Walk/Don’t Walk neighbourhoods . . . and other storiesBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1835 (Published 20 April 2017) Cite this as: BMJ 2017;357:j1835
Exercise deficiency disorder
Evidence to support a link between lack of exercise and obesity and type 2 diabetes comes thick and fast. A cross sectional study of adults in Toronto (BMJ Open doi:10.1136/bmjopen-2016-013889) shows an association between neighbourhood “walkability” and metabolic risk factors. Those in the least walkable areas had higher blood pressure, body mass index, low density lipoprotein cholesterol, and glycated haemoglobin. A cross sectional analysis of the 2008 Health Survey for England, also in the latest BMJ Open (doi:10.1136/bmjopen-2016-014456), carries a similar message: each extra increment of exercise was associated with lower body mass index and glycated haemoglobin. People need to heed the title of Sir Muir Gray’s latest book Sod Sitting.
Better communication, better outcomes
Using a simple measure of patient satisfaction with communication, a study of 6810 American adults with cardiovascular disease looked for an association between quality of dialogue and a range of outcomes (Circ Cardiovasc Qual Outcomes doi:10.1161/CIRCOUTCOMES.117.003635). Outcomes included use of statins and aspirin, health status as reported by patients, use of emergency care, and health expenditure. All were improved when communication was rated good.
Rapid decision aids
To share decisions with patients, clinicians need evidence that is accurate, up to date, and easy to understand. Ten reviewers, plus an information specialist, a biostatistician, and a graphic designer produced a suite of five decision aids for dementia, using selective reviews and rapid evidence synthesis methods (Syst Rev doi:10.1186/s13643-017-0446-2). The time required to complete a rapid review varied from seven to 31 weeks per review (mean standard deviation, 19, SD 10 weeks), at a cost of about £9000 each.
Stilling juvenile idiopathic arthritis
Time was when all juvenile idiopathic arthritis was called “Still’s disease,” and its consequences could be dire. A survey of seven British paediatric and adolescent rheumatology centres shows that in the era of modern active treatment, 67% of juvenile idiopathic arthritis patients had no active joints at one year (Ann Rheum Dis doi:10.1136/annrheumdis-2016-210511). But rating of disease activity depended on which scoring system was used: the figures varied between 48% and 61% for minimally active disease and between 25% and 38% for clinically inactive disease.
Preference adapted trials?
Researchers and ethics committees like to live in a world of clinical equipoise, but clinicians and patients often have strong feelings about treatment choices, even in the absence of evidence. This was illustrated in an endometriosis trial that sought to compare four different kinds of long acting, reversible contraceptive (LARC) (Trials doi:10.1186/s13063-017-1864-0). Only five (6%) women accepted randomisation to all groups, with 63 (82%) having a LARC preference, and 55 (71%) a preference not related to LARC. The authors discuss whether it might be possible to achieve better recruitment by allowing a degree of patient and clinician preference while keeping a balance between groups.
The enhancement of research capacity in low to middle income countries could achieve huge benefits for global health, but there are often few local professionals to call upon. To assess their existing skills, a wheel-like tool has been designed that looks like a radar screen (BMJ Glob Health doi: 10.1136/bmjgh-2016-000229). Competency radar strikes Minerva as a useful assessment tool for wider use: the domains include scientific thinking, ethics, quality improvement, research skills, and management ability.
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