales of Early Learning. There was a significant difference in the change of the total score on the Burke-Fahn-Marsden Movement Scale between probiotic group and placebo group (-12.19 ± 12.12 vs -4.59 ± 4.20, p = 0.020). In leg dystonia, the probiotic group exhibited a change of -4.11 ± 5.11 compared with -0.38 ± 1.50 in the placebo group (p = 0.008). Our findings affirm the feasibility of "L. plantarum" PS128 in Rett syndrome. Future clinical trials are mandatory to further explore its long-term impact on Rett syndrome.

Feeding challenges are a significant concern for autistic children. Literature has yet to comprehensively characterize feeding challenges for autistic children. Further research is needed to understand predictors of feeding severity and identify opportunities for screening and intervention. The purpose of this study was to characterize the presentation of feeding challenges in autistic children and identify predictors of feeding challenge classification and severity. Data from a national cross-sectional survey of caregivers (n = 427) of autistic children with feeding challenges was used. Feeding challenges were characterized using descriptive statistics. Autism diagnosis age and age of onset of feeding challenges was compared using non-parametric testing. Bi-directional stepwise multivariate linear regression was used to identify significant predictors of feeding challenge scores. Sensory-based feeding challenges were the most common. Age of onset of feeding challenges was significantly lower than the age of autism diagnosis. Early feeding challenges differentially predicted feeding challenge severity and classification scores. The results of this study identify the relationships among early feeding challenges and the severity and classification of feeding challenges in later childhood. Results demonstrate the importance of early monitoring of feeding challenges. These findings can be used to inform the identification of critical timepoints for intervention.

We conducted a systematic review of the literature to evaluate the quality of the dietary data and the methods used to obtain them in studies with children and adolescents with ASD. The search of PsycINFO, PubMed, SciELO, and Web of Science using SPIDER strategy retrieved 1975 studies. Data on dietary intake assessment methodologies were extracted. Eighty-nine studies were included. Food records and food frequency questionnaires were the most frequent dietary assessment methods. Overall, studies presented a low quality score. Most of them did not report dietary assessment of bias, description of dietary method application, validity, sensitivity analyses, and statistical adjustments. Future studies must improve the application of dietary assessment methods to advance scientific evidence related to nutrition in ASD.

This review aimed to identify measurement tools to assess dietary intake and physical activity (PA) among individuals with autism spectrum disorder (ASD) and describe the evidence of validity and availability of each tool. Searches were conducted in PubMed, Embase, CINAHL, and PsycINFO using keywords for ASD, PA, diet, and assessment/measurement (n = 2364 articles). After removing duplicates and title/abstract screening, 212 full-text articles were reviewed, and 113 articles were included for data extraction. The most common dietary and PA assessment tools were identified, and each reviewer independently extracted the data on target population of the assessment tool, type of instrument, evidence on psychometrics validation, constructs measured, and instrument availability. Our findings highlight the need for instruments developed for and/or validated in this population.

Autism Spectrum Disorder (ASD) is a constellation of social communication problems in addition to unusual and repetitive behaviors. In this review, we aimed to investigate the effects of probiotics, prebiotics or synbiotics on gastrointestinal (GI) and behavioral symptoms of ASD. We searched the relevant literature in several electronic databases. In total, 344 children with ASD were investigated in this review. The results of this review demonstrated significant effects of the intervention with probiotics and prebiotics on all domains of Autism Treatment Evaluation Checklist (ATEC) score. There were also different reports about their beneficial effects on the improvement of gastrointestinal symptoms, although a need for more clinical trials with the same doses and types of microorganisms is also highlighted.

Purpose: The purpose of this research was to investigate the impact of dietary factors on developmental trajectories in young autistic children. Methods: A gluten-free and casein-free diets, as well as six types of food (meat and eggs, vegetables, uncooked vegetables, sweets, bread, and "white soft bread that never molds") were investigated observationally for up to three years in 5,553 children 2 to 5 years of age via parent-report measures completed within a mobile application. Children had a parent-reported diagnosis of Autism Spectrum Disorder (ASD); 78% were males; the majority of participants resided in the USA. Outcome was monitored on five orthogonal subscales: Language Comprehension, Expressive Language, Sociability, Sensory Awareness, and Health, assessed by the Autism Treatment Evaluation Checklist (ATEC) (Rimland & Edelson, 1999) and Mental Synthesis Evaluation Checklist (MSEC) (Arnold & Vyshedskiy, 2022; Braverman et al., 2018). Results: Consumption of fast-acting carbohydrates -- sweets, bread, and "white soft bread that never molds" -- was associated with a significant and a consistent Health subscale score decline. On the contrary, a gluten-free diet, as well as consumption of meat, eggs, and vegetables were associated with a significant and consistent improvement in the Language Comprehension score. Consumption of meat and eggs was also associated with a significant and consistent improvement in the Sensory Awareness score. Conclusion: The results of this study demonstrate a strong correlation between a diet and developmental trajectories and suggest possible dietary interventions for young autistic children.

Background: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

Kids SIP"smart"ER is a 6-month behavioral and health literacy intervention effective at reducing sugar-sweetened beverage (SSB) intake among middle school students and their caregivers in the rural Appalachian region. This exploratory mixed methods study utilized a convergent parallel design to assess participant acceptability of a school-based curriculum for students and a text messaging program for caregivers. Acceptability was assessed using surveys (873 students and 453 caregivers), five focus groups (34 students) and telephone interviews (22 caregivers). Quantitative data were analyzed descriptively, and qualitative data were content coded. On a 5-point scale, average quantitative survey acceptability ratings ranged from 2.7 to 3.3 among three student-rated questions and 4.1 to 4.2 among four caregiver-rated questions. Qualitative focus group findings suggested that students preferred curricular activities that were hands-on and involved social interaction, while caregiver interview results showed high acceptability of the text messaging program's design, including usability, content messages and personalization. Students and caregivers reported similar program benefits: increased knowledge of SSBs and health risks, increased awareness of SSB behaviors and support to make beverage behavior changes. Results from this study can be used to understand Kids SIP"smart"ER's effectiveness data, communicate the intervention's acceptability with stakeholders and plan for future implementation studies.

Objectives: Overweight and obesity among school-aged children pose a threat to both their academic performance and public health. The Healthy Primary School of the Future (HPSF) initiative was established to address this issue. Our objective was to explore the conditions that make HPSF sustainable based on the perspectives of relevant stakeholders. Design: The study utilised Group Concept Mapping, a structured methodology for conducting mixed-methods participative research, combining qualitative data collection with quantitative data analysis measures. Method: Participants included parents, teachers, school directors, politicians, labour unions, educational, nutrition and health scientists and policymakers. They were asked to respond to the prompt, 'A necessary condition to make the HPSF sustainable is . . .'. The statements generated were then assessed for their importance and feasibility. Using multidimensional scaling and hierarchical cluster analyses, we identified the shared vision among the stakeholders. Results: A total of 106 unique statements were generated and grouped statistically into 10 clusters. The most significant clusters were identified as Financing; Accessibility for everyone; and Content/Lifestyle/School Programme. The clusters that were deemed most feasible included Content/Lifestyle/School Programme; Accessibility for everyone; and Evaluation. Conclusion: Achieving sustainability for the HPSF requires a comprehensive approach that addresses the conditions outlined in all 10 clusters. Based on the ratings of feasibility and importance, our recommendation is to prioritise implementation of Content/Lifestyle/School Programme and Accessibility for everyone. Subsequently, efforts should be directed towards realising the less feasible but crucial conditions, such as Financing and Evaluation, followed by the remaining six clusters of conditions as identified.

Background: Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. Methods: The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. Implications for School Health Policy, Practice, and Equity: Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. Conclusions: Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

We aimed to explore, in a sample of systematic reviews (SRs) with meta-analyses of the association between food/diet and health-related outcomes, whether systematic reviewers selectively included study effect estimates in meta-analyses when multiple effect estimates were available. We randomly selected SRs of food/diet and health-related outcomes published between January 2018 and June 2019. We selected the first presented meta-analysis in each review (index meta-analysis), and extracted from study reports all study effect estimates that were eligible for inclusion in the meta-analysis. We calculated the Potential Bias Index (PBI) to quantify and test for evidence of selective inclusion. The PBI ranges from 0 to 1; values above or below 0.5 suggest selective inclusion of effect estimates more or less favourable to the intervention, respectively. We also compared the index meta-analytic estimate to the median of a randomly constructed distribution of meta-analytic estimates (i.e., the estimate expected when there is no selective inclusion). Thirty-nine SRs with 312 studies were included. The estimated PBI was 0.49 (95% CI 0.42-0.55), suggesting that the selection of study effect estimates from those reported was consistent with a process of random selection. In addition, the index meta-analytic effect estimates were similar, on average, to what we would expect to see in meta-analyses generated when there was no selective inclusion. Despite this, we recommend that systematic reviewers report the methods used to select effect estimates to include in meta-analyses, which can help readers understand the risk of selective inclusion bias in the SRs.

The aim of this study was to evaluate the nutrient intake and dietary antioxidant capacity of children and adolescents with ASD. The study included 38 children and adolescents with ASD aged 6-18 years and 38 gender and age-matched peers without ASD. Caregivers of participants who met inclusion criteria completed a questionnaire form, three-day food consumption record and antioxidant nutrient questionnaire. There were 26 (68.4%) boys and 12 (31.6%) girls in both groups and mean age of participants with and without ASD was 10.9 ± 4.03 years versus 11.1 ± 4.09 years, respectively. The average intake of carbohydrates, vitamin D, calcium, sodium and selenium was lower in participants with ASD than in participants without ASD (p < 0.05). In both groups, dietary fiber, vitamin D, potassium, calcium and selenium intake insufficiency were high, and there was a significant difference between the two groups in terms of carbohydrate, omega 3, vitamin D and sodium intake insufficiency. Considering the antioxidant intakes of the participants, the median value of dietary antioxidant capacity from food consumption record of participants with and without ASD was 3.2 (1.9) mmol versus 4.3 (1.9) mmol, respectively, whereas the dietary antioxidant capacity from antioxidant nutrient questionnaire was 3.5 (2.9) mmol versus 4.8 (2.7) mmol, respectively (p < 0.05). It is predicted that providing nutritional counseling and regulation of diet, especially keeping the antioxidant capacity of diets high, may be effective in reducing some of the symptoms of ASD.

The adoption of genetically modified organisms (GMOs) in Ghana has raised a lot of public concerns and mixed feelings among some Ghanaians. Our present study, therefore, explored the current knowledge of the general public on GMOs, their perceptions, and factors that influence their understanding of GMOs. A total of 200 Ghanaians were interviewed using an online semi-structured questionnaire to solicit information on their knowledge of GMOs. The findings of the study showed that most Ghanaians (183 out of 200) are aware of GMOs. Age and level of education significantly influenced consumers' awareness of GMOs. The results also revealed that most of the participants have a medium to a high level of knowledge of GMOs; however, limited information about GMOs is available to the public. About 61% of the respondents are willing to consume GMOs when made available in Ghana. Also, the findings of the study showed that the respondents would prefer GM-labelled products. The educational level of the respondents significantly influenced their knowledge and understanding of GMOs. The study recommends that scientists and various media platforms provide a platform to address the concerns of the public on GMOs and occasionally engage them in GMO-related issues and their role in addressing food insecurity and malnutrition.

Background: People with intellectual disability frequently have eating, drinking and swallowing difficulties (dysphagia) and are at greater risk of premature mortality, particularly from aspiration and respiratory infections. The insertion of a percutaneous endoscopic gastrostomy (PEG), as part of a multidisciplinary management plan, may help to maintain and improve nutrition. This study included people with intellectual disability who had ever had a PEG inserted and who presented to the specialist Speech and Language Therapy team in one Greater Manchester borough between 2000 and 2022 and assessed the risk of death and sociodemographic and clinical factors associated with this. Methods: This was a cohort study using secondary data. Kaplan--Meier estimates were used to construct the probability of mortality curves. Cox proportional hazards were used to compare death rates in the different sociodemographic and clinical characteristic groups and were presented as hazard ratios and 95% confidence intervals. Findings: Of 42 people included in the study, 18 (43%) died from the point of PEG insertion to the end of the study (December 2022). The median (interquartile range) time to death from PEG insertion was 5 (2-10) years, with four people (10%) dying in the first year. Aspiration pneumonia and unspecified pneumonia were responsible for seven (39%) deaths. No significant associations were found between sociodemographic and clinical factors and risk of death. Conclusion: In persons with intellectual disability and a PEG who were followed up between 2000 and 2022, the mortality was around 40% with deaths occurring in the first year and respiratory conditions being an important cause. The lack of association with sociodemographic and clinical characteristics may have been due to a limited sample size. Further research is needed with larger samples and more variables, including quality of life data, to help understand and improve clinical practice in this area.

Critical thinking is a common and important learning outcome in college curricula. Case-based and problem-based learning can be used to assess and foster critical thinking skills. HNF 250--Contemporary Issues in Human Nutrition is a critical thinking course developed during the redesign of a nutritional sciences major program. Course assignments were designed to assess the course and nutritional sciences major learning outcomes. The nutrition and health claim assignment is scaffolded across the academic semester as three assignments: (1) bibliography assignment; (2) poster presentation; and (3) paper. Course lectures and materials have been designed to prepare students for completion of each assignment. The assignments have been modified over time based on classroom observations and student performance. In 2021, the course learning outcomes were examined by assessing several assignments including the nutrition and health claim poster and paper. Course learning outcome benchmarks using these assessments generally included 80% of students achieving an 80% for each criterion. Results revealed that students were not meeting most of these assessment benchmarks during the 2021 iteration, although benchmark data from other course assessments were more satisfactory. It is possible that the transition from a virtual to an in-person format negatively influenced student performance on these course learning outcomes. This course and the nutrition and health claim assignment example can provide a course design and learning outcome assessment framework for other higher education critical thinking courses.

Reading nutrition facts labels is a competency for which training is given in several nutrition education programs, especially in obesity outreach workshops. The Top Trumps-style card game is commonly used in obesity prevention educational programs to engage participants in reading nutrition facts labels; however, the success of TV cooking shows among children and teenagers has not been explored for educational purposes. This paper is a descriptive study of developing a gamified activity as part of the one-time outreach workshop facilitated by the Obesity and Comorbidities Research Center (OCRC) in Brazil. By playing the MestreChef Nutritional (MCN) game, participants followed similar rules as the corresponding TV cooking show. They were challenged to decide to select food items, calculate dietary food intake, and prepare a recipe to visualize the proportion of macronutrients contained in daily diets. The analysis of the nutritional dietary table completed by participants revealed to be a rich source of information, and we identified in our cohort that selecting an adequate number of food items and making healthy food choices was not concerning. However, their lack of competency in performing mathematical reasoning, particularly in calculating serving sizes and converting grams of macronutrients into calories, was evident. Moreover, facilitators of the workshops agreed that the MCN game presents definitively more didactic effectiveness and playability than the Foods Top Trumps, a former game used in the outreach workshops. The MCN game nourishes the engagement of the participants in learning nutrition-related concepts and may be an efficient didactic resource to improve nutrition knowledge in outreach activities when an alternative method is required to stimulate reading nutrition facts labels.

We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On "day 1," the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.