Understanding exercise uptake and adherence for people with chronic conditions: a new model demonstrating the importance of exercise identity, benefits of attending and support.

Understanding the factors influencing uptake and adherence to exercise for people with chronic conditions from different ages, genders and ethnicities is important for planning exercise services. This paper presents evidence supporting a new model of exercise uptake and adherence applicable to people with chronic conditions from diverse socio-demographic backgrounds. The study is based on 130 semi-structured interviews with people with chronic conditions, including both those who did and those who did not attend exercise services, and supporters of those who attended. Analysis followed the guidelines of 'framework analysis'. Results show that three factors were particularly important in influencing adherence behavior: (i) exercise identity, (ii) support and (iii) perceived benefits of attending. Social and cultural identities impacted on willingness to exercise, importance of exercise and perceived appropriateness of exercising. Having at least one supporter providing different types of support was associated with high levels of attendance. Those people who valued the social and psychological benefits of attending were more likely to be high attenders. The new model illustrates interaction between these three factors and discusses how these can be taken into account when planning exercise services for people with chronic conditions drawn from diverse socio-demographic groups.

How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria.

OBJECTIVES: The two objectives were: (1) to identify, appraise and synthesise research that is relevant to selected UK National Screening Committee (NSC) criteria for a screening programme in relation to partner violence; and (2) to judge whether current evidence fulfils selected NSC criteria for the implementation of screening for partner violence in health-care settings. DATA SOURCES: Fourteen electronic databases from their respective start dates to 31 December 2006. REVIEW METHODS: The review examined seven questions linked to key NSC criteria: QI: What is the prevalence of partner violence against women and what are its health consequences? QII: Are screening tools valid and reliable? QIII: Is screening for partner violence acceptable to women? QIV: Are interventions effective once partner violence is disclosed in a health-care setting? QV: Can mortality or morbidity be reduced following screening? QVI: Is a partner violence screening programme acceptable to health professionals and the public? QVII: Is screening for partner violence cost-effective? Data were selected using different inclusion/exclusion criteria for the seven review questions. The quality of the primary studies was assessed using published appraisal tools. We grouped the findings of the surveys, diagnostic accuracy and intervention studies, and qualitatively analysed differences between outcomes in relation to study quality, setting, populations and, where applicable, the nature of the intervention. We systematically considered each of the selected NSC criteria against the review evidence. RESULTS: The lifetime prevalence of partner violence against women in the general UK population ranged from 13% to 31%, and in clinical populations it was 13-35%. The 1-year prevalence ranged from 4.2% to 6% in the general population. This showed that partner violence against women is a major public health problem and potentially appropriate for screening and intervention. The HITS (Hurts, Insults, Threatens and Screams) scale was the best of several short screening tools for use in health-care settings. Most women patients considered screening acceptable (range 35-99%), although they identified potential harms. The evidence for effectiveness of advocacy is growing, and psychological interventions may be effective, but not necessarily for women identified through screening. No trials of screening programmes measured morbidity and mortality. The acceptability of partner violence screening among health-care professionals ranged from 15% to 95%, and the NSC criterion was not met. There were no cost-effectiveness studies, but a Markov model of a pilot intervention to increase identification of survivors of partner violence in general practice found that such an intervention was potentially cost-effective. CONCLUSIONS: Currently there is insufficient evidence to implement a screening programme for partner violence against women either in health services generally or in specific clinical settings. Recommendations for further research include: trials of system-level interventions and of psychological and advocacy interventions; trials to test theoretically explicit interventions to help understand what works for whom, when and in what contexts; qualitative studies exploring what women want from interventions; cohort studies measuring risk factors, resilience factors and the lifetime trajectory of partner violence; and longitudinal studies measuring the long-term prognosis for survivors of partner violence.

Smoking amongst UK Bangladeshi adolescents aged 14-15.

This paper reports on an investigation into smoking amongst 14- to 15-year-old Bangladeshis living in an UK inner city locality. A survey using self-completion questionnaires was undertaken in conjunction with focus group discussions. The survey of 316 Bangladeshi adolescents was conducted to determine smoking prevalence. Regular smoking was more common amongst Bangladeshi males (39%) than amongst Bangladeshi females (11%). Thirty-one people (17 females and 14 males) took part in seven focus groups (four female and three male) which were conducted in schools (six) and youth clubs (one). Focus group discussions were conducted to examine what smoking means to Bangladeshi teenagers and factors which influence why they do or do not smoke. Differences between what smoking means to Bangladeshi females and males are identified which arise from perceived social norms and cultural values, and greatly influence smoking uptake. However, many of the reasons why Bangladeshi adolescents continue to smoke, stop smoking or never smoke appear similar to those identified in other studies with largely white adolescents. Factors underpinning adolescent choices together with the implications of the study findings for the development of smoking prevention initiatives for inner city Bangladeshi teenagers are discussed.

Health care reforms in Russia: the example of St Petersburg.

This paper describes the changes being introduced into the Russian health care system, particularly the introduction of a compulsory social health insurance system which is paralleled by encouragement of independent health insurance. An example of the implementation of these changes is provided by the early developments in St Petersburg. The effects of the likely changes on health care providers and users are discussed. It is argued that in the light of these reforms, as well as change in other countries, a revision is necessary in the perspectives adopted by geographers of health care to compare national health systems.

Resource allocation problems and health services for the elderly.

The provision of appropriate health support services for the elderly has increased in importance because of the trend towards aging populations in Europe and other developed regions. Health service resource allocation models and their roles in health service systems, which are also changing to reflect changing needs for the elderly, are discussed in this article. Different types of economic and health care delivery systems are examined, particularly those leading towards decentralization, consumer participation and "deinstitutionalization". A promising resource allocation approach--the "balance-of-care" approach--is described in some detail. This and other potential approaches make it possible to identify areas which hold promise for crossnational research.

[Monitoring progress towards health for all in the European region of WHO IV. Changes in health systems]. / Vers la santé pour tous dans la région européenne de l'OMS surveillance des progrès accomplis IV. Réponses des systèmes de santé.

This review deals with recent changes in health services development and support among the Member States of the European Region in response to changes in health indicators in the framework of the Regional targets for Health for all. Developments in research, in health legislation and in training which take into account the targets of Health for all represent long-term actions; several countries mention efforts to increase community participation in the development and evaluation of health programmes, efforts which must be actively pursued. Changes are perforce slow, and economic pressure represents both a challenge and a constraint.

[Monitoring progress towards health for all in the European region of WHO. III. Life style and physical environment]. / Vers la Santé pour tous dans la région européenne de l'OMS surveillance des progrès accomplis. III. Modes de vie et milieu physique.

A review of recent progress towards the Regional targets set for Health for all in the European Region of WHO, as regards lifestyle and environmental factors. Tobacco consumption (in most countries), and alcohol drinking (mainly in countries with previous high consumption) show some improvement. Illicit drug use is emerging in new countries, although it appears to stabilise in previously affected areas. Despite considerable efforts on environmental factors, there remains a serious problem of communication with the public, and action is poorly coordinated; indicators for environmental health show little progress.

Equity and access: exploring the effects of hospital location on the population served--a case study in strategic planning.

This paper describes a case study in which a simulation model, specifically an attraction-constrained spatial interaction model, is used to provide information to assist in the exploration of different options for the future provision of in-patient hospital facilities in an English Regional Health Authority. The model is used to evaluate options on the basis of their effect on two different criteria: first the level of utilization of hospital in-patient facilities relative to need of populations resident in different parts of the region, and secondly the relative ease of geographical access of the facilities to the populations served.

[Toward health for all in the European region of the WHO. Survey of progress accomplished. II. Preliminary conditions: demographic and health status]. / Vers la santé pour tous dans la région européenne de l'OMS. Surveillance des progrès accomplis. II. Conditions préalables: bilan démographique et sanitaire.

A review of recent progress towards the regional targets set for health for all by the Member States of the European Region of WHO, as regards preliminary conditions for health, and for indicators of mortality, morbidity and disability. Life expectancy, infant and maternal mortality, and mortality from ischaemic heart disease and from traffic accidents show an improvement, as does the incidence of several infectious diseases, but the situation has worsened or stagnated as regards suicide and cancer, and there is a lack of information on disability and chronic morbidity. Despite some progress, the goal of equity in health is still very far from being attained.