A Scoping Review of Breastfeeding Interventions and Programs Conducted Across Spanish-Speaking Countries.

Breastfeeding is vital to a child's lifelong health and has significant positive benefits to mother's health. World Health Organization recommends beginning exclusively breastfeeding within the first hour after birth and continuing during the first 6 months of infant's life. The purpose of this review is to identify and examine breastfeeding interventions conducted across the Spanish-speaking countries. A scoping review of the literature was conducted across 14 databases for relevant publications published through April 2023 to find studies in Spanish-speaking countries that involved breastfeeding as an intervention component. A total of 46 peer-reviewed articles were included in this review, across 12 Spanish-speaking countries. Participants ranged from pregnant women, mothers, mother-infant pair, and health care professionals. Intervention at the individual level in combination with support from trained health care professionals or peer counselors seemed to have higher improvements in breastfeeding rates. The greatest improvement in exclusively breastfeeding for 6 months was seen in interventions that included prenatal and postnatal intensive lactation education, for a period of 12 months. The most effective interventions that improved rates of any breastfeeding included promotional activities, educations workshop, and training of health care staff along with changes in hospital care. Breastfeeding promotion is an economical and effective intervention to increase breastfeeding behavior and thereby improving breastfeeding adherence across Spanish-speaking countries.

Reducing Violence Against Women and Girls in the Arab League: A Systematic Review of Preventive Interventions.

The UN's Sustainable Development Goal #5 (Gender Equity) includes violence against women and girls (VAWG), considering it as a violation of the rights of women and girls. The variety of risk factors for VAWG in Arab countries suggests the need to identify effective interventions to guide practitioners and policy makers. A systematic review of preventive interventions across the Arab League examined the outcomes of VAWG. Authors registered the study on the prospective register of systematic reviews database. Authors conducted the search for evidence up to 2023. Database searching identified 1,502 studies and after application of the eligibility criteria, 17 studies remained for inclusion. Quality appraisal used the Mixed Methods Appraisal Tool. Evidence emerged from eight Arab countries. Interventions occurred at the primary, secondary, and tertiary levels of prevention. However, only two studies employed interventions using more than one level of prevention, which considered systems strengthening and the development of community solidarity networks. The evidence revealed a lack of clear evaluation and evidence for the effectiveness of interventions and prevention alongside reactive approaches, with no evidence as to how systems may reduce or prevent VAWG. One main issue is patriarchal dominance in Arab countries creating the lack of a collective female voice in any of the evidence. However, Arab countries can change with support. Achieving the UN's Sustainable Development Goal #5 by 2030 means interventions and programs need to include more than one prevention level, consider systems and include the collective female voice.

Reporting on the Status of Nutrition Programs of Higher Education in the Syrian Arab Republic: A Current Snapshot.

Background: The Syrian Arab Republic (SAR) is experiencing high rates of malnutrition. While many adults experience overweight and obesity, as a direct result of the continuing conflict, SAR is also noted as one of the most food-insecure regions in the Arab world. To combat the health impacts and outcomes related to diet and dietary behaviors, trained nutrition professionals are needed. We aimed to examine current nutrition-affiliated programs offered in post-secondary institutions in the SAR. Methods: The search was conducted between Jan and Feb 2021. An electronic review of universities and colleges' websites, department webpages, and academic programs' homepages and resources of all the private and public universities in SAR was conducted to find programs related to nutrition, nutrition sciences, and dietetics. Results: Only 13%, or 4 out of 30 SAR colleges and universities had bachelor's programs in nutrition or nutrition science, and none had nutrition programs at the graduate or terminal degree levels. Conclusion: A pathway for integration of graduates from nutrition sciences into the healthcare and public health workforce should be defined and an understanding of the value of those with a degree in nutrition should be cultivated in clinical and community care settings. Partnering with existing or creating independent organizations charged with defining the scope of practice and ensuring educational quality and competence of graduating students, as well as readiness to practice as part of a healthcare team or in a public health nutrition role will be integral to moving the nutrition profession forward in the SAR.

A Scoping Review of Nutrition Education Interventions Applied in Prison Settings.

PURPOSE OF REVIEW: Over 11 million individuals are incarcerated globally, facing health challenges such as obesity, diabetes, and cardiovascular disease, possibly exacerbated by prison diets. The objective of this scoping review is to explore the various available types of nutrition education interventions that currently exist in the literature applied in prison settings. RECENT FINDINGS: Utilizing the PRISMA Extension for Scoping Reviews, 19 databases were searched for studies on nutrition interventions in prisons from 2000 to May 2023, guided by the "PICO" structure. Inclusion criteria encompassed articles in five languages from peer-reviewed journals focusing solely on nutrition education interventions. Rayyan QCRI software was utilized for screening and data extraction. Fifteen international studies were analyzed, covering various countries and targeting different populations in prisons. Interventions varied from nutrition education to comprehensive health programs. The outcomes were inconsistent, with some showing health improvements and others encountering challenges. Few utilized established theoretical frameworks, indicating a research gap. The range of interventions highlights the potential complexity of nutrition education interventions within prisons. Implementing recognized theoretical frameworks may enhance effectiveness. The diverse outcomes highlight the challenges in creating impactful programs, emphasizing foundational issues. Recommendations focus on rigorous research designs and understanding prison-specific complexities. Nutrition education interventions in incarcerated settings present varied results, emphasizing the need for well-structured, theoretically grounded, and carefully evaluated programs. Future strategies should recognize the multifaceted nature of correctional facilities, aiming for holistic approaches to improve health in prisons.

Effectiveness of school-based nutrition interventions promoted in the League of Arab States: a systematic review.

Arab countries are doubly burdened with undernutrition as well as overweight and obesity. To provide guidance to those looking to address concerns of obesity and overweight among children in this region, the current review bridges an existing knowledge gap and systematically characterizes and evaluates the available scientific evidence pertaining to school-based nutrition interventions completed to date across the Arab world. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and relevant keywords, terms and phrases, a search of the literature across 14 databases for school-based nutrition interventions implemented in this region was conducted. Out of 1568 articles from 14 databases, 38 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility excluded 23 articles and included one article from hand-searching references, leaving 16 articles in the final analysis. Most articles (n = 7) with the implementation of 5 months or longer found strong positive and significant impacts on limiting sweets consumption, increased dietary knowledge, self-efficacy, breakfast and fruit and vegetable consumption, among others. We also found evidence (n = 5) that teachers trained by experts such as dietitians and pediatricians can effectively implement nutrition interventions that achieve the intended outcomes. Training teachers to implement theory-based nutrition and health promotion curricula serves as a potential solution to improving nutrition knowledge, health behaviors and dietary practices among children living in Arab countries. Appropriately designed and implemented nutrition interventions can positively impact nutrition knowledge, health and diet-related behaviors in children and adolescents in this region.

Registered Dietitian Nutritionists' Knowledge, Attitudes, and Beliefs Regarding Nutrition for the Transgender Population in Three New England States: A Cross-Sectional Study.

This Study examined the knowledge, attitudes, and beliefs of Registered Dietitian Nutritionists (RDN's) practicing in Maine, New Hampshire, and Vermont, regarding the transgender population. 196 RDN's from the Commission of Dietetics Registration registry located in the tri-state area responded to an anonymous online survey. The survey used the Transgender Knowledge, Attitudes and Beliefs (T-KAB) Scale and nine true/false clinically-focused questions. Descriptive statistics and chi-square analysis were used to identify trends and associations in RDN's knowledge, attitudes, and beliefs regarding the transgender population. Political views (p < 0.0001), years practicing (p = 0.0454), and religious commitment (p = 0.0429) were negatively associated, and health disparities awareness (p < 0.0002) was positively associated, with total T-KAB Score. RDN's surveyed had positive attitudes and beliefs, but a low level of knowledge. Future research should focus on training and education of RDN's, and use of the T-KAB scale to evaluate pre/post-education modules regarding nutrition care for transgender patients.

Interventions and Programs to Promote Breastfeeding in Arabic-Speaking Countries: A Scoping Review.

INTRODUCTION: Low prevalence of exclusive breastfeeding in the Arab world is concerning and suboptimal breastfeeding is a leading child health risk factor in several Arab States. Breastfeeding education has the capacity to improve breastfeeding knowledge and practice, thus positively impacting infant and maternal health. The purpose of this review is to identify and examine the impact of breastfeeding promotion interventions across the Arab world. METHOD: A scoping review of the literature was conducted across seventeen databases for relevant publications published through October 2021 to find studies in Arab countries, that involved breastfeeding as an intervention component. Twenty-one articles met inclusion criteria and were reviewed. RESULTS: Individual and community based educational interventions offer the opportunity to positively impact the knowledge, attitudes, and practices of breastfeeding in new mothers in Arab countries. Increased breastfeeding has the potential to lead to improved neonate and maternal health. In addition to significant benefits found across individual and community-based interventions in a variety of Arab countries, there is also evidence that interventions that improve the knowledge of health care professionals and/or the practices of a health care system can contribute to subsequent increases in breastfeeding rates. DISCUSSION: Breastfeeding education is a low-cost and high-impact public health tool that can impact infant and maternal health and potentially increase breastfeeding adherence in the Arab world.

What is already known on this subject? Breastfeeding has major long-term effects on the health and development of children as well as women's health. Combined health systems and community interventions more than double exclusive breastfeeding rates globally. The most cost-effective ways to promote exclusive breastfeeding include counselling and supportive interventions in multiple settings. What this study adds? Multi-component educational and supportive interventions increase breastfeeding initiation and duration among mothers in the Arab world. The most successful interventions among Arab women include education as well as pre- and post-partum support. Education and training for health professionals on the importance of breastfeeding can have broad-reaching impact on improving breastfeeding rates.

National roll-out of early intervention for eating disorders: Process and clinical outcomes from first episode rapid early intervention for eating disorders.

AIM: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention model for young people with recent-onset eating disorders (ED). Promising results from a previous single-centre study and a four-centre study (FREED-Up) have led to the rapid national scaling of FREED to ED services in England (FREED-4-All). Our aim was to evaluate duration of an untreated ED (DUED), wait time target adherence, and clinical outcomes in FREED-4-All and compare these to the (benchmark) findings of the earlier FREED-Up study. METHOD: FREED services submit de-identified data to the central FREED team quarterly. The current study covers the period between September 2018 and September 2021. This FREED-4-All dataset includes 2473 patients. These were compared to 278 patients from the FREED-Up study. RESULTS: DUED was substantially shorter in the FREED-4-All dataset relative to the FREED-Up study (15 vs. 18 months). Adherence to the wait time targets was comparable in both cohorts (~85% of engagement calls attempted in <2 days, ~50%-60% of assessments offered in <14 days, ~40% of treatment offered in <28 days). Patients in the FREED-4-All dataset experienced significant improvements in ED and general psychological symptoms from pre- to post-treatment that were comparable to the FREED-Up study. These findings should be interpreted cautiously as only 6% of FREED-4-All patients had post-treatment data. CONCLUSIONS: Data from the FREED-4-All evaluation suggest that FREED is replicating at scale. However, these data are flawed, uncertain, proximate, and sparse and should therefore be used carefully alongside other evidence and clinical experience to inform decision making.

Video clips of the Mediterranean Diet on YouTube TM: A social Media Content Analysis.

PURPOSE: The present study conducted a social media content analysis on videos describing the Mediterranean Diet (MedDiet) posted onYouTube. SETTING: YouTube TM online video sharing and social media platform. METHOD: Three independent content experts evaluated 141 YouTube videos on the MedDiet in August 2020 utilizing standard rubric and protocol. Data abstracted include media source(s) of posted videos, and viewer exposure/engagement metrics. Information quality was measured by each content expert independently through use of the DISCERN instrument, a 16-item tool designed to assess reliability, dependability, and trustworthiness of an online source, scores were then aggregated for analysis. RESULTS: A majority of videos (n = 102, 72.3%) were educational in nature. A third of videos were less clear and less credible on information presented (n = 46, 32.6%). Most videos were posted by an individual (n = 79, 56%), and the majority of videos were rated as medium quality (n = 88, 62.4%). Overall level of user engagement as measured by number of "likes," "dislikes," and user comments varied widely across all sources of media. Exploratory correlation analysis suggests that the number of a video's views, comments, likes, and dislikes are not correlated with quality. CONCLUSION: Study findings suggest that MedDiet health promotion and education via YouTube has the potential to reach and inform clients; however, existing video content and quality varies significantly. Future intervention research focused on MedDiet should further examine possible predictors of high quality MedDiet content utilizing diverse online video sharing platforms.

Degree-Granting Nutrition Programs in the Republic of Yemen: A Status Report on Postsecondary Education.

Yemen is noted as one of the most food-insecure countries in the Arab world coupled with high rates of malnutrition. To address the public health outcomes related to nutrition, trained nutrition professionals are needed. This report provides a snapshot of current nutrition-affiliated programs offered in postsecondary institutions in Yemen. Partnering with or creating independent organizations responsible for defining the scope of practice is warranted. Additionally, ensuring educational quality, program accreditation, and competence of graduating students and readiness to practice will be central to progressively moving Yemen's dietetics profession forward.

A comparative review of nutrition education intervention duration and impact on reduction of prediabetes or Type 2 diabetes mellitus among adults aged 45 years or older.

Prediabetes and Type 2 diabetes mellitus (T2DM) is increasingly prevalent and both conditions have a variety of comorbidities. There are many programs aimed at the reduction or prevention of prediabetes and/or T2DM. However, only a few studies have evaluated the effect of intervention duration and evidence-based frameworks on specific populations at risk for prediabetes or T2DM. This review evaluated evidence-based lifestyle intervention programs to determine whether the duration of programming relates to the efficacy of evidence-based lifestyle change interventions. The aim was to assess relevant outcomes of these interventions in prediabetic or T2DM individuals aged 45 and older. The PRISMA framework was followed. Searches systematically screened and evaluated 2654 articles. Thirteen articles met the inclusion/exclusion criteria. Databases searched included: PubMed; SCOPUS; ProQuest; Biomed Central; SpringerLink; ScienceDirect; EBSCOHost; JSTOR; Taylor & Francis; Wiley Online; BioOne; CINAHL; SAGE Journal; and Google Scholar (2009-2022). Identifying the most effective timeframe for lifestyle intervention programming to reduce the risks associated with prediabetes/T2DM can help providers develop appropriate educational initiatives for patients at risk for pre-diabetes and/or T2DM. After screening, there were 13 studies which met the review criteria. All of the studies included in this comparative review used evidence-based interventions. Evidence-based lifestyle intervention programs that are ≥12 months produced significant and consistent results in mediating outcomes related to prediabetes/T2DM than <12-month programs in adults aged 45 years and older.

Technology-based nutrition interventions using the Mediterranean diet: a systematic review.

CONTEXT: Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity. OBJECTIVE: For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations. DATA SOURCES: The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian. DATA EXTRACTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria. DATA ANALYSIS: The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio. CONCLUSION: Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.

Food-based dietary guidelines of Arabic-speaking countries: a culturally congruent profile.

OBJECTIVE: Dietary guidelines for food groups, types and portion sizes are common practice at the national level. As the relationship between nutrition and disease and the influence of cultural identity on individual behaviour become clearer, dietary guidelines necessarily evolve. Today, the Arabic-speaking region is experiencing a dual burden of undernutrition and increasing rates of overweight and obesity. Cultural congruency among dietary guidelines in the Arabic-speaking region and how they affect health education, health promotion, and nutrition programme planning or individual dietary behaviours have yet to be examined. The present work provides dietitians and public health professionals a narrative review of proposed food guidelines for the Arabic-speaking region. DESIGN: The current review examined five established dietary guidelines within the Arabic-speaking region, namely the Arab Food Dome (Arab Gulf states), the Healthy Food Palm (Saudi Arabia), the Lebanese Dietary Guidelines, the Omani Guide to Healthy Eating and the Qatar Dietary Guidelines, and compared findings with the regional Eastern Mediterranean guidelines developed by the WHO. Individual guideline recommendations are tabled for comparative review. SETTING: The Arabic-speaking region.ParticipantsRespective Arabic-speaking populations. RESULTS: Health educators, community health practitioners and nutrition professionals can benefit from the cultural contexts associated with dietary guidelines in this region. CONCLUSIONS: Community-level policy and individual behaviour change will benefit from cultural sensitivity; health communication and behaviour change programming require cultural competence provided in the present review; and programme evaluation efforts (prior to and after implementation) should include a detailed understanding of how culture shapes regional policy and individual nutrition behaviours.

Are parental self-efficacy and family flexibility mediators of treatment for anorexia nervosa?

OBJECTIVE: Family-based treatment (FBT) for adolescent anorexia nervosa (AN) promotes faster weight restoration when compared to other treatments. However, the mechanisms through which this occurs are not clarified. This study explored the trajectories of parental self-efficacy and perceived family flexibility during FBT and systemic family therapy (SyFT). We also explored whether parental self-efficacy mediates the effects of treatment on weight gain early in treatment. METHOD: 158 adolescents (12-18 years old; 89% girls) and their parents were randomized to FBT or SyFT. Parental self-efficacy as well as adolescents' and parental perceptions of the family's flexibility were collected at baseline and at sessions 2, 4, 6, and 8. RESULTS: Over time, only parents in FBT reported significantly greater self-efficacy. The change in maternal self-efficacy over the first 8 weeks of treatment was a significant mediator of session 10 weight gain. There were no significant group differences in perceived flexibility by session 8. DISCUSSION: Both parents in FBT and mothers in SyFT understand early the need to change their family's rules and roles. However, the specific strategies of FBT appear to mediate early weight gain in AN.

Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial.

IMPORTANCE: Anorexia nervosa (AN) is a serious disorder with high rates of morbidity and mortality. Family-based treatment (FBT) is an evidence-based therapy for adolescent AN, but less than half of those who receive this approach recover. Hence, it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence-based treatment. OBJECTIVE: To compare FBT with systemic family therapy (SyFT) for the treatment of adolescent-onset AN. DESIGN, SETTING, AND PARTICIPANTS: Research in Anorexia Nervosa (RIAN) is a 2-group (FBT and SyFT) randomized trial conducted between September 2005 and April 2012. Interviewers were blinded to the treatment condition. A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened. Of these, 262 adolescents did not meet the inclusion criteria and 138 declined to participate; hence, 164 adolescents (aged 12-18 years) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AN (except for amenorrhea) were enrolled. Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred. INTERVENTIONS: Two manualized family therapies with 16 one-hour sessions during 9 months. Family-based therapy focuses on the facilitation of weight gain, whereas SyFT addresses general family processes. MAIN OUTCOMES AND MEASURES: The primary outcomes were percentage of ideal body weight (IBW) and remission (≥95% of IBW). The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment (EOT). RESULTS: There were no statistically significant differences between treatment groups for the primary outcome, for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up. Remission rates included FBT, 33.1% at the EOT and 40.7% at follow-up and SyFT, 25.3% and 39.0%, respectively. Family-based therapy led to significantly faster weight gain early in treatment, significantly fewer days in the hospital, and lower treatment costs per patient in remission at the EOT (FBT, $8963; SyFT, $18 005). An exploratory moderator analysis found that SyFT led to greater weight gain than did FBT for participants with more severe obsessive-compulsive symptoms. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT. Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT. TRIAL REGISTRATION: clinicaltrials.gov Identifier NCT00610753.