To systematically review the available evidence on the impact of organizational partnerships on public health outcomes (health improvement and/or a reduction in health inequalities) in England between 1997 and 2008.
Systematic review of quantitative (longitudinal before and after) and qualitative studies (1997–2008) reporting on the health (and health inequalities) effects of public health partnerships in England.
Eighteen electronic databases (medical, social science and economic), websites, bibliographies and expert contacts.
Only 15 studies, relating to six different interventions, met the review criteria and most of these studies were not designed specifically to assess the impact of partnership working on public health outcomes. Of the studies reviewed, only four included a quantitative element and they produced a mixed picture in terms of the impacts of partnership working. Qualitative studies suggested that some partnerships increased the profile of health inequalities on local policy agendas. Both the design of partnership interventions and of the studies evaluating them meant it was difficult to assess the extent to which identifiable successes and failures were attributable to partnership working.
This systematic review suggests that there is not yet any clear evidence of the effects of public health partnerships on health outcomes. More appropriately designed and timed studies are required to establish whether, and how, partnerships are effective.
The aim of this work was to describe the television (TV) viewing time of preschoolers and to examine factors that may be associated with it.
A representative sample of 2374 Greek children aged 1–5 years was examined (GENESIS study). Several anthropometric, socio-demographic and lifestyle characteristics were recorded.
The mean value of children's TV viewing time was 1.32 h/day. Twenty six percent of participants spent ≥2 h/day in TV viewing. The percentage of children whose TV viewing time was longer than 2 h/day was higher in children aged 3–5 years (32.2%) than in those aged 1–2 years (11.1%). Multiple logistic regression revealed that the time parents spent viewing TV and the region of residence were significantly associated with child's TV viewing time among children aged 3–5 years. Among children aged 1–2 years, the maternal educational status, the region of residence and the maternal TV viewing time were found to be related to child's TV viewing time.
The current findings suggest that almost one third of Greek preschoolers exceed the limit of 2 h/day TV viewing and that parental TV viewing time may be the most important determinant of children's TV viewing time.
There are doubts whether diabetes care is equitable across UK ethnic groups. We examined processes and outcomes in South Asians with diabetes and reviewed the UK literature.
We used name search methods to identify South Asians in a regional diabetes database. We compared prevalence rates, processes and outcomes of care between November 2003 and December 2004. We used standard literature search techniques.
The prevalence of diabetes in South Asians was 3–4 times higher than non-South Asians. South Asians were 1.11 times (95% confidence interval 1.06, 1.16) more likely to have a structured review. South Asian women were 1.10 times more likely to have a record of body mass index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00, 1.06) among South Asians, retinopathy 1.36 times more common (95% CI 1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87).
We found evidence of equity in many aspects of diabetes care for South Asians in Tayside. The finding of higher HbA1c and more retinopathy among South Asians needs explanation and a service response. These findings from a region with a small non-White population largely support the recent findings from other parts of the UK.
The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care.
Analysis of mortality for people aged 20 years and over using the 2001 Census data and death data from 1999 and 2001–2003.
England and Wales.
Standardized mortality ratios (SMRs) for alcohol-related deaths and HCC.
Mortality from alcohol-related deaths (23 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219–254; SMR for women [F]: 212, 95% CI: 191–235) and Scotland (SMR-M: 187, CI: 173–213; SMR-F 182, CI: 163–205) and men born in India (SMR-M: 161, CI: 144–181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380–701; SMR-F: 319, CI: 146–605), China and Hong Kong (SMR-M: 492, CI: 168–667; SMR-F: 323, CI: 184–524), West Africa (SMR-M: 440, CI, 308–609; SMR-F: 319, CI: 165–557) and Pakistan (SMR-M: 216, CI: 113–287; SMR-F: 215, CI: 133–319).
These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.
Smoking is a main contributor to health inequalities. Identifying strategies to find and support smokers from disadvantaged groups is, therefore, of key importance.
A systematic review was carried out of studies identifying and supporting smokers from disadvantaged groups for smoking cessation, and providing and improving their access to smoking-cessation services. A wide range of electronic databases were searched and unpublished reports were identified from the national research register and key experts.
Over 7500 studies were screened and 48 were included. Some papers were of poor quality, most were observational studies and many did not report findings for disadvantaged smokers. Nevertheless, several methods of recruiting smokers, including proactively targeting patients on General Physician's registers, routine screening or other hospital appointments, were identified. Barriers to service use for disadvantaged groups were identified and providing cessation services in different settings appeared to improve access. We found preliminary evidence of the effectiveness of some interventions in increasing quitting behaviour in disadvantaged groups.
There is limited evidence on effective strategies to increase access to cessation services for disadvantaged smokers. While many studies collected socioeconomic data, very few analysed its contribution to the results. However, some potentially promising interventions were identified which merit further research.
The intensification of livestock production has led to situations where the amount of manure that is produced exceeds the amounts needed in some areas. The objective of this study was to evaluate the relationship between the intensity of livestock activities and manure products, particularly in swine farms, and the prevalence of diarrhea in adults.
A survey was carried out on 8702 adults living in 161 municipalities in Quebec areas with intensive farming activities. Data were collected by a telephonic interview on diarrheal symptoms that occurred during the previous week of the interview, on water consumption and on selected risk factors. Statistical analysis was performed using a ‘generalized estimating equations’ model.
Prevalence of diarrhea was found to be highest in adults aged between 25 and 34 years. No association was found between swine density or liquid manure application and diarrheal prevalence. There was also no association between cattle or total animal density and diarrheal prevalence. In the areas studied, there was no increase in risk associated with the consumption of tap water with suboptimal treatment and susceptible to microbiologic contamination.
Significant livestock production and excess of manure were not associated with the risk of diarrhea in adults.
In France, as in other industrialized countries, syndromic surveillance systems for the early detection of illnesses have proliferated, but few validation studies on these systems performances exist. In Bordeaux, a south-western city in France, a system using a network of general practitioners house calls, such as SOS Médecins, provided local health data used to guide health service response, in particular in case of flu-like pandemic. We explored the capacity of SOS Médecins system to identify and follow influenza outbreaks using data from the Sentinel network, considered as being a gold standard for tracking seasonal influenza in France.
Data from SOS Médecins were analysed and compared with data from the Sentinel network. The sensitivity and specificity of SOS Médecins system were evaluated for different simulated thresholds.
A relationship between the number of visits for influenza from SOS Médecins and the number of influenza cases from the Sentinel network was observed; data from the two systems were highly correlated. We showed the capacity of SOS Médecins system to identify outbreaks with a sensitivity and specificity of 93%.
The sensitivity and specificity of SOS Médecins for early outbreak detection showed the value of these data in monitoring influenza activity.