An investigation of the process used to develop and evaluate an interactive health communication application using exercise behaviour in students as a context.

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Risk of obesity in immigrants compared with Swedes in two deprived neighbourhoods

<p>Abstract</p> <p>Background</p> <p>Despite a strong social gradient in the prevalence of obesity, there is little scientific understanding of obesity in people settled in deprived neighbourhoods. Few studies are actually based on objectively measured data using random sampling of residents in deprived neighbourhoods. In addition, most studies use a crude measure, the body mass index, to estimate obesity. This is of concern because it may cause inaccurate estimations of the true prevalence and give the wrong picture of the factors associated with obesity. The aim of this study was to estimate the prevalence of, and analyse the sociodemographic factors associated with, three indices of obesity in different ethnic groups settled in two deprived neighbourhoods in Sweden.</p> <p>Methods</p> <p>Height and weight, waist circumference and body fat percentage were objectively measured in a random sample (n = 289). Sociodemographic data were obtained through a survey. Established cut-offs were used to determine obesity. Country of birth was categorized as Swedish, Other European, and Middle Eastern. Odds ratios were estimated by unconditional logistic regression.</p> <p>Results</p> <p>One third of the sample was classified as obese overall, with 39.0% of women being abdominally obese. After adjusting for age, we found higher odds of obesity in Middle Eastern women than in Swedish women regardless of outcome with odds ratios ranging between 2.74 and 5.53. Men of other European origin had higher odds of BMI obesity than Swedish men. Most associations between country of birth and obesity remained in the full model.</p> <p>Conclusion</p> <p>This study demonstrates the magnitude of the obesity problem and the need for prevention programmes targeting native and immigrant adults in deprived neighbourhoods in Sweden. The initiatives should also focus on particular groups, e.g. immigrant women and those experiencing economic difficulties. Further studies are needed on behavioural and environmental factors influencing the risk of obesity in residents settled in deprived neighbourhoods.</p

Teaching with the sky as a ceiling : a review of research about the significance of outdoor teaching for children’s learning in compulsory school

The present review is built on results and conclusions from scientific and systematic overviews, where the authors have studied and analysed research, which illustrates how academic performance among comprehensive school students is affected by outdoor teaching, by regular physical activities and/or contact with nature. The review demonstrates that the evidence is strong enough to ascertain that outdoor education has a positive effect, directly as well as indirectly, on academic performance and achievements. Very few studies indicate a correlation between outdoor education and negative effects on students’ learning, teachers’ work situation, or the school situation in general. It is therefore concluded that there is sufficient evidence for recommending more outdoor education in everyday school activities – as incidents of teaching in combination with being outdoors generate a number of positive effects on students’ learning, health, physique, as well as their personal and social development. In sum, this overview demonstrates the following: outdoor education leads to a number of positive effects for school age children, e.g., improved learning (better cognitive abilities, concentration, working memory, and motivation for studies), sufficient evidence for the possibility to introduce more outdoor-based elements in teaching among children and youth in the whole educational system, sufficient evidence for positive effects of outdoor education on cognition, which makes it worthwhile to strengthen existing as well as new national efforts that could enhance outdoor education, physical activities, and contact with nature in compulsory school, e.g., by involving teacher education institutions in a comprehensive development project at a national level, outdoor education is in line with modern pedagogical models of school development, teaching and learning. Support for improved goal achievement and good public health Research shows that outdoor education with regular physical activities and contact with nature can have positive and meaningful effects, both directly and indirectly, on learning, academic performance, health and wellbeing, as well as on students’ personal and social development. The statistical effects (effect measures) are typically at a rather low to medium level. However, at a social level they could potentially be most relevant from a public health and school perspective, as they contribute to better goal achievement in the compulsory school, preschool and leisure-time centre. The conditions are, that programmes and competence-raising measures are taken to initiate outdoor teaching on a large scale and that they are long-term endeavours. According to research long-lasting and more extensive programmes are more effective, physically, socially as well as cognitively, than shorter ad-hoc educational initiatives. Strong evidence for factors that indirectly influence school performance Research shows that regular physical activity with mobility and contact with nature during the school day has overall positive effects on learning ability, academic performance and a number of other factors that are important for students’ development and for teaching. Essential scientific arguments exist, that outdoor teaching, compared to classroom teaching using more or less traditional teaching methods, promotes factors that have indirect effects on academic performance, such as, improved concentration, working memory, and personal and social development. According to the research this, in turn, could lead to increased study motivation, better self-confidence, self-control and impulse control, creativity, ability to collaborate, and intentions for a healthier lifestyle (physical exercise and eating habits). A high degree of physical activities, together with contact with nature during the school day and in teaching, correlates with academic performance and with a number of factors that have an indirect, positive impact on school results among students. More time in teaching theoretical subjects does not lead to better results Research indicates that increased physical activities during the school day or more Physical Education (PE) lessons do not have a negative influence on the results in theoretical subjects. On the contrary, most of the research indicates that more physical activities seem to have positive effects on students’ achievements in theoretical subjects, even if more research is needed in this area. Nor is there any proof that an increase in the amount of teaching hours in theoretical subjects, at the expense of e.g., physical education, has any positive effects on the results in theoretical subjects. Several researchers and systematic overviews indicate that more classroom teaching in theoretical subjects can raise the risk of physical and mental ill health among students. More longitudinal research is needed In order to increase goal achievement, improve academic results and promote sound everyday habits among children and youth, there is enough strong evidence in the research review for considering a systematic implementation of outdoor education in compulsory school. However, a great deal of the research consists of short-term evaluations, which makes it more difficult to draw conclusions as regards outdoor activities in school and how they can contribute to a purposeful school development that will positively influence academic achievements in the long run. In other words, more longitudinal studies are needed in a Swedish school context. The overall layout of the research review The present review of research literature is divided into three main sections, according to the effects of outdoor education on academic performance, physical activities, and contact with nature, respectively.Johan Faskunger, main author)Anders Szczepanski,  co-author Petter Åkerblom,  editorial processing</p

Klassrum med himlen som tak : en kunskapsöversikt om vad utomhusundervisning betyder för lärande i grundskolan

Kunskapsöversikten bygger på en genomgång av resultat och slutsatser från vetenskapliga och systematiska översikter där författarna sammanställt forskning som belyser hur skolprestationer främst bland barn i grundskoleålder påverkas av utomhusundervisning, av regelbunden fysisk aktivitet och/eller naturkontakt. Kunskapsöversikten visar att evidensen är tillräckligt stark för att konstatera att utomhusundervisning bidrar positivt både indirekt och direkt till skolprestation och skolresultat. Extremt få studier, endast någon enstaka, kan påvisa ett samband mellan utomhusundervisning och negativa effekter på elevernas lärande, pedagogernas arbetssituation eller på skolverksamheten i stort. Slutsatsen är att det finns tillräcklig stark evidens för att rekommendera mer utomhusundervisning i skolans pedagogiska verksamhet – eftersom inslag av undervisning i kombination med utomhusvistelse genererar en rad positiva effekter på elevers lärande, hälsa, fysiska aktivitet och deras personliga och sociala utveckling. Sammantaget visar översikten: att utomhusundervisning leder till en lång rad positiva effekter för elever i grundskoleålder, till exempel förbättrad inlärning (ökad kognitiv förmåga, koncentration, arbetsminne, och studiemotivation), att evidensen är tillräckligt stark för att det är möjligt att överväga implementering av fler utomhusbaserade inslag i undervisningen bland barn och elever i hela utbildningssystemet, att evidensen är tillräckligt stark för utomhusundervisningens positiva kognitiva effekter, vilket gör det möjligt att överväga en förstärkning av befintliga såväl som inrättande av nya nationella utbildningsinsatser som främjar utomhusundervisning, fysisk aktivitet, samt naturkontakt i grundskolan, till exempel genom att involvera landets lärosäten med lärarutbildning i ett gemensamt utvecklingsarbete på nationell nivå, att utomhusundervisning ligger i linje med moderna pedagogiska modeller för skolutveckling, undervisning och lärande. Stöd för ökad måluppfyllelse och god folkhälsa Forskningen visar att utomhusundervisning med regelbunden fysisk aktivitet och naturkontakt både direkt och indirekt kan ha positiva och meningsfulla effekter på lärande, skolprestationer, hälsa och välbefinnande, samt på elevernas personliga och sociala utveckling. De statistiska effekterna (effektmåtten) ligger vanligtvis på en låg till måttlig nivå. Men på samhällsnivå skulle de potentiellt kunna få stor relevans ur ett folkhälso- och skolperspektiv genom att bidra till högre måluppfyllelse inom grundskola, förskoleklass och fritidshem. Detta under förutsättning att program och kompetenshöjande åtgärder för utomhusundervisning införs i bred skala och är långsiktiga. Forskningen påtalar att tidsmässigt längre och mer omfattande utbildningsprogram eller insatser uppnår större effekter både motoriskt, socialt och kognitivt än korta och sporadiska pedagogiska insatser. Stark evidens för faktorer som indirekt påverkar skolprestationer Forskningen visar att regelbunden fysisk aktivitet med utökad rörelse och naturkontakt under skoldagen generellt leder till positiva effekter på inlärningsförmåga, skolprestationer och på en lång rad faktorer som är av betydelse för elevers utveckling men också för undervisningen. Betydelsefulla vetenskapliga argument finns för att utomhusundervisning – jämfört med när elever undervisats helt eller till stor del inomhus med mer eller mindre traditionella undervisningsstrategier – främjar faktorer som indirekt påverkar skolprestationer såsom förbättrad koncentration, arbetsminne samt personlig och social utveckling. Forskningen visar att detta i sin tur kan leda till ökad studiemotivation, förbättrad självkänsla, självkontroll och impulskontroll, kreativitet, samarbetsförmåga samt intention till en hälsosammare livsstil (motion och matvanor). Hög grad av fysisk aktivitet, liksom regelbunden naturkontakt under skoldagen och i undervisningen, uppvisar samband med skolprestation och med en lång rad faktorer som indirekt påverkar skolresultaten i positiv riktning hos elever. Mer undervisningstid i teoretiska ämnen leder inte till bättre resultat Forskningen visar att ökad fysisk aktivitet under skoldagen eller utökad undervisning i Idrott &amp; hälsa inte leder till sämre resultat i teoretiska ämnen. Den mesta forskningen tyder tvärtom på att mer fysisk aktivitet leder till positiva effekter på skolresultat i teoretiska ämnen för elever, även om mer forskning behövs inom området. Inte heller en ökning av antalet undervisningstimmar i teoretiska ämnen, på bekostnad av bland annat Idrott &amp; hälsa, leder till bättre resultat i teoretiska ämnen. Flera forskare och systematiska översikter påpekar också att en ökning av inomhusundervisning i teoretiska ämnen till och med kan öka risken för fysisk och psykisk ohälsa hos eleverna. Mer longitudinell forskning behövs För att öka skolans måluppfyllelse, förbättra skolresultat och främja sunda levnadsvanor bland barn och unga, visar kunskapsöversikten att det finns tillräckligt stark evidens för att överväga systematisk implementering av utomhusbaserad undervisning i skolan. En stor del av forskningsmaterialet består dock av tidsmässigt korta utvärderingar. Detta försvårar delvis möjligheten att dra mer långtgående slutsatser av hur utomhusbaserade inslag i den pedagogiska verksamheten kan bidra till en långsiktig och ändamålsenlig skolutveckling som påverkar skolresultaten i positiv riktning. Således behövs fler longitudinella studier utifrån en svensk skol- och undervisningskontext. Kunskapsöversiktens huvudindelning Litteraturgenomgången resulterade i att forskningsmaterialet kunde sorteras i tre huvudkategorier. I kunskapsöversikten redogörs för kunskapsläget utifrån var och en av dessa kategorier, nämligen utomhusundervisningens effekter på skolprestation, fysisk aktivitet och naturkontakt.Johan Faskunger, huvudförfattare Anders Szczepanski, medförfattarePetter Åkerblom, redaktionell bearbetning och layout</p

Teaching with the sky as a ceiling : a review of research about the significance of outdoor teaching for children’s learning in compulsory school

The present review is built on results and conclusions from scientific and systematic overviews, where the authors have studied and analysed research, which illustrates how academic performance among comprehensive school students is affected by outdoor teaching, by regular physical activities and/or contact with nature. The review demonstrates that the evidence is strong enough to ascertain that outdoor education has a positive effect, directly as well as indirectly, on academic performance and achievements. Very few studies indicate a correlation between outdoor education and negative effects on students’ learning, teachers’ work situation, or the school situation in general. It is therefore concluded that there is sufficient evidence for recommending more outdoor education in everyday school activities – as incidents of teaching in combination with being outdoors generate a number of positive effects on students’ learning, health, physique, as well as their personal and social development. In sum, this overview demonstrates the following: outdoor education leads to a number of positive effects for school age children, e.g., improved learning (better cognitive abilities, concentration, working memory, and motivation for studies), sufficient evidence for the possibility to introduce more outdoor-based elements in teaching among children and youth in the whole educational system, sufficient evidence for positive effects of outdoor education on cognition, which makes it worthwhile to strengthen existing as well as new national efforts that could enhance outdoor education, physical activities, and contact with nature in compulsory school, e.g., by involving teacher education institutions in a comprehensive development project at a national level, outdoor education is in line with modern pedagogical models of school development, teaching and learning. Support for improved goal achievement and good public health Research shows that outdoor education with regular physical activities and contact with nature can have positive and meaningful effects, both directly and indirectly, on learning, academic performance, health and wellbeing, as well as on students’ personal and social development. The statistical effects (effect measures) are typically at a rather low to medium level. However, at a social level they could potentially be most relevant from a public health and school perspective, as they contribute to better goal achievement in the compulsory school, preschool and leisure-time centre. The conditions are, that programmes and competence-raising measures are taken to initiate outdoor teaching on a large scale and that they are long-term endeavours. According to research long-lasting and more extensive programmes are more effective, physically, socially as well as cognitively, than shorter ad-hoc educational initiatives. Strong evidence for factors that indirectly influence school performance Research shows that regular physical activity with mobility and contact with nature during the school day has overall positive effects on learning ability, academic performance and a number of other factors that are important for students’ development and for teaching. Essential scientific arguments exist, that outdoor teaching, compared to classroom teaching using more or less traditional teaching methods, promotes factors that have indirect effects on academic performance, such as, improved concentration, working memory, and personal and social development. According to the research this, in turn, could lead to increased study motivation, better self-confidence, self-control and impulse control, creativity, ability to collaborate, and intentions for a healthier lifestyle (physical exercise and eating habits). A high degree of physical activities, together with contact with nature during the school day and in teaching, correlates with academic performance and with a number of factors that have an indirect, positive impact on school results among students. More time in teaching theoretical subjects does not lead to better results Research indicates that increased physical activities during the school day or more Physical Education (PE) lessons do not have a negative influence on the results in theoretical subjects. On the contrary, most of the research indicates that more physical activities seem to have positive effects on students’ achievements in theoretical subjects, even if more research is needed in this area. Nor is there any proof that an increase in the amount of teaching hours in theoretical subjects, at the expense of e.g., physical education, has any positive effects on the results in theoretical subjects. Several researchers and systematic overviews indicate that more classroom teaching in theoretical subjects can raise the risk of physical and mental ill health among students. More longitudinal research is needed In order to increase goal achievement, improve academic results and promote sound everyday habits among children and youth, there is enough strong evidence in the research review for considering a systematic implementation of outdoor education in compulsory school. However, a great deal of the research consists of short-term evaluations, which makes it more difficult to draw conclusions as regards outdoor activities in school and how they can contribute to a purposeful school development that will positively influence academic achievements in the long run. In other words, more longitudinal studies are needed in a Swedish school context. The overall layout of the research review The present review of research literature is divided into three main sections, according to the effects of outdoor education on academic performance, physical activities, and contact with nature, respectively.Johan Faskunger, main author)Anders Szczepanski,  co-author Petter Åkerblom,  editorial processing</p

Who is not adhering to physical activity referrals, and why?

Objective. To analyse patients self-reported reasons for not adhering to physical activity referrals (PARs). Design and setting. Data on 1358 patients who did not adhere to PARs were collected at 38 primary health care (PHC) centres in Sweden. Intervention. PHC providers issued formal physical activity prescriptions for home-based activities or referrals for facility-based activities. Subjects. Ordinary PHC patients whom regular staff believed would benefit from increased physical activity. Main outcome measure: Reasons for non-adherence to PARs: "sickness", "pain", "low motivation", "no time", "economic factors", and "other". Results. Sickness and pain were the most common motives for non-adherence among older patients. The youngest patients blamed economic factors and lack of time more frequently than those in the oldest age group. Economic factors was a more common reason for non-adherence among those referred for facility-based activities compared with those prescribed home-based activities. Low motivation was a more frequent cause of non-adherence among those prescribed home-based activities compared with those referred for facility-based activities. Furthermore, lack of time was a more common reason for non-adherence among patients issued with PARs due to high blood pressure than other patients, while low motivation was a more common reason among patients issued with PARs because of a BMI of greater than 25. Conclusion. The reasons for non-adherence differ between patients prescribed home-based activities and referred for facility-based activities, as well as between patients with different specific characteristics. The information obtained may be valuable not only for the professionals working in PHC, but also for those who work to develop PARs for use in different contexts

Healthy Cities Phase V evaluation: further synthesizing realism.

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases