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1.
AIDS Behav ; 24(6): 1793-1806, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31782068

RESUMO

The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013-2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.


Assuntos
Depressão , Infecções por HIV , Comportamento Sexual , Minorias Sexuais e de Gênero , Sexo sem Proteção , Adolescente , Adulto , Preservativos , Estudos Transversais , Depressão/epidemiologia , Inglaterra/epidemiologia , Feminino , Homossexualidade Masculina , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Parceiros Sexuais , Adulto Jovem
2.
HIV Med ; 18(8): 604-612, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28294498

RESUMO

OBJECTIVES: We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. METHODS: We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. RESULTS: PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIV-negative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL. CONCLUSIONS: Despite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Nível de Saúde , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/patologia , Resposta Viral Sustentada , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Espirometria , Inquéritos e Questionários , Reino Unido/epidemiologia
3.
Sex Transm Infect ; 85(3): 173-5, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19221105

RESUMO

OBJECTIVE: To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM). DESIGN: Multicentre cross-sectional survey. SETTING: Four genitourinary medicine clinics in the United Kingdom from 2006-7. SUBJECTS: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening. METHODS: Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination. MAIN OUTCOME: Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic. RESULTS: The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%). CONCLUSIONS: Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK.


Assuntos
Chlamydia trachomatis/isolamento & purificação , Homossexualidade Masculina , Linfogranuloma Venéreo/epidemiologia , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Humanos , Linfogranuloma Venéreo/diagnóstico , Masculino , Programas de Rastreamento , Prevalência , Doenças Retais/epidemiologia , Fatores de Risco , Reino Unido/epidemiologia , Doenças Uretrais/epidemiologia
4.
Int J STD AIDS ; 18(6): 404-6, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17609031

RESUMO

Our department has been offering routine rectal chlamydia testing to all individuals reporting ano-receptive sex since 2002. We wanted to determine the prevalence of rectal chlamydia and if there were any factors associated with a positive diagnosis. A retrospective case-notes analysis was performed of all individuals tested for rectal chlamydia from November 2002 until March 2005. In total, 1187 case-notes were examined. Overall, the prevalence of chlamydia infection was 8.5%; in asymptomatic individuals, it was 5.1%. There was a positive association with chlamydia infection in patients who were HIV-positive, those who reported rectal symptoms and from samples in which microscopy of a rectal smear demonstrated >10 polymorphonuclear cells/high power field. The findings support our continuing to offer rectal chlamydia screening to patients attending our service. Chlamydia trachomatis infection should be considered as a possible diagnosis in patients who present with rectal symptoms outside a genitourinary medicine clinic setting.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Doenças Retais/microbiologia , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Microscopia/métodos , Doenças Retais/epidemiologia , Estudos Retrospectivos , Comportamento Sexual , Reino Unido/epidemiologia
5.
Int J STD AIDS ; 17(8): 513-6, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16925895

RESUMO

The aim of the study was to determine medical student attitudes towards HIV-related issues, to examine if the following student factors can affect attitudes: gender, perception of HIV infectivity, exposure to an HIV+ individual, career intent and attending a clinical attachment. A self-administered questionnaire was given to students at the beginning and end of a clinical attachment. Of the 240 questionnaires handed out at the beginning of the attachment, 183 (76%) were completed. Students generally expressed positive attitudes towards people with HIV. Female students and individuals who had considered working in a related specialty or had met an HIV+ person expressed more patient-centred attitudes in some of their responses. Following the course, 72 questionnaires were returned. Responses to several of the attitudinal statements had changed significantly. Medical students generally have enlightened attitudes towards HIV-related issues, which may be affected by student factors and attending a clinical attachment.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/psicologia , HIV , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino
6.
Int J STD AIDS ; 17(3): 185-8, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16510007

RESUMO

The objective of this study is to determine the effect of providing written information about HIV testing on patient knowledge and test uptake. Patients attending our genitourinary medicine clinic in July 2003 were offered written information about HIV and the test. They were asked to complete a questionnaire which elicited knowledge provided on the leaflet. A control group of individuals were offered verbal discussion only.A total of 382 questionnaires were completed. Individuals given written information were more likely to believe that HIV could not be transmitted by insect bites (P = 0.01), more aware of current treatments and that a negative test would not affect a future mortgage application (P = 0.001). There was no difference in test uptake or reasons for declining a test in both groups. Providing written information on HIV testing increases patient knowledge, but does not affect test uptake.


Assuntos
Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Infecções por HIV/psicologia , Promoção da Saúde , Humanos , Folhetos , Inquéritos e Questionários
7.
Int J STD AIDS ; 17(5): 299-303, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16643678

RESUMO

We used qualitative methods to explore factors, which might explain increased anxiety in patients attending a sexually transmitted infection (STI) clinic. Twenty patients, who scored significantly for anxiety on the Hospital Anxiety and Depression Scale (HADS) attended a 20-minute interview. This explored factors contributing to their current psychological symptoms. Transcripts revealed three main themes. First were factors related to possible STIs and the clinic visit. These included health anxieties about HIV or fertility and clinic factors, including staff attitudes and clinic location. Second were factors unrelated to the clinic, including previous emotional difficulties or substance misuse. Third were issues concerning stigma, embarrassment and shame. The origins of anxiety in STI patients are multifactorial and difficult to identify during brief appointments. Despite modern clinics and attitudes, stigma and embarrassment remain prominent. Interventions to address these factors could improve psychological health in this patient group.


Assuntos
Ansiedade/psicologia , Atitude Frente a Saúde , Infecções Sexualmente Transmissíveis/psicologia , Adulto , Atitude do Pessoal de Saúde , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Relações Profissional-Paciente , Autoimagem , Estereotipagem
8.
Int J STD AIDS ; 16(3): 201-2, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15829019

RESUMO

We examined the incidence, presentation and sexual behaviour of gay men diagnosed with early syphilis at the Royal Free Hospital HIV department in 2002. A total of 1086 gay men attended and 31 were diagnosed with early syphilis (2.9/100 person years). Twenty-six (84%) of the men were symptomatic and 15 (48%) had documented negative serology within the previous six months. All of the men reported anal intercourse with a new partner in the previous three months. The results support offering regular serological screening to sexually active gay men attending our HIV outpatients' department.


Assuntos
Instituições de Assistência Ambulatorial , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Sífilis/epidemiologia , Sífilis/fisiopatologia , Hospitais Urbanos , Humanos , Incidência , Londres/epidemiologia , Masculino , Comportamento Sexual , Sífilis/diagnóstico
9.
Int J STD AIDS ; 11(3): 193-5, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10726946

RESUMO

In order to determine if antiretroviral prescribing for patients with HIV infection attending the Central Middlesex Hospital is according to current UK guidelines and effective at reducing the serum HIV viral load, 71 case notes were reviewed. All patients eligible for treatment according to the British HIV Association (BHIVA) guidelines were currently being offered triple therapy. The most recent serum HIV viral loads of patients taking at least 3 antiretrovirals were undetectable in 75% of the 20 patients on their first established regimen and 36% of 14 patients who had failed at least one drug according to previous surrogate marker results. Such work allows an individual clinic to monitor its antiretroviral prescribing practices in the face of constantly updated information and guidelines.


Assuntos
Assistência Ambulatorial , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Ambulatório Hospitalar , Quimioterapia Combinada , Humanos , Londres , Auditoria Médica
10.
Int J STD AIDS ; 11(12): 774-6, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11138910

RESUMO

Our objectives were to determine the prevalence of Neisseria gonorrhoeae not fully sensitive to ciprofloxacin from a sexually transmitted infection (STI) clinic in London and where the isolates were acquired from. Data of antibiotic sensitivities of N. gonorrhoeae from 292 patients were reviewed over a 6-month period at St Mary's Genitourinary Medicine (GUM) Clinic, London. Isolates which exhibited reduced susceptibility (minimum inhibitory concentration [MIC] 0.03-0.12 mg/l) and high level resistance (MIC>0.12 mg/l) to ciprofloxacin represented 10% and 1.3% of the total respectively. All patients infected with a high level resistant isolate to ciprofloxacin had had a recent sexual partner from abroad but 18 of the 28 patients infected with a reduced susceptibility isolate denied recent travel. None of the 20 patients with a non-sensitive isolate who re-attended for post treatment cultures had persistant gonococcal infection. From this study we concluded that although N. gonorrhoeae resistant to ciprofloxacin was rare and probably always acquired abroad, isolates exhibiting reduced susceptibility were more common and were mainly as a result of infection from the UK. A stat dose of ciprofloxacin 500 mg and doxycycline 100 mg twice a day for one week was effective treatment.


Assuntos
Anti-Infecciosos/farmacologia , Ciprofloxacina/farmacologia , Gonorreia/microbiologia , Neisseria gonorrhoeae/efeitos dos fármacos , Viagem , Adolescente , Adulto , Idoso , Centros Comunitários de Saúde , Resistência Microbiana a Medicamentos , Feminino , Gonorreia/epidemiologia , Humanos , Londres/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/microbiologia
11.
Acta Anaesthesiol Belg ; 46(1): 3-18, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7618426

RESUMO

This review considers the pharmacology and indications for use of human albumin and synthetic colloids in general and transplantation surgery. The selection of a particular agent should be based on sound knowledge of their pharmacokinetic and pharmadynamic properties together with some consideration of cost. For correction of hypovolemia, human serum albumin solutions can adequately be replaced by present day colloids such as hydroxyethyl starch solutions. The duration of their effect in the intravascular space and their properties for plasma volume substitution or expansion are the main factors that will influence their selection. Albumin solutions, however, remain useful for treatment of all acute situations of hypovolemia accompanied by hypoalbuminemia during and after surgery.


Assuntos
Coloides/uso terapêutico , Substitutos do Plasma , Albumina Sérica/uso terapêutico , Procedimentos Cirúrgicos Operatórios , Coloides/farmacologia , Hidratação/métodos , Humanos , Pressão Osmótica , Albumina Sérica/farmacologia , Choque/fisiopatologia , Choque/terapia , Transplante
14.
Sex Transm Infect ; 81(5): 437-9, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16199748

RESUMO

OBJECTIVES: To determine patient attitudes toward medical students in the sexual health clinic, and to describe factors associated with patient refusal of medical student involvement. METHOD: A self administered questionnaire was given to 259 consecutive patients attending the general genitourinary medicine clinic. Participants were asked to indicate their attitude to questioning and/or examination by medical students. Information was also collected on sex, age, ethnicity, and previous visits to sexual health clinics and previous exposure to medical students. The proportion of patients reporting comfort with student involvement, and association with age, sex, country of birth, language spoken, and previous experience of student and/or genitourinary medicine clinics are reported. RESULTS: 82.6% of patients agreed to participate. The proportion reporting feeling comfortable with students ranged from 64% for female students questioning them with a doctor present to 35% for a male student questioning them alone. Comfort levels were associated with the sex of the student and previous exposure to medical students, but not age, country of birth, language spoken, or previous attendance at a sexual health clinic. The most common reasons for feeling uncomfortable with students were privacy concerns and poorer quality of care. CONCLUSION: Many patients feel uncomfortable with medical student involvement in a sexual health clinic consultation; particularly patients with no previous contact with medical students. Privacy and standard of care were the most common concerns, which are potentially amenable to change through better explanation of the students' role in the clinic.


Assuntos
Assistência Ambulatorial/psicologia , Educação de Graduação em Medicina , Satisfação do Paciente , Relações Profissional-Paciente , Estudantes de Medicina , Venereologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Privacidade , Estudantes de Medicina/estatística & dados numéricos , Recusa do Paciente ao Tratamento
15.
Anaesthesia ; 50(10): 858-62, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7485874

RESUMO

Clinical measures of ventilation and the relationship between arterial and end-tidal carbon dioxide tensions were studied during inhalational anaesthesia in 18 patients using a laryngeal mask airway or a facemask. Tidal volumes were similar in both groups but expired minute volume, respiratory rate and physiological deadspace ventilation were significantly increased in the facemask group. Both end-tidal and arterial carbon dioxide tensions were higher in the laryngeal mask group. Mean arterial to end-tidal carbon dioxide tension differences ranged from 0.13 to 4.13 kPa in the facemask group and from 0-1.73 kPa with the laryngeal mask airway. Pooled data analysis revealed a better correlation between arterial and end-tidal carbon dioxide tensions during laryngeal mask ventilation as compared to facemask breathing. With both techniques the arterial to end-tidal carbon dioxide tension difference was related to respiratory rate and physiological deadspace ventilation. Estimation of arterial carbon dioxide partial pressure by monitoring end-tidal carbon dioxide tension is more reliable with the laryngeal mask airway than during facemask breathing, in particular at small tidal volumes.


Assuntos
Anestesia por Inalação/métodos , Dióxido de Carbono/análise , Máscaras , Respiração , Adulto , Dióxido de Carbono/sangue , Feminino , Humanos , Máscaras Laríngeas , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Pressão Parcial
16.
Br J Cancer ; 66(1): 136-8, 1992 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-1637663

RESUMO

The importance of axillary dissection as part of the primary surgical procedure in the treatment of operable cases of carcinoma of the breast is established. The morbidity of this procedure, however, is less well documented. A study of 126 women who had had full axillary dissection as part of their initial surgical treatment was undertaken to assess their degree of morbidity in terms of numbness, pain, weakness, swelling, and stiffness. Seventy per cent of cases complained of numbness, 33% of pain, 25% of weakness, 24% of limb swelling, and 15% of stiffness. Objective measurements confirmed decreased sensation in 81%, weakness in 27%, swelling in 10%, and stiffness in 10%. In no case were these symptoms described as severe, though they did have an effect upon the daily lives of 39%. The side effects of full axillary dissection are common and all women should be warned of them prior to surgery; however they are usually mild and therefore should not preclude this procedure as a part of definitive surgical treatment.


Assuntos
Neoplasias da Mama/cirurgia , Excisão de Linfonodo , Neoplasias da Mama/fisiopatologia , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/efeitos adversos , Prognóstico , Inquéritos e Questionários , Fatores de Tempo
17.
Br J Anaesth ; 76(1): 54-60, 1996 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8672381

RESUMO

In a prospective, randomized, multicentre, double-blind, placebo-controlled study, we have compared the efficacy of a single i.v. dose of tropisetron 0.5 mg, 2 mg and 5 mg in the prevention of postoperative nausea and vomiting (PONV). We studied 385 ASA class I and II female patients undergoing abdominal or vaginal gynaecological surgery, including laparoscopy. Tropisetron or placebo were administered before a standardized general anaesthetic. The frequency of vomiting in the 24-h period after entry into the recovery room was reduced from 44% after placebo to 31%, 26% and 30% after tropisetron 0.5 mg, 2 mg and 5 mg, respectively (P = 0.06, P = 0.009 and P = 0.043; unadjusted). Compared with placebo, nausea was reduced from 55% to 46%, 34% and 46% (P = 0.25, P = 0.003, P = 0.22), and need for rescue treatment from 39% to 29%, 23% and 35% (P = 0.13, P = 0.017 and P = 0.59) for the same groups. Tropisetron 2 mg appeared to be the optimal dose for prophylaxis against PONV with a side-effect profile similar to that of placebo.


Assuntos
Antieméticos/administração & dosagem , Genitália Feminina/cirurgia , Indóis/administração & dosagem , Náusea/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Antagonistas da Serotonina/administração & dosagem , Vômito/prevenção & controle , Adulto , Idoso , Período de Recuperação da Anestesia , Antieméticos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Indóis/efeitos adversos , Injeções Intravenosas , Pessoa de Meia-Idade , Estudos Prospectivos , Antagonistas da Serotonina/efeitos adversos , Tropizetrona
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