Culturally aware?

A review of interventions to increase takeup of breast and cervical cancer screening amongst Asian women takes a look at what works, finding that there's no quick fix, although a combination of multiple strategies, such as cultural awareness training for healthcare staff and use of outreach workers, is most effective.  There was little evidence for cost effectiveness or long-term sustainability of any of the programmes.  Another review assesses interventions to improve patient participation in the cancer treatment process for culturally and linguistically diverse groups.

What are the chances?

A team from Cardiff University assesses the state of learning on the association between social inequality and infant health, covering adverse birth events, low birth weight, premature birth, stillbirth, neonatal mortality and post-neonatal mortality.  In all of these categories, there is a clear association between deprivation and poor outcomes: only failure to thrive shows no evidence of association.  Latest ONS (Office for National Statistics) figures on births and deaths in England and Wales show a small rise in stillbirths, along with a rising fertility rate and a continuance of the trend of rising average age of mothers, now at 29.7 years.  Age-standardised mortality rates in 2011 were the lowest ever recorded for England and Wales, at 6,172 deaths per million population for males and 4,402 deaths per million population for females.  More detail in infant mortality (this time for 2009) is also provided by ONS in the Birth Cohort Tables.  This release caught the media's attention, particularly as regards the higher early death risk in multiple births ("twins are five times more likely to  die before their first birthday").  NHS Choices Behind the Headlines site separates the data from the terror and also puts some more alarming figures under the spotlight.  The ONS analysis also shows that mothers aged under 20 have the highest infant mortality rate for both single and multiple births and that the infant mortality rate for mothers born outside of the UK was greater than for UK born mothers.  Meanwhile, first data from the 2011 census shows the largest ever population for England and Wales at 56.1 million;  an animated data visualisation maps the changes over the past century.

5 a day

How effective are targeted schemes to improve access to fruit and vegetables for deprived populations? A study from Norfolk evaluates the effectiveness of a mobile fruit and vegetable store, selling cost-price produce in targeted communities.  This intervention succeeded in its basic aim of improving fruit and vegetable consumption in the areas, but it was a small scale study (255 users).  A study from Australia examines perceptions of affordability and availability of fruit and vegetables amongst women in deprived areas.

The heart of the matter

Coronary heart disease (CHD) mortality in England fell by about 6% every year between 2000 and 2007, yet inequalities between socioeconomic groups widened during this period.  A study published in PLOS Medicine tries to assess the reasons behind this development, concluding that trends in major risk factors for CHD, which vary considerably by socioeconomic group, are the root of the inequality.  While medical treatment has made a major contribution to lowering mortality, this effort is undercut by the effects of rising BMI and diabetes prevalence, particularly marked in lower socioeconomic groups.  A study from the Netherlands looks at how far inequalities in mortality from acute myocardial infarction (AMI) persist amongst the elderly. 

How to do well

Home-based provision of welfare rights advice to economically disadvantaged older people is being trialled in the North east of England in the Do-Well study.  In this qualitative study, participants will be recruited from general practice registers.  Research from Denmark looks at the effectiveness of a preventive home visit programme for older people, finding that although takeup by people from lower socioeconomic groups was less good, more proactive invitation could improve this.  Data from the Uppsala Birth Cohort Study is used to consider the impact of mid-life income and retirement income on mortality.

End of life care

A study from Belgium looks at disparities in end of life decision making, finding that patient inclusion in decision making decreases with age.  End of Life Care Profiles by PCT and local authority are in England have been produced by South West Public Health Observatory for the National End of Life Care Intelligence Network.

On the map

NHS Right Care puts variations in healthcare provision for diabetes and kidney disease under the mapping microscope in two new atlases of variation.  As well as the printed text, there's an online interactive version.  NHS Kidney Care has also published a survey of the evidence base on health inequalities in kidney disease and care amongst adults.