RESUMEN
Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer.
Asunto(s)
Dieta Saludable/economía , Apoyo a la Planificación en Salud/economía , Promoción de la Salud/economía , Enfermedades no Transmisibles/prevención & control , Política Nutricional/economía , Comercio , Análisis de los Alimentos , Etiquetado de Alimentos , Abastecimiento de Alimentos/economía , Conductas Relacionadas con la Salud , Humanos , Mercadotecnía , Metaanálisis como Asunto , Enfermedades no Transmisibles/economía , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Evidence shows that one of the main causes for rising obesity rates is excessive consumption of sugar, which is due in large part to the high sugar content of most soda and juice drinks and junk foods. Worryingly, UK and global populations are consuming increasing amounts of sugary drinks and junk foods (high in salt, sugar and saturated fats). However, there is raised public awareness, and parents in particular want something to be done to curb the alarming rise in childhood obesity. Population-wide policies (i.e. taxation, regulation, legislation, reformulation) consistently achieve greater public health gains than interventions and strategies targeted at individuals. Junk food and soda taxes are supported by increasing evidence from empirical and modelling studies. The strongest evidence base is for a tax on sugar sweetened beverages, but in order to effectively reduce consumption, that taxation needs to be at least 20%. Empirical data from a number of countries which have implemented a duty on sugar or sugary drinks shows rapid, substantial benefits. In the UK, increasing evidence from recent scientific reports consistently support substantial reductions in sugar consumption through comprehensive strategies which include a tax. Furthermore, there is increasing public support for such measures. A sugar sweetened beverages tax will happen in the UK so the question is not 'If?' but 'When?' this tax will be implemented. And, crucially, which nation will get there first? England, Ireland, Scotland or Wales?
Asunto(s)
Bebidas , Obesidad/prevención & control , Salud Pública/métodos , Edulcorantes/efectos adversos , Impuestos , Bebidas/efectos adversos , Bebidas/economía , Programas Gente Sana/métodos , Humanos , Obesidad/etiología , Reino UnidoRESUMEN
OBJECTIVE: To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. METHOD: Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. RESULTS: The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. CONCLUSION: The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.
Asunto(s)
Actitud del Personal de Salud , Atención Dental para Enfermos Crónicos/métodos , Odontólogos/psicología , Trastornos Mentales/diagnóstico , Rol Profesional , Femenino , Odontología General , Humanos , Entrevistas como Asunto , Masculino , Pautas de la Práctica en Odontología , Derivación y Consulta , Muestreo , Encuestas y Cuestionarios , Procedimientos InnecesariosRESUMEN
Much work on the role of general practitioners within palliative care has focused on those working in densely populated inner city areas. This study was undertaken to evaluate the provision of palliative care and training needs of general practitioners in North Wales, a predominantly rural area. Questionnaires were sent to all 240 GPs and 94 responded (40%); those GPs responding were younger and mainly worked within partnerships. During the preceding year a median of four terminally ill patients had been cared for by each GP (range 0-21). General practitioners believed that palliative care was an important part of their role and applicable to patients with all end stage diseases. Use was made of community hospital beds as these were perceived as being more convenient for the patients and allowed the GPs to continue their involvement in patient care. Where services--e.g. palliative care consultants, day care and Marie Curie care--is available this was perceived as being very useful and of benefit. General practitioners believed they would benefit from further education and teaching on all aspects of palliative care, and this was supported by just over 50% of doctors knowing the correct breakthrough doses of morphine and many stating they would not prescribe more than a certain dose of opiates. Training in palliative care during vocational training was poor or non-existent and a preference was expressed for experiential teaching.
Asunto(s)
Medicina Familiar y Comunitaria , Cuidados Paliativos , Servicios de Salud Rural , Aflicción , Competencia Clínica , Medicina Familiar y Comunitaria/educación , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , GalesRESUMEN
It is known that 2% of all children are bereaved of a parent before the age of 18, but there is little support available for these bereaved children in the community. It is not known if these children consult the primary health care team more frequently than their non-bereaved peers. A record-based, case-controlled pilot study of 13 bereaved children over a 2-year period was carried out in a group general practice. All children had been bereaved of a father through malignant disease, and were from seven families. Children who had been bereaved of a parent attended the surgery more frequently than their age/sex-matched controls. There was an observed increase in the frequency of consultations both in the year preceding and following the bereavement. Post-bereavement, over one-third of consultations were for symptoms for which no organic cause could be found. The support needs of these bereaved children did not appear to be addressed. Further research is required to investigate the optimum means of providing support by the primary health care team for the small but significant number of children who are bereaved each year.
Asunto(s)
Servicios de Salud del Adolescente/estadística & datos numéricos , Aflicción , Servicios de Salud del Niño/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Atención Primaria de Salud/estadística & datos numéricos , Psicología Infantil , Adolescente , Estudios de Casos y Controles , Niño , Muerte , Femenino , Humanos , Masculino , Padres , Proyectos PilotoRESUMEN
Although only 25% of patients die at home, more than 90% of the terminally ill patient's last year of life is at home under the care of their own general practitioner (GP). In the United Kingdom, doctors training for general practice undergo a 3-year training with 2 years in hospital posts and a year in general practice. This questionnaire study of 33 GPs who had recently completed their vocational training was carried out to ascertain the teaching given on palliative care during the general practice component of training. Very few GPs (15%) had received tutorials on palliative care from within their practice. Less than a third felt they had received adequate teaching on pain and symptom control and fewer than 10% perceived the teaching on psychological support to be adequate. Compared to previous studies, the knowledge of specific therapeutics in palliative care had improved, but several were uncertain of basic principles such as the maximum dose of oral opiates which could be prescribed. The majority (85%) wished to have a placement in a hospice as part of their vocational training. This survey suggests that today's GPs would be very receptive to more focused teaching on palliative care encompassing both symptom control and psychological care during their GP training and would also welcome the opportunity of a hospice placement.