Search

This study examined the gambling of a cohort of U.S. Air Force recruits (N = 31,104) and the relationship between their gambling and health-risk behaviors. Participants provided self-report data regarding gambling and health-related behaviors. Results suggest that 10.4% of participants gambled weekly or more often, 6.2% reported gambling problems, and 1.9% acknowledged loss of control over gambling. Men were more likely than women to report weekly gambling and possible problematic gambling. Minorities, compared to Caucasians, were more likely to experience gambling problems and report loss of control. Seven health-risk behaviors were significant predictors of frequent gambling; however, considerably fewer health behaviors were uniquely related to problematic gambling. These results suggest that gambling-related problems within the military warrant further attention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The authors investigated behavioral indicators of pathological gambling in a college student sample. PARTICIPANTS AND METHODS: The authors administered a diagnostic interview for pathological gambling to 159 college students, who also completed a demographic questionnaire, and a self-report measure of psychological distress. RESULTS: Consistent patterns of gambling behavior associated with pathological gambling included gambling more than 1.2 times per month, gambling more than 2.1 hours per month, intending to wager more than 6.1% of monthly income, and wagering more than 10.5% of monthly income. In addition, the combination of psychological distress, gambling frequency, and a history of parental gambling problems was significantly associated with pathological gambling in college students. CONCLUSIONS: These findings suggest initial markers of problematic gambling behavior in a college sample that may be used in assessment, prevention, and intervention. [ABSTRACT FROM AUTHOR]

Previous work has explored the bi-directional relation between alcohol consumption and gambling behavior within gambling contexts, highlighting the role of salient factors such as mood. The present experiment sought to further explore how mood state and the urge to consume alcohol vary as a function of the experience of winning or losing while gambling. In this experiment, 76 individuals who reported past year gambling and past month alcohol use were randomly assigned to one of four conditions - neutral gambling, winning gambling, losing gambling, or movie watching. Results indicated that mood state did not significantly differ by experimental condition. However, the urge to consume alcohol significantly differed by experimental condition when accounting for weekly alcohol consumption. Individuals who underwent a losing gambling experience reported significantly greater alcohol-related urges than those who watched a movie or had a neutral gambling experience, but not compared to those who had a winning gambling experience. Exploratory analyses showed that those exposed to a losing gambling experience wanted a significantly greater number of drinks than those who had a neutral gambling experience or watched a movie. These results suggest that experiencing losing may contribute to a greater desire to consume alcohol, and that this relation may occur independent of mood states associated with gambling outcomes. Future research should seek to investigate the relations between gambling, alcohol use, and mood in naturalistic gambling settings beyond the laboratory., Competing Interests: Declarations. Ethical Approval: This study was approved by the University of Memphis Institutional Review Board and was conducted in accordance with the ethical standards of the 1964 Declaration of Helsiniki. Competing Interests: The authors declare that no competing interests exist that readers should know about in relation to this manuscript., (© 2024. The Author(s).)

This brief report expands the results of a prior efficacy study that examined the effect of a letter addressing prospective clients' motivation and expectations for outpatient gambling disorder treatment on initial session attendance. The results of that efficacy study indicated more clients attended the initial session when receiving the letter (77%) compared to receiving a reminder telephone call (51%). The present study examines the effectiveness of messages addressing prospective clients' motivation and expectations for outpatient gambling treatment across an entire treatment system. Messages were sent via letters, telephone, and in-person communication with all clinic staff. Participants were 54 clients with gambling disorder who were seeking outpatient psychological treatment. Results indicated that the percentage of clients attending the initial session was 85%, and no differences in attendance were found between in-person and telehealth sessions. These findings suggest that messages that address motivation and expectations persist under real-world conditions, and treatment systems can make meaningful changes that increase attendance to initial treatment sessions., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The 2018 Supreme Court decision on Murphy v. National Collegiate Athletic Association brought not only a change in the United States commercial gambling landscape, but also considerable speculation across public forums about whether expanded sports gambling causes new, distinct, and greater harm than existing legal forms of gambling. This commentary brings into the focus that the definition of this form of gambling has recently begun to shift without a theoretical basis or empirical evidence. To bring evidence to bear, there is a need for a precise operational definition of sport gambling and greatly clarity to the questions that can drive knowledge generation., (© 2024. The Author(s).)

Objective: The current study was a systematic review and meta-analysis of cognitive behavioral treatment (CBT) for problem gambling and gambling disorder and whether it produced different outcomes than minimal or no treatment controls on three putative change mechanisms: 1) gambling cognitions, 2) coping, and 3) self-efficacy., Method: Studies were identified from five bibliographic databases (i.e., Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and PubMed). Included studies were randomized controlled trials of CBT that included posttreatment data on putative mechanisms. Between-group Hedges's g effect sizes were calculated to examine outcomes of CBT relative to minimal or no treatment control on gambling cognitions, coping, and self-efficacy at posttreatment. Risk of bias was determined using the Cochrane Risk of Bias tool., Results: Fifteen studies, representing 1,536 participants, were eligible for analysis. Participants in CBT had more favorable gambling cognitions (g = -0.41), coping behaviors (g = 0.27), and self-efficacy (g = 1.12) at posttreatment than minimal or no treatment control., Conclusions: Results of the current study provided preliminary support for the effectiveness of CBT on three putative mechanisms of change among individuals experiencing problem gambling and gambling disorder. Although the results were promising, there was significant heterogeneity in the magnitude of effect sizes for all three outcomes, and outcomes were not consistently assessed with psychometrically established assessment tools., 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 © 2024 Elsevier Ltd. All rights reserved.)

Objective: The aim of the current meta-analysis was to examine potential differences in posttreatment effect size estimates for gambling frequency (i.e., the number of days gambled) and gambling expenditure (i.e., the amount of money gambled) when using the gambling timeline followback (G-TLFB) versus other self-report assessments., Method: Using an open-access meta-analysis database of studies on cognitive behavioral treatment for gambling disorder, 22 studies representing 2,824 participants were identified for inclusion. Hedges's g effect sizes representing posttreatment differences on gambling frequency and expenditure between cognitive behavioral treatment versus inactive and minimal treatment controls were calculated, and mixed-effect subgroup analyses examined the effect sizes for each outcome between studies using the G-TLFB versus other self-report assessments., Results: Mixed-effect subgroup analyses indicated that the effect size for gambling frequency was significantly lower for studies using the G-TLFB ( g = -0.15) than studies using other self-report assessments ( g = -0.71). When examining whether the use of the G-TLFB was associated with the posttreatment effect size for gambling frequency in a random-effect metaregression model that controlled for study grant funding status, the use of the G-TLFB was not significantly associated with effect size. The effect size for gambling expenditure was not significantly different between studies using the G-TLFB ( g = -0.22) versus studies using other self-report assessments ( g = -0.38)., Conclusions: The G-TLFB yields more conservative and precise effect size estimates of posttreatment gambling frequency, but not gambling expenditure, than other self-report assessments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emerging research shows that many individuals commonly consume cannabis while gambling. However, individuals' expectations for how cannabis consumption will impact their gambling behavior remain unknown. Participants who gambled weekly ( N = 472) were recruited from Amazon Mechanical Turk and completed assessments of gambling behaviors, cannabis consumption, and expectations about the influence of cannabis on gambling. Almost all participants (94%) screened positive for problem gambling. Over half of participants (55%) reported lifetime cannabis consumption, and almost all those participants (99%) reported gambling under the influence of cannabis (GUIC) in the past month. Most participants agreed with positive expectations of gambling; they expected that they would feel calmer when under the influence of cannabis (61.4%), that gambling would be more enjoyable (61.0%), and that their gambling skills would increase when GUIC (60.6%). At the same time, most participants also agreed with negative expectations of GUIC. They expected cannabis use would make them more careless (56.4%), more anxious (54.8%), and less able to concentrate (53.7%) while gambling. Negative cannabis expectancies were significantly associated with the severity of cannabis consumption. Both positive and negative cannabis expectancies were significantly associated with gambling problems and time spent gambling under the influence of cannabis. These findings indicate that expectations may influence the decision to consume cannabis and gamble simultaneously. This study contributes to the need for addressing cannabis expectations during treatment of gambling problems., Competing Interests: No authors have competing interests., (© 2024 Authors et al.)

Several decades of research have experimentally investigated the influence of alcohol on gambling. However, there has been only minimal experimental exploration of how gambling influences alcohol use. The aim of the current project was to evaluate how gambling influenced mood state and alcohol cravings through randomized experimental design when analyzed with comparison conditions.College students (N = 76) who reported regular alcohol use, gambling within the past year, and being college basketball fans were randomly assigned to watch a video of an exciting basketball game, watch a nondysphoric basketball game, watch a movie, or engage in slot machine gambling. Participants who watched exciting sports or engaged in gambling to reported more energized mood states and higher urges to drink compared to those who watched nondysphoric sports or a movie. These results suggest that the context of gambling may prime individuals to want to consume alcohol., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Asian Americans have been unlikely to seek mental health services despite their needs for treatment, particularly when experiencing significant gambling or Internet gaming problems. Stigma is often considered to be a barrier to seeking help. To understand how stigma impacts Asian Americans' willingness to seek mental health services, the present study used an online survey to investigate the public stigma associated with addictive behaviors and help-seeking stigma among Asian Americans. Participants (N = 431) who self-identified as Asian American, reside in the US. Using a between-groups vignette study design, it was found that the individual with a behavioral addiction received more stigma compared to the individual who experienced a financial crisis. In addition, participants were more likely to seek help if they experienced addictive behavioral problems rather than financial problems. Lastly, this study did not reveal a significant relation between public stigma attached to addictive behaviors and Asian Americans' willingness to seek help, but it found that participants' willingness to seek help was positively associated with public stigma of help seeking (β = 0.23) and negatively associated with self-stigma attached to help-seeking (β = - 0.09). Based on these findings, recommendations are provided to inform community outreach to reduce stigma and promote mental health service utilization among Asian Americans., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The influence of alcohol on risk-taking may be through both pharmacological action and individual expectancies. A recent meta-analysis highlighted the need for evidence about the precise role of alcohol expectations on individuals' gambling behavior while under the influence of alcohol and a need to understand what specific gambling behaviors are influenced. This laboratory study investigated the effects of alcohol consumption and alcohol expectancies on gambling behavior in a sample of young adult men. Thirty-nine participants were randomly assigned to one of three experimental conditions in which they consumed alcohol, alcohol-placebo, or no-alcohol beverages and then played a computerized roulette game. The roulette game provided each participant with the same pattern of wins and losses and recorded gambling behavior including wagers made, number of spins, and final dollar amount remaining. Significant main effects were found between conditions on total number of spins with the alcohol and alcohol-placebo groups gambling significantly more than the no-alcohol group. The alcohol and alcohol-placebo groups were not statistically different. These findings support that individuals' expectations play an important role in understanding the effects of alcohol consumption on gambling; this effect may be primarily associated with persistence in wagering., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection., Competing Interests: Declaration of Competing Interest Authors RAP, MKG, and JPW were authors on two of the five meta-analyses included in the present study. To mitigate this conflict, RAP, MKG, and JPW did not contribute to the coding of the included meta-analyses. Author CLB was a member of the American Psychological Association's Division 12 Committee on Science and Practice and aided in the development of the manual used to guide this evaluation. To mitigate this conflict, CLB was not involved in the evaluation or discussion of the evaluation report submitted to the Division 12 Committee on Science and Practice. No other conflicts of interest were declared. This work was supported by the National Institutes of Health, award number K08AA030301. This work was also supported by the Tennessee Department of Mental Health and Substance Abuse Services. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the state of Tennessee., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Individuals who experience gambling harms report that sustained recovery involves changing both gambling behaviors and psychological symptoms, as well as building a meaningful life. However, there is limited understanding about the effect of cognitive behavioral (CB) techniques on psychological symptoms and quality of life. The purpose of the present study was to examine the effect of CB techniques for gambling-related harms on broader recovery outcomes such as psychological symptoms and quality of life., Method: A systematic article search was conducted to identify randomized controlled trials of CB techniques with nonactive and minimal treatment control groups that assessed psychological symptoms or quality of life as outcomes. Random-effects meta-analysis was used to examine the effect of CB techniques relative to nonactive and minimal treatment control groups., Results: A total of nine studies representing 658 participants were included. Eight studies reported outcomes on depression and anxiety, three on substance use, and six on quality of life. CB techniques significantly reduced anxiety ( g = -0.44) and depression ( g = -0.35) at posttreatment, but not substance use. CB techniques also significantly increased quality of life at posttreatment ( g = 0.40). There was a large amount of heterogeneity suggesting the magnitude of effects could vary significantly in future randomized trials., Conclusions: Future studies should examine the longitudinal associations between gambling harms, psychological symptoms, and quality of life and to assess whether changes in gambling harms throughout treatment precede or are a consequence of changes in psychological symptoms and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A recent meta-analysis of laboratory studies on the effects of acute alcohol consumption on risk-taking did not support that acute alcohol consumption increased risk-taking. Questions about whether this finding generalizes to those gambling in naturalistic settings remain. Therefore, we examined the gambling behavior of frequent gamblers who did and did not consume alcohol while gambling. Participants were 769 weekly gamblers (66% male) who were U.S. residents and at least 18 years old. Participants recruited via MTurk completed measures through the Qualtrics survey platform. Significant predictors of gambling under the influence of alcohol were drinking days per month and PGSI score. A linear regression model predicting percentage of time spent gambling under the influence of alcohol revealed that gambling days per week, gambling hours per day, PGSI score, and drinking days per month were significant predictors. Finally, significant predictors of spending at least 50% of gambling time gambling under the influence of alcohol included: gambling hours per day, PGSI score, and drinking days per month. These findings were consistent with the recent meta-analysis of laboratory studies. However, finding that gambling disorder symptoms and overall rates of alcohol consumption were related to gambling under the influence of alcohol replicated the frequently found relation of alcohol problems among those who also exhibit gambling problems., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up., Method: Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups., Results: Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates., Conclusions: Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder., (© 2023 Society for the Study of Addiction.)

Many individuals diagnosed with an addictive disorder are members of disadvantaged groups and obtain a high school education or less, yet self-report questionnaires widely used to identify symptoms of addictive disorders do not use best practices to ensure item clarity and comprehension. In the present study, we explore how advanced text-analysis technology can be used to guide the development of a diagnostic questionnaire with an emphasis on maximizing its readability and then test the accuracy of this questionnaire. In Study 1, a self-report questionnaire for symptoms of gambling disorder was created using best practices for item clarity and comprehension. In study 2 an experimental design was used to test whether the measure with enhanced readability, compared to a commonly used screening instrument, improved diagnostic symptom accuracy among samples of high school and college educated individuals. Subsequent analyses revealed that education was positively related to item comprehension, and participants who completed the maximized readability questionnaire correctly identified more symptoms of gambling disorder than participants who completed the comparison questionnaire, regardless of educational attainment. These studies indicate that the rate at which individuals accurately identify symptoms of psychopathology is strongly related to their educational attainment and the readability of the questionnaire items themselves., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: To estimate the effect of acute alcohol consumption on risk-taking while gambling, examine blood alcohol concentration as a moderator and explore possible moderators of this effect., Design, Setting and Participants: A systematic review and meta-analysis was completed. A Boolean search strategy was used to identify studies that included (a) alcohol consumption as an independent variable; (b) a gambling or risk-taking task; (c) a control or placebo comparison; (d) human participants; and (e) English publications. Descriptive information, sample characteristics and experimental data were extracted from each study. Searched databases included: PsycINFO, Web of Science, Medline, Cochrane Library and ProQuest Dissertations and Theses. Included as participants were experiments that compared the effects of alcohol and non-alcoholic or placebo beverages on risk-taking while gambling., Measurement: Comprehensive Meta-Analysis version 3.3.070 was used. Standardized mean differences of risk-taking while gambling between the experimental and control conditions were calculated when studies did not report effect sizes. Random-effects models were used for overall effect and meta-regressions while mixed-effects models were used for subgroup analyses., Findings: Twenty articles containing 47 alcohol versus control comparisons met inclusion criteria. The overall Hedges'g for the difference between groups consuming alcohol and groups consuming a placebo or non-alcoholic drink control was 0.03, 95% confidence interval (CI) = -0.07, 0.12, p = 0.60, indicating no significant difference. Larger effect sizes were found for studies using non-alcoholic control drinks (Hedges' g = 0.30, 95% CI = 0.01, 0.58) compared to placebo beverages (Hedges' g = -0.03, 95% CI = -0.13, 0.06), Cochran's Q = 4.67, p = 0.03., Conclusions: Finding that acute alcohol consumption had no reliable effect on risk-taking while gambling was consistent with existing animal research. No support was found for the relation between alcohol dose and risk-taking. The significantly larger effect size for experiments using non-alcoholic versus placebo beverages suggests the potential role of expectancy effects., (© 2022 Society for the Study of Addiction.)

Objective: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates., Method: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates., Results: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators., Conclusions: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Problem gambling screeners are easily accessible and potentially reduce harm for those individuals who engage in risky levels of gambling behavior. However, a recent study found that when frequent gamblers were offered the chance to complete a screener and receive feedback, most chose not to do so. In this paper, secondary analysis was completed on frequent gamblers' open-ended responses to questions regarding reasons for and against completing a problem gambling screener. Participants (N = 262) were individuals who gambled at least once per week and were not currently being treated for gambling problems. A qualitative open-coding procedure independently completed by multiple researchers revealed that the most common reasons for completing the screener were individuals having a desire to check in on their behavior, because they were curious about the screener, because they were experiencing gambling-related harm, or that they were already considering making changes to their gambling. The most common reasons against completing the screener were that they were either avoidant of the experience because they thought it might cause psychological distress, or because they believed that they did not have a problem. This study provides insight into why many individuals who engage in risky levels of gambling behavior do not seek out helping resources. In addition to creating practically accessible helping resources, researchers should focus on techniques that can make help-seeking a less distressing and more acceptable experience., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

There is a need to better understand how to motivate individuals experiencing addiction-related concerns, such as gambling problems, to engage in help-seeking behaviors. This experiment tested whether online messages based on principles of motivational interviewing (MI) could be used to encourage individuals to complete a problem gambling screener. Participants ( N = 805) who gambled at least weekly and were not receiving treatment for gambling problems were recruited via Amazon Mechanical Turk. Participants were randomly assigned to 1 of 3 message conditions that all offered participants the choice to complete either a problem gambling screener or an alternative questionnaire focused on gambling-related attitudes. The first condition was an MI-based interactive message, the second was similar in content but was presented in a noninteractive manner, and the third was a control message that did not include motivational elements. We found that the interactive motivational message yielded significantly higher rates of screener completion (39%) than the noninteractive message (28%) or control message (29%), χ² (2, N = 805) = 8.28, p = .016, Φ = .29. This remained significant after controlling for other study variables. Controlling for message condition, participants were more likely to complete the screener if they gambled more frequently, with more money, were more psychologically distressed and interested in receiving help for gambling problems, or had ever received treatment for gambling problems. These findings provide support for the use of interactive MI-based messages to encourage individuals at-risk for experiencing problems to use helping resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Gambling and alcohol problems commonly co-occur during emerging adulthood. Co-occurring problems may relates to personality factors, physical health, mental health and gambling belief systems. In a large sample of colleges students ( N  = 513), we examined alcohol, gambling and co-occurring problem groups relative to a group without alcohol or gambling problems from large sample of college students. Group differences were found on Constraint and Negative Emotionality ( p s ≤ .05). All three groups had a higher score on gamblers' beliefs of illusion of control compared to the group with no problems (all p s < .05). Those with co-occurring problems had a higher score on illusion of control beliefs than those with alcohol problems only. For luck/perseverance gambling beliefs, those with co-occurring problems had higher levels than other groups on these beliefs. The group with alcohol problems and significantly poorer mental health outcomes than those without alcohol or gambling problems. Individuals with gambling problems or alcohol problems only had significantly poorer self-rated overall physical health ( p  < .01). Differences were found between groups (alcohol, gambling, alcohol + gambling and neither) on self-rated energy and fatigue as well as pain ( p s < .05). Gambling and alcohol problems may relate to emotional and health problems, and personality and belief systems may be related to the co-occurrence of gambling and alcohol problems.

The legalization of recreational cannabis for adults is becoming more common across the United States of America, as well as other counties around the world. Previous research has documented shared risk factors between cannabis use and gambling. Experimental studies have shown cognitive effects of cannabis that might influence gambling behavior. The current study explored demographics, gambling behaviors, and mental health differences based on the degree to which individuals use cannabis while they gamble. Individuals (N = 805) who gambled at least weekly completed an online survey. Thirty percent reported gambling under the influence of cannabis. Of these individuals, 41% reported using cannabis 25% of the time that they gambled, 31% reported being under the influence 50% of the time when gambling, 16% were under the influence 75% of the time when gambling, and 13% reported always or almost always gambling under the influence of cannabis. Those who reported gambling while under the influence of cannabis were more likely to be younger, non-white and non-heterosexual. They also reported higher levels of psychological distress, were more likely to have had a diagnosis of ADHD and a history of treatment for gambling, substance use, or other kinds of mental health concerns. Individuals who used cannabis while gambling also reported gambling more frequently than those who did not. This study provides one of the first explorations into who uses cannabis while gambling. Future experimental studies are required to investigate the direct effects of cannabis on gambling behaviors., 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 © 2020 Elsevier Ltd. All rights reserved.)

In response to NIH initiatives to investigate sex as a biological variable in preclinical animal studies, researchers have increased their focus on male and female differences in neurotrauma. Inclusion of both sexes when modeling neurotrauma is leading to the identification of novel areas for therapeutic and scientific exploitation. Here, we review the organizational and activational effects of sex hormones on recovery from injury and how these changes impact the long-term health of spinal cord injury (SCI) patients. When determining how sex affects SCI it remains imperative to expand outcomes beyond locomotor recovery and consider other complications plaguing the quality of life of patients with SCI. Interestingly, the SCI field predominately utilizes female rodents for basic science research which contrasts most other male-biased research fields. We discuss the unique caveats this creates to the translatability of preclinical research in the SCI field. We also review current clinical and preclinical data examining sex as biological variable in SCI. Further, we report how technical considerations such as housing, size, care management, and age, confound the interpretation of sex-specific effects in animal studies of SCI. We have uncovered novel findings regarding how age differentially affects mortality and injury-induced anemia in males and females after SCI, and further identified estrus cycle dysfunction in mice after injury. Emerging concepts underlying sexually dimorphic responses to therapy are also discussed. Through a combination of literature review and primary research observations we present a practical guide for considering and incorporating sex as biological variable in preclinical neurotrauma studies., (Copyright © 2020 Stewart, MacLean, Stromberg, Whelan, Bailey, Gensel and Wilson.)

A growing literature supports the efficacy of cognitive-behavioral therapies, motivational interventions, and personalized feedback to treat problem and disordered gambling. However, there is currently debate as to how much treatment is necessary. Some studies indicate that attending a greater number of sessions is related to enhanced therapeutic outcomes, while other studies indicate that one session produces equivalent therapeutic outcomes to multiple sessions. To contribute to this debate, meta-analysis was used to examine the relation between dose and outcome in studies of cognitive-behavioral, motivational, and personalized feedback interventions (both individual and group treatment formats were included). Fourteen studies of randomized controlled trials representing 1,203 participants across 19 treatment-control comparisons were identified. The intended treatment dose (i.e., the number of sessions prescribed to participants) across the 14 studies ranged from 1 to 30 sessions. Of the 10 studies reporting the received treatment dose (i.e., the number of sessions that participants attended), the weighted mean dose was 6.8 sessions ( SD = 2.7). Both intended treatment dose and received treatment dose were positively related to outcome at posttreatment-as the number of sessions increased, so too did the magnitude of the between group effect size. There were an insufficient number of studies reporting outcome at long-term follow up to evaluate the relation between intended dose, received dose, and outcome. Discussion centers on several areas for future research on psychological treatments for problem and disordered gambling. Specific recommendations are made for researchers and practicing clinicians. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Eleven US States and the District of Columbia legally allow personal (i.e., recreational) cannabis use by adults, and an additional 22 states allow use of cannabis for medicinal purposes. Of these jurisdictions, only two do not have some form of legalized gambling available (https://www.casino.org/local/guide/). In contrast to this rapid increase in legally available marijuana is the limited knowledge about the intersection of cannabis use and gambling. This paper strives to define the current status of the relevant literatures and consider the implication for future gambling research. We describe the research literature on the prevalence of cannabis use and co-existing gambling problems and the effects of cannabis use on gambling-related cognitive functions and decision-making. We also discuss clinical considerations with treating problem gamblers with a cannabis use disorder. Finally, the potential implications for responsible gambling practices and policies and the most pressing gaps in the research literature are offered.

High rates of treatment refusal and dropout have complicated the delivery of psychological treatment for gambling disorder, which continues accumulating evidence for efficacy. Incorporating motivational interviewing and addressing outcome expectations into psychological treatments has been shown to increase overall attendance. However, no studies have investigated whether motivational interviewing and outcome expectations can increase attendance at the initial and subsequent sessions of psychological treatment for gambling disorder. Participants were 69 prospective clients who contacted an outpatient training clinic requesting treatment services for gambling-related problems. They were randomly assigned to receive a mailed letter that incorporated principles of motivational interviewing and addressed outcome expectancies plus a telephone reminder call or to receive a telephone reminder call only. Clients who received the letter plus reminder call were more likely to attend the initial session than were clients who received the reminder call only. Clients receiving the letter were also more likely to reschedule their initial session and less likely to not show up than were clients receiving the reminder call only. There was no significant difference in attendance at subsequent sessions. These results suggest that mailing a similar letter to prospective clients of psychological treatment for gambling disorder is worthwhile, given the associated ease and low cost. Future investigations should further investigate the value of strengthening the motivation of prospective clients and clinics before initial treatment sessions, and they should investigate the distinction between clients who reschedule versus not show up. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual's gambling behavior, often in comparison to others' gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.

The negative psychological effects of public stigma on disordered gamblers have been well documented. Public stigma deters treatment-seeking and other help-seeking behaviors, and negatively impacts individuals' view of themselves. Different types of disordered gambling activities may attract different degrees of stigma. One increasingly popular form of gambling involves placing bets on the outcomes of competitive video games, also called eSports gambling. This activity shares characteristics with Internet gaming and gambling. The purpose of this study was to compare the degree of public stigma held towards traditional casino gamblers, eSports gamblers, and Internet gamers, as compared to an individual experiencing comparable levels of impairment and distress due to a financial crisis. Using an experimental between-groups vignette study design, we found that all three types of behavioral addictions were more heavily stigmatized than the control condition. The three behavioral addictions were seen as being highly controllable, engendered a significant amount of anger and blame, and resulted in higher levels of desired social distance. Traditional casino gamblers were seen as significantly more dangerous to be around and created a higher level of desired social distance than the Internet gamer. Differences between the Internet gamer and eSports better were less pronounced. These findings underscore the importance of reducing public stigma for gambling and other behavioral addictions, and provide information that can be used when developing interventions to impact stigma.

Although readability has been traditionally operationalized and even become synonymous with the concept of word and sentence length, modern text analysis theory and technology have shifted toward multidimensional comprehension-based analytic techniques. In an effort to make use of these advancements and demonstrate their general utility, 6 commonly used measures of gambling disorder were submitted to readability analyses using 2 of these advanced approaches, Coh-Metrix and Question Understanding Aid (QUAID), and one traditional approach, the Flesch-Kincaid Grade Level. As hypothesized, significant variation was found across measures, with some questionnaires emerging as more appropriate than others for use in samples that may include individuals with low literacy. Recommendations are made for the use of these modern approaches to readability to inform decisions on measure selection and development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.

Disordered gamblers frequently present with concurrent anxiety, depressive, personality, and substance use disorders, which may complicate treatment. Although there is a need for a thorough assessment, some questionnaires may prove lengthy for clients and clinicians. Thus, there is a need for brief screens for identifying co-occurring psychopathology. The present study sought to examine whether a brief, self-report measure of psychological distress could indicate the presence of co-occurring psychopathology among an outpatient sample of disordered gamblers. At intake, 69 participants completed self-report measures of distress and gambling symptomatology, a personality inventory, and a structured interview for the diagnostic criteria for disordered gambling. Gamblers with greater elevations of psychological distress evidenced greater severity of gambling pathology. Clinically significant elevations were present for symptoms of depression, deviancy, and anxiety, but not substance abuse. Greater scores of psychological distress significantly predicted elevations of depression, deviancy, and anxiety. Sensitivity and specificity were evaluated and the findings supported that an average psychological distress score of 16 corresponded with the presence of co-occurring psychopathology. Clinicians treating disordered gamblers should consider screening for co-occurring psychopathology with brief, self-report measures of psychological distress.

Gambling warning messages have been shown to lead to prevention and modification of risk-taking behaviors. Laboratory studies have shown messages can increase a player's knowledge about gambling specific risks, modify their gambling-related cognitive distortions, and even change play. In the present laboratory study, participants were randomly assigned to a winning or losing slot machine gambling experience where they either viewed periodic warning messages or not. It was hypothesized that those in the message conditions would place smaller bets, spend more time considering bets, and spend less time gambling than those in the control conditions. We also hypothesized participants would play differently across the contexts of winning or losing. The results showed those who received warning messages while winning made the fewest number of spins and did not speed up their bet rate over the course of play as much as those in other conditions. Players who received warning messages while losing decreased the size of their bets over the course of play compared to those who received messages while winning. Despite receiving warning messages, losing players did not decrease their number of spins or rate of betting. Winning or losing during slot machine play appears to have significant consequences on the impact of a warning message. Whereas a message to change gambling behavior may encourage a winning gambler to stop play, the same message for a losing player may lead to a small minimization in harm by helping them to decrease bet size, though not their rate of betting. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Most high school adolescents have reported past year gambling, and males gamble more frequently and problematically than females. Ethnic minority adolescents appear to be gambling at a higher rate than Caucasian adolescents. There is evidence indicating that adolescent gambling outcome expectancies are correlated with gambling behavior, but limited evidence that this relation differs by gender. In the present study gender was evaluated as a moderator in the relation between gambling outcome expectancies and gambling behaviors in an African-American high school sample. Males gambled more frequently, gambled more problematically and held more positive gambling outcome expectancies than females. Gender was found to moderate the relations between gambling frequency and the expectations of material gain, affect, self-evaluation and parental approval. Gender also moderated the relations between gambling problems and expectations of affect and self-evaluation. These findings should inform future adolescent gambling prevention and intervention programs.

The acquired preparedness model posits that impulsivity influences the development of outcome expectancies that then influence the engagement in a specific risk taking behavior. The purpose of this study was to test the acquired preparedness model for gambling behavior of college students using a multidimensional approach to impulsivity. Employing a structural equation approach, it was predicted that a full mediational model that includes multiple dimensions of impulsivity and multiple outcome expectancies would predict gambling frequency and gambling symptomatology. Support was found for the acquired preparedness model in understanding why some college students gamble more frequently or problematically. Specifically, better model fit was found for the full mediational model that included outcome expectancies to predict both frequency and gambling symptomatology than the model that included the direct relation between impulsivity and gambling.

Growing evidence for the efficacy of cognitive-behavioral therapy for disordered gambling supports the need for a comprehensive set of gambling-related assessment measures that have been validated with treatment-seeking samples. The Gamblers' Beliefs Questionnaire (GBQ) is a self-report measure that was designed to identify gambling-related cognitive distortions (Steenbergh, Meyers, May, & Whelan, 2002). In this study, the GBQ demonstrated good internal consistency and adequate construct validity in a treatment-seeking sample of disordered gamblers. Additionally, scores on the measure significantly decreased across a brief cognitive-behavioral treatment, providing validity support for use of the GBQ with a clinical population., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Expectancy theory posits that decisions to engage in a given behavior are closely tied to expectations of the outcome of that behavior. Gambling outcome expectancies have predicted adolescent gambling and gambling problems. When high school students' outcome expectancies were measured by Wickwire et al. (Psychol Addict Behav 24(1):75-88 2010), the Adolescent Gambling Expectancy Survey (AGES) revealed five categories of expectancies that were each predictive of gambling frequency and pathology. The present study aimed to explore if the AGES could be successfully replicated with college students. When administered to a diverse college student population, factor analyses identified five factors similar to those found in the high school sample. Several factors of the AGES were also found to predict gambling frequency and gambling problems for college students. Gambling frequency and gambling activity preference were also addressed.

Compared to college females, college males are more likely to report frequent gambling. Research on gambling outcome expectancies has shown that expectations about gambling influence gambling behavior and that endorsement of particular expectancies differs by gender. Knowledge regarding the differential predictive utility of specific gambling expectancies based on gender would help to determine how beliefs about gambling may be fundamentally different for men and women. The present study explored whether gender moderates the relation between gambling expectancy and gambling frequency in a college sample. 421 college students completed an online survey that included questions about their demographics, gambling frequency, and gambling expectancies. Hierarchical regression analyses indicated that gender moderated the relations between the expectancies of social consequences, material gain, and gambling frequency. For females, greater endorsement of social consequences predicted less frequent gambling. For both males and females, greater endorsement of material gain predicted more frequent gambling. The current findings can help inform prevention and intervention efforts by identifying gambling expectations that are differentially related to college student gambling behavior choices.

Gambling-related self-efficacy has been shown to correspond with treatment success and maintenance of treatment gains. Accordingly, there is a need for gambling assessment measures that have been validated with treatment-seeking individuals. In this study, we reported on the evaluation of a measure of perceived self-efficacy to control gambling behavior in high-risk relapse situations, the Gambling Self-Efficacy Questionnaire (GSEQ; May, Whelan, Steenbergh, & Meyers, 2003). Confirmatory and exploratory factor analyses provided some support for the original single-factor solutions, but also suggested the presence of individual patterns of self-efficacy across high-risk situations. The GSEQ demonstrated convergence with indices of problem-gambling severity and scores on the measure significantly increased across a brief cognitive-behavioral intervention. The sensitivity and specificity were evaluated and the findings supported that an average self-efficacy rating of 70% corresponded with indices of pathological gambling.

Impulsivity has been implicated as a contributing factor in the development of gambling problems among college students, but attempts to confirm this relation have been inconsistent. One explanation for these incongruent findings is that impulsivity may be multidimensional and that distinct dimensions differentially predict separate behaviors. Using a large, diverse sample of college students, a factor analysis of self-report measures related to impulsivity revealed a three-factor structure of Behavioral Activation, Preference for Stimulation, and Inhibition Control that was similar to the structure found by Meda et al. (Behav Pharmacol 20(5-6):390-399, 2009) in a different adult sample. Low risk gamblers and symptomatic gamblers scored significantly lower on Behavioral Activation and Inhibition Control than non-gamblers. Conversely, low risk gamblers and symptomatic gamblers scored significantly higher on Preference for Stimulation. Prevalence of gambling and gambling activity preference for this sample was also assessed.

Objective: To report the results and oncological efficacy of laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma with renal vein and inferior vena cava thrombus., Methods: We performed retrospective record review of 41 patients who underwent LRN along with venous thrombectomy at 2 Canadian centers from 2002 to 2012 by dedicated laparoscopic surgeons., Results: The mean age and body mass index of the 41 study patients (34 males and 7 female) were 64.4 years and 28.7 kg/m(2), respectively. Median tumor size was 9.3 cm; 39 patients had renal vein thrombus, and 2 had inferior vena cava thrombus. Nine patients (22%) had metastatic disease to begin with and underwent laparoscopic cytoreductive nephrectomy. Median estimated blood loss, operative time, and length of stay were 100 mL (range, 50-400 mL), 134.5 minutes (range, 99-183 minutes), and 4 days (range, 4-6 days), respectively. There were 4 (9.7%) grade 2 complications. There was no intraoperative death. Mean duration of follow-up was 42 months (range, 6-107 months). Of 32 patients with localized disease, 4 (12.5%) died of progressive disease, 3 (9.3%) died of unrelated causes, and 3 patients (9.3%) were lost to follow-up. Twenty-two patients (68.7%) were alive at a mean follow-up of 47 months., Conclusion: LRN and venous thrombectomy for advanced renal tumors with venous thrombus are safe procedures in experienced hands with significant laparoscopic skills. The short-term oncological data are encouraging and advocate the efficacy of this procedure in this subset of patients, although longer follow-up is required in larger number of patients to further define its role., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Photoselective vaporization of the prostate (PVP) is a bloodless, relatively painless alternative to transurethral resection of the prostate (TURP) for relief of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH)., Objective: We compare the effectiveness, safety and cost-effectiveness of Greenlight Laser PVP (HPS-120) and TURP., Methods: We conducted a prospective, non-randomized trial in 3 Ontario centres from March 2008 to February 2011. Assessments were completed at baseline, 1 and 6 months following surgery at the physicians' offices and at 12 and 24 months by phone. The primary outcome was the change in International Prostate Symptoms Score (IPSS) score at 6 months versus baseline. Secondary outcomes were changes in flow rate, postvoid residual (PVR), prostate-specific antigen (PSA) and sexual health inventory for men (SHIM) scores. Adverse events, health-related quality of life (HRQoL), resource utilization and productivity losses were collected., Results: Although the IPSS decreased in both arms (n = 140 for PVP and n = 24 for TURP) between baseline and 6 months, the difference in change over time between the groups was not statistically significant (p = 0.718). Other outcomes improved equally from baseline and 6 months (Qmax, SHIM, PSA and HRQoL), with only changes in PVR favouring PVP (p = 0.018). There were no statistical differences in serious adverse events. In total, 130 of 140 PVP patients were outpatients, all TURP subjects were inpatients. PVP was less costly than TURP ($3891 vs. $4863; p < 0.001) with similar quality-adjusted life years (0.448 vs. 0.441; p = 0.658)., Conclusion: Greenlight Laser PVP (HPS-120) is a safe and cost-effective alternative to TURP for outpatient treatment of LUTS and can be completed as an outpatient with minimal blood loss.

Background: As an alternative to transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP) provides a bloodless, relatively painless relief of lower urinary tract symptoms for men with benign prostatic hyperplasia. Following a review of the evidence in 2006, the Ontario Health Technology Advisory Committee recommended that a study be conducted to evaluate PVP in Ontario., Objectives: To compare the clinical effectiveness, safety, cost-effectiveness, and budget impact of PVP compared to conventional TURP for the treatment of benign prostatic hyperplasia in Ontario., Methods: A prospective, nonrandomized trial was conducted in 3 Ontario centres. Consenting subjects were assessed at baseline and 1, 3, and 6 months following surgery. Outcome measures included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), post-void residual (PVR) volume, prostate-specific antigen (PSA), health-related quality of life (HRQOL) using the EuroQol 5 Domain questionnaire, and the Sexual Health Inventory for Men (SHIM) score. Adverse events, resource utilization, and productivity losses were also assessed. Cost-effectiveness and budget impact analyses were completed using data from the study., Results: Between February 2008 and August 2010, 164 subjects were enrolled in the study (n = 140 for PVP and n = 24 for TURP). Treatment outcomes were similar between the 2 groups at 6 months, with the IPSS decreasing similarly over time (P = 0.718). For other treatment outcomes (Qmax, PSA, HRQOL, SHIM) both treatments provided similar benefit over time; only changes in PVR volume favoured PVP (P = 0.018). The majority of PVP patients were managed on an outpatient basis, with only 7.1% requiring admission (all TURP subjects were inpatients). At 6 months, PVP was less costly than TURP ($3,891 versus $4,863; P = 0.001), with similar quality-adjusted life-years (0.448 versus 0.441; P = 0.658). PVP remained the most cost-effective treatment across all decision-making thresholds, with the technology costing less and providing similar clinical outcomes. Extrapolating the results to a provincial level indicated (based on an estimated case volume of 12,335 TURPs) that there is an opportunity to reallocate just over $14 million (Cdn), primarily related to the reduced need for hospital admission., Limitations: This study was nonrandomized, and the results should be interpreted with some caution, despite generally similar baseline characteristics between the 2 groups. Recruiting individuals to the TURP arm was a challenge, resulting in a size imbalance between treatment arms., Conclusions: Based on this analysis, PVP appears to be a cost-effective alternative to TURP, providing similar clinical benefit at a lower cost to the health system.

The U.S. Spanish-speaking population has rapidly increased in recent decades and there is a need for psychometrically supported assessment measures for researchers and clinicians who work with this population. A Spanish version of a self-report measure of gamblers' cognitive distortions [Gamblers' Beliefs Questionnaire (GBQ); Steenbergh, Meyers, Whelan, & May, 2002] was translated and psychometrically evaluated in a sample of 219 Spanish-speaking Hispanics residing in the southeast United States. The GBQ-S showed high internal consistency (α = .95). Factor analytic data supported a factor structure similar to the initial psychometric evaluation of the English version. Probable pathological gamblers reported significantly more cognitive distortions on the GBQ-S than nongamblers and nonpathological gamblers., ((PsycINFO Database Record (c) 2013 APA, all rights reserved).)

Introduction: Obese patients are at increased risk for renal stones as well as treatment failures due to increased skin-to-stone distances (SSD) and harder stone compositions. We investigated the relationships between obesometric parameters (body mass index [BMI], body fat distribution and obesity-related hormone levels) with SSD and stone hardness., Materials and Methods: We prospectively enrolled patients undergoing stone interventions at our institution. Computed tomography (CT) scans were analyzed; adipose tissue was identified according to Hounsfield units (HU) and separated into subcutaneous (SAT) and visceral (VAT) components. The pixels were averaged at three levels to calculate fat distribution: %VAT = (VAT)/(VAT + SAT). SSD was measured and HU were used as a surrogate for stone hardness. Obesity-related hormones leptin and adiponectin were measured by ELISA., Results: Seventy-nine patients were prospectively enrolled. Mean BMI and %VAT were 30.02 kg/m2 and 40.13 kg/m2. Mean leptin and adiponectin levels were 17.5 ng/mL and 7.67 mcg/mL indicating high risk for metabolic consequences of obesity. Females had greater proportions of subcutaneous fat than males (%VAT 28.4 versus 46.94, p < 0.001) and greater SSD (11.26 cm versus 9.86 cm, p = 0.025). Among obese patients, subcutaneous fat correlated with SSD independently of BMI (r = 0.454, p = 0.008). Obese patients with %VAT > 40 versus < 40 had SSD of 11.35 cm versus 13.7 cm (p = 0.005). Diabetics had harder stone compositions as measured by HU than non-diabetics (982.86 versus 648.86, p = 0.001)., Conclusion: Obesometric parameters such as BMI, body fat distribution, and the presence of diabetes mellitus are important considerations in the management of renal stone disease. A large proportion of subcutaneous fat, which can be estimated by physical examination, predicts SSD among obese patients and may aid treatment decisions in patients, particularly those without pre-treatment CT scans. Further studies are needed to refine the role of obesometrics in personalizing treatment decisions.

Background: Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed., Methods: Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre., Results: Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery., Discussion: Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any documentation; therefore, timely, goal-directed therapy for surgical and infectious complications is frequently delayed because of the time taken to establish an accurate diagnosis. Refuting the existence of commercial renal transplantation may not be a practical solution; more consistent communication and documentation with transplant teams may be more pragmatic. In the current climate, patients considering the option of overseas commercial renal transplantation should be advised of the potential increased risks.

The proposed DSM-V changes related to the pathological gambling diagnosis hold far-reaching implications, yet these modifications have been met with little public attention. This letter addresses the three changes proposed including the diagnosis' reclassification alongside other addictive behaviors, the lowering of the pathological gambling threshold to the endorsement of 4 symptoms, and the removal of the "illegal acts" criterion. Support for the initial change is well documented, but there is evidence to suggest that the latter two changes should be reconsidered.