Gambling Problems and Military- and Health-Related Behaviour in UK Armed Forces Veterans

Internationally, problem gambling is elevated in Armed Forces veterans compared to the general population. Here, we re-examined the prevalence of problem gambling in veterans and non-veterans residing in England using an established large dataset and investigated whether gambling was associated with length of service, common mental health disorders, substance abuse, or financial management history. Using the 2007 Adult Psychiatric Morbidity Survey, 257 post-national service veterans and 514 age- and sex-matched controls were compared. Veterans had significantly higher rates of problem gambling than non-veterans. Male veterans were more likely than non-veterans to have experienced a traumatic event. The relationship between veteran status and problem gambling was not explained by differences in mental health conditions, substance abuse, or financial management. No differences were found for length of service. Further research is required with larger samples targeting problem gambling and Armed Forces experience in the United Kingdom population using contemporary diagnostic criteria

How to promote, improve and test adherence to scientific evidence in clinical practice

BACKGROUND: Negative variation in the management of patients with the same clinical condition is frequent, and affects quality of care. Recent studies indicate that single interventions are not an effective solution. We aim to demonstrate that a multifaceted strategy can favor the introduction of research into practice, and to assess its long-term effects on a set of common medical conditions exhibiting significant negative variation at our institution. METHODS: The strategy, devised and agreed upon by a multidisciplinary group, was first applied to one relevant medical condition – cerebral ischemic stroke. To test its effectiveness a quasi-experimental study was conducted, comparing an intervention group with historical controls. After validation the strategy was extended to other pathologies, and its long-term effect measured using evidence-based quality indicators. Adherence to each indicator was determined prospectively on a six-month basis for a period of at least two consecutive years. Measures are expressed as proportions with 95% confidence intervals. RESULTS: Validation findings demonstrated that the strategy improved compliance with scientific evidence: the percentage of patients who received a CT scan within 24 hours of hospital presentation rose from 56% to 75%, (χ(2 )= 7.43 p < 0.01); admissions to selected wards increased from 45% to 64%, (χ(2 )= 7.81 p < 0.01); the number of physical medicine visits within 24 hours of the request grew from 59% to 91% (χ(2 )= 14,40 p < 0.001). Over a four-year period the program was gradually applied to 14 medical conditions. Except for 3 cases, compliance with the pathway, i.e. number of eligible patients for whom data on the care process is collected, was above the minimum requirement of 75%. Indicator adherence generally exhibited a positive trend, though variability was observed both among different conditions and between different semesters for the same pathology. CONCLUSION: According to our experience, incorporation of research into practice can be favored by systematically applying a shared, multifaceted strategy, involving multidisciplinary teams supported by central coordination. Institutions should device a tailor-made approach, should train personnel on implementation strategies, and create cultural acceptance of change. Just like for experimental trials, human and economic resources should be allocated within health care services to allow the achievement of this objective