Access to healthy foods: Part I. Barriers to accessing healthy foods: Differentials by gender, social class, income and mode of transport

This paper examines the issues of access to food and the influences people face when shopping for a healthy food basket. It uses data from the Health Edu cation Authority's 1993 Health and Lifestyles Survey to examine the barriers people face in accessing a healthy diet. The main findings are that access to food is primarily determined by income, and this is in turn closely related to physical resources available to access healthy food. There is an associated class bias over access to sources of healthy food. The poor have less access to a car, find it harder to get to out-of-town shopping centres and thus are less able to carry and transport food in bulk. The majority of people shop in supermarkets as they report that local shops do not provide the services people demand and that food choice and quality are limited. In tackling food poverty and pro moting healthy eating, health promotion practice needs to address these struc tural issues as opposed to relying on psycho-social models of education based on the provision of information and choice

Death of the high street: identification, prevention, reinvention

Location is of paramount importance within the retail sector, yet defining locational obsolescence remains overlooked, despite significant concerns over the viability of parts of the complex sector. This paper reviews the existing literature and, through this, explores retail locational obsolescence, including the multi-spatial nature of the driving forces that range from the global economy, local markets and submarkets, to individual property-specific factors; and, crucially, the need to disentangle locational obsolescence from other important concepts such as depreciation and functional obsolescence that are often mistakenly used. Through this, a conceptual model, definition and diagnostic criteria are presented to guide future studies, policy development and the allocation of resources. Importantly, three stages are presented to enable the operationalization of the model, essential to future academic and industry studies as well as the ongoing development of policy in this economically important, complex and contentious area

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

Background Osteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability. Objectives The overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA. Data sources The North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1. Methods Workstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination. Results This programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA. Conclusions Implementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research. Limitations The key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care. Future work recommendations (1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA. Trial registration Current Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full in Programme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information. </jats:sec

Future transport developments Implications for business in Europe

SIGLEAvailable from British Library Document Supply Centre- DSC:q95/33969 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

National office and business space survey

SIGLEAvailable from British Library Document Supply Centre- DSC:q94/21150 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Emerging Europe summary 2003

Available from British Library Document Supply Centre- DSC:m03/25856 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Precautions against fire and dust explosions in industrial powder coating plants

Translated from German (Staub Reinhalt. Luft 1983 v. 43(10) p. 398-402)Available from British Library Document Supply Centre- DSC:9022.381(HSE-Trans--11404)T / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Canterbury shopping study Volume 1 - report

SIGLEAvailable from British Library Document Supply Centre- DSC:OP/LG-5698 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Pacific coast pilot : coasts and islands of Alaska /

Title on spine: Pacific coast pilot : Alaska : Appendix 1 : Meteorology and bibliography."Second series.""Bibliography; a list of the principal works consulted in preparing the meteorological tables of this work": p. 49. "Partial list of charts, maps and publications relating to Alaska and the adjacent region": p. 163-374.Mode of access: Internet

Parking Management

Purpose This chapter explains how and why local parking policies are developed, the sometimes conflicting relationship between parking, revenue raising and economic development and the circumstances in which it may be appropriate to use parking policy as a demand management tool. Methodology/approach This chapter offers a review of prior research and literature on the topic parking management and further explores the impacts and difficulties of parking management. Moreover, empirical data in this chapter comes from the authors’ own survey study of southern, eastern and southeastern European cities about their parking problems and policies. Findings The findings of this chapter show that there is a need to consider what parking solutions cities may choose and what solutions might work for them. It is difficult to say that very different solutions will suit cities of different sizes, but rather that the level of implementation of the solutions must be related to the scale of the problem in each city, and its citizens’ demands. In addition, each city must work within its particular legislative context, which is why certain solutions might not work in some cities. Practical implications Parking policy and parking management are key to urban mobility and to managing its negative effects. It is possible to develop a car parking policy that will manage the negative impacts of urban car use whilst also supporting business and the economy; but this is a balancing act, which is why it is important to learn from the experience of other places, as we have shown in this chapter. Parking demand and the response of different cities to it are very important when considering the rise of car use in Europe and other parts of the world. Future solutions for parking problems are detailed at the end of this chapter. Originality/value of paper This chapter offers a comprehensive overview of prior research in parking management and connects this overview to findings of the authors own survey in south, eastern and southeastern European cities. Very few studies have made similar connections and provided in-depth insights into parking management in European cities. Moreover, the research provides useful information for planners and professionals dealing with parking issues and what solutions might work in their city