Gambling Marketing from 2014 to 2018: a Literature Review

Purpose of Review: Legislation and technology have led to unprecedented changes in the frequency and content of gambling marketing in many countries. We build upon previous reviews by exploring research on gambling marketing from between 2014 and 2018. Recent Findings: Most literature reviewed was from the UK or Australia, with three key findings identified. First, gambling marketing is highly targeted and ubiquitous around sport, with the most popular strategies being increasing brand awareness, advertising complex financial incentives for participation and advertising complex betting odds. Second, perceptions of gambling advertising, particularly among vulnerable groups (e.g. children, problem gamblers) appear to be influenced by this targeted content. Third, emerging research suggests that awareness of gambling marketing is associated with more frequent and riskier gambling behaviour. Summary: The reviewed literature suggests that gambling marketing is targeted and influences how gambling is perceived, and that it may affect gambling-related behaviours

The Effect of Gambling Marketing and Advertising on Children, Young People and Vulnerable People

This report has seven main conclusions. First, gambling companies use the full range of ‘paid for’ advertising channels available to promote a variety of gambling brands and forms of gambling. Second, sport (especially football) is a key conduit for gambling marketing and takes a variety of often subtle forms (e.g. television advertising, shirt sponsorship and pitch side advertising). This could further contribute to the normalisation of gambling, especially for children and young people who are more susceptible to marketing and are not fully aware of the complexity of the bets promoted and the potential impact of gambling related harm Third, advertising portrays gambling as an attractive, normal, and positive behaviour, and includes some content which may appeal to children and young people. Fourth, consumer information and messages in advertising appears inadequate, with limitations in the visibility of age restrictions, consumer protection messages, and T&Cs. Indeed, gambling advertising contains little to no information regarding negative outcomes (e.g. losses or potential harms). Fifth, gambling marketing increasingly features extensive, and often complex, information about the gamble and associated offers, which could result in misperceptions of potential wins and risk. Sixth, some advertising contained content which is supposedly prohibited by existing self-regulation, particularly messages which exploit the susceptibilities of young or vulnerable groups. Finally, this study has identified a lack of UK evidence examining the content, reach and effect of gambling marketing. There is an urgent need for longitudinal cohort studies to investigate the causal relationship between gambling marketing and gambling behaviour

Difficulties with assessment and management of an infant\u27s distress in the postoperative period: optimising opportunities for interdisciplinary information-sharing

OBJECTIVES: The importance of accurate paediatric patient assessment is well established but under-utilised in managing postoperative medication regimens.METHODS: Data for this case report were collected through observations of clinical practice, conduct of interviews, and retrieval of information from the medical record. This case report involving a hospitalised 1-year-old boy demonstrates the difficulties associated with assessing and managing postoperative distress, including pain and other clinical conditions related to the surgical procedure.RESULTS: Postoperatively, there were difficulties in managing pain and an episode of over-sedation, occasioning opiate reversal with naloxone. In addition, he had decreasing oxygen saturation and increased work of breathing. X-ray showed changes consistent with either atelectasis or aspiration, and he was commenced on antibiotics. The patient experienced respiratory distress and required intervention from the medical emergency team.CONCLUSION: This case demonstrated the importance of comprehensive assessment and careful consideration of alternative causes of an infant\u27s distress using the results of assessment tools to aid decision-making. Communication moderates effective patient care, and more favourable outcomes could be achieved by optimising interdisciplinary information-sharing

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Unfractionated heparin therapy in paediatrics

© 2009 Dr. Fiona Helen Newall.Unfractionated heparin (UFH) therapy is frequently used in tertiary paediatric healthcare facilities despite a lack of paediatric-specific research informing the optimal therapeutic intensity, monitoring recommendations or side-effect-profile in infants and children. As a result, the majority of clinical recommendations regarding UFH management in children have been extrapolated from adult evidence. The process of developmental haemostasis, in association with the variable pathogenesis of thromboembolic disease (TED) in children compared to adults, suggests that extrapolation of adult guidelines for UFH management to children is not ideal. This study hypothesised that the process of developmental haemostasis would influence both the action and effect of UFH in children of different ages. This hypothesis was tested by addressing the following aims: 1. To determine the pharmacokinetics (PK) of UFH in children of different ages; 2. To compare the different methods of monitoring UFH in children of different ages; 3. To identify the impact of competitive plasma binding of UFH in children of different ages; 4. To determine the impact of UFH upon tissue factor pathway inhibitor (TFPI) release in children. A prospective cohort study of children receiving a single bolus dose of UFH for primary thromboprophylaxis in the setting of cardiac angiography was conducted. Venous blood samples were collected prior to the UFH, then at 15, 30, 45 and 120 minutes post-UFH bolus. Laboratory assays performed included activated partial thromboplastin time (APTT), anti-Xa assay, anti-IIa assay, thrombin clotting time (TCT), protamine titration and TFPI. Levels of two plasma proteins known to competitively bind UFH (vitronectin and platelet factor 4) were determined and the impact of competitive plasma binding upon UFH activity, as measured by the anti-Xa assay, was quantified. A population approach to pharmacokinetic analysis, based on protamine titration results, was performed using WinNonMix™ Professional 2.0.1 (®1998-2000 Pharsight Corporation, Mountain View, CA, USA). Results were analysed according to the following age-groups: less than one year; one to five years; six to ten years; 11-16 years. Sixty-four children were recruited, ranging in age from six months to fifteen-and-ahalf years. The mean dose/Kg of UFH across the entire cohort was 90.9± 15.5 IU/Kg. Pharmacokinetic model specifications were systematically assessed, investigating the impact of parameter covariates and different error models upon objective function value and/or curve fitting. A first-order kinetic model best fitted the data. This model used weight 0.75 as the covariate of clearance and total weight as the covariate for volume of distribution. Parameter estimates for clearance and volume of distribution both demonstrated variance from adult and small neonatal PK studies of UFH, however methodological differences in PK analysis techniques limited comparisons. The half-life of UFH reported in this study was consistently and significantly shorter than that previously reported for adults, but longer than that reported for neonates. All measures of UFH-effect demonstrated a significant and prolonged increase post- UFH bolus. The mean APTT was 261 seconds 102 ± 25 minutes post-UFH, representing a seven-fold increase from the mean baseline APTT (38 seconds). Anti- Xa assay levels were within the therapeutic range for TED management (0.35 to 0.7 IU/mL), or greater, at every post-UFH bolus timepoint. This prolonged UFH-effect was evident to nearly two hours post-UFH bolus, without concurrent UFH infusion. Age-related differences in UFH-response were evident for anti-Xa, anti-IIa and protamine titration results. Furthermore, during periods of high UFH concentration, the ratio of anti-Xa to anti-IIa activity in children less than one year of age significantly favoured UFH-mediated anti-Xa effect over anti-IIa effect (1.9), compared to teenagers (1.3). This study demonstrated poor correlation between protamine titration and both the anti-Xa assay (r2 = 0.47) and APTT (r2 = 0.56). Use of the anti-Xa assay (0.35 to 0.7 IU/mL) or protamine titration assay (0.2 to 0.4 IU/mL) to establish APTT-based reference ranges for therapeutic management of TED resulted in APTT ranges with upper limits greater than 250 seconds. No age-related quantitative differences in plasma levels of vitronectin or platelet factor 4 were identified across the childhood years. The addition of dextran sulphate (DS) to ex vivo study samples demonstrated no change in anti-Xa activity in samples collected within 20 minutes of UFH bolus, however a significant increase in anti-Xa activity following the addition of DS was evident at all later timepoints post-UFH bolus. The measurement of TFPI before and after a single bolus dose of UFH demonstrated children have a similar immediate increase in TFPI activity following intravenous UFH compared to adults. However, the children in this series demonstrated a significantly prolonged level of increased TFPI activity, out to 102 ± 25 minutes post-UFH, compared to that reported in adult patients. This study has developed the first paediatric-specific PK profile of UFH and has elucidated a number of age-dependent UFH-mechanisms of action that contribute to the previously reported age-dependent response to UFH in children. The results of this study support the hypothesis that developmental haemostasis influences both the action and effect of UFH in children of different ages

Warfarin therapy in infants and children

© 2004 Fiona Helen NewellMuch of the evidence that guides anticoagulant management in infants and children has been presumptively extrapolated from adult medicine. We now know that there are several reasons as to why such extrapolation may not be ideal. This study sought to explore key outcomes of warfarin management in infants and children. The medical literature supports a direct association between patient knowledge and the stability of warfarin therapy. Phases One and Two of this project respectively investigated Parental and Nursing staff understanding of warfarin therapy in the paediatric population. Phase Three constituted a retrospective audit of warfarin management at a single tertiary paediatric centre over a two-year period. Data collected aimed to shed light upon the efficacy and safety outcomes of warfarin therapy in this cohort. Phase Four consisted of the development and implementation of a novel parent education program, which was piloted in a trial of home monitoring of warfarin therapy. Results of Phases One and Two demonstrated that parental and nursing understanding of warfarin therapy in children is poor. Although a causative link cannot be proven between the level of knowledge each of these cohorts possess, the role nurses play as educators must be reviewed in light of these outcomes. Phase Four demonstrated that parental understanding of warfarin therapy significantly improved following implementation of a novel education program, and these improved knowledge outcomes can be sustained over time. This program facilitated the implementation and evaluation of a home INR monitoring pilot study. Target therapeutic range (INR) achievement compared favourably with studies reported in adult patients, despite the presence of numerous confounding factors in the paediatric population. However, adverse event rates were higher than has previously been reported for similar paediatric populations. The incidence of adverse events appeared to be greater in patients not managed by a dedicated anticoagulant clinic. Warfarin management in children presents unique challenges that must be addressed if optimal anticoagulant therapy is to be achieved

Creating a journal club competition improves paediatric nurses' participation and engagement.

BACKGROUND To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation. OBJECTIVE To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition. DESIGN A descriptive exploratory study. SETTING AND PARTICIPANTS An Australian specialist tertiary paediatric hospital with over 1600 nurses. METHODS In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club. RESULTS Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median=20.5 [IQR=18.2, 27.7] vs. 2012 median=9 [IQR=6.5, 12.5], Mann-Whitney U test, p<0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n=224, Attendees n=65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content. CONCLUSION A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings

External evaluation of the Dumfries and Galloway Better Neighbourhood Services Fund (BNSF) Vulnerable Older People's Pathfinder.

EdinburghIn January 2001, the Better Neighbourhood Services Fund (BNSF) was set up by the Scottish Executive to enable local authorities and their community planning partners to improve services in Scotland in accordance with the Social Justice initiative. Twelve local authorities were asked to put forward strategies for the delivery of better services within neighbourhoods in their pathfinder area. Dumfries and Galloway council developed a strategy for older people called the Vulnerable Older People Pathfinder (VOPP), known locally as ‘Guid Services for Older Folk’, which was funded by BNSF for a three year period. The VOPP, together with the Scottish Executive, developed a Local Outcome Agreement (LOA), with a headline aim, or outcome, to: “Enable more vulnerable people to stay living in their own homes for longer, by increasing the range, quality and accessibility of preventative services”. To that end BNSF has funded a number of projects providing preventative services for older people. This approach is underpinned by a wealth of research that highlights the benefits of low-level preventative services to older people’s quality of life (e.g. Clark,et al. 1998).NO DIVISIONpub509pu