Saturday, January 25, 2020
Analysing a Company: DHL
Analysing a Company: DHL          The aim of this strategic planning document is to thoroughly analyze a company and based on the analysis find the right strategy that fits the companys business purpose and mission. The right strategy, depending at what is directed, should help the company strengthen its position on the market; increase profits; help with further development. If a company implements a wrong strategy, it can cause bad damage or it can have huge financial impact on the company which could even end up in bankruptcy, which wipes the company off the market. The company chosen for this paper is DHL Express with focus on European region. DHL is part of the Deutsche Post DHL (further DP DHL) brand/group. The reason why I have chosen DHL for the Strategic Planning Document is that I have been working for DP DHL group for four years. I work specifically for IT Services which is the service line that internally supports the whole IT technology of the whole DP DHL group. ABOUT THE COMPANY          DHL was founded in San Francisco exactly 40 years ago by 3 budding entrepreneurs Adrian Dalsey, Larry Hillblom and Robert Lynn. It went from small company shipping papers by airplane from San Francisco to Honolulu1 to global company shipping EVERYTHING around the world. DHL delivers time-critical shipments as well as goods and merchandise by road, rail, air or sea. DHL transports courier and express shipments via one of the worlds most extensive networks to over 220 countries and territories. The company employs more than 300,000 employees all around the world.          DHL Express provides wide range of easily accessible services and solutions for their customers; from transport of letters, information to transport of parcels and goods. It operates in more than 220 countries around the world and employs more than 100,000 employees. DHL Express is number one in Europe with 25% of market share. Brief history 2 1969 DHL founded by Adrian Dalsey, Larry Hillblom and Robert Lynn in San Francisco; 1974 The first UK office opened in London. Globally, DHL had more than 3,000 customers; 1979 DHL extends its services to delivering packages. Only document services had been available until now. 1983 DHL is the first air express forwarder to serve Eastern European countries. An international distribution centre was opened in Cincinnati, USA; 1985 A state of the art hub was opened in Brussels. More than 165,000 shipments are handled per night 1998 Deutsche Post became a shareholder in DHL; 2002 Deutsche Post World Net became the major shareholder in DHL and 100% shareholding was completed by the end of the year. DHL: Our Company Portrait [online]. Available at www: DHL: Steps to success [online]. Available at www: 2005 DP DHL acquires Exel, the British logistics corporation. Exel primarily offers transport and logistics solutions for key customers; 2008 DHL opens new state of art European air hub at Leipzig/Halle Airport in Germany. DHL legally operates under Groups title defined as Deutsche Post AG and uses its brand name DHL. As previously mentioned DHL is part of DP DHL group and is formed by 3 divisions: Express, Global Forwarding, Freight and Supply Chain supported by internal services Global Business Services. Mail is a standalone division that is part of Deutsche Post brand. All four divisions together create Deutsche Post DHL as the picture below describes. DP DHL: Corporate Presentation, October 2009, p. 3 [online] Available at www. DHL has a divisional form of structure. The DP DHL group is organized into four operating divisions, each of which operates under the control of its own divisional headquarters. The Group management functions are performed by the Corporate Center. Management responsibilities are structured in accordance with decision-making, responsibility and reporting lines: Board departments Corporate departments Business departments Service departments Regions Departments DHL Express provides standardized products and services courier, express and parcel (CEP) both locally and globally depending on the country. Whether it is document or parcel, road or air, DHL Express provides several different types of services that are divided to four basic groups: 1. Same Day An immediate pick-up of a shipment by a dedicated courier, with an emergency delivery within the same day via a dedicated network. 2. Time Definite Express door-to-door delivery by a certain time on an overnight or next possible business day basis. 3. Day Definite Reliable door-to-door delivery within a certain number of days 4. Optional Services Shipping convenience with a range of optional services to support your express transportation DP DHL: Annual Report 2008, p. 22 [online] Available at www. DHL: Express Services Good afternoon [online]. Available at www: External Analysis Courier Express and Parcel (CEP) services exist in every single country around the world. It is neither country specific nor region specific industry. There are thousands of logistics companies operating locally or internationally around the world and Europe is not an exception. PESTLE PESTLE analysis is a view on external environment companies operates in. There are five external factors that influence life of organizations: Political environment, Economical environment, Socio-cultural environment, Legal environment and Environmental factor. The below PESTLE analysis focuses on CEP companies in European market. Political Environment          European region is stable environment that is not affected by any significant political crisis in countries and no major changes in political structure are expected in near future. More than half of European states are integrated into European community, European Union and create one of the biggest single markets for trade and investment in the world. EU enlargement has removed border lines and has made trade and business more accessible for its members. It has brought greater opportunities for businesses, wider range of companies and benefits for their customers.          EU has created closer links with immediate neighbors and enables bigger exports, free movement of services, payments and capital for trade and investment. Prior liberalization in 90s there were many national postal operators acting as monopolies. EU decided to start postal reform that firstly completely liberalized CEP market. Liberalization has enabled both national postal operators (Post Offices) and private postal companies to enlarge their business portfolio into parcel and express market. This happens through acquisitions of well-established companies and smaller national companies. Exactly, as it happened to DHL through acquisition by Deutsche Post in 2002. Full liberalization in Europe will be completed by 2012 which gives current companies time to strengthen their positions, build new networks and gain wider portfolio of customers. EU has also built up confidence in European political and economical future of each member which enables companies to make longer term decisions, strategies and investment plans. Currently the CEP market is highly competitive and companies have to have capital to establish strong and powerful position in such an environment and have to have built up networks supported by the modernist technologies. Summary: Europe is stable environment where no major political changes are expected. Full liberalization of European postal market that will be finished by 2012 will bring more competition especially on domestic level. However, there is a potential to merge or acquire those companies operating in the local markets and increase market share. Big companies operating on international level have an advantage of built global networks and modern technology behind them. Economical Environment CEP is highly potential market and its growth is directly related to the level of GDP. Global trade is on the rising level and together with industrialization has made CEP services more important for majority of industries. Additionally, product life cycles have been reduced, quality awareness among customer is growing and in order to succeed companies are forced to maintain high quality standards. The global economic crises caused decline in economy and it has affected the entire logistics sector. Volume of shipments decreased and the recession slowed down the whole market. Even the big corporations have to fight with decreased revenues and change their investment plans and business strategies. Governments around Europe support investment plans by structural reforms and programs that encourage investors to invest. During the big economic crisis in 30s this did not happen and governments tended to act individually without multinational or even global cooperation. Todays economies learnt from those mistakes which help to lower the implications, increase customer demand and support start of growth. Due to the crisis companies changed their investment plans but did not stop them. Merges with smaller companies, agreements and strategic acquisitions represent one way of increasing the competitive advantage. Emerging markets represent big opportunity in long-term perspective. There is potential for investment and development in emerging markets and it is expected that industrialization will bring opportunities, the economy will growth and market for services will accelerate. The crisis negatively affects profits of every company on one hand but on the other hand big corporations with strong brand and position in the market have to exploit this opportunity. Smaller companies do not have potential to expand because they are in bigger risk of losing money or even bankruptcy if they fail. Big corporations are able to absorb that risk much easier. Companies have started to reduce cost and people have started losing their jobs. Restructuring of company structure is one of the way how to move forward. IT is core element of every company that operates in logistics industry. Companies have to invest huge amount of money to development and maintenance of their IT infrastructure. Recent trend leaves development in Europe and transfers hosting and maintenance of the infrastructure to Asia. Summary: Conclusion from the Economical environment analysis is that companies should not stop their investment plans because of economic crisis. It is important in current situation to strengthen position in the market and expand if possible. Emerging markets represent a potential of rapid economy growth. The risk of loss is the same for all companies but for big corporations is more acceptable. Reduction of cost is evitable for every company and restructuring or outsourcing are the ways of dealing with it. Socio-Cultural Environment The third aspect of PESTLE analysis focuses on forces within society. Social and cultural forces affect customers attitudes, interests and opinions. Companies must be able to offer products and services that aim to complement and benefit customers needs and wants. If they do not quickly respond to changes in society they will lose market share and demand for their product or service will decrease. Removing of border lines makes trade and business in Europe more accessible. Emerging markets are place that is constantly developing and rapidly growing. Although the infrastructure is not as developed as in Western countries, there will be improvement with economic growth. It is important for the company to establish its brand and achieve good and reliable image and service quality among its customers. The portfolio of services that is offered in developing countries is not usually complete and focuses on the biggest needs and wants of the business. Companies do not have the only affect and responsibility to their customers. There are different parts of society they are in contact with. There are needs of employees, investors and the society as a whole. Research Development department play an important role in this area. Customer satisfaction surveys, employee satisfaction surveys, market surveys help the company to build its brand and image, increase employees commitment and shape public awareness. CEP market and logistics industry play one of the key roles in the economic growth globally not only within European market. Increases in volumes of goods transport has lead to higher CO2 emissions which according to climate scientists have direct affect on global warming. It is social cost for the society and governments discourage those social costs with fines, taxes and legislation. Companies responsibility is to decrease these cost and work with more efficient and environmentally friendly means of transport. Social cost have negative affect on customers spending but could be balanced by larger offer of environmental friendly oriented products. Summary: Social forces affect customers needs and wants and it is important for the company to know it and benefit from it. Therefore the role of Research Development is very important. Company has to respond to changes in society quickly not to loose market share and demand for services. Customer satisfaction surveys, market surveys, employee surveys play important role in building companys brand and image in the market. Border lines have been removed within EU and services are more accessible in the whole Europe. Emerging markets represent an opportunity for companies to enter and establish their brand and image. Additionally, there are also social costs for the society that companies have responsibility for. The affect on environment is significant and companies role is to decrease those costs by working with more efficient and environmentally friendly technology which is then balanced by larger portfolio of environmental friendly oriented customers. Technological Environment          Technology environment is vital part of every business that rapidly moves it forward. Technological innovations have changed the world and manner in which every business operates. Technology has created society expecting immediate results. Information exchange between customers, companies, people or any stakeholders is faster. That gives benefit to businesses as they can react quickly to any changes in the operating environment. However, the ability to quickly react also brings extra pressure on companies because they are expected to deliver on time and without any delays. Customers in service industry have to continuously face new challenges in planning, managing and monitoring their business processes. Companies in CEP market (and not only there) started offering customized logistics solutions to meet challenges: for example safety transport of sensitive products such as pharmaceuticals and vaccines to the healthcare industry done within a temperature-controlled environment. Operations in logistics industry is not only about cars, vans and aircraft there are other parts of infrastructure that needs technological development and improvement: posting, collection, sorting, transport, warehousing, delivery and last but not least Information Technologies. IT is core. Speed and reliability are key success factors to be able to meet standards and quality and gain advantage among competition.          It is important to pay special attention to IT area because service industry is fully dependent on it. Companies invest huge amount of money to development and maintenance of their IT infrastructure. As mentioned above IT is one of the key elements for logistics and operations processes. Systems must be accessible and available at all times; security is evitable unauthorized access to data and data manipulation must be prevented, to ensure that software is not delivered with defects or too late. Companies have to fight with decreased revenue and reduce their cost in times of economic crisis but importance of IT technology is so significant that they cannot stop investing in it. Otherwise there is a threat that they will fall behind and loose their market share.          Outsourcing or in other words subcontracting is a way of reducing cost in IT area. Development of new technologies, software or applications goes to another organization. Usually, the company is specialized in software development. Or hosting and maintenance of applications or services are transferred to another company. The decision whether to do in-house or outsource is often based on achieving lower production cost and usage of available resources in better way and focus energy on the core competencies of the business. Summary: Modern technology and environment is key to success of the company that helps to maintain or gain competitive advantage. IT is the most important technology factor for logistics business because speed and reliability are equal to success. However, there is an indisputable constant threat of falling behind.Investments to the modernist technologies are evitable and in times of economic crisis are much more important then anytime before. Company has to decide if it runs internal IT organization or if it outsources most of the services and reduce cost. Legal Environment Legal rules play a role in nearly every aspect of companys operation from state regulations through contracts to treatment of employees. Legal factor is very important because companies work within legislative framework where legislation can either place numerous obligations or can create market conditions beneficial for business. CEP market is regulated by Postal directive applicable in all EU states. Full liberalization process will be completed by 2012 which gives current companies time to strengthen their position, build new networks and get more customers before new competition arrive. CEP market was fully liberalized during 90s and no special license or authorization is required in most of the EU countries. Ten states of EU require companies to receive explicit decision of National regulatory authority that is called general authorization that enables them to start operating in those countries but it does not represent a barrier. General authorization document contains several conditions that are related to e.g. confidentiality of correspondence, restrictions on transport of dangerous goods, data protection standards, etc. As I said previously there are social cost for the society that must be balanced by companies obligations in terms of fines, taxes and additional legislations related to regulation of aircraft noise, regulations concerning emission standards, obligations to reduce greenhouse gas that forces companies to invest into more environmentally friendly means of transport. Summary: Legal factor is important for operations of every company. Companies have obligations like directives, taxes and rules that they must be aligned with to be able to operate in the market. Legal factor can either place numerous obligations on the company or can create market conditions beneficial for business. Liberalization is an example of the benefit. Removal of border lines together with liberalization enabled building and strengthening of positions in the logistics market. There are no special and expensive authorizations necessary in CEP industry which is another benefit for companies. On the other hand there are obligations that balance the above benefits in terms of fines, taxes and directives that are mainly related to environment. Companies are forced to invest into environmentally friendly operations. Environmental Analysis Transportation industry causes major impact on the green house gases in the atmosphere. Mobility has increased and brought many indisputable advantages that must be weighed against the social, economic and environment costs it causes. Countries issue legislation that forces companies to reduce emissions. Companies have started implementing projects that help them to find out ways how to reduce pollutions and to be compliant with issued legislation. Transportation companies are dependent on fossil fuels and to reduce their dependency they have to look for commercial vehicles and aircraft powered differently or non-conventionally. Change of vehicle is not the only option that would reduce air pollution there are other ways that companies could take: to make their business more efficient and effective, to reduce shipping time, to take uniform approach, to offer climate-neutral products or train employees. Research Development department plays important role in those projects because it helps to come up with new ideas, technologies, procedures and processes. Summary: Transportation industry has great effect on air pollution globally. It is undisputable fact and companies are forced to fulfill the requirements of governments to reduce their contribution on pollution of the global environment. Companies have started implementing projects that help them fulfill those requirements. Research Development department is key to the success of it. PESTLE Summary Based on the PESTLE analysis I have identified opportunities and threats that will be taken into account during the SWOT analysis. Opportunity: Full liberalization of European postal market that will be finished by 2012 brings new opportunities to increase market share by acquisitions or merges with other logistics companies or newly liberalized companies. Established companies wit big market share, global network and technology have competitive advantage. Opportunity: Border lines have been removed within EU and services are more accessible in the whole Europe. Emerging markets represent a potential of rapid economy growth therefore it is an opportunity for companies to enter and establish their brand and image and gain bigger market share. Threat: Role of Research Development department in the company is very important. Company has to respond to changes in society quickly not to loose market share and demand for services. Customer satisfaction surveys, market surveys, employee surveys play important role in building companys brand and image in the market. Threat: In times of economic crisis economy slowed down and revenue decreased. Reduction of cost is evitable for every company and restructuring or outsourcing are the ways of dealing with it. Threat: Social costs represent a responsibility of companies towards society. The affect of transportation and logistics companies on environment is significant and companies role is to decrease those costs by working with more efficient and environmentally friendly technology which is then balanced by larger portfolio of environmental friendly oriented customers. Companies are forced to invest into environmentally friendly operations by fines, taxes and directives placed by governments. Therefore, companies have started implementing projects that help them fulfill those requirements. Threat: Modern technology and environment is key to success of the company that helps to maintain or gain competitive advantage. IT is the most important technology factor for logistics business because speed and reliability are equal to success. However, there is an indisputable constant threat of falling behind. Investments to the modernist technologies are evitable and in times of economic crisis are much more important then anytime before. The role of Research Development is evitable here. Porters Five Forces          Courier Express Market is highly competitive market and its growth is directly related to growth of GDP. Customers of logistics companies are demanding. Technology improvements reduce product life cycles, quality awareness among customer is growing and in order to succeed companies are forced to maintain high quality standards. DHL Express has three biggest competitors in CEP market. They are UPS, TNT and FedEx. As you can see in the Picture 2 below DHL Express has the highest market share of 25% as a single company in Europe. All four major competitors operate internationally and have global network with good and modern technology behind them. The picture below also shows us that third of the European market is dismantled among small and medium sized companies that operates independently. European market portrait Customers of logistics companies vary from individuals to big industrial or manufacturing companies. All of them expect that the delivery service will be simple and convenient and that the delivery will be on time without any delay and in a good quality. Customers are more and more demanding because range of suppliers is broadening and they are looking for customized and innovative solutions for delivery of their goods. DP DHL: Annual Report 2008, p. 58 [online] Available at www. The range of offered products is wide but could be introduced in three basic categories: Courier services are fast, door-to-door pick up and delivery services of high-value goods or urgently required documents. Express services are time-sensitive, usually guaranteed services and have delivery time a specific day (in general the next day) and/or specific time. Parcel services are the transport of largely standardized packages with usually non-guaranteed delivery time of 2-3 days (Time-definite and Day-definite) Porters Five Forces mode will help me to analyze five forces that influence the logistics industry and better understand the environment in which DHL Express operates in and competitive advantage the company has or could gain. Threat of New Entrants HIGH          CEP market is large and very attractive to business. Everyone needs to deliver package or parcel. Everyone needs to use courier. Logistics industry is important and dominates to the service sector. It is very easy to entry. There are no special legal barriers, patents or licenses necessary to run the business. There are exceptions as described in PESTLE analysis but those exceptions do not represent impossible to achieve requirements. The market is still growing and there is an assumption that will grow further.          There are no border lines among members of EU which would threaten new companies to enter the CEP market. Company that wants to succeed in such a competitive environment has to have a good network that enables it to operate on local and international level. Good network requires time and financial investment. High technology standard is must. Companies have to protect themselves from the threats of new entrants therefore it is important for them to find ways to turn disadvantages in their favor. They have to capitalize from their historical experience and try to find better ways to provide their service. Current big players in CEP market are well established leaders that have significant cost advantage that is unavailable for the new entrants. Large companies have buying power that allows them to offer discounts to their customers. Simply, bigger the business is lower average unit cost they are able to produce. Customers loyalty is another important factor that increases barriers to entry for other competitors. Loyal and satisfied customer will be unlikely tempted to go to competitors or new entrants. Established companies usually do business set on long-term partnerships and contracts. The basic rule says that customers get everything they need or want.          There are many advantages that economies of scale gives to big corporations but there are also limitations that must be taken into account. Those limitations give competitive advantage to smaller and medium sized companies. Large companies are very complex and with higher complexity the product range is widening. This makes it difficult to succeed and be the best. Specialization and innovative ideas are crucial. Large companies are also known for their high level of bureaucracy which gives smaller companies big advantage because they can satisfy customer faster and it is what matters in logistics industry. Also large companies have thousands of employees with different labor relations in every country which causes additional legal cost. In case of powerful workers union it can decrease power of the company and make their operation more difficult especially in time of restructuring.          As I have mentioned modern technology is an important factor that significantly helps to increase market share and creates more barriers for new entrants. Outsourcing or off shoring are possibilities for companies to take advantage of other economies of scale and use their buying power and specialization in favor of further development. Summary:          In summary, logistics market is large and is attractive to business because when GDP grows the demand for services grows. There is no special barrier to entry. In fact, it is very easy to entry. The market is still growing and there is an assumption that will grow further. Successful companies have built networks that enable them to operate on local and international level. Good network requires time and financial investment. High technology standard is must. Historical experience and appearance in the market is an advantage for companies like DHL. Big companies and corporations use economies of scale in their favor. Bigger company can provide higher discount and has lower profit. Customers loyalty is another important factor that increases barriers to entry for other competitors because of long-term partnerships and contracts.          On the other hand there are also disadvantages for big companies that must be taken into
Friday, January 17, 2020
Disadvantages of Large Population of a Country in Relation to Development Essay
â€Å"Overpopulation is a curse to the society’s overall growth. Several countries facing this problem are trying to control their population growth. India, for example, has been introducing family planning programs to curtail the growth of its population.†Population growth in a country using a capitalist economic system means more demand for products and therefore economic growth. For a country with a low population and a lot of land, it can be an advantage especially if the distribution of wealth remains close to level so everybody can prosper. That’s not a long term solution for the planet however. The disadvantage is that population growth puts tremendous pressure on economic and ecological resources. In the long term, the world will have to come to terms with the fact that we are consuming at a faster rate than nature is able to produce right now. The consequences of not making an adjustment in an orderly manner will not be a pretty sight. Some of the underdeveloped and developing countries face the problem of over population. Too many mouths to feed and fewer natural resources on hand can have a devastating effect on the economy. Countries like India and China have large population. In India, population growth has been on a higher scale than what the country’s economy can handle. The prosperity of a nation depends upon the standard of living of its people. Developed countries, such as the US with less population provide a better standard of living for their people. The Americans have good food to eat, enjoy a luxurious living as compared to the people belonging to Sou th-East Asia. What are the disadvantages of overpopulation one may ask? Depletion of Natural Resources: The effects of overpopulation are quite severe. The first of these is the depletion of resources. The Earth can only produce a limited amount of water and food, which is falling short of the current needs. Most of the environmental damage being seen in the last fifty odd years is because of the growing number of people on the planet. They are cutting down forests, hunting wildlife in a reckless manner, causing pollution and creating a host of problems. Those engaged in talking about overpopulation have noticed that acts of violence and aggression outside of a war zone have increased tremendously while competing for resources. Degradation of Environment: With the overuse of coal, oil and natural gas, it has started producing some serious effects on our environment. Rise in the number of vehicles and industries have badly affected the quality of air. Rise in amount of CO2 emissions leads to global warming. Melting of polar ice caps, changing climate patterns, rise in sea level are few of the consequences that we might we have to face due to environment pollution. Conflicts and Wars: Overpopulation in developing countries puts a major strain on the resources it should be utilizing for development. Conflicts over water are becoming a source of tension between countries, which would result in wars. It causes more diseases to spread and makes them harder to control. Starvation is a huge issue facing the world and the mortality rate for children is being fuelled by it. Poverty is the biggest hallmark we see when talking about overpopulation. All of this will only become worse if solutions are not sought out for the factors affecting our population. We can no longer prevent it, but there are ways to control it. Rise in Unemployment: When a country becomes overpopulated, it gives rise to unemployment as there fewer jobs to support large number of people. Rise in unemployment gives rise to crime as people will steal various items to feed their family and provide them basic amenities of life. High Cost of Living: As difference between demand and supply continues to expand due to overpopulation, it raises the prices of various commodities including food, shelter and healthcare. This means that people have to pay more to survive and feed their families. Top 20 thought provoking effects of over population 1.More mouths to feed. 2.Lower standard of living. 3.Poverty. 4.Overcrowded cities. 5.Sickness and spreading of diseases. 6.Insufficient natural resources to provide adequate goods and services. 7.Inadequate facilities, such as housing, medical etc. 8.Problem of starvation and malnourished population. 9.Education facilities may not meet the requirements of the entire population. 10.Unemployment. 11.Higher crime rate due to unequal distribution of wealth and insufficient financial resources. 12.Environmental pollution. Trees are felled to make space for housing facilities. 13.Agricultural production is insufficient to meet the requirements of the entire population, which results in higher prices. 14.Money is diverted to ensure that the population is fed, rather than carrying out fundamental research. 15.Lower life expectancy. 16.People living in rural areas are not provided with employment opportunities. 17.Large number of people lives in unhygienic conditions. 18.Birth rate is high. 19.Due to lack of proper medical facilities death is also very high. People succumb to various diseases. 20.Child labor is common. To sustain themselves families force their children to work, rather than send them to school.
Thursday, January 9, 2020
Effectiveness of school-based interventions - Free Essay Example
Sample details Pages: 26 Words: 7949 Downloads: 4 Date added: 2017/06/26 Category Statistics Essay Tags: School Essay Did you like this example? ABSTRACT Introduction Background Don’t waste time! Our writers will create an original "Effectiveness of school-based interventions" essay for you Create order Obesity in both adult and children is fast becoming one of the most serious public health problems of the 21st century in developed and developing countries alike. It is estimated that approximately 10% of school age children. The prevalence of childhood overweight and obesity is ever on the increase in the UK as in the rest of the world. It is estimated that the prevalence of overweight and obesity among 2 10 year old children in the UK rose from 22.7%-27.7% and 9.9%-13.7% respectively between 1995 and 2003; these figures are set to increase unless something is done. School-based interventions offer a possible solution in halting obesity prevalence, because the school setting provides an avenue for reaching out to a high percentage of children (especially in the western world), opportunity for constant monitoring of children and the resources for anti-obesity interventions. Objectives To systematically review the evidence of the impact of school-based interventions to prevent childhood obesity on: Adiposity (primary objective) Knowledge, physical activity levels and diet (secondary objectives) Methods The review was done following the Cochrane collaboration guidelines. In addition to searching electronic databases, first authors of all included studies were contacted. A recognised critical appraisal tool was used to assess the quality of included studies. Results Three RCTs and one CCT met the inclusion criteria for the review. All four studies had a control and intervention group; with various study limitations. While none of the studies found statistically significant BMI changes in intervention groups when compared with control group post-intervention, all of them recorded either a significant change in diet, or an increase in physical activity levels. INTRODUCTION BACKGROUND Obesity is generally understood as abnormal accumulation of fat to the extent that presents health risk (Kiess, Marcus et al. 2004), and was added to the international classification of diseases for the first time in 1948 (Kipping, Jago et al. 2008). The worldwide clinical definition of adult obesity by the WHO is body mass index (BMI) 30kg/m2 (WHO 2006). In children however, because of the significant changes in their BMI with age (Cole, Bellizzi et al. 2000), there is no universally accepted definition of obesity (Parizkova and Hills 2004; Bessesen 2008) and it therefore varies from country-to-country. The most commonly used definition of childhood obesity is the US definition which measures overweight and obesity in a reference population using the cut off points of 85th and 95th centiles of BMI for age (Ogden, Yanovski et al. 2007). In the UK, overweight and obesity are diagnosed using a national reference data from a 1990 BMI survey of British children (Stamatakis, Primatesta e t al. 2005). Children whose weights are above the 85th centile are classed as overweight and over the 95th centile are considered obese (Reilly, Wilson et al. 2002). Recent estimates suggest that obesity has reached epidemic proportions globally with about 400 million adults being clinically obese, a figure projected to rise to about 700 million by 2015 (WHO 2006). In children, the current WHO estimates are that about 22 million children globally under age 5 are overweight (WHO 2008). In the UK, evidence suggests that obesity is set to be the number one preventable cause of disease in a matter of time (Simon, Everitt et al. 2005). In the last three decades, the scale as well as the prevalence of obesity have grown rapidly amongst all age, social and ethnic groups in the UK, as well as globally (Table 1)(Kipping, Jago et al. 2008). Estimates suggest that in the UK, between 1984 and 2002/2003, the prevalence of obesity in boys aged 5-10 rose by 4.16%, and by 4.8% in girls (Stamatakis, Primatesta et al. 2005). There is therefore there is an urgent need for the development and implementation of effective intervention strategies to halt the ever increasing obesity prevalence (Summerbell Carolyn, Waters et al. 2005). OBESITY CAUSATION The primary risk factors associated with the increase in prevalence of childhood obesity are ever increasing involvement in sedentary lifestyles and an increase also in the consumption of high energy dense food and drink (Ebbeling, Pawlak et al. 2002; Sekine, Yamagami et al. 2002; Speiser, Rudolf et al. 2005; Topp, Jacks et al. 2009). The underlying mechanism of obesity formation is an imbalance between energy input and expenditure (Moran 1999; Kipping, Jago et al. 2008) Genetic and environmental factors greatly influence the bodys energy balance. Nevertheless, genetic conditions which either cause production of excessive fat in the body or reduce the rate at which it is broken down, of which Prader-Willi syndrome is an example account for less than 5% of obese individuals (Speiser, Rudolf et al. 2005), with environmental factors accounting for a very high percentage (French, Story et al. 2001). The major cause of the rising obesity problem is arguably changes in physical and social environments (French, Story et al. 2001). In recent times, there has been a remarkable shift towards activities that do not promote energy expenditure, for example, most children would travel to school in cars rather walk, in contrast to what obtained in the 1970s (Popkin, Duffey et al. 2005; Anderson and Butcher 2006). There is evidence to suggest that obese children are less active than their non-obese counterparts, hence promoting physical activity such as walking or exercising will help prevent obesity in children (Hughes, Henderson et al. 2006). Media time (television viewing, playing video games and using the computer) has been identified as one of the significant environmental changes responsible for the surge in childhood obesity. Besides promoting physical inactivity, it encourages energy input via excessive snacking and inappropriate food choices as a result of television advertisements (Ebbeling, Pawlak et al. 2002; Speiser, Rudolf et al. 2005). Robinson in his study reveals that between ages 2 and 17, children spend an average of 3 years of their waking lifetime watching television alone (Robinson 1998). Parents play a significant role in where, what and how much their children eat and to an extent, how physically active their children are. In most homes, children make their food choices based on the options they are presented with by their parents, and they characteristically would go for wrong option, more so if they have an obese parent (Strauss and Knight 1999). Other changes within the family such as physical inactivity and working patterns of parents have contributed somewhat to the obesity epidemic. In a family where the parents work full-time, there tends to be very little time for them to prepare wholesome home-made meals and this could possibly explain the increasing demand for eating out (Anderson and Butcher 2006) thereby increasing intake of high energy dense food. Childrens attitude to and participation in physical activities depends largely on how physically active their parents are. Thus children of sporty parents embrace exercise heartily and are therefore less prone to becoming obese.(Sallis, Prochaska et al. 2000). In addition to these family factors, societal factors such as high crime rate, access to safe sports/recreational facilities, transportation and fewer physical education programs in schools significantly impact on energy balance (Koplan, Liverman et al. 2005; Popkin, Duffey et al. 2005; Topp, Jacks et al. 2009). French summarizes the environmental influence on obesity by opining that The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity (French, Story et al. 2001) CONSEQUENCES OF OBESITY Evidence suggests that childhood obesity and/or overweight has a great impact on both physical and psychological health; causing effects such as behavioral problems and low self esteem, with a higher risk in girls than in boys (Reilly, Methven et al. 2003). Although most of the serious consequences do not become evident until adulthood, research has shown childhood obesity to be linked to metabolic disorders such as insulin resistance and type 2 diabetes, stroke and heart attacks, sleep apnea, nonalchoholic fatty liver disease, higher incidence of cancers, depression, dyslipidaemia, increased blood clotting tendency, etc (Ebbeling, Pawlak et al. 2002; Reilly, Methven et al. 2003; Kiess, Marcus et al. 2004; D. A. Lawlor, C. J. Riddoch et al. 2005; Daniels 2006; WHO 2006). One of the long-term serious consequences of childhood obesity is that obese children are twice more likely to grow into obese adults than their non-obese counterparts (Moran 1999); however, this largely depends on factors such as age of onset, severity of the disease and the presence of the disease in one parent (Moran 1999; Campbell, Waters et al. 2001; Kiess, Marcus et al. 2004; WHO 2006). Other long term consequences include early death and adverse socio-economic consequences such as poor educational attainment and low/no income in adulthood (Reilly, Methven et al. 2003; Fowler-Brown and Kahwati 2004; Kiess, Marcus et al. 2004). Obesity-related morbidity places a huge and growing financial demand on governments. In the UK alone, the Department of Health has reported that obesity costs the NHS and the UK economy as a whole about ÂÂ £1b and between ÂÂ £2.3b ÂÂ £2.6b annually respectively, with the cost to the NHS projected to rise to ÂÂ £3.6b by 2010 (DH 2007). TREATMENT AND PREVENTION The treatment of obesity requires a multidisciplinary approach due to the multi-faceted nature of the condition (Parizkova and Hills 2004). This is aimed at reducing caloric intake and increasing energy expenditure through physical activity (Ebbeling, Pawlak et al. 2002). These interventions are more likely to be successful if the patients family is involved and the treatment tailored to individual needs and circumstances (Fowler-Brown and Kahwati 2004). In extreme cases, options such as surgical and pharmacological treatments could be exploited. These options are very unpopular and usually not recommended because the associated health risks outweigh the benefits by far (Epstein, Myers et al. 1998; Ebbeling, Pawlak et al. 2002). Considering the huge costs and high levels of treatment failure associated with obesity treatment (Stewart, Chapple et al. 2008), the axiom by Benjamin Franklin cannot describe any other condition better than it describes obesity management. An ounce of prevention is worth a pound of cure Dietz et al confirm this by saying that prevention remains the best and most effective management of obesity (Dietz and Gortmaker 2001). Obesity prevention interventions are usually set either in the home or at school with an objective of eliminating peer pressure and, by so doing effect behavioral change (Ebbeling, Pawlak et al. 2002). Literature suggests that the school has so far remained the choice setting for these preventive interventions despite the very limited evidence on its effectiveness (Birch and Ventura 2009). Why is the school setting a good focus of intervention? Approximately 90% of children are enrolled in schools in developed countries (Baranowsk, Cullen et al. 2002) Children spend a substantial amount of time in school and therefore consume a considerable proportion of their daily calories at school (Katz, OConnell et al. 2005) School related activities present an opportunity to educate children on the concept of energy balance, healthy living and how to make appropriate food choices (Ebbeling, Pawlak et al. 2002; Koplan, Liverman et al. 2005) It offers opportunity for continuity and constant monitoring via frequent contact (Baranowski T 2002) Schools have an availability of existing manpower and facilities needed for anti-obesity interventions (Kropski, Keckley et al. 2008) In a nut shell, Schools offer many other opportunities for learning and practicing healthful eating and physical activity behaviors. Coordinated changes in the curriculum, the in-school advertising environment, school health services, and after-school programs all offer the potential to advance obesity prevention (Koplan, Liverman et al. 2005). PREVIOUS SYSTEMATIC REVIEWS Systematic reviews have been conducted on the effectiveness of school-based interventions in the prevention of childhood obesity. Campbell et al (2001), conducted a systematic review of 7 randomised control trials (RCTs) (6 were school-based, varying in length of time, target population, quality of study and intervention approach). The review found that dietary and physical education interventions have an effect on childhood obesity prevalence. However, success varied with different interventions amongst different age groups. Two of the three long term studies that focused on a combination of dietary education and physical activity, and dietary education respectively reported an effect on obesity prevalence reduction. Similarly, 1 out of the 3 school based short-term interventions that focused only on reducing sedentary activity also found an effect on obesity prevalence. While this review shows that dietary and physical activity interventions based at school are effective against th e risk factors of obesity, the question of generalisability and reproducibility arises as the review reports the majority of the included primary studies were carried out in the US. Most of the studies used BMI as a measure of adiposity, and BMI as has been documented varies across ethnic and racial groups (Rush, Goedecke et al. 2007), thus, it will be inappropriate to apply the findings of US-based obesity prevention interventions to children in middle and low income countries where conditions are different. There are also concerns about the methodology and study design. For example the school-based study by Gotmaker et al (1999) had limitations such as low participation rate (65%) and the researchers were unable to adjust for maturity in boys and there was also poor assessment of dietary intake. All these limitations could have been responsible for a high percentage of the reported intervention effect thus affecting the validity of the results of the study (Gortmaker, Peterson et al. 1999). The authors of the review however concluded that there is currently very limited high quality evidence on which to draw conclusions on the effectiveness of anti-obesity programmes. A Cochrane review which is an update of the Campbell et al (2001) study by Summerbell et al (2005) has examined the impact of diet, physical activity and/or lifestyle and social support on childhood obesity prevention. Their review examined the effectiveness of childhood obesity prevention interventions which included school based interventions. Their study included 10 long-term (a minimum duration of 12 months) and 12 short-term (12weeks 12 months) clinical trials (randomised and controlled). 19 out of the 22 studies that met their inclusion criteria were school/pre-school based. The study chose the appropriate study type; more than one reviewer was involved in the entire process of data collection, extraction and selection of included studies. In general, the study found that most of the school-based interventions (dietary and/or physical activity) reported some positive changes in targeted behaviours, but however had very little or no statistically significant impact on BMI. The reviewers stated that none of the 22 studies fulfilled the quality criteria because of some form of methodological weakness which includes measurement errors. For instance, the study by Jenner et al (1989) had no valid method of measuring food intake. The studies by Crawford et al (1994), Lannotti et al (1994) and Sallis et al (2000) had similar measurement errors. Reporting error was identified in studies by Little et al (1999) and Macdiarmid et al (1998). There were also reliability concerns about the secondary outcomes measurement in some of the included studies. The reviewers therefore expressed the need for further high quality research on effectiveness. Kropski et al (2008) reviewed 14 school-based studies that were designed to effect a life style change, a change in BMI, decrease overweight prevalence through a change in nutrition, physical activity or a combination of both. Of the 14 studies, three were done in the UK, one in Germany and 10 in the US. The right type of studies were chosen for this review and the whole process was done by more than one reviewer, however they were unable to draw strong conclusions on the efficacy of school-based interventions because of the limited number of primary studies available and methodological or design concerns which include: small sample size (Luepker, Perry et al. 1996; Mo-suwan, Pongprapai et al. 1998; Nader, Stone et al. 1999; Warren, Henry et al. 2003), no intention-to treat analysis (Danielzik, Pust et al.; Sallis, McKenzie et al. 1993; Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003), possibility of type I (Coleman, Tiller et al. 2005) and type II errors (Warren, Henry et al. 2003), unit of analysis errors (Sallis, McKenzie et al. 1993) and inconsistent results (Mo-suwan, Pongprapai et al. 1998; Caballero, Clay et al. 2003; Coleman, Tiller et al. 2005). Despite their inability to draw a conclusion on effectiveness, overall, the review found that a combination of nutritional and physical activity interventions had the most effect on BMI and prevalence of overweight, with the result largely varying from community-to-community. The nutrition only and physical activity only interventions appeared to have had a change on lifestyles of participants but either had no significant effect on the measures of overweight or no BMI outcomes were measured. Another systematic review on the effectiveness of school-based interventions among Chinese school children was carried out by M.Li et al (2008). The authors included 22 primary studies in their review. The review reported that the primary studies showed that there are some beneficial effects of school-based interventions for obesity prevention; the reviewers however expressed their concerns that most of the studies included in the review had what they considered to be serious to moderate methodological weaknesses. Sixteen of the 22 studies included studies were cluster control trials, and there was no mention by any of the researchers that cluster analysis was applied to any of the 16 studies. In addition to lack of cluster analysis, no process evaluation was conducted in any of the studies. Only one study performed an intention to treat analysis. Twelve studies experienced dropouts, but there was incomplete information on the study population at the end of the trial and the reason f or the dropouts. Additionally, none of the studies explained the theory upon which they based their intervention. There was also potential recruitment and selection bias in all the primary studies as identified by the reviewers. They stated that none of the studies reported the number of subjects that were approached for recruitment into the study. As none of the RCTs included described the method they used in randomization, neither did they state if the studies were blinded or not. The methodological flaws in a high percentage of the included primary studies could impact on the validity of the findings of the review. Again, the authors failed to reach a conclusion on the effectiveness of the interventions because of the intrinsic weaknesses found in the primary studies, and as a result state the need for more primary studies that would address the methodological weaknesses that is highly present in nearly all existing primary studies conducted on this topic so far. The study of the efficacy of school-based interventions aimed at preventing childhood obesity or reducing the risk factors is a rather complex one. Pertinent issues on effectiveness of school-based interventions to prevent the risk factors of obesity remain that there is very limited/weak evidence on which to base policies on. Heterogeneity of primary research (in terms if age of study population, duration of intervention, measurement of outcomes and outcomes measured) makes further statistical analysis nearly impossible. BMI is currently the most widely used measure of overweight and obesity in children. However, BMI has no way of distinguishing between fat mass and muscle mass in the body and might therefore misdiagnose children with bigger muscles as obese. Another disadvantage of using BMI in overweight measurement is its inability of depicting the body fat composition (Committee on Nutrition 2003), other surrogate indicators of adiposity may be needed. Most authors that have carried out a review on this topic so far have expressed the need for further research on this topic to add to the existing body of evidence. RATIONALE FOR THIS STUDY All the systematic reviews on this subject so far have focused mainly on the United States. Lifestyle differences such as eating habits between American and British children possibly affect generalisability and reproducibility of US findings to the UK. For example, in the US, research has shown that 0.5% of all television advertisements promote food, and that about 72% of these food advertisements promote unhealthy food such as candy and fast food (Darwin 2009). In the UK paradoxically, the government in 2007 enforced regulations banning television advertisement of unhealthy foods (foods with high fat, salt, and sugar content) during television programmes aimed at children below 16 years of age (Darwin 2009). Thus US children are at a higher risk of becoming obese than their UK counterparts as a result of higher rate of exposure to TV junk food advertisements. Another lifestyle difference between American and British children is physical activity. In the UK, a high percentage of children aged 2 to 15 achieve at least 60 minutes of physical activity daily (about 70% of males and 60% of females) (DoH 2004), as opposed to the US where only about 34% of school pupils achieve the daily recommended levels of physical activity daily (CDC 2008). These differences highlight the importance of public health policies being based on the local population characteristics rather than on imported overseas figures. There is therefore need to review the evidence of UK school-based obesity interventions to inform policy relevant to the UK population. To the best of my knowledge following an extensive literature search, no systematic review has been conducted on the effectiveness of school-based intervention in preventing childhood obesity in the UK, despite the high prevalence of the condition and its public health significance in this country. This research aims to bridge this gap in knowledge by focusing on UK based studies to evaluate the efficacy of school-based interventions in the UK population. This study therefore stands out insofar as it will be assessing the effectiveness of school-based interventions in the reducing the risk factors of obesity in the UK, with a hope of providing specific local recommendations based on UK evidence. This type of review is long overdue in the UK, considering that the governments target to reduce childhood obesity to its pre-2000 levels by the year 2020 (DoH 2007) will require local evidence of effective interventions to succeed. The next stage of this review will describe in detail the research methodology to be used to conduct the proposed systematic review. Also included will be research strategy details to be adopted, study selection criteria, data collection and analysis. AIMS AND OBJECTIVES The aim of this research is to: Systematically review school-based intervention studies in the UK aimed at reducing the risk factors of childhood obesity among school children. Objectives are: To assess the efficacy of school-based anti-obesity interventions in the UK. To identify the most effective form of school-based interventions in the prevention of childhood obesity amongst school children in the UK. CRITERIA FOR INCLUDING STUDIES IN THIS REVIEW METHODS This review was performed as a Cochrane review. The Cochrane guidance on systematic reviews and reporting format were as far as possible adhered to by the author (Green, Higgins et al. 2008). The entire review process was guided by a tool for assessing the quality of systematic reviews, alongside the accompanying guidance (health-evidence.ca 2007a; health-evidence.ca 2007b). TYPES OF STUDY In the search for the effectiveness of an intervention, well conducted randomised control trials (which are the best and most credible sources of evidence) will be the preferred source of studies for this review. However, because of the limited number of RCTs conducted on this topic so far, this study will include controlled clinical trials if there is insufficient availability of RCTs. TYPES OF PARTICIPANTS School children under 18 years of age TYPES OF INTERVENTIONS Interventions being evaluated are those that aim to: Reduce sedentary lifestyle Effect nutritional change Combine the two outcomes above Reduce obesity prevalence Effect an attitude change towards physical activity and diet Studies that present a baseline and post intervention measure of primary outcome. Interventions not included in this study are: Those with no specified weight-related outcomes Those that involved school-age children but were delivered outside of the school setting, as our focus is based on school-based interventions aimed at obesity prevention. Studies done outside the UK Studies with no specified interventions Non-RCTs or CCTs For each intervention, the control group will be school children not receiving the intervention(s). TYPES OF OUTCOMES MEASURED Primary outcomes Change in adiposity measured as BMI and/or skin fold thickness Secondary outcomes Knowledge Physical activity levels Diet SEARCH METHODS FOR IDENTIFICATION OF STUDIES Electronic searches The electronic databases OVID MEDLINEÂÂ ® (1950-2009), PsycINFO (1982-2009), EMBASE (1980-2009) and the British Nursing Index (1994-2009) were all searched using the OVID SP interface. The Wiley Interscience interface was used to search the following databases: Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects. There was also a general search of internet using Google search engine, in an attempt to identify any ongoing studies or unpublished reports before proceeding to search grey literature sources. Grey literature For references to childhood obesity prevention in schools, the following grey literature sources were searched: British Library Integrated Catalogue (https://catalogue.bl.uk/F/?func=filefile_name=login-bl-list) ISI index of Conference Proceedings (https://wok.mimas.ac.uk/) SCIRUS (https://www.scirus.com/) System for Information on Grey Literature (https://opensigle.inist.fr/) ZETOC (https://zetoc.mimas.ac.uk) Additionally, current control trials database at https://www.controlled-trials.com/ was searched for any ongoing research. The UK national research register was also searched at https://portal.nihr.ac.uk/Pages/NRRArchive.aspx. All the links to the grey literature databases were tested at the time of this review and found to be working. Hand searches It was not possible to conduct a hand search of journals due to pragmatic reasons. Reference lists Reference lists of retrieved studies were searched for other potential relevant studies that might have been omitted in the earlier search. Correspondence First author of all included studies were contacted with a view to seeking more references. DATA COLLECTION AND ANALYSIS Selection of studies The abstracts and titles of the hits from the electronic databases searched were screened for relevance by a single assessor. Those that were thought to be potentially relevant were retrieved and downloaded unto EndnoteTM to make the results manageable and also avoid loss of data. At the end of the search, all databases were merged into one single database and duplicated records of the same study were removed. Subsequently, the assessor then sought and obtained the full text of, and reviewed the relevant studies that were considered eligible for inclusion. Multiple reports of same study were linked together. No further data were sought for studies not included in the review. Data extraction Data extraction from included studies was done by a single reviewer and the data recorded on a data extraction form. A summary of each included study was described according to these characteristics: Participants (age, ethnicity etc.), study design, description of school-based interventions, study quality and details such as follow-ups and date, location, outcomes measured, theoretical framework, baseline comparability and results Assessment of methodological quality of included studies A number of researchers (Jackson, Waters et al. 2005) and the Cochrane guidelines for systematic reviews of health promotion and public health interventions (Rebecca Armstrong, Waters et al. 2007) strongly advise using the Quality Assessment Tool for Quantitative Studies (2008a) developed by the Effective Public Health Practice Project in Canada and the accompanying dictionary (to act as a guideline) (2008b) in assessing methodological quality. Based on criteria such as selection bias, study design, blinding, cofounders, data collection methods, withdrawals and drop-outs and intervention integrity, the tool which is designed to cover any quantitative study employs the use of a scale (strong, moderate or weak) to assess the quality of each study included in the review. Analysis Considering the small number of studies included in the review and heterogeneity in terms of interventions, delivery methods, intensity of interventions, age of participants, duration of intervention and outcomes measured, it was not statistically appropriate to undertake a Meta analysis, which admittedly would have been the preferred method of analysing and summarising the results of the studies. A narrative synthesis of the results was done instead. RESULT DESCRIPTION OF STUDIES Results of the search The search of electronic sources identified 811 citations out of which 97 potential studies were retrieved. A reference management software EndnoteTM was used to search for and remove duplicate citations. Further screening of title and abstract reduced the number of citations to 17 potential studies. Full texts of the 17 studies were sought, 13 were excluded, and four met the inclusion criteria and were therefore included in the review. Authors of the four studies were then contacted in view to obtaining additional references. No relevant papers were retrieved through the grey literature search. There were no ongoing studies at the time of this review Included studies Four school based intervention studies carried out in the UK were included in the review. Intervention The aim of the Active Programme Promoting Lifestyle Education in Schools (APPLES) project in Leeds (Sahota, Rudolf et al. 2001), a multidisciplinary and multiagency programme was to reduce risk factors of obesity in primary schools by influencing dietary and physical activity behaviour, by promoting lifestyle education. The intervention was underpinned by the Health Promoting Schools philosophy and involved the whole school community including parents. In the Southwest of England, the Christ Church Obesity Prevention Programme (CHOPPS) (James, Thomas et al. 2004) aimed to prevent excess weight gain by discouraging the consumption of carbonated drinks amongst school children. On the other hand, a pilot study, the Active for life year 5 project in the South Gloucestershire aimed to examine the effects of lessons on physical activity, nutrition and screen viewing on time spent involving in sedentary activities. It also evaluated the feasibility of adapting lessons from a US intervention (Eat well and keep moving) for use in the UK. Fourthly, the aims of the Be Smart intervention in Oxford were to promote healthy diet and/or physical activity in school children and prevent childhood obesity. The development of this intervention was based on the Social Learning Theory. The four intervention programmes employed various media for the delivery of the interventions. The APPLES intervention, over one academic year in September 1996 to July 1997 targeted obesity by promoting healthy eating and physical activity via the school curriculum. The intervention was a multidisciplinary and multiagency programme that embarked on teacher training sessions, modification of school meals to exclude unhealthy foods, and the development of school action plans. Whilst the intervention group received this intervention, the comparison received no intervention. One of the two school based intervention project to involve parents was conducted in Oxford. The Be Smart intervention began in January 2000 and lasted for 20 weeks over four school terms. The intervention involved delivering a 25-minuite interactive and age-appropriate lesson to each intervention group at lunch-time clubs and targeted behavioural change. Four of the authors were involved in the delivery of the lessons, which was delivered weekly in term one and fortnightly in subsequent terms. To ensure continuity, the same author taught the same intervention to the same intervention group for the entire duration of the project. In South Gloucestershire, the Active for life year 5 intervention was conducted over a five-month period from February 2006 to June 2006. This intervention was a multi-component one which was adapted from the Eat Well Keep Moving project in the US. It involved delivering of interactive lessons on nutrition, physical activity and screen viewing by trained primary school teachers. Lastly, the CHOPPS intervention lasted for one school year from August 2001 to October 2002. The intervention was delivered by one of the authors, and was targeted at behavioural change by discouraging the consumption of carbonated drinks. Each class received a one-hour session each term. The first session focused on balance of good health and the ill-effects of carbonated drinks. The subsequent sessions comprised of music competition, presentation of art and a quiz based on a popular television game show. Study design All the four studies had RCT designs. However, the Be smart project (Warren, Henry et al. 2003) did not specify how randomisation was done. All programmes had an intervention and a control group for baseline and post-intervention comparison. The APPLES project (Sahota, Rudolf et al. 2001) was single-blinded and compared outcomes in primary school children aged 7-11 years in Leeds (intervention: n = 314, and control group: n = 322, Boys: 51% and girls: 49%) at baseline and at the end of the intervention. Evaluating outcomes in a slightly similar age group, the Active for Life Year 5 project, a double-blinded cluster RCT compared outcomes in 9-10 year old primary school children in SW England [Intervention schools = 10 clusters (n = 331), control = 9 clusters (n = 348)]. In Oxford, the Be Smart project (Warren, Henry et al. 2003) evaluated its intervention in 5-7 year old school children via a group RCT. There were 3 intervention groups (Eat smart: n = 56, Play smart: n = 54 and Play/E at Smart: n = 54) and a control group (Be Smart: n = 54). Finally, the CHOPPS (James, Thomas et al. 2004) project in SW England was a cluster RCT that assessed its intervention in 7-11 year old school children. There were a total of 19 clusters in the study [Intervention: 15 clusters (n=325); Boys: 169, Girls: 156, and control: 14 clusters (n = 319); Boys: 155, Girls: 164. Outcomes In all the four studies, the effect of the intervention was assessed by collecting the data on growth, measured in terms of BMI (height and weight). There was repeat measure of height and weight in all four studies at baseline, and at the end of the study for Active for life year 5 (Kipping, Payne et al. 2008), APPLES (Sahota, Rudolf et al. 2001) and CHOPPS interventions (James, Thomas et al. 2004). For the Be smart intervention, the repeat measure was taken a month post-intervention (Warren, Henry et al. 2003). Besides weight and height, the individual studies assessed other different outcomes. The Active for life year 5 intervention assessed time spent doing screen-viewing activities (Watching DVDs, television, Videos and playing computer games) and mode of transport to school using questionnaires completed by the children (at baseline and at the end of the study). The APPLES interventions additionally assessed the childrens diet (using a 24hour recall and 3-day food diaries), their knowledge on nutrition and physical activity (via focus group), their psychological state and how physical activity they are (both using questionnaires). In SW England, the CHOPPS project in addition to height and weight assessment, consumption of carbonated drink and water were also assessed (using 3-day diaries completed by the children). Nutrition knowledge, physical activity and diets were also assessed using questionnaires in the Be smart intervention in Oxford. Excluded studies Thirteen published studies were excluded from this review. The reasons for excluding these studies are provided in Appendix 5 and include location (studies carried out outside the UK) and study design (non-RCTs or CCTs). Methodological quality of included studies In terms of overall quality, one of the four included studies has been rated as strong (James, Thomas et al. 2004), two as moderate (Sahota, Rudolf et al. 2001; Kipping, Payne et al. 2008) and one as weak (Warren, Henry et al. 2003). Three of the four studies had cluster RCT study designs (Sahota, Rudolf et al. 2001; James, Thomas et al. 2004; Kipping, Payne et al. 2008) whilst one had a CCT design (Warren, Henry et al. 2003). Of the three RCTs, only one reported blinding of both participants and assessors (Kipping, Payne et al. 2008). Number of participants in all four studies ranged from 213 to 679 school children, and all studies reported follow-up of up to at least 80% of participants. In terms of cofounding, all four included studies reported that there were no significant baseline differences between the intervention and control groups, and as such rated were rated as strong (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004; Kipping, Payne et al. 2008). Validity and reliability of data collection tools were addressed by all four studies, with a few of them identifying issues with validity. Collection tools used for height and weight in all four studies were reliable and valid. However, there were a few validity issues with the questionnaires used for assessing other outcomes such as physical activity and dietary intake. For example, the Active for Life Year 5 project expressed concerns that the questionnaires used for assessing physical activity though reliable, might not have been sufficiently valid (Kipping, Payne et al. 2008). Similarly, in the CHOPPS intervention, there were issues around validity of self collected diary data owing to the possibility of under-reporting by the children (James, Thomas et al. 2004). Again in the APPLES intervention project, problems with dietary and behaviour change assessments were reported (Sahota, Rudolf et al. 2001) Effects of interventions Only one of the four studies compared effectiveness of different types of school based interventions (Warren, Henry et al. 2003). Adiposity Only two of the four studies measured adiposity using indices other than BMI. The Be smart programme (Warren, Henry et al. 2003) measured skin-fold thickness at five sites using a Holtain skinfold calipers. Waist circumferences were also measured at four sites using a standard tape measure. However, there was no comparison either at baseline or post intervention of adiposity between the intervention and control groups using these measures. Similarly, the CHOPPS programme (James, Thomas et al. 2004) measured waist circumference at the point of flexure as the child bends to one side (deducting 1cm to account for clothing). The scores were converted to z scores and comparisons were made between the intervention and control groups. However, no significant changes were observed. BMI All four studies reported results for BMI in terms of height and weight, and found no significant differences between control and intervention groups at the end of the studies (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004; Kipping, Payne et al. 2008). Height and weight measurements were taken using standardised measurement tools in all four studies. Although all the studies reported no significant BMI differences, in terms of the number of overweight children, the CHOPPS intervention (James, Thomas et al. 2004) recorded a 7.5% increase in number of overweight children in the control clusters, compared with a 0.2% decrease in the intervention group (Mean difference 7.7%, 95% CI: 2.2% to 13.1%) at 12 months. At three-year follow-up however, the prevalence of overweight had increased in all the groups (intervention and control), which meant that the significant difference previously recorded at the end of the study was no longer evident. Knowledge Two of the four studies assessed the childrens knowledge about physical and nutritional education at baseline and post intervention. The Be smart intervention(Warren, Henry et al. 2003) assessed nutrition knowledge using a questionnaire where children were shown pictorial representations of different kinds of food and asked to choose the one they thought was healthiest. The end of study analysis showed an increase in nutrition knowledge in both control and intervention groups when compared to the initial stages (p0.01, p0.001). Although unquantifiable, the APPLES programme (Sahota, Rudolf et al. 2001) through a focus group discussion found that when compared to the control group, children in the intervention group had a greater understanding of the health benefits of staying active and healthy eating and were also more able to recall all most of the lessons they were taught during the intervention. Diet Dietary intake was assessed by three of the four studies (Sahota, Rudolf et al. 2001; Warren, Henry et al. 2003; James, Thomas et al. 2004). Sahota 2001, assessed dietary intake using a 24hour recall (using a checklist, where children were required to tick the foods eaten from a list of possible foods) and a free form three day food diary. At the end of the study, an analysis of the 24hour recall showed a 50% increase in vegetable consumption amongst intervention children when compared to the control group (weighted mean difference of 0.3, 95% CI 0.2 to 0.4). However, the three day diary did not show any significant difference; possibly because of the low completion rate of the food diaries. The Be smart intervention (Warren, Henry et al. 2003) similarly reported an overall increase in vegetable (p0.05) and fruit (p0.01) consumption, with no significant differences between the control and intervention groups or genders at baseline or final stage. Intervention group analysis showed that the Eat smart and Be smart groups recorded a significant increase (p0.05) in fruit and vegetable consumption when compared to the other intervention groups. A significant increase in fresh fruit consumption was recorded amongst males (p0.01) when compared to females. No significant changes in consumption of foods high in fat were observed amongst the groups. The CHOPPS intervention (James, Thomas et al. 2004) measured change in diet by assessing the childrens consumption of carbonated drinks using a three day diary. The children were required to record their carbonated drink consumption over two weekdays and one weekend day in a diary. At the end of the study, an analysis of the carbonated drink diaries showed a reduction in the consumption of carbonated drinks in the intervention group compared with the control group (mean difference 0.7 95% CI: 0.1 to 1.3). There was also an increase in water consumption in both the control and intervention groups, but no significant difference between the two groups was recorded. Physical activity levels The Active for life year 5 programme measured physical activity levels by assessing mode of transportation to school and time spent on screen-viewing activities (Kipping, Payne et al. 2008). A questionnaire about the length of time spent of screen-viewing activities (watching televisions, DVDs or playing computer games) was given to the children to complete. The end of study analysis revealed that although the children from intervention groups spent less time on screen- viewing activities when compared to children from the control group, however, the differences between the two groups did not reach a statistically significant level (mean difference at the end of intervention between the two groups adjusted for clustering and baseline: -11.6 minutes, 95% CI: -42.7 to 19.4 for weekday and -15.4 minutes 95% CI: -57.5 to 26.8 for Saturday). The study also found that at the end of the study, children from the control school had higher odds of walking/cycling to school (after adjusting for baseline difference). Similarly, the Be smart intervention (Warren, Henry et al. 2003) assessed physical activity patterns rather than levels by asking the children questions about their mode of transport to school, and activities they undertake a break times. Questionnaires about how physically active the children are after official school hours were issued to their parents to complete. Information on the parental questionnaire included the frequency and duration of their childs habitual attendance of after-school clubs, screen-viewing activities and outdoor play. The post intervention analysis of the questionnaires revealed a slight increase in the number of children that walked to and fro school in both intervention and control groups. For playground activity, an increase was also recorded in all groups, with a higher increase in all intervention groups when compared with the control groups. Overall, there was no significant gender difference in playground activities at either baseline or post interven tion. Similarly, the parental questionnaires reported no intervention effect on activity levels after school hours. The APPLES intervention (Sahota, Rudolf et al. 2001) used a questionnaire to measure physical activity levels and sedentary behaviour in the children. The questionnaire was categorised by how frequent the children were involved in outdoor sporting activities such as swimming and frequency of sedentary activity such as watching television, in the past 24 hours. An analysis of the questionnaires showed no significant difference in physical activity levels in the intervention and control groups. What it however showed, was a 33.3% increase in sedentary activity in overweight children in the intervention group. DISCUSSION Summary and discussion of main results None of the four included studies reported significant short-term changes in BMI at baseline and post intervention. The fact that no significant BMI changes were detected does not in any way imply evidence of ineffectiveness. Possibilities are that small sample/unit sizes and short intervention duration (in all included studies) might have resulted in the inability to detect any weight/height changes. Previous school based intervention studies that have reported significant anthropometric changes in school children both lasted for a minimum duration of two years (Dwyer, Coonan et al. 1983; Gortmaker, Peterson et al. 1999); which is a reasonable time frame to expect any anthropometric changes. Despite the lack of significant anthropometric changes, changes were reported for some other outcomes measured in the primary studies. There was a modest increase in vegetable and fruit consumption in two of the studies (Sahota, Rudolf et al. 2001; James, Thomas et al. 2004). Also a significant reduction in the consumption of carbonated drinks and an increase in water consumption were reported in the CHOPPS project. Although the changes did not reach significant levels, the Active for life year 5 intervention reported a reduction in the time spent on screen viewing activities in the intervention group when compared to the control group. Quality of the evidence Given that this study is a review of intervention effects, the study designs of the included studies were the appropriate types to answer the study question. In terms of global rating, one study was rated as strong, two as moderate and one as weak. However, some caution is required in interpreting findings from this review as all of the studies had some limitations such as small sample/unit sizes and issues around concealment. All these may have introduced a possible systematic measurement bias. Another major issue with all the studies was the short intervention duration. Considering that all the studies measured change in adiposity in terms of weight and height, realistically, it takes a considerable length of time to actually notice a change in either weight or height following an intervention. This shortcoming may have possibly made statistically significant changes difficult to detect. Potential biases in the review process The guidance in Cochrane Handbook for Systematic Reviews of interventions (Higgins and Green 2008) was followed throughout the review process as far as possible. A quality assessment tool for assessing methodological quality of systematic reviews (health-evidence.ca 2007a; health-evidence.ca 2007b) was used in this review to assess the quality of included studies. Judging by the principles set in these resources, a number of potential limitations have been identified in this review. Firstly, in order to minimise errors, limit bias and improve reliability of findings, the Cochrane guidance recommends that key steps of a systematic reviews such as selection of studies and data extraction should be undertaken by more than one reviewer. This was however not possible due to the nature of this piece of work. Although there is strong evidence that RCT is the least bias estimate of effect size (Campbell, Waters et al. 2001) and the preferred method for estimating the effectiveness of interventions (Stephenson and Imrie 1998), there is still a lot of debate around its usefulness in assessing the effectiveness of lifestyle and behavioural interventions (Campbell, Waters et al. 2001). Nevertheless, a majority of the studies included in the review have Randomised controlled trial designs. During the search for studies, efforts were made to comprehensively search all relevant sources such as RCT register and social science databases. Additionally, firs authors of all included studies were contacted. Grey literature sources were also searched. Despite these efforts, it is possible that hand searching of key journals may have identified additional potentially relevant studies. No language restriction was imposed during the search, and as such, no potentially relevant studies were excluded on a language basis. Agreements and disagreements with other studies or reviews AUTHORSS CONCLUSION Implications for practice Despite the need for more research identified by this review, some evidence that school based interventions could have some positive impact on lifestyle behaviours that places children at risk of becoming obese was also found. Although positive effects in terms of adiposity were not shown, no harmful effects of the interventions were shown either. School based anti-obesity interventions should therefore be promoted by local public health authorities and encouraged by schools for long term prevention of obesity and its associated adverse health effects. Considering that children do not have any say at home in terms of purchasing food, involving parents actively in school based interventions could produce a sustained positive effect on children outside of the school setting. Although the study concludes that there is insufficient evidence on the efficacy of school based intervention in preventing childhood obesity, this does not mean evidence of ineffectiveness of these interventions. Given that some positive changes were reported in all the included studies, promotion of school based anti-obesity interventions is greatly encouraged at this time, as these interventions have demonstrated the potential to be beneficial on the long run. Implications for research
Wednesday, January 1, 2020
The Threat Of The Cyber Threat - 1958 Words
Since the onset of the first packet switching event that many believe to be beginning of the internet, no other technology besides the printing press has ever transformed the ability to deliver information. Although the internet is used by a large percentage of the civilized world, few Americans realize how vital cyberspace is to our national infrastructure. Today, we are faced with even more threats although it has been a recognized problem since 2009, when President Barrack Obama said â€Å"The cyber threat is one of the most serious economic and national security challenges we face as a nation. It’s also clear that we’re not as prepared as we should be, as a government or as a country (Obama, 2009).†Every industry that operates in the United States is dependent on the internet for some aspect of their business. Commerce, transportation, financial institutions, military, as well as industrial control systems are all interconnected. This interconnectedness has created vulnerabilities within their infrastructure that have increasingly become targets of terrorists, script kiddies, foreign governments and hackers of all types. Cyber-attacks against Sony Pictures brought the vulnerabilities of poor cyber security policies to light. These attacks are nothing new but they appear to be getting more severe. According to James Clapper, the director of national intelligence, â€Å"Cyber threats to U.S. national and economic security are increasing in frequency, scale, sophistication, andShow MoreRelatedCyber Threats And The Cyber Threat1640 Words  | 7 Pages but these have also brought along unprecedented threats. Since the â€Å"Morris†worm in the 1980’s cyber threat has grown from isolated incidents to high profile attacks on major government and private organizations. Cyber threats can be classified broadly into three distinct areas – ï‚ · Cyber crime – intentional attacks carried out by individuals or groups of individuals with specific objectives of acquiring money, data or causing disruption. ï‚ · Cyber war – an attack conducted by a nation against anotherRead MoreCyber Threats931 Words  | 4 PagesTOP FIVE CYBER SECURITY THREATS FOR 2012 11 August 2012 ABSTRACT The ten cyber security threats in the IT world are boosts in mobile drives and in security tasks, increased C-suite targeting, growing use of social media that will contribute to personal cyber threats, being already infected, and everything physical can be digital. This paper discusses what these threats are, how to defeat and/or demonstrate proficiency in defeating the cyber threats, and the risingRead MoreCyber Threat Intelligence Based On Cyber Threats1612 Words  | 7 Pagesmitigating controls are key, which can be a trying negotiation between the CISO, Chief Technology Officer, Cyber Threat Intelligence (CTI), Infrastructure Engineering, Audit and Assurance teams, and the Investment and Audit committees. How do you harness your entire organization to focus on a common agreed-upon list of key security controls? By defining key controls based on cyber threats (translated into business risks), an organization can more easily right-size the its control set and adaptRead MoreCyber Security And Cyber Threats Essay1510 Words  | 7 Pagesbeen confronting issues of cyber-attacks to such an extent that majority of the patients feel every moment that they are at great risk and thus their treatment processes suffer a lot.(Hacking Healthcare IT in 2016) The small sized clinics do not have many resources to enhance their information security systems. Even the large sized enterprises are vulnerable to the cyber threats. The White House had declared that it would increase opportunities to tackle the cyber threats in every sphere, but the moreRead MoreCyber Threats And Cyber Attacks Essay946 Words  | 4 PagesAccording to the U.S. Department of Homeland Security in the article Cyber Threats to Mobile Phones, phones are now sharing hardware and software similar to a PC and becoming each time more li ke a PC. Therefore, the risks of being hacked are increasing, allowing hackers to attack mobile devices the same way as if they were doing it with a regular PC. Personal and professional information are more often stored on mobile devices therefore it is imperative to have our data secure. Security solutionsRead MoreCyber Security And The Cyber Threat763 Words  | 4 PagesUnfortunately, far two many organizations are unaware and unprepared to deal with the impact of the cyber-threat. With this in mine, security awareness training is economical and obvious choice for organization of all sizes. Many companies invest heavily in cyber security education programs for all employees to learn how to protect their computers and personal information and how to be aware of the cyber criminals that sour the Web in search of targets and vulnerabilities. For the most part the trainingRead MoreThe Threat Of Cyber Security1452 Words  | 6 Pagespurpose of this briefing is to: †¢ Clarify the importance of cyber security in marketing †¢ Educate employees on the importance of cyber security in the workplace †¢ Explain to marketer why they are targets of cyber security attacks †¢ Educate employees on how they can prevent cyber attacks Informing and educating employees on why cyber-attacks are becoming more prevalent and how to identify and prevent them gives an organization ease of mind. A cyber breach or attack is inevitable, however mitigating lossesRead MoreThe Threat Of Cyber Security4382 Words  | 18 Pages2013).These days it takes merely minutes for news to travel around the globe. Our airwaves are filled with tiny nuggets of information whooshing past us undetected; that is, until it is detected. In the 21st century, cyber security is an international issue. The threat of cyber warfare is very real and would be devastating beyond any conventional weapon imaginable. With the entire globe becoming more interconnected, an attack on online infrastructure could ground airplanes, control informationRead MoreThe Threat Of Cyber Terrorism1093 Words  | 5 PagesSolution Q. No. 2 The possible threat posed by cyber terrorism has motivated considerable alarm. Many security experts have exposed the danger of cyber terrorists hacking into government and remote computer systems and service areas of progressive economies. The possible threat is, indeed, very disturbing. So far, despite all the gloomy pre-dictions, no single example of real cyber terrorism has been recorded. This increases the question: about the threat? Psychological, political, and economicRead MoreThe Threat Of Cyber Attacks943 Words  | 4 PagesCyber-attacks are constantly becoming a critical issue for government systems and for businesses around the world. In fact, the cyber challenges that we see today play a huge political factor for government sectors. The U.S is constantly facing these cyber security threats that jeopardize America’s critical infrastructure and the freedoms that many Americans express online (Bucci, S., Rosenzweig, P., Inserra, D. 2013). These challenges that are taking a political factor can also be seen in other
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