The geographical distribution of exercise classes for older people
In 2019 in the UK, an estimated 885,000 people were living with dementia. Although people can still live well with dementia, exercise is one of the approaches that can help both with the management of symptoms and sustaining independence. Even though many exercise classes for older people take place across the UK, there is limited information about the geographical distribution of these classes.
In this study, Long et al (2023) aimed to investigate the location of exercise classes in the UK region of the East Midlands and how they are distributed in relation to siting, population age, socio-economic status, and population density. This would allow the effective planning of the location of classes to enable improved access for the population they are designed for.
The authors used a geographic information software system that allows data input, storage, mapping, and spatial analysis, and identified 520 exercise classes, evenly spread across the region, including areas of socio-economic deprivation. A total of 471 (90%) classes were in urban areas; 428 (80%) in areas where fewer than 20% of the population was over 65 years of age; and only 13 (2%) stated that they were suitable for people with dementia. The study concludes that ‘[p]eople living with dementia are less likely than older people without dementia to have access to exercise classes.’
Homelessness and primary care: problems and solutions
Huey (2023) indicates that homelessness can include ‘sofa surfing’, living in temporary accommodation, experiencing domestic violence, living under threat of eviction, and living in housing unfit for purpose. Homelessness should matter in primary care, asserts the author, citing research showing that 50% of health outcomes are determined by social conditions (40%) and by the physical environment (10%). With homelessness one of the most extreme forms of deprivation, it is in the interests of clinicians to engage with homelessness prevention strategies to prevent morbidity in their patient groups.
Huey (2023) notes that the British Medical Association advises that homeless patients should be able to register at any GP practice without proof of identification or address and that practice staff ‘are not expected to act as immigration officials.’ The paper describes common presentations of people experiencing homelessness and cites research showing that homeless people and those at-risk present to their GPs when they have access, ‘making primary care an ideal setting for identification of housing concerns and referral to appropriate services.’
Further, it is recommended that GPs should consider asking patients about their housing when they harbour concerns, be aware of local housing authority referral processes; and be able to signpost to local organisations that offer support.
Inequalities in children's mental health before and during the pandemic
Miall et al (2023) note that in the UK, children who have grown up in poverty are over three times more likely to experience mental health problems by age 14 years compared to those who have never experienced poverty. In 2020/2021, the COVID-19 pandemic saw disruption of children's social environments, including school closures and a bleak economic outlook.
Miall et al (2023) undertook to determine whether child mental health inequalities changed in 2020/2021 compared with the pre-pandemic situation, by analysing 16 361 observations from 9272 children in the population representative UK Household Longitudinal Study. The study found that children with coupled, well-educated, employed parents and higher household income experienced greater mental health declines during the pandemic than less advantaged groups, leading to narrowed inequalities. Whereas during the pre-COVID-19 period, disadvantaged groups generally had worse mental health than more advantaged groups, during the pandemic, ‘many of these inequalities narrowed as the mental health of children in more advantaged groups saw greater deteriorations.’ There is an urgent need, conclude the authors, for interventions to improve child mental health across all groups, ‘while seeking to maintain the narrower inequalities observed during the first year of the pandemic via upstream policies to reduce socioeconomic disadvantage.’
Ultra-processed food intake is associated with non-alcoholic fatty liver diseaseThe non-alcoholic fatty liver disease (NAFLD) spectrum ranges from the accumulation of liver fat (hepatic steatosis) and inflammatory hepatitis (non-alcoholic steatohepatitis) to end-stage liver disease with fibrosis, cirrhosis, and hepatocellular carcinoma. This is cited by Henney et al (2023) who note that the hepatic component of metabolic syndrome is associated with related diseases like type 2 diabetes and obesity.In this systematic review and meta-analysis, Henney et al (2023) aimed to determine the contribution of ultra-processed food (UPF) consumption to the risk of developing NAFLD. The authors evaluated nine studies and demonstrated a striking association between the consumption of UPFs and the development of NAFLD, with a clear dose–response relationship. Further ‘[t]he risk of NAFLD increases in proportion to the quantity of UPF consumption’, and the association is probably multi-factorial and related to a diversity of possible mechanisms including increased total daily energy intake, adverse macronutrient and micronutrient composition, additional harmful additive chemicals during the processing stage and the presence of other lifestyle-related factors such as lack of exercise.The authors suggest that their findings provide evidence supportive of public health policies in relation to dietary advice in this increasingly prevalent disease.