Background and aimsSelf-exclusion programs offer an intervention for individuals with problem gambling behavior. However, these programs are insufficiently used. This review describes sociodemographic features and gambling behavior of self-excluders as well as goals and motives for initiating self-exclusion from terrestrial and online gambling. In addition, use of further professional help and barriers to self-exclusion are examined.MethodsBased on systematic literature search and quality assessment, n = 16 original studies (13 quantitative, 2 qualitative, and 1 mixed method) published between 1997 and 2017 in English or German language were analyzed. Results are presented for online and terrestrial gambling separately.ResultsOnline self-excluders were on average 10 years younger than terrestrial self-excluders. Self-exclusion was mainly motivated by financial problems, followed by feelings of losing control and problems with significant others. Financial problems and significant others were less important for online than for terrestrial gamblers. Main barriers for self-exclusion were complicated enrollment processes, lack of complete exclusion from all venues, little support from venue staff, and lack of adequate information on self-exclusion programs. Both self-excluders from terrestrial and online gambling had negative attitudes toward the need of professional addiction care.ConclusionTo exploit the full potential of self-exclusion as a measure of gambler protection, its acceptance and its utilization need to be increased by target-group-specific information addressing financial issues and the role of significant others, simplifying the administrative processes, facilitating self-exclusion at an early stage of the gambling career, offering self-determined exclusion durations, and promoting additional use of professional addiction care.

Objectives: There is scarce information about sedation in nursing homes at the end of life. We aimed to assess (1) the use of sedatives generally and "sedatives with continuous effect," based on objective operational criteria, within the last week of life in nursing homes and (2) factors associated with this treatment. Design: Retrospective cohort study, using the nursing homes' medical records. Setting and Participants: Residents who died in 4 German nursing homes from January 2015 to December 2017 and whose medical records were available (n ¼ 512). Methods: Sedatives analyzed were those recommended by guidelines for "palliative sedation": benzodiazepines, levomepromazine, haloperidol (!5 mg/d), and propofol. The definition of "sedatives with continuous effect" and doses judged as at least moderately sedating were consented by palliative care clinicians and pharmacists, based on the literature. Descriptive statistics and multivariate logistic regression analysis were performed (R version 3.6.1). Results: Overall, 110/512 (21%) deceased residents received a sedative at least once during the last week of life, 46/512 (9%) "sedatives with continuous effect." Oral lorazepam was used most frequently. Eleven of 512 (2%) residents received doses judged as at least moderately sedating. The term sedation was not used. Most frequent indications were agitation (58/110; 53%) and anxiety (35/110; 32%); no indication was noted for 36/110 (33%) residents. The resident's involvement in the decision for sedatives was documented in 3/110 (3%). Multivariate logistic regression analysis showed significant associations between use of sedatives and age (OR ¼ 0.94, P < .001) as well as institution (P < .001). Conclusions and Implications: Our data indicate a lower prevalence of sedation compared to international data and considerable differences regarding prevalence between institutions. These differences, potential setting-specific challenges, and need for support measures for consistent best practice of sedation in nursing homes should be further explored.

Abstract. Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.

The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures. What is known: • The context of drinking, e.g. when, where, why and with whom is associated with episodic heavy drinking among adolescents. What is new: • Male and female inpatients with acute alcohol intoxication differ with regards to the context of drinking, i.e. in admission time, drinking situation, drinking occasion and admission context. • Being admitted to hospital from public places is associated with higher blood alcohol concentration.