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Pathological gambling: an increasing public health problem

Article first published online: 7 JUL 200
Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source]

Developmental changes in factors limiting colony survival and growth of the leaf-cutter ant Atta laevigata

ECOGRAPHY, Issue 3 2010
Ernane H. M. Vieira-Neto
Many species of leaf-cutter ants (Atta and Acromyrmex) increase in abundance following natural or anthropogenic disturbances in the vegetation. However, the mechanisms responsible for such an increase are still poorly understood. We evaluated the effects of nesting site and the availability of palatable forage on survival and growth of Atta laevigata colonies at different developmental stages. Foundress queens transplanted into man-made clearings (dirt roads) had a much higher survival than those transplanted into the adjacent undisturbed savannah vegetation. Similarly, incipient colonies (,3-months old) had significantly greater survival and growth rates in dirt roads. In contrast, nesting site did not influence performance of young colonies (,15-months old). Both incipient and young colonies responded strongly and positively to experimental supplementation of palatable forage, and this effect was independent of the nesting habitat. Colonies that received extra food grew faster and had a significantly greater survival rate than control colonies. These results suggest that performance of A. laevigata is affected by the generally greater availability of suitable nesting sites and palatable vegetation in disturbed habitats. This may explain how these ants maintain high densities in these habitats, and since the relative importance of these factors changed with colony ontogeny, our findings highlight the importance of evaluating potential limiting factors throughout the full range of an organism's developmental stages. [source]

Software Use in Psychometric Research

Gary Skaggs
Research on psychometric methods is heavily dependent on software. The quality, availability, and documentation of such software are critical to the advancement of the field. In 2000, an ad hoc committee of NCME recommended that NCME adopt policies that promote greater availability and better documentation of software. This article follows the ad hoc committee's report by examining the use of software in four top-tiered journals in recent years. The results indicated that the most frequently cited programs were those written by the articles' authors. The documentation and availability for these programs are often not clear, particularly for software used for simulations. The use of proprietary software was not widespread in the four journals, but there is still room for concern in the future. This article recommends that NCME form a permanent committee to address software issues. [source]

Defoliation alters water uptake by deep and shallow roots of Prosopis velutina (Velvet Mesquite)

K. A. Snyder
Summary 1Prosopis velutina Woot. (Velvet Mesquite) at a site with limited groundwater availability derived a greater percentage of water from shallow soil at the onset of the summer rainy season than did trees at a site with greater availability of groundwater. Predawn leaf water potentials (,pd) were not a strong indicator of shallow water use for this species with roots in multiple soil layers. 2We experimentally defoliated P. velutina plants to determine if reduced-canopy photosynthesis would alter vertical patterns of root activity. After natural rain events, hydrogen isotope ratios of xylem sap indicated that defoliated P. velutina took up a greater percentage of its water from shallow soils than did undefoliated plants. 3Irrigation with deuterium-labelled water further demonstrated that undefoliated plants were able to use shallow soil water. Defoliation appeared to affect the ability of trees to use deep-water sources. 4Reduced carbon assimilation limited water uptake from deep soil layers. These data highlight that there are internal physiological controls on carbon allocation that may limit water uptake from different soil layers. During periods of high vapour pressure deficit or soil drought, when leaf gas exchange and carbon assimilation decline, this may create positive feedbacks where plants are unable to forage for deep water due to carbon limitations. [source]

Alpha-1-antitrypsin deficiency associated with panniculitis treated with plasma exchange therapy

Priscila De Oliveira MD
Background, Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well-recognized association with early-onset emphysema and cirrhosis, alpha-1-antitrypsin deficiency may be associated with panniculitis. The treatment of this type of panniculitis presents a significant challenge. Previous attempts using immunosuppressive, anti-inflammatory, and cytotoxic drugs have shown variable results. Aim, To report a case of alpha-1-antitrypsin deficiency-associated panniculitis treated with plasma exchange therapy. Methods, A 23-year-old patient developed painful red nodules on her thighs and buttocks with spontaneous ulceration and discharge of oily fluid. A skin biopsy specimen showed septal and lobular panniculitis. The serum alpha-1-antitrypsin level was 22 mg/dL. She was treated with plasma exchange therapy. Results, Treatment of this patient with plasma exchange therapy led to the control of the cutaneous lesions. Conclusions, Plasma exchange therapy represents an alternative treatment which restores serum and tissue alpha-1-antitrypsin levels. This method is proposed because of its clinical benefits and greater availability. [source]

Factors Associated with Home Versus Institutional Death Among Cancer Patients in Connecticut

William T. Gallo PhD
OBJECTIVE: To assess the relationships between home death and a set of demographic, disease-related, and health-resource factors among individuals who died of cancer. DESIGN: Prospective cohort study. SETTING: All adult deaths from cancer in Connecticut during 1994. PARTICIPANTS: Six thousand eight hundred and thirteen individuals who met all of the following criteria: died of a cancer-related cause in 1994, had previously been diagnosed with cancer in Connecticut, and were age 18 and older at the time of death. MEASUREMENT: Site of death. RESULTS: Twenty-nine percent of the study sample died at home, 42% died in a hospital, 17% died in a nursing home, and 11% died in an inpatient hospice facility. Multivariate analysis indicated that demographic characteristics (being married, female, white, and residing in a higher income area), disease-related factors (type of cancer, longer survival postdiagnosis), and health-resource factors (greater availability of hospice providers, less availability of hospital beds) were associated with dying at home rather than in a hospital or inpatient hospice. CONCLUSIONS: The implications of this study for clinical practice and health planning are considerable. The findings identify groups (men, unmarried individuals, and those living in lower income areas) at higher risk for institutionalized death,groups that may be targeted for possible interventions to promote home death when home death is preferred by patients and their families. Further, the findings suggest that site of death is influenced by available health-system resources. Thus, if home death is to be supported, the relative availability of hospital beds and hospice providers may be an effective policy tool for promoting home death. J Am Geriatr Soc 49:771,777, 2001. [source]

Inbreeding and demographic transition in the Orozco Valley (Basque Country, Spain)

J.A. Peña
Inbreeding in the Orozco Valley (Basque Country, Spain) between the 18th and 20th centuries was investigated on the basis of ecclesiastical dispensations and surname lists. The variations over time are very similar to those observed elsewhere in Europe, with a major increase in the coefficient of inbreeding in the late 19th and early 20th centuries. This is due mainly to an increase in marriages between first cousins. A highly marked decrease in inbreeding is observed during the 20th century. The secular trends described by the coefficient calculated on the basis of dispensations and by that calculated on isonymy are very similar. The nonrandom component of isonymy reveals a selective search for a related spouse during the period of maximum inbreeding. These results are associated with the process of demographic transition which affected European populations as a whole in the 19th century, resulting in a greater availability of kin among potential mates and thus enabling inbreeding to increase to levels far higher than those observed for earlier centuries. Am. J. Hum. Biol. 14:713,720, 2002. © 2002 Wiley-Liss, Inc. [source]

Intensification of workplace regimes in British horticulture: the role of migrant workers

Ben Rogaly
Abstract In Britain, international migrants have very recently become the major workforce in labour-intensive horticulture. This paper explores the causes of the dramatic increase since the 1990s in the employment of migrant workers in this subsector. It locates this major change in a general pattern of intensification of horticultural production driven by an ongoing process of concentration in retailer power, and in the greater availability of migrant workers, shaped in part by state initiatives to manage immigration. The paper draws on concepts developed in the US literature on agrarian capitalism. It then uses case histories from British horticulture to illustrate how growers have directly linked innovations involving intensification through labour control to their relationships with retailers. Under pressure on ,quality', volume and price, growers are found to have ratcheted up the effort required from workers to achieve the minimum wage through reducing the rates paid for piecework, and in some cases to have changed the type of labour contractor they use to larger, more anonymous businesses. The paper calls for further, commodity-specific and spatially-aware research with a strong ethnographic component. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Presentations of psychosis with violence: variations in different jurisdictions.

A comparison of patients with psychosis in the high security hospitals of Scotland, England
Background International literature is consistent on there being a significant relationship between psychosis and violence, less so on its extent and nature, but two main presentational types are increasingly recognized. In one, people are unremarkable before onset of illness and psychotic symptoms commonly drive violence; in the other, psychosis is preceded by childhood conduct problems, associated with personality disorder, and psychotic symptoms seem less relevant. Aims To explore the extent to which variations in aspects of social and service context in different jurisdictions affect presentational type among people admitted to high security hospitals. Hypotheses There will be differences between jurisdictions in proportions of patients with pure psychosis or with psychosis and antecedent personality disorder, but symptom drive to violence will be more common in the pure psychosis group regardless of social, legal and service context. Method Independently conducted record studies were used to compare high security hospital patients with psychosis in Scotland and England, all resident between 25 August 1992 and 13 August 1993. Results The cohorts were similar in offence histories, predominance of schizophrenia, age at first hospitalization for psychosis and first high security hospitalization. More Scottish patients had co-morbid substance misuse diagnoses and/or personality disorder than patients in England. Psychotic symptom drive to the index offence was, however, four times more likely in the pure psychosis groups, regardless of sex, ethnic group or country. Scottish patients spent less time in high security after the index act. Conclusions Our hypotheses were sustained. Knowledge about lifestyle before onset of psychosis is important for interpreting literature on how psychotic symptoms relate to violence. This may also influence longer term outcome, although the shorter length of secure hospital stay in Scotland was perhaps affected more by greater availability of open ,step-down' beds. Copyright © 2008 John Wiley & Sons, Ltd. [source]