In search of causality: a systematic review of the relationship between the built environment and physical activity among adults

<p>Abstract</p> <p>Background</p> <p>Empirical evidence suggests that an association between the built environment and physical activity exists. This evidence is mostly derived from cross-sectional studies that do not account for other causal explanations such as neighborhood self-selection. Experimental and quasi-experimental designs can be used to isolate the effect of the built environment on physical activity, but in their absence, statistical techniques that adjust for neighborhood self-selection can be used with cross-sectional data. Previous reviews examining the built environment-physical activity relationship have not differentiated among findings based on study design. To deal with self-selection, we synthesized evidence regarding the relationship between objective measures of the built environment and physical activity by including in our review: 1) cross-sectional studies that adjust for neighborhood self-selection and 2) quasi-experiments.</p> <p>Method</p> <p>In September 2010, we searched for English-language studies on built environments and physical activity from all available years in health, leisure, transportation, social sciences, and geographical databases. Twenty cross-sectional and 13 quasi-experimental studies published between 1996 and 2010 were included in the review.</p> <p>Results</p> <p>Most associations between the built environment and physical activity were in the expected direction or null. Land use mix, connectivity and population density and overall neighborhood design were however, important determinants of physical activity. The built environment was more likely to be associated with transportation walking compared with other types of physical activity including recreational walking. Three studies found an attenuation in associations between built environment characteristics and physical activity after accounting for neighborhood self-selection.</p> <p>Conclusion</p> <p>More quasi-experiments that examine a broader range of environmental attributes in relation to context-specific physical activity and that measure changes in the built environment, neighborhood preferences and their effect on physical activity are needed.</p

Reliability of Two Instruments for Critical Assessment of Economic Evaluations

AbstractObjectiveTo assess the reliability of two instruments designed for critical appraisal of economic evaluations: the Quality of Health Economic Studies (QHES) scale and the Pediatric Quality Appraisal Questionnaire (PQAQ).MethodsThirty published articles were chosen at random from a recent bibliography of economic evaluations in health promotion. The quality of each of these studies was assessed independently by two raters using each of the two instruments. Inter-rater reliability and the agreement between the instruments were measured using an intraclass correlation coefficient (ICC). Cronbach's generalizability theory was also used to assess the sources of variation in quality scores of the studies and to indicate where improvements in reliability could best be made.ResultsInter-rater reliability was excellent for both instruments (ICC = 0.81 for the QHES and 0.80 for the PQAQ).Agreement between the instruments varied (ICC = 0.77 for rater 1 and 0.56 for rater 2). The biggest source of variation in the scores assigned to the articles was the quality of the study (56% of total variance). Conventional measurement error explained 31% of the total variance. Variation due to rater (<0.1%) and measurement instrument (1.8%) was very low.ConclusionsThe results suggest that the two instruments perform equally well. Choice of instrument can therefore be based on other criteria—simplicity and speed of application in the case of one, and detail in the information provided in the case of the other. There is little improvement in reliability to be gained from using more than one rater or more than one assessment of quality

How do government health departments in Australia access health economics advice to inform decisions for health? A survey

YesFunding provided by the Open Access Authors Fund

Economics and intensive care: from general principles to practical implications

Intensive care medicine is an expensive technology but, under certain circumstances also an effective one. Precisely how expensive and under what circumstances it is most effective are unclear. Studies purporting to address the question of the cost-effectiveness of intensive care medicine are inconclusive because of deficiencies in method. In this paper, a case is made for an economic evaluation of intensive care. The research evidence is reviewed and shortcomings in the methods adopted and highlighted. Finally, the practical implications of this literature for both researchers and the managers of intensive care units are discussed.

Self governing trusts: an agenda for evaluation

The proposals contained in the White Paper ‘Working for Patients’ have been described as an attempt to introduce competition into a non-competitive situation. Together with the introduction of practice budgets for family practitioners, the granting of self-governing status to NHS hospitals is the principle mechanism by which this aim will be achieved. Very little is known about the effects of competition on the delivery of health care. Evidence from the United Kingdom is non-existent and from the United States of America is inadequate and contradictory. Yet, despite the inconclusive nature of this evidence, the Government is implementing the most radical reforms of the NHS since its inception without any systematic attempt to monitor the extent to which the reforms achieve the desired ends. In this paper, a call is made to evaluate the effectiveness of self-governing trusts and the impact of the introduction of self-governing status on health services more generally. A variety of methods are described which would enable the reforms to be evaluated without holding back their implementation. No radical reform of the NHS can be expected to have an unambiguously beneficial impact on the delivery of health care. If the Government is genuine in its desire to improve health services in the UK, it should therefore be prepared to subject its proposals to the sort of independent evaluation described in this paper.competition, White Paper

Assessing the congruence between perceived connectivity and network centrality measures specific to pandemic influenza preparedness in Alberta

<p>Abstract</p> <p>Background</p> <p>Recent research has suggested that perceived organizational connectivity may serve as an important measure of public health preparedness. Presumably, organizations with higher perceived connectivity also have a greater number of actual organizational ties. Using network analysis, we evaluate this presumption by assessing the correlation between perceived organizational connectivity and reported inter-organizational connections.</p> <p>Methods</p> <p>During late 2007-early 2008, representatives from organizations involved in the delivery of public health systems in Alberta were asked to complete an online questionnaire on public health preparedness. Organizational jurisdictional information was collected. Items from Dorn and colleagues connectivity scale (2007) were used to measure perceived organizational connectivity. Inter-organizational network data on formal connections in the area of pandemic influenza preparedness were collected using a roster approach. These data were imported into UCINET to calculate in- and out-degree centrality scores for each organization. One-way ANOVA tests assessed if perceived connectivity and in- and out-degree centrality varied among jurisdictions. Pearson correlation coefficients were used to assess the correlation of perceived connectivity and in- and out-degree centrality.</p> <p>Results</p> <p>Significant mean differences among jurisdictions were observed for in-degree (<it>F</it>(3,116) = 26.60, <it>p </it>< 0.001) and between provincial and lower jurisdictions for out-degree centrality (<it>F</it>(3,116) = 5.24, <it>p </it>< 0.01). Higher jurisdictions had higher average centrality. Perceived organizational connectivity was correlated with out-degree (<it>r</it>(123) = 0.22, <it>p </it>< 0.05) but not in-degree centrality (<it>r</it>(123) = -0.07, <it>p </it>> 0.05).</p> <p>Conclusions</p> <p>The results suggest in terms of pandemic preparedness that perceived connectivity may serve as a partial proxy measure of formal out-degree network connectivity.</p

Poverty and inequalities in health

The first objective of the World Health Organisation’s ‘Health For All’ policy is the reduction of health related inequalities by some 25% (WHO, 1985). The UK Government’s endorsement of the HFA targets therefore indicated that health inequalities should never have been off the political agenda. Their continued importance as an issue of health-policy was confirmed recently by the health minister, William Waldegrave, who announced that the reduction of the remaining inequalities in health should be a prime aim of health services. The purpose of this paper is to explore the possibilities for reducing health inequalities by reconsidering the role structural or material conditions play in their determination and role health care might play in their eradication. Since the work of people such as Chadwick and Rowntree no one has doubted the association between ill health and poverty and so it is reasonable to question why the link should be reconsidered here. One reason is the pace of economic change during the 1980s. This period was characterised initially by increased unemployment, widened income differentials and then rapid economic growth which brought a fall in the rate of unemployment. By the end of the decade, the economic boom had ended and the economy was entering a recession which some commentators have suggested may be the worse since the 1930s. The effect of these economic changes on the levels of poverty is disputed and the effect on health inequalities is unknown. In this paper, the evidence on the numbers of people living on low incomes and the relationship between ill health and personal economic circumstances is reviewed before consideration is given to the implications of each on policy to reduce health inequalities.inequality, ill health, poverty, social security, welfare

Assessing the economic cost of a community unit: the case of Dr Barnardo's Intensive Support Unit

The number of children resident in large mental handicap hospitals has fallen substantially in recent years but those that remain tend to be amongst the most profoundly handicapped. If the benefits of community care are to be extended to this group of children then new residential facilities will have to be sufficiently resourced to cater for their special needs. In this discussion paper we report on the economic costs of one such unit, the Dr Barnardo’s Intensive Support Unit (ISU) in Liverpool, which was established especially to accommodate severely mentally handicapped young children. The paper begins with a brief description of the concept of economic cost and a discussion of how the general methodology was applied in practice. The costs of care in the ISU are then compared to the costs of caring for children with similar high levels of disability in an NHS community unit. Although the ISU is found to be initially more expensive per child than the larger NHS unit it has succeeded in its policy of finding foster homes for its children. This success is not only likely to improve the welfare of the children but also reduces the long-term costs of their care. The unit has not been in operation for long enough to ensure that all the costs of foster care are included, However, after three years, it does appear that ISU based care is no more expensive than care in a larger NHS community unit.mental handicap

Health outcomes: a health economics perspective, CHERE Discussion Paper No 19

Interest in and a commitment to "outcomes" is growing. There is general agreement that "health outcomes" are a good idea but, as yet, no generally agreed concept of what health outcomes are about. This paper offers a conceptual framework for the discussion of health outcomes from the perspective of health economics. It is written for a non-economics audience. This framework helps clarify the conceptual basis for health outcomes and identifies an agenda for research and development. The economics perspective on health outcomes draws on the analogy of the production process to clarify the relationships between health inputs, processes, outputs and final health outcomes. Jargon is kept to a minimum and technical points are expanded in self contained notes. A simple model of the production of health is described and then developed to include health promotion and non-health activities which are, nevertheless, beneficial to health. Conceptualising health outcomes with the economic framework provides the clarity needed to promote health outcomes and improve the effectiveness of health services. Doing good in health care is no longer good enough; we need to do better. Health outcomes are about doing better. So too is health economics. By making objectives explicit, and by systematic comparison of the costs and effects or health outcome of alternative means of meeting these objectives, health economics provides the most useful perspective on health outcomes.health outcomes

Counting the costs of community care: a practical introduction to the economic costing of community services for people with a mental handicap

The expansion of community residential facilities for people with a mental handicap requires a significant amount of investment of society’s scarce resources. If the resources are to be used efficiently it is essential that an evaluation of the relative costs and effects of alternative methods of service delivery is undertaken. The paper describes a method of estimating the economic or resource costs of proposed developments in community provision which can be used as a basis for a broader evaluation of their efficiency. It should provide practical guidance to the professional members of planning teams and to other managers and administrators more generally concerned with quality assurance.mental handicap, community services