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Knee replacement surgery decreased after NHS policies on patient's weight were introduced

New research has found that weight/body mass index (BMI) policies introduced by NHS commissioning groups in England are associated with a decrease in knee replacement surgery and may be contributing to health inequalities. With one in ten people likely to need a knee replacement, many thousands of patients are directly affected by these policies.

The National Institute for Health and Care Research (NIHR) funded study, led by the University of Bristol and published in PLOS ONE today, suggest regions that introduced policy changes for access to knee replacement surgery based on a patient's weight/BMI have seen a decline in surgery.

Over the last decade rules have been bought in by NHS clinical commissioning groups (CCGs) across England to change the access to hip and knee replacement surgery for patients who are overweight or obese. However, there is a lot of regional difference, with some regions having no such policy and in the strictest examples patients being denied access to an elective hip or knee replacement operation until their BMI is below a certain threshold.

The research team analyzed the rates of knee replacement surgery of 481,555 patients between January 2009 and December 2019 using data from the National Joint Registry and compared regions with and without a BMI policy.

The aim of the research was to investigate the effect of these commissioning policies on access to elective knee surgery and if there was any evidence of worsening health inequalities through a disproportionate effect on less affluent groups in society.

The study found the policies put in place by NHS CCGs to change access to knee replacement based on a patient's weight/BMI are linked with a decrease in surgery and could have led to postcode health inequalities.

The research highlighted that the rules may be worsening health inequalities as policy introduction can be linked to a rise in patients having private surgery and a reduction in the most economically deprived patients receiving surgery at

all.

Rates of surgery fell in all patient groups, and not just for overweight or obese patients, who the policy was targeted at.

Dr. Joanna McLaughlin, NIHR Doctoral Fellow in the Bristol Medical School: Translational Health Sciences (THS) and lead author of the study, said: "NHS policy on whether people can immediately access referral for knee replacement surgery if they are overweight or obese varies depending on where you live in England.

"Our study raises the concern that these policies are linked with worsening health inequalities with fewer NHS operations for the least affluent groups in society when policies are introduced."

The research team urge commissioners and policy decision-makers to reconsider restrictive policies that affect access to elective surgery as a matter of urgency. The researchers also suggest that the recent formation of Integrated Care Systems from existing CCG groups is an important opportunity for positive changes to policy position. 

Reference: Medical Express: by University of Bristol

Male menopause: Men have it too

Have you or your partner ever noticed that you are having hot flushes, gaining weight, or an impaired sexual function?

These are just a few of the symptoms of male menopause, a health condition that doesn't get much attention.

We all know that women have a fixed ovarian reserve which gradually decreases over time, leading to menopause. Men don't go through menopause, but they face a similar problem as their testosterone levels tend to drop dramatically. And it's called andropause, or just male menopause. As men age, they undergo a number of changes, from graying of hair to loss of muscle mass. The drop in testosterone levels is one of the most dramatic changes men go through.

"It's not often discussed since there isn't much research on the issue, owing to the fact that you don't die from a decrease in gonadal hormones, and the hormone withdrawal isn't as extreme as in women. When males experience this, there are typically other factors at play, in addition to the decline in hormones such as workplace stress, marriage stress, life management, and lifestyles," said Dr Anubha Singh, Gynecologist and IVF Expert from Shantah Fertility Centre, Vasant Vihar, New Delhi.

What is Andropause exactly?

The reduction in testosterone levels in males is referred to as male menopause.

"Anytime beyond the age of 40, when women's oestrogen levels begin to decline. Low testosterone is a term used by certain doctors to describe it. It is natural to see a decrease in the production of the male hormone testosterone as you become older, but it can also happen when you have diabetes.  Late-onset hypogonadism, often known as age-related low testosterone, is a steady decrease in testosterone levels. It is a more gradual menopause than female menopause, in which ovulation stops and hormone production drops over a short period of time," explained Dr. Anubha Singh.

What are a few of the signs and symptoms?

Fatigue, poor libido, and difficulties concentrating are just a few of the symptoms that might occur as a result of this reduction. Apart from these following are other signs and symptoms: 

Reference: The Tribune: 

Diabetes: The golden drink that lowers blood sugar - drink 'immediately' after eating

Type 2 diabetes sends a clear signal that your body isn't processing insulin properly. Insulin is a hormone that's responsible for regulating blood sugar - the main type of sugar found in blood. Stripped of this mechanism, blood sugar levels can rise to dangerous levels. Fortunately, your body has a crucial buffer: sensible dietary decisions.

Specific food and drink can counter the blood sugar spikes that follow eating.

Blood sugar levels rise in response to food being broken down into blood glucose (sugar).

Chamomile tea has been shown to have this moderating effect on blood sugar.

Chamomile tea is made from the flowers of the chamomile plant (a herb belonging to the Asteraceae family). It has long been used in traditional medicine practices.

Chamomile tea shown to reduce high blood sugar levels

An Iranian study, published in the journal Nutrition, found that drinking three cups of chamomile tea a day could improve control of blood glucose levels in people with type 2 diabetes.

Researchers from Tabriz University of Medical Sciences aimed to investigate how the effects of chamomile tea would affect glycaemic (a measure used to determine how much a food can affect your blood sugar levels) control and antioxidant levels in type 2 subjects.

Antioxidants are chemicals that protect or delay against cell damage.

Sixty four participants with type 2 diabetes were recruited, all of whom were aged between 30 and 60.

They consumed chamomile tea three times per day "immediately" after meals for eight weeks, the researchers said.

A control group also followed this routine, but they drank water instead.

What did the researchers find out? The chamomile tea group had significantly reduced HbA1c and serum insulin levels, as well as significantly increased total antioxidant capacity compared to those in the control group.

HbA1c is your average blood glucose (sugar) levels for the last two to three months.

The researchers concluded: "Short-term intake of chamomile tea has beneficial effects on glycemic control and antioxidant status in patients with type 2 diabetes."

However, the researchers noted, a larger sample population and a longer intervention period would be necessary in order to demonstrate significant clinical improvements.

General tips

To weed out the worst offenders for blood sugar spikes, you should refer to the glycaemic index (GI).

The glycaemic index (GI) is a rating system for foods containing carbohydrates.

What is type 2 diabetes? What you need to know

It shows how quickly each food affects your blood sugar (glucose) level when that food is eaten on its own.

Carbohydrate foods that are broken down quickly by your body and cause a rapid increase in blood glucose have a high GI rating.

High GI foods include:

• Sugar and sugary foods
• Sugary soft drinks
• White bread
• Potatoes
• White rice.

Do you have type 2 diabetes?

Many people have type 2 diabetes without realising. This is because symptoms do not necessarily make you feel unwell.

Symptoms include:

• Peeing more than usual, particularly at night
• Feeling thirsty all the time
• Feeling very tired
• Losing weight without trying to
• Itching around your penis or vagina, or repeatedly getting thrush
• Cuts or wounds taking longer to heal
• Blurred vision.

Reference: Daily Express: Adam Chapman

Bowel cancer: Half of us can't identify tell-tale signs despite massive publicity in recent years

A worrying half of UK adults can't identify bowel cancer symptoms when looking at their stools – despite the signs being very well publicised in recent years.

Activist Dame Deborah James has repeatedly spelt out what to look for since being diagnosed with stage four bowel cancer in 2016.

Deborah, who has raised more than £6 million for Cancer Research UK, sadly passed away yesterday (June 28) and even encouraged people to "check their poo - it might just save your life" in a final statement released by her family.

The fact that so many are still unaware of the symptoms is a real concern for health professionals.

The shocking findings were part of Bupa’s 2022 Wellbeing Index, which says 23 per cent of 8,000 surveyed never actually inspect their stools for potential warning signs.

Bupa says around 43,000 in the UK are diagnosed with bowel cancer each year, with some 16,500 unfortunately losing their life to the disease.

The study noted that half (54 per cent) of all bowel cancers are preventable.

The report stated: “If it is caught early, treatment can cure bowel cancer and stop it coming back. However, survival rates decrease dramatically if it’s diagnosed at a later stage”.