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Background. Previous research suggests that children are a high risk group vulnerable to the effects of chronic noise exposure. However, questions remain about the nature of the noise effects and the underlying causal mechanisms. This study addresses the effects of aircraft noise exposure on children around London Heathrow airport, in terms of stress responses, mental health and cognitive performance. The research also focuses on the underlying causal mechanisms contributing to the cognitive effects and potential confounding factors.Methods. The cognitive performance and health of 340 children aged 8–11 years attending four schools in high aircraft noise areas (16h outdoor Leq>66dBA) was compared with children attending four matched control schools exposed to lower levels of aircraft noise (16h outdoor Leq<57dBA). Mental health and cognitive tests were group administered to the children in the schools. Salivary cortisol was measured in a subsample of children.Results. Chronic aircraft noise exposure was associated with higher levels of noise annoyance and poorer reading comprehension measured by standardized scales with adjustments for age, deprivation and main language spoken. Chronic aircraft noise was not associated with mental health problems and raised cortisol secretion. The association between aircraft noise exposure and reading comprehension could not be accounted for by the mediating role of annoyance, confounding by social class, deprivation, main language or acute noise exposure.Conclusions.These results suggest that chronic aircraft noise exposure is associated with impaired reading comprehension and high levels of noise annoyance but not mental health problems in children.

Noise, including noise from transport, industry, and neighbors, is a prominent feature of the urban environment. This paper reviews the effects of environmental noise on the non-auditory aspects of health in urban settings. Exposure to transport noise disturbs sleep in the laboratory, but generally not in field studies, where adaptation occurs. Noise interferes with complex task performance, modifies social behavior, and causes annoyance. Studies of occupational noise exposure suggest an association with hypertension, whereas community studies show only weak relations between noise and cardiovascular disease. Aircraft and road-traffic noise exposure are associated with psychological symptoms and with the use of psychotropic medication, but not with the onset of clinically defined psychiatric disorders. In carefully controlled studies, noise exposure does not seem to be related to low birth weight or to congenital birth defects. In both industrial studies and community studies, noise exposure is related to increased catecholamine secretion. In children, chronic aircraft noise exposure impairs reading comprehension and long-term memory and may be associated with increased blood pressure. Noise from neighbors causes annoyance and sleep and activity interference health effects have been little studied. Further research is needed for examining coping strategies and the possible health consequences of adaptation to noise.

Objective: To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents. Design: Cross-sectional population-based survey. Subjects: In total, 2789 adolescents 11-14 years of age from three highly deprived regional authorities in East London, in 2001. Measurements: Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI X85th centile and obesity as BMI X98th centile. Underweight was defined as BMIp15th centile. Results: In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P ¼ 0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P ¼ 0.03) and obese Bangladeshi boys (P ¼ 0.01) and Bangladeshi girls (P ¼ 0.04), but significantly higher in obese black African girls (P ¼ 0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P ¼ 0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P ¼ 0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P ¼ 0.02) but not with history of dieting, weight perception or psychological factors in either gender. Conclusion: High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.

BackgroundReorganisation of healthcare services into networks of clinical experts is increasing as a strategy to promote the uptake of evidence based practice and to improve patient care. This is reflected in significant financial investment in clinical networks. However, there is still some question as to whether clinical networks are effective vehicles for quality improvement. The aim of this systematic review was to ascertain the effectiveness of clinical networks and identify how successful networks improve quality of care and patient outcomes.MethodsA systematic search was undertaken in accordance with the PRISMA approach in Medline, Embase, CINAHL and PubMed for relevant papers between 1 January 1996 and 30 September 2014. Established protocols were used separately to examine and assess the evidence from quantitative and qualitative primary studies and then integrate findings.ResultsA total of 22 eligible studies (9 quantitative; 13 qualitative) were included. Of the quantitative studies, seven focused on improving quality of care and two focused on improving patient outcomes. Quantitative studies were limited by a lack of rigorous experimental design. The evidence indicates that clinical networks can be effective vehicles for quality improvement in service delivery and patient outcomes across a range of clinical disciplines. However, there was variability in the networks’ ability to make meaningful network- or system-wide change in more complex processes such as those requiring intensive professional education or more comprehensive redesign of care pathways. Findings from qualitative studies indicated networks that had a positive impact on quality of care and patients outcomes were those that had adequate resources, credible leadership and efficient management coupled with effective communication strategies and collaborative trusting relationships.ConclusionsThere is evidence that clinical networks can improve the delivery of healthcare though there are few high quality quantitative studies of their effectiveness. Our findings can provide policymakers with some insight into how to successfully plan and implement clinical networks by ensuring strong clinical leadership, an inclusive organisational culture, adequate resourcing and localised decision-making authority.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1615-z) contains supplementary material, which is available to authorized users.

Transport noise is an increasingly prominent feature of the urban environment, making noise pollution an important environmental public health issue. This paper reports on the 2001-2003 RANCH project, the first cross-national epidemiologic study known to examine exposure-effect relations between aircraft and road traffic noise exposure and reading comprehension. Participants were 2,010 children aged 9-10 years from 89 schools around Amsterdam Schiphol, Madrid Barajas, and London Heathrow airports. Data from The Netherlands, Spain, and the United Kingdom were pooled and analyzed using multilevel modeling. Aircraft noise exposure at school was linearly associated with impaired reading comprehension; the association was maintained after adjustment for socioeconomic variables (beta = -0.008, p = 0.012), aircraft noise annoyance, and other cognitive abilities (episodic memory, working memory, and sustained attention). Aircraft noise exposure at home was highly correlated with aircraft noise exposure at school and demonstrated a similar linear association with impaired reading comprehension. Road traffic noise exposure at school was not associated with reading comprehension in either the absence or the presence of aircraft noise (beta = 0.003, p = 0.509; beta = 0.002, p = 0.540, respectively). Findings were consistent across the three countries, which varied with respect to a range of socioeconomic and environmental variables, thus offering robust evidence of a direct exposure-effect relation between aircraft noise and reading comprehension.

Policy agencies are implementing strategies to increase the use of research in policy decisions. This paper examines the evidence about the effectiveness of these strategies. We conducted an extensive search focused on population health policy and programmes. We classified 106 papers meeting study criteria into research type (conceptual, descriptive and intervention). We examined the descriptive studies to identify commonly nominated potential intervention strategies. We examined the intervention studies to evaluate the impact of the tested strategies in increasing the use of research in policy decisions. There is little evidence about which strategies increase the use of evidence in population health policy and programmes.

Advances in software are allowing the participatory model building approach to be extended to more sophisticated multimethod modelling that provides policy makers with more powerful tools to support the design of targeted, effective and equitable policy responses for complex health problems. Building capacity and investing in communication to promote these modelling methods, as well as documenting and evaluating their applications, will be vital to supporting uptake by policy makers.