Some People Believe That If Children’s Leisure Activities Are Not Educational

How children should utilize their leisure time is an issue which is discussed these days among people,some believe that the activities should be educational while others support giving children freedom to choose. Some teachers and parents have strong opinions about educational activities in childhood. They urge their children to keep studying or get engaged in educational activities. Since childhood is the best time for learning they regard it as golden days for learning.Recent surveys among children between age of 3-8 has shown that those who had educational programs in their free time were more successful in next levels of studying. though it may be hard for children at first ,it makes them to find a way for revealing their hidden talents. Children may not be aware of the result at first but as time goes by they will find it most useful method for finding their way of interest according to Doctor Bahrami's speech in Tehran university.On the contrary,some others encourage their chil dren to play more and enjoy their moments with their friends or toys around them. By their allowance children by themselves have liberty to choose activities of their interest in leisure time. Children have an opportunity to participate in group works and communicate with their same age children. Group activities even playing with same age children put them in a smallest society groups which can lead them to act better in future roles.In myy point of view, letting children to enjoy their childhood by their parents support is the best way to treat these god given beauties. Childhood is the sweetest part of life any one can experience. Creative minds grow while there is no obligation or pressure from an outer person. when children have time to draw paint or make things their talents would appear in their own way of interest. According to psychologist most of creative minds have free childhood without any obligation from their parents side.In this period(childhood)children have time to play,run and do some sports that will help them to keep fit mentally and physically. Running jumping playing keeps their body fresh and healthy and also keeps their body fit. Studies through recent years shows the increasing rate of obesity among children which is caused by modern life. Think about the way u wanted to spend your childhood. Nobody wanted to have childhood with so many educational extracurricular activities. Give your children chance to get rid of this logical acts we suppose them to do.

Omaha Beach Invasion

Early morning hours on June 6, 1944, paratroopers from the British 1st Airborne Division silently dropped and drifted towards the Pegasus Bridge, one of the few bridges that led over the Seine towards Normandy. Moments later, they stormed the bridge with heavy casualties. The Allied invasion of Hitler's â€Å"Fortress Europe† has just begun (Dube, 2005).On those hours, lantern-equipped pathfinders dropped all over the Cotentin Peninsula. Alone and unaided, they were dropped to mark the way for the thousands of men coming in behind them.At dawn, the sea invasion began as an Allied Armada disgorged thousands of troops at five beaches along France's Normandy coast. Allied forces stormed the shores and battled the German defenses in a fight that would go down as the â€Å"Longest Day† in history.The beach’s terrain proved to be an important factor in the assault (Lewis 2000). Its crescent form is bounded at either end by rocky cliffs and its tidal area is gently slop ing. At the western end the shingle bank rested against a stone, which fades further into wood, resembles a sea wall which ranged from 4 feet to12 feet in height. Precipitous bluffs then raised high up to 170 feet, dominating the whole beach and cut into by small wooded valleys.The Germans, earlier anticipating for an attack in the beachheads, constructed three lines of obstacles in the water. This consisted of Belgian Gates with mines lashed to the uprights, logs driven into the sand pointing seaward and hedgehogs installed 130 yards from the shoreline. The area between the shingle bank and the bluffs was both wired and mined with the latter also scattered on the bluff slopes (Gerrard, Bujeiro and Zaloga, 2003).Their troops were concentrated mostly around the entrances to the draws and protected by minefields and wire (Dube, 2005). Each bunker was interconnected by trenches and tunnels. Machine guns, light artillery pieces and anti-tank guns completed the disposition of artillery t argeting the beach. No area of the beach was left uncovered, and the disposition of weapons meant that flanking fire could be brought to bear anywhere along the beach.The Allied forces’ plan of attack includes dividing the Omaha beach into ten sectors. The assault landings were to start at 06:30, which was coined as the â€Å"H-Hour†. Before that, the beach defenses will be bombarded by naval and aerial support forces. The objective was for the beach defenses to be cleared two hours after assault. By the end of the day the forces at Omaha were to have established a bridgehead five miles deep into the enemy territory. To execute this plan the Omaha assault force totaled 34,000 men and 3,300 vehicles with naval support provided by 2 battleships, 3 cruisers, 12 destroyers and 105 other ships (Vat and Eisenhower, 2003).However, during the initial attack, nothing went according to plan (Lewis, 2000). Ten of the landing crafts have gone astray before they reached the beach a nd some were flooded by the rough seas. Some had even sunk. Smoke and mist hinders the navigation of the assault crafts while a heavy current served to push them to the east. The initial bombardment proved to be ineffective. Their mark fell too far inland, thus they hardly touched the coastal defenses. When the landing craft came closer to the shore, the were under increasingly heavy fire from automatic weapons and artilleryWith the failure of the initial assault, a second one started coming ashore about two hours later. Their mission was to bring in reinforcements, support weapons and headquarter elements. Some relief against the mostly unsuppressed enemy fire was gained simply because with more troops landing the concentration of fire was spread more about the many targets available (Dube, 2005). The survivors among the initial forces were not however able to give much covering fire and the landing troops still suffered in places the same high casualty rates as those in the first wave. The failure to clear sufficient paths through the beach obstacles added to the difficulties of the second wave now that the tide was beginning to cover those obstacles. The loss of landing craft as they hit these defenses before they reached the shore began to contribute in the rate of attrition. As in the initial landings, navigation is still difficult and the disturbing miss-landings continued to upset the Allied forces.From the German’s vantage point, at Pointe de la Percee, which is overlooking the entire beach, the assault seemed to have been stopped at the beach. An officer there noted that troops were seeking cover behind obstacles and counted ten tanks burning. However, casualties among their defenders were mounting, chiefly as a result of the allied naval fire. At the same time they were also requesting reinforcement, but their request could not be met because the situation elsewhere in Normandy was becoming more urgent for the defenders (Dube, 2005).As the bat tle progresses, events of the landing were starting to influence the next phase of the battle. The draws, which would serve as the pathway from the beaches to the inner territory, remained strongly concentrated by the defenders. The allies needed to go through these draws to achieve their main target for the day. Also, the issue of leadership began becoming a problem. Miss-landings and blunders in the original plan caused disorganization, and communication between units was compromised (Lewis, 2000).Despite the apparent disadvantage of the Allied forces’ position, continual waves of landings and naval artillery support eventually weakened the German defense.By early afternoon the strong point guarding the draw at Vierville was silenced by the navy, but without enough force on the ground to mop up the remaining defenders the exit could not be opened (Dube, 2005). Traffic was eventually able to use this route by nightfall, and the surviving tanks of the tank battalion spent the night near Vierville. The advance of the initial assault teams cleared away the last remnants of the force defending the draws. When engineers cut a road up the western side of this draw, it became the main route inland off the beaches. With the congestion on the beaches thus relieved, they were re-opened for the landing of vehicles.After the inland infiltration, clashes pushed the grip out barely a mile and a half deep in the enemy area to the east, and the whole beachhead remained under artillery fire. In the evening, the Allies completed the planned landing of infantry, although but losses in equipment were high, because of bad sea conditions. Of the 2,400 tons of supplies scheduled to be landed on D-Day, only 100 tons was actually landed. Casualties were estimated at 3,000 killed, wounded and missing. The heaviest casualties were taken by the infantry tanks and engineers in the first landings. The Germans suffered 1,200 killed, wounded and missing. On the second day, the engine ers constructed the first airfield to be built after D-Day, on the cliff near St. Laurent, and this was used by the Ninth Air Force to support the ground troops as, over the next two days, they accomplished the original D-Day objectives (Lewis, 2000).The complete invasion had not been materialized yet, and the objectives of the D-Day were not achieved. Hundreds of Allied troops are still coming, fighting is ominous, and both sides are unprepared. The D-Day, the â€Å"Longest Day† has ended, but the war on Liberation has just begun.ReferencesAdrian R. Lewis 2000, Omaha Beach: A Flawed Victory, December 3, 2000Alan Dube 2005, A Navy Soldier on Omaha Beach, August 15, 2005Dan van der Vat and John S. D. Eisenhower 2003, D-Day: The Greatest Invasion – A People's History, by November 15, 2003Howard Gerrard, Ramiro Bujeiro, and Steven J. Zaloga 2003, Campaign 100: D-Day 1944 at Omaha Beach, July 23, 2003

The Case for Contamination by Kwame Anthony Appiah Essay

The Case for Contamination by Kwame Anthony Appiah - Essay Example The writer starts the article by describing a setting in a town, Kumasi of Ghana. The town of Kumasi has had experiences with globalizations and cultural diversity yet the original culture of the town was still there. The writer explains a Wednesday festival occurring in the king’s palace. The writer explains how beautiful there was the combination of both globalization and culture at the same time in the festival when there were suited people sitting in the hall talking on their cell phones and on the same time the typical cultural display of honor and grace by the king. The writer explains in the essay that Kumasi is one of the few towns of Ghana which have a vast cultural diversity, one can find people from almost every ethnicity living in the city and yet the original culture of Ghana was observed on the Wednesday festival. The writer explains in the article that forced globalization has been affecting world’s cultures and the global imperialization by the media as well as the globalization has led much culture to the level of their extinction. The affect of globalization on the cultures is that the people watching TV have started to follow the cultures and trends shown mostly on it as they are shown so explicitly that it is almost impossible to avoid them. By doing so they have somewhat lost what was their original culture and are now lost in the modern world. â€Å"Across the street from us, when we were growing up, there was a large house occupied by a number of families, among them a vast family of boys; one, about my age, was a good friend. He lives in London. His brother lives in Japan, where his wife is from. They have another brother who has been in Spain for a while and a couple more brothers who, last I heard, were in the United States. Some of them still live in Kumasi, one or two in Accra, Ghana's capital. Eddie, who lives in Japan, speaks his wife's language now. He has to.† Talking from a religious point of view, the write r has explained in the topic how religions can have both positive and detrimental effects on globalization. As we all know that every religion in the world has given powers to the individuals rather than a central power source which controls everything. Giving powers to the individuals will allow them to decide what they want to have and what want to do. It is up to the people of a specific culture to decide whether they want to continue living in their culture or adapt to the modern world in which modernization is everything and globalization has affected the cultures so badly. Religion gives everyone freedom of speech as well as choosing what is suitable for him. This freedom has been affecting the preservation of cultures so far as impressed by the global media people are choosing ways which are taking them away from their original culture. This is what most of the religious people fear. The religious people who have taken steps for the preservations of their respective cultures fear that the globalization has been having severe detrimental effects on their religions. the most important issue raised by them is Media Imperialization as told by the writer in the article. This imperilization has been affecting many cultures of the world. the writer also describes his hometown that even though globalization has been visiting there too but the cultural roots of the people are still very strong. â€Å"Even here, the villagers will have radios (though the language will

Substance of Reality Essay Example | Topics and Well Written Essays - 1250 words

Substance of Reality - Essay Example Another early philosopher of repute that grappled with the scientific explanation of what the substance of reality really was is Heraclitus who argued that all reality is involved in an ever-shifting flux (Solomon, Martin & Higgins 51). Precisely, Heraclitus argued that no one could ever step into the same river twice. Democritus, on his part, reduced all reality to an inestimable number of imperceptible and inseparable particles known as atoms, which are always moving in the emptiness and bumping into each other as if to combine but then separate. Just like the cosmological speculators, the Sophists also sought alternatives to thinking that was enshrined in authority, tradition and mythology; this established the foundation for two of the greatest ancient Greek philosophers ever known to this day, Plato and Aristotle. While Plato was Socrates’ greatest brainchild and student, Aristotle was Plato’s most famous student. Aristotle also mentored the greatest and most succe ssful conqueror and ruler ever known, the one and only Alexander the Great. Plato had political links both to the oligarchy and democracy and like Socrates, who participated in a discursive practice with his contemporaries challenging them to critically examine their ideas and beliefs, he believed in the prominence of virtue. Socrates taught all his students including Plato that every man was obligated to discuss virtue daily especially because a life that is not examined is not worth living at all. Socrates was largely opposed to the Sophist’s relativism and skepticism. Nevertheless, Socrates also emphasized values rather than physical science like Sophists, unlike other philosophers that came before him. Aristotle points out that Socrates emphasized questions of morality and specific definitions. Granted that Plato was thoroughly enchanted by Socrates’ teachings, it is often felt that his philosophy is a synthesis of the system of critical inquiry he inherited from h is teacher, the Socratic thought he adopted.

Customer Relationship - discussion Essay Example | Topics and Well Written Essays - 500 words

Customer Relationship - discussion - Essay Example Sales people who waste a lot of time on building rapport irk me. I prefer a sales person who values and respects the time of their clients understand their clients’ business needs and offer them good solutions. I also dislike cold calling, as I may not be sure about the caller, and sometimes it is hard to create a connection with a stranger. A good sales person to me is one that approaches me in a way that makes me feel that I am not being sold to, but I am buying. This kind will discuss my needs or desires, and may put in a way to show how the product benefits me. This way, I will feel that their aim is to offer me a solution to my needs, and not just interested in my money. b. Imagine yourself as a service rep for an automobile company. You work with customers who have bought one of the cars for the dealer to take care of warranty issues, i.e. the routine things that come due periodically. What are some of the techniques that you would use to build confidence with that customer?   I am more attentive to face-to-face type of communication. This is because it gives me an opportunity to build rapport with the person I am communicating with. Additionally, this form of communication helps me know the reaction of the person, whether they agree with what Iam telling them, whether they dislike it, or whether they are attentive and interested in what I am telling them or not. This is the only communication form that helps me read the body language of people, unlike the other forms where feedback lacks. However, this is rapidly changing as more people today embrace technology. Communication has moved from physical to virtual, where people communicate in chat rooms. At times, I received call and/or emails associated with the business that Im doing business with. Most companies do a better job of allowing the option to release your info being phone number and/or email, but sometimes that doesnt happen. Now, youre

Demand And Supply Case Study Example | Topics and Well Written Essays - 1750 words

Demand And Supply - Case Study Example ld. (Harberger, AC) In an attempt to completely understand and describe the monopoly, causes, types and relevant issues, it becomes necessary to approach the subject from as a simplistic nature as possible, to stay aligned with the underlying microeconomic structure. Based on the fact that within the market place the root of everything comes down to supply and demand, this is altered by monopolistic practices and therefore society tends to disfavor monopolies as practicing on an unfair basis, and creating barriers of entry to firms wishing to enter the market for profit generation, as well as from the perspective of the consumer, being that the monopoly is unfairly regulating prices, by restricting output and therefore is extracting a price without allowing market forces to determine the correct supply and demand balance of the given commodity. Essentially when dealing with a monopoly consumers are at the mercy of the price determination of that monopoly, which they control via total output restriction and subsequent economic welfare reduction. The Existence of the Monopoly The monopoly comes about when there is little or no competition, normally the latter. The monopoly will always persist based on the barriers to entry for any rival company or concern attempting to enter the market place. Barriers to entry protect a monopoly and at times can even be state sponsored, via legal framework or even finance. The barriers to entry for rival firms include: Legal Barriers – these take the form of legal framework where a government will only allow a producer to supply a product, for example if one considers the first class mail deliver in the United States which USPS is the only allowed deliverer. Patents – similar to legal barriers due to the legal framework that will support a holder of a patent, although this issue is debatable around the cost of research and development in the patent creation process. A certain school of thought agreeing with the pate nt barrier, claims government encouraged innovation incentive, whilst others will claim consumer deprivation due to excessive price fixing. Examples would be the pharmaceutical companies that hold patents on medical drugs, Pfizer who manufactures Viagra – they are the patent holders and are therefore the only company entitled to produce and sell the drug. Control of strategic resources – this would entail a holder of mineral rights or mining rights of a commodity that must be present in order to produce the end product. An example is De Beers controlling 90% of the world’s diamond production (Wessels, W.J). Natural Barriers – also called economies of scale. This is related to the mere cost of establishment within a given industry. It is too expensive and capital intensive to enter the market on a profitable basis. An example of this would be the various utility companies in any given economy. One can safely deduce that monopolies will continue to exist, a s long as there are governments who sponsor such activity, as well as when companies are in the position to be able to create a barrier to entry, via

Environmentally Friendly Sources of Energy Essay

Environmentally Friendly Sources of Energy - Essay Example The anger over high gas prices opened up an old debate over the world's limited fossil fuels, their effect on the environment, and solutions for the future. The course of action is clear, the United States must move beyond Fossil Fuels to more environmentally friendly source of energy. Pollution caused by car fuel is responsible for a number of natural and human afflictions. Topping that long list is acid rain, lung problems including asthma, smog, and global warming. The regulation of car emissions did not begin until 1970. After eighty years of neglect air pollution had become a problem that seemed uncontrollable. President Nixon and his administration struggled to pass legislation that would require vehicles to produce less emissions and be safer for the environment. They did succeed in passing the Federal Clean Air Act, the first in a series of actions meant to improve the quality of air in the United States. The first Act simply stated what was an acceptable amount of emissions and what was not. As the years went by and more provisions were made the Act was still weak, and was used more like a suggestion than a law (Conlin 807). Cars create pollution in a number of ways. The major contribution is ozone being released at a ground level. The World Resources Institute warns "breathing ozone concentrations of 0.012ppm, levels that are typical in many cities can irritate the respiratory tract and impair lung function causing coughing, shortness of breath, and chest pain. In addition to the effects that gas produced pollution has on the human body" (66), it can have a severe effect on the planet as a whole. Another component of car emissions is carbon dioxide, a compound which traps heat. Since the Middle Ages the amount of carbon dioxide in the environment has increased by 30% and the temperature of the planet has increased in a similar way. Global warming can cause many environmental problems including damage to coral reefs, spread of disease, droughts, the melting of the North Pole, and most recently documented severe weather conditions like tropical storms and hurricanes. The amount of gasoline used by cars is staggering. World Resource Institute cites that vehicles used for transportation consumed about 25% of the world's energy, and 80% of that is caused by cars. In 1996 the world's gas consumption topped a trillion liters. America easily uses more gas then it is able to produce. Petroleum is not a renewable resource. The United States imports 50% of the oil it uses (World 79). This leads to an additional problem with petroleum based fuel. The United States has become dependent on foreign countries for this fuel and therefore must maintain a good working relationship with other national governments which nurture terrorism and poor treatment of it's citizens. "Biodiesel is an American-made fuel that can be produced from any fat or vegetable oil, such as soybean oil. Biodiesel is cleaner burning than traditional diesel, and its production and use builds our U.S. economy, rather than our reliance on the Middle East" (Biodiesel, par 3). A shortage of petroleum gas leads to rising gas prices. Of course there are many simple ways that people can cut down on their gas usage. Many of them involved car pooling, not using gas powered machines on ozone days, and to relearn the virtues of taking and enjoying a nice long walk. However, the bigger

Primate Social Behavior Tell Us About Human Evolution Essay

Primate Social Behavior Tell Us About Human Evolution - Essay Example As the groups grow and divide the relationship equation changes at various levels. The leaders need to prove themselves in their body strengths as well as should have the ability so that members of the group follow him. The relationship between people increased with their need to stay together for hunting. When primates started staying together various things got invented, as rightly quoted necessity is the mother of invention. The social structures, needs of leaders and followers, distribution of labor and responsibilities based on age, sex and bodily strengths, language and communication methods and many other things developed. Different cultures have different characteristics. The study of various cultures comes under ethnography. Culture can be defined as the social heritage of human society where social behavior is based on certain norms and rules. Each member of the society needs to abide by these norms and rules. These have an impact on individual and collective behaviors of people. Social behavior has become complex in today’s complex social structure. Social behavior as indicates is the way people live together and communicate with each other. Various biologist and anthropologist have described and explained culture and society differently. Culture and society are different in the modern human society and historical primate’s society. This is the factor which distinguishes the human and nonhuman societies. E. B. Tylor defined human culture as "capabilities and habits acquired by man as a member of society".

Health care Essay Example | Topics and Well Written Essays - 250 words - 27

Health care - Essay Example Since the system is already fair, the government should not take what the rich have worked hard to get. All the money that the rich give as tax goes to the welfare of all the people. The rich should therefore, be treated with equality with the poor (Musgrove, 2012). Though the government may claim that the rich have more vested interests in the nation, they are humans and increasing their tax rates on the basis of their health care consumption would mean that they have more health care demands than the poor (Borowski, 2012). Therefore, based on how much health care services one consumes or needs, it would still be unfair to increase taxes on the rich. It would also be baseless to say that the rich are prone to more chronic diseases that may take up more resources than the poor (Musgrove, 2012). It is unfair to punish people for making their way through life. Any rich person has worked hard to be where he or she is and it would be a punishment not to reward them but offer an increase in taxes for doing better than everyone else. Borowski,  J. (2012, April 30). Why Shouldn’t the Rich Pay More in Taxes? | FreedomWorks. Retrieved  April  5, 2015, from

Working With Groups of Children Essay Example | Topics and Well Written Essays - 3000 words

Working With Groups of Children - Essay Example The deductions from the study revealed that children develop excellent communication skills from the group interactions with regard to the level of development of the children (Wilson, 2008, 87). These children have an easy time in conceptualizing ideas of their colleagues hence this makes the learning of various communication skills through interaction with their fellow colleagues smooth. This is because they have already grasped communication styles and techniques necessary for communication. This shows that the children can gain more from an objective and resourceful interaction from mature persons and their fellow colleagues too (Grossman, 2005, 39). However, the children peg their friendship on the physique and the closeness of their friends. The environment in which the children are operating, and the people the child interacts with are vital in gauging the progress in the development of communication skills through small group interactions. For instance if a child is subjected to harsh people and bad environmental conditions while learning, the child will retreat hence no learning will occur. On the other hand, when a child interacts with a charismatic and friendly pe ople, he or she is likely to open up and will learn ideas presented to him or her. It was found that the environment also a determining factor in the development of a child’s communication skills (Machado, 2012, 97). Another aspect of interaction among children is that same sex children are more likely to learn from each other more easily than children of the opposite sex. This improves their social life because they socialize with less difficulty and losing such attachment slows a child’s social development and communication skill development. Moreover, this may lead to self-centeredness in a child .At this age, children learn from each other through imitation and they agitate to show their psychosocial, emotional and cognitive skills.

The Story Behind Bell Essay Example for Free

The Story Behind Bell Essay â€Å"Mr. Watson, come here. I want you. † These famous words by Alexander Graham Bell were spoken twice – first when the first sentence on the telephone was transmitted, and second when the first transcontinental sentence was exchanged (Feinstein 76, 92). This great genius may be world-famous for his invention of the telephone, but he preferred to be known as something else – the teacher of the deaf (World Book 2001 240). Not only was this brilliant man the creator of the device that transmits speech but also an educator and a very curious human being who desired knowledge and continued to test new ideas throughout his long and productive life. You can see how he changed and influenced the world through the years of his early life, his achievements, his miraculous telephone and its impact on the world, and his other creative inventions. Bell was born on March 3, 1847 in Edinburgh, Scotland (Foster). He was named after his grandfather, Alexander Bell and got his middle name, Graham from a family friend. His father, who was also named Alexander, taught deaf-mutes on how to speak, whereas his mother Elisa was a painter (World Book 2001 240). He was a talented musician, and could play by ear from the years of his childhood which resulted in him receiving a musical education (World Book 2001 240). Bell enrolled as a student teacher in West Howe – which was a boys’ school near Edinburgh – and taught music and speech in exchange for being tutored in other subjects (World Book 2001 240). He eventually started his own school for deaf teachers in 1872, which was one achievement of his in the line of many, although his most important one was the telephone. Ever since he was young, he had a fervent interest in human voice and an ambition for fame and fortune. From the time when Samuel Morse invented the telegraph, Bell was determined to create a new and improved version. In other words, he wanted to be able to transmit human speech. He worked with his partner, Thomas Watson, whom he met at an electrical instrument-making workshop, because he lacked necessary parts (World Book 2001 241). Together, they worked on the creation of the telephone – using a wire, a transmitter, and a receiver. On March 1876, Bell was adjusting the transmitter in the lab of his apartment. Watson was in another room adjusting the receiver, and the door between them was shut. Bell accidentally spilled battery acid on himself, and said those famous words – â€Å"Mr. Watson, come here. I want you,† which Watson heard in the other room through the receiver (Creating America 588). Life flew by for Alexander and Thomas after that. The first telephone patent was issued on March 7, 1876 (World Book 2001 241). The French government awarded Bell the Volta Prize of 50,000 francs, and he used that money to set up more labs, which also meant that he accumulated teams of bright engineers to pursue new ideas (World Book 2001 241, Bellis). Before they knew it, telephones were widely used in the United States. In 1880, more than 50,000 telephones had been sold. A year later, that number changed to 132,000 (Feinstein 89). In 1915, the first transcontinental phone call took place between Bell – who was in New York City, and Watson – who was on the other side of the country, in San Francisco (Feinstein 92). Because this took place, it opened up a whole new level of possibility for Americans. If we could get a telephone call across the country, then why not across the whole world? Today, telephones are widely used, and we all have Bell to thank although not only for this one task. Some more accomplishments of his were when he was elected the first president of the National Geographic Society, and also when he founded the Journal of Science (Ament). Although these achievements may be big, they were not as great as the invention of the telephone. As a result, Bell created the â€Å"Bell Telephone Company† in 1885, which also led to the creation of the â€Å"American Telephone Telegraph Company† (ATT), which still exists today. (Feinstein 89). The invention resulted in Alexander demonstrating his telephone at the Centennial Exhibition in Philadelphia in 1876, and also for Queen Victoria at the Royal Palace (Feinstein 79, 82). Several major scientists at the time saw his exposition, and declared â€Å"Here is the greatest marvel ever achieved in electrical science,† (Creating America 588). Two days after the exhibition, he married Mabel Hubbard and had two daughters – Elsie and Marian (Feinstein 84). They sailed to England and introduced the telephone to the British. The telephone changed the whole world to an unimaginable extent, and it all started with an accident in his lab. Although this creation was one of Bell’s more successful inventions, he also had many that were not as well-known, but were developed with such cleverness that it plainly shows his creativity and hobby for experimentation. Alexander always strived for more knowledge, which meant that he experimented whenever possible. In 1880, he invented the photophone, which transmitted sound over a beam of light (Feinstein 99). He also devised a kite capable of carrying a person, and a â€Å"hydrodome,† which was the fastest boat in the world for several years, travelling at an average speed of 70 mph (Ament). Another one of his well-known inventions was a metal detector, which came in useful when President James Garfield was shot. On July 2, 1881, doctors probed the President’s body with bare and unwashed hands, hoping to find the bullet. They were unsuccessful and called Bell, expecting him to use his metal detector. When Bell first invented this device, he tested it on Civil War veterans who still had bullets in them, and was successful for every single person. When it came to the president, however, it did not work. Garfield eventually died from blood poisoning from the doctors’ filthy hands. After his death, Bell found out that his metal detector was fine, but the springs in the President’s bed had interfered with the functioning of the machine. Many newspapers incorrectly blamed him for the president’s death, but those close to him knew that he had tried his best, and that the death was not his fault in any way (Feinstein 103, 106). Inventing the telephone alone would’ve earned Bell lifelong fame and respect, but he continued to create or improve devices to make the world a better place. Forty-one years later Bell himself passed away. On August 2, 1922, Pernicious Anemia, a blood disease, sadly claimed his life at the age of 75 (Bellis). He is remembered for being the inventor of the telephone, and making the world a smaller place, because friends and family were now just a phone call away. To honor his death, the millions of telephone lines served by the Bell Telephone System in USA and Canada went silent for a whole minute, letting the people remember who invented it and how it dramatically changed the world (Ament). To this very day we can see how Alexander Graham Bell changed each and every one of our lives, and made the world what it is through the years of his early life, his accomplishments, his extraordinary telephone and its impact on the world, and his other astounding creations. He followed his dreams and desires, and told us all to â€Å"Leave the beaten track occasionally and dive into the woods. Every time you do so you will be certain to find something that you have never seen before. † ~Alexander Graham Bell (Feinstein 5).

Effect of School Based Obesity Interventions

Effect of School Based Obesity Interventions ABSTRACT Introduction Background Obesity in both adult and children is fast becoming one of the most serious public health problems of the 21st century in developed and developing countries alike. It is estimated that approximately 10% of school age children. The prevalence of childhood overweight and obesity is ever on the increase in the UK as in the rest of the world. It is estimated that the prevalence of overweight and obesity among 2 10 year old children in the UK rose from 22.7%-27.7% and 9.9%-13.7% respectively between 1995 and 2003; these figures are set to increase unless something is done. School-based interventions offer a possible solution in halting obesity prevalence, because the school setting provides an avenue for reaching out to a high percentage of children (especially in the western world), opportunity for constant monitoring of children and the resources for anti-obesity interventions. Objectives To systematically review the evidence of the impact of school-based interventions to prevent childhood obesity on: Adiposity (primary objective) Knowledge, physical activity levels and diet (secondary objectives) Methods The review was done following the Cochrane collaboration guidelines. In addition to searching electronic databases, first authors of all included studies were contacted. A recognised critical appraisal tool was used to assess the quality of included studies. Results Three RCTs and one CCT met the inclusion criteria for the review. All four studies had a control and intervention group; with various study limitations. While none of the studies found statistically significant BMI changes in intervention groups when compared with control group post-intervention, all of them recorded either a significant change in diet, or an increase in physical activity levels. INTRODUCTION BACKGROUND Obesity is generally understood as abnormal accumulation of fat to the extent that presents health risk (Kiess, Marcus et al. 2004), and was added to the international classification of diseases for the first time in 1948 (Kipping, Jago et al. 2008). The worldwide clinical definition of adult obesity by the WHO is body mass index (BMI) ≠¥ 30kg/m2 (WHO 2006). In children however, because of the significant changes in their BMI with age (Cole, Bellizzi et al. 2000), there is no universally accepted definition of obesity (Parizkova and Hills 2004; Bessesen 2008) and it therefore varies from country-to-country. The most commonly used definition of childhood obesity is the US definition which measures overweight and obesity in a reference population using the cut off points of 85th and 95th centiles of BMI for age (Ogden, Yanovski et al. 2007). In the UK, overweight and obesity are diagnosed using a national reference data from a 1990 BMI survey of British children (Stamatakis, Prima testa et al. 2005). Children whose weights are above the 85th centile are classed as overweight and over the 95th centile are considered obese (Reilly, Wilson et al. 2002). Recent estimates suggest that obesity has reached epidemic proportions globally with about 400 million adults being clinically obese, a figure projected to rise to about 700 million by 2015 (WHO 2006). In children, the current WHO estimates are that about 22 million children globally under age 5 are overweight (WHO 2008). In the UK, evidence suggests that obesity is set to be the number one preventable cause of disease in a matter of time (Simon, Everitt et al. 2005). In the last three decades, the scale as well as the prevalence of obesity have grown rapidly amongst all age, social and ethnic groups in the UK, as well as globally (Table 1)(Kipping, Jago et al. 2008). Estimates suggest that in the UK, between 1984 and 2002/2003, the prevalence of obesity in boys aged 5-10 rose by 4.16%, and by 4.8% in girls (Stamatakis, Primatesta et al. 2005). There is therefore there is an urgent need for the development and implementation of effective intervention strategies to halt the ever increasing obesity prevalence (Summerbell Carolyn, Waters et al. 2005). OBESITY CAUSATION The primary risk factors associated with the increase in prevalence of childhood obesity are ever increasing involvement in sedentary lifestyles and an increase also in the consumption of high energy dense food and drink (Ebbeling, Pawlak et al. 2002; Sekine, Yamagami et al. 2002; Speiser, Rudolf et al. 2005; Topp, Jacks et al. 2009). The underlying mechanism of obesity formation is an imbalance between energy input and expenditure (Moran 1999; Kipping, Jago et al. 2008) Genetic and environmental factors greatly influence the bodys energy balance. Nevertheless, genetic conditions which either cause production of excessive fat in the body or reduce the rate at which it is broken down, of which Prader-Willi syndrome is an example account for less than 5% of obese individuals (Speiser, Rudolf et al. 2005), with environmental factors accounting for a very high percentage (French, Story et al. 2001). The major cause of the rising obesity problem is arguably changes in physical and social environments (French, Story et al. 2001). In recent times, there has been a remarkable shift towards activities that do not promote energy expenditure, for example, most children would travel to school in cars rather walk, in contrast to what obtained in the 1970s (Popkin, Duffey et al. 2005; Anderson and Butcher 2006). There is evidence to suggest that obese children are less active than their non-obese counterparts, hence promoting physical activity such as walking or exercising will help prevent obesity in children (Hughes, Henderson et al. 2006). Media time (television viewing, playing video games and using the computer) has been identified as one of the significant environmental changes responsible for the surge in childhood obesity. Besides promoting physical inactivity, it encourages energy input via excessive snacking and inappropriate food choices as a result of television advertisements (Ebbeling, Pawlak et al. 2002; Speiser, Rudolf et al. 2005). Robinson in his study reveals that â€Å"between ages 2 and 17, children spend an average of 3 years of their waking lifetime watching television alone† (Robinson 1998). Parents play a significant role in where, what and how much their children eat and to an extent, how physically active their children are. In most homes, children make their food choices based on the options they are presented with by their parents, and they characteristically would go for wrong option, more so if they have an obese parent (Strauss and Knight 1999). Other changes within the family such as physical inactivity and working patterns of parents have contributed somewhat to the obesity epidemic. In a family where the parents work full-time, there tends to be very little time for them to prepare wholesome home-made meals and this could possibly explain the increasing demand for eating out (Anderson and Butcher 2006) thereby increasing intake of high energy dense food. Childrens attitude to and participation in physical activities depends largely on how physically active their parents are. Thus children of sporty parents embrace exercise heartily and are therefore less prone to becoming obese.(Sallis, Prochaska et al. 2000). In addition to these family factors, societal factors such as high crime rate, access to safe sports/recreational facilities, transportation and fewer physical education programs in schools significantly impact on energy balance (Koplan, Liverman et al. 2005; Popkin, Duffey et al. 2005; Topp, Jacks et al. 2009). French summarizes the environmental influence on obesity by opining that â€Å"The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity† (French, Story et al. 2001) CONSEQUENCES OF OBESITY Evidence suggests that childhood obesity and/or overweight has a great impact on both physical and psychological health; causing effects such as behavioral problems and low self esteem, with a higher risk in girls than in boys (Reilly, Methven et al. 2003). Although most of the serious consequences do not become evident until adulthood, research has shown childhood obesity to be linked to metabolic disorders such as insulin resistance and type 2 diabetes, stroke and heart attacks, sleep apnea, nonalchoholic fatty liver disease, higher incidence of cancers, depression, dyslipidaemia, increased blood clotting tendency, etc (Ebbeling, Pawlak et al. 2002; Reilly, Methven et al. 2003; Kiess, Marcus et al. 2004; D. A. Lawlor, C. J. Riddoch et al. 2005; Daniels 2006; WHO 2006). One of the long-term serious consequences of childhood obesity is that obese children are twice more likely to grow into obese adults than their non-obese counterparts (Moran 1999); however, this largely depends on factors such as age of onset, severity of the disease and the presence of the disease in one parent (Moran 1999; Campbell, Waters et al. 2001; Kiess, Marcus et al. 2004; WHO 2006). Other long term consequences include early death and adverse socio-economic consequences such as poor educational attainment and low/no income in adulthood (Reilly, Methven et al. 2003; Fowler-Brown and Kahwati 2004; Kiess, Marcus et al. 2004). Obesity-related morbidity places a huge and growing financial demand on governments. In the UK alone, the Department of Health has reported that obesity costs the NHS and the UK economy as a whole about  £1b and between  £2.3b  £2.6b annually respectively, with the cost to the NHS projected to rise to  £3.6b by 2010 (DH 2007). TREATMENT AND PREVENTION The treatment of obesity requires a multidisciplinary approach due to the multi-faceted nature of the condition (Parizkova and Hills 2004). This is aimed at reducing caloric intake and increasing energy expenditure through physical activity (Ebbeling, Pawlak et al. 2002). These interventions are more likely to be successful if the patients family is involved and the treatment tailored to individual needs and circumstances (Fowler-Brown and Kahwati 2004). In extreme cases, options such as surgical and pharmacological treatments could be exploited. These options are very unpopular and usually not recommended because the associated health risks outweigh the benefits by far (Epstein, Myers et al. 1998; Ebbeling, Pawlak et al. 2002). Considering the huge costs and high levels of treatment failure associated with obesity treatment (Stewart, Chapple et al. 2008), the axiom by Benjamin Franklin cannot describe any other condition better than it describes obesity management. â€Å"An ounce of prevention is worth a pound of cure† Dietz et al confirm this by saying that prevention remains the best and most effective management of obesity (Dietz and Gortmaker 2001). Obesity prevention interventions are usually set either in the home or at school with an objective of eliminating peer pressure and, by so doing effect behavioral change (Ebbeling, Pawlak et al. 2002). Literature suggests that the school has so far remained the choice setting for these preventive interventions despite the very limited evidence on its effectiveness (Birch and Ventura 2009). Why is the school setting a good focus of intervention? Approximately 90% of children are enrolled in schools in developed countries (Baranowsk, Cullen et al. 2002) Children spend a substantial amount of time in school and therefore consume a considerable proportion of their daily calories at school (Katz, OConnell et al. 2005) School related activities present an opportunity to educate children on the concept of energy balance, healthy living and how to make appropriate food choices (Ebbeling, Pawlak et al. 2002; Koplan, Liverman et al. 2005) It offers opportunity for continuity and constant monitoring via frequent contact (Baranowski T 2002) Schools have an availability of existing manpower and facilities needed for anti-obesity interventions (Kropski, Keckley et al. 2008) In a nut shell, â€Å"Schools offer many other opportunities for learning and practicing healthful eating and physical activity behaviors. Coordinated changes in the curriculum, the in-school advertising environment, school health services, and after-school programs all offer the potential to advance obesity prevention† (Koplan, Liverman et al. 2005). PREVIOUS SYSTEMATIC REVIEWS Systematic reviews have been conducted on the effectiveness of school-based interventions in the prevention of childhood obesity. Campbell et al (2001), conducted a systematic review of 7 randomised control trials (RCTs) (6 were school-based, varying in length of time, target population, quality of study and intervention approach). The review found that dietary and physical education interventions have an effect on childhood obesity prevalence. However, success varied with different interventions amongst different age groups. Two of the three long term studies that focused on a combination of dietary education and physical activity, and dietary education respectively reported an effect on obesity prevalence reduction. Similarly, 1 out of the 3 school based short-term interventions that focused only on reducing sedentary activity also found an effect on obesity prevalence. While this review shows that dietary and physical activity interventions based at school are effective against th e risk factors of obesity, the question of generalisability and reproducibility arises as the review reports the majority of the included primary studies were carried out in the US. Most of the studies used BMI as a measure of adiposity, and BMI as has been documented varies across ethnic and racial groups (Rush, Goedecke et al. 2007), thus, it will be inappropriate to apply the findings of US-based obesity prevention interventions to children in middle and low income countries where conditions are different. There are also concerns about the methodology and study design. For example the school-based study by Gotmaker et al (1999) had limitations such as low participation rate (65%) and the researchers were unable to adjust for maturity in boys and there was also poor assessment of dietary intake. All these limitations could have been responsible for a high percentage of the reported intervention effect thus affecting the validity of the results of the study (Gortmaker, Peterson et al. 1999). The authors of the review however concluded that there is currently very limited high quality evidence on which to draw conclusions on the effectiveness of anti-obesity programmes. A Cochrane review which is an update of the Campbell et al (2001) study by Summerbell et al (2005) has examined the impact of diet, physical activity and/or lifestyle and social support on childhood obesity prevention. Their review examined the effectiveness of childhood obesity prevention interventions which included school based interventions. Their study included 10 long-term (a minimum duration of 12 months) and 12 short-term (12weeks 12 months) clinical trials (randomised and controlled). 19 out of the 22 studies that met their inclusion criteria were school/pre-school based. The study chose the appropriate study type; more than one reviewer was involved in the entire process of data collection, extraction and selection of included studies. In general, the study found that most of the school-based interventions (dietary and/or physical activity) reported some positive changes in targeted behaviours, but however had very little or no statistically significant impact on BMI. The reviewers stated that none of the 22 studies fulfilled the quality criteria because of some form of methodological weakness which includes measurement errors. For instance, the study by Jenner et al (1989) had no valid method of measuring food intake. The studies by Crawford et al (1994), Lannotti et al (1994) and Sallis et al (2000) had similar measurement errors. Reporting error was identified in studies by Little et al (1999) and Macdiarmid et al (1998). There were also reliability concerns about the secondary outcomes measurement in some of the included studies. The reviewers therefore expressed the need for further high quality research on effectiveness. Kropski et al (2008) reviewed 14 school-based studies that were designed to effect a life style change, a change in BMI, decrease overweight prevalence through a change in nutrition, physical activity or a combination of both. Of the 14 studies, three were done in the UK, one in Germany and 10 in the US. The right type of studies were chosen for this review and the whole process was done by more than one reviewer, however they were unable to draw strong conclusions on the efficacy of school-based interventions because of the limited number of primary studies available and methodological or design concerns which include: small sample size (Luepker, Perry et al. 1996; Mo-suwan, Pongprapai et al. 1998; Nader, Stone et al. 1999; Warren, Henry et al. 2003), no intention-to treat analysis (Danielzik, Pust et al.; Sallis, McKenzie et al. 1993; Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003), possibility of type I (Coleman, Tiller et al. 2005) and type II errors (Warren, Henry et al. 2003), unit of analysis errors (Sallis, McKenzie et al. 1993) and inconsistent results (Mo-suwan, Pongprapai et al. 1998; Caballero, Clay et al. 2003; Coleman, Tiller et al. 2005). Despite their inability to draw a conclusion on effectiveness, overall, the review found that a combination of nutritional and physical activity interventions had the most effect on BMI and prevalence of overweight, with the result largely varying from community-to-community. The nutrition only and physical activity only interventions appeared to have had a change on lifestyles of participants but either had no significant effect on the measures of overweight or no BMI outcomes were measured. Another systematic review on the effectiveness of school-based interventions among Chinese school children was carried out by M.Li et al (2008). The authors included 22 primary studies in their review. The review reported that the primary studies showed that there are some beneficial effects of school-based interventions for obesity prevention; the reviewers however expressed their concerns that most of the studies included in the review had what they considered to be serious to moderate methodological weaknesses. Sixteen of the 22 studies included studies were cluster control trials, and there was no mention by any of the researchers that cluster analysis was applied to any of the 16 studies. In addition to lack of cluster analysis, no process evaluation was conducted in any of the studies. Only one study performed an intention to treat analysis. Twelve studies experienced dropouts, but there was incomplete information on the study population at the end of the trial and the reason f or the dropouts. Additionally, none of the studies explained the theory upon which they based their intervention. There was also potential recruitment and selection bias in all the primary studies as identified by the reviewers. They stated that none of the studies reported the number of subjects that were approached for recruitment into the study. As none of the RCTs included described the method they used in randomization, neither did they state if the studies were blinded or not. The methodological flaws in a high percentage of the included primary studies could impact on the validity of the findings of the review. Again, the authors failed to reach a conclusion on the effectiveness of the interventions because of the intrinsic weaknesses found in the primary studies, and as a result state the need for more primary studies that would address the methodological weaknesses that is highly present in nearly all existing primary studies conducted on this topic so far. The study of the efficacy of school-based interventions aimed at preventing childhood obesity or reducing the risk factors is a rather complex one. Pertinent issues on effectiveness of school-based interventions to prevent the risk factors of obesity remain that there is very limited/weak evidence on which to base policies on. Heterogeneity of primary research (in terms if age of study population, duration of intervention, measurement of outcomes and outcomes measured) makes further statistical analysis nearly impossible. BMI is currently the most widely used measure of overweight and obesity in children. However, BMI has no way of distinguishing between fat mass and muscle mass in the body and might therefore misdiagnose children with bigger muscles as obese. Another disadvantage of using BMI in overweight measurement is its inability of depicting the body fat composition (Committee on Nutrition 2003), other surrogate indicators of adiposity may be needed. Most authors that have carried out a review on this topic so far have expressed the need for further research on this topic to add to the existing body of evidence. RATIONALE FOR THIS STUDY All the systematic reviews on this subject so far have focused mainly on the United States. Lifestyle differences such as eating habits between American and British children possibly affect generalisability and reproducibility of US findings to the UK. For example, in the US, research has shown that 0.5% of all television advertisements promote food, and that about 72% of these food advertisements promote unhealthy food such as candy and fast food (Darwin 2009). In the UK paradoxically, the government in 2007 enforced regulations banning television advertisement of unhealthy foods (foods with high fat, salt, and sugar content) during television programmes aimed at children below 16 years of age (Darwin 2009). Thus US children are at a higher risk of becoming obese than their UK counterparts as a result of higher rate of exposure to TV junk food advertisements. Another lifestyle difference between American and British children is physical activity. In the UK, a high percentage of children aged 2 to 15 achieve at least 60 minutes of physical activity daily (about 70% of males and 60% of females) (DoH 2004), as opposed to the US where only about 34% of school pupils achieve the daily recommended levels of physical activity daily (CDC 2008). These differences highlight the importance of public health policies being based on the local population characteristics rather than on imported overseas figures. There is therefore need to review the evidence of UK school-based obesity interventions to inform policy relevant to the UK population. To the best of my knowledge following an extensive literature search, no systematic review has been conducted on the effectiveness of school-based intervention in preventing childhood obesity in the UK, despite the high prevalence of the condition and its public health significance in this country. This research aims to bridge this gap in knowledge by focusing on UK based studies to evaluate the efficacy of school-based interventions in the UK population. This study therefore stands out insofar as it will be assessing the effectiveness of school-based interventions in the reducing the risk factors of obesity in the UK, with a hope of providing specific local recommendations based on UK evidence. This type of review is long overdue in the UK, considering that the governments target to reduce childhood obesity to its pre-2000 levels by the year 2020 (DoH 2007) will require local evidence of effective interventions to succeed. The next stage of this review will describe in detail the research methodology to be used to conduct the proposed systematic review. Also included will be research strategy details to be adopted, study selection criteria, data collection and analysis. AIMS AND OBJECTIVES The aim of this research is to: Systematically review school-based intervention studies in the UK aimed at reducing the risk factors of childhood obesity among school children. Objectives are: To assess the efficacy of school-based anti-obesity interventions in the UK. To identify the most effective form of school-based interventions in the prevention of childhood obesity amongst school children in the UK. CRITERIA FOR INCLUDING STUDIES IN THIS REVIEW METHODS This review was performed as a Cochrane review. The Cochrane guidance on systematic reviews and reporting format were as far as possible adhered to by the author (Green, Higgins et al. 2008). The entire review process was guided by a tool for assessing the quality of systematic reviews, alongside the accompanying guidance (health-evidence.ca 2007a; health-evidence.ca 2007b). TYPES OF STUDY In the search for the effectiveness of an intervention, well conducted randomised control trials (which are the best and most credible sources of evidence) will be the preferred source of studies for this review. However, because of the limited number of RCTs conducted on this topic so far, this study will include controlled clinical trials if there is insufficient availability of RCTs. TYPES OF PARTICIPANTS School children under 18 years of age TYPES OF INTERVENTIONS Interventions being evaluated are those that aim to: Reduce sedentary lifestyle Effect nutritional change Combine the two outcomes above Reduce obesity prevalence Effect an attitude change towards physical activity and diet Studies that present a baseline and post intervention measure of primary outcome. Interventions not included in this study are: Those with no specified weight-related outcomes Those that involved school-age children but were delivered outside of the school setting, as our focus is based on school-based interventions aimed at obesity prevention. Studies done outside the UK Studies with no specified interventions Non-RCTs or CCTs For each intervention, the control group will be school children not receiving the intervention(s). TYPES OF OUTCOMES MEASURED Primary outcomes Change in adiposity measured as BMI and/or skin fold thickness Secondary outcomes Knowledge Physical activity levels Diet SEARCH METHODS FOR IDENTIFICATION OF STUDIES Electronic searches The electronic databases OVID MEDLINE ® (1950-2009), PsycINFO (1982-2009), EMBASE (1980-2009) and the British Nursing Index (1994-2009) were all searched using the OVID SP interface. The Wiley Interscience interface was used to search the following databases: Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects. There was also a general search of internet using Google search engine, in an attempt to identify any ongoing studies or unpublished reports before proceeding to search grey literature sources. Grey literature For references to childhood obesity prevention in schools, the following grey literature sources were searched: British Library Integrated Catalogue (http://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (http://wok.mimas.ac.uk/) SCIRUS (http://www.scirus.com/) System for Information on Grey Literature (http://opensigle.inist.fr/) ZETOC (http://zetoc.mimas.ac.uk) Additionally, current control trials database at http://www.controlled-trials.com/ was searched for any ongoing research. The UK national research register was also searched at https://portal.nihr.ac.uk/Pages/NRRArchive.aspx. All the links to the grey literature databases were tested at the time of this review and found to be working. Hand searches It was not possible to conduct a hand search of journals due to pragmatic reasons. Reference lists Reference lists of retrieved studies were searched for other potential relevant studies that might have been omitted in the earlier search. Correspondence First author of all included studies were contacted with a view to seeking more references. DATA COLLECTION AND ANALYSIS Selection of studies The abstracts and titles of the hits from the electronic databases searched were screened for relevance by a single assessor. Those that were thought to be potentially relevant were retrieved and downloaded unto EndnoteTM to make the results manageable and also avoid loss of data. At the end of the search, all databases were merged into one single database and duplicated records of the same study were removed. Subsequently, the assessor then sought and obtained the full text of, and reviewed the relevant studies that were considered eligible for inclusion. Multiple reports of same study were linked together. No further data were sought for studies not included in the review. Data extraction Data extraction from included studies was done by a single reviewer and the data recorded on a data extraction form. A summary of each included study was described according to these characteristics: Participants (age, ethnicity etc.), study design, description of school-based interventions, study quality and details such as follow-ups and date, location, outcomes measured, theoretical framework, baseline comparability and results Assessment of methodological quality of included studies A number of researchers (Jackson, Waters et al. 2005) and the Cochrane guidelines for systematic reviews of health promotion and public health interventions (Rebecca Armstrong, Waters et al. 2007) strongly advise using the Quality Assessment Tool for Quantitative Studies (2008a) developed by the Effective Public Health Practice Project in Canada and the accompanying dictionary (to act as a guideline) (2008b) in assessing methodological quality. Based on criteria such as selection bias, study design, blinding, cofounders, data collection methods, withdrawals and drop-outs and intervention integrity, the tool which is designed to cover any quantitative study employs the use of a scale (strong, moderate or weak) to assess the quality of each study included in the review. Analysis Considering the small number of studies included in the review and heterogeneity in terms of interventions, delivery methods, intensity of interventions, age of participants, duration of intervention and outcomes measured, it was not statistically appropriate to undertake a Meta analysis, which admittedly would have been the preferred method of analysing and summarising the results of the studies. A narrative synthesis of the results was done instead. RESULT DESCRIPTION OF STUDIES Results of the search The search of electronic sources identified 811 citations out of which 97 potential studies were retrieved. A reference management software EndnoteTM was used to search for and remove duplicate citations. Further screening of title and abstract reduced the number of citations to 17 potential studies. Full texts of the 17 studies were sought, 13 were excluded, and four met the inclusion criteria and were therefore included in the review. Authors of the four studies were then conta Effect of School Based Obesity Interventions Effect of School Based Obesity Interventions ABSTRACT Introduction Background Obesity in both adult and children is fast becoming one of the most serious public health problems of the 21st century in developed and developing countries alike. It is estimated that approximately 10% of school age children. The prevalence of childhood overweight and obesity is ever on the increase in the UK as in the rest of the world. It is estimated that the prevalence of overweight and obesity among 2 10 year old children in the UK rose from 22.7%-27.7% and 9.9%-13.7% respectively between 1995 and 2003; these figures are set to increase unless something is done. School-based interventions offer a possible solution in halting obesity prevalence, because the school setting provides an avenue for reaching out to a high percentage of children (especially in the western world), opportunity for constant monitoring of children and the resources for anti-obesity interventions. Objectives To systematically review the evidence of the impact of school-based interventions to prevent childhood obesity on: Adiposity (primary objective) Knowledge, physical activity levels and diet (secondary objectives) Methods The review was done following the Cochrane collaboration guidelines. In addition to searching electronic databases, first authors of all included studies were contacted. A recognised critical appraisal tool was used to assess the quality of included studies. Results Three RCTs and one CCT met the inclusion criteria for the review. All four studies had a control and intervention group; with various study limitations. While none of the studies found statistically significant BMI changes in intervention groups when compared with control group post-intervention, all of them recorded either a significant change in diet, or an increase in physical activity levels. INTRODUCTION BACKGROUND Obesity is generally understood as abnormal accumulation of fat to the extent that presents health risk (Kiess, Marcus et al. 2004), and was added to the international classification of diseases for the first time in 1948 (Kipping, Jago et al. 2008). The worldwide clinical definition of adult obesity by the WHO is body mass index (BMI) ≠¥ 30kg/m2 (WHO 2006). In children however, because of the significant changes in their BMI with age (Cole, Bellizzi et al. 2000), there is no universally accepted definition of obesity (Parizkova and Hills 2004; Bessesen 2008) and it therefore varies from country-to-country. The most commonly used definition of childhood obesity is the US definition which measures overweight and obesity in a reference population using the cut off points of 85th and 95th centiles of BMI for age (Ogden, Yanovski et al. 2007). In the UK, overweight and obesity are diagnosed using a national reference data from a 1990 BMI survey of British children (Stamatakis, Prima testa et al. 2005). Children whose weights are above the 85th centile are classed as overweight and over the 95th centile are considered obese (Reilly, Wilson et al. 2002). Recent estimates suggest that obesity has reached epidemic proportions globally with about 400 million adults being clinically obese, a figure projected to rise to about 700 million by 2015 (WHO 2006). In children, the current WHO estimates are that about 22 million children globally under age 5 are overweight (WHO 2008). In the UK, evidence suggests that obesity is set to be the number one preventable cause of disease in a matter of time (Simon, Everitt et al. 2005). In the last three decades, the scale as well as the prevalence of obesity have grown rapidly amongst all age, social and ethnic groups in the UK, as well as globally (Table 1)(Kipping, Jago et al. 2008). Estimates suggest that in the UK, between 1984 and 2002/2003, the prevalence of obesity in boys aged 5-10 rose by 4.16%, and by 4.8% in girls (Stamatakis, Primatesta et al. 2005). There is therefore there is an urgent need for the development and implementation of effective intervention strategies to halt the ever increasing obesity prevalence (Summerbell Carolyn, Waters et al. 2005). OBESITY CAUSATION The primary risk factors associated with the increase in prevalence of childhood obesity are ever increasing involvement in sedentary lifestyles and an increase also in the consumption of high energy dense food and drink (Ebbeling, Pawlak et al. 2002; Sekine, Yamagami et al. 2002; Speiser, Rudolf et al. 2005; Topp, Jacks et al. 2009). The underlying mechanism of obesity formation is an imbalance between energy input and expenditure (Moran 1999; Kipping, Jago et al. 2008) Genetic and environmental factors greatly influence the bodys energy balance. Nevertheless, genetic conditions which either cause production of excessive fat in the body or reduce the rate at which it is broken down, of which Prader-Willi syndrome is an example account for less than 5% of obese individuals (Speiser, Rudolf et al. 2005), with environmental factors accounting for a very high percentage (French, Story et al. 2001). The major cause of the rising obesity problem is arguably changes in physical and social environments (French, Story et al. 2001). In recent times, there has been a remarkable shift towards activities that do not promote energy expenditure, for example, most children would travel to school in cars rather walk, in contrast to what obtained in the 1970s (Popkin, Duffey et al. 2005; Anderson and Butcher 2006). There is evidence to suggest that obese children are less active than their non-obese counterparts, hence promoting physical activity such as walking or exercising will help prevent obesity in children (Hughes, Henderson et al. 2006). Media time (television viewing, playing video games and using the computer) has been identified as one of the significant environmental changes responsible for the surge in childhood obesity. Besides promoting physical inactivity, it encourages energy input via excessive snacking and inappropriate food choices as a result of television advertisements (Ebbeling, Pawlak et al. 2002; Speiser, Rudolf et al. 2005). Robinson in his study reveals that â€Å"between ages 2 and 17, children spend an average of 3 years of their waking lifetime watching television alone† (Robinson 1998). Parents play a significant role in where, what and how much their children eat and to an extent, how physically active their children are. In most homes, children make their food choices based on the options they are presented with by their parents, and they characteristically would go for wrong option, more so if they have an obese parent (Strauss and Knight 1999). Other changes within the family such as physical inactivity and working patterns of parents have contributed somewhat to the obesity epidemic. In a family where the parents work full-time, there tends to be very little time for them to prepare wholesome home-made meals and this could possibly explain the increasing demand for eating out (Anderson and Butcher 2006) thereby increasing intake of high energy dense food. Childrens attitude to and participation in physical activities depends largely on how physically active their parents are. Thus children of sporty parents embrace exercise heartily and are therefore less prone to becoming obese.(Sallis, Prochaska et al. 2000). In addition to these family factors, societal factors such as high crime rate, access to safe sports/recreational facilities, transportation and fewer physical education programs in schools significantly impact on energy balance (Koplan, Liverman et al. 2005; Popkin, Duffey et al. 2005; Topp, Jacks et al. 2009). French summarizes the environmental influence on obesity by opining that â€Å"The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity† (French, Story et al. 2001) CONSEQUENCES OF OBESITY Evidence suggests that childhood obesity and/or overweight has a great impact on both physical and psychological health; causing effects such as behavioral problems and low self esteem, with a higher risk in girls than in boys (Reilly, Methven et al. 2003). Although most of the serious consequences do not become evident until adulthood, research has shown childhood obesity to be linked to metabolic disorders such as insulin resistance and type 2 diabetes, stroke and heart attacks, sleep apnea, nonalchoholic fatty liver disease, higher incidence of cancers, depression, dyslipidaemia, increased blood clotting tendency, etc (Ebbeling, Pawlak et al. 2002; Reilly, Methven et al. 2003; Kiess, Marcus et al. 2004; D. A. Lawlor, C. J. Riddoch et al. 2005; Daniels 2006; WHO 2006). One of the long-term serious consequences of childhood obesity is that obese children are twice more likely to grow into obese adults than their non-obese counterparts (Moran 1999); however, this largely depends on factors such as age of onset, severity of the disease and the presence of the disease in one parent (Moran 1999; Campbell, Waters et al. 2001; Kiess, Marcus et al. 2004; WHO 2006). Other long term consequences include early death and adverse socio-economic consequences such as poor educational attainment and low/no income in adulthood (Reilly, Methven et al. 2003; Fowler-Brown and Kahwati 2004; Kiess, Marcus et al. 2004). Obesity-related morbidity places a huge and growing financial demand on governments. In the UK alone, the Department of Health has reported that obesity costs the NHS and the UK economy as a whole about  £1b and between  £2.3b  £2.6b annually respectively, with the cost to the NHS projected to rise to  £3.6b by 2010 (DH 2007). TREATMENT AND PREVENTION The treatment of obesity requires a multidisciplinary approach due to the multi-faceted nature of the condition (Parizkova and Hills 2004). This is aimed at reducing caloric intake and increasing energy expenditure through physical activity (Ebbeling, Pawlak et al. 2002). These interventions are more likely to be successful if the patients family is involved and the treatment tailored to individual needs and circumstances (Fowler-Brown and Kahwati 2004). In extreme cases, options such as surgical and pharmacological treatments could be exploited. These options are very unpopular and usually not recommended because the associated health risks outweigh the benefits by far (Epstein, Myers et al. 1998; Ebbeling, Pawlak et al. 2002). Considering the huge costs and high levels of treatment failure associated with obesity treatment (Stewart, Chapple et al. 2008), the axiom by Benjamin Franklin cannot describe any other condition better than it describes obesity management. â€Å"An ounce of prevention is worth a pound of cure† Dietz et al confirm this by saying that prevention remains the best and most effective management of obesity (Dietz and Gortmaker 2001). Obesity prevention interventions are usually set either in the home or at school with an objective of eliminating peer pressure and, by so doing effect behavioral change (Ebbeling, Pawlak et al. 2002). Literature suggests that the school has so far remained the choice setting for these preventive interventions despite the very limited evidence on its effectiveness (Birch and Ventura 2009). Why is the school setting a good focus of intervention? Approximately 90% of children are enrolled in schools in developed countries (Baranowsk, Cullen et al. 2002) Children spend a substantial amount of time in school and therefore consume a considerable proportion of their daily calories at school (Katz, OConnell et al. 2005) School related activities present an opportunity to educate children on the concept of energy balance, healthy living and how to make appropriate food choices (Ebbeling, Pawlak et al. 2002; Koplan, Liverman et al. 2005) It offers opportunity for continuity and constant monitoring via frequent contact (Baranowski T 2002) Schools have an availability of existing manpower and facilities needed for anti-obesity interventions (Kropski, Keckley et al. 2008) In a nut shell, â€Å"Schools offer many other opportunities for learning and practicing healthful eating and physical activity behaviors. Coordinated changes in the curriculum, the in-school advertising environment, school health services, and after-school programs all offer the potential to advance obesity prevention† (Koplan, Liverman et al. 2005). PREVIOUS SYSTEMATIC REVIEWS Systematic reviews have been conducted on the effectiveness of school-based interventions in the prevention of childhood obesity. Campbell et al (2001), conducted a systematic review of 7 randomised control trials (RCTs) (6 were school-based, varying in length of time, target population, quality of study and intervention approach). The review found that dietary and physical education interventions have an effect on childhood obesity prevalence. However, success varied with different interventions amongst different age groups. Two of the three long term studies that focused on a combination of dietary education and physical activity, and dietary education respectively reported an effect on obesity prevalence reduction. Similarly, 1 out of the 3 school based short-term interventions that focused only on reducing sedentary activity also found an effect on obesity prevalence. While this review shows that dietary and physical activity interventions based at school are effective against th e risk factors of obesity, the question of generalisability and reproducibility arises as the review reports the majority of the included primary studies were carried out in the US. Most of the studies used BMI as a measure of adiposity, and BMI as has been documented varies across ethnic and racial groups (Rush, Goedecke et al. 2007), thus, it will be inappropriate to apply the findings of US-based obesity prevention interventions to children in middle and low income countries where conditions are different. There are also concerns about the methodology and study design. For example the school-based study by Gotmaker et al (1999) had limitations such as low participation rate (65%) and the researchers were unable to adjust for maturity in boys and there was also poor assessment of dietary intake. All these limitations could have been responsible for a high percentage of the reported intervention effect thus affecting the validity of the results of the study (Gortmaker, Peterson et al. 1999). The authors of the review however concluded that there is currently very limited high quality evidence on which to draw conclusions on the effectiveness of anti-obesity programmes. A Cochrane review which is an update of the Campbell et al (2001) study by Summerbell et al (2005) has examined the impact of diet, physical activity and/or lifestyle and social support on childhood obesity prevention. Their review examined the effectiveness of childhood obesity prevention interventions which included school based interventions. Their study included 10 long-term (a minimum duration of 12 months) and 12 short-term (12weeks 12 months) clinical trials (randomised and controlled). 19 out of the 22 studies that met their inclusion criteria were school/pre-school based. The study chose the appropriate study type; more than one reviewer was involved in the entire process of data collection, extraction and selection of included studies. In general, the study found that most of the school-based interventions (dietary and/or physical activity) reported some positive changes in targeted behaviours, but however had very little or no statistically significant impact on BMI. The reviewers stated that none of the 22 studies fulfilled the quality criteria because of some form of methodological weakness which includes measurement errors. For instance, the study by Jenner et al (1989) had no valid method of measuring food intake. The studies by Crawford et al (1994), Lannotti et al (1994) and Sallis et al (2000) had similar measurement errors. Reporting error was identified in studies by Little et al (1999) and Macdiarmid et al (1998). There were also reliability concerns about the secondary outcomes measurement in some of the included studies. The reviewers therefore expressed the need for further high quality research on effectiveness. Kropski et al (2008) reviewed 14 school-based studies that were designed to effect a life style change, a change in BMI, decrease overweight prevalence through a change in nutrition, physical activity or a combination of both. Of the 14 studies, three were done in the UK, one in Germany and 10 in the US. The right type of studies were chosen for this review and the whole process was done by more than one reviewer, however they were unable to draw strong conclusions on the efficacy of school-based interventions because of the limited number of primary studies available and methodological or design concerns which include: small sample size (Luepker, Perry et al. 1996; Mo-suwan, Pongprapai et al. 1998; Nader, Stone et al. 1999; Warren, Henry et al. 2003), no intention-to treat analysis (Danielzik, Pust et al.; Sallis, McKenzie et al. 1993; Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003), possibility of type I (Coleman, Tiller et al. 2005) and type II errors (Warren, Henry et al. 2003), unit of analysis errors (Sallis, McKenzie et al. 1993) and inconsistent results (Mo-suwan, Pongprapai et al. 1998; Caballero, Clay et al. 2003; Coleman, Tiller et al. 2005). Despite their inability to draw a conclusion on effectiveness, overall, the review found that a combination of nutritional and physical activity interventions had the most effect on BMI and prevalence of overweight, with the result largely varying from community-to-community. The nutrition only and physical activity only interventions appeared to have had a change on lifestyles of participants but either had no significant effect on the measures of overweight or no BMI outcomes were measured. Another systematic review on the effectiveness of school-based interventions among Chinese school children was carried out by M.Li et al (2008). The authors included 22 primary studies in their review. The review reported that the primary studies showed that there are some beneficial effects of school-based interventions for obesity prevention; the reviewers however expressed their concerns that most of the studies included in the review had what they considered to be serious to moderate methodological weaknesses. Sixteen of the 22 studies included studies were cluster control trials, and there was no mention by any of the researchers that cluster analysis was applied to any of the 16 studies. In addition to lack of cluster analysis, no process evaluation was conducted in any of the studies. Only one study performed an intention to treat analysis. Twelve studies experienced dropouts, but there was incomplete information on the study population at the end of the trial and the reason f or the dropouts. Additionally, none of the studies explained the theory upon which they based their intervention. There was also potential recruitment and selection bias in all the primary studies as identified by the reviewers. They stated that none of the studies reported the number of subjects that were approached for recruitment into the study. As none of the RCTs included described the method they used in randomization, neither did they state if the studies were blinded or not. The methodological flaws in a high percentage of the included primary studies could impact on the validity of the findings of the review. Again, the authors failed to reach a conclusion on the effectiveness of the interventions because of the intrinsic weaknesses found in the primary studies, and as a result state the need for more primary studies that would address the methodological weaknesses that is highly present in nearly all existing primary studies conducted on this topic so far. The study of the efficacy of school-based interventions aimed at preventing childhood obesity or reducing the risk factors is a rather complex one. Pertinent issues on effectiveness of school-based interventions to prevent the risk factors of obesity remain that there is very limited/weak evidence on which to base policies on. Heterogeneity of primary research (in terms if age of study population, duration of intervention, measurement of outcomes and outcomes measured) makes further statistical analysis nearly impossible. BMI is currently the most widely used measure of overweight and obesity in children. However, BMI has no way of distinguishing between fat mass and muscle mass in the body and might therefore misdiagnose children with bigger muscles as obese. Another disadvantage of using BMI in overweight measurement is its inability of depicting the body fat composition (Committee on Nutrition 2003), other surrogate indicators of adiposity may be needed. Most authors that have carried out a review on this topic so far have expressed the need for further research on this topic to add to the existing body of evidence. RATIONALE FOR THIS STUDY All the systematic reviews on this subject so far have focused mainly on the United States. Lifestyle differences such as eating habits between American and British children possibly affect generalisability and reproducibility of US findings to the UK. For example, in the US, research has shown that 0.5% of all television advertisements promote food, and that about 72% of these food advertisements promote unhealthy food such as candy and fast food (Darwin 2009). In the UK paradoxically, the government in 2007 enforced regulations banning television advertisement of unhealthy foods (foods with high fat, salt, and sugar content) during television programmes aimed at children below 16 years of age (Darwin 2009). Thus US children are at a higher risk of becoming obese than their UK counterparts as a result of higher rate of exposure to TV junk food advertisements. Another lifestyle difference between American and British children is physical activity. In the UK, a high percentage of children aged 2 to 15 achieve at least 60 minutes of physical activity daily (about 70% of males and 60% of females) (DoH 2004), as opposed to the US where only about 34% of school pupils achieve the daily recommended levels of physical activity daily (CDC 2008). These differences highlight the importance of public health policies being based on the local population characteristics rather than on imported overseas figures. There is therefore need to review the evidence of UK school-based obesity interventions to inform policy relevant to the UK population. To the best of my knowledge following an extensive literature search, no systematic review has been conducted on the effectiveness of school-based intervention in preventing childhood obesity in the UK, despite the high prevalence of the condition and its public health significance in this country. This research aims to bridge this gap in knowledge by focusing on UK based studies to evaluate the efficacy of school-based interventions in the UK population. This study therefore stands out insofar as it will be assessing the effectiveness of school-based interventions in the reducing the risk factors of obesity in the UK, with a hope of providing specific local recommendations based on UK evidence. This type of review is long overdue in the UK, considering that the governments target to reduce childhood obesity to its pre-2000 levels by the year 2020 (DoH 2007) will require local evidence of effective interventions to succeed. The next stage of this review will describe in detail the research methodology to be used to conduct the proposed systematic review. Also included will be research strategy details to be adopted, study selection criteria, data collection and analysis. AIMS AND OBJECTIVES The aim of this research is to: Systematically review school-based intervention studies in the UK aimed at reducing the risk factors of childhood obesity among school children. Objectives are: To assess the efficacy of school-based anti-obesity interventions in the UK. To identify the most effective form of school-based interventions in the prevention of childhood obesity amongst school children in the UK. CRITERIA FOR INCLUDING STUDIES IN THIS REVIEW METHODS This review was performed as a Cochrane review. The Cochrane guidance on systematic reviews and reporting format were as far as possible adhered to by the author (Green, Higgins et al. 2008). The entire review process was guided by a tool for assessing the quality of systematic reviews, alongside the accompanying guidance (health-evidence.ca 2007a; health-evidence.ca 2007b). TYPES OF STUDY In the search for the effectiveness of an intervention, well conducted randomised control trials (which are the best and most credible sources of evidence) will be the preferred source of studies for this review. However, because of the limited number of RCTs conducted on this topic so far, this study will include controlled clinical trials if there is insufficient availability of RCTs. TYPES OF PARTICIPANTS School children under 18 years of age TYPES OF INTERVENTIONS Interventions being evaluated are those that aim to: Reduce sedentary lifestyle Effect nutritional change Combine the two outcomes above Reduce obesity prevalence Effect an attitude change towards physical activity and diet Studies that present a baseline and post intervention measure of primary outcome. Interventions not included in this study are: Those with no specified weight-related outcomes Those that involved school-age children but were delivered outside of the school setting, as our focus is based on school-based interventions aimed at obesity prevention. Studies done outside the UK Studies with no specified interventions Non-RCTs or CCTs For each intervention, the control group will be school children not receiving the intervention(s). TYPES OF OUTCOMES MEASURED Primary outcomes Change in adiposity measured as BMI and/or skin fold thickness Secondary outcomes Knowledge Physical activity levels Diet SEARCH METHODS FOR IDENTIFICATION OF STUDIES Electronic searches The electronic databases OVID MEDLINE ® (1950-2009), PsycINFO (1982-2009), EMBASE (1980-2009) and the British Nursing Index (1994-2009) were all searched using the OVID SP interface. The Wiley Interscience interface was used to search the following databases: Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects. There was also a general search of internet using Google search engine, in an attempt to identify any ongoing studies or unpublished reports before proceeding to search grey literature sources. Grey literature For references to childhood obesity prevention in schools, the following grey literature sources were searched: British Library Integrated Catalogue (http://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (http://wok.mimas.ac.uk/) SCIRUS (http://www.scirus.com/) System for Information on Grey Literature (http://opensigle.inist.fr/) ZETOC (http://zetoc.mimas.ac.uk) Additionally, current control trials database at http://www.controlled-trials.com/ was searched for any ongoing research. The UK national research register was also searched at https://portal.nihr.ac.uk/Pages/NRRArchive.aspx. All the links to the grey literature databases were tested at the time of this review and found to be working. Hand searches It was not possible to conduct a hand search of journals due to pragmatic reasons. Reference lists Reference lists of retrieved studies were searched for other potential relevant studies that might have been omitted in the earlier search. Correspondence First author of all included studies were contacted with a view to seeking more references. DATA COLLECTION AND ANALYSIS Selection of studies The abstracts and titles of the hits from the electronic databases searched were screened for relevance by a single assessor. Those that were thought to be potentially relevant were retrieved and downloaded unto EndnoteTM to make the results manageable and also avoid loss of data. At the end of the search, all databases were merged into one single database and duplicated records of the same study were removed. Subsequently, the assessor then sought and obtained the full text of, and reviewed the relevant studies that were considered eligible for inclusion. Multiple reports of same study were linked together. No further data were sought for studies not included in the review. Data extraction Data extraction from included studies was done by a single reviewer and the data recorded on a data extraction form. A summary of each included study was described according to these characteristics: Participants (age, ethnicity etc.), study design, description of school-based interventions, study quality and details such as follow-ups and date, location, outcomes measured, theoretical framework, baseline comparability and results Assessment of methodological quality of included studies A number of researchers (Jackson, Waters et al. 2005) and the Cochrane guidelines for systematic reviews of health promotion and public health interventions (Rebecca Armstrong, Waters et al. 2007) strongly advise using the Quality Assessment Tool for Quantitative Studies (2008a) developed by the Effective Public Health Practice Project in Canada and the accompanying dictionary (to act as a guideline) (2008b) in assessing methodological quality. Based on criteria such as selection bias, study design, blinding, cofounders, data collection methods, withdrawals and drop-outs and intervention integrity, the tool which is designed to cover any quantitative study employs the use of a scale (strong, moderate or weak) to assess the quality of each study included in the review. Analysis Considering the small number of studies included in the review and heterogeneity in terms of interventions, delivery methods, intensity of interventions, age of participants, duration of intervention and outcomes measured, it was not statistically appropriate to undertake a Meta analysis, which admittedly would have been the preferred method of analysing and summarising the results of the studies. A narrative synthesis of the results was done instead. RESULT DESCRIPTION OF STUDIES Results of the search The search of electronic sources identified 811 citations out of which 97 potential studies were retrieved. A reference management software EndnoteTM was used to search for and remove duplicate citations. Further screening of title and abstract reduced the number of citations to 17 potential studies. Full texts of the 17 studies were sought, 13 were excluded, and four met the inclusion criteria and were therefore included in the review. Authors of the four studies were then conta

Sociological Perspectives Institution Of The Family

Sociological Perspectives Institution Of The Family Society is the subject of the social sciences. Generally Speaking society is that complex social organization of human beings that share an identity inhabiting dynamic relationships and a distinctive culture. Members of a society identify themselves through that society and work together with other members to ensure that the rules generally agreed upon by all members to govern how they relate to each other are in place. Sociological perspectives are viewpoints from which we study and understand society and its varied mechanics and elements. There are varied sociological perspectives available to social scientists for the purpose of study. What sociological perspective is used depends on the theories and purposes of the one undertaking the study. Functionalism, Conflict theory, and Social Interactionism are sociological perspectives that I believe can be used to study the social unit of the family. Functionalism looks at the family as if it was one mechanical entity with every member of the family taking on a role and a function affecting the whole. For example, the mother is the nurturer, support to the husband in terms of keeping the family together taking on household duties as well as economic duties; the father, traditionally is head of the family whose primary function is to provide for the economic and financial needs of his wife and children; the children are dependent on their parents but take on an important role towards each other and to their parents. What these roles are vary according to the age of the children and their stage in life. In the elder years of their parents, the children are expected to become the nurturer and provider for their parents, a role reversal of sorts. Since a functionalist perspectives focuses on roles/functions, when a family is in a state of conflict, the dynamics of family function can be looked at to pinpoint the areas of issue/tension for the purpose of finding solutions. Now, from a functionalist perspective, how can a member of a family view self and society? First off, the self-view will be rooted in function and expectations. The father for example will view himself as one who must provide for and protect his family based on standard expectations of what fathers do and what fatherhood means in the society he belongs to. He will view society as one of function and structure as well where his family makes up a unit integral to the functioning social groups he/his family belongs. Roles then will become part of the expected mental images a functionalist perspective gives in terms of viewing family and society. Thus, the roles of mother, father, daughter, son, aunt, uncle, grandparents, cousins all these are based on social and cultural standards. This extend s out to expected roles functions of key individuals in society as well as social groups (i.e. Priest, teachers, politicians, employers, church, government, businesses, etc.). In terms of social change, if change is systemic, it will be based on or will have to be rooted in the need to overhaul or effect a particular function for the purpose of adapting to or surviving challenges, conflicts or trends. Take for example the trend of and the established need to adapt to new communication technologies (3G phones, mobile internet). Once families used to not need such technologies to keep track of and keep in touch with family members to nurture relationships and fulfil obligations. Now though, parents and children have adapted digital technology in their lives to harness the function of connectivity and communication providing new avenues for family connectedness. On Symbolic Interactionism Symbolic interactionism as a perspective on the other hand looks at the micro relationships between family members looking at their everyday life and the relationship all members have with each other. It seeks to find out the finer details of social relationships in order to understand why they work/dont work. It seeks to see whether families attach certain meanings to social stereotypes in relation to their expectations from each other. At the same time it also seeks to understand how each other come to mean in the lives, choices and interpretations of each member. It seeks to establish the strength and frailty of familial relationships by providing details. It is different from functionalism in that it focuses on quality meaning of relationships instead of function alone. While functionalism sees the family as an organic entity that follows a unique structure according to role designation within the family-group, symbolic interactionism gives more weight to the function of relat ionships in the family structure. For example, the importance of family bonds can be measured in the way family members act towards each other. For Herbert Blumer (1986), the originator of the theory, familial relationships are best understood via the discourses and interactions of family members in their relationships towards each other for meaning is created via this, relationships built, conflicts resolved, positions taken. In other words, this sociological perspective is a discursive microscope that can create a genealogy of family relations and provide a picture of shared beliefs and unique family behaviour that contribute (or due to lack of prohibits from creating) towards a shared family culture and identity. What does this mean for members of a family? It is in discourse that meaning is created. Cultures and traditions of families are built over interaction and shared histories. Without interaction, meaning and relationships cannot be built. For individual members of the fam ily then, family is viewed as a dynamic and continual interaction with each other that allow for meanings and symbolisms to be invested and shared by those who interact. For example, a father can only be a father if he interacts with his children to fulfil his own expectations of himself as a father to his children and if the children respond to him in such a way that the interaction establishes a communication exchange, a discourse where father and children find meaning in each other. Therefore while the father works to provide for his children, without interaction, this relationship is not socially established in meaning making familial relations between father and children non-existent. Society from this perspective is seen as a massive social structure where truth and structures are established based on discourse; without interaction, without discourse, there is no progress especially in terms of shared cultural practices. A family vested in social interaction sees active relati onships as essential in establishing bonds and social change, at least within the family will only happen via discourse. For example, a status qou must be arrived at via discourse in which members of the family have come to agree or view a particular position or necessary action similarly to warrant collective shift in approaches or performance of a particular action. The Conflict Theory Conflict theory, a perspective rooted in the ideas of Emile Durkheim (social conflict crime) Karl Marx (dialectical materialism/Marxism) looks into differentials of power how power, influence and authority influences the distribution of access to resources, for example, in a particular social group. Hence, it is a good perspective in the study of criminology for it can be used to pinpoint the source/forces behind criminality due to access/lack of access to power economic resources. As a perspective in understanding the social unit of the family however, conflict theory can be used to understand the power relations in the family the hierarchy of family authority and control. Thus the use of conflict theory in the study of the family unit can be said to focus on the negative aspects of family structure and relations; at the same time however such a focus can it also bring out the relations of gender, of power and of control. Eventually, it is easy enough to identify who controls w hat and which in the family in order to assign responsibility and correct social and relationship conflict. Conflict theory is a tool used in identifying family issues in order to find ways to fix them. For instance, if a teen is having issues with his/her parents, conflict theory can be used to analyze and pinpoint the source of friction in order to ascertain remedies in fixing parent and child relations. In the case of extended families that are so typical in parts of Asia (i.e. Thailand, the Philippines, Cambodia, Vietnam) wherein extended families allow economic and social support for members of the clan that cannot otherwise support themselves, their children and their needs, conflict theory is perfect in unravelling the relations of power and control including identifying factions, matriarchy patriarchy patterns and areas of resolution (especially if the conflict theory is taken on to resolve a familial issue). Members of a family using the conflict theory can be viewed as so cial agents differentiated by their access to power and resources. Hence, they are essentially competing with each other. A family member can look into ones position in the family to assess his or her access to influence, power and resources to determine his/her position in the family. If parents, for example are fair, and if the mother and the father see each other as equals then in the decisions that they make, this is reflected. But if this is not the case, if the father has more say in family matters including economic issues, then there is a differential between husband and wife in terms of familial authority. If all children in the family are treated the same and given similar opportunities, then one can say that access to resources and authority is fair; but if one is treated better than the other then there is definitely a differential in terms of access to power and resources between children. Members of families who view their primary grouping as one of competition for res ources (i.e. one of conflict) sees society as a bigger representation of their own issues to resources and authority within their families. They will view society as an intensely competitive social arena where to survive; one must be adept in working towards more power and access to resources via structures like schools, government and civilian organizations (businesses, NGOs, private firms). Social change is inevitable for status qou will change dependent on the sway of power at any given time. From this perspective, society is continually changing and power changes hands regularly due to competition. Word Count:1,729