Impaired Self-Awareness in Pathological Gamblers

Lack of self-awareness of one’s decisions remains an understudied and elusive topic in the addiction literature. The present study aimed at taking a first step towards addressing this difficult subject through the use of a combination of behavioral procedures. Here, we explored the association between a metacognitive process (the ability to reflect and evaluate the awareness of one’s own decision) and poor performance on the Iowa Gambling Task (IGT) in a group of pathological gamblers (PG; n = 30), and in a comparison group (n = 35). This metacognitive process was assessed during the IGT with the post-decision wagering procedure, while a number of potential confounds (i.e., reward/loss sensitivity, dual-tasking) were controlled for. Results showed that: (1) Initial performance enhancement of the control group on IGT occurred without explicit knowledge of the task, thus confirming its implicit character; (2) compared to controls, performance of PG on the IGT failed to increase during the task; (3) taking into account increased reward sensitivity and decreased loss sensitivity as well as poorer dual-tasking in pathological gamblers, PG tended to exhibit a bias in evaluating their own performance on the IGT by maximizing their wagers independently of selecting advantageous decks. Our findings suggest that biased metacognition may affect pathological gamblers, leading to disadvantageous post-decision wagering, which is in turn linked to impaired decision making under ambiguity. Perhaps this deficit reflects the impaired insight and self-awareness that many addicts suffer from, thus providing a novel approach for capturing and measuring this impairment, and for investigating its possible causes.     

The aged in the world's constitutions

This article presents a review of legal provisions benefitting the elderly as anchored in the constitutions of countries around the globe. While it is of interest to examine the sheer range of such provisions, it is also possible to gauge from the comparison whether the presence of constitutional guarantees is connected with levels of economic development, conditions of population aging, or other differences among nations. A cross-check with the institutionalization of social security systems is included in the analysis. The results allow an assessment of major differences by world regions, an appraisal of unique cases, and an appreciation of where nations stand today in formulating guarantees and policies regarding the elderly.     

Temporal Orientation in Hearing Impaired People

This paper reviews various aspects of the temporal dimension. Cultural perspectives, audition and language development are suggested as factors that may be involved in the development and expression of the human concept of time. The author argues that deafness may impact sufficiently on one or more of these factors to affect the development of temporal orientation in deaf people. The implications of this for the deaf population are discussed. Tentative hypotheses are made and a number of avenues of research that might enlighten our understanding in this area are proposed.     

Sebostasis of the aged man

Sebostasis in the aged male is a frequent and commonly accepted fact. In order to evaluate the sebostasis of the aged, several experimental parameters were developed to obtain valuable data with regard to the activity of sebaceous glands. The average areas of the lobes of the sebaceous glands and sebocytes, as well as those of the nuclei of sebocytes, were evaluated planimetrically. By means of chromatographic analysis, the skin surface lipids were determined. Using silicone stamping, the average extention of the pore openings was quantitatively measured. Although elderly men show significantly larger sebaceous glands than young people, the concentration of the skin surface lipid is clearly reduced. The transit time is diminished and the drastically reduced intrasebocytic sebum synthesis is of pathogenetic nature. Whereas, namely in young men, the volume of the differentiating sebocytes increases continuously, it remains small in elderly men. As a characteristic expression of this reduced differentiation, the sebocyte nucleus shrinks only very little while the cells migrate from the periphery to the center of the lobe. Consequently, the sebocytes set free only small amounts of sebum with considerable retardation. The qualitative composition of the skin surface lipids in the aged shows differences in respect to the cholesterol and squalene concentrations. The areas of pore openings on the skin surface shrink, probably as a consequence of a reduction of cutaneous elasticity.

The present findings show clearly that sebostasis in the aged is caused by an altered differentiation of the sebocytes themselves. It is unknown whether or not normal influences undergo a decline or whether a deficiency of sebumrelated enzymes plays a role.     

Policymaking for diversity among the aged in India

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.     

Meeting the Needs of Visually Impaired People Living in Lifetime Homes

ABSTRACT

This article explores perceptions on the suitability and effectiveness of Lifetime Homes standards (LTHS) for those with visual impairment in Northern Ireland. LTHS are a series of mandatory United Kingdom public-sector housing design interventions, providing a model for ensuring accessible and adaptable homes throughout an occupant's life span. An aging demographic with increasing incidence of diabetes has led to rising numbers of elderly, visually impaired people wanting to remain in their homes for longer. Qualitative semi-structured interviews were conducted with 13 key stakeholders and thematically analyzed. Although findings show that employing LTHS offers benefits to visually impaired residents, shortcomings were also identified. Evidence indicates a need for policy makers, health-care professionals, and housing associations to modify practices to better meet the housing needs of visually impaired people. Findings may also be applicable to those with other impairments and disabilities in relation to housing for elderly residents.     

Impaired Metacognitive Capacities in Individuals with Problem Gambling

Impaired insight into behavior may be one of the clinical characteristics of pathological gambling. In the present study, we tested whether the capacity to evaluate accurately the quality of one’s own decisions during a non-gambling task was impaired in problem gamblers. Twenty-five problem gamblers and 25 matched healthy participants performed an artificial grammar-learning paradigm, in which the quality of choice remains uncertain throughout the task. After each trial of this task, participants had to indicate how confident they were in the grammaticality judgements using a scale ranging from 1 (low confidence) to 7 (high confidence). Results showed that (i), problem gamblers’ performance on the grammaticality test was lower than controls’; (ii) there was a significant correlation between grammaticality judgments and confidence for control participants, which indicates metacognitive insight and the presence of conscious knowledge; (iii) this correlation was not significant in problem gamblers, which suggests a disconnection between performance and confidence in this group. These findings suggest that problem gamblers are impaired in their metacognitive abilities on a non-gambling task, which suggests that compulsive gambling is associated with poor insight as a general factor. Clinical interventions tailored to improve metacognition in gambling could be a fruitful avenue of research in order to prevent pathological gambling.     

Impaired sensory-emotional integration in a violent adolescent sex offender

Social risk factors, executive neuropsychological functioning, and emotional numbing were examined as potential risk factors for violent sexual assaults by an adolescent male. The subject had been exposed to at least four previously identified social risk factors, including neglect, early separation from both parents, sexual abuse, and low socioeconomic status. At the time of assessment, executive neuropsychological functioning was intact. At the time of assessment, executive neuropsychological functioning was intact. While impaired emotional responsiveness was an important factor in the assaults, the construct of emotional numbing is too broad to identify the specific neuropsychological impairment involved in the subject's assault behavior. The authors suggest that failures in sensory-emotional integration contributed to the likelihood of violent behavior. Implications for further research and clinical practice are discussed.     

The evolution of the system of care for the aged in Denmark

In Denmark, formal services are viewed as a right to be used by any member of that society who is in need of assistance, premised upon a societal model of mutual self-help. The focus here is on the dual themes of philosophical consistency and of transition in the formal system of services and delivery of care in Denmark. Denmark's system centers on meeting the basic needs of the elderly while enabling individuals to retain control over decisions regarding their own lives. It was effective during the economically expansive period of the 1960s and 1970s, but became less effective during the 1980s. Because of the economic necessity of cutting back on budgets, the national government has in fact attempted to define and redirect available choices in service delivery. The dual themes of consistency and dynamism are demonstrated through the case of a rural municipality in northwest Jutland during the prosperous period into the more economically limited period of the last decade and the present. Implications for informal social support and relationships between the aged and their families, friends, and neighbors in Denmark are explored.     

Impaired Probability Estimation and Decision-Making in Pathological Gambling Poker Players

Poker has gained tremendous popularity in recent years, increasing the risk for some individuals to develop pathological gambling. Here, we investigated cognitive biases in a computerized two-player poker task against a fictive opponent, among 12 pathological gambling poker players (PGP), 10 experienced poker players (ExP), and 11 inexperienced poker players (InP). Players were compared on probability estimation and decision-making with the hypothesis that ExP would have significantly lower cognitive biases than PGP and InP, and that the groups could be differentiated based on their cognitive bias styles. The results showed that ExP had a significantly lower average error margin in probability estimation than PGP and InP, and that PGP played hands with lower winning probability than ExP. Binomial logistic regression showed perfect differentiation (100%) between ExP and PGP, and 90.5% classification accuracy between ExP and InP. Multinomial logistic regression showed an overall classification accuracy of 23 out of 33 (69.7%) between the three groups. The classification accuracy of ExP was higher than that of PGP and InP due to the similarities in probability estimation and decision-making between PGP and InP. These impairments in probability estimation and decision-making of PGP may have implications for assessment and treatment of cognitive biases in pathological gambling poker players.     

The development of amyloid beta protein deposits in the aged brain

The deposition of amyloid beta protein (Abeta) in the human brain and the generation of neurofibrillary tangles are the histopathological hallmarks of Alzheimer's disease. Accumulation of Abeta takes place in senile plaques and in cerebrovascular deposits as a result of an imbalance between Abeta production and clearance. This Review describes the different types of Abeta deposits, which can be distinguished by their morphology and by the hierarchical involvement of distinct areas of the brain in Abeta deposition. The role of intracellular Abeta in Abeta deposition and the mechanism of Abeta toxicity are also discussed.     

Recent developments in aged care policy in Australia

A series of major reforms implemented through the mid 1980s sought to contain residential care and expand community care in Australia's long-term care system. While this goal has been maintained, a number of new policy initiatives followed the change of federal government in 1996. This article presents a systematic account of current policy objectives, implementation measures, and outcomes in three major policy areas: changing the balance between residential and community care, targeting in community care, and support for family caregivers. This analysis shows that while there have been shifts in emphasis from time to time, concerted policy efforts over the last 20 years have contained the growth of expenditure on long-term care and realized significant change in the service system.     

Impaired Job Performance and Worksite Trigger Incidents:

Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as "central strategy" of program theory and operation calls for critical investigation of supervisors' referral behavior, factors affecting their use of the strategy, and its effectiveness with the referred employees. This study examined two factors found to influence referral action-job performance and occurrence of an incident at the worksite which serves as a "trigger event" for the supervisor. Supervisors (N = 415) at 25 sites from seven organizations responded to a survey regarding their referral behavior. Both impaired job performance and worksite incidents were found to have significant relationship to the EAP referral handling of a specific "job problems" employee. Reported occurrence of a dramatic worksite incident accounted for about eight times as much of the observed referral index variance as a job performance (impairment) rating scale. An interesting, but statistically nonsignificant, trend was also found - the more "public" the incident, the greater the referral action taken. About half of the respondent supervisors were found to have taken no referral action whatever with their "job problems" subordinate. These findings raise questions about supervisors' perceptions of EAPs and their motivations in referral. More research into referral dynamics is needed if EAPs are to achieve their potential to help impaired workers and maximize cost savings for their host organizations.     

Assessing the efficacy of ombudsman services for the aged in long term care institutions

Long term care ombudsman programs are a recently established component within the gerontological services continuum. Public policy in this area is not yet well defined and there is a conspicuous absence of systematic studies assessing the effectiveness of such program efforts. This research reports on the accomplishments of an urban based, volunteer nursing home ombudsman program. Survey findings show moderate levels of goal attainment in the policy and social relations domains and more promising results in the organizational/managerial sphere. The relationship between perceptions of program success and varying ombudsman role behaviors is underscored.     

听障青少年的污名及其应对策略

任何人类差异都可能成为污名的对象。在社会差别的分类审视下,听障青少年遭遇的污名类型多种多样。从综合视角来看,可分为三类:形象可怕怪异,令人恐惧;身体无用低能,形同朽木;境遇窘迫不堪,让人可怜。在面对这些污名威胁时,他们管理身体与预设的规则体系进行周旋,业已发展出三种污名应对技术:一是身体改造,常态身体的追求;二是身体装扮,秘密信息的管理;三是身体抗争,弱者的对话方式。研究此问题,不仅有利于我们走进听障群体的世界,帮助他们远离污名的困扰,也可以增加社会的相互理解、信任与支持,推动社会的和谐融合。