Maternity care guideline

Intrapartum care for a positive childbirth experience | The World Health Organization

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Image source: http://www.who.int

This guideline brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care.

It highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies.

Full document: Intrapartum care for a positive childbirth experience

 

Additional links: WHO press release | Royal College of Midwives press release

Integrated care: impact on commissioning

Integrated care: what does it mean for commissioning?  | The Nuffield Trust 

This article looks at the risks and opportunities for commissioning as integrated care develops and evolves. Topics discussed include:

  • What are ACSs and ACOs?

  • NHS commissioning to date

  • The limited effectiveness of the market

  • Commissioning in integrated care systems

Additional link: Commissioning: the times are a changing

It’s good to talk- parents can have significant impact on child’s language acquisition and brain development simply by talking with them

Scientists from Massachusetts Institute of Technology (MIT) have found that children from lower income homes who were involved in conversations with parents had developed language skills in a specific area of the brain (Broca’s area) comparable to children in higher-income families. 

father-1633655_1920.jpgStudying conversations between children between 4 and 6 years of age,  the researchers  found that differences in the number of “conversational turns” accounted for a large portion of the differences in brain physiology and language skills that they found among the children. This finding applied to children regardless of parental income or education.

They concluded that conversational experience has a greater impact on children’s neural language processing in the brain over and above the sheer quantity of words heard. This refutes previous findings in an influential  1995 study  which found that children from higher-income families hear about 30 million more words during their first three years of life than children from lower-income families.

The researchers credit their findings to interactive conversations, which enable children to practise their communication, interpreting what others are saying and respond to them appropriately.  The lead author of the paper explained,  “the important thing is not just to talk to your child, but to talk with your child. It’s not just about dumping language into your child’s brain, but to actually carry on a conversation with them.”

While children from higher-income families were exposed to more language on average, children from lower-income families who experienced a high number of conversational turns had language skills and Broca’s area brain activity similar to those of children who came from higher-income families.

Full story from Science Daily 

Full reference:
Romeo, R. R., et al | Beyond the 30-Million-Word Gap: Children’s Conversational Exposure Is Associated With Language-Related Brain Function |Psychological Science |ePub | 2018

The article can be requested by Rotherham NHS staff here 

Using Telecare for Older People in Adult social care (The UTOPIA project)

An online survey of local authority telecare managers, funded by the National Institute for Health Research School for Social Care Research (NIHR SSCR), forms the basis of a  new report published this month. The UTOPOIA project (Using Telecare for Older People In Adult Social Care) study sought to understand how telecare is being used by local authority adult social care departments to support older people; the largest single group of social care users.

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Image source: King’s College London kclpure.kcl.ac.uk

The context for this study was an earlier Department of Health funded randomised controlled trial which became known as the Whole System Demonstrator (WSD) project.  This study concluded that telecare did not produce better outcomes for recipients over a 12 month follow-up period but these findings do not appear to have led to a reappraisal of the value of telecare by local authorities.

The data collected in the UTOPIA survey, which had an overall response rate of 75%, had representation from all types of local authority and regions in England.

The survey findings suggest that telecare in most local authorities is intended to save money. Interest in telecare is likely to be directly related to continuing public sector austerity policies of the current and previous Government but also to wider social change and affluence among many older people.

The full report can be downloaded from King’s College here 
Full reference: Woolham, J. G., et al |2018| The UTOPIA project. Using Telecare for
Older People In Adult social care: The findings of a 2016-17 national survey of local authority telecare provision for older people in England |Social Care Workforce Research Unit, King’s College London|

Communities and health

 

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This resource provides an overview of the different approaches to working with communities for improving health and illustrates the vital role that they have in improving health and wellbeing. The Kings Fund has produced this reading list for those who want to explore the topic of communities and health in more detail. 

The following questions and areas are examined:

  • What is a ‘community’?
  • What is the role of communities in improving health?
  • Health policy and the role of communities in health
  • Examples of community involvement in health

Full resource: Communities and Health | The Kings Fund

Type 2 diabetes can be reversed with very low-calorie diet

Study shows that it is possible to achieve remission from type 2 diabetes by dieting | The Lancet | via National Institute for Health Research

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Type 2 diabetes is a growing epidemic, costing the NHS £23.7 billion per year. By 2016 there were nearly 3.6 million people diagnosed with diabetes in the UK and a further one million estimated to have undiagnosed type 2 diabetes. Rates of diabetes appear to be increasing.

This study aimed to see if a very low-calorie diet program delivered in primary care could lead to at least 15kg weight loss and remission of type 2 diabetes.

The study found that by 12 months:

  • Weight loss of 15kg or more was achieved by 24% of the intervention group compared to none of the usual care group. Average weight loss was 10kg in the intervention group versus 1kg in the usual care group.
  • Diabetes remission occurred in 46% of the intervention group compared to 4% of the usual care group. It only occurred in people who had lost weight.
  • Remission was 20 times more likely with the intervention.
  • Better adherence to the regime increased the amount of weight loss and the chance of diabetes remission.
  • Diabetes medication did not need to be reintroduced for 74% of the intervention group. This was compared to 18% of the usual care group who were able to stop them. Blood pressure tablets were also no longer required for 68% of the intervention group compared to 39% of the usual care group.

Full reference: Lean MEJ, Leslie WS, Barnes AC, et al. |  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.  | Lancet. 2017. [Epub ahead of print].

The association between acne and an increased risk of depression

A UK study that analysed data data from The Health Improvement Network (THIN) (1986-2012), a large primary care database has identified a link between having acne and experiencing depression. The study found the risk of depression was highest within one year after being diagnosed with the skin condition.

skincare-1461395_1920One of the lead researchers, Dr. Isabelle Vallerand, of the University of Calgary, in Canada,  suggests the findings of the study demonstrate the impact that skin can have on an individual’s mental health. “For these patients with acne, it is more than a skin blemish — it can impose significant mental health concerns and should be taken seriously.”

Full story from Science Daily

The  journal article can be requested by Rotherham NHS staff here 

Study finds increased risk of dementia for adults with congenital heart disease

According to new research published in the American Heart Association’s journal Circulation, adults with congential heart disease (CHD) could be at a higher risk of developing dementia compared with the general population, particularly for early onset dementia.  The Danish cohort study, included 10, 632  CHD survivors in the sample; for each CHD adult, 10 individuals from the general population were randomly sampled and matched on sex and birth year.

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This study found the risk of all-cause dementia was increased by =60% compared with a matched general population cohort. The risk was higher for early onset dementia (<65 years of age; more than double) than late-onset dementia (=30% elevated risk) and was elevated for all levels of congenital heart disease complexity,  including those with cyanotic potential.

The study’s key findings are:

  • Adults with congenital heart disease are at increased  risk for dementia, particularly early onset dementia, and these results support the importance of understanding the risk of adverse long-term neurological outcomes in the growing and aging population with congenital heart disease.
  • Although it remains unknown whether the results  are directly generalizable to children diagnosed today, they appear relevant for the large population
    of adults with congenital heart disease alive today.
  • In the absence of disease-modifying treatments for  most dementias, the specific influence of etiologic factors on congenital heart disease is a potential
    target for future investigations to delay dementia onset in this vulnerable population

Abstract

Background—More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population.

Methods—In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year.

Results—The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3−2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1−1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1−2.0), whereas the HR was 2.0 (95% CI, 1.2−3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8−3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0−1.8).

Conclusions—CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.

Abstract from American Heart Association’s Circulation 

Full reference: Carina N. Bagge, C. N. et al | Risk of Dementia in Adults with Congenital Heart Disease: Population- Based Cohort Study | Circulation |Doi: https://doi.org/10.1161/CIRCULATIONAHA.117.029686

The full text article can be accessed here 

The full story is at Science Daily 

Using digital technologies: to improve the public’s health

This report from the Local Government Association includes case studies from across England to consider how digital technology has been used, as well as ten top tips to utilise digital technology to improve the public’s health.
This publication provides guidance for local authorities, highlighting  that digital public health is about so much more than apps and social media.  It provides examples throughout England wherein councils have been working with their partners – both public and private – to innovate and pilot new ways of working.

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One example outlined in the report,  is a pilot in London where pharmacies used a handheld mobile device to test for irregular heartbeats which has reduced the time from testing to treatment from 12 weeks to under three.

The report can be downloaded here 

The full details are available from the Local Government Association  

NHS Health Check

Public Health England has published NHS Health Check commissioning: review of commissioner’s current and potential use of weighted financial remuneration.  This project sought to review the evidence around the use of weighted remuneration for NHS Health Checks to aid commissioners in the design of their contracts to maximise impact of the NHS Health Check programme on population health and reducing health inequalities.  Case studies and top tips have also been produced.