High-fibre diet cuts risk of death from cancer, stroke and heart disease by up to a third

Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet | via ScienceDaily

Eating more fibre, found in wholegrain cereals, pasta and bread as well as nuts and pulses, will reduce people’s chances of heart disease and early death, according to a landmark review published in The Lancet. The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.

The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.

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In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.

While their study did not show any risks associated with dietary fibre, the authors note that high intakes might have ill-effects for people with low iron or mineral levels, for whom high levels of whole grains can further reduce iron levels. They also note that the study mainly relates to naturally-occurring fibre rich foods rather than synthetic and extracted fibre, such as powders, that can be added to foods.

Full story at ScienceDaily

Link to the research: Reynolds, A. et al. | Carbohydrate quality and human health: a series of systematic reviews and meta-analyses | The Lancet | Published January 10, 2019

Related:

Skill and dedication of NHS staff praised as health service productivity outstrips the rest of the economy

NHS England | January 2019 |Skill and dedication of NHS staff praised as health service productivity outstrips the rest of the economy

The NHS’ productivity outperformed the rest of the economy according to figures; productivity in the UK increased by 0.8% in 2016/17, this compares to productivity in the NHS growing by 3%  in the financial year ending 2017. 

NHS England chief executive Simon Stevens said: “These figures are a testimony to the dedication and skill of NHS staff whose efforts, along with new, more efficient ways of working, has led once again to the NHS outperforming the rest of the economy.

“They provide reassurance that NHS funding is and will continue to be used to maximum effect. Although the NHS is already demonstrably one of the most efficient health services in the world, our new NHS Long Term Plan will continue to bear down on waste and ensure that every penny is well spent.”

The full story is available from NHS England

[NICE Consultation] Intrapartum care for healthy women and babies

NICE | January 2019| Intrapartum care for healthy women and babies Clinical guideline [CG190]

A NICE consultation is open on Intrapartum care for healthy women and babies Clinical guideline [CG190]

This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy (‘term’). The guideline helps women to make an informed choice about where to have their baby. It also aims to reduce variation in areas of care such as fetal monitoring during labour and management of the third stage of labour (NICE).

The consultation close on 22 January 2019

Details from NICE 

Making Every Contact Count e-learning programme updates now live

e-Learning for Healthcare | December 2018 | Making Every Contact Count e-learning programme updates now live

This resource, comprising four e-learning sessions, is intended for anyone who has contact with people to “Make Every Contact Count” and develop public health knowledge. Based on feedback from learners, each of the four sessions have been reviewed and now benefit from revised and additional content with a focus on mental health. The template of the programme has also been updated.

In addition to the updated content, the MECC e-learning programme has now received accreditation from The University of Brighton. The MECC e-learning programme is already accredited by the Royal Society for Public Health (RSPH) (Source: e-Learning for Healthcare).

Further details from e-Learning for Healthcare

Visit the programme here 

 

Hunger, malnutrition and food insecurity in the UK

New report says the Government has failed to recognise and respond to the issues of hunger, malnutrition and obesity in the UK and should appoint a minister to ensure cross-departmental action. | Environmental Audit Committee

A new report finds that food insecurity in the UK, defined as “limited access to food … due to lack of money or other resources”, is significant and growing. Levels are among the worst in Europe, especially for children, with 19% of under 15s living with an adult who is moderately or severely food insecure.

knife-and-fork-2754149_1920 The Committee heard how food insecurity can lead to both malnutrition and obesity, with people forced to rely on the very cheapest foods, which are often nutrient-poor but calorie-rich. The Government’s obesity strategy makes no mention of food insecurity and only the Department for International Development mentions hunger in its Single Departmental Plan.

Chair of the Environmental Audit Committee, Mary Creagh MP, said “Instead of seeing hunger as an issue abroad, the Government’s New Year resolution should be one of taking urgent action at home to tackle hunger and malnutrition. This can only be addressed by setting clear UK-wide targets and by appointing a Minister for Hunger to deliver them.” 

See also:

Widely used drugs may have the potential to help treat mental illness

Hayes, J.F. et al | 2019 | Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness | JAMA Psychiatry | Published online ahead of print| doi:10.1001/jamapsychiatry.2018.3907

A study that involved experts from University College London has been published in JAMA Psychiatry, following its finding that  hospital treatment for patients with serious mental illness was reduced  by up to a fifth when they were prescribed drugs in common use for physical health problems. 

The study investigated if drugs in common use for physical health problems are associated with reduced rates of psychiatric hospitalization and self-harm in individuals with serious mental illness.

The researchers analysed the patient information of 142 691 patients with bipolar disorder, schizophrenia, or nonaffective psychosis. It found that the drugs used to treat blood pressure, high cholesterol and type 2 diabetes were found to have the potential to treat severe mental illness as it was associated with reduced rates of psychiatric hospitalizaiton compared with unexposed periods. Self-harm was reduced in patients with bipolar disorder and schizophrenia during exposure to all study drugs and in patients with nonaffective psychosis taking L-type calcium channel antagonists.

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Abstract

Importance  Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).

Objective  To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.

Design, Setting, and Participants  These within-individual cohort studies of patients with SMI compared rates of psychiatric hospitalization and self-harm during periods of exposure and nonexposure to the study drugs, with adjusting for a number of time-varying covariates. Participants included 142 691 individuals from the entire population of Sweden with a diagnosis of bipolar disorder (BPD), schizophrenia, or nonaffective psychosis (NAP) who were 15 years or older and who were treated with psychiatric medication from October 1, 2005, through December 31, 2016. Data were analyzed from April 1 through August 31, 2018.

Interventions  Treatment with HMG-CoA RIs, LTCC antagonists, or biguanides.

Main Outcomes and Measures  Psychiatric hospitalizations and self-harm admissions.

Results  Among the 142 691 eligible participants, the HMG-CoA RI exposure periods were associated with reduced rates of psychiatric hospitalization in BPD, schizophrenia, and NAP and reduced self-harm rates in BPD and schizophrenia. Exposure to LTCC antagonists was associated with reduced rates of psychiatric hospitalization and self-harm in subgroups with BPD, schizophrenia and 0.30, respectively), and NAP  and 0.56, respectively). During biguanide exposure, psychiatric hospitalization rates were reduced in subgroups with BPD, schizophrenia, and NAP, and self-harm was reduced in BPD and schizophrenia.

Conclusions and Relevance  This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.

The article is available from JAMA Psychiatry

In the news:

BBC News Cheap common drugs may help mental illness

NHS staff praised as health service productivity outstrips the rest of the economy

NHS staff boosted productivity by 3% in a single year, dramatically outstripping productivity growth in the rest of the economy new figures have revealed | via NHS England

Data released  by the Office for National Statistics (ONS) has shown that NHS productivity for the financial year ending 2017 grew by 3% in England, more than treble the 0.8% achieved across wider the UK economy in 2016/17.

Health service productivity in England also outpaced that achieved in health services elsewhere in the UK, with a combined UK health service figure of 2.5% in 2016.

Action taken to improve efficiency by NHS England and NHS Improvement includes:

  • The introduction of a cost-per-hour cap on agency staff from November 2015
  • Curbing prescribing of medicines that have little or no benefit saving up to £200 million a year
  • Stopping the routine commissioning of 17 procedures where less invasive, safer treatments are available and just as effective, saving an estimated £200 million a year

Full story at NHS England

Support for older people in England

Human Rights Watch | January 2019| Support for older people in England

A new report from Human Rights Watch- Unmet Needs: Improper Social Care Assessments for Older People in England- finds that older people in the UK are not being given the help they need to live independently. 

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Interviews of 104 people between the ages of 58 and 94  and 20 family caregivers alongside interviews with stakeholders including representatives of charities, NHS staff and Clinical Commissioning Group (CCG) staff and policy experts to name but a few were used to compile the report. Some of the interviewees said that assessors appeared not to understand their disabilities and support needs. In other cases, before beginning an assessment, assessors announced that services would be cut regardless of an individual’s actual need. In some cases services were denied or cut significantly, affecting older people’s health and wellbeing.

Bethany Brown, researcher on older people’s rights at Human Rights Watch, said: “Older people do not always get fair assessments of the support they need to live dignified, independent lives. Older people’s health and wellbeing can be harmed if they do not get the services they are entitled to.

“Many older people in England desperately need these services and have no alternatives, so serious cuts to social services funding and an improper assessment can cause tangible risks to their health and wellbeing (Source: OnMedica).

“Oversight is a crucial part of a properly functioning system, and the UK government should make sure that local authorities consistently conduct fair and accurate assessments and deliver appropriate services.” (via OnMedica)

OnMedica Health risks from poor support for older people

Support for older people in England [Easy Read]

In the news:

OnMedica Health risks from poor support for older people

Health Rights Watch United Kingdom: Older People Left Without Support

GP premises: the patient perspective

Patients Association | January 2019 | GP premises: the patient perspective

Confidentiality, accessibility of the GP practice and travelling to the GP practices were all key issues identified in GP premises: the patient perspective- the report from the Patients Association. 

720 Patients’ views were obtained through four focus groups and an online survey. Over half (56 %) of the participants surveyed mentioned a lack of confidentiality, that is being overheard in the waiting room while speaking the receptionist or when telephoning the practice as being an issue; as privacy is “not good”.

Responses to the survey and focus groups, indicate that 58% (404 of 692 respondents to this question) said that there was not enough space at the practice to allow reasonable privacy.

Access issues were concerns for patients, almost half (46 per cent) noted the absence of a lift at their GP practice, although three-quarters noted an accessible ramp. Other issues raised included:

  • No lift and the corridors are narrow
  • Doctors having to come downstairs to see patients
  • Difficulties in moving around the buildings in wheelchairs
  • Difficulties in being able to get into the building easily or get to the reception desk due to lack of space to turn and manoeuvre.

For 40 per cent of patients the environment was problematic- they stated that this causes feelings of stress and anxiety (Source:  Patients Association).

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Image source: patients-association.org.uk

 

GP premises: the patient perspective [press release]

Patients’ Views on making best use of GP premises 

Liverpool study will address barriers to sweetener use

University of Liverpool| January 2019 | Liverpool study will address barriers to sweetener use

A collaboration between the University of Liverpool and Copenhagen will study the risks and benefits of sweeteners and sweetness enhancers ( S&Es) in the diet. Researchers will review evidence on long term benefits and potential risks involved in using sugar replacements in  the context of public health and safety, obesity, and sustainability.

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As part of this project the research team will also conduct a two-year randomised controlled trial, which will recruit over 600 adult and child participants with overweight or obesity from four European countries. The participants will undertake a two-month weight loss diet. During this period, they will be randomly assigned to one of two treatments:  either consuming food and drink with sweeteners or without (Source: University of Liverpool).

Full details of the research from the University of Liverpool