NHS Bolton Library Presents… Primary Care News, Research and Opinion: Week Ending 6th May 2012

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

Primary Care

• A systematic review of the effectiveness of double checking in preventing medication errors
• Supervised injectable heroin treatment is expensive but cost effective, report says
• Income and job satisfaction fall among US doctors
• Late onset type 1 diabetes: Easily Missed – BMJ Practice
• Tighten GP practice rules to counter ‘health tourism’, group urges
• GPs ‘making too many errors prescribing drugs’

Public Health

• The relationship between subjective wellbeing, low income and substance use among schoolchildren in the north west of England: a cross-sectional study
• FDA moves towards becoming a global public health agency
• Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study | BMJ
• Scottish children ‘shunning’ fizzy drinks, says WHO study

Commissioning

• Chlamydia screening in England: a qualitative study of the narrative behind the policy
• Supervised injectable heroin treatment is expensive but cost effective, report says
• NHS Commissioning Board to redesign local structure
• Integration of health and social care needs financial incentives, experts say

A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme

A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme — Nanchahal et al. 2 (3) — BMJ Open.

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

Abstract

Objectives To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals.

Design Randomised controlled trial.

Setting 23 general practices in Camden, London.

Participants 381 adults with body mass index ≥25 kg/m² randomly assigned to intervention (n=191) or control (n=190) group.

Interventions A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice.

Outcome measures Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months.

Results 217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group.

Conclusions Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary.

Clinical trial registration number Trial registrationClincaltrials.gov NCT00891943.

Can sleep help you lose weight?

Can sleep help you lose weight? – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This research suggests that the extent to which our genetics influence our BMI varies according to how long we sleep. For traits such as weight and BMI, both genetic and environmental factors are generally thought to play a role, and there is some evidence suggesting that genetic and environmental factors may also be able to interact with each other rather than just exist independently.

Girls ‘are being put off exercise and PE’

Girls ‘are being put off exercise and PE’ – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

How much exercise do people generally need?

The amount of activity you need to do each week depends on your age, but young people aged between five and 18 years need to do at least 60 minutes of physical activity every day. This activity should be a mix of:

moderate intensity activity such as brisk walking or playing in the playground

vigorous intensity activity such as gymnastics, dancing or running

Active and passive smoking during pregnancy and ultrasound measures of fetal growth in a cohort of pregnant women

Active and passive smoking during pregnancy and ultrasound measures of fetal growth in a cohort of pregnant women — Iñiguez et al. 66 (6): 563 — Journal of Epidemiology & Community Health.

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

Abstract

Background In utero tobacco exposure has been associated with adverse pregnancy outcomes but few studies have used longitudinal ultrasound measurements to asses the effects on fetal growth. The aim of this study was to examine the impact of active and passive smoking during pregnancy on fetal biometry in a cohort of Spanish women.

Warfarin and aspirin compared as anticoagulants

Warfarin and aspirin compared as anticoagulants – Health news – NHS Choices.

Conclusion

This well-designed trial has compared the efficacy and safety of aspirin and warfarin in patients with heart failure, a normal heartbeat and no clear medical condition requiring anti-clotting medication. In these patients, the study found that there was no difference in the rate of ischaemic strokes, bleeding in the brain or death from any cause between the two groups. The rates of heart attack and hospitalisation for heart failure also did not differ significantly between the two groups. When stroke was considered by itself, warfarin was significantly better than aspirin. However, the rate of major bleeding was significantly higher with warfarin. This study has shown that neither drug has a clear advantage over the other in people with heart failure but a normal heart rhythm who do not have a recognised increased risk of blood clots.

But although the number of strokes in this study was significantly reduced with warfarin, the number of strokes in each group was low: 0.72 strokes per 100 years of patient follow-up in the warfarin group compared with 1.36 strokes per 100 years of patient follow-up in the aspirin group. The increase in major bleeding observed with warfarin was mostly due to bleeding in the gut. Previous studies have found that mild-to-moderate heart failure is associated with an annual stroke risk of approximately 1.5%, and severe heart failure is associated with a risk of approximately 4%, compared with a risk of 0.5% in the general population. A recent Cochrane review concluded that the data available does not support the routine use of oral anticoagulation in patients with heart failure and a normal heartbeat.

Overdue babies ‘more likely to have ADHD

Overdue babies ‘more likely to have ADHD’ – Health news – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

The exact causes of attention deficit hyperactivity disorder(ADHD) are not fully understood, and this large study raises the possibility that late birth may be associated with a higher risk of the disorder in childhood. While this doesn’t mean it has found any cause-and-effect relationship between the length of time a baby spends in the womb and their behaviour as a young child, it certainly raises some interesting possibilities about what factors might contribute to the increasingly common condition. For example, there have also been suggestions that being born early (preterm) may also be linked to an increased risk of ADHD.

Although the study’s design means it can’t prove a cause-and-effect relationship, it does have some strengths.

NHS Commissioning Board to redesign local structure

via Exclusive: NHS Commissioning Board to redesign local structure | 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 NHS Commissioning Board is planning to redesigning its structure of local offices, and is considering having fewer branches than the 50 which had previously been expected.

 

UK government to provide a research portal to make publicly funded research freely available to all

via UK government to provide a research portal to make publicly funded research freely available to all | BMJ.

 

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

The government has enlisted Jimmy Wales, cofounder of Wikipedia, to help realise plans to make all publicly funded research accessible free of charge.

 

Integration of health and social care needs financial incentives, experts say

via Integration of health and social care needs financial incentives, experts say | BMJ.

 

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

After years of talk, is integrated care about to become a reality in England? Three politicians from the leading political parties offered a mixed message at a meeting at the healthcare think tank the King’s Fund on 1 May.

 

Fifteen million and rising—the number of premature births every year

A worldwide study of preterm births has found that 15 million babies are born before 37 weeks’ gestation every year, with one million of those babies dying from complications.

via Fifteen million and rising—the number of premature births every year | BMJ.

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

 

Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark

Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark | BMJ.

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

Abstract

Objective To investigate whether an adjuvanted pandemic A/H1N1 2009 influenza vaccine in pregnancy was associated with an increased risk of fetal death.

NICE guidance on cost-saving drug not sought by DH

via NICE guidance on cost-saving drug not sought by DH | 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 failed to act on expert advice to commission an appraisal of a drug which could lead to savings of £100m for the NHS, it has emerged.

 

 

Just 35 CCGs to be tested in first wave of authorisation

via Just 35 CCGs to be tested in first wave of authorisation | 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 35 emerging clinical commissioning groups which will be the first to go through the authorisation process have been announced by the NHS Commissioning Board.

 

Aspirin is as ‘good as warfarin’ for most heart failure patients

Aspirin could be as effective as more expensive drugs for heart failure patients with a normal heart rhythm, according to researchers.

via BBC News – Aspirin is as ‘good as warfarin’ for most heart failure patients.

 

CCGs to manage and reward GP performance

via CCGs to manage and reward GP performance | News | Health Service Journal.

 

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

GP practices look set to be handed an extensive role in performance managing each other – including through the award of bonuses – under proposals being drawn up by the NHS Commissioning Board.

 

Diagnosis and management of haemophilia

via Diagnosis and management of haemophilia | BMJ.

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

Summary points

In patients with major (head) trauma or major spontaneous bleeding, always give coagulation factor concentrates without delay, before diagnostic imaging or other interventions

Prophylactic administration of factor VIII or factor IX concentrate is the standard of care for patients with severe haemophilia in countries where this is economically feasible

Avoid drugs that affect haemostasis, such as platelet inhibitors and anticoagulants because they aggravate bleeding symptoms

A safety amulet that makes patients with haemophilia easily recognisable may be life saving and is recommended for all patients

Advise female relatives of patients with haemophilia to seek genetic counselling because they may be carriers

Female carriers may have reduced plasma concentrations of factor VIII or factor IX, similar to those seen in patients with mild haemophilia and may also have bleeding symptoms

 

Poor monitoring and processes are responsible for errors in one in 20 GP prescriptions

Poor monitoring and processes are responsible for errors in one in 20 GP prescriptions | BMJ.

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

One in 20 prescriptions written by GPs in England contains an error, and one in 550 contains a serious error, a large study has found.