Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study.

OBJECTIVE: Human papillomavirus-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs. METHODS: In-depth qualitative face-to-face interviews were conducted with 21 GBM/MSM participating in the "Study of the Prevention of Anal Cancer" in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes. RESULTS: Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well-being and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety. CONCLUSION: Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.

Seroconversion in context.

This paper describes the accounts that homosexually active men give of their HIV seroconversion and interrogates these accounts for risk discourses. In particular, this paper asks whether the risk discourses of HIV researchers and educators are present in the men's narratives of their own seroconversion. Such discourses make reference to 'unsafe' sex--particularly the practice of unprotected anal intercourse, numbers of sexual partners or 'promiscuity', and the disinhibiting effect of drugs and alcohol. The data are drawn from an ongoing case-series study of seroconversion in which men who had seroconverted were asked to give an account of the occasion on which they believe they were infected. A number of themes were identified in the men's accounts. The men's descriptions of what they believe to be the seroconversion event indicate that their attributions, i.e., the reasons they give for their HIV infection, vary depending on the context. Within regular relationships, breakdown of negotiated safety, love and intimacy, and fatalism were among the explanations given. Seroconversion attributed to casual sexual encounters was more likely to be explained in terms of pleasure, lack of control, and with reference to particular sexual settings. The ways in which men understood their HIV infection were informed both by the risk discourse of HIV researchers and also by the discourses of love and pleasure, as well as that of control.

Tests in psychiatry.

OBJECTIVE: This essay examines the proposition that clinical psychiatrists should make more use of the ancillary tests available to them. It argues that many of the tests are of doubtful validity and are more concerned with sorting patients into categories which are both impermanent and insubstantial than with clinical usefulness. METHOD: Consideration is given to the way in which many psychiatrists use those tests of mental status which are available to them, often showing little awareness of the scoring procedures, norms and limitations of the tests being used. Many of the questionnaires available restrict the field of enquiry to achieve reliability at the cost of validity. Careful examination of some commonly used measures has shown that they do nothing to improve diagnostic accuracy and can be misleading. Simple direct questions can be more useful and more valid. RESULTS AND CONCLUSIONS: The ancillary tests available to psychiatrists do little to assist them and the important problems of clinical management. In general, they are more concerned with attaching labels to patients than throwing light on the nature of their disorders and how they may be managed.

Assembly of cartilage collagen fibrils is disrupted by overexpression of normal type II collagen in transgenic mice.

Cartilage collagen fibrils, which are characterized by their thin, uniform diameters, are formed of a multicomponent system of three collagen types (II, IX, and XI) and interacting proteoglycans. We have used a genetic approach to test whether the proper assembly of this multiprotein structure was altered by overexpression of one of its normal components. Here we show that in transgenic mice in which the normal mouse alpha 1(II) collagen is overexpressed, thick abnormal collagen fibrils are generated. Mice that showed the highest expression of the transgene also displayed a larger proportion of abnormal fibrils and died at birth. We propose that an imbalance among the constituents of the cartilage collagen fibrils disrupts the mechanism that controls their assembly. The results show the applicability of the transgenic mice system to studies of complex multicomponent protein assemblies in intact animals.

Medical ethics--fact or fiction?

In recent times the ethical behaviour of doctors has come under close scrutiny with some unhappy consequences. During the millennia in which medicine has been practised much has been written about ethics and nowadays there is no shortage of codes and declarations and of ethics committees to tell us what to do. These events raise questions about the status of the general principles of ethics and of the significance of particular assertions in that field. There is also the important question of whether or not there has been, or is, any connection at all between utterances about medical ethics and the behaviour of the members of our profession. I believe that the ethical problems confronting doctors are becoming more complex, and give my two rules of thumb for proper behaviour.

Characterization of a type II collagen gene (COL2A1) mutation identified in cultured chondrocytes from human hypochondrogenesis.

A subtle mutation in the type II collagen gene COL2A1 was detected in a case of human hypochondrogenesis by using a chondrocyte culture system and PCR-cDNA scanning analysis. Chondrocytes obtained from cartilage biopsies were dedifferentiated and expanded in monolayer culture and then redifferentiated by culture over agarose. Single-strand conformation polymorphism and direct sequencing analysis identified a G----A transition, resulting in a glycine substitution at amino acid 574 of the pro alpha 1(II) collagen triple-helical domain. Morphologic assessment of cartilage-like structures produced in culture and electrophoretic analysis of collagens synthesized by the cultured chondrocytes suggested that the glycine substitution interferes with conversion of type II procollagen to collagen, impairs intracellular transport and secretion of the molecule, and disrupts collagen fibril assembly. This experimental approach has broad implications for the investigation of human chondrodysplasias as well as human chondrocyte biology.