Demographic characteristics, gambling engagement, mental health, and associations with harmful gambling risk among UK Armed Forces serving personnel.

INTRODUCTION: Harmful gambling negatively impacts individuals, families and communities. Growing international evidence indicates that the Armed Forces (AF) community may be at a comparatively higher risk of experiencing harm from gambling than the general population. The current study sought to identify general predictors of harmful gambling and gambling engagement among UK AF serving personnel (AFSP). METHODS: We conducted a cross-sectional, exploratory survey to identify associations between demographic factors, mental health, gambling engagement and gambling type in a sample (N=608) of AFSP. RESULTS: Most of the sample reported past-year gambling, with 23% having experienced harm. Male gender, younger age and lower educational attainment all predicted harmful gambling, as did mental health variables of prior generalised anxiety and post-traumatic stress symptomatology. Strategy-based gambling and online sports betting were also predictive of experiencing harm from gambling. CONCLUSIONS: The risk of harm from gambling is associated with demographic, mental health and gambling engagement variables among AFSP. Better understanding of these predictors is important for the development of individualised treatment approaches for harmful gambling.

Social and economic costs of gambling problems and related harm among UK military veterans.

INTRODUCTION: Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans' Health and Gambling Study. METHODS: An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint. RESULTS: Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI -£1016 to -£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status. CONCLUSIONS: Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.

Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey.

OBJECTIVES: Problem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors. STUDY DESIGN: Secondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional national probability sample survey of 7403 adults living in households in England. METHODS: Rates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality. RESULTS: Past year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention-deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR = 2.9, 95% confidence interval = 1. 1, 8.1 P = 0.023). CONCLUSIONS: Problem gamblers are a high-risk group for suicidality. This should be recognised in individual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains.

Critical evaluation of current data analysis strategies for psychophysiological measures of fear conditioning and extinction in humans.

Fear conditioning and extinction is a construct integral to understanding trauma-, stress- and anxiety-related disorders. In the laboratory, associative learning paradigms that pair aversive with neutral stimuli are used as analogues to real-life fear learning. These studies use physiological indices, such as skin conductance, to sensitively measure rates and intensity of learning and extinction. In this review, we discuss some of the potential limitations in interpreting and analysing physiological data during the acquisition or extinction of conditioned fear. We argue that the utmost attention should be paid to the development of modelling approaches of physiological data in associative learning paradigms, by illustrating the lack of replicability and interpretability of results in current methods. We also show that statistical significance may be easily achieved in this paradigm without more stringent data and data analysis reporting requirements, leaving this particular field vulnerable to misleading conclusions. This review is written so that issues and potential solutions are accessible to researchers without mathematical training. We conclude the review with some suggestions that all laboratories should be able to implement, including visualising the full data set in publications and adopting modelling, or at least regression-based, approaches.

Evaluation of executive functioning in people with intellectual disabilities.

BACKGROUND: Executive functioning (EF) is an important concept in cognitive psychology that has rarely been studied in people with intellectual disabilities (IDs). The aim of this study was to examine the validity of two test batteries and the structure of EF in this client group. METHODS: We administered the children's version of the Behavioural Assessment of the Dysexecutive Syndrome (BADS-C) and the Cambridge Executive Functioning Assessment (CEFA) for people with ID, to 40 participants who attended day centres for people with mild to moderate learning disabilities [mean full-scale intelligence quotient (IQ) = 59]. The BADS-C consists of six EF subtests while the CEFA contains eight EF (including two executive memory) subtests and four memory subtests. IQ and receptive language ability were also assessed. The results were subjected to principal components analysis, and regression analysis was used to examine the relationship of the ensuing factors to other cognitive variables. RESULTS: Scores on both sets of EF tests were only weakly related to receptive language ability, and even more weakly related to IQ. Scores on the BADS-C were substantially lower than predicted from the published norms for people in higher IQ ranges, and many participants scored zero on three of the six subtests. This potential floor effect was less evident with scores on the CEFA. Principal components analyses produced one usable factor for the BADS-C, and two factors for the CEFA that differed in both the extent of involvement of working memory and the predominant sensory modality. A combined analysis of the subtests retained from both analyses produced three factors that related uniquely to aspects of IQ and memory. CONCLUSIONS: The CEFA is suitable for use with people with mild to moderate learning disabilities, whereas the BADS-C is at the lower limit of usability with this client group. The lower-than-expected scores observed on the BADS-C may indicate that people known to learning disability services may be more impaired than people of comparable IQ not known to services. The structure of EF seen in people with IDs closely resembles a model of EF in the general population that has received a broad level of support.

Neural correlates of relational reasoning and the symbolic distance effect: involvement of parietal cortex.

A novel, five-term relational reasoning paradigm was employed during functional magnetic resonance imaging to investigate neural correlates of the symbolic distance effect (SDE). Prior to scanning, participants learned a series of more-than (E>D>C>B>A) or less-than (AA) and nonadjacent one-step (AA, D>B and E>C) and two-step (AA and E>B) combinatorial entailed tasks. In terms of brain activation, the SDE was identified in the inferior frontal cortex, dorsolateral prefrontal cortex, and bilateral parietal cortex with a graded activation pattern from adjacent to one-step and two-step relations. We suggest that this captures the behavioural SDE of increased accuracy and decreased reaction time from adjacent to two-step relations. One-step relations involving endpoints A or E resulted in greater parietal activation compared to one-step relations without endpoints. Novel contrasts found enhanced activation in right parietal and prefrontal cortices during mutually entailed tasks only for participants who had learned all less-than relations. Increased parietal activation was found for one-step tasks that were inconsistent with prior training. Overall, the findings demonstrate a crucial role for parietal cortex during relational reasoning with a spatially ordered array.

Evaluation of the ability of people with intellectual disabilities to 'weigh up' information in two tests of financial reasoning.

BACKGROUND: An assessment of mental capacity includes an evaluation of the ability to 'weigh up' information, but how to do this is uncertain. We have previously used a laboratory decision-making task, temporal discounting, which involves a trade-off between the value and the delay of expected rewards. Participants with intellectual disabilities (ID) showed very little evidence of 'weighing up' of information: only a third of participants showed consistent temporal discounting performance, and when present, consistent performance was usually impulsive; and the ability to perform consistently was more strongly related to executive functioning than to IQ. The aim of the present study was to replicate these observations and extend them to a more realistic financial decision-making task. METHODS: We administered a temporal discounting task and a financial decision-making task, as well as tests of executive functioning and IQ, to 20 participants who attended day services for people with learning disabilities (mean Full-Scale IQ = 59), and to 10 staff members. RESULTS: Performance in both decision-making tasks was related more strongly to executive functioning than to IQ. In both tasks, decisions by service users were made largely on the basis of a single item of information: there was very little evidence in either task that information from two sources was being 'weighed'. CONCLUSIONS: The results suggest that difficulty in 'weighing up' information may be a general problem for people with ID, pointing to a need for psycho-educational remediation strategies to address this issue. The importance of executive functioning in decision-making by people with ID is not recognized in the legal test for mental capacity, which in practice includes a possibly irrelevant IQ criterion.

Neither dark age nor renaissance: Research and authorship trends in the experimental analysis of human behavior (1980-1999).

The anniversary of several milestones in the experimental analysis of human behavior (EAHB) provides a prompt for updating previous surveys of EAHB publication trends, which portrayed the field's overall health as good but raised questions about its breadth and trajectory. For the years 1980 through 1999, we examined trends in annual frequency of data-based EAHB articles published in the Journal of the Experimental Analysis of Behavior (JEAB); in the topical emphasis of those EAHB articles; in the geographic region of origin of EAHB articles; and in the relative contributions of new and veteran authors. Our findings show continued productivity in the field, but contradict an earlier report by showing little sustained growth in EAHB over roughly the past 15 years. In terms of authorship, an increasing proportion of EAHB articles are authored by veteran investigators, although the field also benefits from a steady infusion of new authors. International participation in EAHB is limited, with most EAHB research originating in North America. In terms of content, our findings replicate those of previous reports in showing stimulus control and reinforcement and punishment to be the field's most commonly addressed research topics, although content emphases apparently differ across regions of origin. Overall, the data depict EAHB at the close of the 20th century as a multifaceted enterprise, one that is neither bankrupt nor at its full potential for contributing to the overall analysis of behavior. We close with some observations on the value of this type of archival research and some suggestions for improving the archival characterization of the field.

International publication trends of JABA authorship.

The present study addressed international publication trends in JABA authorship between 1970 and 1999. First, we analyzed authorship patterns to identify trends in the appearance of new first authors, unfamiliar authors, and frequent contributors. Second, articles were assigned to either a North American or an international category. The data show a decline in the number of articles by new authors and an increase in the publications of frequent contributors from North America. Trends are shown in comparison to those from the American Journal on Mental Retardation.

Understanding complex behavior: the transformation of stimulus functions.

The transformation of stimulus functions is said to occur when the functions of one stimulus alter or transform the functions of another stimulus in accordance with the derived relation between the two, without additional training. This effect has been demonstrated with a number of derived stimulus relations, behavioral functions, experimental preparations, and subject populations. The present paper reviews much of the existing research on the transformation of stimulus functions and outlines a number of important methodological and conceptual issues that warrant further attention. We conclude by advocating the adoption of the generic terminology of relational frame theory to describe both the derived transformation of stimulus functions and relational responding more generally.

International publication trends in the experimental analysis of behavior.

The present paper assessed international publication trends in the experimental analysis of behavior by recording the geographical origin of the first authors of articles in the Journal of the Experimental Analysis of Behavior (JEAB), the Journal of Applied Behavior Analysis (JABA), and The Behavior Analyst (TBA). Five international categories were identified: Australasia, Europe, Latin America, the Middle East, and North America. A cooperative category was also employed to assess the number of publications with authors from different international categories. First, the percentage and number of international articles published in JEAB, JABA, and TBA are presented. Second, a more detailed analysis of the publication rates within the international categories is presented. The number and rate at which new authors from the categories appeared and the percentage of articles published by different authors are also presented. Some limitations of the review and suggestions for increasing international participation in behavior analysis are outlined.

Why do key integrated delivery stakeholders really matter? Assessing control, coalitions, resources and power.

This is the fourth in a series of articles describing and interpreting the results from the Facing the Uncertain Future (FUF) study. This article focuses on one vital aspect of strategic stakeholder management: assessment of key stakeholders. Specifically, the article uses Round Two data and presents an assessment of four key medical group practice stakeholders: integrated delivery systems/networks (IDS/Ns), managed care organizations (MCOs), physicians and hospitals. These key stakeholders were identified by medical group practice executives as some of the most important stakeholders in the year 2000. These four stakeholders are assessed on the criteria of organizational control, coalition formation, control of resources, and relative power. The FUF study was conducted jointly between the Center for Research in Ambulatory Health Care Administration (the research and development arm of MGMA), and The Institute for Management and Leadership Research (IMLR), College of Business Administration at Texas Tech University, Lubbock, Texas. MGMA's American College of Medical Practice Executives, faculty of Texas Tech University's Ph.D. and M.B.A. Programs in Health Organization Management (HOM), and faculty from the University of Alabama at Birmingham collaborated on the project. Abbott Laboratories, Abbott Park, Ill., provided funding for the FUF project. The administration of Round One was completed in the Fall of 1994. The administration of Round Two was completed in the summer of 1995. Selected Round One and Round Two results have previously been presented in educational programs and publications.

A transformation of self-discrimination response functions in accordance with the arbitrarily applicable relations of sameness, more than, and less than.

In Experiment 1, 2 experimental subjects were given pretraining of nonarbitrary relations that brought their responses under the control of four contextual stimuli; same, opposite, more than, and less than. One control subject was not exposed to this pretraining. The 2 pretrained subjects and the 3rd nonpretrained subject then received training in six arbitrary relations, the following four relations being the most critical: same/A1-B1, same/A1-C1, less than/A1-B2, more than/A1-C2. All 3 subjects were then tested for seven derived relations, the following three relations being the most important: same/B1-C1, more than/B1-C2, less than/B1-B2. The 2 pretrained subjects, but not the nonpretrained subject, showed the derived relations. One of the stimuli (B1) from the relational network and two novel stimuli (X1 and X2) were then used to train three different self-discrimination responses on three complex schedules of reinforcement. That is, all 3 subjects were trained to pick X1 if they had not emitted a response, to pick B1 if they had emitted one response only, and to pick X2 if they had emitted two responses only. The 2 pretrained subjects, but not the nonpretrained subject, showed the predicted transformation of self-discrimination response functions in accordance with the relations of sameness, more than, and less than (i.e., no response, pick B2; one response only, pick C1; and two responses only, pick C2). In Experiment 2, 2 new subjects were employed, and the arbitrary relational training and testing phases were modified to control for a procedural artifact that may have contributed to the results of the first experiment. Experiment 2 replicated the findings of Experiment 1. The pattern of results support the utility of a relational frames approach to understanding derived stimulus relations.

A transfer of self-discrimination response functions through equivalence relations.

The present study tested the idea that human self-discrimination response functions may transfer through equivalence relations. Four subjects were trained in six symbolic matching-to-sample tasks (if see A1, choose B1; A1-C1, A2-B2, A2-C2, A3-B3, A3-C3) and were then tested for the formation of three equivalence relations (B1-C1, B2-C2, B3-C3). Two of the B stimuli (B1 and B2) were then used to train two different self-discrimination responses using either detailed instructions (Subjects 1 to 3) or minimal instructions (Subject 4) on two complex schedules of reinforcement (i.e., subjects were trained to pick the B1 stimulus if they had not emitted a response, and to pick the B2 stimulus if they had emitted one or more responses on the previous schedule). All 4 subjects showed the predicted transfer of self-discrimination response functions through equivalence relations (i.e., no response on the schedule, pick C1; one or more responses on the schedule, pick C2). Subjects also demonstrated this transfer when they were required to discriminate their schedule performance before exposure to the schedule (i.e., "what I intend to do"). Four control subjects were also used in the study. Two of these (Subjects 5 and 6) were not exposed to any form of matching-to-sample training and testing (nonequivalence controls). The 2 remaining subjects (7 and 8) were exposed to matching-to-sample training and testing that incorporated stimuli not used during the transfer test; C1 and C2 were replaced by N1 and N2 during the matching-to-sample training and testing, but C1 and C2 were used for the transfer tests (equivalence controls). All 4 subjects failed to produce the self-discrimination transfer performances observed with the experimental subjects.

Using technology to help rural practice.

Health care providers in rural settings are faced with the same issues as those in urban areas, write Susan Dymond, M.B.A., and Christopher Rankin, but those issues are compounded by the isolation of distance. One answer to this problem is to use telecommunications and satellite technology to bridge these distances and that's just what Texas Tech University is doing.

Negotiating for more than a slice of the pie.

Negotiation is an important way for physician executives to manage conflict and to accomplish new projects. Because of the rapidly changing nature of the health care environment, as well as conflicts and politics within their organizations, managers need to effectively negotiate with a wide range of other parties. Managers should consider the relative importance of both the substantive and relationship outcomes of any potential negotiation. These two factors may guide the executive's selection of initial negotiation strategies.