Configurations of gambling change and harm: qualitative findings from the Swedish longitudinal gambling study (Swelogs)

Background: Gambling participation and problems change over time and are influenced by a variety of individual and contextual factors. However, gambling research has only to a small extent studied gamblers’ own perceptions of transitions in and out of problem gambling.

Method: Qualitative telephone interviews were made with 40 gamblers who had repeatedly participated in the Swelogs Swedish Longitudinal Gambling Study. The framework approach was used for analyses, resulting in a multiple-linkage typology.

Results: Our analyses revealed four configurations of gambling: (a) stable low frequency with no or minor harm, (b) decreasing high frequency with occasional harm, (c) fluctuating with moderate harm, and (d) increasing high frequency with substantial harm. Natural recovery and return to previous levels of gambling intensity were common. Change occurred either gradually, as a result of adjustment to altered personal circumstances, or drastically as a consequence of determined decisions to change. Personal and contextual factors such as psychological well-being, supportive relationships, and meaningful leisure activities played a part in overcoming harmful gambling and keeping gambling on a non-problematic level. Gambling advertising was commonly perceived as aggressive and triggering.

Conclusions: The experience of harm is highly subjective, which should be taken into account when developing preventive measures. Considering the fluid character of gambling problems, help and support should be easily accessible and diversified. To repeatedly be interviewed about gambling and its consequences can contribute to increased reflection on, and awareness of, one’s own behaviours and the societal impacts of gambling.     

Foetal alcohol syndrome: a dental and skeletal age analysis of patients and controls

Foetal alcohol syndrome (FAS) consists of multisystem abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human foetus has now been established beyond reasonable doubt and FAS is one of the most important human teratogenic conditions known today. The purpose of this study was to assess the dental age (DA) and skeletal age (SA) of children with FAS and compare them with matched controls. The samples of 90 children diagnosed with FAS and 90 controls were matched for age, gender, and social class. The mean chronological age (CA) of the FAS subjects was 8.95 years, with the controls slightly older at 9.04 years. This difference was not significant. Dental maturity was determined by assessing the stage of tooth formation and SA assessment was made from hand-wrist radiographs for the patients and controls by assigning a SA and comparing it with standard plates. The means and standard deviations of CA and DA for the stages of calcification were calculated and the Pearson ranked order correlation coefficient was applied to measure the associations between skeletal maturity indicators and DA. t-tests were used to test for group differences between independent groups, and paired t-tests to determine paired group differences. This study provided evidence of a positive association between DA and SA in both the FAS children and the controls. The data suggest that both DA and SA may be a reflection of general somatic growth. It must be acknowledged that growth of individuals is often irregular, when any norms of development based on central tendencies and variabilities of healthy children are applied. Some aspects of growth and development for healthy children may show a variable pattern of growth. Therefore, correlation of these aspects of growth and development will often not show the degree of correlation that theoretically exists between different areas of growth and development. A more complete appraisal of the entire skeleton and an evaluation of the entire dentition, rather than just the mandibular teeth, might improve the correlation between the variables.     

Utilization of pharmaceuticals among patients with temporomandibular disorders: a controlled study

OBJECTIVE: Pharmaceuticals are among factors that might be associated with temporomandibular disorders (TMDs), but knowledge about their utilization is limited. The purpose was to systematically register the regular use of medication in general among TMD patients and matched controls to enable comparisons to be made. MATERIAL AND METHODS: Three hundred consecutive patients referred for diagnosis and treatment of TMDs and fulfilling the Research Diagnostic Criteria were examined prospectively and any medication recorded. Matched controls were registered parallel in time. The pharmaceuticals used were categorized according to the Anatomical Therapeutic Chemical Classification System (ATC). RESULTS: Forty-four percent of the patients received a main diagnosis of "muscle disorder", 39% "disk disorder", and 17% "joint disorder". Fifty-one percent of all patients used some medication on a regular basis compared to 36% of the controls (p<0.001). The average number of ATC categories used among all patients was 0.9 and among controls 0.5 (p<0.001). Of the female patients with the diagnosis "muscle disorder", 23% used antidepressants (N06A), 6% tranquilizers (N05B), and 7% sleep medication or sedatives (N05C) significantly more frequently than controls. Of the female patients diagnosed with a "joint disorder", 26% used antidepressants (N06A) significantly more frequently than controls. All other ATC categories differed non-significantly. CONCLUSIONS: The results suggest that the use of pharmaceuticals differs between patients and controls. TMD patients, particularly women diagnosed with "muscle" or "joint" disorders, appear to use drugs for depression more frequently than ordinary dental patients.     

Renal function and outcome after heart transplantation

Objectives

To investigate whether measured glomerular filtration rate (mGFR) is a risk factor for death and/or end-stage renal disease (ESRD) after heart transplantation (HTx).

Biomechanical strategies to accommodate expected slips in different directions during walking

The aim of the study was to verify whether heel kinematics, ground reaction forces and electromyography (EMG) during walking are affected when anticipating slips in anterior-posterior (AP) and medial-lateral directions (ML). Eight healthy men walked through a 7-m walkway, stepping on a robotic force platform. Initially, baseline (BASE) gait mechanics were assessed with the platform at rest. Subsequently, two sets of randomized perturbations (10-cm translations with at different platform movement velocities) in the AP and ML direction were applied. Perturbations were interspersed with unperturbed walking (i.e., catch-trials C-AP and C-ML). Heel accelerations, ground reaction forces and activities from the perturbed leg and trunk muscles were analyzed. EMG was analysed in four epochs: PRE (-100 ms to heel strike [HS]), EARLY (HS to 150 ms after HS), MID (150-300 ms after HS) and LATE (300 ms to toe-off). Comparisons were made between BASE, C-AP and C-ML. The first peak of the vertical force component (Fz) was decreased for C-AP and C-ML (p<0.05) but no changes were found for braking and propulsion impulses. EMG showed effects of expected slips on tibialis anterior, gastrocnemius lateralis, soleus and peroneus longus, especially for EARLY and MID epochs, with direction-specific increases in activity. In conclusion, expected slips in different directions determine only marginal changes in terms of kinetics and heel kinematics, but selective activation after HS indicates that direction-dependent strategies are adopted when anticipating perturbations.