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.

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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’).

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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).

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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

ABSTRACT

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

Having purpose and a sense of meaning in life may help to reduce risk of anxiety in women

The findings of largest population -based study that considered the association between area deprivation and generalised anxiety disorder (GAD) in women has been published in the BMJ.  The study looked at whether having a coping mechanism decreases women’s risk of generalised anxiety disorder.   

This study used information from a previous cohort study (the European Prospective Investigation of Cancer-Norfolk) which looked at chronic disease, mental health and lifestyle. The participants were then invited to participate in this study, those that consented completed a Health and Lifestyle (HLQ) questionnaire. To complement this  the researchers linked the participants’ postal codes to an earlier Census to derive provide a measure of deprivation. The researchers found that deprived women who had a particular personality trait, perceiving themselves to have purpose in their life and being in control of their lives were less likely to experience anxiety. By contrast, females who also lived in deprived areas but without such traits experienced high levels of anxiety. They found women in areas of deprivation without these characteristics in their personality were two times as likely to have anxiety than females in more affluent communities (via University of Cambridge).

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Abstract

Objective Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women’s risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk.

Design Large, population study.

Setting UK population-based cohort.

Participants 30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996–2000. 10 183 women had data on all variables.
Main outcome measure Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

Results In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91).

Conclusion The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety.

The full article can be downloaded from the BMJ

Full reference:

Remes OWainwright NWJSurtees P, et al | A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study | 

European Immunization Week 23-29 April 2018

World Health Organization | Background

The World Health Organization (WHO) is raising awareness of the role played by vaccines in protecting public health throughout European Immunization Week (EIW).  For instance  20 per cent of infants did not receive their first measles vaccine in the WHO European region. While there was a historic low number of measles cases in 2016, there were over 22 000 cases in 2017 and more than 11 000 cases in the first two months of this year. The WHO reports that the largest current outbreaks are in France, Greece, Serbia and Ukraine.

More details are available from WHO
In the Media:

The Telegraph | Nearly 20m children around the world miss out on life-saving vaccines

Genetic catalysts that speed up antibiotic resistance identified by Oxford Scientists

University of Oxford | April 2018 | Scientists identify genetic catalysts that speed up evolution of antibiotic resistance

In the first study of its kind a team of scientists from the School of Zoology at Oxford University have tested bacteria, Pseudomonas, which are opportunistic with a common antibiotic in controlled experiments. The team found that individual species of the bacterium evolved antibiotic resistance at radically different rates (via University of Oxford).  

Professor Craig MacLean, senior author of the study said,

“It is well established that different species of bacteria evolve resistance to antibiotics during infections at very different rates. One potential explanation for this observation is that some species of bacteria may be intrinsically better at evolving resistance to antibiotics than others.’

‘We identified that the presence of a gene known as ampR is a major cause of this variation. ampR is a master regulatory gene that switches the expression of hundreds of other genes on and off, including genes involved in antibiotic resistance. This gene acts as an evolutionary catalyst for antibiotic resistance. Put simply, species that carry the ampR gene evolve resistance at a higher rate than species that lack this gene. ampR has this effect because it makes it easier for random mutations to increase the expression of antibiotic resistance genes.’

The full, unabriged news piece is available from University of Oxford

The study is published in a paper in the journal Nature Ecology & Evolution.
Abstract

There is an urgent need to develop novel approaches for predicting and preventing the evolution of antibiotic resistance. Here, we show that the ability to evolve de novo resistance to a clinically important β-lactam antibiotic, ceftazidime, varies drastically across the genus Pseudomonas. This variation arises because strains possessing the ampRglobal transcriptional regulator evolve resistance at a high rate. This does not arise because of mutations in ampR. Instead, this regulator potentiates evolution by allowing mutations in conserved peptidoglycan biosynthesis genes to induce high levels of β-lactamase expression. Crucially, blocking this evolutionary pathway by co-administering ceftazidime with the β-lactamase inhibitor avibactam can be used to eliminate pathogenic P. aeruginosa populations before they can evolve resistance. In summary, our study shows that identifying potentiator genes that act as evolutionary catalysts can be used to both predict and prevent the evolution of antibiotic resistance.

Full reference:

Gifford, D.R, Furio, V., Papkou, A., Vogwill, T, Oliver, A & MacLean, C.R.|Identifying and exploiting genes that potentiate the evolution of antibiotic resistance | Nature Ecology & Evolution |ePub| doi:10.1038/s41559-018-0547-x

The journal article may be requested by Rotherham NHS staff here 

Lonely young people are more likely to be depressed, finds King’s College academics

Researchers from King’s College London have explored  young adults’ experience of loneliness.  They interviewed 2000 18 year olds, asking them questions such as how often do you feel you lack companionship?’ and ‘how often do you feel left out?’  The sample were interviewed about their mental and physical health, lifestyle habits, education and employment.  Their key findings include a quarter of the sample reporting feelings of loneliness occasionally, while 7 per cent experienced loneliness most of the time.
Alongside this, adults who were lonely were also twice as likely to have mental health problems and to have visited their GP during the past year. Equally, young people who were lonelier were not as physically active, more likely to be smokers and used technology more compulsively than the others in the sample (via King’s College).

child-891201_1920 Lonelier young people were found to be less confident about their career prospects: as they were likely to be out of work and education. A fifth of those who were the loneliest 10 per cent of the sample were not in education, employment or training, this compared to a tenth of non-lonely young people.

Principal Investigator Dr Timothy Matthews from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, said:

‘It’s often assumed that loneliness is an affliction of old age, but it is also very common among younger people.

‘Unlike many other risk factors, loneliness does not discriminate: it affects people from all walks of life; men and women, rich and poor.’


The full news piece is available from King’s College 

Background

The aim of this study was to build a detailed, integrative profile of the correlates of young adults’ feelings of loneliness, in terms of their current health and functioning and their childhood experiences and circumstances.

Methods

Data were drawn from the Environmental Risk Longitudinal Twin Study, a birth cohort of 2232 individuals born in England and Wales in 1994 and 1995. Loneliness was measured when participants were aged 18. Regression analyses were used to test concurrent associations between loneliness and health and functioning in young adulthood. Longitudinal analyses were conducted to examine childhood factors associated with young adult loneliness.

Results

Lonelier young adults were more likely to experience mental health problems, to engage in physical health risk behaviours, and to use more negative strategies to cope with stress. They were less confident in their employment prospects and were more likely to be out of work. Lonelier young adults were, as children, more likely to have had mental health difficulties and to have experienced bullying and social isolation. Loneliness was evenly distributed across genders and socioeconomic backgrounds.

Conclusions

Young adults’ experience of loneliness co-occurs with a diverse range of problems, with potential implications for health in later life. The findings underscore the importance of early intervention to prevent lonely young adults from being trapped in loneliness as they age.
Full reference: Matthews, T., Danese, A., Caspi, A., Fisher, H., Goldman-Mellor, S., Kepa, A., . . . Arseneault, L. | 2018| Lonely young adults in modern Britain: Findings from an epidemiological cohort study|Psychological Medicine | 1-10 | doi:10.1017/S0033291718000788

Rotherham NHS staff can request the article  here 

Related: Depressed, inactive and out of work — study reveals lives of lonely young adults