Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: elements of effective interventions

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.     

An Examination of the Validity of Retrospective Measures of Suicide Attempts in Youth

Purpose

This study used prospective data to investigate the validity of a retrospective measure of suicide attempts from four different perspectives.

Methods

Data were retrieved from 883 participants in the Raising Healthy Children project, a longitudinal study of youth recruited from a Pacific Northwest school district. The retrospective measure was collected when participants were 18–19 years of age and results were compared with measures of depressive symptoms collected prospectively.

Results

Results showed strong corroboration between retrospective reports of first suicide attempt and prospective measures of depression, with attempters experiencing significantly more depression than their nonattempting peers, t (df = 853) = 10.26, p < .001. In addition, within the attempter group, depression scores during the year of their reported first attempt were significantly higher than the average depression score across previous years, t (df = 67) = 3.01, p < .01.

Conclusions

Results from this study suggest that the reports of older adolescents regarding their suicide attempts are corroborated by their prospective reports of depression in childhood and earlier adolescence. Thus, there is support that retrospective measures of suicidal behavior, namely suicide attempts, may be a valid method of assessment.     

Gaming-Gambling Convergence: Trends,Emerging Risks,and Legislative Responses

A convergence of gaming and gambling products, services, and platforms is presently drawing considerable policy debate. This convergence may be giving rise to a critical area of consumer vulnerability given the addictive potential of gaming and gambling. While some convergence aspects are gaining research attention, the broader contexts of the phenomenon have not been adequately examined. In light of this, the present study aimed to inform four key enquiry areas pertaining to gaming-gambling convergence—contexts and drivers, definitions and framings, risk and harm, and legislative response. Using a narrative review method, 108 articles from the academic and grey literature were examined and thematically summarised to provide an overview of the convergence phenomenon. Findings indicate convergence in multiple overlapping contexts (gaming elements in gambling, games incorporating gambling elements, gambling on games, free simulated online gambling, and social media games and gambling) driven by technological advances and commercial interests. Findings related to definitions and framing include the industry’s strategic use of the term gaming to reduce negative connotations associated with gambling, and community perceptions of gaming as legitimate and harmless entertainment. Potential risks include transitions from games (without money) to real-money gambling, and problem co-existence. Legislative responses are beginning to emerge with the greatest focus being on loot boxes in games. However, the limited evidence of risk and harm has led to hesitancies in legislative actions to regulate gaming-gambling hybrids in some jurisdictions. Considering that convergence is supported by rapid advances in technology and is taking place largely on the Internet (accessible 24 h), harms for consumers could manifest quickly and spread broadly across societies before their existence and severity are established. Based on the Precautionary Principle, the present evidence base call for harm prevention policies and regulations in addition to changes in the definition of money (including digital currency and microtransaction) in gaming and gambling laws.

     

Part II: presentation,diagnosis, classification,treatment, and prevention of stress fractures in female athletes

ABSTRACT

Objectives: Stress fractures (SFx) occur as the result of repetitive loads over short periods of time, which leads to micro-damage of the bone through cortical resorption, ultimately leading to fracture. They are a common injury in female athletes and often cause significant morbidity. The goal of this study is to review the presentation, diagnosis, classification, treatment, and prevention of SFx in female athletes.

Results: A thorough history, physical exam, and appropriate imaging can facilitate early diagnosis of stress fracture (SFx) and faster resolution of symptoms with more conservative management. The female athlete triad is an especially important factor that contributes to the increased risk of SFx in females. The continuum of stress injuries ranges from mild microfailure to complete fracture, which has resulted in the development of newer grading schemas through MRI and radiographic findings. Stress fractures are also classified as low- or high-risk according to anatomic location, as blood supply and applied forces at different locations affect the likelihood of fracture propagation, displacement, delayed union, or non-union.

Conclusions: The ability to screen for at-risk athletes is paramount in preventing SFx. Recognition and prompt treatment of the female athlete triad requires a multidisciplinary approach in order to restore energy balance, correct menstrual irregularities, and improve bone health. This review provides a basis for understanding how to identify and treat stress fractures, which may allow treating physicians to diagnose this condition earlier and minimize any associated morbidity.