bluuebunny/crossref_metadata_2025 huggingface dataset:
26. MORE THAN JUST ANAL SEX: THE POTENTIAL FOR STI TRANSMISSION AMONG MEN VISITING SEX ON PREMISES VENUES IN MELBOURNE
Authors: Phang C. , Hocking J. S. , Fairley C. K. , Bradshaw C. , Hayes P. , Chen M. Y.
Published: December 2007

Objective: Sex On Premises Venues (SOPVs), where men have sex with other men, provide an environment where the transmission of sexually transmitted infections (STIs) is potentially enhanced. However, the extent to which SOPVs contribute to STI transmission is unknown. This study aimed to obtain detailed data on the types of sexual practices and frequency of these practices among men who have sex with men (MSM) visiting SOPVs in Melbourne, Australia.
Methods: In a cross-sectional study, MSM visiting 6 Melbourne SOPVs between December 2006 and February 2007 were asked to complete an exit survey on the types of sexual practices and frequency of such practices they had engaged in at that visit. Of 447 men approached, 150 (34%) participated in the study.
Results: The median age of participants was 42.5 years (range 20-79). Among participants who engaged in receptive oral sex (66%) and insertive oral sex (75%), the median number of such acts reported by each man during the visit was 2 (range 1-10) and 2 (range 1-10) respectively. Eleven men (7%) reported receptive oral sex with ejaculation into their mouth with a median of 1 act (range 1-3) per man.
Among participants who engaged in receptive anal sex (19%) and insertive anal sex (38%), the median number of such acts per man during the visit was 1 (range 1-4) and 1 (range 1-8) respectively. Eleven men (7%) reported unprotected insertive anal sex with a median of 1 act (range 1-4) per man; 4 (3%) reported unprotected receptive sex.
A substantial number of men who did not report any anal sex engaged in practices potentially capable of transmitting infections. Notably, 44 men (29%) reported unprotected rubbing or touching of their penis ('nudging') onto another man's anus without actual anal penetration with a total of 71 other men (median 1 act per man, range 1-10). When specifically asked, 17 (39%) of these men reported that they had not engaged in 'anal sex'. In addition, 32 men (21%) reported being the recipients of 'nudging' with 40 other men. Fourteen (44%) of these men reported not having had any 'anal sex'. Oro-anal sex, whether 'active' or 'passive', was reported by 57 (38%) of men, while 84 (56%) men reported anal penetration using fingers, whether receptive or insertive.
A significant minority (11%) of men reported that their ability to have safe sex was compromised by the use of drugs or alcohol. Of note, 58 (39%) men reported having a regular male partner, with whom 23 (40%) had unprotected anal sex. And 13 (9%) reported having a regular female partner, with whom 10 (77%) reportedly had unprotected vaginal or anal sex.
Conclusions: The potential for STI transmission between men visiting Melbourne SOPVs and to their partners outside these venues is high. The contribution of what might be perceived as 'safer' sex practices to the transmission of STIs among MSM may have been underrecognised.
35. OUT OF THE SPOTLIGHT: AN AUDIT OF FIVE YEARS OF IMPLANON® USE IN QUEENSLAND
Authors: Harvey C. E.
Published: December 2007

The progestogen contraceptive implant -Implanon� was launched into the Australian marketplace in May 2001, with intense marketing and extensive training programs for doctors. However, negative media focused on removal problems and unexpected pregnancies, followed by increased medical indemnity requirements for providers, resulted in restricted access for Australian women as many GPs ceased providing insertions.
To date there is no published data on the use of this contraceptive implant in Australia. To identify trends in usage, continuation rates, side effects and acceptability of this method, a retrospective chart audit of clients attending Family Planning Queensland (FPQ) clinics for implant insertion and/or removal over a 5 year period was conducted. The audit examined1800 implant users from the two busiest FPQ clinics, one in a regional setting.
Preliminary results from the audit indicate:-

All age groups across the reproductive years are represented in the group.

The major reason for removal is unacceptable bleeding patterns

Many women have the device removed because they no longer require contraception.

There have been no pregnancies identified with implants

The last 2 years have seen significant numbers of women presenting for implant replacement, with these women providing valuable information on factors contributing to longer term acceptability of the method.

This presentation will provide an analysis of the audit findings, particularly in relation to duration of use and implications for client acceptability of this contraceptive method. The information about Implanon� use in a clinical setting will be used to make recommendations on improvements in the appropriate selection and counselling of women considering this contraceptive method.
4. UNDERSTANDING VENUS: EXPLORING FEMALE DESIRE
Authors: Weerakoon P.
Published: December 2007

The female sexual response is highly variable and multifaceted and is a result of interplay of physiological, psychological and interpersonal factors. The advent of technology and non-invasive functional brain imaging has provided a map of the regions of the brain involved in sexual arousal and the neurochemistry that underlies the process. However, this increase in the understanding of the biological basis of female sexuality has only reinforced the role of interpersonal and cultural factor in the sexual response, specially the genesis of sexual desire. An acceptance of this by professionals, has led to the consensus for a more holistic biopsychosocial approach for the management of female sexual concerns.
The presentation will discuss the current research on the neural and hormonal basis for female desire and explore the role of sexual desire as a motivator and a force for sexual activity in the context of the prevailing models of the female sexual response.
There is a need for the recognition of the place and value of sexual desire in the female sexual response and an appreciation that whereas there is a biological 'drive', this is tempered by the motivational aspect (individual and relationship psychology) and the cultural and moral overlay of values and attitudes. This will in turn provide the milieu for understanding normal and dysfunctional sexual desire and assist us on the road to discovering a best practice model for the diagnosis and management of 'female desire disorders'.
40. AN INCREASE IN HIV CASES REPORTING HETEROSEXUAL EXPOSURE IN WESTERN AUSTRALIA
Authors: Combs B. G. , Giele C. M , Van Buynder P.
Published: December 2007

Introduction: In Australia, men who have sex with men (MSM) constitute the majority of newly diagnosed HIV cases. After a decline in the late 1990's, several Australian states have reported increases in HIV mainly attributed to MSM. There has also been an increase in HIV in Western Australia (WA), however recently, a larger proportion have been attributed to people who acquired the infection through heterosexual contact.
Objective: This paper describes the epidemiology of HIV in WA from 2000 to 2006, focusing on the increase in cases with heterosexual exposure.
Methods: In WA, notification of HIV cases is mandatory for doctors and laboratories. Information collected includes basic demographics and probable exposure. Descriptive analysis was carried out on de-identified HIV notification data from 2000 to 2006.
Results: An annual average of 49 HIV cases were notified in 2000-2004. However, in 2005 and 2006, this increased to 64 and 72 cases respectively. The increase was mainly among non-Aboriginal males and females reporting heterosexual contact. The number of non-Aboriginal males who reported heterosexual contact increased from an average of 9 cases in 2000-2004 to an average of 20 cases in 2005-2006. The number of non-Aboriginal female cases reporting heterosexual exposure increased from an average of seven cases in 2000-2004 to 9 and 14 cases notified in 2005 and 2006 respectively.
The majority of non-Aboriginal males reporting heterosexual exposure in 2005-2006 acquired their infection overseas (84%). Of these, 71% reported Asia as the place of acquisition.
Of the non-Aboriginal females reporting heterosexual exposure in 2005-2006, 52% were acquired overseas.
The number of Aboriginal cases remained stable between 2000 and 2006 fluctuating between 2 and 11 cases and continued to be mainly heterosexually acquired within WA.
Conclusion: There has been an increase in the number of male and female HIV cases reporting heterosexual exposure in WA. A large proportion reported acquiring their infection overseas highlighting the need to raise awareness among people who travel, work in countries with high rates of HIV.
42. PILOT OF NON-INVASIVE (ORAL FLUID) TESTING FOR HIV WITHIN A COMMUNITY SETTING
Authors: Staunton S. , Debattista J. , Roudenko N. , Davis C.
Published: December 2007

An anonymous HIV surveillance study was conducted to determine the prevalence of HIV amongst patrons attending gay recreational venues, the level of undiagnosed HIV infection and to identify sexual risk behaviour associated with HIV positive, HIV negative and unknown serostatus.
427 men who have sex with men were recruited over a period of one week in various sex on premises venues and gay bars within the inner city of Brisbane. Oral fluid testing for HIV antibodies was undertaken using the Orasure collection system and assay. Each participant was invited to complete a brief behaviour questionnaire and submit an oral fluid specimen. Participants were also asked their HIV status. Surveys and specimens were linked using an anonymous numerical code. Surveys were analysed using Epi-Info. Oral swabs were tested for the presence of HIV antibodies and any reactive specimens were confirmed using an Orasure western Blot. Confirmed serology results were linked to reported sexual behaviours, testing patterns and HIV status. The results of this study - sexual and testing behaviour correlated with serostatus- and implications for HIV prevention programs will be presented. As well as that, discussions will be held regarding the community response to the project.
47. NON-CHLAMYDIAL NON-GONOCOCCAL URETHRITIS - MANAGEMENT AND FOLLOWUP DILEMMAS
Authors: Edmiston N. , Ooi C.
Published: December 2007

Aim: To audit the management of non chlamydial non gonococcal urethritis (NCNGU) for 2006.
Method: A clinic database search for cases of non-specific urethritis was conducted. Charts were reviewed and cases subsequently diagnosed with Chlamydia or gonorrhoea at the visit were excluded. One person reviewed the charts for diagnosis, microscopy, treatment, contact tracing and follow up.
Results: There were 38 recorded of cases of NCNGU. The mean age of cases was 28.8 years (SD 10.8), all were male,15.8% identified as MSM.
Microscopy was performed in 60.5% of cases and PMNLs were detected in 36.8% of all cases (63.6% of cases where microscopy was performed).
Treatment was with azithromycin in 63.2% of cases, doxycycline in 28.9% of cases, tinidazole in one case (2.6%) and no treatment was given in one case.
Patients with PMNLs on microscopy were significantly more likely to be treated with azithromycin than those without PMNLs on microscopy or with no microscopy done (93.8% vs 50.0%, p < 0.01, x2 test).
Contact tracing (CT) was recommended in 17 cases (55.3%) with confirmation of partner treated in 7 cases. There was no significant difference in contact tracing recommendation between those with PMNLs on microscopy and those without or microscopy not done (56.3% vs 36.4%, p > 0.2, x2 test).
Clinical follow up at the clinic occurred in 25 cases. 80% (95%CI 60.9%-91.1%) of those followed up had resolution of symptoms, with the remainder having a recurrence or failure of resolution.
Discussion: NSU management should include antibiotic cover for possible undetected Chlamydia. Azithromycin was more likely to be used if PMNLs were detected. Chlamydia treatment occurred in all but two cases, with one of the two cases having had adequate treatment previously.
New Australian CT guidelines recommend CT M. genitalium but not for NSU. We would recommend CT current or most recent partners in all cases of NCNGU.
5. HIV AND WOMEN: THE AFRICAN EXPERIENCE
Authors: Lewis D. A.
Published: December 2007

Africa as a continent has been devastated by the acquired immunodeficiency syndrome epidemic caused by the human immunodeficiency virus (HIV). Women are more likely to acquire HIV/AIDS for a number of reasons and incidence studies show that younger women are particularly at risk of HIV acquisition. Biologically, they are more vulnerable and the acquisition of HIV can be influenced by hormonal contraceptives as well as sexually transmitted infections, which are often more asymptomatic than is the case for men. Women in Africa are also more vulnerable because of cultural issues; in some countries polygamy is accepted practice. Women are often economically disadvantaged and disempowered. It is often hard for them to insist on the use of condoms with husbands and regular partners. Physical and sexual abuse of women, including rape, remains a major problem on the continent, particularly in times of civil war. Many women are forced to work as sex workers or be involved in transactional sex in order to survive.
Most countries rely on anonymous antenatal surveys to generate HIV seroprevalence data for women of reproductive age. These data is often used as surrogate markers for HIV prevalence rates in men of a similar age. The seroprevalence of HIV among pregnant women differs remarkably around the continent, with the highest rates being seen in Southern Africa, as high as 30%, and much lower rates being seen in West Africa. These reasons underlying these differences are complex and not completely understood.
UNAIDS estimated in 2005 that 470�000 (87%) of the world's 540�000 newly infected children (<15 years old) reside in Sub-Saharan Africa. Prevention of mother to child transmission (PMTCT) of HIV is thus a national priority in many Sub-Saharan African countries. Despite policies, treatment is sometimes not given at the clinic level for several reasons, and when it is, most commonly it is with single dose Nevirapine. Data from South Africa has shown that both mothers and infected babies rapidly acquire nevirapine resistance. It is likely that this will lead to early failure of first line antiretroviral (ARV) therapy among these mothers once they start their ARVs. In South Africa, for example, either efavirenz or nevirapine form the backbone of the first-line ARV regimens.
AIDS defining illnesses (ADIs) in women living in Africa are similar to those observed in men. Tuberculosis is the most common ADI but other life-threatening illnesses such as cryptococcal meningitis are relatively common compared to other parts of the world. Cervical cancer and cervical intra-epithelial neoplasia (CIN) lesions are more common in HIV-infected than in non-infected women. Most countries in Africa do not have cervical screening programmes and, even in richer countries such as South Africa, the national policy is to screen women three times in their life at 30, 40 and 50 years of age. Many HIV specialist centres, with additional donor funds, are now attempting to perform annual cervical screening, at least in South Africa.
51. PATTERNS OF TREATMENT AND RESOURCE UTILISATION IN THE TREATMENT OF GENITAL WARTS IN AUSTRALIAN SEXUAL HEALTH CLINICS
Authors: Morrow A. , Chuah J. , Conway E. L. , Fairley C. K. , McCloskey J. , McNulty A. , Waddell R. , Pirotta M. , Stein A. N. , Ung L. , Carter R. , Garland S.
Published: December 2007

The introduction of the quadrivalent vaccine (HPV types 6, 11, 16, 18), GARDASIL, in the National HPV Vaccination program has the potential to eliminate a substantial proportion of the health burden of genital warts, currently the most common sexually transmitted viral disease in Australia. Although there are an estimated 10�000 cases per year managed through sexual health clinics in Australia, there is very limited data on treatment practices and resource use in this setting. A clinical audit was undertaken in five sexual health clinics in different states of Australia. A total of 500 cases (100 consecutive cases per clinic) were identified of patients aged 18 to 45 years with a first ever diagnosis of genital warts between 1 January 2004 and 31 December 2004. The average age of cases was 27 years for females and 31 years for males with 43% cases female. There was an average of 2.7 visits per case (range 1-22). Ablative measures (cryotherapy, laser or diathermy) were the most common form of treatment applied in 58% cases (mean per case�=�2.4; range 1-16); topical treatments were prescribed in 44% cases (mean per case�=�1.5; range 1-8) and topical treatments were applied by the health care provider in 22% cases (mean per case�=�1.5; range 1-8). Additional analyses including type of treatment, variation in treatment practices by sexual health clinic and duration of cases will be presented.
This study confirms the considerable individual and clinical burden of this common disease.
55. HIGH EFFICACY OF A HPV-16/18 L1 VIRUS-LIKE PARTICLE (VLP) VACCINE ADJUVANTED WITH AS04 AGAINST CIN2+ CAUSED BY HPV-16/18 INFECTION IN A BROAD POPULATION OF YOUNG WOMEN
Authors: Skinner S. R. , Garland S. M. , Denham I. , O'Sullivan M. , Waddell R. , Mindel A. , on behalf of the HPV PATRICIA study group
Published: December 2007

Objectives: Previous studies with the HPV-16/18 L1 VLP AS04 vaccine have shown 100% efficacy against HPV 16/18 associated persistent infection and CIN in women with no previous exposure to oncogenic HPV. This interim analysis of a phase III, randomized, controlled trial assessed vaccine efficacy against HPV 16/18 associated CIN2+ and persistent infection with oncogenic HPV types in a broad population of women.

Methods: Healthy women, aged 15-25 years, with d6 sexual partners and no previous colposcopy were eligible and were randomly allocated to 3 doses of HPV or hepatitis A (control) vaccine at 0, 1, 6 months. Serum antibodies for HPV 16/18 were assessed by ELISA. HPV DNA was detected by PCR on cervical cytology and biopsy. Vaccine efficacy was assessed in women who received at least one vaccine dose, had normal or low-grade cytology and were HPV 16/18 sero- and DNA negative at entry. Additional analyses were undertaken to assign causality where multiple HPV types were present. Immunogenicity was evaluated in a subset of women and safety was assessed in the entire vaccinated cohort.

Results: 18729 women from Asia Pacific (34%), Europe (34%), North (16.5%) and Latin America (14.9%) were enrolled. 18525 were included in the cohort for vaccine efficacy analyses. Mean age was 20 years and mean follow up 15 months from dose 1. Most HPV 16/18 infections were detected prior to dose 3 in this analysis. Of 23 CIN2+ lesions associated with HPV 16/18, 14 contained multiple oncogenic HPV types: three showed no preceding infection or E4 gene expression for the relevant HPV vaccine type. Vaccine efficacy according to HPV DNA detected in the lesion was 90.4% (95% CI, 53.4-99.3); after additional analyses for causality assignment, efficacy was 100% (95% CI: 74.2-100). Cross-protection against 6-months infection with HPV-45, -31, -52; and broad protection against 12-month persistent non-16/18 oncogenic HPV infection was also demonstrated. Seroconversion was 99.5% after dose 2 and 3. Safety profiles were comparable between groups.

Conclusions: In a broad cohort of women, high vaccine efficacy was observed against CIN2+ caused by HPV-16/18.
57. GENOTYPING OF UROGENITAL CHLAMYDIA TRACHOMATIS IN REGIONAL NEW SOUTH WALES, AUSTRALIA
Authors: Mossman D. , Ooi C. , Loewenthal M. , Boyle M.
Published: December 2007

Background: Chlamydia Trachomatis is one of the most common sexually transmitted infections in Australia and world wide. This study was undertaken to map the frequency of Chlamydia genotypes in regional New South Wales (NSW), Australia, to explore the potential utility of genotype analysis in defining local sexual networks, and to investigate whether patterns of genotype frequency are correlated with demographic factors, including age and gender.
Methods: We studied 204 urine samples infected with Chlamydia trachomatis, as determined by PCR analysis using the COBAS Amplicor system. Samples were collected from wide geographic area of regional New South Wales (Hunter, New England, Northern Rivers, South Eastern New South Wales). Sequencing and genotyping were performed after nested PCR of the omp1 gene.
Results: Genotype E was found in 42.6% of infections, with genotypes F (23.5%) and G (16.7%) other common causes of infection. Mixed infection occurred in only 3 cases. There was no significant difference in genotype frequency based on gender or geographic location. There was a significant difference in gender frequency based on patient age, with older patients significantly more likely to demonstrate infection with genotype G (mean age (years) 23.7+/-7.29 sd, E: 21.7 +/-5.7 sd; G: 28.9; sd 10.18; p�=�0.022).
Conclusions: There was no significant difference in genotype frequency in the various regions of New South Wales, suggesting genotype analysis is of limited use in defining sexual networks in regional NSW. The finding of a higher frequency of genotype G in older patients raises the possibility that genotypic variation may be driven by immune responses to genotypes that occur more frequently at a younger age. These results may have implications for the future design of a chlamydial vaccine.
58. CHLAMYDIA SCREENING OF ANTENATAL WOMEN IN MELBOURNE BETWEEN 16-25 YEARS
Authors: De Guingand D. L. , Fairley C. K. , Garland S. , Tabrizi S. , Grover S. , Wallace E. , Hocking J. , Gurrin L. , Carter R. , Pirotta M. , Chen M. Y.
Published: December 2007

Objective: Routine chlamydia screening of pregnant women is not widely practiced in Australia and limited data are available on the prevalence of infection in this population. This cross-sectional study sought to determine the prevalence of genital chlamydial infection among pregnant women aged 16-25 attending antenatal clinics in Melbourne.
Methods: Consecutive women attending 4 major maternity services covering northern, western, eastern and south-eastern Melbourne were approached between October 2006 and May 2007. Of 931 eligible women (those aged 16-25 who had not already been tested for chlamydia) attending the clinics at the time of recruitment, 882 (95%) were approached and 845 (96%) agreed to participate. Participants completed a questionnaire which was translated into Chinese, Vietnamese and Arabic, and provided first-void urine which was tested for Chlamydia trachomatis using polymerase chain reaction.
Results: Eighteen percent of women had a preferred language other than English. Of the 826 tests which were non assessable, 30 were positive representing a prevalence rate of 3.6% (95% CI: 2.5-5.1%). However, among women aged 16-20, 14 of 203 women were infected, representing a prevalence rate of 6.9% (95% CI: 3.8-11.3%). All infected women received treatment with azithromycin and all who have had repeat chlamydia tests to date have been negative.
Conclusion: In this study of a wide cross-section of pregnant Melbourne women, chlamydial infection was common, particularly among teenagers. Screening was highly acceptable, with the great majority of women approached agreeing to be screened.
6. DYADIC PERSPECTIVES ON SUPPORT FOR WOMEN LIVING WITH HIV/AIDS IN AUSTRALIA: AN EXPLORATORY STUDY
Authors: Russell J.
Published: December 2007

There are more women than ever living with HIV/AIDS in Australia and this relatively small heterogenous population has received scant research attention. Women living with HIV/AIDS, face many complex and compelling challenges in managing this stigmatised illness in their everyday lives. This study sought to gain an understanding of these women's support needs. Semi-structured, in-depth interviews were conducted with two groups: women living with HIV/AIDS (Sydney and Melbourne, involved and not in advocacy); and HIV specialists (Sydney and Melbourne) treating women living with HIV/AIDS. There was a consensus view among both specialists and women that women: have limited knowledge of HIV/AIDS; have no collective or historical understanding of HIV/AIDS; are more likely to present late with HIV; experience diagnosis as extremely distressing; are not aware of the resources available including medical treatments; and are more likely to experience social isolation. Both groups recognised the need for psychological and social support. HIV specialists questioned the effectiveness of community based peer support, while women identified this as one of the most important forms of support. HIV specialists differed in their knowledge and views of CBOs, and this influenced their decisions on recommending these to their female patients. The unique nature of this stigmatised illness calls for the recognition of the contributions of all parties in efforts to address these support needs; the women living with HIV/AIDS, HIV specialists and community based organisations. Particularly in light of the potential for social isolation, inquiries into social structures that provide the opportunity to access social resources are arguably a future direction to advance knowledge in this area.
61. GP PERSPECTIVES ON PARTNER NOTIFICATION FOR CHLAMYDIA
Authors: Pavlin N. , Parker R. , Hopkins C. A. , Temple-Smith M. J. , Fairley C. K. , Hocking J. , Russell D. , Bowden F. , Tomnay J. E. , Pitts M. K. , Chen M. Y.
Published: December 2007

As part of a larger, combined qualitative-quantitative study of partner notification, 40 semi-structured in-depth telephone interviews were conducted with General Practitioners (GPs), from Victoria, ACT and Queensland, who had diagnosed at least one case of chlamydia in the last year. Rural doctors and those who had experience working with Aboriginal patients were over-sampled to ensure their views were represented in the study. The interviews explored GPs' current practices with regard to partner notification for chlamydia, barriers they perceived to partner notification for chlamydia in the general practice setting and what resources/incentives they felt would improve partner notification for chlamydia. The GPs in our study primarily ask the index patient to carry out partner notification themselves. It was relatively rare for GPs to have experience of notifying partners on the patient's behalf. Half of the GPs report that they only encourage notification of the patient's current/immediate past partners. There was considerable confusion amongst the GPs interviewed as to the role of government partner notification officers. Many thought that support from a government agency would allow partner notification to occur more effectively. Some were under the impression that this process is automatically activated when they 'notify' that they have diagnosed someone with chlamydia. Some of the main barriers perceived include confusion about issues of privacy and confidentiality with regard to partner notification and the sense that there is a lack of clarity as to what is expected of them in terms of partner notification for chlamydia. Most GPs feel that access to decision support tools and clear guidelines would be helpful. Financial incentives for doing partner notification were seen as particularly important to fund allied health workers' time rather than to pay GPs themselves e.g. for practice nurses and Aboriginal health workers. GPs were enthusiastic about computer based resources to aid in partner notification
62. SEXUAL COMPETENCE AT FIRST SEXUAL INTERCOURSE: FACTORS ASSOCIATED WITH SEXUAL COMPETENCE IN A SAMPLE OF NEW ZEALAND TERTIARY STUDENTS
Authors: Rapsey C. M. , Davidson O. R. , Schaughency E. , Murachver T.
Published: December 2007

It has been proposed that the manner in which people experience their first sexual intercourse has implications for the development of subsequent sexual health. Sexual competence, as utilized by the UK NATSAL 2000 Study, was defined as being willing and autonomous, lacking regret, not being intoxicated, and using a reliable method of contraception
This study explored the construct in an opportunistic sample of 247 students at Otago University and Otago Polytechnic in 2006. Participants were aged between 17 and 21, and completed a self-report questionnaire. Data suggested that, of the 85% who reported having had sexual intercourse, the mean age of first sex was 16 years old. Seventy percent had not decided to have sex or discussed its occurrence with their partners prior to the event. Sexually competent first sexual intercourse was more likely with females than males, was more likely to occur the older they were at the time, was associated with more positive affective responses, and was associated with higher levels of sexual and emotional satisfaction.
The manner in which sexual competence at first sexual intercourse was associated with subsequent sexual satisfaction and sexual health will be explored.
The implications of these findings will also be discussed in terms of how sexual health promotion interventions should be developed, with particular focus on the age and circumstances under which young adults first experience sexual relationships.
65. CIRCUMCISION STATUS AND RISK OF SEXUALLY TRANSMITTED INFECTIONS IN THE HIM COHORT OF HOMOSEXUAL MEN IN SYDNEY, AUSTRALIA
Authors: Templeton D. J. , Jin F. , Prestage G. P. , Donovan B. , Imrie J. , Kippax S. C. , Kaldor J. M. , Grulich A. E.
Published: December 2007

Objectives: To examine circumcision status as an independent risk factor for prevalent and incident sexually transmitted infections (STIs) in the community-based Health in Men (HIM) cohort of homosexual men.
Methods: Between 2001 and 2004, 1427 initially HIV-negative men were enrolled. Circumcision status was self-reported at baseline and was validated by clinical examination in a sub-sample of participants. All participants were tested annually for HIV and offered testing for other STIs including nucleic acid amplification tests (NAAT) for urethral gonorrhoea and chlamydia, and serology for syphilis and herpes simplex virus (HSV). Demographic information and past history of STIs was collected at baseline and detailed information on sexual risk behaviours was collected every 6 months. At annual face-to-face visits, participants reported diagnoses of STIs made in the previous 12 months.
Results: At baseline, 66% of participants reported being circumcised; mostly as infants. Uptake of STI testing was high with over 90% of participants tested each year. On multivariate analysis, controlling for age and sexual risk behaviour, circumcision was not associated with baseline seropositivity to syphilis (p�=�0.34), HSV1 (p�=�0.33) or HSV2 (p�=�0.92), nor with a history of self-reported genital warts (p�=�0.18). There was also no association with incident bacterial urethral infections (p�=�0.67 & p�=�0.89 for gonorrhoea and chlamydia, respectively), self-reported incident genital warts (p�=�0.35), incident HSV1 (p�=�0.70) or incident HSV2 (p�=�0.36). However, circumcision was associated with a significantly reduced risk of incident syphilis after controlling for age, number of casual partners in the previous 6 months and unprotected anal intercourse according to partners' HIV status (HR�=�0.35, 95% CI 0.14-0.87, p�=�0.024).
Conclusion: Circumcised men had a reduced risk of incident syphilis in this cohort. Although most STIs were not associated with circumcision, these data suggest that circumcision may have an effect on syphilis acquisition in homosexual men.
67. HIPPOCRATES APPRENTICES ON EARTH: MEDICAL STUDENTS EXPERIENCES AND CONSENT FOR VAGINAL EXAMINATIONS OF ANAESTHETISED PATIENTS
Authors: Broadmore J. A. , Hutton J. D. , Langdana F. , Parkin C. J.
Published: December 2007

Vaginal examinations (VEs) are an essential sexual health examination skill. Reports of students having difficulties getting experience with VEs are matched by reports of patients being examined without consent. This study prospectively aimed to find out what was happening when medical students sought consent for VEs of anaesthetised patients.
All 66 2005 5th year medical students at OU, WSM & HS were asked to prospectively complete a 14 item questionnaire about their experience at gynaecology operating sessions. Chi-squared test determined result significance.
Student response rate was 78%. 141/184 patients were asked if the student could attend the operation. Students asked 101 patients. Consultants were more likely ask on the student's behalf for males than females. p > 0.0010.
All male students sought consent within 2 hours of operations. Some female students sought consent 5 or more hours beforehand; a significant gender difference (p > 0.0001).
Five patients declined student attendance at their operation.
When asked 96 patients (86.6%/-3.4%) agreed and 16 (13.3% +/-3.4%) declined permission for the student conducting a VE under anaesthesia; with no statistical gender difference in refusal rate.
VEs were done on 82 patients; including 2 without consent. In 19 instances a student had consent but no examination was done. Eleven students (3 male, 6 female) did no examinations.
The value of the examination for student learning was rated 4/5 by 73% students; with no statistical difference by gender or age.
The implications of these findings for teaching sexual health skills to medical students are discussed.
70. A NEW SPIN ON 'FOOTY TRAINING' - TAKING SEXUAL ASSAULT TALKS TO THE AFL
Authors: Williams A.
Published: December 2007

RESPECTFUL BEHAVIOURS: PEOPLE IN SPORT - ADULT SEXUAL ASSAULT - was a presentation that was developed by Dr Angela Williams and Patrick Tidmarsh in conjunction with the Statewide Steering Committee to Reduce Sexual Assault, (established by the Chief Commissioner of Police in Victoria, Christine Nixon), to address the issue of sexual assault in the broader community. The education package was the first element to be implemented of a broader policy to be announced later this year.
The package was designed to best educate men in our community whilst identifying specific needs of AFL elite players. It aimed to air the topics of sexual assault, violence against women and respectful behaviours. The education package was delivered to every club from May through to August 2005.
Education of our community on these issues is extremely important and essential to cultural change. This discussion will address one effective way of educating our community as it looks more specifically at educating men on these topics.
Style and content of education package
What the education package covers
Identifiable risk factors and scenarios
Assessments and evaluations
WHERE TO FROM HERE?
71. IS VULVAL CANCER PREVENTABLE?
Authors: Jones R. W.
Published: December 2007

The incidence of vulval cancer is increasing especially in women under 50 years where the proportion of cases has doubled in the past 25 years.
There are two forms of vulval cancer. The first is seen in younger women and is associated with high risk HPV infection (vulval intraepithelial neoplasia, VIN) and has many similarities with cervical cancer. The second is non-HPV related, seen in older women with chronic skin scarring, most commonly in long standing lichen sclerosus.
The changing prevalence, clinical features, natural history and the influence of treatment on the precursor lesions will be presented.
The impact of climate change on smallholder and subsistence agriculture
Authors: Morton John F.
Published: December 2007

Some of the most important impacts of global climate change will be felt among the populations, predominantly in developing countries, referred to as “subsistence” or “smallholder” farmers. Their vulnerability to climate change comes both from being predominantly located in the tropics, and from various socioeconomic, demographic, and policy trends limiting their capacity to adapt to change. However, these impacts will be difficult to model or predict because of (
i
) the lack of standardised definitions of these sorts of farming system, and therefore of standard data above the national level, (
ii
) intrinsic characteristics of these systems, particularly their complexity, their location-specificity, and their integration of agricultural and nonagricultural livelihood strategies, and (
iii
) their vulnerability to a range of climate-related and other stressors. Some recent work relevant to these farming systems is reviewed, a conceptual framework for understanding the diverse forms of impacts in an integrated manner is proposed, and future research needs are identified.
Phorbol ester stimulation of RasGRP1 regulates the sodium-chloride cotransporter by a PKC-independent pathway
Authors: Ko Benjamin , Joshi Leena M. , Cooke Leslie L. , Vazquez Norma , Musch Mark W. , Hebert Steven C. , Gamba Gerardo , Hoover Robert S.
Published: December 2007

The sodium-chloride cotransporter (NCC) is the principal salt-absorptive pathway in the mammalian distal convoluted tubule (DCT) and is the site of action of one of the most effective classes of antihypertensive medications, thiazide diuretics. We developed a cell model system to assess NCC function in a mammalian cell line that natively expresses NCC, the mouse DCT (mDCT) cell line. We used this system to study the complex regulation of NCC by the phorbol ester (PE) 12-O-tetradecanoylphorbol-13-acetate (TPA), a diacylglycerol (DAG) analog. It has generally been thought that PEs mediate their effects on transporters through the activation of PKC. However, there are at least five other DAG/PE targets. Here we describe how one of those alternate targets of DAG/PE effects, Ras guanyl-releasing protein 1 (RasGRP1), mediates the PE-induced suppression of function and the surface expression of NCC. Functional assessment of NCC by using thiazide-sensitive22Na+uptakes revealed that TPA completely suppresses NCC function. Biotinylation experiments demonstrated that this result was primarily because of decreased surface expression of NCC. Although inhibitors of PKC had no effect on this suppression, MAPK inhibitors completely prevented the TPA effect. RasGRP1 activates the MAPK pathway through activation of the small G protein Ras. Gene silencing of RasGRP1 prevented the PE-mediated suppression of NCC activity, the activation of the H-Ras isoform of Ras, and the activation of ERK1/2 MAPK. This finding confirmed the critical role of RasGRP1 in mediating the PE-induced suppression of NCC activity through the stimulation of the MAPK pathway.
Runs of homozygosity reveal highly penetrant recessive loci in schizophrenia
Authors: Lencz Todd , Lambert Christophe , DeRosse Pamela , Burdick Katherine E. , Morgan T. Vance , Kane John M. , Kucherlapati Raju , Malhotra Anil K.
Published: December 2007

Evolutionarily significant selective sweeps may result in long stretches of homozygous polymorphisms in individuals from outbred populations. We developed whole-genome homozygosity association (WGHA) methodology to characterize this phenomenon in healthy individuals and to use this genomic feature to identify genetic risk loci for schizophrenia (SCZ). Applying WGHA to 178 SCZ cases and 144 healthy controls genotyped at 500,000 markers, we found that runs of homozygosity (ROHs), ranging in size from 200 kb to 15 mb, were common in unrelated Caucasians. Properties of common ROHs in healthy subjects, including chromosomal location and presence of nonancestral haplotypes, converged with prior reports identifying regions under selective pressure. This interpretation was further supported by analysis of multiethnic HapMap samples genotyped with the same markers. ROHs were significantly more common in SCZ cases, and a set of nine ROHs significantly differentiated cases from controls. Four of these 9 “risk ROHs” contained or neighbored genes associated with SCZ (
NOS1AP
,
ATF2
,
NSF
, and
PIK3C3
). Several of these risk ROHs were very rare in healthy subjects, suggesting that recessive effects of relatively high penetrance may explain a proportion of the genetic liability for SCZ. Other risk ROHs feature haplotypes that are also common in healthy individuals, possibly indicating a source of balancing selection.
Hormone Modulation: A Novel Therapeutic Approach for Women with Severe Mental Illness
Authors: Kulkarni Jayashri , Gurvich Caroline , Gilbert Heather , Mehmedbegovic Fatima , Mu Ling , Marston Natasha , Gavrilidis Emmy , de Castella Anthony
Published: December 2007

Objectives: Accumulating evidence describes the effects of oestrogen and other gonadal hormones on the central nervous system and, in particular, on the mental state of women. Evidence supporting the psychotherapeutic effects of exogenous oestrogen has started to emerge only over the past two decades. The purpose of the present paper was to provide an overview of different applications of adjunctive hormones, as treatments for symptoms of severe mental illness in women.

Methods: Three case reports are presented: in each case the woman selected had participated in large, double-blind, randomized controlled trials exploring hormone modulation. Case study 1 presents a premenopausal woman with schizophrenia, who received an 8 week trial of daily adjunctive 200 µg transdermal oestradiol. Case study 2 presents a postmenopausal woman with schizophrenia on a 12 week trial of adjunctive raloxifene hydrochloride 120 mg per day−1. Case study 3 presents a woman with schizoaffective disorder, in the manic phase, who received tamoxifen 40 mg per day−1 for 28 days.

Results: Adjunctive oestradiol was associated with an improvement in symptoms of psychosis in a premenopausal woman with schizophrenia; adjunctive raloxifene was associated with an improvement in cognitive functioning in a postmenopausal woman with schizophrenia; and adjunctive tamoxifen was associated with an improvement in symptoms of mania in a woman with schizoaffective disorder.

Conclusions: These findings are consistent with preliminary research trials suggesting that adjunctive hormone modulation is a promising area of gender-specific treatment for serious mental illness.
Combining Cognitive Behavioral Therapy with Contingency Management for Smoking Cessation in Adolescent Smokers: A Preliminary Comparison of Two Different CBT Formats
Authors: Cavallo Dana A. , Cooney Judith L. , Duhig Amy M. , Smith Anne E. , Liss Thomas B. , McFetridge Amanda K. , Babuscio Theresa , Nich Charla , Carroll Kathleen M. , Rounsaville Bruce J. , Krishnan‐Sarin Suchitra
Published: December 2007

This pilot study evaluated the optimal format of cognitive behavioral therapy (CBT) to combine with contingency management (CM) in a four‐week, high school‐based smoking cessation program. Thirty‐four adolescent smokers received a standard weekly version of CBT or a frequent brief behavioral intervention. Results indicate a trend toward a higher seven‐day point prevalence end‐of‐treatment abstinence rate and percent days abstinent during treatment in the CBT condition. In addition, significantly more participants in the CBT group completed treatment. These preliminary results suggest that when combined with CM, the standard weekly format of CBT is more acceptable to adolescent smokers.
Bayesian ranking of biochemical system models
Authors: Vyshemirsky Vladislav , Girolami Mark A.
Published: December 2007

Motivation: There often are many alternative models of a biochemical system. Distinguishing models and finding the most suitable ones is an important challenge in Systems Biology, as such model ranking, by experimental evidence, will help to judge the support of the working hypotheses forming each model.

Bayes factors are employed as a measure of evidential preference for one model over another. Marginal likelihood is a key component of Bayes factors, however computing the marginal likelihood is a difficult problem, as it involves integration of nonlinear functions in multidimensional space. There are a number of methods available to compute the marginal likelihood approximately. A detailed investigation of such methods is required to find ones that perform appropriately for biochemical modelling.

Results: We assess four methods for estimation of the marginal likelihoods required for computing Bayes factors. The Prior Arithmetic Mean estimator, the Posterior Harmonic Mean estimator, the Annealed Importance Sampling and the Annealing-Melting Integration methods are investigated and compared on a typical case study in Systems Biology. This allows us to understand the stability of the analysis results and make reliable judgements in uncertain context. We investigate the variance of Bayes factor estimates, and highlight the stability of the Annealed Importance Sampling and the Annealing-Melting Integration methods for the purposes of comparing nonlinear models.

Availability: Models used in this study are available in SBML format as the supplementary material to this article.

Contact:  vvv@dcs.gla.ac.uk

Supplementary information: Supplementary data are available at Bioinformatics online.
Nitric oxide and peroxynitrite platelet levels in women with small‐for‐gestational‐age fetuses
Authors: Nanetti L , Giannubilo SR , Raffaelli F , Curzi CM , Vignini A , Moroni C , Tanase L , Carboni E , Turi A , Mazzanti L , Tranquilli AL
Published: December 2007

Objective  The placenta produces reactive oxygen species (ROS) including nitric oxide (NO) and peroxynitrite (ONOO−) that have pronounced effects on placental function. Excessive ROS production may occur in pathological pregnancies, such as those complicated by small‐for‐gestational‐age (SGA) fetuses.

Design  The aim of the present work was to study NO and ONOO− levels in platelets of pregnant women with SGA fetuses compared with a control group.

Setting and population  The study was performed on 30 pregnant women with SGA fetuses (SGA group) and on 30 healthy pregnant women (appropriate‐for‐gestational‐age [AGA] group) matched for maternal and gestational age. All women included in this study were in the third trimester of pregnancy.

Methods  Platelets were isolated by differential centrifugation. NO metabolites, after enzymatic conversion followed by the Griess reaction, were measured as nitrite by spectrophotometric detection. Peroxynitrite (ONOO−) levels were evaluated using the fluorescence probe 2,7‐dichlorofluorescein diacetate (DCFDA).

Main outcome measures  The following determinations were made: platelet nitric oxide and peroxynitrite levels in the SGA group and controls; inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS) and nitrotyrosine (N‐Tyr) expression in the same groups.

Results  Our results show that both platelet NO and ONOO− levels were significantly higher in the SGA group than in the controls.

Conclusion  Increased platelets levels of nitric oxide and peroxynitrite might play a role in the pathophysiology of intrauterine growth restriction. Further investigations are in progress to clarify if these molecules are pathogenetic factors, an epiphenomenon or a pathophysiological marker.