NHS Bolton Library Presents… Primary care news, opinions & research for week ending 30th October 2011

Please find below a selection of the most relevant and interesting news stories of the past week. Including:

Commissioning

• Specialist care housing model losing funding
• Reform conflict of interest concerning most GPs
• Health Bill: Lords to debate hospital failure, integration and commissioning bonus
• The clinical governance development index: results from a New Zealand study

 

Primary Care

• Liberal Democrats end their opposition to health reforms
• NHS Bolton Library Information Consultancy Evidence Summary: Effectiveness of Hydrotherapy/Postural Management in therapy for Cerebral Palsy GMFCS Level 5 child recovering from Hip Surgery
• Burnham attacks coalition over ‘catastrophic’ NHS changes
• CDC panel recommends HPV shot for boys

Public Health

• Minister admits Government has not convinced public of the harms of excessive drinking
• Doctors call for change to alcohol advice
• Richard Vize on local government taking over responsibility for public health
• Changes in the socio-demographic patterning of late adolescent health risk behaviours during the 1990s: analysis of two West of Scotland cohort studies

 

Employers tells DH to make pensions plans more ‘progressive’

via Employers tells DH to make pensions plans more ‘progressive’ | News | Health Service Journal.

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

NHS Employers has sent the government detailed advice on how to exempt nearly half of staff from requirements to pay more towards their pensions next year

 

Aspirin reduces risk of genetic bowel cancer

Aspirin reduces risk of genetic bowel cancer – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This was a well-designed long-term trial. It examined the effect of regular aspirin consumption on bowel cancer rates in a specific group of patients with a raised risk of developing bowel and other cancers. The results indicate that regular treatment with aspirin is an effective method of preventing bowel cancer in this group of high-risk patients.

The study has several strengths, particularly related to design of the trial. For example, even at the end of the study neither the participants nor investigators were made aware of which individuals had received aspirin and which had received placebo. This helps ensure an unbiased analysis of long-term follow-up data, increasing the confidence we can have in the results.

There are, however, several things to consider when interpreting the results:

• This study examined treating patients with a genetic condition that gives them significantly higher risk of developing bowel cancer than the general population. It is unclear whether, based on this study, aspirin would have a protective effect for everybody, and what the size that effect would be.
• Aspirin treatment is not suitable for everyone as it has several known side effects. These include an increased risk of developing ulcers and hemorrhagic stroke. Before treatment began, 8% of those initially recruited had to be excluded due to a medical history suggesting they could be prone to side effects.
• No information was provided regarding side effects in those who went on to receive treatment. Data on such side effects is necessary to ensure that the benefits of treatment outweigh the risks.
• This trial had few observed cases of bowel cancer, even after 10 years of follow-up. Splitting the participants into subgroups based on compliance further reduces the number of cases included in the analysis, which decreases the certainty surrounding these results.
• Intention-to-treat analysis has the advantage of being more like treatment under real-world conditions, where some patients may not take their medication as prescribed. It also prevents bias from influencing the results, as people who do not comply with treatment may be different from those who remain in the study in ways that impact their risk of developing bowel cancer. As the largest effect was seen in patients who had complied with treatment for two years or more it makes generalising this result to a real-world setting difficult, as many people in real life stop their therapy.
• The publication did not indicate whether or not participants continued taking aspirin after the close of the treatment period or whether any participants from the placebo group started taking aspirin. Such patient choices may have influenced the results.
• The researchers say that, importantly, the mechanism by which aspirin protects against cancer development long after patients stop taking the drug is not known. Such knowledge of the natural history of the disease and mechanism of action could be important for designing future trials.

The researchers have planned a follow-up trial with thousands of participants in order to address these points. The trial will also compare multiple doses of aspirin, in order to identify the lowest effective dose. Ensuring that the lowest possible dose is used should help to balance the risk of developing ulcers with the benefit of preventing cancer.

Links to the headlines

Aspirin cuts bowel cancer risk by up to two-thirds. The Daily Telegraph, October 28 2011

Two aspirins daily. The Sun, October 28 2011

Aspirin cuts cancer risk in people with an inherited susceptibility. The Guardian, October 28 2011

Aspirin every day can cut cancer risk by 60%: British scientists find first proof of preventative effect. Daily Mail, October 28 2011

Two aspirins a day can help prevent colon cancer, 10-year study shows. Daily Mirror, October 28 2011

Links to the science

Burn J, Gerdes AM, Macrae F et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. The Lancet, Early Online Publication, 28 October 2011

Liberal Democrats end their opposition to health reforms

Source: Liberal Democrats end their opposition to health reforms — O’Dowd 343 — bmj.com.

An NHS Athens account may be required to view this in full.

Some Liberal Democrat peers seem to have dropped their opposition to the government’s health reforms in the controversial Health and Social Care Bill after a concession from the government.

 

Government uses new method to judge performance of hospitals to try to prevent “gaming” of system

Source:Government uses new method to judge performance of hospitals to try to prevent “gaming” of system — Hawkes 343 — bmj.com.

An NHS Athens account may be required to view this in full.

A new official indicator of the number of patients who die after treatment in hospital has found 14 NHS trusts in England with a higher than expected mortality and 14 whose mortality is lower than expected.

 

Nottingham nurse sacked over Facebook photo

A nurse was dismissed from Nottingham University Hospitals Trust after posting a picture of a patient on Facebook, it has emerged.

via BBC News – Nottingham nurse sacked over Facebook photo.

Minister admits Government has not convinced public of the harms of excessive drinking

Source: Minister admits government has not convinced public of the harms of excessive drinking — O’Dowd 343 — bmj.com.

An NHS Athens account may be required to view this in full.

The government has failed so far to convince the general public of the dangers of excessive drinking of alcohol, MPs have heard.

 

Using formative research to develop CHANGE!: a curriculum-based physical activity promoting intervention

Abstract | Using formative research to develop CHANGE!: a curriculum-based physical activity promoting intervention.

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

Abstract (provisional)

 

Background

Low childhood physical activity levels are currently one of the most pressing public health concerns. Numerous school-based physical activity interventions have been conducted with varied success. Identifying effective child-based physical activity interventions are warranted. The purpose of this formative study was to elicit subjective views of children, their parents, and teachers about physical activity to inform the design of the CHANGE! (Children’s Health, Activity, and Nutrition: Get Educated!) intervention programme.

Methods

Semi-structured mixed-gender interviews (group and individual) were conducted in 11 primary schools, stratified by socioeconomic status, with 60 children aged 9-10 years (24 boys, 36 girls), 33 parents (4 male, 29 female) and 10 teachers (4 male, 6 female). Questions for interviews were structured around the PRECEDE stage of the PRECEDE-PROCEDE model and addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers to participation. All data were transcribed verbatim. Pen profiles were constructed from the transcripts in a deductive manner using the Youth Physical Activity Promotion Model framework. The profiles represented analysis outcomes via a diagram of key emergent themes.

Results

Analyses revealed an understanding of the relationship between physical activity and health, although some children had limited understanding of what constitutes physical activity. Views elicited by children and parents were generally consistent. Fun, enjoyment and social support were important predictors of physical activity participation, though several barriers such as lack of parental support were identified across all group interviews. The perception of family invested time was positively linked to physical activity engagement.

Conclusions

Families have a powerful and important role in promoting health-enhancing behaviours. Involvement of parents and the whole family is a strategy that could be significant to increase children’s physical activity levels. Addressing various perceived barriers to such behaviours therefore, remains imperative

Ovarian cancer risk from IVF still lower

Ovarian cancer risk from IVF still lower – Health News – NHS Choices.

Conclusion

This was a large, long-term cohort study that examined the association between ovarian stimulation during fertility treatment and the subsequent risk of developing ovarian cancer. The study was well designed, especially in terms of its selection of an appropriate comparator group and its attempts to account for potential confounders.

In their attempt to control potential confounders the researchers collected information on baseline ovarian cancer risk through a mailed questionnaire, and on treatment factors through medical record examination.

However, data on factors such as family history of cancer, number of pregnancies, use of birth control and lifestyle characteristics were available in only 65.2% of the total cohort. This may bias the results, as there is no way of telling whether those who returned the survey were significantly different from non-respondents. This bias is further enhanced as the two groups did not respond proportionately: 48.7% of the subfertile/non-IVF group responded, compared to 71.1% of the IVF group.

Similarly, medical record data extraction was only conducted for 76% of the women who had received IVF. Given this large body of missing data there is no way of knowing whether or not these 24% of women were significantly different from those whose records were extracted.

Another strength of this study was that it also examined ovarian cancer risk in subfertile women who did not undergo IVF treatment. Studies that compare women receiving IVF to women in the general population are useful, but their results are open to debate as any increased risk seen in women having IVF could arguably be due to whatever was causing their fertility problem, rather than IVF itself. By comparing the ovarian cancer risk profiles of different subfertile groups, the study could potentially allow us to tease out the effects of IVF, and allow us to ignore the influence of infertility itself.

The researchers also consider the possibility that some of the increased risk for borderline ovarian cancer may be due to increased contact with medical professionals during the IVF process. Ovarian cancer is generally detected at a late stage, in part due to its vague or asymptomatic nature during its early stages. The researchers attempted to determine whether medical surveillance accounted for the difference by interviewing the patients’ doctors. They say that, based on the interviews they were able to conduct, increased surveillance is an unlikely explanation for the trend.

The researchers say that they are concerned by their finding which suggests an elevated risk of developing invasive ovarian cancer in the IVF group after more than 15 years of follow-up. However, there are statistical difficulties in conducting such extensive subgroup analyses: the likelihood of finding a statistically significant result purely by chance increases the more the data is broken down into subgroups. In this instance the small number of observed cases in this subgroup (nine cases in the IVF group, 13 in the general population) suggest the result is unlikely to be robust.

It is important to remember that all the increased risks detected in this study were relative to the risk seen in other groups, and not absolute risks. While IVF-treated women may be at double the risk of developing ovarian cancer relative to women not given IVF, this absolute risk is still small. In the Netherlands, for example, the researchers say that only about 45 among every 10,000 women (0.45%) may develop an ovarian malignancy (including borderline malignancy) by age 55 years. The rate for women who had used IVF was estimated to be 0.71%.

Another key point is that at the time the women received IVF (1983-1995), the technique was not as widespread or advanced as it was today. This means that both the specific treatment used and the women involved may not be representative of IVF used in more-recent times.

Overall, this was a well-conducted study but further research is needed in order to confirm the results. Women contemplating using or currently using IVF can discuss the matter with their specialist, while women who are concerned about their past use of IVF can consult their doctor. However, the level of risk identified in this study is low, and the matter should not be seen as a cause for alarm.

Links to the headlines

IVF doubles risk of non-fatal ovarian cancer. The Daily Telegraph, October 27 2011

IVF treatment doubles the risk of ovary cancer, scientists warn. Daily Mirror, October 27 2011

IVF pill cancer threat. The Sun, October 27 2011

IVF increases women’s risk of ovarian cancer. Daily Express, October 27 2011

Links to the science

van Leeuwen FE, Klip H, Mooij TM et al. Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort. Human Reproduction, 2011

Health secretary promises loans to hospitals in trouble

via Health secretary promises loans to hospitals in trouble — Hawkes 343 — bmj.com.

An NHS Athens account may be required to view this in full.

The health secretary has undertaken to provide support to hospitals crippled by debt, providing they meet a set of conditions.