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Background and Aims: Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry., Method: Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe., Results: A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP-CSO relationship, CRAFT modality and integration of treatment for IP. Meta-analysis found CRAFT to be twice as effective as controls/comparison groups. Multi-modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5-71%), group (60%) and self-directed workbook (13.3-40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5-23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated., Conclusions: Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success., (© 2019 Society for the Study of Addiction.)

Objectives: To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort., Methods: Literature review and practical experience., Results: WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital., Conclusion: Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed., Level of Evidence: 5 Laryngoscope, 130:1388-1395, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries., Methods: A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank., Results: The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82-2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education., Conclusions: The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries., (© 2019 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

Objectives: The primate talus is known to have a shape that varies according to differences in locomotion and substrate use. While the modern human talus is morphologically specialized for bipedal walking, relatively little is known on how its morphology varies in relation to cultural and environmental differences across time. Here we compare tali of modern human populations with different subsistence economies and lifestyles to explore how cultural practices and environmental factors influence external talar shape., Materials and Methods: The sample consists of digital models of 142 tali from 11 archaeological and post-industrial modern human groups. Talar morphology was investigated through 3D (semi)landmark based geometric morphometric methods., Results: Our results show distinct differences between highly mobile hunter-gatherers and more sedentary groups belonging to a mixed post-agricultural/industrial background. Hunter-gatherers exhibit a more "flexible" talar shape, everted posture, and a more robust and medially oriented talar neck/head, which we interpret as reflecting long-distance walking strictly performed barefoot, or wearing minimalistic footwear, along uneven ground. The talus of the post-industrial population exhibits a "stable" profile, neutral posture, and a less robust and orthogonally oriented talar neck/head, which we interpret as a consequence of sedentary lifestyle and use of stiff footwear., Discussion: We suggest that talar morphological variation is related to the adoption of constraining footwear in post-industrial society, which reduces ankle range of motion. This contrasts with hunter-gatherers, where talar shape shows a more flexible profile, likely resulting from a lack of footwear while traversing uneven terrain. We conclude that modern human tali vary with differences in locomotor and cultural behavior., (© 2019 Wiley Periodicals, Inc.)

Aim: The present study aimed to map and summarise the research on children, aged 0-18 years, with Marfan syndrome, identify research gaps and point to research agendas., Methods: A scoping review was systematically performed by searching multiple databases from January 1996 to April 2019. Primary studies presenting results on at least six individuals aged 0-18 years with Marfan syndrome, diagnosed according to the Ghent nosology, were selected., Results: From 2341 de-duplicated records, 92 papers were included, mapped and described. Their topics were diagnostics (12%), cardiovascular matters (50%), skeletal matters (22%), ocular matters (9%), other medical aspects (5%) and psychosocial perspectives (2%). Most studies were from Europe and North America and published between 1999 and 2019 in subject-specific or paediatric journals, while a few were published in genetics journals. All studies had quantitative designs, and very few were multicentre studies. Each study had six to 608 subjects for a total of approximately 5809., Conclusion: A wide range of research topics on adolescent and paediatric Marfan syndrome was found, but qualitative studies and a focus on psychosocial matters were lacking. Future investigations addressing noncardiovascular consequences and patient experiences are needed, as well as studies reaffirming or replicating existing intervention study results., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aims: For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition., Methods: We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5., Results: We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted., Conclusions: Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder., (© 2014 Society for the Study of Addiction.)

In this paper we assume that 'theory' is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES. A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including 'how-to' questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics). In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three 'pillars' as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP. We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES., (© 2011 Blackwell Publishing Ltd.)

The topic of suicide has long been an important socioeconomic issue studied in many countries. Suicides inject an atmosphere of unrest into society, and media attention furthers that social uneasiness. From the viewpoint of economics and management, suicide is a waste of human resource: it decreases the labor force in society and deteriorates human capital. This paper provides a series of analyses of suicide rate based on theoretical reasoning and empirical approaches. Aggregate data from G7 countries are obtained and stacked into panel data for analysis. Data are collected for different age groups. Even though suicide issues have been extensively discussed in the past, newly developed econometric tools are applied to her. Beyond previously recognized relationships between economic factors and suicide rates findings include that unemployment strikes men more than women in terms of psychological pressure: for middle age or older women, unemployment may even be positive for the entire family; and female labor force participation exerts pressure on male counterparts and increases its suicide rate. As a result, a low income family with an unemployed man and an employed woman is at high risk for adult male suicide.

This paper considers issues that relate to staff recruitment, staff development and global mobility of dental academics. Published literature, which has a North American bias, is reviewed. Recommendations, which may be applicable world-wide, are made to address evident and pertinent areas of concern in terms of the availability of quality dental teaching staff in dental teaching institutions so as to sustain the global dental academic enterprise at appropriately high levels of achievement.

The aim of this paper is to review publications discussing the declining prevalence of dental caries in the industrialized countries during the past decades, focusing on some main conferences addressing this issue. Has there been a real decline in the prevalence of dental caries? Several excellent papers and reviews have been published, and there is a general agreement that a marked reduction in caries prevalence has occurred among children in most of the developed countries in recent decades. This fact has stimulated much debate and attempts to identify the most likely explanations for this change. The conclusion made from this review is that the various authors believe that the use of fluoride in various forms has contributed most significantly to the decline in dental caries prevalence. A number of other factors must, however, also be taken into consideration, and such factors have been extensively discussed in the various publications.

The Obligatory Continuing Medical Education (CME) programme of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) which is linked to time-limited certification has now been in operation for over a decade. Its somewhat unique features have attracted widespread interest both nationally and internationally and may be seen as part of an international movement towards obligatory CME in Western Medicine. However, the programme should also be seen as just a part of the educational responses necessary as the medical profession moves into the 1990s, particularly for those of us in the discipline of Obstetrics and Gynaecology. This paper reviews the increasing pressures from within the profession and from the community towards the obligatory CME concepts pioneered by the RACOG, but suggests that the challenges that have been faced in this area in the past although significant, are much less than those which will be faced in the 1990's, as the discipline addresses the challenges of educating obstetricians in the third phase of Continuing Medical Education--education in managing the environment in which our discipline is practised.