Jane Tomnay

Using the CPGI to Determine Problem Gambling Prevalence in Australia: Measurement Issues

Most states and territories in Australia have adopted the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index as the standard measure of problem gambling in their prevalence studies and research programs. However, notwithstanding this attempted standardisation, differences in sampling and recruitment methodologies and in some cases the modification of the scoring methods used in the PGSI have lead to substantial difficulties in comparison of the prevalence rates obtained in different studies. This paper focuses on how these two actions may significantly underestimate the true prevalence percent of problem gambling in Australian studies of the prevalence of problem gambling. It is recommended that the original and validated version of the PGSI is used in future Australian prevalence studies and that prevalence in community studies is studied across the whole community not arbitrarily restricted sub-samples. The adoption of valid scoring methods and unbiased sampling procedures will lead to more accurate and comparable prevalence studies.

Substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual-level sexual behaviors among men who have sex with men in an australian sexual health service from 2007 to 2013

Background To determine the risk-adjusted temporal trend of gonorrhea and chlamydia positivity and associated risk behaviors among men who have sex with men (MSM) attending a sexual health clinic in Melbourne in Australia. Methods Gonorrhea and chlamydia positivity by anatomical site adjusted for year of test, age, number of sexual partners, and condom use among MSM attending Melbourne Sexual Health Centre from 2007 to 2013 were calculated using generalized estimating equation regression models. Results A total of 12,873 MSM were included with a median age of 30.0 years. The proportion with pharyngeal, urethral, and anal gonorrhea was 1.7%, 2.3%, and 2.9%, respectively. The adjusted odds of gonorrhea positivity increased by 9% (95% confidence interval [CI], 3%–15%), 11% (95% CI, 6%–17%), and 12% (95% CI, 7%–17%) per year, respectively. The proportion of MSM who were infected with anal chlamydia was 5.6%, with an average increase of 6% (95% CI, 3%–10%) per year; however, no significant change was observed in urethral chlamydia positivity (adjusted odds ratio, 1.02; 95% CI, 0.98–1.06). Increases in gonorrhea and chlamydia positivity were primarily restricted to MSM who reported more than 10 partners in 12 months. The number of partners in the last 12 months fell from 16.6 to 10.5, whereas consistent condom use with casual partners decreased from 64.6% to 58.9% over the study period. Conclusions Gonorrhea and chlamydia have increased among MSM despite the decrease in the number of sexual partners and are occurring primarily in MSM with high numbers of partners and persist after adjusting for known risk factors, suggesting that unmeasured factors (e.g., more assortative mixing patterns) may explain the observed changes.

Experiences and outcomes of partner notification among men and women recently diagnosed with chlamydia and their views on innovative resources aimed at improving notification rates.

Objective: To describe the partner notification experiences of individuals diagnosed with chlamydia and to determine what supports might best assist them. Goal: To determine what supports might best assist chlamydia infected individuals to notify their partners. Study Design: A telephone survey was undertaken with men and women recently diagnosed with chlamydia across 3 Australian jurisdictions between August 2007 and January 2008. Results: Of the 286 individuals who agreed to be contacted about the study, 202 (71%) completed the survey. Twenty-three percent (333/1458) of recent partners were notified: men who had sex with men (MSM) notified 15% (133/880) of their partners, heterosexual men 31% (114/370), and women 46% (86/188) of their partners (P < 0.001). Overall, 84% (169/202) of individuals notified at least one partner. The main reasons for informing partners were out of concern for them (44%) or because it was considered “the right thing to do” (37%). The preferred methods for contacting partners were telephone (52%) and face-to-face (30%). E-mail (8%) and short message service (SMS) (11%) were less commonly used; however, if offered a website with anonymous e-mail and SMS services, nearly half of individuals indicated they would find this useful. Of those who had not informed all partners with known contact details (n = 94), 34% reported that if web-based tools were available they would have contacted more partners. Over half of participants would like to have been given antibiotics to give to their partner. Conclusion: The availability of tailored resources may assist in improving partner notification for chlamydia.

New technology and partner notification - why aren't we using them?

Partner notification is crucial to the effective control of sexually transmissible infections (STIs) and has not changed substantially over recent years. New technology for communication has been rapidly adopted in our communities but little work has been carried out about its role in contact tracing. Text messaging, emails and the Internet could be useful tools for both provider and patient referral but considerable ethical considerations are involved. Technology is available to help protect the basic tenets of confidentiality and privacy but more thorough exploration of these methods is required to establish efficacy and appropriateness in contact tracing. This research is important if we are to procure an evidence base for future contact tracing strategies rather than allowing these methods to become commonplace at the initiation of our clients.

Molecular analysis of human immunodeficiency virus strains associated with a case of criminal transmission of the virus.

An investigation was done of the evidence for transmission of human immunodeficiency virus (HIV) from an HIV-positive man to several male and female sex contacts. Phylogenetic analysis of sequences from the gag and env genes showed a close relationship between the predominant virus strains from the source and 2 contacts. However, the likelihood that a female contact was infected by the source could not be determined, despite contact tracing indicating that this may have occurred. One male, shown by contact tracing and molecular evidence to have been infected by the source, subsequently transmitted HIV to his female sex partner. HIV sequence from a plasma sample used as a control in the phylogenetic analysis contained env and gag sequences that were closely related to those from the source. An epidemiologic link between these 2 individuals was subsequently confirmed by contact tracing.

Innovative Resources Could Help Improve Partner Notification for Chlamydia in Primary Care

Objective: To examine practices of general practitioners’ (GPs) in relation to partner notification for chlamydia and identify the supports they would find most useful to assist them. Goal: To identify innovative resources that could improve partner notification for chlamydia in primary care. Study Design: A postal survey was undertaken that involved GPs from several jurisdictions across Australia between August and December 2007. GPs were randomly selected from a national database. Results: Of 521 eligible GPs, 234 (45%) returned a completed questionnaire. Ninety-five percent (n = 223) felt that it was their role to discuss partner notification with patients diagnosed with chlamydia; however, only 45% (105/232) were sure how best to assist their patients with this. Considerable variation was shown in the way partner notification was undertaken, including how far back in time GPs recommended contacting partners. GPs considered a wide range of possible resources useful, including a website supporting patients (90%), information sheets generated by practice software when chlamydia is diagnosed (90%), printed information packs for patients (85%), a website designed to assist GPs (80%), and referral to these websites via positive laboratory results (85%). Forty-three percent currently undertook patient delivered partner therapy for chlamydia. Conclusion: GPs want and need greater guidance and resources to assist them with partner notification for chlamydia. Resources utilizing the internet and practice software and mechanisms where GPs are automatically directed to these when chlamydia is diagnosed have wide appeal and the potential to improve the effectiveness of partner notification for chlamydia.

Pathways to problem gambling in seniors.

Little is known about problem gambling in older adults, particularly when gambling problems only commence late in life. Knowledge of pathways to later life problem gambling can assist prompt and effective interventions for vulnerable older adults. This study builds on a generic Pathways Model. It proposes routes to problem gambling for individuals aged 55 years and above, with a particular focus on late-life, rather than lifetime problem gambling. Gambling-related risk and protective factors/correlates were extracted from the literature based on the extent to which the studies were senior-specific. Common themes were then identified and classified into 3 main clusters: 1 concerning individual vulnerability factors, a 2nd concerning social and environmental factors, and a 3rd concerning factors affecting behavioural regulation.

A survey of partner notification practices among general practitioners and their use of an internet resource for partner notification for Chlamydia trachomatis

OBJECTIVES To determine in which circumstances Victorian general practitioners (GPs) offer chlamydia testing to patients, the attitudes of GPs in relation to contact tracing, how often GPs use a pre-printed partner letter and patient brochure and what proportion of GPs have immediate internet access in their consulting rooms. METHODS This study involved two parts, an initial survey of a sample of GPs in Victoria and a study of GP use of a website that provided treatment guidelines, a printable client brochure and a partner letter. RESULTS Of 418 eligible GPs, 221 (53%, 48-58%, 95% CI) returned completed surveys. Of these, 213 (97%, 93-99%, 95% CI) GPs believed that patients were largely responsible for notifying partners. Partner letters were rarely used: 167 (76%, 70-81%, 95% CI) GPs reported they never used partner letters, 18 (8%, 5-13%, 95% CI) GPs reported rare use and 23 (10%, 7-15%, 95% CI) GPs reportedusing them sometimes. Of the GPs, 181 (82%, 77-87%, 95% CI) reported they would find a partner letter and patient brochure on a website helpful. During the study, the website was accessed by 28 GPs (25%, 17-34%, 95% CI) in Gippsland and 17 GPs (8%, 5-13%, 95% CI) in Geelong who received positive chlamydia results on 110 and 208 clients respectively. CONCLUSIONS GPs mostly considered patients responsible for partner notification but uncommonly used partner letters or an information brochure to assist them. Importantly, GPs reported that they could improve partner notification if further support was provided. In addition, when a website was provided with useful documents on it, up to 25% of GPs used it. This indicates that simple and inexpensive interventions can support GPs with strategies that may improve the control of chlamydia.

Does the Internet assist clients to carry out contact tracing? A randomized controlled trial using web-based information

The primary outcome was to determine the acceptability of the Internet, specifically a website for use in standard partner notification. A secondary objective was to determine if a website would enhance the outcomes of currently used partner notification methods. In a randomized control trial, 105 participants diagnosed with chlamydia and non-gonoccocal urethritis (NGU) were randomized and 97 completed the study. About 30% of participants were provided a standard partner letter and 70% were provided the standard partner letter and website. All participants reported that their partners had no objections to the website (0%, 95% confidence interval [CI] 0–5%). There were no complaints received from any partner. The odds ratio for contacting partners was not significantly different between the two groups of participants. The results of this study indicate that providing a website with specific information about the infection to which a partner has been exposed is not harmful.

Pathways to Late-Life Problematic Gambling in Seniors: A Grounded Theory Approach

PURPOSE OF THE STUDY To develop a grounded theory on how older adults, who may not have previously experienced gambling issues, come to develop gambling problems in later life. DESIGN AND METHODS Through semistructured in-depth interviews with 31 adults aged 56-85, routes that led the current sample of older adults to develop late-life gambling problems were identified and mapped into coherent pathways using a constructivist grounded theory methodology. RESULTS Three main pathways to late-life problematic gambling were identified, all linked with a common theme of isolation: a grief pathway associated with unresolved losses; a habit pathway associated with habituation to gambling; and a dormant pathway marked by preexisting behavioral excess or impulsivity. Overall, unresolved losses and/or mismanagement of lifes stresses were found to be the most significant predictors of late-life problematic gambling. IMPLICATIONS As late-life problem gambling appears to predominantly signify late-life emotional distress and an attempt to deal with this distress using gambling as an escape, it is crucial for problem gambling prevention programs to raise awareness about the processes of loss and grief and provide ideas about constructive loss management. In addition, community-level recreational and social opportunities to combat isolation are identified.