Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study.

BACKGROUND: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. OBJECTIVE: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. METHODS: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. RESULTS: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. CONCLUSIONS: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

The early impact of COVID-19 on primary care psychological therapy services: A descriptive time series of electronic healthcare records.

BACKGROUND: There are growing concerns about the impact of the COVID-19 pandemic on mental health. With government-imposed restrictions as well as a general burden on healthcare systems, the pandemic has the potential to disrupt the access to, and delivery of, mental healthcare. METHODS: Electronic healthcare records from primary care psychological therapy services (Improving Access to Psychological Therapy) in England were used to examine changes in access to mental health services and service delivery during early stages of the COVID-19 pandemic. A descriptive time series was conducted using data from five NHS trusts to examine patterns in referrals to services (1st January 2019 to 24th May 2020) and appointments (1st January 2020 to 24th May 2020) taking place. FINDINGS: The number of patients accessing mental health services dropped by an average of 55% in the early weeks after the March 2020 lockdown was announced, reaching a maximum reduction of 74% in the initial 3 weeks after lockdown in the UK, which gradually recovered to a 28% reduction by May. We found some evidence suggesting changes in the sociodemographic and clinical characteristics of referrals. Despite a reduction in access, the impact on appointments appeared limited with service providers shifting to remote delivery of care. INTERPRETATION: Services appeared to adapt to provide continuity of care in mental healthcare. However, patients accessing services reduced, potentially placing a future burden on service. Despite the observational nature of the data, the present study can inform the planning of service provision and policy. FUNDING: AD and TS were funded by Innovate UK (KTP #11,105).

Indoor Exposure to Selected Air Pollutants in the Home Environment: A Systematic Review.

(1) Background: There is increasing awareness that the quality of the indoor environment affects our health and well-being. Indoor air quality (IAQ) in particular has an impact on multiple health outcomes, including respiratory and cardiovascular illness, allergic symptoms, cancers, and premature mortality. (2) Methods: We carried out a global systematic literature review on indoor exposure to selected air pollutants associated with adverse health effects, and related household characteristics, seasonal influences and occupancy patterns. We screened records from six bibliographic databases: ABI/INFORM, Environment Abstracts, Pollution Abstracts, PubMed, ProQuest Biological and Health Professional, and Scopus. (3) Results: Information on indoor exposure levels and determinants, emission sources, and associated health effects was extracted from 141 studies from 29 countries. The most-studied pollutants were particulate matter (PM2.5 and PM10); nitrogen dioxide (NO2); volatile organic compounds (VOCs) including benzene, toluene, xylenes and formaldehyde; and polycyclic aromatic hydrocarbons (PAHs) including naphthalene. Identified indoor PM2.5 sources include smoking, cooking, heating, use of incense, candles, and insecticides, while cleaning, housework, presence of pets and movement of people were the main sources of coarse particles. Outdoor air is a major PM2.5 source in rooms with natural ventilation in roadside households. Major sources of NO2 indoors are unvented gas heaters and cookers. Predictors of indoor NO2 are ventilation, season, and outdoor NO2 levels. VOCs are emitted from a wide range of indoor and outdoor sources, including smoking, solvent use, renovations, and household products. Formaldehyde levels are higher in newer houses and in the presence of new furniture, while PAH levels are higher in smoking households. High indoor particulate matter, NO2 and VOC levels were typically associated with respiratory symptoms, particularly asthma symptoms in children. (4) Conclusions: Household characteristics and occupant activities play a large role in indoor exposure, particularly cigarette smoking for PM2.5, gas appliances for NO2, and household products for VOCs and PAHs. Home location near high-traffic-density roads, redecoration, and small house size contribute to high indoor air pollution. In most studies, air exchange rates are negatively associated with indoor air pollution. These findings can inform interventions aiming to improve IAQ in residential properties in a variety of settings.

Musculoskeletal health in the workplace.

Musculoskeletal (MSK) problems remain the most frequent reason why individuals are absent from work, including those with work-related musculoskeletal disorders (WRMSDs or MSDs) and those with chronic MSK problems. This paper aims to examine changes in work and the workforce since 2000; how work impacts on chronic MSK conditions and how we can help people with these conditions to stay at work. While our knowledge of the causes of WRMSDs has increased since 2000, there has been limited workplace action in reducing exposure to hazards. A life course approach is needed as individuals of all ages are reporting MSK problems. How people work has also changed and informalisation of work contracts has increased with a perceived concurrent reduction in occupational safety and health (OSH) protection. Retaining people at work with MSK problems requires compliance with relevant safety, health and diversity legislation and a risk management approach. Good and open communication within the workplace and identification of other sources of support is also necessary. Considerations must be made at the individual level (internal motivation), organisational level (a supportive manager) and self-management of symptoms. Simple case examples are provided in the paper of what works in practice as well as a proposed research agenda. Increased awareness at all levels of society of MSK health is essential.

Predicting patient engagement in IAPT services: a statistical analysis of electronic health records.

BACKGROUND: Across England, 12% of all improving access to psychological therapy (IAPT) appointments are missed, and on average around 40% of first appointments are not attended, varying significantly around the country. In order to intervene effectively, it is important to target the patients who are most likely to miss their appointments. OBJECTIVE: This research aims to develop and test a model to predict whether an IAPT patient will attend their first appointment. METHODS: Data from 19 adult IAPT services were analysed in this research. A multiple logistic regression was used at an individual service level to identify which patient, appointment and referral characteristics are associated with attendance. These variables were then used in a generalised linear mixed effects model (GLMM). We allow random effects in the GLMM for variables where we observe high service to service heterogeneity in the estimated effects from service specific logistic regressions. FINDINGS: We find that patients who self-refer are more likely to attend their appointments with an OR of 1.04. The older a patient is, the fewer the number of previous referrals and consenting to receiving a reminder short message service are also found to increase the likelihood of attendance with ORs of 1.02, 1.10, 1.04, respectively. CONCLUSIONS: Our model is expected to help IAPT services identify which patients are not likely to attend their appointments by highlighting key characteristics that affect attendance. CLINICAL IMPLICATIONS: This analysis will help to identify methods IAPT services could use to increase their attendance rates.

The Wahine Heart Wellness Program: A Community Approach to Reducing Women's Cardiovascular Disease Risk.

Cardiovascular disease remains the leading cause of death for women in the United States. Although Hawai'i has relatively low rates of death from heart disease and stroke, Native Hawaiians and Other Pacific Islanders (NHOPI) are plagued with disproportionately higher rates of the chronic diseases that contribute to these deaths. This study follows a Practice Inquiry Project framework and aims to improve identification of cardiovascular disease (CVD) risk and promote health literacy of the disease in Asian, Native Hawaiians and Other Pacific Islander women on O'ahu. The study addresses: (a) assessment of current level of awareness of CVD as the leading cause of death for this population; (b) implementation of a CVD risk reduction program; and (c) an evaluation of that program's effectiveness in decreasing CVD risk. The study design used a mixed methods approach. The methods included a cardiovascular awareness questionnaire (pre-test and post-test), a screening process using the American Heart Association's Life's Simple 7 matrix, and 6 educational sessions. With these research methods, the participants' knowledge levels, health perceptions, and behaviors were evaluated. A convenience sample of 20 predominantly Asian, Native Hawaiian, and Pacific Islander women were recruited. At the conclusion of the project, participants showed increased awareness of CVD and improved behaviors to reduce the risk of CVD. The project also demonstrated that collaboration and partnerships between local schools of nursing and community organizations, community-based integrated approaches, incorporating health literacy, and infusing cultural knowledge into practice are important in creating successful and innovative solutions when working with Asian, Native Hawaiian, and Other Pacific Islander women.

The effectiveness of respiratory protection worn by communities to protect from volcanic ash inhalation. Part II: Total inward leakage tests.

Inhalation of ash can be of great concern for affected communities, during and after volcanic eruptions. Governmental and humanitarian agencies recommend and distribute a variety of respiratory protection (RP), most commonly surgical masks. However, there is currently no evidence on how effective such masks are in protecting wearers from volcanic ash. In Part I of this study (Mueller et al., 2018), we assessed the filtration efficiency (FE) of 17 materials from different forms of RP against volcanic ash and a surrogate, low-toxicity dust, Aloxite. Based on those results, we now present the findings from a volunteer simulation study to test the effect of facial fit through assessment of Total Inward Leakage (TIL). Four different disposable RP types that demonstrated very high median FE (≥96% for Aloxite; ≥89% for volcanic ash) were tested without provision of training on fit. These were an industry-certified mask (N95-equiv.); a surgical mask from Japan designed to filter PM2.5; a flat-fold basic mask from Indonesia; and a standard surgical mask from Mexico, which was also tested with an added medical bandage on top, as an additional intervention to improve fit. Ten volunteers (6 female, 4 male) were recruited. Each RP type was worn by volunteers under two different conditions simulating cleaning-up activities during/after volcanic ashfall. Each activity lasted 10 min and two repeats were completed for each RP type per activity. Dust (as PM2.5) concentration inside and outside the mask was measured with two TSI SidePak aerosol monitors (Models AM510 and AM520, TSI, Minnesota, USA) to calculate TIL. A questionnaire was administered after each test to collect perceptions of fit, comfort, protection and breathability. The best-performing RP type, across both activities, was the industry-certified N95-equiv. mask with 9% mean TIL. The standard surgical mask and the basic flat-fold mask both performed worst (35% TIL). With the additional bandage intervention, the surgical mask mean TIL improved to 24%. The PM2.5 surgical mask performed similarly, with 22% TIL. The N95-equiv. mask was perceived to provide the best protection, but was also perceived as being uncomfortable and more difficult to breathe through. This study provides a first objective evidence base for the effectiveness of a selection of RP types typically worn around the world during volcanic crises. The findings will help agencies to make informed decisions on the procurement and distribution of RP in future eruptions.

Verbal task demands are key in explaining the relationship between paired-associate learning and reading ability.

Paired-associate learning (PAL) tasks measure the ability to form a novel association between a stimulus and a response. Performance on such tasks is strongly associated with reading ability, and there is increasing evidence that verbal task demands may be critical in explaining this relationship. The current study investigated the relationships between different forms of PAL and reading ability. A total of 97 children aged 8-10 years completed a battery of reading assessments and six different PAL tasks (phoneme-phoneme, visual-phoneme, nonverbal-nonverbal, visual-nonverbal, nonword-nonword, and visual-nonword) involving both familiar phonemes and unfamiliar nonwords. A latent variable path model showed that PAL ability is captured by two correlated latent variables: auditory-articulatory and visual-articulatory. The auditory-articulatory latent variable was the stronger predictor of reading ability, providing support for a verbal account of the PAL-reading relationship.

Mortality Among Hardmetal Production Workers: UK Cohort and Nested Case-Control Studies.

OBJECTIVE: The aim of this study was to characterize the mortality at two hardmetal production factories in the United Kingdom as part of an international study. METHODS: Standardized mortality ratios (SMRs) were calculated on the basis of mortality rates for England and Wales, and local rates. A nested case-control study of lung cancer was undertaken. RESULTS: The cohort comprised 1538 workers, with tracing complete for 94.4%. All-cause mortality was statistically significantly low for all cancers and nonmalignant respiratory disease, and for lung cancer was nonsignificantly low. The SMR for lung cancer for maintenance workers was elevated, based on only six deaths. The odds ratio for lung cancer per year of exposure to hardmetal was 0.93 (0.76 to 1.13). CONCLUSIONS: In this small study, there is no evidence to support that working in the UK hardmetal manufacturing industry increased mortality from any cause including lung cancer.

Empowering the Physiotherapy Profession in Ethiopia through Leadership Development within the Doctoring Process.

Ethiopia recently introduced the Doctor of Physiotherapy (DPT) degree at Addis Ababa University as a mechanism to increase the work force capacity of primary care providers in the health sector. The DPT program was supported by an international academic partnership and was designed to empower physiotherapists as leaders to move the profession forward. The curriculum was framed by core pedagogical principles and strategies and was phased into two programs. First, the 4-year Advanced Standing DPT program focused on developing registered Ethiopian physiotherapists with Bachelor of Science degrees as academic faculty. Second, these new faculty would then sustain a 6-year Generic DPT program that would matriculate students upon graduation from high school. The curriculum represented depth and breadth of foundation and clinical sciences, evidence-based practice, clinical reasoning skills, and interprofessional education opportunities. A leadership thread provided opportunities to develop skills necessary to effectively navigate and manage the challenges faced by the profession. The main outcomes included (1) an 8-year international partnership, (2) the academic performance of students, and (3) and leadership capabilities as demonstrated through activities and assignments. While the program has been criticized as an unnecessary extravagance for Ethiopia, the advantages of the DPT degree were revealed in a direct comparison to other academic physiotherapy programs in Ethiopia. In the end, because the DPT is new to the country, it will take time to fully understand the true impact within the Ethiopian health system.

Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury.

The aim of this study was to evaluate the effect of direct and non-direct auditory stimulation on arousal in coma patients with severe traumatic brain injury and to compare the effects of direct vs. non-direct auditory stimulation. A crossover intervention study design was used. Nine participants who were comatose after a severe traumatic brain injury underwent direct and non-direct auditory stimulation. Direct auditory stimulation requires a higher level of interpersonal interaction between the patient and stimuli such as voices of family members, orientation by a nurse or family member and familiar music. In contrast, non-direct auditory stimuli were characterized as more general, less familiar, less interactive, indirect and not lively such as general music and TV sounds. Participants received both direct and non-direct auditory stimulation in randomized order for 15 minutes. Recovery of consciousness was measured with the Glasgow Coma Scale (GCS) and Sensory Stimulation Assessment Measure (SSAM). The Friedman test with post hoc analysis by Wilcoxon's signed-rank test comparisons was used for data analysis. Patients who received both direct and non-direct auditory stimulation exhibited significantly increased GCS (p = 0.008) and SSAM scores (p = 0.008) over baseline. The improvement in SSAM scores after direct auditory stimulation was significantly greater than that after non-direct auditory stimulation (p = 0.021), but there was no statistically significant difference in GCS scores (p = 0.139). Auditory stimulation, in particular direct auditory stimulation, might be useful for improving the recovery of consciousness and increasing the arousal of comatose patients. The SSAM is more useful for detecting subtle changes from stimulation intervention than the GCS.

Inadvertent ingestion exposure: hand- and object-to-mouth behavior among workers.

Contact between contaminated hands and the mouth or the area around the mouth (the perioral area) can result in inadvertent ingestion exposure. Exposure by this route is known to occur among children, but adults may also be exposed. Observations of 48 workers were carried out in 8 UK worksites to study hand- and object-to-mouth behavior. Each subject was observed in real-time for ~60 min during normal work activities. Each contact was recorded along with information about time of contact, glove use, respirator use, task and object type. Subjects were interviewed to gather information about smoking, nail biting and risk perception. The effects of factors (glove use, respirator use, smoking, nail biting, risk perception, work sector and task group) on contact frequency were assessed using non-parametric tests and Poisson regression models. Several determinants of contact frequency were identified, including time spent "between" work tasks, glove and respirator use, smoking and nail biting. Hand-to-mouth contact frequencies were particularly high while workers were "between" work tasks (23.6 contacts per hour, compared with the average contact frequency of 6.3 per hour). The factors that were related to contact frequency differed between object- and hand-to-mouth contacts, suggesting that these should be considered separately. These findings could be used for developing exposure models, to inform measurements of inadvertent ingestion among adults and to identify control strategies.

Rater Reliability and Concurrent Validity of Single and Dual Bubble Inclinometry to Assess Cervical Lateral Flexion.

OBJECTIVE: The purpose of this study was to assess interrater and intrarater reliability and validity for single inclinometry (SI) and dual inclinometry (DI) assessment of cervical lateral flexion (CLF) range of motion and compare reliability in a practicing physical therapist (PT) and student PTs (SPTs). METHODS: Twenty-four subjects performed right and left CLF while SI, DI, and 3-dimensional kinematics were concurrently recorded. Subjects were reassessed by 2 SPTs and 1 PT using both SI and DI. Each subject was measured twice per rater in round-robin fashion. RESULTS: There were significant positive relationships between DI and motion capture for both right (r = 0.841; P < .01) and left lateral flexion (r = 0.838; P < .01). Single inclinometry also had a significant correlation with motion capture for right (r = 0.927, P < .01) and left (r = 0.834, P < .01) lateral flexion. Interrater reliability was good for both SI and DI methods. For SI, intraclass correlation coefficient (ICC) (3,1) was 0.905 and 0.870 for right and left CLF, respectively. For DI, ICC(3,1) was 0.803 and 0.757 for right and left CLF, respectively. Intrarater reliability was good for both methods. Average SI values were ICC(2,1) of 0.928 and 0.897 for right and left CLF, respectively. Average DI values were ICC(2,1) of 0.882 and 0.851 for left and right, respectively. Although not significant, the PT had slightly higher reliability in all measures (range, 0.881-0.935) compared to the SPTs (range, 0.880-0.925). CONCLUSIONS: Both SI and DI are acceptable for clinical use and both are reliable measurement methods for CLF between raters and for repeated measures. There are minimal differences in reliability between a PT with experience and SPTs with minimal experience.

Violence-related mild traumatic brain injury in women: identifying a triad of postinjury disorders.

Violence against women whether from domestic partner abuse, sex trafficking injuries, or sexual assault is a pervasive health problem without racial or social boundaries. Regardless of cause, violence results in a complex triad of physical, emotional, and psychological injuries. There is clear evidence that female victims of violence or "battered women" experience brain injury. What is less certain is whether the constellations of events surrounding brain injury including postconcussion syndrome, depression, and posttraumatic stress disorder are acute symptoms after the brain injury, premorbid as a result of persistent abuse, or a synergistic triad of combined disorders as a result of the injuries. The purpose of this article is to examine the relationship between physical violence-associated mild traumatic brain injury (MTBI) and postinjury cognitive, emotional, and psychological disorders. The review of the literature addresses epidemiological factors associated with domestic partners and sexual violence, abuse and health outcomes in women, physical injury, and its consequences. Along with MTBI, a triad of disorders is hypothesized that includes postconcussion syndrome, depression, and posttraumatic stress disorder. Screening for MTBI and the triad of disorders is advocated, and assessment methods are offered.

Dermal exposure from transfer of lubricants and fuels by consumers.

Consumer uses of fuels and lubricants in Europe are subject to the Registration, Evaluation, Authorization and restriction of CHemicals (REACH) legislation. Ten volunteers completed a series of exposure situations to simulate filling a vehicle fuel tank with diesel (ES1 Diesel), adding lubricant to a car engine (two situations, one filling point easier to reach (ES2 Easy) than the other (ES3 Hard)) and lubricating a bicycle chain (ES4 Bike). Dermal exposure to the hands and forearms was assessed using a wipe sampling method. A high proportion of samples was less than the limit of detection (ES1=38%, ES3=60%, ES2 and 4, both 78%). In ES1 Diesel, dermal exposure to the hands and forearms ranged from <0.25 µg/cm(2) to 96.21 µg/cm(2). Significantly higher dermal exposure was observed when a lower level of care was taken to complete the task. In ES2 Easy and ES3 Hard, the hand and forearm results ranged from <0.1 µg/cm(2) to 3.33 µg/cm(2) and from <0.1 µg/cm(2) to 3.54 µg/cm(2), respectively. In ES4 Bike, the hand and forearm exposures ranged from <0.35 µg/cm(2) to 5.25 µg/cm(2). Not all volunteers fully complied with the ES4 instructions, thus highlighting that this situation may have more variability in consumer behaviour. The ratio of the amount measured on the hands and forearms to the amount of product handled for ES1 Diesel, ES2 Easy and ES3 Hard was less than 0.0001%, for ES4 Bike it was 0.04%. Mixed effect models showed that the between and within volunteer variations are small for all except ES1 Diesel, where the within volunteer variation was relatively large (likely due to the few high measurements). This study reports dermal exposure measurement data, which will be of value when updating REACH and other exposure assessments for these, and similar, petroleum products.

Using a human patient simulator to study the relationship between communication and nursing students' team performance.

This study examined the relationship between communication and nursing students' team performance by determining whether variations in team performance are related to differences in communication regarding five task-relevant functions: assessment, diagnosis, planning, implementation, and evaluation. The study results indicate a positive relationship between nursing students' team performance and comments focused on the implementation of treatment(s) and the evaluation of treatment options. A negative relationship between nursing students' team performance and miscellaneous comments made by team members was also observed.

Interrater and intrarater reliability of the active hip abduction test.

STUDY DESIGN: Clinical measurement. OBJECTIVES: To determine the interrater and intrarater reliability of the active hip abduction (AHAbd) test. BACKGROUND: The AHAbd test is used to assess lumbopelvic movement during a dynamic lower limb activity. The test has previously been shown to predict low back pain development during a prolonged standing exposure in previously asymptomatic individuals. As an observation-based assessment for which rater reliability has not been established, similar scoring on the test between clinicians is essential. METHODS: One hundred twenty-eight video clips of participants performing the AHAbd test were recorded. Sixteen practicing physical therapists scored test performance by viewing 20 preselected videos to establish interrater reliability. Fourteen of the 16 raters rescored the videos after a 3-week period to establish intrarater reliability. Demographic data were collected for all raters. Intraclass correlation coefficients (ICCs) were calculated for reliability statistics. Correlations were performed between demographic data and ICCs. RESULTS: Interrater reliability (ICC2,1) for the test using the 4-point scale was 0.70 (95% confidence interval [CI]: 0.56, 0.84) and 0.59 (95% CI: 0.43, 0.76) when the scale was dichotomized into positive/negative scores. Intrarater reliability (ICC3,1) was 0.74 on average. Demographic characteristics were not significantly associated with reliability scores. CONCLUSION: Interrater and intrarater reliability for scoring of the AHAbd test by practicing clinicians was similar, regardless of experience level or practice setting. The AHAbd test can be considered to be a reliable observational tool.

Problem and pathological gambling in a sample of casino patrons.

Relatively few studies have examined gambling problems among individuals in a casino setting. The current study sought to examine the prevalence of gambling problems among a sample of casino patrons and examine alcohol and tobacco use, health status, and quality of life by gambling problem status. To these ends, 176 casino patrons were recruited by going to a Southern California casino and requesting that they complete an anonymous survey. Results indicated the following lifetime rates for at-risk, problem, and pathological gambling: 29.2, 10.7, and 29.8%. Differences were found with regards to gambling behavior, and results indicated higher rates of smoking among individuals with gambling problems, but not higher rates of alcohol use. Self-rated quality of life was lower among pathological gamblers relative to non-problem gamblers, but did not differ from at-risk or problem gamblers. Although subject to some limitations, our data support the notion of higher frequency of gambling problems among casino patrons and may suggest the need for increased interventions for gambling problems on-site at casinos.

Problem gambling knowledge and perceived community impact among Asian-Pacific Islanders and non Asian-Pacific Islanders.

BACKGROUND: Emerging data suggest that problem/pathological gambling may be highly prevalent among Asian-Pacific Islanders (APIs) and that can be a major concern to their communities. METHODS: This study surveyed problem/pathological gambling knowledge, attitudes, and perceived community impact of problem gambling among self-identified male and female APIs and non-APIs attending one of two API community events in Los Angeles County. RESULTS: Unexpectedly, our results indicated no effect for ethnicity with regards to ratings of problem/pathological gambling knowledge, community impact, or consequences. However, a gender effect with women reporting less problem/pathological-gambling-related knowledge than men, regardless of ethnicity was found. Over 40% of all respondents reported that problem/pathological gambling impacted their communities 'a lot', and the ratings for the impact of problem/pathological gambling was equal to ratings for other significant public health issues like diabetes, depression, drug abuse, and alcohol abuse. DISCUSSION: Based on these results, it is recommended that evidence-based legislation support the development of culturally-relevant prevention and intervention programs for problem/pathological gambling in Los Angeles County.

Pathological gamblers demonstrate frontal lobe impairment consistent with that of methamphetamine-dependent individuals.

Using tests that are frequently administered by neuropsychologists, the authors investigated whether pathological gambling is associated with frontal lobe abnormalities. The sample comprised 10 pathological gamblers, 25 methamphetamine-dependent subjects, and 19 matched comparison subjects. The pathological gamblers and methamphetamine-dependent subjects performed significantly less well than comparison subjects, and the gamblers' test scores were comparable to those of the methamphetamine-dependent participants. The overall magnitude of the effect size was large. These findings demonstrate that the severity of frontal lobe dysfunction in pathological gambling is similar to that observed in methamphetamine-dependent individuals on frequently used clinical measures.