Homosexuality among people with a mild intellectual disability: an explorative study on the lived experiences of homosexual people in the Netherlands with a mild intellectual disability.

BACKGROUND: Empirical research on homosexuality among people with an intellectual disability (ID) is limited and, to date, very little is known regarding the personal experiences of gay and lesbian people with an ID. This study set out to answer the question: What are the lived experiences of a specific cohort of homosexual people with an intellectual disability living in the Netherlands? METHOD: To answer this question, a qualitative study was performed in which 21 people with a mild ID were interviewed via semi-structured interviews. In this study, 19 participants were men and two were women (average age = 40.5 years). RESULTS: Participants reported positive and negative experiences, and talked about their gay or lesbian identity. Almost half of the participants (n = 10) reported that they had experienced sexual abuse including partner violence (n = 6). Additionally, they indicated that there was a lack of support for homosexual people with an ID. CONCLUSION: Specific problems impact the lives of homosexual people with ID, namely the high prevalence of negative sexual experiences, the lack of support, training and sex education, and their search for a suitable partner.

Concurrent partnerships and sexual risk taking among African and Caribbean migrant populations in the Netherlands.

Concurrent partnerships have been recognized as a determinant for the spread of HIV and sexually transmitted infections (STIs). We studied the association of concurrent partnerships with sexual behaviour among heterosexual Caribbean and African migrants, who account for a disproportionate burden of STIs and HIV in the Netherlands. Of 1792 migrants, 15% reported concurrent sexual partners in the previous six months. In multivariate multinomial analyses, women were less likely to have concurrent partners than men and they were less likely than men to use condoms with concurrent partners. We could not identify an association with the observed HIV prevalence; however, migrants with concurrent partners were less likely to be tested for HIV. Of migrants tested for STIs, one in three migrants with concurrent partners was diagnosed with an STI. Prevention targeting migrants should address the promotion of HIV/STI testing and stress the potential acceleration of HIV and STI epidemics due to concurrency.

Social-cognitive determinants of HIV risk-taking intentions among men who date men through the Internet.

The present study was set up to investigate social-cognitive determinants of HIV-risk precautionary intentions among men who have sex with men (MSM), who meet sex partners on the Internet. Participants were enrolled through the major gay chat room in The Netherlands, www.chatboy.nl, and were asked to complete an online questionnaire. Theory of Planned Behaviour variables attitude, subjective norm, and perceived control explained 55% of the variance in intention to use condoms for anal sex with future e-dates. Adding descriptive norm, personal norm and anticipated regret explained 70%. Sexual fantasies and HIV-status had unique effects on intentions. Differences between high and lower intenders are presented. Limitations of the study are discussed and objectives for an intervention to promote condom use are given.

Theory- and evidence-based intervention to improve adherence to antiretroviral therapy among HIV-infected patients in the Netherlands: a pilot study.

The objectives of this study were to describe and pilot-test a theory- and evidence-based intervention to improve adherence of HIV-infected patients with antiretroviral medication. Twenty-six treatment-experienced patients (>6 months on treatment) participated in a within-subject comparison design. Adherence was measured electronically with Medication Event Monitoring System (MEMS) caps for at least 5 months: 2 months before the intervention and 3 months during the intervention. MEMS data were used to measure the outcome of the intervention, but also served as feedback to participants during the intervention. Mean adherence during the month before intervention was compared to mean adherence during the third month of intervention. Data for the process evaluation were gathered through direct observation and semi-structured interviews. Adherence improved significantly during the intervention (Z = -2.1, p < 0.05). Mean adherence (percentage of prescribed doses taken within correct time interval) before the intervention was 81.8% compared to 92.5% during the third month of the intervention. More than 65% of the nonadherent patients (<95% adherence) before the intervention were adherent during the third month of the intervention. Both health care professionals and patients positively evaluated the intervention protocol and the electronic measurement of adherence. The only critique from some patients was the lack of userfriendliness of the MEMS cap and its medication container (size and shape). It can be concluded that the proposed intervention fits in standard care procedures, can be executed by trained HIV nurses, seems to improve adherence to antiretroviral medication, and is positively evaluated by the users. Large-scale and long-term research is warranted.

[Transmural care for HIV-seropositive drug users: experiences from Southeast Limburg, the Netherlands]. / Transmurale zorg voor HIV-seropositieve druggebruikers: ervaringen uit oostelijk Zuid-Limburg.

In 1999 the decision was taken to start a transmural consultation service for HIV-seropositive drug users at the Consultation Office for Alcohol and Drugs [Dutch acronym: CAD] in Heerlen, the Netherlands. This consultation service was run by an AIDS consultant from Maastricht University Hospital together with the addiction physician from the CAD. In the period 1 November 1998-30 April 2002 29 HIV-seropositive drug users made use of this consultation service. Highly active antiretroviral therapy was prescribed to 23 patients during an average of 21 months (range: 4-51). Eighteen patients responded well to this therapy (viral load < 50 copies/ml) after 12-24 weeks of treatment and thereafter during 21 months. Direct observed therapy (DOT) was applied to 16 patients. Therapeutic failure due to poor compliance was observed in 3 patients. Two of them had initially been successfully treated with medication whilst under supervision but the treatment failed when they became responsible for taking their own medication. It seems that involving the Consultation Office for Alcohol and Drugs in the treatment and DOT has a favourable effect on the treatment of HIV-positive drug users.

[Diagnostic image (105). A woman with painful nodules. Infection with O. volvulus]. / Diagnose in beeld (105). Een vrouw met pijnlijke noduli. Infectie met O. volvulus.

A 17-year-old woman from the Democratic Republic of Congo presented with painful nodules on the legs and malaise. An infection with Onchocerca volvulus was diagnosed.

Chatters on the Internet: a special target group for HIV prevention.

This study examined characteristics of men who use gay chat boxes on the Internet, including dating behaviour and sexual risk-taking with sex partners who were initially met through chatting. Men on chat boxes were asked to complete a brief questionnaire on the Internet. The questionnaire contained questions on demographics, chatting-related variables, and dating and risk-taking sexual behaviour. The results show that a large majority of the 190 respondents reported actual encounters as well as sex with men who were initially met through chatting. Almost 30% of the respondents who engaged in sex with chat dates reported inconsistent safe sexual behaviour. The level of unprotected sex increased as the number of sex partners who were met through chatting increased. These results suggest that chatters on the Internet may be a new target group for HIV prevention. Further study is needed to gain insight into the feasibility of prevention efforts for this target group.

[Meningitis after a superficial dog bite]. / Meningitis na triviale hondenbeet.

A 63-year-old healthy man developed acute meningitis. A Gram-stain of the cerebrospinal fluid showed Gram-negative rods, which grew slowly. They were identified by 16S ribosomal RNA sequence-analysis as Capnocytophaga canimorsus, an oral commensal found in various animal species including dogs. Upon further questioning, the patient mentioned a superficial dog bite. Using fluorescence-in situ-hybridisation with specific DNA probes, C. canimorsus cells were detected in a gingiva swab from his dog. The strains isolated from the patient and his dog were identical. The patient made a quick recovery following therapy with cefotaxime. Infections with C. canimorsus are associated with immune suppression (especially splenectomy or alcohol abuse), yet 40% of the patients have no predisposing conditions. Documented infections concern mainly sepsis or meningitis, with a mortality of approximately 30%. Due to its fastidious growth, C. canimorsus may be missed in standard culture methods. Therefore, in each case of unexplained sepsis or meningitis contact with animals should be enquired about.

Educational status and young Dutch gay men's beliefs about using condoms.

The higher levels of HIV risk behaviour that have been found in young gay men with lower socio-economic status (SES, among others defined as educational achievement) may result from unequal effects of safer sex interventions. We conducted semi-structured focus group interviews with an educationally diverse sample of 113 young gay men living in The Netherlands. The objective was to bring to light men's salient ('accessible') beliefs about using condoms since information about beliefs might facilitate the formulation of 'personally relevant' safer sex messages that enhance in-depth message processing. We found several educational differences in the areas of knowledge about HIV preventive behaviour, cognitive schemas about the factors involved in HIV transmission, perceived pros and cons of using condoms, perceived social pressure to use condoms and feelings of being in control of protective action. This may suggest that, for intervention efforts to be effective in motivating the diversity of young gay men to engage in safer sex, interventions should convey tailor-made messages that match recipients' educational degree. Several implications for the formulation of such messages are discussed.

One-year follow-up effects of two obesity treatments on psychological well-being and weight.

OBJECTIVES: The effectiveness of a cognitive and a behavioural treatment for obese binge eaters and obese non-binge eaters was evaluated at 1-year follow-up. Furthermore, we examined the role of weight changes on psychological well-being at 1-year follow-up. DESIGN AND METHOD: Participants were reassessed 6 months and 1 year after they had finished a group cognitive treatment or a group behavioural treatment. The outcome measures were; psychological well-being (concerns about shape, weight and eating, self-esteem and depression), binge eating, and weight. RESULTS AND CONCLUSIONS: Analyses on the completers' sample revealed that both treatments had a markedly positive and lasting impact on shape concern, weight concern and eating concern, binge eating, self-esteem, and depression at 1-year follow-up. Cognitive treatment was not superior to behavioural treatment on most outcome measures. This might be due to selective drop-out. Analyses including non-responders showed that the cognitive treatment was superior on shape, weight and eating concern, and binge eating. The 1-year follow-up results for weight-loss were disappointing. Between pre-treatment and 1-year follow-up participants in the behaviour treatment lost 3.0 kg, while participants in the cognitive treatment lost 0.3 kg. However, participants who gained weight were as successful on changes in psychological well-being changes as participants who lost weight.

A prospective, randomized, double-blinded, placebo-controlled trial of empirical teicoplanin in febrile neutropenia with persistent fever after imipenem monotherapy.

Glycopeptide antibiotics are used extensively in the empirical treatment of febrile patients with neutropenia. To come to a more rational and restricted application of these expensive drugs and to reduce the risk of emergence of resistance, we carried out a prospective, double-blinded, placebo-controlled single-centre study to investigate whether the addition of teicoplanin improved the outcome of neutropenic patients who remained febrile after 72-96 h of imipenem monotherapy. Patients with known infections caused by imipenem-resistant microorganisms were excluded. From the 114 evaluable episodes (out of a total of 125) in 105 patients who met the eligibility criteria, 56 episodes were randomized to receive teicoplanin and 58 to placebo. At 72 h after the start of the assigned intervention, 52 (45.6%) of the patients were afebrile; at the end of the aplastic phase, 10 (8.8%) had succumbed. There was no difference between the two study arms. When febrile episodes were subdivided between microbiologically documented infections, clinically documented infections and fevers of unknown origin, again no significant differences were observed. With the exception of methicillin-resistant bacteria, Gram-positive infections seemed to respond well to imipenem monotherapy. It is concluded that the addition of teicoplanin on empirical grounds, i.e. for persistent fever only, is not necessary and that the use of glycopeptides should be restricted to well-defined clinical situations where methicillin-resistant bacteria are involved. Furthermore, it seems that many neutropenic patients respond slowly over more than 72-96 h even when they are treated with antibacterial drugs such as imipenem that are effective against the causative microorganism.

An unusual presentation of sepsis caused by coagulase-negative staphylococci.

We describe a 25-year-old male presenting with fever during the non-neutropenic phase of chemotherapy. The presentation was that of a viral infection. The cause of the fever turned out to be a bacteremia with coagulase-negative staphylococci (CONS) originating from a totally implanted venous access port (VAP). We briefly discuss the different types of VAP-related infections and treatment modalities.

Tissue reactions to bacteria-challenged implantable leads with enhanced infection resistance.

Tissue reactions to implantable pacemaker leads were investigated in an early infection model in rabbits. Both standard leads and surface-modified leads were used. The surface modification technique was applied to achieve controlled release of the antibiotic gentamicin. The insulating polyurethane tubing material of the leads was provided with an acrylic acid/acrylamide copolymer surface graft and then loaded with gentamicin. Implantation periods varied from day 4, to week 3 1/2, to week 10. We investigated tissue reactions in the absence of an infectious challenge and also the efficacy of surface-modified leads in preventing infection after challenge with Staphylococcus aureus was evaluated. It was demonstrated that the applied surface modification did not induce adverse effects although during early postimplantation an increase in infiltration of granulocytes and macrophages and wound fluid and fibrin deposition were observed. After bacterial challenge, standard leads were heavily infected at each explantation period, denoted by abscesses, cellular debris, and bacterial colonies. In contrast, little or no infection was observed, either macroscopically or by bacterial cultures, with the surface-modified leads. Microscopy showed little evidence of the bacterial challenge, and that primarily at day 4. It was concluded that the applied surface modification demonstrated enhanced infection resistance and thus represents a sound approach to the battle against infectious complications with biomaterials.

Tolerance and efficacy of Amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in haematological patients.

The tolerance of aerosolised amphotericin B as prophylaxis against invasive pulmonary aspergillosis was investigated in 61 granulocytopenic periods in 42 patients treated for a haematologic malignancy. Each patient was to receive amphotericin B in doses escalating to 10 mg three times daily (t.i.d.), but only 20 (48%) patients managed to complete the scheduled regimen. One patient tolerated the full dose initially, but had to discontinue treatment when dyspnea developed as a result of pneumonia and acute respiratory distress. Another 22 patients (52%) experienced side effects, including eight (19%) who reported mild coughing and dyspnea but who tolerated the full dose and three (7%) patients whose dose was reduced to 5 mg t.i.d. Another six (14%) patients could tolerate only 5 mg t.i.d., and five (12%) others stopped treatment because of intolerance. Elderly patients (p < 0.05) and those with a history of chronic pulmonary obstructive disease (p = 0.09) were more likely to develop side effects during inhalation. Twelve (28%) patients developed proven of possible invasive fungal infections, but no correlation was established between infection and the total amount of amphotericin B inhaled. Inhalation of aerosolised amphotericin B is poorly tolerated and does not appear useful in preventing invasive pulmonary aspergillosis in granulocytopenic patients.

Applicability of random primer R143 for determination of Aspergillus fumigatus DNA.

The specificity of random primer R143 for Aspergillus fumigatus DNA was determined in order to test its usefulness in establishing the presence of A. fumigatus DNA in fungal cultures. When PCR reaction products of these cultures were compared with those of 21 other bacterial and fungal DNA samples, R143 proved to produce a 1346 bp band with only A. fumigatus. This band has been sequenced completely and the EcoRI restriction site was used for subsequent confirmation of PCR products. The specificity for A. fumigatus DNA was also confirmed by Southern blotting. Comparison of morphological typing of Aspergillus species in cultures with PCR using R143 on DNA isolated from these cultures showed concordance in 22 of 24 cases. In two cases there was discordance: both times PCR results showed correctly the presence of A. fumigatus, initially not detected by culture. R143 is an A. fumigatus specific random primer, with potential for use in detection of A. fumigatus DNA in clinical specimens.