In-depth phone interviews were conducted with 24 parents (4 males) of 10–11-year-old children recruited from six primary schools in Bristol.

Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children's ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision.

Strategies are needed to build children's licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.

Semi-structured interviews and focus groups with 109 health, social care and voluntary staff from three London Boroughs.

Few frontline staff were aware of the Plan. Most respondents did not perceive heatwaves to be a sufficiently frequent event to require prioritization within their routine summer workloads. They highlighted the complexities associated with defining vulnerability and identifying vulnerable individuals as well as barriers to implementation of the Plan. Respondents suggested a multi-faceted approach to interventions including a public health campaign, community engagement and increasing the responsiveness of statutory services.

The issues highlighted could hinder effective implementation of the Heatwave Plan. Ensuring continuity of care so that timely information can be recorded and disseminated may address the problems associated with shifting vulnerability. Best practice with respect to inter-sectoral collaboration should be identified and innovative multi-faceted interventions should be designed and evaluated.

A cross-sectional study among 120 patients was conducted in two primary health-care centers. The test of functional health literacy in adults, a 50-item reading comprehension and 17-item numerical ability test (score, 0–100) were administered. Chi-square test and logistic regression analyses were applied.

Inadequate and marginal health literacy existed in 43 participants (41.0%), and adequate health literacy was present in 62 participants (59.0%). Functional health literacy was significantly different by location, gender, age, marital status, employment, education, material status, self-perception of health and presence of chronic conditions. Based on the multivariate analysis, health literacy was significantly associated with the participant's age (odds ratio [OR], 4.86; 95% confidence interval [CI], 2.41–9.80; P = 0.000), level of education (OR, 4.48; 95% CI, 1.73–11.57; P = 0.002) and chronic conditions (OR, 1.90; 95% CI, 1.16–3.11; P = 0.010).

These results provide evidence that limitations in functional health literacy are widespread among primary health-care patients and encourage efforts for further monitoring. Low health literacy may impair a patient's understanding of health messages and limit their ability to attend to their medical problems.

We estimated the EQ-5D scores for respondents from the 2000–2003 Behavioral Risk Factor Surveillance System. We calculated QALYs and QALE lost to morbidity due to obesity/overweight, smoking, low income and chronic diseases.

The mean EQ-5D score for US adults was 0.870. The mean scores ranged from 0.826 (West Virginia) to 0.902 (Hawaii). Smoking contributed from 5.6 (Utah) to 12.3 (Kentucky) percent, obesity/overweight 5.4 (South Dakota) to 13.8 (Louisiana) percent, low income 16.6 (Hawaii) to 39.9 (South Carolina) percent and chronic diseases 8.7 (Minnesota) to 22.9 (Tennessee) percent of explainable QALYs lost. These risks contributed the greatest proportion of explainable QALYs and QALE lost in Kentucky, Tennessee and South Carolina.

We estimated the burden of disease contributed by selected risk factors. Currently, such data are unavailable but are needed to set targets for reducing modifiable health risks and eliminating health disparities among at-risk populations.

Injury and illness data were collected prospectively in the longitudinal Cambridge study in delinquent development at age 43–48. Hypotheses were that childhood predictors of antisocial behaviour and offending and antisocial behaviour at ages up to 32 would be associated with poorer health at age 48.

Childhood and parental predictors of offending, self-reported delinquency at age 32 and convictions were significantly associated with death and disability by age 48. A model comprising three factors: any antisocial behaviour and any parental risk factor at age 8–10 and any antisocial behaviour at age 27–32 best discriminated death or disability. Two factors: conviction between ages 10–18 and any antisocial behaviour at age 8–10 discriminated almost as well.

Death and disability by age 48 were strongly associated with antisocial behaviour at ages 8–10 and 27–32, convictions and impulsivity during adolescence and parental predictors of offending at age 8–10. Preventing childhood and adolescent antisocial behaviour and offending may also prolong life and prevent disability among those who would otherwise offend.

Data were analysed for 100 000 subjects registered with 78 family practices in the UK General Practice Research Database; the numbers of consultations for RTI and associated antibiotic prescriptions were enumerated.

The consultation rate for RTI declined in females from 442.2 per 1000 registered patients in 1997 to 330.9 in 2006, and in males from 318.5 to 249.0. The rate of consultations for colds, rhinitis and upper respiratory tract infection (URTI) declined by 4.2 (95% CI 2.3–6.1) per 1000 per year in females and by 3.6 (2.3–4.8) in males. The rate of antibiotic prescribing for RTI was higher in females and declined by 8.5 (2.0–15.1) per 1000 in females and 6.7 (2.7–10.8) in males. For colds, rhinitis and URTI, the proportion of consultations with antibiotics was prescribed declined by 1.7% per year in females and 1.8% in males.

Decreasing frequency of consultation and antibiotic prescription for colds, rhinitis and ‘URTI’ continues to drive a reduction in the rate of antibiotic utilization for RTIs.

An observational study compared the accuracy of needs identification in samples of older people before and after SAP introduction. Participants, at risk of entering care homes, were interviewed using standardized measures. Needs elicited from interviews were compared with those from statutory social services assessments to ascertain the reliability of needs identification at both times. Inter-rater reliabilities were calculated using the kappa (k) statistic. A Chi-squared statistic tested the equality of kappa values pre- and post-SAP.

Most needs were identified more reliably after SAP introduction (range adjusted k = 0.05–0.58) than before (range adjusted k = –0.09 to 0.28), this being statistically significant for 9 out of 15 needs. Depression, and associated apathy, was an exception.

Statutory social services assessments better captured need following the introduction of the SAP. However, the extent to which these findings can be attributed to SAP introduction is limited by the introduction of multiple policy initiatives throughout the study period.

Data were collected from a random sample of 4046 Chinese aged 60 years and older in Zhejiang province. Based on the Andersen-Newman service utilization framework, multivariable logistic regression analysis was used to determine independent effects of these variables on the likelihood of having an unmet need for hospitalization service.

Overall, the prevalence of unmet need was 16.2% for hospitalization service. Among predisposing factors, only educational level was statistically significant. Individuals with higher education were less likely to report unmet needs. Among enabling factors, residential area, social support, personal yearly income and personal healthcare expenditure were strongly associated with the presence of unmet need. Those with less enabling resources (e.g. residing in rural areas) were more likely to report unmet need [Odds ratio (OR) = 1.5–6.5]. All the need factors, except for physical function, were strongly associated with the presence of unmet need. Seniors in poorer health (e.g. in fair or poor health) were more likely to report unmet need than their counterparts in better health (OR = 1.5–2.8).

In spite of relatively high insurance coverage rates, unmet need for hospitalization service remains high among the elderly people of Zhejiang province in China. Application of comprehensive intervention strategies such as conducting health education, creating social support, promoting community participation and promoting inter-sectional cooperation may be more effective in reducing unmet need for hospitalization service.

Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007.

A total of 182 191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177 537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily.

Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.

We conducted a retrospective analysis of the General Internal Medicine (GIM) inpatient service at our institution for years 2005 and 2006, which included 5088 patients under GIM care.

Weekend discharge rate was more than 50% lower compared with reference rates whereas Friday rates were 24% higher. Holiday Monday discharge rates were 65% lower than regular Mondays, with an increase in pre-holiday discharge rates. Teams that were on-call or that were on call the next day had 15% higher discharge rates compared with reference whereas teams that were post-call had 20% lower rates. Individual attending physicians and length of attending coverage contributed small variations in discharge rates. Resident scheduling was not a significant predictor of discharge rates.

Day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Introducing greater holiday and weekend capacity as well as reorganizing internal processes such as admitting and attending schedules may potentially optimize discharge rates.

We sought to examine the association of false-positive mammography with depressed mood among women in a screening population. Using data from a state-based mammography registry, women who completed a standardized questionnaire between 7 May 2001 and 2 June 2003, a follow-up questionnaire between 19 June 2003 and 8 October 2004 and who received at least one screening mammogram during this interval were identified. False positives were examined in relation to depressed mood.

Eligibility criteria were met by 13 491 women with a median age of 63.9 (SD = 9.6). In the study population, 2107 (15.62%) experienced at least one false positive mammogram and 450 (3.34%) met criteria for depressed mood. Depressed mood was not significantly associated with false positives in the overall population [OR = 0.96; 95% confidence interval (CI) = 0.72–1.28], but this association was seen among Non-White women (OR = 3.23; 95% CI = 1.32–7.91).

Depressed mood may differentially affect some populations as a harm associated with screening mammography.

For each of the 4 strategies (clean delivery, routine immunization, supplemental immunization campaigns, and surveillance) activities before and after 2000 are described and achievements are summarized using published and unpublished data.

Through routine immunization of pregnant women with tetanus toxoid (TT), NT cases had decreased substantially by 1999, but the final push was provided through the national TT supplemental immunization activities in 2000–2004, which raised the proportion of children protected at birth against tetanus to above 80%. Fewer than 20% of deliveries take place with trained assistance. Although NT surveillance has improved since the extensive Acute Flaccid Paralysis/Polio surveillance infrastructure in Nepal was made available for the NT elimination initiative, it is likely that a number of cases still occur without being reported, particularly in rural areas.

NT elimination was achieved in 2005 in Nepal, but activities must continue and be strengthened to ensure that NT incidence will not increase in the future. The introduction and further expansion of school-based immunization will, in combination with diphtheria-tetanus-pertussis vaccine given in infancy, reduce the need for future cohorts of childbearing age women to be immunized at every pregnancy. However, booster doses will still need to be given in early adulthood to ensure ongoing protection.

We evaluate the effect of keeping all encounters as compared with removing repeat encounters. Using the prospective space–time permutation scan statistic, we performed daily analyses on all encounters versus on episodes defined as encounters new within 2, 6 or 12 weeks. Data were taken from a Massachusetts Health Maintenance Organization (HMO) for the calendar year 1999 for four different syndromes.

We found extensive disagreement in the number of signals detected: 70, 68, 21 and 15 signals when using all encounters versus 15–20, 3, 4–5 and 0 signals when using only new episodes for lower respiratory, lower gastrointestinal, upper gastrointestinal and neurologic syndromes, respectively.

Using all encounters in syndromic surveillance may not only create too many signals but may also miss some signals by masking the anomalies generated by actual episodes. However, it is also possible to miss signals when using episodes.

Qualitative interviews of poultry farmers, retailers, market stall holders and consumers in Hong Kong (n = 20), Guangzhou (n = 25), Vietnam (n = 38) and Thailand (n = 40) were conducted using purposive sampling and analysed using ethnographic principles.

Each location produced three comparable themes: ‘viruses’: HPAI exemplified a periodic, natural, disease process therefore, deserving little concern. For some, science had ‘discovered’ something long known to farmers and lived with for generations. Others believe the virus to be new. Viral ecology was reasonably well understood among farmers, but less so by retailers and consumers; ‘husbandry practices’ included poor hygiene, overcrowding and industrial farming, modern commercial feed and veterinary drugs; ‘vulnerability factors’ included uncontrollable ‘external’ explanations involving the weather, seasonal changes, bird migrations and pollution.

Lay explanations were generally ecologically consistent. Nonetheless, beliefs that HPAI is a normal, recurrent process, external factors and roles of industrialized poultry rearing countered health worker claims of H5N1 seriousness for smallholders. These causal beliefs incorporate contemporary models of H5N1 ecology, but in a manner that contradicts public health efforts at control.

We demonstrate the possibility of creating anonymous links between individual residences and the local environment using digital map data and a data linkage system.

Digital map data were used successfully to anonymously link 1.3 million addresses to the local environment. The data linkage system allows detailed environment data surrounding each residence to be linked both to each resident therein and to their medical records.

Local environment data specific to each house can be effectively and anonymously linked to the population registered with the National Health Service. Our integrated approach potentially enables flexible fine-scale, large-area observational studies of communities and health.