Neck scan could identify early symptoms of dementia in 5 minutes

British Heart Foundation | November 2018 | Neck scan predicts cognitive decline decade in advance

A research team lead by University College London (UCL) Professor John Deanfield, followed over 3000 participants over a fifteen-year period (3,191) middle-aged volunteers, who were given ultrasound in 2002 to measure the intensity of the pulse travelling towards their brain. Over the next 15 years, researchers monitored the participants memory and problem-solving ability.


According to the research a five minute scan of blood vessels in the neck during mid-life predicts cognitive decline a decade before symptoms appear, according to new research  co-funded by The British Heart Foundation. The findings were presented recently at the American Heart Association’s AHA Scientific Sessions conference in Chicago.

The study’s findings would need confirming in larger stuides, but the scan could potentially be used n future to help doctors identify patients who might be at high risk of developing dementia earlier than  previously possible. 

Those participants with the highest intensity pulse (top quarter) at the outset of the study were  approximately 50 per cent  more likely to exhibit accelerated cognitive decline during the next ten years when compared to the rest of the participant cohort. The researchers controlled factors which might also contribute to cognitive decline, like age, BMI, blood pressure and diabetes.

One of the researchers, Dr Scott Chiesa from UCL commented on their findings:

“These findings demonstrate the first direct link between the intensity of the pulse transmitted towards the brain with every heartbeat and future impairments in cognitive function.”

“It’s therefore an easily measurable and potentially treatable cause of cognitive decline in middle aged adults which can be spotted well in advance.” (Source: British Heart Foundation)

Full press release available from BHF 

In the media:

BBC News Dementia risk: Five-minute scan ‘can predict cognitive decline’

Evening Standard Dementia Screening: ‘Five minute neck scan could spot early signs’ say researchers 



Homelessness: duty to refer- for NHS staff

Department of Health and Social Care | November 2018 | Guidance for NHS trusts and foundation trusts providing emergency departments, urgent treatment centres and inpatient services

The Department of Health and Social Care  has released Homelss: duty to refer, for staff or clinical teams who meet and asses patients. 

For health services the impact will be on NHS trusts and foundation trusts in the provision of any of the following NHS health services:

  • accident and emergency services in a hospital
  • urgent treatment centres
  • in-patient treatment (of any kind)



The basic legal requirement for a referral is the inclusion of:

  • the individual’s contact details
  • the individual’s consent
  • the agreed reason for the referral (that they are homeless or threatened with homelessness)

General guidance on the duty to refer has been been published by the Ministry of Housing, Communities and Local Government. (Source: Department of Health and Social Care)

Shifting the centre of gravity

Local Government Association | November 2018 | Shifting the centre of gravity

A new report: Shifting the centre of gravity, sets out the LGA’s refreshed, shared vision and the actions that will help local systems to progress their work on system-wide transformation. 


Image source:

The report includes case studies on six localities – Croydon, Dorset, North East Lincolnshire, Nottinghamshire, Plymouth and Rotherham – and an evidence review of good practice which includes many case examples (Source: Local Government Association).

Read the full report from LGA 

Understanding the causal influence of higher BMI on depression

Tyrell, J. et al | 2018|Using genetics to understand the causal influence of higher BMI on depression |International Journal of Epidemiology|  dyy223|

UK and Australian researchers used data from the UK Biobank, as part of a randomization study involving 48 791 individuals with depression and 291 995 controls participants aged between 37 and 73 recruited in 2006-10. The team looked at a number of genetic variants associated with a high BM, that are also linked with a higher risk factor for diseases such as diabetes and heart disease. In conjunction they looked at a further 14 genetic variants associated with a high percentage of body fat but also with a lower risk of such health problems.


The team then looked at participants’ hospital data and responses given by participants to a number of questionnaires – some of which included  self-reports of seeing a GP or psychiatrist for anxiety or depression. From this the team spotted about 49,000 participants whom they were confident had depression.

The team found participants with a higher BMI were more likely to develop depression.



Depression is more common in obese than non-obese individuals, especially in women, but the causal relationship between obesity and depression is complex and uncertain. Previous studies have used genetic variants associated with BMI to provide evidence that higher body mass index (BMI) causes depression, but have not tested whether this relationship is driven by the metabolic consequences of BMI nor for differences between men and women.


We performed a Mendelian randomization study using 48 791 individuals with depression and 291 995 controls in the UK Biobank, to test for causal effects of higher BMI on depression (defined using self-report and Hospital Episode data). We used two genetic instruments, both representing higher BMI, but one with and one without its adverse metabolic consequences, in an attempt to ‘uncouple’ the psychological component of obesity from the metabolic consequences. We further tested causal relationships in men and women separately, and using subsets of BMI variants from known physiological pathways.


Higher BMI was strongly associated with higher odds of depression, especially in women. Mendelian randomization provided evidence that higher BMI partly causes depression. Using a 73-variant BMI genetic risk score, a genetically determined one standard deviation (1 SD) higher BMI (4.9 kg/m2) was associated with higher odds of depression in all individuals and women only. Meta-analysis with 45 591 depression cases and 97 647 controls from the Psychiatric Genomics Consortium (PGC) strengthened the statistical confidence of the findings in all individuals. Similar effect size estimates were obtained using different Mendelian randomization methods, although not all reached P  more than 0.05. Using a metabolically favourable adiposity genetic risk score, and meta-analysing data from the UK biobank and PGC, a genetically determined 1 SD higher BMI (4.9 kg/m2) was associated with higher odds of depression in all individuals, but with weaker statistical confidence.


Higher BMI, with and without its adverse metabolic consequences, is likely to have a causal role in determining the likelihood of an individual developing depression.

Read the full article in The International Journal of Epidemiology 

In the news:

Science Daily ‘Strongest evidence yet’ that being obese causes depression

Guardian Genetic link between obesity and depression uncovered, say scientists

Community-Centred Practice: Applying All Our Health

Information for front-line staff to adopt community-centred ways of working that help improves the health and wellbeing of the most marginalised communities | Public Health England

Evidence shows that community engagement interventions have a positive impact on a range of health outcomes across various conditions.  Recent NICE guidance on Community Engagement  signals the importance of working in partnership with local communities to plan, design, deliver and evaluate health and wellbeing initiatives.

Image source:

For the NHS, the Five Year Forward View highlighted the need to ‘fully harness the renewable energy of communities’ as part of a greater emphasis on prevention. The community contribution of volunteers and residents active in their neighbourhoods is also important for local government.

From a public health perspective, involving people in volunteer and peer roles can help strengthen social networks and offers a means to access and connect with groups at risk of social exclusion.

This resource aims to help health professionals prevent ill health and promote wellbeing as part of their everyday practice. It includes guidance on:

  • adopting community-centred approaches in a professional practice
  • understanding local needs
  • measuring impact.

Full guidance: Community-Centred Practice: Applying All Our Health | Public Health England

Delayed Transfers Of Care Resources

Call to Action: a series of practical resources to support health and social care staff to reduce delayed transfers of care | NHS England


These guides are aimed to help health and social care colleagues to take prompt practical actions and use every opportunity to prevent delayed transfers of care. Through using these guides, health and social care staff can address the evidence that staying in hospital for longer than required drives adverse outcomes for patients.

Pancreatic cancer across Europe

Pancreatic Cancer Europe & United European Gastroenterology | November 2018 | Pancreatic cancer across Europe

Today (15 November) is World Pancreatic Cancer Awareness Day, Pancreatic Cancer Europe & United European Gastroenterology have released  Pancreatic cancer across Europe: Taking a united stand. Pancreatic cancer has the lowest survival rate in Europe. Patient outcomes have been largely static for the last forty years, in contrast to the improved outcomes in the treatment of other cancers. 

pancreatic cancer
Image source:

The number of  deaths from pancreatic cancer has almost doubled in the
past thirty years, over 90,000 EU citizens die from pancreatic cancer every year. Forecasts predict that this dreadful disease shows no sign of relenting either, with the number of cases and deaths both estimated to increase by 40% by 2035 (Source: Pancreatic Cancer Europe & United European Gastroenterology).

Read the full report Pancreatic Cancer Across Europe Taking a united stand



Call for closer links between GPs and dentists

OnMedica | November 2018 | Call for closer links between GPs and dentists
The British Dental Association Scotland, are calling for greater coordination between health professionals, as well as checks to ensure patients have regular dental check ups, and improved detection and prevention of oral cancer. Oral Cancer a plan for action, focuses on prevention, early detection and having better referral pathways to ensure good links between dentists, GPs and pharmacists 


Last year in the UK, 2,722 people died after developing oral cancer. The 10-year survival rate is between 19% and 58%, depending on where the cancer strikes and how early it is diagnosed. Oral cancer kills three times more people than road traffic accidents in Scotland. Mouth and throat cancers are among the most unequally distributed cancers in the population, with incidence of mouth cancers, and mortality from mouth cancers, both over twice as high in people in the most deprived areas of Scotland (Source: Oral Cancer a plan for action).

Full story OnMedica Call for closer links between GPs and dentists

Read Oral Cancer a plan for action


Technology in care

Care Quality Commission | November 2018 | Technology in care

The Care Quality Commission (CQC) have published a series – Technology in care- which shows how technology is used, the benefits of its usage and it also includes examples of best practice .

Introduction: How technology can support high-quality care

Using surveillance in your care service

Check the way you handle personal information meets the right standards

Find out if you need consent to use technology as part of someone’s care


The health care workforce in England

The health care workforce in England: make or break | The Health Foundation |  King’s Fund | Nuffield Trust 

This briefing highlights the scale of the NHS workforce challenges and the threat this poses to the delivery and quality of care. It sets out the reasons why the NHS long-term plan and a supporting workforce strategy must address the urgent and mounting challenges facing the health care workforce. 

The authors suggest that if the substantial staff shortages continue, they could lead to growing waiting lists, deteriorating care quality and the risk that some of the £20.5bn secured for NHS front-line services will go unspent: even if commissioners have the resources to commission additional activity, health care providers may not have the staff to deliver it.

The briefing will be followed in the coming weeks by a more in-depth report that explores five key levers available nationally and locally that could help ameliorate the workforce crisis affecting both health and social care.

Full briefing available at The King’s Fund

Related:  Staffing shortfall of almost 250,000 by 2030 is major risk to NHS long term plan | The Health Foundation