Facing the future audit 2017: standards for acute general paediatric services

The Royal College of Paediatrics and Child Health have published Facing the future audit 2017: standards for acute general paediatric services. The audit analyses data submitted by paediatric clinical directors on two sets of standards produced by the RCPCH in partnership with children, young people and families – the ‘Facing the Future: Standards for acute general paediatric services’ and ‘Facing the Future: Together for child health’ standards.

Facing the future audit 2017
Image source: rcpch.ac.uk  

The audit provides UK-wide evidence to help us understand how services are meeting standards and what impact they are having on the ground.

It can be accessed here 


Reference: Royal College of Paediatrics and Child Health |April 2018 |Facing the future audit 2017: standards for acute general paediatric services

Mental health statistics for England: prevalence, services and funding

House of Commons | April 2018 | Mental health statistics for England: prevalence, services and funding

The House of Commons Library have issued a research briefing on Mental health statistics for England: prevalence, services and funding.  The most recent survey into adult mental health in England was conducted in 2014, which highlighted the prevalence of common mental disorders (CMDs), such as generalised anxiety disorder, depression or obsessive compulsive disoder, which have increased since 1993.  Figures suggest as many as 1 in 6 over 16s will experience a CMD every week.

mental health england
Image source: researchbriefings.files.parliament.uk 

The briefing paper Mental health statistics for England: prevalence, services and funding can be accessed from the House of Commons Library 

Obese are more likely to develop heart issues

Obese individuals are at greater risk of developing atrial fibrillation- a rapid and irregular heart rate which can cause stroke and heart failure among other complications. Scientists from Penn State College of Medicine in the US, found that people who were obese had as much as a 40 per cent increased challenge of developing the condition.

Individuals with obesity had a very similar risk factor towards developing atrial fibrillation as those with hypertension or diabetes.  They were 40 per cent more likely to develop atrial fibrillation, while they are 45 per cent and 51 per cent more likely to develop hypertension or diabetes.

Lead author Dr Andrew Foy said the association could possibly be explained by the stress and strain obesity places on the heart (via Science Daily). 



Prospective cohort studies involving older adults report an association of obesity and new-onset atrial fibrillation and atrial flutter. To assess this relation, we performed a longitudinal cohort study from January 1, 2006 to December 31, 2013, using a national claims database that tracks all inpatient, outpatient, and pharmacy claims data. The primary end point of new-onset atrial fibrillation was compared between obese and nonobese cohorts. We used logistic regression to determine the strength of association between obesity and new-onset atrial fibrillation controlling for age, gender, hypertension, and diabetes.

Overall, 67,278 subjects were included in the cohort, divided evenly between those with and without a diagnosis of obesity. Obese subjects were significantly more likely to have hypertension (29.5% vs 14.6%) and diabetes (12.7% vs 5.2%) at study onset. Over 8 years of follow-up, we recorded a new diagnosis of atrial fibrillation in 1,511 (2.2%) subjects.

Obesity was strongly associated with a new diagnosis of atrial fibrillation after controlling for age, gender, hypertension, and diabetes (odds ratio 1.4, 95% confidence interval 1.3 to 1.6). In conclusion, this information contributes to the growing evidence supporting the causal relation between obesity and atrial fibrillation, and emphasizes the need of addressing obesity as part of our therapeutic strategy to prevent atrial fibrillation.

Full reference: Foy, Andrew J. et al. | 2018|Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults| American Journal of Cardiology |Vol. 121 |Issue 9 | P. 1072 – 1075 |DOI: https://doi.org/10.1016/j.amjcard.2018.01.019 

Rothterham NHS staff can request the full article here

Data for Public Benefit

Involve | Data for Public Benefit Balancing the risks and benefits of data sharing| April 2018 |

This report collates the findings of workshops across six local authority areas across England. The workshops looked into how  professionals from public and voluntary organisations to learn how they understand, define and value the public benefits which could be derived from the use of personal data.

It also establishes a framework for those providing public services to assess and evaluate the public benefits that the better use of data may be able to deliver and attempt to balance this against the risks sharing data may entail.

patient data
Image source: involve.org.uk

Three key tests arose out of the workshops:

Purposeful– When the purpose of a proposed use or sharing of data is clearly and transparently defined, participants were readier to accept a proposed use of data. It was also felt this helped provide protection (for both the data subject and the organisations involved) against data being used for purposes beyond that for which it was initially shared.

Proportionate- A number of factors contributed to assessments of proportionality in the workshops, including that the proposed use of data minimises the amount of data needing to be shared. Such as if it considers  whether personally identifiable data is necessary to achieve the goal. Equally,  if it has clear parameters to protect against the data being used for purposes it not provided or shared for.  Finally, does it consider the sensitivity of the data, the likelihood of risks being realised and balance the severity of a potential negative impact.

Responsible– Participants explored the idea that to be a justifiable use of public resources, the benefits likely to be achieved by a particular use of data have to be balanced not just against the risks, but against delivering the intended outcome.


The full report is available to download from Involve

Eating and drinking for a person with dementia

Helping a person with dementia to maintain a healthy diet can be difficult
for the people caring for them. This leaflet aims to provide some positive
tips on ways to help | Dementia UK

People with dementia may experience problems with eating and drinking.
There are many reasons this might happen. They might:

  • forget to eat
  • experience difficulties preparing food
  • have difficulty recognising food items
  • have a change in appetite or taste
eating dementia
Image source: http://www.dementiauk.org

Eating a healthy and balanced diet is important for a person’s physical and mental health. Not eating and drinking enough can increase the risk of dehydration, weight loss, a urinary tract infection and constipation. These health problems can be particularly problematic for someone with dementia as they can increase confusion and the risks of delirium, and sometimes make the symptoms of dementia worse.

This leaflet from Dementia UK provides useful tips on the following:

  • Setting the scene for mealtimes
  • Encouraging a person with dementia to eat
  • Encouraging a person with dementia to drink
  • Stocking up and storing food
  • Weight gain or weight loss
  • Swallowing

Full resource: Eating and drinking: Staying well with dementia

Related:   ‘Eating and Drinking Well: Supporting People Living with Dementia’ |Bournemouth University

What causes cancer? Public perceptions of risk factors from UCL and Leeds study

A survey that asked members of the public about the causes of cancer has revealed that general public have misconceptions and ignorance about the causes of cancer. A joint project with University of Leeds and University College London (UCL) surveyed over 1300 people to explore public understanding about some of the causes of cancer (via University of Leeds).


Although they recognised proven causes of cancer including smoking (recognised by 88%)  passive smoking  (cited by 80% ) passive smoking and excessive sun exposure (sunburn 60%), as risk factors; 19 per cent of those surveyed also noted drinking from plastic bottles, residing near power lines and eating genetically modified food.

Among the key findings were three quarters of the sample were unaware that eating less than five a day portions of fruit or vegetables raises the risk of getting the disease. Others in the sample (40 per cent) believed stress and food additives caused cancer.

The full news item from The University of Leeds can be read here 

The findings are published in the European Journal of Cancer 



Literature on population awareness about actual causes of cancer is growing but comparatively little is known about the prevalence of people’s belief concerning mythical causes of cancer. This study aimed to estimate the prevalence of these beliefs and their association with socio-demographic characteristics and health behaviours.


A survey containing validated measures of beliefs about actual and mythical cancer causes and health behaviours (smoking, alcohol consumption, physical activity, fruit and vegetable consumption, overweight) was administered to a representative English population sample (N = 1330).


Awareness of actual causes of cancer (52% accurately identified; 95% confidence interval [CI] 51–54) was greater than awareness of mythical cancer causes (36% accurately identified; 95% CI 34–37; P less than 0.01). The most commonly endorsed mythical cancer causes were exposure to stress (43%; 95% CI 40–45), food additives (42%; 95% CI 39–44) and electromagnetic frequencies (35%; 95% CI 33–38). In adjusted analysis, greater awareness of actual and mythical cancer causes was independently associated with younger age, higher social grade, being white and having post-16 qualifications. Awareness of actual but not mythical cancer causes was associated with not smoking and eating sufficient fruit and vegetables.


Awareness of actual and mythical cancer causes is poor in the general population. Only knowledge of established risk factors is associated with adherence to behavioural recommendations for reducing cancer risk.

Full reference:

The paper can be read at the  European Journal of Cancer or downloaded here 

In the media:

BBC News Fake cancer causes belief ‘rife’, research suggests

King’s Fund: NHS spending on drugs has grown at a rate of 5 per cent every year since 2010/11

The King’s Fund |April 2018 | Rising spend on NHS medicines could jeopardise patients’ access to drugs, warns The King’s Fund 

In  2016/17, NHS spending on drugs was £17.4 billion compared to £13 billion in 2010/11- an average growth of around 5 per cent a year, however within the same period the NHS budget grew by an average of 1 per cent a year. A new report from The King’s Fund highlights how the spending on drugs has outpaced the NHS budget.


According to accompanying press release, much of the increase in spending has been in hospitals, which now account for nearly 50 per cent of the total amount the NHS spends on medicines, with costs having grown by around 12 per cent a year since 2010/11.

Spending in primary care has decreased due to the encouragement of generic, rather than branded drugs leading to reductions of nearly a quarter in the average costs per item.

The full release can be read at The King’s Fund

The report The rising cost of medicines to the NHS is available here 

Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

The Nuffield Trust | April 2018 | Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

Health 1000 is a new model of care that aimed to improve quality of life through personalised care delivered by a clinically-led multidisciplinary team, focusing on prevention and early intervention and supported by contributions from the third sector. Individuals eligible in Barking and Dagenham, Havering and Redbridge boroughs were invited to transfer from their primary care practice to Health 1000.

Image source: nuffieldtrust.org.uk

Using a case-control methodology, where 407 patients registered with Health 1000 were paired with a control who would be registered with another GP in the area. A combination of interviews with patients and staff and surveys were completed by staff of Health 1000 and nearly 50 primary care staff working in the boroughs.
Among the findings were:

  • Staff had reported reductions in unnecessary outpatient referrals and significant improvements to medicines management. They had also referred to the benefits of better care continuity, for example in enabling quicker discharges from hospital and avoiding duplication across the system.
  • However, there is no evidence that the service reduced use of hospital services – whether for all patients, those who satisfied the original eligibility criteria, or those at end of life. However, with the numbers of patients and the period of follow up, it may be too soon to detect any such change.

The report’s key findings and the full details of the evaluation are available from The Nuffield Trust here 

The accompanying report can be downloaded here

Labelling drinks as being ‘low alcohol’ may increase alcohol consumption

University of Cambridge | April 2018 |Labelling alcoholic drinks as lower in strength could encourage people to drink more, study suggests

New research conducted as part of a collaboration between the Behaviour and Health Research Unit at the University of Cambridge and the Centre for Addictive Behaviours Research at London South Bank University has looked into the impact of labelling alcoholic drinks as low alcohol (via University of Cambridge)

The study was conducted in a laboratory designed to look like a bar involved over 260 participants who were randomly assigned to  taste-test drinks with different labels.  Those assigned to the first group were given drinks labelled as  ‘Super Low’ and ‘4%ABV’ for wine or ‘1%ABV’ for beer. In a different group the drinks were labelled ‘Low’ and ‘8%ABV’ for wine or ‘3%ABV’ for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market – wine (‘12.9%ABV’) or beer (‘4.2%ABV’).


Those in the sample, selected to represent the UK population, drank more alcohol if the label on the drink indicated lower alcohol strength.  This meant the mean consumption of drinks labelled ‘Super Low’ was 214ml, compared with 177ml for regular (unlabelled) drinks.
Senior author, Professor Theresa Marteau, said: “Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more.”

ABV- alcohol by volume is the standard measure of how much alcohol is contained in a given volume of an alcoholic drink.

The full press release from the University of Cambridge can be read here 

Full reference:

Vasiljevic M, Couturier DL, Frings D, Moss AC, Albery IP, Marteau TM|  ‘Impact of lower strength alcohol labeling on consumption: A randomized controlled trial’| Health Psychology| DOI: 10.1037|hea0000622

New study finds online ads may encourage pregnant smokers to quit

NIHR | April 2018 | Online ads effective at helping pregnant women stop smoking 

An NIHR funded study has found that an online advertising campaign may be more effective in encouraging expectant mothers to quit smoking, than a clinic based intervention. The study was part of a collaboration between the University of Cambridge, University of East Anglia (UEA), and the University of Nottingham (via UEA).

One of the researchers, Dr Felix Naughton, developed MiQuit, which is a text-messaging intervention specifically for pregnant smokers. As it is automated, the women could use it without health professional’s involvement. In tandem with this the research team also  advertised links to a website providing MiQuit information on Google and Facebook, which incurred a cost. Adverts were also placed on the National Childbirth Trust and NHS Choices websites free of charge.

The team found that the Facebook advert generated initiations throughout pregnancy, around 50 per cent of those who initiated MiQuit via Google were within their first five weeks’ gestation. Adverts attached to online search engines may therefore be a useful way to reach women when they are first pregnant and looking for support or information about smoking during pregnancy. Currently, the earliest cessation interventions tend to target pregnant smokers at their antenatal booking appointment, at around 8-12 weeks’ gestation.

Lead author of the study, Dr Joanne Emery, Research Associate at the University of Cambridge, said: “This study shows that online advertising appears to be a valuable means of promoting health interventions to hard-to-reach groups.

“We found that a significant minority of pregnant smokers were willing to initiate an automated text messaging intervention when offered this online. Given the high reach of the internet this could translate into substantial numbers of pregnant smokers supported to quit.” As a result of this study’s findings, a more definitive trial is now underway.

An article based on this study has been published in the Journal of Medical Internet Research


Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown.

Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet.

Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuitinitiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter.

Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuitwebsite from Google (search-based) and Facebook (banner) adverts, respectively. MiQuitwas initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks).

Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers.
Full reference: Emery, J.L, Coleman, T., Sutton, S., Cooper, S., Leonardi-Bee, J., Jones, M., & Naughton F. | Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study | J Med Internet Res |2018| Vol. 20 |4| e146| DOI: 10.2196/jmir.8525|PMID: 29674308
Related: University of East Anglia Online ads help pregnant smokers quit