What is the evidence that advertising policies could have an impact on gambling-related harms? A systematic umbrella review of the literature.

OBJECTIVE: To summarise the evidence on the impacts of gambling-related advertising that could lead to gambling-related harm, including impacts on vulnerable individuals and inequalities in the distribution of harms. STUDY DESIGN: An umbrella review of studies investigating the impact of gambling advertising. METHODS: A review was undertaken of systematic reviews of qualitative, quantitative and mixed method studies reporting outcomes associated with gambling advertising and marketing. The search strategy included database searches (Web of Science, PsycInfo) and website searches. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews 2. RESULTS: 1024 papers were identified by database searches. Eight systematic reviews, including 74 unique studies, met inclusion criteria. Included studies, using quantitative and qualitative methods, consistently support the existence of a causal relationship between exposure to advertising of gambling products/brands and more positive attitudes to gambling, greater intentions to gamble and increased gambling activity at both individual and population level. There is evidence of a 'dose-response' effect; greater advertising exposure increases participation which leads to a greater risk of harm. There was more evidence for the impact on children and young people and for those already at risk from current gambling activity with those most vulnerable more likely to be influenced. CONCLUSION: Gambling advertising restrictions could reduce overall harm and mitigate the impact of advertising on gambling-related inequalities. Public health harm prevention strategies should include policies which limit exposure to advertising, particularly among children and vulnerable groups.

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.

Gambling Motives: Application of the Reasons for Gambling Questionnaire in an Australian Population Survey.

The Reasons for Gambling Questionnaire (RGQ) consist of 15 items forming five factors: enhancement, social, money, recreation and coping. The RGQ was developed for use in the 2010 British Gambling Prevalence Survey (BGPS) and has now been employed in the second Social and Economic Impact Study (SEIS) of Gambling in Tasmania study conducted in 2011 in Australia. Given differences between Britain and Australia in terms of socio-demographic profiles, gambling cultures and attitudes, gambling access and availability, gambling regulation, and rates and patterns of gambling participation, the aims of this study were to analyse the RGQ data from the SEIS to: (1) determine the most commonly endorsed gambling motives in an Australian jurisdiction, (2) explore the factor structure of the RGQ in an Australian sample, and (3) explore how motives for gambling vary among different Australian population sub-groups. A representative sample of the Tasmanian population who had gambled in the previous 12 months (n = 2,796) were administered the RGQ via computer-assisted telephone interviewing. The five most commonly endorsed reasons for gambling were for fun (62%), followed by the chance of winning big money (52%), it being something to do with friends and family (48%), to be sociable (40%), and excitement (38%). A principal component analysis revealed a five-factor structure that is slightly different from that derived in the BGPS: money, regulate internal state, positive feelings, social, and challenge reasons. Finally, gambling motives varied according to socio-demographic factors, number of gambling activities, problem gambling severity, and participation on different gambling activities. Although some of these findings are consistent with those from the BGPS, there are also some slight differences, suggesting that there may be regional-specific variations in gambling motives.

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012.

BACKGROUND: This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys were carried out of representative samples of the general population living in households in England conducted annually (1993 to 2004). METHODS: Participants were classified as obese if their body mass index was over 30 kg/m(2). Projections of obesity prevalence by 2012 were based on three scenarios: extrapolation of linear trend in prevalence from 1993 to 2004; acceleration (or slowing down) in rate of change based on the best fitting curve (power or exponential); and extrapolation of linear trend based on the six most recent years (1999 to 2004). RESULTS: The prevalence of obesity increased significantly from 1993 to 2004 from 13.6% to 24.0% among men and from 16.9% to 24.4% among women. If obesity prevalence continues to increase at the same rate, it is projected that the prevalence of obesity in 2012 will be 32.1% (95% CI 30.4 to 34.8) in men and 31.0% (95% CI 29.0 to 33.1) in women. The projected 2012 prevalence for adults in manual social classes is higher (43%) than for adults in non-manual social classes (35%). CONCLUSION: If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012. Of these, around 43% are from manual social classes, thereby adding to the public health burden of obesity-related illnesses. This highlights the need for public health action to halt or reverse current trends and narrow social class inequalities in health.

Gregory Bateson's lost world: the anthropology of Haddon and Rivers continued and deflected.

Gregory Bateson was one of the last and most distinguished products of the school of anthropology that Haddon and Rivers created in Cambridge after the Torres Strait Expedition. Beginning his career shortly after Rivers' death, Bateson used the interwar years to create a theoretical approach that continued and deflected that of Haddon and Rivers. His major ethnography from this period, Naven, evidenced his complex academic positioning between the legacy of Rivers and the new paradigm emerging around Malinowski and Radcliffe-Brown. After the Second World War, Bateson's intellectual project emerged as even closer to Rivers' in both psychological and evolutionary dimensions.

The challenge of growing oral spirochaetes.

Research in periodontal disease has shown the presence of oral spirochaetes repeatedly in subgingival plaque. There is uncertainty as to whether these spirochaetes are involved in the actual disease process; however, it has been shown that their presence is a definite marker for disease occurrence. An understanding of their role in periodontal disease requires further characterisation of these organisms. Diagnostic tests would be useful for the clinician and enable treatment for the patient to be planned. Studies on characterising the different treponemal species have been limited by difficulties in culturing these organisms. Moreover, there is a need to obtain pure cultures of these organisms and to identify them in order to associate particular species with disease and, ultimately, to make probes for their easy detection directly from dental plaque. This review examines the methods used, and reports our own experience, in obtaining pure cultures of oral spirochaetes. The techniques available and the problems that occur when identifying these organisms are also considered.

Phospholipid profiles of Clostridium difficile.

Phospholipid molecular species present in 32 isolates of Clostridium difficile were examined by fast atom bombardment-mass spectrometry in negative-ion mode. This revealed major anions consistent with the expected presence of the following phosphatidylglycerol (PG) analogs: PG(31:2), PG(32:1), PG(33:2), PG(33:1), PG(34:2), and PG(34:1). The major phospholipid molecular species are distinct from those of other bacterial groups examined.

In vitro activity of BMS-181184 compared with those of fluconazole and amphotericin B against various candida spp.

We compared the in vitro activity of BMS-181184, the first compound of a new class of antifungal agents, the pradimicins, with those of fluconazole and amphotericin B against 64 clinical isolates of Candida species. MICs were determined by a microdilution method with high resolution medium for BMS-181184 and fluconazole and antibiotic medium no. 3 with 2% glucose for amphotericin B. MICs of BMS-181184 for all yeasts were in the range of 0.78 to 12.5 micrograms/ml. BMS-181184 was active against isolates resistant to other antifungal agents, consistent with a novel mode of action. Minimum fungicidal concentrations for 16 isolates showed that BMS-181184 was fungicidal. Clinical studies are now required to confirm its activity.

In vitro activity of D0870 compared with those of other azoles against fluconazole-resistant Candida spp.

We compared the in vitro activity of a new triazole, D0870, with those of fluconazole, itraconazole, and ketoconazole against 41 clinical isolates of fluconazole-resistant Candida belonging to nine different species. The 50% inhibitory concentrations (IC50s) were determined by a microdilution method with morpholinopropanesulfonic acid (MOPS)-buffered RPMI medium and an inoculum of approximately 10(4) yeasts per ml. After incubation for 48 h at 37 degrees C the optical density at 550 nm was measured. The IC50 was the lowest drug concentration which reduced the optical density at 550 nm by > or = 50% compared with that for a drug-free control. D0870 had significant activity against many of the isolates. Its activity was comparable to that of ketoconazole, slightly superior to that of itraconazole, and markedly superior to that of fluconazole against Candida albicans. Against Candida glabrata, Candida krusei, and Candida inconspicua, it had activity similar to those of itraconazole and ketoconazole but had activity superior to that of fluconazole. D0870 IC50s for some isolates were increased. This may be due to cross-resistance mechanisms because the IC50s of both itraconazole and ketoconazole for these isolates were often high. When IC50s and IC80s were compared there was a marked organism and drug variation. With C. glabrata much higher endpoints for itraconazole were observed when an IC80 endpoint was used. For C. albicans there was also a significant shift upward in endpoints for itraconazole and ketoconazole. Values were changed little when IC50 and IC80 endpoints of D0870 were compared. For 35 of 41 isolates tested the D0870 IC50 was less than the 2.5-mg/liter breakpoint threshold proposed previously. Therefore, D0870 may be a useful agent for the therapy of infections caused by fluconazole-resistant Candida spp.

High prevalence of antifungal resistance in Candida spp. from patients with AIDS.

Three hundred and forty-eight isolates of Candida spp. from patients treated at a regional infectious diseases unit for AIDS, immunocompromised patients admitted to the Hope Hospital and isolates referred from around the North West of England were tested for their in-vitro susceptibility to amphotericin B, fluconazole and flucytosine using standardized methods. Candida albicans comprised 73% of isolates, Candida glabrata 10% and Candida parapsilosis 7%. Ninety-six percent of isolates were susceptible to amphotericin B and resistance to > or = 12.5 mg/L fluconazole was found in 61 (17.5%) of the 348 isolates tested. Among isolates from patients with AIDS the incidence of fluconazole resistance was 33% whereas in other patients the incidence was only 11%. Flucytosine resistance was seen in only 12 (3.4%) isolates, 11 of which were C. albicans and in 6.5% of isolates from patients with AIDS. Resistance to fluconazole and flucytosine is now sufficiently prevalent among Candida spp. isolated from patients with AIDS to warrant routine susceptibility testing of yeast isolates.

Influence of site of drug delivery on the systemic availability of metoprolol: comparison of intragastric infusion and 14/190 Oros administration.

The influence of the site of drug delivery on the systemic availability of metoprolol has been evaluated by measuring plasma drug concentrations in six healthy volunteers after administration of a continuous 13.5 h intragastric infusion and a 14/190 Oros controlled-release dosage form, on two separate occasions. The same total amount of drug was administered at the same rate on both occasions but the Oros system moved through the gut whereas the site of the infusion was constant. The differences between treatments were confined largely to the period 6-15 h after dosing when lower plasma concentrations were obtained after administration of the Oros system. The levels after 20 h were higher for Oros, however, reflecting its longer duration of drug release. The amount of drug reaching the circulation was 19.8% less for the Oros preparation compared with intragastric infusion but this was not due to incomplete release since the residual amounts of drug in three systems recovered from faeces corresponded to less than 12% of the administered dose. Analysis of the plasma profiles by the Wagner-Nelson method indicated a reasonable agreement between in vitro release and in vivo absorption. The appearance of drug in plasma was delayed for both treatments, and for Oros the apparent absorption rate slowed 6 h after dosing. Plasma profiles after 14/190 metoprolol Oros were consistent with prolonged in vivo delivery and absorption from the gut. The absorption process, however, was associated with some reduction both in the rate, after 6 h, and in the total amount reaching the circulation.