Fantasy Sports as Gaming or Gambling? Perception, Attitudes, and Engagement Behavior of College Students.

Background: The current study was carried out owing to the projected increase in the fantasy sports market in India, the popularity of fantasy sports in the age group of 18-25 years, the gambling-related implications of engaging in fantasy sports, and the dearth of published data on the extent and pattern of engagement in fantasy sports among college students in India. We aimed to assess the attributes of engagement in fantasy sports among college students and explore their perceptions and attitudes toward fantasy sports. Methods: This was a cross-sectional observational study among students enrolled in undergraduate courses in an autonomous college in central India. The study questionnaire included a semi-structured proforma that asked for information on the sociodemographic details, questions to assess the gaming (both online and offline) pattern and participation in fantasy sports by the study participants, and a modified Motives for Online Gaming Questionnaire (MOGQ). The participants were also asked to express, on a 10-point scale, their agreement that fantasy sports are similar to gambling. Results: Around one-fifth of the participants had engaged in a fantasy sport at least once. Around 18% had gambled at least once. The participants who reported losing money from fantasy sports also engaged in a significantly greater number of fantasy sports (p = .002). Those who engaged in fantasy sports with the main goal of making money agreed more with the statement that fantasy sports are similar to online gambling compared to those who did not (p = .01). Conclusions: Those who engaged in fantasy sports to make money agreed more with the statement that fantasy sports are similar to gambling. The study helps understand the associations between various psychosocial motives, monetary motivations, and involvement in fantasy sports.

Vaccination coverage against COVID-19 among rural population in Haryana, India: A cross-sectional study.

BACKGROUND: Conducting a study in rural pre-dominant areas will help to understand the penetration of the vaccination campaign during the COVID-19 health crisis. This study aimed to investigate vaccination coverage against COVID-19 among the rural adult population in India and to identify factors associated with vaccination coverage. METHODS: A population-based cross-sectional study was conducted among the rural population in one district of north India from January to February 2023. A semi-structured questionnaire was designed on the SurveyMonkey digital platform for interviewing the participants, which consisted of questions related to socio-demographic profile, health problems, vaccination status, types of vaccine, re-infection after vaccination, and functional difficulties. The data regarding infection with COVID-19 was collected based on self-reported positive testing for SARS-CoV 2 on RT-PCR. FINDINGS: A total of 3700 eligible individuals were enumerated for the survey, out of which 2954 (79.8%) were interviewed. The infection rate of past COVID-19 infection, based on self-report of testing positive, was 6.2% (95%CI: 5.3-7.1). Covishield vaccine was received by most participants (81.3%, 2380) followed by Covaxin (12.3%, 361) and Pfizer manufactured vaccine (0.03,1). The coverage for first, second, and booster doses of the vaccine was 98.2% (2902), 94.8% (2802), and 10.7% (315) respectively. The risk of reinfection at 12 months or more among participants with two doses of vaccine was 1.6% (46/2802, 95%CI: 1.2-2.1). The coverage among those with severe functional difficulties was lesser as compared to those with some or no difficulties. INTERPRETATION: Vaccination coverage against COVID-19 in rural Haryana, India is not dependent on factors like gender or occupation but is dependent on age and education. Although the full and partial vaccination coverage is high, the booster dose coverage is poor. In addition, the presence of severe disability was significantly associated with reduced vaccination coverage.

Impact of global public health days on online health-information-seeking behavior related to substance use: An analysis of five-year data.

The United Nations Organizations observe various global public health days (GPHDs) (also known as world days) throughout the year. We aimed to assess the impact of GPSDs on online health information-seeking behavior related to substance use in the Indian context. We used the Google Trends data for this study using standard guidelines. We conducted a topic search for the query "Substance abuse" to capture online information-seeking behavior (OHISB) for substance use disorder-related searches. The data were analyzed using the Joinpoint Regression software. Joinpoint regression model analysis was conducted to determine the statistically significant daily percent change (DPC) in the RSV trend. We found that there were significant changes in OHISB for substance use-related disorders on the International Day Against Drug Abuse and Illicit Trafficking over the last five years. The increase in the pattern of online search for substance use-related information was not observed around the World No Tobacco Day, World Mental Health Day, and World Suicide Prevention Day. Since most of these world health days are likely to continue to be observed in the coming years, it is important to regularly assess their impact as well as make the necessary modifications to make them more effective in achieving the desired objectives.

A randomized controlled trial of brief intervention for patients with cannabis use disorder.

Objectives: Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder. Materials and Methods: This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12. Results: The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541). Conclusion: In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis.

Nonprescription use of buprenorphine tablets among patients at a tertiary care addictive disorder treatment center in India: Observa-tions and implications.

OBJECTIVE: Nonprescribed use of drugs is a clinical and public health challenge fueled by diversion of controlled opioids like buprenorphine. In this study, we report the nonprescription use of buprenorphine and buprenorphine-naloxone for the first time in India. DESIGN: A cross-sectional observational study utilizing semistructured interviews. SETTING: A tertiary care addictive disorder treatment center in India, which provides inpatient and outpatient medically oriented care that includes agonist treatment (buprenorphine) or detoxification and antagonist treatment (naltrexone). PARTICIPANTS: Patients aged 18-65 years, registered at the center, and who had a history of current (within the past 6 months) nonprescription use of buprenorphine tablets were recruited. MAIN OUTCOME MEASURES: Participants were questioned about demographic and clinical factors and details of nonprescription use of buprenorphine and buprenorphine-naloxone using a structured questionnaire. Since both buprenorphine with naloxone and buprenorphine without naloxone are available and transacted on the street "loose" out of the blister packs, we were unable to differentiate the use of plain buprenorphine and a combination of buprenorphine- naloxone. RESULTS: A majority of the participants used nonprescribed tablets buprenorphine and buprenorphine-naloxone with an intent to control the withdrawal symptoms, and the reason for this use was that other patients shared their prescriptions of these medications. About half of the participants injected the tablets, and liquid pheniramine was most commonly used as the solvent for dissolving the tablets. A "high" was perceived by around half of those who injected. Participants reported knowing, on an average, around 13 peers who injected the tablet buprenorphine or -buprenorphine-naloxone. CONCLUSION: Nonprescription use of tablets buprenorphine and -buprenorphine-naloxone is a clinical concern and also an important public health issue. Geographical and systemic expansions of the availability of buprenorphine may reduce the "demand" for nonprescribed buprenorphine, while the opportunities for diversion from treatment centers can be minimized through more careful clinical prescriptions and monitoring practices.

Toward a national policy on Alcohol: A complex public health issue in need of urgent action.

Alcohol use is a major public health issue. It is also associated with a range of family, social, and economic problems. This led multiple countries worldwide to adopt national policies for alcohol regulation. Over the years, alcohol use and related problems have increased in India. The existing regulatory framework on alcohol varies greatly across states in terms of government sanctions, pricing, and legal drinking age, resulting in variations in its availability and prevalence of alcohol use disorder and related harms. Despite alcohol use being mentioned in several national policies and plans, a comprehensive national policy addressing alcohol is lacking. In this manuscript, the need for a dedicated national alcohol policy is underscored, emphasizing its potential to mobilize resources, prioritize interventions, and guide various stakeholders. The timely implementation of such a policy is crucial to address the multifaceted challenge of alcohol use effectively.

Increasing trend of deaths due to suicide attributable to mental disorders and substance use (disorders) in India.

In this article we aim to assess the change in the deaths due to suicide attributable to mental disorders and substance use (disorders) in India over the past 26 years. We also aim to make projections over the coming years. For the deaths due to suicide attributable to mental disorders there was a biquadratic increasing trend with equations predicting 85.97%, 90.76% and 85.79% variance in the males, females and total deaths, respectively. There was a quadratic increase explaining 94.83% variance in males, 61.79% in females and 95.41% variance in deaths due to suicide attributable to substance use (disorders).

Does Cognitive Therapy Change the Early Maladaptive Schemas in Individuals with Alcohol Dependence? Evidence from a Randomized Controlled Trial.

Background: Although early maladaptive schemas (EMSs) have been suggested as potential vulnerability markers for alcohol dependence (AD), there is less emphasis on addressing these schemas in substance abuse treatment programs. We thus aimed to examine the change in schemas in response to cognitive therapy in individuals with AD. Methods: In this an open-label randomized controlled study, individuals with alcohol dependence syndrome (ADS, n = 84) were randomized to the intervention group (n = 45), which received six cognitive therapy sessions combined with treatment as usual (TAU), or the control group (n = 39), which was on TAU only. Participants were assessed on the measures of EMSs, alcohol use severity, and perceived stress at baseline and posttreatment. Results: The intervention group showed significant improvement in 5 out of 18 EMSs, that is, emotional deprivation, defectiveness, self-sacrifice, unrelenting standard, and negativity, compared to the control group, at the end of the treatment. There was a significant between-group effect for perceived stress but not for alcohol use severity. Conclusion: EMSs can be changed with cognitive therapy in individuals with AD and could be a crucial area to address in treatment programs. Further studies with long-term follow-up are warranted. The trial was registered with the Clinical Trials Registry-India (CTRI/2015/12/006441) on December 17, 2015.

Telemedicine in addiction treatment: Ethical considerations.

The gradual move towards telemedicine for the care and service provided to patients with addictive disorders [1], has been accentuated during the pandemic [2-4]. Telemedicine facilitates expert medical care to those situated at distant locations, and reduces the indirect and direct healthcare costs. While the benefits of telemedicine have made it an exciting opportunity, some ethical concerns still remain [5]. Here, we discuss some of the ethical challenges in providing treatment to patients of addictive disorders through telemedicine.

Impact of three years of prohibition on extent and pattern of alcohol use in Bihar: Observations and insights from the National Family Health Survey.

Bihar Excise (Amendment) Act, 2016 was promulgated in the state and a complete prohibition on alcohol was declared within the state of Bihar. We aimed to assess the impact of the prohibition on extent and pattern of alcohol use in the state of Bihar using the National Family Health Survey data. We also compared the data from Bihar with the data for the whole country, its neighbouring states and the state of Gujarat. There was a 41.78% reduction in the proportion of men who reported alcohol use in Bihar. Among those who reported alcohol use proportion of those who used 'almost every day' reduced by 29.72%. There was a 69.56% reduction in the proportion of women in Bihar who reported alcohol use. There was a significant increase in proportion of men reporting use of tadi madi and country liquor. Since the prohibition of alcohol in the state of Bihar there has been a reduction in self-reported alcohol use among men and women. However, alcohol use continues to be reported in the state even after the prohibition. There are states in the country that have similar extent of alcohol use as compared to Bihar, despite lack of prohibition. This warrants a relook at the policy to address what the prohibition could not achieve.

A randomized controlled trial to assess effectiveness of GamE- an e-Health intervention to self-manage gaming with an aim to prevent gaming disorder.

Gaming disorder is a health concern associated with significant impairment. Digital technology can be helpful for implementing preventive measures for gaming disorder. This randomized trial aimed to assess the effectiveness of an e-Health intervention to prevent gaming disorder among college students. This randomized trial compared an online intervention module aimed at improving knowledge, skill and attitude of the students and empower them with self- help strategies to monitor and regulate their gaming behavior with an aim to prevent gaming disorder, with wait list control. The sample comprised of 30 cases and 33 controls. The understanding of the concept of gaming, understanding of difference between gaming and gaming disorder, understanding of adverse effects associated with gaming disorder, understanding of screening of gaming disorder and self-help techniques of regulating gaming disorder increased more in the intervention group than control. The participants most favored self-monitoring and strategies to promote healthy lifestyles for regulating gaming. Online digital intervention can be effectively used as a strategy to prevent gaming disorder among college students. Such an intervention can empower students with strategies to regulate their extent of gaming.

Experience and insights from the emergency multiday take-home dose methadone dispensing in Ho Chi Minh City in context of COVID-19.

Introduction: We aimed to assess the uptake of the pilot multiday take-home dose methadone program during COVID-19 by the patients and document the experience with this novel approach to Methadone Maintenance Treatment (MMT) in Vietnam through this operational research.Materials and methods: A total of 10 clinics were identified randomly using the PPS method. A total of 502 patients were selected from the clinics using a simple randomization technique. The information was collected from the administrative and treatment records and direct face-to-face interview with the patients.Results: None of the clinics reported an incidence of overdose. A large majority of the patients reported that take home methadone program as being convenient (79.6%) and agreed that they shall like to join the multiday take-home dose in future (98.7%).Conclusions: The findings of the current study suggested that the multiday take-home methadone program was feasible and well accepted by the patients in Ho Chi Minh City. It helped ensure continuity of care to patients on MMT during the COVID-19 pandemic.

Pattern recognition receptor CD14 gene polymorphisms in alcohol use disorder patients and its Influence on liver disease susceptibility.

Background: Alcohol use disorders (AUDs) leading to liver disease is major concern over other spectrum of disorder. Excessive alcohol consumption resulting in leaky gut syndrome is attributed to alcohol-induced liver injury through portal translocation of bacterial endotoxin. Susceptibility to alcoholic liver disease (ALD) in AUD patients could be dependent upon genes responsible for inflammation and alcohol metabolism. The pattern recognition receptor CD14 gene is a major player in endotoxin-mediated inflammation and susceptibility to ALD. This study investigated the genetic association of CD14 polymorphisms and other mechanisms relevant to altered inflammatory responses leading to ALD. Methods: Patients with alcohol use disorder with ALD (n = 128) and without liver disease (ALC, n = 184) and controls without alcohol use disorder (NALC, n = 152) from North India were enrolled. The CD4 gene polymorphisms in the North Indian population were evaluated by RFLP and sequencing. Secretory CD14 (sCD14), LBP, TLR4, MD2, TNFα, IL1b, IFNγ, IL6, IL10, and IL4 levels in serum were measured by ELISA among groups. The influence of polymorphisms on CD14 gene promoter activity and circulatory bacterial DNA level was determined. Results: The CD14 gene promoter and exonic region SNPs were found to be monomorphic, except for SNP rs2569190 for the North Indian population. The genetic association of SNP rs2569190(C/T) with the risk of developing ALD was found significant for TT genotype [ORTT, 95% CI = 2.19, 1.16-4.13 for ALD vs. ALC and OR, 2.09, 1.18-3.72 for ALD vs. NALC]. An increased sCD14 level was observed in AUD patients compared to NALC control. Increased levels of LBP, TLR4, TNFα, IL1ß, IFNγ, and IL6 and reduced levels of MD2, IL10, and IL4 were observed among the ALD patients compared to the other two control groups. Elevated levels of pro-inflammatory and reduced levels of anti-inflammatory cytokines were observed in the risk genotype TT groups of ALD patients and the ALC group compared to NALC. Promoter activity was observed in the intronic region flanking SNPs and risk genotype can influence reporter activity, indicating CD14 gene expression. Conclusion: Enhanced CD14 expression associated with inflammatory responses increases susceptibility to ALD in the TT genotype of AUD patients.

Addictive and other mental disorders: a call for a standardized definition of dual disorders.

The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation.

A Comprehensive Assessment of Self-Reported Post COVID-19 Symptoms Among Beneficiaries of Hospital Employee Scheme at a Tertiary Healthcare Institution in Northern India.

Purpose: With millions of people being affected by COVID-19, people living with post COVID-19 clinical symptoms (PCS) are expected to rise further. The primary aim of the study was to comprehensively assess self-reported PCS and its associated risk factors among beneficiaries of Hospital Employee Scheme of a tertiary healthcare institution in Delhi. Patients and Methods: An online cross-sectional study was conducted using a semi-structured questionnaire developed by employing nominal group technique among individuals aged 18 years and above who were novel SARS-CoV-2 positive from January to April 2021. Participants were telephoned first, before sending the online survey link. Socio-demographic data, information on PCS along with potential risk factors, pre-existing morbidities, vaccination status, severity of acute illness and management were collected between June and July 2021. PCS was presented as relative frequency; Chi-Square test and odds ratio; adjusted values were used to rule out any association between PCS and predictors. Results: In total, 773 of 1801 eligible participants responded to the survey (completion rate 42.9%), with a median age of 34 years (IQR 27-44). Males accounted for 56.4% and PCS was present in 33.2%. The most prevalent symptoms were fatigue (79.3%), arthralgia (33.4%), myalgia (29.9%), hair loss (28.0%), headache (27.2%), breathlessness (25.3%), and sleep disturbance (25.3%). The prevalence of PCS was reduced to 12.8% at 12 weeks. Female gender, older age, oxygen supplementation, severity of acute illness, and pre-existing co-morbidities were positively associated with PCS. Vaccination (second dose) reduced the odds of developing PCS by 39% compared to unvaccinated participants (aOR 0.61; 95% CI 0.40-0.96). Conclusion: PCS affects almost all organ systems of the body, regardless of the severity of acute COVID-19 illness. Two doses of vaccine hel reduce the development of PCS.

Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries.

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

How and What are Indians Drinking? Findings from the National Family Health Survey.

AIMS: To assess recent changes in the extent and pattern of alcohol use in India using the National Family Health Survey (NFHS) data. METHODS: We used unit-level data from both rounds of NFHS. The pattern of alcohol use was categorized as: 'almost every day', 'almost once a week' and 'less than once a week'. The information was segregated for the urban and rural settings. Information was also available on the type of alcoholic beverage used by the respondents. The z test for differences in proportions was carried out for the study variables. RESULTS: Findings suggest a 22.37 and 39.02% reduction in the proportion of men and women who reported alcohol use, respectively. The proportion of men reporting 'almost every day' and 'about once a week' consumption of alcohol increased by 24.19 and 7.14%, respectively. CONCLUSIONS: With the caveats of expected limitations of surveys, the findings suggest an overall decrease in alcohol use in India, though the proportion of men with more frequent alcohol has increased. There is a need to strengthen the investment in the initiatives targeted at the harms due to alcohol use.