Surveying NCDs in prison populations

There are over 10 million prisoners across the world and in the UK there is a rising number of older people in secure environments with little research on chronic diseases. Wright and colleagues surveyed prisoners in two English prisons and cross-checked reported conditions with medical records. They found 46% reported at least one non-communicable disease (NCD) and 26% reported at least one physical health condition. The most common conditions were anxiety and depression, respiratory disease, and hypertension. The prison population presents unique demands given the cornerstone of management, behavioural change, may be hampered by fixed diets and limitations on physical activity.

Improving cancer survival in rural communities

People living in rural areas are more likely to die of cancer than those in cities. Murchie and colleagues highlight the lack of evidence for the cause of these poorer outcomes. This stark inequality is seen throughout the world but the move towards ‘big data’ may obscure rather than illuminate. The scale of rurality in Australia or Canada is not easily compared with western Europe and cultural factors add further complications. Smaller local studies that harness technology and use mixed research methods will be needed to unpick the anthropological and topographical granularity inherent in these remote communities.

Auditing high-dose opioid prescribing

More people are being prescribed opioids at higher doses for chronic pain despite limited evidence of effectiveness. In a Practice & Policy article Bastable and Rann report on an evaluation of high-dose opioid use in one region of the NHS. They audited the prescribing of high-dose opioids for chronic pain and found a prevalence of 0.13%. They noted significant variation between practices and co-prescribing of dependence forming medications was common at 13-14% for benzodiazepines and gabapentinoids were co-prescribed in 42% of patients.  The challenges of de-prescribing were recognised and the authors advocate treating high-dose opioids like any other high-risk drug.