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A ‘Blackout Rage Gallon’ (borg) is a dangerous new alcohol consumption trend popular with young people. It involves creating a customised, individual alcoholic beverage by replacing half the water in a four litre (gallon) jug with alcohol (usually spirits), flavourings, electrolytes and caffeinated energy drinks or caffeine supplements. The most prevalent ‘recipe’ calls for the addition of 750ml of alcohol. The ‘blackout’ part of the name refers to the intent of one person to consume the borg in one session, thereby encouraging risky alcohol use. Indeed, there have been reports in popular media of multiple hospitalisations attributed to consumption of borgs at college events in the United States. Part of the attraction of the trend is to label the borg with a clever name, usually incorporating the term ‘borg’. The trend has gained traction recently on TikTok, which has become an important, yet unregulated, source of information for the public including young people(1). We investigated TikTok videos associated with the hashtag #borg to better understand this dangerous new phenomenon. We identified and analysed highly viewed TikTok videos (n = 105) for engagement, techniques, characteristics of featured individuals, and the portrayal of alcohol and risky drinking behaviours. Alcohol was visible in three quarters of the videos analysed (n = 78), and consumed in one third (n = 34). The average amount of alcohol present was well in excess of safe drinking guidelines (865ml) One quarter of videos (n = 25) promoted alleged benefits such as control of volume of consumption, protection from drink spiking, and mitigation of side effects due to addition of electrolytes and water. Alarmingly, only 9 videos included a warning about potential harms of the borg or alcohol in general. Indeed, videos discussing potential harms and benefits tended to encourage the use of borg, for example ‘I’m on board with the borg’. Our study found the borg TikTok trend encourages risky drinking in a fun and entertaining way, supporting previous studies where the majority of content was positively portraying a product or behaviour(2). As there is an association between viewing alcohol-related content on social media and alcohol use(3), there is an urgent need for social media content restrictions to limit the visibility of risky alcohol consumption, particularly to underage users.

Emerging data suggest unique features characterize the rectal microbiota of men who have sex with men (MSM) and people living with HIV (PLWH). The microbiota may have important health implications in these groups, but most studies have been conducted in the United States or Europe. This study leveraged metagenomic sequencing to evaluate relationships between rectal microbiota composition and clinical, behavioral and demographic characteristics in a cohort of Nigerian MSM. PLWH with suppressed viral load had lower α-diversity (richness) compared to people without HIV (PWoH), with similar trends for PLWH with an unsuppressed viral load. Lower α-diversity (Shannon) was associated with use of petroleum jelly lubricant for anal sex. Lower relative abundance of the genus Prevotella was seen in PLWH with a suppressed viral load versus PWoH. There were differences in abundance of the top 20 taxa associated with age, HIV status (enhanced in virally suppressed PLWH versus PWoH), lubricant use, receptive anal intercourse, and condom use, suggesting multiple clinical and behavioral factors impact the rectal microbiota. Future characterization of health outcomes associated with the rectal or gut microbiota in MSM and PLWH as well as potential interventional insights will necessitate larger, dedicated studies across diverse geographic locations.

The physical location of liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol(1). As children transit to and from school, it is feasible that the presence of liquor stores near schools could also increase their exposure to alcohol advertising. Cumulative exposure to advertising influences alcohol attitudes, intentions and alcohol use(2), so reducing children’s exposure to alcohol advertising is important to delay the initiation of drinking and reduce future harms. As this has not yet been investigated in Australia, the aim of this study was to investigate whether the presence of a liquor store near a school was associated with an increased prevalence of outdoor alcohol advertising in Perth, Western Australia. We identified all outdoor alcohol advertising within a 500m radius (audit zone) of 64 randomly selected primary and secondary schools from low and high socio-economic areas across metropolitan Perth. We recorded the size, type, setting, and location of each advertisement during field data collection. Each zone was categorised by the presence or absence of at least one liquor store within the school audit zone, and results compared across these stratifications. Over half (56%) of the 64 school audit zones had at least one alcohol advertisement. On average, there were 5.9 alcohol advertisements per zone. School audit zones that contained a liquor store (59%) had over thirty times the average number of alcohol advertisements compared with audit zones that did not contain a liquor store (9.7 vs 0.3). The majority of all the alcohol advertisements identified (63%) were located outside a liquor outlet as opposed to other food businesses (2%), along the roadside (31%), on a bus shelter (3%) or on/outside another business (0.5%). Our findings that Perth schools with a liquor store nearby had more outdoor alcohol advertising within a 500m radius, compared with schools without a nearby liquor store, were independent of school type (primary or secondary) or the socio-economic status of the area. This poses significant concerns about the exposure of underage populations to outdoor alcohol advertising, and the resultant influence on alcohol use. These results underscore the necessity for policy interventions to mitigate children’s exposure to alcohol marketing, especially during the daily school commute, by regulating the location of liquor stores and alcohol promotion near schools. It will be important to incorporate the voices of children when developing future policies to assert their right to be consulted, heard and appropriately influence their environments.

TikTok is a global social media platform popular with young people, encouraging viewers to engage with user-generated video content (through likes, shares and comments) and mimic displayed behaviours (by creating similar videos or content). It is therefore a powerful and engaging tool that has potential for the widespread dissemination of information (or misinformation) and to influence behaviours. Social media is saturated with the promotion of ‘diet culture’ and has a strong influence on the eating behaviours of young people (1,2). This is concerning as childhood and adolescence are critical periods of growth requiring optimal nutrition (3). This study aimed to investigate how dieting is portrayed on TikTok and consider the potential implications for public health. A cross-sectional descriptive content analysis was undertaken of 50 videos from each of the five most popular diet-related hashtags (#diet, #whatieatinaday, #wieiad, #dietitian, #diettips). A codebook was developed to analyse the body-related content referenced (weight measurement, calories, body image, body checking, body comparisons over time) and collect the engagement for each video (likes, comments and shares). Overall, the 250 videos contributed to a total of 197.2 million likes (M = 789,051.0, SD = 923,335.0), 126,7251 comments (M = 5,069.0, SD = 9,315.3), and 3.8 million shares (M = 15,423.2, SD = 41,271.3). Most videos featured adults (n = 205, 82%), and only a small number of videos featured identifiable children or adolescents (n = 16, 6.4%). The information and advice regarding diets and eating behaviours came from two types of sources: 'experts’ and regular creators sharing their personal experience. Almost half of the videos were educational or instructional (n = 116, 46.4%), of which 74 (63.8%) were posted by users who claimed expert status. The most common titles by those claiming to be experts were “dietitian” (n = 43, 58.1%), “health and wellness coach” (n = 7, 9.5%), “doctor” (MD; n = 6, 8.1%), “fitness trainer” (n = 6, 8.1%), and “nutritionist” (n = 3, 4.1%). Of the videos that specifically mentioned a certain diet, the most common diets were low calorie (n = 32, 12.8%), vegan (n = 14, 5.6%), self-reported healthy eating (n = 12, 4.8%), and fasting (n = 10, 4.0%). The use of humour was the only feature significantly associated with engagement. Health professionals are presented with a unique opportunity to widely and positively influence the public by utilising the popularity of TikTok amongst young people to disseminate evidence-based information and promote healthy eating behaviours. Our findings suggest that experts using authentic, humorous, and engaging personas would be more likely to be popular on this platform.

Background The impacts of the COVID-19 pandemic have been vast and are not limited to physical health. Many adolescents have experienced disruptions to daily life, including changes in their school routine and family’s financial or emotional security, potentially impacting their emotional wellbeing. In low COVID-19 prevalence settings, the impact of isolation has been mitigated for most young people through continued face-to-face schooling, yet there may still be significant impacts on their wellbeing that could be attributed to the pandemic. Methods We report on data from 32,849 surveys from Year 7–12 students in 40 schools over two 2020 survey cycles (June/July: 19,240; October: 13,609), drawn from a study of 79 primary and secondary schools across Western Australia, Australia. The Child Health Utility Index (CHU9D) was used to measure difficulties and distress in responding secondary school students only. Using comparable Australian data collected six years prior to the pandemic, the CHU9D was calibrated against the Kessler-10 to establish a reliable threshold for CHU9D-rated distress. Results Compared to 14% of responding 12–18-year-olds in 2013/2014, in both 2020 survey cycles almost 40% of secondary students returned a CHU9D score above a threshold indicative of elevated difficulties and distress. Student distress increased significantly between June and October 2020. Female students, those in older Grades, those with few friendships or perceived poor quality friendships, and those with poor connectedness to school were more likely to score above the threshold. Conclusions In a large dataset collected during the first year of the COVID-19 pandemic, the proportion of secondary school students with scores indicative of difficulties and distress was substantially higher than a 2013/2014 benchmark, and distress increased as the pandemic progressed, despite the low local prevalence of COVID-19. This may indicate a general decline in social and emotional wellbeing exacerbated by the events of the pandemic. Trial registration: ANZCTRN (ACTRN12620000922976). Retrospectively registered 17/08/2020. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380429&isReview=true .

World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource?limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic?based cohort across four African countries. The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ?2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm[sup.3] (IQR: 81 to 286) to 298 cells/mm[sup.3] (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ?500 cells/mm[sup.3] was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm[sup.3] (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.

Greenberg and Mitchell (1983) have suggested that the drive/structure model and the relational/structure model are mutually exclusive models of psychic life. We regard their contribution as an invaluable one, which makes explicit the fundamental divergences in psychoanalytic theory. We have examined a derivative tendency in the field, for drive and relational theorists alike, to present psychic life as a dichotomy between inner experience and outer experience. We see a tendency to equate the drive model with unconscious motivation, and to the primacy of internal experience. There seems to be an equivalent tendency to equate the relational model with conscious perception and motivation, and to the primacy of external experience. We are advocating, for drive and relational theorists alike, greater focus on the process of intermediation between internal and external experience in the psychic life of the individual. Within the context of the drive model, precedent for such a focus is found in Freud's conception of the preconscious, an essential third dimension whose function was to mediate between the conscious and the unconscious. Within the context of the relational model, Winnicott's notion of potential space serves as a bridge between interior experience and external reality in the life of the individual. Finally, we have argued that by constructing three-part models of psychic life, these theorists have laid the groundwork for a synthetic theory. Though for Freud the drive state is primary, and for Winnicott the relationship between the infant and its environment (mother) is primary, each theorist posits an intermediating zone that fulfills a similar function in the psychic life of the individual. Whether we choose to call that zone the preconscious or potential space, its function is to translate bidirectionally between the infinitely dimensioned realm of interior, or unconscious, experience and the time-and space-bound realm of external, or conscious, experience. By highlighting the parallel constructs, we are not claiming to have created a synthesis between the theories. Our claim is that the eventual road to synthesis appears to reside in the direction of a movement away from the dichotomy between the primacy of inner or outer experience, and toward the common meeting ground of the primacy of an intermediating function.