Link between deprivation and diabetes and other stories . . .BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3208 (Published 15 June 2016) Cite this as: BMJ 2016;353:i3208
Refugees, neighbourhoods, and diabetes
The government decided where refugees who arrived in Sweden over 25 years ago should live. Investigators used this as a “natural experiment” to see if allocation of neighbourhood affected the incidence of type 2 diabetes in 61 386 refugees aged 25-50 years who arrived in 1987-91 (Lancet Diabetes Endocrinol doi:10.1016/S2213-8587(16)30009-2). Using the area deprivation index, they detected a statistically significant 9% extra risk of diabetes for every five years spent in a high deprivation versus a low deprivation area.
Doug Altman was a pioneer of the evidence based medicine movement in the 1990s and set standards for how to generate evidence and combine it in systematic reviews. But when he and colleagues looked at a large sample of recent systematic reviews, they found that standards often fall short of the basic minimum (PLoS Med doi:10.1371/journal.pmed.1002028). Notably, only 7% looked for unpublished studies, and less than half considered the risk of publication bias.
Silent heart attacks are common
How often does myocardial infarction (MI) occur without being picked up at the time? The Atherosclerosis Risk in CommunitiesStudy provided a baseline cohort of 9498 people without cardiovascular disease when recruited in 1987-9 for investigators to examine later electrocardiograms for changes of MI without documentation of clinical MI in the medical notes (Circulation doi:10.1161/CIRCULATIONAHA.115.021177). During a median follow-up of 8.9 years, 317 (3.3%) participants developed silent MI, whereas 386 (4.1%) developed clinical MI. Both types of MI were more common in men but outcomes were worse in women.
You can’t tell from the urine
“His urine looks very concentrated, doctor,” “OK, push fluids” is a conversation that does not belong to this century. You cannot tell if an older person is dehydrated by urine parameters—specific gravity, colour, osmolality, cloudiness, additional dipstick measures, ability to provide a sample, or the volume of a random sample. Using serum osmolality as a reference, none of these measures provided any useful information in a study of 162 participants of mean age 86 years (Am J Clin Nutr doi:10.3945/ajcn.115.119925).
Consent for kids’ trials
What we need is more Brussels bureaucracy—to help clinical trials involving children in Europe. A study of 25 EU member states and two European Free Trade Association countries until the end of 2014 shows a bewildering variety of different systems for consent and assent (Arch Dis Child doi:10.1136/archdischild-2015-310001). The authors have developed an “informed consent and assent tool kit” that could remove this obstacle if its use could be agreed across the EU.
Is 70 too old for palliative care?
In an analysis of four PhD submissions about the experiences of people dying in the community, researchers from Edinburgh found that patients aged 70 years or more were offered less palliative or supportive care than younger patients (Eur J Palliat Care 2016;23(3)), and that this often caused avoidable distress. Reasons may have been the lack of a clear diagnosis of “dying” in non-cancer conditions. Another may have been the reluctance of health professionals to involve palliative services for old people with complex conditions, who often experienced avoidable distress.
Ringing the changes
A systematic review of 228 tinnitus trials found 35 different outcome domains, 78 primary outcome instruments, and 24 different patient outcome tools (Trials doi:10.1186/s13063-016-1399-9). In 55% of trials the problem of interest was ill defined, and loudness was mentioned in only 14%. No wonder the report ends with a distinct whine.
Investigators in the psychology department at Eastern Washington University have examined the phenomenon of music induced goosebumps, otherwise known as frisson or even “skin orgasm” (Psychology of Music doi:10.1177/0305735615572358). Minerva has gone one further and investigated whether such activation may be suppressed by a hot aqueous environment. Using recordings of the conductor Wilhelm Furtwängler, she has shown that musical goose pimples can readily occur in the bath.