Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia.

Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self-efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio-cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful.

A systematic review of the influence of the retail food environment around schools on obesity-related outcomes.

The high prevalence of childhood obesity has led to questions about the influence of 'obesogenic' environments on children's health. Public health interventions targeting the retail food environment around schools have been proposed, but it is unclear if they are evidence based. This systematic review investigates associations between food outlets near schools and children's food purchases, consumption and body weight. We conducted a keyword search in 10 databases. Inclusion criteria required papers to be peer reviewed, to measure retailing around schools and to measure obesity-related outcomes among schoolchildren. Thirty papers were included. This review found very little evidence for an effect of the retail food environment surrounding schools on food purchases and consumption, but some evidence of an effect on body weight. Given the general lack of evidence for association with the mediating variables of food purchases and consumption, and the observational nature of the included studies, it is possible that the effect on body weight is a result of residual confounding. Most of the included studies did not consider individual children's journeys through the food environment, suggesting that predominant exposure measures may not account for what individual children actually experience. These findings suggest that future interventions targeting the food environment around schools need careful evaluation.

Assessing the options for local government to use legal approaches to combat obesity in the UK: putting theory into practice.

The law is recognized as a powerful tool to address some of the structural determinants of chronic disease, including 'obesogenic' environments which are a major factor in the increasing prevalence of obesity worldwide. However, it is often local - as opposed to national - government that has responsibility for an environment, including the built environment, and their role in reducing obesity using law remains relatively unexplored. With the English government shifting emphasis for improvement of public health from central to local government, this paper reviews the potential for regulatory action by local government to reduce obesity. We took a novel approach to assess the evidence and to identify legal options for implementation by local government: conducting reviews of literature, media reports and case law. Our results provide a clear rational for regulatory intervention that encourages a real choice of behaviour. They highlight strategic legal areas for reduction of obesity through restriction of traffic and promotion of active travel, promotion of access to healthy food and construction of a sustainable and active environment. Importantly, we identify current legal mechanisms for adoption by UK local government including the use of planning, licensing and transport legislation to develop local obesity prevention policy.

Children's acquisition and retention of safety skills: the Lifeskills program.

OBJECTIVES: Assessment of safety skills performance and knowledge, to evaluate the education offered by the Lifeskills "Learning for Living" village, Bristol, UK which emphasizes interactive learning-by-doing. DESIGN: Two quasi-experimental matched control group studies. Study 1: knowledge and performance three months post-intervention. Study 2: knowledge pre-intervention and post-intervention at three time points, to distinguish between immediate learning and longer term retention. SETTING: The Lifeskills training village, Bristol, UK; primary schools in four education authorities in the area. PARTICIPANTS: Study 1: 145 children aged 10-11 years; 109 from the Lifeskills program, 36 control. Study 2: 671 children aged 10-11 years; 511 Lifeskills, 160 control. OUTCOME MEASURES: Three areas (road, home, and fire safety). Five performance tests: observation of children's safety skills. Five knowledge tests: pictorial quiz. RESULTS: Study 1: Lifeskills/intervention children did better than control children on performance and knowledge tests. The knowledge-performance correlation was r = 0.51. Study 2: intervention children did better than control children immediately after the intervention and three months later on all five knowledge tests. On three tests the intervention group showed retention of knowledge from immediately post-intervention to three months, but on two tests there was some loss. This loss was primarily among children from scholastically lower achieving schools. In all other respects the intervention was equally successful for boys and girls, and for children from higher and lower achieving schools. CONCLUSIONS: The Lifeskills package improved both knowledge and performance but had shortcomings. Complexity of material did not affect knowledge acquisition but did affect its retention.

Obesity management by life-style strategies.

This chapter discusses lifestyle management strategies for obesity in adults and is based on an assumption that treatment, resulting in appropriate and sustained weight loss, is of benefit to individuals. It examines dietary management strategies including the use of very low calorie diets, moderate energy restriction and individual and group approaches in commercial and non-commercial environments. It explores the role of physical activity in the treatment of obesity in particular focusing on the associated health benefits and the increasing evidence of the importance of physical activity in weight maintenance. It discusses the effect of behavioural interventions on achieving and maintaining weight loss and briefly offers suggestions for the organisation of lifestyle interventions.