Abstract. Buruli ulcer (BU) is an infectious skin disease that occurs mainly in West and Central Africa. It can lead to severe disability and stigma because of scarring and contractures. Effective treatment with antibiotics is available, but patients often report to the hospital too late to prevent surgery and the disabling consequences of the disease. In a highly endemic district in Ghana, intensified public health efforts, mainly revolving around training and motivating communitybased surveillance volunteers (CBSVs), were implemented. As a result, 70% of cases were reported in the earliest-World Health Organization category I-stage of the disease, potentially minimizing the need for surgery. CBSVs referred more cases in total and more cases in the early stages of the disease than any other source. CBSVs are an important resource in the early detection of BU.

This study seeks to find the dollar value of social costs of gambling. The authors use data from a survey of 99 members of Gamblers Anonymous (GA) groups in southern Nevada. The GA members were asked many questions about their behavior while they were active gamblers, such as how often they missed work because of gambling, how much they borrowed because of gambling, how much they stole because of gambling and their experiences with the judicial system and welfare systems because of gambling. Societal costs of each behavior were calculated and annualized. It was determined that each of the compulsive gamblers imposed social costs of $19,711 on others in southern Nevada. Of these costs, $1,428 (7.2%) were governmental costs, while $6,616 (33.6%) represented economic losses for southern Nevada. Using estimates of the numbers of pathological and problem gamblers in Nevada, it was determined that the overall social costs of compulsive and problem gambling in southern Nevada ranged from $314 million to $545 million per year.

T HIS ARTICLE REFORTS an analysis of new data on the cost to society of compulsive gambling. Such analyses must be available to policymakers who are called on to authorize and control gambling activities. They must also be accessible to courts as they wrestle with questions of assigning legal responsibility for the incidence of problem gambling and its consequences. The gambling phenomenon has witnessed significant expansion over the past decade. Prior to 1988, only two states-Nevada and New Jersey-permitted casino gambling. Then the Indian Gaming Regulatory Act (IGRA) was passed, bringing casino gambling to Native American lands in a score of states. Soon, commercial riverboat casinos appeared on the waterways of Iowa, Illinois, Mississippi, Louisiana, Indiana, and Missouri. South Dakota and Colorado authorized small-stakes casino gaming for selected towns, while Louisiana and Michigan approved high-rolling casinos in their largest cities. Additionally, in recent years the number of states with government-operated lotteries has increased to 37 (plus the District of Columbia), and states with horserace and dograce gambling have also increased in number. 1 Although a wave of gambling fever seems to be sweeping the country, the voices of gambling opponents are also growing louder. In

Legalized gambling is expanding throughout the world. There is considerable variation in the patterns of gambling operations found in different places. This article examines the difference between the mass-marketed casinos of North America and the very restricted casinos of Europe. Explanations for the different styles are suggested. Casinos in other developed nations as well as in the less developed nations are also examined, as are lottery operations. It is suggested that the North American pattern, although appealing to entrepreneurs, will not soon be adopted in Europe or in any widespread way in other parts of the world.

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