Ethnicity classification systems for public health surveys: experiences from HIV behavioural surveillance among men who have sex with men.

BACKGROUND: Race and ethnicity classification systems have considerable implications for public health, including the potential to reveal or mask inequities. Given increasing "super-diversity" and multiple racial/ethnic identities in many global settings, especially among younger generations, different ethnicity classification systems can underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic minorities. We investigated three ethnicity classification methods and their relationship to sample size, socio-demographics and sexual health indicators. METHODS: We examined data from New Zealand's HIV behavioural surveillance programme for men who have sex with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed; recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included Asian, European, indigenous Maori, and Pacific. For each classification method, statistically significant associations with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic regression. RESULTS: Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health outcomes: Maori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using Total Response but not Prioritisation or Single/Combination. CONCLUSIONS: Different classification approaches alter sample sizes and identification of health inequities. Future research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings have broad implications for surveillance and research that is used to inform public health responses.

Observations on the Early Stages of Corrosion on AA2099-T83.

An Al­Cu­Li aerospace alloy has been investigated to determine the order in which corrosion at different types of sites occurs in AA2099-T83. Specifically, the sequence of galvanic attack on intermetallic (IM) particles and other sites of AA2099-T83 was determined as a function of time, in 0.1 M NaCl, through the use of scanning electron microscopy and electron backscatter diffraction characterization techniques. The earliest attack occurred at isolated grains and grain boundaries and on Li-containing dispersoids. Similarly, some constituent IM particles showed evidence of trenching in the surrounding alloy matrix. These IM particles included Al7Cu2Fe and another group of unidentified particles which displayed complete trenching within the first 10 min of exposure. Al13(Fe, Mn)4 were next most active followed by Al37Fe12Cu2 with Al6(Fe,Mn) and large TiB2 particles being the least active.

Investigation of the Internal Structure of a Modern Seafloor Hydrothermal Chimney With a Combination of EBSD, EPMA, and XRD.

Samples from the sphalerite-dominated zone of a seafloor massive sulfide chimney, the Satanic Mills Chimney of the PACMANUS hydrothermal field, have been investigated to determine the internal macrostructure and microstructure of this zone, the phases present, and the distribution of metals. A combination of electron probe microanalysis, electron backscattered diffraction, and x-ray diffraction has been used. At the macroscale, this zone of the chimney wall is heavily porous and is comprised primarily of sphalerite, enclosing minor chalcopyrite, pyrite, and wurtzite. A Pb­As sulfosalt layer of possible microbial origins is present at the outer edge of the sphalerite matrix, next to a pore. The sphalerite has grown in globules on the order of 300 µm in diameter. At the microscale, the sphalerite features a colloform texture and a duplex-type grain structure consisting of either fine-grain regions in the center surrounded by coarse-grained regions or radiating coarse grains only. Pb- and As-rich bands have been detected in the colloform sphalerite, and growth twins have been observed in both the sphalerite and chalcopyrite crystals. A qualitative description of the growth of a typical globule is given, including nucleation, crystal growth, and solute redistribution.

An Examination of the Composition and Microstructure of Coarse Intermetallic Particles in AA2099-T8, Including Li Detection.

Electron and proton microprobes, along with electron backscatter diffraction (EBSD) analysis were used to study the microstructure of the contemporary Al-Cu-Li alloy AA2099-T8. In electron probe microanalysis, wavelength and energy dispersive X-ray spectrometry were used in parallel with soft X-ray emission spectroscopy (SXES) to characterize the microstructure of AA2099-T8. The electron microprobe was able to identify five unique compositions for constituent intermetallic (IM) particles containing combinations of Al, Cu, Fe, Mn, and Zn. A sixth IM type was found to be rich in Ti and B (suggesting TiB2), and a seventh IM type contained Si. EBSD patterns for the five constituent IM particles containing Al, Cu, Fe, Mn, and Zn indicated that they were isomorphous with four phases in the 2xxx series aluminium alloys including Al6(Fe, Mn), Al13(Fe, Mn)4 (two slightly different compositions), Al37Cu2Fe12 and Al7Cu2Fe. SXES revealed that Li was present in some constituent IM particles. Al SXES mapping revealed an Al-enriched (i.e., Cu, Li-depleted) zone in the grain boundary network. From the EBSD analysis, the kernel average misorientation map showed higher levels of localized misorientation in this region, suggesting greater deformation or stored energy. Proton-induced X-ray emission revealed banding of the TiB2 IM particles and Cu inter-band enrichment.

A Patient's Perspective: Pairing the Stethoscope with POCUS to Evaluate Acute Dyspnea in the Clinic.

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Self-reported STIs and sexual health checks in a cross-sectional study of gay and bisexual men in New Zealand.

OBJECTIVES: To determine the incidence of self-reported sexually transmitted infections (STIs) and sexual health checks in community and internet samples of New Zealand gay, bisexual and other men who have sex with men (MSM) and factors associated with these. METHODS: We analysed anonymous self-completed data from 3138 MSM who participated in the location-based Gay Auckland Periodic Sex Survey (GAPSS) and the internet-based Gay Online Sex Survey (GOSS) undertaken in February 2011. RESULTS: Overall 8.2% of the participants reported at least one STI in the previous 12 months, which did not differ significantly by demographic factors or HIV status. While having anal sex and more partners were associated with more STI, after adjustment for the number of partners, the type of partner (regular or casual) was not. Medium and low condom users reported STIs more than high condom users, regardless of partner type. Overall 40% had a sexual health check-up without an STI diagnosed in the past year, with similar numbers attending general practice and sexual health clinics. Having a check-up was lower among Pacific and Asian men, those identifying as bisexual and recruited online. While those with more partners, having anal intercourse and diagnosed with HIV were more likely to go for a check-up, those using condoms less often were not. CONCLUSIONS: STIs are commonly reported in this community sample of MSM but will underestimate the true incidence due to asymptomatic infection. Screening for STIs outside sexual health clinics should be normalised for MSM and made accessible, safe and relevant.

Trends in web-based HIV behavioural surveillance among gay and bisexual men in New Zealand: complementing location-based surveillance.

Most HIV behavioural surveillance programmes for gay, bisexual and other men who have sex with men (MSM) sample from location-based (offline) or web-based (online) populations, but few combine these two streams. MSM sampled online have been found to differ demographically and behaviourally from those sampled offline, meaning trends identified in one system may not hold for the other. The aim was to examine trends among MSM responding to supplementary repeat online behavioural surveillance surveys who had not participated in offline surveillance earlier that year in the same city, to see whether trends were parallel, converged or diverged. We recruited a total of 1613 MSM from an Internet dating site in Auckland, New Zealand in 2006, 2008 and 2011 using identical questionnaires and eligibility criteria to offline surveillance. Condom use was stable over time, HIV testing rates rose, the proportion reporting over 20 recent male partners declined, and anal intercourse rates increased, consistent with trends in offline surveillance conducted concomitantly and reported elsewhere. Variant trends included greater stability in condom use with casual partners among online-recruited MSM, and a rise in regular fuckbuddy partnering not identified among offline-recruited MSM. Among MSM recruited online, the frequency of checking Internet dating profiles increased between 2008 and 2011. In conclusion, supplementary web-based behavioural surveillance among MSM generally corroborates trends identified in offline surveillance. There are however some divergent trends, that would have been overlooked if only one form of surveillance had been conducted. As MSM populations increasingly shift their socialising patterns online and diversify, multiple forms of HIV behavioural monitoring may be required.

Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002-2011: condom use stable and more HIV testing.

OBJECTIVES: Over the last decade, annual HIV diagnoses among men who have sex with men (MSM) in New Zealand increased, then stabilised in 2006 and have not increased further. The aim was to examine trends in behaviours in order to better understand this pattern and inform community-based prevention. METHODS: From 2002 to 2011, we conducted five repeat cross-sectional behavioural surveillance surveys among MSM at community locations in Auckland (fair day, gay bars, sex-on-site venues; n=6091). Participation was anonymous and self-completed. Recruitment methods were consistent at each round. RESULTS: Overall, the samples became more ethnically diverse and less gay community attached over time. Condom use during anal intercourse was stable across three partnering contexts (casual, current regular fuckbuddy, current regular boyfriend), with a drop among casual contacts in 2011 only. In the 6 months prior to surveys, there was a gradual decline over time in the proportion reporting >20 male partners, an increase in acquiring partners from the internet and increases in engagement in anal intercourse in some partnering contexts. HIV testing in the 12 months prior to surveys rose from 35.1% in 2002 to 50.4% in 2011, mostly from 2008. CONCLUSIONS: This first indepth examination of trends in HIV-related behaviours among five consecutive large and diverse samples of MSM in New Zealand does not suggest condom use is declining. However, subtle changes in sexual networks and partnering may be altering the epidemic determinants in this population and increasing exposure.

Atom probe tomography study of the nanoscale heterostructure around an Al20Mn3Cu2 dispersoid in aluminum alloy 2024.

Atom probe tomography (APT) has been used to investigate the surface and sub-surface microstructures of aluminum alloy 2024 (AA2024) in the T3 condition (solution heat treated, cold worked, and naturally aged to a substantially stable condition). This study revealed surface Cu enrichment on the alloy matrix, local chemical structure around a dispersoid Al20Mn3Cu2 particle including a Cu-rich particle and S-phase particle on its external surface. Moreover, there was a significant level of hydrogen within the dispersoid, indicating that it is a hydrogen sink. These observations of the nanoscale structure around the dispersoid particle have considerable implications for understanding both corrosion and hydrogen embrittlement in high-strength aluminum alloys.

Factors associated with recent HIV testing among younger gay and bisexual men in New Zealand, 2006-2011.

BACKGROUND: Understanding HIV testing behaviour is vital to developing evidence-based policy and programming that supports optimal HIV care, support, and prevention. This has not been investigated among younger gay, bisexual, and other men who have sex with men (YMSM, aged 16-29) in New Zealand. METHODS: National HIV sociobehavioural surveillance data from 2006, 2008, and 2011 was pooled to determine the prevalence of recent HIV testing (in the last 12 months) among YMSM. Factors associated with recent testing were determined using manual backward stepwise multivariate logistic regression. RESULTS: Of 3,352 eligible YMSM, 1,338 (39.9%) reported a recent HIV test. In the final adjusted model, the odds of having a recent HIV test were higher for YMSM who were older, spent more time with other gay men, reported multiple sex partners, had a regular partner for 6-12 months, reported high condom use with casual partners, and disagreed that HIV is a less serious threat nowadays and that an HIV-positive man would disclose before sex. The odds of having a recent HIV test were lower for YMSM who were bisexual, recruited online, reported Pacific Islander or Asian ethnicities, reported no regular partner or one for >3 years, were insertive-only during anal intercourse with a regular partner, and who had less HIV-related knowledge. CONCLUSION: A priority for HIV management should be connecting YMSM at risk of infection, but unlikely to test with appropriate testing services. New generations of YMSM require targeted, culturally relevant health promotion that provides accurate understandings about HIV transmission and prevention.

Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends.

Repeated behavioural surveillance should sample all epidemiologically relevant subgroups to provide a complete picture of trends in HIV risk behaviours. Web-based recruitment has been mooted but little empirical data exist on country experiences. We describe who is omitted from three rounds of a conventional offline-only surveillance programme among men who have sex with men (MSM) 2006-2011, but recruited subsequently on Internet dating sites, and the implications of this for understanding trends. The latter were younger, less gay identified and less gay community attached. Importantly, they reported different partnering patterns, lower condom use with casual and fuckbuddy-type male partners, and lower rates of HIV testing, compared to MSM routinely captured in offline surveillance. The replacement of offline socio-sexual activity by the Internet among many MSM means that current venue-based surveillance systems may underestimate risk behaviours, overlook trends among unsampled online MSM, and misinterpret trends observed in sampled MSM due to "sample drift" of most-at-risk MSM.

Actual and undiagnosed HIV prevalence in a community sample of men who have sex with men in Auckland, New Zealand.

BACKGROUND: The prevalence of HIV infection and how this varies between subgroups is a fundamental indicator of epidemic control. While there has been a rise in the number of HIV diagnoses among men who have sex with men (MSM) in New Zealand over the last decade, the actual prevalence of HIV and the proportion undiagnosed is not known. We measured these outcomes in a community sample of MSM in Auckland, New Zealand. METHODS: The study was embedded in an established behavioural surveillance programme. MSM attending a gay community fair day, gay bars and sex-on-site venues during 1 week in February 2011 who agreed to complete a questionnaire were invited to provide an anonymous oral fluid specimen for analysis of HIV antibodies. From the 1304 eligible respondents (acceptance rate 48.5%), 1049 provided a matched specimen (provision rate 80.4%). RESULTS: HIV prevalence was 6.5% (95% CI: 5.1-8.1). After adjusting for age, ethnicity and recruitment site, HIV positivity was significantly elevated among respondents who were aged 30-44 or 45 and over, were resident outside New Zealand, had 6-20 or more than 20 recent sexual partners, had engaged in unprotected anal intercourse with a casual partner, had had sex with a man met online, or had injected drugs in the 6 months prior to survey. One fifth (20.9%) of HIV infected men were undiagnosed; 1.3% of the total sample. Although HIV prevalence did not differ by ethnicity, HIV infected non-European respondents were more likely to be undiagnosed. Most of the small number of undiagnosed respondents had tested for HIV previously, and the majority believed themselves to be either "definitely" or "probably" uninfected. There was evidence of continuing risk practices among some of those with known HIV infection. CONCLUSIONS: This is the first estimate of actual and undiagnosed HIV infection among a community sample of gay men in New Zealand. While relatively low compared to other countries with mature epidemics, HIV prevalence was elevated in subgroups of MSM based on behaviour, and diagnosis rates varied by ethnicity. Prevention should focus on raising condom use and earlier diagnosis among those most at risk, and encouraging safe behaviour after diagnosis.

Quantitative 3D Characterization for Kinetics of Corrosion Initiation and Propagation in Additively Manufactured Austenitic Stainless Steel.

In situ X-ray computed tomography (X-ray CT) is used to investigate the effects of characteristic microstructural features on the pitting initiation and propagation in austenitic stainless steel specimens prepared with laser powder bed fusion (LPBF) additive manufacturing. In situ X-ray CT in probing the mechanism and kinetics of localized corrosion is demonstrated by immersing two LPBF specimens with different porosities in an aggressive ferric chloride solution for the evaluation of corrosion. X-ray CT images are acquired from the specimens after every 8 hours of immersion over an extended period of time (216 hours). Corrosion pit growth is then quantitatively analyzed with a data-constrained modeling method. The pitting growth mechanism of LPBF stainless steel is found to be different from that of conventional stainless steels. More specifically, the mechanism of corrosion pit initiation is closely correlated with the original lack of fusion porosity (LOF) distribution on the surface of the specimens and preferential pit propagation through the LOF pores inside the specimens. Pit growth kinetics are derived from pit volume changes determined through 3D data analysis. The pit growth kinetics in LPBF specimens are found to vary in the initial pit formation, competitive pit propagation, and the dominant pit growth stages.

Electron-beam-induced carbon contamination on silicon: characterization using Raman spectroscopy and atomic force microscopy.

Electron-beam-induced carbon film deposition has long been recognized as a side effect of scanning electron microscopy. To characterize the nature of this type of contamination, silicon wafers were subjected to prolonged exposure to 15 kV electron beam energy with a probe current of 300 pA. Using Raman spectroscopy, the deposited coating was identified as an amorphous carbon film with an estimated crystallite size of 125 A. Using atomic force microscopy, the cross-sectional profile of the coating was found to be raised and textured, indicative of the beam raster pattern. A map of the Raman intensity across the coating showed increased intensity along the edges and at the corner of the film. The intensity profile was in excess of that which could be explained by thickness alone. The enhancement was found to correspond with a modeled local field enhancement induced by the coating boundary and showed that the deposited carbon coating generated a localized disturbance in the opto-electrical properties of the substrate, which is compared and contrasted with Raman edge enhancement that is produced by surface structure in silicon.

National trends in sexual health indicators among gay and bisexual men disaggregated by ethnicity: repeated cross-sectional behavioural surveillance in New Zealand.

OBJECTIVES: To assess trends in sexual health outcomes among men who have sex with men (MSM) disaggregated by ethnicity. DESIGN: Repeated cross-sectional. SETTING: Behavioural surveillance data from 2006, 2008, 2011 and 2014 were collected in-person and online across Aotearoa New Zealand. PARTICIPANTS: Eligible participants were self-identified men aged 16 years or older who reported sex with another man in the past 5 years. We classified 10 525 participants' ethnicities: Asian (n=1003, 9.8%), Maori (Indigenous people of Aotearoa New Zealand, n=1058, 10.3%), Pacific (n=424, 4.1%) and European (n=7867, 76.8%). OUTCOME MEASURES: The sexual health outcomes examined were >20 recent (past 6 months) male sexual partners, past-year sexually transmitted infection (STI) testing, past-year STI diagnosis, lifetime and past-year HIV testing, lifetime HIV-positive diagnosis and any recent (past 6 months) condomless anal intercourse with casual or regular partners. RESULTS: When disaggregated, Indigenous and ethnic minority groups reported sexual health trends that diverged from the European MSM and each other. For example, Asian MSM increased lifetime HIV testing (adjusted OR, AOR=1.31 per survey cycle, 95% CI 1.17 to 1.47) and recent HIV testing (AOR=1.14, 95% CI 1.02 to 1.28) with no changes among Maori MSM or Pacific MSM. Condomless anal intercourse with casual partners increased among Maori MSM (AOR=1.13, 95% CI 1.01 to 1.28) with no changes for Asian or Pacific MSM. Condomless anal intercourse with regular partners decreased among Pacific MSM (AOR=0.83, 95% CI 0.69 to 0.99) with no changes for Asian or Maori MSM. CONCLUSIONS: Population-level trends were driven by European MSM, masking important differences for Indigenous and ethnic minority sub-groups. Surveillance data disaggregated by ethnicity highlight inequities in sexual health service access and prevention uptake. Future research should collect, analyse and report disaggregated data by ethnicity to advance health equity.

Leaching Behavior and Corrosion Inhibition of a Rare Earth Carboxylate Incorporated Epoxy Coating System.

While paint coatings act as important barriers to corrosion, defects can lead to localized, rapid metal loss. The addition of corrosion inhibitors that are capable of leaching from a coating to protect the metal surface at a defect can prevent this type of corrosion. This work investigates the release and corrosion protection capabilities of two rare earth (RE) carboxylate inhibitors from an epoxy coating as an initial step to understanding their leaching behavior and interaction with the coating system. Leaching experiments were performed via inductively coupled plasma mass spectroscopy (ICP-MS) analyses of the solutions in which free-standing coatings loaded with varying concentrations of inhibitor compounds had been immersed. Inhibitor release from the epoxy coating was observed to be dependent on initial inhibitor concentration, inhibitor chemistry, and solution pH conditions. The coating systems with greater initial inhibitor loadings showed higher leaching rates, particularly in acidic environments. Following immersion, the absence of characteristic inhibitor peaks in the FTIR spectra of the coatings also confirmed leaching had taken place. Cross-sectional views of the coatings after exposure to the pH 1 environment presented a chloride infusion zone at the coating/solution interface where the inhibitor had leached out. The RE active inhibition provided by the leached RE carboxylate inhibitors was verified by exposure of a coating defect to a chloride contaminated environment.

Illicit drug use among New Zealand gay and bisexual men: Prevalence and association with sexual health behaviours.

INTRODUCTION AND AIMS: Data are lacking on drug use among gay and bisexual men (GBM) in New Zealand. We establish a baseline estimate of drug use and investigate associations with sexual health and HIV risk. DESIGN AND METHODS: A cross-sectional survey of GBM was conducted in gay community settings and online. Participants were asked their frequency of using nine drugs (poppers, cannabis, ecstasy, methamphetamine, amphetamine, cocaine, LSD, gamma hydroxybutyrate and ketamine) in the previous 6 months. We examined associations between selected drugs and number of recent partners, unprotected anal intercourse with a casual partner and sexually transmitted infections using adjusted odds ratios (AOR). RESULTS: Overall, 3211 participants provided information of whom 55.8% reported any drug use, and 37.9% cannabis, 36.7% poppers, 16.5% ecstasy, 10.5% amphetamine, 7.4% methamphetamine, 6.6% LSD, 6.1% cocaine, 5.3% gamma hydroxybutyrate and 4.4% ketamine use. A quarter of all respondents (25.6%) reported using one drug, 22.8% two to four and 7.4% five or more drugs (polydrugs). Methamphetamine and polydrug use was independently predictive of reporting >20 recent partners (AOR 1.6 and 7.0, respectively), unprotected anal intercourse with a casual partner (AOR 1.8 and 3.2, respectively) and a sexually transmitted infection (AOR 1.6 and 4.3, respectively). DISCUSSION AND CONCLUSIONS: Drug use was common in this sample of GBM. Polydrug and methamphetamine users had especially high sexual health needs, but risks remained elevated among GBM consuming other drugs. Drug harm reduction programs and HIV prevention should target GBM with problematic drug use. Limitations include an inability to attribute causation. [Saxton P, Newcombe D, Ahmed A, Dickson N, Hughes A. Illicit drug use among New Zealand gay and bisexual men: Prevalence and association with sexual health behaviours. Drug Alcohol Rev 2017;00:000-000].

Neither sequence variation in the IL-10 gene promoter nor presence of IL-10 protein in the cerebral cortex is associated with Alzheimer's disease.

Interleukin 10 (IL-10) is an important anti-inflammatory cytokine produced in response to neuroinflammation and might be involved in modulating the progression of Alzheimer's disease (AD) through inhibiting the action of pro-inflammatory cytokines. We have used immunohistochemistry, Western blotting, real time-PCR (RT-PCR) on frontal (BA 6/24) and temporal (BA 20-22) neocortex and hippocampus from AD and control brains as well as genetic association analysis to address the possible involvement of IL-10 in AD. Expression of IL-10 in AD and control brains at both protein and mRNA levels were detected. However, the level of expression, particularly of IL-10 protein, varied considerably in individual brains and we did not find a significant difference between AD and controls. Using direct sequencing we examined five single nucleotide polymorphisms (SNPs) (-3538, -1354, -1087, -824, -597) and two microsatellites (IL-10-G, IL-10-R) in the promoter region of the IL-10 gene. None of the identified SNPs were found to be associated with AD either individually or as haplotypes. Levels of IL-10 protein and gene expression examined also did not appear to be related to AD. Despite this being a relatively small sample, these data suggest that IL-10 does not play a major role in the development of AD.

Frequent condom use with casual partners varies by sexual position among younger gay and bisexual men in New Zealand: national behavioural surveillance 2006-2011.

UNLABELLED: Background Condom promotion remains a cornerstone of HIV/STI control, but must be informed by evidence of uptake and address disparities in use. This study sought to determine the prevalence of, and demographic, behavioural and relational factors associated with, condom use during insertive and receptive anal intercourse with casual partners among younger gay, bisexual and other men who have sex with men (YMSM) in New Zealand. METHODS: The 2006-2011 national HIV behavioural surveillance data for YMSM aged 16-29 years was pooled. Separately for each sexual position, frequent (always/almost always) versus infrequent condom use was regressed onto explanatory variables using manual backward stepwise multivariable logistic regression analysis. RESULTS: Three-quarters of YMSM reported frequent condom use during insertive (76.0%) and receptive (73.8%) anal intercourse. YMSM who were exclusively insertive were more likely to report frequent condom use than versatile YMSM. Factors positively associated with frequent condom use, irrespective of sexual position were: in-person versus web-based recruitment, testing HIV negative versus never testing or testing HIV positive, having no recent sex with women, reporting two to five versus one male sexual partner in the past 6 months, reporting no current regular partner, but if in a regular relationship, reporting a boyfriend-type versus fuckbuddy-type partner, and frequent versus infrequent regular partner condom use. Pacific ethnicity and less formal education were negatively associated with frequent condom use only during receptive anal intercourse. CONCLUSIONS: The findings from this study demonstrate that condom norms can be actively established and maintained among YMSM. Condom promotion efforts must increase YMSM's capacity, agency and skills to negotiate condom use, especially for the receptive partner.

Effect of divalproex sodium on behavioural and cognitive problems in elderly dementia.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) occur in up to 90% of individuals with dementia at some point in their illness. BPSD reduce patient quality of life, cause great distress to caregivers and are the most common reason for institutionalisation. In nursing homes, pharmacological measures (usually antipsychotics or benzodiazepines) are often required to control agitation and aggression in patients with dementia. However, no medications have been approved by the US Food and Drug Administration for this indication as yet. The antiepileptic agent divalproex sodium may have advantages in this setting because of lower rates of drug interactions and adverse effects in this patient population. OBJECTIVE: The aim of the study was to assess the impact of treatment with divalproex sodium on behavioural, mood and cognitive measures in a population of elderly nursing home residents with a history of behaviour problems associated with dementia. MATERIALS AND METHODS: The study was a retrospective analysis of a long-term care database which allowed assessment of the impact of divalproex sodium therapy on behavioural, mood and cognitive measures in elderly nursing home residents with a history of dementia-related behaviour problems. Minimum Data Set items relating to problems of behaviour, cognition and mood were collected prior to and after divalproex sodium treatment over a 1-year period. Two-phase generalised linear regression, with fixed intersections at the time of divalproex sodium initiation, was used to estimate trends in each measure prior to and after divalproex sodium initiation. Monotherapy, combination therapy with benzodiazepines and antipsychotics, and dose comparisons of divalproex sodium were studied. RESULTS: In all three situations (i.e. as monotherapy, in combination with benzodiazepines and antipsychotics, and at both higher and lower doses), divalproex sodium therapy was shown to have multiple beneficial effects on various behavioural, mood and cognition indicators in elderly nursing home residents. In general, the data seemed to support more favourable results for the higher divalproex sodium dose group. CONCLUSIONS: These data support the use of divalproex sodium in elderly nursing home residents with a history of dementia and behaviour problems and warrant conduct of prospective, randomised trials of the drug in this setting.