Gender Differences in Gambling Exposure and At-risk Gambling Behavior.

This study aimed to evaluate the differences in gambling exposure and onset of gambling problems among male and female gamblers by comparing their demographic and behavioral profiles. This study utilized data from the gambling section of the First Brazilian National Alcohol Survey and Related Behaviors. Interviews were conducted with 3007 participants who were recruited after screening for at-risk gambling behaviors. Individuals who tested positive for at-risk gambling behaviors completed the Gambling Progression Questionnaire comprising items on games of chance, and were evaluated using the DSM-IV pathological gambling criteria. The participants' "lifetime gambling exposure" was 12.5%, with 4% having experienced gambling problems during their lifetime. Majority of the male at-risk gamblers (78%) reported that they began gambling in their 20 s and took approximately 3 years to start experiencing gambling-related problems. Contrastingly, female at-risk gamblers started gambling in their 30 s and they took about 12 years to start experiencing gambling-related problems. The present results show that men were 2.3 times more at risk of gambling exposure and 3.6 times more likely to experience gambling-related problems. Male at-risk male gamblers seemed to be lonelier and to have a low socioeconomic status, while women seemed to have lower income and social insertion. Considering these significant differences, more studies evaluating gender differences in gambling behavior are necessary.

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial.

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.

Gambling in Brazil: lifetime prevalences and socio-demographic correlates.

Gambling has experienced world-wide growth. The current study is the first national survey into household gambling conducted in a developing country. The sample was a three-stage probabilistic one designed to cover individuals 14 years old or older, of both genders and from all regions of the national territory; 325 census sectors were visited, including rural areas. DSM-IV-based instruments were used to assess problem and pathological gambling; individuals were asked to estimate their monthly gambling expenditure. The lifetime prevalences were: pathological gambling 1.0%, and problem gambling 1.3%. Maximum gambling expenditure corresponded to 5.4% of the household income for social gamblers, 16.9% for problem gamblers and 20.0% for pathological gamblers. The male:female ratio among adults for pathological gambling was 3.2:1. The data suggest the existence of two subgroups of pathological gamblers, one younger (33.9±4.19) and severe (7 or more DSM-IV criteria), another older (47.8±6.01) and less severe (5-6 criteria). In a multinomial logistic regression, problematic gambling was associated with gender, age, education, employment, region of origin and living in metropolitan areas. The data suggest that feeling active and socially inserted protects against problematic gambling. Individuals who are young, male, unemployed or not currently pursuing further education may be at special risk for severe pathological gambling.

[Factors associated with obesity in school children]. / Fatores associados à obesidade em escolares.

OBJECTIVE: To analyze the relationship between obesity, physical activity and hours of sleep in schoolchildren and parental schooling and obesity. METHODS: We measured the weight, height, body mass index and adiposity (subscapular to triceps skinfold ratio) of children. The children were classified as normal, underweight, overweight or obese, according to body mass index per age. Four hundred and fifty-two schoolchildren were evaluated; 68 children with excess weight and obesity and 97 normal children were selected to answer a questionnaire regarding daily physical activity and sleeping hours, as well as parental schooling, physical activity, weight and height. RESULTS: The prevalence of excess weight and obesity was of 21.1% in boys and 22.9% in girls. Adiposity was different between normal children and the other groups (p < 0.01). In children with excess weight and obesity, adiposity was directly correlated with daily sitting hours and inversely correlated with daily sleeping hours (p < 0.05). Schooling was lower in mothers of overweight and obese children was lower than in mothers of normal children (p < 0.01). The frequency of excess weight and obesity in the parents of overweight/obese children was higher than in the parents of normal children (p < 0.01). Most parents had a sedentary life style. CONCLUSION: We observed an association between excess weight and obesity in children and inactivity. The time spent sleeping was a positive factor for maintaining a balance between weight and height. Maternal schooling and the presence of excess weight/obesity in parents were significantly associated with childhood obesity.

Gambling onset and progression in a sample of at-risk gamblers from the general population.

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.

Tratamentos não-farmacológicos para o tabagismo / Non-pharmacological treatments for smoking

O tabagismo é uma doenca complexa e o seu controle requer a integracão de abordagens diversas: farmacológicas, psicológicas, de comunicacão de massa. econômicas, entre outras. Este artigo revê os princípios e a efetividade das técnicas não-farmacológicas para o tratamento do tabagismo e comenta o seu uso em situacões clínicas usuais e em populacões especiais.

Fatores associados à obesidade em escolares / Factors associated with obesity in school children

OBJETIVO: Analisar a relação entre obesidade em escolares e atividade física e horas de sono da criança, escolaridade e obesidade dos pais. MÉTODOS: Avaliação de peso, estatura, índice de massa corporal e adiposidade (estimada pelas dobras cutâneas tricipital e subescapular) de escolares seguida da classificação das crianças em normais, baixo peso, sobrepeso ou obesidade pelo índice de massa corporal por idade. Foram avaliados 452 escolares e selecionadas 68 crianças com sobrepeso e obesidade e 97 normais para preenchimento de questionários quanto a atividade física e horas de sono diárias da criança, escolaridade, atividade física, peso e estatura dos pais. RESULTADOS: A prevalência de sobrepeso e obesidade foi de 21,1 por cento nos meninos e 22,9 por cento nas meninas. A adiposidade diferiu na comparação das crianças normais com as demais (p < 0,01). Nas crianças com sobrepeso e obesidade, a adiposidade correlacionou-se diretamente com o tempo de permanência sentado e inversamente com as horas de sono (p < 0,05). A ocorrência de sobrepeso e obesidade foi maior nas crianças cujas mães tinham menor escolaridade (p < 0,01). A freqüência de sobrepeso e obesidade nos pais das crianças com sobrepeso e obesidade foi maior do que nos pais das crianças normais (p < 0,01). O sedentarismo predominou na maioria dos pais. CONCLUSAO: O estudo destaca a inatividade das crianças como um dos fatores associados à obesidade. As horas diárias de sono apresentaram-se como fator positivo na manutenção do equilíbrio pôndero-estatural. A escolaridade materna e a ocorrência de sobrepeso e obesidade nos pais estão associados com sobrepeso e obesidade nos filhos.