Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study.

BACKGROUND: While illicit drug use is prevalent among gay and bisexual men (GBM) in Australia, little is known about the factors associated with injecting drug use among GBM. METHODS: The Following Lives Undergoing Change (FLUX) study is a national, online prospective observational cohort investigating drug use among Australian GBM. Eligible participants were men living in Australia who were aged 16.5 years or older, identified as gay or bisexual or had sex with at least one man in the last year. We examined baseline data for associations between socio-demographic and behavioural characteristics and recent (last six months) injecting using log-binomial regression. RESULTS: Of 1995 eligible respondents, 206 (10.3%) reported ever injecting drugs and 93 (4.7%) had injected recently, most commonly crystal (91.4%) and speed (9.7%). Among recent injectors, only 16 (17.2%) reported injecting at least weekly; eight (8.6%) reported recent receptive syringe sharing. Self-reported HIV and HCV prevalence was higher among recent injectors than among other participants (HIV: 46.2% vs 5.0%, p < .001; HCV: 16.1% vs. 1.2%, p < .001). Recent injecting was associated with lifetime use of more drug classes (adjusted prevalence ratio (APR) = 1.31, 95% Confidence Interval (95%CI) 1.21-1.41), longer time since initiating party drug use (APR = 1.02, 95%CI 1.01-1.04), greater numbers of sex partners (2-10 sex partners: APR = 3.44, 95%CI 1.45-8.20; >10 sex partners: APR = 3.21, 95%CI 1.30-7.92), group sex (APR = 1.42, 95%CI 1.05-1.91) and condomless anal intercourse with casual partners (APR = 1.81, 95%CI 1.34-2.43) in the last six months. CONCLUSIONS: Observed associations between injecting and sexual risk reflect a strong relationship between these practices among GBM. The intersectionality between injecting drug use and sex partying indicates a need to integrate harm reduction interventions for GBM who inject drugs into sexual health services and targeted sexual health interventions into Needle and Syringe Programs.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs.

OBJECTIVE: To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications. METHODS: Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination. RESULTS: Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow-up (median of 106 weeks, range 26-227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen. CLINICAL SIGNIFICANCE: The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

Reducing susceptibility artefacts in magnetic resonance images of the canine stifle following surgery for cranial cruciate ligament deficiency.

BACKGROUND: Magnetic resonance (MR) images of the postoperative canine stifle are adversely affected by susceptibility artefacts associated with metallic implants. OBJECTIVES: To determine empirically to what extent susceptibility artefacts could be reduced by modifications to MR technique. METHODS: Three cadaveric limbs with a tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA), or extra-capsular stabilization (ECS) implant, respectively, were imaged at 1.5T. Series of proton density and T2-weighted images were acquired with different combinations of frequency-encoding gradient (FEG) direction and polarity, stifle flexion or extension, echo spacing (ES), and readout bandwidth (ROBW), and ranked. The highest rank (a rank of 1) corresponded to the smallest artefact. RESULTS: Image ranking was affected by FEG polarity (p = 0.005), stifle flexion (p = 0.01), and ROBW (p = 0.0001). For TPLO and TTA implants, the highest ranked images were obtained with the stifle flexed, lateromedial FEG, and medial polarity for dorsal images, and craniocaudal FEG and caudal polarity for sagittal images. For the ECS implant, the highest ranked images were obtained with the stifle extended, a proximodistal FEG and proximal polarity for dorsal images, and craniocaudal FEG and cranial polarity for sagittal images. CLINICAL SIGNIFICANCE: Susceptibility artefacts in MR images of postoperative canine stifles do not preclude clinical evaluation of joints with ECS or TTA implants.

Toggle rod stabilisation of coxofemoral luxation in 14 cats.

OBJECTIVES: To describe the surgical technique and to report outcomes in cats with coxofemoral luxation treated with open reduction and toggle rod stabilisation. METHODS: Retrospective study of cats with coxofemoral luxation stabilised via the toggle rod method. Short-term follow-up included clinical examination and radiographs. Long-term follow-up was via owner questionnaire. RESULTS: Fourteen cats were included. All of the cats had reported unilateral craniodorsal hip luxation. Nine cats (64·3%) had additional orthopaedic injuries. Luxations were stabilised with a 3·2-mm toggle rod (2·7-mm toggle rod in one cat) and two loops of four-metric polydioxanone (five-metric polydioxanone in one cat and three loops of four-metric polydioxanone in two cats). Success rate, in terms of maintenance of reduction, was 86%. Reluxation occurred in two cats (14%), both of which had multiple limb injuries. Eleven owner questionnaires (mean follow-up time 15·5 months) reported a functional outcome of "very good" to "excellent". Although the diameter of the pelvic canal was reduced by the presence of the toggle rod (mean narrowing 16.2%), none of the cats had defaecatory issues. CLINICAL SIGNIFICANCE: Toggle rod stabilisation is an effective method for the treatment of coxofemoral luxation in cats. Injuries to multiple limbs may be a risk factor for reluxation.

Effects of surgical implants on high-field magnetic resonance images of the normal canine stifle.

To determine the effect of surgical implants on the depiction of canine stifle anatomy in magnetic resonance (MR) images, three canine cadaver limbs were imaged at 1.5 T before and after tibial plateau leveling osteotomy (TPLO), tibial tuberosity advancement (TTA), and extra-capsular stabilization (ECS), respectively. Susceptibility artifacts associated with implants were identified in MR images as a signal void and/or signal misregistration, which obscured or distorted the anatomy. Using the preoperative images as a reference, articular structures of the stifle in postoperative images were graded using an ordinal scale to describe to what degree each anatomic structure could be evaluated for clinical purposes. The TPLO implant, which contains ferromagnetic stainless steel, produced marked susceptibility artifacts that obscured or distorted most stifle anatomy. The titanium alloy TTA implants and the stainless steel crimps used for ECS produced susceptibility artifacts that mainly affected the lateral aspect of the stifle, but allowed the cruciate ligaments and medial meniscus to be evaluated satisfactorily. Susceptibility artifact was significantly less marked in images obtained using turbo spin-echo (TSE) sequences than in sequences employing spectral fat saturation. Clinical MR imaging of canine stifles containing certain metallic implants is feasible using TSE sequences without fat saturation.

The use of a stifle flexion device to manage avulsion of the lateral head of the gastrocnemius muscle in a cat.

This report describes the diagnosis and treatment of a traumatic avulsion of the lateral head of the gastrocnemius muscle in a three-and-a-half-year-old male neutered Domestic Shorthaired cat. Surgical repair was achieved using a modified three-loop pulley suture pattern passed through a suture anchor inserted at the point of origin of the tendon and around the fabella. A stifle flexion device was utilised during the postoperative period to protect the repair. Follow-up at five months showed a return to normal function. This is the first report of avulsion of the lateral head of the gastrocnemius in a cat.

A retrospective study of tibial plateau translation following tibial plateau levelling osteotomy stabilisation using three different plate types.

OBJECTIVE: To retrospectively evaluate mediolateral translation of the proximal tibial segment (tibial plateau) after tibial plateau levelling osteotomy (TPLO), stabilised with three types of plate. METHOD: Pre- and postoperative radiographs of 79 dogs that had TPLO surgery using three different types of plates were reviewed. Two plate types incorporated non-locking screws: Slocum (22 cases) and Orthomed Delta (33 cases) plates. The third plate type incorporated locking screws: Synthes TPLO Locking Compression Plate (LCP) (24 cases). The radiographs were viewed by three Diplomate surgeons who were blinded to the type of implant used. Medial or lateral translation of the proximal tibial plateau relative to the tibial diaphysis was assessed and measured at the lateral tibial cortex at the osteotomy site. RESULTS: Mean lateral translation of the tibial plateau was significantly greater when using the Synthes TPLO LCP with locking screws (+2.1 mm) compared to the non-locking Slocum (+0.4 mm) or Orthomed Delta (0.0 mm) plates. CLINICAL SIGNIFICANCE: The use of the Synthes TPLO LCP will maintain a malalignment of the tibial plateau. Accurate alignment of the tibial plateau must be ensured prior to application of the Synthes TPLO LCP.

Evaluation of the transarticular external skeletal fixator for the treatment of tarsocrural instability in 32 cats.

The medical records of all cats with tarsocrural joint instability that were treated between June 2002 and December 2008 at the Royal Veterinary College were retrospectively reviewed. A total of 32 cats were identified. Information gathered included signalment, type of injury (subluxation or luxation), concurrent fractures, presence of soft tissue wounds, transarticular external skeletal fixation (TESF) type, configuration of TESF (number of pins proximal and distal to the joint), duration of hospitalisation, duration of TESF prior to removal, complications and cost. A significant association was identified between the length of hospitalisation and the presence of wounds. Similarly a significant association was present between wounds and final cost of treatment. Additionally, the authors found that a high number of implant related complications were present when only two pins were used proximal and distal to the tarsocrural joint, but this association was not significant.

Influence of signalment on developing cranial cruciate rupture in dogs in the UK.

OBJECTIVES: To investigate risk factors associated with cranial cruciate ligament rupture in dogs. METHODS: Retrospective case-control study: medical records of a first-opinion veterinary practice were searched for dogs diagnosed with cranial cruciate ligament rupture (1995 to 2007). For each case, six unaffected dogs were randomly selected from all dogs presenting that day for comparison. Multi-variable binary logistic regression was performed to assess the association of variables on likelihood of cruciate rupture. RESULTS: Frequency of cranial cruciate ligament rupture was 1·19% [95% confidence interval (CI) 1·02 to 1.36%]. West Highland white terriers (n=17), Yorkshire terriers (n=14) and Rottweilers (n=11) were at significantly increased risk of cranial cruciate ligament rupture (P≤0·002). Rottweilers were at five times greater risk compared with other pure breeds (OR 5·12, 95% CI 2·281 to 11·494, P<0·001), obesity quadrupled the risk of cranial cruciate ligament rupture (OR 3·756, 95% CI 1·659 to 8·502, P=0·001) and females were twice as likely to suffer cranial cruciate ligament failure compared to males (OR 2·054, 95% CI 1·467 to 2·877, P<0·001). Dogs less than two years old were statistically less likely to sustain cranial cruciate ligament rupture than dogs older than eight years (OR 0·246, 95% CI 0·127 to 0·477, P<0·001). There was no significant difference in median weights (in kilograms) of neutered dogs, compared to their entire counterparts in either the case group (P=0·994) or in the control group (P=0·630). There was also no significant difference in body condition (-underweight/normal weight/overweight/obese) of neutered versus entire dogs among the cases (P=0·243), or the controls (P=0·211). CLINICAL SIGNIFICANCE: Cranial cruciate ligament rupture is more likely in Rottweilers and in female dogs, older dogs and obese dogs. Following multi-variable analysis, it was established that neutering was not associated with increased risk of cranial cruciate ligament rupture.

Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV-positive Australians.

OBJECTIVES: Given the importance of adherence to combination antiretroviral therapy (cART) for the reduced morbidity and improved mortality of people living with HIV infection (PLWH), we set out to determine which of a number of previously investigated personal, socioeconomic, treatment-related and disease-related factors were independently associated with self-reported difficulty taking antiretroviral therapy (ART) in an Australian sample of PLWH. METHODS: Using data from a national cross-sectional survey of 1106 PLWH, we conducted bivariate and multivariable analyses to assess the association of over 70 previously investigated factors with self-reported difficulty taking ART. Factors that maintained an association with reported difficulty taking ART at the level of α=0.05 in the multivariable logistic regression analysis were considered to be independently associated with reported difficulty taking ART. RESULTS: A total of 867 (78.4%) survey respondents were taking antiretroviral medication at the time of completing the HIV Futures 6 survey. Overall, 39.1% of these respondents reported difficulty taking ART. Factors found to be independently associated with reported difficulty taking ART included younger age, alcohol and party drug use, poor or fair self-reported health, diagnosis of a mental health condition, living in a regional centre, taking more than one ART dose per day, experiencing physical adverse events or health service discrimination, certain types of ART regimen and specific attitudes towards ART and HIV. CONCLUSIONS: Thirteen previously investigated factors were found to be independently associated with reported difficulty taking ART, reaffirming the dynamic nature of adherence behaviour and the ongoing importance of addressing adherence behaviour in the clinical management of PLWH.

An investigation into risk factors for bilateral canine cruciate ligament rupture.

OBJECTIVES: To investigate the incidence of bilateral cranial cruciate ligament (CrCL) rupture and determine any associated risk factors. METHODS: The patient information system and surgical database at the Queen Mother Hospital for Animals, Royal Veterinary College, were searched from March 1998 to March 2007. Patient files were reviewed and data recorded. The risk factors considered included: gender, neuter status, breed, body mass, age and concurrent orthopaedic disease. RESULTS: In total, 511 dogs were identified as having cruciate rupture and included for analysis. Bilateral rupture of the CrCl was present in 38.7% (198/511) of the dogs. The mean (± SD) time that passed until the contralateral CrCL ruptured was 57.9 weeks (± 54.1; range 3 to 260 weeks). Dogs with bilateral cruciate rupture were younger (mean ± SD; 4.3 ± 2.7 years) than dogs with unilateral cruciate rupture (mean ± SD; 5.3 ± 2.8 years). In dogs with CrCL rupture, male dogs were more likely to have bilateral rupture than female dogs, overweight dogs were more likely to have bilateral rupture, Golden Retrievers were less likely to have bilateral rupture, and Rottweilers had the highest odds of bilateral rupture. CLINICAL SIGNIFICANCE: In dogs with CrCL rupture, this study suggests possible relationships towards the incidence of a bilateral rupture also occurring as more likely in male dogs, young dogs with a mean age of four years (4.3 ± 2.7 years), Rottweiler dogs, and with an average elapsed time between ruptures of 57.9 weeks.

Evaluation of surface contamination with staphylococci in a veterinary hospital using a quantitative microbiological method.

OBJECTIVES: To evaluate microbial contamination of the environment in a veterinary hospital using standards recommended for human hospitals and to provide a baseline against which further investigations can be compared. METHODS: Surfaces were sampled twice daily for five consecutive days using a contact-based counting method to measure the levels of staphylococci in colony forming units (cfu) per cm². RESULTS: Current recommendations for human hospitals were applied in this study; all samples with <2.5 cfu/cm² staphylococci were considered to have passed and those with ≥2.5 cfu/cm² to have failed. Of all the samples, 55.9% failed. The ICU did not have significantly higher failure rates than other areas of the hospital. The floor as a surface was associated with greater than a threefold increase in odds of elevated cfu concentrations relative to the door handle. CLINICAL SIGNIFICANCE: This study provides information on the microbiological cleanliness of a veterinary teaching hospital using techniques and standards adopted by the food industry and recommended for human hospitals. This data can be used as a baseline for other hospitals, to evaluate the effectiveness in improvements in hygiene and cleaning measures and to design effective hospital cleaning protocols and assess ongoing hygiene standards.

No increase in HIV or sexually transmissible infection testing following a social marketing campaign among men who have sex with men.

BACKGROUND: A social marketing campaign ran in 2004 in the Victoria to increase rates of HIV/sexually transmissible infection (STI) testing among men having sex with men (MSM). METHODS: To evaluate the initiative data from HIV sentinel surveillance, laboratory data on testing for HIV/STIs and STI/HIV testing uptake reported in annual surveys were analysed. RESULTS: The sentinel surveillance network showed no increase in the overall extent of HIV testing and no difference in the proportion of MSM reporting regular annual HIV testing during the campaign (43%) and post campaign (41%). The annual behavioural surveys showed that between 2004 and 2006 there was no significant increase in this overall proportion of MSM reporting having an HIV test in the last 12 months (p = 0.96). The behavioural surveys also showed an increasing trend in the proportion reporting specific STI tests over time: anal swab (26% to 39%, p

Coxofemoral luxation in a border collie as a complication of a Clostridium tetani infection.

A four-month-old male, entire, border collie was presented to the Queen Mother Hospital for Animals with a two day history of muscular spasms and "Risus sardonicus". Tetanus was diagnosed, and the dog was treated with tetanus antitoxin, antibiotics and supportive therapy. Coxofemoral luxation resulted as a complication of the tetanus and was successfully managed by performing a femoral head and neck excision. This is the first report of joint luxation associated with Clostridium tetani infection in a dog.

State of the (positive) nation: findings from the fourth national Australian HIV futures survey.

This paper characterises the health and wellbeing of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 4 Survey is a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 1059 responses, approximately 8% of the estimated HIV-positive population. Respondents were aged between 18 and 92 years and 77% were homosexual men. In total, 60% reported a viral load of <500 copies/mL and 83% a CD4 count of over 250 cells/microL. A total of 44% reported another major health condition and 35% a mental health condition. A total of 71% were using antiretroviral therapy. More than half of the respondents had stopped working because of HIV and 25% were living in poverty. In conclusion, adequate planning for the future of our response to HIV/AIDS relies in no small part on our access to detailed information about how the epidemic affects those with the virus.

Differences between HIV-positive gay men who 'frequently', 'sometimes' or 'never' engage in unprotected anal intercourse with serononconcordant casual partners: positive Health cohort, Australia.

By measuring the actual number of risk acts engaged in by HIV-positive men participating in the Positive Health (PH) cohort study, this paper sets out to document the distribution of risk acts, to report on the proportion of acts of unprotected anal intercourse with casual (UAIC) partners that occurred between HIV-positive men (i.e. seroconcordant positive) and to examine the factors that differentiated men who 'frequently' compared with 'sometimes' or 'never' engaged in unsafe UAIC (i.e. UAIC with serononconcordant partners: partners who have not tested positive for HIV). The findings show that 42.6% of all UAIC acts occurred between seroconcordant HIV-positive partners, posing no risk of HIV infection to an HIV-negative person. A minority of participants (10%) accounted for the majority (70.7%) of the unsafe acts of UAIC. The HIV-positive men who 'sometimes' engaged in unsafe UAIC had higher treatment optimism scores and were more likely to use Viagra in comparison with those who did not engage in such risk. Those who reported 'frequent' engagement in unsafe UAIC were more likely to engage in a range of esoteric sexual practices, be slightly less well educated and be taking antiretroviral therapy compared with HIV-positive men who 'sometimes' engaged in unsafe UAIC. As such, taking ART but not viral load, predicted frequent unsafe UAIC. When considered alongside earlier studies, these results suggest that HIV-negative men who engage in esoteric sexual practices may be at increased risk of HIV transmission, not necessarily because they engage in esoteric sex practices but because of the sub-cultural milieu in which esoteric sex is occurring. The findings from this study also endorse the measurement of UAIC acts as a useful gauge of risk.

Marijuana as therapy for people living with HIV/AIDS: social and health aspects.

Therapeutic use of marijuana has emerged as an important issue for people living with cancer, HIV/AIDS and multiple sclerosis. This paper examines therapeutic use of marijuana in the Positive Health cohort study, a longitudinal cohort study of men and women living with HIV/AIDS in NSW and Victoria, Australia. Factors that distinguish therapeutic use of marijuana from recreational use were assessed by comparisons on a range of social and health-related variables. The results show that among 408 participants, 59.8% reported some use of marijuana in the past six months. Of those participants (n=244), 55.7% reported recreational use only of marijuana and 44.3% report mixed use of marijuana for therapeutic and recreational purposes. Multivariate logistic regression analysis showed that participants who used marijuana for therapeutic purposes were significantly more likely than recreational-only users to have used other complementary or alternative therapies, experienced HIV/AIDS-related illness or other illnesses in the past 12 months, had higher CD4/T-cell counts, had lower incomes, be younger in age and less likely to have had a casual partner in the six months prior to interview. These results show that a substantial proportion of people living with HIV/AIDS (PLWHA) use marijuana for therapeutic purposes, despite considerable legal barriers, suggesting marijuana represents another option in their health management. Rather than solely using marijuana in response to illness, the experience of illness may influence a person's understanding of their marijuana use, so that they come to understand it as therapeutic. Further research might consider possible interactions between cannabinoids and antiretroviral treatments, potential use of oral THC and the difficulties faced by clinicians and PLWHA in discussing marijuana in the current legal context.

Individual characteristics are less important than event characteristics in predicting protected and unprotected anal intercourse among homosexual and bisexual men in Melbourne, Australia.

OBJECTIVE: To describe individual, social network and encounter specific factors associated with protected anal intercourse (PAI) and unprotected anal intercourse (UAI). METHODS: This was a cross sectional survey conducted between April and November 2002. A total of 733 sexual encounters were reported by 202 men recruited from the gay community in Melbourne, Australia. Predictors of self reported PAI and UAI were examined. RESULTS: Of the 733 sexual events most (56.3%) did not involve anal intercourse, and more involved PAI than UAI (30.6% versus 13.1%). PAI was more likely than no anal intercourse (NAI) if the participant's social network was mostly homosexual, the partner was an occasional or casual partner, or was HIV positive. PAI was less likely if sex took place at a "beat" but more likely if it took place at a sauna. PAI was more likely if the partner was affected by drugs or alcohol. UAI was more likely than NAI if the participant had injected drugs in the year before interview. It was less likely if the partner was occasional or casual or was HIV positive but more likely if the partner's HIV status was unknown. UAI was much more likely than NAI if the encounter took place at a "sex on premises" venue. CONCLUSIONS: In this analysis it is the characteristics of the sexual encounter that predict whether PAI or UAI rather than NAI takes place.

Health and wellbeing of HIV-positive Australians: findings from the third national HIV Futures Survey.

The aim of this paper is to characterize the health and well being of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 3 Survey was a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 894 responses, 6% of the known HIV-positive population. Respondents were aged between 20 and 77; 79% were homosexual men. In all, 58% reported a viral load of <500 copies/mL, and 81% a CD4 count of over 250 cells/microL. In all, 38% reported another major health condition, and 26% a mental health condition. A total of 72% were using antiretroviral therapy. About 48% were in a regular relationship, and 42% of regular partners were HIV-positive. In all, 55% had stopped working because of HIV and 31% were living in poverty. While the overall picture for PLWHA in Australia is optimistic, there remain clear patterns of health and social disadvantage that require ongoing policy vigilance and service provision.