Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline.

Authors Victoria L. Goosey-Tolfrey and Karen M. Smith were listed under the incorrect affiliations at the time of publication.

Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline.

OBJECTIVES: To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING: International. METHODS: Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS: For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS: Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

Transgender HIV and sexually transmissible infections.

Transgender women across a range of different populations and settings have a high prevalence of HIV infection. There are fewer and often poorer quality studies of sexually transmissible infection (STI) prevalence. There are fewer studies in transgender men and, in general, the prevalence of HIV and STIs is lower than that of transgender women. Susceptibility to HIV and STI infection is inextricably linked to the increased vulnerability of transgender populations, a consequence of a lack of legal and social recognition that results in reduced access to educational and employment opportunities, which can result in high rates of transactional sex. Other measures of disadvantage, such as substance abuse and mental health problems, also increase the risk of HIV and STIs and have an effect on access to health care, highlighting the need for transgender-friendly multidisciplinary services offering individualised risk assessment, prevention advice and testing for STI and HIV.

Evaluation of a sexually transmissible infections education program: Lessons for general practice learning.

BACKGROUND: The New South Wales (NSW) Sexually Transmissible Infections Program Unit (STIPU) produced nine resources to support the diagnosis and management of sexually transmissible infections (STIs) in general practice. OBJECTIVE: In this study, we explored the processes of developing the resources and outcomes achieved. METHODS: We analysed project documents and undertook a focus group interview with the STIPU Working Group to evaluate resource development and dissemination. Interviews with general practitioners (GPs) and practice nurses (PNs), combined with previously reported survey findings, provided an outcomes evaluation. RESULTS: STIPU used a rigorous, multimodal approach to develop evidence-based clinical resources. GPs and PNs received information opportunistically rather than through targeted searches unless they had a particular interest. GPs were less aware of online re-sources. DISCUSSION: STIPU's best practice translation of clinical guidelines could be enhanced by promotion of online resources, links through general practice software, strong engagement with general practice organisations, and developing the role of PNs.

The impact of a chlamydia education program on practice nurse's knowledge and attitudes in relation to chlamydia testing: a cross-sectional survey.

UNLABELLED: Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs). METHODS: A cross-sectional survey was conducted at baseline and 6-12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups. RESULTS: Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P<0.01), with change in knowledge being greater in the education group compared with the non-education group (P<0.01). Knowledge of recommended testing scenarios (P=0.01) and retesting following treatment (P<0.01) increased in the education group. Attitudes to testing scores improved over time in the education group (P=0.03), with PNs more likely to want increased involvement in chlamydia testing (P<0.01). Change in overall attitude scores towards testing between surveys was higher in the education group (P=0.05). Barriers to chlamydia testing scores also increased in the education group (P=0.03), with change in barriers greater in the education vs the non-education group (P=0.03). CONCLUSION: The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates.

A cross sectional study of how people diagnosed with a bacterial sexually transmitted infection inform their partners.

OBJECTIVES: To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. METHODS: At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners. RESULTS: Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67). CONCLUSIONS: Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.

Assessing the research use and needs of organizations promoting healthy living for adults with disabilities.

The uptake of research in community-based organizations (CBOs) is low and still unknown in CBOs that promote active and healthy living in adults with a disability. Using the knowledge to action framework, the objectives of this study were to determine if a gap exists regarding the use of research in CBOs, to learn about the preferred method to receive/read research evidence and to identify the barriers and facilitators of research use. Sixty-two employees of CBOs answered an online questionnaire. A research use gap was found as only 53 % of employees indicated they often or always use research. Conferences, emails and short research summaries were the favoured method of receiving/reading research information. Education, time and financial resources were important barriers to research use, while attitudes, intentions and self-efficacy were facilitators. More efforts are needed to develop tools to help CBOs use research.

Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003-2012.

OBJECTIVES: To analyse changes in testing for sexually transmissible infections (STI) among gay and bisexual men in Melbourne, Sydney and Queensland, Australia, particularly comprehensive STI testing (at least four tests from different anatomical sites in the previous year), and the characteristics of men who had such testing. METHOD: Data were analysed from repeated, cross-sectional, community-based surveys conducted during 2003-2012. Trends in specific STI tests and comprehensive testing were assessed and the characteristics of participants who reported comprehensive STI testing were identified using multivariate logistic regression, stratified by HIV status. RESULTS: Among HIV-negative and unknown status men (n=51 009), comprehensive STI and HIV testing increased substantially from 13% in 2003 to 34% in 2012. During the same period, comprehensive STI testing (excluding HIV testing) increased from 24% to 57% among HIV-positive men (n=5532). In both HIV status groups, comprehensive testing was more commonly reported by men who had unprotected anal intercourse with casual partners, and men with higher numbers of partners. Among HIV-negative/unknown status participants, comprehensive STI and HIV testing was also associated with education level, regional location and finding partners online. Among HIV-positive men, comprehensive STI testing was also associated with free time spent with gay men and illicit drug use. Comprehensive testing was related to a high annual rate of diagnosis with STIs (20% of HIV-negative/unknown status men and 38% of HIV-positive men). CONCLUSIONS: There has been a substantial improvement in the proportion of gay and bisexual men in Melbourne, Sydney and Queensland who report comprehensive testing. Comprehensive testing is most likely among men whose practices put them at increased risk of infection, and is associated with a high rate of STI diagnosis. However, opportunities for comprehensive testing are still being missed, suggesting a need for its ongoing promotion.

Practice nurses and sexual health care -- enhancing team care within general practice.

BACKGROUND: Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health care delivery. However, despite evidenced shortfalls in general practice-based sexual health care, the PN role in sexual health appears underdeveloped. Evaluation of New South Wales Sexually Transmissible Infections Programs Unit GP Project provided an opportunity to canvass views of GPs and PNs regarding PNs and sexual health care. METHODS: A purposively sampled group of 10 PNs and nine GPs were interviewed. Interviews were transcribed and analysed thematically. RESULTS: The extent and nature of PN-GP teamwork in sexual health care was variable, influenced largely by GP recognition and support of the PN role in sexual health care. Other important factors were personal PN interest and supportive practice systems. DISCUSSION: The role played by PNs and a team approach to sexual health care in Australian general practice is underdeveloped. Increased recognition and support of PN roles in sexual health is needed, including supportive practice systems that facilitate team care.

Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance.

UNLABELLED: Background The resurgence of infectious syphilis in men who have sex with men (MSM) has been documented worldwide; however, HIV coinfection and syphilis reinfections in MSM in inner Sydney have not been published. METHODS: For all laboratory syphilis notifications assessed as a newly notified case or reinfection, a questionnaire was sent to the requesting physician seeking demographic data and disease classification. Sex of partner and HIV status were collected for all infectious syphilis notifications in men received from 1 April 2006 to March 2011. RESULTS: From April 2001 to March 2011, 3664 new notifications were received, 2278 (62%) were classified as infectious syphilis. Infectious syphilis notifications increased 12-fold from 25 to 303 in the first and last year respectively, and almost all notifications were in men (2220, 97.5%). During April 2006 to March 2011, 1562 infectious syphilis notifications in males were received and 765 (49%) of these men were HIV-positive and 1351 (86%) reported a male sex partner. Reinfections increased over time from 17 (9%) to 56 (19%) in the last year of the study and were significantly more likely to be in HIV-positive individuals (χ(2)=140.92, degrees of freedom= 1, P=<0.001). CONCLUSION: Inner Sydney is experiencing an epidemic of infectious syphilis in MSM and about half of these cases are in HIV-positive patients. Reinfections are increasing and occur predominantly in HIV-positive men. Accurate surveillance information is needed to inform effective prevention programs, and community and clinician education needs to continue until a sustained reduction is achieved.

What proportion of sexually transmissible infections and HIV are diagnosed in New South Wales' public sexual health services compared with other services?

BACKGROUND: In New South Wales (NSW), publicly funded sexual health services (PFSHSs) target the populations at greatest risk for important sexually transmissible infections (STIs) and so may make a large contribution to the diagnosis of notifiable STIs. We aimed to determine the proportions of STIs diagnosed in PFSHSs and notified to the NSW Ministry of Health in 2009, and describe geographical variations. METHODS: The number of notifiable STIs (infectious syphilis, gonorrhoea, HIV and chlamydia) diagnosed in 2009 was obtained for each Area Health Service (AHS) and each PFSHS. The proportion of diagnoses made by PFSHSs was calculated at the state and AHS level according to five geographical regions: inner and outer metropolitan, regional, rural and remote. RESULTS: The overall proportions of diagnoses made by NSW PFSHSs were syphilis, 25%; gonorrhoea, 25%; HIV, 21%; and chlamydia, 14%. Within each zone, the proportions of these STIs were (respectively): (i) inner metropolitan: 32%, 26%, 21% and 13%; (ii) outer metropolitan: 41%, 24%, 43% and 9%; (iii) regional: 62%, 15%, 23% and 10%; (iv) rural: 8%, 29%, <5% and 20%; and (v) remote: <5%, 43%, <5% and 29%. There was considerable variation in proportions of STIs between and within AHSs (<5-100%). CONCLUSIONS: NSW PFSHSs contribute a large proportion of diagnoses for syphilis, gonorrhoea and HIV, but less so for chlamydia. Across AHSs and zones, there was considerable variation in the proportions. These data support the role of PFSHS in identifying and managing important STIs in high-risk populations.

Promotion and uptake of a new online partner notification and retesting reminder service for gay men.

BACKGROUND: In 2006, two new innovative features were added to a website called WhyTest which provided HIV/sexually transmissable infection (STI) information for gay men. The features were the 'Tell them' service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the 'Remind me' service allowing visitors to register for a 3-, 6- or 12-monthly SMS reminder for a sexual health check. We describe the uptake of the new website functionality, and recognition of a health promotion campaign conducted in January-June 2007 to promote these new features. METHODS: We used Poisson regression to assess trends in monthly partner notification messages and STI testing reminders sent in August 2007-June 2010. We also analysed 2007 Sydney Gay Community Periodic Survey data to measure recall of the campaign. RESULTS: A total of 7923 partner notification messages were sent in the period August 2007-June 2010, with a significant increasing trend in monthly messages sent (P<0001). Of the total messages sent, 7581 (96%) were by SMS and 342 (4%) by e-postcards. A total of 1023 STI testing reminders were sent in the same period, with a significant increasing trend in monthly reminders sent (P<0.001); 516 reminders were by SMS (50.4%) and 507 by email (49.6%). The 2007 Sydney Gay Community Periodic Survey showed that 55% of the 2342 participants recognised the WhyTest image in the campaign. CONCLUSION: There was high awareness of WhyTest campaign images and the SMS partner notification service was more popular than the e-postcard feature.

Sensitivity of 20-minute voiding intervals in men testing for Chlamydia trachomatis.

BACKGROUND: Men are recommended to not urinate for at least 1 hour before urine testing for Chlamydia trachomatis, but some studies have shown that recent urination does not impact test sensitivity for nucleic acid amplification tests. The objective of this study was to estimate the sensitivity of chlamydia testing using samples obtained 20-minutes post void. METHODS: We recruited men returning to Sydney Sexual Health Centre for treatment of urethral Chlamydia trachomatis infection between July 2009 and February 2011. A short questionnaire was used to elicit symptoms, and 2 first-void urine samples were collected-the first after the standard 1 hour minimum and the second 20 minutes later. Men with clinical or microbiologic evidence of urethritis, men receiving antibiotic treatment, and those who had urinated within the last hour were excluded. Samples were tested using Roche COBAS Amplicor PCR. The proportion of samples testing positive at 20 minutes post void was determined using the 1-hour post void sample as a gold standard. RESULTS: Thirty-one men with confirmed chlamydia infection were included in the analysis. Of these, 29 of 31 (93.5%) were positive at 20 minutes (95% CI: 78.6%-99.2%). CONCLUSIONS: The sensitivity of 20-minute voiding intervals in asymptomatic men remains reasonably high relative to standard voiding intervals. Removing the barrier of a 1-hour voiding interval should be considered during opportunistic screening.

High annual syphilis testing rates among gay men in Australia, but insufficient retesting.

INTRODUCTION: Since 2000, infectious syphilis notifications have increased substantially among Australian gay men. We describe testing at a frequency lower than guidelines recommend. METHODS: We examined data from a cross-sectional survey of gay men in 5 Australian cities in 2010. We used logistic regression to identify correlates of no lifetime syphilis test among HIV-uninfected men and <2 tests per year in HIV-infected men and higher-risk HIV-uninfected men. RESULTS: Of 6329 HIV-uninfected men, 65% reported a syphilis test in the past year, and 86% in their lifetime, and factors associated with no lifetime syphilis test were lower social engagement with gay men, older age, fewer sexual partners, no anal sex with casual partners, and not being aware syphilis could be asymptomatic. Among higher-risk HIV-uninfected men (>10 partners in the past 6 months), factors associated with <2 syphilis tests in the past year were nonmetropolitan residence, older age, no anal sex or unprotected anal intercourse with casual partners, not aware syphilis could be acquired through oral sex, and testing at a nonregular general practitioner. Of the 580 HIV-infected, 87% reported a syphilis test in the past year, and 96% in their lifetime, and factors associated with <2 syphilis tests in the past year were unprotected anal intercourse with HIV-uninfected casual partner and recruitment from social or sex-on-premises venues. CONCLUSIONS: Our analysis showed high lifetime and annual syphilis testing rates in Australian gay men, but low retesting rates. We identified factors associated with less frequent syphilis testing rates among Australian gay men to assist in developing targeted screening strategies.

Is screening asymptomatic men who have sex with men for urethral gonorrhoea worthwhile?

We determined the prevalence of symptomatic and asymptomatic urethral gonorrhoea among men who have sex with men (MSM) at our Australian sexual health clinic. Asymptomatic MSM are screened using the Roche Amplicor((R)) PCR, whereas culture is used for symptomatic MSM. We analysed data from all MSM tested for urethral gonorrhoea from March 2006 to July 2008. Among the 4453 asymptomatic MSM, there were two (0.04%) diagnoses of urethral gonorrhoea, compared with 38 (3.13%) among 1213 symptomatic MSM. Despite a high prevalence of symptomatic infection, asymptomatic urethral gonococcal infection was extremely uncommon among MSM seen in our sexual health clinic.

Sexual behaviour and diagnosis of people over the age of 50 attending a sexual health clinic.

OBJECTIVES: To investigate the sexual health and behaviour of older Australians attending a sexual health clinic. METHODS: A retrospective patient record of people aged 50 years and over attending the clinic. RESULTS: 2438 people aged 50 years and over attending. The main reasons for attending were assessment of genital symptoms (40%), testing for sexually transmitted infections (STIs) (23%), and HIV testing/care (13%); more than 50% of the clients had a previous sexual health problem and more than 50% had not been tested for HIV. Men reported more lifetime sexual partners than women and were significantly more likely to report using condoms (P < 0.05), although condom use was variable. Genital herpes (10% women, 6% men) and non-gonococcal urethritis (9% men) were the most commonly diagnosed STIs. CONCLUSIONS: High levels of unsafe sex and many important sexual health problems were identified which provide direction for public health interventions for older sexually active Australians.