Improving public health by tackling climate change.

Across the world, climate change is now responsible for substantial mortality and morbidity, through direct effects on health and also by threatening the determinants of health. This commentary argues that adaptation policies to enhance resilience to adverse climate events are important, but must be coupled with determined action to reduce greenhouse gas emissions. The prize is synergy: many such policies, for example concerning food, travel and community engagement, can simultaneously improve physical and mental health.This is a commentary on http://www.ijhpr.org/content/2/1/23.

Anger Management groups for adolescents: a mixed-methods study of efficacy and treatment preferences.

We compared the efficacy of, and adolescents' preferences for, a Cognitive Behavioural (CBT) and Personal Development (PD) Anger Management (AM) group. The CBT group aimed to help adolescents develop skills to manage predominantly reactive aggression. The PD group aimed to enhance motivation to develop less aggressive identities with less use of proactive aggression. Eighteen adolescents were randomly allocated to a 10-session CBT or PD AM Group; seven additional adolescents formed a control group. They completed pre- and post-intervention questionnaires to assess anger expression and control, use of AM coping skills (also completed by carers) and self-image. Participants were also interviewed pre- and post-intervention; transcripts were subjected to Interpretive Phenomenological Analysis. Both treatment groups demonstrated significant improvements in anger coping and self-esteem, relative to the control group. Participants' age was significantly correlated with self-image and anger control outcomes in the CBT group. Qualitative analysis identified factors associated with improved outcomes, particularly regarding participants' age, motivation and readiness to change, engagement in the therapeutic process, group dynamics and emotional expressiveness. Our ability to interpret data clinically was enhanced by the use of a mixed quantitative-qualitative methodology. The results help us to better match interventions to clients.

The integration of health promotion and social marketing.

The urgency and scale of contemporary health challenges are enormous. The review It's Our Health! published in 2006 found that social marketing had considerable potential to increase the effectiveness of health improvement work, with the intention that it should build on core health promotion principles and not replace them. Health promotion has, however, lost its focus and identity in recent years in some parts of the country, partly due to repeated organizational change, and it has suffered from a lack of proactive workforce development. Over the last year, the National Social Marketing Centre (NSMC) and the Shaping the Future of Health Promotion Collaboration (StFofHP), hosted by the Royal Society for Public Health (RSPH), have explored the relationship between social marketing and health promotion and led a debate with stakeholders. A Delphi consultation with an expert panel drawn from specialists and strategic leaders in several settings, and the academic community, is currently under way and will report in the autumn. Findings so far emphasize the wide variation in understanding and interpretation of the two skill sets, much confusion about definitions and what added value both health promotion and social marketing bring to health improvement. Some of the distinctive contributions of both are described in this paper.

Perspectives on health promotion competencies and accreditation in Europe.

There is a growing and diverse health promotion workforce in Europe; however, no overall body has responsibility for quality assuring standards of training and professional practice at the European level. This paper provides an overview of recent developments in Europe, including initiatives led by the International Union for Health Promotion and Education, in the context of developing a pan-European accreditation system. Specific developments on establishing national-level accreditation processes in the UK, Estonia and The Netherlands are examined. While there is limited experience in this field across Europe, lessons can be learned from those countries with established systems. This paper focuses on those countries which have developed competencies, standards and accreditation systems, and the implications for developing a pan-European accreditation system are discussed. Differences between countries in the formats, content and processes of developing accreditation, coupled with the different educational, practice, political and resource situations, reflect the complexity of developing a pan-European system that is flexible, relevant and comprehensive. The development of competencies, standards and accreditation is not intended to be directed at health promotion specialists alone but aims to assure quality in performance of all those who contribute to health promotion, from whatever background or area of professional practice. It is likely that there will be a need to develop a robust system that will accommodate different levels of accreditation for different levels and fields of practice. Developing a pan-European accreditation system poses a significant challenge but also presents a unique opportunity to form a solid basis for building capacity and assuring quality for health promotion practice, research and training across the European region.

The RSPH Health Promotion and Community Well-Being Organization and Partnership Awards.

The Royal Society for Public Health (RSPH) has launched the Health Promotion and Community Well-Being Organization and Partnership Awards, in collaboration with the Faculty of Public Health, the UK Public Health Register and the Institute of Health Promotion and Education. The Awards demonstrate the new Society's mission of "vision, voice and practice", and will raise the profile of health promotion in the UK and recognize good practice through public and professional acknowledgement. They are linked to a wider programme of advocacy and workforce development led by the RSPH through the Shaping the Future collaboration (see http://www.specialisedhealthpromotion.org.uk). The Awards have a powerful pedigree in the "settings" approach of the World Health Organization, and focus on the strong processes that organizations and partnerships need to develop and implement strategies. The Awards have been developed in partnership with four initial applicants from primary care trusts, and one partnership applicant spanning a primary care trust, local authority and Council for Voluntary Services. Assessment of applications is through peer review and a panel challenge. Examples of evidence from the five initial applicants, and how they relate to the criteria for the Awards, are showcased in this article. They are: Sefton's Health-Promoting Settings Network; the North East Essex Youth Health Trainers scheme; Health Equity Audits in Rotherham; public engagement in North Lancashire; and Health at Work in Plymouth.

Origin and development of the UK Voluntary Register for Public Health Specialists.

This paper describes the milestones, challenges and achievements in establishing the UK Voluntary Register for Public Health Specialists (UKVRPHS), which was launched in 2003. Developments in the UKVRPHS since 2003 are described in the context of the continuing development of the UK multidisciplinary public health workforce as a whole.

Environmental sustainability in the national health service in England.

Health care providers should seek to minimise the environmental damage caused by their activities and to use scarce natural resources wisely. In particular, they should aim to make no contribution to climate change. Well-designed buildings which incorporate nature will contribution to the health of patients, Staff and visitors. A checklist is provided for environmentally sustainable NHS services. Faster progress requires leadership of cultural change and a much greater corporate commitment from the Department of Health.

Withdrawal from progesterone increases expression of alpha4, beta1, and delta GABA(A) receptor subunits in neurons in the periaqueductal gray matter in female Wistar rats.

Premenstrual dysphoric disorder (PMDD) shows comorbidity with other psychiatric conditions such as panic disorder (PD). The symptoms of both conditions are exacerbated during the late luteal phase of the menstrual cycle, when progesterone levels fall sharply. The present study investigated the effect of withdrawal from progesterone (PWD) on expression of alpha4, beta1, and delta GABA(A) receptor subunits in neurons within the panic circuitry of the midbrain periaqueductal gray matter (PAG) in adult female Wistar rats. Immunostaining for alpha4, beta1, and delta GABA(A) receptor subunits was present in neurons throughout the PAG in vehicle-treated animals (VEH), in rats after 24 hours withdrawal from a progesterone dosing regime (PWD, 5 mg kg(-1) i.p. twice daily for 6 days), and in animals maintained on progesterone for 7 days (HP). Compared to HP and VEH animals, which did not differ significantly from each other, the number of immunostained neurons present in the PAG of PWD rats was significantly higher. The effect was most pronounced in the dorsolateral column of the PAG. The parallel changes in the three GABA(A) receptor subunits suggests that falling progesterone levels may be associated with expression of new receptors of the alpha4beta1delta subtype. This could lead to functional changes in GABAergic transmission within the PAG. We suggest that changes in GABA(A) receptor-mediated inhibitory tone in the PAG consequent to withdrawal from progesterone may contribute to the increased anxiety and susceptibility to panic seen during the late luteal phase of the menstrual cycle in PMDD and PD patients.

Assault of the earth.

The NHS needs more incentives to take sustainable development to heart. Achievements by trusts are largely due to personal commitment, and are not systematic. A centrally backed programme of sustainable development could save money and would benefit staff, patients and visitors.

Centile charts II: alternative nonparametric approach for establishing time-specific reference centiles and assessment of the sample size required.

BACKGROUND: Reference intervals, and more generally centile estimates, are used to characterize a reference population for the purposes of interpreting an individual patient's clinical measurement. We describe methods of calculating reference intervals where these centiles vary with a covariate, usually age or time. METHODS: The US Food and Drug Administration and the IFCC have made recommendations on two approaches: the parametric approach, which models the structural characteristics of the data set with a theoretical distribution, and the nonparametric approach, which makes no particular assumption about this structure. In this report we propose a nonparametric procedure that relies on the principles of regression and show how sample size determination can be assessed. We also show how the sample size calculation is influenced by the distribution of the times measured. RESULTS: We illustrated our method on three data sets and compared the results for our proposed nonparametric method with parametric estimates. We showed that the bias is reduced and that the nonparametric method is less likely to produce fluctuating profiles. CONCLUSIONS: To achieve adequate precision the sample size needs to be larger than 120, as has often been recommended. If there is doubt about the parametric model, then threshold sample sizes may need to be as high as 500.

Modeling the hepatitis C virus epidemic in France using the temporal pattern of hepatocellular carcinoma deaths.

Deuffic et al. developed a compartmentalized model that characterized the evolution and spread of the hepatitis C virus (HCV) within France. There were various parameters defining the age- and sex-dependent transition probabilities between chronic hepatitis and cirrhosis in need of determination to completely specify their model. These were estimated by means of a weighted least-squares procedure that was executed numerically. The objective function used was based on the distribution of the age at death from hepatocellular carcinoma (HCC) rather than the temporal pattern of deaths due to HCC from 1979 to 1995. In this report, we investigate the impact of using an objective function based on the temporal pattern of deaths. We show that the dynamics of the epidemic can be quite different, in particular, short-term prediction of HCC deaths by HCV infection and times to death from onset of disease.