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In the news

Drugs to curb excess stomach acid may be linked to heightened risk of death

3 Jul, 17 | by Emma Gray

May be time to restrict use of widely available proton pump inhibitors, say researchers

Proton pump inhibitors (PPIs)—a widely available class of drug designed to curb excess stomach acid production—may be linked to a heightened risk of death, indicates research published in the online journal BMJ Open.

Given how widely available these drugs are, and the accumulating evidence pointing to links with a range of potentially serious side effects, it may be time to restrict the indications for use and duration of treatment with PPIs, suggest the researchers.

Recent research has indicated a link between PPI use and a heightened risk of chronic kidney disease/kidney disease progression, dementia, C difficile infections, and bone fractures in people with brittle bone disease (osteoporosis).

Although far from conclusive, emerging evidence suggests that PPIs may boost the risk of tissue damage arising from normal cellular processes, known as oxidative stress, as well as the shortening of telomeres, which sit on the end of chromosomes and perform a role similar to the plastic tips on the end of shoelaces.

The researchers base their findings on national US data obtained from a network of integrated healthcare systems involving more than 6 million people whose health was tracked for an average of almost six years—until 2013 or death, whichever came first.

They carried out three comparative analyses: those taking PPIs with those taking another type of drug used to dampen down acid production called histamine H2 receptor antagonists or H2 blockers for short  (349, 312 people); users and non-users of PPIs (3,288,092 people);  and users of PPIs with people taking neither PPIs nor H2 blockers.

Compared with H2 blocker use, PPI use was associated with a 25% heightened risk of death from all causes, a risk that increased the longer PPIs were taken.

The other analyses revealed a similar level of risk between users and non-users of PPIs and between those taking PPIs and those taking no acid suppressant drugs.

The risk of death was also heightened among those who were taking PPIs despite having no appropriate medical indication for their use, such as ulcers, H pylori infection, Barrett’s oesophagus (pre-cancerous changes to the food pipe) and gullet (oesophageal) cancer.

This is an observational study, so no firm conclusions can be drawn about cause and effect, added to which participants were mostly older white US veterans, possibly limiting the wider applicability of the findings. Nor were the researchers able to obtain information on the causes of death.

Although there is no obvious biological explanation for their findings, the researchers nevertheless suggest that the consistency of their results and the growing body of evidence linking PPI use with a range of side effects is “compelling.”

They write: “Although our results should not deter prescription and use of PPIs where medically indicated, they may be used to encourage and promote pharmacovigilance [monitoring the side-effects of licensed drugs] and [they] emphasise the need to exercise judicious use of PPIs and limit use and duration of therapy to instances where there is a clear medical indication and where benefit outweighs potential risk.”

Study reveals lack of supporting evidence for claims about fertility treatments

28 Nov, 16 | by Emma Gray

Many claims made by UK fertility clinics about the benefits of treatments beyond standard IVF procedures are not backed up by evidence, finds a study published in the online journal BMJ Open.

These can range from £50 for a single screening blood test to as much as £8000 for egg freezing packages.

The researchers, led by Professor Carl Heneghan at Oxford University’s Centre for Evidence Based Medicine (CEBM), say “there is a need for more information on interventions to be made available by fertility centres, to support well informed treatment decisions.”

The findings will be part of a Panorama undercover investigation broadcast on Monday 28 November at 8.30pm on BBC One.

Infertility is a significant problem, affecting about 1 in 7 UK couples, many of whom seek medical help to have a child.

UK fertility centres are regulated by the Human Fertilisation and Embryology Authority (HFEA). But despite this regulation it has been suggested that some of the treatments offered on top of routine IVF might not be evidence based, are costly, and some clinics might be using techniques that have not been stringently tested.

So the researchers set out to record claims of benefit for treatments offered on top of standard IVF by UK fertility centre websites – and identify the evidence used to support these claims.

A total of 74 fertility centre websites, incorporating 1401 web pages were examined for claims. The team found 276 claims of benefit relating to 41 different fertility interventions made by 60 of the 74 centres.

79 (29%) of the claims included numbers to explain the chances of improved fertility outcomes, but the team identified only 13 websites where any references were included, which referred to just 16 published references. Of these 16 references, only five were high level systematic review evidence.

The authors point to some study limitations, but say it is unlikely that a repeat of their analysis would change the pattern of findings substantially.

“Our findings demonstrate that whilst many claims were made on the benefits of fertility treatments, there was a lack of supporting evidence cited, with the majority of the websites providing no sources for claims made,” they conclude.

In a linked analysis published by The BMJ, Professor Heneghan and colleagues searched for evidence to support 38 interventions offered by UK fertility centres on top of standard IVF, focusing on the key outcome of live birth rates.

They found that most treatments are not supported by good evidence. The National Institute for Health and Care Excellence (NICE) provides clear advice on only 13 (34%) of the 38 interventions investigated, and systematic reviews (the highest level of available evidence) were available for only 27.

They also found that information on harms is often poorly reported.

People seeking fertility treatment need good quality evidence to make informed choices, they write. The current approach by HFEA leaves patients and clinicians to seek evidence for themselves or from staff in private clinics selling fertility services.

“We do not believe this approach is realistic.”

They say there is “an urgent need for randomised controlled trials for many interventions that are currently being offered” and call for changes in guidance to help couples make informed decisions.

Panorama: Inside Britain’s Fertility Business will be broadcast on Monday 28 November at 8:30pm on BBC One

BBC Panorama will reveal that 26 out of 27 so-called “add-on” treatments being offered by UK fertility clinics have no good scientific evidence from trials that they improve the chance of having a baby.  Some may even be harmful.

“Add-on” treatments include things like additional procedures, additional drugs or devices to house an embryo. They can cost anywhere between £100 and £3000 on top of standard fertility care.

Panorama commissioned Oxford University’s Centre for Evidence-Based Medicine to do the research, which has taken almost a year to complete.  

Researchers identified 27 treatments on offer at UK fertility clinics they considered to be “add-ons”.

Only one treatment – called endometrial scratch – had even moderate quality evidence that shows an increase in the chances of a baby with standard fertility care like IVF.  There are still question marks over the evidence for that treatment.  Due to its limitations the researchers noted there is currently a randomised trial ongoing in the UK to determine its effectiveness.  

One “add-on” treatment called Preimplantation Genetic Screening (PGS) tests embryos for abnormalities. A trial in 2007 discovered that an earlier version of this process may have lowered birth rates.  

Many clinics sell newer, more accurate versions, in some cases for up to £3000.  Initial research looks promising and randomised trials are underway, but as yet there is no high quality evidence from robust trials that these new versions improve your chances of having a baby.

Panorama found evidence that, when marketing this add-on treatment, not all clinics are giving patients the full picture to enable them to make a properly informed decision.  

A Panorama reporter went to a fertility fair in November last year and was not given the full picture about the evidence for PGS by every one of clinics she spoke to.

She approached staff from 18 British and foreign clinics at random, asking if PGS would improve her chances on top of IVF.  She told them she was 38 and had been trying for a baby for a year without success.

Five of the 18 clinics were positive about the treatment. Eight said they would only offer it to women over the age of 40 or those who had experienced repeated IVF failures.  There is currently no good scientific evidence from trials that it can increase the birth rate among women in these categories.

Only five clinics gave the full picture, saying that they would not recommend PGS because it lacked evidence.

Pre-teens whose dads embrace parenthood may be less prone to behavioural issues

22 Nov, 16 | by Emma Gray

How new fathers see themselves in child’s early years seems to be most influential

Kids whose dads adjust well to parenthood and feel confident about their new role may be less likely to have behavioural problems in the run-up to their teens, indicates research published in the online journal BMJ Open.

It’s how fathers see themselves as parents in the child’s early years, rather than the amount of direct childcare they give, that seems to be important, the findings suggest.

The nature of parenting in a child’s early years is thought to influence their short and long term wellbeing and mental health, which are in turn linked to development and educational attainment.

But it’s not entirely clear what impact the father’s role might have, as much of the research to date has tended to characterise paternal involvement in a child’s upbringing as one dimensional.

The researchers therefore drew on data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, which has been tracking the health of nearly 15,000 children since birth, to assess several aspects of paternal involvement.

The parents of 10,440 children who were living with both their mum and dad at the age of 8 months were asked to complete a comprehensive questionnaire about their and their child’s mental health; their attitudes to parenting; time spent on childcare; their child’s behaviour and development; as well as details of household income/education.

When the children were aged 9 and 11, their behaviour was assessed using the strength and difficulties questionnaire (SDQ). This covers emotional symptoms, behaviour (conduct) problems, hyperactivity, peer relationship issues, and helpfulness (pro-social behaviour).

Fathers’ parental involvement was measured by asking them to rate their level of agreement with 58 statements, reflecting the amount of direct childcare they engaged in, including household chores; their attitudes to parenting; the relationship with their child; and how they felt about the birth 8 weeks and 8 months afterwards.

The final analysis was based on almost 7000 9 year olds and nearly 6500 of the same children at the age of 11.

Three key factors emerged in relation to the children’s SDQ scores: (1)  fathers’ emotional response to the baby and their parenting role; (2) how much time the dads spent on direct childcare; and (3) how well they adjusted to their new role, including how confident they felt in their abilities as a parent and partner.

But emotional response and confidence in their new role were most strongly associated with lower odds of behavioural problems when their children reached 9 and 11 years of age.

A high paternal factor 1 score was associated with 21% and 19% lower odds of a higher SDQ score at the ages of 9 and 11, respectively. Similarly, a high paternal factor 3 score was associated with 28% lower odds of a higher SDQ score at both time points.

After taking account of potentially influential factors, such as age at fatherhood, educational attainment and household income, hours worked, and sex of the child, every unit increase in factor 1 scores was associated with 15% lower odds of behavioural problems at the age of 9 and 12% lower odds at the age of 11, compared with kids of the same age, sex, and family background.

Similarly, every unit increase in factor 3 scores was associated with 12% lower odds at the age of 9, and 10% lower odds at the age of 11.

This is an observational study so no firm conclusions can be drawn about cause and effect, and as the researchers note, the study dates back 25 years, since when parenting styles may have changed, so the findings may therefore not be widely generalisable.

But they write: “The findings of this research study suggest that it is psychological and emotional aspects of paternal involvement in a child’s infancy that are most powerful in influencing later child behaviour, and not the amount of time that fathers are engaged in childcare or domestic tasks in the household.”

London 2012 Olympics inspired many local kids to get more involved in sport

22 Nov, 16 | by Emma Gray

But levels of physical fitness significantly worsened

The London 2012 Olympic Games inspired many local children to get more involved in sport, reveal the results of a before and after study, published in the online journal BMJ Open.

But this inspiration did not translate into improved physical fitness, levels of which declined significantly in the aftermath of the event, the findings indicate.

When Britain was awarded host status for the Olympic Games in London 2012 in 2005, this was based on a bid which promised to “inspire a generation” and “create a legacy of sport and healthy living,” despite there being no evidence of any such outcome from previous events of this kind, say the researchers.

The Active People Survey showed an initial increase of around half a million adults participating in a weekly 30 minute session of sporting activities between April 2012 and April 2013.

But the data indicate that since then, the number of 16-25 year olds doing this has fallen, a trend that has continued, say the researchers.

To find out if London 2012 was associated with increased levels of physical activity, physical fitness and changes in body mass index (BMI), the researchers carried out a before and after study among pupils at six schools within a 50 km radius of the Olympic park in East London.

Some 733 children between the ages of 10 and 16 were assessed in 2008-9, up to 3+years before London 2012, and 931 from the same schools in 2013-14, up to 18 months afterwards.

At both time points they were quizzed about how much inspiration they took from the Games, and how much physical activity they did. Their cardiorespiratory fitness was assessed in a 20 metre shuttle run by peak V02—a measure of oxygen uptake that is linked to the capacity to perform sustained exercise.

Over half (53%) of the children said London 2012 had inspired them to try new sports/ activities.

Children who continued to take part in sports/activities in the 18 months after London 2012 were more active and fitter than those who didn’t. And average BMI was also lower among the girls.

Compared with those who said they weren’t inspired by the Olympics, peak V02 was higher among those who continued to participate in sports/activities 18 months after London 2012.

This 45% of the sample was also more physically active than those who said they were not inspired, or had been only briefly inspired, by London 2012.

But peak V02 was significantly lower after London 2012 than it had been before among all the children. This is a cause for concern as low levels of cardiorespiratory fitness in childhood are associated with a heightened risk of metabolic disorders in adulthood, say the researchers.

This is an observational study so no firm conclusions can be drawn about cause and effect. Furthermore, the researchers caution that they cannot discount the possibility that the children who had been inspired by the Olympics might already have been fitter and more active, or that other factors might have offset any fitness benefits arising from London 2012.

And the true scale of the legacy may never be known due to the lack of any appropriate measures to monitor changes associated with events like London 2012, they point out.

“High levels of inspiration to participate in new activities reported following London 2012 and positive associations with fitness are encouraging…[But] these associations must be interpreted in the context of the significant declines in fitness shown by our repeated cross-sectional comparison,” they write.

“The cost of hosting future mega-events cannot be justified based on the assumption that they will automatically produce health related benefits,” they add.

‘Worried well’ may be boosting their risk of heart disease

3 Nov, 16 | by Emma Gray

Potential consequences of health anxiety underlines need to treat it, say researchers

People who needlessly worry that they have, or will develop, serious illness—popularly referred to as ‘the worried well’—may be boosting their risk of developing heart disease, suggests research published in the online journal BMJ Open.

Anxiety is a known risk factor for heart disease. And health anxiety, which describes persistent preoccupation with having or acquiring a serious illness, and seeking prompt medical advice, on the basis of misattributed bodily symptoms in the absence of any physical disease, seems to be no exception, say the researchers.

And as such, it needs to be taken seriously and treated properly, they suggest.

They base their findings on 7052 participants of the Norwegian Hordaland Health Study (HUSK), a long term collaborative research project between the National Health Screening Service, the University of Bergen, and local health services.

The participants, all of whom were born between 1953 and 1957, filled in two questionnaires about their health, lifestyle, and educational attainment. And they had a physical check-up, consisting of blood tests, weight, height, and blood pressure measurements, taken between 1997 and 1999.

Levels of health anxiety were assessed using a validated scale (Whiteley Index), comprising 14 items scored from 1-5. Those (710) whose total score amounted to 31 or more were in the top 10% of the sample and considered to have health anxiety.

The heart health of all the participants was subsequently tracked using national data on hospital treatment episodes and death certification up to the end of 2009.

Anyone who received treatment for, or whose death was linked to, coronary artery disease occurring within a year of entering the study, was excluded, on the grounds that they might already have been ill.

In all, 234 (3.3%) of the entire sample had an ischaemic event—a heart attack or bout of acute angina—during the monitoring period, with the average time to the first incident just over 7 years.

But the proportion of those succumbing to heart disease was twice as high (just over 6%) among those who displayed health anxiety as it was among those who didn’t (3%).

While established risk factors for heart disease explained part of the association found, health anxiety was still linked to a heightened risk, after taking account of other potentially influential factors.

Those with health anxiety at the start of the study were 73% more likely to develop heart disease than those who weren’t in this state of mind, the analysis showed. And the higher the Whiteley Index score, the greater was the risk of developing heart disease.

This is an observational study, so no firm conclusions can be drawn about cause and effect, added to which the researchers admit that health anxiety often exists alongside other mental health issues, such as general anxiety and depression, making it hard to differentiate.

But the findings back current thinking on the potentially harmful effects of anxiety on health, they say.

“[Our research] further indicates that characteristic behaviour among persons with health anxiety, such as monitoring and frequent check-ups of symptoms, does not reduce the risk of [coronary heart disease] events,” they write.

If anything, putting the body on a permanent state of high alert may have the opposite effect, they suggest.

“These findings illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of [coronary artery disease],” they conclude.

The findings “underline the importance of proper diagnosis and treatment of health anxiety,” they add.

Current system unlikely to pick up surgeons with above average patient death rates

31 Oct, 16 | by Emma Gray

Performance within ‘expected’ range not good enough to detect outliers, say researchers

Publishing the patient death rates of individual surgeons in England is unlikely to pick up those whose mortality rates are above average, because the caseload varies so much, concludes the first analysis of its kind published in the online journal BMJ Open.  

Performance within the ‘expected’ range is too crude a measure to detect doctors whose practice might be a cause for concern, and is therefore creating a false sense of security, say the researchers.

When the patient death rates for individual surgeons were first published in June 2013, the move was hailed as a major breakthrough in transparency that would drive up standards of care in England.

But the chances of detecting a surgeon whose death rates are worse than the national average is a question of statistical power, say the researchers: in other words, the greater the caseload, the greater the ability to detect worrying trends.

To assess how reliable the available data for individual surgeons are, the researchers reviewed the outcomes for three common high risk procedures—bowel surgery, gullet surgery, and planned aortic aneurysm repair—and three common low risk procedures—hip replacement, bariatric surgery, and thyroid removal.

And they analysed every surgeon’s caseload for each of the procedures, all of which were carried out between 2010 and 2014 across England.

They focused in particular on how well these data would be able to detect a surgeon whose patient death rate in hospital or within 30 or 90 days of the patient’s discharge was between two and five times higher than the national average.

Unsurprisingly, the higher risk procedures were associated with a higher death rate of between 2.2-4.5% while the lower risk ones were associated with a death rate of 0.07-0.4%.

But caseload was an issue. For example, the average number of bowel surgery operations carried out by individual surgeons was 55 over three years, but ranged from just 3 to 237.

With an average national 90 day death rate of 3%, the national average of 55 cases provides 20% statistical power to detect a mortality rate three times the national average. That means that around 20 out of 100 individual surgeons with an actual death rate of 9% would fall outside the expected range.

But the caseload would have to be more than 200 to provide 90% statistical power of detecting a surgeon whose 90 day mortality rate is three times the national average.

Similar findings emerged for gullet surgery, where the average number of procedures was 23 over a two year period, but ranged from 10 to 81.

Based on national 30 day death rates of 2.4%, the average number of cases would provide less than 20% statistical power to detect a surgeon with a patient death rate four times the national average.

And a caseload of 300 procedures would be needed to provide 80% statistical power to detect a 90 day mortality rate twice as high as the national average over two years.

For low risk procedures, the national average caseload ranged from 48 to 75 per surgeon, meaning that fewer than 20 out of 100 surgeons with an actual mortality rate five times the national average would be picked up.

For hip replacements, for example, an annual caseload of more than 500 cases would be needed to provide 80% statistical power to pick up just one individual with a mortality rate five times the national average.

At these kinds of rates it is unlikely that a surgeon would ever perform enough procedures in his/her entire career for a mortality rate five times the national average to be detected, say the researchers.

“On the basis of these rates and published case volumes, surgeons with mortality rates in excess of that expected are highly unlikely to be detected,” they write. “Performance within an expected mortality rate range cannot therefore be considered reliable evidence of acceptable performance.”

More meaningful outcome measures are required, they say. These could include patient satisfaction, the ease with which routine daily tasks can be performed (functional health status), and other health related quality of life indicators.

And an individual’s performance could be addressed by regular internal appraisal and feedback from multiple sources, they suggest.

Interpreting performance data for individual surgeons has major implications for patient care, the individual practitioner, and their employer, they emphasise

But they conclude: “This analysis demonstrates that, for these common procedures, mortality rates are not a robust method for detecting divergent practice. It is not surprising that the performance of all but one surgeon across all six procedures was found to be acceptable.”

Women catching up with men in alcohol consumption and its associated harms

24 Oct, 16 | by Emma Gray

Trend most evident among young adults, international analysis shows

Women are catching up with men in terms of their alcohol consumption and its impact on their health, finds an analysis of the available international evidence, spanning over a century and published in the online journal BMJ Open.

The trend, known as ‘sex convergence’, is most evident among young adults, the findings show.

Historically, men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes. But now evidence is beginning to emerge that suggests this gap is narrowing.

In a bid to quantify this trend over time, the researchers pooled the data from 68 relevant international studies out of a total of 314, all of which had been published between 1980 and 2014. All the studies included explicit regional or national comparisons of men’s and women’s drinking patterns across at least two time periods.

The studies included data collected between 1948 and 2014, representing people born as far back as 1891, all the way up to 2000, and including a total sample size of more than 4 million. Sixteen of the studies spanned 20 or more years; five spanned 30 or more.

The researchers used the following criteria to inform their data search: lifetime and/or current alcohol misuse or dependence; alcohol related problems; treatment for alcohol issues; and the timeframe of use and the development of related problems.

And they used 11 key indicators of alcohol use and associated harms for their analysis. These were grouped into three broad categories of: any use, which included quantities and frequency; problematic use, which included binge/heavy drinking; and the prevalence of associated harms.

Births were grouped into cohorts—specific timeframes from 1891 to 2000—all of which spanned 5 years, with the exception of the first (1891-1910) and the last (1991-2000).

The pooled data showed that the gap between the sexes consistently narrowed across all three categories of any use, problematic use, and associated harms over time.

Men born between 1891 and 1910 were twice (2.2) as likely as their female peers to drink alcohol; but this had almost reached parity among those born between 1991 and 2000 (1.1).

The same patterns were evident for problematic use, where the gender gap fell from 3 to 1.2, and for associated harms, where the gender gap fell from 3.6 to 1.3.

After taking account of potential mathematical bias in the calculations, the gender gap fell by 3.2% with each successive five year period of births, but was steepest among those born from 1966 onwards.

The calculation used was not designed to address whether alcohol use is falling among men or rising among women, the researchers caution.

But among the 42 studies that reported some evidence for sex convergence, most indicated that this was driven by greater use of alcohol among women, and 5% of the sex ratios were less than 1, suggesting that women born after 1981 may actually be drinking more than their male peers, say the researchers.

While they did not set out to explain the reasons behind their observed findings, they emphasise that their results “have implications for the framing and targeting of alcohol use prevention and intervention programmes.”

And they conclude: “Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms.”

School sex education often negative, heterosexist, and out of touch

12 Sep, 16 | by Emma Gray

And taught by poorly trained, embarrassed teachers, say young people

School sex education is often negative, heterosexist, and out of touch, and taught by poorly trained, embarrassed teachers, finds a synthesis of the views and experiences of young people in different countries, published in the online journal BMJ Open.

Schools’ failure to acknowledge that sex education is a special subject with unique challenges is doing a huge disservice to young people, and missing a key opportunity to safeguard and improve their sexual health, conclude the researchers.

They base their findings on 55 qualitative studies which explored the views and experiences of young people who had been taught sex and relationship education (SRE) in school based programmes in the UK, Ireland, USA, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden between 1990 and 2015.

Most of the participants were aged between 12 and 18.

The researchers synthesised the feedback and found that despite the wide geographical reach of the studies, young people’s views were remarkably consistent.

Two overarching themes emerged to explain most of the data. The first of these was that schools have failed to recognise the distinctive and challenging nature of SRE, for the most part preferring to approach it in exactly the same way as other subjects, say the researchers.

Yet the feedback indicated there are distinct challenges when teaching SRE: in mixed sex classes young men feared humiliation if they weren’t sexually experienced and said they were often disruptive to mask their anxieties; their female class mates felt harassed and judged by them.

Young people also criticised the overly ‘scientific’ approach to sex, which ignored pleasure and desire, and they felt that sex was often presented as a ‘problem’ to be managed. Stereotyping was also common, with women depicted as passive, men as predatory, and little or no discussion of gay, bisexual, or transgender sex.

The second principal theme was that schools seem to find it difficult to accept that some of their students are sexually active, leading to content that is out of touch with the reality of many young people’s lives and a consequent failure to discuss issues that are relevant to them, say the researchers.

This was evident in what young people perceived as an emphasis on abstinence; moralising; and a failure to acknowledge the full range of sexual activities they engaged in.  Sex education was delivered too late, some students felt.

But it also manifest in a failure to deliver helpful and practical information, such as the availability of community health services, what to do if they got pregnant, the pros and cons of different methods of contraception, or the emotions that might accompany sexual relationships.

Young people also disliked having their teachers deliver SRE, not only because they felt teachers were poorly trained and too embarrassed, but also because of the potential for this arrangement to disrupt teacher-pupil relationships and breach boundaries.

The researchers point out that despite its low status and variable content and quality, school based SRE is seen as vital by policy makers for protecting young people from ill health, unwanted pregnancies, sexual abuse and exploitation.

And the evidence suggests that young people themselves want SRE to be taught in schools, using an approach that is ‘sex positive’—one that aims for young people to enjoy their sexuality in a way that is safe, consensual, and healthy.

They conclude: “Schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young people’s sexual activity, otherwise [they] will continue to disengage from SRE, and opportunities for safeguarding and improving their sexual health will be reduced.”

Volunteering in middle age and senior years linked to enhanced mental health

8 Aug, 16 | by Emma Gray

No positive association seen before age of 40, suggesting link varies across life course

Volunteering in middle and older age is linked to good mental health/emotional wellbeing, finds a large study of British adults, published in the online journal BMJ Open.

But no such association was seen before the age of 40, suggesting that the link may be stronger at certain points of the life course, say the researchers.

Previous research has shown that volunteering in older age is associated with better mental and physical health, but it’s unclear whether this extends to other age groups.

The researchers therefore mined responses to the British Household Panel Survey (BHPS), involving a representative sample of adults living in 5000 households in Great Britain.

The BHPS ran every year from 1991 until 2008 before being incorporated into a much larger survey.  It included a wide range of questions on leisure time activities, which covered the frequency of formal volunteering—from at least once a week through to once a year or less, or never.

The BHPS also included a validated proxy for mental health/emotional wellbeing known as the GHQ-12.

The researchers gathered 66,343 responses for 1996, 1998, 2000, 2002, 2004, 2006 and 2008.

Around one in five respondents (21%) said they had volunteered. Women tended to volunteer more than men, and while almost a quarter of those aged 60 to 74 said they volunteered, this proportion dropped to 17% among the youngest age group.

GHQ-12 scores were better (lower) among those who volunteered than among those who had never done so—10.7 vs 11.4—across the entire sample, irrespective of age.

The average GHQ score was the best (lowest) among those who were frequent volunteers and worst (highest) among those who never volunteered.

When age was factored in, the positive association between volunteering and good mental health/emotional wellbeing became apparent at around the age of 40 and continued up into old age (80+).

Those who had never volunteered had lower levels of emotional wellbeing, starting at midlife and continuing into old age, compared with those who did volunteer.

The findings held true even after taking account of a range of potentially influential factors, including marital status, educational attainment, social class, and state of health.

By way of an explanation for the findings, the researchers speculate that volunteering at younger ages may just be viewed as another obligation, while social roles and family connections in early middle age may spur people to become involved in community activities, such as in their child’s school.

This is an observational study so no firm conclusions can be drawn about cause and effect, added to which the researchers were not able to gauge the extent of ‘informal’ volunteering, such as helping out neighbours, so couldn’t capture the full spectrum of voluntary activities.

But they nevertheless suggest that the findings show that volunteering may be more meaningful at certain points of the life course, and they call for greater efforts to involve middle aged to older people in some sort of volunteering.

“Volunteering might provide those groups with greater opportunities for beneficial activities and social contacts, which in turn may have protective effects on health status…With the ageing of the population, it is imperative to develop effective health promotion for this last third of life, so that those living longer are healthier,” they write.

Previous research indicates that people who volunteer are likely to have more resources, a larger social network, and more power and prestige, all of which have knock-on effects on physical and mental health, they point out.

“Volunteering may also provide a sense of purpose, particularly for those people who have lost their earnings, because regular volunteering helps maintain social networks, which are especially important for older people who are often socially isolated,” they add.

Third to half of UK population lives with chronic pain

20 Jun, 16 | by Emma Gray

Proportion likely to rise as population ages; major cause of disability and distress

Between a third and half (43%) of the UK population—roughly 28 million adults—lives with chronic pain, finds an analysis of the available evidence, published in the online journal BMJ Open.

This proportion is likely to rise as the population ages, warn the researchers, who add that chronic pain is a major cause of disability and distress among those affected by it.

There is no consensus on the proportion of people living with long term pain in the UK, and in a bid to try and gain an accurate picture, the researchers trawled relevant databases to find research on different types of pain, published after 1990.

Their search included studies on population based estimates of chronic pain—defined as lasting more than 3 months—chronic widespread pain, fibromyalgia (a rheumatic condition characterised by muscular or musculoskeletal pain), and chronic neuropathic pain (pain caused by nerve signalling problems).

From among 1737 relevant articles, 19 studies, involving just under 140,000 adults, were deemed suitable for inclusion in the final analysis.

They pooled the study data to arrive at an estimate of the prevalence of chronic pain, overall, and chronic widespread pain. Summary estimates were also drawn up for moderate to severely disabling chronic pain, fibromyalgia, and chronic neuropathic pain among UK adults.

Based on seven studies, the researchers worked out that the prevalence of chronic pain ranged from 35% to 51% of the adult population, with the prevalence of moderate to severely disabling chronic pain (based on four studies), ranging from 10% to 14%—equivalent to around 8 million people.

Pooling of the data showed that 43% of the population experience chronic pain, and 14% of UK adults live with chronic widespread pain. The summarised data also showed that 8% of UK adults experience chronic neuropathic pain, and 5.5% live with fibromyalgia.

Twelve of the studies categorised the prevalence of pain by age group, and unsurprisingly, these showed that older people were more likely to live with pain over the long term.

Among 18-25 year olds, the prevalence was 14%, although it may be as high as 30% among 18-39 year olds, the analysis indicates—a sizeable chunk of the working population, say the researchers.

Among those aged 75 and above, the prevalence was almost two thirds (62%), suggesting that if current trends continue, the burden of chronic pain may increase further still as the population ages, say the researchers.

Women were more likely than men to be affected by chronic pain, irrespective of age or pain type.

The researchers point out that the included studies varied considerably, and that not all of them were of high quality, so making it difficult to draw firm conclusions.

The studies showed gradually increasing prevalence of chronic pain over time, from 1990. And the researchersestimate that the prevalence of chronic pain in the UK is now around 43%, equating to around 28 million people, based on population stats for 2013.

“Such prevalence data does not itself define need for care or targets for prevention, but reliable information on prevalence will help to drive public health and healthcare policymakers’ prioritisation of this important cause of distress and disability in the general population,” they conclude.