Age, gender and deprivation in diabetes
J R Soc Med 2006; 99: 576–81
This is a large study involving 34 practices in south-west London with 6,035 patients with diabetes out of 201,572 registered patients. It was a purely electronic study measuring the success rates for diabetes quality indicators.
Not surprisingly the study identified large variation in diabetes management between practices. But what I found surprising was the poorer recording of quality care in younger people. Perhaps this is to be expected since it is harder to capture this age group (18–44 years old). Also, this group was found to have poorer glycaemic control, higher levels of cholesterol and lower BP.
Neither gender nor socioeconomic deprivation appeared to affect management. The main weakness of the study is that it covered a period in 2003 which was before the quality framework was introduced.
How to reduce non-attendance in practice
Fam Pract 2006; 23: 699–705
This Malaysian study sought to investigate the effectiveness of text messaging reminders to improve attendance in primary care. The use of text messaging and mobile phone calls to remind patients of their appointment was evaluated.
A total of 993 patients with an appointment were randomised to either a text message or mobile phone reminder 24 to 48 hours before their scheduled appointment. A control group did not receive any intervention.
The attendance rate of the text messaging reminder group was significantly higher compared to the control group (59 per cent and 48.1 per cent respectively). However, there was no significant difference between text message and mobile phone call reminders (59 per cent and 59.6 per cent respectively).
The cost of text messaging reminders was much lower than that of mobile phone call reminder.
Unintended pregnancy and emergency contraception
Lancet 2006; 368:1,782–7
Of 907 women attending an Edinburgh hospital for termination of pregnancy, 89.7 per cent had an unintended pregnancy. Also of the 2,908 women attending the same hospital for antenatal care only 8.6 per cent had an unintended pregnancy and 65.6 per cent were intended pregnancies.
Use of emergency contraception was low. Only 12 per cent of those requesting a termination had used emergency contraception.
However, the study fails to address what the figures would have been without emergency contraception. Was there a much larger number group of women who avoided termination by using emergency contraception? Only 1 per cent of women continuing with their pregnancy had used emergency contraception.
The paper argues the case that with the uptake of emergency contraception so low it is not going to have an impact upon unwanted pregnancy rates.
Effect of physical activity on the weight of young children
BMJ 2006; 333; 1,041–3
This Scottish study aimed to assess whether a physical activity intervention reduces BMI in young children. To do this, 545 children in 36 nurseries (mean age 4.2 years) were encouraged to participate in an enhanced physical activity programme (three 30-minute sessions a week for 24 weeks) plus home-based health edu-cation and increased physical activity through play.
The study compared nurseries of similar profile with one another. The outcome was compared at six and 12 months, at which point no significant effect on physical activity, sedentary behaviour or BMI was observed. However the participants’ motor skills did improve.
Dr Lewis is a GP in Windsor, Berkshire and a member of our team who regularly review the medical journals
Research of the week
Condoms for teenagers
J Fam Plann Reprod Health Care 2006; 32: 219–26
The use of condoms is widely promoted, but where do young people obtain them?
Semi-structured in-depth interviews and a questionnaire found that, in Manchester, family planning clinics and vending machines were the main sources — the former for females and the latter for males. Knowledge on access to condoms was variable. It was felt that advice on accessing condoms should be more readily available.
Younger people preferred a semi-private place, such as a park, school toilet or shopping mall. Older teenagers and those in their early twenties were happy to buy condoms at a pharmacy or from a vending machine in a pub or club.