Internship at MUN-SI in Portugal

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Reflection on objectives and Survival tips for future Interns

We did a great job at the beaches and we mainly covered Practical applications of Anthropometric measurements. However, due to lack of time and a lot of works at the office and beaches we could not cover all objectives. We spent and we put a lot of effort in working on the beaches and we are very happy since theory and practise now are connected together! We had meetings at the office and we been involved in different research programmes in the terms of communicating with people, doing WHO appraisal tool etc, hence we did not really focused on data management (observation and try outs, in out to work, how to create and validate databases in spss) as been mentioned previously due to the lack of time. 

It's been a great summer in Portugal and the Internship at MUNSI. I strongly recommend to consider Portugal as a place to spend time and do your Internship. I had a chance to work with wonderful people and experience a lot of good moments. Work on the beaches was the best? What else we need to be happy? Summer, lovely job, beaches, wonderful weather and colleagues.  Hence, in any time of the year it's warm here, it never snows. P.s. the colleague of mine mentioned only one time she saw a snow in her life, here is only one place in Portugal where the snow can appear. 

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Overcoming challenges

The biggest challenge was a language barrier especially with the people on the beaches.

The positive thing we had girls who translated everything from English to Portuguese so the communication was rather smooth. Another issue some adults were not willing to communicate so they showed demotivation by rejecting to talk and it mainly happened in the first beach called Santo Amaro. In other beaches people were very happy and more of the adults spoke in English.

 Another issue was time since we had only three weeks for three target groups so it was not enough time to assess and make clear results.

It might be helpful to focus more on this target group since elderly people is one of the vulnerable groups who have more health issues and good nutrition is crucial for them. The intake of the water is also important for them since I know that with the age seniors lose their sense of thirst. Older generation is having kidney problems, urinary problems which are linked to a chronic state of dehydration so this is why it is important to get certain amount of the liquids in a day.

I assume in the future we could have more time for the children including more activities and prolonging time in order to cover more groups and make the time enjoyable for the children.

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Summing up Beach Activities

The purpose of going to the beaches was to target different age groups by promoting health, introducing people what kind of food they should bring to the beaches, involving and encouraging people to take care of their health. Therefore, it was also important purpose to do surveys in order to compare people's lifestyles and see how motivated they are in the terms of health.

There was equal distribution among target groups and the focus was really clear & understandable. Hence, the beaches are the places where the communication starts and this how we can meet more people by involving them to participate in our activities, by helping to understand there is the importance of the health promotion, why targeting is necessary and about the problems of obesity. I also conclude that for me was rather surprising that people do not consume and consume only a bit of alcohol at the beaches, they also rarely have an intake of soft drinks, many people bring fruits & vegetables to the beaches. However, sometimes data can be misleading since people might not say the truth about their habits and there is always a probability of lying in the terms of trying to hide real lifestyle roots.

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Dietary Recommendations

We were asked to write a Report and the purpose of this Report was to compare Lithuanian and Portuguese Dietary Guidelines and see how different countries meet their own needs. There is also important to see on which things people focus the most and that is the difference between the populations.

Lithuanian food pyramid has free floors consisted of most crucial foods starting within the bottom line while Portuguese has a plate where each section has foods with indicated percentage of the daily value. In Lithuanian food pyramid water is added together with physical activity, hence Portuguese food plate lacks both of those points. Lithuanian pyramid has the same section with fruits & vegetables while Portuguese plate has separated sections with different recommendations, hence in both pyramid & plate vegetables play more important role than fruits which must be consumed in bigger amounts daily. In the plate was mentioned that we do not need to consume more than 2% of oils and nuts but in the pyramid it was not indicated of how much we need to consume, only that consumption of those products cannot be very frequent with big amounts. Likewise, in the pyramid there is no clear number of how much dairy products people should consume while in the plate there is a clear understanding of the consumption of the dairy products. In the pyramid there is an advice to eat 5-11 portion of Grain, bread, potatoes and the plate shows the exact percentage of how much products we need. Lithuanians also has a restriction based on salt intake which is only one teaspoon per day, Portuguese recommend to take less than 6 grams. Overall the pyramid just indicates to not eat meat in big portions, do not consume a lot of sweets and again the plate shows the equal distribution between products. I can conclude that Portuguese food plate is more advanced than Lithuanian food pyramid due to some reasons: • Portuguese has exact and clear numbers of how much foods person should consume daily and what plays an important role • Plate has more sections while Lithuanian pyramid has the same section together with fruits & vegetables which is misleading etc. However, Portuguese food plate does not have anything related to Physical Activity and water consumption which is very crucial in every person's life. I also assume there is a big disadvantage since Lithuanian pyramid has no translation from Lithuanian to English language and for other people it might be challenging to read in another language. Therefore, it was rather challenging to find and collect data since there is no so much written about pyramids and also about the history of the food pyramids in Lithuania.

Lithuanian Food Pyramid 

Portuguese Food Plate

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Week 4

In this week we worked in three different beaches and we target elderly people ( every week different target group). As previously used questionnaires to ask people if they bring healthy foods to the beaches, what is their opinion about the restaurants located next to the beach, we strongly focused on water consumption. Therefore, we provided different types of flyers : 1. about drinking water ( it's very recommended to consume 2 l of water per day) 2. about antioxidants 3. about healthy snacks ( we observed that many people bring yogurts, sandwiches, chocolates to the beach but there is less intake of fruits and vegetables). In the provided brochures there was tried to explain that there is a need to replace all the unhealthy food to fruits and vegetables, instead of ice tea, soft drinks just to drink water). In the flyers was provided information about the most popular fast foods and calories which are mostly consumed by Portuguese people. Likewise, we tried to show how many calories they get by eating unhealthy foods and how people can replace unhealthy food with less calories.  In this week activities we also used pedometer to measure steps, so we walked with people 1000 steps by detecting the motion of the person's hips. Pedometers are now become quite popular as an everyday exercise measurer and motivator.

Afterwards, we were asked to fill out the Communication Survey where EPODE International Network regularly conducts surveys to better understand the needs and desires of member programmes. The questions had three fields:

Communication at a Central level

Communication at a Local level

External Communication at a Central and Local Level

The answers were based on MUN-SI programme

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This week our target group was preschool aged children where we focused on their physical activity, healthy foods and games!

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Beach activities start! Week 2

Three weeks we will be working and focusing on three different age groups:

Young people

Children

Elderly 

Our first beach activity programme started with a focus on young people in  assessing nutritional status of the population. We made different brochures in both Portuguese and English  where people can get  information about what type of foods they should bring to the beach, what can get ruined during the day, what people should not forget before going to the beach. Likewise, we also made surveys where we asked people to fill out and answer to the questions in regards to food preparation for the beach. First week we also measured people's weight + height and we calculated BMI. In the end of the activities we will collect data and make nutritional assessments. 

An important focus was to communicate with people where we had a unique opportunity to find out about their habits and different lifestyles, it helped to understand why the prevalence of the obesity is one of the highest in Portugal. Likewise, a lot of  young people having obesity problems in Portugal eat a lot of unhealthy snacks and drink soft drinks. 

The entire communication was not a problem since we had provided translators who spoke in Portuguese if in case people could not understand English language. However, we found a lot of people who were willing to communicate in English and understood our questions clearly in English.

In the same week we also had a meeting in the office with the representatives from EPODE network. It was an interview about MUNSI programme consisted of many questions for example what is the purpose of this programme, interventions, target groups etc.

We are looking forward to start our activities with children.  

Calculating BMI

The brochures 

Working day on the beach

At the office!

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My first week and work on WHO appraisal tool

My first first week of Internship started in the office meeting new people and our new work place. Me and my friend Baiba have been asked to start working on the part of the WHO appraisal tool which is the tool for obesity prevention programmes, projects, initiatives and interventions.

This tool was developed to assess good elements of design, monitoring, evaluation and implementation of preventive programmes, projects, initiatives and interventions that aim to counteract obesity and improve nutrition  and physical activity. The aim of the tool is to systematically assess the quality of the programmes

Portugal and other Europe countries have to fill out the document and answer to 43 questions which are consisted of four different parts such as questionnaire , main intervention characteristics (objectives, planned activities, target group, involved stakeholders), monitoring & evaluation (mainly indicators and measurements), implementation (participation of target group, performance and programme management).

The document with the answers must be submitted  with the deadline, after summer months the best answers of the EU countries will be selected and will be decided which type of activities can be used for prevention.

Me and my friend Baiba have been asked to answer to 7 questions out of 43 questions. Before start we had a consultation how the answers should look like and what is expected.

I used two documents in answering the questions in regards to childhood obesity:

Programme Obesity Zero (POZ) it is a community based intervention to address overweight primary school children from five Portuguese municipalities. Portugal is one of the countries having top obesity rates.

MUNSI - Intervention areas: Healthy School, Communication/Awareness, Research, Active City, Professional Health and Education Training, Family.

Requested questions to answer:

Is the intervention based on current scientific knowledge and/or theoretical models and/or previous experience from other projects?

Were existing (inter) national diet and physical activity guidelines taken into account during the development of the intervention?

Does the intervention also address environmental factors (i.e. factors beyond individual control)? 

Is the approach of the intervention designed to have a lasting effect on the risk factors?

Does the intervention aim to empower the target group(s)?

Describe how the outcome of the intervention was measured.

Has a pilot study been performed?

I also visited National Institute of Health 'Doutor Ricardo Jorge Institute' located in Lisbon Portugal. It is a big Institute having six departments:

Food and Nutrition Department

Infectious Diseases Department

Epidemiology Department

Human Genetics Department

Health Promotion and non Communicable Disease Prevention

Environmental Health Department

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Internship objectives

Practical applications of Anthropometric measurements

 1. Measure skin folds (triceps, biceps, subscapular)

 2.  Measure Waist Circumference

 3.  Measure weight and height (BMI)

 4.  Nutritional status assessment

Data analysis/management

 1.  Contact with different databases. Observation and try outs, in out

to work, how to create and validate databases in spss

 2. Literature review

 3.  Works with Nutrition Recommendations

Information updating in English

 1. Intercultural communicative skills, Using social network- Twitter,

Facebook, MUN-SI website

 2.  Create recommendation- posters, brochures etc. (for hand-out

materials)

Indirect involvement in different research projects

1. Collaboration between different NGO`s in EU projects and with

Portugese Research Institutes

2.  Participation in transversal areas related with nutrition

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Portugal!

A short description about me 

Hi, my name is Lina and I am a Bachelor degree student in Global Nutrition and Health doing specialization Public Health Nutrition & Food Policy at Metropolitan University College, Copenhagen Denmark. I am the 4th semester student and it is my first Internship in Portugal during summer months July and August. I am looking forward to start my Internship!

How we found the place :)

Me and my friend Baiba decided to do Internship together and we started looking for a place together. We were not sure to which country we would like to go but we knew we would like to stay in Europe. We found the variety of the choices on Internet in regards to Internship, we contacted many companies in Spain, Portugal, Denmark and also Lithuania where I was born.

However, our teacher Charlotte Dahl provided some Internship ideas for 2014  with the contacts from different countries including Portugal. We discussed that Portugal might be a great opportunity in regards to our Internship and we should try to write an email to MUNSI. As I heard from friends Portugal is a great country for living especially in summer time where the weather is great, prices are low and the nature is beautiful! 

Likewise, our current Internship host replied to us after a couple of days, we arranged a meeting and then we met with her at our school since she collaborates with GNH and lives in Copenhagen. Therefore, we had meetings and telephone calls but it was no difficulties to communicate to each other and sign the papers.

I also assume it is still challenging to manage to find an Internship place during July & August months since majority of the companies/organizations are closed.

Internship place

MUNSI program has a focus on prevention tackling obesity for children and the aim of this program is to decrease the prevalence of childhood obesity in Portugal. MUNSI program coordinated by CEIDSS -  Center for Study and Research of Social Dynamics and Health -  congregate the municipality action, the initiative of University Professors and Researchers of National Institute of Health with institutional support.