Journals Watch - Xanthelasma, dementia and obesity

Not had time to read the journals? Dr Alison Glenesk brings you up to date on the latest research.

Xanthelasma predicts the risk of MI, IHD, severe atherosclerosis and death in the general population (Photograph: SPL)

Xanthelasma, arcus corneae and risk of ischaemic disease
BMJ 2011; 343: d5497

This research included 12,745 Danish people aged 20-93 years, who were recruited for the Copenhagen City Heart Study between 1976 and 1978. Information regarding the presence or absence of arcus and xanthelasma was available for all participants, who were followed up for an average of 22 years.

At baseline, 4.4% had xanthelasma and 24.8%, arcus. After adjustment for age, sex and well-known cardiovascular risk factors, hazard ratios for xanthelasma were 1.48 for MI, 1.39 for IHD, 0.94 for ischaemic stroke, 0.91 for ischaemic cerebrovascular disease and 1.14 for death. The figures for arcus were not significant. Surprisingly, the increased risk for patients with xanthelasma was independent of their lipid profile. This suggests GPs should take the presence of xanthelasma seriously, even if the lipid profile looks normal.

Texting and non-attendance in an ophthalmology clinic
Scott Med J 2011; 56: 148-50

From time to time, we receive stern letters from hospitals regarding patients' non-attendance at their hospital appointment. This article was very interesting in its description of the use of technology to address this problem.

The study included 201 patients in Dunfermline, Fife, who were attending an ophthalmology clinic. Patients were sent a text message two weeks before their appointment. This appears to have reduced the 'did not attend' rate from 12% to 5.5%.

Criticisms of this study are that there is a reliance on historical data, rather than including a control group, and a rather long gap between the message and the appointment; it is possible that many of our non-attending patients will have booked and forgotten their appointment in this time period.

This is, however, a practical example of the numerous methods being piloted to try to increase the efficiency of appointment systems.

Quality of life of dementia patients in residential care
Dement Geriatr Cogn Disord 2011; 32: 39-44

There has been a great deal of criticism about residential care homes in Britain recently. In Japan, this interesting study used the quality of life in Alzheimer's disease assessment tool to assess patients in care.

The study, which was carried out between February 2009 and November 2010 in five residential homes in Japan, included 141 dementia patients with a mini-mental state examination score ≤24 and 74 professional caregivers. It did not include patients who were severely confused or disturbed.

The assessment tool, consisting of 13 items including health, energy, mood, family and friends, was administered to patients and caregivers.

The results showed that staff tended to underestimate patients' reported quality of life. The main determinants of quality of life were functional status and depression, suggesting that targeting these areas might be valuable in improving quality of life in dementia.

Obesity and physical activity in children aged seven to 10
Arch Dis Child 2011; 96: 942-7

The objective of this non-interventional cohort study was to determine whether inactivity leads to fatness, or vice versa.

The study, carried out in Plymouth, included 202 children aged seven to 10 years. More than half were boys and 25 per cent were overweight or obese. Physical activity was measured by accelerometers worn for one week annually. Body fat percentage was measured annually.

Body fat percentage was found to be predictive of changes in physical activity in the following three years, but changes in physical activity did not influence body weight.

This could explain why so far, addressing obesity by promoting activity has been ineffective. However, there was no attempt to influence activity here, which might have had different results.

Ultrasound screening for abdominal aortic aneurysm
Br J Surg 2011; 98(11): 1546-55

We appear to be screening for more conditions, so I was interested to see some preliminary work on screening for abdominal aortic aneurysm (AAA). The object of this health economics modelling study was to determine the cost-effectiveness of screening for AAA at 65 years in men in the Netherlands and Norway.

A model was developed to simulate various economic factors, such as life expectancy, quality-adjusted life-years, net health benefits and other data.

Additional costs of screening compared with no screening were EUR421 per person in the Netherlands, and the additional life-years were 0.097, equating to EUR4,340 per life-year. Figures for Norway were EUR562 and EUR9,860. The conclusion is that screening is highly cost- effective, although this study did not look at the costs once the condition has been detected.

Assessing the patient mix of GP trainees
Br J Gen Pract 2011; 61: 620-1

As a GP trainer, I was interested in this very practical study of the experience of some trainee family practitioners in the Netherlands.

The aim of this prospective cohort study was to describe the patient mix of GP trainees, including differences between firstand third-year trainees, and differences in presentation to males and females.

The study participants were 49 first and 24 third-year trainees, who were starting that period of training in 2008. Data were extracted from the electronic patient record for six months.

Third-year trainees saw significantly more patients aged 45-64 years than first-years. Respiratory and skin diseases were seen most often, while haematological, male genital and social problems were seen least. Female trainees, not surprisingly, saw twice as many female conditions as males.

As well as the actual results of this study, it provides a simple way of looking at trainees' experience and begs the question, can we influence it? The authors caution against this, advising that the relationship between patient mix and competence is complicated.

  • Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Discuss the association between xanthelasma and ischaemic vascular disease at a practice meeting.
  • Audit your 'did not attends' and identify the main reasons for non-attendance. Can you develop any strategies to reduce this?
  • If you are a training practice, look at the reported case mix of your trainees for two weeks and compare it with your own. Can you and should you do anything to influence this?

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