Psychosocial study environment characteristics associated with exposure to sexual harassment at a large public university in southern Sweden: a cross-sectional study.

BACKGROUND: Universities can be understood as work-like environments for students, with similar risks and expectations regarding psychosocial environment. Limited research has examined this study environment from a Demand-Control-Support perspective with regard to sexual harassment. Understanding this environment is key to designing protective measures. This study aimed to examine the association between individual and psychosocial study environment characteristics and exposure to sexual harassment among students at Lund University, Sweden. METHODS: This cross-sectional study utilised data from an online survey conducted among students. Questions on background characteristics, exposure to sexual harassment while at university and psychosocial study environment as measured by a Demand-Control-Support-instrument were used. Bivariate, and multivariable logistic regressions were used, together with Population Attributable Fractions (PAF), and synergy indexes (SI). RESULTS: High demands and low control were independently associated with higher odds of being exposed to sexual harassment among both females and males (OR 1.41, OR 1.26 and OR 1.55, OR1.34, respectively). When adjusting for background characteristics, high study strain (combination of high demands and low control) was associated with exposure to sexual harassment among both female and male respondents (aOR 1.67 and 1.98 respectively) and could account for PAF of 14% and 15% of study environment sexual harassment for females and males, respectively. Low lecturer support was associated with higher odds for sexual harassment among females (aOR 1.19) but not males. Little evidence was found for a buffering effect of student support on high strain and sexual harassment (SI 0.7). CONCLUSION: Working to reduce situations of high strain study environments could be an effective strategy for reducing sexual harassment in university settings. Improving support from lecturers could also modify this relationship, but more research is required to identify causal pathways underlying this result.

Cultivating resilience and hope: A qualitative study of a pilot program using patient navigators to assist men who have sex with men with retention in the HIV care continuum in Uganda.

In Uganda, due to the criminalization of same-sex sexual practices, men who have sex with men (MSM) experience barriers to accessing HIV care. To retain patients within the HIV Care Continuum, some health interventions have used patient navigators as an ancillary support service. To understand the potential care benefits of using patient navigators for marginalized populations experiencing challenges to HIV care and treatment access in a Ugandan context, this qualitative study explored the experiences of newly diagnosed MSM using patient navigators for ARV retention in care in Kampala. Additionally, to gain insight into the feasibility of patient navigator interventions, this study also aimed to understand the perspectives and experiences of patient navigators working with HIV positive MSM. Individual in-depth, semi structured interviews were conducted with 24 HIV positive MSM and four patient navigators that were part of a patient navigator pilot program from January 2019 -December 2020. Analysis was done using manifest and latent qualitative content analysis. Results showed that HIV positive MSM in Uganda experienced a variety of social, emotional, and financial challenges that placed them at risk for dropping off the HIV Care Continuum. Patient navigators provided HIV positive MSM with the skills, support, and resources necessary to overcome these challenges. Based on study results, we conclude that within the patient navigator pilot program, patient navigators improved MSM participants' quality of life by helping them to achieve the HIV Care Continuum stages: diagnosis, linked to care, receiving HIV treatment, and retention in care. Study results suggest future research is needed on the psychosocial support needs of patient navigators, how the support needs of MSM change throughout their lifetime on the HIV Care Continuum, and how potential benefits of patient navigators may differ in rural Ugandan contexts.

Risky sexual behavior and self-rated mental health among young adults in Skåne, Sweden - a cross-sectional study.

BACKGROUND: Risky sexual behavior is a public health challenge that significantly affects young people's health and well-being in Sweden and throughout the world. Moreover, poor mental health, anxiety and depression among adolescents and young adults have increased in recent years. However, although hypothesized, the associations between general mental health and risky sexual behavior among young adults are less established. Thus, this study aimed to examine the association between self-rated mental health and risky sexual behavior among young adults in southern Sweden. METHODS: Population-based, cross-sectional survey data from 2968 participants aged 18-30 years old residing in southern Sweden was used (response rate 42%). The survey included questions on sexual behavior, alcohol habits, sociodemographic background, and mental health. Logistic regression was used to examine the associations between mental health, depression, anxiety, and risky sexual behavior, stratified by sex (gender). Indicators for risky sexual behavior included not using a condom, non-condom use with casual partner, and multiple (≥2) sexual partners during the last year. RESULTS: Generally, male participants rated their depression and anxiety levels considerably lower than their female counterparts. Poor mental health, high depression, and high anxiety scores (levels) were significantly associated with having multiple sexual partners among among female participants; adjusted odds ratios (aOR) was 1.3 (95% CI 1.01 to 1.71). However, findings among males were not statistically significant. Furthermore, overall results indicated that higher depression and anxiety scores were associated with 1.4 and 1.6 higher odds, respectively, of not using condom with a casual partner in the most recent sexual encounter. Similarly, higher anxiety scores were associated with non-condom use in the latest sexual encounter, aOR 1.4 (1.1-1.7), but no significant gender-specific associations were found. CONCLUSION: The associations found between poor mental health factors and multiple sex partners among females warrant consideration in future public health interventions. Further research to increase the understanding of the causal mechanisms that link mental health factors and risky sexual behavior, especially multiple sex partners, among young adult females is needed to support evidence-based interventions.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016.

BACKGROUND: Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear. OBJECTIVES: To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania. METHODS: Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014-2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15-19 years, compared to mothers aged 20-29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival. RESULTS: About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20-29 years-old-mothers, HR 1.80 (95% CI 1.22-2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62-10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers. CONCLUSION: Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents' obstetric care conducted by only skilled personnel should be introduced and implemented.

Risk of poor mental health and experience of violence among a young adult population with same-sex sexuality: a cross-sectional study in southern Sweden.

OBJECTIVES: To assess prevalence and correlates of same-sex sexuality and its relationship to poor mental health and experiences of violence among youth and young adults in Sweden. A secondary aim was to estimate the same-sex sexuality attributable fractions. DESIGN: A population-based cross-sectional survey. SETTING: Southern Sweden. PARTICIPANTS: 2968 respondents out of 7000 youth and young adults between 18 and 29 years old, resident in southern Sweden, selected randomly by the Swedish Central Population Registry (final sample=2931 respondents, 318 with same-sex sexuality and 2613 without). OUTCOME MEASURES: The outcome measures were self-reported poor mental health (depression and anxiety) and experience of violence (physical violence, sexual violence and sexual coercion). RESULTS: Increased odd of high scores of depression (adjusted OR 1.8, 95% CI 1.39 to 2.26) and anxiety (adjusted OR 1.6, 95% CI 1.28 to 2.07) were observed among youth and young adults with same-sex sexuality. Similarly, increased odds of experience of physical violence (OR 1.8, 95% CI 1.23 to 2.51), sexual violence (OR 2.8, 95% CI 1.96 to 3.89) and sexual coercion (OR 2.5, 95% CI 1.95 to 3.30) were observed with same-sex sexuality. Within the entire young population, same-sex sexuality accounted for 4.7% and 4.1% of the self-reported experience of depression and anxiety, respectively. The estimated same-sex sexuality attributable fractions of violence within the entire population of young people were 4.5% for physical violence, 7.3% for sexual violence and 6.4% for sexual coercion. CONCLUSIONS: This study findings suggest that same-sex sexuality is associated with poor self-rated mental health and experience of violence among youth and young adults in Sweden. Some differences were observed between males and females, indicating that the vulnerabilities and experiences vary between young males and females. Further research is needed in order to gain a deeper knowledge of the factors underlying these associations and the gender differences observed.

Comparison of Machine Learning Techniques for Mortality Prediction in a Prospective Cohort of Older Adults.

As global demographics change, ageing is a global phenomenon which is increasingly of interest in our modern and rapidly changing society. Thus, the application of proper prognostic indices in clinical decisions regarding mortality prediction has assumed a significant importance for personalized risk management (i.e., identifying patients who are at high or low risk of death) and to help ensure effective healthcare services to patients. Consequently, prognostic modelling expressed as all-cause mortality prediction is an important step for effective patient management. Machine learning has the potential to transform prognostic modelling. In this paper, results on the development of machine learning models for all-cause mortality prediction in a cohort of healthy older adults are reported. The models are based on features covering anthropometric variables, physical and lab examinations, questionnaires, and lifestyles, as well as wearable data collected in free-living settings, obtained for the "Healthy Ageing Initiative" study conducted on 2291 recruited participants. Several machine learning techniques including feature engineering, feature selection, data augmentation and resampling were investigated for this purpose. A detailed empirical comparison of the impact of the different techniques is presented and discussed. The achieved performances were also compared with a standard epidemiological model. This investigation showed that, for the dataset under consideration, the best results were achieved with Random UnderSampling in conjunction with Random Forest (either with or without probability calibration). However, while including probability calibration slightly reduced the average performance, it increased the model robustness, as indicated by the lower 95% confidence intervals. The analysis showed that machine learning models could provide comparable results to standard epidemiological models while being completely data-driven and disease-agnostic, thus demonstrating the opportunity for building machine learning models on health records data for research and clinical practice. However, further testing is required to significantly improve the model performance and its robustness.

Investigation of the analysis of wearable data for cancer-specific mortality prediction in older adults.

Cancer is an aggressive disease which imparts a tremendous socio-economic burden on the international community. Early detection is an important aspect in improving survival rates for cancer sufferers; however, very few studies have investigated the possibility of predicting which people have the highest risk to develop this disease, even years before the traditional symptoms first occur. In this paper, a dataset from a longitudinal study which was collected among 2291 70-year olds in Sweden has been analyzed to investigate the possibility for predicting 2-7 year cancer-specific mortality. A tailored ensemble model has been developed to tackle this highly imbalanced dataset. The performance with different feature subsets has been investigated to evaluate the impact that heterogeneous data sources may have on the overall model. While a full-features model shows an Area Under the ROC Curve (AUC-ROC) of 0.882, a feature subset which only includes demographics, self-report health and lifestyle data, and wearable dataset collected in free-living environments presents similar performance (AUC-ROC: 0.857). This analysis confirms the importance of wearable technology for providing unbiased health markers and suggests its possible use in the accurate prediction of 2-7 year cancer-related mortality in older adults.

GRK3 deficiency elicits brain immune activation and psychosis.

The G protein-coupled receptor kinase (GRK) family member protein GRK3 has been linked to the pathophysiology of schizophrenia and bipolar disorder. Expression, as well as protein levels, of GRK3 are reduced in post-mortem prefrontal cortex of schizophrenia subjects. Here, we investigate functional behavior and neurotransmission related to immune activation and psychosis using mice lacking functional Grk3 and utilizing a variety of methods, including behavioral, biochemical, electrophysiological, molecular, and imaging methods. Compared to wildtype controls, the Grk3-/- mice show a number of aberrations linked to psychosis, including elevated brain levels of IL-1ß, increased turnover of kynurenic acid (KYNA), hyper-responsiveness to D-amphetamine, elevated spontaneous firing of midbrain dopamine neurons, and disruption in prepulse inhibition. Analyzing human genetic data, we observe a link between psychotic features in bipolar disorder, decreased GRK expression, and increased concentration of CSF KYNA. Taken together, our data suggest that Grk3-/- mice show face and construct validity relating to the psychosis phenotype with glial activation and would be suitable for translational studies of novel immunomodulatory agents in psychotic disorders.

'Fighting an uphill battle': a qualitative study of the challenges encountered by pharmacy workers when providing services to men who have sex with men in Dar es Salaam, Tanzania.

BACKGROUND: Previous research suggests that Tanzanian MSM might prefer consulting pharmacies and drugstores, rather than public healthcare services, when in need of STI medicines and treatment. Yet, few studies have explored the experiences of providing services to MSM clients among those working at pharmacies and drugstores and examined what challenges they encounter in providing these services. OBJECTIVE: To gain increased knowledge and understanding of the perceived challenges encountered by pharmacists and drugstore workers when providing STI services to MSM clients in Dar es Salaam, Tanzania. METHOD: In early 2016, 16 semi-structured interviews were conducted with persons working at private pharmacies and drugstores in Dar es Salaam. Data were interpreted through qualitative content analysis. RESULTS: The overarching theme that emerged was labelled 'Fighting an uphill battle', which reflected the challenges pharmacy workers experienced during interactions with MSM clients, and in particular service provision. Pharmacy workers tried to act upon the best of their knowledge to meet the needs of clients, given their understanding of risks and obstacles that MSM faced. Yet, the lack of educational and professional preparedness and insufficient financial and human resources, regarded as necessary to meet the needs of a stigmatised client group, formed barriers for effective service delivery. CONCLUSIONS: In order to support pharmacists and drug-store workers in Tanzania to address perceived challenges for service delivery to MSM clients, systematic and continuous training on MSM's sexual health is required. Furthermore, inter-professional cooperation that harnesses provider involvement from all tiers in the healthcare system is essential to offer complementary services to ensure proper STI care and treatment. Thus, interventions that focus on inter-professional communication and interaction between pharmacists and physicians could have a positive impact on timely referrals of suspected STI cases among marginalised populations.

'One-size doesn't fit all': Understanding healthcare practitioners' perceptions, attitudes and behaviours towards sexual and reproductive health and rights in low resource settings: An exploratory qualitative study.

Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, "one-size doesn't fit all' in SRHR" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, "aligning a pathway to service delivery", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, "health practitioners acting as gatekeepers", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.

Effectiveness and Safety of Acne Scar Treatment With Nonanimal Stabilized Hyaluronic Acid Gel.

BACKGROUND: Acne scarring affects most patients with acne and have a negative impact on quality of life. New effective treatment options offering minimal downtime are therefore needed. OBJECTIVE: To evaluate improvement in overall facial appearance after hyaluronic acid (HA) treatment of atrophic acne scars. METHODS: Twelve subjects with moderate-to-severe acne scars were treated at 3 sessions 4 weeks apart. At each session, up to 2-mL HA gel was injected into each side of the face. Acne scar severity, global facial aesthetic improvement, and subject satisfaction were assessed up to 36 weeks after treatment. Safety assessments included subject diaries and adverse events. RESULTS: The overall facial appearance and the appearance of atrophic acne scars improved after treatment. Scar severity and subject satisfaction with the overall facial appearance and with the sensation and perception of the skin improved in most subjects. Subjects' self-esteem and self-confidence also improved. Adverse events were typically mild to moderate, expected, and procedure-related. CONCLUSION: Hyaluronic acid gel injections were effective and safe for treatment of moderate-to-severe atrophic acne scars. The treatment effect developed gradually over time with the highest improvement observed at the end of the study.

Evaluating Perceived Naturalness of Facial Expression After Fillers to the Nasolabial Folds and Lower Face With Standardized Video and Photography.

BACKGROUND: Hyaluronic acid (HA) fillers are commonly used in treating facial wrinkles and folds but have not been studied with standardized methodology to include assessment of standard facial expressions. OBJECTIVE: To assess perceived naturalness of facial expression after treatment with 2 HA fillers manufactured with XpresHAn Technology (also known as Optimal Balance Technology). MATERIALS AND METHODS: Treatment was directed to the nasolabial folds (NLFs) and at least 1 additional lower face wrinkle or fold. Maintenance of naturalness, attractiveness, and age at 1 month after optimal treatment were assessed using video recordings and photographs capturing different facial animations. Global aesthetic improvement, subjects' satisfaction, and safety were also evaluated. RESULTS: The treatment was well tolerated. Naturalness of facial expression in motion was determined to be at least maintained in 95% of subjects. Attractiveness was enhanced in 89% of subjects and 79% of subjects were considered to look younger. Most subjects assessed their aesthetic appearance as improved and were satisfied with their treatment. CONCLUSION: Naturalness and attractiveness can be assessed using video recordings and photographs capturing different facial animations. XpresHAn Technology HA filler treatments create natural-looking results with high subject satisfaction.

Exploring the Needs, Expectations, and Realities of Mental Healthcare for Transgender Adults: A Grounded Theory Study on Experiences in Sweden.

Purpose: Transgender persons experience a disproportionate representation in adverse mental health conditions globally. In Sweden, there are tangible efforts to improve mental healthcare overall, but transgender persons still struggle with meeting their mental healthcare needs and there is an absence of understanding the role of mental healthcare for this population and how services are being utilized. Thus, the aim of this study was to gain knowledge from transgender individuals in Sweden concerning their mental healthcare, their needs, expectations, and realities, regardless of transition status. Methods: Eleven in-depth interviews were conducted with persons who identified as transgender, older than 18 years, at some stage of transition in Sweden. Data were collected, analyzed, and interpreted using constructivist ground theory. Results: Three categories emerged from the analysis, Feeling Objectification Rather than Subjectivity, Constructing the Narrative, and Reflecting on Aspects of Care that illustrate the dual tensions at play in transgender visibility, communication with mental healthcare professionals, and expectations of care. Six subcategories further delineate the specific forces at work that construct the mental healthcare experiences for trans persons. Conclusion: Increased knowledge and visibility of transgender persons are needed to adequately serve the mental healthcare needs for this population. Currently, there are barriers that inhibit transgender persons from getting the mental healthcare assistance desired and needed, as they do not view the healthcare system as safe space. As steps are being taken to depathologize transgender identities, momentum should be continued to create space for trans persons that enables unencumbered mental health assistance.

Using pharmacists and drugstore workers as sexual healthcare givers: a qualitative study of men who have sex with men in Dar es Salaam, Tanzania.

BACKGROUND: Previous research has shown that men who have sex with men (MSM) avoid formal healthcare services because of the fear of discrimination as homosexuality is illegal and stigmatized in Tanzania. Instead, self-treatment by medications obtained directly from pharmacies or drugstores may be common when MSM experience symptoms of suspected sexually transmitted infections (STIs) related to sexual activity with men. OBJECTIVE: To explore MSM's perceptions and experiences of seeking treatment and advice from pharmacists and drugstore workers in Dar es Salaam, Tanzania, with regards to their sexual health and STI-related problems. MATERIALS AND METHODS: 15 in-depth interviews were conducted with MSM with experience of seeking assistance relating to their sexual health at pharmacies and drugstores in Dar es Salaam in 2016. A qualitative manifest and latent content analysis was applied to the collected data. RESULTS: Four themes related to different aspects of MSM's perceptions and experiences of pharmacy care emerged from the analysis: (1) Balancing threats against need for treatment reflected informants' struggles concerning risks and benefits of seeking assistance at pharmacies and drugstores; (2) Identifying strategies to access required services described ways of approaching a pharmacist when experiencing a sexual health problem; (3) Seeing pharmacists as a first choice of care focused on informants' reasons for preferring contact with pharmacies/drugstores rather than formal healthcare services; and (4) Lacking reliable services at pharmacies indicated what challenges existed related to pharmacy care. CONCLUSIONS: MSM perceived the barriers for accessing assistance for STI and sexual health problems at pharmacies and drugstores as low, thereby facilitating their access to potential treatment. However, the results further revealed that MSM at times received inadequate drugs and consequently inadequate treatment. Multi-facetted approaches are needed, both among MSM and drugstore, pharmacy, and healthcare workers, to improve knowledge of MSM sexual health, STI treatment, and risks of antibiotic resistance.

Acting within an increasingly confined space: A qualitative study of sexual behaviours and healthcare needs among men who have sex with men in a provincial Tanzanian city.

OBJECTIVE: To explore risk perceptions, sexual practices and healthcare needs among men who have sex with men in the provincial city of Tanga in northern Tanzania. Previous research suggests that HIV/STIs are increasing problems for this population. Yet, few studies have been conducted outside the urban area of Dar es Salaam, which has limited our knowledge about the HIV/STI risk factors and healthcare needs among men who have sex with men who live outside major metropolitan areas. METHOD: During three months in 2013, 10 in-depth interviews with men who have sex with men were conducted in Tanga. Data were interpreted through qualitative content analysis. RESULTS: The theme that emerged was labelled "Acting within an increasingly confined space". The theme reflects the interference of stigma in men's lives, and in the face of potential discrimination, men perceived their sexual and healthcare choices as limited. This created obstacles for forming romantic and sexual relationships, insisting on consistent condom use with sexual partners, maintaining open and conducive relationships with family, and accessing healthcare services when required. CONCLUSIONS: Sexual stigma is a concern as it contributes to HIV/STI risk-related behaviours among men who have sex with men. Priority should be given to programmes that support same-sex practicing men in their efforts to make informed choices regarding their sexual health. Creating safe cyber networks provides an opportunity to reach this population with targeted sexual health education messages. Such programmes might be even more urgent in smaller towns and rural areas where gay specific initiatives are more limited than in urban areas.

The naked truth about HIV and risk taking in Swedish prisons: A qualitative study.

BACKGROUND: This qualitative study explores former prison inmates' perceptions and attitudes towards HIV risk inside Swedish prisons. METHOD: In 2014, eight semi-structured interviews were conducted with former male prisoners to gain a deeper understanding of situations perceived to be associated with risk of HIV transmission. The material gathered from the interviews was analyzed by manifest and latent qualitative content analysis. RESULTS: The findings revealed that risky behavioral practices, such as sharing needles, unprotected sexual activity, and lack of openness about HIV status represented potential health threats with regard to the risk of HIV transmission. CONCLUSIONS: Evidence from the study indicates that educational interventions regarding HIV and the transmission routes are required for HIV prevention in Swedish prisons.

Adaptive and Behavioral Changes in Kynurenine 3-Monooxygenase Knockout Mice: Relevance to Psychotic Disorders.

BACKGROUND: Kynurenine 3-monooxygenase converts kynurenine to 3-hydroxykynurenine, and its inhibition shunts the kynurenine pathway-which is implicated as dysfunctional in various psychiatric disorders-toward enhanced synthesis of kynurenic acid, an antagonist of both α7 nicotinic acetylcholine and N-methyl-D-aspartate receptors. Possibly as a result of reduced kynurenine 3-monooxygenase activity, elevated central nervous system levels of kynurenic acid have been found in patients with psychotic disorders, including schizophrenia. METHODS: In the present study, we investigated adaptive-and possibly regulatory-changes in mice with a targeted deletion of Kmo (Kmo-/-) and characterized the kynurenine 3-monooxygenase-deficient mice using six behavioral assays relevant for the study of schizophrenia. RESULTS: Genome-wide differential gene expression analyses in the cerebral cortex and cerebellum of these mice identified a network of schizophrenia- and psychosis-related genes, with more pronounced alterations in cerebellar tissue. Kynurenic acid levels were also increased in these brain regions in Kmo-/- mice, with significantly higher levels in the cerebellum than in the cerebrum. Kmo-/- mice exhibited impairments in contextual memory and spent less time than did controls interacting with an unfamiliar mouse in a social interaction paradigm. The mutant animals displayed increased anxiety-like behavior in the elevated plus maze and in a light/dark box. After a D-amphetamine challenge (5 mg/kg, intraperitoneal), Kmo-/- mice showed potentiated horizontal activity in the open field paradigm. CONCLUSIONS: Taken together, these results demonstrate that the elimination of Kmo in mice is associated with multiple gene and functional alterations that appear to duplicate aspects of the psychopathology of several neuropsychiatric disorders.

Prevalence of STI symptoms and high levels of stigma in STI healthcare among men who have sex with men in Dar es Salaam, Tanzania: a respondent-driven sampling study.

Symptoms of sexually transmitted infections (STIs), whether they are presented for treatment or diagnosis, and how they are received by the clinician where they are presented, may be concomitants of stigma associated with homosexuality in homophobic climates. We analyzed respondent-driven sampling data from a study on 200 young men who have sex with men (MSM) in Dar es Salaam, Tanzania to examine sample prevalence, treatment and clinician response to 10 symptoms potentially associated with STIs. Survey measures included 10 self-reported STI symptoms, further specified according to location (genital, anal, oral), further specified according to place of diagnosis, place of, treatment whether there was pharmacy treatment or self-medication, healthcare worker (HCW) inquiries about source of infection and whether the HCW was polite. Most common symptoms reported were genital pain, burning urination, genital itching/burning, penile discharge, and groin swelling. Anal symptoms had the lowest proportion of treatment at public clinics and among the highest proportion of pharmacy treatment; anal sores had the highest proportion of self-medication. HCWs were reported as not being polite in response to 71-90% of the symptoms, (median = 82%). The findings suggest that stigma and negative HCW response are barriers to public clinic treatment for MSM in Tanzania and that these may have implications for both STI treatment and the HIV cascade.

Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.

OBJECTIVE: To explore the views and experiences of providing assistance and treatment of sexually transmitted infections to same-sex practicing male clients among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania. Previous research suggests that sexually transmitted infections are an increasing concern for this population. Due to stigma and discrimination, men who have sex with men face limited access to treatment, which might contribute to increased self-medication. However, limited research has been conducted on the role of the pharmaceutical service provider with regards to this population in sub-Saharan Africa. METHOD: In January 2016, 16 service providers at private pharmacies and drugstores with previous experience of providing services to this population were purposively selected for open-ended face-to-face interviews. The analysis was guided by the grounded theory approach. RESULTS: The process that emerged was labelled "Stretching Boundaries for Pharmaceutical Responsibilities". This reflected informants' perceptions of themselves as being involved in a transition from having limited engagement in the care of same-sex practicing male clients to becoming regular service-providers to this group. Findings further revealed that the emotional commitment they developed for clients through this process led to a transgression of provider-client boundaries, which undermined objective decision-making when clients lacked prescription. Financial interests also emerged as an underlying motivation for providing incomplete or inaccurate drug dosages. CONCLUSIONS: Further studies are required to better address incentives related to unregulated sale of drugs. Inter-professional networks between pharmacy and healthcare workers could support the development of targeted treatment for men who have sex with men and other key populations.