Childhood Nutrition ~ From Preventing Malnutrition to Preventing Obesity

In my opinion, childhood obesity is THE single health issue of our day.  If for no other reason, but because obesity is so darned difficult to reverse.  In Utopia, all children are raised in loving environments, taught the wisdom of the world, and when they reach adulthood have equal footing to make their way in this world.  Now that's Utopia, but I think we can strive for as many children as possible to reach adulthood in a position to put their best individual foot forward.

I'm a child of the 60's.  My parents were born and raised in the Depression and WWII.  I believe this influenced not only how they parented, but how this generation formed policies based on their priorities.  Nutritional guidelines, RDA's and all such related things were born out of efforts to prevent malnutrition and disease.  Diseases of deficiencies were real "in their day" and in the true form of forging a better life for one's children, this was a priority for them.    A lot of research capital was spent to determine the nutritional needs of children, and childhood obesity was quite rare.  This is not to diminish the plight of those rare cases, but public policy always targets the majority potentially impacted.  Also, at that time a fat child was more likely to be considered healthy than a scrawny one.  My how times have changed.

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don't you love that quote....so true and something that i have to remember when decorating my own home....

*images courtesy of gretchen o, fern living, knitofactso

HIMSS Senior Vice President on Medical Ethics: Ignore Health IT Downsides for the Greater Good

The Health Information Management Systems Society (HIMSS) is the large health IT vendor trade group in the U.S.  At a Sept. 21, 2012 HIMSS blog post, John Casillas, Senior Vice President of HIMSS Financial-Centered Systems and HIMSS Medical Banking Project dismisses concerns about health IT with the refrain:

... To argue that the existence of something good for healthcare in many other ways, such as having the right information at the point of care when it’s needed, is actually bad because outliers use it to misrepresent claims activity is deeply flawed.

Through the best use of health IT and management systems, we have the opportunity to improve the quality of care, reduce medical errors and increase patient safety. Don’t let the arguments of some cast a cloud over the critical importance and achievement of digitizing patient health records.

Surely, no one can argue paper records are the path forward. Name one other industry where this is the case. I can’t.

Let’s not let the errors of a few become the enemy of good.

The ethics of these statements from a non-clinician are particularly perverse.

The statement "Don’t let the arguments of some cast a cloud over the critical importance and achievement of digitizing patient health records" is particularly troubling.

When those "some" include organizations such as FDA (see FDA Internal 2010 memo on HIT risks, link) and IOM's Committee on Patient Safety and Health Information Technology (see 2012 report on health IT safety, link) both stating that harms are definite but magnitude unknown due to systematic impediments to collecting the data, and the ECRI Institute having had health IT in its "top ten healthcare technology risks" for several years running, link, the dismissal of "clouds" is unethical on its face.

These reports indicate that nobody knows if today's EHRs improve or worsen outcomes over good paper record systems or not.  The evidence is certainly conflicting (see here).

It also means that the current hyper-enthusiasm to roll out this software nationwide in its present state could very likely be at the expense of the unfortunate patients who find themselves as roadkill on the way to the unregulated health IT utopia.

That's not medicine, that's perverse human subjects experimentation without safeguards or consent.

As a HC Renewal reader noted:

Astounding hubris, although it does seem to be effective.  Such is PC hubris.  Who could ever call for reducing the budget of the NIH that is intended to improve health.  Has health improved?  No.

So why does a group with spotty successes if not outright failure never get cut?  It’s not the results, it’s the mission that deserves the funding.  So it’s not the reality of HIT, it’s the promise, the mission, that gets the support.  Never mind the outcome, it’s bound to improve with the continued support of the mission.

Is this HIMSS VP aware of these reports?  Does he even care?

Does he believe patients harmed or killed as a result of bad health IT (and I know of a number of cases personally through my advocacy work, including, horribly, infants and the elderly) are gladly sacrificing themselves for the greater good of IT progress?

It's difficult to draw any other conclusion from health IT excuses such as proffered, other than he and HIMSS simply don't care about unintended consequences of health IT.

Regarding "Surely, no one can argue paper records are the path forward" - well, yes, I can.  (Not the path 'forward', but the path for now, at least, until health IT is debugged and its adoption and effects better understood).  And I did so argue, at my recent posts "Good Health IT v. Bad Health IT: Paper is Better Than The Latter" and "A Good Reason to Refuse Use of Today's EHR's in Your Health Care, and Demand Paper".  I wrote:

I opine that the elephant in the living room of health IT discussions is that bad health IT is infrequently, if ever, made a major issue in healthcare policy discussions.

I also opine that bad health IT is far worse, in terms of diluting and decreasing the quality and privacy of healthcare, than a very good or even average paper-based record-keeping and ordering system.  

This is a simple concept, but I believe it needs to be stated explicitly. 

A "path forward" that does not take into account these issues is the path forward of the hyper-enthusiastic technophile who either deliberately ignores or is blinded to technology's downsides, ethical issues, and repeated local and mass failures.

If today's health IT is not ready for national rollout, e.g., causes harms of unknown magnitude (e.g., see this query link), results in massive breaches of security as the "Good Reason" post above, and mayhem such as at this link, then:

The best - and most ethical - option is to slow down HIT implementation and allow paper-based organizations and clinicians to continue to resort to paper until these issues are resolved.  Resolution needs to occur in lab or experimental clinical settings without putting patients at risk - and with their informed consent.

Anything else is akin to the medical experimentation abuses of the past that led to current research subjects protections such as the "Ethical Guidelines & Regulations" used by NIH.

-- SS

Messi Akhirnya Bergabung Dengan Persib

Kemampuan Mbida Messi mengolah bola ternyata tak hanya menarik minat manajemen Persib Bandung. Klub tetangga, Pelita Jaya Karawang, ternyata juga sempat meminati. Namun sang pemain dan manajernya akhirnya lebih memilih memperkuat Persib.

"Saya banyak teman yang bermain di Indonesia. Mereka membicarakan tentang klub di Indonesia termasuk Persib. Lalu saya juga mendengar tentang sejarah dan target Persib di musim ini," katanya seusai latihan perdana bersama Persib di stadion Siliwangi Bandung, Selasa (25/9/2012).

Ia berharap, apa yang menjadi target Persib di musim ini yakni menjadi juara bisa tercapai.

"Saya ingin memberikan sesuatu. Saya juga punya ambisi untuk memberikan yang terbaik," tutur Messi.

Bermain di Indonesia sendiri merupakan pengalaman baru bagi Messi. Selepas menuntut ilmu di akademi PSV Eindhoven, pemain kelahiran 8 Desember 1980 ini berkelana ke beberapa negara.

"Saya pernah bermain di Turki, Qatar, Portugal dan Angola," ucap Messi.

Ia mengatakan, di Belanda dirinya belajar banyak tentang sepak bola, terutama taktik. Menurutnya, para pemain dari Afrika memang mempunyai kekuatan fisik yang mumpuni.

"Tapi kelemahannya adalah taktik. Jadi saya banyak belajar tentang taktik," tutur Messi.

Dragon Multi-Skills: The final piece of the jigsaw by Julie Rotchell

Julie Rotchell is the Sport Wales manager with a remit for Skills for a Life in Sport, looking at the development of children and young people.

Here she’s explains where the new Dragon Multi-Skills and Sport resource fits into the sporting development of Welsh youngsters.

The launch of our new Dragon Multi-Skills resource and training is the final piece in the jigsaw of resources produced by Sport Wales. This resource is the follow on to our highly rated ‘Play to learn resource’ which develops the physical skills of our children from the age of three.

The methods advocated in both of these resources are about individualised learning making sure that each and every child’s needs are met and children progress and develop their fundamental movement skills in a fun and progressive way.

The resources and training are designed to encourage parents, teachers, coaches and volunteers to get involved. All resources are accessible from our online shop www.sportwales.org.uk/shop  and parents play to learn website; www.playtolearn.org.uk . Training is being coordinated locally through sports development teams.

So how does this new resource fit in with everything else that Sport Wales has produced so far in order to make sure that every child has the opportunity to develop their skills for a life in sport?

This diagram above illustrates how everything fits together and how the packages can be utilised in different environments. 

At Sport Wales our ambition is to get every child hooked on sport for life. In order for us to meet this ambition it is essential that every child has the opportunity to develop their physical skills. This new resource will provide the opportunity for young people to do this in a fun way that is relevant for every child. It is the stepping stone into developing sport specific skills. Our dragon package now involves Dragon Multi skills and Dragon sport.  

For more on Dragon Multi-Skills and Sport click here.

The Evolution of the Dragon by Jan English

Jan English is the Strategic Lead for the South East Wales Physical Education and School Sport Consortium and the title author of Dragon Multi-Skills and Sport.

Here, she talks through the development of the new concept in giving children the sporting skills to get them hooked on sport for life.

 Three years ago, Sport Wales decided to review its Dragon Sport programme to establish if it was still fit for purpose.  Dragon Sport was an extra-curricular initiative aimed at 7-11 year olds that comprised of a training course and a set of sport specific games and activities for each of the eight Dragon Sports (Athletics, Cricket, Football, Golf, Hockey, Netball, Rugby, Tennis). 

At this time Sport Wales engaged in a wide consultation including Dragon Sport Officers, local authority Sports Development Officers, National Governing Body of Sport Officers, Disability Sport Wales, teachers, advisory staff, Physical Education and School Sport (PESS) Officers, volunteers, coaches, leaders and most importantly children, to identify the strengths and weaknesses of the Dragon Sport scheme.  The consultation highlighted many strengths but also some key weaknesses particularly from the children’s perspective.  They wanted more say in what they did and how they did it, they wanted to be with their friends and saw extra-curricular activities as their social time.

At the same time the PESS project had just launched ‘Play to Learn’, a curricular, extra-curricular, community and family approach aimed at enhancing the physical development of 3-7 year olds.  The approach complemented the Foundation Phase ethos adopting a child centred, holistic approach to learning.  ‘Play to Learn’ engages children in physical activity through a range of stimuli including storybooks and activities.  ‘Play to Learn’ sets out a range of FUNdamental technical skills that children should experience over time and when ready.  ‘Play to Learn’ mirrors the Foundation Phase encouraging deliverers to provide opportunities that are appropriate to each child’s stage of development not their age.

Concurrently Sport Wales was considering the future of the PESS project and again engaged in wide consultation.  As part of that consultation secondary school PE teachers reported a lack of skill for incoming pupils in year 7.  They recognised improvements in body management skills that they associated with the concentration of the PESS project on gymnastics and dance, but felt that games skills were particularly poor.  National Governing Bodies of Sport also identified this lack of skill in the Dragon Sport review.

The FUNdamental movement skills approach was gaining popularity throughout the world, building particularly on the experiences in Australia, Canada and New Zealand.  The Youth Sport Trust, Sports Coach UK and many National Governing Bodies of Sport were very keen to adopt FUNdamentals into their coaching education programmes.

As a consequence of being involved in the development of Top Sport and Dragon Sport and one of the main consultants involved in the development of ‘Play to Learn’ I was asked to look at the Multi-Skills agenda and propose a way forward.  One of the first things I did was to recommend that revisions to the Dragon Sport scheme and Multi-skills should not be considered in isolation and that they should be united under one umbrella.  I worked with a group of National Governing Body staff to establish their thoughts on this merger and their keenness to engage in a common multi-skills agenda.  This meeting was the most exciting I have ever been involved in in my 18 years involvement with Sport Wales, because I realised that there was a will to create a cultural shift to develop a consistent high quality child-centred approach to physical education and school sport.  Spurred on by this I set about developing a new vision for Dragon.

I researched existing academic perspectives on the FUNdamentals approach and reviewed over 30 FUNdamental schemes/resources and training courses from around the world.  This work helped me to identify the FUNdamental skills beyond those included in ‘Play to Learn’ and the types of activities that were appropriate and successful in developing these skills.  As I developed the resources I was conscious that if new Dragon was to be successful then it had to be an approach not just another course and set of resources. The philosophy relating to delivery was more important to me than the skills and activities. 

In addition to mapping against the national curriculum and cross referencing skills and activities to make sure I had taken the best ideas from around the world, I have to weave in an approach that would maximise the impact that these resources could have in curricular, extra-curricular, community and family settings.  All of this had to be encapsulated in a joint training course for a range of stakeholders particularly teachers and community coaches. 

The approach advocates:

-          ‘conversation coaching’ with the deliverer working with the child

-          listening to the child

-          valuing their contributions

-          including all children regardless of their ability

-          giving children increased responsibility and ownership for the own learning

-          recognising that friendship groups and positive relationships with teachers, coaches, leaders and other children are important factors to a child’s motivation

-          recognising wider skills such as thinking communication, personal, social and emotional, sporting attitudes, teamwork, leadership, alternative roles are as important to the child as the physical skills.

So Dragon Multi-Skills and Sport grew into:

-          a set of technical skills that progressed from Play to Learn and formed the ‘as they apply their skills’ level of the technical skills hierarchy,

-          a set of multi-skills inclusive activities that provide opportunities for children to use and develop their skills in a fun, small sided generic contexts

-          a set of sport specific inclusive activities and games that represent opportunities to develop their skills in a sport specific context

-          a training course that puts the child at the centre of the activity and transfers responsibility and ownership to the child

-          a common approach that is appropriate for all stakeholders and involves new ways of partnership working

As this approach begins to roll out across Wales, I hope that the ambition and vision to create a cultural shift continues and that children will feel confident to make choices and be more successful regardless of their ability, leading to increased participation, increased frequency of participation, improved performance and life-long participation that will impact positively on children in Wales’ health and well-being.

For more on Dragon Multi-Skills and Sport click here.