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Objective: To determine the cost-effectiveness of a physical activity programme (Be Active) aimed at city-dwelling adults living in Birmingham, UK., Methods: Very little is known about the cost-effectiveness of public health programmes to improve city-wide physical activity rates. This paper presents a cost-effectiveness analysis that compares a physical activity intervention (Be Active) with no intervention (usual care) using an economic model to quantify the reduction in disease risk over a lifetime. Metabolic equivalent minutes achieved per week, quality-adjusted life years (QALYs) gained and healthcare costs were all included as the main outcome measures in the model. A cost-benefit analysis was also conducted using 'willingness-to-pay' as a measure of value., Results: Under base-case assumptions-that is, assuming that the benefits of increased physical activity are sustained over 5 years, participation in the Be Active programme increased quality-adjusted life expectancy by 0.06 years, at an expected discounted cost of £3552, and thus the cost-effectiveness of Be Active is £400 per QALY. When the start-up costs of the programme are removed from the economic model, the cost-effectiveness is further improved to £16 per QALY. The societal value placed on the Be Active programme was greater than the operation cost therefore the Be Active physical activity intervention results in a net benefit to society., Conclusions: Participation in Be Active appeared to be cost-effective and cost-beneficial. These results support the use of Be Active as part of a public health programme to improve physical activity levels within the Birmingham-wide population.

Objectives To explore similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010). Methods Thematic policy and context analysis of the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinningtheoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results There were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy. [ABSTRACT FROM AUTHOR]

Objectives To compare the effectiveness of an exercise programme with usual care in people with Parkinson's disease (PD) who have a history of falls. Design Pragmatic randomised controlled trial. Setting Recruitment was from three primary and four secondary care organisations, and PD support groups in South West England. The intervention was delivered in community settings. Participants People with PD, with a history of two or more falls in the previous year, who were able to mobilise independently. Intervention 10 week, physiotherapy led, group delivered strength and balance training programme with supplementary home exercises (intervention) or usual care (control). Main outcome measure Number of falls during the (a) 10 week intervention period and (b) the 10 week followup Results 130 people were recruited and randomised (64 to the intervention; 66 to usual care). Seven participants (5.4%) did not complete the study. The incidence rate ratio for falls was 0.68 (95% CI 0.43 to 1.07, p=0.10) during the intervention period and 0.74 (95% CI 0.41 to 1.33, p=0.31) during the follow-up period. Statistically significant between group differences were observed in Berg balance, Falls Efficacy Scale-International scores and recreational physical activity levels. Conclusions The study did not demonstrate a statistically significant between group difference in falls although the difference could be considered clinically significant. However, a type 2 error cannot be ruled out. The findings from this trial add to the evidence base for physiotherapy and exercise in the management of people with PD. Trial registration ISRCTN50793425. [ABSTRACT FROM AUTHOR]

Objective: To examine whether physical activity (PA) moderates the association between alcohol intake and all-cause mortality, cancer mortality and cardiovascular diseases (CVDs) mortality.Design: Prospective study using 8 British population-based surveys, each linked to cause-specific mortality: Health Survey for England (1994, 1998, 1999, 2003, 2004 and 2006) and Scottish Health Survey (1998 and 2003).Participants: 36 370 men and women aged 40 years and over were included with a corresponding 5735 deaths and a mean of 353 049 person-years of follow-up.Exposures: 6 sex-specific categories of alcohol intake (UK units/week) were defined: (1) never drunk; (2) ex-drinkers; (3) occasional drinkers; (4) within guidelines (<14 (women); <21 (men)); (5) hazardous (14-35 (women); 21-49 (men)) and (6) harmful (>35 (women) >49 (men)). PA was categorised as inactive (≤7 MET-hour/week), active at the lower (>7.5 MET-hour/week) and upper (>15 MET-hour/week) of recommended levels.Main Outcomes and Measures: Cox proportional-hazard models were used to examine associations between alcohol consumption and all-cause, cancer and CVD mortality risk after adjusting for several confounders. Stratified analyses were performed to evaluate mortality risks within each PA stratum.Results: We found a direct association between alcohol consumption and cancer mortality risk starting from drinking within guidelines (HR (95% CI) hazardous drinking: 1.40 (1.11 to 1.78)). Stratified analyses showed that the association between alcohol intake and mortality risk was attenuated (all-cause) or nearly nullified (cancer) among individuals who met the PA recommendations (HR (95% CI)).Conclusions: Meeting the current PA public health recommendations offsets some of the cancer and all-cause mortality risk associated with alcohol drinking. [ABSTRACT FROM AUTHOR]

Background South Asians in the UK experience high rates of coronary heart disease compared with other ethnic groups. Behavioural risk factors such as physical inactivity have been explored as possible explanations for this trend. However, there have been few comprehensive accounts describing physical activity levels of this ethnic group. Methods Data from the Health Survey for England (1999-2004) on 5421 South Asians and 8974 white participants aged 18-55 years were used to compare physical activity levels. Analyses of covariance tested the association between ethnicity and self-reported total physical activity metabolic equivalents of task (MET) scores, adjusting for age, sex, self-reported health, adiposity and socioeconomic status. Results Total MET-min/week were consistently lower in UK South Asians than in white participants (973 vs 1465 MET-min, p<0.001). This ethnic group difference was consistent across sexes, age groups and subgroups and was independent of covariates. South Asians born in the UK reported higher levels of physical activity than those born elsewhere (p<0.001). Variables such as urbanisation and psychological distress were associated with physical activity; however, despite their inclusion in the models, ethnic group differences remained, indicating that physical inactivity in South Asians was not attributable to area or individual sociodemographic factors. Conclusions Physical activity levels are very low in UK South Asians; this is consistent across all examined population subsets. Physical inactivity is likely to contribute to their high risk of coronary heart disease. Increasing physical activity in all UK South Asians should be a public health priority for health professionals. [ABSTRACT FROM AUTHOR]

The history of English medicine used to consist of chronicles of medical progress and great ideas culminating in twentieth century biomedicine. Unlike earlier generations whose medical beliefs and practices were seen to be both futile and dangerous, modern medicine was thought to be able to eradicate illness with a "magic bullet". During the later part of the 20th century, however, the general public began to have doubts about the efficacy and safety of modern medicine. In turn, both the institution of medicine and the biomedical model began to be challenged by the media. These events led to a spreading desire for people to take a greater responsibility for their own health. One of the areas of greatest interest and growth is that of preventive medicine which focuses on a good diet and exercise. Far from being a new concept, however, the idea of a daily health "regimen" goes back to the ancient Greece and was further developed during the Middle Ages, and by the early modern period (1500-1800). [ABSTRACT FROM AUTHOR]