Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection.

OBJECTIVES: The aim of the study was to assess the feasibility of a national pre-exposure prophylaxis (PrEP) programme using smartphone-compatible data collection. METHODS: This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone-compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV-negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow-up (number with first follow-up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out. RESULTS: Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52-137]. Retention at first follow-up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33-47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment. CONCLUSIONS: In a national PrEP programme using smartphone-compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

Chemsex drugs on the rise: a longitudinal analysis of the Swiss HIV Cohort Study from 2007 to 2017.

OBJECTIVES: Chemsex refers to the use of sex-enhancing drugs among men who have sex with men (MSM) in combination with specific sexual and social behaviours. Longitudinal data on this development and the associated health risks are scarce. METHODS: Data on all recreational drugs reported in the Swiss HIV Cohort Study (SHCS) from 2007 to 2017 were collected. Drug use was analysed longitudinally for all drug classes. In addition, potential associations between patient characteristics and the consumption of methamphetamine, γ-hydroxybutric acid/γ-butyrolactone (GHB/GBL), 3,4-methylenedioxymethamphetamine (MDMA/XTC), cocaine and amphetamine were analysed. RESULTS: We analysed 166 167 follow-up entries for 12 527 SHCS participants, including 7101 free text field entries containing information about recreational drugs other than cannabis, cocaine and heroin. Overall, we observed a stable percentage (9.0%) of recreational drug use (excluding cannabis, amyl nitrite and prescription drugs). For MSM, however, there was an increase in overall drug use from 8.8% in 2007 to 13.8% in 2017, with particularly large increases for methamphetamine (from 0.2 to 2.4%; P < 0.001) and GHB/GBL (from 1.0 to 3.4%; P < 0.001). The use of each of the potentially sex-enhancing drugs methamphetamine, GHB/GBL, cocaine, XTC/MDMA and amphetamine was significantly associated with condomless sex with nonsteady partners, and higher prevalences of depression, syphilis and hepatitis C. CONCLUSIONS: The significant increase in the use of chemsex drugs among MSM in the SHCS and the strong association with coinfections and depression highlights the need for harm reduction programmes tailored to MSM. According to our results, improving knowledge about recreational drugs is important for all health care professionals working with people living with HIV.

Are men who have sex with men in Europe protected from hepatitis B?

Hepatitis B vaccination is recommended for men who have sex with men (MSM) in many countries, but information on vaccine coverage is scarce. We studied hepatitis B vaccination programmes and coverage among MSM in Europe to guide prevention. From a large (N = 174 209) pan-European MSM survey (EMIS-2010), we used data on self-reported hepatitis B vaccination, age, education, settlement size and disclosure of the same-sex sexual orientation ('outness'). We excluded participants with a history of hepatitis B. In multilevel (participants, countries) logistic regression models, we calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). We analysed data of 163 987 MSM in 38 European countries: 38.3% were 'out' to all or almost all, 56.4% reported vaccination against hepatitis B and 65.5% lived in countries with free recommended hepatitis B vaccination for MSM. In the final model the odds for being vaccinated increased with outness ('out to all or almost all': aOR 1.76, 95% CI 1.70-1.83 vs. 'out to no one') and with living in countries, where hepatitis B vaccination was recommended and free-of-charge for MSM (aOR 2.21, 95% CI 1.47-3.32 vs. 'no or unclear recommendation'). To increase hepatitis B vaccination coverage among MSM, implementation of MSM-specific recommendations and improvement of the societal climate for MSM is needed.

Inequalities in HIV testing uptake and needs among men who have sex with men living in Ireland: findings from an internet survey.

OBJECTIVES: HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives. METHODS: We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross-sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio-demographic groups. RESULTS: More than one-third (n = 1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18-24 years, live outside Dublin, have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic. CONCLUSIONS: HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self-sampling and home testing).

Bench-Scale Evaluation of Hydrothermal Processing Technology for Conversion of Wastewater Solids to Fuels.

Hydrothermal Liquefaction (HTL) and Catalytic Hydrothermal Gasification (CHG) proof-of-concept bench-scale tests were performed to assess the potential of hydrothermal treatment for handling municipal wastewater sludge. HTL tests were conducted at 300 to 350 °C and 20 MPa on three different feeds: primary sludge, secondary sludge, and digested solids. Corresponding CHG tests were conducted at 350 °C and 20 MPa on the HTL aqueous phase output using a ruthenium-based catalyst. Biocrude yields ranged from 25 to 37%. Biocrude composition and quality were comparable to biocrudes generated from algae feeds. Subsequent hydrotreating of biocrude resulted in a product with comparable physical and chemical properties to crude oil. CHG product gas methane yields on a carbon basis ranged from 47 to 64%. Siloxane concentrations in the CHG product gas were below engine limits. The HTL-CHG process resulted in a chemical oxygen demand (COD) reduction of > 99.9% and a reduction in residual solids for disposal of 94 to 99%.

HIV testing among Portuguese men who have sex with men--results from the European MSM Internet Survey (EMIS).

OBJECTIVES: To describe HIV testing behaviour and context of MSM in Portugal participating in the European MSM Internet Survey (EMIS). METHODS: Data for the Portuguese sample were extracted and those for 5187 participants were analysed. Multivariate logistic regression models were fitted to quantify the association between participants' characteristics and HIV testing behaviour and context. RESULTS: Seventy-two percent of the participants had ever been tested for HIV and among those ever tested, 11% were diagnosed with HIV. Primary care was the most common testing setting for HIV-negative men (37%). Compared to those never tested, men who had ever taken an HIV test had higher educational level (aOR 1.89, 95% CI 1.67-2.14) and identified themselves as gay/homosexual more frequently (aOR 1.94 , 95% CI 1.70-2.20). HIV testing odds significantly increased with the number of sexual partners in the previous 12 months. Those who reported unprotected anal intercourse (UAI) with a partner of unknown or serodiscordant HIV status in the previous 12 months were less likely to report an HIV test (aOR 0.38, 95% CI 0.33-0.44). Among those never tested or who tested negative, 41% and 22% reported UAI with a partner of unknown or serodiscordant status in the previous 12 months, respectively. Among men with diagnosed HIV, 72% were currently on antiretroviral therapy and 58% reported an undetectable viral load. More than one third (38%) of those who had detectable or unknown/undisclosed viral load reported at least one episode of UAI with a partner of unknown or serodiscordant HIV status in the last 12 months. CONCLUSIONS: Actual interventions should focus on: improving testing uptake and counselling; increasing treatment coverage; achieving and maintaining an undetectable viral load; and intensifying prevention efforts focused on consistent condom use.

[Deficits in STI diagnosis for men who have sex with men (MSM) in German-speaking cities: results of the European MSM Internet Survey (EMIS)]. / Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten : Ergebnisse des Europäischen MSM-Internet-Surveys (EMIS).

BACKGROUND: Sexually transmitted infections (STIs) such as anal/genital warts, syphilis, and genital/rectal gonorrheal/chlamydial infections compromise the health of men who have sex with men (MSM), and increase the per-contact risk of HIV infection. Early detection of asymptomatic STIs requires regular screening including physical examinations and collection of clinical specimens that allow for the detection of infections at sites common to men's same-sex practices. METHODS: From June to August 2010, the European MSM Internet Survey (EMIS) recruited 174,209 MSM from 38 European countries to an anonymous online questionnaire in 25 languages. As sexual health care for MSM in most countries is organized locally, we chose cities for comparison. Multivariable regression models were used to compare accessibility of services and applied diagnostic procedures across 1 Dutch, 1 Swiss, 1 Austrian, 3 English, and 19 German cities (N = 29,962). RESULTS: The proportion of respondents tested for STIs in the last 12 months in the absence of symptoms ranged from 13 % in Magdeburg to 48.0 % in Amsterdam. At a city level, low STI screening correlated with inaccessible services (R(2) = 0.72). At an individual level, anal/penile inspection and anal swabbing was most common in English cities and in Amsterdam. Compared to London, MSM in German-speaking cities had an adjusted odds ratio (AOR) of 0.06-0.20 for anal/penile inspection, and of 0.05-0.17 for anal swabbing (p < 0.001). CONCLUSIONS: Anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in all German-speaking cities. This has implications for the sexual health of MSM, for HIV prevention, and for comparing European surveillance data. There is an urgent need to implement or improve sexual health care tailored to MSM at risk for STIs.

[AIDS. New challenges for social and medical prevention]. / Aids. Neue Herausforderungen für die soziale und medizinische Prävention.

Anti-retroviral therapy (ART) produces spectacular improvements in life expectancy and quality of life for people infected with HIV, and contributes to primary prevention in the wider population by reducing the viral load. Many people infected with HIV begin therapy later than indicated, while, despite ongoing prevention efforts, the number of new HIV diagnoses is increasing, along with the incidence of other STIs and, in identifiable sub-groups, of hepatitis C, above all among men who have sex with men (MSM). The prevention consequences of this complex situation are discussed in the context of the alternative between control and containment (Suchstrategie) and inclusion and cooperation (Lernstrategie), arguing for HIV prevention to be integrated in the broader paradigm of sexual health and sub-group-specific efforts to increase the willingness to undergo testing both through community-based campaigns and in the health care context on the basis of informed consent and counseling. Above all ethical considerations mitigate against an undifferentiated test-and-treat approach. The contribution identifies research gaps and institutional obstacles that stand in the way of achievable advances and productive linkage of social and medical prevention.

The Girls' Leadership Academy: A Promising, Empowerment-Based Approach to the Prevention of Sexual Violence.

Sexual violence (SV) is a pernicious issue that disproportionally impacts girls and women. Although few initiatives have demonstrated effectiveness in leading to reductions in SV, global health organizations have identified empowerment-based programs as a promising approach to SV prevention. The purpose of this article is to discuss the Girls Leadership Academy (GLA), a program of the Nebraska's Women's Center for Advancement, which is a "homegrown," theoretically grounded, practice-based SV prevention program for adolescent girls. More specifically, we discuss previous research relevant to the GLA; the theoretical underpinnings of the GLA; and the history, context, and content of the GLA.

HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic: Results from a prospective observational study in Germany.

Aims: Since 2017, HIV pre-exposure prophylaxis (PrEP) care has been provided through an intersectoral collaboration at WIR (Walk-in-Ruhr, Center for Sexual Health and Medicine, Bochum, Germany). The aim of this study was to establish possible impact of COVID-restrictions on the sexual behavior of PrEP users in North Rhine-Westphalia. Methods: The current PrEP study collected data of individuals using PrEP, their sexual behavior and sexually transmitted infections (STIs) before (each quarter of year 2018) and during the COVID-19 pandemic (each quarter of year 2020). Results: During the first lockdown in Germany from mid-March until May 2020, PrEP-care appointments at WIR were postponed or canceled. Almost a third of PrEP users had discontinued their PrEP intake in the 2nd quarter of 2020 due to alteration of their sexual behavior. The number of sexual partners decreased from a median of 14 partners in the previous 6 months in 1st quarter of 2020, to 7 partners in 4th quarter of 2020. Despite such a significant reduction in partner number during the pandemic in comparison to the pre-pandemic period, a steady rate of STIs was observed among PrEP users in 2020. Conclusion: The SARS-CoV-2-pandemic has impacted PrEP-using MSM in North Rhine-Westphalia with respect to their PrEP intake regimen and sexual behavior in 2020. Our study revealed a steady rate of STI among PrEP users even during the pandemic, thus highlighting the importance of ensuring appropriate HIV/STI prevention services in times of crisis.

Thermal conductivity spectroscopy technique to measure phonon mean free paths.

Size effects in heat conduction, which occur when phonon mean free paths (MFPs) are comparable to characteristic lengths, are being extensively explored in many nanoscale systems for energy applications. Knowledge of MFPs is essential to understanding size effects, yet MFPs are largely unknown for most materials. Here, we introduce the first experimental technique which can measure MFP distributions over a wide range of length scales and materials. Using this technique, we measure the MFP distribution of silicon for the first time and obtain good agreement with first-principles calculations.

Stability of milk fatty acid profile during simulated shipping for analysis by gas chromatography.

Milk fat trans-10 C18:1 can be used in diagnosing low milk fat production on dairy farms because it is a specific marker of biohydrogenation-induced milk fat depression. Individual fatty acids (FA), including the trans C18:1 isomer, can be determined only by gas-liquid chromatography. The analysis is currently available at a limited number of laboratories and often requires long-distance shipping. Expedited shipping with dry ice or ice packs is expensive. Therefore, the objective of this study was to determine the effect of heat treatment before shipping, shipping temperature, and shipping time on milk FA profile. Samples were collected from 3 farms on 2 occasions and stored in a polystyrene foam cooler with an ice pack, at room temperature, or at 37°C for 1, 2, 3, and 7 d. Heating the sample before shipping, shipping temperature, and shipping time had very little effect on any FA analyzed. Differences observed were of small magnitude and not of practical importance, demonstrating that milk FA profile is expected to be very stable during shipping. Based on this, we propose that freezing samples and shipping in a sealed bag by second-day shipment is appropriate and demonstrated that this had little effect on FA profile of 48 milk samples. Importantly, these methods are recommended only for gas-liquid chromatography analysis of FA profile. Freezing is not appropriate for shipping for analysis by mid-infrared spectrometry-based methods or methods quantifying compounds per unit of milk because it is difficult to homogenize samples after freezing or extended shipping that results in denaturization of proteins and breaking of fat globules.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey.

BACKGROUND: Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions. METHODS: The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances. RESULTS: In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39-3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41-5.90, and AOR 5.87, 95%CI 3.08-11.18 respectively). CONCLUSIONS: The prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

Effects of steroid hormones on catalase activity in neuronal and glial cell systems.

The aim of the present study was to determine short- (1 and 3 h) and long-term (24 h) effects of glucocorticoids [GCs; corticosterone (CORT), dexamethasone (DEX) and 6-methylprednisolone (6-MP)] and gonadal steroids [GSs; 17beta-estradiol (E2), progesterone (PROG) and testosterone (TEST)] on the activity of the hydrogen-peroxide-detoxifying enzyme catalase (CAT) in neural hippocampal HT22 cells and glial C6 cells because such effects have been described in peripheral organ systems. In HT22 cells, only long-term treatment with glucocorticoids (10(-5) M) induced effects on catalase activity, whereas gonadal steroids (10(-5) M) affected catalase activity after both short- and long-term incubations. At a lower concentration of 10(-7) M, glucocorticoids exerted only short-term treatment effects on catalase activity, while gonadal steroids (10(-7) M) affected the enzyme activity after short- and long-term treatments. In C6 glial cells, both glucocorticoids (10(-7) M) and gonadal steroids (10(-7) M) induced short- and long-term treatment effects. Thereby, our data show that steroid hormones differentially regulate catalase activity in models of the central nervous system (CNS) in a time- and steroid-dependent manner.

Environmental and interoceptive influences on chronic low back pain behavior.

The operant conditioning theory states that environmental stimuli greatly influence chronic pain behavior. In contrast, the hypochondriasis theory states that pain behavior is the result of an intensified pain perception which is part of a more general augmentation and amplification of normal bodily sensations. The operant theory predicts that pain behavior (operationalized as poorer endurance on the part of chronic low back pain patients as compared to the endurance of control subjects in a series of 6 working-to-tolerance treadmill tests) will decrease when no verbal or non-verbal feedback for treadmilling behavior is given. This hypothesis could not be confirmed in the present study. The hypochondriasis theory predicts that chronic pain patients will report more bodily sensations, both at rest and after treadmill exercises. This hypothesis was strongly supported by the findings of the present study.

Activity loss of glutathione synthesis enzymes associated with human subcapsular cataract.

PURPOSE: To assess the activities of the two enzymes required for glutathione synthesis, gamma-glutamylcysteine synthetase and glutathione synthetase, in various forms of human cataracts. METHODS: The Cooperative Cataract Research Group cataract classification method and standard enzyme assay procedures were used. RESULTS: An inverse relationship was shown between residual activity of each of the glutathione synthesis enzymes and degree of subcapsular cataract. A weaker inverse relationship existed between glutathione synthetase activity and supranuclear and nuclear cataracts. No other parameters yielded comparable correlations with the activity of either enzyme. CONCLUSIONS: Activity loss of the glutathione synthesis enzymes is associated with human subcapsular cataract formation.

Psychological research and chronic low back pain: a stand-still or breakthrough?

Some of the main psychological research topics concerning chronic low back pain (CLBP) are critically discussed. These topics include: 1. research aimed at describing a specific low back pain personality profile, 2. research into the predictability of therapy results on the basis of psychological assessment, and 3. outcome research of psychologically-oriented treatment for CLBP. It is concluded that these topics provide little insight into the role of psychological factors in the development and maintenance of CLBP. Based on the few empirical studies available, some new and promising directions for future research are proposed, aimed at gaining a better insight into the CLBP syndrome itself. Discussed are: 1. Risk factors in the transition from acute to chronic LBP, 2. the deviant sensitivity to acute, experimental pain stimuli of CLBP patients, 3. the relationship between CLBP behavior and psychophysiologic variables, 4. determinants of CLBP behavior, with special attention to endurance, 5. the deviant processing of proprioceptive stimuli, and 6. the implementation for chronic pain of the unpredictability and uncontrollability paradigms. The emphasis in the presentation of these new topics is more on raising questions than on answering them.

Performance level of chronic low back pain patients in different treadmill test conditions.

An experimental group of 39 chronic low back pain (CLBP) patients and an equal number of control subjects matched for age and sex were tested with a standardized back stress physical test. The subjects were given no indication of the performance expected and no feedback was given during the test. The test was repeated with a high frame of reference and feedback offered to the subjects. In the latter condition the control group improved their performance in contrast to the CLBP group. The poorer performance of the CLBP patients in both conditions was unrelated to pain increase, post-test pain level or poor physical condition. However, there is a clear relationship between performance and pre-test pain level, especially in the feedback condition. In this condition, it also seems that increasing pain level during the test is used as a 'rationalization' for the built-in failure experience. Compared to the control group the CLBP patients were less able to estimate their physiological level of exertion and were inclined to overrate their actual effort.

Cognitive factors in the performance level of chronic low back pain patients.

An experimental group of 39 chronic low back pain (CLBP) patients and an equal number of controls, matched for age and sex, completed questionnaires of self-concept and performance motivation. SS were also tested on a standardized back-stress physical test carried out with low external information and feedback. The results revealed a strong tendency for CLBP patients to have a negative self-concept, confirming the findings of previous research. Poorer performance of the CLBP patients on the physical test measure of behavioural persistence and on physiological measures were unrelated to reported pain level or to poor physical condition. Compared to the controls, the chronic low back pain group was less able to estimate their physiological level of exertion, being inclined to overrate their actual individual effort. The interaction of a negative self-concept and negative expectations is discussed.

Persistence behavior of chronic low back pain patients in an acute pain situation.

The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently.