Venn diagram

The overlap between long term conditions relating to physical health and mental health conditions is substantial. According to a report from the King's Fund and the Mental Health Foundation, over a third of people in England with a physical long term condition also have mental health problems; on the flipside, nearly half of people in England with a mental health problem also have a long term physical health condition. Either way, this amounts to something like 4.6 million people and between £8 billion and £13 billion per year in healthcare spending. The report argues that we could do better and that the main route to improvement is through integration. Doing nothing to address the emotional and mental health problems attendant on long term conditions risks the ability of people to manage their physical health. A study from the US looks at how to improve medical adherence amongst people in primary care with co-morbid long term physical and mental conditions (diabetes, coronary heart disease and depression). An analysis of results from the CO-MED trial focuses on depression treatment in patients with general medical conditions. A Cochrane systematic review of self monitoring of blood glucose for people with type 2 diabetes finds this has limited effect on glycaemic control in patients not using insulin. A study underway in Australia, Diabetes MILES, assesses the psychological aspects of living with diabetes: an early publication examines the methods and sample characteristics.

Keep up

There's a raft of evaluations and monitoring reports for active travel programmes, including the I Bike project in Scotland, the Living Streets community walking programme and the Travel Actively projects. A study of urban, multi-ethnic school children considers the association of active travel to school with general physical activity levels. Do "use the stairs" notices work, asks a team from the New York City Department of Health and Mental Hygiene. This study examined the effectiveness of a prompt ("burn calories, not electricity") across a range of different sized buildings and found an immediate increase in stair climbing, which was also maintained after 9 months. An analysis of the Aerobics Center Longitudinal Study adds a little more to the sum of knowledge about the dynamic relationship between fitness, overweight and cardiovascular health. Exercise on prescription schemes are examined in a systematic review and meta-analysis and are found to be of uncertain value in increasing physical activity, fitness and other health outcomes. A cost effectiveness study also suggested that exercise referral schemes only delivered a "modest increase in lifetime costs and benefits."

Lies, damned lies ...

Widely reported in the press was a study by a team at Oxford University's Department of Public Health that revealed a significant improvement in heart attack mortality over the past 10 years. This was a huge study, using HES data, but although the headline numbers tell a clear story, the reasons behind them are less evident. The study shows both a reduction in heart attacks and a rise in survival from attacks; the fall in heart attacks may well be attributable to improvements in lifestyle, detection and management, but as usual further study is needed. Another day, another set of data: the fourth annual national heart failure audit reports relatively poor outcomes, with high mortality rates, particularly amongst patients not admitted to cardiology wards. In-hospital mortality rates for patients admitted to cardiology wards were less than half those for patients admitted to other wards (8% for cardiology ward patients, 15% for general wards and 17% for other wards). Less than half of all patients with acute heart failure were admitted to cardiology wards. Finally, for the cynics, a paper in BMC Public Health considers the question of how to measure and analyse this kind of data, taking US decline in coronary heart disease as a case study.

An aspirin a day?

Widely reported in the press was a large-scale review that questioned the use of aspirin for primary prevention in cardiovascular disease. The meta-analysis published in the Archives of Internal Medicine looked at data from 9 RCTs each involving over 1000 participants. Researchers found reductions in non-fatal heart attacks in each trial, but also the chance of suffering serious internal bleeding increased by about 30%. The study's authors conclude that while the benefit for people who already had a history of heart attack or stroke was not in doubt, "routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis." An article in Pulse quoted several GPs who already advised against aspirin taken in this way and noted doctors should be aware that there was a tendency for patients to self-medicate.