Large Health Center Research Articles

Effects of earthquake on perinatal outcomes: A Chilean register-based study.

BackgroundNatural disasters increase the level population stress, including pregnant women, who can experience prenatal maternal stress, affecting the fetus and triggering perinatal complications, such as low birth weight, smaller head circumference, etc. However, little is known about effects of earthquake on perinatal outcomes.ObjectiveTo evaluate the effect of earthquake occurred on February 27, 2010 and perinatal outcomes of Chilean pregnant women, and to examine these effects by timing of exposure during pregnancy and newborn gender.MethodsA register-based study was performed using data collected from women who had a vaginal delivery in a large private health center in Santiago, Chile, during 2009 and 2010. The study population was categorized according to exposure to earthquake and timing during gestation. Primary perinatal outcomes were gestational age at birth, birth weight, length and head circumference. Analyses adjusted for gender, gestational age at exposure, parity, maternal age and income.ResultsA total of 1,966 eligible vaginal deliveries occurred during 2009 and 2,110 in 2010. Birth weight was not affected by the trimester of exposure; however, length, head circumference and gestational age at birth were significantly different according to trimester of exposure and gender of newborn. In multivariable analysis, newborns were shorter by 2 mm, 5 mm and 4.5 mm, if they were exposed during their first, second and third trimester, respectively. Furthermore, newborns had a smaller head circumference by 1.2 mm and 1.5 mm if they were exposed during first and second trimester of gestation.ConclusionIn this cohort, exposure to the February 2010 earthquake resulted in earlier delivery and reduced length and head circumference in the offspring. This association varied according to trimester of exposure and fetal gender. Health workers should include exposed to high levels of stress associated with natural disasters when assessing pregnancy risk factors.

Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial.

Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

Towards developing a programme theory for the uptake of a national retinopathy screening programme in Ireland: a realist evaluation

Introduction: In 2013, the national diabetic retinopathy screening programme (NDRSP) was introduced in Ireland to offer free, regular retinopathy screening to people with diabetes. Ensuring a high uptake of a national retinopathy screening programme is challenging [1]. Non-attendance for screening has been identified as a risk factor for poor visual outcomes among those with diabetes [2]. Suboptimal uptake has been previously highlighted by regional screening programmes in Ireland, with attendance rates ranging from 49-80% [3-5]. Therefore, it is essential and timely to understand factors that facilitate or deter screening attendance as the NDRSP is implemented. The aim of this study was to identify and explain why the NDRSP was working (or not working), for whom and in what circumstances to produce outcomes. Methods: This study was guided by a realist evaluation framework and adopts a multi-stage mixed methods design. Qualitative data from documents and semi-structured interviews with a purposive sample of national stakeholders (n=19) were used to develop the initial programme theories. These theories were tested in two large primary health centre in Ireland. Quantitative data extracted the medical records of all adults aged ≥18 years with diabetes registered with the practices were collected to establish uptake rates. A qualitative component was conducted using semi-structured interviews. Sampling was based on four outcome groups identified during the quantitative component of the study: consenting, attending, non-attending, not consenting. Framework analysis was used to identify factors that influenced the decision to participate in the NDRSP. Results: Against the back drop of a variation in existing retinopathy screening services, it was expected that members of the target population would decide to attend the NDRSP and a national uptake of 80% would be achieved. A total of 581 people with diabetes were included in the quantitative analysis. Over a 14 month period, the uptake of the screening programme was 63%. Qualitative analysis suggested that a fear of blindness and a belief that retinopathy screening could reduce the risk of diabetes-related blindness enabled screening attendance. Having had a recent eye examination at another screening provider was a common reason for not attending the NDRSP. No relative advantage of attending the NDRSP over exiting screening providers was a barrier to consenting to the newly established service. Discussion/conclusion: Little is known about the characteristics which determine the uptake of retinal screening among those with diabetes in Ireland. Findings from this research will inform the ongoing implementation of the national diabetic retinopathy screening programme and its advertising and recruitment activities. Lessons learned: It is important that efforts to increase the uptake of the NDRSP include increasing the awareness around this change in service provision among members of the target population. Limitations: In the absence of national level data, quantitative analysis relied on data from two primary health care centres. Future research: This study is part of an ongoing evaluation of the National Clinical Programme for Diabetes. Findings from this research will be verified and refined during a multiple case study in four geographical regions in Ireland.

HIV Status Disclosure Among Postpartum Women in Zambia with Varied Intimate Partner Violence Experiences.

HIV-positive pregnant and postpartum women's status disclosure to male sexual partners is associated with improved HIV and maternal and child health outcomes. Yet, status disclosure remains a challenge for many women living with HIV in sub-Saharan Africa, particularly those who are fearful of violence. The objective of the present study is to advance the current understanding of the relationship between intimate partner violence against women and their HIV status disclosure behaviors. We specifically evaluate how the severity, frequency, and type of violence against postpartum HIV-positive women affect status disclosure within married/cohabiting couples. A cross-sectional survey was administered by trained local research assistants to 320 HIV-positive postpartum women attending a large public health center for pediatric immunizations in Lusaka, Zambia. Survey data captured women's self-reports of various forms of intimate partner violence and whether they disclosed their HIV status to the current male partner. Multiple logistic regression models determined the odds of status disclosure by the severity, frequency, and type of violence women experienced. Our findings indicate a negative dose-response relationship between the severity and frequency of intimate partner violence and status disclosure to male partners. Physical violence has a more pronounced affect on status disclosure than sexual or emotional violence. Safe options for women living with HIV who experience intimate partner violence, particularly severe and frequent physical violence, are urgently needed. This includes HIV counselors' ability to evaluate the pros and cons of status disclosure among women and support some women's decisions not to disclose.

Abstract 560: Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function the Paris Prospective Study III

Objective: We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA). Approach and Results: Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.55 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima–media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young’s elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41). Conclusions: In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.

Unveiling Missed Opportunities for Providing Prevention of Mother to Child Transmission of HIV (PMTCT) Intervention at Immunization Clinics: A Case Study of a Large Primary Health Centre in Nigeria

Unveiling Missed Opportunities for Providing Prevention of Mother to Child Transmission of HIV (PMTCT) Intervention at Immunization Clinics: A Case Study of a Large Primary Health Centre in Nigeria

Barriers to uptake of early infant HIV testing in Zambia: the role of intimate partner violence and HIV status disclosure within couples

BackgroundEarly detection of pediatric HIV through uptake of infant HIV testing is critical for access to treatment and child survival. While structural barriers have been well described, a greater understanding of social and behavioral factors that may relate to maternal uptake of early infant HIV testing services is urgently needed. The aim of this study was to explore how gender power dynamics within couples affect HIV-positive women’s uptake of early infant HIV testing at a large health center in Lusaka, Zambia.MethodsIn 2014, 320 HIV-positive married postpartum women were recruited at a large public health facility in Lusaka to participate in a cross-sectional survey. Data on uptake of early infant HIV testing by 4–6 weeks of age was collected through medical records. Simple and multiple logistic regression models determined significant predictors of maternal uptake of early infant HIV testing.ResultsIn the adjusted model, uptake of early infant HIV testing was associated with female-directed emotional intimate partner violence (aOR 0.41; 95% CI 0.21–0.79; p < 0.01), HIV status disclosure to the male partner (aOR 13.73, 95% CI 3.59–52.49, p < 0.001), and maternal postpartum ART adherence (aOR 2.28, 95% CI 1.15–4.55, p < 0.05).ConclusionsDomestic relationship dynamics, including emotional violence and HIV status disclosure to the male partner, may play an important role in maternal uptake of early infant HIV testing. These findings provide additional evidence for the link between intimate partner violence against women and poor HIV-related health outcomes. Programs that adequately screen for and address various forms of intimate partner violence within the context of prevention of mother-to-child transmission are recommended.

Understanding and Improving Knowledge of Cancer Survivorship Care Among College Providers.

This study aimed to assess college providers' basic knowledge of the health risks of young adult cancer survivors (YAS) and related care guidelines and to determine whether an educational in-service is an effective platform for increasing college health providers' knowledge about survivorship care at a large university health center. During phase 1, staff from college health centers and office of disabilities in the Philadelphia area (n=40 staff members from 24 colleges/universities) completed a needs assessment on their experiences with YAS and preferences for education and care coordination. During phase 2, a 1-h educational in-service, informed by results of the survey, was provided to 18 health center medical providers. While most providers indicated that YAS are at risk for chronic health conditions because of cancer treatment, nearly all were unfamiliar with the content of published long-term follow-up guidelines for cancer survivorship. Over half did not have knowledge of cancer survivorship services in their area. All respondents were interested in more education on cancer survivorship care. Attendees of the in-service increased their knowledge of survivorship follow-up guidelines, awareness of local survivorship resources, and comfort with caring for YAS at posttest relative to baseline. The in-service was highly acceptable to providers and feasible to implement. College providers had little baseline knowledge of cancer survivorship guidelines, but were motivated to obtain more information. Through an educational in-service, college health providers may be better equipped to provide acute and longitudinal survivorship care to a vulnerable population who are at risk for inadequate engagement in risk-based follow-up care.

Long-Acting Injectable Antipsychotics for Schizophrenia: Sociodemographic Characteristics and Treatment Adherence.

Long-acting injectable (LAI) antipsychotic medications are employed universally for the treatment of schizophrenia. This study retrospectively assessed the variables that factor into an individual's adherence to LAIs. The data sample was obtained from the adult ambulatory services of a large general hospital mental health center located in Elizabeth, New Jersey. Reports were run in November 2015 to identify patients who had received at least 1 LAI between January 1, 2014, and October 14, 2015. In September 2016, an additional report was run to collect follow-up data. The sample included 120 women and 178 men, ranging in age from 18-81 years, who received at least 1 LAI during a 23-month period. A hazard analysis for single-decrement, nonrepeatable events was used to assess the risk of discontinuation of LAIs during the study period. Separate χ² analyses were conducted to assess differences in discontinuation rates for sociodemographic variables, program type variables, type of long-acting medication, and time effects. The cumulative continuation rate across the study period was 73%. Main effect differences were found in continuation rates for program type (χ²₂undefined= 10.252, P = .006), LAI type (χ²₅ = 23.365, P < .000), and prescribed frequency of LAI (χ²₂ = 7.622, P = .022). In addition, multiple time-dependent effect differences were found. No significant main effect results were found for LAI continuation rates and patient age (χ²₃ = 3.689, P = .297), sex (χ²₁ = 0.904, P = .342), race (χ²₃ = 5.785, P = .123), or enrollment in involuntary outpatient commitment (χ²₁ = 2.989, P = .084). The findings of the current research suggest that medication type, frequency of medication appointments, and program type may be key in increasing and maintaining LAI adherence.

Robert P C MacDonald

Robert P C MacDonald (“Dr Mac”) was a GP on the Hoo Peninsula, where he joined his brother in law, Bob Tilley, who had taken on a small practice in...

Abstract P3-10-10: Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery

Abstract Interrogative examination of wait times for the pathway steps leading to diagnosis, surgical treatment, and oncology consultation for breast cancer within a geographically dispersed publically funded health authority led to advocacy for and establishment of two large one-stop Breast Health Centres (BHCs) within the largest urban cities. One year after publication of the 2000 EUSOMA guidelines for breast cancer diagnosis and treatment, regional breast cancer pathways and wait times did not meet guidelines. Population median wait time from date of first investigation to tissue diagnosis was 2.7 or 5.9 weeks (for clinical presentation or screen presentation respectively), 6.0/7.0 weeks to definitive surgical intervention, and 14.3/11.7 weeks to oncology consultation. Only 39 % of patients were diagnosed initially via core needle biopsy. 5 % of patients underwent immediate reconstructive surgery. Due to wait times for initial imaging (mammogram, ultrasound) at hospital facilities, baseline imaging was often performed at private imaging labs without needle diagnostic capability, and repeated again with a series of wait times at the hospitals - as the initial community images were not accessible to the hospital interventional radiologists. Smaller communities and their hospitals maintained shorter wait times in comparison to the large urban centres. Repeat population based measurement in 2009 indicated wait times were unchanged, and MRI guided biopsy was still not available within the region. Nursing support and patient education re breast cancer prognosis and treatment was not available until the time of oncology consultation. BHCs were planned, funded by the Ministry of Health, established in physical conjunction with the breast screening programs, and became operational as of early 2012. During the first year of BHC operation, population median wait time from date of first investigation was 2.0 weeks for tissue diagnosis, 6.4 weeks for final definitive surgical intervention, and 9.4 weeks for oncology consultation. 90 % of patients were initially diagnosed via initial core needle biopsy with IHC staining for ER, PR, and HER2. Patients served by the BHCs had nurse navigator support and education from time of presentation. The surgical team overcame regional surgical wait time barriers such as available admission beds by establishing the first comprehensive population-based outpatient mastectomy and reconstruction program in Canada with over 1200 performed to date. These wait times have been maintained in spite of increase in the HA population from 1.2 million to 1.6 million during the project timeline. Citation Format: Martin LA, Janzen R, Wong F, Doris P. Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-10.

Postpartum intrauterine contraceptive device: Knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health center in Puducherry, India

Context: Intrauterine contraceptive device (IUCD) has been recommended for insertion within 10 min of placental delivery or within 48 h of delivery (postpartum IUCD [PPIUCD]) by the WHO. However, the acceptance across our country has been low. Aims: To determine the level of knowledge and the factors affecting it and the likely adoption of PPIUCD. Settings and Design: This cross-sectional study was carried out in the antenatal clinic and postnatal ward of a large tertiary care center in South India. Subjects and Methods: A total of 339 women were studied with the help of a validated structured pro forma. Proportions were expressed in percentage. Chi-square test was applied to compare proportions and univariate analysis for the factors affecting knowledge and likely acceptance. Results: Among the 339 women, 152 (44.8%) were aware of the method. Of the 152 women, 56 had a negative attitude about the method. Multiparity of the women was a significant factor affecting knowledge (χ2 = 8.068, P = 0.045). Women who were not exposed to formal health counseling were significantly associated with a lack of knowledge (χ2 = 23.332, P = 0.0001). Primiparity (χ2 = 14.683, P = 0.0001), husbands with skilled jobs (χ2 = 8.272, P = 0.0407), having shared information with their husband regarding the method (χ2 = 38.1, P

Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function: The Paris Prospective Study III.

We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA). Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.5 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima-media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young's elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41). In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.

Cervical cancer screening after 50: near extinction?

ObjectivesThe objectives of this study were to determine the prevalence and predictors of Pap smear screening among women aged 50 years and older. Study designThis cross-sectional study was conducted at two large urban health centres in Selangor. A total of 515 women aged 50 and older were recruited. ResultsThe mean age of the respondents was 58.83±7.05, with a range of 50– 83 years. The prevalence of Pap smear screening was 39.22% (n=202). From the multivariate analysis, Pap smear screening was significantly associated with health care provider advice (adjusted odds ratio (AOR)=18.75; 95% CI=8.30, 42.37); tertiary (AOR=11.26; 95% CI=1.50, 84.68) and secondary education level (AOR=9.47; 95% CI=1.43, 62.84); use of contraception (AOR=2.90; 95% CI=1.48, 5.69); heart disease (AOR=0.22; 95% CI=0.05, 0.97); and worry about Pap smear results (AOR=0.20; 95% CI=0.09, 0.42). ConclusionThe prevalence of Pap smear screening in the older women is unsatisfactory. Health care provider advice, education level, use of contraception, heart disease and worry about Pap smear results were predictors of undergoing Pap smear screening in this study population.

Intimate Partner Violence Against HIV-Positive Women is Associated with Sub-Optimal Infant Feeding Practices in Lusaka, Zambia.

Objectives The aim of this study is to determine how intimate partner violence against HIV-positive women affects safe infant feeding practices in Lusaka, Zambia. Methods A cross-sectional face-to-face survey was conducted with 320 married postpartum women at a large public health center in Lusaka, Zambia, in 2014. Variables were measured using previously validated instrumentsfrom the Demographic and Health Survey. Data were analyzed using simple and multivariate logistic regression in Stata 12. Results Thirty-seven percent of women report early mixed infant feedingprior to six months. Women who experienced intimate partner violence have 2.8 higher adjusted odds of early mixed infant feeding (p<0.001). Women who experienced emotional violence, specifically, have 1.9 higher adjusted odds of early mixed infant feeding (p<0.05), while women who experienced sexual violence have 2.3 higher adjusted odds (p<0.01). There is also a dose-response relationship between IPV and early mixed infant feeding(p < 0.05). Lastly, disclosing one's HIV-positive status to the husband is associated with at least 67% lower adjusted odds of early mixed feeding (p<0.05). Conclusions Intimate partner violence against HIV-positive women, in particular emotional and sexual violence, increases the likelihood of early mixed infantfeeding, putting infants at greater risk for both mother-to-child transmission of HIV and other infant morbidities. Intimate partner violence should thusbe given increased attention within the context of infant feeding and HIV in sub-Saharan Africa.

Health nurses’ experiences and attitudes regarding collaboration with dental personnel

BackgroundCollaboration between primary care personnel and dental personnel to prevent early childhood caries has been established in several countries. The purpose of this study was, firstly, to describe health nurses’ experiences and attitudes regarding collaboration with dental personnel, and secondly, to identify characteristic of health nurses and health centres associated with the collaboration.MethodsHealth nurses working with children answered a questionnaire. In total, 163 of 296 health nurses (55 %) reported demographic information, referral routines, frequency of and reasons for referral of young children to dental personnel, contact with dental personnel and satisfaction with the collaboration. Data were analysed using multivariate logistic regression.ResultsThe majority of health nurses (83 %) were familiar with referral routines and 31 % reported referring children to dental personnel monthly or more often. The most frequent reasons for referral were clinical caries (52 %), dental discolouration (38 %) and dental trauma (34 %). Few health nurses (18 %) had contact with dental personnel monthly or more often. Two-thirds of health nurses (71 %) reported being satisfied with the collaboration with dental personnel. Results of multivariate analysis showed that health nurses were more likely to refer children when the proportion of immigrant children under care in the health centres was high than when proportion of immigrant children was low (OR 6.4, CI 2.7–14.9). Health nurses working in small health centres were more likely to be satisfied with the collaboration than health nurses working in large health centres (OR 3.2, CI 1.4–7.0). Health nurses 45 years or older were more likely to possess knowledge of referral routines than younger health nurses (OR 2.7, CI 1.1–6.4).ConclusionsThe results indicated that the majority of health nurses possessed knowledge of collaboration routines and were satisfied with the collaboration. The proportion of immigrant children under care in the health centres, the size of the health centres and the age of health nurses were factors influencing the collaboration between primary care personnel and dental personnel.

Social and clinical dimensions of citizenship from the mental health-care provider perspective.

Citizenship is a theoretical framework regarding social inclusion and community participation of people with mental illnesses. It is defined by a person's connection to rights, responsibilities, roles, resources, and relationships. The application of this framework in public mental health settings is in its early stages. This study was an exploration of mental health providers' views of the potential contribution of this framework. Eight focus groups were conducted with 77 providers on teams in a large mental health center. A 12-item brief version of a 46-item measure of citizenship was a starting point for discussion of the relevance of the framework and citizenship supports in public mental health care. Two themes were presented: social, including relatedness, stigma, and meaningful choices, and clinical, including client empowerment and barriers to citizenship work in clinical settings. These themes are discussed in relation to the introduction of citizenship-oriented practices in mental health care. Participant comments reflect openness to the concept of citizenship and the need for greater access to normative community life for clients, but also skepticism regarding the ability of providers and mental health centers to incorporate citizenship approaches in current care models. Findings suggest there are challenges to developing and implementing citizenship supports in public mental health settings based on social and clinical factors and limitations. However, it is also noted that efforts to address challenges through consultation and education of providers can support the goal of a life in the community for persons with mental illness. (PsycINFO Database Record

O003 Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey

<h3>Background/introduction</h3> Apart from penile–anal intercourse, other anal sexual practices (oral-anal contact or rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). <h3>Aim(s)/objectives</h3> The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM. <h3>Methods</h3> A cross-sectional survey was conducted among MSM attending a large urban sexual health centre between July 2014 and June 2015. Rectal gonorrhoea cases were identified by culture. <h3>Results</h3> Among 1312 MSM, 4.3% (n = 56) had rectal gonorrhoea. Anal sexual practices, other than anal-penile sex, were common among MSM: receptive oro-anal (rimming) (70.5%), receptive fingering or penile-perianal contact i.e dipping (84.3%) and using partner’s saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant (adjusted OR 2.17; 95% CI 1.00 to 4.71) was significantly associated with rectal gonorrhoea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhoea. The crude population attributable fraction of rectal gonorrhoea associated with use of partner’s saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%). <h3>Discussion/conclusion</h3> Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if a message of prevention is included in not using partner’s saliva for anal sex.

Abstract P164: Ideal Cardiovascular Health and Vascular Aging

Background: Arterial stiffness is a robust subclinical marker of cardiovascular disease (CVD). Furthermore, under the vascular aging concept, arterial stiffness also reflects the cumulative exposure to environment over life. Studying whether and how cardiovascular health (CVH) at a given point in time correlates with arterial stiffness may help identifying asymptomatic subjects who are at high risk for future CVD and who could benefit the most from interventions. Here, we hypothesized that ideal CVH would be inversely associated with arterial stiffness. Methods and results: Common Carotid Artery IMT (CCA-IMT), carotid stiffness (Elastic Young’s modulus) and carotid distensibility were measured by three trained technicians certified in vascular echography using high-precision echotracking device in 6457 participants attending a health check up in a large health center in France between 2008 and 2012. Participants were categorized as having poor, intermediate and ideal cardiovascular health if they had 0-2, 3-4 and 5-7 ideal health metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure). Carotid parameters were dichotomized according to their median value and multivariable logistic regression analysis was performed to examine the relationship between ICVH (exposure variable) with each carotid parameter (outcome). Mean age was 59.4 (SD 6.2) years and 38.2 % were females. Poor, intermediate and ideal cardiovascular health was present in 39.93%, 49.75% and 10.32% of study participants. Mean CCA-IMT was 654.47 (SD 117.77) and 612.45 (SD 113.86) micrometers in subjects with a poor and an ideal CVH respectively, corresponding to an absolute difference of 42 micrometers. After multivariable adjustment and compared to poor ICVH, ideal CVH was associated significantly with lower CCA-IMT (odds ratio = 1.76; 95% CI: 1.46;2.11) and carotid stiffness (odds ratio = 2.19; 95% CI: 1.83;2.63), and higher carotid distension (odds ratio = 2.81; 95% CI: 2.34;3.39). Theses associations were stronger in magnitude with the biological as compared to the behavioral component. Conclusion: In asymptomatic subjects aged 50-75, an ideal cardiovascular health was associated with significantly less arterial stiffening. The absolute difference in CCA-IMT beteween ideal and poor CVH corresponds to a 4.2 years difference in vascular aging. This dramatic difference supports the promotion of ideal cardiovascular health. Key words: Cardiovascular disease prevention, epidemiology, Carotid intima-media thickness, Vascular aging.

Husband's Alcohol Use, Intimate Partner Violence, and Family Maltreatment of Low-Income Postpartum Women in Mumbai, India.

Husbands' alcohol use has been associated with family-level stress and intimate partner violence (IPV) against women in India. Joint family systems are common in India and IPV often co-occurs with non-violent family maltreatment of wives (e.g., nutritional deprivation, deprivation of sleep, blocking access to health care). Alcohol use increases for some parents following the birth of a child. This study examined 1,038 postpartum women's reports of their husbands' alcohol use and their own experiences of IPV (by husband) and non-violent maltreatment from husbands and/or in-laws. We analyzed cross-sectional, quantitative data collected in 2008, from women (ages 15-35) seeking immunizations for their infants <6 months at three large urban health centers in Mumbai, India. Crude and adjusted logistic regression models estimated associations between the independent variable (husbands' past month use of alcohol) and two dependent variables (postpartum IPV and maltreatment). Overall, 15% of husbands used alcohol, ranging from daily drinkers (10%) to those who drank one to two times per week (54%). Prevalence of postpartum IPV and family maltreatment was 18% and 42%, respectively. Prevalence of IPV among women married to alcohol users was 27%. Most abused women's husbands always (27%) or sometimes (37%) drank during violent episodes. Risk for IPV increased with a man's increasing frequency of consumption. Women who lived with a husband who drank alcohol, relative to non-drinkers, were more likely to report postpartum IPV, aOR = 2.0, 95% confidence interval (CI) = [1.3, 3.1]. Husbands' drinking was marginally associated with increased risk for family maltreatment, aOR = 1.4, 95% CI = [1.0, 2.1]. Our findings suggest that men's alcohol use is an important risk factor for postpartum IPV and maltreatment. Targeted services for Indian women contending with these issues are implicated. Postpartum care offers an ideal opportunity to screen for IPV, household maltreatment, and other health risks, such as husband's use of alcohol. There is need to scale up proven successful interventions for reducing men's alcohol use and design strategies that provide at-risk women protection from alcohol-related IPV.