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This paper investigates variations in policy responses to perceptions of social inequities in infant mortality in Canada, Chile, Sweden and the United Kingdom. It outlines patterns and trends in inequalities in infant mortality and some other birth outcomes, distinguishing between the use of routine data in some settings and research evidence in others. It suggests that some distinctive approaches about policies to reduce inequalities can be identified in the four countries. A number of emerging issues are also identified. One concerns the focus of interventions. Another relates to the use of targets. The third concern relates to the ways in which health inequalities are measured and monitored. Finally, the paper recommends the need for more research into areas such as the effectiveness of interventions, the nature of the problems facing ethnic minorities and the possible role of different social welfare regimes in achieving desired outcomes. [ABSTRACT FROM AUTHOR]

Objective: NHS stop smoking services are expected to play a key part in achieving the infant mortality and life expectancy health inequality targets in England by reducing smoking prevalence in deprived areas. This paper assesses the extent to which services have made a contribution to reducing inequalities in smoking between 2003-4 and 2005-6. Methods: Synthetic estimates of baseline smoking prevalence data were compared with national monitoring data about the numbers of smokers in receipt of services and the proportion who self report quilting at four weeks. The social distribution of service recipients and quitters was compared with estimates of smoking prevalence to assess impact on inequalities. Comparisons were made between officially designated disadvantaged areas (the Spearhead Group) and others. Results: Short-term cessation rates were lower in disadvantaged areas (52.6%) than elsewhere (57.9%) (p<0.001), but the proportion of smokers being treated was higher (16.7% compared with 13.4%) (p<0.001). The net effect was that a higher proportion of smokers in the most disadvantaged areas reported success (8.8%) than in more advantaged areas (7.8%) (p<0.001). Using the evidence-based assumption that three-quarters of short-term quitters will relapse within one year, the absolute and relative rate gaps in smoking prevalence between Spearhead areas and others are estimated to fall by small but for Health, University significant amounts from 5.2 and 1.215 (CIs: 1.216 to 1.213) to 5.0 and 1.212 (CIs: 1.213 to 1.210) between 2003-4 and 2005-6. Conclusion: NHS stop smoking services have probably made a modest contribution to reducing inequalities in smoking prevalence. To achieve government targets, however, requires both the development of more innovative cessation interventions for the most addicted smokers and action to ensure that other aspects of tobacco control policy make a larger contribution to inequality goals. [ABSTRACT FROM AUTHOR]

When New Labour came to power in the UK in 1997 it brought with it a strong commitment to reducing inequality and social exclusion. One strand of its strategy involved a focus on area-based initiatives to reduce the effects of persistent disadvantage. Health Action Zones (HAZs) were the first example of this type of intervention, and their focus on community initiatives to tackle the wider social determinants of health inequalities excited great interest both nationally and international. This article draws on findings from the national evaluation of the initiative. it provides an overview of the HAZ experiences and explores why many of the great expectations associated with HAZs at their launch failed to materialise. It suggests that, despite their relatively limited imp act, it is best to consider that they made a good start in difficult circumstances rather than that they failed. As a result there are some important lessons to be learned about the role of complex community-based interventions in tackling seemingly intractable social problems for policy-maker, practitioners and evaluators. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of smoking cessation services in enabling smokers living in disadvantaged areas to access treatment services, and to assess the extent of variations between areas.Observational study of administrative information linked with survey data.A representative sample of 19 of the 95 English health areas in 2001.All England smoking data by deprivation category obtained from the Health Survey of England were used to estimate neighbourhood smoking prevalence rates. Area of residence data from smokers setting a quit date were used to calculate the proportion of smokers in receipt of treatment services in different economic deprivation categories.In general, treatment services were seeing smokers from the most disadvantaged areas where smoking prevalence rates were highest; 32.3% of all smokers in receipt of treatment services lived in the most disadvantaged quintile of areas compared with 9.6% resident in the most advantaged quintile. An indicator of‘positive discrimination’ was calculated for each health authority area to quantify the extent to which the proportion of disadvantaged smokers being treated was greater than the proportion in the local population. This figure ranged from just under 0% to 18%.National Health Service (NHS) smoking cessation services have been successful in reaching smokers from disadvantaged communities. If improved access to support for smokers living in the poorest communities can be extended, sustained and translated into long-term quitting then smoking cessation services have the potential to make a useful contribution to addressing inequalities in health. [ABSTRACT FROM AUTHOR]

To examine the impact of socio-demographic factors, smoking-related behaviour and service characteristics on CO-validated quit rates at 4-week follow-up in English smoking treatment services, and to compare the results with those for self-reported quitters.Observational study of administrative information linked with survey data for 6959 recipients of smoking treatment services who set a quit date between October 2001 and March 2003.Two contrasting areas of England, Nottingham and North Cumbria, consisting of nine primary care trust (PCT) localities.Routine monitoring data specified by the Department of Health included information about basic demographic characteristics, postcode of residence from which a deprivation category was identified, nature of intervention and smoking status at 4-week follow-up. These data were supplemented with additional information about referral pathways, socio-economic status and smoking-related behaviours obtained from consenting service recipients by NHS advisers.More than one-half of clients (53%) were CO-validated as quitters at 4 weeks, rising to 60.7% when self-reported cases were included. Age (OR 1.026; CI 1.022–1.029) and being extremely determined to quit (OR 1.46; CI 1.26–1.71) were associated positively with CO-validated cessation, whereas women (OR 0.85; CI 0.77–0.94), users with lower socio-economic status (OR 0.92; CI 0.88–0.95), those smoking 31 or more cigarettes daily (OR 0.75; CI 0.64–0.88) and those with relatively poor health status (OR 0.72; CI 0.63–0.82) were less likely to quit. Although the vast majority of users received one-to-one support, those who had group counselling were more likely to be successful in their quit attempt (OR 1.38; CI 1.09–1.76). Self-report and CO-validated quitters were similar in terms of their characteristics.These results obtained from routine services support those obtained from clinical trials and confirm the effectiveness of counselling combined with pharmacotherapies to assist smokers to quit in the short term. However, the relative effectiveness of group interventions raises questions about why one-to-one counselling is used much more commonly. The importance of socio-demographic and nicotine-related dependency factors also suggests that local service targets for smoking cessation need to take account of the social distribution of these characteristics. [ABSTRACT FROM AUTHOR]

Contemporary efforts to promote population health improvement and to reduce inequalities in the UK are characterised by their complexity as they engage with a multiplicity of agencies and sectors. Additionally, the emphasis on promoting evidence-based practice has challenged evaluators tasked with collecting and interpreting evidence of impact in complex local health economies. National policy makers, local implementers and other stakeholders will have varying perspectives on impact and the Labour Government''s centralising tendencies have acted to ‘crowd out’ local voices from the policy process. Drawing on the national evaluation of Health Action Zones (HAZ) this article ‘gives voice’ to local stakeholders and their perceptions of impact. Informed by a Theories of Change perspective, we explore HAZ interventions to articulate the nature of impact and its limits. We analyse the claims made by local HAZs with reference to the evidence base and examine their significance in the context of overall HAZ objectives. We conclude that local implementer perspectives are no less sophisticated than those at the policy centre of central government, but that they are informed by three important factors: the local context, a need to be pragmatic and the limited potency of evidence in the public policy system. [Copyright &y& Elsevier]

The aim of this paper is to develop a better understanding of the relationship between income and health using a cross-sectional survey of the general British population. It is divided into two parts. First, it examines a number of methodological inconsistencies in the existing literature and assesses their consequences for the inferences that can be drawn about the income-health association. These issues include: the measurement of income and its functional form; health selection; and the role of confounders. Second, it explores the relative strength of the income-health association in contrast to that of other socioeconomic measures. The relationship between income and health is complex. However, having taken into account a range of methodological problems, income is still significantly associated with health. The association appears to be non-linear and is attenuated but not removed by controlling for health selection effects. The inclusion of a wide range of confounders into models of income and health reduces the association between them, but does not make it insignificant. In comparison to other socioeconomic measures, income appears to be a better discriminator of health status than education or occupation. However, tenure and car ownership seem to be at least as good if not better than current income. [ABSTRACT FROM AUTHOR]

Examines the relationship between income and health over time for adult participants in the British Household Panel Survey from 1991 to 1996/97 with respect to three key aspects of the association. Multivariate models; Significance of average and current income for health; Health risks of persistent poverty and occasional episodes of poverty; Healthy survivor effect.

A growing number of countries are beginning to move from acknowledging the existence of health inequalities to developing policies to reduce them. Many of these policies consist of complex interventions, operating at a number of levels, which aim to make a positive contribution to health improvement in deprived communities. Evaluating the efficacy of such initiatives poses particular challenges for evaluation. This paper argues that there is real potential in applying a theory-based approach to the evaluation of complex community-based initiatives. Using practical examples from the national evaluation of Health Action Zones in England, the paper outlines the key components of such an approach and argues that theory-based evaluation can strengthen programme design and implementation, as well as promote policy and practice learning about the most effective interventions for health improvement. We conclude that sophisticated theory building social change mechanisms in community settings is essential if real learning is to be generated from concerted efforts to achieve social change. [ABSTRACT FROM AUTHOR]

Suggests that in the average level of population health among rich industrial nations, inequalities in the distributions of income may be an important cause of variations. Summary of the English language literature; Presentation of of empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published.

Examines data from developed countries to study the relation between income distribution and average life expectancy at birth. View advanced by Richard Wilkinson; Life expectancy as a key indicator of population health and economic development; Cross sectional comparisons.

Focuses on the fair allocation of resources for health and social care in England. Equity of access to health care; Budget of the government to fund the National Health Service; Patterns of resource allocation in social and community care. INSET: A PATIENT WHO CHANGED MY CAREER.

Focuses on the social inequalities on health in Australia. Development of national goals and target for health; Demand for medical services; Effectivity of health care delivery.

Investigates the health inequalities to children of single mothers in Europe. Occurrence of social deprivation; Association of inequalities with socioeconomic status; Causes of children mortality.

Investigates the public views on the aspects of health care system in Great Britain. Influence of methodological issues in public perceptions; Role of media in the changing the public opinions; Assessment on the levels of satisfaction with National Health Service.

This article examines the nature of public opinion concerning the National Health Service in Great Britain. The first aim of this article is to review trends in public opinion during the late 1980s and early 1990s. It begins by examining data from two series of annual surveys of national opinion. Next, new data collected on behalf of the King's Fund Institute are presented. Responses are analyzed from four surveys of satisfaction with aspects of health care in Great Britain, conducted between August 1991 and May 1992, which have a combined total sample of almost 8,500 people. To begin with, and drawing on the latest available evidence about levels of satisfaction with aspects of the NHS, the study shows that a number of important similarities can be identified across different surveys of public opinion and the NHS. The next part of the article examines the factors associated with satisfaction with both the NHS and some of its constituent parts. A simple conceptual framework for understanding the determinants of public perceptions of the NHS is outlined, and the results of multivariate analyses are presented. These models establish that opinions about the NHS are partly a function of health status and socioeconomic, demographic, regional and other factors, as well as recent experience of using services. The paper concludes by interpreting the findings in the light of current understanding of opinions and contemporary health policy debate. INSETS: NHS in the news, 1991-92.;Health status and recent utilization of health services..

The article discusses the Health Action Zone (HAZ) in England. HAZ focuses on community-based activities aimed to tackle health inequalities both nationally and internationally. Among the strategic objectives of HAZ include the addressing of public health needs, increase in the efficiency of medical services and the development of partnerships for improving public health.

The National Strategy for Neighbourhood Renewal (NSNR) is a central component of British policy to reduce health disparities. This program seeks to improve local socioeconomic and physical environments through the intensive regeneration of disadvantaged communities. We describe the challenges facing evaluators tasked with assessing the impacts of 1 component of the NSNR--the New Deal for Communities initiative--and explore techniques that may be adopted in the evaluation process. (Am J Public Health. 2005;95:626-628.). [ABSTRACT FROM AUTHOR]

Focuses on the scheme employed to monitor and evaluate the implementation of 'Working for Patients' initiated by the National Health Services in Great Britain. Summary of the research projects; Details of the project; Background of the managed competitions employed in the project.

The article reports that policy design and implementation in public health are more neglected than political values. It states that the change of government leadership in England helps to explain why health inequality policies are being refreshed. A broad territory must be covered by any serious consideration of the impact of political science on public health. Much of politics is about values which do not bring themselves easily to scientific examination. According to the author, politics and government is vital to public health and it is time to focus more effort on the improvement of service delivery and performance.

Focuses on the health care system of the United States. Allocation of a percent in the gross national product for care and treatment of citizens; Efforts of the JAMA publication; Comparison of the British health care system.

Focuses on the influence of health policy on the improvement and length of the quality of life in Great Britain. Proposition on the improvement of the structure of the National Health Service; Argument on health policy; Impact of health policy on the differences between the health status among social groups.

Introduces a weighted capitation formula for the National Health Service in Great Britain. Proportion between health care resources and health care needs; Allocation of resources for hospital and community health service; Criticisms on the weighted capitation formula.

Background: Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.Methods: Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.Results: After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.Conclusions: In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) declines during childhood. Important sources of PA are active travel, organised sport and physical education (PE), but it is unclear how these domain-specific PA sources contribute to (changes in) daily moderate-to-vigorous PA (MVPA) in young people. This study aimed to examine (1) the cross-sectional association between domain-specific physical activity (i.e., active travel, organised sport and PE) and daily minutes in accelerometer-assessed MVPA; and (2) the longitudinal association between domain-specific physical activity at baseline and change in daily minutes in MVPA. Methods: Participants (baseline age 11.3 ±.1.2 years) were drawn from three studies in the International Children's Accelerometry Database. The contribution of self-reported standardised active travel, organised sport and PE to accelerometer-measured daily minutes in MVPA was examined using linear regression. In cross-sectional analyses, MVPA was regressed on each PA domain in separate models, adjusted for study, age, sex, maternal education, season, and monitor wear time. In longitudinal analyses, change in MVPA was regressed on each of the baseline PA domains, additionally adjusting for changes in season and wear time, follow-up duration, and baseline MVPA. R-squared was used to compare variance explained by each PA domain. Results: In the cross-sectional analyses (n = 3871), organised sport (standardised β = 3.81, 95% confidence interval [95%CI] = 3.06, 4.56) and active travel (β = 3.46, 95%CI = 2.73, 4.19) contributed more to daily MVPA than PE (β = 0.82, 95%CI = -0.02, 1.66). Compared to the base model which included only covariates (R2 = 21.5%), organised sport (absolute change: + 1.9%) and active travel (+ 1.7%) models explained more of the variance than the PE model (± < 0.1%). Associations followed a similar pattern in the longitudinal analyses (n = 2302), but none of the PA domains predicted change in MVPA (organised sport: standardised β = 0.85, 95%CI = -0.03, 1.72; active travel: β = 0.68, 95%CI = -0.14, 1.50; PE: β = 0.02, 95%CI = -0.87, 0.91). Conclusions: A multi-sectoral approach covering a wide range of PA domains should be promoted to minimise the age-related decline in MVPA during childhood. [ABSTRACT FROM AUTHOR]

Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health. [ABSTRACT FROM AUTHOR]

Aims To explore trends in and predictors of second-hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. Design Repeated cross-sectional study with data from eight annual surveys conducted over an 11-year period from 1996 to 2006. Setting England. Participants Nationally representative samples of children aged 4–15 years living in private households. Measurements Saliva cotinine (4–15-year-olds), current smoking status (8–15-year-olds), smoking status of parents and carers, smoking in the home, socio-demographic variables. Findings The most important predictors of SHS exposure were modifiable factors—whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke-free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes ( P < 0.05). Conclusions In the 11 years leading up to smoke-free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the degree to which welfare state regime characteristics explained the proportional variation of self-perceived health between European countries, when individual and regional variation was accounted for, by undertaking a multilevel analysis of the European Social Survey (2002 and 2004). A total of 65,065 individuals, from 218 regions and 21 countries, aged 25 years and above were included in the analysis. The health outcomes related to people''s own mental and physical health, in general. The study showed that almost 90% of the variation in health was attributable to the individual-level, while approximately 10% was associated with national welfare state characteristics. The variation across regions within countries was not significant. Type of welfare state regime appeared to account for approximately half of the national-level variation of health inequalities between European countries. People in countries with Scandinavian and Anglo-Saxon welfare regimes were observed to have better self-perceived general health in comparison to Southern and East European welfare regimes. [Copyright &y& Elsevier]

Modernising Social Services requires the use of satisfaction surveys in monitoring some key aspects of quality of provision, including user/carer perceptions and experiences of services and involvement of users/carers in assessment and review. Using data from the study Evaluating Community Care for Elderly People (ECCEP), of physically and/or mentally frail community-based older people in England and Wales receiving community care services, this investigation examines three crucial aspects of user satisfaction. The measures were: initial satisfaction with the assessment process and help provided by social services; also two measures obtained from a six month follow-up, namely satisfaction with service levels and with the experience of social services. Examination of overall satisfaction levels provided only a partial picture, due to their association with both user characteristics and the effect of life satisfaction. This association was therefore examined firstly by considering each characteristic separately and secondly by modelling the presence of each satisfaction measure in terms of those characteristics having a significant effect, using logistic regression. Arthritis, loneliness, problems keeping warm and an inner city location were all characteristics associated with reduced satisfaction, while most resource inputs, including social work involvement, were positively related to satisfaction. General life satisfaction was also associated with increased satisfaction levels. The role of life satisfaction as a predictor was further investigated through examining its dependence on case characteristics. While older users were more frequently satisfied with life, those with greater functional impairment and below average self-perceived health reported lower life satisfaction. Findings from this study highlight the complexity of interpreting satisfaction data and suggest that those responsible for designing and conducting surveys need to... [ABSTRACT FROM AUTHOR]

Issues of quality and accountability in social care for older people are of increasing importance. A key factor in determining quality is the extent to which older people themselves are satisfied with both the assessment of their needs and the services provided. The 1997 White Paper, Modernising Social Services, stated that local authorities will need to establish authoritywide objectives and performance measures to improve the quality and efficiency of services. In measuring quality, the White Paper stipulated that social service departments would need to design and administer satisfaction surveys as one means of capturing user and carer perceptions and experiences of services. This paper attempts to highlight some of the main issues to be considered when designing and conducting such surveys with older users of community care services. Through a review of the British and North American literature on older people's satisfaction with services, current approaches to measuring satisfaction are outlined and the relationship between the characteristics and circumstances of older people and their responses to satisfaction questions is examined. The paper concludes by offering some solutions to overcoming current problems by drawing conclusions about quality from survey findings, so that older people's opinions about the services they receive can begin to be assessed in a more meaningful way. [ABSTRACT FROM AUTHOR]

Introduction: An observational study examining 1-year follow-up of clients of two National Health Service smoking cessation services in Glasgow was used to inform a cost-effectiveness analysis. One service involved 7 weeks of group-based support (n = 411) and the other consisted of up to 12 weeks of one-to-one counseling with pharmacists (n = 1,374). Pharmacological aids to quitting (e.g., nicotine replacement therapy) were available to all clients. Methods: Quit rates were calculated for each service at 52 weeks after the quit date, and these were used for an economic evaluation of both the annual and the lifetime cost-effectiveness of the pharmacy- and group-based interventions in comparison with a baseline “self-quit” scenario. The annual cost-effectiveness model established the incremental cost per 52-week quitter, while a Markov model was developed for the lifetime analysis to estimate the potential lifetime outcomes in terms of cost per quality-adjusted life years (QALY) gained, to account for the benefits quitters will receive in terms of extended life years and improvements in quality of life from smoking cessation. Results: The proportion of carbon monoxide–validated quitters from both services combined fell from 22.5% at 4-week follow-up to 3.6% at 52 weeks. The group service achieved a higher quit rate (6.3%) than the pharmacy service (2.8%) but was more intensive and required greater overhead costs. The lifetime analysis resulted in an incremental cost per QALY of £4,800 for the group support and £2,600 for pharmacy one-to-one counseling. Conclusions: Despite disappointing 1-year quit rates, both services were considered to be highly cost-effective. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, accelerometers have increased in popularity as an objective measure of physical activity in free-living individuals. Evidence suggests that objective measures, rather than subjective tools such as questionnaires, are more likely to detect associations between physical activity and health in children. To date, a number of studies of children and adolescents across diverse cultures around the globe have collected accelerometer measures of physical activity accompanied by a broad range of predictor variables and associated health outcomes. The International Children's Accelerometry Database (ICAD) project pooled and reduced raw accelerometer data using standardized methods to create comparable outcome variables across studies. Such data pooling has the potential to improve our knowledge regarding the strength of relationships between physical activity and health. This manuscript describes the contributing studies, outlines the standardized methods used to process the accelerometer data and provides the initial questions which will be addressed using this novel data repository. Methods: Between September 2008 and May 2010 46,131 raw Actigraph data files and accompanying anthropometric, demographic and health data collected on children (aged 3-18 years) were obtained from 20 studies worldwide and data was reduced using standardized analytical methods. Results: When using ≥ 8, ≥ 10 and ≥ 12 hrs of wear per day as a criterion, 96%, 93.5% and 86.2% of the males, respectively, and 96.3%, 93.7% and 86% of the females, respectively, had at least one valid day of data. Conclusions: Pooling raw accelerometer data and accompanying phenotypic data from a number of studies has the potential to: a) increase statistical power due to a large sample size, b) create a more heterogeneous and potentially more representative sample, c) standardize and optimize the analytical methods used in the generation of outcome variables, and d) provide a means to study the causes of inter-study variability in physical activity. Methodological challenges include inflated variability in accelerometry measurements and the wide variation in tools and methods used to collect non-accelerometer data. [ABSTRACT FROM AUTHOR]

Aim To compare the characteristics and outcomes of users accessing pharmacy and group-based smoking treatment. Design Observational study of administrative information linked with survey data. Setting Glasgow, Scotland. Participants A total of 1785 service users who set a quit date between March and May 2007. Intervention Smoking treatment services based in pharmacies providing one-to-one support, and in the community offering group support. Measurements Routine monitoring data included information about basic demographic characteristics, deprivation category of residence, nature of intervention and smoking status at 4-week follow-up determined by carbon monoxide (CO) readings ≤10. These data were supplemented by information about socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers. Findings In the pharmacy-based service 18.6 % of users ( n = 1374) were CO-validated as a quitter at 4 weeks, compared with 35.5 % ( n = 411) in the group-based service. In a multivariate model, restricted to participants ( n = 1366) with data allowing adjustment for socio-demographic and behavioural characteristics and including interaction terms, users who accessed the group-based services were almost twice as likely (odds ratio 1.980; confidence interval 1.50–2.62) as those who used pharmacy-based support to have quit smoking at 4-week follow-up. Conclusions Specialist-led group-based services appear to have higher quit rates than one-to-one services provided by pharmacies but the pharmacy services treat many more smokers. More research is needed to determine what can be done to bring the success rates of pharmacy services up to those of specialist-led groups and how to expand access to group-based services. [ABSTRACT FROM AUTHOR]

To assess the impact of English treatment services on CO-validated quit rates at 52-week follow-up, to explore the relationship between service-related characteristics and socio-demographic and behavioural factors with cessation outcomes, and to compare the characteristics of service users lost to follow-up with CO-validated quitters.Observational study of administrative information linked with survey data for 2069 recipients of smoking treatment services who set a quit date between May and November 2002.Two contrasting areas of England, Nottingham and North Cumbria, consisting of nine primary care trust (PCT) localities.Routine monitoring data specified by the Department of Health included information about basic demographic characteristics, postcode of residence from which a deprivation category was identified, nature of intervention, and smoking status at 4-week follow-up. These data were supplemented with information about smoking status at 52 weeks, referral pathways, relapse experiences, number of follow-up contact attempts, socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers.One user in seven (14.6%) reported prolonged abstinence and was CO-validated as a successful quitter at 52 weeks. This rose to 17.7% when self-report cases were included. Relapse rates between 4 and 52 weeks were almost identical between the two study areas—75%. Relapse was most likely to occur in the first 6 months following treatment. Users who self-reported quitting at 4 weeks were less likely (13.7%) than those with biochemical verification of smoking status at 4 weeks (25.2%) to be CO-validated quitters at 52 weeks (P = 0.004). Older users (OR 1.023; CI 1.014–1.032), people who smoke mainly for pleasure rather than to cope (OR 1.38; CI 1.02–1.87), and those who were extremely determined (OR 1.58; CI 1.21–2.05) were more likely to be quitters at 52-week follow-up, whereas those with lower socio-economic status (OR 0.86; CI 0.78–0.96), who smoked their first cigarette of the day within 5 minutes of waking (OR 0.73; CI 0.55–0.96) or had another smoker in their household (OR 0.65; CI 0.49–0.86) were less likely. In contrast, users lost to follow-up tended to be younger and experienced different referral pathways than CO-validated quitters. Gender was not statistically significantly associated with cessation at 52 weeks and nor were any of the key characteristics of intervention, such as group or one-to-one counselling.These results obtained from routine services are consistent with those obtained from clinical trials in relation to abstinence at one year. Given that a high proportion of smokers relapsed between 4 weeks and 1 year it is important that future assessments of longer-term outcomes are conducted. However, following-up service users many months after an intervention is expensive, and reasonable estimates of quit rates can be estimated from short-term outcomes, provided that they have been CO-validated. Future studies should monitor outcomes from a selection of services treating different groups of smokers, particularly if more is to be learned about the role of smoking treatment services in reducing inequalities in health. [ABSTRACT FROM AUTHOR]

The vaccinia virus complement control protein (VCP) is involved in modulating the host inflammatory response by blocking both pathways of complement activity through its ability to bind C3b and C4b. Other activities arise from VCP''s ability to strongly bind heparin. To map regions within VCP involved in binding complement and heparin experimentally, surface plasmon resonance (SPR) and recombinantly expressed VCP (rVCP) constructs were employed. Using C3b or heparin as the immobilized ligand, various rVCP constructs were tested for their ability to bind. Results suggest that VCP is the smallest functional unit able to bind C3b, thereby blocking complement activity, and only a single site, the large basic region near the C-terminus, is involved in heparin binding. Kinetic analysis was also performed to determine the relative binding affinities between rVCP and complement (C3-MA and C4b), as well as rVCP and heparin. rVCP was found to possess a significantly greater affinity for C3-MA than C4b, as indicated by the 1.50e3-fold greater association rate constant (ka). This study provides insights for the design of new therapeutic proteins capable of blocking complement activation. [Copyright &y& Elsevier]