Characteristics of successful government-led interventions to support healthier populations: a starting portfolio of positive outlier examples.

Despite progress on the Millennium and Sustainable Development Goals, significant public health challenges remain to address communicable and non-communicable diseases and health inequities. The Healthier Societies for Healthy Populations initiative convened by WHO's Alliance for Health Policy and Systems Research; the Government of Sweden; and the Wellcome Trust aims to address these complex challenges. One starting point is to build understanding of the characteristics of successful government-led interventions to support healthier populations. To this end, this project explored five purposefully sampled, successful public health initiatives: front-of-package warnings on food labels containing high sugar, sodium or saturated fat (Chile); healthy food initiatives (trans fats, calorie labelling, cap on beverage size; New York); the alcohol sales and transport ban during COVID-19 (South Africa); the Vision Zero road safety initiative (Sweden) and establishment of the Thai Health Promotion Foundation. For each initiative a qualitative, semistructured one-on-one interview with a key leader was conducted, supplemented by a rapid literature scan with input from an information specialist. Thematic analysis of the five interviews and 169 relevant studies across the five examples identified facilitators of success including political leadership, public education, multifaceted approaches, stable funding and planning for opposition. Barriers included industry opposition, the complex nature of public health challenges and poor interagency and multisector co-ordination. Further examples building on this global portfolio will deepen understanding of success factors or failures over time in this critical area.

Interventions supporting caregiver readiness when caring for patients with dementia following discharge home: A mixed-methods systematic review.

OBJECTIVE: To explore programs and information provided to caregivers of inpatients with dementia to assist with readiness to provide care following discharge. METHODS: A mixed-methods systematic review with meta-analysis was conducted. Search terms included dementia, inpatient, caregiver, anxiety, discharge and counselling. RESULTS: The search yielded 1938 studies (six databases), 13 met the inclusion criteria. Meta-analysis showed no statistically significant changes in anxiety, depression, burden or quality of life 3 months postintervention. Three emergent qualitative themes for staff consideration are as follows: understanding personal characteristics of both patient and caregiver; presenting an inclusive organisational culture; and providing appropriate information at all stages of admission. A Model of Caregiver Readiness was created from the qualitative results. CONCLUSION: The programs did not significantly decrease the outcomes measured. However, caregivers identified that inclusion at all stages during hospital admission was a vital factor to reduce stress and increase caregiver readiness.

An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease.

This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013. The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r=0.59-0.93) and physical activity (r=0.40-0.85) than with respiratory function (r=0.10-0.59). Methodological factors affecting 6MWD include track length, encouragement, supplemental oxygen and walking aids. Supplemental oxygen also affects ISWT and ESWT performance. Responsiveness was moderate to high for all tests, with greater responsiveness to interventions that included exercise training. The findings of this review demonstrate that the 6MWT, ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease.

What to call spinal cord damage not due to trauma? Implications for literature searching.

OBJECTIVES: To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000-2009 with the Medical Subject Headings (MeSH) and Emtree term 'spinal cord diseases' and determine changes in the number of articles over this period. DESIGN: Literature searches and search filter development. SETTING: Australia. INTERVENTIONS: Titles and abstracts searched in MEDLINE and EMBASE (2000-2009) for articles involving humans using search terms 'non-traumatic spinal cord injury' and 'nontraumatic spinal cord injury' (concise search). Develop comprehensive search filter for 'spinal cord damage not due to trauma' and compare the results with the MeSH term 'spinal cord diseases.' OUTCOME MEASURES: Annual publications (2000-2009) identified in MEDLINE and EMBASE literature searches. RESULTS: Concise search identified 35 articles published during 2000-2009. More publications were identified using the term 'nontraumatic spinal cord injury' (n = 20) than 'non-traumatic spinal cord injury' (n = 16). Publications increased for both terms 'spinal cord diseases' (2000 = 279; 2009 = 415) and 'spinal cord damage not due to trauma' identified by the comprehensive search filter (2000 = 1251; 2009 = 1921). CONCLUSIONS: Concise searches using terms 'non-traumatic spinal cord injury' and 'nontraumatic spinal cord injury' fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for 'spinal cord damage not due to trauma.'