Take a deep breath

To accompany last year's outcomes strategy for COPD and asthma, DH has produced a companion document that sets out best practice guidance for commissioners, particulraly in the transition period, ahead of the CCGs and the NHS Commissioning Board taking up the reins.  As Pulse points out, the guidance includes a case-finding approach to identifying undiagnosed patients.  A Swedish study of the use of a mini-spirometer in improving diagnosis of COPD finds it a highly effective device.  The companion document also reveals that DH is trialling the use of microspirometry in case finding in Yorkshire and Humber: the project is due to report in late 2012.

Pack shot

DH has launched its consultation on food labelling, aimed at a creating single system of front of pack nutritional information display.   Currently, around 80% of food products sold in the UK do provide nutritional labelling, but there are many systems.  DH estimates that if the big 7 supermarkets all hamonised their nutritional labelling, this would affect about half of all the food sold in the UK.  Responses are due in by 5 August.  Join the queue!  A recent study of Australian consumers found rather poor understanding of energy labelling at least.  The May issueof Public Health Nutrition carries a few articles on the subject, , looking at strategies to increase food label use int he US, German consumer responses to traffic light labelling systems and an online test from New Zealand of consumer response to low sodium labelling.

Price rise

Minimum pricing for alcohol, a key element in the Government's new alcohol strategy, has been questioned by the Local Government Association, over concerns that this will "cause a surge in counterfeit wine and spirits", the BBC reports.  A study from British Columbia, Canada, where minimum pricing has been in force for many years, suggests that it is effective in reducing alcohol consumption.  Approaching the problem from another perspective, a new Public Health Responsibility Deal pledge aims to make lower strength drinks more widely available.  A paper from the University of Sheffield considers the health economic assessment of public health alcohol harm strategies.  Minimum pricing has found support amongst pub landlords in Wales, who have blamed supermarket sales for a fall in their trade.  A study in Alcohol and Alcoholism examines trends in home drinking in the UK. 

Named and shamed

Several UK supermarkets were on the receiving end of the wrath of the Children's Food Campaign for undermining parents' efforts to encourage their children to eat healthily.  The report, Checkouts Checked Out, was highly critical of how much junk food is displayed at checkouts, both in supermarkets and non-food stores.  One of its recommendations is that removal of this kind of food from checkout areas should be included in the Public Health Responsibility Deal, the latest element of which (a calorie reduction initiative) was announced by DH recently. Public Health features an evaluation of the MEND (Mind, Exercise, Nutirition ... Do it!) healthy living programme as delivered in the West Midlands.  A systematic review of evidence about the association of childhood obesity with primary school built environments finds little to commend in the literature.  Community Practitioner offers an overview of the Food Dudes school-based healthy eating programme. 

Integration ahead

DH's recent evaluation of  the integrated care pilots has been found wanting in several quarters.  GP magazine put in a Freedom of Information Act request for clarity on DH's claim that this telecare route will offer £1.2 bn savings, but was turned down.  A lesss investigative approach from Nick Goodwin of the King's Fund echoes the less than enthusiastic response: "It is fair to say that the collective results of these pilots have been mixed."  He also observes that these pilots suffered from a common problem with integrated care, where the process of integration gets priority over the experience of care.  Another significant finding from the report was that emergency admissions increased over the period studied, while outpatient and elective admissions decreased.  The King's Fund is itself currently looking for case sites in its study of co-ordinated care for people with complex chronic illnesses.

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.

Does it last?

Recent studies from the US, the UK and Finland have shown that there has been a substantial rise in total knee replacements (TKR) for younger people. The study from Finland, published in Arthritis and Rheumatism, shows that, along with an overall increase in the procedure, there was also a marked increase amongst those aged 50-59, while the journal's editorial suggests that more research into outcomes for younger patients is warranted. Another study from the US dismisses the idea that this growth is simply caused by rising obesity and an increase in population numbers. The practice of rationing TKR in the UK is judged not to be cost effective by a study in the BMJ. Researchers used data from the Knee Arthroplasty Trial to show that only offering surgery to patients with a high-to-moderate Oxford Knee Score was "probably unjustified". Body Mass Index, also occasionally used as a metric for rationing, was also found to have no significant effect on cost or outcome.

Steady as she goes

Tai chi retains its status as exercise regime of choice for a range of health conditions. A recent trial of a tailored Tai chi programme to improve postural stability with people with Parkinson's disease found benefit amongst mild to moderate Parkinson's sufferers. Research in Sports Medicine offers another review of this form of exercise for falls prevention. Elsewhere, Tai chi is described as a "promising intervention" for reducing fracture risk amongst older osteopenic women. Exercise of any kind is recommended for people with chronic illness and depressive symptoms in a systematic review.

Ratings

A bad TripAdvisor review can strike fear into the hearts of owners of hotels or restaurants, but does this kind of feedback bear any relation to more formal quality assessments? A team from Imperial College matched feedback given via NHS Choices to a range of hospital quality measures and found there to be a reasonable level of agreement, especially as regards mortality and infection rates. DH announces that "the Government welcomes these findings". A study from the US looks at the relationship between patient satisfaction and healthcare use. A systematic review of the impact of patient and public involvement on NHS healthcare finds there's still room for improvement.

Halcyon daze

Healthy Ageing Across the Life Course, or HALCyon is an interdisciplinary study looking at the factors that contribute to healthy ageing. A survey of early findings from five of the eight workstreams appears in the journal Public Health. The Department of Work and Pensions has released its final report on the Active at 60 pilot into the scope for using smart technology for delivering services to older people. The Journal of Epidemiology and Community Health publishes an evaluation study of a "worksite vitality intervention" for older hospital workers.

Handle with care

Community based screening for frailty in older people is attracting a degree of attention in the literature. A review of how frailty is recognised and managed in primary care is a timely addition. The Journal of the American Geriatrics Society publishes a panel review of screening older people for particular conditions, as represented in a raft of guidelines. They find that screening for insufficient physical activity, cardiovascular risk factors and smoking are appropriate in aiming to prevent functional decline. A systematic review of screening tools for use in primary health care identifies the Tilburg Frailty Indicator and the SHARE Frailty Index as the most appropriate. A prospective study in a community context looks at Tilburg alongside the Gronigen Frailty Indicator and the Sherbrooke Postal Questionnaire.

Clean break

Fragility fractures are often linked to osteoporosis. NICE has just opened consultation on draft guidance to assess the risk of fragility fractures in adults. Responses are due in by 8 March. There's a comparison of UK case-finding strategies for management of hip fractures in the latest issue of Osteoporosis International, looking at the Royal College of Physicians strategy and the newer National Osteoporosis Guideline Group approach. Some more detail is provided on the SCOOP trial of community based screening for osteoporosis. Finally, Value in Health offers a systematic review of cost-effectiveness in strategies for selecting and treating people at risk of osteoporosis and osteopenia.