Externalizing and self-medicating: Heterogeneity among repeat DUI offenders.

AIM: Despite significant reductions in Driving Under the Influence (DUI) in the United States during recent decades, DUI continues to be a major public health threat. The current study investigated the intersection of two domains known to influence DUI: criminal history and psychiatric comorbidity. METHODS: DUI recidivists (N = 743) attending a court-mandated two-week inpatient DUI program completed a computerized mental health assessment as part of their intake to that program. Participants' criminal records were obtained 4-5 years after program attendance. FINDINGS: This study identified three primary repeat DUI offender subtypes with distinct patterns of criminal behavior and psychiatric comorbidity: (Type I) those whose DUI emerges from a pattern of drinking to cope with mood and anxiety problems, (Type II) those whose DUI emerges as part of a larger pattern of externalizing and criminal behavior, and (Type III) those whose DUI offenses reflect more acute triggers and isolated episodes of excessive drinking. CONCLUSION: These findings suggest that current treatment models used in DUI programs are inadequate to address the heterogeneity in the population of DUI recidivists and that earlier and more comprehensive screening would allow for better targeting of resources to DUI offender subtypes.

Reflections on the mating pool for women in plastic surgery.

BACKGROUND: Almost three times as many board-certified female plastic surgeons are unmarried compared with male colleagues. The purpose of this study was to determine why women in plastic surgery are less likely to be married. METHODS: A 52-question survey was sent to all female members of the American Society of Plastic Surgeons. Questions focused on type of training and practice; marital status; age at marriage; spousal education, financial, and professional status; relational goals, values, and satisfaction. A total of 729 questionnaires were sent via e-mail; responses were anonymous. RESULTS: Response rate was 34 percent (n = 250). Respondents were either married (64 percent), engaged (2 percent), in a "serious" relationship (11 percent), or not in a committed relationship (23 percent). Of unmarried respondents, 56 percent wanted to marry, 44 percent did not wish marriage at the time of the survey, and 42 percent had deliberatively postponed marriage. The most frequently cited reasons for being single were perceived lack of desirable partners (45 percent), job constraints (14 percent), and personality differences (13 percent). Female plastic surgeons who married later than 36 years of age were more likely to choose a spouse with a lower income, less education, and lower financial success compared with female plastic surgeons who married at a younger age. CONCLUSIONS: Women in surgical practice who marry later are less likely to find a partner with equal educational level, financial resources, and professional success. Hence, a shift occurs from hypergamy toward hypogamy. These findings are not unique to plastic surgery.

A brief self-help toolkit intervention for gambling problems: a randomized multisite trial.

Two studies conducted in Massachusetts and Nevada evaluated the efficacy of a self-help toolkit for problem gambling. Individuals concerned about gambling-related problems, in response to public notices and newspaper advertisements, volunteered for a randomized trial of the self-help toolkit, Your First Step to Change: Gambling. Participants were randomly assigned to 1 of 3 conditions: (a) a printed toolkit, (b) the toolkit and a brief guide to the toolkit's content, or (c) assignment to a wait-list condition. Participants, 145 in Massachusetts and 170 in Nevada, reported their gambling behavior, beliefs and attitudes about chance, and recent and planned help seeking at baseline, 88% at 1 month later, and 79% at 3 months later. Findings for the complete and intent-to-treat analyses at both sites indicated that participants significantly improved. At the end of the study period, significantly more toolkit recipients than control group participants reported recently abstaining from gambling. Minimally invasive, self-directed resources like this self-help toolkit can assist remediating gambling-related problems among gamblers who do not engage in formal treatment.

Fourth-dimensional changes in nasolabial dimensions following rotation-advancement repair of unilateral cleft lip.

BACKGROUND: Repair of unilateral cleft lip requires three-dimensional craftsmanship and understanding four-dimensional changes. METHODS: Ninety-nine children with unilateral complete or incomplete cleft lip were measured by direct anthropometry following rotation-advancement repair (intraoperatively) and again in childhood. Changes in heminasal width, labial height, and labial width were analyzed and compared measures depending on whether the cleft was incomplete/complete or involved left/right side. RESULTS: Average heminasal width (sn-al) was set 1 mm less on the cleft side and measured only 0.7 mm less at 6 years. Labial height (sn-cphi) was slightly greater on the cleft side at repair and matched the noncleft side at follow-up. Vertical dimension (sbal-cphi) was slightly less at operation; the percent change was the same on both sides. Transverse labial width (cphi-ch) was set short on the cleft side and lengthened disproportionately, resulting in less than 1 mm difference at 6 years. All anthropometric dimensions grew less in complete cleft lips compared with incomplete forms; however, only labial height and width were significantly different. There were no disparities in nasolabial growth between left- and right-sided cleft lips. CONCLUSIONS: Cleft side alar base drifts laterally and should be positioned slightly more medial and secured to nasalis or periosteum. Growth in labial height lags and, therefore, the repaired side should be equal to or slightly greater than on the normal side, particularly in a complete labial cleft. Transverse labial width grows more on the cleft side; thus, lateral Cupid's bow peak point can be marked closer to the commissure to match the labial height on the noncleft side. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Gaming industry employees' responses to responsible gambling training: a public health imperative.

Gaming industry employees work in settings that create personal health risks. They also have direct contact with customers who might engage in multiple risky activities (e.g., drinking, smoking, and gambling) and might need to facilitate help-seeking by patrons or co-workers who experience problems. Consequently, the empirical examination of the processes and procedures designed to prepare employees for such complex situations is a public health imperative. In the current study we describe an evaluation of the Casino, Inc. Play Responsibly responsible gaming program. We surveyed 217 employees prior to and 1 month after (n = 116) they completed a multimedia driven responsible gambling training program. We observed that employees improved their knowledge of responsible gambling concepts from baseline to follow-up. The Play Responsibly program was more successful in providing new knowledge than it was in correcting mistaken beliefs that existed prior to training. We conclude, generally, that Play Responsibly is associated with increases in employees' responsible gambling knowledge.

Predictors of velopharyngeal insufficiency after Le Fort I maxillary advancement in patients with cleft palate.

PURPOSE: Approximately 25% to 40% of patients with cleft lip/palate develop maxillary retrusion that requires Le Fort I osteotomy. Maxillary advancement brings the soft palate forward, and this may cause velopharyngeal insufficiency (VPI). The goal of this study was to identify predictors that place patients with repaired cleft palate at risk of developing VPI after Le Fort I advancement. MATERIALS AND METHODS: This was a retrospective study of nonsyndromic patients with cleft lip/palate who had a Le Fort I osteotomy between 2000 and 2008. Charts were reviewed and data were collected on patient characteristics, preoperative speech assessments, and nasopharyngoscopic reports. Pre- and postoperative cephalometric radiographs were used to measure maxillary advancement and to assess the structure of the velopharynx. Simple logistic regression analysis examined the association between each predictive variable and postoperative VPI, as indicated by need for pharyngeal flap. Predictors with P ≤ .10 were included in the multivariate regression model. In both the univariate and the multivariate analyses, P ≤ .05 was considered statistically significant. RESULTS: Univariate analysis showed a significant association between preoperative soft palatal length and need for a pharyngeal flap (P = .005). By multivariate analysis, both preoperative soft palatal length and postoperative pharyngeal depth were associated with need for pharyngeal flap (P = .003 and P = .030). CONCLUSION: This study shows that a short soft palate is associated with VPI after Le Fort I osteotomy. Assessment of palatal length and pharyngeal depth on cephalometric radiographs is helpful in predicting postoperative VPI and need for a pharyngeal flap in patients with cleft palate after maxillary advancement.

Positioning the caudal septum during primary repair of unilateral cleft lip.

BACKGROUND: Since 1995, the senior surgeon has straightened the deviated anterocaudal septum in all infants undergoing primary repair of unilateral complete cleft lip/palate. METHODS: A retrospective assessment was done on 17 patients who did not have septal correction and 17 patients who did have septal correction at the time of nasolabial repair. Operative reports were reviewed, and secondary procedures on the nose were documented.Posterior-anterior cephalograms were used to measure septal deviation from the midline, angle of septal deviation, and width of the inferior turbinate on the noncleft side. The angle subtended by the superior and inferior segments of the cartilaginous septum was measured at the point of maximal septal deviation. RESULTS: The uncorrected group had a mean maximal septal deviation from the midline of 5.8 mm compared with 4.1 mm in the corrected group (P < 0.01). The uncorrected group had a mean width of the contralateral inferior turbinate of 12.7 mm compared with 10.2 mm in the corrected group (P < 0.01). The uncorrected group had a mean subtended angle of 137.8 degrees compared with 147.9 degrees in the corrected group (P < 0.01). CONCLUSIONS: Positioning the anterior caudal septum during primary repair of unilateral complete cleft lip results in less septal deviation and a smaller contralateral turbinate as documented by posteroanterior cephalometry in adolescence.

The GILLS score: part I. Patient selection for tongue-lip adhesion in Robin sequence.

BACKGROUND: The compromised airway in Robin sequence demands prompt operative intervention. Tongue-lip adhesion is one alternative; however, the outcome of this technique is variable. The purpose of this study was to identify variables that preoperatively predict the success of adhesion in Robin sequence patients with life-threatening respiratory distress. METHODS: This is a retrospective review of infants with severe (Laberge grade II or III) Robin sequence managed by tongue-lip adhesion. Variables analyzed included diagnosis (syndromic versus nonsyndromic), age at operation, preoperative and postoperative airway management, duration of intubation, length of intensive care and hospital stay, serial weight, and postoperative complications. RESULTS: Fifty-three infants had tongue-lip adhesion for airway compromise: 47 (89 percent) were successfully managed and treatment failed in six. Preoperative intubation, days of intubation, intensive care unit days and hospitalization, and reintubation were more common in syndromic infants (p < 0.05). Those infants who had adhesion within 14 days of birth required shorter duration of postoperative ventilator support and intensive care unit/hospital stay (p < 0.05) than those who had a later procedure. Significant variables were gastroesophageal reflux (p = 0.002), intubation preoperatively (p = 0.002), late operation (older than 2 weeks) (p = 0.001), low birth weight (<2500 g) (p = 0.01), and syndromic diagnosis (p < 0.001). The acronym GILLS summarizes these predictive findings; one point was assigned for each variable present. Adhesion was successful in 100 percent of infants with a GILLS score of 2 or less (n = 39) but failed in 43 percent (six of 14 infants) with a score of 3 or more. CONCLUSION: The GILLS score may improve patient selection and predict outcome of tongue-lip adhesion in infants with Robin sequence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.(Figure is included in full-text article.).

A taxometric analysis of actual Internet sports gambling behavior.

This article presents findings from the first taxometric study of actual gambling behavior to determine whether we can represent the characteristics of extreme gambling as qualitatively distinct (i.e., taxonic) or as a point along a dimension. We analyzed the bets made during a 24-month study period by the 4,595 most involved gamblers among a cohort of 48,114 people using an Internet service to gamble on sporting events. We applied two taxometric procedures (i.e., MAMBAC and MAXCOV) to three indicators of betting behavior: total money lost, total number of bets, and total money wagered. The results fail to provide support for the view that the most involved Internet sports gamblers include a distinct category of gamblers. More research is necessary to clarify the similar features of recreational and extreme gamblers and the dimensions that scientists can use to measure these behaviors. Finally, we discuss the implications of these findings for clinical, research, and public policy activities.

Disordered gambling, type of gambling and gambling involvement in the British Gambling Prevalence Survey 2007.

BACKGROUND: The purpose of this study was to examine the relationships between types of gambling and disordered gambling, with and without controlling for gambling involvement (i.e. the number of types of games with which respondents were involved during the past 12 months). METHODS: We completed a secondary data analysis of the 2007 British Gambling Prevalence Survey (BGPS), which collected data in England, Scotland and Wales between September 2006 and March 2007. The sample included 9003 residents, aged 16 or older, recruited from 10 144 randomly selected addresses. 5832 households contributed at least one participant. Post-facto weighting to produce a nationally representative sample yielded 8968 observations. The BGPS included four primary types of measures: participation in gambling (during the past 12 months and during the past 7 days), disordered gambling assessments, attitudes toward gambling and descriptive information. RESULTS: Statistically controlling for gambling involvement substantially reduced or eliminated all statistically significant relationships between types of gambling and disordered gambling. CONCLUSIONS: Gambling involvement is an important predictor of disordered gambling status. Our analysis indicates that greater gambling involvement better characterizes disordered gambling than does any specific type of gambling.

PTSD among a treatment sample of repeat DUI offenders.

Recent studies indicate that posttraumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among driving-under-the-influence (DUI) offenders in treatment. Investigation of DUI offenders' PTSD and clinical characteristics could have important implications for prevention and treatment. This prospective study examined the demographic and clinical characteristics of repeat DUI offenders with PTSD symptoms at baseline and 1-year follow-up. Seven hundred twenty-nine DUI offenders admitted to a 2-week inpatient program participated in the study. Participants with PTSD evidenced more severe psychiatric comorbidity and reported a higher DUI recidivism rate at 1-year than those without PTSD. This study suggests a need to address PTSD among DUI offenders, as well as to further develop methodologies for accurately reporting DUI recidivism.

One decade of self exclusion: Missouri casino self-excluders four to ten years after enrollment.

For more than a decade, casinos around the world have offered self-exclusion programs (SEPs) to gamblers seeking help with their gambling behavior. Despite the proliferation of SEPs, little is known about the long-term outcomes for gamblers who utilize these programs. The current study assessed the experiences of a sample (N = 113) of Missouri self-excluders (SEs) for as long as 10 years after their initial enrollment in the Missouri Voluntary Exclusion Program (MVEP). Most SEs had positive experiences with MVEP and reduced their gambling and gambling problems after enrollment. However, 50% of SEs who attempted to trespass at Missouri casinos after enrollment were able to, indicating that the benefit of MVEP was attributable more to the act of enrollment than enforcement. SEs who engaged in complementary treatment or self-help groups had more positive outcomes than those who did not, suggesting that SEPs ought to encourage and provide information about additional support and treatment options to participants.

Gambling problem symptom patterns and stability across individual and timeframe.

Few studies investigate gambling problems at the symptom level; even fewer investigate how symptom patterns change throughout the course of a gambling disorder. The current study utilized the National Epidemiological Survey on Alcohol and Related Conditions (NESARC; Grant et al., 2004) to investigate how the specific symptoms of disordered gambling relate to its severity and course. Results demonstrated that symptom patterns and stability changed as the number of symptoms endorsed increased. Symptom patterns varied considerably from prior to past year (PPY) to past year (PY) timeframes. Certain symptoms were more stable than others and held predictive value as markers of emerging pathological gambling (PG). In particular, gambling to escape problems was one of the most stable symptoms and also predictive of progression to PG; reliance on others to support gambling was predictive of progression to PG among participants at-risk for PG. The differential diagnostic value of various reported symptoms, as well as their lack of stability, has implications for both researchers and clinicians.

Increased frequency of left-handedness in patients with unilateral coronal synostosis.

OBJECTIVE: Left-handedness reportedly has been more common in persons with neurological afflictions (e.g., stroke) and malformations (e.g., cleft lip with or without cleft palate) that demonstrate marked unilateral involvement. Coronal synostosis is also more frequently unilateral, affecting the right side more commonly than the left. We sought to compare left-handedness in patients with unilateral coronal synostosis versus healthy controls. SUBJECTS: All patients aged 3 years or older with nonsyndromic unilateral coronal synostosis and healthy controls recruited by pediatricians blinded to the study. MAIN OUTCOME MEASURES: Prospective data obtained for all participants included age, gender, and handedness. In patients with unilateral coronal synostosis, the side of synostosis and age at surgery were documented. Left-handedness in the study and control groups was compared using chi-square analysis. Left-handedness also was analyzed in the study group according to side of fusion. RESULTS: Eighty-six patients with nonsyndromic unilateral coronal synostosis comprised the study group; there were 96 controls. The mean ages of the study (8.8 years) and control groups (9.8 years) were not statistically different (p > .05). There were more girls in the study group (67%) than in the control group (56%), but this difference was not statistically significant (p > .05). Left-handedness was documented in 30.2% of the study group and 11.4% of the control group (p < .005). Left-handedness was twice as common in patients with left versus right unilateral coronal synostosis (44.4% versus 20.4%; p < .05). CONCLUSIONS: Left-handedness is nearly three times more common in patients with unilateral coronal synostosis than in controls and four times more likely in patients with left-sided fusion.

Palatoplasty outcomes in nonsyndromic patients with cleft palate: a 29-year assessment of one surgeon's experience.

The primary objective of cleft palate repair is velopharyngeal competence without fistula. The reported incidence of fistula and velopharyngeal insufficiency (VPI) is variable. Our purpose was to assess the senior surgeon's 29-year palatoplasty experience with respect to incidence of fistula and VPI. Our hypotheses were that VPI is related to (1) age at palatoplasty, (2) cleft palate type, and (3) VPI and palatal fistula incidence decrease with the surgeon's experience. We reviewed the records of all children with cleft palate treated by the senior author between 1976 and 2004. Cleft palate was categorized according to Veau. Palatoplasty was performed on 449 patients, using a 2-flap technique with muscular retropositioning. The mean age at palatoplasty was 11.6 +/- 4.9 months (range, 7.0-46.4 months). The incidence of palatal fistula was 2.9%, and velopharyngeal sufficiency was found in 85.1% of patients. We found a significant association between age at palatoplasty and VPI (P = 0.009, odds ratio, 1.06 [95% confidence interval, 1.02-1.10]). Velopharyngeal insufficiency was also associated with the Veau hierarchy (P = 0.001). Incidence of VPI was independent of surgeon experience (P = 0.2). In conclusion, the incidence of palatal fistula was low. Velopharyngeal insufficiency was associated with increasing age at palatoplasty and with the Veau hierarchy.

Real limits in the virtual world: self-limiting behavior of Internet gamblers.

The recent expansion of Internet gambling has stimulated debate, policy, and research on this relatively new phenomenon and its potential consequences. The current study focuses on bettors experiencing problems by sampling Internet gamblers who imposed limits on the amount they were allowed to deposit to a betting site. We analyzed the betting transactions over 18 months of all gamblers who subscribed to an online betting site in February, 2005 (N = 47,134), 567 of whom utilized the site's self-limit feature. Self-limiting gamblers played a wider variety of games and placed more bets than others prior to imposing limits. After imposing limits, self-limiters reduced their activity, but did not reduce the amount they wagered per bet. Time spent gambling, not just money spent, appears to be an important indicator of gambling problems. Self-limit programs appear to be promising options for Internet gamblers at-risk for gambling problems.

Virtual harm reduction efforts for Internet gambling: effects of deposit limits on actual Internet sports gambling behavior.

BACKGROUND: In an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin), imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior. METHODS: We compared (1) gambling behavior of those who exceeded deposit limits with those who did not, and (2) gambling behavior before and after exceeding deposit limits. We analyzed 2 years of the actual sports gambling behavior records of 47000 subscribers to bwin. RESULTS: Only 160 (0.3%) exceeded deposit limits at least once. Gamblers who exceeded deposit limits evidenced higher average number of bets per active betting day and higher average size of bets than gamblers who did not exceed deposit limits. Comparing the gambling behavior before and after exceeding deposit limits revealed slightly more unfavorable gambling behavior after exceeding deposit limits. CONCLUSION: Our findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However, some of these gamblers exhibit some poor outcomes. Deposit limits might be necessary harm reduction measures to prevent the loss of extremely large amounts of money and cases of bankruptcy. We discuss how these limits might be modified based on our findings.

Inside the virtual casino: a prospective longitudinal study of actual Internet casino gambling.

BACKGROUND: Participation in Internet gambling is growing rapidly, as is concern about its possible effects on the public's health. This article reports the results of the first prospective longitudinal study of actual Internet casino gambling behaviour. METHODS: Data include 2 years of recorded Internet betting activity by a cohort of gamblers who subscribed to an Internet gambling service during February 2005. We examined computer records of each transaction and transformed them into measures of gambling involvement. The sample included 4222 gamblers who played casino games. RESULTS: The median betting behaviour was to play casino games once every 2 weeks during a period of 9 months. Subscribers placed a median of 49 bets of euro4 each playing day. Subscribers lost a median of 5.5% of total monies wagered. We determined a group of heavily involved bettors whose activity exceeded that of 95% of the sample; these players bet every fifth day during 17.5 months. On each playing day, these most involved bettors placed a median of 188 bets of euro25. Their median percent of wagers lost, 2.5%, was smaller than that lost by the total sample. CONCLUSION: Our findings suggest that Internet casino betting behaviour results in modest costs for most players, while some, roughly 5%, have larger losses. The findings also show the need to consider time spent as a marker of disordered gambling. These findings provide the evidence to steer public health debates away from speculation and toward the creation of empirically-based strategies to protect the public health.

A study of South Korean casino employees and gambling problems.

BACKGROUND: Casino employees are exposed to disproportionately high levels of gambling, drinking and smoking compared to other occupations. Because of their occupation, they have the opportunity to detect and prevent pathological gambling (PG). AIMS: To identify differences in the mental health status and social attitudes towards PG among casino workers in South Korea depending upon whether they report any gambling problems. METHODS: Data were collected from 388 full-time casino employees. This data provided information about the prevalence of gambling problems, alcohol and tobacco use and depression. Employees were grouped according to their scores on the Korean version of South Oaks Gambling Screen (SOGS), and those employees who gambled without experiencing any gambling problems (Group NP: SOGS = 0) and those who reported any gambling problems (Group P: SOGS > 0) were compared. An exploratory factor analyses identified the domains of casino employee social attitudes towards gambling. RESULTS: Employees who reported gambling problems (Group P) reported a higher prevalence of smoking, alcohol problems and depression (P < 0.01) compared to employees who did not report gambling problems (Group NP). The primary employee social attitude towards gambling was identified by the factor of 'Disease concept/social awareness'. Group NP reported more positive attitudes in this domain than Group P (P < 0.01). CONCLUSIONS: Employees who reported any gambling problems reported a less positive attitude towards developing the public health system to be responsive to gambling problems. These findings indicate a need to develop health education programmes that focus more specifically on casino employees with gambling problems.

Stability and progression of disordered gambling: lessons from longitudinal studies.

OBJECTIVE: Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions. METHOD: We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling. RESULTS: Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption). CONCLUSION: Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling.