Footballers: Too many headers ‘can damage the brain’

Frequently heading a football can lead to brain injury, warn doctors who say they have found proof on brain scans.

via BBC News – Footballers: Too many headers ‘can damage the brain’.

CQC inspector: regulator would not necessarily ‘spot a Mid Staffs’

via CQC inspector: regulator would not necessarily ‘spot a Mid Staffs’ | News | Health Service Journal.

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

A Care Quality Commission inspector has told the Mid Staffordshire Foundation Trust public inquiry the regulator would not necessarily “spot another Mid Staffordshire”, contradicting earlier evidence given to the inquiry by CQC chair Dame Jo Williams.

 

A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients

A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients — Papadakis et al. 1 (2) — BMJ Open.

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

 

Abstract

Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population.

Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic.

Trial design Cluster randomised controlled trial.

Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation.

Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20).

Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial.

Trial registration number http://ClinicalTrials.gov # UOHI2010-1.

Fifth of patients ‘shun HIV test’

As UK experts call for universal HIV testing in a bid to reduce infections, latest figures reveal a fifth offered the test at a sexual health clinic refused to have it.

via BBC News – Fifth of patients ‘shun HIV test’.

Rare condition Timothy syndrome may give clues to autism

Rare condition Timothy syndrome may give clues to autism – Health News – NHS Choices.

Conclusion

This study has furthered researchers’ understanding of the effects of the Timothy syndrome mutation on nerve cells in the laboratory. This type of research has been made possible because of recent scientific advances that allow researchers to produce different types of cell, including nerves, from stem cells derived from adult skin cells. This has granted them a supply of nerve cells that do not need to be sourced from people’s brains or from animals. The results may be more representative of what happens in humans than if the researchers only studied cells from mice that were genetically engineered to carry the Timothy syndrome mutation. Studying these individual skin-derived nerve cells is unlikely to be fully representative of the complexities of the developing human brain, but is likely to be the best method currently available.

Importantly, although the experimental drug roscovitine was found to reduce the activity of one gene in nerve cells derived from the skin of people with Timothy syndrome, whether this would produce any practical benefit for people with this syndrome is not known. Much more laboratory and animal research would be needed to assess the potential effects (including side effects) of this or similar drugs before they could be tested on people with this syndrome. It is also worth noting that Timothy syndrome is a very rare cause of autism. It is not clear to what extent these findings apply to more common forms of autism.

Overall, further study of these Timothy syndrome nerve cells and in animal models of the syndrome will be needed to confirm the results and improve our understanding of the condition.

Links to the headlines

Brain find sheds light on autism. BBC News, November 27 2011

Links to the science

Paşca SP, Portmann T, Voineagu I et al. Using iPSC-derived neurons to uncover cellular phenotypes associated with Timothy syndrome. Nature Medicine, November 27 2011 (published online).

Conflict of interest problems in new NHS have not been solved, regulator says

via Conflict of interest problems in new NHS have not been solved, regulator says | BMJ.

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The government has still not clarified how new NHS commissioning reforms will prevent GPs getting into conflicts of interest, according to a leading health service regulator.

 

New funding system for adult social care is affordable, says Dilnot

New funding system for adult social care is affordable, says Dilnot | BMJ.

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The UK government can afford to bring in a new funding system for adult social care and current economic woes should not be an excuse for inaction, says a leading economist.

A return to “health as a right” is needed to reduce inequalities, says report

via A return to “health as a right” is needed to reduce inequalities, says report | BMJ.

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The current global economic model needs fundamental change if the goal of health equity worldwide is ever to be reached, the third edition of the Global Health Watch report warns.

 

Risk models and scores for type 2 diabetes: systematic review

Risk models and scores for type 2 diabetes: systematic review | BMJ.

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

Abstract

Objective To evaluate current risk models and scores for type 2 diabetes and inform selection and implementation of these in practice.

Design Systematic review using standard (quantitative) and realist (mainly qualitative) methodology.

Inclusion criteria Papers in any language describing the development or external validation, or both, of models and scores to predict the risk of an adult developing type 2 diabetes.

Data sources Medline, PreMedline, Embase, and Cochrane databases were searched. Included studies were citation tracked in Google Scholar to identify follow-on studies of usability or impact.

Data extraction Data were extracted on statistical properties of models, details of internal or external validation, and use of risk scores beyond the studies that developed them. Quantitative data were tabulated to compare model components and statistical properties. Qualitative data were analysed thematically to identify mechanisms by which use of the risk model or score might improve patient outcomes.

Results 8864 titles were scanned, 115 full text papers considered, and 43 papers included in the final sample. These described the prospective development or validation, or both, of 145 risk prediction models and scores, 94 of which were studied in detail here. They had been tested on 6.88 million participants followed for up to 28 years. Heterogeneity of primary studies precluded meta-analysis. Some but not all risk models or scores had robust statistical properties (for example, good discrimination and calibration) and had been externally validated on a different population. Genetic markers added nothing to models over clinical and sociodemographic factors. Most authors described their score as “simple” or “easily implemented,” although few were specific about the intended users and under what circumstances. Ten mechanisms were identified by which measuring diabetes risk might improve outcomes. Follow-on studies that applied a risk score as part of an intervention aimed at reducing actual risk in people were sparse.

Conclusion Much work has been done to develop diabetes risk models and scores, but most are rarely used because they require tests not routinely available or they were developed without a specific user or clear use in mind. Encouragingly, recent research has begun to tackle usability and the impact of diabetes risk scores. Two promising areas for further research are interventions that prompt lay people to check their own diabetes risk and use of risk scores on population datasets to identify high risk “hotspots” for targeted public health interventions.

Predictors of early death in female patients with breast cancer in the UK: a cohort study

Predictors of early death in female patients with breast cancer in the UK: a cohort study — Stapelkamp et al. 1 (2) — BMJ Open.

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

 

Abstract

Objective To identify factors predicting early death in women with breast cancer.

Design Cohort study.

Setting 29 trusts across seven cancer networks in the North Thames area.

Participants 15 037 women with primary breast cancer diagnosed between January 1996 and December 2005.

Methods Logistic regression analyses to determine predictors of early death and factors associated with lack of surgical treatment.

Main exposures Age at diagnosis, mode of presentation, ethnicity, disease severity, comorbidities, treatment and period of diagnosis in relation to the Cancer Plan (the NHS’s strategy in 2000 for investment in and reform of cancer services).

Main outcome measures Death from any cause within 1 year of diagnosis, and receipt of surgical treatment.

Results By 31 December 2006, 4765 women had died, 980 in the year after diagnosis. Older age and disease severity independently predicted early death. Women over 80 were more likely to die early than women under 50 (OR 8.05, 95% CI 5.96 to 10.88). Presence of distant metastases on diagnosis increased the odds of early death more than eightfold (OR 8.41, 95% CI 6.49 to 10.89). Two or more recorded comorbidities were associated with a nearly fourfold increase. There was a significant decrease in odds associated with surgery (OR 0.29, 95% CI 0.24 to 0.35). Independently of disease severity and comorbidities, women over 70 were less likely than those under 50 to be treated surgically and this was even more pronounced in those aged over 80 (OR 0.09, 95% CI 0.07 to 0.10). Other factors independently associated with a reduced likelihood of surgery included a non-screening presentation, non-white ethnicity and additional comorbidities.

Conclusions These findings may partially explain the survival discrepancies between the UK and other European countries in female patients with breast cancer. The study identifies a group of women with a particularly poor prognosis for whom interventions aiming at early detection may be targeted.

Hospital patients ‘more likely to die at weekends’

Being admitted to hospital in England at the weekend is risky, experts say.

via BBC News – Hospital patients ‘more likely to die at weekends’.

This is also aviable via the HSJ by clicking here.

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

Dr Foster guide reveals best and worst hospitals in 2011

Dr Foster guide reveals best and worst hospitals in 2011 – Health news – NHS Choices.

The Daily Telegraph has today revealed the findings of the latest Dr Foster Hospital Guide. The guide, published annually, closely scrutinises a range of healthcare data to measure hospital performance and detect trends that could save lives.

As well as listing the hospital trusts in England that score above and below average on a range of different mortality measures, this year’s guide also found that:

• The rate of patient deaths in England is 20% lower than it was 10 years ago, in part because of improved hospital care.
• For certain conditions, patients admitted to hospital at the weekend are less likely to get treated quickly and have a higher chance of dying.
• Hospitals that perform certain operations infrequently pose a significantly greater risk to patients than those which carry out high numbers of the operation.
• Patient comments and ratings, such as those gathered by NHS Choices, provide a valuable insight into standards of hospital care.
• Rationalisation and networking of hospital services, to create 24/7 centres of expertise in areas such treatment for stroke, saves lives.

Abstract | Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

Abstract | Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes.

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

Abstract (provisional)

 

Background

Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.

Methods

Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of >100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.

Results

Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman’s rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.

Conclusion

TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.

 

NHS Bolton Library Presents…Primary Care news, opinions & research for the week ending 13th November 2011

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

Commissioning

• Painkillers cost the NHS in England £442m a year
• Lack of female CCG leaders puts future success of NHS at risk, report finds
• GP commissioning leaders: CCGs should not set referral limits
• Assura Medical staff told to give chlamydia tests to family and friends

Primary Care

 

• GMC rules against doctor who used unconventional tests and treatments for chronic fatigue syndrome
• Public warned over A&E admissions
• GP partners’ pay decreases as expenses increase

 

 

Public Health

• Age standardization in mapping adult overweight and obesity trends in the WHO European Region
• Study protocol of a Dutch smoking cessation e-health program
• Public Health Responsibility Deal monitoring templates
• Health Promotion in the Workplace: Assessing Stress and Lifestyle With an Intranet Tool
• Why California retailers stop selling tobacco products, and what their customers and employees think about it when they do: case studies
• High fibre foods like brown bread cut bowel cancer risk

Autism ‘may develop while still in the womb’

Autism ‘may develop while still in the womb’ – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This small, preliminary study looked at the anatomical features in brains of children who had autism and compared them to post-mortem brains from children without autism. In the small range of samples tested the researchers found that children with autism had around two-thirds more neurone brain cells in the front region of their brain than children without autism. They also found that when they compared the weight of their brains to age-adjusted norms, the children with autism had heavier brain weights than expected.

These results will no doubt be of great interest to both researchers and the parents of children with autism. However, they must take into account a major limitation to this study: the availability of brain samples for research from children who have died is, understandably, low. This means that this research could only compare seven children who had autism with six children without autism. Having so few samples to compare means we cannot be certain if this type of brain overgrowth is typical of autistic children or simply due to chance findings.

Beyond this limitation, the researchers have described the characteristics of these children but it is possible that children with autism who die from accidents may in some way differ from other children with autistic spectrum disorder which made them more likely to suffer accidents. It is not clear whether the same pattern of overgrowth would be observed in a larger sample and so care should be taken in assuming these results apply to all children with autistic spectrum disorders.

The researchers have suggested new neurones in this area of the brain are not generated after birth, and that the increased number of cells in autistic brains suggests that either there is above-average production of these cells while the children were in the womb, or less-than-average programmed death of these cells after birth to regulate cell numbers. Even though we are born with a pretty much set number of neurones, the neurones can continue to form new branches that join them with other neurones. The number and strength of these connections between neurones is important in determining how our brain functions.

In short, this study only looked at a small number of samples and should be considered to be preliminary. Its intriguing results will now need to be followed up to see if the effects are seen in further samples and also to tell exactly why the phenomenon might occur. For example, we cannot yet tell whether genetic or environmental mechanisms are behind the relationship or exactly how these changes in brain structure might cause the behaviours seen in people with autism.

Links to the headlines

Autism may begin in womb. The Independent, November 9 2011

Autistic children have ‘too many cells in brain region responsible for emotional development’. Daily Mail, November 9 2011

Links to the science

Courchesne E, Mouton PR, Calhoun ME et al. Neuron Number and Size in Prefrontal Cortex of Children With Autism. JAMA. 2011;306(18):2001-2010

Fair and just or just fair? Examining models of government—not-for-profit engagement under the Australian Social Inclusion Agenda

Fair and just or just fair? Examining models of government—not-for-profit engagement under the Australian Social Inclusion Agenda.

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Abstract

This paper explores the interrelationship between two contemporary policy debates: one focused on the social determinants of health and the other on social (inclusion) policy within contemporary welfare regimes. In both debates, academics and policy makers alike are grappling with the balance between universal and targeted policy initiatives and the role of local ‘delivery’ organizations in promoting health and social equality. In this paper, we discuss these debates in the context of a recent social policy initiative in Australia: the Social Inclusion Agenda. We examine two proposed models of engagement between the government and the not-for-profit welfare sector for the delivery of social services. We conclude that the two models of engagement currently under consideration by the Australian government have substantially different outcomes for the health of disadvantaged communities and the creation of a more socially inclusive Australia.

Systematic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone

Systematic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone — Purssell 96 (12): 1175 — Archives of Disease in Childhood.

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Abstract

Objective To evaluate the evidence surrounding the use of combinations of paracetamol and ibuprofen in the treatment of fever.

Design Systematic narrative review of randomised controlled trials using the UK Economic and Social Research Council guidance on the conduct of narrative synthesis.

Setting Inpatient, outpatient and home care.

Patients Children with fever.

Main outcome measures The effect of combination treatments of paracetamol and ibuprofen on fever and comfort, and identification of side effects.

Results Seven studies were identified, six of which provided useful data for the evaluation of the effect of treatment on temperature. Overall these studies showed limited benefit from the combined treatment until around 4 h, after which there was a statistically but only marginally clinically significant benefit. Two studies contained data directly relating to comfort; these suggest a marginal benefit from the combined treatment, but the clinical significance of this was limited. There was no evidence of greater side effects or toxicities associated with the combined treatment. However, it is important to note that these studies were small, short term, and not conducted in the normal setting in which these treatments are given.

Conclusions There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist.

UK is the best at coordinating care for sicker patients, Sweden the worst, shows survey

via UK is the best at coordinating care for sicker patients, Sweden the worst, shows survey | BMJ.

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The UK and Switzerland provide the best all round care for adults with complex health problems with fewer gaps and errors shows a survey that compared patient care in 11 countries.“Patients with primary care practices that help them navigate the care system and provide easy access are far less likely to encounter duplication, delays, and failures to share important information,” said Cathy Schoen, senior author of the analysis, which was published in the journal Health Affairs (doi:10.1377/hlthaff.2011.0923).

 

England and Wales “achieve more with less” on cancer outcomes than other countries

via England and Wales “achieve more with less” on cancer outcomes than other countries | BMJ.

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Researchers say a new study challenges government assertions that the NHS has a poor record internationally in treating cancer. The study found the NHS was “comparatively effective and efficient” achieving sustained improvement in cancer outcomes over a 27 year period that rivalled other major developed countries.

 

More than half a million people could lose incapacity benefit after welfare changes

via More than half a million people could lose incapacity benefit after welfare changes | BMJ.

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Around 600 000 people in Britain are set to lose their incapacity benefit and all other benefits because of welfare changes, despite the fact that they have health or disability needs that restrict their ability to work, says a report.

 

High fibre foods like brown bread cut bowel cancer risk

High fibre foods like brown bread cut bowel cancer risk – Health News – NHS Choices.

Conclusion

A higher intake of fibre has long been thought to decrease risk of colorectal cancer, and this large and valuable review has helped to assess and analyse the existing body of evidence on the matter. It has found that higher intakes of total fibre, cereal fibre and whole grains are all linked to a decrease in the risk of colorectal cancer, a disease which currently kills around 16,000 people in England each year.

The review has several strengths, including that it has searched for all available literature on the subject, and looked only at prospective studies that analysed intake prior to cancer development. Also, as the researchers say, they found no evidence of publication bias (where only studies finding a positive association had been published).

There are some inherent limitations to a systematic review such as this:

• Dietary study and assessment is notoriously hard to perform due to factors such as how accurately people may describe or recall their diet and the way a person’s eating habits may change over time. In this case, the individual studies used different ways to categorise how much fibre a person ate, but it is not clear how people were questioned about their intake. As the researchers say, further studies need to consider ways to reduce this potential for inaccuracy.
• The studies differed in design, included population, methods of dietary assessment, follow-up duration, and the confounding factors that they adjusted for. Also, it is not clear from the review paper how the individual studies confirmed cancer in the cases. However, it is worth noting that heterogeneity (differences) between the individual studies was low, indicating that it was appropriate to combine their results.
• The researchers particularly highlighted that the associations that they have found are only weak, possibly due to the influence of other unmeasured factors (those that could be associated with both dietary fibre and CRC risk). Such factors could include other aspects of the diet (for example, people who eat more fibre may also choose to eat less red meat) or other lifestyle factors (people who eat more fibre may also be less likely to smoke or drink excessively, and more likely to take regular exercise).

Despite these limitations, the review is well-conducted and a valuable source of evidence that suggest that eating more fibre can be protective against colorectal cancer. The results suggest a 10% reduction in risk of colorectal cancer for each 10g-a-day intake of total dietary fibre and cereal fibre, and a roughly 20% reduction for each three servings of whole grains daily (considered to be 90g a day). This “dose response” relationship also adds weight to the idea that fibre is genuinely protective and that it plays an important role in a balanced diet.

Links to the headlines

High-fibre diet cuts bowel cancer risk by a fifth. The Daily Telegraph, November 11 2011

High fibre diets CAN reduce the risk of bowel cancer. Daily Mail, November 11 2011

High-fibre diet cuts bowel cancer risk, analysis of 25 studies finds. The Guardian, November 11 2011

Fibre and whole grains ‘reduce bowel cancer risk’. BBC News, November 11 2011

Links to the science

Aune D, Chan DSM, Lau R et al.  Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011; 343

 

GP partners’ pay decreases as expenses increase

The pay of general practice partners in the United Kingdom has dropped by 4% over the past five years as gross income has fallen and expenses have risen, official data from the NHS Information Centre show.

via GP partners’ pay decreases as expenses increase | BMJ.

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Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies

Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies | BMJ.

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

Abstract

Objective To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer.

Design Systematic review and meta-analysis of prospective observational studies.

Data sources PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses.

Study selection Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer.

Results 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I²=0%), for fruit fibre (n=9) was 0.93 (0.82 to 1.05, I²=23%), for vegetable fibre (n=9) was 0.98 (0.91 to 1.06, I²=0%), for legume fibre (n=4) was 0.62 (0.27 to 1.42, I²=58%), and for cereal fibre (n=8) was 0.90 (0.83 to 0.97, I²=0%). The summary relative risk for an increment of three servings daily of whole grains (n=6) was 0.83 (0.78 to 0.89, I²=18%).

Conclusion A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.

 

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial | BMJ.

Abstract

Objective To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life.

Design A randomised controlled trial of multi-condition collaborative care for depression and poorly controlled diabetes and/or risk factors for coronary heart disease compared with usual care among middle aged and elderly people

Setting Fourteen primary care clinics in Seattle, Washington.

Participants Patients with diabetes or coronary heart disease, or both, and blood pressure above 140/90 mm Hg, low density lipoprotein concentration >3.37 mmol/L, or glycated haemoglobin 8.5% or higher, and PHQ-9 depression scores of ≥10.

Intervention A 12 month intervention to improve depression, glycaemic control, blood pressure, and lipid control by integrating a “treat to target” programme for diabetes and risk factors for coronary heart disease with collaborative care for depression. The intervention combined self management support, monitoring of disease control, and pharmacotherapy to control depression, hyperglycaemia, hypertension, and hyperlipidaemia.

Main outcome measures Social role disability (Sheehan disability scale), global quality of life rating, and World Health Organization disability assessment schedule (WHODAS-2) scales to measure disabilities in activities of daily living (mobility, self care, household maintenance).

Results Of 214 patients enrolled (106 intervention and 108 usual care), disability and quality of life measures were obtained for 97 intervention patients at six months (92%) and 92 at 12 months (87%), and for 96 usual care patients at six months (89%) and 92 at 12 months (85%). Improvements from baseline on the Sheehan disability scale (−0.9, 95% confidence interval −1.5 to −0.2; P=0.006) and global quality of life rating (0.7, 0.2 to 1.2; P=0.005) were significantly greater at six and 12 months in patients in the intervention group. There was a trend toward greater improvement in disabilities in activities of daily living (−1.5, −3.3 to 0.4; P=0.10).

Conclusions Integrated care that covers chronic physical disease and comorbid depression can reduce social role disability and enhance global quality of life.

 

Repeat offenders appear to have worse health in middle-age

A life of crime appears to damage offenders’ health once they reach their 40s, new research suggests.

via BBC News – Repeat offenders appear to have worse health in middle-age.

Tactical analysis of the Barcelona counter-attack

Tactical analysis of the Barcelona counter-attack — Sarmento et al. 45 (15): A4 — British Journal of Sports Medicine.

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Abstract

The purpose of this study was to observe and to characterise the tactical performance in the counter-attack (CA) of the Football Club Barcelona (FCB) in the 2009/2010 sporting season, using sequential analysis. Sixty-two sequences of CA, resulting from twelve games, were encoded using the observational instrument developed by Sarmento et al (Medicina (Kaunas) 2010;46:401–7). The reliability of the data was calculated by the intra- and inter-observer agreement, and values above 0.90 for all criteria were achieved. Observational methodology was used, with special reference to the sequential analysis. For the treatment of the data SDIS-GSEQ software was used. There is a probability that the recovery of the ball possession (RBP) by disarm is followed by a dribble (Z=2.24) and, when the RBP is due an intervention of the goalkeeper, there are a tendency to the sequence to keep going by the right side of the field, in a controlled way, performing actions like the dribble (Z=2.47) and the conduction of the ball (Z=2.71). The execution of the “long pass” is related with ends of the offensive process (EOP) without efficacy, like the EOP due the rules of the game (Z=2.21). In the other hand, the results showed that have behaviours, as the dribble (Z=3.32), the crossing (z=2.82), and the intervention of the opponent without efficacy (Z=3.32), that induce the shot with the goal. The detection of behaviour patterns in the CA of the FCB proves to be particularly interesting. The study of these regularities made it possible, in a phased way, to characterize the observed offensive actions and provide important information for coaches that can be used in the training process.

 

Health minister warns on targets as waiting times rise

Health Minister Lesley Griffiths has warned NHS managers they must meet strict targets or face the consequences.

via BBC News – Health minister warns on targets as waiting times rise.

Stafford Hospital’s A&E department to close at night

Plans to temporarily close Stafford Hospital’s accident and emergency (A&E) unit at night have been approved.

via BBC News – Stafford Hospital’s A&E department to close at night.

Assura Medical staff told to give chlamydia tests to family and friends

via Assura Medical staff told to give chlamydia tests to family and friends | News | Health Service Journal.

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

A private company which has taken over NHS sexual health services in Teeside instructed staff to hand out chlamydia tests to family and friends in a bid to hit screening targets, a leaked memo has revealed

 

NHS lacks leadership consistency, peers told

Britain lacks “a consistency of leadership” in overseeing the NHS due to the changes of health secretary, a Conservative Peer has said.

via NHS lacks leadership consistency, peers told | News | Health Service Journal.

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