A cluster-randomised feasibility trial of a children's weight management programme:the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study

Background: Community-based programmes for children with excess weight are widely available, but few have been developed to meet the needs of culturally diverse populations. We adapted an existing children's weight management programme, focusing on Pakistani and Bangladeshi communities. We report the evaluation of this programme to assess feasibility of programme delivery, acceptability of the programme to participants from diverse communities, and feasibility of methods to inform a future trial. Methods: A cluster-randomised feasibility trial was undertaken in a large UK city. Children's weight management programmes (n = 24) were randomised to be delivered as the adapted or the standard programme (2:1 ratio). Routine data on participant attendance (n = 243) at the sessions were used to estimate the proportion of families completing the adapted and standard programmes (to indicate programme acceptability). Families planning to attend the programmes were recruited to participate in the feasibility study (n = 92). Outcome data were collected from children and parents at baseline, end of programme, and 6 months post-programme. A subsample (n = 24) of those attending the adapted programme participated in interviews to gain their views of the content and delivery and assess programme acceptability. Feasibility of programme delivery was assessed through observation and consultation with facilitators, and data on costs were collected. Results: The proportion of Pakistani and Bangladeshi families and families of all ethnicities completing the adapted programme was similar: 78.8% (95% CI 64.8-88.2%) and 76.3% (95% CI 67.0-83.6%) respectively. OR for completion of adapted vs. standard programme was 2.40 (95% CI 1.32-4.34, p = 0.004). The programme was feasible to deliver with some refinements, and participant interview data showed that the programme was well received. Study participant recruitment was successful, but attrition was high (35% at 6 months). Data collection was mostly feasible, but participant burden was high. Data collection on cost of programme delivery was feasible, but costs to families were more challenging to capture. Conclusions: This culturally adapted programme was feasible to deliver and highly acceptable to participants, with increased completion rates compared with the standard programme. Consideration should be given to a future trial to evaluate its clinical and cost-effectiveness. Trial registration: ISRCTN81798055, registered: 13/05/2014

Resilience in Pre-Columbian Caribbean House-Building: Dialogue Between Archaeology and Humanitarian Shelter

This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s10745-015-9741-5This paper responds to questions posed by archaeologists and engineers in the humanitarian sector about relationships between shelter, disasters and resilience. Enabled by an increase in horizontal excavations combined with high-resolution settlement data from excavations in the Dominican Republic, the paper presents a synthesis of Caribbean house data spanning a millennium (1400 BP- 450 BP). An analysis of architectural traits identify the house as an institution that constitutes and catalyses change in an emergent and resilient pathway. The ?Caribbean architectural mode? emerged in a period of demographic expansion and cultural transition, was geographically widespread, different from earlier and mainland traditions and endured the hazards of island and coastal ecologies. We use archaeological analysis at the house level to consider the historical, ecological and regional dimensions of resilience in humanitarian actionThank you to the Museo del Hombre Dominicano for collaboration on the site of El Cabo, to the Netherlands Organisation for Scientific Research and the Faculty of Archaeology, Leiden University for supporting the archaeological research. Kate Crawford?s post-doctoral post at the Department of Civil, Environmental and Geomatic Engineering at University College London was funded by the Engineering and Physical Sciences Research Council

Estratégias de atuação do nutricionista em consultoria alimentar e nutricional da família Dietitian's procedures in food and nutrition consultancy for the family

O objetivo deste trabalho é apresentar princípios e estratégias de atuação do nutricionista em consultoria alimentar e nutricional da família. O especialista nesta área, denominado personal dieter, tem por objetivo principal a educação nutricional da família. A atuação do personal dieter é baseada em três princípios fundamentais: envolvimento de todos os membros da família, promoção da alimentação saudável e aperfeiçoamento das técnicas dietéticas usadas no preparo dos alimentos. Para isso, o nutricionista realiza visitas domiciliares para conhecer a realidade da família e propõe mudanças dos hábitos alimentares por etapas. O protocolo de intervenção adaptado a cada realidade inclui, entre outras atividades, elaboração de cardápio e de lista de compra de alimentos, prescrição de dieta individualizada e treinamento de cozinheira. O conhecimento detalhado dos comportamentos, hábitos e práticas relacionados à alimentação da família favorece uma intervenção personalizada. Isto é essencial para a adoção de hábitos alimentares saudáveis e garante maior eficácia do profissional nutricionista no cuidado à nutrição e à saúde da família.<br>The objective of this work is to present the principles and strategies of a dietitian in food and nutrition consultancy for the family. Also known as a personal diet specialist, these dietitians focus mainly on the nutrition education of the family. Their practice is based on three fundamental principles: participation of the whole family, promotion of healthy eating habits and optimization of dietary techniques used in the food preparation. To achieve these goals, the dietitian visits families in their households in order to learn about the family's lifestyle and suggests changes in their food habits one at a time. The intervention strategy is personalized and includes, among other things, designs the menu and drafts a groceries shopping list, prescribes an individualized diet and trains the cook. Detailed knowledge of the family's food habits, behaviors and lifestyle promotes a personalized intervention. This is vital for the acquisition of healthy eating habits and guarantees greater dietitian's effectiveness in the nutrition and health care of the family