Health-related quality of life and psychosocial impacts of a diagnosis of non-specific genital infection in symptomatic heterosexual men attending UK sexual health clinics: a feasibility study.

Introduction Non-specific genital infection (NSGI; non-Chlamydia trachomatis, non-Neisseria gonorrhoeae-associated urethritis) is a common diagnosis in symptomatic heterosexual men attending UK sexual health clinics (SHCs). but little is known about the psychosocial impact of this diagnosis. Methods We conducted an observational study among symptomatic heterosexual men attending SHCs to evaluate the psychosocial impact of an NSGI diagnosis compared with a diagnosis of Chlamydia trachomatis (CT), Neisseria gonorrhoeae or no abnormalities detected focusing on the feasibility of our study methodology. Participants completed a computer-assisted self-interviewing (CASI) including two validated measures of psychosocial impact: the EQ-5D-5L health-related quality of life and Rosenberg Self-Esteem Scale, before diagnostic testing and 2 weeks after receiving test results (follow-up 1 (FU-1)) and a qualitative interview. We compared scores between diagnostic groups using paired t-tests, qualitative data were analysed thematically and feasibility was assessed by process analysis. Results 60 men completed the baseline CASI (75% response rate). 46 (76.6%) were eligible for follow-up; 11/46 (23.9%) completed the follow-up CASI, and 3/11 (27.3%) completed the qualitative interview. 81.7% of all participants left CASI feedback at baseline: 73.5% reported the questionnaire as ‘fine’ or ‘very good’. Qualitative interview participants reported the study was acceptable. Compared with baseline, among patients completing FU-1, only patients with a diagnosis of NSGI (p<0.05) or CT (p<0.05) showed increased EQ-5D-5L Index, whereas patients with a diagnosis of NSGI (p=0.05) showed decreased mean Rosenberg Self-Esteem Scale score. Conclusions Although most participants indicated study acceptability at baseline, and we employed measures to increase retention (CASI questionnaires, reminder messages and a focus on men’s health), we experienced high loss to follow-up. We found that heterosexual men attending SHCs with symptoms of urethritis experience both positive and negative psychosocial impacts following their clinic attendance, which warrants further investigation

Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

Objectives To quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing. Design Modelling study. Setting Genitourinary medicine (GUM) services in England. Population A hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection. Interventions The decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); B) triplex POCT for CT-NG and Mycoplasma genitalium (MG); C) quadruplex POCT for CT-NG-MG and Trichomonas vaginalis (TV). Data came from published literature and unpublished estimates. Primary and secondary outcome measures Primary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances. Results In the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC. Conclusions Many benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses

A Search for Nitrogen-Enhanced Metal-Poor Stars

Theoretical models of very metal-poor intermediate-mass Asymptotic Giant Branch (AGB) stars predict a large overabundance of primary nitrogen. The very metal-poor, carbon-enhanced, s-process-rich stars, which are thought to be the polluted companions of now-extinct AGB stars, provide direct tests of the predictions of these models. Recent studies of the carbon and nitrogen abundances in metal-poor stars have focused on the most carbon-rich stars, leading to a potential selection bias against stars that have been polluted by AGB stars that produced large amounts of nitrogen, and hence have small [C/N] ratios. We call these stars Nitrogen-Enhanced Metal-Poor (NEMP) stars, and define them as having [N/Fe] > +0.5 and [C/N] < -0.5. In this paper, we report on the [C/N] abundances of a sample of 21 carbon-enhanced stars, all but three of which have [C/Fe] < +2.0. If NEMP stars were made as easily as Carbon-Enhanced Metal-Poor (CEMP) stars, then we expected to find between two and seven NEMP stars. Instead, we found no NEMP stars in our sample. Therefore, this observational bias is not an important contributor to the apparent dearth of N-rich stars. Our [C/N] values are in the same range as values reported previously in the literature (-0.5 to +2.0), and all stars are in disagreement with the predicted [C/N] ratios for both low-mass and high-mass AGB stars. We suggest that the decrease in [C/N] from the low-mass AGB models is due to enhanced extra-mixing, while the lack of NEMP stars may be caused by unfavorable mass ratios in binaries or the difficulty of mass transfer in binary systems with large mass ratios.Comment: 14 pages, 7 figures, to be published in Ap

Stellar Chemical Signatures And Hierarchical Galaxy Formation

ABRIDGED: To compare the chemistries of stars in the Milky Way dSph galaxies with stars in the Galaxy, we have compiled a large sample of Galactic stellar abundances from the literature. As found in previous studies, the [alpha/Fe] ratios of most stars in the dSph galaxies are generally lower than similar metallicity Galactic stars in this extended sample. Our kinematically selected stars confirm that this is true for all major stellar components of the Galaxy, including the halo, thin disk, and thick disk. There is marginal overlap in the low [alpha/Fe] ratios between dSph stars and Galactic halo stars on extreme retrograde orbits, but this is not supported by other element ratios, like [Ba/Y]. Thus, the full chemical signature of most of the dSph stars are distinct from the main components of the Galaxy. This result rules out continuous merging of low mass galaxies similar to these dSph satellites during the formation of the Galaxy, which is discuss further. The new environments offered by the dSph galaxies also allow us to examine fundamental assumptions related to nucleosynthesis. The metal-poor stars ([Fe/H] < -1.8) in the dSph galaxies have [alpha/Fe] ratio that are consistent with predictions from the alpha-process (alpha-rich freeze out). This may also explain the very low Y abundances, and could suggest a separate r-process site for this light (first peak r-process) element. In stars with higher metallicities ([Fe/H] > -1.8), contributions from the s-process are expected; [Ba/Y] is still much higher in the dSph stars than similar metallicity Galactic stars though, consistent with s-process contributions from only the low metallicity AGB stars in dSph galaxies. Finally, the Na-Ni trend in Galactic halo stars is confirmed, but discuss this in terms of nucleosynthesis, and not the accretion of dSphs.Comment: Accepted for Sept 2004 Astronomical Journal; 26 pages, 9 figures, 3 table