A randomised controlled school-based nutritional intervention in five Middle Eastern countries: Ajyal Salima improved students' dietary and physical activity habits.

OBJECTIVE: The purpose of this study was to measure the impact of the Ajyal Salima school intervention on nutrition and physical activity outcomes in children aged 9­11 years. DESIGN: The study was a 1-year cluster-randomised controlled trial. Ajyal Salima used a multi-component approach including classroom activities, family programme and food service adaptation. Outcomes included daily intake of breakfast, frequency of healthy and unhealthy food consumption, frequency of physical activity, knowledge score and self-efficacy score. Intervention and control groups were compared for all main outcomes and a post-intervention qualitative evaluation assessed strengths and limitations of the intervention components. SETTING: Schools in five countries ­ Lebanon, Jordan, Palestine, Saudi Arabia and Bahrain. PARTICIPANTS: Schools were selected by Ministries of Health and Education within their jurisdictions. Forty-five intervention schools (6052 students) and forty-six control schools (6200 students) were included in the analysis. RESULTS: The intervention group had a significantly higher odds of consuming breakfast daily (OR 95 % CI = 1·60, 1·35, 1·90), consuming healthy foods (OR 95 % CI = 1·60, 1·39, 1·84) and a decreased odds of consuming unhealthy foods and sweetened beverages (OR, 95 % CI = 0·70, 0·60, 0·81). Additionally, school children in the intervention group, as compared with the control group, were 47 % more likely to exercise outside school hours (OR 95 % CI = 1·47, 1·23, 1·76). Lastly, children in the intervention group had a significantly improved nutritional knowledge score and improved self-efficacy by 1·3 score unit and 1·1 score unit, respectively. CONCLUSIONS: The Ajyal Salima intervention led to significant improvements in dietary and physical activity habits among school children and increased nutritional knowledge scores.

Testing the distinctiveness of visual imagery and motor imagery in a reach paradigm.

We examined the distinctiveness of motor imagery (MI) and visual imagery (VI) in the context of perceived reachability. The aim was to explore the notion that the two visual modes have distinctive processing properties tied to the two-visual-system hypothesis. The experiment included an interference tactic whereby participants completed two tasks at the same time: a visual or motor-interference task combined with a MI or VI-reaching task. We expected increased error would occur when the imaged task and the interference task were matched (e.g., MI with the motor task), suggesting an association based on the assumption that the two tasks were in competition for space on the same processing pathway. Alternatively, if there were no differences, dissociation could be inferred. Significant increases in the number of errors were found when the modalities for the imaged (both MI and VI) task and the interference task were matched. Therefore, it appears that MI and VI in the context of perceived reachability recruit different processing mechanisms.

The effect of response-delay on estimating reachability.

The experiment was conducted to compare visual imagery (VI) and motor imagery (MI) reaching tasks in a response-delay paradigm designed to explore the hypothesized dissociation between vision for perception and vision for action. Although the visual systems work cooperatively in motor control, theory suggests that they operate under different temporal constraints. From this perspective, we expected that delay would affect MI but not VI because MI operates in real time and VI is postulated to be memory-driven. Following measurement of actual reach, right-handers were presented seven (imagery) targets at midline in eight conditions: MI and VI with 0-, 1-, 2-, and 4-s delays. Results indicted that delay affected the ability to estimate reachability with MI but not with VI. These results are supportive of a general distinction between vision for perception and vision for action.

Estimation of reach in peripersonal and extrapersonal space: a developmental view.

This study explored the developmental nature of action processing via estimation of reach in peripersonal and extrapersonal space. Children 5 to 11 years of age and adults were tested for estimates of reach to targets presented randomly at seven midline locations. Target distances were scaled to the individual based on absolute maximum reach. While there was no difference between age groups for total error, a significant distinction emerged in reference to space. With children, significantly more error was exhibited in extrapersonal space; no difference was found with adults. The groups did not differ in peripersonal space; however, adults were substantially more accurate with extrapersonal targets. Furthermore, children displayed a greater tendency to overestimate. In essence, these data reveal a body-scaling problem in children in estimating reach in extrapersonal space. Future work should focus on possible developmental differences in use of visual information and state of confidence.

Perceived reachability in single- and multiple-degree-of-freedom workspaces.

In comparisons of perceived (imagined) and actual reaches, investigators consistently find a tendency to overestimate. A primary explanation for that phenomenon is that individuals reach as a "whole-body engagement" involving multiple degrees of freedom (m-df). The authors examined right-handers (N = 28) in 1-df and m-df workspaces by having them judge the reachability of targets at midline, right, and left visual fields. Response profiles were similar for total error. Both conditions reflected an overestimation bias, although the bias was significantly greater in the m-df condition. Midline responses differed (greater overestimation) from those of right and left visual fields, which were similar. Although the authors would have predicted better performance in the m-df condition, it seems plausible that if individuals think in terms of m-df, they may feel more confident in that condition and thereby exhibit greater overestimation. Furthermore, the authors speculate that the reduced bias at the side fields may be attributed to a more conservative strategy based in part on perceived reach constraints.

Quality of life and coping strategies in Lebanese Multiple Sclerosis patients: A pilot study.

Coping strategies used by Multiple Sclerosis patients play a key role in adjusting to the disease and affect their overall quality of life. This relationship has been investigated in developed countries, but none has been studied in developing ones such as Lebanon. Factors including barriers to health care delivery, economic pressure and political instability influence which coping strategies are used and often increases the use of negative coping mechanisms. The current pilot study explored the association between different coping strategies with quality of life and depression, anxiety, fatigue and social support in 34 Lebanese Multiple Sclerosis patients. Results indicated that Multiple Sclerosis patients using positive coping strategies had significantly higher scores of quality of life (U=46, p=.038) and social support (U=33.5, p=.011), and lower depression (U=44, p=.030) and anxiety levels (U=46.5, p=.038) as compared to those using negative coping strategies. Specifically, escape avoidance coping strategy was associated with poor quality of life scores (r=-.609, p<.0001) and high levels of depression (r=.534, p=.001), anxiety (r=.530, p=.001), and fatigue (r=.401, p=.019). Comprehensive assessment of Multiple Sclerosis taking into account coping strategies is needed to develop proper therapeutic interventions which increase quality of life. Future studies are required to confirm these results.

Hand effects on mentally simulated reaching.

Within the area of simulated (imagined) versus actual movement research, investigators have discovered that mentally simulated movements, like real actions, are controlled primarily by the hemispheres contralateral to the simulated limb. Furthermore, evidence points to a left-brain advantage for accuracy of simulated movements. With this information it could be suggested that, compared to left-handers, most right-handers would have an advantage. To test this hypothesis, strong right- and left-handers were compared on judgments of perceived reachability to visual targets lasting 150 ms in multiple locations of midline, right- and left-visual field (RVF/LVF). In reference to within group responses, we found no hemispheric or hand use advantage for right-handers. Although left-handers revealed no hemispheric advantage, there was a significant hand effect, favoring the non-dominant limb, most notably in LVF. This finding is explained in regard to a possible interference effect for left-handers, not shown for right-handers. Overall, left-handers displayed significantly more errors across hemispace. Therefore, it appears that when comparing hand groups, a left-hemisphere advantage favoring right-handers is plausible.

HIV/AIDS in Lebanese prisons: challenges and proposed actions.

PURPOSE: The purpose of this paper is to discuss the extent of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) crisis in Lebanese prisons, propose functional reforms for Roumieh prisons (the country's largest male top-security prison), and outline the main challenges to HIV/AIDS prevention, intervention, and treatment. DESIGN/METHODOLOGY/APPROACH: All recommendations were based on previous successful stories, international prison standards as well as cultural considerations. FINDINGS: This paper argues that prevention and interventions starts within the prison community including inmates, guards, and other prison and provision of appropriate health care, education, and prison infrastructure. SOCIAL IMPLICATIONS: These strategies are not only important in limiting prevention and transmission of HIV/AIDS, but also contribute in optimizing quality of life within the prison system. ORIGINALITY/VALUE: This paper is the first of its kind to discuss the prison situation in Lebanese prisons in terms of public health promotion and reforms.

HIV/AIDS prisoners: a case study on quality of life in Roumieh, Lebanon.

Prisons often lack the basic health services required by HIV/AIDS patients. As with many other chronic illnesses, the treatment of HIV is expensive in terms of medication, hygiene, testing and staff training. Strategies to combat the disease have been thoroughly developed, particularly in Europe (WHO/UNAIDS, 2006). The purpose of this study was to assess quality of life (QOL) of the only 5 reported cases of HIV/AIDS patients in Roumieh prison (the country's largest male top-security prison) using the WHOQOL and the WHO guidelines on HIV infection and AIDS in prison. Virtually all prisoners reported that their rights had been violated. Isolation measures were taken to prevent the spread of the disease. According to UNAIDS, this particular measure has been proven ineffective. In conclusion, other approaches should be implemented to respect inmates' rights and reduce transmission of the virus.

Does target viewing time influence perceived reachability?

This study examined the influence of target viewing time on perceived (estimates of) reachability. Right-handed participants were asked to judge the simulated reachability of midline targets using their dominant limb in viewing conditions of 150 ms, 500 ms, 1 s and 2 s. Responses were compared to actual maximum reach. In reference to percent error, interestingly, the 150 ms condition revealed the least error at peripersonal targets and the most inaccuracy with distal (extrapersonal) targets. This condition was also distinct with a significant overestimation bias -- a common observation in earlier studies. However, with increasing viewing time this bias was reduced. These data provide evidence that 150 ms is effective for estimating reach within one's general peripersonal workspace. However, with judgments distal from that point, more time enhanced accuracy, with 500 ms and 1 s being optimal. Overall results are discussed relative to perceptual effectiveness in programming reaching movements.

Visual cues and perceived reachability.

A rather consistent finding in studies of perceived (imagined) compared to actual movement in a reaching paradigm is the tendency to overestimate at midline. Explanations of such behavior have focused primarily on perceptions of postural constraints and the notion that individuals calibrate reachability in reference to multiple degrees of freedom, also known as the whole-body explanation. The present study examined the role of visual information in the form of binocular and monocular cues in perceived reachability. Right-handed participants judged the reachability of visual targets at midline with both eyes open, dominant eye occluded, and the non-dominant eye covered. Results indicated that participants were relatively accurate with condition responses not being significantly different in regard to total error. Analysis of the direction of error (mean bias) revealed effective accuracy across conditions with only a marginal distinction between monocular and binocular conditions. Therefore, within the task conditions of this experiment, it appears that binocular and monocular cues provide sufficient visual information for effective judgments of perceived reach at midline.

Motor imagery in reaching: is there a left-hemispheric advantage?

The study of motor imagery affords an attractive approach in the quest to identify the specific aspects of cognitive and neuromotor mechanisms and relationship involved in action processing. Here, the authors investigated the recently reported finding that compared to the left-hemisphere, the right brain is at a significant disadvantage for mentally simulating reaching movements. The authors investigated this observation with strong right-handers that were asked to estimate the imagined reachability of visual targets (presented at 150 ms) at multiple points at midline, right- and left visual field; responses were compared to actual maximum reaching distance. Results indicated that individuals are relatively accurate at imagined reachability, with no significant distinction between visual field responses. Therefore, these data provide no evidence to support the claim that the right hemisphere is significantly inferior to the left hemisphere in estimations of motor imagery for reaching. The authors do acknowledge differences in the experimental task and subject characteristics compared to earlier work using split-brain and stroke patients.

Perceived reachability in hemispace.

A common observation in studies of perceived (imagined) compared to actual movement in a reaching paradigm is the tendency to overestimate. Of the studies noted, reaching tasks have been presented in the general midline range. In the present study, strong right-handers were asked to judge the reachability of visual targets projected onto a table surface at midline, right- (RVF), and left-visual fields (LVF). Midline results support those of previous studies, showing an overestimation bias. In contrast, participants revealed the tendency to underestimate their reachability in RVF and LVF. These findings are discussed from the perspective of actor 'confidence' (a cognitive state) possibly associated with visual information, perceived ability, and perceived task demands.