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(1) Poor coordination in childhood is linked to obesity in later life
(2) International medical organisations must lead the condemnation of atrocities in Zimbabwe, say doctors in South Africa
(3) English healthcare system failing to provide basic care, shows major survey

(1) Poor coordination in childhood is linked to obesity in later life
(Physical control and coordination in childhood and adult obesity: longitudinal birth cohort study)
http://www.bmj.com/cgi/content/abstract/337/aug12_3/a699

Poor physical control and coordination in childhood are linked to an increased risk of obesity in later life, suggests a study published on BMJ.com today.

The research contributes to a growing body of evidence on the link between poorer cognitive function in childhood and obesity and type 2 diabetes in adults.

The findings are based on 11 042 individuals, who are part of the ongoing National Child Development Study in Great Britain, which began in 1958.

7990 participants were assessed by teachers at age 7 years to identify poor ability in hand control, coordination, and clumsiness, and 6875 were tested for hand control and coordination at age 11 by a doctor. Tests included copying a simple design to measure accuracy, marking squares on paper within a minute, and the time in seconds it took to pick up 20 matches.

At age 33 body mass index (BMI) was measured. Obesity was defined as a BMI of 30 or over.

The analysis showed that at age 7 years poor hand control, poor coordination, and clumsiness occurred more often among individuals who would be obese adults. In addition, poorer function at age 11 was associated with obesity at age 33.

These findings held true after adjusting for factors likely to influence the results, such as childhood body mass and family social class.

The study did not look at the specific biological processes linking poorer physical control and coordination in childhood with later obesity.

"Some early life exposures [such as maternal smoking during pregnancy] or personal characteristics may impair the development of physical control and coordination, as well as increasing the risk of obesity in later life", say the authors.

"Rather than being explained by a single factor, an accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function", they conclude.

Contacts:
Scott Montgomery, Örebro University Hospital & Karolinska Institutet, Stockholm, Sweden; Imperial College, London, UK
Email: scott.montgomery@ki.se

(2) International medical organisations must lead the condemnation of atrocities in Zimbabwe, say doctors in South Africa
(Editorial: Zimbabwe's humanitarian crisis)
http://www.bmj.com/cgi/content/extract/337/aug12_2/a1286

International medical organisations such as the British Medical Association (BMA), must "loudly and clearly" condemn the abuse of human rights in Zimbabwe, urge a group of doctors from South Africa and Uganda on BMJ.com today.

The Zimbabwean Association of Doctors for Human Rights (ZADHR) have been the sole "moral conscience" of the medical profession and consistently braved the wrath of the Mugabe regime to highlight gross human rights abuses, say the authors.

Professor Dan Ncayiyana and colleagues call on international medical associations to break their silence and support and defend the ZADHR and other Zimbabwean colleagues and organisations to promote ethical practice and human rights.

Recent reports from the non-profit organisation Solidarity Peace Trust and Specialist Doctors in Zimbabwe have documented numerous beatings, abductions, mutilations and other forms of torture all occurring in just 3 months, as well as over 2 900 victims of political violence who have been treated in the nation's hospitals.

In addition, Zimbabwe's health system, once rated as one of sub-Saharan Africa's finest, is "in shambles" say the authors. Shortages of medical supplies and equipment are commonplace while most public health programmes have ground to a halt.

The authors point out that even if a settlement is agreed between Mugabe and the MDC leader Morgan Tsvangirai it would not immediately stop the violence and Zimbabwe would still need money and expertise to rebuild its shattered health system.

"The international medical fraternity can support this endeavour through advocacy and… individuals volunteering their time and technical know-how to help alleviate the skills gap in the reconstruction of health systems and institutions", state the authors.

"The people of Zimbabwe deserve the support of those who claim to uphold the traditions of healing and caring inherent in the medical profession", conclude the authors.

Contact:
Dan Ncayiyana, Vice Chancellor, Durban University of Technology, Durban, South Africa
Email: danjn@telkomsa.net

(3) English healthcare system failing to provide basic care, shows major survey
(Self-reported receipt of care consistent with 32 quality indicators: a national population survey of adults over 50 years old in England)
http://www.bmj.com/cgi/content/abstract/337/aug13_2/a957
(Editorial: Measuring the quality of healthcare systems using composites)
http://www.bmj.com/cgi/content/extract/337/aug13_2/a639

The NHS and private healthcare are not providing good enough basic care to a large portion of the population in England, especially older and frailer people, according to a study published on bmj.com today.

Overall, only 62% of the care recommended for older adults is actually received, conclude the authors.

The large-scale independent study of quality of care involved 8 688 people aged 50 and over and looked at 13 different health conditions including heart disease, diabetes, stroke, depression and osteoarthritis.

The research team led by the University of East Anglia studied whether effective healthcare interventions were received by people aged 50 and over with serious health conditions.

They used questionnaires, face to face interviews and medical-panel endorsed quality of care indicators, for both public and privately provided care, as part of the English Longitudinal Study of Aging (ELSA).

Results showed huge variations by health condition in whether or not people with particular health conditions received the appropriate intervention or care they should.

Treatment for ischaemic heart disease rated well with 83% of appropriate care actually being given, but just 29% of recommended care was received by people with osteoarthritis.

Overall, there were 19 082 opportunities for care to be delivered to people, but actual care was only given in 11 911 (62%) of those opportunities.

The researchers also found that substantially more care was provided for general medical conditions (74%) than for geriatric conditions (57%), the latter comprising falls, osteoarthritis, urinary incontinence, vision problems (cataract), hearing problems, and osteoporosis.

Interestingly, medical conditions that GPs receive extra rewards for dealing with under the Quality and Outcomes Framework of their current contract were attended to better. In 75% of such cases, people did get the right treatment, but only 58% of correct treatment was received by people with conditions not covered by the contract.

Worryingly, conditions associated with disability and frailty had the largest shortfalls in terms of the care that people were not receiving but should have been.

Receipt of care was also substantially higher for screening and preventative care (80%) than for treatment and follow-up care (64%), which in turn was higher than diagnostic care (60%).

The researchers say that initiatives to improve quality for nearly all conditions are needed but the greatest scope for improvement is in chronic conditions that affect the quality of life of older people.

In particular, the quality of care for geriatric conditions was relatively poor in this study, say the researchers, and no geriatric conditions were included in the GP contract. They therefore suggest that including geriatric conditions in future payment for performance schemes for GPs would improve quality.

In an accompanying editorial, Professor Bruce Guthrie from the University of Dundee, says that the future challenge will be to get local measures of the problem of deficiencies in care and then provide local interventions to improve care.

Contacts:
Simon Dunford, Press Officer, University of East Anglia, Norwich, UK
Email: s.dunford@uea.ac.uk
Editorial: Bruce Guthrie, University of Dundee, Dundee, Scotland
Email: b.guthrie@chs.dundee.ac.uk FOR ACCREDITED JOURNALISTS

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