Treatment for the concerned significant others of gamblers : A systematic review

Background and aims: Research recognizes the extent of harm experienced by concerned significant others (CSOs) of gamblers. This systematic review's aims are to examine the interventions for CSOs, evaluate potential benefits, and thematically describe treatment processes. The Stress-Strain-Coping-Support model (SSCS) served as the theoretical framework. Methods: Database searches were conducted in: MEDLINE, CINAHL Complete, Web of Science Core Collection, Social Services Abstracts, Applied Social Science Index and Abstracts, Cochrane Central Register of Controlled Trials, and APA Psyclnfo (between 01/Jan 2011-10/Jun 2021). Other search methods were also utilized. Inclusion criteria: interventions for CSOs with CSO specific outcomes. The Evidence Project Risk of Bias Tool was used for assessment. Results: 19/768 records were included. Nine interventions were utilized: 3 CSO directed, 4 for couples, and 2 low threshold online interventions. A quantitative synthesis (N = 7 studies) of effect size estimates for depression and anxiety measures didn't indicate any intervention to have better outcomes than others. Core themes in the treatment process identified in the qualitative synthesis (N = 7) included: information and understanding, social support, coping skills, communication, and strain. Limitations in the evidence related to sampling, control-conditions and outcome measurements. Discussion and conclusion: Several interventions were identified, yet no specific interventions appeared more beneficial than others. Using the SSCS model, commonalities and differences in intervention content were identified, along with themes that influence treatment processes. The need for tailored interventions is discussed. Future treatment efficacy research should carefully select study designs and outcome measurements.Peer reviewe

Serious conditions among patients with non-specific chief complaints in the pre-hospital setting : a retrospective cohort study

Background Emergency Medical Services (EMS) are faced daily with patients presenting with a non-specific chief complaints (NSC); i.e. decreased general condition, general malaise, sense of illness, or just being unable to cope with usual daily activities. Patients presenting with NSCs often have normal vital signs. It has previously been established that however, NSCs may have a serious underlying condition that has yet to be identified. The primary outcome of this study was to determine the prevalence of serious conditions in patients presenting with NSCs to the EMS. Method A retrospective cohort study of patients >= 18 years of age who were reported as presenting with chief complaints compatible with NSCs to the EMS in Stockholm Region and transported to an emergency department between January 1st, 2013 and December 31st, 2013. Patients were identified via the EMS electronic health care record and followed via records from the National Patient Registry and Causes of Death Registry at Sweden's National Board for Health and Welfare. The definition of serious condition was defined by expert consensus. Descriptive statistics as well as regression analyses were used. Results A total of 3780 patients were included, with a median age of 77 years. A serious condition was present in 35.3% of the patients. The in-hospital mortality rate for the group with serious conditions was 10.1% (OR 6.8, CI 95%, 4.1-11.3), and the 30-day mortality rate was 20.2% (OR 3.1, CI 95%, 2.3-4.0). In the group with no serious conditions the rates were 1.0 and 4.2%, respectively. The total hospitalization rate was 67.6%. The presence of serious conditions as well as increased mortality rates were associated with Rapid Emergency Triage and Treatment system (RETTS) as well as National Early Warning Score (NEWS) irrespective of triage score. Conclusion More than one-third of the patients presenting with NSCs to EMS had a serious underlying condition which was associated with increased mortality and hospitalization rates.Peer reviewe

Gender comparison of online and land-based gamblers from a nationally representative sample : Does gambling online pose elevated risk?

The expansion of online gambling opportunities calls for better comprehension of online gambling, including relevant gender specific correlates. This study compared online and land-based gamblers among males and females separately, utilizing a nationally representative Finnish survey sample of 18-74 year olds. Online gamblers were younger than land-based gamblers and had full-time working status more often than land-based gamblers, with partial indication of land-based gamblers' monthly income being lower. Online gambling was associated with participation in computer or video gaming more strongly than with land-based gambling. Results show that the strongest predictors of online gambling common to both genders were younger age, computer gaming and gambling on multiple gambling types. Risky alcohol consumption and tobacco smoking were not associated to gambling mode when controlling for other factors. Results indicate that particularly for females online gambling may be related to higher relative expenditure and at-risk and problem gambling, providing implications for tailored interventions. The continued study of subgroups of gamblers is necessary to comprehensively understand the altering gambling milieu. (C) 2017 Elsevier Ltd. All rights reserved.Peer reviewe

Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study

Background: Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group. Method: A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used. Results: A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive. Conclusion: Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.Peer reviewe

European Resuscitation Council Guidelines for Resuscitation 2015 Section 10. Education and implementation of resuscitation

M. Castren on Educ Implementation Resuscitation -työryhmän jäsen.Peer reviewe

The phylodynamics of SARS-CoV-2 during 2020 in Finland

Finland has had a low incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections as compared to most European countries. Here we report the origins and turnover of SARS-CoV-2 lineages circulating in Finland in 2020. SARS-CoV-2 introduced to Finland in January 2020 and spread rapidly across southern Finland during spring. We observed rapid turnover among Finnish lineages during this period. Clade 20C became the most prevalent among sequenced cases and was replaced by other strains in fall 2020. Bayesian phylogeographic reconstructions suggested 42 independent introductions into Finland during spring 2020, mainly from Italy, Austria, and Spain, which might have been the source for a third of cases. The investigations of the original introductions of SARS-CoV-2 to Finland during the early stages of the pandemic and of the subsequent lineage dynamics could be utilized to assess the role of transboundary movements and effects of early intervention and public health measures.Peer reviewe

2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 paediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have pri-oritised and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question. (C) 2017 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.Peer reviewe

Diagnosis of out-of-hospital cardiac arrest by Emergency Medical Dispatch : a diagnostic systematic review

Introduction Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. Methods We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to “emergency medical dispatcher”, “cardiac arrest’, and “diagnosis,” among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. Results We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. Conclusion The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilizatio