Alex Burrell is a GP in Bristol.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Obesity care
Obesity rates continue to rise but access to weight management services is limited. This qualitative study interviewed 10 Irish GPs aiming to ‘understand the factors shaping GPs’ obesity-related practices’.1 Key themes included a perceived lack of knowledge, training, and educational resources, particularly on how to have sensitive weight-based conversations to overcome a fear of causing offence or stress. ‘Eat less move more’ still seemed to be the default advice in the absence of clear guidance and specialist services. Proposed interventions follow on logically from these findings: providing GP- specific obesity education; establishing multidisciplinary community obesity services; and the creation of practice and treatment protocols. The authors highlight the need to include GPs as key stakeholders in the development of these potential resources.
Maternal body mass index and childhood infections
As population obesity rates increase, so the proportion of women who are obese giving birth increases: in 2017, 21.6% of women giving birth in England were obese.2 There is evidence of links between maternal obesity and a variety of adverse outcomes for offspring including asthma and cardiovascular disease. This birth cohort study used the Born in Bradford database, which has followed up 12 500 families in Bradford since 2007, to explore the association between maternal body mass index (BMI) and childhood infections.3 There was strong (P<0.0001) evidence of a relationship between the two variables, with infection rates increasing with maternal BMI. This relationship strengthened as child age increased: for children aged <1 year, only women with obesity grades 2 or 3 had offspring with higher infection rates than those born to women of healthy weight, but by age 5–<15 years children born to women who were overweight or with obesity grades 1–3 all had significantly higher rates of infection. Lower respiratory tract infections showed the strongest association with maternal obesity.
Frozen shoulder and diabetes
The association between diabetes and frozen shoulder is well established, but should we be testing for undiagnosed diabetes in people who present with frozen shoulder? This matched cohort study aimed to examine whether a diagnosis of frozen shoulder was associated with subsequent type 2 diabetes diagnosis using UK primary care electronic health records.4 Patients with pre- existing diabetes were excluded. From 2004– 2017, 31 226 patients had an incident diagnosis of frozen shoulder. Of these, 1559 (5.0%) had a new diagnosis of type 2 diabetes during follow-up to February 2020 compared to 88 (0.3%) of the matched cohort without frozen shoulder, giving an adjusted hazard ratio of 20.0 (95% confidence interval [CI] = 16.0 to 25.0). Should we therefore be screening everyone with a new frozen shoulder for type 2 diabetes, and if so, how long after their initial diagnosis and how often? To fall back on an old trope, further research is needed.
Locums
Locum doctors are an important component of the UK primary care workforce. This report on the use of locums in the NHS in England as a whole includes a section on locums in primary care, with the aim of quantifying locum use in general practices from 2017–2019 and comparing to other types of GPs (partners, salaried, retainers, and registrars).5 Locums were generally ‘more mobile, younger males of whom most had qualified in the UK, although a large percentage had qualified elsewhere’ (64% qualified in UK compared to 82% of salaried GPs and 76% of partners). Mean locum use as a percentage of total full- time equivalent (FTE) GPs was 3.15%–3.31% (1046–1157 FTE), with just over a third of practices reporting at least some locum use. Most locums were in long-term positions (74% versus 26% infrequent), and there was substantial variation of locum use between regions (0.4%–13.7% of GP FTE for region). Care Quality Commission ratings were a strong predictor of locum FTE: practices rated inadequate (incidence rate ratio [IRR] 2.108, 95% CI = 1.370 to 3.246) or good (IRR 1.343, 95% CI = 1.103 to 1.637) had higher locum FTE than practices rated outstanding.
References
1. Ryan L, O’Donoghue G, Crotty M, et al. Factors that influence general practitioners’ obesity-related clinical practices and determinants of behavior to target to promote best practice in obesity care: a qualitative exploration. Obes Sci Pract 2024; 10(5): e70012.
2. Public Health England. Health of women before and during pregnancy: health behaviours, risk factors and inequalities. An updated analysis of the maternity services dataset antenatal booking data. 2019. https://assets.publishing.service.gov.uk/media/5dc00b22e5274a4a9a465013/Health_of_women_before_and_during_pregnancy_2019.pdf (accessed 22 Oct 2024).
3. Coathup V, Ashdown HF, Carson C, et al. Associations between maternal body mass index and childhood infections in UK primary care: findings from the Born in Bradford birth cohort study. Arch Dis Child 2024; DOI: 10.1136/archdischild-2024-326951.
4. Dyer BP, Burton C, Rathod-Mistry T, et al. Are patients with newly diagnosed frozen shoulder more likely to be diagnosed with type 2 diabetes? A cohort study in UK electronic health records. Diabetes Obes Metab 2024; DOI: 10.1111/dom.15965.
5. Allen T, Ashcroft D, Ferguson J, et al. The use of locum doctors in the NHS: understanding and improving the quality and safety of care. Health Soc Care Deliv Res 2024; 12(37): 1–266.
Featured photo by Natalia Marcelewicz on Unsplash.
