Current practices of partner notification among MSM with HIV, gonorrhoea and syphilis in the Netherlands: an urgent need for improvement

ABSTRACT: BACKGROUND: Partner notification (PN) among individuals newly diagnosed with HIV/STI is seen as a vital tool to identify others at risk of infection. However, hardly any data are available on the effectiveness of PN on HIV/STI transmission in the Netherlands. This study aims to fill this gap by assessing current PN practices, case-finding effectiveness, and determinants of being notified among men having sex with men (MSM) in the Netherlands. METHODS: Nurses from five STI centers participated in a prospective pilot study on PN outcomes (partners being: at risk, notifiable, notified, and tested) for HIV/STI, by completing a newly developed PN registration form (PN database). PN outcomes including case-finding effectiveness (number of newly diagnosed cases in partners/number of partners being tested) for HIV, syphilis, and gonorrhoea were studied among MSM. Furthermore, the national STI database was analyzed to identify determinants of being notified. The number of infections that remained undetected was estimated based on these two databases. RESULTS: In total 105 MSM, newly diagnosed with HIV/STI, reported 612 sexual partners at risk of whom 41% were notifiable and 31% were notified. Patient referral was the predominant PN method (90%). The overall case-finding percentage was 36% (HIV: 15-33%, gonorrhoea: 17- 50% and syphilis: 4-11%). Case-finding percentages were lower in the national STI database: 21% (5%, 28%, 12%). Persons with one or more sexual partners, known HIV positives, and IDU were more likely to be notified to the STI clinic. Notified clients were more likely to have HIV/STI than unnotified clients (OR 1.7-2.5). Based on these two databases, an estimated 75 to 133 infections remained undetected (HIV: 12-90; gonorrhoea: 28-97; syphilis: 5-12 infections). CONCLUSIONS: Partner notification among MSM in the Netherlands is suboptimal; an extensive number of STI/HIV infections remained undetected mainly due to unnotifiable partners. To enhance PN practices, combined and innovative PN interventions such as Internet-based PN will be implemented for hard-to-reach MSM and other risk groups.     

Preferences for Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence: A Discrete Choice Experiment Among Male Sex Workers in Mexico

AIDS and Behavior - Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking...     

Chronic Social Stress in the Community and Associations with Psychological Distress: A Social Psychological Perspective

Chronic social stress is strongly related to psychological distress in vulnerable groups such as the frail elderly and ill people. Little, however, is known about these phenomena in the general population. The validity and reliability of a new brief measure, the Bergen Social Relationships Scale (BSRS), were investigated in a Norwegian county; the prevalence of chronic social stress was measured using the BSRS, and the associations of chronic social stress and social support with three measures of psychological distress were investigated. Respondents with high BSRS scores had experienced longstanding, important interpersonal relationship problems rather than fleeting stressful incidents. Women reported higher levels of chronic social stress, 60% reporting positively on at least one of the six BSRS items, compared with 50% among men. Social support was negatively and significantly associated with various measures of psychological distress. Chronic social stress was positively and significantly associated with psychological distress. These effects were independent of one another. No buffering effect of social support on social stress was observed. The present data support the importance of positive social ties to health, but suggest that social stress is an independent aspect of social environment with regard to health. If social support and social stress have direct and independent effects on mental health, as the present results indicate, intervention on the one will not necessarily modify the other. Intervention programmes may need to consider explicitly both the lighter and the darker sides of social relationships in building environments that support mental health.     

Starch digestion rate in the small intestine of broiler chickens differs among feedstuffs

Dietary starch is the major energy source for broiler chickens, and knowledge about its digestive behavior can be important. In a digestibility trial with 720 broiler chickens, site, rate and extent of starch digestion were measured for 12 feedstuffs. Starch digestion was determined using the slaughter technique, which involves removal of the small intestine from the recently killed chicken, with manual collection of the contents. Starch digestion coefficients were calculated from remaining starch in three segments of the small intestine and in excreta. Mean retention time in four segments of the small intestine was measured. This enabled calculations for starch digestion rate (k(d)). Ileal starch digestibility varied from 33% (potato starch) to 99% (tapioca). Retention time for digesta in the postduodenal small intestine varied from 136 min (barley diet) to 182 min (potato diet). On the basis of starch digestion rates, a distinction was made between slowly digestible starch (k(d) < 1 h(-1)), gradually digestible starch (k(d):1-2 h(-1)) and rapidly digestible starch (k(d) > 2 h(-1)). Starch from common beans was digested most slowly (k(d): 0.5 h(-1)), and starch from tapioca was digested most rapidly (k(d): 4.3 h(-1)). Starch digestion rates of potato starch and legume seeds were lower than those of cereal grains and tapioca. Degradation of starch entering the hind gut of the birds did not occur. Milling of corn affected rate, but not the extent of starch digestion. We concluded that site of starch digestion within the small intestine is not an accurate indicator for starch digestion rate.     

Irregular users of dental services among Norwegian adults

In 1979-80 a nationwide random sample of 1511 Norwegians, aged 16-79 years, were asked a series of questions about dental health and related factors (behavior, attitude, knowledge, social network, interpersonal communication, and 'health locus of control'). The purposes of the study were to describe the irregular users of dental services and to find mutable factors that could distinguish the regular from the irregular users. 17.4% of the dentate women and 21.7% of the men reported visiting the dentist less than once a year. Among the background variables, age and income/education were the most powerful predictors of use of dental services. Different patterns of behavioral characteristics were found among women as compared with men. The mutable factors that made a significant distinction between the regular and irregular users were use of interdental remedies, use of fluoride, social network, and health attitude (only among women). To a great extent, sociopsychologic and behavioral factors seemed to act through the demographic and economic variables in predicting the regularity of dental attendance.     

Gene expression profiling of peripheral blood cells for early detection of breast cancer

Introduction  

Early detection of breast cancer is key to successful treatment and patient survival. We have previously reported the potential use of gene expression profiling of peripheral blood cells for early detection of breast cancer. The aim of the present study was to refine these findings using a larger sample size and a commercially available microarray platform.