精神卫生与心理咨询从业人员对同性恋群体态度研究

目的:了解精神卫生和心理咨询从业人员对性少数群体的认知、态度和接纳程度,以及可能的影响因素;了解精神卫生与心理咨询从业人员对性倾向扭转治疗的态度,以及扭转治疗的实施现状;为中国同性恋完全去病理化工作提供一定的数据支持。方法:采用自编问卷,结合电话访谈进行线上和线下调查。自编问卷包括基本信息、性少数群体认知、精神卫生与心理咨询从业人员对同性恋来访者接待态度量表和扭转治疗的操作。线下调查采用配额抽样,各地合作机构和个人经过测试培训后完成各地的问卷发放和回收,线上调查由某医学类专业网站发放问卷。有效样本996个,来自全国29个省级行政单位。结果:(1)精神卫生与心理咨询从业人员对同性恋群体的态度得分为3.05,"接待感受"因子平均分为3.11,"接待意愿"因子平均分为3.02。(2)对同性恋的态度在性别认同、职业领域、海外经历、学历、培训程度、是否接待过同性恋、是否支持扭转治疗上存在显著差异。(3)调查对象中从未接受过和很少接受过同性恋相关培训的分别为33.6%和36.1%,对性倾向能否改变最主要的看法是"部分人可以改变",对同性恋的定性最主要的看法是"正常行为"。(4)62.1%的调查对象反对扭转治疗。(5)扭转治疗个案持续时间从1个月以下到6个月以上不等,费用高于普通治疗或咨询。方法以心理治疗为主,最主要的治疗结果为"未改变性倾向"。(6)"是否接受过有关培训"和"对同性恋认识程度"对调查对象对同性恋群体的态度以及是否支持扭转治疗有显著预测作用。结论:总体来说,精神卫生和心理咨询从业人员对同性恋者的接待感受和接待意愿较好,但仍有部分受访者对同性恋者有潜在歧视。性倾向扭转治疗在中国仍然被使用。影响精神卫生与心理咨询从业人员对性少数群体态度的关键因素是他们对性少数群体相关知识的掌握程度,态度对是否支持扭转治疗有显著影响。开展多元性别培训是加强认知与改善态度的重要方法。     

Dermatologic care of sexual and gender minority/LGBTQIA youth,Part I: An update for the dermatologist on providing inclusive care

Sexual and gender minority (SGM) persons, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) individuals, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Unfortunately, our understanding of these needs as they relate to dermatology is still nascent, particularly with respect to children and adolescents. This two‐part review will discuss the dermatologic care of SGM youth, with Part 1 providing practical advice for dermatologists seeking to provide more culturally mindful and accessible care for SGM children and adolescents. A more comprehensive understanding of the psychosocial and physical needs of SGM youth will allow dermatologists to more actively and compassionately care for this health disparity population.     

Dermatologic care of sexual and gender minority/LGBTQIA youth,Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents

Sexual and gender minority (SGM) individuals, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) persons, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Part 2 of this two‐part review will address unique concerns regarding acne, tanning behavior, sexually transmitted infections, and other health disparities among SGM adolescents. A more comprehensive understanding of the dermatologic needs of SGM youth will better allow pediatric dermatologists to actively and compassionately care for this health disparity population.     

New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women

OBJECTIVES: To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner. METHODS: Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner. RESULTS: The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% CI 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78) CONCLUSIONS: Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.     

High prevalence of asymptomatic STDs in incarcerated minority male youth: a case for screening

BACKGROUND AND OBJECTIVES: To assess STD prevalence among a sample of incarcerated minority male youth in a southern US city. METHODS: A consecutive entrant, cross-sectional study of 284 minority males 14 to 18 years was performed. All adolescents were screened for gonorrhea and chlamydia using ligase chain reaction tests. RESULTS: Eighteen percent of youth were identified as having either gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases (STDs) self-reported having no symptoms. Failure to use condoms in the past month was significantly associated with a positive test result for STDs (odds ratio = 1.9, 95% CI = 1.1-3.3). CONCLUSIONS: The findings indicate an urgent need for routine STD screening and STD-prevention programs for adolescent males in detention facilities. A study of 284 detained black male adolescents revealed 18% prevalence of gonorrhea, chlamydia, or both. Approximately 84% of those with sexually transmitted diseases self-reported not having symptoms.     

Prevalence of skin disease among school children and adolescents in a Student Health Service Center in Hong Kong

We document the prevalence and the pattern of dermatologic diseases among primary and secondary school students visiting a Student Health Service Center in Hong Kong. In this study, the differences in prevalence of skin diseases between these two groups are pointed out. A total of 1006 students from both primary (n = 559) and secondary schools (n = 447) were seen in a regional, population-based screening center during the period from October 1996 to September 1997. Each student was asked to answer a simple questionnaire to identify any skin problems and to explore health-seeking behavior. Students were then examined for evidence of skin disease. A total of 314 students (31.3%) had one or more skin disorders, the most common of which were acne vulgaris (9.9%), eczema (6.8%), café au lait spots (4.4%), congenital melanocytic nevus (3.6%), superficial fungal infections (2.2%), keratosis pilaris (1.3%), and pityriasis alba (1.0%), which represented 93% of the skin disorders encountered. Acne vulgaris and tinea cruris were distinctly more common in secondary school students, while atopic eczema and congenital melanocytic nevi were more commonly found in primary school students. Among the 314 students with skin disease, 129 (41%) had symptoms while 185 (59%) did not. Ninety of the 129 students (70%) with symptomatic skin problems did not seek medical attention. The two predominant skin diseases, acne vulgaris and endogenous eczema, both chronic skin problems, incur not only morbidity in affected individuals and families, but also use considerable resources in the community. The lack of medical intervention reported by symptomatic students in this study was unexpectedly high. Therefore it is useful to monitor the epidemiology of skin problems in children so that relevant skin health education programs and preventive measures can be planned and implemented effectively.     

A hand immersion test under laboratory-controlled usage conditions: the need for sensitive and controlled assessment methods

Exaggerated test conditions were frequently used to investigate the cutaneous tolerance of detergent products in the past. As the sensitivity of newly designed biometric methods is steadily improving, the trend towards more realistic test conditions should be encouraged. A hand immersion test under laboratory-controlled usage conditions is presently described, fulfilling such principles. Panelists soaked their hands in 2 different hand dishwashing liquids, 2x daily for 10 min each (with successive in-solution/out-of-solution cycles) for 4 consecutive days. Products were at usual dilution for dishwashing liquids and were randomized between the dominant and non-dominant hands of panelists. Visual scoring of erythema and dryness developing on the whole hands (scoring scales including interdigital areas and joints) during the week did not allow discrimination between the 2 products. However the dominant hands were significantly more susceptible to alterations than the non-dominant hands, regardless of product attribution. In contrast, skin electrical measurements (Corneometer CM800 and Skicon 200) on the dorsum of the hands (muscle mass between thumb and index) and squamometry analysis of tape stripping (harvested from the same site) yielded significant differences between the 2 products. In conclusion, a hand immersion test under realistic conditions has been described, which discriminates between products when sensitive assessment methods are used to explore skin sites partially protected from daily-life skin aggressions.     

Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting

This study aimed to systematically review and describe the evidence on chlamydia and gonorrhoea reinfection among men, and to evaluate the need for retesting recommendations in men. PubMed and STI conference abstract books from January 1995 to October 2006 were searched to identify studies on chlamydia and gonorrhoea reinfection among men using chlamydia and gonorrhoea nucleic acid amplification tests or gonorrhoea culture. Studies were categorised as using either active or passive follow-up methods. The proportions of chlamydial and gonococcal reinfection among men were calculated for each study and summary medians were reported. Repeat chlamydia infection among men had a median reinfection probability of 11.3%. Repeat gonorrhoea infection among men had a median reinfection probability of 7.0%. Studies with active follow-up had moderate rates of chlamydia and gonorrhoea reinfection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both chlamydia and gonorrhoea reinfections among men, with respective medians of 17.4% and 8.5%. Proportions of chlamydia and gonorrhoea reinfection among men were comparable with those among women. Reinfection among men was strongly associated with previous history of sexually transmitted diseases and younger age, and inconsistently associated with risky sexual behaviour. Substantial repeat chlamydia and gonorrhoea infection rates were found in men comparable with those in women. Retesting recommendations in men are appropriate, given the high rate of reinfection. To optimise retesting guidelines, further research to determine effective retesting methods and establish factors associated with reinfection among men is suggested.     

Trends in sexual behaviour among London homosexual men 1998-2003: implications for HIV prevention and sexual health promotion

OBJECTIVES: To examine changes in sexual behaviour among London homosexual men between 1998 and 2003 by type and HIV status of partner. METHODS: Homosexual men (n=4264) using London gyms were surveyed annually between 1998 and 2003 (range 498-834 per year). Information was collected on HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and type of partner for UAI. High risk sexual behaviour was defined as UAI with a partner of unknown or discordant HIV status. RESULTS: Between 1998 and 2003, the percentage of men reporting high risk sexual behaviour with a casual partner increased from 6.7% to 16.1% (adjusted odds ratio (AOR) 1.36 per year, 95% confidence interval (CI) 1.26 to 1.46, p <0.001). There was no significant change in the percentage of men reporting high risk sexual behaviour with a main partner alone (7.8%, 5.6%, p=0.7). These patterns were seen for HIV positive, negative and never tested men alike regardless of age. The percentage of HIV positive men reporting UAI with a casual partner who was also HIV positive increased from 6.8% to 10.3% (AOR 1.27, 95% CI 1.01 to 1.58, p <0.05). CONCLUSION: The increase in high risk sexual behaviour among London homosexual men between 1998 and 2003 was seen only with casual and not with main partners. STI/HIV prevention campaigns among London homosexual men should target high risk practices with casual partners since these appear to account entirely for the recent increase in high risk behaviour.     

Psoriatic arthritis and psoriasis: need for a multidisciplinary approach

Psoriatic arthritis is a progressive and often destructive form of seronegative inflammatory arthritis that is associated with psoriasis. It can be difficult to diagnose because it can present in a number of different ways, often indistinguishable from noninflammatory arthropathies such as osteoarthritis as well as inflammatory arthritis such as gout. Severe arthritis may be observed in the absence of psoriasis, or mild arthritis may be seen in the presence of moderate-to-severe psoriasis. A high index of suspicion, screening of psoriasis patients, and close follow-up and evaluation with rheumatology often is needed to make the diagnosis. Early recognition of the disorder and timely therapy can prevent long-term complications, such as permanent joint destruction and disability. With the advent of biologic agents, we are better equipped to manage psoriatic arthritis today. Because dermatologists are on the front-line of psoriasis management, we are perfectly poised to identify and help improve care for patients who suffer from both psoriasis and psoriatic arthritis.     

Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic

BACKGROUND: Recent increases in rates of sexually transmitted diseases (STDs) and decreases in safe sex behaviors among men who have sex with men (MSM) in several American and European cities have been noted by researchers. It has been suggested that these trends are the result of perceptions that HIV/AIDS is less serious because of the availability of highly active antiretroviral therapy (HAART). GOAL: The goal of the study was to examine trends in STD rates and risk behaviors among MSM and men who have sex with women (MSW) visiting a public STD clinic in Denver and to determine whether there is an ecological association with the availability of HAART. STUDY DESIGN: This is a two-part retrospective analysis of male visits to the Denver Metro Health Clinic (DMHC). The first part describes gonorrhea and early (primary and secondary) syphilis trends among MSM between 1982 and 2001. For the second part, data were grouped into two 6-year time periods to represent pre-HAART and post-HAART time frames, 1990 to 1995 and 1996 to 2001. RESULTS: Gonorrhea and early syphilis cases among MSM declined precipitously between 1982 and 1988 and then stabilized at low rates. The proportion of male visits to the clinic made by MSM decreased from 14.1% in 1990 to 7.2% in 1995 and then increased to 13.0% in 2001. Gonorrhea positivity rates among MSM increased after 1995 and were significantly higher in the period 1996 to 2001 (12.9%) than in the period 1990 to 1995 (8.1%; P<0.0001). Conversely, gonorrhea rates among MSW dropped from 11.2% in the first period to 6.9% in the second (P<0.0001). Among MSM known to be HIV-infected, gonorrhea rates increased from 11.6% in the first time period to 24.0% in the second period (P<0.0001). Reports of anal sex among MSM increased from 64.4% to 70.9% (P<0.0001). Reporting more than one sex partner increased for MSM from 65.2% to 70.3% (P<0.0001), but it significantly decreased from 52.6% to 46.2% for MSW (P<0.0001). No or inconsistent condom use increased from 60.9% to 63.0% for MSM (P=NS) and decreased from 85.1% to 82.4% among MSW (P<0.0001). CONCLUSIONS: These trends appear to reflect a change toward higher risk-taking behaviors among MSM but not MSW since the time HAART became available and raise concerns about the potential for increased HIV transmission in this group.     

Multiple pilomatrixomas in children: the need for long‐term follow‐up and aesthetically sensitive incisions

Pilomatrixomas are benign, calcified epitheliomas of the hair follicle, predominately affecting children and commonly presenting in the head and neck region. The current literature is almost unanimous in recommending surgical excision. Reconstruction of these defects may require the need for a skin graft, resulting in poor cosmetic outcome and donor site morbidity. We present two cases demonstrating the benefits of minimal access incisions for pilomatrixomas in children. We recommend that multiple or recurrent lesions should prompt referral to a specialist for management and long‐term follow‐up.     

The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals.

OBJECTIVES--To study risk factors for sexually transmitted diseases (STDs) and sexual behaviour. Especially to assess whether there is a higher risk of being infected with STDs among ethnic minorities, and if so for what reasons. SETTING--STD-clinic of the Municipal Health Service of Amsterdam, the Netherlands. SUBJECTS--Cross-sectional study of heterosexuals (255 men and 343 women) with multiple sexual partners, who participated between October 1987 and January 1990. RESULTS--Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners. CONCLUSIONS--Prevention activities should be directed at specific sexual and ethnic groups, sources of information should be carefully selected, and some groups should be addressed differently with regard to language but to content as well.     

HIV testing and high risk sexual behaviour among London's migrant African communities: a participatory research study

OBJECTIVES: To describe the demographic and behavioural factors associated with HIV testing among migrant Africans in London. METHODS: A cross sectional survey of migrants from five sub-Saharan African communities (Congo, Kenya, Uganda, Zambia, Zimbabwe) resident in London was carried out. The study formed part of a larger community based participatory research initiative with migrant African communities in London-the MAYISHA project. Trained, ethnically matched interviewers recruited study participants in a variety of community venues. A brief self completion questionnaire collected data on demographic characteristics, utilisation of sexual health services, HIV testing history, sexual behaviour, and attitudes. RESULTS: Valid questionnaires were obtained from 748 participants (396 men and 352 women), median ages 31 and 27 years, respectively. Median length of UK residence was 6 years. 34% of men and 30% of women reported ever having had an HIV test. HIV testing was significantly associated with age and previous STI diagnosis among women; and additionally, nationality, education, employment, and self perceived risk of acquiring HIV among men. After controlling for significant demographic variables, previous diagnosis of an STI (adjusted odds ratio and 95% confidence interval for men: 2.96, 1.63 to 5.38, and women 2.03, 1.06 to 3.88) and perceived risk of acquiring HIV for men (adjusted OR 2.28, 95%CI 1.34 to 3.90) remained independently associated. CONCLUSION: Among these high HIV prevalence migrant communities, these data suggest that HIV testing remains largely associated with an individual's STI history or self perceived risk. This strategy may be inappropriate given the potential for onward and vertical transmission. Antenatal HIV testing combined with proactive targeted HIV testing promotion should be prioritised.