Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study

Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period.

Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample.

Methods: socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded.

Analyses: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease.

Results: for every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44–0.91, P = 0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04–2.68, P = 0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98–2.05, P = 0.045) were associated with diagnoses of more new diseases.

Conclusion: physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development.

Attitudes to and use of complementary medicine among physicians in the United Kingdom

OBJECTIVES

To evaluate the use of attitudes to complementary and alternative medicine (CAM) among UK physicians.

DESIGN

Postal questionnaire.

SUBJECTS

All Members and Fellows of the Royal College of Physicians.

RESULTS

Twelve thousand, one hundred and sixty eight Members and Fellows were surveyed and a response rate of 23% (n = 2,875) was obtained. Responses from the small numbers of general practitioners (n = 127) were not included in the analyses, resulting in a sample size of 2,748: 79% of respondents were in NHS practice, 32% of respondents practised CAM themselves, and 41% referred patients to CAM; of those who referred patients, 78% referred between 0-3 patients per month. CAM is used by physicians more frequently in private as compared to NHS practice. Acupuncture, aromatherapy and manipulative medicine (osteopathy and chiropractic) are the most commonly referred to and the most commonly practised therapies. Eighty seven percent of those using CAM themselves, or as part of their clinical team's commitment, had not had any CAM training. Attitudes to CAM were generally positive, particularly among those in palliative care, rehabilitation, nuclear medicine, and genito-urinary medicine.

CONCLUSIONS

Our conclusions must be tempered by the limited response rate, but assuming all non-responders were disinterested in CAM, then at least one in ten UK specialist physicians are actively involved in CAM treatments, although only 13% of our sample had received any CAM training.

The Bristol shared care glaucoma study: outcome at follow up at 2 years

AIM

To examine the outcome of care for patients with glaucoma followed up by the hospital eye service compared with those followed up by community optometrists.

METHODS

A randomised study with patients allocated to follow up by the hospital eye service or community optometrists was carried out in the former county of Avon in south west England. 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied. The mean number of missed points on visual field testing in the better eye (using a "better/worse" eye analysis) in each group were measured. The visual field was measured using the Henson semiautomated central field analyser (CFA 3000). Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. The mean number of missed points on visual field testing in the worse eye, mean intraocular pressure (mm Hg), and cup disc ratio using a "better/worse" eye analysis in each group at 2 years were also measured. Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. An analysis of covariance comparing method of follow up taking into account baseline measurements of outcome variables was carried out. Additional control was considered for age, sex, diagnostic group (glaucoma suspect/established primary open angle glaucoma), and treatment (any/none).

RESULTS

From examination of patient notes, 2780 patients with established or suspected glaucoma were identified. Of these, 752 (27.1%) fulfilled the entry criteria. For hospital and community follow up group respectively, mean number of missed points on visual field testing at 2 year follow up for better eye was 7.9 points and 6.8 points; for the worse eye 20.2 points and 18.4 points. Similarly, intraocular pressure was 19.3 mm Hg and 19.3 mm Hg (better eye), and 19.1 mm Hg and 19.0 mm Hg (worse eye); cup disc ratio at 2 year follow up was 0.72 and 0.72 (better eye), and 0.74 and 0.74 for hospital and community follow up group respectively. No significant differences in any of the key visual variables were found between the two groups before or after adjusting for baseline values and age, sex, treatment, and type of glaucoma.

CONCLUSIONS

It is feasible to set and run shared care schemes for a proportion of patients with suspected and established glaucoma using community optometrists. After 2 years (a relatively short time in the life of a patient with glaucoma), there were no marked or statistically significant differences in outcome between patients followed up in the hospital eye service or by community optometrists. Decisions to implement such schemes need to be based on careful consideration of the costs of such schemes and local circumstances, including geographical access and the current organisation of glaucoma care within the hospital eye service.

The Bristol Shared Care Glaucoma Study--validity of measurements and patient satisfaction

BACKGROUND

The aims of the study were to determine (1) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and (2) patient satisfaction with follow-up by community optometrists.

METHODS

A randomized study was carried out in the former county of Avon in South West England with patients allocated to follow-up by the hospital eye service or by community optometrists. The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria. The main outcome measures were 91) measurements of key visual parameters (intraocular pressure, visual fields and cup/disc ratio) made by hospital eye service and community optometrists, compared with a research clinic reference standard at baseline, and (2) patient satisfaction at baseline and at six months.

RESULTS

Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service. Patients were significantly more satisfied with a number of aspects of care provided by community optometrists, particularly those relating to waiting times, compared with those from the hospital eye service.

CONCLUSIONS

Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service. Follow-up by community optometrists is acceptable to patients. The costs of each option are reported elsewhere.

Role of epidermal growth factor and transforming growth factor alpha in the developing stomach

AIMS

To determine whether epidermal growth factor (EGF) or the related transforming growth factor alpha (TGF alpha) may have a role in the developing human stomach; to substantiate the presence of EGF in human liquor in the non-stressed infant and whether EGF in amniotic fluid is maternally or fetally derived.

METHODS

The temporal expression and localisation of EGF, TGF alpha, and their receptors during fetal and neonatal life were examined in 20 fetal and five infant stomachs. Simultaneously, samples of amniotic fluid and fetal urine from 10 newborn infants were collected and assayed for EGF by radioimmunoassay.

RESULTS

EGF immunoreactivity was not noted in any of the specimens examined. In contrast, TGF alpha immunoreactivity was shown in mucous cells from 18 weeks of gestation onwards. EGF receptor immunoreactivity was seen on superficial mucous cells in gastric mucosa from 18 weeks of gestation onwards. The median concentration of EGF was 30 and 8.5 pg/ml in amniotic fluid and fetal urine, respectively, suggesting that EGF is not produced by the fetus.

CONCLUSIONS

This study adds weight to the hypothesis that swallowed EGF, probably produced by the amniotic membranes, and locally produced TGF alpha, may have a role in the growth and maturation of the human stomach.

Purchasing evidence: the corollary of evidence-based purchasing

The National Health Service (NHS) market led to problems in funding research and development (R&D). The current policy is to resolve these by funding R&D through a national levy on purchasers. The policy does not, however, address the underlying problem that evidence produced by R&D is largely irrelevant to purchasers. The consequences of this policy are likely to be that purchasing will have limited impact in securing health gain most effectively, the progress and impact of R&D will be impaired, and its funding will remain insecure. If R&D and purchasing were integrated each could become more effective. This integration can be fostered through developing the regulation of purchasers and providers within the NHS market.

The Bristol Shared Care Glaucoma Study: study design

The purpose of this study was the evaluation of community based optometric monitoring of stable glaucoma patients and glaucoma suspects compared to the routine Hospital Eye Services (HES) monitoring. Four hundred and five subjects were recruited from routine outpatient clinics at the Bristol Eye Hospital. All eligible participants were seen in the routine hospital clinic and then within two months were given a 'Gold Standard Assessment' (GSA) by an independent research team. Participants then visited one of 12 glaucoma-trained optometrists, for a standard battery of tests. Randomisation resulted in 204 subjects being allocated to community care, with reviews on a six monthly basis, with 201 who remained a control group within the hospital. Referral criteria were established to enable optometric detection of apparent glaucomatous progression. A questionnaire was used to assess patient satisfaction with both care types. Additionally a cost analysis exercise was performed.

Appropriateness of hospital utilization. The validity and reliability of the Intensity-Severity-Discharge Review System in a United Kingdom acute hospital setting

Assessing the appropriateness of hospital utilization in the United Kingdom may yield practical solutions to problems faced by both purchasers and providers of health care in the National Health Service. It is, however, essential that such assessment is based on a method that is both valid and reliable--in particular, valid in the context in which it is applied. Whereas American methods for the assessment of appropriateness have been shown to be valid in the United States, it is pertinent to question whether the application of such methods to the National Health Service also is valid given the different circumstances, both cultural and financial, under which health care is provided. A study of the appropriateness of admission and hospital stay for a sample of admissions to a large acute hospital in the United Kingdom was carried out, and the assessment of appropriateness was made using the Intensity-Severity-Discharge Review System with Adult criteria (ISD-A). The validity and reliability of using the ISD-A for assessing hospital utilization in the United Kingdom was evaluated. The ISD-A was found to have high reliability and to be valid for assessing appropriateness in the United Kingdom when a full range of alternative forms of care are presumed to be available. It was not found to be valid currently, therefore, for routine assessment of hospital utilization within the National Health Service, when alternatives often are not available.

Risk factors for giardiasis: a case-control study in Avon and Somerset

Giardia lamblia is a common and increasing cause of gastrointestinal illness in the UK. We report a case-control study that examined risk factors for giardiasis. Patients with giardiasis were identified from reports to the Consultants in Communicable Disease in Avon and Somerset, and age-sex matched controls were obtained from their general practitioners' lists. Details of travel history, water consumption and recreational water use were collected by postal questionnaire. Over the period July 1992 to May 1993, 74 cases and 108 matched controls were obtained. The data were analysed using conditional logistic regression. Swimming appeared to be an independent risk factor for giardiasis (odds ratio 2.4, 95% CI 1.0 to 6.1, P = 0.050). Travel (P = 0.001), particularly to developing countries, and type of travel (P = 0.004)--that is, camping, caravanning or staying in holiday chalets--were also observed to be significant risk factors. Other recreational water use and drinking potentially contaminated water were found to be not statistically significant after adjustment for other factors.

Hepatitis C (HCV)-positive blood donors in south-west England: a case control study

The aim of this study was to compare the socio-demographic characteristics and risk factors in anti-HCV positive blood donors with those of matched controls. The participants were 50 hepatitis C antibody (HCV) positive blood donors and 50 matched blood donors with no evidence of HCV infection, who gave blood to the South Western Transfusion Centre between November 1991 and July 1992. A confidential structured interview was conducted to collect socio-demographic data and to elicit information on risk factors for HCV. Measurements were made of the prevalence of risk factors and socio-demographic characteristics in cases and controls. The main results were that 45 of the 50 cases could have been exposed to HCV by previous intravenous drug abuse (IVDA), blood transfusion or medical employment. Cases were significantly more likely to have a history of IVDA, tattooing or of medical employment than matched controls. Cases with no history of IVDA were significantly more likely to have had a blood transfusion. The key conclusions to emerge are that current policies are ineffective at excluding those with a history of IVDA from the donor pool. Consideration should be given to the introduction of a policy of direct confidential questioning about risk factors for all donors, or, at a minimum, the use of a questionnaire.

Dose-response in an outbreak of non-bacterial food poisoning traced to a mixed seafood cocktail

An outbreak of non-bacterial food poisoning presumed due to small round, structured viruses (SRSV) occurred at a national conference. A detailed postal survey of all conference attenders was carried out to ascertain the cause of the outbreak and 355 questionnaires were returned. Univariate analysis showed that mussels in the seafood cocktail were the likely vehicle of infection. A dose-response relationship between the amount of seafood cocktail consumed and the risk of illness was demonstrated. Dose-response has not previously been documented in a food-borne outbreak due to small round structured virus. Detailed quantitative food histories can be useful in eliciting dose-response relationships and may be crucial in establishing the vehicle of infection when investigating food poisoning following consumption of a set-menu meal. Their use should be considered in other outbreak situations.

Fish tank granuloma

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Simplified techniques for identifying Campylobacter pyloridis

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