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ABSTRACT: A measure of sexual activity (homosexual vs. bisexual) and a measure of sexual identification (homosexual/gay vs. bisexual) were combined to classify men who have sex with men (MSM) for [...]

The authors have investigated risk factors associated with HIV incidence among bisexual and gay men in Canada. Results demonstrate that HIV-positive bisexual and gay men usually live in unstable conditions and display more risky substance use and sexual behavior that HIV-negative men.

Many gay men in Montreal still participate in risky sexual behavior, according to researchers connected to the Omega Cohort project. Older gay men were just as likely as young men to engage in risky behavior.

Obesity is a risk factor for major chronic diseases such as hypertension, heart disease, diabetes, and cancers of the breast and colon (1). Hispanic women are at high risk for [...]

The rigorous evaluation of the impact of combination HIV prevention packages at the population level will be critical for the future of HIV prevention. In this review, we discuss important considerations for the design and interpretation of cluster randomized controlled trials (C-RCTs) of combination prevention interventions. We focus on three large C-RCTs that will start soon and are designed to test the hypothesis that combination prevention packages, including expanded access to antiretroviral therapy, can substantially reduce HIV incidence. Using a general framework to integrate mathematical modelling analysis into the design, conduct, and analysis of C-RCTs will complement traditional statistical analyses and strengthen the evaluation of the interventions. Importantly, even with combination interventions, it may be challenging to substantially reduce HIV incidence over the 2- to 3-y duration of a C-RCT, unless interventions are scaled up rapidly and key populations are reached. Thus, we propose the innovative use of mathematical modelling to conduct interim analyses, when interim HIV incidence data are not available, to allow the ongoing trials to be modified or adapted to reduce the likelihood of inconclusive outcomes. The preplanned, interactive use of mathematical models during C-RCTs will also provide a valuable opportunity to validate and refine model projections., Rationale for Cluster Randomized Controlled Trials Significant progress has been achieved in developing, implementing, and scaling- up safe and effective biomedical and behavioural HIV interventions such as promoting condom use, [...]

Background: The majority of new HIV infections are acquired through heterosexual transmission. There is urgent need for prevention methods to compliment behavior change and condom use. Topical microbicide represent a potential strategy for reduction of HIV transmission in women. Methods: Monthly Colposcopy evaluations were performed during pelvic examinations among 299 women enrolled in the Phase 2 portion of HPTN 035 study at four sites (1 in USA, 3 in Southern Africa). This was a phase 2/2b, multisite, randomized, and controlled clinical trial with four arms: BufferGel, 0.5% PRO2000 Gel, placebo gel and no gel. At two of the sites, pelvic examinations were conducted by the use of naked eye without colposcopy. Results: A colposcopy finding of any kind was detected in 48% of participants at baseline compared to 40% at 3 months (p = 0.04). The lower rates were also observed in vaginal discharge (22% at baseline, 16% at 3 months, p = 0.06), erythema (15% at baseline, 8% at 3 months, p = 0.004). The trend towards significance at p = 0.05 disappear when utilizing stringent statistical significance levels. A pelvic finding of any kind was detected in 71% of colposcopy participants compared to 41% of participants who had naked eye examination only conducted at two sites that performed both colposcopy and naked eye without colposcopy. Use of colposcopy yielded significantly higher rates of participants with deep epithelial disruption, erythema and ecchymosis. We observed no cases of incident Chlamydia, Gonorrhea, or Syphilis during the three month follow up. There were 2 cases of incident HIV during 3-month study period neither of which was associated with any abnormal colposcopy evaluation findings. Conclusion: No safety signals were observed in the 4 study arms, allowing seamless transition from phase 2 to 2b. Colposcopy utility in microbicide clinical trials has minimal value given high rates of background noise findings of no relevant clinical significance. Keywords: colposcopic evaluations; topical microbicides; genital epithelium; phase 2; HIV; investigational product., Background The AIDS epidemic continues to spread relentlessly, with an estimate of 2.7 million (2.4 to 2.9 million) new HIV infections in 2010 [1]. The majority of these infections are [...]

Background and aims: The experience of alcohol use among adolescents is complex, with international differences in age of purchase and individual differences in consumption and consequences. This latter underlines the importance of prediction modeling of adolescent alcohol use. The current study (a) compared the performance of seven machine‐learning algorithms to predict different levels of alcohol use in mid‐adolescence and (b) used a cross‐cultural cross‐study scheme in the training‐validation‐test process to display the predictive power of the best performing machine‐learning algorithm. Design: A comparison of seven machine‐learning algorithms: logistic regression, support vector machines, random forest, neural network, lasso regression, ridge regression and elastic‐net. Setting: Canada and Australia. Participants: The Canadian sample is part of a 4‐year follow‐up (2012–16) of the Co‐Venture cohort (n = 3826, baseline age 12.8 ± 0.4, 49.2% girls). The Australian sample is part of a 3‐year follow‐up (2012–15) of the Climate Schools and Preventure (CAP) cohort (n = 2190, baseline age 13.3 ± 0.3, 43.7% girls). Measurements: The algorithms used several prediction indices, such as F1 prediction score, accuracy, precision, recall, negative predictive value and area under the curve (AUC). Findings: Based on prediction indices, the elastic‐net machine‐learning algorithm showed the best predictive performance in both Canadian (AUC = 0.869 ± 0.066) and Australian (AUC = 0.855 ± 0.072) samples. Domain contribution analysis showed that the highest prediction accuracy indices yielded from models with only psychopathology (AUC = 0.816 ± 0.044/0.790 ± 0.071 in Canada/Australia) and only personality clusters (AUC = 0.776 ± 0.063/0.796 ± 0.066 in Canada/Australia). Similarly, regardless of the level of alcohol use, in both samples, externalizing psychopathologies, alcohol use at baseline and the sensation‐seeking personality profile contributed to the prediction. Conclusions: Computerized screening software shows promise in predicting the risk of alcohol use among adolescents. [ABSTRACT FROM AUTHOR]

Objective To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. Methods Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of IV. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. Findings N. gonorrhoeae, T. vaginalis, C trachomatis, and M. genitalium -- but not U. urealyticum -- were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. Conclusions M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials. Keywords: urethral diseases, etiology; Gram-negative bacterial infections; Mycoplasma; Trichomonas vaginalis; Neisseria gonorrhoae; Chlamydia trachomatis; genital diseases, male; Africa, Western. Mots cles: uretre, maladies, etiologie; infection bacterienne, Gram-negatif; Mycoplasma; Trichomonas vaginalis; Neisseria gonorrhoeae; Chlamydia trachomatis; appareil genital masculin, maladies; Afrique de l'Ouest. Palabras clave: enfermedades uretrales, etiologia; infecciones bacterianas gramnegativas; Mycoplasma; Trichomonas vaginalis; Neisseria gonorrhoae; Chlamydia trachomatis; enfermedades de los genitales masculinos; Africa occidental. Bulletin of the World Health Organization, 2001, 79:118-126., Voir page 125 le resume en francais. En la pagina 125 figura un resumen en espanol. Introduction The control of sexually transmitted diseases (STDs) can lead to a substantial reduction [...]

Objectives. This study determined the prevalence and factors associated with hepatitis B virus (HBV) infection among men who have sex with men. Methods. At the baseline visit of an HIV study among men who have sex with men, we asked about HBV vaccination status and tested for HBV markers. Results. Of 625 subjects, 48% had received at least 1 dose of HBV vaccine. Of 328 unvaccinated men, 41% had 1 or more HBV markers. HBV prevalence increased markedly with age and was associated with many sexual and drug related behaviors. In a multivariate model, 7 variables were independently associated with HBV infection: ulcerative sexually transmitted diseases (odds ratio [OR] = 10.1; 95% confidence interval [CI] = 2.6, 54); injection drug use (OR = 5.2; 95% CI = 1.2, 26); gonorrhea or chlamydia (OR = 4.0; 95% CI = 1.9, 8.9); sexual partner with HIV/AIDS (OR = 3.6; 95% CI = 1.8, 7.1); 50 or more casual partners (OR = 3.4; 95% CI = 1.6, 7.1); received money for sex (OR= 3.0; 95% CI = 1.2, 7.8); and 20 or more regular partners (OR = 2.5; 95% CI = 1.1, 6.1). Conclusions. In Montreal, men who have sex with men are at risk for HBV infection, but a substantial proportion remain unvaccinated; new strategies are required to improve coverage. Men who have sex with men and who have a sexually transmitted infection, especially a genito-ulcerative infection, appear to be at particularly high risk for HBV infection. (Am J Public Health. 2000;90:1570-1574)

Background: Intravenous nutrition preparations that are not photoprotected generate oxidants, which are deleterious for cell survival. The question remains: are these observations of clinical relevance in individuals receiving parenteral nutrition (PN), especially in those who exhibit immature antioxidant defenses such as premature infants?, Objective: To review clinical trials reporting the effect of light-exposed vs light-protected PN to determine whether photoprotection reduces neonatal mortality in preterm infants., Data Source: Electronic databases, abstracts in relevant journals, and references in manuscripts between 1980 and 2014., Selection Criteria: Newborn, premature infants, PN, photoprotection, shielding from light, randomization, mortality, death., Methods: Consensus for inclusion reached by 2 reviewers; meta-analysis of trials and observational studies reporting mortality at 36 weeks' gestational age or hospital discharge., Results: Four trials meeting selection criteria, which involved a total of 800 newborn premature infants, were included. Across trials, gestational age (mean ± SD) ranged from 26 ± 1 to 31 ± 2 weeks, birth weight from 775 ± 161 to 1588 ± 366 g, and mortality from 5%-32%. Mortality in the light-protected group was half of that in the light-exposed group (95% confidence interval, 0.32-0.87) and twice as high in males compared with females (χ 2 , P = .01)., Conclusion: Shielding PN from light has vital repercussions that call for action to provide photoprotected delivery systems and infusion sets in premature infants. Further studies should be extended to the increasing number of children and adults receiving long-term home PN to evaluate the effects of light protection on severe complications that impede their quality of life.