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Background: Canada has one of the highest prevalence of cannabis use globally, particularly among young adults aged 20-24 (50%) and youth aged 16-19 (37%). In 2018, Canada legalized recreational cannabis with the aim of protecting youth by restricting their access and raising public awareness of health risks. However, there has been limited qualitative research on the perceptions of harms associated with youth cannabis use since legalization, which is crucial for developing effective harm reduction strategies. This qualitative study examined perceptions of cannabis use among youth from the perspectives of youth, parents, and service providers. We explored how participants described the perceived risks or harms associated with youth cannabis use, as well as how they described their own and others' approaches to reducing cannabis-related risks and harms., Methods: This qualitative study used a community-based participatory research approach in partnership with Families for Addiction Recovery (FAR), a national charity founded by parents of youth and young adults with addiction issues. Virtual semi-structured interviews were conducted, and the data were analyzed using thematic analysis., Results: The study included 88 participants from three key groups (n = 31 youth, n = 26 parents, n = 31 service providers). Two main themes emerged regarding perceived risks or harms associated with cannabis use: (1) concerns about cannabis-related risks and harms, including addiction, brain development, impact on family, and various adverse effects on areas such as motivation, concentration, finances, employment, education, physical and mental health; and (2) minimization of risks and harms, featuring conflicting messages, normalization, and perceptions of cannabis being less harmful than other substances. Additionally, two themes related to harm reduction approaches were identified: (1) implementation of harm reduction, and (2) challenges in implementing a harm reduction approach. Specific challenges for each participant group were noted, along with structural barriers such as unavailable and inaccessible services, easy access to cannabis, inadequate public education, and insufficient information on lower-risk cannabis use guidelines., Conclusions: Youth cannabis use is a significant public health concern that requires a multi-pronged approach. Developing youth-centered harm reduction strategies that recognize the developmental needs and vulnerabilities of youth, as well as the important role of families, is imperative., (© 2024. The Author(s).)

Background/objectives: Childhood maltreatment has been linked to numerous adverse outcomes in adulthood, including problem substance use. However, not all individuals exposed to childhood maltreatment develop substance use problems, indicating the role of other factors in influencing this outcome. Past work suggests that adverse early life experiences, including childhood maltreatment, lead to neurobiological changes in frontolimbic functions that, in turn, result in altered stress and reward responses, heightened impulsivity, affect dysregulation, and, ultimately, increased risk for maladaptive behaviors such as substance use. The aim of this preliminary investigation using cross-sectional data was to test associations between these factors in the relationship between childhood maltreatment and alcohol use problems in a sample of emerging adults., Methods: Emerging adults (18-30 years old) who identified as regular drinkers (i.e., drinking at least 2-4 times in the past month) were recruited from a crowd-sourcing platform (Prolific) as well as community samples. Participants completed online standardized questionnaires assessing reward sensitivity and responsiveness, impulsivity, emotion regulation, and alcohol consequences., Results: Path analyses demonstrated good fit for the data (SRMR = 0.057, RMSEA = 0.096, 90% CI [0.055, 0.142], CFI = 0.957). Childhood maltreatment was associated with reward responsiveness (β = -0.026, Z = -4.222, p < 0.001) and emotion dysregulation (β = 0.669, Z = 9.633, p < 0.001), which in turn was associated with urgency and, subsequently, alcohol consequences (β = 0.758, Z = 7.870, p < 0.001)., Conclusions: Although these findings are preliminary, the current study is one of the first to test a comprehensive model addressing the relationship between childhood maltreatment and alcohol use problems. The findings have the potential to inform treatment strategies that target motivation and goal-directed action for reducing and managing consequences associated with childhood maltreatment. Future research should test the model using longitudinal data to address the limitations of a cross-sectional study and assess temporal associations between constructs.

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection that has a high mortality rate. Proprotein convertase subtilisin kexin 9 (PCSK9) is a serine protease secreted by the liver. Its binding to the low-density lipoprotein (LDL) receptor enhances its degradation, causing an increase in LDL levels in the blood. Objectives : Administering a PCSK9 inhibitor leading to an increase in lipid uptake by the liver may positively affect septic patients due to the increased removal of endotoxins. Methods : This preliminary study aimed to examine the safety of PCSK9 inhibitor use in septic and septic shock patients. We treated five septic patients in the intensive care unit with 300 mg of alirocumab following serious adverse events for 28 days. Results : Four of our patients did not experience any adverse events, and all of them survived. One patient died after discharge from the intensive care unit, and this death was presumably not related to the study drug. The patients rapidly recovered from the inflammatory stage of sepsis. Conclusions : Alirocumab appears safe in severe sepsis and septic shock patients. The outcome data are promising. Only a basic safety profile can be assessed based on this pilot study. Further study with a PCSK-9 inhibitor in septic or septic shock patients is required to further determine its benefit in ICU patients.

Background and Objectives: The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)'s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. Materials and Methods: This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. Results: In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. Conclusions: We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist's preference.

A woman in her mid-30s presented to our 30-bed healthcare centre with extensive burns, hours after falling into a shallow pit of burning dried tea leaves. On arrival, there was no evidence of airway compromise. She was fully conscious but had signs of shock and hypovolemia. Forty-five per cent of the total body surface area was burned, including the face, neck, thorax, abdomen, upper limbs and thighs. The family refused referral to a burns centre and insisted on continuing treatment at our facility. Our hospital, not equipped to manage burns, was adapted to deliver effective, immediate care. After initial stabilisation, the patient was unwilling to remain hospitalised because of her husband's employment commitment. Subsequently, we were notified that the patient died within 1 month of discharge. This article highlights the importance of burns care facilities in rural India and the impact of a failure to access quality health on outcomes., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, M age  = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique., Methods: A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study., Results: Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences., Discussion: The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use., Methods: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis., Results: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services., Conclusion: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms., (© 2023. Crown.)

Background: The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis., Method: A retrospective analysis was conducted from a single pediatric surgery department of all children 5 years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020., Results: 728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5 years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS ( P   <  .05)., Conclusions: C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5 years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.

The recent COVID-19 pandemic has catalyzed the attention of the scientific community to the long-standing issue of lower respiratory tract infections. The myriad of airborne bacterial, viral and fungal agents to which humans are constantly exposed represents a constant threat to susceptible individuals and bears the potential to reach a catastrophic scale when the ease of inter-individual transmission couples with a severe pathogenicity. While we might be past the threat of COVID-19, the risk of future outbreaks of respiratory infections is tangible and argues for a comprehensive assessment of the pathogenic mechanisms shared by airborne pathogens. On this regard, it is clear that the immune system play a major role in dictating the clinical course of the infection. A balanced immune response is required not only to disarm the pathogens, but also to prevent collateral tissue damage, thus moving at the interface between resistance to infection and tolerance. Thymosin alpha1 (Tα1), an endogenous thymic peptide, is increasingly being recognized for its ability to work as an immunoregulatory molecule able to balance a derailed immune response, working as immune stimulatory or immune suppressive in a context-dependent manner. In this review, we will take advantage from the recent work on the COVID-19 pandemic to reassess the role of Tα1 as a potential therapeutic molecule in lung infections caused by either defective or exaggerated immune responses. The elucidation of the immune regulatory mechanisms of Tα1 might open a new window of opportunity for the clinical translation of this enigmatic molecule and a potential new weapon in our arsenal against lung infections., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers., Methods: This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data., Results: The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do.", Conclusion: Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services., (© 2023. The Author(s).)

Wound healing involves a rapid response to the injury by circulating cells, followed by inflammation with an influx of inflammatory cells that release various factors. Soon after, cellular proliferation begins to replace the damaged cells and extracellular matrix, and then tissue remodeling restores normal tissue function. Various factors can lead to pathological wound healing when excessive and irreversible connective tissue/extracellular matrix deposition occurs, resulting in fibrosis. The process is initiated when immune cells, such as macrophages, release soluble factors that stimulate fibroblasts. TGFβ is the most well-characterized macrophage derived pro-fibrotic mediator. Other soluble mediators of fibrosis include connective tissue growth factor (CTGF), platelet-derived growth factor (PDGF), and interleukin 10 (IL-10). Thymosin β4 (Tβ4) has shown therapeutic benefit in preventing fibrosis/scarring in various animal models of fibrosis/scarring. The mechanism of action of Tβ4 appears related, in part, to a reduction in the inflammatory response, including a reduction in macrophage infiltration, decreased levels of TGFβ and IL-10, and reduced CTGF activation, resulting in both prevention of fibroblast conversion to myofibroblasts and production of normally aligned collagen fibers. The amino N-terminal end of Tβ4, SDKP (serine-aspartate-lysine-proline), appears to contain the majority of anti-fibrotic activity and has shown excellent efficacy in many animal models of fibrosis, including liver, lung, heart, and kidney fibrosis. Ac-SDKP not only prevents fibrosis but can reverse fibrosis. Unanswered questions and future directions will be presented with regard to therapeutic uses alone and in combination with already approved drugs for fibrosis., (Copyright © 2022.)

The Novel Coronavirus Disease (COVID-19) pandemic has had profound effects on physical and mental health worldwide. Students transitioning out of high school were uniquely impacted at the onset of the pandemic, having missed the opportunity to properly mark the end of their final year in the K-12 school system. The adverse effects of this loss on this population are still unknown. The purpose of the current study was to examine stress, wellbeing, and affect in a sample of 168 students ( N = 168; M age = 17.0, SD = 0.46; 60% female; 40% male) who were completing their final year of high school during the early stages of the pandemic when emergency stay-at-home orders were in place. Participants completed an online survey assessing the impact of COVID-19 on their life satisfaction (pre-COVID19, during COVID-19, and anticipated five years from now), stress, positive affect, and negative affect. Latent class analysis (LCA) was used to create classes of participants based on their responses to the pandemic. A two-subgroup solution provided the best model for the life satisfaction outcome variable. Subgroup 1, optimists , comprised 24% ( N = 40) of the sample and reported high life satisfaction ratings one year prior to COVID-19 and a slight decrease in life satisfaction during COVID-19, and they anticipated an increase in life satisfaction 5 years from now. This group was characterized by low stress, low negative affect, and high positive affect during the pandemic. Subgroup 2, realists , comprised 76% of the population ( N = 128) and experienced similarly high retrospective ratings of pre-COVID life satisfaction but a larger decrease in life satisfaction during the pandemic and a smaller increase in five years. The realist group was characterized by low positive affect, high stress, and high negative affect during the pandemic. The findings suggest that during the pandemic, certain subsamples of adolescents had greater difficulty in managing this transitional period and experienced changes in mood and well-being (i.e., affect, stress) as compared to other adolescents (i.e., optimists ). Future research should investigate the characteristics and coping mechanisms that are instrumental for increasing life satisfaction and positive affect while lowering stress in this population., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Perceived parental criticism is an important measure of the family emotional environment, linked to a variety of psychological difficulties in emerging adults (EAs) and traditionally assessed at a single timepoint. Our study is the first to examine perceived parental criticism as a dynamic construct that fluctuates and interacts with emerging adult (EA) affect across daily life. EAs ( N = 141; ages 18-22; M age = 19.94, 84.5% women) completed a measure of baseline depression symptoms and daily assessments of perceived parental criticism, anger, anxiety, shame, sadness, and happiness across 30 days. Within-person results revealed that previous day perceived parental criticism predicted subsequent day EA anger (but not vice versa). This cross-lagged association only emerged for anger and not other emotions. Additionally, depression moderated this association, with higher depression symptoms increasing the strength of the association. Between-person results revealed that parental criticism was positively associated with mean/trait anger, anxiety, shame, sadness, but not happiness, as well as affect reactivity (innovation variance) for anger. Associations with affect inertia were not significant. Together, these findings suggest parental criticism is more strongly related to negative than positive emotions, is proximally associated with anger in particular, especially among EAs with increased depression, and may be related to aspects of emotion dysregulation. Family interventions aiming to target negative emotionality in EAs should focus on mitigating criticism or educating parents on the importance of considering psychological health such as depression symptomology when providing critical feedback to minimize heightened negative affect or decrease the likelihood of emotional dysfunction in EAs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives: There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers., Methods: Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data., Results: The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic., Conclusion: At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services., (© 2022. The Author(s).)

Background: Despite interest in transdiagnostic dimensional approaches to psychopathology, little is known about the dynamic interplay of affecting and internalizing symptoms that cut across diverse mental health disorders. We examined within-person reciprocal effects of negative and positive affect (NA, PA) and symptoms (depression and anxiety), and their between-person associations with affective dynamics (i.e., affect inertia)., Methods: Individuals currently receiving treatment for psychological disorders (N = 776) completed daily assessments of affect and symptoms across 14 treatment days (average). We used dynamic structural equation modeling to examine daily affect-symptom dynamics., Results: Within-person results indicated NA-symptom reciprocal effects; PA only predicted subsequent depression symptoms. After accounting for changes in mean symptoms and affect over time, NA-anxiety and PA-depression relations remained particularly robust. Between-person correlations indicated NA inertia was positively associated with NA-symptom effects; PA inertia was negatively associated with PA-symptoms effects., Conclusions: Results suggest that transdiagnostic affective treatment approaches may be more useful for reducing internalizing symptoms by decreasing NA compared to increasing PA. Individual differences in resistance to shifting out of affective states (i.e., high NA vs. PA inertia) may be a useful marker for developing tailored interventions., (© 2022 Wiley Periodicals LLC.)

Introduction: The minimally invasive surgical repair of combined inguinal and ventral hernias often requires shifting from one approach or plane to another. The traditional enhanced-view totally extraperitoneal Rives-Stoppa repair consists of a large retro muscular dissection that is unjustified for small ventral hernias. Here we describe a modification to the minimally invasive Rives-Stoppa repair using a limited retro muscular dissection based on the ventral defect size for small/medium-sized hernias, with or without combined inguinal hernias., Methods: From a single surgical team, a retrospective study was performed over a 1-year period. Demographics, hernia characteristics, surgical techniques, intraoperative/postoperative complications, and outcomes were all analyzed and reported. We also included detailed surgical steps, landmarks, pitfalls, and personal tips for this technique., Results: Twenty-four patients underwent a laparoscopic limited retromuscular dissection ventral hernia repair utilizing the eTEP access technique. Eighteen were primary umbilical hernias and six postoperative incisional hernias, and nine were combined ventral and inguinal hernia repairs. Eight of the primary umbilical hernias were EHS classified as medium size, 11 small, and for the incisional hernias, three were classified as M3W1 and two as M3W2. One procedure was converted to TAPP. There were no intraoperative complications. The mean length of stay was 1.25 days (range 1-3). There was one postoperative retromuscular hematoma and no recurrence during the follow-up period., Conclusion: eTEP with limited dissection offers a good and safe solution for small to medium size hernias; it provides an efficient solution when an inguinal hernia is to be addressed as well., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Obesity is associated with short term perinatal risks, causing increased risks in pre- and post-term birth, small and large for gestational (SGA/LGA), congenital anomalies, and perinatal mortality., Objective: This study evaluate maternal and neonatal outcomes of women with morbid obesity who delivered before BS as compared to their counterparts who delivered after BS., Design: A retrospective analysis in a single institute., Settings: We use the data according to the ICD-9 code and were extracted from hospital archive., Patients: Patients were divided int0 two groups consisted of those of who conceived after BS and those who conceived before BS., Interventions: All women who underwent any BS and retrieved their obstetric files before or after the surgery., Main Outcomes Measures: The pregnancy, delivery data and obstetric factors were collected, clinical variables, background data and surgical bariatric procedures, operating time, length of hospital stay., Results: 149 morbidly obese women, of which 45 delivered after BS (group I) and 104 delivered prior to BS (group II). The most frequent comorbidity was diabetes mellitus, found in 67% of the women who delivered before BS. Time to delivery was longer in the women before BS, (P = 0.015) for the after BS group. Women who delivered before BS compared to women who delivered after BS had higher rates of anemia (p = 0.038), gestational diabetes (p = 0.064), and preeclampsia (p = 0.043). Women with deliveries before BS were characterized by higher birth weight in the neonates, (p < 0.001), more cases of premature membrane rupture, (14%, p < 0.018) and relatively high number of SGAs. A multivariate analysis of the data imply correlation to age and not causation., Limitations: This study was a small retrospective study and selection bias can occur which may reduce the accuracy of the results., Conclusions: There are clear health benefits of weight loss for morbidly obese women of reproductive age, and BS has an important role to play in this population., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Evidence suggests that post-secondary students without pre-existing mental health concerns may have experienced worsening mental health during the COVID-19 pandemic, relative to students with pre-existing mental health concerns. To clarify the psychological impacts of the pandemic, and elucidate why differences may exist among students, 20 interviews were conducted with emerging adults enrolled in university. Using directed content analysis, eight themes were identified: three more common among students with pre-existing mental health concerns, three more common among students without pre-existing mental health concerns, and two shared. Although all students experienced novel stressors during the pandemic, students without pre-existing mental health concerns reported greater increases in social and academic isolation, relative to students with pre-existing mental health concerns. Students with pre-existing mental health concerns also leveraged existing coping repertoires, which further supported their ability to manage pandemic-related challenges. Findings highlight how postsecondary institutions can bolster student well-being., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the the Social Sciences and Humanities Research Council (SSHRC) to conduct this research (grant number: 435-2018-0961)., (© 2022 Society for the Study of Emerging Adulthood and SAGE Publishing.)

Background: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical outcomes. Only a few studies have compared the radiographic results of using unilateral vs. simultaneous bilateral approaches. We aimed to examine and compare the radiographic results of unilateral (UKP) vs. bilateral simultaneous double-balloon kyphoplasty (DKP) for treating symptomatic vertebral compression fractures (VCF)., Methods: A retrospective cohort of all patients treated for VCF by DKP and UKP over five years in a single medical center. From 2009 to 2012, we routinely performed UKP; from 2012, DKP was the routine due to potential benefits in vertebral realignment. We evaluated pre- and post-surgical fracture characteristics including vertebral height, sagittal and coronal Cobb angle, and fracture reduction. Statistical analysis included a t -test for independent variables and Pearson's correlation., Results: The study cohort consisted of 81 patients (75.8 years ± 10.86) who underwent surgery, with a total of 119 vertebras. We performed 89 UKP on fractured vertebras and 30 DKP on 30 vertebrae. The UKP average fluoroscopy radiation exposure was 15.8 mGy (±11.5) per level compared to 11.2 mGy (±8.7) for DKP, p = 0.03. DKP showed significant fracture reduction, 2.8 degrees of Cobb angle, equaling the patient positioning effect on fracture reduction., Conclusion: DKP results in better fracture reduction than UKP, and equals the effect of patient positioning without increased radiation exposure or adverse events.

Purpose: To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing., Method: An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge., Results: During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized., Conclusion: Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens., (© 2020. Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Sleeve gastrectomy is one of the most popular bariatric procedures performed. A complication of this surgery is sleeve stenosis, causing significant morbidity and the need for corrective intervention. Endoscopic treatment using pneumatic dilation has evolved as an effective, and minimally invasive, technique to successfully treat this complication. Here we report our experience with endoscopic management of sleeve stenosis at a tertiary bariatric center., Material and Methods: We identified all patients that underwent endoscopic management of sleeve stenosis at a tertiary bariatric center from 2010. We reviewed patient demographics, operative data, interval to endoscopic treatment, and outcomes of pneumatic dilations., Results: Sixty seven patients underwent 130 endoscopic dilations. The majority of these patients were female (71%), and at the time of sleeve gastrectomy average age was 43.3 years (range 18-68 years) and average BMI was 41.5 kg/m 2 (range 31-63 kg/m 2 ). The time interval to first endoscopic procedure was 7.2 months (range 0.75-53 months), with an average of 2 procedures per patient. During the follow-up period, the success rate of endoscopic dilatation was 76.1%, while the remaining 16 patients underwent conversion to gastric bypass. Two patients underwent emergency conversion to gastric bypass for sleeve perforation during the procedure (1.5%). There was a modest weight gain of 3 kg (4.2% total body weight) after sleeve dilatation., Conclusions: Endoscopic management of sleeve stenosis is safe and effective, with a success rate of over 75%. During endoscopic management, there was a 1.5% risk of sleeve perforation requiring emergency surgery. Mild weight regain occurred following endoscopic sleeve dilation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To describe the abdominal wall reconstruction technique with an Ultrapro mesh and outcome for the repair of postoperative ventral hernias after the use of a Mercedes incision during the initial abdominal operation., Method: A retrospective review of all the patients undergoing elective postoperative ventral hernia repair between 2013 and 2019. The cohort of these patients that had an initial Mercedes incision was used for this study., Results: Fourteen patients met the criteria for this study. Thirteen of the patients were transplant patients (10 liver transplant and 3 combined pancreas and kidney transplant), and one patient was after a hepatectomy. Fifty-seven percent of these hernias were multiple defects. All the patients underwent the same repair of a modified Rives-Stoppa, transversus abdominis release, and a bilateral transverse plication. A partially absorbable Ultrapro mesh was used for all the patients, with two of the patients needing an additional Symbotex mesh in order to bridge a portion of the posterior fascia. There were 6 minor early postoperative complications (hematoma, superficial wound infection, and seroma) that did not require reoperation. Two patients were readmitted for observation of a wound hematoma, and two patients (14.2%) had recurrence during the follow-up period. The average length of hospitalization was 5.6 days., Conclusion: This technique, with the use of an Ultrapro mesh, was found to be safe and effective for the repair of a postoperative ventral hernia due to an initial Mercedes incision., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Introduction: Numerous surgical approaches and hemostatic techniques are used and have been described when operating on the traumatized liver. Despite a substantial decline in operative liver trauma, there still remains a debate on the optimal surgical approach, and goals, during the initial trauma laparotomy. Hepatic resection during the first operation, including the damage control settings, is advocated and practiced in only a select few institutions and remains highly controversial. Here, we describe our success with hepatic resection, repair, and/or hepatic vascular repair, during the trauma laparotomy with our emphasis on the collaboration between the trauma and hepatobiliary surgical teams., Case Series: From 207 patients with liver injuries during the study period, 7 patients had definitive liver resection or repair during the initial trauma laparotomy. One had hepatic tissue repair, 1 had hepatic vein repair, and 5 had liver resections. All the operations involved a hepatobiliary surgeon together with the trauma team. There were no fatalities in the liver operation group, no sepsis, or need for emergent angiography because of hemorrhage. Four patients needed endoscopic retrograde cholangiopancreatography (ERCP) and stenting because of biliary leak. Three patients were discharged home and 4 to rehabilitation., Discussion: Hepatic resection, and/or definitive hepatic repair, may be safe and beneficial to the patients during the initial operation even in a damage control setting when the patients' overall condition allows. We emphasize the benefit of collaboration with experienced and trained liver surgery, especially in lower volume trauma centers. ERCP is commonly needed for postoperative biliary leak and should be readily utilized.

Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, M age = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hamza, Goldstein, Heath and Ewing.)

Objective: Research has documented the relationship between attention-deficit/hyperactivity disorder (ADHD) and increased cannabis use, but the studies largely rely on cross-sectional or longitudinal designs. Few studies have examined the impact of recent (i.e., past 6 months) ADHD symptoms on more proximal cannabis-related factors. The purpose of the current study was to examine the relationship between cannabis use motives (coping, boredom, and sleep) and consequences and the impact of ADHD symptoms on these relationships., Method: Participants were 62 emerging adults (ages 19-25 years; M = 22.12, SD = 2.07; 60% male) who used cannabis regularly (two or more times in the past 2 weeks) and completed a screener assessing past-6-months ADHD symptoms at baseline followed by 14 daily reports on cannabis use, consequences, and motives., Results: Across the 14 days, cannabis consequences were higher for participants with greater past-6-months symptoms of ADHD. In addition, on days when participants used cannabis for boredom and on days when they used cannabis for sleep, cannabis consequences were higher. Although greater past-6-months ADHD symptoms were associated with more consequences on days when sleep motives were endorsed, contrary to hypotheses, the strength of this relationship was greater on days when sleep motives were not endorsed. Overall, greater daily consequences for those with higher ADHD symptoms may reflect exacerbation of these symptoms, and follow-up analyses revealed that the cannabis consequences associated with higher ADHD scores were indeed ones that overlap with ADHD symptoms., Conclusions: The results suggest that ADHD symptoms, along with sleep and boredom motives, contribute to increased daily cannabis consequences and should be considered in developing interventions for emerging adults.

Background: Over the years, the silastic ring vertical gastroplasty (SRVG) has shown poor long-term outcomes with both weight regain and complications. Therefore, most bariatric surgeons have been presented with the need to perform a successful and safe conversion procedure. Yet the preferred and recommended conversion surgery regarding weight loss, comorbidity improvement, and postoperative complications remains under debate., Objective: The aim of this study is to compare the outcomes of conversion from SRVG with either Roux-en-Y gastric bypass (RYGBP) or one anastomosis gastric bypass (OAGB)., Materials and Methods: A retrospective study was conducted from our bariatric surgery units' database. We reviewed the files of patients who underwent either a RYGBP or OAGB after a previous SRVG. Demographics, obesity-related comorbidities, BMI before and after the procedure, postoperative complications, and length of hospital stay were analyzed., Results: Between May 2008 and August 2018, fifty-four patients underwent conversion from a failed SRVG. Twenty-one patients underwent conversion to OAGB (39%), and thirty-three patients underwent conversion to RYGBP (61%). Major complications were reported in 9.5% of the OAGB group and 15.1% of the RYGBP group. At a mean follow-up of 28 months, the OAGB group achieved a 78.5% excess BMI loss compared with 57.6% in the RYGBP group (p = 0.137). One patient (4.7%) of the OGBP group and 5 (15.1%) of the RYGBP group needed reoperations due to complications (p = 0.224)., Conclusion: The OGBP is gaining popularity and evidence as an effective and safe procedure. Here we show the successful utilization of the OGBP, when compared with RYGBP, as a revisional procedure after SRVG.

The advent of immune checkpoint inhibitors has represented a major boost in cancer therapy, but safety concerns are increasingly being recognized. Indeed, although beneficial at the tumor site, unlocking a safeguard mechanism of the immune response may trigger autoimmune-like effects at the periphery, thus making the safety of immune checkpoint inhibitors a research priority. Herein, we demonstrate that thymosin α1 (Tα1), an endogenous peptide with immunomodulatory activities, can protect mice from intestinal toxicity in a murine model of immune checkpoint inhibitor-induced colitis. Specifically, Tα1 efficiently prevented immune adverse pathology in the gut by promoting the indoleamine 2,3-dioxygenase (IDO) 1-dependent tolerogenic immune pathway. Notably, Tα1 did not induce IDO1 in the tumor microenvironment, but rather modulated the infiltration of T-cell subsets by inverting the ratio between CD8 + and Treg cells, an effect that may depend on Tα1 ability to regulate the differentiation and chemokine expression profile of DCs. Thus, through distinct mechanisms that are contingent upon the context, Tα1 represents a plausible candidate to improve the safety/efficacy profile of immune checkpoint inhibitors., (© 2020 Renga et al.)

This study explored the utility of the Coma Recovery Scale-Revised (CRS-R) in predicting emergence from a disorder of consciousness, using a sample of veterans who were treated at one of the five Veterans Affairs (VA) polytrauma rehabilitation centre sites in an Emerging Consciousness programme. Participants ( N  = 70) included both combat and non-combat active duty military personnel and veterans who sustained either a severe traumatic brain injury, or anoxic brain injury and were considered to have a disorder of consciousness at the time of admission. Patient information was retrospectively collected from electronic medical records from one of the VA polytrauma rehabilitation centre sites. Receiver Operator Characteristic models were utilised to explore "cut-off scores" for predicting emergence using the CRS-R. Results showed that week-three scores on the CRS-R were more accurate in determining whether a veteran would emerge from a disorder of consciousness. Limitations, including a limited sample size are explored, along with implications and recommendations for future research and clinical practice.

Chronic granulomatous disease (CGD) is a genetic disorder of the NADPH oxidase characterized by increased susceptibility to infections and hyperinflammation associated with defective autophagy and increased inflammasome activation. Herein, we demonstrate that thymosin β4 (Tβ4), a g-actin sequestering peptide with multiple and diverse intracellular and extracellular activities affecting inflammation, wound healing, fibrosis, and tissue regeneration, promoted in human and murine cells noncanonical autophagy, a form of autophagy associated with phagocytosis and limited inflammation via the death-associated protein kinase 1. We further show that the hypoxia inducible factor-1 (HIF-1)α was underexpressed in CGD but normalized by Tβ4 to promote autophagy and up-regulate genes involved in mucosal barrier protection. Accordingly, inflammation and granuloma formation were impaired and survival increased in CGD mice with colitis or aspergillosis upon Tβ4 treatment or HIF-1α stabilization. Thus, the promotion of endogenous pathways of inflammation resolution through HIF-1α stabilization is druggable in CGD by Tβ4., (© 2019 Renga et al.)

Thymosin alpha1 (Tα1), an endogenous peptide first isolated from the thymic tissue in the mid-sixties, has gained considerable attention for its immunostimulatory activity that led to its application to diverse pathological conditions, including cancer. Studies in animal models and human patients have shown promising results in different types of malignancies, especially when Tα1 was used in combination with other chemo- and immune therapies. For this reason, the advancements in our knowledge on the adjuvant role of Tα1 have moved in parallel with the development of novel cancer therapies in a way that Tα1 was integrated to changing paradigms and protocols, and tested for increased efficacy and safety. Cancer immunotherapy has recently experienced a tremendous boost following the development and clinical application of immune checkpoint inhibitors. By unleashing the full potential of the adaptive immune response, checkpoint inhibitors were expected to be very effective against tumors, but it soon became clear that a widespread and successful application was not straightforward and shortcomings in efficacy and safety clearly emerged. This scenario led to the development of novel concepts in immunotherapy and the design of combination protocols to overcome these limitations, thus opening up novel opportunities for Tα1 application. Herein, we summarize in a historical perspective the use of Tα1 in cancer, with particular reference to melanoma, hepatocellular carcinoma and lung cancer. We will discuss the current limitations of checkpoint inhibitors in clinical practice and the mechanisms at the basis of a potential application of Tα1 in combination protocols.

Background and Aims: Despite increases in female gambling, little research investigates female-specific factors affecting gambling behavior (GB). Although research suggests that some addictive behaviors may fluctuate across menstrual cycle phase (MCP), gambling requires further investigation. In two studies, we examined associations between MCP and three risky GBs: time spent gambling, money spent gambling, and the probability of consuming alcohol while gambling. Associations between MCP and negative affect were also examined in Study 2. We predicted that, consistent with self-medication theory, increases in negative affect (Study 2) and risky GBs (Studies 1 and 2) would occur premenstrually/menstrually relative to other phases., Methods: Data were obtained from 33 female gamblers using a retrospective timeline followback procedure (Study 1) and from 20 female gamblers using a prospective 32-day, daily diary method (Study 2). In Study 2, salivary progesterone levels verified self-reported MCP validity., Results: Findings revealed significant, but somewhat inconsistent, MCP effects on GBs across studies. The self-medication hypothesis was partially supported. Increases relative to another MCP(s) were found for alcohol consumption while gambling premenstrually, time spent gambling menstrually/premenstrually, money spent gambling menstrually, and negative affect premenstrually. Unexpectedly, findings more consistently indicated that GBs increased during ovulation, suggestive of enhanced reward sensitivity. Progesterone assays validated self-reported MCP (Study 2)., Discussion and Conclusions: The results suggest a role of ovarian hormones on negative affect and GBs in females. This research could lead to the identification of female-specific factors affecting gambling and the development of more effective interventions for females with, or at risk for, problematic gambling.

Anxiety and gambling problems co-occur at high rates. Social learning theory (SLT) suggests that people high in anxiety engage in excessive gambling to reduce negative affect. Because anxiety sensitivity (AS) is a vulnerability factor associated with addictive behaviors, it is important to identify mediators in this high-risk pathway. Emerging research shows that social context mediates associations between anxiety vulnerability and addictive behaviors. This literature shows that anxiety-prone people are at increased risk for substance problems because they engage in frequent solitary substance use. Theory would predict a similar pathway to gambling problems, but this remains to be tested. Accordingly, this study aimed to examine solitary gambling as an explanatory variable in the anxiety pathway to gambling problems. We used a longitudinal ecological momentary assessment (EMA) design. After completing baseline measures, young adults (N = 108) were asked to report daily on their gambling behavior over a 30-day period. Bias corrected bootstrapped confidence intervals (CI) supported 1 hypothesized indirect effect from baseline AS (Time 1) to EMA time spent gambling (Time 2) via EMA solitary gambling (Time 2; B = 0.019, 95% CI [0.002, 0.045]). This suggests that emerging adults with high levels of AS at baseline engaged in frequent solitary gambling over the 30-day EMA sampling period, which in turn predicted more time spent gambling over this same time period. Our results show that solitary gambling mediates the relation between anxiety vulnerability and excessive gambling. Understanding how social context relates to excessive gambling can help create interventions to reduce solitary gambling among anxiety-prone individuals. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Introduction: Thymosin alpha 1 (Tα1) is a naturally occurring polypeptide of 28 amino acids, whose mechanism of action is thought to be related to its ability to signal through innate immune receptors. Tα1 (ZADAXIN®) is used worldwide for treating viral infections, immunodeficiencies, and malignancies. Owing to its ability to activate the tolerogenic pathway of tryptophan catabolism - via the immunoregulatory enzyme indoleamine 2,3-dioxygenase - Tα1 potentiates immune tolerance mechanisms, breaking the vicious circle that perpetuates chronic inflammation in response to a variety of infectious noxae., Areas Covered: Tα1 has never been studied in Cystic fibrosis (CF) in which the hyperinflammatory state is associated with early and nonresolving activation of innate immunity, which impairs microbial clearance and promotes a self-sustaining condition of progressive lung damage. Optimal CF treatments should, indeed, not only rescue CF transmembrane conductance regulator protein localization and functionality but also alleviate the associated hyperinflammatory pathology. Because of the inherent complexity of the pathogenetic mechanisms, a multidrug approach is required., Expert Opinion: By providing a multipronged attack against CF, i.e. restraining inflammation and correcting the basic defect, Tα1 favorably opposed CF symptomatology in preclinical relevant disease settings, thus suggesting its possible exploitation for 'real-life' clinical efficacy in CF. This could represent a major conceptual advance in the CF field, namely the proposal of a drug with the unique activity to correct CFTR defects through regulation of inflammation.

Introduction: Thymosin β4 (Tβ4) is a thymic hormone with multiple and different intracellular and extracellular activities affecting wound healing, inflammation, fibrosis and tissue regeneration. As the failure to resolve inflammation leads to uncontrolled inflammatory pathology which underlies many chronic diseases, the endogenous pathway through which Tβ4 may promote inflammation resolution becomes of great interest. In this review, we discuss data highlighting the efficacy of Tβ4 in resolving inflammation by restoring autophagy., Areas Covered: The authors provide an overview of the Tβ4's anti-inflammatory properties in several pathologies and provide preliminary evidence on the ability of Tβ4 to resolve inflammation via the promotion of non-canonical autophagy associated with the activation of the DAP kinase anti-inflammatory function., Expert Opinion: Based on its multitasking activity in various animal studies, including tissue repair and prevention of chronic inflammation, Tβ4 may represent a potential, novel treatment for inflammatory diseases associated with defective autophagy.

Parathyroid imaging modalities have been used to guide clinicians and surgeons in finding the source of hyperparathyroidism for over 40 years. Primary hyperparathyroidism (PHPT) is generally caused by a parathyroid gland(s) autonomous production of parathyroid hormone (PTH), associated by enlargement of one or more glands. Noninvasive imaging procedures that are used in the management of hyperparathyroidism are anatomical (ultrasound, computer tomography, magnetic resonance imaging) and/or functional (nuclear medicine techniques: planar scintigraphy, single photon emission tomography, positron emission imaging) and/or hybrid imaging., Competing Interests: The authors declare that they have no conflict of interest.

Despite often being considered equivalent affective states, shame and guilt have differential associations with problem gambling with only shame showing a strong positive association with problem gambling. However, little is known about the mechanisms underlying the shame-problem gambling association. Further, shame and guilt are associated with distinct coping strategies, with shame motivating maladaptive coping (e.g., avoidance, escape) and guilt motivating adaptive coping (e.g., taking corrective action). This study aimed to examine whether maladaptive coping motives for gambling mediate the relationship between shame, but not guilt, and gambling problems. Participants were 196 (126 male) regular gamblers who completed a same and guilt scale, the Problem Gambling Severity Index, and a modified Gambling Motives Questionnaire, which assessed individual motives to engage in gambling for coping, enhancement, or social reasons. Results indicated that coping motives for gambling fully mediated the relationship between shame and problem gambling severity, but did not mediate the association between guilt and problem gambling severity. Experiencing shame contributes to problem gambling as a result of gambling to cope with negative affect. Cultivating more adaptive strategies to cope with shame may be effective in preventing and treating problem gambling.