Evaluation of the prevalence of musculoskeletal symptoms, presumptive diagnosis, medical care use, and sick leave among female school meal service workers

BACKGROUND: Most of the school meal service workers in Korea are middle-aged individuals. They have high workload, which increases their incidence of musculoskeletal disorders. This study aimed to evaluate the prevalence and risk factors of subjective musculoskeletal symptoms, presumptive diagnosis, medical care use, and sick leave among female school meal workers. METHODS: We analyzed the results of musculoskeletal disease screening of 1581 female school meal workers. The screening consisted of self-administered questionnaire, history taking by occupational physicians, and physical examination. The prevalence of subjective musculoskeletal symptoms, presumptive diagnosis after initial examination by occupational physicians, use of medical care for more than 7 days, and sick leave due to musculoskeletal diseases during the past year were evaluated in this study. The relative risk of four outcome indicators of musculoskeletal disorders was compared with respect to potential factors, such as age, subjective physical loading, present illness, injury experience, and type of school, using log-binomial regression. RESULTS: The prevalence of subjective musculoskeletal symptom was 79.6%; presumptive diagnosis, 47.6%; hospital visits over 7 days, 36.4%; and sick leave, 7.3%. The relative risk of musculoskeletal symptoms by age (≥50 years vs < 50 years) was 1.04 (95% confidence interval (CI): 1.00–1.09); presumptive diagnosis of musculoskeletal disease, 1.17 (95% CI: 1.06–1.30); hospital visits over 7 days, 1.26 (95% CI: 0.85–1.85); and sick leave, 1.17 (95% CI: 1.02–1.34). The relative risk of musculoskeletal symptoms due to subjective physical loading (very hard vs low) was 1.45 (95% CI: 1.33–1.58); presumptive diagnosis, 2.92 (95% CI: 2.25); hospital visits over 7 days, 1.91 (95% CI: 1.02–3.59); and sick leave, 2.11 (95% CI: 1.63–2.74). CONCLUSIONS: Subjective physical loading was a more important factor in musculoskeletal disorders than the age of female school meal workers.

Analysis of Nutrition Teachers' Awareness of Necessity for an Operating School Meal Support Center in Chungnam / 대한지역사회영양학회지

OBJECTIVES: We investigated the operation needs of school meal support centers (SMSC) in Chungnam-do based on analysis of nutrition teachers' perception of them. METHODS: The Chungnam government established the first SMSC in 2012. Thirteen SMSCs are currently being operated in Chungnam-do. To analyze the results quantitatively, we investigated nutrition teachers opinions regarding the necessity for SMSCs as a dependent variable and derived the independent variables based on the causal relationships with dependent variables using the ordered logit model. Those independent variables included region, school type, number of students, attitude regarding free meal policy, satisfaction with school meal policy, and preference for local food. RESULTS: Briefly, teachers in the region in which the SMSC was located more strongly supported the SMSC. In addition, teachers in public schools with a smaller number of students believed that having a SMSC is more beneficial, and that other variables also affected the necessity for SMSCs. Moreover, nutrition teachers preferred local foods rather than organic foods because of the unstable supply of organic foods. CONCLUSIONS: Based on the results of this study, it was recommended that the local government implement the policy consistently. Moreover, it was recommended that the government operate the SMSC more efficiently, enhance the roles of the SMSC as the local organization responsible for student nutritional planing and expand the coverage of agricultural products.

Analysis of Nutrition Teachers' Awareness of Necessity for an Operating School Meal Support Center in Chungnam / 대한지역사회영양학회지

OBJECTIVES: We investigated the operation needs of school meal support centers (SMSC) in Chungnam-do based on analysis of nutrition teachers' perception of them. METHODS: The Chungnam government established the first SMSC in 2012. Thirteen SMSCs are currently being operated in Chungnam-do. To analyze the results quantitatively, we investigated nutrition teachers opinions regarding the necessity for SMSCs as a dependent variable and derived the independent variables based on the causal relationships with dependent variables using the ordered logit model. Those independent variables included region, school type, number of students, attitude regarding free meal policy, satisfaction with school meal policy, and preference for local food. RESULTS: Briefly, teachers in the region in which the SMSC was located more strongly supported the SMSC. In addition, teachers in public schools with a smaller number of students believed that having a SMSC is more beneficial, and that other variables also affected the necessity for SMSCs. Moreover, nutrition teachers preferred local foods rather than organic foods because of the unstable supply of organic foods. CONCLUSIONS: Based on the results of this study, it was recommended that the local government implement the policy consistently. Moreover, it was recommended that the government operate the SMSC more efficiently, enhance the roles of the SMSC as the local organization responsible for student nutritional planing and expand the coverage of agricultural products.

Perceptions of Food Allergen Labeling in School Meal Service among Middle School Girls in Incheon

The purpose of this study was to suggest strategies for effective food allergen labeling in order to prevent food allergies in school meal service. Food allergy experience, eating behavior, and perceptions of food allergen labeling in school meal service were surveyed and compared according to the food allergy experiences of middle school girls in Incheon. Seventy-eight students (17% of total subjects) experienced food allergies. For eating behaviors, students with food allergy experience had significantly higher scores for using nutritional knowledge in their life than inexperienced subjects. For the perception of food allergen labeling in school meal service, girls who had experienced food allergies more often checked labeling of school meals for allergenic foods than those who had no experience of food allergies (P < 0.001). The most desirable method for displaying allergenic foods was an indication of the allergenic food name among students who had experienced food allergies and allergenic food number of the current method for students who had not experienced food allergies (P < 0.001). Students who had not experienced food allergies showed significantly lower interest in food allergen labeling than subjects who had experienced food allergies (P < 0.001). For the importance score of information items in nutrition labeling, allergenic food score was significantly higher in students who had experienced food allergies (3.9 vs. 3.4 points, P < 0.001). These results indicate that students who have experienced food allergies are more interested in food allergen labeling of school meals and that they are more aware. Efforts to improve labeling method such as directly labeling allergenic food name and a more visible indication are required for efficient utilization of food allergen labeling in school meal service.

Effects of students' satisfaction with school meal programs on school happiness in South Korea

BACKGROUND/OBJECTIVES: School meals are not just meals consumed at school, they are part of the culture, education, and life experience at school. Nevertheless, few studies have revealed the influence of school meals on students' school lives. The purpose of this study was to investigate the effect of satisfaction with the school meal program on students' school happiness. SUBJECTS/METHODS: A survey conducted in December 2015 asked 2,336 students (1,062 elementary school students, 880 middle school students, and 394 high school students) about their satisfaction with the school meal program and their school happiness. Multiple regression analyses were used to examine the relation between the students' school meal satisfaction and their happiness level. RESULTS: The average level of satisfaction with school meals of elementary school students was 4.1 out of 5 points, comparatively higher than that of middle and high school students, with a significant difference between school levels (P < 0.001). In addition, school happiness, as well as overall happiness, of elementary school students was higher than that of middle and high school students (P < 0.001). The school meal operation factor (0.232, P < 0.001) had the most influence on students' school happiness, followed by the school meal environment factor (0.219, P < 0.001) and school meal quality factor (0.136, P < 0.001). Overall satisfaction (0.097, P = 0.001) and school meal hygiene factor (0.095, P = 0.001) also had significant influences on students' school happiness. CONCLUSIONS: Students' satisfaction with the school meal program was related to their school happiness. Therefore, plans to enhance students' satisfaction with a school meal program needs to be implemented, with emphasis on placing a priority on school meal operation and school environment factors, in order to improve students' level of happiness.

Evaluation of educational school meal programs in Gyeonggi province, South Korea / 한국영양학회지

PURPOSE: School meal programs should be part of the educational process to promote good eating habits for students. The purpose of this study was to develop an evaluation scale for educational school meal programs and evaluate the achievement level of educational school meal programs using the developed scale. METHODS: The evaluation scale for educational school meal programs consisted of 23 items in eight categories and was developed using content validity ratio (CVR) analysis and analytic hierarchy process (AHP) by 15 related experts. The results of a survey on nutrition teachers or dietitians at 91 elementary, middle, and high schools in Gyeonggi province, South Korea were analyzed to evaluate the achievement levels of educational school meal programs. RESULTS: Overall, total average score was 45.7 out of 100, with significant differences among schools (p = 0.005). Elementary schools (51.9) showed a higher average score than middle (41.5) and high schools (37.1). The score for the category of regular nutrition and dietary education was the lowest (5.7 out of 33.7). In addition, school meal environment (5 out of 10), educational activities through school meal time (9.2 out of 19), and extra-curricular experiential activities (3.5 out of 10) also showed inadequate levels. CONCLUSION: The results show that the overall level of educational school meal programs is not adequate and needs to be improved, especially at middle and high schools. Government support polices need to be implemented to encourage educational activities related to school meal programs.

Análisis de la calidad de los menús del Programa de Alimentación Escolar Nacional en una ciudad de Río de Janeiro - Brasil / Quality analysis of menus of the National School Feeding Program in a city of Rio de Janeiro State - Brazil

The aim of this study was to perform a qualitative analysis of menus planned and executed in a public school of the State of Rio de Janeiro (Brazil). During 1 month school menus were evaluated according to the Qualitative Evaluation of Menus Preparation method by using variables related to food and lunch preparation. Data in relation to the total number of days of menus were evaluated. Planned and executed menus showed, respectively 20% and 26.7% of presence of salad, 100% and 80% of inclusion of fruits and 0% and 26,7% of presence of sweets, respectively. Regarding the garnish, planned menus presented 50% of preparations with vegetables; however, on executed menus, this percentage was 26.7%. The main differences between menus were unscheduled changes that can negatively contribute to the quality of school meals. Reformulations in the planning of menus and more control in their implementation are suggested as measures to promote healthy eating habits in the school environment.

El objetivo de este estudio fue realizar un análisis cualitativo de los menús planeados y ejecutados en una escuela pública del Estado de Río de Janeiro (Brasil). Durante 1 mes los menús escolares fueron evaluados de acuerdo al método de evaluación cualitativa de la preparación de menús utilizando variables relacionadas con los alimentos y preparaciones de comidas. Se evaluaron los datos en relación con el número total de días de los menús. Los menús planeados y ejecutados mostraron, respectivamente, 20% y 26,7% de presencia de ensalada, 100% y 80% de inclusión de frutas y 0% y 26,7% de presencia de dulces. En relación con las guarniciones, los menús planeados presentaron 50% de los preparados con verduras; sin embargo, en los menús ejecutados, este porcentaje fue 26,7%. Las principales diferencias entre los menús fueron los cambios no programados que pueden contribuir negativamente a la calidad de las comidas escolares. Las reformulaciones en la planificación de menús y un mayor control en su aplicación se proponen como medidas para promover hábitos alimenticios saludables en el ámbito escolar.

Perception on food allergy labelling and management of nutritional education among higher grade elementary school students in Jeju area / 한국영양학회지

PURPOSE: This study was conducted to examine the prevalence of food allergy, food allergy knowledge, and perception on food allergen labelling along with management of substitute meals in school foodservice in elementary school students in Jeju, South Korea. METHODS: Six elementary schools in Jeju-si were randomly selected, and the higher grade elementary school students (n=1,500), from fourth graders to sixth graders, were surveyed using a questionnaire in July 2014. A total of 1,000 responses were used for data analysis. RESULTS: The percentage of students who had experienced food allergy was 16.7%; 26.4% had been diagnosed as having a food allergy by doctors. Milk, crabs, and shrimps were the most frequent allergenic foods with common symptoms including urticaria followed by itching, and vomiting. As the student's grade went up, the knowledge scores on food allergy showed a significant increase. Although students with and without food allergy experience had a similar level of knowledge on food allergy and perception on food allergen labelling, students with food allergy experience had a significantly lower level of healthy dietary practices. Last, only 20.4% of students with food allergies were offered substitute meals by school foodservices, and 30.8% of students received food allergy education. CONCLUSION: For prevention and management of food allergies in school foodservice, schools should provide an individualized substitute meal plan and food allergy education to students, parents, and teachers.

Risk Perception of Food Safety by School Food-handlers.

An exploratory descriptive study was conducted with a qualitative approach that used focus groups. The objective of this study was to identify the risk perception of food safety by school food-handlers. The results indicated that the food production process has certain inadequacies, including the weak risk perception by the food-handlers regarding the student’s health. The students, the pedagogical team, and the principal contribute to this behaviour, which can affect the quality of the final product—the served meal. The social devaluation of the food-handlers is also discussed. It is necessary to improve the food-handlers’ training sessions, with the purpose of modifying risk perception and to allow the school community to be involved in healthy and safe feeding practices.

Salt content of school meals and comparison of perception related to sodium intake in elementary, middle, and high schools

Excessive sodium intake leading to hypertension, stroke, and stomach cancer is mainly caused by excess use of salt in cooking. This study was performed to estimate the salt content in school meals and to compare differences in perceptions related to sodium intake between students and staffs working for school meal service. We collected 382 dishes for food from 24 schools (9 elementary, 7 middle, 8 high schools) in Gyeonggi-do and salt content was calculated from salinity and weight of individual food. The average salt content from elementary, middle, and high school meals were 2.44 g, 3.96 g, and 5.87 g, respectively. The amount of salt provided from the school lunch alone was over 80% of the recommended daily salt intake by WHO. Noodles, stews, sauces, and soups were major sources of salt intake at dish group level, while the most salty dishes were sauces, kimchies, and stir-fried foods. Dietary knowledge and attitude related to sodium intake and consumption frequency of the salty dishes were surveyed with questionnaire in 798 students and 256 staffs working for school meal service. Compared with the staffs, the students perceived school meals salty and the proportions of students who thought school meals were salty increased with going up from elementary to high schools (P < 0.001). Among the students, middle and high school students showed significant propensity for the preference to one-dish meal, processed foods, eating much broth and dipping sauce or seasoning compared with the elementary students, although they had higher nutrition knowledge scores. These results proposed that monitoring salt content of school meals and consideration on the contents and education methods in school are needed to lower sodium intake.

O nutricionista no programa de alimentação escolar: avaliação de uma experiência de formação a partir de grupos focais / The dietician in the school food program: evaluation of a training experience based on focus groups

OBJETIVO: O estudo objetivou analisar os resultados relativos à avaliação de um Programa de Formação para Nutricionistas que atuam no Programa Nacional de Alimentação Escolar da região Nordeste. Este programa foi desenvolvido pelo Centro Colaborador em Alimentação e Nutrição do Escolar da Universidade Federal da Bahia em parceria com o Fundo Nacional de Desenvolvimento da Educação, nos idos de 2007 e 2008. MÉTODOS: Os dados foram produzidos através da técnica de grupos focais com nutricionistas que participaram do Programa de Formação. Foram realizados quatro grupos focais e os dados produzidos foram organizados em duas categorias de análise: sobre a aprendizagem durante a formação e sobre a capacidade de instituição de mudanças. RESULTADOS: Os participantes eram predominantemente do sexo feminino, com idade variando entre 20 e 35 anos e haviam participado do Programa de Formação pelo menos três meses antes do estudo. Em relação à avaliação do programa de formação, pôde-se afirmar que o mesmo não apenas proporcionou um aprimoramento técnico-científico em torno dos temas pertinentes à prática profissional exigida, mas também à dimensão ético-política do trabalho. Enfatizou-se que estimulou a mobilização na perspectiva do fortalecimento da categoria, incentivou as parcerias entre os diferentes agentes e setores e fomentou o planejamento de novas ações valorizando o uso da legislação. CONCLUSÃO: A perspectiva dialógica foi marcante para os participantes, que puderam confrontar as suas realidades com as dos demais, possibilitando reflexão coletiva sobre a atuação do nutricionista no campo da alimentação escolar.

OBJECTIVE: This study assessed a training program for dieticians, actors of the Brazilian School Food Program, in Northeast Brazil. This program was developed by a partnership between the Schoolchildren's Food and Nutrition Collaborator Center from the Federal University of Bahia and National Education Development Fund, from 2007 and 2008. METHODS: The focus group method was administered to dieticians who participated in the training program. Four focus groups were done and the data were organized into two categories: one about learning during the training program and one about the ability to make changes. RESULTS: Most participants were females aged 20 to 35 years. Their participation in the training program had been at least three months before the study. Assessment of the training program showed that the program improved their technical and scientific knowledge about themes related to professional practice and about the ethical and political dimension of their work. The program encouraged mobilization for possibly strengthening the category, incentivized partnerships among different agents and sectors and promoted the planning of new law-enforcement actions. CONCLUSION: The dialogical perspective was striking for the participants, enabling them to confront their realities and collectively reflect on the dietician's role in the field of school food.

School Dietitians' Satisfaction with and Needs for School Meal Service Support Centers / 대한지역사회영양학회지

The purpose of this study was to investigate school dietitians' satisfaction with and needs for School Meal Service Support Centers. A web-based on-line survey was conducted with 1,102 nutrition teachers or school dietitians using four School Meal Service Support Centers during the summer of 2011. The data from 578 respondents (52.5%), consisting of 165 (44.4%), 334 (53.4%), 41 (67.2%), and 38 (86.4%) dietitians using Seoul, Gyeonggi, Suncheon and Gyeongju centers, respectively, were analyzed. The main reason for using the centers was subsidies from local governments. The dietitians using the metropolitan centers, which were Seoul and Gyeonggi centers, tended to buy agricultural products through the centers only, and those using local centers, which were Suncehon and Gyeongju centers, bought those products from the private suppliers as well as from the centers. The dietitians' overall level of satisfaction with the centers was not high showing 3.3 out of 5 points; it was significantly associated with the operating system and services of the centers such as system efficiency, delivery accuracy, communication, and information provision rather than the agricultural products provided by the centers. The dietitians preferred joint operation of the centers by local governments and producers' groups. They wanted School Meal Service Support Centers to be evaluated every year. It was suggested that efforts should be made to improve the operation system and service of School Meal Service Support Centers for improving dietitians' satisfaction with the centers. In addition, an evaluation system for School Meal Service Support Centers should be implemented soon based on school dietitians' needs.

Actual Status of School Dietitians' Recognition and Use of Superior Agricultural Products in Daegu / 대한지역사회영양학회지

The purpose of this study was to investigate the perception of the school dietitian on superior agricultural products (SAP) and the status of using superior agricultural products in school meals. Questionnaires were distributed to 185 school dietitians after face to face interview, and a total of 181 responses were used for analysis. 82.3% of the respondents were using SAPs in school meals and there was a significant difference between elementary school (95.1%), middle school (76.8%) and high school (66.7%) dietitians (p < 0.001). 85.2% of the dietitians, who were using SAP, were purchasing SAPs through electronic bidding, and the main reason of not using SAPs was the higher price of SAPs than that of general agricultural products. The good agricultural practices (GAP) product was considered the most appropriate agricultural products for school meals by the majority of respondents (66.9%), and organic products was the next (13.3%). In addition, the most important selection criterion for a SAP perceived by school dietitians was safety (58.0%), and the main reason of using SAPs in school meals, when two choices were allowed, was 'to provide healthful food to children' (98.9%). The major barriers to using SAPs in school meals (two choices were allowed) were 'too expensive' (73.5%) and 'unstable supply' (32.6). In conclusion, it was suggested that there should be an improvement in SAP supply and management systems to increase the use of SAPs in school meals.

Analysis of dietary insoluble and soluble fiber contents in school meal

The objective of this study was to estimate the contents of dietary insoluble and soluble fiber in school meal. Samples of the school meals were collected from May to June in 2008. Three elementary schools and three middle schools around Masan area were selected for analysis. Dietary soluble and insoluble fibers in the school meals were analyzed directly by the AOAC method. From the initial experiment phase, we used cellulose and pectin as a standard of dietary fiber, and average recovery rate of insoluble fiber and soluble fiber was calculated. The recovery rate was observed, the cellulose 109.7+/-11.7% (range 90~150%) and pectin 77.8+/-10.8% (range 64.7~96.7%), respectively. The amounts of insoluble fiber and soluble fiber were analyzed in the total of 66 dishes, which included 7 kinds of cooked rice (bab) made with some cereal products and vegetables, 19 kinds of soup (guk) made with meats or vegetables, 11 kinds of kimchi, 21 kinds of entrees or side dishes, and 8 special dishes. Conclusively the school meal, per serving size, would provide above 75% KDRI of total dietary fibers through mainly soups and special menu, with the exception to fruits. In addition, it might be expected that children could consume more soluble fiber from the meals with the special dishes than from the regular ones.

Comparison of student's satisfaction on school food service environment by the eating place and gender

The purpose of this study was to compare student's satisfaction with school food service environment to improve the quality of middle school meal service. A survey was conducted of 680 students (boys 246, girls 433) from 6 middle schools providing school meals from October to November 2007. The questionnaires were directly distributed to the subjects for comparison of satisfaction of school meals depending on the eating place. As for the quantity of food, classroom group (3.40) expressed significantly higher satisfaction than cafeteria group (3.16, P < 0.01), but as for the satisfaction on hygiene, classroom group (2.76) showed significantly lower satisfaction than cafeteria group (3.03, P < 0.01). About the satisfaction of school meal environment, classroom group showed more satisfaction on distribution time, eating place, eating atmosphere (P < 0.001). The classroom group showed higher satisfaction than cafeteria group in cases of quantity, diversity of types of soup, dessert, and the cost of school meal. To improve eating place and hygiene of school meal, sufficient cafeteria space and pleasant environment is needed to be established.

A Survey on Preferences for Vegetable Cooking Methods and Vegetable-aversion-related Factors among Elementary School Students in Kwangju and Chonnam Regions / 대한지역사회영양학회지

This study was conducted to survey multiple factors of aversion to vegetables and preferences for vegetable-related recipes in school meal services among elementary school children in order to help develop various menus and recipes for school meal services. Questionnaire survey was carried out with the study subjects, who were 401 children in 6th grade attending elementary schools in Chonnam and Kwangju metropolitan regions. Results from the survey can be summarized as follows: 65.1% of respondents answered they try to eat vegetables and other namul side dishes served in school meal service for health. As for the frequency of taking vegetables and namul side dishes out of daily meals, 47.4% of respondents chose 'once or twice'. The reasons for aversion to vegetables in boys were taste and cooking method, while girls were taste and feeling between teeth. In boys there were no differences between regions of Kwangju and Chonnam but the tendency of aversion to vegetables was significantly high in girls. As for the aspects of vegetable aversion of subjects, 46.9% of respondents took up 'black & purple' in the unfavorable color of vegetables. 49.1% in 'bitterness' and 39.2% in 'greasiness''were in terms of the aversive taste of vegetables. The aversive vegetable recipes were 58.6% in 'raw &seasoned' and the unfavorable feeling of vegetables were 53.1% in 'squashiness'. There were differences between regions of Kwangju and Chonnam with boys in color and cooking method in girls. Results from the survey on their preferences for vegetable recipes showed that leafy vegetables like crown daisy (raw/slightly seasoned) and pak choi (broth/pot stew) fell to the most aversive category, while bean sprouts (broth/pot stew) were chosen as the most favorable one. Among root begetables bell-flowers were found to belong to the least preferred recipe, while potatoes were proven to be most preferable in terms of recipes. As for fruit vegetables and other vegetables, all respondents didn't like 'fatsia shoots' vegetable and it's cooking method and they preferred 'green pumpkins (broth/pot stew)'. In respect of mushrooms, enoki mushroom (broth/pot stew) was found most preferred and had high tendency of preferences in boys and girls in Kwangju compared with Chonnam region. The study results indicated that respondents did not show big differences in factors influencing them to be averse to vegetables and their preferences for vegetable recipes depending on regions. In order to have high preference and intake in children's diets, it needs to study in reform of menu about using namul or vegetables mixed with meats and fruits that children preferred or applying roasted and fried other less than namul.

Programa de alimentação escolar no município de João Pessoa – PB, Brasil: as merendeiras em foco / Programa de alimentación escolar en el municipio de la ciudad de João Pessoa – del estado de Paraíba, Brasil: las cocineras en foco / School meals program in the municipality of João Pessoa, Paraíba, Brazil: school meal cooks in focus

A escola é local privilegiado para desenvolver ações educativas e o programa de alimentação escolar excelente ferramenta para promoção de hábitos alimentares saudáveis. Objetivou-se avaliar a percepção das merendeiras acerca da produção e distribuição da alimentação escolar e seu papel neste contexto. Utilizou-se metodologia de grupo focal com merendeiras de 41 escolas públicas municipais de João Pessoa - Paraíba, Brasil. Desenvolveram-se as categorias: capacitação e treinamento; processo de decisão na elaboração dos cardápios; desgaste no processo de trabalho; alimentação escolar e incorporação de hábitos alimentares saudáveis. Evidenciou-se estreita relação de afeto entre merendeiras e escolares e valorização na oferta de alimentação de qualidade com boa aceitação. Foram observadas ausência de treinamentos sistemáticos e fragilidade no uso da alimentação escolar na incorporação de hábitos alimentares saudáveis. Reafirmou-se a importância das merendeiras na utilização da alimentação escolar como espaço permanente de aprendizado.

School is a privileged place for developing educational activities and a school meals program is an excellent means for promoting healthy eating habits. This study aimed to evaluate the perceptions of school meal cooks regarding the production and distribution of school meals and their role in this. Focus group methodology was adopted among school meal cooks from 41 public schools in João Pessoa, Paraíba, Brazil. The categories developed were: training; decision-making for menu preparation; work-related strain; school meals and incorporation of healthy eating habits. The close affective relationship between the cooks and schoolchildren, and the value of offering quality, well-accepted food were shown. Lack of systematic training and fragility in using school meals to incorporate healthy eating habits were observed. The importance of the cooks with regard to using school meals as a permanent learning space was reaffirmed.

La escuela es local privilegiado para desarrollar acciones educativas y el programa de alimentación escolar excelente recurso para la promoción de hábitos alimenticios saludables. Se objetivó evaluar la percepción de las cocineras encargadas de la merienda respecto a la producción y distribución de la alimentación escolar. La metodología de grupo focal se realizó con cocineras de 41 escuelas públicas municipales de João Pessoa, Paraíba (Brasil). Categorías desarrolladas: capacitación y entrenamiento; proceso de decisión al elaborar menúes; desgaste en el proceso de trabajo; alimentación escolar e incorporación de hábitos alimenticios saludables. Se evidenció estrecha relación afectiva entre cocineras y escolares y valorización en la oferta alimenticia de calidad con buena aceptación. Se observó ausencia de entrenamientos sistemáticos y fragilidad en el uso de la alimentación escolar para incorporar hábitos saludables. Se reafirmó la importancia de las cocineras al usar la alimentación escolar como espacio permanente de aprendizaje.

Merenda escolar na promoção da saúde bucal: o potencial cariogênico dos alimentos / School meal in promotion of oral health: the cariogenic potential of food

Studies on school meals have increased in recent years in pursuit of strategies to offer food that serves not only to feed students, but also provide adequate physical and mental development, as well as promote general and oral health, emphasizing the prevention of caries. This article is a bibliographical review concerning works about foods and meals offered in schools, considering their cariogenic potential, as well as its role in the promotion of oral health. Carbohydrates, mainly the simple ones, are the nutrients of bigger impact on caries. However, an active bacterial flora is necessary to metabolize such nutrients in the mouth, which depends on the individual's oral hygiene. The variation in the cariogenic potential of different foods must also be considered, and this depends on the consistency, the way they are prepared and the period of time the food is adhered to the dental surface. Few studies on the cariogenic potential of meals served in schools were found in the literature. However, many foods offered present a great cariogenic potential. Some examples are cheese, bovine milk, rapadura (a Brazilian preparation of raw brown sugar in bars), some fruits, yoghurt and sugar. A lack of con cern about the damage of these foods to the dental health is observed. Some authors alert about the importance of making adjustments in school meals to preserve oral health and recognize that feeding programs must be joined to education about oral hygiene, control of the dental plaque, application of fluorides and permanent reinforcement of the educative task

Estudios sobre la merienda escolar han aumentado en los últimos años procurando estrategias para ofrecer una alimentación que sirva no apenas para saciar el apetito de los alumnos sino también para garantizar unadecuado desarrollo físico y mental, promoverla salud en general y en particular la prevención de la carie dentaria. Este trabajo es una revisión bibliográfica de los trabajos sobre alimentos y comidas ofrecidas en la merienda escolar em relación a su potencial cariogénico y su papelen la promoción de la salud bucal. Los carbohidratos, principalmente los de bajo peso molecular son los nutrientes de mayor impacto sobre la carie. Sin embargo, es necesario que haya una flora bacteriana activa para metabolizar tales nutrientes en la cavidad oral,lo cual está determinado por la higiene bucal.Es necesario considerar también la variación enel potencial cariogénico de los alimentos, que depende de la consistencia, modo de preparación y tiempo que el alimento permanece adherido ala superficie dental. La literatura presenta pocos estudios sobre la cariogenicidad de refeccionesservidas en la merienda escolar, pero muchos delos alimentos ofrecidos presentan gran potencial cariogénico: queso, leche bovino, algunas frutas, yogur y azúcar, sin observar alguna preocupación en relación a los daños de esta alimentación a la salud de los dientes. Algunos autores alertan para la importancia de realizar ajustes en la merienda escolar para contribuir apreservar la salud bucal, advirtiendo también que programas de alimentación deben estar unidos a la enseñaza de higiene bucal, control de la placa bacteriana, aplicación de fluoreto, con refuerzo permanente de la tarea educativa

Estudos sobre a merenda escolar vêm aumentando nos últimos anos com a busca de estratégias para oferecer uma alimentação que não sirva apenas para saciar a fome dos alunos, mas também para proporcionar um adequado desenvolvimento físico e mental, além de promovera saúde geral e bucal, com ênfase na prevenção da cárie. Este artigo refere-se a uma revisão bibliográfica realizada acerca de trabalhos referentes a alimentos e refeições oferecidos na merenda escolar quanto ao seu potencial cariogênico, bem como seu papel na promoção da saúde bucal. Os carboidratos, principalmente os simples, são os nutrientes de maior impacto sobre a cárie. No entanto, é necessário que haja uma flora bacteriana ativa para metabolizar tais nutrientes na cavidade oral, o que depende da higiene bucal do indivíduo. Deve-se considerar também a variação no potencial cariogênico dos alimentos, que depende da consistência, do modo de preparação e do tempo que o alimento fica aderido à superfície dentária. Foram encontrados na literatura poucos estudos sobre a cariogenicidade de refeições servidas na merenda escolar, porém, muitos alimentos oferecidos apresentam grande potencial cariogênico, a exemplo do queijo, leite bovino, rapadura, algumas frutas, iogurte e açúcar, e o que se observa é a inexistência de preocupação quanto aos prejuízos desta alimentação à saúde dos dentes. Alguns autores alertam para a importância de se realizarem ajustes na merenda escolar de forma a preservar a saúde bucal, e reconhecem que programas de alimentação devem estar unidos ao ensino de higiene bucal, controle da placa bacteriana, aplicação de fluoretos e reforço permanente da tarefa educativa

The Study on Dietary Behaviors of Elementary School Student in Chungnam Area According to the School Food Service Type, Gender and Grade / 대한지역사회영양학회지

This study compared the food habits and attitudes towards dietary life culture in types of feeding management, gender and grade. The subjects were 352 elementary school students who lived in Seocheon, Chungnam. The independently managed school students were better than jointly managed school students in food habits (p < 0.05). In skipping school meals, upper grade students were skipped more than lower grade students (p < 0.05). In rate of eating school meals, boys were faster than girls (p < 0.001). The independently managed school students and the jointly managed school students were different on distasteful food. Boys disliked vegetables and girls disliked cereals and beans (p < 0.05). Upper grade students ate more well-balanced meals than lower grade students (p < 0.05). As for the question "what you will do if the distasteful foods are provided through school meals", they responded. the highest percent of students, "I will try once or twice". And the response "I have them for health" was higher independently in managed school students than the jointly managed school students (p < 0.05), girls than boy (p < 0.05), and the lower grades than the upper grades (p < 0.05). As for the question "what you will do if the distasteful foods are provided, after the guide for school meals was performed", the response, "I will make an effort to have it" accounted for the highest percents, and there were differences in lower grade students who were high percents than upper grade students (p < 0.01). As for the recognition for unbalanced diets, most of the students recognized that it is a "bad habit"; the girl students accounted for more percentage than boys (p < 0.05). The criterion of food choice were different in gender and grade (p < 0.01). As for the factor of influences for the food habits formation, lower grade students were "school education" and upper grade students were "parents" (p < 0.05). Thus, the systematic guide for proper intakes of nutrition should be performed. Also, the time when students can be educated by an expert of nutritional education, which is connected with school meals and students can grow healthily.

School Food Safety Practices in USA

The Purposes of this article were to review school meal programs and school food safety practices in USA and to draw up improvement plan of school foodservice in Korea. American school meal programs are composed of national school lunch program(NSLP), school breakfast program(SBP), special milk program(SMP) and summer food service program(SFSP). More than 29 million children receive meals daily. School districts and independent schools that choose to take part in the NSLP get cash subsidies and donated commodities from the USDA for each meal they serve. In case of NSLP, around 59% of the participant students are benefited from free or reduced price. According to the U.S. Government Accounting Office, outbreaks of foodborne disease in schools are rare, but appear to be increasing in incidence proportional to overall increases. School outbreaks tends to comprise a greater number of large outbreaks and this shows a similarity with the foodborne disease trend in Korea. School districts, federal agencies, and state and local agencies in USA use or suggest useful food safety practices for school meal programs. They told that four of these practices had the potential to enhance the safety of school meal programs. The four practices are (1) employing key foodservice personnel who are trained and certified in food safety practices, (2) implementing a risk-based approach for safely preparing, storing, and serving foods, (3) purchasing precooked or irradiated meal and poultry products, and (4) applying the more stringent purchasing specifications that USDA uses when purchasing some of the food commodities it donates to schools.