A Comment: Positive Play is a Subset of Responsible Gambling.

Confronted with criticisms focused on the nature of Responsible Gambling (RG), this article suggests that Positive Play (PP) is a conceptual subset of Responsible Gambling and not a fully developed and independent harm prevention or reduction framework. To advance public health initiatives and focus public policy. This article reviews and clarifies some of the confusing and subtle difference between Responsible Gambling and Positive Play. The discussion defines the notion of responsibility, Responsible Gambling, and Positive Play. We recognize that well-developed RG activities permit and encourage the underpinnings of PP. However, when viewed as a dependent measure, PP does not intend to reduce the prevalence of gambling-related harms or prevent the incidence of gambling-related harms. These objectives are the two basic and fundamental requirements to classify any activity as a RG program.

Moving Away from Individual Responsibility: A Comment.

In this comment, we suggest there has been a crusade among some gambling stakeholders to move the field away from personal responsibility influences and toward social setting effects. This perspective disproportionally attributes gambling-related negative consequences to the social setting rather than the gambler. We argue that personal responsibility is a pivotal issue during the emotional maturation of healthy adults and remains essential to understanding intemperate gambling. This comment explores this movement away from personal responsibility and briefly discusses some of the iatrogenic consequences that this position might create in a clinical setting.

Gambling Research and Industry Funding.

This paper discusses the relationship between investigative credibility and the sources of funding associated with gambling research. Some researchers argue against accepting funding from gambling industry sources; similarly, they decline to participate in activities directly or indirectly sponsored by gambling industry sources. In contrast, these anti-industry investigators evidence less resistance toward accepting funds from sources other than industry, for example, governments, because they believe that they have greater independence, reliability, and validity, and less undue influence and/or interference. We organize this article, around six primary issues: (1) researchers making a priori judgments that restrict positions towards industry associated research; (2) the potential negative impacts of holding such a position; (3) a description of the different sources of funding available to support gambling-related research; (4) an examination of the extant empirical support associated with the sources of funding and whether such support evidences bias; (5) a description of six cases illustrating how refusing to participate in any project funded by the industry can adversely influence the advancement of science and, at times, be itself unethical; and finally, (6) we suggest some remedies to advance solutions to this problem by stimulating the participation of reluctant researchers to work towards a greater harmony, keeping in mind that the pivotal goal of our work is to increase our knowledge in different area of science and to harness it to public goods.

Correction to: Gambling Research and Funding Biases.

Unfortunately, the original publication contains errors. The authors would like to correct the errors.

Imaged-guided and muscle sparing laparoscopic anorectoplasty using real-time magnetic resonance imaging.

A challenge when repairing imperforate anus is positioning the neo-rectum into the center of the sphincter muscle complex (SMC) with limited muscle injury and scarring. Unfortunately, the path through the components of the SMC are often non-linear. We have used MRI to delineate the complex and guide the needle through the center using standard MRI-guidance (Raschbaum GR et al. J Pediatr Surg 45:220-223, 2010; Thomas TT et al. J Pediatr Surg 35:927-930, 2000). However, asynchronous scanning requires multiple, time-consuming scans to advance the needle in stepwise fashion. Asynchronous scanning also prevents visualizing the needle as it is advanced. We recently integrated software into the MRI operative suite that allows placement of the needle with real-time MRI. We report the feasibility and utility of real-time MRI-assisted laparoscopic assisted anorectoplasty (RT MRI-LAARP). Needle guidance was performed with Siemens Espree 1.5 T MRI with T1 Flash RT Sequence. After needle placement, laparoscopic mobilization, fistula takedown and pull-through was performed using the needle to guide dilation to create a tract to pull-through the neo-rectum. Charts of patients who underwent RT MRI-LAARP were reviewed. Demographics, anatomy, number of needle passes, OR duration and complications are reported. There were five children that underwent RT MRI-LAARP; one was a redo secondary to a retracted rectovestibular fistula. Operative time ranged from 187-505 min. Average hospital stay was 4.0 ± 1.0 days. There were no intraoperative complications although one patient had temporary urinary retention post-op. Muscle sparring laparoscopic anorectoplasty using real-time MRI is feasible and facilitates needle placement through the SMC.

Responsible Gambling Research and Industry Funding Biases.

This brief report examines whether there are differences in aspects of different characteristics, including design/methodologies of responsible gambling (RG), between studies funded by industry as compared to other sources. To investigate this, the authors used those studies included in a recent meta-analysis focusing on the empirical basis of RG initiatives (Ladouceur et al. in Addict Res Theory 25:225-235, 2017). We examined eight associations between funding sources, and different design/methodological characteristics of these studies; type of strategy, inclusion of comparison groups, measurement scales and repeated measures, publication source, number of inclusion criteria met, secondary sources of funding, publication year. The results revealed no statistically significant difference between the funding source, and the index study characteristics. These results do not support claims that funding exerts influence on the design or methodologies of RG studies. However, the absence of statistically significant findings should not be used to assert the absence of a funding effect because there are many reasons for failing to find differences, or interpretation of findings. Unexpectedly, a third of the papers included in this study failed to disclose their funding sources. This finding highlights the need for more open and transparent disclosures.

Gambling Research and Funding Biases.

A recent systematic review of the responsible gambling research suggests that there are no significant differences between gambling industry and non-industry funded research with regard to research design and outcomes. This study empirically synthesizes the outcomes of a larger sample of the scientific gambling literature to determine the generalizability of these original results. Our goal was to determine the extent to which funding sources might differentially influence characteristics of research design and outcomes. We conducted a comprehensive review of 18 research databases and examined studies published between January 2008 and August 2018. For four gambling-related journals, we reviewed all of the available studies. For 14 addiction-related journals, we examined only studies that examined gambling-related outcomes. To be included in this study, publications had to be quantitative and include a clear gambling-related hypothesis. After retrieving 1731 gambling studies, we applied the inclusion criteria and retained 720 studies for our final analytic sample. We used hypothesis confirmation and funding source information to determine the presence or absence of funding bias. Gambling industry funded studies were no more likely than studies not funded by the gambling industry to report either confirmed, partially confirmed, or rejected hypotheses. Nonetheless, studies funded by the gambling industry were more likely than other types of funding sources to include a conflict of interest statement. Studies with disclosed funding sources were more likely than those with undisclosed funding sources to include a conflict of interest statement. These findings highlight the importance of transparency and disclosure during research dissemination.

Efficacy of a Self-Help Treatment for At-Risk and Pathological Gamblers.

Available evidence suggests that self-help treatments may reduce problem gambling severity but inconsistencies of results across clinical trials leave the extent of their benefits unclear. Moreover, no self-help treatment has yet been validated within a French Canadian setting. The current study therefore assesses the efficacy of a French language self-help treatment including three motivational telephone interviews spread over an 11-week period and a cognitive-behavioral self-help workbook. At-risk and pathological gamblers were randomly assigned to the treatment group (n = 31) or the waiting list (n = 31). Relative to the waiting list, the treatment group showed a statistically significant reduction in the number of DSM-5 gambling disorder criteria met, gambling habits, and gambling consequences at Week 11. Perceived self-efficacy and life satisfaction also significantly improved after 11 weeks for the treatment group, but not for the waiting list group. At Week 11, 13% of participants had dropped out of the study. All significant changes reported for the treatment group were maintained throughout 1, 6 and 12-month follow-ups. Results support the efficacy of the self-help treatment to reduce problem gambling severity, gambling behaviour and to improve overall functioning among a sample of French Canadian problem gamblers over short, medium and long term. Findings from this study lend support to the appropriateness of self-help treatments for problem gamblers and help clarify inconsistencies found in the literature. The low dropout rate is discussed with respect to the advantages of the self-help format. Clinical and methodological implications of the results are put forth.

Development of an operative suspension system for the performance of MRI-OR-guided laparoscopic anoplasty.

BACKGROUND: MRI-guided laparoscopic assisted anorectoplasty (MRI-LAARP), a new approach for surgical correction of high imperforate anus, does not bisect the sphincter complex as in the PSARP and is able to pull the neorectum through the entire sphincter complex unlike the LAARP. There is no available MRI-compatible device to position and transport patients during this procedure. We report on the design of such a device here. METHODS AND DEVICE: The device was constructed from 1.0″ polyvinylchloride tubing and poly-methyl methacrylate (Plexiglass(®)) platform. The device has a stable, rigid base on which platform is secure. An adjustable and removable superstructure is secured to this base to suspend legs for lithotomy position. RESULTS: MRI-LAARP has been performed on 6 patients. The device has performed well and meets requirements set forth in development including construction with MRI-compatible materials, size fitting in the MRI bore, ability to hold patient in lithotomy position, ability to position and support MRI flex coils, and providing stability while transporting to a separate OR with needle in position. CONCLUSIONS: This device provides a stable structure to position and transport a patient with a needle in a tenuous position without dislodgement allowing this procedure, and potentially other procedures, to be done in hospitals without MROR capability.

Internet-based CBT intervention for gamblers in Finland: experiences from the field.

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8-week Internet-based cognitive behavioral therapy offered for gamblers in Finland. Sixty-four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3-4 points) and 10% were at risk of gambling problems (NODS 1-2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT-C), social consequences, gambling-related cognitive erroneous thoughts and depression (MARD-S). In this sample co-morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling-related cognitive erroneous thoughts.

[Prevalence of gambling habits in Gaspésie and Îles-de-la-Madeleine in 2009]. / [Prévalence des habitudes de jeu en Gaspésie et aux Îles-de-la-Madeleine en 2009].

UNLABELLED: OBJECTIF : Estimer la prévalence des habitudes aux jeux de hasard et d'argent (JHA), du jeu à risque (JAR) et du jeu pathologique probable (JPP) dans la région de la Gaspésie et des Îles-de-la-Madeleine (GIM) (Québec). MÉTHODE : Un sondage téléphonique portant sur les habitudes de jeu a été réalisé auprès de 1014 adultes résidents de la région de la GIM. Les participants ont été sélectionnés aléatoirement. L'échelle Problem Gambling Severity Index de l'Indice canadien du jeu excessif a servi à l'évaluation du jeu pathologique. RÉSULTATS : Quatre-vingt-cinq pour cent des répondants rapportent avoir joué à un JHA au cours de l'année précédente. Les activités les plus populaires sont l'achat de billets de loterie, la participation à des tirages et collectes de fonds, le bingo, les cartes ou jeux de société en famille ou avec des amis pour de l'argent, la loterie vidéo et les jeux de casino. Les taux de prévalence du JAR et du JPP s'élèvent à 1,5 % et 0,8 % respectivement. La loterie vidéo s'avère le jeu le plus souvent identifié comme étant problématique, suivi des loteries instantanées et ordinaires (par exemple, Lotto 6/49). CONCLUSION: Les habitudes de jeu des Gaspésiens et des Madelinots sont similaires à celles observées chez l'ensemble des Québécois. La discussion soulève entre autres la question de la validité de l'évaluation de la présence d'un problème de jeu parmi les membres de l'entourage, et certaines perceptions à risque, dont celle qu'il est impossible de développer un problème aux loteries instantanées et au bingo.

Responsible gambling: general principles and minimal requirements.

Many international jurisdictions have introduced responsible gambling programs. These programs intend to minimize negative consequences of excessive gambling, but vary considerably in their aims, focus, and content. Many responsible gambling programs lack a conceptual framework and, in the absence of empirical data, their components are based only on general considerations and impressions. This paper outlines the consensus viewpoint of an international group of researchers suggesting fundamental responsible gambling principles, roles of key stakeholders, and minimal requirements that stakeholders can use to frame and inform responsible gambling programs across jurisdictions. Such a framework does not purport to offer value statements regarding the legal status of gambling or its expansion. Rather, it proposes gambling-related initiatives aimed at government, industry, and individuals to promote responsible gambling and consumer protection. This paper argues that there is a set of basic principles and minimal requirements that should form the basis for every responsible gambling program.

A warning about measurement and methodological issues associated with coronavirus tracking and evaluation across jurisdictions.

As people around the world experience a devastating pandemic, it is critical that policy-makers consider the methodological and measurement issues that might be associated with coronavirus disease 2019 (COVID-19) public health indicators. This commentary uses four primary variables to illustrate measurement and methodological issues that can complicate comparisons between jurisdictions. Jurisdiction refers to a variety of geographic areas, such as a country, a state, or a province/territory. These variables play a critical role in determining how we understand the trajectory of disease spread. These variables also contribute to our understanding of prevention strategies and their associated efficacy, reflecting the impact of COVID-19 on hospitals. It is critical for public health stakeholders and the public to recognize that these four simple variables can vary substantially across jurisdictions.

Impact of visiting an Onsite Casino information centre on perceptions about randomness and gambling behaviours.

At the beginning of 2000, some educational initiatives in the field of responsible gambling resulted in the implementation of Onsite Casino Information Centres (OCICs). However, no study has yet empirically evaluated the impact of visiting an OCIC. This paper includes two studies evaluating the OCIC Au Centre du Hasard, located in Montreal, Quebec. The goal of the first study was to identify the profile of the visitors and to assess their appreciation. After a visit, 336 patrons accepted to complete a pen and paper questionnaire. The goal of the second study was to evaluate the impact of a visit on the perceptions about randomness and the gambling behaviours of the visitors. For this study, 67 visitors were evaluated before, after, and 3 months following a visit and their results were compared to a control group. Data showed that most visitors were seniors, occasional slot machine gamblers, and in control of their gambling activities. The majority of guests greatly appreciated their visit. A visit to Au Centre du Hasard seemed to modify the misconceptions towards the notion of randomness but not the gambling behaviours. These gains were maintained at 3-month follow-up. Results with respect to other prevention programs are discussed, and future research avenues are suggested.

Links between casino proximity and gambling participation, expenditure, and pathology.

Two studies investigated the relationship between casino proximity and gambling participation, expenditure, and pathology. In Study 1, 8,842 participants were categorized into 1 of 4 driving distances from their home to the nearest casino in the province of Quebec: 0-100 km, 100.01-200 km, 200.01-300 km, or 300.01-981 km. In Study 2, 5,158 participants, who lived within a 100-km driving distance from the Montreal casino, were classified into 1 of 5 equidistant, 20-km driving distances. A survey company interviewed participants regarding their gambling habits. Results indicated a positive link between casino proximity and gambling participation (at the provincial and Montreal levels) and expenditure (at the provincial level only) but no link with the current prevalence rate of probable pathological gambling or of problem gambling. In a setting in which many types of gambling activities are available, casino proximity in itself does not appear to explain the rate of gambling-related problems. It is necessary to continue prospective research on exposure and adaptation theories as potential explanations for the development of pathological gambling.

Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder.

This study examines how cognitive variables, which play a central role in the development and maintenance of generalized anxiety disorder (GAD), manifest themselves when GAD and major depressive disorder (MDD) are comorbid. Thirty-two participants were divided into two groups, a group of individuals with a principal diagnosis of comorbid GAD and MDD and a group of people with a principal diagnosis of GAD without MDD. Groups were compared using four cognitive variables: intolerance of uncertainty, poor problem orientation, cognitive avoidance, and beliefs about worry. Our results show that the group of individuals with a principal diagnosis of comorbid GAD and MDD were more intolerant of uncertainty, presented poorer problem orientation, and displayed more cognitive avoidance. The cognitive implications of these results are discussed, and diagnostic criteria are presented to facilitate the differential diagnosis between both groups.

Evaluation of intolerance of uncertainty: development and validation of a new self-report measure.

Intolerance of uncertainty represents an important risk factor for development of anxiety disorders. However, few measures have been developed in order to evaluate this construct. Four studies were conducted in order to validate a new instrument evaluating intolerance of uncertainty: the Intolerance of Uncertainty Inventory (IUI). The first study described the questionnaire's development and evaluated the psychometric properties of its preliminary version. Study 2 examined the reliability and the factorial validity of the final version of the questionnaire, while Study 3 mainly addressed its convergent validity. Finally, Study 4 examined the questionnaire's temporal stability. Factorial analyses confirmed the IUI's validity. Results also supported the IUI's reliability, convergent validity, and temporal stability. The IUI is the first instrument that offers the possibility of measuring intolerance of uncertainty as a tendency to consider uncertainties to be unacceptable, as well as in terms of cognitive and behavioral manifestations.

Harm Reduction and electronic gambling machines: does this pair make a happy couple or is divorce foreseen?

Recent empirical studies have evaluated if modifying electronic gambling machine (EGM) structural features could encourage safer gambling behaviors and decrease gambling-related problems. Several of these studies refer to Harm Reduction (HR), suggesting that the HR paradigm is useful to design, implement and test the efficacy of various prevention and treatment programs applied to EGM users. After reviewing the origins of HR and specifying its operational definition, this paper discusses the relevance of the HR framework for the study of measures related to EGM use and gambling in general. Examples are given to illustrate the arguments. The results show that HR has been over-inclusive in the field of gambling. A specific and operational definition and application of the HR framework is required for HR to be useful for the advancement of research in the gambling field.

Improved self-exclusion program: preliminary results.

The gambling industry has offered self-exclusion programs for quite a long time. Such measures are designed to limit access to gaming opportunities and provide problem gamblers with the help they need to cease or limit their gambling behaviour. However, few studies have empirically evaluated these programs. This study has three objectives: (1) to observe the participation in an improved self-exclusion program that includes an initial voluntary evaluation, phone support, and a mandatory meeting, (2) to evaluate satisfaction and usefulness of this service as perceived by self-excluders, (3) to measure the preliminary impact of this improved program. One hundred sixteen self-excluders completed a questionnaire about their satisfaction and their perception of the usefulness during the mandatory meeting. Among those participants, 39 attended an initial meeting. Comparisons between data collected at the initial meeting and data taken at the final meeting were made for those 39 participants. Data showed that gamblers chose the improved self-exclusion program 75% of the time; 25% preferred to sign a regular self-exclusion contract. Among those who chose the improved service, 40% wanted an initial voluntary evaluation and 37% of these individuals actually attended that meeting. Seventy percent of gamblers came to the mandatory meeting, which was a required condition to end their self-exclusion. The majority of participants were satisfied with the improved self-exclusion service and perceived it as useful. Major improvements were observed between the final and the initial evaluation on time and money spent, consequences of gambling, DSM-IV score, and psychological distress. The applicability of an improved self-exclusion program is discussed and, as shown in our study, the inclusion of a final mandatory meeting might not be so repulsive for self-excluders. Future research directives are also proposed.

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry.

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.