Perceptions of ageing as an older gay man: a qualitative study

AIMS AND OBJECTIVES

To explore the ageing experiences of gay men in New Zealand over the age of 65 years.

BACKGROUND

An increased acceptance by many people in Western societies towards men who are same-sex attracted is likely to result in a corresponding increase in the number of visible older gay men being the recipients of nursing care. Previous research has shown that nursing has some way to go towards providing a service that is culturally safe and appropriate.

DESIGN

A critical gerontological approach was employed to explore the ageing experiences of gay men in New Zealand over the age of 65 years. This methodology ensured the voices of older gay men were foregrounded in the research.

METHODS

Semi-structured digitally recorded individual interviews with 12 gay men aged between 65-81 years who lived in the community were undertaken. Data were analysed using thematic analysis to identify the repeated patterns across the men's talk.

RESULTS

Three main themes relating to the ageing experiences of these men were identified: 'homophobia', 'being with someone' and 'future care'.

CONCLUSIONS

Resilience was a significant factor in how well older gay men aged even in an environment where homophobia and heterosexism were common. Having a strong social support network was an important factor that contributed to supporting the ageing process. These gay men were wary about having to go into residential care, preferring to age in their own homes.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare professionals need to ensure healthcare services meet the needs of older gay men. Any interaction with older gay men should occur in a way that is open and respectful. The usage of best practice guidelines will assist organisations to deliver culturally safe and appropriate care to this group.

Gay men's explanations of health and how to improve it

Little is known about the health views of gay men. In this article we report on how gay men explained health and the ways they discussed how health for gay men can be improved. We conducted a thematic analysis of data collected from 45 gay men in 11 focus groups and identified that health was mainly explained in individual terms, as were the ways to improve health (personal health care services and health promotion). The second way health was explained drew on social and community factors, with the societal acceptance of gay men being reported as essential for health improvements. These individual and social/community approaches were in tension; overall, the individualized approaches dominated. In line with other theorizing in health, we argue that appropriate policy and service provision to meet the health needs of gay men require greater acknowledgment of the social and community explanations of health and ways of improving health.

Birth weight and growth from infancy to late adolescence in relation to fat and lean mass in early old age: findings from the MRC National Survey of Health and Development

Objective:

High birth weight and greater weight gain in infancy have been associated with increased risk of obesity as assessed using body mass index, but few studies have examined associations with direct measures of fat and lean mass. This study examined associations of birth weight and weight and height gain in infancy, childhood and adolescence with fat and lean mass in early old age.

Subjects:

A total of 746 men and 812 women in England, Scotland and Wales from the MRC National Survey of Health and Development whose heights and weights had been prospectively ascertained across childhood and adolescence and who had dual energy X-ray absorptiometry measures at age 60–64 years.

Methods:

Associations of birth weight and standardised weight and height (0–2 (weight only), 2–4, 4–7, 7–11, 11–15, 15–20 years) gain velocities with outcome measures were examined.

Results:

Higher birth weight was associated with higher lean mass and lower android/gynoid ratio at age 60–64 years. For example, the mean difference in lean mass per 1 standard deviation increase in birth weight was 1.54 kg in males (95% confidence interval=1.04, 2.03) and 0.78 kg in females (0.41, 1.14). Greater weight gain in infancy was associated with higher lean mass, whereas greater gains in weight in later childhood and adolescence were associated with higher fat and lean mass, and fat/lean and android/gynoid ratios. Across growth intervals greater height gain was associated with higher lean but not fat mass, and with lower fat/lean and android/gynoid ratios.

Conclusion:

Findings suggest that growth in early life may have lasting effects on fat and lean mass. Greater weight gain before birth and in infancy may be beneficial by leading to higher lean mass, whereas greater weight gain in later childhood and adolescence may be detrimental by leading to higher fat/lean and android/gynoid ratios.

Mental health promotion for gay, lesbian, bisexual, transgender and intersex New Zealanders

INTRODUCTION

A number of studies have identified that gay, lesbian, bisexual, transgender, and intersex (GLBTI) people have poorer mental health than the general population. This article describes current mental health promotion and service provision for GLBTI people in New Zealand, and the views of stakeholders on current service delivery and concerns facing the sector.

METHODS

An email survey of service providers gathered descriptive data about mental health promotion and services provided for GLBTI people. Data obtained from interviews with key informants and online submissions completed by GLBTI individuals were analysed thematically.

FINDINGS

Five organisations provide clear, specific and utilised services and programmes to some or all of the GLBTI populations. Twelve GLBTI-focused mental health promotion resources are identified. The analysis of data from key informants and GLBTI respondents identified factors affecting mental health for these populations occurring at three levels-macro-social environment, social acceptance and connection, and services and support.

CONCLUSION

While GLBTI individuals have the same basic mental health promotion and service provision needs as members of the general population, they have additional unique issues. To enhance the mental health of GLBTI New Zealanders, a number of actions are recommended, including building sector capacity, allocating sufficient funding, ensuring adequate research and information is available, and reducing stigma, enhancing young people's safety, and supporting practitioners through training and resources. An important role for government, alongside GLBTI input, for improving mental health is noted.

Measurement of the atmospheric νe flux in IceCube

We report the first measurement of the atmospheric electron neutrino flux in the energy range between approximately 80 GeV and 6 TeV, using data recorded during the first year of operation of IceCube's DeepCore low-energy extension. Techniques to identify neutrinos interacting within the DeepCore volume and veto muons originating outside the detector are demonstrated. A sample of 1029 events is observed in 281 days of data, of which 496±66(stat)±88(syst) are estimated to be cascade events, including both electron neutrino and neutral current events. The rest of the sample includes residual backgrounds due to atmospheric muons and charged current interactions of atmospheric muon neutrinos. The flux of the atmospheric electron neutrinos is consistent with models of atmospheric neutrinos in this energy range. This constitutes the first observation of electron neutrinos and neutral current interactions in a very large volume neutrino telescope optimized for the TeV energy range.

Systematic literature review of the effects of food and drink advertising on food and drink-related behaviour, attitudes and beliefs in adult populations

A large body of research confirms that food advertising affects the food preferences and behaviour of children. The impact of food advertising on adults is less clear. We conducted a systematic review exploring the effects of advertising of food and non-alcoholic drinks (referred to as 'food' throughout) on food-related behaviour, attitudes and beliefs in adult populations. We searched seven electronic databases, grey literature sources, and references and citations of included material for experimental studies written in English investigating the effects of commercial food advertising on the food-related behaviours, attitudes and beliefs of adults aged 16 years and over. Nine studies, rated moderate to poor quality, were included in the review; all were from developed countries and explored the impact of televised food advertising. Overall, the results did not show conclusively whether or not food advertising affects food-related behaviour, attitudes or beliefs in adults, but suggest that the impact varies inconsistently within subgroups, including gender, weight and existing food psychology. The identification of a small number of relevant studies, none of which were high quality, and with substantial heterogeneity, highlights the need for further research. Future studies investigating longer term outcomes, diverse advertising formats, and in countries with different levels of economic development will be of particular value.

Search for dark matter annihilations in the sun with the 79-string IceCube detector

We have performed a search for muon neutrinos from dark matter annihilation in the center of the Sun with the 79-string configuration of the IceCube neutrino telescope. For the first time, the DeepCore subarray is included in the analysis, lowering the energy threshold and extending the search to the austral summer. The 317 days of data collected between June 2010 and May 2011 are consistent with the expected background from atmospheric muons and neutrinos. Upper limits are set on the dark matter annihilation rate, with conversions to limits on spin-dependent and spin-independent scattering cross sections of weakly interacting massive particles (WIMPs) on protons, for WIMP masses in the range 20-5000  GeV/c2. These are the most stringent spin-dependent WIMP-proton cross section limits to date above 35  GeV/c2 for most WIMP models.

Mental health promotion for gay, lesbian, bisexual, transgender and intersex New Zealanders

INTRODUCTION: A number of studies have identified that gay, lesbian, bisexual, transgender, and intersex (GLBTI) people have poorer mental health than the general population. This article describes current mental health promotion and service provision for GLBTI people in New Zealand, and the views of stakeholders on current service delivery and concerns facing the sector. METHODS: An email survey of service providers gathered descriptive data about mental health promotion and services provided for GLBTI people. Data obtained from interviews with key informants and online submissions completed by GLBTI individuals were analysed thematically. FINDINGS: Five organisations provide clear, specific and utilised services and programmes to some or all of the GLBTI populations. Twelve GLBTI-focused mental health promotion resources are identified. The analysis of data from key informants and GLBTI respondents identified factors affecting mental health for these populations occurring at three levels—macro-social environment, social acceptance and connection, and services and support. CONCLUSION: While GLBTI individuals have the same basic mental health promotion and service provision needs as members of the general population, they have additional unique issues. To enhance the mental health of GLBTI New Zealanders, a number of actions are recommended, including building sector capacity, allocating sufficient funding, ensuring adequate research and information is available, and reducing stigma, enhancing young people’s safety, and supporting practitioners through training and resources. An important role for government, alongside GLBTI input, for improving mental health is noted. KEYWORDS: General practice; mental health; sexuality; social discrimination

Abstract P1-09-05: The RAZOR trial: a phase II prevention trial of screening plus goserilin and raloxifene versus screening alone in pre-menopausal women at increased risk of breast cancer

Background: Observational studies indicate that oophorectomy at about age 40 reduces breast cancer risk by approximately a half in high risk women. Widespread use of risk reducing oophorectomy is unlikely to be acceptable to these women. We explored the feasibility of giving goserelin to produce reversible ovarian suppression together with raloxifene to maintain bone mineral density (BMD).

Objectives: The primary study objective was adherence to treatment. Secondary objectives were uptake of randomisation, side effects/quality of life and measures of effect on bone and in serum.

Methods: Recruitment was from 3 UK Family History Clinics. Consenting women at ≥ 1 in 3 lifetime risk of breast cancer were randomised to control or monthly subcutaneous goserelin 3.6 mg and raloxifene 60 mg/d orally for two years. Questionnaires (Endocrine Symptom Checklist, Trait & State Anxiety, Sexual Activity & Cancer Worry) measuring toxicity/quality of life were administered by nurses. Dual energy X-ray absorptiometry (DXA) BMD measurements were performed in the treatment arm annually. Lipids and collagen breakdown products were measured by standard methods.

Results: 75 of 511 (14.7%) women approached agreed to randomisation (38 to treatment and 37 to control). The major reason for non-entry was fear of side effects (85%). Median age was 37 and 35 years, for the experimental (A) and control arm (B), respectively. Median follow up is 8.8 years. 20/38 in arm A and 27/37 of controls completed the 24 m study. 18/38 women in arm A withdrew (13 [34%] because of side effects) and 10/37 in arm B for various reasons including the desire for risk reducing surgery (n = 4). No significant differences were seen in the Endocrine Symptom Sub-scale, State or Trait anxiety or Cancer Worry. However, Hot flushes, night and cold sweats (together p <0.005), vaginal dryness (p = 0.006); loss of interest in sex, dyspareunia and reduced sexual pleasure (together p < 0.005) were significantly more in arm A. Despite this, 11 of 23 women in arm A when asked would have been happy to complete a potential five years of treatment. BMD declined by 3–7% and Ctx significantly increased (p < 0.005 each) but both returned to baseline by year 3. Lipids were unchanged. 4 women later developed breast cancer in arm B and 2 in arm A.

Conclusions: Uptake and adherence to treatment was relatively low in this group of women at high risk. The major reason for low uptake was fear of side effects and these were the major reason for drop out from treatment. Raloxifene did not maintain BMD. This approach to breast cancer prevention induced significant symptoms and bone loss, thus methods to ameliorate these need to be developed if ovarian suppression is to play a role in breast cancer prevention.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-09-05.

Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis

We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome with a minimum of one year's follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence. We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry.

Energy expenditure in US automotive technicians and occupation-specific cardiac rehabilitation

BACKGROUND

The standard exercise protocol for patients in a traditional cardiac rehabilitation (rehab) programme may not be adequate for preparing manual workers for a safe return to work, as these activities bear little resemblance to the physical movements and force exertion required in most industrial jobs.

AIMS

To measure the energy expenditure as metabolic equivalents (METs) required for automotive technicians, to compare this MET level with that normally attained in traditional cardiac rehab programmes and to suggest cardiac rehab exercises for automotive technicians based on specificity of training.

METHODS

Automotive technicians who volunteered to participate had their MET levels measured while they performed a defined series of work tasks in the service department of an automobile dealership. Their daily walking distance was also determined.

RESULTS

Thirty-six of 95 eligible subjects participated; a response rate of 38%. Mean peak MET level was 7.1, less than the 8 METs target training goal often used in traditional cardiac rehab programmes. However, patients' outcome MET levels in cardiac rehab are usually measured by a treadmill stress test, whereas the subjects reached 7.1 METs while performing work tasks. The subjects walked an average of 5 km during a normal workday.

CONCLUSIONS

Because MET level measurements are work specific, automotive technicians in a cardiac rehab programme should strive to reach and maintain a level of >7 METs while performing specific training exercises that mimic the work tasks they must do throughout the day. They can also benefit from traditional endurance training such as treadmill walking.

The ecology and evolution of tetracycline resistance

The use of tetracycline over the past few decades has been accompanied by a drastic increase in the frequency of tetracycline resistance in a wide range of bacterial species and genera. A diversity of resistance determinants is found in the microbial world, coding for markedly different mechanisms of resistance. The recent analysis of one family of resistance determinants provides evidence for intergenic and intragenic coevolutionary changes as well as for an unusual evolutionary history of duplication and divergence in function of domains within a single locus.

The age structure of populations of Saccharomyces cerevisiae

A discrete deterministic model is described for the growth of an age-structured population of yeast, Saccharomyces cerevisiae, incorporating recent information on the asymmetry of cell division and control of the cell cycle in this species. Solutions are obtained for the age structure of the population at equilibrium, and for the equilibrium distribution of relative frequency of cells through the cell cycle. The model is applied to experimental data on the changing age structure of nonequilibrium populations of yeast. The model predicts well both the transient behavior and the equilibrium structure of such populations. It is shown that the asymmetry of cell division explains (1) the excess of newly formed daughter cells in the population as compared to the frequency of older cells and (2) the damped oscillations in the frequencies of cells of different ages as demographic equilibrium is approached.

Population divergence and gene flow in an endangered and highly mobile seabird

Seabirds are highly vagile and can disperse up to thousands of kilometers, making it difficult to identify the factors that promote isolation between populations. The endemic Hawaiian petrel (Pterodroma sandwichensis) is one such species. Today it is endangered, and known to breed only on the islands of Hawaii, Maui, Lanai and Kauai. Historical records indicate that a large population formerly bred on Molokai as well, but this population has recently been extirpated. Given the great dispersal potential of these petrels, it remains unclear if populations are genetically distinct and which factors may contribute to isolation between them. We sampled petrels from across their range, including individuals from the presumably extirpated Molokai population. We sequenced 524 bp of mitochondrial DNA, 741 bp from three nuclear introns, and genotyped 18 microsatellite loci in order to examine the patterns of divergence in this species and to investigate the potential underlying mechanisms. Both mitochondrial and nuclear data sets indicated significant genetic differentiation among all modern populations, but no differentiation was found between historic samples from Molokai and modern birds from Lanai. Population-specific nonbreeding distribution and strong natal philopatry may reduce gene flow between populations. However, the lack of population structure between extirpated Molokai birds and modern birds on Lanai indicates that there was substantial gene flow between these populations and that petrels may be able to overcome barriers to dispersal prior to complete extirpation. Hawaiian petrel populations could be considered distinct management units, however, the dwindling population on Hawaii may require translocation to prevent extirpation in the near future.

SU-E-T-258: Assessment of Radiation Induced Second Cancer Risks in Proton Therapy and IMRT for Organs inside the Main Radiation Field

PURPOSE

Radiation therapy can potentially cause a second malignancy. There is clinical evidence that those occur typically within the beam path in the medium/high dose region. The purpose of this study was to assess the risk for developing a radiation induced tumor within the treated volume and to compare this risk for proton therapy and IMRT.

METHODS

Fully contoured age and gender specific whole body phantoms (4-year and 14-year old) were uploaded into a treatment planning system and typical tumor volumes were contoured based on patients treated for optic glioma and vertebral body Ewing's sarcoma. Lifetime attributable risks (LARs) for developing a second malignancy were calculated using a risk model incorporating factors for cell kill, mutations, repopulation, and inhomogeneous organ doses.

RESULTS

For standard fractionation schemes, the LAR for developing a second malignancy from radiation therapy alone were found to be up to 2.7% for a 4-year old optic glioma patient treated with IMRT considering a soft tissue carcinoma risk model only. Sarcoma risks were found to be below 1% in all cases. For the 14-year old, risks were found to be about a factor of 2 lower. For the Ewing's sarcoma cases the risks based on the sarcoma model were typically higher than the carcinoma risks, i.e. up to 1.3% LAR for soft tissue sarcoma. Generally, the risk from proton therapy turned out to be lower by a factor of 2 to 10. However, comparison of a 3-field and 4-field proton plan shows that the distribution of the dose, i.e., the particular treatment plan, plays a role as well.

CONCLUSIONS

In general, proton therapy can significantly reduce the risk for developing an in-field second malignancy. Risk analysis based on our formalism could be applied within treatment planning programs to guide treatment plans for pediatric patients. Federal Share of program income earned by Massachusetts General Hospital on NIH/NCI C06 CA059267.

On-line determination of Förster resonance energy transfer efficiency in drying latex films: correlation of interdiffusion and particle deformation

An instrument is described, which measures the efficiency of Förster resonance energy transfer (FRET) in parallel to the sample's turbidity. The instrument was used to study the film formation from polymer latex dispersions. In this context, the FRET efficiency reflects the diffusion of polymer chains across the interparticle boundaries, while the loss of turbidity reflects the progress of particle deformation. Particle deformation causes tensile in-plane stress, while polymer interdiffusion creates cohesion and thereby helps to prevent cracking. The relative timing between the two therefore is of fundamental importance for successful film formation. The on-line determination of FRET efficiency while the film dries is complicated by the fact that the fluorescence lifetime of the donor, τ(D), depends on the water content in the vicinity of the donor. In the established procedure for data analysis, drifts in τ(D) induce corresponding artifical drifts in the values of the FRET efficiency. A novel algorithm for the analysis of fluorescence decay profiles is proposed, which makes use of the method of moments. The FRET efficiency is quantified by the upward curvature of the fluorescence decay curve in log-linear display. In the application example, interdiffusion is delayed relative to particle deformation by about 10 min. For successful film formation, this delay should be as small as possible.