Abstract
Inflammatory bowel disease and diet
There is increasing interest in diet in inflammatory bowel disease (IBD). Previously considered to have a strong genetic component, the rising prevalence of Crohn’s disease and ulcerative colitis in countries increasingly exposed to a western diet suggests a significant environmental influence. Various diets have been investigated, the Crohn’s and Colitis foundation provide a review of these in the information sheet provided on their website.
www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/publications/food
Dietary advice for the planet: The Eat Lancet Study
For a variety of reasons, I (KS) have recently stopped eating meat. As I reflect on my reading over recent months around this decision, I have been shocked by how little I knew about the food I was eating, both as a member of the public and as a health professional. For those who are interested in reading about this in more detail, the ‘Eat Lancet study: Food in the Anthropocene’ is a fascinating place to start. Regarding meat consumption for example, the article states that ‘optimal intake (of red meat) may be 0 g’, however due to the lack of evidence around low levels of red meat, the guidelines include 14 g per day of red meat. Further interesting reading sources are available from the Plant Based Health Professional website.
www.thelancet.com/commissions/EAT
https://www.plantbasedhealthprofessionals.com/
Non-alcoholic fatty liver disease
Having recently discussed this with a patient, I came across a helpful infographic and flowchart published as part of a recent BMJ article – a very helpful guide to investigation and management of non-alcoholic fatty liver disease based on the pattern of liver function test derangement.
Byrne C, Patel J, Scorletti E, et al. (2018) Tests for diagnosing and monitoring non-alcoholic fatty liver disease in adults. BMJ 362: k2734. DOI: 10.1136/bmj.k2734.
The General Practice Infant Feeding Network
This resource (GPIFN) is designed to provide information for GPs about infant feeding and allied issues. This is often a tricky clinical scenario to manage and highly emotive for mothers with young babies, particularly if unsettled and upset with feeding. As simple cases may be dealt with by health visitors, GPs often see more complex cases. The website provides a range of resources for mothers, fathers and GPs, including a link to online e-learning modules. I think it is a great resource for GPs and also for any new parents with challenging infant feeding issues!
gpifn.org.uk/
Gut microbiota: A new frontier in medicine
There seems to be an immense amount of interest around the complex role of gut microbiota in health and disease, and the role diet, exercise, probiotics and medical interventions, such as antibiotics and chemotherapy, have on the gut. Though, as yet, there is no clear evidence regarding supplemental probiotics, there are aspects of lifestyle, such as increasing fibre in our diet, that are known to have a positive effect on the gut microbiota with associated health benefits. See the article referenced below for a thorough review explaining some of the underlying physiology.
Valdes A, Walter J, Segal E, et al. (2018) Role of the gut microbiota in nutrition and health. BMJ 361: k2179. DOI: 10.1136/bmj.k2179.
Proton pump inhibitor and fracture risk
The ongoing need for proton pump inhibitors (PPIs) often comes up when reviewing patients’ medicines. Personally, I feel I have limited success in getting patients to stop these drugs, although often they do step down use to an ‘as required’ basis rather than daily. Reviewing the evidence regarding fracture risk, I found a systematic review from 2018 that suggested that while PPIs are thought to increase fracture risk, they do not appear to have an impact on bone mineral density (BMD). The Patient UK medicines information page also provides information about the potential link with gastric cancer, highlighting that studies suggesting this link did not adequately account for factors, such as smoking and alcohol use. They suggest that further research is needed.
Nassar Y and Richter S (2018) Proton-pump inhibitor use and fracture risk: An updated systematic review and meta-analysis. Journal of Bone Metabolism 25(3): 141–151. DOI: 10.11005/jbm.2018.25.3.141.
patient.info/digestive-health/indigestion-medication/proton-pump-inhibitors
Social media and gastrointestinal issues
I am finding more and more that social media is a really fascinating way to hear about new research, guidelines and approaches to health and disease. It is important to pick who you follow wisely, but increasingly other medics are using social media to disseminate new evidence, often having critically appraised articles before posting. Some interesting individuals or groups to follow on Instagram, relevant to digestive health for example, are Dr Alan Desmond, a consultant gastroenterologist based in Devon (@devongutdoctor); GP and founder of ‘The Doctor’s Kitchen’, Dr Rupy Aujla (@doctors_kitchen); and GP and proponent of plant-based nutrition, Dr Gemma Newman (@plantpowerdoctor).
Maternal depression
A large Danish cohort study has shown that children of mothers with depression are seen more often in healthcare settings and had more ‘positive’ tests of infection. This association has been demonstrated in other studies; it makes me wonder about possible interventions
Lyngsoe B, Munk-Olsen T, Vestergaard C, et al. (2019) Maternal depression and primary healthcare use for children: A population-based cohort study in Denmark. British Journal of General Practice 69(680): e182–e189. DOI: 10.3399/bjgp18X700733.
Cervical smears
Many young women feel uncomfortable about the idea of cervical smear tests. Human papilloma virus (HPV) self-testing may become a more acceptable alternative.
Nelson E, Maynard B, Loux T, et al. (2017) The acceptability of self-sampled screening for HPV DNA: A systematic review and meta-analysis. Sexually Transmitted Infections 93: 56–61.
Crying at work
Most of us have been taught not to cry or share emotion at work. Fran Robinson, a freelance journalist, explored this in a recent BMJ article. It might be an interesting article to read and then share your views in a tutorial or a practice meeting.
Robinson F (2019) Why it’s ok to cry at work. BMJ 368(8189): 350–352.
Safeguarding LGBT+ adolescents
Issues for people who identify as LGBT+ (lesbian, gay, bisexual, transgender and other identities) are frequently highlighted in the media. This BMJ article discusses some of the health and social inequalities, particularly during adolescence, and flags some of the potential safeguarding issues. The article gives some definitions and makes suggestions to ensure that your practice is inclusive.
Salkind J, Bevan R, Drage G, et al. (2019) Safeguarding LGBT+ adolescents. BMJ 364(8185): 200–202. DOI: 10.1136/bmj.l245.
Paintings in Hospitals
Paintings in Hospitals (and Art in Healthcare in Scotland) collect and display art to support people’s physical and mental health. All types of social and healthcare sites can borrow artworks, and the charity supports patients and staff to choose and interact with the art.
Paintingsinhospitals.org.uk
What your patient is thinking
I have become the ‘go to’ person in the practice when other doctors or nurses have been unable to perform a smear test because the woman is too tense or frightened.
I was interested in the ‘What your patient is thinking’ article, talking about a patient’s view of uncomfortable procedures. I suspect my patients too would call my technique ‘inane chatter’, but it was nice to see my non-science-based approach recognised as being of value.
De Wreede R (2019) I welcomed the inane chatter during a procedure. BMJ 364(8188): 328–329.
MMR vaccine safety
A large cohort study in Denmark, involving over half a million children and more than five million person-years of follow-up has shown the risk of autism to be no higher in mumps, measles, rubella (MMR) vaccinated or unvaccinated children.
Hviid A, Hansen J, Frisch M, et al. (2019) Measles, mumps, rubella vaccination and autism: A nationwide cohort study. Annals of Internal Medicine 170(8): 513–520. DOI: 10.7326/M18-2101.