Epidemiology and public health consequences of diabetes.

In the world of diabetes a number of outdated terms are still in use and some myths exist. Among the former are 'juvenile onset' and 'maturity onset' which, given the changing epidemiology of diabetes, need to be abandoned once and for all. A dangerous myth is that type 2 diabetes is 'mild diabetes'.

The relationship between disease control strategies and health system development: the case of TB.

This paper focuses on the lack of dialogue and policy consonance between those taking the lead in health systems change and those developing specific disease control strategies. In the first part, the origins and characteristics of this situation are explained using, as an example, TB control. Attention is then paid to the development of disease control friendly health systems.

Dietitians' views of overweight and obese people and reported management practices.

Objectives: To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices.

Design: An independent measures survey, questioning dietitians about either overweight or obese people.

The detection and management of abdominal aortic aneurysm: a cost-effectiveness analysis.

Background: Abdominal aortic aneurysm (AAA) is an important cause of death in Canada, and about 80% of the deaths are due to ruptured aneurysm.

Method: To determine the most cost-effective way of controlling AAA in terms of early detection and clinical management, a cohort analysis was undertaken beginning at age 50 years, using a multistate life-table model with parameters derived from published articles. The model was used to determine (a) the optimum size for elective surgery and (b) the optimum rate of detection of intact AAA.

Reproductive health and health sector reform in developing countries: establishing a framework for dialogue.

It is not clear how policy-making in the field of reproductive health relates to changes associated with programmes for the reform of the health sector in developing countries. There has been little communication between these two areas, yet policy on reproductive health has to be implemented in the context of structural change. This paper examines factors that limit dialogue between the two areas and proposes the following framework for encouraging it: the identification of policy groups and the development of bases for collaborative links between them; the introduction of a common understanding around relevant policy contexts; reaching agreement on compatible aims relating to reproductive health and health sector change; developing causal links between policy content in reproductive health and health sector change as a basis for evidence-based policy-making; and strengthening policy-making structures, systems, skills, and values.

Development, validation and utilisation of food-frequency questionnaires - a review.

Objective: The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g.

Nutrition interventions by primary care staff: a survey of involvement, knowledge and attitude.

Objective: To undertake a survey to investigate the quality and format of nutrition health promotion in UK primary care. Data from both primary care practitioners - i.e.

Variations in practice admission rates: the policy relevance of regression standardisation.

Objectives: To explore variations in general practice admission rates, comparing standardisation by regression with direct standardisation of the data to identify explained and unexplained variation.

Methods: Data from hospital episode statistics and the attribution dataset on 8048 cataract admissions from 109 practices in an English health district (North Yorkshire) between 1995 and 1998. Multiple regression was used to estimate the effect of practice characteristics, socio-economic factors, waiting times and distance on practice admission rates.

Assessing the impact of complications on the costs of Type II diabetes.

Aims/hypothesis: 'The Cost of Diabetes in Europe - Type II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients.

Methods: Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication.

Decentralization, health care and policy process in the Punjab, Pakistan in the 1990s.

The Province of the Punjab underwent a number of attempts to decentralize the health sector in the 1990s. Among the most important were the decentralization of financial management within the district, the Sheikhupura PHC Pilot Project, the establishment of the District Health Authorities and District Health Management Teams, the creation of semi-autonomous hospitals and the programme of District Health Government (DHG). These usually received donor support and promotion, and emerged from within the provincial Department of Health, and more specifically the Secretariat and the internationally supported Second Family Health Project (FH2).

Diabetes UK funded surveys of the structural provision of primary care diabetes services in the UK.

Aim: To describe diabetes service provision in primary care in the UK.

Methods: Postal questionnaires were sent to all UK primary care organizations (PCOs), and to a sample of general practices in England and all practices in Wales and Scotland. The data collection period ended on 30 April 2001.

Assessing the impact of complications on the costs of Type II diabetes.

Aims/hypothesis: 'The Cost of Diabetes in Europe-Type II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients.

Methods: Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication.

Public perception of a range of potential food risks in the United Kingdom.

This study aimed to use a standard questionnaire to obtain a nationally representative sample of opinions on a range of potential food risks. Participants were a national sample of 1182 subjects selected using three different approaches: random and sentinel postal samples and a telephone survey. A modified psychometric questionnaire (the Perceived Food Risk Index) was administered to subjects on three occasions, spanning five time-points.

Motivations for fruit and vegetable consumption in the UK Women's Cohort Study.

Background: Despite recommendations to increase fruit and vegetable consumption within the UK population, intakes are still too low. In order to stimulate dietary behaviour change the determinants of food choice need to be explored.

Objectives: To investigate how the priorities of high consumers of fruit and vegetables differ from those of low consumers, with respect to food choice motivations, and to identify what value high and low consumers place on different aspects of food choice behaviour.

Stakeholder interactions and the development of functional foods.

Objective: This paper investigates the roles of the individual stakeholders involved in the development of functional foods and the implications of their actions for public perception of this new food concept.

Results: At a time when consumer awareness of the link between diet and health is strong, a new food concept incorporating of a wide spectrum of foods has captured the imagination of the food industry and consumers alike. Functional foods provide a new category of foods that appear to be offering the public the opportunity to achieve a healthy lifestyle with minimal effort.

The distribution of anti-Salmonella antibodies in the sera of blood donors in Yaoundé, Cameroon.

This cross-sectional study in late 1996 on a group of 230 consecutive blood donors in Yaoundé, Cameroon, found a baseline titre of 1:100 for antisalmonella O antibodies. The seroprevalence and baseline titre for antisalmonella H antibodies was much higher (1:400), suggesting that the H antibody is of limited diagnostic value in Cameroon.

The increase in occurrence of typhoid fever in Cameroon: overdiagnosis due to misuse of the Widal test?

This study investigates the cause of an apparent increase in occurrence of typhoid fever in Cameroon. The reasons explored include an overdiagnosis of the illness related to poor performance of the Widal test in laboratories and interpretation by prescribers. Questionnaires were used in 1996 to evaluate the use and interpretation of the Widal test, and checklists were used to assess its laboratory performance in 2 of the 10 provinces in Cameroon.

Interprofessionality in health and social care: the Achilles' heel of partnership?

Partnership working is now a central plank of public policy in the UK, especially in the field of health and social care. However, much of the policy thrust has been at the level of interorganisational working rather than at the level of interprofessional partnerships. The empirical and theoretical literature is largely sceptical about the feasibility of effective joint working between separate but related professionals--the 'pessimistic tradition'.

Dietitians and the internet: are dietitians embracing the new technology?

Background: Internet use is increasing and in the future it will become a valuable tool for health professionals seeking and communicating health, diet and nutritional information. This study aimed to explore the use of the Internet by dietitians in the UK.

Methods: A cross-sectional study was carried out on a random sample of 200 dietitians selected from the British Dietetic Association database.

Movement and change: independent sector domiciliary care providers between 1995 and 1999.

Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care providers were carried out in 1995 and 1999.

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal.

Objective: To systematically review information on HIV epidemiology and on sexual behaviour in Nepal with a view to identifying gaps in current knowledge.

Methods: Systematic review covering electronic databases, web-based information, personal contact with experts and hand searching of key journals.

Results: HIV-1 seroprevalence has been rising rapidly in association with high-risk behaviours, with current levels of 40% amongst the nation's injecting drug users and approaching 20% amongst Kathmandu's female commercial sex workers (FCSWs).

Incentives and clinical governance: money following quality?

This paper attempts to define quality (particularly in terms of evidence-based health care) and considers the incentives available to bring about improvements in quality. It examines the contribution that economics, as a discipline, can make to the debate on clinical governance. It considers the nature and importance of clinical governance, measuring quality, objectives and behaviour in questions raised concerning objectives and individual and team behaviour.

Modernisation, the NHS Plan and healthy communities.

This paper reviews the NHS Plan from the perspective of the Government's wider programme of "modernising" public services. Although broadly focussed, particularly highlights older people. Two dimensions of modernisation are identified.

Cancer screening coverage of south Asian women in Wakefield.

Objective: To measure the cervical and breast screening coverage of south Asian women in Wakefield, compared with other city residents.

Design: Pairwise measurement of screening histories of women whose names appeared to be south Asian, and of non-Asian women matched by date of birth and general practice.

Data Source: Computerised records of screening histories held by West Yorkshire Central Services Agency, for the eight general practices in central Wakefield.