Multimorbidity could cause a healthcare crisis – here’s what we can do about it

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Older patients often suffer from multiple conditions.
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Professor Chris Salisbury profile picture

Professor Chris Salisbury, Primary Health Care, University of Bristol

Multimorbidity is one of the biggest challenges facing healthcare. In recent years, a succession of research studies have shown that people with multiple health problems are more likely to have a worse quality of life, worse mental health and reduced life expectancy. The more health problems someone has, the more drugs they are likely to be prescribed and the more frequently they are likely to consult a GP or be admitted to hospital.

You might think this is all rather self-evident – it’s hardly a surprise that sick people get ill, take medicines and go to doctors more often than healthy people.

So why has multimorbidity become so prominent in discussions about healthcare over the last decade?

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Statins and venous thromboembolism: should statins use extend beyond lowering cholesterol?

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Dr Setor Kunutsor, Research Fellow in Evidence Synthesis/ Epidemiologist, School of Clinical Sciences, University of Bristol

Statins are well known and established for their role in the prevention of cardiovascular disease (heart attack, strokes, or angina) and this is based on their ability to lower levels of cholesterol in the blood.

However, there is evidence to suggest that statins have multiple effects and these include potential beneficial impacts on other disease conditions.

Venous thromboembolism is a condition involving the formation of blood clots in the veins of the lungs and lower limbs. It affects millions of people globally and is a preventable cause of hospital-related deaths.

Standard techniques for the prevention of venous thromboembolism include the use of elastic stockings, compression devices, patient mobility and rehabilitation, and anticoagulant therapy (blood thinning medications).

Blausen 0290 DeepVeinThrombosis

Deep Vein Thrombosis. Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010.  ISSN 2002-4436

Evidence now suggests that statins also have the ability to reduce inflammation in the body and prevent the formation of blood clots. Based on these properties, there have been suggestions that statins may prevent venous thromboembolism.

Several studies have investigated this, however the evidence has not been conclusive until now.

We decided it was time to bring all the evidence together and evaluate if statins really did have a protective effect on the risk of developing venous thromboembolism.

Altogether we analysed 36 studies (13 observational cohort designs and 23 randomised controlled trials) with data on more than 3.2 million participants.

Our results showed a clear link between the use of statins and a reduced risk of developing venous thromboembolism. Continue reading

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It’s time to put mature students at the heart of widening participation

Why should we care about mature students?

It has become almost routine to read stories giving ‘more bad news’ about part-time student numbers in universities.

Tom Sperlinger is Reader in English Literature and Community Engagement at the University of Bristol.

Lizzie Fleming is Widening Participation and Student Recruitment Officer, and a postgraduate student, at the University of Bristol

On 29 June, the Office for Fair Access (OFFA), which monitors access to universities in the UK, published its outcomes for 2015-16. The report highlights a ‘crisis’ in part-time numbers, which have fallen for a seventh consecutive year, a decline of 61% since 2010-11. Since more than 90% of part-time students are over 21, this has also led to a significant decline in the number of mature students in the sector.

This also means that, overall, the number of students entering universities has fallen significantly since 2012. Continue reading

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The importance of the advice sector in the context of legal aid cuts

Dr Sarah Moore, Lecturer in Sociology (Department of Social and Policy Sciences, University of Bath).

The PolicyBristol blog has the pleasure of welcoming this guest post by Dr Sarah Moore, who was one of the participants in the recent book launch of Advising in Austerity. Reflections on challenging times for advice agencies (Policy Press, 2017). Dr Moore is also the co-author of Legal aid in crisis. Assessing the impact of reform (Policy Press, 2017) and offers here her insightful views on the need to boost the activities and funding of the legal advice sector.

Anyone familiar with legal aid reform will know that the Legal Aid and Sentencing of Offenders Act 2012 (LASPO) has dramatically altered the meaning and nature of legal aid. It has meant, amongst other things, a significant reduction in funding, largely achieved by taking a large number of areas of civil law out of scope, including private family law cases, and almost all cases involving social welfare, housing, medical negligence, immigration, debt, and employment.

The most strenuous critics of LASPO have pointed out that the recent funding cuts restrict people’s access to justice. In answering to these problems, LASPO incorporated a set of exceptions. Those who could provide evidence that they had been victims of domestic violence, for example, were to be given access to legal aid to pursue family law cases. And an Exceptional Case Funding caveat was incorporated in the Act for those who could successfully make a case that their human rights would be breached without publicly-funded legal assistance. Both have been woefully inadequate.

Research led by Rights of Women indicates that, even after the government relaxed the rules on domestic violence evidence and legal aid eligibility, a significant proportion of female victims (38% in their 2014 survey) did not have the mandatory evidence to receive publically-funded support. And the Exceptional Case Funding (ECF) scheme has been a disaster by anyone’s standards. In the first year post-LASPO, the Legal Aid Agency received only 1,520 applications for ECF. According to the Public Accounts Committee, only 69 were granted funding. That is far, far fewer than the Ministry of Justice and Legal Aid Agency had predicted in the post-LASPO period. Applications have picked up in the last year, as has the acceptance rate, but the fact remains that this safety net is sorely under-used. Continue reading

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The General Election 2017: national security, deradicalisation, and citizenship

As we head into the elections this Thursday, national security is a burning issue. The UK has been the target of three major terrorist attacks in the past few months. The latest attack in London comes within just two weeks of the bombing in Manchester last month. The involvement of British nationals in perpetrating these attacks has brought many questions about extremism, radicalisation and integration to the forefront.

Dr Devyani Prabhat, Lecturer in Law, Bristol School of Law

Party leaders are laying out their strategies for counter-terrorism. Theresa May has announced plans to set up a new counter-terrorism agency, monitor social media and web content for extremism, have stronger custodial sentences for terrorism, and work on integration of communities. Meanwhile Jeremy Corbyn has focused on the problems of British foreign policy, funding for terrorist activities, and the lack of policing resources. These plans are not reflected in their respective party manifestos and do not engage directly with the issue of alienated citizens. In fact, Prevent, a mainstay of counter-terrorism, is not even mentioned in the Conservative party manifesto, while the Labour manifesto merely mentions a review of Prevent. Both major parties are, however, likely to comprehensively rethink the current Prevent programme in light of the recent attacks. The Liberal Democrats and Green Party have already announced plans to replace Prevent. When such replacement or revision takes place, parties need to consider why minority citizens can become alienated and what British citizenship means to them as part of long term deradicalisation programmes. Continue reading

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How UKIP’s decline could provide a major boost for Theresa May

Ron Johnston, Professor of Geography, University of Bristol

The British prime minister Theresa May called a snap general election in the expectation that it will deliver her a substantially increased parliamentary majority. This in turn would give her the “strong and stable government” she hopes for as she enters the crucial Brexit negotiations.

So far, opinion polls suggest that the Conservatives have a large lead over Labour. But in order to attain the desired majority, they need to win a substantial number of seats from Labour. There were, however, fewer marginal seats following the 2015 general election than after any previous election since World War II – just 42, for example, where Labour won by a majority of less than ten percentage points over the Conservatives.

If the Conservatives were to win all of them, they would have 374 MPs in the new parliament compared to Labour’s 195 and a majority over all parties of 98.

So how winnable are those 42 seats? The likelihood of many Labour voters from 2015 switching to the Conservatives in 2017 is small, so the Conservatives will have to gain most of the extra votes from other sources. One likely source is those who last time voted for UKIP. Continue reading

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How can universities tackle the challenges and exploit the opportunities of Brexit?

Phil Syrpis, Professor of EU Law, University of Bristol Law School

Brexit will present the UK with a vast number of political, economic, social, and legal challenges and opportunities in the months and years ahead. In this short piece, Professor Phil Syrpis reflects on the steps taken within the University of Bristol to begin to tackle the challenges and exploit the opportunities.

From the time that it became clear, on the morning of Friday 24 June 2016, that the UK had voted to leave the EU, academics have been absorbing, reacting to, and in some cases seeking to shape, the political agenda. Events have been occurring at a dizzying pace. David Cameron was swiftly replaced by Theresa May; Parliament, after Gina Miller’s Supreme Court victory, voted to trigger Article 50 and begin the process of exiting the EU; White Papers and Negotiating Guidelines were issued; and we are now set for a General Election on 8 June, which looks set to be dominated by Brexit (that’s one of the very few predictions I feel able to make). Continue reading

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Environments without Borders

Research Without Borders 8-12 May A week long series of events showcasing the work of postgraduate students. Free tickets: bristol.ac.uk/research-without-borders

Blog authors (and panel members): Laura De Vito is a postgraduate researcher in the School of Geographical Sciences.  Carlos Gracida Juarez is a postgraduate researcher in the School of Biological Sciences.  Alice Venn is a postgraduate researcher in the School of Social Sciences and Law.  Erik Mackie is a postgraduate researcher in the School of Geographical Sciences, working together with the British Antarctic Survey, and kept up a blog during his recent fieldwork in Antarctica.

The effects of climate change vary hugely across political borders, and have wide-ranging impacts on different communities and environments. Climate policy responses must recognize this global interconnectedness, and integrate international cooperation with effective local action. This is why global treaties such as the Paris Agreement are so important in the fight against climate change, but individual nations must also do their bit to achieve the objectives set out in the agreement. In Environments without Borders (part of Research Without Borders), a panel debate hosted by Bristol Doctoral College and the Cabot Institute on Wednesday 10th May, we will discuss some of these issues, using examples from our research on particular challenges facing our global ocean and water environments.

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Advising in Austerity

Professor Morag McDermont, Professor of Socio-Legal Studies, University of Bristol

Professor Morag McDermont, Professor of Socio-Legal Studies, University of Bristol

Ben Crawford, Knowledge Exchange Fellow (University of Bristol Law School)

Research led by Prof Morag McDermont of University of Bristol Law School has explored the ways in which advice organisations such as Citizens Advice (CA) have become key actors in legal arenas, particularly for citizens who face the most disadvantage in upholding their rights. Findings from a four year study in partnership with Strathclyde University, highlight the importance of free-to-access advice in enabling people to tackle problems and engage with the legal and regulatory frameworks that govern their lives.

The advice sector, however, is under threat, as a new book Advising in Austerity: Reflections on challenging times for advice agencies (edited by Samuel Kirwan and published by Policy Press ) demonstrates. The book, co-written by the research team and advisers in the field, highlights both the possibilities and the challenges for an advice sector that largely relies on volunteers to provide a vital interface between citizens and the everyday problems of debt, health, employment and much more.  Despite the skills and enthusiasm of the workforce, many services are caught between rising demand and large-scale funding cuts, as traditional sources of revenue from local authorities and legal aid are dramatically reduced. Across the network, reductions in core funding are forcing agencies to reduce or reconfigure services. In particular, the face-to-face, generalist advice model that provides a holistic assessment of client’s problems is under pressure as services are reduced in favour of telephone or online support. Continue reading

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The Turkish referendum thwarts civil rights struggles – in Europe and in Turkey

Dr Bahar Baser, Research Fellow at the Centre for Trust, Peace and Social Relations (Coventry University) and Associate Fellow at the Security Institute for Governance and Leadership in Africa (SIGLA) at Stellenbosch University.

Dr Aleksandra Lewicki, Postdoctoral Researcher at the Free University of Berlin and a member of the Centre for the Study of Ethnicity and Citizenship at the University of Bristol.

On Sunday, 16th April 2017, Turkish citizens are to decide in a referendum whether Turkey’s parliamentary republic will be turned into a presidential system. Representatives of the Turkish Government have been campaigning in favour of this constitutional reform in Turkey, and have also organized rallies in European countries, including Germany and the Netherlands. Although absentee voter turnout lingered at less than 10% in previous elections, the large diaspora vote can still have a detrimental impact on the results.

Some of the rallies in Europe were cancelled due to security concerns. President Erdoğan immediately associated these reactions with mounting Islamophobia across Europe. He accused German Chancellor Angela Merkel of ‘Nazi methods’ and suggested that ‘the spirit of fascism’ was ‘running rampant in Europe’. His ‘Yes’ Campaign appeals to anti-European sentiments and nourishes the “Sevres Syndrome”, whereby Erdoğan and the AKP present themselves as the alternative to those who threaten Turkey’s citizens’ interests and rights.

Chancellor Merkel, who relies on a deal with Turkey to keep the number of refugees arriving in Germany at its current low, rebuked such crude comparisons rather mildly as ‘unjustifiable’ and condemned the instrumentation of the victims of the National Socialist Regime. As national elections are coming up in September 2017, German political parties are worried of losing their voters to the right-wing populist Alternative für Deutschland (AfD), which successfully mobilized Islamophobic sentiments in 2016. Therefore, although anti-Muslim attitudes are indeed gaining in influence in Germany, initiatives to address Islamophobia hardly feature on the current Government’s political agenda or the election campaign. Continue reading

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