were compared psychometrically. In this study, 525 community-dwelling participants, aged 65-89, were divided into 2 groups: no cognitive impairment (NCI; n -406) and Alzheimer's disease (n = 119). Both tests yielded comparable reliability estimates. Fewer years of education decreased specificity and increased sensitivity, whereas increasing age primarily decreased specificity. It is concluded that although the 2 tests produce comparable effects, the inclusion of a verbal fluency test would increase the sensitivity of the MMSE. Normative data for the NCI group, stratified for 2 age levels (65-79 and 80-89) and 2 educational levels (0-8 and 9+ years), are presented. Folstein, Folstein, and McHugh (1975) introduced the Mini-Mental State Examination (MMSE) as a brief, objective assessment of cognitive functioning and as a measure of changes in cognitive status. The MMSE usually can be administered in 5-10 min and has been employed extensively in clinical settings, community surveys, and epidemiological studies. In a recent review of the literature, Tombaugh and Mclntyre (1992) concluded that the MMSE possessed moderate to high reliability coefficients, demonstrated high levels of sensitivity for cognitive deficits in patients suffering from moderate to severe Alzheimer's disease, and reflected the cognitive decline typical of dementia patients. Criticisms of the MMSE included (a) its failure to discriminate between people with mild dementia and those who are not demented, (b) a limited ability to detect impairment caused by focal lesions, particularly those in the right hemisphere, (c) overly simple language items that reduce sensitivity to mild linguistic deficits, and (d) a large number of false-positive errors because of its bias against individuals with low education. In response to these problems, several attempts have been made to improve the MMSE. Of these, the Modified Mini-Mental State Examination (3MS; Teng & Chui, 1987) represents the most extensive revision. Teng and Chui (1987) added four additional subtests (date and place of birth, word fluency, similarities, and delayed recall of words). The maximum score was

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Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alternatively contact researchonline@lshtm.ac.uk. Available under license: Copyright the author(s)Cochrane Database of Systematic Reviews School feeding for improving the physical and psychosocial health of disadvantaged students (Review) Kristjansson Citation: Kristjansson B, Petticrew M, MacDonald B, Krasevec J, Janzen L, Greenhalgh T, Wells GA, MacGowan J, Farmer AP, Shea B, Mayhew A, Tugwell P, Welch V. School feeding for improving the physical and psychosocial health of disadvantaged students. T A B L E O F C O N T E N T S

Persons with CIND were more likely to have a negative outcome than persons with NCI during a 5-year interval. This was true across etiologic subcategories and suggests that the use of specific diagnostic criteria sets does not improve our identification of those who develop dementia compared with a broader, more inclusive approach. More factors contributed to the prediction of all forms of dementia than to AD, but the most accurate prediction was for those who remained dementia free.

The main objective of this systematic review was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils. A comprehensive search was conducted up to May 2006. We included 18 studies.School meals may have some small benefits for disadvantaged children. We recommend further well‐designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio‐economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.AbstractBackgroundEarly malnutrition and/or micronutrient deficiencies can adversely affect physical, mental, and social aspects of child health. School feeding programs are designed to improve attendance, achievement, growth, and other health outcomes.ObjectivesThe main objective was to determine the effectiveness of school feeding programs in improving physical and psychosocial health for disadvantaged school pupils.Search strategyWe searched a number of databases including CENTRAL (2006 Issue 2), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), PsycINFO (1980 to May 2006) and CINAHL (1982 to May 2006). Grey literature sources were also searched. Reference lists of included studies and key journals were handsearched and we also contacted selected experts in the field.Selection criteriaData from randomized controlled trials (RCTs), non‐randomised controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series studies (ITSs) were included. Feeding had to be done in school; the majority of participants had to be socio‐economically disadvantaged.Data collection & analysisTwo reviewers assessed all searches and retrieved studies. Data extraction was done by one of four reviewers and reviewed by a second. Two reviewers independently rated quality. If sufficient data were available, they were synthesized using random effects meta‐analysis, adjusting for clustering if needed. Analyses were performed separately for RCTs and CBAs and for higher and lower income countries.Main resultsWe included 18 studies. For weight, in the RCTs and CBAs from Lower Income Countries, experimental group children gained an average of 0.39 kg (95% C.I: 0.11 to 0.67) over an average of 19 months and 0.71 kg (95% C.I.: 0.48 to 0.95) over 11.3 months respectively. Results for weight were mixed in higher income countries. For height, results were mixed; height gain was greater for younger children. Attendance in lower income countries was higher in experimental groups than in controls; our results show an average increase of 4 to 6 days a year. Math gains were consistently higher for experimental groups in lower income countries; in CBAs, the Standardized Mean Difference was 0.66 (95% C.I. = 0.13 to 1.18). In short‐term studies, small improvements in some cognitive tasks were found.Reviewers’ conclusionsSchool meals may have some small benefits for disadvantaged children. We recommend further well‐designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio‐economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.