Report on elderly hospital care released

Source: Report on elderly hospital care released – Health news – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Links to the headlines

Basic care given to elderly in hospital ‘alarming’. BBC News, October 13 2011

Where the NHS is getting care wrong for elderly patients. BBC News, October 13 2011

A fifth of hospitals breaking the law by ‘putting paperwork before people’, says watchdog. Daily Mail, October 13 2011

Scandal of elderly in hospitals. Daily Express, October 13 2011

Is this what we get for spending MORE on the NHS than ever before? Shameful neglect of the elderly in one fifth of our hospitals breaks the law, says watchdog. Daily Mail, October 13 2011

Hospitals lambasted for ‘alarming’ treatment of older people. The Guardian, October 13 2011

Patient care is below legal minimum. The Independent, October 13 2011

Elderly people ‘will be hardest hit by NHS reforms’: commentary. The Daily Telegraph, October 13 2011

Elderly suffer poor care in half of NHS hospitals. The Daily Telegraph, October 13 2011

More than 50% of hospitals ‘deny OAPs food and drink’. Daily Mirror, October 13 2011 

Links to the science

CQC calls for action to improve care for older people. Care quality commission 2011, press release

Can combining gene therapy and stem cells beat genetic disease?

Can combining gene therapy and stem cells beat genetic disease? – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Links to the headlines

Gene therapy and stem cells unite. BBC News, October 13 2011

Skin transformed into liver cells to treat an inherited disease. The Guardian, October 13 2011

Genetic liver conditon corrected with stem cells. The Daily Telegraph, October 13 2011

Links to the science

Yusa K, Rashid T, Strick-Marchand H et al. Targeted gene correction of α1-antitrypsin deficiency in induced pluripotent stem cells. Nature, Published online October 12 2011

Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial — Puder et al. 343 — bmj.com

Source:Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial — Puder et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children.

Design Cluster randomised controlled single blinded trial (Ballabeina study) over one school year; randomisation was performed after stratification for linguistic region.

Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerland.

Participants 652 of the 727 preschool children had informed consent and were present for baseline measures (mean age 5.1 years (SD 0.7), 72% migrants of multicultural origins). No children withdrew, but 26 moved away.

Intervention The multidimensional culturally tailored lifestyle intervention included a physical activity programme, lessons on nutrition, media use (use of television and computers), and sleep and adaptation of the built environment of the preschool class. It lasted from August 2008 to June 2009.

Main outcome measures Primary outcomes were aerobic fitness (20 m shuttle run test) and body mass index (BMI). Secondary outcomes included motor agility, balance, percentage body fat, waist circumference, physical activity, eating habits, media use, sleep, psychological health, and cognitive abilities.

Results Compared with controls, children in the intervention group had an increase in aerobic fitness at the end of the intervention (adjusted mean difference: 0.32 stages (95% confidence interval 0.07 to 0.57; P=0.01) but no difference in BMI (−0.07 kg/m², −0.19 to 0.06; P=0.31). Relative to controls, children in the intervention group had beneficial effects in motor agility (−0.54 s, −0.90 to −0.17; P=0.004), percentage body fat (−1.1%, −2.0 to −0.2; P=0.02), and waist circumference (−1.0 cm, −1.6 to −0.4; P=0.001). There were also significant benefits in the intervention group in reported physical activity, media use, and eating habits, but not in the remaining secondary outcomes.

Conclusions A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children.

 

Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study

Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study — Roos et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objective To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome, taking into account maternal characteristics and assisted reproductive technology.

Design Population based cohort study.

Setting Singleton births registered in the Swedish medical birth register between 1995 and 2007.

Participants By linkage with the Swedish patient register, 3787 births among women with a diagnosis of polycystic ovary syndrome and 1 191 336 births among women without such a diagnosis.

Main outcome measures Risk of adverse pregnancy outcomes (gestational diabetes, pre-eclampsia, preterm birth, stillbirth, neonatal death, low Apgar score (<7 at five minutes), meconium aspiration, large for gestational age, macrosomia, small for gestational age), adjusted for maternal characteristics (body mass index, age), socioeconomic factors (educational level, and cohabitating with infant’s father), and assisted reproductive technology.

Results Women with polycystic ovary syndrome were more often obese and more commonly used assisted reproductive technology than women without such a diagnosis (60.6% v 34.8% and 13.7% v 1.5%). Polycystic ovary syndrome was strongly associated with pre-eclampsia (adjusted odds ratio 1.45, 95% confidence interval 1.24 to 1.69) and very preterm birth (2.21, 1.69 to 2.90) and the risk of gestational diabetes was more than doubled (2.32, 1.88 to 2.88). Infants born to mothers with polycystic ovary syndrome were more prone to be large for gestational age (1.39, 1.19 to 1.62) and were at increased risk of meconium aspiration (2.02, 1.13 to 3.61) and having a low Apgar score (<7) at five minutes (1.41, 1.09 to 1.83).

Conclusions Women with polycystic ovary syndrome are at increased risk of adverse pregnancy and birth outcomes that cannot be explained by assisted reproductive technology. These women may need increased surveillance during pregnancy and parturition.

How the risk of liver cancer changes after alcohol cessation: A review and meta-analysis of the current literature

Source: Abstract | How the risk of liver cancer changes after alcohol cessation: A review and meta-analysis of the current literature.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

It is well established that drinking alcohol raises the risk of liver cancer (hepatocellular carcinoma). However, it has not been sufficiently established as to whether or not drinking cessation subsequently reduces the risk of liver cancer and if it does reduce the risk how long it takes for this heightened risk to fall to that of never drinkers. This question is important for effective policy design and evaluation, to establish causality and for motivational treatments.

Method

A systematic review and meta-analysis using the current available evidence and a specific form of Generalised Least Squares is performed to assess how the risk of liver cancer changes with time for former drinkers.

Results

Four studies are found to have quantified the effect of drinking cessation on the risk of liver cancer. The meta-analysis suggests that the risk of liver cancer does indeed fall after cessation by 6-7% a year, but there remains a large uncertainty around this estimate both statistically and in its interpretation. As an illustration it is estimated that a time period of 23 years is required after drinking cessation, with a correspondingly large 95% confidence interval of 14 to 70 years, for the risk of liver cancer to be equal to that of never drinkers.

Conclusion

This is a relatively under researched area and this is reflected in the uncertainty of the findings. It is our view that it is not possible to extrapolate the results found here to the general population. Too few studies have addressed this question and of the studies that have, all have significant limitations. The key issue amongst the relevant studies is that it appears that current drinkers, abstainers and former drinkers are not composed of, or effectively adjusted to be, similar populations making inferences about risk changes impossible. This is a very difficult area to study effectively, but it is an important topic. More work is required to reduce both statistical uncertainty and tackle the various study limitations this paper highlights and until this is done, the current result should be considered preliminary.

DH to ‘bring in line’ commissioners who ration treatments

Source: DH to ‘bring in line’ commissioners who ration treatments | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The Department of Health is moving to “bring into line” commissioners who are increasingly restricting access to treatments and medicine, HSJ has learned.

 

PCTs ordered to adopt single cluster board model

Source: PCTs ordered to adopt single cluster board model | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Primary care trust clusters must have a single board, executive team and chair, the Department of Health has said.

 

Public ‘need to be more honest about eating habits’

People need to be more honest about how much they eat and drink if obesity levels are to be cut, ministers say.

via BBC News – Public ‘need to be more honest about eating habits’.

Stressors and resources mediate the association of socioeconomic position with health behaviours

Abstract | Stressors and resources mediate the association of socioeconomic position with health behaviours.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

Variability in health behaviours is an important cause of socioeconomic health disparities. Socioeconomic differences in health behaviours are poorly understood. Previous studies have examined whether (single) stressors or psychosocial resources mediate the relationship between socioeconomic position and health or mortality. This study examined: 1) whether the presence of stressors and the absence of resources can be represented by a single underlying factor, and co-occur among those with lower education, 2) whether stressors and resources mediated the relation between education and health behaviours, and 3) addressed the question whether an aggregate measure of stressors and resources has an added effect over the use of individual measures.

Methods

Questionnaire data on sociodemographic variables, stressors, resources, and health behaviours were collected cross-sectionally among inhabitants (n=3050) of a medium-sized Dutch city (Utrecht). Descriptive statistics and bootstrap analyses for multiple-mediator effects were used to examine the role of stressors and resources in mediating educational associations with health behaviours.

Results

Higher levels of stressors and lower levels of resources could be represented by a single underlying factor, and co-occurred among those with lower educational levels. Stressors and resources partially mediated the relationship between education and four health- behaviours (exercise, breakfast frequency, vegetable consumption and smoking). Financial stress and poor perceived health status were mediating stressors, and social support a strong mediating resource. An aggregate measure of the stressors and resources showed similar associations with health behaviours compared to the summed individual measures.

Conclusions

Lower educated groups are simultaneously affected by the presence of various stressors and absence of multiple resources, which partially explain socioeconomic differences in health behaviours. Compared to the direct associations of stressors and resources with health behaviours, the association with socioeconomic status was modest. Therefore, besides addressing structural inequalities, interventions promoting financial management, coping with chronic disease, and social skills training have the potential to benefit large parts of the population, most notably the lower educated. Further research is needed to clarify how stressors and resources impact health behaviours, why this differs between behaviours and how these disparities could be alleviated.

 

 

Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Head to Head

No: Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? No — Steele and Brewster 343 — bmj.com.

Yes: Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Yes — Penston 343 — bmj.com.

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James Penston believes all cause mortality is a more reliable measure of the effectiveness of screening, but Robert Steele and David Brewster think it is too stringent

NHS ahead of schedule on efficiency savings, says health secretary

Source: NHS ahead of schedule on efficiency savings, says health secretary — Wise 343 — bmj.com.

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Health secretary Andrew Lansley painted a rosy picture of the state of the NHS finances when questioned by MPs this week.