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Non-communicable diseases

Collette Isabel Stadler: How poor provision of mental health services adds to the risk burden for children in care

26 Jul, 16 | by BMJ

If you are a 65 year old male smoker with hypertension, hyperlipidaemia, and a family history of cardiovascular disease, the QRISK calculator informs a physician that your chances of having a heart attack in the next 10 years are 47%. Health professionals leap into risk modification and disease prevention mode; you are referred to smoking cessation programmes, offered dietary and lifestyle help, and prescribed statins and antihypertensives. The approach is aggressive and holistic. I am proud of the UK’s approach to physical illness prevention on all levels.

If you are a 13 year old child in state care, your chance of having a significant mental health problem during adolescence is 49%, yet this is not always a catalyst for action.  more…

Samir Dawlatly: Who are the casualties of the battle against cancer?

25 Jul, 16 | by BMJ

The NHS is expected to find efficiency savings of £22 billion over the next four years or so. As well as implementing new structures and coping with the potential financial fallout from Britain’s exit from the EU, it is also expected to perform better in many sectors in terms of health outcomes. One such area is cancer diagnosis, treatment, and survival.

Assuming that cancer statistics between European countries are comparable and equally valid, then the UK is a consistently poor performer when it comes to cancer care. There is a drive for earlier diagnosis and treatment in the hope and belief that it will improve survival. more…

John Middleton: Why is there acute hunger in the UK and what is to be done about it?

19 Nov, 15 | by BMJ

john_middleton_2015Every day family doctors face the struggle of being custodians of entitlement to food bank help and backstops for the failures of the welfare system, while at the same time wanting to do their best for their patients, which in extreme cases means getting them something to eat.

This same uncomfortable tension is played out in food banks across the country: how to respect and celebrate the humanity and hard work of food bank volunteers, yet at the same time say this is not a service we should expect to operate in one of the richest countries in the world, which, until now, had a tradition of safety net welfare provision. more…

Bheemaray Manganavar: Managing hypertension and diabetes in resource poor settings

5 Nov, 15 | by BMJ

Bheemaray Manganavar_2015According to the Diabetes Atlas 2006, the number of people with diabetes in India is currently around 40.9 million and is expected to rise to 69.9 million by 2025. Similarly, 118 million people were estimated to have high blood pressure in the year 2000, which is expected to go up to 213 million in 2025.

To address this situation, the Indian government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS). The programme was piloted in 100 districts (of the 646 districts in India) during 2010-12. more…

George Thomas: Diabetes mellitus—the need for better terminology

4 Nov, 15 | by BMJ

george_thomasDiabetes is a global health concern. However, the term “diabetes” connotes archaic concepts and needs to be reviewed. The ancient Greek physician Aretaeus of Cappadocia is often recorded as the first person to use the term “diabetes” (meaning “excessive discharge of urine”) in the first century CE. Later, the word “mellitus” (sweet) was added by Thomas Willis in 1674 after he noted the sweetness of patients’ urine and blood.

However, it was only about 100 years ago that some treatments for diabetes came into existence, with the real advances in the understanding and treatment of diabetes emerging only in the past 50 years. Considering this, it is quite inappropriate to cling on to the atavistic diagnostic term “diabetes mellitus more…

Richard Smith: How well are countries doing in responding to the NCD pandemic?

18 Sep, 15 | by BMJ

richard_smith_2014A pandemic of NCD (non-communicable disease) is sweeping across the world, particularly in poor countries, causing much suffering and premature death and swamping health systems. NCD (cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and common cancers) accounts for 63% of global deaths (37 million annually), with 80% occurring in low and middle income countries. Almost a third of deaths from NCD in poor countries are in those under 60.

Recognising the scale of the problem and that deaths from NCD are expected to increase by 15% between 2010 and 2020, the United Nations held a high level meeting in 2011 and produced plans on how to reduce the growing burden from NCD. Afterwards the World Health Organization (WHO) set a range of targets, including reducing deaths from NCD in those under 70 by 25% by 2025. But how well are countries doing? more…

Toby Shipway: Ticking away

1 May, 15 | by BMJ

toby_shipway_planeIt is surprising how young some patients in the Northern Territory, Australia, present with medical conditions that are traditionally the preserve of older patients.

I am sitting in a clinic room on Groote Eylandt in the Gulf of Carpentaria. It is 3:30 am and there is a patient in their late 20s in front of me with an acute anterior myocardial infarction (MI). I rub my bleary eyes and review the huge ST changes on the ECG and their subsequent sequential improvement. I then double check the date of birth and can confirm this patient is younger than me. more…

Victor Montori: Clinical evidence for the Brave New World of multimorbidity

19 Mar, 15 | by BMJ

victor_MontoriThis blog is part of a series of blogs linked with BMJ Clinical Evidence, a database of systematic overviews of the best available evidence on the effectiveness of commonly used interventions.

The most common chronic condition worldwide is, or will soon be, multimorbidity. While it was previously a concern reserved for the very old, multimorbidity increasingly affects younger people. A prevalence study in Scotland found that the average middle aged person is no longer a healthy one, but a patient with at least one chronic condition; one in four even had two chronic conditions. more…

Jocalyn Clark: Where cancer is a neglected disease

5 Mar, 15 | by BMJ

Jocalyn_Clark1A great deal of attention is being paid to non-communicable diseases (NCDs) as an emerging source of illness, death, and healthcare costs—recognising that low and middle income countries (LMICs) in particular are faced with a growing threat.

The NCDs movement tends to coalesce around four priority conditions—heart disease, diabetes, lung disease, and common cancers—and has been effective at pressing for the inclusion and priority of these diseases in the “post 2015” international development agenda. more…

David Zigmond: The extinction of care by treatment—our healthcare’s heart failure

24 Feb, 15 | by BMJ

david_zigmond2At the end of last year, the media had a brief frisson over another dark story from our NHS: seven recent suicides and one homicide involving people who were acutely mentally ill. The transient newsworthiness came from the probability that the deaths were preventable: psychiatric beds were sought for these patients, but none were available. Typically, the media story has rapidly passed from view and memory, but the vast problems it signifies are still very much with us. What are these problems? How have they arisen and what can we do about them? more…

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