NHS Bolton Library Presents… Primary Care News, Views & Research for week ending 22/1/12

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

Commissioning

• CCG budget allocations delayed until February
• DH letters to staff admit ‘no clarity’ on jobs
• Government will not merge health and social care budgets for the present, minister says
• Delivering sustainable cost improvement programmes

Primary Care

• UK spread the myth that doctors’ language skills may not be tested, says EU commissioner
• Scotland introduces record of ethnicity on death certificates
• Dutch GP association is fined €7.7m for anticompetitive behaviour

Public Health

• Public Health Outcomes Framework
• Effect of running therapy on depression (EFFORT-D). Design of a randomised controlled trial in adult patients [ ISRCTN 1894]
• Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD): A large, nationally representative survey in the Australian population
• Exploring the relationships between housing, neighbourhoods and mental wellbeing for residents of deprived areas.
• The long-term cost-effectiveness of obesity prevention interventions: systematic literature review

 

Efficiency savings drive being ‘distracted’ by reforms

http://www.hsj.co.uk/news/policy/efficiency-savings-drive-being-distracted-by-reforms/5040543.article

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

The government’s controversial NHS reforms are a “distraction” from the £20bn savings and long-term care for the elderly challenges, leading healthcare figures have said.

 

Credit ratings would help to identify failing foundation trusts early, says Monitor

via Credit ratings would help to identify failing foundation trusts early, says Monitor | BMJ.

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

Credit rating agencies could be used to assess the financial soundness of NHS foundation trusts, the regulator Monitor has suggested in a consultation paper.

 

CCG budget allocations delayed until February

via CCG budget allocations delayed until February | 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 release of the first set of “shadow budgets” for clinical commissioning groups has been put back to February, HSJ has learnt.

 

Combined television viewing and computer use and mortality from all-causes and diseases of the circulatory system among adults in the United States

BMC Public Health | Abstract | Combined television viewing and computer use and mortality from all-causes and diseases of the circulatory system among adults in the United States.

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

 

Abstract (provisional)

Background

Watching television and using a computer are increasingly common sedentary behaviors. Whether or not prolonged screen time increases the risk for mortality remains uncertain.

Methods

Mortality for 7350 adults aged [greater than or equal to]20 years who participated in the National Health and Nutrition Examination Survey during 1999 to 2002 and were followed through 2006 was examined. Participants were asked a single question about the amount of time they spent watching television or videos or using a computer during the past 30 days.

Results

During a median follow-up of 5.8 years, 542 participants died. At baseline, 12.7% of participants reported watching television or using a computer less than one hour per day, 16.4% did so for 1 hour, 27.8% for 2 hours, 18.7% for 3 hours, 10.9% for 4 hours, and 13.5% for 5 or more hours. After extensive adjustment, the hazard ratio for all-cause mortality for the top category of exposure was 1.30 (95% confidence interval: 0.82, 2.05). No significant trend across categories of exposure was noted. The amount of screen time was also not significantly related to mortality from diseases of the circulatory system.

Conclusions

In the present study, screen time did not significantly predict mortality from all-causes and diseases of the circulatory system.

The relation between adolescent self assessment of health and risk behaviours

The relation between adolescent self assessment of health and risk behaviours.

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

 

Abstract

Objective: Self-rated health (SRH) has become a key organizing construct for assessing multiple dimensions of populations’ physical and psychosocial health functioning. However, it is unclear how adolescents’ subjective self assessment of health reflects health risk exposures, co-occurring health risks (problem behaviours) and other pre-existing health conditions. It is unknown whether adolescents place more emphasis on mental or physical health functioning in determining overall health.

Methods: We evaluated the association between SRH and a set of behavioural and other psychosocial health risks including pre-existing medical conditions using Colorado Youth Risk Behavioural Survey (2005). We analyzed the data using descriptive statistics and logistic regression models.

Results: Adolescents with behavioural problems were at increased risk of poor health, and in particular females were at a higher risk of poor health compared with boys. However, in sub-group analyses boys with risks of sexual abuses were more likely to report worse health. Current smoking status, perception of body image as overweight and suicidal attempts were the most consistent predictors of poor health among this sampled population.

Conclusions: SRH could be an indicator of health risk in situations where other biomedical information about an adolescent is unavailable. It appears that mental health functioning might be one of the most important factors used to determine the overall health in this population of adolescents. The role of parents and other adult mentors might be crucial in assisting adolescents to make appropriate choices regarding underlying health risks related to overall health functioning.

UK spread the myth that doctors’ language skills may not be tested, says EU commissioner

via UK spread the myth that doctors’ language skills may not be tested, says EU commissioner | BMJ.

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

Michel Barnier, the European Union commissioner responsible for the internal market, has criticised the United Kingdom for perpetuating the “myth” that EU rules are endangering British citizens by banning language tests for doctors from other European countries who come to practise in the UK.

 

From food to fuel

From food to fuel.

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

 

Abstract

Objective: An investigation of the discussion surrounding the relationship between food and exercise in one community of photography-based food blogs that past research has identified as exhibiting characteristics of dietary restraint.

Design: Forty-five blogs written by young adult women belonging to a food-blogging community were selected for study. All selected blogs had been publicly posted online.

Method: Using a qualitative approach of constant comparative analysis, two months of entries from food blogs created by young women were analyzed and coded for entries discussing food before, during and after exercise.

Results: Analysis revealed that bloggers discussed three themes, mainly prior to and following exercise: food as fuel, food restricted and worked off through exercise, and food intake as justified by exercise.

Conclusion: These findings provide insight into how a community of food bloggers views the relationship between food and exercise, suggest ways that women practising dietary restraint perceive food and exercise, and encourage further research on food blogging.

The predictive validity of three self-report screening instruments for identifying frail older people in the community

BMC Public Health | Abstract | The predictive validity of three self-report screening instruments for identifying frail older people in the community.

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

Abstract (provisional)

Background

If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly.

Methods

This is a prospective study with 1-year follow-up among community-dwelling elderly aged 70 or older (n = 430) to test sensitivity, specificity, and positive and negative predicted values of the Groningen Frailty Indicator, Tilburg Frailty Indicator and Sherbrooke Postal Questionnaire on development of disabilities, hospital admission and mortality. Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes.

Results

Adjusted odds ratios show that those identified as frail have more than twice the risk (GFI, 2.62; TFI, 2.00; SPQ, 2,49) for developing disabilities compared to the non-frail group; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital. Sensitivity and specificity for development of disabilities are 71% and 63% (GFI), 62% and 71% (TFI) and 83% and 48% (SPQ). Regarding mortality, sensitivity for all tools are about 70% and specificity between 41% and 61%. For hospital admission, SPQ scores the highest for sensitivity (76%).

Conclusion

All three instruments do have potential to identify older persons at risk, but their predictive power is not sufficient yet. Further research on these and other instruments is needed to improve targeting frail elderly.

The buffering effect of relationship satisfaction on emotional distress in couples

BMC Public Health | Abstract | The buffering effect of relationship satisfaction on emotional distress in couples.

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

Abstract (provisional)

Background

Marital distress and depression frequently co-occur, and partnership quality is associated with depressive symptoms and mental disorders in both men and women. One aim of this study was to investigate the contribution of a set of risk factors for emotional distress among men and women in couples, with a special focus on satisfaction with partner relationship. The most important aim was to investigate the extent to which high relationship satisfaction in couples acts as a buffer against stressful events.

Methods

Pregnant women and their husbands (n = 62,956 couples) enrolled in the Norwegian Mother and Child Cohort Study completed a questionnaire with questions about emotional distress, relationship satisfaction, and other risk factors. Twelve potential risk factors were included in the analyses, including relationship satisfaction, demographic characteristics, and somatic diseases in men and women. Associations between the predictor variables and emotional distress were estimated by multiple linear regression analysis. Cross-spousal effects, in which data reported by one of the spouses predicted emotional distress in the other, were also investigated. Possible interaction effects between certain risk factors and self-reported and partner’s relationship satisfaction were tested and further explored with regression analyses in subsamples stratified by relationship satisfaction scores.

Results

The unique effects of relationship satisfaction were of similar sizes for both men and women: substantial for self-reported (beta = -0.23 and beta = -0.28, respectively) and weak for partner-reported satisfaction (beta = -0.04 and beta = -0.02, respectively). Other relatively strong risk factors were somatic disease, first-time motherhood, and unemployment. Self-reported as well as partner-reported relationship satisfaction appeared to strongly buffer the effects of a number of stressors.

Conclusions

Partner relationship dissatisfaction is strongly associated with emotional distress in men and women. Good partner relationship, both as perceived by the individual him(her)self and by the spouse, quite strongly moderates adverse effects of various types of emotional strain.

DH letters to staff admit ‘no clarity’ on jobs

via Exclusive: DH letters to staff admit ‘no clarity’ on jobs | 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 has given NHS managers a choice of two letters to send staff this month on the future of their roles – one of which is to be used in cases where there is still “no clarity” on what will happen to their jobs.

 

Healthcare use and costs associated with obesity in Badalona, Spain: a study protocol

Healthcare use and costs associated with obesity in Badalona, Spain: a study protocol — Sicras-Mainar et al. 2 (1) — BMJ Open

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

 

Abstract

Introduction The objectives of the study are twofold. First, to calculate healthcare resource utilisation and costs for a cohort of adult overweight and obese patients observed in primary and hospital care centres during eight consecutive years (2003–2010) in an urban setting in Spain. An analysis of whether these costs vary by groups of individuals and types of disease, and of how they compare with the previous literature, is carried out in order to predict actions or policies for resource optimisation. The second objective is to estimate the impact of overweight and obesity on the consumption of resources and costs, accounting for a wide array of controls.

Methods and analysis Observational and retrospective cohort data are used, consisting of medical records of patients followed up in outpatient and hospital care facilities during the years 2003–2010. Three cohorts of patients are analysed: normal weight (18.5≥ body mass index (BMI) <25), overweight (25≥ BMI <30) and obese (BMI ≥30); BMI is computed using clinical information. Individual-level data on comorbidity, resource utilisation and costs are available, and external information provided by the population census regarding socioeconomic status is used. Utilisation and associated costs across BMI groups are compared by computing ratios for overweight and obese individuals relative to those of normal weight. Count data regression models (hurdle and finite mixture models) are used, together with two-part model regression models and taking into account the panel structure of the data set to explore the impact of overweight and obesity on the increased utilisation of health services and costs, accounting for a wide set of controls.

Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol — Chow et al. 2 (1) — BMJ Open

Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol — Chow et al. 2 (1) — BMJ Open.

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

 

Abstract

Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease, providing access to such interventions is a major challenge. This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk.

Methods and analysis Randomised controlled trial with 6 months of follow-up to evaluate the feasibility, acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care. A total of 720 patients with coronary artery disease will be randomised to either standard care or the TEXT ME intervention. The intervention group will receive multiple weekly text messages that provide information, motivation, support to quit smoking (if relevant) and recommendations for healthy diets and exercise. The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months. Secondary end points include a change in systolic blood pressure, smoking status, quality of life, medication adherence, waist circumference, physical activity levels, nutritional status and mood at 6 months. Process outcomes related to acceptability and feasibility of TEXT ME will also be collected.

Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee—Westmead. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences.

Public Health Outcomes Framework

Public health outcomes framework sets out desired outcomes | Modernisation of health and care.

The new public health outcomes framework, which is published today, sets out the desired outcomes for public health and how these will be measured.

The framework concentrates on two high-level outcomes to be achieved across the public health system. These are:

• increased healthy life expectancy
• reduced differences in life expectancy and healthy life expectancy between communities

The outcomes reflect a focus not only on how long people live but on how well they live at all stages of life. The second outcome focuses attention on reducing health inequalities between people, communities and areas. Using a measure of both life expectancy and healthy life expectancy will enable the use of the most reliable information available to understand the nature of health inequalities both within areas and between areas.

A set of supporting public health indicators will help focus understanding of progress year by year nationally and locally on those things that matter most to public health. The indicators, which cover the full spectrum of public health and what can be currently realistically measured, are grouped into four ‘domains’:

• improving the wider determinants of health
• health improvement
• health protection
• healthcare public health and preventing premature mortality

The Department intends to improve this range of information over the coming year and the framework also sets out how it intends to do that, with the continued  engagement and involvement of its partners at local and national levels.