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The studies described in this thesis aimed to examine some of the mechanisms underlying the lower levels of muscle strength and power in older women, who are at higher risk than men for age-related disability, and some of the adaptations in response to resistance training. The initial study showed that it is not only a smaller contractile muscle volume, estimated separately from the intramuscular non-contractile tissue, which accounts for differences in quadriceps muscle strength, expressed as torque, between young and older women, but also a higher level of coactivation of the antagonist muscles. Lower limb explosive power, which depends on both strength and speed of movement, and is more predictive of functional difficulties than strength per se, was then compared between young and older women during a single leg-press action after optimisation of load. The older women could not even move the resistance at which the young women achieved maximum power. Their lower levels of power, which appear to be more affected by ageing than isometric strength, were due to lower levels of both force and velocity at which maximum power was measured. In the third study, the neural adaptations to a short-term resistance-training programme were investigated by analysing the time and frequency-domain characteristics of the surface electromyogram measuredo n the biceps-brachii muscle during constant-force sustained-isometric contractions. Older women responded to the same training programme with a lower increase in strength than the young women. This was accompanied by a different electromyographic response in the two groups. Finally, three modalities of resistance-training, which were carried out for 16 weeks on a cycle-ergometer at either high-resistance and low-speed, low-resistance and high-speed, or a combination of both, were shown to be equally effective in improving power, strength and selected functional abilities in a healthy population of 65-74 year-old women. The findings of these studies are discussed in relation to the current knowledge on mechanisms and adaptations of muscle strength and power in the older woman.

Celiac disease is an autoimmune pathology characterized by a chronic inflammation of the proximal part of the small intestine, caused by exposure to a vegetable protein present in some cereals called gluten. These cereals are wheat, barley, rye and, possibly by cross-contamination issues, oats. Due to a cell-mediated immune response towards gluten, changes in the structure and function of the small intestine mucosa occur, so the gut loses its ability to digest and absorb nutrients from food. The main symptoms are among others, chronic diarrhea, nutritional deficiencies of iron, vitamin B12, vitamin D, increased risk of developing T-cell lymphoma, bloating and abdominal pain, steatorrhea, malnutrition, short stature, delayed puberty, normal fatigue, depression, infertility, rickets, osteopenia, muscle cramps, dental hypoplasia and injury in the pancreas, liver and thyroid. OBJECTIVES: - To evaluate energetic and nutritionally celiac patients from Valencia and verify if their intakes fit with the recommended intake and nutritional goals for the Spanish population. - To determinate delays in the diagnosis of disease, symptoms suffered, recovery after the diagnosis, quality of life and social disruption, the prevalence of other diseases, reproductive problems, prevalence of celiac disease in close relatives and the recommendations of the patient. - To evaluate de utility of the educational workshops to acquire knowledge in celiac children. PATIENTS AND METHODS: A total of 166 patients, 98 adults and 66 children aged 2-14 years with celiac disease were assessed in the survey during the years 2009-2010. RESULTS: In adults, the mean delay in diagnosis was eleven years and the mean of doctors consulted before setting de diagnostic was six. Celiac patients failed to perform many activities because of their particular diet: eating at restaurants, traveling, going to birthday parties, etc... The prevalence of osteoporosis or osteopenia was twice as frequent among those who were diagnosed in the adult stage. 95% of celiacs found difficulties about reading food labels. In children, knowledge about celiac disease and healthy nourishment increased with the educational workshop. / INTRODUCCIÓN La enfermedad celíaca es una enfermedad autoinmune caracterizada por una inflamación crónica de la parte proximal del intestino delgado, causada por la exposición de una proteína vegetal llamada gluten de algunos cereales en la dieta: trigo, cebada, centeno y posiblemente avena. Debido a los cambios en la estructura y función de la mucosa del intestino delgado, se pierde la capacidad de digerir y absorber los nutrientes de la comida. La principal causa de este trastorno es una reacción inmunológica mediada por células, hacia los componentes del gluten. La diana de la respuesta inmunológica es la gliadina, proteína presente en el gluten. Los principales síntomas son debidos a la pérdida de las vellosidades normales del intestino delgado, con la consiguiente disminución de la superficie de absorción de nutrientes. Entre otros, destacan la diarrea crónica, carencias nutritivas vitaminas y minerales, aumento del riesgo de desarrollar un linfoma de células T, distensión y dolor abdominal, esteatorrea, desnutrición, talla baja, retardo puberal, fatiga extrema, depresión, infertilidad, raquitismo, osteopenia, calambres musculares, hipoplasia dentaria y lesiones en páncreas, hígado y tiroides. OBJETIVOS: -Evaluar energética y nutricionalmente a los pacientes celíacos de la Comunidad Valenciana. -Conocer la tardanza en el diagnóstico de la enfermedad, los síntomas padecidos, la recuperación, la calidad de vida, la prevalencia de otras enfermedades, alteraciones en la reproducción, prevalencia en familiares próximos y las recomendaciones del enfermo. -Comprobar la eficacia de los talleres de alimentación infantil. MATERIALES Y MÉTODOS: 166 pacientes completaron un cuestionario de salud internacional para celíacos, 98 adultos y 68 niños. En la evaluación nutricional participaron 139 personas, 71 adultos y 68 niños. RESULTADOS: Se aprecia una progresiva merma de peso y talla medios desde las edades inferiores hasta la adolescencia. El perfil de distribución de nutrientes energéticos está descompensado, con déficit de carbohidratos y fibra y exceso de proteínas. Tras la asistencia de los niños celíacos a un taller educativo, se incrementaron las calificaciones de un test conocimientos sobre alimentación saludable y específica para celíacos. En adultos, el retraso medio en el diagnóstico fue de once años y la media de seis médicos consultados antes de confirmarse la EC, lo cual sugiere la necesidad de una mayor concienciación entre los facultativos sobre la variedad de manifestaciones clínicas. Las altas prevalencias de EC en grupos de riesgo sugieren que la utilización de tests de anticuerpos podrían reducir los retrasos en los diagnósticos. Los hechos de que todos los pacientes que padecen osteoporosis u osteopenia hayan sido diagnosticados en la edad adulta y de que sean casi dos veces más frecuente entre los que tardaron más de cinco años en ser diagnosticados confirman que un diagnóstico temprano de la EC reduciría la prevalencia de estas patologías. Dada la dificultad de determinar si los alimentos contienen o no gluten, sería necesario que los fabricantes aportaran un etiquetado completo y preciso de las fuentes de gluten y que los servicios de restauración proveyeran de una información rigurosa sobre la cantidad de gluten de la comida servida. El impacto de la DSG sobre la calidad de vida es muy alto. Al 85% de los celíacos le parece muy difícil el seguir una dieta estricta sin gluten, el 78% evita los restaurantes; el 46% los viajes y el 92% viaja con comida sin gluten. Entre los niños, el 29% dejó de hacer actividades en el colegio o con amigos a causa de la EC, el 66% se sintió diferente a los demás niños, el 27% sintió vergüenza al llevar alimentos sin gluten a fiestas y el 67% se ha enfadado por tener que seguir una dieta especial.

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This thesis documents the evolution of a research journey which remains a work in progress. The primary goal of this study was to collaboratively create and lead a health promoting high school. This study has two distinct but intertwined areas of focus: action research fieldwork conducted to design and infuse health promoting principles into the context of a traditional, standards based high school, and the documentation and reflection of the professional practice and leadership strategies used to implement the study. This thesis documents the efforts of a school leader to respond to the array of information and research generated by governmental agencies, professional publications and mainstream media suggesting the need for public school educators and school leaders to address national public health goals and the health needs of children within the school setting. Driven by the dearth of literature related to leading health promoting schools in conjunction with the abundance of compelling research citing the health needs of children and the connection of health to lifelong wellness, this study sought to work collaboratively with students, staff, district administrators, and members of the community to integrate health promoting principles into a traditional, standards based culture. Throughout the study intertwined phases of collaborative action research and reflective professional practice were supported by a continual infusion of a multidisciplinary array of literature resulting in the design and implementation of eco-holistic approaches to promoting health and well-being for staff and students within my school. The outcomes of this study far exceeded my expectations. For example, the collaborative creation of a site specific coherent, conceptual, health promoting framework for the high school which integrated standards based initiatives and health promoting principles was viewed as a significant milestone. Additionally, the voices of students whose predominant involvement drove the actions and design of the study resulted in creating substantial change to the health, physical education and nutrition as well as to support services leading to an improved school mission and health promoting school culture. This study has responded to the growing need for school leaders to address the needs of the whole child and the whole school by creating a foundation and framework for change which aligns with standard based expectations and the goals of a democratic society at large. The documentation of leadership strategies utilized for this whole school approach fill a perceived gap in the literature and may have the potential to inspire and assist other aspiring health promoting school leaders gain the courage and confidence to create the deep changes and disruption to the 'status quo' required to infuse health into whole school improvement initiatives.

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