Exploring Reflections, Motivations, and Experiential Outcomes of First Same-Sex/Gender Sexual Experiences among Lesbian, Gay, Bisexual, and Other Sexual Minority Individuals

First sex is an important event in an individual's sexual development. Previous literature has, however, primarily investigated first heterosexual sex, overlooking important contextual factors specific to same-sex/gender sexual experiences. Seventeen in-depth semi-structured interviews were conducted with lesbian, gay, bisexual, and other sexual minority (LGB+) individuals, ages 18-23 years. Four themes emerged from thematic analysis of reported thoughts, affect, and behavior. First, participants reported difficulty defining sex between same-sex/gender partners, especially women who reported that this undermined their personal relationships and identity. Second, participants met partners through several means; however, it was almost exclusively men who reported meeting their first partners online. Third, motivations for first same sex/gender sex included affirmation of personal sexual identity, sexual exploration, social expectation, and spontaneity. Fourth, participants felt underprepared for their first same-sex/gender sex, noting that their earlier sex and relationship education had not included information on same-sex/gender sex or LGB+ identities. Consequently, participants reported relying on experienced partners and seeking information on the internet, including pornography and social media. Greater cultural representation and more comprehensive sex education that recognizes sexual diversity is needed to better prepare LGB+ young people for early sexual encounters.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Masking of an auditory behaviour reveals how male mosquitoes use distortion to detect females

The mating behaviour of many mosquito species is mediated essentially by sound: males follow and mate with a female mid-flight by detecting and tracking the whine of her flight-tones. The stereotypical rapid frequency modulation (RFM) male behaviour, initiated in response to the detection of the female's flight-tones, has provided a means of investigating these auditory mechanisms while males are free-flying. Mosquitoes hear with their antennae, which vibrate to near-field acoustic excitation. The antennae generate nonlinear vibrations (distortion products, DPs) at frequencies that are equal to the difference between the two simultaneously presented tones, e.g. the male and female flight-tones, which are detected by mechanoreceptors in the auditory Johnston's organ (JO) at the base of the antenna. Recent studies indicated the male mosquito's JO is tuned not to the female flight-tone, but to the frequency difference between the male and female flight-tones. To test the hypothesis that mosquitoes detect this frequency difference, Culex quinquefasciatus males were presented simultaneously with a female flight-tone and a masking tone, which should suppress the male's RFM response to sound. The free-flight behavioural and in vivo electrophysiological experiments revealed that acoustic masking suppresses the RFM response to the female's flight-tones by attenuating the DPs generated in the nonlinear vibration of the antennae. These findings provide direct evidence in support of the hypothesis that male mosquitoes detect females when both are in flight through difference tones generated in the vibrations of their antennae owing to the interaction between their own flight-tones and those of a female.

Condom use at first and latest sexual events among young people: evidence from a rural and peri-urban setting in Uganda

BACKGROUND

Condom use remains low among young people despite high prevalence of HIV, STIs, and unplanned pregnancy in Uganda.

OBJECTIVES

This paper presents patterns of condom use at first and latest sexual events and associated factors.

METHODS

The data were obtained from 445 sexually active unmarried people aged 15-24 from one peri-urban and another rural district. Stratified multi-stage cluster sampling technique was applied. Logistic regression was used to identify factors associated with condom use at each of the two sexual events, while multinomial logistic regression was used to establish factors correlated with condom use at both first and last sex.

RESULTS

Factors associated with condom use at each event were residence in the peri-urban district and higher education attainment. Factors correlated with condom use at both first and last sex were residence in peri-urban district (p<0.001) and being in school (p<0.01). Alcohol consumption and age at first sex were only significant at one event.

CONCLUSIONS

Some factors that influence condom use at first sex are different from those that affect condom use at latest sexual event. Prevention programmes against STIs, HIV and unplanned pregnancies among young people focus more on rural areas and those with minimal or no education.

How, not just if, condoms are used: the timing of condom application and removal during vaginal sex among young people in England

OBJECTIVE

To assess the prevalence of, and factors associated with, vaginal penetration before condom application and following condom removal among young people in education in England.

METHOD

A large cross sectional survey (n = 1373) was conducted in educational establishments in England and sexual event diaries were completed by a subsample of young people over a 6 month period.

RESULTS

Of the 375 survey respondents who reported having used a condom on the most recent occasion of vaginal sex, 6% had applied the condom after penetration and 6% had continued penetration after condom removal. Of the 74 diary respondents, 31% applied a condom late and 9% removed a condom early at least once over a 6 month period. The odds of "imperfect" condom use were found to decrease with overall consistency of condom use, confidence in correct condom use, positive reported relationship with mother, non-use of other contraception, and desire to use a condom.

CONCLUSION

Given that late application and early removal of condoms fail to maximise their effectiveness as a method of STI prevention, it is important to address "imperfect" condom use and the factors associated with such use in public health policies and programmes. It is essential that young people understand the importance of using condoms consistently and correctly, and are also equipped with the skills and knowledge to do so.

Latent membrane protein 2A of Epstein-Barr virus binds WW domain E3 protein-ubiquitin ligases that ubiquitinate B-cell tyrosine kinases

The latent membrane protein (LMP) 2A of Epstein-Barr virus (EBV) is implicated in the maintenance of viral latency and appears to function in part by inhibiting B-cell receptor (BCR) signaling. The N-terminal cytoplasmic region of LMP2A has multiple tyrosine residues that upon phosphorylation bind the SH2 domains of the Syk tyrosine kinase and the Src family kinase Lyn. The LMP2A N-terminal region also has two conserved PPPPY motifs. Here we show that the PPPPY motifs of LMP2A bind multiple WW domains of E3 protein-ubiquitin ligases of the Nedd4 family, including AIP4 and KIAA0439, and demonstrate that AIP4 and KIAA0439 form physiological complexes with LMP2A in EBV-positive B cells. In addition to a C2 domain and four WW domains, these proteins have a C-terminal Hect catalytic domain implicated in the ubiquitination of target proteins. LMP2A enhances Lyn and Syk ubiquitination in vivo in a fashion that depends on the activity of Nedd4 family members and correlates with destabilization of the Lyn tyrosine kinase. These results suggest that LMP2A serves as a molecular scaffold to recruit both B-cell tyrosine kinases and C2/WW/Hect domain E3 protein-ubiquitin ligases. This may promote Lyn and Syk ubiquitination in a fashion that contributes to a block in B-cell signaling. LMP2A may potentiate a normal mechanism by which Nedd4 family E3 enzymes regulate B-cell signaling.

Exploring young people's difficulties in talking about contraception: how can we encourage more discussion between partners?

Interviews were conducted with 56 young men and women aged 16-19 within the Southampton Community Health NHS Trust to explore difficulties in talking about contraception. Concern about a partner's hostile or negative reaction to any discussion about contraception was central to explaining why some people found it so difficult to initiate such discussions. Admitting the intention to have intercourse, together with a perceived association between condom use and disease prevention, were the main concerns. There was some indication of gender differences in these findings. Furthermore, this negative reaction is perceived to be exacerbated according to the partner's reputation, the potential for harming one's own reputation and whether there is a desire for a longer-term relationship with this partner. The most important outcome of the interviews was that these concerns about a partner's negative reaction were largely unjustified, with the vast majority of participants showing only positive responses to scenarios of future partners initiating discussions with them about contraception. In addition to the need to improve communication skills, the data suggest that greater awareness about the positive reactions towards such discussions should be encouraged.

Contrasting strategies used by young people to ensure condom use: some findings from a qualitative research project

Interviews conducted among 56 young men and women (aged 16-19) reveal two contrasting strategies used to ensure condom use at first intercourse with a new partner. These are defined as verbal communication based strategies (involving some explicit discussion about contraception before intercourse) and non-verbal communication based strategies (where one partner takes responsibility for using condoms without discussing this with their partner). Whilst the former is argued as being the more effective strategy, this paper suggests an important role for the latter, particularly when young people find themselves in situations where initiating discussions about condom use is perceived as being particularly difficult.

Attenders at young people's clinics in Southampton: variations in contraceptive use

This paper presents findings from a survey of 424 people attending nine young people's clinics within the Southampton Community Health NHS Trust. In addition to recording some descriptive background data on the people attending the clinics, one major aim of the study was to investigate whether talking to the sexual partner about contraception before their first intercourse together and delaying this first intercourse influenced contraceptive use. Overall, 40 per cent of people attending the clinics were aged 16 or under, although there was some variation between clinics in the age groups attracted. Most clients were female (88 per cent), had ever had sexual intercourse (92 per cent), reported four or more lifetime partners (42 per cent) but only one partner within the last six months (73 per cent) and were currently in a relationship (75 per cent). Potential for contraception and sexually transmitted infection was widespread; 46 per cent (of non-virgins) had had intercourse without contraception at least 'a few times' and 18 per cent used condoms 'rarely' or 'never'. In terms of first intercourse with current/most recent partner, 17 per cent had not used any contraception and 32 per cent had failed to use condoms. The most important findings from this study were that use of contraception (and condoms in particular) on the occasion of first intercourse with the current or most recent partner was significantly associated with the following; if partners had talked to each other about contraception before having intercourse together for the first time (p<0.001), and also if this first intercourse was delayed beyond four weeks as opposed to over a few days of first 'going-out' together (p<0.001). Suggestions for further in-depth research are made.

Modelling the spatial distribution of teenage conception rates within Wessex

This study attempts to determine which factors account for the spatial variation in teenage conception rates within the former Wessex Regional Health Authority and what factors account for the eventual outcomes of these conceptions. Postcoded data on all teenage conceptions from 1991 to 1994 were collected and related to census ward level information and indicators of accessibility to family planning services. The results show that the variation in teenage conception rates and conception outcomes is principally determined by the age of the teenager, deprivation levels, the presence of certain homogeneously distinct groups and the distance to the nearest youth-oriented family planning clinic.

Imaging human intra-cerebral connectivity by PET during TMS

Non-invasive imaging of human inter-regional neural connectivity by positron emission tomography (PET) during transcranial magnetic stimulation (TMS) was performed. The hand area of primary motor cortex (M1) in the left cerebral hemisphere was stimulated with TMS while local and remote effects were recorded with PET. At the stimulated site, TMS increased blood flow (12-20%) in a highly focal manner, without an inhibitory surround. Remote covariances, an index of connectivity with M1, were also focal. Connectivity patterns established in non-human species were generally confirmed. Excitatory connectivity (positive covariance) was observed in ipsilateral primary and secondary somatosensory areas (S1 and S2), in ipsilateral ventral, lateral premotor cortex (M2) and in contralateral supplementary motor area (SMA). Inhibitory connectivity (negative covariance) was observed in contralateral M1.

Sexual behaviour in developing countries: implications for HIV control

OBJECTIVE

To provide basic information on pre- and extramarital sex in the general population and other factors related to HIV transmission.

DESIGN

Cross-sectional household survey in 18 countries of the developing world, mainly in Africa and Asia.

RESPONDENTS

Representative samples of 1300-6995 individuals aged 15-49 years, interviewed in 1989-1993.

METHODS

Face-to-face interviewing.

RESULTS

We observed a huge variability between study sites, with the proportion of men reporting sexual contact outside regular partnerships in the last year ranging from 4 to 47%. Contacts with sex workers range from 1 to 25%. Women were much less likely to report non-marital sex than men.

CONCLUSIONS

This first cross-cultural attempt to examine aspects of sexual lifestyles suggests that broad generalizations about multiple-partner sexual networking in particular regions are misleading. Gender, marital status, age and a few other demographic correlates were disclosed as powerful determinants of sexual behaviour, although the strength of associations varied greatly between specific locations. Condom use was very low in most study sites.

Developing decision making skills for people with learning disabilities

A qualitative research methodology was used to identify the influences on the involvement of people with learning disabilities in day to day decision making. This paper describes the part of the study which revealed that some key workers appeared to have unmet training needs, which influenced clients' involvement in decision making and the learning of decision making skills. It suggests that staff responsible for key worker supervision and support ensure they are fully aware of any difficulties experienced by key workers in carrying out their role, and that these are addressed by appropriate training.

Choice of surgery for early breast cancer: psychosocial considerations

A prospective study was conducted with early breast cancer patients who had either been offered, or not been offered, a choice of surgery for treatment. The choice involved mastectomy or wide excision plus radiotherapy. Available evidence suggests that the medical outcome between these two options is similar; this study was designed to investigate selected psychosocial outcomes. It was found that whether or not patients were given a choice was of greater relevance to psychosocial outcomes that was the type of operation performed. Providing a choice led to improved reported adjustments with respect to the ability to undertake work, attitudes towards the future, beliefs about coping, and in physical and psychological functioning.

A review of the nursing literature on attitudes towards old people

This paper reviews recent research in the area of nurses' attitudes towards old people. Published work is categorized into that dealing with the effects on attitudes of characteristics of the nurses being studied, characteristics of the patients, intervention programmes and related attitudes held by the nurses. British and American work is considered. Much of the published work reviewed is found to be lacking in one or more respects. These shortcomings relate to sampling, design features, measures used and data analysis. It is concluded that research in the area will need to be improved if major policy decisions concerning the care of the elderly are to be well-informed.

Sinus node function in the denervated human heart. Effect of digitalis

Evaluation of sinus node function was performed in 5 patients with an intact cardiac autonomic nervous system (group I), and in 8 patients with a transplantated, denervated heart (group 2). After baseline data were recorded, the electrophysiological studies were repeated in all group I patients and in 6 of the 8 group 2 patients, 45 to 60 minutes after the administration of digoxin 1.25 mg intravenously. Baseline cycle length, sinus node recovery time, and sinoatrial conduction time were significantly shorter in the transplanted heart than in those with intact autonomic innervation, but correction of the sinus node recovery time and sinoatrial conduction time for heart rate abolished these differences. Digoxin produced a small increase in cycle length, sinus node recovery time, and sinoatrial conduction time which did not reach statistical significance in this small study group of patients with innervated hearts. In the denervated, transplanted patients, no change in cycle length occurred after digoxin in any patient. The sinus node recovery time was unaffected by glycoside administration in 3 of 6 patients, while the sinoatrial conduction time was unchanged in 4 of 6. In one group 2 patient, digoxin produced first degree sinoatrial node exit block, and in a second patient, 2:1 sinoatrial nodal exit block developed. The mechanisms responsible for these effects in the denervated heart are not clear.