Social and economic costs of gambling problems and related harm among UK military veterans

INTRODUCTION

Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans' Health and Gambling Study.

METHODS

An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint.

RESULTS

Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI -£1016 to -£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status.

CONCLUSIONS

Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.

MRI Guided Adaptive Radiotherapy (MRgART) in Primary and Metastatic Liver Lesions

PURPOSE/OBJECTIVE(S)

The role of stereotactic body radiotherapy (SBRT) in the management of primary hepatic and metastatic tumors has increased significantly over the past few years. MR-Linac is rapidly gaining evidence in the delivery of ablative doses using MR guided adaptive radiotherapy (MRgART) with improved accuracy and dose coverage to the lesions. We report local control and toxicity of patients with primary and metastatic liver lesions treated with MR guided adaptive SBRT.

MATERIALS/METHODS

All patients were treated with MRgART on the Unity 1.5T MR Linacs at two institutions and consented to the ADAPT-MRL study (1). A 4DCT and MRI with abdominal compression were obtained at simulation and the primary MRI sequence used for online treatment included a T2 3D navigated scan. A balanced turbo field echo (btFFE) 2D cine motion scan was also acquired at every fraction to determine movement of the tumor to aid in internal target volume margin. All plans were treated with SBRT prescribed to 3-5 alternate daily fractions. Acute toxicity was reported according to Common Terminology Criteria for Adverse Events version 5 (CTCAE) v.5. Patient demographics, prescribed dose fractionation, acute toxicity and clinical response at 6 months were analyzed. Clinical response to treatment was measured according to RECIST criteria 1.1.

RESULTS

Between February 2021 to January 2023 a total of 30 patients were treated with 149 fractions to the liver. Patients were majority male (70%) with a median age of 66 (range 36-83). 16 patients were treated for primary hepatocellular carcinoma (HCC) of the liver and 14 patients for metastatic liver lesions. The median prescribed dose was 48 Gy (range 30-50Gy) in median 5 fractions (range (3-5 fractions). All patients completed treatment with no interruptions. The mean time from 'patient setup' to 'beam-off' was 52.6 minutes (range 37-73 minutes). Data on acute toxicity at 3 month follow up was available for 28 patients. Of these patients 7/28 (25%) had grade 1 or 2 toxicity and no >/ = grade 3 toxicity was reported. Clinical response at 6 months was available for 18 patients and showed complete response in 44% (8/18), partial response in 22% (4/18), stable disease in 22% (4/18) and progressive disease in 11.1% (2/18).

CONCLUSION

Our experience on MRgART to the liver has shown good local control and minimal acute toxicity in the treatment of primary and metastatic liver lesions. We continue to collect data on patient reported outcomes, clinical response and toxicity to determine the feasibility and safety of this system.

"The person in power told me to"-European PhD students' perspectives on guest authorship and good authorship practice

Questionable authorship practices in scientific publishing are detrimental to research quality and management. The existing literature dealing with the prevalence, and perceptions, of such practices has focused on the medical sciences, and on experienced researchers. In contrast, this study investigated how younger researchers (PhD students) from across the faculties view fair authorship attribution, their experience with granting guest authorships to more powerful researchers and their reasons for doing so. Data for the study were collected in a survey of European PhD students. The final dataset included 1,336 participants from five European countries (Denmark, Hungary, Ireland, Portugal, and Switzerland) representing all major disciplines. Approximately three in ten reported that they had granted at least one guest authorship to "a person in power". Half of these indicated that they had done so because they had been told to do so by the person in power. Participants from the medical, natural and technical sciences were much more likely to state that they had granted a guest authorship than those from other faculties. We identified four general views about what is sufficient for co-authorship. There were two dominant views. The first (inclusive view) considered a broad range of contributions to merit co-authorship. The second (strongly writing-oriented) emphasised that co-authors must have written a piece of the manuscript text. The inclusive view dominated in the natural, technical, and medical sciences. Participants from other faculties were more evenly distributed between the inclusive and writing oriented view. Those with an inclusive view were most likely to indicate that they have granted a guest authorship. According to the experiences of our participants, questionable authorship practices are prevalent among early-career researchers, and they appear to be reinforced through a combination of coercive power relations and dominant norms in some research cultures, particularly in the natural, technical, and medical sciences.

34 PATHFINDER; AN ALTERNATIVE TO THE EMERGENCY DEPARTMENT FOR OLDER PATIENTS WHO DIAL 999/112

Background

Traditionally in Ireland, people who dial 999/112 are transported to the Emergency Department (ED) unless they decline to travel. Many have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while in hospital. Alternative care pathway models can reduce ED crowding and improve patient outcomes.

Methods

This service is a collaboration between the National Ambulance Service and Occupational Therapy (OT) and Physiotherapy Departments at a Dublin teaching hospital; funded by the Sláintecare Integration fund. It responds to low acuity 999/112 calls for people 65 years and older within the hospital catchment.

The team operates Monday–Friday, a ‘Rapid Response Team’ (Advanced Paramedic and Physiotherapy/OT) (8:00–20:00) and a ‘Follow-Up Team’ (Physiotherapy and OT) (8:00–16:00).

Once activated, the ‘Rapid Response Team’ conduct a comprehensive assessment in the home to establish whether a suitable alternative to the ED is available, commonly through the activation of one or more alternative care pathways (e.g. GP, Integrated Care Team, Primary Care Team, Community Intervention Team, Geriatric Day Hospital).

Results

In the first year, 485 patients were responded to. Average age was 80 years, average Rockwood Clinical Frailty Scale score was 6 (moderately frail). The majority (68%) remained at home following initial review. Less than 1% re-presented within 24 hours, 9% re-presented within 7 days. The three most common reasons for dialling 999/112 were falls, generally unwell and non-traumatic back pain. Patient and care-giver feedback demonstrated a very high level of satisfaction with the service.

Conclusion

This model is a safe alternative to the ED for older people following a low-acuity 999/112 call. Access to a network of alternative care pathways and immediate follow-up are two key enablers. The overwhelmingly positive feedback confirms that older people want this service. It is the first model of this kind to be evaluated in Ireland, and could expand, with local adaptation, nationally.

177 Religious Participation and Health in a Changing Ireland. A Qualitative Exploration of Women Aged 65 and Over

Background

The previous decades have seen tangible changes in Ireland’s religious landscape. Religion has been investigated as an important factor in wellbeing for many populations, including those aged 65 and over. Women in this age group in particular have higher religiosity while also being more likely to face challenges such as widowhood and demanding caring roles. We explored the ways in which women relate their religious belief, practice and participation to their wellbeing in later life within the Irish context.

Methods

A qualitative research design was employed. In-depth, semi-structured interviews were conducted with women aged 65 and over (n=11), who self-identified as religious. Women were sampled from church congregations in the North Dublin area. Interviews were recorded and transcribed. Thematic analysis was carried out using NVivo. Women were invited to speak on their lifecourse religious trajectories, relationships, and health, using a flexible interview instrument. Both predetermined and emerging themes were explored.

Results

Participants were aged 67 to 89, and were Catholic-affiliated (n=10) and Church of Ireland-affiliated (n=1). The participants described a range of religious identities, and these coloured their strategies for facing the changing role of the church in Irish society. Church abuse scandals were discussed unprompted by the majority of participants. Apprehension regarding the future of the church was common, as was concern for the religious identities and practices of younger generations within their families. Nevertheless, the majority of participants outlined ways in which religious practice, in particular, was conducive to their wellbeing.

Conclusion

Religious feeling, identity and practice was not homogenous in the sample. Feelings of uncertainty around the future were common, and participants employed a range of strategies to cope with these. The study is limited in how generalisation can be made, but provides insight into some of the mechanisms that can link, both positively and negatively, health and religiosity.

ASKBILL as a web-based program to enhance sheep well-being and productivity

ASKBILL is a web-based program that uses farm measurements, climate data and information on genetics to predict pasture growth, animal performance and animal health and climate risks. The program uses several biophysical models, which are customised by user inputs, localised daily weather updates and a dynamical probabilistic 90-day climate forecast to enhance sheep well-being and productivity. This approach can minimise the requirement for manual, auto and remote measurements, thus reducing labour requirements and complexity. In this article, the animal growth model provides an example of a biophysical model used to provide predictions. This is an energy-based model and the model parameterisation is designed to be physiologically meaningful and able to be customised for the genetic merit of the animal using a growth coefficient that calibrates growth of body components and energy requirements. A key feature of the animal growth model is its forecast projections, which are based on an ensemble of simulations. The model can estimate supplementary feeding rates required to achieve target liveweights and body condition scores and stocking rates required to achieve target pasture levels. The model can be customised for a farm and its livestock and is updated daily in response to climate data. This dynamic feature enables it to provide early stage alerts to users when animal production targets are unlikely to be met.

PURLs: Monitoring home BP readings just got easier

This novel method of identifying patients with uncontrolled hypertension correlates well with ambulatory BP monitoring.

Training family medicine residents in HIV primary care: a national survey of program directors

BACKGROUND AND OBJECTIVES

As the number of people living with HIV steadily increases, severe shortages in the HIV provider workforce in the United States are projected. With an increased emphasis on HIV education during residency, family physicians could play a major role in meeting this need.

METHODS

A nationwide survey of family medicine residency program directors (PDs) was conducted to determine their attitudes toward training residents in HIV care.

RESULTS

Of 440, 224 (51%) PDs responded to the electronic survey. Teaching HIV care was a high priority for 20% of PDs. Twenty percent of PDs reported residents in their program were providing care to at least five HIV-infected patients. Twenty-five percent of PDs felt that their graduates had the skills to be HIV care providers. Fewer than 25% of PDs reported having a formal HIV curriculum or faculty with adequate HIV expertise. The most favored approaches to strengthen the HIV curriculum by PDs were: (1) a half-day mini-course (30%) and (2) developing a faculty member's expertise in HIV care (17%). A total of 79% of directors saw a need to modify their existing curriculum.

CONCLUSIONS

Despite growing numbers of HIV-infected patients, only 25% of family medicine PDs felt that their graduates were adequately trained in HIV primary care, and most saw a need to modify their HIV curricula. Family medicine residency training programs have an important opportunity to develop residency curricula and increase faculty competence to train the next generation of clinicians in HIV care.

Fitwits: preparing residency-based physicians to discuss childhood obesity with preteens

OBJECTIVE

To evaluate the Fitwits MD office tool and games for obesity discussions with 9- to 12-year-olds.

METHODS

A nonrandomized intervention study using pre- and posttest assessments in 2 residency programs compared 31 control group and 55 intervention physicians (34 previously trained, 21 newly trained to use Fitwits). Surveys addressed comfort and competence regarding: obesity prevention and treatment, nutrition, exercise, portion size, body mass index (BMI), and the term "obesity." We surveyed all groups at baseline and 5 months (post 1) and new trainees 3 months later (post 2).

RESULTS

In post 1, prior trainees reported significantly increased comfort and competence for discussing obesity prevention, portion size, BMI, and "obesity." In post 2, new trainees reported significantly increased comfort and competence discussing obesity prevention and treatment, portion size, and BMI.

CONCLUSIONS

Experience using Fitwits improved residency-based physician comfort and competence in obesity prevention and treatment, portion size, BMI, and "obesity" discussions with preadolescents.

FlyBoss: a web-based flystrike information and decision support system

The FlyBoss system consists of comprehensive information on flystrike management and control, programs for assisting decision making, and sortable lists of products for preventing and treating flystrike. Readily accessible, up-to-date, best-practice information on flystrike is essential for effective, humane and economic management of flystrike by Australian wool producers, particularly those who are phasing out mulesing and those looking to adopt optimal insecticidal fly-control strategies. FlyBoss provides information on breeding and management to reduce flystrike susceptibility, effective methods of treating existing flystrike and flystrike prevention programs. The FlyBoss decision aids, which are based on simulation models and incorporate local weather data and sheep susceptibility factors, can assist sheep farmers who wish to optimise sheep management, chemical treatment and non-chemical options to minimise the risk of flystrike. FlyBoss also contains comprehensive information on fly biology, sheep and environmental factors associated with flystrike and information on appropriate chemicals for various situations. FlyBoss draws on expertise from organisations throughout Australia to provide the sheep industry with easily accessible, current and locally targeted information on flystrike management. The present report briefly describes the development of FlyBoss and associated workshops and provides an overview of current recommendations for the control and prevention of flystrike.

Body piercing: more than skin deep

Young adult populations (18-25 years of age) throughout the world have latched onto the mainstream trend of body piercing. Best health care practices for these individuals involves the knowledge of proper procedural techniques, postsite care, common complications, and treatment modalities.

Ethical issues in radiology: perspectives from the Christian tradition

The Christian ethical tradition introduces a number of key values into the clinical context. Moreover, although some denominational differences exist, these are essentially differences of emphasis rather than of substance. Among the central values which the Christian tradition promotes are: the dignity of the person, the individual as embodied spirit and the importance of the common good. Within the evolving discourse, social justice considerations have come to the fore as a critical concern within bioethics. In radiology, like most fields of clinical practice, practitioners frequently encounter conflicts and tensions of an ethical nature. Moreover, the manner in which these conflicts are articulated, conceptualised and ultimately resolved will depend, not only on how the scientific data are analysed and interpreted, but also on how different ethical frameworks are invoked in these disputes. The concern in this brief paper is to discuss the Christian ethical tradition as it is expressed in Roman Catholic and 'Protestant' denominations in the western church, considering the values and norms that underlie Christian ethical engagements with applied questions.

How often is a low 5-min Apgar score in term newborns due to asphyxia?

OBJECTIVE

To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia.

STUDY DESIGN

A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed.

RESULTS

After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001).

CONCLUSIONS

In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.

Development and validation of a food-frequency questionnaire for the determination of detailed fatty acid intakes

Objective:

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

Design:

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

Setting:

Medical Centre, Dublin Airport, Republic of Ireland.

Subjects:

One hundred and five healthy volunteers (43 females and 62 males aged 23–63 years).

Results:

Significant correlations (P < 0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r = 0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r = 0.17 and 0.10 for FIQ and DH, respectively).

Conclusions:

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.

Development and validation of a food-frequency questionnaire for the determination of detailed fatty acid intakes

OBJECTIVE

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

DESIGN

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

SETTING

Medical Centre, Dublin Airport, Republic of Ireland.

SUBJECTS

One hundred and five healthy volunteers (43 females and 62 males aged 23-63 years).

RESULTS

Significant correlations (P<0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r=0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r=0.17 and 0.10 for FIQ and DH, respectively).

CONCLUSIONS

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.

Canine eruption into grafted alveolar clefts: A retrospective study

BACKGROUND

The contemporary treatment of cleft lip and palate involves a sequence of surgical procedures and orthodontic management. Alveolar bone grafting (ABG) is usually undertaken after orthodontic expansion of the maxillary segments between the ages of eight and 12 years. Two of the important goals of alveolar bone grafting are the provision of bony support for the eruption of the canine and the closure of residual oro-nasal fistulae. The purpose of this study was to retrospectively evaluate the root development and eruption of the canine following ABG.

METHODS

Group 1: radiographic and clinical records of a sample of 19 cleft patients who underwent alveolar bone grafting procedures, performed between 1996 and 1999 were reviewed. Group 2: a random sample of 15 cleft patients attending for routine dental review were clinically examined. The age of patient, degree of root development and eruption status of the canine, and presence of oronasal fistulae pre and post alveolar bone grafting were evaluated.

RESULTS

Most cleft canines had continued root development and descended in the alveolus towards eruption following ABG. Four canine teeth (8 per cent) were impacted and required surgical exposure and orthodontic treatment following failure of eruption. Closure of anterior oro-nasal fistulae at the time of grafting was maintained post-operatively.

CONCLUSIONS

This study demonstrated that canine root development and eruption continued satisfactorily through grafted alveolar clefts in most cases and closure of anterior oro-nasal fistulae was achieved in all cases.

Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia

We present our experience with 92 Broviac central venous catheters inserted into 84 infants over a 31-month period. Our technique specifies placement in the neonatal intensive care unit under local anesthesia, with insertion to the inferior vena caval-atrial junction via the saphenous or femoral vein, with a subcutaneous tunnel to an exist site on the anterior thigh. We conclude this technique to be safe, efficient, convenient, cost-effective, and minimally uncomfortable to the infant, with no increase in morbidity or mortality in comparison to previously described methods.

Family perspective on the necessity for advance medical directives

Although our parents made no written advance medical directives before becoming terminally ill, with the support of the nursing staff we were able to assist them in their quest for a natural death with dignity. This article presents some of the dilemas faced by families in making end-of-life decisions. The author acknowledges the importance of permission for and support of the decision making by other health care providers, and reflects that advance directives would have facilitated the process.

Effects of ethaverine hydrochloride on the walking tolerance of patients with intermittent claudication

The effect of ethaverine hydrochloride on exercise tolerance of patients with intermittent claudication was evaluated in a double-blind, placebo-controlled study conducted at three sites. Forty-five patients with symptoms of occlusive arterial insufficiency of the lower extremities were randomly assigned to receive ethaverine 200 mg or placebo four times daily. The patients were evaluated biweekly for 12 weeks with treadmill claudication tests, patient and investigator assessments of symptom severity, and reports of adverse reactions. Doppler ankle/brachial pressure ratios were recorded for 26 patients. Walking tolerance improved for patients in both groups during the course of the study. Increases in distance-to-claudication were significantly greater for patients receiving ethaverine after 6, 8, 10, and 12 weeks of therapy. Ankle/brachial pressure index after exercise was unchanged in both groups. Incidence of adverse reactions was similar for the two groups. Although patients were generally unaware of any improvement in symptoms, the investigators judged significant relief of claudication among those receiving ethaverine compared to those receiving placebo. It was concluded that ethaverine safely increased distance-to-claudication in patients with intermittent claudication.

Readability testing of auxiliary labels

Using a word familiarity index, we studied pharmacy auxiliary labels and selected brief information sheets to determine the reading difficulty of these forms of written communication, which cannot be evaluated by traditional readability testing methods. Results of the study show that 11.2 percent of the 110 words selected from these information sources are above the eighth-grade reading level. The word familiarity index also identified multiple meanings of words and appears to be a valuable tool for evaluating written information that is not suitable for traditional readability testing.

A comparison of pharmaceutical manufacturers as a source of drug information to a telephone inquiry: generic vs brand

A telephone survey was conducted to evaluate and compare drug information received from the pharmaceutical manufacturer in response to a drug interaction question concerning concurrent administration of tetracycline and cimetidine. This study assumes that the pharmaceutical company may often be consulted by the hospital pharmacist seeking information about a particular medication. Forty-five pharmaceutical companies, all marketing tetracycline products, were selected for the study. A conversation protocol was utilized. It was designed to assure consistency and evaluate information received for accuracy, response time, clinical judgement offered, and referrals. Forty pharmaceutical manufacturers responded: 18 brand manufacturers and 22 generic companies. Eleven companies provided information on the interaction identified. Five manufacturers stated that there were no contraindications to concurrent administration of the drugs, one company identified a similar interaction, and five manufacturers successfully provided information identifying the interaction with supportive documentation. Two of the five companies offered clinical judgement as to the clinical significance of the interaction. Both reached different conclusions. The mean time of all phone calls was 4.29 minutes (range 0.39 to 15.41 minutes). The investigator was referred to outside sources by twelve companies. In this study, brand manufacturers performed better than generic companies. Results indicate that few manufacturers are organized to answer drug information requests involving current information sources in a response to a telephone request.