Factors associated with Cryptosporidium in men who have sex with men: A systematic review

BACKGROUND

Cryptosporidium parasites are an important cause of diarrhoea globally and sexual transmission may occur in men who have sex with men (MSM). We aimed to systematically review the literature to explore any factors associated with transmission of Cryptosporidium in MSM to provide insight for future guidelines and public health strategies.

METHODS

We searched MEDLINE, Embase, CINAHL and Web of Science for manuscripts published up to July 2023. A primary author conducted an initial screen of abstracts and full text eligibility, and risk of bias was assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis without meta-analysis method to synthesise narrative data. The review was registered on PROSPERO (CRD42023374279).

RESULTS

Six manuscripts were included in the final review from the USA (n = 3), Europe (n = 1) and Australia (n = 2) and were case series (n = 2), cross sectional (n = 2) and case control studies (n = 2) published between 1984 and 2021 and overall there were 1582 cases of Cryptosporidium in MSM. We identified demographic factors (living with HIV, younger age [<30 years old], geographical areas [Southern Europe v Northern Europe], previous Treponema pallidum, previous Entamoeba histolytica) and behavioural factors (recreational drug use, higher number of sexual partners and MSM attending sex on premises venues with spa/sauna) associated with Cryptosporidium in MSM.

CONCLUSIONS

Despite a small number of manuscripts in this review, we identified demographic and behavioural factors associated with Cryptosporidium in MSM. These data will provide insight for public health interventions for future outbreaks of Cryptosporidium in MSM.

Factors associated with the sexual transmission of Strongyloides stercoralis in men who have sex with men: A systematic review

Strongyloides stercoralis is a parasitic worm with a complex life cycle and can cause significant morbidity, including a proctocolitis and life-threatening hyperinfection syndrome. Limited reports from non-endemic areas, including in men who have sex with men (MSM), suggest sexual transmission of S. stercoralis. In this systematic review of the published literature, we aimed to explore the associated factors of S. stercoralis in MSM. We systematically searched three bibliographical databases (MEDLINE, CINAHL and EMBASE) up to November 2022. We used a two-stage process to assess eligibility: the primary author conducted an initial screen of abstracts, and then three authors conducted independent full manuscripts to determine the final eligible manuscripts. We only included manuscripts written in English that contained data on specific factors associated with sexual transmission in MSM. We used the STROBE checklist to assess the risk of bias and synthesized the narrative data using the SWiM method. Seven manuscripts were eligible for this review (four case reports, one case series, one cross-sectional study and one experimental study), which included 22 individuals from Europe and the Americas. From these studies, S. stercoralis in MSM was associated with living with HIV (including having a low CD4 count and not using antiretrovirals), having a concomitant sexually transmitted infection (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and hepatitis C) and a concomitant (sexually transmitted) protozoal infection (Entamoeba histolytica, Giardia lamblia), travel to the S. stercoralis endemic area, multiple sexual partners from endemic areas, oro-anal sexual contact and chemsex. Although limited by the number of cases in the literature, we have highlighted some possible biological and behavioural risk factors associated with the sexual transmission of S. stercoralis in MSM that could be used to both target future research and S. stercoralis public health control interventions.

Factors and presenting symptoms associated with intestinal spirochaetosis in men who have sex with men: A systematic review

The transmission dynamics and presenting symptoms of intestinal spirochaetosis (Brachyspira pilosicoli, Brachyspira aalborgi) are poorly understood but is seen more frequently in men who have sex with men (MSM) where sexual transmission may occur. We aimed to systemically review the literature to define the factors and presenting symptoms associated with intestinal spirochaetosis in MSM. We systematically searched three bibliographical databases (MEDLINE, EMBASE and Scopus) for manuscripts written in English up to November 2022. The primary author conducted an initial screen and three authors conducted independent reviews to determine the final eligible manuscripts. We only included manuscripts where there were specific data on factors and presenting symptoms associated with intestinal spirochaetosis in MSM. Fifteen manuscripts published between 1981 and 2022 met the inclusion criteria that included 188 MSM. Sexually transmitted intestinal spirochaetosis in MSM was associated with-living with HIV (including having a low CD4 count <200 mm3), having a concomitant sexually transmitted infection, a history of a sexually transmitted infection, co-infection with intestinal parasites; and sexual behaviour including oro-anal sexual contact, oro-genital contact, fisting, condom-less anal sex, receptive anal sex, multiple non-regular sexual partners and increased number of lifetime sexual partners. The presenting symptoms of MSM with intestinal spirochaetosis were diarrhoea, abdominal pain, constitutional symptoms and proctitis, including rectal pain, rectal bleeding rectal discharge, flatulence and tenesmus. We have highlighted some biological and behavioural factors and presenting symptoms associated with intestinal spirochaetosis in MSM which provide insight for clinicians, guidelines and future public health control strategies.

Beyond-66: A pilot evaluation of a novel, peer-led harm reduction intervention for chemsex dependant men who have sex with men in Kuala Lumpur, Malaysia

BACKGROUND

There is little research exploring harm reduction interventions for men who have sex with men (MSM) who engage in chemsex. Beyond-66 is a novel, 132-day, peer-led intervention programme for MSM who are chemsex dependent in Kuala Lumpur, Malaysia. We aimed to evaluate the feasibility, retention and effect of Beyond-66 on: abstinence from chemsex, motivation for abstinence, and mental wellbeing.

METHOD

We collected data on demographics, retention and completion and abstinence between January 2021-August 2023 in MSM using Beyond-66. Using 10-point Likert scales, we compared motivation to remain abstinent and mental wellbeing at the beginning and end of Beyond-66.

RESULTS

25 MSM have either completed or dropped out/referred out of Beyond-66, 12/25(48%) were living with HIV and the median duration of chemsex use was 5 years (IQR = 4-6). 19 (76%) completed programme; 3 were referred out for a psychiatry assessment and 3 dropped out of the programme. 14 (74%) remain abstinent and 5 relapsed. The median motivation for abstinence scores for the 19 completers increased significantly between the pre-programme and post-programme period (7/10 (IQR = 4-8) to 9/10 (IQR = 5-10), p = .04) and the median mental health score (Likert score out of 10 where 10 is poor mental health) reduced significantly (5/10 (IQR = 4-7) to 2/10 (IQR 1-6), p = .008).

CONCLUSION

This pilot evaluation suggests that MSM using Beyond-66 experience high completion (76%) and abstinence (74%) rates and increased motivation for abstinence and mental wellbeing scores. Further research is needed to design, develop, and deliver peer led interventions for MSM who are chemsex dependant.

Independent clinic-based evaluation of dual POCTs for screening for HIV and syphilis in men who have sex with men in Italy, Malta, Peru, and the United Kingdom

INTRODUCTION

Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM).

METHOD AND ANALYSES

A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites.

RESULTS

Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs).

CONCLUSIONS

Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings.

Tomographic FLEET with a wedge array for multi-point three-component velocimetry

Femtosecond laser electronic excitation tagging (FLEET) velocimetry is an important diagnostic technique for seedless velocimetry measurements particularly in supersonic and hypersonic flows. Typical FLEET measurements feature a single laser line and camera system to achieve one-component velocimetry along a line, although some multiple-spot and multiple-component configurations have been demonstrated. In this work, tomographic imaging is used to track the three-dimensional location of many FLEET spots. A quadscope is used to combine four unique views onto a single high-speed image intensifier and camera. Tomographic reconstructions of the FLEET emission are analyzed for three-component velocimetry from multiple FLEET spots. Glass wedges are used to create many (nine) closely spaced FLEET spots with less than 10% transmission losses. These developments lead to a significant improvement in the dimensionality and spatial coverage of a FLEET instrument with some increases in experimental complexity and data processing. Multiple-point three-component FLEET velocimetry is demonstrated in an underexpanded jet.

Impact of Preoperative Mapping and Intraoperative Neuromonitoring in Minimally Invasive Parafascicular Surgery for Deep-Seated Lesions

BACKGROUND

Transsulcal tubular retractor-assisted minimally invasive parafascicular surgery changes the surgical strategy for deep-seated lesions by promoting a deficit-sparing approach. When integrated with preoperative brain mapping and intraoperative neuromonitoring (IONM), this approach may potentially improve patient outcomes. In this study, we assessed the impact of preoperative brain mapping and IONM in tubular retractor-assisted neuro-oncological surgery.

METHODS

This retrospective single-center cohort study included patients who underwent transsulcal tubular retractor-assisted minimally invasive parafascicular surgery for resection of deep-seated brain tumors from 2016 to 2022. The cohort was divided into 3 groups: group 1, no preoperative mapping or IONM (17 patients); group 2, IONM only (25 patients); group 3, both preoperative mapping and IONM (38 patients).

RESULTS

We analyzed 80 patients (33 males and 47 females) with a median age of 46.5 years (range: 1-81 years). There was no significant difference in mean tumor volume (26.2 cm3 [range 1.07-97.4 cm3]; P = 0.740) and mean preoperative depth of the tumor (31 mm [range 3-65 mm], P = 0.449) between the groups. A higher proportion of high-grade gliomas and metastases was present within group 3 (P = 0.003). IONM was related to fewer motor (P = 0.041) and language (P = 0.032) deficits at hospital discharge. Preoperative mapping and IONM were also related to shorter length of stay (P = 0.008).

CONCLUSIONS

Preoperative and intraoperative brain mapping and monitoring enhance transsulcal tubular retractor-assisted minimally invasive parafascicular surgery in neuro-oncology. Patients had a reduced length of stay and prolonged overall survival. IONM alone reduces postoperative neurological deficit.

Harm reduction services for people engaging in chemsex in Brighton, UK: A pilot qualitative study

OBJECTIVE

A broad range of stakeholders commission and provide harm reduction support for people who engage in chemsex, including public health, sexual health, mental health, HIV services and substance misuse services. Understanding the experiences of stakeholders could provide important insights and suggest ways to improve outcomes. We aimed to explore the experiences of stakeholders providing harm reduction support to people who engage in chemsex in Brighton, UK.

METHODS

We conducted semi structured interviews with chemsex harm reduction stakeholders who provide support for people in Brighton, UK. The semi-structured interviews were recorded, transcribed, and analysed thematically using NVivo 1.6.2: Braun & Clarke framework.

RESULTS

We recruited ten stakeholders with at least 6 months of experience in providing commissioning, managing or providing harm reduction services to people who engage in chemsex. Five themes emerged from the stakeholders: stakeholder perception of client pathways (inefficiency in client pathways, inequitable access to services, unmet client mental health needs) and stakeholder experiences (having to use an 'empathy', 'non judgement' and 'guiding hand' approach), and experiencing emotional burnout as a result of the chemsex harm reduction work.

CONCLUSIONS

This pilot study of stakeholders suggests that to improve chemsex harm reduction outcomes, a more integrated approach between providers with clear client pathways and a broader reach including services tailored towards non-MSM, and offering services outside of typical business hours is needed. Furthermore, the sustainability of services requires increased workplace support for chemsex service providers to prevent burnout and maintain service quality.

Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS

BACKGROUND

We sought to explore associations between trainee doctor perception and excess patient mortality.

METHODS

Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.

RESULTS

All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.

CONCLUSION

Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

An evaluation of clinical fellow programmes in an acute teaching hospital trust

BACKGROUND/AIMS

Clinical fellows support the hospital workforce while gaining experience in different specialities, research, leadership and teaching. The authors aimed to assess the impact of clinical fellow programmes in an acute teaching hospital trust.

METHODS

An anonymous electronic service evaluation was sent to clinical fellows to investigate their views on whether the programme had improved patient safety, doctors' clinical performance, training and wellbeing. Thematic analysis was used to analyse the free-text responses.

RESULTS

A total of 95 out of 144 clinical fellows responded to the evaluation survey. The clinical fellows believed that the programme had improved patient safety, clinical performance (time to manage acute patients), foundation and internal medicine training, undergraduate teaching and junior doctors' wellbeing. Four similar themes emerged from the free-text responses: career development, patient safety, training and doctors' wellbeing.

CONCLUSIONS

Clinical fellow programmes may improve patient safety, clinical performance, training, undergraduate education and doctors' wellbeing.

Does low-back pain improve after decompressive spinal surgery? A prospective observational study from the British Spine Registry

OBJECTIVE

Lumbar spine decompression surgery, in the form of laminectomy or discectomy, is known to be effective in improving symptoms of radiculopathy and neurogenic claudication. However, it is less clear how it impacts coexisting low-back pain (LBP). The aim of this study was to quantify the change in LBP after lumbar decompression.

METHODS

This study analyzed data from the British Spine Registry on patients who underwent lumbar decompression surgery. LBP severity was assessed using the visual analog scale (VAS), and the primary outcome was the change in VAS score at 1 year, with secondary outcomes measuring the change in score at 6 weeks, 6 months, and 2 years. The minimal clinically important difference (MCID) was defined as a 30% reduction in pain.

RESULTS

Of the 25,349 patients included in the study, 92.2% reported significant back pain at baseline. Of the entire cohort, 12,951 (55.4%) patients had follow-up data for 6 weeks, 9066 (38.8%) for 6 months, 7926 (33.9%) for 1 year, and 5517 (23.6%) for 2 years; 17,304 (68.3%) patients had follow-up data for at least one time point. Sixty-two percent of patients attained the MCID (VAS score ≥ 30%) in back pain reduction, with 51% reporting a substantial improvement (VAS score ≥ 50%). This improvement was observed by 6 weeks postoperation and was mostly maintained at 2 years. Patients with back pain predominance were more likely to attain the MCID compared with those with leg pain predominance (63.6% vs 60.1%; OR 1.16, 95% CI 1.02-1.34; p = 0.0291). Severity of baseline back pain did not reduce the proportion attaining the MCID.

CONCLUSIONS

Regardless of pain presentation, LBP improves in approximately 62% of patients who undergo lumbar decompressive surgery, with 51% experiencing substantial improvement. Patients undergoing lumbar decompression can be advised on the chance of a meaningful improvement in back pain postsurgery.

Translating digital anthropometry measurements obtained from different 3D body image scanners

BACKGROUND

Body image scanners are used in industry and research to reliably provide a wealth of anthropometric measurements within seconds. The demonstrated utility of the scanners drives the current proliferation of more commercially available devices that rely on their own reference body sites and proprietary algorithms to output anthropometric measurements. Since each scanner relies on its own algorithms, measurements obtained from different scanners cannot directly be combined or compared.

OBJECTIVES

To develop mathematical models that translate anthropometric measurements between the three popular commercially available scanners.

METHODS

A unique database that contained 3D scanner measurements in the same individuals from three different scanners (Styku, Human Solutions, and Fit3D) was used to develop linear regression models that translate anthropometric measurements between each scanner. A limits of agreement analysis was performed between Fit3D and Styku against Human Solutions measurements and the coefficient of determination, bias, and 95% confidence interval were calculated. The models were then applied to normalized scanner data from four different studies to compare the results of a k-means cluster analysis between studies. A scree plot was used to determine the optimal number of clusters derived from each study.

RESULTS

Correlations ranged between R2 = 0.63 (Styku and Human Solutions mid-thigh circumference) to R2 = 0.97 (Human Solutions and Fit3D neck circumference). In general, Fit3D had better agreement with Human Solutions compared to Styku. The widest disagreement was found in chest circumference (Fit3D (bias = 2.30, 95% CI = [-3.83, 8.43]) and Styku (bias = -5.60, 95% CI = [-10.98, -0.22]). The optimal number of body shape clusters in each of the four studies was consistently 5.

CONCLUSIONS

The newly developed models that translate measurements between the scanners Styku and Fit3D to predict Human Solutions measurements make it possible to standardize data between scanners allowing for data pooling and comparison.

Evaluating the prospective utility of pharmacogenetics reporting among Canadian Armed Forces personnel receiving pharmacotherapy: a preliminary assessment towards precision psychiatric care

Pharmacological interventions for treating posttraumatic stress disorder in Canadian Armed Forces (CAF) members and Veterans often achieve modest results. The field of pharmacogenetics, or the study of how genes influence an individual's response to different medications, offers insight into how prior knowledge of gene-drug interactions may potentially improve the trial-and-error process of drug selection in pharmacotherapy, thereby improving treatment effects and remission rates. Given the relative recency of pharmacogenetics testing and sparse research in military samples, we used pharmacogenetics testing in a small pilot group (n=23) of CAF members and Veterans who were already engaged in pharmacotherapy for a service-related mental health condition to better understand the associated opportunities and challenges of pharmacogenetics testing in this population. Our preliminary evaluation involved: (1) reporting the prevalence of pharmacogenetics testing 'bin' status according to participants' reports ('green', 'yellow' or 'red'; intending to signal 'go', 'caution' or 'stop', regarding the potential for gene-drug interactions); (2) calculating the percentage of currently prescribed psychotropic medications that were assessed and included in the reports; (3) evaluating whether prescribers used pharmacogenetics testing information according to clinical notes and (4) collecting informal feedback from participating psychiatrists. While pharmacogenetics testing appeared to provide valuable information for a number of clients, a major limitation was the number of commonly prescribed medications not included in the reports.

British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023

This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.

Are we meeting the standards set for informed consent in spinal surgery?

INTRODUCTION

Informed consent empowers patients to exercise their autonomy and actively participate in their medical care. Guidance published by the British Association of Spine Surgeons (BASS) lists three components of consent: provision of information booklets, patient-centred dialogue and completion of appropriate consent forms. The aim of the study was to review the quality of the spinal surgery consent process against the BASS guidance in a single tertiary neurosurgery centre in London.

METHODS

Retrospective review of clinic letters and consent forms was performed for 100 consecutive cases of elective, non-instrumented spinal decompression surgeries performed in 2019. Documentation was graded for inclusion of the intended benefit (improvement of pain/prevention of neurological deterioration), alternative management options (including no treatment), surgical options and risks (infection, bleeding, paralysis, sphincter disturbances, dural tear and recurrence). Provision of supplementary information booklets was recorded. Two-tailed Fisher exact test was used to calculate statistical significance where appropriate.

RESULTS

Documentation of indications and risks of elective spinal surgery, specifically risk of recurrence (62%) and sphincter disturbance (85%), was suboptimal on the consent forms. Documentation of these risks was also poor in clinic letters (<50%). Alternative treatment options were explained in less than half of the clinic letters, and there was no documentation of information booklet provision prior to elective surgeries.

CONCLUSION

Lack of informed consent plays a major role in medical malpractice claims in spinal surgery. Poor documentation puts the surgeon in a liable position. BASS guidance could be implemented to create a more standardised process of consent in spinal surgery.

Antimicrobial resistance in sexually transmitted Shigella in men who have sex with men: A systematic review

BACKGROUND

Outbreaks of sexually transmitted Shigella flexneri and Shigella sonnei in men who have sex with men (MSM) are a major public health issue. While most cases can be managed conservatively, a minority require antimicrobial treatment. Recent reports have highlighted increasing antimicrobial resistant (AMR) strains of Shigella spp. in men who have sex with men. We aimed to systematically review antimicrobial resistance (and decreased antimicrobial sensitivity) in sexually transmitted shigella in men who have sex with men, focussing on macrolides, quinolones, and third generation cephalosporins.

METHODS

We systematically searched 4 bibliographical databases (EMBASE, medline, EMCARE and CINAHL) from January 2011 to November 2021. We used a 2-stage process to assess eligibility: the primary author conducted an initial screen and then 3 authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts in English which included men who have sex with men with sexually transmitted shigella where data on antimicrobial resistance was available.

RESULTS

Thirty-nine manuscripts met the inclusion criteria. A majority of the manuscripts (N = 34) described reduced susceptibility or antimicrobial resistant to macrolides, quinolones and third generation cephalosporins in circulating strains of shigella within sexual networks of men who have sex with men. Extensively drug resistant outbreaks of shigella in men who have sex with men have been reported containing genetic markers of ceftriaxone resistance (e.g. BlaCTX-M27) where isolates also contained markers of reduced susceptibility, and antimicrobial resistant to macrolides and quinolones.

CONCLUSION

There is little role for macrolides, quinolones or third generation cephalosporins in the management of sexually transmitted shigella in men who have sex with men. More research is needed to develop novel strategies for shigella control in men who have sex with men, as antimicrobial options are diminishing.

Factors associated with sexually transmitted shigella in men who have sex with men: a systematic review

BACKGROUND

Outbreaks of sexually transmitted shigella have been reported in men who have sex with men (MSM) since the 1970s and present a major public health issue. Understanding the factors associated with the sexual transmission of shigella may inform future control strategies.

METHODS

We systematically searched four bibliographical databases (January 2000-February 2022) for manuscripts in English. We used a two-stage process to assess eligibility: the primary author conducted an initial screen and then three authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts that included MSM diagnosed with sexually transmitted shigella where specific factors associated with transmission were identified.

RESULTS

Thirteen manuscripts met the inclusion criteria that included 547 individuals. Sexually transmitted shigella in MSM was associated with: residing in a capital city/urban region, living with HIV (including engaging in seroadaptive sexual behaviour, having a low CD4 count, having a HIV viral load >100 000 and not engaging with HIV care), using HIV pre-exposure prophylaxis, use of geospatial mobile phone applications to meet sexual partners, visiting sex on premises venues, chemsex and recreational drug use, sexual behaviour (including multiple non-regular sexual partners and oral-anal sexual contact) and concomitant STIs.

CONCLUSION

We have highlighted some important risk behaviours and factors that are associated with sexually transmitted shigella in MSM that can be used to target future shigella control interventions.

Prevalence of anti-hepatitis B core in men who have sex with men attending a sexual health clinic in Brighton, UK, from 2012 to 2019

OBJECTIVE

Hepatitis B is sexually transmitted among men who have sex with men (MSM) and has previously been endemic in some populations of MSM. Presence of anti-hepatitis B core (anti-HBc) determines previous or ongoing infection. We aimed to establish the prevalence and associations of anti-HBc in our clinic population of MSM.

METHOD

A cross-sectional study of newly attending MSM to determine the prevalence and associations of testing positive for anti-HBc using our clinic database from 2012 to 2019. We used crude odds ratios to identify any associations.

RESULTS

There were 3342/5842 (58%) newly attending MSM who were tested for anti-HBc between 2012 and 2019. Of the 3342 MSM tested for anti-HBc, the median age was 30years (interquartile range 23-43), 442 (13%) were living with HIV, 10 (0.3%) were HBsAg positive, 62 (1.9%) had past/current hepatitis C, 401 (12%) had a positive syphilis enzyme immunoassay (EIA), 455 (14%) were diagnosed with either gonorrhoea or chlamydia and 1080 (32%) were non-UK born. A total of 331 (10%, 95% confidence interval (CI)=8.9-11.0) tested positive for anti-HBc and the proportion testing positive reduced significantly throughout the study period (P <0.004). Testing positive for anti-HBc was associated with age >30years (OR=8.2, 95% CI=5.9-11.4, P <0.0001), having past/current hepatitis C (odds ratio (OR)=5.0, 95% CI=3.0-8.6, P <0.0001), having a positive syphilis EIA (OR=5.9, 95% CI=4.4-7.3, P <0.0001) and being non-UK born (OR=1.4, 95% CI=1.1-1.8, P <0.006). There were no associations with HIV status or having a diagnosis of gonorrhoea or chlamydia.

CONCLUSION

Although reducing, the prevalence of anti-HBc remains endemic in MSM locally and further efforts are needed to enhance hepatitis B prevention strategies.

Sexually transmitted infection testing and prevalence among MSM using event-based dosing HIV pre-exposure prophylaxis

Event-based dosing (EBD) of HIV PrEP is as effective at preventing HIV transmission in MSM as daily dosing. There are limited data on the differences in STI testing frequency between MSM using EBD-PrEP and daily dosing. A total of 20% of 418 PrEP users were using EBD-PrEP and had a lower number of sexual partners (22 (27%) vs 142 (42%), P=0.008), tested for STIs less frequently (115 (18%) vs 69 (50%), P<0.001), but were diagnosed with a similar number of STIs ((35% vs 34%, P=0.54) compared to daily users. More research is needed to understand the optimal frequency for STI testing in MSM using EBD PrEP.

How are young people's mental health related to their sexual health and substance use? A systematic review of UK literature

OBJECTIVES

The transition from childhood to adulthood is complex and presents challenges to young people's mental health. Mental health impacts and is impacted by a range of contextual and personal factors. Adolescence and young adulthood also coincide with increased experimentation with sex, sexuality and substance use. Addressing the mental health, sexual health and substance-use challenges experienced by young people therefore necessitates an understanding of how these elements relate to one another. By collecting and analysing existing literature, this review aims to identify associations between young people's mental health and sexual health, their mental health and substance use and any resulting gaps-in-knowledge.

CONTENT

Seven electronic databases were searched between March and May 2021 and updated in May 2022 with terms collated under the categories of "young people", "mental health", "sexual health" and "substance use". English-language articles, presenting data from the UK & Ireland, on young people aged 16-24 years inclusive were screened and subjected to a selection process in accordance with PRISMA guidelines (preregistered on PROSPERO, ref. number CRD42021245096). The quality of the resulting articles were assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were tabulated through a data extraction process.

SUMMARY

27 articles were included in the review. Various mental health indices such as depression, anxiety, self-harm, psychotic-like experiences, hypomanic symptoms and binge-purge type eating disorders were found to be associated with higher use of substances such as alcohol, cannabis, ecstasy and generalised drug use. Additionally, mental health indices such as depression, anxiety and self-harm were found to be associated with sex before age 16 and/or unprotected sex at age 16, positive Chlamydia infection and higher levels of sexual activity at a younger age. Overall, cross-sectional associations were stronger than the longitudinal associations presented in the articles.

OUTLOOK

This review into the specific relations between young people's mental health, sexual health and substance use has revealed the complex and bi-directional nature of these associations, with some conditions and substances having been more extensively investigated (e.g., alcohol and depression/anxiety) as opposed to the relations between young people's sexual health and mental health which is lacking in the UK and Irish context. The findings can help inform mental health related policies and service provisions targeted at young people in the UK and Ireland. Areas for future work are suggested.

Perspectives of caregivers of older adults with acute myeloid leukemia during initial hypomethylating agents and venetoclax chemotherapy

BACKGROUND

Older adults with AML commonly receive a hypomethylating agent (HMA) as first-line therapy. The addition of venetoclax (VEN) to HMAs has been shown to improve remission rates and overall survival. The use of combination therapy (HMA + VEN) requires frequent follow-up, results in longer infusion times, and likely increases caregiver responsibility at home. We describe experiences of informal caregivers (family/friends) providing care to older adults with AML receiving HMA + VEN.

METHODS

Fourteen caregivers of older adults with AML receiving HMA + VEN (September 2020 to September 2021) were recruited as part of a control group of an ongoing NIH-funded clinical trial. Semi-structured interviews were conducted to gain initial insight into caregiver experiences at the start of HMA + VEN treatment. Two researchers analyzed the data using thematic content analysis. Data saturation occurred when no new themes were found in subsequent interviews, but all interviews were coded and synthesized.

RESULTS

Of the 14 caregivers interviewed, the majority were spouses (n = 10), female (n = 13), and aged 45 to 83 (median age 65). We identified five themes: (1) the impact of an AML diagnosis in older adulthood, (2) care recipient condition changes, (3) perspectives of caregiving roles and tasks, (4) factors influencing caregiving experiences, and (5) support system roles.

CONCLUSIONS AND IMPLICATIONS

Caregivers for older adults with AML report a range of experiences navigating health systems, caregiving responsibilities, and resource needs. The risk for caregiver burden and unmet needs should be addressed to improve caregivers' abilities to provide care.

A Systematic Review of Decision Aids in Hematologic Malignancies: What Are Currently Available and What Are We Missing?

BACKGROUND

Patient decision aids (PDAs) are tools designed to facilitate decision-making. In this systematic review, we summarized existing studies on the development and evaluation of PDAs for patients with hematologic malignancies.

PATIENTS AND METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for articles in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. We included studies, abstracts, and clinical trial protocols available in English involving PDAs for patients age ≥18 diagnosed with a hematologic malignancy and/or their caregivers. Data were summarized using descriptive statistics.

RESULTS

Of the 5281 titles/abstracts screened, 15 were included: 1 protocol, 7 abstracts, and 7 full-texts. Six were PDA developmental studies, 6 were pilot studies, and 3 were randomized trials. PDA formats included electronic with web content, videos, and/or audio, questionnaires, bedside instruments, and a combination of various formats. Average participant age ranged from 36.0 to 62.4 years. Patients and caregivers identified efficacy, adverse effects, cost, and quality of life as important decision-making factors. PDAs were associated with increased knowledge and patient satisfaction as well as decreased decisional conflict and attitudinal barriers. Research on PDAs for adult patients with hematologic malignancies and their caregivers is limited. Among the studies, PDAs appear to support patients in shared decision-making.

CONCLUSION

While current literature examining the use of PDAs for adults with hematologic malignancies is limited, the positive impact of PDAs on shared decision-making and patient outcomes warrants additional research in this field.

Methods of policy monitoring in physical activity promotion: a systematic review across different levels of government

Background

Even though the importance of policy monitoring in public health has increased in the last decades, there is still a lack of understanding what different approaches of policy monitoring exist and which methodology they employ. In order to address this research gap, this review attempts to provide a comprehensive overview about the methods of policy monitoring in the field of physical activity promotion.

Methods

A systematic search was conducted in five scientific databases, using the terms “physical activity”, “policy” and “monitoring” and their variations. In total, 12.963 studies were identified and, after the elimination of duplicates, screened independently by two reviewers. During full text analysis, information on the methods applied for policy monitoring was extracted and studies were categorized based on their key characteristics (monitoring tool, policy level, and setting).

Results

The search yielded in a total of 112 studies that were structured into seven categories: Report Cards on Physical Activity for Children and Youth, HEPA Monitoring Framework, HEPA Policy Audit Tool, national policies, subnational policies, school setting, and childcare setting. Across all categories, policy monitoring focused mainly on national level policies in a single country. Differences were identified with regards to the level of government involvement which allowed to differentiate between research-driven approaches (little or no government involvement), government-driven approaches (led by governments), and co-production approaches (strong collaboration between researchers and governments).

Conclusions

Research-driven, government-driven and co-production approaches have different strengths and weaknesses with regards to the monitoring of policies. Awareness needs to be raised regarding the implications of these approaches, and more research is needed to analyse the impact of policy monitoring on policy-making in public health.

Pilot evaluation of PrEP EmERGE - A novel digital health innovation designed to support sexual health clinics and HIV-PrEP users

OBJECTIVE

We aimed to evaluate the usability and acceptability of a co-designed mobile health (mHealth) application (PrEP-EmERGE) within a digital health pathway to support HIV pre-exposure prophylaxis (PrEP).

METHODS

This was a cross-sectional study to evaluate the usability and acceptability of the PrEP-EmERGE app. Data were collected via an online survey sent to all PrEP EmERGE users in September 2021. Usability was assessed with a validated usability tool, the System Usability Scale (SUS). Acceptability was assessed using modified patient-reported experience measures (PREMs). Quantitative data were analysed using descriptive and/or inferential statistics and qualitative data (free text responses) using thematic analysis.

RESULTS

In total, 81/133 (61%) active PrEP EmERGE users completed the online survey, which was available directly from their PrEP EmERGE app: 78/81 (96%) identified as cis-male, 74/81 (91%) reported their ethnicity as 'white', 69/81 (85%) reported daily PrEP use, 7/81 (9%) reported using an event-based dosing schedule, and 5/81 (6%) were switching between dosing schedules. Overall, the median SUS score was 78/100 (interquartile range: 70-92). There were no differences in median SUS scores by PrEP dosing schedules (p = 0.78) or months of experience of using the app (p = 0.31). Overall, 73/81 (90%) would recommend the PrEP EmERGE app to a friend and 78/81 (96%) rated their satisfaction of the app as excellent, good or satisfactory. The free text responses generated three key themes: accessibility (for results and information); autonomy [taking responsibility for their (sexual) health] and functionality (including technical recommendations for app development and the digital health pathway).

CONCLUSIONS

Innovative, co-designed digital health pathways, such as PrEP EmERGE can help sexual health services to manage increasing numbers of people accessing PrEP - ensuring that they retain access for those who need to be seen face-to-face. We report high levels of acceptability and usability during the first 4 months of this novel pathway.

Hepatitis A testing and susceptibility in men who have sex with men: an unintended benefit of PrEP

Hepatitis A is a sexually transmitted enteric infection in men who have sex with men (MSM). HIV pre-exposure prophylaxis (PrEP) has increased opportunities for sexual health interventions in MSM. 588 (372 in 2019, 216 in 2021) MSM attended for the first time in the study periods. MSM were significantly more likely to be screened for Hepatitis A susceptibility in 2021 than 2019 (93% vs 56%, P =0.0001). Susceptibility (Hepatitis A IgG negative) to Hepatitis A did not change between in 2021 and 2019 (48% vs 47%, P =0.921). De-medicalising PrEP is important as it will increase overall uptake. However, coupling PrEP with other sexual health interventions must not be lost.

Time-Domain Self-Broadened and Air-Broadened Nitrogen S-Branch Raman Linewidths at 80-200 K Recorded in an Underexpanded Jet

We report pure-rotational N2-N2, N2-air, and O2-air S-branch linewidths for temperatures of 80-200 K by measuring the time-dependent decay of rotational Raman coherences in an isentropic free-jet expansion from a sonic nozzle. We recorded pure-rotational hybrid femtosecond/picosecond coherent anti-Stokes Raman scattering (fs/ps CARS) spectra along the axial centerline of the underexpanded jet, within the barrel shock region upstream of the Mach disk. Dephasing of the pure-rotational Raman coherence was monitored using probe-time-delay scans at different axial positions in the jet, corresponding to varying local temperatures and pressures. The local temperature was obtained by fitting CARS spectra acquired at zero probe time delay, where the impact of collisions was minimal. The measured decay of each available Raman transition was fit to a dephasing constant and corrected for the local pressure, which was obtained from the CARS-measured static temperature and thermodynamic relationships for isentropic expansion from the known stagnation state. Nitrogen self-broadened transitions decayed more rapidly than those broadened in air for all temperatures, corresponding to higher Raman linewidths. In general, the measured S-branch linewidths deviated significantly in absolute and relative magnitudes from those predicted by extrapolating the modified exponential gap (MEG) model to low temperatures. The temperature dependence of the Raman linewidth for each measured rotational state of nitrogen ( J {less than or equal to} 10) and oxygen ( N {less than or equal to} 11) was fit to a temperature-dependent power-law over the measurable temperature domain (80-200 K) and extrapolated to both higher rotational states and to room temperature.

Characteristics of HIV post‐exposure prophylaxis recipients at six English sexual health clinics during COVID‐19

Objectives

Disruption to sexual health services during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2; coronavirus disease 2019 [COVID‐19]) pandemic may have adversely affected the provision of HIV post‐exposure prophylaxis (PEP), possibly leading to increased HIV transmission. Globally, services have reported a reduction in the number of PEP prescriptions dispensed during lockdowns, although it is unclear why. Our primary objective was to describe the temporal change in weekly HIV PEP dispensed at six English sexual health clinics in 2020.

Methods

We performed a cross‐sectional review of PEP prescriptions from six English centres during 2020.

Results

During 2020, 2884 PEP prescriptions were dispensed across the six centres studied, a fall of 34.5% from the 4403 PEP prescriptions in 2019. Before the COVID‐related lockdown in 2020, the PEP dispensed was stable at 82.5 per week. Following the first lockdown, this fell to a nadir of 13 in week 14 (Figure 1). Prescriptions rose to a peak of 79 in week 37 and then declined to 32 prescriptions in the last week of 2020. There was no difference in the following characteristics of PEP recipients before and during the first lockdown: age, ethnicity, country of birth or the service the recipient attended.

Conclusion

Whatever the reason for the fall in PEP seen in England over 2020, it is essential that HIV testing and access to HIV prevention is maintained for those in need.

Chemsex and antiretroviral prescribing in an HIV cohort in Brighton, UK

OBJECTIVES

Chemsex has been reported among men who have sex with men (MSM) living with HIV. There have been concerns about potentially harmful drug-drug interactions between chemsex drugs and antiretroviral therapy (ritonavir and cobicistat). We aimed to describe the prevalence and patterns of chemsex users in our HIV clinic population and to evaluate antiretroviral prescribing among chemsex users.

METHODS

We undertook a cross-sectional study of patients attending our HIV clinic between January 2019 and December 2020. We collected data on patients who disclosed recent recreational drug use including chemsex in the previous 3 months.

RESULTS

In all, 2202/2501 (88%) patients were asked about recreational drug use and 514 (23%) disclosed recreational drug use. Eighty-two (4%) of these disclosed recent chemsex; 73 (89%) used crystal methamphetamine, 51 (62%) used gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), 55 (67%) reported poly-drug use and 63 (76%) reported injecting drug use. The chemsex users were all cis-male MSM and were significantly older (53 vs. 46 years, p < 0.0001), and more likely to have had previous syphilis (73% vs. 28%, p < 0.0001) than patients reporting non-chemsex drug use. All chemsex users were prescribed antiretrovirals and 74 (90%) had an undetectable HIV viral load; 31 (38%) patients were taking either ritonavir (N = 12) or cobicistat (N = 19) as part of their antiretroviral regimen and this was similar to other patients attending for HIV care [31/82 (38%) vs. 768/2419 (31%), p = 0.25].

CONCLUSIONS

The prevalence of chemsex users among our HIV clinic attendants is 4%, and 38% of these were prescribed either ritonavir or cobicistat. Chemsex use should be a factor in antiretroviral therapy decision-making to avoid potential harm.

Effects of a 12% carbohydrate beverage on tackling technique and running performance during rugby league activity: A randomised, placebo-controlled trial

The purpose of this study was to investigate the effects of a 12% carbohydrate (CHO) beverage on tackling technique and running performance during rugby league activity. Using a double-blind, placebo-controlled, randomised, crossover design, 15 academy rugby league players ingested a 250 ml bolus of a 12% CHO solution (30 g maltodextrin and 30 g sucrose in 500 ml) 15 minutes before two bouts of rugby activity. The rugby league match simulation for interchange players was used to standardise the movement patterns of activity and provide reliable outcome measures, whilst also reflecting the duration of a typical field-based conditioning session. Measures of tackling technique, external responses (e.g., fatigue index from sprint data) and rating of perceived exertion (RPE) were recorded throughout. Gut discomfort was measured before each bout. The interaction effect was largely compatible with the hypothesis for relative distance (P<0.001, η2 = 0.217) and fairly compatible for tackling technique (P = 0.068, η2 = 0.0640). The time effect for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, time at high metabolic power, PlayerLoad™, and RPE (all P<0.05; η2 = 0.131-0.701) was compatible with the hypothesis. Data for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, sprint, and sprint to contact fatigue index (all P<0.05; η2 = 0.189-0.612) was compatible with a supplement effect overall despite few differences in the pattern of change (interaction). Minimal gut discomfort was reported for the CHO (bout 1 = 27 ± 17; bout 2 = 23 ± 17 AU) and placebo (bout 1 = 23 ± 18 AU; bout 2 = 24 ± 13) trials. This study shows that a 12% CHO beverage before two bouts of standardised rugby activity is a practical and effective strategy for retaining tackling technique, increasing external responses, and reducing RPE without compromising gut comfort.