New study on health-related causes of gambling in older adults

Courtesy of Wellcome Images

Courtesy of Wellcome Images

Dr Julie Pattinson from the Community and Health Research Unit (CaHRU) at University of Lincoln, recently published an article in the Journal of Behavioral Addictions. The article, entitled ‘Age-related physical and psychological vulnerability as pathways to problem gambling in older adults’, was co-authored by, Dr Adrian Parke, University of Lincoln, Professor Mark Griffiths, Nottingham Trent University and Dr David Keatley, University of Lincoln. This is Julie’s third publication following her PhD thesis on ‘British older adult gambling behaviour; evaluating psychological and physical health as predictive risk for problem gambling.’

JuliePattinsonThe study background discussed clinical treatment and preventative efforts, and highlights the need to understand the pathways to late-life gambling disorder. The study assesses the association between age-related physical health, social networks, and problem gambling in adults aged over 65 years and assesses the mediating role of affective disorders in this association. In total, 595 older adults aged 64-94 years were interviewed using a structured questionnaire to assess physical frailty, geriatric pain, loneliness, geriatric depression, geriatric anxiety, and problem gambling.

Courtesy of Wellcome Images

Courtesy of Wellcome Images

Pathway analysis demonstrated associations between these variables and gambling problems, providing a good fit for the data, but these relationships were mediated by both anxiety and depression symptoms. The study indicated that late-life problem gambling may develop as vulnerable individuals gamble to escape anxiety and depression consequent upon deteriorating physical well-being and social support. Furthermore, when individuals develop late-life problem gambling, it is recommended that the treatment primarily focuses upon targeting and replacing avoidant coping approaches. Full text available at:

By Dr Julie Pattinson

Comparing national multimorbidity policies and guidelines

CaHRU_logotypePeople living with a long-term condition often have more than one condition to contend with. This is known as ‘multimorbidity’, commonly defined as the co-occurrence of two or more chronic conditions within one person. In this situation it is important that the person, not the disease, is the focus. Policies referring to multimorbidity are considered a crucial element in safe health systems.

NadeekaChandraratneThe CaHRU team of Dr Nadeeka Chandraratne and Dr Ravindra Pathirathna, international visiting fellows attached to CaHRU from the Postgraduate Institute of Medicine at the University of Colombo, Sri Lanka, together with Prof Niro Siriwardena and Dr Christopher Harrison from the University of Sydney conducted a content analysis of policy documents and guidelines on multimorbidity from the UK, Australia and Sri Lanka. Despite considerable differences in healthcare structure and financing, all three countries face the challenge of multimorbidity. An understanding of how each country is addressing this challenge was considered important for identifying policy initiatives, gaps and opportunities for further improvement.

RavindraPathirathneThe article describing the study and its findings, ‘A comparison of policies and guidelines related to multimorbidity in the UK, Australia and Sri Lanka‘, was published this month in the first issue of the Australian Journal of General Practice 2018 with an accompanying editorial on Multimorbidity written by Niro Siriwardena and Christopher Harrison.

The team found overall a lack of health policy and guidance for multimorbidity: the guideline ‘Multimorbidity: Clinical assessment and management’ from The National Institute for Health and Care Excellence (NICE), UK was the only specific guideline on multimorbidity. Australia and Sri Lanka lack specific national documents addressing multimorbidity. The promising features observed in Australia were policies that are directly concerned with the health of socially disadvantaged groups, which are at higher risk of multimorbidity. Policies in Sri Lanka were more concerned with preventing chronic conditions, and on community mobilisation and empowerment.

lilyThe paper highlights that Sri Lanka needs to focus on policies that emphasise integration and patient-centred healthcare delivery for people with multimorbidity, whereas in the UK and Australia, policies on community-based approaches to address determinants of multimorbidity are needed.

By Dr. Nadeeka Chandraratne

New study by Jolien Vos from CaHRU on recording sexual health information in primary care

BPrevention through identifying risk factors and health promotion to address these is becoming standard practice, for example in programs supporting patients to stop smoking. However, some risk factors such as sexual behaviour, cannot be easily assessed, are more difficult to measure and less likely to be recorded. Potentially risky sexual behaviour is sensitive information which is more difficult to classify as present or absent, but is still important in assessing a person’s overall health risk. Previous research indicates that although patients prefer to discuss sexual health issues with GPs compared to other healthcare workers, patients often wait for a sign from their GPs before discussing this intimate subject whereas GPs usually wait for a sign from the patient.

Jolien VosThis was confirmed in a recently study, ‘Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)‘, published in Primary Care Research and Development, with lead author Jolien Vos, who is a graduate research assistant at CaHRU. The study team interviewed 13 GPs in Flanders (Belgium) who had experience with HIV patients. The interviews explored what GPs considered to be ‘risk factors’ in terms of sexually risky behaviour as well as how they collected, discussed and registered this information.

CaHRU_logotypeThe study revealed that although participating GPs said that they felt comfortable discussing sexual health with patients, they assumed that patients would not feel at ease with this. GPs felt that waiting for the patient to initiate the discussion would mean that it would only take place when a problem had already occurred. Sexual orientation was often seen as an indicator for GPs to be cautious when enquiring about sexual risk behaviour. The GPs emphasised the importance of discussing sexual health and the need for guidance on recording information sexual risky behaviour more systematically, to support continuity of care while maintaining privacy of sensitive patient data in a country where patients are free to move GP and general practices are becoming more multidisciplinary.

International media coverage for research linking flu vaccine with reduced risk of stroke

ipvastia_wordcloudA study from CaHRU, ‘Influenza vaccination and risk of stroke: self-controlled case-series study‘, recently published in the journal Vaccine, received international coverage in news media. The study of almost 18,000 patients with stroke looked at data from general practices in England using a self-controlled case series analysis, and showed that the risk of suffering a stroke is significantly reduced for up to two months after receiving a flu vaccine.

ipvastia_teamThe lead author was Dr Zahid Asghar, who conducted the research together with Prof Niro Siriwardena (both from CaHRU) and Dr Carol Coupland (from Nottingham University School of Community Health Sciences). This is the fourth in a series of studies over the past 10 years looking at the link between flu vaccination and reduction in risk of heart attack and stroke.

ipvastia_mediamapThe coverage included articles in The Times, Sun and Scottish Sun newspapers, BBC television and radio and online media outlets in the US, Middle East, Asia, Australasia and South America. The team are now designing future studies to explore the potential for flu vaccination to reduce risk of heart attack and stroke.

New study from CaHRU shows link between flu vaccination and reduction in stroke

ipvastia_team2The latest study from CaHRU is published online in Vaccine this month. The study, ‘Influenza vaccine and risk of stroke: self-controlled case series study‘, was co-authored by Dr Zahid Asghar and Professor Niro Siriwardena from CaHRU together with Carol Coupland, professor of medical statistics at Nottingham University. The study used a self-controlled case series design with data from the General Practice Research Database (GPRD) on adult patients aged 18 years and above with fatal or non-fatal stroke during 8 years from September 2001 to May 2009.

h1n1Statistical analysis was used to compute incidence of stroke after flu vaccination compared with incidence during a baseline period in almost 18000 people who received one or more influenza vaccinations and experienced a first stroke during the observation period. The incidence (incidence rate ratio: IRR) of stroke was significantly reduced in the first 59 days following flu vaccination compared with the baseline period. We found reductions in stroke incidence of 55% in the first 1–3 days after vaccination, 36% at 4–7 days, 30% at 8–14 days, 24% at 15–28 days and 17% at 29–59 days after vaccination. Early vaccination between 1 September and 15 November was associated with a greater reduction in incidence of stroke compared to later vaccination given after mid-November.

Flu vaccination was associated with a reduction in incidence of stroke, which confirms findings from previous studies showing possible protective effects of flu vaccination for both heart attack and stroke. This association needs further confirmation with experimental (randomised controlled) trials.