Mortality, morbidity, and predictors of death among amphetamine-type stimulant users - a longitudinal, nationwide register study.

Introduction: Use of amphetamine-type stimulants (ATS) contributes substantially to the global burden of disease. Large-scale follow-up studies of morbidity and mortality in ATS users are few. This study analysed morbidity, mortality, and potential predictors of all-cause mortality in a nationwide cohort of patients with ATS use disorder. Methods: Data was acquired from national Swedish registers. All Swedish residents 18 years or older, with a registered ATS use diagnosis in 2013-2014 were included (N = 5,018) and followed until December 31, 2017. Comorbid diagnoses and causes of death were assessed and potential predictors of all-cause mortality were examined through Cox regression. Results: Median age at inclusion was 36.6 years (interquartile range 27.4---48.1) and 70.5 % were men. The crude mortality rate was 24.6 per 1,000 person-years. The adjusted all-cause standardized mortality ratio was 12.4 (95 % CI [11.34-13.55]). The most common cause of death was overdose (28.9 %). Multiple drug use (hazard ratio 1.39, 95 % CI [1.14-1.70], p = 0.004), anxiety (hazard ratio 1.39, 95 % CI [1.11-1.72], p = 0.014), viral hepatitis (hazard ratio 1.85, 95 % CI [1.50-2.29], p = 0.004), and liver disease (hazard ratio 2.41, 95 % CI [1.55-3.74], p = 0.004) were predictors of all-cause mortality. Conclusions: Multiple drug use, anxiety disorders, viral hepatitis and liver diseases were identified as risk factors for death. Our findings call for better screening, prevention, and treatment of somatic and psychiatric comorbidity among ATS users to reduce mortality.

Nationwide, Multioperator Self-Exclusion and Psychiatric Comorbidity in Patients with Gambling Disorder: A Retrospective Chart Review Study from a Regional Treatment Unit.

Gambling disorder is an addictive disorder that has been shown to have a detrimental effect on an individual's health, social, and financial situations. Voluntary self-exclusion is one way for patients to reduce harm in gambling disorder, but breaching one's self-exclusion appears to be common. In January 2019, Sweden launched a nationwide, multioperator self-exclusion instrument called Spelpaus (literally "game break"). Spelpaus is unique to Sweden, and there is limited research on the use of this type of nationwide, multioperator self-exclusion services, also in relation to gambling disorder and mental health. There is a reason to follow the clinical picture of treatment seeking for gambling disorder over time, and this study aims to explore clinical characteristics of patients seeking clinical gambling disorder treatment, including sex distribution and mental health comorbidity, as well as the use of Spelpaus amongst patients with gambling disorder and how frequently users gambled despite ongoing self-exclusion, in relation to sex and psychiatric comorbidities. A retrospective chart study was carried out on patients presenting to a regional gambling disorder treatment unit. Information regarding self-exclusions using Spelpaus, gambling despite self-exclusion, and the method of gambling despite self-exclusion as well as psychiatric comorbidities were extracted from medical records. Females were markedly more likely to report overall psychiatric comorbidities (48% vs. 25% among males, p < 0.001), affective, neurotic/anxiety-related (p < 0.001), and behavioral/emotional (p = 0.028) diagnoses and more likely to have two or more diagnoses excluding gambling disorder (p = 0.001). From 120 patients from whom information regarding self-exclusion was present, 114 (95%) had chosen to self-exclude. From the 114 self-excluders, 67 reported to have gambled despite self-exclusion, with unregistered websites being the most common method. Self-exclusion was not significantly related to sex (p = 0.146) or to psychiatric comorbidities (p = 0.178). In conclusion, psychiatric comorbidity was particularly common in female gambling disorder patients and gambling despite self-exclusion was common. Gambling regulations should be improved to help self-excluders avoid being able to gamble on unlicensed gambling operators. Further research should focus on sex differences and the association with psychiatric comorbidities.

A nationwide case-control study on cardiovascular and respiratory-related disorders in patients with gambling disorder in Sweden.

OBJECTIVES: We aimed to examine potential relationships and gender differences between cardiovascular disease (CVD), diabetes, obesity, respiratory-related disorders, and gambling disorder (GD). We hypothesized that (1) GD patients would be more likely than controls to have CVD, diabetes, obesity, and respiratory-related diseases; and (2) females with GD would be more likely than men with GD to have CVD, diabetes, obesity, and respiratory-related diseases. STUDY DESIGN: National retrospective case-control study. METHODS: We used data from the Swedish National Board of Health and Welfare between 2005 and 2019. A total of 10,766 patients were included, and 3592 of them had GD. Every GD patient was matched with two age- and gender-matched controls. Patient data, including the history of medical diagnoses, were extracted. Descriptive statistics, Chi-squared and Fisher's exact tests were used to compare GD patients and controls. RESULTS: GD patients had a higher prevalence of CVD and respiratory-related disorders than controls. Diabetes rates were 5% for GD patients and 2% for controls; CVD (18% vs 12%); respiratory-related disease (7% vs 4%); and obesity (7% vs 3%). Women with a diagnosis of GD have a higher prevalence of obesity and somatic comorbidities other than diabetes compared to men. CONCLUSIONS: This is the largest case-control study conducted to date showing GD patients have a higher prevalence of CVD, diabetes, obesity, and respiratory-related disorders than controls. Women with GD appear to be more susceptible than men to CVD, obesity, and respiratory-related disorders; however, this may be partially explained by differences in help-seeking behavior. Thus, our findings highlight the importance of early identification of GD patients who may also have somatic conditions requiring treatment. This can be accomplished by implementing a screening program for GD, CVD, diabetes, obesity, and respiratory-related disorders, and by including healthy lifestyle management strategies.

Self-exclusion and breaching of self-exclusion from gambling: a repeated survey study on the development of a nationwide self-exclusion service.

BACKGROUND: Voluntary self-exclusion from gambling is a common harm reduction tool in individuals with a gambling disorder. Previous data have demonstrated that many gamblers breach their own self-exclusion, typically through other online services outside the jurisdiction in which they are self-excluded. The present study aimed to carry out a new follow-up measure-similar to previous studies in the same setting-of self-exclusion and its breaching in Sweden, in order to allow for the follow-up assessment of a nationwide, multi-operator self-exclusion system introduced in Sweden in 2019. METHODS: A web survey to the web panel of a market survey company addressed 1505 past-year gamblers, who responded to a number of questions about gambling habits, including screening for gambling problems using the Problem Gambling Severity Index and self-exclusion-related items corresponding to previous studies. RESULTS: Nine percent of past-year gamblers had self-excluded using the Spelpaus service. In logistic regression, self-exclusion was significantly associated with gambling problems, past-year online casino gambling, and absence of online poker gambling. Among self-excluders, 49 percent had ever gambled despite being self-excluded. Among those breaching their self-exclusion, the most common gambling types during self-exclusion were online casino (82 percent), sports betting (47 percent) and lotteries (43 percent). DISCUSSION: Self-exclusion remains a popular harm reduction tool against problem gambling, more common than in previous studies, mostly in individuals with recent gambling problems and in online casino gamblers. However, breaching self-exclusion is somewhat more common than in previous research. Online casino represents the most common means of self-exclusion breaching. Policy-making in the area needs to further address the risk of breaching one's self-exclusion and may further address the risk of overseas gambling.

Transcriptomic and clinical heterogeneity of metastatic disease timing within metastatic castration-sensitive prostate cancer.

BACKGROUND: Metastatic castration-sensitive prostate cancer (mCSPC) is commonly classified into high- and low-volume subgroups which have demonstrated differential biology, prognosis, and response to therapy. Timing of metastasis has similarly demonstrated differences in clinical outcomes; however, less is known about any underlying biologic differences between these disease states. Herein, we aim to compare transcriptomic differences between synchronous and metachronous mCSPC and identify any differential responses to therapy. PATIENTS AND METHODS: We performed an international multi-institutional retrospective review of men with mCSPC who completed RNA expression profiling evaluation of their primary tumor. Patients were stratified according to disease timing (synchronous versus metachronous). The primary endpoint was to identify differences in transcriptomic profiles between disease timing. The median transcriptomic scores between groups were compared with the Mann-Whitney U test. Secondary analyses included determining clinical and transcriptomic variables associated with overall survival (OS) from the time of metastasis. Survival analysis was carried out with the Kaplan-Meier method and multivariable Cox regression. RESULTS: A total of 252 patients were included with a median follow-up of 39.6 months. Patients with synchronous disease experienced worse 5-year OS (39% versus 79%; P < 0.01) and demonstrated lower median androgen receptor (AR) activity (11.78 versus 12.64; P < 0.01) and hallmark androgen response (HAR; 3.15 versus 3.32; P < 0.01). Multivariable Cox regression identified only high-volume disease [hazard ratio (HR) = 4.97, 95% confidence interval (CI) 2.71-9.10; P < 0.01] and HAR score (HR = 0.51, 95% CI 0.28-0.88; P = 0.02) significantly associated with OS. Finally, patients with synchronous (HR = 0.47, 95% CI 0.30-0.72; P < 0.01) but not metachronous (HR = 1.37, 95% CI 0.50-3.92; P = 0.56) disease were found to have better OS with AR and non-AR combination therapy as compared with monotherapy (P value for interaction = 0.05). CONCLUSIONS: We have demonstrated a potential biologic difference between metastatic timing of mCSPC. Specifically, for patients with low-volume disease, those with metachronous low-volume disease have a more hormone-dependent transcriptional profile and exhibit a better prognosis than synchronous low-volume disease.

An interrupted time series analysis of gambling behavior based on gambling operator revenue-based taxation during the COVID-19 pandemic in Sweden.

OBJECTIVES: The impact of COVID-19 on gambling behavior and the gambling industry itself has been widely speculated. Prior studies have shown how boredom, social isolation, poor mental health, and financial hardships, all of which have been associated with COVID-19, can aggravate problem gambling behaviors in patients with gambling disorders while also luring newcomers. Few studies have used methods other than self-report to assess longitudinal behavioral changes in gambling behavior before versus during the pandemic. STUDY DESIGN: The present study addresses this gap by using an interrupted time series approach on data obtained from the Swedish Gambling Authority measuring taxation on gambling vendors' revenue between January 2019 and November 2021. METHODS: March, June, and October 2020 were chosen as interruption points as they correspond to the pandemic's commencement, the return of elite sports, and the second wave of cases in Sweden, respectively. We hypothesized that the pandemic would be associated with both temporary changes for select gambling types and long-term increases in online gambling. RESULTS: Results revealed the pandemic's onset was associated with transient effects at each point of interruption, as well as long-term upward trends in total gambling and commercial online gambling, excluding horse betting and the state-owned operator for online casinos and betting. CONCLUSIONS: The present study's findings, although consistent with the theory that gambling activity could increase during the pandemic, contradict previous studies that found no changes or a decrease from pre-COVID-19 levels. Findings indicate that the pandemic and Sweden's reaction to it were associated with increased use of some gambling products.

The live bacterial load and microbiota composition of prepacked "ready-to-eat" leafy greens during household conditions, with special reference to E. coli.

Ready-to-eat (RTE) leafy greens are popular products that unfortunately have been associated with numerous foodborne illness outbreaks. Since the influence of consumer practices is essential for their quality and safety, the objective of this study was to analyze the microbiota of RTE products throughout shelf life during simulated household conditions. Products from different companies were analyzed in terms of plate counts, and resealed and unopened packages were compared. High bacterial loads were found, up to a total plate count of 9.6 log10 CFU/g, and Enterobacteriaceae plate counts up to 6.0 CFU/g on the expiration date. The effect of consumer practice varied, thus no conclusions regarding resealed or unopened bags could be drawn. The tested products contained opportunistic pathogens, such as Enterobacter homaechei, Hafnia paralvei and Pantoea agglomerans. Amplicon sequencing revealed that the relative abundance of major taxonomic groups changed during shelf life; Pseudomonadaceae and Xanthomonadaceae decreased, while Flavobacteriaceae and Marinomonadaceae inceased. Inoculation with E. coli CCUG 29300T showed that the relative abundance of Escherichia-Shigella was lower on rocket than on other tested leafy greens. Inoculation with E. coli strain 921 indicate growth at the beginning of shelf-life time, while E. coli 731 increases at the end, seemingly able to adapt to cold storage conditions. The high levels of live microorganisms, the detection of opportunistic pathogens, and the ability of E. coli strains to grow at refrigeration temperature raise concerns and indicate that the shelf life may be shortened to achieve a safer product. Due to variations between products, further studies are needed to define how long the shelf-life of these products should be, to ensure a safe product even at the end of the shelf-life period.

Fear of COVID-19, compliance with recommendations against virus transmission, and attitudes towards vaccination in Sweden.

Following the immense impact of the COVID-19 pandemic on health and everyday lives world-wide, people's fear of COVID-19 has been studied in a number of settings using the Fear of COVID scale. In Sweden, virus-preventing strategies have differed from comparable countries, with low use of formal lock-down procedures. It is crucial to study correlates of non-compliance with COVID-19 recommendations, and unwillingness to become vaccinated. This study aims to study whether fear of COVID is associated with mental distress and attitudes towards the pandemic, and to study correlates of non-compliance with key anti-COVID recommendations and with reluctancy to vaccination. This anonymous online survey study in web panel participants (N = 1,501) aimed to study a range of behavioral changes during COVID-19. Recommendations and vaccinations reluctancy were analyzed in logistic regressions against socio-demographic data, COVID-19 status, and mental health history. Internal consistency of the Fear of COVID scale was calculated. The Fear of COVID scale had a satisfactory internal consistency (Cronbach-alpha 0.84), and was significantly associated with compliance with all COVID-19 recommendations and with mental health. Non-compliance with recommendations was associated with low fear of disease and younger age, among other variables. Being against vaccination was associated, among other variables, with low fear of disease and with low education. In conclusion, the Fear of COVID scale appears to be associated with key attitudes towards the COVID-19 disease. Anti-virus strategies may need to promote compliance with recommendations in subgroups who feel low fear of disease or who believe not to be in a risk group for severe disease.

Match-Fixing Causing Harm to Athletes on a COVID-19-Influenced Gambling Market: A Call for Research During the Pandemic and Beyond.

Match-fixing, although not a new problem, has received growing attention during the COVID-19 pandemic, which has been reported in the media to have increased the risk of match-fixing events. Gambling is a well-documented addictive behavior, and gambling-related fraud, match-fixing, is a challenge to the world of sports. Most research on match-fixing has a judicial or institutional perspective, and few studies focus on its individual consequences. Nevertheless, athletes may be at particular risk of mental health consequences from the exposure to or involvement in match-fixing. The COVID-19 crisis puts a spotlight on match-fixing, as the world of competitive sports shut down or changed substantially due to pandemic-related restrictions. We call for research addressing individual mental health and psycho-social correlates of match-fixing, and their integration into research addressing problem gambling, related to the pandemic and beyond.

The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Who chooses to enroll in a new national gambling self-exclusion system? A general population survey in Sweden.

BACKGROUND: Self-exclusion from gambling is a common method for prevention and harm reduction in hazardous gambling. However, few national self-exclusion programs, involving a large number of gambling operators and activities in a country, have been assessed scientifically. This study aimed to examine characteristics of individuals who chose to enroll in a recently introduced (January, 2019) national self-exclusion system in Sweden. METHODS: Adults and adolescents (from age 16 and above) were addressed with an online survey sent to members of the web panel of a market survey company (1940 respondents). Psychological distress, previous history of addictive disorders, sociodemographic data, and recent history of gambling patterns and over-indebtedness were recorded. Logistic regression tested associations with self-exclusion, with unadjusted analyses conducted for the sub-group of moderate-risk or problem gamblers. RESULTS: Four percent reported having self-excluded using the new national self-exclusion system. In logistic regression, self-exclusion was significantly associated with younger age (OR 0.65 [0.54-0.79] for increasing age groups) and with the highest level of problem gambling (OR 2.84 [1.10-7.37]). In moderate-risk or problem gamblers, in unadjusted analyses, younger age (p < 0.05) and psychological distress (p = 0.02) were associated with self-exclusion. In none- or low-risk gamblers, 3% had self-excluded, which was significantly associated with younger age (p < 0.001) and self-reported over-indebtedness (p < 0.001). CONCLUSIONS: In a national, multi-venue online and land-based self-exclusion system, aiming to reduce the harm of problem gambling, self-exclusion is expectedly more common in problem gamblers, but also occurs among people without recent gambling problems. Further efforts may be needed in order to increase gambling self-exclusion in problem gamblers, and research in reasons for self-excluding, even in non-problem gamblers, is needed.

Clinical characteristics distinguishing tramadol-using adolescents from other substance-using adolescents in an out-patient treatment setting.

BACKGROUND: Non-medical Prescription Opioid Use (NMPOU) has increased worldwide during the last decades, and specifically, tramadol misuse may represent a novel pattern of substance use among adolescents. The present study aims to analyze characteristics distinguishing tramadol-using adolescents from other substance-using adolescents seeking out-patient treatment. METHODS: This is a cross-sectional study of treatment-seeking patients between 13 and 24 years of age in an out-patient facility for substance use problems in Malmö, Sweden. A total of 526 treatment-seeking adolescents at an out-patient treatment center were included. Data on substance use, treatment history and socio-demographic variables were extracted through a semi-structured interview method aimed specifically for adolescents with alcohol or drug problems (Ung-DOK). Lifetime tramadol users were compared to non-users, and also, primary tramadol users were compared to remaining subjects. RESULTS: Thirty-one percent (n = 162) were tramadol users (lifetime prevalence). In logistic regression, the tramadol group showed a significantly increased risk of tobacco use, problematic lifetime cocaine, benzodiazepine and amphetamine use, and were more likely to report contacts with the judicial system, and less likely to report contacts with child or adult psychiatry, and more likely to have parents born outside the Scandinavian countries. In logistic regression, primary tramadol use was negatively associated with frequent cannabis use. CONCLUSIONS: Tramadol use appears to be a novel pattern among treatment-seeking adolescents. They showed a significantly increased risk of initiation of other illicit drugs and criminal behaviour, despite less contact with psychiatric care. More attention may be needed to this relatively novel pattern of opioid use.

Role of Gambling in Payback Failure in Consumer Credit-Data from a Large Body of Material Regarding Consumer Loan Recipients in Sweden.

Indebtedness is associated with poor health outcomes, and problem gambling may contribute to indebtedness through consumer credits related to gambling expenses. The assessment of consumers' applications for loans may be an opportunity to detect and prevent further problem gambling. The present study analyzed a number of variables including gambling-related transactions and their association with payback failure in 48,197 loans to 20,750 individuals in Sweden. Sums and frequency of gambling deposits or withdrawals generally did not predict failure to pay back loans. Instead, having a loan defaulted at some time was associated with a baseline pattern describing a theoretical loss-of-control gambling pattern (short-term intense gambling), with a higher ratio of gambling deposits or withdrawals per occasion, and with several instances of gambling in close association with a loan. While several group differences were modest, signs of rapid, short-term and intense gambling, rather than gambling itself, may identify risk of payback failure and risk of indebtedness. Implications for early problem-gambling detection and prevention, such as by gambling operators and financial institutes, are discussed and may promote better public health in relation to gambling indebtedness.

Panel 7 - Pathogenesis of otitis media - a review of the literature between 2015 and 2019.

OBJECTIVE: To perform a comprehensive review of the literature from July 2015 to June 2019 on the pathogenesis of otitis media. Bacteria, viruses and the role of the microbiome as well as the host response are discussed. Directions for future research are also suggested. DATA SOURCES: PubMed database of the National Library of Medicine. REVIEW METHODS: PubMed was searched for any papers pertaining to OM pathogenesis between July 2015 and June 2019. If in English, abstracts were assessed individually for their relevance and included in the report. Members of the panel drafted the report based on these searches and on new data presented at the 20th International Symposium on Recent Advances in Otitis Media. CONCLUSIONS: The main themes that arose in OM pathogenesis were around the need for symptomatic viral infections to develop disease. Different populations potentially having different mechanisms of pathogenesis. Novel bacterial otopathogens are emerging and need to be monitored. Animal models need to continue to be developed and used to understand disease pathogenesis. IMPLICATIONS FOR PRACTICE: The findings in the pathogenesis panel have several implications for both research and clinical practice. The most urgent areas appear to be to continue monitoring the emergence of novel otopathogens, and the need to develop prevention and preventative therapies that do not rely on antibiotics and protect against the development of the initial OM episode.

Associations between Problematic Gambling, Gaming, and Internet Use: A Cross-Sectional Population Survey.

BACKGROUND: While pathological gambling, or gambling disorder, is an established diagnosis, a link to other potential behavioural addictions has been suggested. The present study aimed to investigate whether signs of problem gaming and problematic internet use are related to problem gambling in the general population, while including other potential risk factors. METHODS: A cross-sectional study design, using an electronical questionnaire, administered through a marketing survey company for relative representativeness with respect to age and gender. Potential correlates of problem gambling were measured in binary analyses, and significant associations were entered in a logistic regression analysis controlling them for one another. Problem gambling, gaming, and internet use were measured through established screening instruments (the CLiP, the GAS, and the PRIUSS). RESULTS: Statistically significant associations were found between problem gambling and both problem gaming and problematic internet use, as well as with male gender. In logistic regression, problem gaming, problematic internet use, and male gender remained associated with problem gambling. CONCLUSION: After controlling for potential demographic risk factors, problem gaming and problematic internet use may be related to problem gambling, suggesting that these constructs may interact or may share similar risk factors. More research is needed to clarify factors mediating the links between these conditions.

Gambling habits, gambling norms, and problem gambling in foreign born and native populations in Denmark - A general population survey.

BACKGROUND: Being foreign born, i.e. not born in the reception country or belonging to an ethnic minority, has been described as a risk factor of problem gambling, although research so far has been inconclusive. Also, there is limited knowledge about whether this association is caused by differing gambling norms. The present study aimed to study whether foreign origin is associated with problem gambling, when controlling for several potential risk factors, gambling frequency and beliefs about peer gambling, i.e. gambling norms. METHODS: Cross-sectional web survey including 1970 adult individuals from the general population in Denmark (50% female), in April 2018. Binary analyses and hierarchical logistic regression with respect to associations between foreign origin, relevant co-factors and problem gambling. RESULTS: Problem gambling was more common in individuals with foreign origin (15 vs 10%, p = 0.01). In logistic regression, problem gambling was associated with male sex, gambling frequency, foreign origin, psychological distress, smoking, and number of gambling types used. Beliefs about peer gambling did not differ with respect to foreign origin, but were associated with problem gambling until one's own gambling frequency was entered into the model. CONCLUSIONS: When controlling for a number of relevant risk factors, foreign origin still appears to predict problem gambling. Gambling patterns or gambling norms are unlikely to be the sole explanation of the increased prevalence. The findings have implications for preventive work in the foreign born population, and gambling norms may be targeted in screening for at-risk gamblers.

Television gambling advertisements: Extent and content of gambling advertisements with a focus on potential high-risk commercial messages.

BACKGROUND: In problem gambling, recent years have seen an expansion of online gambling in treatment-seeking patients. Television advertising may promote risky gambling, and this study aimed to assess gambling-related advertisements, with respect to potentially risky messages, in a country with high rates of online gambling among treatment seekers, for online casino particularly in treatment-seeking women. METHODS: A total of 144 h in six commercial television channels were studied with respect to frequency, extent and content of gambling-related advertisements, which were analyzed with respect to potentially risky messages and specific target groups, and compared with respect to legal status of gambling companies and for online casino gambling vs other gambling types. Aspects to analyze were elected theoretically and based on acceptable inter-rater agreement between the authors. RESULTS: Nineteen percent (11-28% across different channels) of advertisements promoted gambling, with online casino being by far the most common type of gambling exposed. Messages promoting ease to gamble (including bonuses and rapid cash-out messages) and a female focus were significantly more common in online casino gambling and in non-licensed companies, whereas sports-related messages were more common in licensed companies. Gambling-related advertisements were also common in relation to family movies, and appeared even during children's programs. CONCLUSIONS: Online casino was by far the most common type of televised gambling advertisements. Several risky messages were identified, and female gender, as well as messages promoting the rapidity and facility of gambling, were more commonly addressed by online casino companies. Public health aspects are discussed.

Problem gambling and gaming in elite athletes.

BACKGROUND: High-level sports have been described as a risk situation for mental health problems and substance misuse. This, however, has been sparsely studied for problem gambling, and it is unknown whether problem gaming, corresponding to the tentative diagnosis of internet gaming disorder, may be overrepresented in athletes. This study aimed to study the prevalence and correlates of problem gambling and problem gaming in national team-level athletes. METHODS: A web-survey addressing national team-level athletes in university studies (survey participation 60%) was answered by 352 individuals (60% women, mean age 23.7), assessing mental health problems, including lifetime history of problem gambling (NODS-CLiP) and problem gaming (GASA). RESULTS: Lifetime prevalence of problem gambling was 7% (14% in males, 1% in females, p < 0.001), with no difference between team sports and other sports. Lifetime prevalence of problem gaming was 2% (4% in males and 1% in females, p = 0.06). Problem gambling and problem gaming were significantly associated (p = 0.01). CONCLUSIONS: Moderately elevated rates of problem gambling were demonstrated, however with large gender differences, and interestingly, with comparable prevalence in team sports and in other sports. Problem gaming did not seem more common than in the general population, but an association between problem gambling and problem gaming was demonstrated.

Bacterial-Host Interactions: Physiology and Pathophysiology of Respiratory Infection.

It has long been thought that respiratory infections are the direct result of acquisition of pathogenic viruses or bacteria, followed by their overgrowth, dissemination, and in some instances tissue invasion. In the last decades, it has become apparent that in contrast to this classical view, the majority of microorganisms associated with respiratory infections and inflammation are actually common members of the respiratory ecosystem and only in rare circumstances do they cause disease. This suggests that a complex interplay between host, environment, and properties of colonizing microorganisms together determines disease development and its severity. To understand the pathophysiological processes that underlie respiratory infectious diseases, it is therefore necessary to understand the host-bacterial interactions occurring at mucosal surfaces, along with the microbes inhabiting them, during symbiosis. Current knowledge regarding host-bacterial interactions during asymptomatic colonization will be discussed, including a plausible role for the human microbiome in maintaining a healthy state. With this as a starting point, we will discuss possible disruptive factors contributing to dysbiosis, which is likely to be a key trigger for pathobionts in the development and pathophysiology of respiratory diseases. Finally, from this renewed perspective, we will reflect on current and potential new approaches for treatment in the future.

Correlates of Nine-Month Retention following Interim Buprenorphine-Naloxone Treatment in Opioid Dependence: A Pilot Study.

Interim medication-only treatment has been suggested for the initiation of opioid maintenance treatment (OMT) in opioid-dependent subjects, but this rarely has been studied using buprenorphine instead of methadone. Following a pilot trial assessing interim buprenorphine-naloxone treatment in order to facilitate transfer into OMT, we here aimed to study retention, and potential correlates of retention, in full-scale treatment. Thirty-six patients successfully referred from a waiting list through an interim treatment phase were followed for nine months in OMT. Baseline characteristics, as well as urine analyses during the interim phase and during full-scale OMT, were studied as potential correlates of retention. The nine-month retention in OMT was 83 percent (n = 30). While interim-phase urine samples positive for benzodiazepines did not significantly predict dropout from full-scale OMT (p = 0.09), urine samples positive for benzodiazepines within full-scale OMT were significantly associated with dropout (p < 0.01), in contrast to other substances and baseline characteristics. Retention remained high through nine months in this pilot study sample of patients referred through buprenorphine-naloxone interim treatment, but use of benzodiazepines is problematic, and the present data suggest that it may be associated with treatment dropout.