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Biomedical subjects

G Hart

Publications and source records attributed to G Hart.

At least 19 recordsLinked to original sources

Predictors of high risk sexual behaviour in gay and bisexual men.

Evidence of high risk sex between gay men continues to be reported, as does a range of sexual behaviour. Three hundred and sixty-nine homosexually active men from different areas of England were each assessed twice at an an interval of 9 months in order to examine the extent to which a number of social-psychological factors predicted subsequent high risk sexual behaviour. Few of the variables were significantly related to unprotected receptive anal sex in the way that the Health Belief Model predicted, except for some perceptions of costs and benefits of safer sex. However, whether or not men were involved in a regular relationship with a partner was strongly associated with high risk behaviour. The implications of these results are that health education interventions should focus on alerting all men to the social context in which high risk sex is more likely to happen: the regular partnership.

Attitude to Health

The sexual behaviour of bisexual men in relation to HIV transmission.

Relatively little is known about the behaviour of bisexual men which may help in assessing their role in HIV transmission. A sample of 60 behaviourally bisexual men were asked about their sexual behaviour with male and female partners and their perceptions of risk of HIV infection. Only a minority of men engaged in unprotected anal sex with their male partners while two thirds had unprotected vaginal sex with their female partners. This asymmetrical pattern of sexual behaviour reflects a differential perception of risk of HIV infection with male and female partners. A quarter of the men had unprotected penetrative sex with both male and female partners in the previous year. The pattern of risk behaviour varied amongst men living in gay, heterosexual or bisexual contexts.

Adult

Amyloid myopathy presenting with respiratory failure.

Amyloidosis is a rare cause of myopathy. Its prominent or presenting feature may be respiratory failure. Physiological measurement of transdiaphragmatic pressure and biopsy specimens of muscle show the pathological mechanism to be diaphragm weakness due to amyloid infiltration of the diaphragm rather than parenchymal lung involvement. Thus amyloid myopathy even without the typical macroglossia and muscle pseudohypertrophy should be considered as one of the neurological causes of respiratory failure.

Aged

Factors associated with genital chlamydial and gonococcal infection in females.

BACKGROUND: Predictors of chlamydia and gonorrhoea can be used to increase the cost-effectiveness and acceptability of screening programmes, and allow targeting of control strategies. METHODS: All women attending an STD clinic in 1988-1990 were offered screening for chlamydia and gonorrhoea, and the test results correlated with a wide range of potential predictors using multiple logistic regression. RESULTS: Of 4822 attenders, 3533 (73.3%) were tested for chlamydia over a total of 5430 episodes, yielding 348 (6.4%) positives, and 3510 (72.8%) were tested for gonorrhoea over a total of 5450 episodes, yielding 100 (1.0%) positives. Independent predictors of chlamydial infection were being an STD contact, having endocervical gonorrhoea, being under 25, not having genital herpes, being Aboriginal, using oral contraception, not having a steady partner and having vaginal discharge or dysuria. For gonorrhoea such predictors were being Aboriginal, an STD contact, under 25, tattooed, having vaginal discharge or dysuria, and having had sex outside the state in the past three months. Selective screening criteria for gonorrhoea provided 91% of positives, eliminated the need for 42% of tests and resulted in an increased yield ratio of 1.5 whereas the corresponding outcomes for screening criteria for chlamydia were 91%, 29% and 1.3, respectively. CONCLUSIONS: The diversity of STD epidemiology requires development of empirical screening guidelines for diverse settings. Standardisation of methodology to facilitate comparisons and extrapolation should include investigation of a wide range of variables, available before patient examination, by multivariate analysis, and choice of selective criteria to cover at least 90% of the infected population as well as resulting in a substantially increased yield (preferably an increased yield ratio of at least 1.5).

Adult

Factors associated with pediculosis pubis and scabies.

OBJECTIVE: To ascertain factors associated with genital pediculosis and scabies infestations among attenders at an STD clinic. DESIGN: Cross sectional assessment of potential risk factors by multiple logistic regression. SETTING: A central city sexually transmitted diseases (STD) clinic in Adelaide, South Australia. SUBJECTS: All men and women patients attending from 1988 to 1991. RESULTS: Pediculosis pubis was diagnosed in 205 of 12,170 (1.7%) men and 65 (1.1%) of 6125 women, and scabies in 56 (0.5%) men and 6 (0.1%) women attending an STD clinic from 1988-1991. Independent risk factors by multivariate analysis for pediculosis pubis in women were pregnancy (odds ratio (OR) = 2.3), sex outside the state (OR = 2.2) and age under 25 (OR = 2.0). Many factors were associated with pediculosis pubis in men, including no steady partner (OR = 1.4), multiple partners (OR = 1.6), being unmarried (OR = 2.0) and homosexual behaviour (OR = 1.6). None of these factors was associated with scabies infestation which was strongly associated with being Aboriginal (OR = 6.8) and being unemployed (OR = 2.5). CONCLUSION: In this setting scabies appears to be determined by socioeconomic factors and pediculosis pubis predominantly by sexual activity factors.

Australia

[Consequences of AIDS in the lives of hemophiliacs and their caregiving families in Quebec: stress, response to stress and social support].

The following article focuses on the Québec portion of a national survey on the care needed by hemophiliacs with AIDS or having contracted the HIV virus. The survey was based on an approach that considers social support as a means to face stress. It also examined the needs of dispensers of care and relatives (whether mourning or not) of these persons. Participants revealed having experienced more stress because of an absence of support or simply negative support, than because of the physical deterioration caused by the disease. In addition, the question of confidentiality was often raised. In general, participants said they were satisfied with the support they had received, especially on the part of members of their family.

Acquired Immunodeficiency Syndrome

Factors associated with requesting and refusing human immunodeficiency virus antibody testing.

OBJECTIVE: To ascertain factors associated with having a test for human immunodeficiency virus (HIV) antibody. DESIGN: All attenders at a sexually transmitted diseases (STD) clinic who were at risk of HIV infection and had not been tested previously were included in the study and classified as requesting a test or being offered a test. SETTING: The study was conducted at a central city STD clinic. PARTICIPANTS: Of all patients in 1990, 1835 men and 849 women were excluded because of previous HIV tests and 259 men and 120 women were not tested because of their low risk, leaving a target population of 2249 men and 1153 women. MAIN OUTCOMES: Among men tested the results in 1.2% (9/771) of those requesting a test and in 0.6% (7/1177) of those not requesting a test were positive. There were no positive results among the women tested. RESULTS: Among men, accepting testing was related to intravenous drug use (odds ratio [OR] = 3.49), not having a steady partner (OR = 1.40), and having an STD (OR = 0.57) or a history of STD (OR = 0.67). Among women, accepting testing was related to not having a steady partner (OR = 1.73), being an STD contact (OR = 0.43), having vaginal discharge and/or dysuria (OR = 0.51), and having a history of STD (OR = 0.61), and was unrelated to having an STD. In both men and women accepting testing was unrelated to having multiple sex partners. CONCLUSIONS: The findings are consistent with a failure to associate the risk of HIV infection with risks associated with other STDs. This has implications for health education programs as well as approaches to testing by doctors. Those requesting a test accounted for only 56% (9/16) of infections detected.

Acquired Immunodeficiency Syndrome

The HIV test and sexual behaviour in a sample of homosexually active men.

This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.

AIDS Serodiagnosis

AIDS--ten years on.

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Acquired Immunodeficiency Syndrome

Effects of captopril on membrane current and contraction in single ventricular myocytes from guinea-pig.

1. Single guinea-pig ventricular myocytes were voltage-clamped and cell length was measured with a photodiode array. 2. Captopril (1 x 10(-5) M) reduced both peak early current and active shortening in response to a depolarizing clamp pulse along a similar time course. 3. From a holding potential of around -45 mV peak early inward current was reduced by 37 +/- 9% (P less than 0.001) on exposure to captopril. The early current-voltage relationship was shifted outwards by captopril indicating a reduction in membrane conductance through the L-type calcium channel (ICa). 4. The amplitude of cell shortening in response to depolarizing voltage steps was reduced but the voltage-dependence of contraction after captopril was unchanged. 5. A small negative shift of the potential at which ICa was half-activated was observed after captopril. There was no change in the voltage-dependence of the inactivation variable or in the time-dependence of repriming for ICa. 6. The actions of captopril on ICa and developed shortening were dose-dependent and took place in the same proportion when Ica was increased by isoprenaline. 7. These results are discussed in relation to the effects of captopril on Ica and contraction and to its clinical usage.

Animals

Effects of neuropeptide Y on cell length and membrane currents in isolated guinea pig ventricular myocytes.

Direct effects of neuropeptide Y were studied in left ventricular myocytes isolated from guinea pigs. Contraction was measured as the change in unloaded cell length using a photodiode array. Action potentials were elicited at 1 Hz in current-clamp mode, and membrane currents were measured using a switch-clamp amplifier with 2 M-KCl microelectrodes. At concentrations of 10(-6) M and above, neuropeptide Y reduced contraction in a concentration-dependent fashion. The reduction in contraction by the peptide was proportionately greater in the presence of isoproterenol, and the increase in contraction caused by isoproterenol was completely inhibited by 10(-6) M neuropeptide Y. In response to neuropeptide Y, action potential duration was shortened, and the time course of the shortening was similar to that of the reduction in contraction. Under voltage clamp, 1 x 10(-5) M neuropeptide Y reduced peak L-type calcium current by 32% and shifted the myocyte current-voltage relation during a slow ramp in a manner that suggested a reduction in the background rectifier K+ current. The effects of the peptide on membrane currents were greatly attenuated by preincubation of the cells with pertussis toxin (100 ng/ml). We conclude that neuropeptide Y reduces developed shortening, action potential duration, L-type calcium current, and background rectifier current in single guinea pig ventricular myocytes and that these effects are mediated, at least in part, via membrane G proteins.

Action Potentials

The relationship between literacy and health.

In non-industrialized countries, populations with the lowest literacy rates have the poorest health status. In the United States, however, there is no published research on whether illiteracy, independently of other sociodemographic factors, is related to health status. There are numerous plausible mechanisms by which such a relationship could occur. For example, published reports indicate that most information handouts, consent forms, and other materials for patients are written at reading levels too difficult for most American adults. These and other findings may have important implications in the health care of underserved populations. Research is needed to determine the health effects of impaired literacy skills among Americans, and to develop non-literacy-dependent methods for providing patient education, obtaining informed consent, and administering diagnostic tests.

Educational Status

Gay men, social support and HIV disease: a study of social integration in the gay community.

As part of a large study of the effects of HIV and AIDS on gay male sexual behaviour, we investigated the extent to which gay men in the UK have access to social support and informal care at times of illness. The study sample (n = 502) demonstrated high levels of willingness to disclose sexuality to others, sociability and social integration. Over 90% reported that they had access to people whom they could turn for practical help at times of temporary incapacity. Between 42% and 46% have known a person, or persons, with HIV symptomatic disease, AIDS or someone who has died of AIDS, although men recruited in larger towns and cities were more likely to know people at every stage of HIV infection and AIDS than those from smaller towns. Twenty-five per cent had provided practical help and support to at least one person with AIDS; men in this situation were more likely to have had a close friend, lover or former lover who had died of AIDS. It is argued that it is not possible to expect the gay community to provide fully for the non-medical care of its members and, whilst some needs can be fulfilled on an informal care basis, the demands of long-term serious illness are such that adequate support services should be available in the community.

Adolescent