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OBESITY

By Calvin Cook,2014-05-20 16:53
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INFANT FEEDING. Why this matters. Human breast milk is fundamental to growth and good health and babies should not be introduced to solid food until 6

    OBESITY

Why this matters

This major health threat has crept upon us at national and international level.

    Obesity exposes us to far greater chances of illnesses such as diabetes, circulatory

    problems, arthritis and some cancers. Rising obesity levels in children affect their

    self-esteem and mobility and we are now seeing children with „maturity onset‟

    diabetes, usually a disease of adulthood. If we are to give the younger generations a

    decent legacy of health we have to act fast to reverse this rising trend.

Target

Childhood obesity To halt the year on year rise in obesity in children under age 11

    years.

    Obesity in Reception aged and Year 7 children, 1999-2006, Source: School Nurses, CHIPS dataset, Staffordshire Moorlands PCT.

Where are we with Children?

    25%

    20%

    15%

    Year 7Reception

    10%

    5%

    0%

    1999-002000-012001-022002-032003-042004-052005-06

There is some evidence that the increase has levelled off in older children (year 7).

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    26.4%25.2%

    24.9%25.1%

    29.8%28.5%

    31.4%31.3%

    Adult obesity (Community Strategy, Staffordshire Moorlands): To reduce the rate 30.6%29.5%of increase in obesity in those aged 15-74y, to a 0.5% pa percentage point increase. 32.5% 31.5%Where are we with Adults? 31.9%29.6%

    32.2%31.3%35%26.0%24.8%30%24.6%22.3%

    25%19.9%17.9%2003-420%13.8%2005-614.3%15%11.6%9.5%10%

    5%

    0%

    15-19y

    20-24y

     25-29yObesity by age group, from general practice data 2003-04 and 2005-06, SMPCT. 30-34yObesity is shown to have increased in most age groups. This measurement will be 35-39yrepeated in early 2007-08. 40-44y 45-49yStaffordshire Moorlands experienced an increase of 0.6% pa percentage points 50-54ybetween 2004 and 2006. This failed to meet the target we set with the local 55-59yauthority. 60-64y

    65-69yWhat’s been done?

    70-74y

    Grand TotalAcross both localities there is a well established information system for monitoring

    school children‟s height and weight. Schools are increasingly joining up to the National Healthy Schools Programme which includes action on physical activity and

    food. People are being referred to weight management programmes prior to elective

    surgery if they wish.

    In Staffordshire Moorlands Shaping Up a programme for Action on health

    inequalities prioritises action on obesity with community based action on physical

    activity and food. Newcastle under Lyme Sure Start is supporting new mums and the

    LPSA2 targets several schools in deprived areas.

What more should we do?

An overall coordinated approach addressing prevention and management in adults

    and children. This should include refining existing work on guidelines and care

    pathways, working with partners on access to healthy food, community based

    practical support for those wanting to lose weight, support to the Healthy Schools

    Programme and commissioning a specialist obesity service where required.

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    INFANT FEEDING

Why this matters

    Human breast milk is fundamental to growth and good health and babies should not be introduced to solid food until 6 months old. Children fed formula milk are more likely to develop health problems such as allergies and juvenile diabetes. Breast milk also helps the child‟s immune system develop and results in fewer childhood

    infections which also keep babies out of hospital so that he benefits are in both the short and long term. Mothers benefit too reducing their chances of osteoporosis and some cancers.

Target

    To increase breastfeeding initiation rates by 2% points per annum through the NHS Priorities and Planning Framework 2003 - 2006 focusing especially on women from disadvantaged groups.

Where are we?

    Current initiation rates are suspect as they do not reflect what we know is happening in the first weeks of life. At 2 weeks breastfeeding has increased from 41.94% in 2002-04 to 42.95 in 2004-06 financial years, which is an increase of 3.44% over two years, or 1.72%pa. This clearly is well below the national target.

What’s been done?

    Health visitors and midwives play a pivotal professional role in supporting and encouraging women. Peer support is also known to be critical. The introduction of infant feeding coordinators in Staffordshire Moorlands has seen a significant leap in the percentage of women still breast feeding at 6 weeks and 3 months. The development of the Infant Feeding Policy has been accompanied by other projects such breast feeding cafés, peer support training and a GP Infant Feeding Training package.

What more should we do?

    In both localities there is a need to audit services particularly in relation to antenatal education and information. Better data collection systems are needed to inform service developments.

    Recording of initiation is set to change with health visitors recording a retrospective initiation status at 2 weeks (this is already done but until now has not been captured electronically).

    Putting more resources into sustaining breastfeeding in the few who have already decided to do so is inefficient. The challenge in the coming months is to agree maternity services which realistically allow the time needed to encourage women to breastfeed through truly informing them of the benefits and risks associated with the

    various options, and supporting them through the first weeks of their child‟s life. This

    is where the greatest number of missed opportunities exist.

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    ADMISSION AVOIDANCE AND PROACTIVE CASE MANAGEMENT

Why this matters

From 2000 to 2005 hospital emergency admissions increased by exactly one third for

    the Staffordshire Moorlands population, a similar picture was seen in Newcastle

    under Lyme. In part, this was thought to be due to acute trusts meeting the 4 hour

    wait target for A&E. Those patients previously assessed and cared for in A&E were

    being admitted unnecessarily.

These admissions are costly, unnecessary in many cases, and distressing.

     A&E attenders spending no more than than 4 hours in A&E, England

    100%2001/022002/032003/042004/0595%

    90%

    85%

    80%

    75%

    70%

    SONDJFMAMJJASONDJFMAMJJASONDJFMAMJJASONDJFM

    Source: Prime Minister‟s Delivery Unit 2005.

    1600014746138521400012936115551200011066

    10000

    8000

    6000

    4000Unplanned Episodes2000

    02000-20012001-20022002-20032003-20042004-2005

Unplanned Admissions in Staffordshire Moorlands PCT 2000-05.

    Source: Clearnet.

Targets

Both PCT‟s signed up to Local Public Service Agreement targets (LPSA2)

    1) Heart failure emergency bed days saving of 196 bed days by March 2008

    (pro rata share of 1500)

    2) "All other" emergency bed days saving of 392 bed days by

    March 2008 (pro rata share of 3000)

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Where are we?

    9000030008350382163800007539175277244525007000021251932600002000500001500130340000

    30000100020000Total length of stay50010000

    00Total length of stay heart failure only2002-20032003-20042004-20052005-20062002-20032003-20042004-20052005-2006

The last data from the University Hospital of North Staffordshire, these showed that

    Staffordshire Moorlands to be on target with a similar picture for Newcastle under

    Lyme. Reducing bed days and admissions.

    What’s been done?

The evidence was not strong as to the best model to adopt. Community Matrons

    attached to practices that identified patients at risk of admission, or re-admission,

    using various predictive tools. They managed the long-term conditions of these

    patients (proactive case management), and in addition managed patients who were

    perceived as an admissions risk by other health professionals (interventions).

    Proactive case management is about the care of the whole person, social and

    medical a person who has been identified using evidence-based tools. Proactive case management and the interventionist approach were differentially adopted

    across the two PCT‟s.

The progressive introduction of community matrons allowed for a natural experiment

    and evaluation of the impact of different models and comparison with a control

    group in order to inform the next steps in service development.

What more should we do?

Decisions about what model of care to implement in the new PCT should be

    informed by the evidence of these evaluations. The new PCT should build on the

    best in relation to both proactive care and the interventionist models as

    demonstrated by audit.

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    SEXUALLY TRANSMITTED DISEASES

Why this matters

Sexually transmitted infections can lead to fertility and pregnancy problems, and also

    to some cancers. Certain infections may remain silent and other parts of the body

    may become involved. Diseases that had become rare such as syphilis are on the

    increase once more. Nationally and locally there has been a real rise in the numbers

    of cases of Chlamydia, syphilis, gonorrhoea and HIV.

Targets

National: All patients are to be seen within 48h of contacting a GUM clinic. Regionally,

    this is to be by the end of December 2007.

Where are we?

This has fluctuated between 26% and 52% from May 2005 and February 2006, and

    was on average below regional and national performance.

What’s been done?

There is an agreed Sexual Health Plan which covers both localities and teenage

    pregnancy targets have been met for both areas. The rising trend for gonorrhoea

    has been halted. Chlamydia screening for young people is already happening. „Clinic

    in a box‟ the mobile sexual health clinic for young people.

What more should we do?

Ensure that the action plan for achieving access to genitourinary medicine clinics

    within 48 hours is delivered and implemented. Audit progress against the sexual

    health plan. Better information including raising public awareness about the

    seriousness of the epidemic and also better information for parents to help their

    children. Getting the message across about safe sex and fewer partners.

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    RESPIRATORY DISEASE AND TOBACCO

Why this matters

In general smoking accounts for a third of all cancers and 90% of lung cancers in the

    population. It is the main cause of chronic obstructive pulmonary disease (COPD)

    which leads to a very poor quality of life. It is a major factor in circulatory disease. It

    also interferes with the growth of unborn babies and passive smoking damages the

    lungs of adults and children. In short it is the single most preventable cause of ill-

    health.

Targets

Reducing adult smoking rates (from 26% in 2002) to 21% or less by 2010, with a

    reduction in prevalence among routine and manual groups (from 31% in 2002) to

    26% or less.

Where are we?

    PCT‟s are performance managed on numbers of 4 week quitters. Historically both PCT‟s have performed well delivering well over target. Although the 5 year target is likely to be met performance is now beginning to wane.

What’s been done?

The Smoking Cessation Services have been highly successful achieving their targets

    of 4 week quitters and have been rated good to fair in a of assessments. There are

    „smoke free‟ policies in many local organisations including the NHS. Smoking

    cessation featured in the LPSA2 as a „stretch‟ target.

What more should we do?

Plans to implement smoke free public places (Health Act 2006) requires joined up

    action between Local Authorities and Smoke free Staffordshire Alliance. Smoking

    cessation services need to be promoted and delivered in a more diverse range of

    ways to reach out and engage more smokers. COPD services need to be improved.

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    PHARMACEUTICAL PUBLIC HEALTH

Why this matters

Research shows that:

? 94% of the population visits a pharmacy at least once a year

    ? Each adult visits a pharmacy on average 12 times a year

There are 1.8 million visits to pharmacies every day nationally for prescriptions,

    buying medicines and health advice. Of these, 260,000 visits each day are

    specifically for health advice.

From 1st April 2005, pharmacists have been working under new contractual rules of

    which public health is central.

Where are we

All pharmacies in the North Staffordshire PCT area provide a baseline of 'essential'

    services. Activities to be undertaken as part of each essential service and standards

    of delivery are benchmarked nationally. Those essential services relevant to public

    health that are provided by all community pharmacists in the North Staffordshire PCT

    area are:

? Signposting to appropriate health education and health promotion services,

    promoting important public health messages.

    ? Promotion of healthy lifestyles for people presenting prescriptions who have

    diabetes and coronary heart disease, or those who smoke or are overweight.

    Pharmacists have discussions with patients and customers about relevant health

    issues such as stopping smoking, reducing alcohol intake, nutrition and

    increasing physical activity.

    ? Support for self care - pharmacy staff support people, especially those with long

    term conditions, so they can better care for themselves and their families.

    ? Disposal of waste medicines community pharmacies will accept unwanted

    medicines from patients for safe disposal.

    What’s been done

Services are also provided in addition to „essential‟ services. Such services include

    the following:

? Medicines use review, pharmacists providing face to face medicines review with

    patients

    ? Smoking cessation support, providing support and nicotine replacement therapy

    to patients

    ? Substance misuse service, providing supervised methadone or subutex supply

    and a needle exchange scheme

    ? Emergency hormonal contraception service, where pharmacists can provide the

    „morning after pill‟ free of charge under a Patient Group Direction.

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What more should we do?

With the introduction of the new contract for community pharmacists, we have been

    handed the opportunity to further increasing services provided by from pharmacies.

    Any potential extension to the services our community pharmacies provide will need

    further assessment.

In the short term there is potential for:

? minor aliments and illnesses service

    ? targeted medication use review service

    ? medicines management support to nursing and residential homes.

In the longer term there is potential for:

    ? extension of any minor ailments scheme established, to include provision of

    medicines normally only available from prescribers by pharmacists via „patient

    group directions‟

    ? enhanced medication compliance scheme, helping patients to take their

    medicines regularly and at the correct time using monitored dosage aids. ? diagnostic testing (e.g. for diabetes)

    ? assessment of the currently piloted Medicines Reminder Initiative where patients

    have electronic devices fitted in their homes, prompting them to take their

    medicines.

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    ALCOHOL

Why this matters

    Thirty years ago deaths due to alcoholic liver disease were one seventh of those in Europe. While rates are falling in other European countries they are rising in England and this is matched by the trend in alcohol consumption. Excess drinking is associated with high blood pressure, depression amongst a host of other medical conditions. Equally importantly it is implicated in risk taking behaviour such as violent crime and unsafe sex, particularly among young people.

Targets

    Reduce the proportion of people consuming unsafe levels of alcohol (14 units per week for women and 21 units per week for men).

Where are we?

    Alcohol related admissions in Newcastle-u-Lyme PCT increased from just below 200 in 2001 to over 325 in 2005. The trend was downwards in Staffordshire Moorlands, from just over 100 in 2002 to under 80 in 2005. At present these are below the national average.

    The Regional Lifestyle Survey recorded self-disclosed drinking status and binge drinking among adults aged 18y and over. The proportion of drinkers who binged was lower in Staffordshire Moorlands than the West Midlands (38.2% compared to 39.3 but Newcastle-u-Lyme showed considerably higher binge drinking. In the sample of respondents, 45.1% of drinkers binged compared with 39.3% regionally.

What’s been done?

    Establishment of community addiction services to support those people with less severe alcohol dependency to be managed in a home setting. The LPSA2 features a target on preventive work with schools.

What more should we do?

    Improve surveillance systems in order to target interventions more effectively and share information between agencies. Continue to develop community based services and promote training in screening and the use of brief interventions for alcohol excess in primary care. Better integration between community and hospital services.

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