Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: The sexual health education for professionals scale (SHEPS).

We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.

Structure, Reactivity, and Fragmentation of Small Multi-Charged Methane Clusters.

Small methane clusters (CH4)n are irradiated using intense femtosecond laser excitation at 624 nm. The ionized species and those resulting from their fragmentation are detected via time-of-flight mass spectrometry (TOF MS). We find evidence of bound, multiply charged methane molecules and clusters resulting from Coulomb explosion upon exposure to highly energetic, ultrafast radiation. The assignment of the mass spectra is done after first-principles calculations (at the (R)MP2/aug-cc-pVXZ (X = D,T) level) on the charged (CH4)n(q+) clusters (n = 1-4, q = 1-4). We also considered the cluster stabilities and fragments that may result from intracluster molecular reactivity. Complex intracluster ion-molecule reactions induced by photoionization are expected to occur. Interestingly, we show that multi charged small methane clusters undergo intracluster reactions and fragmentations which are different from those observed for isolated methane ions or for large ionized methane clusters.

Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong, China.

Public health research and interventions often assume that men who have sex with men (MSM) who use the Internet in China have similar characteristics to those in Western countries, though with little empirical evidence. This study aimed to describe and examine the sociodemographic and basic sexual behavioral characteristics of an online sample of MSM in Guangdong, China. In 2010, a total of 1100 MSM were recruited from an lesbian, gay, bisexual, and transgender (LGBT)-oriented website and were asked about their sociodemographic and sexual behavior characteristics. The majority of the participants (77.9%) self-identified as homosexual, and the mean age was 30.0 years (SD = 6.7). About 80% of the participants had attained a college degree and only 4.8% were unemployed. About 60% had a monthly salary of more than CNY 3000 (476 USD), and more than 10% were married. The majority (71.7%) had used condoms in the last anal sex. Nearly half of the participants have never been tested for HIV or other sexually transmitted infections (STIs) (47.3% and 47.7%, respectively). More than 80% were willing to be contacted by researchers after the survey. Findings indicate that the sociodemographic characteristics of Chinese MSM who use the Internet are relatively similar to those in the Western countries. However, Chinese MSM are less likely to self-identify as homosexual and be tested for HIV and other STIs than Western MSM. On a positive note, Chinese MSM would be likely to engage in e-technology research showing potential feasibility of an online HIV/STI intervention.

Military service and health-related quality of life among gay and bisexual prostate cancer survivors: Results from the Restore -2 study.

INTRODUCTION: There are notable disparities in health-related quality of life (HRQOL) between gay and bisexual men (GBM) and heterosexual patients with prostate cancer (PCa); however, the role of past military service is unclear. This study examines HRQOL differences in GBM PCa survivors based on reported military service history. METHODS: We used data from the 24-month follow-up survey of the Restore-2 study, a clinical trial which evaluated a rehabilitation programme for GBM PCa survivors. PCa HRQOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC-50) and the Functional Assessment of Cancer Treatment-Prostate (FACT-P). Mental health quality of life was assessed using the Brief Symptom Inventory-18 (BSI-18) scale, while sexual functioning was measured using the Sexual Minorities and Prostate Cancer Scale (SMACS). Multivariable linear regression was used to estimate unadjusted and adjusted mean differences in HRQOL between GBM with and without a reported history of military service. RESULTS: In this cross-sectional study of 351 GBM PCa survivors, 47 (13.4%) reported a history of US military service. After adjusting for covariates, participants who reported a history of military service (compared with those with no military service) had clinically better scores on the FACT-P physical, social and emotional well-being domains, as well as higher total FACT-General, EPIC urinary bother and hormonal function scores. Additionally, men with a history of military service reported significantly fewer sexual problems, more sexual confidence and less urinary incontinence in sex. CONCLUSION: This exploratory study provides the first evidence that GBM PCa survivors with a military background may have clinically better outcomes than those without military service. Potential reasons may include the structured support and healthcare access associated with military service, fostering resilience and well-being. These findings underscore the need for further research to elucidate how military service influences PCa HRQOL.

Barebacking among men who have sex with men recruited through a Swedish website: associations with sexual activities at last sexual encounter.

The research topic of barebacking emerged in the mid-1990s. Since then, a multitude of studies, largely from the United States, have produced invaluable knowledge of factors that help explain the behaviour among men who have sex with men (MSM), and that may contribute to HIV risk reduction programming and advice to counsellors working with barebackers. Given the scant empirical research about barebacking among European MSM, we conducted a survey among 3,634 MSM recruited through a web community in Nordic countries. The objectives of the study were twofold: to describe the sexual activities associated with barebacking behaviour at last sexual encounter, and to evaluate the relationship of barebacking with relevant variables. Men who reported barebacking (n=356) and men who did not (n=3,278) were compared. On the basis of the results of the analyses, the socio-sexual profile of barebackers drawn was one that is at increased risk of acquiring human immunodeficiency virus (HIV) and other sexually transmitted infections due to their sexual practices, particularly unprotected anal intercourse, but also group sex and rimming. In a multivariate logistic regression analysis, the likelihood of engaging in barebacking was higher for MSM who reported more frequent HIV testing (odds ratio (OR)=5.16), a higher number of female sex partners (OR=16.80), using gay cruising places (OR=1.51) and gay chat rooms (OR=2.11).

Oxygen-containing gas-phase diatomic trications and tetracations: ReO(z+), NbO(z+) and HfO(z+) (z=3, 4).

Three oxygen-containing gas-phase diatomic trications ReO(3+), NbO(3+) and HfO(3+) as well as the diatomic tetracation NbO(4+) have been observed by mass spectrometry at non-integer m/z values. These unusual triply charged molecular ion species, together with the corresponding diatomic dications ReO(2+), NbO(2+) and HfO(2+), were produced by energetic, high-current oxygen ((16)O(-)) ion beam sputtering of rhenium, niobium and hafnium metal samples, respectively, whose surfaces were dynamically oxidized by oxygen primary ion incorporation. In addition, NbO(z+) (z≤ 4) were generated by intense femtosecond laser excitation and photofragmentation (Coulomb explosion) of Nb(x)O(y) clusters and were detected through Time-of-Flight Mass Spectrometry (TOF). Our experimental results confirm previous reports on the detection of NbO(4+), NbO(3+), NbO(2+), HfO(3+) and HfO(2+) with Atom Probe mass spectrometry, whereas ReO(3+) and ReO(2+) apparently had not been observed before. In addition, these multiply charged molecular ions have been studied theoretically for the first time. Ab initio calculations of their electronic structures show that the diatomic trications ReO(3+), NbO(3+) and HfO(3+) are long-lived metastable gas-phase species, with bond lengths of 1.61 Å, 1.62 Å and 1.86 Å, respectively. They present large potential barriers with respect to dissociation of more than 2.7 eV. The corresponding diatomic dications are thermochemically stable molecules with very large dissociation energies (>3.5 eV). Our calculations predict the diatomic tetracation ReO(4+) to be a metastable ion species in the gas phase. We compute a potential barrier toward fragmentation of 0.6 eV; its formation requires a quadruple adiabatic ionization energy of 85.7 eV. Even though our calculations show that NbO(4+) is a weakly bound (dissociation barrier ∼0.1 eV) metastable molecule, it is here identified via linear time-of-flight mass spectrometry.

Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland.

Implementation of HIV care and treatment programs in sub-Saharan Africa is a complex undertaking that requires training of health care providers (HCPs). Many sub-Saharan African countries have introduced training programs to build human resources for health. Evaluation of the ongoing trainings is warranted so that programs can be improved. The purpose of this study was to evaluate Baylor International Pediatric AIDS Initiative's (BIPAI) HCP training program in Swaziland. The specific aims were: (1) to assess coverage and delivery of the training program; and (2) to determine the impact of the training program on HCPs' knowledge about HIV and pediatric practices, attitudes toward HIV/AIDS patients, and self-efficacy to provide antiretroviral therapy (ART). The evaluation was a multimethod design with two types of data collection and analysis: (1) one-group pretest-posttest survey with 101 HCPs; and (2) semi-structured in-depth interviews with seven trainers from Baylor College of Medicine and 16 local HCPs in Swaziland. Quantitative data were analyzed using Stata Statistical Software version 8.2 for descriptive and multivariate analysis while factor analysis was done using Statistical Program for Social Sciences version 14. The transcribed interviews were analyzed using a didactic approach. Process evaluation showed that the training had good coverage, was delivered as intended, and improved as the work progressed. The training program led to a significant increase (p=0.0000) in HCPs' knowledge about HIV/AIDS, ART, and relevant clinical pediatrics practices between pretest (mean 68.7% SD 13.7) and post training (mean 84.0% SD 12.0). The training program also increased trainees' self-efficacy to provide ART and their attitudes toward AIDS patients (p=0.0000 and 0.02, respectively). In conclusion, BIPAI training program in Swaziland had good coverage of all health care facilities and HCPs in Swaziland. The training was effective in imparting knowledge and skills to HCPs and in their attitudes toward HIV/AIDS patients.

Web-based forums for clients of female sex workers: development of a German internet approach to HIV/STD-related sexual safety.

Clients of sex workers in Germany used to be unapproachable for issues of sexual health. Thus, prevention of HIV and sexually transmitted diseases used to focus on sex workers only, even though many sex workers accuse clients preferring unprotected sex. When prostitution was decriminalized in Germany in 2002, a till then unknown platform emerged on the German internet. Clients set up forums for themselves and their peers. These community forums were primarily meant to serve as platforms for the exchange of information, e.g. on the quality of services. We describe the development and expansion of these web-sites for clients of female commercial sex workers, and the clientele and operation of such sites. To study and to describe the sites, a close cooperation with their webmasters and administrators was crucial. The clients' community forums mark a change in paradigm, as clients became an accessible and addressable target group for sexual health and prevention issues on the internet. The Sexsicher sites have been developed to adequately target this group.

Emotional intimacy predicts condom use: findings in a group at high sexually transmitted disease risk.

Previous studies have reported an inverse relationship between condom use and emotional intimacy. The aim of this study was to determine the relationship between condom use and emotional intimacy. The study was a gonorrhoea case-comparison study with the samples being drawn from public health clinics (cases) and select bars/nightclubs (places) of Houston, TX (n = 215). Data were collected by questionnaires administered on a laptop computer. The majority of respondents were African-American (97.7%), women (69.3%) and had either high school or GED education (72.6%). Condom use with the last sexual partner was analysed along with intimacy with that partner assessed on a 3-point scale. Analysis showed that higher intimacy was related to greater condom use which was significant in men but not in women. In conclusion, these data were opposite to those of previous studies, which showed an inverse relationship between condom use and emotional intimacy. We hypothesize that in a high-risk environment, people exert more effort in protecting those they feel closer to. These data suggest a need to further explore the complex relationship between emotional intimacy and condom use.

Medical education in Maharashtra: the student perspective.

BACKGROUND: There is hardly any structured study reporting the perspective of medical students, with regard to the medical education system in Maharashtra, which is facing challenges. AIM: A perception study of students was conducted to explore the situation, challenges, and consequent solutions of medical education in Maharashtra. SETTINGS AND DESIGN: A descriptive perception study. MATERIALS AND METHODS: A structured questionnaire was e-mailed to 92 students, and interviews with seven key-informants comprising of faculty, administrators, and policy makers were conducted, to gather qualitative insights. RESULTS: Thirty-seven student replies were received and analyzed. The satisfaction level of student respondents for various factors was as follows: infrastructure 18/37 (48.6%), quality of teaching 14/37 (37.8%), patient population 22/37 (59.5%), and administration 8/37 (21.6%). Ninety-two percent (34/37) of the students stated that the fundamental problem was the inability of the system to attract good, quality teachers. The reasons stated were low salaries, low level of job satisfaction, high level of bureaucracy, and high work load. CONCLUSIONS: The medical education system in Maharashtra is viewed as being stagnant. The respondents emphasized an urgent need for educational reforms, which should include better compensation for teachers, sharing of facilities between government and private medical colleges, and improved efficiency of the Medical Council of India. In the long run a public-private mix with sharing of resources may be a plausible solution.

Desorption of nitric acid from boehmite and gibbsite.

Solid-state Fourier transform infrared spectroscopy (FTIR), evolved gas analysis-FTIR (EGA-FTIR), thermal gravimetric analysis (TGA), and differential scanning calorimetry (DSC) have been used to investigate the desorption of nitric acid from boehmite and from gibbsite. Samples containing between 3 and 36% of adsorbed nitric acid by mass were prepared by placing the mineral in a 70% nitric acid solution or by the adsorption of nitric acid vapors in humid air. FTIR established that water-solvated nitrate was the main species adsorbed on the surface of either mineral under these conditions. The water-solvated nitrate vaporized as nitric acid at approximately 400 K with an enthalpy of desorption of approximately 50 kJ/mol for both surfaces. A second nitric acid desorption occurred at approximately 450 K and had an enthalpy of desorption of 85 kJ/mol (95 kJ/mol) for boehmite (gibbsite). This was assigned as desorption of partially solvated aluminum hydroxylated nitrate. Monodentate and bridging nitrate were also observed on the boehmite. These species desorbed at approximately 725 K as NO2 and O2 with an enthalpy of reaction of approximately 55 kJ/mol of NO2 desorbed.

Reported sexually transmitted infections in Swedish Internet-using men and women.

Although the Internet has become a forum for making sexual contacts, and has been associated with increased sexually transmitted infection (STI) transmission, we have little information of history of STIs in Internet-based samples. The Internet behaviours that are associated with STI acquisition are poorly understood. We analysed STI histories reported by 904 Swedish men and 931 Swedish women who responded to an Internet-based survey on sexual behaviour in 2002: 16.6% of men and 22.5% of women reported a lifetime history of STIs, with Chlamydia being the most common for both genders. 3% of men and 5% of women who reported an STI, indicated that they had had more than one. Sources of the STI, where known, were Internet-acquired partners in only 3% of cases. There were no differences between men and women with or without an STI history regarding the kind of online sexual activities they engaged in, how they found sexual material online, and the reasons they engage in sexual activities. These rates are similar to those reported in a national random study of sexuality in Sweden. Contrary to prior research, these results suggest no relationship between STI and specific Internet characteristics usage patterns. These data suggest that the Internet is not yet a major source of STIs in Swedish men and women. Given these STI histories, the Internet may be a useful medium to include in STI prevention efforts.

Scapulohumeral osteochondrosis. A retrospective study of 32 horses.

OBJECTIVES: To review the outcome of equine shoulder osteochondrosis (OC) with surgical or conservative treatment. METHODS: Retrospective study of 32 horses, less than two years of age, with scapulohumeral joint (SHJ) OC. The lesion severity was graded based on measurements taken from lateromedial radiographs. Follow-up information was obtained from racing records or telephone conversations with owners. Successful outcome was defined as the ability of the horse to perform its intended use. RESULTS: Sixteen of 32 horses were affected bilaterally (48 joints). Eleven of 16 horses with bilateral OC underwent arthroscopic surgery; five had bilateral arthroscopy, six had unilateral arthroscopy of the most severely affected joint. Eight of 16 horses with unilateral OC underwent arthroscopy. The overall outcome was 'poor'. Only 15.4% (4/26) of potential race horses started a race, whereas 67% (4/6) non-racehorses were 'sound' for the intended use. Statistical analysis evaluating the effect of breed on outcome showed a statistically significant difference. There were no significant interactions between outcome and gender, affected limb, unilateral versus bilateral involvement, treatment or severity of the radiographic lesion. However, radiographic lesion severity on the humerus and glenoid showed significant positive correlation. CLINICAL SIGNIFICANCE: The overall poor prognosis for shoulder OC in young horses appears to be, in part, dependent on breed and intended use. There was not any difference in outcome between surgically and conservatively treated horses.

Anabolic effects of acellular bone marrow, platelet rich plasma, and serum on equine suspensory ligament fibroblasts in vitro.

The purpose of this study was to investigate the response of suspensory ligament fibroblasts (SLF) to in vitro stimulation using acellular bone marrow (ABM), platelet rich plasma (in vitro PRP), and serum as potential treatment modalities for suspensory desmitis. Blood, bone marrow, and suspensory ligaments were collected from five horses. SLF were harvested, grown until confluent, and stimulated with various concentrations of ABM, PRP, equine serum, foetal bovine serum, and medium (control). The responses to the treatments were assessed using a combination of radio-labeling for total protein synthesis and an ELISA for quantification of Cartilage Oligomeric Matrix Protein (COMP) production. Addition of all of the samples resulted in significant increases in COMP and total protein synthesis over controls (P<0.001). ABM caused the greatest increase in both COMP and total protein synthesis by the SLF. Equine ABM, PRP, and serum contain anabolic factors that promote matrix synthesis by SLF in vitro, with ABM having the greatest effect. Application of bone marrow to injured ligaments may enhance healing by providing anabolic factors, other than or in addition to mesenchymal stem cells, which stimulate matrix production.

Incomplete sagittal fracture of the talus in 11 racehorses: outcome.

REASONS FOR PERFORMING STUDY: Little information exists regarding talus fractures in the horse and there have been no previously published case series of racehorses diagnosed with incomplete sagittal fracture of the talus. OBJECTIVE: To describe the diagnosis, treatment and post injury performance of horses with incomplete sagittal fracture of the talus. METHODS: Medical records of 11 racehorses (8 Standardbreds and 3 Thoroughbreds) admitted between January 1992 and January 1999 were reviewed. Subject details, anamnesis, results of lameness examination, radiographs and nuclear scintigraphic findings were evaluated. Racing performance was assessed by comparing pre- and post injury race records. RESULTS: Nuclear scintigraphic examination, performed in 8 of the 11 horses, revealed focal increased radiopharmaceutical uptake in the proximal aspect of the affected talus. Fractures could best be seen on dorsal 10-20 degrees lateral-plantaromedial oblique radiographs; all had raced pre-injury. All horses were treated conservatively and follow-up information was available for 8 horses, of which 7 raced after injury. Performance in 3 horses was improved, in 1 it was unchanged and in 3 horses performance declined. CONCLUSIONS: Horses with incomplete fracture of the talus have a good prognosis for return to racing after conservative management. POTENTIAL RELEVANCE: Incomplete sagittal fracture of the talus should be considered as a cause of hindlimb lameness in racehorses. Further research is necessary to determine the pathophysiology of these fractures.

Effect of age at presentation on outcome following arthroscopic debridement of subchondral cystic lesions of the medial femoral condyle: 85 horses (1993--2003).

REASONS FOR PERFORMING STUDY: Subchondral cystic lesions of the medial femoral condyle (SCMFC) are well documented in horses < or =3 years; arthroscopic debridement or enucleation of the cyst is currently the surgical treatment of choice. However, studies of occurence and outcome following surgery in older horses are lacking. OBJECTIVE: To identify factors important in outcome for horses with SCMFC treated by arthroscopic debridement. HYPOTHESIS: Age of horse at presentation has a significant influence on return to work following arthroscopic treatment for SCMFC. Clinical and diagnostic findings are also significant with respect to prognosis. METHODS: A retrospective review of medical records from 6 equine referral centres identified 85 horses that underwent arthroscopic debridement of SCMFC. Clinical examination, radiographic and arthroscopic findings were analysed together with follow-up data. Univariable analysis and multivariable logistic regression models were used to determine factors affecting return to soundness. Event-time analysis was performed to evaluate return to work. RESULTS: Older horses (>3 years) were less likely to return to soundness (P = 0.02) or to work (P = 0.04) than younger horses (< or = 3 years). Of 39 horses age 0-3 years, 25 (64%, 95% CI 49-79%) returned to soundness. Of 46 horses age >3 years, 16 (35%,95% CI 21-49%) returned to soundness. In addition, cartilage damage at sites other than the SCMFC negatively affected prognosis (P = 0.05). The hospital where treatment was performed had no influence on return to soundness. CONCLUSIONS: Older horses carry a worse prognosis for both return to soundness and return to work. POTENTIAL RELEVANCE: It is important for clients to be made aware of the difference in outcome between age groups.

Perception among upper middle class adolescent in Bombay regarding sex and sexuality.

The study was carried out among the adolescents in respect to their beliefs about sexual behavior and their intended decision with regard to engaging in sexual activity. Both male and female respondents indicated that they believe that individuals of their age should wait until they are older before engaging in sexual activity. However, there were significant differences between the responses of male and female adolescents.

Analysis of stress fractures associated with lameness in Thoroughbred flat racehorses training on different track surfaces undergoing nuclear scintigraphic examination.

REASONS FOR PERFORMING STUDY: There is limited information regarding the impact of training track surface on the occurrence of stress fractures. OBJECTIVES: To evaluate the impact of training track surface on the proportion of long bone and pelvic stress fractures associated with lameness in Thoroughbred horses in flat race training undergoing nuclear scintigraphic examination. STUDY DESIGN: Retrospective study. METHODS: Scintigraphic examinations of Thoroughbred flat racehorses were evaluated from 2 hospitals (hospital A [Toronto Equine Hospital], 2003-2009, and hospital B [George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania], 1994-2006). Horses admitted to hospital A trained at a single track, at which the main training surface changed from dirt to synthetic on 27 August 2006. Two distinct populations existed at hospital B: horses that trained on dirt (numerous trainers) and those that trained on turf (single trainer). All scintigraphic images were evaluated by a blinded reviewer. Fisher's exact test and logistic regression were used when appropriate, and significance was set at P<0.05. RESULTS: When reviewing 528 scintigraphic examinations from hospital A (257 dirt and 271 synthetic, numerous trainers), there was a greater proportion of stress fractures detected in scintigraphic examinations from horses training on a synthetic surface (31.7%) in comparison to scintigraphic examinations from horses training on a dirt surface (23.0%) at an earlier point in time (P = 0.03). There was a greater proportion of hindlimb/pelvic and tibial stress fractures diagnosed in horses from the synthetic surface-trained group than from the dirt-trained group at hospital A (P<0.04 and P = 0.03, respectively). CONCLUSIONS: This study provides evidence that training surface may affect the proportion of stress fractures diagnosed, but other factors, such as training philosophy, appear to be important. Future prospective investigations to fully elucidate the relationship between training track surface and the proportion of stress fractures and other nonfatal musculoskeletal injuries are warranted.

Dominant situational determinants of sexual risk behaviour in gay men.

OBJECTIVE: To examine the interplay between situational, social and psychological factors in gay men's decisions about HIV risk behaviour, using multiple hypothetical situations. METHOD: The sample included 79 gay men from Sydney recruited through flyers, press advertisements or personal contact at gay venues. Subjects were presented with 20 hypothetical situations graphically on a computer, which included different levels of attraction to partner, intoxication, attractiveness to partner, condom availability, desire for anal sex by subject, insistence of partner on using a condom and time constraints in each situation. Subjects used a computerized graphic rating scale to indicate the likelihood of unprotected anal sex in each situation, the frequency with which they had experienced the hypothetical situation in real life and satisfaction with their response. The probability of having unsafe anal sex in any given situation was the dependent variable. All other variables were predictors. RESULTS: A vector of predictors accounted for 30% of the variance (r = 0.54). Ratings of the probability of anal sex increased with the frequency that subjects had experienced hypothetical situations in real life, attraction to partner, attractiveness to partner and time elapsed since real life experience similar to the hypothetical one. Ratings of the probability of anal sex decreased with condom availability. CONCLUSIONS: Our results suggest that interventions must address the way that individuals interact with their partner and their environment in order to be successful.