Intimate partner violence in women living with HIV attending an inner city clinic in the UK: prevalence and associated factors.

OBJECTIVES: Studies have shown high rates of intimate partner violence (IPV) in women living with HIV, but data from the UK are lacking. We aimed to estimate the prevalence of IPV and identify associated factors in women attending our inner London HIV clinic. METHODS: We conducted a cross-sectional study of women attending our HIV clinic in May to December 2011. Participants completed a standardized questionnaire and exposure to IPV was ascertained using a validated tool. Clinical data were collected from patient records. Logistic regression models were fitted to estimate adjusted odds ratios (AORs). RESULTS: This analysis was based on 191 women with available data on IPV. The median age of women was 38 years (range 21-71 years); 74.1% were African-born Black. Over half (99 of 191; 52%) reported experiencing IPV in their lifetime, with 27 of 191 (14.1%) reporting IPV within the past year and 27 of 191 (14.1%) reporting it in pregnancy. Lifetime experience of IPV was associated with mental health problems [AOR 3.44; 95% confidence interval (CI) 1.24-9.57; P < 0.05] and 'other' Black (born outside sub-Saharan Africa) ethnicity (AOR 4.63; 95% CI 1.06-20.11; P < 0.05). We also found an association between older age and decreased likelihood of lifetime IPV (AOR 0.92; 95% CI 0.86-0.97; P < 0.05). CONCLUSIONS: Over half of the women in this study reported lifetime experience of IPV. We found associations between IPV and mental health problems, younger age and other Black ethnicity. In view of its high prevalence, we advocate greater awareness of IPV among HIV healthcare professionals and recommend universal screening.

Olympic outreach: testing for sexually transmitted infections in construction workers.

Concerns have been voiced in the national press that the surge in migrant construction workers leading up to the 2012 Olympics Games would increase the levels of sexual ill health in East London. Between 2009 and 2011, we sent a sexual health outreach team to the Olympic Park and Village. A total of 614 clients were tested, of whom 91% were men and 46% reported English/Scottish/Welsh ethnicity. The age range was 17-73 years and median age 30 years. Reported sexual risk factors were low, including use of commercial sex workers. Prevalence of sexually transmitted infections was low, with Chlamydia trachomatis found in 20 clients (3%), and hepatitis B diagnosed in one client. This study, although small, did not support the image of construction workers presenting a higher than average sexual health risk.

Sexual health of adults working in pornographic films.

We report the frequency of sexually transmitted infections (STIs) diagnosed in performers in the adult pornographic film industry. Over a 13 month period, 445 STI screens were performed in 115 patients, 56 women and 59 men. All reported unprotected sex during filming. Seventy-five percent (86) had at least one sexual partner outside work, and 90% used condoms inconsistently with them. Women worked exclusively with women (23%), men only (38%) or both genders (39%). Almost all men (97%) worked exclusively heterosexually. Thirty-eight percent (44/115) were diagnosed with 77 STIs, including non-specific urethritis (51), gonorrhoea (10), chlamydia (6) and genital warts (6). Gonorrhoea was found exclusively at the pharynx in three heterosexual men. There were no cases of HIV, syphilis, hepatitis B or hepatitis C. Monthly screening and certification is a working requirement for this population but STIs are common in an industry where unprotected sex is the norm.

OptionE: innovative model of HIV care increases satisfaction and reduces clinic visits.

OptionE incorporates nurse-led HIV clinics, review of blood results by doctors, patient contact by email and the option of home delivery of medication. Patient questionnaires showed increased satisfaction associated with fewer, shorter clinic visits. A retrospective case note review suggested clinical outcomes are as good as standard care.

The genitourinary complications of HIV infection in men.

This article discusses infective and malignant complications of HIV affecting the genitourinary tract in men. Immunosuppression increases both the frequency of infections, and the range of organisms that may be involved. Cancers are common and presentations may be atypical.

Time to use text reminders in genitourinary medicine clinics.

Faced with a national 48-hour waiting time target and high non-attendance rates for booked appointments, our sexual health service sought patient preferences for appointment reminders. Questionnaires were distributed to 350 consecutive genitourinary medicine clinic attendees. Eighty-eight percent of respondents approved of appointment reminders, with text messaging being the preferred option. Automated voicemail reminders to mobile phones were acceptable to 84%. Patients would generally choose a voicemail reminder to their mobile phone as opposed to home or work phone, and this preference was more pronounced in younger patients (P = 0.03). The majority of patients considered reminders two or three days in advance sufficient notice, with 98% owning a mobile phone. Text or voicemail reminders may significantly reduce non-attendance rates and their associated costs, improve accessibility and reduce waiting times.

KC60 coding: room for improvement--a study into consistencies and inconsistencies in the use of diagnosing codes.

Twenty mock cases were designed. Thirty-two doctors completed the study, assigning local and KC60 codes for service provision and diagnoses. They gave a wide range of responses, often missing codes or adding inappropriate ones. Where the diagnosis was clear, e.g. gonorrhoea, 97% assigned the correct KC60 code. However, the KC60 codes for service provision (S1, S2, P1A, P3, etc.) were frequently omitted, representing a significant underestimate of workload. Some local codes were given by only 6-28% of clinicians, and when they included them, doctors were more likely to omit KC60 codes. Low response rates for local codes renders these codes unhelpful. Simplification of coding procedures is needed so that diagnoses and workload are documented accurately. This is crucial at a time of modernization of genitourinary (GU) Medicine services and the introduction of Payment by Results.

Mentoring in genitourinary medicine.

Mentoring is a process whereby one doctor (the mentor) facilitates and encourages another doctor (the mentee) to develop their career, in light of their own priorities. Mentees benefit from time dedicated to addressing their needs, challenging the status quo, and exploring ways to change. Mentoring schemes depend on the availability and enthusiasm of suitably trained mentors, as well as the voluntary participation of mentees. The specialty of genitourinary (GU) medicine is setting up such a scheme, which will initially be offered to new consultants. Workshops to train mentors are starting that are specifically tailored to our specialty. We discuss the principles and benefits of mentoring, different models that can be used, and potential difficulties. We also present the results of a survey that demonstrated widespread interest in mentoring within GU medicine.

Work performance when breathing through different respirator exhalation resistances.

This study evaluated performance of individuals exercising at a fixed workload and wearing full-facepiece respirators modified to provide expiratory resistances of 0.27, 0.47, 1.81, 4.43, and 12.27 cmH20 x s x L(-1). On five separate occasions, 15 volunteers exercised to voluntary endpoint on a treadmill at fixed speeds and grades chosen to elicit 85% of maximal aerobic capacity for an unencumbered condition. Exercise performance time was recorded at the cessation of each test. Results showed that performance time decreased linearly (R2 = 0.79; p<0.001) with increased resistances, and no threshold value below which expiratory resistance has no impact on performance was found. Average oxygen consumption rates and minute ventilation also decreased linearly with increased expiratory resistances, indicating that increases in expiratory resistance result in a considerable level of hypoventilation. From the perspective of respirator design, the results of this study suggest that the only practical expiratory resistance level limitation is the reduction in performance that will be acceptable to the end users.

Telephone communications with several commercial respirators.

Previous work showed that telephone communications while wearing military respirators degraded both word comprehension and recognition speed. In addition, electronic amplification of the speech diaphragm signal had shown no advantage to the extra hardware. This experiment was performed to test effects of different configurations of commercially available respirators on telephone communications accuracy and speed. Twelve pairs of subjects were separated into different rooms and communicated by telephone. Modified rhyme-test words were presented by computer to the speaker, who transmitted the word by telephone to the listener. During the first replication, subjects were given no instruction about telephone communications procedure. During the second replication subjects followed a communications protocol that instructed them when to move the telephone handset from their ears to their mouths. Results showed that the protocol uniformly improved communications accuracy without incurring any extra time penalty. Word comprehension was still twice as fast without a respirator as with a respirator. Accuracy with the protocol nearly equaled the no respirator control value for most respirators tested.

Effect of external dead volume on performance while wearing a respirator.

Respirator dead volume accumulates exhaled carbon dioxide and returns it to the respiratory system during subsequent inhalations. Because inhaled carbon dioxide is known to be a powerful respiratory stimulant and psychoactive gas, respirator dead volume would be expected to influence performance times while respirators are worn during work. This experiment was performed at intense levels of treadmill walking (80-85% VO2max) to demonstrate maximum sensitivity to respiratory stress. Six dead volume conditions (representing a range of 280 to 1,160 mL) were imposed on the subjects. Results show linear decreases in performance times and breathing apparatus comfort with increasing dead volumes. For each 350 mL of external dead volume, a 19% decrease of performance time and an 18% decrease in breathing apparatus comfort can be expected.

Communication using a telephone while wearing a respirator.

Respirators have been found to degrade communication effectiveness when wearers speak face-to-face. However, little is known about communication effectiveness when using the telephone and wearing a respirator. Eleven pairs of subjects were asked to pronounce and identify words chosen from Modified Rhyme Test lists. Each word appeared on a computer screen in one room and the speaker said the word into the telephone. The listener in another room identified the word and typed it into a computer linked with the first. Subjects wore U.S. Army M40 full-facepiece air-purifying respirators with hoods. Three different speech diaphragm arrangements and two hood materials were tested. Results show that accuracy suffered by about 10% when respirators and hoods were worn compared with the control condition. Word identification speed was one-third to one-half of the control (no respirator or hood) condition depending on specific equipment worn.

Effect of respirator inspiratory resistance level on constant load treadmill work performance.

Respirator inspiratory resistance can affect performance times, especially when the experiment is optimized to elicit respiratory stress. Twelve subjects performed on a treadmill at constant speeds and grades chosen to result in performance times of 5-15 min. Six levels of inspiratory resistance were used, ranging from 0.78 to 7.64 cm H2O.sec/L. The results showed that performance times decrease linearly with resistance level, and no threshold resistance value is apparent. Inspiratory resistance also induces hypoventilation, with lower minute volumes and lower oxygen consumption values at higher resistances. These trends are also linear. From these results, there is no value for inspiratory resistance that can be given as a design goal. Other parameters such as weight and space may dictate filter resistance values, and these, in turn, will lead to determined performance degradations.

Respirator performance ratings for speech intelligibility.

A respirator degrades speech intelligibility and thus interferes with the ability of the wearer to communicate. The magnitude of this degradation is not well-studied and can vary as a function of numerous parameters. This study investigated the performance degradation of speech intelligibility in low-level noise for different speaker-listener distances and message sets (single words or predictable sentences) that occurred while wearing a respirator compared with not wearing a respirator. Thirteen speaker-listener pairs with normal hearing and speech were used. Speaker-listener separation distances were 0.61, 1.22, 1.83, 2.44, 3.05, and 3.66 m (2, 4, 6, 8, 10, and 12 ft) for the respirator condition and 1.22, 2.44, 3.05, 6.1, 9.15, and 12.2 m (4, 8, 10, 20, 30, and 40 ft) for the no-respirator condition. The means of the scores were used to determine the speech performance rating for both the single-word and sentence comprehension tests. The performance rating expresses the percentage of performance that can be expected while wearing a respirator compared with not wearing a respirator. Scores were interpolated linearly at distances at which no data were obtained. As expected, the speech performance rating was higher for the sentence comprehension test than for the single-word comprehension test at each distance. At a distance of 12.2 m, the speech performance rating for the sentence comprehension was 70%. For the single-word comprehension test, the speech performance rating was zero for distances greater than 9.1 m.

Effect of altered vision on constant load exercise performance while wearing a respirator.

Previous testing has shown that visual acuity greatly influences task performance at light work rate levels. At moderate to heavy work rates, however, the Performance Rating Table (PRT) predicts almost no visual acuity effect. This experiment was performed to determine if the PRT value is realistic. Ten subjects walked on a treadmill at 75-80% of their maximum heart rates until their voluntary end points. Subjects wore various masks of the same kind, each with a different set of clouded lenses. Visual acuities, as measured on the Snellen eye chart, were measured before, during, and after exercise. It was found that visual acuity did not influence performance time, and that an average value for a performance rating of 91 must have been influenced by other mask factors besides visual acuity. These other factors are most likely respiratory stress, thermal stress, and other vision elements. The full-facepiece masks used in this study adversely affected visual acuity by about three-quarters of a Snellen line during exercise. Postexercise visual acuities were found to first decrease below pre-exercise values, then become better than pre-exercise values, then decline asymptotically to pre-exercise values.

Sweat rate inside a full-facepiece respirator.

The accumulation of sweat inside a full-facepiece respirator mask and the rise in facial skin temperature can be important factors for acceptability of respirators worn in the heat. This study questioned how much sweat would have to be removed from a respirator (if a design to remove accumulated sweat were possible). Results from 20 subjects sitting in a warm, humid environment (35 degrees C and 90% relative humidity) for 90 minutes indicated that the average value was about 0.203 g sweat/min from the face, head, and neck, with most of that coming from the neck region. Men were found to have higher sweating rates than women. The results indicate that a large amount of sweat could accumulate inside the mask over a typical 8-hour day. Average facial skin temperature was found to rise about 2 degrees C over the 90-minutes test, and this rise could likely be the cause of the very uncomfortable rating given to the respirator.