Gestational diabetes – glucose intolerance occurring during pregnancy – is relatively common, affecting around four in every hundred pregnancies. A lot of research has linked low birth weight in babies born to mothers with diabetes to increased risk of vascular disease in later adult life. But much less attention has been focused on the mother’s subsequent health risks after having gestational diabetes. In this article, we review the increased risk of diabetes and vascular disease in later life in women suffering gestational diabetes and how to improve follow-up and prevention.
Back to Basics: How oral glycaemic drugs work
Aspirin in Cardiovascular Disease: the Pros and Cons
Aspirin is the most widely used long-term antiplatelet therapy, achieving benefits in patients with a range of cardiovascular conditions by blocking one of the blood clotting pathways. It is cheap and relatively safe, despite the possible risks of gastric irritation or bleeding. In this article, we explore what we know about aspirin, together with its pros and cons in patients with cardiovascular disease.
Facing up to the Challenge of Childhood Obesity
In a recent report on childhood obesity, the British Medical Association described the significant increase in levels of childhood obesity as a ’cause for great concern’ and stated that healthcare professionals have a pivotal role to play in tackling this epidemic. It is estimated that there are now approximately 1 million obese children under the age of 16 in the UK and numbers are increasing annually. In this article, we review the impact of this growing epidemic, the underlying causes and how healthcare professionals can help.
Editorial
All in all, it’s been a good year for primary care in the UK. Results from the first year of the Quality and Outcomes Framework (QOF) showed practices have performed much better than anyone expected in terms of delivering very high quality care. BJPCN is designed to help you keep hitting the challenging targets practice teams will be aiming for in the year ahead.
Which antihypertensives are best? Making sense of the ASCOT study
Newer’ antihypertensive therapy reduces cardiovascular events compared to ‘older’ drugs, according to the recently published Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA). The results showed that antihypertensive therapy based on the calcium channel blocker amlodipine, with the ACE inhibitor perindopril added as required, reduced cardiovascular events compared with treatment based on the beta-blocker atenolol. In this article, we review what the findings mean for primary care management of high blood pressure and put them in perspective.
Back to Basics: Aspirin in CVD prevention
Faddy diets: fact or fiction?
An estimated two-thirds of the population are thinking about, or trying to lose weight at any time. To meet this demand, there is a growing range of commercial and ‘fad’ diets available but, unfortunately, very little research to indicate what works and what doesn’t. This article looks at some of the more popular fad and commercial diets you may be asked about in clinic, giving you the information you need to have a discussion about the pros and cons of different weight loss methods with your patients, to help them lose weight and keep it off. The key finding seems to be – if it sounds too good to be true, it probably is!
Venous leg ulcers
Chronic leg ulcers are a major health problem in the UK, affecting many older people and costing the NHS up to £600 million per year. Chronic leg ulcers are generally managed in primary care: more than 80% of chronic leg ulcers are cared for in the community. Healing rates are currently low and recurrence rates are higher than 67%. However, appropriate use of available treatments can reduce recurrence rates to between 20% and 30%. In this article, we review the causes of venous ulceration, how to spot the problem early and how to optimise leg ulcer healing.
Scoring QOF points for diabetes
IIn this, the fifth article in our series on the Quality and Outcomes Framework (QOF), we review how to score top points for diabetes. This is an area that has been managed almost wholly in Primary Care for many years. Virtually all practices now have a diabetes clinic, which generally has extensive nurse involvement – with many being nurse-led. Practices are doing extremely well in this area and many are achieving a very high percentage of points. Figures for practices in England showed that on average they scored 93.2% of the QOF points for diabetes. This article offers some pointers on how to keep up the good work.
Going for gold: reducing cardiovascular risk with physical activity
Physical activity reduces the risk of developing heart disease and lowers the risk of death and further events in patients with cardiovascular conditions. This article reviews the benefits of exercise and shares some of the strategies our team uses to help patients with heart disease increase their levels of physical activity and keep active after they have completed phase 3 cardiac rehabilitation.
Portion size: how much is enough?
The prevalence of obesity in the UK continues to rise. The Health Survey for England 2003 reported that nearly one in four (23%) of men and women were obese, compared to only 13% and 16%, respectively, in 1993. Obesity increases the risk of developing diseases such as diabetes, coronary heart disease (CHD) and some cancers, and can adversely affect the management of these conditions. So there is obviously a major incentive for primary healthcare professionals to support patients in dealing with this important risk factor. In this article, we look at the simple step of encouraging people to control the size of the portions of food that they eat.
