Search

The emergence of new behaviours associated with communication technologies has prompted questions about the evolution of gambling in the population. The development of online gambling gave rise to public health concerns back 20 years ago. Current knowledge indicates that online gamblers generally tend to show more psychosocial problems than offline gamblers. But those portraits tend to neglect the differences between pure and mixed online gamblers. The goal of this research is to assess if, and to what extent, online gambling generates more harmful impacts on the health and well-being in a sample of adult gamblers in Québec. The propensity score matching method was chosen to assess the variable prevalence of impacts on a sample of 810 regular gamblers recruited from an online panel. They were divided into sub-groups: pure online gamblers (n= 143), mixed online gamblers (n= 125), and a control group of offline gamblers (n= 542). The study has revealed that among online gamblers and their entourage, online gambling does, in fact, result in an extra burden of impacts in several aspects of their lives: work, relationships, mental/physical health, finances, quality of life, and problem gambling according to the Canadian Problem Gambling Index. Results also show that combined with offline gambling, online gambling significantly increases the burden of impacts in terms of both the number and intensity of impacts. This is the first empirical study using propensity score matching to asses the incremental impacts of online gambling by separating pure and mixed gamblers and to compare them to offline gamblers. [ABSTRACT FROM PUBLISHER]

Background: Older adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions and have been repeatedly associated with poor cognitive outcomes, including delirium and dementia, in epidemiologic studies. However, no study has definitively evaluated the causal relationship between anticholinergics and cognition in a randomized controlled trial design. Utilizing our prior experience in deprescribing anticholinergic medications in various clinical environments, we designed an outpatient deprescribing intervention to prospectively test the potential causal relationship between anticholinergics and cognition in primary care older adults., Methods: This cluster randomized clinical trial will be conducted to evaluate the impact of an anticholinergic deprescribing intervention compared to usual care on outcomes of cognition and safety in primary care older adults. Participants will include those aged 65 years and over, receiving primary care in the greater Indianapolis area, using a strong anticholinergic within the last 2 weeks or with evidence of high-risk exposure in the past year. Those excluded will have a diagnosis of Alzheimer's disease or related dementia, or serious mental illness. The trial plans to enroll 344 participants who will be cluster-randomized at the level of primary care physician to avoid contamination. Participants will complete outcome assessments every 6 months up to 2 years by blinded outcome assessors. The primary outcome of the study is a composite measure of cognition that includes domains assessing executive cognitive function, language, and memory. Secondary outcomes include patient-reported measures of pain intensity, depression, anxiety, sleep disturbance, and health-related quality of life., Discussion: The R2D2 trial will be the largest and longest prospective randomized trial testing the impact of an anticholinergic-specific deprescribing intervention on cognition in primary care older adults. Results could influence deprescribing methodology and provide new insight on the relationship between anticholinergics and cognition., Trial Registration: ClinicalTrials.gov NCT04270474. Registered on February 17, 2020., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures have received and maintained ethical approval from the Institutional Review Board of the Indiana University (IRB# 1811254189; Federal-Wide Assurance Number, FWA00003544). The trial has also been registered at ClinicalTrials.gov (Identifier: NCT04270474). Consent for publication: Not applicable—no identifying images or other personal or clinical details of individual participants are presented here or will be presented in reports of the trial results. The participant information materials and informed consent form are available from the corresponding author on request. Competing interests: Dr. Boustani serves as a Chief Scientific Officer and co-Founder of Blue Agilis; the Chief Health Officer of DigiCare Realized, Inc; and the Chief Health Officer of Mozyne Health, Inc. He has equity interest in Blue Agilis, Inc; DigiCare Realized, Inc; and Mozyne Health, Inc. He sold his equity in Preferred Population Health Management LLC and MyShift, Inc (previously known as RestUp, LLC). He serves as an advisory board member or consultant for Eli Lilly and Co; Eisai, Inc; Merck & Co Inc; Biogen Inc; and Genentech Inc. These conflicts have been reviewed by Indiana University and has been appropriately managed to maintain objectivity. All other authors report no conflicts of interest., (© 2024. The Author(s).)

A case series of five patients with a total of six chronic non-healing wounds (>30 day duration) were non-randomly selected to evaluate the performance, safety and handling properties of dehydrated human amnion/chorion membrane allograft, an amniotic membrane scaffolding product. The patients had lower extremity wounds that had previously failed standard of care within a university outpatient/inpatient wound healing programme. Five wounds treated with dehydrated amnion/chorion membrane allograft showed a mean 43% area reduction from baseline (51% median) at 3 weeks into treatment and completely healed with a 64-day median time to closure (SD ±27·6 days). One wound worsened at 3 weeks and was found to have a complete central vein obstruction that was treated with long-term mild compression but still eventually healed at 6 months. Removing this outlier, the four responding wounds had a 72% mean and 69% median change in area from baseline, at the 3 week point. All five patients received only one application of dehydrated human amnion/chorion membrane allograft, and there were no adverse events. The product was easy to use, administer and handle. In summary, dehydrated human amnion/chorion membrane allograft appears to be a safe, effective and easy to use therapy for chronic non-healing wounds. This study describes the details of these clinical cases and provides an overview of the current evidence on the use of amniotic tissue in clinical practice., (© 2015 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Available data show that online gamblers spend more money and dedicate more time to playing compared to gamblers who do not play online, and are more likely to experience gambling problems. Among online players, young people and poker players show higher rates of gambling problems. These observations can be explained in part by such dangerous aspects of online gambling (and also electronic gaming machines) as: immediate and convenient accessibility; ability to pay electronically and to play on credit; anonymity; and the possibility for players to consume alcohol or other drugs while playing. These are elements that could facilitate the development or the intensification of problem gambling. This being said, the public discourse about the inevitability of legalized online gambling is quite unanimous and built upon such arguments as: the imperative duty of the state to protect the population against the dangers of the online gambling black market; and the fact that the medium in itself provides excellent consumer safeguards. A growing number of legislators are following the trend and choosing to establish state control over online gambling. We present some epidemiological and analytical data that challenge some of these assertions and decisions. We recommend a better integration of public health arguments into the commercialization and marketing of online gambling.

Pathological gambling has been identified as a major issue in Montreal's Chinese community. A variety of sources attest to the fact that, though we live in an increasingly heterogeneous society, the services provided to minority communities for preventing and treating pathological gambling are inadequate. An anthropological approach that takes into account cultural characteristics of one's community could lead to better strategies for acknowledgement, definition, diagnosis and treatment of pathological gambling among culturally different communities. Research paths that could help to provide effective treatment and services to specific populations are suggested. An overview of the way the Chinese view gambling, pathological gambling and treatment is presented. The concepts of fate, destiny and luck in Chinese thought, as well as Montreal's Chinese community social norms related to gambling are then described. The incorporation of those cultural understandings in future studies and treatment attempts is suggested.