Potential alcohol use disorder (AUD) among men who have sex with men (MSM) in Ireland

Background

Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) appears to disproportionately affect men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.

Methods

The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM residing in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥ 2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.

Results

In total, 1,793 MSM met inclusion criteria, and 31% screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95%CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95%CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95%CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95%CI 1.14-2.63) (other illicit drugs, aOR 2.28 95%CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95%CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95%CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95%CI 0.46-0.93).

Conclusions

The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Key messages

The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey

BACKGROUND

Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions.

METHODS

The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances.

RESULTS

In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39-3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41-5.90, and AOR 5.87, 95%CI 3.08-11.18 respectively).

CONCLUSIONS

The prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

Inequalities in HIV testing uptake and needs among men who have sex with men living in Ireland: findings from an internet survey

OBJECTIVES

HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives.

METHODS

We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross-sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio-demographic groups.

RESULTS

More than one-third (n = 1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18-24 years, live outside Dublin, have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic.

CONCLUSIONS

HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self-sampling and home testing).

Broadband Direct UVA irradiance measurement for clear skies evaluated using a smartphone

UVA wavelengths (320-400 nm) have been implicated in recent studies to contribute to melanoma induction and skin photoaging in humans and damage to plants. The use of smartphones in UVA observations is a way to supplement measurements made by traditional radiometric and spectroradiometric technology. Although the smartphone image sensor is not capable of determining broadband UVA irradiances, these can be reconstructed from narrowband irradiances, which the smartphone, with narrowband and neutral density filters, can quantify with discrepancies not exceeding 5 %. Three models that reconstruct direct broadband clear sky UVA were developed from narrowband irradiances derived from smartphone image sensor pixel data with coefficients of determination of between 0.97 and 0.99. Reasonable accuracy and precision in determining the direct broadband UVA was maintained for observations made with solar zenith angles as high as 70°. The developed method has the potential to increase the uptake of the measurement of broadband UVA irradiances.

Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April - 3 October 2009

From 28 April 2009 to 3 October 2009, 205 cases of confirmed pandemic H1N1 influenza were hospitalised in Ireland. Detailed case-based epidemiological information was gathered on all hospitalised cases. Age-specific hospitalisation rates were highest in the age group of 15 to 19 year-olds and lowest in those aged 65 years and over. Nineteen hospitalised cases (9%) were admitted to intensive care units (ICU) where the median length of stay was 24 days. Four hospitalised cases (2%) died. Fifty-one percent of hospitalised cases and 42% of ICU cases were not in a recognised risk group. Asthma was the most common risk factor among cases; however, people with haemoglobinopathies and immunosuppression were the most over-represented groups.

Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April – 3 October 2009

From 28 April 2009 to 3 October 2009, 205 cases of confirmed pandemic H1N1 influenza were hospitalised in Ireland. Detailed case-based epidemiological information was gathered on all hospitalised cases. Age-specific hospitalisation rates were highest in the age group of 15 to 19 year-olds and lowest in those aged 65 years and over. Nineteen hospitalised cases (9%) were admitted to intensive care units (ICU) where the median length of stay was 24 days. Four hospitalised cases (2%) died. Fifty-one percent of hospitalised cases and 42% of ICU cases were not in a recognised risk group. Asthma was the most common risk factor among cases; however, people with haemoglobinopathies and immunosuppression were the most over-represented groups.

Enhanced surveillance of initial cases of pandemic H1N1 2009 influenza in Ireland, April-July 2009

From 28 April to 18 July 2009 there were 156 cases of pandemic H1N1 2009 influenza confirmed in Ireland. During this time, Ireland was in containment phase, and detailed case-based epidemiological information was gathered on all cases presenting in the community and acute health care setting. Active case finding was performed among contacts of cases. Eighty percent of cases were in people less than 35 years of age and 86% were imported. The most frequent symptoms were fever, sore throat, myalgia and dry cough. Nine people were hospitalized, no fatalities occurred.

Risk groups and uptake of influenza and pneumococcal vaccine in Ireland

In Ireland, influenza and pneumococcal vaccines are recommended for adults aged 65 years and over and for those with chronic illness or immunosuppression. Influenza vaccine is recommended for healthcare workers (HCWs) and residents of long stay care facilities. Influenza vaccine uptake is only available for those aged 65 years and over. We conducted a survey to estimate the size of risk groups between 18 and 64 years of age, influenza and pneumococcal vaccine uptake in this group, and to determine possible factors influencing vaccine uptake to improve targeted immunisation programmes. Among respondents aged 18-64 years, 136 of 1,218 (11%) belonged to a health risk group; uptake of influenza and pneumococcal vaccine in these risk groups was 28% (95% CI: 20.9-35.4) and 11% (95% CI: 6.7-17.2) respectively. Uptake among persons aged over 65 years was 69% (95% CI: 62.2-74.4) and 41% (95% CI: 35.0-47.9) for influenza and pneumococcal vaccine, respectively. Influenza vaccine uptake among HCWs was 20% (95% CI: 13.1-28.7). Half (47.6%) of influenza-vaccinated respondents reported that their family doctor had recommended it; 60% of non-vaccinated respondents, for whom influenza vaccine was indicated, saw themselves at low risk of influenza.

Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000

In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.

Acute gastroenteritis in northern Ireland and the Republic of Ireland: a telephone survey

Most people with acute gastroenteritis do not seek medical care and are therefore not captured by routine surveillance. For this reason, population-based studies are needed to measure the burden of illness. A study of acute gastroenteritis in Northern Ireland and the Republic of Ireland surveyed 9,903 people by telephone over the 12-month period from December 2000 to November 2001. The rate of acute gastroenteritis was 0.60 episodes per person per year. A general practitioner was consulted by 29.2% of those reporting illness, and 2.0% submitted a stool sample. The use of antibiotics was reported by 7.4% of ill respondents and 14.8% took anti-diarrhoeals. Taking days off work due to illness, was reported by 17.4% of respondents. Acute gastroenteritis causes a large amount of illness in the community. There are established and effective measures to prevent this condition and the challenge is to find new ways of promoting these precautions.

Tuberculosis in the Republic of Ireland at the end of the 1990s

There has been limited detailed epidemiological data available on tuberculosis in the Republic of Ireland. The 1998 and 1999 National TB Reports produced by the National Disease Surveillance Centre presented disaggregate national data describing in detail the epidemiology of TB in the Republic of Ireland. Individual case notifications were collated by health boards, forwarded to NDSC where they were entered onto a national TB database and then analysed using Epi-Info. There were 893 cases of TB notified in 1998-1999. It was more common in older age groups and men. 50% of cases occurred in those less than 45 years, an indication of considerable ongoing transmission of tuberculosis. Regional variation in the rate of TB exists and a relatively small proportion of cases occurred in foreign-born patients. TB in HIV positive patients was not common and MDR-TB has also been observed. TB has not disappeared from the Republic of Ireland. Treatment, contact tracing and surveillance need to be maintained and preferably enhanced.

Outbreak of Vero cytotoxin-producing Escherichia coli O157 in a child day care facility

In December 1998, an outbreak of Vero cytotoxin-producing Escherichia coli (VTEC) O157 in a crèche affected ten out of 45 children and one out of five staff members. Eight cases were symptomatic and three were asymptomatic. There were two asymptomatic adult family contacts of child cases. All specimens were identified as VTEC O157:H7, phage type 32. None of the cases were seriously ill and none developed haemolytic uraemic syndrome (HUS). One child continued to excrete the organism for 14 weeks. The origin of the outbreak was not found but epidemiological investigation was suggestive of person-to-person spread. All children and staff were screened and excluded from the crèche until microbiological clearance was obtained. An inspection of the crèche revealed overcrowding and inadequacies in cleaning and in the food preparation facilities. These problems were remedied before children were re-admitted to the crèche. This outbreak demonstrates the ease with which VTEC O157 can be transmitted between small children. Two specific features of this outbreak were notable: (1) the mild self-limiting nature of the illness and (2) the prolonged shedding of the bacterium by one child.

Outcome of medical screening of Kosovan refugees in Ireland: 1999

In March 1999 armed conflict broke out in Kosova and about 900,000 ethnic Albanians were displaced. We reviewed the health care offered to the 945 Kosovan refugees who arrived in Ireland in 1999, which included screening for tuberculosis (TB) and hepatitis B. On arrival in Ireland 540 refugees had already received oral polio vaccine (57%), 512 diphtheria, tetanus, and acellular pertussis or diphtheria and tetanus vaccine (54%), 310 BCG (33%), 207 measles, mumps, and rubella vaccine (22%) and 60 Haemophilus influenzae type b (6%). Twelve refugees were diagnosed with TB. Twenty-six refugees were HBsAg positive (3%) and 168 were anti-HBcAg positive (18%). Organised screening of Kosovan refugees on a voluntary basis (uptake > 95%) revealed low percentages who had been immunised and relatively high rates of TB and hepatitis B. The provision of optimum immunisation, screening, and treatment services to address these issues requires substantial staffing and financial resources.

Surveillance of tuberculosis in Ireland

The first disaggregate data on tuberculosis in Ireland were collected in 1998. A total of 424 cases were notified (rate 11.7/100 000 population), of which 241 cases were culture positive and 122 were smear positive pulmonary cases. Only 35 cases were fore

A survey of Irish palliative care services

There has been no national policy directing the development of palliative care services in Ireland. Over the last 25 years different palliative care services have been established around the country, due largely to a strong and concerted effort on the part of voluntary groups. A study was carried out to determine the structure and process of all adult palliative care services in Ireland, to determine, where possible, the costs of providing these services and to assess the need for palliative care services in Ireland. All adult palliative care services (24 home care services, three inpatient services and one acute hospital service) in existence at the end of 1993 were circulated and 26 returns received (response rate 93 per cent). Twenty-five counties were covered by palliative care services, serving approximately three-quarters of the national population. Less than 10 per cent of patients had non-cancer diagnoses. Wide variation in staffing levels, workload, travelling, assessment of need and finance arrangements was reported. There is a need for further debate on the breadth and scope of palliative care services that should ideally be provided in Ireland, and how they should be funded in the future.

The overnight dexamethasone test is the procedure of choice in screening for Cushing's syndrome

This study was undertaken to examine the performance of the overnight dexamethasone test, i.e., plasma cortisol level at 8-9 AM following dexamethasone 1 mg by mouth at midnight, in screening for Cushing's syndrome. The participants included 19 patients with Cushing's syndrome (17 with Cushing's disease, 1 with adrenal carcinoma, and 1 with ectopic ACTH syndrome) and 96 patients in whom the possibility of Cushing's syndrome was raised but who did not have the disorder. Utilizing our original very conservative cutoff point of plasma 100 nmol/L (3.62 micrograms/dL) above which Cushing's syndrome was suspected, the sensitivity of the test was 100% but the false positive rate was an unsatisfactory 12.5%. However, the lowest plasma cortisol level achieved following the overnight dexamethasone test in patients with Cushing's syndrome was 259 nmol/L (9.39 micrograms/dL). A plasma cortisol cutoff point of 250 nmol/L (9.06 micrograms/dL) yielded no false negatives and the false positive rate fell to 6.25%. Using a cutoff point of 200 nmol/L (7.24 micrograms/dL) the false positive rate was 7.3%. These performance characteristics of the overnight dexamethasone test compare very favorably with the reported experience of all other screening procedures for Cushing's syndrome including the urinary free cortisol excretion rate and the 48 h dexamethasone test, while the overnight dexamethasone procedure is the simplest for both patients and medical personnel. Since it is possible that some very unusual patients may suppress to plasma cortisol levels lower than that seen in the present study, we now recommend the overnight dexamethasone test using a plasma cortisol cutoff point of 200 nmol/L as the procedure of choice when screening for patients with Cushing's syndrome.

TSH as an index of L-Thyroxine replacement and suppression therapy

When hypothalamic-pituitary function is normal, serum TSH levels measured by ultrasensitive assay yield bioassays of endogenous thyroid action and thus provide an ideal index of thyroid secretion and its relationship to fluctuating endogenous thyroid levels. It is theoretically possible that patients receiving exogenous L-thyroxine for primary hypothyroidism should have suppressed TSH levels if physiological needs are constantly met. To examine this possibility free thyroxine, FT4 and TSH were measured in 90 clinically euthyroid patients receiving treatment with L-thyroxine for primary hypothyroidism. TSH levels were normal in 44, suppressed in 16 and elevated in 30 patients. FT4 levels were normal in 68, elevated in 13 and suppressed in 9 patients. Normal TSH levels were associated with normal FT4 levels in 79.5% of patients, elevated FT4 levels in 13.6% and low FT4 in 6.8%. Suppressed TSH levels were associated with elevated FT4 levels in 37.5% of patients and normal FT4 levels in 62.5%. When FT4 levels were normal, however, TSH levels were normal in only 51.5% and abnormal in 48.5%. We also examined the possibility that FT4 levels may remain within normal range when TSH is suppressed during L-thyroxine treatment for goitre or cancer. FT4 and TSH were measured in 45 patients on L-thyroxine as TSH suppression treatment. TSH was suppressed in 23 patients (51.1%), normal in 20 (44.4%) and elevated in 2 (4.5%). When TSH was suppressed, FT4 was elevated in 30.4% but normal in 69.6% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nelson's syndrome following partial pituitary microadenomectomy and pregnancy

We report for the first time the development of Nelson's syndrome in a patient who had previously undergone unsuccessful pituitary microadenomectomy and subsequently bilateral adrenalectomy. The removal of a 3-mm portion of a microadenoma did not protect against the development of Nelson's syndrome within 3 years which was closely related to pregnancy, a previously noted association. This report suggests that the development of Nelson's syndrome depends not on the size of the initial pituitary tumour but rather on its individual potential for proliferating once free of the inhibitory effects of glucocorticoid excess.

Sex steroids, adiposity and smoking in the pathogenesis of idiopathic hirsutism and polycystic ovary syndrome

Hyperestronemia may be central to the development of polycystic ovary syndrome. The present study was designed to examine whether increased availability of androstenedione or increased aromatase closely associated with adiposity, plays the dominant role in the development of hyperestronemia. We measured plasma androstenedione, estrone and the estrone/androstenedione ratio (an indirect index of peripheral aromatase activity), in 141 patients with idiopathic hirsutism and in 88 patients with polycystic ovary syndrome. Estrone levels were higher in polycystic ovary syndrome, 250.4 +/- 129 (mean +/- standard deviation) than in idiopathic hirsutism, 210.6 +/- 119 pmol/l, p less than 0.05. Plasma androstenedione levels were higher in polycystic ovary syndrome, 8.24 +/- 3.5, than in idiopathic hirsutism, 7.1 +/- 1.7 nmol/l, p less than 0.0025. However, the estrone/androstenedione ratio was similar in the two groups. In all patients who smoked, androstenedione was higher, 8.14 +/- 3.22 than in nonsmokers, 6.99 +/- 2.96 nmol/l, p less than 0.005. Smokers had a lower body mass index, 23.9 +/- 2.3, than non-smokers 25.6 +/- 4.8 kg/m2, p less than 0.025. However, estrone levels were similar in smokers and in non-smokers. These data indicate that elevated estrone is more closely related to increased availability of androstenedione than to increased aromatase activity. While cigarette smoking appears to increase androstenedione levels, it may inhibit aromatase activity either directly or indirectly because of an associated reduction in adiposity. However, since the relative frequency of polycystic ovary syndrome and idiopathic hirsutism was similar in smokers and non-smokers, smoking did not appear to reduce estrone bioactivity as had been claimed.

The overnight dexamethasone test is a worthwhile screening procedure

The overnight low-dose dexamethasone test is a convenient screening procedure for Cushing's syndrome. Claims that the test is associated with a high incidence of 'false positives', rendering it of little value particularly in obese and hospital in-patients, have been investigated in the present study. The data from 100 consecutive subjects undergoing overnight low-dose dexamethasone tests to examine for the possibility of Cushing's syndrome, were reviewed. Cushing's syndrome was identified in four patients, normal suppression of cortisol values occurred in 84 patients and 12 patients exhibited false positive results. Differences in body weights, body mass indices or in-patient status did not distinguish between those subjects with normal suppression of plasma cortisol and those subjects who yielded false positive results. These data indicate that the simple overnight dexamethasone test substituted for the more cumbersome traditional 48-h dexamethasone test in 84 of 96 patients who did not have Cushing's syndrome. Thus the overnight test provides a useful screening procedure but a small percentage of patients, approximately 12.5%, will require additional procedures to exclude Cushing's syndrome.