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Press releases Friday 30 May 2008

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(1) The traditional Mediterranean diet protects against diabetes
(2) Seven in ten patients surveyed hadn't heard of the Summary Care Record
(3) Reduced access to NHS dentistry to blame for dramatic increase in dental abscesses?

(1) The traditional Mediterranean diet protects against diabetes
(Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study)
www.bmj.com/cgi/content/short/bmj.39561.501007.BE

The traditional Mediterranean diet provides substantial protection against type 2 diabetes, according to a study published on bmj.com today.

The Mediterreanean diet is rich in olive oil, grains, fruits, nuts, vegetables, and fish, but low in meat, dairy products and alcohol.

Current evidence suggests that such a diet has a protective role in cardiovascular disease, but little is known about its role on the risk of developing diabetes in healthy populations.

The SUN prospective cohort study involved over 13 000 graduates from the University of Navarra in Spain with no history of diabetes, who were recruited between December 1999 and November 2007, and whose dietary habits and health were subsequently tracked.

Participants initially completed a 136 item food frequency questionnaire designed to measure the entire diet. The questionnaire also included questions on the use of fats and oils, cooking methods and dietary supplements.

Every two years participants were sent follow-up questionnaires on diet, lifestyle, risk factors, and medical conditions. New cases of diabetes were confirmed through medical reports.

During the follow-up period (median 4.4 years) the researchers from the University of Navarra found that participants who stuck closely to the diet had a lower risk of diabetes. A high adherence to the diet was associated with an 83% relative reduction in the risk of developing diabetes.

Interestingly, those participants who stuck strictly to the diet also had the highest prevalence of risk factors for diabetes such as older age, a family history of diabetes, and a higher proportion of ex-smokers. This group of participants was therefore expected to have a higher incidence of diabetes, but this was not the case. If fact, say the authors, they had a lower risk of diabetes, suggesting that the diet might provide substantial protection.

The major protective characteristics of the diet include a high intake of fibre and vegetable fat, a low intake of trans fatty acids, and a moderate intake of alcohol. In addition, a key element of the diet is the abundant use of virgin oil for cooking, frying, spreading on bread, and dressing salads.

The authors conclude by calling for larger cohorts and trials to confirm their findings.

Contact:
Professor Martínez-González, University of Navarra, Pamplona, Spain
Email: mamartinez@unav.es

(2) Seven in ten patients surveyed hadn't heard of the Summary Care Record
(Patients' attitudes to the summary care record and HealthSpace: qualitative study)
www.bmj.com/cgi/content/short/bmj.a114v1

Despite an extensive public information campaign only three in ten people living in the areas piloting the NHS Summary Care Record (SCR) have heard about the programme, according to a study published on bmj.com today.

Several areas in England (of which three were studied) have been piloting the SCR, an electronic summary of a patient's medical record accessible to NHS staff via the internet, and HealthSpace, an internet based personal health organiser from which patients can view their own SCR.

The English government is about to roll out the programme nationwide. Patients who do not want an SCR have to actively opt out. The programme has proved controversial with a range of alleged benefits and drawbacks, from better clinical care and fewer medical errors to high costs and threats to confidentiality.

Researchers from University College London set out to document the views of patients and the public towards the SCR in three pilot areas. Focusing particularly on people with low health literacy, potentially stigmatising conditions, or those with difficulty accessing healthcare, they carried out 103 interviews with people who had recently used the health service in their area, and held seven focus groups with people recruited from voluntary sector organisations.

They found that even though nearly all of the local population had received a letter informing them about the SCR being introduced in their area, most were not actually aware of either the SCR or HealthSpace. Many wrongly believed that electronic records were already shared between health professionals.

Two thirds of people were positive about the SCR and happy not to opt out. But very few were totally in favour of the idea. For most people, say the researchers, the decision about whether to have an SCR was dependent on their own personal experience and involved a process of weighing the positive against the negative.

The most common perceived benefits of the SCR included having medical details safely and consistently in one place and not having to fill out forms or remember what medication they were taking. The latter was particularly important for people with a low health literacy. The most common perceived drawbacks were inappropriate people having access to their records or security breaches.

People with complex health problems or who'd had adverse drug reactions tended to view the SCR positively. People who had been victims of mistaken identity or identity fraud tended to be the most opposed to the SCR.

Most people were not interested in a HealthSpace account with some describing it as 'pointless' and 'irrelevant'. The overwhelming reason for people not wanting a HealthSpace account was a lack of interest in their own health record.

Although most patients wanted to have an SCR, they also wanted to control who had access to it at the point of care. This led the researchers to conclude that it would be more pragmatic and ethical if the mode of consent were to change from 'opt out' where anyone with a 'legitimate relationship' can view the record, to a 'consent to view' model.

Contact:
Trisha Greenhalgh, Department of Primary Care and Population Sciences, University College London, UK
Email: p.greenhalgh@pcps.ucl.ac.uk

(3) Reduced access to NHS dentistry to blame for dramatic increase in dental abscesses?
(Analysis: Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK?)
www.bmj.com/cgi/content/full/336/7655/1219
(Editorial: Reforming NHS Dentistry)
www.bmj.com/cgi/content/full/336/7655/1202

The number of people admitted to hospital with dental abscesses has doubled in the past ten years, according to a study published ahead of print on bmj.com.

The authors of the study say they were prompted to look at the issue after seeing three complicated cases of dental abscesses in a six month period in 2006. In each case the patient arrived at the Accident and Emergency department suffering from an undiagnosed abscess (a collection of pus) in the mouth.

One 48 year old man was twice advised to find a dentist, but unable to do so, he was admitted to the Hospital's Critical Care Unit when he was found unconscious by his partner. He spent three weeks in the unit. In another case, a 48 year old woman spent 44 days in hospital after being referred to the Emergency Unit by her GP. None of the patients were registered with a dentist.

The authors from the University of Bristol say these cases prompted them to look at the data for the frequency of hospital admissions for dental abscesses from the years 1998/99 to 2005/6. They found that the total number of admissions and bed days due to drainage of a dental abscess almost doubled during this time.

On average patients spent approximately two days in hospital. The mean age was 32.

The authors say the oral health of the population has improved during this time so the reason for this dramatic increase is most likely to be changes in the provision of dental care in the UK.

Changes to dentists' pay in the 1990s led many to reduce their NHS workload. At the same time this has been accompanied by a drop in the number of people registered with an NHS dentist - from 23 million in 1994 to 17 million in 2003/4.

The authors say it is possible that changes in service provision have resulted in routine and emergency dental care becoming less available and that this explains the rise in surgical admissions for dental abscesses. They also point to a recent survey which found one in five people had declined dental treatment because of cost.

However, they do say that some of the changes to dental practice occurred before 1998 and advise some caution in drawing causal inferences from the data.

They add: "We believe that a doubling in a preventable condition that can have major consequences and that can even result in death constitutes a major public health problem that requires urgent action."

The authors conclude that there needs to be a review of routine and emergency dental care.

In an accompanying editorial, Professor Ruth Freeman from the University of Dundee suggests that the NHS dental contract, introduced in 2006, led to misunderstandings between the public, patients, and the profession. "The government's sensitivity regarding professional anxieties slipped away and the profession's sensitivities for patient's anxieties were forgotten", she writes.

Freeman points out that only 4% of dentists actually left the NHS after the contract was introduced, despite media stories to the contrary, such as reports of difficulties in accessing NHS dentistry and of deregistered dental patients queuing outside new dental surgeries to register for NHS dental care.

The government now recognises the need for better communication between stakeholders and this should "pave the way to accessible NHS dentistry for all", she concludes.

Contacts:
Dara O'Hare, Public Relations Office, University of Bristol, Bristol, UK.
Email: dara.ohare@bristol.ac.uk
Roddy Isles, Public Relations Office, University of Dundee, Dundee, Scotland
Email: r.isles@dundee.ac.uk

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