Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Ankle fractures
Ankle fractures make up around 7%–9% of all acute sports-related fractures. Given the interest in the sports medicine community about how to support athletes to return to sport following such fractures, a recent systematic review assessed the relevant literature on both operative and non-operative management.1 It identified a high rate of return to sporting activity irrespective of management. Two studies also reported findings which suggest that conservative management, for ‘stable’ undisplaced fracture, may result in a higher proportion of patients returning to sporting activity, more quickly. However, only 13 studies fulfilled the inclusion criteria and methodological quality of the studies was generally poor. Notably, none were randomised controlled trials and the authors highlight that these are now needed to compare conservative with surgical treatment options, for appropriately chosen fracture patterns.
Detecting depression
Depression is one of the commonest conditions treated in primary healthcare (PHC) settings globally and, in systems with well-developed PHC systems, most people with depression are managed in PHC. A research team from Ethiopia recently did a systematic review to synthesise the global evidence on the effectiveness of interventions to improve the detection of depression in PHC.2 Interventions related to implementation of guidelines, screening with feedback, educational interventions that incorporated active learning and clinical practice, and disclosure of screening results were found to be mostly effective. Interventions that combined education, screening, and feedback were particularly more effective. The authors conclude that combining aspects of each type of intervention which are more effective may be useful, although they highlight that few studies to date have been done in low-income countries such as their own.
Laboratory expenditure
In South Africa, like many other countries globally, PHC services have been prioritised, both to contain costs and to improve population health outcomes by improving the quality of healthcare services. To manage laboratory expenditure, South African facility managers are required to use a Laboratory Handbook that indicates the Essential Laboratory List (ELL) tests. A recent study analysed PHC laboratory expenditure to assess the impact of the ELL in South Africa and found that compliance ranged from 97.9% to 99.2% for clinics, community healthcare centres, and community day centres.3 Their findings demonstrate the value of a national ELL-aligned standardised laboratory request form for PHC services, although they also highlight the need for better monitoring for poor-performing facilities.
Donald Trump
On 6 January 2021, rioters stormed the US Capitol in an effort to overturn the congressional certification of Joseph Biden as the 46th president of the US, urged on by a speech by the former president, Donald Trump. Mindful that the wide publicity around this event changed the nation’s sociopolitical context, a Californian research team examined whether it corresponded with an increase in mental health symptoms and whether this relation differed by individual political party affiliation.4
Using the Understanding America Study, a nationally representative panel of adults, they found a modest increase above expected levels in mental health symptoms immediately following the Capitol Riot. Democrats showed the greatest increase of mental health symptoms, supporting notions of political polarisation and allegiance. The authors conclude that social and political events of national importance may adversely affect the mental health of specific subpopulations.
Podcast of the month
If you think you know about the origins of COVID-19, you might be surprised by what you hear on the podcast Fever: the Hunt for Covid’s Origin: https://www.bbc.co.uk/programmes/m001mdfw
REFERENCES
- 1.Sinha A, Robertson G, Maffulli N. Doctor, I fractured my ankle. When can I return to play? An updated systematic review. Br Med Bull. 2022;143(1):35–45. doi: 10.1093/bmb/ldac016. [DOI] [PMC free article] [PubMed] [Google Scholar]
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