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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 based initiatives to tackle the wider social determinants of health inequalities excited great interest both nationally and internationally. This article draws on findings from the national evaluation of the initiative. It provides an overview of the HAZ experience, and explores why many of the great expectations associated with HAZs at their launch failed to materialise. It suggests that, despite their relatively limited impact, 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-makers, practitioners and evaluators. Social programs are complex undertakings. They are an amalgam of dreams and personalities, rooms and theories, paper clips and organisational structure, clients and activities, budgetss and photocopies, and great intentions. (Weiss, 1998: 48)

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. Keywords: Evaluation; Impact: Health Action Zones; Local perspectives; UK

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]

Research has been conducted on the vaccinia virus complement control protein inhibiting the complement activation pathways. Results indicate that the structure of the complement regulation intact regulator will stimulate the design of the therapeutic complement inhibitors.

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined. Key words - inequality, income distribution, life expectancy, infant mortality, OECD countries