The 12-month prevalence of substance use and ICD-10 substance use disorders in Australian adults: findings from the National Survey of Mental Health and Well-Being

Aims. To present the prevalence of substance use and ICD-10 substance use disorders in the adult Australian population using data from the National Survey of Mental Health and Well-Being (NSMHWB). Design. A cross-sectional survey assessing substance use and ICD substance use disorders (harmful use and dependence). Setting and participants. A household survey of a nationally representative sample of 10 641 Australian adults (aged 18 years or older). Measurements. Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). Findings. In the past 12 months 6.5% of the sample had an ICD-10 alcohol use disorder (95% CI: 6.2, 6.9), and 2.2% had another drug use disorder (95% CI: 2.0, 2.4). More males than females had substance use disorders: 9.5% of males (95% CI: 8.5, 10.5) and 3.6% of females (95% CI: 3.2, 4.0) met criteria for an alcohol use disorder, and 3.2% of males (95% CI: 2.8, 3.6) and 1.3% of females (95% CI: 0.9, 1.7) met criteria for another drug use disorder within the past 12 months. The prevalence of substance use disorders decreased with increasing age: 10.5% of respondents aged 18-34 years met criteria for an alcohol use disorder and 4.8% met criteria for a drug use disorder. The rates of these disorders among those aged 55 years or older were 1.8% and 0.1%, respectively. Substance use disorders were more prevalent among the unemployed, those who had never married and those who were Australian-born. Conclusions. The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries.     

Correlates and prevalence of insufficient 25-hydroxyvitamin D status in black and white older adults: the health, aging and body composition study

OBJECTIVES: To determine the prevalence and correlates of vitamin D insufficiency in black and white older adults. DESIGN: Cross‐sectional. SETTING: Health, Aging and Body Composition Study. PARTICIPANTS: Nine hundred seventy‐seven black and 1,604 white adults aged 70 to 81. MEASUREMENTS: Logistic regression and classification and regression tree analysis were used to identify correlates of vitamin D insufficiency (25‐hydroxyvitamin D (25(OH)D) <30 ng/mL) separately in blacks and whites. RESULTS: The prevalence of 25(OH)D insufficiency was 84% in blacks and 57% in whites. Seventy‐six percent of blacks and 56% of whites did not take a multivitamin; those who did not take a multivitamin were more likely to be vitamin D insufficient (odds ratio (OR)=5.17 (95% confidence interval (CI)=3.47–7.70) for blacks; OR=2.56, 95% CI=2.05–3.19 for white). Additional risk factors for vitamin D insufficiency were vitamin D–containing supplement use, female sex, and obesity in blacks; and winter season, low dietary vitamin D intake, obesity, type 2 diabetes mellitus, and female sex in whites. CONCLUSION: Vitamin D insufficiency was more prevalent in blacks than whites. Not consuming a multivitamin increased the odds of vitamin D insufficiency in blacks and whites. Knowledge of additional risk factors such as dietary intake and comorbid conditions may help identify older adults who are likely to be vitamin D insufficient.     

Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study

BACKGROUND AND AIMS: We evaluated the effect of two programs for the prevention of falls leading to acute hospital admission in a population of elderly community-dwelling Danish residents. METHODS: This was a factorial, pragmatic, intervention study. We included 9605 community-dwelling city residents aged 66+ years. We offered a prevention program consisting of a daily supplement of 1000 mg of elemental calcium as calcium carbonate and 400 IU (10 microg) of vitamin-D3 to a total of 4957 participants. The remaining 5063 participants were offered home safety inspection with dietary and health advice, or no intervention. RESULTS: The Calcium and Vitamin D program was followed by 50.3% and the Environmental and Health Program by 46.4%. According to a multivariate analysis including age, marital status and intervention program, female residents who followed the Calcium and Vitamin D Program had a 12% risk reduction in severe falls (RR 0.88; 95% CI 0.79-0.98; p < 0.05; NNT 9). CONCLUSIONS: The present study supports the hypothesis that vitamin D and calcium supplementation prevent falls leading to acute hospitalization in community-dwelling elderly females in a northern European region known to be deficient in vitamin D.     

Couples' knowledge and attitudes regarding the practice of family planning in the jungle of Peru

OBJECTIVE: To assess the association of knowledge and attitudes about family planning (FP) with its practice in couples of the Peruvian jungle region. MATERIAL AND METHODS: A cross-sectional study was carried out in the jungle region in Peru (Pucallpa and Tarapoto), among 600 couples. Males were > or = 15 years old and females between 15 and 49 years old, who had resided in the area for at least two years. A questionnaire was used to determine FP practices (defined as the use of modern contraceptive methods (MCM) for > or = 12 months), as well as attitudes and knowledge regarding FP. Frequencies were compared using the chi-squared test. Logistic regression was used to assess the association between demographic variables and MCM knowledge as well as MCM utilization. The association between sociodemographic variables and attitudes toward MCM was assessed with linear regression models. RESULTS: Males with primary education or with no formal education were twice as likely to have no knowledge about MCM compared with males with professional education (OR: 2.18, 95% CI: 1.05, 4.50). Females with a catholic partner were more likely to know about MCM than those whose partners did not practice any religion (OR: 0.60, 95% CI: 0.37, 0.97). Partner's lower education, older age of women, and rural background of males were all factors associated with a less favorable attitude toward FP practices. Couples in which the man did not know about contraceptive methods were more likely not to use MCM than couples where the man knew about MCM (OR: 1.57, 95% CI: 1.07, 2.30). Couples where the man had an intermediate level of acceptance towards FP were more likely not to use MCM than those where the man had a high level of acceptance (OR: 1.90, 95% CI: 1.03, 3.48). The strength of association was higher when the man had a low level of acceptance toward PF (OR: 2.23, 95% CI: 10, 4.51). CONCLUSIONS: Knowledge of contraceptive methods and attitudes toward FP among men are associated with the practice of FP by couples. Study findings show that male acceptance of MCM and FP is a necessary, important, and influential factor in FP promotion and practice. The English version of this paper is available at:http://www.insp.mx/salud/index.html.     

Characteristics associated with synthetic cannabinoid use among patients treated in a public psychiatric emergency setting

Background: Growing evidence of adverse outcomes following synthetic cannabinoid use has engendered interest into populations at risk. The existing literature reports that synthetic cannabinoid use is predominant among young, white males. However, reports from local Departments of Health have found contrary evidence, showing that synthetic cannabinoid use is prevalent in populations other than those of young, white men. Objectives: This study sought to examine sociodemographic characteristics associated with self-reported synthetic cannabinoid use among a clinical psychiatric population within a public hospital in New York City. Methods: A cross-sectional medical record review was conducted on synthetic cannabinoid users and non-users in an emergency psychiatric setting. A total of 948 patients who presented at the emergency psychiatric setting in 2014 were included in this sample, 110 (11.6%) of whom were synthetic cannabinoid users. Logistic regressions were used to determine the sociodemographic correlates of synthetic cannabinoid use. Results: The most prominent correlate of synthetic cannabinoid use was homelessness/residing in a shelter during time of treatment (AOR = 17.77, 95% CI = 9.74–32.5). Male (AOR = 5.37, 95% CI = 2.04–14.1), non-white (AOR = 2.74, 95% CI = 1.36–5.54), and younger age (AOR = .961, 95% CI = .940–.980) were also significant correlates of synthetic cannabinoid use. Conclusion: Synthetic cannabinoid use among the homeless and mentally ill is a growing public health concern, representing a population with unique clinical and social needs. Areas and populations with high rates of homelessness should be targeted for synthetic cannabinoid prevention and treatment efforts, particularly in urban and racial/ethnic minority communities.     

Easy bruising as a side-effect of inhaled corticosteroids.

We wished to determine the prevalence of easy bruising in patients taking inhaled corticosteroids (ICS) compared with those who do not. Differences in age, dosage and duration of use of ICS between patients who bruised and those who did not were also investigated. Confidential questionnaire surveys were conducted over a 6 month study period amongst patients attending a respiratory out-patient clinic and taking regular ICS, and a control group of patients attending non-respiratory clinics and not taking any form of corticosteroids. Patients with bleeding disorders or taking oral steroids, non-steroidal anti-inflammatory drugs or anticoagulants were excluded from the study. Questionnaires from 202 respiratory patients using ICS (group A) were compared with 204 non-ICS patients (Group B) of similar age and sex distribution. Significantly more patients in Group A reported easy bruising than in group B (47 vs 22%, relative risk 2.18, 95% confidence interval (95% CI) 1.62-2.94), and it was the commonest reported symptom. In Group A, the patients that reported easy bruising tended to be older (61 vs 52 yrs), on higher daily dosages (1,388 vs 1,067 micrograms) and had been taking inhaled corticosteroids for longer (55 vs 43 months) than non-bruisers. Overall, females reported easy bruising more frequently than males in both groups. However, comparing Group A with Group B, males taking ICS had a higher relative risk for bruising than females (males, relative risk 5.80, 95% CI 2.38-14.13; females, relative risk 1.80, 95% CI 1.32-2.44).(ABSTRACT TRUNCATED AT 250 WORDS)     

Cigarettes and oral snuff use in Sweden: Prevalence and transitions

AIMS: To investigate the prevalence and patterns of transitions between cigarette and snus use. DESIGN: Cross-sectional study within the population-based Swedish Twin Registry. SETTING AND PARTICIPANTS: A total of 31 213 male and female twins 42-64 years old. MEASUREMENTS: Age-adjusted prevalence odds ratios (POR) and 95% confidence intervals (CIs) described the association between gender and tobacco use, while Kaplan-Meier survival methods produced cumulative incidence curves of age at onset of tobacco use. Life-time tobacco use histories were constructed using ages at onset of tobacco use and current tobacco use status. FINDINGS: Although more males reported ever smoking (64.4%) than females (61.7%), more males were former smokers (POR: 1.33, 95% CI: 1.27-1.39). Males were far more likely to use snus than females (POR: 18.0, 95% CI: 16.17-20.04). Age at onset of cigarette smoking occurred almost entirely before age 25, while the age at onset of snus use among males occurred over a longer time period. Most men began using cigarettes first, nearly one-third of whom switched to using cigarettes and snus in combination. While 30.6% of these combined users quit tobacco completely, only 7.4% quit snus and currently use cigarettes, while 47.7% quit cigarettes and currently use snus. CONCLUSIONS: Current cigarette smoking is more prevalent among Swedish women than men, while snus use is more prevalent among men. Among men who reported using both cigarettes and snus during their life-time, it was more common to quit cigarettes and currently use snus than to quit snus and currently use cigarettes. Once snus use was initiated, more men continued using snus rather than quit tobacco completely.     

Home blood pressure monitoring among Canadian adults with hypertension: Results from the 2009 Survey on Living with Chronic Diseases in Canada

BACKGROUND:

Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis.

OBJECTIVES:

To characterize the use of HBPM among Canadian adults with hypertension.

METHODS:

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control.

RESULTS:

Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional – with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4).

CONCLUSIONS:

Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.     

Linking substance use with symptoms of subclinical psychosis in a community cohort over 30 years

Aims The aim of the study was to examine the temporal associations between substance use and subclinical psychosis symptoms. Design Data from a prospective community study sampled within a single cohort over 30 years (1978–2008) were analysed with discrete‐time hazard models. Setting General population‐based sample. Participants At initial sampling in 1978 males (n = 292) were 19 and females (n = 299) were 20 years old. Measurements Two psychosis syndromes representing ‘schizotypal signs’ and ‘schizophrenia nuclear symptoms’ and various substance use variables including cannabis, alcohol, tobacco and multiple‐drug use (i.e. cannabis combined with other drugs). Findings In bivariate analyses, schizotypal signs were predominantly associated with regular cannabis use in adolescence (OR = 2.29, 95% CI 1.32–3.97). Schizophrenia nuclear symptoms were mainly related to alcohol (OR = 1.84, 95% CI 1.00–3.38) and multiple‐drug use (OR = 2.35, 95% CI 1.38–4.02) during adolescence. Multivariate analyses showed that, in particular, regular cannabis use during adolescence was associated with the occurrence of subsequent schizotypal symptoms over a 30‐year period (OR = 2.60, 95% CI; 1.59–4.23), whereas multiple‐drug use in adolescence was associated predominantly with schizophrenia nuclear symptoms (OR = 1.75, 95% CI 1.01–3.03). Alcohol misuse was only slightly associated with the onset of such symptoms. Conclusions A significant portion of the occurrence of subclinical psychosis symptoms in adulthood can be attributed to excessive cannabis and multiple‐drug use during adolescence. This is in line with the hypothesis that long‐term sensitization of dopaminergic brain receptors plays a role in developing psychotic symptoms.     

Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly

OBJECTIVE: the effects of regular exercise over 5 years on mortality and ADL impairment were evaluated in elderly people. DESIGN: intervention study. SETTING: Tsuru City, Yamanashi Prefecture, Japan. METHODS: the subjects of this study were 245 elderly people living at home. Of these individuals, 155 (56 males aged 76.5+/-4.2 years at the baseline level; 99 females aged 76.2+/-4.8 years) who voluntarily participated in our original health-promoting programme were regarded as an intervention group. The remaining 90 (29 males aged 77.6+/-5.2 years at the baseline level; 61 females aged 77.3+/-5.1 years) were regarded as a control group. The programme was a 5-year intervention consisting of collective sessions given six times a year every 2 months. The intervention was a combination of an exercise programme based on theories of exercise physiology and a support programme based on health education theories. The relative risks of death and ADL impairment adjusted for age, presence or absence of cardiovascular or musculo-skeletal disorders, and functional fitness level at the baseline were calculated using logistic regression analysis. RESULTS: the rates of participant compliance per year were 67.7% in the first year of the intervention period and gradually decreased thereafter to 43.9% in the last year. Amongst female subjects the percentage of those who exercised habitually at the end of the study period was the same as that in the baseline in the intervention group but was significantly lower at the end of the study in the control group (chi2 = 10.576, P < 0.01). The relative risk of death in the intervention group was 1.0 (95% CI 0.22-4.51) amongst the males and 0.16 (95% CI 0.03-0.81) amongst the females. Relative risk of ADL impairment was 0.22 (95% CI 0.03-1.42) amongst the males and 0.36 (95% CI 0.13-1.02) amongst the females. CONCLUSION: These findings suggest that the improved mortality and state of independence in the female portion of the intervention group occurred as a result of increased physical exercise levels in daily life. However, validation of our results must await research that employs a randomized control trial to avoid various biases and confounding factors between the intervention and the control groups.     

Western blot-indeterminate results in Nigerian patients HIV serodiagnosis: the clinical and public health implication

The clinical and public health implication of HIV Western blot (WB) indeterminate results is yet to be appraised in sub-Saharan Africa, including Nigeria. Using HIV Tri Line Test enzyme-linked immunosorbent assay (ELISA), 1286 patients (600 males and 686 females; age range, 5-60 years) with symptoms suggestive of HIV infection were screened. A total of 1020 (79.3%, 95% confidence interval [CI] 76.8-81.5) of the patients comprising of 514 (85.7%) males and 506 (73.8%) females were HIV seropositive and the difference was statistical significantly (chi(2) = 5.72, df = 1, p < 0.05). Western blot analysis of sera from the 1020 HIV-seropositive individuals using the BIO-RAD NEW LAV-BLOT I specifying World Health Organization (WHO) interpretive criteria, confirmed the HIV serostatus of 815 (79.9%, 95% CI, 77.4-82.4) of them with 205 (20.1%, 95% CI, 17.6-22.6) individuals having indeterminate results consisting of either; 1 env +/- gag +/- pol, gag + pol, gag only or pol only. Of these, 102 (19.8%) were males and 103 (20.4%) were females. Patients aged 11-20 years old recorded the highest percentage of indeterminate results (31.7%, 95% CI, 20.2-43.2) while those aged 21-30 years recorded the least (14.2%, 95% CI, 10.6-17.8) and the difference was statistically significant (chi(2) = 15.73, df = 5, p < 0.05). Result confirmed the limitation of Western blot assays in HIV confirmatory serodiagnosis. After obtaining HIV indeterminate Western blot result, clinicians should consider the total profile for the patient, reassess risk factors for HIV infection, perform a HIV retesting at 3-month intervals for 6 months or use an alternate HIV antibody confirmatory assay and running antibody tests for other human retroviruses.     

Vitamin supplement use in a low-risk population of US male physicians and subsequent cardiovascular mortality

BACKGROUND: Although basic research suggests that vitamins may have an important role in the prevention of cardiovascular diseases (CVD), the data from cohort studies and clinical trials are inconclusive. METHODS: This prospective cohort study was conducted among 83 639 male physicians residing in the United States who had no history of CVD or cancer. At baseline, data on use of vitamin E, ascorbic acid (vitamin C), and multivitamin supplements were provided by a self-administered questionnaire. Mortality from CVD and coronary heart disease (CHD) was assessed by death certificate review. RESULTS: Use of supplements was reported by 29% of the participants. During a mean follow-up of 5.5 years, 1037 CVD deaths occurred, including 608 CHD deaths. After adjustment for several cardiovascular risk factors, supplement use was not significantly associated with total CVD or CHD mortality. For vitamin E use, the relative risks (RRs) were 0.92 (95% confidence interval [CI], 0.70-1.21) for total CVD mortality and 0.88 (95% CI, 0.61-1.27) for CHD mortality; for use of vitamin C, the RRs were 0.88 (95% CI, 0.70-1.12) for total CVD mortality and 0.86 (95% CI, 0.63-1.18) for CHD mortality; and for use of multivitamin supplements, the RRs were 1.07 (95% CI, 0.91-1.25) for total CVD mortality and 1.02 (95% CI, 0.83-1.25) for CHD mortality. CONCLUSIONS: In this large cohort of apparently healthy US male physicians, self-selected supplementation with vitamin E, vitamin C, or multivitamins was not associated with a significant decrease in total CVD or CHD mortality. Data from ongoing large randomized trials will be necessary to definitely establish small potential benefits of vitamin supplements on subsequent cardiovascular risk.     

Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men

HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50–2.44] and casual (aOR = 2.34, 95% CI 1.80–3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53–17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.     

Relation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States.

BACKGROUND: Antioxidants increase the resistance of low-density lipoprotein to oxidation and may thereby reduce risk for atherosclerosis. OBJECTIVE: To determine whether intake of vitamin E, vitamin C, or carotenoids predict risk for total or ischemic stroke. DESIGN: Prospective observational study. SETTING: The Health Professionals Follow-up Study. PARTICIPANTS: 43,738 men 40 to 75 years of age who did not have cardiovascular disease or diabetes. MEASUREMENTS: Repeated and validated dietary assessments were done by using a self-administered 131-item food-frequency questionnaire, which included questions on dose and duration of vitamin supplement use. The follow-up period was 8 years. RESULTS: A total of 328 strokes occurred: 210 ischemic, 70 hemorrhagic, and 48 unclassified. After adjustment for age, smoking, hypertension, hypercholesterolemia, body mass index, physical activity, parental history of myocardial infarction, alcohol consumption, and total energy intake, the relative risk for ischemic stroke in the top quintile of vitamin E intake (median, 411 IU/d) compared with the bottom quintile (5.4 IU/d) was 1.18 (95% CI, 0.77 to 1.82). The relative risk for ischemic stroke in the top quintile of vitamin C intake (1167 mg/d) compared with the bottom quintile (95 mg/d) was 1.03 (CI, 0.66 to 1.59). Results for total stroke were similar. Associations of vitamin intake with hemorrhagic stroke were also nonsignificant, but the CIs were wide. Neither dose nor duration of vitamin E or vitamin C supplement use was related to risk for total or ischemic stroke. The relative risk for ischemic stroke was 1.16 (CI, 0.81 to 1.67) in men using 250 IU or more of vitamin E supplementation per day compared with men who used no vitamin E supplements and was 0.93 (CI, 0.60 to 1.45) in men using 700 mg or more of vitamin C supplementation per day compared with men who used no vitamin C supplements. A significant inverse relation between lutein intake and risk for ischemic stroke was seen but was not independent of other dietary factors. CONCLUSIONS: Vitamin E and vitamin C supplements and specific carotenoids did not seem to substantially reduce risk for stroke in this cohort. Modest effects, however, cannot be excluded.     

Chronic sinusitis and arterial hypertension in a national population health survey

BACKGROUND: To determine if sinusitis is associated with arterial hypertension in the Canadian population. METHODS: Complex survey design incorporating stratification, multiple stages of selection, and unequal probabilities of selection of respondents. Cross-sectional data from 52,992 subjects (25,324 males and 27,668 females) 20-64 years of age who participated in the second cycle of the National Population Health Survey (NPHS), conducted in 1996-1997. All these individuals were asked if they had certain chronic health conditions, that had lasted or were expected to last 6 months or more, including sinusitis and high blood pressure. RESULTS: Overall, males with sinusitis were just over 2% more likely to have hypertension (9.3% vs. 7.1%) whereas the difference was 4% for women (11.8% vs. 7.6%). Adjusted for age, region, habitation, immigrant status, household size, number of bedrooms, income adequacy, education level, smoking status, alcohol consumption, regular exercise and body mass index, the adjusted odds ratio for females was 1.42 (95% CI 1.04, 1.95). CONCLUSIONS: Reported sinusitis is associated with hypertension but only in women. Mechanisms linking upper respiratory disorders to hypertension merit investigation.     

Prevalence and social correlates of sexual intercourse among schoolgoing adolescents in Namibia

Adolescent sexuality is an important public health issue, as it affects risk to contract HIV and other sexually transmitted infections. The assessment of prevalence of sexual intercourse among adolescents is of public health significance, as it may guide policies and programmes aimed at reducing the transmission of sexually transmitted infections among this age group. This cross-sectional study using standardised methodology was conducted to assess the prevalence and correlates of sexual intercourse among Namibian schoolgoing adolescents in 2004. Overall the prevalence of sexual intercourse was 33.2% (44.0% males and 24.8% females). Variables positively associated with the outcome in multivariate analysis were male gender (OR=2.39; 95% CI (1.81, 3.17)), cigarette smoking (OR=1.67; 95% CI (1.07, 2.63)), alcohol drinking (OR=1.63; 95% CI (1.18, 2.26)), and drug use (OR=9.82; 95% CI (6.28, 15.36). Parental supervision was negatively associated with sexual intercourse in the last 12 months (OR=0.73; 95% CI (0.56, 0.94)). Efforts to control unhealthy lifestyles (smoking, alcohol and illicit drug use) may impact on adolescents' sexual activity.     

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales,Australia

Aims To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. Design Telephone‐based cross‐sectional survey. Setting New South Wales, Australia. Participants A total of 1090 people aged 18–39 years old. Findings Seventy‐five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol‐related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51–58%) of both males and females who had consumed at acute‐risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51–61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15–23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7–15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48–61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the ‘non‐intoxicated’ patrons reporting that they had seen licensed premises staff intervene in some way with other ‘intoxicated’ patrons. Conclusions While the majority of 18–39‐year‐olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.     

The management of uncomplicated adult gonococcal infection: should test of cure still be routine in patients attending genitourinary medicine clinics?

In this retrospective study of the outcome of treatment of 245 patients (87 females and 158 males) with a diagnosis of Neisseria gonorrhoeae infection seen between 1996 and 2002, 81% (95% confidence interval (CI) 74%-86.8%) of the males and 88.5% (95% CI 79.9%-94.3%) of the females attended for a test of cure. At initial presentation, 93% (95% CI 87.9%-96.5%) and 94.3% (95% CI 89.5%-97.4%) of males respectively, had symptoms and signs of gonococcal infection compared with 48.3% (95% CI 37.4%-59.2%) and 44.8% (95% CI 34.1%-55.9%) of females, and this difference was statistically significant (P = 0.005). Initial diagnosis at first visit was made by Gram-stained smear in 88.6% (95% CI 82.6%-93.1%) of males and 32.2% (95% CI 22.6%-43.1%) of females, a statistically significant difference P = 0.001. There were 12 (4.9%) cases of reinfection that rebooked to attend after failing to attend for their test of cure in two females and 10 males. There were two (0.8%) treatment failures amongst the 245 episodes in two males who still had symptoms when they returned for their test of cure. One male had a ciprofloxacin-resistant strain (CRNG) acquired locally and the other one had a betalactamase-producing CRNG/penicillinase-producing N. gonorrhoeae (PPNG) isolate acquired abroad in South America. These patients would have sought to return, as they still had signs and symptoms of gonococcal infection, and they would have been recalled following receipt of the antimicrobial susceptibility report. Post-gonococcal urethritis occurred in 36.3% (95% CI 27.8%-45.4%) of the males who attended for their test of cure, 74.8% (95% CI 67.2%-81.5%) received anti-chlamydial therapy with their standard treatment. In men who received anti-chlamydial therapy the odds ratio of having post-gonococcal urethritis was 0.42 (95% CI 0.17-1.06), P = 0.04. Co-infection with Chlamydia trachomatis was more likely to occur amongst females (43.9%), odds ratio 3.97 (95% CI 2.07-7.67), P < 0.001 than males (16.5%). We have now discontinued routine attendance for a test of cure and encourage our patients to telephone for their results with recall only of patients whose antimicrobial susceptibility indicate inappropriate first line therapy or who are still symptomatic.     

Determinants of Risky Sexual Behavior Among Injecting Drug Users (IDUs) in Georgia

Injection risk practices and risky sexual behaviors place injection drug users (IDUs) and their sexual partners particularly vulnerable to HIV. The purpose of the study was to describe and understand determinants of high-risk sexual behavior among IDUs in Georgia. A cross-sectional, anonymous survey assessed knowledge, behavior and HIV status in IDUs in five Georgian cities (Tbilisi, Gori, Telavi, Zugdidi, Batumi) in 2009. The study enrolled in total 1,127 (1,112 males, 15 females) IDUs. Results indicate that occasional sexual relationships are common among male IDUs, including married ones. A subsample of 661 male IDUs who reported having occasional and paid sex partners during the last 12 months was analyzed. Multivariate analysis shows that not having a regular partner in the last 12 month (adjusted odds ratio (aOR) 1.57, 95 % CI 1.04 2.37), and using previously used needles/syringes at last injecting (aOR 2.37, 95 % I 1.10–5.11) are independent correlates of inconsistent condom use with occasional and paid sexual partners among IDUs. Buprenorphine injectors have lower odds of inconsistent condom use with occasional and paid sexual partners compared to heroin injectors (aOR 0.47, 95 % CI 0.27–0.80), and IDUs who live in Telavi are twice more likely to engage in such risky sexual behavior than capital city residents (aOR 2.55, 95 % CI 1.46–4.48). More effective programs focused on sexual risk behavior reduction strategies should be designed and implemented.