On your bike

Preventive Medicine offers several articles on physical exercise interventions, including a UK study on the contribution of active travel to physical activity levels in schoolchildren, the effect of a school-based active commuting intervention and a population-based RCT of a pedometer combined with an intervention toolkit for people with low levels of fitness or physical activity. A systematic review in the American Journal of Preventive Medicine assesses the state of knowledge on adult sedentary behaviour.

Risky rice?

A study linking consumption of white rice with risk of type 2 diabetes has gained an amount of excitable press coverage. NHS Choices Behind the Headlines assesses the merit of this meta-analysis and systematic review and finds it adequate but not overly well represented in the media. Meanwhile, a study from the US Centers for Disease Control (CDC) finds that the HbA1c test is a cost effective pre-diabetes test where the threshold for diagnosis is set at 5.7%, rather lower than the current US level of 6.5%.

The right measure

The new NHS framework for patient experience offers, suggests Jocelyn Cornwall of the King's Fund, a secure evidence base for measuring and improving this key aspect of healthcare. She also argues that measures of patient experience should be aligned with clinical level data on processes and outcomes and embedded in the new NICE quality standard. A discussion paper from NHS Confederation aims to stimulate debate on what it calls the uneasy consensus between patients, citizens and the NHS. While patient experience is not entirely about keeping people happy, some research on the shape of happiness over the lifecourse may be of interest: a survey by ONS shows that happiness is a U-shaped curve, highest amonst teens and people in their 70s.

A breath of fresh air

The American Journal of Preventive Medicine provides an umbrella review of public health interventions for asthma over the past twenty years, with self-management education being the most consistently effective strategy. Asthma UK reports on a project in Yorkshire and Humber that involved training for education professionals. A study in the BMJ looks at the cost effectiveness of mobile phone monitoring for asthma control as compared with the usual paper based approach. This UK primary care based trial, which involved adolescents and adults with poorly controlled asthma, found that using phones didn't work any better than the old school method in enabling asthma control and that it was more expensive.

Balancing act

A DH discussion paper on personal health budgets sets the scene for the programme, which will be rolled out from April 2014. Reflecting on the experience of the Netherlands, an article in the BMJ offers some wisdom based on having learned the hard way. At a recent conference, deputy head of NHS Commissioning Andrew Sanderson proffered the warning that personal health budgets did not provide "an open ended system of entitlement" and that there would need to be a robust way of managing demand. There's also a paper from the Association of Directors of Adult Social Services that looks at the position of young carers in the era of personalisation.

Plain speaking

Plain packaging for tobacco products throughout the EU could be a reality, the EU health Commissioner has implied. At a meeting hosted by the European Parliament, the Commissioner suggested that there should be changes to the EU tobacco products directive to include electonic cigarettes as well as minimising the attractiveness of tobacco products. Recently announced plans to reduce tobacco consumption in France include plain packaging and higher prices. Australia, the first country to adopt plain packaging, is facing a variety of legal challenges to the new regime.

Feet first

NHS Diabetes highlights the cost to patients and the NHS of poor quality diabetic foot care. The annual bill for foot ulcer treatment and amputation is about £650 million. Something like 7% of people with diabetes have had a foot ulcer, a condition that may lead to amputation. In several studies about a third of patients foot ulcers went on to have some form of amputation. Mortality from major amputation and also from foot ulcers is high. Again, effective preventive services, delivered by multidisciplinary teams (MDTs) are offered as the solution: the report provides evidence of how the introduction of MDTs can substantially reduce costs.

What's the risk

Pulse reveals that there is pressure from DH for NICE to recommend lowering the threshold for diabetes testing for adults. Draft guidance on prevention of type 2 diabetes, published last year, proved unpopular when it recommended a case finding approach, whereby GPs would be expected to assess risk of patients and offer lifestyle advice and testing to high risk patients. At this stage, the threshold was set at HbA1c levels of 6.0- 6.4%; according to Pulse, the new proposals suggest a level below 6.0% for high risk patients. A modelling study has recently suggested that using this lower threshold would prevent more cases but with a "disproportionately higher workload". Much reported was the study on variation in incidence of lower limb amputation in England, which suggested that multidisciplinary teams could be a better way of dealing with the issue.

Primary Colours issue 49

Available from our website.