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International studies find that between a quarter and a third of offenders may be defined as problem gamblers. No comparable studies have been conducted in the UK during the last decade, which has seen unprecedented changes in gambling legislation and opportunities. The present study in two English prisons (one male and one female) found that levels of problem gambling were in line with global estimates. 27.8% of men and 18.1% of women were rated as medium-risk and problem gamblers. Gambling problems were linked to current and previous offending for between 7% and 13% of all offenders.

Introduction: The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter defibrillator (ICD) therapy reduced overall mortality in patients with class II or III heart failure and left ventricular ejection fraction (LVEF) ≤ 35%, while amiodarone had no effect on survival. There are limited data regarding the influence of gender on outcome of patients receiving ICDs for primary prevention. Methods: We examined gender differences in response to treatment and outcome in this cohort. Results: Women comprised 23% of the SCD-HeFT cohort, with similar percentages in the amiodarone, ICD, and placebo groups. Compared with men, women were more likely to be non-Caucasian, to have class III heart failure, and nonischemic heart disease. After adjustment for baseline differences, overall mortality risk was lower in women than in men. The gender difference in overall mortality was seen in the placebo group, while no gender difference in overall mortality was seen in the ICD group. There was a significantly lower absolute risk of death in the placebo arm women, compared with the placebo arm men (annual mortality rate approximately 4% vs. 6%). Conclusions: The impact of ICD therapy appears to differ between men and women in this trial, with a smaller ICD benefit among women. However, the test for an interaction between gender and therapy was not significant. The lower overall mortality risk in women in the placebo group and the smaller number of women enrolled may help to explain why treatment differences in women were much smaller and difficult to detect.

Objectives: To compare pain and discomfort ratings of female patients undergoing urethral catheterization randomized to topical application of plain lubricant versus lidocaine gel prior to the procedure. Methods:This was a prospective, randomized, double-blind study involving female patients requiring urethral catheterization at an urban university-based academic emergency department. A staff nurse blinded to the lubricant type injected 5 mL of sterile surgical lubricant or 2% lidocaine gel into the urinary meatus. After 1 minute, an 8-F (for specimen collection) or a 16-F (for continuous collection) catheter was inserted into the urethra. Each patient rated the pain of the procedure on a validated 0- to 100-mm visual analog scale. The Mann-Whitney U test was used to analyze associations between pain ratings, lubricant type, and catheter size. Logistic regression was used to identify the contribution of lubricant type, catheter size, age category, difficulty of insertion, preprocedural pain, and diagnosis of urinary tract infection to procedural pain rating. Results: One hundred women were randomized to plain lubricant (n= 50) or lidocaine (n= 50). The overall mean (± SD) pain score was 23.5 ± 27.2 mm. No significant differences in pain ratings were found based on catheter size or lubricant type. Younger women, aged 18–59 years, experienced higher pain ratings than women aged 60–101 (mean pain difference 14.4 mm; 95% CI = 4.3 to 24.5; p < 0.006). Multiple logistic regression identified preprocedural pain as the only predictor of higher pain rating after catheterization (OR 1.02; 95% CI = 1.002 to 1.039, p = 0.03). Conclusions: Catheter size and lubricant type did not affect the severity of pain after urethral catheterization in women.

To compare pain and discomfort ratings of female patients undergoing urethral catheterization randomized to topical application of plain lubricant versus lidocaine gel prior to the procedure.This was a prospective, randomized, double-blind study involving female patients requiring urethral catheterization at an urban university-based academic emergency department. A staff nurse blinded to the lubricant type injected 5 mL of sterile surgical lubricant or 2% lidocaine gel into the urinary meatus. After 1 minute, an 8-F (for specimen collection) or a 16-F (for continuous collection) catheter was inserted into the urethra. Each patient rated the pain of the procedure on a validated 0- to 100-mm visual analog scale. The Mann-Whitney U test was used to analyze associations between pain ratings, lubricant type, and catheter size. Logistic regression was used to identify the contribution of lubricant type, catheter size, age category, difficulty of insertion, preprocedural pain, and diagnosis of urinary tract infection to procedural pain rating.One hundred women were randomized to plain lubricant (n = 50) or lidocaine (n = 50). The overall mean ( +/- SD) pain score was 23.5 +/- 27.2 mm. No significant differences in pain ratings were found based on catheter size or lubricant type. Younger women, aged 18-59 years, experienced higher pain ratings than women aged 60-101 (mean pain difference 14.4 mm; 95% CI = 4.3 to 24.5; p0.006). Multiple logistic regression identified preprocedural pain as the only predictor of higher pain rating after catheterization (OR 1.02; 95% CI = 1.002 to 1.039, p = 0.03).Catheter size and lubricant type did not affect the severity of pain after urethral catheterization in women.

Serial DFT Measures in Man. Introduction; The defibrillation threshold (DFT) may change throughout the first year following implantation of a cardioverter defibrillator, but it remains uncertain if changes are a consequence of changes in clinical condition or are related to fundamental alterations at the electrode-tissue interface. The purpose of this study was to evaluate the extent and time course of DFT changes over the first year following implantable cardioverter defibrillator (ICD) surgery when extraneous clinical and device variables potentially affecting the DFT were excluded. Methods and Results.: We prospectively enrolled 61 patients undergoing epicardial or non-thoracotomy/transvenous ICD therapy into a series of follow-up studies where the DFT was measured at implant and at 1, 6,12, and 52 weeks following implantation in a uniform manner. Stored energy DFT was measured and recorded for all patients. Patient exclusion criteria were: (1) inability to complete all five measures of the DFT; (2) institution of Class I or Class III antiarrhythmic drugs at any time during the study; (3) lead system changes (relocation or new leads) or programming changes in pulse width or current pathway; or (4) development of a significant change in their clinical status, such as decompensated congestive heart failure or acute ischemia. Only 20 of the 61 patients satisfied the criteria required to complete the study. Two of the excluded patients developed high DFTs, which required reprogramming of the current pathway. Eight patients had an epicardial lead system, and 12 had a nonthoracotomy lead system. The rise in DFT over the first 12 weeks was significant for the eight epicardial lead system patients (P = 0.05) and for the 12 nonthoracotomy lead system patients (P = 0.004). The peak rise in DFT occurred at 1 week for the patients with an epicardial lead system (3.4 ± 1.8 J to 7.9 ± 3.8 J) and at 12 weeks for the patients with a transvenous lead system (10.3 ± 5.3 J to 16.1 ± 7.4 J). Conclusions: This study confirms a transient significant rise in the DFT in the first 12 weeks following ICD surgery that partially returns to the implant value over the remainder of the year. Because specific clinical and technical variables were excluded from this study, the observations made in this patient population suggest that the rise in DFT may be a consequence of changes at the electrode-tissue interface.

Effect of Defibrillation on Pacing Thresholds. Introduction: Significant increases in ventricular pacing threshold have been observed following monophasic waveform ventricular defibrillation shocks. High-output pacing is recommended to ensure consistent capture, particularly in pacemaker-dependent patients who are likely to be defibrillated. Whether biphasic waveform defibrillation compounds this problem is not known. The purpose of this prospective study was to examine serial changes in ventricular pacing thresholds following single, multiple, low- and high-energy biphasic defibrillation sbocks from an implanted defibrillator. Methods and Results: Bipolar pacing thresholds before and after defibrillation, and the adequacy of pacing capture at three times preshock threshold in the immediate aftermath of ventricular defibrillation, were prospectively evaluated in 67 consecutively tested recipients of a biphasic implanted cardioverter defibrillator. Overall, serial pacing thresholds following successful defibrillation were completely unchanged after 141 of 177 (80%) ventricular fibrillation inductions. In no case did the threshold pulse width increment > 0.06 msec from its baseline value after shock, nor did pacing at a pulse width of three times preshock threshold from dedicated bipolar pacing electrodes fail to result in successful ventricular capture. Changes in threshold were not related to when measured from the time of shock, defibrillation energy, number of shocks, electrode system, chronicity of leads, shock orientation, or to clinical factors. Conclusions: No clinically important changes in pacing threshold were observed after biphasic waveform defibrillation. Bradycardia pacing at conventional pacemaker outputs of three times baseline pulse width threshold from bipolar electrodes dedicated exclusively to pacing or sensing (but not defibrillation) consistently allowed for an adequate safety margin following defibrillation.