Search

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license., Background: Small airways obstruction is a common feature of obstructive lung diseases. Research is scarce on small airways obstruction, its global prevalence, and risk factors. We aimed to estimate the prevalence of small airways obstruction, examine the associated risk factors, and compare the findings for two different spirometry parameters. Methods: The Burden of Obstructive Lung Disease study is a multinational cross-sectional study of 41 municipalities in 34 countries across all WHO regions. Adults aged 40 years or older who were not living in an institution were eligible to participate. To ensure a representative sample, participants were selected from a random sample of the population according to a predefined site-specific sampling strategy. We included participants' data in this study if they completed the core study questionnaire and had acceptable spirometry according to predefined quality criteria. We excluded participants with a contraindication for lung function testing. We defined small airways obstruction as either mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than the lower limit of normal or forced expiratory volume in 3 s to forced vital capacity ratio (FEV3/FVC ratio) less than the lower limit of normal. We estimated the prevalence of pre-bronchodilator (ie, before administration of 200 μg salbutamol) and post-bronchodilator (ie, after administration of 200 μg salbutamol) small airways obstruction for each site. To identify risk factors for small airways obstruction, we performed multivariable regression analyses within each site and pooled estimates using random-effects meta-analysis. Findings: 36 618 participants were recruited between Jan 2, 2003, and Dec 26, 2016. Data were collected from participants at recruitment. Of the recruited participants, 28 604 participants had acceptable spirometry and completed the core study questionnaire. Data were available for 26 443 participants for FEV3/FVC ratio and 25 961 participants for FEF25-75. Of the 26 443 participants included, 12 490 were men and 13 953 were women. Prevalence of pre-bronchodilator small airways obstruction ranged from 5% (34 of 624 participants) in Tartu, Estonia, to 34% (189 of 555 participants) in Mysore, India, for FEF25-75, and for FEV3/FVC ratio it ranged from 5% (31 of 684) in Riyadh, Saudi Arabia, to 31% (287 of 924) in Salzburg, Austria. Prevalence of post-bronchodilator small airways obstruction was universally lower. Risk factors significantly associated with FEV3/FVC ratio less than the lower limit of normal included increasing age, low BMI, active and passive smoking, low level of education, working in a dusty job for more than 10 years, previous tuberculosis, and family history of chronic obstructive pulmonary disease. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of small airways obstruction. Interpretation: Despite the wide geographical variation, small airways obstruction is common and more prevalent than chronic airflow obstruction worldwide. Small airways obstruction shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether small airways obstruction is also associated with respiratory symptoms and lung function decline., National Heart and Lung Institute and Wellcome Trust. Supported by Wellcome Trust grant 085790/Z/08/Z for the BOLD study

Aims Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad). Method We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube. Results While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube. Conclusion Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.

BackgroundThe Cross-Cultural Neuropsychological Test Battery (CNTB) is a novel test battery specifically designed to reduce the impact of multiculturality in cognitive assessment.ObjectiveWe aimed to validate the CNTB in Spaniards in patients with Alzheimer's disease (AD), including patients at mild cognitive impairment (MCI) and mild dementia stages, and Parkinson's disease with MCI (PD-MCI).MethodsThirty patients with AD-MCI, 30 with AD-dementia (AD-D), and 30 with PD-MCI were recruited. Each clinical group was compared against a healthy control group (HC) with no differences in sex, age, or years of education. Intergroup comparisons, ROC analysis, and cut-off scores were calculated.ResultsAD-MCI scored lower than HC in those subtests associated with episodic memory and verbal fluency. AD-D also showed lower scores in executive functions and visuospatial tests. Effect sizes for all the subtests were large. PD-MCI showed lower performance than HC in memory and executive functions, particularly on error scores, with large effect sizes. Comparing AD-MCI and PD-MCI, AD-MCI had lower memory scores, while PD-MCI showed the worst performance in executive functions. CNTB showed appropriate convergent validity with standardized neuropsychological tests measuring the same cognitive domains. We obtained similar cut-off scores to previous studies performed in other populations.ConclusionsThe CNTB showed appropriate diagnostic properties in AD and PD, including those stages with mild cognitive impairment. This supports the utility of the CNTB for the early detection of cognitive impairment in AD and PD.

Arguing whether loot boxes are gambling is not a useful exercise by this point in time. Psychological research was justified (at least initially) in conceptualising loot box harms as similar to gambling harms. However, it does not follow that loot box regulation must be viewed through a gambling lens. This similarity should no longer distract us from taking action. Answering that question of whether loot boxes are gambling in the affirmative potentially could have been useful to quickly apply existing gambling law to address the loot box issue (when it was a novel issue), rather than to wait for dedicated regulatory responses to pass through protracted legislative processes. However, half a decade has passed since this issue first entered mainstream discourse. Preoccupation with the gambling law approach to loot box regulation overlooks the possibility of using other existing laws (e.g., consumer protection law) to regulate loot boxes and the potential harms of videogame monetisation (including those not involving randomisation) more broadly. Frankly, today, it matters little whether loot boxes are ‘gambling.’ The potential harms of loot boxes need to be addressed regardless of your answer to that question.

Loot boxes are bought by players with real-world money to obtain random content inside video games. Loot boxes are viewed by many as gambling-like and are prevalently implemented globally. Previous Western and international studies have consistently found loot box spending to be positively correlated with problem gambling. Previous Western studies presented mixed results as to the correlations between loot box purchasing and gambling-related risk factors and mental health. A large-scale survey of adult video game players from the People’s Republic of China (PRC) (N = 2,601) was conducted through Tencent Survey. The positive correlations between loot box spending and problem gambling, and between loot box spending and problem videogaming, were successfully replicated. However, other potential risk factors (i.e., impulsiveness/impulsivity; binary past-year gambling participation status; and sensation-seeking tendencies) did not positively correlate with loot box spending with a meaningful effect size. The Risky Loot Box Index (RLI) mostly strongly positively correlated with, and was the best predictor in a multiple linear regression model for, loot box spending. No negative correlations were found between loot box engagement and PRC players’ mental health. In conclusion, this study shows how cross-cultural research can contribute to our understanding of loot box engagement. The RLI may be effective at measuring loot box harms cross-culturally. The present research could help stimulate further research on loot box harms beyond Western countries.

Objective To examine the clinical utility of Wechsler Adult Intelligence Scale-IV (WAIS-IV) Matrix Reasoning in limited educated recently arrived immigrants in Denmark. Method Participants were 64 limited educated (0–9 years’ education) independently living adult immigrants primarily from Middle Eastern and Sub-Saharan African countries who completed WAIS-IV Matrix Reasoning as well as demographic, and medical questionnaires. Results Thirty-eight participants (59%) scored more than two standard deviations below the Scandinavian mean (scaled score Conclusions The findings indicate that WAIS-IV Matrix Reasoning underestimates cognitive functioning in limited educated recently arrived immigrants, thus calling its clinical utility into question.

In the absence of reliable and valid neuropsychological measures, accurate assessment of culturally diverse groups is a challenge facing the Australian neuropsychological community. This study aimed to investigate the construct validity and to develop specific reference group norms using the WAIS-IV Greek adaption (WAIS-IV GR) for Greek Australian older adults. A convenience sample of 90 healthy older Greek Australians (M = 77.14 ± 4.46; range = 70–85; 39 males & 51 females), with a primary school level of education (M = 5.60 ± 0.68; Range = 4–6) were recruited throughout the Melbourne metropolitan area. Regression modelling showed that age was the most significant predictor, therefore, subtest normative data were stratified according to three age bands. Normative data for all WAIS-IV GR subtests and indices were calculated, in addition to values for the 90% and 95% confidence levels. Confirmatory factor analysis indicated that a four-factor solution consisting of the WAIS-IV GR Index Scores displayed a superior fit with significant parameters of acceptable magnitude. Findings support the application of the traditional WAIS-IV factor structure to a Greek Australian sample. Utilising specific reference group norms for Greek Australians with limited education will facilitate and improve access of cognitive assessment within this population. What is already known on this topic:(1) The use of existing norms can lead to underestimating cognitive function in culturally diverse groups. (2) Access to culturally appropriate norms and tests for the assessment of culturally diverse groups in Australia is limited. (3) Neuropsychological test results are influenced by age, education, and culture. What this topic adds:(1) This is the first study to validate and provide WAIS-IV norms for a culturally diverse group in Australia. (2) Confirmatory factor analysis indicated that the internationally recognised WAIS-IV factor structure was appropriate for Greek Australian older adults. (3) Development of these resources will facilitate and improve access of cognitive assessment within this population.

Access to valid and reliable neuropsychological measures for use with culturally diverse groups in Australia is limited. The aim of this study was to adapt and translate a selection of English language neuropsychological tests, employ several existing standardised Greek language tests, and provide specific reference group normative data for Greek Australian older adults. A convenience sample of 90 healthy older Greek Australians (M = 77.14 ± 4.46; range = 70–85), with a primary school level of education (M = 5.60 ± 0.68; Range = 4–6), was recruited throughout the Melbourne metropolitan area. Several neuropsychological measures were administered which assessed domains such as verbal and visual memory, confrontational naming, and executive functions. Regression modelling revealed that age, education and sex predicted between 5% and 35% of the variance of test scores, with age being the most significant predictor of performance across a majority of measures. Therefore, the normative data for all tests were stratified according to three age bands (70–74, 75–79, 80–85). The use of culture-specific tests and norms for assessment of older Greek-Australians with limited education may facilitate accuracy of assessment findings, improve diagnostic outcomes, and reduce misclassification. What is already known about this topic:The use of English language tests with migrant populations and tests developed in nations of origin can lead to misclassification when applied to long-term immigrant peers.The use of test content derived from English language tests has been found to be inappropriate for use with culturally diverse groups.Access to norms and tests for assessment of culturally diverse groups in Australia are limited. The use of English language tests with migrant populations and tests developed in nations of origin can lead to misclassification when applied to long-term immigrant peers. The use of test content derived from English language tests has been found to be inappropriate for use with culturally diverse groups. Access to norms and tests for assessment of culturally diverse groups in Australia are limited. What this topic adds:This paper provides a template for translating and adapting existing English language tests for use with culturally diverse groups.This is the first study to provide a set of comprehensive norms for Greek Australian older adults.Utilising culturally appropriate and specific reference group norms for Greek-Australians may improve the accuracy of assessment findings and reduce misclassification. This paper provides a template for translating and adapting existing English language tests for use with culturally diverse groups. This is the first study to provide a set of comprehensive norms for Greek Australian older adults. Utilising culturally appropriate and specific reference group norms for Greek-Australians may improve the accuracy of assessment findings and reduce misclassification.

Objective Little is known concerning the stability of the lower airway microbiome. We have compared the microbiota identified by repeated bronchoscopy in healthy subjects and patients with ostructive lung diseaseases (OLD). Methods 21 healthy controls and 41 patients with OLD completed two bronchoscopies. In addition to negative controls (NCS) and oral wash (OW) samples, we gathered protected bronchoalveolar lavage in two fractions (PBAL1 and PBAL2) and protected specimen brushes (PSB). After DNA extraction, we amplified the V3V4 region of the 16S rRNA gene, and performed paired-end sequencing (Illumina MiSeq). Initial bioinformatic processing was carried out in the QIIME-2 pipeline, identifying amplicon sequence variants (ASVs) with the DADA2 algorithm. Potentially contaminating ASVs were identified and removed using the decontam package in R and the sequenced NCS. Results A final table of 551 ASVs consisted of 19 × 106 sequences. Alpha diversity was lower in the second exam for OW samples, and borderline lower for PBAL1, with larger differences in subjects not having received intercurrent antibiotics. Permutational tests of beta diversity indicated that within-individual changes were significantly lower than between-individual changes. A non-parametric trend test showed that differences in composition between the two exams (beta diversity) were largest in the PSBs, and that these differences followed a pattern of PSB > PBAL2 > PBAL1 > OW. Time between procedures was not associated with increased diversity. Conclusion The airways microbiota varied between examinations. However, there is compositional microbiota stability within a person, beyond that of chance, supporting the notion of a transient airways microbiota with a possibly more stable individual core microbiome.

Background: The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations. Objective: To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics. Methods: We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment. Results: RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score

Purpose of review: Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade- offs between individual liberties and harm prevention.Recent findings: Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.Summary: Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. Existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self- regulation), both in terms of compliance and clinical benefits, should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.

Background The lower airways microbiome and host immune response in chronic pulmonary diseases are incompletely understood. We aimed to investigate possible microbiome characteristics and key antimicrobial peptides and proteins in idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). Methods 12 IPF patients, 12 COPD patients and 12 healthy controls were sampled with oral wash (OW), protected bronchoalveolar lavage (PBAL) and right lung protected sterile brushings (rPSB). The antimicrobial peptides and proteins (AMPs), secretory leucocyte protease inhibitor (SLPI) and human beta defensins 1 and 2 (hBD-1 & hBD-2), were measured in PBAL by enzyme linked immunosorbent assay (ELISA). The V3V4 region of the bacterial 16S rDNA gene was sequenced. Bioinformatic analyses were performed with QIIME 2. Results hBD-1 levels in PBAL for IPF were lower compared with COPD. The predominant phyla in IPF were Firmicutes, Bacteroides and Actinobacteria; Proteobacteria were among top three in COPD. Differential abundance analysis at genus level showed significant differences between study groups for less abundant, mostly oropharyngeal, microbes. Alpha diversity was lower in IPF in PBAL compared to COPD (p = 0.03) and controls (p = 0.01), as well as in rPSB compared to COPD (p = 0.02) and controls (p = 0.04). Phylogenetic beta diversity showed significantly more similarity for IPF compared with COPD and controls. There were no significant correlations between alpha diversity and AMPs. Conclusions IPF differed in microbial diversity from COPD and controls, accompanied by differences in antimicrobial peptides. Beta diversity similarity between OW and PBAL in IPF may indicate that microaspiration contributes to changes in its microbiome.

OBJECTIVES: Proactive efforts that take language and cultural barriers into consideration may be needed to raise awareness of dementia and improve access to services in minority ethnic communities. The aim of this study was to assess the feasibility of a culturally tailored dementia information program and the immediate effects on participants' intention to seek help for memory problems, their knowledge and beliefs about dementia, and their knowledge about options for support.METHODS: A novel dementia information program, consisting of one 2-h session, was developed through a collaborative research process with primary care dementia coordinators and multicultural link workers as co-researchers. It provides basic knowledge about dementia to minority ethnic communities and can be delivered in a community setting by non-specialists.RESULTS: Six information program sessions were conducted with a total of 110 participants; 65 Turkish, 19 Pakistani, 20 Arabic-speaking, and 6 with another minority ethnic heritage. The program had a significant effect on participants' immediate knowledge and beliefs about dementia as measured with a quiz (z = -2.02, p = 0.04, d = 0.90). In a post-program focus group meeting, facilitating multicultural link workers reported satisfaction with facilitator training, adopted recruitment strategies, and content and delivery of the information sessions and provided feedback on improving the program.CONCLUSIONS: The results provide support for the feasibility of the culturally tailored dementia information program. The program has the potential to improve knowledge and beliefs about dementia and options for formal support in minority ethnic communities and seems easily implemented in existing services, and at a low cost.

BACKGROUND: Populations living in European countries are becoming increasingly diverse. As performance on traditional neuropsychological tests is heavily influenced by culture, language, (level and quality of) education, literacy, and other factors, neuropsychological assessment practices need to be adapted to account for this diversity. METHOD: The European Consortium for Cross-Cultural Neuropsychology (ECCroN) aims to improve assessment of culturally, educationally, and linguistically diverse individuals across Europe by 1) collaborating on the validation and implementation of cross-cultural neuropsychological tests and 2) working on initiatives geared at improving interpreter use and training programs for neuropsychologists. RESULT: The consortium was founded in late 2019 and currently consists of 16 experts based in 9 countries - some of whom work in multinational contexts. The first meetings of the network stressed several points. First, ECCroN aims to develop and/or validate cross-culturally applicable tests, as opposed to race-based norms for existing tests; for example, current projects aim to validate measures of social cognition and language (naming) in patients with migration backgrounds. Second, ECCroN emphasizes the importance of taking into account diversity across the entire spectrum, both in populations traditionally considered to be 'majority' and 'minority' groups, e.g. best practices should be developed for those with little education regardless of native-born or migrant status. Third, ECCroN aims to identify and share suitable instruments to measure factors potentially influencing the assessment, such as bilingualism, acculturation and educational quality. CONCLUSION: Joint efforts should be undertaken to develop, validate, publish, and implement cross-cultural tests across European countries to reduce misdiagnoses in diverse patient populations.

Cite as: Xiao L.Y., Henderson L.L., Nielsen R.K.L., Grabarczyk P., & Newall P.W.S. (2021). Loot Boxes, Gambling-Like Mechanics in Video Games. In N. Lee (Ed.), Encyclopedia of Computer Graphics and Games. Springer. Loot boxes are mechanics often found in video games that provide the player with randomised virtual rewards. Some loot boxes can be paid for with real-world money and therefore share structural and psychological similarities with gambling.

Due to increasing cultural, linguistic, and educational diversity in older populations across Europe, accurate assessment of cognitive functioning in people from diverse backgrounds becomes increasingly important. This paper aims to provide a state-of-the-art review of cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe, focusing on challenges and recent advances in cross-cultural assessment. Significant work has been carried out on the identification of challenges in cognitive assessment in culturally, linguistically, and educationally diverse older populations and on development and validation of cross-cultural cognitive tests. Most research has addressed the influences of language barriers, education and literacy, and culture and acculturation and in particular, the European Cross-Cultural Neuropsychological Test Battery (CNTB) and the Rowland Universal Dementia Assessment Scale (RUDAS) are well-validated across European countries. However, cross-cultural cognitive assessment is largely still a developing field in Europe, and there is a continuing need for developments within the field.