This article is based on a qualitative multiple case study aimed at evaluating the effects of free school meal interventions on pupils' learning, and on the learning environment in schools. The study was conducted at four schools, each offering free school meals for 20 weeks. At each school individual and focus group interviews were conducted with students in grades 5 to 7 and grades 8 to 9. Furthermore, students were observed during lunch breaks, and interviews were conducted with the class teacher, headmaster and/or the person responsible for school meals. The purpose of the article is to explore the learning potentials of school meals. The cross-case analysis focuses on the involved actors' perceptions of the school meal project and the meals, including places, times and contexts, and the pupils' concepts and competences in relation to food, meals and health, as well as their involvement in the school meal project. The analysis indicates that the pupils have developed knowledge and skills related to novel foods and dishes, and that school meals can contribute to pupils' learning, whether this learning is planned or not. However, if school meals are to be further developed as an arena for learning, greater consideration must be given to the interaction between pupil, school meal and teacher than in the school meal projects presented in this study, and the potentials for learning through school meals clarified and discussed in the schools. Studying the school meal projects raises a number of dilemmas, such as whether the lunch break should be a part of or a break from education, are school meals a common (school) or private (parent) responsibility, and questions about pupils' and teachers' roles and participation in school meals.

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -With the aim of contributing to the evidence base on school-based health promotion, the authors discuss the outcomes and processes of a European intervention project aiming to prevent obesity among children (4-16 years) and promote their health and well-being, titled Shape Up: a school-community approach to influencing determinants of healthy and balanced growing up. Design/methodology/approach -Multiple case study research was carried out in five schools in five EU countries. Data sources included project documents, interviews, and observations. Narrative qualitative cross-case analysis was carried out following the single case analyses. Findings -The study showed that, if given sufficient guidance, pupils can act as agents of health-promoting changes on both school and local community level; they were involved in actions which improved school policies, provisions and affordances for healthier diet and regular physical activity. The study identified three forms of participation, each with a different level of pupil involvement and agency.Research limitations/implications -The study is qualitative, based on five single cases and cross-case analysis; this research design implies caution related to extensive non-contextualised generalisation of the findings. However, valuable implications for research and practice can be drawn, especially in relation to structural barriers for participatory health promotion. Originality/value -The paper is of value for researchers as well as practitioners in the field, particularly those interested in eco-social models of health, whole-school approaches to health promotion and pupil participation. The study's specific value is in the systematic qualitative cross-case analysis, which contributes to the research rigour and allows for situated generalisation.

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Acute Stroke Management and PatientOutcome: The Value of Neurovascular Cure Units (NCU) • Medical records of 455 acute stroke patients admitted to six community hospitals between October and April, 1969 through 1970 and 1971 through 1972, were surveyed. Data were obtained for: demography, diagnosis and management, complications, patient status and outcome variables (discharge status, disposition, length of stay, mortality and survival time), for one year before and after establishment of acute neurovascular care units (NCUs) in three of the hospitals. Patient status on admission based on a self-care scale was the most accurate measure used in predicting outcome (except when secondary complications occurred). There was a significant decline in mortality for nonhemorrhagic strokes for all patients, due to reduction in complication-related deaths among younger and less impaired persons. Forty-one percent of complication-related deaths for both surveys occurred during the first nine hospital days. Complications significantly lengthened hospitalization, increased the risk of late complication-related deaths, and decreased home discharges. Complication-related deaths were reduced in the second survey. Hospitals with NCUs showed a 50% reduction in secondary complications; hospitals without NCUs showed no reduction. Frequency of complications is an excellent measure of the quality of care. The acute NCU appears to be a practical method for achieving such quality.

Purpose – The purpose of the paper is to contribute to the conceptualization and discussion of professional competencies needed for supporting the development of the whole-school approach in school health promotion (SHP). Design/methodology/approach – The paper is based on a conceptual synthesis of literature, guided by a theoretical perspective on health promotion agency and professional competencies to identify core competency domains and elements. This is followed by a discussion of focus, gaps and links in conceptualizations of competency domains and elements. Findings – The synthesis identifies five core competency domains: policy-development; organizational development; professional development; development of students’ learning; and development of health promotion activities. Three critical gaps in the conceptualizations of competency domains and elements are identified and discussed: the downplay of the development of learning domain and the narrow focus on cognitive elements within it; the narrow focus on cognitive elements and technical-organizational elements in the development of HP activities domain; and the downplay of affective competency elements across domains. Practical implications – The five competency domains may provide an overall guiding tool for professionals tasked with practice and competency development in SHP, and a point of departure for the development of conceptualizations of professional competencies in concrete practice contexts. Originality/value – The paper delineates an overall professional competency model for SHP, discusses the specific demands on professional competencies within this field in relation to this model, and addresses three critical gaps in the conceptualizations of competency.