The organisation and delivery of health improvement in general practice and primary care: a scoping study

Background This project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities. Aims The aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice. Methods We undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff. Findings Many of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely. Future Research Future research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc

Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis.

BACKGROUND: School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. OBJECTIVE: To systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children. METHODS: We systematically searched online databases for randomized or quasi-experimental interventions assessing effects of school food environment policies on children's dietary habits, adiposity, or metabolic risk factors. Data were extracted independently and in duplicate, and pooled using inverse-variance random-effects meta-analysis. Habitual (within+outside school) dietary intakes were the primary outcome. Heterogeneity was explored using meta-regression and subgroup analysis. Funnel plots, Begg's and Egger's test evaluated potential publication bias. RESULTS: From 6,636 abstracts, 91 interventions (55 in US/Canada, 36 in Europe/New Zealand) were included, on direct provision of healthful foods/beverages (N = 39 studies), competitive food/beverage standards (N = 29), and school meal standards (N = 39) (some interventions assessed multiple policies). Direct provision policies, which largely targeted fruits and vegetables, increased consumption of fruits by 0.27 servings/d (n = 15 estimates (95%CI: 0.17, 0.36)) and combined fruits and vegetables by 0.28 servings/d (n = 16 (0.17, 0.40)); with a slight impact on vegetables (n = 11; 0.04 (0.01, 0.08)), and no effects on total calories (n = 6; -56 kcal/d (-174, 62)). In interventions targeting water, habitual intake was unchanged (n = 3; 0.33 glasses/d (-0.27, 0.93)). Competitive food/beverage standards reduced sugar-sweetened beverage intake by 0.18 servings/d (n = 3 (-0.31, -0.05)); and unhealthy snacks by 0.17 servings/d (n = 2 (-0.22, -0.13)), without effects on total calories (n = 5; -79 kcal/d (-179, 21)). School meal standards (mainly lunch) increased fruit intake (n = 2; 0.76 servings/d (0.37, 1.16)) and reduced total fat (-1.49%energy; n = 6 (-2.42, -0.57)), saturated fat (n = 4; -0.93%energy (-1.15, -0.70)) and sodium (n = 4; -170 mg/d (-242, -98)); but not total calories (n = 8; -38 kcal/d (-137, 62)). In 17 studies evaluating adiposity, significant decreases were generally not identified; few studies assessed metabolic factors (blood lipids/glucose/pressure), with mixed findings. Significant sources of heterogeneity or publication bias were not identified. CONCLUSIONS: Specific school food environment policies can improve targeted dietary behaviors; effects on adiposity and metabolic risk require further investigation. These findings inform ongoing policy discussions and debates on best practices to improve childhood dietary habits and health

Terrestrial protected areas of Australia

Australia has a long history of establishing protected areas and they are now the cornerstones of its national and regional conservation strategies, covering over 13% of the country. There are large regional variations in levels of coverage, with most large protected areas placed far from dense human populations and away from productive agricultural land. Most of the recent growth in coverage has been driven by Indigenous Protected Areas and private protected areas, a trend that is likely to increase in the future. It is difficult to say how effective protected areas are in conserving biodiversity due to shortcomings in monitoring and evaluation, but the data that exist show that biodiversity outcomes are variable and that management effectiveness could be substantially improved. Threats to the protected area system are currently increasing with strong government pressure to allow extractive industries, such as mining, logging and grazing, and damaging recreational uses such as hunting to occur on land that is currently protected. If this trend continues, the future holds a great deal of uncertainty for Australia's protected areas

Performance, art et anthropologie

La circulation des pratiques culturelles constitue une source de mutations qui ne cesse d’étonner. Ce colloque propose une analyse croisée des rituels issus des sociétés traditionnelles et des performances produites par les artistes contemporains. Ce rapprochement mettra à contribution deux cultures scientifiques : d’une part, l’anthropologie, héritière d’un débat nourri sur la question du rituel, et, d’autre part, l’histoire de l’art, discipline directement concernée par les performances artistiques, mais aussi curieuse des traditions non occidentales. Les dénominateurs communs entre performances artistiques et performances rituelles concernent la spatialité en jeu, la nature des éléments de la manipulation, le temps hors norme de l’action et la production de symbolique. Il est opportun de se pencher sur ces convergences de significations. Nous aborderons, dans ce cadre, trois thématiques qui nous paraissent centrales. La première concerne une mise en perspective historique de la performance, la seconde est liée à l’implication du corps, la troisième questionne la valeur épistémologique des rituels et de la performance. 1. L’évolution actuelle des performances artistiques et rituelles. Nombreux sont les artistes qui se sont inspirés de pratiques rituelles : quelles sont les conséquences de tels déplacements ? Il semble que les rituels ne s’orientent pas nécessairement, contrairement à ce que l’on a pu penser, vers une uniformisation des pratiques découlant de la globalisation. Les processus d’emprunt sont complexes et restent à étudier. 2. La transformation du corps au cours de la performance. Les performances artistiques et rituelles unissent, le temps de l’action, acteurs et spectateurs. Elles établissent dans ce dessein un hors temps pendant lequel le corps est soumis à un ensemble de transformations pouvant aller jusqu’à plonger les participants dans un état second. Comment analyser ces phénomènes qui atteignent au point de déposséder de son identité ? 3. La valeur épistémologique du rituel et de la performance. Au même titre que les performances studies, l’anthropologie théâtrale ou certains dispositifs d’échange proposés par les artistes contemporains, le travail de l’anthropologue sur le terrain peut être considéré comme une "performance interculturelle". Dans cette perspective, nous envisagerons les différents médias permettant de travailler au-delà de l'analyse discursive. Liste de participants Paul Ardenne (faculté des arts, Amiens) Miquel Barcelo (artiste) Lucien Castaing-Taylor (université de Harvard) Francesco Careri et Lorenzo Romito (artistes, Université de Roma TRE -Stalker / Osservatorio Nomade) Catherine Choron-Baix (CNRS) Craigie Horsfield (artiste) kjersti Larsen (université de Oslo) George Marcus (université de Californie, Irvine) Barbaro Martinez-Ruiz (université de Stanford) ORLAN (artiste) Caterina Pasqualino (CNRS/EHESS Paris) Richard Schechner (université de New York, NYU), Arnd Schneider (université de Oslo) Marthe Torshaug (artiste) Barthélemy Toguo (artiste) Chris Wright, (Goldsmiths, université de Londres