Primary care providers' perceptions on the integration of community-led advance care planning activities with primary care: a cross-sectional survey.

BACKGROUND: Advance care planning (ACP) is a process intended to help ensure people receive medical care that is consistent with their values, goals, and preferences during serious and chronic illness. Barriers to implementing ACP in primary care settings exist. Community-led ACP initiatives exist in British Columbia to engage the public directly. These initiatives may help prepare people for conversations with their primary care providers. The objectives of this study were to elicit primary care providers' perceptions of the utility and desired content of community-led ACP activities and suggestions for integrating community-led ACP activities with primary care. METHODS: We conducted an online cross-sectional survey of primary care providers practicing in British Columbia, Canada in 2021. Both quantitative and qualitative survey questions addressed ACP engagement in practice, the perceived role and desired outcomes of community-led ACP activities, and ways to integrate community-led ACP activities with primary care. RESULTS: Eighty-one providers responded. Over 80% perceived a moderate or greater potential impact of community-led ACP activities. The most common reasons for not referring a patient to a community-led ACP activity were lack of awareness of the option locally (62.1%) and in general (44.8%). Respondents wanted their patients to reflect on their values, wishes and preferences for care, to have at least thought about their goals of care and to have chosen a substitute decision maker in the community. They indicated a desire for a summary of their patient's participation and a follow-up discussion with them about their ACP. They suggested ways to integrate referral to programs into existing health care system structures. CONCLUSIONS: Community-led ACP activities were perceived to be useful to engage and prepare patients to continue ACP discussions with clinicians. Efforts should be made to establish and integrate community-based ACP initiatives within existing primary care systems to ensure awareness and uptake.

Synthesis and application of the first planar chiral strong Brønsted acid organocatalysts.

The synthesis of planar chiral strong Brønsted acid organocatalysts derived from [2.2]paracyclophane is described. Resolution was accomplished according to a modified protocol involving pseudo-ortho-substituted [2.2]paracyclophane-based sulfoxides for the synthesis of three new sulfonic acids. The first planar chiral phosphoric acid diester was obtained from the corresponding phenyl-substituted diol derived from enantiopure 4-bromo-12-hydroxy [2.2]paracyclophane. These new classes of catalysts were tested in an enantioselective Friedel-Crafts reaction as well as in a direct asymmetric Mannich reaction and gave yields of up to 93% and ee-values of up to 38%.

The Hadwiger theorem on convex functions, III: Steiner formulas and mixed Monge-Ampère measures.

A complete family of functional Steiner formulas is established. As applications, an explicit representation of functional intrinsic volumes using special mixed Monge-Ampère measures and a new version of the Hadwiger theorem on convex functions are obtained.

Evidence for PTGER4, PSCA, and MBOAT7 as risk genes for gastric cancer on the genome and transcriptome level.

Genetic associations between variants on chromosome 5p13 and 8q24 and gastric cancer (GC) have been previously reported in the Asian population. We aimed to replicate these findings and to characterize the associations at the genome and transcriptome level. We performed a fine-mapping association study in 1926 GC patients and 2012 controls of European descent using high dense SNP marker sets on both chromosomal regions. Next, we performed expression quantitative trait locus (eQTL) analyses using gastric transcriptome data from 143 individuals focusing on the GC associated variants. On chromosome 5p13 the strongest association was observed at rs6872282 (P = 2.53 × 10-04 ) and on chromosome 8q24 at rs2585176 (P = 1.09 × 10-09 ). On chromosome 5p13 we found cis-eQTL effects with an upregulation of PTGER4 expression in GC risk allele carrier (P = 9.27 × 10-11 ). On chromosome 8q24 we observed cis-eQTL effects with an upregulation of PSCA expression in GC risk allele carrier (P = 2.17 × 10-47 ). In addition, we found trans-eQTL effects for the same variants on 8q24 with a downregulation of MBOAT7 expression in GC risk allele carrier (P = 3.11 × 10-09 ). In summary, we confirmed and refined the previously reported GC associations at both chromosomal regions. Our data point to shared etiological factors between Asians and Europeans. Furthermore, our data imply an upregulated expression of PTGER4 and PSCA as well as a downregulated expression of MBOAT7 in gastric tissue as risk-conferring GC pathomechanisms.

Minkowski valuations on convex functions.

A classification of [Formula: see text] contravariant Minkowski valuations on convex functions and a characterization of the projection body operator are established. The associated LYZ measure is characterized. In addition, a new [Formula: see text] covariant Minkowski valuation on convex functions is defined and characterized.

Gamblers seeking treatment: Who does and who doesn't?

BACKGROUND AND AIMS: As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. METHODS: The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. RESULTS: In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. CONCLUSIONS: In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance.

Gambling experiences, problems, research and policy: gambling in Germany.

AIMS: The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. METHODS: The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. RESULTS: Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. CONCLUSIONS: German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.

Has gambling changed after major amendments of gambling regulations in Germany? A propensity score analysis.

Aims This study examined changes in general population gambling in the light of two major amendments of the German gambling regulation, the Fifth Amendment of the German Gambling Ordinance (AGO) for commercial amusement machines with prizes (AWP) and the State Treaty on Gambling (STG) for gambling activities subject to the state monopoly. Methods Applying cross-sectional data from the 2006 and 2009 Epidemiological Survey of Substance Abuse (ESA), propensity-score-matched samples of 7,970 subjects and 3,624 12-month gamblers aged 18-64 years were used for analyses. Logistic regression was employed to examine changes in gambling controlling for possible confounding variables. Results Overall participation in state gambling activities, participation in lotto as well as TV lottery decreased and gambling on Internet card games increased. No changes were found for any other gambling activity, 12-month prevalence of any gambling and pathological gambling. While weekly gambling declined, overall multiple gambling increased. Effects were similar in the total sample and among current gamblers. Conclusions Prohibiting specific gambling activities, e.g., Internet gambling, seem to be insufficient approaches to change gambling behavior. Supply reduction might need to be enhanced by changes in game characteristics and implementation of early intervention measures. However, long-term consequences are uncertain and further monitoring is needed.