• Allogeneic pancreatic islet cell transplantation for type 1 diabetes mellitus
• Intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy
• Interstitial photodynamic therapy for malignant parotid tumours
• Perioperative hypothermia (inadvertent)
• Ulcerative colitis - infliximab
• Abatacept for the treatment of rheumatoid arthritis

Getting it right for people with cancer: what the voluntary sector wants from the cancer reform strategy from the Cancer Campaigning Group outlines the vision of the coalition, working together to improve and save lives. It sets out ambitious yet realistic proposals for how to significantly reduce mortality rates and current inequities in cancer care, and create a service designed around the person throughout their cancer journey.

Proposals include speeding up drug approval, more money for radiotherapy services and a possible clampdown on sunbeds and cigarette vending machines. Breast and bowel cancer screening programmes will also be extended as well as a greater focus on prevention.

The new issue of Journal of Epidemiology and Community Health is now available online. If you want to access the full text of the journal you’ll need your Athens password from the NHS (at the moment you’ll need one from Cheshire and Merseyside but from April this resource will be available nationally. If you don’t have an Athens password and are eligible you can get one here). Full contents of the Journal of Epidemiology and Community Health 2008 62(2) February

In this issue
Carlos Alvarez-Dardet and John R Ashton, Joint Edit
J Epidemiol Community Health 2008; 62: 89. [Extract] [Full text] [PDF]

“If you always do…”
JRA
J Epidemiol Community Health 2008; 62: 90. [Extract] [Full text] [PDF]

The subtle trade-off between personal freedom and social responsibility
Francesco Zambon
J Epidemiol Community Health 2008; 62: 90. doi:10.1136/jech.2007.065847 [Extract] [Full text] [PDF]

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)
R Ocaña-Riola, C Saurina, A Fernández-Ajuria, A Lertxundi, C Sánchez-Cantalejo, M Saez, M Ruiz-Ramos, M A Barceló, J C March, J M Martínez, A Daponte, and J Benach
J Epidemiol Community Health 2008; 62: 147-152. doi:10.1136/jech.2006.053280 [Abstract] [Full text] [PDF]

Adult education and child nutrition: the role of family and community
H Moestue and S Huttly
J Epidemiol Community Health 2008; 62: 153-159. doi:10.1136/jech.2006.058578 [Abstract] [Full text] [PDF]

Is leg length a biomarker of childhood conditions in older Chinese women? The Guangzhou Biobank Cohort Study
C M Schooling, C Q Jiang, M Heys, W S Zhang, X Q Lao, P Adab, B J Cowling, G N Thomas, K K Cheng, T H Lam, and G M Leung
J Epidemiol Community Health 2008; 62: 160-166. doi:10.1136/jech.2006.058917 [Abstract] [Full text] [PDF]

Fetal and childhood growth and the risk of violent and non-violent suicide attempts: a cohort study of 318 953 men
E Mittendorfer-Rutz, D Wasserman, and F Rasmussen
J Epidemiol Community Health 2008; 62: 168-173. doi:10.1136/jech.2006.057133 [Abstract] [Full text] [PDF]

The epidemiology of fractures in England
L J Donaldson, I P Reckless, S Scholes, J S Mindell, and N J Shelton
J Epidemiol Community Health 2008; 62: 174-180. doi:10.1136/jech.2006.056622 [Abstract] [Full text] [PDF]

Explaining the social gradient in long-term sickness absence: a prospective study of Danish employees
Karl Bang Christensen, Merete Labriola, Thomas Lund, and Mika Kivimäki
J Epidemiol Community Health 2008; 62: 181-183. doi:10.1136/jech.2006.056135 [Abstract] [Full text] [PDF]

Living and health conditions of Palestinian refugees in an unofficial camp in the Lebanon: a cross-sectional survey
J E Zabaneh, G C M Watt, and C A O’Donnell
J Epidemiol Community Health 2008; 62: 91-97. doi:10.1136/jech.2006.054338 [Abstract] [Full text] [PDF]

Reducing ambient levels of fine particulates could substantially improve health: a mortality impact assessment for 26 European cities
Ferran Ballester, Sylvia Medina, Elena Boldo, Pat Goodman, Manfred Neuberger, Carmen Iñiguez, Nino Künzli, and on behalf of the Apheis network
J Epidemiol Community Health 2008; 62: 98-105. doi:10.1136/jech.2007.059857 [Abstract] [Full text] [PDF]

Perceived health change in the aftermath of a petrochemical accident: an examination of pre-accident, within-accident, and post-accident variables
M K Peek, M P Cutchin, D H Freeman, N A Perez, and J S Goodwin
J Epidemiol Community Health 2008; 62: 106-112. doi:10.1136/jech.2006.049858 [Abstract] [Full text] [PDF]

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa
J R Hargreaves, L A Morison, J C Kim, C P Bonell, J D H Porter, C Watts, J Busza, G Phetla, and P M Pronyk
J Epidemiol Community Health 2008; 62: 113-119. doi:10.1136/jech.2006.053827 [Abstract] [Full text] [PDF]

Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case–control study
S Palma, R Perez-Iglesias, D Prieto, R Pardo, J Llorca, and M Delgado-Rodriguez
J Epidemiol Community Health 2008; 62: 120-124. doi:10.1136/jech.2006.052985 [Abstract] [Full text] [PDF]

Prevalence of overweight and obesity in East and West German children in the decade after reunification: population-based series of cross-sectional studies
C J Apfelbacher, J Cairns, T Bruckner, M Möhrenschlager, H Behrendt, J Ring, and U Krämer
J Epidemiol Community Health 2008; 62: 125-130. doi:10.1136/jech.2007.062117 [Abstract] [Full text] [PDF]

Preventing disability through understanding international megatrends in Deaf bilingual education
I M Munoz-Baell, C Alvarez-Dardet, M T Ruiz, R Ortiz, M L Esteban, and E Ferreiro
J Epidemiol Community Health 2008; 62: 131-137. doi:10.1136/jech.2006.059378 [Abstract] [Full text] [PDF]

Medical illness, medication use and suicide in seniors: a population-based case–control study
D C Voaklander, B H Rowe, D M Dryden, J Pahal, P Saar, and K D Kelly
J Epidemiol Community Health 2008; 62: 138-146. doi:10.1136/jech.2006.055533 [Abstract] [Full text] [PDF]

Coronary heart disease epidemiology: from aetiology to public health, 2nd ednChildhood cancer in Britain
Alberto Izzotti
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2006.045831 [Extract] [Full text] [PDF]

Childhood cancer in Britain
Kathrine Carlsen
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2007.064709 [Extract] [Full text] [PDF]

If you need any training in using this or any other electronic resource and you work for Liverpool PCT use the contact form below to contact the library.

Food: an Analysis of the Issues, a report from the Cabinet Office suggests that up to 70,000 lives could be saved every year if people improved their diets.  One in ten premature deaths would be prevented if Britons reduce the amount of salt, sugar and fat they eat, it was claimed. And people are digging an early grave for themselves by not eating enough fruit, vegetables, fibre or oily fish, according to a report by the Cabinet Office.  The risk from cancer and heart disease from poor diet is unrelated to the current rise in obesity.

Excess cancer mortality and incidence by PCT in the North West, 2001-2005   a report from the  North West Cancer Itelligence Service states that over a thousand more people die from cancer every year in the North West – who wouldn’t have died if the region had the same rates death rates as the rest of the country. The great majority of these deaths are caused by lung cancer highlighting the links between cancer, smoking and deprivation.

There are 1334 excess deaths annually in the North West than would be expected if the cancer death rates were the same as the rest of the country. 60% of these are due to lung cancer with the rest being down to deaths from many different types of cancer. Cancer deaths in the North West are 8.5% higher for men and 6.7% higher for women than in England and Wales.

The comparison focuses on excess mortality for the most common cancers between 2001 and 2005. Excess mortality is the additional number of cancer deaths above what would be expected using England and Wales rates.

These reports summarise progress against Department of Health inequality targets for 2010.

Infant mortality report

The inequality gap in the infant mortality rate has reduced but not yet by a sufficient amount to meet the target, based on the trend since the current socio economic classifications were introduced in 2001.

Life Expectancy Report

Inequality gaps in male and female life expectancy at birth have both increased since the baseline. If current trends continue, the target would not be met.

Mortality Report

Cancer mortality

The inequality gap in cancer mortality has declined since the baseline and the minimum requirement for the 2010 target has already been met.

All circulatory diseases mortality

The inequality gap in circulatory disease mortality has declined, and is on track to meet the target.

The NHS has improved dramatically over the last few years, but still cannot guarantee that basic minimum standards are being met for patients throughout England and Wales, according to State of Heatlhcare 2007: Improvements and challenges in services in England and Wales. More than a quarter of NHS hospitals failed to provide adequate emergency services for children and 48% could not provide children with a satisfactory service in outpatient clinics, the Healthcare Commission said in its annual report on the state of the nation’s healthcare.

Key findings are:

The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.

• Men are living over four years longer than they were 20 years ago, while women are living three years longer.
• Men from more deprived areas live for a decade less than those in wealthier areas. Looking at local authority areas, for example, Kensington and Chelsea has the highest life expectancy for both men and women, at 82.2 years and 86.2 years respectively. The lowest life expectancy for men is in Manchester at 72.5 years, and for women in Liverpool at 78.1 years.
• In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).

Patients are positive about hospital services overall but some organisations perform poorly. Beneath the headline figures there are concerns about aspects of care such as dignity and privacy.

• National analysis of the Commission’s survey of 80,000 inpatients at acute hospital trusts shows that 89.2% (149) were ranked “satisfactory” on patient experience, 7.8% (13) were “below average” and 3% (5) were “poor”. Eleven of those in the latter two groups were rated as “below average” or “poor” for the second year running. The survey also shows concern about specific issues such as help with eating - one in five patients who wanted help eating did not get it.
• Almost a third of the complaints about hospitals referred to the Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care. They included: patients left in soiled bedding and clothing; no regular baths or showers or oral hygiene; inappropriate or inadequate clothing.

There have been dramatic improvements in waiting times but there are hidden waits for some services, which are not measured and therefore difficult to address.

• Government standards say no patient should wait longer than 26 weeks for a hospital appointment. In 2006/07, 83% of trusts met this, leaving some 350 patients with longer to wait than 26 weeks. This is a vast improvement on figures for 2000 when 264,000 patients waited this long.
• Waiting time targets do not apply fully to some services, making it difficult for problems to be addressed and patients needs to be met. Evidence suggests that a two-year wait for those referred for psychological therapies is not uncommon. People in some areas are still waiting between 12 and 24 months to have hearing aids fitted.

NHS trusts are performing better overall on quality of services, but the performance of primary care trusts (PCTs) has declined, with many not getting to grips with the needs of their communities so as to provide services to match.

• Overall, the quality of NHS services is improving with 46% of trusts rated ‘excellent’ or ‘good’ in 2006/07, compared to 40% in 2005/6. But for PCTS, only 26% were ‘excellent’ or ‘good’ in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance.
• The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.
• The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity. The number of people diagnosed with heart failure is also considerably less (140,000) than expected, indicating that GPs may not be picking up on signs of serious illness. There is also a poor understanding of the sexual health of local populations at a time when sexually transmitted infections are rising rapidly.
• Where there is a known need, PCTs are not always providing the services required. Some 60,000 people with serious long-term conditions did not get the care from community matrons that was originally planned. Forty-one per cent of PCTs failed to purchase sufficient crisis services for people who are seriously mentally ill, resulting in 5,000 fewer people receiving the service than planned. Some 85% of PCTs did not have arrangements for providing education programmes for patients with diabetes in their area. And 2,000 GP practices did not fulfil their PCT’s plans to establish registers for those people at risk of coronary heart disease, designed to help prevent these patients from becoming seriously ill.

There is progress towards a stronger culture of safety and grounds for cautious optimism in reducing healthcare-associated infection. But trust boards need to show stronger leadership.

• On safety more generally, there has been an encouraging increase in reporting of incidents. Reported figures show more than 229,000 known incidents causing low or moderate harm and more than 9,400 incidents causing severe harm or death.
• Only 58% of NHS trusts complied with all the government’s nine core standards on safety, with infection control, decontamination of medical devices and medicines management the biggest areas of concern.
• Infection control is arguably of greatest public concern; latest figures suggest grounds for cautious optimism. Cases of MRSA fell from 7,096 in 2005/2006 to 6,381 in 2006/2007. There are early signs that increases in cases of Clostridium difficile are slowing. Between 2005 and 2006 the number of cases increased 7% to 55,620, compared to a 16% rise from 2004 to 2005.
• By the end of October 2007 the Commission had visited 87 trusts to check their performance in meeting the requirements of the hygiene code. Only one trust needed to be issued with an improvement notice, suggesting that organisations are taking the issue seriously. But there was a need for stronger leadership from trusts’ boards to improve monitoring, isolation facilities, training, and compliance with policies and procedures.

New figures show that more independent healthcare providers meet core standards, mirroring a similar trend among NHS trusts. But there are concerns about compliance among independent providers of mental healthcare.

• The proportion of independent healthcare establishments that met the government’s national minimum standards - including those that were not inspected as they were considered not to be at risk - was 63% in 2006/07 compared to 50% the year before. Five per cent of independent establishments failed five or more of the standards.
• Although NHS trusts must meet a different set of standards, the broad picture is similar. The number of trusts that were “fully met” on government core standards rose from 49% in 2005/06 to 55% in 2006/07. Six per cent of trusts were judged “not met” on core standards overall.
• In the independent sector, non-compliance was greatest on national minimum standards covering: monitoring of quality of treatment (C4); ensuring patients get care from appropriately recruited, trained and qualified staff (C9); and taking account of patients’ views (C6).
• Independent mental health providers, which mostly look after NHS patients, performed worse than others in the sector. Non-compliance was greatest in relation to national minimum standards for: ensuring patients receive care from appropriately recruited, trained and qualified staff (C9); providing treatment in safe and appropriate premises (C17); and ensuring patients are resuscitated appropriately (C27).
  Independent providers of mental health services need to focus on ensuring patients are appropriately and safely restrained. In 2006/7, 17% of establishments failed a standard in this area compared with under 9% in 2005/2006.

The NHS often fails to meet the needs of children and young people and there are concerns about other groups requiring specialist care, such as people with mental health problems and with learning difficulties.

• Paediatric hospital services are generally good at looking after children, but other more general services are not. Some 70% of specialist inpatient services were rated “good” or “excellent” by the Commission, but 28% of emergency and day case services were “weak”. Transition from children to adult services is not managed well in services for people with mental health problems, diabetes and disabilities, and those requiring palliative care services. Vulnerable children such as those with disabilities, those in care and young offenders face particular problems in getting appropriate care. One in 20 NHS trusts are not yet compliant with child protection standards.
• On specialist wards for people with mental health problems and people with learning difficulties, more than half of the inpatients were found to be in mixed-sex accommodation.
  Levels of violence in mental health services remain high, although there are signs of it being dealt with better. The report includes new data from an audit into violence in the sector, which found that almost one in 20 patients reported being assaulted. Forty-six per cent of nurses reported being physically assaulted, and 72% said they had been threatened or made to feel unsafe. On older people’s mental health wards, almost two-thirds of nurses reported physical assault by patients.

There have been dramatic improvements in responding to the big killers - cancer, circulatory and respiratory disease - but five-year survival rates for cancer, and mortality rates for respiratory disease, are worse than in other comparable countries.

• The mortality rate for people under 75 diagnosed with cancer fell by almost 17% between 1996 and 2005, which suggests that some 60,000 fewer people died prematurely.
• Despite this improvement, the UK survival rates do not compare favourably with most of Europe. For instance, the survival rate for lung cancer in Holland and Spain is around double that in England, which stands at 6.5% for men and 7.6% of women.

The Cancer Reform Strategy builds on the progress made since the publication of the NHS Cancer plan in 2000 and sets a clear direction for cancer services for the next five years. It shows how by 2012 our cancer services can and should become among the best in the world.

Associated documents

• What the Cancer Reform Strategy means for patients

• Powerpoint presentation

• Glossary

• Cancer Reform Strategy Impact Assessment
  

• Cancer Reform Strategy Equality Impact Assessment

• National Institute for Health and Clinical Excellence products for cancer

• 15 ‘CRS Visions - Annex A-O’

Mass media stories relating to this strategy can be found for 3rd December, 4th December here, both from Fade the Blog.

This report from the think tank Civitas, uses the concept of avoidable mortality to analyse the NHS’ performance on the biggest ‘killers’, cancer and circulatory disease, focusing on the years 1999-2005. Real improvements have been made, and that performance has compared quite favourably with other European countries of comparable development.

Two concerns identified in Just how well are we? A glance at avoidable mortality from cancer and circulatory disease in England & Wales are:

1. The rate of improvement in avoidable cancer mortality has fallen since 1999.
2. Avoidable mortality from circulatory disease remains high.

Just in time modules on BMJ Learning give you fast, evidence based updates? They go through the essentials on everyday conditions. Just added to BMJ Leanring is the

Whooping cough: a guide to diagnosis, treatment, and prevention

module.

Alternatively why not undertake one of the modules on pain:

Palliative care in the community

Common migraine: how to treat an attack

The role of opioids in cancer pain: an up to date guide

Shingles: diagnosis and management of herpes zoster and postherpetic neuralgia

To use BMJ Learning you’ll need your Athens password from the NHS. (If you work in the North West and don’t have an NHS Athens Password this link will let you apply for one)

If you need training in the use of electronic resources and you work for Liverpool PCT use the contact form below to contact the library.

A third of cancers are caused by diet and lack of exercise and could be prevented, according to Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective, which urges people to stay slim and abstain from too much fast food, red meat and preserved meat such as ham and bacon, and alcohol. The report from the World Cancer Research Fund, is the most authoritative overview of the role that food, drink, obesity and exercise play in causing cancer. Lifestyle could play almost as big a role as stopping smoking in preserving us from disease and that being fat is a big risk for cancer.

The mass media have been busy reporting on the report, 1st November, 2nd November, 4th November.

The Health profile of England 2007 provides a collation of national and regional data to provide a baseline against which people can compare data from their own Local Health Profile (LHP). The 2007 report updates tables showing regional comparisons and national trends for indicators presented in LHP, as well as a wide ranging snapshot of public health and well-being in England and a section on international comparisons.

• A general improvement in health outcome
  The report shows recent improvements in a number of critical areas, e.g.:
  • declining mortality rates in targeted killers (cancers, all circulatory diseases and suicides)
  • increasing life expectancy, now at its highest ever level
  • reducing infant mortality, now at its lowest ever level

Challenges remain to achieve and sustain progress, e.g.:
• rising rates of diabetes

• Similarly for the determinants of health,
  • Improvements in some important areas, e.g.:
  • the number of people who smoke
  • quality of housing stock
  • Areas of concern, e.g.:
  • increasing levels of obesity in adults and children
  • high levels of teenage pregnancy
• Health inequalities are often present
  • The report illustrates various geographical inequalities across the UK
• International comparisons give a wider context presenting national progress in comparison to countries of the European Union (EU), or to the 15 countries that were members of the EU prior to 2004 (EU-15), e.g.:
  • Premature mortality rates from the two biggest killers, circulatory diseases and cancer, are reducing faster in England than the average for the EU
  • Death rates from motor vehicle traffic accidents in the United Kingdom are amongst the lowest in EU
  • The prevalence of obesity in England is the highest in the EU
  • Death rates for chronic liver disease and cirrhosis have risen markedly, particularly since the mid-1990s, and for females, latest data show England has risen above the EU-15 average
  • The percentage of all live births to mothers under age 20 in the United Kingdom remains the highest when compared to other EU-15 countries.

You can see the mass media’s take on this report on 23rd October 2007.