Socioeconomic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socioeconomic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential
Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost-effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front-of-pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost-effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front-of-pack nutritional labelling is likely to be highly cost-effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child-directed advertising are likely to be highly cost-effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.
The food environments in which people develop their dietary behaviour and make their food choices have significant influence on what they purchase and, in turn, what they eat. Food prices, food labelling and food marketing are one of the determinants of food choices. They influence, to a certain degree, what and how much food people buy, and policies based on these determinants have been effective in promoting desirable dietary changes. However, these assessments of dietary changes have been exclusively conducted at the adult level, and not at children level. What are the impacts of such policies on children's overall diet? Do these effects substantially differ between European countries? To answer these outstanding questions, the work package will conduct a contextual review looking at (i) fiscal policies (food and non-alcoholic beverages), (ii) the regulation of food labelling and (iii) the regulation of the marketing of food products to children.
Context and ObjectivesNumerous studies and metaanalysis showed the efficiency of Stroke Units (SU). Organised care has been proven to decrease morbidity and mortality after stroke. In Ile-de-France, there are 16 SU, and among them 10 were created since 2003. The implementation of the SU and of their networks are regularly evaluated on behalf of the regional hospitalisation agency (ARH-IF), with information feedback to multidisciplinary stroke teams and hospital administrators to optimise the quality of care of stroke patients.Description of the ProgramTwo types of indicators are collected. Epidemiological data such as number of hospital admissions for stroke in the region and by territory and establishment and demographic data of stroke patients are analysed. Since 2000, they are collected from the national hospital discharge database, according to a protocol of extraction defined by the professionals. Other indicators concern the hospital management of stroke patients such as proportion of patients admitted in SU vs other nondedicated units, the type of stroke (transient ischaemic attacks, infarction and haemorrhage), the stroke severity, the treatments (including rehabilitation), the complications, the length of hospital stay and the outcome. Time indicators are important to assess the organisation of the care: delay of hospitalisation, of admission within the SU, of access to the neurological expertise, to the brain imaging, to the physiotherapist and speech therapist evaluation and to the stroke rehabilitation unit. These data are prospectively collected from surveys regularly realised on 30 to 50 consecutive patients admitted in SU and stroke rehabilitation wards. A web-based tool was used to collect data from sites. The analysis is realised by the pole ‘Affaires hospitalières de la CRAMIF’. The results of these evaluations are presented during an ARH-IF plenary session to the neurologists, the rehabilitation physicians and the hospital administrators of the concerned establishments, and then within each establishment with all the medical and non-medical multidisciplinary team and the directors.ResultsThese evaluations permit to estimate, in an iterative way, the professional practices and to suggest actions to improve organisation of stroke care, measured in particular on patients' proportion admitted in SU, on the decrease of pre-and intra-hospital delays allowing more patients to have access to the thrombolytic therapy. Within Ile-de-France”, the number of stroke patients admitted in establishments with SU increased from 22% to 48.5% between 2003 and 2008; the median age of stroke patients did not modify in the region (71 years), but the age of stroke patients admitted in establishments with SU increased from 63 to 67 years. The in-hospital stroke mortality decreased from 15.8% to 10.5% and the SU- mortality from 12.5% to 8.6%. The number of patients evaluated within the first 48 h by a physiotherapist and/or a speech therapist increased regularly, while the complications rate decreased.ConclusionsRegular ...
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