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The ‘Lancet Commission on the Value of Death’ proposes radical change and challenges the very core of hospice service provision. Without action, inequalities in access to hospice care will continue to be amplified. The COVID-19 pandemic brought increased needs and demands in the community setting but also provided opportunities for new palliative partnerships and ways of working. Returning to the status quo should not be an option. Rather moving towards a shared vision and purpose, which has the person and their community network at its centre, enables hospices to have a pivotal role and bring about more equitable palliative care.

Objective: To explore the relationship between frequency of walking trips, perceptions of the local environment and individual travel preferences in children. Design: Cross-sectional questionnaire-based study. Setting: Six primary schools in Birmingham, UK, range of socioeconomic classifications. Participants: 473 children aged 9–11 years (82% response rate), including 250 (52.9%) boys and 160 (33.8%) from ethnic minority populations. Outcome measures: The primary outcome measure was level of walking (high or low) based on self-reported walking frequency in the past week. Secondary outcome measures included child perceptions of seven aspects of the local environment and individual travel preference. All outcomes were measured through questionnaires administered at school in the presence of a researcher. Results: 198 (41.9%) children were classified as high walkers and 275 (58.1%) as low walkers. After adjusting for confounding factors, high walkers were more likely to perceive heavy traffic surrounding their homes (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.03 to 2.33), unsafe streets (OR 1.88, 95% CI 1.27 to 2.80) and prefer healthier modes of travel (OR 1.67, 95% CI 2.56 to 1.08). High walkers were less likely to worry about strangers (OR 0.66, 95% CI 0.45 to 1.02) and less likely to report no parks or sports grounds nearby (OR 0.66, 95% CI 0.42 to 1.02). Children from ethnic minority groups walked significantly less than white children (mean number of walking trips 16.8 and 21.9, respectively, p Conclusions: Certain environmental perceptions are related to walking levels in children. Awareness of these may help in the development of future interventions, and also enable healthcare professionals to encourage walking by providing case-specific and appropriate advice.

The frequency distribution of serum thyroid stimulating hormone (TSH) shows a skewed pattern that may change with age. The set point of the hypothalamic-pituitary-thyroid axis for an individual is thought to be genetically determined and has been described as a log-linear relationship of serum TSH to free thyroxine (T4); however, the validity of this hypothesis has yet to be established in older people. The aim of the study was to describe the relationship between serum TSH and free T4 in older people and define factors influencing this relationship. We conducted a cross-sectional, observational study of thyroid function in a community population of older subjects over 65 years of age. The relationship between serum TSH and free T4 was not linear as previously described, but is best described as a fourth-order polynomial. Both gender and smoking status affected the relationship. This suggests that more complex modelling is required when investigating the hypothalamic-pituitary- thyroid axis.

Introduction To determine benefits of healing therapy as an adjunct to conventional management in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Methods : 200 outpatients with IBS or IBD were randomised to either conventional treatment or conventional plus 5 sessions of healing therapy. After 12 weeks Controls also had healing therapy. Outcomes used were, the Measure Yourself Medical Outcomes Profile (MYMOP). IBS-QOL and IBDQ and symptom measures. Results There was a significant improvement in the MYMOP score at week 6 (p Conclusion The addition of healing therapy in IBS was associated with improvements in symptoms and QoL in IBS, and to a lesser extent in IBD. Disclosure of Interest None Declared

Objective: To determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia. Design: Randomised controlled trial. Setting: 31 UK primary care centres. Participants: 478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration. Interventions: Near patient testing for H pylori and open access endoscopy for patients with positive results. Control patients received acid suppressing drugs or specialist referral at general practitioner9s discretion. Main outcome measures: Cost effectiveness based on improvement in symptoms and use of resources at 12 months; quality of life. Results: 40% of the study group tested positive for H pylori. 45% of study patients had endoscopy compared with 25% of controls. More peptic ulcers were diagnosed in the study group (7.4% v 2.1%, P=0.011). Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups. No significant differences were observed in rates of prescribing, consultation, or referral. Costs were higher in the study group (£367.85 v £253.16 per patient). Conclusions: The test and endoscopy strategy increases endoscopy rates over usual practice in primary care. The additional cost is not offset by benefits in symptom relief or quality of life. What is already known on this topic Patients younger than 50 without H pylori infection are unlikely to have treatable disease detected at endoscopy Such patients can be managed by acid suppression and reassurance alone Test and endoscopy (referral of patients testing positive for H pyloriin primary care) has been recommended as a way to reduce endoscopic workload What this paper adds Applying a test and endoscopy strategy increased the endoscopy referral rate from 25% to 40% The strategy produced no significant differences in symptoms or quality of life compared with usual management The increased costs of this strategy cannot be justified